Diagnostic utility of abdominal ultrasound in the evaluation of abdomino-pelvic lesions at Bugando Medical Centre in Mwanza, Tanzania

Background: Despite the fact that abdominal ultrasound has been widely used in many centres in Tanzania as a primary diagnostic imaging for patients with abdomino-pelvic lesions, its diagnostic utility has not yet been assessed in Tanzania, and therefore its use as an alternative diagnostic tool in patients with abdomino-pelvic lesions is not justified. This study aimed to determine the utility of abdominal ultrasound in the diagnosis of abdomino-pelvic lesions in our local setting.Methods: This was a cross sectional study to evaluate the diagnostic utility of abdominal ultrasound in patients presenting with abdomino-pelvic lesions at Bugando Medical Centre between January 2017 and July 2017. Abdominal ultrasonographic findings were cross-tabulated against operative findings (the gold standard). Then, the sensitivity, specificity, accuracy, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy were calculated to determine the diagnostic utility of abdominal ultrasound.Results: A total of 146 patients (M: F ratio = 1: 2.2) were studied. The mean age at diagnosis was 39.3 years. The diagnostic utility of abdominal ultrasound in terms of sensitivity, specificity, PPV, NPV and accuracy were 39.4-100%, 0-100%, 64.7-100%, 0-100% and 40.8-100% respectively.  The kappa statistic (қ) showed good to excellent agreement with the operative findings, the gold standard (қ = 0.75-1.00).Conclusion: The diagnostic utility of abdominal ultrasound in detecting abdomino-pelvic lesions is much lower than that seen in developed countries, hence, abdominal ultrasound is not a reliable tool in detecting abdomino-pelvic lesions at Bugando Medical Centre and therefore its use should be supplemented with abdominal CT scan in selected cases

HIV, appendectomy and postoperative complications at a reference hospital in Northwest Tanzania: cross-sectional study

Background\ud Appendicitis is a frequent surgical emergency worldwide. The present study was conducted to determine the prevalence of HIV, and the association of infection with clinical, intraoperative and histological findings and outcome, among patients with appendicitis.\ud Methods\ud We performed a cross sectional study at Weill-Bugando Medical Centre in northwest Tanzania. In total, 199 patients undergoing appendectomy were included. Demographic characteristics of patients, clinical features, laboratory, intraoperative and histopathological findings, and HIV serostatus were recorded.\ud Results\ud In total, 26/199 (13.1%) were HIV-seropositive. The HIV-positive population was significantly older (mean age: 38.4 years) than the HIV-negative population (25.3 years; p < 0.001). Leukocytosis was present in 87% of seronegative patients, as compared to 34% in seropositive patients (p = 0.0001), and peritonitis was significantly more frequent among HIV-positives (31% vs. 2%; p < 0.001). The mean (SD) length of hospital stay was significantly longer in HIV-positives (7.12 ± 2.94 days vs. 4.02 ± 1.14 days; p < 0.001); 11.5% of HIV patients developed surgical site infections, as compared to 0.6% in the HIV-negative group (p = 0.004).\ud Conclusion\ud HIV infections are common among patients with appendicitis in Tanzania, and are associated with severe morbidity, postoperative complications and longer hospital stays. Early diagnosis of appendicitis and prompt appendectomy are crucial in areas with high prevalence of HIV infection. Routine pre-test counseling and HIV screening for appendicitis patients is recommended to detect early cases who may benefit from HAART

Prevalence of cerumen impaction and associated factors among primary school children in Mwanza city, Tanzania

Background: Cerumen impaction is a worldwide problem constituting a significant proportion of health problems in many settings and its prevalence varies. There is a paucity of published data regarding this condition in Tanzania with none from Mwanza region. The aim of this study was to determine the prevalence of cerumen impaction and associated factors among primary school children in Mwanza City and to assess the effect of cerumen impaction and its removal on hearing ability Methods and Patients: This was a cross-sectional, community-based study of primary school children with cerumen impaction that was carried out in randomly selected primary schools in Mwanza City between December 2016 and May 2017. Multistage cluster sampling technique was employed to obtain a required number of the study population. Results: Out of the 406 participants, ninety-five (23.4%) had cerumen impacted in their ears. Of these, 56 (58.9%) were males and 39(41.1%) were females. The mean age at presentation was 11.24±8.86 years. Ear bud abuse (83.7%) was the most common predisposing factor for cerumen impaction. Cerumen impaction was found in the right ear of 9 (9.5%) patients and in the left ear in 31 (32.6%) patients and bilateral in 55 (57.9%) of patients. The major presenting symptoms were ear itching, otalgia, hearing loss and tinnitus. Ear syringing was used to remove cerumen impaction and caused significant improvement in hearing thresholds. There were no recorded complications. Conclusion: Cerumen impaction is a common otologic presentation in our sub-region. Ignorance with the profound abuse of cotton buds is the major predisposing factor. Health education is of the essence as treatment is simple and effective

Patterns of surgical admissions among geriatric patients admitted to Bugando Medical Centre, Mwanza, Tanzania

Background: Surgery in geriatric patients constitutes a major but neglected public health problem. It hence poses a great challenge to surgeons and general practitioners practising in a resource-limited setting. Geriatric patients are increasingly hospitalized in surgical wards in Tanzania and little information is currently available on this group of patients. This study aimed to determine the pattern of diseases and clinical outcomes among geriatric surgical patients at Bugando Medical Centre and to identify the predictors of outcomes among these patients in our local setting. Methods and Patients: It was a cross-sectional study of geriatric surgical patients admitted to BMC from June 2017 to April 2018. Results: Out of 304 geriatric surgical patients enrolled, males outnumbered females by a male to female ratio of 3.1: 1. The majority of patients were in the 7th decade of life.&nbsp; Associated medical comorbidities were reported in 107 (35.2%) patients. Urology speciality had the highest number of geriatric patients (101; 60.2%) admitted to BMC followed by general surgery in 70 (23.0%) patients. Gynaecology and Neurosurgery had the least number of geriatric patients with 4(1.3%) and 1(0.3%) patients admitted respectively. The majority of geriatric surgical patients, 286(94.1%) were treated surgically. A total of 168 patients (58.7%) developed postoperative complications. The mortality rate was 15.2% and it was significantly associated with loa ng duration of illness, high American Society of Anesthesiologist class, operation under gene anaesthesia and prolonged duration of the operation. Conclusion: This study demonstrated that surgeries among geriatric patients are commonly performed at BMC and are associated with unacceptably high morbidity and mortality. Factors responsible for the high morbidity and mortality in our geriatric surgical patients should be addressed to improve the surgical outcomes in this group of patients

Diagnostic value of pneumoperitoneum on plain abdominal film in patients with suspected visceral perforation at Bugando Medical Centre, Mwanza, Tanzania

Background:&nbsp; The presence of pneumoperitoneum on plain abdominal film has been widely used in many centres in Tanzania as primary diagnostic imaging in patients with suspected visceral perforation. However, its diagnostic value has not yet been assessed in any hospital in the country including Bugando Medical Centre (BMC), and therefore its use as a diagnostic tool in these patients is not justified. This existing knowledge gap prompted the author to conduct this study. The study aimed to determine the diagnostic value of pneumoperitoneum on plain abdominal film in patients with suspected visceral perforation in our local setting. Methods: This was a prospective cross-sectional study among patients with suspected visceral perforation at BMC from June 2017 to May 2018. Pneumoperitoneum on plain abdominal radiography was evaluated, and the findings were cross-tabulated against operative findings, the gold standard. Then, the sensitivity, specificity, accuracy, Positive Predictive Value, Negative Predictive Value and accuracy were calculated to determine the diagnostic value of pneumoperitoneum on plain abdominal film. The Kappa statistic (қ) was calculated to determine the degree of agreement with operative findings. Results: A total of 132 patients were studied. The median age of patients was 35 years. The diagnostic accuracy of pneumoperitoneum on plain abdominal film in the detection of perforation was 90.9% with sensitivity, specificity, PPV and NPV of 90.1%, 92.7%, 96.5% and 80.9% respectively. There was good agreement with operative findings (κ = 0.86). The perforations of the ileum, gastric, duodenum, colon and appendix accounted for 36.3%, 22.0%, 19.8%, 11.0% and 11.0% of cases, respectively. The sensitivity, specificity, PPV, NPV and accuracy perforations of the ileum, gastric, duodenum, colon and appendix were 61.5-100%, 31.7-46.5%, 10.6-37.7%, 85.1-100% and 38.6-59.1% respectively.&nbsp; The kappa statistics showed good agreement with the operative findings (ķ = 0.76-0.89). Conclusion: The presence of pneumoperitoneum on plain abdominal film provides high diagnostic value in the detection of visceral perforation and can be employed at BMC to improve the diagnostic value in patients with suspected visceral perforation and subsequently reduce negative laparotomy and complication rates

HIV seroprevalence, clinical profile and surgical outcomes among patients with acquired anorectal conditions in two referral hospitals in Mwanza, Tanzania

Background: HIV infection, a major health problem worldwide, has been reported to be prevalent in patients with acquired anorectal conditions. There is a paucity of prospective studies regarding acquired anorectal conditions in Tanzania. This study describes the HIV seroprevalence, clinical profile and surgical outcomes among patients with acquired anorectal conditions at Bugando Medical Centre (BMC) and Sekou-Toure Referral Regional Hospital (SRRH). Methods: This was a cross-sectional study that was conducted among patients with acquired anorectal conditions as seen at BMC and SRRH from January 2019 to June 2019. Results:&nbsp; A total of 389 patients (M: F ratio = 1.5:1) were studied. The median age at diagnosis was 42 years. Out of 389 patients, 101(26.0%) were HIV positive. Of these, 54(53.5%) were males and 47 (46.5%) were females. Haemorrhoids were the most common acquired anorectal disease accounting for 50.9% of cases. The rate of HIV infection in this study was significantly high in patients with hemorrhoids (p&lt; 0.001), perianal ulcers (p&lt; 0.001), anorectal abscess (p = 0.009), perianal warts (p&lt; 0.001) and rectal prolapse (p = 0.023). A total of 173 (44.5%) patients underwent surgical treatment for acquired anorectal conditions. Hemorrhoidectomy was the most commonly performed surgical procedure in 95(54.9%) patients. Out of 171 patients who underwent surgical treatment and outcomes evaluated, 138 were treated successfully giving an overall success rate of 80.7%.&nbsp; The success rate was significantly influenced by HIV positivity (p = 0.002). Surgical site infection (SSI) was the most common postoperative complication accounting for 25.8% of cases. The rate of SSI was found to be significantly higher in HIV-positive patients than in HIV-negative patients (39.6% vs 18.5%; p-value = 0.001). Conclusion: HIV infection is prevalent among patients with acquired anorectal conditions in our setting and influences surgical outcomes. We recommend that all patients with acquired anorectal conditions in this region should be screened for HIV infection

Trauma admissions to the Intensive care unit at a reference hospital in Northwestern Tanzania

<p>Abstract</p> <p>Background</p> <p>Major trauma has been reported to be a major cause of hospitalization and intensive care utilization worldwide and consumes a significant amount of the health care budget. The aim of this study was to describe the characteristics and treatment outcome of major trauma patients admitted into our ICU and to identify predictors of outcome.</p> <p>Methods</p> <p>Between January 2008 and December 2010, a descriptive prospective study of all trauma admissions to a multidisciplinary intensive care unit (ICU) of Bugando Medical Centre in Northwestern Tanzania was conducted.</p> <p>Results</p> <p>A total of 312 cases of major trauma were admitted in the ICU, representing 37.1% of the total ICU admissions. Males outnumbered females by a ratio of 5.5:1. Their median age was 27 years. Trauma admissions were almost exclusively emergencies (95.2%) and came mainly from the Accident and Emergency (60.6%) and Operating room (23.4%). Road traffic crash (RTC) was the most common cause of injuries affecting 70.8% of patients. Two hundred fourteen patients (68.6%) required surgical intervention. The overall ICU length of stay (LOS) for all trauma patients ranged from 1 to 59 days (median = 8 days). The median ICU length of hospital stay (LOS) for survivors and non-survivors were 8 and 5 days respectively. (P = 0.002). Mortality rate was 32.7%. Mortality rate of trauma patients was significantly higher than that of all ICU admissions (32.7% vs. 18.8%, P = 0.0012). According to multivariate logistic regression analysis, multiple injuries, severe head injuries and burns were responsible for a longer mean ICU stay (P < 0.001) whereas admission Glasgow Coma Score < 9, systolic blood pressure < 90 mmHg, injury severity core >16, prolonged duration of loss of consciousness, delayed ICU admission (0.028), the need for ventilatory support and finding of space occupying lesion on computed tomography scan significantly influenced mortality (P < 0.001).</p> <p>Conclusion</p> <p>Trauma resulting from road traffic crashes is a leading cause of intensive care utilization in our hospital. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce ICU trauma admissions in this region. Improved pre- and in-hospital care of trauma victims will improve the outcome of trauma patients admitted to our ICU.</p

Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases

Oesophageal perforation is a condition associated with a high mortality. Its management is still controversial with operative treatment being favoured but a shift to conservative management is occurring. Very little exists in medical literature about its management in Sub-Saharan Africa, where the paucity of thoracic surgeons is compounded by limited diagnostic and therapeutic facilities. We report three cases of oesophageal perforation which were all treated conservatively with tube thoracostomy, nil by mouth with feeding gastrostomy, intravenous antibiotics and chest physiotherapy. Two patients achieved oesophageal healing but one died due to severe septicaemia. In a resource restricted setting, conservative management which includes enteral nutrition by feeding gastrostomy, tube thoracostomy to drain inter pleural contaminants, intravenous antibiotics and chest physiotherapy is a safe and effective treatment for oesophageal perforations

A variant branching pattern of the Aortic Arch: a case report

Variant aortic arch branching pattern may occur with different embryological mechanisms. We report on a variant aortic arch branching in a 41-year old Tanzanian male cadaver during dissection practice. The left common carotid artery was seen originating from the root of the brachiocephalic trunk and the left vertebral artery from the arch of the aorta proximal to the origin of the left subclavian artery. We discuss the relative literature, its potential embryologic development and clinical significance

Pattern and Outcome of Chest Injuries at Bugando Medical Centre in Northwestern Tanzania.

Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in developing countries. This study was conducted to outline the etiological spectrum, injury patterns and short term outcome of these injuries in our setting. This was a prospective study involving chest injury patients admitted to Bugando Medical Centre over a six-month period from November 2009 to April 2010 inclusive. A total of 150 chest injury patients were studied. Males outnumbered females by a ratio of 3.8:1. Their ages ranged from 1 to 80 years (mean = 32.17 years). The majority of patients (72.7%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 50.7% of patients. Chest wall wounds, hemothorax and rib fractures were the most common type of injuries accounting for 30.0%, 21.3% and 20.7% respectively. Associated injuries were noted in 56.0% of patients and head/neck (33.3%) and musculoskeletal regions (26.7%) were commonly affected. The majority of patients (55.3%) were treated successfully with non-operative approach. Underwater seal drainage was performed in 39 patients (19.3%). One patient (0.7%) underwent thoracotomy due to hemopericardium. Thirty nine patients (26.0%) had complications of which wound sepsis (14.7%) and complications of long bone fractures (12.0%) were the most common complications. The mean LOS was 13.17 days and mortality rate was 3.3%. Using multivariate logistic regression analysis, associated injuries, the type of injury, trauma scores (ISS, RTS and PTS) were found to be significant predictors of the LOS (P < 0.001), whereas mortality was significantly associated with pre-morbid illness, associated injuries, trauma scores (ISS, RTS and PTS), the need for ICU admission and the presence of complications (P < 0.001). Chest injuries resulting from RTCs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce the incidence of chest injuries in this region