147 research outputs found
Detecting subclinical anthracycline therapy related cardiac dysfunction in low income country (SATRACD study)
No full textIntroduction: Anthracycline therapy-related cardiac dysfunction (ATRCD) is the most common chemotherapy-induced cardiovascular toxicity. It begins with subclinical myocardial cell injury that can be detected using speckle tracking echocardiography (STE), together with Troponin-I. Limited availability of STE in Uganda posts challenges in detecting subclinical ATRCD. Anthracycline can also affect cancer survivors' cardiovascular health through altering patients' lipid homoeostasis. This PhD project aims to describe the incidence and predictors of subclinical ATRCD, assess the accuracy of simple echocardiographic parameters on detecting subclinical ATRCD and investigate the lipoprotein subfractions change after anthracycline therapy. Methods and results: Two hundred seven cancer patients who were scheduled for anthracycline based chemotherapy were recruited and followed up to 6 months after ending chemotherapy. Patients' clinical characteristics, laboratory tests, electrocardiogram and echocardiographic data were collected at the baseline and at each follow up visits. Among the 207 patients, 178 (86.0%) were female, with a median age of 42 years. The cumulative incidence of subclinical and clinical ATRCD were 35.0% and 8.8% respectively at the 6 months after ending the therapy. No factor was found to predict subclinical ATRCD in multivariable model. The development of clinical ATRCD associated with HIV infection and development of subclinical ATRCD at the end of anthracycline therapy. The reduction of mitral annular plane systolic excursion (ΔMAPSE) ≥ 2mm or reduction of mitral annular peak systolic velocity (Δ S') ≥ 0.5cm/s from the baseline defined subclinical ATRCD with fairly good accuracy. Very low density lipoprotein subfraction increased and mean low density lipoprotein particle size decreased following anthracycline therapy. Conclusion: There is high incidence of subclinical ATRCD in Uganda cancer patients. Cardiac surveillance at baseline and ending of anthracycline therapy is essential to identify subclinical ATRCD patients who are at high risk of developing clinical ATRCD, particular in HIV positive patients. The conventional echocardiographic parameters ΔMAPSE and ΔS' may be used to screen subclinical ATRCD in resource limited settings. Anthracycline changes lipoprotein subfraction to more atherogenic pattern. Further studies are needed to explore more on its role on lipid metabolism
Data from: Health services intervention integrating HTN and HIV care improves long-term blood pressure control among people living with HIV in Uganda
No full textData to support the analyses conducted in “Health services intervention integrating HTN and HIV care improves long-term blood pressure control among people living with HIV in Uganda” by Dr. Okello et al. The dataset contains the sex, age group, health center level, and hypertension stage over time (0, 3, 6, 9, 12 months) of 1200 persons with HIV from Uganda
Improved hydrological understanding of a semi-arid subtropical transboundary basin using multiple techniques – the Incomati River Basin
No full textThis study aims at improving the hydrological process understanding of the semi-arid and transboundary Incomati river basin to enable better water management. Comprehensive statistical and trend analysis of rainfall and streamflow were conducted, and the Indicators of Hydrological Alteration tool was deployed to describe the streamflow regime and trends over time. Land use and land cover change, particularly the conversion of natural vegetation into forest plantation, the expansion of irrigated agriculture and the flow regulation due to dam operation were identified as critical drivers of flow regime alteration. Hydrograph separation using long-term hydrochemical data at seasonal scale, and hydrochemical and isotope data at event scale were performed to quantify runoff components. A novel methodology to calibrate recursive digital filters using routinely collected water quality data was developed and tested in the catchment. This method allows for estimation of daily baseflow from readily available daily streamflow data. Dominant runoff generation zones were mapped using the Height Above Nearest Drainage approach. The hydrological model STREAM was then employed, informed by the runoff generation zones mapping and the process understanding gained in the catchment, as well as remote sensing data. The study provides the basis for better operational water management in the catchment.Dissertation submitted in fulfillment of the requirements of the Board for Doctorates of Delft University of Technology and of the Academic Board of the UNESCO-IHE Institute for Water Education.Water Resource
Prevalence of group a streptococcus pharyngeal carriage and clinical manifestations in school children aged 5–15 yrs in Wakiso District, Uganda
No full textAbstract Background Beta-hemolytic streptococci carrier rates in children living in low-income countries are high ranging from 10 to 50%. Although most of these children are asymptomatic, they are a reservoir and pose a risk of transmission. The aim of this study was to determine the prevalence of group a streptococcus pharyngeal carriage and clinical manifestations in school going children in Wakiso district, Uganda. Methods A cross sectional study targeting children age 5–15 years in primary schools in one sub-county of Wakiso district was carried out. Three hundred and sixty-six children from five primary schools were enrolled and evaluated for group a streptococcus (GAS) carriage. A semi-structured questionnaire was used to collect data that included social demographics, school environment and clinical findings. For every enrolled child a throat swab was taken and cultured for GAS and blood was drawn for anti-streptolysin-O titres. Analysis of data was done using STATA. Results The prevalence of GAS carriage was 16%. The children with GAS positive cultures were mainly females. The factor associated with GAS carriage was the school location, with peri-urban schools more likely to have children with GAS compared to rural schools; AOR 2.48 (95% CI: 1.01 – 6.11), P = 0.049. There was no significant difference between the characteristic of children with GAS positive verses GAS negative throat swab cultures. Conclusion There is a high prevalence of GAS pharyngeal carriage among children aged 5–15 years attending primary schools in Wakiso District, Uganda
Prevalence and pattern of echocardiographic abnormalities among patients on haemodialysis at an urban hospital in Central Uganda
No full textBackground: Cardiovascular disease is the most common cause of morbidity and premature mortality in patients on chronic haemodialysis. There are limited data on cardiac abnormalities among these patients in sub-Saharan Africa, including Uganda. We determined the prevalence and patterns of echocardiographic (echo) abnormalities among patients with end-stage renal disease (ESRD) on haemodialysis at Mulago National Referral Hospital, Kampala, Uganda.Methods: Eighty patients with ESRD on chronic haemodialysis were enrolled in the study over a period of five months from November 2017 to March 2018. Wecollected data on demographic and baseline clinical characteristics by reviewing charts and conducting patient interviews. Participants had blood pressure measurements performed and blood samples taken for laboratory investigations. We then conducted a cardiac evaluation using standard transthoracic echo protocols. Bivariable and multivariable analysis was performed to study associations with left ventricular hypertrophy and diastolic dysfunction.Results: Fifty-three of the 80 patients (66%) were male, mean age was 49 ± 16 years and the median duration on dialysis was 9.5 months (interquartile range 4–24 months). Twenty-eight (35%) had to travel >50 km to access dialysis. Seventy-four patients (93%) had at least one cardiac echo abnormality and 30% had at least three abnormalities. Left ventricular hypertrophy (68%) and diastolic dysfunction (64%) were the most common abnormalities. There was a high prevalence of factors that have previously been associated with left ventricular hypertrophy and diastolic dysfunction including anaemia (79%), poorly controlled hypertension (79%) and dyslipidaemia (56%) but none of these was statistically significantly associated in this study.Conclusions: Our study confirmed a high prevalence of cardiac abnormalities among a young population of African patients with ESRD on chronic dialysis. We recommend that echocardiography be part of the routine care to help plan early intervention for those at high risk of cardiovascular events
Cambios del periodo refractario efectivo auricular y de la IKACh tras estimulación vagal más estimulación eléctrica rápida en venas pulmonares
No full textMultinationals or cooperatives: does it matter to farmers? A case study of the Indian dairy sector.
No full textProduction of high quality soybean oil and meal: Studies on extraction methods, processing steps, deep-fat frying and optimization of extrusion aided screw pressing
No full textThe objectives of this research were to evaluate the effects of extraction methods, processing steps, frying time and optimization of extrusion aided screw pressing on the quality of soybean oil and meal. The Crude soybean oil was obtained by commercial hexane solvent extraction (SE), or extrusion aided screw pressing (EASP) or by low temperature screw pressing (SP) methods. Five gallons of each of degummed, refined, bleached, non-deodorized hydrogenated and deodorized hydrogenated oils were prepared and characterized. The five processed oils were tested for stability against frying times. Optimization of extrusion aided screw press processing variables were performed by the application of Response Surface Methods using Design-Expert software package. The crude soybean oil produced by EASP and SP did not show any significant differences in physical and chemical characteristics compared to the crude oil extracted by SE method. All processing steps did not exert the same effect on all quality parameters, but reduced or increased other parameters. The stability of degummed, refined, bleached, and hydrogenated oils did not only depend on the frying time, but also on the nature of processing. Degummed oil was shown to be more stable than refined or bleached oils but less stable than hydrogenated oils. Two prediction models were produced and a combination of 135 2\sp\circC temperature, 8.35 1.5% moisture and 10-p-10-8-8 steam lock were found to give the optimum oil yield of 78 2% of commercial grade, and good quality meal with PDI of 24%, 45% protein and a TI value as low as 2%.Made available in DSpace on 2011-05-07T12:29:10Z (GMT). No. of bitstreams: 2
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Bone-Deep Engagement: Black Methodological Intonations and Ethical Response-Making to Black Living
No full textWhat constitutes an ethical analytical response to Black living? This manuscript thinks with theories of Blackness to explicate how the question of the human, specifically, what it means to be human, interrupts traditional methodological discourse, and requires a critical form of labor to account for the breadth and depth of Black liveliness and living. Diverging from traditional distance-oriented research practices, the author puts forth “Black methodological intonations” as methodological praxes. Unlike conventional methods that prioritize detachment, this manuscript advocates for a transformative attunement that actively engages with and alongside Black liveliness. Grounded in the embodied and relational concept of hapticity, the manuscript outlines the theoretical framework of Black methodological intonations, emphasizing the necessity of transcending mere spectatorship in research on Black life. In conversation with Arthur Jafa’s film, “Love is the Message, the Message is Death” (2016), the manuscript employs haptic reflexivity to consider profound listening, viewing, and feeling experiences in connection with the Black quotidian. Jafa’s film serves as a compelling example of reshaping the white gaze’s racialized power dynamics. The analysis of the film through the lens of hapticity yields valuable insights, culminating in essential considerations for Black methodological intonations as methodological response-making. Key themes include attunement, impressions, slowness, and emanation, contributing to a nuanced understanding of methodological practices that engage with the precarity of Black liveliness and living
Rheumatic heart disease in Uganda: predictors of morbidity and mortality one year after presentation
No full textAbstract
Background
Rheumatic heart disease (RHD), the long-term consequence of rheumatic fever, accounts for most cardiovascular morbidity and mortality among young adults in developing countries. However, data on contemporary outcomes from resource constrained areas are limited.
Methods
A prospective cohort study of participants aged 5\u201360 years with established RHD was conducted in Kampala, Uganda, in which clinical exam, echocardiography, electrocardiography (ECG), and laboratory evaluation were done every 3\ua0months and every 4-week benzathine penicillin prophylaxis was prescribed. Participants were followed up for 12\ua0months and outcomes and predictors of morbidity and mortality were assessed using Kaplan Meier curves and Cox proportional hazards models.
Results
Of 449 subjects, 66.8% (300/449) were females, median age was 30 (interquartile range 20). 73.7% (331/449) had atleast one follow up visit. Among these, 35% (116/331) developed decompensated heart failure and, 63.7% (211/331) developed atrial fibrillation. Heart failure was associated with poor penicillin adherence (OR\u2009=\u20093.3, CI 2\u20135.4, p \u2009=\u20090.001), and left ventricular end diastolic diameter greater than 55\ua0mm (OR\u2009=\u20093.16, CI 1.73\u20135.76, p \u2009=\u20090.001). Atrial fibrillation was associated with left atrial diameter >40\ua0mm (OR\u2009=\u20097.5, CI 2.4\u20139.8, p \u2009=\u20090.001).
There were 59 deaths with a 1-year mortality rate of 17.8%. Most deaths occurred within the first three months of presentation. Subjects whose average adherence to benzathine penicillin was <80% had significantly greater mortality (31% vs. 9%, log rank p \u2009<\u20090.001). In multivariate analysis, the risk of death among those with poor penicillin adherence was 3.81 times higher than those with better adherence (HR\u2009=\u20093.81, CI 1.92\u20137.63, p \u2009=\u20090.001). Other predictors of 1\ua0year mortality included heart failure (HR 8.36, CI 3.28\u201321.31, p \u2009=\u20090.001) and left ventricular end diastolic diameter greater than 55\ua0mm (HR\u2009=\u20091.93, CI 1.07\u20133.49, p \u2009=\u20090.02).
Conclusion
In this study of RHD in Uganda, morbidity and mortality within 1\ua0year of presentation were higher than in recently published from other low and middle income countries. Suboptimal adherence to benzathine penicillin injections was associated with incident heart failure and mortality over 1\ua0year. Future studies should test interventions to improve adherence among patients with advanced disease who are at ..
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