Browsing by Author "Rwiza, Henry Tinka"

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    The aetiology and prognosis of nontraumatic coma in Dar es Salaam.
    (University of Dar es Salaam, 1984) Rwiza, Henry Tinka
    A study of non-traumatic coma was carried out in Muhimbili Medical wards and intensive care unit over a period of 7 months. A total of 100 patients were studied. Seventy four males and 25 females were seen (male: female sex ration 3.6:1) the causes of come in the 100 patients were a cerebral malaria 37% hepatic failure 19% meningitis 9%, cerebrobrovascular disease 9% poisons and toxins 6%, diabetic coma 4%, miscellaneous causes 8, and in 8% of cases the diagnosis could not be determined. Of the 93 patients fully followed up 66 (71%) survived the first week while only 31 (33.3%) survived to the end of the 4 first month, making a one month mortality of 66.7%. Factors determining prognosi’s were the underlying disease condition, the durations of come, the neurological sign on admission and their subsequent evolution and the development of complication. Age, sex and the presence of convulsions (the latter being commonest in cerebral malaria) did not affect prognosis. Cerebral malaria carried the best prognosis with 25(67.6%) of the patients achieving an independent existence and was responsible for the generally good outcome of the whole series. Clinical sign had a strong predictive value. The chances of regaining independent existence were greater in patient who after 24 hours had orienting or confused verbal responses, opened eyes spontaneously or to noise had orienting eye movements, had normal oculocephalic responses and obeying or localizing motor responses. Conversely, the change of regarding an independent existence fell in patients who after one day lacked the following eye opening, spontareous eye movements, papillary light reflexes, full oculocephalic responses,. Motor responses skeletal muscle tone, deep tendon reflexes and corneal reflexes. It is concluded that most of the causes of coma were potentially treatable even without the use of sophisticated facilities. The supply of a few specific drugs such as neomycin and lactulose for hepatic encephalopalhy or pralidoxime for or organophosphorus in secticide poisoning and improvement of the nursing care facilities are recommended as measures for improving outcome especially if intensive care-cabicals with improved nurse to patient rations are established.
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    Epilepsy in adults: a clinical and epidemiological study of 207 outpatients
    (University of Dar es Salaam, 1988) Rwiza, Henry Tinka
    The hundred and seven patients with epilepsy were randomly selected from a population of 590 epileptic patients for a general clinical study of the various factors related to epilepsy. They attended the neurology outpatient clinic between Junuary 1st 1980 and June 30th 1985, at the St. Radboud Academic Hospital of the Catholic University of Nijmegen. The mean age of the patients was 37.4 years (range 15-76), with a male to female ratio of 1.46. the majority of the patients had chromic epilepsy with a mean seizure duration of 8.8 years (range 0-45.2 years). The time of the study, 56.8% of the patients were still on follow up, 20.9% had not attended the clinic for one year or more, while 4.4% had died of brain tumors which were also the underlying cause of the seizures. 7.8% of the patients had been referred or transferred to other hospitals. The seizures experienced by the patients were partial in 69.6% and primary generalized. Seizures were mixed in 6.3% and unclassified in 1.9%. The seizure manifestations in patients with partial seizures included focal motor phenomena (4.1%), special sensory (41.7%), visceral (33.3%), psychic-emotional (29.2%) and somatosensory (20.1%). During a period of 2 years before the date of the last clinic control, the severity of the seizures had remained unchanged in 56.7%, improved in 27.8% and worsened in 15.5% of the patients. There was a positive family history of epilepsy in 24.6% of the cases. Other aetiological factors were present in 62.8% of he cases and included; febrile convulsions (8.7%), neonatal and intrapartum conditions (15.5%), head trauma (24.6%), CNS inflammatory conditions (13.5%), neoplasms (5.3%) and cerebrovascular disease (6.3%). In 34.8% of the patients there were other diseases not directly related to epilepsy. Seizure precipitating factors (psychological, emotional or physical stress, menstruction, alcohol etc.) were present in 64.75 of the cases. Neurological and psychosocial handicaps were present in 37.7% and 52.7% of the cases, respectively, and were associated with difficult control of the seizures and tendency to polytherapy. The mean of EEG’s per patient was 3.4 (range 1-21). 85% of the patients had at least some evidence of irritative abnormalty in one or more of their EEG records. Epileptiform activity was found in 48.9% of the patients. A focal theta or delta focus without evidence of irritative activity was recorded in 6.3% of the patients. The EEG was entirely normal in only 7.7% of the patients. The CT- was the most frequently performed technical investigation and was done mostly in patients with EEG-abnormalities, associated factors and partial seizures. Atrophies were the commonest abnormalities detected (48.9%). Space occupying lesions were detected in 7.2% of the cases. The combination of EED and neurological signs for screening patients needing CT-scan examination was found to be sensitive but non-specific with many false positives. On the other hand, a number of patients with local signs on both EEG and clinical examination unless a definite aetiology e.g. previous head injury is established young patients with normal neurological findings and no focal EEG abnormality may be started on medical therapy and remain under close observation for the development of neurological and/ or focal EEG signs needing further evaluation with the CT-scan. Review of the current prescription practices revealed CBZ to be the most favoured drug for all partial seizures, followed by PHT. VPA was the most frequently prescribed drug for all primary generalized seizures. There was more tendency to use monotherapy or as few drugs s possible per patient, compared to previous practice. This is in agreement with the current therapy recommendations. The average number of AED’s serum level determination per patient per year was 0.8 (range 0-10). The indications were: routine control (42.5%), suspicion of subtherapeutic levels (31.1%), suspicion of toxicity (8.5%) and others (4.7%). No indication was mentioned in 12.3% of the cases. The clinical impression of toxicity or subtherapy did not agree with the actual serum levels in more than 40% of the cases. AED’s serum levels are useful for optimal control of seizures.