School of Bio-Medical Sciences (Bio-Medical)

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    Community-acquired pneumonia in Ugandan adults: short-term parenteral ampicillin therapy for bacterial pneumonia
    (The American Society of Tropical Medicine and Hygiene, 2001) Yoshimine, Hiroyuki ; Oishi, Kazunori ; Mubiru, Francis ; Takahashi, Hidehiko ; Amano, Hideaki ; Ombasi, Philip ; Watanabe, Kiwao ; Joloba, Moses ; Aisu, Thomas ; Ahmed, Kamruddin ; Shimada, Masaaki ; Mugerwa, Roy ; Nagatake, Tsuyoshi
    A hospital-based prospective study of 99 patients with community-acquired pneumonia (CAP) was carried out in Kampala, Uganda. We evaluated microbiological etiologies, clinical features and effectiveness of short term parenteral ampicillin followed by oral amoxicillin for these patients in relation to HIV-status. We demonstrated a very high prevalence (75%) of HIV-1 infection. No significant difference was observed with respect to age, gender, prior antibiotic usage, symptoms, laboratory data or bacterial etiology between HIV-1-infected and HIV-uninfected CAP patients. Most strains of Streptococcus pneumoniae (n = 19) and Haemophilus influenzae (n = 8) isolated from HIV-1-infected patients were penicillin-resistant (95%) and β-lactamase producing (75%) strains, respectively. A high percentage of good clinical response was found in both HIV-1-infected (81%) and HIV-uninfected (86%) among 39 patients with CAP due to a defined bacterial pathogen. These data support the use of short-term parenteral ampicillin for patients with bacterial CAP irrespective of HIV-status.
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    Augmentation of Apoptosis and Interferon-g Production at sites of active Mycobacterium Tuberculosis infection in Human Tuberculosis
    (University of Chicago Press, 2001-02-08) Hirsch, C. S. ; Toossi, Z. ; Johnson, J. L. ; Luzze, H. ; Ntambi, L. ; Peters, P. ; McHugh, M. ; Okwera, A. ; Joloba, M. ; Mugyenyi, P. ; Mugerwa, R. D. ; Terebuh, P. ; Ellner, J. J.
    Pleural tuberculosis (TB) was employed as a model to study T cell apoptosis at sites of active Mycobacterium tuberculosis (MTB) infection in human immunodeficiency virus (HIV)–coinfected (HIV/TB) patients and patients infected with TB alone. Apoptosis in blood and in pleural fluid mononuclear cells and cytokine immunoreactivities in plasma and in pleural fluid were evaluated. T cells were expanded at the site of MTB infection, irrespective of HIV status. Apoptosis of CD4 and non-CD4 T cells in the pleural space occurred in both HIV/TB and TB. Interferon (IFN)–g levels were increased in pleural fluid, compared with plasma. Spontaneous apoptosis correlated with specific loss of MTB-reactive, IFN-g–producing pleural T cells. Immunoreactivities of molecules potentially involved in apoptosis, such as tumor necrosis factor–a, Fas-ligand, and Fas, were increased in pleural fluid, compared with plasma. These data suggest that continued exposure of immunoreactive cells to MTB at sites of infection may initiate a vicious cycle in which immune activation and loss of antigenresponsive T cells occur concomitantly, thus favoring persistence of MTB infection.
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    Household use of sulfadoxine pyrimethamine and factors associated with its utilsation in the treatment of childhood malaria in rural Malawi.
    ( 2002-05) Namagetsi, Doreen Ali
    BACKGROUND: Malaria is a leading cause of morbidity and mortality of children in Malawi. Limited information is available on now SP is used at household level. OBJECTIVES: To assess household use of SP and identify factors associated with its utilization in the treatment of childhood malaria in rural Malawi. PARTICIPANTS: Children under five years old who had a possible attack of malaria 2 weeks preceding the interview and consenting caretakers whose children were selected for the study. METHODOLOGY: The study was done in selected communities of kasungu district in Malawi between January to April 2002. A cross-sectional household cluster survey design was used. The study used both quantitative and qualitative methods. FINDINGS: A Total of 550 caretakers whose children had a possible malaria attack two weeks preceding the study were assessed. Of these, 68.9% gave their children medication at home at onset of fibril illness. Out of the children that were treated at home, 9.8% were reported to have received SP within 24 hours of onset fever. Among the children that received SP, 90% percent of the children of age 6 months to 36 months and 69.2% of children of age above 36 months received appropriate dosages. However, the dose was inappropriate for the one child of less than 6 months old. The main factors associated with SP use were knowledge of caretakers (OR: 6.2, CI: 1.66-23.60); availability of SP in the household (OR: 0.17, CI: 0.05-0.90) and caretaker perception of SP side effects (OR: 31.00, CI: 1.08-884.10). CONCLUSIONS: The prevalence of children less than five years old that received SP promptly is extremely low. About 1 in 10 children received SP treatment within 24 hours of onset illness. However, among the children who received SP, the majority received appropriate dosages. About 9 in 10 of children aged 6 to 36 months and about 2 out of 3 children aged over 36 months received appropriate dosages of SP. The use of SP in the treatment of children is influenced by the availability of SP as well as the knowledge and perceptions of the caretaker regarding SP.
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    The Prevalence and Factors Associated with Non-Adherence to Antiretroviral Therapy among HIV+ People in Kampala.
    ( 2002-05) Byakika-Tusiime, Jayne
    INTRODUCTION: About 40 million people around the world are living with HIV/AIDS with about 72% of these living in sub-Saharan Africa. The introduction of combination antiretroviral therapy (ART) for HIV infection revolutionized treatment of AIDS and HIV disease. It has been recognized that strict adherence to the combination, multidrug regimens is essential to obtain the full benefits of therapy, maintain suppression of viral replication and minimize the development of resistance. However, there are difficulties in establishing and sustaining exceptionally high adherence levels to these therapies over time. STUDY OBJECTIVES: To assess the prevalence of non-adherence to ART in HIV-infected patients in Kampala and beyond and to identify the associated factors in order to make recommendations to health care providers that will improve adherence to combination therapy. STUDY DESIGN: Cross-sectional study employing both quantitative and qualitative data collection methods. SETTING: The study was conducted at JCRJ, Nsambya hospital and mild-May international. These are specialized HIV/AIDS treatment centers. METHODOLOGY: A Total of 304 HIV infected persons on ART were enrolled into the study. The level of non-adherence was assessed by self-report using a semi-structured questionnaire. Two benchmarks were used to measure non-adherence: 5% and 20%. RESULTS: The prevalence of non-adherence the previous day, two, three, four and seven days before the interview was 29.4%, 31.6%, 32.4%, 32.7% and 37.3% (N=302) respectively at the 5% benchmark and 29.4%, 30.4%, 30.4%, 28.6% and 25.9% (N=304) respectively at the 20% benchmark. Factors associated with non-adherence at the 5% benchmark were forgetfulness (OR=5.86, 2.02-17.04), Monthly income 50,000 Ushs- 100,000 Ushs (OR=2.61, 1.31-5.22), 100,000 Ushs-500,000 Ushs (OR=3.20, 1.07-9.57) and self-efficacy belief (i.e confidence about one’s ability to maintain a behavior) (OR=0.41, 0.19-0.90). Factors associated with non adherence at the 20% benchmark were forgetfulness (OR=5.64, 1.45-21.96); Monthly income 50,000 Ushs 100,000 Ushs (OR=3.02, 1.42-6.04), Shortage of drugs due to lack of money (OR=0.4, 0.18-0.93) and inaccessibility of drugs (OR=7.56, 1.52-37.58). CONCLUSION: The prevalence of non-adherence in this population is 29.4% per day. About 1 in 3 people on ART are non-adherent in this population. The level of non-adherence in this population is worrisome given the fear of development of resistance so interventions should be made to minimize this level. Given the low earning power of most of the people, more affordable or free drugs should be provided for people who need ARVs.
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    Prevalence and household factors associated with use of insectcide treated nets in Luweero district.
    ( 2002-05) Bukirwa, Hasifa
    BACKGROUND: Insecticide Treated Nets (ITNs) are widely recommended as a personal protective measure and have been promoted in uganda since the early 1990s. There is however limited understanding among the healthcare providers and health product market promoters of the factors at household level affecting utilisation especially in a population that has no culture of bed net use. This study highlights some of the issues at stake forthe potential ITN users. OBJECTIVE: This study aimed at determining the prevalence of ITN utilisation and the factors influencing use or non-use at the household level. METHODS: This was a cross-sectional study employing quantitative and qualitative investigative methods, which was carried out in a rural population of Butuntumula sub-couty in Luweero district. Field activities were undertaken during the months of january to march 2002. Five hundered eighty two households randomly selected from 49 villages were studied by use of personla questionnaires, focus group discussions, key informant interviews and observations. RESULTS: The major aim of analysis was to describe characteristics of ITN users and non users and to determine any differences in important characteristics between the two groups. Prevalence of ITN use is 8% with significant variations between parishes. Poor availability and accessibility, Lack of information and economic constraints were major issues raised in the study. Knowledge, perception, Level of income and education had a significant influence on ITN use. CONCLUSIONS: Prevalence of ITN use is disapointingly low though better than what is reported in neighbouring kenya and Tanzania. Measures for increased utilisation should be undertaken through intenified health education about ITNs using existing information outlets such as the Tele-centres of which Luwero is s beneficiary. The current cost of ITNs is deterrent to their increased utilisation. RECOMMENDATIONS: Additional avenues for information dissemination should be considered to augment existing ones in order to encourage greater ITN use. Public-provate partnerships should be encouraged to increase ITN availability and accessibility. Subsidies on ITNs should be considered. Other vector control measures like insecticide treated curtains and residual indoor aprating should be looked at and if possible promoted alongside ITNs.
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    Campylobacter spp among Children with acute diarrhea attending Mulago hospital in Kampala - Uganda
    ( 2002-05) Namale, Ssebuliba Leticia
    Introduction HIV positive (HIV+) women are more susceptible to malaria infection during pregnancy than their HIV negative (HIV-) counterparts but the actual prevalence of infection in Ugandan pregnant women is not known. HIV infection limits the pregnant woman's capacity to control P. falciparum parasitaemia with resultant placental malaria. This is the major determinant of its impact on foetal growth and survival. Although prenatal SP prophylaxis seems to be protective to pregnant women in general, there is growing concern that the recommended two doses prenatally may be inadequate in HIV+ mothers. Worse still, the actual dose they should receive is not known. In this study the prevalence of P. falcipavum placental malaria and its association with prenatal SP prophylaxis among HIV+ mothers was determined. Significance of the study The study gave an insight into the situation of malaria among the HIV+ pregnant women. The protection of the standard two-dose prenatal SP was not well established due to the inadequate sample size and therefore a large p-error although these preliminary results seem to suggest that two-dose SP may not be sufficient for the HIV+ mothers. Objectives The aim of the study was to determine the prevalence of P falciparum placental malaria among HIV+ mothers and its association with prenatal SP prophylaxis. Methodology This was a hospital based cross-sectional study of HIV+ pregnant women. The participants in this study were recruited at delivery from an ongoing Nevirapine cohort study in Mulago Hospital where their HIV status had been determined. The history of prenatal SP prophylaxis was determined by self-report. A specimen of placental blood was collected and examined for malaria parasites using Fields stain. The prevalence of placental malaria was determined. Inferences about the protection offered to HIV+ mothers by the standard two-dose prenatal SP prophylaxis were made according to its association with placental malaria. Study instruments Quantitative data was collected using a structured questionnaire. Qualitative data on the practice of SP chemoprophylaxis was collected using key informant interviews of doctors who ran the antenatal clinics. Data management and analysis. The prevalence of placental malaria among the HIV+ mothers was determined. The analysis also included the calculation of the odds ratio (OR), chi-square values (x2) and their p-values and confidence intervals (CI). Adjusted ORs were calculated to control for potential confounders. Logistic regression was done to determine the association between the outcome and the variables of interest. Qualitative data was transcribed and analyzed manually. Results The prevalence of placental malaria was 9.4% The prevalence of placental malaria among the SP users was 9.5% and among the non-users, 9.2%. The difference between the groups was not significant. The association between prenatal SP prophylaxis and placental malaria was not significant. Conclusion The prevalence of placental malaria among HIV+ mothers in .Mulago Hospital is high. Placental malaria among HIV+ mothers is not parity specific. These preliminary results suggest that two-dose SP prophylaxis may be inadequate for HIV+ mothers but are not conclusive due to the large type II error resulting from a small sample size.
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    Factors associated with health seeking behaviour of pulmonary tuberculosis patients at Mulago National Referral Tuberculosis Treatment Centre.
    ( 2002-06) Mpungu, Stephen Kiwuwa
    SETTING: The study was carried out at Mulago National Referral Tuberculosis Treatment Centre, Kampala, Uganda, East Africa. OBJECTIVE: The study aimed at assessing factors associated with the health-seeking behavior of smear positive pulmonary tuberculosis patients so as to make possible recommendations for the improvement of early diagnosis and treatment of tuberculosis. METHODOLOGY: The study was cross-sectional involving 231 consecutively sampled newly diagnosed pulmonary tuberculosis patients, interviewed using a pretested semi structured questionnaire. Time delays between onset of symptoms, first medical consultation and initiation of TB treatment were determined. Personal characteristics, clinical features and health system factors were evaluated for their effect on these intervals. Complimentary information was obtained from focus group discussions as well as in-depth interviews from six patients. RESULTS: The medians of total delay, patient delay and health provider delays were 12 weeks, 1 week and 9 weeks respectively. Patients most often presented to drug shops or pharmacies (39.4%) and private clinics (36.8%) than government health units (10%) as point of first contact. Median health provider delay was shortest for those who first presented to government hospitals compared to those presenting to private clinics was a significantly smaller proportion of total delay attributable to the health provider (43% vs 79% odds ratio= 0.20, 95%CI, 0.15-0.20). Sputum microscopy was underutilized by private clinics compared to government hospitals. Patients were found to have inadequate knowledge about TB. Perceptions that TB is caused by alcohol intake, smoking and that TB is dangerous, increasing AFB smear grades, having not schooled beyond primary, residing alone and having multiple health seeking encounters were associated with increased delay to treatment. Knowing that TB is spread through air, caused by germs and residing within 25 kilometers from mulago hospital, were associated with a shorter delay to treatment. CONCLUSIONS: Delay in diagnosis of pulmonary TB is prolonged in patients presenting at Mulago hospital with a significant proportion of health provider delay. Education of the general public about the symptoms of TB, the importance of early medical consultation and the inclusion of health education on communicable diseases in UPE curriculums will shorten patient delay. Decentralization of diagnosis and management of TB including training and support supervision of health personnel in peripheral health units will improve access to health care and shorten delay to initiation of TB treatment. Continuing medical education about TB management for all stakeholders in the private and government health sectors will shorten health provider’s delay and thereby improve tuberculosis control. Keywords: Pulmonary tuberculosis, diagnosis, delay, health seeking behavior, treatment.
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    Activation of the gab Operon in an RpoS-Dependent Manner by Mutations That Truncate the Inner Core of Lipopolysaccharide in Escherichia coli
    (American Society for Microbiology, 2004-12) Joloba, Moses L. ; Clemmer, Katy M. ; Sledjeski, Darren D. ; Rather, Philip N.
    The gab operon (gabDTPC) in Escherichia coli functions in the conversion of -aminobutyrate to succinate. One component of gab operon regulation involves the RpoS sigma factor, which mediates activation at high cell density. Transposon mutagenesis was used to identify new genes that regulate gab operon expression in rich media. A Tn5tmp insertion in the hldD (formerly rfaD) gene increased gabT::lacZ expression 12-fold. The hldD gene product, an ADP-L-glycerol-D-mannoheptose-6-epimerase, catalyzes the conversion of ADP-D-glycerol-D-mannoheptose to ADP-L-glycerol-D-mannoheptose, a precursor for the synthesis of inner-core lipopolysaccharide (LPS). Defined mutations in hldE, required for heptose synthesis, and waaF, required for the addition of the second heptose to the inner core, also resulted in high-level gabT::lacZ expression. The hldD, hldE, and waaF mutants exhibited a mucoid colony phenotype due to production of a colanic acid capsule. However, in the hldD::cat background, the high-level expression of gabT::lacZ was independent of the regulatory components for colanic acid synthesis (rcsA, rcsB, and rcsC) and also independent of manC (cpsB), a structural gene for colanic acid synthesis. Activation of gabT::lacZ in the hldD::cat background was dependent on the RpoS sigma factor. The hldD::cat mutation resulted in a sixfold increase in the levels of a translational RpoS-LacZ fusion and had a marginal effect on a transcriptional fusion. This study reveals a stress-induced pathway, mediated by loss of the LPS inner core, that increases RpoS translation and gab operon expression in E. coli.
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    The contribution of research in advancing health care in Uganda
    ( 2005-11) Faculty of Medicine, Makerere University ; Sewankambo, Nelson K. ; Tumwine, James K.
    This is a book of abstracts of the first annual scientific conference organised by the Faculty of Medicine, Makerere University on "the contribution of research in advancing health care in Uganda" at Imperial Beach Resort Hotel, Entebbe 24-26 November 2005.
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    Acceptance of routine testing for HIV among adult patients at the medical emergency unit at a national referral hospital in Kampala, Uganda
    ( 2006) Nakanjako, Damalie ; Kamya, Moses ; Kyabayinze, Daniel ; Mayanja-Kizza, Harriet ; Freers, Jurgen ; Whalen, Christopher ; Katabira, Elly
    HIV testing is an entry point to comprehensive HIV/AIDS prevention and care. In Uganda, Routine Testing and Counseling for HIV (RTC) is not widely offered as part of standard medical care in acute care settings. This study determined the acceptance of RTC in a medical emergency setting at Mulago national referral hospital. We interviewed 233 adult patients who were offered HIV testing. Overall, 83% were unaware of their HIV serostatus and 88% of these had been to a health unit in the previous six months. Of the 208 eligible for HIV testing, 95% accepted to test. Half the patients were HIV infected and 77% of these were diagnosed during the study. HIV testing was highly acceptable and detected a significant number of undiagnosed HIV infections. We recommend adoption of RTC as standard of care in the medical emergency unit in order to scale HIV diagnosis and linkage to HIV/AIDS care.
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    Aetiology, risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in Mulago hospital, Uganda
    ( 2006-06) Mugalu, J. ; Nakakeeto, M. K. ; Kiguli, S. ; Kaddu-Mulindwa, Deo H.
    Background: Neonatal septicaemia remains a major cause of morbidity and mortality. The aetiology, risk factors and outcome of this problem need to understood. Objective: To determine the aetiology, risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in Mulago hospital. Methods: Blood cultures were aseptically obtained from neonates presenting with clinical sepsis by WHO criteria to Mulago during a five month period between July and November 2002. Blood was placed in Brain Heart Infusion media and incubated within 30 minutes. Subcultures were plated daily up to 7 days on blood, chocolate and MacConkey agar and incubated in aerobic and 5% carbon dioxide conditions. Pure colonies were identified by Gram stain and biochemical tests and antibiotic sensitivities were obtained. Results: Gram positive organisms were predominant (69.2%) followed by E. coli (17%) and Group B Streptococci (GBS) (7%). Staphylococcus aureus and E. coli dominated isolates in early and late onset sepsis. S. aureus was more sensitive to gentamicin than to cloxacillin. The sensitivity of E. coli to ceftriaxone was 94.1%. Factors significantly associated with neonatal septicaemia were male sex, history of convulsions, hypoglycaemia, lack of antenatal care, late onset sepsis and umbilical pus discharge. Mortality in sepsis cases was 18.1%, and 84% of deaths occurred in the first 2 days of admission. Hypoglycaemia was significantly associated with death (p < 0.01). Conclusion: S. aureus predominates the aetiology of neonatal septicaemia followed by E.coli. Most deaths occur in the first 48 hours of admission and hypoglycaemia is significantly associated with death.
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    Coping with health challenges in the 21st Century
    ( 2006-09) Faculty of Medicine, Makerere University ; Institute of Public Health, Makerere University ; Sewankambo, Nelson K. ; Serwadda, David
    This is a book of abstracts of the second annual scientific conference organised by the Faculty of Medicine and the Institute of Public Health, Makerere University on "coping with health challenges in the 21st century" at Speke Resort Beach, Munyonyo 7-9 September 2006.
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    Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda
    (BioMed Central, 2006-11-07) Bachou, Hanifa ; Tylleskär, Thorkild ; Kaddu-Mulindwa, Deogratias H ; Tumwine, James K
    Background: To establish the magnitude of bacteraemia in severely malnourished children, and describe the types of bacteria and antimicrobial sensitivity by HIV status. Method: Isolates were recovered from 76 blood specimens. Antibiotic susceptibility tests were performed using commercial antibiotic disks and demographic and clinical findings were recorded. Results: Of the 450 children 63% were male; median age 17.0 months (inter quartile range, IQR 12–24) and 57% had oedema. 151 (36.7 %) of 411 tested HIV-positive; 76 (17.1%) of 445 blood specimens grew bacterial isolates; 58% were Gram negative – S. typhimurium (27.6%) and S. enteriditis (11.8%). Staph. aureus (26.3%) and Strep. pneumoniae (13.2%) were the main Gram positive organisms. There was no difference in the risk of bacteraemia by HIV status, age < 24 months, male sex, or oedema, except for oral thrush (OR 2.3 CI 1.0–5.1) and hypoalbuminaemia (OR 3.5 CI 1.0–12.1). Isolates from severely immuno-suppressed children (CD4% <15%) were more likely to grow Salmonella enteriditis (OR 5.4; CI 1.6 – 17.4). The isolates were susceptible (≥ 80%) to ciprofloxacin, ceftriaxone and gentamicin; with low susceptibility to chlorampenicol, ampicillin (< 50%) and cotrimoxazole (<25%). Suspicion of bacteraemia had 95.9% sensitivity and 99.2% specificity. Among bacteraemic children, mortality was higher (43.5% vs 20.5%) in the HIV-positive; OR 3.0 (95%CI 1.0, 8.6). Conclusion: Bacteraemia affects 1 in every 6 severely malnourished children and carries high mortality especially among the HIV-positive. Given the high level of resistance to common antibiotics, there is need for clinical trials to determine the best combinations of antibiotics for management of bacteraemia in severely malnourished children.
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    Attitudes and knowledge gaps of the communities about cervical carcinoma and it’s detection in four selected districts of Uganda
    (INABSTA, 2007) Okwi, A.L. ; Othieno, E ; Byarugaba, W. ; Okoth, A. D. ; Wandabwa, J. ; Ocaido, M.
    The main objective of the study was to determine the attitudes and knowledge gaps about cervical carcinoma in the urban and rural women and health workers. A cross sectional study survey was done on four districts of Sironko in the eastern part of Uganda, Kawempe in the central, Ntungamo in the south-west and Arua in the north. Focus group discussions were held and structured questionnaires was administered 288 rural and urban women and 29 health workers in all the four districts. The study revealed that less than 10% of rural and urban women had claimed to know what cancer of the cervix was and how it was prevented compared to 96% of the health workers. Thirteen percent (n=4) of the health workers knew Pap screening procedures. Regarding the causes of cancer of the cervix, less than 35% of both urban and rural women believed that cancer of the cervix is caused by early coitus, family planning, having many partners and prolonged painful bleeding. While 3.4% rural and 1.4% urban women linked cancer of the cervix to witchcraft, only 0.7% of rural women associating it with “curse from GOD”. Although more than 60% of rural and urban women had a positive attitude towards going to health centers when sick, less than 10% preferred visiting a witchdoctor while less than 30% wanted home medication. None had had a Pap smear done. Eleven percent (n=2) of the female health workers had Pap smear despite the fact that they were near health facilities. Although urban and rural women had different education backgrounds, they had the same low understanding of cancer of the cervix and its prevention. The difference in their beliefs and attitudes on the causes of cancer of the cervix and health seeking behaviour was insignificant. Most of the health workers lacked skills on Pap screening and female health workers were found to have low opinion towards going for Pap screening. There is therefore a need to sensitise rural and urban women, and female health workers about cancer of the cervix and on the relevance of Pap screening. There is equally a great need for health workers to be trained and have Pap screening services introduced at health centers. If the above measures are put in place, then prevention and early detection of cervical carcinoma will be done with good prognosis upon treatment.
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    Characterization of penicillin intermediate serotypes of streptococcus pneumoniae carried by human immunodeficiency virus-infected adults and healthy children in Uganda
    (Mary Ann Liebert, Inc., 2007) Blossom, D. B. ; Cordeiro, S. M. ; Bajaksouzian, S. ; Joloba, M. L. ; Kityo, C. ; Whalen, C. C. ; Salata, R. A. ; Jacobs, M. R.
    There are little data on the genetic relatedness between antibiotic-resistant pneumococcal isolates colonizing the Ugandan population. Penicillin-intermediate pneumococci of serogroups or serotypes rarely or not previously reported as being penicillin nonsusceptible were selected out of 166 isolates representing 26 capsular serogroups or serotypes isolated from Ugandan children in 1995 and human immunodeficiency virus (HIV)-infected Ugandan adults in 2004–2005. Pairs of penicillin-intermediate pneumococci of the same serogroup or serotype present in both patient populations were characterized further by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Seven such pairs of isolates were found and included serogroups 7, 11, 15B/C, and 16 as well as serotypes 13, 21, and 35B. PFGE of these seven pairs showed no clonality between serogroups or serotypes, and clonality only within serogroup 11 and serotype 13. MLST of the 14 individual isolates revealed 13 different sequence types (STs), 11 of which had not previously been recorded. Comparisons with all known STs revealed that most of these strains were related only to strains of the same serotype in other countries, with these related strains frequently also being penicillin intermediate. These findings suggest that penicillin nonsusceptibility in Uganda is likely due to the introduction of antibiotic-resistant pneumococcal clones into Uganda rather than development of resistance within the country.
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    Classical ligands interact with native and recombinant tubulin from Onchocerca volvulus with similar rank order of magnitude
    (Elsevier, 2007) Wampande, Eddie M. ; McIntosh, Richard J. ; Lubega, George W.
    The α- and β-tubulin genes from Onchocerca volvulus were individually expressed for the first time in Escherichia coli (DH5α). The recombinant tubulins were purified, renatured and reconstituted into oligomers, probably dimers, which were competent to bind three classical tubulin ligands: mebendazole (MBZ), taxol (TAX) and vinblastine (VBN). A new charcoal-dependent binding assay allowed accurate discrimination between specific and non-specific ligand binding in crude cell extracts. To compare the magnitude of binding of both native and recombinant forms of tubulin, we developed an ELISA assay for estimating the amount of tubulin in soluble protein extracts of O. volvulus. Binding assays were performed; both the maximum binding at saturating ligand concentrations (Bmax) and the equilibrium dissociation constants (Kd) were determined. The Bmax values of the different ligands were significantly different from one another (P < 0.05), but the order of the Bmax and Kd for each drug were VBN > TAX > MBZ for both native and recombinant tubulin. Indeed, Bmax values for MBZ with native and recombinant tubulins were similar. On average, native tubulin had higher or similar binding capacity (Bmax) but a consistently higher affinity (lower Kd) than the recombinant tubulin. We conclude that at least some of the recombinant molecules form receptors that are similar to those in native tubulin dimers. These data suggest that recombinant tubulin can be used to develop a molecular screen for novel anti-tubulin ligands to develop into drugs against onchocerciasis.
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    Prevalence of methicillin resistant staphylococcus aureus among isolates from surgical site infections in mulago hospital, kampala, uganda.
    ( 2007-06) Ojulong, Julius
    BACKGROUND: Methicillin resistant staphylococcus aureus (MRSA) is a worldwide health problem. MRSA isolates are resistant to penicillins and all other B-lactam antibiotics. Nosocomial MRSA are also resistant to a variety of other antibiotic classes. MRSA infections are associated with a high morbidity and mortality particulary in developing countries where more expensive drugs like vancomycin are not affordable. There is limited data on the magnitude of MRSA in surgical site infections. The objective of this study was to determine the prevalence of MRSA among S. aureus isolates from surgical site infections in mulago hospital, kampala, Uganda. METHODS: One hundred eighty eight pus swabs were collected from patients with surgical site infections. Swabs were inoculated for culture at the microbiology laboratory faculty of medicine, Makerere university. S. aureus was identified biochemically. All S. aureus isolates were subjected to oxacillin agar screen and then tested with a polymerase chain reaction (PCR) assay for detection of the mecA gene which codes for oxacillin resistance. RESULTS: Out of the 188 specimen cultured, 54 (28.7%) grew S. aureus. Seventeen (31.5%) of the 54 isolates were confirmed as MRSA by PCR. CONCLUSION: This study shows a high prevalence of MRSA in surgical site infections in Mulago hospital.
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    Autopsy study on maternal deaths in Mulago hospital
    ( 2007-06) Wandira, Richard
    OBJECTIVES: To describe the anatomical pathological causes of maternal deaths, and establish their relationship with age and parity, in Mulago hospital. METHOD: The first 100 mothers, who died during pregnancy or within 42 days after termination of pregnancy irrespective of the cause of death from April 2005 to March 2006 inclusive, were consecutively entered into the study. I gave each cause a serial number for identification and all the gross findings documented on data entry forms (DEF) as seen in Appendix G. Samples were fixed in 10% formalin and taken to the department of pathology for histological processing and findings entered on DEF. Data from the study was cross-checked, edited and entered into computer using EPI-INFO 6.0 software for storage and analysis. RESULTS: The commonest anatomical pathological causes were direct, mainly ruptured uterus 20% and postabortal sepsis 18%. In fortuitous causes, pyogenic meningitis ranked highest with 12%, followed by cryptococcal meningitis and disseminated tuberculosis each 6%, and the only indirect cause, anaemia 6%. The ages ranged from 17-37 years, with a mean age of 25 years, and the parities ranged from zero to eight. The largest maternal deaths occurred in the 20-24 years age group, and one and two parties. This was a result of more mothers delivering in these categories. A tentative analysis indicated that approximately 90% of the maternal deaths could be classified as avoidable. However, results further showed that age and parity had no statistical significance in relation to causes of maternal morality. CONCLUSION: Other than age and parity, there should be other factors responsible for these predominantly preventable causes of maternal death.
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    Malignant transformation in intra oral papillary lesions diagnosed in the department of pathology, faculty of medicine, Makerere University, Kampala
    ( 2007-07) Micongwe, Moses Isyagi
    Oral papillary lesions account for two and a half percent of benign neoplastic lesions of the oral mucosa and occur at any site within the oral mucosa. Some oral papillary lesions have been associated with HPV infection. An increased incidence of oral papillary lesions in individuals undergoing highly active anti retroviral therapy has been documented. OBJECTIVES: The aim of this study was to document the different histological variants of intra oral papillary lesions diagnosed in the department of pathology, faculty of medicine, makerere university and determine whether they show features of malignant transformation, which include epithelial dysplasma, cellular and nuclear atypia, presence of abnormal mitoses and altered nuclear-cytoplasmic as well as describe the pattern of cytokeratin 19 expression in the epithelial lining of intra- oral papillary lesions. METHODS: This was a laboratory based descriptive cross sectional study on formalin fixed paraffin wax embedded tissue samples of intra oral papillary lesions from the Department of pathology., Faculty of medicine, makerere university. Routine haematoxylin and eosin staining of sections was done in addition to immunohisto-chemical staining using monoclonal antibodies for cytokeratin 19. RESULTS: The histological variants of intra oral papillary lesions seen were oral aquamous papilloma comprising 29 (46.8%) specimens, polyps comprising 15 (24.6%) specimens and one verruca vulgaris. The features of malignant transformation found in this study were epithelial dysplasia in 18(38.3%) specimens followed by nuclear pleomorphism in 9 (19.1%) specimens, increased cyplasmic ratio in 9 (19.1%) specimens, cellular pleomorphism in 7 (14.9%) speciens, abnormal mitoses in 6 (12.8%) specimens and keratin pearls in 5 (10.6%) specimens. Cytokeratin 19 expression within the prickle cell layer was found to be associated with epithelial dysplasia. CONCLUSION: Oral squamous papillomas are the commonest intra-oral papillary lesion showing an equal sex distribution and predilection for the tongue. None of the lesions seen had all the histological features of malignant transformation. Epithelial dysplasia and cytokeratin 19 expression within the prickle cell layer were seen more frequently in specimens from females. Intra oral papillary lesions in women should be routinely biopsied and pathologists should pay special attention while looking for features of dysplasia in such specimens.
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    Priorities for research and better health
    ( 2007-08) Faculty of Medicine, Makerere University ; Institute of Public Health, Makerere University ; Sewankambo, Nelson K. ; Serwadda, David
    This is a book of abstracts of the third annual scientific conference organised by the Faculty of Medicine and the Institute of Public Health, Makerere University on "priorities for research and better health" at Speke Resort Beach, Munyonyo 29-31 August 2007.