Inflammatory arthritis in HIV positive patients: A practical guide

Background: Musculoskeletal manifestations of the human immunodeficiency virus (HIV) have been described since the outset of the global HIV epidemic. Articular syndromes that have been described in association with HIV include HIV-associated arthropathy, seronegative spondyloarthropathies (SPA) (reactive arthritis, psoriatic arthritis (PsA) and undifferentiated SPA), rheumatoid arthritis (RA) and painful articular syndrome. Methods: We carried out a computer-assisted search of PubMed for the medical literature from January 1981 to January 2015 using the keywords HIV, acquired immune-deficiency syndrome, rheumatic manifestations, arthritis, spondyloarthropathy, anti-TNF and disease modifying antirheumatic drugs. Only English language literature was included and only studies involving adult human subjects were assessed. Results: There are challenges in the management of inflammatory arthritis in patients who are HIV-positive, including difficulties in the assessment of disease activity and limited information on the safety of immunosuppressive drugs in these individuals. Conclusions: This review focuses on the clinical characteristics of the inflammatory articular syndromes that have been described in association with HIV infection and discusses the therapeutic options for these patients

Social media and Social Transformation in Uganda‘s families

The development and application of social media, has transformed Ugandan social life. Transformations are seen in the way Ugandans are socializing with one another and in the way families utilize their free time. Through a questionnaire survey, and interviews the paper examines the way technology development is transforming the social family cycle in Uganda. It further examines the challenges faced by families as a result of application of social media. Finally the paper proposes strategies of solving the challenges. This paper will benefit Ugandans and the people beyond, the researchers and educational administrators including the proponents of social media

Vitamin B12 deficiency presenting as an acute confusional state: A case report and review of literature

BACKGROUND: Vitamin B12 deficiency is associated with a wide spectrum of neuro-psychiatric manifestations. RESULTS: We report a case of a 44 year old female patient referred to the haematology unit with vitamin B12 deficiency presenting as an acute confusional state or delirium. Total resolution of the psychiatric symptoms occurred following parenteral vitamin B12 replacement therapy. CONCLUSION: This case report highlights one of the neuro-psychiatric presentations of vitamin B12 deficiency in a previously healthy individual

Vitamin B12 deficiency presenting as an acute confusional state: a case report and review of literature

Background: Vitamin B12 deficiency is associated with a wide spectrum of neuro-psychiatric manifestations. Results: We report a case of a 44 year old female patient referred to the haematology unit with vitamin B12 deficiency presenting as an acute confusional state or delirium. Total resolution of the psychiatric symptoms occurred following parenteral vitamin B12 replacement therapy. Conclusion: This case report highlights one of the neuro-psychiatric presentations of vitamin B12 deficiency in a previously healthy individual

Mineral fertilizers improve the sensory quality of East African Highland bananas (Musa AAA-EA, cv. Kisansa)

Some farmers in Uganda believe that fertilizers negatively affect the sensory attributes of cooking type bananas. This belief may hamper the adoption of fertilizers. To verify the validity of this belief, bunches (Musa AAA-EA, cv. ‘Kisansa’) from fertilized (i.e. N-P-K-Mg-Zn-S-B-Mo) and non-fertilized plots were harvested from on-station trials in central (Wakiso) and southwestern (Ntungamo) Uganda. Samples were anonymously tagged for preparation (boiled or steamed) and sensory evaluation by farmers from southwestern (n=33) and central Uganda (n=35). Data were analyzed in STATA using Tau-b rank test for proportions, median ranks and odds ratios. The frequency of evaluators ranking fertilized steamed bananas highly (i.e. ‘Best’ or ‘Second-best’) was significantly (P=0.05) higher (60%) than for non-fertilized bananas (42%). The opposite was true for boiled bananas (fertilized, 43% vs. non-fertilized, 60%). Irrespective of site of cultivation and evaluators’ origin, gender or age, fertilizers significantly (P=0.05) improved the appearance, odor, softness and acceptability of steamed bananas. For boiled bananas, attributes did not significantly differ between fertilizer treatments, except for appearance, which was significantly inferior (P=0.05) for fertilized bananas. This study shows that the belief that fertilizers negatively affect the sensory attributes of cooking type bananas is generally incorrect. Only when boiled, fertilized bananas appeared less attractive than non-fertilized bananas. The dominant and traditional way of preparing cooking type bananas in Uganda is through steaming (i.e., matooke). We recommend the application of fertilizer, as it will not only positively affect yield, but also the sensory quality of cooking type bananas

Frequency of RANTES gene polymorphisms and their association with incidence of malaria : a longitudinal study on children in Iganga district, Uganda

Background: The severity and outcome of malaria is influenced by host immunity in which chemokines such as Regulated upon Activation, Normal T cell Expressed and Secreted (RANTES) play an important role. Previous studies show that variations in the RANTES gene affect RANTES protein production, hence altering host immunity. In this study, the relationship between presence of mutations in RANTES and incidence of malaria in a cohort of children living in a malaria-endemic area of Uganda was determined. Methods: This was a longitudinal study comprising of 423 children aged between 6 months and 9 years, who were actively followed up for 1 year. Malaria episodes occurring in the cohort children were detected and the affected children treated with national policy drug regimen. Mutations in the RANTES gene were determined by PCR-RFLP method and their frequencies were calculated. A multivariate negative binomial regression model was used to estimate the impact of RANTES mutations on malaria incidence. In all statistical tests, a P-value of <0.05 was considered as significant. Results: The frequencies of the -403A and In1.1C allele were 53.7 and 19.2 %, respectively. No mutations were found at the -28 locus. After adjustment of incidence rates for age, blood group, insecticide-treated bed net (ITN) use, malaria history and the sickle cell trait, 1n1.1T/C heterozygotes and homozygotes showed a non-significant trend towards higher incidence rates compared to wild-type individuals (IRR = 1.10; P = 0.55 and IRR = 1.25; P = 0.60, respectively). Similarly, there was no significant difference in malaria incidence rates between RANTES -403G/A heterozygotes or homozygotes and those without mutations (IRR = 1.09; P = 0.66 and IRR = 1.16; P = 0.50, respectively). No relation was seen between RANTES polymorphisms, baseline parasite densities and the time to first re-infection after administration of anti-malaria drugs. Conclusions: This study showed that the -403A mutation occurs in nearly half of the study population and the In1.1C allele occurs in one in every four children. Despite the high frequency of these mutations, there was no clear association with malaria incidence. Other studies evaluating more markers, that could potentially modulate RANTES gene transcription alongside other genetic modifiers of malaria susceptibility, may provide further explanations to these less dramatic findings

Rheumatic manifestations among HIV positive adults attending the Infectious disease clinic at Mulago hospital

Background: Rheumatic manifestations in HIV are common and sometimes the initial presentation of the disease. HIV is now a common infection at the Infectious Disease Clinic, Mulago. The spectrum of jointdiseases seen depend on a number of factors such as, the CD4 count, HLA status and current therapy.Objective: This study included HIV patients from a heterogeneous population and was designed to determine the prevalence and clinical pattern of rheumatic manifestations among these HIV patients.Methods: Four hundred eighty seven patients were screened and 300 HIV positive patients were consecutively recruited into the study, evaluated for rheumatic manifestations and their clinical and laboratory findingsdocumented.Results: The prevalence of rheumatic manifestations was 27% (81of 300). Arthralgias in 19.3% of the study population were commonest finding followed by HIV associated arthritis at 4.3%. The lower limbs were themost commonly affected with the knees (28.8%) and ankles (26.9%) contributing the highest. All patients had a negative anti-nuclear antibody test, with only two having a positive rheumatoid factor test. An association of antituberculosis drugs with joint disease was further highlighted in this study (OR 3.79 95% CI, 1.44 – 9.93). Septic arthritis due to Staphylococcus aureus was rarely observed except when the patients’ level of CD4 + T cells dropped below 200 cells mm3. The mean CD4+ count was 171 cells mm3.Conclusion: Rheumatic manifestations should be considered among HIV positive adults. Arthralgias are common especially in patients using pyrazinamide

Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda

Background: Greater blood pressure variability has detrimental effects on clinical outcome after a stroke; its effects are controversial and have not been evaluated in Sub-Saharan Africa (SSA). Methods: We conducted a prospective study of patients with CT head confirmed ischemic and hemorrhagic strokes admitted to a tertiary hospital within 7 days of onset of unilateral neurological deficits. Blood pressure variability indices, standard deviation (SD) and coefficient of variation (CV) of systolic and diastolic blood pressure between day 0 and day 7, were calculated with a subsequent modified Rankin Scale (mRS) score on day 14 post-stroke. Linear regression was performed to determine the exponential coefficients of mortality at 14 days post- stroke. Results: Out of 120 patients, 51.7% were female, 52.5% had ischemic stroke and the overall median age was 65 (IQR 54–80) years. Twenty (16.7%) patients died within a median survival time of 7 days, while 32 (26.7%) died by day 14 post-stroke. Patients with hemorrhagic stroke had an overall SDSBP of 16.44 mmHg while those with ischemic stroke had an overall SDSBP of 14.05 mmHg. In patients with ischemic stroke, SDSBP had adjusted coefficients of 1, p = 0.004 with C·I: 1.01–1.04 and NIHSS had adjusted coefficients of 1, p = 0.019 with C·I: 1.00–1.03 while in patients with hemorrhagic stroke, SDSBP had adjusted coefficients of 1, p = 0.045 with C·I: 1.00–1.04 and NIHSS had adjusted coefficients of 1, p ≤0.001 with C·I: 1.01–1.03. Conclusion: Exponential increase in Blood Pressure Variability (BPV) and stroke severity scale were independently associated with early mortality among all stroke patients in our study. We recommend future studies to evaluate whether controlling BPV among patients with stroke in Sub-Saharan Africa can reduce mortality