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Item Xpert Breast Cancer STRAT4 Assay using fine-needle aspiration biopsy samples in a resource-constrained setting: a prospective diagnostic accuracy study(The Lancet Oncology, 2024-10-03) Vuhahula,Edda A.M.Summary Background Use of fine-needle aspiration biopsy (FNAB) specimens on Xpert Breast Cancer STRAT4 Assay (STRAT4; Cepheid, Sunnyvale, CA, USA), a CE-marked in-vitro diagnostic medical device, could potentially increase access to breast cancer biomarker testing in resource-constrained settings. We aimed to assess the performance of a research use-only version of STRAT4 using FNAB specimens in Tanzania. Methods In this prospective diagnostic accuracy study, patients aged 18 years or older with palpable breast masses presenting to the FNAB Clinic at Muhimbili National Hospital (Dar es Salaam, Tanzania) were recruited consecutively. Patients who were pregnant, lactating, or had a previous diagnosis of breast cancer were excluded. STRAT4 testing was performed on off-label FNAB samples using four protocols: the 1 × protocol (using the standard lysate method) on FNAB smears (1 × FNAB), quick lysis and Maui protocols (both on FNAB smears), and the 1 × protocol on formalin-fixed paraffin-embedded (FFPE) cell block material (1 × cell block). For 1 × FNAB and 1 × cell block, tissue was processed using FFPE lysis reagent, incubated at 80°C with proteinase K, and followed by addition of 95% or higher ethanol. Quick lysis was processed using FFPE lysis reagent and 95% or higher ethanol, whereas Maui was processed using a proprietary research-use only lysis reagent. The primary outcomes were overall concordance, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of STRAT4 as compared with immunohistochemistry or immunohistochemistry plus fluorescence in-situ hybridisation performed on cell blocks using clinically validated protocols in a Clinical Laboratory Improvement Amendments-accredited laboratory at the University of California, San Francisco (San Francisco, CA, USA). Findings Between Nov 29, 2017, and Dec 17, 2020, 208 patients were enrolled. Of 208 cases, 51 (25%) were excluded from analysis because of insufficient tissue in the cell block or absent cell blocks, leaving 157 participants (all female) for analysis. For oestrogen receptor, 1 × FNAB had the best performance, with an overall concordance of 95% (95% CI 90–100), sensitivity of 94% (85–100), specificity of 97% (90–100), and AUC of 0·96 (0·81−1·00). For progesterone receptor, 1 × cell block had the best overall performance (overall concordance 89% [95% CI 84–95], sensitivity 91% [82–99], and specificity 89% [81–97], with an AUC of 0·93 [0·89−0·99]) and 1 × FNAB performed the best among the smear protocols, with a concordance of 84% (95% CI 74–93), sensitivity of 63% (43–82), specificity of 97% (92–100), and AUC of 0·91 (0·72−0·97). For HER2, Maui had the highest agreement, with an overall concordance of 93% (95% CI 89–98), sensitivity of 96% (88–100), specificity of 92% (87–98), and AUC of 0·95 (0·98–1·00). For Ki67, Maui had the best performance of smear protocols, with a concordance of 73% (95% CI 64–82), sensitivity of 70% (58–81), specificity of 81% (66–96), and AUC of 0·80 (0·54−0·82). Interpretation Processing FNAB samples with STRAT4 is feasible in Tanzania, and performance for the oestrogen receptor is robust. Further optimisation of STRAT4 for FNAB has the potential to improve timely access to breast cancer diagnostics in resource-constrained settings. Funding US National Institutes of Health; UCSF Global Cancer Program, Helen Diller Family Comprehensive Cancer Center; UCSF Department of Pathology; and Cepheid.Item FNAB samples with the STRAT4 assay for breast cancer diagnosis – Authors' reply(The Lancet. Oncology, 2025-01-26) Vuhahula,Edda A.M.We thank Liqi Li for noting the myriad challenges of implementing leapfrog technologies in a resource-constrained setting. To clarify, our expectation in this pilot study,1 was not to demonstrate high levels of concordance for all biomarkers across all lysate preparation conditions. Our aims were: (1) to test different lysate preparation conditions to identify the optimal method that would facilitate use of off-label fine-needle aspiration biopsy (FNAB) specimens with the Xpert Breast Cancer STRAT4 Assay (STRAT4; Cepheid, Sunnyvale, CA, USA) in a resource-constrained setting; and (2) to assess whether similar concordance levels between results using FNAB specimens and previous results using formalin-fixed paraffin embedded specimens could be achieved.2 Previous studies of STRAT4 in sub-Saharan Africa have also explored multiple preparation methods to establish whether alternative, more reagent-efficient methods could be used.3,4 Although the inability to test all the samples using all sample preparation methods limited the ability to directly compare each method's performance, a sufficient number of samples were collected to assess each sample type independently. The College of American Pathologists (CAP) provides rigorous guidelines on anatomic pathology test validation.5 Using immunohistochemistry and fluorescence in-situ hybridisation results from another accredited laboratory as a reference standard during assay validation is a CAP-recommended practice. We also previously acknowledged that convenience sampling can introduce bias. Random sampling would not have been feasible in our study while ensuring the prospective collection of enough samples in a timely manner. The robust performance of STRAT4 for oestrogen receptor alone has the potential to markedly increase access to life-prolonging endocrine therapies in resource-constrained settings. However, the more modest performance of the other biomarkers reflect the need for additional FNAB lysis method optimisation before broader implementation. Additional studies evaluating real-world performance in resource-constrained settings will also be an essential next step. Our study provides an example of how leapfrog technologies for cancer diagnosis can be successfully investigated, using rigorous methodology, within a resource-constrained setting.Item Androgen receptor overexpression by immunohistochemistry in malignant salivary gland tumors in Tanzania(BMC cancer, 2025-01-25) Vuhahula,Edda E.M.Background Malignant salivary gland tumors (SGTs) present diagnostic challenges and limited treatment options. This study aims to determine the proportion of malignant SGTs overexpressing the androgen receptor (AR) by immunohistochemistry (IHC) and its association to age, sex, anatomical site, histopathological subtype and grade which may inform customized treatment approaches. Methodology This was a retrospective cross-sectional analytical study of archived paraffin embedded tissue blocks of malignant SGTs diagnosed at MNH Central Pathology Laboratory (CPL) from January 2019 to December 2022. IHC staining using a monoclonal Rabbit Anti-Human AR and interpretation was done using Allred score. The AR overexpression was assessed and compared by age, sex anatomical site, histological subtype and histological grade of the tumor. Results Out of 158 (60%) malignant SGTs, 115 cases underwent AR IHC where, mean age was 49.7 ± 17.9, females were 61(53%). Major salivary gland involvement was (67)58.1%, predominantly parotid gland 35(52.2%), Adenoid cystic carcinoma and Mucoepidermoid carcinoma were the most common tumors accounting for 38(33%) and 22 (19%) respectively. High grade tumors were prevalent accounting for 53(46.1%). Androgen receptor overexpression was observed in 49(42.6%). A significant association was observed between AR and parotid gland anatomical location (aOR = 3.45, 95% CI = 1.1–10, p = 0.027) and high-grade tumors (aOR = 5.1, 95% CI = 1.4–19, p = 0.014). No significant association between AR overexpression and age (p-value 0.253), sex (p-value 0.708) and histological subtype (p-value 0.557), although highest proportion were seen in salivary duct carcinoma (71.4%). Conclusion High-grade malignant SGTs and parotid gland location are associated with AR overexpression. This suggests that androgen deprivation therapy (ADT) has the potential to play a role in the management of advanced SGTs. However, large-scale studies that will include comprehensive molecular investigations and efficacy exploration of ADT are recommended to clarify our current findings and inform therapeutic options for patient with high grade and recurrent tumors.Item Prevalence of and factors assocated with alcohol consumption in Temeke in August/September, 2002.(East African Journal of Public Health, 2007) Chande, Hassan M.Objective: To determine the prevalence of alcohol consumption in Temeke district by social demographic characteristics. Methodology: Population-based cross-sectional study was conducted in Temeke district involving persons above 15 years of age. We selected Keko ward for the study and simple random sampling procedure was used to select clusters of ten-cell leaders. All households in the selected ten-cell leaders were included in the study sample. The study was cleared by the Ethical Clearance Committee of the Muhimbili University of Health and Allied Sciences, Dar es Salaam. Chi-squared (chi2) test for contingency tables was used to assess statistical significance and the results were considered significant if p-value was less than 0.5. Results: A total of 246 persons participated in the survey and of these 22% (54) were alcohol drinkers. The age group 25-35 years showed a high prevalence with a male preponderance. There was no difference in the drinking pattern between single and married subjects with 20.1% and 22% respectively. On education basis, 22.1% of primary school leavers drank alcohol. Teachers and businessmen drank alcohol more than other occupational groups with 33.3% and 25.6% respectively. Bad health effect was the most perceived alcohol related problem occurring in 65.4% of all the respondents. Conclusion: It was concluded that alcohol consumption was low in Temeke as compared to other regions and was seen more in males than females and bad health effect was the most perceived problem resulting from alcohol consumption. We recommend that similar studies should be done in other districts of Dar-es-Salaam to validate our findings.Item Evaluation of risk factors for Alzheimer's disease in elderly east Africans(Brain Res Bull, 1997) Chande, Hassan M.A number of biological risk factors have been implicated for Alzheimer's disease (AD). The investigation of prevalence rates of AD in crosscultural populations has much potential in validating these factors. We previously assessed brain amyloid beta (A beta) protein deposition and other lesions associated with AD as possible markers for preclinical AD in elderly nondemented East Africans. In further analysis, we demonstrate that 17-19% of elderly East African subjects without clinical neurological disease exhibited neocortical A beta deposits and minimal neurofibrillary changes at necropsy that was qualitatively and quantitatively similar to that in an age-matched elderly control sample from Cleveland, OH. A beta deposits varied from numerous diffuse to highly localized neuritic plaques and were predominantly reactive for the longer A beta 42 species. In parallel studies, we evaluated another recently implicated factor in AD, the apolipoprotein E genotype. We found relatively high frequencies of the apolipoprotein E-epsilon 4 allele in elderly nondemented East Africans. The frequencies were comparable to those in other African populations but higher than in subjects from developed countries. Our limited study suggests that elderly East Africans acquire cerebral lesions found in AD subjects but the apolipoprotein E-epsilon 4 allele may not be a highly specific factor for the disease among East Africans.Item Filling the gap for healthcare proffessionals leadership training in Africa: the Afya bora consortium fellowship(Annals of Global Health, 2017) Mashalla, Yohana J.Program/Project Purpose: The Afya Bora Consortium is a partnership of five African and four U.S. universities with the mission of providing future global health leaders with advanced skills that are beyond the traditional patient-centered training programs for healthcare professionals. Each year, an interdisciplinary group of twenty physicians, nurses and public health professionals participate in a 12-month African-based intensive fellowship to improve skills in leadership, resource management, program monitoring and evaluation, implementation, and applied research. Structure/Method/Design: The Afya Bora Fellowship provides leadership training in the form of eight in-person and four online modules as well as two 4.5-month mentored attachments at governmental and non-governmental organizations in Botswana, Cameroon, Kenya, Tanzania, and Uganda. The fellows come together during three, month-long highly interactive sessions held in different African countries during which interdisciplinary and multinational learning is encouraged. Afya Bora Fellows complete evaluations of the modules and program as well as self-assessments of learning throughout the year. Data presented here are from all cohorts since 2011 using qualitative analysis of personal reflection reports. Outcome & Evaluation: Fellows described multiple training gaps the fellowship helped fill. Fellows reported that increased skills in communication would help them to better motivate and align others to address pressing problems in their healthcare systems. Improved understanding of and capacity to use data for programmatic purposes was also identified as essential to their ongoing leadership. Fellows reported that their organizational and management abilities had improved both from didactic learning and modeling of program faculty and staff. Finally, fellows reported that the rich cohort experience provided them with an added appreciation of the advantages of inter disciplinarity when solving problems. Going Forward: Well-structured and targeted leadership training is necessary to fill the gaps in traditional medical and nursing education programs. Such training can catalyze healthcare professionals to become more effective in leadership and improve the healthcare systems in their countries while not contributing to “brain drain” (all fellows thus far have remained in their respective countries). The Afya Bora Fellowship can serve as a model for training and research institutions as well as organizations in resource-limited settings to sustainably strengthen human resource capacity to lead and improve health systems.Item Assessment of women's knowledge and attitude towards carcinoma of the cervix in Ilala municipality.(East African Journal of Public Health, 2010) Chande, Hassan M.Main objective: To asses knowledge and attitudes of women towards carcinoma of the cervix in Ilala Municipality. Methodology: A community based cross-sectional study targeting all women in Ilala municipality. Therefore the sample size was 196 women but for the purpose of this study it was increased up to 201 women.A multistage random sampling procedure was used to select a representative sample. Permission was sought at all the appropriate levels in the form of oral as well as written consent.Only women who were willing to participate in the study were interviewed. A questionnaire was developed and data analysed using Epi info software was used to analyse data. Differences beween proportions found in different groups were tested for statistical significant using chi-squared test. Results: A total of 210 women were interviewed. A number of respondents were in the age groups 21-30 and 31-40 years and 76.1% of the respondents were aware of carcinoma of the cervix. The most common mentioned risk factors were early marriage (37.1%) and multiparity (36%). Irregular vaginal bleeding was the most common symptom metioned (51.7%). Irrespective of the level of education 98%-100% of all respondents knew the importance of screening for carcinoma of the cervix. Conclusion: It was therefore concluded that women were aware of carcinoma of the cervix but the knowledge on this disease is still very low.Item How does clinical diagnosis of mycobacterial adenitis correlate with histological findings?(East African Journal of Public Health, 2007) Chande, Hassan M.Objective: To describe and compare histopathological findings with clinical criteria in diagnosis of TB adenitis. Methods: Lymph node biopsies were obtained from 213 patients. Specimens were processed for culture and histopathologic examination, using standard methods. One hundred blocks with good preservation of tissue morphology were selected for detailed histological examination. Results: About 75% of 213 patients had granulomas. In the remaining 25%, neither histopathological nor microbiological evidence of mycobacterial disease was found. Of 100 blocks selected for detailed examination, 79 blocks had granulomatous changes. The granulomas were well organised in 24%, mixed in 33%, and poorly organised in 43%. Langhans giant cells and acid-fast bacilli were observed in 88.6% and 21.5% of the 79 blocks, respectively. Cultured specimens were positive in about 10% of 79 biopsy specimens. Conclusions: Histological evidence of mycobacterial disease was only found in three quarters of patients that were clinically diagnosed and started on empirical treatment for tuberculous adenitis. Neither histological nor mycobacteriological evidence was found in a quarter of the patients who were already on treatment for TB, basing on clinical criteria. These findings call for new research on simple diagnostic tools for patients who seek care for symptoms of extra-pulmonary TBItem 99mTc sestamibi scintimammography in the diagnosis of palpable breast masses(Clinical trial, 2003) Chande, Hassan M.Summary The aim of this prospective study was to evaluate the diagnostic performance of 99m Tc sestamibi scintimammography in a region with a low incidence of breast cancer (East, central and West Africa) and to verify the clinical usefulness of this technique in identifying benign breast diseases. Thirty-eight women (age range 22±38 years) with palpable breast masses (n = 38) and inconclusive mammograms were included. Prone scintimammography was performed 10 min and 60±90 min in all patients after injection using an isotime acquisition of 10 min. A positive scan for breast cancer was defined as tracer uptake on the 10 min image and retention of activity on the 60±90 min image. A negative scan was defined as uptake on the 10 min image and complete washout of activity on the 60±90 min image. All patients subsequently underwent excisional biopsy of the breast masses and histological confirmation of the pathology. The results of scintimammography and histopathology were in agreement in all patients, revealing 36 benign lesions and two malignant lesions. Histopathologically, the lesions were fibroadenomas (27), fibrocystic disease (five), abscesses (four) and invasive intraductal carcinoma (two). It is concluded that, in regions with high incidence of benign breast diseases in young women, 99m Tc sestamibi scintimammography can be used to rapidly characterize benign and malignant breast masses and thereby give priority to the management of those with a serious condition. (# 2003 Lippincott Williams & Wilkins) Keywords: benign, breast disease, fibroadenomas, palpable, scintimammographyItem The anti inflamatory activity of rumex usambarensis(The East and Central African Journal of Pharmaceutical Sciences, 2000) Chande, Hassan M.The anti-inflammatory activity of the extract of Rumex usambarensis Dammer (Polygonaceae) was compared to that of diclofenac sodium. The results of this study have shown that the 0.4 ml and 0.8 ml of the extract had 40.6% and 69.3% of the anti-inflammatory activity of 10mg diclofenac sodium. Histological results were also consistent with the anti-inflammatory activity of Rumex usambarensis.Item Pink spots of Hedley-White in the brain. Evaluation of the significance in the forensic autopsy(Legal medicine, 2000) Ng'walali, Paul M.Pink spots are sharply demarcated round to oval discolorations with a white center in the deeper areas of the formalin-fixed brain. In 152 forensic autopsies with neuropathological examinations, the authors observed pink spots in three of 16 patients with bacterial infectious diseases. Pink spots could not be found in 136 patients without bacterial infectious diseases. These results verify the concept that pink spots correlate with bacterial infections. The presence of pink spots will be used as an indication of infectious diseases in the forensic autopsy.Item Neuropathological diagnosis of Alzheimer's disease in forensic autopsy of elderly persons with fatal accident(Legal medicine, 2002) Ng'walali, Paul M.Cognitive dysfunction in Alzheimer's disease may lead to accidental deaths in the elderly. Neuropathological diagnosis of the disease is, therefore, an important issue in forensic autopsy to determine the causal relation to accidents. To evaluate the suitability of the current histopathological diagnostic criteria for Alzheimer's disease by Khachaturian and Mirra et al. in elderly persons dying from accidents and coming for forensic autopsy, we studied the brains of nine demented and 12 non-demented persons by silver stain and immunohistochemistry. When the density of senile plaque was applied to the criteria, only four out of nine demented persons met the criteria for definite Alzheimer's disease. The demented persons had significantly higher density of diffuse plaque and higher frequencies of amyloid angiopathy, neurofibrillary tangle and neuropil thread than the non-demented persons. These results indicated that the current diagnostic criteria do not always diagnose Alzheimer's disease in forensic autopsy of elderly persons with fatal accident. The presence of abundant diffuse plaque, neurofibrillary tangle, amyloid angiopathy and neuropil thread may help to diagnose Alzheimer's disease in forensic autopsy.Item Fatal intussusception in infancy: an experience in forensic autopsy(Legal medicine, 2003) Ng'walali, Paul M.Intussusception, although a common cause of pediatric surgical emergencies, is a rarely fatal condition. A 7-month-old infant who was discovered in her cot was unresponsive and pronounced dead after 2 h of uneventful cardiopulmonary resuscitation in an emergency hospital. Forensic autopsy which was performed in order to clarify the circumstances surrounding the death revealed intussusceptions at two sites of the ileum. Although morbidity and mortality rates from the condition have progressively declined in recent decades but avoidable deaths still occur as was experienced in the present case. The forensic pathology significance in this case was the occurrence of ‘painless intussusception’ whereby the affected child clinically exhibited no discomfort or characteristic features of acute abdomen until death. In summary, the present case has exhibited an uncommon fatal occurrence and demonstrated the importance of forensic autopsy in such unexpected sudden infant deaths.Item Discrepancy of clinical symptoms and prognosis of a patient — forensic significance of “talk and die” head injury(Legal medicine, 2000) Ng'walali, Paul M.Deaths of patients who had talked after sustaining a head injury and were then assumed clinically to be recovering from the head trauma raise medicolegal questions about the precise causes of deaths. A forensic autopsy on a 77-year-old man who had been talking after a road traffic accident and died on the sixth day showed slight subdural hematoma, bifrontal cerebral contusions and diffuse axonal injury. No natural diseases or delayed complications of injury were found. The cause of death was certified as head injury due to a traffic accident. This is a case of “talk and die” head injury. Forensic autopsy is important in patients with “talk and die” to clarify the causal relation to the head trauma in relation to any further forensic dispute.Item Unusual homicide by air gun with pellet embolisation(Forensic science international, 2001) Ng'walali, Paul M.A homicidal case by an air gun involving a 73-year-old woman who was found dead in her home is described. At autopsy, two gunshot wounds were observed on the left anterior chest and the right back. There was neither exit wound nor powder burns. The fatal pellet, 0.9 g and 5.5 mm diameter, penetrated the left anterior chest and the heart to cause cardiac tamponade (200 ml) before lodging in the left subclavian artery. Death was due to cardiac tamponade. This case has exhibited two rare phenomena: homicide by an air gun and pellet embolisation. This is the first homicide case by use of air gun in Japan and demonstrates that although it may be rare, air guns can be used as potential homicidal weapons. This experience will alert our society and others on the potential hazards of air guns we have tended to regard as toys.Item [Ethanol concentrations in multi-site sampling blood in forensic autopsy cases--a retrospective analysis over a period of six years (1994-1999) in Kumamoto University].(The Japanese Journal of Legal Medicine, 2002) Ng'walali, Paul M.Ethanol and n-propanol concentrations in forensic autopsy cases determined in Department of Forensic Medicine, Kumamoto University School of Medicine were reviewed retrospectively. Out of 388 autopsies in 6 years (1994-1999), ethanol was positive in 88 (22.7%) cases. Higher positive rates were observed in bleeding and burning cases compared to other cases. Histograms of the blood ethanol concentrations in all ethanol positive cases had two peaks at 0.1 mg/ml to 0.5 mg/ml and 1.5 mg/ml to 2.0 mg/ml ranges, which indicated that not only an intermediate but also a weak drunkenness level could be a risk factor of being involved in forensic fatalities. There were no differences in mean ethanol concentrations in the blood samples of the right, left and whole heart blood collected from each victim. The femoral blood, however, was slightly higher than those of heart blood. N-Propanol, an indicator for postmortem ethanol production, was detected in 14.7% of stomach contents samples as early as 6 to 12 hours of post mortem intervals, whereas it was not remarkable in urine and femoral vein blood.Item Self-destruction by multiple methods during a single episode: a case study and review of the literature(African health sciences, 2010) Ng'walali, Paul M.Background: Although the prevalence of suicide in the world is not clear, however, the reported rates of suicides are consistently higher among men tan women regardless of age group. Methods: A case employing multiple methods during a brief time of self-destructive behavior is presented. A 44-year-old postmaster who was under criminal investigation by his head office for embezzlement, leaped down a high river cliff and drowned after an initial attempt to commit suicide by hanging from the bridge over the river. The autopsy and scene investigations were both employed and very helpful. Results: Three different methods of suicide were apparent in this instance: hanging, leaping down the cliff and drowning as was evidenced by the autopsy and positive diatom test. The complexity of this case was the planned protection against the failure of one method employed to commit suicide. The methods used were all highly lethal ones. There was neither history of previous suicide attempts nor psychiatric disorder. Conclusion: Although the cause of death may appear clear at autopsy in cases of self-destruction by multiple highly lethal methods during a single episode, scene investigation is important for the forensic pathologist to understand the whole story of the case and determine the manner and actual cause of death. Scene investigation and autopsy is emphasized as part of the whole postmortem investigation of death in cases of unusual suicide using multiple methods of self-destruction.Item Mob justice in Tanzania: a medico-social problem(African health sciences, 2006) Ng'walali, Paul M.Objective: To investigate the magnitude of mob justice and associated factors. Background: Mob justice is a social and public health problem that has grown in Tanzania in recent decades that has negative effects on social and health of the country, communities, and families. Materials and Methods: A four-year autopsy study was conducted at the Department of Pathology, MUCHS. Information on the cases was obtained from police, the relatives, friends and other witnesses if available. Results: 1249 persons were killed by mobs in Dar es Salaam during the period of 5 years (2000-2004). The alleged offense ranged from a serious crime like theft or murder to a mere violation of local customs or religious beliefs. The mode of the killings were mostly burning (48.11%) and stoning (49.96%). Other modes accounted for only 3.0% of the cases. The pattern of injuries ranged from skull and other skeletal fractures to viscera rupture. Conclusion: MJ is a social, legal and public health problem in Tanzania that needs immediate attention. Unemployment of youth and perceived economic inequalities should be addressed. As long as the judicial system doesn't work and corruption is not punished, people will continue to organize their own trials and judge their suspects in the street. These must be tackled in order to reduce the growing incidences of mob justice, hence saving life. It must be ensured that criminals do not violate the freedom, dignity and respect of each and every human or member of the society. African Health Sciences Vol. 6(1) 2006: 36-38Item Traumatic Basal Subarachnoid Hemorrhage Due to Rupture of the Posterior Inferior Cerebellar Artery(Neurologia medico-chirurgica, 2000) Ng'walali, Paul M.A 20- year-old male presented with traumatic basal subarachnoid hemorrhage after being involved in a fight. Antemortem clinical examination could not exclude the possibility of rupture of abnomal blood vessels because of the absence of the external injuries.Careful postmortem of examination of the head and neck regions and histological examination of the intracranial arteries demonstrated traumatic rupture of the left posterior inferior cerebellar artery due to a fist blow to the jaw.This case indicates the need for careful autopsy examination for the differentiation of traumatic and non traumatic basal suburachnoid hemorrhagesItem The forensic exhumation and human remain identification of an individual with albinism(Forensic Science International, 2022-06-06) Ng'walali, Paul M.This article reports on an exhumation of an individual identified to be a victim of albinism from a trench dug for a well on 16 April 2018, Ukonga, Dar es Salaam, Tanzania. The skeletal remains were sent to the Forensic Bureau of the Tanzania Police Force for further investigation. Ante-mortem and postmortem information, the deoxyribonucleic acid (DNA) and skeletal diagnosis were used in the identification. Skeletal diagnosis suggests that the victim was a young African male aged between 19 and 26 years old with stature of 157–166 cm. Ante-mortem trauma suggest that the individual was wounded with a sharp object on the left shoulder resulting in severe infection. The victim had a problem with acute dental caries suggesting the existence of biochemical reaction. He also had porosity lesions on cranium and vertebral column which is indicative of chronic malaria infection or anemic condition. The distal end of the tibia exhibited a peri-mortem pilon fracture on the articular surface of the malleolus. This signifies he fell into that long edge trench either intentionally or accidentally or pushed by people and that is the circumstances of death. This article also provides a general picture of challenges facing people with albinism in Africa. People with albinism have been victimized in many ways such as restricted right of self-expression, deficiency of freedom, being hunted or repudiated to death, and deficiency of medical treatment. They also are suffering from dermal diseases, injuries and infections that can easily lead to skin cancer and skeletal diseases due to their disability. In fact, this problem requires urgent resolution for health departments and those involved in the protection of civilians, especially the security agencies. It is an intolerable life; therefore, African governments should take serious measures to curtail atrocities committed to people with albinism.