Prevalence and Predictors of Cervical Intraepithelial Neoplasia among HIV Infected women at Bugando Medical Centre, Mwanza-Tanzania.

Cancer of the cervix rank the second most common cause of cancer related deaths among women in Sub-Saharan Africa. It is estimated that 529, 409 new cases are diagnosed annually with a mortality rate approaching 274,883 per year. Cervical Intraepithelial Neoplasia (CIN) precedes almost all cervical cancers. The incidence rate of CIN among HIV infected women is five times higher as compared to the rate in HIV negative women. The screening for cervical dysplasia and an appropriate management in women with CIN are effective methods for preventing cervical cancer. This study was done to determine the prevalence and predictors of CIN among a HIV infected women attending Care and Treatment centre (CTC) at Bugando Medical Centre (BMC). A cross sectional survey was undertaken among HIV infected women aged 18 years and above attending at BMC CTC clinic between February and March 2013. Visual Inspection with Acetic acid (VIA) was used as the screening method for detection of CIN. Socio-demographic, reproductive and clinical information was obtained from participants and the blood was collected for CD4 lymphocyte count. Cervical punch biopsy for histological examination was performed for those who had VIA positive test. Data were entered and analyzed using STATA Version 12.0 soft ware. A total number of 95 (26.8%) participants had positive VIA test among three hundred and fifty-five (355) HIV infected women. Histology results showed; 4(4.2%) were normal, 26 (27.4%) had an inflammatory lesion, 58(61.1%) had CIN and 7(7.3%) had invasive cervical cancer. CIN was found to be associated with a history of multiple sexual partners (P<0.001), a history of genital warts (P<0.001), and a history of STI (P = 0.010). The Cervical Intraepithelial Neoplasia is a problem among HIV infected women. A history of multiple sexual partners, a history of genital warts, a history STI and a low baseline CD4 T lymphocyte were significant predictors for CIN. Screening for Cervical Intraepithelial Neoplasia is recommended for all women with HIV

Scrotal Swelling and Testicular Atrophy due to Schistosomiasis in a 9-Year-Old Boy: A Case Report

Schistosomiasis is a communicable disease which commonly involves urinary bladder causing hematuria, or large bowel causing bloody stool. The common species encountered in this lake region surrounding Lake Victoria in Tanzania are Schistosoma haematobium and Schistosoma mansoni. Complications can lead to portal hypertension due portal fibrosis in liver, and fibrosis in lung can lead to pulmonary hypertension; this commonly seen with S. mansoni. Major complications of S. maeametobium are chronic cystitis with squamous metaplasia with subsequent development of squamous cell carcinoma. Involvement of spinal cord causing paraplegia has been observed in S. haematobium. Other unusual pathology of schistosomiasis has been described, such as involvement of the appendix, ovary, prostate, and cervix. Here, we present a case of schistosomiasis in a 9-year-old boy who presented with left scrotal pain for one year which was accompanied by scrotal swelling; surgical exploration was done, and the finding was hydrocele and atrophic testes with nodules on the surface. Histological examination reveals atrophic testis and heavy active granulomatous inflammation with schistosoma eggs consistent with Schistosoma haematobium in the tunica vaginalis

Dermatological Malignancies at a University Teaching Hospital in north-western Tanzania: A Retrospective Review of 154 Cases

Dermatological malignancies are among the most common form of cancers and the global incidence has been increasing at an alarming rate. A retrospective study was conducted to determine the prevalence, histopathological pattern, anatomical distribution and treatment outcome of dermatological malignancies at Bugando Medical Centre in North-western Tanzania. Data were collected from patients’ files kept in the Medical record department; the surgical wards, operating theatre and histopathology laboratory and analyzed using Statistical package for social sciences system. A total of 154 patients with a histopathological diagnosis of dermatological malignancy were studied. Generally, males outnumbered females by a ratio of 1.4:1. The majority of patients were in the 5th and 6th decades of life. Malignant melanoma was the most common dermatological malignancy (67.5%) followed by Kaposi’s sarcoma (10.4%), Squamous cell carcinoma (8.4%) and Basal cell carcinoma(7.8%). The lower limbs were the most frequent site accounting for 55.8%. Wide local excision was the most common surgical procedure performed in 79.2% of cases. Post-operative wound infection was the most common complication in 58.3% of patients. Mortality rate was 3.8%. Dermatological malignancies are more prevalent in our setting. A high index of suspicion is needed to avoid labelling malignancies “chronic ulcers” and all suspected lesions should be biopse

Experiences With Surgical Treatment of Chronic Lower Limb Ulcers at a Tertiary Hospital in Northwestern Tanzania: A Prospective Review of 300 Cases.

Chronic lower limb ulcers constitute a major public health problem of great important all over the world and contribute significantly to high morbidity and long-term disabilities. There is paucity of information regarding chronic lower limb ulcers in our setting; therefore it was necessary to conduct this study to establish the patterns and outcome of chronic lower limb ulcers and to identify predictors of outcome in our local setting. This was a descriptive prospective study of patients with chronic lower limb ulcers conducted at Bugando Medical Centre between November 2010 and April 2012. Ethical approval to conduct the study was sought from relevant authorities. Statistical data analysis was done using SPSS version 17.0 and STATA version 11.0. A total of 300 patients were studied. Their ages ranged from 3 months to 85 years (median 32 years). The male to female ratio was 2:1. The median duration of illness was 44 days. Traumatic ulcer was the most frequent type of ulcer accounting for 60.3% of patients. The median duration of illness was 44 days. The leg was commonly affected in 33.7% of cases and the right side (48.7%) was frequently involved. Out of 300 patients, 212 (70.7%) had positive aerobic bacterial growth within 48 hours of incubation. Pseudomonas aeruginosa (25.5%) was the most frequent gram negative bacteria isolated, whereas gram positive bacteria commonly isolated was Staphylococcus aureus (13.7%). Twenty (6.7%) patients were HIV positive with a median CD4+ count of 350 cells/μl. Mycological investigation was not performed. Bony involvement was radiologically reported in 83.0% of cases. Histopathological examination performed in 56 patients revealed malignancy in 20 (35.7%) patients, of which malignant melanoma (45.0%) was the most common histopathological type. The vast majority of patients, 270 (90.0%) were treated surgically, and surgical debridement was the most common surgical procedure performed in 24.1% of cases. Limb amputation rate was 8.7%. Postoperative complication rate was 58.3% of which surgical site infection (77.5%) was the most common post-operative complications. The median length of hospital stay was 23 days. Mortality rate was 4.3%. Out of the two hundred and eighty-seven (95.7%) survivors, 253 (91.6%) were treated successfully and discharged well (healed). After discharge, only 35.5% of cases were available for follow up at the end of study period. Chronic lower limb ulcers remain a major public health problem in this part of Tanzania. The majority of patients in our environment present late when the disease is already in advanced stages. Early recognition and aggressive treatment of the acute phase of chronic lower limb ulcers at the peripheral hospitals and close follow-up are urgently needed to improve outcomes of these patients in our environment

Hydatidiform moles among patients with incomplete abortion in Mwanza City, North western Tanzania

Background: Prevalence of hydatidiform mole is not clearly defined, partly because most studies have reported different prevalence rates from different regions. However, there is no previous study that has determined the prevalence and associated risk factors of HM among patients with incomplete abortion evacuated at Bugando Medical Centre (BMC) and Sekou Toure Regional Hospital (STRH).Methods: A total of 180 patients with incomplete abortion were enrolled between February 2013 and April 2013. The products of conception were collected and analyzed using Haemotoxylin and Eosin staining technique for hydatidiform moles.Results: One hundred and eighty patients with incomplete abortion scheduled for uterine evacuation agreed to participate in this study. The overall prevalence of HM was 12.8%. Majority of patients (27.5%) with HM were those aged below 20 years. No significant association was observed with risk factors such as parity, contraceptive use, previous abortion and blood group.Conclusion: The prevalence of HM (12.8%) was high and age between 15-20 years was the only significant associated risk factor with the presence of HM among patients with incomplete abortion. Therefore, we recommend submission of evacuated products of conception for histopathological analysis to minimize missed opportunity.Keywords: Prevalence, hydatidiform mole, incomplete abortion, Mwanza, Tanzania

Gastric Cancer at a University Teaching Hospital in Northwestern Tanzania: A Retrospective Review of 232 Cases.

Despite marked decreases in its incidence, particularly in developed countries, gastric cancer is still the second most common tumor worldwide. There is a paucity of information regarding gastric cancer in northwestern Tanzania. This study was undertaken to describe our experience, in our local setting, on the management of gastric cancer, outlining the clinicopathological and treatment outcome of these patients and suggesting ways to improve the treatment outcome. This was a retrospective study of histologically confirmed cases of gastric cancer seen at Bugando Medical Centre between January 2007 and December 2011. Data were retrieved from patients' files and analyzed using SPSS computer software version 17.0. A total of 232 gastric cancer patients were enrolled in the study, representing 4.5% of all malignancies. The male to female ratio was 2.9:1. The median age of patients was 52 years. The majority of the patients (92.1%) presented late with advanced gastric cancer (Stages III and IV). Lymph node and distant metastasis at the time of diagnosis was recorded in 31.9% and 29.3% of cases, respectively. The antrum was the most frequent anatomical site (56.5%) involved and gastric adenocarcinoma (95.1%) was the most common histopathological type. Out of 232 patients, 223 (96.1%) patients underwent surgical procedures for gastric cancer of which gastro-jejunostomy was the most frequent performed surgical procedure, accounting for 53.8% of cases. The use of chemotherapy and radiotherapy was documented in 56 (24.1%) and 12 (5.1%) patients, respectively. Postoperative complication and mortality rates were 37.1% and 18.1%, respectively. According to multivariate logistic regression analysis, preoperative co-morbidity, histological grade and stage of the tumor, presence of metastases at the time of diagnosis was the main predictors of death (P <0.001). At the end of five years, only 76 (32.8%) patients were available for follow-up and the overall five-year survival rate was 6.9%. Evidence of cancer recurrence was reported in 45 (19.4%) patients. Positive resection margins, stage of the tumor and presence of metastasis at the time of diagnosis were the main predictors of local recurrence (P <0.001). Gastric cancer in this region shows a trend towards relative young age at diagnosis and the majority of patients present late with an advanced stage. Lack of awareness of the disease, poor accessibility to health care facilities and lack of screening programs in this region may contribute to advanced disease at the time of diagnosis. There is a need for early detection, adequate treatment and proper follow-up to improve treatment outcome

Intestinal schistosomiasis associated with intussusception: a case report

We report a case of intestinal schistosomiasis associated with iliocaecal intussusception resulting from obstructions of the terminal part of the ileum by schistosome egg-induced fibrosis. A 7-year-old boy presented with the history of abdominal pain and difficulties in passing stool for two months. Ultrasound examination revealed doughnut signs characterized with multiple concentric rings at the lateral abdomen, and the bowel loop appeared distended. Exploratory laparatomy confirmed intussusception of the terminal part of the ileum into the caecum, extending to the ascending colon. Hemicolectomy and end-to-end iliocolostomy was performed. Histological examination of the resected bowel revealed Schistosoma mansoni eggs within the mucosa, submucosa of the ileum, caecum and ascending colon, granulomatous inflammation with foreign body giant cells accompanied by fibrosis and eosinophilic infiltrate into the mucosa. Postoperatively, the patient recovered well. There may have been a synergistic effect of schistosomiasis with other underlying conditions, leading to intussusception. In conclusion, it is important to consider S. mansoni infection as a differential diagnosis for intestinal obstruction in endemic areas

Knowledge, Attitudes and Practices on Urinary Schistosomiasis-Related Morbidity among Communities in Itilima District, Tanzania

Long-term infections by urinary schistosomiasis can result in urinary tract morbidities and increase the threats to public health. Information on the community’s knowledge, attitudes, and practices (KAP) on various aspects of urinary schistosomiasis, caused by Schistosoma haematobium has been lacking in Itilima District, which is likely to perpetuate the transmission of the disease and its negative health consequences. This study assessed knowledge, attitudes and practices on schistosomiasis-related morbidities in Itilima District from February to June 2021. A cross-sectional survey using a structured questionnaire was used, and a total of 657 participants were involved in the study. A total of 575 participants (87.5%) had awareness on schistosomiasis compared to 82 (12.5%) who were not aware of the disease, and this variation was statistically significant (x² = 369.938, DF = 1, p &lt; 0.001). The relationship between urinary schistosomiasis and its related morbidities was known by 111 (16.9%) respondents, while 546 (83.1%) knew nothing about it, and this variation was also statistically significant (c2 = 388.166, DF = 1, p &lt; 0.001). It can be concluded that knowledge of urinary schistosomiasis and its related morbidities among the communities was limited. This is possibly because knowledge of infection stages of S. haematobium that causes the morbidity requires an understanding of disease etiology. Therefore, this study recommends that interventions to impart knowledge on schistosomiasis and the associated morbidities should be implemented in Itilima District. Keywords:&nbsp;&nbsp;&nbsp;&nbsp; Schistosomiasis, Urinary tract morbidity, Knowledge, Attitudes and Practices, Itilima Distric

Early Marjolin’s ulcer developing in a penile human bite scar of an adult patient presenting at Bugando Medical Centre, Tanzania: A Case Report

Marjolin’s ulcer is a rare but well documented cutaneous malignancy that arises in a scar or chronic ulcer, and is characterized by an aggressive course. The latent period from the injury to the appearance of cancer has been reported to be 25-40 years. Early occurring Marjolin’s ulcer has rarely been described in the literature and its development in a penile human bite scar is still rare. We report a rare case of a 33 year-old patient who presented with an early appearance of Marjolin’s ulcer developing in a penile human bite scar. On histological examination it was found to be poorly differentiated squamous cell carcinoma. He was managed by total penile amputation. Five months after surgery, the patient presented to our surgical outpatient clinic with inguinal lymph node metastases and distant metastases to the lung, liver and bones. However, the patient died shortly after admission. This report highlights the possibility of early appearance of Marjolin’s ulcer arising from a chronic ulcer or healed scar in an unusual sites such as the penis. It is therefore recommended that all chronic ulcers should be thoroughly investigated at presentation, to avoid labelling malignancies ‘chronic ulcers’, leading to delay in appropriate treatment. Early recognition and aggressive treatment of Marjolin's ulcers and close follow-up are urgently needed to improve outcomes in our environment

Mob justice as an emerging medico-legal, social and public health problem in north-western Tanzania: a need for immediate attention

Background: Mob-justice poses a medico-legal, social and public health problem in most developing countries including Tanzania and has shown to have negative effects on social and health of the country, communities, and families. This study was conducted to analyze the mob-justice situation in north-western Tanzania to determine the causes and injury characteristics of mob-justice cases and the outcome of treatment among survivors.Methods: This prospective study involved non-consecutive cases of mob-justice that were reported at Bugando Medical Centre in northwestern Tanzania from August 2006 to June 2014. Bugando Medical Centre in Mwanza, north-western Tanzania. Recruitment of cases to participate in the study was done in the pathology and surgery departments. All mob justice cases that were brought in dead (deceased) underwent autopsy examination in the pathology department and those who were severely injured (alive) were managed in the surgical wards by the admitting surgical team. Information on the cases was obtained from police, the relatives, friends and other witnesses if available. Variables studied included socio-demographic data of victims (age, sex, occupation and education), causes of mob-justice, weapons and methods used in executing mob-justice, body region affected and the type of injury.Results: A total of 234 cases (i.e. 170(72.6%) deaths and 64 (27.4%) seriously injured patients) of mob-justice were studied. The median age of victims was 28 years. Males outnumbered females by a ratio of 6.1: 1. The most common reason for a mob-justice was theft/robbery in 63.2% of cases.  Stoning (50.4%) and burning (43.6%) were the most frequent methods used in executing mob-justice. The head (95.7%) and the musculoskeletal (63.2%) were the most common body region injured. Open wounds (97.4%) and fractures (47.9%) were the most common type of injuries sustained. More than 70% of the victims who were brought in alive (64 cases) were treated surgically, of which wound debridement (75.6%) was the most common procedure performed. Complication and mortality rates were 51.6% and 51.1% respectively. The age &gt; 60 years, late presentation &gt; 48 hours, severe head injury (GCS 3-8) and admission systolic blood pressure &lt; 90 mmHg significantly influenced mortality (p &lt; 0.001). The overall median length of hospital stay was 28 days. Patients who had long bone fractures stayed longer in the hospital and this was statistically significant (p &lt; 0.001).Conclusion: Mob-justice constitutes a medico-legal, social and public health problem in Tanzania that needs immediate attention. Addressing the root causes of mob-justice such as poverty, lack of education, unemployment, and substance abuse will reduce the incidence of mob-justice in our environment, hence saving life