Isolation, culture and neurogenic differentiation of human dental stem cells

A Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree Of Master of Science in Medicine, 2016.Dental stem cells (DSCs) have been identified in teeth and their supporting tissues. They represent an exclusive source of adult stem cells, easily isolated and manipulated for tissue repair and regeneration. This research project evaluated the neurogenic potential of the dental pulp stem cells (DPSCs) and stem cells from the pulp of human exfoliated deciduous teeth (SHEDs) in a South African cohort. Sixty non-carious permanent and deciduous teeth were extracted from healthy patients aged between 18 and 30 years and 5 and 10 years, at the University of the Witwatersrand's Oral Health Clinic in Johannesburg Charlotte Maxeke Academic Hospital, South Africa. The cells, isolated from the extracted pulp tissue were cultured, counted and then phenotyped by flow cytometry analysis. The cells were further expanded in a neural induction medium and immunocytochemistry analysis for Ki-67, doublecortin (DCX) and nestin were performed. Large colonies of both DPSCs and SHEDS were harvested from the extracted pulp tissues and positively cultured. Flow cytometry analysis confirmed the presence of CD44+ and CD29+ cells as well as the known mesenchymal stem cell markers CD90 and CD105. Both DPSCs and SHEDs demonstrated successful proliferation and neural differentiation. This study confirmed that DPSCs and SHEDs are highly proliferative human adult stem cells that exhibit a neurogenic potential that may contribute in the treatment of neurological disorders.AC201

The effectiveness of ultrasound in the diagnosis of bladder tumours at the Muhimbili National Hospital, Dar es Salaam, Tanzania

The importance of an ultrasound in diagnosis of bladder tumours has been investigated by different authors. Some have questioned its effectiveness while others have considered the technique to be an important tool in the initial evaluation of bladder tumours. This study was carried out to establish the effectiveness of the ultrasound in diagnosis of bladder tumours at the Muhimbili National Hospital in Dar es Salaam, Tanzania. Clinical indications and ultrasound findings were recorded. Cystoscopy was done and findings recorded on a preformed questionnaire. The ultrasound findings were compared to cystoscopy findings and the sensitivity, negativity, positive predictive value and negative predictive value determined. A total of 110 patients were recruited in this study and the male to female ratio was 2:1. The commonest (37%) age group was 41-60 years. The most common clinical indication overall was haematuria in 37% of all cases. In males, bladder outlet obstruction due to stricture was the commonest indication (31%). Out of 110 patients scheduled for cystoscopy, 71 had ultrasound done preoperatively. In these patients 70% had some form of abnormal ultrasound findings. The sensitivity, specificity, positive predictive value, and the negative predictive value (NPV) of ultrasound in detection of bladder tumour were 83%, 93%, 89% and 89%, respectively. In conclusion, ultrasound is an effective method for evaluating patients presenting with haematuria or suspected to have bladder tumours. It is cheap, available, affordable and non-invasive; has a high sensitivity, and therefore it can also be useful in the follow-up of patient with bladder cancer

Treatment of multidrug-resistant tuberculosis in a remote, conflict-affected area of the Democratic Republic of Congo.

The Democratic Republic of Congo is a high-burden country for multidrug-resistant tuberculosis. Médecins Sans Frontières has supported the Ministry of Health in the conflict-affected region of Shabunda since 1997. In 2006, three patients were diagnosed with drug-resistant TB (DR-TB) and had no options for further treatment. An innovative model was developed to treat these patients despite the remote setting. Key innovations were the devolving of responsibility for treatment to non-TB clinicians remotely supported by a TB specialist, use of simplified monitoring protocols, and a strong focus on addressing stigma to support adherence. Treatment was successfully completed after a median of 24 months. This pilot programme demonstrates that successful treatment for DR-TB is possible on a small scale in remote settings

An Assessment of the Impacts of Performance Appraisal in Local Government Authority in Tanzania.

The study was done in Chato District Council (CDC). The main objective was to assess the impact on the use of Open Performance Review and Appraisal System (OPRAS) to the performance employees on local government authorities. The study used cross section and deductive research design to accomplish the study objectives. Data were collected from Chato District Council employees as chosen sample. Questionnaires and interview guides used in data collection with a sample size of 146 respondents. A study was descriptive; both qualitative and quantitative approaches were employed. Collected data was analysed by a computer program statistical package for social scientist. The analysis of the data was cross tabulated to produce percentages and frequencies of the respondents on the performance valuable. The results of study found that OPRAS is the only appraisal system which was used to appraise the staff. Also levels of education had influence on commitment to OPRAS implementation, followed by lack of resources which had a negative effect. Moroever, found that OPRAS implementation would do better if working facilities were available, and the teachers pointed out that increased log books, teachers’ houses, school library services and stationeries would facilitate the process of OPRAS implementation. Other resources pointed out as necessary were enough human resources, copies of OPRAS forms, funds for transport allowance and workers training; feedback on staff performance and good working environment. It was concluded that OPRAS still has positive results for improved performance. The study recommended for training, consistency in using OPRAS forms, giving feedback and availability of facilities for implementation of activities. Keywords: Ownership, Accountability, Participation, Openness

The Effect of Service Quality Delivery on Customer Satisfaction in The Public Sectors: The Case Study of Tanzania Electricity Company Limited.

The study assessed the effects of service quality delivery on customer satisfaction in the public sectors, the case study of Tanzania Electric Supply Company (TANESCO). The objectives were to identify the relationship between service quality and customer satisfaction in public sector using TANESCO as a case study, to identify the causes of poor-quality customer services in public sector using TANESCO as a case study, and to identify how customer’s rate average on their level of perception from the service quality provided in region. A research used primary data in data collection whereby questionnaires used to a sample of 63 respondents. Data collected were analyzed quantitatively using Multiple Linear Regression by using the SPSS software. While the qualitative data from interviews analyzed using content analysis. The study found that, there is a positive relationship between service quality and customer satisfaction with the fact that improvement in customer service provision can upgrade the quality hence customer satisfaction becomes inevitable. The study further revealed that, TANESCO has the systematic procedures that are used as measures to assure customers with improved service. Also, the service that is provided by TANESCO satisfies customers as majority of respondents pointed out that the service is of good quality, despite few respondents do not satisfy from the service quality. The study concluded that, quality service highly impacts satisfaction of the customers as they receive the services which meet their expectations. The study recommended that the management has to concentrate more on service quality attributes which are considered more important by clients. Keywords: Service Quality, Customer Satisfaction, Public Sectors, TANESCO

Post-operative pain prevalence, predictors, management practices and satisfaction among operated cases at a Regional Referral Hospital in Dar es Salaam, Tanzania

Background: Post-operative pain is an essential component of good surgical patient care plan. In developing countries however, the prevalence of post-operative pain is relatively very high and pain control strategies are not very promising. The objective of this study was to assess post-operative pain prevalence, predictors, management practices and satisfaction among operated cases at a regional referral hospital in Dar es Salaam, Tanzania.Methods: Prospective hospital based descriptive observational study of operated cases at a Temeke Regional Referral Hospital in Dar es Salaam, Tanzania. Data was collected using a pre-constructed questionnaire and a visual pain intensity scale.Results: A total of 136 patients were recruited with mean age of 37.1±15 years (range= 14–80 years). The prevalence of pain was 100%, 83.9%, and 36% at 12, 24 and 48 hours, respectively. At 12 hours moderate to worst pain was reported in 95.6% of cases. The main prediction factor for severe to worst pain at 12 hours was orthopaedic procedures (p=0.05, AOR=3.456), while widow/divorced marital status and female sex were negatively correlated to severity of pain (p=0.005, AOR=0.0230 and p=0.000, AOR=0.034, respectively). The commonest drugs prescribed post-operatively were injection pethidine (50.5%) and tramadol (48.9%) and oral tramadol (47.6%). Pain management satisfaction rate was paradoxically high (74.3%), with male sex being the main predictor.Conclusion: The prevalence of early post-operative pain is very high. Male sex and orthopaedic procedures are associated with severe pain. Surgeons therefore need to prioritize analgesic prescription at early hours following operation to minimize pain and suffering to patients focusing on orthopaedic procedures

Profil épidémiologique des Cardiopathies congénitales à l’Hôpital Provincial Général de Référence de Bukavu: Epidemiological profile of congenital cardiopathy at General provincial hospital of Bukavu

Context and objective. Congenital heart disease (CHD) is one of the leading causes of child mortality worldwide, but the data from sub-Saharan Africa remains paradoxically scarce. The objective of this study was to describe the epidemiological profile and outcome of congenital heart disease in a semi-rural setting. Methods. In a retrospective study, the medical records of patients admitted for congenital heart disease between November 2014 and October 2016 were examined at the Provincial General Reference Hospital of Bukavu. The diagnosis of clinically suspected CHD was confirmed by transthoracic Doppler echocardiography (TDE). Results. Of the 7,397 children studied during the study period, 54 had CHD with a hospital frequency of 0.73% and an average age of 3 years old. The female sex was predominant (53.7%) with sex ratio of 1.24/1. Their average age was 3 years old. The most observed CHD were isolated interventricular communication (38.9%), isolated interauricular communication (31.5%), an atrio-ventricular canal (13%) and a tetralogy of Fallot (11.1%). In the absence of an appropriate technical platform, only three children (5.5%) underwent surgery. 6 deaths (11.1%) were deplored. Conclusion: The CHD with a preponderance of interventricular and interauricular communication accounts for nearly one percent of admissions to this semi-rural hospital. Unfortunately, their surgical management of CHD remains a very serious problem, which explains late diagnosis and high mortality. Contexte et objectif. Les cardiopathies congénitales (CC) constituent l’une des causes majeures de mortalité infantile dans le monde, mais les données y relatives en Afrique subsaharienne restent paradoxalement fragmentaires. L’objectif de la présente étude était de décrire le profil épidémiologique et l’issue vitale des cardiopathies congénitales dans un milieu semi rural. Méthodes. Dans une étude documentaire, les dossiers des patients admis pour CC entre novembre 2014 à octobre 2016, ont été colligés, à l’Hôpital Provincial Général de Référence de Bukavu. Le diagnostic de CC suspecté cliniquement, était confirmé par une échocardiographie Doppler transthoracique. Résultats. Des 7397 enfants suivis pendant la période d’étude, 54 avaient une cardiopathie congénitale soit une fréquence hospitalière de 0,73 %. Le sexe féminin était prépondérant (53,7%) avec sexe ratio de 1,24/1. Leur âge moyen était de 3 ans. Les CC les plus observées étaient : la communication interventriculaire isolée (38,9%), une communication inter auriculaire isolée (31,5%), un canal atrio-ventriculaire (13%) et une tétralogie de Fallot (11,1%). Faute de plateau technique approprié, seuls trois enfants (5,5%) ont bénéficié d’une chirurgie. 6 décès (11.1%) ont été déplorés. Conclusion. La CC avec une prépondérance des communications interventriculaire et inter auriculaire rend compte de près d’un pourcent d’admissions dans cet hôpital semi rural. Malheureusement leur prise en charge chirurgicale reste un très sérieux problème responsable du diagnostic tardif et de la forte mortalité

Emotional and Relationship Dynamics between HIV SeroDiscordance and Concordance Couples: A Narrative Literature Review and Theoretical Framework

Tanzania is among the countries with high prevalence of HIV prevalence in the World. Despite the fact that the epidemic has been, and still is a threat to persons of all ages, recent studies have suggested that most new infections occur among couples in stable relationships. Infected couples are categorised into two: the positive concordant, where both the partners are HIV positive; and sero-discordant couples, where one partner is HIV positive while the other is negative. Recently, researchers and many other stake-holders working on the HIV/AIDS epidemic have given a remarkable attention to this astonishing reality. For instance one study in East and Southern Africa indicates that there are great variations of discordancy varying from 36% to 85%, with an overall rate of 49%. HIV couple sero-discordancy is responsible for varied levels of psychological distress including heightened levels of anxiety, poor emotional adaptation and increased or excessive substance use, most often coupled with exclusion and social isolation within family and in the neighbourhood. However, to date the influence of sero-discordancy on family and couple relationship functioning and how it differs from that among concordant couples remains elusive. Discordancy have been associated with more difficulties as compared to the seroconverted couples, these include relationship and emotional disturbances, sexual contact distancing, marital separation and disruptions. The Lazarus and Folkman’s (1984)\u27s Transactional Model can be helpful in understanding individuals with HIV discordancy on their emotional response, coping strategies and the ultimate decisions towards their marital relationships fate

Characteristics and Outcomes of Patients with Eclampsia and Severe Pre-eclampsia in a Rural Hospital in Western Tanzania: A Retrospective Medical Record Study.

Eclampsia and pre-eclampsia are well-recognized causes of maternal and neonatal mortality in low income countries, but are never studied in a district hospital. In order to get reliable data to facilitate the hospital's obstetric audit a retrospective medical record study was performed in Ndala Hospital, Tanzania. All patients diagnosed with severe pre-eclampsia or eclampsia between July 2011 and December 2012 were included. Medical records were searched immediately following discharge or death. General patient characteristics, medical history, obstetrical history, possible risk factors, information about the current pregnancy, antenatal clinic attendance and prescribed therapy before admission were recorded. Symptoms and complications were noted. Statistical analysis was done with Epi Info®. Of the 3398 women who gave birth in the hospital 26 cases of severe pre-eclampsia and 55 cases of eclampsia were diagnosed (0.8 and 1.6%). Six women with eclampsia died (case fatality rate 11%). Convulsions in patients with eclampsia were classified as antepartum (44%), intrapartum (42%) and postpartum (15%). Magnesium was given in 100% of patients with eclampsia and was effective in controlling convulsions. Intravenous antihypertensive treatment was only started in 5% of patients. Induction of labour was done in 29 patients (78% of women who were not yet in labour). Delivery was spontaneous in 67%, assisted vaginal (ventouse) in 14% and by Caesarean section in 19% of women. Perinatal deaths occurred in 30% of women with eclampsia and 27% of women with severe pre-eclampsia and were associated with low birth weight and prolonged time between admission and birth. 2.4% of women were diagnosed with severe pre-eclampsia or eclampsia. The case fatality rate and overall perinatal mortality were comparable to other reports. Better outcomes could be achieved by better treatment of hypertension and starting induction of labour as soon as possible