Radiation Safety Awareness among Radiation Workers and Clientele At Mulago Hospital, Kampala, Uganda.

Background: All x-ray utilization in human medicine leads to exposure of the patient and personnel to radiation. Although the quantity is low in diagnostic examinations, special attention should be given to this fact in order to minimize unnecessary exposure for both groups. Exposureto ionizing radiation cannot be avoided in a medical imaging facility. Twenty-two radiation workers and fifty patients responded. The main objective of the study was to determine the level of radiation safety awareness among radiation workers (Personnel) and clientele at Mulago hospital.Methods: Subjects were interviewed using two different questionnaires each one tailored to the radiation workers and the patient (clientele). Fifty patients and twenty-two radiation workers responded. Their views were assessed using structured questionnaires. The data was analysedusing SSPS package.Results: Fifteen (68.2%) reported that they had had a sensitization introduction about radiation safety before they started working with radiation. . 18 (81.8%) thought that the radiation safetymeasures taken at the work place were inadequate. It was noted that radiation workers were well informed about radiation safety, but that the patients expressed ignorance on the subject and many were convinced that x-rays were dangerous.Conclusion: There is need for sensitization of the public on radiation safety and to allay their fears about radiation. The radiation workers should do this before patients are worked on. This requires good communication skills on the part of the radiation workers. There is also need for radiation workers to have introductory seminars on radiation safety before they start working with radiation. They also need continuous education and update on radiation safet

The prevalence and factors associated with musculoskeletal disorders, in patients with sickle cell anaemia, at Mulago National Referral Hospital, Uganda

Background: Sickle cell anaemia (SCA) is a condition characterized by a predominance of haemoglobin S (hbss) in the red blood cells. Musculoskeletal involvement is one of the commonest clinical manifestations of SCA. There is limited information on the prevalence, patterns and factors associated with Musculoskeletal (MSK) disorders among SCA patients in African countries.Methods: This was a descriptive cross sectional study conducted in SCA clinic at Mulago National Referral Hospital, Uganda. It involved 365 SCA patients who attended the clinic between 1st August 2014 and 31st October 2014. These patients were interviewed and assessed to determine the presence of MSK, patterns and factors associated with it. The transient MSK disorders like dactylitis were excluded.Results: The prevalence of MSK disorders among SCA patients was found to be 11.5%.These disorders include avascular necrosis, spine osteonecrosis, osteomyelitis, leg ulcers, pathological fractures and flexion contractures. The age (11-20 years), highly demanding physical activity status and the annual frequency of painful crises were associated with MSK disorders.Conclusion: Musculoskeletal disorders are highly prevalent in SCA patients at Mulago National referral hospital. The femoral Avascular necrosis, spine osteonecrosis, leg ulcers and osteomyelitis were the most common MSK disorders.Keywords: Sickle cell anaemia, Musculoskeletal disorders, Avascular necrosi

Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Rationale: Detailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited. Objective: We determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda . Measurements: As of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation. Main results: The median age was 34.2 years; 67.9% were male; and 14.6% were 130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance. Conclusion: Most of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19.Publisher PDFPeer reviewe

Low Prevalence of Pneumocystis pneumonia (PCP) but High Prevalence of Pneumocystis dihydropteroate synthase (dhps) Gene Mutations in HIV-Infected Persons in Uganda

Pneumocystis jirovecii pneumonia (PCP) is an important opportunistic infection in patients infected with HIV, but its burden is incompletely characterized in those areas of sub-Saharan Africa where HIV is prevalent. We explored the prevalence of both PCP in HIV-infected adults admitted with pneumonia to a tertiary-care hospital in Uganda and of putative P. jirovecii drug resistance by mutations in fungal dihydropteroate synthase (dhps) and dihydrofolate reductase (dhfr). In 129 consecutive patients with sputum smears negative for mycobacteria, 5 (3.9%) were diagnosed with PCP by microscopic examination of Giemsa-stained bronchoalveolar lavage fluid. Concordance was 100% between Giemsa stain and PCR (dhps and dhfr). PCP was more prevalent in patients newly-diagnosed with HIV (11.4%) than in patients with known HIV (1.1%; p = 0.007). Mortality at 2 months after discharge was 29% overall: 28% among PCP-negative patients, and 60% (3 of 5) among PCP-positive patients. In these 5 fungal isolates and an additional 8 from consecutive cases of PCP, all strains harbored mutant dhps haplotypes; all 13 isolates harbored the P57S mutation in dhps, and 3 (23%) also harbored the T55A mutation. No non-synonymous dhfr mutations were detected. PCP is an important cause of pneumonia in patients newly-diagnosed with HIV in Uganda, is associated with high mortality, and putative molecular evidence of drug resistance is prevalent. Given the reliability of field diagnosis in our cohort, future studies in sub-Saharan Africa can investigate the clinical impact of these genotypes

The Triple Assessment In The Pre-Operative Evaluation Of Patients With Breast Cancer In Mulago Hospital, Kampala – Uganda.

Background: Triple assessment has been recommended in diagnosis of Breast cancer in Uganda. This review analyses its diagnostic value in patients presenting with clinically malignant breast lumps. Objective: To establish the validity and reliability of the triple assessment in the pre-operative evaluation of patients with breast cancer in Mulago Hospital. Methods: A total of 200 patients suspected to have breast cancer were evaluated. All patients underwent clinical evaluation, mammography and fine needle aspiration cytology. Histology was done to confirm the diagnosis. Results: A total of 200 patients were studied. The age ranged from 19 to 88 years. Sixty-six patients had benign lesions. There were 134 were breast cancer cases. With triple assessment, 84 patients were diagnostic for malignancy and 30 benign, respectively confirmed by histology. The Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy were respectively 100.0%. Error was 0.0%. The Kappa statistic for the combination was 1.0. Conclusions and Recommendations: The triple assessment is valid and reliable. Breast masses can be diagnosed with a high degree of accuracy by the triple assessment. Diagnostic open biopsy is mandated if the triple assessment results show a lack of concordance

Radiation safety awareness among radiation workers and clientele at Mulago Hospital, Kampala, Uganda.

Background: All x-ray utilization in human medicine leads to exposure of the patient and personnel to radiation. Although the quantity is low in diagnostic examinations, special attention should be given to this fact in order to minimize unnecessary exposure for both groups. Exposure to ionizing radiation cannot be avoided in a medical imaging facility. Twenty-two radiation workers and fifty patients responded. The main objective of the study was to determine the level of radiation safety awareness among radiation workers (Personnel) and clientele at Mulago hospital. Methods: Subjects were interviewed using two different questionnaires each one tailored to the radiation workers and the patient (clientele). Fifty patients and twenty-two radiation workers responded. Their views were assessed using structured questionnaires. The data was analysed using SSPS package. Results: Fifteen (68.2%) reported that they had had a sensitization introduction about radiation safety before they started working with radiation. . 18 (81.8%) thought that the radiation safety measures taken at the work place were inadequate. It was noted that radiation workers were well informed about radiation safety, but that the patients expressed ignorance on the subject and many were convinced that x-rays were dangerous. Conclusion: There is need for sensitization of the public on radiation safety and to allay their fears about radiation. The radiation workers should do this before patients are worked on. This requires good communication skills on the part of the radiation workers. There is also need for radiation workers to have introductory seminars on radiation safety before they start working with radiation. They also need continuous education and update on radiation safet

Application of Case Report-Writing in the Training of Radiology Post Graduate Students at Makerere University.

Background: Postgraduate medical education is much sought after and has become an issue of global significance, appeal and dimensions. The Radiology postgraduate training at Makerere University has been in existence since 1980. As part of their training students are required to write up 30 cases with the help of their lecturers. Methods: We set out to evaluate the role of case report writing in the training of Radiology postgraduate students. A document analysis of 22 case report sets was done. Questionnaires with closed and open ended questions were administered to the 10 Radiologists and 6 students to get their opinions and ideas on the process and how it could be improved. The quantitative data was analyzed by a statistician and focused on the closed-ended statements. The qualitative data was analyzed by the authors with the help of a qualitative expert. Results: The radiologists and students agreed that case report writing helped students acquire a wide range of competences. They also agreed that it is a reliable and valid method of assessment and has a positive impact on learning. The respondents identified problems that were encountered in the process. They have problems identifying cases that are fully worked up and also their work was made challenging because of poor technology, limited access to references and high cost of producing the cases. The cases exposed the students to a wide range of cases and investigations in radiology and helped them integrate Clinical Medicine and Radiology. Conclusion: Case report writing is a good way of training and assessing post graduate students. It is motivational and also helps them acquire a wide range of competences specifically ability to write scientific articles

Immune Response and Mortality Risk Relate to Distinct Lung Microbiomes in Patients with HIV and Pneumonia

RationaleThe potential role of the airway microbiota in dictating immune responses and infection outcomes in HIV-associated pneumonia is largely unknown.ObjectivesTo investigate whether microbiologically and immunologically distinct subsets of patients with HIV and pneumonia exist and are related to mortality.MethodsBronchoalveolar lavage samples from Ugandan patients with HIV and pneumonia (n = 182) were obtained at study enrollment (following antibiotic treatment); patient demographics including 8- and 70-day mortality were collected. Lower airway bacterial community composition was assessed via amplification and sequencing of the V4 region of the 16S ribosomal RNA gene. Host immune response gene expression profiles were generated by quantitative polymerase chain reaction using RNA extracted from bronchoalveolar lavage fluid. Liquid and gas chromatography mass spectrometry was used to profile serum metabolites.Measurements and main resultsBased on airway microbiome composition, most patients segregated into three distinct groups, each of which were predicted to encode metagenomes capable of producing metabolites characteristically enriched in paired serum samples from these patients. These three groups also exhibited differences in mortality; those with the highest rate had increased ceftriaxone administration and culturable Aspergillus, and demonstrated significantly increased induction of airway T-helper cell type 2 responses. The group with the lowest mortality was characterized by increased expression of T-cell immunoglobulin and mucin domain 3, which down-regulates T-helper cell type 1 proinflammatory responses and is associated with chronic viral infection.ConclusionsThese data provide evidence that compositionally and structurally distinct lower airway microbiomes are associated with discrete local host immune responses, peripheral metabolic reprogramming, and different rates of mortality

Comparison of 129 consecutive HIV-infected patients with and without Pneumocystis pneumonia (PCP).

<p>HIV: human immunodeficiency virus; PCR: polymerase chain reaction; <i>dhps</i>: dihydropteroate synthase; <i>dhfr</i>: dihydrofolate reductase; NA: not applicable.</p>*<p>Determined by the student’s t-test or Kruskal-Wallis test for continuous variables, or the chi-squared test for categorical variables.</p>**<p>Among 94 patients with previously-diagnosed HIV.</p