Emergency Medicine

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    Assessment of the Knowledge, Attitude and Practice on Universal Precaution among Emergency Medicine Professionals in Emergency Room Tikur Anbessa Specialized Hospital,AAU,Ethiopia,2013,G.C.
    (Addis Ababa University, 2013-01) Alemayehu, Afework; Seme, Assefa(MD, MPH, Ass. Professor); Azazh, Aklilu (MD, Internist, Emergency Medicine & Critical Care Physician)
    Background employing universal precautions means taking precautions with everybody. If precautions are taken with everyone, health care workers do not have to make assumptions about people's lifestyles and risk of infection. Objectives: The main objective of the study was, to assess the knowledge, attitude and practices about universal precautions among emergency medical professionals and factors associated with its practice in emergency unit. Methods: This hospital based cross sectional descriptive survey was conducted in Tikur Anbessa Specialized hospital, AAU from February through June 2013. The study was carried out using a structured questionnaire which was self-administered to all emergency medicine personnel after preliminary introduction at a plenary session. The study was use both quantitative (which was self-administered) & qualitative(to which an Observation check-list was used to observe whether or not the staff members involved in patient management is using an appropriate technique and timing as per the set guideline) methods. Data was entered, cleaned and analyzed using SPSS for Windows version 16. Frequencies, percentage and graphs was used for descriptive purposes. Study period –study period was from February 2013 to June 2013.The total budget for the accomplishing of this study was 18,465.50 ETB. Results-Only 15(24.6%) of the respondents know the presence of anti HIV prophylaxis after sustaining needle stick or sharp injuries while 46 (75.4%) didn’t know. The respondents who had perceived risk of acquiring HIV infection from their health facility waste, when disposed improperly, 2 said the risk would be for HCW, 3 for supportive staff, 40 (65.6%) for both health professionals & supportive staff and 8 said would be for Health Professionals, Supportive staff, the client / patient & the community. Among the emergency medicine professionals 36(59%) perceived that oxygen delivery materials like mask, nasal cannula & prong can be reusable whereas 25(41%) perceived as this materials can’t be reused. Concerning needle recapping after use, 51(83.6%) the respondents perceived that it should not be recapped and the remaining 10(16.4%) were said should be recapped after use. Discussion-Poor hand washing practice by emergency medicine professionals were found before and after touching the patients were found. Emergency medicine professionals were not properly handling, and disposing used Needle/sharp materials in the study area. Personal protective devices particularly mask and eye goggles, boots etc. were not available during the survey.
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    Prevalence & Predicting Factors of Workplace Violence Against Emergency Department Healthcare Workers in Public Hospitals in Addis Ababa: A Cross-sectional Study
    (Addis Abeba University, 2021-11) Gurara,Kalkidan Kebede; Prof.Azazh, Aklilu(MD, Professor of Emergency & Critical Care Medicine); Dr.Kefyalew, Merahi(MD, Assistant Professor of Emergency & Critical Care Medicine)
    Background Workplace violence is a pervasive problem among the healthcare sector worldwide and the Emergency department is one of the highest affected settings. Workplace violence (WPV) not only affects the performance of healthcare providers, but also leads to acute and chronic physical and psychological consequences which could lead to burnout, decreased work satisfaction, and the decision to leave the profession. There are few studies published that were done in different settings in Ethiopia that explored the prevalence of WPV but none was done in hospitals in Addis Ababa. Objective The objective of this study is to determine the prevalence and predicting factors of workplace violence against healthcare workers practicing at various levels of hospitals in Addis Ababa, Ethiopia. Methods A prospective cross-sectional study was performed at three selected public hospitals in Addis Ababa, Ethiopia. A structured self-administered questionnaire was used to collect data regarding sociodemographic information, exposure to physical, psychological violence, and sexual harassment. Data were entered using SPSS Version 26 for coding and analysis. Summary statistics, descriptive statistics, chi-square, and Fisher’s Exact tests, and binary logistic regression were used to analyze independent variables’ association with workplace violence among ED staff. Results A total of 161 participants were included in the study. The 12-month prevalence of workplace violence was 80.7%. Of the 161 participants, 45% were physically attacked, 73% were verbally attacked and 19.3% experienced sexual harassment. Being an emergency resident was found to have a statistically significant association with exposure to WPV. Regarding the specific types of WPV, sexual harassment was found to be associated with gender and working outside regular hours. Consequences to victims of workplace violence were both physical and psychological and included injuries that required formal treatment, time is taken off work, and symptoms of anxiety, alertness, and avoidance of thinking of the incident. Conclusion There is a significantly high prevalence of WPV among emergency healthcare workers. There is a pattern of low reporting of incidents. Efforts need to be made towards making reporting procedures available and accessible to emergency healthcare workers.
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    Knowledge Attitude and Practice of Disaster Preparedness among Health Professionals Working in the Adult Emergency Department, at two Teaching Hospitals of Addis Ababa, Ethiopia, 2021.
    (Addis Abeba University, 2021-03) Nakachew, Yonas; Dr.Engida, Hywet (MD, Assistant Professor of Emergency Medicine); Dr.Gezahegn, Demmelashhegn (MD, Assistant Professor of Emergency and Critical Care Medicine)
    Background: Disasters lead to loss of property and disrupted infrastructure, and slow societal development worldwide. Every year, natural and man-made disasters destroy and displace lives, and the frequency of disasters strike has increased over the past 50 years. Despite that, for most national authorities developing culture of preparedness remained a challenge. And very little has so far been done in Ethiopia in the area of disaster preparedness. Objective: The main aim of this study is to assess the knowledge, attitude, and practice of disaster preparedness among health professionals working in the emergency department, at two institutional teaching hospitals of Addis Ababa. Methods: A descriptive cross-sectional study was conducted among ED health professionals at two institutional teaching hospitals of Addis Ababa. Data was collected using self-administered questioners. SPSS version 26 was used for data analysis and Bivariate and multivariate analysis was employed. Result: A total of 197 health professionals included in the analysis. Majority of the participants were staff nurses 143 (72.6%) and the rest were physicians. About 58.6 % of participants were male and the mean age was 29.34 years. A significant proportion of the respondent (70.6%) didn’t have disaster management training before and 48.7% of the respondent didn’t know their hospital had disaster plan. They have overall low knowledge level (53.3%), positive attitude (91.9%) and inadequate practice (59.4%). Educational level, previously attended disaster training, working hospital and gender was strongly associated with knowledge of the participant at p-value < 0.05. Year of ED work experience, working hospital and previously attended disaster training, was strongly associated with practice of the participants at p- value of < 0.05. Conclusion: Despite their positive attitude towards disaster and emergency preparedness, health professional’s knowledge and practice level seems poor. Based on this finding, it is very essential that the health professionals receive the adequate knowledge and skill necessary to improve outcomes following a disaster.
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    Retrospective Study of the Clinical Trend of Patients with Mild Head Injury Presented to Tikur anbesa Specialized Hospital Emergency Room
    (Addis Abeba University, 2021-10) Wondafrash, Yegeta; Dr. Beyene, Temesgen(M.D, Emergency Medicine And Critical Care); Dr.Feleke, Yohannes(M.D,Emergency Medicine And Critical Care)
    Background-Clinical information collected at baseline can be useful in knowing the clinical trends of mild head injury. One of the constraints of managing mild head injury patients is the availability and proper use of computed tomography scans. This clinical trend can be used to identify patients who need imaging after mild head injury. As a sub analysis, we compared the Canadian head computed tomography rule with the New Orleans criteria to select patients who need computed tomography scans for Ethiopian mild head injury patients. Objective- The objective of this study is to see the clinical trends and computed tomography scan findings of mild head injury patients. Method- A retrospective observational study of adult mild head injury patients who were seen at the Tikur anbesa specialized hospital. emergency room from December 2018 to July 2021. The study population was adult mild head injury patients who got head computed tomography scans after evaluation at the Tikur anbesa specialized hospital emergency room. The data will be collected from patients' charts using a structured checklist prepared by the investigator. SPSS software version 26 was used. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with abnormal CT scan findings. Pvalue < 0.05 was used to declare statistical significance. Result- patients met the criteria for this study and analyzed. The highest frequency of head injury occurred in the 20 to 29 age group (49.2%). The incidence of mild head injury was higher in males 166(86%). mild head injury patient tends to come slightly more at night shift (51%). the most common referral source was self-referral (39.9%). The number of abnormal CT scan findings seen was 58(30.1%). The most common CT scan finding was skull fracture 44(75.8%). sensitivity of CCHR and NOC rule is 100% and CCHR has higher specificity than NOC rule. Being male, regional referral source, tachycardia, and falling down mechanism of injury were found to be a predictor of abnormal CT scan findings. Conclusion: The clinical trends of MHI patient is very important to determine the eligibility of mild head injury patients for CT scan.
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    The Magnitude of Pityriasis Rosea: A Retrospective analysis of Data Records at Alert hospital Dermatology Clinic, Addis Ababa, Ethiopia of Case Seen from January 2018 to December 2020.
    (Addis Abeba University, 2021-11) W, Meron; Dr.Legese, Yosef(MD,Dermatosurgeon,Assistant Professor); Dr. Lakew, Bezawit(MD,Dermatovenrologist,Assistant Professor)
    BACKGROUND Pityriasis Rosea is an acute self-limiting papulosquamous skin disorder commonly observed in otherwise healthy children and young adult. In 15–90% of cases, typical PR begins with a medallion-like erythematous plaque, called a herald patch,followed by a secondary eruption consisting of smaller scaly papulosquamous lesions on the cleavage lines of the trunk, These secondary lesions take the shape of a Christmas tree when they are arranged along the Langer’s lines on the back it appears in crops at intervals of a few days and reaches its maximum in about 2 weeks OBJECTIVE To assess the magnitude of pityriasis rosea from medical records of patients attended dermatovenerology OPD at ALERT center from 2018-2020 G.C METHOD Hospital-based retrospective, descriptive study was conducted on all medical records of patients who attended a department of dermatovenerology OPD at ALERT center from December 2018 to January 2020,the study period was from June-August 2021. RESULT One hundred forty-eight patients presented with pityriasis rosea. mean age at presentation was 19.48 and Male to Female ratio 1:1.19 peak cases were seen in January .forty-three of the patients were present within weeks. herald patch was present in 18.2% of the patients. the trunk was the commonest affected site and itching was present in 70 patients and it was mild in the majority. 40.5% of the patients were treated with the topical steroids. CONCLUSION The study has shown the magnitude of pityriasis rosea was 0.26% with female predominance .most of them present from January to June. The majority of them had one visit
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    Evaluation of Emergency and Critical Care Medicine Residents’ Accuracy in Electrocardiogram Interpretation in Addis Ababa Ethiopia: A cross-Sectional Study
    (Addis Abeba University, 2021-10) Tesfaye, Meron; Dr.Zewdu, Tigest(Assistant professor of emergency and critical care medicine); Dr.Gezahagne, Demelash(Assistant professor of emergency and critical care medicine)
    Background: Electrocardiogram is the diagrammatic representation of the heart’s electrical activity. Which can detect life-threatening conditions within minutes. It’s one of the major investigative modalities that emergency physicians should be accurate at. The accuracy of emergency residents varies from country to country with improvement in interpretation as the year of residency increases. there are no published papers in ECG interpretation among emergency residents up until now but a study which was done on graduating medical students show low competency. Objective: To assess the accuracy of Emergency and Critical Care Medicine residents in ECG interpretation in Tikur Anbessa Specialized Hospital and Saint Paul Millennium Medical College. Methods: A cross-sectional study was conducted on emergency and critical care medicine residents of Tikur Anbessa specialized hospital and Saint Paul millennium medical college. Data were collected from April 2021 to September 2021 by using a structured questionnaire. Data were entered, cleaned, edited, and analyzed by using SPSS version 26.0 statistical analysis software. Descriptive statistics and bivariate and multivariate binary logistic regression were used to analyze the data. Results: Fifty-seven emergency and critical care medicine residents were able to participate in this study out of which 33 (57.9%) were from Addis Ababa University and 24 (42.1%) were from saint Paul millennium medical college. The average score of EMCC residents on the interpretation of the ECGs was 29.5%. Only ten residents (17%) were able to correctly interpret >50% of the ECGs. most of the residents who participated in this study were year 1 residents (49.1%) followed by year 2 residents (31.2%). Out of 15 ECG abnormalities, the commonly identified ones were polymorphic ventricular tachycardia (64.9%), normal sinus rhythm (49.1%), and double chamber pacemaker (45.6%). Year of residency (AOR 3.34, 95% CI: 1.1,10.2) was found to be significantly associated with higher performance in ECG interpretation. Conclusion According to this study emergency medicine and critical care residents have low accuracy in interpretation of ECG which is comparable to a study which was done in South Africa and Australia.
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    Assessment of Magnitude of Burnout among Emergency Physicians and Emergency Residents Working in Hospitals found in Addis Ababa from June1 to July 30, 2021
    (Addis Abeba University, 2021-10) Haile, Matiwos; Prof.Azazh, Aklilu(MD, internist, EMCC subspecialist, AAU); Dr.Feleke, Yohannis(MD, Assistant professor of EMCC, AAU)
    Background: Burnout is very common in the contemporary work place. It is common among health care workers who work in emergency department. It is defined as syndrome of a reduced sense of personal accomplishment, emotional exhaustion and depersonalization, amongst individuals who work with other people High intensity of workload, working alone, lack of social support, lack of free time, unsociable Rota, violent, abusive or demanding patients, seriously ill patients are common predisposing factors Objective: The objective of this study was to determine the magnitude of burnout among emergency physicians and emergency residents who are working in different hospitals in Addis Ababa and specifically the levels of subscales of burnout. Method: The study areas were Tikur Anbessa Specialized Hospital (TASH) and st.paul specialized hospital and other hospitals which are located in Addis Ababa, the capital city of Ethiopia. Cross sectional study was conducted from June 1 to July 30 2021, data was collected online from emergency and critical care physicians and residents. The data was entered into spss 26 after checking for completeness. Results: Sixty eight participants completed the questionnaire out of 114 emergency and critical care residents and consultants working at different hospitals in Addis Ababa. Among the 68 eligible respondents 50% of them are between the age of 30 and 40 years and the rest of 50% are less than 30 years. 70.6% respondents were male and 38(52.9%) were single. Twenty four of the respondents were first year EMCCM residents, fifteen respondents were consultants and two of the respondents were subspecialists. Forty nine (72.1%) of the respondents had less than 5 years of duration of medical practice and 92.6% of the respondents had not planned to leave the specialty in the next 12 months. For the subscales of burnout, emotional exhaustion the mean score was 18.22 with standard deviation of 11.685, for personal accomplishment mean score was 25 with standard deviation of 12.519 and for depersonalization mean score was 7.21 with standard deviation of 6.149. the magnitude of burnout as defined by high emotional exhaustion and high depersonalization and low personal accomplishment was 8.8%%, plan to leave the specialty in 12months was significantly associated with burnout with p value of 0.04. Conclusion and recommendation: As indicated in this study the magnitude and the level of burnout among emergency and critical care residents and consultants who were working in different hospitals in Addis Ababa was low. Further larger scale study recommended to be done on this important work place phenomenon.
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    Clinical profile of patients presented with cardiogenic shock in black lion specialized hospital adult emergency room.
    (Addis Abeba University, 2021-10) Ayele, Biruk; Dr. Worku, Tigist(Emergency medicine and critical care, Assistant professor); Dr. Tesfaye, Birhanu(Emergency medicine and critical care, Assistant professor)
    Background: Cardiogenic shock is defined as a state of ineffective cardiac output caused by primarily cardiac disorder resulting in inadequate tissue hypo perfusion. Cardiogenic shock is one of the contemporary emergency room and cardiology challenges. The mortality rate is 39 % with range of 27-50%.It is also the leading cause of mortality in patents with myocardial infarction. Objective: The main objective of the study was to determine the clinical characteristics of cardiogenic shock patients in Black line specialized hospital adult emergency room. Methods: This study was conducted in Black lion specialized hospital located in Addis Ababa, Ethiopia. A cross-sectional study was conducted retrospectively on patients who visited Black Lion hospital adult emergency room from June 2019 to June 2021. All patients who were diagnosed to have cardiogenic shock on the mentioned study period were included .Data was collected from patients card by the researcher after structured questioner which was be adopted and modified from previous researches . After checking for clarity and completeness the data was entered in to SPSS version 26 for analysis. RESULT; In this monocentric study which from 98 patients who were enrolled retrospectively 84 patients full fill the inclusion criteria. Out of them patients 39 (46 %) were male. The mean age of the patients was 40.2 years with 19.1 standard deviation. Regarding the residency 67.9% were from urban area. At admission the mean systolic blood pressure of the patients was 59.23 mmHg with standard deviation of 34. The mean heart rate of the patients was 111 beats per minute with 37 standard deviation. Ejection fraction of the patients was depressed with mean EF of 39.9% with 14.4 standard deviation. . Valvular heart disease was the most common underlying etiology accounting for 47.6% or 40 of the patients, followed by ischemic heart disease which accounts for 26.51 % of the cases .In hospital mortality was 38.1 %. Presence of deranged creatinine level was associated with death with p-value of 0.031 and 3.256 adjusted odds ratio [1.116-9.505] 95% confidence interval. Ischemic heart disease was also having association with death with p value of 0.004 and adjusted odds ratio of 7.184 with [1.874-27.543] 95 % confidence interval. CONCLUSION: In this study the most common underlying etiology for cardiogenic shock was chronic rheumatic valvular heart disease .The other finding was the etiology ischemic heart disease and presence of deranged creatinine level were highly associated with in hospital mortality.
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    Assessment of Outcome and Associated factors of adult poisoning cases at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia from January 1,2015 to December 31, 2020
    (Addis Abeba University, 2021-10) Dessie, Belayneh; Dr.Kebede, Sofia(MD, assistant professor of EMCC); Dr. Tesfaye, Birhanu(MD, assistant professorof EMCC)
    Background: With the widespread availability of a vast number of chemicals and drugs, acute poisoning is a common medical emergency worldwide. Morbidity & mortality associated with poisoning is becoming a major public health issue in many countries. Although it has been known that this public problem is a pressing issue in Ethiopia, the extent and magnitude of poisoning is not yet properly explored. Objective: The objective of this study was to assess outcome and associated factors of adult poisoning cases at Tikur Anbessa Specialized hospital. Methods: This was hospital based cross sectional study of adult poisoning cases at TASH from January 1, 2015 to December 31, 2020. Data was collected through retrospective chart review by using structured questionnaire which was prepared from previous literatures with few amendments. The data was coded, cleaned and entered in to SPSS version 26 software program for further analysis. Descriptive statistics, bivariate and multivariate analysis was done to assess the outcome and associated factors and the odd ratio obtained was used as approximation of relative risk. P values less than 0.05 were considered significant. Results: The overall case fatality rate was 13.7% and the overall discharge rate was 86.3%. The common causes of death were Rodenticides (n=10), Barbiturates (n=8) and Organophosphates(n=5). Relative to rural, being from urban place of residence was strongly associated with discharge (AOR=6.384, 95%CI=1.270-32.098, P=0.024). Relative to other main management options, patients who required intubation were less likely to be discharged (AOR=0.045,95%CI=0.003 0.776, p=0.033). Conclusion: In this study the overall case fatality rate was 13.7% which is very high as compared to the findings of other studies done in the country so far. Urban place of residence & management with intubation were independent predictors of outcome. Awareness on proper handling of chemicals should be forwarded to users of these agents by public health workers
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    Clinical profile of patients with hematologic malignancy in Tikur Anbesa specialized hospital Emergency Department.
    (Addis Abeba University, 2021-10) Eshete, Astawesegn; Dr. Jiru, Tilahun(Assistant Professor of Emergency Medicine and Critical Care); Dr.Kefyalew, Merahi(Assistant Professor of Emergency Medicine and Critical Care)
    Background: Hematologic malignancies are among the top non-communicable issues that become a concern for our society and health care system. Tikur Anbesa specialized hospital is one of the hematologic centers and the only referral in the country for hematologic malignancy.The main aim of this study is to know the clinical profile of hematologic malignancy patientspresent to the adult emergency department of Tikur Anbesa specialized hospital. Methods. A prospective study was conducted on hematologic malignancy patients who presented to ED from March 2021 to September 2021 by using a pretested standardquestionnaire in the adult emergency department of Tikur Anbessa Hospital. A total of 168 patients were found during the study period and included in this study. Result and discussion: Out of 168 patients 103(61.3%) were males. The age group between 20 to 40 years old was the most frequent 66(39.4%) and the age group above 60 years was the least19(11.3%). The travel time to the hospital was more than two hours for 76.8% of patients. Easy fatigability was the most common presenting complaint 69(41.1%) followed by fever and weight loss/loss of appetite (14.9%). A total of 46.4% patients presents after two months of symptom onset. The most common hematologic malignancy was ALL (44,26.2%) followed by CML,AML, and NHL 22%,20.8%, and 11.9% respectively.128(76.2%) of patients have stayed in theED for more than 24 hours and lack of bed in the wards were the main reason for ED stay for the majority of patients which account 47.6%. Conclusion: Hematologic malignancy is common in TASH ED and most of the patients travel more than two hours from rural areas and stay longer in ED to get beds in the wards and starttreatment so it is important to consider opening other hematologic centers to address these issues.Most of the patients present late with advanced disease and complications so community healtheducation and awareness creation are very important to overcome this issue.
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    Pattern of Orthopedic Injuries Related to RTA among Patients Managed at Emergency Department of TASH, Addis Ababa Ethiopia, 2021.
    (Addis Abeba University, 2021-01) Bezabih, Yetnayet; Tesfaye, Brhanu(MD); Melaku, Birhanu (MSC)
    Background: Road Traffic Accident (RTA) is an accident which occurs on a way or street open to public traffic; resulted in one or more people is being killed or injured, and at least one moving vehicle involved. Most of orthopedic injuries are caused by RTA. Orthopedic injury is any injury to the musculoskeletal system. Often, relating to the bones and joints as a result of an accident or trauma to the body. Each year approximately 1.3 million people lose their lives on the road and as many as 50 million others are injured and because of injury every year 12 million people disabled and from them 6 million people develop permanent disability. Most of those disabilities are caused by orthopedic injuries. Objective: The aim of this study is to assess pattern of orthopedic injuries related to road traffic accident among patients managed at the emergency department of TASH in Addis Ababa Ethiopia, 2021. Method: Institutional based retrospective cross-sectional study was conducted from March till June 2021 G.C. A total of 354 patients’ chart was selected by using systematic random sampling technique. Data was entered into Epi data version 4.2 & analyzed by SPSS version 26.0 software. Result: A total of 354 RTA victims with orthopedic injury were included in the study. The study reveals that male were mostly injured person (71.7%) with age group of 13-24. Taxi accounts for 36.3% of cause of injury followed by motorbike (27.4%) & lower limb were the commonest anatomic site of injury (47.9). From all injury type fracture is the commonest one with 71.1% especially lower limb fracture (42.1%). More than half victim (59.5%) had open wound. 51.8% experience RTA while they are crossing or walking around road. Conclusion: Reproductive age groups are most vulnerable age groups to RTA. According to my finding the major cause of RTA was minibus and pedestrian were the most injured victims.
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    Knowledge, Attitude, Practice, and Associated Factors towards Glycemic Control among Diabetes Mellitus Patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2021.
    (Addis Abeba University, 2021-06) Mezgebe, Yemane; Beza, Lemlem(Ph.D. Assistant professor); Tesfay, Berhanu (MD, assistant professor of emergency medicine and critical care)
    Background: Diabetes mellitus, (DM) is a metabolic disorder characterized by hyperglycemia due to absolute or relative insulin deficiency and it remained the fourth leading cause of death worldwide. Hyperglycemia or high blood sugar is a common sign of uncontrolled diabetes and leads to severe damage. Poor understanding of the disease could affect glycemic control and result in preventable Diabetic complications. Accordingly, good knowledge, attitude, and practice of glycemic control are important to increased quality of life,minimize diabetes complications,and lower the incidence of death. Objectives: -This paper detailed the cross-sectional study that measures knowledge, attitudes, and practices, and associated factors of diabetic patients about glycemic control. Methods and Materials: A total of 361 were enrolled in the study, the recruitment tool place by using systematic random sampling techniques in one academic teaching hospital, Addis Ababa, Ethiopia. The knowledge, attitude, and practices were measured using standard structured questionnaires. Result: Nearly half (48.8%) of the respondents were males. Good practice was independently associated with gender; accordingly, the male was 1.62 more likely to have good practice compare to their counterpart female gender (AOR=1.62, 95%CI: 1.005-2.62, p= 0.04). However, those participants between 18-35 age groups were 72 % less likely to have good practice verse to reference group followed by participants between the age group of 51-65 who were 51% less likely to have good practice towards glycemic control Conclusion: -Despite they have experienced the event of the hyperglycemic and routine visit of a diabetic patientto a diabetes clinic; the knowledge, attitude, and practice about glycemic were found to be good.
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    Competency of Nurses Working in Adult Emergency Room at Electrocardiography Interpretation :Multicenter Study in Addis Ababa,Ethiopia,2021.
    (Addis Abeba University, 2021-03) Haimanot, Yegremew; Gezahegn, Demmelash(MD Assistant professor of EMCC); Melaku, Birhanu (B SC, EMCC )
    Background; Electrocardiogram (ECG) is a procedure of recording the electrical activity of the heart within a period of time using electrodes placed over the chest. Basic ECG rhythms, such as normal sinus rhythm, sinus tachycardia, sinus bradycardia, atrial fibrillation, atrial flutter, heart blocks, ventricular fibrillation, and asystole should be recognized by any nurse. Nurses are normally the first responders to an in-hospital cardiac arrest in health care facilities, and they must be proficient in basic resuscitation skills. Objective: the objective of this study was to assess the Competency of nurses working in the adult emergency room at ECG interpretation: a multicenter study in Addis Ababa ethiopia2021. Method: An institutional-based descriptive, cross-sectional study design using a quantitative research method with convenience sampling method was used to enroll 175 nurses in five hospitals at adult ER. Data was collected by using standard self-administered questionnaires which were adapted from ECG guidelines. The data was checked for its’ completeness and entered into Epi data version 7.2.2 Then data was imported to SPSS version 26 software for analysis. The descriptive results were presented with frequency distribution tables, graphs and its association were analyzed by fishers extract test instead of X 2 due to occurrence of some observed number being less than 5with significant value of (p<0.05). RESULT: out of 203respondents 175 were actively participated with a response rate of 86.2%.from those respondents 175nurses, 159(90.9%) were not competent (scored <65%) only 16(9.1%) were competent (scored>65%) the mean score was 6.82 from 20 questions and (SD=± 3.65).the minimum score was5% and the maximum score was 90%. Conclusion: the overall level of competency of nurses about ECG interpretation is low. This is difficult to monitor and manage arrhythmias. Level of education and training were a determinant factor to enhance their competency.
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    Knowledge regarding Atlas among nurses working at adult emergency department at Alert and Tash Addis Ababa, Ethiopia, 2021.
    (Addis Abeba University, 2021-06) Zewde, Wondosen; Dr.Gezahegn, Demolish(MD, Assistant professor of emergency medicine and critical care); Melaku, Birhanu(BSc, MSc in EMCCN)
    Background: Trauma is a major cause of mortality and disability in developed as well as developing countries. The ATLS knowledge helps to implement a methodological approach to the trauma patients in the emergency room which aims for rapid and accurate assessment. Trauma management can be improved by implementing ATLS properly. However, for the knowledge of the investigator, there is a limitation of a study conducted in Ethiopia. Objective: To assess the knowledge of nurses on ATLS working in the adult emergency department of TASH and ALERT, Addis Ababa, Ethiopia, 2021. Methods: A descriptive cross-sectional study design was used and data were collected using a structured and self-administering questionnaire. The study population was all nurses working within the adult emergency department of the ALERT and TASH. Participants were selected by convenience sampling technique. The collected data were checked for its completeness by data collectors and PI before entering into the software for analysis. Data were entered using the epidata v 4.6.0, and analyzed using SPSS v26. Binary logistic regression was performed to see the association between the independent and dependent variables. A P-value of less than 0.05 is considered statistically significant. Result: One hundred nurses participated in the study. The majority of them were between the ages of 25 and 29 years, 59% with mean age of 29.5±5.4. There were equal numbers of both sexes out of totally participated subjects, but the most participants were from TASH (56%) while the rest were from ALERT. Educational and the training status of the nurses are identified as the factors affecting the knowledge level of the respondents (AOR=12.3,P=0.022 and AOR=2.47, P= 0.001)respectively’. From study participants, only 45% of the nurses have good knowledge of ATLS. Conclusion and recommendation: in conclusion, there is a significant gap of knowledge towards ATLS in these selected hospitals. . A lack of ATLS expertise among emergency department staff nurses could potentially harm patient outcomes in trauma cases. Therefore ALERT and TASH nurses should get training on ATLS & improve their educational status.
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    Knowledge and Practice of Nurses towards the Prevention of Catheter- Associated Urinary Tract Infection Working in Intensive Care unit of Federally Administer Hospitals in Addis Ababa, Ethiopia, 2021.
    (Addis Abeba University, 2021-06) Teshager, Tilahun; Dr.Kefyalew, Merahi(MD. Assistant professor of EMCC); Hussein, Heyria(MSc in EMCCN, PhD fellow)
    Abstract Background:Urinary catheterization is one of the most common procedures performed in hospitals especially in intensive care units and the single highest risk factor for acquired UTIs.More than 75% of all acquired UTI are due to catheter use.Nurses are the primary healthcare providers who are responsible for inserting and maintaining urinary catheters. But most of the nurses had an inadequate level of knowledge and practice regarding the prevention of catheter-associated urinary tract infection. Objective:This study aimedto assess the knowledge and practice of nurses towards the prevention of catheter-associated urinary tract infection (CAUTI)workingin the Intensive Care Unitoffederally administeredhospitals inAddisAbaba Ethiopia,2021 G.C. Methods: A descriptive cross-sectional study wasconducted.A total of 184 nurses were participated by census sampling method. Data was collected by self-administered questionary.Data wereentered by using epi data 4.6.0 and was analyzed by SPSS version 26.0.Pearson chi-square and Fischer exact testswere performed to see the association between independent and dependent variables.A P< 0.05 was consideredstatistically significant. Results; the study findings showed that more than half of nurses 116 (63.04%) had a poor level of knowledge while only 68 (36.96%)had a good level of knowledge and 96 (52.17%)of nurses had a good level of practice while88 (47.83%) had a poor level of practice. There was a statistical association between nurse’s knowledge and experiences a (p-value=0.031).While there was no statistical association between nurse’s knowledge and practicelevel and nurse’s knowledge and practice with age, sex, level of education, marital status, training, and guidelines/protocols a (p-value>0.05). Conclusion and Recommendation: results showed that nurses had a poor level of knowledge and practice for the prevention of catheter-associated urinary tract infection.Further studies withlarge sample sizesneed to investigate factors affecting nurse’s knowledge and practice towards the prevention of catheter-associated urinary tract infection.
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    Clinical Profile and Outcome of Trauma among Adult Patient Treated at Alert Hospital Trauma Center Emergency Department Addis Ababa, Ethiopia, 2021.
    (Addis Abeba University, 2021-06) Abebe, Tesfaye; Dr.Kefyalew, Merahi(Emergency Physician); Abebe, Asmamaw(MSc IN EMCCN)
    Introduction: A traumatic injury can be caused by a wide range of blunt, penetrating, and other mechanisms. As a result, after a patient has sustained this injury, he/she may require immediate care. So, all aspects of trauma care systems, such as a powerful prehospital care system, skilled human power, facilities, equipment, and continuous supplies, must be in place for a successful outcome. Objective: This study is aimed to assess the clinical profile and outcome of trauma among adult patient treated at ALERT hospital trauma center emergency department Addis Ababa, Ethiopia, from January 1/2019 to December 1/2020. Methods: A retrospective chart review study was performed during the time period of January 2019 to December 2020 on trauma patients treated to the trauma and emergency department of ALERT hospital. For statistical analysis, Epi-data version 4.6 and SPSS version 25 were employed, and Fisher's exact test was performed to determine the statistical association. Results: Male to female ratio was 259:103, with the 24–33 age group predominantly affected by trauma. The most common time of injury was 8–6 a.m., and the taxi was the predominant mode of arrival to the hospital (59.7%). Inter personal violence (IPV) is the most common accident, accounting for 31.8 %. Road traffic injury (R.T.I.) is the second most common cause of injury accounted for 30.7% of victims, three wheelers or Bajaj (45%) dominated over others vehicles. Mostly pedestrian was affected 62.1%. The Kampala severity score II (KTS II) were show milled trauma (82.3%), moderate trauma (11%), and severe trauma account (6.6%). Open wound/ Soft tissue injury (44.2%) and Extremity fracture (24%) were the frontrunners injury, with 11.3% of the victims were polytrauma. The mortality rate was 3.6%. Conclusions and recommendation: The injury was prominently IPV and RTA, the trauma victims were young. The focus should be directed to injury prevention and safety measures. Future studies can be directed to long term outcomes and follow up of injury victims to account for exact mortality and morbidity due to such unfortunate events.
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    Clinical Features and Treatment Outcomes of Preeclampsia and Eclampsia at Gondar University Specialized Teaching Hospital Amhara Ethiopia, 2020/2021.
    (Addis Abeba University, 2021-07) Alemie, Tamalew; Prof.Azazh, Aklilu(MD, Internist, emergency medicine specialist); Abebe, Asmamaw ( MSc, Emccn)
    Background: - Preeclampsia is a disorder of pregnancy characterized by high blood pressure and proteinuria after 20 weeks of gestation, and a common direct obstetric cause for perinatal and maternal morbidity and mortality in developing countries. Objective: To assess the clinical features, and treatment outcome of women with preeclampsia and Eclampsia admitted in Gondar University specialized hospital, Northern Ethiopia 2020/2021. Methods: A retrospective cross-sectional chart review study was conducted at Gondar university specialized hospital from April 9-May/30/2021. Among women hospitalized for preeclampsia and eclampsia 311 mothers selected using systematic sampling. A pretested check list was used to collect data from medical records. The collected data was coded, entered into Epi-data version 4.6, and exported to SPSS 26 for descriptive and inferential analysis. Chi-square and fishers exact test were done to determine a statistically significant factors and a p-value of ≤0.05 was considered to set a statically significant association. Results; Out of 311 study population, almost half of cases (49.8%) were preeclampsia with severity features. While, Eclampsia accounted for 18.6% of women. Above 50% of mothers required immediate interventions to terminate the pregnancy by cesarean section for various indications. Unfavorable maternal outcome was present in more than 25% of cases; the observed unfavorable maternal outcomes were aspiration pneumonia 10.6%, HELLP syndrome 8.7% and maternal death 2(0.6%).While 12.2% of cases had unfavorable perinatal outcome. The unfavorable perinatal outcomes were still birth 31(10%) and early neonatal death 7(2.3%). Disease severity, mode of delivery, aspartate transaminase, gravidity, gestational age and antenatal care were statistically significant factors with outcome of pregnancy. Conclusion; Prevalence of unfavorable maternal and perinatal outcomes of preeclampsia and eclampsia are considerable in the study area. To deter these effects both on perinatal and the maternal outcomes of pregnancy, antenatal care services and emergency obstetrics and new born care should be expanded and strengthen.
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    Causes and Circumstances of Deaths of Patients Admitted to the Adult Medical Intensive Care unit of Tirunesh bejing General Hospital Addis Ababa, Ethiopia.
    (Addis Abeba University, 2021-06) Alemayehu, Sisay; Debebe, Finot(Emergency Medicine Specialist); Michael, Mebrate(MSc IN EMCN)
    Background: Intensive care unit (ICU) is a special unit of a hospital that provides intensivetreatment for patients with severe life-threatening illnesses which require uninterrupted care and close monitoring with life support equipment. The mortality rate is still very high in most ICUs especially in the developing countries due to late presentation of patients, unavailability of welltrained staff and lack of life support equipment. This study tried to identify the causes and circumstances of the death of critically ill patients. Objectives : To identify causes and circumstance of deaths of patients admitted to the adult intensive care unit (ICU) at Tirunesh Beijing Hospital public hospital, Addis Ababa, 2021. Methods: A retrospective cross-sectional study was conducted. All patient charts who were admitted and died in adult ICU from Sept 2018 to August 2020 and met the criteria were included. Data was collected by using structured and pretested checklists. SPSS version 25 software was used for data entry and analysis. Result: A total of 193 death cards were reviewed, of which 116(60.1%) were males and 77(39.9%) were females. Common deaths 91(47.2%) occurred in the age group20-40yrs with meanstandard deviation of 43.92±17.26 years. Stroke is the leading cause of death accounting for 27(14%) of total death followed by Retroviral infection (13.5%).The mortality of patients admitted in MICU was 39% and 52.8% of the deaths took place in the first 72 hours of admission to theintensive care unit. Conclusion: The total mortality was considerably high and it is affecting the young age groups. Majority of the patients are dying in the first 72 hours, indicating that most patients are visiting the intensive care unit in the late stages of their illnesses. Further study is required for better understanding of the existing situation
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    Assessment of Patterns and Outcome of Injury among Victims Visiting Emergency Unit of Nigist Elleni Mohammed Memorial Hospital, Hossana, Southern Ethiopia
    (Addis Abeba University, 2020-06) Amanuel, Selamu; Wubetie, Andualem (BSc, MSc EMCCN); Dr.Seyoum, Nebiyu(MD, Surgeon)
    Background: Every day the lives of more than 14,000 people are cut short as a result of an injury globally. The burden of injury is especially high in LMICs, where over 90% of injury deaths occur. Although the hospitals should have a clear image of injury, little is known about injury statistics. This study was specifically designed to determine the patterns and outcome of commonly occurring injuries based on available health facility records in NEMMH, Hossana, Southern Ethiopia. Methodology: A hospital based retrospective review of records of injury victims in NEMMH from January to December 2019 was evaluated from October to June 2020. Data were collected using a structured checklist that was developed by adapting the World Health Organization instrument. Five degree holder nurses collected the data while investigator closely supervised. Socio demographic characteristics of the patients and injury related information were collected. Data were analyzed using SPSS for windows version 25. Results: Out of 6238 patients visited emergency unit of Nigist Elleni Mohammed Memorial Hospital from January 1, 2019 to December 31, 2019; 762 (12.2%) were victims of injury. Unintentional injury is the most prevalent category of injury (69.4%), of which RTA is the commonest (41% of all unintentional injury) mechanism of injury which in turn affected mostly pedestrians (41.5% of all RTA victims) followed by drivers. Interpersonal violence is the most commonly occurring intentional injury (52.3%) followed by suicidal attempt. Victims who are unintentionally injured those who sustained RTA injury, those who were injured on street, those who encountered chest injury and those who were severely injured were found to be at a higher risk of death as compared to the remaining victims. Conclusion: The magnitude of injury in NEMMH is high. Injury is more prevalent among males and productive age group. Most victims faced their injuries unintentionally, of which RTA is most prevalent; whereas, interpersonal violence is the most prevalent intentional injury. The mortality rate due to injury is also high. Appropriate prevention strategies should be designed and implemented against RTA, and prompt treatment should be commenced to combat bad outcomes.
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    Bacterial Profile and Antimicrobial Susceptibility Pattern of Isolates from Diabetic Foot Infections at Selected Public Hospitals of Addis Ababa, Ethiopia.
    (Addis Abeba University, 2021-08) Berhanu, Bereketeab; Desta, Kassu (Bsc, Msc, PhD candidate, Associate Professor); Dr.Ahmed, Abdurezak(Internist & Endocrinologist, Assistant Professor); Dr.Tsegaye, Mulugeta (MD, Internist)
    Background: Globally, diabetic foot infections continue to be a major public health problem, bringing socio economic burdens to the affected people. Clinically infected foot ulcers require treatment guided by appropriate cultures and antimicrobial susceptibility testing. Updated information is scarce in Ethiopian context in general and in the study sites in particular, hence we tried to fill this gap. Objective: To determine the Bacterial profile and Antimicrobial susceptibility pattern of isolates from Diabetic foot infections at selected public Hospitals of Addis Ababa, Ethiopia. Method: A cross sectional design was used to recruit 135 diabetic adult patients with diabetic foot infections attending selected public hospitals in Addis Ababa, Ethiopia. Convenient sampling was employed in recruiting participants for one year from May, 2018 to April, 2019. Wound Aspirates (deep wound swabs) from the foot ulcers were collected aseptically and inoculated into Blood, MacConkey, Chocolate and Manitol salt Agar. The antimicrobial susceptibility patterns were conducted according to the criteria of the National Committee for Clinical Laboratory Standards (NCCLS) by disk diffusion method. A structured questionnaire was used to collect information regarding the socio-demographic status, clinical history and risk factors of the study participants. Data obtained was analyzed using the statistical package for social sciences software version 20. Statistical significance was set at 95% confidence level and p values ≤0.05 was considered significant. The associated factors of DFI were determined using multiple ordinal regressions with the test of parallel line assumption being fulfilled for each risk category separately. Results: Of the 135 patients investigated majority105 (77.8%) of them were males. The Mean age (SD) of the patients was 57.64 (± 13.20 SD) Years. According to the International Working Group on the Diabetic Foot (IWGDF) classifications, mild, moderate and severe Diabetic foot infections in our study were 36 (26.7%), 75 (55.5%) and 24(17.8%), respectively. One hundred ninty bacterial isolates were identified among 135 patients. Among them, 85 (62.96%) had mono bacterial infection while 50 (37.04%) had mixed bacterial infections. Gram negative aerobic bacterial infections were more accounting 121 cases (63.7%) than gram positive aerobic bacteria 69, (36.3%). The most commonly isolated bacteria was S. aureus (26.3%), followed by Klebsiella spp (22.1%) and Proteus spp (11.1%). In general, 140(73.68%) of the isolates in our study developed multidrug resistance to at least one drug in three different classes of antibiotics. Meropinem and Amikacin appeared to be the best antibiotics for therapy against Gram negative and Cefoxitin and Vancomycin against gram positive organisms. Moreover, Health education on proper foot care (AOR=3.743, 95% CI 1.615-8.674), Peripheral Vascular Disease (AOR=0.298,95% CI 0.116-0.765), Nephropathy (AOR=0.354, 95% CI 0.135-0.927) ,BMI normal (AOR=0.052,95% CI 0.004-0.663) and overweight (AOR=0.072, 95% CI 0.0060.935) were found to be associated with Severity of Diabetic foot infection. Conclusion: High level of multidrug resistance in this study implies, definitive therapy should be based upon culture and susceptibility analysis to promote the rational use of the Antibiotics and reduce emergence of bacterial resistance to antimicrobials.