Diagnostic accuracy of chest ultrasound scan in the diagnosis of childhood tuberculosis.

Chest Ultrasound Scan (CUS) has been utilized in place of CXR in the diagnosis of adult pneumonia with similar or higher sensitivity and specificity to CXR. However, there is a paucity of data on the use of CUS for the diagnosis of childhood TB. This study aimed to determine the diagnostic accuracy of CUS for childhood TB. This cross-sectional study was conducted at the Mulago National Referral Hospital in Uganda. Eighty children up to 14 years of age with presumptive TB were enrolled. They all had CUS and CXR performed and interpreted independently by radiologists. The radiologist who performed the CXR was blinded to the CUS findings, and vice versa. Radiologists noted whether TB was likely or unlikely. A two-by-two table was developed to compare the absolute number of children as either TB likely or TB unlikely on CXR or CUS. This was used to calculate the sensitivity and specificity of CUS when screening for TB in children, with a correction to accommodate the use of CXR as a reference test. The sensitivity of CUS was 64% (95% CI 48.5%-77.3%), while its specificity was 42.7% (95% CI 25.5%-60.8%). Both the CUS and CXR found 29 children with a likelihood of TB, and 27 children unlikely to have TB. CUS met the sensitivity target set by the WHO TPP for Triage, and it had a sensitivity and specificity comparable to that of CXR.

Correlation between clinical and brain computed tomography findings of stroke patients: A cross-sectional study.

Background and Aims: In developing countries, the burden of stroke is growing and causing significant morbidity and disability with high mortality rates. Neuroimaging plays a crucial role in differentiating ischemic stroke from an intracerebral hemorrhage, as well as entities other than stroke. This study sought to determine the correlation between the clinical and brain CT scan findings of stroke patients attending three hospitals in Kampala, Uganda. Methods: This was a cross-sectional study of clinically suspected stroke patients who were sent for brain CT scan at three selected hospitals in Kampala, Uganda. All brain CT scans of patients with suspected stroke were evaluated and the Alberta stroke program early CT score (ASPECTS) was used for middle cerebral artery (MCA) strokes. Univariate analysis was used to describe the clinico-demographic and brain CT features of stroke and summarized them as percentages. Bivariate and multivariate analysis were used to determine the adjusted odds ratios as a measure of association with a 95% confidence interval (CI). Results: Of the 270 study participants, 141 (52.2%) were male. 162 (60%) had CT findings of stroke, and 90 (33.3%) had normal brain CT findings. Eighteen (6.7%) had other CT findings like tumor, dural hemorrhage, epidermoid cyst, and others. Ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage accounted for 124 (45.9%), 34 (12.6%), and 4 (1.5%) respectively. Limb weakness (55.2%), headache (41.1%), and loss of consciousness (39.3%) were associated with stroke findings on CT. Among the acute ischemic strokes, 30 (73.2%) had a worse (0-7) ASPECT score. Those aged ≥65 years were associated with a worse ASPECTS [AOR: 22.01, (95% CI: 1.58-306.09) p = 0.021]. Conclusion: More than a third of patients with a clinical diagnosis of stroke had either no CT features of stroke or had other findings. The most commonly affected vascular territory was left MCA. Old age was strongly associated with having the worst ASPECTS score.

Carotid Doppler findings among patients admitted with stroke in two tertiary care facilities in Uganda: A Hospital-based Cross-sectional Study.

Background: Carotid Atherosclerotic Disease (CAD) Doppler findings including carotid artery stenosis, thickened intima media thickness, and high-risk atherosclerotic plaques are associated with increased risk of stroke and symptomatic cerebrovascular disease. However, few studies have explored these Doppler characteristics among stroke patients in Africa. This study, therefore, investigates these carotid artery Doppler characteristics among stroke patients in Uganda. Methods: A hospital-based cross-sectional study of 95 stroke patients attending two national referral hospitals in Uganda between March and July 2022. Following the caption of their sociodemographic and clinical characteristics, they underwent Doppler sonography of the extracranial carotid arteries using a standard carotid Doppler protocol. Multivariate logistic regression was used to determine factors associated with abnormal carotid Doppler parameters (i.e., carotid intima-media thickness, carotid stenosis). Results: The mean age of the study participants was 61 ± 13 years with 60% (57/95) of the participants being male. Most participants had an ischemic stroke (67%), hypertension (76.4%), and used alcohol (58.9%). The prevalence of significant carotid stenosis in participants with ischemic stroke was 12.5% (8/64) (i.e., 7.8% had severe carotid stenosis and 4.7% had moderate stenosis). The prevalence of high carotid intima media thickness (CIMT) and atherosclerotic plaques were 31.6% (30/95) and 26.3% (25/95), respectively. Most atherosclerotic plaques were echogenic. Age above 60 years (adjusted odds ratio [aOR] = 5.2, 95% Confidence Interval [CI]:1.97-14; p < 0.010), high low-density lipoprotein cholesterol (aOR = 4.2, 95% CI: 1.29-8.79; p = 0.013) increased the likelihood of having abnormal CIMT. Conclusion: The burden of carotid atherosclerotic disease is increasing among stroke patients in Uganda. Large-scale epidemiological studies are needed to further profile the disease in high risk populations.

Cardiovascular abnormalities in chest radiographs of children with pneumonia, Uganda.

Objective: To describe chest radiograph findings among children hospitalized with clinically diagnosed severe pneumonia and hypoxaemia at three tertiary facilities in Uganda. Methods: The study involved clinical and radiograph data on a random sample of 375 children aged 28 days to 12 years enrolled in the Children's Oxygen Administration Strategies Trial in 2017. Children were hospitalized with a history of respiratory illness and respiratory distress complicated by hypoxaemia, defined as a peripheral oxygen saturation (SpO2) < 92%. Radiologists blinded to clinical findings interpreted chest radiographs using standardized World Health Organization method for paediatric chest radiograph reporting. We report clinical and chest radiograph findings using descriptive statistics. Findings: Overall, 45.9% (172/375) of children had radiological pneumonia, 36.3% (136/375) had a normal chest radiograph and 32.8% (123/375) had other radiograph abnormalities, with or without pneumonia. In addition, 28.3% (106/375) had a cardiovascular abnormality, including 14.9% (56/375) with both pneumonia and another abnormality. There was no significant difference in the prevalence of radiological pneumonia or of cardiovascular abnormalities or in 28-day mortality between children with severe hypoxaemia (SpO2: < 80%) and those with mild hypoxaemia (SpO2: 80 to < 92%). Conclusion: Cardiovascular abnormalities were relatively common among children hospitalized with severe pneumonia in Uganda. The standard clinical criteria used to identify pneumonia among children in resource-poor settings were sensitive but lacked specificity. Chest radiographs should be performed routinely for all children with clinical signs of severe pneumonia because it provides useful information on both cardiovascular and respiratory systems.

Association of HIV, cardiovascular risk factors, and carotid intimal media thickness: A cross-sectional study in Western Kenya.

The carotid intimal media thickness (CIMT) is a validated measure of subclinical atherosclerosis. Human immunodeficiency virus (HIV) is a risk factor for cardiovascular disease (CVD) and has been associated with CIMT in North America and Europe; however, there are limited data from Sub-Saharan Africa (SSA). In this cross-sectional study, we measured CIMT in a cohort of 262 people living with HIV (PLHIV) on antiretroviral therapy (ART) for ≥6 months and HIV-negative adults in western Kenya. Using linear regression, we examined the associations between CVD risk factors and CIMT, both overall and stratified according to the HIV status. Among the PLHIV, we examined the association between CIMT and HIV-related factors. Of 262 participants, approximately half were women. The HIV-negative group had a higher prevalence of age ≥55 years (P = .002), previously diagnosed hypertension (P = .02), treatment for hypertension (P = .03), and elevated blood pressure (BP) (P = .01). Overall prevalence of carotid plaques was low (15/262 [6.0%]). HIV-positive status was not significantly associated with a greater mean CIMT (P = .19). In multivariable regression models, PLHIV with elevated blood pressure or treatment for hypertension had a greater mean CIMT (P = .002). However, the CD4 count, viral load, and ART regimen were not associated with differences in CIMT. In the HIV-negative group, older age (P = .006), high total cholesterol levels (P = .01), and diabetes (P = .02) were associated with a greater mean CIMT. In this cross-sectional study of Kenyan adults, traditional CVD risk factors were found to be more prevalent among HIV-negative participants. After multivariable regression analysis, we found no association between HIV status and CIMT, and PLHIV had fewer CVD risk factors associated with CIMT than HIV-negative participants did. HIV-specific factors were not associated with the CIMT.

Vitamin D deficiency in low-birth-weight infants in Uganda; a cross sectional study.

BACKGROUND: Vitamin D deficiency affects 7-86% of infants globally and results in recurrent infections, impaired growth and nutritional rickets. Low-birth-weight infants in Uganda are at risk of vitamin D deficiency due to limited sunlight exposure and dependence on breastmilk. We aimed to determine the prevalence and factors associated with vitamin D deficiency among low-birth-weight infants aged 6 weeks to 6 months at Mulago national referral hospital in Uganda. METHODS: We conducted a cross-sectional study at Mulago Hospital between September 2016 and March 2017. We enrolled infants born with low birth weight between six weeks and six months whose mothers were available and willing to provide informed consent. Upon obtaining informed consent, we administered a structured questionnaire and performed a physical examination on the participants. Blood was drawn for calcium, phosphorus and vitamin D estimation. We measured serum 25 hydroxy vitamin D (25(OH)D) using the electrochemiluminescence method. Vitamin D deficiency and insufficiency were defined as (25(OH)D) < 20ng/ml and from 20ng/ml to <30 ng/ml respectively. To determine factors associated with vitamin D deficiency, we fit multivariable logistic regression models with exposure factors determined a priori. Data were analysed using Stata version 14. RESULTS: We enrolled 297 participants, 49.2% (167/297) of whom were males. The median infant age was nine weeks (interquartile range 7-13). All infants had less than one hour of sunlight exposure and over 90.6% (269/297) had received multivitamin supplements containing vitamin D. The prevalence of vitamin D deficiency was 12.1% (36/297): 95% CI (8.9%-16.4%). The prevalence of vitamin D insufficiency was 19.9% (59/297): 95% CI (15.7%-24.8%). Boys had higher odds of vitamin D deficiency compared to girls [adjusted odds ratio 2.8: 95% CI 1.3-6.1]. CONCLUSION: Vitamin D deficiency was 12.1% among low-birth-weight infants in Uganda although almost all of them had received multivitamin supplements containing vitamin D. We recommend that more studies are done in low-birth-weight infants to assess the risk factors for vitamin D in these population in Uganda.

Adult Computed Tomography examinations in Uganda: Towards determining the National Diagnostic Reference Levels.

INTRODUCTION: Diagnostic Reference Levels (DRLs), typically set at the 75th percentile of the dose distribution from surveys conducted across a broad user base using a specified dose-measurement protocol, are recommended for radiological examinations. There is a need to develop and implement DRLs as a standardisation and optimisation tool for the radiological protection of patients at Computed Tomography (CT) facilities. METHODS: This was a retrospective cross-sectional study conducted in seven (7) different CT scan facilities in which participants were recruited by systematic random sampling. The study variables were dose length product (DLP) and volume-weighted CTDI (CTDIvol) for the radiation doses for head, chest, abdomen and lumbar spine CT examinations. The DRLs for CTDIvol and DLP were obtained by calculating the 3rd quartiles of the radiation doses per study site by anatomical region. The national diagnostic reference levels were determined by computation of DRLs using the 75th centile of the median values. RESULTS: A total of 574 patients were examined with an average age of 47.1 years. For CTDIvol estimates; there was a strong positive significant relationship between the CTDIvol and examination mAs (rs = 0.9017, p-value < 0.001), and reference mAs (rs = 0.0.7708, p-value < 0.001). For DLP estimates; there was a moderate positive significant relationships between DLP and total mAs (rs = 0.6812, p-value < 0.001), reference mAs (rs = 0.5493, p-value < 0.001). The DRLs were as follows; for head CT scan - the average median CTDIvol was 56.02 mGy and the DLP was 1260.3 mGy.cm; for Chest CT, the CTDI volume was 7.82 mGy and the DLP was 377.0 mGy.cm; for the abdomen CT, the CTDI volume 12.54 mGy and DLP 1418.3 mGy.cm and for the lumbar spine 19.48 mGy and the DLP was 843 mGy.cm, respectively. CONCLUSION: This study confirmed the need to optimize the CT scan parameters in order to lower the national DRLs. This can be achieved by extensive training of all the CT scan radiographers on optimizing the CT scan acquisition parameters. Continuous dose audits are also advised with new equipment or after every three years to ensure that values out of range are either justified or further investigated.

Barriers and facilitators to implementing clinical imaging guidelines by healthcare professionals using theoretical domains framework: a mixed-methods systematic review protocol.

Objectives: To identify, categorize, and develop an aggregated synthesis of evidence using the theoretical domains framework (TDF) on barriers and facilitators that influence implementation of clinical imaging guidelines (CIGs) by healthcare professionals (HCPs) in diagnostic imaging. Methods: The protocol will be guided by the Joanna Briggs Institute Reviewers' Manual 2014. Methodology for JBI Mixed Methods Systematic Reviews and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P). Information source will include databases (MEDLINE, EMBASE and The Cochrane Library), internet search (https://www.google.com/scholar), experts' opinion, professional societies/organizations websites and government bodies strategies/recommendations, and reference lists of included studies. Articles of any study design published in English from 1990 to date, having investigated factors operating as barriers and/or facilitators to the implementation CIGs by HCPs will be eligible. Selecting, appraising, and extracting data from the included studies will be independently performed by at least two reviewers using validated tools and Rayyan - Systematic Review web application. Disagreements will be resolved by consensus and a third reviewer as a tie breaker. The aggregated studies will be synthesized using thematic analysis guided by TDF. Results: Identified barriers will be defined a priori and mapped into 7 TDF domains including knowledge, awareness, effectiveness, time, litigationand financial incentives. Conclusion: The results will provide an insight into a theory-based approach to predict behavior-related determinants for implementing CIGs and develop strategies/interventions to target the elicited behaviors. Recommendations will be made if the level of evidence is sufficient. Advances in knowledge: Resource-constrained settings that are in the process of adopting CIGs may opt for this strategy to predict in advance likely impediments to achieving the goal of CIG implementation and develop tailored interventions during the planning phase.Systematic review Registration: PROSPERO ID = CRD42020136372 (https://www.crd.york.ac.uk/PROSPERO).

Carotid artery plaque detected on ultrasound is associated with impaired cognitive state in the elderly: A population-based study in Wakiso district, Uganda.

Carotid artery disease which includes carotid artery stenosis, plaques, clots and increased intima media thickness, have been reported by many studies to be associated with dementia. Dementia is an end stage of usually asymptomatic cognitive impairment. Risk factors of carotid artery disease include; age, atherosclerosis, arteriosclerosis, shorter years in school, history of hypertension, diabetes mellitus, stroke and depression. This study set out to determine the prevalence of abnormal carotid ultrasound findings and their association with cognitive function among the adults ≥60 years in Wakiso district, Uganda in 2018. A total of 210 participants were included. Carotid artery stenosis, presence of plaque, stenosis and intima-media thickness were assessed by ultrasound. Cognitive status was assessed using a Mini Mental State Exam (MMSE) test. The prevalence of plaque was 21.4%. Variables which included; presence of plaque, age, education, gender, marital status, whether participant stayed alone or with someone else, care for self, occupation status, division of staying and history of smoking. The presence of plaque was associated with an abnormal cognitive function at both univariate and multivariate analysis with respective OR = 3.8 (95% CI = 1.90-7.54, p-value = 0.0001) and OR = 3.4 (95% CI = 1.38-8.15, p-value = 0.007). The cognitive function distribution was 43.8%, 19%, 34.3% and 2.9% within the normal, mild, moderate, and severe cognitive function status respectively. This study showed that prevalence of carotid artery plaque was high in this elderly population in Wakiso district Uganda. Also, carotid artery plaque was associated with abnormal cognitive function.

Nutritional rickets among children admitted with severe pneumonia at Mulago hospital, Uganda: a cross-sectional study.

BACKGROUND: There's abundant sunshine in the tropics but severe rickets is still observed. Nutritional rickets is associated with an increased risk of acute lower respiratory infections. Pneumonia is the leading cause of death in the under 5 -year old children with the highest burden in developing countries. Both Pneumonia and rickets are common in the developing countries and may affect clinical presentation and outcome. This study aimed to determine the prevalence and associated factors of nutritional rickets in children admitted with severe pneumonia. METHODS: This was a cross-sectional study of children aged 2-59 months presenting with severe pneumonia at an emergency unit. We enrolled 221 children between February and June 2012 after consent. A pre-coded questionnaire was used to collect data on socio-demographic, nutritional and past medical history. Physical exam was done for signs of rickets and anthropometric measurements. Serum calcium, phosphorus, and alkaline phosphatase (ALP) were assessed. Children with any physical signs of rickets or biochemical rickets (ALP > 400 IU); had a wrist x-ray done. Nutritional rickets was defined as the presence of radiological changes of cupping or fraying and/ or metaphyseal thickening. Severe pneumonia was defined using the WHO criteria. Statistical analysis was performed using the Stata 10 statistical package. P- value < 0.05 was significant. RESULTS: The prevalence of nutritional rickets among children with severe pneumonia is 9.5%. However, 14.5% had raised ALP (biochemical rickets). The factors independently associated with rickets was an elevated alkaline phosphatase; p-value < 0.001, or 32.95 95% CI (10.54-102.93). Other factors like breastfeeding, big family size, birth order were not significantly associated with rickets. Low serum calcium was detected in 22 (9.9%) of the 221 participants. Overall few children with rickets had typical clinical features of rickets on physical examination. CONCLUSION: Rickets is a common problem in our setting despite ample sunshine. Clinicians should actively assess children for rickets in this setting and screen for rickets in those children at high risk even without clinical features.

Subclinical atherosclerosis among HIV-infected adults attending HIV/AIDS care at two large ambulatory HIV clinics in Uganda.

BACKGROUND: The increased immune activation and inflammation of chronic HIV-infection and the characteristic dyslipidemias associated with HIV infection and antiretroviral therapy (ART) contribute to an increased risk of atherosclerotic vascular disease among HIV-infected adults. There is an emerging need to understand determinants of cardiovascular disease (CVD) among individuals aging with HIV in sub-Saharan Africa. We determined the prevalence of subclinical atherosclerosis [carotid intima media thickness (CIMT) ≥ 0.78 mm] and its correlation with traditional CVD risk factors among HIV-infected adults. METHODS: In a cross-sectional study, HIV-infected adults (ART-naïve and ART-treated) were consecutively selected from patients' enrollment registers at two large HIV clinics at Mulago Hospital, Kampala, Uganda. We measured traditional CVD risk factors including age, biophysical profile, fasting blood sugar and serum lipid profile as well as biomarkers of inflammation. High resolution ultrasound was used to measure common carotid CIMT. RESULTS: Of 245 patients, Median age [Interquartile range (IQR)] 37 years (31-43), 168 (69%) were females; and 100 (41%) were ART-treated for at least 7 years. Overall, 34/186 (18%) had subclinical atherosclerosis; of whom 15/108 (14%) were ART-naïve whereas 19/78 (24%) were ART-treated. Independent predictors of subclinical atherosclerosis included age [odds ratio (OR) 1.83 per 5-year increase in age; 95% confidence interval (CI) 1.24-2.69; p = 0.002], body mass index (BMI); OR 1.15; CI 1.01-1.31; p = 0.041 and high low density lipoprotein (LDL) [OR 2.99; CI 1.02-8.78, p = 0.046]. High sensitivity C-reactive protein (hsCRP) was positively correlated with traditional cardio-metabolic risk factors including waist circumference (r = 0.127, p = 0.05), triglycerides (r = 0.19, p = 0.003) and Total Cholesterol: High Density Lipoprotein ratio (TC:LDL) (r = 0.225, p<0.001). CONCLUSION: The prevalence of subclinical atherosclerosis was 18% among HIV-infected adults in Uganda. Traditional CVD risk factors were associated with subclinical atherosclerosis. We recommend routine assessment of traditional CVD risk factors within HIV care and treatment programs in sub-Saharan Africa.

Deep venous thrombosis after major abdominal surgery in a Ugandan hospital: a prospective study.

BACKGROUND: Deep venous thrombosis (DVT) is a major cause of morbidity and mortality among postoperative patients. Its incidence has been reported to range between 16% and 38% among general surgery patients and may be as high as 60% among orthopaedic patients. The most important clinical outcome of DVT is pulmonary embolism, which causes about 10% of hospital deaths. In over 90% of patients, occurrence of DVT is silent and presents no symptoms until onset of pulmonary embolism and/or sudden death. The only effective way of guarding against this fatal condition is therefore prevention/prophylaxis. However, prophylaxis programs are usually based on the estimated prevalence of DVT in that particular community. There is currently no data concerning rates of postoperative DVT in Uganda.The purpose of the study was therefore to determine the prevalence of DVT among postoperative patients at Mulago Uganda's National Referral Hospital. METHODS: A cross sectional descriptive study was conducted between March and June 2011. Eligible patients were identified and screened and patient details were collected. Clinical examinations were done on postoperative days (PODs) 1, 2, and 4 and Doppler ultrasounds were done on POD 7 and POD 21 to assess for DVT. Patients found with DVT were treated appropriately according to local treatment guidelines. RESULTS: A total of 82 patients were recruited, 4/82 (5%) had DVT. The most common risk factor was cancer. The overall mean age was 45 years (range 20-83 years). The male to female ratio was 1.6:1. Participants with more than one risk factor for DVT were 16/82 (20%). CONCLUSIONS: Prevalence of DVT among major post-abdominal surgery patients was low (5%). Cancer was the most common associated factor apart from surgery.