Cervicofacial necrotizing fasciitis among patients attending the Muhimbili National Hospital, Dar es Salaam, Tanzania.

BACKGROUND: Cervicofacial necrotizing fasciitis (NF) is a rare life-threatening infection in the head and neck region that characteristically spreads along the fascial planes to involve subcutaneous tissues, fascia and fat, however, in late stages it can involve muscles and skin. The aim of this study was to determine the occurrence of cervicofacial NF among patients attending treatment at the Muhimbili National Hospital (MNH). METHODS: This was a prospective descriptive cross-sectional hospital-based study which was carried at Muhimbili National Hospital (MNH) from May 2013 to April 2014. It included 42 patients with cervicofacial NF. They were interviewed for demographic information, chief complaints, symptoms, duration and treatment received before reporting at MNH. A thorough assessment of general health condition of the patients and laboratory investigations were followed by management according to MNH protocol. Data obtained from these patients were analyzed using Statistical Package for Social Sciences SPSS 20. RESULTS: During the study period, 151 patients reported at MNH with odontogenic infections. A total of 42 (27.8%) patients satisfied our diagnostic criteria for cervicofacial NF. The age range was 15 years to 83 years (mean 43.95, SD +/- 16.16). Greater (35.7%) proportion was in the age group of 30-39 years with 31 (73.8%) males and 11 (27.2%) females making a male to female ratio of 2.8:1. Fifteen (35.7%) patients had at least one co-existing systemic condition, which included anaemia in 5 (11.9%) patients, followed by diabetes mellitus (DM) and malnutrition 4 (9.5%) patients each and HIV infection 2 (4.8%) patients. Others were combination of; HIV infection and malnutrition, HIV infection and anaemia and diabetes mellitus and anaemia each in one (2.4%) patient. There was a mortality of 42.9% comprising of 14 (33.3%) males and 4 (9.6%) females. CONCLUSIONS: Cervicofacial NF is a polymicrobial infection, requiring surgery, antibiotics and management of co-existing systemic conditions. Anaemia, diabetes mellitus and malnutrition were the main co-existing systemic conditions. The rather high mortality was mainly attributable to late reporting.

Effectiveness of mixture of aspirin and ethanol regimen in the management of geographic tongue: a prospective study.

Geographic tongue is usually an asymptomatic inflammatory disorder of the tongue; however, symptomatic cases do occur and require treatment. Several management strategies have been reported yet they are neither specific nor curative. Objective: The objective was to evaluate the effectiveness of an aspirin-ethanol mixture in the management of geographic tongue. Methods: In this prospective study, an analysis of medical reports of symptomatic cases of geographic tongue managed using an aspirin-ethanol mixture was done. The treatment regimen involved dissolving 3 mg of aspirin (acetylsalicylic acid) into 1 ml of 70% v/v ethanol. Then a sterile gauze is soaked in the prepared mixture and is topically used to clean the tongue with gentle pressure for 2-3 min. Results: The records of 23 patients were analyzed. There were more females (19, 82.6%), and the age range of patients was 15-43 years (mean age of 23.4 years). The symptoms that the patient described included: oral discomfort, burning sensations of the tongue, pain, and loss of taste. Only 21 (91.3%) patients were asymptomatic at 3 months of follow-up. Conclusions: Short-term topical application of the aspirin-ethanol mixture was shown to be effective in treating symptomatic geographic tongue.

Magnitude and Determinants of Dental Anxiety among Adult Patients Attending Public Dental Clinics in Dar-Es-Salaam, Tanzania.

INTRODUCTION: It is estimated that, about 40% of the population suffer from dental anxiety. Dental anxiety is considered to be complex and multifactorial with a wide range of provoking factors which may be patient, provider, or environment-related. AIM: This study aimed to assess the magnitude and determinants of dental anxiety among adult patients attending public dental clinics in Dar es Salaam, Tanzania. Methodology. This was a descriptive cross-sectional study carried out in 4 public hospitals in Dar es Salaam, Tanzania. It included 300 adult patients who had dental caries, periodontal diseases, or dental trauma. Data were collected using a self-administered Modified Dental Anxiety Scale (MDAS) questionnaire. Data were analyzed using the SPSS computer software version 23. A one-way Analysis of Variance (ANOVA) was used to assess the association between variables, and the significance level was set at p < 0.05. RESULTS: The mean age of participants was 32.18 years (±11.06 SD) with a male-to-female ratio of 1 : 1.43. The means MDAS score was 12.84 ± 4.99. Tooth extraction had the highest mean MDAS score. The majority (261, 87%) of participants had mild-to-severe anxiety. The most common (72.2%) anxiety-provoking factor was an unsympathetic dentist; others included unawareness of the procedure to be carried out (58.3%) and the presence of apprehensive patients (52.0%). The level of anxiety was found to be statistically significantly associated (p < 0.05) with young age [p=0.009, AOR 3.06 (95% CI, 1.32, 7.09), female patients [p < 0.001, AOR 4.45 (95% CI, 2.05, 9.70)], and a higher education level [p < 0.05, AOR 2.32 (95% CI, 1.03, 5.25)]. CONCLUSION: The prevalence of dental anxiety was high among the participants of this study. Female gender, young age, and a higher level of education constituted determinants of dental anxiety. An unsympathetic practitioner, unawareness of the procedure, and presence of apprehensive patients were the common anxiety-provoking factors.