Congenital intestinal malrotation is a gastrointestinal anomaly whose most serious complication is midgut volvulus. More commonly, it presents as an incidental finding at laparotomy, or as a finding ...on diagnostic imaging (Ultrasound, CT, Upper GI contrast study). Most patients are diagnosed in childhood. Laparoscopic Ladd's procedure is an accepted alternative to Laparotomy in children but has not been well-studied in adult. We present the case of this unexpected finding in a patient 38 years old, during emergency laparotomy for mechanical intestinal obstruction. Intra-operative findings included intestinal malrotation with small bowel volvulus. The terminal ilea and cecum were gangrenous on the basis of ischemic necrosis. A limited right hemycolectomy and primary end-to- end anastomosis was performed.
A Bochdalek hernia (BH) occurs when abdominal contents herniate through the postero-lateral segment of the diaphragm. The right side is affected considerably less commonly than the left. Most BHs ...present are diagnosed early in life, with some element of cardio-respiratory distress. Rarely, hernias that remain clinically silent until adulthood when they present as life-threatening surgical emergencies. We report a case 35 year old female who emergency exploratory laparotomy for a complete mechanical bowel obstruction. At surgery the redundant transverse colon was twisted and incarcerated within the right hemithorax, creating a closed loop obstruction. The right colon, appendix, terminal ilium, and three accessories right liver lobes were also dragged into the right thoracic cavity. After reducing the hernia, the diaphragmatic defect was primarily repaired with non-absorbable suture. The redundant transvers colon which had been compromised was resected and primary end-to- end anastomosis was carried out. Incidental appendectomy was done. The patient was sent into ICU for post-operative monitoring. She made an uneventful recovery and remains asymptomatic at nine month follow-up. I discuss what i believe to be the first case report of complicated right diaphragmatic hernia in Botswana, associated with another congenital mal-formation (accessories hepatic lobes, partial mal-rotation, and redundant transvers colon) in adult.
Patients who are HIV-positive and have breast cancer have worse overall survival (OS) compared with patients who are HIV-negative. Pathologic complete response (pCR) and relative dose intensity (RDI) ...of chemotherapy are associated with survival. We assessed whether pCR and RDI rates were lower for patients who are HIV-positive and received neoadjuvant chemotherapy (NACT).
This was a prospective cohort analysis of patients initiating NACT in Botswana (February 2017 to September 2019). Primary outcomes were pCR and RDI; secondary outcomes were OS and toxicity. HIV status and zidovudine (ZDV) treatment were stratification factors. Multivariable analysis was used to control for confounding.
In total, 26 of 110 enrolled individuals were HIV-positive. In univariable analysis, HIV-positive (odds ratio OR = 0.2;
= .048) and RDI < 0.85 (OR = 0.30;
= .025) were associated with pCR. In multivariable analysis, the magnitude of association decreased for HIV-positive (OR = 0.28;
= .11), but RDI < 0.85 remained independently associated with pCR (OR = 0.32;
= .035). Patients who are HIV-positive had significantly lower mean RDI, and those on ZDV had significantly lower RDI. Ninety-one (83%) were stage III with 2-year OS significantly worse for patients who are HIV-positive (58%
74%). Hazard ratio for all-cause mortality was 2.68 (95% CI, 1.17 to 6.13;
= .028) in patients who are HIV-positive compared with patients who are HIV-negative. Toxicity rates were similar despite patients who are HIV-positive receiving significantly lower dose intensity chemotherapy.
Patients who are HIV-positive and have breast cancer in Botswana have lower pCR rates and also receive lower dose intensity therapy, which may contribute to worse OS. Patients who are HIV-positive on ZDV-containing regimens received even lower dose intensity of NACT. Administering optimal dose intensity in patients who are HIV-positive remains a challenge, and targeted interventions that address modifiable risk factors are needed to improve therapy delivery and outcomes.
A 43-year-old female presented at the accident and emergency department of Princess Marina Hospital, Gaborone, Botswana. She reported a deep dull aching pain of two years duration in the right iliac ...fossa that has been progressively becoming worse. Ultrasound revealed a large sausage like cystic mass extending from the pelvis up to the medial aspect of the ascending colon. CT scan showed a large sausage like cystic mass extending from the pelvis up to the hepatic flexure of the colon with the cecum displaced. No metastatic features were seen. We made an impression of appendiceal mucocele. A semi-elective laparotomy was scheduled. Intraoperative findings: a giant intact cystic distended appendix with involved base, displacing the cecum cranially. A right hemicolectomy was performed. The histopathological results revealed a low-grade appendicular mucinous neoplasm with no lymph node involvement. The surgical margins were free. The patient recovered uneventfully.
Truth-telling about terminal illness prognosis is a complex and sensitive process, accompanied by several confounding factors and the sometimes-contrasting preferences between the patient, the ...patient's family and the healthcare provider. However, there seems to be limited or no guidelines for truth-telling in terminal illness prognosis in Africa.
The review explored the perceptions, knowledge, attitudes and beliefs of patients, patients' families and healthcare professionals about truth-telling regarding cases of terminal illness prognosis in Africa.
Using a predetermined search strategy, a systematic search of the literature was conducted on EBSCOhost, Web of Science and PubMed. A manual search was also conducted on Google Scholar, Google, HINARI, PubMed and African Journals OnLine. Furthermore, a mixture of backward and forward snowballing was used. The searches yielded a total of 90 results, of which only 13 papers met the review criteria after screening. A review matrix was developed to capture the data from the articles, which was later coded for emerging themes.
Several themes emerged from the literature, namely patient and family preferences, doctors' preferences and practices, patient reception of and reaction to information disclosure, and doctors' perspective regarding patient reception of and reaction to information disclosure. The results suggest that several confounding factors, such as culture and religious beliefs, influence truth-telling.
In Africa, there are several confounding factors, such as culture, religious beliefs and patient and family preferences that should be carefully considered in truth-telling approaches.
•Sixty-eight percent (68.2%) of road traffic collision deaths in Botswana are considered preventable.•The majority of deaths (45%, n=384/909) occurred at the scene.•Head injury in combination with ...haemorrhagic shock was the commonest cause of death at 47.3% (n=430/909).
Road traffic collisions (RTC) are a major cause of mortality and morbidity in Botswana. To our knowledge no research has been conducted in Botswana to investigate preventable deaths that occur as a result of RTCs. The aim of this study is to establish the rate of preventable deaths from RTCs in the greater Gaborone area in Botswana. This was a 5-year retrospective study conducted at the forensic pathology department for the greater Gaborone area, in Botswana. Nine hundred and nine (909) forensic pathology reports were retrieved. Sixty-eight percent (68.2%) of RTC deaths were considered preventable. Head injury in isolation and in combination with other injuries accounted for 87.6% (796/909) of deaths. Haemorrhagic shock was present in 70.2% (638) of all documented injuries. Another documented injury contributing to fatal RTCs was high spinal cord injury. This injury was documented in 13.1% (119/909) of all deaths. We recommend the implementation of a comprehensive trauma system in Botswana to reduce the number of deaths from RTCs.
A 22-year-old female patient was diagnosed to have HIV and treated by highly active antiretroviral therapy (HAART) since 2012 had developed a reduction of vision in both eyes secondary to cataract. ...The cataract was extracted from both eyes with no immediate postoperative complication. During follow-up, it was recognized that she had had bilateral Stage 3 macular hole in both eyes. The visual acuity in both eyes was 6/60 which did not improve with application of pinhole. Pars plana vitrectomy was done and sealed the macular hole in the left eye. The visual acuity remained the same in both eyes despite surgical intervention.
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