Vol 57, No 4 (2019): EMJ October 2019 Issue

Prevalence and patterns of Cardiovascular Diseases among Pregnant Mothers Attending Antenatal care at Saint Paul’s Hospital Millennium Medical College, Addis Ababa

Dawit Bacha (MD)[1], Hailu Abera (MD)¹ , Abdusamed Adem (MD)^{1 ,} , Filagot Tadesse(MD)[2], Delayehu Bekele (MD, MPH)²

Abstract

Back ground:  Cardiovascular disease (CVD) is one of the leading causes of non-obstetric maternal death during pregnancy. There are limited number of studies done to assess the prevalence of CVD during pregnancy in our set up.

Objectives: To describe the prevalence and patterns of cardiovascular diseases among pregnant women attending ANC follow up at St Paul’s hospital

Methods: A total of 398 pregnant mothers who were on follow up at ANC clinic were randomly selected for clinical and echocardiographic evaluation in their 3^rd trimester of pregnancy. Standard echocardiography was done for all of them by using GE Vivid E9 echocardiography machine.

Results: In general 10.3% (n=41) pregnant mothers had cardiovascular disease with clinical evaluation and echocardiography. Thirty-three (8.3 %) of the mothers have at least one echocardiographic abnormality out of which 2.3% (n=9) had significant rheumatic valvular heart disease.  Four (1.0%) of the mothers have moderate-severe pulmonary hypertension.

Conclusion: The study revealed a fairly high prevalence of rheumatic heart disease among pregnant mothers in our set up. Primary care providers of pregnant mothers at ANC should be vigilant in their clinical evaluation to detect such problems in a timely manner.

Background: Surgical removal of third molar is most common surgical procedures carried out in oral and maxillofacial surgery and is quite stressful for many patients. Surgical removal of third molar results in an intense inflammatory response that consists of edema, erythema, pain, warmth and loss of function

Objective: objective is to evaluate the efficacy of submucosally infiltrated dexamethasone in reducing inflammatory sequelae following surgical removal of lower third molar and its comparison with that of control group.

Methods: This study was conducted on 80 patients having mesio-angularly impaced mandibular third molars as an outpatient procedure in the Department of Oral Maxillofacial Surgery, they were randomly divided into two groups, each group of 40 patients. One group of patients were administered 8mg dexamethasone submucosally 5 mins prior to the surgery after achieving local anesthesia which was called as group A. Other group of patients received normal saline submucosally 5mins prior to the surgery called as group B. Swelling, pain and trismus were measured on the first, third and the seventh post-operative days.

 Results: results of this study revealed that inj dexamethasone administered submucosally was effective in controlling post-operative swelling and mouth opening.

 Conclusion: Submucosal route of dexamethasone is quite simple, cost effective, less invasive, painless, convenient to surgeon and the patient in minimizing the post-operative sequellae and discomfort associated with the surgical removal of impacted lower third molars.

Key Words: Dexamethasone, Submucosal, Pain, Swelling, Trismus and Third molar

Abstract

Background: Public universities in Ethiopia are the only available training institutions for post graduate medical education. Have inadequate resources to satisfy patients and post-graduate students; circumstances which impact educational outcomes. As a first step to informed reform, we applied the Post Graduate Hospital Education Environment (PHEEM) survey tool to identify the weaknesses and strengths of the clinical learning environment.

Objectives: To assess the post graduate clinical education environment of Internal medicine, Pediatrics, Surgery, Obstetrics and Gynecology in Tikur Anbessa Specialized Teaching Hospital.

Methods: This cross sectional study was conducted from April 1-30, 2016 using the English version of the PHEEM tool.

Results: Out of 363 residents 218 residents (60.06%) completed the questionnaire; 152 males (71.7%), and 60 females (28.3%), with 89 residents in year one (42%), 64 residents in year 2 (30.2%), 38 year 3 (17.9%) and 20 were in year 4 (20%)). Twenty-two items were rated as poor with a score of less than 2. The overall score on the three domains of PHEEM was 76.8/160, indicating significant perceived problems with the clinical learning environment, including a statistically significant difference among genders, year of residency and department of residency in the perception of the learning environment within each department with p < 0.05, p =0.002, p < 0.001 respectively.

Conclusion and recommendations: Improving the quality of duty rooms, more supervision during working hours, reducing the work load, providing better orientation of junior doctors among other reforms may improve residency.  

Background: Computed tomography (CT) is a major source of ionizing radiation exposure in medical diagnostic imaging. Compared to adults, children are supposed to be more susceptible to radiation risks than adults. Despite these, as of many literatures, referring physician’s knowledge of pediatric CT doses and possible risks incurred following the procedure is in adequate. Hence the objective of this work is to assess the awareness of pediatric residents and medical interns about pediatric CT dose and possible risks..
Methods: A cross-sectional study was conducted on May/ 2016 among year I to year III pediatric residents and 2015/2016 year medical interns attaching pediatrics department during study period in Tikur Anbessa Specialized Referral and Teaching Hospital. Data was collected by distributing standardized structured questionnaires. Finally, after the data was checked for clarity and completeness it was analyzed by using SPSS software .
Result: While the majority (76.3%) of the residents and interns knew that children were more sensitive to radiation than adults, 93.7% did not know that there is currently no annual dose limit set for medical exposure of patients. The majority of the respondents (81.3%) know the risk of cancer from CT scan, but most (60%) of the respondents did not know that many imaging facilities still use adult doses for pediatric patients. Furthermore 18.8% thought that magnetic resonance imaging involves ionizing radiation and 8.9% of the physicians associated ultrasound examinations with ionizing radiation. Within resident group, the level of clinical experience did not affect the outcome.

Abstract

Background: Head trauma is a major part of public health problem worldwide particularly in the young. Computerized tomography is the recommended first line imaging modality. The aim of this first phase thematic study was to document the CT pattern of head injuries on patients scanned at Tikur Anbessa Specialized Teaching Hospital and correlate with the mechanism of injury.

Materials and Methods: This cross-sectional prospective descriptive study included 348 patients with head injury imaged with CT at TASH, from March 2016 to August 2016. CT findings and clinical information were recorded and analyzed and correlated with the mechanism of injury.

Results: Males were more involved, 275(79%) with a male to female ratio of 3.8:1. The age range 20-39 years was the most frequently affected group, (44). RTA was the most frequent etiologic factor 117(55%), followed by assault 63(29.7%), and fall accident 31(14.6 %). Fall accident was the second frequent cause of injury in the pediatric age < 10 years while RTA was the leading one. Skull fracture was the commonest finding 172(49.4%), followed by brain contusion, 105(30.2 %) then epidural hematoma 56(16.1%). Mixed type of injuries were recorded in 158(45.4%) of cases.

Conclusion-This study has demonstrated that the most commonly affected groups in head injury are young males, the most frequent cause being RTA, also in the very young. High proportion of patients had CT findings. Appropriate clinical information is crucial for planning evaluation. The study reinforces the necessity of expanding CT service and concerted effort to reduced RTA.

ABSTRACT

          Background

                In forensic practice as well as in football players, there is a growing need for accurate methods of age estimation.

 Age can be estimated through somatic features that are universally considered associated with chronological age. Unfortunately these features do not always coincide with the real chronological age for these reasons that age determination is often very difficult.

Our aim is to evaluate accuracy of skeletal age estimation using Tomei’s MRI method in subjects 12-19 yrs old.

Method

       MRI images of the left wrist of 90 females and 86 males, without chronic disease or developmental disorders, among adolescents aged  12 to 19years were analyzed.

      A 1.5Tesla MRI scanner was used for the study. 

      Skeletal maturation was determined by the principal Investigator in blinded fashion to the chronological age using Tomei’s MRI atlas.

 Bland-Altman plots were used to determine mean differences between skeletal and chronological age.

Results

     Bland –Altman analysis demonstrated that the differences between chronological and skeletal age are not significant.

Spearman’s correlation coefficient showed good correlation between skeletal and chronological age both in females(spearman’s rho=0.952) and in males(spearman’s rho=0.955)

Pearson’s coefficient also showed a good linear correlation for (females=0.955 and for males=0.951).

Conclusions

Our result showed that MRI skeletal age has good correlation with chronological age and the Tomei’s MRI atlas method may assume an important role in forensic age estimation, as MRI does not use ionizing radiation and is fundamentally more accurate than x-ray due to its high contrast resolution.

Keywords:- Age estimation, MRI, forensic.

Abstract

Background: Developmental dysplasia of the hip is a congenitalanomaly. Clinical assessment is not effective and efficient as assumed previously, and the role of ultrasound imaging has increased over time and is now employed for screening of neonates. The local literature lacks information. The purpose of this article is to do a preliminary ultrasound assessment of itsstatusamong infants.

Methods: A cross-sectional study was conducted in the pediatric unit of the Department of Radiology at TikurAnbessa Specialized Teaching Hospital from August 2018- to February 2019.Participants were selected based on recommended age (4-24 weeks) Hipultrasound was performedusing the Graf static method to measure alpha and beta angles of both hips and measurements were grouped according to the Graf classification. Mean values of alpha and beta angles of both hipsidesand types were analyzed. Independent sample T test was used for analysis where appropriate.

Result:Over the specified period, 65 neonates within the age group 4-24 weekswere scanned. 40(61.5%) were males and 25 (38.5%) females.Graf type II (immature and dysplastic) hips comprised 4.61% for the right hip and 10.7% for the left in males and 4.61% each for both hips in females).Type IV(dislocated) hips comprised 4.61% for the right hip and 1.5% for the left in males and was not identified in females.

Conclusion:The proportion of abnormal hips identified in the study warrants the need for a much larger and more comprehensive study and the use of ultrasound for a wider clinical application or a potential screening strategy is recommended.

Key Words: developmental hip dysplasia, Ultrasound, hip angles