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Introduction: Constipation or difficulty in bowel movement is a common problem in children. It is often results from without any previous illness or previous painful bowel movements. Dietary influences such as low fiber intake and inadequate hydration play a role too. Many factors have been associated with the occurrence of constipation. Aim of the study: The aim of this study was to investigate the factors associated with pediatric constipation and its management. Methods: This cross-sectional study was conducted in out-patient Department of Pediatrics surgery in Enam Medical College and Hospital, Savar, Dhaka, Bangladesh, during the period from July to December 2022. Total 180 patients with constipation were included in this study. Result: Our study of 180 children, average age was 2.4 years and slightly more in females, investigated factors relating to constipation. Most of the children had constipation for 6-12 months and more; and some children had constipation for 3-4 years, with symptoms such as large hard stool (95.0%), painful defecation (88.3%), and abdominal pain or crying (71.1%). Some children had per rectal bleeding and perianal mass or growth that is sentinel piles. A large number of clinical and therapeutic factors were associated with chronic constipation. Conclusion: The findings of this study highlighted the prominence of symptoms like large, hard, and painful defecation of children. With notable findings such as inadequate fluid and fiber intake and change in dietary habit during weaning period and lack of toilet training play an important role in producing constipation.

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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.

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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.

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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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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.