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"Ahmed, Mohammed M. A"
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Our experience with blast and gunshot induced traumatic vascular injuries at Somalia’s major vascular referral center
Blast and gunshot-induced penetrating traumatic vascular injuries represent a significant portion of patients with vascular trauma in countries where there are higher rates of war-related violence. These injuries are especially challenging in resource-limited countries due to early diagnosis and transfer delays. This report aimed to present our experience regarding the surgical management and outcome of such injuries at a major referral vascular surgery centre in the country. A retrospective descriptive review of 326 patients with blast and gunshot-induced penetrating traumatic vascular injuries managed during a five-year period between April 2018 and April 2023. The demographics, mechanism of injury, type of vascular injury, Anatomical location, time to the operation, length of hospital stay, amount of blood products given, concomitant neuroskeletal injuries, development of Vascular injury associated acute kidney injury, surgical procedures performed and patient outcome were reviewed. In this study, 326 patients with 445 vascular injuries fulfilled the inclusion criteria. Most of the patients were male 92.3%, and the mean age was 28.3 ± 9.9 years. The gunshot mechanism of vascular injury was implicated in 76.1% of the injuries, and explosive-induced injury was 78 (23.9%). 193 (59.2%) of the patients had isolated arterial injuries, 117 (35.9%) patients had combined arterial and venous injuries while 18 (4.9%) patients had isolated venous injuries. The most commonly injured arteries were the femoral artery, followed by Brachial and popliteal artery injuries (26.1%, 23.5% and 19.4%, respectively). The median time to revascularization was 8.8 ± 8.7 h. 46.8% of the patients had Concomitant fractures, while 26.5% had Concomitant nerve injuries. Only three patients had temporary non-heparin-bound shunts during their arrival. The most common surgical intervention in arterial injuries was reversed saphenous vein graft 46.1%. The mortality was 5.8% and 7.7% of the patients needed secondary amputation. The majority of wartime arterial injuries are a result of Blast and gunshot vascular injuries. Frequent need for autologous vein grafts should be considered to manage such injuries. Results are encouraging despite delays in intervention; therefore, all viable limbs should be revascularized, keeping in mind the long-term functionality of the limb.
Journal Article
Acceptability to donate human milk among postnatal mothers at St. Francis hospital Nsambya, Uganda: a mixed method study
Background
The World Health Organization recommends the use of donated human milk (HM) as the second-best option for mothers who are temporarily unable to provide sufficient breast milk to meet the needs of their infants. However, HM donation is yet to become an accepted practice in Uganda. We assessed the level of, and factors associated with acceptability to donate HM among postnatal mothers at St. Francis Hospital Nsambya (SFHN).
Methods
A cross-sectional sequential explanatory mixed method study was conducted between October 2018 and March 2019. A questionnaire on sociodemography, awareness and likely acceptability to donate HM was administered to 410 postnatal mothers at SFHN. Multivariate logistic regression analysis was undertaken to determine factors associated with acceptance of HM donation. Focus Group Discussions (4) and Key Informants Interviews (4) were used to explore factors influencing behaviours to donate human milk. Qualitative data were analysed using a content thematic approach.
Results
Overall acceptance of donating the HM was 77.6%, and the significant factors were: willingness to express the HM (AOR 7.5; 95% CI 3.01, 18.68); wet-nursing knowledge (AOR 2.3; 95% CI 1.1, 5.0) and visit to under-5 years’ clinic (AOR 21.3; 95% CI 2.3, 196.9). The major themes in relation to accepting to donate HM were wet nursing experience, and confidence in donating the HM, and its perceived effectiveness. There were concerns about the safety and adequacy of HM and fear of transmitting criminal behaviours and mental illness through human milk.
Conclusions
Acceptance to donate HM among postnatal mothers at St. Francis Hospital Nsambya was very high. Willingness to express and store human milk, prior knowledge about wet nursing and a visit to an under-five outpatient clinic were associated with acceptance. Thus, establishing a human milk bank is feasible in the study setting.
Journal Article
COVID-19 Vaccine Acceptability and Adherence to Preventive Measures in Somalia: Results of an Online Survey
Most countries are currently gravitating towards vaccination as mainstay strategy to quell COVID-19 transmission. Between December 2020 and January 2021, we conducted a follow-up online survey in Somalia to monitor adherence to COVID-19 preventive measures, and COVID-19 vaccine acceptability and reasons for vaccine hesitancy. Adherence was measured via a composite adherence score based on four measures (physical distancing, face mask use, hand hygiene, and mouth covering when coughing/sneezing). We analyzed 4543 responses (mean age: 23.5 ± 6.4 years, 62.4% males). The mean adherence score during this survey was lower than the score during a similar survey in April 2020. A total of 76.8% of respondents were willing to receive the COVID-19 vaccine. Flu-like symptoms were more frequently reported in the current survey compared to previous surveys. Multiple logistic regression showed that participants who experienced flu-like symptoms, those in the healthcare sector, and those with higher adherence scores had higher odds for vaccine acceptability while being a female reduced the willingness to be vaccinated. In conclusion, our data suggest that the decreasing adherence to COVID-19 preventive measures may have caused increased flu-like symptoms over time. COVID-19 vaccine acceptance in Somalia is relatively high but could be improved by addressing factors that contribute to vaccine hesitancy.
Journal Article
Characterization and RNAi-mediated knockdown of Chitin Synthase A in the potato tuber moth, Phthorimaea operculella
Chitin is a major component of insect exoskeleton, tracheal system and gut where it is synthesized by chitin synthase (CHS) enzymes. In this paper, we report the isolation and RNAi of chitin synthase A (
PhoCHSA
) from the potato tuber moth
Phthorimaea operculella
. The full-length cDNA of
PhoCHSA
is 5,627 bp with 4,689 bp open reading frame coding for 1,563 amino acids. Structural analysis of conceptual amino acid translation showed three distinct regions found in all known insect CHS proteins; N-terminus region having 9 transmembrane helices, middle catalytic region containing several conserved domains identified in insect CHS enzymes, and C-terminus region containing seven transmembrane spans. Phylogenetic analysis showed that PhoCHSA protein clustered with CHSA enzymes identified from insects from different insect orders. RNAi targeting three different regions of the gene showed different efficacy against potato tuber moth larvae and dsRNA targeting the 5′ region has the highest efficacy. Results were verified by qRT-PCR which showed that dsRNA targeting the 5′ region caused the highest reduction in
PhoCHSA
mRNA level. Our results show the importance of selecting the RNAi target region and that chitin synthase A can be a suitable RNAi target for the potato tuber moth control.
Journal Article
Numerical Analysis of the Cyclic Behavior of Reinforced Concrete Columns Incorporating Rubber
A numerical analysis of rubberized reinforced concrete columns’ performance under cyclic loading is presented in this study. Three different concrete blends (M1, M2, and M3) were chosen based on the volume of fine aggregate replaced by varying percentages of crumb rubber (CR) (0%, 10%, and 15%). Under cyclic loads, three groups of rubberized reinforced concrete (RRC) columns with circular, square, and rectangular cross-sections and heights of 1.5 m and 2.0 m were analyzed using the finite element software ABAQUS. The proposed model effectively predicts the behavior of rubberized reinforced concrete columns under cyclic loading. Additionally, these columns demonstrate improved performance in lateral displacement, displacement ductility, and damping ratio, with only a slight reduction in lateral load capacity. For the circular columns with a height of 1.5 m, the displacement ductility increased by 47.8% and 89.0% when the fine aggregates were replaced with 10% and 15% CR, respectively. Similarly, for square columns of the same height, the displacement ductility increased by 18.7% and 26.7% with 10% and 15% CR, respectively. The rectangular specimens exhibited enhancements of 34.74% and 58.95%, respectively. Although the analyzed rubberized reinforced concrete columns experienced slight reductions in the lateral load capacity compared to the non-CR columns, the cyclic damage resistance was notably improved.
Journal Article
Comprehensive analysis of neurological disease patterns in a fragile health system in Somalia
Neurological disorders are increasingly prevalent in developing countries, particularly in sub-Saharan Africa. However, data regarding the epidemiology of these conditions in Somalia remain limited. This study aims to analyze the patterns of neurological diagnoses among patients admitted to the neurology department of a tertiary referral hospital in Mogadishu, Somalia. We conducted a retrospective cross-sectional study at Somalia’s largest referral hospital in Mogadishu between July 2019 and July 2024. Data were extracted from electronic medical records of adult patients admitted with neurological conditions to the neurology ward, emergency department, and general intensive care units. Pediatric and trauma-related admissions were excluded. Descriptive statistics, Pearson chi-square tests, binary logistic regression, and Kaplan–Meier survival analysis were employed to assess the distribution of neurological diagnoses and factors associated with in-hospital mortality. A total of 2,126 patients were included in the study. The mean age was 56.03 ± 19.07 years (range: 18–98 years), and the majority were male (n = 1,274; 60%). Most admissions originated from the emergency department (n = 1,741; 82%). Over half of the patients had at least one comorbidity (n = 1,329; 62.5%), with hypertension being the most common (n = 654; 31%), followed by diabetes mellitus (n = 175; 8.2%), epilepsy (n = 138; 6.5%), heart disease (n = 118; 5.6%), and previous stroke or transient ischemic attack (TIA) (n = 67; 3.2%). The leading neurological diagnoses were ischemic stroke (n = 905; 42.6%), hemorrhagic stroke (n = 552; 26%), epileptic disorders (n = 166; 7.8%), cerebral venous thrombosis (n = 138; 6.5%), non-traumatic subarachnoid hemorrhage (n = 92; 4.2%), and Guillain–Barré syndrome (n = 47; 2.2%). Intrahospital mortality was recorded in 342 patients (23%). Poor survival outcomes were significantly associated with advanced age, comorbidities, multiple diagnoses, low Glasgow Coma Scale (GCS) scores, and ICU admission, underscoring the importance of early detection and targeted interventions to reduce mortality. This study represents the first comprehensive assessment of neurological admissions in Mogadishu, Somalia—a region with limited healthcare resources. Cerebrovascular diseases and epileptic disorders were the most common diagnoses. The high in-hospital mortality rate emphasizes the urgent need to strengthen preventative and therapeutic strategies targeting non-communicable neurological diseases in low-resource settings.
Journal Article
COVID-19 in Somalia: Adherence to Preventive Measures and Evolution of the Disease Burden
Following the COVID-19 outbreak in Somalia, strict preventive measures were implemented by the government. We assessed adherence to the government recommendations via two consecutive online cross-sectional surveys between April and July 2020. A five-point adherence score was constructed based on self-reported observance of five preventive measures (physical distancing, face mask use, hand hygiene, mouth covering when coughing/sneezing, and avoidance of touching the face). 4124 and 4703 responses were analyzed during the first and second survey, respectively. The mean adherence score decreased from 3.54 ± 1.5 in the first survey to 3.40 ± 1.6 during the second survey; p < 0.001. More participants experienced at least one flu-like symptom during the second survey (38.2%) compared to the first (16.2%); however, the proportion of positive COVID-19 tests in the first (26.9%) and second survey (26.5%) was similar. The ordinal logistic regression model identified the following predictors for high adherence scores: female gender (odds ratio (OR) = 1.715 (1.581–1.861), p < 0.001); being a healthcare worker/student (OR = 2.180 (2.000–2.377), p < 0.001); obtaining COVID-19 information from official sources (OR = 1.460 (1.341–1.589), p < 0.001); and having postgraduate education (OR = 1.679 (1.220–2.307), p < 0.001). Conversely, obtaining COVID-19 information from social media and residing in urban settings were associated with lower adherence. Targeted and context-specific adaptations of the COVID-19 response may be required in Somalia.
Journal Article