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Introduction: There is uncertainty as to the exact interaction between HIV and Breast Cancer. Available studies are inconclusive about any relation whether causal or protective and the number of patients in these studies small. Objective: To determine the prevalence of HIV among confirmed incident breast cancer cases and to describe the associated clinico-pathological features. Design: Analytical cross sectional study Methods: Over a period of 6 months consecutively eligible patients were recruited from the Mulago Hospital breast clinic. Breast lesions were biopsied and blood withdrawn for HIV sero-survey. Collected data was double entered into Epidata version v 3.1.1, exported to STATA 10.0 for analysis. Results: Sixty two breast cancer patients consented to participate in the study and of these, 22(35.48%) were positive for HIV compared to HIV prevalence in the general population of 6-7%. All the participants were female. The mean age of HIV negative subjects was 45 years (range: 21-80 years) and for HIV positive subjects was 32.4 years (range 18-52 years). There was a significant association between HIV status and age, BMI and CD4 Counts as well as for histological grade and stage (P< 0.024). Conclusion: The prevalence of HIV among the studied breast cancer group was significantly higher than that in the general population. HIV was associated with poor prognostic factors. A high index of suspicion of the co-existence of these two diseases in a context of high HIV preva-lence is warranted. Future studies should explore for a causal association.

Background: Most studies on thyroid dysfunction have been on patients refereed for treatment, little is known about the prevalence in the general populations. The importance of knowing such prevalence data lies in that fact that subclinical thyroid dysfunction is an important risk on development of heart disease, osteoporosis, hypercholesterolemia and mental illness. This study set out to determine thyroid dysfunction prevalence in a health young adult population. Methods: A cross sectional study carried out at the College of Health Sciences, Makerere University enrolled 100 Undergraduate medical students by invitations through notices and announcements. Informed consent was sought after approval from research ethics committee. Results: Of the 100 students enrolled and the samples drawn; 83 tests for TSH and 82 tests for FT4 were successfully run. Three results were abnormal making a prevalence of 3.6% for thyroid dysfunction; a high TSH (5.71) with a normal fT4 (19.2), a normal TSH (1.67) with a high fT4 (22.31) and one with a low TSH (0.03). The mean age of participants was 23 years, there were slightly more males 1.3:1. Conclusion: The prevalence of thyroid dysfunction in this cohort was low but falls in the range found elsewhere. These findings could inform the criteria of screening asymptomatic otherwise young health adults. [ABSTRACT FROM AUTHOR]

Background: Breast Cancer in Uganda is the third commonest cancer in women after cancer of the cervix and Kaposi's sarcoma. The incidence of Breast Cancer in Uganda has nearly tripled from 1961 to 2006. It has been considered a neglected disease but the reasons to why there is an increase in its incidence have not been fully explained. Studies show that age at first full term child birth has been associated with risk of developing breast cancer in the Caucasian population. Objective: To establish whether age at first full term child birth is associated with development of breast cancer among Ugandan women. Method: A case control study was conducted over a six months period from November 2011 to April 2012 with patients confirmed with breast cancer as cases and controls without breast cancer. The sampling were convenient and interview questionnaire were administered, and clinical examinations done .The main predictor were age at first full term child birth and the outcome were histologically confirmed breast cancer. Data were analysed using stata 10; using logistic regression models, p-value of less than 0.05 was considered significant. Results: Over all, 183 women were enrolled, (93 cases and 93 controls). The mean age at first full term child birth was 19.8 years. The histological subtype was ductal carcinoma. No association were found between age at first full term child birth and risk of breast cancer adjusted OR 0.3 (0.1- 2.4), p=0.239. Conclusion: No associations were found between age at first term child birth and risk for breast cancer disease among this group of Ugandan women. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections (SSIs) are the most frequent health-care-associated infections in developing countries. Specific prevention measures are highly effective, but are often poorly implemented. We aimed to establish the effect of a multimodal intervention on SSIs in Africa., Methods: We did a before-after cohort study, between July 1, 2013, and Dec 31, 2015, at five African hospitals. The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures, combined with an adaptive approach aimed at the improvement of teamwork and the safety climate. The primary outcome was the first occurrence of SSI, and the secondary outcome was death within 30 days post surgery. Data on adherence to SSI prevention measures were prospectively collected. The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model, after adjustment for key confounders., Findings: Four hospitals completed the baseline and follow-up; three provided suitable (ie, sufficient number and quality) data for the sustainability period. 4322 operations were followed up (1604 at baseline, 1827 at follow-up, and 891 in the sustainability period). SSI cumulative incidence significantly decreased post intervention, from 8·0% (95% CI 6·8-9·5; n=129) to 3·8% (3·0-4·8; n=70; p<0·0001), and this decrease persisted in the sustainability period (3·9%, 2·8-5·4; n=35). A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods. The likelihood of SSI during follow-up was significantly lower than pre-intervention (odds ratio [OR] 0·40, 95% CI 0·29-0·54; p<0·0001), but the likelihood of death was not significantly reduced (0·72, 0·42-1·24; p=0·2360)., Interpretation: Implementation of our intervention is feasible in African hospitals. Improvement was observed across all perioperative prevention practices. A significant effect on the overall SSI risk was observed, but with some heterogeneity between sites. Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes., Funding: US Agency for Healthcare Research and Quality, WHO., (Copyright © 2018 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.)

Background: Physical activity (PA) is modifiable and linked to decreased breast cancer risk but its impact has not been investigated among indigenous African populations., Methods: From 2011 to 2013, 558 cases and 1,014 controls were recruited into the African Breast Cancer Study in Nigeria, Cameroon, and Uganda, and completed a culturally tailored PA questionnaire that assesses habitual PA the year before diagnosis/interview. PA sub-scores (housework, occupational, and leisure PA) and a total PA score were calculated (metabolic equivalent of task, MET-hours/day). Multiple logistic regressions were performed, adjusting for age, body mass index (BMI), study sites, and menopausal status. The models were then stratified by BMI and study site, respectively., Results: The overall PA score among controls (17.8 MET-hours/day on average) was mainly composed by housework PA and occupational PA with little leisure PA (7.0, 10.3, and 0.5 MET-hours/day, respectively). Multivariable analyses showed that PA was significantly associated with reduced breast cancer risk in both pre- and postmenopausal women (up to 60% risk reduction), with a dose-responsive relationship (Ptrend < 0.001). The inverse association was strong among lean women, less strong but still significant among overweight women, but not existing among obese women. The inverse association held for all intensity-level and domains of PA., Conclusions: PA of African women mainly consists of housework and work-related activities. The preliminary data show that PA may be significantly associated with reduced breast cancer risk., Impact: An inverse association between PA and breast cancer risk was observed among indigenous African women, a unique and understudied population., (©2014 American Association for Cancer Research.)

Background: Alcohol drinking is linked to the development of breast cancer. However, there is little knowledge about the impact of alcohol consumption on breast cancer risk among African women., Methods: We conducted a case-control study among 2,138 women with invasive breast cancer and 2,589 controls in Nigeria, Cameroon, and Uganda from 1998 to 2013. A structured questionnaire was used to collect information on alcohol consumption, defined as consuming alcoholic beverages at least once a week for six months or more. Logistic regression was used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI)., Results: Among healthy controls, the overall alcohol consumption prevalence was 10.4%, and the prevalence in Nigeria, Cameroon, and Uganda were 5.0%, 34.6%, and 50.0%, respectively. Cases were more likely to have consumed alcohol (aOR = 1.62, 95% CI: 1.33-1.97). Both past (aOR = 1.54; 95% CI: 1.19-2.00) and current drinking (aOR = 1.71; 95% CI: 1.30-2.23) were associated with breast cancer risk. A dose-response relationship was observed for duration of alcohol drinking (P-trend <0.001), with 10-year increase of drinking associated with a 54% increased risk (95% CI: 1.29-1.84)., Conclusion: We found a positive relationship between alcohol consumption and breast cancer risk, suggesting that this modifiable risk factor should be addressed in breast cancer prevention programs in Africa.

Introduction: Gunshot injuries of the head and neck from the AK-47 rifle (a common assault rifle, submachine gun type) are a significant contributor to morbidity and mortality among civilians in Sub-Saharan Africa. They may cause significant damage to the closely arranged structures in this region, and the bullet's trajectory can be very difficult to determine. We present an unusual case of gunshot injury with an atypical bullet entry wound, profound injury to the face, lodgment in the right carotid sheath, and 'wandering'; a first of its kind in East Africa., Case Presentation: A 27-year-old African-Ugandan woman of Nilotic ethnicity was referred to the Accident and Emergency Department of a tertiary hospital in Uganda, having sustained complex injuries due to an inadvertent AK-47 rifle gunshot injury. The gunshot injury was to the right side of her face with a large ragged entry wound and no exit wound. Prior basic wound care and radiological imaging showed a comminuted fracture of her mandible with lodgment of the bullet in her neck, anterior to her sixth and seventh cervical vertebrae. Standard debridement of her wound was done. A computed tomography scan showed an apparent cephalad shift ('wandering') of the bullet, leaving it lying partially anterior to her fifth cervical vertebra as well as within her carotid sheath. Other injuries were to her facial and trigeminal nerves, and her middle ear. The 'wandering' bullet was successfully removed surgically. It had caused no damage to any part of her neck structure., Conclusion: AK-47 rifle bullet injuries may present with uncharacteristically large entry wounds and cause complex structural injuries at the area of impact. The consequent trajectory is difficult to predict making regional examination and radiological investigations essential in management. Bullets may be retained, leaving no exit wound. Securing the airway, controlling hemorrhage and identifying other injuries are the first vital steps. This case illustrates all these interventions and the important decision to extract the entrapped bullet from the patient's neck because it had started to 'wander' and could have caused grave injury over time with further migration. Maxillofacial, plastic, trauma, general and military surgeons, otorhinolaryngologists and emergency physicians can gain from this experience because it calls for a multidisciplinary team approach.

Introduction: Ovarian metastases occur in 3 to 8% of women with primary colon cancer. In the setting of a pre-existing colorectal carcinoma this would constitute a hereditary non-polyposis colorectal cancer, Lynch 2 syndrome, accounting for 5 to 10% of colon cancer cases. We unveil a case of 'giant' ovarian tumors mimicking primary ovarian cancer; ostensibly the first reported in East Africa., Case Presentation: A 58-year-old African woman was diagnosed with colorectal adenocarcinoma in June 2009. She had a right hemicolectomy with the tumor staged as regional cancer, following histopathological examination. Chemotherapy was administered both adjuvantly and 1 year later for what was thought to be a recurrence of tumor. Despite this, her general condition deteriorated. Following re-evaluation and an exploratory laparotomy she was found to have bilateral 'giant' ovarian tumors, with peritoneal seedlings and subcutaneous metastases (colonic in origin). A bilateral salpingo-oophorectomy was done, accompanied by histopathological analysis with institution of chemotherapy for ovarian cancer. Following immunohistochemistry tests and microsatellite instability analysis it was found that the ovarian tumors were secondaries from the colon. She was also identified as a Lynch syndrome case or a case of sporadic microsatellite instability, although with no suggestive family cancer history. The treatment regimen was changed to suit metastatic disease., Conclusions: The case presents a diagnostic and thus treatment conundrum. Two primary tumors (suspected Lynch syndrome) had been perceived yet there is actually only metastatic colorectal cancer. We also have a rare and unusual metastatic presentation: 'giant' bilateral ovarian tumors and subcutaneous nodules, concurrently. Further still, she is a case of probable Lynch syndrome, requiring genetic analysis for definitive classification and surveillance for hereditary non-polyposis colorectal cancer-associated cancers.Important inferences are drawn. Firstly, 'giant' ovarian tumors diagnosed as primary ovarian cancer may actually be colonic secondaries. Secondly, immunohistochemistry and microsatellite instability analysis tests ought to be part of the diagnostic package in colon cancer management, particularly for identifying tumor origin and the Lynch syndrome (a condition which has had little attention in resource-limited countries). Thirdly, multidisciplinary team collaboration is emphasized in colorectal cancer management.

Background: Non-cancerous diseases of the breast have assumed increasing importance because of the public awareness of breast cancer. These benign diseases are a recognized important risk factor for later breast cancer which can develop in either breast. The risk estimate of these benign breast diseases has not been well established in sub Saharan Africa. Women with benign proliferative or atypical breast lesions have a two- fold risk of developing breast cancer in western populations. The purpose of this study therefore was to determine the prevalence of proliferative disease ( BPBD) with and without atypia among Ugandan Black women., Methods: A cross-sectional descriptive study conducted at Mulago Hospital Breast Clinic between January 2012 and June 2012; 208 women aged 12 years and above with palpable breast lumps were screened. Fine needle aspiration biopsies were taken for cytological examination., Results: Of the 208 women with benign breast lumps screened, 195 were recruited in the study. The prevalence of BPBD was 18% (35/195). BPBD with atypia was 5.6% (11/195). The mean age and body mass index (BMI) were 28.4 years and 23.26 kg/m2 respectively. The commonest lesions were fibroadenomas for 57%, (111/195), and fibrocystic change were 21% (40/195). Most BPBD with atypia lesions were in the fibrocystic category., Conclusions: Benign proliferative breast diseases are common, found mostly among premenopausal women. A significant proportion of BPBD had atypical proliferation. An accurate breast cancer risk estimate study for BPBD is recommended.

Background: Intussusception is one of the less common causes of intestinal obstruction among adults. It is usually covert (concealed) in its clinical presentation. The ileo-colic type with accompanying anal protrusion is extremely rare. The case at hand is that of both an ileo-colic intussusception with anal protrusion, in the presence of a persistence of both the ascending and descending mesocolons; a case possibly yet to be documented in literature., Case Presentation: A 32 year-old African-Ugandan woman presented with complaints of a mass protruding per anus for 2 weeks. It was reducible and associated with colicky abdominal pain, loose stools, and bloody-mucoid discharge per anus. She had previously had a one and a half month's history of abdominal pain; periodically continuous, while other times colicky in character. Examination and investigations revealed an intussusception with a partial intestinal obstruction. At laparotomy she was found to have an ileo-colic intussusception with a freely mobile colon throughout its length. There were persistent ascending and descending mesocolons, and absent hepatocolic and splenocolic ligaments. The intussusceptum was 'milked' but not completely reducible. A right hemicolectomy was done, with ileo-transverse colonic anastomosis. Histopathological examination revealed no preexisting pathologic lesion as a lead point., Conclusion: The persistence of the ascending and descending mesocolons (azygosis) best explains the anal protrusion of an ileo-colic intussusception with partial obstruction. In this case zygosis (normal retroperitoneal ascending and descending colonic positioning) failed embryologically. This experience is particularly beneficial to general surgeons, radiologists, gastroenterologists, colorectal surgeons and pathologists.

Introduction: Reference values may vary significantly among populations and cultures for which dietary intakes may be different. Each laboratory is expected to investigate the transferability of the expected values to its own patient population and if necessary determine its own reference ranges. This study sought to establish Folic acid and Vitamin B(12) reference values for young Ugandan adults, which reference values could be used as baseline information for future research, especially related to their role in breast cancer prevention., Methods: A cross sectional study in which 200 undergraduate student volunteers were enrolled. The minimum sample size was 126 using the Open Epi version 2. Relevant demographics and physical examination parameters were taken as well as blood samples for laboratory tests. Prior ethical approval was granted., Results: The levels of folic acid were 4.17 - 20 ng/ml and remained constant over the age cohorts. The vitamin B(12) range was 117-1158 pg/ml. Both ranges were comparable to ranges seen in other populations., Conclusion: In as much as the dietary intake for this study population is presumed different from populations in the western countries, the ranges for these two vitamins were similar.