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

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

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

Two case reports: Pica as a persistent eating disorder associated with iron deficiency anaemia

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

Intestinal parasitic infections and the level of immunosuppression in HIV seropositive individuals with diarrhoea in Kilimanjaro, Tanzania: A cross-sectional study

Background: Opportunistic and non-opportunistic intestinal parasites play a significant role in the morbidity and mortality of HIV/AIDS-infected patients. The frequency of their occurrence strongly correlates with the patient’s level of immunity. The most common clinical manifestation of these intestinal parasites is diarrhoea. Prevalence of intestinal parasites among HIV-infected patients has been found to be as high as 95%. Objective: To determine the prevalence of intestinal parasites among HIV-infected participants presenting with diarrhoea and association with CD4 cell counts, ART and cotrimoxazole prophylaxis. Methods: A prospective cross-sectional study was conducted in four HIV clinics in Moshi district, Kilimanjaro Region, Tanzania. Stool samples were collected and analyzed from participants presenting with three or more episodes of loose stool per day or a single bloody bowel movement. The identification of parasites was done using direct microscopy and staining techniques. Demographic data, CD4 counts and stool results were recorded. Data analysis was done using STATA IC/11.1. Results: The study included 83 adult HIV positive patients. There were 36 males (43.4%) and 47 females (56.6%), with a median age of 36 years (range 30-43). The baseline CD4 count was 150 cells/ul (range 72-295 cells/ul). Of our participants, 47 (56.6%) had a baseline CD4 cell count < 200 cell/uL. Only 6(7.2%) had CD4 counts above 500cells/uL. Of the whole group, 62(74.7%) were on ARV therapy and 33(39.8%) were on cotrimoxazole prophylaxis. Intestinal parasites were detected in 25 of our participants. Among these 25 participants, Ascaris lumbricoides was found in 52%, Giardia lamblia in 32% and Entamoeba histolytica in 16%. The frequency of intestinal parasites was significantly associated with CD4 cell counts <200 cells/ul (p=0.02). There was no significant difference in parasitic infections associated with ART status or cotrimoxazole use. Conclusion: The prevalence of parasitic infection is high in HIV-infected patients presenting with diarrhoea despite the use of ART and other prophylactic medications. Intestinal parasites should not be overlooked in HIV-infected patients presenting with diarrhoea

Prevalence and predictors of Immunological failure among HIV-infected adults on HAART in Northwestern Tanzania: A cross sectional study

Background: Guidelines for the treatment of HIV recommend the use of immunological and clinical criteria for treatment monitoring in resource limited settings. Data on the magnitude of immunological treatment failure in sub-Saharan Africa is scarce. This study aimed at assessing the magnitude and factors associated with immunological failure among HIV infected patients on HAART.Methods: A cross sectional study was conducted at Bugando Medical centre HIV care and treatment centre between February-July 2011, involving HIV-infected patients on first line ART for at least one year. Patients with concurrent infections and critically ill were excluded. A designed questionnaire was used to collect socio-demographic and clinical data of patients. Continuous variables were summarized by median and interquartile ranges (IQRs) and categorical variables were summarized by frequency and percentage. Logistic regression was used to find the predictors of immunological failure.Results: A total of 274 participants were enrolled for this study. The median duration on ART was 26 months (IQR 12-45). Majority of the participants were female (65.7%); the baseline CD4 count was 139.5 cells/ul (IQR 60-210). Most  of the study participants (47.8%) presented with WHO clinical stage 3 at the time of enrollment to the clinic. Out of the 274 study participants, 57% fulfilled the criteria for immunological failure. WHO clinical stage 3 or 4 at ART initiation (p&lt;0.001), low level of reported adherence (p=0.001) and longer duration on ART (p&lt;0.001) were predictors of immunological failure in this cohort.Conclusion: Immunological treatment failure was very high in this cohort of HIV-infected patients on first line ART. WHO clinical stage 3 or 4 at enrollment, low level of adherence and longer duration on ART were predictors of immunological failure.Keywords: HIV/AIDS, adult, antiretroviral therapy, CD4 lymphocyte count, treatment monitoring, treatment failure, risk factors, Tanzani

Prevalence of Schistosoma mansoni and its clinical relevance at a primary health care level in rural lake zone of Tanzania: a cross sectional study

Introduction Intestinal schistosomiasis is still endemic in most countries in sub Saharan Africa including Tanzania. It is associated with unacceptably high morbidity and mortality especially due to its long term complications. These complications could potentially be prevented through early diagnosis and timely treatment of Schistosoma mansoni infection. However, in Lake Zone only a small proportion of patients present to tertiary level hospital in early stages of the disease and schistomal status at primary health care level is not described in Lake Zone. The aim of this study was to determine the prevalence of Schistoma mansoni and its clinical relevance at a primary health care level. Materials and methods A cross sectional study including all patients attending Sengerema DDH with abdominal pain and/or diarrhea was done. Their stool samples were examined by routine wet mount preparation and the data of study interest were analyzed including stool sample results, demographic data, clinical symptoms and risks for Schistosomal exposure using stata version 12 to determine the prevalence of Schistosoma mansoni in this study population. ResultsA total of 1255 stool samples were examined parasitologically for presence of intestinal parasites. Most of the study participants were females 783(62.39%) with a mean age of 30 (IQR 2-80) years. Of the 1225 stool samples examined, 561 (44.7%) were parasitologically positive for intestinal parasites where Schistosoma mansoni was recovered in 141 (11.24%) of the study participants being the second most common intestinal parasite after Entamoeba histolytica. Of the positive stool samples Schistosoma mansoni was found in 25.1% of the samples and was strongly associated with a male gender (OR=1.5, p=0.017), age younger than 20 years (OR= 3.4, p Conclusions The current study indicates that Schistosoma mansoni transmission still occurs in Lake Zone, however probably the symptoms due to intestinal Schistosoma infections are frequently common among young people. On clinical aspects these findings are important suggesting that transmission of S. mansoni could significantly be reduced by praziquantel (PZQ) mass drug administration (MDA) targeting those at risk including ages below 20years, but this may need a sustained and more regular frequent PZQ doses a year