Motorcycle helmets have been reported to reduce the risk of death and head injuries following mot... more Motorcycle helmets have been reported to reduce the risk of death and head injuries following motorcycle accidents. The aim of this descriptive prospective study was to determine the injury outcome among helmeted and non-helmeted motorcyclists and passengers at a tertiary hospital in north-western Tanzania. A total of 654 patients involved in the motorcycle accident were studied. Of these, 468 (71.6%) were motorcyclists (riders) and the remaining 186 (28.4%) were passengers. The median age of patients at presentation was 26 years. Male outnumbered females by a ratio of 4.5: 1. Helmet use was reported in 312 (47.7%) patients. Non- helmeted patients were young compared with helmeted patients and this was statistically significant (p = 0.021). The rate of helmet use was significantly higher among motorcyclists than among passengers (p = 0.004). History of alcohol consumption prior to the accident was reported in 212 (32.4%) patients. The rate of helmet use was significantly low among a...
Geriatric injuries pose a major challenge to surgeons and general practitioners in developing cou... more Geriatric injuries pose a major challenge to surgeons and general practitioners in developing countries. The objective of this study was to determine the prevalence, injury characteristics and outcomes of geriatric injury among patients at Shinyanga Regional Hospital in Tanzania. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7% of all trauma admissions were studied. The male to female ratio was 1.4:1. Their mean age was 68.5 years (ranged 60-98 years). Premorbid illness was reported in 38.3% of patients. Most injuries were intentional in fifty-three (56.4%) patients. Assaults, falls and road traffic crashes were the mechanism of injuries in 52.1%, 19.1% and 11.7% of cases, respectively. The majority of cases of assault were females accounting for 64.6%. The majority of injuries (81.9%) occurred at home. Pre-hospital care was recorded in 5.3% of cases. The musculoskeletal (72...
Breast cancer, although reported to be the commonest female malignancy worldwide has not been ext... more Breast cancer, although reported to be the commonest female malignancy worldwide has not been extensively studied in north-western Tanzania. The aim of this retrospective review was to describe in our setting, the stage at diagnosis, clinicopathological and treatment patterns among patients with breast cancer. Data were analyzed using SPSS software system. A total of 384 patients were studied. The median age was 45 years (range 21 to 78 years). The male to female ratio was 1: 46.8. Most of the patients were premenopausal (63.8%) and presented late with advanced breast cancer disease. Majority of patients (63.0%) presented with stage III disease. Lymph node and distant metastasis at the time of diagnosis was reported in 70.8% and 21.4% of patients, respectively. Invasive ductal carcinoma (91.7%) was the most frequent histopathological type and most patients (63.8%) had poorly differentiated tumour. Patients with tumour size greater than 6cm had significantly high rate of lymph node m...
Abdominal trauma continues to be a major cause of trauma admissions all over the world and contri... more Abdominal trauma continues to be a major cause of trauma admissions all over the world and contributes significantly to high morbidity and mortality. A descriptive prospective study was conducted at Bugando Medical Centre in north-western Tanzania to describe our experience on the management of abdominal trauma outlining the causes, injury characteristics and treatment outcome of these patients. Statistical data analysis was done using SPSS programme. A total of 396 patients were studied. Male to female ratio was 3.2: 1. The median age was 28 years. More than three quarter of patients sustained blunt abdominal injuries. Road traffic accidents (RTAs) were the most common cause of injury accounting for 64.9% of cases. None of our patients received any pre-hospital care. The spleen was the most common injured organ in blunt abdominal trauma occurring in 176 (75.9%) patients, while in penetrating injury; gastrointestinal tract was the most common in 24 (10.3%) patients. One hundred twen...
Despite recent advances both in preoperative diagnosis and postoperative care, obstructive jaundi... more Despite recent advances both in preoperative diagnosis and postoperative care, obstructive jaundice still contributes significantly to high morbidity and mortality. A prospective study was undertaken to identify predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania. A total of 138 patients were studied. The male to female ratio was 1:1.6. The median age of patients was 58 years. Patients with malignant obstructive jaundice were older than those of benign type (P < 0.001). Ca head of pancreas (65.1%) was the commonest malignant cause of jaundice where as choledocholithiasis (51.9%) was the commonest benign cause. Twelve (9.7%) patients were HIV positive with a median CD 4+ count of 342 cells/μl. A total of 130 (94.2%) patients underwent surgical treatment and the remaining 8 (5.8%) patients were unfit for surgery. The complication rate was 30.4% mainly due to surgical site infections and it was significantly influenced b...
Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruc... more Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. There is paucity of published data regarding this condition in our setting. This study describes the clinical presentation, mode of treatment and outcome of treatment of this disease and identifies factors responsible for poor outcome of these patients. This was a descriptive retrospective study of infants with HPS admitted to Bugando Medical Centre and subsequently underwent surgery between February 2009 and January 2014. A total of 102 patients (M:F = 4.7:1) were studied. The median age at presentation was 5 weeks. The median duration of illness was 4 weeks. Fifty-four (52.9 %) patients occur in first-born children. Associated anomalies were reported in 7 (6.9 %) patients. Non-bilious vomiting was the most frequent symptom and it was described in all (100 %) patients. A palpable mass was found in 23.5 % of infants. The diagnosis of IHPS was made clinically in 86 (84.3 %) and by ultrasound in 16 (15.7 %) patients. The treatment was Ramstedt&amp;amp;amp;amp;#39;s pyloromyotomy in all cases. There were 6 (5.9 %) intra-operative mucosal perforations which were repaired successively. Postoperative complication was 11.8 %. The median length of hospital stay was 12 days and it was significantly associated with prolonged pre-operative hospitalization (p = 0.001). The mortality rate was 4.9 %. Age below 2 weeks, late presentation (≥14 days), severe dehydration on admission, hypokalaemia on admission and surgical site infection were the main predictors of mortality (p &amp;amp;amp;amp;lt; 0.001). This study has shown that IHPS is a common condition in our setting. Age &amp;amp;amp;amp;lt;2 weeks, delayed presentation, prolonged preoperative hospital stay, surgical site infection and high proportion of dehydration and electrolyte disturbance were the main predictors of poor outcome. A high index of suspicion is needed in infants with non-bilious vomiting to avoid delay in diagnosis.
Fournier&amp;amp;amp;amp;amp;amp;#39;s gangrene (FG) is a rare, rapidly progressive, necrotiz... more Fournier&amp;amp;amp;amp;amp;amp;#39;s gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors. This was a descriptive retrospective study of patients with FG treated at Bugando Medical Centre between November 2006 and April 2014. A total of 84 patients (M:F = 41:1) were studied. The median age was 34 years (range 15-76 years). The most common predisposing factor was diabetes mellitus (16.7 %). Nine (11.3 %) patients were HIV positive. Bacterial culture results were obtained in only 46 (54.8 %) patients. Of these, 38(82.6 %) had polymicrobial bacterial growth while 8 (17.4 %) had monomicrobial bacterial growth. Escherichia coli (28.3 %) were the most frequent bacterial organism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100 % sensitive each respectively. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The median length of hospital stay (LOS) was 28 days and mortality rate was 28.6 %. Systemic inflammatory response syndrome and diabetes mellitus were significantly associated with prolonged LOS (p &amp;amp;amp;amp;amp;amp;lt; 0.001), whereas advancing age (&amp;amp;amp;amp;amp;amp;gt;60 years), late presentation (&amp;amp;amp;amp;amp;amp;gt;48 h), systemic inflammatory response syndrome on admission, diabetes mellitus, extension of infection to the abdominal wall, FG severity score &amp;amp;amp;amp;amp;amp;gt;9 and HIV infection with CD4 count &amp;amp;amp;amp;amp;amp;lt;200 μl/cells) were independent predictors of mortality (p &amp;amp;amp;amp;amp;amp;lt; 0.001). Fournier&amp;amp;amp;amp;amp;amp;#39;s gangrene remains a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce mortality rates associated with this disease in our setting.
Cancellation of elective surgical operations is recognized as a major cause of emotional trauma t... more Cancellation of elective surgical operations is recognized as a major cause of emotional trauma to patients as well as their families. This study was carried out to assess the incidence, causes and pattern of cancellation of elective surgical operations in our setting and to find the appropriate solutions for better patient management. This was a prospective hospital-based study which was conducted in a teaching hospital at Bugando medical Centre from March 2009 to February 2010. A total of 3,064 patients were scheduled for elective surgical operations. Of these, 644 (21.0%) patients' operations were cancelled. General surgery had the highest rate of cancellations (31.5%) followed by orthopaedic surgery in 25.5%. Lack of theatre space and theatre facilities were the most common causes of cancellations in 53.0% and 28.4% of cases respectively. The majority of these cancellations were attributable to hospital administration in 82.0 % and most of them were preventable in 93.8% of c...
Background: Missed injuries remain a worldwide problem in all trauma centers and contribute signi... more Background: Missed injuries remain a worldwide problem in all trauma centers and contribute significantly to high morbidity and mortality among trauma patients. There is paucity of information regarding missed injuries in Tanzania. The aim of this study was to establish the incidence, contributing factors, and short-term outcome of missed injuries among polytraumatized patients in our setting. Methods: This was a one-year duration (from January to December 2009) prospective cohort study involving all multiple trauma patients (ISS > 16) admitted to Bugando Medical Centre. After informed consent to participate in the study, all patients were consecutively enrolled in the study. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer software version 11.5. Results: Ninety six of 462 patients (incidence, 20.1%) had 112 missed injuries. Head and the neck (46.4%) was the most common body region affected. Clinical error (57.1%) was the most common fac...
Background: Enterocutaneous fistulae pose a therapeutic challenge to general surgeons all over th... more Background: Enterocutaneous fistulae pose a therapeutic challenge to general surgeons all over the world and contribute significantly to high morbidity and mortality. The aim of this study was to describe our experience in the management of enterocutaneous fistulas, outlining the causes, fistula characteristics, treatment outcome and prognostic factors for fistula closure and mortality in our local setting. Methods: A prospective study of patients with enterocutaneous fistulae was conducted at Bugando Medical Centre between December 2007 and November 2009. After informed written consent for the study and HIV testing, all patients who met the inclusion criteria were consecutively enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS software version 11.5. Results: Ninety two patients were seen during the study. There were 54 males (58.7%) and 38 (41.3%) females (M: F ratio = 1.4:1). Post-operative complication was the commonest c...
The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ... more The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate. This study was undertaken to describe our own experiences with abdominal fascial closure following elective midline laparotomy and compare with what is described in literature. This was a descriptive prospective study of patients who underwent elective midline laparotomy at Bugando Medical Centre between March 2009 and February 2014. A total of 872 patients (M:F = 2.8:1) were studied. The median age was 38 years. The fascia closure was performed with a continuous and interrupted sutures in 804 (92.2%) and 68 (7.8%) patients, respectively. Mass closure and layered closure were performed in 842 (96.6%) and 30 (3.4%) patients, respectively. Monofilament sutures were applied for fascia closure in 366 (42.0%) patients, multifilament sutures in 506 (58.0%) patients. Non-absorbable sutures were chosen in 304 (34.9%) patients, slowly absorbable sutures in 506 (58.0%), and moderately absorbable sutures in 62 (7.1%) patients. Sutures used for fascial closure were vicryl 464 (53.2%), nylon 250 (28.7%), prolene 62 (7.1%), PDSII 54 (6.2%) and silk 42 (4.8%). Sutures with the strength of 0 were used in 214 (24.4%) patients, with strength of 1 in 524 (60.1%) patients, and with strength of 2 in 134 (15.4%) patients. The mean time required for massive closure of the midline incision was 8.20 ± 6.12 min whereas in layered closure, the mean time required for closure was 12.22 ± 7.11 min and this was statistically significant (p = 0.002). Mass closure was significantly associated with low incidence of wound dehiscence and incisional hernia (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Continuous suture was significantly associated with low incidence of wound dehiscence and incisional hernia as compared to interrupted suture (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Non-absorbable sutures were significantly associated with increased incidence of persistent wound pain and stitch sinus as compared to absorbable sutures (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The use of monofilament sutures was insignificantly associated with low incidence of surgical site infection as compared to multifilament sutures (p = 0.051). Prolene was significantly associated with persistent wound pain as compared to vicryl (p = 0.017). Continuous mass closure with vicryl is commonly used for abdominal fascial closure following elective midline laparotomy in our setting and gives satisfactory results.
Background: Abdominal tuberculosis continues to be a major public health problem worldwide and po... more Background: Abdominal tuberculosis continues to be a major public health problem worldwide and poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was conducted to describe the clinicopathological profile and outcome of surgical treatment of abdominal tuberculosis in our setting and compare with what is described in literature.
Burn injuries constitute a major public health problem and are the leading cause of childhood mor... more Burn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome. A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0. A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (...
Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it aff... more Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people compared to developed countries. No prospective study has been done on this subject in Tanzania and Bugando Medical Centre in particular. This study describes in our region, the clinical presentation, management and outcome of sigmoid volvulus. This was a descriptive prospective study of patients operated for sigmoid volvulus at Bugando Medical Centre from March 2009 to February 2014. A total of 146 patients (M: F = 5.1: 1) representing 14.2% of all cases of bowel obstruction were studied. The median age at presentation was 48 years. The disease significantly affected the older males compared with females (P = 0.012). The majority of the patients 102, (93.2%) presented acutely and had to undergo emergency surgical intervention, the rest were either sub-acute or chronic. Out of the 146 patients studied, 24 (16.4%) had ileo-sigmoid knotting. The majority of patients, 102(69.9%) were treated with resection and primary anastomosis, of which 63.0% were emergency cases. Colostomy was offered to 30.1% of cases. No patient had sigmoidoscopic derotation. Complications mainly surgical site infections were reported in 20.5% of cases. The overall median length of hospital stay was 14 days. Overall mortality rate was 17.1%. The main predictors of mortality were advanced age (&amp;amp;amp;amp;gt;60 years), concomitant medical illness, late presentation (≥24 hours), presence of shock on admission and presence of gangrenous bowel (P &amp;amp;amp;amp;lt; 0.001). The follow up of patients in this study was generally poor as more than half of patients were lost to follow up. Sigmoid volvulus is not uncommon in our setting and commonly affects males than females. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. Findings from this study suggest that in viable bowel, sigmoid resection and primary anastomosis is feasible as it may not adversely affect outcome. Temporary colostomy should be considered if the bowel is gangrenous or perforated. Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease.
The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some... more The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some hospitals in Tanzania. However, its validity and reliability has not been evaluated in any hospital in the country including the study area. This cross-sectional study was conducted at Bugando Medical Centre in northwestern Tanzania to determine the validity, reliability and applicability of triple assessment as an alternative to conventional open biopsy in the pre-operative diagnosis of breast cancer. A total of 212 female patients aged 35 years and above were studied. All patients underwent clinical evaluation, mammography and fine needle aspiration cytology. Histopathology was done to confirm the diagnosis. One hundred and twenty (56.6 %) patients with a median age of 36 years had benign lesions and the remaining ninety-two (43.4%) with a median age of 47 years had breast cancer (P = 0.002). With triple assessment, 92 patients were diagnostic for malignancy and 120 benign, respectively confirmed by histopathology. The Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy were 100.0%. There were no false positive or false negative results. The Kappa statistic for the combination was 1.0 implying excellent agreement with histopathology. The majority of patients (59.9%) underwent triple assessment on the same day with results being available to the patient within 24 to 72 hours. The triple assessment is an accurate and quick method for the evaluation of breast cancer and can be applied as a safe alternative for open biopsy when it is concordant.. ______________________________________________________________________________________
Motorcycle helmets have been reported to reduce the risk of death and head injuries following mot... more Motorcycle helmets have been reported to reduce the risk of death and head injuries following motorcycle accidents. The aim of this descriptive prospective study was to determine the injury outcome among helmeted and non-helmeted motorcyclists and passengers at a tertiary hospital in north-western Tanzania. A total of 654 patients involved in the motorcycle accident were studied. Of these, 468 (71.6%) were motorcyclists (riders) and the remaining 186 (28.4%) were passengers. The median age of patients at presentation was 26 years. Male outnumbered females by a ratio of 4.5: 1.
Background: Animal related injuries are a major but neglected emerging public health problem and ... more Background: Animal related injuries are a major but neglected emerging public health problem and contribute significantly to high morbidity and mortality worldwide. No prospective studies have been done on animal related injuries in our setting. This study was conducted to determine the management patterns and outcome of animal related injuries and their social impact on public health policy in the region.
Background: Perforated peptic ulcer is a serious complication of peptic ulcers with potential ris... more Background: Perforated peptic ulcer is a serious complication of peptic ulcers with potential risk of grave complications. There is paucity of published reports on perforated peptic ulcer disease in our local environment. This study was conducted to evaluate the clinical presentation, management and outcome of patients with peptic ulcer perforation in our setting and to identify predictors of outcome of these patients. Methods: This was a combined retrospective and prospective study of patients who were operated for perforated peptic ulcers at Bugando Medical Centre between April 2006 and March 2011. Data were collected using a pretested and coded questionnaire and analyzed using SPSS computer software version 15.0. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study.
Motorcycle helmets have been reported to reduce the risk of death and head injuries following mot... more Motorcycle helmets have been reported to reduce the risk of death and head injuries following motorcycle accidents. The aim of this descriptive prospective study was to determine the injury outcome among helmeted and non-helmeted motorcyclists and passengers at a tertiary hospital in north-western Tanzania. A total of 654 patients involved in the motorcycle accident were studied. Of these, 468 (71.6%) were motorcyclists (riders) and the remaining 186 (28.4%) were passengers. The median age of patients at presentation was 26 years. Male outnumbered females by a ratio of 4.5: 1. Helmet use was reported in 312 (47.7%) patients. Non- helmeted patients were young compared with helmeted patients and this was statistically significant (p = 0.021). The rate of helmet use was significantly higher among motorcyclists than among passengers (p = 0.004). History of alcohol consumption prior to the accident was reported in 212 (32.4%) patients. The rate of helmet use was significantly low among a...
Geriatric injuries pose a major challenge to surgeons and general practitioners in developing cou... more Geriatric injuries pose a major challenge to surgeons and general practitioners in developing countries. The objective of this study was to determine the prevalence, injury characteristics and outcomes of geriatric injury among patients at Shinyanga Regional Hospital in Tanzania. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7% of all trauma admissions were studied. The male to female ratio was 1.4:1. Their mean age was 68.5 years (ranged 60-98 years). Premorbid illness was reported in 38.3% of patients. Most injuries were intentional in fifty-three (56.4%) patients. Assaults, falls and road traffic crashes were the mechanism of injuries in 52.1%, 19.1% and 11.7% of cases, respectively. The majority of cases of assault were females accounting for 64.6%. The majority of injuries (81.9%) occurred at home. Pre-hospital care was recorded in 5.3% of cases. The musculoskeletal (72...
Breast cancer, although reported to be the commonest female malignancy worldwide has not been ext... more Breast cancer, although reported to be the commonest female malignancy worldwide has not been extensively studied in north-western Tanzania. The aim of this retrospective review was to describe in our setting, the stage at diagnosis, clinicopathological and treatment patterns among patients with breast cancer. Data were analyzed using SPSS software system. A total of 384 patients were studied. The median age was 45 years (range 21 to 78 years). The male to female ratio was 1: 46.8. Most of the patients were premenopausal (63.8%) and presented late with advanced breast cancer disease. Majority of patients (63.0%) presented with stage III disease. Lymph node and distant metastasis at the time of diagnosis was reported in 70.8% and 21.4% of patients, respectively. Invasive ductal carcinoma (91.7%) was the most frequent histopathological type and most patients (63.8%) had poorly differentiated tumour. Patients with tumour size greater than 6cm had significantly high rate of lymph node m...
Abdominal trauma continues to be a major cause of trauma admissions all over the world and contri... more Abdominal trauma continues to be a major cause of trauma admissions all over the world and contributes significantly to high morbidity and mortality. A descriptive prospective study was conducted at Bugando Medical Centre in north-western Tanzania to describe our experience on the management of abdominal trauma outlining the causes, injury characteristics and treatment outcome of these patients. Statistical data analysis was done using SPSS programme. A total of 396 patients were studied. Male to female ratio was 3.2: 1. The median age was 28 years. More than three quarter of patients sustained blunt abdominal injuries. Road traffic accidents (RTAs) were the most common cause of injury accounting for 64.9% of cases. None of our patients received any pre-hospital care. The spleen was the most common injured organ in blunt abdominal trauma occurring in 176 (75.9%) patients, while in penetrating injury; gastrointestinal tract was the most common in 24 (10.3%) patients. One hundred twen...
Despite recent advances both in preoperative diagnosis and postoperative care, obstructive jaundi... more Despite recent advances both in preoperative diagnosis and postoperative care, obstructive jaundice still contributes significantly to high morbidity and mortality. A prospective study was undertaken to identify predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania. A total of 138 patients were studied. The male to female ratio was 1:1.6. The median age of patients was 58 years. Patients with malignant obstructive jaundice were older than those of benign type (P < 0.001). Ca head of pancreas (65.1%) was the commonest malignant cause of jaundice where as choledocholithiasis (51.9%) was the commonest benign cause. Twelve (9.7%) patients were HIV positive with a median CD 4+ count of 342 cells/μl. A total of 130 (94.2%) patients underwent surgical treatment and the remaining 8 (5.8%) patients were unfit for surgery. The complication rate was 30.4% mainly due to surgical site infections and it was significantly influenced b...
Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruc... more Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. There is paucity of published data regarding this condition in our setting. This study describes the clinical presentation, mode of treatment and outcome of treatment of this disease and identifies factors responsible for poor outcome of these patients. This was a descriptive retrospective study of infants with HPS admitted to Bugando Medical Centre and subsequently underwent surgery between February 2009 and January 2014. A total of 102 patients (M:F = 4.7:1) were studied. The median age at presentation was 5 weeks. The median duration of illness was 4 weeks. Fifty-four (52.9 %) patients occur in first-born children. Associated anomalies were reported in 7 (6.9 %) patients. Non-bilious vomiting was the most frequent symptom and it was described in all (100 %) patients. A palpable mass was found in 23.5 % of infants. The diagnosis of IHPS was made clinically in 86 (84.3 %) and by ultrasound in 16 (15.7 %) patients. The treatment was Ramstedt&amp;amp;amp;amp;#39;s pyloromyotomy in all cases. There were 6 (5.9 %) intra-operative mucosal perforations which were repaired successively. Postoperative complication was 11.8 %. The median length of hospital stay was 12 days and it was significantly associated with prolonged pre-operative hospitalization (p = 0.001). The mortality rate was 4.9 %. Age below 2 weeks, late presentation (≥14 days), severe dehydration on admission, hypokalaemia on admission and surgical site infection were the main predictors of mortality (p &amp;amp;amp;amp;lt; 0.001). This study has shown that IHPS is a common condition in our setting. Age &amp;amp;amp;amp;lt;2 weeks, delayed presentation, prolonged preoperative hospital stay, surgical site infection and high proportion of dehydration and electrolyte disturbance were the main predictors of poor outcome. A high index of suspicion is needed in infants with non-bilious vomiting to avoid delay in diagnosis.
Fournier&amp;amp;amp;amp;amp;amp;#39;s gangrene (FG) is a rare, rapidly progressive, necrotiz... more Fournier&amp;amp;amp;amp;amp;amp;#39;s gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors. This was a descriptive retrospective study of patients with FG treated at Bugando Medical Centre between November 2006 and April 2014. A total of 84 patients (M:F = 41:1) were studied. The median age was 34 years (range 15-76 years). The most common predisposing factor was diabetes mellitus (16.7 %). Nine (11.3 %) patients were HIV positive. Bacterial culture results were obtained in only 46 (54.8 %) patients. Of these, 38(82.6 %) had polymicrobial bacterial growth while 8 (17.4 %) had monomicrobial bacterial growth. Escherichia coli (28.3 %) were the most frequent bacterial organism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100 % sensitive each respectively. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The median length of hospital stay (LOS) was 28 days and mortality rate was 28.6 %. Systemic inflammatory response syndrome and diabetes mellitus were significantly associated with prolonged LOS (p &amp;amp;amp;amp;amp;amp;lt; 0.001), whereas advancing age (&amp;amp;amp;amp;amp;amp;gt;60 years), late presentation (&amp;amp;amp;amp;amp;amp;gt;48 h), systemic inflammatory response syndrome on admission, diabetes mellitus, extension of infection to the abdominal wall, FG severity score &amp;amp;amp;amp;amp;amp;gt;9 and HIV infection with CD4 count &amp;amp;amp;amp;amp;amp;lt;200 μl/cells) were independent predictors of mortality (p &amp;amp;amp;amp;amp;amp;lt; 0.001). Fournier&amp;amp;amp;amp;amp;amp;#39;s gangrene remains a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce mortality rates associated with this disease in our setting.
Cancellation of elective surgical operations is recognized as a major cause of emotional trauma t... more Cancellation of elective surgical operations is recognized as a major cause of emotional trauma to patients as well as their families. This study was carried out to assess the incidence, causes and pattern of cancellation of elective surgical operations in our setting and to find the appropriate solutions for better patient management. This was a prospective hospital-based study which was conducted in a teaching hospital at Bugando medical Centre from March 2009 to February 2010. A total of 3,064 patients were scheduled for elective surgical operations. Of these, 644 (21.0%) patients' operations were cancelled. General surgery had the highest rate of cancellations (31.5%) followed by orthopaedic surgery in 25.5%. Lack of theatre space and theatre facilities were the most common causes of cancellations in 53.0% and 28.4% of cases respectively. The majority of these cancellations were attributable to hospital administration in 82.0 % and most of them were preventable in 93.8% of c...
Background: Missed injuries remain a worldwide problem in all trauma centers and contribute signi... more Background: Missed injuries remain a worldwide problem in all trauma centers and contribute significantly to high morbidity and mortality among trauma patients. There is paucity of information regarding missed injuries in Tanzania. The aim of this study was to establish the incidence, contributing factors, and short-term outcome of missed injuries among polytraumatized patients in our setting. Methods: This was a one-year duration (from January to December 2009) prospective cohort study involving all multiple trauma patients (ISS > 16) admitted to Bugando Medical Centre. After informed consent to participate in the study, all patients were consecutively enrolled in the study. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer software version 11.5. Results: Ninety six of 462 patients (incidence, 20.1%) had 112 missed injuries. Head and the neck (46.4%) was the most common body region affected. Clinical error (57.1%) was the most common fac...
Background: Enterocutaneous fistulae pose a therapeutic challenge to general surgeons all over th... more Background: Enterocutaneous fistulae pose a therapeutic challenge to general surgeons all over the world and contribute significantly to high morbidity and mortality. The aim of this study was to describe our experience in the management of enterocutaneous fistulas, outlining the causes, fistula characteristics, treatment outcome and prognostic factors for fistula closure and mortality in our local setting. Methods: A prospective study of patients with enterocutaneous fistulae was conducted at Bugando Medical Centre between December 2007 and November 2009. After informed written consent for the study and HIV testing, all patients who met the inclusion criteria were consecutively enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS software version 11.5. Results: Ninety two patients were seen during the study. There were 54 males (58.7%) and 38 (41.3%) females (M: F ratio = 1.4:1). Post-operative complication was the commonest c...
The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ... more The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate. This study was undertaken to describe our own experiences with abdominal fascial closure following elective midline laparotomy and compare with what is described in literature. This was a descriptive prospective study of patients who underwent elective midline laparotomy at Bugando Medical Centre between March 2009 and February 2014. A total of 872 patients (M:F = 2.8:1) were studied. The median age was 38 years. The fascia closure was performed with a continuous and interrupted sutures in 804 (92.2%) and 68 (7.8%) patients, respectively. Mass closure and layered closure were performed in 842 (96.6%) and 30 (3.4%) patients, respectively. Monofilament sutures were applied for fascia closure in 366 (42.0%) patients, multifilament sutures in 506 (58.0%) patients. Non-absorbable sutures were chosen in 304 (34.9%) patients, slowly absorbable sutures in 506 (58.0%), and moderately absorbable sutures in 62 (7.1%) patients. Sutures used for fascial closure were vicryl 464 (53.2%), nylon 250 (28.7%), prolene 62 (7.1%), PDSII 54 (6.2%) and silk 42 (4.8%). Sutures with the strength of 0 were used in 214 (24.4%) patients, with strength of 1 in 524 (60.1%) patients, and with strength of 2 in 134 (15.4%) patients. The mean time required for massive closure of the midline incision was 8.20 ± 6.12 min whereas in layered closure, the mean time required for closure was 12.22 ± 7.11 min and this was statistically significant (p = 0.002). Mass closure was significantly associated with low incidence of wound dehiscence and incisional hernia (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Continuous suture was significantly associated with low incidence of wound dehiscence and incisional hernia as compared to interrupted suture (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Non-absorbable sutures were significantly associated with increased incidence of persistent wound pain and stitch sinus as compared to absorbable sutures (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The use of monofilament sutures was insignificantly associated with low incidence of surgical site infection as compared to multifilament sutures (p = 0.051). Prolene was significantly associated with persistent wound pain as compared to vicryl (p = 0.017). Continuous mass closure with vicryl is commonly used for abdominal fascial closure following elective midline laparotomy in our setting and gives satisfactory results.
Background: Abdominal tuberculosis continues to be a major public health problem worldwide and po... more Background: Abdominal tuberculosis continues to be a major public health problem worldwide and poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was conducted to describe the clinicopathological profile and outcome of surgical treatment of abdominal tuberculosis in our setting and compare with what is described in literature.
Burn injuries constitute a major public health problem and are the leading cause of childhood mor... more Burn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome. A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0. A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (...
Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it aff... more Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people compared to developed countries. No prospective study has been done on this subject in Tanzania and Bugando Medical Centre in particular. This study describes in our region, the clinical presentation, management and outcome of sigmoid volvulus. This was a descriptive prospective study of patients operated for sigmoid volvulus at Bugando Medical Centre from March 2009 to February 2014. A total of 146 patients (M: F = 5.1: 1) representing 14.2% of all cases of bowel obstruction were studied. The median age at presentation was 48 years. The disease significantly affected the older males compared with females (P = 0.012). The majority of the patients 102, (93.2%) presented acutely and had to undergo emergency surgical intervention, the rest were either sub-acute or chronic. Out of the 146 patients studied, 24 (16.4%) had ileo-sigmoid knotting. The majority of patients, 102(69.9%) were treated with resection and primary anastomosis, of which 63.0% were emergency cases. Colostomy was offered to 30.1% of cases. No patient had sigmoidoscopic derotation. Complications mainly surgical site infections were reported in 20.5% of cases. The overall median length of hospital stay was 14 days. Overall mortality rate was 17.1%. The main predictors of mortality were advanced age (&amp;amp;amp;amp;gt;60 years), concomitant medical illness, late presentation (≥24 hours), presence of shock on admission and presence of gangrenous bowel (P &amp;amp;amp;amp;lt; 0.001). The follow up of patients in this study was generally poor as more than half of patients were lost to follow up. Sigmoid volvulus is not uncommon in our setting and commonly affects males than females. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. Findings from this study suggest that in viable bowel, sigmoid resection and primary anastomosis is feasible as it may not adversely affect outcome. Temporary colostomy should be considered if the bowel is gangrenous or perforated. Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease.
The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some... more The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some hospitals in Tanzania. However, its validity and reliability has not been evaluated in any hospital in the country including the study area. This cross-sectional study was conducted at Bugando Medical Centre in northwestern Tanzania to determine the validity, reliability and applicability of triple assessment as an alternative to conventional open biopsy in the pre-operative diagnosis of breast cancer. A total of 212 female patients aged 35 years and above were studied. All patients underwent clinical evaluation, mammography and fine needle aspiration cytology. Histopathology was done to confirm the diagnosis. One hundred and twenty (56.6 %) patients with a median age of 36 years had benign lesions and the remaining ninety-two (43.4%) with a median age of 47 years had breast cancer (P = 0.002). With triple assessment, 92 patients were diagnostic for malignancy and 120 benign, respectively confirmed by histopathology. The Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy were 100.0%. There were no false positive or false negative results. The Kappa statistic for the combination was 1.0 implying excellent agreement with histopathology. The majority of patients (59.9%) underwent triple assessment on the same day with results being available to the patient within 24 to 72 hours. The triple assessment is an accurate and quick method for the evaluation of breast cancer and can be applied as a safe alternative for open biopsy when it is concordant.. ______________________________________________________________________________________
Motorcycle helmets have been reported to reduce the risk of death and head injuries following mot... more Motorcycle helmets have been reported to reduce the risk of death and head injuries following motorcycle accidents. The aim of this descriptive prospective study was to determine the injury outcome among helmeted and non-helmeted motorcyclists and passengers at a tertiary hospital in north-western Tanzania. A total of 654 patients involved in the motorcycle accident were studied. Of these, 468 (71.6%) were motorcyclists (riders) and the remaining 186 (28.4%) were passengers. The median age of patients at presentation was 26 years. Male outnumbered females by a ratio of 4.5: 1.
Background: Animal related injuries are a major but neglected emerging public health problem and ... more Background: Animal related injuries are a major but neglected emerging public health problem and contribute significantly to high morbidity and mortality worldwide. No prospective studies have been done on animal related injuries in our setting. This study was conducted to determine the management patterns and outcome of animal related injuries and their social impact on public health policy in the region.
Background: Perforated peptic ulcer is a serious complication of peptic ulcers with potential ris... more Background: Perforated peptic ulcer is a serious complication of peptic ulcers with potential risk of grave complications. There is paucity of published reports on perforated peptic ulcer disease in our local environment. This study was conducted to evaluate the clinical presentation, management and outcome of patients with peptic ulcer perforation in our setting and to identify predictors of outcome of these patients. Methods: This was a combined retrospective and prospective study of patients who were operated for perforated peptic ulcers at Bugando Medical Centre between April 2006 and March 2011. Data were collected using a pretested and coded questionnaire and analyzed using SPSS computer software version 15.0. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study.
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