scholarly journals Which clinical parameters predict a positive CSF diagnosis of meningitis in a population with high HIV prevalence?

2014 ◽  
Vol 15 (2) ◽  
pp. 50-54 ◽  
Author(s):  
Will Loughborough ◽  
Louisa Jones ◽  
Michael Abouyannis ◽  
Sharadh Garach
Keyword(s):  
South African ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Clinical Predictors ◽  
Cd4 Cell Count ◽  
Presenting Symptoms ◽  
Resource Limited ◽  
High Incidence ◽  
Sub Saharan ◽  
Cd4 Cell

Background. The HIV epidemic has changed the aetiology of meningitis in sub-Saharan Africa, and frontline clinicians are faced with a variety of meningitic presentations. Doctors working in resource-limited settings have the challenge of appropriately selecting patients for lumbar puncture (LP), a potentially risky procedure that requires laboratory analysis. Methods. In a rural South African hospital, the practice of performing LPs was audited against local guidelines. Data were collected retrospectively between February and June 2013. Symptoms and signs of meningitis, HIV status, investigations performed prior to LP and cerebrospinal fluid (CSF) results were recorded. With the aim of determining statistically significant clinical predictors of meningitis, parameters were explored using univariate and multivariate logistic regression analyses.Results. A total of 107 patients were included, of whom 43% had an abnormal CSF result. The majority (76%) of patients were HIV-positive (CD4+ cell count <200 cells/µl in 46%). Cryptococcal meningitis (CCM) was the most prevalent microbiological diagnosis, confirmed in 10 out of 12 patients. Of the non-microbiological diagnoses, lymphocytic predominance was the most common abnormality, present in 17 out of 33 patients. Confusion (p=0.011) was the most statistically significant predictor of an abnormal CSF result. Headache (p=0.355), fever (p=0.660) and photophobia (p=0.634) were not statistically predictive.Conclusion. The high incidence of CCM correlates with previous data from sub-Saharan Africa. In populations with high HIV prevalence, the classic meningitic symptoms of headache, fever and photophobia, while common presenting symptoms, are significantly less predictive of a meningitis diagnosis than confusion.

scholarly journals Validity of hemoglobin A1c for diagnosing diabetes among people with and without HIV in Uganda

2019 ◽  
Vol 30 (5) ◽  
pp. 479-485
Author(s):  
James Muchira ◽  
Eileen Stuart-Shor ◽  
Jen Manne-Goehler ◽  
Janet Lo ◽  
Alexander C Tsai ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Fasting Blood Glucose ◽  
High Specificity ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Sub Saharan ◽  
And Gender ◽  
Living With Hiv ◽  
Cd4 Cell

Sub-Saharan Africa (SSA) is facing a growing co-epidemic of chronic HIV infection and diabetes. Hemoglobin A1c (A1c) may underestimate glycemia among people living with HIV (PLWH). We estimated the validity of A1c to diagnose diabetes among PLWH and HIV-uninfected persons in rural Uganda. Data were derived from a cohort of PLWH and age- and gender-matched HIV-uninfected comparators. We compared A1c to fasting blood glucose (FBG) using Pearson correlations, regression models, and estimated the sensitivity and specificity of A1c for detecting diabetes with FBG ≥126 mg/dL as reference standard. Approximately half (48%) of the 212 participants were female, mean age of 51.7 years (SD = 7.0) at enrollment. All PLWH (n = 118) were on antiretroviral therapy for a median of 7.5 years with mean CD4 cell count of 442 cells/µL. Mean FBG (89.7 mg/dL) and A1c (5.6%) were not different between PLWH and HIV-uninfected ( P > 0.50) groups, but the HIV-uninfected group had a higher prevalence of A1c >5.7% (33% vs. 20%, P = 0.024). We found a relatively strong correlation between A1c and FBG (r = 0.67). An A1c ≥6.5% had a poor sensitivity (46%, 95% CI 26–67%) but high specificity (98%, 95% CI 96–99%) for detecting diabetes. More work is needed to define an optimal A1c for screening diabetes in SSA.

scholarly journals The Impact of Human Pegivirus on CD4 Cell Count in HIV-Positive Persons in Botswana

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Kombo F N’Guessan ◽  
Motswedi Anderson ◽  
Bonolo Phinius ◽  
Sikhulile Moyo ◽  
Alyyah Malick ◽  
...  
Keyword(s):  
Cell Count ◽  
Disease Progression ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Hiv Disease ◽  
Genotype 1 ◽  
Cd4 Cell Count ◽  
Resource Limited ◽  
Genotype 5 ◽  
Cd4 Cell

Abstract Background Human pegiviruses (HPgV)—formerly known as hepatitis G virus or GB virus C (GBV-C)—are common single-stranded RNA viruses that may have a beneficial impact on slowing HIV disease progression. The data on HPgV in resource-limited regions such as Sub-Saharan Africa are scarce. Thus, we conducted the first study of HPgV in Botswana as part of a natural history study of HIV subtype C disease progression. Methods Plasma samples from 133 HIV-positive adults were evaluated for HPgV RNA, and the 5’UTR was sequenced to determine the HPgV genotype. Results HPgV RNA was detected in 41 (30.8%) individuals. While the presence of HPgV RNA had no impact on baseline HIV viral load, a significant difference in baseline CD4 cell count was observed. HPgV genotypes were determined for 27 individuals and included 5 individuals (18.5%) with genotype 1 and 22 (81.5%) with genotype 5. Baseline CD4 cell counts were significantly higher for persons infected with HPgV genotype 5 compared with genotype 1. Conclusions These data suggest that HPgV infection is common among HIV-positive individuals in Botswana and has a significant impact on CD4 cell count. This difference in CD4 cell count based on HPgV genotype suggests that HPgV genotype should be evaluated as a possible predictor of HIV disease progression and highlights the need for additional studies of this virus in resource-limited settings.

Response to ???CD4 Cell Count Natural History and Informative Censoring in Sub-Saharan Africa???

2007 ◽  
Vol 44 (4) ◽  
pp. 491
Author(s):  
Charles B Holmes ◽  
Robin Wood ◽  
Gary Maartens ◽  
Kenneth A Freedberg ◽  
Elena Losina
Keyword(s):  
Natural History ◽  
Cell Count ◽  
Informative Censoring ◽  
Sub Saharan Africa ◽  
Cd4 Cell Count ◽  
Sub Saharan ◽  
Cd4 Cell

scholarly journals Conservation research output in sub-Saharan Africa is increasing, but only in a few countries

Oryx ◽  
2020 ◽  
pp. 1-10
Author(s):  
P. Christy Pototsky ◽  
Will Cresswell
Keyword(s):  
South African ◽  
Agricultural Land ◽  
Research Output ◽  
Sub Saharan Africa ◽  
Search Term ◽  
African Countries ◽  
Research Papers ◽  
North American Country ◽  
Conservation Research ◽  
Sub Saharan

Abstract We tested if peer-reviewed conservation research output has increased in sub-Saharan African countries over the last 30 years in response to increased development. We carried out a bibliometric analysis to identify the number of conservation research papers published by national authors of 41 sub-Saharan African countries during 1987–2017, to provide an index of national conservation research output. We identified country-specific development factors influencing these totals, using general linear modelling. There were positive relationships between conservation research output and population size, GDP, literacy rate, international tourism receipts and population growth rate, and negative relationships with urban population and agricultural land cover, in total explaining 77% of variation. Thirty-eight per cent of countries contributed < 30 conservation research papers (of 12,701) in 30 years. Analysis of trends in primary authorship in a random subsample of 2,374 of these papers showed that primary authorship by sub-Saharan African authors has increased significantly over time but is now at a lower rate than primary authorship for authors from countries outside the country associated with the search term, usually a European or North American country. Overall, 46% of papers had national primary authors, but 67% of these were South African. The results show that conservation research output in sub-Saharan Africa overall is increasing but only significantly in a few countries, and is still dominated by non-national scientists, probably as a result of a lack of socio-economic development.

scholarly journals Building sustainable research capacity at higher learning institutions in Tanzania through mentoring of the Young Research Peers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emmanuel Balandya ◽  
Bruno Sunguya ◽  
Daniel W. Gunda ◽  
Benson Kidenya ◽  
Tumaini Nyamhanga ◽  
...  
Keyword(s):  
Undergraduate Students ◽  
Professional Education ◽  
Research Training ◽  
Peer To Peer ◽  
Sub Saharan Africa ◽  
Ongoing Research ◽  
Scientific Presentation ◽  
Resource Limited ◽  
Sub Saharan ◽  
Young Researchers

Abstract Background Sustainability of research culture in Sub-Saharan Africa is threatened in part by the lack of a critical mass of young researchers with the requisite skills and interest to undertake research careers. This paper describes an intensive mentorship programme combining hierarchical (vertical) and peer-to-peer (horizontal) mentoring strategies among young researchers in a resource limited setting in Sub-Saharan Africa. Methods A consortium of three partnering large Tanzanian health training institutions (MUHAS, CUHAS and KCMUCo) and two collaborating US institutions (UCSF and Duke University) was formed as part of the five-year Transforming Health Professions Education in Tanzania (THET) project, funded by the NIH through Health Professional Education Partnership Initiative (HEPI). Within THET, the Community of Young Research Peers (CYRP) was formed, comprising of inter-professional and cross-institutional team of 12 Master-level Young Research Peers and 10 co-opted fellows from the former MEPI-Junior Faculty (MEPI-JF) project. The Young Peers received mentorship from senior researchers from the consortium through mentored research awards and research training, and in turn provided reciprocal peer-to-peer mentorship as well as mentorship to undergraduate students. Results At the end of the first 2 years of the project, all 12 Young Peers were proceeding well with mentored research awards, and some were at more advanced stages. For example, three articles were already published in peer reviewed journals and two other manuscripts were in final stages of preparation. All 12 Young Peers participated in CYRP-wide thematic training workshops on mentoring and secondary data analysis; 11 had undertaken at least three research training short courses in identified areas of need; 9 joined at least one other ongoing research project; 5 made at least one scientific presentation, and 5 participated in at least one submitted grant application. Half of the Young Peers have enrolled in PhD programmes. A collective total of 41 undergraduate students were actively mentored by the Young Peers in research. Conclusion The CYRP has demonstrated to be an effective model for dual vertical and horizontal mentorship in research to young investigators in resource-limited settings. This model is recommended to educators working on developing research competence of early career researchers, particularly in Sub-Saharan Africa.

scholarly journals Estimating the burden of cardiovascular risk in community dwellers over 40 years old in South Africa, Kenya, Burkina Faso and Ghana

2021 ◽  
Vol 6 (1) ◽  
pp. e003499
Author(s):  
Ryan G Wagner ◽  
Nigel J Crowther ◽  
Lisa K Micklesfield ◽  
Palwende Romauld Boua ◽  
Engelbert A Nonterah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
South African ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Cvd Risk ◽  
Genomic Studies ◽  
Sub Saharan ◽  
Context Specific ◽  
The Impact

IntroductionCardiovascular disease (CVD) risk factors are increasing in sub-Saharan Africa. The impact of these risk factors on future CVD outcomes and burden is poorly understood. We examined the magnitude of modifiable risk factors, estimated future CVD risk and compared results between three commonly used 10-year CVD risk factor algorithms and their variants in four African countries.MethodsIn the Africa-Wits-INDEPTH partnership for Genomic studies (the AWI-Gen Study), 10 349 randomly sampled individuals aged 40–60 years from six sites participated in a survey, with blood pressure, blood glucose and lipid levels measured. Using these data, 10-year CVD risk estimates using Framingham, Globorisk and WHO-CVD and their office-based variants were generated. Differences in future CVD risk and results by algorithm are described using kappa and coefficients to examine agreement and correlations, respectively.ResultsThe 10-year CVD risk across all participants in all sites varied from 2.6% (95% CI: 1.6% to 4.1%) using the WHO-CVD lab algorithm to 6.5% (95% CI: 3.7% to 11.4%) using the Framingham office algorithm, with substantial differences in risk between sites. The highest risk was in South African settings (in urban Soweto: 8.9% (IQR: 5.3–15.3)). Agreement between algorithms was low to moderate (kappa from 0.03 to 0.55) and correlations ranged between 0.28 and 0.70. Depending on the algorithm used, those at high risk (defined as risk of 10-year CVD event >20%) who were under treatment for a modifiable risk factor ranged from 19.2% to 33.9%, with substantial variation by both sex and site.ConclusionThe African sites in this study are at different stages of an ongoing epidemiological transition as evidenced by both risk factor levels and estimated 10-year CVD risk. There is low correlation and disparate levels of population risk, predicted by different risk algorithms, within sites. Validating existing risk algorithms or designing context-specific 10-year CVD risk algorithms is essential for accurately defining population risk and targeting national policies and individual CVD treatment on the African continent.

Multiple, large intra-abdominal cystic lesions and iron deficiency anaemia as the presenting symptoms of SDHD gastrointestinal stromal tumour (GIST) in a young sub-Saharan woman

2021 ◽  
Vol 14 (9) ◽  
pp. e242146
Author(s):  
Nyenyeri Lieve Darlene ◽  
Niyomwungeri Reverien ◽  
Dirk J J van Leeuwen ◽  
Deo Ruhangaza
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Gastrointestinal Stromal Tumour ◽  
Stromal Tumour ◽  
Sub Saharan Africa ◽  
Cystic Lesions ◽  
Long Term Outcome ◽  
Deficiency Anaemia ◽  
Presenting Symptoms ◽  
Sub Saharan

We report the case of a 27-year-old female patient from sub-Saharan Africa who presented with non-specific abdominal complaints, iron deficiency anaemia and multiple, large intra-abdominal cystic lesions on imaging. The lesions appeared to be a most unusual presentation of gastrointestinal stromal tumour (GIST). GIST is a sarcomatous tumour that comprises only 0.2% of all gastrointestinal (GI) tumours; it is the most common mesenchymal malignancy of the GI tract. Our patient had the succinate dehydrogenase-deficient (SDHD) subtype, identified in some 5%–10% of patients with GIST only, commonly found in women and younger patients. The differential diagnosis of intra-abdominal cystic lesions is briefly discussed, including the relevance of a correct pathological diagnosis. This impacts medical and surgical management decisions, including predicting response to targeted therapy. Tyrosine kinase inhibitor therapy has been a breakthrough in the treatment of GISTs, although with extensive disease, and certainly in case of the SDHD subtype, long-term outcome remains disappointing.

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