Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture

BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.     

Exclusive breastfeeding practice and its associated factors among children aged 6–23 months in Woldia Town,Northwest Ethiopia

BackgroundInappropriate practice of exclusive breastfeeding (EBF) is still a major problem worldwide.ObjectiveTo identify exclusive breastfeeding practice and its associated factors among children aged 6–23 months in Woldia TownMethodsA Community based cross-sectional study was carried out.Interviewer-administered questionnaire was utilized to collect the data. The questionnaire was adapted from the 2016 Ethiopia Demographic and Health Survey. Hosmer-Lemeshow model was fitted at a P-value of 0.91. Finally, Variables having P-Value <0.05 with 95% CI was considered as significant factors.ResultThe prevalence of exclusive breastfeeding practice was 46.2% (95% CI: 42.0, 49.8). Being employed mothers (AOR=0.62,95% CI:0.44,0.87), being head of a household (AOR=0.52,95% CI:0.32,0.83), not g getting husband support (AOR:0.5,95%CI:0.34,0.74), not fed colostrum''s (AOR:0.36,95%CI:0.23,0.57), not affected by traditional belief (AOR:3.59, 95% CI:2.09–6.17) shows significant association with Exclusive breast feeding practice.ConclusionThe prevalence of exclusive breast feeding practice was relatively lower than the National prevalence. Some demographic variable and traditional beliefs were significantly associated with exclusive breast feeding. Designing model policies that empower the role of women and eradicating bad traditional beliefs in the community is fundamental step.     

Tuberculous lesions not detected by routine abattoir inspection: the experience of the Hossana municipal abattoir, southern Ethiopia

The efficacy of the meat inspection procedures implemented for the detection of tuberculous cattle was evaluated by testing for bovine tuberculosis in 751 animals. The study involved routine inspection at slaughter, collection of tissues for detailed examination in the laboratory, and bacteriological investigation to identify Mycobacterium bovis. Of the 751 carcasses examined, 34 (4.5%) were found to have tuberculous lesions. Routine abattoir inspection detected only 29.4% of the carcasses with visible lesions. Eighty-four percent of the tuberculous lesions were found in the lungs and thoracic lymph nodes, 11.5% in the lymph nodes of the head, and the remaining 4.5% in the mesenteric and other lymph nodes of the carcasses. In addition, M. bovis was isolated from a carcass that presented no gross tuberculosis lesions. The low sensitivity of routine abattoir inspection demonstrates that existing necropsy procedures should be improved.     

Group B Streptococcus Recto-Vaginal Colonization in Near-Term Pregnant Women,Southwest Ethiopia

BackgroundGroup B Streptococcus (GBS) is recognized as an important cause of maternal and neonatal morbidity and mortality. Maternal vaginal carriage of GBS (Streptococcus agalactiae) can lead to vertical transmission to the neonate at the time of delivery. However, little is known about its prevalence, predictors and antibiotic susceptibility pattern in Jimma, Ethiopia. This study assessed the prevalence, antimicrobial susceptibility pattern and determinants of GBS recto-vaginal colonization among near-term pregnant women.MethodsA cross-sectional study was conducted from May to August 2015 at Jimma University Medical Centre in Southwest Ethiopia. Data through questionnaire and GBS isolates from vaginal and rectal swabs were collected. Antimicrobial susceptibility testing was performed.ResultsThe overall prevalence of GBS colonization among near term pregnant women (35–37 weeks) was 16.3% (22/135). The majority of GBS isolates were sensitive to Ampicillin and Penicillin G with 95.5% and 90.1%, respectively. Erythromycin and clindamycin were resisted by 50% and 40.9% of the isolates, respectively, whereas gentamicin was resisted by all isolates. GBS colonization was significantly associated with a history of preterm delivery (PTD) (AOR: 6.3, 95% CI: 1.42, 28.3) and history of urinary tract infection (UTI) during current pregnancy (AOR: 6.4, 95% CI, 1.95, 21.1).ConclusionOur study indicated that one among six near-term pregnant women had recto-vaginal GBS colonization. In places where universal screening is not feasible, selective screening for factors particularly history of PTD and UTI during current pregnancy may be a reasonable option. Antibiotic susceptibility testing should be performed while using Erythromycin, Clindamycin or Gentamicin.     

β-defensin Genomic Copy Number Is Associated With HIV Load and Immune Reconstitution in Sub-Saharan Africans

AIDS, caused by the retrovirus human immunodeficiency virus (HIV), is the leading cause of death of economically active people (age, 15-59 years) in sub-Saharan Africa. The host genetic variability of immune response to HIV and immune reconstitution following initiation of highly active antiretroviral therapy (HAART) is poorly understood. Here we focused on copy number variation of the β-defensin genes, which have been shown to have anti-HIV activity, and are important chemoattractants for Th17 lymphocytes via the chemokine receptor CCR6. We determined β-defensin gene copy number for 1002 Ethiopian and Tanzanian patients. We show that higher β-defensin copy number variation is associated with increased HIV load prior to HAART (P?=?.005) and poor immune reconstitution following initiation of HAART (P?=?.003). We suggest a model where variable amounts of β-defensin expression by mucosal cells, due to gene copy number variation, alters the efficacy of recruitment of Th17 lymphocytes to the site of infection, altering the dynamics of infection.     

Risk factors for multidrug resistant tuberculosis patients in Amhara National Regional State

Background

Multidrug resistant tuberculosis(MDR-TB) is becoming a major threat to tuberculosis control programs in Ethiopia.

Objectives

To determine risk factors of MDR-TB patients in Amhara National Regional State, Ethiopia.

Methods

Case-control study was conducted from May 2013 to January 2014. Resistance to rifampicin and isoniazid were done molecularly using line probe assay. TB patients infected with MDR-M.tuberculosis and non MDR-M.tuberculosis strain were considered as cases and controls, respectively. Data was collected using structured questionnaire with face to face interview. Patients'' clinical record review was also done.Multivariate analysis was computed to determine the risk factors of MDR-TB.

Results

A total of 153 MDR-TB and equal number of non MDR-TB patients'' participated in the study. Patients who had TB treatment failure (AOR=13.5,CI=2.69–70), cavitations on chest x-ray (AOR=1.9,CI=1.1–3.38) and contact with MDR-TB patients (AOR=1.4,CI=0.19–0.39) were more likely to be MDR-TB patients. Low monthly income (AOR=1.1,CI=0.34–0.47),alcohol consumption (AOR=1.5,CI=0.2–0.98) and young age (AOR=2.9,CI=1.07–7.68) were the other risk factors of MDR-TB.

Conclusions

TB treatment failure, cavitation on chest X-ray, contact with MDR-TB patients and low socioeconomic status were important risk factors for development of MDR-TB. Therefore, strict adherence to directly observed therapy, appropriate management of TB patients and advice on the value of nutrients are helpful to control the spreading of MDR-TB.     

Health care seeking behavior for depression in Northeast Ethiopia: depression is not considered as illness by more than half of the participants

Background

Depression is one of the most disabling and chronic mental illnesses. Despite its high burden, many people suffering from depression did not perceive that they had a treatable illness and consequently most of them did not seek professional help. The aim of this study was to assess the level of professional help-seeking behavior and associated factors among individuals with depression.

Methods and materials

The community-based cross-sectional study was conducted among residents of Dessie, Northeast Ethiopia. First, 1165 residents were screened for depression using patient health questionnaire and then 226 individuals who were screened positive for probable depression were interviewed with General Help-Seeking Questionnaire to assess the professional help-seeking behavior of participants with depression. Major associated variables were identified using logistic regression with 95% confidence interval (CI), and variables with a p value less than 0.05 were considered statistically significant.

Results

Among the total participants with depressive symptoms, only 25.66% of them did seek professional help. Being female [adjusted odds ratio (AOR)?=?2.769, 95% CI (1.280, 5.99)], current alcohol drinking [AOR?=?2.74, 95% CI (1.265, 5.940)], co-morbid medical-surgical illness [AOR?=?4.49, 95% CI (1.823, 11.071)], perceiving depression as illness [AOR?=?2.44, 95% CI (1.264, 4.928)], having moderate depressive symptoms [AOR?=?2.54, 95% CI (1.086, 5.928)] and moderately severe depressive symptoms [AOR?=?7.67, 95% CI (2.699, 21.814)] were significantly associated with help seeking behavior of participants.

Conclusions

Level of professional help-seeking behavior is as low as previous studies in different countries. The severity of depressive symptoms, co-morbidity of medical–surgical illness, current drinking of alcohol, being female, and perceiving depression as illness were significantly associated with professional help-seeking behavior for depressive symptoms. Working on mental health literacy in the community is important to increase help-seeking behavior.