Subcutaneous face and neck surgical emphysema secondary to presumed spider bite

No Abstrac

Hazardous water: an assessment of water quality and accessibility in the Likangala Catchment area in Malawi

Access to potable water supply remains a serious challenge to the local communities in the Likangala River catchment in southern Malawi. The quality of water resources is generally poor and the supply is inadequate. This paper discusses the results of laboratory analysis of water samples collected from selected water points in the Likangala Basin including the Likangala River itself, existing boreholes and hand dug wells, Likangala Irrigation Scheme and Lake Chilwa at Kachulu harbour. It shows that the water is grossly polluted with faecal matter which comes from the disposal of sewage effluents by different institutions in the Municipality of Zomba. On the other hand, studies conducted on household accessibility to potable water supply indicate that more than 60% of the human population living in the catchment area depends on unprotected traditional wells and the Likangala River for domestic water supply requirements. The poor quality of the water in the catchment area and the inadequacy of water supply facilities have been noted to be the major causes for the recurrent outbreaks of water associated diseases, especially cholera, that affect the local community periodically.Keywords: access; water quality; Likangala river; Malaw

Ward Round – Cough, painful throat and progressive hoarseness of voice for 1 year

No Abstrac

Allergic fungal sinusitis secondary to Acremonium species causing unilateral visual loss

A wide range of fungi have been associated with Allergic Fungal Sinusitis (AFS) or Eosinophilic fungal rhinosinusitis ( EFRS) as it is known in some institutions. To our knowledge, this is the first reported case of aggressive, invasive AFS due to Acremonium species occurring in an immunocompetent patient and leading to unilateral visual loss. Literature on AFS is reviewed.Key words: Eosinophilic fungal rhinosinusitis, Allergic fungal sinusitis, Acremonium species, visual loss

Development of a public audiology service in Southern Malawi: profile of patients across two years

Objective To describe the profile of patients attending the Queen Elizabeth Central Hospital (QECH) audiology clinic in Malawi, over a two-year period (2016–2017). Design A retrospective patient record review. Study sample There were 2299 patients assessed at the QECH audiology department between January 2016 and December 2017. Adult patients’ ages ranged from 18 to 94 years (M = 45.8, SD = 19.22). The mean age of children included in this study was 7.7 years (SD= 5.21). Overall, 45.4% of patients were female. Results Of the 61.6% of adults and 41.7% of children found to have some degree of hearing loss, 28.3% and 15.4% were fitted with hearing aids, respectively. The number of patients seen in 2017 (n = 1385) was 34% higher than that of 2016 (n = 914). Conclusion This study found that demand for hearing services is increasing in this public sector Malawian audiology department but uptake of hearing aids for those in need is low. Future evaluation of service provision and treatment outcomes is needed. Results from this study can be used to inform the development of future audiology clinics in low resource settings

Microbiology of chronic suppurative otitis media at Queen Elizabeth Central Hospital, Blantyre, Malawi: A cross-sectional descriptive study

Background Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore, it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment, avoid complications, and provide records for future reference.Aim The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre, Malawi, and establish their relationship signs and symptoms, and with the demographic pattern of the study.Methods This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM, who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS.version 20.Results The study found that Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent aerobic bacteria, while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOMcausing microorganisms were—significantly more so than the others—characteristically associated with each of the following clinical features: quantity of pus drainage, mode of onset, otalgia, hearing loss, location of tympanic membrane perforation, and mucosal appearance

Suprahyoid approach to base-of-tongue squamous cell carcinoma

Objective. To evaluate the suprahyoid approach to treatment of squamous cell carcinoma of the base of the tongue at Groote Schuur Hospital between 1999 and 2004. Design and method. Retrospective analysis was done of patients with base-of-tongue squamous cell carcinoma treated using the suprahyoid approach. Results. Seventeen patients underwent treatment for base-of-tongue squamous cell carcinoma utilising the suprahyoid approach. Complete medical records were available for 15 of these patients. The most common presenting symptoms were neck mass (40%) and referred otalgia (33%). Alcohol was a risk factor in more patients (64%) than smoking (47%). Adverse pathological findings were present in less than 50% of patients (involved margins 20%, perineural invasion 40%, vascular invasion 33%). Functional outcome in terms of speech intelligibility was excellent and there were minimal swallowing problems, with most patients using compensatory strategies and dietary modification. There were 2 subsequent deaths (13%) as a result of distant metastasis and a second primary. Conclusion. The suprahyoid approach to treatment of base-of-tongue squamous cell carcinoma provides good exposure, local tumour control and excellent functional outcome

Comparative evaluation of a low-cost solar powered otoscope with a traditional device among health care workers in Malawi

Funding: Dorothy Miller Bursary Scheme - University of St Andrews Medical School.Objectives: To comparatively evaluate a low-cost otoscope with a traditional device among health care workers in Malawi. Methods: The study is a prospective, comparative, qualitative observational survey of health care worker's opinions using 5-point Likert rating scales and tick box categories in a 10-item survey questionnaire. Twenty-five mixed cadre health care workers from the Ear, Nose, and Throat Department of the Queen Elizabeth Hospital, Blantyre in Malawi were recruited. Outcomes measures used were ease of speculum attachment, handling, insertion, stability, the quality of view, color, build, brightness, overall ease of use, and their suitability for local work. Results: The low-cost otoscope scored statistically higher in overall combined performance, as well as in the remaining four out of the nine attributes. Notably, 54.2% of users rated the low-cost device more suitable than the traditional device for use in low-middle income countries, 25% were equivocal, and 20.8% preferred the traditional device. Conclusion: This study found the Arclight otoscope to be an appropriate and practical substitute for more expensive traditional otoscopes for the delivery of ENT services in low resource settings. Level of Evidence: N/APublisher PDFPeer reviewe

Diagnostic accuracy of non-specialist versus specialist health workers in diagnosing hearing loss and ear disease in Malawi.

OBJECTIVE: To determine whether a non-specialist health worker can accurately undertake audiometry and otoscopy, the essential clinical examinations in a survey of hearing loss, instead of a highly skilled specialist (i.e. ENT or audiologist). METHODS: A clinic-based diagnostic accuracy study was conducted in Malawi. Consecutively sampled participants ≥ 18 years had their hearing tested using a validated tablet-based audiometer (hearTest) by an audiologist (gold standard), an audiology officer, a nurse and a community health worker (CHW). Otoscopy for diagnosis of ear pathologies was conducted by an ENT specialist (gold standard), an ENT clinical officer, a CHW, an ENT nurse and a general nurse. Sensitivity, specificity and kappa (κ) were calculated. 80% sensitivity, 70% specificity and kappa of 0.6 were considered adequate. RESULTS: Six hundred and seventeen participants were included. High sensitivity (>90%) and specificity (>85%) in detecting bilateral hearing loss was obtained by all non-specialists. For otoscopy, sensitivity and specificity were >80% for all non-specialists in diagnosing any pathology except for the ENT nurse. Agreement in diagnoses for the ENT clinical officer was good (κ = 0.7) in both ears. For other assessors, moderate agreement was found (κ = 0.5). CONCLUSION: A non-specialist can be trained to accurately assess hearing using mobile-based audiometry. However, accurate diagnosis of ear conditions requires at least an ENT clinical officer (or equivalent). Conducting surveys of hearing loss with non-specialists could lower costs and increase data collection, particularly in low- and middle-income countries, where ENT specialists are scarce