Risk Factors that Affect Morbidity and Mortality in Patients with Perforated Peptic Ulcer Diseases in a Teaching Hospital.

BACKGROUND: This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting. METHODS: A two years (January 1, 2016 -December 30, 2018) retrospective cross-sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa, Ethiopia. RESULTS: A total of 93 patients were operated. The median age affected was 29 years (Range 15-75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was =10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(230)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4-13.5)] and a SBP =90mmhg [AOR (95%CI) =4.8(1-24)] were found to be significantly related with higher complication rate. CONCLUSIONS: Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential.

Across the Gap: Geochronological and Sedimentological Analyses from the Late Pleistocene-Holocene Sequence of Goda Buticha, Southeastern Ethiopia.

Goda Buticha is a cave site near Dire Dawa in southeastern Ethiopia that contains an archaeological sequence sampling the late Pleistocene and Holocene of the region. The sedimentary sequence displays complex cultural, chronological and sedimentological histories that seem incongruent with one another. A first set of radiocarbon ages suggested a long sedimentological gap from the end of Marine Isotopic Stage (MIS) 3 to the mid-Holocene. Macroscopic observations suggest that the main sedimentological change does not coincide with the chronostratigraphic hiatus. The cultural sequence shows technological continuity with a late persistence of artifacts that are usually attributed to the Middle Stone Age into the younger parts of the stratigraphic sequence, yet become increasingly associated with lithic artifacts typically related to the Later Stone Age. While not a unique case, this combination of features is unusual in the Horn of Africa. In order to evaluate the possible implications of these observations, sedimentological analyses combined with optically stimulated luminescence (OSL) were conducted. The OSL data now extend the radiocarbon chronology up to 63 ± 7 ka; they also confirm the existence of the chronological gap between 24.8 ± 2.6 ka and 7.5 ± 0.3 ka. The sedimentological analyses suggest that the origin and mode of deposition were largely similar throughout the whole sequence, although the anthropic and faunal activities increased in the younger levels. Regional climatic records are used to support the sedimentological observations and interpretations. We discuss the implications of the sedimentological and dating analyses for understanding cultural processes in the region.

MANAGEMENT OF INFLAMMATORY APPENDICEAL MASS IN ZEWDITU MEMORIAL HOSPITAL, ADDIS ABABA, ETHIOPIA.

BACKGROUND: Appendiceal mass is one of the complications of acute appendicitis. The management of patients with appendiceal mass is controversial and different treatment options have been suggested. OBJECTIVE: The objective of this study was to assess the results of conservative management of patients with appendiceal mass followed by interval appendicecomy. METHODS: The study was a retrospective analysis of 73 medical records of patients with appendiceal mass who were managed conservatively between March 2007 and February 2014. RESULTS: Fifty patients were males and 23 patients were females making the male to female ratio of 2.2:1. The mean age was 29.6 ± 6.3 years (range 12-68 years). The maximum incidence was in the 3rd decade. Forty one (55.8%) of the patients presented one week or more after the onset of their illness. Abdominal pain, right lower quadrant (RLQ) direct and rebound tenderness were observed in all patients. Mass was detected in the RLQ in 84.9% of the patients. Sixty five patients (89%) responded to conservative treatment and these patients were discharged after a mean hospital stay of 6.5 1.5 days (range 3-12 days). Interval appendicectomy was done for 58 patients 8-16 weeks after successful conservative management. The mean hospital stay after interval appendicectomy was 3.5 ± 0.5 days with a range of 2-5 days. One patient (1.7%) had a wound infection. There were no deaths. CONCLUSION: Initial non-operative management of appendiceal mass was successful in most cases and the complication rate after interval appendicecomy seems lower than with early operative treatment.

The evolutionary origin and population history of the grauer gorilla.

Gorillas living in western central Africa (Gorilla gorilla) are morphologically and genetically distinguishable from those living in eastern central Africa (Gorilla beringei). Genomic analyses show eastern gorillas experienced a significant reduction in population size during the Pleistocene subsequent to geographical isolation from their western counterparts. However, how these results relate more specifically to the recent biogeographical and evolutionary history of eastern gorillas remains poorly understood. Here we show that two rare morphological traits are present in the hands and feet of both eastern gorilla subspecies at strikingly high frequencies (>60% in G. b. graueri; ∼28% in G. b. beringei) in comparison with western gorillas (<1%). The intrageneric distribution of these rare traits suggests that they became common among eastern gorillas after diverging from their western relatives during the early to middle Pleistocene. The extremely high frequencies observed among grauer gorillas-which currently occupy a geographic range more than ten times the size of that of mountain gorillas-imply that grauers originated relatively recently from a small founding population of eastern gorillas. Current paleoenvironmental, geological, and biogeographical evidence supports the hypothesis that a small group of eastern gorillas likely dispersed westward from the Virungas into present-day grauer range in the highlands just north of Lake Kivu, either immediately before or directly after the Younger Dryas interval. We propose that as the lowland forests of central Africa expanded rapidly during the early Holocene, they became connected with the expanding highland forests along the Albertine Rift and enabled the descendants of this small group to widely disperse. The descendant populations significantly expanded their geographic range and population numbers relative to the gorillas of the Virunga Mountains and the Bwindi-Impenetrable Forest, ultimately resulting in the grauer gorilla subspecies recognized today. This founder-effect hypothesis offers some optimism for modern conservation efforts to save critically endangered eastern gorillas from extinction.

ACUTE APPENDICITIS IN CHILDREN ADMITTED TO ZEWDITU MEMORIAL HOSPITAL.

BACKGROUND: Acute appendicitis is the most common cause of acute abdomen in children. The rate of appendicular perforation may be related to duration from the onset of symptom presentation to treatment. OBJECTIVE: To describe the clinical characteristics and assess symptom duration as a risk factor for perforation in children with acute appendicitis. PATENTS AND METHODS: A retrospective analysis of medical records of 322 children under 15 years of ages with intraoperative diagnosis of acute appendicitis between the periods of September 2006 and August 2010. RESULTS: Acute appendicitis accounted for 87.5% of all cases of acute abdomen during the study period. Two hundred patients were boys and 122 patients were girls giving male to female ratio of 1.6:1. The mean and median ages were 10.4 and 11 years respectively. The youngest patient was 3 years old. The peak age range was 10-14 years. The most common presenting symptoms were abdominal pain (100%), anorexia (85.1%), vomiting (83.9%), and fever (82.3%). Right lower quadrant tenderness was the leading physical finding observed in 83.9% of patients. The mean duration of symptoms in children with non-perforated appendicitis was 2.5 days whereas the mean duration of symptoms in children with perforated appendicitis was 5.2 days. The mean length of hospital stay in children with non-perforated appendicitis was 3.6 days whereas the mean length of hospital stay in children with perforated appendicitis was 8.4 days. Leucocytosis was observed in 74.5% of children and the mean leucocyte count was 13150/mm3. The incidences of perforation if symptoms were present for less than 24 hours, 24-48 hours and more than 48 hours were 4.1%, 10.2%, and 45.3%, respectively. Postoperative wound infection was observed in 1.9% and 31% of children with non-perforated and perforated appendicitis, respectively. Two children died in the hospital. CONCLUSION: Acute appendicitis was the commonest cause of acute abdomen in children. It was more prevalent in children aged 10-14 years. The commonest presenting symptoms and signs were abdominal pain, anorexia, vomiting, and fever and right lower quadrant tenderness. The risk of perforation is directly proportional to the duration of illness at presentation. Perforated appendicitis was associated with increased morbidity, mortality and prolonged hospital stay.

Intestinal parasitic infections in relation to HIV/AIDS status, diarrhea and CD4 T-cell count.

BACKGROUND: HIV infection has been modifying both the epidemiology and outcome of parasitic infections. Hence, this study was undertaken to determine the prevalence of intestinal parasitic infection among people with and without HIV infection and its association with diarrhea and CD4 T-cell count. METHODS: A cross-sectional study was conducted at Hawassa Teaching and Referral Hospital focusing on HIV positive individuals, who gave blood for CD4 T-cell count at their first enrollment and clients tested HIV negative from November, 2008 to March, 2009. Data on socio-demographic factors and diarrhea status were obtained by interviewing 378 consecutive participants (214 HIV positive and 164 HIV negative). Stool samples were collected from all study subjects and examined for parasites using direct, formol-ether and modified acid fast stain techniques. RESULTS: The prevalence of any intestinal parasitic infection was significantly higher among HIV positive participants. Specifically, rate of infection with Cryptosporidium, I. belli, and S. stercoralis were higher, particularly in those with CD4 count less than 200 cells/microL. Diarrhea was more frequent also at the same lower CD4 T-cell counts. CONCLUSION: Immunodeficiency increased the risk of having opportunistic parasites and diarrhea. Therefore; raising patient immune status and screening at least for those treatable parasites is important.

The large-mammal fauna from the Kibish Formation.

The Kibish faunal remains are useful for reconstructing the habitat of the earliest documented Homo sapiens and for understanding the community within which early modern humans existed. A diverse assemblage of large mammals, including many species of bovids, suids, and equids, has been recovered from the Kibish Formation. There are no extinct large mammals represented in the fossil assemblage, and the overall taxonomic composition of the fossil fauna is similar to the modern-day wildlife community living near the Omo River. The fossil faunal assemblage shows a paucity of arboreal primates, and carnivore species are rare. However, the faunal sample includes possible Cephalophus (duiker) remains and Hylochoerus meinertzhageni (giant forest hog), taxa that are extremely rare in the African fossil record, and both indicate more closed habitats. Comparative analyses of the Kibish faunal remains using the ecological-diversity approach document close associations with edaphic grassland and woodland vegetation types. These vegetation forms are similar to current habitats surrounding the Omo River.

Paleoanthropology of the Kibish Formation, southern Ethiopia: Introduction.

Cranial and skeletal remains of modern humans, Homo sapiens, were discovered in the Kibish Formation in 1967 by a team from the Kenya National Museums directed by Richard Leakey. Omo I, from Kamoya's Hominid Site (KHS), consists of much of a skeleton, including most of the cranial vault, parts of the face and mandible, and many postcranial elements. Omo II, from Paul's Hominid Site (PHS), is a virtually complete calvaria. Only a limited fauna and a few stone artifacts attributed to the Middle Stone Age were recovered in conjunction with the fossil hominids. The available dating techniques suggested a very early age, over 100 ka, for Member I, from which the Omo I and Omo II fossils were recovered. However, in subsequent decades, the reliability of the dates and the provenance of the Kibish hominids were repeatedly questioned. The papers in this volume provide a detailed stratigraphic analysis of the Kibish Formation and a series of new radiometric dates that indicate an age of 196+/-2 ka for Member I and 104+/-1 for Member III, confirming the antiquity of the lower parts of the Kibish Formation and, in turn, the fossils from Member I. Studies of the postcranial remains of Omo I indicate an overall modern human morphology with a number of primitive features. Studies of an extensive lithic record from Members I and III indicate a Middle Stone Age technology comparable to assemblages of similar age elsewhere in Ethiopia. Studies of the mammalian, avian, and fish faunas indicate overall similarities to those found in the region today, with a few distinctive differences.

Faunal remains from Porc-Epic: paleoecological and zooarchaeological investigations from a Middle Stone Age site in southeastern Ethiopia.

The Middle Stone Age (MSA) sediments of Porc-Epic Cave near Dire Dawa, Ethiopia, have produced a large assemblage of archaeofaunal remains dating to the later periods of the Late Pleistocene. As one of the few MSA faunal assemblages from East Africa subject to detailed analysis, it provides rare insight into the foraging behavior of the early modern humans in this region. The MSA fauna include taxa that were not historically present in the area, with the occurrence of reduncines and alcelaphines indicating widespread grasslands and proximity to a perennial source of water. The faunal analysis examined several lines of evidence, including breakage patterns, surface modification, and skeletal-element representation. By incorporating comparisons with multiple actualistic data sets, the analysis of the assemblage demonstrates that, while the influence of carnivores and other biotic agents was evident, the faunal remains were accumulated primarily by hominid activity. The skeletal-element representation at Porc-Epic includes an abundance of high utility bones, in contrast to the predominance of "head-and-foot" elements documented at other MSA and Middle Paleolithic (MP) sites. The MSA occupants of Porc-Epic effectively exploited a wide range of prey with more emphasis on small- and medium-sized mammals.