Predictors of complications and mortality among patients undergoing pacemaker implantation in resource-limited settings: a 10-year retrospective follow-up study.

INTRODUCTION: Pacemakers (PMs) are used to treat patients with severe bradycardia symptoms. They do, however, pose several complications. Even with these risks, there are only a few studies assessing PM implantation outcomes in resource-limited settings like Ethiopia and other sub-Saharan countries in general. Therefore, this study aims to assess the mid-term outcome of PM implantation in patients who have undergone PM implantation in the Cardiac Center of Ethiopia by identifying the rate and predictors of complications and death. METHODOLOGY: This retrospective study was conducted at the Cardiac Center of Ethiopia from October 2023 to January 2024 on patients who had PM implantation from September 2012 to August 2023 to assess the midterm outcome of the patients. Complication rate and all-cause mortality rate were the outcomes of our study. Multivariable logistic regression was used to identify factors associated with complications and death. To analyze survival times, a Kaplan-Meier analysis was performed. RESULTS: This retrospective follow-up study included 182 patients who underwent PM implantation between September 2012 and August 2023 and were at least 18 years old. The patients' median follow-up duration was 72 months (Interquartile range (IQR): 36-96 months). At the end of the study, 26.4% of patients experienced complications. The three most frequent complications were lead dislodgement, which affected 6.6% of patients, PM-induced tachycardia, which affected 5.5% of patients, and early battery depletion, which affected 5.5% of patients. Older age (Adjusted Odds Ratio (AOR) 1.1, 95% CI 1.04-1.1, p value < 0.001), being female (AOR 4.5, 95%CI 2-9.9, p value < 0.001), having dual chamber PM (AOR 2.95, 95%CI 1.14-7.6, p value = 0.006) were predictors of complications. Thirty-one (17%) patients died during the follow-up period. The survival rates of our patients at 3, 5, and 10 years were 94.4%, 92.1%, and 65.5% respectively with a median survival time of 11 years. Patients with a higher Charlson comorbidity index before PM implantation (AOR 1.2, 95% CI 1.1-1.8, p = 0.04), presence of complications (AOR 3.5, 95% CI 1.2-10.6, p < 0.03), and New York Heart Association (NYHA) class III or IV (AOR 3.3, 95% CI 1.05-10.1, p = 0.04) were associated with mortality. CONCLUSION: Many complications were experienced by patients who had PMs implanted, and several factors affected their prognosis. Thus, it is essential to identify predictors of both complications and mortality to prioritize and address the manageable factors associated with both mortality and complications.

Antimicrobial potential of the Ethiopian Thymus schimperi essential oil in comparison with others against certain fungal and bacterial species.

BACKGROUND: To evaluate the in vitro activities of Ethiopian Thymus schimperi with other three hydro distilled essential oils against Dermatophytes (Tricophyton spp. and Microsporum spp.) and other pathogenic micro organisms. METHODS: The studies were carried out using Agar disk diffusion method for screening the most effective essential oils and Agar dilution to determine Minimum Inhibitory Concentration (MIC) of the essential oils. RESULTS: Essential oils of T. schimperi and Cinnamomum zeylanicum were highly active against tested organisms. The MIC were in the range of 0.08 µl/ml to 0.31 µl/ml for T. schimperi, 0.31 µl/ml to 0.16 µl/ml for C. zeylanicum, 2.5 µl/ml to1.25 µl/ml for Citrus limon and 5 µl/ml to 2.5 µl/ml for Eucalyptus camaldulensis against Tricophyton spp. and Microsporum spp. T. schimperi and C. zeylanicum oils also showed antimicrobial effect against Candida albicans, Aspegilus niger, Rhodotorula rubra, Escherichia coli, Shigella spp., Bacillus spp. and Streptococci. CONCLUSIONS: The Ethiopian T. schimperi oil had pronounced antifungal and antibacterial activities against all the tested microbes. Therefore, it is required further investigation in order to identify the active compounds and their clinical applications for treatment of tested organisms.

Assessment of Trend, Indication, Complications, and Outcomes of Pacemaker Implantation in Adult Patients at Tertiary Hospital of Ethiopia: Retrospective Follow Up Study.

Background: A pacemaker is a device implanted in the chest to help people with symptomatic bradycardia and life-threatening irregular rhythm. However, it is also associated with many complications. Therefore, this study evaluated pacemaker-related complications and factors associated with them, as there is little data on pacemaker-related complications in sub-Saharan Africa and Ethiopia. Methods: The study was conducted on 118 patients over 18 years old who had pacemakers implanted between 2017 and 2022 at Tikur Anbessa Comprehensive Specialized Hospital in Addis Ababa, Ethiopia who were reviewed by the authors from September 2022 to December 2022. Sociodemographic factors, clinical characteristics, and complications data were extracted using a structured questionnaire by retrospective review of patient records. The chi-square test or Fisher's exact test was performed to evaluate factors associated with complications. Results: The median age of patients was 60.5 years (IQR = 15 years), with men accounting for 50.8% of patients. Hypertension was the most common comorbidity (64.2%). Symptomatic grade 3 AV block was the most common indication (78.8%) for pacemaker implantation. With a mean follow-up of 3.92 ± 1.94 years, 15.3% of patients had complications. Pneumothorax, pocket site infection, and lead dislodgement were the most common complications occurring in 2.54% of patients each. Patient age during surgery (p-value = 0.02), patient gender (p-value = 0.04), pacemaker implanting team (p-value = 0.01), and adherence to follow-up (p-value = 0.04) are related to pacemakers-related complications. Conclusion: Pacemaker implantation is associated with many complications. Pneumothorax, pacemaker pocket infection, and lead dislodgement were the most common complications. Patient age at pacemaker implantation, patient gender, pacemaker implanting team, and follow-up compliance were factors associated with pacemaker-related complications. Skill development through specialized training and compliance counseling may improve outcomes for patients who have complications related to pacemaker implanting team and poor adherence to follow.

Rare Combination of Right Aortic Arch, Aberrant Left Subclavian Artery and Absent Left Pulmonary Artery in a Boy with Tetralogy of Fallot.

Introduction: Right aortic arch is associated with an aberrant subclavian artery and absence of left pulmonary artery in patients with Tetralogy of Fallot. However, the occurrence of a combination of the right aortic arch, an aberrant left subclavian artery, and an absent left pulmonary artery in a single patient is rare. Therefore, the purpose of this case report was to discuss the rare association between a right aortic arch, the absence of a left pulmonary artery, and an aberrant left subclavian artery in an 8-year-old Ethiopian boy with Tetralogy of Fallot. Case Presentation: An 8-year-old male child who presented with easy fatigability, dizziness, and intermittent difficulty in swallowing solid food over the past two years. He had grade clubbing, cyanosis of the lips, and an ejection systolic murmur at the left lower sternal border. Tetralogy of Fallot with absent left pulmonary and right aortic lesions was diagnosed using echocardiography. CT tomography revealed a detailed vascular anatomy and confirmed the diagnosis of an aberrant left subclavian artery. Conclusion: In the evaluation of patients with Tetralogy of Fallot, it is important to pay close attention to vascular abnormalities such as right aortic arch, aberrant left subclavian artery, and absent left pulmonary artery for not missing them.

The Gasul Phenomenon Still Alive in the Developing World: A Case Report.

Background: In child, ventricular septal defect is the most prevalent congenital cardiac disease. Some ventricular septal defects have the potential for spontaneous closure. In poor nations closure based on indications may not be feasible. The patient's natural course may therefore be observed. The Gasul phenomenon, a right ventricular outflow obstruction, is one of the complications. Case Presentation: A 7-year-old child who had recurrent pneumonia, poor weight gain, and excessive sweating eventually had these symptoms go away. A large peri membranous ventricular septal defect and a small patent ductus arteriosus was detected on echocardiography during infancy. Later, the patient acquired a muscular ridge across the right ventricular outflow tract. Muscular ridge excision and closure of patent ductus arteriosus and ventricular septal defect were done. Patient was discharged in stable condition. Conclusion: Right ventricular outflow tract blockage can be avoided by performing early surgical closure of a ventricular septal defect.

Marginal adaptation of different monolithic zirconia crowns with horizontal and vertical finish lines: A comparative in vitro study.

Background: This study evaluated the influence of different tooth preparation techniques and zirconia materials on marginal adaptation. Methods: Forty-eight healthy human maxillary first premolars were divided into two primary groups based on preparation design: group A (chamfer) and group B (vertical). Within each main group, there were three subgroups, comprising eight teeth each, distinguished by the type of zirconia material employed (Zircad LT, MT, and Prime by Ivoclar Vivadent). All the samples were prepared by the same operator using a dental surveyor. Intraoral scanning was performed on the prepared teeth. SironaInLab CAD 20.0 software was used to design crowns, which were subsequently generated using a 5-axis milling machine. The crowns were cemented to their respective teeth with self-adhesive resin cement. Marginal gap measurements were taken in micrometers (µm) before and after cementation at 16 sites per sample using a digital microscope at×230 magnification. The collected data were evaluated using statistical analysis using the independent t-test, paired t-test, and ANOVA at an 0.05 significance level. Results: The vertical preparation group exhibited the smallest marginal gap, while the chamfer group displayed the largest. This disparity was statistically significant (P<0.05) for pre- and post-cementation measurements across all materials. There were no significant differences between the different monolithic zirconia crowns. Conclusion: The vertical preparation design illustrated significantly better marginal adaptation than the chamfer preparation design. Comparisons between materials showed comparable marginal gaps. The mean values of the marginal gaps in all groups increased significantly after cementation.

Clinical Characteristics, Treatment Outcome and Associated Factors of Epilepsy Among Children at Hospitals of North-West Ethiopia.

Background: Epilepsy is an important cause of neurological morbidity in children and adolescents. Clinical parameters are the main diagnostic tools, especially in developing countries. Although cost-effective treatments for epilepsy are available, studies have shown that uncontrolled seizures can occur in many patients. Objective: To assess clinical characteristics, treatment outcomes, and associated factors for controlled epilepsy among children with epilepsy who underwent follow-up at the Debre Markos Comprehensive Specialized Hospital, North-west Ethiopia from October 28, 2020, to April 28, 2021. Methods: An institutional-based retrospective cohort study was conducted from October 28, 2020, to April 28, 2021. A total of 385 participants who fulfilled the inclusion criteria were included in the study. A pretested, structured, interviewer-administered questionnaire with a chart review was used to collect data. The data were entered into the Epi-data software version 4.4.2.1 and then exported to the Stata version 14 statistical package for analysis. Descriptive statistics were used to describe the sociodemographic and clinical characteristics, treatment profiles, and treatment outcomes of patients with epilepsy. Bivariate and multivariate analyses were used to identify factors associated with treatment outcomes. Results: The most frequent type of seizure among the 385 respondents was Generalized-tonic-clonic seizures (88.1%). The proximate cause of seizures was identified in 15% of patients, of whom 45 had a perinatal history (8.8%), head injury (3.6%), and CNS infection (2.3%). One-third of patients had poor seizure control. Caregiver relationship (father AOR=0.58; 95th CI:0.35,0.97) and poor adherence (AOR=2.97; 95th CI:1.82, 4.86) were significantly associated with treatment outcome. Conclusion: One-third of children with epilepsy have poor seizure control. Poor adherence to treatment is implicated in poor control. Counseling caregivers on proper treatment and adherence to anti-epileptic medication is recommended to improve treatment outcome in children.

Assessment of Treatment Outcome and Its Associated Factors among Adult Epileptic Patients in Public Hospitals in the Southern Ethiopia: A Multi-center Cross-sectional Study.

Background: Epilepsy accounts for 0.5 % of the world's disease burden. Around 80 % of these are living in low and middle-income countries. In Ethiopia, the prevalence is 0.6 to 5 per 1000 population. There is a little study in our study area on the treatment and predictors of response of adult epilepsy. The purpose of this study was to determine the treatment outcome and its associated factors among adult epileptic patients in public hospitals in southern Ethiopia. Methods: Multi-centered, Hospital-based cross-sectional study was conducted from October 2021 - august 2022. Data were collected by face-to-face interviews and record review. Data was analysed using SPSS. The bivariate and multivariable logistic regression analyses have been performed between the dependent and the independent variables. Result: Of the total 422 participants, 55.9 % were males and 62.6% were below 30 years of age. The most common type of seizure was a generalized tonic-clonic seizure. Most (87.9 %) were treated by immunotherapy. Phenobarbitone is most common medication (77.5). One-quarter reported adverse effects of medication. The majority (78%) had good control (seizure free for at least one year) and 22% had poor control. Poor medication adherence (AOR=4.03) and shorter duration of seizure before treatment (AOR=4.233) were associated with poor control. Conclusion: A significant number of patients had poor control of seizures. Early identification of issues on medication adherence and early initiation of treatment will improve treatment outcome.

Health Related Quality of Life and Associated Factors Among Adult Patients with Rheumatic Heart Disease Patients in Ethiopia.

Background: Quality of life (QOL) is defined as "individuals" perceptions of their position in life. Rheumatic heart disease (RHD) is a consequence of severe, single, or recurrent bouts of acute rheumatic fever. To improve overall patient outcomes, there is currently a greater emphasis on assessing the QOL of these patients. The purpose of this study is to assess the QOL of adult RHD patients who had followed up at St Peter and Tikur Anbessa Hospital, Ethiopia. Methods: An institutional-based cross-sectional study done at St Peter and Tikur Anbessa Hospital, Ethiopia from March 1-June 30/2021 in adult RHD patients. The sample size was 297. Socio-demographic and clinical data were collected using a structured questionnaire. The Amharic version of Short form-36 (SF-36) was used to assess the QOL. A logistic regression model was used to identify associated factors. Results: The study included 297 patients. The majority are female (71%), and half of them are aged between 18-30 years of age. Of the patiends, 81.1% had no comorbidity, and 15.8% had interventions. RHD affects all domains and summary scores of short form 36 QOL parameters compared to normative values. Age, marital status, place of residence, presence of comorbidity, number of medications, and whether an intervention was done are associated with the QOL of these patients. Conclusion: RHD patients had poor QOL assessed by SF-36. It affects all domains and summary score of short form 36 QOL parameters. Old age, divorce, living in rural areas, associated comorbid conditions, and no intervention done are associated with poor QOL. Identification and treating comorbid conditions and intervention may improve QOL.

Wandering Spleen with Splenic Torsion: Unusual Cause of Acute Abdomen.

Introduction: Wandering spleen is a rare condition characterised by laxity or lack of splenic ligaments as a result of acquired or congenital causes. There is a possibility of misdiagnosis due to its vague symptoms. In order to make a proper diagnosis, imaging techniques including abdominal ultrasonography and CT scanning are essential. Surgery is the main option of management. If the spleen is viable and there is no thrombosis in the splenic veins, splenopexy is the preferred surgical procedure. Alternatively, splenectomy plus prophylactic antibiotic and vaccination usage may be employed if spleen has infarction. Case Presentation: A 12-year-old male child who had previously experienced constipation, mucoid diarrhoea, and abdominal distention arrived with crampy abdominal pain that had lasted for four days. The patient was tachycardic with abdominal tenderness. Whirlpool sign and lack of a spleen in its normal position were visualized on an abdominal ultrasound. The spleen was located intraoperatively in the lower abdomen, adhered to the ileum and appendix. It was 720° twisted and had necrotic areas. The patient underwent an appendectomy with splenectomy with a smooth post-operative course; combination meningococcal and pneumococcal vaccines were administered; and antibiotic prophylaxis was started for the patient. Conclusion: High clinical suspicion and the use of imaging modalities like ultrasound and CT scan are extremely crucial to diagnose wandering spleen and perform splenic salvage surgery because its clinical diagnosis is challenging.

Anthropometric Indices and Type 2 Diabetes Mellitus as a Risk Factor in Predicting Nonalcoholic Fatty Liver Disease - A Prospective Study in Indian Population.

Background: The different anthropometric indices have different predictive values of nonalcoholic fatty liver disease (NAFLD) in various populations. Since obesity is a common cause of NAFLD and diabetes, therefore, it is critical to correlate the various anthropometric indices as a risk factor in terms of NAFLD and diabetes in the Indian population. In view of reported association between obesity and NAFLD, the study was employed to analyze the relationship of various anthropometric indices (body mass index [BMI], a body shape index [ABSI], waist-height ratio [WHtR], etc.) with NAFLD and to comment, if possible, which among them has the highest predictive value in patients with type 2 diabetes. Material and Methods: Data of 220 diabetic patients (36-80 years) were analyzed. Anthropometric data were collected using standard methods. Routine biochemical investigations data were used. Ultrasonography was used to assess liver status for NAFLD. Results: Based on the results, Waist height ratio [WHtR] and BMI had better correlation with NAFLD than ABSI. The desirable WHtR cutoff value was 0.545 with 62% of sensitivity and 62% of specificity. The cut off for BMI and ABSI were 24.6 and 0.805, respectively, with 65% of sensitivity and 62% of specificity for BMI and 63% of sensitivity and 42% of specificity for ABSI. Conclusion: There is a strong association of BMI and ABSI with NAFLD in this study. Public health measures to limit overnutrition and management of obesity are essential to prevent NAFLD, and as its negative health effects on type 2 diabetes mellitus.

Coverage of indoor residual spraying for malaria control and factors associated with its acceptability in Nasarawa State, North-Central Nigeria.

INTRODUCTION: Indoor residual spraying (IRS) is among the major vector control strategies recommended for endemic populations by the World Health Organization (WHO). The success of IRS requires high coverage which is dependent on its acceptability. In Nigeria, IRS pilots have been ongoing and rejection has been a major setback to its coverage. We assessed coverage of IRS and determined factors associated with its acceptability in Nasarawa Eggon district, Nasarawa state, Nigeria. METHODS: A cross-sectional survey involving 409 households selected using multi-stage sampling was carried out. Trained data collectors administered pre-tested structured questionnaire to collect data on socio-demographic characteristics of household heads or their representatives, their perceptions on IRS and factors associated with IRS acceptability. Descriptive, bivariate and multivariate analyses were done at 5% level of significance. RESULTS: Majority of respondents were male (79.7%) and married (82.6%), and their mean age was 36.4 ± 13.3 years. Coverage of IRS was 99.3%. However, only 82.6% of those who previously accepted IRS were willing to accept it in again. Factors independently associated with acceptability were perceived effectiveness of IRS (aOR = 21.8; 95%CI = 6.9-68.8) and lower household cost of malaria prevention after IRS (aOR = 5.0; 95%CI = 1.1-21.8). CONCLUSION: IRS coverage in the communities studied met WHO minimum standard of 85%. However, for similar results to be achieved in future, acceptability must be promoted by providing information on its effectiveness and its ability to reduce household cost of malaria prevention.

Isolation and characterization of cellulose nanocrystals from parenchyma and vascular bundle of oil palm trunk (Elaeis guineensis).

In this study cellulose nanocrystals were isolated through acid hydrolysis process from parenchyma and vascular bundle of oil palm trunk (Elaeis guineensis). The morphological properties of obtained cellulose nanocrystals were studied by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The microscopy images showed smoother and cleaner surface of parenchyma cellulose nanocrystals when compared to vascular bundle cellulose nanocrystals. The TEM image shows a higher length and diameter for parenchyma cellulose nanocrystals compared to vascular bundle cellulose nanocrystals. The Fourier transform infrared (FTIR) spectra showed changes in functional groups after acid hydrolysis due to removal of lignin, hemicelluloses and other impurities in both type of cellulose nanocrystals. Crystallinity index of cellulose nanocrystals was observed higher for vascular bundle as compared to parenchyma. Thermogravimetric analysis (TGA) was performed to study the thermal stability of cellulose nanocrystals and it was observed higher for parenchyma cellulose nanocrystals compared to vascular bundle.