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Abraham ZS, Zerd F, Mnguruta BJ, Mgute CD, Kahinga AA. Synchronous nasal rhinosporidiosis and inverted papilloma in a paediatric patient in Dodoma, Tanzania: Case report. Int J Surg Case Rep 2024; 117:109578. [PMID: 38531292 PMCID: PMC10979196 DOI: 10.1016/j.ijscr.2024.109578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Nasal rhinosporidiosis refers to a rare chronic granulomatous disease caused by Rhinosporidium seeberi. It affects the mucous membrane of sites such as nasopharynx, conjunctiva and palate. Inverted papillomas are relatively rare and are benign epithelial tumors of the nasal cavity that are locally aggressive, exhibit recurrence tendency and malignant transformation. Both entities are very rare in our setting and this is perhaps the first documented case in Tanzania. CASE PRESENTATION The patient was a 7-year old boy with a 1-year history of left-sided nasal obstruction and intermittent epistaxis for 6 months. He had no history of cheek swelling, pain or numbness, loss or loosening of teeth or alveolar ridge fullness. There were no ophthalmological, otological or neurological complaints reported. Endoscopic excision of the nasal mass was done and histopathological analysis confirmed co-existence of rhinosporidiosis and inverted papilloma. Postoperatively, the patient was kept on oral dapsone at a dose of 50 mg/day for 6-months and with no residual disease recurrence noted after 6-months follow up. CLINICAL DISCUSSION The patient underwent endoscopic excision of the nasal mass and histopathological analysis confirmed co-existence of rhinosporidiosis and inverted papilloma. Postoperatively, the patient was kept on oral dapsone at a dose of 50 mg/day for 6-months and with no residual disease recurrence noted after 6-months of follow up. CONCLUSION Nasal rhinosporidiosis and inverted papilloma lesions may resemble the routinely encountered nasal polyps thus important for both clinicians and pathologists to have a high index of suspicion when managing patients with nasal masses even from non-endemic areas.
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Affiliation(s)
| | - Francis Zerd
- Department of Anatomical Pathology-The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Benard John Mnguruta
- Department of Surgery-University of Dodoma, School of Medicine and Dentistry, Dodoma, Tanzania
| | - Chrispin Dickson Mgute
- Department of Surgery-University of Dodoma, School of Medicine and Dentistry, Dodoma, Tanzania
| | - Aveline Aloyce Kahinga
- Department of Otorhinolaryngology-Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Abraham ZS, Zerd F, Kahinga AA. Nasal rhinosporidiosis masquerading as pyogenic granuloma in a pediatric patient at a Zonal Referral Hospital in Central Tanzania: Case report. Clin Case Rep 2022; 10:e5977. [PMID: 35765285 PMCID: PMC9207230 DOI: 10.1002/ccr3.5977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/14/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022] Open
Abstract
Being rare, rhinosporidiosis is a chronic granulomatous disease that is characterized by polypoidal lesions of the mucous membrane and is caused by Rhinosporidium seeberi. The disease commonly affects the mucous membrane of the nasopharynx, conjunctiva, and palate and its very rare in our geographical location. Nasal rhinosporidiosis lesions may greatly mimic other ordinary nasal polyps, and it is crucial for otorhinolaryngologists to consider rhinosporidiosis as a differential diagnosis whenever encountering patients with nasal masses during routine clinical practice.
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Affiliation(s)
| | - Francis Zerd
- Department of Anatomical Pathology The Benjamin Mkapa Hospital Dodoma Tanzania
| | - Aveline Aloyce Kahinga
- Department of Otorhinolaryngology Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
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Abraham ZS, Zerd F, Kahinga AA. Advanced hypopharyngeal squamous cell carcinoma mimicking thyroid abscess in a young male: Case report and literature review. Int J Surg Case Rep 2022; 94:107154. [PMID: 35658311 PMCID: PMC9093012 DOI: 10.1016/j.ijscr.2022.107154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 10/26/2022] Open
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Cooper F, Lewis EG, Urasa S, Whitton L, Collin H, Coles S, Wood GK, Ali AM, Mdegella D, Mkodo J, Zerd F, Dotchin C, Gray WK, Walker RW. Social vulnerability, frailty and their association with mortality in older adults living in rural Tanzania. J Gerontol A Biol Sci Med Sci 2022; 77:2050-2058. [PMID: 35291011 PMCID: PMC9536438 DOI: 10.1093/gerona/glac066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Social vulnerability correlates with frailty and is associated with mortality and disability. However, few studies have investigated this relationship outside of high-income country settings. This study aimed to produce and analyze a culturally adapted social vulnerability index (SVI) to investigate the relationship between social vulnerability, frailty, and mortality in older adults in Tanzania. Methods An SVI was produced using data from a cohort study investigating frailty in older adults in Tanzania. Variables were selected based on previous SVI studies using the categories established by Andrew et al. from the Canadian Study of Health and Aging, and National Population Health Survey. The SVI distribution was examined and compared with a frailty index (FI) produced from the same sample, using mutually exclusive variables. Cox regression survival analysis was used to investigate the association between social vulnerability, frailty, and mortality. Results A stratified cohort of 235 individuals were included in the study at baseline, with a mean age of 75.2 (SD 11.5). Twenty-six participants died within the follow-up period, with a mean of 503 days (range: 405–568) following the initial assessment. The SVI had a median score of 0.47 (interquartile range: 0.23, range: 0.14–0.86). Social vulnerability significantly predicted mortality when adjusting for age and gender, but not when also adjusting for frailty. Conclusions Social vulnerability can be successfully operationalized and culturally adapted in Tanzania. Social vulnerability is associated with mortality in Tanzania, but not independently of frailty.
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Affiliation(s)
- Fiona Cooper
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Grace Lewis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Research Institute, Moshi, Tanzania
| | - Louise Whitton
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Harry Collin
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Selina Coles
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Karen Wood
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Joyce Mkodo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Francis Zerd
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Catherine Dotchin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Richard W Walker
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
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Zerd F, Moore BE, Malango AE, Hosokawa PW, Lillehei KO, Mchome LL, Ormond DR. Photomicrograph-Based Neuropathology Consultation in Tanzania. Am J Clin Pathol 2020; 154:656-670. [PMID: 32715312 DOI: 10.1093/ajcp/aqaa084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Since neuropathologic diagnosis in the developing world is hampered by limitations in technical infrastructure, trained laboratory personnel, and subspecialty-trained pathologists, the use of telepathology for diagnostic support, second-opinion consultations, and ongoing training holds promise as a means of addressing these challenges. This study aims to assess the utility of static teleneuropathology in improving neuropathologic diagnoses in low- and middle-income countries. METHODS Consecutive neurosurgical biopsy and resection specimens obtained at Muhimbili National Hospital in Tanzania between July 1, 2018, and June 30, 2019, were selected for retrospective, blinded static-image neuropathologic review followed by on-site review by an expert neuropathologist. RESULTS A total of 75 neuropathologic cases were reviewed. The agreement of static images and on-site glass diagnosis was 71% with strict criteria and 88% with less stringent criteria. This represents an overall improvement in diagnostic accuracy from 36% by general pathologists to 71% by a neuropathologist using static telepathology (or from 76% to 88% with less stringent criteria). CONCLUSIONS Telepathology offers a promising means of providing diagnostic support, second-opinion consultations, and ongoing training to pathologists practicing in resource-limited countries. Moreover, static digital teleneuropathology is an uncomplicated, cost-effective, and reliable way to achieve these goals.
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Affiliation(s)
- Francis Zerd
- Department of Pathology, Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Brian E Moore
- Division of Neuropathology, Department of Pathology, Aurora
| | - Atuganile E Malango
- Department of Pathology, Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Patrick W Hosokawa
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora
| | - Kevin O Lillehei
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora
| | | | - D Ryan Ormond
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora
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Lewis EG, Whitton LA, Collin H, Urasa S, Howorth K, Walker RW, Dotchin C, Mulligan L, Shah B, Mohamed A, Mdegella D, Mkodo J, Zerd F, Gray WK. A brief frailty screening tool in Tanzania: external validation and refinement of the B-FIT screen. Aging Clin Exp Res 2020; 32:1959-1967. [PMID: 31811571 DOI: 10.1007/s40520-019-01406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Identifying older people who are most vulnerable to adverse outcomes is important. This is particularly so in low-resource settings, such as those in sub-Saharan Africa (SSA), where access to social and healthcare services is often limited. AIM To validate and further refine a frailty screening tool for SSA. METHODS Phase I screening of people aged 60 years and over was conducted using the Brief Frailty Instrument for Tanzania (B-FIT). In phase II, a stratified, frailty-weighed sample was assessed across a range of variables covering cognition, physical function (including continence, mobility, weakness and exhaustion) nutrition, mood, co-morbidity, sensory impairment, polypharmacy, social support and self-rated health. The frailty-weighted sample was also assessed for frailty according to the comprehensive geriatric assessment (CGA), which we used as our 'gold standard' diagnosis. RESULTS Of 235 people in the frailty-weighted sample, 91 (38.7%) were frail according to CGA, the median age was 73 years and 136 (57.9%) were female. In multivariable modelling, physical disability (Barthel index), cognitive impairment (IDEA cognitive screen), calf circumference, poor distance vision and problems engaging in social activities were found to be associated with frailty. After developing a scoring system, based on regression coefficients, a modified B-FIT screen (B-FIT 2) had an area under the receiver operating characteristic curve of 0.925, a sensitivity of 86.2% and a specificity of 88.8%. DISCUSSION The inclusion of items assessing nutrition, social support and sensory impairment improved the performance of the B-FIT. CONCLUSIONS The B-FIT 2 should be externally validated.
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Affiliation(s)
- Emma Grace Lewis
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise A Whitton
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Harry Collin
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kate Howorth
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Louise Mulligan
- South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Bhavini Shah
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, UK
| | - Ali Mohamed
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Joyce Mkodo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Francis Zerd
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
- Department of Research and Development, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK.
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