Clinical characteristics and management of patient with portal hypertension at tertial level hospital in Tanzania.

BACKGROUND: Portal hypertension is a common diagnosis in Sub-Saharan African countries, with the majority of patients presenting late. This study aimed to understand Clinical characteristics, aetiology, the treatment offered in our setting, and factors associated with portal hypertension at a tertiary-level hospital, in Tanzania. METHODOLOGY: A prospective cross-sectional observational single hospital-based study was conducted at MNH, from May 2021 to April 2022. A minimum of 152 subjects were required with an error of less than 5% and a study power of 80% at a 95% confidence interval. A structured questionnaire was used to collect data. Ethical clearance was obtained from the MUHAS/MNH IRB. RESULTS: A total of 154 eligible participants consented and participated in this study. The mean age of participants was 42 ± 15.8 years (range 2-87). Most of the study participants were males 64.9% with a male-to-female (M: F) ratio of 1.8:1. Vomiting blood was the common symptom among the study participants 51.3%. Schistosomiasis 53.9% and viral infection 26.6% were the common etiologies followed by alcohol abuse 7.8%. Most were medically treated at 89.61% followed by radiological treatment at 8.44% while only 1.95% of patients received surgical treatment. There was a significant association between the grade of oesophagal varices and bleeding consequences (p-value < 0.01). CONCLUSION: The majority of patients were medically treated while patients who require surgical care are unable to assess it. We recommend the establishment of a transplant services program to counteract the unmet need and more retrospective research toward policy establishment.

Assessing the accuracy of the revised Cardiac Risk Index compared to the American Society of Anaesthesiologists physical status classification in predicting Pulmonary and Cardiac complications among non-cardiothoracic surgery patients at Muhimbili National Hospital: a prospective cohort study.

BACKGROUND: The Revised Cardiac Risk Index (RCRI) and the American Society of Anaesthesiologists (ASA-PS) classification system are two commonly used tools for preoperative risk assessment. This study aimed to assess the accuracy of RCRI compared to the ASA-PS classification system in preoperative risk assessment for pulmonary and cardiac problems among non-cardiothoracic surgery patients admitted at Muhimbili National Hospital (MNH). METHODS: This was a prospective cohort study design conducted from August 2022 to April 2023 among 184 patients of 18 years and above admitted at MNH for elective non-cardiothoracic surgery. Data Analysis was conducted using STATA software version 16. Means and standard deviations were used to summarize continuous data. Frequencies and percentages were used to summarize categorical data. The logistic regression and ROC curve analysis were used to determine the correlation between variables. RESULTS: The majority of patients (43.3%) had an RCRI score of 1 point, and 39.9% were classified as ASA class 1. Patients in ASA classes 3 and 4 had higher odds of developing cardiac and pulmonary complications (AUC = 0.75 and 0.77, respectively). Patients with an RCRI score of 2 or ≥ 3 points were also more likely to experience cardiac and pulmonary complications (AUC = 0.73 and 0.72, respectively). There was no significant difference in the predictive ability of the two tools. Both RCRI and ASA-PS classification systems were equally effective in predicting these complications. CONCLUSION: Both the RCRI and the ASA-PS classification system demonstrated good predictive ability for cardiac and pulmonary complications among patients undergoing non-cardiothoracic surgery.

Extent and pattern of symptom relief following surgical castration in patients with advanced prostate cancer treated at a tertiary referral hospital in Tanzania: a prospective cohort study.

BACKGROUND: Advanced prostate cancer leads to many symptoms, notably bone pain and lower urinary tract symptoms (LUTs); however, the degree and duration of pain relief, changes in LUTs severity and underlying factors associated with the extent of symptom relief remain inadequately understood. Surgical castration has proven effective in relieving both bone pain and urinary symptoms for metastatic prostate cancer patients. OBJECTIVE: To determine the extent and pattern of symptom relief in advanced prostate cancer patients following surgical castration at Muhimbili National Hospital (MNH). METHODS: We conducted a prospective cohort study for a period of 6 months involving men with advanced Prostate cancer (PCa) undergoing surgical castration at MNH and followed them for 30 days. The international prostate symptoms score tool was used to assess changes in LUTs, and the pain rating scale was used for assessing changes in bone pain symptoms before and after surgery. Logistic regression model was used to determine factors associated with complete bone pain relief. RESULTS: A total of 210 participants with a mean age of 72.3 years were recruited. The LUTS score showed a decrease of 7.1 points after surgical castration (95% CI: 6.4 to 7.7, p < 0.001). The bone pain score showed an absolute decrease of 39.8% (95% CI: 34.7 to 44.9, p < 0.001) after surgical castration, with more than half of the patients (111, 52.9%) reporting bone pain relief within the first two weeks. Among the factors associated with greater pain relief were being in a marital union (aOR 2.73, 95% CI: 1.26 to 5.89, p < 0.011). Normal BMI was also linked to pain relief in bivariate analysis (OR 1.92, 95% CI: 1.03 to 3.61, p < 0.035). Additionally, patients with severe bone pain before surgical castration were more likely to achieve complete pain relief compared to those with mild or moderate pain (odds ratio 8.32, 95% CI: 3.63 to 19.1, p < 0.001). CONCLUSION: Surgical castration improves both bone pain and lower urinary tract symptoms in patients with advanced prostate cancer. Notably, patients experiencing severe bone pain reported resolution of bone pain symptoms within the first and second weeks, respectively, indicating the prompt effectiveness of the surgery on these symptoms.

An international report on bacterial communities in esophageal squamous cell carcinoma.

The incidence of esophageal squamous cell carcinoma (ESCC) is disproportionately high in the eastern corridor of Africa and parts of Asia. Emerging research has identified a potential association between poor oral health and ESCC. One possible link between poor oral health and ESCC involves the alteration of the microbiome. We performed an integrated analysis of four independent sequencing efforts of ESCC tumors from patients from high- and low-incidence regions of the world. Using whole genome sequencing (WGS) and RNA sequencing (RNAseq) of ESCC tumors from 61 patients in Tanzania, we identified a community of bacteria, including members of the genera Fusobacterium, Selenomonas, Prevotella, Streptococcus, Porphyromonas, Veillonella and Campylobacter, present at high abundance in ESCC tumors. We then characterized the microbiome of 238 ESCC tumor specimens collected in two additional independent sequencing efforts consisting of patients from other high-ESCC incidence regions (Tanzania, Malawi, Kenya, Iran, China). This analysis revealed similar ESCC-associated bacterial communities in these cancers. Because these genera are traditionally considered members of the oral microbiota, we next explored whether there was a relationship between the synchronous saliva and tumor microbiomes of ESCC patients in Tanzania. Comparative analyses revealed that paired saliva and tumor microbiomes were significantly similar with a specific enrichment of Fusobacterium and Prevotella in the tumor microbiome. Together, these data indicate that cancer-associated oral bacteria are associated with ESCC tumors at the time of diagnosis and support a model in which oral bacteria are present in high abundance in both saliva and tumors of some ESCC patients.

Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study.

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined. METHODS: This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach. DISCUSSION: This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research. TRIAL REGISTRATION: This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021,  NCT05177393 .

Surgical task-shifting in a low-resource setting: outcomes after major surgery performed by nonphysician clinicians in Tanzania.

BACKGROUND: Little is known about the breadth and quality of nonobstetric surgical care delivered by nonphysician clinicians (NPCs) in low-resource settings. We aimed to document the scope of NPC surgical practice and characterize outcomes after major surgery performed by nonphysicians in Tanzania. METHODS: A retrospective records review of major surgical procedures (MSPs) performed in 2012 was conducted at seven hospitals in Pwani Region, Tanzania. Patient and procedure characteristics and level of surgical care provider were documented for each procedure. Rates of postoperative morbidity and mortality after nonobstetric MSPs performed by NPCs and physicians were compared using multivariate logistic regression. RESULTS: There were 6.5 surgical care providers per 100,000 population performing a mean rate of 461 procedures per 100,000 population during the study period. Of these cases, 1,698 (34.7 %) were nonobstetric MSPs. NPCs performed 55.8 % of nonobstetric MSPs followed by surgical specialists (28.7 %) and medical officers (15.5 %). The most common nonobstetric MSPs performed by NPCs were elective groin hernia repair, prostatectomy, exploratory laparotomy, and hydrocelectomy. Postoperative mortality was 1.7 % and 1.5 % in cases done by NPCs and physicians respectively. There was no significant difference in outcomes after procedures performed by NPCs compared with physicians. CONCLUSIONS: Surgical output is low and the workforce is limited in Tanzania. NPCs performed the majority of major surgical procedures during the study period. Outcomes after nonobstetric major surgical procedures done by NPCs and physicians were similar. Task-shifting of surgical care to nonphysicians may be a safe and sustainable way to address the global surgical workforce crisis.

Rare clinical scenario and surgical approach for traumatic obstructed Spigelian hernia with penetrating scrotal injury: A case report.

INTRODUCTION AND IMPORTANCE: Traumatic Spigelian hernias, an unusual subtype of traumatic abdominal wall hernias (TAWH). This case highlights the individualized surgical management of Spigelian hernia depending on the presentation, history, and existence of concurrent intra-abdominal injuries. This case report, presented in line with the SCARE criteria, highlights a case of obstructed Spigelian hernia. CASE PRESENTATION: We present a 37-year-old male patient involved in a free fall from a coconut tree while harvesting fruits. A sharp branch injured the scrotum before he landed on the ground. Then he started presenting with abdominal pain, failure to pass stool, abdominal distention, and later on vomiting. Abdominopelvic CT-scan showed ventral hernia concealed at the right lower quadrant of the abdomen with proximal intestinal dilatation. Exploratory laparotomy was done along with Spigelian hernia repair. CLINICAL DISCUSSION: This case was atypical, lacking evidence-based guidelines on surgical treatment. Considering the emergency aspect of the case, we performed an exploratory laparotomy along with hernia repair. The scrotal wound was cleaned and left open. The postoperative follow-up was conclusive, as the patient recovered with the hernia tract having healed by fibrosis. CONCLUSION: Spigelian hernia can be caused by trauma and may be difficult to diagnose at first glance. The attention should be paid to a thorough clinical examination and adequate workup. The surgical intervention may depend on intraoperative findings if done on an emergency basis.

Successful posterior urethroplasty with gracilis muscle flap interposition and a VY gluteal flap of the perineal wound gap following abdominal-perineal resection: A case report.

An iatrogenic urethral perineal fistula can cause challenging problems for surgical reconstruction. In most cases, treatment is performed in three steps: double-diversion urinary and intestinal diversion, closure, and diversion. The augmented posterior urethroplasty interposition with a gracilis muscle function flap for the repair of the perineal gap was successful. CASE PRESENTATION: We reviewed a patient aged 42 years old male who presented to the urology department with leakage of urine per perineum after abdominal perineal resection and end colostomy due to anal-rectal malignancy 2 months earlier. He subsequently had a gapped perineal wound post abdominal-perineal resection (APR). Suprapubic Cystostomy and urethral catheter and a cystoscope showed a normal verumontanum, and there was a left para-verumontanum fistula approximately 3 cm in size that communicated with the perineum gapped wound. Tissue histology revealed chronic inflammation. Augmentation posterior urethroplasty with interposition of the gracilis muscle flap. CLINICAL DISCUSSION: Urethral perineal fistulas have different etiologic origins, such as inflammatory, neoplastic, traumatic, or iatrogenic injury. Treatment is performed in three steps: double diversion urinary and intestinal, closure, and no diversion. In our case, the perineal gapped wound allowed us to access the posterior urethra and this potential space for gracilis muscle interposition, aiming to facilitate fistula repair and cover perineal gap wound repair. CONCLUSION: Posterior urethral perineal fistulas can be repaired by a gracilis muscle flap, providing acceptable treatment results. However, more research is needed in fistula studies evaluating patients' sexual and urinary efficiency to achieve more accurate results.

Postoperative Complications and Factors Associated with Surgical Site Infection at Muhimbili National Hospital, Dar es Salaam, Tanzania: A cross-Sectional study.

Background: Postoperative complications are a leading cause of morbidity and mortality to surgical patients. Different complications are encountered in clinical practice, however surgical site infection (SSI) appears to be the most common. To date, limited published information is known pertaining to the patterns of postoperative complications and factors associated with SSI among patients operated on in other hospitals in Tanzania and referred to Muhimbili national hospital for further management. Therefore, the purpose of this study was to identify patterns of postoperative complications and factors associated with SSI among the study participants. Methods: This was a hospital based cross-sectional study conducted at Muhimbili national hospital from August 2022 to January 2023, which included 181 patients. Obtained data was analysed using frequency tables, Pearson Chi-squared test and binary logistic regression model, at a level of significance of <0.05. Results: One hundred eighty one (181) patients were included in this study, of whom 113(62.4%) were females; median age was 39 years. Cigarette smokers and alcohol consumers were 42(23.2%) and 90(49.7%) respectively. Diabetic patients were 8(4.4%), 35(19.3%) were HIV positive and 52(28.7%) had hypertension. Patients whose diagnosis was related to general surgery accounted for 50.2%, whereas 30.9% were obstetric cases. Patients who had undergone Caesarean section were 45(24.9%), whereas 20(11%) patients had undergone total abdominal hysterectomy. Bowel resection and primary anastomosis included 16(8.8%) patients and perforated peptic ulcer repair 8(4.4%) patients. Patients with infected peritoneal collection were 34(18.8%), postpartum haemorrhage 18(9.9%) and bowel perforation 10(5.5%). Patients who had undergone relaparotomy as part of treatment were 70(38.7%), whereas 30(16.6%) patients with SSIs were treated by serial wound dressing and 26(14.4%) patients were admitted and nursed in intensive care unit. None of the factors was found to have a statistically significant association with SSI. Conclusions: There is a large proportion of patients suffering from postoperative complications after gastroenterology and obstetric surgeries; and of all complications encountered in this study; SSI was the most common contributing 52%, followed by gastrointestinal complications at 31%. Despite the fact that multiple factors were associated with SSI, none of them was found to be statistically significant.

Incidental actinomycosis in a 44-year-old female during total abdominal hysterectomy for abnormal uterine bleeding: A case report.

Actinomycosis, a rare chronic bacterial infection caused by Actinomyces species, presents diagnostic challenges due to diverse clinical presentations. This report presents a case of peritoneal actinomycosis incidentally discovered during a total abdominal hysterectomy in a 44-year-old female with refractory abnormal uterine bleeding and a history of long-term intrauterine contraceptive device use. The patient presented with persistent abnormal uterine bleeding despite conservative management. Intraoperative findings during total abdominal hysterectomy revealed peritoneal involvement, prompting histopathological evaluation confirming actinomycosis. This case highlights diagnostic complexities associated with actinomycosis, emphasizing the significance of histopathological confirmation. Postoperative management with antibiotics demonstrated favorable outcomes, supporting their efficacy in treating actinomycosis. The case underscores the importance of considering uncommon infections in pelvic pathology, particularly in patients with prolonged intrauterine contraceptive device usage. It prompts further exploration of actinomycosis in relation to intrauterine contraceptive device use and highlights the need for timely intervention and histopathological confirmation for optimal patient care.

Surgical excision of acquired urethral diverticulum and single-stage urethroplasty for a 32-year-old male. Case report and literature review.

INTRODUCTION: Urethral diverticulum (UD) is a saccular dilatation of the urethral wall, continuous with the true urethral lumen. It is categorized etiologically into congenital and acquired. The etiology of an acquired urethral diverticulum is thought to be secondary to trauma. The gold standard imaging modalities for diagnosis of UD are retrograde urethrogram (RGU) and micturating cystourethrogram (MCU). Management options include: nonoperative treatment, minimally invasive and open surgeries. Open surgeries comprise a primary anastomosis or, Substitution urethroplasty after UD excision, with the aim of excising the diverticulum, reestablishing the continuity of the urethra, and prevent urethrocutaneous fistula formation. We present a case of urethral diverticulum and bulbar urethral stricture successfully managed by surgical excision of UD and substitution urethroplasty. CASE PRESENTATION: We report a case of a 32-year-old man who had lower urinary tract symptoms following a traumatic urethral catheterization. Investigations done in a peripheral hospital revealed a short, bulbar urethral stricture and direct visual internal urethrotomy (DVIU) was done. Later he presented to us with urine retention, whereupon emergency suprapubic cystostomy was performed. After serial investigations, urethral diverticulectomy followed by single stage urethroplasty with ventral onlay buccal mucosa graft was done. He was followed for 12 months with good surgical outcome. DISCUSSION: The development of Acquired UD has been attributed to several possible factors: pelvic fractures, urethral strictures, straddle injuries, long-term urethral catheterization, endoscopic direct injuries, lower urinary tract infections, and urethral surgeries. Depending on the presentation and investigation findings, management of UD is planned. Conservative management is possible for uncomplicated asymptomatic UD if the patient consents to follow-up. Surgery to remove the diverticulum and urethral reconstruction are required for complicated symptomatic UD; these procedures vary from patient to patient and are individualized. CONCLUSION: It is important to base the choice to do surgery on the clinical presentation. Whether a concurrent urethral stricture is present is a critical factor in deciding on the best course of surgical treatment. In our case we opted to perform a substitution urethroplasty with ventral onlay buccal mucosa graft as our patient had a long bulbar urethral stricture proximal to the diverticulum.

Wandering Spleen in a 47-year-old female treated by non-operative conservative management. Case report and literature review.

INTRODUCTION: Wandering spleen (WS) is a rare clinical condition found in less than 0.5 % of splenectomies and is characterized by ectopic location of the spleen within the abdomen or pelvis. It is always caused by excessive mobility brought on by the ligamentous laxity of its peritoneal attachments. Abdominal ultrasonography and computed tomography are the key imaging modalities for inquiry of WS. CASE PRESENTATION: We report the case of a 47-year-old woman who presented with painless abdominal swelling since the age of 6 years. An abdominal examination revealed a palpable, firm, mobile mass in the right lower abdomen approximately 15 × 15 cm in dimensions. A contrast CT scan of the abdomen revealed the absence of the spleen in the left upper quadrant. The patient was managed conservatively and followed for five years with favourable outcome. DISCUSSION: Failure of the dorsal mesogastrium to merge with the posterior abdominal wall in the second month of embryonic development is one of the reasons for WS. The nonsurgical conservative approach is limited to patients who are high-risk surgical candidates and have minimal symptoms and no complications. CONCLUSION: The good clinical outcome of our patient suggests that conservative non-surgical approach may be a reasonable alternative to unwarranted surgical intervention in selected clinically stable patients who have no evidence of splenic torsion or infarction, avoiding the possible complications of surgery.

Surgical management of huge paratesticular rhabdomyosarcoma in a 20-year-old male: Case report and literature review.

Early diagnosis and aggressive treatment of testicular rhabdomyosarcomas including surgery and chemotherapy significantly reduce local recurrence and improve survival rates in young adults with metastases. Adjuvant chemotherapy is highly recommended to enhances prognosis and survival outcomes.

Breast cancer molecular subtype classification according to immunohistochemistry markers and its association with pathological characteristics among women attending tertiary hospitals in Tanzania.

Background: Breast cancer immunohistochemistry is a biological characteristic of the tumour which has a role to diagnose molecular subtype, prognosticate and guide treatment and is categorised into 4 subtypes. Data in Tanzania was lacking and was based off data extrapolated from studies in Western Africa thus hypothesizing that women of African ancestry predominately develop Triple Negative Breast Cancer (TNBC). Methods: A retrospective cross-sectional study was carried out at two tertiary referral hospitals on participants who were recruited from the cancer registries from 2015 to 2022. Prevalence of each molecular subtype was determined and association between molecular subtype to demographic and pathological characteristics were evaluated. Predictors of molecular subtypes was then determined using logistic regression. Results: Total number of participants were 1214, median age was 50 (IQR: 41-61), median tumor size was 5 cm (IQR: 4-7) with lymph node positivity in 73.7 %. Immunohistochemistry studies showed estrogen, progesterone and Human Epidermal Growth Factor Receptor 2 (HER2) receptor positivity in 54.4 %, 34.4 % and 27.8 % of cases respectively. Molecular subtype classification prevalence for Luminal A was 21.17 % (95 % CI: 18.87-23.47), for Luminal B 35.75 % (95 % CI: 33.05-38.45), for HER2 enriched 11.86 % (95 % CI: 10.04-13.68) and for TNBC 31.22 % (95 % CI: 28.61-33.83). Significant association was seen between molecular subtype with age, tumor size, tumor grade and lymph node involvement. Predictors of Luminal tumors were larger tumor size (aOR 1.217, 95 % CI: 1.149-1.291) no lymph node involvement (aOR 0.429, 95 % CI: 0.313-0.589) while an advanced tumor grade reduced likelihood (aOR 0.041, 95 % CI: 0.011-0.019). Conclusion: In Tanzania Luminal B was most predominant subtype presenting at an earlier age and associated with more favorable pathological characteristics.

Assessment of the Surgical Oncology Case Volume Within the Public Sector in Tanzania.

PURPOSE: Surgery provides vital services to diagnose, treat, and palliate patients suffering from malignancies. However, despite its importance, there is little information on the delivery of surgical oncology services in Tanzania. METHODS: Operative logbooks were reviewed at all national referral hospitals that offer surgery, all zonal referral hospitals in Mainland Tanganyika and Zanzibar, and a convenience sampling of regional referral hospitals in 2022. Cancer cases were identified by postoperative diagnosis and deidentified data were abstracted for each cancer surgery. The proportion of the procedures conducted for patients with cancer and the total number of cancer surgeries done within the public sector were calculated and compared with a previously published estimate of the surgical oncology need for the country. RESULTS: In total, 69,195 operations were reviewed at 10 hospitals, including two national referral hospitals, five zonal referral hospitals, and three regional referral hospitals. Of the cases reviewed, 4,248 (6.1%) were for the treatment of cancer. We estimate that 4,938 cancer surgeries occurred in the public sector in Tanzania accounting for operations conducted at hospitals not included in our study. Prostate, breast, head and neck, esophageal, and bladder cancers were the five most common diagnoses. Although 387 (83%) of all breast cancer procedures were done with curative intent, 506 (87%) of patients with prostate and 273 (81%) of patients with esophageal cancer underwent palliative surgery. CONCLUSION: In this comprehensive assessment of surgical oncology service delivery in Tanzania, we identified 4,248 cancer surgeries and estimate that 4,938 likely occurred in 2022. This represents only 25% of the estimated 19,726 cancer surgeries that are annually needed in Tanzania. These results highlight the need to identify strategies for increasing surgical oncology capacity in the country.

Gall bladder schistosomiasis diagnosed incidentally post laparoscopic cholecystectomy: A case report.

INTRODUCTION AND IMPORTANCE: Schistosomiasis is a neglected tropical disease caused by parasitic worms of the genus Schistosoma. It primarily affects the intestines, liver, and urinary tract however, rare cases have been reported where the parasite invades other organs. This case report presents an incidental finding of schistosomiasis, upon histopathology evaluation, in a patient who underwent laparoscopic cholecystectomy for symptomatic gallstone disease with recurrent attacks of cholecystitis. CASE PRESENTATION: We present the case of a 42-year-old female patient who presented to the emergency department with symptoms and signs suggestive of acute cholecystitis. She underwent conservative management with interval laparoscopic cholecystectomy with histopathology findings of Schistosoma eggs within the walls of the gallbladder. Underwent eradication therapy with praziquantel. CLINICAL DISCUSSION: The finding of Schistosoma eggs in the gallbladder wall during routine histopathological examination highlights the importance of considering schistosomiasis, and other parasites, in cases of recurrent bouts of cholecystitis. The case challenges the conventional understanding of the transmission patterns of this parasitic infection and raises questions about potential atypical life cycle routes within the human body. It also emphasizes the importance of routine histopathology analysis of specimen removed from the body. CONCLUSION: This case report presents a rare occurrence of schistosomiasis cholecystitis in a 42-year-old female patient underscoring the importance of considering parasitic infections. Thorough histopathological examination in routine surgeries is crucial for early detection and targeted treatment. The patient's positive response to praziquantel therapy highlights its effectiveness in managing schistosomiasis, which is a neglected tropical disease.

Prolonged retention of gauze sponge resulting in ileocolic fistula, a rare complication following cesarean section; case report.

INTRODUCTION AND IMPORTANCE: Retained gauze sponge is a medical legal issue with significant clinical implications with catastrophic complications. We report a case of a female who presented with chronic right iliac fossa pain only to be found to have a retained gauze sponge causing bowel fistulisation. We describe our experience on diagnostic formulation and work up and subsequent operative intervention. CASE PRESENTATION: We present the case of a 37-year-old female patient who presented to the outpatient surgical department with symptoms of chronic right iliac fossa pain with a history of cesarean section 2 years prior. A computed tomography scan revealed an inflammatory mass and operative exploration revealed a retained gauze sponge causing a fistula between the terminal ileum and caecum. Underwent a right hemicolectomy with an uneventful postoperative period. CLINICAL DISCUSSION: Retained gauzes can lead to a spectrum of complications including fistulisation presenting with vague non-specific abdominal symptoms. The subtle presentation challenges the clinician to consider the possibility of retained foreign bodies in patient with history of abdominal surgeries. This emphasizes the importance of policies enforcing swab count as a simple retained gauze led to catastrophic complication and ultimately a right hemicolectomy. CONCLUSION: This case report presents a complex and instructive clinical scenario, emphasizing the challenges of diagnosing atypical presentations of retained foreign bodies, the critical importance of surgical counting protocols, and the implications for patient safety and quality of care.

Successful open surgery repair of isolated right diaphragmatic rupture in 1-year-old patient at Muhimbili National Hospital: a case report and literature review.

Diaphragmatic ruptures rarely occur in isolation, a pathology in paediatric that is difficult to diagnose and can lead to serious complications if left untreated. We present a rare case of isolated right diaphragmatic rupture with liver herniation that was successfully repaired, along with a literature review. A 1-year-old female child was admitted at Emergency Department after being involved in a motor traffic crash as a passenger. Based on clinical presentation and radiological findings, we diagnosed a diaphragmatic rapture, laparotomy was performed in which we found a right isolated diaphragmatic rupture, which was repaired primarily. After re-evaluations, the patient was discharged day 16 postoperative. It is essentially important to evaluate the level of organ damage thoroughly for making a timely informed decision in management paediatric chest trauma.

Report from the first Tanzania Liver Cancer Conference: a call for action to unite in the fight against liver cancer in Sub-Saharan Africa, 17-18 March 2023, Dar es Salaam, Tanzania.

The first Tanzania Liver Cancer Conference (TLCC2023) took place on 17-18 March 2023 in Dar es Salaam, Tanzania with the aim of raising awareness among healthcare providers on the problem that liver cancer poses to the Tanzanian population and the urgent need to address this important issue. The conference focused on the following agenda items: 1) to build awareness among local healthcare providers on the status of liver cancer in Tanzania and the available diagnostic and management options, 2) to update Tanzanian healthcare providers on the current standard of care for liver cancer provided in developed countries and recent advancements in liver cancer care and 3) to promote an inclusive and multidisciplinary approach in research and the clinical care of patients with liver cancer in Tanzania. TLCC2023 was preceded by community-facing pre-conference activities, including screening 684 community members for hepatitis B virus free of charge. The conference was attended by 161 healthcare professionals from varying disciplines across Tanzania and abroad. TLCC2023 featured over 30 speakers from Tanzania, Kenya, Egypt, India and the United States that comprehensively covered a wide range of topics related to research and clinical care of liver cancer patients. A holistic and unified approach integrating both private and public sectors is vital in improving care for patients with liver cancer, and this was a common theme ingrained in the majority of presentations. Overall, the conference was well-received by attendees and knowledge assessment scores improved from 50% pre-conference to 75% post-conference (p < 0.001), demonstrating its educational value. As Tanzania's first conference on the subject, TLCC2023 marked an important milestone in a united fight against liver cancer in the country and beyond.

Factors Influencing the Health-Related Quality of Life Among Lower Limb Amputees: A Two-Center Cross-Sectional Study.

Background: Limb amputation is among the commonly performed surgical procedures known to have a significant impact on health-related quality of life (HRQoL). Nonetheless, factors influencing the HRQoL among amputees have not been extensively explored. We therefore conducted a study aiming at determining factors influencing the HRQoL among lower limb amputees. Methods: A cross-sectional study was conducted from May 2021 to December 2021 in two specialized hospitals located in Dar es Salaam, Tanzania. A total of 160 participants who exclusively underwent lower limb amputation(s) were recruited. Data was collected using a checklist incorporating the 36-Item Short Form Survey (SF-36) questionnaire. Multivariable linear regression analysis was performed to identify factors influencing the HRQoL. Results: The mean age of the study participants was 53.8 (±15.44) years; with males constituting 68.7%. The mean duration since amputation was 19.84 (±12.44) months. A relatively poor physical component summary score (PCS), as opposed to the mental component summary score (MCS) of the SF-36 was observed among the participants (42.0 vs. 59.3, respectively). Factors that positively influenced the PCS included achieving a college/university level of education, absence of stump pain, and the use of a prosthetic device or crutches. Conversely, factors that negatively influenced the PCS included increasing age and the absence of associated comorbid conditions. These factors accounted for 34.1% of the variance in the PCS. With reference to the MCS, post-amputation employment, longer durations since amputation, and the use of prostheses or crutches had a positive influence. However, having no associated comorbidity negatively influenced the MCS. These factors explained 26.5% of the variances in the MCS. Conclusion and Recommendations: The aforementioned factors should be addressed accordingly in order to ensure a holistic approach in the management of lower limb amputees. Moreover, longitudinal studies are recommended to systematically study the change in HRQoL over time and to assess its determinants.