Browsing by Author "Kansiime, Grace"

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    Cigarette Smoking is Associated with an Increase in Blood Monocytes in People with Tuberculosis: a cross-sectional study.
    (Medicine, 2022) Baluku, Joseph Baruch; Nabwana, Martin; Kansiime, Grace; Nuwagira, Edwin
    The effect of smoking on immune responses in people with tuberculosis (TB) is not well elucidated. We aimed to compare peripheral blood counts of CD4+ and CD87 + T-lymphocytes, monocytes, and neutrophils and the CD4:CD8 ratio in TB patients with and without history of cigarette smoking. We further determined factors associated with current smoking. Participants with TB were consecutively enrolled in a cross-sectional study at a national TB treatment center in Uganda in 2018. We compared cell counts and the CD4:CD8 ratio using the median test among never smokers, past smokers (>6 months ago) and current smokers (≤6 months). Factors associated with current smoking were determined using logistic regression. A post hoc analysis for factors associated with an increase in the monocytes was also performed. Of 363 participants, there were 258 (71.1%) never smokers, 50 (13.8%) past smokers, and 55 (15.2%) current smokers. Most current smokers (49.1%) had a high sputum mycobacterial load. They also had the lowest body mass index and the highest axillary temperature. The median (interquartile range [IQR]) monocyte count among current smokers was 815 (540–1425) cells/mm3 and was significantly higher than that among past smokers (610 (350–900) cells/mm3, P = .017) and never smokers (560 [400–800] cells/mm3, P = .001). The monocyte counts positively correlated with the number of cigarettes smoked per day among current smokers (R = 0.43, P = .006). Current smokers also had higher neutrophil and CD4+ T-cell counts than never smokers. In a multivariable logistic regression model, an increase in the monocyte count was associated with current cigarette smoking (adjusted odds ratio [aOR] = 4.82, 95% confidence interval 1.61–14.39, P = .005). Similarly, current cigarette smoking was independently associated with an increase in the monocyte count (aOR = 1.80, 95% CI 1.39–2.32, P < .001). Cigarette smoking is associated with an increase in the blood monocytes in people with TB in a dose- and time-dependent manner. Further, current smoking is associated with an increase in neutrophils and CD4+ T-lymphocytes. The findings suggest that current smokers have systemic inflammation that is not necessarily beneficial to TB control in TB patients.
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    Death after cure: Mortality among pulmonary tuberculosis survivors in rural Uganda Joseph Baruch Baluku Brenda Namanda Sharon Namiiro Aggrey Byaruhang
    (Elsevier Ltd, 2024-07) Baluku, Joseph Baruch; Namanda, Brenda; Namiiro, Sharon; Rwabwera, Diana Karungi; Mwesigwa, Gloria; Namaara, Catherine; Twinomugisha, Bright; Nyirazihawe, Isabella; Nuwagira, Edwin; Kansiime, Grace; Kizito, Enock; Nabukenya-Mudiope, Mary G; Sekadde, Moorine Penninah; Bongomin, Felix; Senfuka, Joshua; Olum, Ronald; Byaruhanga, Aggrey; Munabi, Ian; Kiguli, Sarah
    Objectives: To determine the incidence of mortality and its predictors among pulmonary tuberculosis (PTB) survivors treated at a rural Ugandan tertiary hospital. Methods: We conducted a retrospective chart review of data between 2013 and 2023. We included all people that met the World Health Organisation's definition of tuberculosis cure and traced them or their next of kin to determine vital status (alive/deceased). We estimated the cumulative incidence of mortality per 1000 population, crude all-cause mortality rate per 1000 person-years, and median years of potential life lost for deceased individuals. Using Cox proportional hazard models, we investigated predictors of mortality. Results: Of 334 PTB survivors enrolled, 38 (11.4%) had died. The cumulative incidence of all-cause mortality was 113.7 per 1000 population, and the crude all-cause mortality rate was 28.5 per 1000 person-years. The median years of potential life lost for deceased individuals was 23.8 years (IQR: 9.6-32.8). Hospitalization (adjusted hazard ratio (aHR): 4.3, 95% CI: 1.1-16.6) and unemployment (aHR: 7.04, 95% CI: 1.5-31.6) at TB treatment initiation predicted mortality. Conclusion: PTB survivors experience post high mortality rates after TB cure. Survivors who were hospitalized and unemployed at treatment initiation were more likely to die after cure. Social protection measures and long-term follow-up of previously hospitalized patients could improve the long-term survival of TB survivors.
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    Prevalence and pattern of echocardiographic abnormalities among patients on haemodialysis at an urban hospital in Central Uganda
    (African Journal of Nephrology, 2020) Kansiime, Grace; Kalyesubula, Robert; Okello, Emmy; Ocama, Ponsiano
    Cardiovascular disease is the most common cause of morbidity and premature mortality in patients on chronic haemodialysis. There are limited data on cardiac abnormalities among these patients in sub-Saharan Africa, including Uganda. We determined the prevalence and patterns of echocardiographic (echo) abnormalities among patients with end-stage renal disease (ESRD) on haemodialysis at Mulago National Referral Hospital, Kampala, Uganda. Methods: Eighty patients with ESRD on chronic haemodialysis were enrolled in the study over a period of five months from November 2017 to March 2018. We collected data on demographic and baseline clinical characteristics by reviewing charts and conducting patient interviews. Participants had blood pressure measurements performed and blood samples taken for laboratory investigations. We then conducted a cardiac evaluation using standard transthoracic echo protocols. Bivariable and multivariable analysis was performed to study associations with left ventricular hypertrophy and diastolic dysfunction. Results: Fifty-three of the 80 patients (66%) were male, mean age was 49 ± 16 years and the median duration on dialysis was 9.5 months (interquartile range 4–24 months). Twenty-eight (35%) had to travel >50 km to access dialysis. Seventy-four patients (93%) had at least one cardiac echo abnormality and 30% had at least three abnormalities. Left ventricular hypertrophy (68%) and diastolic dysfunction (64%) were the most common abnormalities. There was a high prevalence of factors that have previously been associated with left ventricular hypertrophy and diastolic dysfunction including anaemia (79%), poorly controlled hypertension (79%) and dyslipidaemia (56%) but none of these was statistically significantly associated in this study. Conclusions: Our study confirmed a high prevalence of cardiac abnormalities among a young population of African patients with ESRD on chronic dialysis. We recommend that echocardiography be part of the routine care to help plan early intervention for those at high risk of cardiovascular events.