Background: In developing countries like Uganda, the burden of stroke is growing and causing significant morbidity and disability with high mortality rates. Neuroimaging is required to differentiate ischemic stroke from an intracerebral hemorrhage, as well as to diagnose entities other than stroke. Therefore, understanding the clinico-demographic features and brain Computed Tomography (CT) findings of stroke as well as their correlation is of utmost value in stroke management. Hence, this study sought to determine the clinical and brain CT scan findings of stroke patients attending selected centers in Kampala. Mention ASPECTS briefly Methods: This was a cross-sectional study of clinically suspected stroke patients at three selected hospitals in Kampala, Uganda. All brain CT scans of patients with suspected stroke were evaluated and The Alberta stroke programme early CT score (ASPECTS) a 10-point quantitative topographic CT scan score used for middle cerebral artery (MCA) stroke patients. Data on the clinical-demographic and cranial CT findings were collected, and entered into REDCap software. Univariate analysis was used to describe the clinico-demographic and cranial CT features of stroke and summarized them as percentages. Further analysis was done at bivariate and multivariate levels to determine the adjusted odds ratios as a measure of association with a 95% confidence interval. Results: Of the 270 study participants,141(52.2%) were male. 162(60%) had CT findings of stroke, and 90(33.3%) had normal cranial CT findings. While 18(6.7%) had other CT findings like a tumor, dural hemorrhage, epidermoid cyst, and others. The ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage accounted for 124(45.9%), 34(12.6%), and 4(1.5%) respectively. Limb weakness (55.2%), headache (41.1%), and loss of consciousness (39.3%) were associated with stroke findings on CT. Among the acute ischemic strokes, 30(73.2%) had a worse (0-7) ASPECT score. Those aged ≥65 years were associated with a worse ASPECTS [AOR: 22.01, (95%CI:1.58-306.09) p-value =0.021]. Conclusion: Currently, non-contrasted brain CT is the first line imaging modality for diagnosis, differentiation of the stroke types, patient management, treatment, and timely referral to a stroke center. The clinical diagnosis of stroke is inadequate to exclude other stroke mimics. Hypertension and advanced age are the most prevailing risk factors attributed to both ischemic and hemorrhagic stroke and patients over 65 years were associated with a worse ASPECT score.
Background Tamoxifen therapy is an effective and mainstay adjuvant treatment for estrogen-positive breast cancer patients. However, it has partial estrogen receptor agonist activity that causes hypercoagulation of blood and consequently venous thrombus formation. Patients who are being treated with tamoxifen require monitoring, because of the increased risk for developing deep venous thrombosis (DVT) and pulmonary embolism that could increase morbidity and mortality if left undiagnosed. This study sought to determine the prevalence and associated factors of lower limb DVT among breast cancer patients on tamoxifen, in Uganda. Methods This was a cross-sectional study done among patients receiving tamoxifen therapy who attended the breast clinic at the Uganda Cancer Institute. Clinical evaluation, mean platelet volume (MPV) and bilateral lower limb compression and Doppler ultrasound scans were done to screen for DVT. Univariate analysis was used to summarize continuous variables as mean and corresponding standard deviations, and categorical variables as proportions. Results Of the 180 participants, 170 (94.4%) were females, 141 (78.3%) were below 60 years. More than 95% were neither diabetic nor smokers and 163 (90.6%) of them had a BMI of < 35Kg/m2. The prevalence of DVT was 0.6%. The statistical significance of the associated factors could not be elucidated at bivariate or multivariate analysis due to the very low prevalence of DVT. Conclusion The prevalence of DVT among breast cancer patients on tamoxifen at the Uganda cancer institute was very low (0.6%). The patients with normal MPV findings are unlikely to have DVT despite the intermediate risk on clinical assessment, therefore a routine sonographic examination for younger Ugandan patients on tamoxifen may not be necessary.
Background and Aims: In developing countries, the burden of stroke is growing and causing significant morbidity and disability with high mortality rates. Neuroimaging plays a crucial role in differentiating ischemic stroke from an intracerebral hemorrhage, as well as entities other than stroke. This study sought to determine the correlation between the clinical and brain CT scan findings of stroke patients attending three hospitals in Kampala, Uganda.Methods: This was a cross-sectional study of clinically suspected stroke patients who were sent for brain CT scan at three selected hospitals in Kampala, Uganda. All brain CT scans of patients with suspected stroke were evaluated and the Alberta stroke program early CT score (ASPECTS) was used for middle cerebral artery (MCA) strokes. Univariate analysis was used to describe the clinico-demographic and brain CT features of stroke and summarized them as percentages. Bivariate and multivariate analysis were used to determine the adjusted odds ratios as a measure of association with a 95% confidence interval (CI).Results: Of the 270 study participants, 141 (52.2%) were male. 162 (60%) had CT findings of stroke, and 90 (33.3%) had normal brain CT findings. Eighteen (6.7%) had other CT findings like tumor, dural hemorrhage, epidermoid cyst, and others.Ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage accounted for 124 (45.9%), 34 (12.6%), and 4 (1.5%) respectively. Limb weakness (55.2%), headache (41.1%), and loss of consciousness (39.3%) were associated with stroke findings on CT. Among the acute ischemic strokes, 30 (73.2%) had a worse (0-7) ASPECT score. Those aged ≥65 years were associated with a worse ASPECTS [AOR: 22.01, (95% CI: 1.58-306.09) p = 0.021]. Conclusion: More than a third of patients with a clinical diagnosis of stroke had either no CT features of stroke or had other findings. The most commonly affected vascular territory was left MCA. Old age was strongly associated with having the worst ASPECTS score.
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