Thirty years old lady with nephrotic syndrome: a case of biopsy proven lupus nephritis in Tanzania

We describe a case of a 30 years old female patient who presented with nephrotic syndrome and impaired renal function which was diagnosed to have systemic lupus erythematosus (SLE) with lupus nephritis. This is the first biopsy proven lupus nephritis in Tanzania. SLE is common among females and is reported be more common among Africans as compared to other races. This patient presented with nephrotic syndrome, pleural effusion and pericardial effusion which depicts the multisystem effects of SLE. This patient was treated with cyclophosphamide in combination with steroid as induction therapy and attained remission after one month of treatment. Systemic lupus erythematosus should be considered in patients with nephrotic syndrome and these patients should have renal biopsy to determine renal involvement

Evaluation of immune responses in HIV infected patients with pleural tuberculosis by the QuantiFERON® TB-Gold interferon-gamma assay

<p>Abstract</p> <p>Background</p> <p>Diagnosis of tuberculous (TB) pleuritis is difficult and better diagnostic tools are needed. New blood based interferon-gamma (IFN-γ) tests are promising, but sensitivity could be low in HIV positive patients. The IFN-γ tests have not yet been validated for use in pleural fluid, a compartment with higher level of immune activation than in blood.</p> <p>Methods</p> <p>The QuantiFERON TB^®-Gold (QFT-TB) test was analysed in blood and pleural fluid from 34 patients presenting with clinically suspected pleural TB. Clinical data, HIV status and CD4 cell counts were recorded. Adenosine deaminase activity (ADA) analysis and TB culture were performed on pleural fluid.</p> <p>Results</p> <p>The patients were categorised as 'confirmed TB' (n = 12), 'probable TB' (n = 16) and 'non-TB' pleuritis (n = 6) based on TB culture results and clinical and biochemical criteria. The majority of the TB patients were HIV infected (82%). The QFT-TB in pleural fluid was positive in 27% and 56% of the 'confirmed TB' and 'probable TB' cases, respectively, whereas the corresponding sensitivities in blood were 58% and 83%. Indeterminate results in blood (25%) were caused by low phytohemagglutinin (PHA = positive control) IFN-γ responses, significantly lower in the TB patients as compared to the 'non-TB' cases (p = 0.02). Blood PHA responses correlated with CD4 cell count (r = 0.600, p = 0.028). In contrast, in pleural fluid indeterminate results (52%) were caused by high Nil (negative control) IFN-γ responses in both TB groups. Still, the Nil IFN-γ responses were lower than the TB antigen responses (p < 0.01), offering a conclusive test for half of the patients. We did not find any correlation between blood CD4 cell count and IFN-γ responses in pleural fluid.</p> <p>Conclusion</p> <p>The QFT-TB test in blood could contribute to the diagnosis of TB pleuritis in the HIV positive population. Still, the number of inconclusive results is too high to recommend the commercial QFT-TB test for routine use in pleural fluid in a TB/HIV endemic resource-limited setting.</p

Malignant lymphomas (ML) and HIV infection in Tanzania

\ud HIV infection is reported to be associated with some malignant lymphomas (ML) so called AIDS-related lymphomas (ARL), with an aggressive behavior and poor prognosis. The ML frequency, pathogenicity, clinical patterns and possible association with AIDS in Tanzania, are not well documented impeding the development of preventive and therapeutic strategies. Sections of 176 archival formalin-fixed paraffin-embedded biopsies of ML patients at Muhimbili National Hospital (MNH)/Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania from 1996-2001 were stained for hematoxylin and eosin and selected (70) cases for expression of pan-leucocytic (CD45), B-cell (CD20), T-cell (CD3), Hodgkin/RS cell (CD30), histiocyte (CD68) and proliferation (Ki-67) antigen markers. Corresponding clinical records were also evaluated. Available sera from 38 ML patients were screened (ELISA) for HIV antibodies. The proportion of ML out of all diagnosed tumors at MNH during the 6 year period was 4.2% (176/4200) comprising 77.84% non-Hodgkin (NHL) including 19.32% Burkitt's (BL) and 22.16% Hodgkin's disease (HD). The ML tumors frequency increased from 0.42% (1997) to 0.70% (2001) and 23.7% of tested sera from these patients were HIV positive. The mean age for all ML was 30, age-range 3-91 and peak age was 1-20 years. The male:female ratio was 1.8:1. Supra-diaphragmatic presentation was commonest and histological sub-types were mostly aggressive B-cell lymphomas however, no clear cases of primary effusion lymphoma (PEL) and primary central nervous system lymphoma (PCNSL) were diagnosed. Malignant lymphomas apparently, increased significantly among diagnosed tumors at MNH between 1996 and 2001, predominantly among the young, HIV infected and AIDS patients. The frequent aggressive clinical and histological presentation as well as the dominant B-immunophenotype and the HIV serology indicate a pathogenic association with AIDS. Therefore, routine HIV screening of all malignant lymphoma patients at MNH is necessary to enable comprehensive ARL diagnosis and formulation of preventive and therapeutic protocols.\u

H. pylori-infection and antibody immune response in a rural Tanzanian population

BACKGROUND: Helicobacter pylori (H. pylori) infection is ubiquitous in sub-Saharan Africa, but paradoxically gastric cancer is rare. METHODS: Sera collected during a household-based survey in rural Tanzania in 1985 were tested for anti-H. pylori IgG and IgG subclass antibodies by enzyme immunoassay. Odds ratios (OR) and confidence intervals (CI) of association of seropositivity with demographic variables were computed by logistic regression models. RESULTS: Of 788 participants, 513 were aged ≤17 years. H. pylori seropositivity increased from 76% at 0–4 years to 99% by ≥18 years of age. Seropositivity was associated with age (OR 11.5, 95% CI 4.2–31.4 for 10–17 vs. 0–4 years), higher birth-order (11.1; 3.6–34.1 for ≥3(rd )vs. 1(st )born), and having a seropositive next-older sibling (2.7; 0.9–8.3). Median values of IgG subclass were 7.2 for IgG1 and 2.0 for IgG2. The median IgG1/IgG2 ratio was 3.1 (IQR: 1.7–5.6), consistent with a Th2-dominant immune profile. Th2-dominant response was more frequent in children than adults (OR 2.4, 95% CI 1.3–4.4). CONCLUSION: H. pylori seropositivity was highly prevalent in Tanzania and the immunological response was Th2-dominant. Th2-dominant immune response, possibly caused by concurrent bacterial or parasitic infections, could explain, in part, the lower risk of H. pylori-associated gastric cancer in Africa

Chronic inflammatory cells and damaged limbal cells in pterygium

Background: Chronic inflammation in pterygium occurrence has not been explained. Whether damaged limbal basal epithelial cells are associated with pterygium occurrence in black Africans is not clear. Objective: To explain chronic inflammation in pterygium, and to clarify whether damaged limbal basal epithelial cells were associated with pterygium occurrence in black Africans. Methods: Chronic inflammatory changes and damaged limbal basal epithelial cells were assessed in 59 samples. Results: Chronic inflammatory cells were present in 59 pterygia. Inflammatory cell count in 5 (27.8%) of 18 small pterygia was >200 (high) while in 22 (53.7%) of 41 large growths was <200 (low); p = 0.25. The proportion of pterygia with high counts tended to increase with pterygium extent. Twenty (33.9%) of 59 pterygia recurred after surgery. Ten (50%) of 20 samples had high cell counts and 10 (50%), low counts; p = 0.40. P53 expression was detected in 11 (18.6%) of 59 pterygium samples and 5 (71.4%) of 7 controls; p = 0.007. MMP 1 staining was present in 14 (23.7%) of 59 sections and 5 (71.4%) of 7 controls; p = 0.02. MMP2 in 16 (27.1%) cases and 5 (71.4%)controls; p = 0.03. MMP3 was overexpressed in 16 (27.1%) of 59 cases and 5 (71.4%) controls; p = 0.03. Conclusions: Mild chronic inflammation has a tendency to be more frequent than severe inflammation in pterygia. It is clear that damaged limbal basal epithelial cells are unlikely to be related to pterygium occurrence

EXPRESSION OF OESTROGEN AND PROGESTERONE RECEPI ORS, Ki-67, p53 AND BCL-2 PROTEINS, CATHEPSIN D, UROKINASE PLASMINOGEN ACT1 VATOR AND UROKINASE PLASMINOGEN ACTIVATOR-RECEPTORS IN CARCINOMAS OF THE FEMALE BREAST IN AN AFRICAN POPULATION

Objective: To determine the expression of oestrogen (ER) and proj ;esterone receptor (PgR),Ki-67, p53, bcl-2 proteins and the proteolytic enzymes cathe~lsin D (CD), urokinaseplasminogenactivator (uPA) and its receptor (uPA-R) in primary carcinomas of the breastfrom indigenous Tanzanian female patients by immunohistochenristry.Design: i'rospective cross-sectional study.Setting: Muhimbili Medical Centre, Dar es Salaam, Tanzania.Subjects: Sixty patients admited between 1995 and 1997.Results: Markers were found to be expressed as follows: ER (3: .3%), PgR (18.3%), p53(30%), bcl-2 (43.5%) and the median proliferation rate of Ki-67 was 15%. Proportion oftumours positive for ER, PgR and bcl-2 initially decreased to 12 nonths disease duration,after which it increased. The observed proliferation rate approaches that reported indeveloped countries. p53 expression did not influence the prolife ration rate nor did bcl-2expression. ER, PgR and bcl-2 were strongly co-expressed. CD was wedominantly expressedin stromal macrophages than in cancer cells.Conclusion: The low expression of ER and PgR and their strong co-expression with bcl-2might negatively influence response to hormonal therapy. The influence of bcl-2 on tumourresponse to anti-cancer therapy in patients with long disease duration requires urgentclarification. Determination of CD in stromal macrophages rathe~ than in cancer cells mayhave greatel- prognostic significance in patients of this region

Expression of Oestrogen and progesterone receptors, Ki-67,p53 and bcl-2 proteins, cathepsin D, urokinase plasminogen activator and urokinase plasminogen activator-receptors in carcinomas of the female breast in an African population

(East African Medical Journal: 2001 78(7): 360-365

Toxoplasma encephalitis in HIV: case report

(East African Medical Journal: 2001 78(5): 275-276

Towards sustainable emergence transportation system for maternal and new born: Lessons from the m-mama innovative pilot program in Shinyanga, Tanzania.

Maternal mortality comprises about 10% of all deaths among women of reproductive age (15-49 years). More than 90% of such deaths occur in low- and middle-income countries (LMIC). In this study, we aimed to document lessons learnt and best practices toward sustainability of the m-mama program for reducing maternal and newborn mortality in Tanzania. We conducted a qualitative study from February to March 2022 in Kahama and Kishapu district councils of Shinyanga region. A total of 20 Key Informant Interviews (KII) and four Focused Group Discussions (FGDs) were conducted among key stakeholders. The participants included implementing partners and beneficiaries, Community Care groups (CCGs) facilitators, health facility staff, drivers and dispatchers. We gathered data on their experience with the program, services offered, and recommendations to improve program sustainability. We based the discussion of our findings on the integrated sustainability framework (ISF). Thematic analysis was conducted to summarize the results. To ensure the sustainability of the program, these were recommended. First, active involvement of the government to complement community efforts, through the provision and maintenance of resources including a timely and inclusive budget, dedicated staff, infrastructure development and maintenance. Secondly, support from different stakeholders through a well-coordinated partnership with the government and local facilities. Third, continued capacity building for implementers, health care workers (HCWs) and community health workers (CHWs) and community awareness to increase program trust and services utilization. Dissemination and sharing of evidence and lesson learnt from successful program activities and close monitoring of implemented activities is necessary to ensure smooth, well-coordinated delivery of proposed strategies. Considering the temporality of the external funding, for successful implementation of the program, we propose a package of three key actions; first, strengthening government ownership and engagement at an earlier stage, secondly, promoting community awareness and commitment and lastly, maintaining a well-coordinated multi-stakeholder' involvement during program implementation