A Fibreoptic Endoscopic Study of Upper Gastrointestinal Bleeding at Bugando Medical Centre in Northwestern Tanzania: a Retrospective Review of 240 Cases.

Upper gastrointestinal (GI) bleeding is recognized as a common and potentially life-threatening abdominal emergency that needs a prompt assessment and aggressive emergency treatment. A retrospective study was undertaken at Bugando Medical Centre in northwestern Tanzania between March 2010 and September 2011 to describe our own experiences with fibreoptic upper GI endoscopy in the management of patients with upper gastrointestinal bleeding in our setting and compare our results with those from other centers in the world. A total of 240 patients representing 18.7% of all patients (i.e. 1292) who had fibreoptic upper GI endoscopy during the study period were studied. Males outnumbered female by a ratio of 2.1:1. Their median age was 37 years and most of patients (60.0%) were aged 40 years and below. The vast majority of the patients (80.4%) presented with haematemesis alone followed by malaena alone in 9.2% of cases. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking prior to the onset of bleeding was recorded in 7.9%, 51.7% and 38.3% of cases respectively. Previous history of peptic ulcer disease was reported in 22(9.2%) patients. Nine (3.8%) patients were HIV positive. The source of bleeding was accurately identified in 97.7% of patients. Diagnostic accuracy was greater within the first 24 h of the bleeding onset, and in the presence of haematemesis. Oesophageal varices were the most frequent cause of upper GI bleeding (51.3%) followed by peptic ulcers in 25.0% of cases. The majority of patients (60.8%) were treated conservatively. Endoscopic and surgical treatments were performed in 30.8% and 5.8% of cases respectively. 140 (58.3%) patients received blood transfusion. The median length of hospitalization was 8 days and it was significantly longer in patients who underwent surgical treatment and those with higher Rockall scores (P < 0.001). Rebleeding was reported in 3.3% of the patients. The overall mortality rate of 11.7% was significantly higher in patients with variceal bleeding, shock, hepatic decompensation, HIV infection, comorbidities, malignancy, age > 60 years and in patients with higher Rockall scores and those who underwent surgery (P < 0.001). Oesophageal varices are the commonest cause of upper gastrointestinal bleeding in our environment and it is associated with high morbidity and mortality. The diagnostic accuracy of fibreoptic endoscopy was related to the time interval between the onset of bleeding and endoscopy. Therefore, it is recommended that early endoscopy should be performed within 24 h of the onset of bleeding

Manifestations of Tuberculosis in TB-HIV co-infected patients: A retrospective study

Background: Tuberculosis (TB) is one of the common opportunistic infection and the main cause of death among HIV/AIDS patients. Diagnosis of TB in HIV/AIDS patients has been difficult due to atypical manifestations of TB in these patients Broad objective: The main objective of the present study was to examine the common clinical and radiological manifestations of tuberculosis in association with immune status in HIV-TB co-infected patientsMethodology: Retrospective data of 339 HIV/AIDS patients co-infected with TB attended at Sekou Toure regional hospital between January 2007-May 2010 were collected. Information such as age, sex, baseline CD4 T cell counts, presented symptoms and form of TB were recorded and analyzed by Statistical package for social sciences (SPSS) version 17.0.Results: Out of 339 patients, 165(48.7%) were females and 174 (51.3%) were males with mean age of 35 years. Of all the symptoms recorded, cough was the commonest symptom 320 (94.4%), recorded followed by weight loss 235(69.3%), fever 233(68.7%), night sweats 122(36%), anorexia 78(23%) and chest pain 27(8%) respectively. Radiological findings showed that pulmonary TB (PTB) was present in 310(91.4%) and extra pulmonary TB (EPTB) 48 (14.2%) patients respectively. Patients with both EPTB and PTB were 20(5.9%). Pleura effusion (50%) and adenitis (27%) were the common forms of EPTB. Acid fast bacilli results showed that, 112(33.04%) of the patients were AFB positive. Smear negativity rate was significantly high among patients with CD4 T cell count ≤ 400cells/μl (P=0.0001). Patients with TB symptoms and other clinical symptoms had significant low CD4 T cell counts (≤ 200 cells/μl) (P=0.0001).Conclusions and recommendations: PTB with typical and atypical features was the most common manifestation of TB in HIV/AIDS co-infected patients. EPTB was also common and mostly in form of pleura effusion and adenitis. Low CD4 T cell counts were associated with high smear negativity rate and presence of other conditions in patients with TB symptoms. Sufficient knowledge of TB manifestation in HIV/AIDS patients is necessary for proper diagnosis of TB in HIV/AIDS patients. Moreover standardized diagnosis and optimization of case detection rate in HIV/AIDS needs to be adopted.Key words: Tuberculosis, HIV/AIDS, manifestations, opportunistic infection