ABSTRACT
Background: The variations of the olfactory fossa/ethmoid roof are common. These variations are important to be acknowledged when dealing with endoscopic sinonasal and skull base surgeries due to possibilities of injuries to the vital structures. The depth of the olfactory fossa is classified as Keros type I, II, or III (Depth 1-3mm, 4-7mm, and 8-16mm, respectively). Keros type III is consider the most venerable type to iatrogenic injury followed by type II. The variations can be similar or dissimilar among countries, geographies, and ethnicities. Functional endoscopic sinus surgery (FESS) is currently the preferred surgical option worldwide when dealing with nasal or sinonasal diseases. Awareness of the anatomical landmarks, Variations in the depth of the olfactory fossa, assist the surgeon in avoiding CSF leaking, brain herniation, and hemorrhage. For a few decades, it was introduced in Africa (Egypt, Nigeria, South Africa, Kenya, etc.). FESS was introduced at the Muhimbili National Hospital, Tanzania in 2010 and is currently becoming widely practiced in the country. Only a single study done in Kenya on anatomical variations of the ethmoid roof was found in east Africa. No data was found in Tanzania and due to the scarcity of data in Africa especially in east Africa, this study was necessary.

ABSTRACT
This study explored the transformative role of biomass gasification integrated within Multifunctional Platforms (MFPs) as a sustainable solution to rural energy poverty and agro-industrial stagnation in off-grid areas of Uganda. Anchored within the framework of the Parish Development Model (PDM), the research investigated how advanced biomass gasification technologies stimulated agro-processing, promoted environmental conservation, and drove inclusive economic development at the grassroots. The study was conducted in Kibale District, employing a mixed-methods approach that involved surveys, focus group discussions, and key informant interviews with local farmers, agro-processors, community leaders, and technical experts. Findings revealed that biomass gasification offered a reliable and renewable energy source, especially when harnessed through MFPs to power agro-processing units, support rural enterprises, and reduce post-harvest losses. The technology also contributed to waste management by converting agricultural residues into clean energy, thereby enhancing environmental sustainability. However, adoption was hindered by factors such as limited technical knowledge, inadequate financing mechanisms, and infrastructural gaps. The research underscored the critical need for capacity building, public-private partnerships, and tailored policy interventions to mainstream biomass gasification within the PDM framework. By leveraging locally available biomass resources, Uganda could unlock rural industrial potential, improve livelihoods, and advance its transition to a low-carbon print economy. The study concluded with strategic recommendations to scale up MFPs as engines for sustainable rural transformation and resilient agro-industrial ecosystems in off-grid communities.

ABSTRACT
Introduction: Riedel's thyroiditis (RT) is a rare disease characterized by destructive inflammatory fibrosis of the thyroid gland. It is often part of a systemic disease, idiopathic multifocal fibrosclerosis, which can affect other sites such as the retroperitoneum. We report two cases of RT revealed by retroperitoneal fibrosis (RPF), emphasizing the contribution of biological investigations to the diagnosis and management. Case Reports: Case 1: A 36-year-old female, with no significant medical history, presented with bilateral renal colic and a hard goiter. Laboratory findings revealed renal insufficiency and a normal thyroid panel. Imaging (ultrasound, CT urogram) confirmed RPF. Lymph node and thyroid biopsies confirmed the fibro-inflammatory process. Case 2: A 72-year-old female, with a history of hypertension and diabetes, presented with a long-standing stony goiter. A routine blood test revealed renal insufficiency. Imaging highlighted RPF. Histology after total thyroidectomy confirmed RT. Discussion: Biological investigations play a crucial role at several levels: 1) Screening for systemic involvement (renal failure), 2) Assessment of thyroid status (often normal initially), 3) Search for inflammatory evidence (biological inflammatory syndrome, often present), and 4) Therapeutic monitoring under corticosteroids. The absence of specific autoantibodies makes histology essential for diagnosis. Conclusion: RT is a rare cause of RPF. Although non-specific, biological workup is a key element for diagnosing systemic extension and for follow-up. It must systematically include renal, thyroid, and inflammatory assessments in any suspected case of RT.

ABSTRACT
Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure and carries one of the highest risks of serious complications. The success and safety of ERCP are strongly influenced by both the experience of the endoscopist and the procedural volume of the centre. Evidence have shown that higher case volumes are associated with improved outcomes and lower complication rates. However, this does not imply that low-volume centres are incapable of performing safe and effective ERCPs. This study aims to evaluate the outcomes of ERCPs performed by a single operator at a district general hospital. The results are compared with recognized international standards to assess the safety and efficacy of ERCP in a lower-volume setting. This retrospective study reviewed ERCP procedures performed in the General Surgery Department of Hospital Pakar Sultanah Fatimah, Muar, between 1 January 2021 and 31 October 2023. Data analysis included patient demographics, cannulation success rates, and procedure-related complications. Patients with missing or incomplete source documentation were excluded. A total of 137 ERCP procedures were analysed, of which 102 were first-time ERCPs. Most patients were Malay females. The overall common bile duct (CBD) cannulation success rate was 93.4%. Stone-related indications accounted for 94 procedures, with successful stone clearance during the first ERCP achieved in 58 cases (59.6%). The incidence of post-ERCP pancreatitis was 10.2%. These findings highlight opportunities for improving the ERCP service. In response, targeted changes have already been implemented to enhance patient safety and procedural outcomes.

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Introduction: The aim of this study was to document the factors associated with death in children with cancer in the haematology-oncology unit of the paediatric department at Donka National Hospital between 1 January 2018 and 31 june 2021. Methods: This was a retrospective-prospective analytical study : retrospective over a 3-year period from 1 January 2018 to 30 june 2021. Results: We identified 122 cases of cancer-related deaths, representing 52.81% of the total. Males accounted for the majority of cases, representing 52.45% of the total. The under-2 age group was the most represented, accounting for 28.68%, with an average age of 4.39 years (3.97 years) and extremes of 1 year and 18 years. 57.37% of patients resided outside Conakry. The most common cancer was Burkitt's lymphoma, accounting for 31.14%. The factors associated with death with a statistically significant p-value were age : p-value 0.018; distance from home to the unit : p-value 0.001; the family's socioeconomic status : p-value 0.04; and the type of chemotherapy used : p-value 0.018. Conclusion: Although rare, childhood cancer remains a significant cause of mortality in children. The high mortality rate of these cancers in Guinea demonstrates the importance of this study and highlights the need for an epidemiological surveillance programme to improve care.

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Total knee replacement (TKR) is an established procedure for advanced knee osteoarthritis, primarily indicated when pain and functional limitation significantly impair quality of life and activities of daily living. Surgical outcomes depend greatly on intraoperative technical decisions, particularly tibial cut and polyethylene thickness selection. This study explored the surgical preferences, intraoperative methods, and decision-making factors guiding proximal tibial resection and polyethylene selection among Nigerian orthopedic surgeons performing TKR. A descriptive cross-sectional survey of orthopedic surgeons with TKR experience was conducted using a structured questionnaire across four domains. Data were analyzed with descriptive statistics in SPSS v26. A total of 52 male surgeons participated, with 48.1% aged 41–50 years and 38.5% aged 51–60 years. Most had <10 years of arthroplasty experience (77%) and performed <50 TKRs annually (71%). Tibial resection was commonly guided by a combination of stylus and angel wing (69.2%), while polyethylene thickness was mainly determined by intraoperative gap assessment (69.3%). Key decision factors included flexion–extension gap balance (37.9% for tibial cut; 45.2% for polyethylene thickness) and joint line preservation (26.7% and 30.8%). The majority preferred polyethylene thickness of 10–12 mm (88.5%), with overstuffing indicated by polyethylene popping out on flexion (34.6%) or difficulty with insertion (31.5%). Nigerian orthopedic surgeons predominantly rely on conventional gap-balancing techniques and mid-range polyethylene thickness during TKR. The limited adoption of advanced technologies highlights the need for region-specific guidelines, enhanced training, and access to modern instrumentation to optimize surgical decision-making and long-term outcomes.

ABSTRACT
Background: Hirschsprung’s disease (HD) is the most common surgical condition in pediatrics posing challenges to pediatricians and pediatric surgeons mainly practicing in resource-limited countries. Clinical features of the disease are variable and the risk factors in our setting are not well studied. Objectives: This study aimed at describing the clinical characteristics and determining the risk factors for Hirschsprung’s disease among Hirschsprung’s disease patients at Muhimbili National Hospital. Method: A case-control study was carried out whereby patients with histologically confirmed Hirschsprung’s disease and their caretakers admitted to the ward or attending regular clinics were selected, and verbally interviewed using a structured questionnaire and their findings were compared with corresponding controls without HD. Results: The study enrolled 225 cases and 476 controls. The majority of participants were male accounting for 156(69.4%) and 286(63.4%) for both cases and controls respectively. The mean age of the participants was 58 months, mainly coming from the coastal region where the hospital (MNH) is located. The most common age at first clinical presentation was neonatal age but the most age at confirmatory diagnosis was 25-60 months. Chronic constipation was the most common clinical presentation accounting for 223(99.1%) of cases followed by abdominal distension 207(92.0%) and soiling. Failure to pass meconium within 24 hours was common in cases (37.6%) compared to control (8.6%). %). Prematurity, Down’s syndrome, history of HD, and congenital anomalies in the family were found to be associated risk factors for Hirschsprung’s disease. Conclusion: The most common clinical presentations were found to be chronic constipation, abdominal distension, failure to pass meconium within 24-48 hours of life, and male predominance. Prematurity, Down’s syndrome, history of HD, and congenital anomalies in the family were more likely to be associated with Hirschsprung’