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Sintayehu Asrat Beyene,1 Nahom Tadesse Bogale,1 Binyam Mohammedbirhan Berhe,2 Demis Degu Teshome3 1General Surgery Unit, Department of Surgery, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 2Department of Pathology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 3Department of Obstetrics and Gynecology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, EthiopiaCorrespondence: Sintayehu Asrat Beyene; Nahom Tadesse Bogale, Email sintayehubeyene54@gmail.com; Tadnahi2@gmail.comIntroduction: Endometriosis is a disease condition characterized by the presence of endometrial glands and stroma outside the uterine cavity and musculature. It affects 7– 10% of women of reproductive age and usually involves pelvic organs. The common symptoms include dysmenorrhea, menorrhagia, pelvic pain, dyspareunia, and infertility. Umbilical endometriosis is the rarest form of extra-pelvic endometriosis.Case Presentation: A 32-year-old Para II mother presented with umbilical swelling and pain that worsened during the menses of 2 months. She had two caesarean scars, both transverse Pfannenstein incisions. There was a dark blue, firm to hard 2× 3 cm umbilical mass on physical examination. Laboratory results are normal. Ultrasound of the abdomen showed umbilical mass with homogeneous echotexture measuring 2 cm × 3 cm with an irregular border and hypoechoic texture. An excisional biopsy was performed and a biopsy showed umbilical endometriosis.Discussion: Primary umbilical endometriosis is a disorder first described by Villar in 1886, and among all cases of extra-genital involvement of endometriosis, primary umbilical endometriosis accounts for 0.5– 1%. The usual presentation of primary umbilical endometriosis is typically the presence of a discrete bluish-purple mass in the umbilicus, which becomes swollen, painful, and bleeds concomitantly with the menstrual cycle. Ultrasound and other imaging techniques help in making diagnoses, and the diagnosis is confirmed by cytological examination. The management of umbilical endometriosis involves surgical excision and reconstruction of the umbilicus.Conclusion: Umbilical endometriosis is an uncommon form of extra-pelvic endometriosis. There is a wide differential diagnosis for swellings of the abdominal wall; however, it should be suspected in any female patient of reproductive age with an umbilical lesion that becomes more painful and swollen during her menstrual period. Appropriate clinical examination and workup are helpful to make a diagnosis and do a surgical excision.Keywords: endometriosis, umbilical nodules, umbilical hernia, abdominal wall scar, caesareans section

Abstract Background Satisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region. Objective The study aimed to assess clients’ satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23. Methods A convergent parallel mixed methods design was conducted in Debre Markos town’s public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3). Result The quantitative wing revealed that overall, 65% (95% CI: 60–69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23–11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32–17.31, p-value = 0.017), clients’ knowledge (AOR: 0.26, 95% CI: 0.12–0.59, p-value = 0.001), and clients’ attitude (AOR: 6.43, 95% CI: 3.43–12.03, p-value = 0.000) were significantly associated with CSCCSS. Qualitative result The thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers’ skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners). Conclusion According to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.

Abstract Background Knowledge of the fertility period aids women in refraining and engaging in sexual intercourse to avoid and to get pregnant, respectively. The effect of community-level factors on knowledge of the fertility period was not yet known in Kenya. Therefore, we aimed to investigate the community- and individual-level determinants of knowledge of fertility period among women of childbearing age in Kenya. Methods The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 16,901 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data. Results The overall prevalence of knowledge of the fertility period among Kenyan women was 38.1% (95%CI = 37.3, 38.9). Women’s age, women’s education status, heard FP, contraceptive use, media exposure, and distance from health facility significant individual factors while place of residence, and community-level education, were all of factors were found to be strongly associated with knowledge of fertility period. Conclusion As per the findings of our study, Knowledge of the fertility period among reproductive women was low in Kenya. In the era of increasing refusal of hormone-based family planning, fertility-awareness-based family planning methods may be an option. Promoting the correct fertility period through education and media outreach may be helpful strategies for enhancing fertility decision-making.

Introduction: Global, national, and local studies revealed that the COVID-19 pandemic has significantly reduced institutional childbirth. However, it is not well understood how the COVID-19 epidemic affected institutional childbirth service utilization. Therefore, this study aimed to evaluate COVID-19 related impediments to institutional childbirth service uptake during the early phase of the COVID-19 pandemic (March 20/2020–June 20/2020) in the rural Arsi zone of Ethiopia. Methods: A community-based Phenomenological study was conducted from January 10–25/2022, among mothers who gave birth in the Arsi zone during the early phase of the COVID-19 epidemic (March 20/2020–June 20/2020) in Ethiopia. Data was collected by the primary author and a university graduated Midwives with experience in qualitative data collection. Eight focus group discussions and six in-depth interviews were conducted among mothers who gave birth in selected rural areas of the Arsi zone during the early phase of the COVID-19 pandemic. Nine key informant interviews were also conducted among Midwives, Maternity Ward Heads, and Community Health Extension Workers. Data was transcribed, translated, and analyzed thematically using Atlas Ti.7 version. Results: Four major themes and eleven sub-themes emerged regarding the barriers to institutional childbirth during the early phase of COVID-19 pandemic. The COVID-19 related fear was a reason for avoiding institutional childbirth for almost all participants. COVID-19 restrictions such as transportation bans, market bans and public transport price doubling were also critical concerns to seeking institutional childbirth. Perceived Poor quality of institutional childbirth care during the curfew was also an impeding factor. Poor communication, incomplete care components and absenteeism were mentioned under this theme. Unbalanced mass media tragedies and rumors of unknown sources were COVID -19 related infodemics found affecting the practice of institutional childbirth. Conclusions: COVID-19 related fears, COVID-19 restrictions, Perceived Poor quality of care during the COVID-19 pandemic and the COVID-19 Infodemic were the main reasons for reduced institutional childbirth service utilization during the early phase of the COVID-19 pandemic in Ethiopia. Therefore, strategies must be designed proactively to maintain essential maternal health services, particularly institutional childbirth, during pandemics like COVID-19 and similar future epidemics.

Nahom Tadesse Bogale,1 Sintayew Asrat Beyene,1 Dawit Zerihun Desta,1 Eyob Hailu Tessema,1 Sebsbie Admas Birhanie2 1General Surgery Unit, Department of Surgery, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 2Department of Radiology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, EthiopiaCorrespondence: Nahom Tadesse Bogale; Sintayew Asrat Beyene, General Surgery Unit, Department of Surgery, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, PO Box: 26217/1000, Jigjiga, Ethiopia, Tel +251910182949, Email tadnahi2@gmail.com; sintayehubeyene54@gmail.comIntroduction: Colonic volvulus is an unusual cause of intestinal obstruction in pregnant women. Cecal volvulus, second only to sigmoid volvulus, accounts for 1– 2% of all cases of intestinal obstruction. Due to its infrequent occurrence, only a few articles have documented its diagnosis and management among pregnant women, and we assume this to be the first reported case in Ethiopia, as per the authors’ knowledge.Case Presentation: A 26-year-old Gravida 3, Para 2 mother who has had amenorrhea for the last five months presents with a complaint of upper abdominal cramps with associated vomiting, which is bilious, upper abdominal distension, and obstipation of five-hour duration. Her vital signs were in the normal range, and she had upper abdominal tenderness. Plain abdominal radiography suggested a cecal volvulus and exploratory laparotomy, a right hemicolectomy, and end-to-side ileotransverse colon anastomosis was performed. The postoperative course was uneventful.Discussion: The cecal volvulus is an axial twist of the cecum, segment of the terminal ileum, and ascending colon along its mesentery, resulting in closed-loop obstruction with early vascular compromise and ischemia. It requires an anatomic prerequisite, which makes the cecum hypermobile, unlike the sigmoid volvulus. Diagnosis is challenging in pregnant women, as there are many differential diagnoses and a reluctance to request radiological imaging.Conclusion: A high index of suspicion is of paramount importance whenever a pregnant woman comes with a complaint of persistent abdominal cramps and obstipation. Early diagnosis and management are crucial to improve patients’ outcome. Plain abdominal radiography is the safest option of imaging modality in low-resource areas where magnetic resonance imaging (MRI) is not available during pregnancy whenever intestinal obstruction is considered. Right hemicolectomy is the preferred surgical option.Keywords: Cecal volvulus, intestinal obstruction, pregnancy, right hemicolectomy

Selamwit Gidey,1 Dawit Seyoum Gebremariam,1 Marta Yemane Hadush,1 Amanuel Berhe,1 Tedros Hailu Abay,1 Araya Abrha Medhanyie,2 Selemawit Asfaw Beyene,2 Tadele Tesfean Abraha,2 Yibrah Berhe Zelelow3 1Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 2School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 3Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, EthiopiaCorrespondence: Dawit Seyoum Gebremariam, Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Science, P.O. Box: 1871, Mekelle, Tigray, Ethiopia, Tel +251911731454, Email dgseyoum@yahoo.comBackground: Kangaroo mother care is a proven intervention shown to be effective in reducing neonatal mortality among low-birth-weight infants. The paucity of evidence regarding the practice at home can be highlighted. This study aimed to assess the practice and outcome of kangaroo mother care at home among mothers having low-birth-weight infants discharged from two hospitals in Mekelle, Tigray, Ethiopia.Methods: A prospective cohort study was conducted among 101 paired mothers and low-birth-weight neonates discharged from Ayder and Mekelle Hospitals. Non-probability purposive sampling was used to select 101 infants. Data were collected from patient charts in both hospitals using interviewer-administered structured questionnaire, anthropometric measurements and were then analyzed using SPSS version 20. Characteristics were analyzed using descriptive statistics. Bivariate analysis was used, and variables with p-value < 0.25 were exported to multivariable logistic regression and statistical significance was set at a p-value < 0.05.Results: Kangaroo mother care was continued at home in 99% of the infants. Three of the 101 infants died before the age of 4 months with a possible cause of death from respiratory failure. Exclusive breastfeeding was provided for 67% of the infants, and it was higher in infants who started kangaroo mother care within 24 hours of life (AOR 3.8, 95% CI 1.07– 13.25). Malnutrition was higher in those with birth weight < 1500 grams (AOR 7.3,95% CI 1.63– 32.59); small for gestational age (AOR 4.8,95% CI 1.41– 16.31) and those provided kangaroo mother care for < 8 hours per day (AOR 4.5,95% CI 1.40– 16.31).Conclusion: Early initiation and prolonged duration of kangaroo mother care were associated with increased exclusive breastfeeding practice and decreased incidence of malnutrition. Kangaroo mother care should be promoted at the community level.Keywords: low birth weight, kangaroo mother care, malnutrition, exclusive breastfeeding

Kebede Dinsa, Beshea Gelana Deressa, Waju Beyene Salgedo Department of Health Policy and Management, Jimma University, Jimma, Oromia, EthiopiaCorrespondence: Beshea Gelana Deressa, Department of health policy and management, Jimma University, Jimma, Oromia, Ethiopia, Tel +251 921833996, Email tuniriyabesha@gmail.comBackground: The difference in nursing care quality by institution has implications for both the organization and its clients. Though disparities in patient satisfaction, which is an interpersonal patient outcome with nursing care, have been reported between public and private hospitals, there has been little research on the study area.Objective: To compare the level of patients’ satisfaction towards nursing care services among adult inpatients at Jimma Medical Center, and Oda Hulle hospital Jimma, southwest Ethiopia 2021.Methods: A comparative cross-sectional study design was used among 431 patients of Jimma medical center and Oda Hulle hospital from May 3 to July 3, 2021, using a systematic random sampling technique. The Newcastle scale of satisfaction was used to collect data, which was then entered into Epidata 4.6 and exported to SPSS version 26 for analysis. We used descriptive and logistic regression analysis.Results: Patient satisfaction at public and private hospitals was reported 54.2% (95% CI: 52.9– 59.3) and 57.1% (95% CI: 55.2– 61.7), respectively. In public hospital, the patient satisfaction was affected by being in the age group of 41– 50 years (P = 0.006, AOR = 3), duration of stay in the ward (P = 0.002, AOR = 0.42,), cleanliness of the ward (P = 0.018, AOR = 1.8,), and admission history (P = 0.049, AOR = 0.60,). In private hospital (Oda Hulle), the patient satisfaction was affected by history of admission (P = 0.035, OR = 0.456), ward space (p = 0.007, AOR = 2.8), the perceived capacity of nurses (P = 0.002, AOR = 5.8) to pharmacy services (P = 0.032, AOR = 2.3,).Conclusion: Relatively the patient satisfaction towards nursing care in public hospital was lower compared to the private hospital, though no statistical difference (p = 0.225) observed. Illness history, cleanliness of the ward, Nurses make adequate visits and get their support when needed, Adequacy of ward space, the perceived capacity of nurses, and Access to pharmacy services were positively associated with patient satisfaction.Keywords: nursing care, patients’ satisfaction, public–private, service quality

Marta Yemane Hadush,1 Dawit Seyoum Gebremariam,1 Selemawit Asfaw Beyene,2 Tedros Hailu Abay,1 Amanuel Hadgu Berhe,1 Yibrah Berhe Zelelew,1 Tirhas Asmelash,3 Fisseha Ashebir,3 Samson Yohannes Amare,4 Znabu Hadush,2 Araya Abrha Medhanyie2 1School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 2School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 3Tigray regional health bureau, Mekelle, Ethiopia; 4School of Computing, Mekelle University, Mekelle, EthiopiaCorrespondence: Marta Yemane Hadush, Email marsec112@yahoo.comBackground: Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mortality in low-birth-weight and preterm newborns. Barriers for KMC and its effective practice at a larger scale are highly affected by contextual factors. The purpose of this study is to explore barriers and enablers in the community and health facilities for implementation and continuation of KMC.Methods: This formative study employed a qualitative exploratory approach using focus group discussions and in-depth interviews in five zones of Tigray region, Northern Ethiopia. A total of 16 focus group discussions and 46 in-depth interviews were conducted with health workers and community members. The whole process of data collection took an iterative approach. An inductive thematic analysis was done by going through the transcribed data using ATLAS.ti software.Results: The current study found that problems of infrastructure and equipment for KMC practice, shortage of staff, and absence of trained health workers as the most frequently mentioned barriers by health workers. Low level of awareness, lack of support, mother being responsible for the rest of the family, holding babies in the front being traditionally unacceptable, and preference of incubators for better care of small babies were among the barriers identified in the community. Presence of community health workers and the positive attitude of the community towards them, as well as antenatal and postnatal care were among the favorable conditions for the implementation of KMC at health facilities and continuation of KMC at home.Conclusion: Empowering health workers through training to identify preterm and low-birth-weight babies, to do follow-ups after discharge, and creating awareness in the community to change the perception of kangaroo mother care are necessary.Keywords: kangaroo mother care, KMC, implementation research, low birth weight, Ethiopia, newborn care, preterm birth, KMC implementation, enablers and barriers to KMC

This study identifies, analyses and describes the devices and functions of focus in information structuring in Hadiyya, a Highland East Cushitic language. Data, which were collected from native speakers, were dealt with based on the theory of Functional Grammar (Dik 1997). For focalization, the language uses morphological, lexical and syntactic means. The latter involves word-order change and cleft construction (including pseudo-cleft). Comparatively, the morphological mechanism is the most dynamic and frequent in use while the lexical means is limited both in the number of items employed and in frequency of occurrence.

Maize ( Zea mays L.) is an important food crop in Ethiopia, but productivity is low mainly due to low soil fertility and suboptimal fertilization. Therefore, this study aims to determine the yield, nutrient use efficiency and economic feasibility of maize production under various fertilizer applications and test the suitability of the Quantitative Evaluation of the Fertility in Tropical Soils (QUEFTS) model for predicting maize yield response to fertilization in Sidama region, southern Ethiopia. On-farm experiments were conducted at six sites (Site 1-6) of Sidama region, southern Ethiopia during the 2019 growing season. The experiments were laid out in a randomized complete block design (RCBD) with three replications. The experiment was a nutrient omission trial with seven treatments: control, two full NPK treatments and four nutrient omission treatments with contrasting N and P rates. Omitting N resulted in 5-28 % yield loss and omitting P resulted in 4-44 % yield loss compared to the lower rate of full NPK treatment across all study sites. Whereas omitting K resulted in 21 % yield loss only at sites 2 and 3. An increase in maize yield was mainly associated with an increase in both nutrient uptake and nutrient use efficiency of NPK. The results showed the need to revise blanket recommendations since the highest mean grain yields and net economic returns with acceptable marginal rates of return were obtained with NPK application or higher levels of NP (N2P2 treatment). In addition, the present QUEFTS model validation study revealed the good fit between QUEFTS model predicted maize grain yields (6.3 t ha -1 ) to the average actual yields (7.4 t ha -1 ) and this was also confirmed by small average values of RMSE = 1.5 t ha -1 and PBIAS = 6.9 %. Thus, the model can be a promising option for development of site specific fertilizer recommendations under smallholder farming systems in the region., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Determining the supply and uptake of K nutrient and the dynamic equilibrium (adsorption-desorption) reactions among the K forms in the soils are not commonly addressed in the highlands of Ethiopia. A study was therefore initiated to determine the adsorption capacity of the exchangeable K and the release kinetics of the non-exchangeable K in the soils of the Qenberenaweti Sub-watershed. Twelve disturbed surface (0-20 cm) soil sub-samples were collected from every farmland which was representative of each pre-identified soil type (Vertic Cambisols, Pellic Vertisols, Pisoplinthic Luvisols, Relictistagnic Cambisols, Pisoplinthic Cambisols, and Plinthofractic Cambisols). A composite sample was made in duplicate for the determination of K adsorption capacity and desorption kinetics per soil type. The mean maximum (69.47 ± 4.31 %) and minimum (56.16 ± 6.04 %) K adsorption rates were obtained from the Plinthofractic Cambisols and Vertic Cambisols, respectively. Among the tested isotherm models, the goodness of the Freundlich was better fit the data of all experimental soils; hence, a modified equation of this model (qe = aCe b/a ) could be used to describe the theoretical doses of K fertilizers required to develop K levels in soil solutions. The highest constant K releases from the Plinthofractic Cambisols (47 mg kg -1 ), Pisiopllintic Cambisols (46 mg kg -1 ), and Pisoplinthic Luvisols (44 mg kg -1 ) were attained at the 9th extraction. In comparison, it was noticed at the 7th and 11th extractions of the Relictistagnic Cambisols (45 mg kg -1 ) and both Pellic Vertisols (48 mg kg -1 ) and Vertic Cambisols (42 mg kg -1 ), respectively. The equation of power function was the best to successfully describe the released K + from all the experimental soils. Eventually, determining the adsorption capacity and release kinetics of K at a site-specific level helps to know the relative potential of the soils to supply K and also plan for an effective K fertilization strategy., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Recent clinical data indicate a different performance of biodegradable polymer (BP)-drug eluting stent (DES) compared to durable polymer (DP)-DES. Whether this can be explained by a beneficial impact of BP-DES stent design on the local hemodynamic forces distribution remains unclear., Objectives: To compare endothelial shear stress (ESS) distribution after implantation of ultrathin (us) BP-DES and DP-DES and examine the association between ESS and neointimal thickness (NIT) distribution in the two devices at 9 months follow up., Methods and Results: We retrospectively identified patients from the BIOFLOW II trial that had undergone OCT imaging. OCT data were utilized to reconstruct the surface of the stented segment at baseline and 9 months follow-up, simulate blood flow, and measure ESS and NIT in the stented segment. The patients were divided into 3 groups depending on whether DP-DES (N = 8, n = 56,160 sectors), BP-DES with a stent diameter of >3 mm (strut thickness of 80 μm, N = 6, n = 36,504 sectors), or BP-DES with a stent diameter of ≤3 mm (strut thickness of 60 μm, N = 8, n = 50,040 sectors) were used for treatment. The ESS, and NIT distribution and the association of these two variables were estimated and compared among the 3 groups., Results: In the DP-DES group mean NIT was 0.18 ± 0.17 mm and ESS 1.68 ± 1.66 Pa; for the BP-DES ≤3 mm group the NIT was 0.17 ± 0.11 mm and ESS 1.49 ± 1.24 Pa and for the BP-DES >3 mm group 0.20 ± 0.23 mm and 1.42 ± 1.24 Pa respectively (p < 0.001 for both NIT and ESS comparisons across groups). A negative correlation between NIT and baseline ESS was found, the correlation coefficient for all the stented segments was -0.33, p < 0.001., Conclusion: In this OCT sub-study of the BIOFLOW II trial, the NIT was statistically different between groups of patients treated with BP-DES and DP-DES. In addition, regions of low ESS were associated with increased NIT in all studied devices., Competing Interests: Declaration of competing interest Ron Waksman: Advisory Board: Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Consultant: Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Grant Support: AstraZeneca, Biotronik, Boston Scientific, Chiesi; Speakers Bureau: AstraZeneca, Chiesi; Investor: MedAlliance. All other authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aims: The aim of the study is to assess the impact of the baseline plaque composition on the DREAMS 3G luminal late loss and to compare the serial plaque changes between baseline and 6 and 12 months (M) follow-up., Methods and Results: A total of 116 patients were enrolled in the BIOMAG-I trial. Patients were imaged with optical coherence tomography (OCT) pre- and post-DREAMS 3G implantation and at 6 and 12 M. OCTPlus software uses artificial intelligence to assess composition (i.e. lipid, calcium, and fibrous tissue) of the plaque. The differences between the OCT-derived minimum lumen area (MLA) post-percutaneous coronary intervention and 12 M were grouped into three terciles. Patients with larger MLA differences at 12 M (P = 0.0003) had significantly larger content of fibrous tissue at baseline. There was a reduction of 24.8% and 20.9% in lipid area, both P < 0.001, between the pre-DREAMS 3G OCT and the 6 and 12 M follow-up. Conversely, the fibrous tissue increased by 48.4% and 36.0% at 6 and 12 M follow-up, both P < 0.001., Conclusion: The larger the fibrous tissue in the lesion at baseline, the larger the luminal loss seen at 6 and 12 M. Following the implantation of DREAMS 3G, favourable healing of the vessel coronary wall occurs as shown by a decrease in the lipid area and an increase in fibrous tissue., Competing Interests: Conflict of interest: H.M.G.-G., R.W., G.D.M., M.G., S.B., A.K., and M.B.L. were core laboratory members, and the remaining authors were investigators of the trial. H.M.G.-G. has grants or contracts from Medtronic, Biotronik, Abbott, Neovasc, Corflow, Alucentbio, Philips, and Chiesi (paid to institution), received consulting fees from Boston Scientific and ACIST, and participates in DSMB/advisory board of the VIVID study. R.W. has grants or contracts from Amgen, Biotronik, Boston Scientific, Medtronic, and Philips IGT; received consulting fees from Abbott Vascular, Biotronik, Boston Scientific, Cordis, Medtronic, Philips IGT, Pi-Cardia Ltd, Swiss Interventional Systems/SIS Medical AG, Transmural Systems Inc, and Venous MedTech; received honoraria from AstraZeneca; participates in DSMB/advisory boards of Abbott Vascular, Boston Scientific, Medtronic, Philips IGT, and Pi-Cardia Ltd; and is an investor in MedAlliance and Transmural Systems Inc. J.T. reports grants and contracts from Abbott paid to his institution, speaker honoraria and support for attending meetings from Biotronik, and is an associate editor of Cardiovascular Biologics and Regenerative Medicine and Frontiers in Cardiovascular Medicine. J.E. reports personal fees/speaker honoraria from Abbott, Boston Scientific, Philips, and Shockwave, patents from Shared, and participation in advisory boards of Abbott and Phillips. The institution of J.F.I. receives grants or contracts from Terumo Corp, Biosensors, Concept Medical, Biotronik, Abbott Vascular, and Philips Volcano. J.F.I. reports consulting fees from Biotronik, Medtronic, Cordis, Terumo Corp., and ReCor Medical; speaker fees/honoraria from Terumo Corp, Biosensors, Medalliance, OrbusNeich, Concept Medical, Bristol Myers Squibb/Pfizer, Novartis, Cordis, AstraZeneca, and Philips Volcano; and support to attend meetings from Biotronik and Amgen. The institution of J.B. receives grants or contracts from Shockwave IVLS. J.B. receives consulting fees from Biotronik AG and Boston Scientific and speaker fees/honoraria from Biotronik AG, Boston Scientific, and Abbott Vascular, participates in the DSMB of Boston Scientific, and has a leadership or fiduciary role for Biotronik. G.G.T. reports consulting fees from Biotronik, Medtronic, Abbott, and Terumo and honoraria from Biotronik, Medtronic, Abbott, and Terumo. M.J. reports grant support from Boston Scientific, Cardiac Dimensions, Edwards Lifesciences, and Infraredx; consulting fees from AlchiMedics SAS, Biotronik, TriCares, Veryan, and Shockwave; speaker fees/honoraria from Abbott Vascular, Biotronik, Boston Scientific, Edwards Lifesciences, Cardiac Dimensions, AstraZeneca, Recor Medical, and Shockwave; travel support from SIS Medical, Edwards Lifesciences, Boston Scientific, and Cardiac Dimensions; and participation in Steering Committees of Biotronik and Edwards Lifesciences. R.T. reports lecture fees from Biotronik. M.W. reports speaker honoraria and conference attendance support from Biotronik. G.O. reports lecturer honoraria from Abbott Vascular, Biotronik, and Cordis and is a DSMB member of the SCIENCE trial and a CEC-member of the BIOFREEDOM STEMI trial. M.H. reports grants/contracts from Biotronik, Cardiac Dimensions, OrbusNeich, and Philips; consulting fees from Biotronik, Cardiac Dimensions, Shockwave Medical, and OrbusNeich; honoraria/speaker fees from Biotronik, Cardiac Dimensions, Shockwave Medical, OrbusNeich, and Philips; and support to attend meetings/travel support from Biotronik, is a steering committee member of the BIOSOLVE and BIOMAG trials, and is a past president of EAPCI. All other authors have no conflict of interest to declare., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Half of global under-five mortalities is neonatal. The highest rates are found in low-income countries such as Ethiopia. Ethiopia has made progress in reducing under-five mortality, but neonatal mortality remains high. Evidence collected continuously at the community level is crucial for understanding the trends and causes of neonatal mortality., Objectives: To analyse the trends and causes of neonatal mortality at the Kilte-Awlelo Health and Demographic Surveillance System (KAHDSS) site in Ethiopia from 2010 to 2017., Methods: A descriptive study was conducted using data from neonates born between 2010 and 2017 at the KAHDSS site. Data were collected using interviewer-administered questionnaires. Causes of death were examined, and neonatal mortality trends were described using simple linear regression., Results: The overall average neonatal mortality rate was 17/1000 live births (LBs). The rate increased from 12 per 1000 LBs in 2010 to 15 per 1000 LBs in 2017. The majority of neonatal deaths occurred during the first week of life, and more than one-half died at home. The leading causes were sepsis, pre-term birth (including respiratory distress), disease related to the perinatal period, birth asphyxia, and neonatal pneumonia., Conclusions: The high neonatal mortality in Ethiopia requires urgent attention and action. Sepsis, preterm birth, perinatal diseases, asphyxia, and neonatal pneumonia are the leading causes of death in neonates. Facility- and community-based health services should target the leading causes of neonatal deaths.

Despite termite-induced soil mixing, summarizing termite-affected soil horizons is difficult, while the lack of accurate information on the pedogenic processes featured by termite bioturbation, topography, and land use limits an effort to address land degradation. A study was therefore carried out to quantitatively classify the soils and describe them based on rangeland uses. Based on cluster analysis, five representative soil profiles were studied at different topographical positions. Soil samples were collected from mounds and adjacent soils under enclosure, cultivated, and open-grazing land at the summit and foot slope positions. Agglomerative clustering showed low Ca 2+ , CEC, pH, and Mg 2+ that described cambic horizons formed Cambisols at the summit and back slope. Eluviation-illuviation processes formed Luvisols on the toe slope and foot slope, whereas clay and high CEC described argic horizons. High Ca 2+ , CEC, pH, and Mg 2+ described calcic horizons that formed Calcisols on the bottom slope. Divisive clustering showed that soil properties varied slightly between Cambisols and Luvisols at different topographies. However, the Luvisols on the toe slope were differentiated from the soil on the foot slope by predominant pedogenetic clay formation and a distinctly increased CEC. Calcisols are placed in other clusters due to their distinct properties. Agglomerative clustering reflected pedogenic processes and differentiated diagnostic horizons, while divisive clustering matched WRB classification. The results of this study also showed that termite-mediated soil properties were dictated by rangeland use, and pedogenesis was more noticeable on open-grazing land than on enclosure or cultivated land., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Abinet Bekele reports financial support was provided by 10.13039/501100003081Ethiopian Ministry of Education. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Objective: Electronic Medical Records (EMRs) are digitalized medical record systems that collect, store, and display patient data. It is individual patient clinical information electronically gathered and made instantly available to all physicians in the healthcare chain, assisting in the delivery of coherent and consistent care. However, the acceptance of the electronic medical record status of physicians in Ethiopia is limitedly known due to knowledge, attitude, and computer skill gaps. This study aims to assess the acceptance of electronic medical records and associated factors among physicians working in Ethiopia., Methods: A cross-sectional study was conducted among physicians working in Gondar Comprehensive Specialized Hospital. A total of 205 physicians were included. Data were collected through a self-administered structured questionnaire. Descriptive and Logistic regression were conducted., Result: A one hundred ninety-eight participants returned the questionnaire from the total yielding a response rate of 96.6%. The proportion of those who have good acceptance for EMR was 72.2% and about 48.5%, 78.3%, and 59.6%, were sufficient computer skills, Good knowledge, and a favorable attitude toward EMR respectively. Age ≤ 30 years (AOR =  0.13 (0.02, 0.57), working experience AOR = 0.15 (0.04, 0.54), working department AOR = 0.09 (0.01, 0.90), good computer skills AOR = 8.42 (6.45, 16.02), Good knowledge AOR = 5.21 (1.22, 12.28), and favorable attitude AOR = 15.24 (12.06, 25.94) were significantly associated towards EMR acceptance., Conclusion: Generally, in this study, physicians' acceptance of electronic medical records was good. Age, year of experience, working department, good computer skills, good knowledge, and favorable attitude were significantly associated with physicians' acceptance of the electronic medical record. Improving computer skills, enhancing positive attitudes, and increasing the knowledge of the health care professionals are vital interventions to enhance and improve the acceptance of EMR system in the study area., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Lipids and glucose concentrations in the blood rise during pregnancy period. Poor control of these analytes results in cardio metabolic dysfunction. Despite this, there are no documented studies which investigate lipids and glucose among pregnant women in Tigrai, northern Ethiopia., Objective: The objective of this study was to assess lipid and glucose levels and identify their correlates among pregnant women in Tigrai, northern Ethiopia., Method: We conducted a facility-based cross sectional study comprising of systematically selected 200 pregnant women from July to October 2021. Those who were severely ill were excluded from the study. We used a structured questionnaire to collect socio-demographic and clinical characteristics of pregnant women. Lipids such as triglycerides, low density lipoprotein, cholesterol and blood glucose were also measured using Cobas C311 chemistry machine from plasma samples. The data were analyzed using SPSS version 25. Logistic regression was performed and statistical significance was declared at p-value < 0.05., Result: Proportion of pregnant women with cholesterol, triglyceride, low density lipoprotein and blood glucose levels above the upper limit of the normal range used for clinical decision were 26.5%, 43%, 44.5% and 21%, respectively. Pregnant women's income > = 10,000 ETB (AOR = 3.35; 95%CI: 1.46-7.66), age (AOR = 3.16; 95%CI: 1.03-9.68), gestational age 29-37 weeks (AOR = 8.02; 95%CI: 2.69-23.90) and having systolic blood pressure greater than 120 mmHg (AOR = 3.99; 95%CI: 1.64-9.75) demonstrated statistically significant association with raised levels of lipids., Conclusion and Recommendation: Proportion of pregnant women with out of normal range values of lipids, particularly triglycerides and low density lipoprotein, is high. Gestational age is a strong predictor of increase in blood levels for both lipids. Provision of life style related health education and dietary intake to pregnant mothers matters. Moreover, monitoring lipid profile and glucose level during antenatal care period is essential., Competing Interests: No conflict of interest declared from authors., (Copyright: © 2023 Berihu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

A machine learning (ML) algorithm for automatic segmentation of intravascular ultrasound was previously validated. It has the potential to improve efficiency, accuracy and precision of coronary vessel segmentation compared to manual segmentation by interventional cardiology experts. The aim of this study is to compare the performance of human readers to the machine and against the readings from a Core Laboratory. This is a post-hoc, cross-sectional analysis of the IBIS-4 study. Forty frames were randomly selected and analyzed by 10 readers of varying expertise two separate times, 1 week apart. Their measurements of lumen, vessel, plaque areas, and plaque burden were performed in an offline software. Among humans, the intra-observer variability was not statistically significant. For the total 80 frames, inter-observer variability between human readers, the ML algorithm and Core Laboratory for lumen area, vessel area, plaque area and plaque burden were not statistically different. For lumen area, however, relative differences between the human readers and the Core Lab ranged from 0.26 to 12.61%. For vessel area, they ranged from 1.25 to 9.54%. Efficiency between the ML algorithm and the readers differed notably. Humans spent 47 min on average to complete the analyses, while the ML algorithm took on average less than 1 min. The overall lumen, vessel and plaque means analyzed by humans and the proposed ML algorithm are similar to those of the Core Lab. Machines, however, are more time efficient. It is warranted to consider use of the ML algorithm in clinical practice., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Quantitative flow ratio (QFR) is a technology to evaluate the coronary stenosis significance on 3-dimensional quantitative coronary angiography. The aim of this study is to evaluate and compare the QFR versus fractional flow reserve (FFR) and/or instantaneous free-wave ratio (iFR) in a US population with a fair African American population representation., Methods and Results: This was a retrospective, observational and single-center study that enrolled 100 patients who underwent coronary angiography. The diagnostic performance of QFR in terms of sensitivity was 0.80 (95%CI 0.64-0.97) and specificity was 0.95 (95% CI 0.90-1.00), the positive predictive value (PPV) was 0.83 (0.68-0.98), while the negative predictive value (NPV) was 0.94 (0.88-0.99). The overall accuracy was 0.91 and area under the curve (AUC) was 0.92 (95% CI 0.87-0.97). The R-squared was 0.54 and the Bland-Altman plot showed a bias of 0.0016 (SD 0.063) and limits of agreement (LOA): Upper LOA 0.13 and Lower LOA -0.12. In African Americans (n = 33), accuracy, AUC, sensitivity, specificity (94%; 0.90 [0.80-1.00]; 0.90 [0.71-1.00]; 0.96 [0.87-1.00], respectively) were better than those for the overall population., Conclusions: In a US-based representative population, vessel QFR accuracy and agreement with FFR as reference is high. Diagnostic performance of QFR in African Americans is also excellent., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Percutaneous coronary intervention (PCI) in patients with angiographic evidence of intracoronary thrombus is associated with in-hospital and 30-day adverse clinical outcomes. Cangrelor, a direct, rapid-onset acting intravenous P2Y 12 receptor inhibitor, has been proved to be effective by reducing peri-PCI ischemic complications in subjects who underwent PCI. This study aimed to assess the angiographic and in-hospital clinical outcomes in all-comer patients receiving cangrelor immediately before PCI at a tertiary care center. The study analyzed consecutive unselected subjects treated with cangrelor at the time the decision was made to proceed with PCI. At the end of the procedure, all patients were transitioned to oral antiplatelet therapy. The target lesion angiographic assessment of Thrombolysis in myocardial infarction flow grade (TIMI-Flow), TIMI-thrombus grade (TIMI-Thrombus), myocardial blush grade, and TIMI-myocardial perfusion grade (TMPG) was performed before and post-PCI. Clinical events were recorded during the procedure and at discharge. In total, 223 patients (244 lesions) were included in the analysis (106, 97, and 20 patientswith TIMI-Flow 0/1, TIMI-Flow 2/3, and cardiogenic shock, respectively). The overall mean age was 63 ± 12 years, 70% men and 38% with diabetes mellitus. Acute myocardial infarction was the main presentation (72%). The use of cangrelor improved TIMI-Flow, MGB, TMPG, and TIMI-Thrombus in patients with initial TIMI-Flow 0 to 2. Major bleeding rate was 2.0%. In conclusion, cangrelor was effective and safe in restoring TIMI-Flow 3, reducing thrombus burden and improving myocardial blush grade and TMPG when administered to unselected subjects who underwent PCI. Therefore, cangrelor should be considered in patients presenting with intracoronary thrombus before intervention., (Copyright © 2019. Published by Elsevier Inc.)

The use of optical coherence tomography (OCT) in PCI guidance is limited perhaps by the lack of adequately powered studies which compare its efficacy and outcomes to the other more popular imaging modalities. We therefore performed a meta-analysis to compare clinical outcomes following OCT-guided PCI with the other imaging modalities in two separate comparisons. We abstracted data from randomized control trials and observational comparative studies focusing on OCT versus either angiography- or IVUS-guided PCI outcomes identified following a systematic search (April 2006 and May 2017). This meta-analysis included a total of 2781 patients; OCT-guidance versus Angiography guidance (n = 1753) and OCT-guidance versus IVUS-guidance (n = 1028). Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effect models. OCT guidance showed lower rates of MACE (OR 0.70 [0.49, 1.00] p = 0.05) and cardiac deaths (OR 0.40 [0.18, 0.90] p = 0.03) compared to Angiography-guidance alone but no statistical significant results for myocardial infarction (OR 0.70 [0.42, 1.16] p = 0.17), stent thrombosis (OR 1.17 [0.40, 3.43] p = 0.77) and target lesion revascularizations (OR 1.07 [0.48, 2.38] p = 0.86).No statistical significance was observed in the OCT versus IVUS comparison; MACE (OR 0.89 [0.46, 1.73] p = 0.73), cardiac deaths (OR 0.56 [0.12, 2.70] p = 0.47), MI (OR 0.56 [0.12, 2.70] p = 0.47), ST (OR 0.43 [0.06, 2.95] p = 0.39), and TLR(OR 0.99 [0.45, 2.18] p = 0.99). OCT-guided PCI in comparison with angiography-guided was associated with reduction in adverse events for the composite of cardiac deaths, myocardial infarction and repeat revascularizations. There was no statistically significant difference in clinical outcomes observed in the comparison between OCT- and IVUS-guidance.

The CliRpath Excimer Laser System to Enlarge Lumen Openings (CELLO) registry included patients treated with modified excimer laser catheters for the endovascular treatment of peripheral artery disease affecting the superficial femoral artery (SFA) and proximal popliteal artery. The aim of this study was to assess, via intravascular ultrasound (IVUS) the dissections in the vessel wall following treatment with the laser catheters. IVUS grayscale images from the CELLO registry were systematically reviewed for dissections in the treated vessel segments by two investigators. Images from 33 patients; 66 pullbacks (1867 IVUS frames in 2 phases), were successfully matched frame-to-frame to evaluate identical segments of the treated vessels in the two phases; post-2 mm Turbo-Elite laser pilot channel creation and post Turbo-Booster laser atherectomy. Dissections were categorized as; (1) intimal, (2) medial, (3) intramural hematoma, and (4) adventitial according to the ACC Clinical Expert Consensus Document classification of dissections. An average of 57 frames was evaluated per pullback, giving a total of 3734 frames (1867 matched for pre-ablation (post channel creation) and post-ablation phases). Treatments with the modified Excimer laser catheters resulted in a significant increase in lumen area of 5.5 ± 3.2-mm 2 (95% CI 4.3-6.8, p < 0.0001) and reduction in plaque plus media volume of -10.6 ± 36.0 mm 3 (95% CI -25.8 to 4.6, p = 0.1619) whilst giving rise to mainly intramural hematoma formations post Turbo-Booster laser treatment in 55% of frames assessed and 24% medial dissections with less than 1% adventitial disruption. The Excimer laser based Turbo-Booster treatment of peripheral artery lesions resulted in significant plaque debulking and increased lumen diameter with negligible degree of adventitial layer injury.

Studies on maturation and body composition mention age at peak height velocity (PHV) as an important measure that could predict adulthood outcome. The age at PHV is often derived from growth models such as the triple logistic fitted to the stature (height) data. Theoretically, for a well behaved growth function, age at PHV could be obtained by setting the second derivative of the growth function to zero and solving for age. Such a solution obviously depends on the parameters of the growth function. Therefore, the uncertainty in the estimation of age at PHV resulting from the uncertainty in the estimation of the growth model, need to be accounted for in the models in which it is used as a predictor. Explicit expressions for the age at PHV and consequently the variance of the estimate of the age at PHV do not exist for some of the commonly used non-linear growth functions, such as the triple logistic function. Once an estimate of this variance is obtained, it could be incorporated in subsequent modeling either through measurement error models or by using the variances as weights. A numerical method for estimating the variance is implemented. The accuracy of this method is demonstrated through comparisons in models where explicit solution for the variance exists. The method of estimating the variance is illustrated by applying to growth data from the Fels study and subsequently used as weights in modeling two adulthood outcomes from the same study.