Ethiopian Medical Journal最新文献

Background: Renal diseases are major causes of morbidity and mortality in pediatric practice. Pediatric patientswith renal disease, especially younger ones may present with nonspecific signs and symptoms unrelated to the urinarytract. Unexplained fever or failure to thrive may be the only manifestation. Most children with renal diseasesin our hospital arrive very late either because of inadequate health awareness among the parents or failure of recognizingthe symptoms of renal diseases at a lower health care level. This review will highlight the symptoms ofrenal diseases at presentation and outcomes of treatment in children in a major referral hospital.

Methods: A cross-sectional retrospective chart review was done over a period of 3 years (June, 2012 to May,2015) in 381 admitted children (Birth-17 years) at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa,Ethiopia.

Results: Out of 14521 pediatric ward admissions in the study period, kidney diseases accounted for 473 admissionsin 381 children, accounting for 3.3% of all admissions. The three most common renal diseases observed werecongenital anomalies of the kidney and urinary tract (CAKUT) seen in 127 children (26.8%), followed bynephrotic syndrome in 80 children 16.9% and acute glomerulonephritis in 58 children (12.2%). Other renal diseasesobserved were urinary tract infection 8.0%, urolithiasis 6.7%, Wilm’s tumor 6.3%, acute kidney injury 4.2%and chronic kidney disease 4.0%. Other less frequently detected diseases were bladder exstrophy, lupus nephritis,Henock shonlein Purpura nephritis and prune-belly syndrome.Out of 381 children 207 (54.3%) recovered normal renal function, 20(5.2%) remained with proteinuria, 13(3.4%)progressed to chronic kidney disease and 11(2.9%) died. Sixty one nephrotic children (76.3%) achieved remissionbut 17 children (21.3%) remained with proteinuria; one steroid resistant child died of end stage renal disease. Tenchildren (2.6%) with different renal diseases were lost to follow-up and 5 (1.3%) discharged against medical advice.

Conclusions: This data reflects that many of the renal diseases are preventable or potentially curable. Therefore,improvement of pediatric renal services and training of health workers would help in early detection and treatmentof these conditions leading to reduction in their morbidity and mortality.

Pregnancy is a state of high metabolic demand. Anemia and thrombocytopenia, commonly as a result of the normaldilutional effect of increased plasma volume during pregnancy, are frequently seen in pregnant women but arenot severe enough to require intervention unless aggravated by deficiency of micronutrients. Nutritional deficiencyrelated anemia is often seen in developing countries. In this study, we describe seven cases of severe thrombocytopenia,anemia and leukopenia (pancytopenia) from the same geographic locality and similar clinical presentation.The cases were referred to the Tikur Anbessa Specialized Hospital (TASH) for investigation and treatment. Potentialcauses, methods of prevention and treatment options are discussed along with relevant clinical and laboratoryfindings of the cases.

Kartagener's syndrome is a rare autosomal recessive genetic disorder that causes a defect in the action of the cilia lining the respiratory tract. Patients usually present with chronic recurrent rhinosinusitis, otitis media, pneumonia, and bronchiectasis caused by Pseudomonas infection. In this case report, we present a 12-year old female with Kartagener's syndrome from Tikur Anbessa Teaching Hospital which to our knowledge is the first of it's kind to be reported in Ethiopia. The clinical and imaging findings are discussed.

Background: Valvular heart disease has been a significant cause of heart disease worldwide. In Ethiopia, it particularly affects young individuals and constitutes the major cause of cardiovascular disease. Factors associated with choice of treatment for advanced valvular heart disease are variable. The objective of this study is to review surgery done for Ethiopian patients with valvular heart disease.

Methods: We analyzed data on patients who had valve surgery and follow-up at the Tikur Anbessa Specialized Hospital cardiology unit. We collected data on sociodemographic characteristics, the pre-operative status of effected valves and co-morbidities, and assessed their associations with patient management options.

Results: A total of 157 valve surgeries were done from 1983 to 2013. Mean age at time of surgery was 26.7 years and females constituted 66% of the cases. Patients with rheumatic heart disease were younger, more likely to be female and have atrial fibrillation, but less likely to have impaired left ventricular systolic function when compared to patients with non-rheumatic heart disease. More than 75% of the surgical procedures done were mechanical valve replacement. Mechanical valves, compared with bioprosthetic valves, were more likely to be used in patients with rheumatic heart disease. The median age of those receiving mechanical valves, 24 (IQR 22-28) years, was lower than those receiving bioprosthetic valves, 31.5 (IQR 29.9-37.9) years. Mechanical valve replacement was significantly higher in those under the age of 20 years (Adjusted Odds Ratio 41.0, 95% CI: 3.0-557.2) and in those between 20 and 29 years of age (Adjusted Odds Ratio 14.3, 95% CI: 2.3-88.6).

Conclusions: Valve surgery for valvular heart diseases has been more common performed for young and female patients. A great majority of the replacements done have been with mechanical valves. As many of the patients have been younger and female, the choice of valve surgery and the need for anticoagulation impacts subsequent management of rheumatic heart disease and associated morbidities, lifestyle plans and pregnancy.

Background: Tetanus, a disease that is largely preventable, is still a major public health problem in the developing world and is associated with high morbidity and mortality. There is a paucity of published literature on adult (non-neonatal) tetanus in this study area in Nigeria.

Methods: This was a study describing the clinical characteristics of patients who were clinically diagnosed with tetanus in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, northwest of Nigeria between January 2001 and December 2014.

Results: A total of 91 cases were reviewed. The mean patient age was 20 years, and male to female ratio 2.9:1. The majority (88%) of patients were < 40 years old. The mean onset period was 19 days, nearly all patients (96.7%) had generalized tetanus, and the commonest presenting signs were spasm (93.4%) and trimus (78.0%). The most common site of injury was lower limbs (64.8% of cases). The complication rate was 71.4% and case fatality was 48.4%.

Conclusion: Tetanus is still a major public health problem in our setting and affects the younger age group with a high case fatality rate. The incidence of tetanus can be reduced drastically by an effective and sustained immunization program.

Tuberculosis (TB) is a growing public health threat, particularly in the face of the global epidemics of multidrug resistance. Given the limited efficacy of the current TB vaccine and the recent clinical failure of the most advanced new TB vaccine candidate, novel concepts for vaccine design should be explored. Most T cell antigens in the human-adapted Mycobacterium tuberculosis complex (MTBC) are evolutionarily conserved and under strong purifying selection, indicating that host immune responses targeting these antigens might not be protective. By contrast, a few highly variable T cell epitopes have recently been discovered, which could serve as alternative vaccine antigens. Moreover, there is increasing evidence that the human-adapted MTBC has been co-evolving with the human host for a long time. Hence, studying the interaction between bacterial and human genetic diversity might help identify additional targets that could be exploited for TB vaccine development.

Background: Injuries are a neglected health problem in developing countries. Ethiopia has a high incidence of road traffic accidents and trauma constitutes about half of surgical emergencies among patient seen at health facilities. The objective of this study was to determine the pattern of trauma among patient seen at emergency outpatient departments of public hospitals in northern Ethiopia

Methods: Retrospective data on patient seen at the hospitals during a one-year period (January 1, 2013-December 31, 2013) was collected. The source population was all patients who visited the emergency OPD of two public hospitals in Mekelle, Tig ray.

Results: The 16-25 year old age group was the most commonly affected age group, accounting for 38.5% followed by the 26-35 year old group (21.4%) of the cases. Males were more frequently involved than females ((74.3%) vs 25.7%). Eighty-three per cent of the patients were from urban areas. Interpersonal violence (31%), accidental falls (19.2%) and Road Traffic Accidents (RTA) (14.1%) were the most common causes of injury. The Head (33.5%) was the most commonly involved part of the body.

Conclusion: This study indicates a high burden of trauma in the study area and the need for interventions to control the problem. Given the morbidity and mortality associated with trauma, trauma registry system will be beneficial in Tigray and perhaps for the whole country.

Snakebite is an important public health challenge. Venomous snake bites cause significant morbidity and mortality if treatment measures, especially antivenom therapy, are delayed. We did a case series of 27 adult patients admitted after snakebite to the medical wards of Gondar University Hospital (GUH) from September 2013 to August 2014. The age range was from 15 to 74 years. The male to female ratio was 8:1. The majority (25) of patients presented after 12 hours of being bitten. Most of the bites occurred on the legs. Hematologic complications, including prolonged bedside whole blood clotting test, bleeding complications and Disseminated Intravascular Coagulation, were the common complications detected. The case fatality rate was 4/27 (14.8%). Availability of affordable snake specific antivenom is recommended. A large population study is needed to address the burden in Ethiopia.

Background: Appendiceal mass is one of the complications of acute appendicitis. The management of patients with appendiceal mass is controversial and different treatment options have been suggested.

Objective: The objective of this study was to assess the results of conservative management of patients with appendiceal mass followed by interval appendicecomy.

Methods: The study was a retrospective analysis of 73 medical records of patients with appendiceal mass who were managed conservatively between March 2007 and February 2014.

Results: Fifty patients were males and 23 patients were females making the male to female ratio of 2.2:1. The mean age was 29.6 ± 6.3 years (range 12-68 years). The maximum incidence was in the 3rd decade. Forty one (55.8%) of the patients presented one week or more after the onset of their illness. Abdominal pain, right lower quadrant (RLQ) direct and rebound tenderness were observed in all patients. Mass was detected in the RLQ in 84.9% of the patients. Sixty five patients (89%) responded to conservative treatment and these patients were discharged after a mean hospital stay of 6.5 1.5 days (range 3-12 days). Interval appendicectomy was done for 58 patients 8-16 weeks after successful conservative management. The mean hospital stay after interval appendicectomy was 3.5 ± 0.5 days with a range of 2-5 days. One patient (1.7%) had a wound infection. There were no deaths.

Conclusion: Initial non-operative management of appendiceal mass was successful in most cases and the complication rate after interval appendicecomy seems lower than with early operative treatment.