Outcome of patients undergoing open heart surgery at the Uganda heart institute,Mulago hospital complex

Background

Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI).

Objectives

We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative outcomes and challenges faced in conducting open heart surgery in a developing country.

Methods

Medical records of patients undergoing open heart surgery at the UHI from October 2007 to June 2012 were reviewed.

Results

A total of 124 patients underwent open heart surgery during the study period. The commonest conditions were: venticular septal defects (VSDs) 34.7% (43/124), Atrial septal defects (ASDs) 34.7% (43/124) and tetralogy of fallot (TOF) in 10.5% (13/124). Non governmental organizations (NGOs) funded 96.8% (120/124) of the operations, and in only 4 patients (3.2%) families paid for the surgeries. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and TAPVR. The local team independently operated 19 patients (15.3%). Postoperative morbidity was low with arrhythmias, left ventricular dysfunction and re-operations being the commonest seen. Post operative sepsis occurred in only 2 cases (1.6%). The overall mortality rate was 3.2 %

Conclusion

Open heart surgery though expensive is feasible in a developing country. With increased direct funding from governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally.     

Echocardiographic pattern and severity of valve dysfunction in children with rheumatic heart disease seen at Uganda Heart Institute,Mulago hospital

Background

Rheumatic heart disease (RHD) is the commonest acquired heart disease in children worldwide but in Uganda, data is scarce regarding its morbidity and mortality. The disease has a progressive course and patients usually require valve repair/replacement in the future.

Objectives

To describe the frequency of echocardiographic valvular dysfunction in children with RHDTo explore the relationship between the severity of valvular dysfunction by the age and sex of the children with RHD

Methods

Echocardiographic findings of children ≤15 years with RHD seen at Uganda Heart Institute from January 2007 to December 2011 were retrospectively analyzed.

Results

376 children had a diagnosis of RHD. The mean age of the children was 11.0±2.7 years and 216 (57.4%) were females. Mitral regurgitation was the commonest lesion seen in 98.9% (severe in 73.1%) of the children. Aortic regurgitation (AR) was found in 51.3% (severe in 7.2%), mitral stenosis (MS) was found in 10.6% (severe in 5.9%), tricuspid regurgitation was found in 86.7% (severe in 8.2%) while aortic stenosis was seen in 1.3% (severe in 0.3%). Severe AR was less common in females (OR=0.32, 95%CI 0.13–0.78) and children with MS were older than those without MS (12.7±2.0 Vs. 10.7±2.7 years, p<0.00).

Conclusions

Mitral valve dysfunction was found in almost all the cases of RHD and majority of the children had severe valve disease at the time of their first presentations. Children with MS were predominantly above 10 years and severe AR was more common in males.     

Effect of solvents in extracting polyphenols and antioxidants of selected raw vegetables

Thirty-seven raw vegetables were extracted using four solvent systems: 70% acetone, 70% ethanol, 70% methanol, and distilled water. The extracts were tested for their total phenolic content, total flavonoid content and antioxidant activities (using diphenylpicryl-hydrazyl (DPPH) and ferric reducing antioxidant power (FRAP) assays). The results revealed the effect of different extracting solvents in altering the quantitative analyses of all vegetables and 70% acetone was identified as the most efficient solvent for extracting polyphenolic antioxidants from the vegetables. The highest total phenolic content and total flavonoid content were obtained from 70% acetone extract of Portulaca oleracea (138.2 ± 2.1 mg GAE/g dw basis) and 70% methanol extract of Cosmos caudatus (27.7 ± 1.0 mg QE/g dw basis), respectively. The 70% acetone extract of Etlingera elatior with moderate amount of total phenolic content exhibited the highest antioxidant activity in both assays. The correlation analyses within 37 different extracts of each solvent extraction demonstrated weak to moderate relationships between all the studied parameters. The highest r value of 0.7139 (p < 0.001) was determined between total phenolic contents and FRAP values of the 70% methanol extracts. Meanwhile, a wide range of correlation coefficients was derived from correlation analyses within four different extracts of each vegetable, with the highest relationship between total phenolic contents and FRAP values for the extracts of Coriandrum sativum (r = 0.9998, p < 0.001).     

Mitigation and detection of spurious potassium and sodium results

Spurious laboratory results are results that are analytically correct but do not accurately reflect the in vivo plasma analyte concentrations. Spurious electrolyte results often lead to unnecessary testing or injudicious treatment and have an adverse effect on patient outcome. In this review we discuss the preanalytical and analytical variables that lead to spurious sodium and potassium results. We describe ways to detect them both in the laboratory and in clinical practice and suggest how to prevent them.     

Three techniques for simpler, safer, and cost-effective rigid ureteroscopy

Postureteroscopy colic, accumulation of irrigant fluid in the bladder, and advancement of the ureteroscope through narrow ureters are some of the problems commonly encountered during ureteroscopy. Three methods to overcome these problems and to make ureteroscopy technically easy, safe and cost-effective are described.     

Vasopressin-independent regulation of collecting duct aquaporin-2 in food deprivation

BACKGROUND: Humans and animals are frequently subjected to food deprivation or starvation. However, the adaptation of the kidney to this condition is not well understood. The purpose of these studies was to examine the effects of food deprivation on water handling by the kidney, the expression levels of collecting duct (CD) water channel aquaporin-2 (AQP2), and to determine the role of vasopressin in the adaptation of AQP2 to food deprivation. METHODS: Sprague-Dawley (SD) and Brattleboro rats were placed in metabolic cages and deprived of food but had free access to water for 72 hours. Water balance and urine osmolality were measured daily. Kidney tissues were isolated and examined for the expression of AQP2 using semiquantitative immunoblotting and Northern hybridization. The circulating level of vasopressin and the mRNA expression levels of its precursor were determined by radioimmunoassay and Northern hybridization, respectively. RESULTS: In SD rats, the first 24 hours of food deprivation is associated with a significant polyuria and decreased urine osmolality (Uosm). This correlated with a significant down-regulation of AQP2 in the cortex and outer medulla. After 72 hours of food deprivation, Uosm increased above baseline, and urine volume dropped to a lower value. This was associated with a rebound increase in AQP2 expression in the cortex and OM and its up-regulation in the inner medulla. Interestingly, vasopressin mRNA expression and plasma levels were unchanged during food deprivation. Further, in homozygous Brattleboro rats, in which endogenous vasopressin is absent, food deprivation caused changes in urine volume, urine osmolality, and AQP2 expression, which are qualitatively similar to those observed in normal rats. CONCLUSION: Food deprivation impairs water handling by the kidney by causing dual changes in urine volume and urine osmolality. This effect is associated with parallel alterations in the expression of AQP2 and is independent of vasopressin activity. It is concluded that the increase in water reabsorption in the CD is an adaptive response of the kidney to a long period of food deprivation and is mediated via a vasopressin-independent mechanism.     

An assessment of a new reminder therapy technique for ceasing digit sucking habits in children

Twenty-one digit-sucker children aged 4-12 old years participated in the assessment of a new reminder therapy technique called "long sleeve sleeping gown ". The result of this study indicated that fifteen children (71.4%) out of 21 were able to stop digit-sucking habits after the application of long sleeve's gown during child's bedtime for 6 weeks. The children who failed to cease this digit-sucking habit (28.6%) were found to not accept to complete the trial period or their mothers thought that they were too young to stop the habit. Among the success group no child was reported to return to digit-sucking 3 months after implementation of long sleeves gown.     

Raising urinary citrate lowers calcium oxalate and calcium phosphate crystal formation in whole urine

Crystal formation in whole urine was studied by the technique of rapid evaporation to 1,250 mosmol/l with and without raising citrate concentration by 40-50%. The added citrate reduced calcium oxalate crystal formation at pH 5.3 by about 25% and reduced calcium phosphate crystal formation at pH 6.8 by some 42%. These results support the view that citrate is important in maintaining calcium in solution in whole urine, and that raising the urinary citrate could be effective treatment for calcium oxalate/phosphate urolithiasis.     

Severe CD8 deficiency in a child with miliary tuberculosis

This report described a 6-month-old boy who presented with miliary tuberculosis and severe CD8 deficiency, which is most likely secondary to miliary tuberculosis since his CD8 was back to normal 6 month after therapy and primary CD8 deficiency, (ZAP 70 defect) was ruled out. To our knowledge this is the first paediatric case reported with severe CD8 deficiency secondary to miliary TB.