Internal Medicine

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Proportion and predictors of suboptimal colonic preparation among patients who undergone elective colonoscopy at a tertiary care center, Addis Ababa, Ethiopia: a prospective cross-sectional study.
(Addis Ababa University, 2023-09) Girma,Abel; Belachew,Hiwot(Dr.); Erkie,Mengistu(Dr.)
Background:colonoscopy is an important diagnostic and therapeutic tool for various conditions affecting the colon, rectum and terminal ileum. Bowel preparation is one of the key quality indicators among others. Suboptimal bowel preparation will significantly affect safety and diagnostic yield of the procedure. To date there is no adequate information regarding the quality and outcome of colposcopy preparation as well as predictors of sub optimal preparation in our set up. Aim: -The main objective of this study wastodetermine the proportionand predictors of suboptimal bowel preparation among patients who undergone elective colonoscopy at TASH. Methods: -A prospective cross-sectional study was conducted on 282 elective colonoscopies done at TASH from March, 2023 to August 30, 2023 G.C.After informed consent,interviewer administered structured questioner was used to collect data by a trained interviewer. The edoscopist assessed the quality of preparation using Aronchick scale. The collected data was cleaned, checked for completeness, compiled, entered in to Epidata andexported to SPSS 26 for analysis. Bivariate and multivariable logistic regression analysis was conducted to identify determinants of suboptimal colonic preparation. P value< 0.05 was taken as significant. Result:-Suboptimal colonic preparation was observed in 45% of the cases with 15.2% procedure cancelation rate attributable to inadequate colonic preparation. On multivariate analysis, age more than 60 years and non-adherence to the recommended dose of castor oil were predictors of suboptimal colonic preparation while short telephone call a day before the start of preparation and taking anti diabetic medication where negative predictors of suboptimal colonic preparation. Conclusion: -This study revealed unacceptably high proportion of suboptimal bowel preparation and procedure cancellation rate. Clinical variables independently associated with quality of preparation include; old age, adherence to preparation regimen, anti-diabetic medication intake and telephone counseling. Therefore intervention targeting these predictors should be designed to improve quality of pre –colonosopic bowel preparation.
Role of 18F-Fluorodeoxyglucose–Positron Emission Tomography Before, During and After Treatment in T cell and Nk-Cell Lymphomas: A Retrospective Study from Pascale Hospital, Napoli, Italy 2022 G.C.
(Addis Ababa University, 2023-02) Chimdesa, Amanuel; Alemu,Aschalew; Worku,Bethelhem (Ass. Prof.); Carideo,Luciano(Dr.)
Background: Over the past years, 18F- FDG PET has emerged as an efficient tool to assess Hodgkin’s lymphoma and diffuse large B-cell lymphoma’s response to treatment. 18F- FDG PET is both sensitive and specific for initial staging in T cell /Natural killer cell lymphomas. However, the predictive value of early or post-therapy 18F- FDG PET remains unknown. Objective: Therefore, the objective of this study was to assess the role of 18F- FDG PET before, during and after Treatment in T cell and Natural killer cell lymphomas. Method: A facility-based descriptive retrospective cohort study design was employed. A total of 57 sample populations was selected using purposive sampling technique among patients visiting the nuclear medicine department of the hospital. A quantitative method of data collection was deployed using a data abstraction tool. Data was entered and analyzed using statistical software SPSS for windows V 26.0. The verbal ethical clearance was obtained from National Cancer Institute of Napoli. Result: The result showed that 25 (61%) were males. About 17 (41.5%) of index cases were in the age group “61-75”, and the mean (+SD) age of respondents was 57.8 (±15.4). All 100% of the index cases have been diagnosed with biopsy proven disease and PET/CT also showed positivity on all the index cases. Discussion: Findings of this study revealed that metabolic parameters like SUVmax and whole- body metabolic tumor volume at the time of the diagnostic, interim and post treatment 18F- FDG PET scans does not predict disease progression of T cell /Natural killer cell lymphomas in the index cases. In addition, Sociodemographic variables such as sex and age on top of clinical parameters such as Ann Arbor staging at the time of diagnosis, primary lesion location, ECOG and international prognostic index (IPI) does not seem to have statistical correlation with that of disease progression. Recommendation: It is recommended to conduct the study in other centers as well as amending the limitation of our study challenges.
The use of third-line combined antiretroviral treatment and determinants of treatment outcomes among HIV/AIDS patients in Ethiopia
(Addis Ababa University, 2023-11) Eshetu,Anteneh; Amogne,Wondwossen(MD, PhD)
Background: The treatment of human immunodeficiency virus (HIV) infection involves the use of combination antiretroviral therapy (cART). The use of these multidrug regimens substantially reduces the progression to AIDS, opportunistic infections, hospitalizations, and death. The standard of care in HIV management is to maximally suppress plasma HIV RNA to prevent HIV disease progression and the emergence of drug-resistant virus. Third-line regimens include drugs such as newer generation NNRTIs like etravirine (ETV), boosted PIs like ritonavir-boosted darunavir (DRV/r), as well as the integrase inhibitor like Dolutegravir (DTG) with or without previously used ARV drugs that potentially maintained residual antiviral activity, especially from the NRTI class.(1,2) Although there were few studies with newer agents, cohort data showed high mortality among people for whom second-line ART had failed. Salvage regimens were recommended with new drugs such as DRV/r, ETV and RAL. Objectives: General objectives: To describe baseline, virologic and therapeutic characteristics of PWHIV on 3rd line cART Specific objectives To analyse the virologic suppression in PWHIV on 3rd line cART To describe the adherence status of PWHIV on 3rd line cART To assess the duration of protease inhibitors’ exposure in PWHIV on 3rd line cART To analyse medical comorbidities in PWHIV on 3rd line cART Methods: This is a retrospective study with longitudinal analysis among adults (≥ 18 years) attending Tikur Anbessa Specialized Hospital, Infectious Diseases unit, ART clinic. Then, a longitudinal analysis was conducted to determine virological suppression among patients who was initiated on third-line therapy and for whom a follow-up viral load was determined. The study is aimed to describe the population of patients on third-line therapy. Results: A total of 51 patients are on third line cART( both guideline and expert recommended regimens). Fifty one percent (n= 26) patients are female. Majority of the respondents claimed that they acquired the virus through unprotected sexual intercourse (66%) and 28% percent of patents acquired the virus through vertical transmission from mother to child. Majority of patients had WHO stage-III or stage-IV defining conditions (37.3% & 35.3% respectively). Tenofovir Disoproxil Fumarate/Lamivudine/Efavirenz was the first line regimen in 37.3% of patients and Tenofovir Disoproxil Fumarate, Lamivudine and Ritonavir boosted Atazanavir was a second line cART in 39.2% patients. Dolutegravir, Lamivudine, Ritonavir boosted Darunavir is the expert recommended third line regimen (94.1%). 76.5% (n= 39) have undetectable viral load on third line cART. Patients transferred due to first line treatment failure had an 11 times greater chance of having undetectable HIV RNA levels compared to those referred due to second line treatment failure. Conclusions: The use of expert recommended third line cART composed of DTG, 3TC, DRV and RTV is effective in our setting especially in PWHIV who are referred to our center after 1st line cART treatment failure.
Prevalence of periodontal disease and associated factors of periodontitis among diabetic patients under follow up at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: Institution based cross sectional study
(Addis Ababa University, 2023-07) Leulseged,Beza; Kebede,Tedla(Dr.)
Introduction: Diabetes and periodontal disease are chronic diseases with a significant impact on public health. The relationship between these two diseases has been well established and is said to be bi-directional. Diabetes is a risk factor for periodontal disease, and periodontal disease may have impact on glycemic status and other diabetic complications. There is a paucity of data related to the prevalence and associated factors of periodontal disease among Ethiopian diabetic patients. Objective: The main objective of this study is to determine the prevalence of periodontal disease and associated factors of periodontitis in diabetic patients attending their treatment and follow up at Tikur Anbessa Specialized Hospital Methods: An institution based cross sectional study was conducted from June 1-July 31, 2023 on sampled diabetic patients following in the endocrine clinic of Tikur Anbessa specialized hospital during the study period. The study enrolled 216 diabetic patients in total. To examine the prevalence of periodontal disease and associated factors for periodontits, data were collected using a pretested questionnaire to assess sociodemographic, physical features, clinical parameters, glycemic profile (FBS & HgA1C), and oral hygiene practices. Following that, an oral examination was performed to determine bleeding on probing, community periodontal index (CPI) and clinical attachment loss (CAL). The logistic regression analysis was used to examine factors associated with periodontitis, and the ordinal regression analysis was used to estimate severity based on CAL. Data collected was analysed using STATA version 14 software and outcomes were presented by tables, figures and statements. Results: The overall prevalence of periodontal disease (either gingivitis or periodontitis) was 100%, with gingivitis affecting 98.6% of subjects and periodontitis affecting 91.7%. Multivariate analysis revealed Increasing age (AOR=1.06, 95% CI:1.01-1.11), use of combination antihyperglycemic medications (either combination oral or combination oral & insulin) (AOR=4.85, 95%:1.3-17.9), spironolactone use (AOR-0.21, 95% CI: 0.014-0.78) and presence of dentures (AOR-0.34; 95% CI: 0.04-0.65) to be significantly associated with periodontitis. In addition, bleeding on brushing was found to be significant indicator of periodontitis (AOR- 6.6; 95% CI: 1.5-34.5). Male gender (AOR-2.4, 95% CI: 1.08-5.36), lack of flossing (AOR-4.1, 95% CI: 0.04-1.04), and poor self perception of gum health (AOR-2.82, 95% CI: 1.25-6.38) were variables significantly associated with the risk of developing generalized periodontitis. Ordinal regression analysis showed that male gender (AOR-3.5, 95% CI: 1.4-8.7) and age ≥40 years (AOR-5.3, 95% CI: 1.4-20) were significantly related to periodontitis severity. Conclusion: The finding of this study showed that the magnitude of periodontal disease among diabetic patients was high. Increasing age, use of combination anti hyperglycemic drugs, spironolactone use, presence of dentures, and bleeding on brushing were independently associated with the occurrence of periodontitis. Furthermore, male gender and increasing age were found to be significant predictors of the severity and development of generalized periodontitis.
A Retrospective Analysis of Newly Diagnosed ITP Patients to Analyze Response to First and Further Line Treatments.
(Addis Ababa University, 2023-03) Maasho,Biniam; Gebrmedhin,Amha(Ass.Prof.)
Background Primary immune thrombocytopenia (ITP) is a relatively uncommon hematologic disorder with an estimated incidence of 3 to 6 patients /100,000 per year in the West. Initial response rates to corticosteroids average at 70%. In our country data on patient characteristics and outcome of therapy are scarce. Objective The primary objective of this study is to determine the rate of initial response to corticosteroids in newly diagnosed ITP patients. Secondary objectives include duration of response, associations between independent/patient variables and response, duration of PDN therapy and outcomes with further line treatments. Method: This is a retrospective, single-center study conducted at Tikur Anbessa Specialized Hospital, a tertiary care hospital located in Addis Ababa. All newly diagnosed ITP patients for whom adequate information regarding their outcome after 1st line therapy was available were included in this study. Data obtained thru a standardized questioner was analyzed by IBM-IPSS version 20 statistical software. Result: A total of 48 study participants with the age of 18 & above were included in the study. Females constitute 85% of the participants. 63% of the patients are less than 35 years old. The mean and range of age are 34 Yrs and 17 Yrs – 52 Yrs. 62 % had an initial response to steroids (52% complete response). The rate of SR at 6 months was 68%, a statistically significant difference from previous reports (P-value < 0.0001< , with a 95% C.I. = 0.4544 - 0.7856). Rituximab and prednisolone were the most frequently used 2nd line drugs. 6 patients were splenectomized. Patients with a response to 1st line prednisolone had a marginally significant better outcome with 2nd /3rd line rituximab Conclusion: Initial response rate to steroids was in line with previous studies done elsewhere. The SR rate was 68% that is significantly more than that reported in previous studies of 1st line prednisolone therapy in newly diagnosed ITP patients.
Major Causes and Factors associated the outcome of patients with Upper GI bleeding in Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: Institution Based Prospective cohort study
(Addis Ababa University, 2023-10) W/Giorgis,Blen; Merdassa,Guda(Ass.Prof.); Berhe,Rezene(Ass.Prof.)
Background: Upper gastrointestinal bleeding refers to blood loss within the intraluminal gastrointestinal tract from any location between the upper esophagus to the duodenum at the level of the ligament of Treitz. Bleeding from the upper gastrointestinal tract is approximately five times more common than from the lower gastrointestinal tract. The incidence of upper GI bleeding ranges from 50 to 150/100,000 population annually, and as many as 70% of acute upper GI bleeding episodes occur in patients older than 60 years. This study aimed to assess the Rebleeding and Death at 30 days of the patient’s outcome with those upper GI bleeding in TASH, Addis Ababa, Ethiopia. Method: The study was an institution-based prospective cohort study. A total of 123 patients who had upper GI bleeding were enrolled in this study, and associated factors studied. Data samples were collected from the study participants, together with associated sociodemographic, endoscopic findings, lab profiles, potential risk factors, and other important questionnaires, at the TASH GI Clinic endoscopy unit from January 2023 to September 2023. Result: The mean age of participants with GIB was 41.28 ± 16.352 (range 13–84 years). About 67 (54.5%) of patients were under 40 years of age. Out of 123 patients admitted with upper GI bleeding, 73 (58.5%) of them stayed in hospital for less than 3 days, rebleeding at 30 days occurred in 21 (17.1%) of patients, and death at 30 days occurred in 17 (13.8%). Conclusion: In this study, the mortality rate at 30 days was high about 13.8% and in 17.1% of patients, rebleeding occurred within 30 days. Variceal bleeding was found the most common cause of upper gastrointestinal bleeding accounting for 53.7% of patients.
Burden of Tuberculosis in stage 5 chronic kidney disease patients undergoing maintenance haemodialysis therapy in governmental and non-governmental dialysis centers in Addis Ababa, Ethiopia: A cross-sectional study
(Addis Ababa University, 2023-11) Beyene,Eyob; Amogne,Wondossen(PHD); Melke,Addisu(MD); Jote,Wubshet (MD)
Background Patients with End stage renal disease appear to be at a higher risk of TB due to immunosuppression along with socioeconomic, demographic, and comorbidities. Despite high burden of Tuberculosis in developing countries, there is a scarcity of data regarding burden of TB in ESRD in Ethiopia. Objective The objective of this study is to assess the burden of TB in End stage renal patients receiving haemodialysis in Addis Ababa, Ethiopia. Method A cross-sectional study was conducted on Burden of Tuberculosis in stage 5 chronic kidney disease patients undergoing maintenance hemodialysis therapy in governmental and non- governmental dialysis centers in Addis Ababa, Ethiopia from August 2022 to October 2022 G.C. Patients with a baseline diagnosis of ESRD on HD and age 18 years and above were included in the study. Patients were recruited during their dialysis visit using convenient sampling method and consent was obtained from all participants. A total of 263 participants were included in this study. The diagnosis of ESRD and TB was defined using KDGIO and WHO guidelines. Data were collected through patients interview and reviewing the patient’s electronic medical records. The Collected Data was analyzed using SPSS version 26.0. Results Our study found a diagnosis of tuberculosis in 71 (27%) of study participants. Among the study participants who was diagnosed with TB, 64 (24.3%) had a previous diagnosis of TB and 12 had active TB.Pulmonary tuberculosis was diagnosed in two-third of TB patients and about third had EPTB, TB lymphadenitis was the commonest followed by pleural TB. Imaging evidence was used to make a diagnosis of TB in one-third patients followed by FNAC (26.6%) and Pleural fluid analysis (26.6%). More than half (54.7%) of TB diagnosis was made after initiation of haemodialysis. More than half (54.7%) of TB diagnosis was made after initiation of haemodialysis. Having a contact history with a known TB patient, presence of HIV infection and duration on dialysis for more than 1 year were associated with increased prevalence of TB among CKD patients. Conclusions Because of its atypical presentation and since it is a mimicker of uremic symptoms, physicians should maintain a high degree of suspicion to consider TB among CKD patients. Early identification and treatment of TB among CKD patients is important in decreasing morbidity and mortality among these patients and in decreasing the transmission of TB among patients who undergo dialysis in the same center. TB preventive therapy should also be considered for this group of patients
Rate and predictors of endoscopic mucosal healing among IBD patients on medical therapy at Tikur Anbessa Specialized Hospital: Institution Based Prospective Cross-sectional study
(Addis Ababa University, 2023-10) Shibru,Habtewold; Bane,Abate(Prof.); Adem,Ahmed(MD)
Introduction Inflammatory bowel diseases (IBD) are characterized by chronic inflammation of the intestinal mucosa resulting from strong interaction between genetic, environmental, immunologic and intestinal microbial factors. Medical treatment for inflammatory bowel disease (IBD) has undergone a complete transformation over the last several decades due to the advent of different drugs. Clinical remission and endoscopic healing are integral components of the treat to target strategy in IBD therapy. Endoscopic healing is associated with significant reduction in complications of IBD and/or need for surgery. Objective The objectives of this study are to determine the rates of clinical remission and endoscopic mucosal healing among IBD patients on treatment and to sort out predictors of endoscopic healing. Methodology A prospective cross-sectional study was conducted at Tikur Anbesa Specialized Hospital from January, 2023 to October 2023. The study included all consecutive IBD patients on treatment for six months or more who showed up for a regular follow up at TASH GI clinic in the study period and who were willing to consent and undergo follow up colonoscopy. Results Overall Clinical remission rate from this Cross-sectional study is 69 /106, including 62/87, (71.3%) of CD, 7/17 (41.2%) of UC and 0 /2 Unclassified. Thirty-five (33%) of IBD patients in the study achieved endoscopic healing. Twenty-six of the 87 (29%) patients with CD, 8 of the 17(47%) UC, and one of the two with indeterminate colitis achieved endoscopic mucosal healing. Only 10 of the 32 CD patients with previous history of bowel resection achieved endoscopic healing. Higher ESR value (P = 0.040, AOR 0.946 with 95% CI 0.898-0.997) and younger age at diagnosis (P = 0.046, AOR 1.322 with 95% CI 1.005-1.739) predicted absence of endoscopic healing. Conclusion Sixty-nine of the one hundred six IBD patients (65.1%, 70% for CD, 41.2% for UC) were in clinical remission. The overall endoscopic mucosal healing rate from this study is 33% (29.1% CD, 47.1% UC). Elevated ESR and younger age at the diagnosis predicted absence of endoscopic healing within the study period.
Clinical Characteristics,Treatment Pattern Andoutcome of Burkitt’slymphoma Patients Athaematology unit of Tikur Anbessa Specialized Hospital
(Addis Ababa University, 2024-04-19) Megersa Yadeta; Burkitt Lymphoma.
TREATMENT PATTERN AND OUTCOME OF BURKITT’S LYMPHOMA PATIENTS
Prevalence of Undernutrition and its Associated factors among Heart Failure Patients at the Cardiology Follow-up Clinic of Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia.
(Addis Ababa University, 2024-02) Serkalem Getewey; Dejuma Yadeta
Many studies have consistently highlighted a significant high incidence and prevalence of undernutrition among individuals diagnosed with heart failure. No study looked into undernutrition among heart failure patients in Ethiopia or Tikur Anbessa Specialized hospital
Assessing the Risk Factors, Clinical and Coronary Angiographic Profile, and Hospital Mortality of Acute Coronary Syndrome in Young People : 5-Year Retrospective Cross-Sectional Study
(Addis Ababa University, 2024-04) Zelalem Belay; Bekele Alemayehu
The incidence of coronary disease is positively associated with age. However, in recent years there has been an increased incidence of Acute Coronary Syndromes (ACS) in young adults. The cardiovascular risk profile of these patients appears to be different
Comparison of Abdominal Ultrasound and Abdominal Computed Tomography Findings with Colonoscopy Features in the Diagnosis of Inflammatory Bowel Disease at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
(Addis Ababa University, 2024-03) Fekede,Adil; Berhe,Rezene(Dr.)
Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract. It mainly includes ulcerative colitis and Crohn's disease. The mainstay for the diagnosis of inflammatory bowel disorders is currently colonoscopy. Nevertheless, colonoscopy is a costly, time-consuming, and invasive procedure that patients might not always tolerate. As a result, there is increased interest in non-invasive diagnosing and monitoring techniques such as ultrasonography and computed tomography. However, there is a lack of studies on the comparison between abdominal ultrasound and Computed tomography scan findings with colonoscopy in the diagnosis of inflammatory bowel disease in Ethiopia. The study aims to investigate the correlation between abdominal Ultrasound and Computed tomography scan findings with colonoscopy in diagnosing inflammatory bowel disease among patients who presented with signs and symptoms suggestive of inflammatory bowel disease at TASH, Addis Ababa, Ethiopia. Objective: to assess the comparison of abdominal ultrasound and abdominal computed tomography findings with colonoscopy in diagnosing inflammatory bowel disease among patients who presented with symptoms suggestive of inflammatory bowel disease at TASH, Addis Ababa, Ethiopia. Method: A 6 year retrospective cross sectional study was employed from May 2023 to March 2024 among 120 patients who presented with symptoms suggestive of inflammatory bowel disease at TASH. The data was collected using a standardized questionnaire from the medical records starting from January 01, 2018 to December 30 2023 of patients who underwent abdominal ultrasound, abdominal computed tomography and colonoscopy for suspected IBD. The collected data was entered after checked for completeness, then using SPSS 26, descriptive analysis was applied through frequency, percentage mean and standard deviation. Statistical analysis was employed to see the each test’s diagnostic accuracy through sensitivity, specificity, positive and negative predictive values and accuracy for both ultrasound and computed tomography in comparison to colonoscopy which was used as a gold standard reference for IBD diagnosis. Finally the result was presented using tables, charts and bars. Result: IBD was finally diagnosed in 79.2% of the total cases. Sensitivity, specificity, accuracy, PPV, and NPV were used to evaluate the diagnostic accuracy of each test. The results of our final analysis indicated that Abdominal CT scan had the following values for sensitivity, specificity, accuracy, PPV and NPV: 73.4%, 44.0%, 67.5%, 83.3%, and 30.6%; while Abdominal US had these values at 55.8%, 72.0%, 59.2%, 88.3%, and 30.0%, respectively. The degree of agreement was as follows: for abdominal US, kappa=0.183, there was a significant association and slight agreement; for Abdominal CT scan, kappa=0.152, there was no significant association and slight agreement.
Prevalence of Cardiovascular risk factors in Systemic Lupus Erythematous patients having Rheumatology and Renal clinc follow up
(Addis Ababa University, 2024-03) Kindu,Adugnaw; Abebe,Sintayehu(Dr.); Demelash,Birhanu(Dr.); Getachew,Nebyu(Dr.)
Characterization of Connective Tissue Disease Related Interstitial Lung Disease At Selcted Centers in Addis Abeba, Ethiopia: A 4 years retrospective study
(Addis Ababa University, 2024-02) Zewdu,Ameha; Abdissa,Becky(MD, Ass.Prof.)
Background: CTD-ILD in one of the most frequent systemic manifestation of CTD which is responsible the majority of mortality and morbidity in these group of patient. Indeed characterization of connective tissue diseases related Interstitial lung diseases(CTD-ILD) includes clinical presentation, serological fiding ,Pulmonary function test(PFT) & high- resolution computed tomography (HRCT) findings will help in designing and implementing prevention and management interventions, thereby reducing the severity of illness and the number of deaths that could be associated with the disease. However published evidence are not much available in sub-saharan country including Ethiopia. Objective: To conduct a comprehensive characterization of CTD-related ILD including epidemiology, clinical presentation, radiological finding, PFT, and serological finding who attend the Rheumatology clinic at TASH, Lancet specialized hospital and Rheum specialty clinic from Jan 2020 – Feb 2024 Methods: A Multicenter cross-sectional analytical study was conducted by at the rheumatology clinic at TASH, Lancet and Rheum clinic in Addis Ababa, Ethiopia, during the period Jan 1st 2020 - Feb 2024. Data was collected using a structured checklist, and then entered and analyzed using SPSS version 26. Descriptive analysis was employed to identify the management gaps. Tables and figures were used to present the results. Result With a total patient 92 the majority of the patients are female(89.2) and male (10.8%) with a female to male ratio of 1:8 and the mmedianage of onset is 47.33 years. The most common CTD identified are RA (44.6%), SSC (40.9%) , PM/DM (6.5%), MCTD (4.3%), SLE (3.3%) & USCTD (1.1%). The most common clinical presentation is Cough (72.8%), Decreased exercise tolerance (40.5%) and Dyspnea (41.3% ) but 7.6% of the patient are asympromatic . The most identified Common Antibody Found In ILD are are ANA(47.8%), RF (47.8%) , Anti-scl-70 (37.0%) ,ACPA (29.7%) and frequently encountered ANA pattern are speckled (16.3 %), Homogenous (15.2 %) and nuclear (10.9%). The most frequqnt CXR finding is reticilonodular and GGO but 11% of the patient are normal .The most frequent identified HRCT pattern are NSIP (69.6%) and UIP (28.3%). PFT test done for only 7 patients and 4 patients have restrictive pattern and 3 patients have obstructive pattern. Conlussion Our study identified that CTD-ILD are more common in female and patient with RA % SSc. Most RA patient are older and usually have long duration of illness before the diagnosis of ILD. Relatively SSc patient are younger and most of them have Anti-scl-70 and speckled ANA pattern. We do not identified MTX associated pneumonitis.
Prevalence of Lasparaginase Associated Thrombotic Events and Associated Factors in Adult Patients with Acute Lymphoblastic Leukemia in Tikur Anbessa Specialized Hospital.
(Addis Ababa University, 2024-02) Abrar,Amira; Abdela,Fozia(Dr.)
Background –L-asparaginase is an important component of acute lymhoblastic leukemia treatment. However, it is associated with increased risk of thrombosis which in turn affects leukemia related outcomes and poses increased risk of mortality and morbidity. Objective- To assess the prevalence of thrombotic events associated with L-asparaginase treatment and its determinant factors in adult acute lymphoblastic leukemia patients treated in Tikur Anbessa specialized hospital from November 2020- November 2023 Methodology: The study was conducted at Tikur Anbessa specialized hospital. A total of 152 patients who have been treated or are on treatment for acute lymphoblastic leukemia with L- Asparginase containing regimens at Tikur Anbessa Specialized Hospital from November 2020 to November 2023 were included in the study. Data was collected from the patient’s medical records (both electronic and paper). Data was entered and analyzed with SPSS version 26, and a chi-square test was used to assess the association of independent variables with the dependent variable. Bi-variate and multivariate logistic regression were used to determine a significant correlation between independent and dependent variables. Results: A total of 152 patients were included in the study. The median age was 22.5 years (IQR 18, 30.8), and 59.9% of them were male. The pediatric inspired ALL CL10403 regimen was used for treatment in 84.2% of cases, while CALGB 8811 protocol was used in the rest. The prevalence of thrombotic events in acute lymphoblastic leukemia patients treated with an L- asparaginase containing regimen was 11%. All of the events were venous, and cerebral venous thrombosis was the commonest site of thrombosis, accounting for 41.2% of events, followed by lower extremity deep vein thrombosis. The majority of events were symptomatic, and 44.4% occurred during remission induction. Longer time to achieve complete remission (>4 weeks), adjusted odds ratio AOR 4.8 (95% CI = 1.10, 20.72), and age ≥40 years AOR 10.4(95% CI = 1.47, 75.0) were significantly associated with an increased risk of thrombotic events. Mortality was higher in patients with thrombotic events (47%) when compared to patients who did not develop thrombosis (41.4%) but was not statistically significant (P- value = 0.618). Mortality directly attributed to thrombotic events was 23.5% among patients who developed thrombosis. Conclusion- This study showed that the risk of L-asparginase associated thrombosis in resource limited settings like ours is comparable with previous reports from other parts of the world. Longer time to achieve remission and age above 40 was associated with increased risk of thrombosis.
Assessment of Health-Related Quality of Life in Patients with Inflammatory Bowel Disease at Tikur Anbessa Specialized Hospital, Ethiopia
(Addis Ababa University, 2024-02) Berihun,Asrat; Mohammed,Duelsome(MD)
Introduction: Inflammatory bowel diseases are chronic progressive/relapsing conditions that affect the younger population and have been associated with reduced health-related quality of life. HRQOL is an important outcome measure in IBD and helps to understand impact of the disease on the patient and the effect of treatment on the disease. Aim: To assess health-related quality of life in IBD patients and associated socio-demographic and clinical factors. Methods: A hospital-based cross-sectional study using the "Short Inflammatory Bowel Disease Questionnaire" (SIBDQ) was conducted in Tikur Anbessa Special Hospital from September 1, 2023 to December 30, 2023. Data were entered and analyzed using SPSS version 27. Descriptive statistics were used to show frequencies and percentages. A binary logistic regression model was used to assess predictors of impaired HRQOL in patients with IBD. Strength of association is measured by AOR and 95% CI. Variables with a P-value < 0.05 have a statistically significant association. Results: Thirty-one percent of IBD patients in our study had impaired HRQOL (SIBDQ<50) with no statistically significant difference between IBD types, gender, marital status, residence, surgical treatment and duration of IBD. Unemployment (AOR= 4.36; CI 95%:1.34-14.18; p=0.014), not being in remission (AOR= 14.62; CI 95%: 2.31-92.53; p= 0.004), comorbidity (AOR= 9.18 ;CI 95%: 2.24-37.69, p=0.002), admission (AOR= 5.08; CI 95%: 1.45-17.76, p=0.011) and symptom duration > 6 months before diagnosis (AOR= 4.679; CI 95%: 1.31-16.74; P=0.018) were significantly associated with impaired HRQOL. Conclusion: In our study, about one in three of IBD patients had impaired HRQOL. HRQOL was better with controlled disease activity; no hospitalization, no EIMs, and no comorbidity; early diagnosis, employment, and higher educational level.
Attributes and Factors Associated with Long COVID in Patients Hospitalized for Acute COVID-19: A Retrospective Cohort Study
(Addis Ababa University, 2024-04) Minassie,Bethlehem Berhanu; Kebede,Dawit(MD,Ass.Prof.); Amogne,Wondwossen(MD, PhD, Ass.Prof.)
Background: It is now recognized that many patients have persistent symptoms after recovery from acute COVID-19 infection, an infection caused by the coronavirus SARS-CoV-2. This constellation of symptoms, commonly known in the literature as ‘Long COVID’ or ‘Post COVID-19 Condition’, may manifest with a wide range of physical and cognitive/psychological symptoms. Although the mechanisms are still poorly understood, much effort has been made in the scientific community to characterize this condition better. However, there is a lack of data on the frequency, risk factors, and severity of Long COVID in Africa. Objective: To assess the prevalence, attributes, and factors associated with Long COVID in patients hospitalized for acute COVID 19 Method: This was a retrospective chart review (Electronic Medical Records [EMR]) of patients who were discharged after hospitalization for acute COVID-19 infection from Hallelujah General Hospital (one of the first private hospitals where patients were treated for COVID-19). The hospital’s database was searched for patients who were hospitalized for acute COVID-19 infection from March 2020 to December 2022. Two hundred and forty-seven participants who underwent follow-up beginning four weeks after symptom onset were assessed for Long COVID. A structured questionnaire was used to collect data about their sociodemographic, clinical, laboratory, and imaging information during their admission and follow-up. The data was entered into SPSS version 29 for analysis. The relationship between the independent and dependent variables was explored through binary logistic regression. Results: The mean age of the participants was 58.5 (±13.9) years, and 160 (64.8%) were males. One hundred seventy-eight (72.1%) participants had at least one persisting symptom 4 weeks post symptom onset, at a median follow up time of 35 (IQR 32-40) days. The most frequently reported symptoms were fatigue (41.7%), shortness of breath (31.2%), cough (27.1%), and sleep disturbances (15%). Duration of symptoms more than 7 days before admission [aOR = 1.97; CI95% = 1.04 to 3.75; P=0.038] and length of stay more than 10 days in the hospital [aOR = 2.62; CI95% =1.20 to 5.72; P=0.016] were found to be significantly associated with Long COVID on multivariate analysis. Conclusion: There is a high prevalence of Long COVID among patients hospitalized for acute COVID-19. Those who had longer duration of symptoms before admission and a longer stay in the hospital appear to have a higher risk.
The Proportion, Clinical characteristics, complications, treatment pattern & outcomes of Ph-negative Classic Myeloproliferative Neoplasms at TASH: A Hospital based retrospective Cross-Sectional study.
(Addis Ababa University, 2024-03) Yirgu,Dahlak Teshome; Abdela,Fozia (MD, Ass.Prof.)
Background Haematological malignancies are among non-communicable diseases that are becoming increasingly more common both globally and in our country, Ethiopia. Out of these Philadelphia-negative classic myeloproliferative neoplasms, affecting the elderly population group of the society is seen in increased frequency in outpatient department. This is due to progressively rising global population age and life expectancy, so it is becoming an important public health problem worldwide. Investigations done with a small number of African countries indicated a gradually increasing frequency of philadelphia-negative MPNs in the continent. In growing country, there are few studies that truly define the clinical feature of these patients. Especially in Ethiopia there is no data regarding Ph negative classic MPNs. This will aid to estimate the characteristics, treatment pattern & outcomes based on a local data of patients with diagnosed Philadelphia-negative classic MPNs. Objective: The main objective of the study is to measure the clinical characteristics, complications, treatment pattern & outcomes of Ph negative classic MPN patients. Methods: A single cantered hospital based retrospective cross sectional study was conducted at haematology follow up clinic from January 1, 2019 to December 31, 2023; data was collected and analyzed with IBM SPSS version 27. Result: A total of 151 study participants with the age of 18 & above were included in this study. 57 %( 86/151) of study participants are male & 43% are females, with a male to female ratio of 1.3:1. 58.3% of PV patients were male, 56.7% of ET patients were females. Similarly 72.2% of PMF cases were male. PV was the most common (68%) with a median age at diagnosis of 56 years, followed by ET (20%, median age 55.5 years) and Primary Myelofibrosis (12%, median age 60 years). Female patients had mostly a history of ET; a higher number of male patients had a history of PV and PMF. Among PV cases, the main presenting symptoms were headache/vertigo (37%) followed by fatigue (31.4%), early satiety/ LUQ pain (31%) & splenomegaly was found in 28%. In ET, the main presenting symptoms were fatigue (36.8%), headache, joint pain, and splenomegaly being the other common presenting symptoms Among the PMF patients’, the main presenting symptoms were symptoms of anaemia (40%), fatigue (38%), constitutional symptoms (35%), early satiety/ LUQ pain (35%) & Splenomegaly (72%). JAK2V617 mutation was positive in 92%, 54%, and 44.4% of PV, ET and PMF patients, respectively. The frequency of thrombotic events were high in PV patients compared to other subtypes (PV=33%, ET=26% and PMF=5.6%) and venous thrombosis being higher than arterial. In contrast to other subtypes, bleeding was prevalent in PMF patients (PMF=11%). Thrombotic complication was high in high risk PV & ET patients, while Jak 2 mutation status didn’t affect thrombosis risk. Phlebotomy, ASA and hydroxyurea, Thalidomide/prednisolone and transfusion support were the treatment options used. The five year survival rate of Ph –ve MPNs with median diagnosis of 27months were 81%, which was higher for ET (95%), PV=84% and low for PMF (median survival rate is 4 years). Conclusion: This study showed that, PV is a more prevalent ph negative MPN than ET and PMF. Thrombosis is an important complication in these patients, especially in PV patients occurring in ~1/3rd of the cases. Based on our findings we emphasize that that Ph negative MPNs should be considered & proper evaluation should follow in patient with unexplained abnormalities in hematologic parameters.
The magnitude of premature coronary artery disease and its associated factors among patients who underwent coronary angiography at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
(Addis Ababa University, 2024-02) Ayanaw,Daniel; Gutet,Senbeta(MD,MPH,Prof.)
Background: Coronary artery disease is a major cause of morbidity and mortality in developing countries with occurrence at a young age and association with diverse cardiovascular risk factors. Objective: The objective of this study was to assess the magnitude of premature coronary artery disease and its associated factors among patients who underwent coronary angiography at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Method: A retrospective cross-sectional study was conducted at TASH, Addis Ababa, Ethiopia, on 218 patients who underwent coronary angiography between May 2017 and June 2023. Data on patients’ sociodemographic characteristics, cardiovascular disease risk factors, metabolic profile, cardiac imaging, and angiographic findings was collected using a structured data abstraction checklist from patient medical records. Descriptive statistics and logistic regression were used to assess the association between dependent and independent variables using SPSS version 25. An adjusted odds ratio with a 95% confidence interval was used to show the strength of the association, while a p-value<0.05 was used to declare the significance of the association. Result: A total of 218 patients’ medical records were analyzed and revealed a median age of 55 years with male predominance (82.1%). Forty (18.3%) of patients were diagnosed to have premature coronary artery disease (CAD) among a hundred fifty-eight (72.5 %) patients who had angiographically confirmed CAD. Male sex (AOR=3.5, 95%CI: 1.492,8.367), hypertension (AOR=2.8, 95% CI: 1.162,6.767), low HDL (AOR=2.3, 95% CI:1.025,5.191) and admission diagnosis of chronic coronary syndrome (AOR=2.2, 95% CI: 1.035,4.762) were significantly associated with premature CAD. Conclusion: The magnitude of premature coronary artery disease at TASH is high. It is significantly associated with male sex, hypertension, low HDL, and admission diagnosis of chronic coronary syndrome. Tremendous effort should be applied to preventing, early detection, and control of hypertension and Low HDL at the community and individual level.
Effect of level of adherence of antimalarials on disease activity and its determinants in Systemic lupus erythematous patients on follow up at rheumatology clinic of Tikur Anbessa Specialized Hospital
(Addis Ababa University, 2024-05) Beyene,Eden Tesfaye; Demelash,Berhanu(MD)
Background: Systemic lupus erythematous (SLE) is an autoimmune disease associated with accrual of organ damage and mortality. Antimalarials like Hydroxychloroquine/Chloroquine are important therapeutic options in SLE. But their effectiveness is impeded by non-adherence. Objective: To assess the level of adherence of antimalarials, its determinants and its association to disease activity in SLE patients on follow up at the rheumatology clinic of Tikur Anbessa Specialized Hospital (TASH). Methods: 106 SLE patients taking antimalarials and who had follow up visit from August 1 to October 31 2023 were included in the study. Structured questionnaire was used to assess their sociodemographic and clinical characteristics. Adherence was assessed using Morisky medication adherence scale (MMAS-8) and SLE disease activity was assessed using systemic lupus erythematous disease activity index 2000 (SLEDAI-2K). Data was analyzed using statistical package for social science (SPSS) version 26. Binary logistic regression was used to assess the association between level of adherence and disease activity and to look for clinical predictors of non-adherence. Statistical significance was determined using adjusted odds ratio at 95% confidence interval (CI) and P value <0.05. Results: 98.1% were women and the mean age of the patients was 28.8 years. 91.5% were on chloroquine and 8.5% were taking hydroxychloroquine. 11.3% were on high dose prednisolone. 36.8% of patients were found to be non-adherent to their antimalarials and 53.8% had active disease. Non adherence was seen to have a significant association with active disease (AOR 9.86 95% CI 3.61, 26.87). None of the sociodemographic and clinical factors were found to be predictors of non-adherence. (P>0.2) Conclusion: SLE patients in this study had a fair adherence to antimalarials. There is a strong association between non-adherence to antimalarial and active disease in SLE patients. Sociodemographic and clinical factors were not found to be predictors of medication adherence.

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