Browsing by Author "Natukunda, Bernard"

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    Assessment Of The Diagnostic Performance Of Truehb Point-Of-Care Hemometer Compared With Sysmex I3 Analyzer Among Patients At International Hospital Kampala, Uganda
    (Journal of blood medicine, 2019) Taremwa, Ivan Mugisha; Ndeze, Ivan; Mwambi, Bashir; Atuhairwe, Christine; Achieng, Diana Inda; Natukunda, Bernard
    To assess the diagnostic performance of TrueHb® point-of-care (POC) hemometer compared with Sysmex i3 analyzer at International Hospital Kampala, Uganda.We analyzed ethylenediaminetetraacetic acid blood samples to estimate hemoglobin (Hb) levels using parallel testing with TrueHb® hemometer and Sysmex i3 analyzer. Data were analyzed to ascertain the diagnostic performance of the test assays using the Bland and Altman method. Sensitivity, specificity, positive and negative predictive values were calculated.The study enrolled 402 patients; of these, 156 (38.8%) were males. The average Hb levels were 8.7±1.8 and 13.3±2.6 g/dL for the anemic and nonanemic patients, respectively. One hundred and fifty-five participants were anemic, giving anemia prevalence of 38.56% (95% CI: 35.17–40.38). The mean difference of the TrueHb® and Sysmex i3 assays was 2.2219 (SD 1.07915), and the two devices did not show a difference in their measurements (t=−2.407, p-value 0.017, 95% CI: −0.095–0.010). Further, they showed a significant level of agreement (t=41.281; 95% CI: 2.1161–2.3277) and intraclass correlation coefficients (ICC=0.793). The sensitivity, specificity, positive and negative predictive values were 100.00%, 51.01%, 55.16% and 100.00%, respectively. The average performance turnaround time (TAT) for the TrueHb® hemometer was 2.46 mins (95% CI: 2.37–2.55). TrueHb® POC hemometer is an accurate POC for Hb estimation with a good performance agreement with the Sysmex i3 analyzer. This, coupled with its utility aspects, makes it a good diagnostic tool in a high anemia burden and low-resource setting.
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    Incidence of the Metabolic Syndrome among Patients with Epilepsy Attending a Neuropsychiatric Hospital in Kigali, Rwanda
    (International Journal of Current Science Research and Review, 2021) Ndayambaje, François Xavier; Gahutu, Jean Bosco; Rugera, Simon Peter; Natukunda, Bernard
    Metabolic syndrome (MetS), a combination of diverse metabolic disorders (hypertension, diabetes mellitus, high triglycerides, increased waist circumference, and low high density cholesterol, HDLc), is a well known public health problem worldwide, and its prevalence is increasing dramatically. MetS is a confirmed great risk factor for cardiovascular diseases. Presently, limited information exists about incidence and the risk factors associated with metabolic syndrome (MetS) in patients with epilepsy. We prospectively estimated the incidence of MetS in patients with epilepsy.We recruited 322 participants, 161 patients with epilepsy and 161 healthy volunteers all of them free of any MetS criteria at the baseline and followed-up them for one year. New onset cases of MetS were defined according to the updated National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) criteria. Over a 1-year follow-up, we observed 8 incident cases of MetS (7 individuals in patients group and 1 individual in control group) resulting in an annual cumulative incidence rate of 2.5%. We observed 9 cases losses to follow up. Patients with epilepsy presented a higher risk of developing MetS (RR=7.00, 95% CI: 0.891 - 1.67, p=0.032) than in control group. Sedentariness was associated with higher risk for MetS (hazard ratio, HR=6.537, 95%; confidence interval, C.I=1.269-33.685, p value =0.025. Anti-epileptic therapy combined with sedentariness increases the risk of developing MetS among patients with epilepsy. Holistic clinical management of patients with epilepsy will significantly contribute to MetS prevention.
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    Occurrence Of Anti-D Alloantibodies Among Pregnant Women In Kasese District, Western Uganda
    (Journal of blood medicine, 2015) Mbalibulha, Yona; Muwanguzi, Enoch; Mugyenyi, Godfrey R.; Natukunda, Bernard
    This study was undertaken to determine the distribution of ABO/RhD (rhesus D antigen) blood phenotypes, prevalence of anti-D alloantibodies, and the risk factors for alloimmunization among pregnant women in Kasese District, Western Uganda. Ethylenediamine tetraacetic acid-containing plasma samples and serum samples were taken from pregnant women attending the antenatal clinic. The blood groups were identified using the microplate grouping method, while the presence of anti-D alloantibodies was detected by the indirect antiglobulin test (IAT). Data were also collected from the pregnant women on the risk factors associated with anti-D alloantibody formation.Among the 726 participants, the blood group distribution was as follows: O: 356 (49.%); A: 190 (26.%); B: 152 (21%); and AB: 28 (4%). A total of 28 (3.86%) pregnant women were RhD negative. Anti-D alloantibodies were detected in 88 (12.1%) of the participants; and of these, 13 (14.8%) were RhD negative. Statistically significant risk factors for anti-D alloimmunization included miscarriage, stillbirth, and postpartum hemorrhage.Blood group O was the most common among the pregnant women in this study and the prevalence of Rh negativity was 3.8%. The frequency of anti-D alloimmunization among pregnant women in Kasese District was 12.12%, with 85.5% of these being RhD positive. Risk factors such as a history of stillbirths, miscarriages, and incidence of postpartum hemorrhage were significantly associated with anti-D alloimmunization. There is a need to routinely carry out antenatal blood grouping and IAT screening on pregnant women in Uganda to detect anti-D alloimmunization. Given the high prevalence of anti-D alloantibody formation among RhD-positive women, we recommend additional research studies on the role of autoimmunity among antigen-positive women, as well as the occurrence of RhD variants plus their implications on hemolytic disease of the fetus and newborn, in Uganda.
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    Prevalence of HI V-related thrombocytopenia among clients at Mbarara Regional Referral Hospital, Mbarara, southwestern Uganda
    (Journal of blood medicine, 2015) Taremwa, Ivan M.; Muyindike, Winnie R.; Muwanguzi, Enoch; Boum, Yap; Natukunda, Bernard
    We aimed to determine the prevalence and correlates of thrombocytopenia among people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and to assess occurrence of antiplatelet antibodies, among thrombocytopenic HIV clients at Mbarara Regional Referral Hospital, southwestern Uganda.This was a retrospective review of hematologic results at enrollment to HIV care from 2005 to 2013.. The prevalence and correlates of thrombocytopenia were estimated based on the Immune Suppressed Syndrome (ISS) Clinic electronic database. A cross-sectional study determined the occurrence of antiplatelet antibodies, using the monoclonal antibody-specific immobilization of platelet antigens (MAIPA) technique.We reviewed 15,030 client records. The median age was 35.0 (range 18–78; interquartile range [IQR] 28–42) years, and there were 63.2% (n=9,500) females. The overall prevalence of thrombocytopenia was 17.4% (95% confidence interval [CI]: 16.8%–18.0%). The prevalence of thrombocytopenia was 17.8% (95% CI: 17.1%–18.4%) among antiretroviral therapy (ART)-naïve clients (n=2,675) and was 13.0% (95% CI: 0.3%–21.9%) for clients who were on ART (n=6). The study found a significant association between thrombocytopenia and other cytopenias, CD4 counts, ART, and deteriorating HIV stage (P,0.05). Two of the 40 participants (5.0%) had antiplatelet antibodies.This study has showed a high prevalence of HIV-related thrombocytopenia. Antiplatelet antibodies were found in 5.0% of HIV-infected thrombocytopenic participants. Our study shows a significant association of thrombocytopenia burden in a high-HIV study population (Southwest Uganda); therefore, there is need to monitor platelet counts and initiate platelet transfusion in our blood banking practices, to avert possible risks of bleeding.
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    Red Blood Cell Alloimmunization In Sickle Cell Disease Patients In Uganda
    (Transfusion, 2010) Natukunda, Bernard; Schonewille, Henk; Ndugwa, Christopher; Brand, Anneke
    Blood transfusion is an integral part in the management of sickle cell disease (SCD) patients. Alloimmunization is a recognized complication of red blood cell (RBC) transfusions with consequences including delayed hemolytic transfusion reactions and difficulties in getting compatible blood for future transfusions. The objective of this study was to determine the frequency of RBC alloimmunization in SCD patients in Uganda where pretransfusion screening for alloantibodies is not practiced.In a cross-sectional study, SCD patients at Mulago Hospital Sickle Cell Clinic, Kampala, Uganda, were investigated. The demographic characteristics and transfusion history were recorded. Blood samples were drawn from consenting, previously transfused patients and RBC alloimmunization was demonstrated using immunohematologic techniques.There were 428 patients (median age, 12 years; female/male ratio, 1.0) and they had received a median of 3 units in a median of three transfusion episodes. Twenty-six patients (6.1%) possessed RBC alloantibodies and 21 (80.7%) of them had received up to 10 transfusions. A total of 30 alloantibodies was found; 20 (66.7%) and 5 (16.6%) belonged to Rh and MNS blood groups, respectively. Five of the alloimmunized patients had multiple antibodies.The rate of RBC alloimmunization in Ugandan SCD patients was 6.1%. The homogeneity between donors and SCD patients plus the low transfusion load may explain this immunization frequency. Nevertheless, our study confirms the significance of RBC alloimmunization as a complication in Ugandan SCD patients. Therefore, there is need to improve immunohematologic testing in Uganda so that RBC alloimmunization and its consequences may be prevented.
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    The Role Of Improved Pre-Transfusion Testing In The Prevention Of Delayed Serologic Transfusion Reactions Among Blood Recipients In Uganda: A Randomized Controlled Trial (IPAT Study)
    (ISBT Science Series, 2019) Natukunda, Bernard; Ndeezi, Grace; Er, Lay See; Bajunirwe, Francis; Teramura, Gayle; Delaney, Meghan
    The goal of pre-transfusion testing (PTT) is to provide patients with beneficial and safe transfusions. In Uganda, PTT includes ABO/RhD typing plus room temperature (RT) saline cross-matches without red-blood-cell (RBC) alloantibody screening. The aim of the IPAT study was to assess the role of improved PTT in the prevention of delayed serologic transfusion reactions (DSTRs).In this randomized controlled trial, patients at Mbarara Hospital in Uganda, with a history of RBC exposure, were randomized 1:1 to have either RBC alloantibody screening (SCREEN group) or room temperature saline cross-matches (CONTROL group) during PTT. ‘Home-made’ reagent RBCs from group O RhD-positive volunteers were used for antibody screening in the indirect antiglobulin test. Participants were evaluated for RBC alloantibody production 7–14 days after transfusion. Post-transfusion haemoglobin estimation and direct antiglobulin tests (DATs) were also performed.We randomized 220 patients to either the SCREEN or CONTROL group. Both study arms had similar demographic and transfusion characteristics at baseline. There were 19 (17·3%) individuals in the CONTROL group with DSTRs compared to 8 (7·3%) in the SCREEN group at the time of follow-up (P = 0·02). Overall, post-transfusion DATs were positive in 7 (3·5%) patients but there was no associated decrease in haemoglobin levels.Red-blood-cell alloantibody screening is associated with occurrence of significantly fewer DSTRs. The use of ‘home-made’ reagent cells during PTT in Uganda is feasible. We recommend a change in the local PTT policy to consider the introduction of RBC alloantibody screening.