Mengo Hospital

ABSTRACT Background Posterior reversible encephalopathy syndrome (PRES) is a well‐described neuro‐clinical syndrome characterized by acute‐onset symptoms, seizures, headache, visual disturbances, encephalopathy, and distinctive neuroimaging findings of vasogenic edema, typically in parieto‐occipital regions. A cardinal feature is the reversibility of both clinical and radiological abnormalities, often within days to weeks of addressing the inciting trigger. Case presentation This report presents a highly atypical case of a 47‐year‐old hypertensive male being managed for abdominal sepsis with a history of recurrent seizures and altered mentation with symptoms persisting more than 4 months after the initial brain magnetic resonance imaging (MRI). The MRI 5 days post symptoms revealed bilateral, symmetrical occipital lobe vasogenic edema consistent with PRES, in the absence of acute infarction, hemorrhage, or vasculopathy. Conclusion This case challenges the conventional temporal boundaries of PRES, demonstrating that the “reversible” component may, in rare instances, extend over several months, thereby expanding the recognized clinico‐radiological spectrum of this syndrome.

ABSTRACTObjective To identify modifiable intensive care unit factors associated with outcomes among patients receiving invasive mechanical ventilation in a low-income setting.Methods This prospective, multicenter, registry-embedded observational study has two components: a prospective registry-based cohort assessing patient- and care-process-related factors and a cross-sectional intensive care unit survey evaluating organizational structure. Functional intensive care units in Uganda will be included. Patients aged ≥ 15 years old requiring invasive mechanical ventilation will be enrolled. Patients extubated within 48 hours, transferred after > 24 hours, and imminent early death will be excluded. Primary outcomes will include 28-day intensive care unit mortality, intensive care unit length of stay, and mechanical ventilation duration. Tracheostomy-related outcomes will be explored in a pre-planned sub-study. Factors potentially associated with outcomes will be categorized into non-modifiable and potentially modifiable factors. Non-modifiable factors will include patient-related factors like age, comorbidities, and illness severity; potentially modifiable factors include processes of care (e.g., sedation levels) and intensive care unit organizational structure (e.g., staffing patterns). Multilevel multivariable logistic regression models will assess association outcomes. Survival analysis (Kaplan-Meier curves) will explore mortality trends. Confounders will be identified using directed acyclic graphs.Results (anticipated findings) This study will generate high-quality data on modifiable intensive care unit factors associated with ventilated patient outcomes in low-resource settings.Conclusion This is Uganda’s first registry-embedded, multicenter intensive care unit study to systematically potentially modifiable factors associated with ventilated patient outcomes. This study will provide evidence-based insights to optimize critical care management in low- and middle-income countries by leveraging real-time intensive care unit registry data.

First-degree relatives (FDRs) of colorectal cancer patients in China face distinctive health behavior challenges shaped by cultural and familial contexts. Little is known about how familial responsibilities influence their health motivations. This study explored FDRs' perceptions and motivations regarding healthy lifestyles using a qualitative descriptive design. Semi-structured interviews with 16 FDRs revealed 2 themes: (1) Health Perceptions in Cultural Context-integrating traditional Chinese medicine with modern views, with contradictions about exercise/tobacco/alcohol; and (2) Dual Role of Family Responsibility-acting as both motivation and barrier when interacting with economic pressures. Culturally adapted interventions addressing multilevel socioeconomic factors are essential.

BackgroundThe relationship between education and cardiovascular health (CVH) metrics in low- and middle-income countries (LMICs) remains unclear. This study explores the associations between education and ideal cardiovascular health score (CVHS), as well as seven CVH metrics.MethodsThis cross-sectional study extracted data from the STEPwise approach to surveillance surveys in 36 LMICs between 2010 and 2020. We assessed CVHS using the sum score in seven metrics defined by American Heart Association: (1) ≥ 150 min/week of moderate, or 75 min/week of vigorous activity, or an equivalent combination; (2) BMI < 25 kg/m2 for non-Asians (< 23 kg/m2 for Asians); (3) fruit and vegetable intake ≥ 4.5 servings per day; (4) nonsmoking; (5) blood pressure < 120/80 mmHg (untreated); (6) total cholesterol < 200 mg/dL (untreated); and (7) fasting blood glucose < 100 mg/dL (untreated). The ideal CVHS score ranged from 5 to 7. We disaggregated prevalence of ideal CVHS and seven metrics by education, and constructed Poisson regression models to adjust for other socioeconomic factors.ResultsAmong 81,327 adult participants, the overall ideal CVHS prevalence for the studied countries was highest among individuals with primary education (52.9%, 95% CI: 51.0–54.9), surpassing those of other education levels − 48.0% (95% CI: 44.6–51.3, P = 0.003) for those with no education and 39.1% (95% CI: 36.5–41.8, P < 0.001) for those with tertiary education. Five (ideal physical activity, BMI, blood pressure, total cholesterol, and blood glucose) in seven CVH metrics peaked among participants with primary or secondary education. For instance, the prevalence of ideal blood pressure among individuals with primary education was 34.4% (95% CI: 32.7–36.1), higher than the prevalence in other education levels, ranging from 28.6% to 32.3%. These patterns were concentrated in low-income countries and lower-middle-income countries, while in upper-middle-income countries, the prevalence of ideal CVHS increased with higher education levels, ranging from 15.4% for individuals with no education to 33.1% for those with tertiary education.ConclusionsIn LMICs, the association between education and ideal CVHS, along with several CVH metrics, exhibited un inverted U-shape, which may be closely related to the different stages of epidemiologic transition.

Antimicrobial Resistance (AMR) poses a global public health challenge, necessitating advanced tools to support data analysis, and visualization. This study introduces interactive Geographic Information System (GIS) dashboards as innovative platforms for AMR data analysis and visualization, offering comprehensive insights into resistance patterns, and geographic distribution across multiple countries, with a specific focus on Africa. Three GIS dashboards were developed to address key objectives. The first integrates over 860,000 ATLAS data points from 83 countries, providing an interactive platform. Users can filter data by variables such as country, year, and region, enhancing data accessibility and visualization. The second dashboard focuses on the ATLAS dataset for Kenya and Uganda, incorporating detailed variables such as species, sample sources, and resistance phenotypes. The third involves Kampala, Uganda, to fill data gaps, enabling localized analyses through interactive features like geographic mapping and sample breakdowns by year. Sub-Saharan Africa faces three major challenges in handling antimicrobial resistance (AMR) data: limited accessibility for non-technical users, inefficiencies in processing large datasets, and insufficient longitudinal data for analysis. The introduction of interactive dashboards significantly improved AMR data visualization and interpretation across different scales. The global AMR dashboard effectively mapped geographical trends, uncovering critical data gaps, particularly the scarcity of AMR records from Africa. The Kenya and Uganda dashboard revealed key resistance patterns, highlighting the ineffectiveness of Ceftriaxone, Erythromycin, Levofloxacin, and Ampicillin against E. coli isolates. Additionally, the Kampala-specific dashboard, developed using simulated data, demonstrated the potential for localized AMR visualization, providing valuable insights where real-world data is limited. Across all platforms, the dashboards' interactive features enhanced data accessibility and streamlined trend identification, making AMR insights more interpretable, especially for researchers in Sub-Saharan Africa. Interactive GIS dashboards enhance AMR data analysis in Sub-Saharan Africa by improving accessibility, efficiently handling large datasets, and addressing data gaps. Unlike spreadsheets such as Excel, which struggle with large datasets due to computer constraints, dashboards offer dynamic visualization, real-time updates, and intuitive data exploration.

This review article, developed by the EASD Global Council, addresses the growing global challenges in diabetes research and care, highlighting the rising prevalence of diabetes, the increasing complexity of its management and the need for a coordinated international response. With regard to research, disparities in funding and infrastructure between high-income countries and low- and middle-income countries (LMICs) are discussed. The under-representation of LMIC populations in clinical trials, challenges in conducting large-scale research projects, and the ethical and legal complexities of artificial intelligence integration are also considered as specific issues. The development of global research networks and strategies for improved training, standardisation of data and enhanced accessibility to big data analytics to drive innovation and personalised medicine are recommended. With regard to diabetes care, inequalities in access to essential medications, particularly insulin and novel therapies, and disparities in healthcare infrastructure are discussed. Proposed initiatives include international support programmes, improved healthcare provider training and the inclusion of newer diabetes medications in essential drug lists. The importance of global screening programmes, a universal diabetes education curriculum and standardised healthcare checklists is also emphasised. Regarding healthcare organisation, the development of national diabetes registers, benchmarking performance across regions and strengthening international collaborations are highly advised. The role of diabetes specialists as care coordinators and the need for structured assessments to improve early intervention and long-term outcomes are also discussed. Ultimately, the EASD Global Council urges action for a unified, global approach to diabetes research and care to bridge the gap between scientific innovation and clinical practice, ensuring equitable healthcare worldwide.Graphical Supplementary InformationThe online version contains a slideset of the figures for download available at 10.1007/s00125-025-06504-5.

BackgroundAntimicrobial misuse and overuse propagate antimicrobial resistance, yet data on factors influencing antibiotic prescription decisions in low-resource settings are limited. We describe factors influencing antimicrobial prescription at a large tertiary care private not-for-profit hospital in Uganda.MethodsWe conducted a descriptive phenomenology qualitative study involving face-to-face in-depth interviews of 12 purposively selected prescribers (four intern doctors, six medical officers and two Internal Medicine physicians) in a private not-for-profit hospital in Kampala, Uganda. Audio recordings and filed notes were transcribed verbatim and analysed manually by content analysis. Emerging themes and sub-themes were recorded and reported.ResultsThree broad themes emerged: experience with antimicrobial use in Uganda, barriers and facilitators to rational antimicrobial prescription and measures to address irrational antimicrobial use. Participants recognized that antibiotics are often used irrationally, prescribed even when there is uncertainty regarding clinical evidence for infection, and influenced by drug promoters, and noted high levels of antibiotic resistance. Patients’ symptoms and clinical signs, previous experience using antibiotics, fear of bad outcomes, patient demand and expectations, influence from senior colleagues, the turnaround time of clinical investigations and drug marketers were the barriers and facilitators to antimicrobial prescription. Prescribers also acknowledged the need to update clinical guidelines, set up hospital antibiograms, and provide continuous medical education on rational antimicrobial use.ConclusionsA complex interplay of intrinsic and extrinsic factors influences antibiotic prescribing decisions in this hospital. Targeted interventions through continuous education and training for prescribers, providing local prescription guidelines and antibiograms and implementing regulations on over-the-counter antibiotic sales are needed to implement robust antimicrobial stewardship programmes to curb antimicrobial resistance successfully.