RESUMO
BACKGROUND: Benchmarking operative volume and resources is necessary to understand current efforts addressing thoracic surgical need. Our objective was to examine the impact on thoracic surgery volume and patient access in Rwanda following a comprehensive capacity building program, the Human Resources for Health (HRH) Program, and thoracic simulation training. METHODS: A retrospective cohort study was conducted of operating room registries between 2011 and 2016 at three Rwandan referral centers: University Teaching Hospital of Kigali, University Teaching Hospital of Butare, and King Faisal Hospital. A facility-based needs assessment of essential surgical and thoracic resources was performed concurrently using modified World Health Organization forms. Baseline patient characteristics at each site were compared using a Pearson Chi-squared test or Kruskal-Wallis test. Comparisons of operative volume were performed using paired parametric statistical methods. RESULTS: Of 14,130 observed general surgery procedures, 248 (1.76%) major thoracic cases were identified. The most common indications were infection (45.9%), anatomic abnormalities (34.4%), masses (13.7%), and trauma (6%). The proportion of thoracic cases did not increase during the HRH program (2.07 vs 1.78%, respectively, p = 0.22) or following thoracic simulation training (1.95 2013 vs 1.44% 2015; p = 0.15). Both university hospitals suffer from inadequate thoracic surgery supplies and essential anesthetic equipment. The private hospital performed the highest percentage of major thoracic procedures consistent with greater workforce and thoracic-specific material resources (0.89% CHUK, 0.67% CHUB, and 5.42% KFH; p < 0.01). CONCLUSIONS AND RELEVANCE: Lack of specialist providers and material resources limits thoracic surgical volume in Rwanda despite current interventions. A targeted approach addressing barriers described is necessary for sustainable progress in thoracic surgical care.
Assuntos
Equipamentos e Provisões Hospitalares/provisão & distribuição , Mão de Obra em Saúde/estatística & dados numéricos , Cirurgia Torácica/organização & administração , Cirurgia Torácica/estatística & dados numéricos , Procedimentos Cirúrgicos Torácicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesiologia/instrumentação , Criança , Pré-Escolar , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Estudos Retrospectivos , Ruanda , Treinamento por Simulação , Cirurgia Torácica/instrumentação , Procedimentos Cirúrgicos Torácicos/educação , Procedimentos Cirúrgicos Torácicos/instrumentação , Adulto JovemRESUMO
Introduction: The knowledge of anatomy is essential for surgical safety and impacts positively on patients' outcomes. Surgeons operating on the liver and bile ducts should keep in mind the normal anatomy and its variations as the latter are common. Case Presentation: We conducted a structured surgical dissection course of the supra-colic compartment of the abdominal cavity on 2nd and 3rd October 2020. While dissecting a 46years-old male cadaver, we encountered unusual anatomical variations of the hepatic arterial branching, the biliary tree, and arterial supply to the common bile duct. The common hepatic artery was dividing into two branches: a common short trunk for the left hepatic artery and the right gastric artery (hepato-gastric trunk) and a common trunk for the right hepatic artery and gastroduodenal artery (hepato-gastroduodenal trunk). The right hepatic duct was duplicated with a main right hepatic duct and an additional smaller duct. The bile duct was supplied by an artery coming from the abdominal aorta. Conclusion: We described three unusual anatomical variations: a variation of the hepatic arteries branching pattern, an aberrant right hepatic duct, and blood supply to the bile duct from the abdominal aorta. Surgeons should be aware of these rare variations.
Assuntos
Ductos Biliares , Artéria Hepática , Humanos , Artéria Hepática/anatomia & histologia , Ductos Biliares/anatomia & histologia , Fígado , CadáverRESUMO
Objective: Road traffic injuries (RTI) cause â¼1.2 million deaths and 50 million injuries annually, disproportionately occurring in low- and middle-income countries. Although policy changes and infrastructural developments have continued to contribute to the decrease in RTI-related deaths, limited studies have investigated the relationship between motorcycle taxi driver behaviors and RTIs in Rwanda. This study aims to describe the safety behaviors of commercial motorcyclists in Kigali, Rwanda.Methods: We surveyed 609 commercial motorcyclists in January 2014 then conducted a cross-sectional analysis of the results, including descriptive and bivariate logistic regression analyses.Results: We found that 38.7% of surveyed motorcycle drivers experienced a crash during their lifetime, of which, more than half (n = 134, 56.8%) suffered injuries. Of all injuries, 38.8% (n = 52) resulted in hospitalization, and 14.2% (n = 19) in disability. Among motorcyclists, 100% reported always wearing a helmet, 99% reported always wearing a chin strap, and 98.8% reported always having a passenger helmet. There was an association between sustaining a crash and believing that helmets (p = 0.08) and chin straps (p = 0.05) reduced crash risk.Conclusions: Rwandan commercial motorcyclists demonstrate generally proper safety behaviors, but remain a high-risk occupational group. Road safety policy initiatives have been effective in changing driver behavior regardless of driver safety beliefs.
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Acidentes de Trânsito , Comércio , Motocicletas , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/classificação , Adolescente , Adulto , Idoso , Estudos Transversais , Bases de Dados Factuais , Dispositivos de Proteção da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Ruanda/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: There is conflicting evidence regarding the impact of human immunodeficiency virus serostatus on trauma outcomes in low-resource settings. This study sought to evaluate the impact of human immunodeficiency virus serostatus on mortality outcomes for Rwandan patients presenting after trauma. METHODS: This retrospective review of the University of Rwanda trauma registry captured all adult trauma patients with known human immunodeficiency virus status presenting between March 2011 and July 2015. Confirmed human immunodeficiency virus-positive cases were matched 1:2 with known human immunodeficiency virus-negative controls using a modified Kampala Trauma Score, sex, and district of residence or primary hospital. All-cause mortality was compared using multivariable logistic regression. RESULTS: In total, 11,280 patients were recorded prospectively in the registry (169 human immunodeficiency virus positive; 334 human immunodeficiency virus negative matches). There was no difference in delay of hospital presentation or time until operation (Pâ¯=â¯.50 and Pâ¯=â¯.57, respectively). Less than 30% of all patients underwent operation during admission (nâ¯=â¯133), and the rate of operative intervention was independent of human immunodeficiency virus serostatus (Pâ¯=â¯.946). There was no association between development of any complication and human immunodeficiency virus status (Pâ¯=â¯.837). The overall mortality rate was 8.9% and 3.3% for human immunodeficiency virus-positive and human immunodeficiency virus-negative patients, respectively (Pâ¯=â¯.010). Human immunodeficiency virus positivity was associated with increased 30-day mortality when controlling for potential confounders (Pâ¯=â¯.016; odds ratio 3.60, 95% confidence interval: 1.27-10.2, C statistic 0.88). CONCLUSION: Both human immunodeficiency virus and trauma pose substantial public health threats in sub-Saharan Africa. Known human immunodeficiency virus seropositivity in Rwandan trauma patients is associated with early mortality. Further investigation regarding testing, treatment, and outcomes in human immunodeficiency virus-positive trauma patients is warranted and provides an opportunity for leveraging human immunodeficiency virus global health efforts in trauma outcomes assessment.
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Infecções por HIV/epidemiologia , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Ruanda/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricosRESUMO
BACKGROUND: The primary objective was to provide proof of concept of conducting thoracic surgical simulation in a low-middle income country. Secondary objectives were to accelerate general thoracic surgery skills acquisition by general surgery residents and sustain simulation surgery teaching through a website, simulation models, and teaching of local faculty. METHODS: Five training models were created for use in a low-middle income country setting and implemented during on-site courses with Rwandan general surgery residents. A website
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Competência Clínica , Pobreza/economia , Treinamento por Simulação/métodos , Cirurgia Torácica/educação , Adulto , Currículo , Países em Desenvolvimento , Educação de Pós-Graduação em Medicina/economia , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/economia , Cirurgia Geral/educação , Humanos , Internato e Residência/métodos , Masculino , Ruanda , Treinamento por Simulação/economia , Cirurgia Torácica/economiaRESUMO
OBJECTIVE: Traumatic brain injury (TBI) is a leading cause of death and disability. Patients with TBI in low and middle-income countries have worse outcomes than patients in high-income countries. We evaluated important clinical indicators associated with mortality for patients with TBI at University Teaching Hospital of Kigali, Kigali, Rwanda. METHODS: A prospective consecutive sampling of patients with TBI presenting to University Teaching Hospital of Kigali Accident and Emergency Department was screened for inclusion criteria: reported head trauma, alteration in consciousness, headache, and visible head trauma. Exclusion criteria were age <10 years, >48 hours after injury, and repeat visit. Data were assessed for association with death using logistic regression. Significant variables were included in a multivariate logistic regression model and refined via backward elimination. RESULTS: Between October 7, 2013, and April 6, 2014, 684 patients were enrolled; 14 (2%) were excluded because of incomplete data. Of patients, 81% were male with mean age of 31 years (range, 10-89 years; SD 11.8). Most patients (80%) had mild TBI (Glasgow Coma Scale [GCS] score 13-15); 10% had moderate (GCS score 9-12) and 10% had severe (GCS score 3-8) TBI. Multivariate logistic regression determined that GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were significantly associated with death. CONCLUSIONS: GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were associated with mortality. These findings inform future research that may guide clinicians in prioritizing care for patients at highest risk of mortality.