Background: Septic shock is a medical emergency causing significant morbidity and mortality. Mult... more Background: Septic shock is a medical emergency causing significant morbidity and mortality. Multiple factors affect the outcome of septic shock in a particular clinical setting. Identifying factors associated with poor treatment outcomes is crucial for the improvement of medical care in patients with septic shock. Objectives: The aim of this study was to determine the outcome of septic shock treatment and to determine factors associated with poor outcome. Methods: A hospital based medical record review of patients admitted to the University of Gondar Hospital with the diagnosis of septic shock from January 2014 to October 2016 was conducted. Socio-demographic, clinical history and laboratory data were collected. Data entry and analysis was done using SPSS version 20. Results: Ninety eight cases of septic shock fulfilled the criteria for analysis. The most common source of infection was the gastrointestinal tract. The in Hospital mortality rate of septic shock is 42 %. Longer durati...
Background: Septic shock is a medical emergency causing significant morbidity and mortality. Mult... more Background: Septic shock is a medical emergency causing significant morbidity and mortality. Multiple factors affect the outcome of septic shock in a particular clinical setting. Identifying factors associated with poor treatment outcomes is crucial for the improvement of medical care in patients with septic shock. Objectives: The aim of this study was to determine the outcome of septic shock treatment and to determine factors associated with poor outcome. Methods: A hospital based medical record review of patients admitted to the University of Gondar Hospital with the diagnosis of septic shock from January 2014 to October 2016 was conducted. Socio-demographic, clinical history and laboratory data were collected. Data entry and analysis was done using SPSS version 20. Results: Ninety eight cases of septic shock fulfilled the criteria for analysis. The most common source of infection was the gastrointestinal tract. The in Hospital mortality rate of septic shock is 42 %. Longer durati...
Infective endocarditis (IE) is a disease characterized by high morbidity and mortality. IE was fi... more Infective endocarditis (IE) is a disease characterized by high morbidity and mortality. IE was first described in the mid-16th century. Right-sided infective endocarditis (RSIE) represents 5% to 10% of all IE episodes in adults. RSIE can be divided into three groups according to the underlying risk factors: intravenous drug users (IDUs), cardiac device carriers, and the “three noes” group (no left-sided IE, no IDUs, and no cardiac devices). Tricuspid valve endocarditis in nonintravenous drug users can occur in a variety of conditions including congenital heart disease, intracardiac devices, central venous catheters, and immunologically debilitated patients. Due to the rareness of isolated native nonrheumatic tricuspid valve endocarditis, here, we like to present an 18-year-old male from rural Ethiopia with the diagnosis of isolated native tricuspid valve endocarditis that was treated and cured.
Rhinocerebral mucormycosis is an uncommon and deadly acute necrotizing fungal infection. It usual... more Rhinocerebral mucormycosis is an uncommon and deadly acute necrotizing fungal infection. It usually affects individuals with underlying immunosuppression with uncontrolled diabetes and diabetic ketoacidosis being the most commonly identified condition. High index of suspicion is crucial for early diagnosis and management as it is a rapidly progressive infection with high rate of fatality. In this case report, we present an 18 years old female patient with type 1 diabetes mellitus, diabetic ketoacidosis and confirmed rhinocerebral mucormycosis from University of Gondar Hospital. The clinical presentation, diagnostics and hospital course is discussed.
Introduction Even though atrial fibrillation is a common risk factor of stroke which contributes ... more Introduction Even though atrial fibrillation is a common risk factor of stroke which contributes to poor outcome, data concerning this association is scarce in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital. Methods Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head CT scan and ECG results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form. Results A total of 94 patients with mean age of 67.4±12.4 years and Female to male ratio of 1.13:1 were analyzed. The prevalence of AF was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes respectively. The in hospit...
Rhinocerebral mucormycosis is an uncommon and deadly acute necrotizing fungal infection. It usual... more Rhinocerebral mucormycosis is an uncommon and deadly acute necrotizing fungal infection. It usually affects individuals with underlying immunosuppression with uncontrolled diabetes and diabetic ketoacidosis being the most commonly identified condition. A high index of suspicion is crucial for early diagnosis and management as it is a rapidly progressive infection with a high rate of fatality. In this case report, we present an 18 year old female patient with type 1 diabetes mellitus, diabetic ketoacidosis and confirmed rhinocerebral mucormycosis from University of Gondar Hospital. The clinical presentation, diagnostics and hospital course is discussed.
Background: According to a report on the worldwide trends in blood pressure from 1975 to 2015, me... more Background: According to a report on the worldwide trends in blood pressure from 1975 to 2015, mean blood pressure is increasing in low and middle income countries while it is either decreasing or stabilizing in high income countries. Few studies have been published on the prevalence of hypertension in Ethiopia demonstrating an increased trend; however, these studies had small sample size and were limited to participants older than 35 years; which left the burden among adolescents and young adults unaddressed. The aim of this study was to assess prevalence of hypertension (HTN) and associated factors in Gondar city.
Introduction: Even though atrial fibrillation is a common risk factor for stroke which contribute... more Introduction: Even though atrial fibrillation is a common risk factor for stroke which contributes to poor outcome, data concerning this association is rare in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital. Methods: A Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head computerized tomogrpaghic scan and elecrocardiogrphy results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form. Results: A total of 94 patients with mean age of 67.4±12.4 years and female to male ratio of 1.13:1 were analyzed. The prevalence of atrial fibrillation was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes, respectively. The in hospital case fatality of stroke associated with and without atrial fibrillation was 22.2% and 8% respectively while the rate of improvement at discharge was 34% and 68% respectively. Atrial fibrillation was associated with a low rate of improvement at discharge (OR = 0.28 CI: 0.1-0.78). Conclusion: Atrial fibrillation is common in stroke patients in our hospital, especially in the elderly population. It is associated with low rate of improvement at discharge. Appropriate screening and treatment of atrial fibrillation is invaluable for the primary and secondary prevention of stroke.
Abstract: Coma represents a serious, life-threatening medical condition which should be treated e... more Abstract: Coma represents a serious, life-threatening medical condition which should be treated effectively. It is important to recognize the underlying causes of coma in order to provide timely medical treatment. There is dearth of data on causes of medical coma in adults in Africa. This research aimed at determining the cause and outcome of coma in University of Gondar Hospital. Methods: A prospective observational descriptive study was conducted from 01/01/2014 to 31/06/2014 G.C in University of Gondar Hospital. All consecutive non trauma patients admitted to the medical wards with a Glasgow Coma Scale of 8 or less were included. An interview administered questionnaire to patient attendants and neurologic examination were employed to collect data like sociodemographics and clinical features. All important laboratory tests and outcome data were documented at patient discharge. Verbal consent from attendants was taken. Data was entered to and analyzed using Epiinfo7. Result: A total of 53 patients constituting approximately 3.4% of the medical emergencies seen during the study period were included in the study. The most common cause of coma were diseases that cause no focal neurologic deficit (FND), occurring in 31 (58.5%) patients. Among the causes with non-localizing signs, the most common causes were intoxications, uremic and hepatic encephalopathies, occurring in 11 (20.8%), 7 (13.2%), and 5 (9.4%) of the patients, respectively. Organophosphate (malathion) poisoning was the most common agent of intoxication responsible for 9 patients out of 11. These were followed by diseases with FND and meningitis syndromes, occurring in 14 (26.4%) and 8 (15.1%) patients, respectively. Among the patients admitted with coma without FND, 17 (54.8%) of the patients died, 6 (19.3%) had disability and 8 (25.8%) patients were discharged with improvement. In contrast, among patients admitted with coma with FND, no patient was discharged with improvement, 7 (50%) died and 7 (50%) were disabled. Among patients admitted with meningitis syndrome, 4 (50%) died, 2 (25%) were disabled and 2 (25%) were discharged with improvement. Conclusion: Diseases presenting without focal neurologic deficit, including toxic and metabolic causes, are the most common causes of coma. Among these, the most common was malathion poisoning which is reversible with appropriate care. Meningitis syndrome was not found to be a prominent cause of coma. Medical coma, regardless of the etiology, was associated with high mortality rate. Keywords: Focal Neurologic Deficit, Glasgow Coma Scale, Intoxication, Meningitis Syndrome
Stroke is one of the commonest causes of morbidity and mortality among non-communicable diseases.... more Stroke is one of the commonest causes of morbidity and mortality among non-communicable diseases. Its occurrence has been significantly increasing in Sub Saharan Africa in the last couple of decades. Mortality has been shown to be higher in this area compared to developed countries. Yet, there is a big information gap about stroke in Ethiopia. This study aimed at describing the clinical pattern, risk factors and outcome of adult stroke patients admitted to university of Gondar hospital. Retrospective chart record analysis of adult patients with stroke who had Computerized tomography(CT) scan of the brain admitted to University of Gondar hospital medical wards from June 2010 to May 2013 was done. Relevant data including sociodemographics, risk factors, type of stroke and outcome were collected using a data extraction form. Data was entered and analyzed using Epi info7. Results: A total of 98 patients with a median age of 68 years (IQR: 60-76) and F:M ratio of 1.13:1 were analyzed. Ischemic stroke accounted for 69.4% of the cases. The median ages of patients with hemorrhagic and ischemic stroke were 60 and 70 years respectively (P=0.0027). Hypertension (55.9%), any type of structural heart disease (44.6%) and atrial fibrillation (28.7%) were the most commonly identified risk factors. Atrial fibrillation was more prevalent in ischemic stroke patients (34.3%) compared to hemorrhagic stroke (14.8%) (P= 0.049). In hospital mortality rate was 13% with median duration of hospital stay before death of 6 days. Respiratory failure secondary to aspiration pneumonia and increased intracranial pressure were the most common immediate causes of death. Conclusion: Even though ischemic stroke was the most common stroke subtype, the proportion of hemorrhagic stroke was higher compared to studies from the developed world. Appropriate screening and treatment of hypertension, structural heart disease and atrial fibrillation should be give due attention as they are the most commonly identified risk factors. Most deaths occurred early after admission due to stroke related acute complications with respiratory failure; as such an emergency stroke care unit capable of managing these complications can partially decrease the death rate. Keywords: Cerebrovascular Accident,
Background: Septic shock is a medical emergency causing significant morbidity and mortality. Mult... more Background: Septic shock is a medical emergency causing significant morbidity and mortality. Multiple factors affect the outcome of septic shock in a particular clinical setting. Identifying factors associated with poor treatment outcomes is crucial for the improvement of medical care in patients with septic shock. Objectives: The aim of this study was to determine the outcome of septic shock treatment and to determine factors associated with poor outcome. Methods: A hospital based medical record review of patients admitted to the University of Gondar Hospital with the diagnosis of septic shock from January 2014 to October 2016 was conducted. Socio-demographic, clinical history and laboratory data were collected. Data entry and analysis was done using SPSS version 20. Results: Ninety eight cases of septic shock fulfilled the criteria for analysis. The most common source of infection was the gastrointestinal tract. The in Hospital mortality rate of septic shock is 42 %. Longer durati...
Background: Septic shock is a medical emergency causing significant morbidity and mortality. Mult... more Background: Septic shock is a medical emergency causing significant morbidity and mortality. Multiple factors affect the outcome of septic shock in a particular clinical setting. Identifying factors associated with poor treatment outcomes is crucial for the improvement of medical care in patients with septic shock. Objectives: The aim of this study was to determine the outcome of septic shock treatment and to determine factors associated with poor outcome. Methods: A hospital based medical record review of patients admitted to the University of Gondar Hospital with the diagnosis of septic shock from January 2014 to October 2016 was conducted. Socio-demographic, clinical history and laboratory data were collected. Data entry and analysis was done using SPSS version 20. Results: Ninety eight cases of septic shock fulfilled the criteria for analysis. The most common source of infection was the gastrointestinal tract. The in Hospital mortality rate of septic shock is 42 %. Longer durati...
Infective endocarditis (IE) is a disease characterized by high morbidity and mortality. IE was fi... more Infective endocarditis (IE) is a disease characterized by high morbidity and mortality. IE was first described in the mid-16th century. Right-sided infective endocarditis (RSIE) represents 5% to 10% of all IE episodes in adults. RSIE can be divided into three groups according to the underlying risk factors: intravenous drug users (IDUs), cardiac device carriers, and the “three noes” group (no left-sided IE, no IDUs, and no cardiac devices). Tricuspid valve endocarditis in nonintravenous drug users can occur in a variety of conditions including congenital heart disease, intracardiac devices, central venous catheters, and immunologically debilitated patients. Due to the rareness of isolated native nonrheumatic tricuspid valve endocarditis, here, we like to present an 18-year-old male from rural Ethiopia with the diagnosis of isolated native tricuspid valve endocarditis that was treated and cured.
Rhinocerebral mucormycosis is an uncommon and deadly acute necrotizing fungal infection. It usual... more Rhinocerebral mucormycosis is an uncommon and deadly acute necrotizing fungal infection. It usually affects individuals with underlying immunosuppression with uncontrolled diabetes and diabetic ketoacidosis being the most commonly identified condition. High index of suspicion is crucial for early diagnosis and management as it is a rapidly progressive infection with high rate of fatality. In this case report, we present an 18 years old female patient with type 1 diabetes mellitus, diabetic ketoacidosis and confirmed rhinocerebral mucormycosis from University of Gondar Hospital. The clinical presentation, diagnostics and hospital course is discussed.
Introduction Even though atrial fibrillation is a common risk factor of stroke which contributes ... more Introduction Even though atrial fibrillation is a common risk factor of stroke which contributes to poor outcome, data concerning this association is scarce in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital. Methods Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head CT scan and ECG results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form. Results A total of 94 patients with mean age of 67.4±12.4 years and Female to male ratio of 1.13:1 were analyzed. The prevalence of AF was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes respectively. The in hospit...
Rhinocerebral mucormycosis is an uncommon and deadly acute necrotizing fungal infection. It usual... more Rhinocerebral mucormycosis is an uncommon and deadly acute necrotizing fungal infection. It usually affects individuals with underlying immunosuppression with uncontrolled diabetes and diabetic ketoacidosis being the most commonly identified condition. A high index of suspicion is crucial for early diagnosis and management as it is a rapidly progressive infection with a high rate of fatality. In this case report, we present an 18 year old female patient with type 1 diabetes mellitus, diabetic ketoacidosis and confirmed rhinocerebral mucormycosis from University of Gondar Hospital. The clinical presentation, diagnostics and hospital course is discussed.
Background: According to a report on the worldwide trends in blood pressure from 1975 to 2015, me... more Background: According to a report on the worldwide trends in blood pressure from 1975 to 2015, mean blood pressure is increasing in low and middle income countries while it is either decreasing or stabilizing in high income countries. Few studies have been published on the prevalence of hypertension in Ethiopia demonstrating an increased trend; however, these studies had small sample size and were limited to participants older than 35 years; which left the burden among adolescents and young adults unaddressed. The aim of this study was to assess prevalence of hypertension (HTN) and associated factors in Gondar city.
Introduction: Even though atrial fibrillation is a common risk factor for stroke which contribute... more Introduction: Even though atrial fibrillation is a common risk factor for stroke which contributes to poor outcome, data concerning this association is rare in African countries. This study assessed the prevalence of confirmed atrial fibrillation and its effect on outcome in stroke patients admitted to University of Gondar Hospital. Methods: A Hospital based cross-sectional study by record analysis was done from December 2014 to February 2015. All adult stroke patients with documented head computerized tomogrpaghic scan and elecrocardiogrphy results admitted to university of Gondar hospital during June 2010 to May 2013 were included. Relevant data including sociodemographics, type of stroke, and presence of atrial fibrillation was collected from patient charts using a data extraction form. Results: A total of 94 patients with mean age of 67.4±12.4 years and female to male ratio of 1.13:1 were analyzed. The prevalence of atrial fibrillation was 28.7%. It occurred in 34% and 14% of ischemic and hemorrhagic strokes, respectively. The in hospital case fatality of stroke associated with and without atrial fibrillation was 22.2% and 8% respectively while the rate of improvement at discharge was 34% and 68% respectively. Atrial fibrillation was associated with a low rate of improvement at discharge (OR = 0.28 CI: 0.1-0.78). Conclusion: Atrial fibrillation is common in stroke patients in our hospital, especially in the elderly population. It is associated with low rate of improvement at discharge. Appropriate screening and treatment of atrial fibrillation is invaluable for the primary and secondary prevention of stroke.
Abstract: Coma represents a serious, life-threatening medical condition which should be treated e... more Abstract: Coma represents a serious, life-threatening medical condition which should be treated effectively. It is important to recognize the underlying causes of coma in order to provide timely medical treatment. There is dearth of data on causes of medical coma in adults in Africa. This research aimed at determining the cause and outcome of coma in University of Gondar Hospital. Methods: A prospective observational descriptive study was conducted from 01/01/2014 to 31/06/2014 G.C in University of Gondar Hospital. All consecutive non trauma patients admitted to the medical wards with a Glasgow Coma Scale of 8 or less were included. An interview administered questionnaire to patient attendants and neurologic examination were employed to collect data like sociodemographics and clinical features. All important laboratory tests and outcome data were documented at patient discharge. Verbal consent from attendants was taken. Data was entered to and analyzed using Epiinfo7. Result: A total of 53 patients constituting approximately 3.4% of the medical emergencies seen during the study period were included in the study. The most common cause of coma were diseases that cause no focal neurologic deficit (FND), occurring in 31 (58.5%) patients. Among the causes with non-localizing signs, the most common causes were intoxications, uremic and hepatic encephalopathies, occurring in 11 (20.8%), 7 (13.2%), and 5 (9.4%) of the patients, respectively. Organophosphate (malathion) poisoning was the most common agent of intoxication responsible for 9 patients out of 11. These were followed by diseases with FND and meningitis syndromes, occurring in 14 (26.4%) and 8 (15.1%) patients, respectively. Among the patients admitted with coma without FND, 17 (54.8%) of the patients died, 6 (19.3%) had disability and 8 (25.8%) patients were discharged with improvement. In contrast, among patients admitted with coma with FND, no patient was discharged with improvement, 7 (50%) died and 7 (50%) were disabled. Among patients admitted with meningitis syndrome, 4 (50%) died, 2 (25%) were disabled and 2 (25%) were discharged with improvement. Conclusion: Diseases presenting without focal neurologic deficit, including toxic and metabolic causes, are the most common causes of coma. Among these, the most common was malathion poisoning which is reversible with appropriate care. Meningitis syndrome was not found to be a prominent cause of coma. Medical coma, regardless of the etiology, was associated with high mortality rate. Keywords: Focal Neurologic Deficit, Glasgow Coma Scale, Intoxication, Meningitis Syndrome
Stroke is one of the commonest causes of morbidity and mortality among non-communicable diseases.... more Stroke is one of the commonest causes of morbidity and mortality among non-communicable diseases. Its occurrence has been significantly increasing in Sub Saharan Africa in the last couple of decades. Mortality has been shown to be higher in this area compared to developed countries. Yet, there is a big information gap about stroke in Ethiopia. This study aimed at describing the clinical pattern, risk factors and outcome of adult stroke patients admitted to university of Gondar hospital. Retrospective chart record analysis of adult patients with stroke who had Computerized tomography(CT) scan of the brain admitted to University of Gondar hospital medical wards from June 2010 to May 2013 was done. Relevant data including sociodemographics, risk factors, type of stroke and outcome were collected using a data extraction form. Data was entered and analyzed using Epi info7. Results: A total of 98 patients with a median age of 68 years (IQR: 60-76) and F:M ratio of 1.13:1 were analyzed. Ischemic stroke accounted for 69.4% of the cases. The median ages of patients with hemorrhagic and ischemic stroke were 60 and 70 years respectively (P=0.0027). Hypertension (55.9%), any type of structural heart disease (44.6%) and atrial fibrillation (28.7%) were the most commonly identified risk factors. Atrial fibrillation was more prevalent in ischemic stroke patients (34.3%) compared to hemorrhagic stroke (14.8%) (P= 0.049). In hospital mortality rate was 13% with median duration of hospital stay before death of 6 days. Respiratory failure secondary to aspiration pneumonia and increased intracranial pressure were the most common immediate causes of death. Conclusion: Even though ischemic stroke was the most common stroke subtype, the proportion of hemorrhagic stroke was higher compared to studies from the developed world. Appropriate screening and treatment of hypertension, structural heart disease and atrial fibrillation should be give due attention as they are the most commonly identified risk factors. Most deaths occurred early after admission due to stroke related acute complications with respiratory failure; as such an emergency stroke care unit capable of managing these complications can partially decrease the death rate. Keywords: Cerebrovascular Accident,
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Papers by Ermias Greffie
to recognize the underlying causes of coma in order to provide timely medical treatment. There is dearth of data on causes of
medical coma in adults in Africa. This research aimed at determining the cause and outcome of coma in University of Gondar
Hospital. Methods: A prospective observational descriptive study was conducted from 01/01/2014 to 31/06/2014 G.C in
University of Gondar Hospital. All consecutive non trauma patients admitted to the medical wards with a Glasgow Coma Scale
of 8 or less were included. An interview administered questionnaire to patient attendants and neurologic examination were
employed to collect data like sociodemographics and clinical features. All important laboratory tests and outcome data were
documented at patient discharge. Verbal consent from attendants was taken. Data was entered to and analyzed using Epiinfo7.
Result: A total of 53 patients constituting approximately 3.4% of the medical emergencies seen during the study period were
included in the study. The most common cause of coma were diseases that cause no focal neurologic deficit (FND), occurring
in 31 (58.5%) patients. Among the causes with non-localizing signs, the most common causes were intoxications, uremic and
hepatic encephalopathies, occurring in 11 (20.8%), 7 (13.2%), and 5 (9.4%) of the patients, respectively. Organophosphate
(malathion) poisoning was the most common agent of intoxication responsible for 9 patients out of 11. These were followed by
diseases with FND and meningitis syndromes, occurring in 14 (26.4%) and 8 (15.1%) patients, respectively. Among the
patients admitted with coma without FND, 17 (54.8%) of the patients died, 6 (19.3%) had disability and 8 (25.8%) patients
were discharged with improvement. In contrast, among patients admitted with coma with FND, no patient was discharged with
improvement, 7 (50%) died and 7 (50%) were disabled. Among patients admitted with meningitis syndrome, 4 (50%) died, 2
(25%) were disabled and 2 (25%) were discharged with improvement. Conclusion: Diseases presenting without focal
neurologic deficit, including toxic and metabolic causes, are the most common causes of coma. Among these, the most
common was malathion poisoning which is reversible with appropriate care. Meningitis syndrome was not found to be a
prominent cause of coma. Medical coma, regardless of the etiology, was associated with high mortality rate.
Keywords: Focal Neurologic Deficit, Glasgow Coma Scale, Intoxication, Meningitis Syndrome
occurrence has been significantly increasing in Sub Saharan Africa in the last couple of decades. Mortality has been shown to
be higher in this area compared to developed countries. Yet, there is a big information gap about stroke in Ethiopia. This study
aimed at describing the clinical pattern, risk factors and outcome of adult stroke patients admitted to university of Gondar
hospital. Retrospective chart record analysis of adult patients with stroke who had Computerized tomography(CT) scan of the
brain admitted to University of Gondar hospital medical wards from June 2010 to May 2013 was done. Relevant data including
sociodemographics, risk factors, type of stroke and outcome were collected using a data extraction form. Data was entered and
analyzed using Epi info7. Results: A total of 98 patients with a median age of 68 years (IQR: 60-76) and F:M ratio of 1.13:1
were analyzed. Ischemic stroke accounted for 69.4% of the cases. The median ages of patients with hemorrhagic and ischemic
stroke were 60 and 70 years respectively (P=0.0027). Hypertension (55.9%), any type of structural heart disease (44.6%) and
atrial fibrillation (28.7%) were the most commonly identified risk factors. Atrial fibrillation was more prevalent in ischemic
stroke patients (34.3%) compared to hemorrhagic stroke (14.8%) (P= 0.049). In hospital mortality rate was 13% with median
duration of hospital stay before death of 6 days. Respiratory failure secondary to aspiration pneumonia and increased
intracranial pressure were the most common immediate causes of death. Conclusion: Even though ischemic stroke was the
most common stroke subtype, the proportion of hemorrhagic stroke was higher compared to studies from the developed world.
Appropriate screening and treatment of hypertension, structural heart disease and atrial fibrillation should be give due attention
as they are the most commonly identified risk factors. Most deaths occurred early after admission due to stroke related acute
complications with respiratory failure; as such an emergency stroke care unit capable of managing these complications can
partially decrease the death rate.
Keywords: Cerebrovascular Accident,
to recognize the underlying causes of coma in order to provide timely medical treatment. There is dearth of data on causes of
medical coma in adults in Africa. This research aimed at determining the cause and outcome of coma in University of Gondar
Hospital. Methods: A prospective observational descriptive study was conducted from 01/01/2014 to 31/06/2014 G.C in
University of Gondar Hospital. All consecutive non trauma patients admitted to the medical wards with a Glasgow Coma Scale
of 8 or less were included. An interview administered questionnaire to patient attendants and neurologic examination were
employed to collect data like sociodemographics and clinical features. All important laboratory tests and outcome data were
documented at patient discharge. Verbal consent from attendants was taken. Data was entered to and analyzed using Epiinfo7.
Result: A total of 53 patients constituting approximately 3.4% of the medical emergencies seen during the study period were
included in the study. The most common cause of coma were diseases that cause no focal neurologic deficit (FND), occurring
in 31 (58.5%) patients. Among the causes with non-localizing signs, the most common causes were intoxications, uremic and
hepatic encephalopathies, occurring in 11 (20.8%), 7 (13.2%), and 5 (9.4%) of the patients, respectively. Organophosphate
(malathion) poisoning was the most common agent of intoxication responsible for 9 patients out of 11. These were followed by
diseases with FND and meningitis syndromes, occurring in 14 (26.4%) and 8 (15.1%) patients, respectively. Among the
patients admitted with coma without FND, 17 (54.8%) of the patients died, 6 (19.3%) had disability and 8 (25.8%) patients
were discharged with improvement. In contrast, among patients admitted with coma with FND, no patient was discharged with
improvement, 7 (50%) died and 7 (50%) were disabled. Among patients admitted with meningitis syndrome, 4 (50%) died, 2
(25%) were disabled and 2 (25%) were discharged with improvement. Conclusion: Diseases presenting without focal
neurologic deficit, including toxic and metabolic causes, are the most common causes of coma. Among these, the most
common was malathion poisoning which is reversible with appropriate care. Meningitis syndrome was not found to be a
prominent cause of coma. Medical coma, regardless of the etiology, was associated with high mortality rate.
Keywords: Focal Neurologic Deficit, Glasgow Coma Scale, Intoxication, Meningitis Syndrome
occurrence has been significantly increasing in Sub Saharan Africa in the last couple of decades. Mortality has been shown to
be higher in this area compared to developed countries. Yet, there is a big information gap about stroke in Ethiopia. This study
aimed at describing the clinical pattern, risk factors and outcome of adult stroke patients admitted to university of Gondar
hospital. Retrospective chart record analysis of adult patients with stroke who had Computerized tomography(CT) scan of the
brain admitted to University of Gondar hospital medical wards from June 2010 to May 2013 was done. Relevant data including
sociodemographics, risk factors, type of stroke and outcome were collected using a data extraction form. Data was entered and
analyzed using Epi info7. Results: A total of 98 patients with a median age of 68 years (IQR: 60-76) and F:M ratio of 1.13:1
were analyzed. Ischemic stroke accounted for 69.4% of the cases. The median ages of patients with hemorrhagic and ischemic
stroke were 60 and 70 years respectively (P=0.0027). Hypertension (55.9%), any type of structural heart disease (44.6%) and
atrial fibrillation (28.7%) were the most commonly identified risk factors. Atrial fibrillation was more prevalent in ischemic
stroke patients (34.3%) compared to hemorrhagic stroke (14.8%) (P= 0.049). In hospital mortality rate was 13% with median
duration of hospital stay before death of 6 days. Respiratory failure secondary to aspiration pneumonia and increased
intracranial pressure were the most common immediate causes of death. Conclusion: Even though ischemic stroke was the
most common stroke subtype, the proportion of hemorrhagic stroke was higher compared to studies from the developed world.
Appropriate screening and treatment of hypertension, structural heart disease and atrial fibrillation should be give due attention
as they are the most commonly identified risk factors. Most deaths occurred early after admission due to stroke related acute
complications with respiratory failure; as such an emergency stroke care unit capable of managing these complications can
partially decrease the death rate.
Keywords: Cerebrovascular Accident,