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Apolot D, Erem G, Nassanga R, Kiggundu D, Tumusiime CM, Teu A, Mugisha AM, Sebunya R. Brain magnetic resonance imaging findings among children with epilepsy in two urban hospital settings, Kampala-Uganda: a descriptive study. BMC Med Imaging 2022; 22:175. [PMID: 36203127 PMCID: PMC9541090 DOI: 10.1186/s12880-022-00901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Epilepsy is one of the most common neurological conditions in children worldwide. Its presentation is heterogeneous, with diverse underlying aetiology, clinical presentation, and prognosis. Structural brain abnormalities are among the recognized causes of epilepsy. Brain Magnetic Resonance Imaging (MRI) is the imaging modality of choice for epilepsy workup. We aimed to determine the prevalence and describe the structural abnormalities identified in the brain MRI studies performed on children with epilepsy from two urban hospitals in Kampala, Uganda. Methods This was a cross-sectional descriptive study performed at two urban hospital MRI centres. The study population was 147 children aged 1 day to 17 years with confirmed epilepsy. Brain MRI was performed for each child and a questionnaire was used to collect clinical data. Results The prevalence of structural abnormalities among children with epilepsy was 74.15% (109 out of 147). Of these, 68.81% were male, and the rest were female. Among these, the majority, 40.14% (59 of 144) were aged 1 month to 4 years. Acquired structural brain abnormalities were the commonest at 69.22% with hippocampal sclerosis (HS) leading while disorders of cortical development were the most common congenital causes. An abnormal electroencephalogram (EEG) was significant for brain MRI abnormalities among children with epilepsy with 95% of participants with an abnormal EEG study having epileptogenic structural abnormalities detected in their brain MRI studies. Conclusion and recommendation Two-thirds of children with epilepsy had structural brain abnormalities. Abnormal activity in the EEG study was found to positively correlate with abnormal brain MRI findings. As such, EEG study should be considered where possible before MRI studies as a determinant for children with epilepsy who will be having imaging studies done in the Ugandan setting.
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Affiliation(s)
- Denise Apolot
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Geoffrey Erem
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rita Nassanga
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Kiggundu
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Crescent Max Tumusiime
- Department of Radiology, Mother Kevin Postgraduate Medical School, Uganda Martyrs University School of Medicine, Kampala, Uganda.,St.Francis hospital, Nsambya, Uganda
| | - Anneth Teu
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alex Mwesigwa Mugisha
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Sebunya
- Department of Pediatrics, Mother Kevin Postgraduate Medical School, Uganda Martyrs University School of Medicine, Kampala, Uganda.,St.Francis hospital, Nsambya, Uganda
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Kirabira VN, Nakaggwa F, Nazziwa R, Nalunga S, Nasiima R, Nyagabyaki C, Sebunya R, Latigi G, Pirio P, Ahmadzai M, Ojom L, Nabwami I, Burgoine K, Blencowe H. Impact of secondary and tertiary neonatal interventions on neonatal mortality in a low- resource limited setting hospital in Uganda: a retrospective study. BMJ Open 2022; 12:e055698. [PMID: 35953254 PMCID: PMC9379481 DOI: 10.1136/bmjopen-2021-055698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the impact of secondary and tertiary level neonatal interventions on neonatal mortality over a period of 11 years. DESIGN Interrupted time series analysis. SETTING Nsambya Hospital, Uganda. INTERVENTIONS Neonatal secondary interventions (phase I, 2007-2014) and tertiary level interventions (phase II, 2015-2020). PARTICIPANTS Neonates. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: neonatal mortality. SECONDARY OUTCOME case fatality rate (CFR) for prematurity, neonatal sepsis and asphyxia. RESULTS During the study period, a total of 25 316 neonates were admitted, of which 1853 (7.3%) died. The average inpatient mortality reduced from 8.2% during phase I to 5.7% during phase II (p=0.001). The CFR for prematurity reduced from 16.2% to 9.2% (p=0.001). There was a trend in reduction for the CFR of perinatal asphyxia from 14.9% to 13.0% (p=0.34). The CFR for sepsis had a more than a twofold increase (3%-6.8% p=0.001) between phase I and phase II. CONCLUSION Implementation of secondary and tertiary neonatal care in resource-limited settings is feasible. This study shows that these interventions can significantly reduce the neonatal mortality, with the largest impact seen in the reduction of deaths from perinatal asphyxia and prematurity. An increase in sepsis related deaths was observed, suggesting emphasis on infection control is key.
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Affiliation(s)
- Victoria Nakibuuka Kirabira
- Paediatrics, Nsambya Hospital, Kampala, Uganda
- Medicine Post Graduate School, Nkozi University, Kampala, Uganda
| | - Florence Nakaggwa
- School of Nursing and Midwifery, Clarke International University, Kampala, Uganda
| | - Ritah Nazziwa
- Medicine Post Graduate School, Nkozi University, Kampala, Uganda
| | | | | | | | | | | | | | - Malalay Ahmadzai
- UNICEF Eastern and Southern Africa Regional Office, Kampala, Uganda
| | | | | | - Kathy Burgoine
- Neonatal Unit, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
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Abou Mehrem A, Al Awad E, Anninck K, Au-Young S, Aydinol N, Bartmann P, Benders M, Benlamri A, Bolderheij L, Celik Y, Chan N, Chau C, Chau V, Chen X, Chetcuti Ganado C, Coetser A, Cools F, Da Rocha G, Deigner HP, Dereymaeker A, Deshmukh L, Domonoske R, Dossani S, Dsouza JM, El Gamal M, Eshemokhai P, Esser M, Fiedrich E, Franz A, Ghosh A, Groenendaal F, Grunau RE, Venkata SKRG, Hamitoglu S, Hellström-Westas L, Irvine L, Jansen K, Javadyan A, Jenkin G, Kamanga N, Kaur N, Keles E, Keller M, Kelly E, Kesting SJ, Kgwadi D, Kim B, Kohl M, Kowal D, Kricitober JD, Leijser L, LePine M, Lim YP, Lodha A, Londhe A, Ly L, Maes E, Malhotra A, Marlow N, Mathew JL, McDonald C, McLean M, Metcalfe C, Meyer R, Miller SP, Miller S, Mogajane T, Mohammad K, Momin S, Montpetit J, Mukiza N, Murthy P, Scott JN, Nakibuuka V, Nakwa F, Naulaers G, Noort J, Ntuli N, Ondongo-Ezhet C, Paul R, Pepper M, Plum A, Rombough B, Saugstad O, Scotland J, Scott J, Seake K, Sebunya R, Selvanathan T, Sepeng L, Simsek H, Steins-Rang C, Stonestreet B, Tang S, Taskin E, Thewissen L, Thomas S, Thomas R, van Kwawegen A, van Rensburg J, Velaphi S, Wu Y, Yaman A, Yapicioglu-Yildizdas H, Yawno T, Zaki P, Zein H, Zhou L. Proceedings of the 13th International Newborn Brain Conference: Neuroprotection strategies in the neonate. J Neonatal Perinatal Med 2022; 15:427-439. [PMID: 35431186 DOI: 10.3233/npm-229003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Jallow S, Wilmshurst JM, Howard W, Copelyn J, Seakamela L, Chan KW, Sebunya R, Sibiya R, Du Plessis H, Jacobs C, Berkowitz N, Blumberg L, McCarthy K, Maseti E, Kamupira M, Dlamini N, Gumede N, Diop OM, Lau YL, Moonsamy S, Eley B, Suchard M. Accelerated Immunodeficiency-associated Vaccine-derived Poliovirus Serotype 3 Sequence Evolution Rate in an 11-week-old Boy With X-linked Agammaglobulinemia and Perinatal Human Immunodeficiency Virus Exposure. Clin Infect Dis 2021; 70:132-135. [PMID: 31086993 PMCID: PMC6912151 DOI: 10.1093/cid/ciz361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/29/2019] [Indexed: 01/10/2023] Open
Abstract
Primary B-cell immunodeficiencies are risk factors for the generation of vaccine-derived polioviruses. We report immunodeficiency-associated vaccine-derived poliovirus serotype 3 in an 11-week-old boy with X-linked agammaglobulinemia. Unique characteristics of this case include early age of presentation, high viral evolutionary rate, and the child's perinatal exposure to human immunodeficiency virus.
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Affiliation(s)
- Sabelle Jallow
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Neuroscience Institute, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Wayne Howard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Julie Copelyn
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Lerato Seakamela
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Koon-Wing Chan
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, China
| | - Robert Sebunya
- Department of Paediatric Neurology, Neuroscience Institute, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Rosinah Sibiya
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Heleen Du Plessis
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Charlene Jacobs
- Division of Public Health, Surveillance and Response, Department of Health, Provincial Government of the Western Cape, Cape Town
| | | | | | - Kerrigan McCarthy
- Outbreak Response Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Elizabeth Maseti
- Child, Youth and School Health, National Department of Health, Pretoria, South Africa
| | - Mercy Kamupira
- World Health Organization (WHO) Country Office, Pretoria, South Africa
| | - Nonhlanhla Dlamini
- Child, Youth and School Health, National Department of Health, Pretoria, South Africa
| | - Nicksy Gumede
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Ousmane M Diop
- Polio Department, WHO Strategic Initiatives Cluster, Geneva, Switzerland
| | - Yu Lung Lau
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, China
| | - Shelina Moonsamy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg.,Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kibirige D, Atuhe D, Sebunya R, Mwebaze R. Suboptimal glycaemic and blood pressure control and screening for diabetic complications in adult ambulatory diabetic patients in Uganda: a retrospective study from a developing country. J Diabetes Metab Disord 2014; 13:40. [PMID: 24593933 PMCID: PMC3974012 DOI: 10.1186/2251-6581-13-40] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 02/10/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Currently, Sub Saharan Africa is faced with a substantial burden from diabetes mellitus. In most of the African countries, screening for diabetes related complications and control of blood pressure and glycaemic levels is often suboptimal.The study aimed at assessing the extent of optimal glycaemic and blood pressure control and the frequency of screening for diabetic complications in adult ambulatory Ugandan diabetic patients. METHODS This was a retrospective study of 250 medical records of adult diabetic patients attending the outpatient diabetic clinic at St. Raphael of St. Francis hospital Nsambya in Kampala, Uganda. RESULTS The mean age of the patients was 51.6 ± 9.2 years with the majority being females (155, 62%). Using fasting blood glucose levels assessed in all the patients, optimal glycemic control of <7.2 mmol/l was noted in 42.8% of the patients. Glycated haemoglobin was performed at least once in the last year in 24 (9.6%) patients , of which 5 (20.8%) of these attained optimal control of <7%. Optimal blood pressure (BP) control defined as BP ≤140/80 mmHg was noted in 56% of the patients. Hypertension and diabetic neuropathy were the most screened for diabetic complications in 100% and 47.2% of the patients respectively and were also the most prevalent diabetic complications (76.4% and 31.2% respectively). CONCLUSIONS This study demonstrates that glycemic and blood pressure control and screening for diabetic complications among the adult ambulatory diabetic patients in this urban diabetic clinic is suboptimal. This substantiates development and implementation local guidelines to improve diabetes care.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, P.O. Box 7146, Kampala, Uganda
| | - David Atuhe
- Department of Medicine, St. Raphael of St. Francis hospital Nsambya, Kampala, Uganda
- Mother Kevin Postgraduate Medical School, Uganda Martyrs University Nkozi, Nkozi, Uganda
- Diabetes and endocrine clinic, St. Raphael of St. Francis hospital Nsambya, Kampala, Uganda
| | - Robert Sebunya
- Mother Kevin Postgraduate Medical School, Uganda Martyrs University Nkozi, Nkozi, Uganda
| | - Raymond Mwebaze
- Department of Medicine, St. Raphael of St. Francis hospital Nsambya, Kampala, Uganda
- Mother Kevin Postgraduate Medical School, Uganda Martyrs University Nkozi, Nkozi, Uganda
- Diabetes and endocrine clinic, St. Raphael of St. Francis hospital Nsambya, Kampala, Uganda
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Sebunya R, Musiime V, Kitaka S, Ndeezi G. Incidence and risk factors for first line anti retroviral treatment failure among Ugandan children attending an urban HIV clinic. AIDS Res Ther 2013; 10:25. [PMID: 24215971 PMCID: PMC3832883 DOI: 10.1186/1742-6405-10-25] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/05/2013] [Indexed: 11/16/2022] Open
Abstract
Background Early recognition of antiretroviral therapy (ART) failure in resource limited settings is a challenge given the limited laboratory facilities and trained personnel. This study aimed at describing the incidence, risk factors and the resistance associated mutations (RAMs) of first line treatment failure among HIV-1-infected children attending the Joint Clinical Research Centre (JCRC), Kampala, Uganda. Methods A retrospective cohort of 701 children who had been initiated on ART between January 2004 and September 2009 at the JCRC was studied. Data of children aged 6 months up to 18 years who had been started on ART for at least 6 months was extracted from the clinic charts. The children who failed the first-line ART were taken as cases and those who did not fail as the controls. Data was analysed using STATA version10. Results Of 701 children, 240(34%) failed on first line ART (cases) and 461(66%) did not fail (controls). The overall median time (IQR) to first line ART failure was 26.4 (18.9 – 39.1) months. The factors associated with treatment failure were poor adherence [(OR = 10, 95 CI: 6.4 – 16.7) p < 0.001], exposure to single dose nevirapine (sdNVP) [(OR = 4.2, 95% CI:1.8-9.4), p = 0.005] and a NVP containing regimen [(OR = 2.2,95% CI:1.4-3.6), p < 0.001]. Of 109 genotypic resistance profiles analyzed, the commonest non nucleoside reverse transcriptase inhibitor (NNRTI) resistance associated mutations (RAM) were: K103N (59; 54%)), Y181C (36; 27%)) and G190A (26; 24%)) while the commonest nucleoside reverse transcriptase inhibitor (NRTI) RAM was the M184V (89; 81%). Thymidine analogue- mutations (TAMs) were detected in 20% of patients. Conclusions One in three children on first-line ART are likely to develop virological treatment failure after the first 24 months of therapy. Poor adherence to ART, a NVP based first-line regimen, prior exposure to sdNVP were associated with treatment failure.
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