Occult Hepatitis B virus infection among HIV negative and positive isolated anti-HBc individuals in eastern Ethiopia

The absence of hepatitis B surface antigen (HBsAg) and the presence of antibody to hepatitis B core antigen (anti-HBc) in the blood of apparently healthy individuals may not indicate the absence of circulating hepatitis B virus (HBV) and might be infectious. Despite the risk of HBV transmission, there has been no report from Ethiopia examining this issue; therefore, this study determined occult HBV infection (OBI) among isolated anti-HBc (IAHBc) HIV negative and HIV positive individuals on ART in eastern Ethiopia. A total of 306 IAHBc individuals were included in this study. DNA was extracted, amplified, and detected from plasma using a commercially available RealTime PCR platform (Abbott m2000rt) following the manufacturer's instructions. Data were entered into EPI Data version 3.1, cleaned, and analyzed using Stata version 13. Descriptive analysis was used to calculate prevalence, summarize sociodemographic data and other factors. From the 306 IAHBc individuals (184 HIV positive and 122 HIV negative) included in the study, 183 (59.8%) were female of which 142 (77.6%) were within the reproductive age group. DNA extraction, amplified and detection was conducted in 224 individuals. The overall OBI prevalence was 5.8% (5.6% in HIV negative and 6% in HIV positive) among the IAHBc individuals. The HBV DNA concentration among the occult hepatitis B individuals was < 200 IU/mL, indicating a true occult. This study reported the burden of OBI, which pauses a significant public health problem due to the high burden of HBV infection in the country. OBI may cause substantial risk of HBV transmission from blood transfusion, organ transplantation as well as vertical transmission as screening is solely dependent on HBsAg testing.

Retinopathy in patients of Tikur Anbessa Hospital diabetic clinic

A total of 302 diabetic patients were selected from regular attendants of the Tikur Anbessa Hospital (TAH) diabetic clinic to determine the prevalence of retinopathy from December 1994 to March 1995. The mean age was 41.4 +/- 14.4 years (range 14-85). There were 160 males (53%) and 142 females (47%). One hundred forty (46%) were type 1 and 162 (53.6%) were type 2. The mean duration of diabetes was 9.4 +/- 5.4 years and the mean Hemoglobin Alc (HbAlc) was 10.4 + 2.2%. On the day of the examination the mean fasting blood glucose (FBG) and random blood glucose (RBG) were 195.5 +/- 79.9 mg/dl and 273.1 +/- 114.5 mg/dl respectively. The mean serum total cholesterol, triglycerides, LDL, VLDL and GDL were 166.5 +/- 45.5 mg/dl, 129.9 +/- 92.4 mg/dl, 94.5 +/- 36.4 mg/dl, 24.4 +/- 15.1 mg/dl and 44.3 +/- 11.5 mg/dl respectively. The overall prevalence of retinopathy was 37.8% out of which 108 patients (36.1%) had background retinopathy and 5 patients (1.7%) had proliferative retinopathy. The retina could not be visualized in three patients because of dense cataract. Retinopathy correlated positively with age, duration of diabetes and blood pressure respectively, however no significant correlation was seen with mean total HgAlc and serum lipids. Prevalence of retinopathy was comparable in type 1 and type 2 (p > 0.05). The prevalence of retinopathy in our patients relative to the duration of diabetes mellitus is high. Therefore, improving facilities for the diagnosis and treatment of retinopathy is recommended.

Graves' thyroid ophthalmopathy in Ethiopian patients

In a prospective study, we evaluated the clinical manifestations, severity, complication and management of Graves' thyroid ophthalmopathy (GTO) in 37 Ethiopian patients. Twenty-seven were females and 10 were males (F:M = 2.7:1). The mean age was 35 years (range 19-70 yrs). The mean duration of ocular symptoms was 33.4 months (range 2-120 months) while the mean duration of hyperthyroid symptoms was 36.2 months (range 6-120 months). GTO was found in 30 (81.1%) hyperthyroid, 1 (2.7%) hypothyroid and 5 (13.5%) euthyroid patients. Upper lid retraction was the most common clinical finding, being detected in 31 (83.8%) of the patients. One (2.7%) patient had marked extraocular muscle involvement, involving the inferior rectus muscle of one eye. Though 18 (48.6) patients had signs of soft tissue inflammation, only 4 (10.8%) required the administration of systemic steroids to control the inflammatory process. None of our patients had sight loss from the complications of GTO. Larger prospective studies are suggested to evaluate both the prevalence and possible racial difference in its clinical presentation.

Prevalence of gestational diabetes mellitus in rural pregnant mothers in northern Ethiopia

In a community based survey of gestational diabetes in 18 rural villages of the eastern zone of Tigray administrative region, northern Ethiopia, a total of 890 pregnant women with gestational age of 24 weeks and above were examined for gestational diabetes mellitus based on WHO criteria. A 75 gm oral glucose tolerance test was performed on each subject with measurement of glucose at 0 and 2 h. Blood glucose was determined by glucose oxidase method using capillary blood (Accutrend alpha, Boehringer Mannheim). The mean age of the mothers was 27.4 +/- 7.1 years. Forty four percent of the subjects were multiparas. The prevalence rate of gestational diabetes mellitus was found to be 3.7% (95% CI 2.5-4.9). The mean blood glucose 2 h after glucose load in those pregnant diagnosed to have gestational diabetes mellitus was 154.6 +/- 14.4 mg/dl (J.W. Rich-Edwards, G.A. Colditz, M.J. Stampfer, W.C. Willett, M.W. Gillman, C. Hennekens, F.E. Speizer, J.E. Manson, Birth weight and the risk for type 2 diabetes mellitus in adult women, Annu. Intern. Med. 130 (1999) 278-284). The prevalence of gestational diabetes mellitus in this region of the country is high as compared to other parts of Africa. The possible role and contribution of exposure of the general population in this area to chronic malnutrition as a result of prolonged famine, drought and war, to the high prevalence of gestational diabetes mellitus warrants further study.

Profile of coronary artery risk factors in Ethiopian diabetic patients

OBJECTIVES

To assess the coronary artery risk factors in Ethiopian diabetic patients.

DESIGN

A cross sectional study done on a representative sample of diabetic patients to evaluate the coronary risk factors.

SETTING

Hospital-based study.

SUBJECTS

A total of 302 diabetic patients randomly selected from the 3000 regularly attending diabetic patients in the Tikur Anbessa Hospital Diabetes Centre of whom 161(53.3%) were males, 141(46.7%) were females, 140(46.4%) were Type 1 and 162(53.6%) were Type 2.

OUTCOME MEASURES

Assessment of the coronary risk factors in diabetic patients.

RESULTS

There were 20(6.6%) smokers and no ex-smokers. All smokers were males of whom five (25%) were Type 1 and 15(75%) were Type 2. Hypertension and obesity were found in 64(21.2%) and 69(22.8%) patients respectively. Sixty one (20.2%) patients and 43(14.2%) patients had hypercholesterolaemia and hypertriglyceridaemia respectively.

CONCLUSION

Our diabetic patients share the risk factors for developing coronary artery disease like any other diabetic patient in the developed countries but at a lower level.

Impotence in Ethiopian diabetic men

Prevalence of impotence was assessed among 292 consecutive diabetic men attending the Tikur Anbessa Hospital, diabetic clinic. The mean age was 41.4 +/- 15.5 years (range 18-86 years). One hundred and forty nine (51.6%) were type I and 143 (49%) were type II patients. The mean duration of diabetes was 9.9 +/- 6.7 years and 37.7% had known long term diabetic complications. The overall prevalence of impotence was 48.7%. The mean duration of impotence was 3.5 +/- 3.4 years. In the majority of the cases, impotence started after diagnosis of diabetes mellitus. Many of the patients (79.1%) had never complained to physicians and 59.2% of the patients did not know that impotence is a complication of diabetes mellitus. All except 10 patients (7.5%) had libido. Impotence is significantly higher in type II as compared to type I patients (94/143 versus 40/132, p < 0.001) and in patients with complications than without (76/104 versus 54/159, p < 0.001). The mean duration of diabetes mellitus is significantly higher in patients with impotence than without impotence (12.3 years versus 8.1 years, p < 0.001). We conclude that impotence is a common and significant problem in our diabetic men and we recommend further study to assess its social and psychiatric impact.

Pleural empyema due to Salmonella paratyphi in a patient with AIDS

Pleural empyema due to Salmonella has rarely been reported in immunocompromised patients. Here, we present a case of a 25-year old man infected with the human immunodeficiency virus type-1 (HIV-1) who presented with a left-sided pleural effusion. The cause was confirmed bacteriologically to be due to Salmonella paratyphi. The outcome was favourable after antibiotic therapy coupled with pleural drainage. It should be recognised that pleural empyema due to Salmonella may occur in HIV-infected subjects and we suggest that patients presenting with pleural empyema due to uncommon pathogens be tested for HIV-1 antibodies.

Systematic inspection of insulin injection sites for local complications related to incorrect injection technique

We systematically inspected insulin injection sites in 100 insulin-requiring patients attending the Diabetic Clinic of the Tikur Anbassa Hospital (TAH) in order to identify local complications related to incorrect injection technique: local complications were found in 53 cases: skin hyperpigmentation and/or indurations in 30 patients; and fat atrophy or hypertrophy in 31 patients. Illiteracy was significantly more common among those with local complications (18/53 versus 6/47, chi 2 5.03, P < 0.05). Mean fasting blood glucose on the day of the inspection was significantly higher (14.9 + 6.3 mmol/l versus 10.5 + 6.1 mmol/l, P < 0.001) and a fasting blood glucose > 10 mmol/l more common (41/53 versus 20/47, chi 2 14.1, P < 0.0005) in those with than in those without local complications. There was no significant difference between the two groups in mean duration of diabetes (6.9 + 5.6 years versus 6.6 + 5.8 years), frequency of hypoglycaemic episodes (12/53 versus 5/47, chi 2 1.76, P > 0.05) or mean daily insulin dose (44 + 18 units versus 44 + 22 units per day). Therefore, we concluded that local complications resulting from incorrect injection technique, a common finding in the group of patients studied, may be common among insulin requiring diabetic patients in general. Incorrect insulin injection causes local complications and disfigurement which may compromise compliance. Furthermore, insulin absorption tends to be erratic from intradermal and fat hypertrophy sites thus interfering with effective diabetic control. Insulin injection sites should be inspected routinely to detect and correct family technique promptly.

Bronchial asthma in Jima: a prospective analysis of 204 patients

Two hundred and four (204) consecutive adult asthmatic patients who visited the outpatient clinic of Jima Institute of Medical Sciences from May 1 to August 30, 1989 were prospectively studied. Data on age, sex, ethnic distribution and the associated etiological factors were documented. The age range was from 17-75 (mean 33.4) years and the male to female ratio was 1.4:1. The majority (80%) were not members of the ethnic group indigenous to the area. Of the total, 175 (85%) were not natives of Jima town and its surroundings. One hundred and fifty (85.7%) of the latter developed the disease in Jima. Ninety-six (64%) of the 150 patients contracted the disease in less than 5 years of their stay in the area. Infections, emotional stress, dust, and weather changes were the main precipitating factors. The majority of the attacks occurred from June to October. Allergic rhinitis was present in 88% of the patients and atopic dermatitis in 3%. Forty-one (20%) patients had a family history of asthma. Forty-eight percent of the patients claimed that change of climate relieved their symptoms. Eosinophilia was documented in 51.5% and parasitic infestations were observed in 39% of patients. The study shows that a variety of environmental factors such as pollen dust, fungus and climatic changes play a major role and may account for the high performance of asthma in Jima town. It is recommended that further studies be conducted to find out the causative factors so that appropriate preventive measures can be implemented.

The pattern of tuberculosis in Addis Ababa, Ethiopia

Two hundred and forty available charts of medical patients treated for tuberculosis at Tikur Anbessa Hospital in Addis Ababa, Ethiopia over 2 years (9/83-9/85 were studied. TB was diagnosed in 11.2% of medical admissions. The average age of TB patients was 30.5; 58% were males; 53% were classed as poor. TB patients were poorer than other medical patients and averaged 38.9 days in hospital, non-TB patients averaged 31.9 days. Pulmonary disease was most common (47% of total), followed by spondylitis (12.1%), peritonitis (11.5%), and disseminated disease (11.1%). There were no cases of renal or cutaneous disease. 6% of admissions were diabetic, 16.4% had defaulted from previous TB treatment. Only 45% of patients had the diagnosis proven by histology or bacteriology. Pleural biopsy, lymph node biopsy, peritoneal biopsy, and sputum AFB stain were the most useful procedures in proving the diagnosis. A variety of drugs were given, 53% received INH-EMB-SM, 26% INH-SM-Thiacetazone; 32% received no form of vitamin supplements. The overall death rate was 8%, including 9% of pulmonary cases and 22% of patients with disseminated disease. Comparison is made with Ethiopian and other African data. It is suggested that patients receive definitive diagnostic tests earlier, along with earlier therapy and more consistent use of pyridoxine.