[Show abstract][Hide abstract] ABSTRACT: A case-series study of all admissions using patient registers was carried out to analyse patterns of medical admissions into the Medical Intensive Care Unit (MICU) of the Addis Ababa University Teaching Hospital, and evaluate for any changes in that pattern over a study period. All patients admitted to the MICU of a 500-bed Teaching Hospital in Addis Ababa between 1985-2000 were the study subjects. Demographic variables, specific categories of diagnoses and their outcomes were recorded A total of 3548 patients (male to female ratio of 1.4:1, mean age 37.10 +/- 17.29) were admitted from September 1985 to August 2000. Acute infectious and cardiovascular diseases accounted for half of the entire critical care admissions with infectious diseases accounting for 30%. Among specific diagnoses, diabetic ketoacidosis was the leading cause of admission followed by acute myocardial infarction and severe and complicated malaria, each accounting for 10.7, 9.8 and 9.3% of all admissions respectively. Trends of admissions over the sixteen-year period showed steady increase in relative frequency of acute complications of non-communicable diseases consisting of diabetes, acute myocardial infarction and stroke while infectious diseases showed interspersed peaks of admissions coinciding with epidemics. The overall mortality of the MICU was 32%, with proportionally more female deaths, 34.8 versus 29% (P = 0.0002). Severe and complicated malaria was the leading cause of death (10.3%) followed by tetanus (6.4%) and acute myocardial infarction (6.3%). The increase in relative and absolute frequency of acute complications of non-communicable diseases most probably heralds an emerging epidemic of non-communicable diseases related to life style changes in the urban well to do in addition to existing problems of infectious diseases of poverty.
No preview · Article · Feb 2006 · Ethiopian medical journal
[Show abstract][Hide abstract] ABSTRACT: The objectives of the study were to evaluate severity of rhenumatic heart disease (RHD) using age at time of death as its indicator and to look for factors associated with the severity. Retrospective study of consecutive cardiovascular deaths in the medical wards of Tikur Anbassa Teaching Hospital (TAH) from January 1995 to December 2001 was carried out. Information on age at the time of death, sex, type of valve lesions, status of secondary prophylaxis, presence or absence of arrhythmia, infective endocarditis, embolic phenomena, co-morbid illness, immediate cause(s) of death and duration of follow up at health institutions were obtained There were a total of 457 cardiovascular deaths including cerebrovascular accidents (CVA). 121(26.5%) were due to RHD. Charts of 115 RHD patients were available for detailed analysis. The overall mean age at the time of death was 25.89+/-11.05 years. The median age for males was lower than that of females (19 years, I.Q. 16-32 versus 25 years, IQ 15 - 30 years), but not statistically significantly different (p = 0. 10). There were more female deaths accounting for 57.4 %. About 70% of RHD patients died from congestive heart failure. Eleven per cent (13 patients) each died from systemic embolism and co-morbid conditions. Combined mitral and aortic valve disease within a patient accounted for majority (42.6%) of the lesions followed by combined mitral regurgitation and stenosis (24.4%). Isolated mitral stenosis, or regurgitation was a relatively less common cause of death. Aortic valve lesion without mitral valve involvement was a rare cause (3.5%) of death. In conclusion RHD in our patients ran more aggressive course as indicated by death occurring at much younger age than in even the preprophylaxis era in western world. The more frequent combined valve lesions and infrequent secondary prophylaxis may significantly contribute to the rapid course, but cannot fully explain the very low mean age. Factors responsible for rapid course in an Ethiopian need to be addressed urgently.
No preview · Article · Feb 2004 · Ethiopian medical journal