Crepitus following a dog bite.

Crepitus following an animal bite is a rare case. We report a case of a 20-year-old man who presented to the surgical emergency department 1 h after being bitten by a medium-sized pet dog.

Prevalences of diabetic foot ulcer and foot self-care practice, and associated factors in adult patients with diabetes in south-east Ethiopia.

OBJECTIVE: We aimed to assess the prevalences of foot ulcer and foot self-care practices, and identify associated factors in adult patients with diabetes attending a referral hospital in south-east Ethiopia. METHODS: We performed a cross-sectional study of 267 diabetic patients. Multivariable binary logistic regression was used to identify factors associated with diabetic foot ulcer and foot self-care practice. RESULTS: The prevalence of diabetic foot ulcer was 11.2% (95% confidence interval [CI] 7.42-15.05). One hundred and forty-four (53.9%; 47.9, 59.9) patients demonstrated good foot self-care. Living rurally (adjusted odds ratio 2.27; 95% CI: 1.86-6.97), lack of regular exercise (3.91; 1.51-10.10), peripheral neuropathy (2.77; 1.05-7.33) and foot calluses (5.69; 1.74-18.59) were associated with diabetic foot ulcer. Urban inhabitants (2.01; 1.09-3.69), patients with diabetes for >10 years (2.92; 1.48-5.77), women (2.95; 1.66-5.22), and patients with a glucometer at home (2.05; 1.09-3.85) were more likely to have good foot self-care practice. CONCLUSION: The prevalence of diabetic foot ulcer was 11.2%. This prevalence is lower than those identified in other Ethiopian studies. However, patient awareness regarding foot self-care practice and risk reduction should be improved.

Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement.

This Delphi exercise aimed to gather consensus surrounding risk factors, diagnosis, and management of chyle leaks after esophagectomy and to develop recommendations for clinical practice. Background: Chyle leaks following esophagectomy for malignancy are uncommon. Although they are associated with increased morbidity and mortality, diagnosis and management of these patients remain controversial and a challenge globally. Methods: This was a modified Delphi exercise was delivered to clinicians across the oesophagogastric anastomosis collaborative. A 5-staged iterative process was used to gather consensus on clinical practice, including a scoping systematic review (stage 1), 2 rounds of anonymous electronic voting (stages 2 and 3), data-based analysis (stage 4), and guideline and consensus development (stage 5). Stratified analyses were performed by surgeon specialty and surgeon volume. Results: In stage 1, the steering committee proposed areas of uncertainty across 5 domains: risk factors, intraoperative techniques, and postoperative management (ie, diagnosis, severity, and treatment). In stages 2 and 3, 275 and 250 respondents respectively participated in online voting. Consensus was achieved on intraoperative thoracic duct ligation, postoperative diagnosis by milky chest drain output and biochemical testing with triglycerides and chylomicrons, assessing severity with volume of chest drain over 24 hours and a step-up approach in the management of chyle leaks. Stratified analyses demonstrated consistent results. In stage 4, data from the Oesophagogastric Anastomosis Audit demonstrated that chyle leaks occurred in 5.4% (122/2247). Increasing chyle leak grades were associated with higher rates of pulmonary complications, return to theater, prolonged length of stay, and 90-day mortality. In stage 5, 41 surgeons developed a set of recommendations in the intraoperative techniques, diagnosis, and management of chyle leaks. Conclusions: Several areas of consensus were reached surrounding diagnosis and management of chyle leaks following esophagectomy for malignancy. Guidance in clinical practice through adaptation of recommendations from this consensus may help in the prevention of, timely diagnosis, and management of chyle leaks.

Prevalence and Factors Associated with Diabetic Retinopathy among Adult Diabetes Patients in Southeast Ethiopia: A Hospital-Based Cross-Sectional Study.

Background: Diabetic retinopathy (DR) is the most prevalent microvascular consequence of diabetes mellitus, and it can result in blindness that is irreversible. Due to delayed diagnosis and limited access to diabetic care, the situation is even worse in developing countries. Scientific evidence on the prevalence of DR and its associated factors among diabetes patients in low-income countries, such as Ethiopia, is limited. This study aimed to determine the prevalence of DR and associated factors among adult diabetes patients in southeast Ethiopia. Methods: A hospital-based cross-sectional study was conducted among diabetes patients who visited Madda Walabu University Goba Referral Hospital. Fundus and slit-lamp examination were performed for screening of DR. Multivariate binary logistic regression was computed to identify factors associated with DR. Results: A total of 256 patients (144 men, 56.2%) aged 50.15±15.71 years were included in the study. The prevalence of any DR was 19.9% (95% CI 15.4%-25.3%), mild nonproliferative diabetic retinopathy (NPDR) 10.9% (95% CI 7.6%-15.4%), moderate NPDR 5.9% (95% CI 3.5%-9.5%), severe NPDR 0.9% (95% CI 0.2%-3.9%), and proliferative DR 2.3% (95% CI 1.0%-5.1%). Duration of diabetes ≥10 years (AOR 10.22, 95% CI 1.70-61.44), central obesity (AOR 5.42, 95% CI 1.38-21.19), overweight/obese (AOR 2.65, 95% CI 1.02-6.92), lower high-density lipoprotein (HDL) cholesterol (AOR 5.82, 95% CI 1.86-18.24), moderate triglyceride:HDL cholesterol ratio (AOR 4.13, 95% CI 1.13-15.15), and urban dwelling (AOR 2.84, 95% CI 1.04-7.78) were significantly associated with DR. Conclusion: One in every five DM patients had DR. Sociodemographic, anthropometric, and blood lipids were independently associated with DR. To reduce the burden of diabetes, strategies that focus on lifestyle modifications targeted at identified modifiable risk factors are essential.

Incidence and risk factors of gestational diabetes mellitus in Goba town, Southeast Ethiopia: a prospective cohort study.

OBJECTIVE: Gestational diabetes mellitus (GDM) is becoming a public health concern in low/middle-income countries, and is known to cause severe morbidity and mortality for mothers and newborns. However, evidence reported for the incidence and risk factors of GDM is scant in Ethiopia. We aimed to assess the incidence of, and risk factors for, GDM in Goba town, Southeast Ethiopia. DESIGN: Prospective cohort study. SETTING: Goba town, Southeast Ethiopia. PARTICIPANTS: Four hundred eighty pregnant women on antenatal care follow-up from 30 April to 30 September 2021. PRIMARY AND SECONDARY OUTCOMES: Incidence and risk factors of GDM using fasting capillary blood glucose. Log-binomial model was used to identify the risk factors of GDM. Adjusted relative risk (aRR), along with 95% CIs, were calculated to estimate the strength of associations. RESULTS: The cumulative incidence rate of GDM in this study was 15.7% (95% CI: 12.3% to 19.2%). Being unemployed (aRR=2.73; 95% CI: 1.36 to 5.47), having a family history of diabetes mellitus (DM) (3.01; 2.09 to 4.35), low physical activity (2.43; 1.11 to 5.32), inadequate dietary diversity (1.48; 1.29 to 1.92), anaemia (2.51; 1.32 to 3.54) and antenatal depression (4.95; 3.35 to 7.31) were significantly associated with GDM. CONCLUSION: The cumulative incidence of GDM was relatively high among the study participants. Having antenatal depression symptoms, low physical activity, inadequate dietary diversity, being unemployed, anaemia and a family history of DM were significant risk factors for GDM.

Prevalence of depression and associated factors among people living with HIV/AIDS in public hospitals of Southeast Ethiopia.

BACKGROUND: Depression is the most frequent mental health condition among human immune deficiency virus or acquired immune deficiency syndrome (HIV/AIDS) patients. It has been related to negative health outcomes. This could lead to hospitalization and an increase in medical expenses. This study aimed to assess the prevalence of depression and associated factors among HIV/AIDS patients in public hospitals Bale Zone, Southeast Ethiopia. METHODS: A hospital-based cross-sectional study design was randomly employed among 554 study participants. A systematic random sampling technique was used to select the study subjects. A structured Patients Health Questionnaires- 9 was used to measure the depression status of HIV/AIDS patients. Data were collected using a pretested interviewer administered structured questionnaire as well as review of patients medical charts or records. Descriptive statistics were computed. Multivariable logistic regression analyses were conducted identify factors associated with the prevalence of depression. Adjusted odds ratio (AOR), along with a 95% confidence interval (CI), was used to estimate the strength of the association. A p-value of < 0.05 was considered statistically significant. RESULTS: The prevalence of depression among the study participants was found to be 44.9% (95% CI: 40.79%, 49.1%). Perceived HIV related stigma is the single most dominant predictor of depression [(AOR = 8.2, 95% CI: (4.96, 13.68)], low income level [(AOR = 3.1, 95% CI: (1.59, 6.22)] Experiencing any form of a side effect of highly active anti-retroviral therapy (HAART) [(AOR = 1.5, 95% CI: (1.04, 2.56)], having normal BMI [(AOR = 0.49, 95% CI: (0.29, 0.8)] being HIV patients at WHO clinical stage II [(AOR = 0.44, 95% CI: (0.22, 0.9)], were significantly associated with prevalence of depression. CONCLUSION: The study revealed that the prevalence of depression among people living with HIV in the study settings was high, almost two out of every five HIV patients were depressed. Low income level, side effect to HAART, and having HIV related stigma were more likely to suffer from depression.

Prevalence of central obesity and its associated risk factors among adults in Southeast Ethiopia: A community-based cross-sectional study.

BACKGROUND: Obesity and overweight are known public health problems that affect populations across the world. These conditions have been associated with a wide range of chronic diseases including type 2 diabetes mellitus, cardiovascular disease, and cancers. In Ethiopia, the literature regarding the burden of central (abdominal) obesity is scarce. This study aimed to fill this gap by assessing the prevalence and risk factors associated with central obesity among adults in Ethiopia. METHODS: From May to July 2021, a community-based cross-sectional survey was conducted on a sample of 694 adults aged ≥18 years in administrative towns of Bale zone, Southeast Ethiopia. Multi-stage sampling followed by systematic random sampling was employed to identify study participants. Waist and hip circumferences were measured using standard protocols. The World Health Organization STEPS wise tool was used to assess risk factors associated with central obesity. Bi-variable and multi-variable binary logistic regression were used to identify factors associated with central obesity. Adjusted odds ratios (AOR) and their corresponding 95% confidence intervals (CI) have been reported to estimate the strength of associations. RESULTS: The overall prevalence of central obesity using waist circumference was 39.01% [(95% CI: 35.36-42.76; 15.44% for men and 53.12% for women)]. Multi-variable binary logistic regression analysis revealed that female sex (AOR = 12.93, 95% CI: 6.74-24.79), Age groups: 30-39 years old (AOR = 2.8, 95% CI: 1.59-4.94), 40-49 years (AOR = 7.66, 95% CI: 3.87-15.15), 50-59 years (AOR = 4.65, 95% CI: 2.19-9.89), ≥60 years (AOR = 12.67, 95% CI: 5.46-29.39), occupational status like: housewives (AOR = 5.21, 95% CI: 1.85-14.62), self-employed workers (AOR = 4.63, 95% CI: 1.62-13.24), government/private/non-government employees (AOR = 4.68, 95% CI: 1.47-14.88), and skipping breakfast (AOR = 0.46, 95% CI: 0.23-0.9) were significantly associated with central obesity. CONCLUSIONS: Abdominal obesity has become an epidemic in Bale Zone's towns in Southeastern Ethiopia. Female sex, age, being employed were positively associated with central obesity, while skipping breakfast was a protective factor.

Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV Positive Adult and Adolescent Clients in Southeast Ethiopia.

BACKGROUND: Antiretroviral therapy (ART) regimen failure is linked to an increased risk of disease progression and death, while early detection of ART failure can help to prevent the development of resistance. This study aimed to evaluate virological and immunological ART failure and predictors among HIV-positive adult and adolescent clients in southeast Ethiopia. METHODS: A retrospective cohort study was implemented from January 2016 to November 30, 2020; all HIV-positive nave patients on follow-up during the study period from four hospitals were included. Virological and immunological treatment failure was the primary outcome of the study. Cox proportional hazards regression models were employed for analysis. Hazard ratios with 95% confidence intervals were reported and variables with p-values <0.05 were considered statistically significant predictors of treatment failure. RESULTS: A total of 641 HIV patients' charts were reviewed, 62.6% of the study participants were females. Of the total study participants, 18.4% and 15% developed virological and immunological ART regimen treatment failure respectively. The median time to virological failure was 40 months. WHO stage IV [AHR = 4.616; 95% CI: (2.136-9.974)], WHO stage III [AHR = 2.323; 95% CI: (1.317-4.098)], poor adherence to HAART regimen [AHR = 3.097; 95% CI: (1.349-7.108)], and fair adherence [AHR = 2.058; 95% CI: (1.234-3.432)] were significantly associated with virological treatment failure among adolescent and adult study participants in southeast Ethiopia. CONCLUSION: The prevalence of virological treatment failure was 18.4% (95% CI: 15.4 -21.4) and the prevalence of immunological treatment failure was 15% (95% CI: 11.8-18.4). WHO clinical stage III/IV and non-adherence were independent predictors of virological ART treatment failure. Early management of clinical WHO stages and improving patients' ART regimen adherence are important to decrease the prevalence of ART regimen treatment failure.

High parity is associated with increased risk of cervical cancer: Systematic review and meta-analysis of case-control studies.

BACKGROUND: Cervical cancer is the fourth most common cancer among women. High parity has long been suspected with an increased risk of cervical cancer. Evidence from the existing epidemiological studies regarding the association between parity and cervical cancer is variable and inconsistent. Therefore, the objective of this systematic review and meta-analysis was to synthesize the best available evidence on the epidemiological association between parity and cervical cancer. METHODS: Case-control studies reporting the association between parity and cervical cancer were systematically searched in databases like MEDLINE/PubMed, HINARI, Google scholar, Science direct, and Cochrane Libraries. All studies fulfilling the inclusion criteria and published between 2000 and 7 March 2020 were included in this meta-analysis. This study reported according to PRISMA guideline. Cochran's Q-statistics and I2 tests were performed to assess heterogeneity among included studies. Egger's regression analysis was performed to assess publication bias. A random-effect meta-analysis model was used to compute pooled odds ratio of the association between parity and cervical cancer. RESULTS: A total of 6685 participants (3227 patients and 3458 controls) were incorporated in the 12 studies included in this meta-analysis. The meta-analysis revealed that women with high parity had 2.65 times higher odds of developing cervical cancer compared to their counterparts (odds ratio = 2.65, 95% confidence interval = 2.08-3.38). CONCLUSION: High parity is positively associated with cervical cancer. Strong epidemiological studies are recommended to further explore the mechanisms and role of parity in the causation of cervical cancer.

Prevalence of anemia and associated factors among adult diabetic patients attending Bale zone hospitals, South-East Ethiopia.

BACKGROUND: Anemia found in diabetes patients is often unrecognized like many other chronic diseases. The occurrence of anemia is also an additional burden to the micro vascular complications of patients with diabetes. In the selected study structure no published data were found on the prevalence of anemia and associated factors in diabetic patients. Hence, the findings of this study are very fruitful as an input for further studies and after the repetition of similar studies in different frameworks. It is helpful as input for the development of guidelines at diabetes clinics to request the laboratory assessment of hemoglobin as a routine activity. OBJECTIVE: This study aimed to assess the prevalence of anemia and its associated factors among diabetic patients who attended Bale zone hospitals. METHODS: A cross-sectional study design was conducted from September 2020-to January 2021 GC among adult diabetic patients who had follow-up at Bale zone hospitals. A total of 238 study participants were determined by single population proportion sample size calculation formula taking prevalence of anemia among adult diabetic patients 19.0%. Systematic random sampling technique was used to select the study participants. Information on demographic and associated factors of anemia in diabetic patients was collected using an interviewer-administered questionnaire. Blood sample collection was performed under aseptic conditions by a licensed medical laboratory professional. Data were entered into EpiData version 3.1, cleaned and exported to statistical package for the social sciences (SPSS) version 25 software tools. Logistic regression was used to assess factors associated with anemia in diabetic patients. P-value less than 0.05 and 95% CI were considered as statistically significant. The odds ratios were reported to indicate the strength of associations. Frequencies, percentages, charts and tables were used to summarize the characteristics of study participants. RESULTS: In this study anemia among adult diabetic patients is 18.1% (95% CI (13.2, 23.0%). Multivariable logistic regression analysis revealed that the sex of the study participants and the type of diabetes mellitus were found to be statistically significant to associate with anemia. The odds of having anemia among females are nearly three times higher when compared with males (AOR 2.78, 95% CI 1.40-5.52). In addition, the odds of having anemia among adult diabetic patients who had type II diabetes mellitus (AOR 2.18, 95%CI 1.04-4.54) were 2.18 times higher than those who had type I diabetes mellitus patients. CONCLUSION: Nearly one out of five adult diabetic patients had anemia. Sex of the patients and the type of diabetes are associated with anemia among adult diabetic patients.

COVID-19-related anxiety and knowledge toward its preventive measures among patients with chronic medical illness on follow-up in public hospitals of Bale, East Bale, and West Arsi zones, Ethiopia.

BACKGROUND: Coronavirus disease 2019, also known as 2019-nCoV cluster of acute respiratory illness with unknown causes, which occurred in Wuhan, Hubei Province, in China, was first reported to World Health Organization country office as of December 30, 2019. People with medical illness are at a higher risk for coronavirus disease, and the pandemic influences mental health and causes psychological problems, particularly in those with chronic medical illness. Hence, this study aimed to assess coronavirus disease 2019-related anxiety and the knowledge on its preventive measures among patients with medical illness on follow-up in public hospitals of Bale, East Bale, and Arsi zones. OBJECTIVE: To assess coronavirus disease 2019-related anxiety and knowledge toward coronavirus disease 2019 preventive measures among patients with chronic medical illness on follow-up in public hospitals of Bale, East Bale, and West Arsi zones. METHODS: A hospital-based cross-sectional study was conducted in selected hospitals of Bale and West Arsi zones, Southeast Ethiopia. A total of 633 study participants were included in this study, and data were collected through an interviewer-administered questionnaire. A descriptive summary was computed. Bivariable and multivariable logistic regression analyses were carried out to identify the associated factors. RESULTS: Overall, the prevalence of anxiety among chronic patients in this study was 6.3% (95% confidence interval: 4.6%-8.5%) and 420 (66.35%) had good knowledge on the preventive measures of coronavirus disease 2019. Factors significantly associated with anxiety among chronic patients were being educated (95% confidence interval: adjusted odds ratio = 0.26 (0.09-0.74)), being male (95% confidence interval: 2.69 (1.11-6.53)), and use of mask (95% confidence interval: 0.11 (0.05-0.26)). CONCLUSION: The prevalence of coronavirus disease 2019-related anxiety among chronic patients was high and being males, uneducated, and not using face mask was significantly associated with coronavirus disease 2019-related anxiety.

Traumatic Arteriovenous Fistula of Superficial Temporal Vessel: A Rare Case Report.

Arteriovenous fistulae are abnormal direct communications between artery and venous system. It rarely occurs in superficial temporal vessel and is usually caused by trauma. Clinical manifestation includes pulsatile mass, headache, hemorrhage and tinnitus. Angiography is standard diagnostic modality and surgical removal of the pulsating mass with ligature of the feeding vessel is definitive treatment. The authors describe the case of a 35-year-old female patient who developed a pulsatile tortuous mass, extending from the left preauricular area to the left scalp after sustaining thorn injury (extremely rare penetrating injury). The treatment done was a complete surgical removal of the pulsatile mass and ligature of the feeding superficial temporal artery.

Compliance towards infection prevention measures among health professionals in public hospitals, southeast Ethiopia: a cross-sectional study with implications of COVID-19 prevention.

INTRODUCTION: The new coronavirus disease 2019 is an emerging respiratory disease caused by the highly contagious novel coronavirus which has currently overwhelmed the world. Realizing a comprehensive set of infection prevention measures is a key to minimize the spread of this virus and its impacts in all healthcare settings. Therefore, this study was aimed to assess the compliance towards COVID-19 preventive measures and associated factors among health professionals in selected public hospitals, southeast Ethiopia. METHODS: A descriptive hospital-based cross-sectional study was conducted among 660 health professionals in public hospitals of southeast Ethiopia from October 1 to 31, 2020. A multistage sampling technique was used to select the study participants. Data were collected by interview using structured and pretested questionnaires. Ordinary logistic regression modeling was used to estimate the crude and adjusted odds ratio. To declare the statistical significance of factors associated with the outcome variable, P-value < 0.05 and 95% confidence interval were used. RESULTS: A total of 654 health professionals were involved in the study; of whom, 313 participants were nurses. The overall good compliance and knowledge of health professionals regarding COVID-19 preventive measures were 21.6 and 25.5%, respectively. Working in the general hospital (AOR = 0.55; 95% CI 0.38, 0.79), service year (AOR = 2.10; 95% CI 1.35, 3.21), knowledge (AOR = 1.80; 95% CI 1.14, 2.89), and water availability (AOR = 3.26; 95% CI 2.25, 4.72) were some of the factors found to have a statistically significant association to compliance of health professionals regarding COVID-19 preventive measures. CONCLUSION: In this study, nearly one fifth of health professionals had good compliance towards COVID-19 prevention practices. Thus, a consistent supply of COVID-19 prevention materials, facilities, and improving the knowledge of health professionals through on and off-job training are crucial.

Geographical variation and factors associated with unsafe child stool disposal in Ethiopia: A spatial and multilevel analysis.

BACKGROUND: Unsafe disposal of children's stool makes children susceptible to fecal-oral diseases and children remain vulnerable till the stools of all children are disposed of safely. There is a paucity of data on spatial distribution and factors associated with unsafe child stool disposal in Ethiopia. Previous estimates, however, do not include information regarding individual and community-level factors associated with unsafe child stool disposal. Hence, the current study aimed (i) to explore the spatial distribution and (ii) to identify factors associated with unsafe child stool disposal in Ethiopia. METHODS: A secondary data analysis was conducted using the recent 2016 Ethiopian demographic and health survey data. A total of 4145 children aged 0-23 months with their mother were included in this analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of unsafe child stool disposal. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant spatial clusters. A multilevel multivariable logistic regression model was fitted to identify factors associated with unsafe child stool disposal. RESULTS: Unsafe child stool disposal was spatially clustered in Ethiopia (Moran's Index = 0.211, p-value< 0.0001), and significant spatial SaTScan clusters of areas with a high rate of unsafe child stool disposal were detected. The most likely primary SaTScan cluster was detected in Tigray, Amhara, Afar (north), and Benishangul-Gumuz (north) regions (LLR: 41.62, p<0.0001). Unsafe child stool disposal is more prevalent among households that had unimproved toilet facility (AOR = 1.54, 95%CI: 1.17-2.02) and those with high community poorer level (AOR: 1.74, 95%CI: 1.23-2.46). Higher prevalence of unsafe child stool disposal was also found in households with poor wealth quintiles. Children belong to agrarian regions (AOR: 0.62, 95%CI 0.42-0.91), children 6-11 months of age (AOR: 0.65, 95%CI: 0.52-0.83), 12-17 months of age (AOR: 0.68, 95%CI: 0.54-0.86), and 18-23 months of age (AOR: 0.58, 95%CI: 0.45-0.75) had lower odds of unsafe child stool disposal. CONCLUSIONS: Unsafe child stool disposal was spatially clustered. Higher odds of unsafe child stool disposal were found in households with high community poverty level, poor, unimproved toilet facility, and with the youngest children. Hence, the health authorities could tailor effective child stool management programs to mitigate the inequalities identified in this study. It is also better to consider child stool management intervention in existing sanitation activities considering the identified factors.

Prevalence of Goiter Among School-Aged Children in Ethiopia: Update of Systematic Review and Meta-analysis.

BACKGROUND: Iodine deficiency is a major public health concern throughout the world. Goiter is the most visible sign of iodine deficiency. In Ethiopia, a study finding regarding the prevalence of goiter among school-age children is inconsistent and highly variable. OBJECTIVES: To estimate the pooled prevalence of goiter among school-age children in Ethiopia. METHODS: Three international databases (MEDLINE/Pub-Med, Google Scholar and Science Direct) were systematically searched. Besides, the reference sections of identified articles were searched to increase the chance of detecting missed articles in gray literature. STATA Version 14 statistical software was used to conduct a meta-analysis. The pooled prevalence with a 95% confidence interval was displayed using the forest plot. A random-effect meta-analysis model was used to compute the pooled prevalence, and The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. RESULTS: A total of 14 studies fulfilled the inclusion criteria and included in this systematic review and Meta-analysis, with a total sample size of 26,282. The finding of this systematic review revealed that the pooled prevalence of goiter among school-age children was 42.9% (95% CI: 38.8-46.9). The highest prevalence of goiter (46.7%) was observed in Oromia region and the lowest (26.3%) was observed in Benishangul-Gumuz region. CONCLUSIONS: This review finding revealed that more than two in five of the school children in Ethiopia suffer from iodine deficiency disorder as manifested by the goiter rate.

Correct Use of Facemask Among Health Professionals in the Context of Coronavirus Disease (COVID-19).

PURPOSE: Coronavirus disease (COVID-19) mainly spreads through respiratory droplets and close contacts. Wearing a facemask and other personal protective equipment (PPE) is essential in preventing the spread of COVID-19. However, the use of PPE alone does not provide a sufficient level of protection, and correct use and disposal are required. Hence, this study aimed to assess health professionals' practice regarding proper use of facemask in the perspectives of COVID-19 prevention. METHODS: A web-based online survey was conducted from June 3, 2020, to August 11, 2020, to assess health professionals' practice regarding correct use of facemask. The survey tool was prepared in Google form and distributed to the health professionals through their emails and social media pages. Data were analyzed using STATA version 14. A descriptive result was reported using frequency tables and bar charts. Factors associated with correct use of facemask were assessed using binary logistic regression model. RESULTS: A total of 368 health professionals have participated in this study. All of the participants' work involves direct contact with patients and 98 (26.6%) of them work in direct contact with COVID-19 patients daily. The level of overall correct use of facemask was 10.1% (95% CI: 7.4-13.6). Two hundred fifty-five (69.3%) do not perform hand hygiene before wearing a facemask and 238 (64.7%) do not perform hand hygiene after removing the facemask. Three hundred twenty-three (87.8%) of the study participants reuse disposable facemasks. The odds of practicing correct use of facemask were more than two times higher among health professionals who received training related to personal protective equipment utilization (AOR= 2.2, 95% CI: 1.1-4.5) compared to their counterparts. CONCLUSION: This study revealed that health professionals' practice regarding the correct use of facemask in the context of COVID-19 prevention is very low. Receiving training related to proper utilization of personal protective equipment was found to favor the correct use of facemask. In this regard, health authorities should provide training to enable the rational and correct use of facemask among healthcare workers.

Disinfection of Stethoscope and Non-Infrared Thermometer: Practices of Physicians in Ethiopia in the Era of COVID-19.

BACKGROUND: Stethoscopes and non-infrared thermometers are the customary medical equipment used by the physicians on a daily basis, among various patients. With the rise of potential infections in the healthcare facilities and the transmission nature of the current COVID-19 pandemic, consistent and correct disinfections of these devices after each use should not be pardoned. This study, therefore, aimed to assess the level of stethoscope and non-infrared thermometer disinfection practices among physicians involved in direct patient contact during the COVID-19 pandemic. METHODS: A web-based cross-sectional survey was conducted among physicians working in Ethiopia to assess their practice of stethoscope and non-infrared thermometer disinfection. The online survey was circulated using an anonymous and self-reporting questionnaire via Google form with a consent form appended to it. The developed Google form link was shared with physicians through their email addresses and social media pages. A descriptive summary was computed and presented by tables and figures. Multivariable logistic regression model was used to identify factors associated stethoscope and non-infrared thermometer after every use. RESULTS: The proportion of stethoscope and non-infrared thermometer disinfections after every use was 13.9% (95% CI: 10.9-17.6) and 20.4% (95% CI: 16.7-24.5), respectively. Taking COVID-19 training (AOR: 2.52; 95% CI: 1.29-4.92) and the availability of stethoscope disinfection materials at the workplace (AOR: 3.03; 95% CI: 1.29-7.10) were significantly increased the odds of stethoscope disinfection after every use. The odds of stethoscope disinfection after every use was significantly decreased for those who reported the use of shared stethoscope (AOR: 0.34; 95% CI: 0.12-0.92). CONCLUSION: Only a wee share of the respondents reported that they have disinfected their stethoscopes and non-infrared thermometers after every use - possibly jeopardizing both patients and clinicians safety, particularly during the COVID-19 pandemic.

Perforated tuberculous appendicitis: a rare case report.

BACKGROUND: Gastrointestinal tuberculosis (TB) accounts for 3% of extrapulmonary TB. Tuberculous appendicitis is a rare type of abdominal TB and is seen in only 0.1%-0.3% of cases. Diagnosis is usually made after histopathologic examination of the appendectomy specimen. In Ethiopia, there had been no previous report of perforated appendicular TB, and to our knowledge, this is the first case report of a patient with perforated tuberculous appendicitis to be presented. CASE REPORT: A 22-year-old male patient presented with complaints of severe abdominal cramp, periumbilical pain, nausea, 2 episodes of nonbilious vomiting, as well as high-grade fever. Upon admission, abdominal examination revealed direct tenderness below the umbilicus bilaterally and rebound tenderness over the right lower quadrant of the abdomen. The peritoneal cavity was opened through a lower midline incision, and a perforated appendix at the base was found. DISCUSSION: From the resected appendix, a sample biopsy was sent for histopathology, and the histological picture revealed granulomatous caseification lesion in the body of the appendix, but no granulomatous lesions elsewhere in the bowel or omentum. Based on these findings, the final diagnosis of perforated tuberculous appendicitis was made. After surgery, the patient started anti-TB treatment on the fourth postoperative day and continued therapy for 6 months, and marked clinical recovery has been observed to date. CONCLUSION: Perforated tuberculous appendicitis was diagnosed only after histopathologic examination of the resected appendix. Hence, TB, a highly prevalent disease in low-income countries, should always be considered in patients with nonspecific abdominal clinical sign and symptoms. It is also suggested that all specimens from perforated appendicitis be subjected to histopathologic examination.

Generalized peritonitis after spontaneous rupture of pyonephrosis: a case report.

BACKGROUND: Peritoneal fistulization of a pyonephrosis is an extremely rare event which invariably leads to generalized peritonitis. This is a very rare case report on generalized peritonitis after spontaneous rupture of pyonephrosis. CASE PRESENTATION: A 28-year-old male patient from the rural part of Bale zone, Ethiopia, was admitted to Goba Referral Hospital with high-grade fever, diffused abdominal pain and abdominal distension. Initially, he experienced colicky and intermittent pain that made him stay at home for 2-3 days. He then started to develop constant left flank pain which gradually got worse and was associated with urinary frequency of approximately 5-6 times/day, high-grade intermittent fever, chills, rigors and loss of appetite. With the diagnosis of generalized peritonitis, we resuscitated him with two bags of normal saline and one bag of ringer lactate intravenously. During an abdominal ultrasound examination we identified that the left kidney was replaced by an abscess containing sac, and there was a huge intraperitoneal loculated abscess with internal septation and an associated free inter-loop and pelvic echo debris abscess. When we performed an exploratory laparotomy, 1 L-thick abscess from the general peritoneum was aspirated and early fibrinous inter-loop adhesion was identified. In addition, there was a large retroperitoneal cystic abscess containing sac extended from the spleen up to the pelvic brim crossing the midline to the right side and bulged intraperitoneally. Furthermore, a 1.5 cm wide perforation that pour abscess in to peritoneal cavity was found. A total of 4 L of puss was removed from the left kidney. As treatment, since the left kidney lost all function and became a pus-contacting sac, we performed a left-sided nephrectomy and abdominal lavage. Postoperatively, the patient had an uneventful recovery and was discharged from the hospital on the eighth day. We followed him for 6 months, and kidney function tests were normal and he did not develop any complications. CONCLUSION: This case report highlighted the importance of recognizing the possibility of underlying kidney rupture in a patient with generalized peritonitis. Uretero-pelvic junction obstruction (UPJO) might be the possible cause of pyonephrosis in our case. As a treatment, nephrectomy is a preferable option when the affected kidney is not fully functional and the contralateral kidney is normal.

Left-sided incarcerated Amyand's hernia with cecum and terminal ileum: a case report.

BACKGROUND: Amyand's hernia, which is the presence of a normal or pathological appendix as a part of an inguinal hernia, is a rare clinical entity. We are reporting a very rare case of left-sided incarcerated Amyand's hernia with cecum and terminal ileum involvement. CASE PRESENTATION: A 4-year-old male child with left inguinal swelling of 2-year duration presented to Goba Referral Hospital. Two days before the patient visited our hospital, the swelling had become irreducible and caused severe groin pain. He had abdominal cramps, bilious vomiting, and mild abdominal distention, but passed feces. With the diagnosis of left-sided incarcerated inguinal hernia, the patient was investigated and prepared for surgical management. During the operative procedure, we identified the presence of appendix, cecum, and terminal ileum in the scrotum as the herniated component. After the sack was dissected, since there was also appendicitis, an appendectomy was performed. Then, high ligation of sack was done after cecum and ileum were reduced. After 3 uneventful postoperative days in the hospital, the patient was discharged. The patient was followed-up for 6 months, and he did not develop any complications. CONCLUSION: Left-sided incarcerated Amyand's hernia with cecum and terminal ileum involvement is a rare clinical entity. Even though it is not common, appendicitis is one of the comorbidities that can be seen in patients with left-sided incarcerated Amyand's hernia with cecum and terminal ileum. Surgeons should have a high index of clinical suspicion and be aware of the potential involvement of appendix, cecum, and ileum as part of an incarcerated hernia during surgery, even in the left inguinal region. In this case, left-sided incarcerated inguinal hernia which involved inflamed appendix, cecum, and terminal ileum was successfully managed using an inguinal approach.