జర్నల్ ఆఫ్ క్లినికల్ కేస్ రిపోర్ట్స్

Background: The practice of contraception remains unpopular in Somaliland often attributed to cultural barriers, and misconceptions associated with practice of contraception, all of which discourage women from accessing reproductive health services. This study aimed to assess the prevalence and associated factors with the practice of contraception among married women of reproductive age in Somaliland.

Methods: The data consists of 2304 married women; only 169 (7.3%) of these women were practicing contraception of any kind. The data source for the analysis was the 2020 SLDHS data, which is secondary. A multilevel binary logistic regression model with random intercept and fixed slope models was used in the current investigation.

Results: Among the respondents in the study area, only 7.3% of them practiced contraception of any kind. Among the predictor variables, urban residence, husband’s support, and secondary education and above, wealth, skilled/manual occupations, awareness of methods, completion of family, women who had access to mass media, and those women visited by FP workers significantly encourage the practice of contraception in the study area. On the other hand, lack of husband’s support (AOR=0.8684, p-value<0.01), lower education (AOR=0.8390, p-value<0.01), women who had no access to mass media (AOR=0.7845, p-value=0.0451) and women not visited by the FP worker (AOR=0.3970, p-value=0.04162) were associated with the less practice of contraception and having a desire of more children in the study area.

Conclusion: The strong patriarchal culture is one of the factors in which husbands do not play a major role in contraceptive choices because of the presence of women empowerment to use the long-term contraception method. Close communication between husband and wife and the socialization of LARC by health workers is expected to increase its use is another methods used to reduce the influence of husbands on contraception use. For those individuals who can’t get access of mass media, family planning campaigns play significant role in implementing contraception.

Background: Neonatal mortality is the death of the neonate within the first month of life. Globally each year over four million neonates died within 28 days of birth. In Ethiopia, the prevalence of neonatal mortality is not proportional across regions as such the Amhara region was the second highest neonatal mortality with 54 deaths per 1000 live births. Therefore, this study aimed to investigate the prevalence and associated factors of neonatal mortality in Public hospitals in Amhara region, Ethiopia.

Methods: A community-based cross-sectional study was conducted on 1299 randomly selected neonates for the current study from March to May 2023. A multistage sampling technique with Logistic regression model was conducted in current study. Administered structured questioners, prepared by WHO in 2016 were used for data collection. SPSS version 25 software was used for analysis and data entry too.

Results: The risk of neonatal mortality in the study area was 20.9 per 1000 live births. Among the predictor variable; the preterm neonates (AHR=4.54, 95% CI፡ 1.57, 13.17, p-value=0.005), neonates borne from prim parous mother(AHR=4.21, 95% CI፡ 1.39, 12.7, p-value=0.011), neonates from mothers who had a previous neonatal history (AHR 3.50, 95% CI፡ (1.33, 9.20), p-value=0.011), neonates borne for mothers who did not have antenatal care (AHR=3.20, 95% CI፡ (1.10, 9.30), p-value=0.033), neonates whose delivery not at health institutes (AHR=4.17, 95% CI፡ (1.24, 14.08), p-value=0.02) and neonates born from mothers with an abortion history (AHR=4.60, 95% CI፡ (1.90, 11.32), p-value=0.001) had significant role for the existence of neonatal death in the study area.

Conclusion: The risk of nneonatal death was significantly associated with mother’s order of birth, duration of pregnancy, antenatal care, history of neonatal mortality, place of delivery and history abortion. Health related education should be conducted for women of reproductive age to get the antenatal care service and to deliver at health institutes. Hence, it is important to encourage mothers to use antenatal care service and deliver in health institutions.

Background: Human immune deficiency virus weakens a person's defenses against infection and leading to acquired immune deficiency syndrome. The objective of this study was to identify predictors associated with time to viral load suppression among adult HIV positive patients under HAART in public Hospitals in Amhara Region.

Method: This study was conducted at public hospitals in Amhara region, Ethiopia using a Cross sectional study design. The source of data in this study was secondary source obtained from Amhara Public Health Institution. The data were collected by the health staff working at public hospitals in the region.

Result: Among the potential predictor variables under study, Patients aged between 25-34 years (AOR=0.694, 95% CI: (0.408-0.773), p-value=0.020), Tertiary Educated patients (AOR=0.860, 95% CI: 0.762-0.906, p-value=0.001), patients disclosed their disease status AOR=0.972, 95% CI: 0.701–0.997), p-value=0.014), patients with low baseline Viral load (AOR=0.949, 95% CI: 0.815–0.989), p-value=0.018), patients with high number of CD4 cells/mm3 (AOR=0.791, 95% CI: 0.819-0.890), p-value=0.021), good adherent patients (AOR=0.854, 95% CI;(0.746, 0.927), p-value=0.011) significantly associated with short time to viral load suppression. On the other hand, TB/HIV co-infected patients (AOR=1.317, 95% CI: 1.120, 1.436), p-value=0.015) and patients who used substance (AOR=1.241, 95% CI: (1.173, 1.383), p-value=0.026) significantly associated with longer time to viral load suppression.

Conclusion: The result in the current study revealed that significant predictor variables associated to time to viral load suppression were identified. Further studies should be done on HIV positive adult patients by considering other important independent variables not included in this study. Awareness should be created for patients to disclose their disease status and to be good adherent for their medication.

Objective: Symparastasi online programme was created because of the quarantines due to covid-19. The professional care centers were closed. After the quarantines there was a need of professional care for patients who live away from the big city centers. Symparastasi programme aimed to educate the informal dementia caregivers in order for them to be able to perform some non-pharmacological interventions to their patients effectively and safely. The programme offered psychoeducation and multicomponent training programme for the caregivers of patients with Mild Cognitive Impairment (MCI) and mild dementia. The aim of the programme was to examine which group had the best results in 3 domains: a) maintain or enhance cognitive abilities, b) Decrease Behavioural and Psychological Symptoms (BPSD) and c) improve the quality of life of patient and caregivers.

Methods/Design: This is randomized controlled trial with 426 participants of both genders. The participants were randomly assigned into 3 groups of 142 patients each. Group A received only the multicomponent training programme, group B received only the psychoeducation and group C received both interventions. The programme was online and the caregivers should have access to the internet. There were 11 multicomponent training videos with progressive difficulty of the exercises, and 11 psychoeducation videos that were referring to topics regard dementia, its progress, its prognosis, prevention, BPSD, non-pharmacological interventions etc. The 12th session was a private session of each patient and caregiver in order to ask questions and be supported emotionally. The measurements used were: the Timed Up and Go test (TUG), Berg Balance Scale (BBS) and 30second Sit to Stand Test for the physical tests. For the cognitive abilities used: Mini Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination-Revised (ACE-R). For the neuropsychiatric problems used: Neuropsychiatric Inventory (NPI). For the caregivers the study used the following scales: State Trait Anxiety Inventory (STAI-S) in order to record the anxiety levels, Beck Depression Inventory (BDI) for the depression and NPI and Zarit Burden Interview (ZBI) in order to record caregivers’ burden. The programme lasted for 24 weeks and there was three recordings of the results: at the beginning of the programme (T1), after 6 months of performing the interventions (T2), and 3 months after the end of the programme (T3), as a follow up.

Results: All groups had positive results in the three domains, but group C had the best results. In terms of cognitive abilities the interventions did not enhance the cognitive skills but tried to maintain the good results for a period of time. BPSD were reduced statistically significant and the caregivers’ burden and anxiety and depression levels were also decreased. Some results maintained over time.

Conclusion: The combination of psychoeducation and multicomponent training programme has positive results in maintaining the cognitive abilities, decrease BPSD and improve the general quality of life of both patients and caregivers in patients with MCI and mild dementia.

Dextrocardia, a rare congenital heart defect, becomes exceedingly unusual when accompanied by Atrial Fibrillation (AF). With the advancements in AF-related guidelines, anticoagulation therapy has become increasingly important. Lifelong oral anticoagulants remain imperative after successful AF ablation. Percutaneous Left Atrial Appendage Occlusion (LAAO) is an efficacious and secure strategy for averting AF-related thromboembolic incidents, thereby confirming the progressive suitability of the one-stop approach of AF ablation + LAAO. Cryoablation, favoured for its short procedural duration and enhanced tolerability, is particularly advantageous for older patients with AF, facilitating a streamlined procedure under local anaesthesia. However, the presence of abnormal anatomical structures presents challenges to this technique. This study describes a case of successful cryoablation + LAAO performed under Intracardiac Echocardiography (ICE) guidance in an elderly patient with dextrocardia and AF, providing a reference for the treatment of AF in patients with ectopic anatomy.

Locally advanced breast cancer presents significant challenges to the multidisciplinary team, particularly in cases involving hormone receptor (HR)-positive, HER2-negative tumors, which typically show lower rates of pathological complete response to chemotherapy. Cyclin-Dependent Kinase (CDK) 4/6 inhibitors are the cornerstone of treatment in metastatic Hormone Receptor (HR)-positive, HER2-negative breast cancer and have more recently been considered in the adjuvant setting. However, their effectiveness in the neoadjuvant setting remains uncertain.

We report the case of a 55-year-old postmenopausal woman initially diagnosed with metastatic HR+/HER2- breast cancer due to a unique L5 bone lesion. Systemic treatment was initiated with an Aromatase Inhibitor (AI) and a CDK4/6 inhibitor. After six months of treatment, imaging reevaluation confirmed that the L5 lesion, which had remained unchanged, was benign, allowing for curative surgery. Final pathology revealed a complete histological response with no residual tumor, highlighting the potential of CDK4/6 inhibitors in managing locally advanced HR+/HER2- breast cancer.

Vulvovaginal Candida glabrata is more challenging to treat than Candida albicans because of antifungal drug resistance. A 48-year-old woman with an ongoing complaint of vaginal irritation, pain, itching, and dyspareunia sought medical care multiple times over the course of two years with her primary care provider, gynecology and urology due to vulvovaginal Candida glabrata. She was treated with intravaginal boric acid, low dose vaginal estrogen cream, oral fluconazole, amphotericin-B vaginal tablets and oral oteseconazole, but found none of these treatments effective. Finally, she was treated with amphotericin B (100 mg) and flucytosine (1000 mg) formulated in a vaginal cream. Her symptoms resolved, and she tested negative. In conclusion, recurrent resistant vulvovaginal Candida glabrata is clinical challenging to treat, and for this woman led to her feeling frustrated and hopeless over these two years until a successful treatment was found.