Vol 61, No 1 (2023): JANUARY 2023 VOLUME 61 NUMBER 1

Introduction: Pulmonary embolism is one of the complications of COVID-19, with reported incidence ranging from 3 to 33 % in non-ICU patients to as high as 40% among ICU patients. Since the clinical presentations of COVID-19 and Pulmonary embolism overlap, it is difficult to differentiate between these cases. This study aimed to assess the incidence of pulmonary embolism and associated factors among confirmed Covid-19 Patients in Ethiopia.

Methods: A nested case control study was conducted among 131 patients with COVID-19 (40 COVID-19 patients with Pulmonary embolism and 91 COVID-19 patients with no PE) who were on follow up from May, 2021 to May, 2022. Data was summarized using frequencies with percentages. A chi-square test/ Fisher's exact test was run to determine the presence of a significant difference between the exposure variables and the development of PE. To identify factors associated with the development of Pulmonary embolism, a multivariable Binary Logistic Regression model with sensitivity analysis was run.

Results: The incidence of PE was 30.5% (95% CI, 22.9% - 37.4%) in the cohort of patients for whom upfront CTPA was performed. The Chi-square/ Fisher's exact test results showed a significantly higher proportion of patients with PE tend to present with shortness of breath, chest pain and anosmia/ageusia than those with no PE. However, in a subsequent regression analysis, only chest pain was found to be significantly associated with the development of PE in COVID-19 patients (AOR= 3.24, 95% CI= 1.10, 9.54, p-value=0.033).

Conclusion: The incidence of PE among COVID-19 patients was found to be relatively lower than reports from other countries. Having chest pain was found to be a significant factor that indicates the development of PE, implying that in a setting where performing upfront CTPA is not practical, detailed symptom inquiry could serve as an important clinical criteria.

Background: Reconstruction of scar excision defects with expanded flaps is a veritable option in reconstruction but unaffordable to patients in resource-poor settings. The recycling of the expanders is avoided for fear of infection. The study presents our preliminary experience with recycled tissue expanders in a resource-constrained setting.

Patients/Methods: This is a retrospective study of all patients who had tissue expansion using recycled expanders. The expanders were sterilized by boiling intermittently in sterile water over 12 hours and washed with ceftriazone just before surgery.

Results: A total of 14 expanders were used in all female patients with mean age of 25 years. About 71% of cases had successful expansion while 29% had implant extrusion of which only 7% was severe and had termination of expansion.

Conclusion: The success with recycled tissue expanders presents an opportunity to offer a reconstructive care to resource-constrained patients and improve the volume of patients undergoing expansion.

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Background: Urinary Tract Infections (UTIs) are the most common bacterial infections. The objective of the study was to assess UTI prevalence, common bacterial pathogens responsible for UTI, and the drug susceptibility pattern of bacteria towards commonly used drugs for UTI treatment among war-disabled patients admitted to Denden Military Hospital, Asmara, Eritrea.

Methods: A prospective cross-sectional study was conducted among 236 war veterans who were disabled during the war and took treatment at Denden Military Hospital.Midstream urine samples were collected in culture bottles. All collected urine samples were then cultured on different bacteria culture media. Biochemical tests were performed on posi­tive urine cultures based on significant bacteriuria as per the Kass count (>10⁵ organisms/mL). Antimicrobial susceptibility tests were performed to analyze the resistance/ susceptibility pattern. Statistical Package for Social Services, version 20.1 was used for data entry and analysis.

Results: The overall prevalence of UTI was 81.7% (193/236). The common isolates were Escherichia coli (E.coli) 73(36.8%) followed by Staphylococcus aureus (S. aureus)38(19.1%). Usage of catheters with culture positivity was 22 (95.6%), 58 (95%), and 38(90.4%) for suprapubic, Condom, and Urethral Catheters, respectively. The antibiogram showed 62(84.9%) isolates of E.coli were resistant to Nitrofurantoin, while Staphylococcus aureus was found resistant to Tetracycline 25 (65.7%).

Conclusion: The results showed that most of the disabled patients included in the study were infected with UTI, and the most common pathogen isolated was E. coli followed by S. aureus.  Based on the antimicrobial susceptibility test, the drug of choice for Gram-negative bacteria can be Amikacin, Gentamycin, and Cefalexin. While for Gram-positive bacteria it can be Ampicillin.

Introduction: There are several risk factors being used to identify undiagnosed HIV-infected adults. As the number of undiagnosed people gets less and less, it is important to know if existing risk factors and risk assessment tools are valid for use.

Methods:  Data from the Tanzania and Zambia Population-Based HIV Impact Assessment (PHIA) household surveys which were conducted during 2016 was used. We first included 12 risk factors (being divorced, separated or widowed; having an HIV+ spouse; having one of the following within 12-months of the survey: paid work, slept away from home for ≥1-month, having multiple sexual partners, clients of sex workers, sexually transmitted infection, being tuberculosis suspect, being very sick for ≥3-months; ever sold sex; diagnosed with cervical cancer; and had TB disease into a risk assessment tool and assessed its validity by comparing it against HIV test result. Sensitivity, specificity and predictive value of the tool were assessed. Receiver Operating Characteristic (ROC) curve comparison statistics was also used to determine which risk assessment tool was better.

Results: HIV prevalence was 2.3% (2.0%-2.6%) (n=14,820). For the tool containing all risk factors, HIV prevalence was 1.0% when none of the risk factors were present (Score 0) compared to 3.2% when at least one factor (Score ≥1) was present and 8.0% when ≥4 risk factors were present. Sensitivity, specificity, PPV, and NPV were 82.3% (78.6%-85.9%), 41.9%(41.1%-42.7%), 3.2%(2.8%-3.6%), and 99.0%(98.8%-99.3%), respectively. The use of a tool containing conventional risk factors (all except those related with working and sleeping away) was found to have higher AUC (0.65 vs 0.61) compared to the use of all risk factors (p value <0.001).

Conclusions: The use of a screening tool containing conventional risk factors improved HIV testing yield compared to doing universal testing. Prioritizing people who fulfill multiple risk factors should be explored further to improve HIV testing yield.

Introduction: Dialysis still remains the most common modality for the treatment of end stage kidney disease and it could be maneuvered to augment its dose, minimize complications and improve outcome. Dialysis prescription is a brief of how dialysis is to be given and involves adjustments in patients’ characteristics, disease or dialytic procedure. This study aimed to assess the determinants of the prescribed dialysis and its relationship with intradialytic complications and the dialysis dose.

Methods: A prospective study in which 1248 sessions for 232 consented participants with end stage kidney disease on maintenance hemodialysis were studied from 2017-2020. Biodata was taken, participants were examined and blood samples were taken to determine electrolytes, urea/creatinine and hematocrit. Pearson’s correlation was used to determine the strength of association between dialysis dose and some variables.

Results: Determinants of the prescribed dose were dialysis frequency (P<0.001), and predialysis systolic blood pressure (P<0.001) and packed cell volume (P<0.001). Dialysis sessions without significant intradialytic blood pressure changes were most likely to be completed, as sessions with intra-dialysis hypotension were most likely to be terminated. Participants dialyzed with high flux dialyzers, via an arterovenous fistula, higher blood flow and ultrafiltration rates had higher dialysis doses (P<0.001 in all instances).

Conclusion:  Higher dialysis doses were achieved with higher blood flow and ultrafiltration rates. Intradialytic hypotension was common with dialysis termination, higher blood flow and ultrafiltration rates. Intradialytic hypertension was common with low flux dialyzers. An optimized dialysis prescription is needed to deliver an adequate dialysis dose and minimize complications.

Background: Understanding the COVID-19 disease course in terms of viral shedding is important to assist in providing a tailored isolation and treatment practice. Therefore, the current study aimed to estimate time to viral clearance and identify determinants among SARS-CoV-2 infected individuals admitted to Millennium COVID-19 Care Center in Ethiopia.

Methods:  A Prospective observational study was conducted among 360 randomly selected SARS-CoV-2 infected individuals who were on follow up from 2nd June to 5th July 2020. Kaplan Meier plots, median survival times, and Log-rank test were used to describe the data and compare survival distribution between groups.  Association between time to viral clearance and determinants was assessed using the Cox proportional hazard survival model, where hazard ratio, P-value, and 95% CI for hazard ratio were used for testing significance

Results: The Median time to viral clearance was 16 days. The log-rank test shows that having moderate and severe disease, one or more symptoms at presentation, and presenting with respiratory and constitutional symptoms seems to extend the time needed to achieve viral clearance. The Final Cox regression result shows that the rate of achieving viral clearance among symptomatic patients was 44% lower than patients who were asymptomatic (AHR=0.560, 95% CI=0.322-0.975, p-value=0.040).

Conclusions: Presence of symptoms was found to be associated with delayed viral clearance implying that symptomatic patients are more likely to be infectious and therefore, attention should be paid to the practices regarding isolation and treatment of COVID-19 patients.

Introduction: A cluster of pneumonia cases of unknown origin was first reported in Wuhan China then the causative pathogen was identified and named severe acute respiratory syndrome coronavirus 2  (SARS-Cov2) and the associated disease was named coronavirus disease 2019 (COVID-19). Chest radiograph has lower sensitivity for the detection of lung abnormalities but it has a role in disease progression and also in the late stages of COVID-19. This study aims to evaluate the value of baseline radiographs in COVID-19-infected patients.

Method: This is a retrospective study of COVID-19 patients with RT-PCR confirmation who were admitted to Eka Kotebe General Hospital and had baseline chest x-ray between April and May 2020. Baseline chest x-ray of all patients who have confirmed COVID-19 infection was reviewed and analyzed.

Result: The study included 355 patients, 224 (63.1%) were male and 131 (36.9%) were female. Patient age ranged from 4 - 82 years with a mean age of 35. Two hundred twelve patients were symptomatic; the rest 143 were asymptomatic. Of the 355 baseline CXR, only 60 (16.9%) had abnormal radiographs and the rest 295 (83.1%) had normal radiographs. A combination of interstitial changes and GGO were the predominant descriptive finding accounting for 33.3% .

Conclusion: Even if chest radiographs are important in the workup of patients with COVID-19 infection, the use of baseline radiographs in COVID-19 infection should not be a routine practice. Disease severity and timing of imaging appear to impact the rates of normal baseline imaging.

Background: Chlorpromazine (CPZ), a typical anti-psychotic drug, has been associated with irreversible ocular toxicity signs which are dependent on total dosage and duration where exact values varied in different studies. In Ethiopia, there is no data on chlorpromazine induced ocular toxicity.The current study aimed to determine the prevalence of Chlorpromazine induced ocular toxicity. 

Method: All consecutive psychiatric patients taking Chlorpromazine at a dose of 100mg/d or more for more than one month were included. Then, socio-demographic data, daily dosage and duration of Chlorpromazine treatment were obtained from self-administered questionnaire as well as patients’ chart review. Visual acuity of each eye was taken using Snellen’s illiterate “E” chart at a distance of 6 meters. Examination was especially directed to the lids and conjunctiva for pigmentation. Complete slit lamp examination was done to look for anterior segment toxicity signs and direct ophthalmoscope for posterior segment findings.

Result: Out of the total 92 patients examined, 30 (32.6%) (95% CI: 22-41.8) had signs of ocular toxicity ie 8 with rosette pigments, 11 with anterior stellate cataract alone and 11 with concomitant anterior stellate cataract and corneal changes. The minimum cumulative total dose resulting in ocular toxicity was in the range between 500gm and 750gm taken more than 5 years. ALL patients having anterior stellate cataract with corneal changes had severe visual impairment.

Conclusion: Chlorpromazine is associated with lens and corneal toxicity at a minimum cumulative dose ranging between 500gm and 750gm taken more than 5 years. Patients with concomitant lens and corneal changes had severe visual impairment. Close and combined management of patients on Chlorpromazine between ophthalmologists and psychiatrists is recommended.

Introduction: Acute Bacterial meningitis is still a major cause of death in under-five children. Surveillance on Pediatric Bacterial Meningitis has been set up by the World Health Organization to generate data on vaccine preventable causes of Meningitis in under-five children. Ethiopia is one of the countries conducting the surveillance and Gondar University Hospital is one of the sentinel surveillance sites. In this study we described the epidemiological data on Bacterial meningitis in under-five children at Gondar University Hospital from 2012-2021.

Methods:  Data were extracted directly from Gondar University Hospital surveillance database collected from under-five children admitted to the Hospital with suspected meningitis from January 1^st, 2012 to December 31^st, 2021. Socio-demographic and clinical characteristics were collected using standard pretested questioners. All under-five children with suspected meningitis over the 10-years period were included and descriptive statistics like frequency, percentage, mean, median and standard deviations were used for the characteristics of under-five Children with Suspected Bacterial Meningitis.

Results: In this study, a total of 4311 under-five admitted with suspected bacterial meningitis from 2012 to 2021 were enrolled.  The majority, 71% of suspected meningitis were reported in infants. The mortality rate in suspected meningitis during the study period was 1%. The majority (92.4 %) had fever at presentation followed by seizure (62.7 %), altered consciousness (58.9 %) and bulged fontanel in 48.3 %, respectively. The commonest bacteria identified by CSF culture and Polymerase Chain Reaction was Streptococcus pneumonia (SPN). There was a reduction of confirmed meningitis cases from 2012 to 2021 (26 cases in 2012 and 6cases in 2021).

Conclusions:  Streptococcus pneumoniae was the commonest cause of PBM. Bacterial detection by culture was low which showed that Polymerase Chain Reaction (PCR) test should be encouraged to improve bacterial detection.