ABSTRACT
Arteria lusoria, also known as an aberrant right subclavian artery (ARSA), is a congenital vascular anomaly of the aortic arch in which the right subclavian artery arises directly from the aorta distal to the left subclavian artery, rather than from the brachiocephalic trunk. This variation, occurring in a small percentage of the population, is frequently associated with a Kommerell’s diverticulum, a pouch-like aneurysmal dilation at the origin of the aberrant artery. A recent case at Mohammed VI University Hospital in Oujda involved a 62-year-old patient with exertional dyspnea who underwent thoracic angioscanning for suspected pulmonary embolism, revealing a retro-oesophageal right subclavian artery and a 22 mm Kommerell's diverticulum. In the absence of significant symptoms or complications, a conservative management strategy was chosen, consisting of therapeutic abstention and regular follow-up, with no issues reported to date. Diagnosis is primarily based on thoracic CT imaging, which provides detailed anatomical insights, and treatment varies from observation to surgical or endovascular intervention depending on clinical findings. The management of this anomaly is tailored to each case, considering symptom severity, potential complications, overall health status, and patient preferences.

ABSTRACT
Background: Stress hyperglycemia is common among critically ill patients admitted in the intensive care units (ICU), affecting 17-68%of patients within the first 48 hours of admission. Long-term stress hyperglycemia is linked to poor clinical outcomes and increases mortality. The burden and outcomes of stress hyperglycemia in critically ill patients is unknown in Tanzania. Methodology: Prospective short-term cohort study was conducted at Muhimbili National Hospital for 6 months. Adult critically ill patients in medical and surgical ICU were recruited consecutively. On admission, HbA1c and RBG were checked. FBG/RBG was tested daily until discharge or death. Stress hyperglycemia was defined as FBG≥6.1mmol/l or RBG of 140mg/dl (7.8mmol/L) or more observed during ICU admission. Length of stay and ICU mortality in one month of follow-up were recorded. SH proportion is reported as percentages. Predictors of SH were analyzed using logistic regression. P value <0.05 was considered statistically significant. Kaplan Meier’s mortality curves were used to compare the mortality of patients with SH to those without. Results: A total of 270 patients were enrolled, among them 120/270(44.4%) developed SH. These patients were largely male (58.2%) with a mean age of 48.2±17.8years. predictors of SH were having comorbidities and the use of steroids. Stress hyperglycemia increased the risk of staying in the ICU for ≤ 5 days by 2 folds aOR (95%CI), 2.416 (1.261-4.629) P=0.008. Steroid use reduces the risk of SH by 67% aOR (95%CI), 0.326 (0.167-0.636) P=0.001 and by 78% for patients with other comorbidities aOR (95%CI), 0.2196(0.097-0.497) P<0.001. Conclusion: The incidence of stress hyperglycemia is high in ICU patients as evidenced in this study. Duration of ICU stay, comorbidities, and steroid use was significantly associated with stress hyperglycemia. Stress hyperglycemia contributes to a higher mortality rate among critically ill patients.

ABSTRACT
Teenage pregnancy remains a significant public health concern globally, especially in low- and middle-income countries like Tanzania. It contributes to increased maternal and fetal morbidity and mortality, including complications such as anemia, hypertensive disorders, obstetric hemorrhage, low birth weight, and preterm delivery. Despite various interventions, teenage pregnancy rates remain high. This study aimed to assess obstetric outcomes and associated factors of teenage pregnancy in Mwanza region, Tanzania. A hospital-based cross-sectional study was conducted from April to June 2019 in four hospitals: Misungwi District Hospital, Sengerema District Designated Hospital, Bugando Medical Center, and Sekou Toure Regional Referral Hospital. A total of 357 teenage mothers who met inclusion criteria participated. Data were collected using structured questionnaires and checklists, then analyzed using STATA version 13. The mean age of participants was 17±1.3 years, with 72% from rural areas and 85.7% having no education or only primary education. Most were primiparous (90.2%) and had booked antenatal care (98.9%), though attendance and service utilization were inadequate. Vaginal delivery was common (79.2%). Adverse maternal outcomes included perineal tears (28.4%), anemia (59.7%), and hypertensive disorders (11.8%). Fetal outcomes showed 75% healthy live births, with occurrences of low birth weight (12.9%), small for gestational age (37.2%), and prematurity (14.8%). Hypertensive disorders were independently associated with poor fetal outcomes. The study concludes that teenage pregnancy is high-risk, often leading to adverse maternal and neonatal outcomes, highlighting the need for targeted interventions.

ABSTRACT
Diabetes mellitus (DM) is assuming epidemic proportions worldwide, particularly in developing countries. Identifying the current burden of DM in Nigeria is essential for effective healthcare planning and resource allocation for prevention. This review aimed to determine the current prevalence and risk factors of DM across the six geopolitical zones of Nigeria over the last two decades. Using the preferred reporting items for systematic review and meta-analysis (PRISMA) study design, articles pertinent to the study objective were searched from 2000 to 2024. The quality of the studies included in this review was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool for descriptive studies. Forty-four full-text publications met the eligibility criteria, out of which 23 were excluded because only an abstract was published, and 21 articles were included in the review. The overall pooled prevalence of DM in Nigeria was 6.3%. The prevalence of DM in the six geopolitical zones of Nigeria was 6.2% in the north-west, 6.1% in the north-east, 5.6% in the north-central zone, 5.4% in the south-west, 13.1% in the south-east, and 6.0% in the south-south zone. The prevalence of DM in Nigeria has increased over the last two decades compared to previous reports. Physical inactivity, unhealthy diet, and obesity are important perpetuating factors. A national diabetes care and prevention policy is highly recommended.

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Abstract: HER2-positive metastatic breast cancer represents a significant therapeutic challenge. Its prognosis has been altered thanks to significant advances in targeted anti-HER2 therapies. These treatments, such as trastuzumab and pertuzumab, have significantly improved the management of this pathology, enhancing patient survival, but are also responsible for adverse effects. Hypothyroidism, although less frequent than other complications, is an important side effect to recognize and manage. This clinical case presents a 47-year-old patient with HER2-positive metastatic breast cancer treated with chemotherapy combined with a dual anti-HER2 blockade using trastuzumab and pertuzumab, along with letrozole. After 52 cycles of dual blockade, the patient developed overt hypothyroidism. Levothyroxine replacement therapy improved her symptoms. This case illustrates the clinical importance of endocrine monitoring in patients receiving targeted anti-HER2 therapies, highlighting the need for a multidisciplinary approach to optimize the management of adverse effects and the quality of life of patients. A diagnostic delay of hypothyroidism can potentially impact the prognosis of the disease.

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Background: Neoadjuvant chemotherapy (NAC) with either Gemcitabine-Cisplatin (GC) or Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (DD-MVAC) is a standard approach for muscle-invasive bladder cancer (MIBC). While efficacy is established, toxicity profiles may differ and impact treatment delivery. This retrospective study compares the toxicity of GC and DD-MVAC regimens at the Moulay Ismail Military Hospital in Meknes. Methods: We retrospectively analyzed the records of 21 patients with MIBC treated with NAC between January 2020 and December 2023 (Corrected Date): 14 received GC (Gemcitabine 1000 mg/m² D1, D8; Cisplatin 70 mg/m² D1, q21 days) and 7 received DD-MVAC (Methotrexate 30 mg/m² D1; Vinblastine 3 mg/m² D2; Doxorubicin 30 mg/m² D2; Cisplatin 70 mg/m² D2, q14 days with G-CSF support). Toxicities were graded according to NCI-CTCAE v5.0. Results were compared descriptively and contextualized with published data. Results: In the GC group (n=14), the most frequent grade ≥3 toxicities were neutropenia (21.4%), anemia (14.3%), and thrombocytopenia (7.1%). Grade 1-2 renal toxicity occurred in 21.4%. In the DD-MVAC group (n=7), grade ≥3 neutropenia (42.9%) and mucositis (28.6%) were predominant. Two cases (28.6%) of febrile neutropenia were observed in the DD-MVAC arm (Corrected Number). Grade 1-2 renal toxicity was noted in 28.6% of DD-MVAC patients, and one case (14.3%) of Grade 3 renal toxicity occurred. All patients completed their planned NAC regimen, except for one patient (DD-MVAC arm) who discontinued due to Grade 3 renal toxicity. Conclusion: In our small cohort, both NAC regimens induced significant toxicity. DD-MVAC appeared associated with higher rates of severe neutropenia and mucositis compared to GC. These findings, although limited by sample size, underscore the need for vigilant monitoring and proactive toxicity management for both regimens in our setting, potentially favoring GC in patients perceived as more vulnerable to

ABSTRACT
Background: Peripheral arterial disease (PAD) is a disease of public health significance, ranging from asymptomatic to symptomatic presentation. The impact of PAD may be profound in many low to middle income countries (LMICs) where walking a substantial distance is required to obtain the daily basic needs. This study was conducted to determine prevalence of peripheral arterial disease and risk factors among diabetic patients attending an outpatient clinic in Northwestern Tanzania. Methods: A descriptive cross-sectional study carried out among adult patients attending a Diabetic Outpatient Clinic in Mwanza Tanzania. Demographic data and risk factors for PAD were recorded on a pretested questionnaire. Ultrasound guided ABI was measured using a standard mercury sphygmomanometer. Edinburgh Claudication Questionnaire (ECQ) was compared to the Fontaine Classification in PAD detection. Chi-square test, Fisher’s exact test and logistic regression analyses were used to test for significance of association between independent and dependent variables with a p-value (p) <0.05 considered statistically significant. Receiver operator characteristic (ROC) curve analysis was also utilized to determine performance of ABI against clinical grading of PAD. Results: A total of 386 participants were enrolled in this study with a mean age of 60.0 ± 12.3 years. There was a significant association between an abnormal ABI with HbA1c, family history of cardiovascular diseases, hypertension, cigarette smoking and claudication (p=0.04 to <0.001). Claudication [aOR (95% CI) = 6.30 (3.14-12.64), p<0.001] was independently associated with an abnormal ABI. Prevalence of PAD was slightly lower based on clinical grading of PAD (30.8%) in comparison to an abnormal ABI respectively (34.5%). ABI had a sensitivity of 64.7%, specificity of 79.0%, positive predictive value of 57.9%, negative predictive value of 83.4%, accuracy of 74.6%. Area under the ROC curve of ABI was 0.72 against clinical grading of PA