Undiagnosed diabetes mellitus and impaired glucose tolerance among hypertensive patients in Mulago Hospital, Kampala, Uganda

Both diabetes and impaired glucose tolerance (IGT) are rising globally, and are known to be associated with hypertension. We have assessed the prevalence of, and risk factors for, abnormal glucose tolerance (AGT) among hypertensive patients in Kampala, Uganda. A total of 320 randomly chosen hypertensive patients were studied, demographic and other data collected, and an oral glucose tolerance test (OGTT) carried out. AGT was found in 237 (74%) patents ­ 50% had IGT and 24% type 2 diabetes. The following factors were significantly associated with AGT: body mass index (BMI) over 28.0 kg/m2 (p=0.003), family history of diabetes (p=0.002), physical inactivity (p=0.001), alcohol consumption (p=0.01), and a systolic blood pressure (BP) over 140 mmHg. We conclude that diabetes and IGT are highly prevalent in hypertensive patients and screening for these conditions in such patients should be considered

Predictors of treatment failure among pulmonary tuberculosis patients in Mulago hospital, Uganda.

INTRODUCTION: Early identification of Tuberculosis (TB) treatment failure using cost effective means is urgently needed in developing nations. The study set out to describe affordable predictors of TB treatment failure in an African setting. OBJECTIVE: To determine the predictors of treatment failure among patients with sputum smear positive pulmonary TB at Mulago hospital. The study was carried out in the TB clinic of Mulago hospital Kampala, Uganda. This was an unmatched case control study where fifty patients with a diagnosis of TB treatment failure (cases) and 100 patients declared cured after completing anti TB treatment (controls) were recruited into the study. Cases were compared with controls to determine predictors of treatment failure. RESULTS: Significant predictors of treatment failure in this study included a positive sputum smear at 2 months of TB treatment (OR 20.63, 95%CI 5.42- 78.41) and poor adherence to anti TB treatment (OR 14.59, 95%CI 3.04-70.15). CONCLUSION: This study identified a treatment related and a simple laboratory predictor of TB treatment failure in Mulago hospital which may be used in resource limited settings for early recognition of those at risk and early intervention.

Hepatitis B virus and hiv infections among patients in Mulago hospital.

OBJECTIVE: To compare the frequency of exposure to hepatitis B infection among HIV seropositive and HIV seronegative medical outpatients. DESIGN: Case control study. SETTING: Mulago hospital medical outpatient clinics. PATIENTS: One hundred and twenty nine consecutive HIV seropositive patients and one hundred and twenty nine HIV seronegative control patients. RESULTS: The frequency of anti-HBc among the HIV seropositive patients was 65.1% compared to 41.9% in the HIV seronegative patients (95% confidence interval: 1.51-4.45; p-value: 0.0002). Of the 84 HIV positive patients with anti-HBc, 52 (61.9%) had more than five lifetime sexual partners. In comparison, of the 45 HIV positive patients with no anti-HBc, only 18 (40%) had more than five lifetime sexual partners (95% confidence interval: 1.04-1.80; p-value: 0.028). There was no significant difference in the frequency of HBsAg and HBeAg among the HIV seropositives and HIV seronegatives. CONCLUSION: The frequency of previous exposure to hepatitis B infection was higher among HIV seropositive patients compared with HIV seronegative patients and was associated with a greater number of lifetime sexual partners. Safe sexual behaviour and reduction in the number of sexual partners should continue to be promoted in the community including HIV positive patients, because it is likely to have the added advantage of reducing coincident exposure to HBV infection. This is especially important for the immunocompromised HIV positive patients who are more likely to develop a chronic infectious carrier state and among whom HBV control by vaccination is less effective than in the immunocompetent individuals.