Browsing by Author "Opio, Christopher Kenneth"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    Biomass fuel as a risk factor for esophageal squamous cell carcinoma: a systematic review and meta-analysis
    (Environmental Health, 2019) Okello, Samson; Akello, Suzan Joan; Dwomoh, Emmanuel; Byaruhanga, Emmanuel; Opio, Christopher Kenneth; Zhang, Ruyang; Corey, Kathleen E.; Muyindike, Winnie R.; Ocama, Ponsiano; Christiani, David D.
    The link between use of solid biomass fuel (wood, charcoal, coal, dung, and crop residues) for cooking and/or heating and esophageal squamous cell carcinoma (ESCC) is inconclusive. Objective: We systematically reviewed the literature and performed a meta-analysis to determine whether cooking fuel type influences esophageal squamous cell carcinoma. Methods: We searched MEDLINE, EMBASE, Web of Knowledge and Cochrane Database of Systematic Reviews for studies investigating cooking fuel and ESCC from 2000 until March 2019. We performed random effects meta-analysis stratified by the continent, World Bank’s country income classifications and fuel type and calculated pooled odds ratios and 95% CIs for the risk of esophageal squamous cell carcinoma in biomass fuel users compared with non-users. Results: Our analysis included 16 studies (all case-control) with 16,189 participants (5233 cases and 10,956 controls) that compared risk of ESCC among those using nonsolid fuels and biomass fuels. We found use of biomass fuel was associated with Esophageal squamous cell carcinoma with a pooled odds ratio (OR) 3.02 (95% CI 2.22, 4.11, heterogeneity (I2) = 79%). In sub-group analyses by continent, Africa (OR 3.35, 95%CI 2.34, 4.80, I2 = 73.4%) and Asia (OR 3.08, 95%CI 1.27, 7.43, I2 = 81.7%) had the highest odds of ESCC. Use of wood as fuel had the highest odds of 3.90, 95% CI 2.25, 6.77, I2 = 63.5%). No significant publication bias was detected. Conclusions: Biomass fuel is associated with increased risk of Esophageal squamous cell carcinoma. Biomass fuel status should be considered in the risk assessment for Esophageal squamous cell carcinoma.
  • Thumbnail Image
    Item
    Elevated liver stiffness without histological evidence of liver fibrosis in rural Ugandans
    (J Viral Hepat, 2019) Tibuakuu, Martin; Jjingo, Caroline; Dale Kirk, Gregory; Thomas, David Lee; Gray, Ronald; Ssempijja, Victor; Nalugoda, Fred; Serwadda, David; Ocama, Ponsiano; Opio, Christopher Kenneth; Kleiner, David Erwin; Charles Quinn, Thomas; Reynolds, Steven James
    Liver fibrosis may be assessed noninvasively with transient electrography (TE). Data on the performance of TE for detecting liver fibrosis in sub-Saharan Africa are limited. We evaluated the diagnostic accuracy of TE by performing liver biopsies on persons with liver fibrosis indicated by TE. We enrolled HIV-infected and HIV-uninfected participants with TE scores consistent with at least minimal disease (liver stiffness measurement [LSM]≥7.1 kPa). Biopsies were performed and staged using the Ishak scoring system. A concordant result was defined using accepted thresholds for significant fibrosis by TE (LSM ≥ 9.3 kPa) and liver biopsy (Ishak score ≥ 2). We used modified Poisson regression methods to quantify the univariate and adjusted prevalence risk ratios (PRR) of the association between covariates and the concordance status of TE and liver biopsy in defining the presence of liver fibrosis. Of 131 participants with valid liver biopsy and TE data, only 5 participants (3.8%) had Ishak score ≥ 2 of whom 4 had LSM ≥ 9.3 kPa (sensitivity = 80%); of the 126 (96.2%) with Ishak score < 2, 76 had LSM < 9.3 kPa (specificity = 61%). In multivariable analysis, discordance was associated with female gender (adjPRR = 1.80, 95%CI 1.1-2.9; P = .019), herbal medicine use (adjPRR 1.64, 95% CI = 1.0-2.5; P = .022), exposure to lake or river water (adjPRR 2.05, 95% CI = 1.1-3.7; P = .016), and current smoking (adjPRR 1.72, 95%CI 1.0-2.9; P = .045). These data suggest that TE among rural Ugandans has low specificity for detection of histologically confirmed liver fibrosis. Caution should be exercised when using this tool to confirm significant liver fibrosis.
  • Thumbnail Image
    Item
    One-year Incidence and Standardized Mortality Rates for Esophageal Squamous Cell Carcinoma in Uganda
    (Research Square, 2021) Okello, Samson; Byaruhanga, Emmanuel B.; Lumori, Boniface Amanee Elias; Akello, Suzan Joan; Dwomoh, Emmanuel; Opio, Christopher Kenneth; Ocama, Ponsiano; Muyindike, Winnie R.; David, Christiani C.; Corey, Kathleen E.
    Little is known about the survival of patients with esophageal squamous cell cancer in resource limited settings. Objectives: We sought to determine the incidence of one-year all-cause mortality and age-standardized mortality rates for esophageal squamous cell carcinoma in Uganda. Methods: Prospective cohort of 92 participants with histologically confirmed esophageal squamous cell cancer at Mbarara Regional Referral Hospital, southwestern Uganda. Participants were enrolled between January 2018 and March 2020 and followed until death. We used Kaplan-Meier methods to determine allcause mortality and median survival time; Cox regression to determine predictors of survival; and determined age-standardized mortality rates (SMR) using the WHO standard population. Results: All 92 participants contributed a total 353.8 months at risk, 89 (96.7%) died representing an incidence rate of 251.5 (95% CI 204.3, 309.6) per 1000 person-months. The difference in the one-year risk of all-cause mortality among men and women was negative 6.4 percentage points. The overall SMR was 9.96 (95%CI 7.63, 12.29) per 100,000 and median survival time was 3.03 (95% CI 2.60, 3.47), shortest (1.77 months) among men younger than 45 and longest (7.77 months) among women aged 75 years or greater. In a fully adjusted model, high socioeconomic status predicted longer survival while increasing age and low socioeconomic status predicted shorter survival. Conclusion: After diagnosis, the one-year incidence rates of all-cause mortality and age-standardized mortality rates among ESCC patients in rural Uganda are high. Initiatives to improve access to oncology care for diagnosis and treatment should be prioritized to improve overall survival.
  • Thumbnail Image
    Item
    Praziquantel and Upper Gastrointestinal Bleeding in Hepatic Schistosomiasis: A Quasi‑Experimental Study
    (Drugs-real world outcomes, 2021) Opio, Christopher Kenneth; Kazibwe, Francis; Kabatereine, Narcis B.; Rejani, Lalitha; Ocama, Ponsiano
    There is a general consensus that widespread use of praziquantel in populations where schistosomiasis is endemic prevents development of hepatic schistosomiasis and its complications. However, a few studies have reported discordant findings linking praziquantel to the occurrence of upper gastrointestinal bleeding (UGIB) in some patients with hepatic schistosomiasis and varices. Objective We explored if there was any causal association between recent praziquantel use (rPZQ) and upper gastrointestinal bleeding in hepatic schistosomiasis in rural Africa. Patients and Methods A quasi-experimental, retrospective case-controlled study was performed. It involved adult patients with past or acute UGIB, varices, periportal fibrosis, and/or cirrhosis. Cases had acute variceal bleeding while controls did not. The outcome was the frequency of lifetime episodes of UGIB and exposure was rPZQ (received praziquantel in the last 11 months from the date of enrollment). The data analysis included 2 × 2 tables, logistic regression, and propensity-score matching. Odds ratios (ORs), average treatment effects (ATEs), and their 95% confidence intervals (CIs) were used for inference. Results Over 6 weeks, we enrolled 19 cases with 92 lifetime episodes of UGIB, and 66 controls with 192 lifetime episodes of UGIB. Cases were more likely to experience UGIB than controls following rPZQ (92% vs. 62%; OR 7.6; 95% CI 3.4–17). Factors predictive of more lifetime episodes of UGIB at multivariable analysis included rPZQ (adjusted OR 13; 95% CI 2.9–53), relative leukocytosis (adjusted OR 26; 95% CI 7.6–89), large varices (adjusted OR 5.0; 95% CI 1.7–15), a family member with hepatosplenic schistosomiasis (adjusted OR 19; 95% CI 7.4–51), advanced periportal fibrosis (adjusted OR 8.0; 95% CI 2.6–22), ascites (adjusted OR 14; 95% CI 4.3–47), and jaundice (adjusted OR 32; 95% CI 7.8–128). While the ATE following rPZQ among the treated was 0.40 (95% CI 0.33–0.48). Conclusions Our findings suggest the presence of a plausible causal association between recent praziquantel use and increased frequency of UGIB in our study population.
  • Thumbnail Image
    Item
    Profiling lifetime episodes of upper gastrointestinal bleeding among patients from rural Sub-Saharan Africa where schistosoma mansoni is endemic
    (The Pan African Medical Journal, 2016) Opio, Christopher Kenneth; Kazibwe, Francis; Ocama, Ponsiano; Rejani, Lalitha; Nikolaevna Belousova, Elena; Ajal, Paul
    Severe chronic hepatic schistosomiasis is a common cause of episodes upper gastrointestinal bleeding (UGIB) in sub-Saharan Africa (SSA). However, there is paucity of data on clinical epidemiology of episodes of UGIB from rural Africa despite on going public health interventions to control and eliminate schistosomiasis. Methods: Through a cross sectional study we profiled lifetime episodes of upper gastrointestinal bleeding and associated factors at a rural primary health facility in sub-Saharan Africa were schistosomiasis is endemic. The main outcome was number of lifetime episodes of UGIB analyzed as count data. Results: From 107 enrolled participants, 323 lifetime episodes of UGIB were reported. Fifty-seven percent experienced ≥ 2 lifetime episodes of UGIB. Ninety-four percent had severe chronic hepatic schistosomiasis and 80% esophageal varices. Alcohol use and viral hepatitis was infrequent. Eighty-eight percent were previously treated with praziquantel and 70% had a history of blood transfusion. No patient had ever had an endoscopy or treatment for prevention of recurrent variceal bleeding. Multivariable analysis identified a cluster of eight clinical factor variables (age ≥ 40, female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated (P-value < 0.05) with increased probability of experiencing two or more lifetime episodes of UGIB in our study. Conclusion: Upper gastrointestinal bleeding is a common health problem in this part of rural SSA where schistosomiasis is endemic. The clinical profile described is unique and is important for improved case management, and for future research.
  • Thumbnail Image
    Item
    Schistosomiasis, Upper Gastrointestinal Bleeding, and Health Related Quality of Life Measurements in Rural Africa
    (Research Square, 2020) Opio, Christopher Kenneth; Kazibwe, Francis; Rejani, Lalitha; Kabatereine, Narcis B.; Ocama, Ponsiano
    Health related quality of life (HRQOL) measurements, which include disability weights, are important endpoints of health care delivery. These measurements are scarce for patients with upper gastrointestinal bleeding (UGIB) in rural sub-Saharan Africa (SSA) where schistosomiasis is endemic. Methods and materials In 2014, we studied HRQOL measurements among patients with UGIB in SSA where schistosomiasis is endemic. Participants included adult inpatients and outpatients with a history of UGIB at a primary health facility. We measured HRQOL using the EuroQoL 5-dimension (EQ-VAS/EQ5D) instrument and derived disability weights from EQ-VAS and EQ5D measurements. We profiled each participant’s medical history, physical examination, laboratory tests, imaging, and endoscopy findings. These were summarized through descriptive and inferential statistics. Results We studied 107 participants with a median age of 45 years. All participants experienced ≥1 lifetime episode of UGIB, 60% were females, while 22% had acute severe UGIB requiring admission, 98% hepatic schistosomiasis, 90% splenomegaly, 80% had esophageal varices, and 20% had peptic ulcers. Most (80%) had ever received praziquantel for schistosomiasis. No participant had ever had an endoscopy for UGIB or received propranolol for prevention of recurrent variceal UGIB. Measures of the 5 dimensions of health revealed a large proportion of participants had problems related to self-care (76%), anxiety/depression (88%), and pain/discomfort (89%). Few participants had problems with mobility(37%). The mean/median EQ-VAS derived disability weights and EQ5D derived disability weights were 0.38/0.30 and 0.38/0.34, respectively. Participants with ascites, acute UGIB, and severe anemia were found to have the highest EQ-VAS and EQ5D median disability weights. At linear regression age, female gender, ascites, and acute UGIB predicted EQ-VAS derived disability weights [F(4,100)=9.35, p<0.0000,Rsquared =0.27] and EQ5D derived disability weights [F(4,100)=23.24, p<0.0000, R-squared =0.44]. Within these models, all four factors were significantly predicted higher disability weights, P-value <0.05. Conclusions In our study, older age, female gender, those with ascites or acute UGIB had the highest disability weights, and the greatest probability of having higher disability weights among patients with a history of UGIB where schistosomiasis is endemic. These findings are unique and improve the definitions of different health states among patients with UGIB and schistosomiasis.