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.
Background Artemisinin (ART) partial resistance has been reported in Southeast Asia and East Africa, but its population-level phenotypic dynamics remain poorly understood. We aimed to evaluate population-level changes in ART susceptibility in Plasmodium falciparum in Northern Uganda using an ex vivo quantitative ring-stage survival assay (qRSA), which assesses parasite survival across 7 serial dihydroartemisinin (DHA) concentrations.Methods We conducted repeated cross-sectional surveys in 2014, 2015, 2022, and 2024 in Gulu, Northern Uganda. Ex vivo qRSA was used to compare parasite survival across DHA concentrations before and after the known emergence of ART partial resistance. qRSA resistance level was operationally defined as the highest DHA concentration at which the survival rate (SR) was >= 1%.Results A total of 323 participants with uncomplicated symptomatic P. falciparum monoinfection were enrolled. qRSA data were obtained from 156 samples. After the known emergence of ART partial resistance, low-level parasite survival persisted toward progressively higher DHA concentrations, resulting in a shift toward higher qRSA resistance levels. All pure kelch13 A675V isolates were classified at the highest qRSA resistance level (700 nM), whereas pure C469Y isolates were distributed across qRSA resistance levels from 87.5 to 700 nM. A similar, but less robust, shift was observed among kelch13 wild-type isolates, accompanied by increased SRs, particularly at 700 nM.Conclusions These findings suggest that the population-level shift in ART susceptibility was characterized by persistence of low-level survival toward higher DHA concentrations. Multiconcentration RSA may provide additional insights into early changes in ART susceptibility that are not captured by conventional binary resistance classifications. Using ex vivo quantitative ring-stage survival assay across 7 dihydroartemisinin concentrations, we identified a population-level shift toward reduced artemisinin susceptibility between 2014-2015 and 2022-2024 in Northern Uganda, even in kelch13 wild-type parasites.
BackgroundBody mass index does not capture regional fat distribution, which is now recognised as a stronger determinant of cardiometabolic and pulmonary function than total adiposity. Whether these associations are already detectable in apparently healthy young adults, and whether they extend to respiratory endurance, remains poorly characterised in sub-Saharan African populations.MethodsIn a cross-sectional study of 81 apparently healthy undergraduates (45 male, 36 females; aged 18–30 years) at the Federal University of Technology, Owerri, Nigeria, we measured waist circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and conicity index (ConI) alongside systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), resting heart rate (HR), and breath-holding time (BHT). Between-sex comparisons used independent-samples t-tests, corroborated by Mann-Whitney U tests after Shapiro-Wilk and Levene’s testing indicated departures from normality for several variables. Associations were examined using Spearman’s rank correlation, with sex-stratified analysis, exact coefficients and 95% confidence intervals (bootstrap, 10,000 resamples), and a significance threshold of p < 0.05. Multiplicity was controlled with the Benjamini-Hochberg false discovery rate (FDR, q < 0.05) applied consistently across both the nine between-sex comparisons and the correlation family; key associations were additionally tested by partial correlation adjusting for age and body mass index (BMI).ResultsWaist circumference did not differ by sex (80.54 ± 8.04 cm vs 79.00 ± 8.41 cm, p = 0.403), but WHR was significantly higher in males (0.85 ± 0.04 vs 0.80 ± 0.05, p < 0.001, surviving correction), indicating a more android fat distribution despite equivalent waist girth. Males had nominally higher SBP (122.04 ± 7.82 vs 118.25 ± 7.13 mmHg, p = 0.027) and longer BHT (43.02 ± 13.15 vs 36.94 ± 13.91 s, p = 0.047), neither surviving FDR correction (q = 0.076 and q = 0.092, respectively), whereas males had significantly lower resting HR than females at both thresholds (70.96 ± 10.68 vs 78.56 ± 11.40 bpm, p = 0.003, q = 0.014). Mann-Whitney U tests confirmed all between-sex conclusions except for WHtR, which reached nominal significance non-parametrically (U test p = 0.038) but not by t-test (p = 0.057); neither survived FDR correction. HR correlated positively with SBP in males (ρ = 0.325, nominal p = 0.030) but not females, and did not survive correction (q = 0.201). WHR correlated modestly and positively with BHT in males (ρ = 0.294, nominal p = 0.050), which likewise did not survive correction (q = 0.201) and weakened further after adjustment for age and BMI (partial ρ = 0.279, p = 0.063); no adiposity index correlated with BHT in females.ConclusionEven where absolute waist circumference is equivalent between sexes, WHR was robustly higher in males, consistent with a more android pattern of fat distribution. Sex differences in SBP and BHT, and a correlation between WHR and BHT in males, were observed at nominal significance but did not survive correction for multiple comparisons or adjustment for age and BMI; these findings are hypothesis-generating and require confirmation in an adequately powered study with objective pulmonary function testing before any claim of a sex-specific adiposity–respiratory relationship can be made. WHR may add information beyond BMI and waist circumference alone for early cardiometabolic screening, but this cross-sectional, single-centre dataset cannot establish the direction or mechanism of any association.
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
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.
