Myelodysplasia in Ugandan Patients with HIV/AIDS: An Autopsy Study

Background: Myelodysplasia has been reported to occur quite frequently in the spectrum of HIV/AIDS disease and is thought to be partly responsible for bone marrow failure in these patients. However, the frequency and type of myelodysplasia appear to differ at different stages of the disease in different populations with mechanisms of its development not well understood.Objective: To document the pattern of myelodysplasia in Ugandan patients with terminal HIV/AIDS disease.Design: Prospective descriptive study.Setting: Department of Pathology, Faculty of Medicine, Makerere University College of Health Sciences.Subjects: Bone marrow necropsies from patients who died with AIDS disease at Mulago teaching hospital in Kampala, Uganda during a one-year period.Results: Eighty-four (84%) of the 50 cases studied had myelodysplasia with 39 cases having megakaryocytic myelodysplasia. Myelodysplasia involving erythroid cell series occurred in 23 and in 20 of these cases was in combination with megakaryocytic dysplasia. Granulocyte myelodysplastic features were observed in only two cases and these two cases did not have other cell lines involved.Conclusion: Myelodysplastic features are common in HI V patients with megakaryocytic and eythroid cell lines being the most affected. This could be due to the direct HIV effect, or the combined effect of opportunistic infections, neoplasms, drugs and HIV itself affecting the haemopoietic stem cell and or its microenvironment

Cancer survival in Kampala, Uganda

Epidemiological data on the occurrence of cancer in sub-Saharan Africa are sparse, and population-based cancer survival data are even more difficult to obtain due to various logistic difficulties. The population-based Cancer Registry of Kampala, Uganda, has followed up the vital status of all registered cancer patients with one of the 14 most common forms of cancer, who were diagnosed and registered between 1993 and 1997 in the study area. We report 5-year absolute and relative survival estimates of the Ugandan patients and compare them with those of black American patients diagnosed in the same years and included in the SEER Program of the United States. In general, the prognosis of cancer patients in Uganda was very poor. Differences in survival between the two patient populations were particularly dramatic for those cancer types for which early diagnosis and effective treatment is possible. For example, 5-year relative survival was as low as 8.3% for colorectal cancer and 17.7% for cervical cancer in Uganda, compared with 54.2 and 63.9%, respectively, for black American patients. The collection of good-quality follow-up data was possible in the African environment. The very poor prognosis of Ugandan patients is most likely explained by the lack of access to early diagnosis and treatment options in the country. On the policy level, the results underscore the importance of the consistent application of the national cancer control programme guidelines as outlined by the World Health Organization

Lymphomas diagnosed in Uganda during the HIV/AIDS pandemic

Background: There are numerous reports from different countries documenting a change in frequency and profile of lymphomas after the onset of the HIV/AIDS pandemic. In Uganda little is known concerning the distribution of lymphoma subtypes diagnosed at the Department of Pathology, Makerere University College of Health Sciences during this period.Objective: To examine the frequency and diagnostic profile of lymphomas diagnosed in Uganda in the HIV/AIDS era.Design: Retrospective study.Setting: Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda.Subjects: One thousand and thirteen patients diagnosed with lymphomas in the period 1980-1989.Results: The most common type of non-Hodgkin lymphoma was Burkitt lymphoma (36%). The frequencies of lymphocytic and histiocytic types were 34.5% and 8.2% respectively.Conclusion: There was a decrease in histopathologically diagnosed lymphomas in Uganda in the period 1980-1989. Burkitt lymphoma continues to be the most common subtype diagnosed, some major lymphoma subtypes like T-cell and follicular lymphomas were not reported in the country in the HIV/AIDS era

Heterogeneity among Mycobacterium ulcerans isolates from Africa

Mycobacterium ulcerans causes Buruli ulcer, an ulcerative skin disease in tropical and subtropical areas. Despite restricted genetic diversity, mycobacterial interspersed repetitive unit-variable-number tandem repeat analysis on M. ulcerans revealed 3 genotypes from different African countries. It is the first time this typing method succeeded directly on patient samples

Clinico-pathological pattern and early post-operative complications of gastro-duodenal perforations at Mulago Hospital Kampala- a prospective cohort study

Background: Gastro-Duodenal Perforations are one of the commonest causes of mortality and morbidity in conditions that require emergency surgery. The main objective of this study was to determine the clinico-pathological pattern and evaluate factors for early post operative complications of Gastro-duodenal perforations in Mulago. Methods: This was a prospective cohort study of patients with gastro-duodenal perforations managed by simple repair between September 2014 and April 2015 in Mulago was studied. Primary/ secondary outcomes were mortality and complications respectively. Data was managed using stata-12 and multivariate analysis using log-binomial regression model. Results: A total of 65 patients were operated for Gastro-duodenal perforations in the study period. 86.2% were male (M: F 6.2:1). Median age was 35 years (range 16- 80 years). 93.9% had gastric perforations. Clinical diagnosis was predicted in 89.3%. H. pyloriwas present in 7.9%. Mortality was 18.5% and complications developed in 58.5%. Age above 35 and presence of   co morbidity predicted mortality (CI 1.22- 21.12, p= 0.009) (CI 1.26- 8.82, p= 0.024) and early post-operative complications (CI 1.03- 2.44, p= 0.031) (CI 1.23- 2.44, p= 0.011) respectively. Conclusion: Gastroduodenal perforations remain a common surgical emergency in Mulago hospital affecting mainly young men below 35 years. Majority are gastric perforations. Mortality and early post-operative complications are high, and increase with age and presence of co morbidity. Keywords: gastro-duodenal perforations, perforated peptic ulcer disease, gastric perforation

Agreement between diagnoses of childhood lymphoma assigned in Uganda and by an international reference laboratory

BACKGROUND: Correct diagnosis is key to appropriate treatment of cancer in children. However, diagnostic challenges are common in low-income and middle-income countries. The objective of the present study was to assess the agreement between a clinical diagnosis of childhood non- Hodgkin lymphoma (NHL) assigned in Uganda, a pathological diagnosis assigned in Uganda, and a pathological diagnosis assigned in The Netherlands. METHODS: The study included children with suspected NHL referred to the Mulago National Referral Hospital, Kampala, Uganda, between 2004 and 2008. A clinical diagnosis was assigned at the Mulago National Referral Hospital, where tissue samples were also obtained. Hematoxylin and eosin-stained slides were used for histological diagnosis in Uganda, and were re-examined in a pathology laboratory in The Netherlands, where additional pathological, virological and serological testing was also carried out. Agreement between diagnostic sites was compared using kappa statistics. RESULTS: Clinical and pathological diagnoses from Uganda and pathological diagnosis from The Netherlands was available for 118 children. The agreement between clinical and pathological diagnoses of NHL assigned in Uganda was 91% (95% confidence interval [CI] 84–95; kappa 0.84; P < 0.001) and in The Netherlands was 49% (95% CI 40–59; kappa 0.04; P = 0.612). When Burkitt’s lymphoma was considered separately from other NHL, the agreement between clinical diagnoses in Uganda and pathological diagnoses in Uganda was 69% (95% CI 59–77; kappa 0.56; P < 0.0001), and the corresponding agreement between pathological diagnoses assigned in The Netherlands was 32% (95% CI 24–41; kappa 0.05; P = 0.326). The agreement between all pathological diagnoses assigned in Uganda and The Netherlands was 36% (95% CI 28–46; kappa 0.11; P = 0.046). CONCLUSION: Clinical diagnosis of NHL in Uganda has a high probability of error compared with pathological diagnosis in Uganda and in The Netherlands. In addition, agreement on the pathological diagnosis of NHL between Uganda and The Netherlands is very low

HIV Serostatus and Tumor Differentiation Among Patients with Cervical Cancer at Bugando Medical Centre.

Evidence for the association between Human immunodeficiency virus infection and cervical cancer has been contrasting, with some studies reporting increased risk of cervical cancer among HIV positive women while others report no association. Similar evidence from Tanzania is scarce as HIV seroprevalence among cervical cancer patients has not been rigorously evaluated. The purpose of this study was to determine the association between HIV and tumor differentiation among patients with cervical cancer at Bugando Medical Centre and Teaching Hospital in Mwanza, North-Western Tanzania. This was a descriptive analytical study involving suspected cervical cancer patients seen at the gynaecology outpatient clinic and in the gynaecological ward from November 2010 to March 2011. A total of 91 suspected cervical cancer patients were seen during the study period and 74 patients were histologically confirmed with cervical cancer. The mean age of those confirmed of cervical cancer was 50.5 ± 12.5 years. Most patients (39 of the total 74-52.7%) were in early disease stages (stages IA-IIA). HIV infection was diagnosed in 22 (29.7%) patients. On average, HIV positive women with early cervical cancer disease had significantly more CD4+ cells than those with advanced disease (385.8 ± 170.4 95% CI 354.8-516.7 and 266.2 ± 87.5, 95% CI 213.3-319.0 respectively p = 0.042). In a binary logistic regression model, factors associated with HIV seropositivity were ever use of hormonal contraception (OR 5.79 95% CI 1.99-16.83 p = 0.001), aged over 50 years (OR 0.09 95% CI 0.02-0.36 p = 0.001), previous history of STI (OR 3.43 95% CI 1.10-10.80 p = 0.035) and multiple sexual partners OR 5.56 95% CI 1.18-26.25 p = 0.030). Of these factors, only ever use of hormonal contraception was associated with tumor cell differentiation (OR 0.16 95% CI 0.06-0.49 p = 0.001). HIV seropositivity was weakly associated with tumor cell differentiation in an unadjusted analysis (OR 0.21 95% CI 0.04-1.02 p = 0.053), but strong evidence for the association was found after adjusting for ever use of hormonal contraception with approximately six times more likelihood of HIV infection among women with poorly differentiated tumor cells compared to those with moderately and well differentiated cells (OR 5.62 95% CI 1.76-17.94 p = 0.004).\ud Results from this study setting suggest that HIV is common among cervical cancer patients and that HIV seropositivity may be associated with poor tumour differentiation. Larger studies in this and similar settings with high HIV prevalence and high burden of cervical cancer are required to document this relationship