Clinical and cranial computed tomography scan findings in adults following road traffic accidents in Kampala, Uganda.

Background: Globally, road traffic accidents are a major cause of death and disability. The developing countries bear a disproportionately large share of the RTAs which account for about 85% of the deaths. Most of these RTAs result in head injury, which globally, most scholars and medical practitioners consider a significant economic, social and medical problem. In Mulago National referral hospital, RTA is the leading cause of surgical admission. Objective: To describe the cranial computed tomography (CT) scan findings in adults following RTA in Mulago hospital. Methods: Using CT, detailed analysis of 178 adult patients with head injury following RTA was performed. Data was analyzed using SPSS version 16 and presented in tables and graphs. Data recorded included socio-demographic characteristics, clinical and CT variables. Results: Seventy seven percent of the respondents were between 18- 39 years. 52.6% of patients had open head injury. Headache was the most common clinical variable followed by dizziness and aphasia. The most common CT characteristic was extra cerebral haemorrhage followed by brain oedema and raised Intra-cranial pressure (ICP). Intra-cerebral haemorrhage was commonest in the frontal lobe followed by parietal lobe. Conclusion: Public health interventions like advocacy and education of the population on safe and responsible road usage should be emphasized to reduce on RTAs

Outcome at two weeks in patients with Traumatic brain injury following road traffic accidents in an urban tertiary hospital in Uganda

Road traffic accidents (RTAs) are a major global public health problem and are now a recognized neglected pandemic. Head injuries cause immediate death in 25% of acute trauma. We conducted this study to determine the immediate outcomes in adult with head injury following RTA. A prospective study was conducted among 178 adult patients and followed up for two weeks to determine immediate outcomes. Multivariate logistic regression analysis was used to determine predictor variables of immediate outcome. Majority had moderate disability (38.2%), then severe disability (25.8%) and good recovery (24.7%) at two weeks. Persistent vegetative state and death occurred in 2% and 9% of patients respectively. Sixty-three percent of patients had favourable outcome. Convulsions, intracerebral haemorrhage had significant p-values at bivariate analysis (0.019, 0.008 respectively) at GCS. Vomiting, convulsions, extra cerebral haemorrhage and intracerebral haemorrhage had significant association P values (0.000, 0.001, 0.000 and 0.000 respectively) at two weeks by GOS. Level of consciousness (p-value = 0.000), intracerebral haemorrhage (p = 0.003), skull fractures (p = 0.001) and surgery (p = 0.016) were statistically significant at multivariate analysis. GCS and GOS were important in assessment of immediate outcomes at 2 weeks but GOS was a more reliable assessment tool

Circulating plasma NT-proBNP predicts subclinical coronary atherosclerosis on CT angiography among older adults in Uganda

Abstract Objective Phenotypes and mechanisms of cardiovascular disease (CVD) may differ across global populations. In sub-Saharan Africa (SSA), distinct environmental determinants may influence development and progression of atherosclerotic coronary artery disease (CAD). Methods We investigated associations between 6 established markers of myocardial stress and subsequent subclinical CAD (sCAD), defined as presence of any atherosclerosis on coronary CT angiography (CCTA) in a 2-year prospective cohort of Ugandan adults enriched for cardiometabolic risk factors (RFs) and HIV. Six plasma biomarkers were measured baseline among 200 participants (50% with HIV) aged ≥ 45 years with ≥ 1 cardiovascular RF. At 2-year follow-up, 132 participants (52% with HIV) who returned underwent coronary CCTA. Results In logistic regression models adjusted for cardiovascular RFs (age, diabetes, hypertension, hyperlipidemia, smoking, obesity) and non-traditional RFs (HIV, chronic kidney disease), only NT-proBNP predicted subsequent subclinical CAD (p < 0.008, Bonferroni correction for multiple testing). In sensitivity analyses adjusted for ASCVD risk category (instead of individual RFs) in the baseline cohort with multiple imputation applied to missing year 2 CCTA data (n = 200), NT-proBNP remained significantly associated with subsequent CAD (p < 0.008). Conclusions NT-proBNP consistently predicted subclinical CAD in Uganda in the absence of such an association among other markers of myocardial stress, suggesting a role for NT-proBNP in atherosclerosis independently of coronary microvascular dysfunction

Cardiovascular abnormalities in chest radiographs of children with pneumonia, Uganda

Objective: To describe chest radiograph findings among children hospitalized with clinically diagnosed severe pneumonia and hypoxaemia at three tertiary facilities in Uganda. Methods: The study involved clinical and radiograph data on a random sample of 375 children aged 28 days to 12 years enrolled in the Children’s Oxygen Administration Strategies Trial in 2017. Children were hospitalized with a history of respiratory illness and respiratory distress complicated by hypoxaemia, defined as a peripheral oxygen saturation (SpO2 ) Findings: Overall, 45.9% (172/375) of children had radiological pneumonia, 36.3% (136/375) had a normal chest radiograph and 32.8% (123/375) had other radiograph abnormalities, with or without pneumonia. In addition, 28.3% (106/375) had a cardiovascular abnormality, including 14.9% (56/375) with both pneumonia and another abnormality. There was no significant difference in the prevalence of radiological pneumonia or of cardiovascular abnormalities or in 28-day mortality between children with severe hypoxaemia (SpO2 : Conclusion: Cardiovascular abnormalities were relatively common among children hospitalized with severe pneumonia in Uganda. The standard clinical criteria used to identify pneumonia among children in resource-poor settings were sensitive but lacked specificity. Chest radiographs should be performed routinely for all children with clinical signs of severe pneumonia because it provides useful information on both cardiovascular and respiratory systems

Two by two table of chest ultrasound scan and chest radiography.

Two by two table of chest ultrasound scan and chest radiography.</p

Characteristics of the study participants.

Chest Ultrasound Scan (CUS) has been utilized in place of CXR in the diagnosis of adult pneumonia with similar or higher sensitivity and specificity to CXR. However, there is a paucity of data on the use of CUS for the diagnosis of childhood TB. This study aimed to determine the diagnostic accuracy of CUS for childhood TB. This cross-sectional study was conducted at the Mulago National Referral Hospital in Uganda. Eighty children up to 14 years of age with presumptive TB were enrolled. They all had CUS and CXR performed and interpreted independently by radiologists. The radiologist who performed the CXR was blinded to the CUS findings, and vice versa. Radiologists noted whether TB was likely or unlikely. A two-by-two table was developed to compare the absolute number of children as either TB likely or TB unlikely on CXR or CUS. This was used to calculate the sensitivity and specificity of CUS when screening for TB in children, with a correction to accommodate the use of CXR as a reference test. The sensitivity of CUS was 64% (95% CI 48.5%-77.3%), while its specificity was 42.7% (95% CI 25.5%-60.8%). Both the CUS and CXR found 29 children with a likelihood of TB, and 27 children unlikely to have TB. CUS met the sensitivity target set by the WHO TPP for Triage, and it had a sensitivity and specificity comparable to that of CXR.</div

Sex-specific performance of the ASCVD pooled cohort equation risk calculator as a correlate of coronary artery calcium in Kampala, Uganda

IntroductionThe prevalence of cardiovascular disease (CVD) is rising in Sub-Saharan Africa, but it is not known whether current risk assessment tools predict coronary atherosclerosis in the region. Furthermore, sex-specific performance and interaction with HIV serostatus has not been well studied.MethodsThis cross-sectional study compared ASCVD risk scores and detectable coronary artery calcium (CAC&gt;0) by sex in Kampala, Uganda (n&nbsp;=&nbsp;200). The cohort was enriched for persons living with HIV, and all participants had at least one CVD risk factor. We fit log binomial regression models and constructed ROC curves to assess the correlation between ASCVD scores and CAC&gt;0.ResultsThe mean age was 56. 62% were female and 50% of both men and women were living with HIV. The median 10-year ASCVD risk score was significantly higher in men (11.0%, IQR 7.6-19.4%) than in women (5.1%, IQR 3.2-8.7%), although the prevalence of CAC&gt;0 was similar (8.1 vs 10.5%, p&nbsp;=&nbsp;0.63). Each 10% increase in ASCVD risk was associated with increased risk of CAC&gt;0 in men (PR 1.59, 95% CI 1.00-2.55, p&nbsp;=&nbsp;0.05) but not women (PR 1.15, 95% CI 0.44-3.00, p&nbsp;=&nbsp;0.77). ROC curves demonstrated an AUC of 0.57 for women vs 0.70 for men. Adjustment for HIV serostatus improved the predictive value of ASCVD in women only (AUC 0.78, p&nbsp;=&nbsp;0.02).ConclusionsASCVD risk score did not correlate with the presence of CAC in women. When HIV status was added to the ASCVD risk score, correlation with CAC was improved in women but not in men