Internal Medicine

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Clinical profile, treatment outcome and predictors of treatment outcome of Chronic Lymphocytic Leukemia (CLL) patients at Tikur Anbessa Specialized Hospital:A three-year retrospective study
(Addis Ababa University, 2023-03) Gemechu,Lalise; Tadesse,Fissehatsion (Ass.Prof.)
Background Chronic Lymphocytic Leukemia (CLL) is the most prevalent type of leukemia worldwide. So far there are only few studies conducted in this area in Ethiopia. Understanding of the current clinical presentation as well as outcome of treatment in CLL patients is relevant in improving diagnostic as well as treatment modalities of this disease in developing countries such as Ethiopia. Objective The main objective of this study is to describe the clinical profiles and treatment outcomes of Chronic Lymphocytic Leukemia (CLL) patients at Tikur Anbessa Specialized Hospital. Methods A retrospective cross sectional design was used to conduct the study at Tikur Anbessa Specialized Hospital from September 1, 2021 to December 31, 2022. Structured questionnaire was used to collect data from electronic medical recording system of all adult Chronic Lymphocytic Leukemia (CLL) patients seen at Hematology clinic from September 2019 to August, 2022. Descriptive as well as correlation analysis were done using the software Statistical Package for the Social Science (SPSS) data editor version 25 .0. Result There were a total of 169 Chronic Lymphocytic Leukemia (CLL) patients included in the study. The male- to-female ratio was 1.91:1. The mean age at diagnosis was 57 years. Majority of patients were from the capital Addis Ababa. The commonest presenting symptom was swelling at lymph node site which was found on 58.4% and the commonest presenting sign was palpable lymphadenopathy in 74%. The commonest laboratory finding was leukocytosis (91.5%). Majority of patients had Rai stage 2 disease (34.7%) followed by Rai stage 1 disease in 24%. Only 33% of the patients required CLL directed therapy with the commonest indication for treatment being Rai stage 3 or 4 disease. The commonest first line regimen used was BR regimen. Total response rate to first line regimen was 76.1%. The relapse rate among responders was 57.1%. The lost to follow up rate was very high, 55.6% and the proportion of confirmed death was18.3% from the whole cohort. Age, sex and treatment regimen were among the factors affecting treatment response and sex was the major factor affecting relapse rate and progression free survival with female patients having better response, lower risk of relapse and longer progression free survival than males. Overall survival was affected only by age with patients younger than 50 years having better overall survival. Conclusion The clinical presentation of patients with CLL in our set up is similar with most centers worldwide but with younger mean age at presentation. The proportion of advanced disease seems to have lowered compared from previous findings. Response to therapy are comparable with other similar set ups. Age, sex and type of regimen are major factors affecting response to treatment.
Clinical characteristics, treatment outcome and determinants of outcome in patients with multiple myeloma treated at TASH from January 2017 to December 2021:A five years retrospective study
(Addis Ababa University, 2023-03) Gebregiorgis,Mahlet; Tadess,Fissehatsion (Ass.Prof.)
Background Multiple myeloma is a malignant proliferation of plasma cells in the bone marrow, with relatively high prevalence in African populations. Reports from Africa are few and involve small cohorts, but suggest significant epidemiological and clinical differences from Caucasian patients. The outcome of myeloma has significantly improved due to use of chemotherapeutic agents including immunomodulatory agents and proteasome inhibitors. Methods A retrospective Cross-sectional study design was used to define the clinical characteristics, outcome and determinants of outcome of multiple myeloma patients treated at TASH from January 1,2017 to December 30,2021. Result A total of 85 patients were included in the study. The median age at diagnosis was 53 years, male patients accounted for 64.7 % of the patients. The most common presenting symptoms were bone pain 85.9 % and symptoms of anemia 48.2 %. 41.2 % of patients had hg < 10 g/dl at presentation while 76.5 % had lytic lesions on imaging. In addition, 85.1 % had detectable paraprotein on SPEP. At the end of induction therapy 55.2 % of patients had undetectable paraprotein on SPEP. The median PFS for this cohort was 24 months. Conclusion Most patients with multiple myeloma in this cohort were diagnosed at a relatively young age, presented with late stage disease and bone pain, and had a shorter PFS. Factors associated with worse survival were late Durie-Salmon stage disease, high calcium, and presence of pathologic fracture.
Clinical Outcomes of Diabetic Foot Ulcer: A 5-year retrospective analysis at a Tertiary Referral Hospital in Ethiopia.
(Addis Ababa University, 2023-12) Taye,Melaku; Reja, Ahmed (PhD)
Background Diabetic foot ulcer is a common, serious, and costly complication of diabetes. It is the leading cause of non-traumatic lower extremity amputation carrying a high risk of morbidity and mortality. The clinical outcomes of diabetic foot ulcer in Ethiopia are not well studied. This study aimed to assess the outcomes of diabetic foot ulcer at tertiary care setting in Ethiopia. Methods A retrospective study conducted including all consecutive patients with diabetic foot ulcer admitted to a 642-bed tertiary hospital in Ethiopia from January 2018 to October 2022. Data were collected using a pretested, structured questionnaire. Then, the open data kit (ODK) completed form was exported and analyzed using SPSS version 25. Descriptive statistics were used to describe participants’ characteristics. To identify determinants of lower extremity amputation, bivariable and multivariable 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 A total of 146 participants were included (79.5% were males, mean (±SD) age was 59.4 (±11.7) years). Glycemic goal achieved in 12.3% of patients while only 4.8% met their triple targets of blood glucose, blood pressure and lipids. Lower extremity amputation was performed in 53.4% of the patients with major amputation done for the overwhelming majority. In-patient mortality was 8.2%. Independent predictors of amputation were: long standing diabetes (duration ≥10 years: Adjusted Odds Ratio: 2.42; [95% Confidence Interval: 1.01-5.80]), longer ulcer duration before presentation (every week of delayed presentation: 1.14 [1.01-1.03]), history of previous foot ulcer (4.34 [1.55-12.13]), advanced ulcer stages with University of Texas stage C or D (2.86 [1.19- 6.90]). There was statistically non-significant trend of increased risk of amputation with advancing age and insulin treatment. Conclusion: the rate of lower extremity amputation in diabetic foot ulcer was excessively high. Long standing diabetes, ulcer duration, history of previous foot ulcer, and advanced ulcer severity were significantly associated with amputation. Prompt attention to these risk factors may reduce amputation rate among these patients. The high LEA rate in a low-income country indicates the mega-disparity in preventive and limb saving interventions reflecting the global health inequity that needs addressing.
The Risk factors for Osteoporosis and Falls, their Association, and Knowledge in Patients with Type 1 Diabetes Mellitus
(Addis Ababa University, 2023-12) Efrem,Paulos; Feleke,Yeweyenhareg(Prof.)
Background: Patients with type 1 diabetes have a lower bone mineral density (BMD) and up to 6-fold higher risk of fracture compared to healthy subjects, justifying the classification of the disease as a non-modifiable risk factor for osteoporosis. The literature describes a variety of risk factors for low BMD in patients with type 1 diabetes, with some conflicting evidence. Data on osteoporosis and related factors in patients with type 1 diabetes in Ethiopia, Africa, and other low- and middle-income countries is lacking. Objectives: To determine the risk factors for osteoporosis and falls, their association, and knowledge in patients with Type 1 Diabetes age 40 years and above. Methods: An institution-based cross-sectional study was conducted from June 1 to August 31, 2023GC at the diabetes clinic in Tikur Anbessa Specialized Hospital, Addis Ababa. All patients with Type 1 diabetes age 40 years and above attending the diabetes clinic during 2023GC were enrolled. Data was collected through pretested structured interviewer-administered questionna ires and analyzed using SPSS version 26. The statistical association was tested using Pearson's correlation coefficient, chi-square test, bivariate and multivariable logistic regression. Statistica l significance was considered at a level of significance of 5%, and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to present the estimates of the strength of the association. Finally, outcomes were presented with tables, figures, and statements. Results: This study involved a total of 106 participants of which 54.7% were males and 47.2% were between the ages of 40-44 years. Ninety-six percent of the study participants were living with Diabetes for more than 10 years and two-thirds had persistent proteinuria. Fifty-two percent had diabetic eye complications, 10.4% had an eGFR of <60ml/min/1.73m2 while 9.4% of the participants consumed more than three units of alcohol per day. Only two participants had a high FRAX fracture risk score but 13.2% had a history of previous fragility fracture. Age and duration of diabetes had a positive correlation and eGFR had a negative one with the 10-year probability of a major osteoporosis-related and hip fracture. The magnitude of osteoporosis was 15%. Fifteen percent of the study participants had frequent falls and 13.2% had a high concern of falling. Being female (AOR=1.6, 95% CI=1.42, 5.88), having previous fragility fractures (AOR=1.8, 95% CI=1.04, 9.27), and osteoporosis (AOR=4.1, 95% CI=1.15, 16.49) were associated with frequent falls. Eighty-three percent had poor knowledge about osteoporosis with a higher level of education associated with a higher level of osteoporosis knowledge. The factors associated with osteoporosis 10 were female gender (AOR=1.8, 95% CI=1.41, 7.69), excess alcohol use (AOR=5.7, 95% CI=1.69, 47.38), diabetic eye complications (AOR=4.7, 95% CI=1.91, 24.35), and frequent falls (AOR=5.6, 95% CI=1.19, 26.15). Conclusion: Type 1 diabetes carries an increased risk of osteoporosis, falls, and fractures. Being female, having previous fragility fractures and osteoporosis had a positive association with frequent falls, whereas being female, excess alcohol use, diabetic eye complications, and frequent falls were independent determinants of osteoporosis. A significant osteoporosis knowledge deficit was also seen among the participants with a higher level of education being positively associated. A high concern of falling with difficulties maintaining balance were other concerning outcomes.
Magnitude of distal symmetrical polyneuropathy using Michigan neuropathy screening instrument and biothesiometer among diabetic patient following at Tikur Anbessa Specialized hospital, Addis Ababa Ethiopia, Institutional based cross sectional study
(Addis Ababa University, 2023-08) Belay,Saba; Aberra,Theodrose(MD); Tarekegn,Getahune(MD)
Background:Diabetic neuropathy is most common complication in diabetic patients affecting 50-75 % of diabetic patient. In around 50% of patient distal symmetrical polyneuropathy is asymptomatic and result in increased risk of limb loss and hospitalization, which affect the quality of life of patient. Once it occur there is no reversibility, hence early picking of the problem will help in management of diabetic patient .The finding from this Study will help ,in our set up ,which tool to use to detect early distal symmetrical polyneuropathy. Objective:The study is designed to assess Magnitude of distal symmetrical polyneuropathy using Michigan neuropathy scoring instrument and Biothesiometer among Diabetic patient attending Tikur Anbessa Specialized Hospital. Method:An institution-based cross-sectional study was conducted at Tikur Anbessa Hospital on 290 diabetic and pre-diabetic individuals. Study subjects were recruited from the diabetic clinic using systematic random sampling methods, every other clinic schedule. Data were collected using Kobotoolbox which was fed with a well-structured questionnaire, which was then cleaned exported to Stata version 19 for Analysis. Both bivariate and multivariate binary logistic regressions were employed to identify factors associated with DSPN. A variable having a p value of <0.25 in the bivariate model was subjected to avoid confounding variable’s effect. After checking for model-fitting information (Hosmer and Lemeshow test p=0.523) the adjusted odds ratio with a 95% confidence interval and a p-value <0.05 was used to determine statistical significance Result:This study showed DSPN prevalence of 43.8% using MNSI and 85.2 % using biothesiometer. After multivariate analysis Smoking history, duration of diabetes, LDL value above 70 mg /dl and obesity have significant association with the occurrence of DSPN. Patient with smoking history had 2.5 times likely to develop DSPN as compared to non-smoke (AOR =2.5 95 % CI (1.16, 5.63),P-value of 0.02). Duration of diabetes longer than 10 years was 2 times associated with DSPN as compared to duration of below five year (AOR=2.03 95 CI(1.01,4.09) ,P-value 0.047).Patients who had LDL value above 70 mg /dl were likely to have DSPN 1.9 times DSPN ( AOR=1.9 95% CI (1.05,3.45) ,P – value =0.035.Obese individuals were 2.7 times likely to have DSPN as compared to normal weight ( AOR= 2.7, CI95% (1.28-5.72),P-value =0.009 Conclusion:Most of the study participant had DSPN using biothesiometer DSPN. Long duration of diabetes, smoking history, obesity and high low density lipoprotein were independent risk factor for DSPN .Biothesiometer peak 79.1% of participant with no clinical symptom based on MNSI symptom .Symptomatic participant has sever DSPN biothesiometer .Thus our finding suggest prevalence of DSPN is high and can use biothesiometer for early detection of DSPN.
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 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).
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.
Correlation of angina symptoms, baseline electrocardiogram abnormalities and findings on stress protocol with myocardial perfusion scintigraphy outcomes, a retrospective study, in Monadi Hospital, Naples, Italy.
(Addis Ababa University, 2023-02) Shewangizaw,Yonas; Guteta,Senbeta(Ass.Prof.); Abeje,Desalegn (MSc); Raddi,Marco(MD)
Background: Myocardial perfusion scintigraphy is an imaging modality used in the management of coronary artery diseases. Previous studies have shown that the combination of angina symptoms, baseline electrocardiogram abnormalities, and findings on stress protocols can provide valuable information for predicting the likelihood of abnormal imaging findings. However, the correlation and effect between these variables and imaging outcome is not well established. Objective: To evaluate the correlation and effect between angina symptoms, baseline electrocardiogram abnormalities in coronary artery diseases and during stress exam with abnormal MPS outcomes and their predictive value. Method: Hospital-based single-center retrospective cross-sectional study was conducted using medical records of 328 patients that underwent myocardial perfusion scintigraphy between 2020 and 2022. A systematic random sampling method was used to attain an appropriate sample size. Data were extracted from an electronic database using a checklist. The collected data were coded, entered, and analyzed using SPSS version 26. Pearson chi-square test and logistic regression were performed to evaluate the association and effect of independent variables. The statistical significance was measured at 95% CI and P-value less than 0.05(95%). Results: The study population consisted of 328 patients, among them 185(56.4%) were males and 143(43.6%) were females. A significant association was observed between the severity of the chest pain category, baseline electrocardiogram abnormalities, inducible ischemia, and metabolic equivalent score with abnormal myocardial scintigraphy parameters. For each outcome variable, the aforementioned factors exhibited a statistically significant effect upon logistic regression. The odds of abnormal myocardial perfusion scintigraphy parameters were significantly higher for each independent variable. Conclusions and recommendation: According to results in this study, clinical and electrocardiogram features can help prognosticate coronary artery disease before imaging which can lead to more effective and personalized diagnostic and treatment strategies for patients. Further studies with different methodologies are needed to validate the findings of this study.
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.
Prevalence of Advanced HIV Disease and Associated Factors among Newly Diagnosed Patients at Public Hospitals in Addis Ababa, Ethiopia, 2023: Multi-Center Retrospective Cross-Sectional Study
(Addis Ababa University, 2024) Moges Berhanu; Amogne Wondwossen
Many patients having HIV present to the health care system with advanced HIV disease. Patients with advanced HIV disease have CD4 cell count of less than 200cells/mm3 or WHO stage III or IV clinical events. The primary culprits responsible for severe morbidity and mortality are tuberculosis, severe bacterial infections and cryptococcal meningitis.
Risk Factors for Ten-Year Risk of Osteoporosis in type 2 DM Patients Attending Tikur Anbessa Specialized Hospital Diabetic Center-Crosssectional Study
(Addis Ababa University, 2024-04-03) Gebeyehu Tessema; Abera Theodros
Osteoporosis is characterized by decreased bone density and microarchitectural changes which lead to fragility fractures. Type 2 diabetes mellites is also exposed to fragility fractures by interfering with the metabolism of carbohydrates, fats, and proteins. It also dysregulates calcium, phosphorus, and magnesium metabolisms.
Comprehensive Assessment of the Electronic Medical Record System at Tikur Anbessa Specialized Hospital
(Addis Ababa University, 2022-12) Yaregal, Abiot; Mekonnen, Desalew
Background: Related to its bundles of advantages there is a worldwide trend toward paperless medical recording to avert the drawbacks of the paper based system. However, there is limitation in the adoption, expansion and modernization of Electronic Medical record (EMR) system in Ethiopia. There is also scarcity of data assessing the utilization of EMR in Ethiopia. Objective: The objective of this study and Quality Improvement (QI) project is to assess the quality of the EMR system used in TASH, to assess Knowledge, Attitude & Practice (KAP) of health professionals toward EMR and determinant factors for EMR improvement. Methods: A quantitative hospital based cross sectional descriptive study was conducted to assess KAP of health professionals while quality of EMR software was assessed using a checklist. Descriptive statistical methods were applied to analyze the KAP data. Results: Study participants were all degree and above, mainly males (63.6 %), physicians (76.54 %) and from department of internal medicine (67.7%). Most own personal computer (98.8%) and had adequate EMR knowledge (74.7%) and preferred using EMR than paper based record system (87.7%). Seventy (43.2%) had EMR experience at other government hospital. Fifty percent of the participants claimed TASH EMR did not contain all necessary functions and majority (70.4% for Doctor iCare) agreed on the need to improve TASH EMR system though EMR satisfaction was generally good (87.1% for Doctor iCare). Orientation by colleagues and work exposure were the main sources of EMR knowledge; only 10% participants got training. Majority agreed on hospital leaders (76.5%) and financial constraints (72.3%) as primary barriers for EMR expansion and improvement. Conclusion: Knowledge, attitude and practice of the end users are better. The interest to use EMR as compared to paper based recording is rewarding. EMR can be better implemented at TASH with better engagement of the hospital leaders and financial support.
Community Participation and the Effect of Participatory Research in South-Western Ethiopia
(Addis Ababa University, 1995-05) Kebede, Adugna; Stansfield, Sally (PhD)
A descriptive study was conducted from October 1994 to March 1995 to document the patterns and determinants o f community p a rticipation (CP) in 25 peasant associ at ion s in Seka Chekorsa Wo r e da. An experimen tal componen t o f the study tested the e ffect o f participatory r e search (PR ) on t he measurement and promot ion o f CPo The study address the barri ers to fuller communities participation in health development activities despite the high demand from the health sector. Ov e r half (52 . 5%) o f communi t y members rep o r ted partic ipatio n i n h ealth activ i t i e s wi t hin the preceding month . Most common forms of participation reported were contribution of labor (31.2%) or materials (11 . 9%) and attending meetings regarding health development (29 . 9%). Communities were most likely to identify more passive forms of CP, including s ervice utilization (60 . 9%), attending meetings (44.8%), and contri bution o f materi a l o r l abo r (33 . 9%) Few (11.2%) indi c a ted that CP implied involvement in dec ision making and planning. Key barriers to promotion of CP in health inc luded poor c ommuni t y aware ness of roles and responsibilities, lack of technical and f inancial res ources , and lack o f strategies and orga nizational structures to promote CPo PR was ef f ective in increas~ng community awareness of CP, and in increas i ng r ates of part i c ipa t ion , including through attending mee t ~ngs and through decision making the development and planning . S:rengthening CP through of clear strateg~es and policies and decentral ization of financial and technicial resources togethe r with utilization of existing mutual self help soc ieties such a s funeral soc ieties (Edi r ) were recomended in order to improve health development programs .
Radiological Manifestations in Symptomatic Patients with Positive (RT-PCR) covid19 Admitted at Tikur Anbessa Specialized Hospital AddisAbaba Ethiopia
(Addis Ababa University, 2022-02) Mwapule, LuthGregory; Dr.Haile, Tewodros(PCCM Specialist); Dr.Ahmed, Abdurezak (Cardiothoracic Imaging Specialist)
Introduction: In severe form patients with positive (RT-PCR) covid19 candevelop pneumonia or ARDS. It is reported that 30-50%of covid19 hospitalizedpatients can develop pneumonia. CXR/CT scan helps to identify covid19pneumonia by recognizing radiological manifestations of covid19 out of otherCXR/CT scan manifestations. Delay in diagnosis and subsequent treatment,developsserious acute respiratory failure, multiple endorgan failure, or death.Wedescribedsociodemographic, comorbidities and radiological manifestations insymptomatic patients with positive (RT-PCR)covid19 admitted at TASH.Methodology:A descriptive hospital based retrospective study was conductedamongsymptomaticpositive(RT-PCR)covid19 patients admitted in the covid19ICU and isolation covid19 wardfrom November 2020 to October2021. All adultpatients with CXR/CT scan recorded inmed-web (Tele-medicine internet softwareversion 7.0.11) computerized hospital medical system were included.Arrangements was made for abnormal CXR/CT scan to be reviewed jointly with aThoracic Radiologist. All information was recorded usingcase report formandanalysis was done using SPSS version 23.0Results:243patientswere recruited in this study, out of them 51.4%were female.Median age was 46years, IQR (30 - 60). The prevalence of radiologicalmanifestations was 65.8%, out of them 51.9%were male.Predominant CXR findings were bilateral 48.6%, multiple 47.3%, interstitial42.0%, patchy opacities 40.3%, peripherally 21.0%, lower 55.1% and middle46.1% lung zones. Most lesions had increased densities 44.9% followed by GGOdensities 17.7%. Common CT scan findings were bilateral 70.6%, multiple lobes70.6% and GGO23.5%.Majority of patients withold age (p-value=0.000*), CVD(p-value=0.016*),DM(p-value=0.013*), chronic lung disease (p-value=0.018*),PTB(p-value=0.038*),respiratory symptoms (p-value=0.000*), cough (p-value=0.000*), dyspnea(p-value=0.000*) chest pain (p-value=0.008*) and lower SPO2 (p-value=0.000*)when CXR/CT scan was taken had radiological manifestations.Majority cancerpatients didn’t have radiological manifestations (p-value=0.000*)Conclusion and Recommendation: Radiological manifestations in symptomaticpatients with positive (RT-PCR) covid19 admitted in isolation and covid19 ICU atTASHare common.Early recognition of radiological manifestations and propermanagement of comorbiditieswill improve care in covid19 patients.Patientswithcomorbidities, symptoms and radiological manifestationsshould be screened for covid19 (RT-PCR).COVID-19 Patients with cancer may not showradiologic abnormalities.
Patterns of Anticoaulation and Outcome in COVID -19 Patients Admitted to TASH Isolation center, Addis Ababa Ethiopia, Retrospective Study (June 2020-June 2021)
(Addis Ababa University, 2021-12) Nurlegn, Serkalem; Yusuf, Hanan(MD, Assistant Professor and Consultant in pulmonology and intensive care, consultant internist)
Background Earlier reports of high prevalence of thrombosis and related mortality has led to use of anticoagulants being part of the main treatment with varying results. Despite current large scale data showing credible benefits there are no studies done to determine the pattern of anticoagulation use and outcome in COVID patients in Ethiopia. OBJECTIVE To assess patterns of anticoagulation and outcome, of COVID-19 patients admitted to TASH isolation ward June2020- June 2021. METHODOLOGY Facility based retrospective cross-sectional study using secondary data analysis, was conducted. Records were retrieved using TASH, isolation log book. 126 patients were included. Data was analyzed using descriptive and binary logistic regression analysis Result Of the total 126 cases, Anticoagulation was used in 94 pts 74.6%. Therapeutic dose anticoagulation was used in 13(13.8%) pts of which 8 had severe disease. Prophylactic dose 79(84%), intermediate dose in two pts. UFH was used in 78(82.9%), LMWH 13(13.8%), DOAC 2(2.2%). only 58.8% of the patients received the full dose of prescribed anticoagulation. Pulmonary Thrombo-Embolism occurred in 9 pts of which 8 had severe disease and nearly half were on anticoagulation. Venous thrombosis occurred in 7 pts among those 5 had severe disease. Three out of the seven pts were on anticoagulation. In Hospital mortality was (n=14, 11.8%). Conclusion In conclusion, majority of patients received anticoagulation with UFH in prophylactic dosage. Anticoagulation use was not associated with diseases severity, in hospital mortality or 3 months outcome. Complications of anticoagulation were rare and minor. Complications were not associated with poor outcome.
Prevalence of Neurocognitive Impairment and Associated Factors among Type-2 Diabetic Patients on Follow Up at Diabetic Clinic, Tikur anbessa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Ababa University, 2021-12) Gedefa, Bikila; Tarekegn, Getahun (MD, Consultant Internist and Endocrinologist)
Background:-Neurocognitive disorders in patients with type 2 Diabetes Mellitus has spectrum manifestation which might range from subtle executive dysfunction to memory loss and overt dementia. Diabetes patients are at higher risk of all types of cognitive impairment, mainly because some diabetes complications results in cognitive impairments and they are also being considered as disease of the same spectrum. Even though it is estimated that more than 50 million peoples live with dementia worldwide, there is no enough data from low and middle income countries, including Ethiopia, where the number is projected to increase to 152 million by 2050. Hence this study will focus on assessing the overall prevalence, potential determinant and contributing factors among patients with type 2 DM over a period of two months at Black Lion Specialized Hospital, Ethiopia. Objective: - To assess the neurocognitive impairment and associated factors among diabetic patients on follow up at diabetic clinic, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia from July 1- August 30, 2021 Methods A hospital based Cross-sectional study was conducted on total of 338 type 2 diabetic patients on follow-up at BLH. The sociodemographic, anthropometric and clinical data was collected by trained final year medical students. Both face to face interview and medical record reviews were used for data collection. A validated Mini Mental Status Examination tool was used to assess cognitive impairment. Data was entered to epi-data cleared and analyzed by SPSS version 26.0. Finally, Descriptive analysis was carried out and presence of statistical association between neuro-cognitive impairment and associated factors was assessed using logistic regression and associations with p-value of < 0.05 will be considered to be statistically significant. Results The overall prevalence of neurocognitive impairment among type 2 diabetic patients on follow up at black lion specialized hospital was 38.75%. From Socio-demographic factors low educational level [AOR=3.65(1.855-7.188)] was associated with increased odds of encountering cognitive impairments. While some clinical characteristics like being on oral hypoglycemic agents [AOR=0.786 (0.370-1.669)] or oral hypoglycemic agents combined with insulin [AOR=1.87(1.054-4.264) were associated with decreased likelihood of cognitive impairments. Total duration of DM [(AOR=1.95(0.987-3.877)] and overall glycemic control [AOR= 2.21(1.238-3.947)] had significant association with NCI. additionally coexisting hypertension [AOR= 0.53(0.314-0.918)] and presence of diabetic eye disease [AOR=1.84(1.056-3.229)] were also associated with increased odds of encountering impairment. Conclusion: - The finding indicated high prevalence of neurocognitive impairment among respondents who had low level of education, prolonged duration of DM, poorly controlled DM, diabetic eye disease and coexisting hypertension.
Patterns of Diabetic Retinopathy Predicting Diabetic Kidney Disease Severity ,at Tikur Anbessa Specialized Hospital (TASH),College of Health Sciences, Addis Ababa University.
(Addis Abeba University, 2021-12) Mengesha, Wodajo; Dr.Kebede, Tedla(MD, Associate Professor); Dr.Zemenfes, Abel(MD, Associate Professor)
Background: Diabetic retinopathy and diabetic kidney disease are microvascular complications of diabetes mellitus. Patients with diabetic retinopathy are prone to develop diabetic kidney disease. However, there is limited evidence on the relationship between diabetic retinopathy stages and diabetic kidney disease severity. Objective: To identify the relationship between patterns of diabetic retinopathy and diabetic kidney disease Methods: A hospital based cross-sectional study was conducted at diabetes clinic of TASH, Ethiopia from June 2021 to July 2021. Structured questionnaire, patients’ charts and/or electronic medical records were used to collect data among 101 diabetic patients with diabetic retinopathy aged 18 years and above. Data were cleaned, coded and entered into IBM SPSS version 26 software for analysis. Descriptive and logistic regression analyses were used and P-value < 0.05 was used as statistically significant. Results: The mean (±SD) age of the participants was 52.9 (±11.8) years. Majority (94.1%) of our diabetic retinopathy patients had nonproliferative retinopathy and 70.3% of diabetic retinopathy patients had concomitant diabetic kidney disease. In multivariable logistic regression analyses, diabetic retinopathy severity (severe nonproliferative diabetic retinopathy to proliferative diabetic retinopathy vs. mild to moderate nonproliferative diabetic retinopathy) [AOR= 3.97; 95% CI: 1.01 - 15.62], T2DM [AOR= 3.74; 95% CI: 1.29 - 10.75], presence of CVD [AOR= 3.18; 95% CI: 1.05- 9.59] were the independent predictors of diabetic kidney disease. Conclusions: In this study, diabetic retinopathy severity was strongly associated with diabetic kidney disease. Therefore, evaluation of diabetic retinopathy severity at the time of retinal screening is recommended. Budget grant: Addis Ababa University (AAU), College of Health Sciences, School of Medicine
Sociodemographic Features, Risk Factors, Clinical Characteristics and Treatment Outcomes of Patients with Chronic Portal Vein Thrombosis Seen at TASH and Adera Medical Center during the Period between August 2019 and August 2021, Addis Ababa, Ethiopia
(Addis Abeba University, 2021-08) Yizelkal, Selamawit; Prof.Bane, Abate(MD,Consultant Internist and Gastroenterologist/hepatologist)
Background:Portal vein thrombosis is the most common cause of extra-hepatic portal vein obstruction. Its prevalence is variable based on studied population, but is higher in developing countries than developed countries. PVT is mainly associated with cirrhosis and depends on the severity of the disease. Objectives: This study was conducted to assess the socio-demographic features, risk factors, clinical characteristics and treatment outcomes of patients with chronic portal vein thrombosis seen at Tikur Anbessa specialized hospital (TASH) and Adera medical center during the period between August 2019 and August 2021, Addis Ababa, Ethiopia. The study also tried to assess the difference of presentation and outcome of patients between cirrhotic andnoncirrhoticPortal vein thrombosis (PVT). Methods and materials: The study will be conducted as a cross sectional cohort descriptive study in two centers to describe the socio-demographic features risk factors, clinical characteristics and treatment outcome of PVT in patients following at Gastrointestinal (GI) outpatient clinic, or admitted at the emergency department (ED), intensive care unit (ICU) or medical wards in TASH and Adera medical center, Addis Ababa University. Datawas gathered through review of medical records and a questionnaire regarding their demographic characteristics, and clinical information including etiology, results of laboratory and imaging tests.The data was checked for clarity and completeness. Computerized data analysis was conducted by using SPSS (statistical package for the social sciences) version 26 software. Results:The mean age at diagnosis was 34.64 (± 11.86) years. Majority of patients in the study were male (52 (69.3%) Vs 23(30.7%)). Majority of patients (63.9%) had chronic presentation than acute presentation, which was seen in 36.1%. Majority of patients had normal liver enzymes and coagulation profile. The most common risk factors identified in this study were cirrhosis (28%), MPD (17.3%) and intra-abdominal infections (12%). The most common compilations identified were esophageal varices, portal hypertensive gastropathy, ascites and gastric varices. Endoscopic variceal band ligation was done, nonselective beta blocker, anticoagulation was given for 29, 38& 24 patients, respectively. Mortality among the 75 patients were 2.7%, 12 patients were lost to follow up and 61 patients continued follow up. Mortality was mainly as a result of the underling cirrhosis. Conclusion: Most Portal vein thrombosis patients in this study had chronic presentations of symptoms. Mortality of patients with cirrhosis is higher than those without cirrhosis.
The Incidence, Risk Factors and Prognosis of Acute Kidney Injury in Severe and Critically Ill Patients with COVID-19 in ICU of Eka Kotebe Hospital, Addis Ababa Ethiopia: A Retrospective Chart Reviews.
(Addis Abeba University, 2021-12) Gudeta, Nigusu; Dr.Kebede, Dawit; Dr.Melkie, Addisu
Abstract Background-The incidence, clinical characteristics and outcomes of acute kidney injury (AKI) in patients with COVID-19 admitted to intensive care unit and its association with mortality and disease severity. Objective-To determine the incidence, risk factors, clinical characteristics and outcomes of AKI in a cohort of patients with COVID-19 admitted to Eka Kotebe Intensive Care Unit (ICU), and its association with in-hospital mortality(survival), dialysis requirement, increased need of mechanical ventilation, disease severity and renal status at discharge. Methods- It’s a single centered cohort study from a registry of patients with COVID-19. A total of 174 patients were admitted to medical ICU with confirmed COVID-19 between from 1st October 2020 to 31 may 2021. We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the need for mechanical ventilation, and in-hospital mortality. Measurements-Stage of AKI, LOS, mechanical ventilation, discharge, and in-hospital mortality. Results-Of the total 174 patients registered to the log book during the study time, and only 156 patients were found to be eligible for study and from this 95(60.9%) developed AKI, 36 (37.9%) presented with AKI, and 59 (62.1%) developed AKI in-hospital. High charlson comorbidity index, low lymphocyte count, low serum albumin level, higher white blood cell counts and Serum alkaline phosphatase measurement, vasopressor need for life support, and mechanical ventilation were found to be associated significantly with increased risk for AKI. Limitations-a cohort study with small sample size limits precision of estimates. Lack of nonhospitalized and stable admitted patients with confirmed COVID-19 as controls limits causal inferences. Conclusions-Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk.

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