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.

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.

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.

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.

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.

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.

A Genomic Analysis of Esophageal Squamous Cell Carcinoma in Eastern Africa.

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) comprises 90% of all esophageal cancer cases globally and is the most common histology in low-resource settings. Eastern Africa has a disproportionately high incidence of ESCC. METHODS: We describe the genomic profiles of 61 ESCC cases from Tanzania and compare them to profiles from an existing cohort of ESCC cases from Malawi. We also provide a comparison to ESCC tumors in The Cancer Genome Atlas (TCGA). RESULTS: We observed substantial transcriptional overlap with other squamous histologies via comparison with TCGA PanCan dataset. DNA analysis revealed known mutational patterns, both genome-wide as well as in genes known to be commonly mutated in ESCC. TP53 mutations were the most common somatic mutation in tumors from both Tanzania and Malawi but were detected at lower frequencies than previously reported in ESCC cases from other settings. In a combined analysis, two unique transcriptional clusters were identified: a proliferative/epithelial cluster and an invasive/migrative/mesenchymal cluster. Mutational signature analysis of the Tanzanian cohort revealed common signatures associated with aging and cytidine deaminase activity (APOBEC) and an absence of signature 29, which was previously reported in the Malawi cohort. CONCLUSIONS: This study defines the molecular characteristics of ESCC in Tanzania, and enriches the Eastern African dataset, with findings of overall similarities but also some heterogeneity across two unique sites. IMPACT: Despite a high burden of ESCC in Eastern Africa, investigations into the genomics in this region are nascent. This represents the largest comprehensive genomic analysis ESCC from sub-Saharan Africa to date.

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.

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.

The effect of reproductive, hormonal, nutritional and lifestyle on breast cancer risk among black Tanzanian women: A case control study.

PURPOSE: This study aimed to determine the effect of reproductive, hormonal, lifestyle and nutritional factors on breast cancer development among Tanzanian black women. METHODOLOGY: We undertook a case-control study age-matched to ±5years in 2018 at Muhimbili National Hospital. The study recruited 105 BC patients and 190 controls giving it 80% power to detect an odds ratio of ≥2 at the alpha error of <5% for exposure with a prevalence of 30% in the control group with 95% confidence. Controls were recruited from in patients being treated for non-cancer related conditions. Information regarding hormonal, reproductive, nutritional and lifestyle risk for breast cancer and demography was collected by interviews using a predefined data set. Conditional multinomial logistic regression used to determine the adjusted odds ratio for variables that had significant p-value in the binomial logistic regression model with 5% allowed error at 95% confidence interval. RESULTS: The study recruited 105 cases and 190 controls. Only old age at menopause had a significant risk, a 2.6 fold increase. Adolescent obesity, family history of breast cancer, cigarette smoking and alcohol intake had increased odds for breast cancer but failed to reach significant levels. The rural residency had 61% reduced odds for developing breast cancer though it failed to reach significant levels. CONCLUSION: Older age at menopause is a significant risk factor for the development of breast cancer among Tanzanian women. This study has shed light on the potential role of modifiable risk factors for breast cancer which need to be studied further for appropriate preventive strategies in similar settings.

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 .

Diagnostic challenges and management of choledochal cyst in an 11-year-old child: a delayed diagnosis (a case report).

Choledochal cyst are rare congenital disease of the biliary tree. It presenting as cystic dilatations of the biliary tree can involve the extrahepatic biliary radicles, the intrahepatic biliary radicles or both. They are typically a surgical problem of infancy and childhood, but less than a quarter of the patients the diagnosis is delayed until adulthood as it presenting with vague and nonspecific signs and symptoms. In a case with biliary symptoms, abdominal ultrasound scan is the initial imaging modality of choice. Precise and accurate delineation of the biliary system mandates cholangiography with the advantage of non-invasive magnetic resonance cholangiopancreatography (MRCP) over endoscopic retrograde cholangiopancreatography. A case report of 11-year-old Tanzania girl with abdominal swelling and jaundice presented to a health facility for evaluation. She complained of abdominal swelling that her mother noticed when she was 3 years old, located above the umbilicus and since then it was not changed its size until 8 years later when it rapidly increased in size associated with non-specific dull pain. Abdominal computed tomography (CT) scan was done showed A well-defined hypo-attenuated non-enhancing retro-gastric cyst. Percutaneous transhepatic cholangiopancreatography (PTC) was performed due to inconclusive findings from CT-scan showed extrahepatic huge cystic dilatation, dilated central right hepatic ducts, left intrahepatic ducts failed to be visualize. Diagnosis of choledochal cyst type isovaleric acidaemia (IVA) was made. Explorative laparotomy was done, huge cystic mass occupying common bile duct was seen below the liver with distended gallbladder covered with visceral peritoneum. Second part of duodenum, pancreases and transverse colon was adhered to the inferior surface of the mass that further make difficult for cyst excision and reconstruction. Cyst was decongested and cholangioenterostomy with Roue-en-Y reconstruction was made. Cholecystectomy was done, hemostasis archived abdomen closed and patient sent to Intensive care units (ICU). Despite of advanced diagnostic modalities, delayed diagnosis of choledochal cyst can be a challenge due to its vague and nonspecific signs and symptoms. Excision of the cyst and reconstruction by hepatojejunostomy as the standard therapy could be difficult due to its biliary complications such as adhesion and infection and hence cyst-enterostomy drainage procedure can be done as option for relief of patient discomfort and prevent further complications.

Improvised vacuum assisted closure dressing for enterocutenous fistula, a case report.

INTRODUCTION: Management of enterocutaneous fistula is challenging with high morbidities and mortalities despite the recent advances in surgical technique. The bad outcomes are a result of associated metabolic complications. Vacuum-assisted closure dressing for the management of enterocutaneous fistula is a relatively new technique with benefit as a bridge to definitive surgery or definitive management in achieving spontaneous closure at a shorter time. In the current report, we share our experience of improvising vacuum-assisted closure dressing for managing postoperative enterocutaneous fistula and achieving spontaneous closure PRESENTATION OF CASE: We describe a case of a 56-year-old male from Tanzanian with a postoperative discharge of intestinal contents from the wound. He was diagnosed to have a proximal enterocutaneous fistula. After sepsis control and achieving hemodynamic stability, the enterocutaneous fistula was managed with parenteral nutrition, proton pump inhibitors, anti-cathartics, and somatostatin analogs. Endoscopic therapies and fibrin sealants are other described nonoperative interventions for enterocutaneous fistula. The unavailability of these modalities limited us. Vacuum-assisted closure dressing was improvised using gauze pieces, feeding tube, and Op-site dressings at a pressure of -30 mmHg. We achieved spontaneous closure of the proximal enterocutaneous fistula in 32 days. DISCUSSION: The time to closure was within the range of 12-90 described for conventional vacuum assisted closure dressing, and there were no complications. Close monitoring of improvised VAC dressings is required as the risks are unknown; however, given the known complications of conventional VAC dressing, a risk of hemorrhage and creation of entero-atmospheric fistula exists. CONCLUSION: Improvised VAC dressing for ECF is potentially an acceptable option with promising outcomes in low-resource settings.

Supervision and support in surgical practice using mobile platform: a case of mass hydrocele surgeries in remote regions.

BACKGROUND: Globally, nearly 19 million people with Lymphatic filariasis (LF) who require surgery have not been attended. To reach them needs the scaling up and expansion of surgical services. In Tanzania, hydrocele is more prevalent in the coastal belt, where surgical workforce is also scarce. Thus, scaling up hydrocele surgery services would require the use of non-physician clinicians (NPCs) that are currently based there by offering procedure specific training. With new technique of partial sac excision, constant support and mentorship would be required. We therefore sought to test if use of mobile platform would be an adjunct to supervision and support to practicing non surgeon clinicians in Tanzania. METHODS: This was a prospective cohort study done in Mtwara and Lindi regions during the period of 2014-2015. Training model followed the West African Morbidity Management protocol for hydrocele followed by practical sessions in the operating room in each locality. Subsequently, patients were screened and discussed by sharing pictures on WhatsApp created to link the hydrocele teams and the two consultant surgeons. Patients with simple hydrocele not to require scrotoplasty and with non-coexistent of hernia were recruited. Data collected included: number of cases performed, time spent per procedure, hematoma formation and adherence to local anesthesia. Descriptive statistics was used to summarize the findings. RESULTS: Fifteen NPCs were successfully trained and mentored throughout the study period and were subsequently able to perform 1,337 hydrocelectomies in 1,250 patients with 387 having bilateral hydrocele. The use of local anesthesia was successful in nearly all the patients and case selection was appropriate as can be seen with only 7/1,250 requiring additional procedures other than hydrocelectomy. The mean procedure duration was 50.2±0.24 minutes and complications rates were low at 2.16%. CONCLUSIONS: Mobile platform with instant photo and video sharing capacity can be a reliable tool in offering support and supervision in surgical service provision.

The African Esophageal Cancer Consortium: A Call to Action.

Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of cancer-related death; however, worldwide incidence and mortality rates do not reflect the geographic variations in the occurrence of this disease. In recent years, increased attention has been focused on the high incidence of esophageal squamous cell carcinoma (ESCC) throughout the eastern corridor of Africa, extending from Ethiopia to South Africa. Nascent investigations are underway at a number of sites throughout the region in an effort to improve our understanding of the etiology behind the high incidence of ESCC in this region. In 2017, these sites established the African Esophageal Cancer Consortium. Here, we summarize the priorities of this newly established consortium: to implement coordinated multisite investigations into etiology and identify targets for primary prevention; to address the impact of the clinical burden of ESCC via capacity building and shared resources in treatment and palliative care; and to heighten awareness of ESCC among physicians, at-risk populations, policy makers, and funding agencies.

Characterization of hormonal receptors and human epidermal growth factor receptor-2 in tissues of women with breast cancer at Muhimbili National Hospital, Dar es salaam, Tanzania.

BACKGROUND: Breast cancer is a leading cause of morbidity and deaths among women worldwide. In Tanzania there is no published data on human epidermal growth receptor-2 (HER2/neu) expression in breast carcinoma. Hormonal receptors and HER2/neu status reportedly influence post-mastectomy adjuvant therapy and predict treatment outcome and prognosis. Here we evaluate hormonal receptors and HER-2 status in biopsies of women with breast cancer at Muhimbili National Hospital (MNH). METHODS: A cross-sectional study of female breast post-modified radical mastectomy (MRM)/incisional biopsies confirmed to be carcinoma at the Histopathology Unit (January-December 2013). Tissue blocks having poor morphology, without tumor, secondary tumors, cases outside the study period and male patients were excluded. Routine staining was done followed by immunohistochemistry for estrogen (ER), and progesterone (PgR) receptors and HER2. Data analyzed using Statistical Package for Social Sciences (SPSS). RESULTS: A total of 218 cases were confirmed to be carcinoma including 70 meeting inclusion criteria. Age at diagnosis ranged 18-75 years and mean age was 48.36 years. Majority (64.3%) were in the 36-55 years age-group. Histologically, most (88.6%) women had invasive ductal carcinoma including 43.1% of intermediate grade. A great majority (78%) were stage three. Due to logistical constrains, 75.7% (n = 53/70) cases where immunostained for hormones including 43.4% (ER+), 26.4% (PgR+), and 28% (ER+/PgR+). Furthermore, 65.7% (n = 46/70) cases were immunostained for HER-2 and 15.2% (n = 7/46) were positive, 45.6% were triple negative (ER-,PgR-,HER2-), 23.9% (ER+,PgR+,HER2-) or luminal B, 2.2% (ER+,PgR-,HER2+),13% (ER-,PgR-,HER2+) and 15% (ER+,PgR-,HER2-) with none being triple positive. CONCLUSIONS: Hormonal receptors and HER2 expression at MNH appears to be comparable to previous Africans/African Americans reports but not with studies among Caucasians and the current proportion of triple negative breast carcinomas (TNBC) is higher than in a previous Tanzanian report and majority are luminal. HER2 over-expression is relatively common. It is strongly recommended that receptor status assessment be made routine for breast cancer patients at MNH.

Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania.

INTRODUCTION: Antimicrobial prophylaxis for urologic procedures is a major issue, as potential advantages of antibiotic administration should be carefully weighed against potential side effects, microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic use in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third world environment. METHODS: This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software. RESULTS: Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction. Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or treatment intention. CONCLUSION: Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.

Manual laparoscopic skills development using a low-cost trainer box in Tanzania.

OBJECTIVES: To explore the feasibility and effectiveness of guided practice using a low-cost laparoscopic trainer on the development of laparoscopic skills by surgeons in a resource-poor setting. DESIGN: This was a prospective trial involving a pretest/posttest single-sample design. Study participants completed a background survey and pretest on the 5 McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) tasks using a simulator developed and validated by researchers from the University of California, San Francisco. On completion of a 3-month guided practice course, participants were again tested on the MISTELS tasks and completed an exit survey. SETTING: The Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania. PARTICIPANTS: Fourteen Tanzanian surgery residents and specialists completed the study. RESULTS: Most of the subjects were surgical residents (64.3%). Only 2 participants (14.2%) had previous laparoscopic training, and baseline laparoscopic surgical experience was limited to intraoperative observation only. Study subjects practiced the MISTELS tasks for an average of 8.67 hours (range: 4.75-15.25) over the 3-month course. On the posttest, participants improved significantly in performance of each of the MISTELS tasks (p < 0.001). Total scores on the tasks increased from 24 ± 44 on the pretest to 384 ± 49 on the posttest (p < 0.001). All study participants were satisfied with the course, found the training personally valuable, and felt that their laparoscopic skills had improved on completion of the training. CONCLUSIONS: We have demonstrated the feasibility and effectiveness of training with a low-cost laparoscopic trainer box in Tanzania. Study participants achieved impressive posttest scores on the 5 MISTELS tasks with minimal baseline laparoscopic exposure. We feel that guided training by an expert was key in ensuring correct technique during practice sessions.

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.