Background: Intraocular Foreign Bodies (IOFBs) are one of the common causes of visual loss. Missed IOFBs can lead to devastating complications. Case Report: A 14-year-old boy presented with one-month history of vision loss in the right eye from an electric cable used to whip a cart-horse. He was treated with unspecified eye drops and intravenous antibiotics at peripheral facilities. At a Tertiary hospital, CT scan revealed panophthalmitis and IOFB with orbital extension. He was managed with evisceration and foreign body removal. Conclusion: A high index of suspicion and appropriate investigations help minimize complications in patients with IOFBs.
Background: Childhood illnesses are a leading cause of morbidity and mortality in Sub-Saharan Africa, where healthcare infrastructure and trained personnel are limited. MedBrain, a digital decision support system (DDSS), aims to enhance pediatric emergency care by supporting mid-level healthcare workers in low-resource settings. Objective: To evaluate MedBrain’s triage and diagnostic performance among children presenting with common acute conditions to the emergency departments of two large hospitals in Ethiopia. Methods: A prospective observational diagnostic accuracy study was conducted between July 2024 and April 2025 at St. Paul’s Hospital Millennium Medical College and Alert Comprehensive Specialized Hospital. MedBrain’s triage and diagnostic performance were compared against healthcare professionals’ triage and pediatricians’ top presumptive diagnoses as gold standards. Performance metrics included accuracy, sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), likelihood ratios (LR+ and LR–), and Cohen’s Kappa for reliability. Diagnostic performance was assessed for MedBrain’s top three ranked diagnoses (Top 1: highest probability diagnosis; Top 2: top two diagnoses; Top 3: top three diagnoses). Results: Of 1,204 patients screened, 274 were excluded for conditions not yet represented in MedBrain’s database (including malaria), leaving 930 participants. Of which, most were infants (33.8%) and children under 5 (31.9%), with pneumonia (20.4%) the most common diagnosis. MedBrain achieved 72.2% triage agreement, with 3.7% over-triage and 24.2% under-triage. Total diagnostic accuracy was 84.1% (Top 1), 91.5% (Top 2), and 93.3% (Top 3), with Sn of 93.3% and PPV of 100%. For prevalent conditions (pneumonia, acute bronchitis, late-onset neonatal sepsis, acute gastroenteritis, bronchiolitis, and meningitis), accuracy exceeded 97.4%, and Sp and PPV were consistently perfect. Sn increased from 73.0–98.6% (Top 1) to ≥90–100% (Top 2–3).NPV increased from 97.1–99.9% (Top 1) to 98.9–100% (Top 2) and 99.2–100% (Top 3). LR– improved from 0.014–0.270 (Top 1) to 0–0.100 (Top 2) and 0–0.079 (Top 3). Similarly, Cohen’s Kappa rose from 0.830–0.993 (Top 1) to 0.943–1.000 (Top 2) and 0.955–1.000 (Top 3). Diagnostic failures were rare, highest for late-onset neonatal sepsis (0.8%), bronchiolitis (0.5%), and pneumonia (0.4%), and none for gastroenteritis. Conclusion: MedBrain demonstrated high diagnostic accuracy and reliability in Ethiopian pediatric emergency settings. Under-triage and limited disease coverage remain challenges, warranting further validation with expanded disease libraries and in diverse settings.
Introduction: Mineral bone disease (MBD) abnormalities are common complications in patients with chronic kidney disease (CKD). The MBD abnormalities are known to be associated with increased morbidity and mortality. In spite of their importance, there are limited data on CKD-MBD abnormalities in Ethiopia. This study looked in to the magnitude and determinants of biochemical CKD-MBD abnormalities among predialysis CKD patients. Methods: A cross-sectional study was conducted from July 1 to September 30, 2020 in Tikur Anbessa specialized hospital. One hundred patients who had had follow-up for at least 6 months with an estimated glomerular filtration rate (eGFR)<60ml/min/1.73m2 using CKD-EPI equation without race factor were included. Serum calcium, albumin, phosphorus and PTH levels were determined. Demographic and clinical data were collected using a structured questionnaire. IBM SPSS software version 26 was used for analysis. Descriptive statistics was used to describe the demographic and clinical data. Chi-square was used to identify correlations between the grouped variables. The analysis for comparison among three or more categories was done using one-way ANOVA and Tukey post hoc test. Linear correlation and multiple regression analysis were used to identify associations between clinical and biochemical findings. Results: Among the 100 patients included in this study; the median age was 58 years with IQR of 73. The male to female ratio was 2.7:1. Patients in stages 3a, 3b, 4 and 5 CKD accounted for 23%, 29%, 26% and 22%, respectively. The main causes of CKD were diabetes and hypertension. Among these patients, 31% had hyperphosphatemia, 36% had hypocalcemia, and 89% had hyperparathyroidism. The mean values of calcium in CKD stage 3a,3b,4 and 5 were 8.91, 8.81, 8.7 and 7.14mg/dl, respectively; where as those of serum phosphorus were 3.58, 3.83, 3.83 and 5.53mg/dl, respectively. The median values of PTH were 140.6, 137.2, 274.05 and 440.85Pg/ml, respectively. Estimated GFR correlated negatively with serum parathyroid hormone (PTH) level but correlated positively with serum calcium level. In addition, serum calcium level is inversely associated with diabetes and diastolic blood pressure whereas serum PTH is directly associated with diastolic blood pressure and female sex. Conclusion: Hypocalcemia, hyperparathyroidism, and hyperphosphatemia are common biochemical CKD-MBD abnormalities among predialysis CKD patients in the renal clinic of Tikur Anbessa specialized hospital. Monitoring for CKD-MBD should begin earlier and treatment should be initiated accordingly to improve patient outcome.
Background: There is a lack of research on imaging findings of acute headaches in Ethiopia. Most available studies for cross-reference are conducted in developed countries and do not consider clinical and epidemiologic factors unique to developing countries. This study aims to identify the most common radiologic findings in patients presenting with acute headaches and examine their relationship with sociodemographic and clinical variables in an Ethiopian context. Methodology: A cross-sectional study was adopted in this study. The brain MRI reports and files of 497 patients who were referred for the evaluation of acute headache (less than or equal to one-month duration) to Wudassie Diagnostic Center in Addis Ababa, Ethiopia, from January 2016 to September 2018 were analyzed. The demographic variables and the clinical data of the patients were correlated to the imaging findings. Data analysis was done using IBM SPSS Statistics for Windows Version 20.0. Results: 60.6% of the patients referred for the evaluation of acute headache had abnormal MRI findings. Nonspecific white matter lesions (which neither explain the reason for acute headache nor alter patient outcome and management) were the most frequently observed radiologic diagnosis (16%), followed by neoplasms (11.1%) and infections (7.7%). Tuberculoma was the most frequently diagnosed infectious cause. The majority of patients with comorbid illnesses (hypertension and HIV) had abnormal imaging findings. Age had a weak but significant positive correlation with abnormal imaging findings. Conclusion: The findings suggest that acute headaches are frequently associated with significant underlying pathologies, particularly in older patients and those with comorbidities such as HIV or hypertension. The prominence of tuberculoma among infectious causes reflects the influence of local epidemiological factors. These results highlight the importance of targeted imaging protocols to enhance diagnostic accuracy and optimize patient management in resource-limited healthcare settings.
Background: Esophageal cancer is the eighth leading cancer and the top sixth cause of cancer mortality worldwide. According to Globocan 2012 estimate, in Ethiopia, esophageal cancer ranks the seventh and eighth as the leading cause of cancer mortality and morbidity respectively. Methods: A retrospective cross-sectional study using record review was employed at Gastroenterology and Hepatology Unit and Department of Pathology of SPHMMC with the aim to assess the clinical, pathological and endoscopic characteristics of esophageal cancer patient attending at St Paul Hospital Millennium Medical College (SPHMMC) from January, 2015 to December, 2019 in Addis Ababa, Ethiopia. . All newly confirmed esophageal cancer patients (n=255) who were registered at SPHMMC from January 2015 to December 2019 were included in this study. Patients chart, Endoscopy report and Histology data were reviewed . Finally, basic descriptive statistics (frequency, mean, median), bivariate and multivariable analysis were performed. Result: A total of 255 esophageal cancer patients’ charts were reviewed. and 222 patients have confirmed Histology report of esophageal cancer. There were 173 (77.9%) cases of squamous cell carcinoma. The mean age at diagnosis was 57 years with comparable male to female ratio. The Upper , middle . lower esophagus are involved in 10.4%,38.4%, and 48.6% of the patients respectively. Most patients 220(86.6%) seek esophagogastrduodenoscopy for dysphagia and only 15(6.8%) of patients have staging work up and majority presented at stage (80%). Conclusion: Squamous cell carcinoma was the most predominant histologic type followed by adenocarcinoma affecting males and females equally. Most of the esophageal cancer patients were diagnosed in advanced stages affecting the treatment outcome of esophageal patients.
Thyrotoxicosis in the newborn is usually the result of the passage of thyroid stimulating antibodies from the mother to the fetus. This is a case report of a ten-day-old male neonate who presented with signs of neonatal thyrotoxicosis and heart failure. He had a high T3 (>7.7nmol/l), high T4 (> 300nmol/l), and low TSH (0.14 uIU/ml). He was hospitalized at the neonatal intensive care unit of Myungsung Comprehensive Specialized Hospital and was successfully treated with propylthiouracil, propanolol, furosemide, lugols iodine, hydrocortisone, and supportive care. Clinical features and management of neonatal thyrotoxicosis are discussed with a literature review.
Background: Appendiceal adenomatous polyps are rare and present diagnostic challenges. The reported incidence of these polyps during autopsy ranges from 0.004% to 0.08%. The identification of appendiceal polyps during colonoscopy is uncommon, and there is limited literature on this subject. This case highlights the importance of thorough assessment of the appendix during colonoscopy. Case Presentation: A patient with a history of chronic constipation presented with complaints of per rectal bleeding and rectal pain. The patient had previously undergone a surveillance colonoscopy several years ago, which showed normal findings. During the current colonoscopy, a 0.5 cm x 0.5 cm polyp was identified at the appendiceal orifice. Discussion: Appendiceal polyps are rare findings during colonoscopy, and their detection can be difficult due to the anatomical location of the appendix. The significance of these polyps lies in their potential to cause complications such as malignancy, intussusception, or chronic appendicitis. While guidelines for the follow-up of patients with appendiceal orifice polyps are limited, this case emphasizes the need for careful examination of the appendix during colonoscopy. Conclusion: A thorough assessment of the appendix during colonoscopy is essential for detecting appendiceal polyps and preventing potential complications. Further research and clearer follow-up guidelines are needed for patients with appendiceal opening polyps.
Background: Extracellular vesicles (EVs) are secreted by all bacteria, including those that cause sepsis, and are distributed throughout the bloodstream before getting excreted in the urine. The study aimed to analyze bacterialderived extracellular vesicles in the urine of patients with sepsis and compare them with those in healthy controls. Methods: The study included a total of 25 patients, comprising 9 cases with positive bacterial cultures in clinically significant specimens and 11 healthy controls. Urine samples, either midstream or collected via Foley catheter, were obtained before the initiation of antibiotic treatment. Extracellular vesicles were isolated from these samples using centrifugation. Metagenomic analysis was conducted on the isolated EV samples, focusing on bacterial 16S rDNA to identify the bacterial genera present. Results: In all febrile patients with culture-positive cases, genetic material from multiple bacterial genera was detected through metagenomic analysis, although the specific bacteria identified in clinical cultures were not found in most cases. The bacterial distributions observed in the normal control group were markedly different from those in the febrile patients. Conclusions: The findings suggest that bacterial components are likely entering the bloodstream from multiple sites within the body in the form of extracellular vesicles, both in septic and normal states. The distinct bacterial distributions observed in the urine of sepsis patients compared to healthy individuals require further investigation to understand the underlying mechanisms.
Background:Peritoneal melanosis is a benign disease that can be encountered during laparotomy. We are reporting this extremely rare condition with less than 20 cases reported in the world literature and also in Ethiopia. This condition is usually incidental finding during laparotomy and is mainly associated with ovarian lesions. Case: A 71-year-old woman presented to gynecology out-patient department with abdominal swelling of 1-year duration. Abdominopelvic mass with gross ascites detected, likely arising from the ovary. She then underwent a unilateral salpingo-oophorectomy followed by total abdominal hysterectomy and unilateral salpingooophorectomy with a high index of an advanced ovarian cancer. The intraoperative findings showed a diffuse dark pigmentation involving the greater omentum, the visceral peritoneum, and serosa of the large and small bowel segments. The histopathology revealed a moderately differentiated mucinous adenocarcinoma with benign peritoneal melanosis. With this diagnosis she completed adjuvant chemotherapy. Conclusion: Though occurrence of peritoneal melanosis with ovarian adenocarcinoma doesn’t suggest different treatment or prognosis. We recommend surgeons during laparotomy to be aware of this benign condition during laparotomy. Little is known about this rare condition therefore, women with peritoneal melanosis should be followed closely for the long-term outcome
Background: Intrathecal opioids are routinely used during spinal anesthesia for post cesarean analgesia. In this research, the analgesic effects of adding pethidine or morphine to intrathecal bupivacaine have been compared. Methods: In a double-blinded, randomized trial, 110 parturients who were scheduled for elective cesarean section were randomized into two groups of 55 patients each. In one group, 12 mg of bupivacaine (0.5%) plus 200 mcg of intrathecal morphine and in the second group 12 mg of bupivacaine (0.5%) plus 20 mg of pethidine in a total volume of 3 cc was injected as an intrathecal injection. Data variables were recorded at 1st, 4th, and 24th hours postoperatively. The primary outcome was the pain intensity numerical rating scale (0-10). The secondary outcomes were nausea, vomiting, itching, sedation (Ramsey Sedation Scale), shivering, and demand for analgesic medication. Results: No statistically significant differences were found between the two groups in terms of shivering, sedation, pain and pain severity, duration of painlessness period, number of demanded analgesics and level of sensory block, at 1st, 4th, and 24th hours post-operatively. At 24 hours after surgery, the rate of nausea and vomiting was significantly lower in the pethidine group (3 vs. 11, p=0.02), but at the same time, itching complaints were higher in the morphine group (10 vs. 0, p=0.001). Conclusion: Adding intrathecal morphine and pethidine to bupivacaine in spinal anesthesia for cesarean section both creates a long-term and acceptable analgesia. However, in controlling itching, nausea and vomiting, pethidine showed to be more effective than morphine. Thus, it is suggested that 12 mg of bupivacaine (0.5%) is applied in combination with 20 mg of pethidine in spinal anesthesia for this surgery.
Introduction: The enhancement of reproductive health in women can result in an improvement of children’s nutritional status resulting in improvement of reproductive health. This association is important for sustainable population growth without overusing resources. This study aims to examine the relationship between household food insecurity and contraceptive use.Method: A study was conducted on 651 reproductive-age women in three randomly selected Woredas (districts), Lideta Sub-city from February to March 2023. Six Ketenas (villages) were selected using a probability proportional to size technique from three Woredas. Data were collected through a validated survey by trained individuals, and household income and expenditure were used to measure food insecurity access. The Pearson chi-square test (c2) and logistic regression were used to examine the relationship between household food insecurity and contraceptive use, considering other covariates.Result: Modern contraception usage was at 50.5% in the study area. Women with food insecurity had only a 32.0% usage rate, while those who were food secure had the higher rate of 68.7%. Women in food-insecure households had a 76.5% lower chance of using modern contraception. Positive attitude, family planning information, partner discussion, income, and childhood mortality were associated with contraceptive use (p <0.05).Conclusion: Use of modern methods of contraception showed a negative correlation with food insecurity. Therefore, addressing household food insecurity as a potential obstacle to the development of family planning services requires comprehensive stakeholder engagement and socio-economic policy intervention.
Spontaneous hemothorax and perinephric hematoma are rare presentations of renal cell carcinoma. We present the case of a 30-year-old female who presented with progressive fatigue and weight loss over a 2-month period. Initially, she was suspected to have empyema and received anti-tuberculosis therapy at a local hospital. However, further evaluation revealed a low hemoglobin level and a CT scan showed a right renal mass with lung metastasis, along with massive hemothorax, perinephric, and retroperitoneal hemorrhage. She underwent surgical management with radical nephrectomy and evacuation of the hematoma. Pathological examination of the surgical specimen confirmed renal cell carcinoma. After treatment, the patient was discharged in stable clinical condition.
Background: Frozen section is an intraoperative rapid diagnostic tool that could direct a patient's intra- or postoperative therapy. Given the importance of frozen section in the management of surgical patients and the lack of published research in Ethiopia, it is prudent to evaluate its efficacy in our setting.Methods: A prospective diagnostic accuracy study was done on 39 samples from June 2022 to December 2022. Cases were selected based on suspicion of a neoplasm and where there was an indication to perform frozen section. Data analysis was conducted using SPSS version 23. Findings were demonstrated using text, charts and diagrams.Results: The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of frozen section as opposed to histopathological diagnosis using paraffin-embedded samples was found to be 92.3%, 88% and 95.2%, 94.1%, 90.9%, respectively. The mean turnaround time for frozen section was found to be 23 minutes.Conclusion: The accuracy, ability to detect true positive cases, and ability to exclude false-positive cases of frozen section diagnosis in this research are consistent with most worldwide quality assurance data for frozen section. Despite its constraints, frozen section is a highly dependable method when carried out by experienced personnel, in the study context.
Background: A good number of patients with viral hepatitis are asymptomatic and detected as incidental findings. Early detection of the hemodynamic changes as well as prompt treatment is paramount to prevent the development of complications such as portal hypertension, liver cirrhosis and hepatocellular carcinoma. The congestive index (CI) of the portal vein has a high sensitivity and specificity in the diagnosis of hepatic fibrosis and portal hypertension and it is therefore imperative to assess these categories of patients using this index. The objective of this study is to compare the portal vein CI of patients with asymptomatic hepatitis B viral infection and normal individuals"Methods and Patients : This is an institution-based case-control study comprising 112 cases with serological diagnosis of hepatitis B viral infection and 112 age and sex-matched controls that were seronegative for hepatitis B and C viral infection and had normal LFT parameters. The CI of the participants were obtained using duplex Doppler ultrasound, and the data obtained were analyzed using statistical package for social sciences (IBM SPSS version 23.0. Armonk, NY).Result: 224 participants made of 112 cases and 112 age and sex-matched controls were evaluated. The age of the participants ranged from 18-63 years. 113 (50.4%) of the participants were males, while 111 (49.6%) were females. The mean value of the portal vein CI was 0.04±0.003cmS among controls and 0.06±0.01cmS among cases; however, the difference was not statistically significant (p 0.192). CI was noted to increase with age and was higher among the male gender, but the difference was also not significant statistically. Also, LFT parameters among the participants was higher in cases than the control and most were statistically significant except for ALP andAST.Conclusion: The CI of the portal vein and LFT parameters were higher in cases than control and and it may therefore be a useful tool in the assessment of patients with hepatitis, particularly in symptomatic cases.
Background: The mortality due to COVID-19 in low-income settings has been grossly underestimated. The gap in the estimated deaths as the cause of COVID-19 and observed deaths in Africa requires further investigation. Hence, we aimed to assess the socio- demographic characteristics, clinical and laboratory profiles of patients who died from COVID-19 at the treatment centers in the Oromia region, Ethiopia.Method: A retrospective chart review was conducted from all health facilities that reported more than ten COVID-19 deaths from April 2020 to November 2021 in Oromia. CSPro Data Entry and STATA version 14 were used for data entry and analysis, respectively.Result: Of the 594 COVID-19 deaths reported during the study period, 454 (76.4%) were captured in nine health facilities. Of the 454 participants, 288 (63.4%) were men and 192 (42.3%) were over 60 years. Cough and shortness of breath were the most prevalent symptoms. Cough and shortness of breath were the most prevalent symptoms. Upon presentation, 394 (97.28%) exhibited tachypnea, 78 (27.56%) had a fever, and 366 (84.92%) had oxygen saturation levels below 92%. At least one comorbidity was present in 60% of the individuals. The median length of stay in the facility before death was five days (IQR 2–8). Common laboratory tests include complete blood counts, renal function and liver function tests. In 35(15%) of cases, the estimated glomerular filtration rate was <30 ml/min/1.73 m2. Neutrophilia was in 83.9% of cases, lymphocytosis in 2.6% and elevated creatinine in 35%. Chest X-ray was the frequently used imaging modality with opacity was the most common finding. Antibiotics and steroids were administered primarily.Conclusion: Most of the cases had comorbidity and were older aged. However, a quarter of patients were less than 45 years and two-fifths of patients had no known comorbidity. Strengthening vaccine acceptance across all age groups has paramount importance in preventing the severity of disease and death.
Anorectal malignant melanoma (ARMM) is an aggressive and rare tumour. It carries a poor prognosis due to its inherent aggressive systemic activity and advanced disease at the time of diagnosis. Surgery is the mainstay treatment which ranges from wide local excision to abdominoperineal resection (APR). Neither chemotherapy nor radiotherapy has proven benefits in increasing survival rate or reducing loco-regional recurrence. In this case report, we present a 52-year-old male patient with anorectal melanoma. Staging scans showed an anorectal tumour with nodal involvement. He underwent laparoscopic abdominoperineal resection in Hospital Taiping, Malaysia. He was discharged home well postoperatively.
Gouty panniculitis is uncommon manifestation of gout associated with monosodium urate (MSU) deposition into subcutaneous tissue. We report our local experience of this disease and its management strategy. Our patient was 39 years old gentleman, known to have gout who had not been compliant to follow up, presented with bilateral gluteal swellings for one month associated with discharge from the left gluteal swelling for 2 days. Clinical diagnosis of gluteal abscess with suspected infected gouty tophi was made. Wound debridement of infected left gluteal swelling was performed, followed by short course antibiotic therapy according to culture and sensitivity. Subsequently our rheumatology colleagues had assisted us with medical management of his gout, in which his right gluteal swelling did not get worsen and he remained well during our follow up.
