Patient-reported oral mucositis in solid tumour patients undergoing chemotherapy: a Ugandan experience.

Purpose: The mitotic rate of the gastrointestinal tract (GIT) mucosa predisposes the entire system to chemotherapeutic-induced mucositis but the oral cavity due to its accessibility provides an opening to evaluate the extent of the problem much more easily. In addition, the oral cavity being the gateway to the GIT affects the feeding ability of the patient when the ulcers set in.It is therefore from this perspective that we embarked on a study to evaluate the extent of mucositis among patients being treated for solid tumours at our centre. Methods: Using the mouth and throat soreness (OMDQ MTS) questionnaire, we prospectively evaluated mucositis among 100 patients undergoing chemotherapy for solid tumours at the Uganda Cancer Institute. In addition to patient reported outcomes, we also had clinician assessed mucositis measurements. Results: Approximately, 50% of the participants were breast cancer patients. The results demonstrated that patient assessment of mucositis is possible in our setting at a 76% full compliance rate. Up to 30% of our patients reported moderate-to-severe mucositis, though the figure was lower as assessed by the clinicians. Conclusions: The self-reported OMDQ MTS can be useful in our setting for daily mucositis evaluation, hence leading to timely hospital visits before the manifestation of severe complications.

A Quasi-experimental Study Evaluating the Effectiveness of Cryotherapy on Chemotherapy-induced Oral Mucositis Prevention at the Uganda Cancer Institute.

INTRODUCTION: Low-cost interventions such as cryotherapy are not routinely practiced in sub-Saharan Africa to prevent chemotherapeutic-induced oral mucositis. We investigated the feasibility and effect of cryotherapy on oral mucositis at the Uganda Cancer Institute. METHODS: This was a quasi-experimental nonequivalent research study design. We had two groups with each group meant to have 100 participants. We analyzed based on participants who underwent the protocol procedures. RESULTS: Only cancer types were significantly different between the control and intervention groups (χ2=31.09, df =18, p=.030). Twenty percent (n=19) out of the 95, while 8.2% (n=7) out of the 85 in the control and intervention groups respectively developed moderate to severe mucositis (Mantel-Cox and Generalized Wilcoxon p= .026 and p=.031, respectively). CONCLUSION: The use of cryotherapy in our local setting and many sub-Saharan African countries is feasible and affordable to prevent and control chemotherapy-induced oral mucositis.

Determination of age reference standards based on mandibular third molar root development in a Ugandan population aged 10-22 years.

Background: This study was aimed at establishing age estimates based on distal root development of the mandibular third molar for Ugandans aged 10-22 years. This was a cross-sectional study using orthopantomograms (OPGs) of 671 patients attending the Mulago Hospital Dental Clinic. The patients' chronological age and sex were obtained from either their national identity cards or birth certificates (females; n = 326, 48.6%). Third molar root development was assessed using Demirjian, Goldstein, and Tanner (DGT), modified Demirjian by Solari, Moorrees, Fanning, and Hunt (MFH), and Haavikko methods. Age was summarized using means/standard deviation (SD), medians, and lower and upper quartiles. Sex differences were assessed using Student's t-test. Results: Crown completion (stage D) and root initiation (stage Ri) were observed at 12.6 years for females and 13.5 years for males (P = 0.02), while complete apex closure occurred at 19.8 for females and 20.1 for males (P = 0.3). There were statistically significant differences in Demirjian root stages E, F, and G and MFH and Haavikko stages Ri, R1/4, and R1/2 between the sexes (P < 0.05). The difference in the mean age of root development between females and males ranged between 0.9 year at DGT/MFH root stages D and Ri (13.5-12.6) and 1.4 years at Solari, MFH, and Haavikko root stages F, R1/4, and R1/2 (16.3-14.9, 17.1-15.7). No differences were observed between the right and left mandibular molars. Conclusions: This study provides age reference standards based on third molar root development specific to the Ugandan adolescent and young adult population. The findings can be used to formulate contemporary standards and utilized as reference material to assess third molar maturity for forensic purposes.

Smell and Taste Symptoms Among Patients With Mild and Moderately Severe COVID-19 Infection in Uganda.

Objective: Patients with coronavirus disease 2019 (COVID-19) may present with smell/taste dysfunctions in addition to the most frequent symptoms (fever, cough, and shortness of breath) or as the first symptom or even the only symptom. There is paucity of documentation of prevalence and characteristics of smell/taste dysfunction in COVID-19 in sub-Saharan Africa. The aim of this study was to determine the prevalence of smell/taste symptoms in our setting to institute local evidence-based practice. Study Design: Cross-sectional study. Setting: COVID-19 treatment centers in Uganda. Methods: Patients hospitalized for COVID-19 at 3 treatment sites from November 2020 to March 2021 were recruited. Following written informed consent, their demographics, comorbidities, and smell/taste symptoms data were collected using a questionnaire. Results: Of 614 patients recruited, 409 (63.8%) had mild symptoms and 232 (36.2%) had moderate to severe symptoms; 64.3% were male, and the mean age was 48.6 ± 15.51 years. In total, 23.1% were health responders and 12.2% had contact with a positive case. Smell and taste impairment was seen in 425 (66.3%) patients, second to cough (71.6%). Smell and taste impairment was seen in 162 (38.1%) as the first symptom, in 128 (30%) as the only symptom, and significantly more in those with mild COVID-19 symptoms (P < .001). Conclusion: COVID-19 manifests with various symptoms, including impairment of smell and taste. This study shows that smell and taste impairment is common and can be the first and only symptom in less severe COVID-19 infections. Therefore, inclusion in the Ministry of Health guidelines is strongly recommended.

Experiences of patients who developed oral mucositis during solid neoplasms treatment: a Ugandan qualitative study.

BACKGROUND: Research on the management of complications of chemotherapy is important in facilitating the growing approaches to individualized patient management. Hence the need to document patient's perspectives about chemotherapy-induced mucositis and the support they need from cancer care teams. METHODS: We carried out a qualitative study using in-depth interviews (IDI) and focus group discussions (FGD). We collected patient's experiences on chemotherapy-induced mucositis by conducting 5 FGD and 13 IDIs. RESULTS: One glaring improvement that we need to make is the provision of information and counseling before, during, and after chemotherapy. Additionally, we need to explore inexpensive mucositis preventive strategies to aid our patients as they undergo treatment. CONCLUSION: As a country, we must move away from taking cancer patients' needs as those of common tropical diseases. This will allow us to provide that extra help needed outside the usual diagnosis and administration of medication.

A descriptive study of human papilloma virus in upper aero-digestive squamous cell carcinoma at Uganda cancer institute assessed by P16 immunohistochemistry.

BACKGROUND: Cancer burden in sub-Saharan Africa is on the rise with one-third of cancers estimated to be caused by infectious agents. Head and neck squamous cell cancer (HNSCC) is the sixth most common malignancy in sub-Saharan Africa and includes tumors in the Upper Aero-digestive Tract (UADT). The established risk factors are tobacco and alcohol exposure with a recent recognition of the role of Human Papilloma Virus (HPV). The HPV related HNC is seen predominantly in the oropharynx, presents at a younger age and has a better prognosis. With a rapidly increasing incidence of these cancers in the developed world, it was important to study HPV in HNC in Uganda. The HPV can be detected using P16 immunohistochemistry as a surrogate marker thus making it suitable for screening. The study aimed at establishing the presence of HPV and the commonly affected sites in UADT squamous cell carcinoma (SCC) at Uganda Cancer Institute (UCI) using P16 immunohistochemistry. METHODOLOGY: This was a cross sectional study in which 59 patients with histologically proven SCC from the oral cavity, oropharynx, larynx and hypopharynx were recruited. These patients' demographics and clinical data were collected. Tissue sections from retrieved histology samples were stained by Haematoxylin and Eosin to reconfirm SCC. Subsequently, P16 expression was determined using P16 immunohistochemistry. RESULTS: Seventy-one patients were enrolled and 59 patients with confirmed SCC of the sites of interest were analyzed. The majority (79.7%) of the participants were male and over 50 years. 59.3% were tobacco smokers, 66.1% used alcohol, 52.2% used both. Only 27.1% used none of the substances. Only 27.1% of the participants were HIV positive. Most of the tumors were in the larynx (37.3%) and 64.4% were overall TNM stage 4. The overall prevalence of HPV in UADT SCC at UCI was 20.3, 95%CI 10.9-32.8. The oropharynx had the highest prevalence (30.8%). CONCLUSION: The prevalence of HPV in UADT SCC at UCI is significant at 20.3%. The most affected site, is the oropharynx. Vigilant HPV screening of these sites with confirmation where possible is recommended.

Public knowledge about oral cancer in Uganda: a free dental camp experience.

PURPOSE­: The purpose of this paper is to assess the levels of awareness and knowledge about oral cancer, its causes and or risk factors among Ugandan patients seeking oral healthcare. DESIGN/METHODOLOGY/APPROACH­: This was a cross-sectional study on adult patients who attended a free dental camp. An assistant-administered questionnaire either in English or Luganda was provided to every even-numbered registered adult who consented to participate in the study. Information on demographics and known risk factors for oral cancer were captured. The two knowledge questions on oral cancers were scored by adding up all the correctly identified causes, non-causes and risk factors then scored out of the total. Data analysis was done by calculating proportions, Student's' t-tests and χ 2 tests with significant p-value set at 0.05. FINDINGS­: The results showed a low level of awareness/knowledge about oral cancer in studied population. In total, 60 percent and less than 50 percent of respondents identified smoking and alcohol use as risk factors for oral cancer, respectively. Majority of respondents (88.8 percent) would seek help from medical personnel if diagnosed with oral cancer. Screening for cancer was low despite awareness and knowledge that it improves the chances of successful treatment. RESEARCH LIMITATIONS/IMPLICATIONS­: Emphasis on risk factors including alcohol use in public health messages, use of mass media, religious and community leaders to disseminate messages to the communities and further research were recommended. PRACTICAL IMPLICATIONS­: We need to emphasize the role of alcohol in oral cancer causation just as we do for tobacco consumption. ORIGINALITY/VALUE­: No study has been conducted in Uganda on the level of awareness yet the incidence of the disease and use of high-risk products are rising.

Survival and associated factors among patients with oral squamous cell carcinoma (OSCC) in Mulago hospital, Kampala, Uganda.

BACKGROUND: Despite improvements in diagnosis and patient management, survival and prognostic factors of patients with oral squamous cell carcinoma (OSCC) remains largely unknown in most of Sub Saharan Africa. OBJECTIVE: To establish survival and associated factors among patients with oral squamous cell carcinoma treated at Mulago Hospital Complex, Kampala. METHODS: We conducted a retrospective cohort study among histologically confirmed oral squamous cell carcinoma (OSCC) patients seen at our centre from January 1st 2002 to December 31st 2011. Survival was analysed using Kaplan-Meier method and comparison between associated variables made using Log rank-test. Cox proportional hazards model was used to determine independent predictors of survival. P-values of less than 0.05 were considered statistically significant. RESULTS: A total of 384 patients (229 males and 155 females) were included in this analysis. The overall mean age was 55.2 (SD 4.1) years. The 384 patients studied contributed a total of 399.17 person-years of follow-up. 111 deaths were observed, giving an overall death rate of 27.81 per 100 person-years [95% CI; 22.97-32.65]. The two-year and five-year survival rates were 43.6% (135/384) and 20.7% (50/384), respectively. Tumours arising from the lip had the best five-year survival rate (100%), while tumours arising from the floor of the mouth, alveolus and the gingiva had the worst prognosis with five-year survival rates of 0%, 0% and 15.9%, respectively. Independent predictors of survival were clinical stage (p = 0.001), poorly differentiated histo-pathological grade (p <  0.001), male gender (p = 0.001), age > 55 years at time of diagnosis (p = 0.02) and moderately differentiated histo-pathological grade (p = 0.027). However, tobacco & alcohol consumption, tumour location and treatment group were not associated with survival (p > 0.05). CONCLUSIONS: The five-year survival rate of OSCC was poor at 20.7%. Male gender, late clinical stage at presentation, poor histo-pathological types and advanced age were independent prognostic factors of survival. Early detection through screening and prompt treatment could improve survival.

Maxillofacial injuries among trauma patients undergoing head computerized tomography; A Ugandan experience.

AIM: The aim of this study was to investigate epidemiological features of maxillofacial fractures within trauma patients who had head and neck computed tomography (CT) scan at the Mulago National referral hospital. METHODS: CT scan records of trauma patients who had head scans at the Department of Radiology over 1-year period were accessed. Data collected included sociodemographic factors, type and etiology of injury, and concomitant maxillofacial injuries. RESULTS: A total of 1330 trauma patients underwent head and neck CT scan in the 1-year study period. Out of these, 130 were excluded due to incomplete or unclear records and no evidence of injury. Of the remaining 1200, 32% (387) had maxillofacial fractures. The median age of the patients with maxillofacial fractures was 28 (range = 18-80) years and 18-27 age group was most common at 47.5%. Road traffic accidents constituted 49.1% of fractures. The single most affected isolated bone was the frontal bone (23%). The number of maxillofacial bones fractured was predicted by age group (df = 3 F = 5.358, P = 0.001), association with other fractures (df = 1 F = 5.317, P = 0.03). CONCLUSIONS: Good matched case-control prospective studies are needed to enable us tease out the finer difference in the circumstances and pattern of injury if we are to design appropriate preventive measures.

Ugandan medical and health sciences interns' infection control knowledge and practices.

BACKGROUND: We assessed the level of knowledge, attitudes, and practices of recent graduates of clinical health sciences who started their one-year internship in Uganda. METHODOLOGY: This was a cross-sectional survey responded to by 209 (response rate of 70%) new interns who started their internships in August 2011 in different Ugandan hospitals. Validated self-administered questionnaires with knowledge, attitude, and practices questions were distributed to the participants during a two-day internship orientation organized by the national internship committee. RESULTS: Out of 299 subjects approached, the survey was completed and returned by 209 (70%). More nurses (51.4%) failed the questions on odds of HIV transmission after a needle stick injury compared to 23.0% and 36.4% of medical and dental graduates, respectively(χ² = 24.06 p = 0.001). There was no difference in proportions of those who re-sheath needles. Respondents who had an encounter with positive tuberculosis history when taking clinical notes while unprotected were not more motivated to use masks (χ² = 7.06; p = 0.07). Nurses and dentists reported more regular hand washing before and after patient contact compared to medical doctors. CONCLUSION: Overall, the knowledge of infection control was not impressive and the attitudes and practices appeared to be heavily influenced by the lack of an enabling environment in training hospitals and internship hospitals. There is little likelihood of change due to internship experience except for those who go to missionary hospitals that have stricter infection control protocols. More effort must be made in teaching hospitals to encourage better infection control.

Ranulas: possible signs for HIV/AIDS? 1 year Ugandan descriptive study.

INTRODUCTION: Certain oral manifestations signal progression of HIV disease among HAART naïve patients or an increase in the plasma HIV-1 RNA levels for those on treatment. Ranulas may be one of those manifestations. Therefore, this study describes the clinical features of patients who presented with ranulas including their demographics, HIV sero-status and the CD4 CD8 cell counts for those who were HIV positive. METHODS: A prospective study on ranulas was undertaken at Mulago national referral hospital and St Mary's hospital Lacor covering the period December 2008 to November 2009. RESULTS: Fifty-seven cases participated in the study: 38.6% male and 61.4% female. Out of the study group, 73.7% were HIV positive. This was statistically significant (Chi = 12.789, df = 1, p = 0.001). In relation, to CD4 cell count, 23.8% had <200 cells/mm(3), 35.7% between 200-500 cells/mm(3) and 40.5% more than 500 cells/mm(3). The CD4-to-CD8 ratio ranged from 0.02-0.98 with an average of 0.31 ± 0.23, median and mode of 0.27 and 0.32, respectively. CONCLUSIONS: It is felt that ranulas may be one of the oral manifestations of worsening immunity in HIV/AIDS disease. Therefore, more research is needed to establish if it should be included among known oral manifestations of the disease.

Oral maxillofacial tumors and tumor-like conditions: a Ugandan survey.

AIM: Currently, there is very little information from Uganda as to the range and prevalence of oral diseases in children. Most of these studies focus on prevalence of caries, periodontal disease, malocclusions, and trauma to teeth. Since the epidemiology of oral maxillofacial tumors is variable between regions yet there are no publications on this entity in the pediatric population available from Uganda, the authors of this study decided to carry out the first Ugandan retrospective survey. DESIGN: All entries for specimens from children between the ages of 0 and 16 years during the 5-year period from 2006 to 2010 were retrieved and compiled into five diagnostic categories. RESULTS: During the study period, 610 (29.33%) specimens came from children between the ages of 0 and 16 years, with a male to female ratio of 1.29:1. The diagnostic category with the largest number of specimens was malignant (61.08%), followed by inflammatory/reactive lesions (16.07%) and benign tumors (12.13%). In all, there were 51 benign tumors of non-odontogenic origin and 23 odontogenic tumors. The most frequently diagnosed lesions were Burkitt's lymphoma, which accounted for over 55.24% of all cases. This was followed by irritation fibromas that accounted for 5.74% of all cases. CONCLUSIONS: This survey shows that, while nearly 29% of cases biopsied at the authors' unit are from children under 16 years of age, the majority of lesions are malignant. Burkitt's lymphoma took up the lion's share; this entity requires chemotherapeutic treatment, hence there is need to strengthen medical oncology. Odontogenic tumors are relatively rare in this age group; however, certain lesions such as adenomatoid odontogenic tumor are common in children and therefore should be considered when we have failed maxillary canine eruption.

Knowledge and Antibiotics Prescription Pattern among Ugandan Oral Health Care Providers: A Cross-sectional Survey.

BACKGROUND AND AIMS: Irrational prescription of antibiotics by clinicians might lead to drug resistance. Clinicians do prescribe antibiotics for either prophylactic or therapeutic reasons. The decision of when and what to prescribe leaves room for misuse and therefore it is imperative to continuously monitor knowledge and pattern of prescription. The aim of the present study was to determine the knowledge of antibiotic use and the prescription pattern among dental health care practitioners in Uganda. MATERIALS AND METHODS: A structured and pretested questionnaire was sent to 350 dental health care practitioners by post or physical delivery. All the questionnaires were sent with self-addressed and prepaid postage envelopes to enable re-spondents to mail back the filled questionnaires. Chi-squared test was used to test for any significant differences between groups of respondents based on qualitative variables. RESULTS: The response rate was 40.3% (n=140). Of these 52.9 % were public health dental officers (PHDOs) and 47.1% were dental surgeons. The males constituted 74.3% of the respondents. There were statistically significant differences be-tween dental surgeons and (PHDOs) in knowledge on prophylactic antibiotic use (P = 0.001) and patient influence on pre-scription (P = 0.001). Amoxicillin, in combination with metronidazole, was the most common combination of antibiotics used followed by co-trimoxazole with metronidazole. CONCLUSION: The knowledge of dental health care practitioners in antibiotic use in this study was generally low. A combi-nation of amoxicillin with metronidazole was the most commonly prescribed antibiotics subsequent to different dental pro-cedures.

Oral maxillofacial fractures seen at a Ugandan tertiary hospital: a six-month prospective study.

AIM: To investigate the epidemiological characteristics of maxillofacial fractures and associated fractures in patients seen in the Oral Surgery Unit of Mulago Hospital, Kampala, Uganda. METHODOLOGY: A six-month prospective study was conducted. Data collected included socio-demographic factors, type and etiology of injury, additional fractures, and post-surgery complications. RESULTS: One hundred thirty-two (132) cases ranging from 5-70 yrs of age were reported, with a male: female ratio of 7.7:1. The 21-30 yr age group was the largest, comprising 51.51% of cases (n=68). Road traffic accidents contributed to 56.06% (n=74) of fractures. In total, 66% of the sample (n=87) suffered isolated mandibular fractures. Symphyseal and maxillary fractures were the most common mandibular and mid-facial fractures, respectively. Among associated fractures, the femur was most affected. A total of 39 (29.54%) of patients had post-operative complications, of which infection accounted for 48.71% (n=19), and malocclusion accounted for 17.94% (n=7). CONCLUSIONS: Anticipated changes in maxillofacial trauma trends necessitate regular epidemiologic studies of facial fractures to allow for development and implementation of timely novel preventive measures.

Oral maxillofacial fractures seen at a ugandan tertiary hospital: a six-month prospective study

AIM: To investigate the epidemiological characteristics of maxillofacial fractures and associated fractures in patients seen in the Oral Surgery Unit of Mulago Hospital, Kampala, Uganda. METHODOLOGY: A six-month prospective study was conducted. Data collected included socio-demographic factors, type and etiology of injury, additional fractures, and post-surgery complications. RESULTS: One hundred thirty-two (132) cases ranging from 5-70 yrs of age were reported, with a male: female ratio of 7.7:1. The 21-30 yr age group was the largest, comprising 51.51 percent of cases (n=68). Road traffic accidents contributed to 56.06 percent (n=74) of fractures. In total, 66 percent of the sample (n=87) suffered isolated mandibular fractures. Symphyseal and maxillary fractures were the most common mandibular and mid-facial fractures, respectively. Among associated fractures, the femur was most affected. A total of 39 (29.54 percent) of patients had post-operative complications, of which infection accounted for 48.71 percent (n= 19), and malocclusion accounted for 17.94 percent (n=7). CONCLUSIONS: Anticipated changes in maxillofacial trauma trends necessitate regular epidemiologic studies of facial fractures to allow for development and implementation of timely novel preventive measures.

Oral maxillofacial neoplasms in an East African population a 10 year retrospective study of 1863 cases using histopathological reports.

BACKGROUND: Neoplasms of the oral maxillofacial area are an interesting entity characterized by differences in nomenclature and classification at different centers.We report neoplastic histopathological diagnoses seen at the departments of oral maxillofacial surgery of Muhimbili and Mulago referral hospitals in Tanzania and Uganda respectively over a 10-year period. METHODS: We retrieved histopathological reports archived at the departments of oral maxillofacial surgery of Muhimbili and Mulago referral hospitals in Tanzania and Uganda respectively over a 10-year period from June 1989-July 1999. RESULTS: In the period between June 1989 and July 1999, 565 and 1298 neoplastic oro-facial cases were retrieved of which 284 (50.53%) and 967 (74.54%) were malignant neoplasms at Muhimbili and Mulago hospitals respectively. Overall 67.28% of the diagnoses recorded were malignant with Kaposi's sarcoma (21.98%), Burkiits lymphoma (20.45%), and squamous cell carcinoma (15.22%) dominating that group while ameloblastoma (9.23%), fibromas (7.3%) and pleomorphic adenoma (4.95%) dominated the benign group.The high frequency of malignancies could be due to inclusion criteria and the clinical practice of selective histopathology investigation. However, it may also be due to higher chances of referrals in case of malignancies. CONCLUSION: There is need to reexamine the slides in these two centers in order to bring them in line with the most recent WHO classification so as to allow for comparison with reports from else where.