JAK/STAT signaling pathway affects CCR5 expression in human CD4+ T cells.

CCR5 serves as R5-tropic HIV co-receptor. Knocking out CCR5 in HIV patients, which has occurred <10 times, is believed important for cure. JAK/STAT inhibitors tofacitinib and ruxolitinib inhibit CCR5 expression in HIV+ viremic patients. We investigated the association of JAK/STAT signaling pathway with CCR5/CCR2 expression in human primary CD4+ T cells and confirmed its importance. Six of nine JAK/STAT inhibitors that reduced CCR5/CCR2 expression were identified. Inhibitor-treated CD4+ T cells were relatively resistant, specifically to R5-tropic HIV infection. Furthermore, single JAK2, STAT3, STAT5A, and STAT5B knockout and different combinations of JAK/STAT knockout significantly reduced CCR2/CCR5 expression of both RNA and protein levels, indicating that CCR5/CCR2 expression was positively regulated by JAK-STAT pathway in CD4+ T cells. Serum and glucocorticoid-regulated kinase 1 (SGK1) knockout affected CCR2/CCR5 gene expression, suggesting that SGK1 is involved in CCR2/CCR5 regulation. If cell surface CCR5 levels can be specifically and markedly down-regulated without adverse effects, that may have a major impact on the HIV cure agenda.

Cytoreductive surgery for giant locally advanced intra-abdominal tumors in Uganda.

Cytoreductive surgery is removal of tumor as much as possible when complete resection is impossible because of advanced disease. It is a management option for giant intra-abdominal tumors with pressure symptoms. We present three patients who underwent cytoreductive surgery for giant intra-abdominal tumors between May 2019 and November 2021. Patient 1 had a gastrointestinal stromal tumor (GIST) involving stomach, spleen and transverse colon. En bloc resection of the GIST with the involved viscera was done. Patient 2 had a liposarcoma measuring 25.8 × 19.6 × 15.3 cm infiltrating the stomach, spleen and the left hemidiaphragm. Involved viscera and liposarcoma were resected en bloc. Patient 3 had a liposarcoma measuring 40 × 35 × 12 cm and encasing the left ureter. Mass was excised together with part of the left ureter and left ureter reconstructed. Giant intra-abdominal tumors are rare. Involvement of adjacent structures may necessitate multivisceral resections with or without organ reconstruction.

Management of neonatal complications of macrosomia: A case report at a tertiary hospital in a developing country.

Fetal macrosomia can present with numerous complications. We report a case of a term baby girl with a birthweight of 5.31 kg admitted with respiratory distress and suffered several complications of macrosomia. There is a need to closely monitor neonates for early diagnosis and management of complications of macrosomia.

Case Series: Management of Hypernatremia in DKA in a Tertiary Healthcare Setting in a Developing Country.

Diabetic ketoacidosis (DKA) commonly presents with hyponatremia, but hypernatremia is a rare case. We report two cases of hypernatremia, a 54-year-old woman (case 1) admitted with altered sensorium with blood glucose unrecordably high, serum sodium 134 mmol/L and an 18-year-old girl (case 2) admitted with reduced levels of consciousness, a random blood sugar of 21.2 mmol/L and serum sodium of 121 mmol/L. Case 1 was hydrated with isotonic saline and serum sodium values then escalated to 154 mmol/L on day 2, reaching 166 mmol/L on day 4. Case 2 was hydrated with isotonic saline and also given hypertonic saline for treatment of hyponatremia, and the sodium levels for this patient rose to 153 mmol/L on day 2 reaching a maximum of 176 mmol/L on day 3. On day 2, both patients were switched to half strength Darrow's for correction of the hypernatremia along with insulin therapy. The patients recovered fully and were discharged without any sequelae. These reports exhibit a learning point in the choice of intravenous fluids for the treatment of DKA. They also show the need to delay the correction of hyponatremia in patients with high blood glucose levels.

The Era of Coronavirus: Knowledge, Attitude, Practices, and Barriers to Hand Hygiene Among Makerere University Students and Katanga Community Residents.

BACKGROUND: The Novel Coronavirus was declared as a pandemic by the WHO at the end of 2019. Proper hand hygiene was identified as one of the simplest most cost-effective Covid-19 control and prevention measures. It is therefore very important to identify gaps in the knowledge, attitude, and practices, and barriers regarding hand hygiene in the community. METHODS: A descriptive cross-sectional study was conducted using a simple random sampling technique. An interviewer-guided questionnaire with questions on knowledge, attitude, practice, and barriers to hand hygiene was used in data collection. Collected data were analyzed using Microsoft office excel 2016 and STATA 15 software. A 95% confidence interval was used and statistical significance was P<0.05. RESULTS: Only 88 (24.5%) of the participants had adequate knowledge of hand hygiene. 32.8% of the university students had adequate knowledge compared to 6.3% of the Katanga residents. The majority of 336 (93.6%) participants had a good attitude towards hand hygiene. University students had a significantly better knowledge of hand hygiene while Katanga slum residents had a slightly better attitude towards hand hygiene. Only 19.6% accomplished all the seven steps of handwashing. 38.4% of the participants were still greeting by handshaking. Of the participants, 60.1% noted lack of soap as a barrier to hand hygiene and 62.9% reported having more than three barriers to hand hygiene. Participants who had been taught handwashing were more likely to have better hand hygiene knowledge and practice. CONCLUSION: There was an overall high proportion of participants with a low level of hand hygiene knowledge. There is a need for optimizing hand-hygiene practices through addressing the barriers and promoting public health education.

Patients' Involvement in Decision-Making During Healthcare in a Developing Country: A Cross-Sectional Study.

PURPOSE: Patient autonomy and participation have a significant impact on patient satisfaction and compliance with treatment. We aimed to establish and describe the level of shared decision-making (SDM) among the patients in a developing country. Uganda is a low resource country with a 2019 GDP of 35.17 billion US dollars. In some regions, over 60% of Ugandans live below the national poverty line and most of them depend on the underfunded health care system. METHODS: A cross-sectional, quantitative study was carried out among the outpatients attending Kisenyi Health center IV, Kampala, Uganda. An interviewer-administered questionnaire with a 5-point Likert scale was used to assess patients' SDM. All statistical analysis was performed using STATA 15 software. RESULTS: A total of 326 patients participated in this study. Majority of the participants were females (n=241, 73.9%) and aged 18-35 years (n=218, 66.9%). Only 22 (7%) of the participants knew the name of their consulting doctor. Most of the participants, 84% were given enough time to narrate their symptoms. Overall, only 11.3% (n=37) of the participants had adequately participated in SDM. The overall mean score of participation in SDM was 2.7 (SD:0.8). Participants who knew the name of their consulting doctor were approximately 11 times more likely to participate in SDM (OR: 10.7, 95% CI: 4.2-27.0, P<0.0001). CONCLUSION: The majority of patients attending Kisenyi Health Center IV did not adequately participate in SDM. Continued medical education should be organized for healthcare professionals to promote SDM.