St. Mary's Hospital Lacor, commonly referred to as Lacor Hospital, is a hospital in Gulu District, Northern Uganda. It was founded by Comboni Missionaries and is administered and managed by Roman Catholic Archdiocese of Gulu.
Background: Kounis syndrome is an acute coronary syndrome triggered by allergic or hypersensitivity reactions, mediated by inflammatory cascades and mast cell activation. It can manifest as coronary vasospasm, plaque rupture, or stent thrombosis. Electrocardiographic presentations vary and may mimic ST-elevation myocardial infarction, occasionally with atypical features such as atrial fibrillation or extreme ST-segment elevation patterns. Case Presentation: We report a case of an adult African patient who developed acute chest pain, hypotension, and localized allergic manifestations (pruritus and soft tissue swelling at sting sites) following multiple bee stings. Notably, no generalized urticaria or angioedema was observed. Electrocardiography revealed atrial fibrillation with a "shark-fin" ST elevation pattern, a combination not previously reported in an African patient with Kounis syndrome suggestive of extensive myocardial ischemia. Emergent management included hydrocortisone, diphenhydramine, epinephrine infusion, and intracoronary nitroglycerin. Coronary angiography and clinical evolution supported a diagnosis of coronary vasospasm highly consistent with type I Kounis syndrome, in the absence of confirmatory biomarker testing. Discussion: Kounis syndrome remains underrecognized, particularly in low-resource settings. The coexistence of atrial fibrillation and shark-fin ST elevation is rare and represents the distinguishing novelty of this case; it may lead to misdiagnosis as primary myocardial infarction or ventricular tachycardia. The confounding role of exogenous epinephrine administered during resuscitation must be acknowledged in interpreting the angiographic findings. Allergic mediators such as histamine and leukotrienes can induce coronary vasospasm and electrical instability. Early recognition is critical, as management requires simultaneous treatment of both allergic and cardiac components. Conclusion: Kounis syndrome should be considered in patients presenting with acute coronary syndromes in the context of allergic triggers such as bee stings. The simultaneous occurrence of atrial fibrillation and shark-fin ST elevation is a rare, diagnostically challenging presentation. Prompt recognition and dual-pathway management can improve outcomes.
Human immunodeficiency virus (HIV)-exposed infants face elevated risks of neonatal sepsis, influenced by maternal antiretroviral therapy (ART) regimens. Dolutegravir (DTG), a widely used integrase transfer inhibitor (INSTI), and the preferred first line drugs for management of HIV in pregnancy, has shown potential adverse effects such as hyperglycaemia, which may impact neonatal outcomes including risk of neonatal sepsis. We estimated the pooled incidence of neonatal sepsis among neonates exposed to INSTIs in utero compared to non-INSTIs-based ART regimens. A systematic review and meta-analysis were conducted following written as per the PRISMA guidelines. Databases including PubMed/MEDLINE, Embase, Cochrane Library, CINAHL, Global Health and Global Index Medicus were searched for studies published between January 2013 and September 2025. Eligible studies included clinical trials and cohort studies comparing INSTI-based ART regimens with non-INSTI regimens among pregnant women living with HIV. Data were extracted using Covidence software, Cochrane risk of bias (RoB) and Newcastle-Ottawa Scale (NOS) were used to assessed for quality of randomised clinical trials and observational studies, respectively. The certainty of the evidence was assessed using the Grading, Recommendation, Assessment, Development and Evaluation (GRADE) framework. A total of 714 studies were identified and screened based on their titles and abstracts, of which 63 articles underwent full-text review. Ultimately, four studies, comprising 7,636 participants, met the predefined eligibility criteria and were included in the analysis. The pooled odds ratio (OR) for neonatal sepsis among infants exposed to INSTIs was 0.44 (95
Abstract Background Acute acalculous cholecystitis (AAC) is an inflammatory gallbladder disease occurring in the absence of gallstones. It typically presents with right upper quadrant (RUQ) pain, fever and gastrointestinal symptoms, and is diagnosed by ultrasound evidence of cholecystitis without gallstones. AAC can have multiple causes, including infections, with malaria only rarely reported. Case presentations We describe four Ugandan children who developed malaria-associated AAC. They were all referred from other centers and presented at a more advanced stage of disease. Apart from AAC, they also presented blackwater fever (BWF) and severe acute kidney injury (AKI), complications increasingly recognized in malaria. AAC was managed conservatively, while two patients required dialysis for kidney failure. All patients ultimately recovered both gallbladder and renal function. Conclusions We provide a review of the literature on malaria-associated AAC, which identified 28 previously reported cases, only 7 in children. Most reported patients contracted the infection in malaria-endemic regions but were then managed in high-income countries. The majority were managed conservatively and had favorable outcomes. Including our series, 32 cases (11 pediatric) have now been reported. Our findings suggest that AAC, which can often occur in association with BWF and AKI, is likely underrecognized in malaria-endemic regions. Heightened clinical awareness and early assessment are important, and practical management recommendations are provided.
Background Hepatocellular carcinoma (HCC) patients are often diagnosed with advanced-stage disease. We aimed to identify care-seeking patterns, assess correlates of earlier diagnosis and determine the impact of diagnostic delay on mortality among HCC patients.Methods Cross-sectional study, enrolled (March 2015 to August 2020), HCC patients in three Ugandan tertiary care hospitals. Time to HCC diagnosis was the duration between the onset of the first reported symptom(s) and ultrasound-based diagnosis. We used negative binomial regression to estimate incidence rate ratios (IRRs) for correlates of time to HCC diagnosis and Kaplan-Meier survival curves for time-to-death analysis.Results Of 651 HCC patients, 442 (67.9%) were male, median age 43 years (IQR 32–56). Majority 97.7% sought healthcare for HCC-related symptoms prior to enrolment; 248 (38.1%) once and 388 (59.6%) two or more times. These included public facilities (442, 69.4%), private facilities (493, 77.5%) and traditional and complementary medicine practitioners (140, 22%); 45 patients (6.9%) visited all three types at least once. Median time to HCC diagnosis was 90 days (IQR 58–173). Shorter time to HCC diagnosis was associated with male sex (IRR 0.84; 95% CI 0.71 to 0.99; p=0.04), chronic hepatitis B (IRR 0.78; 95% CI 0.66 to 0.93), HIV (IRR 0.64; 95% CI 0.51 to 0.79) and having at least secondary education (IRR 0.83; 95% CI 0.69 to 0.99). Longer time to HCC diagnosis was associated with age ≥50 years (IRR 1.29; 95% CI 1.02 to 1.64) and attending multiple facilities (IRR 2.20; 95% CI 1.54 to 3.00). Time to HCC diagnosis was not significantly associated with survival.Conclusion Diagnostic pathways for HCC in Uganda are characterised by repeated healthcare visits across multiple provider types. Strategies to improve outcomes should promote timely care-seeking, strengthen surveillance of high-risk individuals and improve diagnostic capacity and coordination of care within the pluralistic healthcare system.
Background: Pericardial effusion is a recognized manifestation of overt hypothyroidism, but progression to cardiac tamponade is rare. In tuberculosis-endemic settings, diagnostic focus often favors tuberculous pericarditis, risking delayed recognition of reversible endocrine causes. Case Presentation: A 65-year-old Black African woman from Northern Uganda presented with five months of progressive dyspnea, orthopnea, and generalized edema, followed by acute pleuritic chest pain. She had a history of hypertension and type 2 diabetes mellitus. No prior thyroid disease, tuberculosis, malignancy, or rheumatologic condition was identified. Examination revealed marked sinus bradycardia (42 beats/min), elevated jugular venous pressure, muffled heart sounds, pulsus paradoxus, and Woltman's sign. The thyroid gland was diffusely enlarged without palpable nodules or cervical lymphadenopathy. Electrocardiography showed low-voltage QRS complexes. Transthoracic echocardiography demonstrated a large circumferential pericardial effusion (maximal posterior separation 3.2 cm) with right ventricular diastolic collapse and Doppler evidence of tamponade physiology, and a mildly reduced left ventricular ejection fraction of approximately 40%, with diffuse hypokinesis and no regional wall motion abnormalities, making ischemic cardiomyopathy less likely. Urgent pericardiocentesis drained 520 mL of clear, straw-colored fluid. Pericardial fluid analysis showed elevated total protein (4.2 g/dL; serum protein 7.0 g/dL; fluid-to-serum ratio 0.6), moderately elevated lactate dehydrogenase (below 1000 U/L), low adenosine deaminase (<5 U/L), and negative mycobacterial studies, making tuberculous pericarditis unlikely. Thyroid function tests confirmed severe primary hypothyroidism (thyroid-stimulating hormone 88.08 mIU/L; free thyroxine 4.0 pmol/L) with positive anti-thyroid peroxidase antibodies, consistent with autoimmune thyroiditis. Low-dose levothyroxine was initiated with gradual titration. Hemodynamic status improved immediately after pericardiocentesis. Follow-up echocardiography showed complete resolution of the effusion, and the patient achieved biochemical euthyroid within three months. Conclusion: Severe primary hypothyroidism should be routinely considered in patients with unexplained pericardial effusion, even in tuberculosis-endemic settings. Paradoxical bradycardia in tamponade, Woltman's sign, low-voltage electrocardiography, and a protein-rich pericardial effusion with low adenosine deaminase are important diagnostic clues. Prompt pericardiocentesis treats hemodynamic compromise, while cautious levothyroxine replacement prevents recurrence.
