Ectopic pregnancy managed medically at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background: Ectopic pregnancy, a pregnancy in which the embryo implants outside the endometrial cavity, is an important cause of maternal mortality, especially in developing countries. It can be managed medically using methotrexate. In Ethiopia, limited evidence exists regarding the treatment outcome of this approach.Methods: This retrospective study was conducted based on medical records of ectopic pregnancies managed medically using methotrexate. The data of women who had unruptured ectopic pregnancy and who were managed medically in the study period at St. Paul’s Hospital Millennium Medical College were included. Data were extracted from patients’ medical records and analysed using SPSS software.Results: During the 5-year period 2015 to 2019, 81 women with unruptured ectopic pregnancy were managed medically using methotrexate with 93.8% (n=76) success. Methotrexate was administered intramuscularly to all patients in either single dose or multiple doses. Five out of the 81 patients underwent surgical intervention for either ectopic rupture or persistent ectopic mass. There were no fatal complications.Conclusion: Methotrexate is a successful and safe alternative to surgical management of unruptured ectopic pregnancy in our settings. It should be given a trial in patients who meet the selection criteria in a setting ready for emergency surgical intervention and blood transfusions.

Hearing loss among patients on treatment for drug-resistant tuberculosis in Uganda

Introduction: Second-line injectable therapy using aminoglycosides (AG) like kanamycin, amikacin or capreomycin is associated with irreversible hearing loss. We aimed to determine the incidence and predictors of hearing loss among patients with drug resistant tuberculosis (DR-TB) who received AG.Method: This was a retrospective cohort study conducted at the tuberculosis treatment unit of Mbarara Regional Referral Hospital (MRRH). All adult patients with a diagnosis of DR-TB between March 2016 and December 2019 were candidates for inclusion in the study. Hearing loss was defined as a hearing threshold of >20 decibels (dB) at any test frequency in at least one ear. The incidence and predictors of hearing loss were analysed using multivariable Cox model. A p-value of ≤0.05 was considered as statistically significant. Data analysis was done using STATA version 13.Results: The estimated rate of developing hearing loss was 107 per 1000 person months. Thirty-seven (52.9%) of 70 DR-TB patients experienced some degree of hearing loss, of which 25 (67.6 %) developed mild, 5 (13.5%) moderate, and 3 (8.1%) severe hearing loss. Male sex (HR 2.05, CI 1.03-4.10, p-value 0.041), increasing age (HR.5.17, CI 1.42-18.87, p-value 0.013) and high BMI (HR 3.31, CI 1.15 - 9.53, p-value 0.026) were significant predictors of new onset of hearing loss.Conclusion: The incidence of hearing loss among DR-TB patients was high, with the majority having a mild hearing loss. Patients who were male, older, overweight and/or obese were more likely to develop AG-induced hearing loss.

What can be done about adolescent pregnancy in South Sudan?

Introduction: The World Health Organization (WHO) defines ‘adolescents’ as individuals aged 10-19 years. The national family planning policy of South Sudan states that “by the age of 19, one out of three girls is already married or in union; and the same proportion has already started childbearing”. The causes of adolescent pregnancy can be attributed to social, cultural, political and health systems gaps.Objective: This review article looks at the contributory factors for adolescent pregnancy in South Sudan, the effects of these pregnancies and describes some solutions and recommendations.Method: A direct search was conducted in Google scholar and other search engines looking at titles such as teenage/adolescent pregnancy in South Sudan, adolescent pregnancy in Africa, effects of adolescent pregnancy, and interventions to combat teenage/adolescent pregnancy.Results: The contributory factors for adolescent pregnancy in South Sudan are sociocultural where the need for dowries, forced and arranged marriages, gender based violence are examples, economic and political factors; where poor implementation or inadequate adolescent policies, illiteracy and poverty are major factors, failure of health systems; where the unavailability of health services such as the provision of contraceptives for adolescents and scarcity of teenager/adolescent-friendly health clinics; and individual factors whereadolescents reported desire to be mothers, societal recognition and peer pressure. In addition to all of these, rape and sexual slavery are reported as causes of adolescent pregnancy.Conclusions: Causes of adolescent pregnancy in South Sudan are multifactorial. The country needs to adopt the published guidelines from WHO on reduction of adolescent pregnancy and learn from experiences of countries that showed a greater reduction. The utilization of interventions made through research and evidence-based information which are suitable to South Sudan context are crucial.

Giant pleomorphic adenoma of the parotid gland: a case report

Pleomorphic adenomas account for the majority of parotid masses, typically arising in the tail of the gland and enlarging slowly. Most are 2 to 6 cm in size when resected. We report the resection of a benign mixed tumour of the left parotid gland with a history of bleeding. The resected tumour measured 21 cm in diameter, weighed 1.81 kg, and on pathologic examination was a benign mixed tumour without malignant degeneration. The implications of this unusual case for the management of mixed tumours are discussed with a review of the literature.

The MAMI Care Pathway Package: A resource to support the management of small and nutritionally at-risk infants under six months of age and their mothers (MAMI)

Globally, millions of infants under six months (u6m) are small and nutritionally at-risk, but many do not get the care they need to survive and thrive. Although the 2013 World Health Organisation (WHO) guidelines for severe malnutrition management recommend outpatient care for clinically stable infants u6m, most national guidelines still recommend inpatient care for all infants u6m. To help put the WHO recommendations into action, the MAMI Global Network has developed the MAMI Care Pathway Package – a resource to facilitate the screening, assessment, and management of small and nutritionally at-risk infants u6m and their mothers. The Package uses an integrated care pathway approach and is designed to embed within and support Integrated Management of Childhood Illness (IMCI). By improvingcontinuity of care and facilitating patient management, the MAMI Care Pathway Package aims to help health workers improve outcomes for infants and mothers worldwide while also simplifying their care.

Back-to-basics. Cough: causes and diagnosis

Cough is a common complaint and may be a feature of serious underlying disease. A working knowledge of the mechanisms and differential diagnoses is crucial. A carefully taken clinical history followed by a thorough physical examination will often lead to a correct conclusion and confirmatory investigations and in turn to appropriate management.

Stop killing healthcare workers in South Sudan

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Pulmonary tuberculosis among young children with severe pneumonia at Al Sabah Children’s Hospital, Juba, South Sudan

Background: Tuberculosis is a major public health problem worldwide. It can present in an acute form especially in endemic settings, which might lead to missed and delayed diagnosis, prolonged hospital stays, and increased mortality in children. South Sudan has a high prevalence of tuberculosis in the adult population. However, there is no published data on paediatric tuberculosis. We aimed to determine the prevalence and factors associated with pulmonary tuberculosis in children admitted with pneumonia in Al Sabah Children’s Hospital, South Sudan.Method: This was a cross sectional study of 404 children aged 2 to 59 months admitted with severe pneumonia from June-October 2018 at Al Sabah Children’s Hospital. We excluded children on anti-TB treatment. Data were collected using a pretested questionnaire which captured socio-demographic characteristics, clinical history, physical examination, and laboratory investigations. Sputum examination for Mycobacterium tuberculosis was performed for all participants using X-pert MTB/RIF. Additional investigations included Chest X-ray and blood count.Results: We recruited 404 children, out of which 78 (19.3%) had pulmonary tuberculosis. Of these, 13 (16.7%) were bacteriologically confirmed while 65 (83.3%) were clinically diagnosed. The factors significantly associated with pulmonary tuberculosis were age above two years [AOR 2.32 (95% CI 1.04-5.17)] p value 0.039, positive HIV Status [AOR 24.2 (95% CI 2.88-202.62)] p value 0.003, severe acute malnutrition [AOR 15.67 (95% CI 6.68-36.73)] p value <0.001, lack of BCG immunization [AOR 3.09 (95% CI 1.06-9.03)] p value 0.038, and contact with a known tuberculosis patient [AOR 55.14 (95% CI 10.12-300.6)] p value <0.001.Conclusion: There is a high burden of pulmonary tuberculosis in children presenting with severe pneumonia. There is a need for screening for pulmonary tuberculosis in children with any of the associated factors to improve early diagnosis and treatment.