Prevalence and predictors of postpartum anemia after caesarean delivery in Ethiopia: A retrospective analysis of risk factors.

BACKGROUND: Despite the burden of anemia during pregnancy has been extensively studied, the magnitude of postpartum anemia (PPA) and its predictors, especially after caesarean delivery remains unexplored. Therefore, we investigated the prevalence of postpartum anemia, and its predictors among women who underwent cesarean delivery. METHODS: A retrospective study was conducted among women who underwent caesarean delivery in Southern Ethiopia. Data were retrospectively retrieved from the medical records of the participants. Multivariate logistic regression analysis identified independent predictors associated with postpartum anemia. An adjusted odd ratio (AOR), and a 95% confidence interval (CI), were used to identify associations. A p-value < 0.05 is considered statistically significant. RESULTS: A total of 368 women who underwent caesarean delivery were included in this study. The overall incidence of PPA using a cut-off value of hemoglobin level < 11 g/dl after cesarean delivery was 103(28%). Multiple logistic regression analysis showed that the predictors of PPA were more likely among women with Prepartum Anemia (AOR=5.46: 95% CI=2.09-14.31), Grand parity (AOR=3.98: 95% CI=1.45-10.90), Placenta previa (AOR=7.73: 95% CI=1.91-31.38), ANC follow-up < 3 times (AOR=2.33: 95% CI=1.07-3.47), and those who developed Postpartum Hemorrhage (AOR=2.73: 95% CI=1.51-4.93). CONCLUSION: More than one-fourth of women who underwent caesarean delivery in Southern Ethiopia had PPA. Poor ANC- follow-up, grand parity, placenta previa, Prepartum anemia, and PPH were the best predictors of PPA. Therefore, implementing strategies that consider the identified predictors could help to reduce the prevalence of PPA and its complications.

Incidence of extubation failure and its predictors among adult patients in intensive care unit of low-resource setting: A prospective observational study.

BACKGROUND: Previous studies have found an association between various predictors and extubation failure (EF) in intensive care units (ICUs). However, this problem remains unexplored in low-resource settings, where predicting the extubation outcomes are more challenging. This study investigates the incidence of EF and its predictors among patients who received mechanical ventilation (MV). METHODS: This is a prospective observational study of 123 patients' ≥ 18 years of age receiving MV for ≥ 48 hours and tolerated spontaneous breathing trials (SBTs) in the ICU of a low-resource setting. We collected data on the baseline characteristics and clinical profiles before and after SBTs. Patients were categorized into extubation failure (EF) and extubation success (ES) groups. Multivariate logistic regression analyses were performed to identify independent predictors for EF. A p-value < 0.05 is considered statistically significant. RESULTS: We included 123 patients, and 42 (34.15%) had developed EF. The identified predictors for EF: Moderate to copious secretions (adjusted odds ratio [AOR]: 3.483 [95% confidence interval [CI] 1.10-11.4]), age > 60 years of age ([AOR]: 4.157 [95% CI 1.38-12.48]), and prolonged duration of MV ≥ 10 days ([AOR]: 4.77 [95% CI 1.55-14.66]). CONCLUSION: Moderate to copious secretions, patients > 60 years of age, and prolonged duration of MV ≥ 10 days were the best predictors of EF. Based on our findings, we recommend that the identified predictors could help in the decision-making process of extubation from MV.

Management of patient presenting with breast fibroadenoma and medullary thyroid cancer in a young male: A case report and review of the literature.

Introduction and importance: Fibroadenoma of the male breast is a rarely diagnosed lesion that often occurs concurrently with gynecomastia and the intake of medications that alter sex hormone levels. Herein, we report the first case of fibroadenoma of the male breast, presenting with medullary thyroid cancer. In addition, we reviewed the current management strategies for fibroadenoma of the male breast in the literature. Case presentation: A 25-year-old male patient presented to our surgical unit with medullary thyroid cancer (MTC). The physical examination revealed an unnoticed lump in his left breast. We delayed the planned thyroid surgery to determine whether the breast mass was associated with metastasis from MTC. We performed pathological tests from excised breast mass and confirmed the diagnosis of fibroadenoma. After confirming the benign nature of the breast mass, the patient underwent total thyroidectomy with selective neck dissection for MTC. Clinical discussion: Fibroadenoma of the male breast was diagnosed based on clinical presentation and histopathological findings. Fibroadenoma of the male breast is a rarely diagnosed lesion: and is often associated with gynecomastia and altered serum sex hormone level. The presentation of this case without those concurrences is even rarer, as revealed in our case. The management for suspected fibroadenoma of the male breast presented with MTC should include delaying the thyroid surgery to rule out the presence of malignancy and metastasis. Conclusion: The finding indicates that fibroadenoma can be considered a differential diagnosis in the male breast even in the absence of those concurrences. The timely diagnosis and orderly management of fibroadenoma of the male breast and MTC could help to improve the patient outcome.

Predictors and management outcomes of perforated appendicitis in sub-Saharan African countries: A retrospective cohort study.

Background: Previous studies have found an association between various predictors and perforated appendicitis. However, there is limited evidence of studies determining the severity of acute appendicitis (AA) in resource-limited settings. Thus, this study aimed to identify predictors and outcomes of perforated appendicitis (PA) in sub-Saharan countries. Methods: This is a retrospective cohort study of 298 adult patients who underwent surgical intervention for acute appendicitis. Demographic characteristics, clinical parameters, intraoperative findings, length of hospital stay, and postoperative complications were collected. We computed multivariate logistic regression to identify predictors of PA. P-value <0.05 was considered statistically significant. Results: Of 298 patients, PA was 142(47.65%). The identified risk factors for PA are referred patients (AOR = 3.932; 95% CI (2.201-7.027), fever >38 °C (AOR = 4.569; 95% CI (2.249-9.282), and duration of symptoms >2 days (AOR = 2.704; 95% CI (1.400-5.222). Perforation was associated with an increased rate of postoperative complications (45.07vs. 6.41%; P < 0.001) and a longer length of hospital stay (3 vs. 5 days; P < 0.001). Conclusions: The incidences of PA in our study are consistent with other reports in developing countries. Referred patients, longer duration of symptoms >2 days, and presence of fever >38 °C were the best predictors of PA. The overall total postoperative complications and the length of hospital stays were higher in PA. Based on our findings, we recommend that the identified predictors should be considered during the preoperative diagnosis and subsequent management.

Incidence and factors associated with post-anesthesia care unit complications in resource-limited settings: An observational study.

Background and aims: Postoperative complications are frequent encounters in the patients admitted to postanesthesia care units (PACU). The main aim of this study was to assess the incidence of complications and associated factors among surgical patients admitted in limited-resource settings of the PACU. Methods: This is an observational study of 396 surgical patients admitted to PACU. This study was conducted from February 1 to March 30, 2021, in Ethiopia. Study participants' demographics, anesthesia, and surgery-related parameters, PACU complications, and length of stay in PACU were documented. Multivariate and bivariate logistic regression analyses, the odds ratio (OR), and 95% confidence interval (CI) were calculated. p-value < 0.05 was considered as statistically significant. Results: The incidence of complications among surgical patients admitted to PACU was 54.8%. Of these, respiratory-related complications and postoperative nausea/vomiting were the most common types of PACU complications. Being a female (adjusted odds ratio [AOR] = 2.928; 95% CI: 1.899-4.512) was significantly associated with an increased risk of developing PACU complications. Duration of anesthesia >4 h (AOR = 5.406; 95% CI: 2.418-12.088) revealed an increased risk of association with PACU complications. The occurrences of intraoperative complications (AOR = 2.238; 95% CI: 0.991-5.056) during surgery were also associated with PACU complications. Patients who develop PACU complications were strongly associated with length of PACU stay for >4 h (AOR = 2.177; 95% CI: 0.741-6.401). Conclusion: The identified risk factors for complications in surgical patients admitted to PACU are female sex, longer duration of anesthesia, and intraoperative complications occurrences. Patients who developed complications had a long time of stay in PACU. Based on our findings, we recommend the PACU team needs to develop area-specific institutional guidelines and protocols to improve the patients' quality of care and outcomes in PACU.

Appendiceal knotting causing small bowel obstruction: A rare case report.

INTRODUCTION AND IMPORTANCE: Appendicitis causing intestinal obstruction by forming a knot around a small bowel is uncommon. Preoperative diagnosis is challenging as the typical presentations of appendicitis are not usually seen. The diagnosis of appendicular knotting is usually an intraoperative surprise. CASE PRESENTATION: A 34-year-old male patient (BMI-20.86 kg/m2) presented to the surgical emergency unit with colicky central abdominal pain of 2-days duration, which later involved the whole abdomen. In association with this, he had a history of frequent vomiting of ingested matter which later became bilious. The abdominal examination revealed diffuse abdominal tenderness with guarding and rigidity. On midline exploratory laparotomy, the inflamed appendix which was adherent to the distal part of the ileum was observed. The appendix and the encircled segment of the distal ileum were both gangrenous, and the patient underwent resection of the bowel segment in addition to appendectomy. CLINICAL DISCUSSION: Whenever an appendix wraps around an intestine or its tip adheres with small bowel, cecum, or posterior peritoneum forming a ring-like structure, and a segment of a bowel herniates through an opening can cause a closed-loop obstruction with or without strangulation. The management for ileo-appendicular knotting associated with gangrenous bowel could be appendectomy and resection of the bowel segment. Postoperatively, the patient had developed diarrhea caused by ileocecal resection, which later subsided by medication. CONCLUSION: Ileo-appendicular knotting is a rare cause of small intestinal obstruction, and it's challenging to diagnose during the preoperative period. As surgeons dealing with acute abdomen in routine clinical practice, knowledge of this unusual case is helpful for clinical suspicion and evidence-based management.

The practice of procedural pain assessment and management in neonatal intensive care unit in Ethiopia: Cross-sectional study.

BACKGROUND AND AIMS: Neonates in intensive care units undergo frequent painful procedures for diagnostic or care-related purposes. Untreated pain has serious short-term and long-term complications. This study aims to evaluate the frequency of painful procedures, pain assessment, and their analgesic management practice among neonates admitted to the NICU. METHODS: The present study is a hospital-based cross-sectional study of neonates admitted at level II NICU of St. Paul hospital millennium medical college in Ethiopia between March and August 2019. Data were collected from medical charts of neonates and bedside observation using a checklist. The parameters included were demographic characteristics, types of painful procedures, pain assessment practice, and analgesic intervention provided during painful procedures. Descriptive statistics, Mann-Whitney U-test, and Kruskal-Wallis test were used to compare the number of painful procedures and influencing factors. P-value < .05 was considered statistically significant. RESULTS: Of the 325 neonates included in this study, a median of 4 (3-7) painful procedures were performed per neonate in the first 24 hours of NICU stay. Heel lance 280 (20.7%) and Venipuncture 249 (18.41%) were the most commonly performed painful procedures. Of the 1352 painful procedures, none of the neonates received any form of analgesic intervention and none of the neonate's pain scores were documented on their medical chart. The higher number of painful procedures were associated with gestational age between 28 and 31 weeks, birth weight less than 1500 g, and use of CPAP respiratory support P-value <.001, <.001, and .0015, respectively. CONCLUSION: Painful procedures were frequently performed in NICU without any form of analgesic intervention. Strategies to introduce neonatal pain assessment and their analgesic management for clinical practice are necessary.

The practice of foreign body removal from the ear, nose, and upper esophageal in children in Ethiopia: A retrospective descriptive study.

BACKGROUND: Ear, nose, and upper esophageal foreign body (FB) impaction in children is a common emergency in-hospital service. There are no clear guidelines regarding the management of ingested FBs. This study aimed to determine the FB in terms of type, anatomic site, management outcome, and associated complications. METHODS: Retrospective study of children with ear, nose, and upper esophageal FB managed under general anesthesia (GA) at operating room of Wolkite Hospital in the southern part of Ethiopia between January 2019 and February 2021. Data were collected from the medical chart of the patients using a prepared checklist. The parameters included were age, sex, FB anatomic site, type, management outcome, and associated complications related to FB or procedure modalities. RESULTS: A total of 169 (31.4%) study subjects were required GA for the removal of FBs. The mean age was 4.45 ± 3.20 years. Under 5 years old children comprises 61.5% of total cases. The most common anatomic site of FB impaction was in the ear 97 (57.4%). The most commonly found type of FB was cereals or seeds, which constituted 102 (60.35%). The complication rate was 18.35%. Epistaxis was the commonest complication (6.51%) from the nose while canal abrasion (5.92%) was common from the ear. CONCLUSION: Ear, nose, and upper esophageal FBs were found more frequently in younger children. The ear was the most common anatomic site of FB impaction followed by the nose and upper esophageal. The most common type of FB was cereals or seeds. LEVEL OF EVIDENCE: 4.