Uro Care Hospital

BackgroundUganda has the highest prevalence and incidence of cervical cancer in the East African region, with 80% of women diagnosed at advanced stage when survival is minimal. Literature on uptake of cervical cancer screening is limited in Uganda and thus womens' knowledge and uptake of cervical cancer screening in the general population remains unknown. This study examined this gap of knowledge among women aged 25-65 years, across rural, urban and semi urban communities in a Ugandan district to inform design of targeted future cervical cancer screening programs in the country.MethodsThis descriptive cross-sectional study was conducted in Wakiso district, Uganda in May 2024 among 783 eligible women. Face-to-face interviews were conducted. Uptake of cervical cancer screening (outcome of interest) was dichotomously (yes/no) assessed. Knowledge of cervical cancer disease was assessed using the AWACAN validated tool, knowledge of cervical cancer screening was assessed using a set of ten (10) questions adapted from previous studies elsewhere, and all were measured on a Likert scale. Univariate, bivariate, and multivariable Poisson regression models with robust variance were performed using Stata software version 17.ResultsRespondents' median age was 31 years (IQR 27-39 years). Majority (89.5%, 701/783) had heard of cervical cancer, and 90.6% (635/701) were aware of screening. Median knowledge score on signs and symptoms, risk factors and cervical cancer screening was 8.0 (IQR = 5-10), 8.0 (IQR = 5-11) and 7.0 (IQR = 4-10) respectively, and 54.3% had high knowledge about cervical cancer screening. Uptake of cervical cancer screening was 33.4%. Living in urban areas (aPR = 1.41, 95% CI: 1.05-1.88), being the ages 40-49 years (aPR = 1.76, 95% CI: 1.36-2.27), 50 years and above (APR = 2.16, 95% CI: 1.53-3.04), smoking (aPR = 1.39, 95% CI: 1.05-1.86), partner involvement (aPR = 2.61, 95% CI: 2.12-3.21), high knowledge about cervical cancer screening (aPR = 3.29, 95% CI: 2.35-4.60), and living with HIV (aPR = 1.66, 95% CI: 1.66-2.13) were significantly associated with higher uptake of cervical cancer screening among women in this setting.ConclusionKnowledge of cervical cancer screening was high, but the uptake of cervical cancer screening was lower than the recommended population coverage by WHO and Uganda national guidelines. There is need to improve accessibility to cervical cancer screening, increase nationwide cervical cancer awareness campaigns focusing on high-risk age groups and design targeted, tailored, culturally and socially sensitive interventions for young women aged 25-39 years to improve cervical cancer screening in Uganda.

Vitamin-D deficiency (VDD) is a global health concern. It is known to play a critical role in the immunomodulation, and thus, its metabolism could be investigated to unravel its contribution in common immune-mediated diseases, e.g., celiac disease (CD). Genotyping of SNPs from vitamin D receptor (VDR) gene, such as rs11568820 (Cdx2) and rs2228570 (Fok1) using allele specific multiplex polymerase chain reaction (ASM-PCR) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) respectively; and rs7041 and rs4588 of vitamin D binding protein (VDBP/GC) using PCR-RFLP were done in 969 subjects including CD cases (n=506) and controls (n=463). Genotype data for 86 CD and 712 controls for rs11568820 and rs7041 were retrieved from already published Immunochip genotype data. Serum concentration of vitamin-D and vitamin D binding protein (VDBP) were measured for 283 participants (98 CD and 185 controls). rs4588-A allele was identified as protective allele [OR=0.6(0.4-0.7), P<0.0001]. Significantly reduced serum level of vitamin-D was observed in CD patients [median=16.25 ng/mL, IQR (8.94-23.60)] than in controls [median=19.94 ng/mL, IQR (13.91-28.46)] with P=0.001. Notably, rs7041-GG, rs4588-CC, and 1F (GC) haplotype of VDBP/GC showed significant association (P<0.05) with reduced serum vitamin D level. We did not find any significant association with VDBP serum concentration. Significant vitamin D and VDBP level correlations were observed in controls (spearman r = 0.3, P=0.005). The present study highlights the significance of reduced vitamin-D serum level in CD. 1F variant of VDBP and lower vitamin-D levels contribute to CD. No correlation between vitamin-D and VDBP levels suggests that vitamin-D supplementation may improve vitamin-D levels but might not affect VDBP levels in CD subjects.

Introduction: Guideline-Directed Medical Therapies (GDMT) are evidence-based treatments recommended by clinical practice guidelines for the management of Cardiovascular Diseases (CVDs). While GDMT is foundational for treating Heart Failure (HF), its adoption promotes uniform, evidence-driven practices across various cardiovascular conditions. This therapy includes drug classes such as Beta-Blockers (BB), Angiotensin-Converting Enzyme inhibitors, Angiotensin-Receptor Blockers, and Angiotensin Receptor-Neprilysin Inhibitors (ACEi/ARB/ARNI), Mineralocorticoid Receptor Antagonists (MRAs), and Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i). Implementing GDMT can enhance cardiac function, improve quality of life and reduce hospitalisation and mortality risks. Aim: To understand the preferences of drug choice among Indian Healthcare Practitioners (HCPs) regarding the adaptation of GDMT in CVD management. Materials and Methods: A cross-sectional, questionnaire-based study was conducted in India from December 2022 to March 2023. Participants (n=93) included cardiologists, electrophysiologists and cardiophysicians, who were actively involved in managing CVD. A predefined questionnaire consisting of seven questions, developed from existing literature, guidelines and expert opinions, was used. Responses were digitally analysed, with descriptive statistics presented as numbers and percentages. Results: For hypertension management in Acute Coronary Syndrome (ACS), telmisartan (60.22%) was the most preferred ARB, followed by metoprolol (48.39%; BB), amlodipine (39.78%; Calcium Channel Blockers [CCB]), and torsemide (32.26%; diuretics). For patients with diabetes and ACS, SGLT2i (89.29%) were favoured. Clopidogrel (56.99%) was the preferred oral antiplatelet drug alongside aspirin in ACS. In Acute Decompensated HF (ADHF), the preferred sequential addition of GDMT includes loop diuretics (44.74%) as the first choice, followed by ARB, SGLT2i, and MRAs as subsequent choices. One in four HF patients was on ARNI (37.36%) and SGLT2i (35.62%), while three in four HF patients were on BB (36.99%) and ACEi/ARBs (34.28%). In HF patients on loop diuretics and MRAs, the preferred doses were torsemide 10 mg with spironolactone 25 mg (57.32%) and torsemide 10 mg with spironolactone 50 mg (37.80%). In addition to symptomatic treatment with loop diuretics in HF patients, 72.50% of HCPs preferred ARNI, and 35.0% preferred ARBs as combination therapy. Conclusion: ARBs and BBs were preferred for hypertension in ACS, while SGLT2i were favoured for diabetes. Clopidogrel was the most popular P2Y12 inhibitor in ACS. For HF, HCPs favoured sequential therapy, with loop diuretics and ACEi/ARBs as the first and second choices and preferred combinations of ARNI or ARBs with loop diuretics for symptomatic HF.

Introduction:Chronic limb-threatening ischemia (CLTI) can potentially result in limb loss without revascularization. Inframalleolar modifier (IM) is described in global vascular guidelines, but there are no studies correlating outcomes in relation to IM. This study is designed to understand the effect of pedal modifiers in predicting limb-based patency in patients with CLTI after revascularization.Materials and Methods:This prospective study included patients above 18 years of age with CLTI with the primary objective of assessing limb-based patency and technical success of revascularization in relation to pedal modifier staging. The study was designed to include the technical success of revascularization, limb-based patency, amputation-free survival, quality of life scores, and adverse cardiovascular events.Results:Fifty-eight patients were included. Of them 47 (81%) were male, and 11 (19%) were female. The mean age was 68.05 years (range: 52-87 years). Six patients were of Rutherford Category 4, 49 were Category 5, and 3 were Category 6. Preoperative Vascular Quality of Life questionnaire-6 score ranged from 6 to 17 with a mean of 11.38. Seven patients (12%) were in IM modifier stage P0, 43 (74%) were in P1, and 8 (13.7%) were in P2. Three patients were lost to follow-up, four patients died, one patient had reintervention, and one patient underwent below-knee amputation. Technical success was seen in 51 (87.9%) patients. Based on pedal modifiers, it was 7/7 (100%) for P0, 38/43 (88%) for P1, and 6/8 (75%) for P2. Overall amputation-free survival was in 51 (87.9%). It was 7/7 (100%) for P0, 38/43 (88%) for P1, and 6/8 (75%) for P2. Limb-based patency was seen in 49 (84.4%) patients with 6/7 (85.7%), 37/43 (86%), and 6/8 (75%) for P0, P1, and P2, respectively.Conclusions:Patients with a complete pedal arch (P0) have better amputation-free survival and limb-based patency following revascularization.