Vol 53, No 1 (2015): January Issue
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Original Article
Objective: Medical and neurologic complications of acute stroke adversely impact patient outcome and in some cases can be preventable. There is scarcity of data in the African medical setup and none to date in our country to our knowledge. The current study aims to describe types and frequencies of neuro-medical complications occurring in hospitalized patients after an acute stroke and to identify risk factors for development of these complications and the role of these factors on mortality.
Methods: A total of 71 patients with acute stroke (excluding Sub-arachnoid Hemorrhage) who were admitted to three hospitals in Addis Ababa from June 2008 to March 2009 were included in the study. These patients were prospectively followed until their discharge or death to look for the nature and frequency of neuro-medical complications. Basic demographic data, stroke related medical information, pre-existing medical conditions, admission laboratory and imaging findings were recorded. All events were documented for each patient using pre-defined medical complication using a data collection format. Descriptive and analytic statistical tests were performed to measure associations between risk and outcome factors.
Results: Stroke-complications were detected in 71.8% (51/71) of the study participants and the most frequent complication was aspiration pneumonia which occurred in 33.8% (24/71). Miscellaneous complications such as sepsis, hypokalemia exposure keratitiswere detected in 25% (17/71) of stroke patients. Complications were more common in patients with severe neurologic deficit as measured by Glasgow coma scale (GSC) and old age. GCS < 12 and age > 40 years were both significantly associated with developments of complications after stroke (p< 0.05). A total of 17 (23%) patients died during their in-patient stay. GCS <12 was significantly associated with mortality related to stroke in the admitted patients (p=0.0002) while there was no association between old age and mortality.
Conclusions: Complications after stroke are common and are major factors contributing to mortality. Being aware of the types of common complications and associated risk factors helps the clinical team involved in the care of stroke patients to make preparations and plans for the best possible care and to take preventive measures that will save a lot of lives with best possible use of meager resources available such as educating the population to avoid oral feeding for patients with altered mental state and physicians to evaluate gag reflex bedside swallowing test and proper positioning of patients to avoid aspiration pneumonia. GSC measurement at admission is an important predictor of complications and death following stroke.
Key words: Stroke, Complications, Neuro-medical, Inpatient, Ethiopia
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Background: The term acute abdomen denotes any sudden spontaneous non traumatic disorder whose main manifestation is in the abdominal area. It is one of the most commonly encountered emergencies in the practice of general surgery but there is no much study regarding the magnitude and pattern in Ethiopia and in the study area in particular.
Objective: The study was aimed at assessing the causes, pattern and outcomes of surgical regimen of acute abdomen in the study area.
Methods: This is a descriptive retrospective study conducted in all adult patients with acute abdomen admitted in Mekelle hospital from Sept, 2008 to August, 2010. Patient demographics, clinical features, white cell count levels, operative findings and outcomes were adequately recorded. Adequate recording has been maintained in the hospital. The source and the study groups (N-299) were patients of adult age categories.
Results: A total of 2628 surgical procedures were performed during the study period. Of these, 299 cases were surgical emergency conditions for acute abdomen accounting for (11.4%) of all surgeries. During the study period, there were 989 adult surgical emergency procedures of which 299 (30.2%) cases were laparotomies for acute abdomen. The age ranged from 15 years to 95 years (mean=31.5years). The male to female ratio was (M: F; 4.1:1). In this series, the most common symptoms were abdominal pain, vomiting and abdominal distention accounting for 299 (100.0%), 149 (49.8%) and 38 (16.4%) respectively. The frequent clinical signs were tenderness, localized guarding and rebound tenderness accounting for 287 (96.0%), 269 (90.0%) and 139 (46.4%) respectively. Acute abdomen was most common between 20-29 years of age at a rate of 96 (32.1%) with male 74 (24.7%) preponderance. Acute appendicitis was the leading cause of acute abdomen accounting for 159 (53.2%) followed by small bowel obstruction 48 (16.0%), sigmoid volvulus 38 (12.7%) and PPUD 13 (4.3%). Of the surgically treated patients for acute abdomen 92 (30.8%) had post-operative complications other than deaths. The three commonest immediate post-operative complications observed were wound infection (19.7%), pneumonia (9.0%) and sepsis (2.0%). In this series, there were 19 deaths giving an overall mortality rate of (6.4%). The low rate of mortality observed in study may be attributed to early presentation, early diagnosis and prompt surgical interventions.
Conclusion: The present study has depicted that acute abdomen commonly occurred in the 2ndto 3rddecades of life, majority caused by acute appendicitis and males were predominantly affected than females. Small bowel obstruction, sigmoid volvulus, PPUD and incarcerated hernias were other observed causes of acute abdomen.
Key words: Acute Abdomen, cause, Adults, Mekelle.
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