Vol 54, No 2 (2016): April Issue

Background: Valvular heart disease has been a significant cause of heart disease worldwide. In Ethiopia, it particularly affects young individuals and constitutes the major cause of cardiovascular disease. Factors associated with choice of treatment for advanced valvular heart disease are variable. The objective of this study is to review surgery done for Ethiopian patients with valvular heart disease.

Methods: We analyzed data on patients who had valve surgery and follow-up at the Tikur Anbessa Specialized Hospital cardiology unit. We collected data on sociodemographic characteristics, the pre-operative status of effected valves and co-morbidities, and assessed their associations with patient management options.

Results: A total of 157 valve surgeries were done from 1983 to 2013. Mean age at time of surgery was 26.7 years and females constituted 66% of the cases. Patients with rheumatic heart disease were younger, more likely to be female and have atrial fibrillation, but less likely to have impaired left ventricular systolic function when compared to patients with non-rheumatic heart disease. More than 75% of the surgical procedures done were mechanical valve replacement. Mechanical valves, compared with bioprosthetic valves, were more likely to be used in patients with rheumatic heart disease. The median age of those receiving mechanical valves, 24 (IQR 22 – 28) years, was lower than those receiving bioprosthetic valves, 31.5 (IQR 29.9 – 37.9) years. Mechanical valve replacement was significantly higher in those under the age of 20 years (Adjusted Odds Ratio 41.0, 95% CI: 3.0-557.2) and in those between 20 and 29 years of age (Adjusted Odds Ratio 14.3, 95% CI: 2.3-88.6).

Conclusions: Valve surgery for valvular heart diseases has been more common performed for young and female patients. A great majority of the replacements done have been with mechanical valves. As many of the patients have been younger and female, the choice of valve surgery and the need for anticoagulation impacts subsequent management of rheumatic heart disease and associated morbidities, lifestyle plans and pregnancy.

Keywords: Rheumatic heart disease, valve surgery, valve choice, Ethiopia

Background: Appendiceal mass is one of the complications of acute appendicitis. The management of patients with appendiceal mass is controversial and different treatment options have been suggested.

Objective: The objective of this study was to assess the results of conservative management of patients with appendiceal mass followed by interval appendicectomy.

Methods: The study was a retrospective analysis of 73 medical records of patients with appendiceal mass who were managed conservatively between March 2007 and February 2014.

Results: Fifty patients were males and 23 patients were females making the male to female ratio of 2.2:1. The mean age was 29.6±6.3 years (range 12-68 years). The maximum incidence was in the 3^rd decade. Forty one (55.8%) of the patients presented one week or more after the onset of their illness. Abdominal pain, right lower quadrant (RLQ) direct and rebound tenderness were observed in all patients. Mass was detected in the RLQ in 84.9% of the patients. Sixty five patients (89%) responded to conservative treatment and these patients were discharged after a mean hospital stay of 6.5±1.5 days (range 3-12 days). Interval appendicectomy was done for 58 patients 8-16 weeks after successful conservative management. The mean hospital stay after interval appendicectomy was 3.5±0.5 days with a range of 2-5 days. One patient (1.7%) had a wound infection. There were no deaths.

Conclusion: Initial non-operative management of appendiceal mass was successful in most cases and the complication rate after interval appendicectomy seems lower than with early operative treatment.

Key Words: Acute appendicitis, appendiceal inflammatory mass, conservative management, interval appendicectomy

Background: Injuries are a neglected health problem in developing countries. Ethiopia has a high incidence of road traffic accidents and trauma constitutes about half of surgical emergencies among patient seen at health facilities. The objective of this study was to determine the pattern of trauma among patient seen at emergency outpatient departments of public hospitals in northern Ethiopia

Methods: Retrospective data on patient seen at the hospitals during a one-year period (January 1, 2013 - December 31, 2013) was collected. The source population was all patients who visited the emergency OPD of two public hospitals in Mekelle, Tigray.

Results: The 16-25 year old age group was the most commonly affected age group, accounting for 38.5% followed by the 26-35 year old group (21.4%) of the cases. Males were more frequently involved than females (74.3%) vs 25.7%). Eighty- three per cent of the patients were from urban areas. Interpersonal violence (31%), accidental falls (19.2%) and Road Traffic Accidents (RTA) (14.1%) were the most common causes of injury. The dead (33.5%) was the most commonly involved part of the body.

Conclusion: This study indicates a high burden of trauma in the study area and the need for interventions to control the problem. Given the morbidity and mortality associated with trauma, trauma registry system will be beneficial in Tigray and perhaps for the whole country.

Keywords: Traffic accidents,  trauma, Mekelle, Tigray

Background: Tetanus, a disease that is largely preventable, is still a major public health problem in the developing world and is associated with high morbidity and mortality. There is a paucity of published literature on adult (non-neonatal) tetanus in this study area in Nigeria.

Methods: This was a study describing the clinical characteristics of patients who were clinically diagnosed with tetanus in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, northwest of Nigeria between January 2001 and December 2014.

Results: A total of 91 cases were reviewed. The mean patient age was 20 years, and male to female ratio 2.9:1. The majority (88%) of patients were < 40 years old. The mean onset period was 19 days, nearly all patients (96.7%) had generalized tetanus, and the commonest presenting signs were spasm (93.4%) and trimus (78.0%). The most common site of injury was lower limbs (64.8% of cases). The complication rate was 71.4% and case fatality was 48.4%.

Conclusion: Tetanus is still a major public health problem in our setting and affects the younger age group with a high case fatality rate. The incidence of tetanus can be reduced drastically by an effective and sustained immunization program.

Key words: adult tetanus, clinical characteristics, case fatality, outcome, North West Nigeria

ABSTRACT

Introduction: Diabetes mellitus is becoming a common chronic disease in both developed and developing nations and is associated with a significant cardiovascular disease morbidity and mortality. The presence of hypertension in patients with diabetes mellitus will double the risk of cardiovascular disease including coronary heart disease, congestive heart failure, ischemic and hemorrhagic stroke, renal failure and peripheral arterial disease.

Objective: The aim of this study was to assess the pattern of antihypertensive drug therapy among diabetic-hypertensive patients in Zewditu Memorial Hospital Diabetic Clinic in Addis Ababa.

Methods: This is a hospital based retrospective review of medical records of 382 diabetic-hypertensive patients who visited Zewditu Memorial Hospital Diabetic Clinic in the period between August 2014 and January 2015.

Results: The most frequently prescribed antihypertensive drug classes were ACEI in 321 (84%) followed by CCB in 229(60%) and BB in 145 (38%) patients. Enalapril, nifedipine, atenolol, losartan and hydrochlorthiazide was the only ACEI, CCB, BB, ARB and DI prescribed respectively. Enalapril was used as a monotherapy in 73(19%) and nifedipine in 26(7%) patients. The recommended target SBP <140 mmHg and DBP <90mmHg was achieved in only 57(15%) patients while the rest 325(85%) did not attain the target blood pressure. Renal function was assessed in 351(92%) patients, of whom 23(6%) had renal impairment with an estimated GFR < 60 ml/min.

Conclusion: The pattern of antihypertensive drug therapy in our patients was consistent with the current treatment guidelines. However, majority of diabetic-hypertensive patients did not reach target blood pressure.