Master of Medicine in Internal Medicine

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    Electrocardiogram Pattern and Factors Associated with Abnormal Findings among Heart Failure Patients at Kampala International University Teaching Hospital, Ishaka, Uganda
    (Kampala International University, 2021-08) Yves Tibamwenda Bafwa
    Background: The prevalence of cardiovascular diseases is increasing rapidly in Sub-Saharan Africa. A multicenter prospective cohort study of 1,006 patients with acute heart failure in a Sub-Saharan Africa survey showed that 814 patients had ECGs readings among which 97.7% had abnormalities. There is paucity of data on ECG abnormalities among heart failure patients in many developing countries, Uganda inclusive. Methods: A descriptive cross sectional survey was conducted in six months at KIU-TH between January and March then completed between October and December 2020. The study recruited 122 heart failure patients. Questionnaires were administered to respondents to obtain factors associated with ECG abnormalities among heart failure patients. A 12-lead ECG machine was used to obtain ECG findings. Data were analyzed using univariate, bivariate and multivariate logistic regression analyses to determine the ECG pattern and factors associated with abnormal ECG findings among heart failure patients. Results: The mean age of study respondents was 63.4 ± 21 years and 57.4% of the respondents were females. The prevalence of ECG abnormalities among heart failure patients was 82.8 % (95% CI: 74.91-88.56). The main ECG abnormalities were left ventricular hypertrophy (24.6%), left bundle branch block (8.2%) and right bundle branch block (7.4%). The factors associated with ECG abnormalities were heart failure duration more than one year (aOR = 6.4, 95% CI: 1.14 – 35.53, p= 0.035), hypertension (aOR = 6.7, 95% CI: 1.45 – 31.24, p= 0.015) and being in NYHA functional class III and IV (aOR = 7.2, 95 % CI: 1.88 – 27.74, p=0.004). Conclusion: The prevalence of abnormal ECG among heart failure patients was very high. Respondents with heart failure duration of more than one year, hypertensive and those staged in NYHA functional classes III and IV had a higher risk of having abnormal ECG. Regular refresher training on use of ECG in the management of heart failure should be organized for clinicians. Routine health education on heart failure prevention measures, should be encouraged at triage centres of all health facilities by the Ministry of Health in Uganda.
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    Prevalence and Factors Associated with Electrocardiographic Abnormalities among Heart Failure Patients at Kampala International University Teaching Hospital, Ishaka, Uganda
    (Kampala International University, 2020-07) Yves Tibamwenda Bafwa
    Background: The prevalence of cardiovascular diseases is increasing rapidly in Sub-Saharan Africa. A multicenter prospective cohort study of 1,006 patients with acute heart failure in a Sub-Saharan Africa Survey showed that 814 patients had ECGs readings among which 97.7% had abnormalities. There is paucity of data on ECG abnormalities among heart failure patients in many developing countries, Uganda inclusive. Methods: A cross sectional study was conducted at KIU-TH between January and March 2020 which recruited 122 heart failure patients. Questionnaires were administered to respondents to obtain factors associated with ECG abnormalities. A 12-lead ECG machine was used to obtain ECG findings. Data were analyzed using bivariate and multivariate logistic regression analyses to establish the association between each independent variable and the ECG abnormalities. Results: The mean age of study respondents was 62.4 ± 20 years and 54.9% of the respondents were females. The prevalence of ECG abnormalities among heart failure patients was 86.1 % (95% CI: 78.6-91.2). The main ECG abnormalities were left ventricular hypertrophy (29.5%), left bundle branch block (12.4%) and right bundle branch block (11.4%). The factors associated with ECG abnormalities were age ≥ 50 years (aOR = 23.1, 95% CI: 1.81 – 294.33, p= 0.016), smoking (aOR = 23.6, 95% CI: 1.19 – 465.86, p= 0.038), hypertension (aOR = 11.9, 95% CI: 1.05 – 135.65, p= 0.046) and being in NYHA functional class III and IV (aOR = 168.7, 95 % CI: 6.85 – 4155.5, p=0.002). Conclusion: The prevalence of abnormal ECG among heart failure patients was very high. Respondents aged above 50 years, smokers, hypertensive and those staged in NYHA functional class III and IV were at high risk of having abnormal ECG. It is recommended that ECG test should be included as a routine test in the management of heart failure patients at KIU-TH, regular refresher training in ECG should be organized for clinicians. Routine health education on the dangers of alcohol misuse and smoking to the heart and other organs, should be encouraged at triage centres of all health facilities by the Ministry of Health in Uganda.
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    Identification, susceptibility pattern and factors associated with antibiotic resistance of bacterial pathogens in productive cough among adult patients attending Hoima Regional Referral Hospital
    (Kampala International University, 2024-01) Winnie Ezekiel Mwamtobe
    Background: Antibiotic resistance is one of the most pressing public health and societal issues of our time. This is complicated by a paucity of information regarding the patterns of bacterial pathogens, antibiotic susceptibility, and the factors associated with the emergence and spread of antibiotic resistance in patients with a productive cough in Uganda. Objective. To identify the bacterial pathogens and to determine the antibiotic susceptibility patterns of bacterial isolates and the associated factors in the sputum among patients with a productive cough in a regional referral hospital in Uganda. Methodology: A cross-sectional study involved 216 adult outpatients and employed standard questionnaires to determine the socio-demographic, lifestyle, and medical characteristics of the patients and microbiological tests to identify bacterial isolates and their antibiotic susceptibility. The relationship between patient factors and antibiotic resistance was determined by bivariate and multivariate logistic regression analyses. Results: Out of the 216 specimens collected, 139 (64.4%) demonstrated bacterial growth, with a few patient samples having more than one bacterial pathogen species. The most predominant bacteria isolate was Streptococcus pneumoniae (40.8%), followed by Staphylococcus aureus (28.6%), Klebsiella pneumoniae (12.2%), Streptococcus pyogenes (10.2%), Streptococcus viridans (3.4%), Pseudomonas aeruginosa (2%), Moraxella catarrhalis (1.4%), and Haemophilus influenza (1.4%). Most bacterial isolates were sensitive to imipenem (75.5%), ceftazidime (66.7%), and cefepime (58.5%), and the least sensitivity was observed to ampicillin (9.5%), amoxicillin (9.5%), and chloramphenicol (19%). Factors that were significantly associated with antibiotic resistance were smoking (aOR=2.89, 95%CI=1.074-7.784, P =0.036), and antibiotic use (aOR=2.65, CI=1.103-6.369, P =0.029). Conclusion: Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae were the most dominant bacterial isolates in outpatients with a productive cough at Hoima Regional Referral Hospital. The isolates were most susceptible to ceftazidime and imipenem, while resistant to ampicillin and amoxicillin. The antibiotic resistance was significantly associated with smoking and antibiotic use. Molecular studies are needed to understand the mechanisms of antibiotic resistance.