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Ntirenganya F, Twagirumukiza JD, Bukibaruta G, Byiringiro F, Rugwizangoga B, Rulisa S. Predictors of molecular subtypes in women with breast cancer in Rwanda. rmj 2022. [DOI: 10.4314/rmj.v79i4.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION: Breast cancer (BC) constitutes a major public health problem worldwide. It remains a major scientific, clinical and societal challenge, generally in Africa and particularly in Rwanda. The purpose of this study was to determine clinical and histopathological predictors of BC molecular subtypes in Rwandan women.METHODS: A retrospective cohort study including patients with histological confirmation of BC. Using R statistical software, a regression model for multinomial responses was developed. Univariate and multivariate logistic regression analyses were used to identify independent BC molecular subtypes predictors. A two-sided p<0.05 indicated a statistically significant difference.RESULTS: Forty seven percent of cases presented with advanced stages (Stage III and IV). Postmenopausal BC (p=0.0142), absence of infertility (p=0.018) predicted Luminal A subtype with a predictive accuracy of 0.65. Age (p=0.003), postmenopausal BC (p=0.005), absence of axillar lymph nodes (p= 0.008) and poorly differentiated tumor (p=0.012) were predictors for Luminal B subtype with a predictive accuracy of 0.86. Age (p=0.045), BMI (p=0.005), rapid progression (p=0.032), tumor size T2-T3 (p<0.001) were predictors of HER2-Enriched subtype with a predictive accuracy of 0.70. Age below 40 (p=0.005), painless mass (p=0.030), nodal involvement (p=0.008), Nottingham grade 3 (p<0.001) predicted Triple Negative tumors with a predictive accuracy of 0.71.CONCLUSION: Clinical and histopathological tumor characteristics can be used to predict BC molecular subtypes with acceptable accuracy. Further studies are needed to explore the possibility of developing a scoring system for clinical decision-making, especially in settings where immunohistochemistry testing is limited.
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Umugwaneza N, Byiringiro F, Ndahimana P, Ivang A, Nyundo M, Ntirenganya F, Gashegu J. Unusual anatomical variations of the hepatic arteries and bile ducts: What are the surgical implications. Afr Health Sci 2022; 22:697-702. [PMID: 36910391 PMCID: PMC9993316 DOI: 10.4314/ahs.v22i3.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The knowledge of anatomy is essential for surgical safety and impacts positively on patients' outcomes. Surgeons operating on the liver and bile ducts should keep in mind the normal anatomy and its variations as the latter are common. Case Presentation We conducted a structured surgical dissection course of the supra-colic compartment of the abdominal cavity on 2nd and 3rd October 2020. While dissecting a 46years-old male cadaver, we encountered unusual anatomical variations of the hepatic arterial branching, the biliary tree, and arterial supply to the common bile duct. The common hepatic artery was dividing into two branches: a common short trunk for the left hepatic artery and the right gastric artery (hepato-gastric trunk) and a common trunk for the right hepatic artery and gastroduodenal artery (hepato-gastroduodenal trunk). The right hepatic duct was duplicated with a main right hepatic duct and an additional smaller duct. The bile duct was supplied by an artery coming from the abdominal aorta. Conclusion We described three unusual anatomical variations: a variation of the hepatic arteries branching pattern, an aberrant right hepatic duct, and blood supply to the bile duct from the abdominal aorta. Surgeons should be aware of these rare variations.
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Nickenig Vissoci JR, Krebs E, Meier B, Vieira IF, de Andrade L, Byiringiro F, Rulisa S, Staton CA. Road traffic crash experience among commercial motorcyclists in Kigali, Rwanda. Int J Inj Contr Saf Promot 2020; 27:181-187. [PMID: 32138575 DOI: 10.1080/17457300.2020.1724158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Road traffic injuries (RTI) cause ∼1.2 million deaths and 50 million injuries annually, disproportionately occurring in low- and middle-income countries. Although policy changes and infrastructural developments have continued to contribute to the decrease in RTI-related deaths, limited studies have investigated the relationship between motorcycle taxi driver behaviors and RTIs in Rwanda. This study aims to describe the safety behaviors of commercial motorcyclists in Kigali, Rwanda.Methods: We surveyed 609 commercial motorcyclists in January 2014 then conducted a cross-sectional analysis of the results, including descriptive and bivariate logistic regression analyses.Results: We found that 38.7% of surveyed motorcycle drivers experienced a crash during their lifetime, of which, more than half (n = 134, 56.8%) suffered injuries. Of all injuries, 38.8% (n = 52) resulted in hospitalization, and 14.2% (n = 19) in disability. Among motorcyclists, 100% reported always wearing a helmet, 99% reported always wearing a chin strap, and 98.8% reported always having a passenger helmet. There was an association between sustaining a crash and believing that helmets (p = 0.08) and chin straps (p = 0.05) reduced crash risk.Conclusions: Rwandan commercial motorcyclists demonstrate generally proper safety behaviors, but remain a high-risk occupational group. Road safety policy initiatives have been effective in changing driver behavior regardless of driver safety beliefs.
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Affiliation(s)
- Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Elizabeth Krebs
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Meier
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Luciano de Andrade
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Fidele Byiringiro
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stephen Rulisa
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Catherine A Staton
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Martin AN, Byiringiro JC, Petroze RT, Nkeshimana M, Byiringiro F, Calland JF. Assessing the impact of HIV status on injury outcomes: A multicenter study of trauma patients in Rwanda. Surgery 2018; 165:444-449. [PMID: 30327188 DOI: 10.1016/j.surg.2018.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the impact of human immunodeficiency virus serostatus on trauma outcomes in low-resource settings. This study sought to evaluate the impact of human immunodeficiency virus serostatus on mortality outcomes for Rwandan patients presenting after trauma. METHODS This retrospective review of the University of Rwanda trauma registry captured all adult trauma patients with known human immunodeficiency virus status presenting between March 2011 and July 2015. Confirmed human immunodeficiency virus-positive cases were matched 1:2 with known human immunodeficiency virus-negative controls using a modified Kampala Trauma Score, sex, and district of residence or primary hospital. All-cause mortality was compared using multivariable logistic regression. RESULTS In total, 11,280 patients were recorded prospectively in the registry (169 human immunodeficiency virus positive; 334 human immunodeficiency virus negative matches). There was no difference in delay of hospital presentation or time until operation (P = .50 and P = .57, respectively). Less than 30% of all patients underwent operation during admission (n = 133), and the rate of operative intervention was independent of human immunodeficiency virus serostatus (P = .946). There was no association between development of any complication and human immunodeficiency virus status (P = .837). The overall mortality rate was 8.9% and 3.3% for human immunodeficiency virus-positive and human immunodeficiency virus-negative patients, respectively (P = .010). Human immunodeficiency virus positivity was associated with increased 30-day mortality when controlling for potential confounders (P = .016; odds ratio 3.60, 95% confidence interval: 1.27-10.2, C statistic 0.88). CONCLUSION Both human immunodeficiency virus and trauma pose substantial public health threats in sub-Saharan Africa. Known human immunodeficiency virus seropositivity in Rwandan trauma patients is associated with early mortality. Further investigation regarding testing, treatment, and outcomes in human immunodeficiency virus-positive trauma patients is warranted and provides an opportunity for leveraging human immunodeficiency virus global health efforts in trauma outcomes assessment.
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Affiliation(s)
- Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Jean Claude Byiringiro
- Division of Clinical Education and Research, University Teaching Hospital of Kigali, Kigali, Rwanda; College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Robin T Petroze
- Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Menelas Nkeshimana
- Department of Accident and Emergency, University Teaching Hospital of Kigali, Rwanda
| | - Fidele Byiringiro
- Department of Surgery, University Teaching Hospital of Kigali, Rwanda
| | - James F Calland
- Department of Surgery, University of Virginia, Charlottesville, VA
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Ramirez AG, Nuradin N, Byiringiro F, Ntakiyiruta G, Giles AE, Riviello R. General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits. World J Surg 2018; 43:36-43. [PMID: 30132227 DOI: 10.1007/s00268-018-4771-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Benchmarking operative volume and resources is necessary to understand current efforts addressing thoracic surgical need. Our objective was to examine the impact on thoracic surgery volume and patient access in Rwanda following a comprehensive capacity building program, the Human Resources for Health (HRH) Program, and thoracic simulation training. METHODS A retrospective cohort study was conducted of operating room registries between 2011 and 2016 at three Rwandan referral centers: University Teaching Hospital of Kigali, University Teaching Hospital of Butare, and King Faisal Hospital. A facility-based needs assessment of essential surgical and thoracic resources was performed concurrently using modified World Health Organization forms. Baseline patient characteristics at each site were compared using a Pearson Chi-squared test or Kruskal-Wallis test. Comparisons of operative volume were performed using paired parametric statistical methods. RESULTS Of 14,130 observed general surgery procedures, 248 (1.76%) major thoracic cases were identified. The most common indications were infection (45.9%), anatomic abnormalities (34.4%), masses (13.7%), and trauma (6%). The proportion of thoracic cases did not increase during the HRH program (2.07 vs 1.78%, respectively, p = 0.22) or following thoracic simulation training (1.95 2013 vs 1.44% 2015; p = 0.15). Both university hospitals suffer from inadequate thoracic surgery supplies and essential anesthetic equipment. The private hospital performed the highest percentage of major thoracic procedures consistent with greater workforce and thoracic-specific material resources (0.89% CHUK, 0.67% CHUB, and 5.42% KFH; p < 0.01). CONCLUSIONS AND RELEVANCE Lack of specialist providers and material resources limits thoracic surgical volume in Rwanda despite current interventions. A targeted approach addressing barriers described is necessary for sustainable progress in thoracic surgical care.
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Affiliation(s)
- Adriana G Ramirez
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA. .,University of Virginia Medical Center, P.O. Box 800681, Charlottesville, VA, 22908-0709, USA.
| | - Nebil Nuradin
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Fidele Byiringiro
- Department of Surgery, School of Medicine, University of Rwanda, Kigali, Rwanda
| | | | - Andrew E Giles
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Robert Riviello
- Center for Surgery and Public Health, Women and Brigham Hospital, Harvard University, Boston, MA, USA
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Ramirez AG, Nuradin N, Byiringiro F, Ssebuufu R, Stukenborg GJ, Ntakiyiruta G, Daniel TM. Creation, Implementation, and Assessment of a General Thoracic Surgery Simulation Course in Rwanda. Ann Thorac Surg 2018; 105:1842-1849. [PMID: 29476717 DOI: 10.1016/j.athoracsur.2018.01.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/30/2017] [Accepted: 01/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The primary objective was to provide proof of concept of conducting thoracic surgical simulation in a low-middle income country. Secondary objectives were to accelerate general thoracic surgery skills acquisition by general surgery residents and sustain simulation surgery teaching through a website, simulation models, and teaching of local faculty. METHODS Five training models were created for use in a low-middle income country setting and implemented during on-site courses with Rwandan general surgery residents. A website <http://thoracicsurgeryeducation.com> was created as a supplement to the on-site teaching. All participants completed a course knowledge assessment before and after the simulation and feedback/confidence surveys. Descriptive and univariate analyses were performed on participants' responses. RESULTS Twenty-three participants completed the simulation course. Eight (35%) had previous training with the course models. All training levels were represented. Participants reported higher rates of meaningful confidence, defined as moderate to complete on a Likert scale, for all simulated thoracic procedures (p < 0.05). The overall mean knowledge assessment score improved from 42.5% presimulation to 78.6% postsimulation, (p < 0.0001). When stratified by procedure, the mean scores for each simulated procedure showed statistically significant improvement, except for ruptured diaphragm repair (p = 0.45). CONCLUSIONS General thoracic surgery simulation provides a practical, inexpensive, and expedited learning experience in settings lacking experienced faculty and fellowship training opportunities. Resident feedback showed enhanced confidence and knowledge of thoracic procedures suggesting simulation surgery could be an effective tool in expanding the resident knowledge base and preparedness for performing clinically needed thoracic procedures. Repeated skills exposure remains a challenge for achieving sustainable progress.
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Affiliation(s)
- Adriana G Ramirez
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
| | - Nebil Nuradin
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Robinson Ssebuufu
- Department of Surgery, Kampala International University Teaching Hospital, Western Campus, Ishaka-Bushenyi, Uganda
| | - George J Stukenborg
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | | | - Thomas M Daniel
- Department of Surgery, University of Virginia, Charlottesville, Virginia
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Krebs E, Gerardo CJ, Park LP, Nickenig Vissoci JR, Byiringiro JC, Byiringiro F, Rulisa S, Thielman NM, Staton CA. Erratum to "Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda" [World Neurosurgery 102 (2017) 571-582]. World Neurosurg 2017; 106:1047. [PMID: 28803734 DOI: 10.1016/j.wneu.2017.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elizabeth Krebs
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Charles J Gerardo
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Lawrence P Park
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | | | - Stephen Rulisa
- University Teaching Hospital of Kigali, Kigali, Rwanda; School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Krebs E, Gerardo CJ, Park LP, Nickenig Vissoci JR, Byiringiro JC, Byiringiro F, Rulisa S, Thielman NM, Staton CA. Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda. World Neurosurg 2017; 102:571-582. [PMID: 28336445 PMCID: PMC5681277 DOI: 10.1016/j.wneu.2017.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a leading cause of death and disability. Patients with TBI in low and middle-income countries have worse outcomes than patients in high-income countries. We evaluated important clinical indicators associated with mortality for patients with TBI at University Teaching Hospital of Kigali, Kigali, Rwanda. METHODS A prospective consecutive sampling of patients with TBI presenting to University Teaching Hospital of Kigali Accident and Emergency Department was screened for inclusion criteria: reported head trauma, alteration in consciousness, headache, and visible head trauma. Exclusion criteria were age <10 years, >48 hours after injury, and repeat visit. Data were assessed for association with death using logistic regression. Significant variables were included in a multivariate logistic regression model and refined via backward elimination. RESULTS Between October 7, 2013, and April 6, 2014, 684 patients were enrolled; 14 (2%) were excluded because of incomplete data. Of patients, 81% were male with mean age of 31 years (range, 10-89 years; SD 11.8). Most patients (80%) had mild TBI (Glasgow Coma Scale [GCS] score 13-15); 10% had moderate (GCS score 9-12) and 10% had severe (GCS score 3-8) TBI. Multivariate logistic regression determined that GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were significantly associated with death. CONCLUSIONS GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were associated with mortality. These findings inform future research that may guide clinicians in prioritizing care for patients at highest risk of mortality.
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Affiliation(s)
- Elizabeth Krebs
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Charles J Gerardo
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Lawrence P Park
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | | | - Stephen Rulisa
- University Teaching Hospital of Kigali, Kigali, Rwanda; School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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