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El presente artículo pretende identificar cuáles son las condiciones que fortalecen el reconocimiento numérico de una sola cifra, base del pensamiento matemático en una estudiante de nueve años que presenta Discapacidad Intelectual (DI) y cursa tercero de primaria en una institución pública de Sogamoso (Boyacá). La menor presenta dificultad en procesos cognitivos (atención, memoria y lenguaje), no sigue instrucciones, su aprendizaje es a corto plazo y es dependiente en la realización de actividades cotidianas. Este estudio presenta una metodología cualitativa con diseño investigación tipo estudio de caso. Los resultados evidencian que el aprendizaje en estudiantes que presentan discapacidad intelectual ocurre de manera significativa mediante la interacción y cooperativismo con pares, de igual manera, el rol que desempeña el docente es fundamental, debido a que, al brindar estímulos interactivos, recursos didácticos, realizar ajustes razonables de acuerdo con las necesidades educativas identificadas, fomentar espacios de enseñanza-aprendizaje y hacer seguimiento constante de dicho proceso, se logra que el estudiante pueda afianzar el conocimiento adquirido y logre implementarlo en su cotidianidad.

Cyanobacteria have raised great interest in biotechnology, e.g., for the sustainable production of molecular hydrogen (H2) using electrons from water oxidation. However, this is hampered by various constraints. For example, H2-producing enzymes compete with primary metabolism for electrons and are usually inhibited by molecular oxygen (O2). In addition, there are a number of other constraints, some of which are unknown, requiring unbiased screening and systematic engineering approaches to improve the H2 yield. Here, we introduced the regulatory [NiFe]-hydrogenase (RH) of Cupriavidus necator (formerly Ralstonia eutropha) H16 into the cyanobacterial model strain Synechocystis sp. PCC 6803. In its natural host, the RH serves as a molecular H2 sensor initiating a signal cascade to express hydrogenase-related genes when no additional energy source other than H2 is available. Unlike most hydrogenases, the C. necator enzymes are O2-tolerant, allowing their efficient utilization in an oxygenic phototroph. Similar to C. necator, the RH produced in Synechocystis showed distinct H2 oxidation activity, confirming that it can be properly matured and assembled under photoautotrophic, i.e., oxygen-evolving conditions. Although the functional H2-sensing cascade has not yet been established in Synechocystis yet, we utilized the associated two-component system consisting of a histidine kinase and a response regulator to drive and modulate the expression of a superfolder gfp gene in Escherichia coli. This demonstrates that all components of the H2-dependent signal cascade can be functionally implemented in heterologous hosts. Thus, this work provides the basis for the development of an intrinsic H2 biosensor within a cyanobacterial cell that could be used to probe the effects of random mutagenesis and systematically identify promising genetic configurations to enable continuous and high-yield production of H2via oxygenic photosynthesis.

In the present study, flame propagation statistics from turbulent statistically planar premixed flames obtained from simple and detailed chemistry, three-dimensional Direct Numerical Simulations, were evaluated and compared to each other. To this end, a new database was established encompassing five different conditions on the turbulent premixed combustion regime diagram, using nearly identical numerical methods and the same initial and boundary conditions. A detailed discussion of the advantages and limitations of both approaches is provided, including the difference in carbon footprint for establishing the database. It is shown that displacement speed statistics and their interrelation with curvature and tangential strain rate are in very good qualitative and reasonably good quantitative agreement between simple and detailed chemistry Direct Numerical Simulations. Hence, it is concluded that simple chemistry simulations should retain their importance for future combustion research, and the environmental impact of high-performance computing methods should be carefully chosen in relation to the goals to be achieved.

Flame propagation statistics for turbulent, statistically planar premixed flames obtained from 3D Direct Numerical Simulations using both simple and detailed chemistry have been evaluated and compared to each other. To achieve this, a new database has been established encompassing five different conditions on the turbulent combustion regime diagram, using nearly identical numerical methods and the same initial and boundary conditions. The discussion includes interdependencies of displacement speed and its individual components as well as surface density function (i.e., magnitude of the reaction progress variable) with tangential strain rate and curvature. For the analysis of detailed chemistry Direct Numerical Simulation data, three different definitions of reaction progress variable, based on CH4,H2O and O2 mass fractions will be used. While the displacement speed statistics remain qualitatively and to a large extent quantitatively similar for simple chemistry and detailed chemistry, there are pronounced differences for its individual contributions which to a large extent depend on the definition of reaction progress variable as well as on the chosen isosurface level. It is concluded that, while detailed chemistry simulations provide more detailed information about the flame structure, the choice of the reaction progress variable definition and the choice of the resulting isosurface give rise to considerable uncertainty in the interpretation of displacement speed statistics, sometimes even showing opposing trends. Simple chemistry simulations are shown to provide (a) the global flame propagation statistics which are qualitatively similar to the corresponding results from detailed chemistry simulations, (b) remove the uncertainties with respect to the choice of reaction progress variable, and (c) are more straightforward to compare with theoretical analysis or model assumptions that are mostly based on simple chemistry assumptions.

El presente proyecto ha logrado incrementar la producción de granos básicos, su industrialización y comercializaciónparateneralternativasalimentarias y nutritivas, de modo que se fortalezca la soberanía alimentaria de las zonas rurales de Costa Rica. El impacto en lo local se expresa en el for talecimiento de los ingresos familiares de las personas involucradas en el proyecto, el incremento de la producción de granos, la industrialización producto de la transferencia de tecnología, el mejoramiento en la dieta y la generación de empleo para las mujeres, tanto en la producción de granos en el campo como en el manejo poscosecha y el procesamiento para la elaboración de productos empacados para el mercado. La generación de capacidades en las asociadas a la Red de Mujeres Rurales y el fortalecimiento de esta son logros del compromiso de las mujeres y el apoyo constante del proyecto. Por otra parte,se generó un producto a base de frijol y arroz con un alto valor nutritivo, que se ha vendido en ferias y algunos pequeños locales comerciales, y que se podrá distribuir en escuelas, centros infantiles y abastecedores locales. El impacto regional se da en la introducción del producto, cuyo principal consumidor meta es la población infantil y juvenil, ya que se busca mejorar sus hábitos alimenticios; posteriormente, se pretende extender al mercado nacional.This project was able to increase grain production, industrialization and marketing, to have food and nutrition alternatives to strengthen the food security of rural areas. The local impact is expressed in strengthening family income of the people involved in the project, the increase in grain production, industrialization technology transfer, diet improvement and employment generation for women, both in grain production in the field and in food processing. Capacity building in women associated to Rural Women’s Network was possible because of women’s commitment and the continued suppor t of the project. A product based on beans and rice with a high nutritional value was generated, which could be distributed in schools, childcare centers and local suppliers.The regional impact is given in the product introduction with emphasis on children. Then, it will be extended to larger market.

The aim of the present study was to test the cognitive ethology approach, which seeks to link cognitions and behaviours as they operate in everyday life with those studied in controlled lab-based investigations. Our test bed was the understanding of first-person and third-person perspectives, which in lab-based investigations have been defined in a diverse and multi-faceted manner. We hypothesized that because these lab-based investigations seek to connect with how first- and third-person perspective operates in everyday life, then either some of the divergent lab-based definitions are missing their mark or the everyday conceptualization of first- and third-person perspective is multi-faceted. Our investigation revealed the latter. By applying a cognitive ethology approach we were able to determine that a) peoples' everyday understanding of perspective is diverse yet reliable, and b) a lab-based investigation that applies these diverse understandings in a controlled setting can accurately predict how people will perform. These findings provide a 'proof of concept' for the cognitive ethology approach. Moreover, the present data demonstrate that previous lab-based studies, that often had very different understandings of first- and third-person perspective, were each in and of themselves valid. That is, each is capturing part of a broader understanding of perspective in everyday life. Our results also revealed a novel social factor not included in traditional conceptualizations of first-person third-perspective, that of eye gaze, i.e., eye contact is equated strongly with first-person perspective and the lack of eye-contact with third-person perspective.

Accidental ingestion of foreign bodies during dental procedures is relatively common, with the potential for serious complications, including intestinal perforations and severe pulmonary disorders. Our case report describes the prolonged, asymptomatic retention of a swallowed hex driver in the small bowel of a 38-year-old male, managed conservatively over an extended period. The patient, with a significant medical history of depression, was undergoing a dental procedure involving implant-supported restorations when the incident occurred. Initial x-rays confirmed the presence of the hex driver in the gastrointestinal tract. Despite its stationary position for over a week, it passed naturally without requiring invasive intervention. This case highlights the importance of individualized patient care and deferring recommendations for intervention in certain instances. We recommend a more individualized approach to managing ingested foreign bodies in dental settings, emphasizing the need for tailored strategies based on the patient's specific circumstances and clinical stability., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Ken Chapman Kigozi et al.)

Background: Antenatal care is essential for reducing maternal and neonatal mortality, particularly in low-income regions. However, the adequacy of the care provided is crucial for achieving maternal health goals. Maternal mortality rates in Uganda are still among the highest globally. Thus, evaluating the adequacy of antenatal care (ANC) services, especially in high-risk regions is imperative., Objective: To determine the prevalence of adequate ANC and associated factors in Eastern Uganda., Design: A multicenter quantitative cross-sectional study was conducted at four healthcare facilities in Eastern Uganda from July to August 2022., Methods: We included immediate postpartum mothers who had given birth within 48 h with a record of their ANC information on a card or book. Adequate ANC was measured by a composite index of 10 core components per WHO guidelines on ANC for a positive pregnancy experience. Data were collected using a structured questionnaire designed with Kobo Toolbox and analyzed using Stata 15.0. Bivariable and multivariable logistic regression analyses assessed factors associated with receiving adequate ANC. Statistical significance was determined by a p value <0.05., Results: We recruited 1104 postnatal mothers, most aged 20-34 years ( n  = 805, 72.9%). Only 5.9% received adequate ANC, with most mothers receiving an average of 6.9 (±2.0) of the 10 assessed ANC components. Receiving adequate ANC was associated with urban residency (AOR: 2.3; 95% CI: 1.16-4.38, p  = 0.017), age between 20 and 34 years (AOR: 3.5; 95% CI: 1.07-11.30, p  = 0.038), current or previous complications (AOR: 1.8; 95% CI: 1.02-3.29, p  = 0.043), and delivery at a general hospital (AOR: 4.8; 95% CI: 2.60-8.83, p  < 0.001)., Conclusion: There is a critical gap in providing adequate ANC in Eastern Uganda, especially for rural and younger mothers. Policy efforts should focus on expanding access, enhancing maternal education, and strengthening healthcare infrastructure to meet the recommended ANC standards., (© The Author(s), 2024.)

Background: The World Health Organization (WHO) recommends at least 8 antenatal care (ANC) contacts during pregnancy, but many women in low and middle-income countries do not adhere to this schedule, which may contribute to high rates of maternal and neonatal mortality. This study assessed compliance to the WHO recommended 8+ ANC contacts schedule and associated factors among postpartum mothers in eastern Uganda., Methods: This was a cross-sectional multicenter study conducted between July and August 2022 at four selected hospitals in Eastern Uganda using quantitative techniques. We recruited postnatal mothers who had given birth within 48 hours with records of their ANC contacts. Compliance to the WHO recommended 8+ ANC contacts schedule was defined as having received the recommended ANC contacts as per the gestational age at childbirth following the current ANC for a positive pregnancy experience WHO guidelines. We conducted multivariable logistic regression analysis to assess the association between compliance to the WHO recommended 8+ ANC contacts schedule and selected independent variables., Results: A total of 1104 postpartum mothers participated in the study with a mean age (± standard deviation) of 26 ± 6.4 years, and a majority had given birth from a referral hospital (n = 624 56.5%). Compliance to the WHO recommended 8+ ANC contacts schedule was low (n = 258, 23.4%), and only 23.2% (196) of the women had attended their first antenatal care contact within the first trimester. Factors associated with compliance to the WHO recommended 8+ ANC contacts were: attending the first antenatal care contact within 12 weeks of gestation [AOR: 6.42; 95% CI: (4.43 to 9.33)], having 2 to 4 children [AOR: 0.65; 95% CI: (0.44 to 0.94)], having a spouse who is unemployed [AOR: 1.71; 95% CI: (0.53 to1.08)] and having insurance coverage [AOR: 2.31; 95% CI: (1.17 to 4.57)]., Conclusion: Compliance with the 8+ ANC contacts schedule remains very low. Efforts should focus on increasing health education, particularly for multiparous women, and encouraging mothers to begin ANC in their first trimester. Exploring the dynamics of partner support, especially with employment status, may offer insights into improving ANC attendance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Neglected tropical diseases (NTDs), including soil-transmitted helminths (STHs) and schistosomiasis, continue to impose a heavy burden, especially in sub-Saharan Africa and Uganda, despite being preventable. Integration of NTD management into primary healthcare has been inadequate. While researchers have explored community perspectives, there is a notable gap in understanding the viewpoints of healthcare workers (HCW), which is crucial for effective NTD control strategies. This study explores HCW' perspectives in Eastern Uganda, highlighting challenges in schistosomiasis and STH prevention and management., Methods: In this qualitative descriptive study, we conducted semistructured interviews with 10 key informants who were HCW in Eastern Uganda with experience in managing STHs and schistosomiasis. Participants were selected purposively and interviewed through Zoom guided by a comprehensive interview guide. The data were transcribed, coded and analyzed thematically., Results: We identified five key themes regarding the impact and management of NTDs: (i) the burden of NTDs, where schistosomiasis and STHs were notably prevalent among children and communities adjacent to water bodies; (ii) transmission of NTDs, emphasizing water bodies and poor sanitation as primary routes of disease spread; (iii) clinical manifestations of NTDs, detailing the symptomatic presentations that complicate diagnosis and management; (iv) challenges in managing and diagnosing NTDs, highlighting the shortages of essential medications and diagnostic tools, along with the under-prioritization of NTDs within healthcare systems; and (v) fatalities and complications arising from NTDs, reporting on the severe outcomes and under-reporting of deaths associated with NTDs due to misdiagnosis, delayed treatment and traditional healing preferences., Conclusion: The interviewed Ugandan HCW demonstrated sufficient knowledge of schistosomiasis and STHs, but faced challenges due to inadequate diagnostic tools and medication shortages. The study underscores the need for NTD prioritization with direct funding and government involvement, alongside strategies that integrate continuous medical training, effective community outreach and an enhanced healthcare system response to reduce the burden of NTDs., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Neglected tropical diseases (NTDs) affect millions of people in Africa, with Uganda bearing a significant burden. The World Health Organization (WHO) set a goal to reduce NTDs and improve access to diagnosis and management by 2030. However, NTDs have not been well integrated into primary healthcare in many countries, including Uganda, due to limited knowledge and resources among health workers. The study aimed to assess the readiness and capacity of primary healthcare centres to diagnose and manage soil-transmitted helminths (STHs) and schistosomiasis., Methods: A cross-sectional quantitative study was conducted among 204 health workers in 20 health facilities in four districts bordering Lake Kyoga. In this study we evaluated health workers' knowledge of symptoms, diagnosis and management of STHs and schistosomiasis as well as the availability of resources and training., Results: Our findings indicate that health workers have strong knowledge about STHs (86.76%), with lower knowledge levels regarding Schistosoma haematobium (59.72%) and Schistosoma mansoni (71.43%). Regarding resources and training, 95% of health facilities had laboratory services, but the majority lacked diagnostic equipment. Furthermore, only 17% of health workers reported prior training on schistosomiasis and related topics and only 25% had training on surveillance and reporting., Conclusions: While health workers in eastern Uganda demonstrated a good knowledge base for some NTDs, there were knowledge gaps and challenges in training on surveillance and reporting mechanisms. Continuously building the capacity of health workers along with investing in diagnostic infrastructure is essential for improved NTD control and ultimately reducing associated morbidity and mortality in the region., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Introduction: Despite advancements in Antiretroviral Therapy (ART), people living with HIV (PLHIV) face increasing risks of HTN, leading to significant morbidity and premature mortality, undermining the hard-earned gains of fighting HIV. The prevalence of hypertension among HIV patients and associated risk factors has not been extensively studied in the rural parts of Uganda., Objective: We assessed the prevalence, awareness, and factors associated with hypertension among PLHIV at two health facilities in Eastern Uganda., Methods: A cross-sectional study was conducted at Mbale Regional Referral Hospital and Bugobero Health Center IV HIV clinics from May to July 2023. We recruited patients with HIV above the age of 18 years and willing to consent. Participants were interviewed using a structured questionnaire adapted from the WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) and the AIDS Clinical Trials Group. Anthropometric measurements and blood pressure were taken. Bivariate and multivariable logistic regression were performed. A P value <0.2 in the bivariate analysis was transferred to the multivariable logistic regression model. A P value < 0.05 was statistically significant., Results: The study surveyed 400 PLHIV with a mean age of 46.5 (SD: 12.4) years; most were female (n=261, 65.3%). Hypertension prevalence was at 37.5%, with 20.5% in stage 2 and 68% ((n=102) of hypertensive participants were unaware. Hypertension was associated with age ≥50 years (aOR: 2.11, 95% CI: 1.33-3.37, p = 0.002), a suppressed viral load (aOR: 3.71, 95% CI: 1.02-5.13, p = 0.046) and BMI ≥25 Kg/m 2 (aOR: 1.64, 95% CI: 1.01-2.66, p = 0.044)., Conclusion: Hypertension is a significant burden among PLHIV in Eastern Uganda, influenced by HIV and lifestyle-related risk factors. Improved screening and diagnosis are needed with close monitoring for patients with viral load suppression due to the possible negative effects of ART on blood pressure., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Kanyike et al.)

Background: Antimicrobial resistance (AMR) is significantly driven by misuse and overuse of antibiotics. Graduate health profession interns often prescribe antimicrobials under minimum supervision., Objectives: This study explored the knowledge, perceptions and confidence of health profession interns in Uganda regarding AMR and rational prescription practices., Methods: This was a cross-sectional survey employing quantitative techniques carried out between October and November 2022 at six tertiary hospitals in Uganda. Health profession interns including doctors, nurses, midwives and pharmacists were recruited as study participants. Data were collected using online Kobo toolbox software. Data analysis was performed using STATA (StataCorp) version 16. Bivariate analysis and multivariable logistic regression were performed. P  < 0.05 was considered statistically significant., Results: We recruited 281 participants with a mean age of 27 ± 3.8 years, of which few ( n  = 53; 19%) had good knowledge about AMR and rational prescription. The use of professional organization guidelines as a source of information was significantly associated with good knowledge (adjusted OR = 1.9; 95% CI: 1.0-3.5; P  = 0.046). Nurses had the least knowledge compared with doctors and pharmacists. Continuous medical education (99%) and availability of clinical guidelines (98%) were identified as the most helpful intervention to improve knowledge. Most participants were confident about accurately diagnosing infections and sepsis and selecting appropriate antimicrobials., Conclusions: Continuous medical education and availability of clinical and professional organization guidelines should be leveraged to improve the knowledge of AMR and rational prescription among health profession interns. Their high confidence in rational prescription practices should be pivotal to the fight against AMR., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Background: Surgery has been largely neglected within global public health despite growing evidence that the overall burden of disease requiring surgical intervention is rapidly growing and affordable access to surgical care can avert many deaths and disabilities. This study assessed the factors influencing delayed access to essential surgical care in Uganda., Methods: A descriptive multi-center cross-sectional survey was carried out in three hospitals designated for major surgeries in Uganda from December 2019 to December 2021 across three regions of the country in a prospective manner. Patients admitted to the hospitals that required surgical intervention were included. Bivariate analysis using the chi-square test or Fischers' exact test and multivariable logistic regression models to adjust for confounders were carried out., Findings: A total of 635 patients participated in the study of which the majority were males ( n  = 399, 63%) from the Northern region ( n  = 347, 54.7%.). Most patients and sought surgical help immediately ( n  = 406, 63.9%) and were operated on time ( n  = 402, 63.3%), however only 23.3% ( n  = 148) were able to reach the hospital for care on time. Caretakers' hesitancy on the surgical procedure (aOR: 2.41 95% CI: 1.07 - 5.43; p  = 0.035), hospital inaccessibility (aOR: 5.35 95% CI: 1.82 - 5.75; p  = 0.002), and delayed surgical procedure performance (aOR: 6.37 95% CI: 2.64 - 5.34; p <0.001) contributed to surgical delays among other factors., Interpretation: All three factors contribute to surgical delay but most significantly access to hospital. Several socioeconomic factors like education, long distances, and poverty interplay in a complex web to hamper access to essential surgical care., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

On August 21, 2022, healthcare authorities in the Democratic Republic of the Congo (DRC) announced an outbreak of Ebola virus disease in North Kivu Province, bringing the total to 15 outbreaks nationwide. On September 20, 2022, Uganda's authorities declared an outbreak of the Sudan strain of the Ebola virus following a confirmed a case in Mubende district. As of October 6, 2022, the reported numbers of cases were 63, with 29 deaths in Uganda and 1 case with 1 death in DRC, respectively. Ebola virus causes an acute and severely fatal illness, resulting in death within a very short time if left untreated. In addition, these outbreaks in DRC and Uganda pose a major threat to the health and socioeconomic well-being of the people of East Africa due to multiple cross-border activities. Adequate preparations need to be made by the healthcare authorities of the nations concerned; the government, healthcare workers, and the East-African community as a whole have important roles to play in the effective prevention and control of the spread of Ebola virus within and across their borders., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: A robust emergency care system is a cost-effective method of reducing preventable death and disability, especially in low-and middle-income countries. To scale emergency care expertise across the country, the Uganda Ministry of Health and Seed Global Health established the Emergency Medical Services (EMS) ECHO program. We describe the process of establishing the program in a resource-limited setting, best practices, and lessons learned in Uganda., Methods: Investigators conducted a mixed-methods evaluation to assess the initial 4 months' implementation of the EMS ECHO. We conducted pre/post-program assessments of healthcare worker knowledge, self-efficacy, and professional's satisfaction with the program. The analysis compared the differences between pre/post-test scores descriptively., Results: The EMS ECHO was initiated in November 2021. A phased curriculum was developed with the initial phase focusing on the ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach to the emergency patient. This phase reached 2,030 health workers cumulatively across 200 health facilities. The majority of the participants were medical doctors ( n  = 751, 37%), and nurses ( n  = 568, 28%). Majority of participants (95%) rated the sessions as informative. On whether the ECHO sessions diminished professional isolation, 66% agreed or strongly agreed., Conclusions: Similar to other ECHO program evaluation results, Uganda's EMS ECHO program improved knowledge, skills, and the development of a virtual community of practice thereby diminishing professional isolation. It also demonstrates that through a planned stepwise process, virtual learning and telementorship can be used efficiently to improve healthcare worker knowledge,skills and multiply the limited number of emergency care experts available in the country., Competing Interests: The authors declared no conflicts of interest., (© 2023 The Authors. Published by Elsevier B.V. on behalf of African Federation for Emergency Medicine.)

Paracecal hernias are a rare form of internal hernias. This is a case of a spontaneous paracecal retroperitoneal hernia in an elderly patient. A 73-year-old male, a known patient of adenocarcinoma of the rectum, who had undergone neoadjuvant radiotherapy and chemotherapy a year ago, presented with a 2-day-history of exacerbated colicky peri-umbilical and right-sided non-radiating abdominal pain, with associated progressive abdominal distension, which were aggravated by feeding. A contrasted abdominal computed tomography scan showed features of small bowel obstruction. An exploratory laparotomy revealed herniation of gangrenous small bowel ~30 cm through a small, tight opening just below the base of the cecum. Resection and anastomosis and closure of the retroperitoneal pouch were done. Patient recovered and was discharged on the fourth post-operative day. Spontaneous retroperitoneal hernias can occur in elderly patients with additional risk factors like neoplasms, with a high risk of bowel ischemia, hence the urgent need for surgical intervention., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.)

Background: Antimicrobial resistance (AMR) is an important global health concern, projected to contribute to significant mortality, particularly in developing countries. This study aimed to determine the knowledge, perceptions of clinical health professions students towards antimicrobial resistance and rational use of medicine and confidence level to prescribe antimicrobials., Methods: An online descriptive cross-sectional survey was conducted among clinical health professions students across 9 medical schools in Uganda. A semi-structured questionnaire using Kobo Toolbox form was shared among participants via WhatsApp Messenger (Meta, California, USA). Knowledge was categorized using modified Bloom's cut-off. One-way ANOVA, Chi-square or Fisher's exact test, and logistic regression were used to assess the association between dependent and independent variables. A p < 0.05 was considered statistically significant., Results: We surveyed 681 participants, most were pursuing a Bachelor of Medicine and Surgery degree (n = 433, 63.6%), with a mean age of 24 (standard deviation: 3.6) years. Most participants (n = 596, 87.5%) had sufficient knowledge about antimicrobial resistance with a mean score of 85 ± 14.2%. There was a significant difference in mean knowledge scores of year 4 (86.6%) compared to year 3 (82.4%) (p = 0.002) and year 5 (88.0%) compared to year 3 (82.4%) (p < 0.001). Most participants (n = 456, 66.9%), were confident on making an accurate diagnosis of infection, and choosing the correct antimicrobial agent to use (n = 484, 71.1%)., Conclusion: Health profession students exhibited good knowledge on antimicrobial resistance and high self-perceived confidence that should be leveraged to foster better future antimicrobial prescription practices. However, they still agreed that a separated course unit on AMR is necessary which responsible authorities should consider to consolidate the efforts., (© 2022. The Author(s).)

Background: There is an unmet need for internal medicine physicians in Uganda owing to the growing burden of diseases. This study aimed at evaluating the factors associated with career choices of undergraduate medical students regarding internal medicine in Uganda., Methods: We conducted a cross-sectional study in the first 3 weeks of October 2021 via WhatsApp messenger. Medical students in the 3rd to 5th year of study who had completed internal medicine clinical rotations and pursuing a Bachelor of Medicine and Bachelor of Surgery (MBChB) degree at 7 Ugandan universities (4 public and 3 private) were enrolled. Multivariable logistic regression model was constructed to determine factors associated with a career choice in internal medicine., Results: We enrolled 418 participants, median age was 24 (interquartile range (IQR): 23-26) years, 67.7% were male, and 36.1% had a family member or relative who was a doctor. Most of the students (84.0%) were interested in research. The top three most preferred specialties were internal medicine (52.6%), surgery (51.2%), and obstetrics and gynaecology (51.0%). Overall, 186 (44.5%) participants reported plans to pursue a Master of Medicine degree in internal medicine. Interest in research was the only factor independently associated with 2.5-fold higher odds of pursuing a career in internal medicine (adjusted odds ratio: 2.5, 95% CI: 1.4-4.6, p = 0.003). About 73% of the participants strongly agreed that internal medicine requires wide reading., Conclusion: There is a strong interest to pursue a career in internal medicine among Ugandan medical students. We recommend an increase in training opportunities in Internal Medicine, especially in view of the growing disease burden and increasing population growth., Competing Interests: The authors declare that they have no conflicts of interest in relation to this work., (© 2022 Bongomin et al.)

Background: Lockdown is an important public health approach aimed at curbing the raging effect of the coronavirus disease-2019 (COVID-19). This study aimed at determining the impact of prolonged lockdown on mental health and access to mental health services among undergraduate students in Uganda., Methods: An online cross-sectional study was conducted anonymously among undergraduates across 10 universities in Uganda. The Distress Questionnaire-5 (DQ-5) and the Patient Health Questionnaire-2 (PHQ-2) were used. Logistic regression analysis was conducted to determine factors associated with psychological distress., Results: We enrolled 366 participants with a mean age of 24.5 ± 4.6 years. The prevalence of psychological distress was 40.2% ( n = 147) (cut off 14/25 based on DQ-5) while depression stood at 25.7% ( n = 94; cut off 3/6 based on PHQ-2) with mean scores of 12.1 ± 4.6 and 1.7 ± 1.6 respectively. Female gender (aOR: 1.6, 95%CI: 1.0-2.6, p = 0.032), pursuing a non-medical program (aOR: 2.2, 95%CI: 1.3-3.7, p = 0.005) were factors associated with psychological distress while non-medical program (aOR: 2.2, 95%CI: 1.3-3.7, p = 0.005) was associated with increased depression. Access to mental health services was associated with both reduced distress (aOR: 0.5, 95%CI: 0.3-0.8, p = 0.005) and depression (aOR: 0.6, 95%CI: 0.3-0.9, p = 0.034). A majority (65.3%) of the participants reported knowing how to access mental health care and 188 (51.4%) reported having needed emotional support but, only 67 (18.3%) ever sought care from a mental health professional. Of those who had access, only 10 (7%), and 13 (9%) accessed a counselor or a mental health unit, respectively. The barriers to accessibility of mental health care included financial limitations (49.5%), lack of awareness (32.5%), lack of mental health professionals (28.4%), and stigma (13.9%)., Conclusion: Among university students in Uganda during the COVID- 19 lockdown, the burden of psychological distress and depression was substantial. However, access to mental health services was limited by several factors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nantaayi, Ndawula, Musoke, Ssewante, Nakyagaba, Wamala, Makai, Wannyana, Wamala, Kanyike, Akech, Ojilong, Agira, Nakimuli, Asiimwe and Bongomin.)

Background: Uganda has had the longest COVID-19-induced closures of schools world over of over 20 months, according to a recent UNICEF report, which has greatly affected learning and mental health of University students. This study assessed levels of anxiety, challenges and coping strategies of students at a university in Uganda during the COVID-19 pandemic lock down., Methods: We conducted an online, descriptive, cross-sectional study between 26th June and 26th July 2021 using mixed quantitative and qualitative methods among students of Busitema University in Eastern Uganda. The survey assessed anxiety levels of students using General Anxiety Disorder 7 (GAD-7) scale, and its associations using the Chi-Square or Fischer's exact test and multivariate logistic regression. We also explored the challenges and coping strategies employed by students through in-depth interviews., Results: A total of 338 students participated, 213 (63%) were male with median age of 23 years (21-25), majority from Faculty of health sciences (n = 153, 45%). Overall, 179 (53%) of the students had anxiety which was mostly mild anxiety (n = 127, 38%). Students concerned about inadequate internet facilities to support online learning were twice more likely to have anxiety (aOR 2.0, 95% CI 1.1-3.7; p = 0.021). Among those with anxiety, avoidance coping strategies had higher scores with a median of 8 (3-12) compared to other strategies (p < 0.001). In-depth interviews revealed challenges with online learning, academic progress, and changes to daily routine and fear of contracting COVID-19 and getting vaccinated., Conclusion: The largest number of students had anxiety especially those from faculty of health sciences and engineering of which most used avoidance strategies to cope up with the anxiety. This highlights areas where the university authorities should gear effort to design appropriate strategies to maintain mental health of students even after the pandemic., Competing Interests: Competing interest The authors declare that they have no competing interests

Background: Uganda continues to depend on a health system without a well-defined emergency response system. This is in the face of the rising cases of out-of-hospital cardiac arrest contributed largely to the high incidence of road traffic accidents. Non-communicable diseases are also on the rise further increasing the incidence of cardiac arrest. Medical students are key players in the bid to strengthen the health system which warrants an assessment of their knowledge and attitude towards BLS inclusion in their study curriculum., Methods: A descriptive cross-sectional study was conducted in 2021 among undergraduate medical students across eight public and private universities in Uganda. An online-based questionnaire was developed using Google forms and distributed via identified WhatsApp groups. Chi-square or Fisher's exact test and logistic regression were performed in STATA 15 to assess the association between knowledge of BLS and demographics. P < 0.05 was considered statistically significant., Results: Out of the total 354 entries obtained, 351 were analyzed after eligibility screening. Of these, (n = 250, 71.2%) were male less than 25 years (n = 273, 77.8%). Less than half (n = 150, 42.7%) participants had undergone formal BLS training. Less than a third of participants (n = 103, 29.3%) had good knowledge (≥ 50%) with an overall score of 42.3 ± 12.4%. Age (p = 0.045), level of academic progress (p = 0.001), and prior BLS training (p = 0.033) were associated with good knowledge. Participants with prior training were more likely to have more BLS knowledge (aOR: 1.7, 95% CI: 1.1-2.7, p = 0.009). The majority (n = 348, 99.1%) believed that BLS was necessary and would wish (n = 343, 97.7%) to have it included in their curriculum., Conclusions: Undergraduate medical students have poor BLS knowledge but understand its importance. Institutions need to adopt practical teaching methods such as clinical exposures, field experience in collaboration with local implementers, and participating in community health promotion campaigns., (© 2022. The Author(s).)

Background: Coronavirus disease 2019 has been associated with adverse pregnancy outcomes, including preeclampsia. Coronavirus disease 2019 and preeclampsia have overlapping clinical features and are therefore challenging to differentiate. Since pregnant women are not routinely tested for coronavirus disease 2019, it is prudent to test for it among patients presenting with preeclampsia or eclampsia., Case Presentation: A 23-year-old female, a Munda, gravida 1 para 0, at 36 weeks and 5 days of amenorrhea presented to Mal Super Specialty Hospital as a referral in a semiconscious state after a severe attack of tonic-clonic seizures. Detailed history from the husband was insignificant except for a persistent cough for the last 7 days. She had denied any visual changes, headaches, or vaginal discharge. Physical examination revealed tachycardia (150 beats per minute), elevated blood pressure (187/111 mmHg), tachypnea (36 breaths per minute), and oxygen saturation of 94% on room air. Routine coronavirus disease 2019 rapid test was positive, and urine dipstick was +3. Additional tests revealed leukocytosis and elevated liver enzymes. Chest radiograph revealed prominent interstitial markings, and a bedside transabdominal ultrasonography showed a live single intrauterine fetus in cephalic presentation with normal cardiac activity and movements. A diagnosis of a prime gravida with eclampsia and coronavirus disease 2019 was made. She was managed with intravenous labetalol; she had already received a loading dose of intravenous magnesium sulfate, and we administered two maintenance doses during monitoring. Within an hour of admission, she had a spontaneous rupture of the amniotic membranes, with meconium-stained liquor (grade 2), and the fetal heart rate (148 beats per minute) was reassuring. She had an uncomplicated vaginal delivery of a live male newborn. Shortly after delivery, she developed slight respiratory distress and significant fluid overload that was managed with furosemide. Coronavirus disease 2019 reverse-transcription polymerase chain reaction test came back negative for the neonate and positive for the mother. She was shifted to the coronavirus disease 2019 treatment unit, and her contact with the child was limited. She was kept on a course of tablets ivermectin, zinc, vitamin C, montelukast, azithromycin, metronidazole, and injectable pantoprazole. The mother and child were discharged on day 15 after recovery with negative COVID nasopharyngeal swab., Conclusion: A diagnosis of preeclampsia or eclampsia should prompt testing for coronavirus disease 2019., (© 2022. The Author(s).)

The objectives of this study were to explore the content of web-based communication on COVID-19 by religious authorities (RAs) in Uganda and to assess the level of integration of the Uganda Ministry of Health (MoH) and World Health Organisation (WHO) COVID-19 risk communication guidelines into the statements released by these RAs. A grey literature review was conducted by searching the websites of intra- and inter-religious bodies for the terms "COVID-19" and "coronavirus". Thematic analysis was used to assess the content of RA statements which were also mapped to the items of the MoH and WHO statements. Results indicate that RA communications were centred on COVID-19 description and management; the need to adhere to established guidelines; and the adoption of health-protective behaviours, notably, social distancing and avoidance of misinformation. RAs also discussed the effects of COVID-19 and its control measures on the population and spoke against pandemic-aggravated injustices (gender-based violence and embezzlement). The RA messages incorporated the WHO statement to a greater extent than the MoH statement. In conclusion, RAs played a critical role in delivering public health messages in Uganda during the COVID-19 pandemic, a position we believe should be maximized by public health authorities for effective communication during emergencies., Competing Interests: The authors declare no competing interests., (Copyright: Etheldreda Leinyuy Mbivnjo et al.)

Postpartum hemorrhage (PPH), the loss of more than 500 mL of blood following childbirth, is a leading cause of maternal mortality worldwide. The current coronavirus disease 2019 (COVID-19) pandemic has strained health-care systems globally. Pregnant women are a vulnerable group at a high risk of severe infection with COVID-19 due to the physiological changes in their immune state. Although the infection can be asymptomatic, severe COVID-19 infection is associated with respiratory distress, fever and coagulopathies that can complicate an already hypercoagulable pregnancy state. There is a dearth of existing literature regarding the complications of COVID-19 infection during pregnancy, and much is yet to be known about this rapidly evolving pandemic. In our case report, we received a 23-year-old gravida 2 para 1 woman who was COVID-19 positive but asymptomatic; she presented to the obstetric department with labor pains which progressed to severe postpartum hemorrhage and development of mild respiratory distress., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Kalsar et al.)

Background: COVID-19 is still a major global threat for which vaccination remains the ultimate solution. Uganda reported 40,751 cases and 335 deaths as of 9 April 2021 and started its vaccination program among priority groups like health workers, teachers, those with chronic diseases among others in early March 2021. Unanimous uptake of the COVID-19 vaccine is required to subsequently avert its spread; therefore, we assessed COVID-19 vaccine acceptability, hesitancy, and associated factors among medical students in Uganda., Methods: This study employed an online descriptive cross-sectional survey among medical students across 10 medical schools in Uganda. A structured questionnaire via Google Form was conveniently sent to eligible participants via WhatsApp. Each medical school had a coordinator who consistently shared the data tool in the WhatsApp groups. Chi-square or Fisher's exact test, and logistic regression were used to assess the association between vaccine acceptability with demographics, COVID-19 risk perception, and vaccine hesitancy., Results: We surveyed 600 medical students, 377 (62.8%) were male. COVID-19 vaccine acceptability was 37.3% and vaccine hesitancy 30.7%. Factors associated with vaccine acceptability were being male (adjusted odds ratio (aOR) = 1.9, 95% CI 1.3-2.9, p=0.001) and being single (aOR= 2.1, 95% CI 1.1-3.9, p=0.022). Very high (aOR= 3.5, 95% CI 1.7-6.9, p<0.001) or moderate (aOR =2.2, 95% CI 1.2-4.1, p=0.008) perceived risk of getting COVID-19 in the future, receiving any vaccine in the past 5 years (aOR= 1.6, 95% CI 1.1-2.5, p=0.017), and COVID-19 vaccine hesitancy (aOR 0.6, 95% CI 0.4-0.9, p=0.036)., Conclusions: This study revealed low levels of acceptance towards the COVID-19 vaccine among medical students, low self-perceived risks of COVID-19, and many had relied on social media that provided them with negative information. This poses an evident risk on the battle towards COVID-19 in the future especially when these future health professions are expected to be influencing decisions of the general public towards the same.

Background: Irrational prescription of drugs can lead to high cost of treatment thus limiting access to essential medicines. We assessed the affordability and appropriateness of prescriptions written for diabetic patients in Eastern Uganda., Methods: We collected secondary data from the health management information system registers of patients who attended the outpatient medical clinic at Mbale regional referral hospital from January 2019 to December 2019. The average cost of the prescriptions was calculated and adjusted odds ratios for predictors for unaffordability estimated using logistic regression. Computed scores for indicators of rational drug prescription were used to assess the extent of rational prescribing., Results: The median cost per prescription was USD 11.34 (IQR 8.1, 20.2). Majority of the diabetic patients (n = 2462; 94.3%, 95% CI: 93.3-95.1%) could not afford the prescribed drugs. Predictors for unaffordability were if a prescription contained: ≥ 4 medicines (AOR = 12.45; 95% CI: 3.9-39.7); an injectable (AOR = 5.47; 95%CI: 1.47-20.32) and a diagnosis of diabetes mellitus with other comorbidities (AOR = 3.36; 95%CI: 1.95-5.78). Having no antidiabetic drug prescribed was protective for non-affordability (AOR = 0.38; 95%CI: 0.24-0.61). The average number of drugs per prescription was 2.8. The percentage prescription of drugs by generic name and from the essential medicine and health supplies list of Uganda were (6160/7461; 82.6%, 96% CI: 81.7%-83.4%) and (6092/7461; 81.7%, 95% CI: 80.8%-82.5%) respectively against WHO standard of 100%., Conclusion: The majority of diabetic patients (94.3%) in Eastern Uganda cannot afford to buy prescribed medicines. The government should therefore ensure that essential medicines are readily accessible in public health facilities., Competing Interests: The authors have declared that no competing interests exist.

Background: The coronavirus disease (COVID-19) pandemic is a global public health concern affecting over 5 million people and posing a great burden on health care systems worldwide., Objective: The aim of this study is to determine the knowledge, attitude, and practices of medical students in Uganda on the COVID-19 pandemic., Methods: We conducted an online, descriptive cross-sectional study in mid-April 2020, using WhatsApp Messenger. Medical students in 9 of the 10 medical schools in Uganda were approached through convenience sampling. Bloom's cut-off of 80% was used to determine good knowledge (≥12 out of 15), positive attitude (≥20 out of 25), and good practice (≥12 out of 15)., Results: The data of 741 first- to fifth-year medical students, consisting of 468 (63%) males with a mean age of 24 (SD 4) years, were analyzed. The majority (n=626, 84%) were pursuing Bachelor of Medicine and Bachelor of Surgery degrees. Overall, 671 (91%) had good knowledge, 550 (74%) had a positive attitude, and 426 (57%) had good practices. Knowledge was associated with the 4th year of study (adjusted odds ratio [aOR] 4.1, 95% CI 1.6-10.3; P<.001). Attitude was associated with the female sex (aOR 0.7, 95% CI 0.5-1; P=.04) and TV or radio shows (aOR 1.1, 95% CI 0.6-2.1; P=.01). Practices were associated with the ≥24 years age category (aOR 1.5, 95% CI 1.1-2.1; P=.02) and online courses (aOR 1.8, 95% CI 1.1-3.2; P=.03). In total, 592 (80%) medical students were willing to participate in frontline care if called upon., Conclusions: Medical students in Uganda have sufficient knowledge of COVID-19 and will be a large reservoir for health care response when the need arises., (©Ronald Olum, Jonathan Kajjimu, Andrew Marvin Kanyike, Gaudencia Chekwech, Godfrey Wekha, Dianah Rhoda Nassozi, Juliet Kemigisa, Paul Mulyamboga, Oscar Kabagambe Muhoozi, Lauryn Nsenga, Musilim Lyavala, Asaph Asiimwe, Felix Bongomin. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 19.06.2020.)

Purpose: To evaluate the results of phacoemulsification and intraocular lens (IOL) implantation in eyes with pseudoexfoliation (PEX) and zonular weakness., Methods: Two hundred and ninety-five patients (295 eyes) were recruited. This study is a retrospective case review of 143 PEX eyes with preoperative (Group 1) and intraoperative (Group 2) signs of zonular weakness, 76 PEX eyes (Group 3) and 76 non-PEX eyes without zonular weakness (Group 4) undergoing phacoemulsification and IOL implantation performed by single surgeon from year 1988 to 2010. Outcome measures included frequency of postoperative pseudophakodonesis, anterior capsule contraction and IOL decentration/dislocation. Postoperative vision, intraocular pressure (IOP) and glaucoma medication requirements were also assessed. A subanalysis on identical postoperative outcomes of capsular tension ring (CTR) implantation was performed. Comparisons were made for 52 PEX eyes with zonular weakness receiving nonsutured CTR implantation (Group A), 91 PEX eyes with zonular weakness not receiving CTR implantation (Group B) and 142 PEX eyes without zonular weakness (Group C)., Results: Mean follow-up was 4.08 ± 0.48 years and maximum was 8.3 years. Both Groups 1 and 2 showed higher incidence of complications than Groups 3 and 4 (p < 0.01). Vision, IOP and glaucoma medication requirements were similar postoperatively for all four groups. Groups A and B had a significantly higher proportion of postoperative complications than Group C (p < 0.01). There was no significant difference in risk of developing these complications between Groups A and B (p = 0.64)., Conclusion: Postoperative complication rates are higher in PEX eyes with preoperative and/or intraoperative signs of zonular weakness undergoing phacoemulsification. Nonsutured CTR implantation does not prevent IOL and capsular complications postoperatively., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Context: -Medical examiner cases are increasingly used as tissue donor referral sources to meet the ever-growing need for transplant tissues. The assumption is often made that traumatic and sudden deaths have minimal risk of unsuspected neoplasia. An autopsy of a registered tissue donor with strong preautopsy clinical assessment of a saddle pulmonary embolus revealed unsuspected acute lymphoblastic leukemia, prompting a review of the incidence of unsuspected neoplasia from a regional forensic autopsy practice., Objective: -To determine the incidence of (1) unsuspected neoplasia, (2) clinical concordance of known neoplasia, and (3) potential donor referral in a regional forensic autopsy service., Design: -A retrospective, 5-year review of 412 autopsies from a regional, primarily forensic, autopsy service to determine the incidence of unsuspected neoplasia, clinical concordance of known neoplasia, and the preautopsy assessment of potential donor referral suitability., Results: -Unsuspected neoplasia rate at autopsy was 7% (29 of 412 patients); cancer was the cause of death in 41% (12 of 29 patients) of these individuals. In patients with a history of cancer, the discordance of cancer diagnosis was 44% (4 of 9 patients [11 patients with known cancer, 2 who refused medical evaluation were excluded from the study]). Nearly 60% (17 of 29 patients) of the unsuspected cancer cases had no apparent reason for deferral of tissue procurement before the autopsy examination., Conclusions: -The 7% incidence of unsuspected cancer in a forensic autopsy practice raises concern for the potential introduction of neoplastic tissue in the donor pool. To ensure the safety of this vital resource, mandatory complete autopsies on deceased donors are advocated as well as a tissue-recipient registry to track donor-related neoplasia.