Internal Medicine

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A Prospective Cross Sectional Study to Evaluate the Incidence of Acute Transfusion Reaction and its Associated Risk Factors in Ateritiary Care Center in Ethiopia.
(Addis Ababa University, 2023-02) Assefa,Temesgen; Tadesse,Fissehatsion(Ass.Prof.)
Background:Transfusion reactions are adverse events associated with the transfusion of whole blood or one of its components. There is no institutional or national data in Ethiopia regarding the incidence of ATR & their risk factors. Theaim of this study is to measure the incidence of ATRs, frequency& time of occurrence of each ATR & evaluate their association with risk factors there by contributing to the institutional & national hem vigilance system. Objective:The main objective of the study is to measure the incidence of ATR & determine their association with different clinical variables. Methods: Prospective cross sectional study design is used to study in patient & outpatient adult transfusion recipients at the department of internal medicine, data was collected with a structured check list, analyzed with IBM SPSS version 24 software. Result: A total of 210 study participants with the age of 13 & above were included in the study from September 1, 2022 – November 30 2022. 50.5 % of study participants are male & 49.5% are females ,the most common age group are between the age of 18 -40,the commonest blood group was O positive.Acute myelogenous leukemia is the commonest underlying diagnosis of the study participants; PRBC is transfused for the majority of patients given for 74.8% of cases. ATR incidence is found to be 10%,ATR was reported in 19.6%of platelet transfused patients as compared to 7% of PRBC, and none of FFP transfused patients develop ATR. FNHTR & urticaria are the commonest ATR observed. Significant association is seen between ATR & female gender, autoimmune disease & ABO incompatible platelettransfusion. Conclusion:The incidence of ATR is higher than reported from previous studies indicating the need to improve institutional transfusion services particularly in high risk patients.
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.
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.
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.
Assessment of indications and clinical significance of bone scintigraphy among patients referred to Nuclear Medicine Unit, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
(Addis Ababa University, 2023-02) Yemaneberha,Solome; Worku,Bethelehem(Ass.Prof.); Abeje,Desalegn
Background: Bone scintigraphy is a very sensitive diagnostic nuclear medicine imaging technique that uses a radiotracer to assess the distribution of active bone growth in the skeleton in relation to malignant and benign disease as well as a physiologic process. The general indications for bone scintigraphy are to investigate for particular bone disease, unexplained symptoms and prior to therapy for metabolic evaluation. There is no baseline study to assess the indications and clinical significance in TASH. Objective: The aim of this study was to evaluate the clinical indication and significance of bone scintigraphy in patients who were referred to Tikur Anbessa Specialized Hospital. Methods: A hospital-based retrospective cross-sectional study was conducted using secondary data from a record of a bone scintigraphy from 2007 to 2012 at the Nuclear Medicine Unit at Tikur Anbessa Hospital. SPSS version 22 was used to examine and analyze the gathered data using descriptive and inferential statistics. Result: In this investigation, 110 Planar and SPECT scan record of patients was used. Out of which 76 (69.1%) were female and 34 (30.9%) were male. The most common indications was the evaluation of metastatic breast cancer at 59 (53.6%), followed by prostatic cancer 22 (20%), Using a binary logistic regression analysis there was a significant correlation between female patients and positive outcome of scans p=0.06 and OR=4. Those aged between 40-49 years had a significant correlation with outcome of the scan compared to their oldest counterpart ( >70yr) p=0.03, OR=11. Conclusion: In this study, 94.5% of indications were for oncologic work up. Breast cancer metastatic workup is the most common indication. Positive results were four times more likely to be seen in female patients than males. People between the ages of 40 and 49 had an eleven fold higher likelihood of obtaining positive scans than the oldest age group (>70 years).
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.
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.
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.
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.
Assessment of Quality of Care Given To Adult Acute Stroke Patients and Associated Factors in Tikur Anbessa Hospital,Zewditu Memorial Hospital,Yekatit 12 medical college Hospital ,Addis Ababa, cross sectional study, 2023
(Addis Ababa University, 2024-04-09) Birku Taye; Tsehayneh Fikru
Globally, stroke is the second-leading cause of death and the third-leading cause of death and disability combined worldwide. Even though the prevalence is decreasing in developed countries, it is increasing in developing countries. Quality of care given during acute phases of stroke has significant effect in improving mortality and morbidity. Studying the quality of care given for adult acute stroke patients helps to know the level of stroke care given and to improve the service
Assessment Of Renal Scintigraphy, Indications And Results, Among Patients Referred For Renal Scintigraphy At Nuclear Medicine Unit, Instituto Nazionale Tumori IRCCS-Fondazione G-Pascale.
(Addis Ababa University, 2023-02) Abrahim, Ziyad; Jorge,Yohannes (Ass.Prof.); Damtew,Emeshaw(M.Sc, PhD fellow); Carideo,Luciano (MD)
Background: Renal scintigraphy is an imaging method that uses radiopharmaceuticals to evaluate renal anatomy, physiology, and pathology. It is performed by using a variety of methods, each providing a slightly different approach to assess renal function or anatomy. These methods includes functional imaging (visual assessment of perfusion and function) and Renography (TAC representative of function). Objective: The aim of this study was to assess renal scintigraphy, indications and result, among patients referred for renal scan at nuclear medicine unit, Istituto Nazionale Tumori IRCCS-fondazione G-Pascale from November 1, 2017 to October 31, 2022. Methods: Hospital based retrospective cross-sectional study was conducted to assess renal scintigraphy. All patients with full records of Renal scintigraphy at nuclear medicine unit, Istituto Nazionale Tumori IRCCS-fondazione G-Pascale from November,1 2017 - October,31 2022 were used in this study. After completion of data collection and processing, data was checked for completeness, clarity and consistency. The collected data was edited, coded by microsoft Excel and entered processed and analyzed with computer using SPSS version 26 software. Result: Out of 265 renal scintigraphy studies most of the scan 110 (41.5%) were indicated for evaluation of hydronephrosis and 91 (34.3%) were indicated for evaluation of patient with renal cancer. Among 110 patient in whom renal scintigraphy are indicated for evaluation of hydronephrosis 83 (39%) renal unit were normal, 53 (24%) showed functional obstruction, and 38 (17%) renal unit showed anatomical obstruction. The most common risk factor for renal disorder is renal cancer constituting 63 (23.8%) followed by renal cancer plus obesity in 34 (12.8%) of patient Conclusion: The most common indication of renal scintigraphy in the study area was for evaluation of patients with various degrees of hydronephrosis followed by renal carcinoma, renal functional status evaluation and raised creatinine.
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.
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.
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.
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.
Barriers to Uptake of Cataract Surgery in Southern Ethiopia
(Addis Ababa University, 2023-05-13) Henok Samuel; Alemayehu Woldeyess
Cataract is the leading cause of avoidable blindness globally and in Africa. However, various factors limit access of cataract blind individuals to cataract surgery. This study aims to investigate the factors contributing to delayed utilization of cataract services among patients attending a free surgical eye camp in Wolaita, Southern Ethiopia
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
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.
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
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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