A rare case of a patient with a foreign body in the esophagus for two years which perforated into the mediastinum.

A 6-year-old girl was referred to the ENT (Ear nose and throat) unit at Mulago National Referral Hospital with a foreign body in the esophagus diagnosed by routine chest radiograph. The child's parents recall she had ingested a round object (galvanised iron umbrella cap of a roofing nail) two years prior to this, but they thought that the child had passed it out in stool since she had continued eating and swallowing normally. On arrival at the National referral hospital, the child had two esophagoscopies done but the foreign body was not seen, not until a barium swallow was done was it confirmed that the FB(foreign body) had perforated the esophagus and entered the mediastinum. The cardiothoracic surgeons were consulted, and they removed the foreign body via a thoracotomy. The child recovered well and was discharged from hospital on day 55.

Relative prevalence of methicilline resistant Staphylococcus aureus and its susceptibility pattern in Mulago Hospital, Kampala, Uganda.

Methicilline resistant Staphylococcus aureus (MRSA) strains are becoming increasingly multiresistant, and have recently developed resistance to vancomycin, which has been used successfully to treat MRSA for many years. In-vitro determination of resistance patterns of S. aureus is critical in terms of administering suitable antimicrobial treatments. The objective of this study was to determine the relative prevalence of MRSA among S. aureus isolates from surgical site infections and their antibiotic susceptibility pattern in Mulago Hospital, Kampala, Uganda. One hundred eighty eight pus swabs were collected from patients with surgical site infections. Swabs were inoculated for culture at the Microbiology Laboratory of the Faculty of Medicine, Makerere University. S. aureus isolates were identified using standard procedures and tested for oxacillin resistance according to methods of the National Committee for Clinical Laboratory Standards. Out of the 188 specimens, 54 (28.7%) grew S. aureus. Seventeen (31.5%) of the S. aureus isolates were confirmed as MRSA by PCR. Resistance rates of MRSA were 88.2% for trimethoprim-sulfamethoxazole, 88.2% for erythromycin, 58.8% for gentamycin, 70.6% for ciprofloxacin, and 88.2% for chloramphenicol. All isolates were found to be sensitive to vancomycin and clindamycin though the D-test was found to be positive in 82.4% of the isolates. In our region, although methicillin resistance increased in S. aureus strains, because of the unavailability and the high cost of alternative antibiotics, gentamycin is still suggested as an alternative for treatment of S. aureus infections. These results however indicate that vancomycin seemed to be the only antimicrobial agent effective against MRSA and it could be the drug of choice in treating multidrug resistant MRSA infection.

Pioneer human open heart surgery using cardiopulmonary by pass in Uganda.

INTRODUCTION: For the first time in Uganda in April 2007,two open-heart surgeries were done using cardiopulmonary by pass. A multidisciplinary team of largely indigenous Ugandans professionals working in Uganda formed the pioneering team. CONTEXT: Access in cardiac surgery in the developing countries is very limited. The challenges that impede access to adequate and appropriate health care including open-heart surgery are in the least complex and daunting. PATIENT SELECTION: Two 13 and 17 year old males with Secundum Atrial Septal defects were chosen from a long waiting list. The criteria used included no or minimal co morbidity states, patient fitness and available ICU ventilation facilities. PREPARATION: Took an eleven months period, including formulation and adoption of peri and intra operation protocols, training of staff, sourcing of usable and mobilizing the financing. OUTCOMES: The procedure for the two patients was successfully performed. The immediate and short-term postoperative periods were uneventful. At the twelve months review point both patients were leading a normal life. In the months that followed 19 other open-heart procedures were done including two mitral valves replacements. CONCLUSION: This program has greatly enhanced the level of care for the critically ill at this facility. Its sustenance and replication in other centres in the country is essential. Government and development partners' support is critical. The educational value of this program ought to be exploited by health professions students in the country.