INTRODUCTION: HIV/AIDS remains a public health concern in both Rwanda and Burundi. These countries share many characteristics but in the last 15 years economic growth has been stronger in Rwanda. This has influenced HIV epidemiology and risky behaviour. METHODS: We extracted data from tables in the available DHS reports from 2010-2019/20. The tables were selected to capture information on vulnerable populations, knowledge levels, at risk behaviour and media access. We compared this information with economic data from the two countries. RESULTS: Rwanda has higher HIV prevalence than Burundi. However, higher prevalence in women, against lower at-risk sexual behaviour, was a common feature. Patterns of HIV prevalence differed in age groups, education level, wealth quintile and residence in the two countries over the past 15 years. Economic growth in Rwanda was markedly higher than Burundi over the same time period. Access to media in general increased and shifted from newspapers to social media, more markedly in Rwanda. CONCLUSION: Epidemiological and behavioural differences suggest that higher economic prosperity in Rwanda compared with Burundi in the past 15 years increased the risk of acquiring HIV in some population groups, in spite of increased access to information. This implies HIV prevention strategies in low- and middle-income countries with marked economic growth may need to be adapted for potential changes in behaviour in certain populations. Enhanced access to social media, as economic growth rises, provides an opportunity to target those with increased risk of acquiring HIV with tailored information.
{"title":"Economic growth and HIV knowledge, prevention and access to media in Burundi and Rwanda","authors":"A. Ngabirano, M. Hadley","doi":"10.4314/rmj.v79i4.1","DOIUrl":"https://doi.org/10.4314/rmj.v79i4.1","url":null,"abstract":"INTRODUCTION: HIV/AIDS remains a public health concern in both Rwanda and Burundi. These countries share many characteristics but in the last 15 years economic growth has been stronger in Rwanda. This has influenced HIV epidemiology and risky behaviour. METHODS: We extracted data from tables in the available DHS reports from 2010-2019/20. The tables were selected to capture information on vulnerable populations, knowledge levels, at risk behaviour and media access. We compared this information with economic data from the two countries. RESULTS: Rwanda has higher HIV prevalence than Burundi. However, higher prevalence in women, against lower at-risk sexual behaviour, was a common feature. Patterns of HIV prevalence differed in age groups, education level, wealth quintile and residence in the two countries over the past 15 years. Economic growth in Rwanda was markedly higher than Burundi over the same time period. Access to media in general increased and shifted from newspapers to social media, more markedly in Rwanda. CONCLUSION: Epidemiological and behavioural differences suggest that higher economic prosperity in Rwanda compared with Burundi in the past 15 years increased the risk of acquiring HIV in some population groups, in spite of increased access to information. This implies HIV prevention strategies in low- and middle-income countries with marked economic growth may need to be adapted for potential changes in behaviour in certain populations. Enhanced access to social media, as economic growth rises, provides an opportunity to target those with increased risk of acquiring HIV with tailored information.","PeriodicalId":38181,"journal":{"name":"Rwanda Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49380735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Tuyishimire, H. Irere, C. Muhizi, A. Ndatinya, O. Karangwa, F. Rutarama, C. Nsanzabaganwa, L. Mutesa
INTRODUCTION: Although Treacher-Collins syndrome has to be considered a differential diagnosis in congenital craniofacial abnormalities, the clinical diagnosis and research related to it still present a gap, especially in African regions. Thus, this work aims at highlighting this syndrome's clinical features for raising medical awareness. CLINICAL CASE: We reviewed a 1-year-old patient referred to our clinical genetic unit at Rwanda military hospital, Kigali, Rwanda. Physical examinations indicated severe craniofacial abnormalities, including downward-sloping eyes, slight notching of the lower lids, small and underdeveloped eyebrow bones, vision problems, small outer ears, small and underdeveloped cheekbones, and jaw. Within the limits of the techniques used in our laboratory, the cytogenetic analysis revealed a normal karyotype, 46, XY. CONCLUSION: The patient was diagnosed with Treacher-Collins syndrome based on clinical manifestations of craniofacial features. Nevertheless, laboratory tests performed were limited to karyotyping and should not detect any gene defect. Long-term follow-up of the patient and his family was recommended. Further molecular analyses should be performed to identify causing genetic mutation mainly in the TCOF1, POLR1C, or POLR1D genes.
{"title":"Diagnosis of Treacher-Collins Syndrome: The role of the multidisciplinary team in patient management and family genetic counseling","authors":"B. Tuyishimire, H. Irere, C. Muhizi, A. Ndatinya, O. Karangwa, F. Rutarama, C. Nsanzabaganwa, L. Mutesa","doi":"10.4314/rmj.v79i4.10","DOIUrl":"https://doi.org/10.4314/rmj.v79i4.10","url":null,"abstract":"INTRODUCTION: Although Treacher-Collins syndrome has to be considered a differential diagnosis in congenital craniofacial abnormalities, the clinical diagnosis and research related to it still present a gap, especially in African regions. Thus, this work aims at highlighting this syndrome's clinical features for raising medical awareness. CLINICAL CASE: We reviewed a 1-year-old patient referred to our clinical genetic unit at Rwanda military hospital, Kigali, Rwanda. Physical examinations indicated severe craniofacial abnormalities, including downward-sloping eyes, slight notching of the lower lids, small and underdeveloped eyebrow bones, vision problems, small outer ears, small and underdeveloped cheekbones, and jaw. Within the limits of the techniques used in our laboratory, the cytogenetic analysis revealed a normal karyotype, 46, XY. CONCLUSION: The patient was diagnosed with Treacher-Collins syndrome based on clinical manifestations of craniofacial features. Nevertheless, laboratory tests performed were limited to karyotyping and should not detect any gene defect. Long-term follow-up of the patient and his family was recommended. Further molecular analyses should be performed to identify causing genetic mutation mainly in the TCOF1, POLR1C, or POLR1D genes.","PeriodicalId":38181,"journal":{"name":"Rwanda Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42513508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dr. Syed Esam, Mahmood, A. A. Khan, D. Imtiaz, M. Munif, S. Mahmood, M. S. Khan, A. Nasar
INTRODUCTION: Infectious diseases are a major cause of morbidity and mortality in children. Immunization remains a cost-effective method for child survival against vaccine-preventable diseases. Despite all the interventions put in by the government for 100% immunization coverage, there remain pockets of low coverage, especially in rural areas.Our aim was to estimate the immunization coverage and assess sociodemographic factors associated with immunization among children aged 12-23 months in a rural area of Bareilly. METHODS: The present cross-sectional study was carried out in the field practice area under RHTC from January 2016 to June 2016 using a 30 by 7 cluster sampling technique. A total of seven children aged 12-23 months were interviewed from each cluster on a preformed, pretested, and semi-structured questionnaire, thus giving a sample size of 210. Statistical analysis was done using the Chi-square test. RESULTS: More than two-thirds (69%) of study participants were completely vaccinated, whereas about 31% were partially or not vaccinated. Immunization coverage was found to be highest for BCG (80.4%) and lowest for the third dose of DPT (69.0%). The most common reason for partial or non-immunization was found to be unawareness (45.5%) and fear of side effects (43.9%). CONCLUSION: There is a need to create awareness and increase knowledge among caretakers of children about the importance and benefits of getting immunization for their children as a major step toward achieving Sustainable Development Goals (SDGs) goals.
{"title":"Immunization coverage in a rural area of Bareilly district: a cross-sectional community-based study","authors":"Dr. Syed Esam, Mahmood, A. A. Khan, D. Imtiaz, M. Munif, S. Mahmood, M. S. Khan, A. Nasar","doi":"10.4314/rmj.v79i4.5","DOIUrl":"https://doi.org/10.4314/rmj.v79i4.5","url":null,"abstract":"INTRODUCTION: Infectious diseases are a major cause of morbidity and mortality in children. Immunization remains a cost-effective method for child survival against vaccine-preventable diseases. Despite all the interventions put in by the government for 100% immunization coverage, there remain pockets of low coverage, especially in rural areas.Our aim was to estimate the immunization coverage and assess sociodemographic factors associated with immunization among children aged 12-23 months in a rural area of Bareilly. METHODS: The present cross-sectional study was carried out in the field practice area under RHTC from January 2016 to June 2016 using a 30 by 7 cluster sampling technique. A total of seven children aged 12-23 months were interviewed from each cluster on a preformed, pretested, and semi-structured questionnaire, thus giving a sample size of 210. Statistical analysis was done using the Chi-square test. RESULTS: More than two-thirds (69%) of study participants were completely vaccinated, whereas about 31% were partially or not vaccinated. Immunization coverage was found to be highest for BCG (80.4%) and lowest for the third dose of DPT (69.0%). The most common reason for partial or non-immunization was found to be unawareness (45.5%) and fear of side effects (43.9%). CONCLUSION: There is a need to create awareness and increase knowledge among caretakers of children about the importance and benefits of getting immunization for their children as a major step toward achieving Sustainable Development Goals (SDGs) goals.","PeriodicalId":38181,"journal":{"name":"Rwanda Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43315982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Muhizi, H. Irere, B. Tuyishimire, A. Ndatinya, O. Karangwa, F. Rutarama, L. Mutesa, C. Nsanzabaganwa
INTRODUCTION: Neurofibromatosis Type 1 (NF1) or Von Recklinghausen’s disease, is a rare genetic disease characterized by multiple benign tumors of nerves and skin (neurofibromas), and skin decorations. However, it is multisystem and can affect each organ in the body, leading to debilitating effects.CLINICAL CASE: We present a case of an 18-year-old girl with NF1. The disease onset started in childhood at the age of 3 years with the appearance of hyperpigmented skin macules. Her mother also presented with multiple nodules on the face and trunk, and her little brother was reported to have disseminated macules. She had poor performance at school and delayed menses. The diagnosis of NF-1 was made, and a multidisciplinary team was involved in management of the patientCONCLUSION: Although genetic testing and confirmation are available, NF1 remains a clinical diagnosis and requires management by multidisciplinary team
{"title":"Neurofibromatosis type 1 – A clinical case report and management review","authors":"C. Muhizi, H. Irere, B. Tuyishimire, A. Ndatinya, O. Karangwa, F. Rutarama, L. Mutesa, C. Nsanzabaganwa","doi":"10.4314/rmj.v79i4.9","DOIUrl":"https://doi.org/10.4314/rmj.v79i4.9","url":null,"abstract":"INTRODUCTION: Neurofibromatosis Type 1 (NF1) or Von Recklinghausen’s disease, is a rare genetic disease characterized by multiple benign tumors of nerves and skin (neurofibromas), and skin decorations. However, it is multisystem and can affect each organ in the body, leading to debilitating effects.CLINICAL CASE: We present a case of an 18-year-old girl with NF1. The disease onset started in childhood at the age of 3 years with the appearance of hyperpigmented skin macules. Her mother also presented with multiple nodules on the face and trunk, and her little brother was reported to have disseminated macules. She had poor performance at school and delayed menses. The diagnosis of NF-1 was made, and a multidisciplinary team was involved in management of the patientCONCLUSION: Although genetic testing and confirmation are available, NF1 remains a clinical diagnosis and requires management by multidisciplinary team","PeriodicalId":38181,"journal":{"name":"Rwanda Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49019869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION: Dropout has been renowned as one of the main challenges of Community Health Workers (CHWs) programs in addition to the health facilities. This has got a serious public health implication as it can hinder the increase of health service delivery in rural and urban areas. This study aimed to determine the factors associated with dropout among CHWs in Musanze District, Rwanda.METHODS: A descriptive cross-sectional study was conducted. Three sectors from the district were selected purposively with a total sample size of 252 CHWs who were elected and recruited in 2013. Data was collected using semi-structured questionnaire and was analysed using SPSS version 25. Multiple logistic regression analysis was performed to determine the independent factors associated with dropout of CHWs.RESULTS: Out of the total (252 CHWs) enrolled since 2013, about 10% had left the health system in a period of 4 years. Following the multiple logistic regression analysis; being single [AOR=2.58, 95%CI=1.09-6.93], engaged in business [AOR=3.22, 95%CI=1.25-8.27] and relationship with supervisors [AOR=0.25, 95%CI=0.09-0.67] were independently associated with dropout of CHWs.CONCLUSION: Dropout rate during the period of four years was 9.9%. Marital status and occupation are main factors affecting dropout of CHWs in Musanze district.
{"title":"Factors Associated with Dropout Among Community Health Workers in Musanze District, Rwanda: A Cross Sectional Study","authors":"M. F. Muremba","doi":"10.4314/rmj.v79i4.11","DOIUrl":"https://doi.org/10.4314/rmj.v79i4.11","url":null,"abstract":"INTRODUCTION: Dropout has been renowned as one of the main challenges of Community Health Workers (CHWs) programs in addition to the health facilities. This has got a serious public health implication as it can hinder the increase of health service delivery in rural and urban areas. This study aimed to determine the factors associated with dropout among CHWs in Musanze District, Rwanda.METHODS: A descriptive cross-sectional study was conducted. Three sectors from the district were selected purposively with a total sample size of 252 CHWs who were elected and recruited in 2013. Data was collected using semi-structured questionnaire and was analysed using SPSS version 25. Multiple logistic regression analysis was performed to determine the independent factors associated with dropout of CHWs.RESULTS: Out of the total (252 CHWs) enrolled since 2013, about 10% had left the health system in a period of 4 years. Following the multiple logistic regression analysis; being single [AOR=2.58, 95%CI=1.09-6.93], engaged in business [AOR=3.22, 95%CI=1.25-8.27] and relationship with supervisors [AOR=0.25, 95%CI=0.09-0.67] were independently associated with dropout of CHWs.CONCLUSION: Dropout rate during the period of four years was 9.9%. Marital status and occupation are main factors affecting dropout of CHWs in Musanze district.","PeriodicalId":38181,"journal":{"name":"Rwanda Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44743638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION: At most institutions, the favored contrast MR sequence is T1-weighted imaging (T1WI). However, lesion enhancement is occasionally inconspicuous on T1WI.Objective: This study aims to evaluate the diagnostic value of contrast-enhanced FLAIR compared to contrast-enhanced T1WI for intracranial tumors and to offer data for further clinical judgment. METHODS: 88 consecutive cases of intracranial tumors referred for contrast-enhanced brain MRI were analyzed. FLAIR and T1 were used alternately in equal percentages as the first contrast-enhanced sequence to avoid delayed contrast-enhancement effects of the lesions. Six quantitative criteria were considered: lesion-to-white matter contrast ratio (CR) and contrast-to-noise ratio (CNR), lesion-to-gray matter CR and CNR, and lesion-to-cerebrospinal fluid CR and CNR. For qualitative evaluation, two experienced radiologists assessed lesion conspicuity on contrast-enhanced-T1WI and FLAIR sequences using the following three scales: 1, FLAIR superior; 2, sequences equal; 3, T1 superior. RESULTS: For quantitative measurement, the contrast enhanced-FLAIR lesion-to-white matter, lesion-to-cerebrospinal fluid CR, and CNR values were statistically superior to those of the contrast enhanced-T1 weighted images (p = 0.001 in all). However, lesion-to-gray matter CR and CNR were slightly higher on CE-FLAIR, but with no statistically significant difference (p = 0.159, 0.184, respectively). For qualitative evaluation, both radiologists assessed that contrast enhanced-FLAIR images were superior to contrast enhanced-T1 weighted images for the evaluation of lesion conspicuity, especially when it was performed as the second sequence. CONCLUSION: FLAIR sequence was superior or comparable to T1 sequence, especially when performed as a second post-contrast sequence. Using contrast enhanced-FLAIR as a routine MRI sequence will increase diagnostic confidence.
{"title":"Contrast-enhanced fluid-attenuated inversion-recovery (FLAIR) versus contrast-enhanced T1 MRI in the evaluation of intracranial tumors: A comparative study","authors":"Q. Hassan","doi":"10.4314/rmj.v79i4.4","DOIUrl":"https://doi.org/10.4314/rmj.v79i4.4","url":null,"abstract":"INTRODUCTION: At most institutions, the favored contrast MR sequence is T1-weighted imaging (T1WI). However, lesion enhancement is occasionally inconspicuous on T1WI.Objective: This study aims to evaluate the diagnostic value of contrast-enhanced FLAIR compared to contrast-enhanced T1WI for intracranial tumors and to offer data for further clinical judgment. METHODS: 88 consecutive cases of intracranial tumors referred for contrast-enhanced brain MRI were analyzed. FLAIR and T1 were used alternately in equal percentages as the first contrast-enhanced sequence to avoid delayed contrast-enhancement effects of the lesions. Six quantitative criteria were considered: lesion-to-white matter contrast ratio (CR) and contrast-to-noise ratio (CNR), lesion-to-gray matter CR and CNR, and lesion-to-cerebrospinal fluid CR and CNR. For qualitative evaluation, two experienced radiologists assessed lesion conspicuity on contrast-enhanced-T1WI and FLAIR sequences using the following three scales: 1, FLAIR superior; 2, sequences equal; 3, T1 superior. RESULTS: For quantitative measurement, the contrast enhanced-FLAIR lesion-to-white matter, lesion-to-cerebrospinal fluid CR, and CNR values were statistically superior to those of the contrast enhanced-T1 weighted images (p = 0.001 in all). However, lesion-to-gray matter CR and CNR were slightly higher on CE-FLAIR, but with no statistically significant difference (p = 0.159, 0.184, respectively). For qualitative evaluation, both radiologists assessed that contrast enhanced-FLAIR images were superior to contrast enhanced-T1 weighted images for the evaluation of lesion conspicuity, especially when it was performed as the second sequence. CONCLUSION: FLAIR sequence was superior or comparable to T1 sequence, especially when performed as a second post-contrast sequence. Using contrast enhanced-FLAIR as a routine MRI sequence will increase diagnostic confidence.","PeriodicalId":38181,"journal":{"name":"Rwanda Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45296086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Ntirenganya, J. Twagirumukiza, G. Bukibaruta, F. Byiringiro, B. Rugwizangoga, S. Rulisa
INTRODUCTION: Breast cancer (BC) constitutes a major public health problem worldwide. It remains a major scientific, clinical and societal challenge, generally in Africa and particularly in Rwanda. The purpose of this study was to determine clinical and histopathological predictors of BC molecular subtypes in Rwandan women.METHODS: A retrospective cohort study including patients with histological confirmation of BC. Using R statistical software, a regression model for multinomial responses was developed. Univariate and multivariate logistic regression analyses were used to identify independent BC molecular subtypes predictors. A two-sided p<0.05 indicated a statistically significant difference.RESULTS: Forty seven percent of cases presented with advanced stages (Stage III and IV). Postmenopausal BC (p=0.0142), absence of infertility (p=0.018) predicted Luminal A subtype with a predictive accuracy of 0.65. Age (p=0.003), postmenopausal BC (p=0.005), absence of axillar lymph nodes (p= 0.008) and poorly differentiated tumor (p=0.012) were predictors for Luminal B subtype with a predictive accuracy of 0.86. Age (p=0.045), BMI (p=0.005), rapid progression (p=0.032), tumor size T2-T3 (p<0.001) were predictors of HER2-Enriched subtype with a predictive accuracy of 0.70. Age below 40 (p=0.005), painless mass (p=0.030), nodal involvement (p=0.008), Nottingham grade 3 (p<0.001) predicted Triple Negative tumors with a predictive accuracy of 0.71.CONCLUSION: Clinical and histopathological tumor characteristics can be used to predict BC molecular subtypes with acceptable accuracy. Further studies are needed to explore the possibility of developing a scoring system for clinical decision-making, especially in settings where immunohistochemistry testing is limited.
{"title":"Predictors of molecular subtypes in women with breast cancer in Rwanda","authors":"F. Ntirenganya, J. Twagirumukiza, G. Bukibaruta, F. Byiringiro, B. Rugwizangoga, S. Rulisa","doi":"10.4314/rmj.v79i4.7","DOIUrl":"https://doi.org/10.4314/rmj.v79i4.7","url":null,"abstract":"INTRODUCTION: Breast cancer (BC) constitutes a major public health problem worldwide. It remains a major scientific, clinical and societal challenge, generally in Africa and particularly in Rwanda. The purpose of this study was to determine clinical and histopathological predictors of BC molecular subtypes in Rwandan women.METHODS: A retrospective cohort study including patients with histological confirmation of BC. Using R statistical software, a regression model for multinomial responses was developed. Univariate and multivariate logistic regression analyses were used to identify independent BC molecular subtypes predictors. A two-sided p<0.05 indicated a statistically significant difference.RESULTS: Forty seven percent of cases presented with advanced stages (Stage III and IV). Postmenopausal BC (p=0.0142), absence of infertility (p=0.018) predicted Luminal A subtype with a predictive accuracy of 0.65. Age (p=0.003), postmenopausal BC (p=0.005), absence of axillar lymph nodes (p= 0.008) and poorly differentiated tumor (p=0.012) were predictors for Luminal B subtype with a predictive accuracy of 0.86. Age (p=0.045), BMI (p=0.005), rapid progression (p=0.032), tumor size T2-T3 (p<0.001) were predictors of HER2-Enriched subtype with a predictive accuracy of 0.70. Age below 40 (p=0.005), painless mass (p=0.030), nodal involvement (p=0.008), Nottingham grade 3 (p<0.001) predicted Triple Negative tumors with a predictive accuracy of 0.71.CONCLUSION: Clinical and histopathological tumor characteristics can be used to predict BC molecular subtypes with acceptable accuracy. Further studies are needed to explore the possibility of developing a scoring system for clinical decision-making, especially in settings where immunohistochemistry testing is limited.","PeriodicalId":38181,"journal":{"name":"Rwanda Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46748140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Tuyishimire, H. Irere, F. Rutagarama, A. Ndatinya, O. Karangwa, A. Gasana, C. Nsanzabaganwa, L. Mutesa
INTRODUCTION: Disorders of sex development (DSDs) are genetic abnormalities characterized by discordance between phenotypic, gonadal, and genetic sex. They are grouped into two categories based on karyotype: 46, XX DSD and 46, XY DSD.CASES: We reviewed two patients referred to the Rwanda Military Hospital genetic unit. The first patient was a 3-year-old toddler who was referred for confusing sex organs. Physical examination showed ambiguous genital organs with hypospadias and micropenis. Pelvic examination showed a swelling solid mass hat leading to a suspicion of ovary or undescended testes or combined ovary and testes (ovotestes). The second patient was a 17 years old teenager who presented with primary amenorrhea and lack of female secondary sexual characteristics at her age. The karyotype test was performed to investigate the genotypic sex of the patients and results revealed the karyotype formula of 46, XX/XY indicating the presence of two cell lines in the patient for the toddler and 46XYinv9 (p11q13) indicating the mismatch between the genotype and phenotype of the patients for the teenager. CONCLUSION: Patients were diagnosed with Disorder of Sex Development with 46, XX/XY and 46, XY genotypes respectively. A multidisciplinary team of a geneticist, urologist, endocrinologist and a psychologist reviewed the patient for the effective management.
{"title":"Management challenges of disorders of sex development- Case Series","authors":"B. Tuyishimire, H. Irere, F. Rutagarama, A. Ndatinya, O. Karangwa, A. Gasana, C. Nsanzabaganwa, L. Mutesa","doi":"10.4314/rmj.v79i3.9","DOIUrl":"https://doi.org/10.4314/rmj.v79i3.9","url":null,"abstract":"\u0000 \u0000 \u0000INTRODUCTION: Disorders of sex development (DSDs) are genetic abnormalities characterized by discordance between phenotypic, gonadal, and genetic sex. They are grouped into two categories based on karyotype: 46, XX DSD and 46, XY DSD.CASES: We reviewed two patients referred to the Rwanda Military Hospital genetic unit. The first patient was a 3-year-old toddler who was referred for confusing sex organs. Physical examination showed ambiguous genital organs with hypospadias and micropenis. Pelvic examination showed a swelling solid mass hat leading to a suspicion of ovary or undescended testes or combined ovary and testes (ovotestes). The second patient was a 17 years old teenager who presented with primary amenorrhea and lack of female secondary sexual characteristics at her age. The karyotype test was performed to investigate the genotypic sex of the patients and results revealed the karyotype formula of 46, XX/XY indicating the presence of two cell lines in the patient for the toddler and 46XYinv9 (p11q13) indicating the mismatch between the genotype and phenotype of the patients for the teenager. \u0000CONCLUSION: Patients were diagnosed with Disorder of Sex Development with 46, XX/XY and 46, XY genotypes respectively. A multidisciplinary team of a geneticist, urologist, endocrinologist and a psychologist reviewed the patient for the effective management. \u0000 \u0000 \u0000","PeriodicalId":38181,"journal":{"name":"Rwanda Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47901108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. G. S. Musabwasoni, E. Ngoga, B. Sitini, J. Muganda, E. Kanyamanza, E. Nyiringango, O. Tengera, M. Uwimana, K. Muganwa, O. Bazirere, M. Mukeshimana, T. Uhawenimana
BACKGROUND: Various countries have ratified the law declaring that safe abortion is a fundamental women’s right. Rwanda has expanded legal grounds for abortion in Law n° 68/2018 of 30/08/2018, determining offenses and penalties in general. This study aimed to gain an in- depth understanding of how physicians, midwives and nurses perceive safe abortion service provision and their experience of providing the service in Rwanda. METHODS: A qualitative, descriptive phenomenological method with transcendental theory devised by Husserl Edmund was used to guide this study. A non-random purposive sampling recruited twenty-three informants, and a semi-structured interview guide was used to collect data. The data analysis used NVivo pro 12 software to categorize and code ideas, while the eight steps of transcendental descriptive phenomenology were used to generate the final themes. RESULTS: Four themes with ten sub-themes were generated: (1) personal feelings and beliefs (humiliation and stigma, guilty and wonder); (2) resilient mechanisms (Clients’ protection, institutional support, appreciation of the law); (3) training and (4) informants’ recommendations (integrated service, community awareness, psychological support, follow-up). CONCLUSION: Healthcare providers’ willingness to provide safe abortion services depend on the individual’s beliefs about abortion. Professionalism and resilient mechanisms are key to sustaining the safe abortion service provision in addition to the law determining offenses and penalties in general in Rwanda.
背景：各国已批准法律，宣布安全堕胎是妇女的一项基本权利。卢旺达在2018年8月30日第68/2018号法律中扩大了堕胎的法律依据，确定了一般罪行和处罚。本研究旨在深入了解医生、助产士和护士如何看待安全堕胎服务的提供，以及他们在卢旺达提供堕胎服务的经验。方法：采用胡塞尔-埃德蒙提出的具有先验理论的定性、描述性现象学方法来指导本研究。非随机目的性抽样招募了23名线人，并使用半结构化访谈指南收集数据。数据分析使用NVivo pro 12软件对想法进行分类和编码，而先验描述性现象学的八个步骤用于生成最终主题。结果：产生了四个主题，共十个子主题：（1）个人情感和信仰（羞辱和耻辱、内疚和惊奇）；（2） 弹性机制（客户保护、机构支持、法律欣赏）；（3） 培训和（4）举报人的建议（综合服务、社区意识、心理支持、后续行动）。结论：医疗保健提供者提供安全堕胎服务的意愿取决于个人对堕胎的信念。专业性和弹性机制是维持安全堕胎服务的关键，也是卢旺达确定犯罪和惩罚的法律。
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U. U. Nnadozi, C. J. Okeke, C. Maduba, I. Ajayi, O. Amu, A. Ogbuanya, I. C. Madu, U. Unigwe
BACKGROUND: The COVID-19 pandemic and the institution of measures to contain the spread of the virus have disrupted patients' elective and emergency care, with scarce resources being channeled towards care of emergency presentations and containing the virus. The study aimed to assess the impact of COVID-19 on surgical accidents and emergency presentations in a major teaching hospital. METHOD: This was a comparative retrospective study. All presentations between February to July 2019 (non-COVID-19 period) were compared with the same period in 2020 (COVID-19 period). Patients' biodata, including surgical specialty that managed the patient, diagnosis, and treatment offered, were collated and analyzed with IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: I.B.M. Corp. RESULTS: We included 3463 patients in the study; 2419 (69.9%) were males, while 1044(30.1%) were females. The mean age of the patients in 2019 was 31.83 ±19.31 years, and that of 2020 was 34.93±19.99 years (P=0.001). During the lockdown period, emergency surgical presentations declined significantly by 17% (1894 versus 1569: P=0.001). There was a general decline in surgical emergency presentations across surgical specialties, with orthopedic and otorhinolaryngology (E.N.T.) having the greatest impact (313 versus 202 P=0.044). Presentation for trauma decreased by 18% (1394 versus 1144 P=0.711). Operative interventions declined by 47% (292 versus 155 P=0.001). There was a decline of 31% in the number of admissions for in-patient care (420 versus 290 P=0.019). CONCLUSION: The COVID-19 lockdown in Nigeria was associated with a reduction in the number of surgical emergency presentations and surgical interventions.
背景：新冠肺炎大流行和遏制病毒传播的措施的制定扰乱了患者的选择性和紧急护理，稀缺的资源被用于紧急情况下的护理和遏制病毒。该研究旨在评估新冠肺炎对一家主要教学医院的手术事故和急诊表现的影响。方法：这是一项比较回顾性研究。将2019年2月至7月（非新冠肺炎期间）的所有演示与2020年同期（新冠肺炎期间）进行比较。患者的生物数据，包括管理患者的外科专业、诊断和提供的治疗，用IBM SPSS Statistics for Windows 25.0版进行整理和分析。纽约州Armonk：I.B.M.公司结果：我们将3463名患者纳入研究；2419人（69.9%）为男性，1044人（30.1%）为女性。2019年患者的平均年龄为31.83±19.31岁，2020年为34.93±19.99岁（P=0.001）。在封锁期间，急诊手术表现显著下降了17%（1894例对1569例：P=0.001），其中整形外科和耳鼻喉科（E.N.T.）的影响最大（313对202，P=0.044）。创伤表现下降了18%（1394对1144，P=0.011）。手术干预下降了47%（292对155，P=0.001）。住院人数下降了31%（420对290，P=0.019）。结论：尼日利亚新冠肺炎封锁与外科紧急情况介绍和外科干预的数量减少。
{"title":"Impact of COVID-19 on surgical emergency presentations in a tertiary hospital in the developing world","authors":"U. U. Nnadozi, C. J. Okeke, C. Maduba, I. Ajayi, O. Amu, A. Ogbuanya, I. C. Madu, U. Unigwe","doi":"10.4314/rmj.v79i3.4","DOIUrl":"https://doi.org/10.4314/rmj.v79i3.4","url":null,"abstract":"\u0000 \u0000 \u0000BACKGROUND: The COVID-19 pandemic and the institution of measures to contain the spread of the virus have disrupted patients' elective and emergency care, with scarce resources being channeled towards care of emergency presentations and containing the virus. The study aimed to assess the impact of COVID-19 on surgical accidents and emergency presentations in a major teaching hospital. \u0000METHOD: This was a comparative retrospective study. All presentations between February to July 2019 (non-COVID-19 period) were compared with the same period in 2020 (COVID-19 period). Patients' biodata, including surgical specialty that managed the patient, diagnosis, and treatment offered, were collated and analyzed with IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: I.B.M. Corp. \u0000RESULTS: We included 3463 patients in the study; 2419 (69.9%) were males, while 1044(30.1%) were females. The mean age of the patients in 2019 was 31.83 ±19.31 years, and that of 2020 was 34.93±19.99 years (P=0.001). During the lockdown period, emergency surgical presentations declined significantly by 17% (1894 versus 1569: P=0.001). There was a general decline in surgical emergency presentations across surgical specialties, with orthopedic and otorhinolaryngology (E.N.T.) having the greatest impact (313 versus 202 P=0.044). Presentation for trauma decreased by 18% (1394 versus 1144 P=0.711). Operative interventions declined by 47% (292 versus 155 P=0.001). There was a decline of 31% in the number of admissions for in-patient care (420 versus 290 P=0.019). \u0000CONCLUSION: The COVID-19 lockdown in Nigeria was associated with a reduction in the number of surgical emergency presentations and surgical interventions. \u0000 \u0000 \u0000","PeriodicalId":38181,"journal":{"name":"Rwanda Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47434895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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