Vol 55, No 4 (2017): October issue

Abstract

Background: Both motor and non-motor symptoms (NMS) have an impact on the health-related quality of life (HrQoL) among patients with Parkinson’s disease (PD). Little is known about health-related quality of life (HrQoL) among people with Parkinson’s disease (PD) in Ethiopia.

Objective: To determine the health related quality of life in PD patients seen in the outpatient clinics of TikurAnbessa Specialized Hospital (TASH) and Zewuditu Memorial Hospital, (ZMH) Addis Ababa, Ethiopia.

Methods: All PD patients attending neurology follow up clinic aged 18 years and above at TASH AND ZMH from October 2014 to December 2014 were included in the study. Health-related quality of life was evaluated using PDQ-39 which is a 39 item questionnaire. Motor symptoms severity was evaluated with UPDRS: part 3.

Results: A total of 128 PD patients participated in the study. The mean age of the participants was 59.5 years. Mean duration of illness was 6 years. The mean PDQ 39 SI was 40.5 with 95% CI of (37,44). The PDQ 39 domains with higher scores were ADL, emotional wellbeing, body discomfort and cognition; while profiles such as social support, communication, stigma and mobility showed lowest scores (good QOL).

Conclusion:  HrQOL worsens with increased depression anxiety, and disease severity. Therefore, it is prudent to recognize and assess depressive symptoms and disease severity so we can manage symptoms and patients would have better quality of life.

Key Words- Parkinson’s Disease, PDQ-39, Quality of life in PD. Ethiopia

Background: Chronic liver disease /CLD/ is one of the major causes of admission in hospitals. It has a wide spectrum of presentation, causes and requires organized treatment approaches to reduce the mortality.

Objectives: To assess the prevalence of CLD among medical admissions, clinical presentations, types of management received and hospital outcomes in St. Paul’s Hospital Millennium Medical College.

Materials and Methods: Data was collected retrospectively from January 20, 2009 - September 11, 2014 G.C in admitted patients from medical wards and ICU. Questionnaire was comprised of basic demographic data, clinical symptoms and signs, laboratory results, type of treatment received and hospital outcomes.

Results: The proportion of CLD in the medical wards during the study period was 2.3%. Men comprised 91.5% of admission due to CLD. The most common clinical presentations were abdominal distension and jaundice with 70% and 33.3% prevalence respectively. From viral causes, Hepatitis B virus was diagnosed in 44.4 % and 18% of the causes were due to Hepatitis C Virus; 3 individuals had mixed infection. Patients received only supportive treatment and 41% passed away during their hospital stay and only 28% of were discharged improved.

Conclusions:Chronic liver disease is prevalent in the study and associated with high  mortality. Despite the burden of the disease, at the time of the study, no antiviral or other targeted treatment was provided in the hospital. We recommend further study to assess the cause of the increased mortality and provision of anti-viral and other targeted therapies.

Key words: CLD, HBV, HCV, Hepatocellular Cancer, Ethiopia.

Background: The field of urology has undergone unprecedented advances in the past decades and the remarkable studies surrounding surgery made possible the development of modern urology we practice today.

Objective: The study was aimed at assessing the extent of urologic conditions and the treatment modalities in the study area.

Methods and patients: A retrospective analysis of all patients with urologic conditions was carried out in Mekelle hospital in three years period.

Results: Overall, 623 cases were operative procedures for urologic lesions. BPH, urethral structures and urinary stone diseases were the principal diagnostic features in a rate of 208 (33.3%), 135 (21.1%) and 96 (15.5%) respectively. Hypospadias 56 (9.0%), UDT 18 (2.9%) and bladder tumors 17 (2.7%) were others seen in this series. Open prostatectomy 208 (33.3%), DVU/ Urethroplasty 135 (21.7%), open stone retrieval 96 (15.4%) and hyospadias repair 56 (9.0%) were among the most frequent urologic procedures carried out in this series.

 Conclusion: BPH, urethral strictures, urinary tract calculi and hypospadias were among the major diagnosis features of urologic conditions in this series. Open surgical procedures were carried out in most of the urologic cases.  The recent advances in urologic endoscopy which are applicable in the wide range urologic diseases have to replace the open techniques in this country.

Key words: Urologic diseases, Magnitude,Treatments, Mekelle.

Background: Sigmoid volvulus (SV) is the wrapping of the sigmoid colon around itself. The aim of this study is to evaluate the changes in SV from past to present.

Methods: The clinical records of 993 patients treated over a 50-year period between June 1966 and June 2016 were analyzed, retrospectively until June 1986 (612 patients), and prospectively thereafter (381 patients).

Results: The incidence decreased over the last 25 years (p<0.001). Although the patients' age, gender, history, and comorbidity rate were similar, the symptom duration shortened (p<0.001), and the rate of shock decreased (p<0.005). The clinical presentation did not change. Non-operative therapeutic procedures were most commonly used (p<0.001), and flexible endoscopy took the place of barium enema and rigid endoscopy (p<0.001). Although the success rate of the non-operative procedures increased (p<0.001) and the hospitalization period shortened (p<0.001), rates of morbidity, mortality, and recurrence did not change. The pre-operative diagnostic accuracy rate increased (p<0.001). The need for surgical treatment, as well as volvulus direction and over rotation rate were similar, while bowel gangrene was seen less often (p<0.05).  Non-resectional surgical methods were used less frequently (p<0.001), and resection with primary  anastomosis generally took the place of the resection with stoma (p<0.005). The morbidity and mortality rates of the surgery decreased (p<0.05, for each) and the hospitalization period shortened (p<0.001), while the recurrence rate did not change.

Conclusions: We observed a decrease in the incidence of SV as well as changes in the diagnostic and therapeutic strategies, and an improvement in the prognosis, while the clinical features did not change.

Key words: Sigmoid colon, Volvulus, Intestinal obstruction, Diagnosis, Treatment

Background: Gastrointestinal endoscopy service in Ethiopia is mainly limited to the capital city Addis Ababa. The service started in Ayder referral hospital, Mekelle, in 2011 after two physicians obtained six weeks unstructured, on-site training where each of them was able to perform only 20 supervised procedures. The major objective of this study was to determine the pattern of endoscopic findings of diseases in our endoscopy practice at Ayder referral hospital.

Methods: The study design was a facility-based retrospective cohort study. The endoscopy registry was interrogated retrospectively and analyzed using descriptive statistics.

Results: A total of 2,486 patients’ endoscopic examinations were included in the study. Upper and lower gastrointestinal endoscopy totalled 1,994 and 492 procedures, respectively. Seventy four percent of colonoscopies and 58.7% of esophago-gastroduodenoscopies (EGD) were performed on male patients. The mean, minimum and maximum age of the study subjects was 40, 1 and 94 years of age respectively. The common EGD findings were erythema of gastric mucosa in 489 (24.5%), varices in 253 (12.7%), gastric cancer in 188(9.4%), peptic ulcer disease in 176 (8.8%) and gastroesophageal reflux disease in 96 (4.8%). The common colonoscopic findings were colorectal cancer in 114(23.2%), non-specific erythema of colonic mucosa in 78 (15.9%) and internal hemorrhoids in 37(7.5%).There was a poor correlation (0.5-57.7%) between clinical and endoscopic diagnosis; however, endoscopic diagnosis showed significant correlation (73%-100%) with histological diagnosis.

 Conclusion: Our findings are in agreement with those of other similar cohort studies. Hence, endoscopy service in such a resource-limited setting may be expanded by giving short-term, unstructured, onsite training to physicians.

Key words: Gastrointestinal endoscopy, Ayder Referral Hospital, Mekelle University, histological, clinical, diagnosis

Background: Neurologic disorders are becoming an increasing threat to public health in developing countries and present special challenges in sub-Saharan Africa with its poorly developed medical infrastructure. Moreover, the burden of illness and the neurologic patterns are not well documented in those countries including Ethiopia.

Objective: To assess the spectrum of inpatient and outpatient neurological disorders at Zewditu Memorial Hospital in Addis Ababa, Ethiopia.

Methods: A retrospective cross-sectional survey was carried out at neurology health care facilities of the Department of Neurology at Zewditu Memorial Hospital in Addis Ababa, Ethiopia. We reviewed medical records of new outpatients seen at the adult neurology clinic, and those admitted for a primary neurologic illness at the hospital for the 3 year period between 2009 and 2012. Central tendency, measures of dispersion, frequencies and percentages were calculated using SPSS Version 19 statistical software and tabulations of the neurologic disorders were made.

Results: A total of 222 inpatients and 1,285 new outpatients were included during the study period. The most common diagnostic category amongst outpatients was neuropathy/radiculopathy/low back pain which accounted for 724(56.3%). Others were movement disorders 119(9.3%), seizure/epilepsy 94(7.3%), headache/cephalalgia 73(5.7%) and cerebrovascular disease 56(4.4%). Amongst inpatients cerebrovascular diseases accounted for 97(43.7%) cases, meningitis/meningoencephalitis 37(16.7%), intracranial space occupying diseases 32(14.4%), coma/encephalopathy 21(9.5%) and myelopathy and seizure/epilepsy in 6(2.7%) patients each.

Conclusion: Differences in the pattern of neurological disorders among outpatients and inpatients was seen.

Key words: Neurologic disorders, Ethiopia