Home versus in-patient treatment for deep vein thrombosis

Peer reviewedPublisher PD

The reference range of serum magnesium substance concentration among healthy young adults at Makerere University College of Health Sciences 2012

Background: Magnesium is the second most abundant intracellular cation, with only a small proportion of the body’s content being in the extracellular fluid. It is required for the active transport of other cations such as calcium, sodium and potassium across the membrane by active transport system. It is also needed for many intracellular metabolic pathways. This study was carried to establish the reference intervals for serum magnesium substance concentration among healthy medical students in Uganda.Methods: This was purposive study in which ante-cubital venous blood samples were drawn without stasis from 60 healthy, natively Ugandan pre-clinical medical students and analysed without delay using Cobasintegra 400/700/800 automated analyser which flagged each result using the in-built seemingly temperate reference range of 0.65-1.05 mmol/L.Results: The distribution of serum magnesium substance concentration was unimodal, leptokurtic, and positively skewed with empirical range of 0.86 – 1.32 mmol/L. There was no result flagged as low. Twenty-six out of sixty (43.3%) results were flagged as high values while none approached 2.0 mmol/L, considered the threshold of hypermagnesaemia symptoms. Using the central 95 percentile, the reference range was set as 0.81 – 1.29 mmol/L which is higher and slightly broader than the 0.65 – 1.05 mmol/L often quoted for populations in temperate regions and in-built in automated analysers exported even to the tropics.Conclusion: Reference ranges were higher in the studied healthy young adults in Uganda than those in the temperate regions. Effort should therefore be made to enable our laboratories establish their own reference values

Human immunodeficiency virus and AIDS and other important predictors of maternal mortality in Mulago Hospital Complex Kampala Uganda

BACKGROUND: Women with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda. METHODS: This was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care. RESULTS: Severe pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39), maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1.The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8), non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2), non use of oxytocics (OR 4.0, 95% CI 1.7-9.7), lack of essential drugs (OR 3.6, 95% CI 1.1-11.3) and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9) and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1). CONCLUSION: The predictors of progression from severe maternal morbidity to mortality were: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS.There is need to improve on the referral system, economic empowerment of women and to offer comprehensive emergency obstetric care so as to reduce the maternal morbidity and mortality in our community

Knowledge, Attitude, and Beliefs of Communities and Health Staff about Echinococcus granulosus Infection in Selected Pastoral and Agropastoral Regions of Uganda

A descriptive cross-sectional survey was done to determine knowledge, attitudes, and beliefs of the communities and health workers about cystic echinococcosis (CE) in pastoral region of Northeastern (NE) and agropastoral regions of Eastern (E) and Central (C) Uganda. Overall a total of 1310 participants were interviewed. Community respondents from NE region were more aware of CE infection than those from Eastern (OR 4.85; CI: 3.60–6.60; p0.05). 51.7% of the community respondents from Central believed CE is caused by witchcraft, compared with 31.3% and 14.3% from NE and EA regions, respectively (p0.05). None of the participants knew his/her CE status. The communities need to be sensitized about CE detection, control, and management and health staff need to be trained on CE diagnosis

Identification of <i>Echinococcus granulosus</i> strains using polymerase chain reaction–restriction fragment length polymorphism amongst livestock in Moroto district, Uganda

A descriptive study was conducted to identify the different strains of Echinococcus granulosus occurring in livestock in Moroto district, Uganda. Echinococcus cysts from 104 domestic animals, including cattle, sheep, goats and camels, were taken and examined by microscopy, polymerase chain reaction with restriction fragment length polymorphism and Sanger DNA sequencing. Echinococcus granulosus genotypes or strains were identified through use of Bioinformatics tools: BioEdit, BLAST and MEGA6. The major finding of this study was the existence of a limited number of E. granulosus genotypes from cattle, goats, sheep and camels. The most predominant genotype was G1 (96.05%), corresponding to the common sheep strain. To a limited extent (3.95%), the study revealed the existence of Echinococcus canadensis G6/7 in three (n = 3) of the E. granulosus–positive samples. No other strains of E. granulosus were identified. It was concluded that the common sheep strain of Echinococcus sensu stricto and G6/7 of E. canadensis were responsible for echinococcal disease in Moroto district, Uganda

Immunological and biochemical biomarker alterations among SARS-COV-2 patients with varying disease phenotypes in Uganda

Abstract Every novel infection requires an assessment of the host response coupled with identification of unique biomarkers for predicting disease pathogenesis, treatment targets and diagnostic utility. Studies have exposed dysregulated inflammatory response induced by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as significant predictor or cause of disease severity/prognosis and death. This study evaluated inflammatory biomarkers induced by SARS-CoV-2 in plasma of patients with varying disease phenotypes and healthy controls with prognostic or therapeutic potential. We stratified SARS-CoV-2 plasma samples based on disease status (asymptomatic, mild, severe, and healthy controls), as diagnosed by RT-PCR SARS-CoV-2. We used a solid phase sandwich and competitive Enzyme-Linked Immunosorbent Assay (ELISA) to measure levels of panels of immunological (IFN-γ, TNF-α, IL-6, and IL-10) and biochemical markers (Ferritin, Procalcitonin, C-Reactive Protein, Angiotensin II, Homocysteine, and D-dimer). Biomarker levels were compared across SARS-CoV-2 disease stratification. Plasma IFN-γ, TNF-α, IL-6, and IL-10 levels were significantly (P < 0.05) elevated in the severe SARS-CoV-2 patients as compared to mild, asymptomatic, and healthy controls. Ferritin, Homocysteine, and D-dimer plasma levels were significantly elevated in severe cases over asymptomatic and healthy controls. Plasma C-reactive protein and Angiotensin II levels were significantly (P < 0.05) higher in mild than severe cases and healthy controls. Plasma Procalcitonin levels were significantly higher in asymptomatic than in mild, severe cases and healthy controls. Our study demonstrates the role of host inflammatory biomarkers in modulating the pathogenesis of COVID-19. The study proposes a number of potential biomarkers that could be explored as SARS-CoV-2 treatment targets and possible prognostic predictors for a severe outcome. The comprehensive analysis of prognostic biomarkers may contribute to the evidence-based management of COVID-19 patients

Risk factors associated with cystic echinococcosis in humans in selected pastoral and agro-pastoral areas of Uganda

It was to determine the risk factors responsible of occurrence of cystic echinococcosis (CE) of humans in the pastoral and agro-pastoral (PAP) in Uganda.Aim: It was to determine the risk factors responsible of occurrence of cystic echinococcosis (CE) of humans in the pastoral and agro-pastoral (PAP) in Uganda. Materials and Methods: A cross-sectional study was conducted in districts: Moroto, Napak, Nakapiripirit and Amudat in Karamoja region; in agro-pastoral communities of Teso region, in the districts of Kumi and Bukedea; Nakasongola district in Central region and in Kasese district in the Western region. People were subjected to voluntary ultrasound screening for CE. Those found positive to CE on ultrasound screening were interviewed using a special designed form to find out the probable predisposing factors for acquisition of CE infection. Predisposing factors considered were location, age, sex, dog ownership, occupation, water source, and religion. Univariate and multivariate logistic regression analysis was performed to identify key risk factors. Results: In Karamoja region, being female, age beyond 40 years and open spring water sources were the risk factors. While for Nakasongola age beyond 40 years was a risk factor. In Kasese dog ownership, age >60 years and being a Muslim were risk factors. In Teso region dog ownership and age >60 years were the risk factors. Conclusion: Being a pastoralist, a female, increasing age beyond 40 years, open spring water sources, dog ownership and being a Muslim were the risk factors for CE in PAP areas in Uganda