Internal Medicine

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    Ambulatory Blood Pressure Control Pattern in Hypertensive Patients at Tikur Anbesa Specialized Hospital: A Cross Sectional Study
    (Addis Abeba University, 2021-05) Alemayehu, Mulualem; Dr.Abebe, Sintayehu; Dr.Yadeta, Dejuma; Dr.Alemayehu, Bekele
    Background: Hypertension is the most common cardiovascular problem globally with a particularly increasing burden in developing countries like Ethiopia. Ambulatory blood pressure (ABPM) is superior to office blood pressure (OBP) measurement for diagnosing, prognosticating and following treatment efficacy for hypertension. There is no available data on ABPM control pattern in Ethiopians. This study will determine the ABPM control patterns in Ethiopian hypertensive patients on treatment. Material and Methods: This was a cross sectional study in hypertensive patients at Tikur Anbessa Specialized Hospitals outpatient departments carried out during January to May 2021. ABPM values of 244 consecutively sampled patients were analyzed. All patients had their BP monitored over 24 h with a Tonoport V (GE CS V6 71), and the data was interpreted using GE CardiosoftTM ABPM software in accordance with European Society of hypertension guidelines. Ethical clearance was given by Addis Ababa University Institutional Review Board and the study was conducted in compliance to standard ethical guidelines. Results: The study involved 244 adult hypertensive patients; mean age of the patients was 59.4years and, 54% were females. 58.6% of patients had controlled OBP, while only 45.1% had controlled ABPM. The mean OBP was 137 (19)/81 (10) mmHg and mean 24-hr ABP was 137 (16)/81 (10) mmHg; mean daytime BP was 136/79 ± 17/11 mmHg; mean night-time BP, 138/84 ± 16/11 mmHg. Mean ABPM values were not significantly different between men and women. Comparison of ABPM values with OBP revealed high prevalence of the white coat effect (32%) and masked uncontrolled hypertension (46%). Presence of comorbidities particularly diabetes predicted poor ABPM control. Conclusion: More than half of patients had uncontrolled BP as per ABPM criteria and significant discrepancy exists between ABPM and OBP in assessing adequacy of BP control. Guiding management decisions using ABPM can improve BP control rates.
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    Assessment of clinical practice of secondary prophylaxis for varceal bleeding and prevalence of recurrence, among adult patients in TikurAnbesa Specialized Hospital, in Addis Ababa, Ethiopia, 2020.
    (Addis Abeba University, 2020-12) Jemal, Kamil; Mersdessa, Guda(consultant internist,Gastro Interologist and Hepatologist)
    Background: - Variceal bleeding refers to bleeding due to rupture of varix which is usually found in the esophagus or stomach. Recurrent variceal bleeding is a bleeding episode that occurs after 5 th day of initial episode. The approaches to patients who have had first variceal bleeding is controlling the acute bleeding and prevent further re-bleeding. To prevent re-bleeding and mortality, secondary prophylaxis is indicated for all patients. This usually requires repeated variceal band ligation until varices are obliterated and/or nonselective Beta blocker. Failure to apply guideline based clinical practice of secondary prophylaxis will predispose to increased risk of recurrent variceal bleeding, hospitalization and mortality. There is no published data regarding clinical practice of secondary prophylaxis for variceal bleeding and prevalence of recurrence in Ethiopian context. Objective: - To assess the clinical practice of secondary prophylaxis for variceal bleeding and prevalence of recurrence among adult patients in Tikur Anbesa Specialized Hospital, in Addis Ababa, Ethiopia, 2015-2019. Methods: - A hospital based cross-sectional study was conducted on 140 adults who had endoscopically confirmed variceal bleeding during 2015-2019. Retrospective data from hospital records including socio-demographic characteristics, clinical and laboratory data and endoscopic results of the patients were collected. EpiData version 4.4.2.1 software was used for data entry and STATA15.1 for analysis. Descriptive data were presented as mean, percentage and standard deviations. Result: - Propranolol was the main medical treatment given as secondary prophylaxis. Propranolol (96.4%), EVL & propranolol (2.9%), and carvidelol (0.7%) were started before or at discharge. Of these patients 9.4%, 11.5%, 20.2% and 28.6% achieved the guide line recommended target heart rate at 2-6 week, 6 week-3 month, 3 month-6 month, and 6 month- 1 year respectively on follow up. More than 70% of the pat ients’ heart rate is not in the target rate in each follow up. 61.2%, 65.8%, 53.6%, 69% patients had their dose of propranolol adjusted at each consecutive follow up. Significant proportion of patients, 38.8%, 34.2%, 46.4%, & 31% were not provided with the appropriate dose adjustment. Of the patients who were on follow up 11.5% had experienced recurrence of variceal bleeding. Conclusion and recommendation:-There was a significant gap in clinical practice of guideline recommended secondary prophylaxis for the prevention of variceal rebleeding in patients on follow up in TASH during the study period. There was lack of continuous supply of EVL bands in the country and appropriate escalation of the dose of propranolol was not implemented as per guideline recommendations in significant proportion of patient. Physicians should follow the appropriate evidence based guidelines in the management of variceal bleeding and prevention of rebleeding. Furthermore the hospital should avail necessary supplies like EVL which are vital for endoscopic intervention to control acute bleeding and for prevention of rebleeding.
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    Assessment of Dyslipidemia and its Associated Risk Factors among Adult Type-2 Diabetic Patients on Follow up at Tikur Anbessa Specialized Hospital: A Hospital based Cross Sectional Study
    (Addis Abeba University, 2021-12) Addis, Wondwosen; Aberra, Theodros(MD,Endocrinologist &assistant professor)
    Background: Dyslipidemia is one of the major modifiable risk factors for cardiovascular diseases (CVD) in a type-2 diabetic (T2DM) patient. Dyslipidemia in T2DM patients is attributed to increased free fatty acid flux secondary to insulin resistance. Globally burden of dyslipidemia in diabetic patients is continuously increasing. Intensive management of dyslipidemia and its associated factors is required to prevent cardiovascular disease. Objective: The study was designed to assess the prevalence and associated factors of dyslipidemia among adult patients with type 2 diabetes at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Method: An institution-based- cross-sectional study was conducted from July 10 to November 10, 2021. A convenience sampling technique was used to recruit 208 T2DM patients. Data on socio-demographic characteristics, behavioral, and clinical factors were collected using a structured questionnaire through face to face interview. Anthropometry and blood pressure were measured. Laboratory data were retrieved from patients chart. Data was entered and analyzed using SPSS version 25. To identify determinant factors of dyslipidemia, bivariate and multivariate binary logistic regression analyses were done. Statistical significance was considered at the level of significance of 5%, and adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to present the estimates of the strength of the association. Results: The overall prevalence of dyslipidemia among study participants was 78.4%. Hypertriglyceridemia was found in 42.8%, hypercholesterolemia in 25.1%, high low-density lipoprotein in 30.3%, and low high-density lipoprotein in 36.5% study participants. Longer duration of diabetes &physical inactivity were significantly associated with dyslipidemia. Patients who have more than 10 years duration of diabetes had five times (95% CI, 1.24-20.149) more risk of dyslipidemia as compared with less than 5 years duration. Type2 DM patients who don’t perform moderate physical activity had nearly three times (95% CI, 1.077-7.767) increased risk of dyslipidemia as compared with those who perform 5-7 days moderate physical activity in a week. Conclusion: A high prevalence of dyslipidemia was found among T2DM patients in the study area. Physical inactivity and longer duration of diabetes were significantly associated with dyslipidemia among T2DM patients. Clinicians need to screen, treat, and educate diabetic patients about dyslipidemia and its associated risk factors.
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    Assessment of Knowledge and Practice of ICU Care Bundles in Infection Control among Physicians and Nurses Working in Three Governmental Hospitals (Tikur Anbesa Specialized Hospital (TASH),Yekatit 12 and st. Peter Specialized Hospital) Adult ICU,Ethiopia, 2021
    (Addis Abeba University, 2021-12) Teshome, Mulugeta; Dr.Haile, Tewodros(Consultant internist and PCCM)
    Background: Intensive care is a continuum of care from various source of admissions where patients‘ requiring a frequent evaluation and support to assure safe and effective outcomes. Mortality in intensive care unit (ICU) is a global burden which results in a huge loss of productivity and financial costs. In Africa, the ICU mortality rate is high compared to developed continents. ‗‗Evidence-Based Bundle‘‘ of care which involves 3–5 structured interventions help to reduce and prevent hospital acquired infections (HAI‘s). OBJECTIVE: To assess the knowledge and practice of ICU care bundles among physicians and nurses working in three government hospitals Adult ICU, Addis Ababa, Ethiopia 2021. METHODS: A cross-sectional descriptive study was conducted using a structured questionnaire and observational check list. Proportional sampling technique was used. Collected data was cleaned, coded and entered in to excel and SPSS version 26was used for analysis and descriptive methods such as frequencies, or proportions. A score of ≥ 60% is considered as knowledgeable or good practice. X 2 tests were used to look for association with P <0.05. RESULT: A total of 101 health professionals participated with the response rate of 96.2%. Of this 53 (52.5%) were nurses and 48 (47.3%) were physicians, majority 55 (54.5%) were from TASH, 64.4% of them were males and the mean age of respondents was 29.4 (SD ± 3.32) years. Regarding knowledge of ICU care bundles, 53 (52.5%), 69 (68.3%) and 79 (78.2%) were knowledgeable regarding VAP, sepsis and urinary catheter care bundle respectively. But 50 (49.5%), 64 (63.4%) and 68 (67.3%) were observed to have good practice of elements of VAP, sepsis and urinary catheter care bundles in their daily activity respectively. This study also showed that there is significant association between knowledge and practices (p < 0.001). DISCUSSION AND CONCLUSION: Even through nurses' and physicians‘ overall knowledge regarding ICU care bundles was good, the practice was inadequate and the health care workers do not implement the latest evidenced based bundle practices. So the overall knowledge and practice of ICU care bundles used for prevention of ICU infection was suboptimal.
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    Assessment of Knowledge and Practice towards Household Transmission Prevention among People with Chronic Hepatitis B Attending Liver Clinic at Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia.
    (Addis Abeba University, 2021-12) Liban, Dida; Dr.Belachew, Hiwot(MD, Consultant Gastroenterologist and Hepatologist, Assistant Professor at Department of internal medicine)
    Background: Hepatitis B infection is a major global public health problem. Better disease related knowledge among Hepatitis B patients is important for prevention of transmission and facilitate screening of their sexual partners and household contacts. Objective: To assess the level of knowledge and practice of household transmission prevention among people with chronic hepatitis B attending liver clinic at Tikur Anbessa Specialized Hospital, Ethiopia. Methods: A cross-sectional study among 229 hepatitis B patients visiting liver clinic for follow up service was undertaken in 2021. Data were collected using a structured interviewer guided questionnaires and analyzed using descriptive and inferential statistical methods in SPSS 26. Results: Mean age of respondents was 40 years, 68% were male, Mean total knowledge score was 11.1(79 out of 100) with 65% of respondents scoring ≥75 (defined as a high knowledge). In adjusted linear regression, age <40 years, presence of additional infected household members and disease duration >3 years were associated with higher knowledge score (R 2 = 0.106, F=8.936, P<0.001).Mean total practice score was 4.7 with only 38.6% of paticipants scoring ≥6 (defined as good prevention practice). In Adjusted logistic regression, factors associated with poor practice were; low level of education (OR: 5.218; 95%CI: 1.34-20.23; p=0.017), being on anti HBV treatment (OR: 3.582; 95%CI: 1.04-12.33; p=0.043) and duration of follow up at TASH <2 years (OR: 2.93; 95%CI: 1.14-7.55; p=0.025). Conclusion: Poor implementation of recommended prevention practices and misunderstandings about transmission were identified among chronic hepatitis B patients.
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    Assessment of Knowledge on Hepatitis B infection, Hepatitis B Vaccine and Vaccination Status among Health Care Workers in TASH from March 10-Sept 10 ,2020 G.C
    (Addis Abeba University, 2020-12) Girum, Alebachew; Birhanu, Yohannes (MD, Internist, consultant Gastroenterologist and Hepatologist)
    Background: Hepatitis B infection is usually higher among health workers than the general population, particularly in the sub-Saharan region. WHO recommends vaccination for all health care workers (HCWs) against the highly infectious, blood borne virus: HBV. However, previous studies reported that knowledge of HCWs toward the hepatitis B infection, Hepatitis B vaccine and their vaccination coverage was low and vary among HCWs in different settings. Objective: This study was aimed to assess knowledge about HBV infection, HBV vaccine and status of HBV vaccination among healthcare workers in TASH, Addis Ababa, Ethiopia from March 10 to September 10, 2020. Methods and materials: Hospital based cross-sectional study was conducted on 358 HCWs who were selected randomly. Stratified random sampling method was used to collect the data using self-administered questionnaire. Then, the data was entered into Epi-data 4.2 version and was exported to Statistical Package for Social Science (SPSS) version 26 for analysis. All covariates that showed p value < 0.25 in binary logistic analysis were further analyzed by multiple logistic regressions to detect true predictors. Result: Among the health care workers, who participated in this study, 180 (51.4%) of them had adequate knowledge on the HBV infection. Medical doctors were the most knowledgeable among the HCWs, with interns [AOR=11.3(95% CI=4.5-28.6)], consultant physicians [AOR=7(95% CI=3.1-15.9)] & resident physicians [AOR=3.5(95% CI=1.9-6.9)] being significant predictors of good knowledge. Vaccination coverage was 60% which was predicted by a shorter work experience [AOR=4.7(95%=1.4-5.8)]. Conclusion: This study reveals that general knowledge level of HCWs about HBV is inadequate and vaccine coverage is suboptimal. Thus, concerned stakeholders should devote more efforts to improve the HCWs awareness about the virus and role of its vaccine and also more work to avail vaccine.
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    Assessment of Knowledge, Attitude and Practice of Diabetic Foot Care among Diabetic Patients in Tikur Anbessa Specialized Hospital, Ethiopia
    (Addis Abeba University, 2021-12) Fekadu, Elfign; Reja, Ahmed (MD, Endocrinologist)
    Background- The prevalence of diabetes continues to be a growing problem throughout the world and contributes significantly to the health care burden. One of the major complications that diabetes carries is foot ulcer. Diabetic foot ulcer (DFU) is one of the most feared complications and a common reason for the hospitalization of diabetic patients. The ultimate endpoint of diabetic foot disease could be amputation, which is associated with significant morbidity and mortality. It also has significant social, psychological, and financial consequences. Objective- This study is designed to address the status of knowledge, attitude and practice of diabetic foot care and barriers to foot care practice among diabetic patients on follow up at Endocrine clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methodology- This is a descriptive cross-sectional study which was done on diabetic patients on follow up at Endocrine clinic in Tikur Anbessa specialized hospital. The study included 378 diabetic patients using a convenient sampling technique. All patients whose records met the inclusion criteria were reviewed. SPSS version 25 was used for data analyses. Knowledge, attitude, and practice of foot care were assessed using descriptive statistics and bivariable and multivariable logistic regression. Results- A total of 378 study diabetic patients were included in this study where the mean age of the participants was 54 years. There was comparable sex distribution. The mean knowledge score using questionnaires adapted from recommendations by American College of Foot and Ankle surgeons was 12.1 1.94 of which 47.6% and 52.4% had good and poor knowledge of diabetes foot care respectively. The mean attitude score using questionnaires adapted from a previous Saudi study was 3.85 0.90 of which 73.5% had good attitude and the remaining 26.5% had poor attitude towards foot care. The practice score using questionnaires that were adapted from the Nottingham Assessment of Functional Foot Care (NAFFC) was considered good if the participants scored above mean. Based on that, 54.5% of the participants had good practice while 45.5% of the participants were considered to have poor practice. With regards to barriers of foot care nearly one third didn’t know what to do, 27.5% didn’t think it was important, and 6.9% of the participants mentioned poor communication between patients and HCP. Conclusion and recommendation- Knowledge and practice of foot care among diabetes patients in our study participants weren’t satisfactory. The result of this study displays the gaps in their knowledge and practice and puts an emphasis on the need for patient education. Most patients are reported to have good attitude which can signify that patients are willing to learn and practice if they get access to proper diabetes education. In conclusion, it is important to focus on the role of health education to minimize diabetic foot complications.
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    Assessment of self-reported insulin injection techniques among patients with Diabetes Mellitus on follow-up at adult Endocrine clinic at Tikur Anbessa Specialized Hospital: Hospital-based cross-sectional study September 1 - October 31, 2020 G.C.
    (Addis Abeba University, 2020-12) Efrem, Paulos; Dr.Tarekegn, Getahun(MD, Internist,Endocrinologist)
    Background Assessment of injection device use and injection technique, are key components of a comprehensive diabetes medical evaluation and treatment plan. Proper insulin injection technique may lead to more effective use of this therapy and, as such, holds the potential for improved clinica l outcomes. The lack of a clear number of patients with diabetes mellitus requiring insulin therapy, and few studies focused on either assessing injection techniques or associated complicat ions separately have indicated suboptimal knowledge and skill with higher than the worldwide average on the presence of complications. Objective Major insulin injection parameters were assessed among patients with diabetes mellitus on followup at the adult diabetes referral clinic in TASH, Addis Ababa from September 1 to October 31, 2020. Methods A cross-sectional survey was conducted from September 1 to October 31, 2020, at the diabetes clinic in Tikur Anbessa Specialized Hospital. Data were collected by using a structured, interviewer-administered questionnaire. Then, entered and analyzed using SPSS version 20. To identify factors associated with injection techniques, bivariable and multivariable binary logist ic regression analyses were done. Statistical significance was considered at a level of significance of 5%, and adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to present the estimates of the strength of the association Results A total of 293 participants were included in this study. The most common type of diabetes reported was Type 2 diabetes mellitus. From the recommended injection sites, 256 (87.4%) inject at more than 1 site with the thigh (249/85%) being the most often used site. The median total daily insulin dose was 54IU. Insulin syringe reuse was practiced by practically all (98%) of the participants. Injection site rotation is practiced by 272 (92.8%) of the participants. The presence of anyswellings or lumps over the injection sites was reported by 113 (38.6%) of the participants with the thigh being the most common site. Disposal of used syringes capped into the trash is the practice of 176 (60.1%) of the study participants. From the multivariate analysis, sex (AOR=2.33, 95% CI:1.13-4.83), total daily dose of insulin (AOR=0.99, 95% CI:0.98-0.99), last time injection instructions were reviewed (AOR=0.35, 95% CI:0.13-0.97) and hyperglycemia events (AOR=0.56, 95% CI:0.31-0.99) showed significant association with the presence of lipohypertrophy. Conclusion: This study revealed that there are alarmingly high rates of injection-related complications. The diabetes education given pertaining to injection parameters and evaluation of injection sites are neglected which will fuel the occurrence of complications. It highlights the need for the provision of patient-centered instruction and education about insulin injection techniques.
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    Assessment of Statin Utilization Pattern for Primary Prevention in Patients with Type 2 DM Who have Follow up at Diabetic Clinic in Tikur Anbessa Specialized Hospital; A Hospital-Based Cross Sectional Study, 2021
    (Addis Abeba University, 2021-12) Guadie, Ayanaw; Yadeta, Dejuma(MD, Assistant Professor of Internal Medicine and cardiology)
    Background: cardiovascular disease is the leading cause of morbidity and mortality among type 2 diabetic (T2DM) patients. Statin therapy is effective in reducing cardiovascular events for both primary and secondary prevention of ASCVD. Objective: to assess statin utilization extent for primary prevention of CVD in patients with type 2 DM who are above 40yrs having follow up at diabetic clinic TASH. Methods and materials: a hospital based cross-sectional study was conducted based on data collected using structured questionnaire by face-to-face interview and the digital record system from june 10, 2021, to September 20,2021.Data entry was made using Epi info version 3.1 and was analyzed using SPSS software version 25. RESULT: A total of 376 of patients with the age above of 40 with T2DM were participated in this study. statin prescription rate was 87.4%. almost all of patients (99.1%) who are taking statin were on moderate intensity and above with 59.3%% and 39.8%% received moderate and high -intensity statin respectively. From the study conducted, the most commonly prescribed statin was Atorvastatin (85.6%). Predictors of statin prescription were age, use of Both insulin and metformin, occupational status and monthly income as independent determinants of statin use. Use of both insulin and metformin increased the odds of statin use by 2.29 times as compared to the counterparts [AOR= 2.29; 95% CI: 1.07, 4.95]. Having other occupation led to 79% less odds for statin use as compared to government employees [AOR=0.21; 95% CI: 0.09, 0.51]. For each 1-year increase in the age of the patients, the odds of using statin increases by 5% [AOR= 1.05; 95% CI: 1.02, 1.10]. CONCLUSION: In conclusion this study done at showed the highest rate of statin prescription of 87% for primary prevention of ASCVD in type 2 DM patients who are above 40 compared to other studies done recently.Which is consistent with contemporary guidelines recommendation for dyslipidemia and primary prevention of ASCVD.
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    Assessment of the Diagnosis, Follow-up and Treatment Outcomes in Patients with Hyperthyroidism at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia
    (Addis Abeba University, 2021-05) Gulilat, Amare; Dr.Tarekegn, Getahun (Consultant Internist and Endocrinologist )
    Background Hyperthyroidism is a disease condition characterized by increased synthesis and secretion of thyroid hormone by the thyroid gland. A diagnosis of hyperthyroidism is made based on clinical presentation and abnormality in TFT characterized by low level of TSH and elevated thyroid hormones. Diagnosing the different forms of hyperthyroidism based on clinical manifestations and TFT alone is challenging. Objective To assess the diagnosis, follow-up and treatment outcomes in patients with hyperthyroidism at Endocrine Clinic, TASH. Methods A retrospective follow-up study was employed to evaluate the diagnosis, follow-up and treatment outcomes of patients with hyperthyroidism at Endocrine Clinic, TASH. A census was performed to those patients who were aged 18 years and above, diagnosed to have hyperthyroidism on Antithyroid drug for more than 18 months on follow up from September 2009 to August 2012 E.C, excluding pregnant women. Patients’ response to different treatment options were evaluated. Also, factors associated with treatment outcomes were identified. While descriptive statistics (mean, proportion, percentage and standard Deviations) were used to summarize the results, multivariate logistic regression and chi square test were used as appropriate to check the association between dependent and independent variables. Statistical significance was determined at a p value of < 0.05 and CI of 95%. Results In this study, a total of 230 patients with hyperthyroidism were involved, of which 208[ 90.4%] of them were female and 22[ 9.6%] were male. The female to male ratio was 9.4 to 1. The mean age of the participants was 44 years +/-13 SD. In about 60 % of patients the duration of diagnosis of hyperthyroidism was less than 04 years. The most common symptom and sign were palpitation and goiter accounting [89.6%] and [78.2%] respectively. Significant association was found with therapy and duration of treatments. Those patients who had been following treatment for four years and above, were more likely to have improved outcome compared to those who were following their treatment for less than four year (AOR=2.869, CI=1.173-7.0211, p=0.021). In addition, those patients who were on initial combination therapy (Beta adrenergic blocker + ATD) were 2.189 times highly likely to have improved outcomes compared to those who took single therapy (ATD or Beta-adrenergic blocker) (AOR=2.189, CI=1.144-4.187, p=0.018). Conclusions In this study, the most common cause of hyperthyroidism was TMNG and Treatment outcome was strongly associated with duration of hyperthyroidism and initial usage of combination therapy.
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    Assessment of utilization, practice, indication and complications of blood and blood component therapy at internal medicine wards Tikur Anbessa Specialized Hospital.
    (Addis Abeba University, 2019-11) Gebregiorgis, Mahlet; Dr.Gebremedhin, Amha(Consultat internist and heamatologist)
    Background: Despite the increased use of blood and blood component transfusion there seems to be an obvious lack in the knowledge and practice of the process. There is also a lack of institution wide guideline on the practice and adequate training given to physicians. This is a special concern because even though blood and blood component transfusion is a life saving process it carries its own risks. Objective: To evaluate the utilization, practice, indications, complications of blood and blood component therapy in medical patients admitted to Tikur Anbessa hospital. Methodology: Institutional based prospective quantitative descriptive study will be conducted to assess utilization, indications, complications of blood and blood component transfusion. Data will be collected using pre prepared check list and will be analyzed using Statistical Package for Social Sciences, version 20. Results: During the study period there were a total of 329 units of blood and blood component issued to the medical wards with 148 episodes of transfusion. Male patients accounted for % of patients and females accounted for -%. The most common age group transfused was (n = %). The most common indication for transfusion is (n = %). He most common primary diagnosis is ( n %). The most commonly used blood component is (n = %). Vital sign was recorded only in (n = 8, 5.4%) prior to transfusion, (n = 5, 3.4%)during transfusion and (n = 10, 6.8%) post transfusion. Conclusion: This study provides information about the trend of utilization, indication and practice of blood and blood component therapy in medical wards of black lion hospital. The data obtained will help to guide improve transfusion practice, and planning for future needs in blood and component therapy in the future.
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    Breaking Bad News Knowledge and Attitude of Junior Physician Practicing at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
    (Addis Abeba University, 2021-12) Mitiku, Tilahun; Dr.Merkebu, Ermias(Pulmonologist and Critical care specialist)
    Introduction: Breaking bad news to patients or discussing a serious case with a patient is part of the daily activity of many healthcare professionals and it is an inevitable clinical duty. In a Medical setting bad news is any information likely to alter drastically a patient's view of his or her future perspectives and vision of life. Effective communication skills of delivering bad news are very important to develop good patient-physician relationships. Objective; To assess the Knowledge, and Attitude of TASH Junior physicians about breaking bad news. Methods: An institutional-based cross-sectional study at Tikur Anbessa specialized hospital, Addis Ababa Ethiopia from August to October 2021, and comprised 286 postgraduate residents of different specialties making a 98% response rate. Their knowledge and attitude were assessed by using a specifically-designed questionnaire based on SPIKES protocol. It is a six-step protocol of Setting, Perception, Invitation, Knowledge, Empathy, and Summarizing model. Data were collected through self-administered questionnaires and online surveys. The collected data were entered into Microsoft excel, then it was exported to SPSS of version 26.0 for analysis. Bivariate and multivariate analysis using logistic regression models was used to determine the association between different predictor variables with the dependent variable Results: Among 286 respondents, 201 (70.3%) were males and 85(29.7) were females and the mean age of the participants was 29.69 years (SD±2.205) years).98.3% of participants have been involved in breaking bad news, (37.1%) admitted bad experience in breaking bad news and 87.6% did not have any specific teaching or training on BBN. The mean and median score of the participants' knowledge about breaking bad news in this study was 5.94 (SD ± 1.100) and 6 respectively. Among participants, 70.3% had good knowledge, followed by a poor knowledge (16.4%) and a Moderate level of knowledge (13.3%). From self-reported breaking bad news skills majority of participants (57.7%) of participants were only fairly satisfied with their BBN skills. Conclusion Most of the participating physicians didn’t receive any training on BBN, a substantial number of residents didn't follow BBN protocol. Even though a majority of participants had good knowledge they had little satisfaction regarding their BBN skills Recommendation Education and training for trainees during their residency programs to improve their BBN skills should be considered and adoption of BBN protocol
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    Bronchiectasis: Knowledge, Attitude and Treatment Practice among Residents Working at Tikur Anbessa Specialized Hospital, St. Paul Millennium Medical College and Yekatit 12 Hospital: Addis Ababa, Ethiopia : A Cross-Sectional Study
    (Addis Abeba University, 2021-12) Bassa, Samson; Merkebu, Ermias(Assistant Professor of internal medicine)
    Background: Diseases of the respiratory system are a leading cause of morbidity, mortality and disability worldwide. Bronchiectasis is a progressive respiratory disease characterized by a permanent dilation of bronchi. The prevalence and incidence of bronchiectasis is increasing worldwide mainly due to the increased recognition of the disease and availability of better diagnostic modalities. Post-infectious bronchiectasis was the most common cause of bronchiectasis among those with identified risk factors, of which post-Tb bronchiectasis is the commonest one. The most common factors that influence prognosis and mortality are severity of disease, age, bacterial colonization, frequency of disease exacerbation and underlying and comorbid condition. Current guidelines generally recommend treatment in several categories: chest clearance and pulmonary rehabilitation techniques that aim to improve muco-ciliary clearance, muco-active drugs, anti-inflammatory therapy, bronchodilators and antibiotic treatment. Objectives: The survey was to investigate the knowledge, attitude, and practices of resident physicians working in three hospitals towards bronchiectasis. Materials and Methods: The survey was done using a self-administered questionnaire which was adopted from a similar study to resident physicians working in Tikur Anbessa specialized hospital, St, Paul millennium medical college and Yekatit 12 Hospitals. Data were anonymized and analyzed at an individual level, field of practice, year of residency and health facility. Data analysis was done using SPSS version 26. Results were presented as frequencies and chi-square and bivariate correlation was done to determine statistical significance and correlation. Results: A total of 103 participants were recruited from Tikur Anbessa specialized hospital (64/103, 62.1%), St. Paul millennium medical college (30/103, 29.1%) and Yekatit 12 hospital (9/103, 8.7%). Among the 103 participants (83/103, 80.6%) are internal medicine residents and (20/103, 19.4%) were family medicine residents. Median age was 28.9 years, with 69.9% male participants. Most participants have good knowledge as to the definition, diagnosis and investigation. Most participants did not have access to guidelines and recognized the need. Conclusion: The study highlights the need for local guidelines for bronchiectasis care and management that considers local contexts. Though most participants have good knowledge, there was variation in treatment and investigation of such patients. Most participants agree on the need for guideline.
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    The Burden and Determinates of anemia among predialysis chronic kidney disease patients following in renal unit at Tikur Anbessa Specialized Hospital
    (Addis Abeba University, 2021-02) Abdi, Semir; Melkie, Addisu(MD, Internist and Consultant in Nephrology); Seifu, Lissane(MD, Internist and Consultant in Nephrology )
    Background: Anemia is common and significant complication of chronic kidney disease (CKD). Anemia of chronic kidney disease is associated with significant cardiovascular morbidity mortality and poor quality of life. However, its prevalence and management has not been studied thoroughly at local and national level. Objective: To assess the prevalance, severity and management of anemia among predialysis chronic kidney disease (CKD) patients on follow up at Tikur Anbessa Specialized hospital (TASH) renal clinic. Methods and Materials: A hospital based cross sectional hospital study was conducted from April 1 to July 30, 2020. Consecutive sampling was used to recruit 100 study participants. participants were interviewed using structured questionnaire, and their medical records were reviewed to obtain information on relevant medical history and laboratory parameters. Serum Iron panel was determined for all enrolled patients. Data was analyzed using SPSS version 26. Continuous variables were presented as means ± standard deviations and compared by t-test. Categorical variables were expressed as count with percentage and compared by Chi-square. Bivariate and multivariate logistic regression analyses were used to identify independently associated factors of anemia. P-value <0.05 was used to declare association. Results: the burden of anemia in CKD was high (48%) and its prevalence increased with worsening kidney function. Diabetes (40%) and hypertension (25%) were the leading causes of CKD. CKD stage, iron marker and BMI were found to be independent determinant of anemia among CKD patients. Among patients with anemia, only 35.4% were treated, only 27% of patients were managed with iron agent and only 8.3% were managed with ESA. Conclusion: Screening and intervention programs should be implemented to improve the outcome of CKD patients with anemia. Grant source: Addis Ababa University, college of health sciences, school of medicine
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    Clinical and imaging characterization of patients with focal liver lesions with emphasis on hepatocellullar carcinoma at Tikur Anbessa Specialized Hospital (TASH) from august1, 2019to july30, 2020.
    (Addis Abeba University, 2020-12) Woldie, Amare; Dr. Sultan, Amir (Internist, consultant Gastroenterologist and hepatologist)
    Abstract Background: The accurate and reliable determination of the nature of the liver mass is critical, not only to reassure individuals with benign lesions but also, and perhaps more importantly, to ensure that malignant lesions are diagnosed correctly. Accurate diagnosis allows the appropriate selection of optimal management. Objective: This study was aimed to assess clinical and imaging characterization in patients with focal liver lesions with emphasis on HCC at Tikur Anbessa specialized hospital (TASH) from august1, 2019 to july30, 2020. Method: Institution based descriptive and retrospective study was conducted from August 1, 2019 to July 30, 2020. A total of 135 patients with imaging result of focal liver lesion were included in the study data was collected using standardized questionnaire. Clinical and imaging pattern was assessed from records. Summary statistics like mean and median were computed. Both bivariate and multivariate logistic regression was fitted to identify associated variables. A 95% confidence interval odds ratio (OR) was computed and considered variables having p - value less than 0.05 in the multi variable model as significantly associated with the dependent variables. Result: A total of 135 patients were included in the study. The mean age was 49.83(SD 13.866) years. Most of the patients were from Addis Ababa and Oromia (82.3%). Majority of lesions in this study were malignant (81%), hepatocellular carcinoma (63%) and hemangioma (29.9%) being the commonest malignant and benign lesions respectively. Many of the lesions were solitary (62%) and size ≥5cm. right lobe was mostly involved (57.1%). Abdominal pain was the commonest presentation (74.8%) in most of the patient. HBV (22.2%) and HCV(7.4%) infection was significantly associated with hepatocellular carcinoma among the risk factors. Conclusion: Majority of lesions in this study were malignant and solitary. Hepatocellular carcinoma and hemangioma were commonest malignant and benign lesions respectively. Right lobe was mostly involved and abdominal pain was the commonest presentation in most of the patient. Among the risk factors HBV and HCV infection was significantly associated with hepatocellular carcinoma. Grant source: Addis Ababa University, college of health sciences, school of medicine
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    Clinical characteristics and Endoscopic outcomes of patients who underwent UGIE for an indication of dyspepsia at Tikur Anbesa Hospital Gastroenterology referral clinic from December 1, 2015- December 30 2019.
    (Addis Abeba University, 2020-12) Kefyalew, Endashaw; Dr. Sultan, Amir(MD, internist, Consultant Gastroenterologist)
    Background: Dyspepsia is a frequent syndrome in our country, where there is limited endoscopy service and high prevalence of Helicobacter pylori (H. pylori) infection with some having an organic cause while others have functional dyspepsia. Endoscopy is the most accurate method of diagnosis of most endoscopically positive conditions associated with dyspepsia, including gastric cancer, peptic ulcer disease, esophagitis and gastro- duodenitis. Helicobacter pylori infection is associated with various upper gastrointestinal pathologies. Objective: The purpose of this study is to Clinical characteristics and Endoscopic outcomes of patients who underwent UGIE for an indication of dyspepsia at Tikur Anbesa Hospital Gastroenterology referral clinic. Methods: A Hospital based- Retrospective cross-sectional study was conducted using pretested, structured questionnaires to determine clinical characteristics of patients between 17-76 years’ old who underwent endoscopic procedure at Tikur Anbesa Hospital Gastrointestinal referral clinic. The study is conducted from April 2020-september 2020 G.C. A sample of 270 patients were included in the study. Based on the structured questionnaire, presenting symptom, alarm symptom, H.pylori test result and endoscopic finding and risk factors are assessed by the investigator. Organic dyspepsia findings were analyzed with different variables to verify statistically significant associations. Result: Two hundred seventy patients were included and analyzed in the study. The mean age was 38 years and Men comprised 58.5% of the study. 37 % of the patients reported alarm symptoms. The prevalence of H. pylori infection was 37.8 %. Endoscopic finding constitutes Normal, 29%, Ulcer disease, 16% (duodenal in 13% and gastric ulcer in 3%), Gastropathy/Gastritis 33 %, 13% had GERD and esophageal erosion and gastric mass account for 2.2 %. Ulcer diseases were found to have statistically significant association with H. pylori infection OR, (0.38 95% CI, (0.143-0.552) and alarm symptom (iron deficiency anemia and persistent vomiting), p <0.05. Conclusion: The endoscopic diagnosis in our setting showed predominance of abnormal findings and of this ulcer disease is the major endoscopic outcome with strong associations with Helicobacter pylori infection and GERD diagnosis was also shown to be frequent endoscopic diagnosis among our dyspeptic patient. Whereas cancer was an uncommon finding, despite the high prevalence of H. pylori.
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    Clinical characteristics and outcomes of patients with dialysis requiring AKI at the Tikur Anbessa specialized hospital.
    (Addis Abeba University, 2019-11) Getachew, Nebiyu; Dr.Melike, Addissu(Consultat internist and Nephrologist)
    Background: Acute kidney injury (AKI) in developing countries is the disease of the young and children while developed countries elderly patients with co morbid conditions predominate. The management of patients with acute kidney injury (AKI) is supportive, with renal replacement therapy (RRT) indicated in patients with severe kidney injury. Even though, government run dialysis service is given in few centers in Ethiopia, data on epidemiological and clinical characteristics of dialysis requiring AKI patients and its outcome is sparse. Objectives: The objective of this study is to describe socio-demographic, clinical characteristics of patients with dialysis requiring AKI and their renal and hospital outcome at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: The study is an institution based retrospective chart review of patients with AKI who were hospitalized and had hemodialysis inTikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia from July 14, 2016 to September 2019. Data on socio-demographic characteristics, clinical profiles, and dialysis and hospital outcomes were collected using a structured questionnaire. Data entry and analysis was done on (SPSS) version 20. Frequency tables and odds ratio was used to explain and analyze the results. Factors found to be significantly associated with mortality on bivariate analysis (P-value< 0.05) were analyzed with a multivariate model using logistic regression to determine the predictors of in-hospital mortality. P values less than 0.05 were considered statistically significant. Result A total 275 patients underwent hemodialyis during the period, of which 130 patients, 71 females (54.6%) and 59 males(45.6%), with a median age of 34 were included in the study. The most common causes of AKI were sepsis (33.8%), glomerulonephritis(31.5%) and pregnancy related causes (16.2%). A quarter of the patients (25.4%) did require ICU admission. The in hospital mortality was 26.2%. Sepsis, co morbid heart failure and age above 50 year were associated with increased mortality. In 12(9.2%) patients’ glomerulonephritis as a cause of AKI increased the risk of dialysis requirement beyond 4 weeks. Conclusion In this setting the majority of patients with dialysis requiring AKI are young. We have observed a shift in the etiology of dialysis requiring AKI in the last two decades; from Malaria and septic abortion predominated to sepsis and glomerulonephritis.
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    Clinical Characteristics and Predictors of Outcome of Lupus nephritis Patients on Follow up at Two Centers in Addis Ababa, Ethiopia from August 1, 2016 up to August 30, 2020
    (Addis Abeba University, 2020-12) Fekade, Seife; Tadesse, Yewondwossen (MD, Internist, Consultant Nephrologist)
    Background: SLE is a multisystem chronic autoimmune disease which commonly involves the kidney and is associated with high mortality and morbidity especially in populations of African descent. Objective: To describe the clinical characteristics, treatment patterns and predictors of outcome in a group of Ethiopia lupus nephritis patients from two centers. Patients and Methods: The records of 97 lupus nephritis patients on follow up from August 1, 2016 up to August 30, 2020 in two centers, Tikur Anbessa specialized hospital and a private practice center (Shebelle Higher Clinic), Addis Ababa, Ethiopia were reviewed to acquire data on clinical characteristics and outcome. All patients fulfilled 2012 SLICC criteria for SLE. Result: There were a total of 89 females and 8 male patients. Mean age at presentation of LN was 27.4 with 80(82.5%) of patients having LN as first presentation of SLE. Nephrotic range proteinuria was present in 27% and impaired kidney function was seen in 51.6% at presentation. Kidney biopsy done for 17 patients showed Class III and class IV as the commonest types. 70(74.5%) patients received immunosuppressive therapy with cyclophosphamide and MMF used in the majority. Favorable outcome was seen in 73(73.7%) after 6 months of therapy. After a median follow up of 41 months, 71.3% of patients had favorable outcome, 8(8.5%) patients had died and 1(1.1%) developed ESRD. Follow up at Tikur Anbessa specialized hospital, renal flare history and absence of response at 6 months were found to be significantly associated with unfavorable outcome. Conclusion: LN, in this study of Ethiopian patients, is mostly diagnosed concomitantly with SLE and it presents at a younger age group and with more degrees of kidney impairment, but has response to treatment comparable to most other series.
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    Clinical Characteristics and Treatment Outcomes of Patients with Dermatofibrosarcoma Protuberans Treated with Imatinib at Tikur Anbessa Specialized Hospital:Hospital-based cross-sectional study May-September 2020 G.C.
    (Addis Abeba University, 2020-12) Gebray, Niguse; Gebremedhin, Amha(MD, Internist, hematologist associate professor of medicine)
    Background:DFSP is a rare soft tissue tumor with indolent growth and low probability of distant metastasis. More than 90% of cases are positive for CD34 and are characterized by translocation of chromosome 17 and 22 (t (17; 22)) resulting in the expression of fusion gene-COL1A1-PDGFRb. A TKI, imatinib targets this fusion gene and showed efficacy in treating both locally advanced and metastatic DFSP. Objective:The aim of this study is to describe the clinical characteristics of patients and to evaluate response to imatinib of patients with DFSP treated in Tikur Anbessa Hospital. Methods: We assessed retrospectively 26 patients with DFSP treated with imatinib from 2004-2020 at hematology unit of Tikur Anbessa Hospital, in Addis Ababa. Clinical data was extracted from medical records and patients and analyzed with SPPS version 26. Response to imatinib was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST). Results:18 of the patients were males and 8 were females with a median age of 35 years (range: 22-66). Trunk is the commonest location of primary tumor constituting 61.5%, followed by head and neck. Twelve patients have been treated with imatinib for locally recurrent disease, which was difficult to resect surgically, and 6 (50%) showed partial response, 3 (25%) complete response, 1 (8.33%) patient had stable disease and 2 (16.67%) had disease progression. On the other hand, thirteen patients underwent surgery for locally recurrent disease followed by imatinib therapy for residual disease. Six (6) of these patients had complete response, 3 patients had partial response and 4 patients had progressive disease while on imatinib. One patient had recurrent disease with liver metastasis and he underwent surgery for local recurrence and imatinib was given for liver metastasis which disappeared after 3 months. The overall clinical response rate was 73.1%. The major adverse effects of imatinib were: GI upset in 38.5%, skin depigmentation in 34.4%, anemia in 23%, leukopenia in 23% and edema in 19.2%, which were all transient and self-limiting. Conclusion: DFSP is highly recurrent tumor after surgical resection. We found out that Imatinib is well tolerated and an effective treatment option for locally recurrent and advanced disease that is difficult for complete surgical resection, with over all clinical response of 73.1%.
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    Clinical characteristics, diagnosis and treatment response of adult prolactinoma patients on follow up at endocrine clinic of TikurAnbessa Specialized Hospital during the period from June 2015 to June2020, Addis Ababa, Ethiopia.
    (Addis Abeba University, 2020-06) Beyene, Eyerusalem; Dr.Ahmed, Abdurezak(Consultant internist and Endocrinologist, department of internal medicine, college of health sciences, Addis Ababa University)
    BACKGROUND-Prolactinomas are the most common type of pituitary adenomas in both sexes with different age distribution.They are benign neoplasms accounting for approximately 40% of all pituitary tumors. They are classified into two main groups based on the size of pituitary tumour at presentation: microprolactinoma (tumour diameter <1 cm) and macroprolactinoma (tumour diameter >1 cm). The clinical presentation of prolactinoma includes manifestations relating to hyperprolactinaemia and features relating to tumor bulk. OBJECTIVE- The objective of this study is to assess the clinical profile, diagnosis and treatment response of patients with prolactinoma on follow up at endocrine clinic ofTikurAnbessa specialized Hospital(TASH). METHOD; Ahospital based retrospective cross sectional study was conducted on adult patients with confirmed prolactinoma attending Endocrine clinicof TASH from June, 2015 to June 2020. All patients with prolactinoma on follow up at endocrine clinic of TASHon the stated period were included. Data collection was conducted by the principal investigatorfrom the charts and electronic medical records of patients using a structured questionnaire. Data was cleared and entered to IBM SPSS version 26. Result was processed and analyzed using SPSS version 26.Descriptive statistics were used as a statistical data analysis method and presented as frequencies and percentages with their corresponding confidence intervals. Logistic regression analysis was used to assess the association between initial tumor size and prolactin level and a P value of <0.05 was considered significant. Result:Among the 217 patients with pituitary adenoma, prevalence of prolactinomawas 91(41.9%). 76.8% patients with prolactinoma were females. The mean age was 30.78 years (SD±7.97). Headache was the major presenting symptom (68.1%) followed by visual disturbance (49.3%).Most patients (79.7%) had macroadenoma. PRL level was <250ng/ml in 54.71% females and >500ng/ml in 56.25% males. 67out of the 69 patients were treated (medical and/or surgical). 59(85.5%)patients had clinical response and 10 (14.5%) had no clinical response.On multivariate logistic regression the prolactin level has strong association with the initial tumor size with p value <0.003, AOR of 19.51, 95% CI (2.689, 141.6). Treatment was discontinued in 16 out of the 65 patients and disease remission and financial limitation were the major reasons. Conclusion: Prolactinomas are the most common secretory pituitary tumors accounting for 41.9%. The initial tumor size has association with the presenting symptom and initial prolactin level. Our Patients with prolactinoma has good clinical response to medical therapy Recommendation- Laboratory investigations of hormonal analysis, MRI and drugs (dopamine agonists) should be available in the hospital.