Ethiopian Medical Journal最新文献

Introduction: Diabetes mellitus is becoming a common chronic disease in both developed and developing nations and is associated with significant cardiovascular disease morbidity and mortality. The presence of hypertension in patients with diabetes mellitus doubles the risk of cardiovascular disease including coronary heart disease, congestive heart failure, ischemic and hemorrhagic stroke, renalfailure and peripheral arterial disease.

Objective: The aim of this study was to assess the pattern of antihypertensive drug therapy among diabetic hypertensive patients in Zewditu Memorial Hospital Diabetic Clinic in Addis Ababa.

Methods: This is a hospital based retrospective review of medical records of 382 diabetic-hypertensive patients who visited the Zewditu Memorial Hospital Diabetic Clinic in the period between August 2014 and January 2015.

Results: The most frequently prescribed antihypertensive drug classes were angiotensin converting enzyme inhibitor in 321 (84%) followed by calcium channel blocker in 229 (60%) and beta blocker in 145 (38%) patients. Enalapril, nifedipine, atenolol, losartan and hydrochlorthiazide were the only angiotensin converting enzyme inhibitor, calcium channel blocker, beta blocker, angiotensin receptor blocker and diuretic prescribed, respectively. Enalapril was used as a monotherapy in 73 (19%) and nifedipine in 26(7%), patients. The recommended target systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg was achieved in only 57 (15%) patients while the remaining 325 (85%) did not attain the target blood pressure. Renal function was assessed in 351(92%) patients, of whom 23 (6%) had renal impairment with an estimated glomerular filtrate rate < 60 ml/min.

Conclusion: The pattern of antihypertensive drug therapy in our patients was consistent with the current treatment guidelines. However, the majority of diabetic-hypertensive patients did not reach target blood pressure.

Colonic lipoma is a rare non-epithelial mesenchymal tumour which is the second most common benign tumour of the colon excluding hyper-plastic polyps. It is often small and asymptomatic but may become symptomatic and mimic malignant lesions as the size increases. This is a case report of a 68 year-old female patient who presented with lower abdominal pain, constipation and rectal bleeding of one year duration. Colonoscopy revealed a sessile tumour 40 cm from the anal verge with an inconclusive histology. After incising and removing the lipoma, the redundant mucosal fold was then resected. The patient recovered completely and was discharged on the fifth postoperative day. Keyword: Colonic lipoma , subserosal lipomas.

Objective: Chronic empyema is a serious problem and is often difficult to manage. Its incidence has dropped worldwide, but continues to pose health problems in low and middle income countries. This study has been conducted to assess the outcome of open thoracic window in patients with neglected chronic thoracic empyemain Ethiopian patients.

Methods: A six-year (June 2008 to October 2014) retrospective study was conducted on thirty five patients (ten females and twenty five males, age ranging from 30-70 years). Open window thoracostomy was performed on these patients for chronic empyema with residual lung tissue and with or without bronchopleural fistula who failed to respond to the conventional methods of treatment.

Results: The etiology was primary empyema in 16 patients, post-traumatic in 12 patients, and post-thoracotomy in seven patients. Spontaneous closure was achieved in 12 patients; simple closure was done on 18 patients; and closure with muscle flap in five patients. In all patients, the cavity cleared from secretions in two to three weeks and the residual space narrowed in seven to nine months. All patients gained weight following the surgery.

Conclusion: Our result has revealed that open thoracic window is still an alternative method for the treatment of chronic empyema when the conventional method of treatment fails.

Background: Physiological range of clinically important hematological laboratory values and lipid profiles of healthy population in Ethiopia is not well assessed.

Objective: to determine hematologic and lipid profiles of healthy blood donors in Addis Ababa.

Methods: Red Cross Society located in Addis Ababa was selected as a study area. 336 donors; age range between 18-58 years participated. Venous blood sample was collected by tube containing Ehtylenediaminetetraaceticacid tri potassium (EDTA) for hematology test and sterile tube for lipid test. After centrifugation serum was extracted for lipid test and transported to St. Pauls's Millennium Medical College (SPHMMC) within 5-8hrs of sample collection. IBM.SPSS version 21 was used for data analysis, statistical significance was set at P< 0.05 and 95% CL was accepted.

Results: Red blood cell count, mean corpuscular volume, platelet count and triglyceride level were significantly higher in the present study than the reference range. RBC indices, white blood cell, Hemoglobin, hematocrit, high density lipoprotein, low density lipoprotein and total cholesterol were higher in the reference range used in clinical practice. Significantly higher red blood count (p = 0.000), Hg (p = 0.000), Hematocrit (p = 0.000) and mean corpuscular hemoglobin concentration (p = 0.009) were observed in the male. Significantly higher platelet count and high density lipoprotein were observed among females (p = 0.001 and p = 0.001 respectively). No significant change in hematological laboratory values and lipid profiles was seen across age groups.

Conclusion: It is evident from this study that hematological and lipid variables obtained were statistically significantly different from the reference range currently used in clinical practice.

Background: The treatment response of HCV infection is dependent on genotype and stage of the disease. However, genotype pattern and treatment outcomes of HCV infection among Ethiopian patients has not been studied so far.

Objectives: To evaluate the common HCV genotypes and treatment outcomes among Ethiopian adult patients.

Method: Adult patients aged 18 and above with HCV infection referred from various regions of the country were included in the study after written informed consent. As there was no free or insurance coverage for treatment of HCV infection in the country, those who could afford to pay for treatment with PEG Interferon and Ribavirin were recruited during January 1, 2008 through December 31,2013 at United Vision, Adera. Old Airport, and Mexico referral higher clinics in Addis Ababa. Patients with decompensated cirrhosis and pregnant ladies were excluded from the study. The patients were counseled on treatment options, cost, treatment outcomes, adverse drug effects, and possible complications. Data were collected on demographic features, clinical characteristics, viral genotypes, and treatment outcomes during follow up visits until six months after completion of recommended standard treatment. Data were analyzed using SPSS software.

Results: A total of 200 adults with chronic HCV infection were treated with PEG-Interferon and Ribavirin (for 24 or 48 weeks according to the genotypes) during the study period. Of the 200 patients enrolled in the study, 120 (60%) were male, 90% were from Addis Ababa, and the median age was 48 years. Sixty per cent of the patients were infected with genotype 4,17% with genotype 1, 13.5% with genotype 2 and 9.5% with genotype 3. Eighty percent of the patients had end of treatment response; of these, 74.4% had undetectable HCV RNA at 6th month after end of treatment. The end of treatment response was noted to be close to 90% for patients with HCV genotypes 2 and.3 infections.

Conclusion: This study indicates that genotype 4 is the prevalent HCV genotype followed by 1, 2, and 3 among Ethiopian patients. Treatment with interferon and ribavirin was well tolerated and provided a very good response.

Hydatid cyst of the breast is extremely rare even in endemic areas and it only accounts for 0.27% of all hydatid cyst disease cases. It can either be a primary site or part of a disseminated hydatidosis. Surgery remains to be a treatment of choice. Only few reports are published in the literatures and most of the reported cases have been diagnosed postoperatively as it is not easy to reach at a definitive diagnosis with clinical examination and radiological investigations only. This is a case of an isolated hydatid cyst of breast in an 18-year old woman from the Amhara region, Ethiopia. She presented with left breast painless lump of 5 years duration and a correct pre-operative diagnosed was made by fine needle aspiration cytology, then confirmed after surgery. We believe this disease should be included in the differential diagnosis of benign breast lumps especially in endemic areas.

Visceral leishmaniasis (VL) is a ftial and growing public health problem in Ethiopia. VL is recently reported outside the major endemic foci, the lowlands in the northwest and the Omo and Abaroba-plain, Segen and Woito valleys in the southwest. Here, we report a visceral leishmaniasis case from Benishangul-Gumuz Regional state near the Guba area. The patient had no history of travel to known VL endemic areas. The patient is a temporary farm laborer from West Go'jam Zone, Wanbermna District in Amhara Regional State. While in Benishangul-Gumuz, the patient was diagnosed with prolonged and intermittentfever, epistaxis, splenomegaly, skin pallor, diarrhea, cough and oedema. Laboratory diagnosis results showed that he had marked leucopenia, thrombocytopenia and anemia. The patient was suspected of having VL and checked with rK39 immunochromnatography and direct agglutination tests which were positive for anti leishmanial antibodies. After getting full dose of sodium stibogluconate as per the national visceral leishmaniasis treatment guideline, was clinically cured. As the area in Benshangul-Gumuz where this patient contracted visceral leishmaniasis is under social and ecological transformation with large scale projects attracting huge influx of temporary laborers and settlers, due attention is needed with respect to introduction or emergence of VL transmission.

Background: Intussusception is one of the frequent causes of bowel obstruction in infants and toddlers (1). It involves invagination of a portion of intestine into another(2-4). The peak age of occurrence is between the age of 4 and 8 months. The aim of this study is to review the pattern of clinical presentation and seasonal variation of intussusception in our hospital, and to analyze the mode and outcomes of treatment.

Patients and methods: This is a four-year retrospective study of children aged 13 years and below who were admitted and treated for intussusception between January 2011 and December 2014 at the pediatric surgery unit of Tikur Anbesa Specialized Hospital (TAH) in Ethiopia. Information on the patients' demographic characteristics, clinical presentation, and month of occurrence as well as the operative findings and outcome were obtained from the pediatric surgery unit record book, patient charts, and the operating theatre registry.

Results: One hundred and thirty six cases of intussusception were admitted to TAH, Addis Ababa over a four year period, of which 130 charts were retrieved and analyzed. Males dominated in the series. Age distribution showed that 59.2% of the cases were ≤ one year old, and 77.7 % were ≤ two years old. Abdominal pain, vomiting, bloody mucoid diarrhea and a mass palpated abdominally and/or rectally were the most common modes of presentations, with the classic triad of abdominal pain, vomiting and bloody mucoid diarrhea occurring in nearly two third of cases. The highest peak of presentation was in the month of June with 18 (13.9%) cases. The mean duration of symptoms before presentation to our hospital was 5.2 days with a range of 1-21 days. Intraoperatively, it was found that ileocolic intussusception was the most common type. Simple reduction without bowel resection was possible in 70.8% of cases. There were 44 (33.9 %) complications, wound site infection being the most common occurring in 20 (15.4%) cases and there were 6 deaths.

Conclusion: Intussusception was more common in the wet season. There was delayed presentation with a higher rate of operative management and bowel resection. The mortality rate has decreased significantly compared with a previous study from this institution.

Background: An outbreak of a chronic liver disease of unidentified cause, known as "Unidentified Liver Disease (ULD)" by local communities was first observed in a rural village in Tigray, northern-Ethiopia in 2001. Little was known about the geographical extent, trend, and epidemiology of the disease.

Methods: The Ethiopian Public Health Institute (EPHI) by then Ethiopian Health and Nutrition Research Institute (EHNRI), Centers for Disease Control and Prevention, World Health Organization, and Tigray Regional Health Bureaue established the ULD surveillance system in 2009 to characterize and monitor trends for this emerging disease and to identify cases for treatment and follow up. A large-scale official training was provided to the surveillance staff on case identification, management and reporting. In absence of a confirmatory test, the system used simple case definitions that could be applied by frontline staff with varying clinical training. To maximize resources, health extension workers already conducting household visits in affected communities identified cases and increased community awareness about the disease. A team was placed in Shire, in close proximity to the outbreak region, to provide support and collect reports from health facilities and district health offices.

Results: As of September 2011, a total of 1,033 cases, including 314 deaths were identified. Contamination of locally produced grains with several pyrrolizidine alkaloid producing plants was identified cause of the disease. Staff interviews identified that shortage and turnover of trained staff were major challenges.

Lessons learned: Long term dedication by frontline staff, using simple case definitions to identify cases, and active collection of missing reports were critical for surveillance of this chronic non-infectious disease of unknown cause in a rural, resource-limited setting.