Lathyrism in rural northwestern Ethiopia: a highly prevalent neurotoxic disorder

Lathyrism is a disorder of the central motor system, induced by heavy consumption of the grass-pea, Lathyrus sativus an environmentally tolerant legume containing the neurotoxic excitatory amino acid beta-N-oxalylamino-L-alanine (BOAA). A complete door-to-door resurvey of the Dembia and Fogera regions of northwestern Ethiopia, areas endemic for lathyrism, revealed an estimated mean disease prevalence of 0.6%-2.9%. Most patients developed the disease in the epidemic of 1976/77, although new cases appear to have occurred with an estimated mean annual incidence of 1.7:10,000. Production and consumption of grass-pea is increasing in Ethiopia, making attempts to develop low-BOAA strains to prevent lathyrism increasingly important.     

Most common causes of natural and injury-related deaths in Addis Ababa, Ethiopia

In Ethiopia, like many developing countries, autopsy is rare unless conducted in the medico-legal arena, making vital statistics that include pathological diagnoses sparse. To determine the most common factors contributing to death among individuals who died from natural or injury-related events in Ethiopia 200 consecutive autopsies were conducted in 2006 at the Forensic Medico-legal Pathology Department, Menelik II Hospital, Addis Ababa, Ethiopia. The results describe significant pathological observations, putative cause of death, age distribution, and gender ratios. Eighty-one percent of the cases were male, and the mean age was 38.9 (±15.5 years). Fifty-two percent of the individuals died from natural causes, including infections, and 48% died from injury-related events. In the natural deaths group, as determined by gross examination at autopsy pulmonary complications were the most commonly reported cause of death, with suspected tuberculosis accounting for 12%. Tuberculosis (21, 8%) and liver disease (14, 5%) were the most common histopathological findings in the natural and injury-related causes groups, respectively. In the injury-related group, automobile accident was the most common cause of accidental death (80%), and homicide by beating was the most common cause of death in the intentional injury group (31%). These data provide valuable unbiased analyses of causes of death among individuals in Addis Ababa, Ethiopia.     

Increased plasma chymase concentration and mast cell chymase expression in venous neointimal lesions of patients with CKD and ESRD

The underlying inflammatory component of chronic kidney disease may predispose blood vessels to intimal hyperplasia (IH), which is the primary cause of dialysis access failure. We hypothesize that vascular pathology and markers of IH formation are antecedent to arteriovenous (AV) fistula creation. Blood, cephalic, and basilic vein segments were collected from predialysis chronic kidney disease (CKD) patients with no previous AV access and patients with end-stage renal disease (ESRD). Immunohistochemistry was performed with antibodies against mast cell chymase, transforming growth factor-beta (TGF-β) and interleukin-6 (IL-6), which cause IH. Plasma chymase was measured by ELISA. IH was present in 91% of CKD and 75% of ESRD vein segments. Chymase was abundant in vessels with IH, with the greatest expression in intima and medial layers, and virtually absent in the controls. Chymase colocalized with TGF-β1 and IL-6. Plasma chymase concentration was elevated up to 33-fold in patients with CKD versus controls and was associated with increased chymase in vessels with IH. We show that chymase expression in vessels with IH corresponds with plasma chymase concentrations. As chymase inhibition attenuates IH in animal models, and we find chymase is highly expressed in IH lesions of patients with CKD and ESRD, we speculate that chymase inhibition could have therapeutic value in humans.     

Predictors of central venous catheter use at the initiation of hemodialysis

Central venous catheter (CVC) use at hemodialysis (HD) initiation remains high, despite reports of CVC-associated morbidity and mortality, and efforts at early arteriovenous fistula placement. In order to determine predictors of CVC use at the start of HD, data from the end-stage renal disease (ESRD) Clinical Performance Measures (CPM) Project was linked to the Centers for Medicare & Medicaid Services Medical Evidence (2728) Form. Of the 4071 incident hemodialysis patients in study years 1999–2003, 71.6% used a CVC at dialysis initiation. After controlling for demographic and co-morbid variables, patients with a CVC were 24% more likely to be female ( p  =   0.006), and 38% more likely to have ischemic heart disease ( p  =   0.002), while those with obesity (BMI ≥30) were 24% less likely to start dialysis with a CVC ( p  =   0.006). Pre-ESRD hypoalbuminemia (<3.5 g/dl) was associated with a twofold higher risk of CVC use ( p  =   <0.001), while patients with pre-ESRD anemia (hgb <11 g/dl) were 29% more likely to use a CVC at dialysis initiation ( p  =   0.006) compared to those with hemoglobin ≥11 g/dl. Patients receiving predialysis erythropoietin had a 41% lower odds of CVC use at dialysis initiation ( p  =   <0.001). Finally, dialysis year was predictive of CVC use; in 2002, 76% of patients initiated dialysis with a CVC compared with 66% in 1998 ( p  <   0.001). Overall, female gender, ischemic heart disease, lack of obesity, factors suggesting poor pre-ESRD care, and successive year of dialysis initiation were predictive of CVC use at hemodialysis initiation.     

Prevalence and burden of primary headache in Akaki textile mill workers, Ethiopia

Headache disorders are the most common complaints worldwide. Migraine, tension-type and cluster headaches account for majority of primary headaches and impose a substantial burden on the individual, family or society at large. The burden is immense on workers, women and children in terms of missing work and school days. There are few studies that show relatively lower prevalence of primary headaches in Africa as compared to Europe and America. There might be many reasons for this lower prevalence. The objective of this study is to determine the prevalence and burden of primary headaches among the Akaki textile factory workers, which may provide data for the local and international level toward the campaign of lifting the burden of headache worldwide. The overall 1-year prevalence of all types of primary headaches was found to be 16.4%, and that of migraine was 6.2%. The prevalence of migraine in females was 10.1% while it was 3.7% in males. The prevalence of tension-type headaches was found to be 9.8%. This was 16.3 % in females as compared to 5.7% in males. The burden of the primary headaches in terms of lost workdays, gross under recognition and absence of effective treatment is tremendous. In conclusion, the prevalence of primary headaches in the Akaki textile mill workers is significant, particularly in females, and the burden is massive, in a place of poverty and ignorance. We recommend the availability and administration of specific therapy to the factory workers with primary headaches, and community based well-designed study for the whole nation’s rural and urban population.