The prevalence of depression and its associated factors among patients with diabetes mellitus attending a tertiary clinic in Gaborone, Botswana.

Background: Depression is one of the commonest co-existing medical conditions among patients with diabetes mellitus (DM). A bidirectional relationship between depression and DM exists, complicating glycaemic control leading to an increase in diabetic complications. There is a dearth of information regarding the prevalence of depression and associated factors among patients with DM in Botswana. Aim: This study aimed to determine the prevalence of depression and associated factors among patients with DM. The study also assessed the association between depression and glycaemic control. Setting: A tertiary diabetic referral clinic in Gaborone, Botswana. Method: A sample of 260 randomly selected patients with DM was recruited in this cross-sectional study. Socio-demographic and clinical characteristics of the patients were collected using a case report form. Depression was evaluated using the Patient Health Questionnaire (PHQ)-9 scale. Multivariate regression analysis was used to determine factors significantly associated with depression. Results: The mean age (standard deviation [s.d.]) of study participants was 58.4 (11.8) years, and the majority, 160/260 (61.5%), were females. The prevalence of depression was 30.4% and significantly associated with female sex (adjusted odds ratio [AOR] = 5.529, p-value = 0.004), three or more diabetes-related hospitalisations (AOR = 3.886, p-value = 0.049) and inversely associated with systolic blood pressure (SBP) ≥ 140 mmHg (AOR = 0.11, p-value = 0.001). Conclusion: Depression is a common problem among patients with DM in our setting. Routine screening of depression in diabetic patients to enable early detection and treatment is recommended.

Duration of Tenofovir Use and Diabetes Mellitus Predict Microalbuminuria among Well-controlled Human Immunodeficiency Virus-infected Patients Attending a Tertiary Clinic in Gaborone, Botswana.

The study aimed to determine the prevalence and associated factors of microalbuminuria among patients infected with human immunodeficiency virus (HIV). A cross-sectional study was conducted at the Infectious Disease Control Center of Princess Marina Hospital, a Tertiary Clinic in Gaborone, Botswana. The risk factors of microalbuminuria were determined by comparing the sociodemographic and clinical characteristics of patients with the presence of microalbuminuria or normoalbuminuria. In total, 297 randomly selected HIV-infected patients were included in the analysis. The mean age of the study participants was 48.6 years, with the majority of patients (60.9%) being females. The study participants were largely well-controlled both immunologically and virologically, with 283/297 (95.3%) and 280/297 (94.3%), having CD4 counts of more than 200 cells/mm3 and undetected viral load (<400 copies/mL), respectively. The prevalence of microalbuminuria was found to be 46.5%. Microalbuminuria was associated with the duration of exposure to a regimen containing tenofovir [P <0.001, odds ratio = 1.137, 95% confidence interval (CI) = 1.073-1.205] and a history of diabetes mellitus (P = 0.044, odds ratio = 9.260, 95% CI = 1.058-81.06). Sociodemographic characteristics and other clinical factors were not associated with microalbuminuria. There is a need to carry out prospective studies among HIV- infected patients with microalbuminuria to determine the short- and long-term cardiovascular morbidity and mortality outcomes.

Prevalence of chronic kidney disease using estimated glomerular filtration rate among diabetes patients attending a tertiary clinic in Botswana.

OBJECTIVES: Diabetes mellitus (DM) is one of the most common contributors of chronic kidney disease (CKD). The epidemiology of CKD, a concern among patients with DM, has not been studied in Botswana. Consequently, the objective of this study was to estimate its prevalence among these patients in Botswana to provide future guidance to both government personnel and physicians. METHODS: Observational cross-sectional study in a leading clinic in Botswana. Demographic and clinical data were obtained from patients through interviews and from their notes using a standard questionnaire. The study was conducted from July to October 2015. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet for Renal Disease equation. CKD was defined as an eGFR < 60 ml/min/1.73 m2. Multivariable logistic regression analyses were performed to assess the associations between CKD and potential factors. RESULTS: The mean age and duration of DM among study participants were 54.67 years (range 21-92 years) and 5.0 years, respectively. Over half, i.e. 213/370 (57.6%) and 232/370 (62.7%), had an average blood pressure greater than 140/90 mmHg and poor glycemic control (HbA1c > 7%), respectively. 31/370 patients (8.4%) had CKD. However, only 18/370 (4.9%) had a diagnosis of CKD documented in their charts. Age, level of education, and duration of diabetes were independently associated with CKD. CONCLUSION: The prevalence of CKD by estimated eGFR was low compared to most previous studies. However, half of patients with CKD are not documented resulting in the potential for prescription errors and drug toxicity. A substantial number of our patients had uncontrolled hypertension and poor glycemic control. Older age, low level of education and longer duration of DM were associated with CKD. There is a need to carry out prospective studies to determine the association and role of glycemic and blood pressure control in CKD causation among patients with DM in Botswana.

Disseminated Burkitt's Lymphoma with a Pancreatic Mass in a HIV Positive Woman Diagnosed by Axillary Lymph Node Biopsy.

Burkitt's Lymphoma (BL) is a highly aggressive B cell lymphoma of non-Hodgkin's type usually presenting in extranodal sites for endemic and sporadic types of the disease. Like other non-Hodgkin's Lymphomas (NHL), HIV positive associated BL is associated with peripheral lymphadenopathy. We present a case of 22-year-old newly diagnosed HIV positive female patient who presented with generalized peripheral lymphadenopathy and obstructive jaundice. Initial work up was suggestive of acute pancreatitis with further evaluation revealing a pancreatic head mass. BL was confirmed both by axillary lymph node biopsy and immunohistochemistry, highlighting the importance of high index of suspicion and prompt histopathological diagnosis to enable treatment of this fatal disease that is potentially curable.