Publications by authors named "Andrea Conroy"

Article Synopsis
  • A study conducted in Uganda followed children aged 6 months to 4 years who were discharged from the hospital after being treated for specific severe malaria manifestations, comparing their post-discharge health to asymptomatic community children.
  • Over 12 months, 56.6% of children with severe malaria experienced one or more hospitalizations, significantly higher than the 30.8% of community children, with a majority of the hospitalizations being malaria-related.
  • The findings indicate a pressing need for research into post-discharge malaria prevention treatments to help reduce the healthcare burden on children who have suffered from severe malaria.
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Introduction: Few studies have described post-discharge morbidity of children with specific manifestations of severe malaria (SM) beyond severe malarial anemia or cerebral malaria.

Methods: Children 6 months to 4 years of age admitted at Jinja and Mulago hospitals in Uganda, with one or more of the five most common manifestations of SM, cerebral malaria (n=53), respiratory distress syndrome (n=108), malaria with complicated seizures (n=160), severe malarial anemia (n=155) or prostration (n=75), were followed for 12 months after discharge, along with community children (CC) (n=120) recruited from the household or neighborhood of the children with SM. Incidence and risk of post-discharge readmission, death or outpatient clinic visits were compared between children with SM and CC.

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Background: Iron deficiency is the most common nutritional deficiency in the world, but iron supplementation can increase risk of opportunistic infections, especially in children living with HIV. We aimed to assess the effect of supplemental iron on haemoglobin concentration in children living with HIV and mild-to-moderate anaemia in Uganda.

Methods: We did a double-blind, randomised, placebo-controlled trial of iron supplementation in children aged 6 months to 12 years living with HIV at two sites (ie, Kampala and Fort Portal, Uganda).

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Article Synopsis
  • The study aimed to evaluate the relationship between the perfusion index (PI), a noninvasive tool, and clinical markers of perfusion in critically ill children hospitalized with severe malaria, investigating its potential to identify those at higher risk of mortality.
  • Conducted in two hospitals in Uganda, the research analyzed data from 600 children under five with severe malaria and found that lower admission PI correlated with clinical signs of poor perfusion and complications, as well as higher mortality odds.
  • The results indicated that consecutive low PI measures (< 1%) were predictive of mortality, suggesting that PI could serve as an important indicator for managing severe malaria in pediatric patients.
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Article Synopsis
  • - Unexplained increases in blackwater fever (BWF) in Eastern Uganda prompted a study examining how immune complexes and glucose-6-phosphate dehydrogenase (G6PD) deficiency relate to severe malaria (SM) in children.
  • - The study, involving 557 children with SM and 101 community children, found that those with SM had significantly higher levels of circulating immune complexes (cIC), which were linked to complications like severe anemia and jaundice, along with predicting readmissions.
  • - G6PD deficiency, particularly in males, was shown to elevate cIC levels, and the analysis indicated that this deficiency contributes to recurring severe anemia and BWF due to the presence of these immune complexes.
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Background: Current prognostic tools do not reliably and objectively identify children with pneumonia at risk of a severe or life-threatening episode. Heparin-binding protein (HBP) is a host immune protein that is released in response to infection. We hypothesized that measuring HBP concentrations at hospital admission could help risk-stratify children with pneumonia and identify those at higher risk of an adverse prognosis.

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A growing body of research is categorizing sex differences in both sickle cell anemia (SCA) and acute kidney injury (AKI); however, most of this work is being conducted in high-resource settings. Here, we evaluated risk factors and clinical parameters associated with AKI and AKI severity, stratified by sex, in a cohort of children hospitalized with SCA and vaso-occlusive pain crisis (VOC). The purpose of this study was to explore sex disparities in a high-risk, vulnerable population.

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Article Synopsis
  • People with sickle cell anemia often need blood transfusions, and hydroxyurea can help reduce this need, but access and dosage challenges hinder its use in Africa.
  • The ADAPT trial will investigate how hydroxyurea affects transfusion rates and whether personalized dosing through pharmacokinetics can improve treatment in children with SCA in Uganda.
  • Success in reducing transfusion reliance and optimizing hydroxyurea dosing could enhance access to this life-saving treatment for sickle cell anemia across sub-Saharan Africa.
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Background: Blood-brain barrier (BBB) disruption is a central feature of cerebral malaria (CM), a severe complication of Plasmodium falciparum (Pf) infections. In CM, sequestration of Pf-infected red blood cells (Pf-iRBCs) to brain endothelial cells combined with inflammation, hemolysis, microvasculature obstruction and endothelial dysfunction mediates BBB disruption, resulting in severe neurologic symptoms including coma and seizures, potentially leading to death or long-term sequelae. In vitro models have advanced our knowledge of CM-mediated BBB disruption, but their physiological relevance remains uncertain.

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Background: Children exposed to severe malaria may recover with gross neurologic deficits (GND). Several risk factors for GND after cerebral malaria (CM), the deadliest form of severe malaria, have been identified in children. However, there is inconsistency between previously reported and more recent findings.

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Background: Supplemental O is not always available at health facilities in low-income and middle-income countries (LMICs). Solar-powered O delivery can overcome gaps in O access, generating O independent of grid electricity. We hypothesized that installation of solar-powered O systems on the paediatrics ward of rural Ugandan hospitals would lead to a reduction in mortality among hypoxaemic children.

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After starting hydroxyurea treatment, Ugandan children with sickle cell anemia had 60% fewer severe or invasive infections, including malaria, bacteremia, respiratory tract infections, and gastroenteritis, than before starting hydroxyurea treatment (incidence rate ratio, 0.40 [95% confidence interval, 0.29-0.

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Globally, there are an estimated 13.3 million cases of acute kidney injury (AKI) annually. Although infections are a common cause of AKI globally, most infection-associated AKI occurs in low- and lower-middle-income countries.

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Background: Malaria is an important cause of mortality in African children. Identification of biomarkers to identify children at risk of mortality has the potential to improve outcomes.

Methods: We evaluated 11 biomarkers of host response in 592 children with severe malaria.

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Persistent neurodisability is a known complication in paediatric survivors of cerebral malaria and severe malarial anaemia. Tau, ubiquitin C-terminal hydrolase-L1, neurofilament-light chain, and glial fibrillary acidic protein have proven utility as biomarkers that predict adverse neurologic outcomes in adult and paediatric disorders. In paediatric severe malaria, elevated tau is associated with mortality and neurocognitive complications.

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Background: The relationship of apolipoprotein-E4 (APOE4) to mortality and cognition after severe malaria in children is unknown.

Methods: APOE genotyping was performed in children with cerebral malaria (CM, n = 261), severe malarial anemia (SMA, n = 224) and community children (CC, n = 213). Cognition was assessed over 2-year follow-up.

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Background: Acute kidney injury (AKI) is independently associated with increased morbidity and mortality across the life course, yet care for AKI remains mostly supportive. Raising awareness of this life-threatening clinical syndrome through education and advocacy efforts is the key to improving patient outcomes. Here, we describe the unique roles education and advocacy play in the care of children with AKI, discuss the importance of customizing educational outreach efforts to individual groups and contexts, and highlight the opportunities created through innovations and partnerships to optimize lifelong health outcomes.

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Background: Globally, a very high percentage of acute kidney injury (AKI) occurs in low- and middle-income countries (LMICs) where late recognition contributes to increased mortality. There are challenges with using existing biomarkers of AKI in LMICs. Emerging evidence suggests renin may serve as a biomarker of kidney injury that can overcome limitations in creatinine-based diagnostics.

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Background: Malaria in early pregnancy is a risk factor for preterm birth and is associated with sustained inflammation and dysregulated angiogenesis across gestation. This study investigated whether malaria is associated with increased gut leak and whether this contributes to systemic inflammation, altered angiogenesis, and preterm birth.

Methods: We quantified plasma concentrations of gut leak markers, soluble CD14 (sCD14) and lipopolysaccharide binding protein (LBP) from 1339 HIV-negative pregnant Malawians at <24 weeks gestational age.

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Severe anemia is an important contributor to mortality in children with severe malaria. Anemia in malaria is a multi-factorial complication, since dyserythropoiesis, hemolysis and phagocytic clearance of uninfected red blood cells (RBCs) can contribute to this syndrome. High levels of oxidative stress and immune dysregulation have been proposed to contribute to severe malarial anemia, facilitating the clearance of uninfected RBCs.

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Cerebrovascular injury frequently occurs in children with sickle cell anaemia (SCA). Limited access to magnetic resonance imaging and angiography (MRI-MRA) in sub-Saharan Africa impedes detection of clinically unapparent cerebrovascular injury. Blood-based brain biomarkers of cerebral infarcts have been identified in non-SCA adults.

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