Pleomorphic adenoma (mixed tumor) of the upper lip: A case report.

BACKGROUND: Salivary gland tumors are relatively rare. Most minor salivary gland tumors are malignant with benign tumors accounting for 18% of the tumors. Pleomorphic adenoma (PA) is the most common salivary gland tumor. Lip PA is uncommon with 9.8% occurring in the upper lip. We are adding on the knowledge of the rare upper lip PA (benign mixed tumor). CASE SUMMARY: We report an upper lip PA (benign mixed tumor) in a 28-year-old man. His complaint was a painless swelling on the upper lip. A painless, non-tender, well-circumscribed, slightly mobile, sessile, nodular, and rubbery (in consistency) tumor measuring 5.0 cm x 2.0 cm was noted on the left side of his upper lip. The overlying skin was not fixed and of normal color. There was no ulceration, and palpation did not elicit pain or bleeding. There was no history of trauma. Blunt dissection was used to completely excise the nodular, whitish, and encapsulated tumor. Microscopy showed a well-circumscribed and partly encapsulated biphasic lesion, with large lobules of myxo-chondroid stroma and intervening cellular nodules of basaloid cells, well-formed tubules containing eosinic secretion, and nests of myoepithelial cells. A diagnosis of PA (benign mixed tumor) was confirmed. CONCLUSION: Blunt dissection is indicated to preserve the cosmesis and function of the upper lip.

Ossifying Fibroma in the Maxilla and Mandible: A Case Report With a Brief Literature Review.

Fibro-osseous lesions in the jaw bones include fibrous dysplasia, ossifying fibroma (OF), cemento-ossifying fibroma, florid osseous dysplasia, and focal osseous dysplasia. OF is the most common fibro-osseous tumor that presents as a slow-growing well-encapsulated benign neoplasm composed of varying amounts of bone or cement-like tissue in a fibrous stroma well-demarcated from the adjacent normal bone. OF is most common in the jaw bones, with a predilection for the mandible. OF usually occur as solitary lesions and rarely as multiple lesions in a patient. We present clinical and radiologic features, histopathology, and surgical management of a rare case with large synchronous OFs in the mandible and maxilla and a brief review of the literature.

Health professions faculty's perceptions of online teaching and learning during the COVID-19 pandemic.

The global societal impact of the COVID-19 pandemic is incalculable with profound social suffering, deep economic hardships and enforced closure of schools, businesses, and higher learning institutions through the imposition of lockdown and social distancing in mitigation of the spread of the SARS-Cov-2 infection. Institutions have had to hastily migrate teaching, learning and assessment to online domains, at times with ill-prepared academics, students and institutions and with unwelcome and disorienting consequences. Our study surveyed perspectives of faculty at the University of Zimbabwe Faculty of Medicine and Health Sciences (UZFMHS) towards the hastily adopted online teaching, learning and assessment implemented in response to the mitigation of the COVID-19 pandemic. Twenty nine (29) faculty in all the major disciplines and career hierarchy. There were mixed responses regarding the use of this modality for teaching, learning and assessment: training before online teaching, learning and assessment, advantages and disadvantages, cost effectiveness, effectiveness for teaching, learning and assessment, effect on student feedback, disruptions from internet connectivity issues, interaction with students, suitability for practical training, and barriers to online teaching, learning and assessment. These results would enable the UZFMHS develop institutional and personalised approaches that would enable execution of online teaching, learning and assessment under the current and post COVID-19 pandemic.

Emergency Medical Services (EMS) Utilization in Zimbabwe: Retrospective Review of Harare Ambulance System Reports.

Background: Emergency medical services (EMS) are a critical but often overlooked component of essential public health care delivery in low- and middle-income countries (LMICs). Few countries in Africa have established EMS and there is scant literature to provide guidance for EMS growth. Objective: This study aimed to characterize EMS utilization in Harare, Zimbabwe in order to guide system strengthening efforts. Methods: We performed a retrospective chart review of patient care reports (PCR) generated by the City of Harare ambulance system for patients transported and/or treated in the prehospital setting over a 14-month period (February 2018 - March 2019). Findings: A total of 875 PCRs were reviewed representing approximately 8% of the calls to EMS. The majority of patients were age 15 to 49 (76%) and 61% were female patients. In general, trauma and pregnancy were the most common chief complaints, comprising 56% of all transports. More than half (51%) of transports were for inter-facility transfers (IFTs) and 52% of these IFTs were maternity-related. Transports for trauma were mostly for male patients (63%), and 75% of the trauma patients were age 15-49. EMTs assessed and documented pulse and blood pressure for 72% of patients. Conclusion: In this study, EMS cared primarily for obstetric and trauma emergencies, which mirrors the leading causes of premature death in LMICs. The predominance of requests for maternity-related IFTs emphasizes the role for EMS as an integral player in peripartum maternal health care. Targeted public health efforts and chief complaint-specific training for EMTs in these priority areas could improve quality of care and patient outcomes. Moreover, a focus on strengthening prehospital data collection and research is critical to advancing EMS development in Zimbabwe and the region through quality improvement and epidemiologic surveillance.

Microstomia Following Caustic Soda Ingestion: Report of a Case.

Caustic soda ingestion causes strictures in the respiratory, gastrointestinal systems and even death. In the oral and perioral areas it causes contractures leading to microstomia that is difficult to manage to restore structure and function of the oral cavity. The present case is of a 42-year-old female who presented with microstomia, no endoscopic esophageal injury and ankyloglossia following ingestion of caustic soda in an attempted suicide following a dispute with her spouse. Satisfactory mouth opening and tongue movement were achieved by bilateral release of buccal contractures, commissuroplasty and release of the tongue that was tethered to the floor of the mouth.

Understanding Ethical, Legal and Societal Issues (ELSIs) in Human Biobanking and Genomics for Research and Healthcare in Zimbabwe: The Genomics Inheritance Law Ethics and Society (GILES) initiative.

Biobanks and human genomics applications are key for understanding health, disease and heredity in Africa and globally. Growing interest in these technologies calls for strengthening relevant legal, ethical and policy systems to address knowledge disparities and ensure protection of society, while supporting advancement of science. In Zimbabwe there is limited understanding of ethical, legal, and societal issues (ELSI) for biobanking and genomics. The Genomics Inheritance Law Ethics and Society (GILES) initiative was established in 2015 to explore the current status and gaps in the ethical and legal frameworks, knowledge among various stakeholders, and to establish capacity for addressing ELSI of biobanking and genomics as applied in biomedical and population research, and healthcare. A multi-methods approach was applied including document reviews, focus group discussions and in-depth interviews among health and research professionals, and community members in six provinces comprising urban, peri-urban and rural areas. Emerging findings indicates a need for updating guidelines and policies for addressing ELSI in biobanking and genomics research in Zimbabwe. Emerging terminologies such as biobanking and genomics lack clarity suggesting a need for increased awareness and educational tools for health professionals, research scientists and community members. Common concerns relating to consent processes, sample and data use and sharing, particularly where there is trans-national flow of biospecimens and data, call for nationally tailored ELSI frameworks aligned to regional and international initiatives. This paper describes the strategy undertaken for the development and implementation of the GILES project and discusses the importance of such an initiative for characterisation of ELSI of human biobanking and genomics in Zimbabwe and Africa. Conducting this explorative study among a wide range of stakeholders over a countrywide geographical regions, established one of the most comprehensive studies for ELSI of human biobanking and genomics in Africa.

Medical Education Partnership Initiative (MEPI) in Zimbabwe: Outcomes and Challenges.

BACKGROUND: Sub-Saharan Africa has an inadequate number of health professionals, leading to a reduced capacity to respond to health challenges, including HIV/AIDS. From 2010 to 2015, the Medical Education Partnership Initiative (MEPI)-sponsored by the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health (NIH)-was enthusiastically taken up by the University of Zimbabwe College of Health Sciences (UZCHS) and 12 other sub-Saharan African universities to develop models of training to improve medical education and research capacity. In this article, we describe the outcomes and challenges of MEPI in Zimbabwe. METHODS: UZCHS in partnership with the University of Colorado, Denver; Stanford University; University of Cape Town; University College London; and King's College London designed the Novel Education Clinical Trainees and Researchers (NECTAR) program and 2 linked awards addressing cardiovascular disease and mental health to pursue MEPI objectives. A range of medical education and research capacity-focused programs were implemented, including faculty development, research support, mentored scholars, visiting professors, community-based education, information and technology support, cross-cutting curricula, and collaboration with partner universities and the ministries of health and education. We analyzed quantitative and qualitative data from several data sources, including annual surveys of faculty, students, and other stakeholders; workshop exit surveys; and key informant interviews with NECTAR administrators and leaders and the UZCHS dean. FINDINGS: Improved Internet connectivity and electronic resource availability were early successes of NECTAR. Over the 5-year period, 69% (115 of 166) of faculty members attended at least 1 of 15 faculty development workshops. Forty-one faculty members underwent 1-year advanced faculty development training in medical education and leadership. Thirty-three mentored research scholars were trained under NECTAR, and 52 and 12 in cardiovascular and mental health programs, respectively. Twelve MEPI scholars had joined faculty by 2015. Full-time faculty grew by 36% (122 to 166), annual postgraduate and medical student enrollment increased by 61% (75 to 121) and 71% (123 to 210), respectively. To institutionalize and sustain MEPI innovations, the Research Support Center and the Department of Health Professions Education were established at UZCHS. CONCLUSION: MEPI has synergistically revitalized medical education, research capacity, and leadership at UZCHS. Investments in creating a new research center, health professions education department, and, programs have laid the foundation to help sustain faculty development and research capacity in the country.

Health Education Advanced Leadership for Zimbabwe (Healz): Developing the Infrastructure to Support Curriculum Reform.

An economic crisis in Zimbabwe from 1999-2009 resulted in a shortage of faculty at the University of Zimbabwe College of Health Sciences (UZCHS) and declining enrollment and graduation rates. To improve proficiency and retention of graduates, the college sought to develop a competency-based curriculum using evidence-based educational methodologies. Achievement of this goal required a cadre of highly qualified educators to lead the curriculum review and innovation processes. The Health Education Advanced Leadership for Zimbabwe (HEALZ) program was established in 2012 to rapidly develop the needed faculty leadership. HEALZ is a one-year program of rigorous coursework delivered face-to-face in three intensive one-week sessions. Between sessions, scholars engage with mentors to conduct a needs assessment and to develop, implement, and evaluate a competency-based curriculum. Forty scholars completed training from 2012-15. All participants reported they were satisfied or extremely satisfied with the training after each week. Pre-post surveys identified significant knowledge gains in all key content domains. The program garnered significant organizational support. Scholars showed significant variation in progress toward implementing and evaluating their curricula as well as the quality of the work demonstrated by program end. Interviews of scholars and UZCHS leaders revealed important impacts of the program on the quality and culture of medical education at the college.

Access, attitudes and training in information technologies and evidence-based medicine among medical students at University of Zimbabwe College of Health Sciences.

BACKGROUND: The Medical Education Partnership Initiative, has helped to mitigate the digital divide in Africa. The aim of the study was to assess the level of access, attitude, and training concerning meaningful use of electronic resources and EBM among medical students at an African medical school. METHODS: The study involved medical students at the University of Zimbabwe College of Health Sciences, Harare. The needs assessment tool consisted of a 21-question, paper-based, voluntary and anonymous survey. RESULTS: A total of 61/67 (91%), responded to the survey. 60% of the medical students were 'third-year medical students'. Among medical students, 85% of responders had access to digital medical resources, but 54% still preferred printed medical textbooks. Although 25% of responders had received training in EBM, but only 7% found it adequate. 98% of the participants did not receive formal training in journal club presentation or analytical reading of medical literature, but 77 % of them showed interest in learning these skills. CONCLUSION: Lack of training in EBM, journal club presentation and analytical reading skills have limited the impact of upgraded technology in enhancing the level of knowledge. This impact can be boosted by developing a curriculum with skills necessary in using EBM.

Cleft lip-cleft palate in Zimbabwe: estimating the distribution of the surgical burden of disease using geographic information systems.

OBJECTIVES/HYPOTHESIS: To evaluate the prevalence and unmet need for cleft lip-cleft palate reconstructive surgery by using incidence. Our hypotheses were that the age of presentation to screening clinics will decrease between 2006 and 2012, and the geospatial distribution of cases will expand to a more rural catchment area. STUDY DESIGN: Longitudinal cross-sectional/geospatial distribution study. METHODS: An online, secure database was created from intake forms for children with cleft lip-cleft palate (N=604) in Zimbabwe (2006-2012). Univariate analysis was completed. A linear regression model was fitted to test the time trend of a child's age at the time of presentation. Unique patient addresses (n=411) were matched. Maps presenting cleft diagnosis and presentation year were created with geographic information systems (GIS) software. RESULTS: The median age of presentation was greater for isolated cleft palate (4.2 years, n=106) than isolated cleft lip (1.5 years, n=251) and cleft lip-cleft palate (2.0 years, n=175). Cleft lip cases were mostly left sided with equal gender distribution. The overall age of presentation remained stable (P=.83). The age of children with isolated cleft palate decreased by 0.8 years per surgical trip (P=.01), suggesting the prevalence of unrepaired cleft palate is decreasing due to local and visiting surgeons. The catchment area extended to a less populous area, but clustered around Harare and Bulawayo. CONCLUSIONS: This study gives Zimbabwe-specific evidence that supports reports of the persistent burden of disease requiring attention. The GIS software provided data for the primary needs assessment, which will direct communication to healthcare providers and prospective patients outside of the current catchment area. LEVEL OF EVIDENCE: 3

Strengthening research governance for sustainable research: experiences from three Zimbabwean universities.

A robust research system requires a robust governance framework. As part of the Medical Education Partnership Initiative, three Zimbabwean universities partnered with two U.S. universities in a project to strengthen research governance in the Zimbabwean universities. The project aimed at (1) developing research policies, (2) strengthening central research management offices, (3) developing a research administration curriculum, and (4) enhancing awareness about the role and relevance of research administration in other universities and research institutions in Zimbabwe. Through the efforts of the partners, a generic research policy was developed and successfully adapted by the institutions. A curriculum was drafted, and module development experts are helping to finalize the curriculum to meet university requirements for accreditation of training research administrators. The Association of Research Managers of Zimbabwe was established to promote information sharing and professionalize research administration. The consortium approach enabled rapid and smooth development and adoption of research policies in the institutions. It also helped researchers and managers accept research administration as an essential structure and function. The experiences and lessons learned are reported here to benefit other institutions and consortia.

Innovations to enhance the quality of health professions education at the University of Zimbabwe College of Health Sciences--NECTAR program.

The University of Zimbabwe College of Health Sciences (UZCHS) is Zimbabwe's premier health professions training institution. However, several concerns were raised during the past decade over the quality of health education at UZCHS. The number of faculty and students declined markedly until 2010, when there was a medical student intake of 147 while the faculty comprised only 122 (39%) of a possible 314 positions. The economic and political crises that the country experienced from 1999 to 2009 compounded the difficulties faced by the institution by limiting the availability of resources. The Medical Education Partnership Initiative funding opportunity has given UZCHS the stimulus to embark on reforms to improve the quality of health education it offers. UZCHS, in partnership with the University of Colorado School of Medicine, the University of Colorado Denver Evaluation Center, and Stanford University, designed the Novel Education Clinical Trainees and Researchers (NECTAR) program to implement a series of health education innovations to meet this challenge. Between 2010 and 2013, innovations that have positively affected the quality of health professions education at UZCHS include the launch of comprehensive faculty development programs and mentored clinical and research programs for postgraduate students. A competency-based curriculum reform process has been initiated, a health professions department has been established, and the Research Support Center has been strengthened, providing critical resources to institutionalize health education and research implementation at the college. A core group of faculty trained in medical education has been assembled, helping to ensure the sustainability of these NECTAR activities.

Substantial regional differences in human herpesvirus 8 seroprevalence in sub-Saharan Africa: insights on the origin of the "Kaposi's sarcoma belt".

Equatorial Africa has among the highest incidences of Kaposi's sarcoma (KS) in the world, thus earning the name "KS Belt." This was the case even before the HIV epidemic. To date, there is no clear evidence that HHV-8 seroprevalence is higher in this region but interpretation of the available literature is tempered by differences in serologic assays used across studies. We examined representatively sampled ambulatory adults in Uganda, which is in the "KS Belt," and in Zimbabwe and South Africa which are outside the Belt, for HHV-8 antibodies. All serologic assays were uniformly performed in the same reference laboratory by the same personnel. In the base-case serologic algorithm, seropositivity was defined by reactivity in an immunofluorescence assay or in 2 enzyme immunoassays. A total of 2,375 participants were examined. In Uganda, HHV-8 seroprevalence was high early in adulthood (35.5% by age 21) without significant change thereafter. In contrast, HHV-8 seroprevalence early in adulthood was lower in Zimbabwe and South Africa (13.7 and 10.8%, respectively) but increased with age. After age adjustment, Ugandans had 3.24-fold greater odds of being HHV-8 infected than South Africans (p < 0.001) and 2.22-fold greater odds than Zimbabweans (p < 0.001). Inferences were unchanged using all other serologic algorithms evaluated. In conclusion, HHV-8 infection is substantially more common in Uganda than in Zimbabwe and South Africa. These findings help to explain the high KS incidence in the "KS Belt" and underscore the importance of a uniform approach to HHV-8 antibody testing.

Xeroderma pigmentosum: a retrospective case series in Zimbabwe.

PURPOSE: To present our experience with the clinical features and management of black African patients with xeroderma pigmentosum (XP). PATIENTS AND METHODS: Twelve patients with XP were seen over a 25-year period, and were retrospectively reviewed for age, gender, clinical features, treatment, and follow-up. RESULTS: There were 8 females and 4 males with an age range of 3 to 18 years. One patient, the longest survivor, was followed until death at 18 years. Nine patients had the severe form of XP and 3 had the mild form. All patients had early ocular involvement with photophobia and early blindness. Squamous cell carcinoma (SCC) was present on the skin, lip, and tongue in most patients. One patient had ocular surface SCC. There was marked skin photosensitivity. No history of consanguinity was noted in the parents of the patients. Surgery was the treatment modality of choice. Follow-up was poor. CONCLUSION: XP is uncommon in our black population, and presents in the severe form with SCC as the malignant skin, lip, and tongue lesion. It is common in early childhood with severe photosensitivity, photophobia, and eventual blindness. Follow-up is difficult in our environment.

Noma (cancrum oris) in human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV and AIDS): clinical experience in Zimbabwe.

PURPOSE: This retrospective study describes the clinical features and management of noma (cancrum oris) in patients with HIV and AIDS. PATIENTS AND METHODS: Records of 48 consecutive patients with noma (cancrum oris) seen between July 2002 and November 2006 were reviewed for age, gender, clinical features, and management. Other reports on noma in HIV and AIDS in Zimbabwe were also reviewed. RESULTS: There were 48 patients included; 35.4% (n = 17) were males, of which 64.7% (n = 11) were children (16 years and younger) and 35.3% (n = 6) were adults; 64.6% (n = 31) were females, out of which 87.1% (n = 27) were children and 12.9% (n = 4) were adults. The average age was 14.2 years (range, 3 to 30 years) for males and 9.2 years (range, 1 to 36 years) for females. The average age for the entire group was 11 years (range, 1 to 36 years). All patients were HIV-positive by the ELISA method. Only 13 patients had CD4 cell and CD8 cell count obtained, ranging from 10 to 594 cells/microL with a CD4/CD8 ratio ranging from 0.02 to 0.45. Only 5 patients had microbiologic investigations conducted, isolating Staphylococcus aureus, Klebsiella species, group D Streptococcus, and group B hemolytic Streptococcus. Isolated cheek defect (37.5%) was most common, followed by the type I and type IV defect (25% each). Administration of antibiotics, nutritional support, wound debridement, and sequestrectomy were conducted before definitive reconstructive surgery. Facial reconstruction was performed using distant and local advancement flaps. No bony reconstruction was performed. Satisfactory results were achieved with minimal infection and flap breakdown. Follow-up was difficult; patients were lost to follow-up within 6 to 12 months after surgery. CONCLUSION: Noma cases are on the increase in line with the current HIV and AIDS epidemic. Female children appear to be more commonly affected than their male counterparts. Reconstructive surgery is possible in patients with low CD4/CD8 ratios because of HIV infection.

Oral candidiasis as a marker of HIV disease progression among Zimbabwean women.

OBJECTIVES: To estimate oral disease prevalence among Zimbabwean women by HIV serostatus and CD4 cell count and to assess accuracy of oral disease diagnoses made by nurses as compared with an oral surgeon. METHODS: Standardized oral mucosa examinations were performed by trained nurse-examiners and by an oral surgeon among women recruited in Harare, Zimbabwe. RESULTS: A total of 461 women (320 HIV-infected, 141 uninfected) were seen by nurses and an oral surgeon within a 2-week period. Oral candidiasis (OC) was the most common lesion diagnosed in nearly one quarter of HIV-infected women, whereas hairy leukoplakia and Kaposi sarcoma were found in <3%. The prevalence of OC diagnosed by nurses or the surgeon was significantly higher among women with a CD4 count <200 cells/mm than in women with a CD4 count from 200 to 499 cells/mm3 or a CD4 count >499 cells/mm3. The sensitivity of nurse examinations compared with examinations by the oral surgeon among HIV-infected women for the diagnosis of OC was 73%, the specificity was 95%, and the kappa-statistic was 0.71. CONCLUSIONS: OC was the most common lesion in HIV-infected women and was strongly associated with a low CD4 cell count. Interexaminer agreement was good for the diagnosis of OC among HIV-infected women. This study suggests that OC may play a role, in combination with other clinical indicators as a marker of disease progression in resource-poor settings.

Primary malignant melanoma of the oral mucosa.

PURPOSE: To present our experience on the epidemiology, clinical features, management, and survival of patients with oral malignant melanoma. PATIENTS AND METHODS: Records of patients with a histologic diagnosis of primary oral mucosal malignant melanoma seen over a 23-year period were retrospectively reviewed. RESULTS: There were 6 females and 2 males, ranging in age from 18 to 60 years; 4 cases in the maxilla, 2 in the mandible, 1 on the lower lip, and 1 on the buccal mucosa. Local recurrences developed in 2 patients who eventually died with clinical metastatic cervical nodal disease. Follow-up ranged from 6 months to 16 years 3 months. Surgery was the only treatment available. CONCLUSION: Primary oral mucosal melanoma is rare, with a 3 to 1 female to male ratio and an average age of 41.7 years at presentation. It is most common in the maxilla and has poor prognosis despite apparent adequate local surgical control.

Ranula: experience with 83 cases in Zimbabwe.

PURPOSE: To document the clinical features, management, and outcome of ranulas in Zimbabwe. METHODS: A retrospective review of clinical and pathologic records of 83 patients with ranulas who presented during the period of January 1981 to September 2003 was undertaken. RESULTS: Thirty-six (43.4%) of the ranulas were in males and 47 (56.6%) in females. Sixty-one (73.5%) were in the 0 to 10-year-old age group. Oral ranulas (92.8%) were equally distributed on the right and left sublingual region. Six (7.2%) were plunging ranulas. In a study group of 38 patients, 88.5% of ranula patients were HIV-positive with 95% of them in the 0 to 10-year-old age groups. Excision of ranula with sublingual gland removal was done in 80.7% of the cases with 0% recurrence; marsupialization (cavity left open and cavity packed) was done in 12% (n = 10) of the patients with 20% (n = 2) recurrence. CONCLUSIONS: Female predominance with no right or left sublingual region predilection was noted. Ranula was most common in the 0 to 10-year-old age group; 95% of this group were HIV positive. HIV salivary gland disease could be an etiologic factor. No recurrence was observed when the ranula was excised along with removal of the sublingual gland. Plunging ranula is uncommon.