Management of traumatic arterio-venous fistulas,experience in Armed Forces General Hospital,Addis Ababa

In Armed Forces General Hospital from March to December 1999, 53 patients were operated for Arterio-venous fistula. All were males, their age ranging from 19 to 46 years, average 27 years. The diagnosis of arterio-venous fistulas was established clinically. The pathological distribution of the lesions were: 23(43.4%) Arterio-Venous aneurysm; 11(20.75%) Arterio-Venous fistula, 19(35.85%) Arterial false aneurysms. The anatomical location was: 15 femoral, 10 Tibial, 6 poplitial, 6 brachial, 4 Axilláry, 1 ulnar, 7 external carotid and 1 occipital. The types of surgical procedures performed were: 29 (54.72%) excision of the arterio-venous fistula and aneurismal sac with arterial restoration by end to end anastomosis and/or saphenous vein graft, 16(30.19%) by excision of arteriovenous fistula and quadriple ligation of small vessels, 8(15.09%) excision of the false aneurismal sac and lateral repair of the artery (lateral arterioraphy). During the post operative period the patients were followed for three months, and we had the following results based on the clinical outcome criteria; 37(69.81%) excellent, 15(28.3%) good and 1(1.89%) fair.     

Kangaroo mother care: a randomized controlled trial on effectiveness of early kangaroo mother care for the low birthweight infants in Addis Ababa, Ethiopia

A randomized controlled trial was conducted over a 1-year period (November 2001-November 2002) in Addis Ababa to study the effectiveness of early Kangaroo mother care before stabilization of low birthweight infants as compared with the conventional method of care. There were 259 babies weighing less than 2000 g during the study period and a total of 123 (47.5 per cent) low birthweight infants were included in to the study. Sixty-two infants were enrolled as Kangaroo Mother Care (KMC) and the remaining 61 were Conventional Method of Care (CMC) cases. The demographic and socioeconomic characteristics for both groups were comparable. The mean age at the time of enrollment was 10 and 9.8 h for KMC and CMC, respectively (p>0.05 with 95 per cent confidence interval). The mean birthweight was 1514.8 g (range 1000-1900 g) for KMC and 1471.8 g (range 930-1900 g) for CMC (p>0.05 with 95 per cent CI) and the mean gestational age was 32.42 and 31.59 weeks for KMC and CMC cases, respectively. Fifty-eight per cent of KMC and 52 per cent of CMC cases were on i.v. fluid. Twenty-one of 62 (34 per cent) of KMC and 23/61 (37 per cent) of CMC babies were on oxygen through nasopharyngeal catheter. The mean age at exit from the study was 4.6 days for KMC and 5.4 days for CMC. Ninety-one per cent and 88 per cent of babies in KMC and CMC were discharged from the study in the first 7 days of life, respectively. The study showed that 14/62 (22.5 per cent) of KMC vs. 24/63 (38 per cent) CMC babies died during the study (p<0.05 and CI of 95 per cent.) The majority of deaths occurred during the first 12 h of life. Survival for the preterm low birthweight infants was remarkably better for the early kangaroo mother care group than the babies in the conventional method of care in the first 12 h and there after. More than 95 per cent of mothers reported that they were happy to care for their low birthweight babies using the early Kangaroo mother method. It was recommended to study the feasibility and effectiveness of Kangaroo mother care at the community level.     

H-type tracheoesophageal fistula

We are reporting a case of a newborn infant who was admitted to the Neonatal unit of the Tikur Ambessa Hospital. The baby was diagnosis to have H-type tracheoesophageal fistula. The patient presented with choking, coughing and sneezing during breast-feeding. The definitive diagnosis was made by Fluoroscopy guided Barium swallow X ray at the age of 21 days. Surgical intervention was done and the baby was discharged in good condition.     

Nutritional status and cognitive performance of mother–child pairs in Sidama,Southern Ethiopia

The purpose of this study was to assess the nutritional status and cognitive performance of women and their 5‐year‐old children using a cross‐sectional design. Cognitive performance of mothers and children was assessed with Raven's Colored Progressive Matrices (CPM) and Kaufman Assessment Battery for Children‐II (KABC‐II). Demographic characteristics, food consumption patterns and anthropometry were also measured. Four rural districts in Sidama, southern Ethiopia served as the setting for this study. Subjects were one hundred women and their 5‐year‐old children. Mean ± standard deviation age of the mothers was 29 ± 6 years and family size was 7.0 ± 2.6. Maternal body mass index (BMI) ranged from 15.3 to 29.0 with 14% of the mothers having BMI < 18.5. Anthropometric assessment of children revealed 29% to be stunted (height‐for‐age z‐score < ?2) and 12% to be underweight (weight‐for‐age z‐score < ?2). Mothers' education significantly contributed to prediction of both mothers' and children's cognitive test scores. There were significant differences in mean cognitive test scores between stunted and non‐stunted, and between underweight and normal‐weight children. Height‐for‐age z‐scores were correlated with scores for short‐term memory (r = 0.42, P < 0.001), and visual processing (r = 0.42, P < 0.001) indices and weight‐for‐age z‐scores were also correlated with scores of short‐term memory (r = 0.41, P < 0.001) and visual processing (r = 0.43, P < 0.001) indices. Malnutrition in the community likely contributed to the cognitive performance of the subjects. Performance on memory and visual processing tasks was significantly lower in children with growth deficits suggesting that efficient and cost effective methods to alleviate malnutrition and food insecurity would impact not only child health but also cognitive function.     

Skin disorders affecting human immunodeficiency virus-infected children living in an orphanage in Ethiopia

Background. Skin disorders are common in children in Ethiopia, and it is estimated that 92 000 Ethiopian children are infected with human immunodeficiency virus (HIV). HIV infection increases the prevalence of cutaneous disease, but the effect of antiretroviral therapy (ART) on the pattern of skin disease affecting children in sub‐Saharan Africa (SSA) is unclear. Aim. To assess the prevalence and nature of skin disorders in HIV‐infected children living in a dedicated orphanage in Addis Ababa, Ethiopia. Methods. Two dermatologists performed a clinical examination, including the skin, hair, nails and oral cavity of all the residents of an orphanage in Addis Ababa. The examiners knew that all the children were infected with HIV, but did not know their treatment or immune status. Diagnoses were made clinically and recorded anonymously, and treatment recommendations were made. Details of the children’s treatment and CD4 lymphocyte counts were obtained after the examination had been completed. Results. In total, 84 children [53 male (63%); 31 female (37%); median age 10 years] were examined. Of the 84 children, 57 (68%) were on ART, with 51 (61%) of these on cotrimoxazole prophylaxis. The median CD4 percentage was 27.1%. There were 66 children (79%) with at least one skin disorder; 21 of these had two disorders and 6 had three disorders. The commonest diagnosis was tinea capitis, affecting 39% of children. The other common diagnoses were: molluscum contagiosum (MC) (21%), verruca vulgaris (13%), plane warts (8%) and seborrhoeic dermatitis (7%). There was no significant difference in the prevalence of skin disease between children receiving ART and those who were not. Children with MC had significantly lower recent CD4 counts than children who did not have skin disease. Conclusions. Skin disorders in this population were very common, and the disorders identified were those that commonly affect children without HIV in Ethiopia. However, MC and plane warts appeared to have a higher frequency than would be expected in uninfected children.     

Antibacterial Effects of Artemisia afra Leaf Crude Extract Against Some Selected Multi-Antibiotic Resistant Clinical Pathogens

BackgroundDue to improper use of antibiotics, some pathogenic bacteria that cause serious and deadly infections have become resistant to commonly used broad spectrum antibiotics. This antibiotic resistance has become major global healthcare problem. Therefore, there is an urgent need to develop novel antibacterial agents; hence, much attention has been made on medicinal plants such as Artemisia afra. Thus, the current study was aimed to evaluate the antibacterial activity of ethanolic, methanolic and n-hexane extracts of this plant leaf against four multi-antibiotic resistant clinical pathogens.MethodsCrude extracts from A.afra leaf were prepared using ethanol, methanol and n-hexane and the antibacterial effect of each extract was tested against Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. In addition, minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) were evaluated.ResultsAmong the crude extracts, the highest zone of inhibition (25.33±0.58mm) was recorded against E. coli when methanolic extract was applied. On the other hand, the lowest inhibition was exhibited when n-hexane extract was applied against S.aureus (5.67±1.56 mm). Concerning MIC values of the different extracts, varied results were obtained. MIC value of 6.25mg/mL was recorded when methanolic extract was applied against all clinical pathogens. Moreover, both methanolic and ethanolic extracts showed MBC value of 12.5mg/mL against the four clinical pathogens. However, the methanolic extract gave MBC value of 6.25mg/mL against E. coli.ConclusionFrom this study, it can be concluded that it is possible to develop and formulate of new, efficacious, less toxic and inexpensive herbal medicine from A.afra leaf extract that act against multi-antibiotic resistant clinical pathogens.     

Intestinal smooth muscle spasmolytic actions of the aqueous extract of the roots of Taverniera abyssinica

A room temperature aqueous extract of the roots of Taverniera abyssinica antagonized the contractile responses of the guinea-pig ileum to acetylcholine and histamine. The extract also relaxed the smooth muscle of the rabbit duodenum, abolished the pendular contractions and antagonized the effects of acetylcholine and histamine on this tissue. The results confirm that there may be a sound pharmacological basis for the ethnomedical use of the roots of this plant to treat stomach ache.