Vol 59, No 03 (2021): July 2021 Issue

Introduction: Rheumatoid arthritis is the most common inflammatory rheumatic disease in adults and chronic autoimmune disease with a prevalence of 0.5% in the world. It is four times more frequent in women than in men. The aim of this study was to determine the clinical, para-clinical, and therapeutic parameters of patients with rheumatoid arthritis in Western Algerian region (Sidi bel Abbes area in particular).

Methods: We carried out a retrospective study based on medical records over 300 patients with RA diagnosed between 2015-2019 in the internal medicine department and functional rehabilitation department of the University Hospital of Sidi Bel Abbes. All data were processed and analyzed via SPSS 22.0 (Statistical Package for the Social Sciences, IBM Corporation; Chicago, IL. August 2013).

Results: out of all the enrolled participants in our study, 85.7 % were females and 14.3% were males, the mean age of diagnosis was 52,717±12,2273, ranging from 14 to 84 years old. The average time of disease duration was 4,173±3,9381 years. 53.7% of  the subjects had moderate activity, and 45% were menopausal. The main medical histories were high blood pressure (41%) type 2 diabetes  (84.7%), hypothyroiditis  (06%) and osteoporosis (4.7%).  81.3% of patients were seropositive and 46.51% of smokers had a highly seropositive ACPA(Anti Citrullinated Peptides Antibodies) (p=0.002).Most patients used DAMRDS (Disease Modifying Anti-Rheumatic Drug) as treatment.

Conclusion: Our study has shown that relatively older adults are commonly affected; majority presented in moderate stage of the disease and more than the half of our patients were seropositive.

Background: Paediatrics Emergency ward is one of the critical wards in hospitals Overcrowding and urgent nature of the patients makes Emergency rooms a particularly challenging area.   Therefore, fast and accurate diagnosis is very crucial & mandatory for a proper patient management. So, Paediatrics residents, working in paediatric ER(emergency room) are required to preliminarily interpret imaging for management. This study assessed the skill level of paediatrics residents in interpreting emergency X-rays &identified some factors associated with their interpretations.

Methods: A Cross sectional study was conducted among paediatric residents in TikurAnbesa Specialized Hospital (TASH). Ten X-rays (7 CXRs, 2 abdominal and one extremity X-ray) were selected based on the most commonly seen emergency cases residents are expected to diagnose. The x-rays were displayed in Power Point and residents asked to complete a questionnaire. A consultant radiologist also interpreted the images in the same setting. The data was then analysed by using SPSS 25.0.

Results: A total of 79 paediatrics residents were enrolled in this study. Only 32 (40.5 %)of the residents had a good skill level of interpretation with 73% accuracy rate which was very low. The overall discrepancy rate was 49.6%.The sensitivity of the residents in detecting abnormal radiographs was 72 (91.1 %) with specificity of 34 (43 %). Significant association was found with year of residency and confidence level with (P- 0.020 and P-0.044) respectively.

Conclusions: Skills of residents in interpreting radiographs were very low regardless of the prevalence of the condition in the Emergency.

Background and aims: The highest burden of human immunodeficiency virus (HIV) infection occurs in sub-Saharan Africa. Yet descriptions of oncologic disorders among children living with HIV in the region is scant. The objectives of this study were to evaluate the prevalence of Acquired immunodeficiency syndrome (AIDS) defining and non-AIDS defining malignancies among children and adolescents living with HIV and under care at a tertiary Hospital in Addis Ababa, Ethiopia.

Methods: A facility based cross-sectional study was conducted from 1^st May – 30^th September, 2019. There were 323 children and adolescents eligible for the study with their follow-up period spanning from 2000 – 2018. Data was collected using a structured and pre-tested questionnaire and analyzed by SPSS version 25.0 software. Bivariate and multivariate analyses were conducted with 95% confidence interval and P-value < 0.05.

Results: The prevalence of all types of malignancies in the study population during their follow-up period was 3.4%: AIDS defining (1.55%) and non AIDS defining malignancies (1.85%). Non-Hodgkin’s Lymphoma from the AIDS defining and Hodgkin’s lymphoma among the non AIDS defining malignancies were the commonest diagnoses. Five of eleven patients achieved cure. Advanced HIV infection correlated significantly with a diagnosis of a malignancy (AOR: 7; 95% CI: 1.5, 34).

Conclusions: The prevalence of oncologic disorders in a pediatric cohort living with HIV is described. Advanced infection was associated with the development of a malignancy. Early diagnosis and timely initiation of anti-retroviral treatment can help prevent the development of cancers in children and adolescents living with HIV.

Abstract

Background: COVID-19 is a major global threat. The only significant way to impact its magnitude is by applying preventative measures such as proper physical distancing, hand hygiene and respiratory hygiene practices.

Objective: To assess the status of measures to prevent COVID-19 transmission by patients, attendants and health care workers at the gates of Tikur Anbessa Specialized Hospital.

Methods: An institutional based cross-sectional study was conducted on all patients, attendants, health care workers and support staff entering the premises of Tikur Anbessa Specialized Hospital between 7:45 to 9:30 am via three gates from June 22 to August 30, 2020. A systematic random sampling method was employed to select 20 participants from each gate to observe twice weekly the status of individual behavior on hand and respiratory hygiene and physical distancing.

Results: Overall, 1000 individuals were involved in the study. From this 568 (56.8%) were men. The majority 79.6 (79.6%) were in the age group of 18 to 50. Altogether, the practices of proper hand hygiene, proper physical distancing and proper utilization face mask were 10.7%, 77.3% and 86.9%, respectively, over the period of 10 weeks.

Conclusion: There was an overall good practice of social distancing and mask usage. On the contrary, hand hygiene practice was remarkably low. Enforcement issues and shortage of infrastructures were key challenges observed in this study

Abstract

Purpose

Over-expression of Bcl-2 and EGFR is seen in many malignancies. Since few studies have studied these biomarkers in bladder tumors, the aim of this study is to evaluate expression of Bcl-2 and EGFR biomarkers in benign and malignant tumors of urothelial carcinoma of bladder.

Methods

This case control study was conducted on 57 bladder tumors (40 malignant tumors and 17 benign tumors) in Shahid Rahnemoun hospital, Yazd, Iran during 2016-2018. Immunohistochemistry method was used for assessment of EGFR and bcl-2 expression in tissue tumors.

Results

Frequency distribution of patients in terms of EGFR showed that among 57 tumors, 10 tumors (17.4%) were EGFR positive. Moreover, among them, 25 tumors were bcl-2 positive (44%). There was no significant difference between benign and malignant tumors in terms of EGFR (p=0.830) and bcl-2 expression (p=0.094). The mean EGFR in low and high grade was 4.13± 13.22 and 7.69± 26.26, respectively (p= 0.91).The mean bcl-2 in low and high grade was 3.72± 12.81 and 13.31±26.14, respectively (p=0.51). Moreover, significant difference was seen between two groups (benign and malignant group), regarding age and tumor size (p>0.05).

Conclusion

According to results of current study, no significant difference was seen between benign and malignant tumors in terms of EGFR and bcl-2 expression. Moreover, no relation was seen between EGFR and Bcl2 expression and grade. Therefore, expression of these biomarkers didn't affect on progression of the tumor and clinical outcomes. In addition, malignant or benign tumor was affected by factors including age and tumor size.

Background: Stunting is widely used to assess nutritional status of children. Neonates with fetal growth restriction are at substantially increased risk of being stunted at 24 months and of development of non-communicable diseases in adulthood. Under-nutrition during the first 1000 days post conception causes an important wasting of human potentials.

Objectives: To determine the prevalence and associated risk factors for newborn stunting.

Methods: A cross-sectional study was conducted on newborns at Tikur Anbessa Hospital from July - August 2018. Exposures were Socio-demographic and behavioral maternal risk factors, maternal medical illness during pregnancy. Main outcomes were newborn stunting defined as birth length for sex and gestational age below 3^rd centiles of the INTERGROWTH-21^st standard and neonatal admission to neonatal intensive care unit.

Results: There were a total of 392 singleton newborns included in the study. Stunting affected 15.1% of all newborns. In bivariate analysis maternal socio-economic, and obstetric variables were not found as risk factors for stunting in newborns, except use of biofuel for cooking (p< 0.049 95% CI 0.586, 1.956) and parity (p< 0.011, 95% CI 1.181, 3.837). Among fetal factors birth weight and birth weight for gestational age were significant factors. On multiple regression analysis only significant determinant of stunting among neonates at birth.

Conclusions: Prevalence of newborn stunting is high in our setting. Further study is recommended to determine the risk factors for stunting at birth with a larger sample size.  Appropriate intervention should be put in place to mitigate the high prevalence of stunting in newborns.

Background: Epilepsy is considered to be present when 2 or more unprovoked seizures occur in a time frame of longer than 24 hr. Public awareness and attitudes towards epilepsy differ across cultures. It has been noted that traditional beliefs and lack of knowledge strongly influence attitudes towards epilepsy. Epilepsy remains a stigmatized disease especially in Sub-Saharan Africa.

Objectives: To assess knowledge, attitude and practices of Parents and Guardians of children with epilepsy attending follow up at pediatric neurology clinic in Tikur Anbessa Specialized Hospital.

Methods: Hospital based cross-sectional descriptive study was conducted among 186 parents and guardians of children with epilepsy attending pediatrics neurology clinic from September 1 to October 30, 2018.

Results: More than 60% of the parents/guardians had some knowledge on epilepsy and the type of antiepileptic drug treatment their children were receiving. Fifty-eight percent of the parents/guardians administered some recommended first aid measures to their epileptic children during a fit, but many of them combined these with potentially harmful first aid measures. Spiritual healing and to a lesser extent traditional medicine were perceived to be important components of therapy for epilepsy when used in conjunction with hospital treatment. An increased level of education of the parents/guardians had a positive influence on their knowledge, attitudes and practices towards epilepsy.

Conclusions: Some epilepsy-related issues still require improvement in parental knowledge. Ensuring education and support at community and school levels for both parents and children with epilepsy should be the principal goal of health-care service.

Key words: Epilepsy, children, Ethiopia

Introduction: Transferring of adolescents living with HIV from pediatric care to adult care, is beyond changing the location of the services. The transition process will greatly affect the success of treatment for individual patients. The aim of this study was to assess the clinical outcomes of adolescents who were transferred to adult care.

Methods: Facility-based retrospective cohort study based on a review of the clinical records of adolescents who were transferred from pediatric clinic to adult clinic from January 2016 to 31 December 2017 in Tikur Anbessa Specialized Hospital. Data was extracted from paper-based and electronic medical records using a structured data abstraction tool. Data were analyzed using SPSS version 24.

Result: Out of the 151 patients, 18 (11.9%) of them were lost to follow up after one year of transfer to adult care. There was one death, which occurred three months after the transfer. At the time of transfer, 11(7.5%) of adolescents had poor adherence, and after six months of the transfer, this number has increased to 52(34.4%). The number of adolescents with CD4 count < 200 cells/?l has increased from 2.7% (at time of transfer) to 13.2%( six months of transfer).

Conclusion: Although the majority (87.4%) of adolescents remained engaged in their follow-up after transfer to adult care, there is a major gap in adherence, and these also reflected by a subsequent increment of patients who have a CD4 count less than 200 cells/?l. This suggests that more should be done to ease the transition process of adolescents.