The blood pressure response to dynamic exercise testing: a systematic review

Although blood pressure (BP) is measured routinely during exercise testing, its clinical significance is not fully understood or appreciated. As the number of studies has increased, conflicting data have emerged, partly due to differences in methodologies, populations studied, testing procedures, and definitions used for an abnormal BP response. This article attempts to review the literature studying the physiology and pathophysiology of the BP response to exercise testing and summarize the evidence for its diagnostic and prognostic applications.     

National mortality burden due to communicable,non-communicable,and other diseases in Ethiopia, 1990–2015: findings from the Global Burden of Disease Study 2015

Background

Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years.

Methods

GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015.

Results

CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age-standardized death rates in Ethiopia in 2015.

Conclusions

Ethiopia has been successful in reducing deaths related to communicable, maternal, neonatal, and nutritional deficiency diseases and injuries by 65%, despite unacceptably high maternal and neonatal mortality rates. However, the country’s performance regarding non-communicable diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, was minimal, causing these diseases to join the leading causes of premature mortality and death rates in 2015. While the country is progressing toward universal health coverage, prevention and control strategies in Ethiopia should consider the double burden of common infectious diseases and non-communicable diseases: lower respiratory infections, diarrhea, tuberculosis, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Prevention and control strategies should also pay special attention to the leading causes of premature mortality and death rates caused by non-communicable diseases: cardiovascular disease, cancer, and diabetes. Measuring further progress requires a data revolution in generating, managing, analyzing, and using data for decision-making and the creation of a full vital registration system in the country.

     

Bacterial profile and their antimicrobial susceptibility patterns in patients admitted at MaddaWalabu University Goba Referral Hospital,Ethiopia: a cross sectional study

BackgroundHospital acquired infections (HAIs) are one of the global concerns in resource limited settings. The aim of the study was to determine bacteria profile and their antimicrobial susceptibility patterns among patients admitted at surgical and medical wards.MethodsA hospital based cross-sectional study was conducted from November 2016 to July 2017 in MaddaWalabu University Goba Referral Hospital. Urine and wound swabs were processed and standard disk diffusion test was done to assess susceptibility pattern. Association among variables was determined by Chi-square test.ResultsAmong 207 patients enrolled, 24.6% developed HAI, of which, 62.7% and 37.3% were from surgical and medical wards, respectively. The male to female ratio was 1.5:1. The age ranged from 19 to 74 years with a mean of 41.65(±16.48) years. A total 62 bacteria were isolated in which majority of the isolates were gram negative bacteria. Most isolates were resistance to most of the antibiotics tested but sensitive to Ceftriaxone, Norfloxacin and Ciprofloxacin.ConclusionDue to the presence of high level drug resistant bacteria, empirical treatment to HAI may not be effective. Therefore, treatment should be based on the result of culture and sensitivity.     

Cervical cancer patients presentation and survival in the only oncology referral hospital,Ethiopia: a retrospective cohort study

Background

Women infected with Human Immune Deficiency Virus (HIV) are assumed to be at higher risk of developing Cervical Cancer (CC). This is due to a rapid progression of pre-invasive to invasive lesions. However, evidences suggest, due to the availability of antiretroviral therapy (ART) and care services; an improved survival and treatment outcome of CC patients (CCPs) with HIV infection is expected.

Objective

The aim of this study is to examine the clinical characteristics and survival of of CCPs registered at the radiotherapy center of Tikur Anbessa Specialized Hospital (TASH), Addis Ababa University, Ethiopia.

Methods

We conducted a retrospective cohort study. Data from 1655 CCPs diagnosed between September 2008 and September 2012 were included. The primary endpoint was death from any cause. Kaplan-Meier estimates were compared using the log-rank test. Cox proportional hazards regression model was used to identify predictors of death. Data were analyzed using STATA version IC/14.

Results

The mean age of all patients was 49 years (SD?=?11.6 years). Of all CCPs, 139 (8.4%) were HIV positive, 372 (22.5%) patients had a known negative HIV status and 1144 (69.1%) patients were asymptomatic with unknown HIV status. Due to late stage and waiting times, only 13.5% of the patients received curative radiotherapy doses. HIV-positive CCPs presented more often with advanced disease compared to HIV negative CCPs ((44.6%) versus 39.7%, p?=?0.007). There was no significant difference in survival between HIV-positive and HIV-negative CCPs. Older age (HR?=?2.01; 95% CI, 1.01,-4.05), advanced disease (HR?=?2.6; 95% CI, 1.67–4.04) and baseline anemia (HR?=?1.65; 95% CI, 1.24, 2.20) were independent predictors for higher risk of death.

Conclusion

Survival rates of CCPs did not differ according to HIV status. The risk of death was higher for patients with older age, advanced disease and anemia. HIV patients should be screened for CC according to guidelines to avoid late presentation.

     

Adding an Electrocardiogram to the Pre-participation Examination in Competitive Athletes: A Systematic Review

No matter how rare, the death of young athletes is a tragedy. Can it be prevented? The European experience suggests that adding the electrocardiogram (ECG) to the standard medical and family history and physical examination can decrease cardiac deaths by 90%. However, there has not been a randomized trial to demonstrate such a reduction. While there are obvious differences between the European and American experiences with athletes including very differing causes of athletic deaths, some would highlight the European emphasis on public welfare vs the protection of personal rights in the USA. Even the authors of this systematic review have differing interpretation of the data: some of us view screening as a hopeless battle against Bayes, while others feel that the ECG can save lives. What we all agree on is that the USA should implement the American Heart Association 12-point screening recommendations and that, before ECG screening is mandated, we need to gather more data and optimize ECG criteria for screening young athletes.     

Analysis and reporting of meningococcal meningitis epidemic in north Gondar 2001-2002

Severe epidemic meningococcal meningitis occurs in countries of the meningitis belt of Sub-Saharan Africa, including Ethiopia. Many epidemics occurred in this country in the past decade, the recent being in 2000 in Addis Ababa unusually during the wet and rainy season. The study was a cross-sectional design. Data were collected with prepared questionnaires and the line listing. CSF (Cerebro Spinal Fluid) culture and antibiotic sensitivities were done for a limited number of patients. The objective of the study was to assess the progress and management outcome of the epidemic. During the out breaks of epidemic meningitis in north Gondar zone of the Amhara regional state in 2001 and 2002 children and young adults were most affected. There were 384 cases and 26 deaths in 2001 and 1235 cases and 128 deaths, in 2002, making a total of 1619 cases and 154 deaths with a case fatality rate of 9.5%. The etiologic agent was sero-group A. The most affected age group was 15-30 years. About 80% of the cases were in the age 30 years and below. Surveillance, epidemic preparedness, interventions and response were found to be inadequate. Selective vaccination was not effective in handling the epidemic. Efficient surveillance, local processing and use of data, regional laboratory support, multisectoral approach and mass vaccination were recommended to appropriately and timely handle such epidemics.     

Implantable gastric stimulation (IGS) as therapy for human morbid obesity: report from the 2001 IFSO symposium in Crete

This supplement contains reports from a symposium on a novel approach to treat obesity, gastric myo-electrical stimulation, that was held at the IFSO in Greece in 2001. There were four presentations. Xavier Pi-Sunyer from Columbia University in New York discussed medical risks of obesity. Karl Miller from Austria presented technical aspects of the surgery. Valerio Cigaina from Italy, the originator of the concept, reviewed his 7-year results with this therapy. Finally, Jerome D'Argent from France gave his preliminary results employing higher energy electrical stimulation parameters. Customarily weight loss data are presented as percent excess weight lost (%EWL), an antiquated measurement, e.g. all subjects were purchasing life insurance, the poor and minorities were under-represented and those with heart disease, malignancies or diabetes were excluded. In this supplement weight loss data are presented in a novel manner: percent excess body mass index (BMI) lost %EBL. This innovation merits an explanation and justification. The NIH/NIDDK convened a panel, chaired by Professor Pi-Sunyer, that concluded that for adults a BMI of 25 should be considered the upper limit of normal. Accordingly, we have proposed that BMI units in excess of 25 be considered to represent 100% of the excess weight of an individual. The USA FDA has agreed to accept weight loss data presented as %EBL. The intriguing data presented justify further evaluation of this novel, potentially useful and relatively benign treatment of obesity.     

Sero-prevalence of Hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone,Southwest Ethiopia: Community based cross-sectional study

BackgroundHepatitis B virus infection is one of the leading causes of liver diseases which occurs worldwide particularly in developing countries. It is often caused by prenatal transmission from mother to child or household transmission from a close contact during early childhood. It causes different complications like; jaundice, induces premature labor, and prematurity.ObjectiveThe aim of this study was to estimate the sero-prevalence of hepatitis B virus surface antigen and associated factors among women of reproductive age in Bench Maji Zone, South West Ethiopia.MethodsA community-based cross-sectional study was conducted from December 15th, 2016 to February 15th, 2017. Multistage sampling technique was applied to select study participants. Logistic regression analysis was applied and p-values < 0.05 was used to see the significant association between dependent and independent variables.ResultsA total of 330 participants were included in this study yielding 98.8% response rate. The sero-prevalence of hbsag among women of reproductive age was 28(8.5%). Having multiple sexual partners (AOR = 18.73, 95% CI = [3.65, 96.21) history of unprotected sex (AOR = 9.39, 95% CI = [1.64, 53.77) were found to be significantly associated with sero-prevalence of HBV.ConclusionsThe sero-prevalence of HBV infection among women of reproductive age was highly endemic. Hence, behavioral education and communication programs focusing on reduction of risky sexual behaviors should be designed to reduce HBV infection.