Occurrence of oral lesions in relation to clinical and immunological status among HIV-infected adult Tanzanians

OBJECTIVE: To determine the association, if any, between the presence of oral lesions and clinical and immunological status of untreated HIV-infected adults in Tanzania. DESIGN: A cross-sectional study. SETTING: AIDS Clinical Trial Clinic (ATCC) at Muhimbili Medical Centre in Dar-es-Salaam, Tanzania. SUBJECTS: 192 HIV-infected individuals not receiving treatment; 156 individuals confirmed to be HIV-seronegative acted as a control group. METHODS: Examination of oral structures, determination of HIV serostatus, clinical status, and peripheral CD4+ T cell and total lymphocyte counts. MAIN OUTCOME MEASURE: Presence of oral lesions. RESULTS: Intra-oral lesions were seen among 7.7% of the HIV-seronegative, 10.4% of the HIV-seropositive and 36.8% of the AIDS groups, respectively. Enlarged parotid glands were seen in 20% of the AIDS patients, 11.9% of the HIV-seropositives, and 5.1% of the HIV seronegatives. Enlargement of submandibular salivary glands was seen in 29.6% of the AIDS patients, 31.3% of the HIV-seropositives compared with 14.7% among the HIV-seronegatives. Multiple regression analysis was used to calculate adjusted odds ratio (OR) for presence of oral lesions. OR for an intra-oral lesion was 1.6 (95% CI = 0.5; 5.0) among the HIV-seropositives and 8.2 (95% CI = 3.5; 19.7) among the AIDS patients using the HIV-seronegatives as reference. OR for an intra-oral lesion was 0.9 (95% CI = 0.3; 2.9) in HIV-infected patients with peripheral CD4+ T cell count of between 200-500 cells mm-3 and 2.7 (95% CI = 0.9; 7.7) in patients with less than 200 cells mm-3. OR for an intra-oral lesion was 0.4 (95% CI = 0.2; 0.9) for patients with peripheral total lymphocyte counts of between 1000-2000 cells mm-3 and 0.9 (95 CI = 0.4; 2.0) for patients with less than 1000 cells mm-3. CONCLUSION: The association of oral lesions with the clinical stage of HIV infection and to a lesser extent peripheral CD4+ T cell count does suggest that these lesions could be used as additional markers of immunosuppression and AIDS.     

The prevalence of Parkinson's disease in rural Tanzania

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 from SSA, but still lower than the developed world. Many PD patients in SSA may never be diagnosed or treated, with consequent reduction in their life expectancy and quality of life. With the world population ageing PD is predicted to become an increasing problem. © 2007 Movement Disorder Society     

Presentation and management of chronic osteomyelitis in an African patient with pycnodysostosis

A case is reported of pycnodysostosis (PCD) with chronic osteomyelitis in the mandible. The clinical and radiological features and the problems of management and follow-up are discussed.     

Gangrenous stomatitis (cancrum oris): clinical features, etiologic factors, and complications.

Gangrenous stomatitis (cancrum oris) is a lesion involving the orofacial structures that is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene. The general clinical features, associated etiologic factors, and ensuing complications in eight consecutive cases diagnosed between 1991 and 1995 are presented and discussed.     

Proceedings: Designing formulated foods for the cardiac-concerned

The per capita sugar consumption, expressed as a percent of carbohydrate consumption, has more than doubled in the past 50 years. The prudent diet suggests a reduction in the consumption of sugars, particularly sucrose. A noncaloric sweetener for formulated foods is required in the absence of a drastic change in food preferences. A reduction in salt consumption is suggested. Per capita salt consumption is estimated to be 14.5 g per day, 45% of which is user added. Dietary fat is estimated to provide 40% of the caloric value of the diet; a reduction to 35% is indicated. Available food fats are examined. There are insufficient supplies of vegetable oils to provide a $\text{P}\text{S}$ ratio of 1.0 with an isocaloric ratio for saturated, monounsaturated, and polyunsaturated fatty acids, as is indicated for the prudent diet. Examples of baking shortening, margarine, and frying shortening derived from oils of high $\text{P}\text{S}$ ratio are given. Dietary cholesterol, estimated at 560 mg per capita per day, should be reduced to 300 mg. The major dietary sources of cholesterol, on a per capita daily basis, are beef, pork, lamb, and veal (211 mg), eggs (195 mg), and milk fat-excluding butter (79 mg).     

Antimicrobial susceptibility pattern of bacteria isolated from pyogenic oro-facial lesions in Dar es Salaam

The aim of this study was to identify bacterial agents responsible for oro-facial infections in patients referred to Muhimbili Medical Centre in Dar es Salaam and to investigate their sensitivity pattern to the commonly used antibiotics. According to our results the most common agent was S. aureus, which accounted for about one third of all isolates. The other notable agents were Viridans streptococci, Enterococcus faecalis and Klebsiella spp. Most isolates were sensitive to erythromycin, cloxacillin, cotrimoxazole, ampicillin, amoxycillin and penicillin G. None of the antibiotics was effective in combating all infections, underlining the need for routine culture and sensitivity. However, where laboratory facilities are lacking, as may be the case in peripheral clinics, erythromycin, cloxacillin, chloramphenicol and cotrimoxazole could be used for blind treatment. This, however, has to be guided by continuous drug surveillance.