97 research outputs found
Prevalence, types and factors associated with echocardiographic abnormalities among newly diagnosed diabetic patients at Mulago Hospital
Background: The prevalence of Diabetes mellitus (DM) is on a rise in sub Saharan Africa and will more than double by 2025. Cardiovascular disease (CVD) accounts for up to 2/3 of all deaths in the diabetic population. Of all the CVD deaths in DM, 3/4 occur in sub Saharan Africa (SSA). Non invasive identification of cardiac abnormalities, such as Left Ventricular Hypertrophy (LVH), diastolic and systolic dysfunction, is not part of diabetes complications surveillance programs in Uganda and there is limited data on this problem. This study sought to determine the prevalence, types and factors associated with echocardiographic abnormalities among newly diagnosed diabetic patients at Mulago National referral hospital in Uganda.Methods: In this cross sectional study conducted between June 2014 and December 2014, we recruited 202 newly diagnosed adult diabetic patients. Information on patients' socio-demographics, bio-physical profile, biochemical testing and echocardiographic findings was obtained for all the participants using a pre-tested questionnaire. An abnormal echocardiogram in this study was defined as the presence of LVH, diastolic and/or systolic dysfunction and wall motion abnormality. Bivariate and multivariate logistic regression analyses were used to investigate the association of several parameters with echocardiographic abnormalities.Results: Of the 202 patients recruited, males were 102(50.5%) and the mean age was 46±15 years. Majority of patients had type 2 DM, 156(77.2%) and type 1 DM, 41(20.3%) with mean HbA1C of 13.9±5.3%. Mean duration of diabetes was 2 months. The prevalence of an abnormal echocardiogram was 67.8 % (95% CI 60%-74%). Diastolic dysfunction, systolic dysfunction, LVH and wall motion abnormalities were present in 55.0%, 21.8%, 19.3% and 4.0% of all the participants respectively. In bivariate logistic regression analysis, the factors associated with an abnormal echocardiogram were age (OR 1.09 [95% CI 1.06 1.12], P <0.0001), type 2 DM (OR 5.8[95% CI 2.77-12.07], P<0.0001), hypertension (OR 2.64[95% CI 1.44-4.85], P=0.002), obesity (OR 3.51[955 CI 1.25-9.84], P=0.017 and increased waist circumference (OR 1.02[95% CI 1.00-1.04], P=0.024. On Multiple logistic regression analysis, age was the only factor associated with an abnormal echocardiogram (OR 1.09[95%CI 1.05-1.15], P<0.0001).Conclusion: Echocardiographic abnormalities were common among newly diagnosed adults with DM. Traditional CVD risk factors were associated with an abnormal echocardiogram in this patient population. Due to a high prevalence of echocardiographic abnormalities among newly diagnosed diabetics, we recommend screening for cardiac disease especially in patients who present with traditional CVD risk factors. This will facilitate early diagnosis, management and hence better patient outcomes.Keywords: Diabetes mellitus, echocardiography, cardiac abnormalitie
Proportion of patients in the Uganda rheumatic heart disease registry with advanced disease requiring urgent surgical interventions
Introduction: Since the establishment of the Uganda Rheumatic Heart Registry, over 900 patients have been enrolled. We sought to stratify the patients in the registry according to disease severity and optimal management strategy.Methods: We reviewed data of 618 patients who had enrolled in the Registry between March 2010 and February 2013. The 67 patients who had died were excluded leaving 551 patients who were recruited. The optimum management strategy was determined according to the 2012 European Society of Cardiology guidelines on the management of valvular heart disease.Results: Out of the 551 patientâs records evaluated, 398 (72.3%) required invasive intervention, with 332(60.3%) patients requiring surgery and 66 (12.0%) requiring percutaneous mitral commissurotomy (PMC). This leaves only 27.7% of patients who required only medical management. Currently, majority of the patients (498, 90.4%) in the registry are on medical treatment. Of the 60.3% requiring surgical intervention, only 8.0% (44 patients) underwent valvular surgery and 5(1.0%) patients of the 66 (12.0%) underwent PMC successfully.Conclusion: There is a high proportion of patients with severe disease that require surgical treatment yet they cannot access this therapy due to absence of local expertise.Keywords: Rheumatic Heart Disease, surgical intervention, percutaneuos interventio
Prevalence, types and factors associated with echocardiographic abnormalities among newly diagnosed diabetic patients at Mulago Hospital.
Background: The prevalence of Diabetes mellitus (DM) is on a rise in
sub-Saharan Africa and will more than double by 2025. Cardiovascular
disease (CVD) accounts for up to 2/3 of all deaths in the diabetic
population. Of all the CVD deaths in DM, 3/4 occur in sub Saharan
Africa (SSA). Non invasive identification of cardiac abnormalities,
such as Left Ventricular Hypertrophy (LVH), diastolic and systolic
dysfunction, is not part of diabetes complications surveillance
programs in Uganda and there is limited data on this problem. This
study sought to determine the prevalence, types and factors associated
with echocardiographic abnormalities among newly diagnosed diabetic
patients at Mulago National referral hospital in Uganda. Methods: In
this cross sectional study conducted between June 2014 and December
2014, we recruited 202 newly diagnosed adult diabetic patients.
Information on patients\' socio-demographics, bio-physical profile,
biochemical testing and echocardiographic findings was obtained for all
the participants using a pre-tested questionnaire. An abnormal
echocardiogram in this study was defined as the presence of LVH,
diastolic and/or systolic dysfunction and wall motion abnormality.
Bivariate and multivariate logistic regression analyses were used to
investigate the association of several parameters with
echocardiographic abnormalities. Results: Of the 202 patients
recruited, males were 102(50.5%) and the mean age was 46\ub115 years.
Majority of patients had type 2 DM, 156(77.2%) and type 1 DM, 41(20.3%)
with mean HbA1C of 13.9\ub15.3%. Mean duration of diabetes was 2
months. The prevalence of an abnormal echocardiogram was 67.8 % (95% CI
60%-74%). Diastolic dysfunction, systolic dysfunction, LVH and wall
motion abnormalities were present in 55.0%, 21.8%, 19.3% and 4.0% of
all the participants respectively. In bivariate logistic regression
analysis, the factors associated with an abnormal echocardiogram were
age (OR 1.09 [95% CI 1.06\u20131.12], P <0.0001), type 2 DM (OR
5.8[95% CI 2.77-12.07], P<0.0001), hypertension (OR 2.64[95% CI
1.44-4.85], P=0.002), obesity (OR 3.51[955 CI 1.25-9.84], P=0.017 and
increased waist circumference (OR 1.02[95% CI 1.00-1.04], P=0.024. On
Multiple logistic regression analysis, age was the only factor
associated with an abnormal echocardiogram (OR 1.09[95%CI 1.05-1.15],
P<0.0001). Conclusion: Echocardiographic abnormalities were common
among newly diagnosed adults with DM. Traditional CVD risk factors were
associated with an abnormal echocardiogram in this patient population.
Due to a high prevalence of echocardiographic abnormalities among newly
diagnosed diabetics, we recommend screening for cardiac disease
especially in patients who present with traditional CVD risk factors.
This will facilitate early diagnosis, management and hence better
patient outcomes
Rheumatic heart disease in Uganda: the association between MHC class II HLA DR alleles and disease: a case control study
Background
Rheumatic heart disease (RHD), the only long term consequence of acute rheumatic fever, remains a leading cause of morbidity and mortality among young adults in Uganda. An inherited susceptibility to acute rheumatic fever centers around the major histocompatibility class II human leucocyte antigens. However, there is paucity of data from sub-Saharan Africa. This study compares the frequency of HLA class II DR alleles between RHD cases and normal controls in Uganda. Methods
One hundred ninety-nine participants including 96 established RHD cases aged 5â60 years and 103 age and sex matched normal controls were recruited for participation. DNA was manually extracted from buffy coat samples and HLA analysis was performed. HLA-DR allelic frequency comparison between cases and controls were estimated using conditional logistic regression with 95% confidence intervals. P -values were corrected for multiple hypothesis testing. Results
199 participants (103 female, 51.8%) completed the study. The mean (SD) age in years for cases and controls were 29.6 (10.2) and 29(18), respectively. After conditional logistic regression and multiple hypothesis testing, HLA-DR1was associated with a decreased risk of RHD (ORâ=â0.42, CI 0.21-085, Pâ=â0.01, Corrected P value (PC)â=â0.09,) while HLA-DR11 was associated with increased risk of RHD (ORâ=â3.31, CI 1.57-6.97, Pâ=â\u3c0.001, Pcâ\u3câ0.001). No other significant associations were found. Conclusion
In this first study of HLA genetic susceptibility to RHD in Uganda, HLA- DR1 was more common in normal controls while HLA- DR11 was more common among RHD cases suggesting a disease susceptibility association. In future studies, high resolution HLA analysis and genome wide studies should be carried out to confirm this pattern
Anthracycline induced cardiotoxicity in adult cancer patients: a prospective cohort study from a specialized oncology treatment centre in Uganda.
PURPOSE: To determine the cumulative incidence of anthracycline induced cardiotoxicity (AIC), its predictors, and associated electrocardiographic and echocardiographic manifestations in adult cancer patients at Uganda Cancer Institute (UCI). METHODS: We enrolled 160 participants between June 2013 and April 2014 and followed them up for a median of 146 days. Data on clinical, electrocardiographic and echocardiographic findings was obtained at baseline, and at completion of chemotherapy. The Pearson chi square test was used to identify the predictors associated with cardiotoxicity. RESULTS: Of the 64 patients who were accessible for follow-up electrocardiography (ECG) and echocardiography (ECHO), fourteen participants developed cardiotoxicity hence a cumulative incidence rate of 21.9% with 95% CI 13.5%-33.43%. The predictors of AIC were female gender (p=0.025), LVEF (p=0.014) and LVFS (P=0.019). Anthracycline therapy was associated with shortening of the QRS duration (84.3±7.9 Vs 82.1±11.8 ms, p=0.005), prolongation of the QTc interval (411.9±30.7 Vs 447.2±39.4 ms, p=<0.001) and reduction in the LVEF (66.4±7.7 Vs 63.9±8.4%, p=0.026) and LVFS (36.9±6.2 Vs 35.1±6.6%, p=0.03). CONCLUSION: The cumulative incidence of AIC in this study cohort was high. Our findings emphasize the need for early monitoring for AIC
Anthracycline induced cardiotoxicity in adult cancer patients: a prospective cohort study from a specialized oncology treatment centre in Uganda
Purpose: To determine the cumulative incidence of anthracycline induced
cardiotoxicity (AIC), its predictors, and associated
electrocardiographic and echocardiographic manifestations in adult
cancer patients at Uganda Cancer Institute (UCI). Methods: We enrolled
160 participants between June 2013 and April 2014 and followed them up
for a median of 146 days. Data on clinical, electrocardiographic and
echocardiographic findings was obtained at baseline, and at completion
of chemotherapy. The Pearson chi square test was used to identify the
predictors associated with cardiotoxicity. Results: Of the 64 patients
who were accessible for follow-up electrocardiography (ECG) and
echocardiography (ECHO), fourteen participants developed cardiotoxicity
hence a cumulative incidence rate of 21.9% with 95% CI 13.5%- 33.43%.
The predictors of AIC were female gender (p=0.025), LVEF (p=0.014) and
LVFS (P=0.019). Anthracycline therapy was associated with shortening of
the QRS duration (84.3\ub17.9 Vs 82.1\ub111.8 ms, p=0.005),
prolongation of the QTc interval (411.9\ub130.7 Vs 447.2\ub139.4
ms, p=<0.001) and reduction in the LVEF (66.4\ub17.7 Vs
63.9\ub18.4%, p=0.026) and LVFS (36.9\ub16.2 Vs 35.1\ub16.6%,
p=0.03). Conclusion: The cumulative incidence of AIC in this study
cohort was high. Our findings emphasize the need for early monitoring
for AIC. DOI: https://dx.doi.org/10.4314/ahs.v19i1.40 Cite as: Kibudde
S, Mondo CK, Kibirige D, Walusansa V, J O. Anthracycline induced
cardiotoxicity in adult cancer patients: a prospective cohort study
from a specialized oncology treatment centre in Uganda. Afri Health
Sci. 2019;19(1). 1647-1656. https://dx.doi.org/10.4314/ahs. v19i1.4
Proportion of patients in the Uganda rheumatic heart disease registry with advanced disease requiring urgent surgical interventions
Introduction: Since the establishment of the Uganda Rheumatic Heart
Registry, over 900 patients have been enrolled. We sought to stratify
the patients in the registry according to disease severity and optimal
management strategy. Methods: We reviewed data of 618 patients who had
enrolled in the Registry between March 2010 and February 2013. The 67
patients who had died were excluded leaving 551 patients who were
recruited. The optimum management strategy was determined according to
the 2012 European Society of Cardiology guidelines on the management of
valvular heart disease. Results: Out of the 551 patient\u2019s records
evaluated, 398 (72.3%) required invasive intervention, with 332(60.3%)
patients requiring surgery and 66 (12.0%) requiring percutaneous mitral
commissurotomy (PMC). This leaves only 27.7% of patients who required
only medical management. Currently, majority of the patients (498,
90.4%) in the registry are on medical treatment. Of the 60.3% requiring
surgical intervention, only 8.0% (44 patients) underwent valvular
surgery and 5(1.0%) patients of the 66 (12.0%) underwent PMC
successfully. Conclusion: There is a high proportion of patients with
severe disease that require surgical treatment yet they cannot access
this therapy due to absence of local expertise
Differences in socio-demographic and risk factor profile, clinical presentation, and outcomes between patients with and without RHD heart failure in Sub-Saharan Africa: results from the THESUS-HF registry
Background: Rheumatic heart disease (RHD) was found in the THESUS-HF registry to be the third most common cause of acute heart failure (AHF) in Sub-Saharan Africa.
Methods: One thousand six patients with AHF from 9 Sub-Saharan African countries were recruited in THESUS-HF, of which 143 (14.3%) had RHD-AHF. Clinical characteristics and outcomes in patients with RHD-AHF and non-RHD-AHF were compared. Kaplan-Meier plots for time to all-cause death and/or HF readmission according to the presence of RHD-AHF and non-RHD-AHF were performed and survival distributions compared using the log-rank test. Cox regression was used to determine the hazard ratio of death to day 180 and death or readmission to day 60 after adjusting for confounders.
Results: Patients with RHD-AHF were younger, more often females, had higher rates of atrial fibrillation, had less hypertension, hyperlipidemia and diabetes, had lower BP, and higher pulse rate and better kidney function and echocardiographic higher ejection fraction larger left atria and more diastolic dysfunction. Patients with RHD-AHF had a numerically longer mean stay in the hospital (10.5 vs. 8.8 days) and significantly higher initial hospitalization mortality (9.1% vs. 3.4%).
Conclusions: In conclusion, patients with HF related to RHD were younger, have higher rate of atrial fibrillation and have a worse short-term outcome compared to HF related to other etiologies in Sub-Saharan Afric
Kidney disease in Uganda: a community based study.
BACKGROUND: Chronic kidney disease (CKD) is a major cause of morbidity and mortality in Sub-Saharan Africa (SSA). The majority of studies on CKD in SSA have been conducted among HIV-infected populations and mainly from large health facilities. We determined the prevalence of CKD and its predictors among populations in communities in central Uganda. METHODS: A cross-sectional study was conducted in Wakiso district using multi-stage sampling. Data was collected on age, sex, socio-economic status, history of alcohol intake, diabetes mellitus, hypertension and smoking. Measurement of blood pressure, weight and height to determine body mass index (BMI) and investigations including HIV testing, fasting blood sugar, creatinine and urinalysis were conducted. Logistic regression was used to estimate the strength of the association between variables and the presence of CKD estimated using the Cockcroft Gault formula. RESULTS: A total of 955 participants aged 18-87Â years were enrolled into the study. The median age was 31Â years (Interquartile range 24-42) and majority (67%) were female. Up to 21.4% (204/955) had abnormal renal function with CKD stage 1 in 6.2% (59/955), stage 2 in 12.7% (121/955), stage 3 in 2.4% (23/955), CKD stage 4 in 0% and CKD stage 5 in 0.1% (1/995). Female gender OR 1.8 (95% Confidence Interval [CI] 1.2-2.8), age >30Â years OR 2.2(95% CI 1.2-3.8) and high social economic status OR 2.1 (95% CI 1.3-3.6) were associated with increased risk of CKD while BMIâ>â25Kg/m2 was protective against CKD OR 0.1 (95% CI 0.04-0.2). Traditional risk factors such as HIV-infection, diabetes mellitus, smoking and alcohol intake were not found to be significantly associated with CKD. CONCLUSION: We found a high prevalence of kidney disease in central Uganda. Interestingly the traditional risk factors associated with CKD previously documented, were not associated with CKD
Utility of albumin to creatinine ratio in screening for microalbuminuria among newly diagnosed diabetic patients in Uganda: a cross sectional study
Background: The aim of this study was to determine the prevalence and
factors associated with microalbuminuria among newly diagnosed diabetic
patients in Mulago National Referral Hospital, Uganda. Methods: In this
cross-sectional study conducted between June 2014 and January 2015, we
collected information on patients' socio-demographics, biophysical
profile, blood pressure, biochemical testing and echocardiographic
findings using a pre-tested questionnaire. Bivariate and multivariate
logistic regression analyses were used to investigate the association
of several factors with microalbuminuria. Results: Of the 175 patients
recruited, males were 90(51.4%) and the mean age was 46\ub115 years.
Majority of patients had type 2 DM 140 (80.0%) and the rest had type 1
DM 35 (20.0%). Mean glycated hemoglobin (HbA1C) was 13.9\ub15.3%.
Mean duration of diabetes was 2 months. Prevalence of microalbuminuria
was 47.4 % (95% CI: 40.0%-54.9%) overall. Pregnancy was associated with
microalbuminuria (OR7.74[95%CI.1.01-76.47] P=0.050) while mild and
moderate physical activity at work were inversely associated with
microalbuminuria respectively (OR0.08[95%CI0.01-0.95] P=0.046) and
(OR0.07[95%CI0.01-0.77] P=0.030). Conclusion: Prevalence of
microalbuminuria was high in this group. Physical activity at work may
be protective against microalbuminuria and this calls for longitudinal
studies. Early detection and management of microalbuminuria in
diabetics may slow progression to overt diabetic nephropathy (DN).
DOI: https://dx.doi.org/10.4314/ahs.v19i1.36 Cite as: Muddu M, Mutebi
E, Ssinabulya I, Kizito S, Mulindwa F, CM K. Utility of albumin to
creatinine ratio in screening for microalbuminuria among newly
diagnosed diabetic patients in Uganda: a cross sectional study. Afri
Health Sci. 2019;19(1). 1607-1616. https://dx.doi.
org/10.4314/ahs.v19i1.3
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