Clinicopathological features and management of obstructive jaundice at Queen Elizabeth Central Hospital, Malawi. A retrospective cohort analysis.

Introduction: The diagnosis of obstructive jaundice (OJ) is a challenge and is often made late especialy in low-resource settings. There is a paucity of data on the aetiology and prognosis of patients with obstructive jaundice in Malawi and Sub-Saharan Africa. The objective of this study was to determine the aetiology, clinical presentations, and short-term treatment outcomes of patients managed for OJ in Malawi. Methodology: A review of case notes of all patients admitted with a clinical diagnosis of OJ from 2012 to 2022 was done. We reviewed the clinical presentation, laboratory findings, management, intra and post-operative complications, and patient outcomes. Data was entered into an Excel spreadsheet and analysed using SPSS version 25. Results: Of 26,796 patient admissions, 5339 (19.9%) were for non-trauma abdominal symptoms, of which 164 (0.6% of surgical admissions and 3% of abdominal symptoms) were for obstructive jaundice. Ages varied from 16 to 89 years. Females were 45 (58.4 %) of the population. The commonest presenting complaint was jaundice followed by abdominal pain and distention. The mean duration of symptoms at presentation was 8.5 weeks. The most frequent imaging modality was abdominal ultrasound 50(65 %). Twenty-six patients (33.8 %) were discharged with a diagnosis of obstructive jaundice of undetermined pathogenesis. The commonest diagnosis was pancreatic cancer 20(26.0 %) followed by Choledocholithiasis11(14.3 %). Patients younger than 50 years had the same likelihood of presenting with cancer as those older than 50 years. Conclusion: It is important to have a high index of suspicion in all adult patients presenting with obstructive jaundice as patients younger than 50 years have a similar risk of malignancy as older patients.

Cochlear implantation in Malawi: report of the first four cases.

OBJECTIVE: This paper reports on the first four cochlear implant cases in Malawi. CASE REPORTS: Three patients were deafened from infectious diseases and one from an unknown cause. They all had post-lingual deafness. Six months after the last implant, they are all progressing well. CONCLUSION: Despite significant practical difficulties, it has proved possible, with the right support, to carry out cochlear implantation in one of the world's poorest countries. The project has also raised awareness of deafness in Malawi and highlighted significant public health issues relating to the aetiology of deafness in developing countries.

Prevalence and causes of hearing impairment in Africa.

OBJECTIVE: To systematically assess the data on the prevalence and causes of hearing impairment in Africa. METHODS: Systematic review on the prevalence and causes of hearing loss in Africa. We undertook a literature search of seven electronic databases (EMBASE, PubMed, Medline, Global Health, Web of Knowledge, Academic Search Complete and Africa Wide Information) and manually searched bibliographies of included articles. The search was restricted to population-based studies on hearing impairment in Africa. Data were extracted using a standard protocol. RESULTS: We identified 232 articles and included 28 articles in the final analysis. The most common cut-offs used for hearing impairment were 25 and 30 dB HL, but this ranged between 15 and 40 dB HL. For a cut-off of 25 dB, the median was 7.7% for the children- or school-based studies and 17% for population-based studies. For a cut-off of 30 dB HL, the median was 6.6% for the children or school-based studies and 31% for population-based studies. In schools for the deaf, the most common cause of hearing impairment was cryptogenic deafness (50%) followed by infectious causes (43%). In mainstream schools and general population, the most common cause of hearing impairment was middle ear disease (36%), followed by undetermined causes (35%) and cerumen impaction (24%). CONCLUSION: There are very few population-based studies available to estimate the prevalence of hearing impairment in Africa. Those studies that are available use different cut-offs, making comparison difficult. However, the evidence suggests that the prevalence of hearing impairment is high and that much of it is avoidable or treatable.

Microbiology of chronic suppurative otitis media at Queen Elizabeth Central Hospital, Blantyre, Malawi: A cross-sectional descriptive study.

BACKGROUND: Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore, it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment, avoid complications, and provide records for future reference. AIM: The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre, Malawi, and establish their relationship signs and symptoms, and with the demographic pattern of the study. METHODS: This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM, who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS.version 20. RESULTS: The study found that Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent aerobic bacteria, while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOM-causing microorganisms were-significantly more so than the others-characteristically associated with each of the following clinical features: quantity of pus drainage, mode of onset, otalgia, hearing loss, location of tympanic membrane perforation, and mucosal appearance.

Microbiology of Chronic Suppurative Otitis Media at Queen Elizabeth Central Hospital; Blantyre; Malawi: A Cross-Sectional Descriptive Study

Background.Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore; it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment; avoid complications; and provide records for future reference. Aim. The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre; Malawi; and establish their relationship signs and symptoms; and with the demographic pattern of the study.Methods.This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM; who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS version 20.The study found that Proteus mirabilis; Pseudomonas aeruginosa; and Staphylococcus aureus were the most prevalent aerobic bacteria; while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOM-causing microorganisms were-significantly more so than the others-characteristically associated with each of the following clinical features: quantity of pus drainage; mode of onset; otalgia; hearing loss; location of tympanic membrane perforation; and mucosal appearance

Emergency percutaneous tracheostomy.

We present a case of acute upper airway obstruction secondary to angio-oedema. The patient underwent emergency percutaneous tracheotomy. Other options available for emergency surgical airway are discussed.

Tracheostomy in human immuno-deficiency virus infected children at the Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

UNLABELLED: Tracheostomy in adults with HIV/AIDS has been reported to be associated with both high and early mortality of 47-100%. There is minimal data regarding the role of tracheostomy in HIV infected children. We did a retrospective analysis of HIV positive children that underwent tracheostomy at our institution over a 5-year period, 2002-2006. A total of 70 tracheostomies were done during the period and 15 (21.4%) of these children were confirmed as HIV infected. The average age at presentation for HIV infected children with upper airway obstruction resulting eventually in tracheostomy was 9.4 months and 60% were under 1 year of age. Only three (20%) were on Anti-Retroviral Therapy (ART) prior to presentation. The cause of upper airway obstruction was croup in 14 (93%) of these 15 children. Following tracheostomy all were treated with ART. To date six children have been successfully decannulated (40%) and there have been three deaths (20%) which were unrelated to tracheostomy. CONCLUSION: Tracheostomy in HIV positive children is not associated with the high mortality that has been reported in adults provided such children are started on treatment with antiretroviral therapy.

Mastoiditis at Red Cross War Memorial Children's Hospital; Cape Town; 1999-2003

During the 5-year period 1999 - 2003; we treated 36 children with a clinical diagnosis of mastoiditis. Post-auricular tenderness; swelling or abscess was the presenting feature in all cases. Twenty of these children had acute mastoiditis; 12 had acute-onchronic mastoiditis and 4 had a post-auricular abscess and no signs of mastoiditis on mastoid exploration (pseudomastoiditis). No pathogenic organisms were cultured from 25of cases overall; but among those with positive culture Streptococcus pyogenes and Staphylococcus aureus were the commonest organisms in the acute mastoiditis group and Proteus mirabilis was the commonest in the acute-on-chronic group. In the acute mastoiditis group (20 patients) only 1 patient was successfully treated with antibiotics; the rest requiring cortical mastoidectomy. In the acute-on-chronic mastoiditis group (12 patients) 9 children had cholesteatoma and underwent an open cavity procedure and the other 3; who underwent cortical mastoidectomy; all had positive histology/culture for tuberculosis

Suprahyoid approach to base-of-tongue squamous cell carcinoma.

OBJECTIVE: To evaluate the suprahyoid approach to treatment of squamous cell carcinoma of the base of the tongue at Groote Schuur Hospital between 1999 and 2004. DESIGN AND METHOD: Retrospective analysis was done of patients with base-of-tongue squamous cell carcinoma treated using the suprahyoid approach. RESULTS: Seventeen patients underwent treatment for base-of-tongue squamous cell carcinoma utilising the suprahyoid approach. Complete medical records were available for 15 of these patients. The most common presenting symptoms were neck mass (40%) and referred otalgia (33%). Alcohol was a risk factor in more patients (64%) than smoking (47%). Adverse pathological findings were present in less than 50% of patients (involved margins 20%, perineural invasion 40%, vascular invasion 33%). Functional outcome in terms of speech intelligibility was excellent and there were minimal swallowing problems, with most patients using compensatory strategies and dietary modification. There were 2 subsequent deaths (13%) as a result of distant metastasis and a second primary. CONCLUSION: The suprahyoid approach to treatment of base-of-tongue squamous cell carcinoma provides good exposure, local tumour control and excellent functional outcome.

Adult tonsillectomy - are long waiting lists putting patients at risk? : otolaryngology

There is a paucity of data on morbidity associated with long waiting lists for adult tonsillectomy. The aim of this study was to assess the morbidity associated with long waiting lists for adult tonsillectomy in a developing world setting. Of 350 patients on the waiting list at Groote Schuur Hospital for 18 months or more; only 55 were contactable. This low yield (15.7) from the telephonic survey highlighted the difficulty of managing long waiting lists efficiently in a developing world setting. As only 1/55 patients on the waiting list had a complication (quinsy); it appears to be safe to delay tonsillectomy in adult patients. Only half of patients ultimately required tonsillectomy because of a natural reduction in the number of episodes of tonsillitis with time. In order to avoid unnecessary tonsillectomy we need to find better prognosticators to identify the subgroup of adult patients likely to have continued recurrent tonsillitis

An interview with Professor John Chiphangwi.

This interview was conducted on April 10th, 2000. At the time of this interview, Professor Chiphangwi mentioned how tired he felt and how much he longed for retirement. We are deeply saddened that illness has overtaken his plans for retirement and will not allow him to enjoy to the full this milestone of ten years of the College of Medicine. We acknowledge his personal vision and enormous contribution.