Abstract

Background: Hyperthyroidism is a common thyroid disorder especially in women. The disorder manifests predominantly as Graves’ disease in iodine-sufficient areas and nodular toxic goiter in iodine-deficient countries. In Ethiopia, the magnitude of the disorder is unknown and its management remains suboptimal.

Objective: The aim of this study was to analyze the pattern and management of patients with hyperthyroidism at the United Vision Medical Services Center (UVMSC), between August 30, 2013 and February 1, 2018.

Patients and Methods: The study was a retrospective analysis of all patients with hyperthyroidism at UVMSC. The data was statistically analyzed using the SPSS package. The results were tabulated and discussed with literature review.

Results: A total of 589 patients were studied. The median age was 40 years; the male to female ratio was 1.0:7.9; and 93% of patients presented with goiter. Majority presented more than two years after the onset of symptoms, in 91% with a toxic nodular goiter. A low thyroid stimulating hormone was noted in 83% of patients and 94% used propylthiouracil. Among 213 patients, 96% underwent a near-total thyroidectomy, in 92% without incident.

Conclusions: The incidence and prevalence of hyperthyroidism is apparently on the increase in Addis Ababa. Hyperthyroidism predominantly affects women and toxic nodular goiter is more common than diffuse goiter and the treatment of choice in experienced hands is near-total thyroidectomy.

Keywords:-Hyperthyroidism, pattern, management, United vision Medical Services, Addis Ababa.

Background: Healthcare workers are contracting infection following accidental needle-stick injuries and splashes with blood and body fluids. In Ethiopia, occupational exposures are often under report and/or not reported at all in many healthcare facilities. This study aims to determine the prevalence and factors associated with needle-stick injuries and splashes with blood and body fluids among healthcare workers in hospitals of southeast Ethiopia.

Methods: A cross-sectional study was conducted from February 1 to March 10, 2018. A total of 404 healthcare workers were included using simple random sampling technique from five hospitals (one primary, three general and one referral hospital). Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were carried out at 95% Confidence Interval (CI) to identify factors.

Results: A total 394 healthcare workers participated in the study. The life time needle stick injury prevalence was 61.2 % (95%CI: 56.1-66.0%) and the last one year prevalence was 38.3 % (95%CI: 33.8-43.1%). Life time and one year prevalence of blood or body fluids splash exposure were 60.2 % (95%CI: 55.6-64.7%) and 44.9% (95%CI: 39.8-50.0) respectively. Needle recapping (AOR= 2.25; 95%CI: 1.26-4.03) and working in surgical and medical wards (AOR=1.85; 95%CI: 1.06-3.21) were factors associated with needle-stick injury and body fluid splashes exposure respectively.

Conclusions: There was a high level of occupational exposures among healthcare workers. Health authorities need to formulate urgent strategies to promote safe practice and occupational safety protocols along with strict adherence to infection prevention principles. 

Background:  Heart failure is a burgeoning problem worldwide, with more than 20 million people affected. This study was done with the aims to determine, etiology, clinical characteristics, management and in hospital outcome of heart failure patients.

Methods : Retrospective patient chart review was conducted at St Paul Hospital Millennium medical college Addis Ababa, Ethiopia .A data of 496 patients admitted with acute heart failure over five years from September 2010 –September 2015 was collected with a pretested data abstraction form and entered and analyzed by SPSS Version 20.

Results: We analyzed medical record of 496 patients admitted with acute heart failure to one of teaching hospital in Ethiopia. The mean age was 47.1±19.4 years, and 57.8% were male. The mean systolic blood pressure  were 107.5±33 mmHg .Rheumatic heart disease (30%) was the most frequent cause of HF. In total 428 of analyzed patients had Echocardiography 136(31.77%)  .ejection fraction  was 40% or less, and ECG result showed atrial fibrillation  in 27.5%. Angiotensin converting enzyme inhibitors , beta-blockers, and spironolactone prescribed 38.9%,27.9%, and 71% respectively at discharge. In-hospital mortality was 24.4%. The median duration of hospitalization was 11 days. CKD as comorbidity, female sex , and high heart rate at admission was predicators of lower in-hospital survival

Conclusions : In our patients acute heart failure affects  young age and associated with high mortality. Our patients are under investigated and treated. We recommend further large scale multi centered prospective study for better characterization of Ethiopian patients with acute heart failure.

Background: Gastrointestinal diseases are important healthcare problems in pediatric age groups across the world. Patients can have diverse clinical manifestations of gastrointestinal problems. Since the inception of pediatric endoscopy in 1970’s, it has been used widely in clinical practice to identify the causes of different upper and lower gastrointestinal complaints and, hence has become standard of care towards diagnosing and treating ( like esophageal band ligation, sclerotherapy, balloon dilatation, polypectomy, biopsy taking, etc) of different pediatric gastrointestinal problems.

Objective: This study assessed the clinical profiles and outcomes of children with gastrointestinal problems, atTikurAnbessa specialized hospital, Addis Ababa, Ethiopia.

Methods:A retrospective-cross-sectional descriptive study was conducted through chart review of all pediatric patients who underwent Esophagogastroduodenoscopy& colonoscopy performed at TASH (TikurAnbessa Specialized Hospital) from September 2013 to January 2017, and data was analyzed using Statistical package for social sciences (SPSS) version 25.0.

Results: In this study, there were 615 patients, male, 340(55.3%) and female, 275(44.7%) for whom endoscopy was done. The commonest indication for gastroscopy was bloody vomiting, 186/420(44.3%) with gastroscopic finding being esophageal varices, 159/420(37.9%), colonoscopic indication was rectal bleeding, 96/195 (49.2%) with findings revealing rectal polyps, 130/195(66.7%).

Conclusions: This study clearly demonstrated that the commonest indication for gastroscopic and colonoscopic procedureswere bloody vomiting and rectal bleeding respectively.Esophageal varices, polyps and IBD (inflammatory bowel disease) were found to be the commonestgastroscopic&colonoscopic findings, indicating that endoscopy is the modality of procedure for diagnosis and treatment of gastrointestinal problems in children.

Abstract

Coronary artery variation/anomaly is defined as a coronary artery with abnormal origin, course, termination or anomalies of intrinsic coronary arterial anatomy. Thorough, sound and complete knowledge of the magnitude of a variant coronary artery is important for correct interpretation of angiography findings mainly during cardiac surgery. The aim of the study was to identify a variant coronary artery among cadaver hearts in Ethiopia. A descriptive, laboratory-based, observational study was conducted. A total of thirty cadaver hearts were obtained from the Department of Anatomy in different medical schools of Ethiopia. The median arteries were identified in 43.3% of the specimens. The myocardial bridge was found in three (10% of the heart) of the median arteries. The presence of myocardial bridge was significantly associated with median artery (p-value <0.05). The conus artery or third coronary artery arose separately from right aortic sinus and nourished the proximal outflow part of the right ventricle in 6.7% of the heart. Mostly (66.7%), the sino-atrial nodal artery was originated from the right coronary artery. The right coronary artery was dominant in 63.3%, while the left coronary artery was dominated in 23.3% and the rest was co-dominant. This study identified important coronary artery variation among Ethiopian ethnic group.

Keywords: Coronary artery, Variation, Cadaver, Heart

Introduction: For several decades minimal access surgery has become the path of preference in the treatment of most surgical diseases of the urinary tract; replacing open surgery. It is a common treatment modality in the developed countries unlike the developing countries. In Ethiopia, retroperitoneoscopic renal cysts decortications was introduced for the first time, by our team.

Objective: To determine the outcome of minimal access urologic surgeries at SPHMMC

Methods: A prospective study was conducted on patients for whom laparoscopic urology surgeries were performed from January 1, 2017 to June 31, 2017 in St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Results: 33 laparascopic urology surgeries were performed in the study period. 20 were renal cysts excision, 11 Nephrectomies and the remaining 2 were Ureterolithotomies. For all procedures there was no significant blood loss (<70ml).  After laparoscopic cystectomy the post-operative hospital stay was 24 hours and all patients started routine work on average of 15 days. After laparoscopic ureterolithotomy the total hospital stay was 48 hours. At the 15^th post OP day both patients started their routine work. After laparoscopic nephrectomy all patients were discharged after 48-hours, and on average at the 21^st day they started their routine work.

Conclusion: Minimally invasive surgery is a safe and effective option, for the treatment of renal cyst, ureterolithiasis and pathologies requiring nephrectomy. It provides a shorter hospital stay, earlier return to work than open surgery.  

Keywords: Retroperitoneoscopy; Renal cyst decortications; Ureterolithotomy; Retroperitoneoscopic Nephrectomy, Hand-assisted transperitoneal laparoscopic nephrectomy

ABSTRACT

Aims/Purposes: Currently colonoscopy has become one of the gold standard investigation modality for many colon and distal ileum pathologies. Its accuracy and success is highly dependent on many amendable factors such as bowel preparation and patient sedation. The quality of colonoscopy service should be measured in any institute regularly.

Objectives: To assess the clinical indications and colonoscopy outcomes among patients seen at St. Paul’s Hospital Millennium Medical College

Method: Institutional based cross-sectional study was conducted among 608 patient. Data of patients who were investigated with colonoscopy at St. Paul’s hospital endoscopy unit from February 1, 2016 – January 31, 2017 E.C. was evaluated.

Results: The mean age of patients in this study was 45.8 years. Analgesia and sedation was not given for 6.1% of patients. Inadequate bowel preparation (22%) was the sole reason for all completely abandoned colonoscopies and it was the single most preventable cause of incomplete colonoscopies. Colonoscopy completion rate was 76%. The commonest colonoscopy finding in this study was haemorrhoidal diseases (29.8%). The diagnostic yield was 72.5%. The only documented complication was post procedure intra luminal bleeding in 2 (0.3%) patients.

Conclusion: There was low polypectomy, colonoscopy completion and bowel preparation rates compared to the standard. The colonoscopy completion rate was lowest for those with inadequate/poor bowel preparation with significant statistical association. The technique of bowel preparation should be revised.

Key words: Colonoscopy, cecal intubation, complete colonoscopy, bowel preparation, colonic polyp

Background: Yellow fever (YF) is a reemerging public health threat in Ethiopia; however, there is limited information on the seroprevalence of Yellow Fever Virus (YFV) in different parts of the country and the sociodemographic factors that may predispose individuals to infection. In this study the seroprevalence and associated risk factors of YFV infection were assessed in Borena district, southern Ethiopia..

Methods: An institution based cross-sectional study was conducted from May to August 2016. A total of 519 consecutive acute febrile patients attending the outpatient departments of Teltelle Health Center, Yabelo and Moyale Hospitals were enrolled. Data on socio-demographic and environmental risk factors were collected using a structured questionnaire. Blood samples were collected from all participants and screened for yellow fever virus exposure using the indirect immunofluorescent assay.

Result: The overall prevalence of anti-YFV IgG and IgM was 12.5% and 7.3% respectively. IgG seropositivity was significantly higher among male subjects compared to females (15.7% and 9.6% respectively, AOR=1.69, 95% CI: 1.01-2.91, p-value=0.04). A relatively higher IgM titer was observed in females compared to males (8.8% and 6.0% respectively) but it did not attain statistical significance (COR=1.51, 95% CI:0.78-2.95, p=0.16) . Furthermore, there was no significant association of IgG and IgM seropositivity by age.

Aim

To assess job satisfaction and turnover intention of physicians and public health officers in government health facilities.

Methods

A national cross-sectional study was conducted in 2014 involving 375 physicians and 127 health officers working in government health facilities selected randomly from the nine regional states and two city administrations. Data were collected using a face-to-face interview. The main variables of interest were satisfaction with job, working and living conditions, intention to leave and factors associated with a decision to leave. In addition to descriptive analysis, multivariable logistic regression analysis was done to identify factors associated with job satisfaction and turnover intention.

Results

Considering everything, only 39.2% of physicians and 48.8% of health officers were satisfied with their job. Moreover, 47.5% of physicians and 61.4% of health officers said they planned to leave their job within one year. Low pay, poor access to higher education, and limited opportunities for promotion were ranked as the three most important reasons for a decision to leave. The odds of job satisfaction was higher among health officers than physicians. It was also higher among respondents who perceived facility management & leadership, salary & benefits, and recognition by the community more favorably. The likelihood of intention to leave was lower among respondents with more positive perception of facility management & leadership and their own living conditions.

Conclusions

The level of dissatisfaction and turnover intention among physicians and health officers is considerable driven largely by poor leadership & management, salary, and living conditions.