Surgery

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Research done on patient and/or parent satisfaction among patients underwent hypospadias surgery at TASH and DMCSH; Three years cross sectional, prospective study; Ethiopia, 2022
(Addis Ababa University, 2023) Misgea,Abdureuf; Temesgen,Fisseha(MD)
Introduction Hypospadias is one of the most common congenital anomalies in boys, occurring in 1 in 150 to 300 live births (Elliott et al., 2011; Springer et al., 2015) followed by Down’s Syndrome, Cleft Lip and Spinal bifida. Surgeon perspective of outcome assessment is vital; but it will not be complete without patient input. In spite of what surgeons may determine a successful repair, parental and patient perception of their outcomes may differ (Lorenzo et al., 2014; Mureau et al., 1996). Longitudinal studies following hypospadias repair are still rare and the real impact in adolescence and adult life remains uncertain. This may be due to lack of condition specific validated patient-related outcome (PRO) measures and objective tools to evaluate young people and families The study was done determine the Parent reported outcome of hypospadias repair in our institution and to identify the effects of factors on post-operative PRO. Objective The objective of study was to assess patient and/or parent satisfaction among patients underwent hypospadias surgery for three years in TASH and DMCSH; 2022 Methodology The study was conducted in TASH and DMCSH for children with hypospadias operated during January, 2019 – December, 2021. Data was collected in four major stages as chart retrieval, address identification, phone communication and data analysis. The study design was hospital based cross sectional descriptive. Result and Discussion Potential variables identified for confound of association for post hypospadias surgery satisfaction includes age, location, type of hypospadias, type of first procedure, and total number of procedure. Bivariate and multinomial logistic regression was done with above variables showed that there is strong association of satisfaction level with localities from Addis Abeba (P=0.02, 95% CI) Our study revealed that locality or address, type of hypospadias, and repeated procedures all shares major contribution in reducing our patients and parents level of satisfaction after hypospadias surgery. We are also showed that it is possible to assess post-operative PRO and post-operative follow up by the use of mobile phones with consistency of operating team and strong network connection. Conclusion and Recommendation Parental and /or patient related outcome assessment and satisfaction level has paramount importance than surgeon oriented outcome assessment. We can use phone calls for post hypospadias surgery satisfaction assessment without much difficulty.
The pattern of clinicopathologic presentation of gall bladder cancer patients managed at Tikur Anbessa specialized hospital from April 1, 2018, to March 31, 2023, Addis Ababa, Ethiopia: a retrospective cross-sectional study.
(Addis Ababa University, 2023-06) Dagne,Andualem; Nigussie,Shimelis(Ass.Prof.)
Background: Gallbladder cancer (GBC) is a rare tumor with a very poor prognosis. It is often incidentally found during routine cholecystectomy for gall stone or diagnosed at the advanced clinical stage at the time of presentation. In Ethiopia, no published data assessed the clinicopathologic presentation and the management approach of patients with gall bladder cancer. Objective: The main objective of this study was to assess the pattern of clinicopathologic presentation of gallbladder cancer patients managed at Tikur Anbessa Specialized Hospital from April 1, 2018, to March 31, 2023, in Addis Ababa, Ethiopia. Methods: Facility based retrospective cross-sectional study was conducted on the pattern of clinicopathologic presentation of gallbladder cancer patients managed at Tikur Anbessa Specialized Hospital from April 1, 2018, to March 31, 2023, in Addis Ababa, Ethiopia. Secondary data were extracted from patients’ clinical charts and recorded to a pre-tested checklist. Data was entered into epidata version 3.1 and exported to SPSS version 26 for descriptive analysis using frequency tables, mean, median and standard deviations. Result: During the study period a total 70 gallbladder cancer cases were studied. The mean age at presentation was 56.5 ± 12.2 years and most of the patients were females with a 1.9:1 F: M ratio. The Most (82.9%) common presenting feature was abdominal pain with a median duration of symptoms of 3months (IQR 5.7 months). About 12.8% of patients were found incidentally. Close to half (47.2%) of the patients were having metastasis, with liver involvement accounting for 63.6% and non-regional nodes for 30.3% of metastasis. The remaining 31.4% were resectable and 21.4% of patients were locally unresectable. GB mass lesion is the most frequent imaging feature while gallstones were detected in 50% of cases. Surgical exploration was performed in 35.7% of patients, the rest majority were managed with supportive care (35.7%) and palliative chemotherapy (18.6%). Adenocarcinoma was the commonest histologic type identified (94.4%). Conclusion: - The prevalence of concomitant gallstones in this study was low compared to other studies. Most of the patients were having either locally advanced or metastatic gall bladder cancer. It requires a high index of suspicion and appropriate imaging in middle age individuals and above who presented with persistent abdominal pain to diagnose gall bladder cancer at the early curative stage
Perioperative outcomes and associated factors of patients with hepatic resection, in Central Ethiopia: a multicenter prospective cohort study.
(Addis Ababa University, 2023-06) Dagne,Andualem; Abdurahman,Zeki(Ass.Prof.)
Introduction: As a relatively recent experience practiced only in a few tertiary centers across Ethiopia, the perioperative outcome of patients with hepatic resection is barely known. The main objective of this study is to assess perioperative outcomes and associated factors among patients treated with hepatic resections from July 1, 2022 – June 30, 2023, at tertiary hospitals in Addis Ababa, Ethiopia. Methods: It is multi-center prospective cohort study. Data were collected regarding demographics, comorbidities, the extent of resection, intraoperative findings, perioperative morbidity, and mortality. Data was entered into epidata version 3.1 and exported to SPSS version 26 for descriptive analysis and statistical analyses using binary logistic regression. Result: A total of 76 patients underwent hepatic resection, there were 44 females and 32 males. One-third (32.9%) of these patients had underlying liver disease. The main indication was primary hepatic cancer in 65.8% with HCC in 55.3%. The majority (82.9%) of patients had anatomic-based hepatic resections. Major hepatectomy was performed in 34.2% of patients. The mean duration of surgery was 3.2±1.23 hr., the length of hospital stay was 6.04 ± 3.35 days while the median blood loss was 800ml (IQR 500-1000 ml), and 40.8% of the patients required transfusions. Overall 30- day mortality and morbidity were 3.9% and 32.9% respectively. Morbidity was higher in patients requiring blood transfusion (p=0.008) and malignant disease indications (p= 0.071) although not statistically significant. Conclusion: The perioperative morbidity and mortality of hepatic resection are consistent with the other published literatures. The requirement for blood transfusion and malignant disease indications were associated with higher morbidity.
Peridictive Accuracy of Absent Color Flow on Doppler Ultrasound in the Operative Finding of Intussusception at Tikur Anbessa Specialized Hospital,Ethiopia
(Addis Ababa University, 2023-10) Brhanu,Freselam; Gossaye,Abay(Ass.Prof.)
Background: Intussusception is a common paediatric surgical emergency condition which has contributed a significant burden on morbidity, mortality, and emergency surgical health care. Despite ultrasound serving a great deal as an accurate tool in diagnosing intussusception, evidences on the diagnostic accuracy of absent colour flow with the intraoperative finding are limited. The aim of the study was to assess the diagnostic accuracy of absent flow on colour Doppler Ultrasound study with intraoperative findings of Intussusception Methods: Hospital based retrospective crossectional study was used. The medical record number of patients operated in the past 5 years, from September 2017-December 2022, with the preoperative diagnosis of intussusception, was traced and their charts were retrieved. The data was collected with standardised questionnaire. The data was cleaned, entered and analyzed using SPSS version 25. Diagnostic accuracy of absent color flow to predict gangrenous and viable bowel was measured using Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Uni-variate analysis was performed to test factors associated with gangrenous intussusception. A binary logistic regression mode was used to identify independent risk factors. Results of logistic regression reported as adjusted odds rations (OR) with 90% confidence intervals. Results: During this crossectional study, data from 121 patients were collected. The median age was 9 months (±IQR 9) with male predominance (70.2%). The most common complaints were vomiting (93.4%), non-bloody Diarrhea (78.5%), abdominal pain (89.3%), fever (29.7%), abdominal distension (14%) and, bloody diarrhea (8.3%). while the commonest physical findings were currant jelly stool detected at the time of DRE (62.8%), palpable abdominal mass (45.5%), abdominal distension (41.3%). Classic triads were present in 35.5% of the patients. The postoperative complication rate was 20.7% and mortality rate was 2.5%. Conclusion: In our setting Color Doppler US had Sensitivity of 46.8%, Specificity of 84.3%, PPV of 66.67% and NPV of 70.2% in predicting whether or not an intussuscepted bowel is gangrenous.
Treatment Outcome of Hydrocephalus among patients with Dandy Walker Malformation managed with ETV at Zewditu Memorial Hospital, from January 2021- May 2023 Addis Ababa, Ethiopia.
(Addis Ababa University, 2023-11) Hailu,Bereket; Zewdie,Kibruyisfaw( Ass.Prof.); Bizuneh,Yemisirach( Ass.Prof.)
Background: Dandy-Walker complex (DWC) is a term coined to describe a continuum of posterior fossa anomalies categorizing spectrum of cystic malformation posterior fossa depending on extent of involvement and severity. DWS has been reported to occur in 1 of 25,000 to 30,000 newborns, with the majority of patients presenting in the first year most of them present with hydrocephalus (70–90%). There are different treatment modalities to treat hydrocephalus in Dandy-walker Malformation patients endoscopic Third ventriculostomy being one of them. In our country Ethiopia, ETV has also been applicable for the treatment of the hydrocephalus in those patients with DWM lately. Despite its applicability in the management of Hydrocephalus its outcome hasn’t been properly assessed. This research aims at assessing the treatment outcomes of ETV. Objectives: To assess the treatment outcomes of Hydrocephalus among patients with DWM who are treated with ETV at Zewditu Memorial Hospital. Methods: Retrospectively collected data in 33 children with confirmed Dandy-Walker Malformation patients who have undergone ETV was conducted at Zewditu Memorial Hospital from January 2021 to May 2023. The Data collected was analyzed using SPSS. Frequency distribution will be used to describe the characteristics of the patients. Data analysis was performed using chi-squared tests and survival analysis by Kaplan-Meier tests to assess the treatment outcomes and survival probability. Result: The median age at surgery was 7 months and 84.7% of the patients were less than 1 year. There was slight Male predominance than females 1.75:1. ETV was successfully done in 22(66.7%) of the patients with improvement in their initial presenting clinical sign & symptoms. The 6-month ETV failure rate was 33.3% to whom we did redo ETV/VP-shunting. All failures occurred within the first 6 months after surgery. The estimated cumulative survival probability was 75.8% at 2.4 months, 70 % at 4 months and with mean follow up time of 18 months. Conclusion: The 6 month ETV failure rate was 33.3%. Endoscopic third ventriculostomy should be strongly considered as primary management in treating DWC associated hydrocephalus.
Screening Practice of major congenital malformation and associated factors among health care professionals at three teaching hospitals in Addis Ababa, Ethiopia
(Addis Ababa University, 2023-10) Belay,Eden; Temesgen,Fisseha (MD)
Background: Congenital anomalies are structural, functional, and metabolic abnormalities that occur during the formation of organs and appear at birth or later in life. Newborn screening an activity aimed at early identification of newborns affected with certain genetic and/or metabolic conditions. Early diagnosis and treatment of these conditions reduce morbidity and mortality. Objectives: To evaluate the health care professionals’ practice on screening of major congenital anomalies among newborn infants at three tertiary government hospitals in Addis Ababa, Ethiopia. Methods and Materials: Cross-sectional study was conducted from November 2022 to September 2023 on 163 healthcare professionals working at labor and delivery ward and neonatal intensive care units of Tikur Anbessa Specialized hospital, St. Paul Hospital Millennium Medical College and Menilik II comprehensive specialized hospital on Knowledge, attitude and practice of screening of congenital malformations. Analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26 and descriptive statistics were reported as frequency, median, mean ± standard deviation (SD). Binary logistic regression analysis was done. Tests with P-Value < 0.05 were considered statistically significant. Results: The Average score of knowledge, Attitude and practice were 6.52 (±1.48), 3.62 (±.304) and 4.63(±1.79), respectively. Only 45(27.6%) of the health care professionals had adequate overall knowledge, 113(69.3%) have favorable attitude and 18(11%) of the respondents have good practice. Conclusion: majority of HCPs have moderate to adequate knowledge (74.2%), favorable attitude (69.3%) and poor practice (89%) regarding screening of congenital malformations. Knowledge of congenital malformations had shown a positive significant association with screening practice.
Aerodigestive foreign body in pediatrics: a retrospective study in tertiary hospital
(Addis Ababa University, 2023-07) Abebaw,Etsub; kiflu,Woubedil(Ass.Prof.)
Objective – The aim of this research is to assess the outcome and complications of aero digestive foreign body and associated risk factors in pediatric patients in Tikur Anbesa Specialized Hospital. Method – The medical records of 302 children who were treated for an aero-digestive foreign body during a three-year period were reviewed at TASH. Patient’s demography (age, sex,adress), clinical data (Duration of symptoms, vomiting, dysphagia, cough ,fever, fast breathing, preoperative aspiration pneumonia,URTI), image finding, type of foreign body, type and length of the procedure, outcome, intra op and post-op complications ,rate of redo bronchoscopy procedure were analyzed using logistic regression. Results – The overall rate of removal of FBS in the 1st procedure was 97(95.1%) and 5(4.9%) pushed distally. 66(65.7%) removed with Magill’s forceps and esophagoscopy done in 36(35.3%) .28(27.5%) develop complications. from this 20(19.6%) accounted for minimal esophageal mucosal bleeding during the procedure.4 cases(3.9%) have esophageal perforation and managed with chest tube and antibiotics.one case(2.9%)had TEF and 2 managed conservatively.one patient TEF repair through cervical approach. One patient died post esophagoscopic removal of battery from esophagus with hemorrhagic shock 2ndary to AEF. With mortality rate of (1%). In patents with FBA rigid bronchoscopy done in 195(97.5%) and direct laryngoscopy with Magill’s in 5(2.5%).FB removal was not successful in 24(12%) of patients, 1 in laryngoscopic group and 22 in bronchoscopy group. During the procedure 122(61%) develop complications, majority were intra operative complications like laryngospasm in 46(23%), persistent intra operative hypoxia occurred in 93(46.5%), which was associated with intraop bradycardia in 43(21.5%) and intraoperative cardiac arrest in 9(4.5%). Minimal bleeding from the air way mucosa occurred in 13(6.5%) during the procedure. But there was significant bleeding from the air way and death in one patient during removal of sharp FB.in 12 (6%) of patients there was pus in the air way during removal of airway FB in 9(4.5%) pneumothorax occurred in 9(4.5%) of cases .one patient (0.5%) came with pneumothorax preoperatively. two patients had pneumomediastinum, Five (2.5%) develop BPF.72 (36%) had air way edema, 17(8.5%) developed HAP,. One patient (0.5%) develop HIE during the procedure iv Our analysis showed in patients with air way FB presence of preoperative infections (AOR 3.086; 95% CI, 1.486; 6.41, P=0.003 and desaturation at presentation (AOR 5.52; 95% CI, 2.555-11.925; P=0.000), had increased risk of complications .patients with complication had prolonged hospital stay (AOR 3.661; 95% CI, 1.327-10.104; P=0.012). Delayed presentation (>24 hours) (AOR 23.135; 95% CI, 4.44-120.54; P=0), sharp and battery foreign bodies (AOR 50.803; 95% CI, 5.742-449.49; P=0) were independent risk factors for occurrence of complications in esophageal FB. Conclusion – In patients with air way FB presence of preoperative infection and desaturation at presentation had increased risk of complications with significant association .patients with complication had prolonged hospital stay .Delayed presentation (>24 hours),sharp and battery foreign bodies radiolucent FB on imaging, were independent risk factors for occurrence of complications in esophageal FB in children.
Patterns of Injury and Outcomes of patients with Thoraco-abdominal Injury in public hospitals in Addis Ababa, Ethiopia
(Addis Ababa University, 2023) Friew, Hedagewoin; Gebremariam, Shemeles (PhD.)
Background; Trauma is a major public health issue accounting for 10% of the total death globally. The thorax and the abdomen are commonly injured sites in association with RTA and account for the most common cause of death next to head injury. In relation to several compounding factors concurrent presence of injury in this two body cavities imposes significant challenge in the diagnosis as well as in the management plan of such cases. The relative rarity in this pattern of injury has hindered large scale study both in this country and globally. Therefore, the optimal management strategies in this population still remains area of debate. Worldwide, the mortality rate of abdominal trauma is reported to be between 1 and 20%. Thoracic trauma is a significant cause of mortality. Globally, chest trauma is the third important cause of mortality and morbidity. Abdominal injuries require careful triaging for appropriate intervention because approximately 25% of such injuries require surgery. Therefore, the optimal management strategies in this population still remain area of debate. The aim of this study is to assess the pattern and outcome of patients with thoraco-abdominal injury attending four public hospitals, Addis Ababa, Ethiopia, Objectives; Assess the patterns of injury, associated factors and outcomes among patients with thoraco- abdominal injury attending in four public hospitals, Addis Ababa, Ethiopia. Method; Institution based retrospective quantitative cross-sectional study design was used to get patients chart for assessing the patterns of injury and outcomes in patients with thoraco-abdominal injury admitted to the 4 hospitals in Addis Ababa over a period of 3 years. A standard checklist was used to collect all the necessary data from patient’s medical record and OR registry. The collected data was entered into Google Form, and then exported to IBM SPSS version 26 for analysis and descriptive statistics was used to present the result. Descriptive and inferential statistics as well as binary logistic regression analysis was done. All factors on the bivariate analysis discordant at P 0.25 were included in a stepwise logistic regression model to identify independent predictors of mortality. Model fitness checked by Hosmer-Lemshow goodness of fit test and multi collinearity checked by VIF. Results;96 patients fulfilling the inclusion criteria were identified, men make up the majority of the study population 84(87.5%). The mean age of the patients was 31.2 years ± SD 11.3. 56(58.3%) arrived at the health facility within 6 hours of injury. Penetrating injury is the commonest mechanism of injury 50(52.1%), stab accounts for 35(36.5%), gunshot occurred in 16(16.7%) and blast in 5 (5.2%). 50(52%) were hemodynamically unstable at presentation and among this 42(84%) were managed operatively. 27(28.1%) required ICU admission and 9 (9.4%) patients had massive transfusion. FAST was done in 50(52.1%) patients at the emergency and it was positive in 35(70%). The diagnosis of thoraco-abdominal injury was made with CT scan in 22 patients and 13(59%)of them were managed operatively. Among these patients only 1(7%) patient was operated within 24 hours of presentation. Majority of the patients were managed with concomitant tube thoracotomy and laparotomy 47(49%), 15(15.6%) were managed with laparotomy alone, 4(4.2%) undergone thoracotomy, 10(10.4%) were conservatively managed and only 1 patient had dual cavity intervention. Among the 63 patients who had laparotomy, in 1(1.5%) patient the laparotomy was unnecessary and in 13(19.40%) of them the laparotomy was non-therapeutic and among this 5(38.46%) had died and 1 patient was re operated. From the 67 among the total 96 patients who were operatively managed repair was done for the 39(40.6%) as part of the operative intervention, 4(4.2%) underwent resection and anastomosis,12(12.5%) had diversion. Among the 8 patients who had IOF of splenic injury 7(7.3%) had splenectomy and 1 patient had splenorraphy, there were two patients who had IOF of kidney injury, 1(1%) of them had nephrectomy and the other one1(1%) had renorraphy. damage control surgery was performed in 4(4.2%) of the patients, 1(1%) patient had right middle lobe wedge resection for massive hemo thorax, Cholecystectomy was done for 2(2.1%) of the patients, 2(2.1%) of the patients were just explored. The in hospital mortality rate is 14.6%. For those patients discharged improved the average length of hospital stay is 16.18 days. The need for ventilator support was associated with increased risk of mortality. Conclusion;Patients presenting with thoraco abdominal injury poses significant diagnostic and therapeutic challenge due to the high requirement of timely surgical intervention despite a considerable number of negative and non-therapeutic laparotomy rate. Therefore, Routine laparotomy should be abandoned and should be reserved for patients who are hemodynamically unstable, having signs of peritonitis, or evisceration and non-operative management should be considered in select cases provided that close follow up and imaging modalities are available. The significant mortality rate associated with ICU admission requirement calls for improvement in the setup of the facilities as well as in the provision of care of critical trauma patient starting from the emergency to the ICU unit. A multidisciplinary team of health professionals should also be organized in the management of this patients to effect in a better outcome.
Predictors of Treatment Outcomes in Patients with Craniopharyngioma Surgically Treated at Two Teaching Hospitals Addis Ababa,Ethiopia: A 10 Year Retrospecive Cohort Study From Jan2013-Jan2023.
(Addis Ababa University, 2023-11) Yigzaw,Mengistu Ayele; Bogale,Thomas (Ass.Prof.); Gizaw,Abel (Ass.Prof.)
Background: Craniopharyngioma is a rare disabling disease due to its malignant behavior though it’s histologically benign. The bulk of literatures that describe treatment strategies and treatment outcomes of patients with craniopharyngioma are from westerns and the long term neurological, endocrinological, ophthalmological and psychosocial outcomes are not well studied in developing countries. Objective: The aim of this study was to assess neurological, ophthalmological, endocrinological and overall functional outcomes of patients with craniopharyngioma at TASH and MCM comprehensive specialized hospitals from Jan 2013 to Jan 2023. Methodology: Retrospective cohort study was conducted to assess the predictors of treatment outcome of patients with craniopharyngioma was undertaken at TASH and MCM hospitals in Addis Ababa, Ethiopia which are affiliated Neurosurgical hospitals. The long term neurological, ophthalmological, endocrinologic and general functional outcomes of patients treated for the past 10 years from Jan 2013 to Jan 2023 was studied. Data was collected by chart review and via phone contact to the patients. The MRI/CT image was re-evaluated when available. The neurological, ophthalmological, endocrinological and overall functional outcomes were analyzed. The functional independence and Craniopharyngioma clinical status scale (CCSS) was used to assess the overall functional status of patients. Factors affecting the functional outcome were identified and correlations were performed using SPSS Version 25. Results: Among 40 patients included in the study headache (95%, 38/40), visual deterioration (87.5%, 35/40) and lethargy (85%, 34/40) were the most common presentations. Thyroxine and cortisol were the most deficient hormones preoperatively (35%, 14/40) and (32.5%, 13/40) respectively. Pre operative DI was present in 35% of the patients. Craniotomy was done in (70 %, 28/40) and trans nasal surgery for (22.5%, 9/40) of patients, VPS for (5%, 2/40) and EVD for (2.5%, 1/40) patients. STR was done in (60%, 24/40) and GTR in (20%, 8/40) patients. Based on craniopharyngioma clinical status scale, 40% (16/40) of patients have sever neurologic deficit, iv 42.5% (17/40) of patients have bilateral blindness, 25% (10/40) have DI and panhypopituitarism, 45% (18/40) of patients have post operative obesity and 60% (24/40) of patients are entirely dependent on others for self-care. The mortality rate was 47.5% (19/40). There was statistically significant association between tumor epicenter, tumor size, brain stem involvement, HCP, meningitis, dysnatremia, length of hospital stay and length of ICU stay with poor functional outcome. Conclusion: Craniopharyngioma is associated with very high rate of mortality rate in our setup and higher grade of hypothalamic involvement and signs of increased ICP at presentation are predictors of mortality. Majority of the survivors have also significant ophthalmologic, neurologic and endocrinologic morbidities.
The Pattern of Head and Neck Cancers of the Oral cavity, Nasal cavity and Paranasal Sinuses, and Salivary Glands at ALERT Comprehensive Specialized Hospital, Addis Ababa, Ethiopia: Retrospective Cross-sectional Study
(Addis Ababa University, 2023-12) Adem,Reyad; G/egziabher,Abraham(Ass.Prof.)
Background: Despite substantial clinical advancements that make it possible for early detection and treatment, head and neck cancers (HNCs) continue to be a major public health problem worldwide, resulting in significant morbidity and mortality. Head and neck cancers account for around 5% to 7% of all cancer cases worldwide, exhibiting significant epidemiologic variability across geographical areas. Objectives: The primary objective of this study is to determine the patterns of head and neck cancers of the oral cavity, nasal cavity, paranasal sinuses, and salivary glands at ALERT Comprehensive Specialized Hospital Plastic Surgery unit, between May 1, 2015 to May 1, 2023. Methods: Retrospective cross-sectional chart review of all patients with diagnosis of head and neck cancers seen at ALERT comprehensive specialized hospital, Plastic surgery unit, during the study period who fulfill the inclusion criteria was done. The data was cleaned, coded, entered to SPSS version 26 software and analyzed. Result and Discussion: A total of 101 patients with HNC of the oral cavity, salivary glands, and nasal cavity/paranasal sinuses were documented during a period under review. Charts of 76 patients were chosen for analysis. Male patients constitute 68.4% of all patients. The mean age of the study participants was 45.5±19.68 SD. Patients with oral cancers were 47 years old on average. Addis Ababa had the highest proportion of patients (30%), followed by the Southern Region (27.5%). Lip and oral cavity cancers account for 63.2% of the total cases, followed by salivary gland malignancies (30.3%). SCC is the most frequent histologic type (54%), followed by adenoid cystic carcinoma (10.5%) and mucoepidermoid carcinoma (9.2%). Tobacco usage, consumption of alcohol, and chat chewing were the most frequently noted risk factors. About 27.5% of patients had cervical lymph node metastases, and Half of the patients were diagnosed with advanced-stage disease at presentation
Comparative Outcome Analysis of Single Vs. Staged Proximal Hypospadias Repair in Children Treated at Tikur Anbessa Specialized Hospital and Menilik II Hospital from 2010 To 2020 G.C
(Addis Ababa University, 2023-10) Kefiyalew,Samuel; Tadesse,Amezene(Prof.)
Introduction: Long-term surveillance show proximal hypospadias repair has a higher complication rate (50% to 68%) than distal hypospadias repair (5% to 10%). In present study, we aim to identify and compare the complication rate between single stage hypospadias repair and staged hypospadias repair. Methods: A retrospective chart review study of boys undergoing proximal hypospadias repair between January 2010 and December 2020 G.C. in Tikur Anbessa specialized and Comprehensive Hospital and its affiliate Menilik Comprehensive Hospital. Pearson Chi-square and logistic regression analyses were performed to assess associations and effect size, respectively. Results: A total of 75 patients were included, with a median age at surgery of 36.0 months. Forty-six in single stage group (Long tubularized incised late (TIP) 30, Transverse Ventral Preputial Flap (TVPF) 15, and Onlay Island Flap (OIF) 1) and 29 in staged group (staged preputial island flap 27, and staged preputial graft 2). The overall complication rate was 70.6% (53/75 patients), 32/46 (69.6%) single stage repair, and 21/29 (72.4%) staged repair. There was a significant preference toward staged hypospadias repair in last 4 years of the study period. Reoperation for glans dehiscence was significantly higher in the staged group (31.0% vs. 4.3%, P = 0.002). Overall complication rate and urethrocutaneous fistula (UCF) were significantly higher in TVPF when compared with Long TIP, 93.3% vs. 56.7% and 73.3% vs. 26.7%, respectively. Conclusion: We found a high complication rate for both single stage and two stage repairs. Higher complication rate in our report warrants further investigation and risk identification to achieve satisfactory outcomes.
Perioperative outcomes among patients undergoing open biliary bypass surgery for malignant biliary obstruction in a low resource setting: a multi-centre prospective cohort
(Addis Ababa University, 2023-07) Solomon,Yoseph; Nigussie,Shimelis(Ass.Prof.)
Introduction: Obstructive jaundice is the most common symptom of malignant diseases of the extrahepatic biliary system and necessitates either non-operative or operative biliary bypass. Because of percutaneous and endoscopic approaches, the use of palliative surgical procedures has decreased in recent years. However, in resource- limited situations, open biliary bypasses remain a viable option. This study aimed to identify factors associated with adverse perioperative outcomes following open biliary bypass. Methods: From June 2022 to May 2023, 69 patients underwent open biliary bypass for malignant biliary obstruction. Postoperative morbidity and mortality within 30 days of surgery were assessed. A Kaplan-Meier was used for categorical variables, and a log- rank test was used to determine the statistically significant difference between variables. A Cox regression analysis was conducted to identify factors associated to time to develop complications. Results: The hazard of developing complications among those with preoperative cholangitis was 2.49 times higher than those without preoperative cholangitis (HR 2.49, 95% CI [1.06, 5.84]). For every hour increment in the length of surgery, the hazard of getting complications increased by 2.47 times (HR 2.47, 95% CI [1.28, 4.77]). As serum bilirubin increased by 1mg/dl, the hazard of developing complications increased by 14% (HR 1.14, 95% CI [1.03, 1.17]). Conclusion: Patients who had long operation times, preoperative cholangitis, and elevated total bilirubin levels are at increased risk for poor perioperative outcomes. Clinicians may use these results to optimize these patients to decrease their elevated risk of serious morbidity and mortality
Epidemiology and clinical features of patients with hepatocellular carcinoma in Tikur Anbessa Specialized Hospital
(Addis Ababa University, 2023-07) Solomon,Yoseph; Abdurahman,Zeki(Ass.Prof.)
Intraoperative accident and associated factors in Carotid Body Tumor surgery at tertiary Hospital in Addis Ababa ,Ethiopia
(Addis Ababa University, 2023-09) Beshir,Abdi; Seyoum,Nebyou(MD,Prof.)
Background – Carotid body tumors (CBTs) are the rare tumors of the head and neck region, accounting for 60% of the cervical paragangliomas. CBTs classified etiologically into sporadic, hyperplastic and familial type. Anatomic classification designed by shamblin describes how CBTs envelope carotid vessel and grouped into 3 according to degree of encasement. Patients commonly present with slowly growing painless mass at carotid triangle. They may have local compressive symptoms like dysphagia or dysphonia.Surgical excision is safe and main treatment option for resectable CBTs. However, complication like bleeding, cranial nerve injury, and stroke continue to be major concerns even in the hands of experienced surgeon. Therefore, the study aimed to assess intraoperative accident during carotid body tumor excision at tertiary hospital in Ethiopia. Method: A retrospective cross-sectional study was conducted among 153 patient operated over the past 10 years period by reviewing medical record at tertiary hospital in Ethiopia. Data was collected through structured questionnaire. The data was summarized using frequency (percentage) table and graph. To identify significant factor associated with intraoperative accident, mulitvariable binary logistic regression model was used, where Adjusted Odds Ratio (AOR), 95% CIs for AOR and p-value were used for interpretation. Result: Among 153 cases patient operated 132(86.3%) were female and mean age was 39.42± 11.161. . Almost all patient presented with neck mass (98.7%) which were painless in 58.8% of cases. Most patient presented more than 3 years after onset of symptoms (61.5%).Tumor size more 5 cm was found in 72.1% of cases. Patients were mostly investigated with neck ultrasound(97.4%) and neck CT(71.22%). Overall, 14.45% were Shamblin I CBTs; 54.2% were Shamblin II; and 31.4% were ShamblinIII. There were Intra operative accident in 24.8 % of patient. Hypoglossal nerve (9.2%) and ECA (9.2%) were commonly injured structure. shamblin class of the tumor was found to be significant exposure for the development of intraoperative accident for those shamblin III as compared to shamablin I with odds increasing with shamblin class (AOR=6.6067, 95% CI=1.07,34.4, p=0.018 for shamblin III). Conclusion : The prevalence of intraoperative accident during CBT excision in our setup comparable with the current literature from different country which implies CBT excision can be done safely in our institution with acceptable level complication with available resource. major factor associated with intraoperative accident was shamblin class of the tumour.
Cross Sectional Study on Nurses’ Knowledge and Practices Regarding Tracheostomy Care at TASH & Yekatit-12 Medical College in AA, Ethiopia
(Addis Ababa University, 2023-11) Tegegne,Chernet; Bogale,Mesele(Ass.Prof.); Girum,Siraw(Ass.Prof.)
Background: Tracheostomy is a common surgical procedure in critically ill patients. Post- tracheostomy care is vital as potential life-threatening complications like tube block, displacement, accidental decannulation, including bleeding, can be prevented by care, timely recognition and intervention. Although tracheostomy is performed by Otolaryngologists, the postoperative period is spent in ICU or in general wards, where nursing staff are the caregivers of continuing contact. Objective: this study was conducted to assess nurses’ knowledge and practices regarding tracheostomy care at Tikur Anbessa Specialized Hospital & Yekatit-12 medical college in Addis Ababa, Ethiopia. Methodology: A cross-sectional design was used to assess nurse’s knowledge and practice about tracheostomy care in Tikur Anbessa Specialized Hospital and Yekatit-12 medical Hospital within the study period from December, 2022, to October, 2023. The study used adopted standardized and structured questionnaires to collect participant’s socio-demographic characteristics, knowledge and practice of tracheostomy care at the hospitals with modification. Then, data was entered and analyzed in SPSS software version no. 26 for the assessment of descriptive and regression analysis. Result: A total of 80 study participants were recruited and included in the study. Out of the total participants, the majority of them were female (58.8%), young adult (20-39-year group) (67.5%), had 5-10 years working experience (42.5%); BSc educational level (78.8%), surgical ward working department (23.8%). The ‘poor’ knowledge level was 61.2% which scored less than or equal to 7 correctly out of 15 questions and ‘medium’ & ‘satisfactory’ knowledge level was 36.3% and 2.5%, respectively. Similarly, the ‘poor practice’ level was 16.2%) that scored less than or equal to 10 out of 20; while ‘medium’ & ‘satisfactory’ practice level was 55% and 28.8% respectively. Moreover, the study explored that there were statistically significant associations between practice level of participants and age group, educational level, working experience and working department (P<0.05). However, there was no significant association between knowledge level & any of the associated factors (P>0.05). Conclusions and Recommendation: The study concluded that participants were having relatively low or poor knowledge about tracheostomy care than the skill and practice of it. VIII Hence; it is recommended to the hospitals and policy makers to provide more focus on knowledge and practice of nurses about tracheostomy care to avoid further complications.
A cross sectional descriptive study on oral cancer awareness among patients that visited department of dentistry and oral and maxillofacial surgery unit at Tikur Anbesa Specialized Hospital , Addis Ababa University
(Addis Ababa University, 2023-07) Abera,Feven; Garoma,Gelana(Ass.Prof. ,OMFS); Dejene,Demerew (Ass.Prof. ,OMFS)
Background: Oral cancer is a malignant tumor that develops in a part of the mouth. It may be on the surface of the tongue, the inside of the cheeks, the roof of the mouth (palate), floor of mouth, the lips or gums. It is a preventable disease. Its occurrence is mostly due to lifestyle. Knowledge of the signs and symptoms of oral cancer may well aid in early diagnosis and treatment. This is bound to increase in survival rate. Objectives: To assess the awareness of Oral cancer among patients that visited department of Dentistry and maxillofacial surgery at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia. Methods: A hospital based cross-sectional study; interviewer-administered questionnaire was conducted amongst 221 adult patients attending the Tikur Anbesa Hospital during June, 2023. A 29-item questioner which has 3 sections: demographics, knowledge of risk factors and knowledge of sign & symptoms of oral cancer were used during data collection. Time frame: The study was conducted from June 1 up to June 30, 2023 Result: A total of 221 patients visited the department during the study period. The female to male ratio was 1.51:1 & the mean age of patients was 37.09 years with standard deviation ±13.77. Majority of the participants (86.4%, N=191) were urban & 57.9% (N=128) of the participants were employed. About 52.0% (N=115) of the participants had a basic education or have accomplished primary & secondary level of school. The majority of the participants 65.2% (N=144) didn‟t have any habit of substance use & 75.1% (N=166) of the participants did not hear of oral cancer prior to this research. A total of 45.2% (N=100) of the participants demonstrated good knowledge of signs & symptoms of oral cancer whereas a total of 44.3% (N=98) of the participants demonstrated good knowledge of risk factors of oral cancer. Conclusion: This research demonstrated a lack of public awareness & knowledge about oral cancer. Different measures should be taken to improve public awareness of oral cancer. Dentists and health workers should do more in educating the public.
Correlation of Preoperative Urine Culture and Post Pcnl Stone Culture and their Association with Post Pcnlsirs
(Addis Ababa University, 2024-10-09) Sadam Aliye; Abeselom Lemma
Under ideal conditions PCNL has a stone clearance rate of over 90%. However, after PCNL, 10% to 35% of patients experience a systemic inflammatory reaction, and a small proportion progresses to sepsis
Outcome of Pediatric Patients Treated For Ventriculitis at ZMH ,A Hospital-Based Prospective Study
(Addis Ababa University, 2024-10-10) Abdisamed Abdi; Yemisirach Bizuneh
-Ventriculitis is associated with high mortality and negatively affects the prognosis of neurosurgical patients. Procedures that can lead to post-neurosurgical ventriculitis include craniotomy, EVD, ventriculostomy, lumbar puncture, and VP shunt insertion.The management of ventriculitis can be lengthy and expensive and ventriculitis can lead to serious long-term sequelae and even result in death.Therefore, early diagnosis, identification of the pathogen, and time to initiation of adequate antibiotic therapy are important variables that can improve the clinical outcomes of ventriculitis in children
Percutaneous Nephrostomy Effectiveness: a Prospective Review in Atertiary Teaching Hospital in Addis Ababa, Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia
(Addis Ababa University, 2024-07-15) Ahmed Abebe; Mesay Mekonnen
Magnitude and Predictors of Unresec table Pancreatic Ductal Adenocarcinoma at Tikur Anbesa Specialized Hospital in Ethiopia 2024
(Addis Ababa University, 2024-06-23) Haile Maryam; Abebe Alemayehu
Pancreas ductal adenocarcinoma is the most common type of pancreas cancer with a dismal prognosis. Over the previous 50 years, it has increased in incidence and fatality rate, and for the next three decades, it will continue to rise.

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