An ovarian tumor larger than the patient's body weight

Surface epithelial-stromal tumors constitute by far the most important group among all ovarian neoplasms. Sixty-four kilogram left ovarian serous cystadenoma was removed from a forty-nine kilogram weighing Ethiopian woman. She presented with twenty-five years history of abdominal swelling. She had extreme degree of difficulty in bearing her weight, which resulted in keeping her to the house. This unusually big tumor is discussed with clinicopathologic correlation and literature review.     

Detection of enteroviral RNA by polymerase chain reaction in faecal samples from patients with aseptic meningitis.

An assay based on the polymerase chain reaction (PCR) for detection of enteroviral RNA in stool samples was carried out using specimens from 74 patients with aseptic meningitis. The primer pair and probe were derived from the highly conserved 5' non-coding enterovirus genomic region. Enteroviral RNA was detected in faeces of all 36 patients in whom an enterovirus was isolated from stool. The PCR assay yielded positive results in additionally 3/6 cases where enterovirus diagnoses were obtained by virus isolation from cerebrospinal fluid and/or serological tests. Thus, the positive outcome of the PCR assay was 39 (93%) among the 42 patients with enterovirus diagnoses. Furthermore, 7/19 (37%) cases with an etiology that was not established by other means were positive in the test indicating that the PCR assay may give considerable additional etiological information in patients with aseptic meningitis. The limit of RNA detectability in the PCR assay was about 100 TCID50 when highly cytopathogenic enterovirus types (coxsackievirus type B5 and echovirus type 11) were tested. The PCR was negative in all 13 patients with non-enterovirus diagnoses except in one case with a herpes simplex virus type 2 infection. Since enterovirus-specific IgM antibodies could be detected in this case a dual infection seemed probable. All the negative controls, included in the study, were PCR-negative and no contamination was encountered. This study proves the usefulness of the PCR assay for detection of enteroviral RNA in stool samples and suggests that the test may be an alternative to virus isolation for rapid enterovirus diagnosis in patients with aseptic meningitis.     

The relationships between dehydroepiandrosterone sulphate (DHEAS), the intensity of Schistosoma mansoni infection and parasite-specific antibody responses. A cross-sectional study in residents of endemic communities in north-east Ethiopia

There are speculations that the puberty-related hormone dehydroepiandrosterone sulphate (DHEAS) might influence the intensity of infection and immune responses during Schistosoma infections. We studied the relationships between DHEAS, intensity of Schistosoma mansoni infection and humoral immune responses in 135 residents of Ethiopia. Serum levels of eight antibody isotypes against worm and egg antigens were determined by ELISA. DHEAS was measured with an immunoluminometric assay. There was a significant negative correlation between serum levels of DHEAS and intensity of S. mansoni infection. A significant increase in serum levels of DHEAS in the age group 15-19 years was accompanied by a progressive decline in the intensity of infection. Peak level of DHEAS coincided with the lowest intensity of infection in the age group 20-29 years. Multiple regression analysis showed that DHEAS alone had a significant (p<0.0001) negative effect when the effect of age was removed. Age also had a significant (p<0.0001) negative effect on the intensity of infection, after removing the effect of DHEAS. The two predictive variables accounted for 34.4% of the decline in the intensity of infection. Age accounted for 24.9%, whereas DHEAS accounted for 15.2% when the effect of each of the variables was removed. DHEAS had significant negative effects on AWA-specific IgG (p=0.02) and IgG1 (p=0.018) and SEA-specific IgG1 (p=0.009), after adjusting for the effect of age.     

Traditional pharmaceutical practice in Gondar region, northwestern Ethiopia

The knowledge and skills of Ethiopian traditional healers in Gondar region on the pharmaceutical aspects of their practice were assessed using a questionnaire. Of the 86 healers interviewed, only 83 gave responses good enough to be considered in the analysis of results. It was shown that the healers obtained their drugs mainly from natural substances and these in descending order of frequency were plants, animals and minerals. The healers prepared the drugs in various dosage forms including liquids, ointments, powders and pills. They also prescribed drugs in a "non-formulated" form. They usually incorporated additives and more than one drug in a single dosage form. Drugs were administered using eight routes, the main ones being, topical, oral and respiratory. Most of the healers claimed to determine doses and to know about side-effects of drugs. When side-effects became severe, "antidotes" were claimed to be used. The healers imposed restriction when certain types of drugs were taken by patients. Most of them stored the drugs that should not be dispensed immediately after collection or preparation. Drugs were usually stored in containers such as bottles, papers, pieces of cloth, leaves and horns, and were kept anywhere at home. The results are discussed mainly in relation to modern pharmaceutical and medical practices and their importance to health care services among the people in Gondar region is also stated.     

Development of a nucleic acid sequence-based amplification assay that uses gag-based molecular beacons to distinguish between human immunodeficiency virus type 1 subtype C and C' infections in Ethiopia

A gag-based molecular beacon assay utilizing real-time nucleic acid sequence-based amplification technology has been developed to differentiate between the two genetic subclusters of human immunodeficiency virus type 1 (HIV-1) subtype C (C and C') circulating in Ethiopia. Of 41 samples, 36 could be classified as C or C' by sequencing of the gag gene. All 36 isolates were correctly identified by the gag beacon test. Three isolates with genomes that were recombinant in gag were unambiguously typed as belonging to the C' subcluster. Further analysis revealed that these contained the most sequence homology with a reference subcluster C' sequence in the target region of the beacon and hence were correct for the analyzed region. For one sample, sequencing and gag molecular beacon results did not match, while another isolate could not be detected at all by the beacon assay. Overall, high levels of sensitivity and specificity were achieved for both beacons (90.5% sensitivity and 100% specificity for the C beacon and 100% sensitivity and 95.2% specificity for the C' beacon). The availability of a diagnostic test which can quickly and reliably discriminate between C and C' HIV-1 infections in Ethiopia is an important first step toward studying their respective biological characteristics. As the assay is specific to the Ethiopian HIV-1 subtype C epidemic, it will contribute to characterizing the circulating viruses in this population, thereby generating the information necessary for the development of a potential efficacious HIV-1 vaccine appropriate for the Ethiopian context.     

Duration of Supplemental Oxygen Requirement and Predictors in Severe COVID-19 Patients in Ethiopia: A Survival Analysis

BackgroundWith the rising number of new cases of COVID-19, understanding the oxygen requirement of severe patients assists in identifying at risk groups and in making an informed decision on building hospitals capacity in terms of oxygen facility arrangement. Therefore, the study aimed to estimate time to getting off supplemental oxygen therapy and identify predictors among COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia.MethodsA prospective observational study was conducted among 244 consecutively admitted COVID-19 patients from July to September, 2020. Kaplan Meier plots, median survival times and Log-rank test were used to describe the data and compare survival distribution between groups. Cox proportional hazard survival model was used to identify determinants of time to getting off supplemental oxygen therapy, where hazard ratio (HR), P-value and 95%CI for HR were used for testing significance and interpretation of results.ResultsMedian time to getting off supplemental oxygen therapy among the studied population was 6 days (IQR,4.3–20.0). Factors that affect time to getting off supplemental oxygen therapy were age group (AHR=0.52,95%CI=0.32,0.84, p-value=0.008 for ≥70 years) and shortness of breath (AHR=0.71,95%CI=0.52,0.96, p-value=0.026).ConclusionAverage duration of supplemental oxygen therapy requirement among COVID-19 patients was 6 days and being 70 years and older and having shortness of breath were found to be associated with prolonged duration of supplemental oxygen therapy requirement. This result can be used as a guide in planning institutional resource allocation and patient management to provide a well-equipped care to prevent complications and death from the disease.     

Malpractice Awareness among Surgeons and Surgical Trainees in Ethiopia

BackgroundIn Ethiopia, a country where seeing medical errors is not rare, there is a lack of data concerning the overall awareness of medical malpractice issues among physicians. A recent study showed that 80% of malpractice claims in Ethiopia are related to some form of surgery or operation room activities.MethodsA cross-sectional survey was conducted among surgeons and surgical trainees. Data were collected anonymously by an online survey using Google forms through a 56-items structured questionnaire. Subsequently, the data were analyzed and reported employing nonparametric statistical methods with SPSS software package 26.ResultsIn our sample, the overall awareness regarding medical malpractice was relatively low. Surgery on a wrong patient (71.1%) was the most commonly reported form of malpractice, whereas unintended damage to adjacent organs (10.8%) was the most frequently disagreed up on form. In the event of a medical error, the majority (59.6%) reported readiness to disclose their error to the patient. The most common mentioned reason for not revealing a mistake was a threat of physical or verbal assault (68%). A significant number of respondents, i.e., 120(59.1%), reported being physically/verbally assaulted by a patient or their attendants at some point in their practice.ConclusionThe findings of our study provided a general picture of surgeons'' and surgical trainees'' knowledge, attitude, and practice regarding medical malpractice. This study recommends more robust ethics and law training modules to surgical trainees, refresher courses to surgeons, and advanced training programs in ethics and law.     

Enhanced contractile responses of arteries from streptozotocin diabetic rats to sodium fluoride.

1. Previous studies from this laboratory have demonstrated that alpha 1-adrenoceptor-mediated increases in tension and phosphoinositide metabolism are enhanced in the aorta and mesenteric arteries from diabetic rats. The purpose of the present investigation was to determine whether contractile responses to sodium fluoride (NaF), which directly stimulates GTP-binding proteins (G-proteins), are also enhanced in diabetic arteries. 2. NaF (1-20 mM) in the presence of 10 microM aluminium chloride produced slowly developing, concentration-dependent contractions in mesenteric arteries from three month streptozotocin-diabetic (60 mg kg-1, i.v.) male Wistar rats and age-matched control rats. The maximum contractile response but not the sensitivity to NaF was significantly greater in mesenteric arteries from diabetic than from control rats, as was the response to noradrenaline (NA). Maximum contractile responses of aorta and caudal artery from diabetic rats to NaF were also significantly enhanced. 3. Removal of the endothelium and denervation with 6-hydroxydopamine did not significantly alter the maximum contractile response of mesenteric arteries from either control or diabetic rats to NaF. Similarly, NaF had no effect on cyclic AMP levels in aorta, and no difference in cyclic AMP levels, either basally or in the presence of NaF, was detected between control and diabetic rat aorta. 4. Contractile responses of mesenteric arteries from both control and diabetic rats to NaF were diminished in calcium-free Krebs solution, but the NaF response remained significantly elevated in mesenteric arteries from diabetic rats compared to control. 5. Ryanodine (30 microM) which depletes intracellular calcium stores, nifedipine (3 microM) which blocks dihydropyridine-sensitive calcium channels and calphostin C (0.5 microM) which selectively inhibits protein kinase C, all significantly inhibited maximum contractile responses of mesenteric arteries from control and diabetic rats to NaF. There were no significant differences between control and diabetic arteries in the relative magnitude of the inhibition produce by the three antagonist. 6. These data suggest that there may be increased activation of the same signalling processes that mediate NA-stimulated vasoconstriction, perhaps contraction-associated G-proteins or the effectors coupled to these G-proteins, in response to NaF in mesenteric arteries from diabetic rats. This may also be responsible for the enhanced contractile responses of these arteries to alpha 1-adrenoceptor stimulation.