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Tonny Kyagambiddwa,1,&ast; Timothy Mwanje Kintu,1,&ast; Emmanuel Miiro,1,&ast; Franchesca Nabalamba,1 Gloria Suubi Asiimwe,1 Anne Marion Namutebi,2 Fardous C Abeya,3 Boniface A Lumori,3 Isaac Ijuka,4 Rose K Muhindo,1,3 Andrew Mutekanga,1,3 Richard Musinguzi,5 Francis Natuhwera,6 Joseph Ngonzi,1,7 Edwin Nuwagira3,8 1Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Kabale Regional Referral Hospital, Kabale, Uganda; 3Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 4Mayanja Memorial Hospital, Mbarara, Uganda; 5Masaka Regional Referral Hospital, Masaka, Uganda; 6Fort Portal Regional Referral Hospital, Fort Portal, Uganda; 7Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda; 8Tuberculosis Treatment Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda&ast;These authors contributed equally to this workCorrespondence: Tonny Kyagambiddwa; Edwin Nuwagira, Mbarara University of Science and Technology, Tel +256782980116 ; +256779096887, Email tonnykyagambiddwa97@gmail.com; enuwagira@must.ac.ugBackground: There is scarcity of data regarding young and middle-aged adults hospitalized with severe Corona Virus Disease 2019 (COVID-19) in Africa. In this study, we describe the clinical characteristics and 30-day survival among adults aged 18 to 49 years admitted with severe COVID-19 in Uganda.Methods: We reviewed treatment records of patients admitted with severe COVID-19 across five COVID-19 treatment units (CTU) in Uganda. We included individuals aged 18 to 49 years, who had a positive test or met the clinical criteria for COVID-19. We defined severe COVID-19 as having an oxygen saturation < 94%, lung infiltrates > 50% on imaging and presence of a co-morbidity that required admission in the CTU. Our main outcome was the 30-day survival from the time of admission. We used a Cox proportional hazards model to determine the factors asso

Andrew Mutekanga,1,&ast; Edwin Nuwagira,1,&ast; Elias Kumbakumba,2 Victoria Nyaiteera,3 Stephen Asiimwe,4 Medal Gasumuni,5 Nelson Wandera,5 Robert Natumanya,5 Denis Akena,5 Siraje Senoga,1 Joseph Kyobe Kiwanuka,6 George Kateregga,6 Emmanuel Munyarugero,6 Fardous Charles Abeya,1 Paul Stephen Obwoya,1 Stephen Ttendo,6 Rose Muhindo1,&ast; 1Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda; 3Department of ENT, Mbarara University of Science and Technology, Mbarara, Uganda; 4Global Health Collaborative, Massachusetts General Hospital, Boston, MA, USA; 5Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda; 6Department of Anesthesiology and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda&ast;These authors contributed equally to this workCorrespondence: Rose Muhindo, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda, Tel +256772406337, Email rosie@must.ac.ugBackground: COVID-19 has created a burden on the healthcare system globally. Severe COVID-19 is linked with high hospital mortality. Data regarding 30-day in-hospital mortality and its factors has not been explored in southwestern Uganda.Methods: We carried out a retrospective, single-center cohort study, and included all in-patients with laboratory-confirmed, radiological, or clinical severe COVID-19 admitted between April 2020 and September 2021 at Mbarara Regional Referral Hospital (MRRH). Demographic, laboratory, treatment, and clinical outcome data were extracted from patients’ files. These data were described comparing survivors and non-survivors. We used logistic regression to explore the factors associated with 30-day in-hospital mortality.Results: Of the 283 patients with severe COVID-19 admitted at MRRH COVID-19 unit, 58.1% were male. The mean age ± standard deviation (SD) wa

Edwin Nuwagira,1 Mitala Yekosani,2 Birungi Abraham,2 Raymond Atwine,2 Tuhumwire Caleb,3 Joseph Baruch Baluku4 1Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Department of Pathology, Mbarara University of Science and Technology, Mbarara, Uganda; 3Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda; 4Division of Pulmonology, Mulago National Referral Hospital, Kampala, UgandaCorrespondence: Edwin NuwagiraMbarara University of Science and Technology, P.O Box 1410, Mbarara, UgandaTel +256 779096887Email enuwagira@must.ac.ugBackground: Extrapulmonary drug-resistant tuberculosis is extremely rare and is almost always associated with poor treatment outcomes. This is partly due to the difficulty in confirming the diagnosis.Case Presentation: A 40-year-old HIV-negative male presented with a painless scrotal mass, low-grade fever, general malaise, night sweats, and no pulmonary symptoms. He was initially treated for malaria with no improvement. His final diagnosis was rifampicin-resistant tuberculosis following Xpert® MTB/RIF Ultra (Xpert-Ultra) assay performed on a fine needle aspirate of the scrotal mass. Second-line anti-tuberculosis medication was initiated, and the patient is being followed up with directly observed therapy.Conclusion: With the scale-up of Gene-Xpert technology, this case raises awareness about tuberculosis masquerading as a testicular mass and the possibility of extrapulmonary drug-resistant tuberculosis in high endemic areas.Keywords: drug-resistant tuberculosis, genitourinary tuberculosis, extrapulmonary tuberculosis, tuberculous orchitis, sub-Saharan Africa, Uganda

Background Gender differences among patients with drug resistant tuberculosis (DRTB) and HIV co-infection could affect treatment outcomes. We compared characteristics and treatment outcomes of DRTB/HIV co-infected men and women in Uganda. Methods We conducted a retrospective chart review of patients with DRTB from 16 treatment sites in Uganda. Eligible patients were aged ≥ 18 years, had confirmed DRTB, HIV co-infection and a treatment outcome registered between 2013 and 2019. We compared socio-demographic and clinical characteristics and tuberculosis treatment outcomes between men and women. Potential predictors of mortality were determined by cox proportional hazard regression analysis that controlled for gender. Statistical significance was set at p < 0.05. Results Of 666 DRTB/HIV co-infected patients, 401 (60.2%) were men. The median (IQR) age of men and women was 37.0 (13.0) and 34.0 (13.0) years respectively (p < 0.001). Men were significantly more likely to be on tenofovir-based antiretroviral therapy (ART), high-dose isoniazid-containing DRTB regimen and to have history of cigarette or alcohol use. They were also more likely to have multi-drug resistant TB, isoniazid and streptomycin resistance and had higher creatinine, aspartate and gamma-glutamyl aminotransferase and total bilirubin levels. Conversely, women were more likely to be unemployed, unmarried, receive treatment from the national referral hospital and to have anemia, a capreomycin-containing DRTB regimen and zidovudine-based ART. Treatment success was observed among 437 (65.6%) and did not differ between the genders. However, mortality was higher among men than women (25.7% vs. 18.5%, p = 0.030) and men had a shorter mean (standard error) survival time (16.8 (0.42) vs. 19.0 (0.46) months), Log Rank test (p = 0.046). Predictors of mortality, after adjusting for gender, were cigarette smoking (aHR = 4.87, 95% CI 1.28–18.58, p = 0.020), an increase in alanine aminotransferase levels (aHR = 1.05, 95%