Browsing by Author "Kaggwa, Sam"

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    Genetic Risk of Prostate Cancer in Ugandan Men
    (The Prostate, 2018) Du, Zhaohui; Lubmawa, Alexander; Gundell, Susan; Wan, Peggy; Nalukenge, Cissy; Muwanga, Proscovia; Lutalo, Moses; Nansereko, Deborah; Ndaruhutse, Olivia; Katuku, Molly; Nassanga, Rosemary; African Ancestry Prostate Cancer Consortium; Asiimwe, Frank; Masaba, Benon; Kaggwa, Sam; Namuguzi, Dan; Kiddu, Vicky; Mutema, George; Conti, David V.; Luke, Asiimwe; Job, Kuteesa; Henry, Dabanja M.; Haiman, Christopher A.; Watya, Stephen
    Men of African-ancestry have elevated prostate cancer (PCa) incidence and mortality compared to men of other racial groups. There is support for a genetic contribution to this disparity, with evidence of genetic heterogeneity in the underlying risk alleles between populations. Studies of PCa among African men may inform the contribution of genetic risk factors to the elevated disease burden in this population.We conducted an association study of >100 previously reported PCa risk alleles among 571 incidence cases and 485 controls among Uganda men. Unconditional logistic regression was used to test genetic associations and a polygenic risk score (PRS) was derived to assess the cumulative effect of the known risk alleles in association with PCa risk. In an exploratory analysis, we also tested associations of 17 125 421 genotyped and imputed markers genome-wide in association with PCa risk.Of the 111 known risk loci with a frequency >1%, 75 (68%) had effects that were directionally consistent with the initial discovery population,14 (13%) of which were nominally significantly associated with PCa risk at P < 0.05. Compared to men with average risk (25th−75th percentile in PRS distribution), Ugandan men in the top 10% of the PRS, constructed of alleles outside of 8q24, had a 2.9-fold (95%CI: 1.75, 4.97) risk of developing PCa; risk for the top 10% increased to 4.86 (95%CI: 2.70, 8.76) with the inclusion of risk alleles at 8q24. In genome-wide association testing, the strongest associations were noted with known risk alleles located in the 8q24 region, including rs72725854 (OR = 3.37, P = 2.14 × 10−11) that is limited to populations of African ancestry (6% frequency).The ~100 known PCa risk variants were shown to effectively stratify PCa risk in Ugandan men, with 10% of men having a >4-fold increase in risk. The 8q24 risk region was also found to be a major contributor to PCa risk in Ugandan men, with the African ancestry-specific risk variant rs72725854 estimated to account for 12% of PCa in this population.
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    Male genital mutilation (amputation) and its complications: a case report
    (BMC research notes, 2014) Kaggwa, Sam; Galukande, Moses
    Genital losses from ritual attacks are often reported in the media and often discussed in the social media but are hardly reported in medical literature. Male genital mutilation (MGM) refers to permanent modification of the external genitalia that involves ablation of genital tissues. When found, it is usually as a consequence of poor circumcision skills, auto mutilation/castration or genital injuries caused by attacks or accidents. Male circumcision on its own is widely regarded as a rather safe and acceptable practice which is known to have some health benefits and in keeping with several religious customs as rite of passage. Outside of professional performed circumcision, MGM is usually associated with dark arts and malicious intentions like witchcraft or as a consequence of torture of prisoners of war for information. Case presentation: In this case we describe a 5-year old Ugandan boy who had his genitals mutilated in bizarre circumstances within a ritual attack. He survived and a urethrostomy was fashioned. Conclusion: There is need to document more of these cases in order to gather enough information to inform prevention and treatment strategies. Issues of hormonal replacement therapy (HRT) and possible sex change require much debate. These genital sex changing operations should preferably be avoided until a child can fully participate in decision making.
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    Pretraining Experience and Structure of Surgical Training at a Sub-Saharan African University
    (World journal of surgery, 2013) Galukande, Moses; Ozgediz, Doruk; Elobu, Emmanuel; Kaggwa, Sam
    The common goal of surgical training is to provide effective, well-rounded surgeons who are capable of providing a safe and competent service that is relevant to the society within which they work. In recent years, the surgical workforce crisis has gained greater attention as a component of the global human resources in health problems in low- and middle-income countries. The purpose of this study was to: (1) describe the models for specialist surgical training in Uganda; (2) evaluate the pretraining experience of surgical trainees; (3) explore training models in the United States and Canada and areas of possible further inquiry and intervention for capacity-building efforts in surgery and perioperative care. Methods This was a cross-sectional descriptive study conducted at Makerere University, College of Health Sciences during 2011–2012. Participants were current and recently graduated surgical residents. Data were collected using a pretested structured questionnaire and were entered and analyzed using an excel Microsoft spread sheet. The Makerere University, College of Health Sciences Institutional Review Board approved the study.
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    Use of surgical task shifting to scale up essential surgical services: a feasibility analysis at facility level in Uganda
    (MC health services research, 2013) Galukande, Moses; Kaggwa, Sam; Sekimpi, Patrick; Kakaire, Othman; Katamba, Achilles; Munabi, Ian; Mwesigye Runumi, Francis; Hagopian, Amy; Blair, Geoffrey; Barnhart, Scott; Luboga, Sam; Mills, Ed.
    The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level. Methods: 37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations. Results: Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting.
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    Validation of supra-pubic ultrasonography for preoperative prostate volume measurement in sub-Saharan Africa
    (International urology and nephrology, 2011) Malemo, Kalisya; Galukande, Moses; Hawkes, Michael; Bugeza, Sam; Nyavandu, K.; Kaggwa, Sam
    Advances in urological techniques in sub-Saharan Africa need to be supported with practical ancillary diagnostics. This study aimed at determining the accuracy of suprapubic ultrasonography (SPUS) relative to transrectal ultrasonography (TRUS), the current gold standard, in estimating preoperative prostate volume in a sub-Saharan African hospital. Methods Cross-sectional study of prospectively enrolled patients with severe lower urinary tract symptoms and histologically confirmed benign prostatic hyperplasia. The volume of the prostate was estimated using two modalities, SPUS and TRUS. Open prostatectomy was performed on all patients, and the mass of the enucleated prostate adenoma was measured directly. Results Fifty patients were enrolled, with a mean age of 69 years. The mean prostate volume as determined by TRUS, SPUS, and direct measurement of enucleated prostatic tissue was 96.0, 95.9 and 83.5 mL, respectively.