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BackgroundRequesting blood prior to a surgical procedure for perioperative transfusion is a common practice in surgical patients. More unit of blood is requested than used by anticipating the patient will be transfused to provide a safety margin in an event of unexpected haemorrhage. Over requesting with minimal utilization results in significant wastage of blood, reagents and human resource. This study was conducted to assess blood utilization practice of the largest tertiary hospital in Ethiopia.MethodsA cross-sectional prospective study method was used. Data was collected using a Proforma questionnaire by perusal of each individual patient’s records from December 1, 2017 to February 28, 2018.patient age, sex, department requesting the blood, level of operating surgeon, hemodynamic status, number of unit requested, number of unit crossed matched and number of unit transfused were collected. Efficiency of blood utilization was calculated with three indices: Crossmatch to transfusion ratio, transfusion probability, and transfusion index indices.ResultsBlood was requested for 406 patients and a total of 898 units were crossmatched for this patients. Overall Crossmatch to transfusion ration, transfusion probability and transfusion index were 7.6, 15.3% and 0.29 respectively. Results showed insignificant blood usage. Among different departments and units, better blood utilization was seen in neurosurgical unit with C/T ratio, TP and TI of 4.9, 24.4 and 0.6% respectively, while worst indices were from obstetrics unit with C/T ratio, TP and TI of 31.0, 6.5% and 0.06.ConclusionUsing all the three parameters for evaluation of efficiency of blood utilization, the practice in our hospital shows ineffective blood utilization in elective surgical procedure. Blood requesting physician should order the minimum blood anticipated to be used as much as possible.

Spina bifida, also known as meningomyelocele, is a major birth defect mostly associated with folate deficiency in the mother early in pregnancy. The prevalence of spina bifida is disproportionately high in Ethiopia compared to the global average; about 10,500 liveborn are affected annually. Many affected infants do not receive timely repair surgery. There are a high number of stillbirths, and neonatal, infant, and under‐five deaths. Mandatory fortification of staple foods such as wheat and maize flour with folic acid, a B vitamin, is an effective primary prevention strategy for spina bifida. Survival in those with spina bifida increases if neurosurgical intervention is available soon after birth, along with continuous surgical and clinical aftercare throughout the lifespan. Currently, Ethiopia does not have mandatory food fortification for primary prevention or adequate neurosurgical capacity to meet the need to prevent adverse outcomes associated with spina bifida. We present in this paper two concurrent and complementary policy and practice solutions occurring in Ethiopia through global partnerships: (1) capacity‐building of neurosurgery care through training programs; and (2) promoting national mandatory folic acid fortification of staples for primary prevention of spina bifida. These two policy and practice interventions ensure all affected infants can receive timely pediatric neurosurgery and sustained surgical aftercare through required neurosurgeon availability, and ensure primary prevention of spina bifida. Primary prevention of spina bifida frees up significant neurosurgical capacity in resource‐poor settings that can then be directed to other critical neurosurgical needs thus lowering child mortality and morbidity.

Pilomyxoid astrocytomas (PMA) are new class of Pilocytic Astrocytoma (PA.), which typically have their origin in hypothalamus and Chiasmatic region. There are very few case reports of PMAs arising from cerebellum. Their imaging features are similar to PA but they behave more aggressively than PA. To increase awareness of PMA within the neurosurgical community, the authors reviewed a case of 11-year-old male child who presented with truncal and cerebellar ataxia and vomiting and right cerebellar tumor diagnosed as PA radiologically but PMA on histopathology examination. These findings indicate that PMA may be a unique entity that is distinct from PA, or it may be an unusual variant.Key words: -Pilocytic astrocytoma • pilomyxoid astrocytoma • diagnosis • cerebellar DOI: http://dx.doi.org/10.4314/ecajs.v21i3.22 IntroductionPilocytic astrocytomas are generally benign, typically showing 20-year survival rates of 70 to 80%, even when only a subtotal resection is achieved. 1 These highly treatable and potentially curable pediatric tumors are considered Grade I neoplasms according to the World Health Organization tumor classification system. 2, 3 Prior to its recognition, PMA was grouped with PA, because the two display similar histological features.In 1999, Tihan and colleagues provided the sentinel description of PMAs. 1 Because of their similar histological and radiological features, 2 PMAs were classified as PAs prior to acceptance of this publication. . Earlier reports pointed out unusual features of some pediatric astrocytomas, particularly those within the hypothalamic/chiasmatic region, but did not specifically use a term to distinguish them. 4,5,9 In contrast to PAs, PMAs demonstrate a more aggressive clinical course 8-9 and appear to be associated with a higher incidence of leptomeningeal spread. 9 Pilomyxoid astrocytomas are considered to be WHO Grade II neoplasms, and most often arise from the hypothalamic/chiasmatic region. However, PMAs sometimes originate from the posterior fossa. 4 whereas hypothalamic PMAs have been well described in the literature, there is a relative paucity of information about PMAs that arise from the cerebellum. Although limited clinical experience makes it difficult to generate conclusive prognostic data regarding this recently described pediatric tumor, PMA has been shown to behave more aggressively than PA . 11 Here we report a case of cerebellar PMA in a 11 year old male child and discuss literature review Case reportThis was an 11 year old male patient who was relatively in a good state of health prior to his presentation to neurosurgical referral clinics at which time he presented with global headache,projectile vomiting of ingested matter of one moth duration, these symptoms were associated with difficulty of maintaining balance, and blurring of vision.Physical examination revealed papilledema with positive Romberg's test.Abnormal rapid alternating movements, and tandemwalk were indicative of cerebellar ataxia and truncal ataxia. Brain CT scan with contrast was done, With di...