Chronic suppurative otitis media: bacteriology, susceptibility and clinical presentation among ENT patients at Mulago Hospital, Uganda

Background: Chronic Suppurative Otitis Media (CSOM) is a major health concern in developing countries due to its association with hearing impairment, particularly among children as it may affect their communication skills. Serious complications like meningitis and brain abscess have been reported as a cause of death.Objective: The study aimed to determine the bacteriology, susceptibility and clinical presentation of chronic suppurative otitis media among ENT patients at Mulago, Uganda.Methodology: We performed a cross sectional study and enrolled 89 patients. Pus was collected from the middle ear for microbial laboratory examination. Our primary outcome was microbial isolates, sensitivity patterns and common clinical features.Results: The commonest isolates identified were Pseudomonas aeruginosa (17.32%), Klebsiella pneumoniae (17.32%), Proteus mirabilis (13.39%), Escherichia coli (9.5%) and Staphylococcus aureus (9.5%). Pseudomonas aeruginosa was found to be 64.7% sensitive to ciprofloxacin, 57.1% to chloramphenicol, and 41.2% to gentamicin. More than 60% of patients had a hearing impairment; 78% had a central perforation.Conclusion: Susceptibility patterns to antimicrobial agent greatly varied but most demonstrated sensitivity to ciprofloxacin followed by choramphenicol and gentamicin.Keywords: chronic suppurative otitis media, bacterial isolates, susceptibility profile

Embryonic rhabdomyosarcoma of the petrous bone in a child: a case report

Rhabdomyosarcoma (RMS) is a cancer of skeletal muscle origin, and the second most common soft tissue sarcoma encountered in childhood. The  head and neck are common sites though the temporal bone is rare. Rhabdomyosarcoma represents 3.5% of all malignancies in children aged 0-14 years, with approximately 250 new cases diagnosed each year. Despite the more intensive management modalities including surgery and  combination chemo-radiation, the outcome for patients with metastatic disease remains poor. Here, we report a case of temporal bone Embryonic RMS in a three and half year-old male who was seen at Mulago National Referral Hospital, Kampala in 2016 and describe the clinical, radiological and histopathological presentation of relevance to RMS. Key Words: rhabdomyosarcoma, temporal bone, mesenchymal tissue, parameningeal, chronic suppurative otitis media, multi-modality therapy, Kampal

Is hearing impairment associated with HIV? A systematic review of data from low- and middle-income countries.

OBJECTIVES: To systematically review evidence on the prevalence and characteristics of hearing impairment among children and adults living with HIV in low- and middle-income countries (LMIC). METHODS: Articles were identified up to January 2016 through searching four electronic databases. Epidemiological studies conducted in LMIC that explored the association between HIV status and hearing loss, with or without an HIV-uninfected comparison group, were eligible for inclusion. Results were screened and assessed for eligibility, and data were extracted by two reviewers, with discussion in the case of disagreement. Findings were narratively synthesised. RESULTS: The search identified 638 unique references, of which 21 studies were included in the review, including 3491 people with HIV from 13 LMIC. There was lack of consistency in the definition used for hearing loss, making comparability across studies difficult. Among children with HIV, across the three studies that used a cut-off of >15 dB in either ear, the prevalence of hearing loss ranged from 22 to 37%. Among the three studies that used >25 dB in either ear, the prevalence ranged from 32 to 39%. Among adults with HIV, for the five studies that used a threshold of >25 dB for either ear, the prevalence ranged from 10 to 43%. The prevalence of hearing impairment was significantly higher among people with HIV than in controls in eight of the ten studies that assessed this comparison. Conductive hearing loss was the most common type of hearing loss in children with HIV, while sensorineural hearing loss was more common in adults with HIV. There was a lack of evidence for an association between ART use and hearing loss, although there was some suggestion that late stage of HIV disease or low CD4 count was related to hearing loss. There were concerns about the quality of the studies included in the review. CONCLUSIONS: The current evidence is suggestive of a high prevalence of hearing loss among people living with HIV compared to people without HIV, or to WHO estimates for the general population. More research is needed to better understand the aetiology of hearing loss in relation to HIV, and whether screening for and treatment of hearing loss can be effectively integrated into HIV treatment services needs further research

Chronic suppurative otitis media: bacteriology, susceptibility and clinical presentation among ENT patients at Mulago, Uganda

Background: Chronic Suppurative Otitis Media (CSOM) is a major health concern in developing countries due to its association with hearing impairment, particularly among children as it may affect their communication skills. Serious complications like meningitis and brain abscess have been reported as a cause of death. Objective: The study aimed to determine the bacteriology, susceptibility and clinical presentation of chronic suppurative otitis media among ENT patients at Mulago, Uganda. Methodology: We performed a cross sectional study and enrolled 89 patients. Pus was collected from the middle ear for microbial laboratory examination. Our primary outcome was microbial isolates, sensitivity patterns and common clinical features. Results: The commonest isolates identified were Pseudomonas aeruginosa (17.32%), Klebsiella pneumoniae (17.32%), Proteus mirabilis (13.39%), Escherichia coli (9.5%) and Staphylococcus aureus (9.5%). Pseudomonas aeruginosa was found to be 64.7% sensitive to ciprofloxacin, 57.1% to chloramphenicol, and 41.2% to gentamicin. More than 60% of patients had a hearing impairment; 78% had a central perforation. Conclusion: Susceptibility patterns to antimicrobial agent greatly varied but most demonstrated sensitivity to ciprofloxacin followed by chloramphenicol and gentamicin

Determinants of utilization of a no-cost HIV transition clinic: a cross-sectional study of young adults living with HIV/AIDS

Agnes Nyabigambo,1,2,* Joshua Kanaabi Muliira,3,* Lynn Atuyambe,1,* Harriet M Babikako,1,* Andrew Kambugu,2,* Christopher Ndoleriire4,* 1School of Public Health, 2Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; 3College of Nursing, Sultan Qaboos University, Al Khod, Muscat, Oman; 4Department of ENT, College of Health Sciences, Makerere University, Kampala, Uganda*These authors contributed equally to this workAbstract: There is minimal research that has been conducted among young adults to understand the determinants of the utilization of human immunodeficiency virus (HIV) health services in this population. The purpose of this study was to explore the levels and determinants of HIV transition clinic (HTC) services utilization by young adults living with HIV/acquired immunodeficiency syndrome (YALHA). The study used a cross-sectional design and quantitative methods to collect data from a sample of 379 YALHA between the ages of 15–24 years who were registered clients of an HTC in Uganda. During data analysis, utilization was categorized into two levels: regular (kept all appointment visits) and irregular (missed one or more appointment visits) utilization. Univariable, bivariable, and multivariable logistic regression analyses were used to examine the determinants associated with HTC utilization. The HTC services that were most utilized by the YALHA were those based at the clinic and provided by professional health care providers and these were: clinical examination (96%); laboratory services (87.1%); and counseling (69.7%). The services that were least utilized were home visiting (5.8%) and peer support services (19.8%). Of the 379 YALHA, only 32.4% regularly utilized the HTC. Multivariable analysis showed that the main determinants of HTC utilization were CD4 count category of ≥251/µL (adjusted odds ratio [AOR] =0.58, 95% confidence interval [CI] =0.36–0.95); not being on antiretroviral therapy (AOR =0.27, 95% CI =0.15–0.47); and not receiving counseling services (AOR =0.47, 95% CI =0.27–0.83). Regular utilization of the HTC by YALHA was low and utilization seems to be influenced by HIV infection stage and HIV counseling services, but not sociodemographic factors or community factors.Keywords: transition clinic, HIV/AIDS, young adults, service utilization, Ugand

Engaged pedagogy and responsibility: A postcolonial analysis of international students

This paper responds to increasing discussions about responsibility within geography by exploring some of the spatialities imbued in thinking responsibly about internationalisation in the UK Higher Education system, and it uses the categorisation of the international student as a way in to this exploration. Although international students have been considered from the viewpoint of migration studies, global education studies and critical pedagogical studies, this paper attempts a postcolonial analysis of international students, to consider what forms of pedagogic responsibility are called forth through this framework. Building on bell hooks’ call for an ‘engaged pedagogy’, this paper shows that routing care and responsibility through postcolonial geographies incites a more sharply demanding political praxis