17 research outputs found
Adequacy of Hemodialysis and Its Associated Factors among Patients Undergoing Chronic Hemodialysis in Dar es Salaam, Tanzania
Get PDFThe worldwide prevalence of maintenance hemodialysis continues to rise. An adequate delivery of hemodialysis dose as measured by Kt/V or urea reduction ratio is a crucial determinant of clinical outcome for chronic hemodialysis patients. )e aim of this study was to assess the adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam. )is was a cross-sectional study done on patients undergoing chronic hemodialysis in four dialysis centers in Dar es Salaam. Sociodemographic information and treatment characteristics were collected. Urea reduction rate and single-pool Kt/V were calculated to determine the adequacy of hemodialysis. )e data were analyzed and any associated factors for inadequate hemodialysis were determined using a chi-square test and a logistic regression analysis. A total of 143 patients participated in the study. Males represented 65.7% of the study population. )e mean age (±SD) was 51.7 ± 1.2 years. Only 34.3% (based on urea reduction ratio (URR)) and 40.6% (based on Kt/V) of patients received adequate hemodialysis. )e univariate analysis showed that males were more likely to have inadequate dialysis (65.6% versus 48.0%, p = 0.048 based on Kt/V). Patients using hemodialyzers with dialyzer surface area less than 1.4 m2 received significantly less hemodialysis dose than those with more than 1.4 m2 (69.0% versus 41.2%, p = 0.02, by URR) (62.7% versus 35.3%, p = 0.03, by Kt/V criteria). Patients who had hemoglobin \u3c10 g/dl received significantly inadequate hemodialysis dose as compared to patients with hemoglobin ≥10 g/dl by Kt/V criteria (69.8% versus 51.3%, p = 0.03). None of the factors acquired significance in the multivariate analysis. )e proportion of patients receiving an adequate hemodialysis dose is low (34.3% based on URR and 40.6% based on Kt/V). Male gender, dialyzer surface area of \u3c1.4 m2 , and hemoglobin level of \u3c10 g/dl were associated with an inadequate delivered dose of hemodialysis in the univariate analysis but not in the multivariate analysis. )is study can increase awareness about the importance of measuring hemodialysis adequacy and giving the correct hemodialysis dose to achieve the intended benefit
Frequency, predictors and outcomes of intradialytic complications in patients on maintenance haemodialysis in Dar es Salaam: Prospective longitudinal study.
No full textIntroductionHemodialysis is a crucial renal replacement therapy option for end stage renal disease (ESRD) patients. Currently, there is a rise of patients who require hemodialysis with concurrent rise in intradialytic complications which can potentiate several outcomes some of which are life threatening. This study assessed the frequency, predictors, and outcomes of intradialytic complications amongst ESRD patients on maintenance hemodialysis.MethodologyProspective longitudinal study using self-designed questionnaires including patient's demographic data and relevant past medical history, pre-hemodialysis assessment and intra-dialysis monitoring was done for 2 months at Aga Khan Hospital and Muhimbili National Hospital, in Dar es salaam, Tanzania.Results215 patients were enrolled, of which 138(64.2%) were males with mean age 57(SD 15.37), height 1.64(SD 0.08) and weight 69.27(SD 12.62). Most patients 197(91.6%), were on thrice weekly schedule of which the duration of each session in most patients 206(95.8%) was 4 hours. Diabetes mellitus was the most common etiology of ESRD 126 (58.6%), ArterioVenous fistula (AVF) was the most common vascular access for the procedure 90(41.9%) and mostly, high flux dialyzers were used, FX100 & FX80, (211, 98.2%). There was a statistically significant association between pre-dialysis vital signs, blood flow rate and sex (p value ConclusionHemodialysis is a life-saving procedure with multiple complications of which some have detrimental outcomes. Nonetheless, having a good understanding of the factors associated with the complications, appropriate management and ways of preventing them will remarkably improve the procedure and make it a safer renal replacement modality. Carefully, monitoring pre-dialysis vitals and taking necessary measures when deranged, individualized proper machine settings, sufficient fluid removal and standard blood flow rate may improve the dialysis procedure
Endobronchial Tuberculosis: A Rare Presentation
Get PDFEndobronchial tuberculosis (EBTB) is an infection of the tracheobronchial tree by Mycobacterium tuberculosis. It is common among young females. Patient can present with fever, cough, wheeze, with or without any constitutional symptoms. It presents as a diagnostic dilemma, as patient sputum smear can be false negative. CT scan may or may not show any abnormality, or any endobronchial lesion. Bronchoscopy with bronchoalveolar lavage and biopsy offers the diagnostic choice. We hereby report a case of a young immunocompetent Asian female who was found to have endobronchial pathology, leading to diagnosis and timely therapy
Invasive liver abscess syndrome caused by Klebsiella pneumoniae: first Tanzanian experience
Get PDFOver the past 20 years there has been growing awareness of community-acquired primary liver abscess caused by strains of Klebsiella pneumoniae (K. pneumoniae) especially in patients of Asian descent, a minority of which are characterized by metastatic spread. A common and frequent destructive complication is endophthalmitis as well as the involvement of the central nervous system (CNS), causing suppurative meningitis or brain abscess. Here we report a case of invasive liver abscess caused by K. pneumoniae in an Asian patient who presented to our hospital in Tanzania with bilateral lower limb swelling for 6 weeks with acute onset of difficulty in breathing
Factors Associated with Mortality Among Hospitalized Adults with COVID-19 Pneumonia at a Private Tertiary Hospital in Tanzania: A Retrospective Cohort Study
Get PDFNadeem 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
Prevalence & Factors Associated With Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention at a Tertiary Healthcare Facility in Tanzania
No full textBackground: Coronary artery disease (CAD) is the leading cause of mortality and morbidity globally. Percutaneous coronary intervention (PCI) is a minimally-invasive lifesaving intervention for these patients; however, acute kidney injury (AKI) is a serious complication of the procedure commonly occurring due to radiocontrast-induced nephropathy.
Methods: A retrospective cross-sectional analytical study was carried out at the Aga Khan Hospital, Dar es Salaam (AKH,D), Tanzania. A total of 227 adults who underwent a percutaneous coronary intervention from August 2014 to December 2020 were enrolled. The AKI was defined based on an increase in absolute and rise in percentage creatinine using the Acute Kidney Injury Network (AKIN), and contrast-induced acute kidney injury (CI-AKI) by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Bivariable and multivariable logistic regression was utilized to analyze factors associated with AKI and the outcomes of these patients.
Results: Twenty-two of the 227 (9.7%) participants sustained AKI. The majority of the study population was male and of Asian ethnicity. No statistically significant factors were associated with AKI. The in-hospital mortality rate was 9% for the AKI versus 2% for non-AKI groups. The AKI group had a longer hospital stay and required ICU care and organ support including hemodialysis.
Conclusions: Nearly 1-in-10 patients undergoing PCI are likely to develop AKI. The in-hospital mortality rate is x4.5 times higher for patients with AKI post-PCI compared to those without AKI. Further larger studies are recommended to determine factors associated with AKI in this populatio
COVID-19 and stroke in sub-Saharan Africa: case series from Dar es Salaam
Get PDFLow and middle-income countries including those in sub-Saharan (SSA) Africa are experiencing a steady increase in the number of COVID-19 cases. To the best of our knowledge, reports of COVID-19 related strokes are scarce in SSA. The peculiar situation of stroke care in SSA makes COVID-19 associated stroke a bothersome entity as it adds other dynamics that tilt the prognostic balance. We present a case series of COVID -19 related stroke in 3 patients from Tanzania. We emphasized protected code stroke protocol
A rare case report of tuberculosis endometritis in a private hospital Dar es salaam, Tanzania
No full textTuberculosis endometritis is a pathological diagnosis and has been always over shadowed by pelvic tuberculosis. It is usually asymptomatic, but patients could complain of menstrual irregularity and per vaginal discharge. We report a case of a 37-year-old female who presented with per vaginal discharge for 2 years. Histopathology showed numerous caseating and non-caseating granulomas with plasma cells, Ziehl–Neelsen stain for acid fast bacillus is positive, and she was initiated on anti-tuberculosis treatment. On subsequent follow-up visits, patient was doing well with complete resolution of symptoms. Genital tuberculosis is usually caused by reactivation of organism from systemic distribution during primary infection. It is estimated that approximately 8 million cases of tuberculosis occur worldwide every year, 95% of which are from developing countries. Tuberculosis usually affects the lung but about one-third of patients have extra pulmonary involvement which include female genitals organs and other organs. Genital tuberculosis is an indolent infection: its common symptoms include pelvic pain, vaginal bleeding, amenorrhea, vaginal discharge, and infertility. Most of the patients respond quickly after initiating anti-tuberculosis medications. We recommend that all patients with a positive Ziehl–Neelsen stain and menstrual abnormalities undergo aggressive evaluation for genital tuberculosis
Performance in mortality prediction of SAPS 3 And MPM-III scores among adult patients admitted to the ICU of a private tertiary referral hospital in Tanzania: a retrospective cohort study
Get PDFBackground: Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU). They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM0-III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality.
Methods: This was a retrospective cohort study of adult patients admitted to the ICU of the Aga Khan Hospital, Dar- es- Salaam, Tanzania between August 2018 and April 2020. Demographics, clinical characteristics, outcomes, source of admission, primary admission category, length of stay and the support provided with the worst physiological data within the first hour of ICU admission were extracted. SAPS 3 and MPM0-III scores were calculated using an online web-based calculator. The performance of each model was assessed by discrimination and calibration. Discrimination between survivors and non-survivors was assessed by the area under the receiver operator characteristic curve (ROC) and calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test.
Results: A total of 331 patients were enrolled in the study with a median age of 58 years (IQR 43-71), most of whom were male (n = 208, 62.8%), of African origin (n = 178, 53.8%) and admitted from the emergency department (n = 306, 92.4%). In- hospital mortality of critically ill patients was 16.1%. Discrimination was very good for all models, the area under the receiver-operating characteristic (ROC) curve for SAPS 3 and MPM0-III was 0.89 (95% CI [0.844-0.935]) and 0.90 (95% CI [0.864-0.944]) respectively. Calibration as calculated by Hosmer-Lemeshow goodness-of-fit test showed good calibration for SAPS 3 and MPM0-III with Chi- square values of 4.61 and 5.08 respectively and P-Value \u3e 0.05.
Conclusion: Both SAPS 3 and MPM0-III performed well in predicting mortality and outcome in our cohort of patients admitted to the intensive care unit of a private tertiary hospital. The in-hospital mortality of critically ill patients was lower compared to studies done in other intensive care units in tertiary referral hospitals within Tanzania
Postoperative myocardial injury in a patient with left ureteric stone and asymptomatic COVID-19 disease
Get PDFCoronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic
