Patterns of Surgically Treated Thyroid Disease: A Two Years Review at St. Paul Hospital Millennium medical Collage, Addis Ababa, Ethiopia

BACKGROUND: Thyroid disease is a common disorder of the endocrine system worldwide. It is a common problem in developing countries, including Ethiopia. The aim of this study was to determine the burden and the pattern of thyroid disease in St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.METHODS: A retrospective review of patients’ medical records over a two-year period, January 2013-december 2014, was done. OR log books, and individual patient medical records was used for the review. Data was analyzed with SPSS version 20.RESULTS: A total of 2201 general surgical operations were done in a two-year period. Of these, 250(11%) were for thyroid surgery. Records of 222(88.8%) patients were found and used for analysis. Females accounted for 91.4% with F: M ratio of 10.7:1. The common mode of presentations were anterior neck swelling (91.4%) and toxic (29.7%) and pressure symptoms(19.4%). The common physical findings identified were multi nodular goiter (57.2%), diffuse goiter (23.9%) and solitary nodule (5.8%). FNAC showed that Nodular colloid goiter was common diagnosis (68.5%). Neoplasms accounted for 15.9% of the diagnosis; of this follicular neoplasm make (54%) and papillary cancer (20%). Functionally, hyperthyroid goiter 28.8% and euthyroid goiters (64 %). Transient hypocalcaemia (3.2%) and hoarseness of voice (1.8%) were the commonest complications. There was no postoperative mortality.CONCLUSION: Hyperthyroidism and neoplasms make significant proportions of the patients. Follicular neoplasm is the commonest tumor. Morbidity and mortality rates are comparable to the literature.

Giant Mesenteric Lipoma Causing Small Bowel Volvulus: A Case Report

BACKGROUND: A lipoma of the small bowel mesentery is a rare clinical entity. It rarely causes intestinal obstruction mainly due to volvulus.CASE: We report a case of a 25 years old male who presented with acute exacerbation of abdominal pain, nausea and vomiting. Plain abdominal x-ray showed complete small bowel obstruction. At laparotomy, there was small bowel volvulus with a big yellow mass as an axis. Enbloc resection and end-to-end ileal anastomosis was done.CONCLUSION; Mesenteric lipoma are rare. They should be considered in cases of long standing abdominal pain.

Magnitude and Pattern of Inpatient Surgical Mortality in a Tertiary Hospital in Addis Ababa, Ethiopia

BACKGROUND: Inpatient mortality is among regularly collected data in Key performance indicators in the Ethiopian healthcare system, and it is generally reported to the Federal Ministry of Health and is used as one of inpatient services quality indicators. This study was undertaken to identify the magnitude, causes and pattern of mortalities among patients who are admitted and treated in surgical wards in Saint Paul Hospital Millennium Medical College for a period of three years.METHODS: A retrospective review was done on all patients admitted and died in the Department of Surgery in St. Paul's Hospital Millennium Medical College from January 1, 2016–Dec 30, 2018.RESULT: There were 10,259 admissions over three years and out of which there were 350 deaths between 2016-2018 making a crudemortality rate of 3.41 %. The commonest mode of admission was for emergency conditions, 195(62.7%). Out of emergency admissions, 139 mortalities were from general emergency surgery and 75 patients died from elective general surgery admissions. Eighty-four (26.9%) patients had comorbidity and the commonest comorbidity was anemia 21(25%). The commonest possible cause of death was multi-organ failure secondary to septic shock, 159(51%). Mortality rate patterns along the three years (2016, 2017, 2018) showed 3.34% (112/3360), 2.87% (102/3552) and 2.92% (98/3347) respectively.CONCLUSION: The mortality rate of this study is much higher than global rates, but still there is a significant difference from other developing countries and also other researches in this country. Pattern of mortality did not show any difference across years of the study period

Quality of Life in Patients Living with Stoma

BACKGROUND፡ Background and Objective: Quality of life of patients can be affected a treatment. A good quality of life is essential to achieve a goal in treating patients. This study aims to assess stoma related quality of life.METHODS: A cross-sectional study was done at St. Paul’s Hospital millennium Medical College from February 1 to July 31, 2019. A structured questionnaire was used to interview patients and review charts of patients to retrieve information on sociodemographic variables, type, and indications of the stoma. Data was collected using structured questionnaire adopted from the City of Hope and Beckman Research Institute after modifications to make it in line with the Ethiopian context.RESULTS: The mean score for the overall quality of life for stomata was 7.42 ± 0.53. Around 70% of patients have adjusted their dietary style due to stoma. More than half of them reported feelings of depression following stoma surgery. Only 34% of patients resumed sexual activity and only 11% were satisfied with it. None of them were enrolled in stoma association or support group. Factors such as type of ostomy (temporary/permanent), adjustment in dietary style due to stoma, depression, change in diet for not passing gas in public, and change in clothing style had significant effects on overall quality of life and its subscales (P < 0.05).CONCLUSIONS: This study demonstrated that living with stoma has a greater impact on the overall aspect of quality of life