Epidemiological analysis of tuberculosis in Ethiopia: a ten-year trend analysis

Tuberculosis has been one the major causes of morbidity and mortality in Ethiopia for long. Accordingly, the Ethiopian Ministry of Health and its stakeholders have their unreserved and integrated efforts on this health problem. Among these efforts was the well developed HMIS for Tuberculosis programs. However, the direction to where Tuberculosis in Ethiopia is heading hasn't been well analyzed and unpackaged by epidemiologically relevant factors. The overall aim of this study was to examine the epidemiological trends of Tuberculosis in Ethiopia for the ten-year period from 2000-2009. The trends were investigated from spatial, temporal, disease type and gender perspectives. A time-series study design was applied to analyze the ten-year trends of Tuberculosis in Ethiopia. Data on ten-key indicators for the period of 2000-2009 was obtained from the Ministry of Health public documents. Five stratifying variables were used to analyze the trends in the key TB indicators. The data on the indicators have undergone five stages of analysis: Aggregation, computation, summarization, graphics and model fitting. The incidence rate of tuberculosis is increasing in Ethiopia at a rate of 5 new TB cases per 100,000 population per year. Urban agro-ecological zones have been more affected by the disease throughout the ten-year period. Extra-pulmonary rate and smear-negativity has shown a modest increment during the study period. Masculine gender was also disproportionately affected by tuberculosis during the ten-year study period. On the other hand case detection rate and treatment success rate are found to be increasing at a rate of 0.5% per year.     

Age at menarche and the menstrual pattern of secondary school adolescents in northwest Ethiopia

Background  

Population studies on normal and dysfunctional characteristics of menstrual cycles are scarce in Ethiopia. In addition variability in menarcheal age and menstrual characteristics are common. Knowledge on this variability is necessary for patient education and to guide clinical evaluation.     

Hepatotoxicity and Associated Risk Factors in HIV-Infected Patients Receiving Antiretroviral Therapy at Felege Hiwot Referral Hospital,Bahirdar, Ethiopia

Background

In Human Immunodeficiency Virus (HIV) infected patients on antiretroviral treatment (ART), hepatotoxicity is life threatening. Its outcome may lead to liver failure and death. This study was conducted to determine the rate and determinants of elevated alanine amino transferase (ALT) (referred as >40IU/L for both males and females).

Methods

A cross sectional study was conducted on HIV infected individuals who are on ART and suspected of drug resistance at Felege Hiwot Referral Hospital, Bahir Dar from July to December 2012. Venous bloods were collected from each patient and processed parallely to determine ALT, number of HIV RNAs, CD4 and CD8 T cells count, anti hepatitis C virus (HCV) and hepatitis B surface antigen.

Results

Out of 269 HIV infected patients receiving ART, 32% were confirmed of grades 1–4 levels of elevated ALT. The rate of severe hepatotoxicity (grade 3 and 4) was 1.84%. Patients with increased CD8 T cell counts (P=0.011; AOR=1.82; CI: 1.12 –2.54), alcohol over use (P=0.014; AOR = 1.23; CI: 1.36–3.29) and detectable HIV-1 RNA copies (P=0.015; AOR=2.07; CI: 1.15–3.74) independently predicts the elevation of ALT.

Conclusions

In HIV infected patients on ART, extreme elevations of ALT were infrequent but minor elevations were common so that patient-linked variables such as use of alcohol intake must be taken in to account for better clinical management of ART patients. The role of active HCV co-infection on the treatment outcome of ART should be further studied.     

Development of a C3c-based ELISA method for the determination of anti-complementary potency of Bupleurum polysaccharides

Traditionally, determination of inhibitory potency of complement inhibitors is performed by the hemolytic assay. However, this assay is not applicable to the lectin pathway, thus impeding the understanding of complement inhibitors against the overall function of the complement system. The main objective of our study was to develop a specific enzyme-linked immunosorbent assay (ELISA) as an alternative method to assess the anti-complement activity, particularly against the lectin pathway. By using respective coating substrates against different activation pathways, followed by capturing the stable C3c fragments, our ELISA method can be used to screen complement inhibitors against the classical pathway and the lectin pathway. The inhibitory effect of suramin on the classical pathway, as measured by our hemolytic assay is consistent with previous reports. Further assessment of suramin and Bupleurum polysaccharides against the lectin pathway showed a good reproducibility of the method. Comparison of the lectin pathway IC₅₀ between Bupleurum smithii var. parvifolium polysaccharides (1.055 mg/mL) and Bupleurum chinense polysaccharides (0.98 mg/mL) showed that, similar to the classical and alterative pathway, these two Bupleurum polysaccharides had comparable anti-complementary properties against the lectin pathway. The results demonstrate that the described ELISA assay can compensate for the shortcomings of the hemolytic assay in lectin pathway.Abbreviations: Abs, antibodies; AP, alternative pathway; BCPs, Bupleurum chinense polysaccharides; BG, background value; BPs, Bupleurum smithii var. parvifolium polysaccharides; BSA, bovine serum albumin; CP, classical pathway; CV, coefficient of variation; DFC, drug-free control; ELISA, enzyme-linked immunosorbent assay; HRP, horseradish peroxides; LP, lectin pathway; LPS, lipopolysaccharide; MASP, MBL-associated serine proteases; MBL, mannose-binding lectin; OD, optical density; PBS-T-BSA, PBS containing 0.05% Tween-20 and 1% BSA; SRBC, sheep erythrocytes; VBS, Veronal buffer salineKEY WORDS: ELISA, Complement C3c, Suramin, Bupleurum smithii var.  parvifolium, Bupleurum chinense, Polysaccharides     

Septic shock

Septic shock remains an important cause of death and serious morbidity in medical, surgical and obstetric illness. Many patients with septic shock succumb despite aggressive therapy. Any microorganism can initiate septic shock; the pathophysiology of the disease is not clear; the clinical manifestation is not specific; and there is no reliable laboratory result to diagnose septic shock before it is late. Moreover, despite increasingly complex modes of mechanical ventilation, sophisticated respiratory and hemodynamic monitoring, and a continually expanding array of potent antibiotics, the overall mortality from septic shock remained constant. Better outcome is more likely when recognition is early and treatment is much more aggressive. Therefore, where there is suspicion of septic shock: commence fluid resuscitation, administer oxygen, take blood, urine, and other fluids for culture, commence intravenous broad-spectrum antibiotics, pass a urethral catheter, determine the cause of sepsis and remove if possible, consult for expert medical advice and possible patient transfer to intensive care units, and provide supportive care to involved organ systems.     

The role of platelet parameters for the diagnosis of preeclampsia among pregnant women attending at the University of Gondar Comprehensive Specialized Hospital antenatal care unit,Gondar, Ethiopia

BackgroundPreeclampsia (PE) is a pregnancy‐related illness characterized by high blood pressure (BP) and proteinuria after the 20th gestational week (GW). Platelet (PLT) parameter changes are the common hematological abnormalities observed in PE patients. The main aim of this study was to assess the role of PLT parameters for PE diagnosis among pregnant women.MethodsA comparative cross‐sectional study was conducted at the University of Gondar Specialized Hospital. A total of 126 pregnant women (63 normotensive [NT] and 63 PE) were recruited using a convenient sampling method. Three milliliter blood was collected from each participant, and PLT parameters were determined using Sysmex XS‐500i analyzer. An independent t‐test supplemented with receiver‐operating characteristics (ROC) were used for comparisons and diagnostic value of PLT parameters between the study groups.ResultsPlatelet count (PC) was significantly lower in the PE group compared to that in the NT group, whereas mean platelet volume (MPV), platelet large cell ratio (P‐LCR), and platelet distribution width (PDW) were significantly higher in PE. MPV had the largest area under the curve (AUC) [0.91: 95% CI; 0.85–0.96] followed by PC [0.79: 95% CI; 0.72–0.87]. MPV can differentiate PE patients from NT pregnant women at cut‐off value ≥12.10 fl (84.1% sensitivity and 87.3% specificity) while PC can indicate PE at a cut‐off value ≤176.5 × 10⁹/L (65.1% sensitivity and 87.3% specificity).ConclusionA decreased PC and an increased MPV, P‐LCR, and PDW can be used as a simple, cost‐effective, quick, and reliable method of PE screening. Of them, MPV is the best indicator of PE.     

Estimation of Stature from Arm Span,Arm Length and Tibial Length among Adolescents of Aged 15–18 in Addis Ababa,Ethiopia

BackgroundKnowing the relationship between stature and different anatomical anthropometric parameters help forensic scientists, anatomists and clinicians to estimate standing height from mutilated remains of body parts in clinical practices and forensic investigations. It is a necessity when measuring height is unenviable due to certain medical conditions and in field studies. This study aims to estimate stature from arm span, arm length and tibial length among adolescents of age 15–18 in Ethiopia.MethodsA school based cross-sectional study was carried out among 416 high school students in Addis Ababa, Ethiopia from May to June 2019. Stratified multi-stage sampling techniques were used to select the study participants. Anthropometric measurement including weight, height, arm span, arm length and tibial length was measured. Data entry was done by Epi-Data a version 4.4.3.1 and data analysis was carried out by Statistical Package for Social Sciences version 23. Regression models and multiplication factors were generated for estimation of height from anthropometric parameters.ResultFrom total participants 51.4% were females and 48.6% were males. The mean height of study participants was 164.36±8.89cm for males and 155.75±5.86cm for females. The correlation coefficients(R) of anatomical anthropometric measurements with height were: arm span (males R=0.843, females R=0.708), arm length (males R=0.806, females R=0.635), and tibial length (males R=0.738, females R=0.611).ConclusionStature predicted from arm span, arm length, and tibial length is a valid indicator of height. Arm span was appeared to be the best predictor of stature.     

Yield of Ultrasound Guided Fine-Needle Aspiration of Intraabdominal Masses and Lymph Nodes: A Prospective Cross-Sectional Study

BackgroundUltrasonography (USG) guided fine needle aspiration cytology (FNAC) is a safe, rapid and accurate procedure for establishing diagnosis of intraabdominal lesions. The aim of this study is to assess the efficacy, and factors affecting the yield of USG guided FNAC. In addition, we intent to analyze the various intraabdominal masses based on location and cytological features.MethodsA prospective cross-sectional study was conducted in the department of radiology, between September 2019 – September 2020. Patients'' preparation and USG guided FNAC procedures were performed according to the departments protocol. Chi-square test was used to assess the significance of association between independent and dependent variables.ResultsSeventy-four USG guided FNAC were performed. The liver was aspirated in 34 (45.9%) followed by omentum, nine (12.2%), abdominal lymph nodes in seven (9.5%) and ovaries in four (5.4%) of the cases. The sample was diagnostically adequate in 56 (75.7%). Malignancy was diagnosed in 52 (70.3%) followed by inflammatory 3(4.1%) and one (1.4%) case of indeterminate spindle cell neoplasm (1.4%). There were no statistically significant associations between the diagnostic yield and location of the lesion, the size of the lesion, the sampling technique, the number of needle passes and qualification of the operators.ConclusionUSG guided FNAC provides a good diagnostic yield and there is no difference in diagnostic yield between the various location of the lesions, sampling techniques, number of needle passes and qualification of the operators. A larger size study is recommended to better analyze factors affecting the diagnostic yield of this procedure.