Digoxin for the Management of Unstable Paroxysmal Supraventricular Tachycardia in a Patient Who Refused Electrical Cardioversion in a Rural Hospital.

Background: The most frequent atrioventricular tachycardia in the emergency room is atrioventricular nodal reentrant tachycardia (AVNRT). The first treatment option for ending stable narrow QRS complex SVTs is vagal maneuvers and adenosine. When adenosine or vagal maneuvers fail to change a patient's rhythm to normal sinus rhythm, long-acting AV nodal-blocking medications, including nondihydropyridine calcium channel blockers (verapamil and diltiazem), flecainide, or beta-blockers, are employed. Electricity (synchronized cardioversion) is the preferred form of treatment for unstable patients. Case Presentation. A 40-year-old male patient presented to the Emergency Department of Dubti General Hospital, the Afar regional state in Ethiopia, with a complaint of shortness of breath, palpitation, extreme fatigue, and chest pain of a day's duration. His blood pressure was 80/50 mmHg, he had cold extremities and a weak radial pulse, and his apical heart rate was fast, making it difficult to count. His electrocardiogram (ECG) showed paroxysmal supraventricular tachycardia (PSVT) with a heart rate of 200. He was a candidate for electrical cardioversion due to unstable PSVT, but he and his family members refused to give consent. Even though he is not indicated for pharmacologic therapy, none of the commonly used drugs were available at the hospital. We managed him with digoxin, and the outcome was positive. Conclusion: Even though we could not find a clear recommendation regarding the use of digoxin for patients with unstable PSVT (AVNRT), by taking into consideration its negative chronotropic effect and its action to suppress the AV nodal conduction velocity, it may reduce the heart rate, and it can be used as an alternative in such difficult scenarios and a resource-limited setting. But this should be further investigated.

Surgical outcome and predictors of neonates with esophageal atresia admitted at Tikur Anbesa Specialized Hospital.

BACKGROUND: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. This anomaly continues to cause considerable morbidity and mortality in Sub-Saharan Africa, presenting various concerns about how to treat esophageal atresia. Esophageal atresia-related neonatal mortality can be reduced by evaluating the surgical outcome and identifying associated factors. OBJECTIVE: This study aimed to assess the surgical outcome and identify predictors of neonates with esophageal atresia admitted at Tikur Anbesa specialized hospital. METHODS: Retrospective crossectional study design was employed on 212 neonates with esophageal atresia who were undergone surgical intervention in Tikur Anbesa specialized hospital. Data were entered into epi data 4.6 and exported to Stata version 16 software for further analysis. A logistic regression model with Adjusted odds ratio (AOR), confidence interval (CI) and p-value <0.05 were used to identify predictors of poor surgical outcome of neonates with esophageal atresia. RESULT: In this study, 25% of newborns who underwent surgical intervention at TikurAbnbesa specialized hospital had successful surgical outcomes, compared to 75% of neonates with esophageal atresia who had poor surgical outcomes. Significant predictors of the poor surgical outcome of neonates with esophageal atresia were severe thrombocytopenia (AOR = 2.81(1.07-7.34)), timing of surgery (AOR = 3.7(1.34-10.1), aspiration pneumonia (AOR = 2.93(1.17-7.38)) and related abnormalities (AOR = 2.26(1.06-4.82)). CONCLUSION: The results of this study showed that, when compared to other studies, a substantial percentage of newborn children with esophageal atresia had poor surgical outcomes. Early surgical management, aspiration pneumonia and thrombocytopenia prevention and therapy play a big part in improving the surgical prognosis for newborns with esophageal atresia.

Epidural blood patch in the treatment of severe post dural puncture headache after spinal anesthesia: A rare case report.

INTRODUCTION AND IMPORTANCE: Spinal anesthesia is a type of regional anesthesia that involves injecting a local anesthetic directly into the cerebrospinal fluid. In Ethiopia, the prevalence of PDPH was 42.6%, with large spinal needles and repeated attempts being independently associated risk factors. CASE PRESENTATION: A 20-year-old woman is undergoing a cesarean section while under spinal anesthesia. On the second postoperative day, the patient begins to complain of PDPH-like headaches. The headache was severe according to the VAS score, and the team attempted to manage it using the WHO analgesic ladder, but it was refractory to supportive and pharmaceutical therapy. We then used EPDBP, and the headache was promptly reduced. The treatment had a considerable impact on the movement, satisfaction, and discharge conditions of the patients. CLINICAL DISCUSSION: A prospective research conducted in Helsinki found that EBP was effective in 88-96% of the patients in the various study groups. One randomized, double-blind trial on the therapeutic efficacy of EPDBP found that it is an effective treatment for PDPH. It provides complete symptom relief in a high number of people. In the remaining patients, it lessens the severity of their headaches and allows them to resume their normal activities. An epidural blood patch is a highly successful treatment option for a subset of people suffering from post-Dural puncture headache. It is an elective procedure with a low risk of complications. CONCLUSION: The epidural blood patch procedure that we use proved helpful in treating severe PDPH after spinal anesthesia for cesarean delivery. There were no complications associated with the procedure until she was discharged from the hospital.