Outcomes of Surgical Tracheostomy on Mechanically Ventilated COVID-19 Patients Admitted to a Private Tertiary Hospital in Tanzania.

OBJECTIVES:  The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in the number of patients necessitating prolonged mechanical ventilation. Data on patients with COVID-19 undergoing tracheostomy indicating timing and outcomes are very limited. Our study illustrates--- outcomes for surgical tracheotomies performed on COVID-19 patients in Tanzania. METHODS:  This was a retrospective observational study conducted at the Aga Khan Hospital in Dar es Salaam, Tanzania. RESULTS:  Nineteen patients with COVID-19 underwent surgical tracheotomy between 16th March and 31st December 2021. All surgical tracheostomies were performed in the operating theatre. The average duration of intubation prior to tracheotomy and tracheostomy to ventilator liberation was 16 days and 27 days respectively. Only five patients were successfully liberated from the ventilator, decannulated, and discharged successfully. CONCLUSIONS:  This is the first and largest study describing tracheotomy outcomes in COVID-19 patients in Tanzania. Our results revealed a high mortality rate. Multicenter studies in the private and public sectors are needed in Tanzania to determine optimal timing, identification of patients, and risk factors predictive of improved outcomes.

Factors Associated with Mortality Among Hospitalized Adults with COVID-19 Pneumonia at a Private Tertiary Hospital in Tanzania: A Retrospective Cohort Study.

BACKGROUND: The emergence of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There has been paucity of data for hospitalized African patients suffering from COVID-19. This study aimed to identify factors associated with in-hospital mortality in patients suffering from COVID-19 in Tanzania. METHODS: This was a single center, retrospective, observational cohort study in adult patients hospitalized with confirmed COVID-19 infection. Demographics, clinical pattern, laboratory and radiological investigations associated with increased odds of mortality were analyzed. RESULTS: Of the 157 patients, 107 (68.1%) patients survived and 50 (31.8%) died. Mortality was highest in patients suffering with severe (26%) and critical (68%) forms of the disease. The median age of the cohort was 52 years (IQR 42-61), majority of patients were male (86%) and of African origin (46%), who presented with fever (69%), cough (62%) and difficulty in breathing (43%). Factors that were associated with mortality among our cohort were advanced age (OR 1.07, 95% CI 1.03-1.11), being overweight and obese (OR 9.44, 95% CI 2.71-41.0), suffering with severe form of the disease (OR 4.77, 95% CI 1.18-25.0) and being admitted to the HDU and ICU (OR 6.68, 95% CI 2.06-24.6). CONCLUSION: The overall in-hospital mortality was 31.8%. Older age, obesity, the severe form of the disease and admission to the ICU and HDU were major risk factors associated with in-hospital mortality.

COVID-19 and stroke in sub-Saharan Africa: case series from Dar es Salaam.

Low and middle-income countries including those in sub-Saharan (SSA) Africa are experiencing a steady increase in the number of COVID-19 cases. To the best of our knowledge, reports of COVID-19 related strokes are scarce in SSA. The peculiar situation of stroke care in SSA makes COVID-19 associated stroke a bothersome entity as it adds other dynamics that tilt the prognostic balance. We present a case series of COVID -19 related stroke in 3 patients from Tanzania. We emphasized protected code stroke protocol.

Postoperative myocardial injury in a patient with left ureteric stone and asymptomatic COVID-19 disease.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic.