Specialist Hospital Research Articles

Prevalence of antibacterial resistance among hospitalized patients in Tigray, Ethiopia, 2021: A cross-sectional design

ObjectiveTo describe the prevalence of antibacterial resistance among hospitalized patients in Tigray. MethodsA cross-sectional study design was applied in hospitalized septic medical patients in Ayder Comprehensive Specialized Hospital from March 2020 to January 2021. Socio-demographic, clinical, and laboratory-related data was collected, and descriptive analysis was done to present the result. ResultIn this study, a total of 153 hospitalized septic patients were included with a median age of 30 IQR (22-49) years. A total of 187 different samples were collected from 153 participants of the blood and foci of infection, and bacterial isolates were found in 103 (55%) samples. A total of 70 (45.6%) septic patients showed antibacterial resistance at least to one antibiotic. The most common isolates were Klebsiella pneumonia, followed by Escherichia coli and Acinetobacter species with equal distribution. These isolates were found to be resistant to ampicillin (79.9%), cotrimoxazole (64.1%), and ciprofloxacin (64.1%). ConclusionThis study revealed a significant problem of antibacterial resistance in the referral hospital. The most commonly prescribed and affordable antibiotics were found to be resistant. So, the hospital and the country as well are expected to minimize the magnitude of the problem through different AMR strategic stewardship initiatives.

Lung abscess caused by Streptococcus constellatus: Case report

This case report presents a detailed case study of Lung abscess caused by Streptococcus constellatus. This case underscores the critical role of accurate microbiological diagnosis in the effective management of lung abscesses, highlighting the necessity for precise identification and targeted treatment strategies. A 47-year-old male who exhibited persistent fever and mucopurulent cough, leading to a visit to the Emergency Department of a local hospital in Riobamba, Ecuador. Initially, the patient was diagnosed with pneumonia and treated with moxifloxacin and itraconazole. However, as his condition deteriorated, he was transferred to a specialty hospital in Quito, Ecuador. Chest X-rays identified a cavitary lesion, which was further confirmed by CT chest imaging to be a lung abscess. Additional diagnostic work through CT-guided biopsy and culture confirmed the presence of Streptococcus constellatus. The patient's treatment regimen included targeted antibiotic therapy with piperacillin-tazobactam, resulting in a six-week hospitalization. The patient's condition significantly improved, and he was subsequently discharged.

A retrospective study to assess the effectiveness of bath in burns healing by reducing the Length of Stay in hospital at Apollo Speciality Hospital, Vanagaram

Background: Ours is a dedicated burns unit at Apollo Speciality Hospitals, Vanagaram. This study deals with two mass casualties at Neyveli Lignite Corporation (NLC) and Pharmaceutical company (Pondicherry). This came to initiate the quick recovery of the patient of the hospital stay. Methods: Retrospective cohort study research design was taken for this study. The study was conducted at Apollo Speciality Hospitals, Vanagaram for a duration of 3 months, 60 samples using simple random sampling who met the inclusion criteria were selected as study samples. Data collection tool such as Socio- Demographic Data (Age in years, Sex, Average Length Of Stay, Scar sites) and clinical variables proforma of cleansing modality, cleansing solution, additives, frequency were used. Result: Percentage of total body surface area will reflect in Average Length Of Stay. 33 responders were given the bathroom bath was discharged with 11-20 days of hospital stay. 4 responders of bathroom bath were discharged with 21-30 days of hospital stay. In this study the estimation of hospital Length Of Stay was calculated as 1 day per percent total body surface area burn (1 day/%TBSA) by improving the wound healing by giving bathroom bath. Conclusion: Wound cleansing and dressing is the basic procedure where the wound healing begins.

Prevalence of treatment-resistant depression and associated factors among major depressive disorder follow-up patients at Saint Amanuel Mental Specialised Hospital in Ethiopia: a cross-sectional study

ObjectivesThis study aimed to assess the prevalence of treatment-resistant depression (TRD) and associated factors among patients with major depressive disorder (MDD) on follow-up at Amanuel Mental Specialised Hospital, Addis Ababa,...

Neurocognitive impairment and its associated factors among patients with diabetes mellitus who have follow up at referral hospital in Northwest, Ethiopia

BackgroundNeurocognitive impairment is a condition that makes it difficult for a person to make decisions that affect memory, learning new things, concentration on daily activities, and can range from mild to severe forms. It is a major health problem, less known and less addressed complication of diabetes mellitus.ObjectivesThe aim of the study is to assess prevalence of neurocognitive impairment and associated factors among diabetic mellitus patients.MethodsWe conducted an institutional-based cross-sectional study involving 512 diabetic patients under follow-up at XXX Specialized Hospital from March 1 to April 30, 2023. Data on cognition, behavior, and depression were collected using standardized tools, including the Mini Mental State Examination for cognition, the CAGE assessment tool for alcohol-related behavior, and the PHQ-9 for depression. These assessments were conducted through face-to-face interviews and chart reviews. A diagnosis of diabetes is confirmed in adults when fasting blood glucose levels exceed 126 mg/dl in three consecutive follow-up measurements. Data entry was performed using Epidata version 4.6, and analysis was conducted using SPSS version 26. Variables with a P-value < 0.25 in bivariate analysis were included in multivariable logistic regression. Statistical significance was set at P ≤ 0.05 with a 95% CI. Results were presented using tables, graphs, and descriptive text.ResultsThe prevalence of neurocognitive impairment among diabetic patients at XXX Comprehensive Specialized Hospital was 28.3% [95% CI: 24.57–32.39]. Factors associated with this impairment included being female (AOR=2.29 [95% CI: 1.43-3.67]), rural residence (AOR=3.16 [95% CI: 2.01-4.95]), comorbidity (AOR=3.30 [95% CI: 2.08-5.23]), diabetes duration of 6-10 years (AOR=1.72 [95% CI: 1.01-2.94]), diabetes duration >10 years, and blood sugar level >126 mg/dl (AOR=2.25 [95% CI: 1.42-3.57]). Patients are encouraged to adhere to proper medication regimens to effectively control their blood glucose levels. This study found a high prevalence of neurocognitive impairment (NCI) among diabetic patients, affecting about one-fourth based on MMSE scores. Key risk factors identified include female gender, rural residence, comorbidities, longer duration of diabetes, and elevated blood glucose levels.

Successful biventricular assist device Berlin heart implantation leading to heart transplant in a complicated pediatric case: an experience from a single center

The use of the Berlin heart EXCOR ventricular assist device (VAD) as a bridge to heart transplantation in pediatric patients has become increasingly widespread. This case report presents a detailed account of the successful implantation of a biventricular assist device (BIVAD) Berlin heart device in a complex pediatric case at the esteemed King Faisal Specialist Hospital and Research Center. The patient, diagnosed with dilated cardiomyopathy (DCM) and Kawasaki disease, underwent a series of interventions and treatments before requiring extracorporeal membrane oxygenation (ECMO) support and subsequently receiving the Berlin heart device. The post-implantation period was marked by significant challenges, including instances of bleeding and clot formation, necessitating multiple interventions and careful management. Ultimately, a heart transplant was performed; however, the patient encountered humoral rejection, leading to additional targeted treatment. Despite these intricate complications, the patient exhibited substantial improvement in left ventricular ejection fraction (LVEF) following the transplant, indicating a positive outcome. This case underscores the successful use of a BIVAD Berlin heart device as a viable bridge to heart transplantation in a complicated pediatric case, highlighting the crucial role of a multidisciplinary approach and meticulous management of complications throughout the entire treatment process.

A Comparative Study of Imipramine and Tolterodine for the Treatment of Children with Primary Nocturnal Enuresis

Background: Nocturnal enuresis (NE), or bed-wetting, affects children aged ≥5 years after ruling out organic causes. The ICCS defines NE as intermittent urinary incontinence during sleep, categorized into monosymptomatic (MNE) and non-monosymptomatic (NMNE) forms. NE is also classified by onset: primary (no dry period) and secondary (bed-wetting after a dry period). Contributing factors include sleep disorders, stress, hereditary predisposition, and delayed bladder development. Management involves behavioral and pharmacological treatments, with desmopressin and anticholinergic drugs being common options. Aim of the study: This study aims to find out an alternate effective and safe drug for the treatment of primary nocturnal enuresis. Methods: This study was conducted at the Department of Urology(outdoor), Shahid Sk. Abu Naser Specialized Hospital, Khulna, Bangladesh from January 2020 to December 2021. After excluding 12 patient’s pre-randomizations for non-cooperation, 60 patients were split into two groups: Group A received 25mg of imipramine before bedtime, while Group B took 1mg of tolterodine tartrate twice daily evaluated efficacy over 6 months, including a 2-week behavioral modification baseline and follow-ups at 3 and 6 months. Data were analyzed using SPSS 26, employing various statistical tests with significance set at p <0.05. Result: The study involved 60 children (mean age 10.0±3.1 years, 55% male), assessing bed-wetting patterns and treatment outcomes. The majority (80%) had unsatisfactory behavioral modifications, with 35% having a family history of enuresis. Both groups (A and B) showed no significant difference in bed-wetting episodes at baseline or after 3 months of treatment. Complications were more common in Group A, including dry mouth, nausea, and insomnia. Imipramine led to a higher proportion of patients with fewer than 50 dry nights after drug withdrawal, while Tolterodine showed better results at month 3 but a higher decrease in dry ...

An alternative communication model for breastfeeding intervention in antenatal clinics

Objectives: This study evaluated the effectiveness of the dual-feedback loop communication model in countering misconceptions about exclusive breastfeeding among pregnant women attending routine antenatal clinic at Specialist Hospital, Yola Adamawa State, Nigeria. The specific objectives of the study are to: (a) Use a pre-test to identify misconceptions pregnant women have on exclusive breastfeeding; (b) implement a behavior change intervention that targets the knowledge, attitude, and practices (KAPs) of pregnant women; and (c) administer a post-test to determine a variance in the KAPs of pregnant women after the intervention. Material and Methods: A mixed-method design that combines quantitative and qualitative methods was adopted for the study. Data for the study comprised health talks delivered in antenatal clinics and responses of cross-section of participants in pre- and post-tests. Thirty-three (33) pregnant women selected purposively served as participants for the study. Participants who met the inclusion criteria had previously breastfed and have been attending the routine antenatal clinical sessions at Specialist Hospital, Yola. The rhetorical structure of the health talks were examined based on insights from discourse and communication theories. Results: Results of the qualitative analysis revealed misconceptions on exclusive breastfeeding arising from inadequate (K)nowledge, poor (A)ttitudes, and unhealthy (P)ractices. The quantitative analysis revealed significant variation between maternal (K)nowledge (KEBF r = 0.636, P > 0.05), (A)ttitude (AEBF r = 0.595, P > 0.05), and (P)ractices (PEBF r = 0.757, P > 0.05) on exclusive breastfeeding and the intervention’s impact. Conclusion: Misconceptions about exclusive breastfeeding and defects in the communication model used in delivering health talks perpetuate misconceptions among pregnant women attending antenatal clinic in the health facility studied. Empowering pregnant women attending antenatal clinics with requisite knowledge of the health benefits of exclusive breastfeeding using a dual-feedback loop communication model can promote compliance to exclusive breastfeeding, which, ipso facto, can reduce the incidence of child mortality resulting from non-compliance to exclusive breastfeeding. Further research is needed to test the effectiveness of the dual-feedback loop model in countering misconceptions in other health talks in Nigeria.

Prognostic Significance of DSCC1, a Biomarker Associated with Aggressive Features of Breast Cancer

Background and Objectives: Invasive breast cancer (BC) was traditionally investigated visually, and no technique could identify the key molecular drivers of patient survival. However, essential molecular drivers of invasive BC have now been discovered using innovative genomic, transcriptomic, and proteomic methodologies. Nevertheless, few evaluations of the prognostic factors of BC in Saudi Arabia have been performed. Evaluating the biomarkers associated with the development of early-stage BC could help determine the risk of metastasis and guide treatment decisions. In a previous study, using large BC cohorts and artificial neural network techniques, DNA replication and sister chromatid cohesion 1 (DSCC1) was found to be one of the principal genes in invasive BC samples. To date, no studies have addressed the prognostic significance of DSCC1 in invasive BC and its association with aggressive tumor behavior. This research aimed to address this gap. Materials and Methods: The association of clinicopathological features and patient outcomes with DSCC1 expression at the mRNA level was assessed using the Molecular Taxonomy Breast Cancer International Consortium (METABRIC; n = 1980) and The Cancer Genome Atlas (TCGA; n = 854) cohorts. DSCC1 was also evaluated at the protein level using immunohistochemistry on samples from invasive BC patients (n = 100) presenting to King Abdul Aziz Specialist Hospital in Saudi Arabia. The association of clinicopathological parameters (including patient age, tumor grade, tumor size, and patient outcome) with protein level was also evaluated. Results: In both METABRIC and TCGA cohorts, high expression of DSCC1 was significantly associated with high histological grade, large tumor size, lymphovascular invasion positivity, and hormone receptor negativity (all p < 0.001). A high DSCC1 mRNA level was associated with poor outcomes (p < 0.001 for METABRIC, p = 0.23 for TCGA). At the protein level, high DSCC1 expression was associated with high histological grade (p = 0.001), lymph node presence (p = 0.008), hormone receptor negativity (p = 0.005), high Ki67 expression (p = 0.036), and shorter survival (p = 0.008). Conclusions: This study confirmed the prognostic significance of DSCC1 in invasive BC patients. DSCC1 could be a therapeutic target in BC cases with poor outcomes.

Asymptomatic nasopharyngeal carriage of multidrug resistant bacteria among children at University of Gondar Hospital Northwest Ethiopia Revealing Hidden Health Risks

Gram-negative bacteria in the nasopharynx can eventually invade bacteria-limited sites and cause serious illnesses such as meningitis, otitis media, and pneumonia. However, data related to the carriage of these bacteria in children attending outpatient departments in the study area are limited. To assess nasopharyngeal carriage, antibiotic susceptibility patterns, and associated factors of gram-negative bacteria among children attending the outpatient department at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A hospital-based cross-sectional study was conducted from September 1, 2023, to December 30, 2023. A total of 385 children aged 3 to 14 years were enrolled using a systematic random sampling technique. Sociodemographic and clinical data were collected using a semistructured questionnaire. A total of 385 nasopharyngeal samples were collected using a sterile specimen collection nasopharyngeal swab, transported using Amie’s transport medium, and subsequently inoculated on chocolate agar, blood agar, modified thayer martin agar, and MacConkey agar plates. Bacterial species were identified by colony morphology, Gram staining, and biochemical tests such as oxidase tests, satellitism tests, and carbohydrate utilization tests. An antibiotic susceptibility test was performed using the Kirby–Bauer and modified Kirby–Bauer methods on Mueller–Hinton agar plates. The data were entered into Epi-Data version 4.6.0.6 and exported to SPSS version 25 for analysis. The adjusted odds ratio at a 95% confidence interval with a P value of < 0.05 in the binary logistic regression model was considered to indicate statistical significance. The overall nasopharyngeal carriage of gram-negative bacteria was 146 (37.9%) (95% CI: 33.2–42.9). Among these, nonfastidious gram-negative bacteria represented 45 (11.7%), followed by M. catarrhalis 41 (10.6%), N. meningitidis 34 (8.8%), and H. influenzae 26 (6.8%). The isolates exhibited high resistance to tetracycline (85; 75.9%), trimethoprim-sulfamethoxazole (105; 71.9%), ampicillin (76; 67.9%), and amoxicillin/clavulanic acid (60; 69.8%) but high susceptibility to meropenem (122; 83.6%), gentamicin (73; 84.9%), and minocycline (87; 72.5%). There were 99 total multidrug-resistant strains (67.8%, 95% CI: 59.7–75.0). Male sex (AOR = 1.785, 95% CI: 1.102–2.892, P = 0.019), smoking (AOR = 2.675, 95% CI: 1.149–6.230, P = 0.022), and large family size (≥ 5) (AOR = 1.857, 95% CI: 1.140–3.023, P = 0.013) were risk factors for nasopharyngeal colonization. Increased nasopharyngeal colonization of multidrug-resistant gram-negative isolates was observed in this study. Gentamicin, minocycline, and meropenem were the most effective antibiotics for the tested isolates. Bacterial colonization increased with increasing family size, smoking status, and male sex. Therefore, a definitive diagnosis in the outpatient pediatric department should be based on culture and susceptibility test results.

Evaluation of Musculoskeletal Physiotherapy Service Quality in Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia

Evaluation of Musculoskeletal Physiotherapy Service Quality in Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia

Affordability of health services and associated factors among patients with diabetes mellitus under regular follow-up at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia

BackgroundThe burden of chronic illnesses, including cardiovascular disease and diabetes, is increasing in low- and middle-income countries. However, health systems often struggle to meet the needs of chronically ill patients. Affordability is crucial in ensuring access to quality healthcare for patients with diabetes mellitus (DM) and evaluating healthcare costs. Therefore, this study aimed to assess the affordability of health services and identify associated factors among DM patients receiving regular follow-ups at Dessie Comprehensive Specialized Hospital in Northeast Ethiopia, 2023.MethodsA cross-sectional study was conducted among 392 DM patients at Dessie Comprehensive Specialized Hospital (DCSH) from July 1 to 30, 2023. Data was collected using a structured questionnaire and chart review checklist. Systematic random sampling was employed, and the data were analyzed using EPI INFO version 7 and SPSS version 26. The outcome variable, affordability of health services, was measured by five items using a structured questionnaire. Logistic regression analysis was performed to identify significant factors associated at 95% confidence interval using odds ratio.ResultsMost participants were married (74.2%), and 55.9% were male. Among the DM patients, 211 (53.83%) found the health services affordable, with an interval of 48.85–58.72% at a 95% confidence interval with a p-value less than 0.05. Factors significantly associated with healthcare affordability included marital status, family size, average monthly income, and brand prescription.ConclusionThe study revealed that healthcare services were affordable for approximately half of the DM patients. However, this level of affordability falls short of the ideal standard. Improving the affordability and accessibility of healthcare services for DM patients, particularly those from low-income backgrounds, is crucial to ensuring better health outcomes.

Assessing differences among persistent, episodic, and non- high-need high-cost hospitalized children in China after categorization by an unsupervised learning algorithm

BackgroundHigh-need, high-cost (HNHC) patients are a major focus of international healthcare reform. However, research on HNHC children in China remains limited. This study aims to classify HNHC pediatric patients, analyze the differences among groups, and explore the factors influencing HNHC status.MethodsData were obtained from a retrospective observational cohort of hospitalized children in Shanghai, China from 2017 to 2023. K-means clustering, one of the unsupervised learning algorithms, was employed to classify patients according to their HNHC status. Descriptive statistical analysis and the Kruskal-Wallis H test were used to describe and test the differences among different groups, with the logit regression models to analyze the predictors.Results688,131 hospitalized children were classified into three groups: 1,871 persistent HNHC, 32,539 episodic HNHC, and 653,721 non-HNHC. Significant differences were observed among these groups. Persistent HNHC patients have significantly higher costs and longer HNHC durations compared to episodic and non-HNHC patients, who were more likely to be aged 30 days to 1 year or 13–18 years, female with only one type of health insurance, and leukemia was the most prevalent and costly disease. They exhibited distinct healthcare utilization patterns, including emergency admissions, higher surgery rates, longer hospital stays, more frequent hospitalizations, and a preference for tertiary and specialized hospitals in city centers. Multiple influencing factors of persistent HNHC versus episodic HNHC and non-HNHC were identified.ConclusionThis study provides valuable insights into the classification, characteristics, and influencing factors of persistent, episodic, and non-HNHC hospitalized children in China. Persistent HNHC patients warrant targeted interventions to improve health outcomes and reduce healthcare costs. Enhanced medical coverage for key diseases, high-quality healthcare services tailored to their needs, and early interventions are crucial.

Nurse and doctor turnover and patient outcomes in NHS acute trusts in England: retrospective longitudinal study

ObjectiveTo investigate the association between monthly turnover rates of hospital nurses and senior doctors and patient health outcomes (mortality and unplanned hospital readmissions).DesignRetrospective longitudinal study.SettingAll 148 NHS acute trusts in...

Effect of Phytochemical-Rich Food Intake on Respiratory and Muscle Function in Middle-Aged Patients with COPD: A Cross-Sectional Study.

Background: It is known that the consumption of single phytochemicals improves respiratory function in chronic obstructive pulmonary disease (COPD) patients. Since phytochemicals have a synergistic effect on health, a more comprehensive analysis is needed. The aim of this study was to estimate the intake of phytochemicals using the dietary phytochemical index (DPI) and assess their association with respiratory function, inspiratory muscle strength and function, and peripheral muscle strength. Methods: This study was conducted at the Special Hospital for Pulmonary Diseases in Zagreb (September 2023 to May 2024). The DPI was assessed using three 24 h recalls from 71 COPD patients (66.5 ± 8.4 years; 53.5% men). Anthropometric measurements, respiratory function, inspiratory muscle function and strength, and peripheral muscle strength were assessed during pulmonary rehabilitation following standard protocols. Results: Patients were divided into DPI tertiles with mean values of 7.3 ± 3.0, 16.0 ± 3.0, and 32.2 ± 8.8, respectively. After controlling for confounding factors, a significant association was found between DPI tertiles and FEV1 (p-trend < 0.001), FVC (p-trend = 0.002), FEV1/FVC (p-trend < 0.001), MIP (p-trend = 0.012), and MSUE (p-trend = 0.002). In addition, an inverse association was found between DPI tertiles and diaphragm thickness during inhalation (p-trend = 0.012) and exhalation (p-trend = 0.013). Conclusions: This study suggests that a higher intake of phytochemicals could be beneficial in dietary interventions for COPD therapy. Future prospective studies are needed to confirm these findings.

Anxiety and care experiences in adolescents with chronic health conditions: an international, longitudinal study across the transfer of care

ObjectivesTo evaluate changes in anxiety, care experiences and condition impact among adolescents with chronic health conditions in two countries as they transfer to adult healthcare and to assess factors influencing...

Failure mode and effects analysis-based strategies for controlling multidrug-resistant organism infections in cancer patients.

In the context of advancing medical procedures, postoperative infections in cancer patients, particularly those involving multidrug-resistant organisms, have become a significant clinical concern. This study aims to comprehensively and systematically evaluate the effectiveness of infection prevention and control for multidrug-resistant organisms (MDROs) in postoperative cancer patients using Failure Mode and Effects Analysis (FMEA). This study was conducted in a tertiary A-level cancer specialty hospital in China, employing Failure Mode and Effects Analysis (FMEA) to assess the risks of hospital infections. Intervention measures were implemented for high-risk and medium-high-risk factors. Through the hospital's infection information system, data on patients who underwent surgical treatment from 2017 to 2022 were extracted. Data from 2017 to 2019 served as the control group, and data from 2020 to 2022 as the intervention group, to compare the changes in hospital infection incidence and MDRO infection incidence before and after the intervention. Categorical data were described in terms of frequency and percentage. The chi-square test was utilized for statistical inference to assess the differences in infection rates before and after the intervention. Prior to the intervention (2017-2019), the incidence rate of hospital infections was 1.66%, which decreased to 1.22% after the intervention (2020-2022), showing a statistically significant difference (χ2 = 48.83, P < 0.001). The incidence rate of MDRO infections also decreased from 1.808‰ before the intervention to 1.136‰ after the intervention, with a statistically significant difference (χ2 = 11.417, P = 0.001). This study confirms the effectiveness of the FMEA method in preventing and controlling MDRO infections in postoperative cancer patients. It highlights the practicality and value of widespread adoption of this method, particularly in the context of the COVID-19 pandemic.

A Comparative Review of Spine Surgeries in Two New Neurosurgery Centres in an Urban and Rural Environment in Southeast Nigeria

Background: The Imo State University Teaching Hospital (IMSUTH) located in a rural setting commenced neurosurgical services in January 2016 with a spine procedure as the first case whereas the Imo State Specialist Hospital (IMSSH) located in an urban setting commenced neurosurgical services in April 2021 and spine procedures in August 2021. The presentation of surgically managed spine pathologies in both hospitals were compared. Aims: The study aimed to descriptively compare the number of spine procedures performed in both hospitals including the age and gender distribution of the surgically managed spine patients, the spine pathologies and their distribution. Methods: The surgical records of all spine patients who had surgical procedures at IMSUTH, Orlu, from January 2016 to May 2020 (42 months), and at IMSSH, Owerri, from August 2021 to July 2024 (36 months) were retrospectively reviewed. Results: During the study periods, in IMSUTH, Orlu, there were 27 spine surgeries, giving an average of 1 spine procedure in 2 months whereas in IMSSH, Owerri, there were 157 spine surgeries giving an average of 4 spine surgeries per month. Interestingly the distribution of spine procedures revealed that the highest frequency of spine surgeries was performed in the lumbar spine (n=7, 26% in IMSUTH; n=43, 27.3% in IMSSH) followed by lumbosacral spine (n=6, 22.2% in IMSUTH; n=42, 26.8% in IMSSH) in both hospitals. And quite interesting also is that trauma (n=15, 55.6%) accounted for the highest number of spine surgeries in the rural environment of IMSUTH, Orlu, while degenerative spine diseases (n=113, 71.9%) accounted for the highest number of spine surgeries in the urban environment of IMSSH, Owerri. Conclusion: The study revealed that spine pathologies are not uncommon in resource poor settings especially in the urban environment. There is a male preponderance for spine surgeries. Lumbar/lumbosacral spine pathologies are common in our resource poor settings but trauma related spine pathologies are more common factors for spine surgeries in rural settings. There is need to improve access to spine care in the rural environments.

Challenges and outcomes of airway surgery in a post-war low-resource setting: A case series from Mekelle, Ethiopia.

This study aims to document and analyze the challenges and outcomes of performing complex airway surgery in a low-resource, post-war setting in Mekelle, Ethiopia. This prospective case series examines clinical data from five patients who underwent airway reconstruction surgeries and one patient who underwent total laryngectomy at Ayder Comprehensive Specialized Hospital in Mekelle. Data included patient demographics, airway stenosis etiology and severity, operative details, postoperative outcomes, complications, and hospital length of stay. Ethical approval was obtained from institutional review boards at Mayo Clinic and Mekelle University. The study included six patients aged 9-62 years, with surgeries comprising three cricotracheal resections, two tracheal resections, and one laryngectomy. Three reconstructions were for war-related injuries. Challenges included power outages during surgeries, limitations in medical supplies and equipment, and inadequate perioperative care. Despite these, three patients requiring tracheostomies were successfully decannulated within a year. However, complications such as restenosis, infections, and the need for reintubation were common. Airway surgeries in a low-resource, post-war setting face significant hurdles, including perioperative care quality, resource limitations, and infrastructure issues. Successful outcomes require multidisciplinary training tailored to local contexts, investments in hospital infrastructure and reliable electricity, and proper perioperative nutrition. This study highlights the need for comprehensive interventions to improve surgical care in such settings. Level of evidence: IV.

Adverse drug reactions and its associated factors among geriatric hospitalized patients at selected comprehensive specialized hospitals of the Amhara Region, Ethiopia: a multicenter prospective cohort study

BackgroundAdverse drug reactions are more prevalent in geriatric patients and are frequently associated with a range of polypharmacy-related issues as well as some physiological aging-related alterations. These affect the pharmacokinetic and pharmacodynamic properties of drugs. This study aimed to assess the magnitude of ADRs and their contributing factors among geriatric patients admitted at Comprehensive Specialized Hospitals of the Amhara Region.MethodsA multicenter prospective cohort study was carried out from May 2023 to August 2023 on geriatric patients admitted to four randomly selected comprehensive hospitals in the Amhara region. We used logistic regression to find the factors influencing the occurrence of ADRs. A P value of less than 0.05 was deemed statistically significant.ResultsDuring the study’s follow-up period, 373 patients in total were included. An incidence rate of 31.10% (95% CI: 26.38–35.82) was obtained from the identification of 121 ADRs in total. The organ most frequently affected by ADRs was the gastrointestinal tract (28.92%), followed by the cardiovascular system (19.01%), and the drug class most often implicated in ADRs was antibiotics (21.49%), then anticoagulants (12.40%). ADRs were substantially linked to being overweight (P < 0.001), having been hospitalized in the previous six months (P = 0.000), and hyperpolypharmacy (p = 0.047). 93.39% of all ADRs received the interventions. 85.12% of the adverse drug reactions were successfully resolved.ConclusionsThis study found that over one-third of older people and individuals admitted to the hospital experienced ADRs. Overweight, hyperpolypharmacy, and patients who had previously been admitted during the preceding six months were significantly linked with the occurrence of ADRs. Improving the drug safety of elderly patients, particularly those who are admitted, should be a greater priority for healthcare professionals.