Mulago Hospital

About: Mulago Hospital is a healthcare organization based out in Kampala, Uganda. It is known for research contribution in the topics: Population & Health care. The organization has 542 authors who have published 545 publications receiving 34804 citations.

Simultaneous joint fusion and limb lengthening for knee deformities in children: A one-stage procedure The Kampala experience

Abstract: Background: Delay in the treatment of septic or tuberculous arthritis of the knee often results in a painful and stiff joint, mainly in a position of flexion. Often limb shortening is also present. A clinical study was undertaken to see what the long-term results of a one-stage procedure is, whereby an external fixator is used to achieve fusion of the knee and limb equalisation simultaneously by means of distraction of the callus at the arthrodesis site. Method: Seven children, with a mean age of 13.5 years at presentation, were included in this study. Four children had septic arthritis and three had tuberculosis. All children had the same procedure. The deformity was corrected and an Orthofix device applied. After seven days, distraction of the arthrodesis site was started and continued until the desired length was obtained. Screw replacement was necessary in five cases due to pin-track infection. Results: A stable, painless, well-aligned limb was obtained in all the patients and they were able to walk unsupported. Complete correction of limb length discrepancy was obtained in five patients and partial correction in the remaining two cases. Conclusion: Knee arthrodesis is a suitable option for managing severe deformities in children and young adults as it results in a stable and painless limb and eliminates the use of walking aids. In cases where leg length discrepancy is also present, the fusion can be achieved simultaneously with the equalisation process. Our experience has shown that this is a worthwhile clinical procedure which can result in a marked improvement in the quality of the life of these children.

Does chronic alcohol use by HIV-infected patients on d4T/3TC/NVP drug regimen effect the HIV viral load and what is the therapeutic window of the drugs, CD4+ count and WBC count in patients with high viral load during the 9 months period of follow up?

Abstract: The study investigated the effects of chronic alcohol use on HIV viral load in HIV-infected patients on d4T/3TC/ NVP drug regimen during 9 months follow up period. It also determined plasma drug concentrations of d4T, 3TC and NVP; CD4 + and WBC counts for patients with high HIV viral load. A case-control study using repeated measures with serial measurements was used. A total of 41 patients (20 alcohol group and 21 control group) were screened for alcohol use using WHO AUDIT tool and chronic alcohol use biomarkers. Blood sampling was done at 3 month intervals for a period of 9 months. HIV viral load was determined using Roche Amplicor HIV-1 monitor test, version 1.5 (Amplicor). The d4T, 3TC and NVP concentrations were determined by Shimadzu Class-VPTM HPLC Chromatography data system version 6.1. The CD4 + cell count was determined using FACSCalibur flow cytometer. T he WBC was determined using automated hematological Coulter CBC-5 Hematology Analyzer system. Results show that % patients with HIV viral load ≥400 copies/ml in control group was highest (23.8%, n=5) at 3 month while in chronic alcohol use group, it was at 0 month (35%, n=7) for both WHO AUDIT tool and chronic alcohol-use biomarkers groups. Generally patients with high viral load ≥400 copies/ml was observed in chronic alcohol use as compared to control group in both WHO AUDIT tool and biomarkers group despite of patients having high steady state d4T, 3TC and NVP plasma drug concentrations in circulation that is available to suppress HIV virus. The high viral load could be associated with the emergence of resistance of the HIV virus and these patients generally had a low CD4 + cell count. Some of these patients had no detectable d4T plasma drug concentrations in circulation and most of them with high viral load had sub-therapeutic NVP plasma drug concentrations in their blood circulation. Chronic ethanol use by HIV-infected patients on d4T/3TC/NVP drug regimen increased HIV viral load and the patients with high viral load had sub-therapeutic NVP plasma drug concentrations and some with undetectable d4T drug concentrations in their blood circulation.

High prevalence of low high-density lipoprotein cholesterol and insulin resistance among children and adolescents living with HIV in Uganda: Harbinger for metabolic syndrome?

Abstract: Background: Antiretroviral Therapy-associated adverse effects and comorbidities are still pervasive in people living with HIV, especially metabolic syndrome (MetS), which is on the rise and occurring at early age. However, there is paucity of data on MetS in children and adolescents living with HIV (CALWH), particularly in sub-Saharan Africa. We investigated the age-dependent prevalence of components of MetS in this population. Methods: A cross-sectional pilot study of CALWH treated at the Baylor Uganda Clinical Centre of Excellence in Kampala, Uganda. Using stratified by age group and sex random sampling, participants were recruited from May to August 2021. At enrollment, we collected data on participant demographics, anthropometric measurements, HIV disease characteristics, and past medical history and obtained blood for fasting levels of glucose, insulin, triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol. The primary outcome of MetS was defined by both the International Diabetes Federation (IDF) and Adult Treatment Panel (ATPIII) criteria. We estimated the prevalence of MetS and its components for all participants and by the stratification factors. Results: We enrolled 90 children and adolescents: <10 y/o (N=30), 10 to <16 y/o (N=30), and ≥16 (N=30) y/o. Fifty-one percent were females. The prevalence of MetS was 1.11% (1 of 90) using either IDF or ATPIII criteria for all participants, and 3.33% for ≥16-year group. Over 55% of participants had ≥1 IDF component, with 47% having low HDL cholesterol; 14% of participants had early insulin resistance using the HOMA index. The proportion of early insulin resistance was 6.67%, 23.33%, and 13.33% for the three age groups, respectively. Two participants (6.67%) in the 10 to <16 years group had significant insulin resistance. For every 1-year increase in age, HOMA index increased by 0.04 (95% Confidence Interval 0.01, 0.08), p=0.02. Conclusions: The high prevalence of components of MetS, particularly low HDL and early insulin resistance, are of concern. With increasing survival of CALWH into adulthood and increased lifetime exposure to ART, the frequency of MetS in this population may rise, increasing the lifetime risk for associated health problems, such as type 2 diabetes, myocardial infarction, stroke, and nonalcoholic fatty liver disease.

Kwashiorkor and malnutrition.

Abstract: Summary The term malnutrition, as it is used in English, is not sufficiently specific, in our opinion, to be used for the disease we prefer to call “kwashiorkor”. Kwashiorkor et « malnutrition ». Il semble aux auteurs que le terme de « malnutrition », utilise dans la langue anglaise, ne soit pas suffisamment specifique de la maladie, et ils preferent utiliser celui de Kwashiorkor. Kwashiorkor und Fehlernahrung. Der Ausdruck Fehlernahrung, wie er im englischen Sprachbereich gebraucht wird, ist nicht hinreichend spezifisch, um — nach der Meinung des Autors — fur die besser «Kwashiorkor» zu nennende Krankheit gebraucht zu werden. Kwashiorkor y malnutrition. El termino “malnutrition” tal cual se usa en ingles, no es suficientemente especifico, en la opinion de los autores, para aplicarlo a la enfermedad que ellos prefieren llamar Kwashiorkor.