10 research outputs found
Prevalence and severity of malnutrition in people living with HIV on chronic haemodialysis in Dar es Salaam.
No full textBACKGROUND: Human immunodeficiency virus is still a global burden more so in sub-Saharan Africa. Chronic kidney disease and end-stage renal disease are important comorbid conditions that are prevalent in HIV-infected individuals. Patients who are HIV positive and on hemodialysis have triple risk factors for development of malnutrition (i.e. Human immunodeficiency virus, chronic kidney disease, and haemodialysis). Malnutrition greatly impacts these patient’s morbidity and mortality and thus the great need to address this gap which will improve their prognosis. OBJECTIVE: The objective of the study was to assess the prevalence and severity of malnutrition in people living with HIV on chronic haemodialysis in Dar es Salaam. METHOD: This was a cross-sectional analytic study done at 5 haemodialysis centers in Dar es Salaam between December 2019 and April 2020. The study included all HIV-positive patients on haemodialysis for three months or more. Detailed history was obtained from the patients and their medical record files using a semi structured questionnaire. A validated nutritional screening tool subjective Global assessment-dialysis malnutrition score was used to assess for malnutrition. Descriptive statistics were analyzed using SPSS. RESULTS: Total of 56 patients with median age (SD) of 50.0(13.6) years from five haemodialysis centers in Dar es Salaam were enrolled in the study. The years of being HIV positive ranged from 1year to 40 years with a median (SD) of 5(7.4) years. The overall prevalence of malnutrition was 87.5 (49/56), with 85.7 %( 48/5) being mild to moderately malnourished and 1.8 %( 1/56) being severely malnourished. CONCLUSION: The state of malnutrition in people living with HIV on haemodialysis is high, hence, the study has highlighted the burden. Assessment of nutritional status among these patients is of great importance and emphasis should be placed on regular screening and follow-up by health-care team in haemodialysis centers
Furrowed tongue, fatten lip and facial droop
No full textMelkersson-Rosenthal syndrome (MRS) is a rare, neuro-mucocutaneous syndrome characterized by recurrent facial nerve palsy, swelling of the upper lip, and fissured tongue. Young adults in the second and third decades are more predisposed. We report a case of a 23-years old female Chinese who presented with 5 days history of right facial weakness; her second event in one year (first weakness was on the left). On examination, she had right peripheral facial nerve palsy (House-Brackmann stage IV) and, mild swelling of the upper lip (Image-Arrow A). Her tongue revealed two central furrows. The anterior central furrow (Image-Arrow B) measured about 2cm and the posterior one measured about 1.5cm with lateral grooves and few posterior perpendicular furrows measuring about 1-2 mm in depth. Her complete blood count, blood sugar, urine routine, C-reactive protein, serum angiotensin-converting enzyme level was all normal. Her brain magnetic resonance imaging revealed no abnormal signals. She was commenced on oral prednisolone 60mg daily for 5 days, acyclovir 800mg 4 times daily for 5 days, vitamin B capsules and methylcellulose drops to prevent scleritis. She was commenced on physiotherapy with steady clinical improvement. Although fissured tongue is a common clinical condition with a long list of differential diagnosis, the presence of recurrent facia nerve palsy and swollen lip should raise the suspicion of MRS. Other causes of recurrent facial nerve palsy and buccal mucosa involvement like sarcoidosis, system lupus erythematosus, Bechet disease and Crohn disease should be considered
Factors Associated with Mortality Among Hospitalized Adults with COVID-19 Pneumonia at a Private Tertiary Hospital in Tanzania: A Retrospective Cohort Study
No full textNadeem Kassam,1 Eric Aghan,2 Omar Aziz,1 Hanifa Mbithe,1 Kamran Hameed,1 Reena Shah,3 Salim Surani,4 James Orwa,5 Samina Somji1 1Internal Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, Dar-es- Salaam, Tanzania; 2Family Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, East Africa, Dar-es-Salaam, Tanzania; 3Infectious Disease & Internal Medicine, The Aga Khan University, Medical College, Nairobi, Kenya; 4Pulmonology & Internal Medicine, Texas a&m University, Texas A&M College Station, TX, USA; 5Population Health, Aga Khan University, Medical College, East Africa, Nairobi, KenyaCorrespondence: Nadeem Kassam Email [email protected]: The emergence of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There has been paucity of data for hospitalized African patients suffering from COVID-19. This study aimed to identify factors associated with in-hospital mortality in patients suffering from COVID-19 in Tanzania.Methods: This was a single center, retrospective, observational cohort study in adult patients hospitalized with confirmed COVID-19 infection. Demographics, clinical pattern, laboratory and radiological investigations associated with increased odds of mortality were analyzed.Results: Of the 157 patients, 107 (68.1%) patients survived and 50 (31.8%) died. Mortality was highest in patients suffering with severe (26%) and critical (68%) forms of the disease. The median age of the cohort was 52 years (IQR 42– 61), majority of patients were male (86%) and of African origin (46%), who presented with fever (69%), cough (62%) and difficulty in breathing (43%). Factors that were associated with mortality among our cohort were advanced age (OR 1.07, 95% CI 1.03– 1.11), being overweight and obese (OR 9.44, 95% CI 2.71– 41.0), suffering with severe form of the disease (OR 4.77, 95% CI 1.18– 25.0) and being admitted to the HDU and ICU (OR 6.68, 95% CI 2.06– 24.6).Conclusion: The overall in-hospital mortality was 31.8%. Older age, obesity, the severe form of the disease and admission to the ICU and HDU were major risk factors associated with in-hospital mortality.Keywords: COVID-19, factors, hospital, mortality, Tanzani
A comparative analysis of TOAST and ASCOD criteria in etiologic subtyping of acute ischemic stroke at a tertiary hospital in Tanzania
No full textBackgroundEtiologic subtyping of ischemic stroke is crucial for determining its treatment, prognosis, and prevention. However, data on the widely utilized TOAST and ASCOD criteria remain scarce in the East African region.AimsThe study aimed to compare the performance of the TOAST and ASCOD systems in subtyping ischemic stroke among stroke patients at a tertiary hospital in Tanzania.MethodsThis was an institutional cross-sectional study. All adults (≥18 years) admitted with a diagnosis of stroke over a six-year period were selected from the registry, and their clinical details reviewed retrospectively. One hundred and thirty (130) patients with first- or second-time acute stroke (as defined by the World Health Organization) were included. Acute stroke was confirmed as ischemic by magnetic resonance imaging. For each index stroke, TOAST and ASCOD criteria were applied. The discordance and level of agreement between the approaches were assessed using McNemar's test χ2 (P-value) and Cohen's kappa coefficient (κ), respectively. The value of κ was interpreted as moderate (0.41–0.6), good (0.61–0.8), very good (0.81–0.9), or excellent (0.91–1.0). Statistical significance was set at P < 0.05.ResultsThere was no significant discordance between TOAST and the grade 1 level of evidence of ASCOD (ASCOD1) in assigning stroke to all subtypes, except for undetermined etiology χ2 (P = 0.023). Agreement between these systems was good to very good (κ = 0.601 to 0.843, P < 0.01) across the subtypes. TOAST and ASCOD1 failed to determine a definitive etiology in 34.6% and 48.5% of strokes, respectively. On comparing TOAST vs. combined grade of evidence 1 and 2 of ASCOD (ASCOD1,2), there was a discordance in allocation of strokes to the cardioembolic subtype χ2 (P < 0.001), and agreement was moderate (κ = 0.471, P = 0.001). However, the agreement across other identified subtypes was good to very good (κ = 0.601 to 0.875, P ≤ 0.001).ConclusionThere was a good to very good agreement between TOAST and ASCOD1 in etiologic subtyping of ischemic stroke. Further research is warranted to evaluate their consistency across diverse local settings and to explore factors influencing their performance
Severe Crohn’s Disease With Intra-abdominal Fistula: First Reported Case From Tanzania
No full textBackground
We describe a case of Crohn\u27s disease occurring in a young Tanzanian female. Crohn’s disease is rare in Africa and not encountered normally. The presentation of Crohn’s disease overlaps with many other abdominal disorders that are common in an African setting, such as tuberculosis and schistosomiasis. The disease is probably underdiagnosed in Africa due to limitations in diagnostic testing and rarity.
Introduction
Crohn’s disease (CD) is a chronic relapsing inflammatory bowel disease (IBD). It is chiefly characterized by a transmural granulomatous inflammation affecting any part of the gastrointestinal tract, most frequently the terminal ileum [1]. CD arises from a complex interaction between genetic and environmental factors [2]. The incidence and prevalence of CD appear to be growing globally but vary by geographic location and are considered uncommon in an African setting. The prevalence of tuberculous enterocolitis and schistosomiasis in Africa is considered an impediment to effectively diagnosing CD since both have clinical and histological similarities [3-5]. The distinction of CD from tuberculosis is relatively even more challenging if the lesion is granulomatous [5]. A case of histopathologically confirmed CD is presented here because of the paucity and clinical curiosity of this entity. Case Presentation A 24-year-old female of African origin was admitted to our hospital with a six-month history of fresh persistent bloody diarrhea and joint pain. She reported that the diarrhea was foul-smelling, mucoid, and infrequently watery. Her bowel frequency was progressively increasing over time to around 8 to 10 bowel movements per day associated with crampy abdominal pain especially on defecation. Her symptoms were associated with unintentional weight loss of around 10 kg over the past three months. The joint pains were localized to both the ankles and the metacarpophalangeal (MCP) joints, which were worse in the morning. She reported no fevers throughout her illness but developed a few episodes of non-bilious vomiting one day prior to the admission. The patient was a primary school teacher with no history of alcohol consumption or cigarette smoking and denied use of any chronic medication. She had multiple outpatient visits to several facilities for which she was treated for infectious diarrhea with no improvement. She tested negative for HIV, was given steroids for her joint pain, and was asked to adjust her diet. Her past medical history was unremarkable for chronic disease or previous surgeries; she was nulliparous and had normal menstrual cycles. On examination, the patient was ill-looking, afebrile, mildly pale, and dehydrated with three pustular lesions noted on her face. At the time of admission, the patient had normal vitals, apart from mild tachycardia (heart rate of 110 beats/minute). Abdominal examination revealed mild epigastric tenderness, and a digital rectal examination was normal. On local examination of the perineum, she had multiple excoriations and three well-demarcated shallow ulcers with regular margins having a diameter of less than 1 cm. A musculoskeletal examination revealed evident swelling of both her ankle joints and MCPs. There was no back deformity noted but was tender on both sacroiliac joints. The patient’s initial investigation revealed the following: hemoglobin (Hb) of 9 g/dL (normal: 12.3-15.2 g/dL), an elevated erythrocyte sedimentation rate (ESR) at 73 mm/hour (normal: 0-20 mm/hour), and mildly decreased albumin level of 31.05 g/L (normal: 34-54 g/L). The patient underwent esophagogastroduodenoscopy and colonoscopy, which revealed severe pancolitis, as shown in Figure 1.
A biopsy of the colon was taken, histology of which revealed transmural inflammation with granulomatous inflammation suggestive of CD (Figure 2). Esophageal and gastric tissue histology showed features suggestive of active chronic gastritis (Figure 3). The patient was diagnosed with severe CD with IBD associated with arthritis.
The patient was started on sulfasalazine 500 mg every 12 hours and prednisolone 40 mg daily. On return to the clinic, she reported persistent but mildly improved symptoms. Abdominal computed tomography (CT) was performed, as seen in Figure 4, which revealed bowel-wall thickening, strictures at the distal ileum and rectosigmoid junction, and ileocolic and ileoileal fistula.
Discussion
CD causes inflammation of the digestive tract, mostly affecting the ileum [1]. CD is considered a disease with bimodal distribution having two peaks of onset, the first peak between age 20 and 30 years, as seen in our patient, and the second peak at age 50 years with a median age of 30 years [6]. Despite its changing epidemiology and with the incidence rising in Asia and Eastern Europe [7,8], CD is still considered a rare entity in the developing world, especially among black African patients [9,10]. We hypothesize that this disease is likely underdiagnosed due to the lack of endoscopic resources and the overlap of symptomology with schistosomiasis and tuberculosis of the bowel [4]. Review of risk factors attributable to CD remains incompletely understood despite several theories stating the interplay between infective agents, environmental, and genetic factors [11,12]. Our case cannot truly ascertain the risk factor in our patient; nevertheless, low vitamin D level is a well-studied phenomenon and associated with disease activity in CD [13]. Lifestyle factors such as stress, sleep, obesity, and exercise are poorly studied in an African context. The presentation of CD may vary and can be insidious and nonspecific [14], and alarming symptoms as seen in our patients such as weight loss, bloody diarrhea, and other systemic manifestations should require further evaluation. We postulate that limitations of diagnostic capabilities serve as a hindrance to an established diagnosis of CD. These limitations force clinicians in low-resource settings to provide empirical care for common diseases that present in a similar fashion such as malaria and many waterborne diseases. It is likely that this patient would have benefitted from induction therapy with an anti-tumor necrosis factor (TNF) agent such as infliximab in combination with an immunomodulator such as azathioprine, which is considered first-line therapy for patients presenting with fistulizing disease. She would also need close follow-up with a dietician and surgical expertise in IBD. All of these are, sadly, hard to come by in our general setting.
Conclusions
We presented the case as a wake-up call to the health care providers to start considering CD as a possibility in patients presenting with GI symptoms in an African context. Our case had an almost hallmark presentation of CD with both gastrointestinal and extragastrointestinal manifestations, which, unfortunately, was not picked up at her index visit. CD is considered by many as a very rare disease in Africa. The symptoms of CD may mimic many other abdominal conditions for which medical attention is required. However, it should be kept in mind as one of the causes of acute abdomen, especially in those patients who have a long history of intestinal complaints whose treatments greatly differ. A histopathologically confirmed diagnosis is necessary for the medical field especially of the emerging evidence with an increased risk of adenocarcinoma in patients with CD
Smart Watch Detection of Supraventricular Tachycardia (SVT): First Case from Tanzania
No full textSmartwatches like the Apple Watch have been on the rise worldwide and their use is gaining popularity in developing countries. Their ability to detect dysrhythmias is well documented. Present practice discourages the use of these devices as a diagnostic tool. Nevertheless, atypical findings from these devices should be clinically investigated. This case demonstrates an eventual diagnosis of supraventricular tachycardia (SVT) based on an Apple watch alert which was subsequently confirmed by electrophysiological evaluation
Magnitude, Distribution and Contextual Risk Enhancing Predictors of High 10-Year Cardiovascular Risk Among Diabetic Patients in Tanzania
No full textIntroduction:
Atherosclerotic Cardiovascular Disease (ASCVD) is the leading cause of death worldwide. In Diabetics, ASCVD is associated with poor prognosis and a higher case fatality rate compared with the general population. Sub-Saharan Africa is facing an epidemiological transition with ASCVD being prevalent among young adults. To date, over 20 million people have been living with DM in Africa, Tanzania being one of the five countries in the continent reported to have a higher prevalence. This study aimed to identify an individual’s 10-year ASCVD absolute risk among a diabetic cohort in Tanzania and define contextual risk enhancing factors.
Methods:
A prospective observational study was conducted at the Aga Khan hospital, Mwanza, for a period of 8 months. The hospital is a 42-bed district-level hospital in Tanzania. Individuals 10-year risk was calculated based on the ASCVD 2013 risk calculator by ACC/AHA. Pearson’s chi-square or Fischer’s exact test was used to compare categorical and continuous variables. Multivariable analysis was applied to determine contextual factors for those who had a high 10-year risk of developing ASCVD.
Results:
The overall cohort included 573 patients. Majority of the individuals were found to be hypertensive (n = 371, 64.7%) and obese (n = 331, 58%) having a high 10-year absolute risk (n = 343, 60%) of suffering ASCVD. The study identified duration of Diabetes Mellitus (\u3e10 years) (OR 8.15, 95% CI 5.25–14.42), concomitant hypertension (OR 1.82 95% CI 1.06–3.06), Diabetic Dyslipidemia (OR 1.44, 95% CI 1.08–1.92) and deranged serum creatinine (OR 1.03, 95% CI 1.02–1.03) to be the risk enhancing factors amongst our population.
Conclusion:
The study confirms the majority of diabetic individuals in the lake region of Tanzania to have a high 10-year ASCVD risk. The high prevalence of obesity, hypertension and dyslipidemia augments ASCVD risk but provides interventional targets for health-care workers to decrease these alarming projection
Residency training on the frontlines of the COVID-19 pandemic - a qualitative study from Tanzania
No full textIntroduction: the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease.
Methods: this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis.
Results: twelve residents and six faculty members participated in this study. Two main themes emerged. The first was: New and unfamiliar teaching and learning experiences. Residents and faculty had to adapt to changes in the learning environment and the academic program. Residents had increased responsibilities, including providing front line care and working with reduced supervision. The second theme was: Learning opportunities amidst crisis. There were opportunities to improve critical care and procedural skills. They also had opportunities to improve non-technical skills like teamwork and communication.
Conclusion: residents and faculty had to adapt to changes in teaching and learning. Residents also had to take up additional responsibilities. Support systems are required to help them adapt to the changes and settle in their new roles. There were opportunities to learn new skills, and training should be restructured to maximize the use of these opportunities
Outcomes of Surgical Tracheostomy on Mechanically Ventilated COVID-19 Patients Admitted to a Private Tertiary Hospital in Tanzania
No full textObjectives:
The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in the number of patients necessitating prolonged mechanical ventilation. Data on patients with COVID-19 undergoing tracheostomy indicating timing and outcomes are very limited. Our study illustrates outcomes for surgical tracheotomies performed on COVID-19 patients in Tanzania. Methods: This was a retrospective observational study conducted at the Aga Khan Hospital in Dar es Salaam, Tanzania.
Results:
Nineteen patients with COVID-19 underwent surgical tracheotomy between 16 th March and 31st December 2021. All surgical tracheostomies were performed in the operating theatre. The average duration of intubation prior to tracheotomy and tracheostomy to ventilator liberation was 16 days and 27 days respectively. Only five patients were successfully liberated from the ventilator, decannulated, and discharged successfully.
Conclusions:
This is the first and largest study describing tracheotomy outcomes in COVID-19 patients in Tanzania. Our results revealed a high mortality rate. Multicenter studies in the private and public sectors are needed in Tanzania to determine optimal timing, identification of patients, and risk factors predictive of improved outcome
The Pattern of Admission, Clinical Characteristics, and Outcomes Among Patients Admitted to the Intensive Care Unit of a Tertiary Hospital in Tanzania: A 5-Year Retrospective Review
No full textIntroduction:
Despite the implementation of complex interventions, ICU mortality remains high and more so in developing countries. The demand for critical care in Sub-Saharan Africa is more than ever before as the region experiences a double burden of rising rates of non-communicable diseases (NCD) in the background battle of combating infectious diseases. Limited studies in Tanzania have reported varying factors associated with markedly high rates of ICU mortality. Investigating the burden of ICU care remains crucial in providing insights into the effectiveness and challenges of critical care delivery.
Material and Methods: A single-center retrospective study that reviewed records of all medically admitted patients admitted to the ICU of the Aga Khan Hospital, Dar-es-Salaam, from 1st October 2018 to 30th April 2023. To define the population in the study, we used descriptive statistics. Patients’ outcomes were categorized based on ICU survival. Binary logistic regression was run (at 95% CI and p-value \u3c 0.05) to identify the determinants for ICU mortality.
Results:
Medical records of 717 patients were reviewed. The cohort was male (n=472,65.8%) and African predominant (n=471,65.7%) with a median age of 58 years (IQR 45.0–71.0). 17.9% of patients did not survive. The highest mortality was noted amongst patients with septic shock (29.3%). The lowest survival was noted amongst patients requiring three organ support (n=12,2.1%). Advanced age (OR 1.02,CI 1.00–1.04), having more than three underlying comorbidities (OR 2.50,CI 1.96–6.60), use of inotropic support (OR 3.58,CI 1.89–6.80) and mechanical ventilation (OR 9.11,CI 4.72–18.11) showed association with increased risk for mortality in ICU.
Conclusion:
The study indicated a much lower ICU mortality rate compared to similar studies conducted in other parts of Sub- Saharan Africa. Advanced age, underlying multiple comorbidities and organ support were associated with ICU mortality. Large multi- center studies are needed to highlight the true burden of critical care illness in Tanzania
