Dermatological Malignancies at a University Teaching Hospital in north-western Tanzania: A Retrospective Review of 154 Cases

Dermatological malignancies are among the most common form of cancers and the global incidence has been increasing at an alarming rate. A retrospective study was conducted to determine the prevalence, histopathological pattern, anatomical distribution and treatment outcome of dermatological malignancies at Bugando Medical Centre in North-western Tanzania. Data were collected from patients’ files kept in the Medical record department; the surgical wards, operating theatre and histopathology laboratory and analyzed using Statistical package for social sciences system. A total of 154 patients with a histopathological diagnosis of dermatological malignancy were studied. Generally, males outnumbered females by a ratio of 1.4:1. The majority of patients were in the 5th and 6th decades of life. Malignant melanoma was the most common dermatological malignancy (67.5%) followed by Kaposi’s sarcoma (10.4%), Squamous cell carcinoma (8.4%) and Basal cell carcinoma(7.8%). The lower limbs were the most frequent site accounting for 55.8%. Wide local excision was the most common surgical procedure performed in 79.2% of cases. Post-operative wound infection was the most common complication in 58.3% of patients. Mortality rate was 3.8%. Dermatological malignancies are more prevalent in our setting. A high index of suspicion is needed to avoid labelling malignancies “chronic ulcers” and all suspected lesions should be biopse

Patterns and outcome of surgical management of goitres at Bugando Medical Centre in northwestern Tanzania

Despite the well established endemicity of goitres little work has been done on the management of goiters in Tanzania. A cross-sectional study was conducted at Bugando Medical Centre (BMC) in Mwanza, Tanzania to determine the pattern and outcome of surgical management of goitres. Data was collected using a pre-tested, coded questionnaire. A total of 152 patients were studied of which 140 (92.1%) were females and males were 12 (7.9%) (F: M = 11.7: 1). Their ages ranged from 18 to 72 years (mean =38.4± 12.5 years). The mean duration of illness was 9.2 years. The thyroid gland size at admission was grade III in 63.8% of patients. Multinodular goitres were reported in 51.3% of patients. The majority of patients (92.1%) presented with euthyroid goitres and the remaining (7.9%) patients had toxic goitres. Pressure symptoms and cosmetic disfigurement were the common indications for thyroidectomy in 47.4% and 23.7%, respectively. Near total thyroidectomy and total thyroidectomy were the surgical procedures performed for benign and malignant goitres in 47.3% and 8.1% of patients, respectively. Simple multinodular goitres were the most common histopathological pattern accounting for 67.2% of cases. Twelve (7.9%) patients had a histologically proven thyroid malignancy, of which follicular and papillary carcinoma were reported in 41.7% and 33.3% of cases, respectively. Post-operative complications rate was 7.9%. The mean length of hospital stay was 14.4 days (range 3 to 34 days). Five patients died giving a mortality rate of 3.4%. In conclusion, this study has shown that the pattern of surgical goitres seen at Bugando Medical Centre is similar to what is reported from other parts of the world. However, the majority of patients present for surgery very late with huge goitres predisposing them to increased risk of post-operative complications, prolonged length of hospital stay and cost of medical care. It is therefore recommended that health education should be given to the community about the cause, prevention and treatment options so that patients could seek early medical attention

Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania

<p>Abstract</p> <p>Background</p> <p>Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting.</p> <p>Methods</p> <p>A cross-sectional study involving all patients suspected to have acute appendicitis at Bugando Medical Centre over a six-month period between November 2008 and April 2009 was conducted. All patients who met the inclusion criteria were consecutively enrolled in the study. They were evaluated on admission using the MASS to determine whether they had acute appendicitis or not. All patients underwent appendicectomy according to the hospital protocol. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical judgment and not the MASS. The diagnosis was confirmed by histopathological examination. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software.</p> <p>Results</p> <p>A total number of 127 patients were studied. Their ages ranged from eight to 76 years (mean 29.64 ± 12.97). There were 37 (29.1%) males and 90 (70.9%) females (M: F = 1:2.4). All patients in this study underwent appendicectomy. The perforation rate was 9.4%. Histopathological examination confirmed appendicitis in 85 patients (66.9%) and the remaining 42 patients had normal appendix giving a negative appendicectomy rate of 33.1% (26.8% for males and 38.3% for females). The sensitivity and specificity of MASS in this study were 94.1% (males 95.8% and females 88.3%) and 90.4% (males 92.9% and females 89.7%) respectively. The Positive Predictive Value and Negative Predictive Value were 95.2% (males 95.5% and females 90.6%) and 88.4% (males 89.3% and females 80.1%) respectively. The accuracy of MASS was 92.9% (males 91.5% and females 87.6%).</p> <p>Conclusion</p> <p>The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy and can be employed at Bugando Medical Centre to improve the diagnostic accuracy of acute appendicitis and subsequently reduces negative appendicectomy and complication rates. However, additional investigations may be required to confirm the diagnosis in case of atypical presentation.</p

Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

Obstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify prognostic factors for morbidity and mortality. This was a descriptive prospective study which was conducted at Bugando Medical Centre between July 2006 and June 2010. All patients with a clinical diagnosis of obstructive jaundice were, after informed consent for the study, consecutively enrolled into the study. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS computer software version 11.5. A total of 116 patients were studied. Females outnumbered males by a ratio of 1.3:1. Patients with malignant obstructive jaundice were older than those of benign type. Ca head of pancreas was the commonest malignant cause of jaundice where as choledocholithiasis was the commonest benign cause. Abdominal ultrasound was the only diagnostic imaging done in all patients and revealed dilated intra and extra-hepatic ducts, common bile stones and abdominal masses in 56.2%, 78.9%, 58.1% and 72.4% of the cases respectively. A total of 110 (94.8%) patients underwent surgical treatment and the remaining 6 (5.2%) patients were unfit for surgery. The complication rate was 22.4% mainly surgical site infections. The mean hospital stay and mortality rate were 14.54 days and 15.5% respectively. A low haematocrit and presence of postoperative sepsis were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes and presence of postoperative complications mainly sepsis significantly predicted mortality (P < 0.001). Obstructive jaundice in our setting is more prevalent in females and the cause is mostly malignant. The result of this study suggests that early diagnosis and treatment plays an important role in the prognosis of patients with obstructive jaundice

Pattern of childhood burn injuries and their management outcome at Bugando Medical Centre in Northwestern Tanzania

Burn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome. A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0. A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (48.0%) sustained superficial burns. Eight (2.3%) patients were HIV positive. Most patients (89.8%) presented to the hospital later than 24 h. The rate of burn wound infection on admission and on 10th day were 32.4% and 39.8% respectively.Staphylococcus aureus were more common on admission wound swabs, with Pseudomonas aeruginosa becoming more evident after 10th day. MRSA was detected in 19.2% of Staphylococcus aureus. Conservative treatment was performed in 87.1% of cases. Surgical treatment mainly skin grafting (65.9%) was performed in 44 (12.9%) of patients. The overall average of the length of hospital stay (LOS) was 22.12 ± 16.62 days. Mortality rate was 11.7%. Using multivariate logistic regression analysis; age of the patient, type of burn, delayed presentation, clothing ignition, %TBSA and severity of burn were found to be significantly associated with LOS (P < 0.001), whereas mortality rate was found to be independently and significantly related to the age of the patient, type of burn, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (P < 0.001). Childhood burn injuries still remain a menace in our environment with virtually unacceptable high morbidity and mortality. There is need for critical appraisal of the preventive measures and management principles currently being practiced

Aetiological spectrum, injury characteristics and treatment outcome of head injury patients at Bugando Medical Centre in north-western Tanzania

Head injury is considered as a major health problem that is a frequent cause of death and disability and makes considerable demands on health services.A cross-sectional study was conducted to determine the etiological spectrum, injury characteristics and treatment outcome of head injury patients at Bugando Medical Centre (BMC) in North-western Tanzania. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS programme. A total of 260 head injury patients (mean age=26.84 years) were studied. Males outnumbered females by a ratio of 1.5:1. Road traffic accidents (RTAs) were the most common cause of injury accounting for 49.2% of patients. Scalp injuries, cerebral concussion and skull fractures were the most common type of head injuries. Fifty-six (21.5%) patients had associated injuries of which musculoskeletal region (36.1%) was commonly affected. Most of patients (66.1%) sustained mild head injury. The majority of patients (75.8%) were treated conservatively and only 24.2% of patients needed surgical interventions. Most of patients (85.4%) had good recovery. The mean hospital stay (LOS) was 24.56 days and the mortality rate was 11.2%. Patients who had RTAs, penetrating head injuries, associated long bone fractures and those who were treated surgically were found to have significantly longer LOS (P< 0.001). Mortality was found to be significantly associated with extreme of age, presence of pre-morbid illness and associated injuries, admission Glasgow Coma Score < 9, systolic blood pressure < 90mmHg, injury severity core ≥16, longer duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on computed tomography scan (P < 0.001). Head injuries resulting from RTAs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of head injuries in this region

The Use of IV-Tubing as a Closed-Suction Drainage System During Neurosurgical Cases in Tanzania.

Commercial closed-suctions drainage systems are commonly used in the United States and many other countries for use in neurosurgical cases. However, in Tanzania and other developing nations with fewer resources, these are not available. This report explores another option for a closed-system drainage system utilizing inexpensive supplies found commonly in hospitals around the world. Sterile IV-tubing is cut, inserted into the wound, and brought out through an adjacent puncture incision. For suction, an empty plastic bottle can be attached to the tubing. The IV-tubing closed-suction drainage system was applied in both cranial and spinal neurosurgical procedures, including as subdural, subgaleal, epidural, and suprafacial drains. It maintained suction and was an adequate substitute when commercial drains are unavailable. This report illustrates how sterile IV-tubing can be adapted for use as a closed-drainage system. It utilizes inexpensive supplies commonly found in many hospitals throughout the world and can be applied to both cranial and spinal neurosurgical procedures

Experiences with childhood colostomy at a tertiary hospital in Mwanza, Tanzania

Colostomy is a common life saving procedure in children and may be attended by significant morbidity. This cross-sectional study was carried out to describe experiences with childhood colostomy outlining the common indications, complications and their management and to identify factors associated with these complications in a tertiary hospital in Mwanza, Tanzania. Data was collected using a pre-tested, coded questionnaire. A total of 134 patients were studied. Seventy-eight (58.2%) were males and females were fifty-six (41.8%) (M: F =1.4:1). Their mean age was 1.83 years (range 1 day to 10 years). Anorectal malformations and Hirschsprung’s disease were the most common indications for colostomy formation in 46.3% and 40.3%, respectively. Transverse loop colostomy was the commonest type of colostomy performed accounting for 79.1% of cases. Colostomy-related complications were recorded in 35.8% of cases. Skin excoriation and colostomy prolapse were the most common complications accounting for 19.4% and 17.9% respectively. The overall complication rate was significantly common in transverse colostomy than in sigmoid colostomy and in colostomies performed by junior doctors (