A case of osteosarcoma presenting primarily as breast mass

Osteosarcoma presenting as a breast mass is a rare disease. We present a case of a 22 year old female who was admitted to our hospital with a complaint of left sided breast mass of 6months duration. On physical examination she had a huge mass on the left breast with no skin lesion and no lymph nodes. Pathology from biopsy showed osteosarcoma. Here we report the findings in detail along with current review of literature. Keywords: Osteosarcoma, Breas

Influencing preventive behavior with regard to HIV/AIDS among the Police Force of Harari Region, Eastern Ethiopia, 2011

Background: HIV/AIDS has emerged as one of the serious public health challenges in Ethiopia. This disease has individual and institutional impacts, making difficult for the police services to act effectively in protecting the public from crime.Objective: To assess factors that influence HIV/AIDS prevention among police personnel in Harari Region, Ethiopia, 2010.Methodology: A cross-sectional study was conducted in January 2010 involving 310 out of the 790 police personnel found in the Region. A simple random sampling technique was used to select study participants by using their identification numbers as sampling frame from registration books of the Personnel Department of the Regional Police Commission. Both bivariate and multivariate analyses were used to identify  determinants of sexual behavior.Results: Attitudes and perceptions of study participants showed significant association with their sexual behavior. Fifty two percent of the respondents were engaged in risky sexual practices and believed that they are susceptible to HIV infection. Twenty-nine percent had multiple sexual partners of which 60% did not use condom consistently. Overall, the study participants were of young age group and have habits of consuming alcohol. Almost all have access to VCT services and opportunities for peer education.Conclusion: The study participants were at risk of HIV because of their sexual behavior and misconceptions related to the risk factors and means of prevention. Hence, basic police training should include BCC on HIV/AIDS, expansion of HIV counseling and testing services, strengthening of peer education and establishing anti-AIDS clubs.[Ethiop. J.Health Dev. 2012;26(1):3-8

Pattern of Injury and Associated Variables as Seen in the Emergency Department at Tikur Anbessa Specialized Referral Hospital, Addis Ababa, Ethiopia

Background: Traumatic injuries represent a significant and growing disease burden in the developing world, and now represent one of the leading causes of death in economically active adults in many low- and middle-income countries. This study was aimed at determining the patternof injuries and variables associated among patients visiting Emergency Department (ED) due to injury at Black Lion Hospital, Addis Ababa, Ethiopia.Methods: This was a prospective cross sectional hospital based study done with a systematic random sampling method. The study was done in Tikur Anbessa specialized referral hospital. The study was conducted in between February 1 to April 30, 2013. Results: A total of 3287 new patients were seen in the ED, of whom 989 (32.5%) reported to be injury victims, of them 321 patients were included in the study. The M: F ratio is3.58:1.  More than 41% of patients were aged between 20 and 29.The most  frequent cause of injury was Road Traffic Accident (RTAs), 123(38.3%), followed by stuck/hit by a person or object, 101(31.5%), and fall accident 68(21.2%).Further analysis showed that the odds of injury of assault to be increased for males (P= 0.037, AOR, 2.528, 95%CI (1.058-6.037),  patients with monthly income < 650 Ethiopian birr{(P= 0.002, AOR 2.91, 95% CI (1.493-5.705)},and age< 40 years old is significantly associated with injury of assault {(P= 0.004, AOR 3.27, 95%CI(1.451-7.375)}. Injury of assault is 61% less likely to be occurred in rural areas than the urban dwellers {(P= 0.002, AOR 0.39%CI (.219-.707)}.Conclusion: Appropriate interventions to reduce the occurrences of injuries should be instituted by the local authorities and other responsible body. There is also a need to educate the community members particularly risk groups on how to prevent injuries. Key Words: Injury, Variables associated with injury, Emergency departmen

Trauma in Ethiopia Revisited: A systematic Review

Background: This is a systematic review on trauma/injury incidents which has tried to examine the variety of socio-demographic, vehicular,  environmental, and behavioral factors that are associated with injury and its outcome across different settings.Data Sources: Electronic searches for trauma/injuries from peer-reviewed literature and websites from 1960 to August 2013.Study Selection: 36 studies met the study inclusion criteria.Data Extraction: A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables.Results: A higher proportion of injury was found in economically active age groups of 15-59 years (Range 56.4 %–80%) across all studies. Similarly majority of the articles reported a higher proportion (Mostly 2/3rd) of injuries among male than female patients (range 53.9 %-91.2 %). Eventhough in all studies injuries were a concern for every population, some studies [12, 13, 15, and, 29] showed a higher incidence among farmers, students and house wife that other occupation. Unintentional injuries were the primary cause for the majority of injury-related reports made withthe weighted pool average percentage of 60.7% (range from 44.6 %11 to 98%20). MVIs were the leading cause of injury among lists of unintentional injuries followed by Falls (16%) machine/tools injury (5.9%), burn (5.3%), poisoning (1.0%) and Animal bite (1.3%). Trauma from interpersonalviolence (Homicide) is the leading causes of intentional injury (24.4%) reported followed by disproportionately low incidence of Fire arm(5%) and Self-harm injuries( 2.1%). Nine of the 36 articles reported percentage distribution of Mortality by Mechanism of injury and the rates of deathfrom MVIs and homicide are generally higher with an average weighted pool percentage of 37.5% and 24.1% respectively.Conclusion: The review showed injury as a significant cause of morbidity and mortality in Ethiopia. Based on the available data, possible strategies relating to trauma prevention are discussed. Because of the uncertainties about the quality and the absence of some data in certain region of Ethiopia, we recommend a need to more accurately define this burden at a national scale.Key words: Trauma, Injury, Accident, Ethiopi

The Gap between Surgical Resident and Faculty Surgeons Concerning Operating Theatre Teaching: Report from Addis Ababa, Ethiopia

Background: In a continent like Africa where the number of surgeons is alarmingly few, training of a large number of residents is the way forward. However, sudden expansion in the number of trainees in an existing teaching environment may bring the quality of the most fundamentaleducation i.e. operation room teaching into question.Method: We wanted to investigate the different perceptions of our surgeons-under-training and faculty concerning preoperative preparation, intra operative teaching and postoperative feedback. A validated questionnaire was administered to our surgical residents and faculty at the Addis Ababa University, School of Medicine, Department of Surgery. Results were analyzed with 2-sample t tests, comparing Likert scores. Findings were significant if the p value was < 0.05.Results: Forty residents (15 second year, 15 third years and 10 final years) and 30 faculty members completed the survey. With respect to preoperative preparation, faculty were significantly more likely to claim that residents’ preparation in terms of reading is low (3.77 vs 2.45; p=0.001) and anatomy review (3.73 vs 2.34; p=0.001) before the procedure. There was a very significant difference with regards to intra-operative teaching activities, i.e teaching of the operative steps (2.60 vs 3.79; p=0.048), instrument handling (2.30 vs 3.72; p=0.002), and surgical technique (2.23vs 3.83; p= 0.001). Residents’ perception of the effort of the faculty to act as a teacher in the operating room was significantly lower compared to the faculty (2.13 vs 3.94; p=0.002). Postoperatively, significant differences were found in perceptions of positive feedback (2.48 vs 3.86; p=0.01) and feedback on areas to improve (1.85 vs 3.34; p=0.001).Conclusion: There is a universal agreement on the need to improve the current residency training. However, the difference between resident and faculty in the teaching-learning process is alarmingly significant. As there is no substitute for the intra-operative training of residents, every effort must be made to not to trade off number of graduates with quality and  competence of surgeons-under-training.  Keywords: Resident, Surgeons, Operating, Theatre, Teachin

Does export dependency hurt economic development? Empirical evidence from Singapore

A rapid export growth in East Asia was once identified as a source of the sustainable economic development that the region enjoyed. However, the current global recession has turned exports from an economic virtue to a vice. There is a growing awareness that a heavy reliance on exports has caused a serious economic downturn in the region. The present paper chooses Singapore as a case study to examine the relationship between the origin of the East Asian Miracle (i.e. export dependency) and the economic growth. For this purpose, the study employs a causality test developed by Toda and Yamamoto. The empirical findings indicate that despite a negative long-run relationship between export dependency and economic growth, Singapore's heavy reliance on exports does not seem to have produced negative effects on the nation's economic growth. This is because the increase in export dependency was an effect, and not a cause, of the country's output expansion.

Longer delays in diagnosis and treatment ofpulmonary tuberculosis in pastoralist setting, Eastern Ethiopia

Purpose: This study aimed to assess the extent of patient, health system and total delays in diagnosis and treatment of pulmonary tuberculosis (TB) in Somali pastoralist setting, Ethiopia. Patients and Methods: A cross-sectional study among 444 confirmed new pulmonary TB patients aged ≥15 years in 5 TB care units was conducted between December 2017 and October 2018. Data were collected using a structured questionnaire and record review. We measured delays from symptom onset to provider visit, provider visit to diagnosis and diagnosis to treatment initiation. Delays were summarized using median days. Mann- Whitney and Kruskal-Wallis tests were used to compare delays between categories of explanatory variables. The Log-binomial regression model was used to reveal factors associated with health system delay ≥15 days, presented in adjusted prevalence ratio (APR) with 95% confidence interval (CI). Results: The median age of patients was 30 years, ranged from 15 to 82. The majority (62.4%) were male, and nearly half (46.4%) were pastoralists. The median patient, health system and total delays were 30 (19-48.5), 14 (4.5-29.5) and 50 (35-73.5) days, respec-tively. The median patient delay (35.5 days) and total delay (58.5 days) among pastoralists were substantially higher than the equivalent delays among non-pastoralists [p<0.001]. Of all, 3.8% of patients (16 of 18 were pastoralists) delayed longer than 6 months without initiating treatment. Factors associated with health system delay ≥15 days were mild symptoms [APR (95% CI) = 1.4 (1.1-1.7)], smear-negativity [APR (95% CI) = 1.2 (1.01- 1.5)], first visit to health centers [APR (95% CI) = 1.6 (1.3-2.0)] and multiple provider contacts [APR (95% CI) = 5.8 (3.5-9.6)]. Conclusion: Delay in diagnosis and treatment remains a major challenge of tuberculosis control targets in pastoralist settings of Ethiopia. Efforts to expand services tailored to transhumance patterns and diagnostic capacity of primary healthcare units need to be prioritized. © 2020 Getnet et al.Purpose: This study aimed to assess the extent of patient, health system and total delays in diagnosis and treatment of pulmonary tuberculosis (TB) in Somali pastoralist setting, Ethiopia. Patients and Methods: A cross-sectional study among 444 confirmed new pulmonary TB patients aged ≥15 years in 5 TB care units was conducted between December 2017 and October 2018. Data were collected using a structured questionnaire and record review. We measured delays from symptom onset to provider visit, provider visit to diagnosis and diagnosis to treatment initiation. Delays were summarized using median days. Mann- Whitney and Kruskal-Wallis tests were used to compare delays between categories of explanatory variables. The Log-binomial regression model was used to reveal factors associated with health system delay ≥15 days, presented in adjusted prevalence ratio (APR) with 95% confidence interval (CI). Results: The median age of patients was 30 years, ranged from 15 to 82. The majority (62.4%) were male, and nearly half (46.4%) were pastoralists. The median patient, health system and total delays were 30 (19-48.5), 14 (4.5-29.5) and 50 (35-73.5) days, respec-tively. The median patient delay (35.5 days) and total delay (58.5 days) among pastoralists were substantially higher than the equivalent delays among non-pastoralists [p<0.001]. Of all, 3.8% of patients (16 of 18 were pastoralists) delayed longer than 6 months without initiating treatment. Factors associated with health system delay ≥15 days were mild symptoms [APR (95% CI) = 1.4 (1.1-1.7)], smear-negativity [APR (95% CI) = 1.2 (1.01- 1.5)], first visit to health centers [APR (95% CI) = 1.6 (1.3-2.0)] and multiple provider contacts [APR (95% CI) = 5.8 (3.5-9.6)]. Conclusion: Delay in diagnosis and treatment remains a major challenge of tuberculosis control targets in pastoralist settings of Ethiopia. Efforts to expand services tailored to transhumance patterns and diagnostic capacity of primary healthcare units need to be prioritized. © 2020 Getnet et al

High-cut harvesting of maize stover and genotype choice can provide improved feed for ruminants and stubble for conservation agriculture

In smallholder crop–livestock systems where maize (Zea mays L.) is a staple cereal, the stover is usually an important but low-quality ruminant feed. Maize stover has various competing uses, and optimal allocation of stover, particularly for forage and mulch, is essential for improving whole-farm productivity and sustainability. Knowledge that feed quality increases with height in maize stover provides opportunities. An experiment investigated the effects of a high cutting height of stover at grain harvest (cut at two internodes below the lowest ear) on the yields and feed quality of the upper and lower stover (stubble) fractions. Measurements were made on six maize genotypes at two sites during two cropping seasons in Ethiopia. The upper stover fraction (USF) on average comprised 674 g kg–1 of the entire stover and was also substantially higher (P <.001) than the lower stover fraction (LSF) in in vitro dry matter digestibility (527 vs. 450 g kg−1 dry matter [DM]) and total N concentrations (8.8 vs. 6.2 g kg−1 DM) and was lower in fiber. Stems (including leaf sheath and tassel), husks (including shank), and leaf blade comprised 484, 310, and 206 g kg−1 of the USF, respectively. Yields and feed quality of stover varied among genotypes and environments. Use of an USF can provide a feedstuff of increased nutritional quality for ruminants, but the efficacy of the LSF for mulch requires investigation. In conclusion, a simple management change to harvest maize stover at higher stubble height combined with use of appropriate genotypes can provide higher-quality feed while leaving stubble for conservation agriculture

Challenges in delivery of tuberculosis services in Ethiopian pastoralist settings: clues for reforming service models and organizational structures

BACKGROUND: The End-TB strategy aims to see a world free of tuberculosis (TB) by the coming decade through detecting and treating all cases irrespective of socioeconomic inequalities. However, case detections and treatment outcomes have not been as they should be in Somali pastoral settings of Ethiopia. Hence, this study aimed to explore the challenges that hinder the delivery and utilization of TB services in pastoral areas. METHODS: A qualitative study was conducted between December 2017 and October 2018 among pastoralist patients with delay of >/=2 months in seeking healthcare, healthcare providers and programme managers. Data were collected from different sources using 41 in-depth interviews, observations of facilities and a review meeting of providers from 50 health facilities. The data were transcribed, coded and analyzed to identify pre-defined and emerging sub-themes. ATLAS.ti version 7.0 was used for coding data, categorizing codes, and visualizing networks. RESULTS: Poor knowledge of TB and its services, limited accessibility (unreachability, unavailability and unacceptability), pastoralism, and initial healthcare-seeking at informal drug vendors that provide improper medications were the key barriers hindering the uptake of TB medical services. Inadequate infrastructure, shortage of trained and enthused providers, interruptions of drugs and laboratory supplies, scarce equipment, programme management gaps, lack of tailored approach, low private engagement, and cross-border movement were the major challenges affecting the provision of TB services for pastoral communities. The root factors were limited potential healthcare coverage, lack of zonal and district TB units, mobility and drought, strategy and funding gaps, and poor development infrastructure. CONCLUSION: In pastoral settings of Ethiopia, the major challenges of TB services are limited access, illicit medication practices, inadequate resources, structural deficits, and lack of tailored approaches. Hence, for the pastoral TB control to be successful, mobile screening and treatment modalities and engaging rural drug vendors will be instrumental in enhancing case findings and treatment compliance; whereas, service expansion and management decentralization will be essential to create responsive structures for overcoming challenges

Incremental impact upon malaria transmission of supplementing pyrethroid-impregnated long-lasting insecticidal nets with indoor residual spraying using pyrethroids or the organophosphate, pirimiphos methyl

Background Long-lasting, insecticidal nets (LLINs) and indoor residual spraying (IRS) are the most widely accepted and applied malaria vector control methods. However, evidence that incremental impact is achieved when they are combined remains limited and inconsistent. Methods Fourteen population clusters of approximately 1000 residents each in Zambia’s Luangwa and Nyimba districts, which had high pre-existing usage rates (81.7 %) of pyrethroid-impregnated LLINs were quasi-randomly assigned to receive IRS with either of two pyrethroids, namely deltamethrin [Wetable granules (WG)] and lambdacyhalothrin [capsule suspension (CS)], with an emulsifiable concentrate (EC) or CS formulation of the organophosphate pirimiphos methyl (PM), or with no supplementary vector control measure. Diagnostic positivity of patients tested for malaria by community health workers in these clusters was surveyed longitudinally over pre- and post-treatment periods spanning 29 months, over which the treatments were allocated and re-allocated in advance of three sequential rainy seasons. Results Supplementation of LLINs with PM CS offered the greatest initial level of protection against malaria in the first 3 months of application (incremental protective efficacy (IPE) [95 % confidence interval (CI)] = 0.63 [CI 0.57, 0.69], P < 0.001), followed by lambdacyhalothrin (IPE [95 % CI] = 0.31 [0.10, 0.47], P = 0.006) and PM EC (IPE, 0.23 [CI 0.15, 0.31], P < 0.001) and then by deltamethrin (IPE [95 % CI] = 0.19 [−0.01, 0.35], P = 0.064). Neither pyrethroid formulation provided protection beyond 3 months after spraying, but the protection provided by both PM formulations persisted undiminished for longer periods: 6 months for CS and 12 months for EC. The CS formulation of PM provided greater protection than the combined pyrethroid IRS formulations throughout its effective life IPE [95 % CI] = 0.79 [0.75, 0.83] over 6 months. The EC formulation of PM provided incremental protection for the first 3 months (IPE [95 % CI] = 0.23 [0.15, 0.31]) that was approximately equivalent to the two pyrethroid formulations (lambdacyhalothrin, IPE [95 % CI] = 0.31 [0.10, 0.47] and deltamethrin, IPE [95 % CI] = 0.19 [−0.01, 0.35]) but the additional protection provided by the former, apparently lasted an entire year. Conclusion Where universal coverage targets for LLIN utilization has been achieved, supplementing LLINs with IRS using pyrethroids may reduce malaria transmission below levels achieved by LLIN use alone, even in settings where pyrethroid resistance occurs in the vector population. However, far greater reduction of transmission can be achieved under such conditions by supplementing LLINs with IRS using non-pyrethroid insecticide classes, such as organophosphates, so this is a viable approach to mitigating and managing pyrethroid resistance