Department of Obstetrics and Gynecology

Polycystic Ovarian Syndrome Diagnosis in a Patient Undergoing Treatment for Bipolar Affective Disorder at Mbale Regional Referral Hospital, Uganda :

Sat, 01 Aug 2020 00:00:00 GMT

Polycystic Ovarian Syndrome Diagnosis in a Patient Undergoing Treatment for Bipolar Affective Disorder at Mbale Regional Referral Hospital, Uganda : Achipa, Doreen; Nteziyaremye, Julius BACKGROUND: The association between bipolar affective disorder (BAD) and polycystic ovarian syndrome (PCOS) is elucidated in medical literature. However, what is inconclusive is whether one causes the other and /or the neuroleptics such as sodium valproate could cause PCOS as a side effect. However, to the best of our knowledge, there is a dearth of such case reports in our setting. We therefore report a case of this nature in our setting with the aim of further reemphasizing the likely comorbidity and the need for collaborative multidisciplinary approach during management of such patients. CASE REPORT: We present a case of 34 years old, parity 0+1, human immune virus seronegative, a known patient of bipolar affective disorder (BAD) for 18 years. She was initially started on chlorpromazine and carbamazepine that she used for 13 years and later switched to sodium valproate and sertraline daily due to side effects of chlorpromazine in 2014. She presented with 6 years’ history of abnormal uterine bleeding and dysmennorrhoea for 2 months. A diagnosis of PCOS was made based on history and confirmed by laboratory and radiological investigations. CONCLUSIONS: Physicians need be aware of the likely comorbidity or sequel and the need for multidisciplinary engagement. Key words: Bipolar affective disorder; polycystic ovarian syndrome; sertraline; sodium Valproate; Mbale; Uganda Research article

Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale hospital, eastern Uganda

Thu, 19 Mar 2020 00:00:00 GMT

Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale hospital, eastern Uganda Nteziyaremye, Julius; Iramiot, Stanley Jacob; Nekaka, Rebecca; Musaba, Milton W.; Wandabwa, Julius; Kisegerwa, Enoch; Kiondo, Paul Background Asymptomatic bacteriuria in pregnancy (ASBP) is associated with adverse pregnancy outcomes such as pyelonephritis, preterm or low birth weight delivery if untreated. The aim of this study was to determine the prevalence of asymptomatic bacteriuria, the isolated bacterial agents, and their antibiotic sensitivity patterns in pregnant women attending antenatal care at Mbale Hospital. Methods This was a cross sectional study in which 587 pregnant women with no symptoms and signs of urinary tract infection were recruited from January to March 2019. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured using standard laboratory methods. The bacterial colonies were identified and antibiotic sensitivity was done using disc diffusion method. Chi squared tests and logistic regression were done to identify factors associated with asymptomatic bacteriuria. A p value < 0.05 was considered statistically significant. Results Out of the 587 pregnant women, 22 (3.75%) tested positive for asymptomatic bacteriuria. Women aged 20–24 years were less likely to have ASBP when compared to women aged less than 20 years (AOR = 0.14, 95%CI 0.02–0.95, P = 0.004). The most common isolates in descending order were E. coli (n = 13, 46.4%) and S.aureus (n = 9, 32.1%). Among the gram negative isolates, the highest sensitivity was to gentamycin (82.4%) and imipenem (82.4%). The gram positive isolates were sensitive to gentamycin (90.9%) followed by imipenem (81.8%). All the isolates were resistant to sulphamethoxazole with trimethoprim Funding: The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competinginterests: The authors have declared that no competing interests exist (100%). Multidrug resistance was 82.4% among gram negative isolates and 72.4% among the gram positive isolates. Conclusion There was high resistance to the most commonly used antibiotics. There is need to do urine culture and sensitivity from women with ASBP so as to reduce the associated complications. Article

Asymptomatic bacteriuria and candida colonization among pregnant women in a district hospital in eastern Uganda.

Mon, 27 May 2019 00:00:00 GMT

Asymptomatic bacteriuria and candida colonization among pregnant women in a district hospital in eastern Uganda. Bakandonda, Fredrick; Muwanguzi, Shadrack; Nakate, Prossy; Opolot, Ismail; Imongit, Sam; Nnakanwagi, Mariam Mirembe; Nteziyaremye, Julius; Nekaka, Rebecca; Iramiot, Jacob Stanley Background: Urinary tract infection (UTI) is the most common reason for which antimicrobials are prescribed in pregnancy Worldwide. This study aimed to determine the prevalence of asymptomatic bacteriuria, Candida colonization and antimicrobial susceptibility patterns among pregnant women attending antenatal in a District Hospital in Eastern Uganda. Materials and Methods: A descriptive cross sectional study was conducted in which pregnant mothers who had come for routine antenatal care were counseled and their consents obtained before taking off urine samples for laboratory diagnosis. For those samples found to have pus cells, culture and sensitivity test was done to identify the organisms and determine susceptibility to particular antibiotics and antifungal agents. Results: Gram negative isolates were more sensitive to meropenem (100%), and ciprofloxacin (93.8%) but less sensitive to trimethoprim/sulphurmethoxazole (20%), Ceftazidime (7%), and Cefepime (6%). Gram positive isolates were more sensitive to vancomycin (100%), meropenem (87%) and linezolid (88.1%) but less sensitive to Cefotaxime (31%) and Trimethoprim / sulphurmethoxazole (14%). All bacteria isolated in this study were multi-drug resistant (MDR). All Candida isolates were susceptible to Econazole and Nystatin whereas all isolates were resistant to Griseofulvin. Conclusion: The prevalence of asymptomatic bacteriuria among pregnant women in Butaleja district is high with many of the bacteria isolated exhibiting resistance to the commonly used antibiotics. Antifungal resistance was common in this study. Keywords: Asymptomatic bacteriuria; antimicrobial resistance; UTI; pregnant women. Article

Prevalence, indications, and community perceptions of caesarean section delivery in Ngora district, eastern Uganda :

Mon, 20 Jul 2020 00:00:00 GMT

Prevalence, indications, and community perceptions of caesarean section delivery in Ngora district, eastern Uganda : Waniala, Isaac; Nakiseka, Sandra; Nambi, Winnie; Naminya, Isaac; Ajeni, Margret Osuban; Iramiot, Jacob; Nekaka, Rebecca; Nteziyaremye, Julius Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and community based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analysed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analysed into themes and subthemes with the help of NVIVO 12. Results. Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion. Several misconceptions that could hinder access to CS were found which calls for more counselling and male involvement. Although facility based, the rate is higher than the desired 5–15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counselling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS. Article