Mother Kevin Postgraduate Medical School

Beta cell function, insulin resistance and glycemic control in type 2 diabetes mellitus

2015-08-01T00:00:00Z

Beta cell function, insulin resistance and glycemic control in type 2 diabetes mellitus Karatunga, Pascal Diabetes Mellitus (DM) patients may be categorized into two major groups: type 1 - and type 2 diabetes. Beta cell failure and insulin resistance is the hall mark of type 2 diabetes. Knowledge on the pathophysiology of diabetes improves clinical management. There is scanty data on beta cell function and insulin resistance in type 2 diabetes patients in Uganda. This study investigated beta cell function, insulin resistance and glycaemic control in type 2 diabetes patients attending St. Francis Hospital, Nsambya, Kampala Study objective: To describe beta cell function, insulin resistance and glycemic control among type 2 DM patients at Nsambya hospital, Kampala Uganda. Methods: A cross sectional study was conducted among out – patients at Nsambya hospital, diagnosed with DM at ages above 30 years, on oral hypoglycemic agents and of less than 10 years DM duration. Venous blood samples were drawn and the patients’ fasting blood glucose, fasting serum C – peptide and HbA1c levels were determined. Their respective insulin resistance (HOMA2 IR), insulin sensitivity (HOMA2 %S) and beta cell function (HOMA2% B×HOMA2 %S) were estimated using the HOMA2 evaluation tool. Statistical analysis was done using SPSS version 20. Results: Eighty one study participants were selected from the type 2 DM Clinic at Nsambya hospital. The mean beta cell function was 0.397 + 0.052 (Standard Error of Mean (SEM)). The proportion of beta cell dysfunction (HOMA2% B×HOMA2 %S < 1.0) was 94.4 %. The mean Insulin Resistance was 3.3 + 0.4 (SEM). The proportion of insulin resistance (HOMA2 IR > 2.5) was 35.8 % (29/81). Twenty seven percent of study participants had severe insulin resistance (HOMA2 IR > 3.0). Sixty eight percent (55/81) of study participants had suboptimal glycemic control (HbA1c > 7.0 %). There were no correlations of statistical significance between participants’ baseline characteristics with beta cell function nor insulin resistance. Conclusions: Beta cell dysfunction was a more predominant factor (94.4%) than insulin resistance (35.8 %) among type 2 DM patients at Nsambya hospital. The proportion of suboptimal glycemic control was high (68%). There were no correlations between patients’ baseline characteristics with beta cell dysfunction nor insulin resistance. Recommendations: 1. It is recommended that case control and / or prospective cohort studies with larger type 2 DM patient numbers would provide a better understanding of the evolution of beta cell function and insulin resistance as a means of accounting for differences in individual physiology and the multi – factorial nature of dependence of glycemic control in type 2 DM. Dr. Bahendeka K. Silver; Dr. Mwebaze M. Raymond

Saccharomyces boulardii added to zinc in management of rotavirus gastroenteritis among children aged 3-36 months: A pilot study at Nsambya hospital

2014-05-01T00:00:00Z

Saccharomyces boulardii added to zinc in management of rotavirus gastroenteritis among children aged 3-36 months: A pilot study at Nsambya hospital Byaruhanga, Charles Background: Even with the current standard of care for acute water diarrhea, rotavirus infection still kills 527,000 children annually. Objectives: To determine the effect of adding Saccharomyces boulardii to zinc in the management of rotavirus gastroenteritis among children aged 3-36 months. Methods: A pilot randomized open label trial was conducted among hospitalized children with rotavirus gastroenteritis in the paediatrics ward. Ninety five patients were screened for rotavirus using SD BIOLINE Rotavirus kit; 42 children tested positive for rotavirus. These were randomly assigned into two equal groups to receive both zinc gluconate and rehydration (standard of care) or Saccharomyces boulardii added to standard of care group. The study participants had baseline characteristic recorded and then followed up daily for 5 days assessing diarrhoea and vomiting characteristics. Results: Patients consisted of 24 females and 20 males with mean age of 12.15 ±7.18 months. Baseline characteristics were similar; all children presented with diarrhoea and vomiting. No significant differences regarding duration of illness, episodes of diarrhoea and vomiting and degree of dehydration was found among the two groups at time of hospitalization. Adding Saccharomyces boulardii to standard of care had the following effect; reduced the mean duration of diarrhea from 4.47 days 2. 70 days when compared to Standard of care (P=0.001), reduced the time to resolution of vomiting but this was not statistically significant (p = 0.944). Conclusions: Adding Saccharomyces boulardii to zinc as compared to standard of care; reduced the duration of rotavirus diarrhoea but had little effect on time to resolution of vomiting. Recommendation: - A larger study is needed to assess possibility of adding Saccharomyces boulardii as an adjunct therapy to zinc formulation in the management of rotavirus diarrhoea in a similar setting. - Further, studies with a larger sample size are needed to study why the addition of Saccharomyces boulardii added to zinc gluconate increased the time to resolution of vomiting. Dr. Namisi P Charles; Dr. Mworozi Edson

Short term poor outcome determinants of patients with traumatic pelvic fractures: Across-sectional study at three private not for profit hospitals of Nsambya, Lubaga and Mengo.

2018-08-01T00:00:00Z

Short term poor outcome determinants of patients with traumatic pelvic fractures: Across-sectional study at three private not for profit hospitals of Nsambya, Lubaga and Mengo. Osuta, Hope Methuselah Background: Although relatively rare, pelvic fractures signify major trauma that are frequently associated with multiple injuries, threat to life and poor functional outcome. This study aimed to establish poor outcome determinants in traumatic pelvic fracture patients admitted and treated at three urban PNFP Hospitals in Kampala. Methods: A cross-sectional study reviewing charts of patients admitted and treated at three urban PNFP hospitals in Kampala, Uganda between January 2014 and December 2018. A pretested data abstraction form was used to obtain data. All variables with a p-value < 0.24 at bivariate logistic regression were included in multivariate analysis. A backward stepwise elimination method was used to identify predictors of poor outcome, with Odds Ratios at 95% confidence intervals used to report results. Data was analyzed using STATA version 14.0 at a p value < 0.05. Results: Of the 73 patients admitted and treated for pelvic fractures, 40(54%) were males and the mean age of 37.4± 17.7 years. Overall, 83.3% fractures were stable while 16.7% were unstable. The most commonly associated injuries were in extremities (52.38%), head and neck region (25.40%), abdomen (7.94%) and chest regions (7.94%). Factors significantly associated with poor outcome among patients with pelvic fractures were surgical intervention (p = 0.001) and poor heart rate (p = 0.008), regardless of whether stable or unstable pelvic fractures. Conclusion: Poor Outcome determinants for pelvic fracture were operational interventions and elevated heart rate. Associated injuries were mainly in the extremities and head and neck regions. Deliberate and focused attention should be given to stabilize the cardiovascular system in pelvic fracture patients who present with elevated heart rate. Very close monitoring of pelvic fracture patients who require or have undergone operative intervention is very essential for optimal outcome. Mutyaba Frederick; Sr.Nassali Gorretti

Predictive value of dipstick and microscopy in diagnosis of urinary tract infections among under-fives presenting with fever to Nsambya hospital

2014-08-01T00:00:00Z

Predictive value of dipstick and microscopy in diagnosis of urinary tract infections among under-fives presenting with fever to Nsambya hospital Ocokoru, Christine Background: Urinary tract infection (UTI) is a common paediatric problem with the potential to cause long-term complications, globally. Children < 5 years often present with non-specific symptoms and signs making the diagnosis of urinary infection challenging. Fever may be the only sign of UTI in under-fives. Effective treatment depends on clinicians’ high index of suspicion and laboratory urine test results. Early diagnosis of UTI is essential to institute prompt treatment and reduce lifelong morbidity. Urine dipstick for nitrites and leucocyte esterase, and microscopy for leucocytes and bacteriuria are good screening tests to select urine specimens for culture which is the gold standard for UTI diagnosis. The screening tests provide more rapid information than urine culture, which could be utilized as decision-making tool for initiating treatment of UTI. Objective: To determine the predictive value of a combination of urine dipstick and microscopy in diagnosing UTI in children. Methodology: A cross-sectional study was conducted at the paediatric out patients’ department of Nsambya Hospital from December 2013 to April 2014.Children <5 years presenting with fever were approached and inquiries made about their prior antibiotic use. All children with temperatures ≥37.5⁰C and aged ≤59 months who had not been on antibiotic therapy 48 hours prior to hospital visit were enrolled into the study upon obtaining consent from their parents/caretakers. Basic information was filled in a data collection form. Two urine samples were collected from every participant-one for urine dipstick and microscopy and the other for urine culture. Data was entered in a computer using Epidata version 3.1 and analyzed using SPSS version 19 software. Findings: The sensitivity, specificity, positive predictive value and negative predictive value of combined urine dipstick and microscopy were 98.8%, 95%, 87.9% and 99.5% respectively. Urine dipstick alone had sensitivity of 46.9%, specificity 95.5%, positive predictive value of 79.2% and negative predictive value of 83.1%.Urine microscopy used alone had sensitivity of 95.1%, specificity 98.2%, positive predictive value 95.1% and negative predictive value of 98.2%. Conclusions: A combination of urine dipstick and microscopy is reliable in the diagnosis of UTI Recommendation: The MoH of Uganda should continue prioritizing the use of microscopy for the diagnosis of UTI among children under-five years of age. Nantulya Florence; Nannyonga Maria Musoke