A Retrospective Analysis on Cervical Spine Magnetic Resonance Imaging Findings in Patients with Neck Pain in a Tertiary Hospital,Addis Ababa,Ethiopia

BackgroundNeck pain is a common health problem throughout the world causing significant individual disability and economic burden on health care facility. Many factors are mentioned as a cause or association in relation to neck pain, of which degenerative and posttraumatic cause are the main ones. The aim of this study is to assess cervical spine Magnetic Resonance Imaging (MRI) patterns in patients presented with neck pain.MethodsA retrospective analysis of 160 patients who had cervical spine Magnetic Resonance Imaging (MRI) for evaluation of a neck pain was done. The study was conducted between February to August 2018 at Tikur Anbessa Specialized Hospital. The patients'' clinical history and magnetic resonance imaging reports were reviewed from their medical records. All patients who have cervical spine Magnetic Resonance Imaging (MRI) for a neck pain were included in the study. Those patients with acute traumatic neck pain were excluded.ResultsFrom a total of 160 patients, 71(44.4%) were males and 89(55.6%) were females. Degenerative cervical spine findings such as intervertebral disc degenerations were seen in 127(79.4%) patients. Non-degenerative imaging findings such as neoplasm and infection were seen in 10(6.3%) patients only. The MRI was normal in 23(14.4%) of them.ConclusionThe most common cause of neck pain from this study is degenerative changes of the cervical spine, which was predominant in the older age groups. Non-degenerative causes such as neoplasm and infection were less common findings.     

Prevalence of onchocercal skin disease and infection among workers of coffee plantation farms in Teppi,southwestern Ethiopia

In June 1996, a study on the economic impacts of onchocercal skin disease was initiated in southwestern Ethiopia. We made parasitological and clinicoepidemiological investigations among 1619 workers of a coffee plantation firm in Teppi, south-western Ethiopia. Sixty percent of the workers were included in the study. The prevalence of onchocercal skin disease (OSD) was 85.3%. Severe OSD (SOSD) was found in 17.3% of the study subjects. This was 1/5 of all OSD cases. The overall nodule carrier rate was 44.2%, which differed significantly by age classes from a rate of 12.3% to 73.0%. This rate varied by sex, 51.7% in males and 22.6% in females. Microfilarial carrier rate (MFCR) was 77.6%. This rate did not vary neither with severity of disease nor with presence or absence of pruritus or onchodermatitis. Mean microfilarial count was determined to be 38.1 per mg of skin snip or 44.4 per mg of infected skin snips. The geometric mean of microfilarial load per infected skin was 23.8. The community microfilarial load (CMFL) was estimated to be 14.0 per mg skin snip. The study showed that SOSD is prevalent in Teppi and affects a substantial number of the working population. An intervention program is called for.     

Antimicrobial susceptibility pattern of Helicobacter pylori strains isolated from adult dyspeptic patients in Tikur Anbassa University Hospital, Addis Ababa, Ethiopia

Presently, there is no published information on the antimicrobial susceptibility pattern of H. pylori strains in Ethiopia to guide the choice of drug for therapy. Therefore, it is becoming clinically relevant to test the in vitro susceptibility of H. pylori clinical isolates prior to treating patients. Susceptibility testing was performed on 50 clinical H. pylori isolates obtained from adult dyspeptic patients referred to the gastrointestinal (GI) Clinic of Tikur Anbassa University Hospital. Five antibiotics were evaluated, by using the Episolmeter test (E-test). The antibiogram of 50 H. pylori clinical isolates showed that all strains were sensitive to clarithromycin, erythromycin and tetracycline, while 38/50 (76%) and 3/50 (6%) of the strains were resistant to metronidazole and amoxicillin, respectively. Infection by metronidazole or amoxicillin resistant H. pylori is an important factor leading to treatment failure. Testing of all H. pylori clinical isolates to metronidazole and amoxicillin is recommended. If it is not possible to perform susceptibility tests on each clinical isolate, a program to survey the prevalence of resistance should be implemented in a given area or population. When treatment of H. pylori infection is indicated in dyspeptic patients, the potential availability, simplicity of use, safety and low cost of the antimicrobial agents have to be taken into account.     

Avoiding Early Revision Rhytidectomy: A Biomechanical Comparison of Tissue Plication Suture Techniques

Background: Manipulation and suspension of the superficial musculoaponeurotic system (SMAS) is performed by 74% of rhytidectomy surgeons. Multiple variations in suture techniques are employed in this task, but they have never been evaluated for differences in their ability to withstand stress. Objective: To compare the biomechanical properties of two different suture techniques that are used in SMAS plications during rhytidectomy: a double‐layered running locking (DRL) stitch and multiple horizontal mattress stitches. Methods: Fourteen horizontal mattress plications, in rows of six sutures, and comparable lengths of 16 DRL stitch plications of pig skin samples, were stressed using a tensometer with grip displacement increasing at a constant rate of 0.5 cm/Min. The required force to cause plication failure was recorded for each sample at three suture break points. Results: There was no significant difference between the two groups in the force required to cause the initial suture failure. Unlike the horizontal mattress plication, an initial break seemed to cause minimal to no distortion of the DRL tissue plication. When results were normalized by the initial break forces to account for small variations in tissue properties, the force ratio required to cause a second suture break was significantly larger in the DRL group than in the horizontal mattress technique. This is evidenced by the average second to first break force ratios of 1.62 vs. 1.13 for the DRL and horizontal mattress stitches, respectively, with a P‐value of .60. The mean ratios of third to first break forces for the DRL and horizontal mattress groups were 2.08 and 0.91, respectively, with a P‐value of .08. Conclusion: The DRL stitch requires more force than the horizontal mattress stitch to cause significant failure of tissue plication. This technique may enable plastic surgeons to avoid early revision rhytidectomy due to suture failure, and to create a long‐lasting, youthful cosmetic result.     

The impact of bariatric surgery on pulmonary function: a meta-analysis

Morbid obesity may affect several body systems and cause ill effects to the cardiovascular, hepatobiliary, endocrine, and mental health systems. However, the impact on the pulmonary system and pulmonary function has been debated in the literature. A systematic review and meta-analysis for studies that have evaluated the impact of bariatric surgery on pulmonary function were pooled for this analysis. PubMed, Cochrane, and Embase databases were evaluated through September 31, 2016. They were used as the primary search engine for studies evaluating the impact pre– and post–bariatric surgery on pulmonary function. Pooled effect estimates were calculated using random-effects model. Twenty-three studies with 1013 participants were included in the final meta-analysis. Only 8 studies had intervention and control groups with different time points, but 15 studies had matched groups with different time points. Overall, pulmonary function score was significantly improved after bariatric surgery, with a pooled standardized mean difference of .59 (95% confidence interval: .46–.73). Heterogeneity test was performed by using Cochran’s Q test (I² = 46%; P heterogeneity = .10). Subgroup analysis and univariate meta-regression based on study quality, age, presurgery body mass index, postsurgery body mass index, study design, female patients only, study continent, asthmatic patients in the study, and the type of bariatric surgery confirmed no statistically significant difference among these groups (P value>.05 for all). A multivariate meta-regression model, which adjusted simultaneously for these same covariates, did not change the results (P value > .05 overall). Assessment of publication bias was done visually and by Begg’s rank correlation test and indicated the absence of publication bias (asymmetric shape was observed and P = .34). This meta-analysis shows that bariatric surgery significantly improved overall pulmonary functions score for morbid obesity.     

Biomonitoring of metals and trace elements in urine of central Ethiopian populations

Biomonitoring of chemical concentrations in humans is important for detecting, monitoring, and addressing a wide range of health threats. However, it is virtually absent across many African nations, including Ethiopia. This study aims to determine urinary concentrations for metals and trace elements in populations living in the central Ethiopian Rift Valley. The region is unindustralized, rural, and characterized by unique geologic rifting and volcanic activities that have produced vast pyroclastic materials, forming its aquifer and fertile agricultural soils. Millions of people in the region rely on wells for drinking water and are engaged in cereal-based subsistence agriculture. We enrolled a total of 386 residents aged 10–50 years old (201 females and 185 males). The levels of 23 elements except F^─ were quantified in water and urine samples by ICP-MS. Mean concentrations of B, F^─, Ca, and Mg were measured in mg/L levels, while concentrations of Mo, Zn, Sr, Rb, and Li ranged between 100 and 700?μg/L. Mean concentrations between 5 and 15?μg/L were found for Ni, Cu, and Mn, while Ag, Be, Cd, Co, Pb, Sb, Th, TI, and U were all below 5?μg/L. Arsenic and Al had mean concentrations between 30 and 50?μg/L. Mean urinary concentrations of Ca, Cu, Mg, Pb, Sr, and Zn were significantly higher in males than females, whereas Co and Mn were higher in females. Finally, younger individuals (10–30 years) had significantly higher mean concentrations of B, Cd, Co, Mg, Mo, and Pb than those between 31 and 50 years, whereas only Ca was higher in the older age group. The concentration ranges of B, Mo, Mn, TI, Li, Zn, and in particular F^─ (0.44–44.6?mg/L) and As (2.2–164?μg/L) in urine were higher than the reference ranges reported in healthy unexposed North American and European populations, while those for the remaining 16 elements were comparable to published reference ranges from such settings. The established concentration ranges are important to monitor future changes in exposure, and risk factors for disease, that might stem from the economic growth and industrialization that is currently underway in the region.     

The incidence of oxygen desaturation during rapid sequence induction and intubation

BACKGROUND:

Rapid sequence induction and intubation (RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII.

METHODS:

An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection.

RESULTS:

A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for difficult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41 (26.8%), 50 (32.7%), 51 (33.3%), 38 (24.8%) and 25 (16.3%) patients respectively. Cricoid pressure was not applied at all for 17 (11.1%) patients and 53 (34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55 (35.9%) patients desaturated during RSII (SPO₂<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%–64%, 65%–74%, 75%–84%, 85%–89 % and 90%–94% for 6 (3.9%), 7 (4.6%), 5 (3.3%), 10 (6.5%), 13 (8.5%) and 14 (9.2%) patients respectively.

CONCLUSION:

The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.KEY WORDS: General anesthesia, Rapid sequence induction and intubation, Oxygen desaturation     

Hopane-type saponins from the seeds of Glinus lotoides

Four new hopane-type saponins, glinusides F, G, H, and I (1-4), and the known succulentoside B (5), as well as the two known flavones 5,7,4'-trihydroxyflavone-6,8-di-C-glucoside (vicenin-2) and 5,7,4'-trihydroxyflavone-8-C-sophoroside (vitexin-2' '-O-glucoside), were isolated from the seeds of Glinus lotoides growing in Ethiopia. On the basis of the spectroscopic data analysis, including 2D NMR and HRESIMS, the new structures were characterized as 3beta-O-beta-D-xylopyranosyl-6alpha-O-beta-D-xylopyranosyl-16beta-O-beta-D-xylopyranosyl-22-hydroxyhopane (1), 3beta-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-xylopyranosyl-6alpha,16beta-dihydroxy-22-O-alpha-L-rhamnopyranosylhopane (2), 3beta-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-xylopyranosyl-6alpha-O-beta-D-xylopyranosyl-16beta-hydroxy-22-O-alpha-L-rhamnopyranosylhopane (3), and 3beta-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-d-xylopyranosyl-6alpha-O-beta-D-xylopyranosyl-16beta-O-beta-D-xylopyranosyl-22-hopane (4).