School of Medicine

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Browsing School of Medicine by Author "Abdela Fozia"

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    Prevalence of Lasparaginase Associated Thrombotic Events and Associated Factors in Adult Patients with Acute Lymphoblastic Leukemia in Tikur Anbessa Specialized Hospital.
    (Addis Ababa University, 2024-02) Abrar Amira; Abdela Fozia
    Background –L-asparaginase is an important component of acutelymhoblastic leukemia treatment. However, it is associated with increased risk of thrombosis which in turn affects leukemia related outcomes and poses increased risk of mortality and morbidity. Objective- To assess the prevalence of thrombotic events associated with L-asparaginase treatment and its determinantfactorsinadult acute lymphoblastic leukemia patients treated inTikur Anbessa specialized hospital from November 2020- November 2023 Methodology: The study was conducted at Tikur Anbessa specializedhospital. A total of 152patients who have been treated or are on treatment for acute lymphoblastic leukemia with L-Asparginase containing regimens at Tikur Anbessa Specialized Hospital from November 2020 toNovember 2023 were included in the study. Data was collected from the patient’s medical records (both electronic and paper). Data was entered and analyzed with SPSS version 26, and achi-square test was used to assess the association of independent variables with the dependentvariable. Bi-variate and multivariate logistic regression were used to determine a significantcorrelation between independent and dependent variables. Results: A total of 152 patients were included in the study. The median age was 22.5 years (IQR18, 30.8), and 59.9% of them were male. The pediatric inspired ALL CL10403 regimen was usedfor treatment in 84.2% of cases, while CALGB 8811 protocol was used in the rest. Theprevalence of thrombotic events in acute lymphoblastic leukemia patients treated with an L-asparaginase containing regimen was 11%. All of the events were venous, and cerebral venousthrombosis was the commonest site of thrombosis, accounting for 41.2% of events, followed bylower extremity deep vein thrombosis. The majority of events were symptomatic, and 44.4%occurred during remission induction.Longer time to achieve complete remission (>4 weeks), adjusted odds ratio AOR 4.8 (95% CI =1.10, 20.72), and age ≥40 years AOR 10.4(95% CI = 1.47, 75.0) were significantly associatedwith an increased risk of thrombotic events. Mortality was higher in patients with thromboticevents (47%) when compared to patients who did not develop thrombosis (41.4%) but was notstatistically significant (P- value = 0.618). Mortality directly attributed to thrombotic events was23.5% among patients who developed thrombosis. Conclusion- This study showed that the risk of L-asparginase associated thrombosis in resourcelimited settings like ours is comparable with previous reports from other parts of the world.Longer time to achieve remission and age above 40 was associated with increased risk ofthrombosis.
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    The Proportion, Clinical characteristics, complications, Treatment Pattern & outcomes of Ph-negative Classic Myeloproliferative Neoplasms at TASH: A Hospital Based Retrospective Cross-Sectional Study.
    (Addis Ababa University, 2024-03) Yirgu Dahlak Teshome; Abdela Fozia
    Background Haematological malignancies are among non-communicable diseases that are becoming increasingly more common both globally and in our country, Ethiopia. Out of these Philadelphia-negative classic myeloproliferative neoplasms, affecting the elderly population group of the society is seen in increased frequency in outpatient department. This is due to progressively rising global population age and life expectancy, so it is becoming an important public health problem worldwide.Investigations done with a small number of African countries indicated a gradually increasing frequency of philadelphia-negative MPNs in the continent. In growing country, there are few studiesthat truly define the clinical feature of these patients. Especially in Ethiopia there is no data regardingPh negative classic MPNs. This will aid to estimate the characteristics, treatment pattern & outcomesbased on a local data of patients with diagnosed Philadelphia-negative classic MPNs. Objective: The main objective of the study istomeasurthelinical characteristics, complications,treatment pattern & outcomes of Ph negative classic MPN patients. Methods: A single cantered hospital based retrospective cross sectional study was conducted athaematology follow up clinic from January 1, 2019 to December 312023data was collected and analyzed with IBM SPSS version27 Result: A total of 151 study participants with the age of 18 & above were included in this study. 57%( 86/151) of study participants are male & 43% are females, with a male to female ratio of 1.3:1.58.3% of PV patients were male, 56.7% of ET patients were females. Similarly 72.2% of PMF caseswere male. PV was the most common (68%) with a median age at diagnosis of 56 years, followed byET (20%, median age 55.5 years) and Primary Myelofibrosis (12%, median age 60 years). Femalepatients had mostly a history of ET; a higher number of male patients had a history of PV and PMF.Among PV cases, the main presenting symptoms were headache/vertigo (37%) followed by fatigue(31.4%), early satiety/ LUQ pain (31%) & splenomegaly was found in 28%. In ET, the mainpresenting symptoms were fatigue (36.8%), headache, joint pain, and splenomegaly being the othercommon presenting symptoms Among the PMF patients’, the main presenting symptoms weresymptoms of anaemia (40%), fatigue (38%), constitutional symptoms (35%), early satiety/ LUQ pain(35%) & Splenomegaly (72%). JAK2V617 mutation was positive in 92%, 54%, and 44.4% of PV, ETand PMF patients, respectively. The frequency of thrombotic events were high in PV patientscompared to other subtypes (PV=33%, ET=26% anPMF=5.6%) and venous thrombosis beinghigher than arterial. In contrast to other subtypes, bleeding was prevalent in PMF patients(PMF=11%). Thrombotic complication was high in high risk PV & ET patients, while Jak 2 mutationstatus didn’t affect thrombosis risk. Phlebotomy, ASA and hydroxyurea, Thalidomide/prednisoloneand transfusion support were the treatment options used. The five year survival rate of Ph –ve MPNswith median diagnosis of 27months were 81%, which was higher for ET (95%), PV=84% and low for PMF (median survival rate is 4 years). Conclusion: This study showed that, PV is a more prevalent ph negative MPN than ET and PMF.Thrombosis is an important complication in these patients, especially in PV patients occurring in~1/3rd of the cases. Based on our findings we emphasize that that Ph negative MPNs should beconsidered & proper evaluation should follow in patient with unexplained abnormalities in hematologic parameters.