Background Leptospirosis is a zoonotic disease transmitted through the urine of wild and domestic animals, and is responsible for over 50,000 deaths each year. In East Africa, prevalence varies greatly, from as low as 7% in Kenya to 37% in Somalia. Transmission epidemiology also varies around the world, with research in Nicaragua showing that rodents are the most clinically important, while studies in Egypt and Chile suggest that dogs may play a more important role. There are no published studies of leptospirosis in Rwanda. Methods & findings We performed a cross-sectional survey of asymptomatic adults recruited from five occupational categories. Serum samples were tested using ELISA and Microscopic Agglutination Test (MAT). We found that 40.1% (151/377) of asymptomatic adults had been exposed to Leptospira spp. Almost 36.3% of positive subjects reported contact with rats (137/377) which represent 90.7% among positive leptospira serology compared with 48.2% of negative subjects (182/377) which represent 80.5% among negative leptospira serology (OR 2.37, CI 1.25–4.49) and 1.7 fold on prevalence ratio and 2.37 of odd ratio. Furthermore, being a crop farmer was significantly associated with leptospirosis (OR 2.06, CI 1.29–3.28). We identified 6 asymptomatic subjects (1.6%) who met criteria for acute infection. Conclusions This study demonstrates a high prevalence of leptospiral antibodies infection among asymptomatic adults in rural Rwanda, particularly relative to neighboring countries. Although positive subjects were more likely to report rat contact, we found no independent association between rats and leptospirosis infection. Nonetheless, exposure was high among crop farmers, which is supportive of the hypothesis that rats together with domestic livestock might contribute to the transmission. Further studies are needed to understand infecting Leptospira servers and elucidate the transmission epidemiology in Rwanda and identify means of host transmitters.

Background: Kidney failure known as renal failure or Stage 5 CKD or End Stage Renal Diseases is a major problem among kidney diseases worldwide, its incidence and prevalence are rising yearly. The management requires renal replacement therapy, hemodialysis, 3 sessions per week or peritoneal dialysis until the time of renal transplantation. The cost is high in low income countries and is not covered by major medical insurances. Few renal patients are able to afford dialysis and renal transplantation. Case Presentation: A 45-year-old man Butcher, living in rural Rwanda presented with renal failure and Hypertension with history of native medication intake. He remained on chronic maintenance hemodialysis since October 2017, at one to two hemodialysis sessions per month. He preserved quality of life and cognitive function. He is reporting to have more than 1000 cc of urine volume per day. Conclusion: This case demonstrates that suboptimal hemodialysis sessions can help the renal patients to survive when they preserve residual renal functions.

Background: Admitted patients with anemia are at increased morbidity and mortality risk as well as length of hospital stay. It affects more than 2 billion people worldwide and is causing significant morbidity and mortality. Its etiology is varying with many predisposing factors including nutritional deficiencies, infections, Malignancies, chronic inflammations and other chronic diseases like autoimmune diseases, chronic liver disease, and chronic kidney disease. Methods: We performed a non-randomized, prospective observational study of 143 patients admitted in Internal Medicine between March and April 2021, we assessed their hemoglobin level in order to determine the prevalence of anemia. The demographic and clinical data were collected using a designed questionnaire. All patients found to have anemia were followed for outcome assessment (either discharge or died). Results: The prevalence of anemia was high (52.4%) among 143 admitted patients in Internal Medicine, CHUK. Patients with HIV, cancer and chronic kidney disease had 5.84-, 4.11- and 3.79-times risk of having anemia respectively. In 75 patients who had anemia 10 patients died among them 5 patients were having severe anemia; 25 patients were 60 years old and above; 60 patients had normocytic anemia and they had an average of length of hospital stay of 20.6 days, patients with severe anemia, length of hospital stay was 28 days. Conclusion: This study demonstrated a high prevalence of anemia which is associated with high mortality rate among admitted patients in CHUK. Priority should be given to the preventive medicine, optimal management of chronic disease and geriatric medicine.

Background: Venous thromboembolism (VTE) is a common and preventable disease among non-surgical hospitalized patients. Its incidence is high and alarming. Acute medical patients have VTE risk during and after hospitalization. The Padua prediction score is a risk model created to identify high VTE risk patients among non-surgical hospitalized patients. Methods: We performed a cross-sectional survey of 107 patients admitted to Internal Medicine wards who were assessed as acutely ill patients at Emergency Department, in a period of 4 weeks. The demographic and clinical data were collected using a designed questionnaire. VTE risk was defined as having a Padua Prediction score of ≥4 points. A statistical analysis was done to determine prevalence. The patients at high VTE risk received thromboprophylaxis. Results: One hundred and seven eligible patients were included. 84% were found to be at high risk for VTE. Among physiologically unstable patients, 60% of the patients were classified in red color during the time of triage; this means they were severely sick and needed resuscitation. Among the leading diagnosis, severe pneumonia was predominant (29%). Severe pneumonia and uncontrolled DM showed a significant association with high VTE risk. 11.1% of high VTE risk patients were taking anticoagulant thromboprophylaxis prior to the recruitment. Conclusion:This study demonstrated a high prevalence of VTE risk among acute ill medical patients and underuse of anticoagulants for thromboprophylaxis in potential patients at Kigali University Teaching Hospital, CHUK. The Padua prediction score should be implemented for early detection of patients at-risk of VTE in severely ill patients and to start anticoagulant thromboprophylaxis on time for reducing mortality and morbidity. Doi: 10.28991/SciMedJ-2022-0401-5 Full Text: PDF

Background: Venous thromboembolism (VTE) is common and preventable disease among non-surgical hospitalized patients. Its incidence is high and alarming. Acute medical patients have VTE risk during and after hospitalization. Padua prediction score is a risk model created to identify high VTE risk patients among non-surgical hospitalized patients. Methods: We performed a cross-sectional survey of 107 patients admitted in Internal Medicine wards that were assessed as acute ill patients at Emergency Department, in a period of 4 weeks. The demographic and clinical data were collected using a designed questionnaire. VTE risk was defined as having a Padua Prediction score of ≥4 points. Statistical analysis was done to determine prevalence. The patients at high VTE risk received thromboprophylaxis. Results: Of one hundred and seven eligible patients included. 84% were found with high VTE risk. Among physiologically unstable patients, 60% of the patients were classified in red color during the time of triage, this means, they were severely sick and needing resuscitation. Among leading diagnosis, severe pneumonia was predominant (29%). Severe pneumonia and uncontrolled DM showed significant association with high VTE risk. 11.1% of high VTE risk patients were taking anticoagulant thromboprophylaxis prior to the recruitment. Conclusion: This study demonstrated a high prevalence of VTE risk among acute ill medical patients and underuse of anticoagulants thromboprophylaxis in potential patients at Kigali University Teaching Hospital, CHUK. Padua prediction score should be implemented for early detection of patients at-risk of VTE in severely ill patients and start anticoagulant thromboprophylaxis on time for reducing mortality and morbidity.