Vol 52, No 4 (2014)

Background: Adnexal torsion remains a challenging diagnosis, often leading to delayed operative intervention and resultant ovarian loss. Objective: To describe the clinical profile and therapeutic approaches of adnexal torsion in the Ethiopian setting. Methods: A retrospective cross sectional descriptive chart review of women with surgically proven adnexal torsion was conducted in two teaching hospitals from Jan1 2007- Dec 31, 2011. Results: A total of 53 women with AT were analyzed. About 33(62%) of torsion occurred in the age group of 20- 29 years. The most common symptoms were lower abdominal pain 52 (98.1%) followed by nausea and vomiting 46 (86.8%), whereas, the common physical findings were lower abdominal tenderness 49(92.5%) and palpable pelvic mass 40 (76.9%). Adnexal torsion was considered in the differential diagnosis upon initial evaluation only in 27 (51%) of the cases. Of the study subjects, only 7(13.2%) had surgery within 24 hours of arrival to the facility and the mean time from initial evaluation to surgery was 53.8±44.5 hours. Moderately positive correlation was observed between ultrasound and intra-operative adnexal size measurement (r = 0.716, p = 0.000). Using non-parametric independent sample test, none of the clinical profile categories studied show significant difference in mean time from initial evaluation to surgery. Despite the overwhelmingly benign pathology, most 46 (86.8%) of patients underwent adnexectomy with only 3(5.7%) adnexal salvage rate. Conclusion: Delayed surgical intervention and low ovarian salvage rate in spite of predominantly benign pathology was observed. Therefore, high degree of suspicion, especially in patients with high risk factors, and timely intervention must be exercised in an effort to salvage the adnexae.

Keywords: Adnexal, Torsion

Abstract

Background

Cardiovascular diseases are leading causes of mortality worldwide. Specific etiologies vary in different regions and these variations are explained by the concept of Epidemiologic transition.

Objectives

To describe the pattern of echocardiographically detected cardiac diseases among patients who presented to Cardiac clinic of Ayder referral hospital and to analyze associations of cardiac diseases with age and economic status.

Methods

A retrospective review of records of adult patients who had echocardiographic study at Cardiac Clinic of Ayder referral hospital from September 2011 to June 2013 was made. The collected data was analyzed using SPSS Version 21.

Results

Total of 1028 echocardiograms were reviewed. The mean age of the patients was 50.6 (sd =18.7) years with male to female ratio of 0.93. Commonest echocardiographic abnormality was Valvular heart disease (44.6%), with rheumatic in younger and degenerative etiologies in older age groups. Diastolic heart failure accounted for 31.9% of abnormal studies, 60.4% of which were ascribed to hypertensive heart disease. Pulmonary hypertension of any etiology was diagnosed in 32.6% of the cases. Among patients with rheumatic heart diseases, co-occurrence of Mitral and Aortic valve disease was the commonest.

Conclusion

Valvular disease was the most common echocardiographic finding among adult cardiac patients in the study area.

Introduction: Preterm premature rupture of membranes is a common complication of pregnancy associated with significant maternal, fetal and neonatal risks. An understanding of its magnitude and consequences is critical in providing appropriate intervention to prevent poor pregnancy outcomes.

Objective:  To describe maternal and perinatal outcomes of preterm premature rupture of membranes at Tikur Anbessa Hospital, Addis Ababa, Ethiopia.

Methodology: A Retrospective cross-sectional descriptive study done at Tikur Anbessa Hospital from June, 2010 G.C. to June, 2013 G.C. 

Results: The prevalence of preterm premature rupture of membranes in this study was 1.4%. Intra-amniotic infection, seen in 31.5% (35/111), was the commonest maternal complication. The mean latency period from rupture of membranes to delivery was 6.6 days. Twenty-six (23.2%) neonates were delivered by cesarean section. There were a total of 12 perinatal deaths, 4 (3.6%) stillbirths (2 antepartum and 2 itrapartum) and 8 (7.1%) early neonatal deaths, making the gross perinatal mortality rate to be 107 per 1000 live births. Prematurity was the commonest cause of neonatal death.

Conclusion and recommendations: Although the prevalence of preterm premature rupture of membranes in this study appears lower than many prior reports, the level of maternal and perinatal morbidity is high compared to many prior reports from similar setups. Especially the proportion of mothers presenting with established chorioamnionitis is high. Therefore, it is important that women be well informed regarding maternal, fetal and neonatal complications of premature rupture of membranes so that proper and timely management is provided.

Key words: PROM, Pre-term PROM, PPROM, Chorioamnionitis