Browsing by Author "Erem, Geoffrey"

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    Challenges Associated with the Roll-out of HCC Surveillance in Sub-Saharan Africa - the Case of Uganda
    (Journal of Hepatology, 2020) Hees, Stijn Van; Muyindike, Winnie; Erem, Geoffrey; Ocama, Ponsianoo; Seremba, Emmanuel; Apiyo, Paska; Michielsen, Peter; Okwir, Mark; Vanwolleghem, Thomas
    In their recent review article, Singal and coworkers describe the challenges associated with surveillance for hepatocellular carcinoma (HCC) and propose interventions to increase the effectiveness of surveillance. We agree with the authors that improved uptake of screening and performance of HCC surveillance should be considered a high priority in Western countries. In sub-Saharan Africa, where HBV infections are the main cause of HCC, surveillance programs are mostly not available. Nonetheless, with an incidence rate of 8.9 cases per 100,000 inhabitants per year, which is likely to be an underestimate, HCC surveillance is a pressing medical need in this part of the world. The recent introduction of country-wide vaccination programs in these countries will likely result in a drop in HCC incidence a few decades from now, but this does not apply to patients that are currently infected. In a recent African cohort of 1,315 hepatocellular tumors, 84% of the tumors were diagnosed at a late, multifocal disease stage with a mean size of 8 ± 4 cm and a median survival of 2.5 months.Given the strong association between early detection and improved survival, these findings highlight the need to set up surveillance programs in sub-Saharan Africa, provided curative treatment options are available.
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    Clinical and cranial computed tomography scan findings in adults following road traffic accidents in Kampala, Uganda
    (African health sciences, 2017) Erem, Geoffrey; Bugeza, Samuel; Malwadde, Elsie K.
    Background: Globally, road traffic accidents are a major cause of death and disability. The developing countries bear a disproportionately large share of the RTAs which account for about 85% of the deaths. Most of these RTAs result in head injury, which globally, most scholars and medical practitioners consider a significant economic, social and medical problem. In Mulago National referral hospital, RTA is the leading cause of surgical admission. Objective: To describe the cranial computed tomography (CT) scan findings in adults following RTA in Mulago hospital. Methods: Using CT, detailed analysis of 178 adult patients with head injury following RTA was performed. Data was analyzed using SPSS version 16 and presented in tables and graphs. Data recorded included socio-demographic characteristics, clinical and CT variables. Results: Seventy seven percent of the respondents were between 18- 39 years. 52.6% of patients had open head injury. Headache was the most common clinical variable followed by dizziness and aphasia. The most common CT characteristic was extra cerebral haemorrhage followed by brain oedema and raised Intra-cranial pressure (ICP). Intra-cerebral haemorrhage was commonest in the frontal lobe followed by parietal lobe. Conclusion: Public health interventions like advocacy and education of the population on safe and responsible road usage should be emphasized to reduce on RTAs
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    Coronary artery calcium, HIV and inflammation in Uganda compared with the USA
    (Open Heart, 2019) Alencherry, Ben; Erem, Geoffrey; Mirembe, Grace; Ssinabulya, Isaac; Yun, Chun-Ho; Hung, Chung-Lieh; Siedner, Mark J.; Bittencourt, Marcio; Kityo, Cissy; McComsey, Grace A.; Longenecker, Chris T.
    To compare the prevalence of detectable coronary artery calcium (CAC) among higher risk, older people living with HIV (PLWH) and uninfected persons in Uganda versus the USA, and second to explore associations of CAC with HIV-specific variables and biomarkers of inflammation. This cross-sectional study of 430 total subjects compared 100 PLWH on antiretroviral therapy and 100 age-matched and sex-matched HIV-uninfected controls in Uganda with 167 PLWH on antiretroviral therapy and 63 uninfected controls in the USA. Multivariable logistic regression was used to examine associations with detectable CAC (CAC >0). Compared with US subjects, Ugandans were older (mean age 56 vs 52 years) and were more likely to have diabetes (36% vs 3%) and hypertension (85% vs 36%), but were less likely to be male (38% vs 74%) or smokers (4% vs 56%). After adjustment for HIV serostatus, age, sex and traditional risk factors, Ugandans had substantially lower odds of CAC >0 (adjusted OR 0.07 (95% CI 0.03 to 0.17), p<0.001). HIV was not associated with CAC >0 in either country (p>0.1). Among all PLWH, nadir CD4 count was associated with the presence of CAC, and among Ugandans soluble intercellular adhesion molecule (p=0.044), soluble CD163 (p=0.004) and oxidised low-density lipoprotein (p=0.043) were all associated with the presence of CAC. Ugandans had a dramatically lower prevalence of any coronary calcification compared with US subjects. The role of HIV infection and inflammation as risk factors for subclinical coronary disease in sub-Saharan Africa merits further investigation.
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    HIV and Pericardial Fat are Associated with Abnormal Cardiac Structure and Function among Ugandans
    (Heart, 2020) Buggey, Jonathan; Yun, Chun-Ho; Hung, Chung-Lieh; Kityo, Cissy; Mirembe, Grace; Erem, Geoffrey; Ssinabulya, Isaac; McComseya, Grace A.; Longenecker, Chris T.
    To examine the relationship between pericardial fat (PCF) and cardiac structure and function among HIV-infected patients in the sub-Saharan African country of Uganda. People living with HIV (PLHIV) have altered fat distribution and an elevated risk for heart failure. Whether altered quantity and radiodensity of fat surrounding the heart relates to cardiac dysfunction in this population is unknown. One hundred HIV-positive Ugandans on antiretroviral therapy were compared with 100 age and sex-matched HIV-negative Ugandans; all were >45 years old with >1 cardiovascular disease risk factor. Subjects underwent ECG-gated non-contrast cardiac CT and transthoracic echocardiography with speckle tracking strain imaging. Multivariable linear and logistic regression models were used to explore the association of PCF with echocardiographic outcomes. Median age was 55% and 62% were female. Compared with uninfected controls, PLHIV had lower body mass index (27 vs 30, p=0.02) and less diabetes (26% vs 45%, p=0.005). Median left ventricular (LV) ejection fraction was 67%. In models adjusted for traditional risk factors, HIV was associated with 10.3 g/m2 higher LV mass index (LVMI) (95% CI 3.22 to 17.4; p=0.005), 0.87% worse LV global longitudinal strain (GLS) (95% CI −1.66 to −0.07; p=0.03) and higher odds of diastolic dysfunction (OR 1.96; 95% CI 0.95 to 4.06; p=0.07). In adjusted models, PCF volume was significantly associated with increased LVMI and worse LV GLS, while PCF radiodensity was associated with worse LV GLS (all p<0.05). In Uganda, HIV infection, PCF volume and density are associated with abnormal cardiac structure and function.