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Evaluation of risk factors for Alzheimer's disease in elderly east Africans
(Brain Res Bull, 1997) Chande, Hassan M.
A number of biological risk factors have been implicated for Alzheimer's disease (AD). The investigation of prevalence rates of AD in crosscultural populations has much potential in validating these factors. We previously assessed brain amyloid beta (A beta) protein deposition and other lesions associated with AD as possible markers for preclinical AD in elderly nondemented East Africans. In further analysis, we demonstrate that 17-19% of elderly East African subjects without clinical neurological disease exhibited neocortical A beta deposits and minimal neurofibrillary changes at necropsy that was qualitatively and quantitatively similar to that in an age-matched elderly control sample from Cleveland, OH. A beta deposits varied from numerous diffuse to highly localized neuritic plaques and were predominantly reactive for the longer A beta 42 species. In parallel studies, we evaluated another recently implicated factor in AD, the apolipoprotein E genotype. We found relatively high frequencies of the apolipoprotein E-epsilon 4 allele in elderly nondemented East Africans. The frequencies were comparable to those in other African populations but higher than in subjects from developed countries. Our limited study suggests that elderly East Africans acquire cerebral lesions found in AD subjects but the apolipoprotein E-epsilon 4 allele may not be a highly specific factor for the disease among East Africans.
Discrepancy of clinical symptoms and prognosis of a patient — forensic significance of “talk and die” head injury
(Legal medicine, 2000) Ng'walali, Paul M.
Deaths of patients who had talked after sustaining a head injury and were then assumed clinically to be recovering from the head trauma raise medicolegal questions about the precise causes of deaths. A forensic autopsy on a 77-year-old man who had been talking after a road traffic accident and died on the sixth day showed slight subdural hematoma, bifrontal cerebral contusions and diffuse axonal injury. No natural diseases or delayed complications of injury were found. The cause of death was certified as head injury due to a traffic accident. This is a case of “talk and die” head injury. Forensic autopsy is important in patients with “talk and die” to clarify the causal relation to the head trauma in relation to any further forensic dispute.
Pink spots of Hedley-White in the brain. Evaluation of the significance in the forensic autopsy
(Legal medicine, 2000) Ng'walali, Paul M.
Pink spots are sharply demarcated round to oval discolorations with a white center in the deeper areas of the formalin-fixed brain. In 152 forensic autopsies with neuropathological examinations, the authors observed pink spots in three of 16 patients with bacterial infectious diseases. Pink spots could not be found in 136 patients without bacterial infectious diseases. These results verify the concept that pink spots correlate with bacterial infections. The presence of pink spots will be used as an indication of infectious diseases in the forensic autopsy.
The anti inflamatory activity of rumex usambarensis
(The East and Central African Journal of Pharmaceutical Sciences, 2000) Chande, Hassan M.
The anti-inflammatory activity of the extract of Rumex usambarensis Dammer (Polygonaceae) was compared to that of diclofenac sodium. The results of this study have shown that the 0.4 ml and 0.8 ml of the extract had 40.6% and 69.3% of the anti-inflammatory activity of 10mg diclofenac sodium. Histological results were also consistent with the anti-inflammatory activity of Rumex usambarensis.
Traumatic Basal Subarachnoid Hemorrhage Due to Rupture of the Posterior Inferior Cerebellar Artery
(Neurologia medico-chirurgica, 2000) Ng'walali, Paul M.
A 20- year-old male presented with traumatic basal subarachnoid hemorrhage after being involved in a fight. Antemortem clinical examination could not exclude the possibility of rupture of abnomal blood vessels because of the absence of the external injuries.Careful postmortem of examination of the head and neck regions and histological examination of the intracranial arteries demonstrated traumatic rupture of the left posterior inferior cerebellar artery due to a fist blow to the jaw.This case indicates the need for careful autopsy examination for the differentiation of traumatic and non traumatic basal suburachnoid hemorrhages
The Anti-Inflammatory Activity Of Rumex usambarensis
(The East and Central African Journal of Pharmaceutical Sciences, 2000) Chande, Hassan M.
The anti-inflammatory activity of the extract of Rumex usambarensis Dammer (Polygonaceae) was compared to that of diclofenac sodium. The results of this study have shown that the 0.4 ml and 0.8 ml of the extract had 40.6% and 69.3% of the anti-inflammatory activity of 10mg diclofenac sodium. Histological results were also consistent with the anti-inflammatory activity of Rumex usambarensis.
Unusual homicide by air gun with pellet embolisation
(Forensic science international, 2001) Ng'walali, Paul M.
A homicidal case by an air gun involving a 73-year-old woman who was found dead in her home is described. At autopsy, two gunshot wounds were observed on the left anterior chest and the right back. There was neither exit wound nor powder burns. The fatal pellet, 0.9 g and 5.5 mm diameter, penetrated the left anterior chest and the heart to cause cardiac tamponade (200 ml) before lodging in the left subclavian artery. Death was due to cardiac tamponade. This case has exhibited two rare phenomena: homicide by an air gun and pellet embolisation. This is the first homicide case by use of air gun in Japan and demonstrates that although it may be rare, air guns can be used as potential homicidal weapons. This experience will alert our society and others on the potential hazards of air guns we have tended to regard as toys.
Neuropathological diagnosis of Alzheimer's disease in forensic autopsy of elderly persons with fatal accident
(Legal medicine, 2002) Ng'walali, Paul M.
Cognitive dysfunction in Alzheimer's disease may lead to accidental deaths in the elderly. Neuropathological diagnosis of the disease is, therefore, an important issue in forensic autopsy to determine the causal relation to accidents. To evaluate the suitability of the current histopathological diagnostic criteria for Alzheimer's disease by Khachaturian and Mirra et al. in elderly persons dying from accidents and coming for forensic autopsy, we studied the brains of nine demented and 12 non-demented persons by silver stain and immunohistochemistry. When the density of senile plaque was applied to the criteria, only four out of nine demented persons met the criteria for definite Alzheimer's disease. The demented persons had significantly higher density of diffuse plaque and higher frequencies of amyloid angiopathy, neurofibrillary tangle and neuropil thread than the non-demented persons. These results indicated that the current diagnostic criteria do not always diagnose Alzheimer's disease in forensic autopsy of elderly persons with fatal accident. The presence of abundant diffuse plaque, neurofibrillary tangle, amyloid angiopathy and neuropil thread may help to diagnose Alzheimer's disease in forensic autopsy.
[Ethanol concentrations in multi-site sampling blood in forensic autopsy cases--a retrospective analysis over a period of six years (1994-1999) in Kumamoto University].
(The Japanese Journal of Legal Medicine, 2002) Ng'walali, Paul M.
Ethanol and n-propanol concentrations in forensic autopsy cases determined in Department of Forensic Medicine, Kumamoto University School of Medicine were reviewed retrospectively. Out of 388 autopsies in 6 years (1994-1999), ethanol was positive in 88 (22.7%) cases. Higher positive rates were observed in bleeding and burning cases compared to other cases. Histograms of the blood ethanol concentrations in all ethanol positive cases had two peaks at 0.1 mg/ml to 0.5 mg/ml and 1.5 mg/ml to 2.0 mg/ml ranges, which indicated that not only an intermediate but also a weak drunkenness level could be a risk factor of being involved in forensic fatalities. There were no differences in mean ethanol concentrations in the blood samples of the right, left and whole heart blood collected from each victim. The femoral blood, however, was slightly higher than those of heart blood. N-Propanol, an indicator for postmortem ethanol production, was detected in 14.7% of stomach contents samples as early as 6 to 12 hours of post mortem intervals, whereas it was not remarkable in urine and femoral vein blood.
99mTc sestamibi scintimammography in the diagnosis of palpable breast masses
(Clinical trial, 2003) Chande, Hassan M.
Summary The aim of this prospective study was to evaluate the diagnostic performance of 99m Tc sestamibi scintimammography in a region with a low incidence of breast cancer (East, central and West Africa) and to verify the clinical usefulness of this technique in identifying benign breast diseases. Thirty-eight women (age range 22±38 years) with palpable breast masses (n = 38) and inconclusive mammograms were included. Prone scintimammography was performed 10 min and 60±90 min in all patients after injection using an isotime acquisition of 10 min. A positive scan for breast cancer was defined as tracer uptake on the 10 min image and retention of activity on the 60±90 min image. A negative scan was defined as uptake on the 10 min image and complete washout of activity on the 60±90 min image. All patients subsequently underwent excisional biopsy of the breast masses and histological confirmation of the pathology. The results of scintimammography and histopathology were in agreement in all patients, revealing 36 benign lesions and two malignant lesions. Histopathologically, the lesions were fibroadenomas (27), fibrocystic disease (five), abscesses (four) and invasive intraductal carcinoma (two). It is concluded that, in regions with high incidence of benign breast diseases in young women, 99m Tc sestamibi scintimammography can be used to rapidly characterize benign and malignant breast masses and thereby give priority to the management of those with a serious condition. (# 2003 Lippincott Williams & Wilkins) Keywords: benign, breast disease, fibroadenomas, palpable, scintimammography
Fatal intussusception in infancy: an experience in forensic autopsy
(Legal medicine, 2003) Ng'walali, Paul M.
Intussusception, although a common cause of pediatric surgical emergencies, is a rarely fatal condition. A 7-month-old infant who was discovered in her cot was unresponsive and pronounced dead after 2 h of uneventful cardiopulmonary resuscitation in an emergency hospital. Forensic autopsy which was performed in order to clarify the circumstances surrounding the death revealed intussusceptions at two sites of the ileum. Although morbidity and mortality rates from the condition have progressively declined in recent decades but avoidable deaths still occur as was experienced in the present case. The forensic pathology significance in this case was the occurrence of ‘painless intussusception’ whereby the affected child clinically exhibited no discomfort or characteristic features of acute abdomen until death. In summary, the present case has exhibited an uncommon fatal occurrence and demonstrated the importance of forensic autopsy in such unexpected sudden infant deaths.
Patient knowledge, practices and challenges to health care system in early diagnosis of mycobacteria adenitis
(East African medical journal, 2005) Chande, Hassan M.
Objective: To assess diagnostic delay, knowledge and practices related to tuberculosis among patients with mycobacterial adenitis. Design: A cross sectional study involving comparison analysis of high-risk groups. Setting: Seven hospitals in rural and semi-rural districts of Arusha. Subjects: Four hundred and twenty six clinically diagnosed adenitis patients. Interventions: Biopsy specimens were processed for culture, histology, and sera for HIV testing. A questionnaire was used to assess knowledge, practice, and diagnostic time. Main outcome measures: Tribal comparisons were made using proportions and means. Results: About 90% (387/423) of patients first visited medical facilities within a mean time of 10.1(SD, 15.7) weeks after becoming aware of their illness, and a diagnosis was made at a mean of 27 (SD, 25) weeks. Non-Iraqw patients, especially the Datoga, practised drinking raw milk (35.2% 43/122), eating raw animal products (18.8% 24/128) and living in houses with poor ventilation (33.6% 44/131), more than Iraqw patients. Of the investigations done, 14.5% (60/415) were culture positive, 11.3% (16/142) were HIV positive, and 73.6% (128/174) had histological features consistent with tuberculosis. The knowledge of TB spread by air droplets was poorer in Iraqw (74.1%, 203/274) than in non-lraqw (61.1%, 77/126) patients. About 35.0% (45/129) of non-lraqw and 27.3% (79/289) of Iraqw patients were not aware that TB could be transmitted from animals to humans. Conclusions: The health system diagnostic delay is about twice the patient delay. The knowledge and practices related to both human and bovine TB transmission were poor in all patients, especially in the patients from nomadic tribes.
Mob justice in Tanzania: a medico-social problem
(African health sciences, 2006) Ng'walali, Paul M.
Objective: To investigate the magnitude of mob justice and associated factors. Background: Mob justice is a social and public health problem that has grown in Tanzania in recent decades that has negative effects on social and health of the country, communities, and families. Materials and Methods: A four-year autopsy study was conducted at the Department of Pathology, MUCHS. Information on the cases was obtained from police, the relatives, friends and other witnesses if available. Results: 1249 persons were killed by mobs in Dar es Salaam during the period of 5 years (2000-2004). The alleged offense ranged from a serious crime like theft or murder to a mere violation of local customs or religious beliefs. The mode of the killings were mostly burning (48.11%) and stoning (49.96%). Other modes accounted for only 3.0% of the cases. The pattern of injuries ranged from skull and other skeletal fractures to viscera rupture. Conclusion: MJ is a social, legal and public health problem in Tanzania that needs immediate attention. Unemployment of youth and perceived economic inequalities should be addressed. As long as the judicial system doesn't work and corruption is not punished, people will continue to organize their own trials and judge their suspects in the street. These must be tackled in order to reduce the growing incidences of mob justice, hence saving life. It must be ensured that criminals do not violate the freedom, dignity and respect of each and every human or member of the society. African Health Sciences Vol. 6(1) 2006: 36-38
How does clinical diagnosis of mycobacterial adenitis correlate with histological findings?
(East African Journal of Public Health, 2007) Chande, Hassan M.
Objective: To describe and compare histopathological findings with clinical criteria in diagnosis of TB adenitis. Methods: Lymph node biopsies were obtained from 213 patients. Specimens were processed for culture and histopathologic examination, using standard methods. One hundred blocks with good preservation of tissue morphology were selected for detailed histological examination. Results: About 75% of 213 patients had granulomas. In the remaining 25%, neither histopathological nor microbiological evidence of mycobacterial disease was found. Of 100 blocks selected for detailed examination, 79 blocks had granulomatous changes. The granulomas were well organised in 24%, mixed in 33%, and poorly organised in 43%. Langhans giant cells and acid-fast bacilli were observed in 88.6% and 21.5% of the 79 blocks, respectively. Cultured specimens were positive in about 10% of 79 biopsy specimens. Conclusions: Histological evidence of mycobacterial disease was only found in three quarters of patients that were clinically diagnosed and started on empirical treatment for tuberculous adenitis. Neither histological nor mycobacteriological evidence was found in a quarter of the patients who were already on treatment for TB, basing on clinical criteria. These findings call for new research on simple diagnostic tools for patients who seek care for symptoms of extra-pulmonary TB
Prevalence of and factors assocated with alcohol consumption in Temeke in August/September, 2002.
(East African Journal of Public Health, 2007) Chande, Hassan M.
Objective: To determine the prevalence of alcohol consumption in Temeke district by social demographic characteristics. Methodology: Population-based cross-sectional study was conducted in Temeke district involving persons above 15 years of age. We selected Keko ward for the study and simple random sampling procedure was used to select clusters of ten-cell leaders. All households in the selected ten-cell leaders were included in the study sample. The study was cleared by the Ethical Clearance Committee of the Muhimbili University of Health and Allied Sciences, Dar es Salaam. Chi-squared (chi2) test for contingency tables was used to assess statistical significance and the results were considered significant if p-value was less than 0.5. Results: A total of 246 persons participated in the survey and of these 22% (54) were alcohol drinkers. The age group 25-35 years showed a high prevalence with a male preponderance. There was no difference in the drinking pattern between single and married subjects with 20.1% and 22% respectively. On education basis, 22.1% of primary school leavers drank alcohol. Teachers and businessmen drank alcohol more than other occupational groups with 33.3% and 25.6% respectively. Bad health effect was the most perceived alcohol related problem occurring in 65.4% of all the respondents. Conclusion: It was concluded that alcohol consumption was low in Temeke as compared to other regions and was seen more in males than females and bad health effect was the most perceived problem resulting from alcohol consumption. We recommend that similar studies should be done in other districts of Dar-es-Salaam to validate our findings.
How does clinical diagnosis of mycobacterial adenitis correlate with histological findings?
(East African Journal of Public Health, 2007) Chande, Hassan M.
Objective: To describe and compare histopathological findings with clinical criteria in diagnosis of TB adenitis. Methods: Lymph node biopsies were obtained from 213 patients. Specimens were processed for culture and histopathologic examination, using standard methods. One hundred blocks with good preservation of tissue morphology were selected for detailed histological examination. Results: About 75% of 213 patients had granulomas. In the remaining 25%, neither histopathological nor microbiological evidence of mycobacterial disease was found. Of 100 blocks selected for detailed examination, 79 blocks had granulomatous changes. The granulomas were well organised in 24%, mixed in 33%, and poorly organised in 43%. Langhans giant cells and acid-fast bacilli were observed in 88.6% and 21.5% of the 79 blocks, respectively. Cultured specimens were positive in about 10% of 79 biopsy specimens. Conclusions: Histological evidence of mycobacterial disease was only found in three quarters of patients that were clinically diagnosed and started on empirical treatment for tuberculous adenitis. Neither histological nor mycobacteriological evidence was found in a quarter of the patients who were already on treatment for TB, basing on clinical criteria. These findings call for new research on simple diagnostic tools for patients who seek care for s ymptoms of extra-pulmonary TB.
Prevalence of and factors associated with alcohol consumption in Temeke in August/September, 2002
(East African Journal of Public Health, 2007) Chande, Hassan M.
Objective: To determine the prevalence of alcohol consumption in Temeke district by social demographic characteristics. Methodology: Population-based cross-sectional study was conducted in Temeke district involving persons above 15 years of age. We selected Keko ward for the study and simple random sampling procedure was used to select clusters of ten-cell leaders. All households in the selected ten-cell leaders were included in the study sample. The study was cleared by the Ethical Clearance Committee of the Muhimbili University of Health and Allied Sciences, Dar es Salaam. Chi-squared (chi2) test for contingency tables was used to assess statistical significance and the results were considered significant if p-value was less than 0.5. Results: A total of 246 persons participated in the survey and of these 22% (54) were alcohol drinkers. The age group 25-35 years showed a high prevalence with a male preponderance. There was no difference in the drinking pattern between single and married subjects with 20.1% and 22% respectively. On education basis, 22.1% of primary school leavers drank alcohol. Teachers and businessmen drank alcohol more than other occupational groups with 33.3% and 25.6% respectively. Bad health effect was the most perceived alcohol related problem occurring in 65.4% of all the respondents. Conclusion: It was concluded that alcohol consumption was low in Temeke as compared to other regions and was seen more in males than females and bad health effect was the most perceived problem resulting from alcohol consumption. We recommend that similar studies should be done in other districts of Dar-es-Salaam to validate our findings.
Assessment of women's knowledge and attitude towards carcinoma of the cervix in Ilala municipality.
(East African Journal of Public Health, 2010) Chande, Hassan M.
Main objective: To asses knowledge and attitudes of women towards carcinoma of the cervix in Ilala Municipality. Methodology: A community based cross-sectional study targeting all women in Ilala municipality. Therefore the sample size was 196 women but for the purpose of this study it was increased up to 201 women.A multistage random sampling procedure was used to select a representative sample. Permission was sought at all the appropriate levels in the form of oral as well as written consent.Only women who were willing to participate in the study were interviewed. A questionnaire was developed and data analysed using Epi info software was used to analyse data. Differences beween proportions found in different groups were tested for statistical significant using chi-squared test. Results: A total of 210 women were interviewed. A number of respondents were in the age groups 21-30 and 31-40 years and 76.1% of the respondents were aware of carcinoma of the cervix. The most common mentioned risk factors were early marriage (37.1%) and multiparity (36%). Irregular vaginal bleeding was the most common symptom metioned (51.7%). Irrespective of the level of education 98%-100% of all respondents knew the importance of screening for carcinoma of the cervix. Conclusion: It was therefore concluded that women were aware of carcinoma of the cervix but the knowledge on this disease is still very low.
Self-destruction by multiple methods during a single episode: a case study and review of the literature
(African health sciences, 2010) Ng'walali, Paul M.
Background: Although the prevalence of suicide in the world is not clear, however, the reported rates of suicides are consistently higher among men tan women regardless of age group. Methods: A case employing multiple methods during a brief time of self-destructive behavior is presented. A 44-year-old postmaster who was under criminal investigation by his head office for embezzlement, leaped down a high river cliff and drowned after an initial attempt to commit suicide by hanging from the bridge over the river. The autopsy and scene investigations were both employed and very helpful. Results: Three different methods of suicide were apparent in this instance: hanging, leaping down the cliff and drowning as was evidenced by the autopsy and positive diatom test. The complexity of this case was the planned protection against the failure of one method employed to commit suicide. The methods used were all highly lethal ones. There was neither history of previous suicide attempts nor psychiatric disorder. Conclusion: Although the cause of death may appear clear at autopsy in cases of self-destruction by multiple highly lethal methods during a single episode, scene investigation is important for the forensic pathologist to understand the whole story of the case and determine the manner and actual cause of death. Scene investigation and autopsy is emphasized as part of the whole postmortem investigation of death in cases of unusual suicide using multiple methods of self-destruction.
High prevalence of tuberculosis diagnosed during autopsy examination at Muhimbili National Hospital in Dar es Salaam, Tanzania
(Tanzania journal of health research, 2013) Chande, Hassan M.
The primary aims of tuberculosis (TB) control programmes is early diagnosis and prompt treatment of infectious cases to limit transmission. Failure to diagnose and adequately treat TB could lead to premature death and unrecognized transmission of Mycobacterium tuberculosis. The proportion of missed TB cases has not been reported in Tanzania. The objective of this study was to quantify the number of cases of TB identified by autopsy. Deceased morbid bodies from Muhimbili National Hospital were involved. Retrieval of admission, diagnostic and other important records used to manage the patient after admission was done. Demographic information, site and type of disease, past medical history, chest x-ray report, clinical diagnosis and cause of death reported upon death certification were recorded. Lung tissues, lymphnodes and blood clots for HIV testing were collected. Biopsy tissues were processed through Ziehl Nielsen staining and examined by microscopy. The study involved 74 deceased individuals where 56 (75.7%) were males. Information for duration of seeking health care before death was available for 41(55.4%) subjects. Thirty-four (45.9%) cases received diagnosis before death. The main diagnoses were pneumonia 10(13.5%), heart failure 6(8.1%), AIDS-related illnesses 6 (6.8%) and malaria 5 (6.8%). The main clinical findings were wasting (51/74 (68.9%)) and abnormal fluid collection in different body cavities, 61(50.8%). In 24 out of 71(33.8%) biopsies acid fast bacilli (AFB) were detected. Records of lymphnodes examination were available in 63 cases and 22 of them had AFB. Twenty-two (34.9%) from the paratracheal and hilar lymphnodes were observed to have AFB. HIV was detected by ELISA in 19 (33.3%) out of 57 deceased, and 12 (63.2%) of the HIV positive deceased were co-infected with TB. Out of the 22 cases positive for AFB on tissue-biopsies 12 (54.5%) were HIV positive. There is a high number of TB cases diagnosed after death that could not be detected before they died. There is a need for increased awareness and to include postmortem data in the annual statistics of TB for precise reporting of the magnitude of the TB burden in the country.

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