Diagnostic accuracy of computed tomography in adults with suspected acute appendicitis at the emergency department in a private tertiary hospital in Tanzania

Introduction. The increasing incidence of acute appendicitis in sub-Saharan Africa emphasizes the need for accurate and reliable diagnostic tools. However, the variability in the diagnostic performance of computed tomography for suspected acute appendicitis coupled with comparatively higher negative appendectomy rates in this setting highlight a possible concern regarding the diagnostic accuracy. This study evaluated the diagnostic accuracy of a computed tomography scan for suspected acute appendicitis at the emergency department in Tanzania. Methods.A retrospective diagnostic accuracy study was conducted from July to October 2020. All patients above 14 years of age who presented at the emergency department with right iliac fossa abdominal pain of fewer than ten days and underwent computed tomography for suspected acute appendicitis were evaluated, and the Alvarado score was computed. Histological diagnosis and clinical follow-up of 14 days were considered the reference standard. Ethical clearance was sought from the Aga Khan University Ethical review committee. Results 176 patients were included in this study. The sensitivity, specificity, and diagnostic accuracy were 100% (95% CI 91.8–100), 96.9% (95% CI 92.2–99.1), and 96.9% (95% CI 93.1–98.3), respectively. The mean Alvarado score in those without acute appendicitis was 4 (95% CI 3.7–4.3) compared to a mean score of 6.6 (95% CI 6.0–7.2) amongst those with acute appendicitis. The area under the receiver operator characteristics curve of computed tomography was 98.4%, and that of the Alvarado score was 84.1%. Conclusions The diagnostic performance of computed tomography in this study is similar to that established elsewhere. However, the Alvarado score is not routinely used for the initial screening of suspected acute appendicitis patients. A threshold of Alvarado score of 4 as a guide to conduct computed tomography for suspected acute appendicitis would have decreased computed tomography use by 50%, and missed 4 cases. Implementation studies that address Alvarado score use should be conducted

Late diagnosis of congenital diaphragmatic hernia: a case report

Background Congenital diaphragmatic hernia beyond the neonatal period is not uncommon. Its diagnosis in infancy and early childhood poses a challenge owing to different clinical presentation ranging from gastrointestinal to respiratory symptoms. These neonates are usually misdiagnosed as having pneumonia until radiological imaging picks up the defect during routine scan for worsening respiratory symptoms. In high-income countries, the survival rate for these patients has been reported to be high, while in Sub-Saharan Africa the survival rate is still low due to delayed diagnosis, delayed referral, and hence delayed management. Case report We present an African male baby from non-consanguineous parents, 6 weeks old, diagnosed with congenital diaphragmatic hernia at 6 weeks of age after failure to respond to antibiotics for suspected pneumonia. Despite attempts at management, he died at 5 weeks post surgery. Conclusion Our case emphasizes the importance of early clinical suspicion and early detection for a differential diagnosis of congenital diaphragmatic hernia in infants who present with respiratory symptoms not responding to antibiotics or recurrent pneumonia, and improving the availability of imaging in primary care facilities to diagnose such defects early and manage them accordingly

Prevalence of Incidental Prostate Carcinoma among Patients Undergoing Turp for Benign Prostatic Enlargement

Background Incidental prostate cancer is detected by histological examination of resected biopsy tissue that has been previously diagnosed as benign. It has the potential for progressing to become a disease necessitating active treatment. There is paucity of data on detection of incidental prostate cancer in Tanzania. A study done in northern Tanzania among the urban public sector revealed an alarming detection rate of 21.71%. We aimed to establish the prevalence of incidental prostate cancer among men surgically treated for benign prostate enlargement with considered normal range of prostate specific antigen. Methods This was a retrospective hospital-based cross-sectional study conducted to establish the prevalence of incidental prostate cancer among men who underwent transurethral resection of prostate with considered normal range of prostate-specific antigen from 2010 to 2019 at Aga Khan Hospital Dar es salaam, Tanzania. To find the prevalence of incidental prostate cancer with 95% confidence level, 5% tolerable error, minimum of 195 participants’ data was reviewed, and factors associated with incidental prostate carcinoma were evaluated by binary regression analysis. Results Total of 195 men were included in the study. The prevalence of incidental prostate cancer among men with prostate-specific antigen levels of less than 5.5ng/mL was 7.2% (95% CI, 4.0 to 11.8%). More than half of the patients had high-grade cancer and three quarters had T1b histological subtype making up the clinically significant category. For every 1-year increase in age from age of 65 years, risk of incidental prostate cancer increased by 1.6 (95% CI, 1.054 to 23.38; P Conclusion The Incidental prostate cancer detection rate of 7.2% in our settings is within the range found internationally

Esophageal atresia with tracheoesophageal fistula: two case reports

Abstract Background The incidence of esophageal atresia with tracheoesophageal fistula is 1 out of 3000–5000 live births. Its incidence in lower middle income countries is not known. The infants usually present with excessive secretions or choking while feeding and are at risk for aspiration. The outcome of these infants in lower middle income countries is not encouraging due to delays in referral, sepsis at presentation requiring preoperative stabilization, postoperative complications such as anastomosis leaks, pneumonia, and pneumothorax. Case presentation We present two African babies who were term infants at age 2 days (male) and 5 days (female) with diagnosis of esophageal atresia and tracheoesophageal fistula. The 5-day-old infant required preoperative stabilization due to sepsis and delayed surgery with a poor postoperative outcome. The 2-day-old infant was preoperatively stable and had a good postoperative outcome. The challenges faced in management of these two cases have been highlighted. Conclusion Outcome of infants with esophageal atresia and tracheoesophageal fistula in lower middle income countries is not encouraging due to delays in referral and poor postoperative healing attributed to sepsis and recurrent pneumothorax. Timely referral, preoperative condition of the infant, and timely management has shown to be a contributory factor for an improved outcome