Penetrating cardiac injury presentation and management in resource-limited settings: A case series from Ethiopia.

INTRODUCTION AND IMPORTANCE: Penetrating cardiac injury is rare (0.1 % of trauma admissions) but fatal. Presentation is with features of cardiac tamponade or hemorrhagic shock. Urgent clinical evaluation, ultrasound, temporizing pericardiocentesis or surgical repair with cardiopulmonary bypass as back up consist of standard management. In this paper, experience of management of penetrating cardiac injury from a resource limited country is presented. CASE PRESENTATIONS: There were seven patients, five had a stab injury and two had gunshot wound. All were men with mean age of 31.1 years. Patients arrived within 30 min (3), 2 h (2), 4 h (1) and 18 h (1) after injury. Mean initial blood pressure and pulse rates were 83/51 mm Hg and 121, respectively. One patient had pericardiocentesis before referral. Exploration was via left anterolateral thoracotomy. Four (57.1 %) had right ventricle perforation, one had both right and left ventricle, and two (28.5 %) had left ventricle perforation. Suture repair (6) and pericardial patch (1) were done without bypass machine as back up. Mean duration of stay in the intensive care unit and in the surgical wards were 4.4 days (range: 2-15) and 10.8 days (range: 1-48), respectively. All were discharged improved. CLINICAL DISCUSSION: Penetrating cardiac injury presents with low blood pressure and tachycardia after stab or gunshot wounds. Right ventricle is mostly affected. Pericardiocentesis can be done as temporary measure. While having bypass machine as back up is recommended, the absence of it should not preclude intervention. Suture repair can be done with left anterolateral thoracotomy. CONCLUSION: Penetrating cardiac injury can be managed in resource limited settings without back up of cardiopulmonary bypass. Early identification and surgical intervention results in favorable outcome.

Incidence and patterns of adverse drug reactions among adult patients hospitalized in the University of Gondar comprehensive specialized hospital: A prospective observational follow-up study.

BACKGROUND: Adverse drug reactions (ADRs) have continued to be a public health challenge with significant clinical and healthcare costs. However, little is known regarding the incidence of ADR in Ethiopia, particularly in the study setting. Thus, this study aimed to assess the incidence and patterns of ADRs in patients admitted to the University of Gondar comprehensive specialized hospital (UoGCSH). METHODS: A prospective observational follow-up study was conducted on admitted patients at the medical ward in the UoGCSH from May to August 2022. A multifaceted approach involving daily chart review and patient interviews was employed to collect the data. A standard Naranjo ADR Probability Scale measuring tool was used to characterize the probability of existing ADR. The data was analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Logistic regression analysis was employed to determine the association between the occurrence of ADRs and other variables. A p-value at the 95% confidence interval was considered statistically significant. RESULTS: This study included 237 participants in total. The average length of follow-up was 16.4 (±5.2) days. Overall, 65 ADRs were identified, resulting an incidence rate of 27.4 (95% CI: 19.8-30.4) per 100 admissions. The most common ADRs were hypokalemia (10.7%), followed by constipation, diarrhea, hypotension, and rash (9.2% each). The majority of these ADRs (73.8%) were classified as "definite" by the Naranjo ADR probability scale. Gastrointestinal tract (GIT) (41.5%) and metabolic (18.6%) were the most frequently exposed systems for ADR. Antibiotics (26.2%) and cardiovascular medications (24.7%) were the most frequently implicated medications in existing ADRs. ADRs were significantly associated with age (p = 0.035), the presence of comorbidities (p = 0.021) and complications (p = 0.008), and receiving a higher number of medications (p = 0.04). CONCLUSION: In this study, ADR was identified in about one-fourth of the participants. Older patients, patients with comorbidities and complications, and patients who received a higher number of medications were more likely exposed for ADRs. Healthcare providers should strictly follow the admitted patients to minimize ADRs.

Effectiveness of Single Chest Tube vs Double Chest Tube Application Postdecortication: Prospective Randomized Controlled Study.

BACKGROUND: Draining the chest cavity with 2 tubes is a common practice among thoracic surgeons. This research was conducted in Addis Ababa from March 2021 to May 2022. A total of 62 patients were included. STUDY DESIGN: This study was conducted to investigate the superiority of either single or double tube insertion after decortication. Patients were randomized in a ratio of 1:1. In group A, 2 tubes were inserted; in group B, single 32F tubes were inserted. Statistical analyses were performed using Statistical Package for Social Sciences version 27.0, Student's t test and Pearson chi-square test. RESULTS: The age range of patients was 18 to 70 years, with a mean of 44 ± 14.4434 years; the male to female ratio was 2.9:1. The dominant underlying pathologies were tuberculosis and trauma (45.2% vs 35.5%); the right side was more involved (62.3%). Drain output was 1,465 ± 1,887.9751 mL in group A vs 1,018 ± 802.5662 mL in group B (p value = 0.00001); the duration of drains was 7.5498 ± 11.3137 days in group A vs 3.8730 ± 1.4142 days in group B (p value = 0.000042). The degree of pain was 2.6458 ± 4.2426 vs 2.000 ± 2.1213 in group A and group B, respectively (p value = 0.326757). The length of hospital stay was 21.5818 ± 11.9791 days in group A vs 13.6091 ± 6.2048 days in group B (p value = 0.00001). Group A had air leak of 90.3% vs 74.2% in group B; subcutaneous emphysema was 9.7% in group A and 12.9% in group B. There was no fluid recollection, and no patients required tube reinsertion. CONCLUSIONS: The placement of a single tube after decortication is effective in reducing drain output, time of drain, and hospital stay. There was no association with pain, and there was no effect on other endpoints.

Osteoporosis-related appendicular fractures in Tikur Anbessa Specialized Hospital, Ethiopia: a prospective observational study.

We examined the frequency of osteoporotic fractures among patients presenting to Tikur Anbessa Specialized Hospital. Osteoporotic fractures accounted for 10.4% of all fractures and 31.8% of those 40 years and older. In addition, hip fractures accounted for 60%. Therefore, devising strategies for preventing, treating, and rehabilitating osteoporotic fractures is critical. PURPOSE: Examine the frequency of osteoporotic fractures among patients presenting to Tikur Anbessa Specialized Hospital. METHODS: This is an observational study of prospectively collected data between January 2018 and December 2021. Patients were categorized as having osteoporotic fracture if they were 40 years or older, sustained a low-energy injury, and had characteristic fracture patterns to the hip, proximal humerus, distal radius, tibia (in females only), clavicle, and scapula. A descriptive analysis was carried out to assess patient demographics. Risk factors were then evaluated using a binary logistic regression model. RESULTS: A total of 4712 orthopedic injury patients presented to the emergency department with 4422 fracture cases. Of these, 461 fulfilled the diagnostic criteria for osteoporotic fractures. The overall rate of osteoporotic fractures was 10.4% of all patients with fractures and 31.8% of those 40 years or older. Overall, 63.3% were female. One in four females and 5% of males with musculoskeletal trauma had an osteoporotic fracture. Osteoporotic hip fractures made up 59.9% of osteoporotic fractures and 5.9% of all fractures, followed by distal radius (23%), tibia in females (8.2%), and proximal humerus (7.4%). Pelvis (2.6%), clavicle (0.9%), and scapula (0.2%) fractures were found to be rare. Among all patients with fractures following low-energy injuries, when patients were aged 50 years and older, there was a higher risk that the trauma resulted in an osteoporotic fracture. This figure was highest among those aged 80 years and older (odds ratio (OR), 11.88; 95% CI, 7.01-20.11). CONCLUSIONS: Further studies need to be done to show the prevalence of osteoporosis and osteoporotic fractures in Ethiopia and examine risk factors. Devising strategies for preventing, treating, and rehabilitating osteoporotic fractures is critical.

A rare case of huge intrathoracic lipomatosis filling the right pleural cavity removed by open thoracic surgery: A case report.

INTRODUCTION AND IMPORTANCE: Lipoma is a benign tumor that arises from adipose tissue; subcutaneous fat is the most common site. It is the most common soft tissue tumor in adulthood. They are usually curable with simple excision. They are slow growing and can rarely become cancerous. Lipomatosis is when there are multiple lipomas with different pedicles. Lipomas arising from the thoracic pleura are rare and intrathoracic lipomatosis is exceptionally rare. Here we report a case of huge lipomatosis removed from the right pleural cavity in a 65 years old man. CASE PRESENTATION: A 65 years old male from southern region of Ethiopia, presented with shortness of breath associated with chest pain, productive cough, easy fatigability, and dyspnea on exertion. On exams, he had dullness on chest percussion and absent air entry on the right hemichest on auscultation. He had a history of treatment for pulmonary tuberculosis seven years back. Chest CT showed huge lobulated heterogeneous mass in the right pleural space with significant mediastinal shift to the left. All the large and small masses were removed by a thoracotomy and the specimen was subjected to histopathology examination which revealed myxoid lipoma. DISCUSSION: Lipoma is a benign tumor with no risk of malignant transformation. Intrathoracic lipoma is quite rare that we don't really find much reported cases. CONCLUSION: Intrathoracic lipomatosis is a rare condition that progresses without symptoms until it reaches a big size, at which point compressive symptoms appear. The primary approach for both diagnostic and therapeutic purposes continues to be surgical resection.

Biliopleural fistula after penetrating thoracoabdominal injury: A case report.

INTRODUCTION: Biliopleural fistula is a rare complication of thoraco-abdominal injury. Due to its rarity, the experience of any one surgeon is minimal, there is a paucity of literature regarding optimal treatment. This case report can be an addition to the existing reports to guide surgeons in better understanding and management of such cases. CASE PRESENTATION: A 30 yrs old male patient presented 2 weeks after he sustained gunshot injury over the right posterior chest. He was referred to our hospital because there was bilious chest tube output. Thoracotomy was done and finding was 10 cm right diaphragmatic defect with lacerated liver oozing bile and subcapsular hematoma that herniated into chest. Clotted blood had trapped the lung with pleural peel. Clot evacuation, decortication, biliary leak and liver laceration repair was done. The diaphragmatic defect was then closed. Patient had smooth postoperative course. DISCUSSION: Patients with BPF after thoracoabdominal injury can present with shortness of breath, bile output through chest tube and pleural effusion. Since bile has corrosive effect on lung with subsequent complications like empyema and bronchobiliary fistula, early diagnosis and treatment are imperative. BPF after thoracoabdominal injury can be effectively managed with thoracotomy, decortication and closure of diaphragmatic defect. CONCLUSION: Biliopleural fistula is uncommon after penetrating thoraco-abdominal injury and high index of suspicion and early diagnosis are of paramount importance to prevent complication. Surgery is best treatment option to stop biliary leak, close the diaphragmatic defect, manage further injuries in the chest and release trapped lung.

Academic Partnerships in Global Surgery: An Overview American Surgical Association Working Group on Academic Global Surgery.

: Most surgeons from high-income countries who work in global surgery will do so through partnerships between their institutions and institutions in low- and middle-income countries (LMICs). In this article, the American Surgical Association Working Group for Global Surgery lays out recommendations for criteria that contribute to equitable, sustainable, and effective partnerships. These include ethically engaging with the LMIC partner institution by putting its interests first and by proactively seeking to be aware of cultural issues. Formally structuring the partnership with a memorandum of understanding and clearly designating leaders at both institutions are important criteria for assuring long-term sustainability. Needs assessments can be done using existing methods, such as those established for development of national surgical, obstetric, and anesthesia plans. Such assessments help to identify opportunities for partnerships to be most effective in addressing the biggest surgical needs in the LMIC. Examples of successful high-income countries-LMIC partnerships are provided.

Appendico ilial knotting: a rare cause of small bowel obstruction.

Small bowel obstruction (SBO) is one of the most common acute surgical conditions that needs immediate innervation to prevent the morbidity and mortality associated with it. The common causes of SBO are different in developed and developing nations. Well-versed knowledge of the rare causes of SBO including its option of management is necessary. In this article, we present a case of an acute SBO secondary to Appendico-ileal knotting. The diagnostic difficulty and the options of management are discussed.

FATAL TRACHEO-INNOMINATE ARTERY FISTULA ASSOCIATED WITH A TRACHEOSTOMY TUBE AT A TEACHING UNIVERSITY HOSPITAL IN ADDIS ABABA: CASE REPORT AND REVIEW OF LITERATURE.

Tracheo-innominate artery fistula (TIAF) is a potentially lethal but rare complication associated with tracheostomy. As tracheostomies are one of the common life saving procedures that are performed routinely in the country, bring this complication to the attention of all health care professionals is of paramount importance. Hence, this case report is prepared.

Dynamics of land use and land cover and its effects on hydrologic responses: case study of the Gilgel Tekeze catchment in the highlands of Northern Ethiopia.

Unprecedented land use and land cover (LULC) changes in the Gilgel Tekeze catchment of the upper Nile River basin in Ethiopia may have far-reaching consequences for the long-term sustainability of the natural resources base. This study analyzed the dynamics and hydrologic effects of LULC changes between 1976 and 2003 as shown in satellite imagery. The effects of these LULC changes on the hydrologic response were investigated using the WetSpa model to estimate spatially distributed average annual evapotranspiration, surface runoff, and groundwater recharge. Digital image analysis revealed major increments of cultivated land and settlements of 15.4 and 9.9%, respectively, at the expense of shrubland and grazing lands. Population growth and the associated demand for land were found to be the major driving forces. The WetSpa simulation showed an increase in annual surface runoff of 101 mm and a decrease in groundwater recharge of 39 mm over the period 1976-2003. These results signify an increasing threat of moisture unavailability in the study area and suggest that appropriate land management measures under the framework of the integrated catchment management (ICM) approach are urgently needed.