Latent tuberculosis among pregnant mothers in a resource poor setting in Northern Tanzania: a cross-sectional study

Untreated latent TB infection (LTBI) is a significant risk factor for active pulmonary tuberculosis, hence predisposing to adverse pregnancy outcomes and mother to child transmission. The prevalence of latent tuberculosis in pregnancy and its association, if any, with various socio-demographic, obstetric and clinical characteristics was evaluated. Northern Tanzania was chosen as the study site. In a cross-sectional study, a total of 286 pregnant women from 12 weeks gestational age to term were assessed. Screening was undertaken using an algorithm involving tuberculin skin testing, symptom screening in the form of a questionnaire, sputum testing for acid fast bacilli followed by shielded chest X-rays if indicated. HIV serology was also performed on consenting participants.\ud Prevalence of latent infection ranged between 26.2% and 37.4% while HIV sero prevalence was 4.5%. After multivariate logistic analysis it was found that age, parity, body mass index, gestational age, and HIV sero status did not have any significant association with tuberculin skin test results. However certain ethnic groups were found to be less vulnerable to LTBI as compared to others (Chi square = 10.55, p = 0.03). All sputum smears for acid fast bacilli were negative. The prevalence of latent tuberculosis in pregnant women was found to be relatively high compared to that of the general population. In endemic areas, socio-demographic parameters alone are rarely adequate in identifying women susceptible to TB infection; therefore targeted screening should be conducted for all pregnant women at high risk for activation (especially HIV positive women). As opposed to the current policy of passive case detection, there appears to be an imminent need to move towards active screening. Ethnicity may provide important clues into genetic and cultural differences which predispose to latent tuberculosis, and is worth exploring further

Post-Partum Pituitary Insufficiency and Livedo Reticularis Presenting a Diagnostic Challenge in a Resource Limited Setting in Tanzania: A Case Report, Clinical Discussion and Brief Review of Existing Literature.

Pituitary disorders following pregnancy are an important yet under reported clinical entity in the developing world. Conversely, post partum panhypopituitarism has a more devastating impact on women in such settings due to high fertility rates, poor obstetric care and scarcity of diagnostic and therapeutic resources available. A 37 year old African female presented ten years post partum with features of multiple endocrine deficiencies including hypothyroidism, hypoadrenalism, lactation failure and secondary amenorrhea. In addition she had clinical features of an underlying autoimmune condition. These included a history of post-partum thyroiditis, alopecia areata, livedo reticularis and deranged coagulation indices. A remarkable clinical response followed appropriate hormone replacement therapy including steroids. This constellation has never been reported before; we therefore present an interesting clinical discussion including a brief review of existing literature. Post partum pituitary insufficiency is an under-reported condition of immense clinical importance especially in the developing world. A high clinical index of suspicion is vital to ensure an early and correct diagnosis which will have a direct bearing on management and patient outcome

Transradial Access Results in Faster Recanalization in Left Anterior Circulation Stroke with Bovine Arch Anatomy

Background We compared technical and clinical outcomes of transradial (TRA) versus transfemoral (TFA) access for mechanical thrombectomy of acute ischemic stroke due to large vessel occlusion in the left anterior cerebral circulation of bovine origin. Methods A single‐center retrospective review of a prospectively maintained neurointerventional database from a large volume service in a tertiary academic center. Procedural metrics, technical, and clinical outcomes data were collected and analyzed for patients who underwent mechanical thrombectomy presenting with acute ischemic stroke and large vessel occlusion in the left anterior circulation of bovine origin. Clinical and procedural outcomes included the average number of passes, single first effective pass, rate of successful recanalization (thrombolysis in cerebral infarction score≥2b), 3‐month disability modified Rankin scale scores, time from skin puncture to microcatheter placement, and recanalization. Results Between January 2018 and January 2021, 26 patients (TRA=13, TFA=13) underwent mechanical thrombectomy. The TRA cohort had a significantly shorter time in minutes for skin puncture to microcatheter placement (TRA: 17.0±5.8 versus TFA: 35.4±20.5; P=0.0001), shorter skin puncture to recanalization (TRA: 34.0±15.6 versus TFA: 58.1±34.6; P=0.01), and shorter total fluoroscopy time (TRA: 13.8±9.4 versus TFA: 29.5±18.0; P=0.03). The 3‐month modified Rankin scale score of (0–1) was higher in the TRA group (38.5% versus 7.69%; P=0.06). Conclusions In patients with large vessel occlusion in the left anterior cerebral circulation of bovine origin, right TRA access permits more direct navigation and provides a stable platform resulting in shorter procedure times and faster recanalization with potential for improved functional outcomes