School of Bio-Medical Sciences (Bio-Medical)
http://hdl.handle.net/10570/6
2024-03-29T09:22:21Z
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Abdominal sonographic changes among HIV-TB co-infected adult patients initiating highly active antiretroviral therapy at Mulago Hospital Complex.
http://hdl.handle.net/10570/4354
Abdominal sonographic changes among HIV-TB co-infected adult patients initiating highly active antiretroviral therapy at Mulago Hospital Complex.
Jabo, Christian Roy Thomas
Human immunodeficiency virus (HIV) infection increases the risk for infection with Mycobacterium tuberculosis (TB). In HIV-TB co-infected patients, abdominal tuberculosis accounts for 11-16% of extra pulmonary cases. Abdominal sonographic changes following initiation of Highly Active Antiretroviral Therapy (HAART) in these patients may be due to the response to anti-Tuberculous drugs and HAART, due to adverse reactions to these treatments or due to other associated co-morbidities. The changes may show improvement of abdominal features during treatment or worsening as a result of paradoxical TB-IRIS. They may also be new findings due to other opportunistic infections. Ultrasound imaging is a useful auxiliary investigative modality in the management of HIV-TB co-infected patients initiating HAART and it can demonstrate these abdominal sonographic changes. However, there is no recent research on its role in the management of HIV-TB co-infection in Uganda.
Objective
The study aimed at describing the abdominal sonographic findings among HIV-TB co-infected adult patients initiating HAART at Mulago Hospital Complex.
Methodology
A prospective descriptive study design was used. This study was nested in a prospective observational cohort study whose aim was to determine the incidence and predictors of clinical and immunological outcomes in adult patients co-infected with TB-HIV. It was conducted in the Department of Radiology at Mulago Hospital, the national referral hospital. Adults with HIV-TB co infection eligible for HAART were enrolled in the study. Serial abdominal ultrasound scans using low frequency (2-5MHZ) and high frequency probes (7-12MHZ) were performed. Data were collected on structured questionnaires, entered into a computer using Epi data version 3.1 and analysed using Stata version 11 with the help of a statistician.
Results
Eighty nine patients were enrolled and had a baseline ultrasound scan, 70 (78.7%) patients had a scheduled follow up scan and 10 (11.2%) had an ultrasound scan during an unscheduled visit. 9 patients (10.1%) were lost to follow up of whom 6 patients died (66.7%) while 3 (33.3%) did not return for the scheduled scan. 65.2% were males and 34.8 % were females giving a male to female ratio of 1.9:1. The age range was from 20-62 years and the median age was 32 years.
There was no statistically significant difference in the abdominal sonographic findings at base line and 4 weeks after initiating HAART. Clinical features of abdominal pain and abdominal distention were significantly associated with development of abdominal sonographic changes while abdominal pain was the only symptom significantly associated with worsening of the abdominal sonographic changes (a OR=6.0, 95% CI=1.106-13.552 and a p value=0.038) on follow up or on development of symptoms of TB-IRIS.
Fourteen patients had normal abdominal scans while 75 had features suggestive of abdominal TB on baseline scan like lymphadenopathy, hepatosplenomegaly and splenic nodules. Fourteen patients had features suggestive of TB-IRIS on the follow up and unscheduled scans. Co-morbidities like nephropathy, splenic candidiasis and carvenous hemangiomas were diagnosed.
Sonographic changes observed in the abdomen were resolution of splenic infarction, regression of splenic abscesses, appendicitis, prostatic abscess, ascites, lymphadenopathy, cholecystitis, splenomegaly and hepatomegaly.
Conclusions
There is an increased incidence of HIV-TB co-infected patients with sonographic features which may be suggestive of abdominal tuberculosis at baseline scan.
Worsening abdominal sonographic changes within 4 weeks of initiating HAART tend to be associated with paradoxical TB-IRIS.
Abdominal pain and distention are associated with development of abdominal sonographic changes.
Abdominal pain is significantly associated with worsening of abdominal sonographic features on follow up visits.
There is no statistically significant difference between abdominal sonographic features at baseline and follow up 4 weeks after initiating HAART.
Recommendations
A study designed to establish the clinico-sonographic-pathological correlation and the schedule for follow up scans is highly recommended.
Follow up abdominal sonography should be delayed beyond 4 weeks unless patients develop new symptoms or worsened symptoms.
A screening ultrasound examination for TB-IRIS should be performed in all HIV-TB co-infected on treatment who develop abdominal pain.
A thesis submitted in partial fulfillment of the requirements for the award of the Masters of Medicine Degree in Radiology of Makerere University
2014-01-01T00:00:00Z
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Acceptance of routine testing for HIV among adult patients at the medical emergency unit at a national referral hospital in Kampala, Uganda
http://hdl.handle.net/10570/1158
Acceptance of routine testing for HIV among adult patients at the medical emergency unit at a national referral hospital in Kampala, Uganda
Nakanjako, Damalie; Kamya, Moses; Kyabayinze, Daniel; Mayanja-Kizza, Harriet; Freers, Jurgen; Whalen, Christopher; Katabira, Elly
HIV testing is an entry point to comprehensive HIV/AIDS prevention and care. In Uganda, Routine Testing and Counseling for HIV (RTC) is not widely offered as part of standard medical care in acute care settings. This study determined the acceptance of RTC in a medical emergency setting at Mulago national referral hospital. We interviewed 233 adult patients who were offered HIV testing. Overall, 83% were unaware of their HIV serostatus and 88% of these had been to a health unit in the previous six months. Of the 208 eligible for HIV testing, 95% accepted to test. Half the patients were HIV infected and 77% of these were diagnosed during the study. HIV testing was highly acceptable and detected a significant number of undiagnosed HIV infections. We recommend adoption of RTC as standard of care in the medical emergency unit in order to scale HIV diagnosis and linkage to HIV/AIDS care.
2006-01-01T00:00:00Z
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Activation of the gab Operon in an RpoS-Dependent Manner by Mutations That Truncate the Inner Core of Lipopolysaccharide in Escherichia coli
http://hdl.handle.net/10570/1791
Activation of the gab Operon in an RpoS-Dependent Manner by Mutations That Truncate the Inner Core of Lipopolysaccharide in Escherichia coli
Joloba, Moses L.; Clemmer, Katy M.; Sledjeski, Darren D.; Rather, Philip N.
The gab operon (gabDTPC) in Escherichia coli functions in the conversion of -aminobutyrate to succinate. One component of gab operon regulation involves the RpoS sigma factor, which mediates activation at high cell density. Transposon mutagenesis was used to identify new genes that regulate gab operon expression in rich media. A Tn5tmp insertion in the hldD (formerly rfaD) gene increased gabT::lacZ expression 12-fold. The hldD gene product, an ADP-L-glycerol-D-mannoheptose-6-epimerase, catalyzes the conversion of ADP-D-glycerol-D-mannoheptose to ADP-L-glycerol-D-mannoheptose, a precursor for the synthesis of inner-core lipopolysaccharide (LPS). Defined mutations in hldE, required for heptose synthesis, and waaF, required for the addition of the second heptose to the inner core, also resulted in high-level gabT::lacZ expression. The hldD, hldE, and waaF mutants exhibited a mucoid colony phenotype due to production of a colanic acid capsule. However, in the hldD::cat background, the high-level expression of gabT::lacZ was independent of the regulatory components for colanic acid synthesis (rcsA, rcsB, and rcsC) and also independent of manC (cpsB), a structural gene for colanic acid synthesis. Activation of gabT::lacZ in the hldD::cat background was dependent on the RpoS sigma factor. The hldD::cat mutation resulted in a sixfold increase in the levels of a translational RpoS-LacZ fusion and had a marginal effect on a transcriptional fusion. This study reveals a stress-induced pathway, mediated by loss of the LPS inner core, that increases RpoS translation and gab operon expression in E. coli.
© 2004 American Society for Microbiology. All Rights Reserved. Available online at http://jb.asm.org/
2004-12-01T00:00:00Z
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Activity and dermal safety of Citrus limon (L.) Burm. f oil from Soroti, Uganda against selected Gram positive and Gram-negative bacteria.
http://hdl.handle.net/10570/11833
Activity and dermal safety of Citrus limon (L.) Burm. f oil from Soroti, Uganda against selected Gram positive and Gram-negative bacteria.
Mpaata, Peter
Background: Essential oils are widely used for culinary and nonculinary purposes like nutraceuticals, traditional medicine, aromatherapy and cosmetics. Genus citrus of the Rutaceae family has several plants including Citrus limon (C. limon) that are rich in essential oils known to have strong antibacterial activity. Citrus limon extracts are locally used in Uganda as astringent, to treat skin and mucocutaneous conditions. However, composition of essential oils varies with geographical origin of the plant and this may compromise their efficacy and safety. The main aim of this study was to evaluate activity of C. limon on both gram-negative and gram-positive bacteria and assess its dermal safety. Methodology: Citrus limon peel oil was extracted from fresh peels by hydro distillation using Clevenger’s apparatus for 6 hours and phytochemicals were identified by gas chromatography. Antibacterial activity was evaluated using Agar well diffusion and broth dilution methods, while dermal safety was evaluated using Draize’s method. Results: Yield of peel oil was 0.20%, D-limonene, terpineol and sabinene were the major chemical components identified. Only the gram-positive bacteria were susceptible to C. limon peel oil, the largest zones of inhibition were observed with Staphylococcus aureus and its minimum inhibitory concentration (MIC) was 105mg/ml. C. limon peel oil caused mild dermal irritation with no oedema in albino rabbits on a single exposure. Conclusion: Citrus limon oil has antibacterial activity on Staphylococcus aureus and Streptococcus pyogenes. When applied on albino rabbit skin, C. limon oilcauses hyper sensitivity reaction at a dose of 210 mg/ml and above.
A dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of Master of Science Degree in Pharmacology of Makerere University.
2018-08-02T00:00:00Z