Molla Abebe

Antiretroviral treatment associated hyperglycemia and dyslipidemia among HIV infected patients at Burayu Health Center, Addis Ababa, Ethiopia: a cross-sectional comparative study

BackgroundThe effects of highly active antiretroviral therapy (HAART) on glucose and lipid metabolism among sub-Saharan Africans, for whom access to antiretroviral therapy is expanding, remain largely unknown. Therefore, the aim of this study was to assess antiretroviral treatment associated hyperglycemia and dyslipidemia among HIV infected patients at Burayu health center, Addis Ababa, Ethiopia.MethodsA cross-sectional comparative study was conducted among HIV infected adults at Burayu Health Center, Addis Ababa, Ethiopia from September, 2011 to May, 2012. Equal number of HAART naïve and HAART initiated patients (n = 126 each) were included in the study. Demographic data were collected using a well-structured questionnaire. Total cholesterol (TC), Triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and glucose were determined. The data were analyzed using SPSS version 20 software.ResultOf 252 study participants, 72.2% were females; mean age was 35.3 years; mean Body Mass Index (BMI) was 21.4(kg/m2); mean time living with the virus was 20.6 months and 15.5% were TB-HIV co-infected. The prevalence of hyperglycemia, increased LDL-C hypercholesterolemia, hypertriglyceridemia and decreased HDL-C were 7.9%, 23%, 42.1%, 46.8% and 50.8% in HAART and 5.6%, 7.1%, 11.1%, 31% and 73% in non-HAART groups, respectively. First line antiretrovirals were drugs containing 2 nucleoside backbones (from Zidovudine/Stavudine/Lamivudine/Tenofovir) with either Nevirapine or Efavirenz. There was statistically significant increase in serum lipid profile levels among HAART initiated patients than HAART naïve individuals (p =0.01 for TG and <0.001 for others).ConclusionFirst-line HAART is associated with potentially atherogenic lipid profile levels in patients with HIV infection compared to untreated patients. This indicates glucose and lipid profile levels need to be monitored regularly in HIV infected patients taking antiretroviral treatment.

Processing medical data: a systematic review

BackgroundMedical data recording is one of the basic clinical tools. Electronic Health Record (EHR) is important for data processing, communication, efficiency and effectiveness of patients’ information access, confidentiality, ethical and/or legal issues. Clinical record promote and support communication among service providers and hence upscale quality of healthcare. Qualities of records are reflections of the quality of care patients offered.MethodsQualitative analysis was undertaken for this systematic review. We reviewed 40 materials Published from 1999 to 2013. We searched these materials from databases including ovidMEDLINE and ovidEMBASE. Two reviewers independently screened materials on medical data recording, documentation and information processing and communication. Finally, all selected references were summarized, reconciled and compiled as one compatible document.ResultPatients were dying and/or getting much suffering as the result of poor quality medical records. Electronic health record minimizes errors, saves unnecessary time, and money wasted on processing medical data.ConclusionMany countries have been complaining for incompleteness, inappropriateness and illegibility of records. Therefore creating awareness on the magnitude of the problem has paramount importance. Hence available correct patient information has lots of potential in reducing errors and support roles.

Type 2 Diabetes Mellitus and Its Association with the Risk of Pancreatic Carcinogenesis: A Review.

The prevalence of diabetes mellitus (DM) and associated diseases such as cancers are substantially increasing worldwide. About 80% of the patients with pancreatic cancer have glucose metabolism alterations. This suggests an association between type 2 DM and pancreatic cancer risk and progression. There are hypotheses that show metabolic links between the diseases, due to insulin resistance, hyperglycemia, hyperinsulinemia, low grade chronic inflammation, and alteration in the insulin-insulin-like growth factor axis. The use of diabetes medications can influence the extent of carcinogenesis of the pancreas. This study briefly reviews recent literature on investigation of metabolic link of type 2 DM, risk of carcinogenesis of the pancreas and their association, as well as the current understanding of metabolic pathways implicated in metabolism and cellular growth. The main finding of this review, although there are discrepancies, is that according to most research long-term DM does not raise the risk of pancreatic cancer. The longest duration of DM may reflect hypoinsulinemia due to treatment for hyperglycemia, but recent onset diabetes was associated with increased risk for pancreatic cancer due to hyperinsulinemia and hyperglycemia. In conclusion, the review demonstrates that type 2 DM and the duration of diabetes pose a risk for pancreatic carcinogenesis, and that there is biological link between the diseases.

Hematological indices and their correlation with fasting blood glucose level and anthropometric measurements in type 2 diabetes mellitus patients in Gondar, Northwest Ethiopia

Background Diabetes mellitus is (DM) a global public health problem and a complex disease characterized by chronic hyperglycemia that leads to long-term macrovascular and microvascular complications. Recent studies have reported the role of hematological indices in contributing to the vascular injury in diabetic patients. Thus, the aim of this study was to determine hematological indices and their correlation with fasting blood glucose level and anthropometric measurement in type 2 DM patients in comparison with healthy controls. Methods A comparative cross-sectional study was conducted at the chronic illness clinic of Gondar University Hospital from February to April 2015. A total of 296 participants (148 cases and 148 healthy controls) were selected using systematic random sampling technique. Data were collected using a pretested structured questionnaire. Fasting blood glucose levels and hematological indices were determined by using Bio Systems A25 and Sysmex-KX 21N analyzers, respectively. Independent sample t-test, Mann–Whitney U-test, and correlation statistics were used. A P-value <0.05 was considered as statistically significant. Result There was significant difference in red blood cell distribution width (47.3±2.6 fL vs 45.2±3 fL) between diabetic patients and controls. Total white blood cells in 103/µL (6.59±1.42 vs 5.56±1.38), absolute lymphocyte count in 103/µL (2.60±0.70 vs 2.04±0.63), and absolute neutrophil count in 103/µL (3.57±1.46 vs 3.11±1.04) increased significantly in diabetic patients compared with controls, respectively. Among platelet indices, mean platelet volume (10.4±1.1 fL vs 9.9±1.1 fL) and platelet distribution width (14.5±2.1 fL vs 13.4 ±2.1 fL) were found to be significantly increased in the diabetic patients (P<0.05). Anthropometric measurements significantly correlated with white blood cell and platelet indices. Conclusion The study showed statistically significant difference in some hematological parameters of diabetic patients compared to controls. Thus, hematological indices could be useful indicators of vascular complication and glycemic control in type 2 DM patients.

Metabolic syndrome among hypertensive patients at University of Gondar Hospital, North West Ethiopia: a cross sectional study

BackgroundData is sparse concerning the magnitude of metabolic syndrome (MetS) in developing countries like Ethiopia whose major health problem had long been under-nutrition and infectious diseases rather than non-communicable diseases (NCDs) including hypertension, obesity and MetS. However, it is obvious that the NCDs are recently taking over and becoming the major health care concerns in the developing countries. This pattern could be partly explained by the nation’s sustained economical growth in the last few decades in addition to the increasing globalization related adoption of western lifestyle. The aim of this study was to assess the prevalence of metabolic syndrome and associated factors among hypertensive patients in North West Ethiopia.MethodA cross sectional study was conducted on 300 hypertensive individuals who get follow-up care at University of Gondar Hospital after diagnosed as hypertensive. The WHO STEP-wise approach to surveillance of NCD was used. Fasting blood glucose level, triglyceride and high density lipoprotein cholesterol were determined using standardized laboratory procedures.ResultThe prevalence of metabolic syndrome was 40.7% and 39.3% according to the modified NCEP-ATP III and IDF criteria respectively. Low HDL-c was found to be the most frequently encountered (81.3%) component of MetS other than the hypertension. Being female was significantly associated with MetS (AOR = 4.34; 95% CI: 2.09, 8.99) using IDF and (AOR = 3.30; 95% CI: 1.66, 6.58) using NCEP-ATP III criteria. Abnormal BMI which included both high and low BMI was found to have significant association with MetS (AOR = 3.10; 95% CI: 1.73, 5.58) using IDF and (AOR = 1.84; 95% CI: 1.05, 3.22) as diagnosed using the NCEP-ATP III criteria.ConclusionWe recommend a comprehensive medical care approach to hypertensive patients to adequately assess and address the additional components of MetS which are known to potentiate the risks of cardiovascular diseases among hypertensive patients.

Accuracy of Sensocard Glucose Meter: Comparing with Reference Glucose Oxidase Method

Introduction: Diabetes mellitus is a cause of morbidity, disability and mortality worldwide. Glucose measurement by glucose meter is one of the diagnosing and monitoring tools of diabetes mellitus. However, the accuracy of this instrument is in question. Therefore, the aim of this study was to assess the accuracy of SensoCard glucose meter comparing with reference glucose oxidase method at University of Gondar Hospital, Gondar, Ethiopia. Methods: A prospective cross-sectional study was conducted in March, 2014. A total of 122 (equal number of type 1 and II) diabetic mellitus patients were selected by consecutive sampling technique. Glucose value was determined by SensoCard glucose meter and reference glucose oxidase method. The data were entered and analyzed using SPSS version 20 and Analyse-it version 3.76.1 softwares. Correlation coefficient and bias were calculated to observe the agreement of the glucose meter result with the comparative method. The minimum accuracy of Sensocard was determined based ISO 15197:2003 and ISO 15197:2013 criteria. Results: Sixty three (51.6%) participants were females. The mean age was 46.16 ± 15.5. The mean serum glucose value measured by reference method was 164.78 ± 86.33 mg/dl and the mean capillary blood glucose value measured by SensoCard glucose meter was 161.19 ± 78.1 mg/dl. There was no statistically significant difference between the means of SensoCard glucose meter and reference method glucose value (p-value=0.052). The correlation coefficient between the two methods was 0.975. The SensoCard glucose meter underestimated the overall glucose value from the reference method glucose value by a bias of 3.59. Conclusion: SensoCard did not fulfill the minimum accuracy requirements of ISO 15197:2003 and ISO 15197:2013. Further study should be undertaken including hypoglycemic and normoglycemic individuals to see the accuracy of SensoCard in low and normal levels of blood glucose in addition to high blood glucose level in diabetes mellitus patients.

Haematological and immunological reference intervals for adult population in the state of Amhara, Ethiopia

Reference intervals (RIs) currently being used in Ethiopia are derived from western populations. Thus, this study aimed to establish locally derived haematological and immunological RIs.

Proportion and predictors of transfusion-transmissible infections among blood donors in North Shewa Zone, Central North Ethiopia

Background Transfusion-transmissible infections (TTIs) pose a significant challenge for the availability and safety of blood transfusion. The aim of this study was to investigate the prevalence and risk factors for TTIs among blood donors in North Shewa zone, central North Ethiopia. Methods A retrospective survey of blood donors’ medical records was conducted from April 2014 to June 2017 to assess the presence of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis infections. Descriptive statistics such as percentage, median and interquartile range were used to summarize the data. Results Out of 8460 donations, 207 (2.4%, 95% CI 2.06–2.71%) had serological evidence of infection with at least one pathogen. Four of the blood donors (0.047%) had co-infection with more than one pathogen; 2HIV/HBV and 2HIV/syphilis. The overall prevalence of HBV, HCV, HIV, and syphilis among the donors were 1.2% (95% CI 0.98–1.45%), 0.32% (95% CI 0.2–0.44%), 0.25% (95% CI 0.14–0.35%), and 0.71% (95% CI 0.53–0.89%) respectively. Male sex was significantly associated with higher risk of HBV (OR 1.75, 95% CI 1.1–2.8) and syphilis sero-reactivity (OR 4.5, 95% CI1.9–10.5). Farmers and older donors were found to be at a higher risk for syphilis seropositivity. Conclusion The prevalence of TTIs among blood donors in North Shewa zone was relatively low compared to those of other geographic places in Ethiopia. However, TTIs remain a concern for the availability and safety of blood transfusion as they are still prevalent in the study area. Therefore, more efforts are required to ensure the safety of blood supply and transfusions.

Reference intervals of routine clinical chemistry parameters among apparently healthy young adults in Amhara National Regional State, Ethiopia

Background Clinical laboratory reference intervals (RIs) are essential for clinical diagnosis, treatment and therapeutic monitoring. Locally established RIs are required to correctly interpret clinical laboratory results. In Ethiopia, clinical laboratory test results are interpreted based on RIs derived from a western population. Methods A multicenter cross-sectional study was conducted among blood donors in Amhara National Regional State, Ethiopia from March 2016 to May 2017. A total of 1,175 apparently healthy study participants were included in the study from four blood banks in the region. All clinical chemistry parameters were analyzed using Mindray BS-200E full automated clinical chemistry analyzer. The 95% RIs were estimated using reference limits at 2.5th percentile for the lower reference limit and 97.5th percentile for the upper reference limit. Kolmogorov–Sminorv and Wilcoxon rank-sum tests were used to check data distribution normality and whether partitions were needed between variables, respectively. Results RIs established include: ALT 5.13–42.88 U/L for males and 4.3–37 U/L for females; AST 12.13–46.88 for males and 10–43.8 U/L for females; ALP 77.2–475.8 U/L for males and 89–381 U/L for females; amylase 29–309.8 U/L for males and 29–287.9 U/L for females; GGT 7–69.8 U/L for males and 6–39.1 U/L for females; total bilirubin 0.11–1.18 mg/dl for males and 0.08–0.91 mg/dl for females; creatinine 0.48–1.13 mg/dl for males and 0.47–1.09 mg/dl for females; total cholesterol 78.13–211.75 mg/dl for males and 83.6–202.7 mg/dl for females; total protein 5.7–9.7 g/dl for males and 5.6–9.47 for females; triglycerides 36–221.9 mg/dl for males and 35.3–201.5 mg/dl for females; urea 12–43 mg/dl for males and 10–38.7 mg/dl for females; and uric acid 2.7–6.9 mg/dl for males and 2.1–5.9 mg/dl for females. Conclusion This study has established RIs for routine clinical chemistry parameters. These RIs are important as they support the interpretation of clinical laboratory results for medical decision making and other health-related activities.

Male and undernourished children were at high risk of anemia in Ethiopia: a systematic review and meta-analysis

BackgroundAnemia is one of the global public health problems affecting more than one-third of the world population. It has been strongly associated with limited psychomotor development; and poor growth and performance in cognitive, social, and emotional function in children. Despite published data revealed that anemia is a public health problem among children in Ethiopia, there is no a pooled national estimate on the prevalence and associated risk factors of anemia.MethodsPublished articles until December 31, 2017, were searched using comprehensive search strings through PubMed/Medline, EMBASE, SCOPUS, HINARI, Web of Science, Google Scholar and Google. Reference probing of published articles and hand searching were employed for grey literature. Two groups of review authors independently appraised the studies for eligibility and extracted the data. The quality of articles was assessed using Joana Brigg’s institute critical appraisal checklist for prevalence and analytical studies. The pooled estimates were determined using random effect model. Heterogeneity between the included studies was assessed using the I2 statistics. Subgroup analysis was employed in the evidence of heterogeneity. Publication bias was assessed by visual inspection of the funnel plot and Egger’s regression test statistic.ResultsOf the total 871 articles retrieved, 34 articles which involved 61,748 children were eligible for meta-analysis. The overall pooled prevalence of anemia using random effect model was 31.14% (95% CI: 24.62, 37.66%). In subgroup analysis, the pooled prevalence of anemia was higher among preschool-aged children (44.17%; 95% CI: 37.19, 51.15%) than school-aged children (22.19%; 95% CI: 17.54, 26.83%). Furthermore, the odds of anemia was higher among children who were male (OR = 1.11; 95% CI: 1.03, 1.19), stunted (OR = 1.95; 95% CI: 1.52, 2.51), and wasted (OR = 2.05; 95% CI: 1.36, 3.10).ConclusionThe pooled prevalence of anemia among children was high, indicating that it had been continuing to be a public health problem. Therefore, there is a need to design a comprehensive prevention and control strategies to reduce its burden.