Appropriateness of Head CT Scans at Tikur Anbessa Specialized Hospital,Ethiopia

BackgroundOverutilization of advanced diagnostic imaging modalities strains health care systems, especially in resource limited setups. The aim of this study is to identify magnitude of inappropriate Head Computed Tomography scans at Tikur Anbessa Specialized Hospital.MethodsRetrospective cross-sectional study was conducted at Tikur Anbessa Specialized Hospital, Radiology department, among patients getting Head Computed Tomography examinations in the period of August 2018- November 2018. Appropriateness of each scan was assessed using the American College of Radiology Appropriateness Criteria.ResultOf the 443 Head Computed Tomography scans assessed, 61.6% were done for male patients and the mean age of patients scanned is 35. Children younger than 14yrs of age constituted 17.2%. No contrast was used in 63.9% of the scans and 64.3% were initial imaging with no prior study for similar indication. Out of the scans evaluated, 11.7% were inappropriate. Headache (38.5%), Seizure (23.1%) and Head trauma (23.1%) were the commonest indications for inappropriate scan. Scans done for cerebrovascular disease were 240 times more likely to be appropriate. Large number of inappropriate scans were requested from central triage (33.3%) and adult emergency (26.2%). Pediatric department requested inapproprieate scans in 11.9% of the cases. Residents requested majority of inappropriate scans (82.3%). Inappropriateness was associated with use of contrast agent and having only incidental outcomes.ConclusionA large number of inappropriate Head Computed Tomography scans are being done. Mechanisms such as preauthorization by radiologists, increasing awareness by medical students, physicians, radiology residents and radiologists and preparing customized imaging appropriateness guidelines should be implemented.     

In vivo wound healing activity and phytochemical screening of the crude extract and various fractions of Kalanchoe petitiana A. Rich (Crassulaceae) leaves in mice

Ethnopharmacological relevance

The leaves of Kalanchoe petitiana A. Rich (Crassulaceae) are used in Ethiopian folk medicine for treatment of evil eye, fractured surface for bone setting and several skin disorders including for the treatment of sores, boils, and malignant wounds.

Aim of the study

In order to scientifically prove the claimed utilization of the plant, the effects of the extracts and the fractions were investigated using in vivo excision, incision and dead space wound models.

Materials and method

Mice were used for wound healing study, while rats and rabbit were used for skin irritation test. For studying healing activity 80% methanolic extract and the fractions were formulated in strength of 5% and 10%, either as ointment (hydroalcoholic extract, aqueous and methanol fractions) or gel (chloroform fraction). Oral administration of the crude extract was used for dead space model. Negative controls were treated either with simple ointment or sodium carboxyl methyl cellulose xerogel, while positive controls with nitrofurazone (0.2 w/v) skin ointment. Negative controls for dead space model were treated with 1% carboxy methyl cellulose. Parameters, including rate of wound contraction, period of complete epithelializtion, hydroxyproline contents and skin breaking strength were evaluated.

Results

Significant wound healing activity was observed with ointment formulated from the crude extract at both 5% and 10% concentration (p<0.01) compared to controls in both excision and incision models. In dead space model, 600 mg/kg (p<0.01) but not 300 mg/kg significantly increased hydroxyproline content. Fractions showed variable effect, with the chloroform fraction lacking any significant effect. Both 5% and 10% formulations of the aqueous and methanolic fractions significantly increased wound contraction, decreased epithelializtion time and increased hydroxyproline content in excision wound model (p<0.05) as compared to controls. These fractions were also endowed with higher skin breaking strength in incision wound model (p<0.01).

Conclusions

The present study provided evidence that the leaves of Kalanchoe petitiana A. Rich possess remarkable wound healing activities supporting the folkloric assertion of the plant. Fractionation revealed that polar or semi polar compound may play vital role, as both aqueous and methanolic fractions were endowed with wound healing activity.     

Soil Transmitted Helminths and Associated Factors Among Schoolchildren in Government and Private Primary School in Jimma Town,Southwest Ethiopia

Background

Soil transmitted helminth infections are among the most common human infections. They are distributed throughout the world with high prevalence rates in tropical and sub-tropical countries mainly because of lack of adequate sanitary facilities, inappropriate waste disposal systems, lack of safe water supply, and low socio-economic status.

Methods

A comparative cross sectional study was conducted from December 2011 to June 2012 to determine and assess the prevalence of soil transmitted helminths and their associated factors among government and private primary school children. Stool samples were collected from 369 randomly selected children and examined microscopically for eggs of soil transmitted helminth following McMaster techniques. Soil samples were collected from different parts of the school compound and microscopic examination was performed for eggs of the helminths using sodium nitrate flotation technique.

Results

The overall prevalence rate of soil transmitted helminth infections in private and government schools was 20.9% and 53.5% respectively. T. trichiura was the most common soil transmitted helminth in both schools while hookworm infections were identified in government school students only. Type of school and sex were significantly associated with soil transmitted helminth. Soil contamination rate of the school compounds was 11.25% with predominant parasites of A. lumbricoides.

Conclusion

Higher prevalence of soil transmitted helminth infection was found among government school students. Thus, more focus, on personal hygiene and sanitary facilities, should be given to children going to government schools.     

First line antiretroviral treatment failure and associated factors among people living with HIV in northwest Ethiopia

BackgroundAnti-retroviral treatment enhances the immune status and reduces unwanted outcomes. However, development of treatment failure and drug resistance raises concern over lifelong treatments to chronic diseases such as HIV/AIDS.ObjectivesThis study determined proportion of treatment failure (TF) and identified factors associated with TF among people living with human immunodeficiency virus (HIV) in Bahir Dar, Northwest Ethiopia.MethodsFacility based cross sectional study was carried out from November, 2017 to April, 2018. Sociodemographic and clinical data were collected using structured questioner. Blood sample was collected and analyzed for viral load, complete blood count (CBC), liver and kidney function test and CD4 count. A patient is declared as treatment failure when viral load value is higher than 1000 RNA copies/ml in two consecutive viral load analyses within three months interval. Data were entered and analyzed using SPSS version 23. To identify factors associated with TF, logistic regressions model was employed.ResultsA total of 430 people who had six months and above antiretroviral treatment (ART) follow up were enrolled in the study. Of these, 57.9% were females & the mean age was 38 years. The mean month of ART follow up was 83 months. In the first viral load analysis, 106 (24.7%) of the cohort were virologically failed. These failed people were followed for 3 months with intensive adherence support; then second viral load analysis showed a viralogical failure among 65 people of the second cohort. Thus, the overall viralogical failure or TF was 15.1%. The re-suppression rates were 41(38.7%). Male gender, people with history of drug discontinuation, poor adherence, irregular time of drug intake, multiple sexual practice showed significant association with TF. Moreover, base line and current CD4 counts of <200 cells/ml also demonstrated significant association with TF.ConclusionSignificant proportion of treatment failure was reported in the present study. Moreover, behavioral factors such as drug discontinuation, poor adherence, multiple sexual partner were associated with treatment failure. Hence, to avoid TF, regular patient counseling and monitoring should be in place. To identify the predictors for treatment failure, further follow-up study is desirable.     

The impact of baseline faecal egg counts on the efficacy of single-dose albendazole against Trichuris trichiura

There is considerable variation in the efficacy of single-dose albendazole (400mg) against Trichuris trichiura across human trials. Factors contributing to this variation have not yet been identified. We assessed the impact of mean baseline faecal egg counts (FEC) on the efficacy of single-dose albendazole against T. trichiura in five previously conducted trials. Our results suggest that efficacy measured by reduction in mean FECs decreased significantly (p<0.0001) when mean baseline FECs increased, highlighting that this parameter should be considered as an important confounding factor for drug efficacy.     

Evidence of changes in sexual behaviours among male factory workers in Ethiopia

OBJECTIVE: To assess changes in sexual behaviours among male factory workers in Ethiopia. DESIGN: Open cohort studies in two factories near Addis Ababa. DATA AND METHODS: At intake and biannual follow-up visits, data were collected on sexual behaviours including casual sex, sex with commercial sex workers (CSW), condom use, and history of sexually transmitted diseases (STDs) as indicated by genital discharge and genital ulcer. Health education, HIV testing, and counselling were offered to all participants. RESULTS: Between February 1997 and December 1999, 1124 males were enrolled in the two cohort studies. At intake, the prevalence of casual sex in the past year, sex with CSWs, condom use with the last casual partner, history of genital discharge in the past 5 years, and history of genital ulcer in the past 5 years were 9.7, 43.4, 38.8 (Akaki site only), 10.6 and 2.1%, respectively. At the Wonji site, the intake prevalence of casual sex, sex with CSW, and history of genital discharge decreased significantly by calendar year between 1997 and 1999. At both sites combined, between the first and the fourth follow-up visits, there was a decline in the proportion of males reporting recent casual sex (from 17.5 to 3.5%, < 0.001), sex with CSWs (from 11.2 to 0.75%, < 0.001), and genital discharge (from 2.1 to 0.6%, = 0.004). CONCLUSION: There was a decline over time in risky sexual behaviours reported by cohort participants. Part of this decline occurred independently of cohort interventions.