Seroprevalence of HBV and HCV Among Diabetes Mellitus Patients Attending University of Gondar Hospital, Northwest Ethiopia.

BACKGROUND: Hepatitis B and hepatitis C viruses are common infections and main causative agents of chronic liver diseases, cirrhosis, and hepatocellular carcinoma. The liver is the major site of hormone and glucose metabolism which have deep interconnection with diabetes. Hepatitis-B and hepatitis-C virus infection and diabetes are prevalent diseases worldwide associated with increased morbidity and mortality. High prevalence of DM, HCV, and HBV showed that there is a higher chance of coexisting in an individual. Therefore, our study tried to assess the coexistence of hepatitis viruses and diabetes mellitus among DM patients at the University of Gondar comprehensive specialized hospital. METHODS: The hospital-based, cross-sectional study was conducted from November 01 to December 30, 2019 to as-sess the prevalence and associated factors of HBV and HCV among diabetes patients attending at University of Gondar referral hospital. Sociodemographic data was collected using a semi-structured questionnaire. Four milliliters of blood were collected using an anticoagulant free test tube for measurement of biochemical parameters and detection of hepatitis viruses. HBsAg and anti-HCV antibody detection was performed using One Step Cassette Style HBsAg Rapid Test and EUGENE® anti-HCV rapid test, respectively. Binary and multivariable logistic regression models were used to evaluate associated risk factors for the outcome variable. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 288 diabetes patients were included in this study and the prevalence of HBV and HCV was 7 (2.43%) and 18 (6.25%), respectively. Hepatitis B virus showed similar prevalence for type 1 and type 2 diabetes at 2.6% and 2.3%, respectively, but HCV showed a wide variation with 17.5% and 4.3% prevalence, respectively, for both diabetes types. In a multivariable logistic regression model compared with younger age (≤ 24 years), older age ≥ 65 years (AOR: 19.545, 95% CI: 2.577 - 22.827) age groups and poor glycemic control (AOR: 18.84, 95% CI: 17.83 - 20.39) showed significant association with HBV. CONCLUSIONS: A considerably large number of diabetes patients tested positive for anti-HCV antibody as a marker of Hepatitis C virus infection. None of the variables showed significant association with active Hepatitis B virus infection whereas older ages (≥ 65 years) and diabetes patients with poor glycemic control showed significant association with anti-HCV antibody positivity.

Sero-epidemiology and associated factors of HIV, HBV, HCV and syphilis among blood donors in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Transfusion transmissible infections (TTIs) remain a major public health problem in developing countries including Ethiopia. In Ethiopia, comprehensive information about sero-epidemiology of major TTIs is lacking at the national level. Therefore, this systematic review and meta-analysis was aimed at providing the pooled estimate of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis among blood donors in Ethiopia. METHODS: Relevant studies published until May 31, 2019 were searched through PubMed/Medline, EMBASE, SCOPUS, HINARI, Cochrane database library, Web of Science, Google Scholar and Google. The methodological quality of articles was assessed using Joanna Brigg's Institute critical appraisal checklist for prevalence and analytical studies. The pooled sero-epidemiology of HIV, HBV, HCV and syphilis were determined using the random-effects model. Heterogeneity between the studies was assessed using the I2 statistics. Publication bias was assessed by visual inspection of the funnel plot and Egger's statistics. RESULTS: A total of 7921 articles were retrieved, and 7798 were screened for eligibility after duplicates removed. Forty-nine full-text articles were assessed for eligibility; of which 45 were eligible for qualitative and quantitative synthesis: categorized as 36, 34, 31 and 23 studies for estimations of HBV, HIV, HCV and syphilis, respectively. In the random-effects model, the pooled sero-epidemiology of HBV, HIV, HCV and syphilis was 5.20, 2.83, 0.93 and 1.50%, respectively. Moreover, being a male blood donor was significantly associated with HBV and syphilis infection, whereas being a replacement blood donor was significantly associated with a high burden of HIV, HBV and HCV infections. CONCLUSION: The pooled sero-epidemiology of major TTIs among blood donors was high. Therefore, there is a need to design prevention and control strategies in a comprehensive approach to reduce the burden.

Hematological Indices of Pregnant Women at the University of Gondar Referral Hospital, Northwest Ethiopia: a Comparative Cross-Sectional Study.

BACKGROUND: Pregnancy is a natural physiological variation as a result of hormonal and metabolic changes. Worldwide a large proportion of women are expected to die each year as a result of pregnancy complication related to hematological profile alterations. Therefore, this study is aimed at assessing hematological indices of pregnant in comparison with non-pregnant women. METHODS: A comparative cross-sectional study was conducted among pregnant and non-pregnant women at the University of Gondar Hospital, from February to April 2015. A blood sample was collected from 139 pregnant and 139 age-matched non-pregnant women using systematic random sampling technique. Data analysis was made using SPSS version 20. Level of significance was analyzed using independent t-test and Mann-Whitney U test. A p-value ≤ 0.05 was considered statistically significant. RESULTS: In this study, pregnant women had significantly higher WBC count [(7.08 ± 2.07 vs. 5.77 ± 1.85) x 109/L], MCV [(93.16 ± 3.44 vs. 90.74 ± 4.12) fL], MCHC [(30.40 ± 1.19 vs. 29.47 ± 1.46) pg], Neutrophil count [(4.73 ± 1.86 vs. 3.06 ± 1.47) x 109/L], Lymphocyte count [(1.65 ± 0.41 vs. 1.2 ± 0.54) x 109/L], RDW [(49.35 ± 2.9 vs. 46.37 ± 2.73) fL], PDW [(14.02 ± 0.6 vs. 13.12 ± 0.19) fL], and MPV [(10.49 ± 0.95 vs. 10.06 ± 1.18) fL] compared with controls. The RBC count [(4.55 ± 0.38 vs. 5.14 ± 0.53) x 1012/L], Hb [(13.73 ± 0.96 vs. 15.30 ± 1.074) g/dL], Hct [(42.14 ± 2.55 vs. 47.16 ± 3.36)%], and Platelets [(196.07 ± 48.88 vs. 249.36 ± 62.73) x 109/L] were significantly lower among pregnant women compared to the control group, respectively. This study also indicated that there was a significant difference in MCV, MCH, platelet count, absolute lymphocyte count and RDW across the three trimes-ters of pregnancy. CONCLUSIONS: This study found a statistically significant difference in the majority of hematological indices between pregnant and non-pregnant women. Trimesters of pregnancy have an influence on some hematological indices. This study provides baseline data for basic hematological indices changes, and it is vital especially in the antenatal care assessment to avoid pregnancy-related adverse outcomes.

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

OBJECTIVE: 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. METHOD: The study was conducted in Amhara State, Ethiopia with a total of 967 (55.2% males) participants. 56.9% of males and 43.1% of females were eligible for haematological and immunological RI determination. A non-parametric test was used for the determination of upper (97.5th percentile) and lower (2.5th percentile) reference interval limits with 95% CI. The Harris and Boyd Rule was used to determine the need of partitioning of reference intervals based on gender. RESULT: The established 95% reference intervals (2.5th-97.5th percentile) were: for WBC: 3-11.2 × 109 /l; for platelet: 90-399 × 109 /l; for RBC: 4-6 × 1012 /l for males and 3.5-5.6 × 1012 /l for females; for haemoglobin: (Hgb) 12-18.9 g/dl for males and 10.7-17.5 g/dl for females; for PCV: 35.7-55.3% for males and 32.2-50.1% for females; for CD4: 400-1430 × 109 /l for males and 466-1523 × 109 /l for females; for CD4 percentage: 18-49.1% for males and 21.3-52.9% for females; for MCV: 81-100 fl; for MCH: 25.3-34.6 pg; MCHC: 28.8-36.9%; for RDW: 11.6-15.4% and for MPV: 8-12.3 fl. Males had significantly higher RBC, Hgb and PCV than females. CD4 counts and CD4 percentage were significantly higher in females. CONCLUSION: The reference intervals established in this study differ from others and thus should be used for the interpretation of laboratory results in diagnosis and safety monitoring in clinical trials in Amhara.

Clinical Laboratory Reference Intervals in Ethiopia: Current Status and Future Considerations: Review.

Background: Clinical laboratory reference intervals are derived from a sample of selected healthy population and they are used for disease diagnosis, management, and monitoring. International guidelines recommended that laboratories and manufacturers are supposed to establish their own RIs for a certain group of population. Therefore, the aim of this narrative review is to summarize the current status and to show future directions regarding reference intervals of clinical laboratory parameters among Ethiopian population. Methods: PubMed, Google Scholar, and Google databases were searched to access relevant reference interval studies in Ethiopia. Journal articles, guidelines, reports, and related documents published in English language were included without publication period restriction. Results: Fifteen studies were conducted to establish local reference intervals for hematology, immunology, and clinical chemistry parameters in Ethiopia from 1999 - 2018. The majority of those studies determined clinical laboratory reference intervals for adults only. Some other Ethiopian reference interval studies did not include the majority of routine hematology and clinical chemistry parameters. In addition, the studies we reviewed did not consider the cultural, ethnic, demographic, and geographical diversity of Ethiopian population. Conclusions: There is limited data regarding locally established reliable clinical laboratory reference intervals in Ethiopia though attempts are made. Therefore, further local reference interval studies should be undertaken considering the cultural, ethnic, demographical, and geographical diversity of the Ethiopian population.

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

BACKGROUND: Data 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. METHOD: A 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. RESULT: The 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. CONCLUSION: We 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.

Phenotype, Allele and Genotype Frequency of ABO and Rhesus D Blood Groups of Blood Donors at the North Gondar District Blood Bank, Northwest Ethiopia.

BACKGROUND: Knowledge of the ABO and RhD group distribution is essential for blood banks inventory and assuring quality blood transfusion services. The objective of this study was to determine the frequency of ABO and RhD phenotype, allele, and genotype among blood donors at North Gondar District Blood Bank from 2010 to 2012, Northwest Ethiopia. METHODS: The data of the current study were obtained from registration logbooks of blood donors registered. The ABO and RhD grouping was done by using commercially available monoclonal antibodies (anti-A, anti-B and anti-D) by slide methods. Results with no agglutination by anti-D antibody were confirmed using anti-human globulin test. Descriptive statistics were analyzed using SPSS version 20. The allele and genotype frequency of the donors was determined by Hardy-Weinberg equilibrium assumption. The difference between the observed and expected frequency was tested by online Chi-square calculator. P-value of <0.05 was considered statistically significant. RESULTS: Among 6471 blood donors, 82.1%, 94.1% and 55.4% were males, replacement donors and in the age group of 21-30 years, respectively. Blood group O (47.04%) and blood group AB (4.81%) were the dominant and least common, respectively. The distribution of the RhD negative blood group was 5.76%. The distribution of A, B and O alleles was 0.1714, 0.1433 and 0.6859, respectively. Moreover, the genotype frequency of AA, AO, BB, BO, AB and OO was 0.0294, 0.2350, 0.0205, 0.1966, 0.0491 and 0.4704, respectively. The genotype frequency of DD, Dd and dd was 0.5774, 0.3649 and 0.0576, respectively. The result showed that there was no statistically significant difference between observed and expected allele and genotype frequency (P-value >0.05). CONCLUSION: Blood group O and AB were the most and least prevalent, respectively. The allele and genotype frequency of the population was fulfilled the Hardy-Weinberg equilibrium assumption. This finding might be useful for blood transfusion services.

Hematological malignancies in the Northwest Ethiopia.

BACKGROUND: The effect of malignant diseases is increasing globally, particularly in developing countries as shown by recent cancer statistics from the world health organization reports. It is anticipated that with an increase in life expectancy consequent upon the improved standard of living and increasing urbanization, the burden of hematological malignancies in sub-Saharan Africa particularly in Ethiopia is likely to increase recently. Therefore, this study was aimed to determine the incidence and trend of hematological malignancy in Northwest Ethiopia. METHODS: A facility-based retrospective study was conducted from 2015 to 2019 at the University of Gondar and Bahir-Dar Felegehiwot comprehensive specialized hospitals. Hematological malignancy data were collected by using a data collection sheet that was consisted of patients' socio-demography, clinical, and laboratory data. Then, data were entered into Epi-info 3.5.1 and exported to SPSS version 20 for analysis. Skewness and kurtosis were used to check data distribution. Descriptive statistics were summarized as percentages, means, and standard deviations of background variables, and the trend were analyzed. RESULTS: In this study, a total of 1,342 study participants were included. The mean age of study participants was 41.49 ± 16.3 years with a range of 1 to 92 years. About 58.3%, 52.2%, and 80% of the cases were observed among males, 18-45 age group, and urban residences, respectively. Of the total cases, 92.9% and 7.1% were lymphoma and leukemia, respectively. On the other hand, from lymphoma cases, 72.3% and 27.7% were HL and NHL, respectively while from leukemic cases, 61.1%, 23.2, 6.3%, 4.2%, and 5.3% were CLL, ALL, CML, AML, and other HM types, respectively. In this study, there was no trend. CONCLUSION: We concluded that lymphoma was the dominant type of hematological malignancy observed in northwest Ethiopia. The study indicated that the majority of cases were observed among male, urban residents, and adult populations aged 18-45 years. Therefore, special focus should be given to the highly affected population. Further, a prospective cohort study should be conducted for a better understanding of the prevalence and associated factors to it.

Efficacy of Glucagon-Like Peptide-1 Analogs in Nonalcoholic Fatty Liver Disease: A Systematic Review.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. It is believed to be the hepatic manifestation of the metabolic syndrome. Many treatment approaches have been suggested so far, and several types of studies have been done to find treatment for NAFLD, the most promising of which are those with lifestyle interventions. OBJECTIVE: The aim of this systematic review was to evaluate the efficacy and safety of glucagon-like peptide-1 (GLP-1) analogs on the management of NAFLD. METHODS: The PubMed, MEDLINE, and Cochrane Central Library were searched to identify randomized controlled trials, single arm trials, and cohorts that compared GLP-1 analogs with a control treatment or baseline values with respect to efficacy and safety in patients living with NAFLD. The key outcomes were a change in serum transaminase, resolution of disease status measured by imaging or histological techniques, improvement in insulin resistance, and reduction in body weight. RESULTS: Initial searching retrieved 201 peer-reviewed articles and abstracts. Ten studies met all inclusion criteria. The review included a total of 590 participants with NAFLD. Following administration of GLP-1 analogs, a decrease in serum transaminases, improvement in liver histology and insulin resistance, and a reduction in body weight were observed. Compared with baseline, body weight, alanine aminotransferase, aspartate aminotransferase, and gamma glutamyltransferase were decreased by 5.5%, 59.5%, 52.8%, and 44.8%, respectively, due to GLP-1. Likewise, a reduction of proinflammatory cytokines and fibrosis markers and an enhancement of protective adipokines were observed in some of the studies. CONCLUSION: The decrease in a key biochemical marker of liver injury following treatment with GLP-1 analogs, as well as improvements in imaging and histology, suggests that these agents may be effective alternatives for managing NAFLD. REGISTRATION: CRD42018087262.

Association of ABO and Rh Blood Group Phenotypes with Type 2 Diabetes Mellitus at Felege Hiwot Comprehensive Referral Hospital Bahir Dar, Northwest Ethiopia.

BACKGROUND: ABO and Rh blood group antigens are thought to be among genetic determinants of type 2 diabetes mellitus. Identification of blood group phenotypes are more associated with type 2 diabetes mellitus. It will be helpful for individuals who are susceptible blood groups to take care of themselves by avoiding other predisposing factors and taking preventive measures. METHODS: Hospital-based comparative cross-sectional study was carried out from February to April 2019 at Felege Hiwot Comprehensive Referral Hospital. Sociodemographic and clinical data were collected with a semistructured pretested questionnaire. ABO and Rh Blood group were determined by slide and test tube methods. Biochemical parameters were determined with Mindray BS-200E fully automated clinical chemistry analyzer. Data were analyzed by IBM SPSS version 20 statistical software. Chi-square test and logistic regression analysis were employed for data analysis. A P value of < 0.05 was considered statistically significant. RESULTS: From a total of 424 participants included for this study, blood group O was found higher in frequency with 74 (34.9%) and 97 (45.75%) for cases and healthy controls, respectively. ABO blood groups showed significant association with T2DM, a chi-square value of 12.163 and P value of 0.007. However, the Rh blood group was not associated with T2DM. Binary logistic regression analysis revealed that blood group B had a higher risk (OR: 2.12, 95% CI: 1.33-3.32) and blood group O had decreased risk (OR: 0.636, 95% CI: 0.43-0.94) of T2DM as compared to other blood groups. CONCLUSION: ABO blood group antigens showed significant association with type 2 diabetes mellitus. Blood group B was associated with an increased risk and O blood group with decreased risk of type 2 diabetes mellitus.

Glycemic control and diabetes complications among diabetes mellitus patients attending at University of Gondar Hospital, Northwest Ethiopia.

BACKGROUND: Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia due to either insulin deficiency or resistance or both. Hyperglycemia induces tissue damage through mitochondrial superoxide production, affecting retina, glomerulus, and neurons. It requires continuing medical care and ongoing self-care management to prevent and delay acute and long-term complications. Therefore, our study was designed to assess glycemic control and diabetes complications among diabetes patients attending at University of Gondar Hospital. MATERIALS AND METHODS: A cross-sectional study was conducted among DM patients attending at University of Gondar Hospital diabetes follow-up clinic during February-March 2017. Five milliliters of blood was collected using aseptic technique. Levels of fasting blood sugar (FBS), triglycerides, and cholesterol were measured using MINDRAY BS-200E machine. FBS ≥152 mg/dL was taken as poor glycemic control. Binary and multivariable logistic regression models were used to evaluate associated risk factors for the outcome variable. A P-value of <0.05 was considered as statistically significant. RESULT: Three hundred sixty-seven diabetes patients were included in this study. About 222 (60.5%) of them had poor glycemic control (FBS ≥152 mg/dL). The proportion of poor glycemic control was slightly higher among type 1 DM patients (61.4%) than type 2 DM patients (59.8%). Age ≥65 years (adjusted odds ratio [AOR]: 0.070; 95% CI: 0.016-0.308), being divorced (AOR: 0.226; 95% CI: 0.064-0.8000), and increased waist circumference (AOR: 0.361: 95% CI: 0.181-0.720) were factors that significantly reduce poor glycemic control. Diabetes complications were slightly higher in insulin- and tablet-only users, 72.5% and 64.5%, respectively. DM complications were also higher in patients who had poor glycemic control (61/222) and type 2 diabetes (78 [37.3%]). CONCLUSION: Prevalence of poor glycemic control and DM complications was high, which indicate that appropriate intervention is required to improve glycemic control and prevent or control complications among DM patients.

Waist Circumference Cutoff Point Determination for Defining Metabolic Syndrome in Type 2 Diabetes Mellitus in Ethiopia.

BACKGROUND: Metabolic syndrome (MetS) is a complex disorder characterized by a cluster of interrelated cardiovascular risk factors. So far, cutoff point variability of waist circumference was documented to define MetS. OBJECTIVE: To determine the classification power and cutoff point of waist circumference to define MetS among patients with type 2 diabetes. METHODS: An institution-based cross sectional study was conducted from March to April 2017 at Ayder Comprehensive Specialized Hospital among patients with type 2 diabetes. Using systematic sampling technique, 520 participants were enrolled into the study. Data were collected by checklist, anthropometric measurements and biochemical analyses. Data were entered to Epi-info 3.5.1 and transferred to SPSS 20 for analysis. Participants having more than one abnormal MetS components were categorized as patients and the others were considered as control. The classification power of waist circumference to distinguish patients from controls was determined by ROC curve analysis. Waist circumference cutoff points were determined by taking the point that had a maximum youden index. RESULTS: Among the 520 participants, 308 (59.2%) were females. The mean age of the participants was 56 ± 10.8 years for males and 55 ± 11.4 years for females. The classification power of waist circumference was 0.67 (0.58-0.75) for male and 0.63 (0.52-0.73) for females. The optimal waist circumference cutoff point to distinguish patients from controls were 95.5 cm (sensitivity 39.8%, specificity 86.3%, p< 0.001) for males, and 87.5 cm (sensitivity 73.1%, specificity 54.5%, p< 0.017) for females. CONCLUSION: The positive predictive value of waist circumference was 93% for females and 90% for males in Northern Ethiopia using 87.5 and 95.5 cm points cut-off for females and males, respectively.

Gestational diabetes mellitus in HIV-infected pregnant women: A systematic review and meta-analysis.

BACKGROUND: Impaired glucose metabolism during pregnancy can result in a significant adverse pregnancy-outcomes. Previous studies have reported the contribution of ART to the impaired glucose tolerance and gestational diabetes mellitus (GDM) in HIV-infected pregnant women. METHODS: PRISMA guideline was followed for this systematic review and meta-analysis. The STATA version 11 was employed to compute the pooled prevalence of GDM using the random effect model and 95% confidence interval. Subgroup analysis was conducted by geographical regions. Visual inspection of the funnel plot and Egger's regression test statistic were used to show the publication bias. RESULTS: A total of 13,517 articles were identified, of which 21 publications met the inclusion criteria. The pooled prevalence of GDM among HIV-infected pregnant women was 4.42% (95% CI: 3.48; 5.35). According to the subgroup analysis, the pooled prevalence of GDM among HIV-infected pregnant women was 7.1% (95%CI: 3.38; 10.76) in Asia, 5.83% (95% CI: 2.61; 9.04) in Europe, 3.58% (95% CI: 2.67; 4.50) in America and 3.19% (95% CI: -2.89; 9.27) in Africa. CONCLUSION: The pooled prevalence of GDM among HIV-infected pregnant women is expectedly high. Therefore, early screening of HIV-infected pregnant women for GDM is vital to reduce its complications related to pregnancy. PROTOCOL REGISTRATION NUMBER: International Prospective Register of Systematic Reviews CRD42018090735.

Prevalence of Liver Function Test Abnormality and Associated Factors in Type 2 Diabetes Mellitus: A Comparative Cross-Sectional Study.

BACKGROUND: Determining liver biomarkers can help to screen and facilitate early management of potential liver diseases. However, such studies are scarce in the present study area. Therefore, our study planned to assess the prevalence of liver function test abnormality and associated factors among Type 2 Diabetes Mellitus (T2DM) patients. METHODS: A comparative cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital from January 1, 2018 to May 20, 2018 among 159 T2DM patients and 159 nondiabetic controls. Clinical, lifestyle, anthropometric data and 5 ml of blood were collected from all study subjects. Liver function tests (LFTs), lipid profiles and fasting blood sugar were determined. Systematic random sampling technique was used to select the study subjects. Binary logistic regression and bivariate correlation was used to assess association of factors with outcomes and p value of ≤0.05 was considered as significant. RESULTS: Overall, 53 (33.3%) of T2DM had one or more liver test abnormality above the upper limit of the normal (ULN) reference range. Alanine aminotransferase was the most frequently raised liver enzyme in T2DM (n=37, 23.3%). The mean value of LFTs was significantly different between T2DM and the control group. Alcohol drink, sex and age were found to be a significant factor for impairment of LFTs. CONCLUSION: The prevalence of abnormal LFTs was higher in T2DM patients than nondiabetic control group. Hence, we recommended the utilization of LFTs to monitor liver conditions in T2DM patients.

Variation of Urine Parameters among Diabetic Patients: A Cross-Sectional Study.

BACKGROUND: Diabetic kidney disease is a common and severe microvascular complication of diabetes mellitus (DM). There are limited data regarding alteration of urine parameters other than proteinuria among DM patients. METHODS: Institution based cross-sectional study was conducted from February to May 2017 to assess alteration of urine parameters among DM patients at the University of Gondar Hospital, Northwest Ethiopia. A Systematic random sampling technique was used to recruit adult (≥18 years) diabetic participants. Data were collected after ethical requirements had been fulfilled. The degree of association between variables was evaluated through bivariable and multivariable logistic regression models. RESULTS: The majority (69.4%) of the study participants were type 2 DM patients. The prevalence of altered urine chemical parameters was 11.3% proteinuria, 4.5% ketonuria, 13.6% hematuria, 53.8% glucosuria, 24.9% leukocyturia and 1.7% positive for nitrite. Diastolic blood pressure and poor glycemic control were significantly associated with proteinuria. Male participants were 2.4 times more likely to have leukocyturia than female participants. The prevalence of abnormally increased microscopic findings was red blood cells 3.1%, white blood cells 12.5%, epithelial cells 27.5%, yeast cells 1.7%, bacteria 17.8%, casts 3.7% and crystals 29.2%. CONCLUSIONS: The prevalence of altered urine parameters among DM patients is found to be considerable. These increased prevalences of altered urine parameters are potential indicators for diabetic kidney disease.

Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study.

Importance: Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. Objective: To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories. Design, Setting, and Participants: This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018. Exposures: Being under the age of 20 years between 1990 and 2017. Main Outcomes and Measures: Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability. Results: Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile. Conclusions and Relevance: Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.

Prothrombin time, activated partial thromboplastin time and platelet counts of type II diabetes mellitus: a comparative study.

BACKGROUND: The incidence of cardiovascular disease due to thrombosis is 2-4 folds greater in diabetic patients. Prothrombin time, activated partial thromboplastin time and platelet count are hematological indices that give an insight into the coagulation status. Hence, this study aims to assess the coagulation status of type II diabetic patients. METHODS: A comparative cross-sectional study was conducted at Bahir Dar Felege Hiwot referral hospital, Northwest Ethiopia. A total of 40 treated type II diabetic, 40 untreated diabetics and 40 non-diabetic subjects were included. After taking informed consent, structured questionnaire was used to collect socio-demographic data. Following interview, 4 ml of blood was collected to determine PT, aPTT and platelet count of the three groups. The data were entered into SPSS version 20 and analyzed. One-way ANOVA was used to compare means of PT, aPTT and platelet count among the groups. A P value less than 0.05 was considered as statistically significant. RESULTS: The mean aPTT of non-diabetic, treated and untreated type II diabetic patient was 32.8 ± 4.12 s, 34.4 ± 5.3 s, and 25.42 ± 8.46 s, respectively. The proportion of untreated diabetic patients with normal PT, aPTT and platelet counts was 60.0%, 7.5 and 92.5%, respectively. There was a significant shortening of aPTT in untreated diabetic as compared to both treated and non-diabetic controls (P < 0.001). CONCLUSIONS: Shortening of aPTT in untreated type II diabetic patients might be useful marker in patients with diabetes. Therefore, monitoring the aPTT in newly diagnosed diabetic patients is important.

Biochemical Profiles of Pregnant and Non-pregnant Women Attending at the University of Gondar Hospital, Northwest Ethiopia: A Comparative Cross-sectional Study.

BACKGROUND: Pregnancy is a natural physiological statement with hormonal and metabolic changes that helps the growth and survival of the fetus. However, biochemical profiles derangement may lead to pregnancy complications. Therefore, there is a need for determining biochemical profiles among pregnant women. METHODS: A comparative cross-sectional study was conducted among pregnant and non-pregnant women at the University of Gondar Hospital, from February to April, 2015. Fasting blood sample was collected from 139 pregnant and 139 age matched non-pregnant women using systematic random sampling technique. Interviewer-administered questionnaire was used to collect socio-demographic and clinical data. Fasting blood glucose and lipid profile were measured by A25 Biosytemchemistry analyzer using enzymatic calorimetric methods. Data analysis was done using SPSS version 20. Level of significance between groups was analyzed using independent student t-test and Mann-Whitney U test. A p-value of <0.05 was considered as statistically significant. RESULT: Pregnant women as compared to non-pregnant had significantly increased glucose (96.35±14.45 and 81.12±9.86 mg/dl), total cholesterol (211.9±40.88 and 172.40±29.64 mg/dl) [p<0.05], respectively. It had also significantly high triglycerides (190.81±81.04 and 107.43±45.80 mg/dl) and low-density lipoprotein cholesterol (116.03±37.26 and 86.12±27.29mg/dl) [p<05] in pregnant as compared to non-pregnant women. The level of high-density lipoprotein cholesterol was significantly lower in pregnant women (59.58±14.26) than control (63.63±11.4, P <0.05). CONCLUSION: There were statistically significant increment in glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol and decrement in high-density lipoprote in cholesterol levels among pregnant women compared with non-pregnant women. Therefore, pregnant women have to be monitored closely for their biochemical profiles to avoid adverse pregnancy outcomes.

Chronic Kidney Disease and Associated Risk Factors Assessment among Diabetes Mellitus Patients at A Tertiary Hospital, Northwest Ethiopia.

BACKGROUND: The prevalence of chronic kidney disease, particularly in diabetic patients, is increasing rapidly throughout the world. Nowadays, many individuals in developing nations are suffering from diabetes which is one of the primary risk factors of chronic kidney disease. METHODS: Institution based cross-sectional study was conducted at the University of Gondar Hospital from February to April 2016. A total of 229 study participants were selected using systematic random sampling technique. Urine sample was collected for albumin determination by dipstick. The Simplified Modification of Diet in Renal Disease study equation was used to estimate glomerular filtration rate. Binary logistic regression model was used to identify risk factors. RESULTS: Of the total 229 study participants, 50.2% were females and the mean age was 47±15.7 years. Among study participants, the prevalence of chronic kidney disease (CKD) was found to be 21.8% (95% CI: 16% - 27%). Of all study participants, 9(3.9%) had renal impairment (eGFR < 60 ml/min/ 1.73 m2) and 46 (20.1%) had albuminuria. Older age (AOR: 5.239, 95% CI: 2.255-12.175), systolic blood pressure ≥140mmHg (AOR: 3.633, 95% CI: 1.597-8.265), type 2 diabetes mellitus (AOR: 3.751, 95% CI: 1.507-9.336) and longer duration of diabetes (AOR: 3.380, 95% CI: 1.393-8.197) were independent risk factors of CKD. CONCLUSIONS: The study identified high prevalence (21.8%) of CKD among diabetic adults. CKD was significantly associated with older age, systolic blood pressure, type 2 DM and longer duration of DM. Thus, DM patients should be diagnosed for chronic kidney disease and then managed accordingly.

Undiagnosed Diabetes Mellitus and Associated Factors among Psychiatric Patients Receiving Antipsychotic Drugs at The University of Gondar Hospital, Northwest Ethiopia.

BACKGROUND: Undiagnosed diabetes mellitus cases are at higher risk for diabetic related complications. In low-income African countries, patients with undiagnosed diabetes mellitus account for 75% of diabetes cases. Psychiatric disorders have a greater impact on the global burden of diseases and disability associated with chronic diseases like diabetes mellitus and cardiovascular diseases. METHODS: Institution based cross-sectional study was conducted at the University of Gondar Hospital from February to April 2016. A total of 205 psychiatric patients aged above 15 years that were taking antipsychotic were included by the simple random sampling method. Fasting blood glucose, triglycerides and cholesterol level were determined from venous blood samples to evaluate diabetes mellitus based on WHO criteria. RESULTS: Among 205 psychiatric patients taking antipsychotics, 15(7.3%) had undiagnosed diabetes mellitus. Duration of antipsychotic treatment and sex had a statistically significant association with the prevalence of undiagnosed diabetes mellitus. As the duration of antipsychotic drug treatment increased by one year, the risk of having a diabetes mellitus increase by 1.47 times (AOR: 1.47 CI: 1.021-2.125). CONCLUSION: The prevalence of undiagnosed diabetes mellitus among psychiatry patients taking antipsychotics was higher than the estimated diabetes national prevalence of Ethiopia. Screening of diabetes mellitus in particular, patients having a longer duration of antipsychotic treatment is mandatory to bring more undiagnosed cases for medical attention.