Ethiopian Medical Journal最新文献

Podoconiosis is a geochemical disease occurring in individuals exposed to red clay soil of volcanic origin. This Neglected Tropical Disease (NTD) is highly prevalent in Ethiopia. According to the nationwide mapping in 2013, the disease is endemic in 345 districts, where an estimated 35 million people live. The government of Ethiopia prioritized podoconiosis as one of eight priority NTDs and included it in the national integrated master plan for NTDs. An integrated lymphoedema management guideline has been developed. Service expansion has continued in the last few years and lymphoedema management services have been expanded to over one hundred endemic districts. The last few years have been critical in generating evidence about the distribution, burden and effective interventions for podoconiosis in Ethiopia. Although the extent of the problem within Ethiopia is considerable, the country is well positioned to now scale-up elimination efforts. Given the extraordinary progress of the past ten years and the current commitment of government, private and third sectors, Ethiopia seems to be on course for the elimination of podoconiosis in our lifetime. We need continued strong partner commitment, evidence-building, and scale-up of activities to accomplish this.

Background: Knowledge of the characteristics and outcomes of critically ill patients admitted to Medical Intensive Care Unit (MICU) helps with identification of priorities and the resources required to improve care. The objective of this study was to examine admission patterns and outcomes in MICU at St. Paul’s Hospital Millennium Medical College.

Materials: A retrospective review of 1256 patients’ case notes who were admitted to the MICU at St. Paul’s Hospital Millennium Medical College from 2007 to 2012 was carried out. The data was analyzed by SPSS version 18.0 to obtain descriptive and inferential measurements. P values < 0.05 were considered significant for all tests.

Results: Among specific diagnoses, diabetic ketoacidosis; 187 (14.9%), was the leading cause of admission, followed by all Strokes; 103 (8.2%), and Unspecified Diseases of Circulatory System; 81 (6.4%). The overall mortality rate was 39 %. Strokes were the leading causes of death, accounting for 12.2% of total deaths. The deceased were older than the survivors by five mean age years, mean age (±SD) 41.9 (± 18.5) and 36.7 (± 17.4) years, respectively.

Conclusions: Non- communicable will continue to be increasing proportion of ICU admissions in the study. The mortality in this study is also substantial, and reasons looks like late admissions and limited care in the facility. Improving the ICU infrastructure and staffing with skilled personnel might improve the quality of care.

Ganglioneuroma (GN) is benign tumor arising from sympathetic ganglion which commonly occurs at posterior mediastinum, retroperitoneum and adrenal gland. Rarely, it may also present in cervical region as slow growing painless neck mass. Here we present a 7 years old female child with 4 years duration of slow growing left lateral neck mass. After proper investigations the patient was prepared & taken to the operation room for complete excision of the mass. Post operation biopsy settled the definitive diagnosis as Ganglioneuroma. Thus ganglioneuroma should be considered in patients with neck mass.

Introduction: Tuberculosis outbreaks emerge occasionally in long-term care facilities and various educationalestablishments. This study was designed to determine the five year overall prevalence and trend of tuberculosisand associated factors among students at Adama Science and Technology University and Addis Ababa UniversitySidist Kilo campus.

Methods: A five-year retrospective study was conducted on students’ medical records of tuberculosis DirectlyObserved Treatment Short Course clinics from September 2009– July 2014. The overall prevalence and the trendof smear positive, smear negative and extra pulmonary tuberculosis cases was determined. Odds ratio with 95percent confidence interval was calculated for categorical variables using a multivariate logistic regression modelto assess the strength of association.

Results: A total of 112 and 263 tuberculos cases were recorded in Addis Ababa University Sidist Kilo campusand Adama Science and Technology University, respectively. The mean proportion of tuberculosis cases of alltypes among the total number of students enrolled at Adama Science and Technology University and Addis AbabaUniversity Sidist Kilo campus was 1098.1 and 511.7 cases per 100,000 population, respectively. There was a statisticallysignificant difference in prevalence of tuberculosis among students in Adama Science and TechnologyUniversity compared to that in Addis Ababa University Sidist Kilo campus [adjusted odds ration: 2.881, 95% CI(1.76-4.71)]. The trend of tuberculosis prevalence showed a steady decline from the first to the last year of thestudy period.

Conclusion: The number of tuberculosis cases observed among university students in this study was high. Governmentaland nongovernmental agencies involved in tuberculosis control must consider higher education institutionsas focal points for prevention and elimination of tuberculosis in Ethiopia.

Introduction: Retention of patients on anti-retroviral treatment in Ethiopia is a challenge. Use of anti-retroviral treatment experienced patients to prepare and re-engage them when they miss follow-ups is recommended, but evidence on its effectiveness is limited. This study evaluated its effectiveness.

Methods: : A retrospective cohort study in 10 randomly selected health facilities was conducted to compare outcomes before and after initiation of the adherence supporters program in HIV care and treatment from September 2001 to August 2013. Data analysis involved Kaplan-Meier survival and Log-rank test analysis on STATA statistical software Version 12 to compare survival experiences.

Results: Of 18,835 records that were available, 938 (4.36%) records with missing values were excluded and data from the remaining 17,897 was analyzed. The incidence of first instance lost to follow-up was 22.2 per 100 person-years (95% confidence interval 21.7-22.7). The risk of missing follow-ups after initiation of the program was high (Hazard Ratio –1.22, P < 0.001). The incidence of restarting after missed follow-ups was 23 per 100 PY (95% CI 22.2-24.0). The likelihood of restarting after missed follow-ups was four times higher during the period adherence supporters were present (P<0.001). Patients who stayed longer in care before missing follow ups were more likely to restart (5.7 times the chance of restarting treatment for those whose first lost to follow-up occurred at≥12 months compared to <3 months, P< 0.001).Time to restarting treatment was shorter after the initiation of the adherence supporters program (median 37 vs. 115 days). The risk of recurrence of being lost to follow-up in the presence of adherence supporters was significantly higher than when there were no adherence supporters; 38.8 (95% CI 36.3-41.6) per 100 PY vs. 26.1 (95% CI 19.8-34.4) per 100 PY, respectively.

Conclusion: Adherence supporters were effective in improving re-engagement of patients in treatment and care after they were lost to follow-up. Yet, prevention of lost to follow-up cases has remained a challenge to the program.

Genetic, gonadal, phenotypic and psychological genderis the basis for gender assignment to an individual. Derangementin genetic makeup, under or over exposure to sex hormones and problems related to sex hormone receptorswill lead to abnormal development of the external and internal genitalia. Failure to respond for the endogenousandrogen, Androgen Insensitivity Syndrome is one of the common causes of genital ambiguity and intersex.In this case series we have presented three girls from a family of seven children visited Tikur Anbassa SpecializedHospital (TASH) with a complaint of primary amenorrhea and diagnosed to have androgen insensitivity syndrome.Their clinical presentation, relevant laboratory and histopathologic findings, karyotype and genetic analysisresults are summarized. Potential causes and treatment options are discussed.

Introduction: Even though atrial fibrillation is a common risk factor of stroke which contributes to poor outcome, data concerning this association is scarce in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital.

Methods: Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head CT scan and ECG results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form.

Results: A total of 94 patients with mean age of 67.4±12.4 years and Female to male ratio of 1.13:1 were analyzed. The prevalence of AF was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes respectively. The in hospital case fatality of stroke associated with and without atrial fibrillation was 22.2% and 8% respectively while the rate of improvement at discharge was 34% and 68% respectively. Atrial fibrillation was associated with a low rate of improvement at discharge (OR= 0.28 CI: 0.1-0.78).

Conclusion: Atrial fibrillation is common in stroke patients in our hospital, especially in the elderly population. It is associated with low rate of improvement at discharge. Appropriate screening and treatment of atrial fibrillation is invaluable for the primary and secondary prevention of stroke.

Introduction: Referral is part of patient care when done appropriately. Common reasons for referral include seekingexpert advice, technical examination and/or intervention, care beyond the facility’s capacity.Objectives: Determine the rate, reason for and type of cases referred among patients seen at surgical EmergencyRoom of SPHMMC during May to July 2015.

Patients and methods: Cross sectional study was done at St. Paul’s Hospital Millennium Medical College EmergencyRoom, including all surgical patients seen in three months period. Data was collected from the individualpatient’s medical records, records of the ER and the liaison office and Interns morning reporting book. Data wasanalyzed with SPSS version 20.

Results: Total of 2,492 patients were seen. The mean number of patients seen per day was 27.7 with a range from13 to 51. Trauma made 70% (1746) of all cases seen. Cases that needed admission made 30.1% (755), but only49.5 % (374) of them were admitted. The overall referral rate was 15.3%. The referral rate in patients who neededadmission was 50.5 % (381). Trauma made 77.4% (295) of the referrals, mainly orthopedic, 54.6% (161) andneuro-traumas, 38% (112). Among non trauma cases acute abdominal conditions tops, 75% (56). Lack of inpatientbeds was the main reason for referral 65.6% (250). Specialist care need was the reason for referral in 34.5%(131) of cases. Among patients referred only 14.4% (55) left the hospital at the time of referrals. Four percent (13)of the kept patients died in the ER waiting for referrals.

Conclusions: The rate of referral from St. Paul’s Hospital Millennium Medical College Emergency Room is high.It is higher in trauma cases, specifically orthopedic and neuro-traumas. Main reason for referrals was lack of bed.The capacity of the hospital and other hospitals in AA in absorbing traumas, specifically orthopedic and neurotraumasneed to be evaluated and necessary policy adjustments should be implemented. Further study at each hospitaland the whole city gives better picture of referrals among hospitals in Addis Ababa.