Browsing by Author "Lukande, Robert"

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    Building capacity for geospatial cancer research in Uganda: a feasibility study
    (The Lancet Global Health, 2019) Beyer, Kirsten; Lukande, Robert; Kasasa, Simon; Kavanya, Gray; Nambooze, Sarah; Amulen, Phoebe; Cassidy, Laura; Tumwesigye, Nazarius; Babikako, Harriet; Anguzu, Ronald; Oyana, Tonny; Wabinga, Henry
    There is a growing epidemic of cancer and other non-communicable diseases in sub-Saharan Africa. Targeted, specific, cost-effective strategies are needed to manage the growing burden of cancer. In high-resource settings, geospatial analysis has transformed cancer control through geographic targeting of interventions and policies. A similar approach could improve cancer control in sub-Saharan Africa; however, georeferenced cancer data and increased geospatial research capacity are needed. Here, we aimed to assess the feasibility of geocoding and mapping small-area cancer data from a cancer registry in Uganda. We established a partnership including the Makerere University Department of Pathology, School of Public Health and College of Computing and Information Sciences, the Kampala Cancer Registry, Uganda, and the Medical College of Wisconsin, USA. The overarching goal of our multidisciplinary and multi-institutional partnership is to increase geospatial cancer research capacity at Makerere University to enhance the prioritisation and targeting of limited cancer prevention and control resources in Uganda. Two medical students from the Medical College of Wisconsin, mentored by faculty at their own institution and Makerere University, worked in Kampala with registry staff to identify, enter, and quality-check geographic codes of residence for approximately 1522 cervical cancer records from 2005 to 2014. Information about district (n=1520, 99·9%) and subcounty (n=1486, 97·6%) was available for the vast majority of cases, and the parish was identifiable for a large proportion of cases (n=1242, n=81·6%), with increasing availability in more recent years. A seed grant is supporting ongoing capacity building at the Kampala Cancer Registry, including the purchase of new computing hardware and software and the implementation of a revised geographic data collection protocol to support future geospatial analysis of Kampala Cancer Registry data.
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    Evaluation of Cepheid’s Xpert MTB/RIF Test on Pleural Fluid in the Diagnosis of Pleural Tuberculosis in a High Prevalence HIV/TB Setting
    (PLoS ONE, 2014) Lusiba, John K.; Nakiyingi, Lydia; Kirenga, Bruce J.; Kiragga, Agnes; Lukande, Robert; Nsereko, Maria; Ssengooba, Willy; Katamba, Achilles; Worodria, William; Joloba, Moses L.; Mayanja-Kizza, Harriet
    Diagnosis of pleural tuberculosis (TB) using routinely available diagnostic methods is challenging due to the paucibacillary nature of the disease. Histopathology and pleural tissue TB culture involves an invasive procedure which requires expertise and appropriate equipment, both often unavailable in many health units. Xpert MTB/Rif test has been widely evaluated in sputum specimens but data on its performance in pleural TB is scarce. We evaluated the accuracy of Cepheid’s Xpert MTB/Rif test on pleural fluid in the diagnosis of pleural TB in Uganda. Methods: Consenting adult patients with exudative pleural effusions underwent pleural biopsy and the tissue obtained subjected to Lowenstein-Jensen and mycobacterial growth indicator tube MTB cultures and histopathology. Pleural fluid for Xpert MTB/Rif testing was also collected. Data on socio-demographic characteristics, clinical symptoms, HIV status and CD4 count were also collected. Sensitivity, specificity, positive and negative predictive values of Xpert MTB/Rif test on pleural fluid in pleural TB diagnosis were calculated using pleural tissue MTB culture and/or histopathology as the reference standard. Results: Of the 116 participants [female 50%, mean age 34 (SD 613], 87/116 (75%) had pleural TB confirmed on pleural tissue culture and/or histopathology. The Xpert MTB/Rif test identified 25 (28.7%) of the 87 confirmed pleural TB cases. The sensitivity and specificity of Xpert MTB/Rif test were 28.7% and 96.6% respectively while the positive and negative predictive values were 96.1% and 31.1% respectively. Conclusion: Xpert MTB/Rif test on pleural fluid does not accurately diagnose pleural TB and therefore cannot be used as an initial evaluation test in patients with suspected pleural TB. New, rapid and accurate tests for the diagnosis of pleural TB are still warranted.
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    Gastrointestinal cryptococcoma – Immune reconstitution inflammatory syndrome or cryptococcal relapse in a patient with AIDS?
    (Medical mycology case reports, 2015) Musubire, Abdu K.; Meya, David B.; Lukande, Robert; Kambugu, Andrew; Bohjanen, Paul R.; Boulware, David R.
    The introduction of antiretroviral therapy (ART) may lead to unusual paradoxical and unmasking pre- sentations of opportunistic infections. Intra-abdominal cryptococcosis is a rare manifestation of Cryp- tococcus. We present the case of an HIV-infected patient on ART, with a history of cryptococcal meningitis who presented with subacute, worsening abdominal pain during immune recovery. This evolved into chronic abdominal pain, with thickened bowel, and abdominal lymphadenopathy, while receiving em- piric tuberculosis treatment. At 6-months, he developed intestinal perforation due to a histologically confirmed cryptococcoma.
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    High-resolution disease maps for cancer control in low-resource settings: A spatial analysis of cervical cancer incidence in Kampala, Uganda
    (Journal of Global Health, 2022) Beyer, Kirsten; Kasasa, Simon; Anguzu, Ronald; Lukande, Robert; Nambooze, Sarah; Nansereko, Brendah; Oyana, Tonny; Savino, Danielle; Feustel, Kavanya; Wabinga, Henry
    The global burden of cervical cancer is concentrated in low-and middle-income countries (LMICs), with the greatest burden in Africa. Targeting limited resources to populations with the greatest need to maximize impact is essential. The objectives of this study were to geocode cervical cancer data from a population-based cancer registry in Kampala, Uganda, to create high-resolution disease maps for cervical cancer prevention and control planning, and to share lessons learned to optimize efforts in other low-resource settings.
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    Neuroinflammation and Not Tauopathy Is a Predominant Pathological Signature of Nodding Syndrome
    (Journal of Neuropathology & Experimental Neurology, 2019) Hotterbeekx, An; Lammens, Martin; Idro, Richard; Akun, Pamela R.; Lukande, Robert; Akena, Geoffrey; Nath, Avindra; Olwa, Francis; Colebunders, Robert
    Nodding syndrome (NS) is an epileptic disorder occurring in children in African onchocerciasis endemic regions. Here, we describe the pathological changes in 9 individuals from northern Uganda who died with NS (n = 5) or other forms of onchocerciasis-associated epilepsy (OAE) (n = 4). Postmortem examinations were performed and clinical information was obtained. Formalin-fixed brain samples were stained by hematoxylin and eosin and immunohistochemistry was used to stain astrocytes (GFAP), macrophages (CD68), ubiquitin, α-synuclein, p62, TDP-43, amyloid β, and tau (AT8). The cerebellum showed atrophy and loss of Purkinje cells with hyperplasia of the Bergmann glia. Gliosis and features of past ventriculitis and/or meningitis were observed in all but 1 participant. CD68-positive macrophage clusters were observed in all cases in various degrees. Immunohistochemistry for amyloid β, α-synuclein, or TDP-43 was negative. Mild to sparse AT8-positive neurofibrillary tangle-like structures and threads were observed in 4/5 NS and 2/4 OAE cases, preferentially in the frontal and parietal cortex, thalamic- and hypothalamic regions, mesencephalon and corpus callosum. Persons who died with NS and other forms of OAE presented similar pathological changes but no generalized tauopathy, suggesting that NS and other forms of OAE are different clinical presentations of a same disease with a common etiology.
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    Neuropathological Changes in Nakalanga Syndrome—A Case Report
    (Pathogens, 2021) Hotterbeekx, An; Lammens, Martin; Onzivua, Sylvester; Lukande, Robert; Olwa, Francis; Kumar-Singh, Samir; Hees, Stijn Van; Idro, Richard; Colebunders, Robert
    Nakalanga syndrome is a clinical manifestation of onchocerciasis-associated epilepsy characterized by stunting, delayed or absent secondary sexual development and skeletal deformities, and is often accompanied by epileptic seizures. The pathophysiology of Nakalanga syndrome is unknown. Here, we describe the post-mortem findings of a 17-year-old female who died with Nakalanga syndrome in northern Uganda. Macroscopic and histopathological examination of all major organs (liver, lungs, kidney and heart), including the brain and the pituitary gland, was performed. The suspected cause of death was malaria, and all major organs and pituitary gland appeared normal, except the lungs, which were edematous consistent with the malaria. Neuropathological changes include signs of neuro-inflammation (gliosis and activated microglia), which co-localized with tau-reactive neurofibrillary tangles and threads. The pathology was most abundant in the frontal cortex, thalamic and hypothalamic regions, and mesencephalon. The choroid plexus showed psammoma bodies. These findings indicate accelerated aging, probably due to repeated seizures. The neuropathological findings were similar to other persons who died with onchocerciasis-associated epilepsy. Examination of the pituitary gland did not reveal new information concerning the underlying pathophysiological mechanism of Nakalanga syndrome. Therefore, more post-mortem studies should be performed.
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    Parish level social factors predict population-based cervical cancer incidence in Kampala, Uganda, 2008–15: an ecological study
    (The Lancet Global Health, 2022) Beyer, Kirsten M M; Kasasa, Simon; Anguzu, Ronald; Nambooze, Sarah; Amulen, Phoebe Mary; Nansereko, Brendah; Zhou, Yuhong; Lukande, Robert; Wabinga, Henry
    The burden of cancer in Africa is growing. Although cancer outcomes are understood as the product of influences at multiple socioecological levels, population-based studies of geographical factors and cancer outcomes in Africa are scarce. The objective of this study was to identify parish-level social factors associated with cervical cancer incidence in the Kampala Cancer Registry catchment area, using a novel linkage between population-based cancer registry data and small-area census data from Uganda. Kampala Cancer Registry cervical cancer records (2008–15) were augmented to add the parish of residence at diagnosis. Parish-level population and housing profile data (2014) were obtained from the Uganda Bureau of Statistics and linked to Kampala Cancer Registry records. Stepwise forward Poisson regression modelling was used to estimate incidence ratios (IR) assessing associations between social factors and incidence. Housing tenure, infrastructure, gender equality, economic status, and employment were examined, controlling for population density. The significance level was set at α=0·05. Factors related to higher incidence included a higher girl-to-boy ratio of 6–12-year-olds not attending school (IR 1·33 [95% CI 1·15–1·54]; p<0.001), a higher percentage of 10–17-year-olds ever married (IR 1·22 [95% CI 1·06–1·40]; p=0·006) and a higher percentage of households receiving remittances (IR 1·03 [95% CI 1·00–1·06]; p=0·026). Factors associated with lower incidence included a higher percentage of household owner occupancy (IR 0·95 [95% CI 0·92–0·98]; p=0·002) and a higher percentage of households with piped water (IR 0·97 [95% CI 0·95–0·99]; p=0·009). Interpretation Parish-level social factors predict cervical cancer incidence in Uganda. Communities most at risk are characterised by inequity in educational access for girls, higher prevalence of child marriage, low home ownership, inadequate infrastructure, and financial dependence. These communities would benefit from HPV vaccination and screening campaigns to prevent and control cervical cancer. Investments should be made to enhance population-based cancer surveillance and census data collection in Africa to offer new strategies and targets for cancer prevention and control.
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    Reversal Effects of N-Acetyl Cysteine on Moringa oleifera Leaves-Induced Sub-Acute Hepatotoxicity in Wistar Albino Rats
    (Neuroscience & Medicine, 2019) Kasolo, Josephine N.; Namaganda, Agnes; Bbosa, Godfrey S.; Muwonge, Haruna; Lukande, Robert; Nfambi, Joshua; Kimuli, Ivan; Okullo, Isaac
    M. oleifera is a highly valued medicinal plant used widely from time immemorial to treat various ailments. However, with continued un-standardized use of the plant leaves, studies have reported organ toxicity to the liver, kidney and the heart. As communities continue to use M. oleifera leaves for its medicinal and nutritional values, there is need to find an antidote for its hepatotoxicity. Aim: The study established the reversal effect of N-Acetyl Cysteine (NAC) on M. oleifera aqueous leaf extract-induced hepatotoxicity in Wistar albino rats. Methods: Twenty-four (24) rats received a toxic dose (8.05 g/kg bwt) of M. oleifera leaf extract for 28 days to cause sub-acute hepatotoxicity. They were divided into 4 groups of 6 rats each. Group I received 1 ml normal (control group), Group II received 1000 ng/kg NAC, Group III received 1200 mg/kg NAC and Group IV received 1500 mg/kg NAC. Another group of 6 rats (Group V) received 0.75 mg/kg Paracetamol to cause hepatotoxicity. Group V (a positive control) received the prescribed clinical dose of 1200 mg/kg NAC which reverses the hepatotoxicity. All the NAC doses were given once a day intragastric for 7 days. On days: 1, 3 and 7 of receiving NAC, liver serum enzymes and bilirubin were measured. On day 7 the animals were sacrificed and liver tissue harvested for histopathology analysis. Results: A dose of 8.05 g/kg of M. oleifera leaf extract and 0.75 mg/kg Paracetamol were able to induce hepatotoxicity in Wister albino rats in 28 days. The M. oleifera extract induced hepatotoxic rats treated with NAC at doses of 1000 mg/kg, 1200 mg/kg and 1500 mg/kg, had a reduction in mean serum liver enzymes, plus reduced mean serum bilirubin levels. The liver histopathological analysis showed reduced inflammation after treatment with NAC for 3 and 7 days in the M. oleifera and paracetamol induced hepatotoxic rats. Conclusion: NAC can reverse M. oleifera leaf aqueous extract-induced sub-acute hepatotoxicity in Wistar Albino rats.
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    Usability of a smartphone-compatible, confocal micro-endoscope for cervical cancer screening in resource-limited settings
    (BioMed Central, 2024-09-02) Kadama-Makanga, Philippa; Semeere, Aggrey; Laker-Oketta, Miriam; Mubiru, Musa; Lukande, Robert; Huchko, Megan; Freeman, Esther; Kulkarni, Nachiket; Martin, Jeffrey; Kang, Dongkyun; Nakalembe, Miriam
    More efficient methods to detect and treat precancerous lesions of the cervix at a single visit, such as low-cost confocal microscopy, could improve early diagnosis and hence outcomes. We piloted a prototype smartphone-compatible confocal micro-endoscope (SCME) among women presenting to a public cervical cancer screening clinic in Kampala, Uganda. We describe the piloting of the SCME device at an urban clinic used by lower cadre staff.BACKGROUNDMore efficient methods to detect and treat precancerous lesions of the cervix at a single visit, such as low-cost confocal microscopy, could improve early diagnosis and hence outcomes. We piloted a prototype smartphone-compatible confocal micro-endoscope (SCME) among women presenting to a public cervical cancer screening clinic in Kampala, Uganda. We describe the piloting of the SCME device at an urban clinic used by lower cadre staff.We screened women aged 18 and 60 years, who presented for cervical cancer screening at the Kawempe National Referral Hospital Kampala, and evaluated the experience of their providers (nurses). Nurses received a 2-day training by the study doctors on how to use the SCME, which was added to the standard Visual Inspection with Acetic acid (VIA)-based cervical cancer screening. The SCME was used to take colposcopy images before and after VIA at positions 12 and 6 O'clock if VIA negative, and on precancer-suspicious lesions if VIA positive. We used questionnaires to assess the women's experiences after screening, and the experience of the nurses who operated the SCME.METHODSWe screened women aged 18 and 60 years, who presented for cervical cancer screening at the Kawempe National Referral Hospital Kampala, and evaluated the experience of their providers (nurses). Nurses received a 2-day training by the study doctors on how to use the SCME, which was added to the standard Visual Inspection with Acetic acid (VIA)-based cervical cancer screening. The SCME was used to take colposcopy images before and after VIA at positions 12 and 6 O'clock if VIA negative, and on precancer-suspicious lesions if VIA positive. We used questionnaires to assess the women's experiences after screening, and the experience of the nurses who operated the SCME.Between November 2021 and July 2022, we screened 291 women with a median age of 36 years and 65.7% were HIV positive. Of the women screened, 146 were eligible for VIA, 123 were screened with the SCME, and we obtained confocal images from 103 women. Of those screened with the SCME, 60% found it comfortable and 81% were willing to screen again with it. Confocal images from 79% of the women showed distinguishable cellular features, while images from the remaining 21% were challenging to analyze. Nurses reported a mean score of 85% regarding the SCME's usefulness to their work, 71% regarding their satisfaction and willingness to use it again, 63% in terms of ease of use, and 57% concerning the ease of learning how to operate the SCME.RESULTSBetween November 2021 and July 2022, we screened 291 women with a median age of 36 years and 65.7% were HIV positive. Of the women screened, 146 were eligible for VIA, 123 were screened with the SCME, and we obtained confocal images from 103 women. Of those screened with the SCME, 60% found it comfortable and 81% were willing to screen again with it. Confocal images from 79% of the women showed distinguishable cellular features, while images from the remaining 21% were challenging to analyze. Nurses reported a mean score of 85% regarding the SCME's usefulness to their work, 71% regarding their satisfaction and willingness to use it again, 63% in terms of ease of use, and 57% concerning the ease of learning how to operate the SCME.Our findings demonstrate the feasibility of using the SCME by lower cadre staff in low-resource settings to aid diagnosis of precancerous lesions. However, more work is needed to make it easier for providers to learn how to operate the SCME and capture high-quality confocal images.CONCLUSIONOur findings demonstrate the feasibility of using the SCME by lower cadre staff in low-resource settings to aid diagnosis of precancerous lesions. However, more work is needed to make it easier for providers to learn how to operate the SCME and capture high-quality confocal images. MEDLINE - Academic