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Article ; Online: Ruptured bilateral brain arteriovenous malformations in a young woman with early pregnancy: a case report.

Magitta, Ng'weina F / Sindato, Emmanuel M / Meda, John R / Toroha, Hasna N / Meremo, Alfred J

2023 Volume 17, Issue 1, Page(s) 219

Abstract: Background: Brain arteriovenous malformations (AVMs) are rare congenital developmental vascular lesions, and often presents with symptoms upon rupture. The controversy exists as to whether pregnancy confers an increased risk of intracranial hemorrhage. ... ...

Abstract	Background: Brain arteriovenous malformations (AVMs) are rare congenital developmental vascular lesions, and often presents with symptoms upon rupture. The controversy exists as to whether pregnancy confers an increased risk of intracranial hemorrhage. The diagnosis of brain AVMs, in the absence of brain imaging, is challenging in resource-limited settings, particularly in sub-Saharan Africa. Case presentation: A 22-year old black African woman, primigravida at 14 weeks of gestation, presented with a history of persistent throbbing headache which was treated at primary health care facilities with analgesics and anti-migraine medications without relief. She later developed severe headache 2 weeks prior to admission and one-day history of serial partial generalized tonic-clonic seizures which were followed by post-ictal confusion and persistent right upper limb weakness. Initial evaluation revealed her to be pregnant and she later underwent a brain magnetic resonance angiography (MRA) at a university teaching hospital which revealed bleeding bilateral parietal AMVs with intracerebral haematoma and associated perilesional vasogenic oedema. The patient was managed conservatively using antifibrinolytic drugs and prophylactic anti-seizure drugs. Seven months later, she underwent a control brain MRA which revealed resolution of intracranial haematoma and associated vasogenic oedema and had her seizures well controlled. The headache had subsided and the pregnancy was allowed to continue to term under close obstetric and neurological observation. On follow up visits she reported episodes of nasal bleeding which upon ENT examination revealed nasal AVMs, suggesting the diagnosis of hereditary hemorrhagic telangiectasia (HHT). Conclusion: AVMs are rare but should prompt suspicion in young patients with atypical Central Nervous System (CNS) manifestations without evident underlying causes.
MeSH term(s)	Pregnancy ; Female ; Humans ; Young Adult ; Adult ; Intracranial Arteriovenous Malformations/complications ; Intracranial Arteriovenous Malformations/diagnostic imaging ; Intracranial Arteriovenous Malformations/therapy ; Brain/pathology ; Telangiectasia, Hereditary Hemorrhagic/complications ; Telangiectasia, Hereditary Hemorrhagic/pathology ; Intracranial Hemorrhages/complications ; Cerebral Hemorrhage/etiology ; Headache/etiology
Language	English
Publishing date	2023-05-27
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2269805-X
ISSN	1752-1947 ; 1752-1947
ISSN (online)	1752-1947
ISSN	1752-1947
DOI	10.1186/s13256-023-03946-6
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Article ; Online: Ruptured bilateral brain arteriovenous malformations in a young woman with early pregnancy

Ng’weina F. Magitta / Emmanuel M. Sindato / John R. Meda / Hasna N. Toroha / Alfred J. Meremo

Journal of Medical Case Reports, Vol 17, Iss 1, Pp 1-

a case report

2023 Volume 7

Abstract: Abstract Background Brain arteriovenous malformations (AVMs) are rare congenital developmental vascular lesions, and often presents with symptoms upon rupture. The controversy exists as to whether pregnancy confers an increased risk of intracranial ... ...

Abstract	Abstract Background Brain arteriovenous malformations (AVMs) are rare congenital developmental vascular lesions, and often presents with symptoms upon rupture. The controversy exists as to whether pregnancy confers an increased risk of intracranial hemorrhage. The diagnosis of brain AVMs, in the absence of brain imaging, is challenging in resource-limited settings, particularly in sub-Saharan Africa. Case presentation A 22-year old black African woman, primigravida at 14 weeks of gestation, presented with a history of persistent throbbing headache which was treated at primary health care facilities with analgesics and anti-migraine medications without relief. She later developed severe headache 2 weeks prior to admission and one-day history of serial partial generalized tonic–clonic seizures which were followed by post-ictal confusion and persistent right upper limb weakness. Initial evaluation revealed her to be pregnant and she later underwent a brain magnetic resonance angiography (MRA) at a university teaching hospital which revealed bleeding bilateral parietal AMVs with intracerebral haematoma and associated perilesional vasogenic oedema. The patient was managed conservatively using antifibrinolytic drugs and prophylactic anti-seizure drugs. Seven months later, she underwent a control brain MRA which revealed resolution of intracranial haematoma and associated vasogenic oedema and had her seizures well controlled. The headache had subsided and the pregnancy was allowed to continue to term under close obstetric and neurological observation. On follow up visits she reported episodes of nasal bleeding which upon ENT examination revealed nasal AVMs, suggesting the diagnosis of hereditary hemorrhagic telangiectasia (HHT). Conclusion AVMs are rare but should prompt suspicion in young patients with atypical Central Nervous System (CNS) manifestations without evident underlying causes.
Keywords	Brain arteriovenous malformation ; Intracranial hemorrhage ; Seizures ; Pregnancy ; Spetzler-Martin classification ; Medicine ; R
Subject code	616
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Determinants of Men's Involvement in Maternity Care in Dodoma Region, Central Tanzania.

Gibore, Nyasiro S / Ezekiel, Mangi J / Meremo, Alfred / Munyogwa, Mariam J / Kibusi, Stephen M

Journal of pregnancy

2019 Volume 2019, Page(s) 7637124

Abstract: Background: Men's involvement in maternity care is recognized as a key strategy in improving maternal health and accelerating reduction of maternal mortality. This study investigated the factors determining men's involvement in maternity care in Dodoma ... ...

Abstract	Background: Men's involvement in maternity care is recognized as a key strategy in improving maternal health and accelerating reduction of maternal mortality. This study investigated the factors determining men's involvement in maternity care in Dodoma Region, Central Tanzania. Methods: This cross-sectional survey used multistage sampling in four districts of Dodoma Region to select 966 married men participants aged 18 years and above. Data were collected using a structured questionnaire. Multivariate logistic regression analysis was carried out in SPSS version 21.0 to measure the determinants of men's involvement in maternity care. Results: The study found that only 1 in 5 men were involved in maternity care of their partners. Factors found to determine men's involvement in maternity care were having >4 children (AOR=1.658, 95%CI=1.134 to 2.422), urban area of residence (AOR=0.510, 95%CI=0.354 to 0.735), waiting time >1 hour at the health care facility (AOR=0.685, 95%CI=0.479 to 0.978), limited access to information (AOR=0.491, 95%CI=0.322 to 0.747), and limited spousal communication (AOR=0.3, 95%CI=0.155 to 0.327). Conclusions: Long waiting time to receive the service and limited access to information regarding men's involvement are associated with low men's involvement in maternity care. Male friendly maternity care should recognize men's preferences on timely access to services and provide them with relevant information on their roles in maternity care. Spousal communication is important; mothers must be empowered with relevant information to communicate to their male partners regarding fertility preferences and maternity care in general.
MeSH term(s)	Adolescent ; Adult ; Cross-Sectional Studies ; Fathers/psychology ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Logistic Models ; Male ; Maternal Health Services ; Middle Aged ; Pregnancy ; Professional-Family Relations ; Sex Factors ; Socioeconomic Factors ; Tanzania ; Young Adult
Language	English
Publishing date	2019-06-02
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2595413-1
ISSN	2090-2735 ; 2090-2735
ISSN (online)	2090-2735
ISSN	2090-2735
DOI	10.1155/2019/7637124
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Article: Adrenal Insufficiency: A Forgotten Diagnosis in HIV/AIDS Patients in Developing Countries.

Nassoro, David D / Mkhoi, Mkhoi L / Sabi, Issa / Meremo, Alfred J / Lawala, Paul S / Mwakyula, Issakwisa Habakkuk

International journal of endocrinology

2019 Volume 2019, Page(s) 2342857

Abstract: Adrenal insufficiency (AI) is one of the most common endocrine disease in patients with HIV/AIDS, leading to high morbidity and mortality in HIV patients who become critically ill. Various etiologies are associated with the condition, including ... ...

Abstract	Adrenal insufficiency (AI) is one of the most common endocrine disease in patients with HIV/AIDS, leading to high morbidity and mortality in HIV patients who become critically ill. Various etiologies are associated with the condition, including cytomegalovirus (CMV),
Language	English
Publishing date	2019-06-23
Publishing country	Egypt
Document type	Journal Article ; Review
ZDB-ID	2502951-4
ISSN	1687-8345 ; 1687-8337
ISSN (online)	1687-8345
ISSN	1687-8337
DOI	10.1155/2019/2342857
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Article ; Online: Prevalence and Risk Factors Associated With Chronic Kidney Disease Among Patients Presenting at a Haemodialysis Unit in Dodoma, Tanzania.

Meremo, Alfred J / Masalu, Matobogolo B / Sabi, Issa / Ngilangwa, David P / Kapinga, Janet / Tagalile, Rehema / Munyogwa, Mariam J / Mwashambwa, Masumbuko Y

The East African health research journal

2018 Volume 2, Issue 1, Page(s) 53–57

Abstract: Background: Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and the associated cardiovascular morbidity and mortality. However, data on the burden of CKD among patients attending hospitals in ... ...

Abstract	Background: Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and the associated cardiovascular morbidity and mortality. However, data on the burden of CKD among patients attending hospitals in Tanzania are still limited. The aim of this study was to determine the prevalence and risk factors associated with CKD among patients presenting at the University of Dodoma (UDOM) haemodialysis unit in Tanzania. Methods: In this retrospective study, we reviewed data of 1,395 patients who presented at the UDOM haemodialysis unit from January 2013 to June 2015. Data were descriptively and inferentially analysed using Stata version 11.0. Results: From January 2013 to June 2015, a total of 1,395 patients presented at the UDOM haemodialysis unit with history of kidney disease. Of these patients, 1244 (89.2%) enrolled into this study, 651 (52.3%) of them were female. Almost two-thirds (n=792, 63.7%) of the patients were found to have CKD, 59.1% with an estimated glomerular filtration rate of <60 mL/min/1.73 m Conclusion: CKD was common among patients presenting in our hospital and is associated with high cardiovascular risk. To that end, patients should be thoroughly evaluated to identify and correct causes of their kidney disease, and efforts should be put in place for early detection and screening as well as advocacy on risk factors for CKD development in Tanzania.
Language	English
Publishing date	2018-04-01
Publishing country	Burundi
Document type	Journal Article
ISSN	2520-5285
ISSN (online)	2520-5285
DOI	10.24248/EAHRJ-D-16-00367
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Article: High prevalence of tuberculosis among adults with fever admitted at a tertiary hospital in north-western Tanzania.

Meremo, Alfred J / Kidenya, Benson R / Mshana, Stephen E / Kabangila, Rodrick / Kataraihya, Johannes B

Tanzania journal of health research

2015 Volume 14, Issue 3, Page(s) 183–188

Abstract: Tuberculosis is a leading cause of death in developing countries where HIV is endemic. This hospital based study was done to estimate the magnitude of pulmonary and extra-pulmonary tuberculosis and to determine predictors of tuberculosis among febrile ... ...

Abstract	Tuberculosis is a leading cause of death in developing countries where HIV is endemic. This hospital based study was done to estimate the magnitude of pulmonary and extra-pulmonary tuberculosis and to determine predictors of tuberculosis among febrile adults admitted at Bugando Medical Centre (BMC), Mwanza, Tanzania. A total of 346 adults febrile patients admitted in medical wards were studied. Sputum for AFB microscopy and chest X-rays was used to diagnose tuberculosis. Clinical features were collected using standardized data collection tool. HIV testing and CD4 counts were determined. Data were analyzed using STATA version 11 software. Of 346 febrile adults patients 116 (33.5%) were diagnosed to have tuberculosis; of which 79 (68.1%) and 37 (31.9%) had pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis, respectively. Smear negative PTB were more common in HIV positive than in HIV negative patients (50% vs. 18.5%, p=0.007). Extra-pulmonary tuberculosis was more common in HIV positive patients than pulmonary tuberculosis (86.4% vs. 13.6%), p=0.000 1). On multivariate logistic regression analysis the predictors of tuberculosis were; age above 35 years (OR =2.38, p=0.007), cardinal symptoms (OR=37, p<0.0001), pleural effusion (OR=24, p=0.0001), and HIV status (OR =3.2, p=0.0001). Of 79 patients with PTB, 48 (60.7%) were AFB smear positive and 31 (39.3%) were AFB smear negative. HIV patients with smear negative tuberculosis had significantly lower CD4 count than IV patients with smear positive tuberculosis (63.5 cells/µl versus 111.5 cells/µl) [Mann-Whitney test p=0.0431]]. No different in mortality was observed between patients with TB and those without TB admitted in BMC medical wards (28.5% vs. 23.0%, p= 0.13 18). Tuberculosis is the commonest cause of fever among adults patients admitted at BMC and is predicted by age above 35 years, positive HIV status, cardinal PTB symptoms, and pleural effusion. Routinely TB screening is highly recommended among adults with fever, cough, night sweating and wasting in countries where HIV is endemic.
MeSH term(s)	AIDS-Related Opportunistic Infections/epidemiology ; Adult ; CD4 Lymphocyte Count ; Cross-Sectional Studies ; Female ; Fever/epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Tanzania/epidemiology ; Tertiary Care Centers ; Tuberculosis/epidemiology
Language	English
Publishing date	2015-11-16
Publishing country	Tanzania
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2656045-8
ISSN	1821-6404 ; 0856-6496
ISSN	1821-6404 ; 0856-6496
DOI	10.4314/thrb.v14i3.4
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Article ; Online: Challenges and outcomes of haemodialysis among patients presenting with kidney diseases in Dodoma, Tanzania.

Meremo, Alfred J / Ngilangwa, David P / Mwashambwa, Masumbuko Y / Masalu, Matobogolo B / Kapinga, Janet / Tagalile, Rehema / Sabi, Issa

BMC nephrology

2017 Volume 18, Issue 1, Page(s) 212

Abstract: Background: Kidney Diseases contribute a significant proportion to the global burden of non-communicable diseases. Haemodialysis services as the main modality of renal replacement therapy in most resource limited countries is only available in few ... ...

Abstract	Background: Kidney Diseases contribute a significant proportion to the global burden of non-communicable diseases. Haemodialysis services as the main modality of renal replacement therapy in most resource limited countries is only available in few cities and at higher costs. The aim of this study was to determine the challenges and outcomes of patients who were on haemodialysis at the University of Dodoma (UDOM) haemodialysis unit in Tanzania. Methods: In this retrospective study; we reviewed haemodialysis registers and charts of 116 patients dialyzed from January 2013 to June 2015 at The UDOM haemodialysis unit. Data were descriptively and inferentially analysed using Stata version 11 software. Results: Of the 116 patients, 52 (44.9%) were male, and 38(32.8%) were married. Their median age was 45 years. Thirty-two (27.6%) had acute kidney injury, of them 26 (81.3%) patients had recovery of renal function after haemodialysis. Indications for hemodialysis were anuria (18), intoxications (14), electrolyte imbalance (9), uraemia (7) infections (6) and fluid overload (4). Eighty-four (72.4%) patients had End Stage Renal Diseases (ESRD), of which 37 (44.1%) absconded/lost to follow up, 15 (17.9%) died, 22 (26.2%) were referred to Muhimbili National Hospital (MNH), 12 for possible kidney transplant abroad after haemodialysis, and 10 (11.9%) were still attending our unit for haemodialysis. Residing outside Dodoma was predictive for poor outcomes while on haemodialysis (OR 5.2, 95% CI 3.2-8.6, p < 0.001). In addition the odds ratio for poor outcomes was 7.3 times for a patient ESRD (OR7.34, 95% CI 3.26-18.17, p < 0.001). Patients who had no National Health Insurance Fund (NHIF) coverage (OR 6.6, 95% CI 5.4-12.7, p < 0.001) also had higher odds of poor outcomes after starting haemodialysis. Conclusion: Unavailability and high costs related to utilization of haemodialysis services among patients needing dialysis are the challenges for better outcomes. Therefore, haemodialysis and renal transplants services should be made easily available in regional referral hospitals at reasonable costs. In addition, members of the public should be educated on joining health insurance schemes and on making healthy life style choices for preventing chronic kidney disease and its progression.
Language	English
Publishing date	2017-07-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/s12882-017-0634-2
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Article ; Online: ATRIAL SEPTAL DEFECT IN A 50 YEARS OLD MALE PRESENTING AS OBLIQUE SEPTAL CANAL THAT APPEARED TO BE REGULATED BY FIVE LUMINAL BANDS

Ainory Peter Gesase / Gabriel J. Mchonde / Alfred Meremo / Mange Manyama

International Journal of Anatomy and Research, Vol 3, Iss 3, Pp 489-

2014 Volume 493

Abstract: To date seven different types of atrial septal defects (ASD) have been described and they include septum primum, septum secundum, superior vena cava, inferior vena cava, coronary sinus and patent foramen ovale types of ASD. One feature in common among ... ...

Abstract	To date seven different types of atrial septal defects (ASD) have been described and they include septum primum, septum secundum, superior vena cava, inferior vena cava, coronary sinus and patent foramen ovale types of ASD. One feature in common among these ASD’s is that they all present with a hole that may allow communication between the left and right atria. The current observation reports what appears to be a new type of ASD that is characterized by the presence of an oblique septal canal that opens into the right and left atria. The right atrial opening was D-shaped and measured about 0.9 cm wide and the left atrial opening was crescent-shaped and measuring about 0.5 cm wide. In addition to this the left atrial opening was associated with five luminal bands; the last three bands lies on the roof of the oblique septal canal. The action of pulling the first luminal band resulted into closure of the left atrial opening an indication that the bands prevented blood coming from the lungs from entering into the right atrium. The presence of oblique septal canal and luminal bands has not been reported in relation to the ASD’s. Continued documentation of such anomalies remains clinically important particularly in African settings where unexplained illnesses are easily attributed to endemic diseases.
Keywords	Atrial septal defects ; Oblique septal canal ; Luminal bands ; Heart. ; Human anatomy ; QM1-695 ; Science ; Q
Language	English
Publishing date	2014-09-01T00:00:00Z
Publisher	International Journals of Medical and Health Research
Document type	Article ; Online
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Article ; Online: ATRIAL SEPTAL DEFECT IN A 50 YEARS OLD MALE PRESENTING AS OBLIQUE SEPTAL CANAL THAT APPEARED TO BE REGULATED BY FIVE LUMINAL BANDS

Ainory Peter Gesase / Gabriel J. Mchonde / Alfred Meremo / Mange Manyama

International Journal of Anatomy and Research, Vol 2, Iss 3, Pp 489-

2014 Volume 493

Abstract	To date seven different types of atrial septal defects (ASD) have been described and they include septum primum, septum secundum, superior vena cava, inferior vena cava, coronary sinus and patent foramen ovale types of ASD. One feature in common among these ASD’s is that they all present with a hole that may allow communication between the left and right atria. The current observation reports what appears to be a new type of ASD that is characterized by the presence of an oblique septal canal that opens into the right and left atria. The right atrial opening was D-shaped and measured about 0.9 cm wide and the left atrial opening was crescent-shaped and measuring about 0.5 cm wide. In addition to this the left atrial opening was associated with five luminal bands; the last three bands lies on the roof of the oblique septal canal. The action of pulling the first luminal band resulted into closure of the left atrial opening an indication that the bands prevented blood coming from the lungs from entering into the right atrium. The presence of oblique septal canal and luminal bands has not been reported in relation to the ASD’s. Continued documentation of such anomalies remains clinically important particularly in African settings where unexplained illnesses are easily attributed to endemic diseases.
Keywords	Atrial septal defects ; Oblique septal canal ; Luminal bands ; Heart. ; Human anatomy ; QM1-695 ; Science ; Q
Language	English
Publishing date	2014-09-01T00:00:00Z
Publisher	International Journals of Medical and Health Research
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Acute renal failure in a Caucasian traveler with severe malaria: a case report.

Meremo, Alfred J / Kilonzo, Semvua B / Munisi, David / Kapinga, Janet / Juma, Mwinyikondo / Mwanakulya, Simfukwe / Mpondo, Bonaventura

Clinical case reports

2014 Volume 2, Issue 3, Page(s) 82–85

Abstract: Key clinical message: Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation ... ...

Abstract	Key clinical message: Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation of hemodialysis proves to be useful in restoration of renal function.
Language	English
Publishing date	2014-03-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.65
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