Faculty Bibliography

OBJECTIVE: Rapid urbanization is changing the epidemiology of non-communicable diseases in sub-Saharan Africa. We aimed to identify the determinants of raised blood pressure in urban Uganda to highlight targets for preventive interventions. DESIGN: Case-control. SETTING: Three community-based sites in Kampala, the capital of Uganda. PARTICIPANTS: Participants were eligible to enroll if they were aged >/=18 years and not pregnant. METHODS: 450 cases with raised blood pressure were frequency matched by sex and age to 412 controls. Unconditional logistic regression was used to evaluate the association of socio-demographic, lifestyle, anthropometric, and laboratory variables with the outcome of raised blood pressure. Cases currently treated with antihypertensive medication and cases not treated with antihypertensive medication were analyzed separately. RESULTS: Significantly increased odds of raised blood pressure were associated with overweight body mass index (BMI) (25 kg/m2 /= 30 kg/m2) and hemoglobin A1c >/= 6.5%. Significantly decreased odds of raised blood pressure were associated with moderate-to-vigorous work-related physical activity of >4 hours/week. No significant associations were found between raised blood pressure and marital status, education level, car or flush toilet ownership, dietary habits, alcohol consumption, smoking habits, moderate-to-vigorous leisure-related physical activity > 4 hours/week, waist-to-hip ratio, or total cholesterol levels. CONCLUSIONS: Targeted interventions are needed to address the key modifiable risk factors for raised blood pressure identified in this study, namely elevated BMI and regular physical activity, in order to reduce the burden of cardiovascular disease in urban Uganda.

Multiple sclerosis (MS) has been infrequently described in association with human immunodeficiency virus (HIV) infection. Underreporting, missed diagnoses or a true negative association between MS and HIV infection are all possible explanations for the paucity of published cases. Since MS involves inflammation and demyelination of the central nervous system by autoreactive T cells, immunosuppression caused by HIV infection would be expected to confer a reduced risk of MS. This report describes a case of relapsing-remitting MS in a woman with non-progressive HIV-1 infection for 5 years. The patient has stable normal CD4+ cell counts and a low viral load in the absence of combination antitretroviral treatment (cART). She experienced typical neurological symptoms of MS including optic neuritis, trigeminal neuralgia, and transverse myelitis. MRI of the spinal cord demonstrated multiple lesions on T2-weighted images. Immune mechanisms associated with HIV control that may have contributed to the development and relapses of MS in this patient are discussed.

Neurologists are often the first medical providers to evaluate patients with possible infectious meningitis. Knowledge of the clinical presentations and cerebrospinal fluid, microbiologic, and neuroimaging findings for different etiologies is essential to make a prompt diagnosis and initiate appropriate treatment. Tuberculosis is a common cause of meningitis in developing countries with a high prevalence of pulmonary tuberculosis. However, tuberculosis affects populations in every country and all neurologists need to be vigilant for possible cases of tuberculous meningitis presenting to their medical facilities. This article discusses the challenges of diagnosing and treating tuberculous meningitis and highlights recent advances in diagnostic technology.

Mycobacterium tuberculosis is one of the most prevalent human infections. Although the largest share of the burden of disease is in Africa and Asia, tuberculosis has a global footprint due to travel and migration. Resource constraints in many low- and middle-income countries are hampering efforts to control new infections and to prevent drug resistance. Infection of the central nervous system by Mycobacterium tuberculosis includes meningitis, tuberculoma, and abscess and carries a high morbidity and mortality. High clinical suspicion, combined with cerebrospinal fluid analysis and brain imaging studies, can improve the diagnostic certainty. The recent scale-up of nucleic acid amplification technology may allow earlier diagnosis of tuberculous meningitis in many regions of the world. Treatment of tuberculous infection of the central nervous system is usually empirical and follows conventional regimens for pulmonary tuberculosis. The optimal treatment regimen is still being elucidated and has been the subject of recent clinical trials.