Dar Es Salaam Medical Students' Journal

Dental fluorosis knowledge and perception among students of the health sciences

D Shunu — 2013-05-22

Introduction: The effect of excessive intake of fluoride is obviously seen among people in endemic areas of fluorosis in Tanzania but people have not openly expressed what they feel about of dental fluorosis.
Objective: To assess dental fluorosis perception among students of the health sciences at Muhimbili University of Health and Allied Sciences (MUHAS).
Materials and methods: A cross-sectional study among students of the health sciences at MUHAS was conducted in April 2012. A total of 40 students aged 19-28 years from different courses were involved to assess their views using a self-administered questionnaire and tables were prepared using Microsoft excel.
Results: thirty students, which is 75% of all students interviewed were bothered by brown mottled teeth, while the remaining 10(25%) responded that having brown mottled teeth was normal to them. A total of 31(77.5%) didn’t know how to prevent dental fluorosis while 9(22.5%) had knowledge on the effect of excess fluoride so they also knew how to prevent fluorosis.
Conclusion: Majority of the students perceived dental fluorosis as a problem while few had knowledge on how to prevent it. This shows a need to educate them about fluorosis to put them in a better position to combat this problem.

The Black Death

FS Matemu — 2013-05-22

Introduction
Bubonic plague is a deadly bacterial disease that causes fever and painful swollen lymph nodes called buboes. The disease also causes spots on the skin that are red at first and then turn black. The Black Death was one of the most devastating pandemics in human history, peaking in Europe between 1348 and 1350. Although there were several competing theories
as to the etiology of the Black Death, it has been conclusively proven via analysis of ancient DNA from plague victims in northern and southern Europe that the pathogen responsible is the Yersinia pestis bacterium that causes bubonic plague.
Objectives
The aim of this paper is:
1. To describe the risks of getting the disease (Bubonic plague)
2. To describe the magnitude and impact of Bubonic Plague
3. To describe the pathogenesis of bubonic plague
4.To describe different ways of managing and controlling the disease clinically

Methodology
This paper is a product of literature review from journals, books and Internet search.
Results
From 1987-2001, the World Health Organization reported an annual average of 38,876 cases of the plague with 2847 deaths worldwide. The number of actual cases was probably much higher, given the failure of many countries to diagnose and report plague. Most cases occur in the developing countries of Africa and Asia. Recent outbreaks of plague have
occurred in Vietnam, India, Algeria, Madagascar, and the northeastern part of the Democratic Republic of the Congo. [2] During 2000-2001, 95% of the world's cases occurred in Africa. Bubonic plague has a 1-15% mortality rate in treated cases and a 40-60% mortality rate in untreated cases.
Conclusions
Bubonic plague is a threat to man. This disease is very virulent due to its rapid nature of transmission and very high mortality rate if untreated.

Dilemma of choice between breastfeeding and replacement feeding among HIV positive mothers in Tanzania

LM Mnongya — 2013-05-22

Breast milk provides all the nutrients needed during the first few months of life, and also contains agents that help protect against common childhood illnesses such as diarrhoea and respiratory infections. The objective of the study is to express challenges facing HIV positive mothers in choosing between replacement feeding and breast-feeding in Tanzania from 1999-2011. Breastfeeding is part of the fundamental human rights; the right to food and to health. In HIV+ mothers, if no antiretroviral drugs are being taken, breastfeeding for two or more years can double the risk of the baby becoming infected to around 40 %. But if the mother opts to breast-feed, she and her child must adhere 100% to ARV’s throughout the
breastfeeding time. But percentage of HIV+ breastfeeding mothers accessing ARV’s in developing countries is only 59%. Replacement feeding is the only 100% effective way to prevent mother-to-child transmission of HIV after birth, but the risk of infant mortality from other illnesses such as diarrhoea must be taken into account. It was also advised that replacement feeding could take place where it was “acceptable, feasible, affordable, sustainable and safe.” Breastfeeding should be promoted as ideal for most babies in low and middle income countries. HIV positive mothers should be supported not only by their husbands and health personnel but also by the community in general to choose between breastfeeding and replacement feeding in order to ensure growth of the infant and to support the mother physically and mentally to attain that goal.

Rabies, the neglected cause of mortality in developing countries

IP Kessy — 2013-05-22

BACKGROUND:Rabies is a very deadly zoonosis, caused by a lyssavirus which belongs to the family Rhabdoviridae. The reservoirs include wild wolves, bats, skunks, raccoons and foxes. This disease satisfies all World Health Organization (WHO) criteria for diseases that are a priority for control. Contrary to expectations, its control is unfortunately neglected
especially in developing countries. Rabies is recognized as one of the causes of many preventable deaths. Globally it causes 35,000 deaths annually and strikingly, 24,000 of the deaths occur in Africa. A multi-centre study from India reported 18,500 human rabies deaths per year, while in Tanzania 380-1,900 deaths have been reported to occur annually. Most
of the studies on rabies in Tanzania have been conducted by foreign scientists and the WHO and few Tanzanians-often junior researchers and research assistants. Currently, there is an on-going study at Ifakara on immunization of dogs and results are still pending. Rabies is a fatal disease that carries a very high mortality. Tanzanians are encouraged to carry out several studies in different regions especially in rural areas and congested urban areas where stray dogs are plenty so as to combat this deadly disease. There is paucity of information regarding the actual magnitude of this disease in developing countries including Tanzania, resulting in a gap that needs to be filled by conducting research on the subject. Scientists in Tanzania are therefore encouraged to carry out several studies in different regions especially in rural areas and congested
urban areas where stray dogs are in plenty so as to generate comprehensive information about rabies that will contribute to the control and prevention of this deadly disease.
MAJOR FINDINGS: The global DALY (Disability Adjusted Life Years) value is about 1.16 million that is much greater than that of a disease like leprosy that has a DALY value of about 117,000, but the latter has been given prominence as a disease of public health importance. This observation signifies the need to promote public awareness regarding rabies and also the need to implement workable and effective interventions for control and prevention. After a review of different articles on this topic, it is evident that rabies affects children, with a prevalence of 26% among those aged between 0-4 years and 34% among those aged 5-14 years. Prevalences of 33%, 3.5% and 4.2% were reported among
individuals aged 15-44 years, 45-59 years, and 60 years and above, respectively. Causes of neglect of this disease include lack of political commitment towards control of the disease, low awareness about the magnitude of the problem due to under reporting of cases, high cost of Post-Exposure Prophylaxis, low coverage of vaccination of dogs in developing countries and lack of proper ownership and care for dogs that turn out to be ‘stray dogs’ that serve as reservoirs for the infection.
CONCLUSION: Rabies has caused significant preventable mortality in developing countries and affects mostly the juvenile population. Domestic dogs should be well vaccinated and reached with veterinary services, there should be a joint venture among the political leaders, health care providers, veterinary doctors and the mass at large to control this disease. There should be thorough mass education and facilitation to community participation. PEP should be available in close proximity so aiming at reducing mortality in population groups at high risk of infection.

Pharmaceutical product cross-contamination: industrial and clinical pharmacy practice

E Mathia — 2013-05-22

Therapeutic consultation by patients is made complete by drug management which is expected to solve the patients’ problems. Pharmaceutical product cross-contamination is a serious problem which has been detected as an obstacle towards successful therapeutic goals. In the pharmaceutical care of patients in developed countries, cross-contamination of drugs has been well addressed and controlled unlike in most developing countries including Tanzania. This review intends to provide insight into this problem, aiming at increasing awareness on the health impacts of crosscontamination on patients in order to promote preventive strategies employed in combating cross-contamination in both industrial and clinical pharmacy practice.

History of diagnosis of cardiovascular diseases

C Lubinza — 2013-05-22

BACKGROUND
Access to the anatomy, physiology and pathology of cardiovascular system organs has been made easy by the invention of various tools and techniques. One third of all deaths globally are due to heart diseases. Future predictions indicate that by the year 2020, heart diseases will be the leading cause of death globally; therefore early diagnosis is needed for a better prognosis. Tools that are currently central to diagnosis of cardiovascular diseases are: the stethoscope, sphygmomanometer,
electrocardiogram, emission techniques like X-rays and echocardiograms. From the early sixteenth through the twenty first century, these devices have been modified to increase their sensitivity and specificity.
For further modification of these devices, understanding the concepts of their discovery in the first place is inevitable.
OBJECTIVES
1. To elucidate the evolutionary understanding of the cardiovascular system

2. To show the historical discovery of some of the devices used in the diagnosis of cardiovascular system diseases

METHODOLOGY
This work was compiled by reviewing books, journals and websites with information on the historic advancement of diagnosis of cardiovascular diseases.
RESULTS
Before the 17th Century, knowledge on the cardiovascular system was much contributed to by Pliny and Galen (a Greek physician and teacher).
This knowledge came to be challenged in the 17th Century by William Harvey. His experiments led to the present understanding of the cardiovascular system, and are considered the greatest achievement of that century. The discovery of the sphygmomanometer was steered by reverend Hales who watched a horse’s arterial blood climb 8 feet six inches high in a glass tube. Dr. Laennec heard heart sounds better using folds of hard paper and so laid foundations for the discovery of the stethoscope.
The concept of the electrocardiogram began by the observation of bioelectricity by L.Galvan in 1787.
CONCLUSION
Humans always struggle to master their environments. As a problem arises, the need to understand better and modify the present solving techniques or invent new ones arises.

Unnoticed but important two in one

L Salingwa — 2013-05-22

Introduction: Nuclear medicine is a branch of medicine that uses small amounts of radioactive material to diagnose and determine the severity of some diseases and on the other hand treat a variety of diseases.
Diagnostic Part: This involves administration of a radionuclide with an affinity for an organ or tissue of interest followed by the recording of the distribution of radioactivity with a stationary or scanning external scintillation camera (commonly a Gamma camera). Basing on the radioactivity pattern, a disease condition is diagnosed and/or its severity
(or distribution) determined.
Interventional Nuclear Medicine: This involves use of ionizing radiation energy (short range beta rays) from a radioactive material introduced into the body to kill cancer cells and shrink tumors. An important example is radioactive iodine (I131) therapy in thyroid hyperactivity.
Conclusion: The resolution of structures of the body when using nuclear medicine may not be as high as with other imaging modalities such as CT or MRI but is more sensitive especially when coupled with CT such as in PET/CT; and the functional information gained from it is often unobtainable when other imaging modalities are used.