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  • 1
    Online Resource
    Online Resource
    The impact of HIV infection on clinical presentation and mortality among persons with hepatocellular carcinoma in Kampala, Uganda
    Springer Science and Business Media LLC ; 2023
    In:  BMC Infectious Diseases Vol. 23, No. 1 ( 2023-04-06)
    Details
    In: BMC Infectious Diseases, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-04-06)
    Abstract: HIV infection is associated with more rapid progression of some comorbidities. This study assessed the impact of HIV-infection on the presentation and outcome of HCC. Methods HCC patients attending the Mulago National Referral Hospital in Uganda were enrolled into a natural history study of HCC between March 2015 and February 2019. Standardized methods were used to collect clinical, ultrasound and laboratory data at enrolment. HCC cases were confirmed and enrolled based on a combination of clinical, ultrasound, tumor marker and pathology data. Follow-up contact was made at one, three, six, and twelve months post-enrolment to determine vital status. Symptoms and signs at diagnosis and subsequent survival were compared by HIV status. Kaplan Meier curves were used to assess HCC survival. Results Of 441 persons with HCC, 383 (87.0%) died within 12 months following HCC diagnosis. The median (IQR) survival was 42 (20, 106) days. HIV infection was present in 79 (18%) cases. After adjusting for baseline demographic and clinical characteristics, HIV infection was associated with increased mortality but only among those with severe HIV-associated immunosuppression (CD4 count  〈  200 cells per cubic milliliter), aHR (95% C) = 2.12 (1.23–3.53), p = 0.004, and not among PLWH with ≥ 200 CD4 cells per cubic milliliter, aHR (95% C) = 1.15 (0.82–1.60), p = 0.417. Conclusion Among relatively young Ugandans, HCC is a devastating disease with rapid mortality that is especially rapid among people living with HIV(PLWH). HIV was associated with slightly higher mortality, notably among PLWH with lower CD4 cell counts. As a substantial majority of PLWH diagnosed with HCC were engaged in HIV care, further investigation should determine the effectiveness of incorporating screening and early identification of HCC among high-risk individuals into existing HIV care programs. Concurrent with growing access to curative localized treatment for HCC in sub-Saharan Africa, leveraging HIV care infrastructure affords opportunities for earlier HCC intervention.
    Type of Medium: Online Resource
    ISSN: 1471-2334
    URL: Article
    DOI: 10.1186/s12879-023-08164-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2041550-3
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  • 2
    Online Resource
    Online Resource
    Microbiological Findings and Clinical Outcomes in Ugandan Patients with Infected Burn Wounds
    MDPI AG ; 2023
    In:  European Burn Journal Vol. 4, No. 1 ( 2023-02-07), p. 69-79
    Details
    In: European Burn Journal, MDPI AG, Vol. 4, No. 1 ( 2023-02-07), p. 69-79
    Abstract: Nosocomial wound infections are a dreaded complication in patients with burns. However, access to the necessary microbiological diagnostics is impaired in low-resource settings. This prospective observational cohort study aimed to describe the bacterial pathogens, resistance profiles and clinical outcomes of patients with wound infections admitted to the largest specialized unit for burns and plastic surgery in Uganda. Blood and wound swab cultures were taken for bacterial species identification and antibiotic susceptibility testing. A total of 140 patients (female: n = 62, 44.3%) with a median age of 26 (IQR 7–35) years were included between October 2020 and April 2022, of which the majority (n = 101, 72.2%) had burn wounds (72.3% Grade 2b, 14.9% Grade 3). Gram-negative Enterobacterales, Pseudomonas spp. and Acinetobacter spp. were most commonly isolated from wound swabs and nearly all isolates were multidrug resistant with very limited treatment options. While the clinical outcome was favorable in 21 (15%) study participants, the majority were left with disabilities (minor: n = 41, 29.3%, moderate: n = 52, 37%, major: n = 14 (10%)). Twelve (8.6%) study participants died, mostly of Gram-negative sepsis. Our findings highlight the urgent need for routine access to microbiological diagnostics to improve patient care and local surveillance efforts on antimicrobial resistance.
    Type of Medium: Online Resource
    ISSN: 2673-1991
    URL: Article
    DOI: 10.3390/ebj4010007
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 3007631-6
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  • 3
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    Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda
    Public Library of Science (PLoS) ; 2023
    In:  PLOS ONE Vol. 18, No. 4 ( 2023-4-10), p. e0284165-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 4 ( 2023-4-10), p. e0284165-
    Abstract: Health workers’ failure to adhere to guidelines for screening, diagnosis and management of HIV-associated cryptococcal meningitis (CM) remains a significant public health concern. We aimed to assess adherence to the standards of care and management of HIV patients at risk of CM per the MoH guidelines and assess stock management of CM supplies in the period of January to June 2021 at selected public health facilities (HFs) in Uganda. Methods The study employed an observational cross-sectional design to assess the level of adherence of health workers to standards of clinical care and management of HIV positive patients at risk of CM as per the clinical guidelines for Uganda, and stock management of CM supplies in the period of January to June 2021in selected public health facilities. The study team used a survey guide designed by MoH to assess and score the screening, diagnosis and management practices of Health Facilities towards CM. Scoring was categorized as red ( 〈 80%), light green (80%-95%), and dark green (˃95%) in the order from worst to best adherence. The data was transcribed into a spread sheet and analysed using STATA–v15. Results The study team visited a total of 15 public health facilities including 5 general hospitals, 9 regional referral hospitals (RRHs) and 1 National Referral hospital (NRH). The mean score for adherence to screening and management of CM for all the combined facilities was 15 (64.7%) classified as red. 10 (66.7%) HFs had not performed a baseline CD4 test for eligible patients within 2 weeks of ART initiation. With regards to treatment, 9 (60%) of the HFs were scored as light green on knowledge of the procedure for reconstituting intravenous Liposomal Amphotericin B. None of the HFs visited had potassium chloride tablets in stock. Conclusion Major MoH guidelines are generally not being adhered to by health workers while managing cryptococcal meningitis. It is vital that government and implementing partners regularly support HFs with training, mentorship, and support supervision on CM management to improve adherence to CM screening and treatment guidelines.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0284165
    DOI: 10.1371/journal.pone.0284165.g001
    DOI: 10.1371/journal.pone.0284165.t001
    DOI: 10.1371/journal.pone.0284165.t002
    DOI: 10.1371/journal.pone.0284165.t003
    DOI: 10.1371/journal.pone.0284165.t004
    DOI: 10.1371/journal.pone.0284165.s001
    DOI: 10.1371/journal.pone.0284165.s002
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2023
    detail.hit.zdb_id: 2267670-3
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  • 4
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    Herbal medicine use among patients with viral and non-viral Hepatitis in Uganda: prevalence, patterns and related factors
    Springer Science and Business Media LLC ; 2020
    In:  BMC Complementary Medicine and Therapies Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Complementary Medicine and Therapies, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: There is some evidence that patients with liver diseases commonly use complementary and alternative therapies to address general and liver-disease specific health concerns. The purpose of this study was to assess and describe prevalence, patterns and related factors of herbal medicine use among adults diagnosed with viral and non-viral hepatitis in Kampala, Uganda. Methods A cross-sectional study was conducted on 310 adult patients attending the gastrointestinal clinic in Mulago hospital referral hospital in Kampala. Data on prevalence, types and reasons for herbal medicine use was collected using standardized questionnaires and focus group discussions. Modified Poisson regression analyses were used to examine factors related to use. Results Usage of various herbal remedies within 12 months prior to April 2018 was reported by 46.1% (143/310) of patients with 27.3% (39/143) of these reporting having used conventional and herbal therapies concurrently. Herbal remedies were used to treat various health conditions including hepatitis. Patients with hepatitis C virus infection (PRR = 1.16, p  = 0.02) compared to those with hepatitis B virus infection, and those who believed that it was safe to use herbal and conventional therapies concurrently (PRR = 1.23, p  = 0.008) had higher prevalence odds of herbal medicine use. Conversely, patients who had been newly diagnosed with hepatitis (PRR = 0.69, p  = 0.03) compared to those who had been diagnosed more than one-year prior, had lower prevalence odds of herbal medicine use. Various types of local herbs were reported as most commonly used however most patients did not know the ingredients of commercially prepared herbal therapies. Conclusion A high prevalence of herbal medicine use was found among newly-diagnosed patients and patients with hepatitis C more likely to use herbal remedies after adjusting for other factors. Usage was influenced by the belief that herbal medicine is safe and effective. Health workers need to consistently elicit information about herbal remedy use. Research is needed on benefits, adverse effects and outcomes in patients who use herbal remedies to treat primary liver diseases in order to facilitate evidence of efficacy and product safety.
    Type of Medium: Online Resource
    ISSN: 2662-7671
    URL: Article
    DOI: 10.1186/s12906-020-02959-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 3037610-5
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  • 5
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    A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital
    Public Library of Science (PLoS) ; 2023
    In:  PLOS Global Public Health Vol. 3, No. 8 ( 2023-8-15), p. e0001880-
    Details
    In: PLOS Global Public Health, Public Library of Science (PLoS), Vol. 3, No. 8 ( 2023-8-15), p. e0001880-
    Abstract: The global spread of antimicrobial resistance (AMR) poses an increasing challenge for clinicians in Uganda, where microbiological diagnostics are not routinely available or accessible. The aim of this study was to determine pathogen prevalence and antibiotic resistance patterns in patients with wound infections following trauma at a national referral hospital in Kampala, Uganda. In addition, the suitability of currently used empirical treatment options in this setting was evaluated. This prospective, observational study analysed antimicrobial prescriptions, culture results and antimicrobial sensitivity testing (AST) of wound swabs and blood samples from patients with clinical signs of wound infections on the trauma ward. A total of 124 patients (n = 99, 79.8% male) with a median age of 30 years (IQR 23–39) were enrolled between October 2021 and January 2022. Wound infections were classified as nosocomial in 69% of the cases. Pathogens were isolated from 122 wound swabs, yielding 238 bacterial isolates. The most prevalent pathogens were gram-negative bacteria including Escherichia coli (n = 48, 20.2%) and Acinetobacter spp. (n = 43, 18.1%). Empiric treatment consisted of ceftriaxone and gentamicin which was administered to 67.2% (n = 78) and 62.1% (n = 72) of patients, respectively. High rates of antimicrobial resistance could be demonstrated across gram-negative and gram-positive species towards the most common empiric antibiotics. Following the AST results, over 95% (n = 111) of patients required a change of treatment. Our findings demonstrate that current empiric treatment for wound infections is missing its target in hospitalized patients in Kampala. To address the growing problem of AMR in Uganda, there is a pressing need to enhance diagnostic capacity and implement structured antimicrobial stewardship programs.
    Type of Medium: Online Resource
    ISSN: 2767-3375
    URL: Article
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    DOI: 10.1371/journal.pgph.0001880
    DOI: 10.1371/journal.pgph.0001880.g001
    DOI: 10.1371/journal.pgph.0001880.g002
    DOI: 10.1371/journal.pgph.0001880.g003
    DOI: 10.1371/journal.pgph.0001880.t001
    DOI: 10.1371/journal.pgph.0001880.t002
    DOI: 10.1371/journal.pgph.0001880.t003
    DOI: 10.1371/journal.pgph.0001880.s001
    DOI: 10.1371/journal.pgph.0001880.s002
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2023
    detail.hit.zdb_id: 3101394-6
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