Case of the month: Cutaneous myiasis in a returning traveller from the Algarve: first report of tumbu maggots, Cordylobia anthropophaga, acquired in Portugal

A 61 year old woman returning to the UK from the Algarve and complaining of boil-like lesions was found to have cutaneous myiasis caused by tumbu maggots, Cordylobia anthropophaga. This is apparently the first report of acquisition of this form of myiasis in Portugal.     

Sonographic detection of subcutaneous fly larvae in human myiasis

Sonographers increasingly face imported diseases such as subcutaneous myiasis. In myiasis, some fly species such as the American Dermatobia hominis and the African Cordylobia anthropophaga use humans as intermediate hosts for the maturation of their larvae. High-resolution gray-scale and color Doppler sonography enabled us to identify D hominis larvae in 2 travelers to Central America by visualizing their typical shape, segmentations, and the continuous fluid transport inside the larval body cavity and spiracles. The small C anthropophaga larva in an individual returning from Namibia was initially not detected. Only when using color Doppler sonography was the larva discerned by its intralarval fluid transport. Sonography enables clinicians to locate viable subcutaneous larvae in suspected cases of myiasis.     

Furuncular Myiasis From Dermatobia Hominus: A Case of Human Botfly Infestation

Background: Travelers to tropical regions are at risk for a myriad of exotic illnesses. Malaria and dengue are diagnoses that are associated with insect bites, in particular, mosquito bites, acquired while traveling in foreign, tropical countries. Infestation with Dermatobia hominus, the human botfly, endemic to South and Central America, is usually transferred via a mosquito vector. The human botfly should be considered in patients who have traveled to these endemic regions and present with a mosquito bite history and non-healing skin lesions. Objectives: We present this case to increase awareness among emergency physicians regarding furuncular myiasis from the human botfly. Case Report: A 39-year-old pregnant woman presented to the Emergency Department (ED) with an intensely pruritic lesion to the right calf and mild systemic symptoms 6 weeks after travel to Belize. The lesion she thought was a mosquito bite had persisted despite escalating treatment modalities and had been incorrectly diagnosed by multiple physicians. Conclusion: Parasitic disease is not always a systemic process. Botfly infestation presents as local boil-like lesions that are irritating and uncomfortable. Once correctly identified, it can be easily treated in the ED.     

Identification of subcutaneous myiasis using bedside emergency physician performed ultrasound

Background: Subcutaneous myiasis, a maggot infiltration of human tissue, is common in tropical countries. However, physicians in the United States may be unlikely to consider this etiology of dermatologic abnormalities even when a travel history suggests the diagnosis should be included in the differential. Case Report: We report the case of a patient who returned from Sierra Leone with an infestation of a maggot of Cordylobia anthropophaga (tumbu fly) that was diagnosed and appropriately treated based on ultrasound findings. Conclusion: As international travel increases, clinicians should maintain a high level of suspicion for tumbu fly infestation in returned travelers from endemic areas. The increasing use of ultrasound in the Emergency Department for evaluation of skin and soft tissue infections may aid the physician in making the diagnosis of subcutaneous myiasis.     

Prevalence and impact of disability in north-western Ethiopia

Purpose.?To assess the prevalence and impact of disability in one urban and three rural areas in north-western Ethiopia.

Methods.?The study design is cross-sectional and quantitative. Data was collected by using pretested and standardized structured questionnaires containing socio-demographic characteristics, type of disability, functional, and social dysfunction.

Results.?A total of 932 individuals with disability were found out of a total of 24,453 individuals giving the overall crude disability rate for the three towns as 3.8%. Disability in the lower locomotor was the most frequently reported type – 442 (47.0%) – followed by blindness 269 (28.6%), upper motor 152 (16.1%), mental retardation 97 (10.3%) and hearing loss 78 (8.3%) respectively. The major self-care problem experienced by the disabled is toileting in 292 (31.1%) cases, bathing in 248 (26.4%) and dressing 157 (16.7%). Other problems experienced by the respondents are parents' negative attitudes towards the disabled, evidenced by hiding them. This was observed in 340 (36.2%) cases. No care was provided by caregivers in 221 (23.6%) cases.

Conclusion.?The majority of disabled people have problems with activities of daily life especially toileting, bathing and dressing. Interventions to alleviate the problems of the disabled should be designed and implemented.     

Prevalence and impact of disability in north-western Ethiopia

Purpose. To assess the prevalence and impact of disability in one urban and three rural areas in north-western Ethiopia.

Methods. The study design is cross-sectional and quantitative. Data was collected by using pretested and standardized structured questionnaires containing socio-demographic characteristics, type of disability, functional, and social dysfunction.

Results. A total of 932 individuals with disability were found out of a total of 24,453 individuals giving the overall crude disability rate for the three towns as 3.8%. Disability in the lower locomotor was the most frequently reported type - 442 (47.0%) - followed by blindness 269 (28.6%), upper motor 152 (16.1%), mental retardation 97 (10.3%) and hearing loss 78 (8.3%) respectively. The major self-care problem experienced by the disabled is toileting in 292 (31.1%) cases, bathing in 248 (26.4%) and dressing 157 (16.7%). Other problems experienced by the respondents are parents' negative attitudes towards the disabled, evidenced by hiding them. This was observed in 340 (36.2%) cases. No care was provided by caregivers in 221 (23.6%) cases.

Conclusion. The majority of disabled people have problems with activities of daily life especially toileting, bathing and dressing. Interventions to alleviate the problems of the disabled should be designed and implemented.     

Head and Neck Myiasis,Cutaneous Malignancy,and Infection: A Case Series and Review of the Literature

Background

There is a paucity of literature on wound myiasis of the head and neck originating in the United States. To our knowledge, only three reports during the past 20 years exist in the literature. Even less common is a case of recurrent myiasis, with only one report published from India during the 1970s. There is often a preconceived notion that larvae are noninvasive and “only eat dead tissue.” This mentality must be corrected; invasive larvae exist, there are unique myiasis-related infections, and serious complications can occur. We review the literature and describe recent cases of head and neck myiasis treated at our institution in upstate New York.

Case Reports

Four cases, all initially presenting to the emergency department, were identified. Each case was superimposed on cutaneous malignancy and all patients presented with leukocytosis and positive blood or wound cultures. In the case of the recurrent myiasis, initial treatment was external beam radiation therapy for the malignancy, which had the added benefit of eradicating the larvae. Treatment for the other cases was limited to antibiotics and supportive care for medical comorbidities.

Why Should an Emergency Physician Be Aware of This?

Serious complications can develop from head and neck myiasis and, in our experience, an underlying malignancy should be suspected. Proper management is critical and should include, at a minimum, empiric antibiotics, tetanus prophylaxis, biopsy of the surrounding tissue, and reporting to the appropriate health agency. Additional management can include bedside debridement, pharmacologic antiparasitics, and treatment of the underlying disorder.     

Treatment of cutaneous larva migrans and Toxocara infection

The treatment of cutaneous larva migrans and Toxocara infection relies on antihelminthic agents such as thiabendazole, albendazole and ivermectin. The efficacy of these agents varies according to the helminthic disease.     

Sleep deprivation and associated factors among students of the Institute of Health in Jimma University,Southwest Ethiopia

Objective: Despite getting sufficient sleep being one of the most important things that we can do to keep our body and mind healthy, sleep deprivation has become a major public health concern. This study aimed to determine the prevalence of sleep deprivation and its associated factors among students of the Institute of Health in Jimma University.Methods: An institution-based cross-sectional study was conducted from April 10 to April 24 in 2019. Data were collected from 365 randomly selected participants and analyzed using Statistical Package for the Social Sciences (SPSS; version 23). Multivariate logistic regression analysis was used to identify the factors associated with sleep deprivation. The level of significance was declared at a P-value of <0.05. Results: A total of 365 participants participated, with a response rate of 97.6％. The study findings showed that 60.8％ of students had sleep deprivation and 68.2％ had sleep latency. Health problems (adjusted odds ratio [AOR] = 1.91 [95％ confidence interval {CI} = 1.01–3.58]), alcohol consumption [AOR = 0.42 (95％ CI = 0.2–0.89)], cigarette smoking [AOR = 0.31 (95％ CI = 0.09–0.93)], khat chewing [AOR = 0.47 (95％ CI = 0.12–0.82)], use of an electronic device before bedtime [AOR = 5.26 (95％ CI = 1.78–15.52)], and cumulative grade point average (CGPA) [AOR = 0.48 (95％ CI = 0.27–0.83)] were significantly associated with sleep deprivation. Conclusions: Sleep deprivation was common in the study area. This is mainly due to health problems, substance utilization, long-time use of an electronic device, and low CGPA. Therefore, a strategy and system should be established to limit substance use, enhance proper use of electronic devices, and create awareness on the impact of nonoptimal sleep.     

Prevalence and associated factors of khat use among university students in the University of Gondar,northwest Ethiopia

Habitual khat use has negative psychological, social, sexual, and economic consequences. Therefore, this study was aimed to assess the prevalence of khat use and associated factors among university students in the University of Gondar. Institution-based cross-sectional study was conducted from February to September 2011. Multistage sampling techniques were used to select the study participants. Anonymous self-administered questionnaire was used to collect the data. Epi Info and SPSS softwares were used to enter and analyze the data. Binary logistic regression was used to identify the determinant factors. Independent two-sample “t” test was employed to compare academic performance between khat chewers and non-chewers. Odds ratio with 95% confidence interval was used to assess the strength of the association. P-value <0.05 was considered statistically significant. The current prevalence of khat chewing was 16.4%. Sex, place of upbringing, alcohol use, cigarette smoking, and history of family and friends related chewing khat were statistically associated with khat chewing habit. The prevalence of khat chewing was found moderate and had not any influence on academic performance. Targeted and consistent counseling by a close controller and guidance is recommended as a direct in-campus intervention to tackle this habit.     

Perception of caring behavior and associated factors among nurses and midwives working in public hospitals in Southern Ethiopia

ObjectiveThis study aimed to assess the perception of caring behaviors and associated factors among nurses and midwives who provided maternal health care services at Sidama region public hospitals, Hawassa, Ethiopia.MethodsAn institutional-based cross-sectional study design was used on a sample of 269 nurses and midwives working in maternity wards in Sidama region public hospitals. A self-administered questionnaire was used to collect data. Bivariate and multivariable logistic regression analysis was used to identify factors associated with nurses’ and midwives’ perceptions of caring behaviors.ResultsTotally 261 nurses and midwives participated the survey. Based on the mean score, participants’ perception of caring behavior was classified as higher and lower. According to this study, 75.1% (196/261) of nurses and midwives demonstrated a higher perception of caring behavior. Respondents’ age, professional satisfaction, personal satisfaction, midwife/nurse-doctor relationship and workload were significantly associated with their perception of caring behavior.ConclusionsAssessing the nurses’ and midwives’ perception of caring behavior and related factors is crucial for providing high-quality nursing and midwifery interventions. It is suggested to create a positive and conducive caring behavior in the organization by reducing excessive workload of nurses and midwives, as well as enhancing nurse/midwife-doctor relationship, and increasing their job satisfaction by providing recognition and reward will improve nurses’ and midwives’ caring behavior.     

Family planning practice and related factors of married women in Ethiopia

KO I.S., YOU M.A., KIM E.S., LEE T.W., KIM S., KIM Y.M., NAM J.J., LEE H.K. (2010).Family planning practice and related factors of married women in Ethiopia. International Nursing Review 57 , 377–382 Background: The family planning (FP) practice rate of Ethiopian women of reproductive age is lower than in most other sub‐Saharan African countries. Aim: To examine the status of FP practice and identify intrapersonal, interpersonal and community factors associated with FP practice among married Ethiopian women in a rural area. Methods: A cross‐sectional survey was conducted with a convenient sample of 193 married women of reproductive age. A structured questionnaire, which was modified based on the Ethiopian Demographic Health Survey, was used. Multiple logistic regression analysis was conducted to identify factors associated with FP practice at three levels: intrapersonal, interpersonal and community. Results: Almost 67% of women were currently using at least one FP method and most women obtained FP methods from the public health sector. Short‐term methods such as pills and injections were most commonly used. FP practice was significantly associated with willingness to use long‐term or permanent FP methods in future and spousal discussion about FP. Conclusions: Both intrapersonal and interpersonal factors were related to FP practice. Community factors, however, need to be further assessed using various methods to plan a comprehensive and more culturally acceptable community‐based FP program. Caution is needed to generalize the findings because of the convenient sample, but community‐based FP programs emphasizing long‐term or permanent methods and male involvement in FP counseling would be successful strategies to increase FP practice. Implications for nursing practice: Nurses and midwives need to be trained to provide knowledge and skills for long‐term or permanent FP methods for service quality.     

Low neonatal pain management practices and associated factors among nurses and midwives working in governmental hospitals of central Ethiopia, 2021

BackgroundNeonatal pain management is a significant problem in the clinical settings of developing countries. Several studies have revealed that neonatal pain management practices among health professionals were overlooked. As a result, the data regarding the factors affecting nurses' and midwives' neonatal pain management practices is essential in designing interventions to address this gap. Therefore, this study aimed to assess neonatal pain management practices and associated factors among nurses and midwives working in government hospitals in central Ethiopia from September 1, 2019 to September 30, 2021.MethodsAn institution-based quantitative cross-sectional study design was employed among randomly selected 268 nurses and midwives after obtaining ethical approval from Ambo University. The data were collected using a pretested, structured, self-administered questionnaire. The collected data were checked, coded, and entered into Epi-data version 3.1 and exported to SPSS version 25 for analyses. Bivariate and multivariate logistic regression analyses were carried out. The odd ratio along with the 95% CI were computed to ascertain the association.ResultsThe study revealed that 37.3% [95% CI: 31.4–43.3] of the study participants had good practices for neonatal pain management. Respondents with less than five years of work experience [AOR = 2.4 (1.16, 4.99)], Nurses or Midwives with no neonatal pain training [AOR = 2.89 (1.58, 5.29), poor neonatal pain knowledge [AOR = 1.09 (1.09, 3.61)], and an unfavorable attitude toward neonatal pain [AOR = 3.19 (1.74, 5.85)] were factors significantly associated with poor neonatal pain management practice.ConclusionsThe overall practice of neonatal pain management is low. Factors like work experience, training, knowledge, and attitude were significantly associated with poor practices in neonatal pain management. All stakeholders should consider the necessary interventions. Moreover, educational and convenient training programs on neonatal pain management are needed to better assess and manage neonatal pain.     

Cutaneous involvement in relapsed multiple myeloma

Cutaneous involvement in multiple myeloma with extramedullary disease is rare. We report the case of a refractory multiple myeloma patient who developed a cutaneous lesion. Histopathology revealed dermal immature plasma cell infiltrate with a lack of CD138 expression. This cutaneous location was associated with an aggressive clinical course and short survival.     

Initiation of breast-feeding practice and associated factors among mothers who have infants less than 12 months of age in Debre Tabor Town,North West Ethiopia, 2021: A multicenter community-based cross-sectional study

Introductioninitiation of breastfeeding is crucial in preventing newborn deaths and influences childhood nutrition. There was limited updated evidence regarding early initiation of breast-feeding practice and associated factors among the target population in the study area.ObjectiveTo assess initiation of breastfeeding practice and its associated factors among mothers who have infants less than six months of age in, North West Ethiopia, 2020.MethodsThe Community based quantitative cross-sectional study was conducted among 405 respondents in the stud area, then data would be entered and analyzed by using SPSS version 20 statistical packages. Bivariate and multivariable logistic regression model analysis would be done. Odds ratio with 95% confidence was computed to determine the level of significance-value less than 0.05 considered as significant.ResultThis study showed that 94.7% of mothers in Debre Tabor Town practiced initiation of breastfeeding for their infants within the Less Than 12 Months of age. In multivariable analysis I n f a n t S e x, Female [AOR (95% CI) = 0.068 (0.002, 1.659), and Age of Mother 20–24 years [AOR (95% CI) = 2.33 (0.030, 17.12)], 25–29 years ((AOR = 8.20 [(95% CI: 12.212, 22.189]), and 30–34 years (AOR = 4.48 [95% CI: 0.463, 15.478], Assists (Attend) during delivery, Doctor (AOR = 0.644 [95% CI: 0.041, 10.138]) and Encourage BF by religious father (AOR = 6.669 [(95% CI: 4.27, 8.895]) were remained significantly associated with the outcome variable with at 95% CI and P- value of <0.05.Conclusionand Recommendation: The prevalence of EIBF among mother-infant pairs of less than 12 months in debre tabor town, Northwest, Ethiopia, was found to be high as compared to national and global infant and young child feeding guidelines. However; it shows improvement as compared with some previous studies in Ethiopia. I n f a n t s e x, age of mother, assists during delivery, and encourage BF by religious father were factors associated with outcome in the stud area.     

Prevalence of erectile dysfunction and its associated factors among patients with diabetes in Ethiopia: a systematic review and meta-analysis

ObjectivesWe aimed to estimate the pooled prevalence of erectile dysfunction (ED) among patients with diabetes mellitus (DM) in Ethiopia and to identify its associated factors.MethodsWe performed a systematic search of scientific databases (PubMed, ScienceDirect); the grey literature was also searched (Google, Google Scholar). Data were extracted from primary studies using a data extraction format and exported for statistical analysis. I² tests were used to assess the heterogeneity of studies. Owing to heterogeneity among the included studies, we used a random-effects model to determine pooled estimates of ED. Publication bias was assessed using Egger’s and Begg’s tests.ResultsThe pooled prevalence of ED among patients with DM in Ethiopia was 54.3% (95% confidence interval [CI]: 28.2–80.5). Older age (OR: 4.42, 95% CI: 2.83–6.00) and duration of DM (OR: 3.2, 95% CI: 1.74–4.66) had statistically significant associations with ED.ConclusionOne in two individuals with DM in Ethiopia also had ED. This finding highlights the need to integrate assessment and management of ED into routine medical care in diabetes follow-up visits. Special attention is recommended for patients with older age and a longer duration of DM.     

Assessment of malaria prevalence in Boset District,East Shawa Zone, Oromia Regional State,Ethiopia: a retrospective study

ObjectiveIn this study, we aimed to assess the epidemiological profile and associated risk factors of malaria in Boset District using clinical records from the Boset District Health Office Central Surveillance Unit, East Shawa Zone, Oromia, Ethiopia.MethodsThis health facility-based retrospective cross-sectional study included clinical malaria data for 5 years (2016–2020) recorded at all public and private health facilities in the district.ResultsThe present study revealed an overall malaria slide positivity rate of 12.4% (21,059/169,986), ranging from 23.3% to 5.3% during 2016–2020 in Boset District. Malaria cases were recorded in all age groups, but individuals aged 15 years and above accounted for a higher (56.2%) average proportion of malaria cases. Concerning the relative proportion of malaria parasite species, Plasmodium falciparum was slightly predominant (58%) over P. vivax (42%).ConclusionThe present study revealed a declining trend in malaria cases over the 5-year study period in Boset District. Scaling up the available malaria prevention strategies and control measures is recommended to achieve malaria pre-elimination.