Browsing by Author "Kiwanuka, Julius"
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Item Anaemia in HIV-infected children: severity, types and effect on response to HAART.(BMC Pediatrics, 2012) Ruhinda, Eunice Nyesigire; Bajunirwe, Francis; Kiwanuka, JuliusHIV and anaemia are major health challenges in Africa. Anaemia in HIV-infected individuals is associated with more rapid disease progression and a poorer prognosis if not addressed appropriately. This study aimed at determining the severity and types of anaemia among HIV infected children and its effect on short term response to antiretroviral therapy (ART).Item Assessment of Survival Outcomes of Histopatho-Logical Subtypes of Colorectal Adenocarcinoma in Ugandan Patients(New Horizons in Medicine and Medical Research, 2022) Wismayer, Richard; Kiwanuka, Julius; Wabinga, Henry; Odida, MichaelIn the West, high grade mucinous adenocarcinomas are more common in younger patients and are associated with a poor prognosis. The survival outcomes of the various histopathologic subtypes of colorectal adenocarcinoma (CRC) and lymphovascular invasion (LVI) are unknown in Uganda. We looked at the survival rates of various histopathologic subtypes of CRC and LVI in Ugandan patients.Item The Bacterial and Viral Complexity of Postinfectious Hydrocephalus in Uganda(Science translational medicine, 2020) Paulson, Joseph N.; Williams, Brent L.; Hehnly, Christine; Mishra, Nischay; Sinnar, Shamim A.; Zhang, Lijun; Ssentongo, Paddy; Kabachelor, Edith Mbabazi; Wijetunge, Dona S. S.; Bredow, Benjamin von; Mulondo, Ronnie; Kiwanuka, Julius; Bajunirwe, Francis; Bazira, Joel; Bebell, Lisa M.; Burgoine, Kathy; Couto-Rodriguez, Mara; Ericson, Jessica E.; Erickson, Tim; Ferrari, Matthew; Gladstone, Melissa; Guo, Cheng; Haran, Murali; Hornig, Mady; Isaacs, Albert M.; Kaaya, Brian Nsubuga; Kangere, Sheila M.; Kulkarni, Abhaya V.; Kumbakumba, Elias; Li, Xiaoxiao; Limbrick, David D.; Magombe, Joshua; Morton, Sarah U.; Mugamba, John; Ng, James; Olupot, Peter Olupot; Onen, Justin; Peterson, Mallory R.; Roy, Farrah; Sheldon, Kathryn; Townsend, Reid; Weeks, Andrew D.; Whalen, Andrew J.; Quackenbush, John; Ssenyonga, Peter; Galperin, Michael Y.; Almeida, Mathieu; Atkins, Hannah; Warf, Benjamin C.; Lipkin, W. Ian; Broach, James R.; Schiff, Steven J.Postinfectious hydrocephalus (PIH), often following neonatal sepsis, is the most common cause of pediatric hydrocephalus world-wide, yet the microbial pathogens remain uncharacterized. Characterization of the microbial agents causing PIH would lead to an emphasis shift from surgical palliation of cerebrospinal fluid (CSF) accumulation to prevention. We examined blood and CSF from 100 consecutive cases of PIH and control cases of non-postinfectious hydrocephalus (NPIH) in infants in Uganda. Genomic testing was undertaken for bacterial, fungal, and parasitic DNA, DNA and RNA sequencing for viral identification, and extensive bacterial culture recovery. We uncovered a major contribution to PIH from Paenibacillus, upon a background of frequent cytomegalovirus (CMV) infection. CMV was only found in CSF in PIH cases. A facultatively anaerobic isolate was recovered. Assembly of the genome revealed a strain of P. thiaminolyticus. In mice, this isolate designated strain Mbale, was lethal in contrast with the benign reference strain. These findings point to the value of an unbiased pan-microbial approach to characterize PIH in settings where the organisms remain unknown, and enables a pathway towards more optimal treatment and prevention of the proximate neonatal infections.Item Dietary Risk Factors for Colorectal Cancer in an Indigenous East African Population(Perspective of Recent Advances in Medical Research, 2022) Wismayer, Richard; Kiwanuka, Julius; Wabinga, Henry; Odida, MichaelLow-income countries in East Africa have a lower incidence of colorectal cancer (CRC) than high-income countries; however, the incidence has steadily increased in the last few decades. In East Africa, the extent to which genetic and environmental factors, particularly dietary factors, contribute to the aetiology of CRC is unclear. Therefore, the objective of our study was to determine the relationship between dietary factors and CRC in an indigenous population in East Africa. We conducted a case-control study and recruited 128 cases and 256 controls, block matched for age (±5 years) and sex. Data regarding diet were obtained from all the participants using an interview-based questionnaire. The potential dietary risk factors and protective factors evaluated included the type, frequency of meat consumed and the type and frequency of fibre foods consumed. The frequency was either 4x and above/week or 2-3x/week or 1x/week or never. Ordinal and conditional logistic regression analyses were used to determine the odds ratios associated with the different risk and protective factors. The mean age (SD) was 53.5(16.2) years and the male:female ratio was 1:1 for all the participants. The most significant risk factors included consumption of boiled beef 2-3x/week (aOR:1.63; p<0.001) and consumption of fried chicken 2-3x/week (aOR: 2.60; p=0.027). Consumption of high fibre foods, including:- cassava for ≥4x/week (aOR: 0.40; p=0.016), millet for 1x/week (aOR: 0.49; p=0.034) and for ≥4x/week (aOR:0.32; p=0.001), spinach for ≥4x/week (aOR:0.30; p=0.003), and potatoes 2-3x/week (aOR: 0.44; p=0.041), were protective against CRC.Item Evaluation of the Initial 12months of a Routine Cryptococcal Antigen Screening Program in Reduction of HIV-Associated Cryptococcal Meningitis in Uganda(BMC Health Services Research, 2022) Enock, Kagimu; Kiwanuka, Julius; Abila, Derrick Bary; Rutakingirwa, Morris K.; Kasibante, John; Kiiza, Tadeo Kandole; Kwizera, Richard; Semeere, Aggrey; Meya, David B.Asymptomatic Cryptococcal Antigenemia (CrAg) patients develop meningitis within a month of testing positive. Pre-emptive antifungal therapy can prevent progression to Cryptococcal meningitis (CM). In April 2016, a national CrAg screening program was initiated in 206 high-volume health facilities that provide antiretroviral therapy in Uganda. We report the evaluation of the CrAg screening cascade focusing on linkage to care, fluconazole therapy for 10 weeks and 6 months follow up, and ART initiation in a subset of facilities. We conducted a retrospective, cross-sectional survey of patients with CD4 < 100 at seven urban and seven rural facilities after 1 year of program implementation. We quantified the number of patients who transitioned through the steps of the CrAg screening cascade over six-months follow-up. We defined cascade completion as a pre-emptive fluconazole prescription for the first 10 weeks. We conducted semi-structured interviews with lab personnel and clinic staff to assess functionality of the CrAg screening program. Data was collected using REDCap. We evaluated 359 patient records between April 2016 to March 2017; the majority (358/359, 99.7%) were from government owned health facilities and just over half (193/359, 53.8%) had a median baseline CD4 cell count of < 50 cell/μL. Overall, CrAg screening had been performed in 255/359 (71.0, 95% CI, 66.0–75.7) of patients’ records reviewed, with a higher proportion among urban facilities (170/209 (81.3, 95% CI, 75.4–86.4)) than rural facilities (85/150 (56.7, 95% CI, 48.3–64.7)). Among those who were CrAg screened, 56/255 (22.0, 95% CI, 17.0–27.5%) had cryptococcal antigenemia, of whom 47/56 (83.9, 95% CI, 71.7–92.4%) were initiated on pre-emptive therapy with fluconazole and 8/47 (17.0, 95% CI, 7.6–30.8%) of these were still receiving antifungal therapy at 6 months follow up. At least one CNS symptom was present in 70% (39/56) of those with antigenemia. In patients who had started ART, almost 40% initiated ART prior to CrAg screening. Inadequacy of equipment/supplies was reported by 15/26 (58%) of personnel as a program barrier, while 13/26 (50%) reported a need for training about CM and CrAg screening. There was a critical gap in the follow-up of patients after initiation on fluconazole therapy. ART had been initiated in almost 40% of patients prior to CrAg screening.. Higher antigenemia patients presenting with CNS symptoms could be related to late presentation. There is need to address these gaps after a more thorough evaluation.Item Prognostic Factors for Survival of Colorectal Adenocarcinoma Patients in Uganda(Cancer Management and Research, 2022) Wismayer, Richard; Kiwanuka, Julius; Wabinga, Henry; Odida, MichaelIn Uganda, similar to other countries in East Africa, the incidence of colorectal cancer (CRC) has been steadily increasing. This increase in incidence is accompanied by a poor prognosis. There is limited knowledge on factors responsible for the poor outcome of patients with CRC in Uganda. Cancer survival analysis is one way of determining some of these prognostic factors. The aim of this study was to determine prognostic factors associated with CRC survival in Ugandan patients.Item Surgery for Colorectal Cancer Improves Survival in Uganda: A Cohort Study(Current Practice in Medical Science, 2022) Wismayer, Richard; Kiwanuka, Julius; Wabinga, Henry; Odida, MichaelColorectal carcinoma (CRC) incidence and mortality rates are rising in Uganda and other developing low-income nations in Sub-Saharan Africa, while CRC rates are dropping in high-income industrialized countries. In Uganda, many people with CRC do not have access to curative surgery or oncological care. To analyze the impact of surgery and oncology care on CRC in the resource-limited environment of a low-income developing nation, we compared the survival results of patients who underwent curative surgery and, if necessary, adjuvant chemotherapy to those who did not. The study included people who were diagnosed with CRC between January 1, 2008, and December 31, 2018. The Kampala Cancer Registry and medical records from Ugandan hospitals were linked for these patients. The researchers wanted to know if the individuals had had curative surgery and adjuvant treatment. Our outcome variable was survival at 3 years. The log-rank test was used to calculate and compare survival. A total of 247 patients were involved in the study. There were 177 (71.66 %) patients who received curative surgery and 70 (28.34 %) who did not. Curative rectal cancer surgery had a better survival than no curative surgery (p=0.003). Curative colon cancer surgery tended to have a better survival than no surgery (p=0.137). Curative surgery and adjuvant chemotherapy showed better survival than no surgery with no adjuvant chemotherapy (p=0.007). Curative surgery, if necessary, paired with adjuvant chemotherapy, improves survival in a resource-constrained situation. As a result of the increasing burden of CRC, the findings of our study serve to support the extension of CRC care by upgrading surgery and oncology infrastructure in resource-limited areas.Item Surgical Resection for Colorectal Cancer Improves Survival in Uganda(Journal of Advances in Medicine and Medical Research, 2022) Wismayer, Richard; Kiwanuka, Julius; Wabinga, Henry; Odida, MichaelIn Uganda and other developing low-income countries in Sub-Saharan Africa, colorectal carcinoma (CRC) incidence and mortality rates are increasing whereas in high income developed countries, CRC rates are declining. Many patients do not have access to curative surgery and oncological treatment for CRC in Uganda. In this study, we compared the survival outcomes of patients who underwent curative surgery, and, if necessary, adjuvant chemotherapy to those who did not to assess the impact of surgery and oncology care on CRC in the resource-limited setting of a low-income developing country. Participants with a diagnosis of CRC between 1 January 2008 and 31 December 2018 were included. These patients had linked data in the Kampala Cancer Registry and medical records from hospitals in Uganda. Data on whether the patients had or did not have curative surgery and adjuvant chemotherapy were obtained. Our outcome variable was survival at 3 years. We computed and compared survival using the log-rank test. Two hundred and forty seven patients were included in the study cohort. These were 177 (71.66%) patients that had curative surgery, while 70 (28.34%) had no curative surgery. Curative rectal cancer surgery had a better survival than no curative surgery (p=0.003). Curative colon cancer surgery tended to have a better survival than no surgery (p=0.137). Curative surgery and adjuvant chemotherapy showed better survival than no surgery with no adjuvant chemotherapy (p=0.007). In a resource-limited environment, curative surgery and if necessary, combined with adjuvant chemotherapy improves survival. The findings in our study therefore serve to encourage the expansion of CRC care by improving the surgery and oncology infrastructure in resource-limited environments due to the increasing burden of CRC.