Mulago Hospital

About: Mulago Hospital is a healthcare organization based out in Kampala, Uganda. It is known for research contribution in the topics: Population & Health care. The organization has 542 authors who have published 545 publications receiving 34804 citations.

Prevalence and patterns of traumatic bone loss following open long bone fractures at Mulago Hospital.

Abstract: Introduction Significant traumatic bone loss in developed countries occurs in a high proportion of open fractures ranging from 11.4% to 40%. However, literature from developing countries such as Uganda scarcely documents the prevalence and patterns of traumatic bone loss. Direct trauma and iatrogenic factors have been associated with traumatic bone loss as possible etiologies. Objective The study was aimed at establishing the prevalence and patterns of traumatic bone loss following open long bone fractures, and identifying factors associated with traumatic bone loss among patients presenting to Mulago Hospital within 24 hours of sustaining the injury up to completion of the initial fracture debridement, reduction, and fixation. Methodology It was a prospective cohort study conducted at Mulago Hospital. A total of 136 open long bone fractures were registered and physically examined for traumatic bone loss. Patients who consented were recruited consecutively to participate in the study. Data on the patients' sociodemographics and fracture patterns were collected using pretested questionnaires and analyzed using Stata version 12. Results From 123 patients, a total of 136 open long bone fractures were registered. The prevalence of traumatic bone loss following open long bone fractures was 26.5%. Of the 36 open long bone fractures with traumatic bone loss, the more common pattern (61.1%) was significant traumatic bone loss (≥ 2.5 cm long). Commercial motorcycle riders (22.0%) and traders (20.3%) were the most common occupations associated with open long bone fractures. Gunshot injuries were the leading cause of traumatic bone loss in open long bone fractures. Conclusion Our setting has a high prevalence of traumatic bone loss among open long bone fractures with the majority occurring in Gustilo type IIIB injuries of the tibia. The likelihood of traumatic bone loss is higher in open fractures caused by gunshots.

Metastatic colorectal carcinoma mimicking primary ovarian carcinoma presenting as 'giant' ovarian tumors in an individual with probable Lynch syndrome: a case report.

Abstract: Ovarian metastases occur in 3 to 8% of women with primary colon cancer. In the setting of a pre-existing colorectal carcinoma this would constitute a hereditary non-polyposis colorectal cancer, Lynch 2 syndrome, accounting for 5 to 10% of colon cancer cases. We unveil a case of ‘giant’ ovarian tumors mimicking primary ovarian cancer; ostensibly the first reported in East Africa. A 58-year-old African woman was diagnosed with colorectal adenocarcinoma in June 2009. She had a right hemicolectomy with the tumor staged as regional cancer, following histopathological examination. Chemotherapy was administered both adjuvantly and 1 year later for what was thought to be a recurrence of tumor. Despite this, her general condition deteriorated. Following re-evaluation and an exploratory laparotomy she was found to have bilateral ‘giant’ ovarian tumors, with peritoneal seedlings and subcutaneous metastases (colonic in origin). A bilateral salpingo-oophorectomy was done, accompanied by histopathological analysis with institution of chemotherapy for ovarian cancer. Following immunohistochemistry tests and microsatellite instability analysis it was found that the ovarian tumors were secondaries from the colon. She was also identified as a Lynch syndrome case or a case of sporadic microsatellite instability, although with no suggestive family cancer history. The treatment regimen was changed to suit metastatic disease. The case presents a diagnostic and thus treatment conundrum. Two primary tumors (suspected Lynch syndrome) had been perceived yet there is actually only metastatic colorectal cancer. We also have a rare and unusual metastatic presentation: ‘giant’ bilateral ovarian tumors and subcutaneous nodules, concurrently. Further still, she is a case of probable Lynch syndrome, requiring genetic analysis for definitive classification and surveillance for hereditary non-polyposis colorectal cancer-associated cancers. Important inferences are drawn. Firstly, ‘giant’ ovarian tumors diagnosed as primary ovarian cancer may actually be colonic secondaries. Secondly, immunohistochemistry and microsatellite instability analysis tests ought to be part of the diagnostic package in colon cancer management, particularly for identifying tumor origin and the Lynch syndrome (a condition which has had little attention in resource-limited countries). Thirdly, multidisciplinary team collaboration is emphasized in colorectal cancer management.

Keratomalacia in liver disease

Abstract: 1. 1. The conditions under which xerophthalmia occurs in Uganda are briefly outlined, with a description of its manifestations. 2. 2. A case of keratomalacia presenting unique features is described. 3. 3. The fact that the patient was in the habit of consuming ample quantities of vitamin-containing foods, and that therapeutic administration of such foods together with a preparation rich in vitamin A produced no appreciable change in his condition, places the case in a category entirely apart from that of deficient vitamin intake. 4. 4. Jaundice together with an enlarged liver was present, and blood-sugar estimations showed a striking degree of hypoglycaemia. 5. 5. Postmortem evidence of severe liver damage due to biliary cirrhosis was obtained. 6. 6. The authors believe that xerophthalmia occurred in this case as a result of interference with the part played by the liver in the metabolism of vitamins, the intake of the latter being ample. 7. 7. They conclude that the liver is of primary importance in the process leading to the utilisation of ingested vitamin A by the tissue cells.