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2.
Afr Health Sci ; 19(4): 3225-3234, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32127900

RESUMO

Background: Variceal upper gastrointestinal bleeding (UGIB) is common in sub-Saharan Africa (SSA). However, poor access to endoscopy services precludes the diagnosis of varices. Objectives: We determined the diagnostic accuracy of routine clinical findings for detection of esophageal varices among patients with UGIB in rural SSA where schistosomiasis is endemic. Methods: We studied patients with a history of UGIB. The index tests included routine clinical findings and the reference test was diagnostic endoscopy. Multivariable regression with post-estimation provided measures of association and diagnostic accuracy. Results: We studied 107 participants with UGIB and 21% had active bleeding. One hundred and three (96%) had liver disease and 86(80%) varices. Factors associated with varices (p-value <0.05) were ≥ 4 lifetime episodes of UGIB, prior blood transfusion, splenomegaly, liver fibrosis, thrombocytopenia, platelet count spleen diameter ratio <909, and a dilated portal vein. Two models showed an overall diagnostic accuracy of > 90% in detection of varices with a number needed to misdiagnose of 13(number of patients who needed to be tested in order for one to be misdiagnosed by the test). Conclusion: Where access to endoscopy is limited, routine clinical findings could improve the diagnosis of patients with UGIB in Africa.The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic.


Assuntos
Técnicas de Diagnóstico do Sistema Digestório/estatística & dados numéricos , Técnicas de Diagnóstico do Sistema Digestório/normas , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Reprodutibilidade dos Testes , População Rural/estatística & dados numéricos , Esquistossomose/complicações , Adulto , África ao Sul do Saara/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Esquistossomose/epidemiologia
3.
J Virus Erad ; 2(1): 19-21, 2016 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27482430

RESUMO

BACKGROUND: The prevalence of hepatitis B virus (HBV) infection in Uganda is 10%. Hepatitis B virus genotypes impact on treatment response, rate of spontaneous recovery and progression of chronic HBV infection and hepatocellular carcinoma. There is little information on the HBV genotypic distribution in Uganda. OBJECTIVES: To determine HBV genotypes in Uganda. METHODS: The MBN clinical laboratory performs HBV viral load and genotype testing in Uganda. It receives hepatitis B surface antigen (HBsAg)-positive samples from all over the country for additional HBV testing. Samples are stored for 6 months before being discarded. Our study used delinked stored samples. PCR-positive samples had DNA extracted and used as template for HBV genome amplification by nested PCR. Reverse hybridisation was performed and genotypes were determined by the line probe assay method (INNO-LiPA). RESULTS: One hundred stored HBsAg-positive plasma samples with detectable viral loads were analysed. Of these, 93 samples showed PCR amplification products and gave genotype-specific probe lines on the INNO-LiPA assay. Of the patients, where gender was recorded, 60.9% were female, and the overall median age (IQR) was 25 (2-60) years. There was a predominance of HBV genotype D (47 patients; 50.5%), followed by genotype A, (16 patients; 17.2%). One patient (1.1%) had genotype E. In 28% of the samples mixed infections were detected with genotypes A/E (9.7%) and A/D (6.5%) being most common. Genotypes B, C, E and H only occurred as part of mixed infections. CONCLUSION: Hepatitis B genotypes D and A were predominant in our study population.

4.
BMC Gastroenterol ; 14: 86, 2014 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-24886558

RESUMO

BACKGROUND: Adult intussusception is a rare clinical condition worldwide. It contributes to less than 5% of all cases of intussusception. Few studies have been conducted in low-income countries compared to high-income countries; particularly Sub-Saharan Africa. Based on anecdotal evidence, the authors hypothesized that the condition is not as rare in a Sub-Saharan setting in comparison with western countries. We set out to conduct the first review study of adult intussusception in Uganda. METHODS: The medical records of 37 (out of a total of 62 cases) adolescent and adult patients with a postoperative diagnosis of intussusception at Mulago National Referral and Teaching Hospital, from January 2003 to December 2012, were analyzed. The clinical features, diagnosis, treatment and pathologic features of lesions for these patients were reviewed. Intraoperative findings were described with reference to: the site of the intussusception, and the triggering lesion (either idiopathic or with a lead point). RESULTS: The mean age was 33.6 years, with a range of 13 - 72 years. The male to female ratio was 1.85:1. The mean number of days for which symptoms had been present prior to presentation was 6.3 days, while the median was 4 days. All 37 patients presented with abdominal pain. Only 13 (35.1%) had the classical paediatric triad of abdominal pain, a palpable abdominal mass and bloody stool. Most of the remaining patients presented sub-acutely with non-specific symptoms. A lead point was present in 28 patients (75.7%). Of these, 24 (64.9%) cases involved tumours. Among the tumours, 54.2% were malignant. Treatment did not involve intussusception reduction in 14 patients (37.8%). Some form of operative surgery was conducted in 31 (83.8%) patients; mainly segmental bowel resections and hemi-colectomies. CONCLUSION: Adult intussusception is uncommon in the Uganda, though probably less so than in western countries. It presents sub-acutely or chronically and is often diagnosed at laparotomy. Lead points are the triggering lesion most times and are due mainly to tumours. The bulk of tumours are malignant. Most patients require surgical resection, with prior reduction done in selected cases.


Assuntos
Doenças do Íleo/diagnóstico , Valva Ileocecal , Intussuscepção/diagnóstico , Dor Abdominal/etiologia , Adenocarcinoma/complicações , Adolescente , Adulto , Idoso , Estudos de Coortes , Colectomia , Neoplasias do Colo/complicações , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças do Íleo/etiologia , Doenças do Íleo/terapia , Neoplasias do Íleo/complicações , Enteropatias/diagnóstico , Enteropatias/etiologia , Enteropatias/terapia , Intussuscepção/etiologia , Intussuscepção/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Uganda , Adulto Jovem
5.
J Med Case Rep ; 6: 58, 2012 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-22330123

RESUMO

INTRODUCTION: Adenocarcinoma of the colon is the most common histopathological type of colorectal cancer. In Western Europe and the United States, it is the third most common type and accounts for 98% of cancers of the large intestine. In Uganda, as elsewhere in Africa, the majority of patients are elderly (at least 60 years old). However, more recently, it has been observed that younger patients (less than 40 years of age) are presenting with the disease. There is also an increase in its incidence and most patients present late, possibly because of the lack of a comprehensive national screening and preventive health-care program. We describe the clinicopathological features of colorectal carcinoma in the case of a young man in Kampala, Uganda. CASE PRESENTATION: A 27-year-old man from Kampala, Uganda, presented with gross abdominal distension, progressive loss of weight, and fever. He was initially screened for tuberculosis, hepatitis, and lymphoma, and human immunodeficiency virus/acquired immunodeficiency syndrome infection. After a battery of tests, a diagnosis of colorectal carcinoma was finally established with hematoxylin and eosin staining of a cell block made from the sediment of a liter of cytospun ascitic fluid, which showed atypical glands floating in abundant extracellular mucin, suggestive of adenocarcinoma. Ancillary tests with alcian blue/periodic acid Schiff and mucicarmine staining revealed that it was a mucinous adenocarcinoma. Immunohistochemistry showed strong positivity with CDX2, confirming that the origin of the tumor was the colon. CONCLUSIONS: Colorectal carcinoma has been noted to occur with increasing frequency in young adults in Africa. Most patients have mucinous adenocarcinoma, present late, and have rapid disease progression and poor outcome. Therefore, colorectal malignancy should no longer be excluded from consideration only on the basis of a patient's age. A high index of suspicion is important in the diagnosis of colorectal malignancy in young African patients.

6.
Afr Health Sci ; 8(2): 80-4, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19357755

RESUMO

BACKGROUND: In Uganda, as in many other parts of the world cancer of the oesophagus (CAE) is on the rise. Squamous cell carcinoma and adenocarcinoma are the common subtypes. Risk factors for this cancer have been identified but not studied systematically in Uganda. Identification of these factors would enable establishment of preventive measures. OBJECTIVE: To determine the prevalence, histological features and associated factors for CAE among patients referred to the endoscopic unit of Mulago hospital, Kampala, Uganda. METHODS: We performed a 1-year cross-sectional study in 2004 and 2005 of all patients presenting for oesophageal-gastro-duodenoscopy (EGD) at Mulago Hospital. Demographic characteristics, behavioural practices, endoscopy findings and histology results where biopsies were performed were collected using a study tool. Data analysis was done using STATA 8 statistical package. RESULTS: Two hundred nineteen patients were enrolled in the study, three were excluded because they could not tolerate the endoscopy procedure. Fifty five (19%) of the 287 had histologically proven CAE. Squamous cell carcinoma was found in 100% of tumours of the upper third, 91% middle third, and 73% lower third of the oesophagus. Four patients had a histological diagnosis of adenocarcinoma of the oesophagus. Factors that were associated with CAE included age (OR 1.63, CI 1.34-1.98, p value <0.001), smoking (OR 3.63, CI 1.82-7.23, p value <0.001) and gender (OR 2.17, CI 1.07-4.41, p value 0.032). CONCLUSION: Many patients referred for EGD in Uganda had esophageal cancer most of which were.squamous cell type. Smoking, male gender and older age were risk factors. Preventive measures should target stopping smoking.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Neoplasias Esofágicas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Estudos Transversais , Neoplasias Esofágicas/patologia , Esofagoscopia/efeitos adversos , Feminino , Hospitais/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Uganda/epidemiologia
7.
Clin Infect Dis ; 44(7): 996-1000, 2007 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-17342656

RESUMO

BACKGROUND: The common occurrence of hepatitis B virus (HBV) infection in patients who carry the human immunodeficiency virus (HIV) demands that both viruses be recognized, evaluated, and treated when appropriate. METHODS: We identified 357 HIV- and hepatitis B surface antigen-positive patients who underwent testing from 1999 to 2003; 155 patients who were new to our clinic and who initiated therapy for HIV and HBV coinfection were considered for inclusion in the study. The frequency of HIV testing (to determine HIV load and CD4+ cell count) performed during the first year of therapy was compared with the frequency of HBV measurements (to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load), abdominal ultrasound examination, and measurement of levels of alpha-fetoprotein in serum. RESULTS: HBV load data were obtained for only 16% of patients before initiation of antiretroviral therapy (ART), whereas HIV load was determined for 99% of patients before initiation of ART. The total number of HIV load measurements obtained during the first year after ART initiation was 497 (median number of HIV load measurements per patient, 3.0), compared with 85 measurements of HBV load (median number of HBV load measurements per patient, <1; P<.001). The percentage of patients who received any level of HBV monitoring (i.e., tests to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load) after ART initiation increased from 7% in 1999 to 52% in 2001 (P<.001), whereas the percentage of patients who underwent HIV load testing remained at 80%-90% during the same period. CONCLUSIONS: Health care providers treating patients with HIV infection during the period 1999-2003 infrequently monitored HBV response in coinfected patients, but they systematically monitored HIV response after ART initiation. Improved physician adherence to guidelines that better delineate HBV treatment and monitoring for patients with HIV-HBV coinfection is needed.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade/métodos , Pessoal de Saúde/normas , Antígenos E da Hepatite B/análise , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Antivirais/uso terapêutico , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Pessoal de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Monitorização Fisiológica/tendências , Determinação de Necessidades de Cuidados de Saúde , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Índice de Gravidade de Doença , Carga Viral
8.
Am J Med ; 118(12): 1413, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16378788

RESUMO

Hepatitis B virus currently infects more than 400 million people worldwide. Despite the availability of hepatitis B vaccine, the overall prevalence of hepatitis B virus infection has declined little in recent years. Hepatitis B virus causes liver injury by an immune response against the virus-infected liver cells and is not directly cytopathic, although immunosuppression appears to enhance replication and lead to direct cytotoxicity. The interplay of the host immune response and the virus's ability to replicate is a prime determinant of the likelihood of liver injury, its intensity, and progression to cirrhosis. A series of stages evolve in the life cycle of each patient's infection, with associated decreases in viral load at each successive stage. Viral mutations in the polymerase or the core gene affect replication and may enhance liver injury. Recently, genotypes have been identified that are linked to clinical outcomes, drug responses, and mutations. Four drugs (interferon alpha, lamivudine, adefovir, and entecavir) have been approved by the US Food and Drug Administration for treatment of hepatitis B virus; they effectively decrease replication and reduce inflammation and fibrosis. Treatment of hepatitis B virus in complex situations such as co-infection with human immunodeficiency virus or immunosuppressive therapy remains challenging. The use of hepatitis B vaccine has been shown to reduce the incidence of new infection in many regions. A decline in the prevalence of hepatitis B infection worldwide will require changes in high-risk behavior and the wider use of vaccination.


Assuntos
Antivirais/uso terapêutico , Vírus da Hepatite B/patogenicidade , Hepatite B/tratamento farmacológico , Hepatite B/virologia , Adolescente , Adulto , Idoso , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/virologia , Criança , Pré-Escolar , Feminino , Hepatite B/genética , Hepatite B/patologia , Hepatite B/prevenção & controle , Vacinas contra Hepatite B/uso terapêutico , Vírus da Hepatite B/genética , Humanos , Incidência , Lactente , Recém-Nascido , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/virologia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade
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