Renal echogenicity predicting renal dysfunction in patients with chronic kidney disease at Muhimbili National Hospital

Objective: Chronic kidney disease (CKD) is a slow progressive loss of kidney function over the span of years. Many studies have been done on correlating sonographic renal changes with renal function by using serum creatinine as a functional mark of renal failure but less is reported on correlation of eGFR with sonographic findings. The aim of this study was to determine the role of renal sonography in predicting renal function among patients with chronic kidney disease (CKD).Method: This was a cross-sectional study which evaluated 145 patients with CKD who underwent both kidney sonography and renal function test based on estimated glomerular filtration rate (eGFR). This study was conducted at Muhimbili National Hospital from June to December 2009. We evaluated three variables; cortical echogenicity, cortical volume and Renal function. These variables were compared by using correlation, sensitivity, specificity, positive and negative predictive values and Likelihood Ratio.Results: The regression correlation between renal cortical echogenicity and renal function (eGFR) revealed a correlation coefficient of r2 = 0.622, p<O.OO. The sensitivity of echogenicity as predictor of renal function was 74.7% (95% Confidence Interval (CI): 0.68 - 0.78), specificity was 93.5% (95% CI: 0.85 - 0.99). Positive Likelihood Ratio (LR) +11.6; p<O.OOI), hence echogenicity proved to be a strong prediction sign.Conclusions: Renal cortical echogenicity sign was potentially useful as surrogate marker of the renal function.Keywords: CKD, Ultrasonography, cortical echogenicity, eGF

Investigation of Infants with Hydrocephalous at Muhimbili National Hospital Using Anterior Transfontanelle Ultrasound Scan

Background: Hydrocephalus is accumulation of cerebrospinal fluid in the cranium due to an imbalance between its production and absorption. There is an estimated 750,000 children and adults living with hydrocephalus. It is one of the most common developmental disabilities as it affects one in every 500 live births. There is a significant burden of hydrocephalus in East Africa, with more than 6000 new cases estimated per year and in the majority the cause is neonatal infection. Though there a number of studies on this study area, less is reported on the sonographic pattern of infantile hydrocephalus at our set-up.Objective: We aimed at determining the sonographic pattern of infantile hydrocephalus and the associated factors.Methods: Eighty (80) infants with hydrocephalus were consecutively included into the study. To every infant a cranial ultrasound was performed using an Ultrasound machine (Phillips, HP5000, Eindhoven, Best, Netherlands) with 2- 5MHZ frequency curve-linear transducer. Questionnaires were used to collect  demographic data and clinical information. Data analysis was done using the Statistical Package for Social Sciences (SPSS) version 17. Chi-square (X2) and Fisher’s exact tests were used to compare between clinical and sonographic variables. The p-value of < 0.05 indicated statistically significance  differenceResults: Among the 80 studied infants 42 (52.5%) were males, the youngest was 1 month and the oldest was to 10 months old with mean age of 3.4 months. Hydrocephalus was most common (46.2%) in much younger infants aged 2 months and below (P-value=0.012). Non communicating hydrocephalus was the most common type 62 (77.5%). Higher proportions of hydrocephalus were seen in infants with >2500grams of birth weight (76.2%), normal (spontaneous vertex) delivery 61 (76.2%) and those who were born at term (75%).Conclusion: Cranial Ultrasonography is an important tool in evaluation of infants with hydrocephalus. This information is helpful in making accurate management decision. Hydrocephalus was most common in much younger infants aged 2 months and below and the most common type was noncommunicating hydrocephalus which accounted for 77.5%. Hydrocephalus is common in males and is associated with >2500grams of birth weight, term delivery and normal spontaneous vertex delivery though the observations were not statistically significant.Keywords: Hydrocephalus, Infant, Cranial Ultrasonograph

Improved Image Quality in Digital Mammography Using Anti-Scatter Grids

Curability and effective management of breast cancer are dependent on its early detection. Early diagnosis strategies focus on providing timely access to breast cancer treatments by reducing barriers and improving access to effective early diagnosis. Mammography is the screening method of choice but suffers from degrading effects of scatter photons obstructing visualization of ductal carcinoma in situ and micro-calcifications in the breast. Quantitative evaluation of scatter suppression by anti-scatter grid using the beam stopper method has been investigated. Breast tissue equivalent phantom, polymethyl methacrylate was evaluated at X-ray mammographic nominal energy ranges. The anti-scatter grid used had aluminium interspace material and carbon fibre covers with varying grid features. Transmitted scatter and primary photon to the detector was analysed and evaluated. A scintillator type detector–model a Dexela 2315 MAM of size 290.8 ×229.8 mm having a resolution of 3072×3888 pixels was used. Transmitted scatter values in the range of 0.123 to 0.243 across the polymethyl methacrylate thickness of 10 mm to 80 mm were observed, whereas transmitted primary values recorded ranged from 0.713 to 0.495. Object, anti-scatter grid and X-ray energy exposure factors influenced the scatter fraction significantly. Improved mammography images showed significant improvements with this scatter reduction method using anti-scatter grid. Keywords: Digital mammography; Anti-scatter grids; Breast screening; Scatter image artifacts; Beam stopper method

Evaluation of scatter suppression algorithm for X-ray exposure of soft tissue equivalent phantoms over nominal energy range using FLUKA code

Soft tissue imaging is heavily impaired by streaks and cupping effects associated with X-ray scatter. Quality of images from projection imaging may be improved by the use of enhanced anti-scatter grids’ designs with potency to reject significant scatter. However, optimization of grid characteristics requires investigation to improve diagnostic image quality. Transmitted scatter spatially distributed degrades images engendering need for effective scatter correction protocols. This study investigated the pre-scan scatter suppression algorithm for X-ray exposure of soft tissue equivalent phantoms over nominal energy range. Adipose tissue and polymethyl methacrylate phantoms of cross-sectional area (30 x 30) cm2 and of varying thickness from 2 to 8 cm in 1 cm increments were successively exposed using energy ranging between 20–50 kVp. Monte Carlo simulation based on FLUKA code and flair interface was used to generate an input file for execution. The source simulated five cycles of ten million photons each of annular X-ray photon beam of radius, r = 0.5 cm at fixed field of view (FOV) through anti-scatter grid on to gadolinium oxysulfide detector. The transmitted total, scatter and primary estimates were evaluated with and without grids over varying phantom thicknesses, energy and grid design features. The simulated and experimental results obtained were comparable and in agreement with previous literature. Pearson’s correlation coefficients for scatter fraction and scatter to primary ratio were 0.983 and 0.981, respectively. The strong correlation between simulation and experiment results indicated correctness in methodology and protocol. The algorithms and protocols in the simulation would be appropriate for designing grids with enhanced scatter rejection capabilities. Keywords: FLUKA code, Monte Carlo simulation, Scatter suppression algorithm, Scatter correction, X-ray imaging systems. &nbsp

Effect of age, cerebral infarcts, vasculopathy and haemoglobin on cognitive function, in Tanzanian children with sickle cell anaemia

BACKGROUND: Developmental difficulties in many cognitive domains are common in children with sickle cell anaemia (SCA). Children with stroke are most affected but delayed or atypical cognitive function has been reported in children with SCA and silent infarcts (SCI), vasculopathy, and normal brain MRI. However, very few studies of cognition have been conducted in Africa, a continent with 75% of the SCA burden. We therefore investigated cognitive profiles in Tanzanian children with SCA and examined the impact of age, SCI, vasculopathy, and haemoglobin concentration (Hb). METHODS: Children aged 6-16 years with and without SCA were eligible for this cross-sectional study. Cognitive assessment was performed using Raven's Matrices, assessing fluid, non-verbal intelligence and subtests from the Wechsler Intelligence Scales for Children (WISC-IV), assessing processing speed (PS), perceptual reasoning (PR), and working memory (WM) as these tests are less culture-bound. Magnetic resonance imaging (MRI) and angiography (MRA) were also completed to assess the presence of SCI and vasculopathy. Hb was collected in both SCA children and their non-SCA siblings. RESULTS: Seventy-three children with SCA and 71 healthy siblings (Meanages 11.9, SD = 2.8 and 11.1, SD = 2.9 years respectively) were recruited. Compared with healthy siblings, children with SCA had lower PS (Meandiff 7.35 points; p = .002). Older children had higher performance scores on all tests in relation to their ages. Lowest cognitive scores were observed on the PS subtest, where patients with SCI (SCI+) had lowest mean values as compared to children with no SCI (SCI-) and healthy siblings (i.e., SCI+ < SCI- < healthy siblings, p = .028). On post-hoc analysis the difference was between SCI+ and healthy siblings SCI+ < non-SCA siblings (p = .015); there was no difference between SCI+ and SCI- patient groups. PS was significantly lower in SCA patients with no vasculopathy as compared to healthy siblings. The mean difference from healthy siblings was -8.352 and -0.752 points for VASC- and VASC + respectively (p = .004). There was a significant positive effect of Hb on PSI (p = .001) in both patients and controls and a trend level significant positive effect of Hb on PR (p = .050) and WM (p = .051). CONCLUSION: In this Tanzanian study, cognitive performance was reduced in children with SCA with or without SCI on MRI or vasculopathy. Cognitive performance improved with increasing age. Lower Hb was associated with lower cognitive performance in both patients with SCA and their non-SCA siblings. SCI and vasculopathy do not appear to have an impact on cognitive function

Effect of age, cerebral infarcts, vasculopathy and haemoglobin on cognitive function, in Tanzanian children with sickle cell anaemia

Background: Developmental difficulties in many cognitive domains are common in children with sickle cell anaemia (SCA). Children with stroke are most affected but delayed or atypical cognitive function has been reported in children with SCA and silent infarcts (SCI), vasculopathy, and normal brain MRI. However, very few studies of cognition have been conducted in Africa, a continent with 75% of the SCA burden. We therefore investigated cognitive profiles in Tanzanian children with SCA and examined the impact of age, SCI, vasculopathy, and haemoglobin concentration (Hb). Methods: Children aged 6–16 years with and without SCA were eligible for this cross-sectional study. Cognitive assessment was performed using Raven's Matrices, assessing fluid, non-verbal intelligence and subtests from the Wechsler Intelligence Scales for Children (WISC-IV), assessing processing speed (PS), perceptual reasoning (PR), and working memory (WM) as these tests are less culture-bound. Magnetic resonance imaging (MRI) and angiography (MRA) were also completed to assess the presence of SCI and vasculopathy. Hb was collected in both SCA children and their non-SCA siblings. Results: Seventy-three children with SCA and 71 healthy siblings (Mean ages 11.9, SD = 2.8 and 11.1, SD = 2.9 years respectively) were recruited. Compared with healthy siblings, children with SCA had lower PS (Mean diff 7.35 points; p = .002). Older children had higher performance scores on all tests in relation to their ages. Lowest cognitive scores were observed on the PS subtest, where patients with SCI (SCI+) had lowest mean values as compared to children with no SCI (SCI-) and healthy siblings (i.e., SCI+ &lt; SCI- &lt; healthy siblings, p = .028). On post-hoc analysis the difference was between SCI+ and healthy siblings SCI+ &lt; non-SCA siblings (p = .015); there was no difference between SCI+ and SCI- patient groups. PS was significantly lower in SCA patients with no vasculopathy as compared to healthy siblings. The mean difference from healthy siblings was -8.352 and -0.752 points for VASC- and VASC + respectively (p = .004). There was a significant positive effect of Hb on PSI (p = .001) in both patients and controls and a trend level significant positive effect of Hb on PR (p = .050) and WM (p = .051). Conclusion: In this Tanzanian study, cognitive performance was reduced in children with SCA with or without SCI on MRI or vasculopathy. Cognitive performance improved with increasing age. Lower Hb was associated with lower cognitive performance in both patients with SCA and their non-SCA siblings. SCI and vasculopathy do not appear to have an impact on cognitive function. </p

Abstracts of Tanzania Health Summit 2020

This book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); &amp; Tindwa Medical and Health Services (TMHS) held on 25–26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the country’s and regional health challenges and set the agenda for a healthier future. Summit Title: Tanzania Health SummitSummit Acronym: THS-2020Summit Date: 25–26 November 2020Summit Location: St. Gasper Hotel and Conference Centre in Dodoma, TanzaniaSummit Organizers: Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); &amp; Tindwa Medical and Health Services (TMHS)