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Rationale: Detailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited., Objective: We determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda., Measurements: As of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation., Main Results: The median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance., Conclusion: Most of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Carotid artery disease which includes carotid artery stenosis, plaques, clots and increased intima media thickness, have been reported by many studies to be associated with dementia. Dementia is an end stage of usually asymptomatic cognitive impairment. Risk factors of carotid artery disease include; age, atherosclerosis, arteriosclerosis, shorter years in school, history of hypertension, diabetes mellitus, stroke and depression. This study set out to determine the prevalence of abnormal carotid ultrasound findings and their association with cognitive function among the adults ≥60 years in Wakiso district, Uganda in 2018. A total of 210 participants were included. Carotid artery stenosis, presence of plaque, stenosis and intima-media thickness were assessed by ultrasound. Cognitive status was assessed using a Mini Mental State Exam (MMSE) test. The prevalence of plaque was 21.4%. Variables which included; presence of plaque, age, education, gender, marital status, whether participant stayed alone or with someone else, care for self, occupation status, division of staying and history of smoking. The presence of plaque was associated with an abnormal cognitive function at both univariate and multivariate analysis with respective OR = 3.8 (95% CI = 1.90-7.54, p-value = 0.0001) and OR = 3.4 (95% CI = 1.38-8.15, p-value = 0.007). The cognitive function distribution was 43.8%, 19%, 34.3% and 2.9% within the normal, mild, moderate, and severe cognitive function status respectively. This study showed that prevalence of carotid artery plaque was high in this elderly population in Wakiso district Uganda. Also, carotid artery plaque was associated with abnormal cognitive function., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Ultrasonography is essential in the prenatal diagnosis and care for the pregnant mothers. However, the measurements obtained often contain a small percentage of unavoidable error that may have serious clinical implications if substantial. We therefore evaluated the level of intra and inter-observer error in measuring mean sac diameter (MSD) and crown-rump length (CRL) in women between 6 and 10 weeks' gestation at Mulago hospital., Methods: This was a cross-sectional study conducted from January to March 2016. We enrolled 56 women with an intrauterine single viable embryo. The women were scanned using a transvaginal (TVS) technique by two observers who were blinded of each other's measurements. Each observer measured the CRL twice and the MSD once for each woman. Intra-class correlation coefficients (ICCs), 95% limits of agreement (LOA) and technical error of measurement (TEM) were used for analysis., Results: Intra-observer ICCs for CRL measurements were 0.995 and 0.993 while inter-observer ICCs were 0.988 for CRL and 0.955 for MSD measurements. Intra-observer 95% LOA for CRL were ± 2.04 mm and ± 1.66 mm. Inter-observer LOA were ± 2.35 mm for CRL and ± 4.87 mm for MSD. The intra-observer relative TEM for CRL were 4.62% and 3.70% whereas inter-observer relative TEM were 5.88% and 5.93% for CRL and MSD respectively., Conclusions: Intra- and inter-observer error of CRL and MSD measurements among pregnant women at Mulago hospital were acceptable. This implies that at Mulago hospital, the error in pregnancy dating is within acceptable margins of ±3 days in first trimester, and the CRL and MSD cut offs of ≥7 mm and ≥ 25 mm respectively are fit for diagnosis of miscarriage on TVS. These findings should be extrapolated to the whole country with caution. Sonographers can achieve acceptable and comparable diagnostic accuracy levels of MSD and CLR measurements with proper training and adherence to practice guidelines.

Aim: The aim of this study was to investigate epidemiological features of maxillofacial fractures within trauma patients who had head and neck computed tomography (CT) scan at the Mulago National referral hospital., Methods: CT scan records of trauma patients who had head scans at the Department of Radiology over 1-year period were accessed. Data collected included sociodemographic factors, type and etiology of injury, and concomitant maxillofacial injuries., Results: A total of 1330 trauma patients underwent head and neck CT scan in the 1-year study period. Out of these, 130 were excluded due to incomplete or unclear records and no evidence of injury. Of the remaining 1200, 32% (387) had maxillofacial fractures. The median age of the patients with maxillofacial fractures was 28 (range = 18-80) years and 18-27 age group was most common at 47.5%. Road traffic accidents constituted 49.1% of fractures. The single most affected isolated bone was the frontal bone (23%). The number of maxillofacial bones fractured was predicted by age group (df = 3 F = 5.358, P = 0.001), association with other fractures (df = 1 F = 5.317, P = 0.03)., Conclusions: Good matched case-control prospective studies are needed to enable us tease out the finer difference in the circumstances and pattern of injury if we are to design appropriate preventive measures., Competing Interests: There are no conflicts of interest.

Aim: There is limited literature on brain imaging studies of children with cerebral palsy (CP) in low and middle income countries. We investigated neuroimaging patterns of children with CP attending a tertiary referral centre in Uganda to determine how they differed from studies reported from high income countries and their relationship with prenatal and postnatal factors., Methods: Precontrast and postcontrast computed tomography (CT) scans of 78 CP children aged 2-12 years were conducted using a Philips MX 16-slice CT scanner. Two radiologists, blinded to the patient's clinical status, independently reviewed the scans., Results: Abnormal CT scans were detected in 69% of the children sampled, with very few having primary white matter injuries (4%). Primary grey matter injuries (PGMI) (44%) and normal scans (31%) were most frequent. Children with a history of hospital admission following birth were three times more likely to have PGMI (odds ratio [OR] 2.8; 95% CI 1.1-7.1), suggesting a perinatal period with medical complications., Conclusion: Brain imaging patterns in this group of CP children differed markedly from imaging studies reported from high income countries, suggesting a perinatal aetiology in full-term infants and reduced survival in preterm infants., (©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: Reliability and validity studies of different lumbar curvature analysis and measurement techniques have been documented however there is limited literature on the reliability and validity of subjective visual analysis. Radiological assessment of lumbar lordotic curve aids in early diagnosis of conditions even before neurologic changes set in., Objective: To ascertain the level of reliability and validity of subjective assessment of lumbar lordosis in conventional radiography., Design: A blinded, repeated-measures diagnostic test was carried out on lumbar spine x-ray radiographs., Setting: Radiology Department at Joint Clinical Research Centre (JCRC), Mengo-Kampala-Uganda., Subjects: Seventy (70) lateral lumbar x-ray films were used for this study and were obtained from the archive of JCRC radiology department at Butikiro house, Mengo-Kampala., Results: Poor observer agreement, both inter- and intra-observer, with kappa values of 0.16 was found. Inter-observer agreement was poorer than intra-observer agreement. Kappa values significantly rose when the lumbar lordosis was clustered into four categories without grading each abnormality., Conclusion: The results confirm that subjective assessment of lumbar lordosis has low reliability and validity. Film quality has limited influence on the observer reliability. This study further shows that fewer scale categories of lordosis abnormalities produce better observer reliability.

Background: Maternal mortality is related to obstetric complications in pregnancy some of which could be revealed by obstetric sonography. Obstetric sonography has become part of routine antenatal care in both urban and rural settings. The objective of the study was to assess the utilization of obstetric sonography in a rural hospital of Uganda, including the frequency and appropriateness of its usage as well as determine whether there was any relation between number of obstetric scans, patient management and obstetric outcomes., Methods: It was a retrospective study in which review of all obstetric charts and obstetric scan requisition forms for all deliveries in Ndejje Health Centre (Uganda) was done., Results: During the study period, there were 105 singleton deliveries, and these mothers underwent a total of 232 obstetric scans. More than half (53.4%) of the scans were classified as inappropriate. There were no significant differences in the number of scans between low- and high-risk pregnancies or between uncomplicated deliveries and those in which induction or instrumental or operative delivery occurred, nor was there any relation between number of scans and obstetric outcome., Conclusion: Obstetric sonography has become popular in rural health settings as part of antenatal care. However, it was over-used in the health centre. This overuse was not associated with any identifiable effect on obstetric outcome. Therefore, more appropriate use of obstetric sonography, in accordance with evidence-based guidelines, is recommended.

Introduction: Hysterosalpingography (HSG) is still a commonly used investigation in the evaluation of the female genital tract and the main indication for HSG is infertility., Objective: The purpose of this study was to find the pathology detected at HSG in patients with infertility in our setting., Materials and Methods: A retrospective review of 289 consecutive patients who underwent hysterosalpingography using ionic water-soluble contrast media was done at 2 private x-ray units in Kampala. Clinical notes and radiological findings were analysed for demographic data, uterine status, tubal and pelvic pathology., Results: The commonest age group seen was 26-30 yrs. Most were of low parity. Secondary infertility was commoner than primary infertility. Abnormal findings at hysterosalpingography were found in 83.4%. The commonest finding was tubal blockage., Conclusion: The commonest pathology found on HSG in women presenting with infertility in Kampala is tubal blockage possibly secondary to chronic pelvic inflammation. The fact that secondary infertility is common points to pelvic infection complicating mismanaged pregnancies, septic abortions or sexually transmitted infections. A study to establish associated factors is recommended.

Camurati-Engelmann's disease is a rare condition worldwide. No cases have been documented in Uganda. A 26 year old female presented with a history of grinding pain in the limbs for over 20 years. Strong painkillers would temporally relieve the pain. She had an asthenic stature with generalised reduction in muscle bulk. Plain x-rays revealed the characteristic symmetrical thickening and sclerosis of the diaphyses of the appendicular skeleton and skull base, which is pathognomonic of Camurati-Engelmann's disease. Involvement of the metaphyses of these long bones as well as the metacarpal bones makes this an unusual case.

While pelvic endometriosis is relatively common, thoracic menstruation is rare. A report of what is believed to be the first case of thoracic endometriosis in Uganda is given. A 34-year-old female was complaining of on and off chest pain mainly on the right side. Clinically she had signs of pleural effusion and 500 mls of altered blood were tapped from her right pleural space. Worried about a possibility of a malignant process, an urgent chest CT scan was performed. A right posterior pleural mass and pleural effusion were found. A pleural biopsy was taken and confirmed at histology as endometrial tissue. She did well on surgical excision and hormonal therapy. This was a rare case of endometriosis which shows the usefulness of imaging in the patient work up.