The anthropometric determinants of peak expiratory flow rate among children in Dar Es Salaam, Tanzania.

BACKGROUND: Peak expiratory flow rate (PEFR) is an important tool for assessing lung function, which can be affected by environmental and physical factors such as altitude, nutrition, genetics, age, height, and weight. Conducting a study to assess the correlation between peak expiratory flow rate and anthropometric measurements in Tanzanian schoolchildren is crucial to derive a population-specific prediction formula and further simplify respiratory health assessment. METHODS: This cross-sectional study was conducted in a single center private primary and secondary school in Dar es Salaam, Tanzania using data from an asthma screening camp. Variables of interest were height, weight, Body Mass Index (BMI) and PEFR. Independent t-test was performed to identify any differences in mean flow rate values between different ethnicities and genders. Correlation coefficients (r) were used to observe the relationship between PEFR and anthropometric measurements. A prediction equation by gender was generated using linear regression analysis. Statistical significance was set at the 5% level. All statistical data was analyzed using SPSS version 25.0. RESULTS: The study involved 260 participants with a mean age of 9.5 years. Males were 51.2% and 65% of participants were of Asian ethnicity. PEFR was not observed to differ across the different ethnic groups and genders. Height was found to have the strongest correlation coefficient of 0.745, while BMI had the weakest correlation coefficient of 0.366. The strongest correlation was found with height for females (r = 0.787), while the weakest was with body mass index for boys (r = 0.203). The derived prediction equation for males was PEFR = 279.169 (Height of Student in meters) -134.12, while the predictive equation for females was PEFR = 318.32 (Height of Student in meters) -195.69. CONCLUSION: This study found a strong correlation between PEFR and anthropometric characteristics in school children from Dar es Salaam, Tanzania. A prediction equation by gender for PEFR was developed based on anthropometric characteristics. This equation may be applied in population-based studies or situations where peak flow meters are not readily available. Further research is needed to explore how well this prediction formula performs in other Tanzanian settings and to determine other factors that may affect lung function in this population.

Incidental right renal agenesis in a 23-year-old patient: A case report.

Renal agenesis refers to the congenital absence or complete failure of development of one or both kidneys. It occurs when the kidneys fail to form during embryonic development. This case report describes the presentation of a 23-year-old male patient who experienced sporadic episodes of abdominal pain on the right side and occasional episodes of hematuria. Diagnostic investigations, including ultrasonography and magnetic resonance imaging scans, confirmed the diagnosis of right renal agenesis. The management of the patient in this case report involved close monitoring of renal function and regular follow-up visits. Initially, the patient was followed for a period of 3 months and based on the patient's clinical status and any associated risk factors, it was determined that a follow-up schedule of visits every 6 months is appropriate. This interval allows for ongoing assessment of renal function and facilitates early detection of any potential complications or changes in kidney health. This case highlights the importance of early diagnosis, comprehensive management, and long-term monitoring in individuals with renal agenesis.

A private hospital's approach to treating acute familial Mediterranean fever in Dar es Salaam.

Familial Mediterranean fever is a rare autosomal recessive autoinflammatory disorder prevalent in Middle Eastern populations, characterized by episodic abdominal pain. This case report presents a 34-year-old Egyptian man with severe lower abdominal pain, chest discomfort, and joint pain, along with a positive family history of familial Mediterranean fever but had no previous personal history of this condition. Blood work revealed leukocytosis with neutrophilia and elevated C-reactive protein and erythrocyte sedimentation rate. The patient received intravenous fluids, antiemetics, and analgesics before further evaluation. Diagnosis of familial Mediterranean fever relies on clinical symptoms, ethnic origin, and family history, supported by specific criteria. Typical familial Mediterranean fever attacks involve serositis-induced pain, recurrent episodes, short-duration fever (12 h to 3 days), and arthritis. Familial Mediterranean fever may mimic other acute abdominal conditions, warranting consideration, particularly in individuals from Mediterranean regions. Genetic testing is valuable in confirming familial Mediterranean fever diagnosis.

Dorsal pancreas agenesis, an incidental finding during acute appendicitis diagnosis; A case report.

INTRODUCTION AND IMPORTANCE: Dorsal pancreas agenesis is a rare congenital anomaly characterized by the absence or severe underdevelopment of the dorsal pancreatic bud. We report a case of a man who presented with features of appendicitis only to the incidentally discovery of dorsal pancreas agenesis during the diagnosis of acute appendicitis. We describe our experience on radiological diagnostic formulation and work up. CASE PRESENTATION: We present the case of a 45-year-old male patient who presented to the emergency department with symptoms and signs suggestive of acute appendicitis. A computed tomography scan and laboratory investigations confirmed the diagnosis of appendicitis. Incidentally, the scan also revealed the absence of dorsal pancreatic tissue, leading to the incidental diagnosis of dorsal pancreas agenesis. CLINICAL DISCUSSION: Dorsal pancreas agenesis is often asymptomatic and can be incidentally discovered during imaging studies or surgical interventions for unrelated conditions. In our case, the initial presentation of acute appendicitis provided an opportunity for the fortuitous diagnosis of dorsal pancreas agenesis. This emphasizes the importance of comprehensive imaging reporting in patients who undergo imaging for other conditions. CONCLUSION: This case report highlights the fortuitous discovery of dorsal pancreas agenesis during the diagnostic workup for acute appendicitis. It emphasizes the need for thorough imaging evaluation and reporting along with the importance of considering anatomical variations in patients presenting with abdominal symptoms. Increased awareness among healthcare professionals about such congenital anomalies can lead to their early recognition and appropriate management.

Diagnostic challenge of perimenopause molar pregnancy in a 52-year-old lady: Case report.

INTRODUCTION AND IMPORTANCE: Gestational trophoblastic disease is an uncommon group of pregnancy-related disorders, with a course of trophoblastic proliferation, including hydatidiform mole (Agha et al., 2020), invasive and metastatic mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelial trophoblastic tumor. Choriocarcinoma and trophoblastic tumor of the placenta are the most important tumors associated with pregnancy. CASE FINDINGS: A 52-year-old woman Para 2 Living 3, 3 years post-menopausal presented with prolong per vaginal bleeding for five weeks accompanied by lower abdominal pain. Diagnosis of gestational trophoblastic disease (choriocarcinoma type) was made by using beta HCG, radiology, and histology report. Patient underwent total abdominal hysterectomy and bilateral salphingo-opherectomy, followed by 2 cycles of chemotherapy. DISCUSSION: Trophoblast disease of pregnancy disease includes a unique tissue group with a wide range of endocrine and angiogenic functions derived from placental trophoblasts. They are associated with uncommon, interrelated conditions, which differ according to the following parameters: invasion, regression, metastasis, and recurrence rate. Beta HCG remains initial investigation to be taken in patients suspecting trophoblastic disease. CONCLUSION AND RECOMMENDATIONS: Gestational trophoblastic disease should be considered in the differential diagnosis of peri and postmenopausal vaginal bleeding. Long term follows up with beta HCG needs to be done to detect recurrence.

Pregnancy following robot-assisted laparoscopic bilateral endometriotic cystectomy rare case report of endometriosis stage IV.

INTRODUCTION AND IMPORTANCE: Endometriosis is a common cause of infertility in women. In this case report we explain successful conception in deep-infiltrating ovarian endometriosis following robot-assisted surgery and androgenic agonist treatment. CASE PRESENTATION: A 38-year-old current Para 2, Living 2 presented 8 years ago with chronic lower abdominal pain, dysmenorrhea, and delayed conception. Advance endometriosis was highly suspected from the history and examination. Robot-assisted laparoscopic partial cystectomy was performed for the deep-infiltrating ovarian endometriosis. She was then discharged with postoperative androgenic agonists and with timed intercourse, she got pregnant within 9 months. CLINICAL DISCUSSION: Advanced endometriosis (Stage III or IV disease) is associated with distorted pelvic anatomy and adhesions. These changes can impair oocyte release or pick-up, alter sperm motility, cause disordered myometrial contractions, and impair fertilization and embryo transport. Successful rate of conception in advanced endometriosis is <20 %, with minimal chances of successful conception, however, our patient conceived. CONCLUSION: Endometriosis should be considered in evaluation of reproductive woman with chronic lower abdominal pain, history of infertility and dysmenorrhea. Prompt management is crucial, and in a setting of advanced technology, robotic laparoscopic surgery is the best to diagnosis and treat advanced endometriosis.

Shortness of breath in a young lady, rare case report of thoracic endometriosis.

INTRODUCTION AND IMPORTANCE: Endometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The clinical presentation is depends on site of implantation. Complications include pneumothorax, pneumohemothorax or hemothorax. CASE PRESENTATION: A 31 year old woman with history of infertility presented with shortness of breath and was found to have a significant right sided pneumohemothorax. Drainage was done followed by chemical pleurodesis using bleomycin with resolution of symptoms on her follow up. CLINICAL DISCUSSION: Thoracic endometriosis tend to present with chronic or sub-acute symptoms which are non-specific symptoms leading to late diagnosis. Video Assisted Thoracoscopic surgery offer both diagnostic and therapeutic in thoracic endometriosis. However in limited settings chemical pleurodesis can be carried out done to prevent recurrence of shortness of breath due to thoracic endometriosis. CONCLUSION: Therefore, clinical suspicion of thoracic endometriosis in evaluation of shortness of breath in a young lady with history of infertility or pelvic surgery is indispensable.

Residency training on the frontlines of the COVID-19 pandemic - a qualitative study from Tanzania.

INTRODUCTION: the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease. METHODS: this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis. RESULTS: twelve residents and six faculty members participated in this study. Two main themes emerged. The first was: "New and unfamiliar teaching and learning experiences." Residents and faculty had to adapt to changes in the learning environment and the academic program. Residents had increased responsibilities, including providing front line care and working with reduced supervision. The second theme was: "Learning opportunities amidst crisis." There were opportunities to improve critical care and procedural skills. They also had opportunities to improve non-technical skills like teamwork and communication. CONCLUSION: residents and faculty had to adapt to changes in teaching and learning. Residents also had to take up additional responsibilities. Support systems are required to help them adapt to the changes and settle in their new roles. There were opportunities to learn new skills, and training should be restructured to maximize the use of these opportunities.

Barriers to timely disclosure of HIV serostatus: A qualitative study at care and treatment centers in Dar es Salaam, Tanzania.

INTRODUCTION: Disclosure of Human Immunodeficiency Virus (HIV) status is important to prevent the spread of HIV and maintain the health of people living with HIV, their spouses, and the community. Despite the benefits of disclosure, many people living with HIV delay disclosing their status to those close to them thereby increasing the risk for disease transmission. This study aimed to determine the barriers to timely disclosure of HIV serostatus for people living with HIV in Dar es Salaam, Tanzania, and identify what motivated disclosure. METHODS: A qualitative descriptive study using in-depth individual interviews was conducted with10 participants attending HIV care and treatment centers in Dar es Salaam. The participants were people living with HIV who had delayed disclosing their serostatus for more than one month after diagnosis. Data was analyzed using qualitative content analysis. RESULTS: Three categories emerged from the analysis: Barriers hindering timely disclosure, motivation for disclosure of serostatus, and consequences of delayed disclosure. Barriers to timely disclosure included denial of one's status, the fear of stigmatization, fear of being separated or divorced, the need to protect loved ones, and lack of adequate knowledge about the disease. Reasons that motivated disclosure included gaining social support, preventing disease transmission and wanting to be at peace. CONCLUSION: Timely disclosure is hindered by stigma because HIV is negatively perceived by the public. People living with HIV prefer not to disclose to avoid the negative consequences of disclosure, especially because of fear of being discriminated against and losing their social status, which plays a major role in social status in Tanzania. Trust and adequate counseling from health care workers helps prompt disclosure.