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.

End-of-Life Palliative Care Practices and Referrals in Uganda

Abstract: Background: While early involvement and integration of palliative care with oncology can positively impact quality of life and survival of patients with advanced cancer, there is a dearth of information regarding this integration in sub-Saharan Africa. Objective: We sought to describe the rate and factors predicting specialist palliative referrals among cancer patients in Uganda. Design: We examined the rate of referrals of cancer patients to palliative specialists via a chart review, while also surveying and interviewing doctors at the Uganda Cancer Institute (UCI) about their approaches to palliative care. Setting: All adult patients at the UCI who died in a 20-month interval from 2014 to 2015. All UCI doctors were approached for the survey and 25 (96%) participated. Seven of these doctors were also individually interviewed. Measurements: Number of referrals to palliative specialists and qualitative responses to questions about end-of-life care management. Results: Sixty-six (11.1%) of 595 pati...

Anal protrusion of an ileo-colic intussusception in an adult with persistent ascending and descending mesocolons: a case report.

Abstract: Background: Intussusception is one of the less common causes of intestinal obstruction among adults. It is usually covert (concealed) in its clinical presentation. The ileo-colic type with accompanying anal protrusion is extremely rare. The case at hand is that of both an ileo-colic intussusception with anal protrusion, in the presence of a persistence of both the ascending and descending mesocolons; a case possibly yet to be documented in literature. Case presentation: A 32 year-old African-Ugandan woman presented with complaints of a mass protruding per anus for 2 weeks. It was reducible and associated with colicky abdominal pain, loose stools, and bloody-mucoid discharge per anus. She had previously had a one and a half month’s history of abdominal pain; periodically continuous, while other times colicky in character. Examination and investigations revealed an intussusception with a partial intestinal obstruction. At laparotomy she was found to have an ileo-colic intussusception with a freely mobile colon throughout its length. There were persistent ascending and descending mesocolons, and absent hepatocolic and splenocolic ligaments. The intussusceptum was ‘milked’ but not completely reducible. A right hemicolectomy was done, with ileo-transverse colonic anastomosis. Histopathological examination revealed no preexisting pathologic lesion as a lead point. Conclusion: The persistence of the ascending and descending mesocolons (azygosis) best explains the anal protrusion of an ileo-colic intussusception with partial obstruction. In this case zygosis (normal retroperitoneal ascending and descending colonic positioning) failed embryologically. This experience is particularly beneficial to general surgeons, radiologists, gastroenterologists, colorectal surgeons and pathologists.

Malignant Lymphoma of the Jaws

Abstract: The clinical features,1' 2 pathologic appearances,3' 4and histologic characteristics5 6 of the malignant lymphoma prevalent among children in tropical Africa are now well recognized. Although descriptions of this tumor syndrome usually have been confined to Africa, investigations into its nature and distribution have attracted the attention of cancer research workers in many countries because of the implications that aspects of this tumor may have in other branches of cancer research. In Western countries, this curious neoplasm has aroused more interest among pathologists than among clinicians, in whose eyes this far-off curiosity appeared to have little practical relevance to their work. Although this tumor has not yet been shown to be a common neoplasm in any country outside tropical Africa, with the single exception of New Guinea, it is becoming increasingly apparent that occasional cases occur in many countries with both tropical and temperate climates. Clinicians outside Africa should therefore be aware of this tumor syndrome which, in view of its diversity of clinical manifestations, may pose a diagnostic problem in almost any specialty of medicine. More than 50 per cent of the patients have jaw lesions, and the earliest detectable changes are related to the teeth, so it is of paramount importance that dental surgeons should be aware of these changes. Moreover, since the patient most amenable to treatment is the one in whom the disease is recognized early by the dental surgeon, the importance of confident diagnosis at this stage is evident. INCIDENCE AND GEOGRAPHY.-It was formerly believed that this tumor was virtually limited to the areas in tropical Africa where it is known to be common. It is now apparent that the geographical distribution cannot be simply divided into

Impact of second-line antiretroviral regimens on lipid profiles in an African setting: the DART trial sub-study

Abstract: Increasing numbers of HIV-infected patients in sub-Saharan Africa are exposed to antiretroviral therapy (ART), but there are few data on lipid changes on first-line ART, and even fewer on second-line. DART was a randomized trial comparing monitoring strategies in Ugandan/Zimbabwean adults initiating first-line ART and switching to second-line at clinical/immunological failure. We evaluated fasting lipid profiles at second-line initiation and ≥48 weeks subsequently in stored samples from Zimbabwean patients switching before 18 September 2006. Of 91 patients switched to second-line ART, 65(73%) had fasting samples at switch and ≥48 weeks, 14(15%) died or were lost 14 days and 2(2%) had no samples available. 56/65(86%) received ZDV/d4T + 3TC + TDF first-line, 6(9%) ZDV/d4T + 3TC + NVP and 3(5%) ZDV + 3TC with TDF and NVP. Initial second-line regimens were LPV/r + NNRTI in 27(41%), LPV/r + NNRTI + ddI in 33(50%) and LPV/r + TDF + ddI/3TC/ZDV in 6(9%). At second-line initiation median (IQR) TC, LDL-C, HDL-C and TG (mmol/L) were 3.3(2.8-4.0), 1.7(1.3-2.2), 0.7(0.6-0.9) and 1.1(0.8-1.9) respectively. Levels were significantly increased 48 weeks later, by mean (SE) +2.0(0.1), +1.1(0.1), +0.5(0.05) and +0.4(0.2) respectively (p 5.2 mmol/L; 3% vs 25% LDL-C >3.4 mmol/L and 91% vs 41% HDL-C 1.8 mmol/L (0 vs 3%) and TC/HDL-C ≥5 (40% vs 33%) (p > 0.15). Modest lipid elevations were observed in African patients on predominantly LPV/r + NNRTI-based second-line regimens. Routine lipid monitoring during second-line ART regimens may not be warranted in this setting but individual cardiovascular risk assessment should guide practice.