Dr. Edwin R . Lugazia

ABSTRACT Background: Primary cardiac neoplasms are rare most of them are benign. Cardiac myxomas are the commonest benign lesion and the initial presentation may be accompanied with pulmonary, cerebral or systemic complications. Complete resection of the tumour is associated with good prognosis but recurrence is a frequent post operative complication. We report a first rare case from our centre of right atrial myxoma occurring in a young lady of 20 years old, a diagnosis and technique of resection is also explained. Case presentation: We report a rare case of a young girl who had presented to us with history of shortness of breath and easy fatigability, she was also found to have features of both upper andlower cava hypertension and was in NYHA class IV. The 2-D echocardiography revealed a right atrial tumor encroaching the tricuspid valve, chest radiography showed gross cardiomegally and right lower lung collapse. A clinical diagnosis of right atrial tumour was reached. The patient was scheduled to undergo open heart surgery and tumour resection on 23rd September 2009 and was prepared accordingly. A classical median sternotomy followed by major vessel cannulation in which the cava were cannulated distally. Patient was cooled to 22 centigrade the tumour was found filling the whole of right atrium cavity, friable with a broad stalk on the right atrial appendage extending and infiltrating the crista terminalis. It was excised and tissue was taken for histopathology. The right atrium was reconstructed and closed with adequate size of atrium. The histopathology revealed a typical right atrial myxoma. Postoperatively the patient developed massive right sided pleural effusion that was managed by tube thoracostomy. Eventually the patient recovered and was discharged to be followed at outpatient clinic. Conclusion: Right atrial myxomas are rare lesion occurring in 5- 10% of all cases of cardiac myxoma. The peak incidence is between 3rd to 6th decades of life. Our case was unusual as it occurred in the 2nd decade and in the right atrium with multicentric origin though still confined in the right atrium. She also presented with pulmonary complication of right sided lung collapse. Early diagnosis andresection is followed by good prognosis and recurrence rate is low. Resection was done and the postoperative period was uneventful.

Background: Disease in adenoids and tonsils are among the most common problems in paediatrics. Adenotonsillectomy is usually accompanied by significant post operative retching and vomiting. Objective: The aim of the study was to evaluate the role of dexamethasone in prevention of postoperative retching and vomiting (PORV) among paediatric patients undergoing adenotonsillectomy. Methods: This was a single blinded clinical trial study to find out the extent and risk factors of postoperative nausea and vomiting at Muhimbili National Hospital, (MNH.) Results: A total of 94 patients were eligible for the study, the overall proportions of retching and vomiting were 31.91% and 12.77 respectively. More complications of retching and vomiting occurred at the recovery room compared to the ward, which were 30.85% and 8.51% vs. 9.57 and 4.26% respectively. Conclusion: In general patients who received dexamethasone had lower incidence of PORV compared to the controls, however this finding was not statistically significant and did not show to have any effect in the prevention of PORV. Key words: Retching and vomiting, adenotonsillectomy, dexamethasone.

Background: Rheumatic heart disease remains a major health cardiac problem in developing countries as the culprit of rheumatic fever. Mitral valve stenosis is the most common complication of valvular heart disease and its consequences of increase in pulmonary hypertension, heart failure, pulmonary vascular disease and if untreated death ensues. The management of this condition varies depending on availability of expertise and resource; however in a facility deprived country with low economic status closed mitral valvotomy remain the standard palliative treatment! The aim of this study was to evaluate the clinical status of patients with mitral stenosis following closed mitral valvotomy treated at Muhimbili National Hospital, Cardiothoracic Unit. Methods: All patients presenting with severe mitral stenosis in absence of calcification in its leaflets and regurgitation were enrolled for the study from May 2008 to November 2009. Excluded were those who failure consents. Results:A total ...

Efforts from the developed world to improve surgical, anesthesia and obstetric care in low- and middle-income countries have evolved from a primarily volunteer mission trip model to a sustainable health system strengthening approach as private and public stakeholders recognize the enormous health toll and financial burden of surgical disease. The National Surgical, Obstetric and Anesthesia Plan (NSOAP) has been developed as a policy strategy for countries to address, in part, the health burden of diseases amenable to surgical care, but these plans have not developed in isolation. The NSOAP has become a phenomenon of globalization as a broad range of partners – individuals and institutions – help in both NSOAP formulation, implementation and financing. As the nexus between policy and action in the field of global surgery, the NSOAP reflects a special commitment by state actors to make progress on global goals such as Universal Health Coverage and the United Nations Sustainable Develo...

Treating deranged vital signs is a mainstay of critical care throughout the world. In an ICU in a university hospital in Tanzania, the implementation of the Vital Signs Directed Therapy Protocol in 2014 led to an increase in acute treatments for deranged vital signs. The mortality rate for hypotensive patients decreased from 92% to 69%. In this study, the aim was to investigate the sustainability of the implementation two years later. An observational, patient-record-based study was conducted in the ICU in August 2016. Data on deranged vital signs and acute treatments were extracted from the patients’ charts. Adherence to the protocol, defined as an acute treatment in the same or subsequent hour following a deranged vital sign, was calculated and compared with before and immediately after implementation. Two-hundred and eighty-nine deranged vital signs were included. Adherence was 29.8% two years after implementation, compared with 16.6% (p<0.001) immediately after implementation...

Despite emergency and essential surgery and anaesthesia care being recognised as a part of Universal Health Coverage, 5 billion people worldwide lack access to safe, timely and affordable surgery and anaesthesia care. In Tanzania, 19% of all deaths and 17 % of disability-adjusted life years are attributable to conditions amenable to surgery. It is recommended that countries develop and implement National Surgical, Obstetric and Anesthesia Plans (NSOAPs) to systematically improve quality and access to surgical, obstetric and anaesthesia (SOA) care across six domains of the health system including (1) service delivery, (2) infrastructure, including equipment and supplies, (3) workforce, (4) information management, (5) finance and (6) Governance. This paper describes the NSOAP development, recommendations and lessons learnt from undertaking NSOAP development in Tanzania.The NSOAP development driven by the Ministry of Health Community Development Gender Elderly and Children involved bro...

Traumatic brain Injuries represents a significant cause of morbidity and mortality worldwide and road traffic crashes accounts for a significant proportion of these injuries. However, access to neurosurgical care is poor in low income countries like Tanzania. The aim of this study was to assess the management and outcome of Traumatic brain injury patients at a tertiary level health facility in Tanzania. A retrospective observational study of Traumatic brain injury patients attended at Muhimbili Orthopedic Institute between January 2014 and June 2014. A total of 627 Traumatic brain injury (TBI) patients were seen, 86% were males. Majority (73%) were between 15 - 45 years age group. Road traffic crashes were the leading cause of injury (59.3%). Majority 401/627 (64%) sustained mild TBI, 114/627 (18.2%) moderate TBI and 112/627 (17.8%) severe TBI. All mild TBI patients had good recovery. Among patients with moderate and severe TBI; 19.1% had good recovery, 50.2% recovered with disabili...