Patterns of Hepatocellular Carcinoma on Computed Tomography at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

BACKGROUND: Hepatocellular cancer is the commonest liver cancer which contributes to a high incidence of morbidity and mortality in both developed and developing countries. Despite the anticipated high burden of the disease in the country, there is paucity of data on the associated risk factors and its pattern on imaging. The aim of this study was to assess Computed Tomography patterns and the risk factors of hepatocellular carcinoma.METHODS: A cross-sectional, prospective study on patients with a diagnosis of HCC on Computed Tomography examination, at Tikur Anbessa Specialized Hospital from July, 2016 to July, 2017. All patients who had characteristic Computed Tomography features and those who were diagnosed by Fine needle aspiration cytology (FNAC)/biopsy and had Computed Tomography examination were included in the study. Risk factors identified were reviewed from patients’ medical records.RESULT: A total of 70(n=70) patients were included in the study. The mean age was 50 ± 16 years. Fifty-seven (81.4%) of the participants were males, and 13(18.6%) were females. Forty-five (64.3%) of them came from urban areas and 25(35.7%) of them were from rural areas. The lesions were focal in 52(74.3%) and infiltrative in 18(25.7%) of the cases. Vascular invasion and distant metastases were seen in 49(70%) and 17(24.3%) respectively. Twenty-nine (41%) had negative hepatitis markers, and 13(19%) were not investigated for hepatitis infection.CONCLUSION: The majority of the patients presented with advanced disease such as vascular invasion and metastases. The major risk factors such as hepatitis infection were negative in significant number of patients. The risk factors in our setting should be studied further. Moreover, high-risk group selection and screening is essential to diagnose HCC early

Mature teratoma with aspergilloma

Mediastinal mature teratomas are benign germ cell tumors which rarely involve the lung, but when they involve the lung they can cavitate. Aspergilloma developing in a mature teratoma is extremely rare, and according to our English literature search, there is only one previously reported case. We report a 21-year-old female who presented with cough and foul-smelling sputum. investigations revealed an intrathoracic mass, which intraoperatively and upon subsequent histological exam was found to be a mature mediastinal teratoma involving the lung and associated with an aspergilloma. Reporting our case will add to the understanding of this rare presentation of mediastinal mature teratomas. Keywords: mature teratoma; aspergilloma; surgical treatment

The journey of Radiology in Ethiopia

The practice of radiology began after the invention of X-rays in 1895 which then spread to different parts of the world. There is no documentation on how and when the x-ray was introduced to the Ethiopian medical practice. However, radiology as a profession was in place for the last four decades. Similar with the experience in other countries, the history of progress in the field of radiology in the Ethiopian setup is related directly to technological advances that occurred during the past few decades.Radiography was the main modality used in the first two decades. In the early years of the initiation of radiology training,  only radiographs and ultrasounds were available for training and service. In the subsequent years, modern cross-sectional imaging equipment was introduced. This was mainly accomplished with the involvement of the private institutions which played a significant role. So far, there are more than 300 practicing radiologists as diagnosticians. Recently, also radiologic interventions were also introduced with the commencement of subspecialty training

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Skin Entrance dose to patients from routine P-A chest X-ray examination, Radiology Department, Tikur Anbessa Referral Hospital

Background: Radiation of any amount is potentially hazardous and it should be minimized as much as possible during health care delivery. Objective: To determine and assess the variation of the dose received by patients undergoing chest x-ray examination, and to provide a useful baseline data to evaluate the dose to the general public from CXR. Methods: Radiation doses received by 100 adults patients undergoing postero-anterior/P-A/ chest x-ray examination have been measured using thermoluminescent dosimeter / TLD/. Result: The average skin entrance dose was 1.24 mGy , ranging from 0.68 to 1.98 milligray /mGy/. TheBody mass Index / BMI/ for 98% of the patients was below 85th prcentile excluding obesity as a factor for the high entrance dose observed. Conclusion: The dose received from P-A chest x-ray obtained in this study is significantly high. A further detail study covering the whole country, both private and governmental institution, to assess the practice and come up with lasting solution is highly recommended. (Ethiopian Journal of Health Development, 2001, 15(2): 145-151

Stakeholders Analysis of Ethiopian Telemedicine Projects, the case of Black Lion Hospital, Addis Ababa, Ethiopia

The deployment of core health care service delivery applications such as Telemedicine presents various challenges in low income countries. The challenges range from technical problems to complex politico-economic, managerial, and behavioral issues. We conducted a case study (Yin, 2009) to understand the impact of various stakeholders on the current telemedicine projects at the Black Lion Teaching Hospital, Addis Ababa, Ethiopia. Preliminary findings reveal an absence of mechanisms for balancing varying interests of multiple stakeholders involved in the Telemedicine projects. The study has both practical and theoretical contributions. First, the study revealed practical implications for Telemedicine projects in the study area, and may be extended to other low income countries in Africa and elsewhere. Second, use of stakeholders’ theory was found to offer a robust and sound analysis and explanatory lens for explaining the varying interests among stakeholder groups and the effect of these phenomena on telemedicine use

In search of Insights for Institutionalization of Telemedicine in the Health Care System in Ethiopia

Accessibility and health service coverage problems impact many low income countries. Telemedicine is one of the technologies that can play a significant role in reducing these healthcare related issues. The study is primarily aimed at exploring how institutionalization of a system occurs and its impact on system use. This study is informed by theories on institution and institutional work to develop a conceptual schema for institutionalization of Telemedicine systems. Using a case study methodology we explore the use of telemedicine at the Black Lion Hospital in Addis Ababa, Ethiopia. The study reveals absence of organizing vision for telemedicine projects and limited role of actors to alter the institutional context in order to institutionalize telemedicine systems. When validated with further studies the conceptual schema used in this study would have great theoretical contribution. The link observed between institutionalization and Telemedicine system use will have practical relevance for similar projects

Implementing the WHO integrated tool to assess quality of care for mothers, newborns and children: results and lessons learnt from five districts in Malawi.

In 2014 the World Health Organization (WHO) developed a new tool to be used to assess the quality of care for mothers, newborns and children provided at healthcare facility level. This paper reports on the feasibility of using the tool, its limitations and strengths. Across 5 districts in Malawi, 35 healthcare facilities were assessed. The WHO tool includes checklists, interviews and observation of case management by which care is assessed against agreed standards using a Likert scale (1 lowest: not meeting standard, 5 highest: compliant with standard). Descriptive statistics were used to provide summary scores for each standard. A 'dashboard' system was developed to display the results. For maternal care three areas met standards; 1) supportive care for admitted patients (71% of healthcare facilities scored 4 or 5); 2) prevention and management of infections during pregnancy (71% scored 4 or 5); and 3) management of unsatisfactory progress of labour (84% scored 4 or 5). Availability of essential equipment and supplies was noted to be a critical barrier to achieving satisfactory standards of paediatric care (mean score; standard deviation: 2.9; SD 0.95) and child care (2.7; SD 1.1). Infection control is inadequate across all districts for maternal, newborn and paediatric care. Quality of care varies across districts with a mean (SD) score for all standards combined of 3 (SD 0.19) for the worst performing district and 4 (SD 0.27) for the best. The best performing district has an average score of 4 (SD 0.27). Hospitals had good scores for overall infrastructure, essential drugs, organisation of care and management of preterm labour. However, health centres were better at case management of HIV/AIDS patients and follow-up of sick children. There is a need to develop an expanded framework of standards which is inclusive of all areas of care. In addition, it is important to ensure structure, process and outcomes of health care are reflected