ABSTRACT
An elderly male, a former smoker, was evaluated at the pulmonary medicine clinic for recurrent episodes of streaky hemoptysis for the last 3 years. He had a history of being successfully treated for microbiologically confirmed pulmonary tuberculosis in the past. He presented in this consultation with two episodes of large volume hemoptysis, and the laboratory results suggested an ongoing active infection. Sputum smear was negative for an infectious etiology. Contrast-enhanced CT of the thorax revealed a lung cavity in the right upper lobe. He underwent flexible bronchoscopy with bronchoalveolar lavage which revealed Klebsiella pneumoniae infection. Small-diameter bronchoscope was used to navigate into the affected lung segment which revealed a cave-like appearance. This was an interesting finding and physicians should be familiar with such bronchoscopic findings and techniques in the management of their patients, particularly in tuberculosis endemic areas.
ABSTRACT
Despite adequate treatment for diabetes, it is estimated that 15%- 20% of people with diabetes are struggling with a moderate to severe form of depression daily. Little is known about depression in diabetes in East Africa, particularly in Tanzania. The study is aimed at determining the prevalence of depression and associated factors among patients with diabetes. A descriptive cross-sectional study was carried out at the diabetes clinic of Muhimbili National Hospital. The 9-item Patient Health Questionnaire (PHQ 9) scale was used to assess presence of depressive symptoms among diabetes patients at the clinic. In addition, patient's sociodemographic and clinical characteristics were obtained and analysed for their association with depression. A total of 353 participants were recruited, of whom 229 (64.9%) patients were female and 156 (44.2%) were aged between 41 and 60 years. The overall prevalence of depression among diabetes patients at the diabetes clinic was 87%. Most (56.7%) had minimal depression, 22.1% had mild depression, and 8.2% had moderate depression. None had severe depression. Factors independently associated with a diagnosis of mild to moderate depression were being on insulin therapy and being a current smoker. There was a high prevalence of depression in this diabetic population. Majority of patients had minimal depression but about 30% had either mild or moderate depression. A holistic approach that focuses on the identification and management of depression among patients with diabetes is recommended.
ABSTRACT
Depression is a common condition in developed countries and is a growing problem in developing countries like Tanzania. Various risk factors have been identified through different studies. This study aimed at finding the prevalence of depression in a predominantly migrant Asian community and the behavioral, familial, social, and medical factors influencing it. A cross-sectional study among adults in a closed Asian community was done. Interviews and self-administered questionnaires were used to obtain details of symptoms and factors related to depression. DSM-IV criteria were used to diagnose depression in the individuals. Factors were assessed for significance using Chi square test. A total 384 participants were interviewed. Depression was found in 6.5% of the population. Risk factors included psychological stress (p < 0.001, OR = 6.37, 95% CI = 2.42-16.69) and a family history of depression (p = 0.023, OR = 2.57, 95% CI = 1.02-6.42). A sufficient family income was associated with a lower risk of depression (p = 0.013, OR = 0.21, 95% CI = 0.06-0.77). The prevalence of depression is within the range of the worldwide prevalence. Past psychological trauma and a family history of depression were significant risk factors, while a sufficient income was protective.
ABSTRACT
BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency, which is potentially fatal. Proper management of UGIB requires risk-stratification of patients which can guide the type and aggressiveness of management. The aim of this was study was identify the causes of UGIB and factors that increase the risk of mortality in these patients. METHODS: This was a prospective cohort study conducted over a period of seven months at a tertiary hospital. Adults admitted with UGIB were included in the study. Demographic data, laboratory parameters and endoscopic findings were recorded. Patients were then followed up for 60 days to identify the occurrence of mortality. Chi-square tests and cox-regression was used to determine association between risk factors and mortality in the bivariate and multivariate analysis, respectively. RESULTS: A total of 170 patients with UGIB were included. Males accounted for the majority (71.2%). Median age of the study population was 40.0 years. Chronic liver disease was present in 30.6% of study patients. The most common cause of UGIB among the 86 patients who underwent endoscopy was oesophageal varices (57%), followed by peptic ulcer disease (18%) and gastritis (10%). Mortality occurred in 57 patients (33.5%) and was significantly higher in patients with high white blood cell count (HR 2.45, p 0.011), raised serum alanine aminotransferase (HR 4.22, p 0.016), raised serum total bilirubin (HR 5.79, p 0.008) and lack of an endoscopic procedure done (HR 4.40, p <0.001). Rebleeding was reported in 12 patients (7.1%) and readmission due to UGIB in 4 patients (2.4%) CONCLUSIONS: Oesophageal varices was the most common cause of UGIB. One-third of patients admitted with upper gastrointestinal bleeding died within 60 days of admission, signifying a high burden. Rebleeding and readmission rates were low. A high WBC count, raised serum ALT, raised serum total bilirubin and a lack of endoscopy were independent predictors of mortality. These findings can be used to risk-stratify patients who may benefit from early and more aggressive management.
