Road traffic accident clinical pattern and management outcomes at JUMC Emergency Department; Ethiopia

Background: Road Traffic Accident is an incident on a way or street open to public traffic. It becomes one of the most significant public health problems in the world especially in developing countries. In Ethiopia, it represents a significant risk for morbidity and mortality. It is also the major public health problem even though studies done on this topic in the study area is limited. Objective: To assess clinical pattern, associated factors and management outcomes among road traffic accident Victims attending emergency department of Jimma University Medical Center. Methods: Hospital based cross sectional study design was employed to review patients' chart visited the hospital from March to April 2021. A systematic random sampling technique was applied. The data were collected using pretested checklist and analyzed using SPSS version 26. Descriptive statistics and multivariate logistic regression were computed. Variables with P<0.05 were considered statistically significant. Results: About 49.6%) were pedestrians injured of which motorcycle accounted 42.9%. More than half of victims never got any type of prehospital care. On arrival, 38.7% were classified as Red of which 71.4% of them were managed surgically. About 84.9% of victims were discharged with improvement whereas12.6% were died. Victims with head injury (AOR= 16.61: 95% CI; 3.85, 71.71), time elapsed to reach nearby health facility (AOR= 3.30; 95 CI (1.13, 9.60), condition of patient at Emergency Department (AOR= 7.78; 95% CI: 2.33, 26.06), GCS at admission (AOR= 20.12; 95% CI: 7.23, 55.96) and days spent in hospital (AOR= 6.85; 95% CI 5.81, 8.06) were independent predictors of unfavorable outcome. Conclusion: Road Traffic Accident represents a significant risk for morbidity and mortality in Ethiopia, of which head injury and multiple sites injury increase injury severity. Targeted approaches to improving care of the injured victims may improve outcomes. Thus, the clinician should take into consideration the clinical presentation and give due attention to the identified contributing factors in its management.

Adverse drug reactions in the department of dermatology at a tertiary care hospital: a prospective study

Background: To study cutaneous adverse drug reactions with regard to their clinical pattern. etiology, causality and severity.Methods: It was a prospective study undertaken in a 300 bedded tertiary care hospital. Patients with cutaneous ADRs presenting in Dermatology OPD were studied. Causality and severity of the adverse drug reactions were analysed and other parameters such as gender wise distribution of the ADRs and types of ADR were studied.Results: 35 cases of ADRs were enrolled for the study in the duration of Sept.2016 to May 2017. The majority of the patients were in the age group of 21-30 years (37.14%). The most common CADRs were Acne vulgaris (22.86%), followed by Fixed Drug eruption (11.43%) and Tinea cruris (8.57%). The most common class of drugs causing ADRs were topical steroids (64%), followed by non-steroidal anti-inflammatory drugs (14.29%).Conclusions: Female preponderance was seen. Topical steroids were the most offending drug followed by Diclofenac Sodium, the analgesic. Causality assessment showed a high score of Certain category. These variations may be explained by variations in drug usage patterns. The knowledge of the adverse drug reactions and the drugs causing them is essential for the clinician so that the choice of drug therapy can be made keeping these adverse drug reactions in mind.

Patogenia, cuadro clínico y diagnóstico imagenológico por resonancia magnética de las hernias discales / Pathogenia, clinical pattern, and imagenologic diagnosis through magnetic resonance of the disc herniation

Las hernias discales constituyen un importante problema de salud que causa ausentismo laboral en personas laboralmente activas, de ahí que el costo generado por esta afección sea motivo de preocupación a escala mundial. La revisión bibliográfica acerca de su patogenia, cuadro clínico y diagnóstico imagenológico resulta de vital importancia para su prevención, diagnóstico y tratamiento oportunos. En el diagnóstico por imágenes, la resonancia magnética ha tenido un mayor impacto en el análisis de las afecciones de la columna vertebral, pues posibilita investigar las características del disco intervertebral. Tiene superioridad diagnóstica respecto a la tomografía axial computarizada y la mielografía, debido a que no utiliza radiaciones ionizantes, en tanto, se considera más sensible y específica para demostrar anomalías, lesiones, así como enfermedades de la columna que no pueden visualizarse o quedar ocultas con los otros métodos.

Disc herniations constitute an important health problem causing absenteeism in active people, so that the cost generated by this disorder is reason of concern at world scale. The literature review on their pathogenia, clinical pattern and diagnostic imaging is of vital importance for its prevention, diagnosis and opportune treatment. In the diagnosis through images, the magnetic resonance has had a higher impact in the analysis of the spine disorders, because it facilitates to investigate the characteristics of the intervertebral disc. It has diagnostic advantage regarding the computerized axial tomography and myelography, because it uses no ionizing radiations, also, it is considered more sensitive and specific to demonstrate anomalies, lesions, as well as spine diseases which cannot be visualized or may be hidden with the other methods.

Prevalence and Clinical Pattern of Acute and Chronic Complications in African Diabetic Patients.

Aims: The aim of this study was to describe the proportion, profile and clinical pattern of acute and chronic complications associated with diabetes and its potential risk factors. Study Design: This was a retrospective study. Place and Duration of Study: We conducted this study at an Accident and Emergency unit of a tertiary hospital between February 2012 and January 2013. Methodology: Type 1 and Type 2 diabetes patients (18 years and older) that presented with diabetes-related complications within the study duration were studied. The emergency case record of patients who were brought in on account of diabetes complications was identified and information relevant to this research was extracted. Descriptive statistics was used to summarize data, while Chi-Square test was used for the categorical variables. Regression analysis was done to ascertain the risk factors associated with various complications. Results: Two hundred and sixty-two cases of diabetes complication were reported. Males (159, 60.7%) and those in 1-5 years group (89, 34%) were the majority. The mean age was 55.2±13.2 (SD) years, while the mean diabetes duration was 9.9±7.8 (SD) years. A slight majority were hypertensive (138, 52.7%), with mortality reported in five patients (1.9%). Acute complications accounted for 47.3% of the reported cases, with hyperglycaemia being the most common (71, 27.1%). Microvascular complications were more common than macrovascular complications (47.8% vs. 19.6%). Conclusions: More efforts focused on education programmes and early diagnosis through mass population screening, good glycaemic control, proper lifestyle modification through dieting and engaging in physical activity can forestall or reduce complications. Furthermore, government should seek ways to subsidize diabetes medication and make it affordable to the less privileged.

Clinical Presentation of Infertility in an Outpatient Clinic of a Resource Poor Setting, South-East Nigeria.

Aim: To identify the prevalence, common symptoms, signs, partner contribution, common diagnosis and outcome of infertility in a resource poor setting. Study Design: Descriptive retrospective study. Place and Duration of Study: Ebonyi state University teaching Hospital, Abakaliki south-east, Nigeria, in two years (1st January 2009 to 31st December 2010). Method: Case notes of patients who attended the infertility clinic over the study period were retrieved from the health services department of the hospital and analysed. Results: Infertility patients were 295 out of 1,913 new gynaecological cases during the period under review, forming 15.4% of the study population. The number of folders with complete information was 266 which were 90.2%. Primary infertility patients were 94(35.3%) of all infertility cases) while 172(64.7%) were secondary infertility. The age range was 19 to 47 years, with a mean value of 30.9±2.3 of two standard deviations across the mean. The mean parity was 1.4±0.8 and ranged between 0 – 7 children. Among those with previous deliveries, 68.2% had no living child. The predominant symptoms in the females were insomnia, inadequate coital exposure, galactorrhoea and vaginal discharge. The commonest demonstrable signs were galactorrhoea in 92(34.6%) patients, cervical excitation tenderness in 54(20.3%) and uterine mass in 65(24.4%).Some 44(16.5%) persons had no remarkable findings. Partner contributions were: 93 (34.9%) for females; 60(22.6%) males; 64(24.1%) both partners. Pelvic infections (75.5%) and tubal occlusion (16.9%) were the commonest aetiologic factors. Others were: endocrine disorders including polycystic ovarian diseases, uterine myoma, uterine synaechiae and tubo ovarian masses. The outcome of treatment was: 40(15.0%) pregnancies; 112(42.1%) still on treatment and counseling; 75(28.2%) referrals and 39(14.6%) patients lost to follow up. Conclusion: Astute history taking and physical examination helped in elucidating the cause of infertility in many of our patients. Secondary infertility as in other parts of our country takes upper hand thereby reinforcing the need for prevention of pelvic infection in women of reproductive age. Total cares of infertility couples require the cooperation of men, laboratory scientists, radiologists, and even clinical psychologists (it is multidisciplinary). Treatment outcome is still poor and may be improved through increased priority in public funding, equipment supply, and manpower training as well as health education.

A Statistical Observation on 1,430 Cases of Cutaneous Malignant Tumors over 20 Years (1987~2006) in Gwangju City and Chonnam Province / 대한피부과학회지

BACKGROUND: The incidence of cutaneous malignant tumors has recently markedly increased due to the increased longevity of life, along with the changes of social and environmental factors. However, few articles have reported on these changes, from a statistical aspect, of malignant skin tumors in Gwangju City and Chonnam Province. OBJECTIVE: Our purpose was to clarify the recent trends and changes in the incidence and clinical patterns of cutaneous malignant tumors observed in Gwangju City and Chonnam Province and to compare them with the previously reported data. METHODS: A total of 1,430 cases were pathologically diagnosed as cutaneous malignant tumor during a 20 year period between January 1987 and December 2006 at the Department of Dermatology in Chonnam National University Hospital. The tumor incidence and its changes, the age and gender distribution and the anatomical sites were investigated. RESULTS: The average annual incidence of cutaneous malignant tumors among the total number of outpatients was 1.4+/-0.5%. The incidence of cutaneous malignant tumors increased with time in 10-year intervals, from 1+/-0.25% (1987~1996) to 1.83+/-0.38% (1997~2006). Among the malignant tumors, the incidence of basal cell carcinoma (BCC) was increased up to 1.14% (1997~2006) as compared to 0.05% (1987~1996). The most common tumor among the 1,430 patients with cutaneous malignant tumor was BCC (58.96%), followed by squamous cell carcinoma (SCC) (17.58%), malignant melanoma (MM) (10.01%), metastatic carcinoma (3.57%) and malignant lymphoma (3.01%). The mean age of onset of the patients who were diagnosed with cutaneous malignant tumors was 63.64 years old (males: 62.23, females: 63.61) in this study. There was a similar incidence of malignant skin tumors between the males and females (1:1.04). The most common site for the development of malignant skin tumors were the head and neck where 94.54% of the BCCs and 63.3% of SCCs developed. The nose (33.02%) was the most preferential site for BCC, followed by the cheek (20.72%). SCC most frequently developed in the cheek (20.72%), followed by the lower lip (10.76%). The most frequent site for the development of MM was the sole and heel (36.37%) rather than the head and neck (14.7%). CONCLUSION: The total number of patients and the incidence of malignant skin tumors have gradually increased in the area of Gwangju City and Chonnam Province. Especially, BCC has markedly increased and this is mainly due to the increment of aged people in this area, along withsocial and environmental factors.

Clinical Analysis of Pediatric Mandibular Fractures

This retrospective study comprised 50 patients(57 fractures) with pediatric mandibular fractures sustained in various accidents and treated in the Department of Plastic and Reconstructive Surgery at the Dong-A Medical Center from September 1990 till May 2005. These patient's medical records were then retrospectively analysed in order to gain insight into a clinical pattern. 1.The seasonal and monthly incidence was the highest in Summer and August, the commonest accident time was between 12:00 p.m and 06:00 p.m. 2.The highest incidence in the age was between seven and nine years old, with male predominating over female in 1.7:1 ratio. 3.The most common cause of mandibular fractures was motor vehicle accidents followed by fall, exercise accident and others. 4.Nasal bone fracture was the commonest associate facial bone fracture. 5.Open reduction was done in 59% of total cases. 6.The cases of condyle fracture were treated with closed reduction or conservative management. Complications were malocclusion(4), TMJ limitation(2), asymmetry(2).

A Clinical Analysis of the Mandible Fractures

There is a tendency that facial traumas are increasing constantly due to the growing traffic accidents and criminal violences with the industrialization of the society. Among these traumas, the frequency of the mandible fracture is the second highest next to that of the nasal bone fracture. The mandible is an evitable part which makes the temporomandibular joint movement and occlusion. The reduction of these fractures is considered important in view of the aesthetic and functional aspects of human beings. This retrospective study comprised 587 patients with mandibular fracture who had been treated in the Department of Plastic and Reconstructive Surgery from March, 1, 1997 to February, 28, 2004. The studied items are age and sex distribution, prevalent time, causes of the fracture, fracture sites, accompanied soft tissue and bone injuries, treatment methods, time interval between the accident and operation, and the complications. The following results were obtained. 1. The male and female ratio of mandibular fractures was 4.1:1. The mandibular fractures of the young men in twenties were the highest(32.7%). 2. The monthly incidence was the highest on June and the greatest numbers of incidence occurred between 9 p.m and 3 a.m.(51.2%). 3. The most common cause of mandibular fracture was the traffic accident(35%). 4. The most common fracture site was symphysis (36.6%), followed by angle(28.9%), condyle(24.2%). 5. The mandibular fractures were usually accompanied with zygoma, maxilla, orbit and nasal fractures. 6. We have done 518 operative treatments out of 587 cases. We can get perfect reduction and shorten the treating period, performing operative treatment, which is open reduction with the plate and screw. In case of subcondyle level, we utilize the external fixation. 7. The most common time interval between onset and surgical intervention was less than 10 days(66.8%). 8. The long term follow up longer than 6 months was possible in 286 patients. Malocclusion(14 cases, 4.9%), sensory disturbance of lower lip(11 cases, 3.8%), malunion or nonunion(8cases, 2.8%), and infection(8cases, 2.8%) were the complications found in these patients.

A Clinical and Histopathologic Study of 154 Cases with Congenital Melanocytic Nevus / 대한피부과학회지

BACKGROUND: Congenital melanocytic nevus(CMN) is regarded as benign, however it can be transformed to malignant melanoma. Thus, careful follow-up is mandatory. OBJECTIVE: To identify the clinical and histologic characteristics of CMN METHOD: We evaluated the clinical characteristics of CMN from 154 patients diagnosed at the Department of Dermatology in Chonnam National University Hospital from January, 1993 to December, 2002. Histopathologic exam was done from 50 patients. RESULTS: Female was more common(62.3%) and most cases(96.8%) were clinically apparent at birth. Medium-sized nevi(1.5cm> or =, <20cm) was most common(75.3%). The commonest location was on the head and neck region(45.5%). Most lesions were brown, dark brown or black in color, and flat-surfaced or slightly elevated in contour. About half of the cases manifested excessive hair growth on the surface and the possibility to have hair was positively correlated with the size of CMN. Some cases accompanied with neurofibromatosis, nevus flammeus and vitiligo were observed. Large CMN, compared with medium-sized or small CMN, involved deeper in the dermis. In 25 cases(50%), nevus cells involved the skin appendages, nerves, and vessels. CONCLUSION: Medium-sized CMNs on the head and neck were most prevalent. Some cases were associated with other diseases, especially pigmentary and vascular disorders. There was positive correlation between the size of CMN and the possibility to be hairy and, larger CMN tended to involve deeper in lower reticular dermis.

Pattern of hospitalized-stroke patients in ASEAN countries an ASNA stroke epidemiological study.

To better understanding the demographic characteristics, admission time, clinical pattern, risk factors, stroke type, length of stay, and discharge outcome of hospitalized acute stroke patients in ASEAN member countries, ASEAN Neurological Association (ASNA) formed a Standing Commiltee for Stroke in 1996 and this is the first ASNA Stroke Epidemiological Study using the same stroke protocol. This prospective hospital based study was conducted in seven ASEAN countries (Brunei, Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam) by participating neurologists from October 1996 to March 1997. Of the 3723 consecutive hospitalized stroke patients (2030 males and 1660 females) from 44 participating hospitals in this study ie Brunei (n=53), Indonesia (n=2065), Malaysia (n=300),Philippines (n=545),Singapore (n=232), Thailand (n=244) and Vietnam (n=284), the mean age was 59.0 ± 13,8 years 16% of patients were younger than 45 years and 37% of patients were older than 65 years. There were no significant differences in age at onset among stroke subjects except in Vietnam (younger) and Singapore (older). The sex distribution showed a slight higher prevalence of women in Singapore and in the age group > 64 years. The mean adrnission time was 41.5 ± 87.0 hours, 19% of patients were admitted within 3 hours, 29% within 6 hours and 66% more than 6 hours (delayed admission) especially in Malaysia and Singapore (80% and 77% respectively). Motor disability was the most prevalent clinical feature in all countries and carotid bruit was the rarest (1%). Hypertension was the most common risk factor (68%) in all countries, followed by TIA (35%), smoking, diabetes mellitus, ischnemic heart disease and hypercholesterolemia. CT scan was performed on 76% of subjects. The diagnostic classification was non lacunar anterior circulation (32%), lacunar infarction (14%), hemorrhagic stroke (26%), SAH (4%). Mean length of stay was 11.4 ± 11.8 days. Most of the patients discharged from the hospital were alive improved (57%) and mean death rate was 22%, highest in Thailand (45%) and lowest in Brunei (8%). This hospital based stroke data showed the recent characteristics of stroke pattern in seven ASEAN member countries and it will be very important data for health policy maker in these countries and for further cooperative researches in the future.

A Study on the Incidence and Patterns of Early and Late Seizures after Head Injury

Post-traumatic seizure is a known consequence of head trauma and a major public problem. But the surveillance study of this problem in our country is very rate. The purpose of the current study was to determine the incidence, clinical patterns and the outcome of the post-traumatic seizure in our institute. A retrospective review of management in 5053 patients with head injury was performed in our department between 1983 and 1992. In our series, the frequency of post-traumatic epilepsy was 254 patients, giving 1 5.0% incidence rate(early seizure occurred in 2.2% and late seizure occurred in 2.8% of patients). Of these, the records of 203 patients who received follow-up care for at least 2 years was reviewed. The first early epileptic attack occurred within 24 hours of injury in one third of the cases(33.3%), and the first late epileptic attack occurred within 1 year was about two thirds of the cases(64.6%). On CT scan findings, the early epilepsy had a higher incidence in scans that showed diffuse brain swelli ng and the late epilepsy had a higher incidence in subdural and intracerebral hematoma. 57.5% of early seizure were focal type, and 55.2% of late seizure were generalized convulsive seizure. The outcome of severe head injury patients with early seizure was better than that of late seizure group. The severity of head injury was related to the occurrence of late post-traumatic seizure.Development of new antiepileptic drugs, increasing knowledge of preventing post-traumatic sequelae and demand for surgical treatments have allowed the reduction of the incidence of the post-traumatic seizures. But further survey or study is recommanded in order to achieve more improvement in the management of post-traumatic seizures.

A Case of Atypical Linear Porokeraotsis / 대한피부과학회지

Porokeratosis is a familial, chronic, progressive disorder which demonstrates a characteristic clinical and histologic picture. Since Mibelli described three cases in 1893, several clinical variants have been identified, all of which are delineated by a diagnostic histopathologic pattern. We reported a case of atypical linear porokeratosis that had three types of skin lesions. One was the plaque type, as originally described by Mibelli. And others were atypical lesions, as papules and verrucoid hyperkeratotic plaques.