Ethiopian Medical Journal

Clinical Diagnosis of Wiskott–Aldrich Syndrome Without Molecular Testing: Two Pediatric Cases from Ethiopia

Zelalem Yimam, Iman Mohammed, Tinsae Alemayehu — Mon, 17 Nov 2025 00:00:00 +0000

Wiskott-Aldrich syndrome is an uncommon X-linked recessive disorder characterized by a triad of symptoms: micro thrombocytopenia/bleeding, eczema, and recurrent infections. This syndrome presents diagnostic challenges due to its diverse clinical manifestations and limited diagnostic capabilities in resource-constrained settings. The report highlights two cases exhibiting similar triad symptoms, albeit with varying degrees of organ-specific expressions and severity. The diagnosis was made by leveraging clinical syndrome as a basis for heightened suspicion, coupled with clinical diagnostic criteria. Thus, prompt identification in low-resource settings can be achieved by combining a high index of suspicion with the diagnostic criteria in male children exhibiting the clinical syndrome.

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, Dr. Abraham Genetu — Mon, 30 Jun 2025 00:00:00 +0000

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.

Sigmoid diverticulitis complicated with anterior abdominal wall necrotizing fasciitis: rare but potentially lethal

Shong Sheng Tan, Muhammad Akmal Sallahuddin, Kyi Kyi Win — Mon, 17 Nov 2025 00:00:00 +0000

Necrotizing fasciitis (NF) is a perilous infection of the soft tissue, typical for its profound impact on morbidity and mortality rates. We present a 70-year-old man with an unusual anterior abdominal wall necrotizing fasciitis secondary to perforated sigmoid diverticulitis in septic shock. He had undergone wound debridement and proximal fecal diversion for source control, followed by serial wound debridement in view of worsening sepsis and local wound inflammation. Despite multidisciplinary management in our patient with aggressive treatment strategies, he succumbed to death. This demonstrates high mortality rate in case of perforated sigmoid diverticulitis complicated with anterior abdominal wall necrotizing fasciitis.

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

Mon, 30 Jun 2025 00:00:00 +0000

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, II. Siti Rahmah Binti Hashim Isa Merican — Fri, 29 Aug 2025 00:00:00 +0000

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.

Optimal Breastfeeding Practice and Associated Factors Among Employee Mothers in Central Tigray, Northern Ethiopia

Yemane Leake, Zemichael weldegebrial, Negassie Berhe, Hagazi — Mon, 07 Apr 2025 00:00:00 +0000

Background: Breastfeeding has significant short- and long-term medical and neurodevelopmental advantages. It is the most widely recognized and effective intervention for preventing early childhood deaths. However, there is limited evidence regarding optimal breastfeeding practices among employed mothers in Tigray specifically and Ethiopia more generally. Therefore, this study was conducted to estimate optimal breastfeeding practices and associated factors among employed mothers working in public institutions in Aksum town.

Methods: A cross-sectional study design was conducted among employed mothers in public institutions of Aksum town from May 1 to 30, 2018. A structured questionnaire was administered to collect data, which was then coded, cleaned, entered, and analyzed using Statistical Product and Service Solutions (SPSS) version 21. Results were presented using tables and charts. Descriptive statistics such as percentages, means, and standard deviations (SD) were computed. Binary and multiple logistic regression models examined associations between dependent and independent variables. Associations were considered statistically significant within a 95% confidence interval and P values less than or equal to 0.05.

Result: A total of 114 participants were included in the analysis. The mean age of the mothers and their children was 28.3(SD ± 4.4) years and 12.2 (SD ± 5.9) months, respectively. The study showed that the overall optimal breastfeeding practice was 54.4%. Teachers and accountants had reduced odds of practicing optimal breastfeeding compared to health professionals (AOR = 0.24, 95% CI: 0.06, 0.99; P = 0.049) and (AOR = 0.17, 95% CI: 0.04, 0.70; P = 0.015), respectively. Additionally, mothers who lacked supervisory support to breastfeed at their workplace had lower odds of optimal breastfeeding practice compared to those supported by supervisors (AOR = 0.17, 95% CI: 0.06, 0.46; P = 0.000).

Conclusion: The breastfeeding practices among employee mothers in our study were low. Factors associated with breastfeeding practices included the mother's occupation and lack of supervisor support at the workplace for breastfeeding.

Prevalence and Associated Risk Factors of Intestinal Parasitic Infections in HIV-infected Individuals at Enchini Hospital, West Shewa Zone of Oromia , Central Ethiopia

Solomon Tesfaye, Bekele Fufa, Damtew Bekele, Zinaye Tekeste, Amir Alelign — Tue, 01 Apr 2025 00:00:00 +0000

Background: Little attention has been given to the prevalence of intestinal parasitic infections (IPIs) among

HIV/AIDS patients in various regions of Ethiopia. This study aimed to determine the prevalence of IPIs and associ

ated risk factors in individuals attending the antiretroviral therapy (ART) unit at Enchini Hospital in Ethiopia.

Methods: A cross-sectional study was conducted in 2020. Wet mount, formol-ether sedimentation, and modified

Ziehl-Neelson techniques were used to examine stool samples collected from 222 HIV/AIDS patients. A pretested

questionnaire was used to collect data on socioeconomic characteristics and risk factors for IPIs.

Results: The overall prevalence of IPIs among HIV/AIDS patients in the study area was 34.2% (76/222) with

95% CI (27.9%-40.5%).The prevalence of IPIs was found to be significantly higher (P<0.001) in pre-ART 46.4%

(51/110) than on-ART 22.3% (25/112). Entameoba histolytica / dispar 28 (12.6%), Cryptosporidium parvum 12

(5.4%) and Isospora belli 9 (4.1%) were the most common IPIs identified in the study. Living in rural areas

(Adjusted odd ratio (AOR)=6.23,95% CI= 1.70-22.67), not taking antiretroviral therapy (AOR=4.14,95% CI=1.49

- 11.35), a monthly income of ≤1500 Ethiopian birr (AOR=32.06, 95% CI=4.76-215.80), the use of river water for

drinking purposes (AOR=18.04, 95% CI=5.05-64.43) and CD4 count <200 cells/

Profile of Specific Cancer Types in Patients Undergoing Curative Radiotherapy: Findings from a One-Year Descriptive Study

Emeshaw Zebene, Dr. Hagos Medhin, Dr. Edom Woldetsadik, Prof. Gurja Woldemichael — Mon, 17 Nov 2025 00:00:00 +0000

Background: The incidence and mortality rates of cancer have risen rapidly worldwide, driven by an aging population, urbanization, sedentary lifestyles, economic development, and increased tobacco and alcohol consumption.

Objective: This study aimed to evaluate the one-year occurrence of cancer and the sociodemographic and clinical features of patients receiving curative radiotherapy at Tikur Anbessa Specialized Hospital.

Methodology: We conducted a cross-sectional descriptive study on cancer patients receiving curative radiotherapy at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, from April 2021 to March 2022. A standardized questionnaire was used to collect sociodemographic and clinical data. Descriptive statistics were analyzed using SPSS version 24, with a significance level set at 0.05.

Results: A total of 64 patients (44 females and 20 males) were analyzed. The majority (42.2%) were aged 45 to 64 years, and 70% resided in urban areas, where a higher incidence of gynecologic cancer was noted. Most patients (78%) had locally advanced cancer, and 84.4% (54) were unaware of their cancer diagnosis. Head and neck cancer was the most prevalent, accounting for 31.3% (20 cases), while cervical cancer was the leading type among women, with 17 cases (38.6%), of which 15.9% (7) were HIV positive.

Conclusion: The findings indicate that head and neck cancer is the most prevalent type of cancer, with cervical cancer as the leading cause among women. Most patients presented at a locally advanced stage, and many lacked awareness of cancer. Awareness-raising initiatives are crucial to enhance public knowledge about cancer, facilitating early detection and treatment.

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

Fri, 29 Aug 2025 00:00:00 +0000

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.

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

Mon, 30 Jun 2025 00:00:00 +0000

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

Mon, 30 Jun 2025 00:00:00 +0000

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

Mon, 30 Jun 2025 00:00:00 +0000

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.

Description of Clinical Trials in Ethiopia: Insights from the WHO International Clinical Trial Registry Platform Database

Shiferaw Tilahun, Dawit Getachew Asefa, Medhin Selamu, Yasmin Jemal Ahmed — Mon, 07 Apr 2025 00:00:00 +0000

Introduction: Over the past few years, there has been a noticeable surge in clinical trials and investments in re-

search worldwide. However, close observation reveals that research activities, especially clinical trials, lag in Ethiopia and Africa. As per the data provided by Clinical Trials.gov, Ethiopia stands at the 8th position in Africa with just 85 registered trials, which is relatively low compared to other countries. The Pan African Clinical Trials Registry (PACTR) Consistently ranked Ethiopia 5th in Africa, with 74 registered trials. In contrast, the Interna- tional Standard Randomized Controlled Trial Number Registry (ISRCTN) has placed Ethiopia in the 9^th position with only 18 registered trials.

Methods: We searched the World Health Organization (WHO)International Clinical Trial Registry Platform for all trials with at least one recruitment center in Ethiopia. The results were exported in XML format, and a descrip- tive rational database was formed.

Result: As of March 3, 2025, 502 trials have been registered in the World Health Organization International Clin- ical Trial Registry Platform. It was found that 41.6% (209) of the trials were registered at Clinicaltrials.gov. Most registered trials completed recruiting; approximately 45.8% (230) and 56.4% (283) of the studies were registered retrospectively. Our update found a shift in the disease focus. Infectious and other disease conditions (including surgical, endocrine, and anesthetic) accounted for more than 50% of the trials. There has been an introduction of pragmatic and other designs. Local investors' involvement in sponsoring trials increased by 10%.

Conclusions: We described the landscape of trials conducted in Ethiopia between January 2017 and March 2025. The number of registered clinical trials tripled compared with the period from 2000 to 2016. Although the country is the second most populous in Africa, it remains underrepresented in the number and diversity of clinical trials available. There is a need for more investment from governmental bodies in clinical research in Ethiopia. Further- more, collaborations are needed to find solutions to the current infectious disease threats faced by the country.

Impact of Pulmonary Rehabilitation in Lung Cancer Patients: A Systematic Review

Jagurothula Bhaskara Rao, Kshitija Bansal — Mon, 07 Apr 2025 00:00:00 +0000

Background: After any surgical intervention for lung cancer, patients experience hypoxemia and reduced gas exchange due to damage to the structure and physiology of the lungs. This can lead to respiratory failure in some patients. Breathing exercises consist of various respiratory techniques which enhance the inhalation and exhalation process in lung cancer patients by enabling them to take deeper breaths and utilize more oxygen. This systematic review aims to evaluate the impact of breathing exercises on lung cancer patients regarding improvements in lung function and pulmonary complications.

Methods: From 2019 to 2024, literature was searched in electronic databases, including Google Scholar, PubMed, and ScienceDirect. The terms "breathing exercises," "lung cancer," and "adults" were used to conduct the literature search and identify relevant studies. The methodological quality of the included studies was evaluated using the Mixed Methods Appraisal Tool (MMAT).

Results: Overall, six studies were included based on the selection criteria for this review. Following the quality assessment, all six studies were reported to be of high quality according to the MMAT. The studies demonstrated the impact of various breathing exercises on improving dyspnea and quality of life (QOL) in patients with lung cancer.

Conclusion: The review highlighted the positive impact of various breathing exercises on physical activity, exercise capacity, respiratory function, dyspnea, short-term recovery quality, cardiorespiratory fitness, quality of life, postoperative complications, psychological symptoms, length of hospital stay, and mortality rate.

Soft Robotics: An Innovative Strategy for Management of Cancer

Anitha Pandi, Vijayashree Priyadharsini Jayaseelan — Mon, 07 Apr 2025 00:00:00 +0000

Not available - perspective

Thrombosis with Thrombocytopenia Syndrome (TTS) Associated with COVID-19 Vaccines: Its Safety, Security and Grave Concerns

Tue, 01 Apr 2025 00:00:00 +0000

The COVID-19 pandemic created public health catastrophes around the globe. On December 11, 2020, the first vaccine (Pfizer-BioNTech COVID-19) was introduced for emergency use authorization (EUA). Since then, there have been several COVID-19 vaccines available for the general public. The World Health Organization (WHO) approved more than thirteen COVID-19 vaccines to be used in different parts of the world. The process of approval of a vaccine to be made available on the market requires rigorous quality control (QC) procedures and GCP compliant clinical trials. Due to the unprecedented mortality arising from COVID-19 infections, the vaccines were authorized for emergency use. Hence, some of the vaccines did not pass through rigorous approval process.. Recently, adverse effects from COVID-19 vaccines have been highlighted in studies, with reports ranging from mild to fatal reactions. In February 2024, AstraZeneca announced that its COVID-19 vaccines (Covishield and Vaxzevria), may induce thrombosis with thrombocytopenia syndrome (TTS) in vaccinated individuals. TTS may lead to internal blood clotting that affects various organs of the body. This can trigger complications such as myocardial infarction leading to cardiac arrest, stroke, acute kidney failure and encephalitis. TTS is rarely reported across the globe, and often fall within a three-month period post-administration of the COVID-19 vaccine. Hence, further study is required to identify the exact mechanism that leads to TTS from COVID-19 vaccines.