Surgery and Anesthesiology

Organisation, staffing and resources of critical care units in Kenya

2023-07-27T00:00:00Z

Organisation, staffing and resources of critical care units in Kenya Wambui Mwangi, Ronnie Kaddu, Carolyne Njoki Muiru, Nabukwangwa Simiyu, Vishal Patel, Demet Sulemanji, Dorothy Otieno, Stephen Okelo, Idris Chikophe, Luigi Pisani, Dilanthi Priyadarshani Gamage Dona, Abi Beane, Rashan Haniffa, David Misango, Wangari Waweru-Siika, Kenya Critical Care Registry Investigators To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors. https://doi.org/10.1371/journal.pone.0284245

Rationale, Design, and the Baseline Characteristics of the RHDGen (The Genetics of Rheumatic Heart Disease) Network Study†

2023-01-01T00:00:00Z

Rationale, Design, and the Baseline Characteristics of the RHDGen (The Genetics of Rheumatic Heart Disease) Network Study† Tafadzwa Machipisa, , Chishala Chishala, , Gasnat Shaboodien, Liesl J. Zühlke, Babu Muhamed, Shahiemah Pandie, Jantina de Vries, , Nakita Laing, Alexia Joachim, RN Rezeen Daniels, Mpiko Ntsekhe, Christopher T. Hugo-Hamman, Bernard Gitura,Stephen Ogendo, Peter Lwabi, , Emmy Okello, Albertino Damasceno, Celia Novela, RN, Ana O. Mocumbi, Geoffrey Madeira, John Musuku, Agnes Mtaja, , Ahmed ElSayed, Huda H.M. Alhassan, Fidelia Bode-Thomas, Christopher Yilgwan, Ganiyu Amusa, Esin Nkereuwem, Nicola Mulder, Raj Ramesar, Maia Lesosky, Heather J. Cordell, Michael Chong, Bernard Keavney, BM,, Guillaume Paré, Mark E. Enge BACKGROUND: The genetics of rheumatic heart disease (RHDGen) Network was developed to assist the discovery and validation of genetic variations and biomarkers of risk for rheumatic heart disease (RHD) in continental Africans, as a part of the global fight to control and eradicate rheumatic fever/RHD. Thus, we describe the rationale and design of the RHDGen study, comprising participants from 8 African countries. METHODS: RHDGen screened potential participants using echocardiography, thereafter enrolling RHD cases and ethnicallymatched controls for whom case characteristics were documented. Biological samples were collected for conducting genetic analyses, including a discovery case-control genome-wide association study (GWAS) and a replication trio family study. Additional biological samples were also collected, and processed, for the measurement of biomarker analytes and the biomarker analyses are underway. RESULTS: Participants were enrolled into RHDGen between December 2012 and March 2018. For GWAS, 2548 RHD cases and 2261 controls (3301 women [69%]; mean age [SD], 37 [16.3] years) were available. RHD cases were predominantly Black (66%), Admixed (24%), and other ethnicities (10%). Among RHD cases, 34% were asymptomatic, 26% had prior valve surgery, and 23% had atrial fibrillation. The trio family replication arm included 116 RHD trio probands and 232 parents. CONCLUSIONS: RHDGen presents a rare opportunity to identify relevant patterns of genetic factors and biomarkers in Africans that may be associated with differential RHD risk. Furthermore, the RHDGen Network provides a platform for further work on fully elucidating the causes and mechanisms associated with RHD susceptibility and development.

Surgery is really a team sport

2022-01-01T00:00:00Z

Surgery is really a team sport Varallo John E , Fitzgerald Laura , Okelo Stephen, Itungu Stella, Mwape Lillian, Hardtman Pandora, Ashengo Tigi Adamu A surgical team consists of healthcare professionals from various disciplines, all with different priorities, roles, expertise, and experience. This interdisciplinary team relies on the skills of all members and conducts interdependent tasks in a highly dynamic work environment, with a shared goal of delivering safe surgical care. The requirement for effective teamwork and communication within and across health-care teams and organisations to deliver safe, high-quality surgical care is well established. Therefore, we champion the importance of enhancing leadership capabilities for all surgical team members as a way to strengthen surgical ecosystems in the countries in which we work.

Partnering to deliver sustainable children's surgical care in Kakuma refugee camp

2023-01-01T00:00:00Z

Partnering to deliver sustainable children's surgical care in Kakuma refugee camp Kaseje Neema, Khalid Hassan, Muriithi Jesse, Burton John , Weswa Benjamin, Ojwando Kefa , Chirchir Collins, Kinara Stephen, Cunningham David , Okelo Stephen The devastating milestone of 100 million people globally forced to flee their homes because of war, violence, persecution, and discrimination was reached on May 23, 2022.1 Women and children are disproportionately affected. 42% of forcibly displaced people worldwide are children. In Kenya, by September, 2021, 76% of registered refugees and asylum seekers were women and children. These women and children have considerable negative health consequences with increased rates of morbidity and mortality compared with non-displaced populations. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(22)01105-9.pdf

Rationale, Design, and the Baseline Characteristics of the RHDGen (The Genetics of Rheumatic Heart Disease) Network Study

2023-01-01T00:00:00Z

Rationale, Design, and the Baseline Characteristics of the RHDGen (The Genetics of Rheumatic Heart Disease) Network Study Tafadzwa Machipisa, Chishala Chishala, Gasnat Shaboodien, Liesl J Zühlke, Babu Muhamed, Shahiemah Pandie, Jantina de Vries, Nakita Laing, Alexia Joachim, Rezeen Daniels, Mpiko Ntsekhe, Christopher T Hugo-Hamman, Bernard Gitura, Stephen Ogendo, Peter Lwabi, Emmy Okello, Albertino Damasceno, Celia Novela, Ana O Mocumbi, Geoffrey Madeira, John Musuku, Agnes Mtaja, Ahmed ElSayed, Huda HM Alhassan, Fidelia Bode-Thomas, Christopher Yilgwan, Ganiyu Amusa, Esin Nkereuwem, Nicola Mulder, Raj Ramesar, Maia Lesosky, Heather J Cordell, Michael Chong, Bernard Keavney, Guillaume Paré, Mark E Engel, RHDGen Network Consortium† The genetics of rheumatic heart disease (RHDGen) Network was developed to assist the discovery and validation of genetic variations and biomarkers of risk for rheumatic heart disease (RHD) in continental Africans, as a part of the global fight to control and eradicate rheumatic fever/RHD. Thus, we describe the rationale and design of the RHDGen study, comprising participants from 8 African countries. https://doi.org/10.1161/CIRCGEN.121.003641

The Burden of Motorcycle Crash Injuries on the Public Health System in Kisumu City, Kenya

2023-01-01T00:00:00Z

The Burden of Motorcycle Crash Injuries on the Public Health System in Kisumu City, Kenya Wilberforce Cholo, Wilson Odero, Japheths Ogendi Background: In Kenya, the increased use of motorcycles for transport has led to increased morbidity, mortality, and disability. These injuries exert a burden on the public health system, yet little information exists on health care resource usage by motorcycle crash injury patients. We aimed to estimate the burden of motorcycle crash injuries on the health system in Kisumu City. Methods: We conducted a 6-month prospective study of all motorcycle crash injury patients who presented to 3 Tier III public and private hospitals in Kisumu City between May and November 2019. We collected data on demographics, emergency department (ED) visits, admissions, anatomic injury site, services used, and injury severity. We reviewed hospital records to obtain denominator data on all the conditions presenting to the EDs. Results: A total of 1,073 motorcycle crash injury cases accounted for 2.0%, 12.0%, and 13.6% of total emergency visits, total injuries, and total admissions to the hospitals, respectively. Men were overrepresented (P<.001). The mean age was 29.6 years (6standard deviation [SD] 12.19; range=2–84). The average injury severity score was 12.83. Surgical interventions were required by 89.3% of patients admitted. Of the 123 patients admitted to the intensive care unit, 42.3% were due to motorcycle accident injuries. Conclusion: Motorcycle injuries impose a major burden on the Kisumu City public health system. Increased promotion and reinforcement of appropriate interventions and legislation can help prevent accidents and mitigate their consequences. Focusing on motorcycle injury prevention will reduce accident-related morbidity, hospitalization, severity, and fatalities and the impact on the public health system

Prediction of BRCA Mutations Using the BRCAPRO Model in Clinic-Based African American, Hispanic, and Other Minority Families in the United States

2009-01-01T00:00:00Z

Prediction of BRCA Mutations Using the BRCAPRO Model in Clinic-Based African American, Hispanic, and Other Minority Families in the United States Dezheng Huo, Ruby T Senie, Mary Daly, Saundra S Buys, Shelly Cummings, Jacqueline Ogutha, Kisha Hope, Olufunmilayo I Olopade BRCAPRO, a BRCA mutation carrier prediction model, was developed on the basis of studies in individuals of Ashkenazi Jewish and European ancestry. We evaluated the performance of the BRCAPRO model among clinic-based minority families. We also assessed the clinical utility of mutation status of probands (the first individual tested in a family) in the recommendation of BRCA mutation testing for other at-risk family members.

Data-independent acquisition mass spectrometry in severe rheumatic heart disease (RHD) identifies a proteomic signature showing ongoing inflammation and effectively classifying RHD cases

2022-01-01T00:00:00Z

Data-independent acquisition mass spectrometry in severe rheumatic heart disease (RHD) identifies a proteomic signature showing ongoing inflammation and effectively classifying RHD cases M Taariq Salie, Jing Yang, Carlos R Ramírez Medina, Liesl J Zühlke, Chishala Chishala, Mpiko Ntsekhe, Bernard Gitura, Stephen Ogendo, Emmy Okello, Peter Lwabi, John Musuku, Agnes Mtaja, Christopher Hugo-Hamman, Ahmed El-Sayed, Albertino Damasceno, Ana Mocumbi, Fidelia Bode-Thomas, Christopher Yilgwan, Ganiyu A Amusa, Esin Nkereuwem, Gasnat Shaboodien, Rachael Da Silva, Dave Chi Hoo Lee, Simon Frain, Nophar Geifman, Anthony D Whetton, Bernard Keavney, Mark E Engel Background Rheumatic heart disease (RHD) remains a major source of morbidity and mortality in developing countries. A deeper insight into the pathogenetic mechanisms underlying RHD could provide opportunities for drug repurposing, guide recommendations for secondary penicillin prophylaxis, and/or inform development of near-patient diagnostics. Methods We performed quantitative proteomics using Sequential Windowed Acquisition of All Theoretical Fragment Ion Mass Spectrometry (SWATH-MS) to screen protein expression in 215 African patients with severe RHD, and 230 controls. We applied a machine learning (ML) approach to feature selection among the 366 proteins quantifiable in at least 40% of samples, using the Boruta wrapper algorithm. The case–control differences and contribution to Area Under the Receiver Operating Curve (AUC) for each of the 56 proteins identified by the Boruta algorithm were calculated by Logistic Regression adjusted for age, sex and BMI. Biological pathways and functions enriched for proteins were identified using ClueGo pathway analyses. Results Adiponectin, complement component C7 and fibulin-1, a component of heart valve matrix, were significantly higher in cases when compared with controls. Ficolin-3, a protein with calcium-independent lectin activity that activates the complement pathway, was lower in cases than controls. The top six biomarkers from the Boruta analyses conferred an AUC of 0.90 indicating excellent discriminatory capacity between RHD cases and controls. Conclusions These results support the presence of an ongoing inflammatory response in RHD, at a time when severe valve disease has developed, and distant from previous episodes of acute rheumatic fever. This biomarker signature could have potential utility in recognizing different degrees of ongoing inflammation in RHD patients, which may, in turn, be related to prognostic severity.

Design of a novel online, modular, flipped-classroom surgical curriculum for East, Central, and Southern Africa

2022-01-01T00:00:00Z

Design of a novel online, modular, flipped-classroom surgical curriculum for East, Central, and Southern Africa Andrea S Parker, Katherine A Hill, Bruce C Steffes, Deirdre Mangaoang, Eric O’Flynn, Niraj Bachheta, Maria F Bates, Caesar Bitta, Nicholas H Carter, Richard E Davis, Jeremy A Dressler, Deborah A Eisenhut, Akinniyi E Fadipe, John K Kanyi, Rondi M Kauffmann, Frances Kazal, Patrick Kyamanywa, Justus O Lando, Heath R Many, Valentine C Mbithi, Amanda J McCoy, Peter C Meade, Wairimu YB Ndegwa, Emmy A Nkusi, Philip B Ooko, Dixon JS Osilli, Madison ED Parker, Sinkeet Rankeeti, Katherine Shafer, James D Smith, David Snyder, Kimutai R Sylvester, Michelle E Wakeley, Marvin K Wekesa, Laura Torbeck, Russell E White, Abebe Bekele, Robert K Parker Objective: We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA). Summary Background Data: Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary. Methods: We utilized Kern’s 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation. Results: Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination.

Data-independent acquisition mass spectrometry in severe rheumatic heart disease (RHD) identifies a proteomic signature showing ongoing inflammation and effectively classifying RHD cases

2022-01-01T00:00:00Z