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Wekiya E, Mujuzi GP, Nakiyingi J, Sanya J, Matovu M, Guido O, Nakaweesi J, Karamagi C, Nakayaga JK, Mutebi EI, Nakanjako D. The clinical utility of cystatin C based eGFR in assessing renal function among HIV/AIDs patients on ART at Mildmay Uganda. BMC Nephrol 2024; 25:144. [PMID: 38654183 PMCID: PMC11036554 DOI: 10.1186/s12882-024-03581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In clinical practice, Measurement of estimated glomerular filtration rates (eGFR) is the gold standard assessing renal function the glomerular filtration rate often estimated from plasma creatinine. Several studies have shown Cystatin C based eGFR (Cys C) to be a better parameter for the diagnosis of impaired renal function. Cystatin C based eGFR has been proposed as a potential renal function marker but its use in HIV&AIDS patients has not been well evaluated. METHODS A cross sectional study was carried out on 914 HIV&AIDS patients on antiretroviral therapy (ART) attending Mildmay Uganda for care and treatment between January to March 2015. Serum Cystatin C based eGFR was measured using the particle enhanced immunoturbidimetric assay. Creatinine was analyzed using enzymatic Creatinine PAP method and creatinine clearance was calculated according to C&G. RESULTS The sensitivity of Cystatin C based eGFR was 15.1% (95% CI = 8.4, 24) with specificity 99.3% (95% CI = 98- 99.7). The positive and negative predictive values were 70.0% (95% CI 45.7-88.1) and 91.2% (95% CI 98.11-92.94) respectively. The positive likelihood ratio was 18.81 and negative likelihood ratio was 0.85. Cystatin C based eGFR had diagnostic accuracy of 90.7 and area under curve was 0.768. CONCLUSION Cystatin C based eGFR exhibited a high specificity and a high positive likelihood ratio in diagnosis of kidney disease among HIV&AIDS patients. Cystatin C based eGFR can be used as a confirmatory test.
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Affiliation(s)
- Enock Wekiya
- Mildmay Uganda, P.O Box 24985, Kampala, Uganda.
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Godfrey P Mujuzi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | | | - Moses Matovu
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ocung Guido
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | - Charles Karamagi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Joan K Nakayaga
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Edrisa I Mutebi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Damalie Nakanjako
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Dorothy N, Niringiyimana B, Enock W, Guido O, Joel K, Isa A, Katuramu A, Beatrice O, Korsah CN, Kyomugasho L, Oola D, Musisi K, Kim E, Yu N, Kaliisa R, Lee Y, Kim B, Ronald S, Kiwanuka N, Achilles K, Joloba ML. Evaluating the effectiveness of Uganda's Supranational TB Reference Laboratory quality management system training program. Hum Resour Health 2023; 21:89. [PMID: 37990265 PMCID: PMC10664520 DOI: 10.1186/s12960-023-00876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Achieving the targeted organizational goals through effective training can increase employee satisfaction. Since 2015, the Supranational Reference Laboratory Uganda (SRL Uganda) has trained National Tuberculosis Reference Laboratories (NTRLs) from 21 countries in a variety of areas that cover both technical and programmatic aspects pertinent to TB laboratories. The Laboratory Quality Management System (LQMS) under SRL coordinates actions intended to ensure sustained quality of the laboratory services offered by the National TB Reference Laboratories. In order for laboratory results to be helpful in a clinical or public health setting, they must be accurate, reliable, and timely. The LQMS course aims to provide learners with knowledge on how to attain and maintain this quality. Prior to this study, there was hardly any data available on the effectiveness of LQMS trainings provided by SRL Uganda; using Kirkpatrick model, which is popular among researchers for evaluating the efficacy of the training program, this paper seeks to establish the effectiveness of the LQMS training offered by the SRL Uganda. METHOD We evaluated the effectiveness of LQMS training within the Uganda's SRL network for courses offered during the period 2017 and 2021 for participants from the Southern and East African sub-Saharan region. RESULTS In 2017 and 2021, respectively, test results from 10/17 and 9/17 showed overall post-test scores above 80%. Of the 18 labs evaluated, 14 showed improvement; of these, 7 labs were from the Eastern region and the other 7 were from Southern Africa; one facility in this region also maintained its accreditation. In the post-evaluation assessment, attendees of the LQMS course gave feedback of strongly agree and agree variety. CONCLUSION More SRL Uganda network laboratories in the regions achieved a 5-star SLIPTA level rating and among these, 5 NTRLs got ISO 15189:2012 accredited by the end of 2021, while one maintained its accreditation status. This proves that the Laboratory Quality Management System training program was an effective tool in improving the quality of laboratory services, work practices, and processes.
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Affiliation(s)
- Nakiwala Dorothy
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda.
| | - Benjamini Niringiyimana
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | - Wekiya Enock
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | - Ocung Guido
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | - Kabugo Joel
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | - Adam Isa
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | - Anita Katuramu
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | - Orena Beatrice
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | | | - Lillian Kyomugasho
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | - Denis Oola
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | - Kenneth Musisi
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
| | - Eunjung Kim
- Korea Foundation for International Healthcare (KOFIH), Seoul, Korea
| | - Nayeong Yu
- Korea Foundation for International Healthcare (KOFIH), Seoul, Korea
| | - Ruth Kaliisa
- Korea Foundation for International Healthcare (KOFIH), Seoul, Korea
| | - Yeni Lee
- Korea Foundation for International Healthcare (KOFIH), Seoul, Korea
| | - Bounggui Kim
- Korea Foundation for International Healthcare (KOFIH), Seoul, Korea
| | | | - Noah Kiwanuka
- College of Health Science, Makerere University, Kampala, Uganda
| | | | - Moses L Joloba
- National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda
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Kabahita JM, Kabugo J, Kakooza F, Adam I, Guido O, Byabajungu H, Namutebi J, Namaganda MM, Lutaaya P, Otim J, Kakembo FE, Kanyerezi S, Nabisubi P, Sserwadda I, Kasule GW, Nakato H, Musisi K, Oola D, Joloba ML, Mboowa G. First report of whole-genome analysis of an extensively drug-resistant Mycobacterium tuberculosis clinical isolate with bedaquiline, linezolid and clofazimine resistance from Uganda. Antimicrob Resist Infect Control 2022; 11:68. [PMID: 35550202 PMCID: PMC9102340 DOI: 10.1186/s13756-022-01101-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Uganda remains one of the countries with the highest burden of TB/HIV. Drug-resistant TB remains a substantial challenge to TB control globally and requires new strategic effective control approaches. Drug resistance usually develops due to inadequate management of TB patients including improper treatment regimens and failure to complete the treatment course which may be due to an unstable supply or a lack of access to treatment, as well as patient noncompliance. Methods Two sputa samples were collected from Xpert MTB/RIF® assay-diagnosed multi-drug resistant tuberculosis (MDR-TB) patient at Lira regional referral hospital in northern Uganda between 2020 and 2021 for comprehensive routine mycobacterial species identification and drug susceptibility testing using culture-based methods. Detection of drug resistance-conferring genes was subsequently performed using whole-genome sequencing with Illumina MiSeq platform at the TB Supranational Reference Laboratory in Uganda. Results In both isolates, extensively drug-resistant TB (XDR-TB) was identified including resistance to Isoniazid (katG p.Ser315Thr), Rifampicin (rpoB p.Ser450Leu), Moxifloxacin (gyrA p.Asp94Gly), Bedaquiline (Rv0678 Glu49fs), Clofazimine (Rv0678 Glu49fs), Linezolid (rplC Cys154Arg), and Ethionamide (ethA c.477del). Further analysis of these two high quality genomes revealed that this 32 years-old patient was infected with the Latin American Mediterranean TB strain (LAM). Conclusions This is the first identification of extensively drug-resistant Mycobacterium tuberculosis clinical isolates with bedaquiline, linezolid and clofazimine resistance from Uganda. These acquired resistances were because of non-adherence as seen in the patient’s clinical history. Our study also strongly highlights the importance of combating DR-TB in Africa through implementing next generation sequencing that can test resistance to all drugs while providing a faster turnaround time. This can facilitate timely clinical decisions in managing MDR-TB patients with non-adherence or lost to follow-up. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01101-2.
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Mutayoba BK, Michael Hoelscher, Heinrich N, Joloba ML, Lyamuya E, Kilale AM, Range NS, Ngowi BJ, Ntinginya NE, Mfaume SM, Wilfred A, Doulla B, Lyimo J, Kisonga R, Kingalu A, Kabahita JM, Guido O, Kabugo J, Adam I, Luutu M, Namaganda MM, Namutebi J, Kasule GW, Nakato H, Byabajungu H, Lutaaya P, Musisi K, Oola D, Mboowa G, Pletschette M. Phylogenetic lineages of tuberculosis isolates and their association with patient demographics in Tanzania. BMC Genomics 2022; 23:561. [PMID: 35931954 PMCID: PMC9356438 DOI: 10.1186/s12864-022-08791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mycobacterium tuberculosis presents several lineages each with distinct characteristics of evolutionary status, transmissibility, drug resistance, host interaction, latency, and vaccine efficacy. Whole genome sequencing (WGS) has emerged as a new diagnostic tool to reliably inform the occurrence of phylogenetic lineages of Mycobacterium tuberculosis and examine their relationship with patient demographic characteristics and multidrug-resistance development. METHODS 191 Mycobacterium tuberculosis isolates obtained from a 2017/2018 Tanzanian drug resistance survey were sequenced on the Illumina Miseq platform at Supranational Tuberculosis Reference Laboratory in Uganda. Obtained fast-q files were imported into tools for resistance profiling and lineage inference (Kvarq v0.12.2, Mykrobe v0.8.1 and TBprofiler v3.0.5). Additionally for phylogenetic tree construction, RaxML-NG v1.0.3(25) was used to generate a maximum likelihood phylogeny with 800 bootstrap replicates. The resulting trees were plotted, annotated and visualized using ggtree v2.0.4 RESULTS: Most [172(90.0%)] of the isolates were from newly treated Pulmonary TB patients. Coinfection with HIV was observed in 33(17.3%) TB patients. Of the 191 isolates, 22(11.5%) were resistant to one or more commonly used first line anti-TB drugs (FLD), 9(4.7%) isolates were MDR-TB while 3(1.6%) were resistant to all the drugs. Of the 24 isolates with any resistance conferring mutations, 13(54.2%) and 10(41.6%) had mutations in genes associated with resistance to INH and RIF respectively. The findings also show four major lineages i.e. Lineage 3[81 (42.4%)], followed by Lineage 4 [74 (38.7%)], the Lineage 1 [23 (12.0%)] and Lineages 2 [13 (6.8%)] circulaing in Tanzania. CONCLUSION The findings in this study show that Lineage 3 is the most prevalent lineage in Tanzania whereas drug resistant mutations were more frequent among isolates that belonged to Lineage 4.
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Affiliation(s)
- Beatrice Kemilembe Mutayoba
- Department of Preventive Services, Ministry of Health, Dodoma, Tanzania.
- Department of Infectious Diseases and Tropical Medicine, Medical Center of the, University of Munich, Munich, Germany.
| | - Michael Hoelscher
- Department of Infectious Diseases and Tropical Medicine, Medical Center of the, University of Munich, Munich, Germany
| | - Norbert Heinrich
- Department of Infectious Diseases and Tropical Medicine, Medical Center of the, University of Munich, Munich, Germany
| | - Moses L Joloba
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Eligius Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Andrew Martin Kilale
- Muhimbili Research Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Nyagosya Segere Range
- Muhimbili Research Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Bernard James Ngowi
- Muhimbili Research Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
- University of Dar Es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | | | - Saidi Mwinjuma Mfaume
- Muhimbili Research Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Amani Wilfred
- Muhimbili Research Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Basra Doulla
- Central Tuberculosis Reference Laboratory, Ministry of Health, National TB and Leprosy Programme, Dar es Salaam, Tanzania
| | - Johnson Lyimo
- Department of Preventive Services, Ministry of Health, National Tuberculosis and Leprosy Programme, Dodoma, Tanzania
| | - Riziki Kisonga
- Department of Preventive Services, Ministry of Health, National Tuberculosis and Leprosy Programme, Dodoma, Tanzania
| | - Amri Kingalu
- Central Tuberculosis Reference Laboratory, Ministry of Health, National TB and Leprosy Programme, Dar es Salaam, Tanzania
| | - Jupiter Marina Kabahita
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Ocung Guido
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Joel Kabugo
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Isa Adam
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Moses Luutu
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maria Magdalene Namaganda
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanitah Namutebi
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - George William Kasule
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Hasfah Nakato
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Henry Byabajungu
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Pius Lutaaya
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Kenneth Musisi
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Denis Oola
- National Tuberculosis Reference Laboratory/Supranational Reference Laboratory, Luzira, Uganda
| | - Gerald Mboowa
- Africa Centres for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - Michel Pletschette
- Department of Infectious Diseases and Tropical Medicine, Medical Center of the, University of Munich, Munich, Germany
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Caillot D, Legouge C, Lafon I, Ferrant E, Newinger M, Guido O, Favennec C, Bernard A, Krause D, Martin L, Bonniaud B, Favrot N, Dalle F. Performance du scanner thoracique pour le diagnostic des mucormycoses pulmonaires chez des patients atteints de leucémies aiguës. J Mycol Med 2013. [DOI: 10.1016/j.mycmed.2013.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Roques M, Caillot D, Noel R, Chretien ML, Guido O, Lafon I, Ferrant E, Duvillard L, Dalle F. Intérêt de la procalcitonine sérique (PCT) comme aide au diagnostic des infections fongiques invasives (IFI) au cours des hémopathies malignes. J Mycol Med 2013. [DOI: 10.1016/j.mycmed.2013.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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