Giant pilomatrix carcinoma of the scalp with intracranial extension: A case report.

Key Clinical Message: A very rare skin cancer. Malignant variant of pilomatricoma. It is unique because of its highly aggressive behavior. Responds poorly to chemotherapy and radiotherapy. Treated with a wide surgical excision with safe margins. Abstract: Pilomatrix carcinoma is uncommon and locally aggressive tumor of the hair follicle matrix. It is a malignant variant of pilomatricoma. If left untreated for a long time may attain massive size and has the potential for distant spread. Only few cases with brain extension have been reported in the literature. Diagnosis of these tumors is established by histopathology. Although pilomatrixoma and pilomatrix carcinoma are well-recognized lesions, clinically they are frequently misdiagnosed as other skin conditions. The tumors respond poorly to chemotherapy and radiotherapy. Thus, recommended treatment is a wide surgical excision with safe margins. Herein, we report the case of a 39-year-old African woman with pilomatrix carcinoma of the scalp eroding the skull bone with intracranial extension.

Button battery ingestion: A serious pitfall of diagnosis of ingested foreign bodies in children from resource-limited settings - A case report.

INTRODUCTION AND IMPORTANCE: Button battery ingestion and impaction in the oesophagus can result in severe morbidity and even fatality if not diagnosed and managed urgently. Delayed or missed diagnosis due to the sometimes-vague symptomatology and limited investigations in resource-limited settings further increases the complications rate. CASE PRESENTATION: Case 1: A 2 years old male child presented with a nine months history of recurrent respiratory tract infections not responding well to medical treatment. A radio-opaque round foreign body (FB) was incidentally seen in the chest. Rigid esophagoscopy and removal were done, but the child had developed a trachea oesophagal fistula. The fistula was managed conservatively by retaining a nasogastric tube until spontaneous fistula closure happened. Case 2: A 2 years old female child presented with a one-year history of poor feeding, vomiting, difficulty in breathing and persistent wet cough, and fever. He underwent tonsillectomy with no improvement. A radio-opaque round FB was incidentally seen in the oesophagus near the carina by a chest x-ray. A thoracotomy had to be done after two failed removal attempts by rigid esophagoscopy. CLINICAL DISCUSSION: The similarity in the symptomatology of common aerodigestive conditions with FB ingestion compounded with low chances of witnessing the ingestion creates a possible pitfall for clinicians when resulting in a missed or a delayed diagnosis, further raising the complications rate of FB impaction in the oesophagus, such as tracheoesophageal fistula formation or the need for a massive surgery such as thoracotomy to remove the button battery. CONCLUSION: Complications of foreign body ingestion in the paediatric population can have serious complications. High morbidity and mortality may be attributed to delayed diagnosis and intervention.

Congenital hyporhinia with associated malformations: Case report of a rare congenital anomaly.

Congenital hyporhinia, also known as partial arhinia, is a very rare congenital abnormality of nasal embryogenesis with unknown etiology. It is commonly associated with other craniofacial anomalies which are thought to be caused by an absent or rudimentary nose. A 3-h-old neonate presented to our facility with hypoplastic nasal pyramid, hypertelorism, microcephaly, and micrognathia, a case of congenital hyporhinia with associated anomalies is presented and the embryology and literature review are discussed.

Rhinocerebral mucormycosis in a diabetes type 2 patient: A fatal case report from northern Tanzania.

Mucormycosis is an acute and aggressive fungal infection usually, but not exclusively, occurring in immunocompromised individuals. Lack of knowledge and awareness in developing countries hinders timely management. This case highlights the importance of a prompt index of suspicion for the timely and aggressive intervention of mucormycosis to the Tanzanian community. We report a case of fatal rhino-orbital-cerebral mucormycosis in a diabetic patient presenting at a tertiary hospital in the Kilimanjaro region, Tanzania. Nasal deformity, proptosis, chemosis and left-sided hemiplegia were evident on physical examination. Nasoendoscopy revealed extensive necrosis of the nasal septum, inferior turbinate and involvement of the frontal recess. Computed tomography and magnetic resonance imaging of the paranasal sinuses and head revealed necrosis and ischemic changes due to fungal invasion. The patient deceased due to intracranial complications of advanced fungal invasion. Late presentation and unacquainted with mucormycosis our patient had an unfavourable outcome. Early diagnosis, extensive surgical debridement and a multidisciplinary approach to treatment are of the essence in favour of a better prognosis.

The introduction of a paediatric ENT and anaesthesia skills course in Kilimanjaro Christian Medical Centre hospital, (KCMC), Moshi, Tanzania.

Human factors and a safe operating theatre environment are of paramount importance, wherever surgery is undertaken. The majority of patients in sub-Saharan Africa do not yet have access to safe surgery. The Paediatric ENT Skills and Airway Course introduced and evaluated here was designed to improve outcomes and safety in a typical East African environment. The lectures, tutorials and practicals covered technical and non-technical skills. Responses from pre- and post-course questionnaires were evaluated as an initial surrogate for effectiveness of this course. The latter showed improvement in all taught skills and found universal recommendation. The course had been established to try to minimise morbidity and mortality after paediatric surgery at our institution, KCMC. We encouraged team co-operation in the care of patients, and recommend other centres consider similar courses building on human factors for safer operating theatre working practices.

Prevalence of Ear Nose and Throat (ENT) Manifestations Among HIV Seropositive Patients at a Tertiary Hospital in Northern Tanzania: A Descriptive Cross-Sectional Study.

BACKGROUND: To date, HIV/AIDS remains a threat of the 21st century. The overall rate of new HIV infection continues to decline in several countries, but there is still a remarkable burden of disease seen in sub-Saharan Africa. Several studies observed that 70% to 90% of HIV-infected patients present with ear, nose and throat symptoms. The aim of this study was to identify the magnitude of ENT manifestations among HIV-infected patients attended HIV clinics at KCMC based on age, sex, and CD4 count. METHODS: This was a descriptive cross-sectional study conducted at KCMC hospital involving HIV-infected patients who attended HIV clinics from February to July 2018. Convenient sampling was employed to get study participants, and 200 patients were recruited in the study. Data were collected through a questionnaire from patients, and results were analyzed using SPSS version 20. RESULTS: Sixty-eight (34%) of 200 HIV-infected patients had ENT manifestations. The most affected age group was 0-9 years. ENT manifestations were more prevalent in females (23.5%) than in males (10.5%). Those with CD4 count less than 200cells/µL also it was a high prevalence (56.3%). CONCLUSION: This study observed that one-third of the studied population had ENT manifestations. All medical practitioners should be aware of ENT manifestations in HIV-infected patients in order to assure early and appropriate intervention.

The effect of antibiotics on post-adenotonsillectomy morbidity in Tanzanian children: study protocol for a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Adenotonsillectomy is the most frequently performed operation in children worldwide. For decades, prophylactic antibiotics have been prescribed to limit postoperative complications. The effect of this antibiotic use has been refuted in a Cochrane Review. However, all reviewed studies were carried out in developed countries. In Tanzania, like many other developing countries with limited resources and a high burden of infectious diseases, postoperative antibiotic prescription is still very common to decrease the supposed higher postoperative morbidity. However, as a consequence of this widespread use of postoperative antibiotics, cross-resistance and risk of allergic side effects rise. Well-designed randomized controlled trials are needed to limit unnecessary antibiotic prescription and secondary antibiotic resistance. AIM: The aim of this study is to analyse the prophylactic role of postoperative antibiotics on morbidity following adenotonsillectomy in children in Tanzania. DESIGN: The double-blinded, randomized, placebo-controlled trial was set in northern Tanzania. Participating centres are the Department of Otolaryngology at Kilimanjaro Christian Medical Centre in Moshi and the Department of Paediatric Surgery at the Arusha Lutheran Medical Centre in Arusha. METHODS: Around 270 children aged 2-14 years, all scheduled for elective (adeno)tonsillectomy, will be included and assigned to receive either a standard regimen of 5 days of antibiotic prophylaxis or placebo after surgery. The primary outcomes are postoperative haemorrhage, fever and pain. Secondary outcomes are the time until normal diet is resumed, the time until normal activities are resumed and the occurrence of adverse events and microbial recolonization of the tonsillar beds. DISCUSSION: This study will enhance an increase of proper antimicrobial prescription in Tanzanian institutions as well as other resource-limited countries where prescription of antibiotics is still very common. In addition, it might augment current knowledge about surface and core tonsillar micro-organisms and sensitivity patterns. TRIAL REGISTRATION: Pan African Clinical Trials Registry, PACTR201905466349317. Retrospectively registered on 15 May 2019. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=8119.

Prevalence, clinical presentations, associated risk factors and recurrence of laryngeal papillomatosis among inpatients attended at a Tertiary Hospital in Northern zone Tanzania.

INTRODUCTION: Although Laryngeal papillomatosis is a rare disease and can be conventionally managed through surgical excision as well as adjuvant therapy yet Laryngeal papillomatosis has high tendency to recur raising its prevalence in the community, airway involvement warrants dangerous complications requiring emergency tracheostomy, especially if clinical course is poorly understood and misdiagnosis is common. The study aims to determine the prevalence, clinical features, risk factors and recurrence of Laryngeal Papillomatosis among patients attending ENT department at KCMC from 2005 to 2015. METHODS: This was a 10 year experience/ Descriptive hospital based cross-sectional study conducted based on patients' medical record at KCMC. Information was recorded into data collection sheets, entered and analyzed through SPSS version 20, summarized and presented in tables and charts, proportions and percentage used to compare groups. RESULTS: 51 patients were identified over the 10 years study period corresponding to a prevalence of 0.09%. 26 were males and 25 females, ages ranging from 1 to 67 years. The median age of onset was 6 years. Children less than 5 years accounted for 19 (37.3%) and 58.8% had repeated surgeries. Clinical presentation ranged from hoarseness in 43 (84.3%) patients to weight loss 3 (5.9%) and 96.1% showed complete or partial presence of the clinical triad of risk factors. CONCLUSION: Laryngeal papillomatosis is a rare disease that carries severe morbidity due to its highly recurring nature. It is primarily a paediatric disease, generally affecting more males; its clinical features highly resemble other airway obstructive diseases and therefore a careful thorough clinical evaluation is required in order to correctly diagnose Laryngeal papillomatosis.