A rare case of pulmonary embolism in a Mt. Kilimanjaro recreational hiker: A case report with review of literature.

Pulmonary embolism is one of the rarest complications of high-altitude sickness that can coexist with high altitude pulmonary edema. The risk of developing this phenomenon increases significantly with prolonged stay in high altitudes especially above 5000 m. Given the fatality of the condition, early screening and management is crucial; however, there is no gold standard approach in diagnosis. A 44-year-old male, a Tanzanian tourist first time hiking Mt. Kilimanjaro developed difficulty in breathing on the 4th day of ascending on a route that takes 6 days to summit whereby he was saturating at 38% on room air at the height of 4775 m. He was admitted with the clinical diagnosis of high altitude pulmonary edema. However, in the course of treatment for 72 h with no improvement, further investigations including computed tomography scan were suggestive of pulmonary embolism whereby he was treated with full recovery. Pulmonary embolism case reports are increasingly rising with the difficult to notice among high altitude pulmonary edema patients given their presentation similarities. A high index of suspicion based on clinical examination and investigations should prompt a clinician to include or exclude it.

Penetrating spinal cord injury causing paraplegia in a bird hunter in rural Tanzania.

Introduction: Cultural and socioeconomic factors influence the risk of sustaining a Traumatic Spinal Cord Injury (TSCI). The standard of management and rehabilitation available to TSCI patients differs greatly between high-income and low-income countries. Case presentation: We report a 17-year-old male bird hunter, with no prior medical history, presenting with paraplegia and sensory loss from the xiphoid process down after being struck by an arrow in the left lateral side of the neck. Discussion: Penetrating neck injuries are potentially life threatening because of the complex arrangement of vital structures in the neck. Management of spinal cord trauma resulting from such injuries in low-resource settings is challenging.

The characteristics of cervical spinal cord trauma at a North Tanzanian Referral Hospital: a retrospective hospital based study.

INTRODUCTION: Surviving a traumatic cervical Spinal Cord Injury (SCI) has an immense effect on an individual's physical function and independence. It also predisposes them to financial, social, psychological and several medical complications throughout their life. In high-income countries, improved multidisciplinary care has led to better long term outcomes, however in low-income countries, the burden of the condition and its associated mortality remain high. The aim of this study was to illustrate the sociodemographic and clinical characteristics of cervical level Traumatic Spinal Cord Injuries (TSCIs) at Kilimanjaro Christian Medical Centre (KCMC) in northern Tanzania. METHODS: This was a retrospective hospital-based study of 105 cervical TSCI cases admitted to KCMC from January 2012 to December 2016. RESULTS: We included 105 patients in the study cohort, with a male preponderance of 86.7%, giving a male-to-female ratio of 6.5:1. The mean age at injury was 44.1 years. Overall, 65.7% were farmers and 69 patients were from within the Kilimanjaro region. Road Traffic Crashes (RTCs) accounted for 47.6% of the injuries, 17.9% had associated injuries, 38.1% sustained complete TSCIs and 45.7% developed secondary complications during the ward stay. The mortality rate before discharge from hospital care was 35.2%. CONCLUSION: The majority of patients were males from a low socioeconomic background and the most common cause of injury was RTCs. The secondary complication rates and mortality rates before discharge from hospital care are high.

Mountain neurology.

Mountain climbers may develop specific illnesses that largely depend on the altitude reached and the rate of ascent. The popularity of travel to high altitude destinations, extreme tourist activities and mountain climbing means that neurologists in low-altitude countries are increasingly likely to encounter neurological problems and disorders in people exposed to high altitude. Additionally, they may have to advise patients with pre-existing neurological conditions on the risks of ascent to altitude. This article focuses on neurological-related high-altitude illnesses: acute mountain sickness and high-altitude cerebral oedema, as well as high-altitude retinopathy and other neurological disorders. This overview combines current understood pathogenesis with the experience of managing altitude-related illness at the foot of Mount Kilimanjaro in northern Tanzania, the tallest free-standing mountain in the world.

A case report of atlanto-axial instability in a Down Syndrome patient.

INTRODUCTION: Down Syndrome (DS)-also referred to as Trisomy 21-is associated with multiple deformities affecting various systems of the body. Joint laxity resulting in unstable atlanto-occipital and atlanto-axial joints-with an increased susceptibility to fatal cord injuries-is a recognized phenomenon in patients with DS. CASE PRESENTATION: We report on a 30-year-old man with DS from Tanzania with no previous neck complaints, who presented with a 5-week progressive history of paraparesis that evolved into a quadriparesis. During his initial presentation, the patient reported that 5 months ago he had been involved in a headlock during a playground encounter. DISCUSSION: Primary prevention of the traumatic spinal cord injuries is an important public health measure and a heightened emphasis should be placed to prevent such injuries in high risk populations-including DS patients.

The characteristics of traumatic spinal cord injuries at a referral hospital in Northern Tanzania.

STUDY DESIGN: Retrospective study. OBJECTIVES: To describe the epidemiology of traumatic spinal cord injury (TSCI) in Northern Tanzania. SETTING: Main referral hospital for Northern Tanzania. METHODS: A retrospective review of 125 TSCI cases admitted to Kilimanjaro Christian Medical Centre (KCMC) over a period of 5 years. RESULTS: We included 125 patients in the sample size, with a male majority of 107 (85.6%), giving a male-to-female ratio of 5.9:1. The mean age at injury was 39.9 (±16.0) years. Overall, 66 (52.8%) were farmers and an overwhelming majority (109 (87.2%)) were referrals from peripheral medical centres. Fall injuries accounted for 65 (52.0%) of the admissions and 49 (39.2%) were injured due to a Road Traffic Accident (RTA). Severity of injury was classified according to the American Spinal Injury Association Impairment Scale (AIS) and 57 (45.6%) injuries were categorised as AIS A and 68 (54.4%) as AIS BCD. Cervical level injuries (59 (47.2%)) were the most frequent among the cohort. The in-hospital mortality rate was 24.1%. CONCLUSION: The majority of patients affected by TSCIs were young males and the most common cause was fall injuries. Cervical level injuries were the most common and in-hospital mortality was high.