Specialist Hospital Research Articles

A case report of bilateral psoas abscess with co-existing gluteal abscess in Pott`s disease of the spine in a middle-aged woman in a Specialist Hospital

Psoas abscess (PA) is the buildup of suppurative fluid in the fascia surrounding the psoas/iliopsosas muscle, is a rare condition, with diagnostic difficulty. Pott`s disease also called spinal tuberculosis occurs due to extra pulmonary tuberculosis. Backpain, fever, weight loss, lump in the groin and limping are its main symptoms. Curable by administering antitubercular therapy and sensitive antimicrobials with analgesics for indicative relief. Surgical procedures can be carried out to eliminate the accrued fluid based on the inter individual degree of presentation. In this case report, we report a rare case of bilateral psoas abscess with co-existing gluteal abscess and Potts’s disease. A 48-year old female presented with complaints of backpain, limping, lump in the flank/buttock and fever of two weeks. Abdominopelvic computed tomography scan showed massive right iliopsoas muscle collection with extension into the ipsilateral gluteal region and subcutaneous tissue. Similar collection was seen in the left psoas muscle superiorly. The bone window of the lumbosacral spine showed the anterior wedged collapse of the vertebral bodies with gibbus deformity. The patient had spontaneous rupture of the gluteal collection and surgical drainage of the right iliopsoas and left psoas collection was done. Anti-Kochs therapy was commenced and patient is currently doing great. The introduction of computed tomography (CT) and magnetic resonance imaging (MRI) has greatly improved the diagnosis of psoas abscess with Pott`s disease or in its isolated forms.

Paracetamol and ibuprofen fixed-dose combination for the management of acute mild-to-moderate pain in children: strengthening and enhancing of result of Nominal Group Technique through Delphi consensus

BackgroundParacetamol and ibuprofen are the most commonly used drugs for pain treatment in children and their combination has shown improved analgesic effect compared to treatment with either drug alone. Current literature lacks specific guidelines regarding the settings in which this combination should be adopted.MethodsThe survey, conducted with Delphi methodology, involved 75 hospital and outpatient pediatricians with clinical experience in the management of pain in children. Pediatricians involved were asked to validate or not the results of the previous NominalGroup Tecnique (NGT) consensus and thus specify the optimal clinical settings in which the paracetamol/ibuprofen fixed-dose combination could be adopted.ResultsThe results confirm the importance of the fixed-dose paracetamol and ibuprofen combination for the control of mild-to-moderate acute pain in children. Particularly, this association seems to be appropriate in case of headache, earache, odontalgia and musculoskeletal pain, and in specific settings such as post-operative and post-procedural pain. The broadening of the panel brought to slight variations in clinical management practices between hospital and outpatient specialists. Nonetheless, overall consensus supports the notion that the fixed dose combination is more efficacious than monotherapies and it is well tolerated. Moreover, experts unanimously agree on the usefulness of the combination for caregivers, leading to improved adherence and effectiveness.ConclusionsBoth the NGT consensus and the broader Delphi consensus confirm the usefulness of the paracetamol-ibuprofen fixed-dose combination in pediatric pain. This is attributed to its superior effectiveness compared to monotherapies, a good tolerability profile, and improved compliance and ease of use. Some pain settings related to chronic, inflammatory and rheumatological pathologies remain to be investigated to evaluate the use of this combination.

Associations between general practice and outpatient care continuity in people with multimorbidity

Abstract Background Relational continuity in primary and secondary care is linked to better health outcomes for patients, but it is unclear whether metrics of continuity in each setting are associated. Our study examined the association between relational continuity in general practice (GP) and continuity of hospital outpatient specialties in people with clusters of multimorbidity. Methods We used GP records from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics outpatient records. Included were patients ≥18 years, with two or more of 212 Long-Term Conditions (LTCs), registered throughout 2019 and with at least three GP and three outpatient appointments. The Continuity of Care Index (COCI) was calculated separately for visits to the same i) GP and ii) hospital specialty, where 0 represents no continuity and 1 represents all visits to the same GP or specialty. We assessed the association between the indices using univariable and multivariable fractional logit regression. We calculated expected COCI scores for each LTC and assessed variation in the COCI between LTCs assigned to one of 15 clusters of co-occurring diseases derived previously. A sensitivity analysis repeated analysis using the Sequential Continuity (SECON) score, which captures longitudinal continuity. Results Of 1,135,903 patients, 56.2% were ≥60 years. The median (IQR) COCI in GP was 0.22 (0.11-0.40) and in outpatients was 0.33 (0.20-0.52). Although statistically significant (p < 0.001) the relationship between the two measures was clinically insignificant in both univariable and multivariable models. No strong relationships were found between COCI scores and LTC clusters. Similar patterns were found using the SECON score. Conclusions We found no strong association between continuity of care in GP and outpatient settings, and no clear patterns with LTC clusters. This suggests that lack of continuity in secondary care is not compensated for by increased continuity of care in primary care. Key messages • We found no meaningful association between measures of continuity of care in general practice and hospital outpatient settings. • Our findings suggest that lack of continuity of outpatient care is not compensated for by increased continuity in primary care.

Health care provider payment schemes in Central and Eastern European countries

Abstract Background Health care provider payment schemes are key elements of the health care system that influence providers behavior, quality of care, and efficient use of resources. In recent decades, Central and Eastern European (CEE) counties have implemented various reforms that have changed payments methods and other elements of the purchasing process. The aim of the study was to provide an overview of the current provider payment schemes within the public health system in selected CEE countries and identify the main directions of their reforming. Methods Based on existing literature, a theoretical framework and data collection form were first developed. Next, desk research was conducted to collect data on provider payment methods and other elements of the purchasing process in primary care, outpatient specialized care, hospital care, and long-term care. The collected information was verified and supplemented though consultations with national experts. Nine countries were included: Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. The study was conducted in 2023. Results Capitation, fee-for-service, and case-based payments are the most commonly used methods in the analyzed countries. The countries are increasingly using blended payment methods. Primary and hospital care have the most diverse payment method mix and have experienced the most substantial changes in their payment schemes since 2010. The most common changes focused on modifying existing methods (detailing payment categories, changing the principles of tariff valuation), and introducing additional methods to pay for specific services or performance (fee-for-service, bonus payments). Conclusions CEE countries are following similar directions in reforming provider payment systems, with the goal of strengthening primary health care, shifting emphasis from inpatient to outpatient care and improving cooperation between health care providers. Key messages • CEE countries largely use output-based methods to pay for health care services. • Provider payment systems are becoming more blended as countries look for the most effective payment method mix to meet policy objectives.

Neonatal screening for hearing loss and its associated factors: A pediatric hospital experience

Abstract Introduction Hearing impairment affects 0.6% of children worldwide, with 60% of cases being preventable. Identifying risk factors for hearing impairment would facilitate early detection and better patient prognosis. Objectives To identify factors associated with abnormalities in auditory screening in a pediatric hospital. Methods A cross-sectional study was conducted on patients assessed in the early hearing detection program at the Pediatric Tower of the High Specialty Hospital of Veracruz, Mexico, between June 2022 and 2023. Screening was performed using otoacoustic emissions initially. Those with abnormalities underwent two retests, and those positive in all three evaluations underwent confirmatory testing. Newborn screening was conducted at discharge for healthy neonates and after reaching a weight of over 1.8 kg and more than 34 gestational weeks for preterm infants. For term and low-birth-weight babies, screening occurred when they reached 2 kg, considering positive results in any of the three tests indicative of altered screening and probable hearing impairment. Results A total of 2731 patients were fully evaluated, with 1416 (51.8%) being male, and a median Apgar score of 9 at 5 minutes. The incidence of hearing impairment was 0.7%, comprising 19 patients. Evaluation of sex, 5-minute Apgar score, weight, gestational age, congenital malformations, history of neonatal asphyxia, hyperbilirubinemia, sepsis, TORCH infections, family history of hearing impairment, maternal exposure to ototoxic drugs, substances, COVID-19, gestational diabetes, or maternal hypertension obtaining values of p > 0.05 in each of them. Conclusions The prevalence of hearing loss is similar to that reported in the literature. In our population, auditory screening abnormalities are not associated with classic perinatal factors, indicating the complexity of contributors to neonatal hearing impairment. Key messages • The neonatal screening program plays a fundamental role in identifying patients with hearing loss even without any clinical factor that arouses suspicion of hearing loss. • Early diagnosis will favor timely care for patients with hearing loss, favoring their development with adequate care to improve their quality of life.

Evaluating an integrated clinical pharmacy service model in an ambulatory cardiac clinic- a single centre study

Abstract Background Evidence suggests that multidisciplinary cardiology clinics improve patient outcomes. Currently, there is limited data on the type of pharmacist-led interventions occurring in cardiac ambulatory clinics in the Australian setting. Purpose The primary aim of this pilot audit is to examine the frequency and type of pharmacist-led interventions in the ambulatory clinics of this specialist hospital. The secondary aim is to assess factors associated with hospital readmissions within 30 days of Pharmacists' reviews. Methods A retrospective pilot audit was conducted for patients who attended an integrated multidisciplinary Heart Failure (HF) and Hypertension (HTN) clinic from April 2023 to February 2024. Patients’ demographics, Charlson comorbidity index (CCI), and the number and types of pharmacist interventions and readmission data 30 days post clinic review were recorded. Descriptive statistics were used to evaluate patient characteristics and logistic regression for hospital readmissions. Results A total of 398 patients were reviewed by pharmacists, with 300 (75%) from the HF clinics and 98 (25%) from the HTN clinics. Patients’ median age was 63± 14.8 years and median CCI was 4± 3.7. Pharmacists documented medication histories for all patients (100%) and provided 355 recommendations, of which 213 (60%) were actioned by the cardiologist. Pharmacists had a face-to-face consultation and provided education and counselling to 175 (44%) patients. The most common types of interventions were related to guideline-directed prescribing and deprescribing (68, 39%), followed by up-titration of current therapies (61, 35%). Pharmacists also provided education on medication adherence and lifestyle modifications (28, 16%) as well as optimizing medications related to other comorbidities (18, 10%). A total of 8 patients (2%) were re-admitted l within 30 days of clinic review from either heart failure exacerbation or hypertensive crisis. Patients who had a face-to-face consultation and education with a pharmacist were less likely to be readmitted within 30 days (P=0.048). However, none of the other predictors tested for readmission such as age (P= 0.572), gender (0.296), history of non-compliance (0.834), CCI (0.984) or a diagnosis of HF or HTN (0.473) were predictors for readmission within 30 days of clinic review. Conclusion Pharmacists play an integral role in the cardiac ambulatory setting by providing expert medication advice and patient education to optimize patients’ outcomes. This study demonstrates that the activities performed by pharmacists working in Australian cardiac clinics are consistent with other international ambulatory clinics. The study also identified opportunities to develop a similar service for other ambulatory clinics at this hospital such as lipid and atrial fibrillation clinics. Additionally, further research is required to assess long term benefit of pharmacist led interventions on cardiac patients.

Trend, prevalence, and associated factors of uterine rupture at Nekemte Specialized Hospital, Oromia Regional State, Western Ethiopia

Maternal morbidity and mortality have long been among the world’s most challenging health issues. Uterine rupture is one of the peripartum complications that kills almost one in every thirteen mothers. However, there is limited evidence on uterine rupture trends, proportions, and determinants. Thus, this study assessed the trend, prevalence, and associated factors of uterine rupture at Nekemte Specialized Hospital, Oromia Regional State, Western Ethiopia. An institution-based cross-sectional study was conducted among 2661 clients selected using a systematic random selection technique among the data collected for the project between January 2014 and December 2022 at Nekemte Specialized Hospital. Data were collected through an interview-administered questionnaire and card review from March 2023 to August 2023. The collected data were checked, coded, and entered into Epi info version 7.2 and then exported to SPSS Version 27 for analysis. Logistic regression models were fitted to identify the factors of uterine rupture. Adjusted odds ratio with 95% Confidence Interval was estimated to measure the strength of the association, and statistical significance was declared at a p-value less than 0.05. The trend of uterine rupture declined from 1.54% in 2014 to 0.93% in 2022. The overall prevalence was 3.53% (95%CI: 2.7%, 4.3%). Low household income (Adjusted OR = 3.75, 95%CI: 1.97, 7.13), grandmultiparity (Adjusted OR = 7.78, 95%CI: 4.70, 12.88), having a history of obstetrics complications such as prolonged labor (Adjusted OR = 3.78, 95%CI:2.11, 6.75), a history of cesarean section (Adjusted OR = 2.49, 95%CI:1.42, 4.35), and history of uterine repair (Adjusted OR = 18.01, 95%CI: 6.81, 47.64) were significantly associated with uterine rupture. This finding showed that the trend is declining, and the proportion of uterine rupture is still higher. A more vigilant approach to increase access to lower-income mothers, prevent prolonged and obstructed labor, and maintain antenatal care with complete packages and a referral system are issues to be addressed to minimize the chance of uterine rupture among women.

Missed nursing care and associated factors among nurses at University of Gondar Comprehensive Specialized Hospital, Ethiopia, 2022

The issue of missed nursing care is a problem that affects the overall quality of nursing care in hospitals around the world. However, there is limited research about it in Ethiopia. This study assessed missed nursing care and factors among nurses. An institutional-based cross-sectional study was conducted among 485 nurses at the University of Gondar Specialized Hospital. The data were collected from May 15 to June 15, 2022 using a self-administered questionnaire. A simple random sampling technique was used to select study participants. The data was entered to EPI DATA version 4.6 and exported to SPSS version 23 for analysis. Descriptive statistics were computed, and a summative score of missed nursing care was calculated. Then, multiple linear regression analysis was used to identify the factors. A P-value of 0.05 was used to declare significant level. In this study, missed nursing care was 62.5% (95% CI 60.98–64.02). Documentation, vital signs assessment, intravenous care, and assessment as per hospital policy and patient education were the most frequently missed nursing care. Being single in marital status (B = −4.609, P = 0.004), adequacy of nursing staff (B = −2.458, P = 0.003), satisfaction with income (B = −8.753, P = 0.007), working in medical unit (B = −5.708, P = 0.002) and working in both day and night shift (B = 1.731, P = 0.027) were statistically associated factors. More than half of the participants missed basic nursing care. Most of the identified factors correlated with missed nursing care negatively. Efforts should be done to enhance communication between health team members, assign a manageable number of patients per nurse, and adjust shifts and units.

Patient autonomy in self-managing their bronchial asthma exacerbation and its associated factors, 2024

IntroductionAsthma, a global chronic respiratory condition, varies in patient autonomy due to limited resources, health literacy, and cultural beliefs, emphasizing the importance of understanding this autonomy for improved asthma management.MethodsA cross-sectional study was conducted at Jimma University Comprehensive Specialized Hospital, involving face-to-face interviews with 175 patients. Data was collected on sociodemographic characteristics, clinical factors, and autonomy levels using a validated Patient Autonomy Preference Index. Descriptive statistics and binary logistic regression analysis were used.ResultsA total of 175 participants were recruited, out of them 41.7% (95% CI: 31.19, 40.41)) of participants were autonomous in managing their asthma exacerbation. 127 (72.6%) of study participants were female, with a mean age of 47.51 (SD ± 13.96), 101(57.7%) were live in urban areas, 54 (30.9%) had no formal education, 140 (80%) were married, 112 (64%) had health insurance, and 102(83.3%) obtained health information about their condition from healthcare workers. Reside in an urban area (AOR = 3.24; 95% CI: 1.40–7.49, p < 0.006), have health insurance (AOR = 4.30; 95% CI: 1.76–10.51, p < 0.001), those doing regular exercise (AOR = 4.79; 95% CI: 1.69–13.64, p < 0.003), have family history (AOR = 7.47; 95% CI: 1.61–34.60, p < 0.01), have a duration above five years since diagnosis (AOR = 0.44; 95% CI: 1.04–1.26, p < 0.003), and participants with a high level of health literacy (AOR = 1.10; 95% CI: 1.00–1.20, p < 0.042) become associated with being autonomous in managing asthma exacerbation.Conclusion and recommendationOnly around forty-two percent of study participants were autonomous in managing their asthma exacerbation. Thus healthcare providers should give due attention to those who reside in rural areas, are not insured, recently diagnosed with asthma, and with low health literacy to enhance patient autonomy and self-management practices, ultimately improving health outcomes for individuals with asthma.

Nurses’ implementation of evidence based practice in nursing process and its associated factors in South Wollo Zone public hospitals, Northeast Ethiopia: a mixed method study

BackgroundEvidence-based practice is clinical decision-making using the best evidence available in the context of individual patients’ preferences and clinical expertise. It is serving as a crucial instrument for the health science disciplines to minimize the theory-practice gap although the level of practice is unknown. Thus, this study aimed to assess nurses’ implementation of evidence-based practice in nursing process and its associated factors in South Wollo Zone Public Hospitals.MethodsAn explanatory sequential mixed method was employed from April 1 to May 29, 2023, among 419 nurses for the quantitative part and 15 others for the qualitative part. The data were collected using structured, pretested, self-administered questionnaires. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. The bivariable analysis was done primarily, and variables with a p-value < 0.25 were further examined using a multivariable logistic regression model to control con-founders. Then, variables having a p-value less than 0.05 with a 95% CI were used to declare significantly associated factors. The key informants were interviewed using pre-made interview guidelines, and then open code software was utilized to conduct a thematic analysis.ResultNurses who had poor implementation of evidence-based practice in the nursing process were 228 [54.42%; 95% CI: (49.8–59.3)]. Similarly, the key informants concluded that the implementation of evidence-based practice in the nursing process was low. Participants who were 31– 40 years old [AOR = 0.61, 95% CI: (0.38–0.99)], 41–50 years [AOR = 0.32, 95% CI: (0.15–0.65)], working at general hospitals [AOR = 3.37, 95% CI: (1.39–8.18)] and comprehensive specialized hospitals [AOR = 7.29, 95% CI: (3.06 − 17.31)], lack of training about evidence-based practice (AOR = 2.50, 95% CI: (1.36–4.56)], and lack of internet access [AOR = 2.46, 95% CI: (1.43–4.23)] were factors associated with poor levels of nurses’ implementation of evidence-based practice in the nursing process. The absence of computers, libraries, and updated guidelines were other factors identified on the quality analysis.ConclusionNurses’ implementation of evidence-based practice in the nursing process was low. Age, working in general hospitals, and comprehensive and specialized hospitals, lack of training, and internet access were factors that had significant associations. Hence, hospital managers should give an attention to internet access and training about utilization of evidence-based practice in nursing process, particularly for those aged above thirty years old.

P-72373284-1386 - Patterns of Primary Oral and Maxillofacial Malignancies among Patients seen at Tikur Anbessa Comprehensive Specialized Hospital – A retrospective study.

P-72373284-1386 - Patterns of Primary Oral and Maxillofacial Malignancies among Patients seen at Tikur Anbessa Comprehensive Specialized Hospital – A retrospective study.

Comparative Assessment of Fetal Malnutrition Using the Clinical Assessment of Nutritional Score and Anthropometry Among Newborns Delivered at Debre Markos Comprehensive Specialized Hospital, Ethiopia

Comparative Assessment of Fetal Malnutrition Using the Clinical Assessment of Nutritional Score and Anthropometry Among Newborns Delivered at Debre Markos Comprehensive Specialized Hospital, Ethiopia

The effect of war and siege on children with diabetes admitted to ayder comprehensive specialized hospital in mekelle, tigray, ethiopia: a cross-sectional study

The armed conflict in Tigray, which spanned from November 2020 to November 2022, along with the accompanying siege, led to the near-total collapse of Tigray’s healthcare system. Type 1 Diabetes Mellitus, the most common chronic condition in children, requires significant lifestyle adjustments, including daily insulin injections, regular glucose monitoring, and dietary modifications; all of which are severely impacted by war and siege. This study compared Type 1 diabetes care for children at the Ayder Comprehensive Specialized Hospital, Tigray, during the conflict and siege period with that of the pre-war period. We conducted a retrospective cross-sectional survey, analyzing data from September 2019 to August 2020 (pre-war period) and comparing it with data from September 2021 to August 2022 (war and siege period). Descriptive statistics, including frequencies and percentages, were employed, and Pearson’s or Spearman’s correlation analyses were used to evaluate correlations where appropriate. We identified 143 pediatric patients admitted (56 during the pre-war period and 87 during the war and siege period), with a mean age of 109 months in both periods. During the war and siege, a higher proportion of diabetes admissions were due to diabetic ketoacidosis (DKA) (90%) compared to the pre-war period (75%). In the pre-war period, the most common trigger for DKA was infections (35%), while in the war and siege period, it shifted to malnutrition (47%), infections (46%), lack of access to healthcare facilities (31%), and running out of medicines (24%). Complications such as death, renal failure, cerebral edema, and shock were more prevalent during the war and siege periods. The case fatality rate was significantly higher during the war and siege (9%) compared to the pre-war period (0%), correlating strongly with the severity of DKA, the degree of hypokalemia, the presence of complications, and admission during the war and siege. Our study showed the negative impact of war and siege on diabetes care in children demonstrating a high rate of DKA admissions with increased severity, complications, malnutrition, and case fatality rates. People with diabetes especially type 1 deserve great attention during such a crisis as the lack of insulin could lead to severe complications including death.

Severe Deep Fascial Spaces Infections with Pregnancy: A Retrospective Study.

Background: Odontogenic infections are common and self-limiting in most cases, but, they can lead to severe consequences and considerable morbidity and can even be fetal in spite of modern medical therapy. Patients and Methods: Retrospective study included data of pregnant patients with deep fascial space infections, done in Oral & Maxillofacial Surgery Department, Faculty of Dentistry. Alexandria University, and Oral & Maxillofacial Surgery Department, King Fahd Specialist Hospital, Burayda, Qassim, Saudi Arabia, from June2017 to Dec2022. Data were analyzed to study incidence, etiology, pattern, treatment modalities, outcomes, complications, and effects on pregnancy. Results: Thirty-eight pregnant patients, with a mean age of 30.8 ± 6.21 years, were included. The mean age of pregnancy was 24.5 ± 4.3 weeks. Diabetes mellitus was identified in seven cases (18.42%) and combined with hypertension in one case (2.63%) and with valvular heart disease in another one. The commonest affected single space was the submandibular space that occurred in six cases (15.8%). Canine space was the second single commonly involved one which occurred in five patients (13.2%). Complications occurred in 11 patients. Unesthetic scar occurred in three patients (7.9%). Trismus was observed in two patients (5.3%). Recurrent abscess was found in one case. Complications affecting the developing fetus and considered the most serious occurred in four patients: two cases of preterm labor and two cases of abortion. Conclusion: These infections may lead to serious outcomes and may have irreversible effects on the pregnancy and the developing fetus. Urgent intervention with multidisciplinary team to provide adequate care.

Bacterial profiles and their antibiotic susceptibility patterns in neonatal sepsis at the University of Gondar Comprehensive Specialized Hospital, Ethiopia

BackgroundNeonatal sepsis is a major cause of morbidity and mortality worldwide. Understanding the bacterial profiles and antibiotic susceptibility patterns causing neonatal sepsis is crucial for guiding appropriate treatment, improving patient outcomes, and combating the emergence of antibiotic resistance. Despite its importance, data regarding neonatal sepsis in the study area is limited. Therefore, this study aimed to characterize the bacterial pathogens and identify associated factors among neonates with suspected sepsis at the University of Gondar Comprehensive Specialized Hospital, Ethiopia.MethodsA cross-sectional study was conducted by reviewing laboratory records of neonates admitted for suspected sepsis from January 2019 to December 2021. Data were checked for completeness and encoded in a spreadsheet program. Then, data were exported to STATA version 17 for analysis. Descriptive statistics such as frequency and percentage were computed. The association between neonatal sepsis and potential risk factors was assessed using Pearson’s chi-square test. A p-value of &amp;lt; 0.05, was considered statistically significant.ResultsA total of 1,236 neonates were included. Of these, 96.2% (1,190/1,236) had a fever before admission. The prevalence of culture-confirmed sepsis was 25.4% (314/1,236). Bacterial pathogens accounted for 23% (284/1,236) of these isolates, with Gram-negative bacteria being more prevalent at 75.3% (214/284) than Gram-positive bacteria at 24.7% (70/284). The most frequently isolated bacterial pathogens were K. pneumoniae 38.7% (110/284) and S. aureus 13% (37/284). The isolates demonstrated a high resistance level to commonly used antibiotics, with 61.6% exhibiting multidrug resistance. K. pneumoniae showed the highest rate of multidrug resistance (90.9%). Neonatal sepsis was associated with several factors, including fever before and after admission, hypothermia, increased respiration, suspected pneumonia, and suspected meningitis.ConclusionThis study identified a high prevalence of culture-confirmed sepsis in neonates at UoGCSH, with Gram-negative bacteria, especially K. pneumoniae, dominating the isolated pathogens. The isolated bacteria exhibited alarming resistance to commonly used antibiotics, with a high proportion demonstrating multidrug resistance. Implementing effective antibiotic stewardship programs is crucial to optimize antibiotic use, reduce unnecessary prescriptions, and curb the spread of resistant strains.

Outcomes of Open Knee Joint Injuries in Trauma Patients at Tibebe-Ghion Specialized Hospital, Bahir-Dar, Ethiopia

Background: Open knee joint injury is a deep traumatic laceration violating the joint capsule. This study aimed to assess outcomes and associated factors of open knee joint injuries in trauma patients at Tibebe-Ghion Specialized Hospital, Bahirdar, Ethiopia, 2021. Methods: An institution-based retrospective cross-sectional study was conducted by reviewing the medical records of 43 patients treated for open knee joint injuries from January 2019 to July 2021, with an 86% response rate. Data were entered and exported using Epidata Manager Version 4.4 and analyzed using SPSS version 25. Results: Fourteen (32.5%) of the study subjects developed either infections or limping during follow-up due to open knee injuries, with the majority of injuries (58.1%) being caused by car accidents. The presence of associated injuries, wound size, time to wound closure, debridement as a management option, sex, and diagnostic methods showed a significant association with complication outcomes. Among the diagnosed infections, 90% were cases of septic arthritis. During the study period, eight patients (18.6%) developed limping during follow-up. The complication rate among open knee injury patients in the study area was significantly high, with one-third of patients experiencing complications. Targeted public awareness campaigns like car accidents should be conducted to educate the population about orthopedic emergencies and strategies to reduce complication risks, aiming for more favorable outcomes.

Histopathologic Patterns of Urinary Bladder Lesions and Associated Factors in Hawassa University Comprehensive Specialized Hospital, Sidama Region, Ethiopia

Background: Urinary bladder lesions, non-neoplastic and neoplastic, are collectively responsible for significant morbidity and mortality throughout the world. Bladder cancer is a prevalent disease affects a significant number of individuals each year worldwide. The most common non-neoplastic and neoplastic lesion of the urinary bladder is non-specific cystitis and urothelial carcinoma respectively. Objectives: The aim of this study is to describe histopathologic patterns of urinary bladder lesions and associated risk factors in Hawassa University Comprehensive Specialized Hospital from January 2017 to December 2023. Methods: A 7-year cross sectional study was conducted to describe histologically diagnosed bladder lesions and associated factors at Hawassa University Comprehensive Specialized Hospital from January 2017 to December 2023. Results: This study comprised a total of 182 patients who have bladder biopsies at Hawassa University Comprehensive Specialized Hospital, Pathology department from January 2017 to December 2023. Out of which 21 cases (12.1%) are non-neoplastic, while 152 cases (83%) are neoplastic. Nine cases (4.9%) have a descriptive diagnosis. With 139 (90.44%) cases, urothelial neoplasms have the highest frequency form all neoplastic lesions. Ninety-seven cases, or 69.8%, of urothelial neoplasms were invasive; of them, 78 (80.4%) were high grade cases. Low-grade noninvasive papillary carcinomas, which accounted for 24 instances. One case is a cystectomy specimen, and the remaining 181 cases are TURBT. The age range of 50-59 years was the most frequent accounting for 39 (21.4%) of all cases, with a male to female (M: F) ratio of 2.9:1. The most frequent presenting symptom in 146 (85.7%) of patients was hematuria. Conclusions: This study demonstrates that 139 (90.44%) of the neoplastic bladder lesions were bladder neoplasms of urothelial origin, 97 (69.8%) of which are invasive urothelial carcinoma with rising numbers each year and implying the burden in the region.

Prevalence and associated factors of acute postoperative pain in adult surgical patients: A prospective study

BackgroundPain, as defined by the International Association for the Study of Pain, is an unpleasant sensory and emotional experience associated with, or resembling, that is associated with actual or potential tissue damage. In Ethiopia, where healthcare facilities and offerings are expanding to handle countless patients requiring surgical intervention, managing acute postoperative pain is a serious concern. ObjectivesTo assess the prevalence of acute postoperative pain and associated factors after elective surgery among adult patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2023 MethodologyThis is an institution-based cross-sectional study. A structured data collection format was used to collect data from 219 participants. Bivariable and multivariable logistic regression analyses described the association between independent and dependent variables. ResultsOf 219 patients, 180 (82.2 %) had acute postoperative pain. The prevalence of moderate to severe pain was 34.24 %. Preoperative anxiety, the use of intraoperative analgesics, and duration of surgery were the main factors associated with the prevalence of acute postoperative pain. ConclusionOur study revealed that the overall prevalence of postoperative pain was relatively low in the study area. This suggests that the attention given to postoperative pain recognition and management is better than that in other areas. However, the finding of a significant gap in managing postoperative pain underscores the need for further improvements in pain management practices. This should motivate us to commit to change, particularly in the identified areas of concern, such as preoperative anxiety, use of intraoperative analgesics, and duration of surgery.

Perceptions towards practicability of humanitarian principles for emergency cases in Ethiopia: case of Tikur Anbessa Specialized Hospital

IntroductionThe health of people is negatively impacted by emergencies and catastrophes, and many lives are lost as a result. The guidelines for humanitarian action during times of crisis, whether brought on by armed war or natural disasters, are provided by the humanitarian principles. The purpose of this study was to evaluate how the staff and clients at Tikur Anbessa Specialized Hospital felt about the applicability of the four humanitarian principles when responding to emergency conditions.MethodologyFacility-based descriptive and explanatory cross-sectional study designs were employed. The study intended to collect data with structured questionnaires from a total of 209 individuals in Tikur Anbessa Specialized Hospital. The participants were selected randomly based on, their willingness. Of the 209 participants, 105 included staff and the rest 104 included clients (patients and caregivers in the emergency room) of Tikur Anbessa Specialized Hospital. The collected data were analyzed using Statistical Package for Social Science version 23.ResultsThe descriptive analysis shows that principles of humanity are practiced better with (mean = 3.5) and principles of impartiality are practiced less with (mean = 3.2) as to the perception of the participants. Correlational analysis was used to examine the relationship between the ages, profession, gender, status, work experience, and familiarity with humanitarian principles, and the results indicated a non-significant correlation between variables, r (209) = 0.01 (2 tailored), “p = ns”. This suggests that familiarity with humanitarian principles or other independent variables does not affect the applicability of humanitarian principles in healthcare settings.ConclusionFrom the results of this study, it can be concluded that the state of being a staff (health care practitioners and those providing ancillary services) and client of Tikur Anbessa Specialized Teaching Hospital has nothing to do with developing a certain perception towards the practicability of the four humanitarian principles (humanity, impartiality, neutrality, and independence).

Assessment of serum protein profile in sickle cell disease

Background: Sickle Cell disease (SCD) is known to be caused by a mutation in the beta-globin gene of the hemoglobin that affects the red blood cells (RBCs) and is passed down through generations. This study was carried out to determine the effect of sickling of RBC on serum protein profile in SCD individuals. Methods: A case-controlled study was carried out among 80 patients. They were forty-five sickle cell disease individuals (HbSS) attending Children Specialist Hospital Ilorin and thirty-five healthy controls (HbAA). The levels of total protein and albumin were determined spectrophotometrically and serum protein electrophoresis (SPE) was carried out using cellulose acetate electrophoresis. Results: Significant hypoalbuminemia and hypergammaglobulinemia were observed in SCD groups compared with controls. A higher proportion of the SCD group, 11(25%) had hypergammaglobulinemia and 21(49%) had hypoalbuminemia (P&lt;0.05). Plasma protein electrophoresis in SCD patients shows an intense colour at the gamma region which was not seen in control. There was a significant relationship between the patterns of serum protein electrophoresis and the frequency of crisis. Conclusions: Sickle cell disease crisis and other associated underlying conditions may be prevented early through assessment of serum protein profile, especially SPE. Hypergammaglobulinemia and hypoalbuminemia may be associated with frequent episode of crisis.