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Purpose: Vagus nerve injuries during gastroesophageal surgery may cause significant symptoms due to loss of vagal anti-inflammatory and neuromodulator function. Many previous studies have shown high anatomical variability of the vagus nerve at the esophageal hiatus, but information on its variability in Uganda specifically and Africa in general is scanty. This study provides a reliable and detailed description of the anatomical variation and distribution of the vagus nerve in the esophageal hiatus region of post-mortem cases in Uganda., Methods: This was an analytical cross-sectional survey of 67 unclaimed post-mortem cases. Data collection used a pretested data collection form. Data were entered into Epi-Info version 6.0 data base then exported into STATA software 13.0 for analysis., Results: The pattern of the anterior vagal trunk structures at the esophageal hiatus was: single trunk [65.7%]; biplexus [20.9%]; triplexus [8.9%] and double-but-not-connected trunks [4.5%]. The pattern of the posterior trunk structures were: single trunk [85.1%]; biplexus 10.4% and triplexus [4.5%]. There was no statistically significant gender difference in the pattern of vagal fibres. There was no major differences in the pattern from comparable British studies., Conclusion: The study confirmed high variability in the distribution of the vagus nerve at the esophageal hiatus, unrelated to gender differences. Surgeons must consider and identify variants of vagal innervation when carrying out surgery at the gastroesophageal junction to avoid accidental vagal injuries. Published surgical techniques for preserving vagal function are valid in Uganda., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS part of Springer Nature.)

Skeleton models are important in facilitating a student's easy retention and recollection of information in the future. These may assist students carry out hands-on practice in order to acquire and practice new skills that are relevant to first aid. The increasing number of medical institutions and medical students attracts the challenge of inadequate facilitation of the teaching and learning processes. This warrants a study and/or an exploration of an alternative solution such as wooden models in order to solve the problem of scarce and ethically restricted human teaching aids. Wooden pieces (50 cm length × 20 cm diameter) from a Jacaranda mimosifolia tree were prepared for the carving process, and wooden replicas of human skulls were made. Two experimental groups of randomly selected medical students (60: active and 60: control) were separately taught using wooden and natural skull models, respectively. The two groups were assessed and evaluated using the natural skull models to compare their understanding of the anatomy of the skull. Additionally, opinion statements were collected from participants in the active group during the oral examination. Six (6) wooden skull models were produced and used for experimental study. Comparisons of academic scores (mean and median) between active (students using the wooden skull) and control (students using natural skull) groups showed no statistically significant difference ( P ≥ 0.05). Concerning the enhancement of learning skills, the wooden model was constructed in a way that would be able to enhance learning as it would be the natural skull. The wooden skull model, with more improvement in structural formation, can adequately facilitate the teaching and learning of anatomy of the human skull. This project and the experimental study about utilization of the wooden skull model provide a good potential of using the wooden models to supplement the use of the natural human skull., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Kintu Mugagga et al.)

Background: The global transition to use of dolutegravir (DTG) in WHO-preferred regimens for HIV treatment is limited by lack of knowledge on use in pregnancy. Here we assessed the relationship between drug concentrations (pharmacokinetics, PK), including in breastmilk, and impact on viral suppression when initiated in the third trimester (T3)., Methods and Findings: In DolPHIN-1, HIV-infected treatment-naïve pregnant women (28-36 weeks of gestation, age 26 (19-42), weight 67kg (45-119), all Black African) in Uganda and South Africa were randomised 1:1 to dolutegravir (DTG) or efavirenz (EFV)-containing ART until 2 weeks post-partum (2wPP), between 9th March 2017 and 16th January 2018, with follow-up until six months postpartum. The primary endpoint was pharmacokinetics of DTG in women and breastfed infants; secondary endpoints included maternal and infant safety and viral suppression. Intensive pharmacokinetic sampling of DTG was undertaken at day 14 and 2wPP following administration of a medium-fat breakfast, with additional paired sampling between maternal plasma and cord blood, breastmilk and infant plasma. No differences in median baseline maternal age, gestation (31 vs 30 weeks), weight, obstetric history, viral load (4.5 log10 copies/mL both arms) and CD4 count (343 vs 466 cells/mm3) were observed between DTG (n = 29) and EFV (n = 31) arms. Although DTG Ctrough was below the target 324ng/mL (clinical EC90) in 9/28 (32%) mothers in the third trimester, transfer across the placenta (121% of plasma concentrations) and into breastmilk (3% of plasma concentrations), coupled with slower elimination, led to significant infant plasma exposures (3-8% of maternal exposures). Both regimens were well-tolerated with no significant differences in frequency of adverse events (two on DTG-ART, one on EFV-ART, all considered unrelated to drug). No congenital abnormalities were observed. DTG resulted in significantly faster viral suppression (P = 0.02) at the 2wPP visit, with median time to <50 copies/mL of 32 vs 72 days. Limitations related to the requirement to initiate EFV-ART prior to randomisation, and to continue DTG for only two weeks postpartum., Conclusion: Despite low plasma DTG exposures in the third trimester, transfer across the placenta and through breastfeeding was observed in this study, with persistence in infants likely due to slower metabolic clearance. HIV RNA suppression <50 copies/mL was twice as fast with DTG compared to EFV, suggesting DTG has potential to reduce risk of vertical transmission in mothers who are initiated on treatment late in pregnancy., Trial Registration: clinicaltrials.gov NCT02245022., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: ML declared research grants from ViiV, Janssen and personal fees from Mylan.

Several studies have established a relationship between morphological and behavioral asymmetry making investigations of bilateral bone asymmetry an attractive and important research area. The purpose of this study was to investigate bilateral asymmetry patterns of skeletal specimen from five geographical locations (Rwanda, Burundi, Congo, Kenya, and Uganda) at Galloway Osteological Collection, Department of Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences. The angle of torsion and retroversion, mid-shaft circumference, length, and weight of 232 pairs of humeri were determined. A Torsiometer was used to measure the angle of torsion in degrees according to Krahl and Evans 1945, a tape was used to measure the mid-shaft circumference at the level of the apex of the deltoid V, and the length in cm was determined. An osteometric board was used to measure the length of the humerus in centimeters. A weighing balance was used to measure the weight of the humerus in grams. The analysis of humeral asymmetry with respect to parameters of the human skeletal specimen at the Galloway Osteological Collection Mulago revealed bilateral asymmetrical status observed in the angle of torsion, length, weight, and mid-shaft circumference. Our result mostly showed lateralization to the right in all the parameters investigated except the torsion angle which is to the left. Our investigation revealed that humeral torsion is inversely proportional to weight, length, and mid-shaft circumference of the humerus. This study established the existence of bilateral asymmetries in the humeri of all the geographical regions investigated with more asymmetry observed in the male compared with the female., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper

Background: The development of a safe and effective vaccine against HIV type 1 for the prevention of mother-to-child transmission of HIV would significantly advance the goal of eliminating HIV infection in children. Safety and feasibility results from phase 1, randomized, double-blind, placebo-controlled trial of ALVAC-HIV vCP1521 in infants born to HIV type 1-infected women in Uganda are reported., Methods: HIV-exposed infants were enrolled at birth and randomized (4:1) to receive vaccine or saline placebo intramuscular injections at birth, 4, 8, and 12 weeks of age. Vaccine reactogenicity was assessed at vaccination and days 1 and 2 postvaccination. Infants were followed until 24 months of age. HIV infection status was determined by HIV DNA polymerase chain reaction., Results: From October 2006 to May 2007, 60 infants (48 vaccine and 12 placebo) were enrolled with 98% retention at 24 months. One infant was withdrawn, but there were no missed visits or vaccinations among the 59 infants retained. Immune responses elicited by diphtheria, polio, hepatitis B, haemophilus influenzae type B, and measles vaccination were similar in the 2 arms. The vaccine was well tolerated with no severe or life-threatening reactogenicity events. Adverse events were equally distributed across both study arms. Four infants were diagnosed as HIV infected [3 at birth (2 vaccine and 1 placebo) and 1 in vaccine arm at 2 weeks of age]., Conclusion: The ALVAC-HIV vCP1521 vaccination was feasible and safe in infants born to HIV-infected women in Uganda. The conduct of high-quality infant HIV vaccine trials is achievable in Africa.

Background: Mentoring is a core component of medical education and career success. There is increasing global emphasis on mentorship of young scientists in order to train and develop the next leaders in global health. However, mentoring efforts are challenged by the high clinical, research and administrative demands. We evaluated the status and nature of mentoring practices at Makerere University College of Health Sciences (MAKCHS)., Methods: Pre-tested, self-administered questionnaires were sent by email to all Fogarty alumni at the MAKCHS (mentors) and each of them was requested to complete and email back the questionnaire. In addition to training level and number of mentors, the questionnaires had open-ended questions covering themes such as; status of mentorship, challenges faced by mentors and strategies to improve and sustain mentorship within MAKCHS. Similarly, open-ended questionnaires were sent and received by email from all graduate students (mentees) registered with the Uganda Society for Health Scientists (USHS). Qualitative data from mentors and mentees was analyzed manually according to the pre-determined themes., Results: Twenty- two out of 100 mentors responded (14 email and 8 hard copy responses). Up to 77% (17/22) of mentors had Master's-level training and only 18% (4/22) had doctorate-level training. About 40% of the mentors had ≥ two mentees while 27% had none. Qualitative results showed that mentors needed support in terms of training in mentoring skills and logistical/financial support to carry out successful mentorship. Junior scientists and students reported that mentorship is not yet institutionalized and it is currently occurring in an adhoc manner. There was lack of awareness of roles of mentors and mentees. The mentors mentioned the limited number of practicing mentors at the college and thus the need for training courses and guidelines for faculty members in regard to mentorship at academic institutions., Conclusions: Both mentors and mentees were willing to improve mentorship practices at MAKCHS. There is need for institutional commitment to uphold and sustain the mentorship best practices. We recommend a collaborative approach by the stakeholders in global health promotion to build local capacity in mentoring African health professionals.