Vol 58, No 02 (2020): EMJ April Regular issue

Introduction: Despite an increasing number of studies reporting high levels of co-morbidity between depression and hypertension in high-income countries, there is limited information on co-morbid depression among hypertensive patients in low- and middle-income countries.                                                                                                                      Objectives: The aim of this study was to determine the prevalence of depression, associated factors and treatment gap among hypertensive patients attending outpatient follow-up at a referral hospital in Ethiopia.

Methods: A hospital-based cross-sectional study was conducted in 302 consecutive outpatient attendees with hypertension. Probable depression was measured using an interviewer administered depression scale (the Patient Health Questionnaire; PHQ-9) previously validated for the Ethiopian setting for a cut-off of 9 and above. Contextualised standardized measures of medication adherence, alcohol and khat use were used. Clinical information was extracted from medical notes, augmented by assessment of body mass index. Univariate and multivariable analyses were carried out to assess factors associated with depression.

Results: The prevalence of probable depression among participants was 22.2%. The treatment gap was 91%. Only 9% (n=6) had received any treatment for depression. Of these, all were prescribed an antidepressant. Female gender, adjusted odds ratio (aOR) 2.6, (95% confidence interval (CI) 1.2, 5.8), being unmarried (aOR 2.0; 95% CI 1.0, 3.7) and having two or more co-morbid medical illnesses (aOR 12.6; 95% CI 4.3, 37.0) were associated independently with depression. There was no association between depression and medication adherence, diet, physical activity or body mass index.

ABSTRACT

Purpose:Fatigue is a severe problem for many people living with Parkinson’s disease (PD). Best estimates suggest that more than 50% of PDpatients experience this debilitating symptom.Fatigue is related to disease progression and excessive daytime sleepiness (EDS) and yet there has been no prior report on Fatigue among patients with PD living in Ethiopia. The present study aimed at assessing the prevalence and determinant of fatigue among PD patients in Ethiopia.

Methods: A cross-sectional study of all PD patients attending the follow-up clinics of the Departments of Neurology at Tikur Anbessa and Zewditu Memorial Hospital in Addis Ababa, Ethiopia, from July 1 to October 30, 2015 was conducted.We collected information using a structured questionnaire which assessed demographic information, clinical history, the Parkinson’s fatigue scale item_sixteen (PFS-16, distressing fatigue defined asPFS-16 mean score >3.3) and the Epworth Sleepiness Scale (ESS).

Results: Of the 155 patients surveyed 155 patients responded for PFS-16 items with mean (+SD) score of 3.88+0.79. Distressing fatigue was noted on 120/151(79.5%) of the respondents. Excessive day time sleepiness, ESS>10(OR 3.39; 95% CI 1.41 - 8.20, p=0.004)and unemployment(OR 2.71; 95% CI 1.19 – 6.17, p=0.016) associated with distressing fatigue.There was no statistical association with age, gender, PD stage, duration of PD symptoms, previous history of sleep disturbance, Levodopa or Trihexyphenidyluse and higher PDSS-2 score.

Conclusions: The prevalence of distressing fatigue in Ethiopian PD patientsis substantially high. Further investigations into contributors in our PD patients are needed.

Keywords: Parkinson’s disease, Fatigue, Ethiopia.

COPD is currently the fourth leading cause of death in the world. In 2012, ? 3 million people died of COPD, accounting for 6% of all deaths globally. Pulmonary tuberculosis is emerging as a potential risk factor in the pathogenesis and severity of COPD. The object of this study was to evaluate the prevalence of COPD in patients successfully treated for PTB seen at Tikur Anbessa Specialized Hospital, in Ethiopia.

Methodology: We conducted a cross-sectional study of patients > 15 years of age who were successfully treated for PTB and followed in the Chest Unit at TASH from August 2016 to September 2017.  All patient had lung function measured using a Diagnostic EasyOne Plus model 2001 SN spirometer. Spirometric acceptability and reproducibility were determined using the published criteria of the ERS/ATS. A diagnosis of COPD was based on a post-bronchodilator FEV1/FVC<70% as recommended by the GOLD guidelines.

Results: A total of 99 patients were included in the analysis. 56% were male; the mean age of the group was 42.7 years. Forty-one of 99 (41.4%) study participants had post-bronchodilator FEV1/FVC<70%, meeting the study criteria for COPD. This percent was approximately 8 times higher than the 5% previously determined for COPD in the general population for subsaharan Africa. The majority of diagnosed COPD cases in our study had moderate to severe GOLD stage disease. 

Conclusions: The prevalence of COPD is high in our patients who were successfully treated for PTB and they should be strongly considered for screening and possible treatment

Abstract

BACKGROUND:  Clinical presentation of rhegmatogenous retinal detachment in the developing world is not very well known. This study reports the clinical presentation of 321 cases of rhegmatogenous retinal detachments in Ethiopian patients.

METHODS: A prospective cross sectional descriptive study was undertaken to evaluate the clinical presentation of all patients with rhegmatogenous retinal detachment seen at the retina clinic of Menelik II Hospital from October 2013to February 2016. Complete ophthalmic examination was done including U/Sound when the media was hazy.

RESULTS:  The mean age at presentation was 41.8 years with male to female ratio of 2.3:1. Two hundred eighty of the involved eyes (75.8%) were blind (visual acuity < 3/60). The duration of symptoms was over 1 month in 220 (68.5%) cases and, in 268 (93.7%) the macula was detached at presentation. Long distance from the tertiary center was the main reason (25.8%) for late presentation. Myopia, 151(47%), was the major predisposing factor.

CONCLUSIONS: The profile of rhegmatogenous retinal detachment among Ethiopians presenting at a tertiary care center includes many young cases, late presentations and macula-off detachments, commonly related to myopia. Improvement in primary health care and education should reduce the delay in presentation.

Key words: rhegmatogenous retinal detachment, myopia, late presentation

Aims/Purpose: Caregivers of people with severe mental illness (SMI) experience substantial burden from providing care. This burden is likely to be higher in low- and middle-income countries where statutory medical and social services are scarce. We conducted a study aiming to evaluate the level of caregiver burden among caregivers of people with SMI. Methods: The study was population-based cross-sectional evaluation conducted in the Sodo district of the Gurage zone in south Ethiopia. Three hundred people with SMI and matched caregivers were included. The involvement evaluation questionnaire (IEQ), a widely used tool for assessing caregiver burden, was administered. The core tool assessing burden has four domains (urging, worry, supervision and tension). Results: Caregivers were predominantly women (52.5%), married (67.6%), under 45 years of age (57.5%) and had little or no formal education (60.9%). The overall mean burden score (95% confidence interval (CI)) was 45.3 (43.2, 47.4); highest for “urging” (mean=15.5; 95% CI=14.6, 16.4) and “worrying” domains (mean=13.7; 95% CI=12.9, 14.4). Being female caregiver, first degree relative, experiencing distress and caring for patients with higher levels of symptomatology and disability were significantly associated with higher overall burden score. Conclusions: As anticipated, caregivers in this setting have substantially higher levels of burden of caring compared with care givers in Europe and other settings. Interventions should aim not only at decreasing patient symptoms and improving functionality, but also at decreasing caregiver distress focused on women and first-degree relatives.

Introduction: Circle of Willis, is an arterial circle, furnishing arterial supply to most of the brain and meninges. However, its formation and a complete arterial circle, differs among individuals.

Objectives: In the present study, an attempt has been made to identify those variations and to segregate them into anterior and posterior circulation.

Materials and method: Thirty-two cadaveric brains were used for the study.

Results: The results show that the variations of the anterior circulation exceeded those observed in the posterior circulation.

Conclusions: These variations would add on to the previous findings and thus help the neurosurgeons while operating this region.

Background: Group B streptococcus (GBS) was identified as the leading cause of neonatal disease in developed countries. The surrogate for early onset neonatal disease caused by GBS is rectovaginal colonization of pregnant women before delivery. In this study we sought to determine colonization rate of GBS among pregnant women and their new born, vertical transmission rate and serotype distribution at Tikur Anbessa Specialized Hospital (TASH).

Methods: A cross-sectional study was conducted at TASH from March 2015 to August 2015.  280 pregnant women and their newborn were screened for GBS. Isolated GBS were serotyped by using serotype specific antisera. Structured questionnaire was used to collect socio-demographic and obstetric data. Logistic regression was used to compare colonization rate obtained from pregnant women and their newborn with different risk factors. P value less than 0.05 was considered statistically significant.

Result: Maternal, newborn GBS colonization rate and vertical transmission rate were 65(23.2%), 95% CI [18.6-28.9], 32(11.3%), 95% CI [7.8-14.8] and 32/65(49.2%) respectively. GBS serotype distributions were: Ia 22(22.7%), Ib 16(16.5%), II 29(29.9%), III 7(7.2%), V 18(18.6%), and non typeable 5 (5.2%).

Conclusion: GBS colonization rate in this study was high. Serotype II was the predominant serotype followed by serotype Ia. In the future concerned bodies should consider implementation of prevention strategy to minimize the burden of disease. Vaccine formulation which include serotype II, Ia, V, Ib, and II may prevent majority of neonatal disease the study area.

Abstract

Background: Fracture is a loss in the structural continuity of bone which results from injury, repetitive stress, or abnormal weakening of the bone. Globally, fracture injury continues to be an important cause of morbidity and disability both in the developed and developing countries.

Objective:  The aim of this study was to assess the clinical profile and patterns of extremity fracture patients visiting orthopedic department at TASH, Ethiopia.

Materials and Method: Institutional based retrospective cross-sectional study was carried out. The sample size was 354 and study participants were extermity fracture cases. The data were analyzed using SPSS 21. Chi-square (?2) test was applied to see if there was any association between the different variables.

Results: Most of the fracture victims, 111 (32.6%), were between the ages of 15 and 29 years. Lower extremity fracture (65.6%) was more common compared to upper extremity (34.7%). The femur (23.7 %) was the commonest fractured bone. The common patterns of fractures were transverse type which accounted for (35.5 %). The leading causes of fractures were road traffic injuries (RTIs) (42.2%) followed by falling down accidents (29.6%). The Cause of fracture and number of bone fracture were significantly associated with age (p<0.05). 

Conclusion: The most commonly fractured bone in the extremities was the femur followed by tibia and fibula. Transverse factures followed by communited-type of fractures were the commonest patterns of fracture. The leading cause of fracture was road traffic injury followed by falling-down accidents.

Keywords:  Extremity, fracture, Patterns, Tikur Anbessa specialized hospital, Ethiopia

 Aims: To establish the frequency and stage of ROP in preterm babies examined in a tertiary eye center and the outcomes of treatment.

 Methods: Retrospective review of medical records of preterm infants attending WGGA eye center (June 2016-August 2019). Information on birth weight (BW), gestational age (GA), postmenstrual age at presentation, age at first examination, diagnosis and stage of ROP, and treatment outcomes were analyzed.

 Results: 66 infants were included. 28 (42.4%) had ROP: 17 (25.8%) had vision-threatening ROP (any Zone I disease (n=1), Stage 2 or 3 in Zone II with plus disease (n=5), aggressive posterior ROP (n=1), or Stage 4 or 5 (n= 10)). The mean GA of these 17 infants was 28.4±1.6 (range 26-32) weeks; mean BW was 1172.7±259.6 (range 680–1800)g. Treatment was as follows: anti-VEGF injection 5; laser 1; anti-VEGF and laser 1; lens-sparing vitrectomy 1; laser, then lensectomy with vitrectomy 1. In 16 cases ROP regressed (10 spontaneously; 6 after treatment), and one failed follow up. One progressed to stage 4 despite extensive treatment. Ten (10/66, 15.2%) were blind or visually impaired.

 Conclusions: Preterm infants at risk of ROP are now surviving in Ethiopia. There is a need to establish ROP screening and treatment services and to increase awareness. Wide criteria should be used initially to delineate the population at risk of vision threatening ROP in this context.