Surgical blood order equation in femoral fracture surgery.

AIM: This study aimed at establishing the clinical utility of the surgical blood order equation (SBOE) in patients undergoing femoral fracture surgery. BACKGROUND: A blood ordering schedule defines the perioperative blood use in elective surgery. It lists the number of units of blood required for each procedure preoperatively. MATERIALS AND METHODS: A case-control study was performed among homogeneous groups of patients (n = 62 each) undergoing open reduction and internal fixation of femoral fractures. Correct prediction of blood use in the group of patients using the SBOE was compared to the group whose blood orders were made without any guideline. RESULTS: The surgical blood ordering equation was exactly correct in ordering blood for 46 (74·2%) of 62 patients (cases). The current unaided blood ordering method was exactly correct in ordering blood for 27 (43·5%) of 62 patients (controls). Use of the SBOE resulted in a significantly lower crossmatch-to-transfusion ratio compared to that of the current ordering system (1·5 vs 2·3) and saved the hospital transfusion laboratory 465 US$ of crossmatch and inventory management costs in this cohort of patients. CONCLUSION: The SBOE is a more accurate and cost-saving tool in predicting blood use. It should replace the current unaided method of ordering for perioperative blood in femoral fracture surgery at Mulago Hospital. However, its introduction to other hospitals should be preceded by more rigorous research to strengthen its external validity.

Plasma vitamin C concentration in pregnant women with pre-eclampsia in Mulago hospital, Kampala, Uganda.

BACKGROUND: Oxidative stress plays a role in the aetiology of pre-eclampsia and vitamin C may prevent pre-eclampsia. OBJECTIVE: To determine the association between plasma vitamin C and pre-eclampsia in Mulago Hospital, Kampala, Uganda. METHODS: This case-control study was conducted at Mulago Hospital from 1(st) May 2008 to 1(st) May 2009; 207 women were the cases and 352 women were the controls. Plasma vitamin C was assayed in the women using a colorimetric method. An independent t test was used to find the difference in the means of plasma vitamin C and logistic regression was used to find the association between plasma vitamin C and pre-eclampsia. RESULTS: The mean plasma vitamin C was 1.7(SD=0.7) × 10(3) µg/L in women with pre-eclampsia and 1.9(SD=0.7) × 10(3) µg/L in women with normal pregnancy (P=0.005). Women with low plasma vitamin C were at an increased risk of pre-eclampsia (OR 2.91, 95% CI: 1.56-5.44). CONCLUSION: There was a strong association between low plasma vitamin C, and pre-eclampsia in women attending antenatal clinics at Mulago Hospital, Kampala. Health workers need to advise women at risk in the antenatal period about diet, especially foods which are rich in vitamin C to probably reduce pre-eclampsia.

Blood loss and contributing factors in femoral fracture surgery.

BACKGROUND: Substantial blood losses frequently accompany orthopedic procedures. METHODS: We prospectively noted peri-operative hemoglobin changes in 93 patients undergoing surgery for femoral fracture with an aim of establishing blood loss and related factors. RESULTS: The mean total blood loss assessed 72 hours after the surgical procedure was 3.31 (SD 1.56) units of whole blood. A multiple regression analysis revealed diathermy use and a simple fracture pattern as significant factors in reducing blood loss (p<0.01). CONCLUSIONS: Open intramedullary fixation of femur fractures leads to considerable peri-operative blood loss. This is can be reduced by use of diathermy during surgery.

Thyroid hormones profile in students of Makerere College of Health Sciences in Kampala Uganda.

Serum concentrations of thyroxine (T4), triiodothyronine (T3) and Thyroid Stimulating Hormone (TSH) are used to assess thyroid function. It is recommended that each laboratory or hospital should establish its own reference values of T4, T3 and TSH for their clients because these hormones vary with ethnicity, geographical and climatic conditions of a population. There is no documented study which has been done to determine the Thyroid hormones profile in Ugandan general population. This study is one of the first attempts to determine Thyroid hormones profile in healthy Ugandans. The main objective of this study was to determine the thyroid hormones profile of students of the Makerere College of Health Sciences in Kampala, Uganda. A cross sectional descriptive study was done involving 72 students, with the mean age of 24.17 +/- 4.48 years. Subjects who volunteered to participate in the study were interviewed; their height and body weight measured, 5 ml of blood withdrawn, and sera harvested. FT4 and T3 Radioimmuno Assay (RIA) were done and TSH was assayed using Immunoradiometric Assay (IRMA) technique. The mean serum concentration of FT4 was 17.016 +/- 3.847 mol/L. For T3, mean serum concentration was 1.43 +/- 0.825 nmol/L, and mean serum TSH level was 2.412 +/- 2.284 microIU/ml. Variations of serum concentrations of FT4, T3 and TSH with sex, age, or region of origin were not statistically significant. Serum concentration of TSH increased with increased body mass index (BMI). It was 2.073 +/- 1.907 microIU/ml for subjects with BMI of < or = 24.9 Kg/m2, 3.588 +/- 1.495 microIU/ml for subjects with BMI of 25 - 29.9 kg/m2 and 4.450 +/- 0.593 microIU/ml for subjects with BMI > or = 30 kg/m2 (P=0.009). However, BMI had no effect on serum concentrations of FT4 and T3. Serum concentrations of T4, T3 and TSH obtained from this study all differ with the values which are currently used as reference ranges in the country. We recommend a similar study involving a population representative of Ugandans to be conducted so as to establish normal reference values of T4, T3 and TSH for Ugandans. We also recommend BMI of patients to be taken into consideration during interpretation of serum TSH concentrations results.

Bottlenecks of blood processing in Uganda.

AIM: To identify where and why delays occur in Uganda blood banks. BACKGROUND: The timely provision and supply of safe and efficacious blood components to hospitals depends on sound systems in the processing blood banks. Poorly managed systems lead to apparent blood shortages in hospitals and increase discard rates due to expiry before dispatch. MATERIALS AND METHODS: We reviewed records of 4126 units of whole blood delivered by the mobile collection teams to a major regional blood bank, in the period 1 March 2009 to 30 June 2009, to ascertain the time intervals between the critical steps in the blood processing chain. This was followed by interviews with staff in two blood banks to establish the causes of process delays. RESULTS: The average duration between blood collection and final labelling (release from quarantine for final storage) was 15·4 (SD 10·8) days. In timeline, the step between matrix generation and grouping was (median duration 8 days) the longest, whereas grouping to labelling was the shortest (median duration 2 days). Blood expiry had the highest discard rate (0·17%) among the non-transfusion transmissible infection marker causes. A minimally facilitated small staff contributed to the process flaws. CONCLUSION: A considerable amount of blood does not reach hospitals because of process delays between collection and ultimate dispatch. This is caused by a thin staff working with inadequate materials, out-of-date methods and in an overcrowded environment. Provision of adequate staff and improved financial allocations to the Uganda Blood Transfusion Services will mitigate this situation.

Plasma levels of DDT/DDE and liver function in malaria control personnel 6 months after indoor residual spraying with DDT in northern Uganda, 2008.

OBJECTIVE: We investigated the relationship between plasma levels of dichlorodiphenyltrichloroethane (DDT) and liver function in malaria control personnel 6 months after one round of DDT indoor residual spraying (IRS). METHOD: This was a cross-sectional study in the districts of Apac and Oyam of Lango, northern Uganda. Volunteers were clinically examined, and 5 ml samples of venous blood were taken in heparinised tubes for a 6-month post-spray screening for DDT and plasma markers of liver function and internal organ disease. DDE/DDT was assayed using ELISA kits (Abraxis, USA); plasma enzyme activity concentrations of amylase, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transpeptidase (GGT) were analysed using routine clinical chemistry-automated methods (Konelab, Vantaa, Finland). RESULTS: All 96 plasma samples analysed for xenobiotics contained DDE/DDT in the empirical range of 24.00 - 128.00 parts per billion (ppb) with a mean (SD) of 77.00 (+/-26.00) ppb. All 119 plasma samples studied for the markers exhibited enzyme activity concentration values within the population reference ranges, with empirical means (SD) of amylase 71.86 (34.07), AST 23.83 (12.71), ALT 7.84 (10.01) and GGT 58.37 (62.68) microg/l. CONCLUSION: Six months after IRS with DDT, the spray team had an average concentration of plasma DDE/DDT of 77 ppb. This had no deleterious effect on liver function. We recommend continued use of DDT for IRS disease control in Uganda until better practical alternatives are available.

The interface between blood preparation and use in Uganda.

BACKGROUND AND OBJECTIVES: The interface between preparation and use of blood impacts directly on the outcome of hemotherapy. The present study explores the knowledge and opinions of key players at, practical realities at, and quality improvement strategies of this interface. MATERIALS AND METHODS: We surveyed clinicians (n = 81) and blood bank staff (n = 25) to assess their knowledge on key issues in their counterparts' working domains, the turnaround time on effecting a blood order from a hospital transfusion laboratory and strategies to improve communication of blood needs to blood banks. RESULTS: Out of 81 clinicians, 20 knew the four available blood products while only 17 knew the three uses of these products. Twenty-three blood bank staff reported the patient's condition as the main factor on which blood orders are based. Forty-four (54.3%) clinicians reported reception of a blood product within an hour of placing the order. Addressing infrastructure and human resource were some of the strategies suggested to improve this step of the transfusion chain. CONCLUSIONS: The knowledge of staff at the extreme ends of the clinical interface in their counterparts' working domain is far from adequate. However, they have well formed opinions on strategies to improve this interface.

Bedside practice of blood transfusion in a large teaching hospital in Uganda: An observational study.

BACKGROUND: Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients. MATERIALS AND METHODS: An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG) in Groningen, The Netherlands. RESULTS: In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed. CONCLUSION: The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.

Plasma cholesterol and related lipid levels of seemingly healthy public service employees in Kampala, Uganda.

BACKGROUND: As Uganda's economy improves, many people tend to adopt western diets and sedentary life styles that predispose to cardiovascular diseases including hypertension. These may be in silent danger without any typical symptoms to send early warning signals. In Uganda, cardiovascular diseases (CVD) and diabetes mellitus are rapidly emerging as major causes of morbidity and mortality. OBJECTIVE: This study was conducted to determine spot levels of plasma lipid indicators of CVD in seemingly healthy public service employees in Kampala, Uganda. The purpose of this study was achieved through analysis of fasting plasma samples for the following: Total cholesterol (TC), Triacylglycerols (TG), High density lipoprotein cholesterol (HDL), Low density lipoprotein cholesterol (LDL), and molar ratios of LDL/HDL, TC/ HDL, and TC/TG. METHODS: One hundred and seventy four fasting executives 85 males and 89 females employed in public service in Kampala, Uganda, were investigated to determine enzymatically spot levels of TC, TG, HDL, and LDL from which their mutual ratios were calculated. RESULTS: In each of the 7 parameters studied, the samples showed risk factors for CVD at the following rates: HDL 10%, LDL/HDL 12%, TG 47%, LDL 48%, TC/HDL 53% TC 66%, TG/HDL 68%,. CONCLUSIONS: In all the cut off points used, each analyte had a significant percentage of public service employees at risk of CVD. It is therefore concluded that hypercholesterolaemia and other dyslipidemias exist among seemingly healthy public service employees in Kampala, Uganda, and this needs urgent intervention at both individual and national levels.

Initial attempt to establish population reference values for blood glucose and lipids in Makerere University undergraduate students.

UNLABELLED: The purpose of this study was to establish blood glucose and lipid profile of Makerere University undergraduate students. STUDY DESIGN: This was a cross-sectional study. MATERIALS AND METHODS: A total of 183 students participated in the study. Capillary blood glucose was read instantly on a finger prick sample off Sensorex glucose analyzer. Venous blood from the antecubital vein was used for lipid assays. Total cholesterol was assayed by the oxidase-peroxidase enzyme system. Plasma triacylglycerols were analyzed using the glycerokinase-oxidase reagents. HDL and LDL cholesterol were analyzed using homogeneous enzymatic methods. Concentration results for each variable were plotted in histograms and the type of distribution established. Summary statistics were then calculated non- parametrically to set reference values. RESULTS: Empirical ranges were: Cholesterol 2.1-7.2 mmol/L; triacylglycerols 0.4-6.87 mmol/L; HDLC 0.09-2.13 mmol/L; LDLC 0.95-5.38 mmol/L and capillary blood glucose 2.72-9.21 mmol/L. The reference ranges covering the central 95 percentile were: Cholesterol 2.65-5.15 mmol/L, triacylglycerols 0.61-4.03 mmol/L; HDLC 0.58-1.97 mmol/L; LDLC 1.25-3.57 mmol/L and capillary blood glucose 3.11-7.55 mmol/L. CONCLUSION: The established reference values for the age group 20-26 years were: Total Cholesterol 2.65-5.15 mmol/L, LDL 1.25-3.57 mmol/L, HDL 0.58-1.97 mmol/L, TG 0.61-4.03 mmol/L and capillary blood glucose 3.11-7.55 mmol/L which differed from set international values. RECOMMENDATIONS: We recommend the establishment of indices for the indigenous populations, conscientiously planned diets, and regular exercise.

Blood pressure profiles among Makerere University undergraduate students.

UNLABELLED: The purpose of this study was to set reference values for spot blood pressure and its derivatives among Makerere university undergraduate students. STUDY DESIGN: This was a cross- sectional study. MATERIALS AND METHODS: A total of 183 undergraduates including 63 females and 120 males participated in the study. Blood pressure was measured, with the respondent seated, using a sphygmomanometer. Mean arterial pressure was determined as the average of the systolic and diastolic values. Pulse pressure was the difference between systolic and diastolic values. Dividing systolic by diastolic values gave the required ratio. Histograms and cumulative percentages of these results were plotted and used to set the central 95 th percentile range as the reference values. RESULTS: Empirical ranges were: systolic BP 100-179 mmHg; diastolic BP 60-139 mmHg; systolic: diastolic pressure ratio 1.20-2.30 mmHg, mean arterial pressure 80-159 mmHg and pulse pressure 20-85 mmHg. The reference ranges covering the central 95 percentile were: systolic BP 100-150 mmHg, diastolic BP 64-100, systolic: diastolic BP ratio 1.29-2.03, the mean arterial pressure 85121 mmHg, and pulse pressure 25-70 mmHg. According to the systolic pressure, 35% were normal, 54% pre-hypertensive and 11% hypertensive. According to diastolic values, 48% were normotensive, 43% pre-hypertensive and 18% hypertensive. The mean arterial pressure was distributed like the parent pressures. The pulse pressure and the systolic:diastolic ratio were trimodally distributed with the three peaks corresponding to normotension, pre-hypertension and hypertension. CONCLUSION AND RECOMMENDATION: Reference values for the university student population have been derived and they are recommended for application in clinical evaluation.

Forensic medicine services in Uganda--present and future.

Forensic medicine services (medico-legal services) as it is provided today in Uganda is discussed with special reference to forensic pathology and also to future plans for improvement to ensure quality service. Forensic medicine services are divided into clinical forensic medicine and forensic pathology. In Uganda, these services are rendered partly by pathologists attached to University, by pathologists and medical officers employed by police and by medical officers attached to hospitals. In Uganda, all types of unnatural deaths are reported to nearest police station and appointed investigating police officer(s) will take necessary action to have a medico-legal postmortem done as soon as possible. Currently there is no qualified forensic pathologist in Uganda. Suggestions are made with regard to the enactment of a Forensic Medicine Services Act by the Department of Health, the creation of a forensic medicine unit with, under the administrative umbrella of pathology department, in medical schools and imparting of forensic medicine training to anatomical pathologists to act as a qualified, specialist forensic pathologists.