HIV sero-positivity and risk factors for ischaemic and haemorrhagic stroke in hospitalised patients in Uganda: A prospective-case-control study.

Objectives: We examined HIV sero-positivity and risk factors in patients admitted with ischaemic stroke (IS) and haemorrhagic stroke (HS) in Kampala, Uganda. Study design: We conducted a matched case-control study between December 2016 and December 2018 â€‹at â€‹St Francis Hospital, Nsambya. Methods: The study population comprised of stroke cases (adults aged ≥18 years with IS or HS confirmed by neuroimaging) and controls (age- and sex-matched stroke-free adults aged ≥18 years who were recruited from the same hospital as the cases). A comprehensive assessment for sociodemographic, lifestyle and clinical factors was performed using the World Health Organization (WHO) STEP-wise approach to Surveillance (STEPS) for stroke risk factor surveillance. We used conditional logistic regression to identify risk factors associated with IS or HS. Results: We enrolled 137 matched case-control pairs; 48 (35%) were men, and the mean ages were 62.4 years (SD â€‹± â€‹14.8) for cases and 61.1 years (SD â€‹± â€‹14.1) for controls. Of stroke patients, 86 (63%) had IS and 51 (37%) had HS. Overall, HIV sero-positivity was 10% among stroke cases versus 7% among controls. HIV sero-positivity was not significantly associated with stroke (unadjusted odds ratio [uOR] â€‹= â€‹1.49, 95% confidence interval [CI] 0.59-3.78). A self-reported family history of diabetes mellitus was associated with an increased risk of all stroke (adjusted odds ratio [aOR] â€‹= â€‹4.41, 95% CI 1.47-13.2), as well as for IS and HS separately (aOR â€‹= â€‹3.66, 95% CI 1.09-12.4 and aOR â€‹= â€‹4.99, 95% CI 1.02-24.4, respectively). High blood pressure (≥140/90 â€‹mmHg) was associated with an increased risk of all stroke (aOR â€‹= â€‹12.3, 95% CI 42-44.1), and this was also true for IS and HS individually (aOR â€‹= â€‹6.48, 95% CI 1.15-36.7 and aOR â€‹= â€‹5.63, 95% CI 1.74-18.2, respectively). Conclusions: No association was found between HIV sero-positivity and stroke occurrence among Ugandan stroke patients. Hypertension and a self-reported family history of diabetes mellitus were significant risk factors for both IS and HS. Interventions to reduce hypertension and diabetes mellitus in the Ugandan population are urgently required. Much larger studies are required to demonstrate if any association exists between HIV and stroke.

Outbreak of type A foodborne botulism at a boarding school, Uganda, 2008.

Botulism has rarely been reported in Africa. In October 2008, botulism was reported in three Ugandan boarding-school students. All were hospitalized and one died. A cohort study was performed to assess food exposures among students, and clinical specimens and available food samples were tested for botulinum toxin. Three case-patients were identified; a homemade, oil-based condiment was eaten by all three. In the cohort study, no foods were significantly associated with illness. Botulinum toxin type A was confirmed in clinical samples. This is the first confirmed outbreak of foodborne botulism in Uganda. A homemade, oil-based condiment was the probable source. Consumption of homemade oil-based condiments is widespread in Ugandan schools, putting children at risk. Clinicians and public health authorities in Uganda should consider botulism when clusters of acute flaccid paralysis are seen. Additionally, schools should be warned of the hazard of homemade oil-based condiments, and take steps to prevent their use.

Rheumatic manifestations among HIV positive adults attending the Infectious Disease Clinic at Mulago Hospital.

BACKGROUND: Rheumatic manifestations in HIV are common and sometimes the initial presentation of the disease. HIV is now a common infection at the Infectious Disease Clinic, Mulago. The spectrum of joint diseases seen depend on a number of factors such as, the CD4 count, HLA status and current therapy. OBJECTIVE: This study included HIV patients from a heterogeneous population and was designed to determine the prevalence and clinical pattern of rheumatic manifestations among these HIV patients. METHODS: Four hundred eighty seven patients were screened and 300 HIV positive patients were consecutively recruited into the study, evaluated for rheumatic manifestations and their clinical and laboratory findings documented. RESULTS: The prevalence of rheumatic manifestations was 27% (81 of 300). Arthralgias in 19.3% of the study population were commonest finding followed by HIV associated arthritis at 4.3%. The lower limbs were the most commonly affected with the knees (28.8%) and ankles (26.9%) contributing the highest. All patients had a negative anti-nuclear antibody test, with only two having a positive rheumatoid factor test. An association of antituberculosis drugs with joint disease was further highlighted in this study (OR 3.79 95% CI, 1.44 - 9.93). Septic arthritis due to Staphylococcus aureus was rarely observed except when the patients' level of CD4 + T cells dropped below 200 cells mm(3). The mean CD4+ count was 171 cells mm(3). CONCLUSION: Rheumatic manifestations should be considered among HIV positive adults. Arthralgias are common especially in patients using pyrazinamide.

Effect of HIV-1 Infection on Malaria Treatment outcome in Ugandan Patients

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 95CI 0.4- 0.8; p a 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 95CI 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 cotrimo-xazole prophylaxis should be reinforced in HIV positive patients and it should be reassessed if these patients present with acute episodes of malaria

Who should be screened to reduce the endoscopy workload in Mulago Hospital?

A retrospective study of 330 patients who had been endoscoped in Mulago hospital was done. It was found that of these 119 (36.1) were normal endoscopically. Normal endoscopy was significantly associated with patients presenting with dyspepsia. Dyspepsia was common in the age group 13-45 years compared to the age group 46-85 years. The older age group; 46-85 years; had a singificantly higher prevalence of serious disease. It is concluded that it is the younger patients with dyspepsia who should be screened to reduce the endoscopy workload. Published guidelines should be used to assist in the screening process

Who should be screened to reduce the endoscopy workload in Mulago Hospital?

A retrospective study of 330 patients who had been endoscoped in Mulago hospital was done. It was found that of these 119 (36.1%) were normal endoscopically. Normal endoscopy was significantly associated with patients presenting with dyspepsia. Dyspepsia was commoner in the age group 13-45 years compared to the age group 46-85 years. The older age group, 46-85 years, had a significantly higher prevalence of serious disease. It is concluded that it is the younger patients with dyspepsia who should be screened to reduce the endoscopy workload. Published guidelines should be used to assist in the screening process.

Who should be screened to reduce the endoscopy workload in Mulago Hospital?

A retrospective study of 330 patients who had been endoscoped in Mulago Hospital was done. It was found that of these 119(36.1) were normal endoscopically. Normal endoscopy was significantly associated with patients presenting with dyspepsia. Dyspepsia was commoner in the age group 13-45 years compared to the age group 46-85 years. The older age group; 46-85 years; had a significantly higher prevalence of serious disease. It is concluded that it is the younger patients with dyspepsia who should be screened to reduce the endoscopy workload. Published guidelines should be used to assist in the screening process