Pica as a pe rsistent eating disorder associated with iron deficiency anae mia: two case reports

Introduction: Pica is a mysterious condition characterised by patients developing cravings for non- nutritive substances that may escalate into serious medical complications. We present two case reports with a somewhat unusual nature of presentation attributed to iron deficiency. The first is a 25-year old African woman with abnormal uterine bleeding presenting with a fondness for eating clay, cold drinks, and icepacks. The second is 15- year old African girl who presented with bleeding from the nose, habitual smelling of soil, consuming ice packs and chewing rubber bands. Both presented with haematological parameters diagnostic of iron deficiency anaemia.Conclusion: Despite being practised for centuries, the clinical significance of pica symptoms is often not recognised particularly among the younger physicians. Both our patients responded well to managing the primary cause of blood loss and iron supplementation. We are convinced that pica is an important pointer to iron deficiency and clinicians should suspect occult blood loss in a patient presenting with pica symptoms.Keywords: pica, eating disorder, iron deficiency anaemia, case repor

Magnitude and correlates of moderate to severe anemia among adult HIV patients receiving first line HAART in Northwestern Tanzania: a cross sectional clinic based study

Introduction: Moderate to severe anemia is an important clinical problem in HIV patients on Highly Active Antiretroviral Therapy. The rate of progression and mortality in this sub group of patients is high compared to non anemic patients. In sub Saharan Africa with scale up of Anti retroviral therapy, the magnitude of this problem is not known especially in Tanzania. This study aimed at determining the magnitude and correlates of moderate to severe anemia in HIV patients receiving first line ART in northwestern Tanzania. Methods: This was a cross sectional clinic based study, involving adult HIV patients on first line Highly Active Antiretroviral Therapy at Bugando Medical Centre Care and Treatment Center. The patients' data were analyzed using STATA version 11 to determine the prevalence of moderate to severe anemia and risk factors that could predict occurrence of anemia. Results: In this study 346 patients on Highly Active Anti-Retroviral Therapy were enrolled, of whom 100(40.46%) had moderate to severe anemia. The odds of being anemic were strongly predicted by Zidovudine based regime, low baseline CD4 count (< 200 cells/μl) and HIV stage 3&4 at enrollment. Most of the anemic patients had mean corpuscular volume of >100fl. Conclusion: The prevalence of moderate to severe anemia is significantly high in this cohort of HIV-infected patients on first line Anti Retroviral Therapy and it is strongly predicted by Zidovudine based regime, low baseline CD4 and HIV stage 3 and 4. On clinical grounds this suggests that patients who are initiated on Zidovudine based regimen and those in advanced HIV at enrollment should have regular haemoglobin follow up to identify anemia at its earliest stage to improve the clinical outcome of these patients.Pan African Medical Journal 2016; 2

Pattern of head and neck cancers among patients attending Muhimbili National Hospital Tanzania

Background: It is estimated that there are more than 640,000 new cases and 350,000 deaths due to head and neck cancers (HNCA) each year worldwide. Lack of baseline data in Tanzania concerning head and neck malignancies makes it difficult to appreciate the pattern and magnitude of the problem in the country. The objective of this study was to determine the pattern of head and neck cancers among patients attending the Otorhinolaryngology Department at the Muhimbili National Hospital in Dar es Salaam, Tanzania.Methods: All inpatients and outpatients with histologically proven malignant lesions in the head and neck region who attended the Otorhinolaryngology department of Muhimbili National Hospital between 1st July 2012 and 31st January 2013 were enrolled in the study. A special designed questionnaire was used for data collection. Clinical examination, computed tomography scan and/or magnetic resonance image were done accordingly, followed by fine needle aspiration cytology and/or tissue biopsy. Results: A total of 113 patients, 75 (66.3%) males and 38 (33.7.0%) females with a male to female ratio 2:1 were involved in the study. The mean age at the time of diagnosis was 51±18. Patients below age of 40 years accounted for 28.4% of all head and neck cancer patients. The commonest observed anatomical location was nasal and paranasal sinuses (23.9%) followed by the larynx (20%). Carcinoma accounted for 94% of head and neck cancers in which squamous cell carcinoma was the most frequent (74%). Lymphoma (2%) was the least frequent histological variant encountered. Nasal and paranasal sinuses had the most histological variations of all anatomical locations of head and neck cancer.Conclusion: This study shows a significant number of head and neck cancer patients in a younger generation and a high magnitude of sinonasal cancerrelative to other head and neck cancer

Prevalence and associated factors of incidentally diagnosed prostatic carcinoma among patients who had transurethral prostatectomy in Tanzania: a retrospective study

Background: Prostatic carcinoma carries a high morbidity and mortality if it is not diagnosed early. In resource limited countries, patients are at increased risk of being diagnosed late as they are operated for presumed benign prostatic hyperplasia. The information on the magnitude and risk factors of this problem inour setting could assist in the overall optimization of care of patients at risk.Methods: A retrospective study of patients who underwent prostatectomy for presumed benign prostatic enlargement was done at Bugando University Hspital in Tanzania. Patients’ age, creatinine levels, urological Ultrasound, prostate specific antigen and Biopsy results were analyzed using STATA 11. The prevalence of incidental prostatic cancer was calculated and logistic regression was done for factors associated with incidental prostatic cancer.Results: In total, 152 patients were included in this study. The median age was 69 (SD 9.4) years, 16 (10.53%,) and 49 (32.24%) participants had Hydronephrosis and elevated creatinine levels respectively. Eighty six (58.56%) patients had PSA >10 ng/mL and in total; 33 (21.71%) had incidental prostatic carcinoma. The incidental prostatic carcinoma was independently associated with age of 70- 80years (AOR=2.8, p = 0.013) and PSA levels >10ng/mL (AOR=3.2, p=0.014).Conclusions: The prevalence of incidental prostatic carcinoma is high among patients undergoing transurethral prostatectomy for presumed benign prostatic hyperplasia in Tanzania with increased risk at age of 70-80 years and among those with PSA >10ng/mL. A national awareness campaign coupled with focused screening of patients above 60 years could increase the detection rate of prostatic carcinoma and reduce the magnitude of incidental diagnosis of this disease.Keywords: Incidental prostatic carcinoma, PSA, Tertiary level hospital, Tanzani

Cytopenias among ART-naive patients with advanced HIV disease on enrolment to care and treatment services at a tertiary hospital in Tanzania: A crosssectional study

Background: HIV/AIDS causes high morbidity and mortality through both immunosuppression and complications not directly related to immunosuppression. Haematological abnormalities, including various cytopenias, occur commonly in HIV through immune and non-immune pathways. Though these complications could potentially cause serious clinical implications, published literature on the magnitude of this problem and its associated factors in Tanzania is scarce. This study aimed at determining the prevalence and risk factors of HIV-associated cytopenias among ART-naive patients enrolling for care and treatment services at Bugando Care and Treatment Centre (CTC) in Mwanza, Tanzania.Methods: This was a cross-sectional clinic-based study done between March 2015 and February 2016, involving all antiretroviral therapy (ART)-naive adult HIV positive patients enrolling for care and treatment services at Bugando CTC. Patients younger than 18 years and those with missing data were excluded. Data were analysed using Stata version 11 to determine the prevalence and risk factors of cytopenias.Results: A total of 1205 ART-naive patients were included. Median age was 41 years (interquartile range [IQR] 32 to 48). Most participants were female (n = 789; 65.6%), with a female-to-male ratio of 2:1. The median baseline CD4 count was 200 cells/μL (IQR 113 to 439). About half (49%) of the study participants had baseline CD4 counts less than 200 cells/μL. Anaemia, leucopenia, and thrombocytopenia were found in 704 (58.4%), 285 (23.6%), and 174 (14.4%) participants, respectively, and these were strongly associated with advanced HIV infection.Conclusions: The magnitude of cytopenias is high among ART-naive HIV-positive adults, and cytopenias are more marked with advanced HIV infection. Early diagnosis of HIV and timely initiation of ART could potentially reduce the number of people living with advanced HIV disease and its associated complications, including the cytopenias investigated in this study. Patients with cytopenias should undergo thorough screening for tuberculosis, which is an important and treatable correlate of cytopenia, in addition to close follow-up for any potential negative outcomes

Centrally-located pulmonary hamartoma diagnosed in a 16-year-old boy presenting with chronic chest pain: a case report

Pulmonary hamartomas are the most common benign tumors of the lung. They are usually diagnosed incidentally while evaluating for other conditions. These tumors have been shown to be uncommon below the age of 25 years. We report a case of a 16-year-old male who presented with chronic chest pain and was histologically confirmed to have pulmonary hamartoma. The tumor was successfully resected. This is the first case of hamartoma to be reported in our country, and the atypical age at presentation together with the tumor’s position makes it more unique. In conclusion, although very rare, pulmonary hamartomas can occur in young age with the central location. Clinically, the presentation is usually non-specific and the diagnosis is mostly incidental while investigating other conditions. There is a need to increase awareness among clinicians on hamartomas to improve early treatment for this rare disease in the adolescents

Brugada-like syndrome presenting with monomorphic ventricular tachycardia and Brugada-type electrocardiogram unmasked by fever in an infant: a case report

Brugada syndrome is an autosomal-dominant arythmogenic genetic disorder associated with mutation in the SCN5A gene. We report a case of 3-month-old Tanzanian male who was admitted at Muhimbili National Hospital in Dar es Salaam, Tanzania with severe pneumonia, high fever and monomorphic ventricular tachycardia. The patient was treated with intravenous Amiodarone. In addition, oxygen, parenteral antibiotics, antipyretics and intravenous fluids were also given. About 2 hours and 20 minute later the child stabilized. An ECG obtained shortly after termination of ventricular tachycardia showed the typical J-point and coved ST elevation typical of  Brugada type I pattern. To the best of our knowledge, this is the first paediatric case with Brugada-type ECG to be reported in Sub-Saharan Africa. This case emphasizes the need to increase awareness among clinicians of clinical and genetic arythmogenic disorders. Multiple ECGs during and after febrile disorders should be performed in children who exhibit extreme tachycardia or signs of cardiac failure

Risk factors for mortality among tuberculosis patients on treatment at Bugando Medical Centre in north-western Tanzania: a retrospective cross-sectional study

 Background: Tuberculosis (TB) is still an important cause of morbidity and mortality worldwide. Though it can effectively be treated, still a significant proportion of patients die on the course of their treatment. The objective of this study was to determine the outcome and risk factors of mortality among patients diagnosed with TB in a tertiary hospital in north-western Tanzania.Methods: A retrospective cross sectional study was done among all patients diagnosed with TB between January and December 2015 at Bugando Medical Centre. Information of demographic characteristics, smear positivity, haemoglobin concentration, HIV status, CD4 counts for HIV positive patients and treatment outcomes were collected and analysed. TB treatment outcomes as dead or alive were calculated and logistic regression was done to determine the factors associated with increased risk of death of patients on anti-TB treatment.Results: In total 701 patients were diagnosed with TB during the study period. Of these, 361 (51.5%) were males with a median age of 38 (IQR 27- 47) and 421 (60.06%) were younger than 40 years. Majority of the participants 409 (58.35%) had smear positive pulmonary tuberculosis and about half of patients (51.07%) tested positive for HIV. Of the enrolled patients 610 (87.02%) were alive at the end of TB treatment while 91 (12.98%) died in the course of treatment. The odds of deaths of patients on anti-TB treatment were strongly associated with male sex, HIV co infection and severe anaemia.Conclusion: The proportion of patients who die from TB treatment at BMC is high, with an increased risk of death among HIV co-infected, older than 40 years and severely anaemic patients. Improvement of strategies for early diagnosis and prompt treatment of TB patients will potentially improve treatment outcome

Acute Renal Failure in a Caucasian Traveler with Severe\ud Malaria: A Case Report

Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation of hemodialysis proves to be useful in restoration of renal function