Showing papers by "Mulago Hospital published in 2002"

Hepatitis B virus and hiv infections among patients in Mulago hospital.

Abstract: Objective : To compare the frequency of exposure to hepatitis B infection among HIV seropositive and HIV seronegative medical outpatients. Design : Case control study. Setting : Mulago hospital medical outpatient clinics. Patients : One hundred and twenty nine consecutive HIV seropositive patients and one hundred and twenty nine HIV seronegative control patients. Results : The frequency of anti-HBc among the HIV seropositive patients was 65.1% compared to 41.9% in the HIV seronegative patients (95% confidence interval: 1.51-4.45; pvalue: 0.0002). Of the 84 HIV positive patients with anti-HBc, 52 (61.9%) had more than five lifetime sexual partners. In comparison, of the 45 HIV positive patients with no anti-HBc, only 18 (40%) had more than five lifetime sexual partners (95% confidence interval: 1.04- 1.80; p-value: 0.028). There was no significant difference in the frequency of HBsAg and HBeAg among the HIV seropositives and HIV seronegatives. Conclusion : The frequency of previous exposure to hepatitis B infection was higher among HIV seropositive patients compared with HIV seronegative patients and was associated with a greater number of lifetime sexual partners. Safe sexual behaviour and reduction in the number of sexual partners should continue to be promoted in the community including HIV positive patients, because it is likely to have the added advantage of reducing coincident exposure to HBV infection. This is especially important for the immunocompromised HIV positive patients who are more likely to develop a chronic infectious carrier state and among whom HBV control by vaccination is less effective than in the immunocompetent individuals. (East African Medical Journal: 2002 79(2): 68-72)

A public-private partnership for malaria control: lessons from the Malarone Donation Programme.

Abstract: In 1996, Glaxo Wellcome offered to donate up to a million treatment courses annually of Malarone, a new antimalarial, with a view to reducing the global burden of malaria. The Malarone Donation Programme (MDP) was established the following year. Eight pilot sites were selected in Kenya and Uganda to develop and evaluate an effective, locally sustainable donation strategy that ensured controlled and appropriate use of Malarone. The pilot programme targeted individuals who had acute uncomplicated Plasmodium falciparum malaria that had not responded to first-line treatments with chloroquine or sulfadoxine-pyrimethamine. Of the 161 079 patients clinically diagnosed at the pilot sites as having malaria, 1101 (0.68%) met all the conditions for participation and received directly observed treatment with Malarone. MDP had a positive effect at the pilot sites by improving the diagnosis and management of malaria. However, the provision of Malarone as a second-line drug at the district hospital level was not an efficient and effective use of resources. The number of deaths among children and adults ineligible for MDP at the pilot sites suggested that high priority should be given to meeting the challenges of malaria treatment at the community level.

A sampling and analytical methodology for dental trace element analysis

Abstract: The role of trace elements in human health and environmental pollution has developed into an extensive field of research. This study describes a sampling and analytical strategy to determine the trace element content of primary (deciduous) teeth and to assess their use in environmental health and nutrition studies. Exfoliated and extracted primary teeth were collected from 21 Ugandan and 27 UK children. The crown and root of the teeth were separated and the former digested and analysed for several elements by inductively coupled plasma mass spectrometry. The influence of country, tooth type, age and gender were statistically investigated in addition to within-person variation. A principal components analysis (PCA) was used to treat the data in a multivariate fashion and facilitated the moderation of outliers. The results demonstrated that country of origin has an important influence on the elemental composition of teeth and that tooth type should be controlled in these types of studies. Given such a restriction, the age and gender of the donor should have no effect and do not need to be controlled. In addition, where country of domicile, age and gender were controlled, the concentrations of most elements within a single tooth type were representative of an individual and therefore may be indicative of health status.

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

Abstract: 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.