Dynamic Bowel Obstruction: Aetiology; Clinical Presentation; Management and Outcome at Bugando Medical Centre; Mwanza; Tanzania

Dynamic bowel obstruction is a common and potentially dangerous surgical emergency with high morbidity and mortality worldwide. No prospective study has been done on this subject in our setting. This study was conducted to describe in our region; the aetiology; clinical presentation; management and outcome of dynamic bowel obstruction. Data were analyzed using SPSS software system. A total of 342 patients were studied. Males outnumbered females by a ratio of 2.1: 1. The median age of patients at presentation was 34 years (range 11 to 78 years). Obstructed hernias (32.7) were the commonest cause of dynamic bowel obstruction. Abdominal pain (100) and vomiting (86.5) were the most frequent presenting symptoms. Thirty-one (9.1) patients were HIV positive. Small bowel was the commonest site of obstruction accounting for 89.2 of cases. Herniorrhaphy was the most frequent surgical procedure performed in 112 (32.7) patients. Surgical site infection (38.8) was the most common post-operative complication and it was significantly associated with HIV positivity and low CD 4+ count (p0.001). The overall median of length of hospital stay was 26 days (range 1 to 72 days). Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p

Dermatological Malignancies at a University Teaching Hospital in North-Western Tanzania: A Retrospective Review of 154 Cases

"Abstract:Dermatological malignancies are among the most common form of cancers and the global incidence has been increasing at an alarming rate. A retrospective study was conducted to determine the prevalence; histopathological pattern; anatomical distribution and treatment outcome of dermatological malignancies at Bugando Medical Centre in North-western Tanzania. Data were collected from patients' files kept in the Medical record department; the surgical wards; operating theatre and histopathology laboratory and analyzed using Statistical package for social sciences system. A total of 154 patients with a histopathological diagnosis of dermatological malignancy were studied. Generally; males outnumbered females by a ratio of 1.4:1. The majority of patients were in the 5th and 6th decades of life. Malignant melanoma was the most common dermatological malignancy (67.5) followed by Kaposi's sarcoma (10.4); Squamous cell carcinoma (8.4) and Basal cell carcinoma(7.8). The lower limbs were the most frequent site accounting for 55.8. Wide local excision was the most common surgical procedure performed in 79.2 of cases. Post-operative wound infection was the most common complication in 58.3 of patients. Mortality rate was 3.8. Dermatological malignancies are more prevalent in our setting. A high index of suspicion is needed to avoid labelling malignancies ""chronic ulcers"" and all suspected lesions should be biopsed."

Geriatric Injuries among Patients Attending a Regional Hospital in Shinyanga Tanzania

Abstract:Geriatric injuries pose a major challenge to surgeons and general practitioners in developing countries. The objective of this study was to determine the prevalence; injury characteristics and outcomes of geriatric injury among patients at Shinyanga Regional Hospital in Tanzania. Data was collected using a pre-tested; coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7 of all trauma admissions were studied. The male to female ratio was 1.4:1. Their mean age was 68.5 years (ranged 60-98 years). Premorbid illness was reported in 38.3 of patients. Most injuries were intentional in fifty-three (56.4) patients. Assaults; falls and road traffic crashes were the mechanism of injuries in 52.1; 19.1and 11.7 of cases; respectively. The majority of cases of assault were females accounting for 64.6. The majority of injuries (81.9) occurred at home. Pre-hospital care was recorded in 5.3 of cases. The musculoskeletal (72.3) and head (66.0) regions were commonly affected. Soft tissue injuries (wounds) (89.4) and fractures (52.2) were the most common type of injuries. The majority of patients (90.4) underwent surgical treatment of which wound debridement was the most common procedure performed in 91.8 of cases. Complication rate was 39.4. The mean length of hospital stay was 28.6 days (ranged 1 - 124 days). The length of hospital stay was significantly longer in patients with co-morbidities; long bone fractures and those with complications (P0.05). Mortality rate was 14.9 and it was significantly related to advanced age; presence of pre-morbid illness; high injury severity score; severe head injuries and the need for ventilatory support (P 0.05). In conclusion; traumatic injuries in elderly constitute a major but preventable public health problem in Shinyanga region and contribute significantly to high morbidity and mortality. Urgent preventive measures focusing at the root causes of the injuries and early appropriate treatment is highly needed to reduce the occurrence; morbidity and mortality associated with these injuries