Experience Sharing on Continuity of Healthcare Services in Internally Displaced Peoples: The Case of Tigray War Crisis.

The war and siege in Tigray led millions to displace internally. More than three-fourths of the health facilities were either destroyed or not functional as the equipment and other resources were stolen. Furthermore, the remaining functioning health facilities were flooded beyond their capacity, resulting in many patients received treatment late, and ending with complications including life loss. Mekelle City is one of the largest towns with many internally displaced people from different areas of Tigray. To provide services for the most vulnerable populations, 11 IDP clinics were opened for internally displaced people and the surrounding host community in Mekelle. A total of 6732 patients received clinical services, of which 3465 were males. The age of the patients was in ranged of 24 days to 95 years. A total of 364 patients were emergency cases and 428 outbreaks were seen. A total of 722 patients with chronic illnesses received follow-up services, the most common being hypertension (112), diabetes (79), and asthma (70). Overall, 1198 investigations were done and 1339 were referred to higher-level healthcare facilities. Upper respiratory infection (n = 976), acute gastroenteritis (n = 667), and pneumonia (n = 612) were the most common disease conditions in IDP clinics. Antibiotics were the most commonly prescribed medication for 2468 patients, followed by anti-pain/pyretic (1402). This community engagement showed us that, it is possible to continue healthcare services when health facilities get collapsed during crisis owing to the relocation and mobilization of available resources.

Amputation of left foot macrodactyly improve quality of life for a toddler: a case report from Tigray, Northern Ethiopia.

Macrodactyly is an uncommon, not inherited congenital malformation of the digit with unknown prevalence and path of pathogenesis. The condition was described in 1940 and since then 107 cases were reported. Manifestations may mislead the diagnosis of hemangiomas and lymphangiomatosis. There are different options for treatment without a clear consensus. The authors are presenting a macrodactyly case that improved the quality of his life after he underwent surgical amputation of the toes. Case presentation: The authors had a case of a 2-year and 4-month-old male child presented with progressive growth of the left foot toes; which started since birth in the 4th toe and then involved 3rd and 5th toe later; resulting in deformity and difficulty in wearing shoes. Physical examination; showed left foot enlargements of the 3rd-5th toes. X-ray of the left foot was done he was diagnosed to have macrodactyly. Under general anesthesia metatarsophalangeal joint of the 4th-5th toe and distal interphalangeal joint of the 3rd toe, disarticulation was done. The patient is doing okay on follow-up for the last year. Clinical discussion: Consistently with other case reports from Korea, Tanzania, and Congo our patient presented with a primary type of left foot macrodactyly in his early life, and he was successfully managed with amputation of the affected digits. Conclusion: This is one of the rare cases which needs a high index of suspicion to diagnose and treat early to improve quality of life. Amputation is the most important management in resources limited areas.

Prevalence of Hypertensive Emergency and Associated Factors Among Hospitalized Patients with Hypertensive Crisis: A Retrospective Cross-Sectional Study.

BACKGROUND: Hypertensive emergency (HE) is an acute stage of uncontrolled blood pressure which poses a substantial cardiovascular morbidity and mortality in developing countries. In our setting, the prevalence of HE and the characteristics of patients with a hypertensive crisis are not certainly known yet. OBJECTIVE: The study assessed the prevalence of hypertensive emergency and associated factors among hospitalized patients with hypertensive crisis. METHODS: A retrospective cross-sectional study was conducted by reviewing records of patients having a diagnosis of hypertensive crisis with systolic/diastolic blood pressure raised to more than 180/120 mmHg admitted to Ayder Comprehensive Specialized Hospital (ACSH) from September 2018 to August 2019. Patients' medical records with complete information were enrolled consecutively. Socio-demographic, clinical characteristics, and other related variables were collected using a structured data collection tool from patient medical records. Data were entered and analyzed using SPSS version 20. Logistic regression was employed to determine factors associated with HE. RESULTS: A total of 141 patients' records with a diagnosis of a hypertensive crisis were enrolled in the study; the majority were females 77 (54.6%) and residing in the urban setting 104 (73.8%). The mean age of the participants was 58.8 years. HE was found in 42 (29.8%) of patients. Intravenous Hydralazine 39 (27.7%) and oral calcium channel blocker 102 (72.3%) were the prescribed drugs for acute blood pressure reduction in the emergency setting. Surprisingly, patients who had no history of hypertension (adjusted odds ratio (AOR)=2.469; 95% confidence interval (CI): 0.176‒0.933) and female sex (AOR=2.494; 95% CI: 1.111‒5.596) were found to be independently associated factors with HE. CONCLUSION: The prevalence of HE was found to account a significant proportion of patients. Hence, hypertensive patients should be strictly managed accordingly, and promoting screening programs could reduce the risk of target organ damage.

Zinc Monotherapy as an Alternative Treatment Option for Decompensated Liver Disease due to Wilson Disease?

BACKGROUND: Wilson disease is a rare metabolic disorder involving copper metabolism, and patients may present with a variable degree of hepatic, neurologic, and psychiatric manifestations. In the case of hepatic presentation, treatment is usually initiated with potentially toxic copper chelators (D-penicillamine or Trenton). Although zinc is of low toxicity and low cost for treatment of Wilson disease, it has been limited to the adjunctive as a single maintenance drug or for asymptomatic patients. The use of zinc monotherapy in patients suffering from a severe liver disease was not well studied. In our case report, we describe a pediatric patient who presented with liver failure and the use of zinc monotherapy in patients with severe hepatic manifestations. Case presentation. A 15-year-old male patient from Ethiopia presented with generalized body swelling (edema and ascites) with yellowish discoloration of his eyes and easy fatigability. He had hyperbilirubinemia, coagulopathy, hypoalbuminemia, and deranged liver enzymes. He had a Keyser-Fleischer ring visible with the naked eye, which was confirmed by slit-lamp examination. He had very low serum ceruloplasmin (<8 mg/L) and high 24-hour urine copper (150 mcg/dl). In accordance with the scoring system proposed by the 8th International Meeting on Wilson Disease and Menkes Disease, a diagnosis of Wilson disease was made. Zinc monotherapy with low copper diet was initiated for decompensated liver disease due to Wilson disease because of the inaccessibility of chelators (D-penicillamine or Trientine). After months of treatment with zinc, the patient experienced normalization of hepatic synthetic function and resolution of hypoalbuminemia and coagulopathy. The patient had also clinically stabilized (ascites, lower extremity swelling, edema, and jaundice were improved. Currently, the patient is on follow-up almost for the last four years in the gastrointestinal clinic. CONCLUSION: Our case shows that zinc has the potential for treatment in improving liver function. Though zinc has its own side effects, it is important and maybe an alternative treatment option in those with limited resources (not able to access chelators). This example hopefully will encourage future investigations and researches on zinc monotherapy for treating symptomatic decompensated hepatic Wilson disease.

How Common is Eosinophilia in Tuberculosis? Case Report.

Though peripheral blood eosinophilia is common due to allergic diseases, drugs, parasitic infections, and malignancies, it is rarely reported due to tuberculosis (TB). The association between eosinophilia and TB is not well known. We have a case of the 9-year-old female present with abdominal pain in the right upper quadrant which is non-radiating associated with decreased appetite, weight loss, malaise and low-grade fever and vomiting of ingested of two weeks. On examination, she had severe wasting and hepatomegaly. On investigations, she had leukocytosis with 50% of eosinophilia, high ESR, multiple liver cysts (abdominal ultrasound and CT) and biopsy suggestive of TB. Finally, the patient started on anti-TB and her response was followed by clinical and laboratory parameters. After three weeks of treatment with anti-TB, she starts to gain weight, improve abdominal pain, appetite loss, and the investigation also normalized (leukocyte and the eosinophil become normalized, ESR corrected). The patient was to follow up for two years in the clinic and finally discharged. The coexistence of eosinophilia and TB in our patient is suggested because of the biopsy results in conjunction with the improvement of peripheral blood eosinophilia with anti-TB treatment. This example hopefully will encourage future investigations and researchers to look at the prevalence and a clear association of TB and peripheral eosinophilia.

Physicians' utilization of microbiologic reports and determinants of their preference to order culture in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

OBJECTIVE: The main aim of the study was to assess physicians' utilization of microbiologic reports and determinants of their preference in ordering microbiologic culture among patients with systemic bacterial infection at Tikur Anbessa Specialized Hospital. RESULTS: Of the total 369 patients observed, 91 (24.7%) had microbiologic reports (culture and gram stain). About 12% of the patients had culture reports of which majority (77.8%) were available after 72 h of the initial antibiotic start. Antimicrobial susceptibility test was done for 83.3% of the positive cultures. Although 99.5% of the patients were initially placed on empiric therapy, adjustment was done in 114 (30.9%) of the patients. Among these patients with adjusted therapy, changes were unrelated to microbiologic reasons in 103 (90.4%) patients. None of these changes were for the reason of streamlining therapy. Prolonged hospital stay (AOR = 2.9, 95% CI 1.2-6.7), senior physician consultation (AOR = 4.1, 95% CI 1.1-17.7) and suspicion of new site of infection (AOR = 2.6, 95% CI 1.1-6.2) were positive independent predictors for physicians' preference in ordering culture.