Citywide Trauma Experience in Mwanza, Tanzania: A Need for Urgent Intervention.

Trauma remains a leading cause of morbidity and mortality in resource limited countries. There is paucity of published reports on trauma care in Tanzania, particularly the study area. This study was carried out to describe our experiences in trauma management outlining the etiological spectrum, injury characteristics and treatment outcome of trauma patients at our local setting and compare our results with those from other centers in the world. A descriptive prospective study of trauma patients was conducted at Bugando Medical Centre from April 2010 to March 2012. Statistical data analysis was done using SPSS software version 17.0. A total of 5672 trauma patients were enrolled in the study. The male to female ratio was 2.3: 1. The majority of patients were in the 2nd decade of life. Road traffic accident was the most common cause of trauma accounting for 60.7% of cases. The majority of patients (76.6%) sustained blunt injuries. Musculoskeletal (68.5%) and head/neck (52.6%) were the most frequent body region injured. Soft tissue injuries (open wounds) and fractures were the most common injuries accounting for 82.8% and 76.8% respectively. Majority of patients (74.4%) were treated surgically with wound debridement (94.0%) being the most frequently performed procedure. Postoperative complications were recorded in 31.5% of cases.The overall median duration of hospitalization was 26 days (range 1 day to 144 days). Mortality rate was 16.7%. Patients who had polytrauma, burn injuries and those who had tetanus and long bone fractures stayed longer in the hospital and this was statistically significant (P < 0.001), whereas the age > 65 years, severe trauma, admission Systolic Blood Pressure < 90 mmHg, presence of tetanus, severe head injury, the duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on CT scan of the brain significantly influenced mortality (P < 0.001). Trauma resulting from road traffic accidents remains a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of trauma in this region

In-patient management of leg ulcers

Objective: To review in-patient management of leg ulcers and to compare our experiences with those from other similar centres.Design: A retrospective study.Setting: University of Benin Teaching Hospital, Nigeria.Patients: Forty five patients hospitalisad with leg ulcers.Results: There were 27 male and 18 females (MF 3:2). The age range was 8-90 years (mean 32.5 years). The commonest sites were around the ankle(55.6%) and the distal third of the leg (40%). Trauma, dibb muitus and sickleell dkaw accounted Tor the commonest aetiological factors(35.6%, 22.2% and 17.8% respctively). Coliorw and Staphylococcus aureus were the commonest organisms isolated on culture. AU the patients had routine wound dressing and antibiotics but only 25 patients (56%) responded fully to this Line of preliminary management. The other 20 patients had wound debridement in addition. Nineteen patients(42% ) needed skin grafting while four patients (9%) had below-knee amputation.Conclusion: Our experience shows that leg ulcers whose nature portend an increase in morbidity and mortality are best managed as in-patients. The underlying causes should be addressed while local wound care is administered. Skin grafting and amputation sbould be employed when necessary

Pneumoperitoneum, pneumomediastinum, pneumopericardium and subcutaneous emphysema following colonoscopy- a case report

Colonoscopy is a relatively safe procedure used in the diagnosis and treatment of colonic lesions. Complications such as bleeding, post-polypectomy electrocoagulation syndrome and perforation can occur during the procedure. Although bowel perforation is rare, it is the most serious complication and can lead to death.Following perforation, air can leak into the peritoneal cavity or extra-peritoneally or a combination of the two. Combined intra-peritoneal and extra-peritoneal leakage of air following colonic perforation is rare.We present a case of combined intra-peritoneal and extra-peritoneal leakage of air due to colonic perforation complicating colonoscopy presenting as pneumoperitoneum, pneumomediastinum, pneumopericardium and subcutaneous emphysema in a 68 year old woman who was successfully managed non-operatively

Management of pregnancy associated breast cancer

Background: The peak age incidence for breast cancer in developing countries is 35-45 years, which is part of the reproductive years of our women. As women defer childbearing on account of education and careers, the incidence of pregnancy associated breast cancer is expected to increase. Aim: This study presents 4 cases of pregnancy associated breast cancer (PABC) to illustrate the challenges and dilemma in the management of these patients. Methods: The clinical features, stage of presentation of the disease, treatment and outcome of treatment of 4 patients with PABC are reviewed. Results: There were live births of normal babies by all 4 patients, but 100% mortality as all the 4 patients with PABC died within 18 months of delivery from metastatic breast cancer. Conclusion: Seventy to 80% of non-pregnant patients present with advanced breast cancer. PABC as illustrated by these 4 cases presented at worse stages of the advanced cancer. The late stage at diagnosis of PABC and the desire by the patients to have normal live birth at term have worsened prognosis for the PABC patients in our environment. Recommendation: Multidisciplinary team approach by midwives, obstetricians, surgeons and counselors using BSE, CBE and screening at ante-natal clinics for early detection and diagnosis. Counselors to assist patients take decision in the best interest of patient and unborn baby to reduce morbidity and mortality. Keywords: Pregnancy, Breast, CancerPort Harcourt Medical Journal Vol. 3 (1) 2008: pp. 37-4