Elective Abdominal Ultrasonography by Surgeons at MNH, Dar-Es-Salaam, Tanzania.

Background: Ultrasound scanning (USS) is an important diagnostic tool in most specialties of surgery. The abdomen is the most commonly scanned region and learning and practicing abdominal USS is the most rewarding. This study was aimed at sharing our experience of elective abdominal ultrasound scanning (USS) done by surgeons at the Department of Surgery, Muhimbili National Hospital (MNH).Methods: This is a retrospective audit of indications and sonographic findings in 1782 elective scannings done over a 42-month period. All scanning was done by surgeons using Aloka SSD 500scanner with a 3.5 MHz probe. Average patient scanning time was 5-10 minutes.Results: The most frequent indications for abdominal ultrasound scanning were abdominal pain (27%), urinary tract symptoms (25%) and abdominal swelling / mass (13%). Overall 47 % of all scanned patients and 58% of those with abdominal pain had normal findings. Of all the patients with abnormal USS findings 42% had abdominal mass. Stone disease was infrequent, seen in 49 (2.7% of all scanned) patients.Conclusion: Pain is the most frequent reason for requesting abdominal ultrasound scanning but it has a low yield of sonographic findings. Scanning for abdominal swelling/mass gave the highest proportion of abnormal findings. USS of a surgical patient done by surgeons expedites diagnostic workup, shortens hospitalization, facilitates biopsy and may help to avoid diagnostic laparotomy

Post-Circumcision Urethro-Cutaneous Fistula: The Key to Successful Reconstruction.

Background: Routine circumcision of boys is a common practice in Tanzania. Because sometimes it is performed by persons with no surgical training, complications, including urethro-cutaneous fistula (UCF), are not uncommon.Methods: Five boys whose ages ranged between 4 and 12 years with UCF were seen at four Dar es Salaam hospitals between 2002 and 2005. Personal particulars, the personnel doing the circumcision, description of the repair and follow up were recorded on a data sheet. Intravenous Augmentin was given at induction of anaesthesia for the fistula repair. A urethral catheter was inserted, and then a tourniquet was applied at the base of the penis. After incision and development of skin flaps the urethra was closed, a layer of dartos fascia interposed, followed by closure of the skin, all with 6/0 Vicryl. A compression dressing was applied, and the catheter was left in for 5-7 days.Results: The boys ranged in age between 5 and 12 years, and had undergone circumcision at age 2 to 12 years. All patients were circumcised by paramedical personnel or a traditional practitioner. Urine leakage commenced 2 days to 2 weeks after circumcision. Four boys had coronal while one had a glandular UCF. No post repair complication was reported after follow up of 3 to 20 weeks.Conclusion: Use of fine synthetic absorbable sutures and careful closure of the fistula with interposition of a pedicles dartos graft, are the main prerequisites for success. Attention to details of surgical technique can produce consistently good results in repair of UCF

Bacteria isolated from bloodstream infections at a tertiary hospital in Dar es Salaam, Tanzania – antimicrobial resistance of isolates

Objective. A bloodstream infection (BSI) is a life-threatening condition. We studied the causative agents of BSIs and antimicrobial susceptibility patterns of bacterial isolates at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods. A retrospective analysis of blood culture results obtained at MNH from January 2005 to December 2009 was done. Blood culture isolates judged to be clinically significant and antimicrobial susceptibility results of the bacteria were included. The frequencies and proportions of bacteria isolated and antimicrobial susceptibility results were analysed and compared using Pearson’s chi-square test and Fisher’s exact test where applicable, or the Mann-Whitney U-test. Results. A total of 13 833 blood cultures were performed. Bacterial pathogens were detected in 1 855 (13.4%), Gram-positive bacteria (1 523; 82.1%) being significantly more prevalent than Gramnegative bacteria (332; 17.9%) (p=0.008). The most common bacterial pathogens isolated were coagulase-negative staphylococci (CoNS) (1 250; 67.4%), S. aureus (245; 13.2%), Escherichia coli (131; 7%) and Klebsiella spp. (130; 7.0%). All bacteria isolated showed high resistance to penicillin G (70.6%), tetracycline (63.8%), cefotaxime (62.5%) and ampicillin (62.3%). Moderate to high resistance was seen against chloramphenicol (45.2%), erythromycin (35.0%), ciprofloxacin (29.3%), co-trimoxazole (25.0%) and gentamicin (23.5%). Of S. aureus isolates, 23.3% were resistant to methicillin. Conclusions. CoNS accounted for two-thirds of the bacterial pathogens isolated. High-level resistance was seen to first-line and inexpensive antimicrobial agents. Routine screening for extendedspectrum beta-lactamase production and methicillin resistance among Gram-negative rods and S. aureus from blood cultures should be instituted to monitor spread of multidrug-resistant isolates

Integrity of Indigenous Knowledge Systems in Natural Resource Management: The Case of the Arid and Semi-Arid Baringo Herders of Kenya

Ineffective management of natural resources in arid and semi-arid lands (ASALs), resulting in resource depletion, rapid loss of biodiversity and environmental degradation, is of great concern globally. The Baringo herders in the ASALs of Kenya have been branded as perpetrators of this vice, with the blame placed particularly on their traditional livestock management, utilising indigenous knowledge systems (IKS). These IKS involve livestock mobility and maximisation, and have been regarded as being outdated and inefficient in meeting the challenges and demands for environmental conservation and sustainable management of the natural resources. A common reaction of the government has been to advocate modern interventions that are based on exogenous knowledge systems (EKS), involving sedentary livestock raising and destocking. These EKS are, however, not performing as well as expected, since they are not adapted to the ASALs ecological conditions and the herders\u27 socio-economic and cultural situations (Aboud et al 1997; Makenzi, 2003). This study empirically explored the above propositions, in order to test the integrity of the IKS, in relation to EKS and the herders\u27 levels of education

Experiences of obesity among Saudi Arabian women contemplating bariatric surgery: An interpretative phenomenological analysis

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2013 The Authors.This study explored experiences of obesity, its perceived causes and motives for surgery, as described by seven Saudi women contemplating bariatric surgery. The women experienced cultural restrictions on their physical and social activities. Obesity embodied these restrictions, attracting stigma and moral failure. Traditional clothing, foods, hospitality norms and limited outdoor female activities were regarded as barriers to weight loss. Bariatric surgery was chosen to protect health and to access normative female roles. Some were encouraged by relatives who had undergone surgery. Opting for surgery reflected both participants’ sense of powerlessness to self-manage weight and the social acceptability, within their family context, of this biomedical approach

Adherence to Hippocratic Oath in the Treatment of Urinary Tract Stones by Minimally Invasive Surgery; A five Years Experience in Dar es Salaam, Tanzania

Background: Minimally invasive treatment – (referring to endoscopic,  laparoscopic and shockwave procedures) have made open surgery for stones nearly obsolete hence adhering to the father’s of medicine that not to provide treatments which are pointless or harmful. The development of shock wave lithotripsy, percutaneous nephrolithotomy techniques and intracorporeal lithotripsy devices has conferred unprecedented  management tools for upper tract stones. With experience, successful stone retrieval has occurred in upwards of 90% of cases, again with  minimal complications. Moreover, transfusion rates, hospital costs, and convalescence periods have been markedly reduced when compared to open surgery.Objective: This study aimed to document the profile and outcome of patients treated for urinary tract stones by minimally invasive approach at Apollo Medical Centre – Dar-es-salaam, for five years being an experience in a typical third world environment.Methods: This was a five years hospital based descriptive, combined retrospective and prospective study conducted by using a structured data collecting tool. The data were analyzed using SPSS software.Results: A total of 281patients treated for urinary tract stones by minimally invasive approach in a period of five years were enrolled, of which 204 were retrospective, and 77 patients were prospective. Males were the majority at 66.9% (188) giving M:F ratio of 2:1. Majority of the patients, 274 (80%) were over 30 years of age. Renal stones were the commonest at 45.5% with ESWL being the most popular procedure performed in 47.7% of all patients. ESWL had a success rate of 70.7%, lower than contact lithotripsy and forceps picking. Only 4.6% complication rate was reported, both being minor.Conclusions: the prevalence of urinary tract stones is increasing among female. Our patients deserve the benefits of minimally invasive techniques in the management of urolithiasis as they have been demonstrated to be feasible, safe and ESWL non-technically demanding.Key words; Minimal invasive treatment, Urinary stones, Complications, Succes

Existence of solution for some quasi-homogenous and quasi-elliptic Nonlinear Eigenvalue Problems

The existence of solutions for a non linear eigenvalue problems is well studied and proved for n even. In this article we will study the case of odd dimension n>1 for the family of quasi-homogeneous and quasi-elliptic operators and we will give some examples for the case n=3. We study the conditions for which we can prove the existence of non trivial solution for each case

The NMR Study and Antimicrobial Activity of Some Schiff Bases Derived From Sulphonamide Drug

Some Schiff base compounds derived from sulfonamide drug were synthesized by reaction of 4-aminobenzenesulfonamide with aromatic aldehydes (2-hydroxy-1-naphthaldehyde, 3,4-dihydroxybenzaldehyde and 2-hydroxy benzaldehyde) in good yields.  Characterization of synthesized compound was carried by elemental analysis, IR, 1H,13C, HSQC and HMBC- NMR spectroscopy. The synthesized compounds were screened for their antibacterial activity against Staphylococcus aureus, Streptococcus sp., Bacillus subtillus, Escherichia coli and  Klebsiella pneumonia. Additionally, the compounds were tested for antifungicidal activity against Candida krusei, Candida tropicalis, Aspergillus fumigates and Aspergillus niger. Â