Ethiopian Medical Journal最新文献

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.

Myxomas occupying multiple chambers of the heart are extremely rare, being more common in familial cases. Recurrenceof these tumors after surgical excision is also a rare condition, observed in about 3% of patients in sporadiccases. Systemic embolization especially to the brain is one of the common presentations of cardiac myxomasapart from intracardiac obstruction and systemic symptoms.We report an adolescent girl presenting with recurrent myxoma arising from multiple cardiac chambers with systemicembolization. As a diagnostic and preventive measure of recurrence and chronic systemic embolization, werecommend a regular follow up of such patients with echocardiographic evaluation following surgical resection.

Introduction: The survival of neonates with surgical conditions has greatly improved in developed countries, butstill remains poor in developing countries. Available evidence suggests that this is due to several challenges encounteredin neonates requiring surgical care. The aim of this study was to determine causes and outcomes ofneonatal surgical admissions.

Patients and methods: retrospective review of medical records of neonates who were admitted and treated at TikurAnbessa Hospital between January1, 2010 and December 31, 2014. Data were analyzed using descriptive statisticsand association between variables measured using regression analysis on SPSS version 16 statistical software.

Results: There were a total of 652 surgical neonatal admissions during the study period of which 396 were males,252 females and 4 with indeterminate genitalia. The male to female ratio was 1.6:1. Majority of the cases 562(86.2%) had congenital malformation. Lesions of the gastrointestinal tract 282(43.3%), mainly Anorectal malformationsfollowed by abdominal wall defects. Two-third (66.6%) of the cases were surgically managed. Nearly onequarterof them died. The proportion who died ranged from 0.03% for Hirschsprung’s disease to 73.2% for esophagealatresia. The immediate causes of death among these series of neonates were ascribed to septic shock andrespiratory failure.

Conclusion: Neonatal surgical admission is common in the Hospital. The overall number of deaths in this series ofneonatal surgical cases was high. The type of principal diagnosis and the age of the neonates at admission weresignificantly associated with outcome. Creating awareness about neonatal surgical conditions may help to improvethe current poor result.

Background: There is a growing global concern about the public health implications of the increasing populationof the elderly. One main issue of concern is centered on how to address their mental health needs using homegrowninterventions and services. We expect that important lessons on geriatric mental health issues would bebrought to fore in this report.

Methods: This is a four-year (2007-2011) retrospective report on the mental health services rendered to 938 clientsaged 60 years and above at a Lagos based mental health treatment facility in Nigeria. Designed questionnaireswere filled with socio-demographic and clinical data obtained from patients case notes based on the objectivesof the study.

Results: The mean (standard deviation) age of elders was (±7.93) 69.6 years, and 65.5% were females. Majoritywere married, self-employed and belonged to low socio-economic status (73.1%, 63.1% and 63.2%, respectively).Close to two-thirds (62.4%) commute for at least one hour to get treatment. The commonest diagnosis was psychoticdisorders (34.8%), while 5.5% had Alzheimer’s dementia. Some 96.5% of the elders were solely on medications.About a quarter had past history of mental illness and 48.5% reported co-morbid medical conditions, withcardiovascular problems (53.0%) being the commonest physical comorbidity. The middle old along with very oldelders (aged≥70 years), and those with at least tertiary education, were more likely to present with dementia were more likely to present with index episode of mental illness and receive outpatient care

Conclusion: The elders were managed for a wide range of treatable mental illnesses and other comorbidities andcommute for hours to access care. Pharmacotherapy was the preponderant sole treatment modality. There is needfor sustained development of expertise to enhance multimodal care and scaling up of comprehensive geriatricmental health services. Further research is needed on how to appropriately link and/or integrate geriatric carewith services at all-tiers of health care delivery.

Ackground: Ethiopia is one of the countries that has high burden of all forms of tuberculosis and there is no publishedreport on computerized tomography scan and/or magnetic resonance imaging of intracranial tuberculomas.Objective : to review the clinical, computerized tomography and/or magnetic resonance imaging features of intracranial tuberculoma.

Methods: retrospective review of patient’s medical records of patients operated for intracranial mass that hadcomputerized tomography and/or magnetic resonance imaging brain scans and had histopathological diagnoses,at Tikur Anbessa Specialized Hospital between January 2009 and June 2013.

Results: Of 222 operated cases of intracranial mass subjected to histopathological test 29 (14.6%) were found tohave tuberculomas, 28 (14.1%) had caseous necrosis and one was a tuberculous abscess, in 25 cases imaging wasavailable for review and were included in the study . There were 15 males and 10 females with age range being 2to 65 years and with the Median age being 13 years. Twenty patients had computerized tomography and five patientshad magnetic resonance imaging. Seizure 15/25 (60%) and headache 11/25 (44%) were the commonestpresentation. Solitary or confluent large lesions were seen in 12/25 (48%) of patients. 14/25 (56%) of the lesionshad their size between 2 cm and 5 cm. Majority of the lesions 15/25 (60%) were in the frontal and parietal lobes.The lesions were isodense on CT in 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rimenhancement after intravenous administration of the contrast medium.

Conclusion: Tuberculoma, more frequently, presented with non-specific clinical findings and chronic seizure disorderand comonly occurred in young patients and often seen infratentorialy. It is often complicated with hydrocephalusin the pediatric age group. Computerized tomography scan and/or magnetic resonance imaging featuresare not different from reports from other countries.

Reexpansion pulmonary edema following repair of missed diaphragmatic hernia is very rare .Here reported is a case of bilateral reexpansion pulmonary edema occurring after reconstruction of left sided post traumatic diaphragmatic hernia. The patient was re intubated and ventilated later put on supplemental oxygen via a catheter through the endotracheal tube followed by extubation and non re breather face mask to compensate for hypoxemia. He was given intravenous diuretics and inotropic support. Forty-eight hours after the acute event, the patient recovered with minimal residual hypoxemia. Reexpansion pulmonary edema after repair of missed diaphragmatic hernia is a rare complication with a high mortality rate of up to 20%. It should be considered in cases of hypoxemia following any chest reexpansion procedure. The exact pathophysiology leading to this complication is not clear but it is believed to be permeability pulmonary edema as a result of pulmonary micro vascular damage. Risk factors for reexpansion pulmonary edema should be evaluated and considered prior to insertion of chest tubes. Treatment is supportive and emphasis should be given for preventive measures.

Background: Female genital mutilation is one of the harmful traditional practices among women and girls. Morethan 130 million girls and women live today who have undergone female genital mutilation. In Ethiopia, a highprevalence (74.3% national and 68.5% in Amhara region) has been reported. This study was aimed to identifydeterminant factors of female genital mutilation practices in East Gojjam Zone, Western Amhara, Ethiopia

Methods: community based cross sectional study was conducted among 730 women aged 15-49 years and havingchildren < 5 years old in September, 2014. Data were collected using a pretested interviewer administeredquestionnaire. Descriptive statistics were used to describe study objectives, and bivariate and multivariate analysisto identify determinant factors to female genital mutilation.

Results: 718 women and 805 daughters participated in the study. FGM prevalence was 689 (96%) and 403 (49%)among women and daughters< 5 years of age, respectively. Type1 and type 2 FGMs were common and daughters<1 years of age exhibited 91% female genital mutilation. Daughters' age, parent education level, residence,women circumcision history, culture, health education, frequent health extension workers follow up and participationin anti FGM interventions were risk factors to female genital mutilation practice.

Conclusions: Female genital mutilation practices continues to be a major problem to women and daughter <5years of age in the study area. A number of factors were associated with FGM practices including daughters’ age,parent education level, residence, health education, culture, mothers circumcision history, frequent health extensionsworkers follow up and participation in anti FGM interventions were determinants to higher FGM practices.

Cysts commonly occurring in the neck include thyroglossal cyst and dermoid cysts in the midline, cystic thyroidnodules, branchial cysts and cystic Hygroma in the lateral neck. Hydatid cyst disease is commonly seen in the rightlobe of the liver, the lung and rarely in other parts of the body. In general, cysts in the neck are not common in thesecond decade of life. In this article, we present a case of hydatid cyst presenting as left lateral cystic mass in anEthiopian boy. The diagnostic difficulty, the need for diagnostic suspicion and consideration of hydatid cyst in thedifferential diagnosis and the management options are discussed.