Surgical Outcome of Chronic Pulmonary Aspergilloma: An Experience from Two Tertiary Referral Hospitals in Addis Ababa, Ethiopia

Background: Surgical management of pulmonary aspergillosis is challenging and controversial. This study is designed to assess the clinical profile, indications and surgical outcome of Pulmonary aspergilloma.Methods: A retrospective cross-sectional analysis of 72 patients who underwent pulmonary resection for pulmonary aspergilloma over the period from November, 2014, to November, 2019 was done. Data on demographic, clinical and surgical out come were retrieved. Analysis was done using SPSS version 23. Chi-square test was used to assess for significance of the association between variables and surgical outcome.Results: There were 46(63.9%) males and 26(36.1%) female patients with a mean age of 35.2+/-11.6 years (Range 16– 65 years). All patients were previously treated for tuberculosis. Cough, hemoptysis, and shortness of breath were the main symptoms identified. A ball of fungus together with the surrounding lung was removed. Accordingly, 32(44,4%) lobectomies, 12(16.7%) pneumonectomy, 7(9.7%) Bi-lobectomy,and 21(29.2%) cavernostomy were done. Intraoperative and Postoperative complications were seen in 8(11.1%) and 21(29.1%) patients respectively. Major morbidity encounters included massive intraoperative blood loss, prolonged air leak, empyema, air space, bronchopleural fistula, and wound infection. The hospital mortality was 3(4.2%) and the average hospital stay was 14.8days. Postoperative complications were evaluated for the difference in socio-demographic characteristics and other variables and a statistically significant difference was detected only for the location of aspergilloma, site of the lung involved and type of surgery done. (P-value <0.05.)Conclusion: Pulmonary resection done for pulmonary aspergilloma showed favorable outcomes when done with good patient selection, meticulous surgical techniques, and good postoperative management. However, its long term outcome and role of antifungal treatment as adjunctive therapy for surgical resection need further investigation.&nbsp

Motivation and Factors Affecting It among Health Professionals in the Public Hospitals, Central Ethiopia

BACKGROUND: Motivation is an individual’s degree of willingness to exert and maintain an effort towards organizational goals. This study assessed motivational status and factors affecting it among health professionals in public hospitals of West Shoa Zone, Oromia Region.METHOD: Facility based cross-sectional survey was employed. All health professionals who served at least for 6 months in Ambo, Gedo and Gindeberet hospitals were included. Self-administered Likert scale type questionnaire was used. Data were analyzed using SPSS version 20. Mean motivation calculated as percentage of maximum scale score was used. Bivariate and multiple linear regression analyses were done to see the independent effects of explanatory variables.RESULTS: The overall motivation level of health professionals was 63.63%. Motivation level of health professionals varied among the hospitals. Gindeberet Hospital had lower motivation score as compared to Ambo Hospital (B = -0.54 and 95% CI; -0.08,-0.27). The mean motivation score of health professionals who got monthly financial benefit was significantly higher than those who did not (B = 0.71 and 95% CI; 0.32, 1.10). Environmental factors had higher impact on doctors’ motivation compared to nurses’ (B = 0.51 and 95% CI; 0.10, 0.92). Supervisor-related factors highly varied in motivation relative to other variables.CONCLUSIONS: Motivation of health professionals was affected by factors related to supervisor, financial benefits, job content and hospital location. Efforts should be made to provide financial benefits to health professionals as appropriate especially, to those who did not get any such benefits. Officially recognizing best performance is also suggested.KEYWORDS: Motivation, Health Professionals, West Shoa, Hospital, Oromia, Ethiopi

Gossypiboma: A Case Series and Literature Review

BACKGROUND: Gossypiboma (retained surgical sponge) is a rare medical event. It could cause a serious complication that can threaten patients’ life. Its diagnosis is usually difficult because the clinical symptoms are nonspecific and the imaging findings are often inconclusive.CASE PRESENTATIONS: We present two cases, a 32 years old woman who passed a retained surgical sponge via rectum 5 months after cesarean section and a 30 years old lady presented with an acute abdomen that later found to have localized right lower quadrant abscess with a retained surgical sponge.CONCLUSION: The most important approach to reduce the incidence of gossypiboma is prevention. At the end of the surgery, a correct count is always the gold standard safeguard against it. Although errors are not to be completely avoided, continuous CPD and strict adherence to rules of the operating room will reduce its incidence to a minimum

Rural-urban linkage in market oriented dairy development in Ethiopia: lessons from the Ada'a District

Addis Ababa, with an estimated human population of over 3 million, has a high demand for cereals, pulses, fresh vegetables, fruits, milk and milk products and meat and eggs. The Ada’a Woreda is one of the important areas that supply the well known ‘maja’ teff, chickpeas, fresh vegetables, eggs and chicken, meat and milk. The Woreda capital, Debre Zeit town, is only 45 km southeast of Addis Ababa and has a very good road and railway connection. The Ada’a Dairy Cooperative was established in 1998 in Debre Zeit based on its comparative market advantage, the conducive agro-ecological conditions for dairy production and the available support services. The cooperative was established with 34 members and an initial capital of 3,400 Birr. The main objectives are to minimize transaction costs, reduce price fluctuations over seasons, increase production efficiency, improve incomes and create job opportunities. Milk collection and marketing started in January 2000, with a daily total of 308 liters. The association has made significant progress so far and currently has over 850 members (about 50% female) who individually own over 3000 dairy cows. The current capital of the association has increased to USD 138,029. The number of milk collection sites has increased to 10 and job opportunity has been created for 62 staff. Daily milk collection has increased to over 8,000 liters and is mainly sold to the Dairy Development Enterprise (DDE) in Addis Ababa. The cooperative has established a small processing unit for the production of butter, yoghurt and cottage cheese during periods of excess supply. Members use mainly crossbred animals and the management level is relatively intensive with limited land area. Most animals are stall fed. The cooperative supplies inputs such as grass hay, concentrate feeds, veterinary drugs and services, and artificial insemination service to members at reasonable prices. Rural dairy farmers are joining the cooperative, taking advantage of market access for their milk. Inputs required in dairy production include feeds and water, labour, veterinary drugs and services, artificial insemination and equipment and utensils. The largest input in terms of volume and financial requirements is feed. These involve roughages and concentrate feeds. The main rural areas that provide roughage feeds (grass hay and crop residues) include Selale, Ada’a and adjacent Woredas, and Arsi. Concentrate feeds such as bran, middlings, oil seed cakes, molasses are supplied by ago-industries around Addis Ababa, Debre Zeit and Nazareth, but the row materials come from various parts of the country. Molasses is supplied from Wonji and Shoa Sugar Estates. Another major input is water which is used for animal consumption, washing and cleaning purposes. Most dairy farmers use expensive municipal water supply. Most of the milk collected is supplied to DDE. Pasteurized and processed products are mainly sold in Addis. Some fresh milk is also sold directly to hotels and restaurants in Addis Ababa, Debre Zeit, Dukem and Nazareth towns. In addition, milk collected from Ada’a by the Sebeta agro-industry is processed and supplied to urban centres as far as Bahir Dar. Manure produced from dairy farms is also supplied to a limited extent to rural areas, particularly to horticultural crops producing farms. A strong and organized rural-urban linkage is evolving informally at the moment and this should be recognized and strengthened to benefit both rural and urban dwellers in taking advantage of the value chain. Although urban and peri-urban dairy production system plays important role in the national economy, the system has been marginalized and there is limited research and institutional support addressing this issue. This paper presents the activities and achievements of the Ada’a dairy cooperative and also highlights the rural and urban linkages through the value chain of milk production, processing and marketing

Missed appointments among rifampicin-resistant tuberculosis (RR-TB) patients at a decentralised RRTB outpatient clinic in Johannesburg, South Africa

Background. With the implementation of outpatient (ambulatory) decentralised rifampicin-resistant tuberculosis (RR-TB) treatment in South Africa (SA) since late 2011, the high rates of loss from treatment are a significant concern. Missed appointments lead to treatment interruptions and may contribute to amplification of resistance, ongoing transmission of RR-TB and an increased risk of morbidity and mortality to the patient.Objective. To describe characteristics of patients who missed scheduled appointments during ambulatory RR-TB treatment.Methods. The study was a retrospective, deidentified electronic medical record review of RR-TB patients at an outpatient clinic in Johannesburg, SA, from March 2013 to December 2014. Associations between missed appointments and clinical and demographic characteristics were analysed using time-to-event Cox proportional hazards regression.Results. Of 172 patients who met the eligibility criteria, 53.5% missed at least one appointment and 39.5% missed three or more. More than half (59.8%) of first missed appointments occurred within the first 3 months after treatment initiation. The median number of days from initiation until the first missed appointment was 82 (interquartile range 52 - 260.5). HIV-infected patients with a CD4 count of ≤100 cells/ μL (adjusted hazard ratio (aHR) 4.25, 95% confidence interval (CI) 1.49 - 12.18), patients referred from an inpatient facility (aHR 1.96, 95% CI 1.18 - 3.25) and patients aged 18 - 24 years as opposed to those aged 35 - 44 years (aHR 3.26, 95% CI 1.20 - 8.84) were all more likely to miss one or more appointments.Conclusion. HIV-infected patients with a low CD4 count, patients referred from inpatient care and young patients are at high risk of missing appointments and should receive interventions targeted at improving retention

Determinants of technical efficiency among smallholder dairy farmers in Tanzania

Irish Ai

A call to action: Addressing the reproductive health needs of women with drug-resistant tuberculosis

Although there is substantial risk to maternal and neonatal health in the situation of pregnancy during treatment for rifampicin-resistant tuberculosis (RR-TB), there is little evidence to guide clinicians as to how to manage this complexity. Of the 49 680 patients initiated on RR-TB treatment from 2009 to 2014 in South Africa, 47% were women and 80% of them were in their reproductive years (15 - 44). There is an urgent need for increased evidence of the safety of RR-TB treatment during pregnancy, increased access to contraception during RR-TB treatment, and inclusion of reproductive health in research on the prevention and treatment of TB

Magnetic field reversals in an experimental turbulent dynamo

We report the first experimental observation of reversals of a dynamo field generated in a laboratory experiment based on a turbulent flow of liquid sodium. The magnetic field randomly switches between two symmetric solutions B and -B. We observe a hierarchy of time scales similar to the Earth's magnetic field: the duration of the steady phases is widely distributed, but is always much longer than the time needed to switch polarity. In addition to reversals we report excursions. Both coincide with minima of the mechanical power driving the flow. Small changes in the flow driving parameters also reveal a large variety of dynamo regimes.Comment: 5 pages, 4 figure