Browsing by Author "Kakande, Ignatius"

Now showing 1 - 9 of 9

An Analysis of the Short Term Outcomes of Laparotomy Among Surgeons in Mulago Hospital Using POSSUM Scoring System
(International Research Journals, 2011-09-01) Kitara, Lagoro David; Kakande, Ignatius; Mugisa, D. Didas
More than 600 laparotomy operations are conducted in Mulago National Referral Hospital (MNRH) every year. However, there are no criteria for judging the outcomes (morbidity and mortality) and comparing the short-term outcomes of these operations among surgeons in the Department of Surgery. The Physiological Operative Severity Score for the enumeration of Morbidity and Mortality (POSSUM) was used to analyze the short-term outcomes of laparotomy among surgeons in MNRH. A cross-sectional study was conducted using 76 consecutively recruited patients who underwent emergency and elective laparotomy. POSSUM scoring system was used and patients followed-up to 30th post-operative day. Day-care surgeries, patients who died on table before induction of anesthesia, and patients below 13 years of age were excluded from the study. Informed consent and assent was obtained from each patient before surgery and ethical approval was obtained from the research and review committee of Makerere University Medical School. There were 51 emergencies (67.1%) and 25 (32.9%) electives. 13 patients (17.1%) were operated by consultants, 8 (10.5%) by registrars and 55 (72.4%) by senior residents. Short-term outcome (morbidity) among the surgeons was: consultants (t= -0.081, p=0.243), registrars (t= -0.039, p=0.368), and senior residents (t= -0.041, p=0.362). Mortality outcomes for surgeons were consultants (t= -0.012, p=0.460), registrar (t=.-0.012, p=0.460) and senior residents (t= 0.087, p=0.228). POSSUM successfully analyzed the short-term outcomes of laparotomy among surgeons in MNRH. All the surgeons were performing well within the predictive power of Possum.
HIV seroprevalence and its effect on outcome of moderate to severe burn injuries: A Ugandan experience
(Springer Nature, 2011-06-09) Chalya, L Phillipo; Ssentongo, Robert; Kakande, Ignatius
Background: HIV infection in a patient with burn injuries complicates the care of both the patient and the treating burn team. This study was conducted to establish the prevalence of HIV among burn patients in our setting and to compare the outcome of these patients who are HIV positive with those who are HIV negative. Methods: This was a prospective cohort study involving burn injury patients admitted to Mulago Hospital between November 2005 and February 2006. Patients were stratified into HIV positive (exposed) group and HIV negative (unexposed) group. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 11.5. Results: Of the 130 patients included in the study, 17 (13.1%) patients tested HIV positive and this formed the study (exposed) group. The remaining 113 patients (86.9%) formed the control (unexposed) group. In the HIV positive group, females outnumbered males by a ratio of 1.4:1 and the mean age was 28.4 ± 21.5 years (range 3 months-34 years). 64.7% of HIV positive patients reported to have risk factors for HIV infection. Of these, multiple sexual partners [Odds Ratio 8.44, 95% C.I. (3.87-143.23), P = 0.011] and alcoholism [Odds Ratio 8.34, 95% C.I. (5.76-17.82), P = 0.002] were found to be independently and significantly associated with increased risk to HIV infection. The mean CD4 count for HIV positive and HIV negative patients were 394 ± 328 cells/μL and 912 ± 234 cells/μL respectively which is statistically significant (P = 0.001). There was no difference in the bacteria cultured from the wounds of HIV positive and negative patients (P = 0.322). Patients with clinical signs of sepsis had lower CD4+ counts compared to patients without sepsis (P < 0.001). ). Skin grafting was carried out in 35.3% of HIV negative patients and 29.4% of HIV positive patients with no significant difference in skin graft take and the degree of healed burn on discharge was the same (P = 0.324). There was no significant difference in hospital stay between HIV positive and negative patients (P = 0.674). The overall mortality rate was 11.5%. Using multivariate logistic regression analysis, mortality rate was found to be independently and significantly related to the age of the patient, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (p-value < 0.001). Conclusion: HIV infection is prevalent among burn injury patients in our setting and thus presents an occupational hazard to health care workers who care for these patients. All burn health care workers in this region need to practice universal precautions in order to reduce the risk of exposure to HIV infection and post-exposure prophylaxis should be emphasized. The outcome of burn injury in HIV infected patients is dependent upon multiple variables such as age of the patient, inhalation injury and %TBSA and not the HIV status alone.
Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group
(PLOS, 2009-12-01) Luboga, Sam; Macfarlane, B. Sarah; Schreeb, Von Johan; Kruk, E. Margaret; Cherian, N. Meena; Bergstro¨, Staffan; Bossyns, B. Paul; Denerville, Ernest; Dovlo, Delanyo; Galukande, Moses; Hsia, Y. Renee; Jayaraman, P. Sudha; Lubbock, A. Lindsey; Mock, Charles; Ozgediz, Doruk; Sekimpi, Patrick; Wladis, Andreas; Zakariah, Ahmed; Dade, Babadi Name'oua; Donkor, Peter; Gatumbu, Kabutu Jane; Hoekman, Patrick; IJsselmuiden, B. Carel; Jamison, T. Dean; Jessani, Nasreen; Jiskoot, Peter; Kakande, Ignatius; Mabweijano, R. Jacqueline; Mbembati, Naboth; McCord, Colin; Mijumbi, Cephas; Miranda, de Helder; Mkony, A. Charles; Mocumbi, Pascoal; Ndihokubwayo, Bosco Jean; Ngueumachi, Pierre; Ogbaselassie, Gebreamlak; Okitombahe, Lodi Evariste; Toure, Tidiane Cheikh; Vaz, Fernando; Zikusooka, M. Charlotte; Debas, T. Haile
Is General Surgery on the Verge of Demise?
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2012) Kakande, Ignatius
Although general surgery remains one of the most respected residencies available to medical students today, it is facing terrible pressures, including less attraction to surgery as a profession, increasing interest in surgical sub specialization, and high attrition rates. In November 2007, Josef Fischer sounded an alarm among physicians in the US with the commentary: “The impending disappearance of the general surgeon,” published in the Journal of the American Medical association. He note that the reasons for the “disappearance” were multiple including fewer graduating surgical residents pursuing general surgery as well as less favourable working conditions and less lucrative reimbursement for general surgeons. In the U.S. the imminent demise of the general surgeon has been a growing concern for the medical community and the general public, both who fear an end to a once robust medical discipline and its consequences for patients with general surgical problems. There is an abundance of literature addressing the challenges facing general surgery. Longo3 in Yale University School of Medicine in the USA reported that 5% to 20% of residents leave general surgery training annually compared to roughly 3% to 5% of physicians who leave medicine voluntarily. The Association of Surgeons of South Africa has identified and was concerned about the decline in the number of applicants for registrar posts and the critical shortage of general surgeons in the state sector
Mortality Prediction using Possum Scoring System for Laparotomy Patients in Mulago National Referral Hospital, Uganda
(University of Papua New Guinea, 2012-03) Kitara, Lagoro David; Kakande, Ignatius; Mugisa, B Didas
Prediction of serious complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of dying contributes significantly to the quality of surgical care and cost reduction. The postoperative mortality of patients who underwent laparotomy in Mulago Hospital was studied using Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM). Consecutive patients who underwent laparotomy in Mulago Hospital were recruited and consent obtained. Patients operated were followed up to the 30th postoperative day. Postoperative deaths were promptly investigated and findings recorded. Follow-up of patients was conducted by phone and surgical review once a week in outpatient. Ethical approval was obtained from the Institutional Review Board (IRB) of Makerere University Medical School. Seventy-six patients participated and the observed mortality was 14.5% and the predictive value of POSSUM using Receiver Operative Characteristics (ROC) curve was 0.817 (95% Confidence Interval 0.711, 0.924) and the Hosmer and Lemeshow test predicted 18.2% of mortality and survival 100%. Postoperative mortality can be predicted in the modern management of surgery using POSSUM. It is markedly influenced by the preoperative, operative and postoperative conditions of the patients.
Our Medical Colleges: A Reflection On The Past, Present and Future
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2004-12-02) Kakande, Ignatius
“The medical student’s present education is badly fragmented because his professors are not teaching him clinical medicine as should be taught – mainly because they themselves are not usually clinical doctors” Dr. J. Knowles. “Medical Professors poorer and less experienced in the art of healing – producing doctors in their deficient image” -Dr. John Knowles, General Director of Massachusetts General Hospital “The Goals of medical schools are, in a sense, a three-legged stool in which teaching, research and patient care form the necessary support. Unfortunately, recently most modern medical school have had a hypertrophy (overgrowth) of the research leg, stimulated by the trophic effect of the over-abundant sums of money in the form of research grants…. The full-time clinical professor has become primarily a research professor whose chief claim to fame is his ‘grantsmanship” and whose hallmark is ‘publish or perish’ “. Some professors are fundamentally lacking interest in teaching clinical medicine to medical students.” Willis E Brown, University of Arkansas Medical Center.
An Overview Cancer Management And Prevention In Africa
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2001) Kakande, Ignatius
The Pattern of Cancer in Kampala, Uganda
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2001) Kakande, Ignatius; Ekwaro, Lawrence; Obote, W. Wiam; NassaLi, Gorreti; Kakande, Irene Rarban; Kabuye, S.
This study on the pattern of cancer in Kampala is based on data collected from 2246 patients at Mulago Hospital and 355 patients at St. Francis Hospital Nsambya, between January 1995 and December 1998. All diagnoses were histologically confirmed. Of these 2601 patients, 1225 were males and 1376 were females. Kaposi's Sarcoma was the commonest malignancy, accounting for 28.6% of all cancers. Among males, Kaposi's Sarcoma (KS) was the most common cancer (37.1°/o) followed by prostaticcancer(9.60/0), lymphomas (8.5%), oesophageal cancer (7.0°/o), eye malignancies (3.8%) and pharyngeal cancer (3.8%). In females, the order of frequency of malignancies was cervical cancer (22.200), Kaposi's Sarcoma (21.1°/0), breast cancer (10.9%), lymphoma (5.9%), oesophageal cancer (4.6%) and eye malignancies (3.60/0). The incidence of KS has dramatically increased from 6.3% in males and 0.4% in females among patients with cancer diagnosed in 1977-80, before HIV infection was recognized. This paper compares the cancer patterns of 1995-98 with those of 1977-80 and discusses the possible influence of HIV infection on the change of patterns of cancer in Uganda.
The Specialist Surgeon Workforce in East, Central and Southern Africa: A Situation Analysis
(Springer, 2016-01-01) O’Flynn, Eric; Andrew, Judith; Hutch, Avril; Kelly, Caitrin; Jani, Pankaj; Kakande, Ignatius; Derbew, Miliard; Tierney, Sean; Mkandawire, Nyengo; Erzingatsian, Krikor
Background In East, Central and Southern Africa accurate data on the current surgeon workforce have previously been limited. In order to ensure that the workforce required for sustainable delivery of surgical care is put in place, accurate data on the number, specialty and distribution of specialist-trained surgeons are crucial for all stakeholders in surgery and surgical training in the region. Methods The surgical workforce in each of the ten member countries of the College of Surgeons of East, Central and Southern Africa (COSECSA) was determined by gathering and crosschecking data from multiple sources including COSECSA records, medical council registers, local surgical societies records, event attendance lists and interviews of Members and Fellows of COSECSA, and validating this by direct contact with the surgeons identified. This data was recorded and analysed in a cloud-based computerised database, developed as part of a collaboration programme with the Royal College of Surgeons in Ireland. Results A total of 1690 practising surgeons have been identified yielding a regional ratio of 0.53 surgeons per 100,000 population. A majority of surgeons (64 %) practise in the main commercial city of their country of residence and just 9 % of surgeons are female. More than half (53 %) of surgeons in the region are general surgeons. Conclusions While there is considerable geographic variation between countries, the regional surgical workforce represents less than 4 % of the equivalent number in developed countries indicating the magnitude of the human resource challenge to be addressed.