39 results on '"Mzee, A."'
Search Results
2. Microbiological Characterisation of Community-Acquired Urinary Tract Infections in Bagamoyo, Tanzania: A Prospective Study
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Joseph Schmider, Nina Bühler, Hasina Mkwatta, Anna Lechleiter, Tarsis Mlaganile, Jürg Utzinger, Tutu Mzee, Theckla Kazimoto, and Sören L. Becker
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antimicrobial susceptibility ,bacteria ,diagnosis ,Escherichia coli ,infection ,Klebsiella spp. ,Medicine - Abstract
Urinary tract infections (UTIs) are among the most common infections in sub-Saharan Africa, but microbiological data to guide treatment decisions are limited. Hence, we investigated the bacterial aetiology and corresponding antimicrobial susceptibility patterns in outpatients with UTIs in Bagamoyo, Tanzania. Urine samples from symptomatic individuals were subjected to microbiological examinations for bacterial species identification using conventional methods and disc diffusion-based resistance testing. Subsequently, urine samples were transferred to Germany for confirmatory diagnostics using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and automated resistance testing. Overall, 104 out of 270 (38.5%) individuals had a positive urine culture and 119 putative pathogens were identified. The most frequently detected bacteria were Escherichia coli (23%), Klebsiella spp. (7%), Enterobacter cloacae complex (3%) and Staphylococcus aureus (2%). E. coli isolates showed high resistance against cotrimoxazole (76%), ampicillin (74%), piperacillin (74%) and fluoroquinolones (37%), but widespread susceptibility to meropenem (100%), fosfomycin (98%), piperacillin/tazobactam (97%) and amoxicillin/clavulanic acid (82%). The agreement between E. coli susceptibility testing results in Tanzania and Germany was ≥95%, except for piperacillin/tazobactam (89%) and ciprofloxacin (84%). Given the considerable resistance to frequently prescribed antibiotics, such as cotrimoxazole and fluoroquinolones, future research should explore the potential of oral alternatives (e.g., fosfomycin) for the treatment of UTIs in Tanzania.
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- 2022
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3. Obstetric fistulae, birth outcomes, and surgical repair outcomes: a retrospective analysis of hospital-based data in Dodoma, Tanzania
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Athanase Lilungulu, Balthazar Gumodoka, Mzee Nassoro, Patrice Soka, and Kibusi Stephen
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obstetrics fistula ,recto-vaginal fistula ,vesico-vaginal fistula ,surgical repair ,female genital mutilation ,Tanzania. ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Introduction: Obstetric Fistula (OF) among pregnant women remains a widespread condition with devastating consequences and poses a significant challenge in a community as well as globally. Objective: To determine the predictors and contributing factors associated with OF and birth outcomes in women undergoing fistula repair at the Dodoma Regional Referral Hospital (DRRH). Method: This retrospective study used hospital records of women repaired over 2013 and 2014. Data were analysed using SPSS version 21 for Window (SPSS Inc., Chicago, IL, USA). Frequency tables were generated and bivariate analyses were conducted to determine the contributing factors associated with OF using chi-squared statistics. Results: Fifty two women underwent surgical repair of a fistula; 47(90.2%) were primiparous and 5(9.6%) multiparous. There were 42(80.8%) vesico-vaginal fistulae (VVF), and 10(19.2%) recto-vaginal fistulae (RVF). Of those with VVF 5 (9.6%) had been living with urine leakage for 10 years, 25 (48.1%) for 17 years, and 12 (23.1%) for 20 years; all 10 (19.2%) with RVF had been living with the defect for 10 years. No patient had been living with both vaginal and recto fistulae. Most of the fistulas were associated with prolonged difficult spontaneous vaginal delivery but two were associated with surgery: Caesarean Section and hysterectomy. Surgical repair was by the transvaginal 47(90.4%) and trans abdominal 5(9.6%) routes. Female genital mutilation (FGM) was found in all the 28 women from the Gogo tribe but only in 12 of the 24 women from other tribes. Conclusion: Timely fistula repair by experienced fistula surgeons, adhering to fastidious basic surgical principles, will improve outcomes and limit the clinical insult and distress that OF invariably causes. Keywords: obstetrics fistula, recto-vaginal fistula, vesico-vaginal fistula, surgical repair, female genital mutilation, Tanzania.
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- 2018
4. Point-of-Care Approaches for Meningitis Diagnosis in a Low-Resource Setting (Southwestern Uganda): Observational Cohort Study Protocol of the 'PI-POC' Trial
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Gaudenzi, Giulia, Kumbakumba, Elias, Rasti, Reza, Nanjebe, Deborah, Réu, Pedro, Nyehangane, Dan, Mårtensson, Andreas, Nassejje, Milly, Karlsson, Jens, Mzee, John, Nilsson, Peter, Businge, Stephen, Loh, Edmund, Boum II, Yap, Andersson-Svahn, Helene, Gantelius, Jesper, Mwanga-Amumpaire, Juliet, and Alfvén, Tobias
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Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundA timely differential diagnostic is essential to identify the etiology of central nervous system (CNS) infections in children, in order to facilitate targeted treatment, manage patients, and improve clinical outcome. ObjectiveThe Pediatric Infection-Point-of-Care (PI-POC) trial is investigating novel methods to improve and strengthen the differential diagnostics of suspected childhood CNS infections in low-income health systems such as those in Southwestern Uganda. This will be achieved by evaluating (1) a novel DNA-based diagnostic assay for CNS infections, (2) a commercially available multiplex PCR-based meningitis/encephalitis (ME) panel for clinical use in a facility-limited laboratory setting, (3) proteomics profiling of blood from children with severe CNS infection as compared to outpatient controls with fever yet not severely ill, and (4) Myxovirus resistance protein A (MxA) as a biomarker in blood for viral CNS infection. Further changes in the etiology of childhood CNS infections after the introduction of the pneumococcal conjugate vaccine against Streptococcus pneumoniae will be investigated. In addition, the carriage and invasive rate of Neisseria meningitidis will be recorded and serotyped, and the expression of its major virulence factor (polysaccharide capsule) will be investigated. MethodsThe PI-POC trial is a prospective observational study of children including newborns up to 12 years of age with clinical features of CNS infection, and age-/sex-matched outpatient controls with fever yet not severely ill. Participants are recruited at 2 Pediatric clinics in Mbarara, Uganda. Cerebrospinal fluid (for cases only), blood, and nasopharyngeal (NP) swabs (for both cases and controls) sampled at both clinics are analyzed at the Epicentre Research Laboratory through gold-standard methods for CNS infection diagnosis (microscopy, biochemistry, and culture) and a commercially available ME panel for multiplex PCR analyses of the cerebrospinal fluid. An additional blood sample from cases is collected on day 3 after admission. After initial clinical analyses in Mbarara, samples will be transported to Stockholm, Sweden for (1) validation analyses of a novel nucleic acid–based POC test, (2) biomarker research, and (3) serotyping and molecular characterization of S. pneumoniae and N. meningitidis. ResultsA pilot study was performed from January to April 2019. The PI-POC trial enrollment of patients begun in April 2019 and will continue until September 2020, to include up to 300 cases and controls. Preliminary results from the PI-POC study are expected by the end of 2020. ConclusionsThe findings from the PI-POC study can potentially facilitate rapid etiological diagnosis of CNS infections in low-resource settings and allow for novel methods for determination of the severity of CNS infection in such environment. Trial RegistrationClinicalTrials.gov NCT03900091; https://clinicaltrials.gov/ct2/show/NCT03900091 International Registered Report Identifier (IRRID)DERR1-10.2196/21430
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- 2020
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5. Bleeding complications in patients on new oral anticoagulants for venous thromboembolism in Kenya
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Anders Barasa, Jasmit Shah, Ahmed Sokwala, Mzee Ngunga, and Antonina Obayo
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Male ,medicine.medical_specialty ,Aspirin ,business.industry ,General surgery ,Cardiovascular Topics ,Administration, Oral ,Anticoagulants ,Hemorrhage ,Venous Thromboembolism ,General Medicine ,Middle Aged ,Kenya ,Dabigatran ,Text mining ,Rivaroxaban ,Medicine ,Humans ,In patient ,Female ,business ,Cardiology and Cardiovascular Medicine ,Venous thromboembolism ,Aged - Abstract
BACKGROUND: The incidence of bleeding complications in patients with venous thromboembolism (VTE) on new oral anticoagulants (NOACs) has not been widely studied in contemporary clinical practice in Africa. The purpose of this study was to determine the rates of major bleeding, clinically relevant non-major bleeding (CRNM) and minor bleeding associated with NOAC use METHODS: A retrospective review was carried out of patients diagnosed with venous thromboembolism and treated with NOACs at the Aga Khan University Hospital, Nairobi, from January 2014 to December 2019. Clinical and outcome data were collected from medical records and the hospital mortality database. All patients with VTE aged > 18 years and initiated on NOACS were recruited. Patients with missing information were excluded. They were followed up from the time of commencement of oral anticoagulation to completion of therapy, or to the time of the first major bleed, CRNM or minor bleeding. Data on bleeding were obtained from the hospital database and through telephone interviews. Unadjusted rates of the first major bleeding event or CRNM were calculated as the number of bleeding events per 100 person-years. RESULTS: Two hundred and forty-three patients with VTE were recruited and 222 (91.4%) were initiated on rivaroxaban, 12 (4.9%) on dabigatran and nine (3.7%) on apixaban, with a median follow up of 213 [interquartile range (IQR): 119–477] days. The median age of the patients was 57 (IQR: 45–71) years. A total of 64 bleeding events were identified in 50 (20.6%) patients. Overall, the incidence rate for bleeding events was 17.24 per 100 patient-years. The incidence rate of major bleeding was 3.79 per 100 person-years. Gastrointestinal bleeding was the most common major bleeding site. There were more females with bleeding events (70.7%) compared to males. Anaemia and the use of aspirin and other antiplatelets were associated with a higher incidence of major and CRNM bleeding [relative risk (RR) = 3.77, confidence interval (CI) = 1.37–10.39, p = 0.005 and RR = 8.89, CI = 2.06–38.33, p = 0.0003, respectively]. CONCLUSIONS: Most of these bleeds were minor, with the gastrointestinal tract being the most common source of major bleeding and menorrhagia being the commonest cause of bleeding. Anaemia and the use of aspirin were associated with a higher incidence of major bleeding.
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- 2022
6. Case report: The value of early trimester ultrasound scanning: a case of congenital malformation from Kibaha, Tanzania
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Athanase Lilungulu, Willy Mwibea, Mzee Nassoro, and Balthazar Gumodoka
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early trimester sonography ,foetal congenital anomaly ,induction of labour ,intracervical balloon catheter ,misoprostol ,Caesarian Section ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
A case report of a mother presenting at 25 weeks pregnancy. An ultrasound scan suggested the size of the foetus to be about 32 weeks with indications of a malformation and hydrops foetalis. A balloon catheter followed by misoprostol given vaginally was used but labour did not progress satisfactorily. A Caesarean Section was carried out and confirmed the congenital abnormalities. The value of early obstetric ultrasonography is discussed.
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- 2018
7. Performance of Low-Cost Agar from Gracilaria salicornia on Tissue Culture of Pleurotus HK-37
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Farid Mzee Mpatani and Said Ali Hamad Vuai
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Technology ,Medicine ,Science - Abstract
Currently, the demand of Pleurotus HK-37 (oyster mushroom) in Tanzania is growing rapidly due to the increasing of awareness on its nutrition, health, and economic benefits. Despite the increasing demand, the availability of strains of Pleurotus HK-37 species is still a challenge due to high cost of tissue culture technology. The high cost of importing agar seems to be among the factors for this failure. This study aimed at investigating the performance of low-cost agar from local Gracilaria salicornia on tissue culture of Pleurotus HK-37. Local extracted agars with different gel strengths ranging between 100, 200, 300, 400, and 500 g/cm2 were used to make PDA media. The average mycelia growth rate (mm/day) ranged between 9.87 ± 1.44 and 14.9 ± 0.85 mm/day. Low-cost agar shows quite similar performance as that of standard agar on active growth of Pleurotus HK-37 mycelia. All PDA plates appeared white and feathery and showed to grow in a circular mode (radial extension). Mycelia growth on standard agar PDA took 5 days while on extracted local agar PDA took 5 to 7 days to fully colonize the plate at 27 ± 2°C. The present study shows that the production cost can be reduced by ∼35–78% by using local agar.
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- 2019
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8. Safe Thrombolysis During Pregnancy for Recurrent Acute Ischaemic Stroke Due to Concomitant Isolated Left Ventricular Non-Compaction and Bilateral Foetal Posterior Communicating Arteries
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Leonard Mzee Ngunga, Wangari Waweru-Siika, Fatimah Juma, and Dilraj Sokhi
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ischaemic stroke ,medicine.medical_specialty ,Pregnancy ,business.industry ,medicine.medical_treatment ,stroke in pregnancy ,Case Report ,General Medicine ,Thrombolysis ,left ventricular non-compaction ,medicine.disease ,Heart failure ,Internal medicine ,Concomitant ,Ischaemic stroke ,Circulatory system ,Cardiology ,medicine ,Gestation ,cardiovascular diseases ,foetal posterior communicating artery ,business ,Contraindication - Abstract
Isolated left ventricular non-compaction (ILVNC) is a rare congenital cardiomyopathy and is associated with arrhythmias, heart failure and thromboembolism including ischaemic stroke. Pregnancy is a relative contraindication to thrombolysis for acute ischaemic stroke, although case reports suggest the treatment can be given in selected cases. We report a case of recurrent cryptogenic strokes in a 36-year-old female who was thrombolysed with good outcome at 37 weeks’ gestation and was eventually found to have ILVNC as the cause. She had a predilection to recurrent posterior circulatory strokes due to foetal posterior communicating arteries. To our knowledge this is the first case report of safe thrombolysis for acute ischaemic stroke in pregnancy caused by ILVNC.
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- 2021
9. Recent SARS-CoV-2 Outlook and Implications in a COVID-19 Vaccination Era
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Teddy Ehianeta, Said Abdulrahman Salim Mzee, Muslimat Kehinde Adebisi, Oluwayemisi Ehianeta, and Stijn van der Veen
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Host immunity ,Coronavirus disease 2019 (COVID-19) ,SARS-CoV-2 ,business.industry ,breakthrough infections ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Repertoire ,COVID-19 ,Review Article ,Infectious and parasitic diseases ,RC109-216 ,EUA ,medicine.disease_cause ,immune response ,Vaccination ,Molecular mimicry ,Immune system ,vaccine ,Pandemic ,Immunology ,Medicine ,business - Abstract
While repurposed drugs came in handy earlier in the wake of the coronavirus disease 2019 (COVID-19) pandemic, vaccination has been considered a more sustainable approach. The recent spikes have been linked to “double,” “triple,” and even multi-mutant variants, thus renewing calls for deeper structural and functional insights of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a lead to rationale design of therapeutics, vaccines, and point-of-care diagnostics. There is a repertoire of findings from the earliest SARS-CoV-2 molecular mimicry to evade host immunity cum host immune responses to the role of the viral glycocalyx in modulating the susceptibility and severity of infection through attraction and repulsive interactions. Recently, molecular studies of some viral components that aid infection in the face of vaccination seem unending. In addition, the wave of infections and the attendant case fatality ratios have necessitated the need for emergency use authorizations for COVID-19 vaccines and in vitro diagnostics. This review provides key updates of SARS-CoV-2, current antigenic and formulation strategies, with emergency use authorizations considerations for future vaccine candidates and diagnostics. We also premise that despite the difficulty in modeling and analyzing glycans, understanding and exploiting their roles in the SARS-CoV-2 architecture is fundamental to glycan-based COVID-19 vaccines devoid of inconsistent clinical outcomes.
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- 2021
10. International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19
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Nicholas D. Palmer, Marija Vavlukis, Anthony H. Gershlick, Héctor Hugo Escutia-Cuevas, Mzee Ngunga, Otilia Tica, Chris P Gale, Parham Sadeghipour, Pilar Jiménez-Quevedo, Imad Meray, Luciano Candilio, Ghada Kazamel, Gregg W. Stone, Andrew Morrow, Minhaj Arefin, Colin Berry, Sharon Kean, Nick Curzen, Alim Namitokov, Peter Ludman, Jacques Mansourati, Federico Ariel Sanchez, Stephen P. Hoole, Marek Roik, Aly Saad, Albert Ariza-Solé, Shankar Sangaraju, Adriano Caixeta, Jianhua Wu, Gianfranco Sinagra, Manel Sabaté, Thomas A Kite, Steven Lindsay, Iqbal S. Malik, Angel M. Iniesta, Flavien Vincent, Bernard J. Gersh, Vinoda Sharma, and Stefano Savonitto
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,NSTE-ACS, non–ST-segment elevation acute coronary syndrome ,medicine.medical_treatment ,Population ,Infarction ,030204 cardiovascular system & hematology ,Revascularization ,Coronary Angiography ,acute coronary syndrome ,03 medical and health sciences ,non–ST-segment elevation myocardial infarction ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Hospital Mortality ,Registries ,education ,Stroke ,Original Investigation ,COVID-19, coronavirus disease 2019 ,Aged ,education.field_of_study ,PCI, percutaneous coronary intervention ,business.industry ,Cardiogenic shock ,cardiogenic shock ,COVID-19 ,STEMI, ST-segment elevation myocardial infarction ,Middle Aged ,medicine.disease ,ST-segment elevation myocardial infarction ,N-STEMI, non–ST-segment elevation myocardial infarction ,Heart failure ,Emergency medicine ,MI, myocardial infarction ,ACS, acute coronary syndrome ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear. Objectives The purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre–COVID-19 cohorts. Methods From March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re–myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre–COVID-19 databases (MINAP [Myocardial Ischaemia National Audit Project] 2019 and BCIS [British Cardiovascular Intervention Society] 2018 to 2019). Results In 144 ST-segment elevation myocardial infarction (STEMI) and 121 non–ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p, Central Illustration
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- 2021
11. Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania
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Mzee Nassoro, Deogratius Bintabara, Athanase Lilungulu, and Enid Chiwanga
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medicine.medical_specialty ,Article Subject ,Referral ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Laparotomy ,Health care ,medicine ,Caesarean section ,030212 general & internal medicine ,Retrospective review ,030219 obstetrics & reproductive medicine ,biology ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Gynecology and obstetrics ,biology.organism_classification ,medicine.disease ,Uterine rupture ,Uterine atony ,Tanzania ,RG1-991 ,business ,Research Article - Abstract
Background. Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. This study was carried out to analyse the circumstances that had caused these deaths. Methods. A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019 was made. Results. A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grand multiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12 (52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). The leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterine atony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)). Conclusion. Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. The leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. There is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture.
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- 2020
12. Effects of reconstruction techniques after proximal gastrectomy: a systematic review and meta-analysis
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Zakari Shaibu, Isah Adamu Danbala, Zhihong Chen, Acquah Theophilus, and Said Abdulrahman Salim Mzee
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medicine.medical_specialty ,Proximal gastrectomy ,Gastric cancer or neoplasms ,lcsh:Surgery ,Review ,Anastomosis ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Gastrectomy ,Stomach Neoplasms ,Medicine ,Humans ,Jejunal interposition ,Reflux esophagitis ,business.industry ,Jejunal pouch interposition ,Incidence (epidemiology) ,lcsh:RD1-811 ,Prognosis ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Double flap ,Surgery ,Jejunum ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,Operative time ,Esophagogastrostomy ,030211 gastroenterology & hepatology ,Double tract reconstruction ,business ,Complication - Abstract
Background Additional studies comparing several reconstruction methods after proximal gastrectomy have been published; of note, it is necessary to update systematic reviews and meta-analysis from the current evidence-based literature. Aim To expand the current knowledge on feasibility and safety, and also to analyze postoperative outcomes of several reconstructive techniques after proximal gastrectomy. Methods PubMed, Google Scholar, and Medline databases were searched for original studies, and relevant literature published between the years 1966 and 2019 concerning various reconstructive techniques on proximal gastrectomy were selected. The postoperative outcomes and complications of the reconstructive techniques were assessed. Meta-analyses were performed using Rev-Man 5.0. A total of 29 studies investigating postoperative outcomes of double tract reconstruction, jejunal pouch interposition, jejunal interposition, esophagogastrostomy, and double flap reconstruction were finally selected in the quantitative analysis. Result Pooled incidences of reflux esophagitis for double tract reconstruction, jejunal pouch interposition, jejunal interposition esophagogastrostomy, and double flap reconstruction were 8.6%, 13.8%, 13.8%, 19.3%, and 8.9% respectively. Meta-analysis showed a decreased length of hospital in the JI group as compared to the JPI group (heterogeneity: Chi2 = 1.34, df = 1 (P = 0.25); I2 = 26%, test for overall effect: Z = 2.22 (P = 0.03). There was also a significant difference between JI and EG in length of hospital stay with heterogeneity: Chi2 = 1.40, df = 3 (P = 0.71); I2 = 0%, test for overall effect: Z = 5.04 (P < 0.00001). Operative time was less in the EG group as compared to the JI group (heterogeneity: Chi2 = 31.09, df = 5 (P < 0.00001); I2 = 84%, test for overall effect: Z = 32.35 (P < 0.00001). Conclusion Although current reconstructive techniques present excellent anti-reflux efficacy, the optimal reconstructive method remains to be determined. The double flap reconstruction proved to lower the rate of complication, but the DTR, JI, JPI, and EG groups showed higher incidence of complications in anastomotic leakage, anastomotic stricture, and residual food. In the meta-analysis result, the complications between the JI, JPI, and EG were comparable but the EG group showed to have better postoperative outcomes concerning the operative time, blood loss, and length of hospital stay.
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- 2020
13. Obesity may increase the prevalence of Parkinson’s Disease (PD) while PD may reduce obesity index in patients
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Abdullateef Taiye Mustapha, Liuyi, Abdul Nazif Mahmud, Li Xue Zhong, Aaron Gia Kanton, Muslimat Kehinde Adebisi, and Mzee Said Abdulraman Salim
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medicine.medical_specialty ,Parkinson's disease ,Index (economics) ,business.industry ,Internal medicine ,medicine ,In patient ,medicine.disease ,business ,Obesity - Published
- 2020
14. Prognostic Value of Bleeding in Gastrointestinal Stromal Tumors: A Meta-Analysis
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Liwen Zhang, Fan Xin, Yang Hanqing, Chen Gong, Han He, Said Abdulrahman Salim Mzee, Ji-Xiang Chen, and Sun Zhiyu
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Cancer Research ,medicine.medical_specialty ,Gastrointestinal bleeding ,Stromal cell ,Gastrointestinal Stromal Tumors ,gastrointestinal bleeding ,Clinical manifestation ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,value ,Internal medicine ,medicine ,Humans ,Stromal tumor ,RC254-282 ,Proportional Hazards Models ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Disease Management ,medicine.disease ,Prognosis ,Patient Outcome Assessment ,Oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,030211 gastroenterology & hepatology ,Disease Susceptibility ,business ,Gastrointestinal Hemorrhage ,Value (mathematics) ,Publication Bias ,Meta-Analysis - Abstract
Background: Gastrointestinal bleeding is the most common clinical manifestation of gastrointestinal stromal tumor. It is of great significance to the prognosis of patients. But the results are controversial. The purpose of this study was to evaluate the relationship between gastrointestinal bleeding and clinical prognosis in patients with GIST. Methods: A systematic literature search was performed in Pumbed, Cochrane Library, EMBASE, ClinicalTrials.gov , CNKI, VIP and wanfang databases with the pattern of unlimited languages. 12 studies with 2781 individuals were included in the final analysis. The overall survival (OS), recurrence-free survival/disease-free survival (RFS/DFS) and related factors affecting bleeding in patients with gastrointestinal stromal tumor (GIST) were extracted. Hazard ratio (HR) and 95% confidence interval (CI) were used for in the meta-analysis. Results: A total of 12 articles were included in the study, including 2781 patients with GIST, including 845 patients with gastrointestinal bleeding. The OS of GIST patients with gastrointestinal bleeding was significantly worse (HR = 2.54, 95% CI = 1.13-5.73, P = 0.025). But there was no significant difference in RFS between gastrointestinal bleeding patients and non-bleeding patients (HR = 1.35, 95% CI = 0.70-2.61, P = 0.371). Further analysis of the related factors of GI bleeding in GIST patients was observed, besides the aging factor (HR = 1.02, 95% CI = 0.69-1.50, P = 0.929), Small intestinal stromal tumor (HR = 0.56, 95% CI = 0.41-0.76, P < 0.001), tumor diameter ≥ 5 cm (HR = 2.09, 95% CI = 1.20-3.63, P = 0.009), Mitotic index ≥ 5/50 HPF (HR = 1.66, 95% CI = 1.11-2.49, P = 0.014) and tumor rupture (HR = 2.04, 95% CI = 1.0-3.82, P = 0.026) all increased the risk of GI bleeding in patients with GIST. Conclusions: The OS of GIST patients with GI bleeding was worse than non-GI bleeding, but had no significant effect on RFS. Nevertheless the aging factor, the location of GIST in the small intestine, tumor diameter ≥ 5 cm, Mitotic index ≥ 5/50 HPF and tumor rupture all increased the risk of GI bleeding in patients with GIST.
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- 2021
15. Treatment and outcomes in patients with left ventricular thrombus - experiences from the Aga Khan University Hospital, Nairobi - Kenya
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Mzee Ngunga, Jasmit Shah, Mohamed Hasham Varwani, and Mohamed Jeilan
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Adult ,Male ,anticoagulants ,medicine.medical_specialty ,Hemorrhage ,Ventricular Dysfunction, Left ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Thrombus ,Stroke ,Aged ,Retrospective Studies ,Ejection fraction ,Ischemic cardiomyopathy ,left ventricular thrombus ,business.industry ,Research ,Incidence (epidemiology) ,systolic dysfunction ,Warfarin ,Thrombosis ,General Medicine ,Middle Aged ,Left ventricular thrombus ,medicine.disease ,Kenya ,stroke ,directly acting oral ,Echocardiography ,cardioembolic ,left ventricular ,Etiology ,Female ,business ,medicine.drug - Abstract
Introduction left ventricular thrombus (LVT) may lead to thromboembolism and has been associated with increased morbidity and mortality. Little is known about the incidence, etiology and outcomes in patients with LVT in Africa. The objective was to determine the etiology, treatment practices, rate of resolution and clinical outcomes in patients with LVT in the region. Methods a review of all echocardiograms performed in 2017 and 2018 at the Aga Khan University Hospital, Nairobi was carried out and patients with LVT identified. Physician review of charts was performed to document clinical characteristics and outcomes. Results during the study period 100 patients with LVT were identified (1.3% of adult echoes). The mean LVEF was 28.5% (±11.0%) and 88 (88%) patients had an LVEF of less than 40%. Underlying etiology of LV dysfunction was post myocardial infarction (MI) in 28 (28%), chronic ischemic cardiomyopathy in 42(42%) and non-ischemic cardiomyopathy in 30 (30%) patients. In 15 (15%) patients a stroke or TIA predated the diagnosis of LVT. Long term anticoagulation was given to 92 (92%) patients. Among these, 34 (37%) received warfarin while 58 (63%) were treated with a DOAC. In the 64 patients who had reassessment imaging (median duration 177 days), complete thrombus resolution was noted in 38 (59.4%). One-year clinical outcome data was available for 85 patients: 13 (15.3%) patients had died, 4 (4.7%) had suffered a stroke, and 8(9.4%) had had a bleeding episode. Rates of thrombus resolution (warfarin 64%, DOAC 55.6%, p=0.51), stroke (warfarin 2.9%, DOAC 1.7%, p=1.0) and bleeding (warfarin 5.9%, DOAC 5.2%, p = 1.00 were not significantly different among patients treated with warfarin and DOAC. Conclusion we noted a high incidence of LVT compared to contemporary Western series. The majority of our patients were treated with DOACs. There were no significant differences in outcomes between patients treated with a DOAC and those receiving warfarin. Prospective evaluation on the efficacy and safety of DOACs for this indication is needed.
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- 2021
16. Cardiovascular risk factors among people living with HIV in rural Kenya: a clinic-based study
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Sylvia Mbugua, Gerald Yonga, Kenneth Juma, Roseanne Nyabera, Mzee Ngunga, George Odinya, David Zakus, and JO Jowi
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Adult ,Male ,medicine.medical_specialty ,Waist ,Cardiovascular risk factors ,Human immunodeficiency virus (HIV) ,HIV Infections ,Rural Health ,030204 cardiovascular system & hematology ,Logistic regression ,medicine.disease_cause ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Diabetes Mellitus ,Prevalence ,Humans ,Medicine ,Obesity ,Stroke ,Dyslipidemias ,business.industry ,Stavudine ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Health Surveys ,Kenya ,Cross-Sectional Studies ,Anti-Retroviral Agents ,Cardiovascular Diseases ,Hypertension ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Objective To determine the prevalence of cardiovascular risk factors and their association with antiretroviral therapy (ART) among HIV-infected adults in a rural sub-county hospital in Kenya. Methods This was a descriptive survey of patient charts characterising cardiovascular risk among adult patients (> 18 years) at Ukwala sub-county hospital between June 2013 and January 2015. Post-stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios (AOR) for each variable related to cardiovascular risk factors were calculated using logistic regression models. Results Overall, the prevalence of diabetes mellitus was 0.4%, 0.3% of patients had had a previous cardiovascular event (heart attack or stroke), 40.4% had pre-hypertension, while 10.4% had stage 1 and 2.9% stage 2 hypertension. Up to 14% of patients had elevated non-fasting total cholesterol levels. Factors associated with hypertension were male gender (AOR 1.59, p = 0.0001), being over 40 years of age (AOR 1.78, p = 0.0001) and having an increased waist circumference (OR 2.56, p = 0.0014). Raised total cholesterol was more likely in those on tenofovir disoproxil fumarate (TDF) (AOR 2.2, p = 0.0042), azidothymidine (AZT) (AOR 2.5, p = 0.0004) and stavudine (D4T) -containing regimens (AOR 3.13, p = 0.0002). Conclusions An elevated prevalence of undiagnosed cardiovascular risk factors such as hypertension and raised total cholesterol levels was found among people living with HIV. There was an association between raised total cholesterol and nucleoside reverse-transcriptase inhibitor (NRTI) -based ART regimens. Our findings provide further rationale for integrating routine cardiovascular risk-factor screening into HIV-care services.
- Published
- 2019
17. Multi-Segment Indexes of Arterial Stiffness Show Lower Repeatability Than Carotid–Femoral Pulse Wave Velocity or Systolic Blood Pressure
- Author
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David Mzee, Fernando G. Beltrami, and Christina M. Spengler
- Subjects
Adult ,Male ,medicine.medical_specialty ,Coefficient of variation ,Cardiovascular health ,Blood Pressure ,Multi segment ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,Vascular Stiffness ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Pulse wave velocity ,business.industry ,Reproducibility of Results ,Repeatability ,medicine.disease ,Healthy Volunteers ,Confidence interval ,Blood pressure ,Carotid-Femoral Pulse Wave Velocity ,Arterial stiffness ,Cardiology ,Female ,business - Abstract
BACKGROUND We investigated the inter-day repeatability of newly proposed indexes of cardiovascular health based on the absolute (PWVABS) or relative (PWVRATIO) difference in pulse wave velocity (PWV) between the carotid–femoral (PWVCF) and carotid–radial (PWVCR) segments compared with PWVCF alone and with systolic blood pressure (BPSYST) over multiple days. METHODS All variables were measured in triplicates in a group of 16 young, healthy individuals (8 men/8 women, body mass 66 ± 14 kg, height 1.7 ± 0.1 m, age 27 ± 3 years old, all mean ± SD) on 6 different occasions, always at the same time of the day (± 1 hour) and with at least 48 hours between assessments. RESULTS Values did not differ significantly over the 6 different visits for any of the parameters (all Ps > 0.08). Intraclass coefficients (ICCs) ranged from 0.52 (PWVRATIO) to 0.8 (PWVCF). The ICC 95% confidence interval of PWVRATIO (0.30–0.77) and PWVABS (0.33–0.78) did not overlap with that of PWVCF (0.79–0.95), indicating lower repeatability. The coefficient of variation (CV) of PWVABS was over 5-fold larger than the next largest one (46.7 vs. 8.1% for PWVABS and PWVRATIO, respectively), whereas PWVCF and BPSYST showed the lowest CVs (4.6 and 4.0%, respectively). CONCLUSION Between PWVABS and PWVRATIO, the relative method showed better repeatability and might be more sensitive to longitudinal changes in patients. Nonetheless, indexes of arterial stiffness-based PWV gradients between different segments show lower inter-day repeatability compared with PWVCF or BPSYST, suggesting that the latter are still preferable in clinical practice.
- Published
- 2018
18. Enhancing cardiovascular skills development in Africa: Khartoum first PTMC workshop
- Author
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Mzee Ngunga, Mohamed Jeilan, Minha Mohamed, Mujahed Mohammed, and Ahmed A A Suliman
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Cardiovascular News ,Medical education ,business.industry ,MEDLINE ,Medicine ,General Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
19. Preservation of the Arterial Arc Formed by Left Colic Artery, Proximal Inferior Mesenteric Artery, and the First Branch of Sigmoid Arteries in Anus Saving Treatment of Low Rectal Cancer
- Author
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Zakari Shaibu, Said Abdulrahman Salim Mzee, Zhihong Chen, and Acquah Theophilus
- Subjects
Laparoscopic surgery ,Left colic artery ,Adult ,Male ,medicine.medical_specialty ,Abdominal Abscess ,Colon ,medicine.medical_treatment ,Operative Time ,Anastomotic Leak ,Constriction, Pathologic ,Adenocarcinoma ,Postoperative Hemorrhage ,Inferior mesenteric artery ,Arc (geometry) ,Low rectal cancer ,Postoperative Complications ,Colon, Sigmoid ,medicine.artery ,medicine ,Humans ,Digestive System Surgical Procedures ,Retrospective Studies ,business.industry ,Rectal Neoplasms ,Anastomosis, Surgical ,General Medicine ,Arteries ,Length of Stay ,Middle Aged ,Anus ,Intersphincteric resection ,Surgery ,Mesenteric Arteries ,medicine.anatomical_structure ,Female ,Laparoscopy ,Sigmoid arteries ,business - Abstract
Background Low anterior, ultralow anterior, and intersphincteric resection are conventional, elective anus-sparing techniques for low rectal cancer, and good prognosis depends on a good blood supply and tension-free anastomosis. Aim The goal is to assess the effect of preserving the arc formed by the left colic and proximal inferior mesenteric arteries (IMAs), and first branch of the sigmoid arteries on the anastomotic blood supply, tension, and leakage rate in anus-sparing surgery for low rectal cancer. Method From 2011 to 2020, a patient with low rectal cancer resection was distributed into the ligation group (42 cases with inferior mesenteric artery ligation) and the preservation group (61 cases with preservation of the left colic and proximal IMAs and first branch of the sigmoid artery). Results We evaluated patient characteristics, operative results, morbidity, and postoperative follow-up results. There were comparable outcomes between ligation and preservation groups in relations to the number of patients in each operative procedure, duration of surgery, operative blood loss, postoperative hospital stay, and the number of patients with protective stoma ( P >.05). In postoperative morbidity, there were similar outcomes between ligation and preservation groups in terms of anastomotic subclinical dehiscence, bleeding and stricture, and urinary retention ( P >.05). There were significant differences in anastomotic leakage and intra-abdominal abscess ( P < .05). Conclusion Preservation of the arterial arc formed by left colic artery, proximal IMA, and the first branch of sigmoid arteries with apical lymph node dissection could increase anastomotic blood supply, reduce anastomotic tension, and leakage rate in anus-saving treatment of low rectal cancer.
- Published
- 2021
20. Abstract 15792: Etiology, Treatment and Outcomes in Patients With Left Ventricular Thrombus - Experiences From an African Center
- Author
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Mohamed Hasham Varwani, Leonard Mzee Ngunga, Mohamed Jeilan, and Jasmit Shah
- Subjects
medicine.medical_specialty ,business.industry ,Physiology (medical) ,Internal medicine ,Cardiology ,medicine ,Etiology ,Center (algebra and category theory) ,In patient ,Left ventricular thrombus ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Left ventricular thrombus (LVT) may lead to thromboembolism and has been associated with increased morbidity and mortality. Little is known about the incidence, etiology and outcomes in patients with LVT in Africa. Objectives: To determine the etiology, treatment practices, rate of resolution and outcomes in patients with LVT in the region. Methods: A review of all echocardiograms performed in 2017 and 2018 at the Aga Khan University Hospital, Nairobi was carried out and patients with LVT identified. Physician review of charts was performed to document clinical characteristics and outcomes. Results: During the study period 100 patients with LVT were identified (1.3% of adult echoes). The mean LVEF was 28.5% (±11.0%) and 88% of the patients had an LVEF of less than 40%. Underlying etiology of LV dysfunction was post MI in 28%, chronic ischemic cardiomyopathy in 42% and non ischemic cardiomyopathy in 30%. In 15% of the patients a stroke or TIA predated the diagnosis of LVT. Long term anticoagulation was given to 92 patients. Among these, 37% received warfarin while 63% were treated with a DOAC (rivaroxaban (50%), dabigatran(7.6%) and apixaban(5.4%)). In 60% of the patients, anticoagulation was continued beyond a year. In patients with reassessment imaging (64%, median time 177 days), complete thrombus resolution was noted in 59.4%. One year follow-up data was available for 85 patients: 13 (15.3%) patients had died, 4 (4.7%) had suffered a stroke, and 8(9.4%) had a bleeding episode. Rates of thrombus resolution, stroke and bleeding were not significantly different among patients treated with warfarin and DOAC (Figure 1). Conclusions: We noted a high incidence of LVT compared to contemporary Western series. The majority of our patients were treated with DOACs. There were no significant differences in outcomes between patients treated with a DOAC and those receiving warfarin. Prospective evaluation on the efficacy and safety of DOACs for this indication is needed.
- Published
- 2020
21. Quality of intrapartum care: Direct observations in a low-resource tertiary hospital
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Said Mzee Said, Ali Gharib Mohamed, Marcus J. Rijken, Joyce L. Browne, Diederick E. Grobbee, Arie Franx, Marieke C. Punt, Nicolaas P.A. Zuithoff, Natasha Housseine, Tarek Meguid, Nanna Maaløe, and Obstetrics and Gynaecology
- Subjects
Adult ,medicine.medical_specialty ,Labour ,Psychological intervention ,Reproductive medicine ,Developing country ,Guidelines ,Rate ratio ,Tanzania ,lcsh:Gynecology and obstetrics ,Developing countries ,Tertiary Care Centers ,Young Adult ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Intermittent auscultation ,Pregnancy ,Interquartile range ,Low resource ,Humans ,Medicine ,Maternal Health Services ,Prospective Studies ,030212 general & internal medicine ,Poisson regression ,lcsh:RG1-991 ,reproductive and urinary physiology ,Foetal monitoring ,030219 obstetrics & reproductive medicine ,biology ,business.industry ,Research ,Public health ,Obstetrics and Gynecology ,Delivery, Obstetric ,biology.organism_classification ,Obstetrics ,Reproductive Medicine ,Emergency medicine ,symbols ,Female ,Guideline Adherence ,business - Abstract
Background The majority of the world’s perinatal deaths occur in low- and middle-income countries. A substantial proportion occurs intrapartum and is avoidable with better care. At a low-resource tertiary hospital, this study assessed the quality of intrapartum care and adherence to locally-tailored clinical guidelines. Methods A non-participatory, structured, direct observation study was held at Mnazi Mmoja Hospital, Zanzibar, Tanzania, between October and November 2016. Women in active labour were followed and structure, processes of labour care and outcomes of care systematically recorded. Descriptive analyses were performed on the labour observations and compared to local guidelines and supplemented by qualitative findings. A Poisson regression analysis assessed factors affecting foetal heart rate monitoring (FHRM) guidelines adherence. Results 161 labouring women were observed. The nurse/midwife-to-labouring-women ratio of 1:4, resulted in doctors providing a significant part of intrapartum monitoring. Care during labour and two-thirds of deliveries was provided in a one-room labour ward with shared beds. Screening for privacy and communication of examination findings were done in 50 and 34%, respectively. For the majority, there was delayed recognition of labour progress and insufficient support in second stage of labour. While FHRM was generally performed suboptimally with a median interval of 105 (interquartile range 57–160) minutes, occurrence of an intrapartum risk event (non-reassuring FHR, oxytocin use or poor progress) increased assessment frequency significantly (rate ratio 1.32 (CI 1.09–1.58)). Conclusions Neither international nor locally-adapted standards of intrapartum routine care were optimally achieved. This was most likely due to a grossly inadequate capacity of birth attendants; without whom innovative interventions at birth are unlikely to succeed. This calls for international and local stakeholders to address the root causes of unsafe intrafacility care in low-resource settings, including the number of skilled birth attendants required for safe and respectful births.
- Published
- 2020
22. Prevalence, antimicrobial susceptibility and genotypic characteristics of Staphylococcus aureus in Tanzania: a systematic review
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Rose Masalu, Joseph Madata, Markus Bischoff, Tutu Mzee, Mecky Matee, Theckla Kazimoto, and Sören L. Becker
- Subjects
Colonization ,Staphylococcus aureus ,Genotyping ,Veterinary medicine ,medicine.drug_class ,Science ,Antibiotics ,Erythromycin ,Antimicrobial resistance ,medicine.disease_cause ,Antibiotic resistance ,Ampicillin ,Prevalence ,medicine ,General Environmental Science ,biology ,business.industry ,biology.organism_classification ,Antimicrobial ,Penicillin ,Tanzania ,General Earth and Planetary Sciences ,Infection ,business ,medicine.drug - Abstract
Background Data on the prevalence, genotypes and antibiotic resistance patterns of colonizing and infection-associated Staphylococcus aureus (S. aureus) strains both in humans and animals in Tanzania are scarce. Given the wide range of infections caused by S. aureus and the rise of methicillin-resistant S. aureus (MRSA) globally, this review aims at collecting published data on S. aureus bacterium to improve our understanding of its epidemiology in Tanzania. Main body We carried out a systematic review of scientific studies reporting on prevalence, antibiotic resistance and genotyping data pertaining to S. aureus in human and animal infection and colonization. The literature extracted from electronic databases such as PubMed and Google Scholar was screened for eligibility and relevant articles were included. The review is limited to manuscripts published in English language between the years 2010 and 2020. A total of 45 studies conducted in 7 of the 9 administrative zones in Tanzania were reviewed to gather data on S. aureus prevalence in humans and animals. Prevalence in humans ranged from 1 to 60%. Antibiotic resistance patterns of S. aureus isolated from colonized humans showed high resistance rates against co-trimoxazole (46%) and erythromycin (41%) as compared to reports from studies conducted outside Africa. The review suggests an increased MRSA prevalence of up to 26% as compared to 6–16% reported in previous years. Genotypic data reviewed suggested that MRSA predominantly belonged to ST88. The prevalence of S. aureus in animal studies ranged from 33 to 49%, with 4 to 35% of MRSA isolates. Most studies reported low antibiotic resistance levels, with the exception of penicillin (85%) and ampicillin (73%). Conclusion The prevalence of S. aureus and MRSA in Tanzania is rising, although clear variations between different geographic areas could be observed. Non-susceptibility to commonly prescribed antibiotics in community-associated S. aureus is of concern. Research strategies to ameliorate our knowledge on S. aureus epidemiology should employ regular antibiotic resistance surveillance, antimicrobial stewardship as well as genotypic characterization.
- Published
- 2020
23. Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to pregnant women? A national survey for improving policy of prevention of mother-to-child transmission of HIV in Tanzania
- Author
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Athanase Lilungulu, Bonaventura C.T. Mpondo, Mzee Nassoro, Shakilu Jumanne, and Deogratius Bintabara
- Subjects
Counseling ,medicine.medical_specialty ,media_common.quotation_subject ,PMTCT ,Psychological intervention ,HIV Infections ,Hiv testing ,Antenatal care ,Pmtct service ,Diagnostic tools ,Tanzania ,HIV Testing ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Pregnancy ,Virology ,Medicine ,Humans ,Pharmacology (medical) ,Quality (business) ,030212 general & internal medicine ,Poisson regression ,reproductive and urinary physiology ,media_common ,biology ,business.industry ,030503 health policy & services ,Research ,Prevention of mother to child transmission ,High-quality ,RC581-607 ,biology.organism_classification ,Infectious Disease Transmission, Vertical ,Policy ,Family medicine ,Facility readiness ,symbols ,Molecular Medicine ,Female ,Pregnant Women ,Provider-initiated HIV testing and counseling ,Immunologic diseases. Allergy ,0305 other medical science ,business - Abstract
Background Provider-initiated HIV testing and counseling (PITC) is a recommended approach to screen for HIV to all pregnant women during antenatal care (ANC) visits, and all with HIV positive results have to be enrolled into prevention of mother-to-child transmission of HIV (PMTCT) program. However, little is known about the relationship between facility readiness and the uptake of PITC to pregnant women attending ANC in Tanzania. Therefore, this study assessed whether the facility readiness promotes the uptake of PITC to the pregnant women attending ANC for the purpose of improving the PMTCT interventions in Tanzania. Methods This study analyzed data for health facilities obtained from the 2014–2015 Tanzania service provision assessment survey. The Primary outcome measure was a composite variable (with score of 0–5) in which its higher scores indicates provision of high-quality of PITC. Also, facilities scored higher in the PMTCT service readiness index were considered to have high readiness to provide PMTCT services. In Poisson regression analyses, a series of models were fitted to assess whether there is an association between provision of high-quality of PITC and facility readiness. In all statistical analysis, a P Results Out of 1853 included first-visit ANC consultations, only about one-third of pregnant women received all five components required for PITC. The mean percentage of PMTCT readiness score was moderate 63.96 [61.32–66.59]%. In adjusted model, we found that facility with high readiness to provide PMTCT services was significantly associated with the provision of high-quality of PITC (model 2: [β = 0.075, P = 0.00]). Conclusion In order to increase high-quality of PITC services, efforts should be made to improve the PMTCT facility readiness by increasing availability of trained staffs, diagnostic tools, and ARTs among health facilities in Tanzania.
- Published
- 2020
24. Long-Term Outcomes and Factors Associated with Mortality in Patients with Moderate to Severe Pulmonary Hypertension in Kenya
- Author
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Jeilan Mohamed, Anders Barasa, Mzee Ngunga, and Abdulaziz Mansur Abeid
- Subjects
Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,Epidemiology ,Hypertension, Pulmonary ,Risk Assessment ,Severity of Illness Index ,Risk Factors ,Internal medicine ,Diabetes mellitus ,pulmonary hypertension ,Medicine ,Humans ,In patient ,Hospital Mortality ,Survival analysis ,Original Research ,Aged ,Retrospective Studies ,Community and Home Care ,business.industry ,Proportional hazards model ,Medical record ,lcsh:Public aspects of medicine ,prognostic factors ,Atrial fibrillation ,lcsh:RA1-1270 ,medicine.disease ,Pulmonary hypertension ,Obesity ,Kenya ,Survival Rate ,lcsh:RC666-701 ,long-term outcomes ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background: Pulmonary hypertension is poorly studied in Africa. The long-term survival rates and prognostic factors associated with mortality in patients with moderate to severe pulmonary hypertension (PH) in Africa are not well described. Objectives: To determine the causes of moderate to severe PH in patients seen in contemporary hospital settings, determine the patients’ one-year survival and the factors associated with mortality following standard care. Methods: A retrospective review of patients diagnosed with moderate to severe PH at Aga Khan University Hospital (AKUHN) from August 2014 to July 2017 was carried out. Clinical and outcome data were collected from medical records and the hospital mortality database. Telephone interviews were conducted for patients who died outside the hospital. Survival analysis was done using Kaplan-Meier, and log-rank tests were used to assess differences between subgroups. Cox regression modelling with multivariable adjustment was used to identify factors associated with all-cause mortality. Results: A total of 659 patients with moderate to severe PH were enrolled. Median follow-up time was 626 days. The survival rates of the patients at 1 and 2 years were 73.8% and 65.9%, respectively. The following variables were significantly associated with mortality: diabetes mellitus [adjusted HR 1.52, 95% CI (1.14–2.01)], WHO functional class III/IV [adjusted HR 3.49, 95% CI (2.46–4.95)], atrial fibrillation [adjusted HR 1.53, 95% CI (1.08–2.17)], severe PH [adjusted HR 1.72, 95% CI (1.30–2.27)], right ventricular dysfunction [adjusted HR 2.42, 95% CI (1.76–3.32)] and left ventricular dysfunction [adjusted HR 1.91, 95% CI (1.36–2.69)]. Obesity [adjusted HR 0.68, 95% CI (0.50–0.93)] was associated with improved survival. Conclusion: Pulmonary hypertension is associated with poor long-term outcomes in African patients. Identification of prognostic factors associated with high-risk patients will assist in patient management and potentially improved outcomes.
- Published
- 2020
25. Maternal Mortality in Dodoma Regional Referral Hospital, Tanzania
- Author
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Paul Chetto, Enid Chiwanga, Athanase Lilungulu, Jacquiline Wambura, Mzee Nassoro, and Deogratius Bintabara
- Subjects
medicine.medical_specialty ,Retrospective review ,030219 obstetrics & reproductive medicine ,Eclampsia ,biology ,Referral ,Article Subject ,business.industry ,Ruptured uterus ,Gynecology and obstetrics ,biology.organism_classification ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Tanzania ,Standardized mortality ratio ,Emergency medicine ,medicine ,RG1-991 ,Health survey ,Maternal death ,030212 general & internal medicine ,business ,Research Article - Abstract
Background. Maternal mortality has remained a challenge in Tanzania. The Tanzania Demographic and Health Survey 2015-16 has shown that the problem has been increasing despite various strategies instituted to curb it. It has been shown that most of the maternal deaths occurring in health facilities, whether direct or indirect, have other contributing factors. The objective of this study was to analyse causes and associated factors for maternal deaths in Dodoma Regional Referral Hospital (DRRH). Methods. A retrospective review of all files of the women who died in 2018 and were classified as maternal deaths. Results. A total of 8722 women gave birth in DRRH, out of which 35 died and were confirmed as maternal deaths. The number of live births was 8404 making the maternal mortality ratio of 417 per 100,000 live births. The leading causes of maternal death were eclampsia (9), sepsis (6), ruptured uterus (5), and haemorrhage (5). The third-phase delay was the leading contributing factor to 19 maternal deaths. This includes delays in referral from another facility as well as delays in getting treatment at DRRH and inadequate skills of providers at both the referring facilities and DRRH. The first-phase and second-phase delays contributed to 7 and 6 deaths, respectively. Furthermore, poor antenatal care contributed to 2 deaths. Conclusion. Maternal mortality is still high in Dodoma Regional Referral Hospital. Eclampsia was the leading cause of maternal deaths in 2018 followed by sepsis and obstetric haemorrhage. Delays associated with health system factors (third-phase delay) contributed much more to maternal mortality than the first-phase delay. Mentorship programmes on management of obstetric complications need to be instituted in order to reduce maternal deaths in Dodoma Regional Referral Hospital.
- Published
- 2020
26. Incidence and Predictors of Maternal and Perinatal Mortality among Women with Severe Maternal Outcomes: A Tanzanian Facility-Based Survey for Improving Maternal and Newborn Care
- Author
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Enid Chiwanga, Athanase Lilungulu, Paulo Chetto, Simon Mujungu, Deogratius Bintabara, and Mzee Nassoro
- Subjects
medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Article Subject ,Referral ,biology ,business.industry ,Obstetrics ,Perinatal mortality ,Incidence (epidemiology) ,Public health ,MEDLINE ,Obstetrics and Gynecology ,Gynecology and obstetrics ,biology.organism_classification ,03 medical and health sciences ,0302 clinical medicine ,Standardized mortality ratio ,Tanzania ,RG1-991 ,Medicine ,030212 general & internal medicine ,business ,Newborn care ,Research Article - Abstract
Introduction. Maternal and perinatal mortality is still a major public health challenge in Tanzania, despite the ongoing government efforts to improve maternal and newborn care. Among the contributors to these problems is the high magnitude of severe maternal outcomes (maternal near-miss). The current study, therefore, aimed to identify the magnitude and predictors of maternal and perinatal mortality among women with severe maternal outcomes admitted to Dodoma Regional Referral Hospital. Methods. A retrospective cross-sectional study was conducted from October 2015 to January 2016 at Dodoma Regional Referral Hospital in Dodoma City. All maternal deaths and maternal near-misses based on WHO criteria were included in this study. Three outcome variables have been identified: maternal mortality, perinatal mortality, and neonatal complications. To examine the predictors for the three predetermined outcome variables, the three logit models each containing unadjusted and adjusted findings were fitted. A P-value less than 0.05 was considered indicative of statistically significant. Results. A total of 3600 pregnant women were admitted for obstetric reasons during the mentioned period. 140 of them were diagnosed with severe maternal outcomes; hence, they were included in this study. The severe maternal outcome incidence ratio was 40.23 per 1000 live births, the institutional maternal mortality ratio was 459.77 per 100000 live births, and the perinatal mortality rate was 10.83 per 1000 total births. Most of the maternal morbidity and mortality were due to direct causes in which postpartum hemorrhage and hypertensive disorders were the leading causes. In adjusted analysis, per-protocol management, maternal age, and mode of birth were predictors of maternal mortality, perinatal mortality, and neonatal complications, respectively. Conclusion. Establishing and strengthening obstetric ICUs will help reduce maternal mortality as the response time from the onset of obstetric complications, while the provision of high-quality care will be substantially reduced. Furthermore, the study recommends regular provision of in-service refresher training to emphasize the practice and compliance of per-protocol case management through a team approach in order to reduce the burden of maternal and perinatal mortality in Tanzania.
- Published
- 2020
27. Obesity may Increase the Prevalence of Parkinson's Disease while Parkinson's may Reduce Obesity Index in Patients
- Author
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Adebisi Muslimat Kehinde, Kanton Aaron Gia, Salim Mzee Said Abdulraman, Teddy Ehianeta, Liuyi, Mustapha Abdullateef Taiye, and Mahmud Abdul Nazif
- Subjects
medicine.medical_specialty ,Parkinson's disease ,Index (economics) ,business.industry ,Internal medicine ,medicine ,In patient ,medicine.disease ,business ,Obesity - Published
- 2019
28. Short-term evaluation of immune levels and nutritional values of EN versus PN in gastric cancer: a systematic review and a meta-analysis
- Author
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Said Abdulrahman Salim Mzee, Chen Gong, Fan Xin, Godwin Botwe, Han He, Sun Zhiyu, Chen Jixing, and Said Twahir Said
- Subjects
Parenteral Nutrition ,medicine.medical_specialty ,Time Factors ,PN ,medicine.medical_treatment ,lcsh:Surgery ,Nutritional Status ,Review ,lcsh:RC254-282 ,Gastroenterology ,law.invention ,03 medical and health sciences ,Enteral Nutrition ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,Stomach Neoplasms ,Gastrectomy ,law ,Internal medicine ,medicine ,Humans ,ERAS ,Feeding tube ,Randomized Controlled Trials as Topic ,Postoperative Care ,business.industry ,Retrospective cohort study ,lcsh:RD1-811 ,Length of Stay ,Prognosis ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Immunity, Innate ,Confidence interval ,Treatment Outcome ,Parenteral nutrition ,Oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,Relative risk ,030211 gastroenterology & hepatology ,Surgery ,EN feeding tubes ,Gastric cancer ,business ,Nutritive Value - Abstract
Background Postsurgical patients’ oral feeding begins with clear fluids 1–3 days after surgery. This might not be sufficiently nutritious to boost the host immune system and provide sufficient energy in gastric neoplastic patients to achieve the goal of enhanced recovery after surgery (ERAS). Our objective was to analyze the significance of early postoperative feeding tubes in boosting patients’ immunity and decreasing incidence of overall complications and hospital stay in gastric cancer patients’ post-gastrectomy. Methods From January 2005 to May 24, 2019, PubMed and Cochrane databases were searched for studies involving enteral nutrition (EN) feeding tubes in comparison to parenteral nutrition (PN) in gastric cancer patients undergoing gastrectomy for gastric malignancies. Relative risk (RR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI) were used to estimate the effect sizes, and heterogeneity was assessed by using Q and χ 2 statistic with their corresponding P values. All the analyses were performed with Review Manager 5.3 and SPSS version 22. Results Nine randomized trials (n = 1437) and 5 retrospective studies (n = 421) comparing EN feeding tubes and PN were deemed eligible for the pooled analyses, with a categorized time frame of PODs ≥ 7 and PODs
- Published
- 2019
29. A Case of Haematometra Secondary to Cervical Stenosis after Vesicle Vaginal Fistula Surgical Repair
- Author
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Athanase Lilungulu, Willy Mwibea, Balthazar Gumodoka, and Mzee Nassoro
- Subjects
Surgical repair ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,Vaginal fistula ,medicine.medical_treatment ,Fistula ,Obstetrics and Gynecology ,Case Report ,Explorative laparotomy ,medicine.disease ,lcsh:Gynecology and obstetrics ,Surgery ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,medicine.anatomical_structure ,Medicine ,Abdomen ,030212 general & internal medicine ,Hysterotomy ,business ,Surgical incision ,lcsh:RG1-991 - Abstract
Background. Haematometra is a rare postobstetrics fistula surgical repair outcome complication; however the condition can be misinterpreted especially in limited resource areas that lack routine ultrasound guidance and with a slowly progressed increase in size of abdomen accompanied with a history of amenorrhoea together with a history of having unprotective sexual intercourse which may increase the possibility of being controversial to full-term gravid uterus. The causes of haematometra might be either due to congenital abnormality of the vaginal canal or acquired iatrogenically. However, any other cause that involved vaginal canal can be a predisposing factor of haematometra. We present a case of a 32-year-old female patient, who had obstetric fistula which was successfully repaired over the past two years. She presented with one-year-and-two-month history of an amenorrhoea that was progressive accompanied with distended abdomen to the extent of looking typically as the gravid uterus. Explorative laparotomy was performed successfully and surgical incision managed by hysterotomy and salpingotomy, whereby approximately ten liters of serosanguinous blood fluid mixed with blood clots was completely suctioned. Despite being a rare condition after vesicle vaginal fistula repair complication outcome, haematometra remains to be relatively common gynaecological condition among female adolescence during postpubertal period.
- Published
- 2017
30. Controlled Human Malaria Infection of Tanzanians by Intradermal Injection of Aseptic, Purified, Cryopreserved Plasmodium falciparum Sporozoites
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Eric Huber, Claudia Daubenberger, Peter F. Billingsley, Seif Shekalaghe, Eric R. James, Ali Hamad, Tutu Mzee, Paul Mutani, Robert W. Sauerwein, Meera Venkatesan, Mwajuma Chemba, Cornelus C. Hermsen, Omar Lweno, Marcel Tanner, Stephen L. Hoffman, Anusha Gunasekera, Alwisa Urassa, Omar Juma, Maximillian Mpina, Salim Abdulla, Philip Sasi, Elizabeth Saverino, Adam Ruben, Debbie Padilla, Ali Mohammed, L. W. Preston Church, Tobias Schindler, Anita Manoj, Beatus Simon, B. Kim Lee Sim, Christopher V. Plowe, and Mastidia Rutaihwa
- Subjects
Infectivity ,030231 tropical medicine ,lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] ,Plasmodium falciparum ,Parasitemia ,Biology ,medicine.disease ,biology.organism_classification ,Virology ,PfSPZ vaccine ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Immunology ,parasitic diseases ,Gametocyte ,medicine ,Parasitology ,030212 general & internal medicine ,Aseptic processing ,Intradermal injection ,Malaria - Abstract
Item does not contain fulltext Controlled human malaria infection (CHMI) by mosquito bite has been used to assess anti-malaria interventions in > 1,500 volunteers since development of methods for infecting mosquitoes by feeding on Plasmodium falciparum (Pf) gametocyte cultures. Such CHMIs have never been used in Africa. Aseptic, purified, cryopreserved Pf sporozoites, PfSPZ Challenge, were used to infect Dutch volunteers by intradermal injection. We conducted a double-blind, placebo-controlled trial to assess safety and infectivity of PfSPZ Challenge in adult male Tanzanians. Volunteers were injected intradermally with 10,000 (N = 12) or 25,000 (N = 12) PfSPZ or normal saline (N = 6). PfSPZ Challenge was well tolerated and safe. Eleven of 12 and 10 of 11 subjects, who received 10,000 and 25,000 PfSPZ respectively, developed parasitemia. In 10,000 versus 25,000 PfSPZ groups geometric mean days from injection to Pf positivity by thick blood film was 15.4 versus 13.5 (P = 0.023). Alpha-thalassemia heterozygosity had no apparent effect on infectivity. PfSPZ Challenge was safe, well tolerated, and infectious.
- Published
- 2014
31. Neurosurgery Simulation in Residency Training
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Achal Patel, Adrian Mzee Smith, Thomas Jefferson Holbrook, Alan Muns, Bart MacDonald, Jaime Gasco, Juan Ortega-Barnett, Sohum Desai, Marc Moisi, David Paulson, Joel T. Patterson, and Yong Fan Kuo
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Educational measurement ,medicine.medical_specialty ,Medical education ,Cost–benefit analysis ,business.industry ,Knowledge acquisition ,medicine ,Cadaveric dissection ,Surgery ,Neurology (clinical) ,Neurosurgery ,Clinical competence ,business ,Curriculum ,Residency training - Abstract
BACKGROUND:The effort required to introduce simulation in neurosurgery academic programs and the benefits perceived by residents have not been systematically assessed.OBJECTIVE:To create a neurosurgery simulation curriculum encompassing basic and advanced skills, cadaveric dissection, cranial and sp
- Published
- 2013
32. Economic and Environmental Measures on Maritime Transportation Logistics the Case of GHG Emissions
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Philemon Kazimil Mzee and Tumaini Shabani Gurumo
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Business community ,media_common.quotation_subject ,General Engineering ,Globe ,Maritime logistics ,medicine.anatomical_structure ,Greenhouse gas ,Transportation logistics ,medicine ,Production (economics) ,Business ,Prosperity ,Industrial organization ,Simulation ,media_common - Abstract
Freely flowing international trade, carried predominantly by a large and heterogeneous fleet of ocean going vessels, has been the impetus behind the significant advances in world prosperity experienced in the second-half of the 20th century. Decreased trading barriers and reduced tariffs have facilitated the development of a truly interlinked and globalised economy. The business community has responded to this new trading environment and has increasingly sought commercial partners, suppliers and customers throughout the globe. The very act of producing goods for markets has also changed radically as suppliers and manufacturers have developed efficient production processes that reduce inventory holding to a very minimum production processes made possible by fast, efficient and unfettered international transport. The emerging paradigm for global prosperity has been predicated on near frictionless transport and trade. This paper looks at the implications of various emission policies for maritime logistics. There can be important trade off that can be important benefits associated with such measures as reduction in streaming speed and change in the number of vessels in the fleet and more conventional logistics.
- Published
- 2012
33. Iodine Deficiency Persists in the Zanzibar Islands of Tanzania
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R. K. Mzee, H. Abuu, Celestin Mgoba, Vincent Didas Assey, Stefan Peterson, Sabas Kimboka, and Ted Greiner
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Male ,Pediatrics ,medicine.medical_specialty ,Goiter ,Adolescent ,Cross-sectional study ,Geography, Planning and Development ,Population ,Nutritional Status ,Health Promotion ,Tanzania ,Environmental health ,parasitic diseases ,Prevalence ,medicine ,Humans ,Sodium Chloride, Dietary ,Child ,education ,education.field_of_study ,Schools ,Nutrition and Dietetics ,integumentary system ,biology ,business.industry ,food and beverages ,Nutritional status ,biology.organism_classification ,medicine.disease ,Micronutrient ,Health Surveys ,Iodine deficiency ,Trace Elements ,Cross-Sectional Studies ,Female ,Urinary iodine ,Child Nutritional Physiological Phenomena ,business ,Goiter, Endemic ,Iodine ,Food Science - Abstract
Background Iodine is an essential micronutrient for normal human growth and development. It is estimated that more than 1.6 billion people live in iodine-deficient environments, yet there are still some countries and areas where the prevalence of iodine-deficiency disorders is unknown. Objective To establish the prevalence of iodine-deficiency disorders in the Zanzibar Islands, a community assumed to have ready access to iodine-rich seafoods. Methods In a cross-sectional study, 11,967 schoolchildren were palpated for goiter prevalence, a subsample was evaluated for urinary iodine concentration, and the availability of iodated salt was assessed at the household and retail levels. Results The mean total goiter prevalence was 21.3% for Unguja and 32.0% for Pemba. The overall median urinary iodine concentration was 127.5 μg/L. For Unguja the median was 185.7 μg/L, a higher value than the median of 53.4 μg/L for Pemba ( p < .01). The household availability of iodated salt was 63.5% in Unguja and 1.0% in Pemba. The community was not aware of the iodine-deficiency problem and had never heard of iodated salt. Conclusions The inadequate intake of iodine documented in the Zanzibar Islands belies the common assumption that an island population with access to seafood is not at risk for iodine-deficiency disorders. We urge health planners to implement mandatory salt iodation and education efforts to alleviate the situation.
- Published
- 2006
34. Persistent hepatitis A infection: case report
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MV Shah and Mzee Ngunga
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Adult ,Male ,business.industry ,viruses ,Hepatitis A Infection ,Hepatitis A ,General Medicine ,medicine.disease ,Viral infection ,Virology ,Kenya ,Immunology ,Medicine ,Humans ,business - Abstract
Hepatitis A viral infection resolves completely within six months in all patients infected. The case presented is a rare one that took fifteen months to resolve from hepatitis A viral infection.
- Published
- 2012
35. Standard antenatal care regimen, with or without multivitamins and additional deworming, improve anemia outcomes in pregnant Zanzibari women
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Justine A. Kavle, James M. Tielsch, Tamer H. Farag, Sabra S. Khalfan, Rebecca J. Stoltzfus, and Mzee R. Khatib
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Gynecology ,medicine.medical_specialty ,Pediatrics ,business.industry ,Anemia ,medicine.disease ,Biochemistry ,Deworming ,Regimen ,Genetics ,Medicine ,business ,Molecular Biology ,Biotechnology - Published
- 2008
36. 187 A Novel Virtual Reality Simulation for Hemostasis in a Brain Surgical Cavity
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Jaime Gasco-Tamarit, Patrick Kania, Dan Branch, Sohum Desai, Thomas Jefferson Holbrook, Ben Roitberg, Adrian Mzee Smith, Silvio Rizzi, Pat Banerjee, Achal Patel, and Cristian Luciano
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medicine.medical_specialty ,business.industry ,Hemostasis ,medicine ,Surgery ,Medical physics ,Neurology (clinical) ,Neurosurgery ,Current (fluid) ,Virtual reality ,business - Published
- 2013
37. Seasonal variation of bovine anti-J in the tropics
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R. M. Mzee and Mikael Brænd
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Maximum temperature ,Tropical Climate ,Equator ,Temperature ,Tropics ,General Medicine ,Seasonality ,Biology ,medicine.disease ,Altitude ,Animal science ,Isoantibodies ,medicine ,Blood Group Antigens ,Animals ,Cattle ,Seasons ,Sea level - Abstract
Summary Close to the Equator at an altitude of 1750 m above sea level a total of 27 cows of various breeds have been studied with regard to the fluctuation of their anti-J naturally occurring antibodies. Over 16 consecutive months the average total score of anti-J varied from a minimum of 20 in October to a maximum of 37 at. the end of December. Practically all the sera had the lowest level of anti-J in October. This is about two months after the lowest yearly maximum temperature. It is concluded that gradual changes in temperature can cause variation in anti-J titer, and that the magnitude of the seasonal temperature changes influences the fluctuation of the natural anti-J.
- Published
- 1979
38. Osmotic demyelination syndrome: case report
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K. Hameed, Mzee Ngunga, R. Harania, and JO Jowi
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medicine.medical_specialty ,Alcohol Drinking ,business.industry ,Osmolar Concentration ,MEDLINE ,General Medicine ,Diagnosis, Differential ,Alcoholism ,Risk Factors ,Seizures ,Myelinolysis, Central Pontine ,Medicine ,Humans ,business ,Intensive care medicine ,Demyelinating Diseases - Abstract
We present a 40 year old man who was admitted to the hospital with convulsions. His final diagnosis was osmotic demyelination syndrome (ODS). We discuss the diagnostic and management challenges and the possible complications of this rare diagnosis.
39. Experience and challenges from clinical trials with malaria vaccines in Africa
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Seif Shekalaghe, Salim Abdulla, Beverly Msambichaka, Nahya Salim, Bernhards Ogutu, Marcel Tanner, Grace Mwangoka, Shubis Kafuruki, Maxmillian Mpina, and Tutu Mzee
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medicine.medical_specialty ,Biomedical Research ,Experiences ,Psychological intervention ,HIV Infections ,Clinical trials ,Malaria Vaccines ,parasitic diseases ,medicine ,Humans ,Tuberculosis ,Challenges ,Clinical Trials as Topic ,Vaccines ,Modalities ,Case Study ,Malaria vaccine ,business.industry ,Public health ,Neglected Diseases ,medicine.disease ,Malaria ,Clinical trial ,Infectious Diseases ,Family medicine ,Action plan ,Immunology ,Africa ,Neglected tropical diseases ,Workforce ,Parasitology ,business - Abstract
Malaria vaccines are considered amongst the most important modalities for potential elimination of malaria disease and transmission. Research and development in this field has been an area of intense effort by many groups over the last few decades. Despite this, there is currently no licensed malaria vaccine. Researchers, clinical trialists and vaccine developers have been working on many approached to make malaria vaccine available. African research institutions have developed and demonstrated a great capacity to undertake clinical trials in accordance to the International Conference on Harmonization-Good Clinical Practice (ICH-GCP) standards in the last decade; particularly in the field of malaria vaccines and anti-malarial drugs. This capacity is a result of networking among African scientists in collaboration with other partners; this has traversed both clinical trials and malaria control programmes as part of the Global Malaria Action Plan (GMAP). GMAP outlined and support global strategies toward the elimination and eradication of malaria in many areas, translating in reduction in public health burden, especially for African children. In the sub-Saharan region the capacity to undertake more clinical trials remains small in comparison to the actual need. However, sustainability of the already developed capacity is essential and crucial for the evaluation of different interventions and diagnostic tools/strategies for other diseases like TB, HIV, neglected tropical diseases and non-communicable diseases. There is urgent need for innovative mechanisms for the sustainability and expansion of the capacity in clinical trials in sub-Saharan Africa as the catalyst for health improvement and maintained.
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