Browsing by Author "Kabuye, Ronald"

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    An Unusual Occurrence of Penetrating Aortic Arch Injury by a Ball‑point Pen: a case report and review of the literature
    (Journal of Cardiothoracic Surgery, 2022-12-12) Ariaka, Herbert; Magala, John Paul; Kebba, Naomi; Kabuye, Ronald; Namirembe, Stella Magara; Nalule, Miriam
    Aortic arch injuries account for about 8% of thoracic aortic injuries. Penetrating zone I neck injuries account for 18% of vascular injuries in the neck and have great potential to traverse to involve thoracic vascular structures as well. The hard and soft signs of vascular injury facilitate triage of patients on an individual basis. We present a case of a ball-point pen traversing through zone I of the neck and causing penetrating aortic arch injury with minimal mediastinal haemorrhage. We present a polytrauma patient who was admitted with traumatic brain injury and a ball-point pen lodged above the sternal notch in zone I of the neck following a road traffic accident. He underwent mediastinal exploration via a median sternotomy. The ball-point pen was found penetrating the anterior wall of the aortic arch and resting in its lumen. The ball-point pen was successfully explanted and primary repair of the penetrating aortic arch injury was done. He had an uneventful recovery without any added secondary neurological complications. Penetrating aortic arch injuries are rare compared to injuries of the ascending aorta and descending aorta. They require a high index of suspicion, rapid investigation and urgent intervention in view of their high associated fatality. The ball-point pen in this case assumed the shape of a plug which acted as a seal at the site of injury preventing catastrophic exsanguination.
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    Development of an Operative Trauma Course in Ugandad - A Report of a Three-Year Experience
    (Journal of Surgical Research, 2020) Ullrich, Sarah J.; DeWane, Michael P.; Cheung, Maija; Fleming, Matthew; Namugga, Martha M.; Kurigamba, Gideon; Kabuye, Ronald; Mabweijano, Jackie; Galukande, Moses; Ozgediz, Doruk; Pei, Kevin Y.
    Trauma is a leading cause of morbidity and mortality in low-income countries. Improved health care systems and training are potential avenues to combat this burden. We detail a collaborative and context-specific operative trauma course taught to postgraduate surgical trainees practicing in a low-resource setting and examine its effect on resident practice. Three classes of second year surgical residents participated in trainings from 2017 to 2019. The course was developed and taught in conjunction with local faculty. The most recent cohort logged cases before and after the course to assess resources used during initial patient evaluation and operative techniques used if the patient was taken to theater. Over the study period, 52 residents participated in the course. Eighteen participated in the case log study and logged 117 cases. There was no statistically significant difference in patient demographics or injury severity precourse and postcourse. Postcourse, penetrating injuries were reported less frequently (40 to 21% P < 0.05) and road traffic crashes were reported more frequently (39 to 60%, P < 0.05). There was no change in the use of bedside interventions or diagnostic imaging, besides head CT. Of patients taken for a laparotomy, there was a nonstatistically significant increase in the use of four-quadrant packing 3.4 to 21.7%) and a decrease in liver repair (20.7 to 4.3%). The course did not change resource utilization; however, it did influence clinical decision-making and operative techniques used during laparotomy. Additional research is indicated to evaluate sustained changes in practice patterns and clinical outcomes after operative skills training.
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    Gastroschisis in Uganda: Opportunities for improved survival
    (Journal of pediatric surgery, 2016) Wesonga, Anne S.; Fitzgerald, Tamara N.; Kabuye, Ronald; Kirunda, Samuel; Langer, Monica; Kakembo, Nasser; Ozgediz, Doruk; Sekabira, John
    Neonatal mortality from gastroschisis in sub-Saharan Africa is high, while in high-income countries, mortality is less than 5%. The purpose of this study was to describe the maternal and neonatal characteristics of gastroschisis in Uganda, estimate the mortality and elucidate opportunities for intervention. An ethics-approved, prospective cohort study was conducted over a one-year period. All babies presenting with gastroschisis in Mulago Hospital in Kampala, Uganda were enrolled and followed up to 30days. Univariate and descriptive statistical analyses were performed on demographic, maternal, perinatal, and clinical outcome data. 42 babies with gastroschisis presented during the study period. Mortality was 98% (n=41). Maternal characteristics demonstrate a mean maternal age of 21.8 (±3.9) years, 40% (n=15) were primiparous, and fewer than 10% (n=4) of mothers reported a history of alcohol use, and all denied cigarette smoking and NSAID use. Despite 93% (n=39) of mothers receiving prenatal care and 24% (n=10) a prenatal ultrasound, correct prenatal diagnosis was 2% (n=1). Perinatal data show that 81% of deliveries occurred in a health facility. The majority of babies (58%) arrived at Mulago Hospital within 12h of birth, however 52% were breastfeeding, 53% did not have intravenous access and only 19% had adequate bowel protection in place. Four patients (9%) arrived with gangrenous bowel. One patient, the only survivor, had primary closure. Average time to death was 4.8days [range<1 to 14days]. The mortality of gastroschisis in Uganda is alarmingly high. Improving prenatal diagnosis and postnatal care of babies in a tertiary center may improve outcome.
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    Tuberculosis as a Primary Cause of Oesophageal Stricture: a case report
    (Journal of Cardiothoracic Surgery, 2018) Mbiine, Ronald; Kabuye, Ronald; Lekuya, Herve Monka; Manyillirah, William
    Tuberculous (TB) oesophagitis is a rare manifestation of dysphagia occurring in 0.3% of all gastro-intestinal tract TB infections as well as 0.15% of all cases of dysphagia and often is misdiagnosed. This report presents a rare manifestation of TB as a cause of oesophageal stricture.
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    Vascular Surgery in Sub-Saharan Africa: Challenges and Opportunities—The Experience of Uganda
    (A Global Perspective, 2016-10-21) Mwambu, Tom P.; Kabuye, Ronald; Oketcho, Michael
    Sub-Saharan Africa (SSA) is home to among the least developed nations in the world with the exception of the Republic of South Africa. The average annual economic growth rate for the region is estimated at 5 % [1] with about 42.7 % of the population living on less than USD 1.9 a day [2]. Communicable diseases such as malaria and respiratory tract diseases such as tuberculosis rank highest in the regions’ disease burden however, due to changing lifestyles non-communicable diseases (NCDs) including cardiovascular disease are on the increase. Vascular surgical services do come with a high cost including availability of specialist human resource, necessary sundries and appropriate equipment which are all not readily available in sub-Saharan Africa including Uganda. In such low socio-economic settings allocation of resources to the health sector is a challenge and availing resources for appropriate vascular surgical care remains an uphill task.