Human Immunodeficiency Virus and AIDS in Uganda

"HIV-1 infection; initially described as ""slim disease""; was first recognised in Uganda in 1982; and is now a predominant health problem. Approximately 1.5 million Ugandans are now infected; largely through heterosexual transmission. In many areas half of adult deaths are now caused by HIV. Seroprevalence rates in urban antenatal clinics have been dropping in the last several years; as have rates in young adults in two rural community cohorts where the epidemic is long established. Tuberculosis cases and admissions have increased dramatically. among the clinical manifestations of HIV in Uganda; epidemic Kaposi sarcoma; crypotcoccal meningitis; suspected toxoplasmosis and cardiomypathy; as well as atypical or extrapulmonary tuberculosis are seen with increasing frequency. Mother to child transmission of HIV accounts for about 10of total cases; with a transmission rate of 26in two studies. Epidemiological and clinical research programs are well developed in Uganda; especially in areas of tuberculosis; maternal and paediatric HIV infection and sexually transmitted infections. Societal openness; a multisectoral approach by the government and innovative programmes; including large-scale HIV testing and counselling and the pioneering work of The AIDS support Organisation (TASO); distinguish the Ugandan response to the epidemic. Source: East-Afr-Med-J. 1996 Jan; 73(1):20-6."

Endoscopy versus radiology in African AIDS patients with oesophageal disorders

Upper gastrointestinal endoscopy and double contrast barium radiology were compared prospectively in 45 Ugandan patients with AIDS and upper gastrointestinal oesophageal symptoms. Both investigating techniques were normal as was the histopathology in 5 patients. In 40 cases a definite pathological diagnosis (candidiasis; non-specific inflammation; malignancy) was made. Endoscopic examination provided a correct disgnosis in 38 cases; while only 15 cases were diagnosised from barium studies. Radiology was normal in 2 cases later proved to have definite pathology on endoscopy and histopathologic examination (oesophageal candidiasis). Endoscopy in this series was found to have 95sensitivity in diagnosing oesophageal disorders in AIDS patients; compared to a sensitivty of 37.5for radiology. The difference between the two procedures regarding sensitivity was statistically significant (p0.005). A combination of oral thrush and dysphagia was strongly associated with oesophageal candidiasis (positive predictive value 95; p0.0025). Endoscopy would be the ideal diagnostic procedure for oesophageal candidiasis. The above finding; however; provides a basis for empirical antifungal therapy especially in places where diagnostic facilities are limited

Endoscopy versus radiology in African AIDS patients with oesophageal disorders

Upper gastrointestinal endoscopy and double contrast barium radiology were compared prospectively in 45 Ugandan patients with AIDS and upper gastrointestinal oesophageal symptoms. Both investigating techniques were normal as was the histopathology in 5 patients. In 40 cases a definite pathological diagnosis (candidiasis; non-specific inflammation; malignancy) was made. Endoscopic examination provided a correct disgnosis in 38 cases; while only 15 cases were diagnosised from barium studies. Radiology was normal in 2 cases later proved to have definite pathology on endoscopy and histopathologic examination (oesophageal candidiasis). Endoscopy in this series was found to have 95sensitivity in diagnosing oesophageal disorders in AIDS patients; compared to a sensitivty of 37.5for radiology. The difference between the two procedures regarding sensitivity was statistically significant (p0.005). A combination of oral thrush and dysphagia was strongly associated with oesophageal candidiasis (positive predictive value 95; p0.0025). Endoscopy would be the ideal diagnostic procedure for oesophageal candidiasis. The above finding; however; provide a basis for empirical antifungal theraphy especially in places where diagnostic facilities are limited

The impact of cigarettes smoking on cardiovascular health

The cost of mounting health education programmes to warn people about the dangers of smoking is far below the expensive resources necessary to undertake major palliative operations such as coronary artery bypass grafting and heart-lung transplantation; not to mention the man-power loss due to the smoking-related morbidity and mortality. It means that prevention is better than treatment