Department of Surgery

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Upper gastrointestinal endoscopic findings in adolescents at Lacor hospital, Uganda
(African Health Sciences, 2006) Okello, Tom Richard
Background and Objectives: Fiberoptic endoscopy is a highly efficient diagnostic tool, which is now being increasingly used, in the pediatric age group. This study has been carried out to demonstrate indications for and common findings of endoscopy in children. Materials and Methods: We retrospectively reviewed the medical records for endoscopy indication and result of children who had endoscopy between Jan 2000 to June 2005. Results: We analyzed 135 children who were referred for upper gastrointestinal endoscopy. There were 38 boys and 97 girls. The mean age was 16 years (SD+/-1.4293). The main indications comprised epigastric pain (67.4%), dyspepsia (11.9), hematemesis (8.9%), recurrent abdominal pain (3%) recurrent vomiting (3%), and miscellaneous (5.8%). Endoscopic diagnose included duodenal ulcer (14.8%) and gastritis (12.6%); duodenal scarring (5.2%), bile reflux (5.2%) duodenitis (4.4%) and miscellaneous 6.4%. Conclusion:In Upper gastrointestinal endoscopy is a diagnostic procedure in children with gastrointestinal disorder. Gastritis and duodenal disease are commonly seen in children, hence must be included in differential diagnosis of children with digestive complaints and its management.
Sigmoid Volvulus and Ileosigmoid Knotting at St. Mary’s Hospital Lacor in Gulu, Uganda
(Eastand Central African Journal of Surgery, 2009) Okello, Tom Richard; Ogwang, David Martin; Kisa, P.; Komagum, P.
Background: Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people. Little is known about this condition in our country and there is yet no literature from an environment like ours (northern Uganda) where civil war has devastated the economy with most of the populace displaced into internally displaced peoples’ camp. The main objective of this study was to determine the demographics, treatment and outcome of sigmoid Volvulus cases seen at Lacor Hospital. Methods: This was both a retrospective and prospective study of patients who presented with sigmoid volvulus at St. Mary’s Hospital Lacor over a period of 61/2 years from 1stJanuary 2002 to 31st July 2008. Medical records of patients who underwent sigmoid surgery was stratified for the following measures; demographic characteristics, presentation to hospital (emergency or elective), operative finding and operative procedure, complication, co-ominous factors and outcome. Similar data was gathered from patients who were prospectively followed up. Data was analyzed using SPSS. Results: A total of 44 patients were studied. Their age ranged from 16 to 80 years with a mean of 52.2years (SD +/- 15.98) and a mode of 60years. There was a preponderance of male (84%) with a male to female sex ratio of 5.3: 1. The disease significantly affected the older males compared with females P=0.032. Approximately 77% of the patients presented acutely and had to undergo emergency surgical intervention, the rest were subacute. About 75% of the patients were treated with primary resection and anastomosis, of which 52.2% were emergency cases. Colostomy was offered to 20.5% and sigmoidoscopic derotation to 4.5%. Overall mortality rate was 15.9% and of the patients who died, 18% had primary resection and anastomosis, while 11% were offered colostomy, (P>0.05). Most of those who died were either the older ones (median age 68years) and/or had co morbid illness such as diabetes mellitus, hypertension, intra-abdominal abscess and cancer. Conclusion: Sigmoid volvulus is relatively rare in our community. It commonly affect males particularly the old. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. In viable bowel, primary resection and anastomosis of the twisted sigmoid is feasible as it may not adversely affect outcome. Nevertheless colostomy should be considered if the bowel is gangrenous or perforated. Though the disease carries a high mortality, most of the patient who die are either older and/or have co-morbid conditions.
African Health Sciences Vol 12 Issue 4 December 2012518Endoscopic findings in upper gastrointestinal bleeding patients atLacor hospital, northern Uganda
(African Health Sciences, 2012) Alema, ON; Ogwang, David Martin; Okello, Tom Richard
Background: Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. Objective: To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda. Methods: The study was carried out at Lacor hospital, located at northern part of Uganda. The record of 224 patients who underwent endoscopy for upper gastrointestinal bleeding over a period of 5 years between January 2006 and December 2010 were retrospectively analyzed. Results: A total of 224 patients had endoscopy for UGIB which consisted of 113 (50.4%) males and 111 (49.6%) females, and the mean age was 42 years ± SD 15.88. The commonest cause of UGIB was esophagealvarices consisting of 40.6%, followed by esophagitis (14.7%), gastritis (12.6%) and peptic ulcer disease (duodenal and gastric ulcers) was 6.2%. The malignant conditions (gastric and esophageal cancers) contributed to 2.6%. Other less frequent causes of UGIB were hiatus hernia (1.8), duodenitis (0.9%), others-gastric polyp (0.4%). Normal endoscopic finding was 16.1% in patients who had UGIB Conclusions: Esophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment as compared to the west which is mainly peptic ulcer disease.
Prevalence of hospital-associated infections can be decreased effectively in developing countries
(Journal of Hospital Infection, 2013) Ogwang, David Martin; Paramatti, D.; Molteni, T.; Ochola, E.; Okello, Tom Richard; Salgado, J.C.Ortiz; Kayanja, A.; Greco, C.; Kizza, D.; Gondoni, E.; Okot, J.; Praticò, L.; Granata, V.; Filia, H.; Ayugi, H.Kellar; Greco, D.
Background Hospital-acquired infections (HAI) are an important public health problem worldwide. Little information is available from African countries, but published data show that the burden of HAI is greater in Africa than in developed countries. In 2002, the World Health Organization (WHO) published guidelines for preventing HAI. Aim To evaluate the impact of a hospital infection control programme on the prevalence of HAI among patients in a large Ugandan hospital. Methods A one-day cross-sectional prevalence survey and a ward procedure survey were performed in Lacor Hospital in March 2010 using standardized questionnaires. All patients admitted to hospital not less than two days before the survey were eligible to participate in the prevalence survey. Modified WHO criteria for HAI were used. The ward procedure survey examined the procedures to prevent HAI. Several hospital infection control measures were subsequently implemented, in accordance with WHO infection control guidelines, starting in October 2010. The prevalence survey and ward procedure survey were repeated in October 2011. Findings The prevalence of HAI was 34% in 2010 and 17% in 2011. The prevalence of infected patients reduced from 28% to 14%. The prevalence of HAI was lower in all age groups and for all types of HAI except urinary tract infections following the implementation of infection control activities. Conclusion This study showed that HAI is an important problem in this large African hospital, and that the prevalence of HAI can be reduced effectively following the adoption of basic infection control procedures.
Prostatic Specific Antigen (PSA) Relationship to Patient Age, Prostate Volume and Prostate Histology at St. Mary’s Hospital Lacor,
(East and Central African Journal of Surgery, 2014) Okello, Tom Richard; Alema, N. O; Ogwang, David Martin
The use of PSA for the diagnosis of cancer prostate has remained controversial as well as unreliable because many factors affect PSA levels. Included amongst the many factors that can increase PSA level are riding bicycle, rectal exam, sex, age, serum calcium, prostate inflammation, increased prostate volume. This study was aimed at determining the clinic-patho-radiological finding of patients presenting with enlarged prostate and to determine the PSA profile of all patients presenting with enlarged prostate in St. Mary’s Hospital Lacor. Results: Approximate 135 patients were evaluated in the study and significantly, elderly persons constituted 64.5%, compared with Adult (34.5%) and youth 1%, (P=0.00). Most patients presented with retention of urine (30%), dribbling of urine (23%), hesitancy (16%) and dysuria (13%). When the serum PSA was classified into Low (0.1-2.4ng/ml), Moderate (2.5-3.9ng/ml) and High 4ng/ml and above, we found that 60.7% of the patients had high PSA while 9.6% had moderate and low was 29.6%. PSA correlates positively with patients age (r= 0.24, P=0.005). Prostates volume also correlates positively with serum PSA, (Pearson’s Correlation r=0.275 and P= 0.002). Age and prostate volume also had a significant relation P=0.054 but there was only a very weak relationship between PSA level and Histological diagnosis, (Pearson’s correlation r=0.1). Conclusion: Age and prostate volume significantly correlate with serum PSA, just as age and prostate volume also correlates significantly
Invasive procedures and Hospital Acquired Infection (HAI) in A large hospital in Northern Uganda.
(East and Central African Journal of Surgery, 2014) Okello, Tom Richard; Kansiime, Jackson; Odora, J.
Background: Hospital Acquired Infection (HAI) increases morbidity, mortality and decreases quality of life of patients. It also increases the cost of patient care, both direct and indirect, through the need for additional and expensive drugs, laboratory and other diagnostic test. Lacor hospital which, carries-out on average 16 major surgical operations per day and has C/section rate of 14% could provide a conducive hub for HAI unless it strictly adheres to universal procedure and Standard precautions. Hence there is need to continuously monitor HAI rate for all invasive procedure done in the hospital. Methods: Through a across sectional descriptive study done in March 2014 on all in patients in the hospital to determine HAI rates. Using WHO standards, HAI was determined in the following invasive procedures; intravenous line sepsis, surgical site infection, urinary tract infection, Lower respiratory tract infection. Data collected was entered and analyzed using SPSS version 15. Results: Approximately 129 patients fulfilled the WHO inclusion criteria for HAI survey out of which, 18 patients (14%) were found to be having HAI as according to WHO guideline. Of the 18, 10 had been catheterized and there was a significant correlation between catheterization and HAI (r=0.319, P=0.00) but Urinary tract infection (UTI) rate in hospital was 38%. The rate of surgical site infection (SSI) was 21.9% and there was significant correlation between surgical intervention and development of HAI (P value of 0.003, r=0.259). However, only 3 (3%) of the patients with intravenous (IV) line had IV line infection and the average duration of IV line in-situ in the hospital was 2.4days. Conclusion: Overall the HAI in Lacor hospital is 14% and is comparable to the levels seen in other regional facilities. Many hospitals can monitor their rate of hospital infection rate and use it to improve quality of services. Recommendation: All health facility should have an infection control committee which monitors rates of hospital acquired infection at least once a year and disseminate for critical reflection and decision making.
919 Routine Hospital Acquired Infection surveys are feasible in low income health care settings and can inform quality improvement interventions
(Oxford University Press, 2014) Ochola, Emmanuel; Okello, Tom Richard; Kansiime, Jackson; Praticò, Liliana; Greco, Donato
Background. Prevention of acquisition of infection in the health care setting is imperative for reduction in morbidity and mortality for patients and health workers and improvement health care quality. However, data is scarce on prevalence and trends of hospital acquired infections (HAI) in low income settings, unlike in developed countries. We instituted annual surveys to determine HAI prevalence and determinants in a hospital in Gulu, Northern Uganda, an area recovering from over 20 years of war. Methods. An external expert mentored local hospital staff at the request of the Board, to do HAI surveys for 2 years after which a local team continues the exercise. Using standard WHO checklists. A one-day survey is done, recruiting all patients admitted in the hospital for 48hours or more. Data is collected by doctors and nurses on demographics, new diarrhea, Urinary Tract Infections (UTI), respiratory conditions, wound infection and intravenous catheter infections that were absent during admission. Urinalysis was done to confirm UTI. Results were analysed using SPSS, reporting basic statistics and p values of chi square tests comparisons. Results. A total 1174 clients were surveyed in four years, average 293 per survey. There was a 56% decline in HAI prevalence from 28% in 2010 to 14.2% in 2011 (p < 0.0001). Prevalence of HAI was 15.1% in 2013 and 14% in 2014. In different years, the key hospital acquired infections included UTI accounting for 39% (21.5-55%) of the total HAI, intravenous line infection 27% (18.2-30.4%), respiratory tract infections, 17.5% (5.5-25.5%), and surgical wound infections, 16.0% (8.7-20%). In 2013 which had UTI at 58%, UTI was present in 53.3% of catheterized clients, compared to 14.8% in 2011. Conclusion. The HAI surveys are practical, and feasible to perform, even in poor settings. The surveys prompted the institution of the hospital infection control committee. HAI surveys can generate glaring gaps, which when intervened on, like urinary catheter overstay, poor wound care, duration of iv lines, and hand washing practices, can improve care quality. The surveys can suggest corrective actions for good care practices. Nevertheless, prevention of HAI needs continuous efforts of all health workers.
Challenges Facing the Push and Pull Hybrid System in the Supply of Essential Medicines in Gulu, Northern Uganda
(American Journal of Public Health Research, 2015) Okello, Tom Richard; Mshilla, Maghanga; Olido, Kenneth
Essential medicines are supplied to the public health facilities using the pull and push system. In many countries the decision to use the pull, push or combination of both is a policy decision, but Uganda has used each of the supply system individually in past and currently is using a hybrid despite the rampant out-cry of essential medicines stock out. Challenges facing the hybrid supply system need to be examined to advise policy makers on the how efficient the system supplies medicines. A cross-sectional study was carried out in the public health facilities in Gulu to examine the major challenges affecting the hybrid system of medicines supply. A sample of 131 health workers filled a pretested coded questionnaire as respondents and the data were then entered and analysed using SPSS version 15. Approximately 27.7% (n=131) of the respondents reported that the store management in the hybrid system is unsatisfactory and inadequate. Quality of essential medicines supplied in the hybrid system to the public health facilities is unsatisfactory and inadequate as reported by 46.5% of the respondents. Collaborative linkages with the National Medical Stores (NMS) the mandated supplier of essential medicines in the country, is weak (42.9%) and quantification of essential medicines by health workers under the hybrid system is poor (33.3%). Furthermore support supervision in weak and inadequate under the hybrid system (37.6%); and personnel who dispense essential medicines are inadequate (44.3%). Approximately 30.3% patients have poor access to essential medicines. The current hybrid system is riddled with a number of challenges which requires re-dressed in order improve access and availability of essential medicines to the public.
Five-Year Review of the Pattern and Outcome of Management of Spinal Diseases Seen at St. Mary’s Hospital Lacor in Uganda.
(East and Central African Journal of Surgery, 2015) Okello, Tom Richard; Odul, E; Opiyo, P.
Background: Spinal cord injury or lesion is a devastating event with social, psychological and physical ramifications that has dehumanizing experiences. The aim of this study was to describe the biographic, etiological factors and outcome of patients with spinal lesions cared for at St Mary’s hospital Lacor within a 5yrs period. Methods: Through a 5yrs review of data of paralyzed patients admitted and treated at St Mary’s hospital Lacor from Jan 2009 to Dec 2013, the following secondary data was extracted and analyzed using SPSS version 15: Age, sex, duration of hospitalization, type of paralysis, cause of the spinal lesion, vertebral lesion, outcome and recovery of neurological function. Results: Approximately 241 met the criteria analysis, the mean age for spinal lesion was 31 years, average duration of hospitalization was 61 days and the Male gender predominated (64.3%) compared to the females (35.7%), P-value 0.000. Paraplegia was the commonest form of neurological deficit (79.67%) followed by tetraplegia (13%), P-value 0.000. TB spine is the leading cause of spinal lesion (19%) followed by road traffic accidents (17%) and lymphoma (15.8%). In 16.6% of the patients, the etiology of the spinal cord lesion was not known. Spinal lymphoma lesion was common in pediatric age group compared to TB spine and traumatic spinal lesion (p-value 0.000). Out of the 241 cases studied, 73 (30.3%) recovered their limb function completely and were reintegrated into the community. However 39 (16.2%) died from the lesions and/or the associated complications. Conclusions and Recommendation: Spinal lesions are commonest in young male populations with a mean age of 31 years. TB Spine, RTA and falls represent the commonest etiological factors in youth and adults while lymphomas lead in children. Approximately 30% of spinal lesion recovered and 16% died. The health facilities should consider setting up spinal care units
Determinant of Essential Medicines Availability in The Public Health Facilities in Uganda
(2015) Okello, Tom Richard; Olido, K; Mshilla, M.M
This study aimed at examining the key essential medicines availability determinants in public health facilities in Gulu District, Northern Uganda. This cross-sectional study focused on stock-out rates of the six official tracer medicines listed by the Ministry of Health. Data from the health facilities at health centre II to IV levels were collected using questionnaires and interviews. It was established that quantification, ordering methods, lead-time, stock-card management, stores management, quality assurance, collaborative linkages, personnel, funds and health unit management committee were the key determinants of essential medicines availability (P-value 0.000). Stock-out rate was 85% and this was more prevalent in the lower health center IIs and IIIs under the push supply system than in the higher health center IVs which operate under the pull system. Quinine was the most commonly out-of-stock medicine in lower health units. There is a high stock-out rate in the public health facilities and addressing key determinants could improve stocks-in rates.
A 10 years Trend of Peptic Ulcer Disease and other Gastrointestinal Disorders in Northern Uganda
(East and Central African Journal of Surgery, 2016) Okello, Tom Richard; Ogwang, David Martin; Pecorella, Irene
Background: The changing trend of GI disorders has not been expounded in our setting, there is need to examine the extent to which major endoscopically diagnosed upper GI disorders have changed in the last 10 years (2005 to 2015). Methods: This was a retrospective study in which endoscopically diagnosed GI disorders of Jan-Jun 2005 were compared with 2015 (10 years) for the same period Results: In the 10 years (2005 to 2015), the prevalence of peptic ulcer disease (PUD) reduced from 9.6% to 2.9% (P value 0.000), followed by esophageal varices from 10.3% to 4.0%, and duodenitis from 3.2% to 0.7% respectively. Gastritis increased from 18.4% to 48.2% (P value 0.000), followed by cancer esophagus from 3.2% to 5.1%. Conclusion: As the prevalence of PUD decreases in our community, gastritis increases hence patients with upper GI symptoms tend to suffer gastritis thus clinicians should focus on treating gastritis and eradication of Helicobacter pylori
An Evaluation of 605 Endoscopic Examination in a Rural Setting, Lacor Hospital in Northern Uganda
(British Journal of Medicine & Medical Research, 2016) Okello, Tom Richard; Ogwang, D. M; Alema, N. O.; Pecorella, Irene
Introduction: The aim of this study was to evaluate the profile of esophagogastroduodenal (EGDS) diseases diagnosed by upper endoscopy in a rural area of Uganda in a retro-protective study of 605 patients. Results: The mean age of patients with digestive symptoms was 39.7yrs (SD +/-16.11) and female gender predominated by 60% compared to the male (P value 0.000). Peasant farmers were the commonest group with GI symptoms requiring EGDS compared to the rest 72.1% v 27.9%. Epigastric pain was the commonest indication (58%) for EGDS, followed by chest pain (11%), abdominal pain (8.8%), dyspahgia (7.6%) and hematemesis (7.3%). The commonest endoscopy finding was gastritis (47.9%) followed by esophagitis (14.4%), cancer esophagus (5.1%), esophageal varicose (4%), PUD (2.3%), gastric cancer (1%). However 19.5% of patients had normal EGDS. There was a significant correlation between the outpatient diagnosis and endoscopy finding (P value 0.01, r = 0.144) and between endoscopy finding and histology findings (P value 0.001, r = 0.236). H. pylori was positive in 53% of patients with gastritis. Conclusion: Gastritis is the commonest lesion (47.9%) of which 53% have H pylori and Cancer esophagus account for 5.1% of GI lesion in our setting. Cancer stomach is rare in our setting.
Intestinal intussusception in an adult caused by helminthic parasitosis
(PAGEPress, Italy, Gastroenterology Insights 2016; 7:6469, 2016) Pecorella, Irene; Okello, Tom Richard; Ogwang, David Martin; Opira, Cyprian
Intestinal intussusception is an uncommon acute condition in adults and is most commonly caused by an intestinal tumor mass. Helminthic parasitosis is a widespread infection in Africa, and the load of worms is often high in individuals living in areas with inadequate sanitation. We report a case of intestinal obstruction caused by Ascaris lumbricoides infection, which was complicated by ileo-caecal intussusception and required surgical treatment in a 40-year-old Ugandan woman. This case reinforces the importance of anthelminthic prophylaxis in African rural areas.
Follicular dendritic cell sarcoma of the head and neck. Literature review and report of the tonsil occurrence in a Ugandan patient
(Pathologica, 2017) Pecorella, Irene; Okello, Tom Richard; Ciardi, G; Ochola, E; Ogwang, David Martin
We report a case of follicular dendritic cell sarcoma (FDCS) in a 60-year-old Ugandan female who presented with a 6-year history of a progressive left sided tonsillary mass. General systemic examination was unrevealing and the patient underwent left tonsillectomy. She was subsequently lost to follow-up. Grossly, the mass measured 6 cm in diameter and had a mottled appearance due to tissue microhaemorrhages. Markers specific for follicular dendritic cell differentiation (CD21, CD35 and CD23), p53 and EGFR were expressed on immunohistochemical analysis. Review of all of the 49 published reports of tonsil FDCS showed that this entity tended to occur at younger age (mean: 44.5 yrs) in women than in men (mean: 49.4 yrs). Tumour size ranged from 0.8 to 5 cm in maximum dimension (mean 2.9 cm). Only 12.2% of the patients presented with metastatic disease at initial diagnosis, all localised in the cervical lymph nodes. Local or distant recurrences occurred after a mean period of 72.5 months. In conclusion, although the pertinent literature suggests that FDCS should be considered at least of intermediate grade, our review indicates that FDCS of the tonsil region behaves as a low-grade sarcoma.
Barriers and Factors Affecting Personal Protective Equipment Usage in St. Mary’s Hospital Lacor in Northern Uganda
(East and Central African Journal of Surgery, 2017) Okello, Tom Richard; Kansime, K; Odora, J; Apio, J A; Pecorella, Irene
Background: To protect health workers (HCWs) from risky occupation exposure, CDC developed the universal precautions (Ups) including Personal Protective Equipment (PPEs). However compliance to it by HCWs has remained poor even in high-risk clinical situation. The objective of this study was to identify and describe the factors that influence a HCWs’ decision to wear PPEs and the barriers that exist in preventing their use Methods: A cross-sectional survey was carried out in the St. Mary’s Hospital Lacor in all the wards to collected quantitative information as well as qualitative and observational data on PPE use Results: Out of the total 59 respondents, 2% do not know the purpose of PPE, 23.7% do not know how to don and doff PPEs, 13.6% do not use PPE even when indicated and 10% are not using an appropriate PPE. The main barriers relates to poor fitting and weak domestic gloves, few of aprons, frequent stock out and inadequate PPE as well as lack of training in PPE Conclusion: This study provides a baseline for measuring the effectiveness of interventions to improve compliance.
Case Report: Swallowed toothbrush in the stomach of a 56 year female at St Mary’s Hospital Lacor, Uganda [version 1; referees: 1 approved with reservations, 1 not approved]
(AAS Open Research, 2018) Amone, Derrick; Okot, Christopher; Mugabi, Patrick; Okello, Tom Richard; Ogwang, David Martin
Toothbrush swallowing is a rare occurrence. Toothbrush swallowing presents a risk of impaction and perforation along the gastrointestinal tract. This case report describes a 56 year old female that presented to the emergency unit of St Mary’s Hospital Lacor with a 1 day history of chest pain after a toothbrush was pushed down her throat by a traditional healer who was managing her for pharyngitis. The chest pain was associated with difficulty in breathing. She also reported dull abdominal pain. There was no history of vomiting or drooling of saliva. On examination, we found that she was in pain and had respiratory distress with a respiratory rate of 32 breath/ min and was using accessory muscles. There was no oedema, aneamia or jaundice. Blood pressure of 120/80 mmHg and pulse rate of 87 beats/ min. The abdominal findings were normal, but ultrasound scan suggested that the toothbrush was in the stomach. The plain erect abdominal x-ray was inconclusive. She was admitted to the ward for conservative management. After 2 weeks we decided to do exploratory laparotomy and we found the toothbrush in the stomach, that we removed and closed the abdomen in layers. Post-operatively the patient recovered uneventfully on the ward. Toothbrush swallowing is a rare occurrence. The commonest foreign bodies ingested by adults are bones, spoons and dentures. Toothbrush ingestion occurs commonly among patients with psychiatric conditions like bulimia or anorexia nervosa, schizophrenia and bezoar. Most swallowed toothbrushes have been found in the esophagus or the stomach of affected patients. Most people who swallowed their toothbrushes did so entirely without erotic intent, as with this case where the patient had the brush pushed down her throat by a traditional healer. This is the first case of toothbrush swallowing in this hospital.
Student self-assessment after Essential Surgical Skills training for final-year medical students at Gulu University, northern Uganda
(East And Central African Journal of Surgery, 2018) Okello, Tom Richard; Mugabi, Patrick; Ghee, Hwang; Michelle, Sutter; Lett, Ronald
Background Medical practice depends on a set of essential clinical and surgical skills, yet inadequate attention is given to training these skills in medical school. This study aimed to evaluate the effect of Essential Surgical Skills® (ESS) training on self-report comfort levels in performing surgical skills among final-year medical students at Gulu University in Gulu, Uganda. Methods This study analysed 5 years’ worth of pre- and post-course ESS self-evaluation questionnaires completed by final-year medical students attending Gulu University between 2013 and 2017. Pre- and post-course results were compared using Student’s t-test. ESS elements covered over the 5-day course were: surgery fundamentals; respiratory and anaesthesia skills; and skills related to gastrointestinal, obstetric, and orthopaedic surgery. Results There was a significant improvement in the students’ level of comfort related to all ESS components when pre- and post-course questionnaire responses were compared (P < 0.001). Conclusions Medical schools should emphasize training of essential clinical and surgical skills because these give medical students the confidence and proficiency needed in clinical practice.
Major limb loss (MLL): An overview of etiology, outcomes, experiences and challenges faced by amputees and service providers in the post-conflict period in Northern Uganda
(Journal of Global Health Reports, 2019) Okello, Tom Richard; Magada, Samuel M; Atim, Pamela; Ezati, Daniel; Campion, Alice; Moro, Emmanuel B; Huck, Jonathon; Byrne, Ged; Redmond, Anthony; Nirmalan, Mahesh
Background Trauma is a leading cause for major limb loss (MLL) during war. As societies transition into peace other factors become important. The voluntary sector plays a diminishing role in service delivery as countries transition towards peace. Methods We undertook a retrospective review of 141 inpatient case notes at two hospitals in Northern Uganda to study the etiology of MLL. Focus group discussions, a literature search and key informant interviews were undertaken to ascertain patients’ experience and the state of current services. Results The most common indication for amputation was malignancy (36%), followed by gangrene and complications from diabetes. Trauma was the 5th most common cause. The mean (standard deviation, SD) age of this cohort was 43 (22.2) years and the mean (SD) distance from their homes to the closest rehabilitation service unit was 91 (75) km. Less than 1% of patients were formally referred to rehabilitation services. Patients described experiences of stigma and marginalization impacting relationship and/or employability. Rehabilitation services were limited/ unaffordable and inaccessible. Unpreparedness of government agencies in taking over rehabilitation services was evident. Conclusions Non-communicable diseases account for the majority of MLL in this region now. These new cohorts of patients join an existing large pool of war-related amputees. Chronic dependence on the voluntary sector has rendered a state of unpreparedness amongst the local health providers.
Case Report: Biloma gastrostomy after failed sonogram-guided percutaneous aspiration, pigtail catheter insertion and surgical drainage [version 1; peer review: 2 approved with reservations]
(AAS Open Research, 2019) Okello, Tom Richard; Ocen, Davidson; Okello, Jimmy; Pecorella, Irene; Amone, Derrick
Bilomas are rare abnormal extrabiliary accumulation of bile. This can be either intrahepatic or extrahepatic following traumatic or spontaneous rupture of the biliary tree. The commonest causes of biloma are surgery, percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, transcatheter arterial embolization and abdominal trauma. We report here a 15 year old patient whom we followed for over 10 years. His chief complaints were right hypochondriac pain, loss of appetite and vomiting. Initial clinical presentation, sonographic as well as laboratory findings suggested a liver abscess, which was drained, but the definitive diagnosis of biloma was entertained after sonographically guided percutaneous aspirations and percutaneous transhepatic cholangiography 7 years later. We also discuss the role of imaging and surgical challenges encountered that culminated into bilomo-gastrostomy. The patient is now enjoying a peaceful life.
Factors affecting mortality after traumatic brain injury in a resource-poor setting
(BJS Open, 2019) Okidi, Ronald; Ogwang, Martin David; Okello, Tom Richard; Ezati, Daniel; Kyegombe, W.; Nyeko, D.; Scolding, N. J.
Background: Traumatic brain injury (TBI) is a major cause of long-term disability and economic loss to society. The aim of this study was to assess the factors affecting mortality after TBI in a resource-poor setting. Methods: Chart review was performed for randomly selected patients who presented with TBI between 2013 and 2017 at St Mary’s Hospital, Lacor, northern Uganda. Data collected included demographic details, time from injury to presentation, and vital signs on arrival. In-hospital management and mortality were recorded. Severe head injury was dened as a Glasgow Coma Scale score below 9. Results: A total of 194 patient charts were reviewed. Median age at time of injury was 27 (i.q.r. 2–68) years. The majority of patients were male (M : F ratio 4⋅9 : 1). Some 30⋅9 per cent of patients had severe head injury, and an associated skull fracture was observed in 8⋅8 per cent. Treatment was mainly conservative in 94⋅8 per cent of patients; three patients (1⋅5 per cent) had burr-holes, four (2⋅1 per cent) had a craniotomy, and three (1⋅5 per cent) had skull fracture elevation. The mortality rate was 33⋅0per cent; 46 (72 per cent) of the 64 patients who died had severe head injury. Of the ten surgically treated patients, seven died, including all three patients who had a burr-hole. In multivariable analysis, factors associated with mortality were mean arterial pressure (P = 0⋅012), referral status (P = 0⋅001), respiratory distress (P = 0⋅040), severe head injury (P = 0⋅011) and pupil reactivity (P = 0⋅011). Conclusion: TBI in a resource-poor setting remains a major challenge and affects mainly young males. Decisions concerning surgical intervention are compromised by the lack of both CT and intracranial pressure monitoring, with consequent poor outcomes

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