Explore the vast range of titles available.

Cancer, the most stressful event a person may experience often triggers depression. Depression among these groups of people, in turn, affects chemotherapy adherence, length of hospitalization, quality of life and cancer treatment outcome. Even though the problem is enormous studies that address it are limited. Therefore this study was conducted to determine the prevalence of depression and associated factors among cancer patients on chemotherapy in Felege-Hiwot referral hospital and University of Gondar referral hospital, Northwest Ethiopia. An institution-based cross-sectional study was conducted from April to May 2019. A total of 302 cancer patients on chemotherapy were included. Depression was assessed using the patient health questionnaire (PHQ-9). Binary logistic regression was used to select variables and determine Crude Odds Ratio (COR). Variables with P value < 0.2 were entered into multivariable logistic regression. Adjusted Odds Ratio (AOR) with 95% confidence intervals for variables with P-value < 0.05 was estimated to show factors affecting depression among cancer patients. The fitness of the model was checked by using the Hosmer-Lemeshow goodness-of-fit test. The prevalence of depression among cancer patients on chemotherapy was 70.86% (95% CI: 65.38, 75.92). Educational status of college and above (AOR = 0.1, 95% CI: 0.02, 0.43), Jobless (AOR = 0.15, 95% CI: 0.04, 0.58), Underweight(AOR = 2.39, 95% CI: 1.10, 5.19)chemotherapy duration [greater than or equal to] 6 months or more (AOR = 2.36, 95% CI: 1.16, 4.79) were notably associated with depression. The burden of depression among cancer patients in this study was high. We recommend concerned bodies working to curve the problem to intervene based on the identified risk factors. Improving educational status, reducing work stress and maintaining normal weight would reduce depression.

Background Post-stroke delirium, a frequent and significant complication of stroke, manifests as a sudden onset of confusion, altered consciousness, and cognitive decline. Various factors contribute to its occurrence, including old age, multiple comorbidity, electrolyte abnormalities, and infections. The impact of post-stroke delirium on stroke recovery is substantial. It leads to prolonged hospital stays, heightened risk of institutionalization, increased dependence, and elevated mortality rates. As a result, early identification and prompt treatment of post-stroke delirium are imperative for optimizing outcomes in stroke patients. Objective The objective of this study is to determine the Prevalence of post-stroke delirium and associated risk factors in hospitalized patients at TASH, Y12HMC, and YSC, Addis Ababa, Ethiopia from August to December 2023. Method We performed a prospective observational study, including all the stroke patients admitted to the respective study areas during the study period from August to December 2023. Participants who fulfilled the inclusion criteria were involved in this study. Data was collected using an interviewer-administered Questionnaire with a well-tested and validated tool, Patients were assessed for Delirium within 48 h of admission and subsequently screened every 12 h. Descriptive statistics was used to summarize the data in terms of frequency, proportion, mean, and standard deviation. Bivariate and multivariate logistic regression analyses were carried out to identify associated factors. Statistical significance was considered when the p-value was below 0.05. Results Out of 101 patients 26(25.7%) had Post-Stroke Delirium. The majority 56 (55.4%) of the patients were females. The mean (SD) age of the study participants was 56.05 ± 15.38 years, and the mean time in days until the occurrence of delirium was 3 ± 1 days. Multivariable logistic regression analysis showed that, Age Greater than 60(AOR = 19.1, 95% CI (1.7–211) p  = 0.016, Presence of Sepsis (AOR = 8.3, 95% CI (1.2–56) P  = 0.029, Presence of Polypharmacy (AOR = 157, 95% CI (10.2–244) P  = 0.0001, Presence of Electrolyte Derangement (AOR = 65.2, 95% CI (3.4–124.1) P  = 0.005 were statistically significant risk factors. Conclusion Our Study showed that Post Stroke Delirium occurs in a quarter of patients admitted with a Diagnosis of Acute Stroke, and the Identified risk factors were Age greater than 60, Polypharmacy, Presence of Sepsis and Electrolyte Derangement. Medical professionals responsible for caring for acute stroke patients should be vigilant in identifying those at higher risk of developing post-stroke delirium. Additionally, they should focus on preventing and treating possible precipitating factors such as infections or electrolyte abnormalities. Incorporating delirium screening into routine patient assessments is crucial.

Limited diagnostic service availability challenges the timely diagnosis and treatment of tuberculous lymphadenitis, the most common extrapulmonary tuberculosis in endemic areas. To address this, our study aimed to develop a clinical scoring rule for estimating the likelihood of tuberculous lymphadenitis, designed as a simple and easy-to-apply classification tool to facilitate timely diagnosis. We used a cross-sectional study to collect data from 1364 patients with lymphadenopathy. A prediction model was developed by incorporating predictors from multivariable logistic regression analysis. Optimal cutoff point was determined using Youden’s Index. Performance was evaluated using discrimination and calibration. Internal validation and clinical utility were assessed using bootstrapping and decision curve analysis, respectively. A total of 790 patients (57.9%, 95% CI 55.3%–60.5%) were diagnosed with tuberculous lymphadenitis. Sex, duration, size, location, and consistency of lymphadenopathy, presence of pain, sinus tract, systemic symptoms, and erythrocyte sedimentation rate were predictors incorporated to develop the scoring rule. With a discrimination power of 96.9% (95% CI 96.1%, 97.8%), the clinical scoring rule using these predictors showed a sensitivity, specificity, and accuracy of 93.7%, 89.7%, and 92%, respectively. It demonstrated internal validity with near-zero optimism coefficients for various performance metrics. Using easily accessible clinical parameters, we developed a scoring rule that reliably predicts tuberculous lymphadenitis. Besides its use in clinical settings for making timely clinical decisions, the scoring rule is a valuable candidate for community-level screening, facilitating early case detection.

Background Lateral mass screw and rod fixation is widely used for posterior cervical arthrodesis and stabilization in cases of cervical instability, trauma, neoplasm, decompression, and deformity correction. However, clinical and radiological data on its outcomes, especially in our setting, remain limited. Objective Clinical and radiographic evaluation of posterior cervical arthrodesis and stabilization using lateral mass screws and rod fixation. Methods A retrospective cross-sectional study of lateral mass screw and rod fixation from September 2019 to September 2024 was performed, and the clinical and radiographic parameters were evaluated. Sixty-six patients were assessed via a structured questionnaire. Clinical parameters were assessed by the ASIA score, functional assessment in degenerative conditions (mJOA), and radiographic evaluation (computed tomography and dynamic X-ray) of 325 lateral mass screws inserted into the evaluated patients. Complications were assessed from a patient chart and radiology archive. Results Patients ranged from 16 to 75 years in age (40.1), and 84.9% of the patients were between the ages of 20 and 60. Trauma accounted for 92.4% of the indications, with fracture dislocations being C4/C5 (28.8%), C5/C6 (25.8%), C6/C7 (16%), and C4/5 (10.8%)—unilateral locked facets in 4.5% and floating lateral masses in 6% of patients. A total of 325 screws were placed, with C5 being the most common (110 screws). There was no postoperative change in the ASIA score. The complications included dural tear (3%), joint violation (1.9%), hardware failure (1 patient), and postoperative surgical site infection (6%). The postoperative follow-up ASIA score was significantly associated with the preoperative score, with a likelihood ratio and Fisher’s exact test P value < 0.001. The mean postoperative follow-up mJOA score was 13.3 ± 0.58, which was greater than the preoperative mean mJOA score, which was 8.67 ± 1.16. Conclusion Lateral mass screw and rod fixation is an effective method of cervical stabilization in our setting. Clinical trial number Not applicable.

Severe community-acquired pneumonia is a common life-threatening infection with a high rate of unfavorable outcome. This study aimed to assess the outcomes and predictors of hospitalized severe community-acquired pneumonia patients at University of Gondar comprehensive specialized hospital. A prospective follow-up study was conducted at University of Gondar comprehensive specialized hospital from May 1 to September 31, 2021. The data was collected by reviewing patients' charts and interviewing the patients themselves. Descriptive statistics, binary and multivariable logistic regression analysis were performed accordingly. Variables with -value <0.2 on binary logistic regression were analyzed using multivariable logistic regression and variables with <0.05 were considered to have significant association. A total of 239 admitted patients with severe community-acquired pneumonia were enrolled in the study. An unfavorable outcome was observed in 105 (44%) patients; 24.27% was in-hospital all-cause mortality, 12.5% was nonresolution, 5.8% was complicated cases, and 1.26% were gone against medical care for poor prognosis. After analyzing multivariable logistic regression, confusion (OR= 4.84; 95%CI: 1.47-15.88), anemia (OR= 2.36; 95%CI: 1.01-5.52), leukopenia (OR=4.38; 95%CI: 1.26-15.25), leukocytosis (OR=3.15; 95%CI: 1.23-7.96), elevated creatinine (OR=5.67; 95%CI: 1.72-18.65), intubation (OR=7.27; 95%CI: 1.58-33.37) and antibiotic revision during treatment for a different reason (OR=0.02; 95%CI: 0.01-0.07) were variables significantly associated with unfavorable outcome. Unfavorable outcome was high among hospitalized severe community acquired pneumonia patients, and confusion, elevated creatinine, anemia, leukopenia, leukocytosis, intubation during admission, and antibiotic revision during the course were independent predictors associated significantly with the unfavorable outcome. It is important to consider the development of a treatment protocol for the hospital and to further research incorporating the microbiologic profile of the patients.

Acquired hepatocerebral degeneration (AHD) is a neurologic syndrome caused by liver dysfunction and long-standing portosystemic shunting. The pathogenesis of the condition is predominantly considered to be related to the deposition of manganese in parts of the brain due to shunting. We report a case of a 25-year-old male who underwent splenectomy and splenorenal shunt for recurrent upper GI bleeding (UGIB) due to esophageal varices caused by non-cirrhotic portal hypertension (NCPH). He presented with bradykinesia, hypophonia, gait instability, and rigidity of the lower extremities 18 months after the procedure was done.

Headache disorders are the most common complaints worldwide. Migraine, tension-type and cluster headaches account for majority of primary headaches and impose a substantial burden on the individual, family or society at large. The burden is immense on workers, women and children in terms of missing work and school days. There are few studies that show relatively lower prevalence of primary headaches in Africa as compared to Europe and America. There might be many reasons for this lower prevalence. The objective of this study is to determine the prevalence and burden of primary headaches among the Akaki textile factory workers, which may provide data for the local and international level toward the campaign of lifting the burden of headache worldwide. The overall 1-year prevalence of all types of primary headaches was found to be 16.4%, and that of migraine was 6.2%. The prevalence of migraine in females was 10.1% while it was 3.7% in males. The prevalence of tension-type headaches was found to be 9.8%. This was 16.3 % in females as compared to 5.7% in males. The burden of the primary headaches in terms of lost workdays, gross under recognition and absence of effective treatment is tremendous. In conclusion, the prevalence of primary headaches in the Akaki textile mill workers is significant, particularly in females, and the burden is massive, in a place of poverty and ignorance. We recommend the availability and administration of specific therapy to the factory workers with primary headaches, and community based well-designed study for the whole nation’s rural and urban population.

Background Headache disorders are the most common complaints worldwide. Migraine, tension type and cluster headaches account for majority of primary headaches and improvise a substantial burden on the individual, family or society at large. There is a scanty data on the prevalence of primary headaches in sub-Saharan Africa in general and Ethiopia in particular. Moreover there is no population based urban study in Ethiopia. The purpose of this study is to determine the prevalence and burden of primary headaches in local community in Addis Ababa, Ethiopia. Methods Cross-sectional sample survey was carried out in Addis Ketema sub city, Kebele 16/17/18 (local smallest administrative unit). Using systematic random sampling, data were collected by previously used headache questionnaire, over a period of 20 days. Results The study subjects were 231 of which 51.5% were males and 48.5% were females. The overall one year prevalence of primary headache disorders was 21.6% and that for migraine was 10%, migraine without aura 6.5% migraine with aura was 2.6% and probable migraine was 0.9%. The prevalence of tension type of headache was found to be 10.4%, frequent episodic tension type headache was 8.2% followed by infrequent tension type headache of 2.2%. The prevalence of cluster headache was 1.3%. The burden of primary headache disorders in terms of missing working, school or social activities was 68.0%. This was 78.3% for migraineurs and 66.7% for tension type headache. Majority 92.0% of primary headache cases were not using health services and 66.0% did not use any drug or medications during the acute attacks and none were using preventive therapy. Conclusion Prevalence and burden of primary headache disorders was substantial in this community. Health service utilization of the community for headache treatment was poor.

Alternative treatments for visceral leishmaniasis (VL) are required in East Africa. Paromomycin sulphate (PM) has been shown to be efficacious for VL treatment in India. A multi-centre randomized-controlled trial (RCT) to compare efficacy and safety of PM (20 mg/kg/day for 21 days) and PM plus sodium stibogluconate (SSG) combination (PM, 15 mg/kg/day and SSG, 20 mg/kg/day for 17 days) with SSG (20 mg/kg/day for 30 days) for treatment of VL in East Africa. Patients aged 4-60 years with parasitologically confirmed VL were enrolled, excluding patients with contraindications. Primary and secondary efficacy outcomes were parasite clearance at 6-months follow-up and end of treatment, respectively. Safety was assessed mainly using adverse event (AE) data. The PM versus SSG comparison enrolled 205 patients per arm with primary efficacy data available for 198 and 200 patients respectively. The SSG & PM versus SSG comparison enrolled 381 and 386 patients per arm respectively, with primary efficacy data available for 359 patients per arm. In Intention-to-Treat complete-case analyses, the efficacy of PM was significantly lower than SSG (84.3% versus 94.1%, difference = 9.7%, 95% confidence interval, CI: 3.6 to 15.7%, p = 0.002). The efficacy of SSG & PM was comparable to SSG (91.4% versus 93.9%, difference = 2.5%, 95% CI: -1.3 to 6.3%, p = 0.198). End of treatment efficacy results were very similar. There were no apparent differences in the safety profile of the three treatment regimens. The 17 day SSG & PM combination treatment had a good safety profile and was similar in efficacy to the standard 30 day SSG treatment, suggesting suitability for VL treatment in East Africa. www.clinicaltrials.govNCT00255567.

Visceral leishmaniasis (VL) is a major health problem in developing countries. The untreated disease is fatal, available treatment is expensive and often toxic, and drug resistance is increasing. Improved treatment options are needed. Paromomycin was shown to be an efficacious first-line treatment with low toxicity in India. This was a 3-arm multicentre, open-label, randomized, controlled clinical trial to compare three treatment regimens for VL in East Africa: paromomycin sulphate (PM) at 15 mg/kg/day for 21 days versus sodium stibogluconate (SSG) at 20 mg/kg/day for 30 days; and the combination of both dose regimens for 17 days. The primary efficacy endpoint was cure based on parasite-free tissue aspirates taken 6 months after treatment. Overall, 135 patients per arm were enrolled at five centres in Sudan (2 sites), Kenya (1) and Ethiopia (2), when the PM arm had to be discontinued due to poor efficacy. The trial has continued with the higher dose of PM as well as the combination of PM and SSG arms. These results will be reported later. Baseline patient characteristics were similar among treatment arms. The overall cure with PM was significantly inferior to that with SSG (63.8% versus 92.2%; difference 28.5%, 95%CI 18.8% to 38.8%, p<0.001). The efficacy of PM varied among centres and was significantly lower in Sudan (14.3% and 46.7%) than in Kenya (80.0%) and Ethiopia (75.0% and 96.6%). No major safety issues with PM were identified. The efficacy of PM at 15 mg/kg/day for 21 days was inadequate, particularly in Sudan. The efficacy of higher doses and the combination treatment warrant further studies.