Journal Articles (Medical School)

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Endomyocardial fibrosis in Uganda (Davies' disease). Part II: An epidemiologic, clinical, and pathologic study
(Elsevier - American Heart Journal, 1968) Connor, Daniel H.; Somers, Krishna; Hutt, Michael S.R.; Manion, William C.; D'Arbela, Paul G.
Endomyocardial fibrosis in Uganda (Davies' disease) is a common type of fatal heart disease in the autopsy population at Mulago Hospital. During this study, endomyocardial fibrosis caused 25 per cent (1665) of deaths from intrinsic heart disease; it showed a striking and unexplained predilection for the immigrant Rwandans, but spared the large local indigenous tribe, the Ganda. Clinically the patients had a sudden or insidious onset of failure of one or both ventricles, which proved fatal over a period of days, weeks, months, or years. At necropsy there were mural endocardial lesions at one or more of three sites—the apex of the right ventricle, the posterior wall of the left ventricle, and the apex of the left ventricle. In the early stage the cardiac connective tissues, especially those of the endocardium, were swollen with acid mucopolysaccharide (AMP) and covered by a layer of fibrin. In later lesions, the involved areas had resolved as hard, white scard composed of collagen and elastica. There were peculiar, and we believe characteristic, foci of collagen necrosis in the scar tissue at the endomyocardial junction. The cause of endomyocardial fibrosis remains unknown, but the consistent mucinous swelling of the cardiac “ground substance” and vessels plus the focal nonsuppurative disintegration of collagen suggest to us that hypersensitivity is the underlying mechanism. Although rheumatic heart disease and endomyocardial fibrosis have a number of common features, including diffuse and focal disruption of the cardiac connective tissues, the consistent differences in RHD and EMF have convinced us that the two are different diseases. At the present time there is no microscopic evidence to support the view that endomyocardial fibrosis in Uganda (Davies' disease) has a similar histogenesis to cardiopathies in other parts of the world.
Familial Cases of Endomyocardial Fibrosis in Uganda
(Br Med J - The BMJ, 1971) Patel, Ashvin K.; Ziegler, John L.; D'Arbela, Paul G.; Somers, Krishna
This report describes nine cases of endomyocardial fibrosis occurring in four families. All patients came from Rwanda or South-western Uganda, and five had tropical splenomegaly syndrome as well. It seems likely that genetic as well as environmental factors are operative in the aetiology of endomyocardial fibrosis.
Survival after first presentation with endomyocardial fibrosis
(British Heart Journal, 1972) D'Arbela, Paul G.; Mutazindwa, T.; Patel, Ashvin K.; Somers, Krishna
Forty-six cases of necropsy endomyocardial fibrosis are analysed and presented with the objective of determining their prognosis after first symptoms of the disease. Survival from first symptoms ranged from 12 days to 12 years and 2 weeks, the mean survival being 24 months. The commonest mode of termination was by progressive myocardial failure, very frequently associated with acute respiratory events - either pulmonary oedema, bronchopneumonia, or pulmonary infarction. Un-explained sudden deterioration and collapse probably due to a terminal acute dysrhythmia was the second most important immediate cause of death. Patients with sole left-sided endomyocardial fibrosis run a higher risk of succumbing to acute pulmonary oedema. Protection by development of severe right-sided endomyocardial fibrosis, organic tricuspid regurgitation, or pulmonary hypertension was therefore a relative advantage, and if other un-expected complications were excluded, survival time was increased. The role of the continuing myocardial destructive process in determining survival rate is discussed.
Endomyocardial fibrosis and eosinophilia
(British Heart Journal, 1977) Patel, Ashvin K.; D'Arbela, Paul G.; Somers, Krishna
Absolute eosinophil counts were assessed in 15 African patients with proven endomyocardial fibrosis. Though the mean eosinophil count in patients with endomyocardial fibrosis was higher compared with the normals reported from Kampala (1-13 vs 0.72X10(9)/1), the absolute range was comparable. A high percentage of patients with endomyocardial fibrosis had malarial parasites, high malarial antibody titres, hookworms, or strongyloides, but the correlation of eosinophilia to various parasitic infections was poor. Both eosinophilia and parasitic infections are common in the tropics and they effect patients with endomyocardial fibrosis no more than the population at large. Other aetiological factors, genetic, environmental, and immunological, are felt to be important in the causation of endomyocardial fibrosis in Uganda and evidence for this is reviewed. Though there is a similarity in pathological features, African endomyocardial fibrosis is a distinct entity from Löffler's endocarditis and cardiac lesions seen in eosinophilic leukaemia or reactive eosinophilia. There is no hard evidence to suggest that African endomyocardial fibrosis is a variant of Löffler's endocarditis caused by parasitic infections via eosinophilia.
The Pattern of Cancer in Kampala, Uganda
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2001) Kakande, Ignatius; Ekwaro, Lawrence; Obote, W. Wiam; NassaLi, Gorreti; Kakande, Irene Rarban; Kabuye, S.
This study on the pattern of cancer in Kampala is based on data collected from 2246 patients at Mulago Hospital and 355 patients at St. Francis Hospital Nsambya, between January 1995 and December 1998. All diagnoses were histologically confirmed. Of these 2601 patients, 1225 were males and 1376 were females. Kaposi's Sarcoma was the commonest malignancy, accounting for 28.6% of all cancers. Among males, Kaposi's Sarcoma (KS) was the most common cancer (37.1°/o) followed by prostaticcancer(9.60/0), lymphomas (8.5%), oesophageal cancer (7.0°/o), eye malignancies (3.8%) and pharyngeal cancer (3.8%). In females, the order of frequency of malignancies was cervical cancer (22.200), Kaposi's Sarcoma (21.1°/0), breast cancer (10.9%), lymphoma (5.9%), oesophageal cancer (4.6%) and eye malignancies (3.60/0). The incidence of KS has dramatically increased from 6.3% in males and 0.4% in females among patients with cancer diagnosed in 1977-80, before HIV infection was recognized. This paper compares the cancer patterns of 1995-98 with those of 1977-80 and discusses the possible influence of HIV infection on the change of patterns of cancer in Uganda.
An Overview Cancer Management And Prevention In Africa
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2001) Kakande, Ignatius
Assessment of a Pilot Antiretroviral Drug Therapy Programme in Uganda: Patients' Response, Survival, and Drug Resistance
(Elsevier, 2002-07-06) Weidle, J Paul; Malamba, Samuel; Mwebaze, Raymond; Sozi, Catherine; Rukundo, Gideon; Downing, Robert; Hanson, Debra; Ochola, Dorothy; Mugyenyi, Peter; Mermin, Jonathan; Samb, Badara; Lackritz, Eve
Background Little is known about how to implement antiretroviral treatment programmes in resource-limited countries. We assessed the UNAIDS/Uganda Ministry of Health HIV Drug Access Initiative—one of the first pilot antiretroviral programmes in Africa—in which patients paid for their medications at negotiated reduced prices. Methods We assessed patients' clinical and laboratory information from August, 1998, to July, 2000, from three of the five accredited treatment centres in Uganda, and tested a subset of specimens for phenotypic drug resistance. Findings 912 patients presented for care at five treatment centres. We assessed the care of 476 patients at three centres, of whom 399 started antiretroviral therapy. 204 (51%) received highly active antiretroviral therapy (HAART), 189 (47%) dual nucleoside reverse transcriptase inhibitors (2NRTI), and six (2%) NRTI monotherapy. Median baseline CD4 cell counts were 73 cells/μL (IQR 15–187); viral load was 193 817 copies/mL (37 013–651 716). The probability of remaining alive and in care was 0·63 (95% CI 0·58–0·67) at 6 months and 0·49 (0·43–0·55) at 1 year. Patients receiving HAART had greater virological responses than those receiving 2NRTI. Cox's proportional hazards models adjusted for viral load and regimen showed that a CD4 cell count of less than 50 cells/μL (vs 50 cells/μL or more) was strongly associated with death (hazard ratio 2·93 [1·51–5·68], p=0·001). Among 82 patients with a viral load of more than 1000 copies/mL more than 90 days into therapy, phenotypic resistance to NRTIs was found for 47 (57%): 29 of 37 (78%) who never received HAART versus 18 of 45 (40%) who received HAART (p=0·0005). Interpretation This pilot programme successfully expanded access to antiretroviral drugs in Uganda. Identification and treatment of patients earlier in the course of their illness and increased use of HAART could improve probability of survival and decrease drug resistance.
Development of Phenotypic and Genotypic Resistance to Antiretroviral Therapy in the UNAIDS HIV Drug Access Initiative – Uganda
(Wolters Kluwer Health, Inc., 2003-07) Weidlea, J. Paul; Downingb, Robert; Sozic, Catherine; Mwebaze, Raymond; Rukundo, Gideon; Malamba, Samuel; Respessa, Richard; Hertogsf, Kurt; Larderg, Brendan; Ochola, Dorothy; Mermin, Jonathan; Badara Sambk, Badara; Lackritz, Eve
Objective: We describe phenotypic drug resistance, response to therapy, and geno-typic mutations among HIV-infected patients in Uganda taking antiretroviral medica-tions for ≥ 90 days who had a viral load ≥ 1000 copies/ml. Methods: HIV-1 group and subtype, virologic and immunologic responses to anti-retroviral therapy, phenotypic resistance to antiretroviral drugs, and associated geno-typic mutations among patients at three treatment centers in Uganda between June 1999 and August 2000 were assessed. Therapy was two nucleoside reverse tran-scriptase inhibitors (NRTIs) or highly active antiretroviral therapy (HAART). Results: All HIV identified was HIV-1, group M, subtypes A, C, and D. Sixty-one (65%) of 94 patients with a phenotypic resistance result had evidence of phenotypic resistance including resistance to a NRTI for 51 of 92 (55%) taking NRTIs, to a non-nucleoside reverse transcriptase inhibitor (NNRTI) for nine of 16 (56%) taking NNRTIs, and to a protease inhibitor (PI) for eight of 37 (22%) taking PIs. At the time of the first specimen with resistance, the median change from baseline viral load was –0.56 log copies/ml [interquartile range (IQR), –1.47 to +0.29] and CD4+ cell count was +35 × 106 cells/l (IQR, –18 to +87). Genotypic resistance mutations, matched with phenotypic resistance assay results and drug history, were generally consistent with those seen for HIV-1, group M, subtype B infections in industrialized countries. Conclusion: Initial phenotypic resistance and corresponding genotypic mutations among patients treated in Uganda were similar to those with subtype B infections in North America and Europe. These data support policies that promote the use of HAART regimens against HIV-1, group M, non-B subtypes in a manner consistent with that used for subtype B infections.
Therapeutic Responses to AZT 1 3TC 1 EFV in Advanced Antiretroviral Naive HIV Type 1-Infected Ugandan Patients
(Mary Ann Liebert, Inc., 2004-07-05) Kebba, Anthony; Atwine, Diana; Mwebaze, Raymond; Kityo, Cissy; Nakityo, Rose; Mulenyi, Peter
Convenient, non-food-dependent dosing, low tablet volume, and relatively low cost have made nonnucleoside reverse transcriptase inhibitors a first choice for both clinicians and patients in Uganda. Concerns exist as to their efficacy in patients with viral loads (VL) above 100,000 copies/ml, a feature common to about 75% of HIV-1-infected patients presenting at the Joint Clinical Research Center (JCRC) in Uganda. Furthermore, there are few data on the response to such therapy of non-B subtypes, A and D, predominant in Uganda. Presented here is a retrospective analysis of therapeutic responses in 11 antiretroviral (ARV) naïve HIV-1-infected Ugandan patients who had been initiated on zidovudine (AZT), lamivudine (3TC), and efavirenz (EFV). Laboratory assessments subsequent to initiation of ARV therapy, done at 11.6 ± 3.9 weeks and 30.6 ± 5.9 weeks, showed 88.9 and 71.4% patients achieved undetectable viral load, respectively. Virological suppression to below detection occurred in 85.7% of patients at 11.6 weeks despite baseline VL ≥ 100,000 copies/ml. At 31 weeks there was a median increment of +183 cells/mm3 in CD4+ T lymphocytes. These findings reflect significant efficacy in the use of AZT + 3TC + EFV in advanced ARV naive non-B subtype HIV-1-infected patients. The therapeutic responses were comparable to those previously described in the western world.
Our Medical Colleges: A Reflection On The Past, Present and Future
(The College of Surgeons of East, Central and Southern Africa (COSECSA), 2004-12-02) Kakande, Ignatius
“The medical student’s present education is badly fragmented because his professors are not teaching him clinical medicine as should be taught – mainly because they themselves are not usually clinical doctors” Dr. J. Knowles. “Medical Professors poorer and less experienced in the art of healing – producing doctors in their deficient image” -Dr. John Knowles, General Director of Massachusetts General Hospital “The Goals of medical schools are, in a sense, a three-legged stool in which teaching, research and patient care form the necessary support. Unfortunately, recently most modern medical school have had a hypertrophy (overgrowth) of the research leg, stimulated by the trophic effect of the over-abundant sums of money in the form of research grants…. The full-time clinical professor has become primarily a research professor whose chief claim to fame is his ‘grantsmanship” and whose hallmark is ‘publish or perish’ “. Some professors are fundamentally lacking interest in teaching clinical medicine to medical students.” Willis E Brown, University of Arkansas Medical Center.
Long-Term Experience Providing Antiretroviral Drugs in a Fee-for-Service HIV Clinic in Uganda
(Wolters Kluwer Health, Inc., 2005-04-15) Kabugo, Charles; Bahendeka, Sylver; Mwebaze, Raymond; Malamba, Samuel; Katuntu, David; Downing, Robert; Mermin, Jonathan; Weidle, J. Paul
Objective: To describe the long-term experience of providing anti-retroviral (ARV) therapy, including CD4+ cell count and virologic response, at St. Francis Hospital, Nsambya, Uganda. Methods: The HIV clinic established in 1998 is a fee-for-service model where patients pay for ARVs. The care of patients who started ARVs from August 1, 1998 until October 31, 2000 was evaluated through December 31, 2002. Data were collected at the HIV clinic on standardized clinical forms. These patients had free CD4+ cell count and viral load testing performed at times determined by the physician. All persons who had ≥1 CD4+ cell count or viral load done ≥90 days after starting therapy were evaluated. Results: Three hundred twenty-one patients (49% women, 66% ARV naive, median age = 38 years, median CD4+ cell count = 79 cells/mm3, and median viral load = 249,489 copies/mL) attended the HIV clinic. Two hundred sixty-three (82%) patients returned at least once after the initial visit, of whom 54 (21%) had an interruption in therapy for >1 year. One hundred thirty-five patients were in care in 2002, 69 were known to have died (9 of whom died in 2002), and 68 were lost to follow-up. The probability of remaining alive and in care at 1 year was 0.56 (95% confidence interval [CI]: 0.50-0.61), 0.46 (95% CI: 0.41-0.51) at 2 years, 0.40 (95% CI: 0.34-0.45) at 3 years, and 0.35 (95% CI: 0.29-0.41) at 4 years. In an on-treatment analysis, the median CD4+ cell count increase during year 1 was +55 cells/mm3, +112 cells/mm3 during year 2, +142 cells/mm3 during year 3, and +131 cells/mm3 during year 4. The median log viral load change from baseline during year 1 was −1.4 copies/mL, −1.32 copies/mL during year 2, −1.9 copies/mL during year 3, and −1.51 copies/mL during year 4. Conclusions: This fee-for-service HIV clinic providing ARV treatment has successfully operated and managed patients for more than 4 years. Those who survived and remained on therapy derived long-term virologic and immunologic responses to ARV drugs in a manner similar to that observed in industrialized countries. Strategies to reduce the financial burden and other barriers to uninterrupted care as well as incentives to increase such practice models should be further explored in the African context.
Neonatal Hypothermia in Uganda: Prevalence and Risk Factors
(Oxford University Press, 2005-08-01) Byaruhanga, Romano; Bergstrom, Anna; Okong, Pius
The aim of the study was to determine the prevalence of neonatal hypothermia and associated risk factors. A cross sectional, descriptive study of neonatal hypothermia was performed on 300 newborns consecutively recruited day and night during 2 months at a Ugandan periurban hospital. Parallel tympanic and rectal temperature measurements were made at 10, 30, 60, and 90 min post partum. Rectal temperatures taken at 10, 30, 60, and 90 min showed that 29, 82, 83, and 79 per cent of the newborns, respectively, were hypothermic. Newborns observed to have no body contact with the mother comprised 87 per cent of hypothermic newborns, whereas this was the case in 75 per cent of non-hypothermic newborns ( p^0.03). The mean birthweight was 3218 g. Low birthweight newborns constituted 9/86 (10 per cent) among hypothermic newborns, whereas this was the case in 9/209 (4 per cent) among non-hypothermic newborns at 10 min ( p^0.08). Adolescent mothers were encountered more often among mothers with neonatal hypothermia of the newborn than among non-hypothermic newborns ( p^0.025). Parity, preterm delivery, daytime or night time delivery, rupture of membranes `24 h and location of newborns in theatre, labour ward, or nursery did not differ when hypothermic and non-hypothermic newborns were compared. A persistent pattern of high prevalence of neonatal hypothermia was confirmed and indicates that more vigorous efforts have to be undertaken, also in a tropical setting, to overcome problems of non-adherence to appropriate methods for thermo protection of the newborn.
Audit of Severe Maternal Morbidity in Uganda – Implications for Quality of Obstetric Care
(John Wiley & Sons, Inc., 2006-07-01) Okong, Pius; Byamugisha, Josaphat; Mirembe, Florence; Byaruhanga, Romano; Bergström, Staffan
Background. For every maternal death, there are probably 100 or more morbidities, but the quality of health care for these women who survive has rarely been an issue. The purpose of this study is to explore audit of severe obstetric morbidity and the concept of near miss in four referral hospitals in Uganda. Methods. This was an exploratory systematic enquiry into the care of a subset of women with severe morbidity designated as near miss cases by organ failure or dysfunction. Patient factors and environmental factors were also explored. Data were abstracted from clinical records and from interviews with patients, relatives, and health workers. Results. Records of 685 women with severe maternal morbidity were examined and 229 cases fulfilled the criteria for near miss cases. Obstetric hemorrhage, rupture of the uterus, puerperal sepsis, and abortion complications were the major conditions leading to the near miss state in more than three quarters of the patients. Nearly half the cases were at home when the events occurred. More than half the cases delayed to seek care, because the patients were unwilling, or relatives were not helpful. Similar proportion also experienced substandard care in the hospitals. Conclusions. A systemic analysis found substandard care and records, and patient‐related factors in more than half the cases of severe maternal morbidity. Audit of near miss cases might offer a non‐threatening stimulus for improving the quality of obstetric care.
Perceptions Among Post-delivery Mothers of Skin-to-Skin Contact and Newborn Baby Care in a Periurban Hospital in Uganda
(Elsevier, 2006-09-06) Byaruhanga, Romano; Bergstro¨m, Anna; Tibemanya, Jude; Nakitto, Christine; Okong, Pius
Objective: to explore the perceptions among post-delivery mothers of skin-to-skin contact and newborn baby care. Design: a qualitative design using focus-group discussions. Five focus groups were conducted with post-delivery mothers who had had normal deliveries. A latent content analysis was used to derive the themes from the focus-group discussions. Settings and participants: 30 post-delivery mothers were purposively sampled from 249 mothers in the postnatal ward at St Francis Hospital, Nsambya, which is located in a periurban area in Kampala, Uganda. Findings: two main themes emerged from the focus-group discussions: ‘acceptability of health practices are influenced by knowledge and sensitisation’ and ‘pregnant women’s choices are dependent on social, cultural and economic factors’. Mothers expressed varying opinions about the usefulness of skin-to-skin contact: some knew about its use to reduce the risk of hypothermia; others were ignorant, whereas some believed skin-to-skin contact was an intervention used to distract them from the pain in the post-delivery period. The vernix caseosa and the mixture of amniotic fluid with blood in the post-delivery period were perceived as dirty and infectious. The best informants for helping mothers understand the skin-to-skin intervention were the health-care providers. Social, cultural and economic factors, as well as the dominant role of the husband, were identified as important determinants for their choice and place of delivery. Key conclusions and implications for practice: the gap between the knowledge and practice of skin-to-skin contact in hospital needs to be bridged. Health-care providers need to be encouraged to continuously advocate for, educate and implement regular skin-to-skin contact.
Effect of HIV-1 Infection on Malaria Treatment Outcome in Ugandan Patients
(MAKERERE UNIV, FAC MED , PO BOX 7072, KAMPALA, UGANDA, 2007-11-09) Byakika-Kibwika, Pauline; Ddumba, Edward; Kamya, Moses
Background: Malaria and HIV-1 infection cause significant morbidity and mortality in sub-Saharan Africa. HIV-1 increases risk for malaria with the risk increasing as immunity declines.The effect of HIV-1 infection on antimalarial treatment outcome is still inconclusive. Objective: To compare antimalarial treatment outcome among HIV-1 positive and negative patients with acute uncomplicated falciparum malaria treated with chloroquine plus sulfadoxine-pyrimethamine (CQ+SP). Methods: Ninety eight HIV-1 positive patients aged 18 months or older with acute uncomplicated falciparum malaria were treated with CQ+SP and followed for 28 days to monitor outcome.Treatment outcome of HIV-1 positive patients was compared to that of 193 HIV-1 negative historical controls.The primary study outcome for both groups was treatment failure. Results: HIV-1 positive patients older than 5 years of age were less likely to have treatment failure compared to HIV-1 negative patients in the same age group (RR 0.59 95% CI 0.4- 0.8, p α 0.001) and HIV-1 positive patients on routine cotrimoxazole prophylaxis were less likely to have treatment failure following CQ+SP treatment compared to HIV negative patients (RR 0.6 95% CI 0.43-0.92, p = 0.006).There was no difference in treatment outcome according to HIV-1 status for children younger than 5 years of age. Conclusions: Adherence to cotrimoxazole prophylaxis should be reinforced in HIV positive patients and it should be reassessed if these patients present with acute episodes of malaria.
Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group
(PLOS, 2009-12-01) Luboga, Sam; Macfarlane, B. Sarah; Schreeb, Von Johan; Kruk, E. Margaret; Cherian, N. Meena; Bergstro¨, Staffan; Bossyns, B. Paul; Denerville, Ernest; Dovlo, Delanyo; Galukande, Moses; Hsia, Y. Renee; Jayaraman, P. Sudha; Lubbock, A. Lindsey; Mock, Charles; Ozgediz, Doruk; Sekimpi, Patrick; Wladis, Andreas; Zakariah, Ahmed; Dade, Babadi Name'oua; Donkor, Peter; Gatumbu, Kabutu Jane; Hoekman, Patrick; IJsselmuiden, B. Carel; Jamison, T. Dean; Jessani, Nasreen; Jiskoot, Peter; Kakande, Ignatius; Mabweijano, R. Jacqueline; Mbembati, Naboth; McCord, Colin; Mijumbi, Cephas; Miranda, de Helder; Mkony, A. Charles; Mocumbi, Pascoal; Ndihokubwayo, Bosco Jean; Ngueumachi, Pierre; Ogbaselassie, Gebreamlak; Okitombahe, Lodi Evariste; Toure, Tidiane Cheikh; Vaz, Fernando; Zikusooka, M. Charlotte; Debas, T. Haile
A Randomised Placebo-Controlled Safety and Acceptability Trial of PRO 2000 Vaginal Microbicide Gel in Sexually Active Women in Uganda
(BMJ Publishing Group, 2010) Kamali, Anatoli; Byomire, Helen; Muwonge, Catherine; Bakobaki, Julie; Rutterford, Clare; Okong, Pius; Profy, Albert; Byaruhanga, Romano; Namukwaya, Stella; McCormack, Sheena; Grosskurth, Heiner; Nunn, J Andrew; Lacey, J.N. Charles
Abstract Objectives To determine the safety of 0.5% and 2% PRO 2000 gel in terms of local and systemic adverse events (AE) and the acceptability of gel use. Design A randomised placebo-controlled trial among healthy, sexually active African women aged 18–45 years. Between June 2003 and September 2004, 180 consenting women were randomly assigned to one of four groups: PRO 2000 gel (0.5% or 2%), placebo gel, or condom use only. Participants were screened for sexually transmitted infections, with HIV counselling and testing. Women randomly assigned to gel used this intravaginally twice a day for 28 days. Follow-up visits were fortnightly up to 6 weeks from enrolment, and comprised a physical examination including colposcopy, laboratory testing and questionnaire interviews. Results Ten women were lost to follow-up, none due to AE. Adherence with total gel doses was 69%. Observed rates of the primary toxicity endpoints, ulceration greater than 2×1 cm and clinically relevant coagulation abnormalities were, for PRO 2000 0.5%: 1.6% (95% CI 0.04% to 8.5%) and 0% (97.5% CI 0% to 5.7%), and for PRO 2000 2%: 0% and 0% (97.5% CI 0% to 5.9%). Women randomly assigned to active gels did not show an increased rate of AE. Gel use had no significant effect on haematology and biochemistry results. Women found gel use highly acceptable. Conclusions Both concentrations of PRO 2000 gel were found to be safe and well tolerated. These data justified testing the gels in large-scale effectiveness trials.
Risk of Being Seropositive for Multiple Human Papillomavirus Types Among Finnish and Ugandan Women
(Informa Healthcare, Taylor & Francis, 2010-02-24) Namujju, Bazanya Proscovia; Surcel, Heljä-Marja; Kirnbauer, Reinhard; Kaasila, Marjo; Banura, Cecily; Byaruhanga, Romano; Muwanga, Moses; Mbidde, Katongole Edward; Koskela, Pentti; Lehtinen, Matti
Although infections with multiple human papillomavirus (HPV) types have been reported widely, more information is needed on the occurrence of the different types. We determined the distribution of seroprevalences to multiple HPV types in Finland and Uganda to compare the epidemiology of the different HPV types in the 2 populations. Serum samples were obtained from 2784 Finnish and 1964 Ugandan women (mean ages 22 y and 25 y, respectively) of whom 44% and 57%, respectively, had antibodies to at least 1 of the 7 HPV types (6, 11, 16, 18, 31, 33, 45) tested ( p 0.001). Multiple HPV antibody positivity was common. HPV45-seropositive Finns had a higher risk of having antibodies to other high-risk HPV types: HPV18 (odds ratio (OR) 10.9), HPV31 (OR 6.1), HPV33 (OR 12.2), than their Ugandan counterparts: HPV18 (OR 3.4), HPV31 (OR 2.2), HPV33 (OR 3.3). Increased estimates for being double antibody-positive were also noted among HPV18- and HPV16- seropositive women, but there were no major differences between HPV16-seropositive Finns and Ugandans. In addition to biological and behavioural factors, iatrogenic and societal factors (screening vs no screening) may also result in the different occurrence of infections with the high-risk HPV types in Finland and Uganda.
Prevalence and Types of Cognitive Impairment Among Patients With Stroke Attending a Referral Hospital in Uganda
(Pan African Association of Neurological Sciences, 2011) Mukisa, Robert; Ddumba, Edward; Seggane, Musisi; Kiwuwa, M Steven
Background Cognitive impairment is associated with short and long term adverse outcomes in stroke patients that may impair functional recovery during their rehabilitative process. Aims This study determined the prevalence, grades and demographic factors associated with cognitive impairment among patients with stroke attending Mulago National Referral Hospital in Uganda, a teaching hospital for Makerere University College of Health Sciences. Methods This was a cross-sectional descriptive study conducted from Mulago National Referral Hospital between June 2006 and March 2007. Eighty five patients with stroke confirmed by brain computed tomography scan, consenting either by themselves or by their guardians, were consecutively recruited from the Medical wards, Neurology clinic and the Physiotherapy department. A standardized questionnaire was interviewer administered, to obtain demographic and clinical data, and the Mini-Mental State Examination instrument was used to screen and grade cognitive impairment. Results Of the 85 patients evaluated, 70 (82.4%) had infarct and 15 (17.6%) hemorrhagic stroke. Fifty-four (63%, 95% confidence interval (CI): 53 - 73) had cognitive impairment; of which 23 (27%) and 14 (16%) had mild and moderate cognitive impairment respectively accounting for 43% of the cognitively impaired but with no dementia, and 17 (20%) had severe cognitive impairment (dementia). The only socio-demographic factor associated with cognitive impairment was age . 40 years (odds ratio (OR) 4, 95% CI 1.2 - 13.4, P = 0.024). Conclusions The prevalence of cognitive impairment among patients with stroke is high. Increasing age is significantly associated with cognitive impairment. There is need for neurocognitive assessment programs among stroke patients and the introduction of rehabilitation services should target to maximize their functional recovery.
Bacteriuria Among Adult Non-Pregnant Women attending Mulago Hospital Assessment Centre in Uganda
(Makerere University, 2011-06-02) Mwaka, Amos Deogratius; Mayanja-Kizza, H; Kigonya, E; Kaddu-Mulindwa, D
Background: Urinary tract infections (UTIs) in women are a common problem in primary health care settings. Resistance of bacterial uropathogens to commonly used antibiotics is common in many places. Objectives: To determine the prevalence of UTI, associated uropathogens and their antimicrobial susceptibility. Methods: A cross section study carried out at Mulago hospital outpatients’ department. Midstream urine samples (MSU) were collected from 399 women, who gave informed consent and fulfilled other study criteria. Quantitative culture method, identification of uropathogens and antibiotic susceptibility testing using the Kirby-Bauer disc diffusion technique were applied to the isolates. Results: Out of 399 MSU samples, 40 pure significant bacterial growths (>105 colony forming units (cfu)/ml of urine) were isolated and these included Escherichia coli, 23 (57.5%), Staphylococcus aureus, 9 (22.5%), Enterococci spp, 6 (15%) and Klebsiella pneumoniae, 2 (5.0%). Overall, sensitivities were: nitrofurantoin (98.3%), cefuroxime (89.3%), and cotrimoxazole (20%) by all uropathogens isolated. Conclusions: Culture positive UTI among adult non-pregnant women are a common problem, occurring in 10% of the study population. Most bacterial uropathogens showed high sensitivity to nitrofurantoin but low sensitivity to SXT. Recommendations: Nitrofurantoin should be considered as drug of choice for empirical treatment of community acquired uncomplicated UTI in adult non-pregnant women.

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