A survey of paediatric CT radiation doses in two selected hospitals in Kampala, Uganda: a radiation safety concern

Purpose: We describe radiation doses imparted to paediatric patients during Computerised (CT) scan examinations by estimation Weighted CT dose index (CTDIw) and Dose Length Product (DLP) and compare these doses with the International dose reference values.Methods: Demographic data and acquisition parameters of 257paediatric CT scans done using Multi-Slice CT (MSCT) and Dual Slice CT (DSCT) were collected from request forms and CT scan consoles. The values of CTDIw, CTDIvol and DLP were calculated using ImPACT (Imaging Performance and Assessment of Computed Tomography) dosimetry software for Philips MX-1800 scanner and GE Hispeed Dual scanner. Data was analysed using mean, range, 3rd quartile, as well as chi square.Results: The commonest indication was head injury with the majority patient aged 0-4 years and 10-14 years for MSCT and DSCT, respectively. There were significantly higher doses imparted by MSCT compared to DSCT on both the head CTDIw (mGy) (40 vs 22, p = 0.000), CTDIvol (mGy) (60 vs 7, p = 0.000), DLPmGy.cm (1022 vs 114, p = 0.000) and body CTDIw (mGy) (41 vs 18, p =0.000), CTDIvol (mGy) (27 vs 6 p-value=0.000) and DLP (782 vs 73 p-value=0.001) respectively. Paediatric 3rd quartile values for CTDIvol (mGy) (57.7 vs 31) 0-1 year, (74.5 vs 47) 4-7 years and DLP mGy.cm (1068 vs 333) 0-1 year and (1168 vs 374) 4-6 years respectively for MSCT were higher than the recommended international values. The calculated CTDIvol for the head were significantly higher than the values displayed on the console (p-value=0.000, 95%CI) for MSCT.Conclusion: The radiation dose values for CTDIw, CTDIvol and DLP for MSCT were significantly higher than those for DSCT and other countries which raise a radiation safety concern. Studies to establish the factors responsible for these high doses are recommended

Prevalence, patterns, functional disability of Bertolotti syndrome among patients with low back pain at Mulago National Referral Hospital

Background: Bertolotti syndrome is a differential diagnosis in back pain. We know little about it in Uganda. This study aimed to describe the prevalence, clinical and radiological patterns of Bertolotti syndrome and functional disability associated with it.Methods: We did a descriptive cross-sectional study at the spine outpatients’ clinic of Mulago National Referral Hospital. We screened patients with chronic low back pain for lumbosacral transitional vertebrae over four months and classified them according to Castellvi. We collected demographics, clinical symptoms, and functional disability data and summarized it descriptively.Results: Out of 385 patients, we identified 39 with Bertolotti syndrome. The prevalence and the median age were at 10.1% and 49 years respectively, with most patients being females (66.7%) in the age range of (36 to 50) years, the pain started during the age range of 31-40. The commonest and least were type IIA (20.5%) and type IV (10.3%), respectively. Most patients (66.3%) had radicular symptoms, mainly the toe extension nerve root. The average visual analog scale was 6.3. However, most patients suffered from mild- to moderate disability (66.7%).Conclusion: Bertolotti syndrome is common and functionally debilitating. We should consider it in the differential diagnosis of chronic low back pain. Keywords: Bertolotti syndrome; Transitional vertebrae; Functional disability

Chronic respiratory symptoms and lung abnormalities among people with a history of tuberculosis in Uganda: a national survey

Background People with pulmonary tuberculosis (TB) are at risk of developing chronic respiratory disorders due to residual lung damage. So far, the scope of the problem in high burden TB countries is relatively unknown. Methods Chronic respiratory symptoms (cough and phlegm lasting >2 weeks) and radiological lung abnormalities were compared between adults with and without a history of TB among the general population of Uganda. Multivariable regression models were used to estimate odds ratios with adjustment for age, gender, smoking, education, setting and region. Random effects models accounted for village clustering effect. Results Of 45,293 invited people from 70 villages, 41,154 (90.9%) participated in the survey. 798 had a history of TB and among them, 16% had respiratory symptoms and 41% x-ray abnormalities. Adjusted odds ratios showed strong evidence for individuals with a history of TB having increased risk of respiratory symptoms (OR=4·02, 95%CI: 3·25-4·96) and x-ray abnormalities (OR=17·52, 95%CI: 14·76-20·79); attributing 6% and 24% of the respective population risks. Conclusions In Uganda, a history of TB was a strong predictor of respiratory symptoms and lung abnormalities, before older age and smoking. Eliminating TB disease could reduce the prevalence of chronic respiratory symptoms as much as eliminating smoking

Congenital lobar emphysema: a diagnostic challenge and cause of progressive respiratory distress in a 2 month-old infant

Congenital lobar emphysema (CLE) is a rare congenital abnormality characterized by over inflation of a pulmonary lobe. It often presents a diagnostic and therapeutic dilemma. No case has been described in Uganda in the previous 10 years. We describe a case of a 2 months old infant who presented with severe respiratory distress. A diagnosis of congenital left upper lobar emphysema was established on diagnostic imaging. Both his vascular anatomy and the bronchial wall were normal. He improved dramatically after surgery. The SaO2 normalized within 12 hours of Surgery (lobectomy) and the postoperative period was uneventful

The prevalence and clinical course of HIV-associated pulmonary cryptococcosis in Uganda

BACKGROUND: The prevalence and clinical course of pulmonary cryptococcosis in Sub-Saharan Africa are not well-described. METHODS: Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between September 2007 and July 2008 with cough ≥ 2 weeks were enrolled. Patients with negative sputum smears for acid-fast bacilli were referred for bronchoscopy with bronchoalveolar lavage (BAL). BAL fluid was examined for mycobacteria, Pneumocystis jirovecii, and fungi. Patients were followed two and six months after hospital discharge. RESULTS: Of 407 patients enrolled, 132 (32%) underwent bronchoscopy. Of 132 BAL fungal cultures, 15 (11%) grew Cryptococcus neoformans. None of the patients were suspected to have pulmonary cryptococcosis on admission. The median CD4 count among those with pulmonary cryptococcosis was 23 cells/µL (IQR 7–51). Of 13 patients who completed six-month follow-up, four died and nine were improved, including five who had started antiretroviral therapy (ART) but had not received antifungal medication. CONCLUSIONS: Pulmonary cryptococcosis is common in HIV-infected TB suspects in Uganda. Early initiation of ART in those with isolated pulmonary infection may improve outcomes, even without anti-fungal therapy. This finding suggests that some HIV-infected patients with C. neoformans isolated from respiratory samples may have colonization or localized infection

High incidence of pulmonary tuberculosis in children admitted with severe pneumonia in Uganda

Abstract Background A high prevalence of tuberculosis (TB) in children presenting with severe pneumonia has previously been reported in South Africa. However, little is known about TB among children with pneumonia in Uganda and other resource limited countries. Moreover, TB is associated with high morbidity and mortality among such children. We conducted this study to establish the burden of pulmonary TB in children admitted with severe pneumonia in our setting. Methods A cross-sectional study was conducted at Mulago, a National Referral and teaching hospital in Uganda. Hospitalised children 2 months to 12 years of age with severe pneumonia based on WHO case definition were enrolledfrom February to June 2011. Children with a previous TB diagnosis or receiving anti-TB treatment were excluded. Each child was screened for TB using Tuberculin skin test, Chest X-ray, induced sputum samples and blood culture for mycobacterium. Sputum smears were examined using fluorescent microscopy, and cultured on both Lowenstein Jensen media (LJ) and Mycobacterial Growth Indicator Tubes (MGIT). Results Of the 270 children with severe pneumonia who were recruited over a 5-month period in 2011, the incidence ratio of pulmonary TB in children admitted with severe pneumonia was 18.9% (95% CI 14.6 – 23.9). The proportion of culture confirmed PTB was 6.3% (95% CI 3.8 – 9.7). Age group under 1 year and 1 to 5 years (OR 2.8 (95% CI 1.7 – 7.4) and OR 2.4 (95% CI 1.05 – 5.9) respectively) were more likely to be associated with pulmonary TB compared to those children over 5 years of age. A history of TB smear positive contact was associated with pulmonary TB (OR 3.0 (95% CI 1.3–6.5). Conclusions We found a high burden of pulmonary TB in children admitted with severe pneumonia. These data highlight the need for TB screening in children admitted with severe pneumonia so as to improve TB case finding and child survival.</p

High incidence of pulmonary tuberculosis in children admitted with severe pneumonia in Uganda

TB is associated with high morbidity and mortality among such children. We conducted this study to establish the burden of pulmonary TB in children admitted with severe pneumonia in our setting.Background A high prevalence of tuberculosis (TB) in children presenting with severe pneumonia has previously been reported in South Africa. However, little is known about TB among children with pneumonia in Uganda and other resource limited countries. Moreover, TB is associated with high morbidity and mortality among such children. We conducted this study to establish the burden of pulmonary TB in children admitted with severe pneumonia in our setting. Methods A cross-sectional study was conducted at Mulago, a National Referral and teaching hospital in Uganda. Hospitalised children 2 months to 12 years of age with severe pneumonia based on WHO case definition were enrolledfrom February to June 2011. Children with a previous TB diagnosis or receiving anti-TB treatment were excluded. Each child was screened for TB using Tuberculin skin test, Chest X-ray, induced sputum samples and blood culture for mycobacterium. Sputum smears were examined using fluorescent microscopy, and cultured on both Lowenstein Jensen media (LJ) and Mycobacterial Growth Indicator Tubes (MGIT). Results Of the 270 children with severe pneumonia who were recruited over a 5-month period in 2011, the incidence ratio of pulmonary TB in children admitted with severe pneumonia was 18.9% (95% CI 14.6 – 23.9). The proportion of culture confirmed PTB was 6.3% (95% CI 3.8 – 9.7). Age group under 1 year and 1 to 5 years (OR 2.8 (95% CI 1.7 – 7.4) and OR 2.4 (95% CI 1.05 – 5.9) respectively) were more likely to be associated with pulmonary TB compared to those children over 5 years of age. A history of TB smear positive contact was associated with pulmonary TB (OR 3.0 (95% CI 1.3–6.5). Conclusions We found a high burden of pulmonary TB in children admitted with severe pneumonia. These data highlight the need for TB screening in children admitted with severe pneumonia so as to improve TB case finding and child survival