Ahmed Jusabani
Aga Khan University, Radiology, Faculty Member
Introduction and importance Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered... more
Introduction and importance Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered as causative agent in at risk individuals in tuberculous endemic regions. Management involves drainage and initiation of adequate antibiotics with radiological guided percutaneous approach considered the appropriate initial approach. Case presentation 50-year-old immunosuppressed presenting with left iliopsoas abscess who underwent ultrasound guided drainage and placement of pigtail catheter successfully without the need for open surgical drainage. Our experience of interventional radiology for diagnosis of causative agent and treatment in a sub-Saharan Africa. Clinical discussion We concur with the recommendation to analyse fluid for tuberculosis in at risk individuals with minimally invasive procedures via interventional radiology as an adequate first line diagnostic and treatment option of psoas abscess. Ultrasound guided catheter placement and drainage successfully drained the abscess by day 10 similarly seen as the average duration in a case series from India. Conclusion The importance of the role of interventional radiology in treatment for complex abdominal pathologies in sub-Saharan Africa with its ability to diagnose and treat via minimally invasive procedures at highest precision and lowest risks and complications while maintaining a high level of suspicion for tuberculosis as the underlying etiology is highlighted.
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Introduction The increasing incidence of acute appendicitis in sub-Saharan Africa emphasizes the need for accurate and reliable diagnostic tools. However, the variability in the diagnostic performance of computed tomography for suspected... more
Introduction The increasing incidence of acute appendicitis in sub-Saharan Africa emphasizes the need for accurate and reliable diagnostic tools. However, the variability in the diagnostic performance of computed tomography for suspected acute appendicitis coupled with comparatively higher negative appendectomy rates in this setting highlight a possible concern regarding the diagnostic accuracy. This study evaluated the diagnostic accuracy of a computed tomography scan for suspected acute appendicitis at the emergency department in Tanzania. Methods A retrospective diagnostic accuracy study was conducted from July to October 2020. All patients above 14 years of age who presented at the emergency department with right iliac fossa abdominal pain of fewer than ten days and underwent computed tomography for suspected acute appendicitis were evaluated, and the Alvarado score was computed. Histological diagnosis and clinical follow-up of 14 days were considered the reference standard. Eth...
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Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or... more
Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negativeappendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania. Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for suspected AA with histological evaluation of specimens. The study was powered to detect the NAR at 95% confidence level and 80% power. Results: The histological NAR was 38.5% and the perforation rate was 25.3%. The Alvarado score (AS) was rarely applied (6%), despite ademonstrated ability in this study to decrease the NAR by half. Females were four times more likely to undergo negative appendectomy than males. Conclusi...
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Research Interests: Incidence Geometry, Tanzania, Medicine, Stroke, Prospective studies, and 15 moreHumans, Female, Male, Young Adult, Differential Diagnosis, Incidence, Aged, Middle Aged, Adult, Urban Population, X ray Computed Tomography, Prospective Cohort Study, Rural Population, Medical and Health Sciences, and Population surveillance
Research Interests: Audiology and Swallowing
The burden of stroke is high in sub-Saharan Africa, and improved knowledge of risk factors is needed. Antiphospholipid antibodies are a common acquired stroke risk factor in young individuals. Antiphospholipid antibodies may be induced by... more
The burden of stroke is high in sub-Saharan Africa, and improved knowledge of risk factors is needed. Antiphospholipid antibodies are a common acquired stroke risk factor in young individuals. Antiphospholipid antibodies may be induced by infectious diseases. Sub-Saharan Africa has a high infectious burden, and we analyzed the contribution of antiphospholipid antibodies to the risk of stroke in an incident population from rural and urban Tanzania. Stroke cases and age- and sex-matched community-acquired controls from the rural Hai district and urban Dar-es-Salaam areas of Tanzania were recruited in a wider study of stroke incidence between June 2003 and June 2006. Lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein I, and antiphosphatidylserine/prothrombin antibodies were determined in stored plasma, as well as IgG antibodies against Treponema pallidum. Data from 158 stroke cases and 369 controls were analyzed. Thirty cases (19%) and 4 controls (1%) had a lupus anticoagulant ...
Research Interests: Tanzania, Medicine, Stroke, Humans, Female, and 15 moreJournal Article, Male, Incidence, Clinical Sciences, Aged, Prevalence, Middle Aged, Odds ratio, Urban Population, Neurosciences, Confidence Interval, Case Control Studies, Lupus Anticoagulant, Rural Population, and Cardiovascular medicine and haematology
Most people with epilepsy (PWE) in low-income countries are not treated. We identified risk factors for the epilepsy treatment gap in rural Tanzania. We identified adult PWE in a community-based prevalence study. Factors associated with... more
Most people with epilepsy (PWE) in low-income countries are not treated. We identified risk factors for the epilepsy treatment gap in rural Tanzania. We identified adult PWE in a community-based prevalence study. Factors associated with failure to access or default from medical care were identified using logistic regression modelling. A total of 291 PWE were included, of whom 253 (86.9%) had presented to medical services. Failure to present was positively associated with using alcohol (odds ratio (OR) 4.20; 95% confidence interval (CI) 1.63 to 10.82) or attending traditional healers (OR 2.62; CI 1.00 to 6.83) and inversely associated with having completed primary education (OR 0.33; CI 0.11 to 0.96). Default from treatment was associated with being male (OR 3.35; CI 1.39 to 8.09), having a seizure-related injury (OR 2.64; CI 1.12 to 6.19), believing in a supernatural cause for epilepsy (OR 5.44; CI 1.48 to 19.94) or having no expressed knowledge of cause (OR 5.29; CI 1.60 to 17.52)....
Research Interests: Psychology, Epilepsy, Medicine, Logistic Regression, Humans, and 15 moreFemale, Male, Psychological Intervention, Regression Analysis, Clinical Sciences, Aged, Middle Aged, Longitudinal Studies, Adult, Odds ratio, Elsevier, Neurosciences, Confidence Interval, Health Services Accessibility, and Age distribution
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Most of the patients identified in a community-based prevalence study of Parkinson's disease (PD) in the Hai district, rural northern Tanzania, in 2005-2006, had not been previously diagnosed or treated. Screening methods to... more
Most of the patients identified in a community-based prevalence study of Parkinson's disease (PD) in the Hai district, rural northern Tanzania, in 2005-2006, had not been previously diagnosed or treated. Screening methods to identify patients have been previously described. Diagnosis was confirmed by the UK, PD Society Brain Bank Criteria. Patients were assessed in their own home with the assistance of a local translator and completed: Unified PD Rating Scale (UPDRS), Non-motor Symptoms Assessment Scale, PDQ-39, Hoehn and Yahr scale, and Hospital Anxiety and Depression Scale (HAD). Thirty-three (23 male, mean age 74, range 38-94 years) patients were identified. Only 5 had ever taken PD medication, and only 3 were currently treated. Hoehn and Yahr stage ranged from 2 to 5, disease duration from 3 months to 19 years, mean UPDRS was 50 (range 24-97), mean PDQ-39 386 (range 219-580) and mean non-motor symptom scale score 62 (range 11-209). Some patients who had never taken medication for PD, and who did not fulfil the Lewy Body Dementia diagnostic criteria, had experienced visual hallucinations. By studying patients at varying stages of PD who have not received treatment we can learn more about the symptoms of late stage PD and ascertain whether they are drug- or disease-related, or a combination of both. Hallucinations are likely to be a manifestation of the disease, but are often precipitated or exacerbated by medication. These patients have now commenced treatment, with close monitoring for complications, including motor or neuro-psychiatric symptoms.
Research Interests: Cognitive Science, Dementia, Medicine, Anxiety, Humans, and 15 moreHallucinations, Female, Disease, Male, Clinical Sciences, Rating Scale, Aged, Middle Aged, Adult, ANXIETY, Parkinson Disease, Severity of Illness Index, Psychiatric Status Rating Scales, Disability Evaluation, and Residence Characteristics
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Background: Carotid artery stenosis is not thought to be a major cause of stroke in sub-Saharan Africa, though data are limited. The aim of this study was to use Duplex ultrasonography to establish the prevalence of significant carotid... more
Background: Carotid artery stenosis is not thought to be a major cause of stroke in sub-Saharan Africa, though data are limited. The aim of this study was to use Duplex ultrasonography to establish the prevalence of significant carotid artery stenosis in an incident stroke population in Tanzania. Methods: Duplex ultrasound scan was carried out on consecutive cases of stroke, in the latter part of a stroke incidence study, who survived long enough to undergo investigation. As part of the wider incidence study, demographic data, social history, medical history, levels of current disability and findings from computer tomography scan and electrocardiogram were recorded. Results: 132 incident stroke cases were identified over the whole study period, of whom 56 (42.4%) underwent Duplex ultrasound. Only 1 case (female, aged 56 years) had evidence of right internal carotid artery stenosis, with a mild degree of stenosis of around 50%. There was no evidence of stenosis of either common carot...
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The prevalence of Parkinson's disease (PD) varies worldwide from 7 to 450 per 100,000, and appears low in sub‐Saharan Africa (SSA) but few data exist. We conducted a prevalence study of PD in rural Tanzania. A door‐to‐door study was... more
The prevalence of Parkinson's disease (PD) varies worldwide from 7 to 450 per 100,000, and appears low in sub‐Saharan Africa (SSA) but few data exist. We conducted a prevalence study of PD in rural Tanzania. A door‐to‐door study was conducted in the Hai district project area (population 161,071), using a screening questionnaire followed by structured history and examination of positive responders. Diagnosis was based on the UK PD Society Brain Bank Criteria. 33 (23 men) cases of PD were detected, with mean age 74 years (range 38–94). One patient died before the prevalence date. 78% were previously undiagnosed and untreated. Mean duration of symptoms was 5 years, and median Hoehn and Yahr stage 3. Crude prevalence rates were 30/100,000 (men), 11/100,000 (women) and 20/100,000 (combined). The direct age‐standardized prevalence rates compared with the UK population were 64/100,000 (men), 20/100,000 (women) and 40/100,000 (combined). These rates are higher than previously reported f...
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Research Interests: Cardiology, Incidence Geometry, Developing Countries, Mu, Medicine, and 15 moreElectrocardiography, Humans, Internal Medicine, Female, Male, Atrial Fibrillation, Incidence, Clinical Sciences, Aged, Middle Aged, Left ventricular hypertrophy, Atrial Flutter, Coronary Artery Disease, Case Control Studies, and Department of Radiology
Research Interests: Anxiety, Humans, Female, Male, Hospital Anxiety and Depression Scale, and 15 moreClinical Sciences, Aged, Adult, Cross Section, Cognitive Function, ANXIETY, Cost of Illness, Healthcare system, Cross sectional Study, Cross Sectional Studies, Long Term Study, Control Group, Cohort Studies, Barthel Index, and functional outcome
It was previously thought that the prevalence of... more
It was previously thought that the prevalence of Parkinson's disease (PD) in developing countries, and in particular sub-Saharan Africa (SSA), was lower than the rest of the world. The Hai PD prevalence project [1] diagnosed 32 patients (the majority previously undiagnosed and untreated) with PD from a population of 161,000, giving age standardised prevalence rates of 64 (men) and 20 (women)/100,000, respectively. Subsequently, drug treatment has been commenced for all surviving patients with annual follow up. The aim of the study was to document response to treatment, development of side effects, progression of disease and feasibility and sustainability of supplying medication to patients in rural Tanzania. Eleven patients died before the start of medication, and a further four during follow up. One patient moved away from the study area. At the end of 3 years of treatment, 16 patients were surviving. Only one stopped medication due to side effects (dyskinesia). At 3 years, 9/16 experienced wearing off and a further three had dyskinesias. Non motor symptoms were a problem at initial assessment [2] and continued to be a problem for many of the patients. We have shown that it is possible to find, treat and follow up patients with PD in a rural sub-Saharan African setting. Availability of affordable medication locally is a major issue. Acknowledging that movement disorders and neurological diseases in general are an issue in this setting is important to drive education and training, and for allocation of funding from health care providers in SSA.
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Aim: The aim of this project was to develop a dementia screening instrument for use in the hospital or community in populations with low levels of formal education. Methods: A screening instrument was developed from retrospective data... more
Aim: The aim of this project was to develop a dementia screening instrument for use in the hospital or community in populations with low levels of formal education. Methods: A screening instrument was developed from retrospective data collected in a rural area of Tanzania in 2010. The community screening instrument for dementia was administered to over 95% of the population aged 70 years and older of 6 villages (n = 1198) in Hai district, Tanzania. Factor analysis, regression modeling, and Mokken scale analysis (MSA) were used to develop screening instruments from these data, which were then tested and refined during prospective fieldwork. Results: A 5-item screening instrument with an area under the receiver–operating characteristic (AUROC) curve of 0.871, sensitivity of 91.7%, and specificity of 61.7% was developed using a combination of factor analysis and logistic regression modeling and had a higher AUROC (0.786) than a 7-item screening instrument developed using MSA. During pr...
Research Interests: Dementia, Medicine, Logistic Regression, Activities of Daily Living, Prospective studies, and 15 moreHumans, Female, Male, ROC Curve, Clinical Sciences, Aged, Retrospective Studies, Reproducibility of Results, Geriatric Assessment, Neurosciences, Logistic Models, Receiver Operating Characteristic, Predictive value of tests, Homes for the Aged, and mass Screening
ObjectivesDespite the growing burden of dementia in low‐income countries, there are few previous data on the prevalence of dementia in sub‐Saharan Africa. The aim of this study was to estimate the prevalence of dementia in those who are... more
ObjectivesDespite the growing burden of dementia in low‐income countries, there are few previous data on the prevalence of dementia in sub‐Saharan Africa. The aim of this study was to estimate the prevalence of dementia in those who are 70 years and older in the rural Hai District of Tanzania.MethodsThis was a two‐phase cross‐sectional survey. Using census data, we screened individuals aged 70 years and older from six rural villages using the Community Screening Instrument for Dementia in Phase I. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM‐IV criteria.ResultsOf 1198 people who fulfilled the inclusion criteria, 184 screened positive for probable dementia, and 104 screened positive for possible dementia using the Community Screening Instrument for Dementia. During clinical assessment in Phase II, 78 cases of dementia were identified according to the DSM‐IV criteria. The age‐standardised prevalence of dementia was 6.4% (95% co...
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Introduction and importance Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered... more
Introduction and importance Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered as causative agent in at risk individuals in tuberculous endemic regions. Management involves drainage and initiation of adequate antibiotics with radiological guided percutaneous approach considered the appropriate initial approach. Case presentation 50-year-old immunosuppressed presenting with left iliopsoas abscess who underwent ultrasound guided drainage and placement of pigtail catheter successfully without the need for open surgical drainage. Our experience of interventional radiology for diagnosis of causative agent and treatment in a sub-Saharan Africa. Clinical discussion We concur with the recommendation to analyse fluid for tuberculosis in at risk individuals with minimally invasive procedures via interventional radiology as an adequate first line diagnostic and treatment option of psoas abscess. Ultrasound guided catheter placement and drainage successfully drained the abscess by day 10 similarly seen as the average duration in a case series from India. Conclusion The importance of the role of interventional radiology in treatment for complex abdominal pathologies in sub-Saharan Africa with its ability to diagnose and treat via minimally invasive procedures at highest precision and lowest risks and complications while maintaining a high level of suspicion for tuberculosis as the underlying etiology is highlighted.