Dejene Tolossa Debela

Background: Abdominal wall endometriosis is a rare condition, often occurring as a complication following gynecologic surgery, especially caesarean sections. Its diagnosis is frequently delayed due to non-specific symptoms and a wide range of differential diagnoses. Case Description: We report A 25-year-old woman, para 1 by caesarean section, presented with cyclic left lower abdominal pain and swelling, worsening during menstruation. Physical examination revealed a firm, nontender mass near the caesarean scar. Imaging studies including ultrasound and color Doppler identified a hypoechoic lesion in the rectus abdominis muscle with internal vascularity. Fine needle aspiration cytology supported a diagnosis of endometriosis. Intervention and Outcome: Surgical excision under spinal anaesthesia was performed in complete removal of the lesion, with no postoperative complications. The patient remained symptom-free at six-month follow-up. Conclusion: This case highlights the importance of considering abdominal wall endometriosis in women with cyclical pain and prior uterine surgery. Imaging and histopathology are key to diagnosis, while complete surgical excision remains the definitive treatment.

Background: Holoprosencephaly is a congenital brain malformation resulting from incomplete division of the forebrain (prosencephalon) into two hemispheres during early embryonic development, typically during the 4th–6th week of gestation. Cyclopia is a rare and fatal form of holoprosencephaly characterized by severe craniofacial abnormalities resulting from incomplete cleavage of the embryonic prosencephalon, leading to the failure of separation of the orbital cavities. The prevalence is 1.31 per 10,000 for live births and 1:250 for spontaneous abortions. Case Presentation: This is a case report of a 33‐year‐old Gravida 5, Para 4 woman with no history of abortion and a prior history of normal vaginal deliveries, who presented to the obstetric triage with a 7‐day history of absent fetal movements. After a detailed history was taken, a physical examination and ultrasound scan confirmed an intrauterine fetal death. Termination of the pregnancy was decided after the mother was counseled on the possible outcome of the pregnancy. Induction with misoprostol per the hospital protocol was given to deliver an 1800‐g, Grade 3 macerated male fetus with a diagnosis of a severe form of holoprosencephaly with cyclopia and proboscis. Conclusion: Although holoprosencephaly is rare, early first‐trimester anatomical ultrasound conducted by an experienced clinician is critical for accurate diagnosis, and evaluation of severity is pivotal for counseling families regarding expected outcomes and pregnancy termination decisions.

Objective : This study assessed cervical cancer screening uptake and its associated factors among reproductive-age women in Jimma university medical centre. Design, Setting and Population: A community-based cross-sectional study was conducted in Jimma University Medical Centre among randomly selected 905 reproductive-age women. Method and outcome measures : Data were collected using face-to-face interviews using a structured questionnaire. Descriptive summaries of data were done using descriptive statistics. Binary logistic regression was used for the analytical study. Adjusted odds ratio and 95% confidence interval were respectively used to measure statistical associations and their statistical significance. Results: 905 women participated in the study making the response rate 96.79%. Only 83 (9.2%) women had ever been tested for cervical cancer. Being Muslim (OR=0.36, 9% CI; 0.15-0.88), not being head of household (OR= 0.23, 95% CI; 0.08-0.67), lack of knowledge of cervical cancer (OR=0.26, 95% CI; 0.09-0.74), lack of a favorable attitude towards cervical cancer screening (OR=0.13, 95% CI; 0.04-0.49), not listening to radio (OR=0.23, 95% CI; 0.07-0.74) were negatively associated with uptake of cervical cancer screening, whereas, none ever use of contraceptive (OR=2.92; 95% CI: 1.10-7.72) was positively associated with uptake of the screening. Conclusion: The rate of cervical cancer screening uptake from the current study is unacceptably low. Streamlining and strengthening curriculum integration and extracurricular health education intervention on cervical cancer giving due emphasis to Muslim-dominated communities and contraceptive users are recommended. Due emphasis should also be given to mass-media expansions and increasing coverage of health education to promote cervical cancer screening. Funding : None

Objective: Although the overall abortion‐related maternal mortality ratio has shown a downward trend in Ethiopia, the case‐fatality rate from abortion is still high. This study identified factors associated with delays in seeking an abortion until the second trimester at Jimma Medical Centre, Jimma, southwest Ethiopia.Methods: From February to August 2023, we conducted a cross‐sectional study on pregnant women seeking safe abortion care. Participants were selected through systematic sampling from a sample size of 260 calculated based on a previous study's prevalence of second‐trimester abortion (19.2%), with 80% power and a 5% margin of error. Participants were selected using systematic sampling and data were collected by an interviewer‐administered questionnaire. P‐value adjusted odds ratios (AORs) with their 95% confidence interval (CI) were used to determine the association between variables.Results: The study found a high prevalence of second‐trimester abortion at 58%. Factors significantly associated with delays in seeking abortion services until the second trimester included being from a rural area (AOR = 2.1, 95% CI: 1.2–3.8), experiencing social stigma (AOR = 4.2, 95% CI: 2.9–7.8), being unmarried (AOR = 1.6, 95% CI: 1.0–3.0), having limited knowledge of menstrual periods (AOR = 2.3, 95% CI: 1.2–4.6), delaying suspicion and testing for pregnancy (AOR = 18.2, 95% CI: 2.1–8.9–37.3), postponing the decision to have an abortion by more than 1 week (AOR = 4.9, CI: 1.0–23.7), and being a primigravidae (AOR = 2.1, CI: 1.1–4.1).Conclusions: Being from a rural area, social stigma surrounding abortion, being unmarried, limited knowledge of menstrual periods, and being a primigravidae were found to be significantly associated with delays in seeking abortion services until the second trimester. A multifaceted approach and efforts should focus on improving access to healthcare resources in rural areas, reducing social stigma surrounding abortion through education and advocacy, and providing comprehensive reproductive health education to enhance knowledge about menstrual cycles and pregnancy testing adapting to local contexts including employing community‐based approaches, using visual and interactive tools, and ensuring cultural sensitivity.

Objectives: Although HIV self-testing technologies have created new opportunities for achieving national and global HIV testing goals, current developments have not been compiled to inform policy and practice, especially in high HIV burden countries of Africa. We aimed to compile and synthesize the evidence about HIV self-testing technologies, strategies, and uptake in the top-10 high HIV burden countries of Africa. Methods: We searched CINAHL, PubMed, Web of Science, PsycINFO, Social Science Citation Index, and EMBASE to include eligible articles published in English between January 2012 and November 2022. Results: In total, 865 articles were retrieved and only 16 studies conducted in five African countries were eligible and included in this review. The two types of HIV self-testing modalities presently being used in Africa are: The first is Home Self-Test which is done entirely at home or in another private location by using oral fluid or blood specimen. The second modality is Mail-In Self-Test (self-sampling), where the user collects their own sample and sends this to a laboratory for testing. Perceived opportunities for the uptake of HIV self-testing were autonomy and self-empowerment, privacy, suitability, creating a chance to test, and simplicity of use. The potential barriers to HIV self-testing included fear and worry of a positive test result, concern of the test results is not reliable, low literacy, and potential psychological and social harms. The oral-fluid self-testing is preferred by most users because it is easy to use, less invasive, and painless. The difficulty of instructions on how to use self-test kits, and the presence of different products of HIV self-testing kits, increase rates of user errors. Conclusion: Adopting HIV self-testing by overcoming the challenging potential barriers could enable early detection, care, treatment, and prevention of the disease to achieve the 95-95-95 goal by 2030. Further study is necessary to explore the actual practices related to HIV self-testing among different populations in Africa.

Background: Treatment of latent tuberculosis infection (LTBI) is effective in preventing progression to TB disease. This study aimed to synthesize available evidence on the efficacy, adherence, and safety of LTBI treatment in order to assist policymakers to design appropriate national treatment policies and treatment protocols.Method: The PRISMA-NMA was used to review and report this research. Randomized controlled trials which compared the efficacy and safety of LTBI treatments were included. A systematic literature search was done to identify relevant articles from online databases PubMed/ MEDLINE, Embase, and Cochrane Center for Clinical Trial database (CENTRAL). The network meta-analysis was done using R- studio Version 1.4.1103.Result: In this review, 42 studies were included, which enrolled 46,022 people who had recent contact with patients with active tuberculosis, evidence radiological of previous tuberculosis, tuberculin test equal or greater than 5 mm, radiographs that indicated inactive fibrotic or calcified parenchymal and/or lymph node lesions, had conversion to positive results on a tuberculin skin test, participants living with HIV, chronic Silicosis, immigrants, prisoners, old people, and pregnant women who were at risk for latent TB were included.The incidence of TB among people living with HIV who have taken 3RH as TPT was lower, followed by 48%,followed by 6H (41%). However, 3HP has also the potential to reduce the incidence of TB by 36% among HIV negative patients who had TB contact history. Patients’ adherence to TPT was higher among patients who have taken 4R (RR 1.38 95% CI 1.0,1.89) followed by 3RH (34%). The proportion of subjects who permanently discontinued a study drug because of an adverse event were three times higher in the 3RH treatment group. Furthermore, the risk of grade 3 and 4 liver toxicity was significantly higher in 9H followed by 1HP, and 6H.Conclusion: From this review, it can be concluded 3RH and 6H has a significant impact on the reduction of TB incidence among PLWH and 3HP among HIV negative people who had TB contact history. However, combinations of rifampicin either with isoniazid were significantly associated with adverse events which resulted in permanent discontinuation among adult patients. Furthermore, grade 3 and 4 liver toxicity was more common in patents who have taken 9H, 1HP, and 6H. This may support the current recommended TPT regimen of 3HP, 3RH, and 6H.

Different anti-infective drugs have been proposed for the treatment of patients with COVID-19. We carried out a network meta-analysis to assess their relative efficacy and safety. We searched relevant databases for all randomized controlled trials that reported the efficacy and or safety of any anti-infective drugs published up to April 30, 2022 for different outcomes. We did both pairwise and network meta-analysis with 95% confidence intervals using a fixed-effect model. We assessed studies for quality of evidence using an extension of the standard Grading of Recommendations, Assessment, Development and Evaluation approach considering P<0.05 to be statistically significant. We included 68 RCTs for 27,680 participants on 22 anti-infective drugs. For clinical recovery at 14 days Ivermectin (OR= 3.00, 95%CI: [1.82; 4.96]; p < 0.0001; moderate certainty evidence), Baricitinib plus Remdesivir (OR= 2.20, 95%CI: [1.35; 3.53]; p = 0.005; low certainty evidence), and Favipiravir (OR= 2.16, 95%CI: [1.27; 3.68]; p = 0.004; moderate certainty evidence) were statistically effective than standard of care. There was no statistically significant difference between treatments for the viral clearance at 14 days outcome and standard of care. In terms of death outcome, only combined therapy of Baricitinib and Remdesivir showed statistically significant risks of ratio (RR= 0.47, 95%CI: [0.23; 0.99]; p = 0.03). Arbidol (RR= 0.46, 95% CI: [0.23; 0.95]; p = 0.04) was statistically safe drug than standard of care. This Network Meta-analysis suggests that Baricitinib plus Remdesivir is more effective than the other anti-infective drugs in treating patients with COVID-19 in terms of clinical recovery at 14 days, mortality and adverse events outcomes.

Background: Diabetic ketoacidosis (DKA) is an acute life-threatening complication of diabetes mellitus. This study aimed to evaluate the clinical characteristics and the burden of DKA cases during the period of the COVID-19 outbreak in Ethiopia. Methods: An institutional-based retrospective chart review study was conducted. 178 randomly selected patients’ medical charts were included. Data were collected from medical records in the period between October 2020 to July 2022. To investigate the association between the dependent and independent variable, binary and multivariable logistic regression were done with statistically significant at P ≤0.05. Results: A total of 178 medical records were reviewed. The mean (±SD) age of the patients was 41.3 (±13.2) years and 45% of patients had type 2 diabetes. Acute diabetic complications were documented in 25.8% of patients where DKA was the commonest (16.3%). Nearly half of the DKA patients (n=13, 44.8%) were presented with poly-symptoms at the time of diagnosis. Furthermore, missing drug (31%) was the most frequent precipitating factor followed by community-acquired pneumonia (21%), and multiple factors (17%). Besides, patients in the DKA group had a higher mean length of hospital stay (3 days versus 2.6 days). Conclusion: The poly-symptoms were the common clinical features of DKA at the time of presentation. Pneumonia and a history of missing drugs were identified as leading precipitating factors of DKA. Even though the DKA complication is low in this research, diabetes health education at the community and institutional level, routine screening for diabetes at health centers, and treating the infections early are strongly recommended.

Background Ethiopia stands fifth in pneumonia death rate among children under five worldwide but the severity and determinants of the disease are inconsistently reported, hindering policy and practice. This study aimed to assess the magnitude and determinants of severe pneumonia among hospitalized children under five in Adama town, Ethiopia. Method A facility-based cross-sectional study was conducted among under five children admitted at Adama Hospital and Medical College (AHMC), Adama Town, East Shoa Zone of Oromia in Ethiopia. Using adapted, structured questionnaire and systematic random sampling, the patients’ parents or caregivers were interviewed to determine the magnitude of the disease and underlying determinants including sociodemographic, environmental, comorbidity, nutrition, and immunization characteristics. The bivariate logistic regression model was used to test the association between variables on SPSS version 21. Result The study enrolled 465 hospitalized children under five, with a mean (standard deviation) age of 22.4 (15.5) months, 236 (50.8%) males, and 285 (61.3%) living in urban areas. The magnitude of severe pneumonia among the children was 41.9%. Factors significantly associated with severity of the pneumonia episode were: persistent diarrhea lasting two or more weeks [adjusted odds ratio (AOR) 4.31, 95% CI 2.14–8.66], non-exclusive breastfeeding [AOR 3.23, 95% CI 1.23–8.49], undernutrition [AOR 1.73, 95% CI 1.04–2.90], and smoking of a family member [AOR 8.33, 95% CI 4.10–17.00]. Conclusion Severe pneumonia among hospitalized children under five was higher in Adama town, and more common among those with persistent diarrhea, non-inclusive breastfeeding, undernutrition, and living closely with smokers that require a coordinated intervention.

Background: Deep vein thrombosis (DVT) is commonly identified and diagnosed in the emergency department. Factors including sedentary life (immobility), pregnancy in women, cancer, postoperation, admission to ICU, smoking, and obesity are identified risks for thrombosis development. We report a case of a 35-year-old man who presented to the emergency department developing left lower leg swelling and pain, low-grade fever, and headache after he was treated and discharged, cured of severe COVID-19. Then venous and arterial Doppler ultrasound of the lower leg revealed dilated, absent flow and luminal thrombus in the distal popliteal, anterior and posterior tibial veins and perforator vessels were diagnosed as leg DVT. Conclusion: DVT is a hematological emergency that needs serious consideration in prevention as well early diagnosis in patients with possible risk factors. This case report aims to arouse the clinician’s awareness of the occurrence of deep vein thrombosis during and after COVID-19.