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SURGICAL SOCIETY OF ETHIOPIA (SSE)የኢትዮጵያ ቀዶ ህክምና ማኅበር

24th Date: October 3 & 4, 2019

Venue: Inter continental Addis Hotel, Addis Ababa, Ethiopia

ANNUAL GENERAL MEETING (AGM) AND SCIENTIFIC CONFERENCE

St. Paul’s Hospital Millennium Medical College Printing Press

BOOK OF ABSTRACTS AND PROGRAMS

Date: October 3 & 4, 2019Venue: Inter continental Addis Hotel,

Addis Ababa, Ethiopia

OUR SPECIAL SERVICES

We believe in giving back to the society. Because, we own a world class hospital equipped with multidisciplinary international health professionals

Emergency care system state of the art ICU with an outstanding critical care services Multifunctional operating theaters with laminar flow

Comprehensive OPDs

General care

Annual Health Screen

Diagnostic Center with

1.5 Tesla MRI128 Slices CT

Digital Subtraction Angiography (DSA)

Latest model of surgical Microscopy

Address: Near to Sarbet, Opposite to Vatican Embassy, and Next to Gibson School.Email: silkroadhos [email protected]

URL:www.silkroadhospitaladdis.com

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24TH ANNUAL GENERAL MEETING (AGM) AND SCIENTIFIC CONFERENCE PROGRAMS

The Surgical Society of Ethiopia (SSE)የኢትዮጵያ ቀዶ ህክምና ማኅበር

24th Annual General Meeting (AGM) and Scientific Conference Programs

Date: October 3 & 4 , 2019

Venue: InterContinental Addis Hotel, Addis Ababa, Ethiopia

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SURGICAL SOCIETY OF ETHIOPIA EXECUTIVE MEMBERS

Dr. Dereje Gulilat President

Dr. Girmaye Tamirat Secretary General

Dr. Engida Abebe Program Officer

Dr Hanna Getachew Fund Raising

Dr Henok Seife Public Relation

Dr.Endale Anberber Treasury and Finance

COSECSA COUNTRY REPRESENTATIVES

Dr . Hanna Getachew

Dr. Dereje Gulilat

SCIENTIFIC COMMITTEE

Prof. Berhanu Kotiso

Dr. Hagos Bilutsi

Dr. Mulat Taye

Dr. Mahteme Bekele

SECRETARIAT OFFICE

Azeb Kebede

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SURGICAL SOCIETY OF ETHIOPIA EXECUTIVE MEMBERS

Dr. Dereje Gulilat President

Dr. Girmaye Tamirat Secretary General

Dr. Engida Abebe Program Officer

Dr Hanna Getachew Fund Raising

Dr Henok Seife Public Relation

Dr.Endale Anberber Treasury and Finance

COSECSA COUNTRY REPRESENTATIVES

Dr . Hanna Getachew

Dr. Dereje Gulilat

SCIENTIFIC COMMITTEE

Prof. Berhanu Kotiso

Dr. Hagos Bilutsi

Dr. Mulat Taye

Dr. Mahteme Bekele

SECRETARIAT OFFICE

Azeb Kebede

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24TH AGM PRESIDENTIAL MESSAGE

Dear SSE Members

I wish a healthy and prosperous 2012 with your loved once. It is great honor and opportunity to be a member of esteemed association. It is much more to serve as a member of executive committee and lead the society of great Ethiopian surgeons & associates.

I am great full to you for giving me full support and active participation during the last two terms of leadership in the society. Your dedicated executive committee has been working hard to lift up the activity of the society with full of commitment. This has resulted in tremendously increase in active membership, establish chapters office , increase networking by creating a website and media groups, organized surgical campaign, CME, semi –annual regional assembly or chapter meetings. This activity has hugely boosted your organization to lay ground for much pace to move forward.

I am proud of our members who have shown willingness to give services to the needy Ethiopians free of charge in their area of expertise. We have seen a response of 40 surgeons willing to participate in less than 48 hours when we had a call for ‘’ operation giving back Surgical Campaign’’. This surgeons were with different specialties skills area of assignment wanting to reach our people and serve without any support. The executive committee in addition to the central offices and stakeholders active participation has tried its level best to reach our colleagues in the regions. We have harvested lots of our colleagues to come back and participate actively in their mother society.

We have noticed a profound inspiration among our colleagues in the regions when we visited them and established local chapter .We stand well on our financial statues this year. We are working to bring our surgical workforces to a bigger consortium as soon as possible.

We have made the necessary preparation to make the 24th SSE AGM to equip you with new knowledge and skill. This year pre conference CME is all exciting to be conducted two days. The conferences is packed with

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program which are all attractive, awardees, panel discussion, state of art lecture, scientific presentation and entertaining gala dinner. It s is going to be exciting meeting friends and colleagues from all the regi0ns and also from Eritrea.

I urge you all to attend the entire program and participate fully in all events. Finally, I wish you all best during the conference and also going back to your services inspired safely.

God Bless Ethiopia and Ethiopian People

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program which are all attractive, awardees, panel discussion, state of art lecture, scientific presentation and entertaining gala dinner. It s is going to be exciting meeting friends and colleagues from all the regi0ns and also from Eritrea.

I urge you all to attend the entire program and participate fully in all events. Finally, I wish you all best during the conference and also going back to your services inspired safely.

God Bless Ethiopia and Ethiopian People

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SSE OF ETHIOPIA24THAGM SCIENTIFIC SESSION

Pre conference CMEsplastic & Reconstructive Surgery

Sponsored by plastic & Reconstructive Surgeons society

Venue – AAU Department of Surgery ,Tikur Anbesa Hospital Tuesday October 1,2019

Morning 9;00—12;30 - Afternoon 14:00- 16:00

Chairs :- Dr. Yohannes Demmissie & Dr. Abraham G/Egziabher Topics Speaker1 Basics in Local Flaps Dr . Mekonnen Eshete

consultant Plastic & Rec. Surgeon2 The Management of Acute

Facial TraumaDr. Ataklity Baraki consultant Plastic & Rec. Surgeon

3 The Management of Post Burn Deformities

Dr. Yigeremu Kebede consultant Plastic & Rec. Surgeon

4 Management of Pressure Sore

Dr . Abdurezak Mohammed consultant Plastic & Rec. Surgeon

5 Breast Reconstruction Dr . Abeje Berhanu consultant Plastic & Rec. Surgeon

6 Management of Acute Burn Injury

Dr. Bereket Atnafu consultant Plastic & Rec. Surgeon

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Pre conference CMEsProudly Sponsored by Artemis Hospital, New Delhi, India

Venue: AAU Department of Surgery, Tikur Anbesa HospitalOCTOBER 2, 2019

Morning (9:00-12:00)

Chairs: Dr. Zeki A and Dr. Henok S Topics Speaker1 Curative intent Surgery for

Pancreatic AdenocarcinomaDr. Giriraj Singh Bora

Consultant HBP surgeon2 Palliative intent Surgery for


Consultant HBP surgeon3 Radiologic interventions in

HBP ,Focus on Pancreatic Cancers

Dr. Rajive Sharma , Consultant Intervention Radiologist

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Venue: AAU Department of Surgery, Tikur Anbesa HospitalOCTOBER 2, 2019

Morning (9:00-12:00)

Chairs: Dr. Zeki A and Dr. Henok S Topics Speaker1 Curative intent Surgery for


Consultant HBP surgeon2 Palliative intent Surgery for


Consultant HBP surgeon3 Radiologic interventions in

HBP ,Focus on Pancreatic Cancers


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Venue: St Paul’s Hospital Millennium Medical College OCTOBER 2, 2019

Afternoon:- (14:00-16:30)Chairs: Dr. Wuletaw C and Dr. Gulilat T Topics Speaker1 Curative intent

Surgery for Pancreatic Adenocarcinoma

Dr. Giriraj Singh Bora Consultant HBP surgeon

2 Palliative intent Surgery for Pancreatic Adenocarcinoma

Dr. Giriraj Singh Bora Consultant HBP surgeon

3 Radiologic interventions in HBP ,Focus on Pancreatic Cancers


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Pre conference CMEsManagement of Breast Cancer

Proudly Sponsored by Aster Hospital Bangalore, Indian

Venue – Site I. St. Paul’s Hospital Millennium Medical College Wednesday October 2 ,2019 Morning 9:00- 12:00

Chair person Dr. Birhanetsehay T and Dr . Yisehak Suga Topic 1 Updates on the surgical Management of Breast

Cancer Speaker Dr . Endale Anberbir /Endocrine and Breast

Surgeon

Topics 2 Updates in neo-adjuvant and Adjuvant Treatment in Breast Cancer

Speaker Dr. Vijay Agarwal Medical Oncologist Topic 3 Palliative care in Advance breast cancer

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Venue – Site I. St. Paul’s Hospital Millennium Medical College Wednesday October 2 ,2019 Morning 9:00- 12:00

Chair person Dr. Birhanetsehay T and Dr . Yisehak Suga Topic 1 Updates on the surgical Management of Breast

Cancer Speaker Dr . Endale Anberbir /Endocrine and Breast

Surgeon



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Venue – AAU Department of Surgery ,Tikur Anbesa Hospital Wednesday October 2 ,2019 Afternoon 14:00- 16:00

Chair person Dr. Girmaye Tamirat Topic 1 Updates on the surgical Management of

Breast Cancer Speaker Dr . Endale Anberbir /Endocrine and Breast

Surgeon



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Day I – Thursday: October 3rd, 2019 Main Hall

10:30 - 11:00 Tea Break and Medical Exhibition Tour

8:00 - 9:00 Registration Event organizers9:00 - 9:10 Welcoming Address Dr. Girmaye Tamirat ,

Secretary General9:10 - 9:15 Presidential Address Dr. Dereje Gulilat , President SSE9:15 - 9:25 Opening Address FMOH representative9:20 - 9:45 SSE Recognition

Long years of Service Outside Addis AbabaLong years of service and Teaching

Committee

9:45 - 10:30 Business Meeting/AGM SSE EC

Panel Discussion Topic: “Enhancing Quality of Surgical Education in Ethiopia ”

Chairpersons Dr. Mulat Taye & Dr. Samson Esseye

Panelist

11:00 -11:15 The Quality of Surgical training in Ethiopia the Last Three decades ;The perspective of Current trainer and early trainee

Dereje Gulilat (MD)Associate professor of Surgery

11:15 - 11:30 The Current Status of Surgical training in Ethiopia

Reiye Essayas (MD)Associate professor of Surgery, CCD Ayider Hospital MU

11:30-11:45 The Quality of Surgical training in Ethiopia; Perspective from the Stakeholder (FMOH)

Abraham Haile’amlak (MD)Professor , Advisor for the FMOH

11:45-12:00 The way forward in Enhancing the quality of Surgical training in Ethiopia

Andualem Deneke(MD)Associate professor of Surgery, Head Department of Surgery ,AAU

12:00 - 12:30 Discussion

LUNCH BREAK 12:30 - 13:30

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Day I – Thursday: October 3rd, 2019 Main Hall

10:30 - 11:00 Tea Break and Medical Exhibition Tour

8:00 - 9:00 Registration Event organizers9:00 - 9:10 Welcoming Address Dr. Girmaye Tamirat ,

Secretary General9:10 - 9:15 Presidential Address Dr. Dereje Gulilat , President SSE9:15 - 9:25 Opening Address FMOH representative9:20 - 9:45 SSE Recognition

Long years of Service Outside Addis AbabaLong years of service and Teaching

Committee

9:45 - 10:30 Business Meeting/AGM SSE EC

Panel Discussion Topic: “Enhancing Quality of Surgical Education in Ethiopia ”

Chairpersons Dr. Mulat Taye & Dr. Samson Esseye

Panelist

11:00 -11:15 The Quality of Surgical training in Ethiopia the Last Three decades ;The perspective of Current trainer and early trainee

Dereje Gulilat (MD)Associate professor of Surgery

11:15 - 11:30 The Current Status of Surgical training in Ethiopia

Reiye Essayas (MD)Associate professor of Surgery, CCD Ayider Hospital MU

11:30-11:45 The Quality of Surgical training in Ethiopia; Perspective from the Stakeholder (FMOH)

Abraham Haile’amlak (MD)Professor , Advisor for the FMOH

11:45-12:00 The way forward in Enhancing the quality of Surgical training in Ethiopia

Andualem Deneke(MD)Associate professor of Surgery, Head Department of Surgery ,AAU

12:00 - 12:30 Discussion

LUNCH BREAK 12:30 - 13:3011


Room II sessions Day I, Thursday November October 3rd , 2019 Afternoon

Scientific session I,

Lecture I Professor Taye Mekuria Memorial Lecture

Tea Break 15:00- 15:20Lecture II

Professor Asrat Woldeyes’s Memorial Lecture

Chairs Urology13:30-13:40 ASSESSMENT OF LEVEL OF PATIENT SATISFACTION

AFTER ROSTATECTOMY FOR BENIGN PROSTATIC HYPERPLASIA AndualemDeneke (MD), Mezgeb Gedefe (MD)

13:40-13:50 KNOWLEDGE AND ATTITUDE TOWARDS ORGAN DONATION AMONG PATIENT ATTENDANTS AT ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE, ADDIS ABABA, ETHIOPIA Wubshet Jote(MD) , Berhanu worku(MD) ,Tigist Workneh (MD) ,Mahteme Bekele (MD)

13:50-14:00 GIANT BLADDER STONE IN A YOUNG MANSeid Mohammed (MD), Habtemariam Demoz (MD, MPH)

14:10-14:25 (Q and A)

Chair Person Professor Milliard Deribew& Dr. Berhanu NTime 14:25 – 15:00Topic Current Trends in Global Surgery

Presenter Abebe Bekele MD, FACS,Professor of Surgery

Chair Person Dr. Daniel Z & Dr. Mohamed Ibrahim Time 15:20-16:00Topic Colorectal Cancer current concept of Adjuvant

Treatment Presenter Dr.Viyaj Agarwal

ASTER Hospital,BangalEnd of Day ONE

18:00 – 21:00 pm: Gala dinner Skylight HotelFor Registered members, Associate Members and invited Guests

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Day II Friday: October 4th , 2019 Room :- Blue Nile Scientific Session I A Chairs Dr. Chuchu Girma & Dr. Anteneh K8:30-8:40 HIV INFECTION: IT’S IMPACT ON PATIENTS WITH

APPENDICITIS IN BOTSWANA Alemayehu Ginbo Bedada, MD; Marvin Hsiao, MD PhD; Georges Azzie, MD

8:40- 8:50 ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS BREAST CANCER AND ITS EARLY DETECTION MEASURES AMONG FEMALE STUDENTS OF RIFT VALLEY UNIVERSITY Mahteme Bekele(MD), Osman Emam(MD), Misrach Ayalew (MD)

8:50- 9:00 MANAGING ADULTS WITH PREVIOUSLY TREATED ANORECTAL MALFORMATIONS Alemayehu Ginbo Bedada(MD), Ann C. Gaffey(MD), Georges Azzie(MD)

9:00- 9:05 APPENDICULO-ILEAL KNOT PRESENTING AT THE THIRD TRIMESTER OF PREGNANCY Engida Abebe(MD), Ayelign Tsehay(MD), Befekadu Lemu(MD), Kirubel Abebe(MD),Sultan Redi(MD)

9:05- 9:10 GIANT APPENDICOLITHIASIS PRESENTING WITH CHRONIC ABDOMINAL PAIN AND MASS: A CASE REPORT Engida Abebe(MD), Kirubel Abebe(MD)

9: 10 – 9:25

Discussions(Q and A)

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Day II Friday: October 4th , 2019 Room :- Blue Nile Scientific Session I A Chairs Dr. Chuchu Girma & Dr. Anteneh K8:30-8:40 HIV INFECTION: IT’S IMPACT ON PATIENTS WITH

APPENDICITIS IN BOTSWANA Alemayehu Ginbo Bedada, MD; Marvin Hsiao, MD PhD; Georges Azzie, MD

8:40- 8:50 ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS BREAST CANCER AND ITS EARLY DETECTION MEASURES AMONG FEMALE STUDENTS OF RIFT VALLEY UNIVERSITY Mahteme Bekele(MD), Osman Emam(MD), Misrach Ayalew (MD)

8:50- 9:00 MANAGING ADULTS WITH PREVIOUSLY TREATED ANORECTAL MALFORMATIONS Alemayehu Ginbo Bedada(MD), Ann C. Gaffey(MD), Georges Azzie(MD)

9:00- 9:05 APPENDICULO-ILEAL KNOT PRESENTING AT THE THIRD TRIMESTER OF PREGNANCY Engida Abebe(MD), Ayelign Tsehay(MD), Befekadu Lemu(MD), Kirubel Abebe(MD),Sultan Redi(MD)

9:05- 9:10 GIANT APPENDICOLITHIASIS PRESENTING WITH CHRONIC ABDOMINAL PAIN AND MASS: A CASE REPORT Engida Abebe(MD), Kirubel Abebe(MD)

9: 10 – 9:25

Discussions(Q and A)

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Scientific Session II A Chairs David J & Dr. Lidia Gemechu9:25 - 9:35 EVALUATION OF ONE WEEK BLOCK ESSENTIAL SURGICAL

SKILLS COURSE FOR YEAR V MEDICAL STUDENTS AT SPHMMC Mekdim Tadesse Siyoum.MD.MHPE.

9:35 - 9:45 UTILITY AND EFFECTIVENESS OF ULTRASOUND GUIDED SUPRACLAVICULAR LIMB BLOCK AT SODDO CHRISTIAN HOSPITAL, WOLAITTA ETHIOPIA” Abenezer Iyassu, MD, Shewalul Teketel, MSC, David Jeffcoach, MD, Gezahegne Tilahun, MD and Andrew Chew, MD

9:45 - 9:55 PRIVATE WING ADMISSION PATTERN AND EXTENT OF RESIDENT INVOLVEMENT IN PRIVATE WING PROCEDURES: EXPERIENCE FROM T ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE, ADDIS ABABA-ETHIOPIA Mahteme Bekele Muleta MD

9:55 - 10:05 ‘THE GOOD, THE BAD & THE BETTER’ QUALITY OF COSECSA TRAINING IN ETHIOPIA: Tigistu Adamu (MD)

10:05 – 10:20 Discussion( Q&A)

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Scientific Session III A :

Lecture III Prof. Orvar Daniel Johnson Memorial Lecture

Chairs Dr. Mahteme B & Dr. Burhan M10: 35 - 10:45 PATTERNS, EPIDEMIOLOGY AND MANAGEMENTS OF

BLUNT ABDOMINAL TRAUMA PATIENTS AT SINGLE HOSPITAL IN A RESOURCE LIMITED AREA, SODDO, ETHIOPIA Tsegaye Woldegiorgis, MD, Andrew Chew, MD, Gezahegne Tilahun, MD, and David Jeffcoach, MD

10: 45 – 10:55 IMPACT OF FALL RELATED TRAUMA IN SOUTHERN ETHIOPIA Leul Shigut, MD, Andrew Chew, MD, Gezahegne Tilahun, MD, and David Jeffcoach, MD

10:55 – 11:05 PREVALENCE OF DEPRESSION AND ANXIETY AND ASSOCIATED FACTORS AMONG PATIENTS VISITING ORTHOPAEDIC OUTPATIENT CLINIC AT TIKUR ANBESSA SPECIALIZED HOSPITAL, ADDIS ABABA, ETHIOPIA, 2017 Mengesha Srahbzu(MD), Niguse Yigizaw(MD), Tolesa Fanta(MD), Dawit Assefa(MD), Enguday Tirfeneh(MD)

11: 05 – 11:15 NEUROLOGICAL IMPROVEMENT AFTER CORTICOTOMY AND EVACUATION OF ICH DUE TO HEMORRHAGIC STROKE: A CASE REPORT FROM WOLAITTA SODDO UNIVERSITY HOSPITAL (OTTONA HOSPITAL); Tamrat Bugie (MD),Sherefa Hussien (MD)

11: 15 – 11:30 Discussion (Q & A)

Chair Person Prof .Birhanu Kotisson & Dr. Kalid ATime 11:30-12:15Topic Advance in Management of Benign Biliary structure

Emphasis on Post Cholecystectomy Biliary Structure Presenter Dr.Giriraj Singh Bora ARTEMIS Hospital

New Delhi ,India Discussion 12:15- 12-30

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Scientific Session III A :

Lecture III Prof. Orvar Daniel Johnson Memorial Lecture

Chairs Dr. Mahteme B & Dr. Burhan M10: 35 - 10:45 PATTERNS, EPIDEMIOLOGY AND MANAGEMENTS OF

BLUNT ABDOMINAL TRAUMA PATIENTS AT SINGLE HOSPITAL IN A RESOURCE LIMITED AREA, SODDO, ETHIOPIA Tsegaye Woldegiorgis, MD, Andrew Chew, MD, Gezahegne Tilahun, MD, and David Jeffcoach, MD

10: 45 – 10:55 IMPACT OF FALL RELATED TRAUMA IN SOUTHERN ETHIOPIA Leul Shigut, MD, Andrew Chew, MD, Gezahegne Tilahun, MD, and David Jeffcoach, MD

10:55 – 11:05 PREVALENCE OF DEPRESSION AND ANXIETY AND ASSOCIATED FACTORS AMONG PATIENTS VISITING ORTHOPAEDIC OUTPATIENT CLINIC AT TIKUR ANBESSA SPECIALIZED HOSPITAL, ADDIS ABABA, ETHIOPIA, 2017 Mengesha Srahbzu(MD), Niguse Yigizaw(MD), Tolesa Fanta(MD), Dawit Assefa(MD), Enguday Tirfeneh(MD)

11: 05 – 11:15 NEUROLOGICAL IMPROVEMENT AFTER CORTICOTOMY AND EVACUATION OF ICH DUE TO HEMORRHAGIC STROKE: A CASE REPORT FROM WOLAITTA SODDO UNIVERSITY HOSPITAL (OTTONA HOSPITAL); Tamrat Bugie (MD),Sherefa Hussien (MD)

11: 15 – 11:30 Discussion (Q & A)

Chair Person Prof .Birhanu Kotisson & Dr. Kalid ATime 11:30-12:15Topic Advance in Management of Benign Biliary structure

Emphasis on Post Cholecystectomy Biliary Structure Presenter Dr.Giriraj Singh Bora ARTEMIS Hospital

New Delhi ,India Discussion 12:15- 12-30

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Day II, Friday: October 4, 2018, Afternoon Scientific Session IV

Lecture IV State of the Art

14:25 – 14:35 Tea Break

15:30-16:00 Closing Remarks –SSE President, Dr. Dereje Gulilat

Chairs Dr . Andrew C /Dr. Behailu 13:30 – 13:40 SHORT TERM OUTCOME OF SURGERY FOR GASTRIC

CANCER IN TWO HOSPITALS IN ADDIS ABABAHailu wondimu(MD)

13:40 - 13:50 OUT COME AND ASSOCIATED FACTORS OF PERFORATED PEPTIC ULCER DISEASE AT DESSIE REFERRAL HOSPITAL, NORTH EAST ETHIOPIAWondwossen Amtataw,Tesfaye Birhan

13:50 - 14:00 NOVEL METHOD FOR TOTAL EXTRAPERITONEAL (TEP) LAPAROSCOPIC INGUINAL HERNIA REPAIR: CASE REPORT David Jeffcoach, MD

14:00 - 14:10 APPENDICEAL MUCOCELE: A CASE REPORTMahteme Bekele(MD), Bezawit Demoze(MD) , Bereket Berhane(MD), Ayelign Tsehaye(MD

14:10 - 14:25 Discussion (Q&A)

Chair Person Dr. Hailu Wondimu / Dr. Kibrom GTime 14:35 - 15:15Topic Management of Esophageal Cancer Presenter Dr. Ashish Shah Aster Hospital /BangaloreDiscussion 15:15- 15-30

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Day II Friday, October 4th , 2019 Scientific Session I B—Room Blue Nile Chairs Dr. Amezene T & Dr. Abeje B8:30-8:40 DELAYED PRESENTATION AND REPAIR OF BOCHDALEK

HERNIA: CASE PRESENTATION David Jeffcoach, MD8:40- 8:50 HUGE THYROGLOSSAL DUCT CYST AT THE SUPRA-STERNAL

NOTCH Engida Abebe(MD), Abebe Megersa (MD), and Kirubel Abebe (MD)

8:50- 9:00 ORAL HEALTH–RELATED QUALITY OF LIFE OF CHILDREN BORN WITH OROFACIAL CLEFTS IN ETHIOPIA AND THEIR PARENTSMekonen Eshete Abebe, Wakgari Deressa, et al

9:00- 9:10 THE ROLE OF ENVIRONMENTAL FACTORS IN THE ETIOLOGY OF NONSYNDROMIC OROFACIAL CLEFTS IN THE ETHIOPIAN POPULATIONMekonen Eshete (MD), Fikre Abate(MD), Abiye Hailu (MD) et Al

9: 10–9:25 Discussion (Q and A)

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Day II Friday, October 4th , 2019 Scientific Session I B—Room Blue Nile Chairs Dr. Amezene T & Dr. Abeje B8:30-8:40 DELAYED PRESENTATION AND REPAIR OF BOCHDALEK

HERNIA: CASE PRESENTATION David Jeffcoach, MD8:40- 8:50 HUGE THYROGLOSSAL DUCT CYST AT THE SUPRA-STERNAL

NOTCH Engida Abebe(MD), Abebe Megersa (MD), and Kirubel Abebe (MD)

8:50- 9:00 ORAL HEALTH–RELATED QUALITY OF LIFE OF CHILDREN BORN WITH OROFACIAL CLEFTS IN ETHIOPIA AND THEIR PARENTSMekonen Eshete Abebe, Wakgari Deressa, et al

9:00- 9:10 THE ROLE OF ENVIRONMENTAL FACTORS IN THE ETIOLOGY OF NONSYNDROMIC OROFACIAL CLEFTS IN THE ETHIOPIAN POPULATIONMekonen Eshete (MD), Fikre Abate(MD), Abiye Hailu (MD) et Al

9: 10–9:25 Discussion (Q and A)

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Scientific Session II

Chairs Dr. Mekdim T & Dr. Mengistu Worku 9:25 - 9:35 RATE AND DETERMINANT FACTORS FOR ELECTIVE CASE

CANCELATION IN ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE, ADDIS ABABA, ETHIOPIAMahteme Bekele(MD), Shanko Gebru(MD), Dagmawi Mesi(MD)

9:35 - 9:45 PATIENT SATISFACTION WITH EMERGENCY LAPARATOMY SERVICES AND ASSOCIATED FACTORS IN THREE PUBLIC HOSPITALS IN ADDIS ABABA, ETHIOPIA, 2018:CROSS SECTIONAL STUDY. Ayalew Tizazu (MD)

9:45 - 9:55 QUALITY OF LIFE ASSESMENT IN PATIENTS LIVING WITH STOMA: CROSS-SECTIONAL STUDYTilahun Deresse (MD)Wuletaw Chanie (MD), Yishak Suga (MD)

9:55 - 10:05 THE IMPACT OF A QUALITY IMPROVEMENT PROGRAM ON REDUCING SURGICAL SITE INFECTIONS AND IMPROVED SURGICAL PATIENT FOLLOW UP; LIFEBOX CLEAN CUT PROGRAM Natnael Gebeyhu(MD), Nichole Starr(MD), Senait Bitew, Assefa Tesfaye, Jared Forrester(MD), Tadesse Habteyohannes, Ebisa Wayessa(MD), Thomas Weiser(MD), Tihitena Negussie(MD)

10:05- 10:20 Discussion (Q and A)

10:20 – 10:35 Tea Breaks

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Scientific Session III

Final sessions at Blue Nile Hall I

Chairs Dr. Mahlet Tesfaye and Dr. Anwar Mohamed10: 35 - 10:45 PREDICTORS OF POST LAPARATOMY WOUND

DEHISCENCE AT TIKUR ANBESA & ITS AFFILIATED HOSPITALS: A ONE YEAR CASE CONTROL STUDYHiwot Fentahun (MD), Henok T|Silassie (MD,Msc)

10: 45 – 10:55 OUT COME ANALYSIS OF CONSERVATIVE MANAGEMENT OF ACUTE CHOLECYSTITIS IN ADDIS ABABA, ETHIOPIABelete Shikuro (MD), Henok Seife(MD)

10:55 – 11:05 A PROSPECTIVE REVIEW OF FACTORS AFFECTING THE OUTCOME OF ACUTE APPENDICITIS AFTER SURGERY IN ADULTS AT THREE HOSPITALS IN ADDIS ABABA, ETHIOPIAYonas Zerabruk(MD), Henok Seife(MD)

11: 05 – 11:15 PENETRATING THORACIC TRAUMA, TO REMOVE OR NOT TO REMOVE THE KNIFE: CASE REPORTDavid Jeffcoach, MD

11: 15 – 11:30 Discussion (Q & A)

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Scientific Session III

Final sessions at Blue Nile Hall I

Chairs Dr. Mahlet Tesfaye and Dr. Anwar Mohamed10: 35 - 10:45 PREDICTORS OF POST LAPARATOMY WOUND

DEHISCENCE AT TIKUR ANBESA & ITS AFFILIATED HOSPITALS: A ONE YEAR CASE CONTROL STUDYHiwot Fentahun (MD), Henok T|Silassie (MD,Msc)

10: 45 – 10:55 OUT COME ANALYSIS OF CONSERVATIVE MANAGEMENT OF ACUTE CHOLECYSTITIS IN ADDIS ABABA, ETHIOPIABelete Shikuro (MD), Henok Seife(MD)

10:55 – 11:05 A PROSPECTIVE REVIEW OF FACTORS AFFECTING THE OUTCOME OF ACUTE APPENDICITIS AFTER SURGERY IN ADULTS AT THREE HOSPITALS IN ADDIS ABABA, ETHIOPIAYonas Zerabruk(MD), Henok Seife(MD)

11: 05 – 11:15 PENETRATING THORACIC TRAUMA, TO REMOVE OR NOT TO REMOVE THE KNIFE: CASE REPORTDavid Jeffcoach, MD

11: 15 – 11:30 Discussion (Q & A)

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RECOGNITION AWARDSDR.DEREJE ZEWUDE

Dr. Dereje Zewude was born in Addis Ababa, Ethiopia. He got Degree in General Medicine from Medical Faculty of Santiago De Cubain 1986 and degree of specialization in urology from the same faculty in 1990.

Dr. Dereje has worked as a specialist in Urology at Black lion specialized referral hospital affiliated with department of surgery at Addis Abeba University , Addis Abeba, From 1985-2008 E.C .

He has participated in several national and international conferences and workshops. He received gratitude and special recognition from general armed forces Hospitals for free service rendered during the “Badema” war under the auspice of Ministry of Health and Department of surgery at Addis Abeba University .

He has also be given a gratitude and special recognition from Hawassa University and AMRIF for service rendered on job training work shop under the auspice of Hawassa university and AMRIF.

Dr. Dereje is married and a father of 2 daughters.

The SSE executive committee is proud to recognize nearly 3 decades of service and teaching rendered by Dr. Dereje and chose him to be the surgeon of the year for recognition in long years of service in Ethiopia.

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DR.KELEMU DESTA Dr. Kelemu Desta got his MD from Addis Ababa University Medical College in 1984.He worked as a general practioner in Arba Minch Hospital. He also got his Specialty certificate in general surgery from Faculty of medicine of Addis Ababa University in 1992.He Served as general surgeon for six months at the same work place he used to serve as A general practitioner.

Dr. Kelemu did sub-specialty training in Plastic and reconstructive Surgery Royal College of Surgeons of England from 192-1996.

Dr. Kelemu has worked as Registrar [plastic surgery] at institution of George Elliot Hospital, England, Wolaitta Soddo and Soddo Christian Hospital as Medical Director, and a Founder and Medical Director of Feya General Hospital since 2007. He is serving as -Instructor of Surgery, in PAACS program at Soddo Christian Hospital he started since February 2006.

He is an active member of Pan – African Academy of Christian Surgeons /PAACS/, Surgical Society of Ethiopia and College of Surgeons of East, Central and Southern Africa (COSECSA).

Dr. Kelemu has published two research papers related to the area of his expertises.He also received a recognition as Honorary staff at Wollayeta Soddo University.

The SSE executive committee has decided to give this year’s 2019 award on longtime service in the countryside to Dr. Kelemu for his unreserved service for more than two decades in the field of surgery at Southern Nations, Nationalities and People Regional State .

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DR.KELEMU DESTA Dr. Kelemu Desta got his MD from Addis Ababa University Medical College in 1984.He worked as a general practioner in Arba Minch Hospital. He also got his Specialty certificate in general surgery from Faculty of medicine of Addis Ababa University in 1992.He Served as general surgeon for six months at the same work place he used to serve as A general practitioner.

Dr. Kelemu did sub-specialty training in Plastic and reconstructive Surgery Royal College of Surgeons of England from 192-1996.

Dr. Kelemu has worked as Registrar [plastic surgery] at institution of George Elliot Hospital, England, Wolaitta Soddo and Soddo Christian Hospital as Medical Director, and a Founder and Medical Director of Feya General Hospital since 2007. He is serving as -Instructor of Surgery, in PAACS program at Soddo Christian Hospital he started since February 2006.

He is an active member of Pan – African Academy of Christian Surgeons /PAACS/, Surgical Society of Ethiopia and College of Surgeons of East, Central and Southern Africa (COSECSA).

Dr. Kelemu has published two research papers related to the area of his expertises.He also received a recognition as Honorary staff at Wollayeta Soddo University.

The SSE executive committee has decided to give this year’s 2019 award on longtime service in the countryside to Dr. Kelemu for his unreserved service for more than two decades in the field of surgery at Southern Nations, Nationalities and People Regional State .

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THE BRIEF ACCOUNT OF THE REPUBLIC OF CUBA CONTRIBUTION IN THE DEVELOPMENT OF

SURGICAL SERVICE AND TRAINING IN ETHIOPIA

It is a great pleasure and honor for us to say a few words about the legacy of the people and the Government of Republic of Cuba contribution for development of surgical service and training in Ethiopia.

Cuba has one of the best medical service and training in the world for the last several decades. Cuba assisted all corners of peoples of the world through providing medical service and training. In addition to going to the needy people, Cuba also helped the developing nations through providing free scholarship to students from such countries, Ethiopia being one of them.

The Ethio-Cuban friendship and diplomatic relationship was started four decades ago. In these years many Cuban doctors and paramedics came and served all corners of Ethiopia. Cuban surgeons were the first surgeons in some parts of Ethiopia. Cuban specialists had also contributed enormously in opening medical school in the then Jimma Institute of Health Science, now Jimma University.

Since the beginning of the relationship between Ethiopia and Cuba, the government and people of Cuba, under President Fidel Castro and Raul Castro leadership gave a scholarship for more than 4,000 young Ethiopians in all fields of modern education. Significant number of these did health related studies and became nurses, pharmacist, doctors (general practitioners and specialists) etc. …Ethiopians were trained in all fields of medicine at a specialist level, among which more than 50 were surgeons. These are 13 General surgeons, 11 Gynecologists, 8 Dentists, 04 Urologists , 4 ENT surgeons, 3 Orthopedic Surgeons , 3 Ophthalmologist, 02 neurosurgeons, 1 maxillofacial surgeons, 01 pediatric surgeon , , , … etc. These surgeons were among the early surgical task force of Ethiopia.

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Cuba not only trained Ethiopians, but also continued to send specialists and subspecialist surgeons to date to assist service and training in Ethiopia. Among the remarkable continued support is the maxillofacial surgery service and training which is still hugely assisted by Cuban surgeons. The scholarship provided to Ethiopians is still ongoing. One cannot summarize the contribution of Cuba in such a short note. Due to space issue we stop here.

Hence, the Surgical Society of Ethiopia feels honored to recognize and award the Government and the Peoples of Republic of Cuba for their contribution in the field of surgery.

The Surgical Society of Ethiopia

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Cuba not only trained Ethiopians, but also continued to send specialists and subspecialist surgeons to date to assist service and training in Ethiopia. Among the remarkable continued support is the maxillofacial surgery service and training which is still hugely assisted by Cuban surgeons. The scholarship provided to Ethiopians is still ongoing. One cannot summarize the contribution of Cuba in such a short note. Due to space issue we stop here.

Hence, the Surgical Society of Ethiopia feels honored to recognize and award the Government and the Peoples of Republic of Cuba for their contribution in the field of surgery.

The Surgical Society of Ethiopia

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ABSTRACTSASSESSMENT OF LEVEL OF PATIENT SATISFACTION AFTER

ROSTATECTOMY FOR BENIGN PROSTATIC HYPERPLASIAAndualemDeneke (MD), Mezgeb Gedefe (MD)

INTRODUCTION: BPH is very common problem in aging men. In the best setups,TURP comprises 95% of all surgical procedures and is the treatment of choice for prostates sized between 30 mL and 80 –100 mL. Open surgery is the treatment of choice for large glands (bigger than 80–100 mL), and for those with associated complications such as large bladder stones, or bladder diverticula which needs resection.

Many literatures show that, the overall patient satisfaction rate and clinical outcome of TURP for BPH are very good. However, researches that directly assess level of satisfaction after open prostatectomy are very few. Patient satisfaction has variety of definitions in different literatures, but most definitions have ‘underlying patient expectation’ as a common variable.

Survey instruments may be generic i.e. applicable to multiple conditions or disease-specific.The goal of patient satisfaction surveys is to understand from the patient perspective a hospital’s/institution’s or health system specific strengths and weaknesses in order to improve the delivery of care.

In our research we tried to measure patients’ satisfaction with the overall satisfaction (i.e the generic method) and also with disease specific outcome.

OBJECTIVE: The general objective of this study was ‘assessing level of patient satisfaction after undergoing TURP and TVP for BPH at TikurAnbessa Hospital and Menilik II hospital’.

DATA AND METHODOLOGY: In this research convenient sampling technique was used i.e. all patients who had undergone prostatectomy during the study period and fulfil inclusion criteria were taken. The study design was multicentre prospective cohort study. Standardized

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questioner was prepared in English and later translated into Amharic. Information about demographic data, preoperative data, intraoperative data, and immediate postoperative data were taken while the patient was in the hospital. At first and third month of prostatectomy, patients were inquired on their level of satisfaction about their disease specific satisfaction on the urinary function and their sexual function, and about their generic patient satisfaction by the Hospital Consumer Assessment of Health Care Providers and Systems survey (HCAHPS) Measure of Patient Satisfaction Tool, which was used. After data collection, the data was entered in to SPSS. Descriptive statistics like frequency tables, graphs and descriptive summaries are used to describe the independent variables.

RESULTS: Total of 89 patients were enrolled in the study from both hospitals.Even though the hospitals at which this study was undertaken are in a poor socio economic country, the hospitals have endoscopic equipments and expertise in urology. Therefore, our data reflected a mixed picture of the relative frequency of these procedures i.e TURP was done for 65.2% of the patients. The rate of major perioperative complication was found to be low. More than half of patients had postoperative hospital stay of three or less days. Majority of patients were satisfied with the care given by the nurses (68.2%) and doctors (84.3%) with relatively higher physicians’ care satisfaction level. More than 60% of the patients were highly satisfied with their urinary surgical outcome, additionally it was found that urinary function improves with time as assessed at the first and third month of the surgery. With regard to hospital environment, around 60% of the patients reported they were very satisfied with cleanliness of the rooms and bath rooms and also the quietness of the rooms at night. On the contrary around 16% were very dissatisfied about the cleanliness of the rooms and bathrooms and 10% were also very dissatisfied with the quietness of the rooms at night.Most important factors that are found to be associated with patient satisfaction were postsurgical urinary function and hospital stay.

This study showed that type of surgery and presence of comorbidities were not associated with patients’ satisfaction. To conclude whether rate of complications, rate of reoperations, and subsequent procedures related to prostatectomy affect level patient satisfaction or not was difficult because of low incidence of these events.

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questioner was prepared in English and later translated into Amharic. Information about demographic data, preoperative data, intraoperative data, and immediate postoperative data were taken while the patient was in the hospital. At first and third month of prostatectomy, patients were inquired on their level of satisfaction about their disease specific satisfaction on the urinary function and their sexual function, and about their generic patient satisfaction by the Hospital Consumer Assessment of Health Care Providers and Systems survey (HCAHPS) Measure of Patient Satisfaction Tool, which was used. After data collection, the data was entered in to SPSS. Descriptive statistics like frequency tables, graphs and descriptive summaries are used to describe the independent variables.

RESULTS: Total of 89 patients were enrolled in the study from both hospitals.Even though the hospitals at which this study was undertaken are in a poor socio economic country, the hospitals have endoscopic equipments and expertise in urology. Therefore, our data reflected a mixed picture of the relative frequency of these procedures i.e TURP was done for 65.2% of the patients. The rate of major perioperative complication was found to be low. More than half of patients had postoperative hospital stay of three or less days. Majority of patients were satisfied with the care given by the nurses (68.2%) and doctors (84.3%) with relatively higher physicians’ care satisfaction level. More than 60% of the patients were highly satisfied with their urinary surgical outcome, additionally it was found that urinary function improves with time as assessed at the first and third month of the surgery. With regard to hospital environment, around 60% of the patients reported they were very satisfied with cleanliness of the rooms and bath rooms and also the quietness of the rooms at night. On the contrary around 16% were very dissatisfied about the cleanliness of the rooms and bathrooms and 10% were also very dissatisfied with the quietness of the rooms at night.Most important factors that are found to be associated with patient satisfaction were postsurgical urinary function and hospital stay.

This study showed that type of surgery and presence of comorbidities were not associated with patients’ satisfaction. To conclude whether rate of complications, rate of reoperations, and subsequent procedures related to prostatectomy affect level patient satisfaction or not was difficult because of low incidence of these events.

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Most (90.7%) of the patients asked at third month of the post-surgery reported that they recommend the same surgery they have undergone, which can lead us to conclude both procedures have high degree of satisfaction.

CONCLUSIONS AND RECOMMENDATIONS: Both TURP and TVP have high level of patient satisfaction and associated with low perioperative major complications and therefore can be recommended for patients with indications for prostatectomy. Equipping urology and general surgery residents in prostatectomy skills should be emphasized.

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KNOWLEDGE AND ATTITUDE TOWARDS ORGAN DONATION AMONG PATIENT ATTENDANTS AT ST. PAUL’S HOSPITAL

MILLENNIUM MEDICAL COLLEGE, ADDIS ABABA, ETHIOPIAWubshet Jote(MD) , Berhanu worku(MD) ,Tigist Workneh (MD)

,Mahteme Bekele (MD)

INTRODUCTION: Kidney transplantation is the gold standard method of management for ESRD. Making transplant service more available depends on the available organ donors’ pool, Most countries are increasing the trend of kidney donation by informing the public Objective: The aim of this study was to assess knowledge and attitude towards organ donation and associated factors among patient attendants at St Paul’s Hospital Millennium Medical College.

METHODS: A hospital based cross sectional study was conducted from March 1st to May 31, 2019, at St. Paul’s Hospital Millennium Medical College. Descriptive statistics is presented with frequency tables and figures. Associated factors were assessed using Binary logistic regression, where odds ratio, P-value and 95% CI for odds ratio was used for testing significance and interpretation of results.

RESULTS: A total of 414 patient attendants participated in the study. The study showed that only 44 (10.6%) of the study participants had good knowledge about organ donation and sex was significantly associated with knowledge (AOR=2.127 95% CI: 1.036, 4.368). It is also found that 219 (52.9%) of the study participants had favorable attitude and more than one source of information and education for secondary school complete and were found to be significantly associated with attitude towards organ donation.

CONCLUSIONS: Knowledge about organ donation was found to be poor and attitude towards organ donation was found to be unfavorable among patient attendants at SPHMMC. We recommend to aware the general public about the benefits of organ donation using multiple Medias and at all educational level.

KEY WORDS: Knowledge, Attitude, kidney donation, cross sectional study, Logistic Regression, Ethiopia

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KNOWLEDGE AND ATTITUDE TOWARDS ORGAN DONATION AMONG PATIENT ATTENDANTS AT ST. PAUL’S HOSPITAL

MILLENNIUM MEDICAL COLLEGE, ADDIS ABABA, ETHIOPIAWubshet Jote(MD) , Berhanu worku(MD) ,Tigist Workneh (MD)

,Mahteme Bekele (MD)

INTRODUCTION: Kidney transplantation is the gold standard method of management for ESRD. Making transplant service more available depends on the available organ donors’ pool, Most countries are increasing the trend of kidney donation by informing the public Objective: The aim of this study was to assess knowledge and attitude towards organ donation and associated factors among patient attendants at St Paul’s Hospital Millennium Medical College.

METHODS: A hospital based cross sectional study was conducted from March 1st to May 31, 2019, at St. Paul’s Hospital Millennium Medical College. Descriptive statistics is presented with frequency tables and figures. Associated factors were assessed using Binary logistic regression, where odds ratio, P-value and 95% CI for odds ratio was used for testing significance and interpretation of results.

RESULTS: A total of 414 patient attendants participated in the study. The study showed that only 44 (10.6%) of the study participants had good knowledge about organ donation and sex was significantly associated with knowledge (AOR=2.127 95% CI: 1.036, 4.368). It is also found that 219 (52.9%) of the study participants had favorable attitude and more than one source of information and education for secondary school complete and were found to be significantly associated with attitude towards organ donation.

CONCLUSIONS: Knowledge about organ donation was found to be poor and attitude towards organ donation was found to be unfavorable among patient attendants at SPHMMC. We recommend to aware the general public about the benefits of organ donation using multiple Medias and at all educational level.

KEY WORDS: Knowledge, Attitude, kidney donation, cross sectional study, Logistic Regression, Ethiopia

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GIANT BLADDER STONE IN A YOUNG MAN Seid Mohammed (MD), Habtemariam Demoz (MD, MPH) ABSTRACT

Bladder stones heavier than 100 gms are defined as giant bladder stones. Bladder stones occur more frequently in men compared to women. The disease is frequently manifested clinically with hematuria, recurrent urinary tract infection or urine retention. In this article, a 37-year-old man who presented with LUTS symptoms ,urgency ,urge incontinence and intermittent hematuria was found to have a giant bladder stone measuring around 16cmx11cmx8cm in size, weight of 1,040gram is presented.

KEY WORDS: Young man, giant bladder stone, cystolithotomy

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HIV INFECTION: IT’S IMPACT ON PATIENTS WITH APPENDICITIS IN BOTSWANA Alemayehu Ginbo Bedada, MD; Marvin Hsiao, MD

PhD; Georges Azzie, MD Abstract

BACKGROUND: To compare the presentation, management, and outcome of HIV positive patients with appendicitis to those of HIV negative patients with appendicitis. Summary Background Data: Literature is limited regarding the impact of HIV infection on patients with appendicitis.

METHODS: A retrospective review of patients with appendicitis and known HIV status admitted to Princess Marina Hospital, Gaborone, Botswana, aged 13 years and greater was performed from January 2013 to December 2015. Data on patient demographics, presentation, laboratory findings, management and outcomes were analyzed.

RESULTS: A total of 295 patients with appendicitis and known HIV status were identified. 119(40.3%) were HIV positive. The median[IQR] ages for HIV positive and HIV negative patients were 34[29-42] and 26[20-33] years respectively. The male to female ratio for the same two groups were 0.8:1 and 1.4:1 respectively. Presenting symptoms, signs, and white blood cell count were similar in both groups. HIV positive patients had significantly higher overall (4.2% vs 0.0%, p=0.010) and post-operative (4.4% vs 0.0%, p=0.024) mortality rates. There was no significant difference in the total complication rate between HIV positive and HIV negative patients (13.2% vs 7.9%, p=0.192). Compared to HIV positive patients with a CD4 count ≥200, patients with a CD4 count <200 have a significantly higher postoperative mortality rate (17.6% vs 1.4%, p=0.023) and a trend towardsa higher total post-operative complication rate (31.3% vs 10.8%, p=0.054).

CONCLUSION: Within our setting, HIV infection, particularly with a CD4<200, was correlated with significantly higher mortality inpatients with acute appendicitis. Key words: Appendicitis, HIV infection, outcome

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HIV INFECTION: IT’S IMPACT ON PATIENTS WITH APPENDICITIS IN BOTSWANA Alemayehu Ginbo Bedada, MD; Marvin Hsiao, MD

PhD; Georges Azzie, MD Abstract

BACKGROUND: To compare the presentation, management, and outcome of HIV positive patients with appendicitis to those of HIV negative patients with appendicitis. Summary Background Data: Literature is limited regarding the impact of HIV infection on patients with appendicitis.

METHODS: A retrospective review of patients with appendicitis and known HIV status admitted to Princess Marina Hospital, Gaborone, Botswana, aged 13 years and greater was performed from January 2013 to December 2015. Data on patient demographics, presentation, laboratory findings, management and outcomes were analyzed.

RESULTS: A total of 295 patients with appendicitis and known HIV status were identified. 119(40.3%) were HIV positive. The median[IQR] ages for HIV positive and HIV negative patients were 34[29-42] and 26[20-33] years respectively. The male to female ratio for the same two groups were 0.8:1 and 1.4:1 respectively. Presenting symptoms, signs, and white blood cell count were similar in both groups. HIV positive patients had significantly higher overall (4.2% vs 0.0%, p=0.010) and post-operative (4.4% vs 0.0%, p=0.024) mortality rates. There was no significant difference in the total complication rate between HIV positive and HIV negative patients (13.2% vs 7.9%, p=0.192). Compared to HIV positive patients with a CD4 count ≥200, patients with a CD4 count <200 have a significantly higher postoperative mortality rate (17.6% vs 1.4%, p=0.023) and a trend towardsa higher total post-operative complication rate (31.3% vs 10.8%, p=0.054).

CONCLUSION: Within our setting, HIV infection, particularly with a CD4<200, was correlated with significantly higher mortality inpatients with acute appendicitis. Key words: Appendicitis, HIV infection, outcome

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ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS BREAST CANCER AND ITS EARLY DETECTION MEASURES AMONG FEMALE STUDENTS OF RIFT VALLEY

UNIVERSITY/Mahteme Bekele(MD), Osman Emam(MD), Misrach Ayalew (MD)

BACKGROUND: Globally cancer is the top leading causes of death. Breast cancer is the most common cancer in women worldwide. Health education and communication have been found to promote health seeking behavioral change with sufficient utilization and compliance to breast cancer prevention and screening strategies. This study was designed to assess knowledge, attitude and practice regarding Breast cancer and its early detection measures among female students of Rift Valley University

METHODOLOGY: A cross-sectional study design was used to select 310 study subjects randomly. Self-administered questionnaires were used to collect information. The collected data were entered into SPSS version 20.Simple statistics such as frequencies, means, and standard deviations were done as appropriate.

RESULT: A total of 310 respondents participated in the study, of these, only 2.8% of them had good knowledge about risk factors, signs and symptoms and early detection measures of breast cancer and 59.2% had positive attitude towards breast cancer early detection measures. About 29.4% of the respondents had done breast self-examinations, from these only 6.8% of them practiced monthly. Level of education of the participant, parents’ occupation and program of enrolment were statistically significant association knowledge. Students whose parents’ occupation is health related are more likely to practice BSE than others with AOR (95%CI) 7.654 (1.92, 16.12)CONCLUSION AND RECOMMENDATION: The finding of this study revealed that respondents have poor knowledge of risk factors, early detection measures and early warning signs of breast cancer. Improving women’s awareness and practice mainly through health education should be given emphasis.KEY WORDS: Breast Cancer, cancer prevention, Knowledge about breast cancer, breast cancer early detection

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MANAGING ADULTS WITH PREVIOUSLY TREATED ANORECTAL MALFORMATIONS

Alemayehu Ginbo Bedada(MD), Ann C. Gaffey(MD), Georges Azzie(MD)

ABSTRACTBACKGROUNDAlthough rare, it is not unheard of to encounter patients whose anorectal malformations have been ignored until adulthood in resource-limited environments. However, it is extremely uncommon to be faced with patients whose early primary management was directed toward a permanent stoma. In cases where the proximal rectum is all but sacrificed, the management for definitive repair and reconstitution of intestinal continuity is a challenge. Little information exists in the literature.

METHODSThe management of two adult female patients born with rectovestibular fistulas in a resource-limited environment is reviewed. Their management was complicated by inadequate repair, followed by resection of the distal intestine, and creation of a permanent end stoma. Both patients were seeking definitive repair of the inadequately treated anorectal malformation and reconstitution of intestinal integrity. The existing literature is reviewed.

RESULTSBoth patients are doing well three years after the final surgical interventions. Neither patient has fecal incontinence. One initially had issues with constipation, but has successfully overcome the problem using dietary measures. Neither has issues with the genitourinary system. Review of the literature revealed

numerous articles describing the delayed presentation of patients with anorectal malformations, but none describing this specific group of patients in whom the initial management specifically targeted a permanent stoma.

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MANAGING ADULTS WITH PREVIOUSLY TREATED ANORECTAL MALFORMATIONS

Alemayehu Ginbo Bedada(MD), Ann C. Gaffey(MD), Georges Azzie(MD)

ABSTRACTBACKGROUNDAlthough rare, it is not unheard of to encounter patients whose anorectal malformations have been ignored until adulthood in resource-limited environments. However, it is extremely uncommon to be faced with patients whose early primary management was directed toward a permanent stoma. In cases where the proximal rectum is all but sacrificed, the management for definitive repair and reconstitution of intestinal continuity is a challenge. Little information exists in the literature.

METHODSThe management of two adult female patients born with rectovestibular fistulas in a resource-limited environment is reviewed. Their management was complicated by inadequate repair, followed by resection of the distal intestine, and creation of a permanent end stoma. Both patients were seeking definitive repair of the inadequately treated anorectal malformation and reconstitution of intestinal integrity. The existing literature is reviewed.

RESULTSBoth patients are doing well three years after the final surgical interventions. Neither patient has fecal incontinence. One initially had issues with constipation, but has successfully overcome the problem using dietary measures. Neither has issues with the genitourinary system. Review of the literature revealed

numerous articles describing the delayed presentation of patients with anorectal malformations, but none describing this specific group of patients in whom the initial management specifically targeted a permanent stoma.

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CONCLUSIONAdults with inadequately repaired rectovestibular fistulas whose initial surgical management specifically targets resection of the proximal rectum and creation of a permanent end colostomy are rare. Their management is a challenge, especially in resource-limited environments. When the anorectal malformation is of a favourable type, appropriate investigation coupled with meticulous surgical planning of the definitive repair may yield excellent outcomes.

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APPENDICULO-ILEAL KNOT PRESENTING AT THE THIRDTRIMESTER OF PREGNANCY

Engida Abebe(MD), Ayelign Tsehay(MD), Befekadu Lemu(MD), Kirubel Abebe(MD),Sultan Redi(MD)

Though appendicitis is the most common cause of acute abdomen, the vermiform appendix as a cause of small bowel obstruction is a rarity. The inflamed appendix can cause obstruction by making a knot around the small bowel. There are only few case reports on Appendico-ileal knotting (AIK). We have not found any report on AIK causing small bowel obstruction during pregnancy. The diagnosis of acute abdomen in pregnancy is difficult due to the accompanying anatomic and physiologic changes. Because obstruction due to AIK present like any other cause of obstruction diagnosing the condition pre-operatively is uncommon. Here, we report 30 years old Gravida 9, Para 8 women who presented with cardinal symptoms of small bowel obstruction at term and found to have AIK intra-operatively. The challenge of difficulty in making the diagnosis and management options are discussed

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APPENDICULO-ILEAL KNOT PRESENTING AT THE THIRDTRIMESTER OF PREGNANCY

Engida Abebe(MD), Ayelign Tsehay(MD), Befekadu Lemu(MD), Kirubel Abebe(MD),Sultan Redi(MD)

Though appendicitis is the most common cause of acute abdomen, the vermiform appendix as a cause of small bowel obstruction is a rarity. The inflamed appendix can cause obstruction by making a knot around the small bowel. There are only few case reports on Appendico-ileal knotting (AIK). We have not found any report on AIK causing small bowel obstruction during pregnancy. The diagnosis of acute abdomen in pregnancy is difficult due to the accompanying anatomic and physiologic changes. Because obstruction due to AIK present like any other cause of obstruction diagnosing the condition pre-operatively is uncommon. Here, we report 30 years old Gravida 9, Para 8 women who presented with cardinal symptoms of small bowel obstruction at term and found to have AIK intra-operatively. The challenge of difficulty in making the diagnosis and management options are discussed

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GIANT APPENDICOLITHIASIS PRESENTING WITH CHRONIC ABDOMINAL PAIN AND MASS: A CASE REPORT

Engida Abebe(MD), Kirubel Abebe(MD)

BACKGROUND: Appendicitis is the most common cause of acute abdomen. The diagnosis of appendicitis can be easy when it presents with the classical symptoms or is very challenging when present with atypical presentation. Around 20-30% of patients operated on for appendicitis have appendicolithiasis. Appendicolithiasis are usually small in size, and are called giant when more than 2cm in size.

CASE DETAIL: A 36 years old man was referred from a district hospital with a diagnosis of cecal cancer. His complaints were right lower quadrant (RLQ) abdominal mass of 03 months and pain of 18 months duration. Colonoscopy was normal but abdominal CT showed a RLQ mass with a dense radio-opaque shadow at its center.

CONCLUSIONS: Giant appendicolith is a rare condition. A high index of suspicion and careful review of imaging findings is the key in early diagnosis and improved patient outcomes.KEYWORDS; Appendicitis, Appendicolithiasis, Appendiceal mass, Giant appendicolithiasis, Ethiopia

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EVALUATION OF ONE WEEK BLOCK ESSENTIAL SURGICAL SKILLS COURSE FOR YEAR V MEDICAL STUDENTS AT SPHMMC

Mekdim Tadesse Siyoum.MD.MHPE.

BACKGROUND: The use of simulation labs in medical schools with competency based curricula is practiced widely around the world, and especially so for surgical skills acquisition. Saint Paul Hospital Millennium Medical College (SPHMMC)is using, Essential Surgical Skills (ESS) curriculum designed by a Canadian charity organization called Canadian Network for International Surgery (CNIS). The ESS curriculum has been serving for the past 22 years despite a shift of surgical curriculum and practice in the country currently.

OBJECTIVES: To explore the ESS curriculum implementation and whether it accordance with the curriculum of the college and the scope of work of general practitioner set by the Ethiopian ministry of health (MoH).

METHODS: A descriptive qualitative study and quantitative methods at Saint Paul hospital millennium medical college in 2018. The logic model will be used as a framework. The survey questions were entered into epi- info, data cleaned and analyzed using SPSS 20 frequencies and cumulative frequencies were run for the descriptive analysis. Qualitative data audio recorded, the part taken in Amharic was, transcribed and translated. During data collection themes and categories were identified to facilitate analysis and analyzed manually. Overarching themes and selected exemplary quotations were selected by investigator.

RESULTS: The content and timing of the ESS course doesn’t align with the SPHMMC curriculum and the SOP of GPs set by the Food medicine and health administration and control authority of Ethiopia (MOH)

CONCLUSIONS AND RECOMMENDATIONS; The ESS course needs to be revised thru discussion among all stakeholders aligned with the SPHMMC curriculum and set SOP for GPs.

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EVALUATION OF ONE WEEK BLOCK ESSENTIAL SURGICAL SKILLS COURSE FOR YEAR V MEDICAL STUDENTS AT SPHMMC

Mekdim Tadesse Siyoum.MD.MHPE.

BACKGROUND: The use of simulation labs in medical schools with competency based curricula is practiced widely around the world, and especially so for surgical skills acquisition. Saint Paul Hospital Millennium Medical College (SPHMMC)is using, Essential Surgical Skills (ESS) curriculum designed by a Canadian charity organization called Canadian Network for International Surgery (CNIS). The ESS curriculum has been serving for the past 22 years despite a shift of surgical curriculum and practice in the country currently.

OBJECTIVES: To explore the ESS curriculum implementation and whether it accordance with the curriculum of the college and the scope of work of general practitioner set by the Ethiopian ministry of health (MoH).

METHODS: A descriptive qualitative study and quantitative methods at Saint Paul hospital millennium medical college in 2018. The logic model will be used as a framework. The survey questions were entered into epi- info, data cleaned and analyzed using SPSS 20 frequencies and cumulative frequencies were run for the descriptive analysis. Qualitative data audio recorded, the part taken in Amharic was, transcribed and translated. During data collection themes and categories were identified to facilitate analysis and analyzed manually. Overarching themes and selected exemplary quotations were selected by investigator.

RESULTS: The content and timing of the ESS course doesn’t align with the SPHMMC curriculum and the SOP of GPs set by the Food medicine and health administration and control authority of Ethiopia (MOH)

CONCLUSIONS AND RECOMMENDATIONS; The ESS course needs to be revised thru discussion among all stakeholders aligned with the SPHMMC curriculum and set SOP for GPs.

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EUTILITY AND EFFECTIVENESS OF ULTRASOUND GUIDED SUPRACLAVICULAR LIMB BLOCK AT SODDO CHRISTIAN

HOSPITAL, WOLAITTA ETHIOPIA”Abenezer Iyassu, MD, Shewalul Teketel, MSC, David Jeffcoach, MD,

Gezahegne Tilahun, MD and Andrew Chew, MD

BACKGROUND: Ultrasound guided (USG) brachial plexus block first started in the early 1990’s and it is becoming more widespread and practical in upper limb surgery. However, in a survey of Ethiopian anesthesia providers by Merga Haile in 2014, the reported use of USG regional anesthesia amongst 105 anesthetists in 22 public Ethiopian hospitals was zero. The aim of this study is to evaluate the utility and effectiveness of USG supraclavicular limb block at Soddo Christian Hospital.

METHODS: This is a prospective observational study done from 2017 to 2019. Contraindication to limb blocks were patients with a preoperative neurological deficiency from trauma and they were excluded from the study. Time required to perform the block, duration of the surgical procedure, complications, patient’s self-reported pain score using the visual analog system (VAS), qualification of anesthetist and the surgeon’s evaluation of the block were studied. Stata is used for data analysis.

RESULTS: From 2017 to 2019 480 consecutive blocks were performed and included in the study. Block procedure time ranged from 2 minutes to 20 minutes with a mean of 5.3 minutes. Surgical procedure time ranged from 15 minutes to 410 minutes with a mean of 118 minutes. 90% of the patients experienced a pain free procedure recording a 0 VAS score. There was only one reported complication. One patient had a small pneumothorax which did not require intervention. Surgeon’s evaluation was excellent for 91% of the blocks. Various levels of anesthesia qualification performed the blocks - 47% were performed by BSc, 34% by Msc and 18% by anesthesia students under supervision. CONCLUSION: USG limb block is found to be safe, highly effective, and widely accepted by both the patient and the operating surgeon. USG guided supraclavicular blocks can be performed and taught by competent anesthesia providers of varying qualifications. Dissemination of this technique should be facilitated in this country.

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PRIVATE WING ADMISSION PATTERN AND EXTENT OF RESIDENT INVOLVEMENT IN PRIVATE WING PROCEDURES:

EXPERIENCE FROM T ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE, ADDIS ABABA-ETHIOPIA

Mahteme Bekele Muleta MD

BACKGROUND:-The African continent faces a health crisis occasioned by very low funding for health services and deterioration of health service infrastructure undermining both training and service provision. Establishment of private wings in public hospitals is one aspect of the Ethiopian government’s health sector financial reform program which was launched in 2008. The setup is meant to improve the quality and timeliness of services.

OBJECTIVE:-This study aimed to document the experience of private wing admission and extent of resident involvement in private wing procedure.

METHODOLOGY:- A hospital based retrospective review of surgical procedures performed from September 2013 to August 2016. 4995 patients were admitted and procedure performed on elective bases. The data was collected by structured questionnaire and analyzed using SPSS version 20.1. RESULT:- 4995 patients were admitted and operated in the private wing out of which 56.7% were females and 43.3% were males. Cholelithiasis is the leading cause of admission accounting to 44.9% of the general surgery admission followed by thyroid pathologies and hernias. BPH is the leading cause of admission followed by urolithiasis and urethral stricture in the urology unit. Residents have been involved in 62.7% private wing procedures. These procedures ranges from excision of soft tissue mass to abdomenoperinial resection (APR)CONCLUSION–Cholelithiasis, thyroid pathologies and hernias are common surgical pathologies threated in the private wing. Surgical residents are the primary assistant in most procedures. The private wing admission has opened a new window of opportunity addressing the increased demand of surgical service and increased the opportunity of surgical residents’ exposure to variety of surgical procedures.KEY WORDS: Private wing, surgical admission, resident involvement

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PRIVATE WING ADMISSION PATTERN AND EXTENT OF RESIDENT INVOLVEMENT IN PRIVATE WING PROCEDURES:

EXPERIENCE FROM T ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE, ADDIS ABABA-ETHIOPIA

Mahteme Bekele Muleta MD

BACKGROUND:-The African continent faces a health crisis occasioned by very low funding for health services and deterioration of health service infrastructure undermining both training and service provision. Establishment of private wings in public hospitals is one aspect of the Ethiopian government’s health sector financial reform program which was launched in 2008. The setup is meant to improve the quality and timeliness of services.

OBJECTIVE:-This study aimed to document the experience of private wing admission and extent of resident involvement in private wing procedure.

METHODOLOGY:- A hospital based retrospective review of surgical procedures performed from September 2013 to August 2016. 4995 patients were admitted and procedure performed on elective bases. The data was collected by structured questionnaire and analyzed using SPSS version 20.1. RESULT:- 4995 patients were admitted and operated in the private wing out of which 56.7% were females and 43.3% were males. Cholelithiasis is the leading cause of admission accounting to 44.9% of the general surgery admission followed by thyroid pathologies and hernias. BPH is the leading cause of admission followed by urolithiasis and urethral stricture in the urology unit. Residents have been involved in 62.7% private wing procedures. These procedures ranges from excision of soft tissue mass to abdomenoperinial resection (APR)CONCLUSION–Cholelithiasis, thyroid pathologies and hernias are common surgical pathologies threated in the private wing. Surgical residents are the primary assistant in most procedures. The private wing admission has opened a new window of opportunity addressing the increased demand of surgical service and increased the opportunity of surgical residents’ exposure to variety of surgical procedures.KEY WORDS: Private wing, surgical admission, resident involvement

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‘THE GOOD, THE BAD & THE BETTER’ QUALITY OF COSECSA TRAINING IN ETHIOPIA:

Tigistu Adamu (MD)

ABSTRACT: COSECSA provides a comprehensive training programme for trainees at 113 COSECSA accredited training hospitals across 19 countries. Training programmes are led by more than 150 COSECSA Accredited Trainers and 28 Master Trainers. The ‘college with out walls’ is a promising new vision for training in Africa, the implementation in Ethiopia may need a revision, given the limited interaction between the trainees, the challenges of connectivity outside major academic institutions and the limited support and supervision from the master trainers. The trainees plan to 1) share brief introduction of the COSECSA training and fellowship for interested residents and consultants 2) provide Ethiopia specific feedback from the current trainees perspective 3) Creat opportunity for accredited trainers to share insight on how to improve the quality of training.

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PATTERNS, EPIDEMIOLOGY AND MANAGEMENTS OF BLUNT ABDOMINAL TRAUMA PATIENTS AT SINGLE HOSPITAL IN A

RESOURCE LIMITED AREA, SODDO, ETHIOPIATsegaye Woldegiorgis, MD, Andrew Chew, MD, Gezahegne Tilahun,

MD, and David Jeffcoach, MD

INTRODUCTION: Abdominal trauma is a major public health problem for all nations and all socioeconomic strata. Abdomen is the third most common injured region of the body. And from which, blunt abdominal trauma is often missed because clinical signs are less obvious. This study was designed to determine the incidence, patterns, management and outcomes of blunt abdominal injuries in trauma patients at our hospital.

METHODS: This is retrospectives review of prospectively collected data from a trauma registry for all blunt abdominal trauma patients admitted to Soddo Christians hospital January, 2016 to December, 2018.

RESULTS: Total of 121 patients were included in the study. M:F ratio is 4.5:1. The majority of the patients are male 99(81.85) and age less than 40 years 105(86.7%). The road traffic accident is the major cause blunt abdominal injury. 43(35.5%) patients have polytrauma.77 patients (63.6%) are managed by non-operative management. The common surgery done in blunt abdominal trauma patients are exploratory laparotomy for splenectomy 15(12.4%), exploratory laparotomy with packing 10(8.3%), bladder repair 05(4.1%) and jejunum repair 05(4.1%). Inpatient hospital mortality is 13.2% (16). From which,14 patients (87.5%) sustained trauma by road traffic accident and 10 patients (62.5%) have polytrauma.

CONCLUSIONS: The majority of our patients were male and aged <40 years, which has significant economic impacts both at a personal or family level as well as on society as a whole. These consequences are particularly magnified in resource poor countries such as Ethiopia. Blunt abdominal trauma is mostly managed non-operatively. Poor outcome is significantly associated with cause of trauma (road traffic accident) and type of trauma (polytrauma). Prevention, pre-hospital care and early transfer to hospital are essential to decrease morbidity and mortality of blunt abdominal trauma.

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PATTERNS, EPIDEMIOLOGY AND MANAGEMENTS OF BLUNT ABDOMINAL TRAUMA PATIENTS AT SINGLE HOSPITAL IN A

RESOURCE LIMITED AREA, SODDO, ETHIOPIATsegaye Woldegiorgis, MD, Andrew Chew, MD, Gezahegne Tilahun,

MD, and David Jeffcoach, MD

INTRODUCTION: Abdominal trauma is a major public health problem for all nations and all socioeconomic strata. Abdomen is the third most common injured region of the body. And from which, blunt abdominal trauma is often missed because clinical signs are less obvious. This study was designed to determine the incidence, patterns, management and outcomes of blunt abdominal injuries in trauma patients at our hospital.

METHODS: This is retrospectives review of prospectively collected data from a trauma registry for all blunt abdominal trauma patients admitted to Soddo Christians hospital January, 2016 to December, 2018.

RESULTS: Total of 121 patients were included in the study. M:F ratio is 4.5:1. The majority of the patients are male 99(81.85) and age less than 40 years 105(86.7%). The road traffic accident is the major cause blunt abdominal injury. 43(35.5%) patients have polytrauma.77 patients (63.6%) are managed by non-operative management. The common surgery done in blunt abdominal trauma patients are exploratory laparotomy for splenectomy 15(12.4%), exploratory laparotomy with packing 10(8.3%), bladder repair 05(4.1%) and jejunum repair 05(4.1%). Inpatient hospital mortality is 13.2% (16). From which,14 patients (87.5%) sustained trauma by road traffic accident and 10 patients (62.5%) have polytrauma.

CONCLUSIONS: The majority of our patients were male and aged <40 years, which has significant economic impacts both at a personal or family level as well as on society as a whole. These consequences are particularly magnified in resource poor countries such as Ethiopia. Blunt abdominal trauma is mostly managed non-operatively. Poor outcome is significantly associated with cause of trauma (road traffic accident) and type of trauma (polytrauma). Prevention, pre-hospital care and early transfer to hospital are essential to decrease morbidity and mortality of blunt abdominal trauma.

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IMPACT OF FALL RELATED TRAUMA IN SOUTHERN ETHIOPIALeul Shigut, MD, Andrew Chew, MD, Gezahegne Tilahun, MD, and

David Jeffcoach, MD

BACKGROUND: Soddo Christian Hospital cares for a large volume of trauma victims in our region. It may come as a surprise that the third leading cause of unintentional injury-related death in the U.S.A. is falls. There is a dearth of information regarding the impact and burden of falls in Southern Ethiopia. This study was done to assess the prevalence and overall impact of fall accidents treated at Soddo Christian hospital.

METHOD: A retrospective review of prospectively collected trauma registry data was performed from June 1, 2016 – May 31, 2019. Only patients requiring in-patient care were included. Patient records were analyzed to elaborate the demography, mechanism of injury, degree and pattern of injury, and morbidity and mortality from slip, trip and fall accidents. Statistics and data analysis software STATA version 14.0 was used for analysis.

RESULTS: Of over 4000 trauma admissions, falls were responsible for 720 admissions (18%). Men accounted for 502 (70%) while women made up 218 (30%) of the patients. Age ranged from 1-93, with highest frequency (25%) of falls observed at age group of 15-30 years. Farmers and students had the highest frequency of falls observed each making up 24% of the population. The patients had to travel 150km on average to get to the hospital and they took an average of 11 days to reach the hospital. 176 (25%) of the patients came from their home, 63 (9%) came straight from trauma scene while 475 (66%) were referred from other health centers/hospitals. 81 (11%) of patients had traumatic brain injury (TBI) of which it was severe (GCS ≤8) in 19 patients, moderate (GCS 9-12) in 32 and remainder was mild. .

In this patient population there were 66 skull fractures, 29 maxillofacial fractures and 143 patients with intracranial hemorrhage. 11 patients had concomitant chest injury. Extremity injury was the most common associated injury with fractures found in 323 of the patients while 32 patients sustained extremity dislocations. The average length of stay was 9.4 days and there were 8 deaths (1%).

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CONCLUSION: Given that nearly 20% of all trauma admissions are from fall accidents only highlights the verity that we should be focusing on the impact fall accidents has on our community. WHO reports that less than half of patients with fall accidents seek medical attention, thus we might be seeing only the tip of the ice berg. It is concerning that the most frequently affected age group is also the most economically productive group coupled with 6,822 cumulative days spent in our hospital, we can safely argue that the price of morbidity from fall accidents is well beyond what we can afford to pay as a community. More effort should be placed on fall awareness and preventive modalities

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CONCLUSION: Given that nearly 20% of all trauma admissions are from fall accidents only highlights the verity that we should be focusing on the impact fall accidents has on our community. WHO reports that less than half of patients with fall accidents seek medical attention, thus we might be seeing only the tip of the ice berg. It is concerning that the most frequently affected age group is also the most economically productive group coupled with 6,822 cumulative days spent in our hospital, we can safely argue that the price of morbidity from fall accidents is well beyond what we can afford to pay as a community. More effort should be placed on fall awareness and preventive modalities

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PREVALENCE OF DEPRESSION AND ANXIETY AND ASSOCIATED FACTORS AMONG PATIENTS VISITING ORTHOPAEDIC

OUTPATIENT CLINIC AT TIKUR ANBESSA SPECIALIZED HOSPITAL, ADDIS ABABA, ETHIOPIA, 2017

Mengesha Srahbzu(MD), Niguse Yigizaw(MD), Tolesa Fanta(MD), Dawit Assefa(MD), Enguday Tirfeneh(MD)

ABSTRACTINTRODUCTION: - Orthopaedic Trauma exerts a holistic influence on survivors’ physical health including a range of mental health problems which interfere with survivors’ recovery. Psychiatric disorders and behavioral disturbances are reported to be 3-5 times more common among people with injuries and are predictor of poor outcome and ongoing disability. Therefore, assessing depression and anxiety among orthopedic trauma patients play a vital role in implementing further interventions.

OBJECTIVE: To assess the prevalence of depression and anxiety and associated factors among patients visiting orthopaedic outpatient clinic at Tikur Anbessa specialized Hospital, Addis Ababa, Ethiopia, 2017 Methods: Institutional based cross-sectional study was conducted at Tikur Anbessa specialized hospital from May 29-June 30, 2017. Hospital anxiety and depression scale was used to assess anxiety and depression by using face to face interview. Systematic sampling technique was used to select a total of 407participants. Data has been analyzed using SPSS 20. Bivariate and multivariate logistic regression was done to identify associated factors. Variables with p-value <0.05 have been considered as statistically significant.

RESULT: prevalence of depression and anxiety were 36.1% and 39.8% respectively. Being female (AOR=2.3595%CI (1.48,3.72)), poor social support (AOR=2.5195%CI (1.30,4.85)), developing complication (AOR=1.9195%CI (1.07,3.52)), presence of amputation (AOR=3.6495%CI (1.60,8.24)) and having pain (AOR=2.0295%CI (1.24,3.30)) for depression and being female (AOR=1.9995%CI(1.11,3.57)), having chronic medical illness (AOR=3.0795%CI(1.36,6.92)), having family history of mental illness (AOR=2.24 95%CI (1.05,5.4.91)), lower extremity injury (AOR=2.93 95%CI (1.38,6.21)) and having severe pain

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(AOR=2.75 95%CI (1.32,5.74)) for anxiety had significant association at p–value <0.05.

CONCLUSION AND RECOMMENDATION; prevalence of depression and anxiety were high. Being female, having poor social support, developing complication, presence of amputation and having pain for depression; and being female, having chronic medical illness, having family history of mental illness, lower extremity injury and having severe pain for anxiety were significantly associated factors. It is good if clinicians give emphasis for orthopedic patients especially for females and with chronic medical illness.

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(AOR=2.75 95%CI (1.32,5.74)) for anxiety had significant association at p–value <0.05.

CONCLUSION AND RECOMMENDATION; prevalence of depression and anxiety were high. Being female, having poor social support, developing complication, presence of amputation and having pain for depression; and being female, having chronic medical illness, having family history of mental illness, lower extremity injury and having severe pain for anxiety were significantly associated factors. It is good if clinicians give emphasis for orthopedic patients especially for females and with chronic medical illness.

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NEUROLOGICAL IMPROVEMENT AFTER CORTICOTOMY AND EVACUATION OF ICH DUE TO HEMORRHAGIC STROKE: A CASE

REPORT FROM WOLAITTA SODDO UNIVERSITY HOSPITAL (OTTONA HOSPITAL);

Tamrat Bugie (MD),Sherefa Hussien (MD)

INTRODUCTION Intracerebral hemorrhage (ICH) is a hemorrhage within the brain parenchyma. It is the second most common form of stroke (15-30% of strokes), but the most deadly one. The volume of the hematoma correlates highly with morbidity and mortality. The usefulness of surgery is still controversial but seems limited to some cerebellar hemorrhages and select supratentorial hemorrhages that come within 1cm of the cortical surface. It may lower morbidity from rebreeding (especially if aneurysms or AVM are identified as the cause of ICH), edema or mass effect of the hematoma (unproven) but rarely causes neurologic improvement. Meta-analysis yield inconclusive or conflicting results. In our case a 65 years old male patient presented with sudden onset of failure to talk and move right side of his body. Later brain CT has shown 65cc ICH in the parietal lobe with mass effect on ventricles and midline shift of 7mm. mini-craniotomy and corticotomy was done and around 70ml clotted blood was evacuated.

CASE PRESENTATION A 65 years old male patient presented to medical emergency OPD 24 hours after experiencing sudden onset of failure to communicate and move right side of his body (both upper and lower limbs). He had severe global type headache since 2 weeks prior to current compliant for which he was taking pain killer drugs. He has no any noticed history of hypertension, diabetes mellitus and longstanding liver or renal problem. He has no history of smoking or alcohol consumption.

On arrival his BP = 150/90mmHg, PR = 108, RR= 20 SPO₂ = 96%. His conjunctiva is pink and no icterus of sclera. No remarkable physical finding detected in respiratory, cardiovascular, GI or genitourinary system. CNS examination showed GCS of 10 with motor aphasia. Power

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is zero in right upper and lower extremities and five in the left upper and lower limbs. Pupil is midsized and sluggish in the left side but normal in the right side.

With assessment of Broca’s aphasia and right side hemiplegia secondary to possible hemorrhagic stroke the patient was put on medical management and brain CT taken 2 days later showed around 65ml ICH in the left parietal lobe with some edema, mass effect on the ventricles and midline shift of 7mm to the right side. With this finding the patient was transferred to surgical side for possible surgical management.

Mini-craniotomy was done on the left parietal lobe, around 2cm incision was made on the dura, 1cm corticotomy was done and around 70ml clotted blood was evacuated. On the immediate postoperative day aphasia has disappeared and patient has started to talk. On the 3rd postoperative day power on the affected lower limb increased to 1 and the patient has gained power of 3 on this limb on the 5th postoperative day. There is no change on the upper limb of the affected side. The patient is currently on 7th postoperative date in a better condition.

DISCUSSION It has been long hypothesized and studied in pre-clinical models that surgical evacuation of an ICH aids in removing both the mass effect of the primary injury along with the reduction in the secondary injury associated with clot- induced blood-brain barrier breakdown, the release of inflammatory cytokines and the development of perihematomal edema. But, two randomized clinical trials, STITCH 1 and STITCH 2 failed to prove this theory due to their inability to strongly demonstrate a statistically significant difference in those offered surgical evacuation through standard craniotomy compared with medical, even in those with superficially located lesions. As we can see from case presentation part, this patient has got better neurological outcome with open surgical drainage against all the odds written in the literature. This ignites us to consider surgical drainage of ICH in critically selected patients. With this result clinical trial can be arranged for further study.

CONCLUSION The presentation of a hemorrhagic stroke is multidimensional due to the size, location and extent of secondary pathological processes

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is zero in right upper and lower extremities and five in the left upper and lower limbs. Pupil is midsized and sluggish in the left side but normal in the right side.

With assessment of Broca’s aphasia and right side hemiplegia secondary to possible hemorrhagic stroke the patient was put on medical management and brain CT taken 2 days later showed around 65ml ICH in the left parietal lobe with some edema, mass effect on the ventricles and midline shift of 7mm to the right side. With this finding the patient was transferred to surgical side for possible surgical management.

Mini-craniotomy was done on the left parietal lobe, around 2cm incision was made on the dura, 1cm corticotomy was done and around 70ml clotted blood was evacuated. On the immediate postoperative day aphasia has disappeared and patient has started to talk. On the 3rd postoperative day power on the affected lower limb increased to 1 and the patient has gained power of 3 on this limb on the 5th postoperative day. There is no change on the upper limb of the affected side. The patient is currently on 7th postoperative date in a better condition.

DISCUSSION It has been long hypothesized and studied in pre-clinical models that surgical evacuation of an ICH aids in removing both the mass effect of the primary injury along with the reduction in the secondary injury associated with clot- induced blood-brain barrier breakdown, the release of inflammatory cytokines and the development of perihematomal edema. But, two randomized clinical trials, STITCH 1 and STITCH 2 failed to prove this theory due to their inability to strongly demonstrate a statistically significant difference in those offered surgical evacuation through standard craniotomy compared with medical, even in those with superficially located lesions. As we can see from case presentation part, this patient has got better neurological outcome with open surgical drainage against all the odds written in the literature. This ignites us to consider surgical drainage of ICH in critically selected patients. With this result clinical trial can be arranged for further study.

CONCLUSION The presentation of a hemorrhagic stroke is multidimensional due to the size, location and extent of secondary pathological processes

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(perihematomal edema, ventricular hemorrhage, hydrocephalus etc.). Though we understand the inherent limitations to an anecdotal case report, we hope that this brings contemplation and consideration in the future trials.

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PENETRATING THORACIC TRAUMA, TO REMOVE OR NOT TO REMOVE THE KNIFE: CASE REPORT

David Jeffcoach, MD

BACKGROUND: Assault accounts for approximately 15% of trauma admissions at Soddo Christian Hospital. Of those, we have an average of 20 penetrating injuries requiring admission annually. With regard to management of thoracic penetrating wounds, there is a common practice to remove knives in the operating theater. Some surgeons even advocate performing surgical thoracotomy to directly visualize the knife being removed. With modern imaging and practice techniques this may not be necessary.

CASE REPORT: A twenty-year-old man transferred from a nearby hospital after knife stab wound to left chest seven hours prior to arrival. He had a chest tube placed at the referring hospital and arrived tachycardic, normotensive and with increased respiratory rate. Intravenous fluids were started. He only had 20 ml of blood from his chest tube and it was in the appropriate position. On X-ray the blade was deep into the left lung near the cardiac silhouette. There was no pericardial fluid on cardiac ultrasound. The knife was then removed at bedside in the emergency department with direct surgical supervision. The wound was cleaned and closed. The patient was discharged three days later after chest tube removal.

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PENETRATING THORACIC TRAUMA, TO REMOVE OR NOT TO REMOVE THE KNIFE: CASE REPORT

David Jeffcoach, MD

BACKGROUND: Assault accounts for approximately 15% of trauma admissions at Soddo Christian Hospital. Of those, we have an average of 20 penetrating injuries requiring admission annually. With regard to management of thoracic penetrating wounds, there is a common practice to remove knives in the operating theater. Some surgeons even advocate performing surgical thoracotomy to directly visualize the knife being removed. With modern imaging and practice techniques this may not be necessary.

CASE REPORT: A twenty-year-old man transferred from a nearby hospital after knife stab wound to left chest seven hours prior to arrival. He had a chest tube placed at the referring hospital and arrived tachycardic, normotensive and with increased respiratory rate. Intravenous fluids were started. He only had 20 ml of blood from his chest tube and it was in the appropriate position. On X-ray the blade was deep into the left lung near the cardiac silhouette. There was no pericardial fluid on cardiac ultrasound. The knife was then removed at bedside in the emergency department with direct surgical supervision. The wound was cleaned and closed. The patient was discharged three days later after chest tube removal.

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DISCUSSION: Penetrating thoracic wounds can be challenging. With proper evaluation, ample caution and the use of available imaging some knives can be removed safely at bedside. The key is thorough evaluation and critical thinking.

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SHORT TERM OUTCOME OF SURGERY FOR GASTRIC CANCER IN TWO HOSPITALS IN ADDIS ABABA

Hailu wondimu(MD)

BACKGROUND: There is an abundant literature about gastric cancers in the west and Asia but there are only few literatures from Africa in general and in Ethiopia in particular.

OBJECTIVE: To determine the short term outcome of surgery for gastric cancer and to see the type of cancer and outcome of surgery performed in TASH and Zewditu memorial hospital in one year.

METHOD: All patients operated for gastric cancer by a single upper GI surgeon in one year were analyzed retrospectively.

RESULT: a total of 47 patients were operated. These were 28 male and 19 female patients. Age ranges from 26 to 80 years. Mean and Median age being 53.9 and 50.5(+/- 2.3) respectively. The commonest age groups were 41-50 and 51-60. The commonly performed procedures were distal gastrectomy in 13, a bypass often GJ in 9, total gastrectomy in 8 patients. There were 5 post-operative deaths (one from total gastrectomy).

Adenocarcinoma account the majority (40/47), two were carcinoid tomors and five were GIST.

CONCLUSION: Gastric cancer surgery outcome in TASH and Zewditu is quite acceptable but a proper pre-operative evaluation and patient selection is necessary before undergoing gastrectomy to decrease morbidity and mortality further. A prospective long term study is required. Key words: gastric, cancer, surgery, outcome

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SHORT TERM OUTCOME OF SURGERY FOR GASTRIC CANCER IN TWO HOSPITALS IN ADDIS ABABA

Hailu wondimu(MD)

BACKGROUND: There is an abundant literature about gastric cancers in the west and Asia but there are only few literatures from Africa in general and in Ethiopia in particular.

OBJECTIVE: To determine the short term outcome of surgery for gastric cancer and to see the type of cancer and outcome of surgery performed in TASH and Zewditu memorial hospital in one year.

METHOD: All patients operated for gastric cancer by a single upper GI surgeon in one year were analyzed retrospectively.

RESULT: a total of 47 patients were operated. These were 28 male and 19 female patients. Age ranges from 26 to 80 years. Mean and Median age being 53.9 and 50.5(+/- 2.3) respectively. The commonest age groups were 41-50 and 51-60. The commonly performed procedures were distal gastrectomy in 13, a bypass often GJ in 9, total gastrectomy in 8 patients. There were 5 post-operative deaths (one from total gastrectomy).

Adenocarcinoma account the majority (40/47), two were carcinoid tomors and five were GIST.

CONCLUSION: Gastric cancer surgery outcome in TASH and Zewditu is quite acceptable but a proper pre-operative evaluation and patient selection is necessary before undergoing gastrectomy to decrease morbidity and mortality further. A prospective long term study is required. Key words: gastric, cancer, surgery, outcome

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OUT COME AND ASSOCIATED FACTORS OF PERFORATED PEPTIC ULCER DISEASE AT DESSIE REFERRAL HOSPITAL, NORTH EAST

ETHIOPIAWondwossen Amtataw,Tesfaye Birhan

BACKGROUND: Peptic ulcer perforation is serious complication of peptic ulcer disease with significant morbidity and mortality.

OBJECTIVE: to identify factors associated for operative complication and mortality in patients operated for perforated peptic ulcer (PPU) at Dessie referral hospital.

METHODOLOGY: A retrospective analysis was used to conduct the study by revising three years patient card registry data from June1/ 2016 to June 2019 at DRH and data was collected using data abstracting checklist. Basic descriptive analysis was used for describing the study population in relation to relevant variables. Qui square was used to assess the association between dependent and independent variables.

RESULT: A total of 101 patients were studied. Males outnumbered females by a ratio of 19.6: 1. The mean age of patients was 36.05 ± 16.56 years. A majority of the patients (60%) had a history of gastritis and antacid use. The median duration of illness was 2.5 days. Most perforations were located on the first part of duodenum (92, 92%). The majority of patients, 97 (97.1%) had Graham’s omental patch of the perforations.

There were forty-five post-operative complications recorded in eighteen (18%) patients. Respiratory infections (34.24%), Superficial surgical site infection (28.3%),post-operative collections (17.18%), wound dehiscence (16.15%),acute kidney injury (6.7%) repair site failure (3.7%) and ECF (1%) were the complications recorded. Post-operative complication was significantly associated with age more than 50 years, comorbidity, SBP<90mmHg and presentations after 24hrs (P <0.05).

A total of 4 patients (4%) died at the hospital postoperatively. Mortality was significantly associated with age more than 50 years, comorbid illness and hypotension (P<0.05).

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CONCLUSION: Among the analyzed parameters old age, comorbidity, delayed presentation, and shock having comorbid disease were found to have an effect on morbidity. But only comorbid illness and hypotension were associated with mortality.

KEY WORDS: peptic ulcer, perforation, morbidity, mortality

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CONCLUSION: Among the analyzed parameters old age, comorbidity, delayed presentation, and shock having comorbid disease were found to have an effect on morbidity. But only comorbid illness and hypotension were associated with mortality.

KEY WORDS: peptic ulcer, perforation, morbidity, mortality

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NOVEL METHOD FOR TOTAL EXTRAPERITONEAL (TEP) LAPAROSCOPIC INGUINAL HERNIA REPAIR: CASE REPORT

David Jeffcoach, MD

BACKGROUND: Totally extraperitoneal (TEP) laparoscopic inguinal hernia repair was first pioneered in the early 1990’s. It is touted as having decreased post-operative pain, decreased infection rates, decreased hospital length of stay, and earlier return to daily activities compared to open inguinal hernia repair. It is also reported as having a difficult learning curve given the complexity of anatomy and decreased working space. For this TEP approach, a preperitoneal balloon dissector is commonly used to create the space to access the inguinal anatomy. The lack of balloon in our resource limited setting was first perceived as a deterrent to performing TEP inguinal hernia repair. This case report describes performing a TEP with manual dissection rather than balloon dissection.Case: A 65-year-old man with a history of smoking presented to clinic with several years of left sided groin pain. On exam he was found to have a reducible direct inguinal hernia. Laparoscopic repair was desired but no preperitoneal balloon dissector was available at our hospital. Instead, a 12mm Optiview trochar was used to enter the preperitoneal space posterior to the rectus muscle. It was advanced carefully to dissect between the peritoneum and rectus muscle to the pubic symphysis. Gentle side to side dissection cleared an adequate space to place the additional two trochars. The space was insufflated without difficulty and there was no evidence of bleeding. The additional trochars were placed and the TEP proceeded uneventfully. A 10 x 15 cm polypropylene mesh was tacked in place. The patient recovered well and was discharged the following day.

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DISCUSSION: TEP was performed without balloon dissection with no perceived increase in bleeding or procedure time. Some types of advanced laparoscopic surgery can be done in resource limited settings when creativity is applied.

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DISCUSSION: TEP was performed without balloon dissection with no perceived increase in bleeding or procedure time. Some types of advanced laparoscopic surgery can be done in resource limited settings when creativity is applied.

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APPENDICEAL MUCOCELE: A CASE REPORTMahteme Bekele(MD), Bezawit Demoze(MD) , Bereket

Berhane(MD), Ayelign Tsehaye(MD)

Appendiceal mucocele is a rare disease. It is resulted from accumulation of mucoid material due to obstruction of the lumen. It has multiple pathologic forms and classification is controversial. Recently a consensus reached on the pathologic reporting checklist and classification which is helpful for standardization of diagnosis, management plan and comparison of different centers outcome.

CASE:-We presented a 41 year Ethiopian male patient, who has presented with vague abdominal pain, after imaging study he was diagnosed with appendiceal mucocele. Patient was admitted and counseled about the possibility of Right hemi-colectomy. Laparotomy performed through a vertical mid line incision. Intraoperative finding was tense pear-shaped 10x6cm appendicular mass which contain fluid with 3cm fibrous base with no luminal communication with the cecum and no surrounding tissue infiltration or dissemination of the content to the surrounding (figure2), appendectomy was performed and specimen sent for histopathologic examination. His post- -operative stay was smooth and patient was discharged on the 2nd postoperative day. Histologic examination revealed low grade appendiceal mucinous neoplasm. The presentation, imaging findings, management and histological appearance of the case discussed with review of literature

CONCLUSION:- Appendiceal mucocele is a rare disease .A correct diagnosis before surgery is very important for the selection of surgical technique to avoid severe intraoperative and postoperative complications. Imaging studies should be used extensively for this purpose. Pathologic result will govern further treatment plan and follow up of the patient.

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DELAYED PRESENTATION AND REPAIR OF BOCHDALEK HERNIA: CASE PRESENTATION

David Jeffcoach, MD

BACKGROUND: Bochdalek hernias occur in the posterolateral position of the diaphragm and are one of several types of congenital diaphragmatic hernias. The vast majority of these hernias are diagnosed at birth with significant respiratory distress secondary to pulmonary hypoplasia. Some authors report mortality rates as high as 25-60%. Bochdalek hernias commonly have visceral organs displaced into the thorax but rarely do the liver and kidneys herniate into the chest.

CASE: A fourteen-month-old girl presents for respiratory distress to the emergency department. She has a history of recurrent pneumonia and growth retardation. She was also found to have rickets disease. On chest x-ray there was a significant right sided diaphragmatic hernia that was confirmed by CT scan. Her right kidney, right adrenal gland, right colon, 60% of her liver, and portions of small bowel were located in her right chest. After initiation of treatment for her rickets disease and nutritional optimization over two months she was brought back for definitive repair. She underwent successful transabdominal reduction of her Bochdalek hernia and primary repair of the diaphragm. With adequate mobilization of tissue, she did not require mesh repair of the diaphragmatic defect. She did not require mechanical ventilation post operatively and was discharged on the fifth post-operative day.

DISCUSSION: Although Bochdalek hernias are usually diagnosed in infancy, they can be missed resulting in persistent respiratory complications. Once diagnosed, it is recommended to nutritionally optimize the patient prior to repair.

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DELAYED PRESENTATION AND REPAIR OF BOCHDALEK HERNIA: CASE PRESENTATION

David Jeffcoach, MD

BACKGROUND: Bochdalek hernias occur in the posterolateral position of the diaphragm and are one of several types of congenital diaphragmatic hernias. The vast majority of these hernias are diagnosed at birth with significant respiratory distress secondary to pulmonary hypoplasia. Some authors report mortality rates as high as 25-60%. Bochdalek hernias commonly have visceral organs displaced into the thorax but rarely do the liver and kidneys herniate into the chest.

CASE: A fourteen-month-old girl presents for respiratory distress to the emergency department. She has a history of recurrent pneumonia and growth retardation. She was also found to have rickets disease. On chest x-ray there was a significant right sided diaphragmatic hernia that was confirmed by CT scan. Her right kidney, right adrenal gland, right colon, 60% of her liver, and portions of small bowel were located in her right chest. After initiation of treatment for her rickets disease and nutritional optimization over two months she was brought back for definitive repair. She underwent successful transabdominal reduction of her Bochdalek hernia and primary repair of the diaphragm. With adequate mobilization of tissue, she did not require mesh repair of the diaphragmatic defect. She did not require mechanical ventilation post operatively and was discharged on the fifth post-operative day.

DISCUSSION: Although Bochdalek hernias are usually diagnosed in infancy, they can be missed resulting in persistent respiratory complications. Once diagnosed, it is recommended to nutritionally optimize the patient prior to repair.

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HUGE THYROGLOSSAL DUCT CYST AT THE SUPRA-STERNAL NOTCH

Engida Abebe(MD), Abebe Megersa (MD), and Kirubel Abebe (MD)

Thyroglossal duct cysts (TGDC) are the most common congenital cysts in the neck. TGDC typically present as a midline swelling anywhere between the foramen cecum and the isthmus of the thyroid gland. Majority occurs just below the hyoid bone and those descending below the thyrohyoid membrane are rare. TGDC are usually less than 3 cm in diameter while big cysts are uncommon. We present a 19 years old female patient who presented with giant (12 cm diameter) supra-sternal notch cyst which was diagnosed as TGDC only after histopathology. The rarity of such huge TGDC in such uncommon site, which was misdiagnosed as a retention cyst (Mucocele) made us report this case.

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ORAL HEALTH–RELATED QUALITY OF LIFE OF CHILDREN BORN WITH OROFACIAL CLEFTS IN ETHIOPIA AND THEIR PARENTS

Mekonen Eshete Abebe, Wakgari Deressa, et al

OBJECTIVE: To assess the oral health–related quality of life (OH-RQoL) using a translated standardized measure in an understudied population of Ethiopian children born with orofacial clefts (OFCs) and their parents.Methods: Using a descriptive study design, we assessed the OH-RQoL of 41 patients with OFCs between the ages of 8 and 17 years and their parents. Participants received multidisciplinary cleft care from 2008 to 2016. They completed an Amharic translation of the Child Oral Health Impact Profile (COHIP).

RESULTS: There was strong internal reliability with the translated COHIP for parents and patients. Parents’ COHIP scores ranged from 67 to 186, and patients’ scores were 78 to 190. The mean for patients and parents was 155, indicating good OH-RQoL.

CONCLUSION: The Amharic translation of the COHIP appears appropriate for use with families in Ethiopia. Both parents and patients reported OH-RQoL at similar levels as other international populations.

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ORAL HEALTH–RELATED QUALITY OF LIFE OF CHILDREN BORN WITH OROFACIAL CLEFTS IN ETHIOPIA AND THEIR PARENTS

Mekonen Eshete Abebe, Wakgari Deressa, et al

OBJECTIVE: To assess the oral health–related quality of life (OH-RQoL) using a translated standardized measure in an understudied population of Ethiopian children born with orofacial clefts (OFCs) and their parents.Methods: Using a descriptive study design, we assessed the OH-RQoL of 41 patients with OFCs between the ages of 8 and 17 years and their parents. Participants received multidisciplinary cleft care from 2008 to 2016. They completed an Amharic translation of the Child Oral Health Impact Profile (COHIP).

RESULTS: There was strong internal reliability with the translated COHIP for parents and patients. Parents’ COHIP scores ranged from 67 to 186, and patients’ scores were 78 to 190. The mean for patients and parents was 155, indicating good OH-RQoL.

CONCLUSION: The Amharic translation of the COHIP appears appropriate for use with families in Ethiopia. Both parents and patients reported OH-RQoL at similar levels as other international populations.

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THE ROLE OF ENVIRONMENTAL FACTORS IN THE ETIOLOGY OF NONSYNDROMIC OROFACIAL CLEFTS IN THE ETHIOPIAN

POPULATIONMekonen Eshete (MD), Fikre Abate(MD), Abiye Hailu (MD) et Al

BACKGROUND: Nonsyndromic orofacial clefts (NSOFCs) represent the most common congenital anomalies in the head and neck region. Multiple factors contribute to the occurrence of this anomaly. The etiology of NSOFCs in the Ethiopian population has not been investigated prior to this study.

AIMS OF THE STUDY: To assess the role of maternal environmental factors in the occurrence of NSOFCs in the Ethiopian Population.

METHODS: The authors used unmatched case control study design and evaluated the role of environmental factors to the occurrence of NSOFCs in the Ethiopian population. The participants were recruited from the same institution (Yekatit 12 Hospital Medical College). The authors studied 760 mothers (359 mothers of children born with NSOFCs and 401 mothers of children born without any congenital anomalies). Univariate and multivariate logistic regression analyses were used to calculate relative risk by odds ratio and 95% confidence interval.

RESULTS: Mothers who gave history of bronchial asthma and mothers who were admitted for threatened abortion had a higher risk of delivering a child with NSOFCS P value.0.013; AOR.0.194, 95% CI [0.053–0.712], P value <0.001; AOR. 0.179, 95% CI [0.091–0.352] respectively. Higher number of children with NSOFCs were born to mothers who were exposed to diagnostic X-ray investigation during early pregnancy than those who were not exposed P value 0.048; AOR.0.375, 95% CI [0.142–0.990].

CONCLUSION: Maternal exposure to diagnostic x-ray, maternal chronic illness like bronchial asthma and threatened abortion were found to be associated with the occurrence of NSOFCS in the studied population.

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RATE AND DETERMINANT FACTORS FOR ELECTIVE CASE CANCELATION IN ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL

COLLEGE, ADDIS ABABA, ETHIOPIAMahteme Bekele(MD), Shanko Gebru(MD), Dagmawi Mesi(MD)

BACKGROUND:-Cancellations of planned surgical procedures have been a major and long standing problem for health care organizations across the world. This study aimed to determine the rate and determinant factors for elective case cancelation in St. Paul’s Hospital Millennium Medical College.

METHODS: - A cross sectional study was conducted from March 1, 2018 till February 30, 2019, to determine rate of case cancellation and determinant factors for cancellation. Data was collected by structured questionnaire and entered into SPSS. Descriptive statistic generated in forms of tables, and figures to present the findings of the study.

RESULT: the rate of cancellation during the study period was found to be 8.9%. The highest rate of cancellations was seen in gynecologic surgeries 18.3%. Among the cancelled patients 65.9% were younger than 45, 88% with HCT level of >31 %, 89. 4% no associated comorbidity and 89.8 were ASA class I and II. The highest share of reasons for cancellation was seen in administration related factors making 73.1% out of which time constraint and CSSD problem where the leading reasons.

CONCLUSION: - Most of the cancelled patients were young and fit for both surgery and anesthesia. The most common reason for cancellation was found to be administrative related factors, which are avoidable factors. The hospital and the departments need to consider the factors and plan a strategy to tackle the problem by devising different policy and quality improvement projects

KEY WORDS: - Case Cancellation, Rate of cancellation, Operation theater schedule, reason for cancellation, elective surgical case

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RATE AND DETERMINANT FACTORS FOR ELECTIVE CASE CANCELATION IN ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL

COLLEGE, ADDIS ABABA, ETHIOPIAMahteme Bekele(MD), Shanko Gebru(MD), Dagmawi Mesi(MD)

BACKGROUND:-Cancellations of planned surgical procedures have been a major and long standing problem for health care organizations across the world. This study aimed to determine the rate and determinant factors for elective case cancelation in St. Paul’s Hospital Millennium Medical College.

METHODS: - A cross sectional study was conducted from March 1, 2018 till February 30, 2019, to determine rate of case cancellation and determinant factors for cancellation. Data was collected by structured questionnaire and entered into SPSS. Descriptive statistic generated in forms of tables, and figures to present the findings of the study.

RESULT: the rate of cancellation during the study period was found to be 8.9%. The highest rate of cancellations was seen in gynecologic surgeries 18.3%. Among the cancelled patients 65.9% were younger than 45, 88% with HCT level of >31 %, 89. 4% no associated comorbidity and 89.8 were ASA class I and II. The highest share of reasons for cancellation was seen in administration related factors making 73.1% out of which time constraint and CSSD problem where the leading reasons.

CONCLUSION: - Most of the cancelled patients were young and fit for both surgery and anesthesia. The most common reason for cancellation was found to be administrative related factors, which are avoidable factors. The hospital and the departments need to consider the factors and plan a strategy to tackle the problem by devising different policy and quality improvement projects

KEY WORDS: - Case Cancellation, Rate of cancellation, Operation theater schedule, reason for cancellation, elective surgical case

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PATIENT SATISFACTION WITH EMERGENCY LAPARATOMY SERVICES AND ASSOCIATED FACTORS IN THREE PUBLIC

HOSPITALS IN ADDIS ABABA, ETHIOPIA, 2018:CROSS SECTIONAL STUDY.

Sisay Mengidtu (MD), Ayalew Tizazu (MD)

BACKGROUND: Patient satisfaction represents a balance between the perception and expectation of care received. Evaluating to what extent patients are satisfied with health services is clinically relevant, as satisfied patients are more likely to comply with treatment. Globally, increasing consideration has been given to the assessment of patient satisfaction as method of monitor of the quality of health care provision, however little is known in the context of emergency laparatomy. The study aimed to quantify the association between patient experiences & satisfaction. The rationale of the study is to use the findings to improve emergency laparatomy surgical service delivery.

METHODS: Hospital based quantitative cross-sectional study was conducted in three public hospitals in Addis Ababa from July 1-September 30, 2018. Structured Amharic version questionnaire and checklist used for data collection. All patients who had emergency laparatomy during the study period included. Both univariate analysis & multivariate regressions used to identify the variables which had association with the satisfaction. P-values < 0.05 were considered statistically significant.

RESULTS: In a well-fitting multivariable analysis (R2=0.553 ), variables significantly associated with a higher global satisfaction score were”Confidence and trust in Doctors”(β=9.41, 95% CI 3.89–14.93,p= 0.001), “sufficient information given about treatment”(β= 5.94, 95% CI 1.32–10.54,p= 0.012), “being from the rural area” (β= 8.60, 95% CI 3.32– 13.88,p = 0.002) and having “prior history of surgery” (β = 8.43, 95% CI 3.68–13.17, p = 0.001)CONCLUSION: Patient satisfaction was strongly associated with confidence and trust in doctors and the delivery of sufficient information about condition and treatment.These findings could be utilized to introduce patient satisfaction improvement strategies. Though they are not modifiable, being from the rural area and having previous surgeries have a positive effect on satisfaction in our study.

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QUALITY OF LIFE ASSESMENT IN PATIENTS LIVING WITH STOMA: CROSS-SECTIONAL STUDY.

Tilahun Deresse (MD)Wuletaw Chanie (MD), Yishak Suga (MD)

BACKGROUND: Quality of life (QOL) of patients is affected due to procedures done to treat the disease. A good QOL is essential to achieve a holistic approach in treating patients. Despite efforts to maintain intestinal tissue while treating gastrointestinal diseases, a large number of patients undergo stoma surgery each year. Although exact number of stoma patients in Ethiopia isn’t known; stoma surgery is among the most commonly performed procedure and there is no documented information regarding impact of stoma on their QOL.

OBJECTIVE: To assess stoma related quality of life in patients living with stoma.

MATERIALS AND METHODS: A facility based cross sectional study was done from February 1 to July 31, 2019. A structured questionnaire was used to interview patients and review charts of patients to retrieve information on socio-demographic variables, type and indications of stoma. Stoma related QOL was assessed by the structured questionnaire (QOL-S) adopted from City of Hope and Beckman Research Institute after modifications done to make it in line with Ethiopian set up and approved by the review board of the college.

Statistical analysis: Data was entered, categorized, coded, and summarized using Epi-Info 7.0 and exported to SPSS version 23.In accordance with study objective, descriptive analysis was used and factors described in mean and SD. To test difference between groups chi-square test, independent t test and ANOVA were used. Univariate, bivariate and multiple regression tests were performed to identify predictors of QOL.

RESULTS:The mean score for the overall QOL for stoma patients 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 after surgery and

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QUALITY OF LIFE ASSESMENT IN PATIENTS LIVING WITH STOMA: CROSS-SECTIONAL STUDY.

Tilahun Deresse (MD)Wuletaw Chanie (MD), Yishak Suga (MD)

BACKGROUND: Quality of life (QOL) of patients is affected due to procedures done to treat the disease. A good QOL is essential to achieve a holistic approach in treating patients. Despite efforts to maintain intestinal tissue while treating gastrointestinal diseases, a large number of patients undergo stoma surgery each year. Although exact number of stoma patients in Ethiopia isn’t known; stoma surgery is among the most commonly performed procedure and there is no documented information regarding impact of stoma on their QOL.

OBJECTIVE: To assess stoma related quality of life in patients living with stoma.

MATERIALS AND METHODS: A facility based cross sectional study was done from February 1 to July 31, 2019. A structured questionnaire was used to interview patients and review charts of patients to retrieve information on socio-demographic variables, type and indications of stoma. Stoma related QOL was assessed by the structured questionnaire (QOL-S) adopted from City of Hope and Beckman Research Institute after modifications done to make it in line with Ethiopian set up and approved by the review board of the college.

Statistical analysis: Data was entered, categorized, coded, and summarized using Epi-Info 7.0 and exported to SPSS version 23.In accordance with study objective, descriptive analysis was used and factors described in mean and SD. To test difference between groups chi-square test, independent t test and ANOVA were used. Univariate, bivariate and multiple regression tests were performed to identify predictors of QOL.

RESULTS:The mean score for the overall QOL for stoma patients 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 after surgery and

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only 11% were satisfied with it. None of the study subjects were enrolled in any form of stoma association or stoma support group and only 2 of the subjects have access to formal stoma bag for some time. Univariate analysis indicated that factors such as the 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 QOL and its subscales (P < 0.05). The results of the regression analyses showed that only type of stoma and dietary adjustment due to stoma were statistically significant in predicting patients’ QOL and its subscales (P < 0.05).

CONCLUSIONS: This study demonstrated that, living with stoma has a greater impact on the overall aspect of QOL. There is a definite need of inclusive stoma support groups in all hospitals across the country.

KEY WORDS: Colostomy, Ileostomy, Quality of life, QOL-S, Stoma patients

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THE IMPACT OF A QUALITY IMPROVEMENT PROGRAM ON REDUCING SURGICAL SITE INFECTIONS AND IMPROVED

SURGICAL PATIENT FOLLOW UP; LIFEBOX CLEAN CUT PROGRAM

Natnael Gebeyhu(MD), Nichole Starr(MD), Senait Bitew, Assefa Tesfaye, Jared Forrester(MD), Tadesse Habteyohannes, Ebisa Wayessa(MD), Thomas Weiser(MD), Tihitena Negussie(MD)

Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low resource settings. Clean Cut is a six-month quality improvement program focused on reducing postoperative infectious complications through strengthening adherence to infection prevention standards embedded in the WHO Surgical Safety Checklist. Methods:

Adherence to Clean Cut standards were assessed during a month baseline period and continuously monitored afterwards, with 30-day outcomes obtained for all enrolled patients. After piloting in three hospitals, the implementation strategy was refined and modified through individual interviews and facility-level group meetings with all involved perioperative staff to identify common strengths and weaknesses. Subsequently the program was introduced over six months in two additional Ethiopian hospitals.

RESULTS:The results including the three pilot hospitals and the two after modification hospitals. Modifications included 1) creating a local mentor relationship between a tertiary referral hospital and primary hospital, 2) emphasizing active hospital administration participation and engagement of entire operating room (OR) staff in discussions, 3) establishing a platform for shared learning, and 4) instituting supplementary educational trainings reinforcing critical infection prevention standards.

Compared to baseline (n=368), adherence to standards improved significantly post-program implementation (n=1521). Appropriate use of the WHO Surgical Safety Checklist, proper hand decontamination, sterility indicator use with instruments and surgical linen all improved

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THE IMPACT OF A QUALITY IMPROVEMENT PROGRAM ON REDUCING SURGICAL SITE INFECTIONS AND IMPROVED

SURGICAL PATIENT FOLLOW UP; LIFEBOX CLEAN CUT PROGRAM

Natnael Gebeyhu(MD), Nichole Starr(MD), Senait Bitew, Assefa Tesfaye, Jared Forrester(MD), Tadesse Habteyohannes, Ebisa Wayessa(MD), Thomas Weiser(MD), Tihitena Negussie(MD)

Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low resource settings. Clean Cut is a six-month quality improvement program focused on reducing postoperative infectious complications through strengthening adherence to infection prevention standards embedded in the WHO Surgical Safety Checklist. Methods:

Adherence to Clean Cut standards were assessed during a month baseline period and continuously monitored afterwards, with 30-day outcomes obtained for all enrolled patients. After piloting in three hospitals, the implementation strategy was refined and modified through individual interviews and facility-level group meetings with all involved perioperative staff to identify common strengths and weaknesses. Subsequently the program was introduced over six months in two additional Ethiopian hospitals.

RESULTS:The results including the three pilot hospitals and the two after modification hospitals. Modifications included 1) creating a local mentor relationship between a tertiary referral hospital and primary hospital, 2) emphasizing active hospital administration participation and engagement of entire operating room (OR) staff in discussions, 3) establishing a platform for shared learning, and 4) instituting supplementary educational trainings reinforcing critical infection prevention standards.

Compared to baseline (n=368), adherence to standards improved significantly post-program implementation (n=1521). Appropriate use of the WHO Surgical Safety Checklist, proper hand decontamination, sterility indicator use with instruments and surgical linen all improved

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(Table 1). Inpatient surgical site infections (SSI) significantly decreased (6.5% to 2.3%, p=0.02).

There was a nonsignificant decrease in all inpatient infectious complications (9.8% to 5.4%, p=0.10) and overall complications (11% to 7.7%, p=0.30), although the study was not powered to detect such changes. Regarding patient follow up, overall 81.4% of patients were reached by 30-day follow up phone call after discharge. The rural study site was able to reach 87% of patients by phone; the urban site reached 71.5% of patients (p<0.0001). Regarding surgical infections, 48% of SSIs were captured as outpatient during the phone follow up (p<0.0001), and 34% of all complications were captured as outpatient (p<0.0001).

DISCUSSION:After piloting, the program at the three hospitals and implementing the modified version for the Clean Cut program focused on local mentorship and larger team discussions improved communication allowing for more rapid uptake through multidisciplinary process change.

Adherence to recognized infection prevention standards improved with an associated SSI reduction. Larger scale implementation with further refinement highlighting established mentor hospitals could improve infection prevention practices in Ethiopian ORs and reduce postoperative infections. Additionally, phone follow-up after surgery in Ethiopia is feasible and valuable, and can be accomplished for most surgical patients. Phone or other outpatient follow up identified nearly half of all SSI and a third of total complications. Given the increasing use of mobile phones in Ethiopia and ease of implementation, this model could be practical in other low-resource surgical settings.

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Date: October 3 & 4, 2019Venue: Inter continental Addis Hotel,

Addis Ababa, Ethiopia

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24th Date: October 3 & 4, 2019

Venue: Inter continental Addis Hotel, Addis Ababa, Ethiopia

ANNUAL GENERAL MEETING (AGM) AND SCIENTIFIC CONFERENCE

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