Based on the differentiation of deficiency (hyporeactivity) and excess (hyperreactivity) syndromes according to the Traditional Chinese Medicine (TCM) logic, 65 labyrinthine tinnitus cases of the example was classified into three groups, the excess constitutional type (18 cases), the deficiency constitutional type (37 cases) and the intermediate type (10 cases). Acupuncture treatment was carried out under the guidance of the basic principles of "seeking the fundamental of a disease in treatment"based on TCM.
The effect was evaluated using two parameters of subjective tinnitus assessment score in a special questionnaire (STS) and objective tinnitus loudness level in dB SL (OTL). Based on the changes in STS and OTL before and after the end of all therapeutic courses, the gross effective rate (GER) of 65 cases containing effective STS or OTL was 72.3%, while the strict effective rate where both STS and OTL showed effective (BER) was 47.7%. Among the three TCM syndromes differentiation groups, the excess constitutional type had the best therapeutic effect (66.7%of BER), fellows the deficiency constitutional type (48.7%of BER), and the intermediate type was the worst (only 10%of BER). Statistically, there was a significant difference among each syndrome differentiation group (p<0.05).
Meanwhile, the entire GER and BER went down to 55.4%and 38.5%respectively 2 months after the end of treatment to show a decreasing tendency of therapeutic effectiveness compared with those treatment rates immediately after the end of treatment. Especially, GER of the deficiency constitutional type showed a significant decrease (P<0.05).
We concluded that the TCM differentiation of deficiency and excess syndromes is a prerequisite for the determination of a correct acupuncture treatment for labyrinthine tinnitus. Through a thorough analysis and treatment on 65 clinical cases, the tinnitus of the excess constitutional type showed a higher reactivity for the treatment comparing to the other two types, the deficiency and the intermediate.

Objective: To determine the prevalence of toxoplasmosis and to assess the possible risk factors associated with the infection among pregnant women attending antenatal care center at Felege Hiwot Referral Hospital, Bahir Dar town, northwest Ethiopia. Methods: A hospital based cross-sectional study was designed to determine the prevalence of toxoplasmosis among pregnant women. Three hundred eighty four serum samples were collected from November 2013 to January 2014. Data on socio-demographic and predisposing factors were collected from each study participant with simple random sampling technique. The serum samples were examined for anti- Toxoplasma gondii (T. gondii) antibodies using latex agglutination test. Results: The overall seroprevalence of T. gondii among the pregnant women was 18.5%. All of T. gondii positive cases found to be positive only for IgG antibody. Significant association was observed between seroprevalence and presence of domestic cats [AOR = 2.85, 95% CI: 1.66-4.90, P = 0.000], consumption of raw or undercooked meat [AOR = 1.98, 95% CI: 1.15-2.43, P = 0.014] and history of abortion [AOR = 2.47, 95% CI: 1.40-4.34, P = 0.002]. No significant association was observed between seroprevalence and socio-demographic characters, gestational age, gravidity, consumption of raw vegetable, and blood transfusion. Conclusions: The seroprevalence of toxoplasmosis among pregnant women in Bahir Dar town was relatively high. Presence of domestic cats at home and consumption of raw or undercooked meat were identified as main risk factors for T. gondii infection. Therefore, health education towards avoiding eating raw or undercooked meat and avoiding contact with cats are recommended for prevention of miscarriage or defects during pregnancy.

Traditional Chinese acupuncture was used in four cases of intractable tinnitus associated with presbyacusis, showing greater losses at higher frequencies while lower frequencies were only slightly below the normal threshold on a pure tone audiogram. Further audiologic evaluation by means of a speech discrimination test and short-increment sensitivity index (SISI) showed that cases 1 and 2 were the labyrinthine impairment type, case 3 was the mixed type, and case 4 was the retrolabyrinthine type. However, the etiology and pathogenesis of all patients were diagnosed as constitutional deficiency of kidney essence failing to nourish both the ear and brain, the so-called “sea of marrow” based on TCM differentiation. Following the principle of invigorating kidney essence and nourishing “Kidney Qi, ” acupuncture treatment was given around the ear as well as at distal points on the extremities once a week, with 10 sessions constituting one therapeutic course.
In cases 1, 2 and 3, a temporary minor reduction effect of tinnitus lasting half a day to a few days could usually be achieved by each acupuncture session, and long-term effects, with significant improvement of subjective intensity and loudness of tinnitus (which always dropped to 1/2-1/3 of the pretreatment levels) was possibly obtained after 3-4 treatment sessions. Acupuncture was less effective in case 4, in which some fluctuation of tinnitus loudness values was reported within the period of treatment, but there was no remarkable stable improvement, either in terms of loudness or disturbance of the tinnitus after 10 treatment sessions.
The results indicate that traditional Chinese acupuncture is a recommendable therapy in treating age-related tinnitus, especially the labyrinthine type or mixed type rather than the retrolabyrinthine type.

OBJECTIVETo determine the prevalence and antimicrobial susceptibility of bacteria from suspected urinary tract infections.

METHODSA retrospective analysis of bacterial pathogens and their antimicrobial susceptibility was done on urine samples at Dessie Regional Laboratory in the period 2003 to 2010. Antimicrobial susceptibility tests were done using disc diffusion technique as per the standard of Kirby-Bauer method.

RESULTSThe male to female ratio of the patients was 1:1.96. Of the total 1 404 samples, 319 (22.7%) were culture positive. Escherichia coli was the dominant isolate (63.6%) followed by Klebsiella spp. (8.5%) and Proteus spp. (8.2%). The overall resistance rates to erythromycin, amoxycillin, and tetracycline were 85.6%, 88.9% and 76.7%, respectively. The three most frequently isolated bacteria had resistance rates of 80.1%-90.0% to, amoxycillin, and tetracycline and sensitivity rates of 0 to 25% to nitrofurantoin, ciprofloxacin and gentamicin. Antibiogram of isolates showed that 152 (47.85%) isolates were resistance to two and more antimicrobials.

CONCLUSIONSIn the study area resistance rates to erythromycin, amoxycillin and tetracycline were high. Since most isolates were sensitive to nitrofurantoin and gentamicin, they are considered as appropriate antimicrobials for empirical treatment urinary tract infections.

BACKGROUND: Health care professionals (HCPs) are at high risk of contracting blood-borne infections due to their occupational exposure to blood and body fluids (BBFs). The incidence of these infections among HCPs are higher in low income countries such as Ethiopia. The aim of the study was to investigate the extent of occupational exposure to BBFs and its associated factors among HCPs in Bahir Dar town, Ethiopia. METHODS: A cross-sectional study was used from October 1, 2012 to October 30, 2012. Three hundred and seventeen HCPs were included in the study using a simple random sampling technique. The data were collected using a structured questionnaire and analyzed using SPSS version 16. Bivariate and multivariate analyses were used to identify the factors related to exposure to BBFs. RESULTS: Two hundred and nine (65.9%) HCPs were exposed to BBFs in the past year, of which 29.0% were needlestick injuries. Work experience [adjusted odds ratio (AOR) 4.13, 95% confidence interval (CI) 1.56-10.91], inconsistent use of gloves (AOR 1.98, 95% CI 1.04-3.43), and not complying with standard precautions (AOR 1.80, 95% CI 1.00-3.22) were the factors associated with occupational exposure to BBFs. CONCLUSION: A high proportion of HCPs was exposed to BBFs in this study. Occupational exposure to BBFs was determined by the use of gloves and not complying with standard precautions. Ensuring the availability of gloves, training about standard precautions, and motivation of HCPs to implement standard precautions should be emphasized to avoid such exposures.
Body Fluids* ; Cross-Sectional Studies ; Delivery of Health Care* ; Ethiopia* ; Incidence ; Motivation ; Multivariate Analysis ; Needlestick Injuries ; Occupational Exposure* ; Odds Ratio ; Surveys and Questionnaires

Unconventional and 'non-lethal' weapons are being used in crowd control regularly nowadays. The use of these arms is not risk-free. The paramilitary forces in 2010 used the old fashioned slingshots for crowd control in Kashmir. A young male suffered from a fracture of the distal humerus due to a marble from a slingshot. He was managed by debridement and plaster splintage. Use of apparently innocuous weapons for crowd control is not without risk, as the projectiles fired from them can achieve high velocities and cause significant damage.
Elbow Joint ; Fractures, Bone ; Humans ; Humerus

Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a combination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.
Aged ; Bone Plates ; Female ; Fibula ; transplantation ; Fracture Fixation, Intramedullary ; methods ; Fractures, Ununited ; surgery ; Humans ; Humeral Fractures ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications

A 15-year-old teenager with Type 1 Neurofibromatosis presented with grade 4 spondylolisthesis over T12/L1 junction resulting paraparesis (Frankel D). Radiograph showed a Cobb angle of 88 degrees. Computed tomography scan showed dysplastic vertebral bodies, pedicles and facet joints of T11, T12 and L1 vertebra with complete T12/L1 facets dislocation. Magnetic resonance imaging confirmed presence of spinal cord compression. He underwent posterior instrumentation and posterolateral fusion (T8 to L4) using hybrid instrumentation. Extensive corticotomy of the posterior elements was followed by the use of large amount of bone graft. Post operatively, his neurology improved markedly back to normal. Radiographs showed a good correction of the deformity. He was immobilized in a thoracolumbar orthosis for six months. A solid posterior fusion was achieved at six months follow up. At 36-month follow up, he remained asymptomatic. This case report illustrates a successful treatment of a grade 4 thoracolumbar spondylolisthesis secondary to neurofibromatosis with posterior spinal fusion alone.

Mastocytosis is an uncommon, sporadic, heterogenous illness resulting from hyperplasia of mast cells. Diffuse cutaneous mastocytosis is the rarest subtype of mastocytosis affecting children, with bullous mastocytosis being its least common variety. Systemic manifestations like nausea, vomiting, bone pain, diarrhea, and central nervous system abnormalities are less common in children than adults. We report a four-month old male who presented with a two-month history of generalized yellowish to tan macules, papules and plaques with peau d'orange texture, with some blisters and erosions on the back, abdomen and scalp. Darier's sign was positive. Baseline laboratory workup were negative for systemic involvement. CD117 and Giemsa staining were positive for mast cells. Based on the clinical findings and histopathologic results, a diagnosis of bullous mastocytosis was made. Treatment included ketotifen drops, mupirocin cream and cetirizine drops, which resulted in flattening of most lesions and resolution of blisters and erosions.

Human ; Male ; Infant ; Blister ; Cetirizine ; Diarrhea ; Hyperplasia ; Ketotifen ; Mast Cells ; Mastocytosis ; Mastocytosis, Cutaneous ; Mupirocin ; Nausea ; Vomiting

Background: Globally, ischemic stroke outnumber hemorrhagic strokes. However, it was observed that hemorrhagic stroke is more common in Kashmir valley. The present study was conducted to substantiate this notion, and to identify the possible risk factors. Methods: This prospective study was conducted on 6,906 patients with fi rst ever stroke admitted to S. M. H. S. Hospital, an associated teaching hospital of the Government Medical College, Kashmir, from January 1996 to June 2009. Other than clinical history, examination and routine biochemistry, cranial CT scan (non-contrast) was performed in all the cases within three days of the stroke onset. MRI brain, CSF analysis, screening for cardiovascular disorders, prothrombotic states and collagen profi le were performed wherever deemed necessary. Results: There was predilection of stroke among the males and rural population. Eighty three percent of patients developed fi rst-ever stroke in sixth and seventh decade. Fifty four percent of cases had a Glasgow coma score of >10 on admission. Intracerebral hemorrhage was observed in 64.7% patients with male preponderance. Putamen (53.5%) was the most common, site of hemorrhage, followed by thalamus (29.7%). Hypertension, smoking and multiple risk factors were observed in 92.3%, 70.3% and 67.9% cases respectively. Poor antihypertensive medication compliance was observed in 55.9% cases. Conclusions: Intracerebral hemorrhage was the commonest stroke-type observed in Kashmir accounting for close to two third of strokes with male preponderance.