Ethiopian Journal of Health Sciences最新文献

Background: The Circle of Willis (COW) is a vital cerebral arterial network that maintains balanced blood flow in the brain. Despite initial insights from Thomas Willis, recent research has highlighted its complex anatomical variations.

Objective: This study aims to evaluate the anatomical variations of the COW in Ethiopian cadavers.

Methods: We employed a descriptive observational approach on thirty-two cadavers. Detailed morphological examinations of the COW were performed following meticulous dissection at various Ethiopian universities.

Results: Significant anatomical variations were observed, particularly in the anterior divisions of the COW, with 57.14% of cases exhibiting notable differences. Variations in the anterior communicating artery (62.5%) and anterior cerebral artery (37.5%) were particularly diverse. In the posterior segment, 66.6% of anomalies involved unilateral right hypoplastic posterior communicating arteries, and bilateral hypoplastic posterior cerebral arteries were noted in two male cadavers. Essential vessels were present in all specimens.

Conclusion: Comparative analysis with global studies reveals both similarities and differences, highlighting genetic and methodological influences. Recognizing these variations is crucial for diagnosing cerebrovascular diseases and managing intracranial aneurysms. Further longitudinal studies using advanced imaging techniques are recommended to enhance understanding in the Ethiopian population and beyond.

Background: Road traffic injuries (RTIs) are a significant public health and development challenge. This study assessed injury characteristics, severity, and management outcomes of RTI victims at Jimma Medical Center, Jimma, Ethiopia.

Method: A retrospective chart review was conducted on RTI victims treated at the Emergency Department of Jimma Medical Center between September 2021 and June 2022. The World Health Organization's Road traffic injury surveillance tool and the Kampala Trauma Score II (KTS II) were used to evaluate injury severity. Data were entered using EpiData version 3.4 and analyzed with SPSS version 20. Descriptive statistics and cross-tabulations were used in the analysis.

Results: Of the 391 victims included, 270 (69.1%) were male, with a median age of 25 years. Pedestrians (52.9%, n=207) were the most affected group, followed by drivers (17.4%, n=68). Cars accounted for over half of the accidents (52.2%, n=204), while motorcycles were involved in 31.7% (n=124). Musculoskeletal (35.5%) and head injuries (25.6%) were the most common. Severe injuries were reported in 62.2% (n=140) of cases. Fewer than half (44.5%, n=174) of the victims were transported by ambulance, and only 21% (n=82) received first aid from healthcare providers. Most victims (93.5%, n=359) survived, while 6.4% (n=25) died.

Conclusion: RTIs present a considerable burden in this setting with pedestrians mostly affected. Targeted interventions should address road safety, enhance pre-hospital care, and improve medical documentation. A multi-sectoral injury surveillance system and identification of key risk factors are essential for reducing RTI impacts.

Background: SGCE myoclonus dystonia is a rare genetic movement disorder caused by mutations in the SGCE gene. It typically presents in childhood and is characterized by myoclonus and dystonia. The inheritance pattern is autosomal dominant with maternal imprinting. Patients often exhibit associated psychiatric disorders, although cognitive function remains intact. Treatment includes antiseizure medications for myoclonus and anticholinergic agents or botulinum toxin for dystonia. Deep brain stimulation may be used for severe cases.

Case presentation: We present the case of a 2-year-old female who developed dystonia in her lower limbs over eight months, followed by myoclonus affecting her trunk and extremities. She met her developmental milestones and had no family history of similar conditions. Genetic testing revealed a pathogenic variant of the SGCE gene. She showed improvement with clonazepam.

Conclusion: Myoclonus dystonia should be considered in patients presenting with early-onset myoclonus and dystonia. Genetic testing can confirm the diagnosis by identifying SGCE gene mutations. We hope this case increases awareness of SGCE myoclonus dystonia and encourages further research.

Background: Pain is a stressful condition considered a global health problem, with children being the most vulnerable and underserved population. Inadequate management of pediatric postoperative pain (POP) results in increased suffering, morbidity, and mortality, prolonged hospital stays, and higher healthcare costs.

Methods: A longitudinal prospective study design was employed using a structured questionnaire and checklist. The study population consisted of all pediatric patients who underwent surgical procedures and met the inclusion criteria. The consecutive sampling technique was used to enroll participants. Data entry and analyses were conducted using Epidata version 6.0 and Statistical Package for Social Sciences (SPSS) version 20.0. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with the dependent variable.

Results: A total of 154 postoperative pediatric patients participated in the study, yielding a 100% response rate. The mean age was 4.14 ± 4.19 years. The highest prevalence of overall POP and moderate-to-severe POP was observed at 6 hours postoperatively (n=129, 83.7%) and (n=60, 38.9%), respectively. Independent predictors associated with POP included incision size greater than 10 cm (AOR=8.73, 95% CI 1.07-71.02, p=0.043) and surgery duration ≥1 hour (AOR=2.02, 95% CI 1.01-4.03, p=0.045).

Conclusion: The study revealed that the highest prevalence of moderate-to-severe POP occurred 6 hours post-surgery (60, 38.9%). Healthcare providers need to promptly assess and treat POP to reduce its consequences in this population.

Background: The prevalence of hypertension in rural communities remains high despite various preventive measures. Contributing factors to suboptimal hypertension prevention include a lack of positive attitudes, weak social norms, and the adoption of unhealthy behaviors. This study aimed to analyze the factors influencing hypertension prevention behaviors in rural communities of Indonesia.

Methods: A cross-sectional study was conducted among 380 hypertension patients selected through proportional random sampling from three primary health centers with the highest rates of unmet hypertension management in Bondowoso Regency, Indonesia. A self-administered questionnaire was used to collect sociodemographic data. Additional questionnaires were utilized to assess attitudes, subjective norms, perceived behavioral control, intentions, and hypertension prevention behaviors, as developed from the Theory of Planned Behavior (TPB). Blood pressure was measured using a calibrated Omron HBP-1100 sphygmomanometer. Data analysis was performed using Structural Equation Modeling (SEM) with Partial Least Squares (PLS).

Results: The blood pressure classification showed that 60.3% of respondents had stage I systolic hypertension, 72.9% had stage I diastolic hypertension, and 59.2% had abnormal Mean Arterial Pressure (MAP). Internal factors (experience) significantly influenced attitudes, subjective norms, and perceived behavioral control, while external factors (media exposure) only significantly influenced subjective norms. Both attitudes, through intention, and perceived behavioral control, both directly and through intention, significantly influenced hypertension prevention behaviors (p-value < 0.05).

Conclusions: TPB can effectively explain the factors influencing hypertension prevention behaviors in rural areas. Interventions that can strengthen perceived behavioral control through education and social support are essential for improving the effectiveness of hypertension prevention programs in rural communities.

Background: The relationship between angiotensinogen gene variations and other risk factors in ischemic heart disease (IHD) remains unclear, largely due to the complex interplay of genetic and environmental factors. This study aimed to investigate the association of high cholesterol levels, and the angiotensinogen M235T (rs699) gene variant with ischemic heart disease in hypertensive patients.

Methods: A hospital-based case-control study was conducted with 70 hypertensive patients diagnosed with IHD and 70 age- and sex-matched healthy controls. Sociodemographic and clinical data were collected, and blood samples were taken for biochemical and genetic testing. Polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), and agarose gel electrophoresis were used to determine the angiotensinogen M235T genotypes.

Results: The AGT-TT genotype (OR = 3.35, 95% CI = 1.30-6.63; P < 0.05) and T allele (OR = 2.50, 95% CI = 1.51-4.14; P < 0.001) were significantly more frequent in patients than in controls. Furthermore, dyslipidemia was more prevalent in the patient group compared to the controls (OR = 4.57, 95% CI = 1.71-12.18; P = 0.0024).

Conclusion: The AGT M235T TT genotype and T allele are associated with ischemic heart disease in hypertensive patients, which may suggest as a potential biomarker for early detection and prevention. Dyslipidemia was higher in ischemic heart disease patients with hypertension.

Background: Venous thromboembolism (VTE) is a potentially life-threatening and costly complication of hospitalization. In many developing countries, VTE risk assessment at admission is not routinely conducted. This quality improvement project aimed to audit and improve the VTE risk assessment and prophylaxis administration among patients admitted to the Meridian Cardiac Centre in Lagos, Nigeria, over two cycles.

Methods: This was a quality improvement project. The National Institute for Health and Clinical Excellence (NICE) guideline NG89 served as the standard. In the second cycle, the Caprini Risk Assessment Model (RAM) was introduced for assessing VTE risk at admission. The RAM was also retrospectively applied to assess patients' VTE risk categories in both cycles.

Results: No patients were assessed for their VTE risk during the first cycle. By the second cycle, following an educational meeting and the introduction of the Caprini RAM, 56% of patients were assessed for their VTE risk.

Conclusions: VTE risk assessment practices were poor in this facility. Continuous education for medical practitioners and proper documentation of clinical notes will improve the categorization of medical inpatients based on their VTE risk and improve the outcomes of future audits.

Background: This study aimed to examine nurses' burnout and sleep quality during the COVID-19 pandemic.

Methods: A cross-sectional design was employed. Data were collected from 256 nurses working in COVID-19 units between July 2021 and January 2022 using the Nurse Identification Form, the Maslach Burnout Scale (MBS), and the Pittsburgh Sleep Quality Index (PSQI).

Results: Participants had worked in COVID-19 units for an average of 11.41 ± 9.11 months, with 50.6% employed in state hospitals. Significant differences were observed in the emotional exhaustion and depersonalization subscale scores of the MBS based on the type of COVID-19 unit and nurses' work patterns (p < 0.05). A significant positive correlation was found between PSQI scores and emotional exhaustion (p < 0.05).

Conclusion: Nurses who experienced higher emotional exhaustion during the pandemic also reported poorer sleep quality.

We present the case of a 63-year-old male patient with a history of chronic obstructive pulmonary disease (COPD), heavy smoking, and poor dental hygiene, who presented with progressive dyspnea, fever, and a productive cough. The patient was initially evaluated for pneumonia, but a chest radiograph revealed a right-sided pleural effusion. Further analysis of the pleural fluid showed an exudative effusion. Histopathological examination of a pleural biopsy sample identified gram-positive branching filamentous rods with yellow sulfur granules, consistent with a diagnosis of pulmonary actinomycosis. The patient was initially treated with intravenous amoxicillin/sulbactam, later switched to oral amoxicillin. This case highlights a rare clinical presentation of pleural effusion in a patient with pulmonary actinomycosis.

Background: Malaria remains a major public health and economic burden globally, with sub-Saharan Africa (SSA) accounting for over 90% of cases and deaths. Children under five and pregnant women are the most vulnerable. Resistance to artemisinin-based therapies and insecticides has compounded the challenge. This review evaluates malaria mitigation strategies, emphasizing the potential of vaccination, particularly RTS,S/AS01, as a cornerstone for malaria eradication and achievement of Sustainable Development Goal 3 (SDG 3).

Methods: A narrative review approach was adopted. Peer-reviewed literature from 2014 to 2024 was sourced from credible scientific databases, including PubMed, Google Scholar, and ScienceDirect. Selection prioritized studies on malaria control strategies, vaccine trials, efficacy data, implementation frameworks, and health system challenges specific to SSA. The review critically analyzed vaccine trials, community perceptions, and logistical concerns while incorporating the authors' expert perspective.

Results: The RTS,S/AS01 vaccine demonstrated moderate efficacy (30-55%) in preventing malaria in children under five in Ghana, Kenya, and Malawi. Other candidates such as R21/Matrix-M showed up to 77% efficacy in trials. Implementation challenges include limited funding, vaccine hesitancy, poor healthcare infrastructure, and community misconceptions. However, integration with routine immunization, enhanced community engagement, and increased investment in health systems significantly improve vaccine acceptance and impact.

Conclusion: Vaccination represents a promising, cost-effective, and scalable strategy for malaria eradication in SSA. Strengthening healthcare infrastructure, amplifying vaccine acceptance campaigns, and increasing funding for research and vaccine production are pivotal. Malaria vaccination offers a practical and sustainable pathway toward global malaria elimination and the realization of SDG 3 by 2030.