Ethiopian Medical Journal

Fractured Tracheostomy tube Aspiration: A Case Report - When the Airway Solution Itself Becomes a Dire Emergency Hundred Miles Away from Bronchoscopy Service.

Demmelash G Nigatu — 2025-06-30

A 55-year-old male patient with squamous cell carcinoma of the larynx on metallic tracheostomy for 4 years came with difficult breathing and stridor after he experienced an outer metallic tube fracture and aspiration to the left main bronchus. A rigid bronchoscopy was done and the broken outer metallic tube was removed. The patient was stabilized and discharged home.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Following Phenytoin Use:

Bethelhem Zerfu — 2025-06-30

Introduction

Drug Reaction with Eosinophilia and Systemic Symptoms syndrome is a rare but potentially life-threatening hypersensitivity reaction, often following the use of anticonvulsants medications like phenytoin. This case report discusses the presentation, diagnosis, and management of a 37-year-old male patient who developed DRESS syndrome after taking phenytoin for seizure disorder.

Discussion

Drug rash with eosinophilia and systemic symptoms syndrome (DRESS) is a potentially life threatening, drug-induced, multi-organ system reaction. The most frequently involved organ is the liver, followed by the kidneys and lungs. Early detection and diagnosis followed by withdrawal of the offending agent is vital to minimize the associated morbidity and mortality.

Key word

DRESS syndrome, Phenytoin, Eosinophilia, Drug-induced hypersensitivity

From Obscurity to Emergence: A Rare Case of Sigmoid Colon Vovulus in Undetected Hirschsprung's Disease in Adult

Muhamad Noor Azrie Taha — 2025-08-29

Background: Hirschsprung Disease (HD) rarely presents in adulthood and is often overlooked due to delayed or missed diagnosis. Adult patients may present with chronic constipation, recurrent obstruction, or acute complications such as volvulus.

Case: We report a 20-year-old woman who presented with acute bowel obstruction and was diagnosed with sigmoid volvulus. She underwent emergency sigmoid colectomy with stoma formation and recovered uneventfully. The stoma was closed six months later, after which she remained well for nearly two years. She subsequently developed recurrent abdominal pain, distension, and constipation. Despite laparoscopic adhesiolysis for presumed adhesive obstruction, her symptoms persisted. Colonoscopy with biopsy confirmed aganglionosis consistent with very short-segment HD. Her course was complicated by Superior Mesenteric Artery syndrome, diagnosed by CT angiography, which resolved with nutritional support. She was scheduled for definitive pull-through surgery following nutritional optimization.

Conclusion: Adult-onset HD is rare and diagnostically challenging. Early suspicion and rectal biopsy in young adults with chronic constipation or recurrent obstruction are crucial to prevent repeated interventions and complications.

Incidence of CKD and Death among Reproductive Age Women with Dialysis Requiring Acute Kidney Injury in Ethiopia: The Role of Obstetric Risk Factors

Ayantu Tesfaye Lemma — 2025-08-29

Background: Obstetric risk factors are major preventable causes of Acute Kidney Injury (AKI) in reproductive-age women. Obstetric-related AKI (ORAKI) significantly increases AKI burden in resource-constrained settings, leading to poor maternal and perinatal outcomes. Hence, understanding the impact of these factors on AKI progression is crucial. This study sought to determine the incidence of chronic kidney disease (CKD) and death, and obstetric risk factors' effect on these outcomes among reproductive-age women with dialysis-requiring AKI at Ethiopia's national renal transplant center.

Methods: A retrospective cohort study was conducted on 127 AKI cases (57 ORAKI and 70 non-ORAKI) who were on dialysis at the center from January 2018 to June 2020. Data characterization and comparison was made using frequencies with percentages, median with interquartile range, chi-square test/ Fischer’s exact test and Mann-Whitney U test. Incidence rate (IR) was measured using person day (PD) observation. A Robust Poisson regression model was used to identify factors that affect AKI progression to CKD and death, with adjusted relative risk (ARR), 95% CIs for ARR, and P-values reported for result interpretation.

Results: The overall IR of CKD was 5.4 per 1000 PD (ORAKI group=0 and non-ORAKI group= 9.7 per 1000 PD) and the overall IR of death was 7.8 per 1000 PD (ORAKI group=5.5 per 1000 PD and non-ORAKI group= 9.7 per 1000 PD). Participants with ORAKI had a 22% lower risk of progression to CKD or death than those with non-ORAKI (ARR=0.78, 95% CI=0.67-0.90, p=0.001).

Conclusions: Although having obstetric related risk factors has been associated with an increased risk of developing AKI, once it occurs, those with ORAKI have a significantly better prognosis than those with non-ORAKI. Continued efforts to prevent AKI in pregnant women and to slow its progression once it has developed are critical for a better maternal and fetal outcome.

The Pattern of Claimed Medicolegal Issues and Challenges Encountered in Handling Cases in the Addis Ababa City Administration (2015 - 2023)

Eyayalem Melese Goshu — 2025-06-30

Background: Medico-legal claims are rising globally often due to malpractice, negligence, and issues surrounding patient safety. In Addis Ababa, the Health Professionals' Ethics Committee has evaluated over 282 cases in the past seven years, yet the patterns of accusations and challenges in handling these cases remain unclear.

Objective: To assess the pattern of claimed medico legal issues and challenges encountered in handling cases in the Addis Ababa City Administration from 2015 to 2023.

Methods: A sequential explanatory mixed-methods approach was used, consisting of a descriptive cross-sectional quantitative study and a phenomenological qualitative study. The quantitative phase involved analysis of 210 medico-legal case records using SPSS version 28, with descriptive statistics and Chi-square tests (P < 0.05) to assess associations. The qualitative phase explored the perspectives of 16 current and former ethics committee members through in-depth interviews, analyzed using Colaizzi’s seven-step method with Atlas.ti version 9.

Results: A total of 210 files were reviewed, with 95% (N=195) originating from residents of Addis Ababa. Among the patients, 121 (58.6%) were admitted with life-threatening emergencies. Of these cases, 66 (31.4%) were related to obstetrics and gynecology, 41 (20%) to general surgery, 32 (15%) to orthopedics and trauma, The committee found that 31.9% (67) of cases involved ethical breaches or malpractice. A chi-square test showed a significant association (p < 0.005) between healthcare ethics violations and factors like patient death, resource shortages, referrals, treatment delays, and communication issues. The qualitative study highlighted five main themes: evidence availability, knowledge gaps, documentation, space availability, and cooperation.

Conclusion: The study reveals that most medico-legal cases involved women and urban residents between the ages of 18 and 45. Major contributing factors included inadequate infrastructure, unethical practices, and substandard procedures frequently observed in private clinics. Obstetrics and gynecology were the most commonly implicated specialties, highlighting the critical role of effective communication. Disciplinary actions primarily involve OBGYN specialists, clinical nurses, and general surgeons, indicating the need for focused training. The majority of disputes arose from delays in diagnosis, treatment, and clinical decision-making. To address these issues, the study recommends proactive risk management, improved communication, ethical guidance, efficient care coordination, continuous professional development, and a stronger commitment to institutional accountability.

Computed Tomographic Characteristics of Abdominal Aortic Aneurysms Cases at Tertiary Hospital in resource limited setup: A Retrospective Analysis

Henok Zeleke Tekilesilasie — 2025-06-30

Background: Abdominal aortic aneurysm (AAA) is a life-threatening vascular condition characterized by an abnormal focal dilation of the abdominal aorta. Due to the high mortality associated with rupture, early detection and intervention are critical. This study aims to determine the CT characteristics of AAA cases and the prevalence of rupture at Tikur Anbessa Specialized Hospital, Ethiopia

Methods: We conducted a retrospective record review from May 1, 2022, to May 1, 2023, analyzing abdominal CT images of 38 patients diagnosed with AAA. Data on aneurysm location, size, morphology, and complications were collected. Descriptive and inferential statistical analyses were employed to explore the associations between these factors and the risk of aneurysm rupture.

Results: Among the 38 cases of AAAs, 33(86.8%) were infra-renal with a median transverse diameter of 57.15 mm (IQR: 48.58 - 77.23). Twenty-five (65.8%) of AAAs were fusiform. Rupture was identified in 13(34.2%) of cases, with 10(26.3%) of cases being contained. Thrombus was observed in 30(78.9%) of AAA cases. Although traditional predictors of rupture, including AAA size, location, morphology, gender, and age, were observed, none reached statistical significance in this analysis. The odds of rupture were 21% lower in males compared to females, but this difference was not statistically significant (OR = 0.791, 95% CI: 0.206, 3.032)

Conclusion: This study identified the clinical presentations and morphologic characteristics of AAAs at presentation in Ethiopia. It also demonstrated that some patients presented with rupture, emphasizing the necessity of early detection and tailored management strategies to reduce rupture risks.

Assessment of Maternal Satisfaction and Associated Factors Regarding Epidural Labor Analgesia at Hemen Medical Center, Addis Ababa, Ethiopia (2023/24): A Facility Based Cross-Sectional Study

Adugna Kassa — 2025-06-30

Abstract

Background: Although labor epidural analgesia is considered the most effective method of pain relief and its use is increasing in Ethiopia, maternal satisfaction with this technique has not been assessed in our country. The growing demand for enhanced healthcare quality underscores the importance of evaluating patient satisfaction. Understanding maternal satisfaction with labor epidural analgesia is crucial, as it provides insights into the quality of care and identifies factors contributing for dissatisfaction.

Objective: The purpose of this study is to determine the level of satisfaction of mothers toward labor epidural and to identify factors associated with it in pregnant mothers who received labor epidural analgesia at Hemen Maternal and Child Health Center.

Methods: A prospective cross-sectional study was conducted on patients who had received epidural analgesia for delivery from May to November, 2023. Data were collected from volunteer mothers who gave birth using labor epidural 1 day after delivery and before they are discharged. A structured self-administered questionnaire was used to collect the data. The level of satisfaction was measured using a 5-point Likert Scale. Descriptive statistics was used to present frequency and percentages, and a logistic regression was conducted to analyze the association between dependent and independent variables.

Results: One hundred and fifty mothers age ranging from18 – 37 years were included in this study. The rate of satisfaction with the Labor epidural analgesia service was 98%. We couldn’t find any association between level of satisfaction and independent variables, mainly due to lack of a sizable comparative group, a small subset of dissatisfied patients (only 2%).

Conclusion: The magnitude of satisfaction with Labor Epidural Analgesia service at Hemen MCH is remarkably high. The use of a customized labor epidural analgesia protocol, developed based on feedback and self-reflections from previous techniques, is a possible reason for the high satisfaction rate.