The electrocardiogram in healthy northwest Ethiopians

The normal values for ECG have not been fully investigated on Ethiopians. This cross sectional study was conducted in 1999/2000 to obtain baseline ECG information on normal healthy northwest Ethiopians and to find out whether normal ranges of ECG parameters in our population differ from those of Caucasians or other black Africans. A standard 12-lead electrocardiogram was done in 690 selected healthy northwest Ethiopians. They were 392 (56.8%) male and 298 (43.2%) female with a median age of 23 years. The systolic and diastolic blood pressures were within the normal range in all subjects. The total incidence of deviation from the accepted normal ECG was recorded in 393 (57.0%) subjects. This was found in 294 (75.0%) male and 99 (33.2%) female subjects. The most common type of "abnormalities" were high peaked T wave, 104 (26.5%), elevated S-T segment, 70 (17.8%), and elevated ST segment with high peaked T wave, 32 (10.9%) in male and negative or flat T wave, 35 (11.7%) in female. All types of variations were more pronounced in young subjects of both sexes and less common in those aged 40 years and above. The normal ECG variants found in Ethiopians were similar to those found in other subjects of black African origin. In conclusion, the normal variants identified in this study must be taken into consideration in the interpretation of ECG from cardiac patients which prevents this useful test from being understood wrongly.     

Normal thyroid function values in Ethiopians

Thyroid function values were determined in 56 healthy nongoitrous adult Ethiopians. The mean triiodothyronine (T3) values for 20 males and 36 females were 1.42 +/- 0.32 nmol/L and 1.51 +/- 0.25 nmol/L, and thyroxine (T4) values were 119 22 nmol/L and 116 +/- 21 nmol/L respectively. The mean thyrotropin (TSH) values for males and females were identical at 1.85 +/- 0.94 mu/L. Radioactive iodine uptake (RAIU) at 2 hours was 8.6 +/- 4.4% in males and 11.3 +/- 4.3% in females, and at 24 hours 31.7 +/- 11.7% and 38.9 +/- 11.1% respectively. The differences between males and females were significant at both 2 and 24 hours (P less than 0.05). The ranges for the 3 hormones derived from the mean 2SD values are close to those supplied with the kits but the Ethiopian RAIU values are higher than the values currently applicable in developed countries, probably indicative of the lower level of dietary iodine available to the population here. The values obtained in this study are offered to serve as normal reference for the interpretation of thyroid function results in Ethiopian patients. A strategy for the rational utilization of the available in vivo [corrected] tests is suggested.     

Central nervous system toxoplasmosis in adult Ethiopians

OBJECTIVES: Toxoplasmosis is identified as one of the major central nervous system (CNS) opportunistic infections in AIDS patients. Sero-epidemiological surveys done among Ethiopian patients indicated a very high prevalence rate. This study was conducted to describe the clinical course of the disease in Ethiopians with AIDS. PATIENTS AND METHODS: Three hundred and twenty three patients with AIDS and CNS Toxoplasmosis that were consecutively admitted and treated with Sulfadoxine Pyrimethamine (SP) at the Tikur Anbessa Specialized Referral Hospital were reviewed. The diagnosis CNS Toxoplasmosis was made based on clinical features or neuroradiologic findings and response to treatment. In over 80% of the cases the dose of Pyrimethamine used was 100 mgs for two days and then 25 mgs daily PO. RESULTS: The male to female ratio was one to one. The median age was 34 years (range 18 - 75). The most common presenting symptoms were headache 293 (91%), fever 269 (83%), and abnormal level of consciousness in 201 (62%) of the cases. Focal neuralgic deficits were seen in 203 (63%) of the cases. The diagnosis of CNS toxoplasmosis was based on clinical features and response to treatment in 186 (58%) of the cases and on CT scan findings and clinical response in 54 (17%) of the cases. Among the 248 (78%) of the cases that had responded favorably to SP, 53% had improvement on the 7th day, while the rest had improvement on the 14th day of treatment. Major treatment related adverse reactions, which required changing treatment, were seen in 68 (20%) of the cases. Among patients who survived the first episode of toxoplasmosis, the median follow up was for 29 days (range 15-1800). CONCLUSION: Toxoplasmosis had been the most AIDS defining event in the study group and clinical response to empiric treatment was essentially diagnostic. In our study group the outcome seen with SP as compared to the standard recommended treatment yielded comparable results. Tolerance to treatment was better and the adverse effects warranting change in treatment were fewer despite that only few patients received folinic acid supplements. We recommend a well-designed prospective study to establish the efficacy and optimal dose of SP in the treatment of CNS toxoplasmosis.     

Low absolute CD4 counts in Ethiopians

The CD4+ T-lymphocyte count is a widely used marker of HIV disease progression. The marker also plays a crucial role in determining therapeutic interventions in HIV infections, especially with the initiation and monitoring of antiretroviral therapy and prophylactic treatment for opportunistic infections. In general, immunological studies done thus far on adult Ethiopians revealed that, healthy HIV-negative Ethiopians exhibit significantly decreased values for absolute CD4 counts than other populations. However, it remains to be illucidated whether Ethiopian AIDS patients develop opportunistic infections at much lower CD4 values than AIDS patients from Western countries, and whether Ethiopian HIV infected patients progress to AIDS more rapidly. Thus, establishing locally appropriate standard CD4 values is important in order to implement certain prophylactic or therapeutic interventions in our setting. Most of these studies are reported on international journals, which are hardly accessible to the Ethiopian medical/scientific community. The aim of this mini-review is, therefore, to provide the local scientific community and clinicians with the available information.     

Gene frequency and type of colour blindness in Ethiopians

All 954 boys and 1064 girls attending two schools in north-western Ethiopia were tested in February 1988 for colour blindness using the Ishihara plates. A total of 40 colour blinds (4.2%) were found among males and 2 (0.2%) among females. There were 31 (3.2%) deutans and 9 (0.9%) protans among males. Both female colour blinds were deutans. This study confirms a previous observation on the gene frequency of colour blindness in this population. For the first time it also provides information on the frequency of this polymorphism in female Ethiopians, as well as types of red-green defects.     

Obstructive jaundice in adult Ethiopians in a referral hospital

Forty-nine adult Ethiopians with obstructive jaundice were studied. Right upper quadrant pain was the main presenting complaint (89%). Most (94%) of the jaundiced patients had right upper quadrant tenderness. In 87% the obstruction was corroborated by ultrasonographic examination, but causal factors were identified in only 39%. Operative findings showed that choledocholithiasis (41%) and malignant conditions (22%) were the two important causes of obstructive jaundice among the adult patients seen at a referral hospital in Addis Ababa. The causes and the outcome of the different types of surgical procedures used in the management are discussed.     

Xanthine oxidase activity is influenced by environmental factors in Ethiopians

Objectives To investigate xanthine oxidase (XO) polymorphism in Ethiopians and influence of environmental factors, smoking habit and gender-related differences on enzyme activity among Ethiopians living in Ethiopia or Sweden.Methods One hundred healthy unrelated Ethiopians living in Ethiopia and 73 living in Sweden participated in the study. Subjects received a 100-mg oral dose of caffeine before bedtime. All urine voided in the following 8 h was collected and the concentrations of 1-methyluracil (1U) and 1-methylxanthine (1X) (mol/l) were analyzed by means of high-performance liquid chromatography. The 1U/(1X+1U) metabolic ratio (MR) was calculated and used as an index of XO activity.Results XO activity was not normally distributed (P<0.0001; Shapiro-Wilk's test). The incidence of putative XO poor metabolizers in Ethiopians was 4%. The effect of differences in country of residence, gender and smoking habit was analyzed using three-way ANOVA/MANOVA. The post-hoc test (P<0.05) and Kruskal-Wallis ANOVA (P<0.004), median test showed a significant difference in XO activity among Ethiopians living in Ethiopia compared with those living in Sweden, the activity being higher in Ethiopians living in Ethiopia. The 95% CI for differences between the two means was (0.012; 0.044). No significant difference was observed in XO MR between men and women or between smokers and non-smokers, the 95% CI for the differences being (–0.059; 0.037) and (–0.010; 0.016) respectively.Conclusion The XO activity is polymorphic in Ethiopians. Neither gender nor smoking-related differences influenced XO activity but the difference in activity between Ethiopians living in Sweden or in Ethiopia indicates influence of other environmental factors such as dietary habits on XO activity.     

Multiple myeloma in Ethiopians: analysis of 22 cases.

Twenty-two cases of multiple myeloma were seen in the Department of Internal Medicine, Tikur Anbessa (Black Lion) Hospital, a teaching and referral hospital in Addis Abeba, Ethiopia, from January 1983 to December 1990. The age range was 38 to 76 (mean +/- SD = 51.5 +/- 12.2) years; a third were in the fifth decade. The male:female ratio was 1.75:1. The common clinical findings were bone pain in 20 (91%), bone tenderness in 15 (68%), anaemia in 14 (64%) and spinal cord compression in 8 (36%). The erythrocyte sedimentation rate (ESR) was raised in 21. Serum protein was raised in 17 (77%) and hyperglobulinaemia was seen in 20 (91%). Serum uric acid, blood urea nitrogen (BUN) and calcium were elevated in 10, 8 and 5 patients respectively, Bence-Jones proteinuria and albuminuria were each found in 9 patients. All patients had radiological abnormalities; 9 had a combination of lytic lesions, osteoporosis and pathological fractures (41%). Ten patients presented in clinical stage III. Four patients are being followed after 3-84 (median 40.5) months; eight were lost to follow-up 1-8 (median 2.0) months after diagnosis. Ten patients have died after 1-55 (median 11) months. Multiple myeloma is not uncommon in Ethiopians. Except for a lower age at presentation, the clinical, haematological, biochemical, and radiological findings, and the response to therapy, are similar to those reported elsewhere.     

Anatomical variations of gallbladder and biliary ducts among Ethiopians

The extrahepatic biliary system was investigated to determine the types and frequency of variations in a group of Ethiopian subjects. A total of 110 specimens were obtained from adult Ethiopian subjects. Each specimen consisting of the whole of the liver, stomach, duodenum and the lesser omentum was removed and dissected carefully to expose the gallbladder and biliary ducts without disturbing their relationship. The majority (51%) of subjects had supramarginal type of gallbladder. The neck and infundibulum of the gallbladder were shorter in the present group compared to reports in other populations. There were significantly more cases of kinking of the gallbladder and Hartmann's pouch in the female than in the male subjects. However, there was no significant difference between the present and previously reported groups as well as the male and female subjects of the present group in the length or course of the cystic, hepatic or bile ducts. The findings in the present study suggest that variations in the gallbladder and the biliary ducts seen in the Ethiopian group are similar to what is reported in other populations. The significantly higher prevalence of kinking of the gallbladder and Hartmann's pouch in the female than in the male subjects may have some contribution to the higher rate of gallstone formation and biliary tract diseases in females.