ABSTRACT
Health is a state of complete physical, mental and social well-being; it is not just the absence of disease or infirmity" [1, 2]. The resources mobilized in developing countries to deal with health problems in general, and particularly in the context of primary health care, are low in most cases and sometimes unevenly distributed. Objective: To analyze the health impacts of this insecurity on the population of the Douentza circle. Method: this was a retrospective, prospective and analytical study which took place. from March 2012 to December 2019. Results: During the study period, the incidence of severe malaria was between 22-31%, diarrheal diseases between 9-11% While the prevalence of SAM was between 25-. 57%, that of SAM with complications was between 2-4% in the district. Malaria-related mortality was under-reported. As part of epidemiological surveillance, only cases of measles and meningitis were regularly reported. reference evacuation was disorganized with the mobility of the population and nursing staff. Conclusion: Insecurity has had a negative impact on the entire health system in general and particularly on the state of health of the population with direct and indirect consequences.

ABSTRACT
Introduction: Malnutrition is an emerging but neglected problem in hospitalized surgical patients which contributes significantly to the adverse postoperative outcomes. However, in most of our settings; patients scheduled for abdominal surgeries are not routinely assessed for nutritional status rendering difficultness in mitigating the avoidable predicaments. Objective: To determine the prevalence of malnutrition and its association with the early outcomes among patients undergoing abdominal surgery at Bugando Medical Centre (BMC), Mwanza, Tanzania. Methods: This was a prospective longitudinal study involving adult patients who underwent abdominal surgeries at BMC from January 2023 to June 2023. Nutritional status assessment was done according to the Nutrition Risk Screening tool (NRS-2002). Results: The overall prevalence of malnutrition was found to be 51.8%. Complication and mortality rates were 25.4% and 8.3% respectively. The overall length of hospital stay ranged from 5 days to 14 days (median of 9 days). Preoperative malnutrition was found to be statistically significant associated with early postoperative complications (OR=4.1, 95% [2.0-8.2], p-value< 0.001), prolonged Length of hospital stay (LOS) (OR=2.5, 95% [1.4-5.8], p-value = 0.003) and mortality (OR=4.6, 95% [2.5-11.2], p-value < 0.001). Furthermore, preoperative malnutrition significantly predicted surgical site infections (OR=2.2, 95% [1.0-4.8], p-value =0.047) and anastomotic leakage (OR=3.1, 95% [1.1-8.9], p-value =0.035). Conclusion: Preoperative malnutrition is a significant and independent risk factor for postoperative complications, prolonged hospital stay and mortality following abdominal surgery. This study emphasizes the need for routine assessment of nutritional status using a validated tool preoperatively so as to draft a nutrition care strategy to prevent postoperative malnutrition-related adverse outcomes.

ABSTRACT
Background: The increased incidences of caesarean section rate is associated with a number of post-operative complications; one being re-laparotomy which is considered a maternal near-miss. The purpose of a re-laparotomy is to manage complications of the previous surgery such as unsecured hemostasis, manage intraabdominal infection, repairing of iatrogenic damaged organs like bowels, ureters and bladder, relieve intestinal obstruction and maintain intestinal continuity or to carry out delayed curative surgery. In general, second surgery increases not only the morbidity but also the risk of maternal mortality. Methods: The study was cross sectional, conducted at the Department of Obstetrics and Gynecology in MNH. It involved review of medical records of all women who necessitated re-laparotomy following Caesarean Section (CS) that was performed either at MNH or from referring health facilities during the study period. Results: There were 193 relaparotomy cases, 98% were referrals. Atonic uterus and sepsis (septic uterus, pelvic abscess and pus in peritoneal cavity) as intraoperative finding showed statistical significance in our study. Atonic uterus for those women who underwent relaparotomy due to post-partum hemorrhage (PPH) increase from 1(7.7%) in 2017 to 6(14%) in 2021 with an average increase of 2.31 % every year. Number of cases for sepsis (combination of septic uterus, pelvic abscess and pus in peritoneal cavity) was significant decreasing every year from 22(37.3%) in 2018 to 7(16.3%) 2021with an average decrease of 3.15% every year from 2017 to 2021. The number of cases who had hysterectomy as one of the post-operative outcomes was statistically significant decreasing from 44(74.6%) to 26(60.5%) over the study period with an average decrease of 5.89% every year from 2018 to 2021. Conclusion: The most frequent indication for relaparotomy after CS was a burst abdomen. For the women who had relaparotomy due to uncontrollable PPH, the main intraoperative .......

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Background: Cancer is an emerging global public health threat in low- and middle-income countries, and poor health literacy has resulted into poor outcomes due to late diagnosis and care. Fibrosarcoma is among the rare - highly malignant tumor with poor prognosis when diagnosed late. Its survival rate is estimated to be around 20% in Low- and middle-income countries (LMICs) as compared to more than 80% in high-income countries. Case presentation: Herein we report a case of 14-years-old boy with a relapsing mass in his left hand. It was initially thought to be benign and it was resected, but later confirmed by tissue histopathological examination to be an infantile fibrosarcoma. Limb salvage surgery was not possible only to end up with forearm amputation. Discussion: Health literacy of healthcare workers and community at large has an influence on outcome of cancer treatments, it reduces incidences of late diagnoses as primary physicians will have an increased suspicion for malignancies whenever they encounter such a mass especially in children. Most of fibrosarcoma are deemed unresectable at diagnosis hence necessitating a multimodal approach including preoperative cytoreductive therapy and surgery. Conclusion: Fibrosarcoma has good prognosis when diagnosed early. To prevent unfavorable cancer-related outcomes and to have good oncological outcomes; health literacy on soft tissue sarcomas should be promoted especially at the community level as it is the case in other types of cancers.

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Oral and Maxillofacial Surgeons may encounter complications while performing major as well as minor surgical procedures, either intraoperatively or postoperatively. Bleeding after a dental extraction is a frequent complication following surgery. This article discusses an uncommon postoperative complication characterized by prolonged bleeding and the formation of a "liver clot" coagulum, observed 72 hours following the extraction of root stump in an elderly female during a follow-up visit.

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Background: Most patients admitted to the surgical ward undergo laparotomy for various reasons, despite the use of analgesics pain control could remain inadequate. Inadequate postoperative pain management can lead to undesired post-operative complications which increases the risk of morbidity and increased hospital stay. This study aimed to determine the prescription pattern of analgesics, inadequacy of postoperative pain management and its associated factors in the first three days among patients undergoing laparotomy at Bugando Medical Centre. Method: Prospective longitudinal study was conducted at Bugando Medical Centre from April to July 2022, involving 106 adult postoperative patients undergone laparotomy and were admitted to the general surgery wards. Structured questionnaires were used to obtain post-operative information. Postoperative pain severity scores were assessed by using a Numerical Rating Scale (NRS). Data were analysed using STATA v.15. Bivariate analysis and multivariate logistic regression were done. A P-value of <0.05 was considered significant. Results: The types of analgesics commonly prescribed postoperatively were a combination of Pethidine and Paracetamol (67.8%), followed by combinations of Pethidine and Paracetamol with Diclofenac (25.2%) and lastly Pethidine, Paracetamol and Tramadol (7.0%). The prevalence of moderate to severe postoperative pain within 12, 24, 48 and 72 hours were 97.7%, 92.2%, 47% and 21.8% respectively. There was a significant association between sex with the severity of pain. Conclusions: Postoperative pain management was inadequately managed at Bugando Medical Centre. The proportion of postoperative pain in the first twenty-four hours post-operative was the highest. There was no uniformity in the postoperative pain management in our setting and a suboptimal prescription of pethidine was noted. The frequency of pethidine prescription was eight hours instead of four to six hours. Male sex was associated .........

ABSTRACT
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the alimentary tract. Now a day GISTs represents 0.1-3% of all gastrointestinal malignancies, making it a diagnostic challenge. Lesions are frequently located in stomach and proximal small intestine but rarely elsewhere in the abdomen. They are believed to result from mutations of protooncogenes c-Kit or platelet-derived growth factor receptor alpha polypeptide, this increase tyrosine kinase receptor activity, leading to uncontrolled proliferation of stem cells that differentiate into cells of Cajal. They can occur at any age but predominantly in middle-aged people and in elderly. We reported the cases presented to our hospital with progressively distension of the abdomen, finding in diagnostic image suggested GIST without evidence of metastasis disease, total excision was done, Cytologic and immunohistochemistry analysis confirm diagnosis of GISTs.