Introduction: Pulmonary hypertension (PH) is a rare disease and when associated with pregnancycan be devastating. In the developed world, maternal mortality from PH has decreased from 56% in the 1970s to 16% as of 2014. In the developing world, there are still many challenges in the management of these cases.

Objective: to review the management of such patients in a resource limited setting from September 2016 to September 2017.

Methods: Cases with severe PH were identified from high risk antenatal care follow up, cardiology clinic and wards. Severity and type of pulmonary hypertension, NYHA functional status, mode of delivery and anesthesia as well as neonatal and maternal outcomes were noted.

Results:21 cases of severe PH were reviewed.Seventeen of the patients had Rheumatic Heart Disease (RHD)(Group 2 PH, with average Mital Valve Area (MVA) of 0.9sqcm), 1 had pure congenital heart defect (CHD)/Membranous Ventricular Septal Defect (VSD)(Group 1 PH) and 3 had both CHD and RHD.The average pulmonary arterial pressure as measured on Echocardiography was 102.9 mmHg (SD 16.9).Fourteen of the patients had NYHA functional class III or more (66.7%), 10 patients underwent cesarean deliveries, 5 underwent vaginal deliveries with assisted second stage. Twopatients underwent termination of pregnancy at 16 &19 weeks and are alive.There were 4maternal deaths (19.1%) with a mean age at death of 28 years(SD 5.3). 76.2% of pregnancies resulted in live birth.

Key words: pulmonary hypertension, pregnancy, anesthesia

Intravenous urography has been the imaging modality of choice for long due to its good special resolution and excellent anatomic details of the collecting system of the kidney. Due to the introduction of cross-sectional imaging, the use of IVU as the modality to look for collecting system diseases have been challenged. Despite all the developments in imaging, IVU still is used in the work up of some collecting system diseases. However, despite current consensus there is still a strong tendency among physicians to refer patients to radiology units for IVU evaluation for lots of indications which are now obsolete.  This study was conducted with the objective of assess the pattern of utilization of IVU at Black lion hospital and to identify the most frequent indications for different age groups.

A total of 253 cases were included in this study prospectively and the commonest indications for IVU were renal stones (36.8%) and hydronephrosis. Hematuria was the indication in 5 (2.0%) patients. About 23.7% had normal finding on IVU.

Most of the indication at the place where this study was done were unjustified and would have been avoided particularly the induction for pediatric patients were obsolete. So the indication for IVU should adhere the international current standards and should be cautiously used in pediatric patients.

Background: Within the aging population, coexisting of glaucoma and cataract is frequent. The treatment of either condition can influence the course of the other. Cataract extraction, glaucoma filtration surgery or combined procedures are the management options. The choice of procedure depends on the level of visual impairment, severity of glaucoma, level of intraocular pressure and other factors.

Objective: The study was aimed at assessing the outcome of combined manual small incision cataract surgery and trabeculectomy in lowering intraocular pressure and restoration of vision.

Methods and Patients: A retrospective chart review of one year follow-up of patients who under went combined manual small incision cataract surgery and trabeculectomy at Menelik II Hospital.

Results: Forty-nine eyes of 43 patients were included in the study. Pre-operative intraocular pressure decreased from mean 27.04 mmHg to 13.41 mmHg at 12 months postoperative follow-up, with mean reduction of 13.63 mmHg.  Hypotensive medication was not required in 71.4% of the operated eyes. Visual acuity, which was less than 6/18 in all eyes on Snellen chart improved to greater than 6/18 in 35 eyes, 71.4%.

Conclusion: Combined manual small incision cataract surgery and trabeculectomy is effective in terms of IOP control and vision restoration in treating patients with coexisting cataract and glaucoma.

Recommendation:  The procedure is doable and cost effective for eye care professionals who handle glaucoma patients and practicing manual small incision cataract surgery.

Key words: Cataract, Glaucoma, Manual small incision cataract surgery and trabeculectomy.

Aim/Purpose

In Ethiopia data concerning the influence of gender on mortality and loss to follow-up are controversial. Our study is intended to further investigate gender-related differences in antiretroviral therapy (ART) outcomes in Tigray (Ethiopia).

Methods

We used data from the “Cohort of African people Starting Antiretroviral therapy’ (CASA) project, a prospective study of a cohort of HIV-positive patients who started ART in Tigray. The study population included HIV-positive patients starting ART between January 2013 and December 2015. Baseline characteristics were compared between men and women using Kruskal Wallis t-test and Chi-squared test. Kaplan-Meier method was used to estimate the probability of mortality and loss to follow-up for men and women. Univariate and multivariate Cox Proportional Hazards models were used to compare differences in ART outcomes by gender.

Results

The study population included 1622 patients, 1003 (61.84%) women and 619 (38.16) men. Median follow-up time was 2.6 years and 2.1 years, respectively for women and men. In the multivariate analysis men had a significantly higher risk of loss to follow-up than women (aHR 2.83, 95% CI: 2.00-4.01); but no significant sex differences in mortality was observed (aHR 1.19, 95% CI: 0.76-1.84).

Conclusions

Findings showed gender-related differences in loss to follow-up, not in mortality. Several structural and social factors may influence the gender difference in loss to follow-up. However, specific investigations are needed to get a better understanding of the reasons why men are more likely to be lost to follow-up than women and programmes with a gender-oriented approach should be implemented.

Background: Children develop distinct surgical conditions, present unique anesthetics challenges and have special preoperative need. Childhood surgical diseases are as common in the developing world as they are in developed countries. To date there has been limited data published on pediatrics surgery in SSA. In Ethiopia, as in other Sub-Saharan Africa countries, there is insufficient data on pediatric surgical conditions.

Methods: This was a retrospective study of pediatrics surgical patients (< 13yrs.) who had undergone surgery in Tikur Anbessa Specialized Hospital(TASH) between September 1, 2012 and August 31, 2017.

Results: 4538 pediatrics patients were admitted and had procedures. Age of the patients’ ranges from 12 hours to 13 years with median age of 28.00 months. Out of this neonates accounts for 734 (16.2%), infants were 808(17.8%), 1-5 years 1741(38.4%) and above age of 5 is 1255(27.7%).

M: F ratio, 2.18:1. Out of all cases 2737(60.3%) were emergency and 1801(39.7%) were elective cases. Congenital conditions were the leading indication for admission and procedure. It accounts for 2158 (47.6%) followed by trauma which accounts for 970 (21.4%). Ingested foreign body accounts for 10% of admissions while foreign body aspiration accounts for 7.9% of all surgical admissions.

Conclusion: In this study we found that congenital anomalies are still the most common group of pediatrics condition that requires surgery in our setting.  There is significant increase in number of foreign body ingestions and aspirations compared to previous studies.

Key words: Pediatric surgery, Admissions, Procedures, Ethiopia

Abstract

Background: Pre conceptional care(PCC) is a general care provided to those planning pregnancy with goal of making future pregnancy and delivery safe. The aim of the study is to assess knowledge, attitude and practice of physicians in Tikur anbesa Specialized hospital(TASH) about PCC with the view of providing recommendations to optimize the uptake and delivery of the service.

Method: A descriptive cross sectional study was conducted among 156 internal medicine and obstetrics and gynecology(Ob-Gyn) residents of TASH and data was analyzed.

Result: Among the respondents 69.2% had good, 26.9% had moderate and 3.8% had poor knowledge about PCC. Ob-Gyn residents had significantly better knowledge about PCC than internal medicine residents. Of all the respondents 48.5% had positive, 43.8% had intermediate and only 7.7% had negative attitude towards PCC. Only 19.2% of them had good practice scores, whereas 42.3% had moderate and 38.5% had poor PCC practice scores.

Conclusion: Even though most residents had good knowledge and favorable attitude about PCC, the practice was poor. Efforts should be made by the concerned bodies to improve the practice of PCC through preparation of standardized program and guidelines to improve the practice.

Key words:  pre conceptional care, KAP, Ethiopia

Introduction: Dramatic increase in the number of mothers referred to Tikur Anbassa Specialized Hospital (TASH) from Eastern Shoa and Arsi zones of Oromia region of Ethiopia, with problems of severe anemia and thrombocytopenia, has been observed.. Further investigation in TASH revealed features of megaloblastic bone marrow changes. The aim of the study was to identify potential risk factors associated with the disease.

Methods: A case control study was conducted on 50 cases and 156 controls from mothers attending ANC in Adama and Assala Hospitals. .

Result: Cases were more exposed to fertilizers (AOR 7.3, 95% CI 3.6-15) and pesticides (AOR 6.2, 95% CI 2.8-13.5) than controls although specific chemicals were not identified in this study. Increased adverse maternal outcomes, including maternal deaths and perinatal mortality were observed among cases than controls.

Conclusion and recommendation:. Cases are more frequently exposed to pesticides and fertilizers and also have poor outcome compared to controls. This calls for further large scale study to explore potential environmental exposures, including those identified in this study and to further unravel the cause of this fatal and significant public health problem in this highly populated and industrial region of the country.

Key words: Hematological disorders during pregnancy, Risk factors, Megaloblastic anemia.

Background: - Breast cancer is the most common cancers in women worldwide. And its incidence has been increasing throughout the world. In our country the exact figures of breast cancer are not known and this study, will try to demonstrate the prevalence of breast cancer in JUMC, which is the sole pathology service provider in south-west Ethiopia serving over 15 million people

Methods and materials: - A record of a total number of patients who have undergone FNAC over the past five years from September 2013- July 2018 for a breast complaint were taken as the study population. And the information was collected by trained data collectors using a structured data collecting guide. Data was compiled and analyzed using SPSS V.22 software and presented using tables and figures.             

  Result: - Total of 698 patients had undergone FNAC for breast complaints during the study, period. Out of the 683 cases included in the study there were 598(89%) females and 75(11%) males. The age of the participants ranged from 8 to 80 years with a mean age of 32 and SD ± 13 years. In the study there were 73(10.7%) malignant cases.

 Conclusion: the study shows that there is an increasing trend of breast cancer in the study area and female in the 6^th and 7^th decade have the highest rates of breast cancer. Patients with breast cancer wait a significant amount of time before seeking health care and more than half of the cases come with features of locally advanced cancer.