Vol 56, No 1 (2018): January issue

Background: The introduction of image-guided biopsy has revolutionized the quality of patient care by avoiding open surgical biopsies and complications associated with it and the use anesthesia. Even though Ethiopian radiological training dates back to more than two decades, interventional radiology is a very recent introduction. This study reports the safety and significance of image guided biopsy on patient care.

Patients and methods: This study was a prospective study carried out to assess the impact and safety of doing image-guided biopsy in a tertiary care teaching Hospital in Addis Ababa, Ethiopia.

Results: A total of 117 patients, their age ranging from 3 to 80years and a mean age of 41 were evaluated; 6.8% of them were children below the age of 10. Around two-thirds of the cases had intra-abdominal indications for biopsy followed by mediastinal pathologies. Ultrasound was used as a guide in about 85% of the cases. Except for one case that developed massive hemoptysis following fine needle aspiration of a middle mediastinal mass and treated conservatively, there was no major complication. A few minor complications, like mild pain and minor hemorrhage, required only close observation.

Conclusion: On the whole, our study indicates that image-guide biopsy improves the existing medical care. Moreover, institutions particularly those providing training in radiology should promote the establishment of interventional radiology for better patient diagnosis and improved planning of subsequent treatment.

Keywords: Safety, Image-guided biopsy

Introduction: Educational environment in a teaching hospital determine the engagement and motivation of residents and lead to greater achievement of educational outcomes.

Objective: To evaluate the educational environment as perceived by residents in the three domains of Postgraduate Hospital Educational Environment Measure and factors influencing their perception of this environment.

Methods: Institution based cross sectional study was conducted among all residents of St. Paul’s Hospital Millennium Medical College (N=87). This study used English version of the Postgraduate Hospital Educational Environment Measure to assess the educational environment for all residents of internal medicine, gynaecology, paediatrics, surgery and radiology speciality programs. Nonparametric methods of Mann-Whitney U for two independent samples and Kruskal-Wallis for multiple independent samples were used to measure the statistical significance.

Results: Eighty (92%) residents completed the questionnaire. The residents’ re­sponse scored 102.6 out of 160 maximum score in rating of Postgraduate Hospital Education Evaluation Measure that showed overall learning environment more positive than negative but with room for improvement. Out of 40 items, those that depicted mean values less than 2 were availability of an in­formative junior doctors handbook, clinical protocol, workload, quality of accommodation, and adequate catering facilities during on call hours. Gender and specialty programs had statistically significant association with perceptions of the educational environ­ment, (P<0.001).

Conclusion: Educational environment among residents remain positive with potential aspects for improvement. Specialty programs and gender were important factors influencing perceptions of the educational environ­ment. The college should be aware of the importance of equal participation of all specialty program and female residents in the improvement of educational environment plan. 

Keywords: Educational environment ,educational outcomes, SPHMMC

Background: Stroke is a devastating neurological emergency with high mortality and morbidity rate. Stroke has been considered as a major cause of seizures and in fact a leading cause of epilepsy in the elderly. Little is known about the magnitude and outcome of stroke related seizures in Ethiopia. We studied patients who were admitted with the diagnosis of stroke, their clinical presentation, associated complications and outcome.

Methods:-This is a cross-sectional study based on analysis of clinical charts of patients admitted with the diagnosis of ischemic and hemorrhagic stroke to Tikur Anbassa Hospital from January 2009 to January 2012. Disability was measured using the Modified Rankin Scale. Data was collected from all charts with the diagnosis of stroke using a pre-prepared questionnaire, analyzed using SPSS version 20, and summarized using tables.

Results: During the study period, there were 174 patients who were admitted with the diagnosis of stroke. Among these, 148 were included in the study. Of these, 14 patients with subarachnoid hemorrhage, five patients with venous strokes and seven patients who did not have imaging study were excluded from the study. Of the 148 patients, 37(25%) had different forms of seizure.  Of the 76 patients with ischemic stroke 14/ (18.6%) and 23 (31.9%) of the 72 patients with hemorrhagic stroke had seizures.

Conclusion: In this study, a substantial proportion of the patients developed seizure. The frequency of seizures in this study is similar with reports of studies conducted elsewhere. A well-designed epidemiological study is recommended to determine the magnitude, associated risk factors and clinical profile of seizures among adult patients with stroke.

Key words: Stroke, Seizures in stroke-patients, Ethiopia

Introduction: Causes and clinical features of third, fourth and sixth cranial nerve palsy showed variation among previous studies and cases were analyzed regarding final causal diagnosis.

Method: A cross sectional study was performed among112 patients with third, fourth, and sixth nerve palsy who were consecutively seen at the neuro-ophthalmic clinic of the Ophthalmology Department of Menelik II Hospital. Data was collected prospectively and the etiology and results of ocular examination on each visit were reviewed. A multivariate logistic regression analysis using SPSS version 17.0 was performed to identify independent factors associated with the etiology.

Results: The sixth cranial nerve was affected most frequently (n=60 (53.6%) and head trauma (n=48 (42.9%) was the most common etiology. The mean age at presentation was 34.3 (± 2.54) years. Involvement of the left eye (p= 0.010) and head trauma (p=0.02) as the etiology were statistically significantly associated with sixth nerve cranial palsy.

Conclusion: Sixth cranial nerve is the commonest affected nerve and head trauma is the main cause of cranial nerve paralysis.

Keywords: cranial nerve; palsy; clinical features, Menelik II; Ethiopia

Introduction: Provision of intensive care services is growing globally. The service is on the increase in Ethiopia, but is not well studied to date. The rationale of this study is to assess the admission pattern, length of hospitals stay, and treatment outcomes of patients admitted to a medical intensive care unit.

Methods: We reviewed the registries and clinical charts of patients admitted to Medical Intensive Care Unit of Ayder Comprehensive Specialized Hospital in Mekele, Tigray, during the period, November 2011 - February 2015.

Results: A total of 1,211 patients were admitted to Medical Intensive Care Unit during the study period. Males constituted a higher proportion (55.6%) than females (44.4%). The commonest admissions were patients with cardiovascular diseases (26%), followed by infectious diseases (20%) and neurological diseases (19.8%). The commonest specific causes of admission to the Unit were diabetic ketoacidosis and heart failure, constituting 16% each, followed by stroke (15.2%). The overall mortality was 27%. The commonest cause of death was stroke (17%), followed by septic shock (11%). older age, HIV positive, acute respiratory distress syndrome, septic shock and status epilepticus were independent predictors of death.

Conclusion: There is an epidemiologic transition from the once by far the commonest diseases like infectious diseases to non-communicable diseases like cardiovascular diseases. Non-communicable diseases need to receive due attention. Communicable diseases still cause a substantially high number of deaths, though over taken by non-communicable disease. Expansion of intensive care unit care is required in order to optimize critical patients.

Key words: Intensive care unit, admission pattern, hospital stay, Ayder, outcome.

Background: Cerebellopontine angle (CPA) masses are the most common neoplasm in the posterior fossa, accounting for 5%-10% of intracranial tumors.

Objective: The objective of this study was to describe the imaging feature, identify the prevalence of the various CPA masses, and determine the diagnostic accuracy of computedtomography and magnetic resonance imaging in the evaluation of CPA masses.

Methods: Five-years cross sectional descriptive study was done at Tikur Anbessa Specialized Hospital and Myungsung Christian MedicalCenter between January 2011 and December 2015. Thirty-Eight patients with CPA masses on computedtomography and/ormagnetic resonance imaging that were surgically treated and histopathological proven were selected. Patients’ demographic data, diagnosis on admission, clinical manifestations, computedtomography/ magnetic resonance imaging features and diagnosis, and histologic diagnostic results were collected using structured questionnaire. Data entry and analysis were carried out using SPSS Version 20.0.

Results: A total of 58 patients underwent surgery for CPA masses, of which 38 had brain computedtomography/magnetic resonance imagingand biopsy proven diagnosis. The highest number of cerebellopontine anglemasses was found in the age group between 31 and 40 years. Equal sex distribution was observed. The most common clinical presentation was headache. Most masses were multiple and right-sided. Order of frequency of CPA mass was vestibular schwannoma followed by meningioma and epidermoid cyst.

Conclusion: The most common CPA mass was vestibular schwannoma followed by meningioma and epidermoid cyst. Magnetic resonance imaging is more sensitive and more specific in diagnosing cerebellopontine anglemass than computedtomography scan.

Key words: Cerebellopontine, Mass, Schwannoma, tomography, magnetic resonance, Ethiopia

Background: Uterine rupture remains a significant public health problem contributing to 13% of maternal mortality and 74%-92% for perinatal mortality in developing countries. This study assesses the prevalence and factors associated with rupture of gravid uterus and feto-maternal outcome in Ethiopian mothers with uterine rupture.

Methods: A retrospective cohort study was conducted to identify risk factors associated with rupture of gravid uterus and feto-maternal outcomes. The data source included clinical records of patients seen at Dilla University Referral Hospital over a one-year period. The data was collected using a structured data collection form developed for the purposes of the study. The study involved a total 2,498 women with a gravid uterus, gestational age of ?28 weeks and registered in the labor and delivery registration books in the Obstetrics and Gynecology Department. Bivariate and multivariate regression analyses were carried out at 95% Confidence Interval to identify factors independently associated with uterine rupture.

Results: Out of 2,498 reviewed deliveries, 46 cases developed uterine rupture making an overall hospital prevalence of 1.8 % or one in 53 deliveries. Malpresentation (80%), contracted pelvis (47.8%), vertex malposition (10.8%), and previous uterine scar (2.1%) were the causes of uterus ruptures. In multivariate analysis, clients’ residence, parity, birth weight, Antenatal Care follow-up and duration of labor were statistically significantly associated with uterine rupture. Maternal and fetal case fatality rates were 8.7% and 97.8%, respectively.

Conclusion: Uterine rupture remains an important problem in the study area. Patients with identified risk factor(s) should stay close to the hospital in late pregnancy. Besides, strengthening antenatal care follow-up and referral linkage should be considered.

Key Words: Antenatal Care, Prevalence, Uterine Rupture, Dilla, Ethiopia

Background: Human immunodeficiency virus is a public health problem in sub-Saharan countries, with complex determinant factors. Intimate partner violence, although known to associate with acquiring human immunodeficiency virus understanding how it relates to sexual risk behaviors is important.

Objective: To assess the relationship of human immunodeficiency virus with intimate partner violence as related to risky-sexual behaviors.

Methods: A facility based case control study was conducted among human immunodeficiency virus positive and negative women visiting antenatal care. A total of 128 positive and 382 negative women from the prevention service of mother-to-child transmission of human immunodeficiency virus in selected health facilities in Addis Ababa were included.  A standardized and pretested questionnaire was used to assess the experience of intimate partner violence, and sexual behaviors of women and their spouses.

Result: Physical violence during lifetime is associated with human immunodeficiency virus infection status. Besides, sexual violence by strangers is associated with human immunodeficiency virus infection. Risky sexual behaviors, represented by having multiple partners, transactional sex and having a casual partner, were associated with intimate partner violence as well as human immunodeficiency virus infection status. Similarly, report of experiencing symptoms of sexually transmitted infection and having suspected unfaithful spouse were associated with intimate partner violence and human immunodeficiency virus infection status.

Conclusion: The study showed that intimate partner violence could be associated directly and in directly with human immunodeficiency virus infection by increasing exposure to risky sexual behaviors and considered as a resolution for disparate sexual behavioral. Therefore, prevention and control interventions against intimate partner violence could play significant role in prevention and control of human immunodeficiency virus infection.

 Key words: Intimate Partner Violence, sexual-behavior, human immunodeficiency virus infection, Addis Ababa

Background: Diagnosis of urinary tract infection in children requires a high index of suspicion and optimal specimen collection method and processing for culture. This study was conducted to identify the common urinary tract pathogens and their susceptibility pattern in children at a teaching Hospital in Addis Ababa, Ethiopia.

Objectives- to identify the predominant urinary pathogens and their antimicrobial susceptibility pattern in children admitted with fever and no other source of infection

Methods- This cross sectional study was conducted from April 2015-July 2016 in children between 0-15 years of age who were admitted to the emergency unit of the Department of Pediatrics with fever and no other source of infection. Antimicrobial sensitivity was determined according to laboratory standards.  

Results: A total of 237 children were admitted with fever and no other source of infection. There were 46 urine culture positives of single organisms (19.4%). The most common organisms isolated were Eschericha.coli in 50% and Klebsiella species in 37%. Escherichia coli was resistant to gentamycin in 60.9%; ceftriaxone 79.6%, and ampicillin 95.7%. Klebsiella was 100% resistant to ampicillin, cotrimoxazole and augmentin.

Conclusion: A high rate of urinary tract infection and resistance compels area specific surveillance to select the appropriate antibiotic for empirical treatment of urinary tract infection in children.

Key words: Pediatrics, emergency unit, urinary tract infection, young infant

Background: Female genital mutilation/cutting is a traditional practice that affects more than 23 million females in Ethiopia.  It is a violation of human rights and healthcare practitioners are expected to identify and manage this condition. Our objective was to assess the knowledge, attitude and practice of healthcare practitioners.

Methods: An interviewer-administered survey was distributed to a total of 427 practitioners at Jimma University Hospital and four local health clinics. Convenience sampling was used to recruit participants from June to August of 2013. Respondents were physicians, health officers, nurses, midwives, and medical students. Bivariate analyses with Fischer’s exact test and linear regressions were used to determine associations.

Results: The study consisted of 72% male and 28% female practitioners. Respondent knowledge about the complications of female genital mutilation/cutting was poor. More than a quarter of practitioners (28.6%) believed there were health benefits from the practice. Respondents who held an attitude that their medical training for female genital mutilation/cutting was sufficient were more likely to discuss the topic with patients. Attitudes were primarily to educate and sensitize patients (77.5%) or ignore the issue (12.2%).

Conclusions: The majority of practitioners felt their medical training on female genital mutilation/cutting was inadequate. An attitude of sufficient training increases the likelihood healthcare practitioners will discuss female genital mutilation/cutting. With the high proportion of males in the healthcare system, it is necessary for future interventions to educate healthcare providers, particularly males, on female genital mutilation/cutting. Open discussion may serve to increase awareness and communication about the prevailing social expectations around female genital mutilation/cutting. 

 Keywords: Female genital mutilation/cutting, healthcare provider knowledge, Ethiopia