ABSTRACT
In Africa south of the Sahara, there are very few urologists. To fill this gap, a training in urology started in Guinea in 2005. The aim of this study was to take stock of this teaching, both theoretical and practical. Two different questionnaires were established for this survey. The first one was addressed to the students in order to collect their satisfaction and wishes regarding the teaching provided, and the second one to the person in charge of the teaching concerned the objectives of the DES, the conditions of participation in this training, and the teaching methods. Nineteen students (76%) responded to our questionnaire. Their average age was 34.74 years. The teaching provided was close to the practical concerns of the students in 68.42% of cases (n=13). The difficulties encountered by the enrollees were dominated by the payment of training fees (73.68%; n=14) and access to the internet (68.42%n=13). The most cited suggestions were the improvement of the technical platform (13.32%; n=4), easy access to the internet and scientific journals (10%; n=3). The surgical simulator, surgical training in animals, and surgical tutoring during the course are the practical teaching methods to be promoted according to the training manager. In conclusion, our study has enabled us to form an opinion on the training of doctors in the context of specialisation in Guinea, and to highlight what has been achieved and what needs to be improved in order to maintain the quality of teaching.

ABSTRACT
Background: Abdominal pregnancy is a rare form of ectopic pregnancy with a higher misdiagnosis rate. Sepsis is a life-threatening complication associated with this type of ectopic pregnancy. Various techniques for managing septic advanced abdominal pregnancy have been discussed in the literature. In this article, we report a case of managing septic abdominal pregnancy in which a macerated baby was delivered, and the necrotic placenta was left in situ. Case presentation: We report a 34-year-old African woman, para 5 living 4, who was three days post laparotomy due to abdominal pregnancy. A re-laparotomy was done due to maternal sepsis. The peritoneum had foul-smelling pus, with a necrotized placenta which was still attached to various parts of the abdomen. The placenta was left in situ and the abdomen was left open. Pus swab revealed methicillin-resistant staphylococcus aureus which was sensitive to Vancomycin. She was managed with a ten-day Vancomycin regime. Dressing with normal saline and honey twice or thrice a day for eight weeks was done. Secondary suturing was done and the patient was discharged home later in good health. Conclusion: Advanced abdominal pregnancy is a rare condition, and its management is very challenging. Once it complicates into maternal sepsis the life of the mother becomes endangered. Identifying and treating the source of infection with daily dressing using normal saline and honey is simple and cheap, it saves life.

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Background: Acute myocardial infarction is a condition where the blood flow to the heart muscle is blocked, leading to the death of heart tissue. It is a major cause of heart failure and fatalities worldwide. Objective: To assess risk factors in MI patients and determine clinical criteria for patients with MI. Methods: This cross-sectional observational study was done from January 2023 to June 2023 at the Mymensingh Medical College Hospital, Mymensingh, Bangladesh. A total of 100 people were observed in this study. Results: Our study showed that a maximum of 32 individuals aged 50-59 suffered from acute myocardial infarction. Most were male (74%) and Muslim (93%). 83% had hypertension, 78% had diabetes mellitus, and 77% were smokers. Different types of MI were identified, with anterolateral MI being the most common (25 patients). Conclusion: Several risk factors increase the chance of developing acute myocardial infarction, including family history, sedentary lifestyle, unhealthy diet, smoking, lack of exercise, and certain health conditions like diabetes, hypertension, dyslipidemia, SLE, vasculitis, or obesity.

ABSTRACT
Cardiovascular diseases (CVDs), which are often thought to be a “man’s” challenge, are now recorded as the primary cause of death for women globally. Consequently, the present study set out to assess the cardiovascular indices in obese women resident in Rivers State, Nigeria. Utilizing the Leslie Fischer's formula; exactly 334 obese and non-obese women within their 18 and 65 years of age with no obvious health condition and resident in Upland and Riverine areas of Rivers State were recruited by the present study. The multistage sampling technique was used, and subjects were drawn across the upland and riverine locations of the State. Consenting subjects were randomly surveyed from the multi-ethnic residents of the state. Anthropometric (body mass index-BMI) data and auscultatory blood pressure measurement were done using Seca weight/height scale and mercury sphygmomanometer and stethoscope respectively. Electrocardiographic (ECG) features were recorded using the standard resting 12 – lead ECG. Numerical data obtained were subjected to statistical analyses using the statistical package for social sciences (SPSS) version 21.0. One-way analysis of variance (ANOVA) and independent t-test with a p< 0.05 considered statistically significant were determined. The BMI values were generally higher in the RVR subjects when compared to their UPL counterparts, but only that of obese class II were significant (P<0.05) of the aforementioned increases. The systolic and diastolic blood pressure (SBP and DBP) of all subjects indicated graded increases from obese class I to obese class III and these increases were seen to be significant (P<0.05) when compared to that of the non-obese and down the successive groups. The ECG features in the non-obese and obese class I subgroups indicated higher prevalence of left ventricular hypertrophy in the UPL residents than the RVR residents. The study thus found that there was a significantly raised prevalence of obesity in younger RVR .......

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Introduction: Metastatic pleural effusion complicates many cancers and impairs patients' quality of life. In a palliative situation, the decision between thoracoscopy talc pleurodesis, tube chest, iterative punctures or abstention is difficult and often operator dependent. Materials and methods: We report a study of 87 patients with metastatic pleural effusion treated by video assisted thoracoscopy talc pleurodesis. Results: Breast cancer constitutes the primary site causing metastatic pleural effusion in approximately half of cases, followed by bronchopulmonary cancers and finally digestive cancers. The complete response rate in the short and medium term is very satisfactory. We did not report any complications apart from one case of empyema. Conclusion: video assisted thoracoscopy talc pleurodesis constitutes an interesting treatment for recurrence of metastatic pleural effusion.

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Background: Head and neck malignancies are often diagnosed at a late stage in sub-Saharan Africa including Tanzania, thus resulting in a generally poor prognosis. The reason for this sad experience is not known. This study was undertaken in our local setting, to describe the stage at presentation and factors associated with late diagnosis of head and neck malignancies at Bugando Medical Centre, Mwanza, Tanzania. Methods: This was analytical cross sectional study involving all patients confirmed to have head and neck malignances at Bugando Medical Center from February to June 2019. Results: Out of 60 patients enrolled in the study, 35(58.3%) were males and 25(41.7%) were female making a male to female of 1.4:1. The mean age was 56 [range, 12-89] years. Majority of patients, 44(73.3%) presented with advanced (late) stage of the disease, with stage III been the most prevalent stage accounting for 49.3% of cases. Only one (1.7%) patient had stage I tumor involving the oral cavity. Distant metastasis was documented in only 16.7% of cases. The oropharynx was the most common anatomical site for head and neck malignancies (n=18, 30%). Patients with oropharyngeal malignancies were associated with late-stage presentation whereas those with laryngeal malignancies were associated with early-stage presentation. Patient-related factors such as rural residence (p-value = 0.048) and use of local herbs (p-value = 0.001) were significantly associated with advanced (late) tumor stage at presentation. The level of health care facility first visited (p-value = 0.876) and the number of referrals (p-value =0.579) were not significantly associated with late stage at presentation. Conclusion: This study demonstrated that the head and neck malignancies are not uncommon at Bugando Medical Center and the majority of patients present late with advanced stage cancer. Therefore, increasing awareness among rural residence regarding head and neck malignancies and their symptoms, and training ......

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Background: Orofacial clefts are the most common craniofacial anomalies in most parts of the world and its management remains a challenge to otorhinolaryngology, plastic/reconstructive, oral and maxillofacial surgeons practicing in resource limited countries. There is limited data on surgical management of these birth defects in Tanzania and Bugando Medical Centre (BMC) in particular. This study aimed to describe our own experience regarding the surgical management of orofacial clefts at BMC, a tertiary care hospital in Tanzania. Methods: This was a cross sectional study involving all children with orofacial clefts that were treated at BMC between February 2019 and June 2019. Results: A total of 98 patients with orofacial clefts were recruited. Males outnumbered males by a male to female ratio of 1.7:1. The majority of patients (64.3%) were within 12 months at presentation. The median ages at surgery in patients with cleft lip and those with cleft palate were 3 [IQR, 2 to 8] and 11(IQR, 7 to 18) months, respectively. Orofacial clefts in association with congenital anomalies were recorded in 5(5.1%) patients. More than half of patients (55.1%) had combined cleft lip and palate. Unilateral clefts, 77(78.5%) were more common and showed left side preponderance in 52(53.1%) patients. All patients underwent cleft surgery under general anesthesia. Millard rotation advancement flap repair and von-Langenbeck were the most common techniques of cleft lip and palate repair performed in 42(52.5%) and 30 (41.7%) patients, respectively. The overall complication rate was 14.3% and the most common postoperative complications were bleeding, palatal fistula, wound dehiscence and surgical site infections in 6(31.6%), 4(21.1%) and 3(15.8%) each respectively. No death was recorded in this study. Among the 98 patients operated, 79 were treated successfully giving an overall success rate of 80.6%. The success rate was significantly influenced by nutrition status (p= 0.010), co-existing con

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Background: Emergencies of the upper aero-digestive tract emergencies (UADTEs) are common in our setting, can be life threatening, challenging to the otolaryngologists and yet there is a paucity of clinical studies on these emergencies. This study aimed to determine the clinical profile, treatment modalities and outcomes of upper aero- digestive tract emergencies at Bugando Medical Centre (BMC), Mwanza, Tanzania. Methods: Between January and May 2019, a cross sectional study involving patients presenting with a clinical diagnosis of UADTEs was conducted at BMC. Data on socio-demography, clinical presentation, duration of symptoms, time interval between admission and intervention, type of intervention, postoperative complications and length of hospital stay were collected in questionnaire designed for the study. Ethical clearance was obtained from the Joint CUHAS/BMC Research, Ethics and Review Committee. Results: Of 487 ENT emergencies seen during study period, 128 (26.3%) patients had UADTEs. Male outnumbered females by a ratio of 1.5: 1. Their median age at presentation was 5 [range, 2-40] years. The major causes of UADTEs were foreign body ingestion, head & neck tumors and foreign body aspiration and cut-throat injuries that were seen in 56(43.8%), 33(25.8%), 25(19.5%) and (3.9%) respectively. The most frequent presentations were dysphagia 81(63.3%), difficulty in breathing 61(47.7%) and odynophagia 56(43.8). Poor outcome following esophagoscopy was associated with younger age (0-17 years) (p=0.02), prolonged duration to treatment (p=0.04) and low blood oxygen saturation (SPO2) (p=0.04). In addition, delayed duration to treatment (p=0.01) and foreign body ingestion (p=0.001) were significantly associated with prolonged hospital stay. Conclusion: At Bugando Medical Centre, UADTE pose a serious burden and challenge. Peripheral hospitals should be equipped with trained health workers and basic equipment to resuscitate and manage these patients before they are ......

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Tibial tubercle avulsion fracture is a rare injury in adolescents; its association with a patella fracture is exceptional. This current case report describes an 10-year-old boy admitted to the department of pediatric orthopaedic surgery for a left knee trauma. X-ray showed a displaced fracture of the tibial tubercle associated with a fracture of the patella, the sciatic nerve, and the fibrous band. We performed a surgical reduction of the tibial fragment with two cancellous screws and tension band wiring of the patellar fragment.

ABSTRACT
Background: Placenta accreta spectrum (PAS) is a broad term that includes placenta accreta, placenta increta, and placenta percreta. The major risk factor is a scarred uterus commonly as a result of prior cesarean delivery, myomectomy, or uterine instrumentation. We report a case of placenta increta in the absence of identifiable risk factors. Case presentation: A 22-year-old, para 2 living 2, presented with postpartum hemorrhage due to retained placenta post vaginal delivery at a gestational age of 38 weeks and 4 days, manual removal of placenta was attempted general anesthesia without success; necessitating explorative laparotomy where the placenta was found deeply invading into the myometrium. Intractable bleeding necessitated supracervical hysterectomy. Histopathological results later revealed placenta increta. Conclusion: PAS in an unscarred uterus in the absence of other identifiable risk factors is quite uncommon; however, carries high maternal morbidity and mortality. This case serves as an eye opener on the need to evaluate for radiological features of PAS during antenatal visits even in low-risk group.