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ItemPulmonary microthrombosis and associated demographics in fatal covid-19 cases at Mulago national referral hospital, Kampala.(Makerere University, 2025-11-03)Pulmonary micro thrombosis (PMT) emerged as a consequential complication in fatal COVID-19, significantly impacting morbidity and mortality globally (WHO, 2022) Despite its recognized significance, there existed a paucity of data concerning its prevalence and associated demographic factors and comorbidities in sub-Saharan African settings, such as Kampala, Uganda. This knowledge gap hindered evidence-based management of the disease in such settings. Objective: This study sought to determine the prevalence of pulmonary microthrombi and establish its association with sex, age and comorbidities namely diabetes, hypertension, and HIV among patients who died of COVID-19 and had an autopsy done at Mulago National Referral Hospital. Methods: A cross-sectional study with a retrospective approach on archived formalin fixed paraffin embedded (FFPE) lung tissue blocks of COVID-19 patients who died and had an autopsy done at Mulago National Referral Hospital (MNRH) from June 2020 to September 2021 were studied. The sample size was 120, Hematoxylin and Eosin, and and Modified Carstairs stain were used. Results: 120 lung tissue cases were enrolled and analysed. The mean age of the deceased from where the specimens were taken was 59, standard deviation ±15. The majority were males, 52.5% (n=63) and most, 86.7% (n=104) had an unknown HIV status. Slightly less than half, 46.7% (n=56) were hypertensive, and most, 67.5% (n=81) didn’t have diabetes or unknown to have diabetes. There was an association between pulmonary microthrombi in fata COVID-19 and sex at MNRH. Conclusion: The prevalence of pulmonary microthrombi among patients who died of COVID19 and had an autopsy done at Mulago National Referral Hospital was high (65%). In this autopsy-based study, male sex was the only independent predictor of pulmonary microthrombosis. On multivariate logistic regression, females were significantly less likely to exhibit microthrombi compared to males (aOR ≈ 0.4, p = 0.035). In contrast, age, HIV infection, diabetes mellitus, and hypertension showed no statistically significant associations with pulmonary microthrombosis, as their odds ratios approximated unity and p-values exceeded the 0.05 threshold. These results highlight sex-specific vulnerability, while the non significant variables may reflect limitations of retrospective data capture and study power rather than absence of biological effect.
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ItemPrevalence and factors associated with comorbid cognitive impairment and depression among Stroke patients attending Mulago National Referral Hospital, Neurology Clinic : a cross-sectional study(Makerere University, 2025)Introduction: Individuals with stroke suffer from both cognitive impairment and depression at varying degrees, with these two conditions negatively affecting quality of life and delaying improvement during rehabilitation. Frequency of co-occurrence of these conditions is likely to be high given their high individual prevalence. There is paucity of data on the comorbidity of cognitive impairment and depression after stroke especially in the sub-Saharan context. Objectives: This study determined the prevalence and factors associated with comorbid cognitive impairment and depression among stroke patients at Mulago National Referral Hospital in Uganda. Methods: This was a quantitative cross-sectional study conducted from October 2024 to January 2025. It included participants aged ≥18 years with a confirmed stroke status recruited by consecutive sampling. The Mini-Mental State Exam (MMSE) was used to collect data on cognitive function while the Patient Health Questionnaire 9 (PHQ-9) was used to assess for depression. The Barthel Index assessed functionality based on activities of daily living. Cognitive impairment was based on a MMSE cut off score of ≤23 while depression was based on a PHQ-9 cut off score of ≥10. Data were analysed with Stata version 15.1 with the association between comorbid cognitive impairment and depression with the independent variables being determined using logistic regression. Results: The study recruited 173 participants with a mean age of 53.4 years (SD = 13.8) majority of whom were males 80 (58.0%), unemployed 90 (65.2%), and married 122 (70.5%). Comorbid cognitive impairment and depression was found in 25 participants representing 14.5%). After adjusting for age and sex, diabetes mellitus (OR = 4.8, CI 1.680 – 13.550, p = 0.003) was found to be significantly associated with comorbid cognitive impairment and depression. Conclusion: Comorbidity of cognitive impairment and depression is common among stroke patients at Mulago National Referral Hospital, affecting nearly 15% of survivors. The strong association of diabetes mellitus highlights the need for routine screening and integrated management of cognitive and mood disorders, particularly among stroke survivors with metabolic comorbidities. Early identification and multidisciplinary intervention may improve recovery and overall quality of life in this population.
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ItemPatterns and factors associated with malignant conjunctival growths among adult patients with conjunctival growths attending eye clinic in Mulago National Referral Hospital(Makerere University, 2024)Background: Conjunctival growths encompass a wide spectrum of lesions that can be benign, pre-malignant, and malignant tumors. Malignant conjunctival growths can cause visual loss, eyeball loss, or even death if not well managed. Conjunctival growth surgeries are the most common surgery in Mulago National Referral Hospital eye department; however, little is known about the patterns and factors associated with malignant conjunctival growths. General objective: To determine the patterns and factors associated with malignant conjunctival growths among adult patients attending the Eye Clinic at Mulago National Referral HospitalMethods: This was a quantitative, cross-sectional study conducted at Mulago National Referral Hospital (MNRH) Eye Clinic. Patients with conjunctival swellings were consented and recruited consecutively and Data was collected using a structured, pre-tested questionnaire and entered into EpiData 4.2 which was exported to STATA 17 for analysis. Descriptive statistics were presented as means, standard deviation (SD), frequencies, and proportions. Factors associated were assessed using logistic regression to obtain odds ratios with their corresponding P-values at a 95% confidence interval. Results: A total of 110 participants were included in this study. Their mean age was 49 (SD=+/-13) years. 29% of the conjunctival growths were malignant and the rest were non-malignant (benign and pre-malignant). Of the malignant growths encountered, the majority had Squamous Cell Carcinoma (SCC) at 90.6%, and 9.4% had conjunctival melanoma. Amongst those with SCC, most participants had carcinoma in situ (38%), followed by well-differentiated growths at 31%. All participants with conjunctival melanoma had pT1a pathological staging. White color (aOR:39.6, 95% CI=2.83-553.51), mixed color (aOR:17.6,95%CI=1.51205.02), sub-epithelial involvement (aOR:1, 95%CI= 0.000-0.0237), Leucoplakia (aOR:1, 95%CI= 0.001-0.313), Pigmentation(aOR:0.3,95%CI=0.000-0.658) and having a rough texture (aOR:10.8,95% CI =1.23-94.51) were indicators of malignancy.Conclusion: The commonest malignant conjunctival growth was SCC followed by malignant conjunctival melanoma. Carcinoma in situ was the most common histological pattern while for conjunctival melanoma was the pT1a stage. Leucoplakia, pigmentation, rough texture, and sub-epithelial involvement were found to be highly associated with conjunctival malignancy.
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ItemPrevalence, patterns and factors associated with ocular findings among adolescents living with HIV at the Baylor College of Medicine Mulago.(Makerere University, 2025)Introduction Human Immunodeficiency Virus (HIV) is a major cause of morbidity and mortality worldwide. In 2021, 38.4 million people were living with HIV/AIDS globally, including 1.71 million adolescents. Despite the understanding that HIV can impact various organs, including the eyes and cause blindness, few studies have been conducted to describe the prevalence, patterns, and factors associated with ocular findings of HIV in adolescents, particularly in Africa and specifically in Uganda. General objective: To determine the prevalence, patterns, and factors associated with ocular findings among adolescents living with HIV at the Baylor College of Medicine Mulago. Methods: This was a cross-sectional study conducted at the Baylor College of Medicine in Mulago. Adolescents aged 10-19 were recruited consecutively. Data were collected on the history, clinical examination, and ocular findings using an interviewer-administered, pre-tested questionnaire and entered into EpiData 4.2, which was then exported to STATA 15 for analysis. Descriptive statistics were presented as means and standard deviations (SD), frequencies, and proportions. Factors associated with the outcome were assessed using a modified Poisson regression model to obtain prevalence ratios, along with their corresponding P-values and 95% confidence intervals. Results: A total of 341 adolescents with HIV were recruited. Most participants were females 179 (52.5%), aged 15-19 years 198 (58.1%). The prevalence of at least one abnormal ocular finding in HIV was 17%, (n=57). In this study, most of the abnormal ocular findings were found on the conjunctiva (n=41, 72%) and optic disc (9, 17%). Other ocular findings included abnormal retinal findings (n=3, 0%) patients and maculopathies (n=3, 5%) patients among others. Adolescents who had a high viral load were 53% less likely (PR=0.47; p=0.049) to have ocular findings than those with a suppressed viral load. Conclusion and recommendations: In this study, the prevalence of ocular findings was 17%. We recommend that the adolescents should continue adhering to their treatment and care. Since our study found ocular findings in states of low viremia and normal CD4 which is contrary to what has been found in previous studies, we recommend another study, probably a longitudinal study on a larger sample size to further establish the association of the viral load with ocular findings.
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ItemOutcomes and factors affecting survival of children diagnosed with Burkitt’s lymphoma in Lacor Hospital(Makerere University, 2025)Background: Burkitt’s lymphoma (BL) is the most common childhood cancer in Uganda with a prevalence of 28%. The incidence of BL has been reported to be even much higher in northern Uganda than elsewhere in Africa. Lacor Hospital has an oncology unit that treats BL and other solid tumors. The overall survival rate of the most common childhood cancer and the factors affecting it are unknown among the affected children living in the most endemic region in Africa. Objective: To determine the 5-year clinical outcomes and factors associated with survival of children with BL that received care from St. Mary’s Hospital Lacor. Method: This was a retrospective cohort study involving chart review for children diagnosed with Burkitt’s Lymphoma from January 2015 to December 2020 at St. Mary’s hospital Lacor. Relevant data was extracted and analyzed. Kaplan-Meier survival curves were used to estimate 5-year survival. Cox regression analysis was used to assess the prognostic factors and presented as hazard ratios with their 95% confidence interval at both bivariate and multivariate levels. Results: The five-year survival rate among children with known outcomes was 34.1%. Most patients (79.7%) presented with advanced-stage disease (Stage III or IV). Significant predictors of improved survival included higher baseline hemoglobin levels (median 11.0 g/dL vs. 9.0 g/dL), higher absolute lymphocyte counts (median 3.0 vs. 2.0 x10⁹/L), achieving clinical remission, and completing more chemotherapy cycles (median 6 vs. 2). Treatment abandonment was reported in 12.3% and loss to follow-up in 24.8% of cases. Regional disparities were noted, with higher adherence in West Nile and Karamoja compared to Eastern Uganda. Underweight status was nearly universal (97.3%), and HIV status was unknown (78%) of participants, limiting conclusions about its prognostic role. Conclusion: Survival of pediatric BL in Lacor Hospital is far below global statistics. Chemotherapy delivery was feasible though late-stage presentation, undernutrition, and high attrition rates severely limited survival outcomes. Early diagnosis, nutritional support, improved treatment adherence, and robust follow-up systems are urgently needed to improve survival in this vulnerable population. KEY WORDS: Burkitt’s lymphoma, pediatric cancer, Uganda, survival outcomes, treatment adherence, low-resource settings, chemotherapy, St. Mary’s Hospital Lacor.