Willingness to start insulin therapy among insulin-naïve persons with type 2 diabetes mellitus at Gulu Regional Referral Hospital, Gulu City, Uganda.

Background: Most patients with type 2 diabetes mellitus (DM2) will require insulin for glycemic control during their disease. Objectives: We evaluated the willingness to start insulin therapy among insulin-naïve persons with DM2 in urban Northern Uganda. Design: A facility-based, quantitative, cross-sectional study was conducted between June and August 2023 recruiting insulin-naïve type 2 diabetes mellitus patients attending routine health care at Gulu Regional Referral Hospital, Gulu, Uganda. Methods: We gauged participants' willingness to use insulin by asking, 'If your doctor prescribed insulin for you, would you accept to use it?' with responses categorized as either 'Yes' or 'No'. Poisson regression analysis was performed to assess the factors associated with willingness to start insulin therapy. p < 0.05 were considered statistically significant. Results: We enrolled 190 participants, with a mean age of 55 ± 12.72 years. Most participants were female (63.7%, n = 121), attained a primary level of education (70.0%, n = 133), and were unemployed (84.2%, n = 160). Overall, 73.4% (n = 138) of the participants were willing to receive insulin therapy if indicated. Participants recently advised on insulin showed a 34% higher willingness [adjusted prevalence ratio (aPR): 1.34, 95% confidence interval (CI): 1.06-1.72, p = 0.007], whereas those with a disease duration of 6 years or more were 43% less willing (aPR: 0.57, 95% CI: 0.39-0.81, p = 0.002) and those concerns about coping with insulin therapy were 55% less willing to commence insulin therapy (aPR: 0.57, 95% CI: 0.39-0.81, p = 0.002). Conclusion: About three in every four participants with DM were willing to receive insulin if indicated. However, healthcare providers should consider personalized counseling strategies to alleviate concerns and enhance informed decision-making regarding insulin initiation. Future interventions should focus on addressing specific barriers associated with prolonged disease duration and apprehensions related to insulin therapy to optimize glycemic control in this population.

Exploring readiness for insulin treatment in people with type 2 diabetes at Gulu Regional Referral Hospital, Uganda In this study, we investigated the willingness to start insulin therapy among individuals with type 2 Diabetes Mellitus (DM2) in urban Northern Uganda. Understanding the importance of insulin for glycemic control in DM2, we surveyed 190 participants at Gulu Regional Referral Hospital. We found that more than three-quarters of the participants expressed a willingness to receive insulin therapy if recommended. Factors influencing this willingness included recent advice on insulin, which was associated with a 34% higher likelihood of acceptance. Conversely, individuals with a disease duration of 6 years or more were 43% less willing, and those concerned about coping with insulin therapy were 55% less willing to commence treatment. These findings underscore the need for healthcare providers to offer personalized counseling strategies, addressing specific concerns, to facilitate informed decision-making regarding insulin initiation. Looking ahead, interventions should prioritize overcoming barriers related to prolonged disease duration and apprehensions about insulin therapy to optimize glycemic control and improve the well-being of individuals with DM2 in this population.

Factors Associated With Mortality Among the COVID-19 Patients Treated at Gulu Regional Referral Hospital: A Retrospective Study.

Background: The advent of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. As of December 2021, there is inadequate data on the outcome of hospitalized patients suffering from COVID-19 in Africa. This study aimed at identifying factors associated with hospital mortality in patients who suffered from COVID-19 at Gulu Regional Referral Hospital in Northern Uganda from March 2020 to October 2021. Methods: This was a single-center, retrospective cohort study in patients hospitalized with confirmed SARS-CoV-2 at Gulu Regional Referral Hospital in Northern Uganda. Socio-demographic characteristics, clinical presentations, co-morbidities, duration of hospital stay, and treatments were analyzed, and factors associated with the odds of mortality were determined. Results: Of the 664 patients treated, 661 (99.5%) were unvaccinated, 632 (95.2%) recovered and 32 (4.8%) died. Mortality was highest in diabetics 11 (34.4%), cardiovascular diseases 12 (37.5%), hypertensives 10 (31.3%), females 18 (56.3%), ≥50-year-olds 19 (59.4%), no formal education 14 (43.8%), peasant farmers 12 (37.5%) and those who presented with difficulty in breathing/shortness of breath and chest pain 32 (100.0%), oxygen saturation (SpO2) at admission <80 4 (12.5%), general body aches and pains 31 (96.9%), tiredness 30 (93.8%) and loss of speech and movements 11 (34.4%). The independent factors associated with mortality among the COVID-19 patients were females AOR = 0.220, 95%CI: 0.059-0.827; p = 0.030; Diabetes mellitus AOR = 9.014, 95%CI: 1.726-47.067; p = 0.010; Ages of 50 years and above AOR = 2.725, 95%CI: 1.187-6.258; p = 0.018; tiredness AOR = 0.059, 95%CI: 0.009-0.371; p < 0.001; general body aches and pains AOR = 0.066, 95%CI: 0.007-0.605; p = 0.020; loss of speech and movement AOR = 0.134, 95%CI: 0.270-0.660; p = 0.010 and other co-morbidities AOR = 6.860, 95%CI: 1.309-35.957; p = 0.020. Conclusion: The overall Gulu Regional Hospital mortality was 32/664 (4.8%). Older age, people with diabetics, females, other comorbidities, severe forms of the disease, and those admitted to HDU were significant risk factors associated with hospital mortality. More efforts should be made to provide "additional social protection" to the most vulnerable population to avoid preventable morbidity and mortality of COVID-19 in Northern Uganda.

Herpes zoster complicated by phrenic nerve palsy and respiratory compromise.

BACKGROUND: Herpes zoster can be associated with severe neurological complications. CASE PRESENTATION: In this article, we describe the case of a 54-year-old man with herpes zoster affecting his right upper chest and neck region complicated by phrenic nerve palsy and respiratory compromise. The diagnosis of herpes zoster was made based on the classic appearance of the rash and associated neuropathic-type pain. The diagnosis of phrenic nerve palsy was made by chest x-ray and ultrasound. CONCLUSION: Clinicians should be aware of the possibility of phrenic nerve palsy occurring in patients who have herpes zoster affecting the region of C3,4,5 dermatomes. Although symptoms of unilateral diaphragmatic paresis are usually mild, in patients with obesity or comorbid lung disease, new onset phrenic nerve palsy can lead to significant respiratory compromise.

Chest Deformity and Disability due to Tenofovir-Induced Hypophosphatemic Osteomalacia: Case Report and Call for Improved Global Access to Laboratory Testing.

Millions of people worldwide take tenofovir disoproxil fumarate (TDF) for the treatment of human immunodeficiency virus (HIV) and/or hepatitis B infection. Although generally safe and well tolerated, clinicians need to be aware that TDF can cause proximal renal tubular dysfunction and loss of bone mineral density, especially in patients with concomitant renal disease or other risk factors. We present the case of a patient with chronic HIV infection and urethral stricture who developed TDF-related proximal renal tubular dysfunction with hypophosphatemia and osteomalacia, presenting with bone pains, skeletal deformity, and disability. We review risk factors for TDF-related renal tubular toxicity and recommendations for monitoring creatinine, phosphate, alkaline phosphatase, and urinalysis.

Impaired renal function and associated risk factors in newly diagnosed HIV-infected adults in Gulu Hospital, Northern Uganda.

BACKGROUND: Screening for renal diseases should be performed at the time of diagnosis of human immunodeficiency virus (HIV) infection. Despite the high prevalence of HIV/AIDS in Northern Uganda, little is known about the status of renal function and its correlates in the newly diagnosed HIV-infected individuals in this resource limited region. We aimed to determine the status of renal function and factors associated with impaired renal function in newly diagnosed HIV-infected adults in Northern Uganda. METHODS: This was a seven month cross-sectional hospital-based study, involving newly diagnosed HIV-infected patients, 18 years and older. Patients with history of diabetes mellitus, hypertension and renal disease were excluded. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula (Table one). Factors associated with impaired renal function (eGFR < 60 ml/min/1.73 m(2)) were thus sought. RESULTS: We enrolled 361 participants (230, 63.7% female) with Mean ± standard deviation age of 31.4 ± 9.5 years. 52, (14.4%) had impaired renal function (eGFR <60 mL/min/1.73 m(2)) and of this 37 (71.2%) moderate renal impairment (eGFR 30-59.9 mL/min/1.73 m(2)) while 15 (28.8%) had severe renal impairment (eGFR <30 mL/min/1.73 m(2)). Proteinuria was recorded in 189 (52.4%) participants. Of these, 154 (81.5%) had mild (1+) while 8 (4.2%) had severe (3+) proteinuria. Using logistic regression, age, CD4 cell count, and proteinuria were significantly associated with impaired renal function; age >34 years (OR 2.8, 95% CI 1.3-5.9; P =0.009), CD4 count <350 cells/µL (OR 2.4, 95% CI 1.0-4.7; P =0.039) and proteinuria (OR 9.6, 95% CI 5.2-17.9; P < 0.001). CONCLUSION: The prevalence of impaired renal function was high in new HIV-infected individuals in this region with limited resources. So, screening for renal disease in HIV is recommended at the time of HIV diagnosis.