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Article ; Online: Postoperative antibiotics can be de-escalated after laparoscopic surgery for complex appendicitis.

Bhangu, Aneel / Buchwald, Pamela / Ntirenganya, Faustin

2023 Volume 401, Issue 10374, Page(s) 323–324

MeSH term(s)	Humans ; Appendicitis/surgery ; Anti-Bacterial Agents/therapeutic use ; Appendectomy ; Postoperative Complications/surgery ; Laparoscopy ; Retrospective Studies ; Length of Stay ; Acute Disease
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-01-17
Publishing country	England
Document type	Journal Article
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(22)02544-2
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Article: Estimating mortality risk in burn patients admitted at Rwanda's largest referral hospital.

Shyaka, Ian / Miranda, Elizabeth / Velin, Lotta / Mukagaju, Francoise / Nezerwa, Yves / Ntirenganya, Faustin / Furaha, Charles / Riviello, Robert / Pompermaier, Laura

International journal of burns and trauma

2024 Volume 14, Issue 1, Page(s) 25–31

Abstract: Background: Burns is a disease of poverty, disproportionately affecting populations in low- and middle-income countries, where most of the injuries and the deaths caused by burns occurs. In Sub-Saharan Africa, it is estimated that one fifth of burn ... ...

Abstract	Background: Burns is a disease of poverty, disproportionately affecting populations in low- and middle-income countries, where most of the injuries and the deaths caused by burns occurs. In Sub-Saharan Africa, it is estimated that one fifth of burn victims die from their injuries. Mortality prediction indexes are used to estimate outcomes after provided burn care, which has been used in burn services of high-income countries over the last 60 years. It remains to be seen whether these are reliable in low-income settings. This study aimed to analyze in-hospital mortality and to apply mortality estimation indexes in burn patients admitted to the only specialized burn unit in Rwanda. Methods: This retrospective study included all patients with burns admitted at the burn unit (BU) of the University Teaching Hospital in Kigali (CHUK) between 2005 and 2019. Patient data were collected from the BU logbook. Descriptive statistics were calculated with frequency (%) and median (interquartile range, IQR). Association between burns characteristics and in-hospital mortality was calculated with Fisher's exact test, and Wilcoxon rank, as appropriate. Mortality estimation analysis, including Baux score, Lethal Area 50 (LA50), and point of futility, was calculated in those patients with complete data on age and TBSA. LA50 and point-of-futility were calculated using logistic regression. Results: Among the 1093 burn patients admitted at the CHUK burn unit during the study period, 49% (n=532) had complete data on age and TBSA. Their median age, TBSA, and Baux score were 3.4 years (IQR 1.9-17.1), 15% (IQR 11-25), and 24 (IQR 16-38), respectively. Overall, reported in-hospital mortality was 13% (n=121/931), LA50 for Baux score was 89.9 (95% CI 76.2-103.7), and the point-of-futility was at a Baux score of 104. Conclusion: Mortality estimation indexes based on age and TBSA are feasible to use in low-income settings. However, implementation of systematic data collection would contribute to a more accurate calculation of the mortality risk.
Language	English
Publishing date	2024-02-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2664425-3
ISSN	2160-2026
ISSN	2160-2026
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Article ; Online: Unusual anatomical variations of the hepatic arteries and bile ducts: What are the surgical implications.

Umugwaneza, Nathalie / Byiringiro, Fidele / Ndahimana, Paul / Ivang, Andrew / Nyundo, Martin / Ntirenganya, Faustin / Gashegu, Julien

African health sciences

2023 Volume 22, Issue 3, Page(s) 697–702

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.: ... ...

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.
MeSH term(s)	Humans ; Hepatic Artery/anatomy & histology ; Bile Ducts/anatomy & histology ; Liver ; Cadaver
Language	English
Publishing date	2023-02-24
Publishing country	Uganda
Document type	Case Reports ; Journal Article
ZDB-ID	2240308-5
ISSN	1729-0503 ; 1680-6905
ISSN (online)	1729-0503
ISSN	1680-6905
DOI	10.4314/ahs.v22i3.74
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Article: Building Sustainable Reconstructive Microsurgery in Countries with Limited Resources: The Rwandan Experience.

Shyaka, Ian / Nezerwa, Yves / Mukagaju, Francoise / Dang, Rushil R / Furaha, Charles / Ntirenganya, Faustin

Plastic and reconstructive surgery. Global open

2023 Volume 11, Issue 10, Page(s) e5332

Abstract: Background: Reconstructive microsurgery practice has been well adopted in developed countries, but this has not been the same in low- and middle-income countries (LMICs). Injuries related to road traffic accidents are highest in these countries, with 93% ...

Abstract	Background: Reconstructive microsurgery practice has been well adopted in developed countries, but this has not been the same in low- and middle-income countries (LMICs). Injuries related to road traffic accidents are highest in these countries, with 93% of the world's fatalities on the roads occurring in LMICs. The objective of this study was to highlight the need for sustainable microsurgery in LMICs and share strategies undertaken in Rwanda. Methods: We review the contemporary literature about the needs and challenges facing reconstructive microsurgery in LMICs. We describe the strategies undertaken in Rwanda towards developing microsurgery. We also report the outcomes of the first ever microsurgery visiting professorship organized in the country and the steps taken towards achieving sustainable microsurgery practice in Rwanda. Results: There is a huge unmet need for reconstructive microsurgery in LMICs. Most of the microsurgical operations in these countries are done in short term surgical mission setups. No data focusing on sustaining reconstructive microsurgery in LMICs has been described in the contemporary literature. There is a 2.5-fold increase in the number of trained plastic surgeons in Rwanda over the past 5 years, with increasing skills in microsurgery and opportunities for formal overseas fellowships. Conclusion: With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable microsurgery services is possible in countries with limited resources. In our experience, the fly-in-fly-out microsurgical missions aimed at mainly providing surgical care to patients seem to have a limited long-term impact and sustainability. We recommend integrating these missions into planned microsurgical initiatives of pre-existing local plastic surgery training programs.
Language	English
Publishing date	2023-10-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000005332
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Article ; Online: Has There Been Exacerbation of Disparities in Antimicrobial Resistance during the SARS-Cov-2 Pandemic?

Rickard, Jennifer / Boulware, David R / Guan, Weihua / Ntirenganya, Faustin / Kline, Susan

Surgical infections

2022 Volume 23, Issue 7, Page(s) 613–615

MeSH term(s)	Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; COVID-19 ; Drug Resistance, Bacterial ; Humans ; Pandemics ; SARS-CoV-2
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-07-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2022.099
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Article ; Online: Factors Influencing Seeking and Reaching Care in Patients With Peritonitis in Rwanda.

Munyaneza, Martin / Jayaraman, Sudha / Ntirenganya, Faustin / Rickard, Jennifer

The Journal of surgical research

2019 Volume 246, Page(s) 236–242

Abstract: Background: Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in ... ...

Abstract	Background: Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda. Methods: This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors. Results: Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449). Conclusions: In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Health Expenditures/statistics & numerical data ; Hospitals, University/economics ; Hospitals, University/statistics & numerical data ; Humans ; Male ; Medicine, African Traditional/psychology ; Medicine, African Traditional/statistics & numerical data ; Middle Aged ; Patient Acceptance of Health Care/psychology ; Patient Acceptance of Health Care/statistics & numerical data ; Peritonitis/economics ; Peritonitis/surgery ; Rwanda ; Socioeconomic Factors ; Surgical Procedures, Operative/economics ; Surgical Procedures, Operative/psychology ; Surgical Procedures, Operative/statistics & numerical data ; Tertiary Care Centers/economics ; Tertiary Care Centers/statistics & numerical data ; Time-to-Treatment/statistics & numerical data ; Young Adult
Language	English
Publishing date	2019-10-11
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2019.09.027
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Article: Premenopausal Breast Cancer Risk Factors and Associations with Molecular Subtypes: A Case-Control Study.

Ntirenganya, Faustin / Twagirumukiza, Jean Damascene / Bucyibaruta, Georges / Rugwizangoga, Belson / Rulisa, Stephen

International journal of breast cancer

2021 Volume 2021, Page(s) 5560559

Abstract: Background: Breast cancer (BC) is the most prevalent cancer in women and the leading cause of women's cancer-related deaths and morbidity worldwide. In Rwanda, BC incidence is increasing with an unacceptably high mortality rate in premenopausal women.!## ...

Abstract	Background: Breast cancer (BC) is the most prevalent cancer in women and the leading cause of women's cancer-related deaths and morbidity worldwide. In Rwanda, BC incidence is increasing with an unacceptably high mortality rate in premenopausal women. Objectives: The purpose was to identify modifiable BC risk factors and assess associations between common breast cancer risks factors and molecular subtypes in premenopausal women in Rwanda. Methods: This was a case-control study. Premenopausal women with histological confirmation of BC and frequency-matched for age controls were recruited. A preestablished questionnaire was administered to both cases and controls for sociodemographics, BC probable risk factors, and clinical and pathological characteristics. BC was classified into luminal A, luminal B, HER2-type, basal-like (triple negative), and unclassified molecular subtypes by immunohistochemistry (IHC). Odds ratio (OR) and 95% confidence interval (CI) were estimated using multivariate logistic regression analysis. Results: 340 participants were recruited into the study (170 cases Conclusion: Several reproductive, environmental, and lifestyle risk factors have been identified to be associated with premenopausal BC. Among them, alcohol intake and obesity/overweight during adolescence/early adulthood can be modified. Interventions targeting alcohol consumption and obesity/overweight in adolescents and young adults may decrease the incidence of premenopausal breast cancer.
Language	English
Publishing date	2021-10-08
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2603566-2
ISSN	2090-3189 ; 2090-3170
ISSN (online)	2090-3189
ISSN	2090-3170
DOI	10.1155/2021/5560559
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Article ; Online: Global Health in the 21st Century: Equity in Surgical Training Partnerships.

Rickard, Jennifer / Ntirenganya, Faustin / Ntakiyiruta, Georges / Chu, Kathryn

Journal of surgical education

2018 Volume 76, Issue 1, Page(s) 9–13

Abstract: Introduction: Safe and affordable surgical care has been recognized as an important component of global health. One of the challenges in providing safe and affordable surgical care is the shortage of trained surgical workforce. Partnerships have ... ...

Abstract	Introduction: Safe and affordable surgical care has been recognized as an important component of global health. One of the challenges in providing safe and affordable surgical care is the shortage of trained surgical workforce. Partnerships have developed between institutions in high-income countries (HICs) and low- and middle-income countries (LMICs) to strengthen and expand surgical education in LMICs. As these relationships evolve, emphasis needs to focus on development of equitable, bilateral partnerships. Methods: We reviewed different global surgery education partnerships to describe key components and features of successful partnerships. We then provide a framework for equitable global surgical training partnerships. Results: Key features of equitable global surgical education partnerships included an alignment with local priorities, long term collaborations, and locally integrated, competency-based training. To develop a partnership, both parties must meet and perform a needs assessment of the LMIC institution and jointly agree how the partnership can best address these needs. Both the HIC and LMIC institutions must clearly define their goals and expectations. Ideally, a set of output measures will be defined to assess the success of the partnership. Conclusions: Improving surgical education in LMIC countries is an integral part of health equity in global surgery. Key components of equitable education partnerships focus on local ownership and long-term relationships. Each party needs to clearly define goals and expectations for the partnership. Equity is essential and unequal relationships must be avoided.
MeSH term(s)	Developing Countries ; Education, Medical, Graduate/standards ; Global Health ; Specialties, Surgical/education
Language	English
Publishing date	2018-08-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2018.07.010
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Article ; Online: Necrotizing Soft Tissue Infections at a Tertiary Referral Hospital in Rwanda: Epidemiology and Risk Factors for Mortality.

Mpirimbanyi, Christophe / Rickard, Jennifer / Furaha, Charles / Ntirenganya, Faustin

World journal of surgery

2018 Volume 42, Issue 8, Page(s) 2314–2320

Abstract: Background: Necrotizing soft tissue infections (NSTI) are emergency surgical conditions with severe physiologic and metabolic derangement. These infections are associated with increased rates of mortality and morbidity worldwide, particularly in ... ...

Abstract	Background: Necrotizing soft tissue infections (NSTI) are emergency surgical conditions with severe physiologic and metabolic derangement. These infections are associated with increased rates of mortality and morbidity worldwide, particularly in developing countries if not diagnosed and treated early. Methods: This prospective, observational cohort study includes all patients aged 12 and above who presented at Department of Surgery, University Teaching Hospital of Kigali from April 2016 to January 2017 with NSTI. We describe epidemiology, operative management, and outcomes of care. We determined risk factors for mortality using multivariate logistic regression. Results: We identified 175 patients with confirmed diagnosis of NSTI. The majority of patients (53%) were male, and the mean age was 44 years. The median duration of symptoms was 8 days [interquartile range (IQR) 5-14]. The median length of hospital stay was 23 days (IQR 8-41). The overall mortality was 26%. Multivariate regression analysis revealed four independent predictors of mortality: presence of shock at admission [odds ratio (OR) 14.15, 95% confidence interval (CI) 0.96-208.01, p = 0.050], renal failure (OR 8.92, 95% CI 1.55-51.29, p = 0.014), infection located on the trunk (OR 5.60, 95% CI 0.99-31.62, p = 0.050), and presence of skin gangrene (OR 4.04, 95% CI 1.18-13.76, p = 0.026). Conclusion: In Rwanda, NSTI mortality is high and associated with advanced disease. It is imperative that efforts are focused on early consultation, diagnosis, and surgical management to prevent adverse outcomes.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Fasciitis, Necrotizing/epidemiology ; Female ; Humans ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Rwanda/epidemiology ; Soft Tissue Infections/epidemiology ; Soft Tissue Infections/etiology ; Soft Tissue Infections/mortality ; Tertiary Care Centers ; Young Adult
Language	English
Publishing date	2018-02-07
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-018-4515-z
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Article: Use of Student-Generated Multiple Choice Questions to Enhance Team-Based Learning of Anatomy at the University of Rwanda.

Sibomana, Isaie / Karenzi, Irenee David / Niyongombwa, Irenee / Byiringiro, Jean Claude / Gashegu, Julien / Ntirenganya, Faustin

Advances in medical education and practice

2020 Volume 11, Page(s) 825–832

Abstract: Introduction: Teaching of human anatomy has undergone significant changes in the past three decades. At the University of Rwanda, anatomy is being taught using team-based learning (TBL). While student-generated multiple choice questions (MCQs) stimulate ...

Abstract	Introduction: Teaching of human anatomy has undergone significant changes in the past three decades. At the University of Rwanda, anatomy is being taught using team-based learning (TBL). While student-generated multiple choice questions (MCQs) stimulate deeper thinking on a given topic, their impact on anatomy learning is not known. This study aimed to find out the impact of student-generated MCQs on the current anatomy teaching method at the University of Rwanda. Methods: In this comparative interventional study, two similar chapters on anatomy were selected; one was taught using TBL while for the other one, in addition to TBL, students were encouraged to set MCQs while studying. Pre- and post-test scores were analyzed using SPSS 23 and the Student's Results: Thirty-one medical students were recruited. Pre-test mean scores were 25.10 and 25.19 out of 50 for chapters 1 and 2, respectively. Although the students' post-test scores improved after teaching for each chapter, the improvement was much greater for chapter 2 than for chapter 1, with mean scores of 39.97 and 32.45 out of 50, respectively ( Conclusion: This study found that student-generated MCQs can be used as a simple and cost-effective tool to enhance TBL of anatomy.
Language	English
Publishing date	2020-11-03
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2578539-4
ISSN	1179-7258
ISSN	1179-7258
DOI	10.2147/AMEP.S274298
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