Browsing by Author "Ndebele, W."

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    A case report of complete appendiceal duplication on the normal site of a single caecum: A new variant?
    (2020) Ngulube, A.; Ntoto, C.O.M.; Matsika, D.; Ndebele, W.; Dube, N.S.; Gapu, P.
    INTRODUCTION: Duplicated appendix is an uncommon entity, typically discovered as an incidental finding during surgery for appendicitis or other abdominal pathologies. It may be associated with other congenital malformations. We report a case of a male neonate incidentally discovered to have an unrecognized variant of duplicated appendix during a laparotomy plus diversion colostomy for imperforate anus at 4 days of age. PRESENTATION OF CASE: A baby delivered at home from an unbooked pregnancy at term, was referred from a primary care clinic to a specialist referral hospital, with a fever and suspected neonatal sepsis on day 1 of life. The patient had not passed meconium and physical examination revealed an imperforate anus. After initiating treatment for sepsis, the patient underwent a laparotomy where a situs inversus totalis and complete appendiceal duplication was found, with both appendices on the normal site of a single caecum. The appendices were left in situ and a diversion colostomy was performed. The patient did well following surgery and was discharged on postoperative day 10 to await definitive surgery. DISCUSSION: Appendiceal malformations have been reported either in isolation or in association with other congenital anomalies. Duplicated appendix occurs rarely and the pathogenesis is not fully under stood. This case adds more evidence that the classification of appendiceal abnormalities should continue evolving as newer types are described. CONCLUSION: Surgeons operating on patients with congenital anomalies must exercise extreme vigilance to identify and document other rare pathologies that may later pose challenges thus avoid morbidity, mortality and potential medicolegal pitfalls.
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    A case report of complete appendiceal duplication on the normal site of a single caecum: A new variant?
    (Elsevier, 2020) Ngulube, A.; Ntoto, C.O.M.; Ndebele, W.; Matsika, D.; Dube, N.S.; Gapu, P.
    Abstract Introduction Duplicated appendix is an uncommon entity, typically discovered as an incidental finding during surgery for appendicitis or other abdominal pathologies. It may be associated with other congenital malformations. We report a case of a male neonate incidentally discovered to have an unrecognized variant of duplicated appendix during a laparotomy plus diversion colostomy for imperforate anus at 4 days of age. Presentation of case A baby delivered at home from an unbooked pregnancy at term, was referred from a primary care clinic to a specialist referral hospital, with a fever and suspected neonatal sepsis on day 1 of life. The patient had not passed meconium and physical examination revealed an imperforate anus. After initiating treatment for sepsis, the patient underwent a laparotomy where a situs inversus totalis and complete appendiceal duplication was found, with both appendices on the normal site of a single caecum. The appendices were left in situ and a diversion colostomy was performed. The patient did well following surgery and was discharged on postoperative day 10 to await definitive surgery. Discussion Appendiceal malformations have been reported either in isolation or in association with other congenital anomalies. Duplicated appendix occurs rarely and the pathogenesis is not fully understood. This case adds more evidence that the classification of appendiceal abnormalities should continue evolving as newer types are described. Conclusion Surgeons operating on patients with congenital anomalies must exercise extreme vigilance to identify and document other rare pathologies that may later pose challenges thus avoid morbidity, mortality and potential medicolegal pitfalls.
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    Adaptation and implementation of local maternity dashboards in a Zimbabwean hospital to drive clinical improvement
    (World Health Organisation, 2013-11-27) Crofts, J.; Moyo, J.; Ndebele, W.; Mhlanga, Samson; Draycott, T.; Sibanda, T.
    Problem:The Commission on Information and Accountability for Women’s and Children’s Health of the World Health Organization (WHO) reported that national health outcome data were often of questionable quality and “not timely enough for practical use by health planners and administrators”. Delayed reporting of poor-quality data limits the ability of front-line staff to identify problems rapidly and make improvements. Approach: Clinical “dashboards” based on locally available data offer a way of providing accurate and timely information. A dashboard is a simple computerized tool that presents a health facility’s clinical data graphically using a traffic-light coding system to alert front-line staff about changes in the frequency of clinical outcomes. It provides rapid feedback on local outcomes in an accessible form and enables problems to be detected early. Until now, dashboards have been used only in high-resource settings. Local setting: An overview maternity dashboard and a maternal mortality dashboard were designed for, and introduced at, a public hospital in Zimbabwe. A midwife at the hospital was trained to collect and input data monthly. Relevant changes: Implementation of the maternity dashboards was feasible and 28 months of clinical outcome data were summarized using common computer software. Presentation of these data to staff led to the rapid identification of adverse trends in outcomes and to suggestions for actions to improve health-care quality. Lessons learnt: Implementation of maternity dashboards was feasible in a low-resource setting and resulted in actions that improved health-care quality locally. Active participation of hospital management and midwifery staff was crucial to their success.
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    Massive hemoptysis and complete unilateral lung collapse in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome: a case report.
    (BioMed central., 2013-08-22) Masukume, Gwinyai; Sengurayi, Elton; Moyo, Phinot; Feliu, Julio; Gandanhamo, Danboy; Ndebele, W.; Ngwenya, Solwayo; Gwini, Rudo
    Background: We report an extremely rare case of massive hemoptysis and complete left-sided lung collapse in pregnancy due to pulmonary tuberculosis in a health care worker with good maternal and fetal outcome. Case presentation: A 33-year-old human immuno deficiency virus seronegative African health care worker in her fourth pregnancy with two previous second trimester miscarriages and an apparently healthy daughter from her third pregnancy presented coughing up copious amounts of blood at 18 weeks and two days of gestation. She had a cervical suture in situ for presumed cervical weakness. Computed tomography of her chest showed complete collapse of the left lung; subsequent bronchoscopy was apparently normal. Her serum â-human chorionic gonadotropin, tests for autoimmune disease and echocardiography were all normal. Her lung re-inflated spontaneously. Sputum for acid alcohol fast bacilli was positive; our patient was commenced on anti-tuberculosis medication and pyridoxine. At 41 weeks and three days of pregnancy our patient went into spontaneous labor and delivered a live born female baby weighing 2.6 kg with APGAR scores of nine and 10 at one and five minutes respectively. She and her baby are apparently doing well about 10 months after delivery. Conclusion: It is possible to have massive hemoptysis and complete unilateral lung collapse with spontaneous resolution in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome.
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    A ‘one-stop shop’ approach in antenatal care: does this improve antiretroviral treatment uptake in Zimbabwe?
    (Public Health Action, 2013-12-21) Gunguwo, H.; Zachariah, R.; Bissell, K; Ndebele, W.; Moyo, J.; Mutasa-Apollo, T.
    A one-stop shop approach to ART integration along with task-shifting considerably increased ART uptake and is of benefit to mothers and newborns. This is in line with the goal of ensuring that no child is born with HIV by 2015.