Introduction: Mortality among people with mental illness is higher than the general population. Given the changes in the health service delivery in the past decade in Ethiopia, evaluating the pattern of mortality during this period may provide policy relevant information.  The aim of this study was to assess the mortality pattern in a tertiary psychiatric hospital in Ethiopia.

Method: A case-control design was employed. Using the Health Management Information System  records and clinical records kept at the tertiary hospital; data on inpatient mortality was collected respectively for a period of nine years (2006-2014). Changes in the service configuration were also tracked over the nine years period to explore the potential impact of changes in management upon mortality. Data was analyzed through simple descriptive methods and logistic regression.

Result: A total of 16,081 patients were admitted during the nine year period. The overall mortality rate of inpatients was 2.5/1000 admitted patients. The sex specific all-cause mortality rates were high in females (4.6/1000) than in males (1.8/1000). The mortality rate varied over the nine years between 0.5/1000 to 5.0/1000, with indications of fluctuations commensurate with changes in service organizational changes although these changes were not statistically significant. Although suicide  accounted for the death of 12.5% (n=5), most died of natural causes and also primarily of infectious diseases .

Conclusion:Mortality occurs mainly from preventable causes including suicide. Service reconfigurations may play important role in mitigating mortality. However, further systematic studies are required to determine the impact of service configurations on mortality and general morbidity.

Keywords: Mortality, Pattern of Mortality, Mental Illness, Serious Mental Illness, Inpatient Service, Ethiopia

Introduction: Breast cancer is the most common cancer in the world in women and its incidence is rising, especially in low- and middle-income countries. In Africa, breast cancer has become a leading cancer among women. In sub-Saharan Africa, it is less common, occurs in younger age groups, and majority present late. In Ethiopia, the actual magnitude of the disease is unknown.

Objective: The aim of this retrospective study is to analyze the pattern and treatment outcome of patients with breast cancer at our center.

Methods: The study includes analysis of the clinical findings and treatment outcome of 404 patients with breast cancer managed from October 1, 2005 to September 30, 2015 at the United Vision Medical Services center, Addis Ababa, Ethiopia.

Results: The median age was 45 years; majority (61.2%) in the age group 35-54 years. The female to male ratio was 66.3:1.0. The most common presenting symptom was breast lump (85.3%). The mean duration of presenting symptoms was 9.2 months. On examination, breast lump was noted in 82.2% of the patients. The most frequent histological type was grade II ductal carcinoma. Most patients (80%) underwent breast surgery, mastectomy in nearly 97%. During follow up, 107 of 370 patients (28.9%) developed recurrences/metastasis. The overall 5 year survival was 69.5%.

Conclusion: Our study has shown that relatively young females are commonly affected; majority presented in advanced stage of the disease and the recurrence rates were high.

Key words: Breast cancer, outcome, private medical service, Ethiopia.

Introduction: Preeclampsia remains a major cause of prenatal morbidity and mortality worldwide. It is considered to be a likely trophoblastic disorder and since ?-hCG is secreted by trophoblastic cells, its serum level may be essential in diagnosing preeclampsia. Hence the aim of this study was to determine serum levels of ?-hCG in normotensive and preeclamptic pregnant women.

Methods: A case control study was conducted in TikurAnbessa Specialized Hospital from June, 2013 to March, 2014. Cases were preeclamptic pregnant women and controls were normotensive pregnant women. Serum levels of ?-hCG were determined by an electrochemiluminescence immunoassay, , and compared among the patient groups. Binary logistic regression and bivariate correlation analysis were done to determine associations between  ?-hCGother obstetric factors.

Results: A total of 76 pregnant women (38 cases and 38 controls) were included in this study. Mean serum levels of ?-hCG in the case group was 34439.2+/- 28223.67mIU/ml and significantly higher that of the control group,20582 +/-17588.31. Serum levels of ?-hCG in the case group was positively correlated with mean arterial blood pressure and negatively correlated with maternal age, gestational age and parity. Witha cutoff point of 12,953mIU/ml, the sensitivity and specificity of maternal serum level of ?-hCG as a diagnostic test for preeclampsia was 76.3% and 52.6% respectively.

Conclusions: In this study, maternal serum level of ?-hCGand family history of preeclampsia were significantly associated  preeclampsia.

Key words: Preeclampsia, normotensive, human chorionic gonadotropin.

Introduction: Urinary stone disease is a disorder with significant impact on quality of life. Moreover, children have a higher recurrence rate owing to associated metabolic and anatomic abnormalities. Management has changed with technological advances. Despite the current trend, open stone surgery is still widely practiced in developing countries. However, there have been no reports regarding treatment of  this disease in children from Ethiopia so far. We aimed to determine the mode of management and outcomes of the différent approches for childhood urolithiasis  which practiced in our institution.  We also tried to assess factors leading to adverse outcomes.

Methods: This is a retrospective descriptive study of pediatric patients who underwent surgical procedures for urolithias from September 2010 to August 2015. Medical records were reviewed for factors thought to affect outcome of management.  

Results: We investigated 50 children aged 0-15 years and the mean age for operation was 8.5 ± 3.2 years. The stones were found exclusively in upper urinary tract in 56%, lower urinary tract in 30% and a combination of sites in 14%. All lower urinary tract stones were managed with open surgery, of which cystolithotomy comprised 81%. Common procedures performed for upper urinary tract stones were open stone surgery (41 %) and ureteroscopic intervention in (34.5%). Success rate with ureteroscopy was 30%. Post-operative complications occurred in 24%; common ones being urinary tract infection (10%) and urinary leak (10%). The factors with significant correlation to post-operative complications were history of urinary tract infection and chronic kidney disease (p=0.02 and p=0.047 respectively). Recurrence occurred in 12%. Thirty percent of the children required a second surgical procedure.

Conclusion: The practice in our institution is still evolving towards the standard approaches of stone treatment. Metabolic evaluation is lacking, post-operative complications are high and our experience with pediatric ureteroscopy was not satisfactory. Most of these issues were associated with our socioeconomic status, as facility was not adequately equipped and patients presented late with renal failure. 

Keywords: Pediatric urolithiasis, Stone disease in Ethiopia

Introduction: Isoniazid prevention therapy alone can reduce the risk of tuberculosis in people with HIV regardless of CD4 count or antiretroviral treatment. In Ethiopia, there is scarcity of evidence on implementation of isoniazid prevention therapy and factors associated with its uptake.

Objective: The study aimed to assess isoniazid preventive therapy implementation and factors associated with isoniazid completion among human immunodeficiency virus infected children in Felege-Hiwot and Gondar University Referral Hospitals in Northwest Ethiopia.

Methods: A facility-based cross-sectional study using a combination of face-to-face interviews of caregivers/parents and retrieval of client records was conducted in May 2014. Trained nurses with experience in human immunodeficiency virus infection and tuberculosis care conducted the document review and interviews. Data were entered onto Epi Info version 3.5.4 for windows, cleaned and exported to Statistical Package for Social Sciences version 20.0 for windows for analysis.

Results: A total of 454 HIV infected children (51.8% females and 48.2% males) were studied. Nearly a third, 168 (37%),of children were provided isoniazid prevention therapy and 67.9% completed the full course. Isoniazid completion was associated with distance from hospital (p<0.005), explanation of the reasons to take isoniazid pills (p<0.001), thinking isoniazid may be dangerous to child’s health (p<0.001), believing that the chance of getting sick from tuberculosis is high for the child (p<0.001), disclosure of human immunodeficiency virus infection status (p<0.04) and isoniazid preventive therapy disclosure status (p<0.001).

Conclusions: Uptake of isoniazid preventive therapy was low among human immunodeficiency virus infected children. In addition, isoniazid therapy completion was very low. The hospitals and Regional Health Bureau should avail isoniazid preventive therapy in the nearby health facilities and strengthen adequate counseling on the role of isoniazid preventive therapy for tuberculosis.

Key words: Tuberculosis; isoniazid preventive therapy; completion; children; Ethiopia.

Objectives: There are many incisions that are most commonly recommended for performing neck dissection for oral cancer. The need towards more conservative surgical treatment of oral cancer has led to performing various incisions.

Methods: In this study the Schobinger and MacFee Incisions were used in radical neck dissection (RND) and compared intraoperatively, postoperative and during follow up at regular intervals. The study was conducted from November 2011 to June 2014 on 30 patients who were biopsy proven case of squamous cell carcinoma (SCC). Fifteen patients aged 20-60 including males and females were randomly sorted into Schobinger incision group and MacFee incision group. The study was conducted in the Department of Oral and Maxillofacial Surgery SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India.

Result: The Schobinger incision (Group I) and MacFee incision (Group II) both had 12 males and 3 females. Time taken to raise and close the flap was greater among Schobinger incision patients. Dehiscence was observed less in the MacFee incision group. Marginal necrosis of the flap was also less in MacFee incision. Wound contraction, infection, and scar assessment was better in the MacFee incision compared to the Schobinger incision.

Conclusion: MacFee incision was observed to have better cosmetic effect, the time taken for the raise and closure of the flap was less, and post-operative healing was better achieved. The Schobinger incision on the other hand provided a better exposure of neck during dissection, but a higher incidence of marginal necrosis and contracture of the flap with scaring was observed. In MacFee incision there was difficulty observed during neck dissection under the flap and in the posterior triangle.

Keys words: Schobinger Incision, MacFee Incision, Neck Dissection, Healing, Scar assessment.