Evaluation of C-Reactive Protein and Associated Factors Among Patients Suffering from Rheumatoid Arthritis at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder, which is associated with increased pro-inflammatory mediators to induce an elevation in acute-phase response, migration of immune cells and swelling of synovial joints. Evaluation of the level of C-reactive protein and associated risk factors in RA patients was the main aim of this study. Identifying the association between disease activity of RA (hsCRP) and socio-demographic characteristics was another aim of the study. METHODS: Institution-based cross-sectional study was conducted at the Rheumatology Clinic of Tikur Anbessa Specialized Hospital. In this study, the level of hsCRP was measured in both case and control groups. Simple descriptive statistics, multivariate analysis, independent sample t-test were utilized for statistical analysis. The strength of association between different risk factors and hsCRP was measured using odds ratio and 95% confidence interval. P-value < 0.05 was considered as statistically significant. RESULT: The result of this study showed that the hsCRP level was significantly higher among RA patients as compared to the control groups (P-value = 0.004). There was an association between smoking and high disease activity status (AOR= 20.03, p= 0.40). Low economic status had a statistically significant association with high hsCRP level (AOR = 12.79, p=0.00). In this study, 42 RA patients had >3mg/l hsCRP level with different occupational exposures. On the other hand, 31 RA patients had <3mg/l hsCRP level among different exposures. Although there was no statistically significant association, the association between associated risk factors (oil consumption, physical exercise, educational status) and disease activity was computed in this study. CONCLUSION: The inflammatory marker, hsCRP was significantly higher among patients as compared to controls. The higher hsCRP showed a high grade of systemic inflammation in RA patients. C-reactive protein was elevated in rheumatoid factor positive patients and patients with high BMI value. Additionally, the result of our study showed that different socio-economic factors had an association with disease activity of RA.

Assessment of Serum Lipid Profiles and High-sensitivity C-reactive Protein Among Patients Suffering from Rheumatoid Arthritis at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by severe joint pain, swelling, damage, and disability which leads to joint destruction and loss of function. The complication of RA is associated with cardiovascular diseases, particularly due to systemic inflammation and dyslipidemia. The purpose of this study was to assess the development of atherosclerosis, which acts as a major risk factor for cardiovascular complications in RA patients. METHODS: A hospital-based cross-sectional study was conducted at the Rheumatology Clinic of Tikur Anbessa Specialized Hospital. The study made a comparison of risk factors (dyslipidemia and inflammatory status) between individuals having RA as a case group and apparently healthy individuals as a control group. Simple descriptive statistics, one-way ANOVA, independent sample t-test and multivariate analysis were utilized for statistical analysis. p-value of <0.05 at the 95% confidence level was considered as statistically significant. RESULTS: The result of this study demonstrated that there was a significant elevation of mean ±SD of TC, TC/HDL, LDL/HDL, and lowered value of HDL-C was seen among RA patients than controls (P-value <0.05). The mean ±SD of inflammatory marker, high-sensitivity C-reactive protein (hsCRP), was significantly higher among RA patients compared to controls (P<0.05). HDL-C had a significant negative correlation with a hsCRP whereas TC/HDL-C and LDL/HDL-C had a significant positive correlation with hsCRP (P<0.05). CONCLUSION: In this study, RA patients had lipid abnormalities and elevated systemic inflammation than controls. An increase in hsCRP and dyslipidemia status among RA patients indicates the possible development of an atherosclerotic event. Therefore, assessment of lipid profiles and hsCRP in early RA patients may be helpful to assess the possible development of cardiovascular complications.

Assessment of hypertension control and factors associated with the control among hypertensive patients attending at Zewditu Memorial Hospital: a cross sectional study.

OBJECTIVE: This study was conducted to assess hypertension control and factors associated with it among hypertensive patients on treatment at Zewditu Memorial Hospital. RESULTS: A total of 225 patients were included in the study, of which 55.6% of patients were females. The mean age of the patients was 55.2 years and half of them had a family history of hypertension. About 29% of patients had comorbidities. Angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs) and beta-blockers (BBs) were the most frequently prescribed medications. Majority of (83.1%) the patients received combination therapy. The most frequent two and three drugs class combination were ACEI + BB and ACEIs + CCB + BB, respectively. Drug treatment was modified for 22.2% of patients and blood pressure (BP) was controlled in 26.2% of patients. Older age was associated with good BP control (AOR 2.58, CI 1.27-5.24), while treatment modification was associated with poor BP control (AOR 0.21, CI 0.07-0.65). The findings indicate that BP control was low and factors like middle age and treatment modification contributed to the low BP control. It is recommended that the physicians should be adherent to current guidelines regarding the selection of appropriate antihypertensive medications so as to achieve target BP goals.

Quality of life and its predictors among patients with chronic kidney disease: A hospital-based cross sectional study.

INTRODUCTION: Quality of life (QoL) is increasingly being considered as an important measure of how disease affects patients' lives, especially for long-term diseases like chronic kidney disease (CKD). Even though there is no statistically significant association between stages of CKD and QoL, it is decreased in patients with early stages of the disease. Hence, this study aimed to assess QoL and its predictors among patients with CKD at Tikur Anbessa Specialized Hospital (TASH). METHODS: A cross sectional study was conducted at the nephrology clinic of TASH. A total of 256 patients were recruited through systematic random sampling. Data were collected using the Medical Outcomes Study Short Form 36-Items (SF-36). The data were entered into Epi Info 7.2.2.2 and analyzed using SPSS version 20.0 statistical software. Descriptive statistics like frequency, percent, mean and standard deviation were used to summarize patients' baseline characteristics. Student's unpaired t-test and ANOVA were conducted to compare two groups and more than two groups in the analysis of QoL, respectively. Multivariable linear regression was employed to investigate the potential predictors of QoL. RESULTS: Quality of life was decreased in all stages of CKD. A reduction in physical functioning (p = 0.03), bodily pain (p = 0.004), vitality (p = 0.019) and social functioning (p = 0.002) was observed progressively across stages of CKD. High income status and greater than 11g/dl hemoglobin level were found to be predictors of all high score SF-36 domains. High family income (ß 15.33; 95%CI: 11.33-19.33, p<0.001), higher educational status (ß 7.9; 95%CI: 4.10-11.66, p<0.001), and hemoglobin ≥11g/dl (ß 8.36; 95%CI: 6.31-10.41, p<0.001) were predictors of better QoL in the physical component summary, whereas absence of CKD complications (ß 2.75; 95%CI: 0.56-4.94, p = 0.014), high family income (ß 10.10; 95%CI: 5.10-15.10, p<0.001) and hemoglobin ≥11g/dl (ß 4.54, 95%CI: 2.01-7.08, p = 0.001) were predictors of better QoL in the mental component summary. CONCLUSION: In this setting, QoL decreased in CKD patients in the early stages of the disease. Study participants with low income and hemoglobin level were considered to have worse quality of life in both physical and mental component summaries.

Management practice, and adherence and its contributing factors among patients with chronic kidney disease at Tikur Anbessa Specialized Hospital: A hospital-based cross-sectional study.

INTRODUCTION: Chronic kidney disease (CKD) has a complicated interrelationship with other diseases and major risk factor for cardiovascular disease. Therapeutic management for CKD patients is complicated due to co-morbidities and dominant risk factors of CKD. Non-adherence to treatment is an increasing problem for patients with CKD and it has not been extensively studied in patients with CKD. Hence, the present study was carried out to assess the management practice, medication adherence and factors affecting medication adherence in CKD patients at Tikur Anbessa Specialized Hospital (TASH). METHODS: A hospital-based cross-sectional study was conducted at the nephrology clinic of TASH. A total of 256 patients were recruited through systematic random sampling. Data were collected from medical records and interviewing patients. The degree of adherence was determined using eight-item Morisky Medication Adherence Scale. The data were entered into Epi Info 7.2.2.2 and analyzed using SPSS version 20.0 statistical software. Descriptive statistics such as frequency, percent, mean and standard deviation were used to summarize patients' baseline characteristics. Univariable and multivariable binary logistic regression were used to investigate the potential predictors of medication non-adherence. RESULTS: About 55% patients with hypertension only were treated with non-angiotensin converting enzyme inhibition based regimens; 57.3% of diabetes mellitus with hypertension treated with combination of insulin and ACEI based regimens. About three-fourth of patients with anemia and osteodystrophy complications were treated with iron preparations and calcium based phosphate binder. Only 61.3% of the study population were adherent to their treatment regimens. Forgetfulness (79.8%) was the major reason for medication non-adherence. Patients who had an average and high monthly income were 4.14 (AOR = 4.14, 95% CI: 1.45-11.84, p = 0.008) and 6.17 times (AOR = 6.17, 95% CI: 1.02-37.46, p = 0.048) more likely to adhere as compared to those who had very low income. Patients who were prescribed with ≥5 drugs were 0.46 times (AOR = 0.54, 95% CI: 0.27-1.10, p = 0.049) less likely to adhere compared to their counterpart. Patients who were students, drivers, teachers working in private school were about 7.46 times (AOR = 7.46, 95% CI: 1.49-37.26, p = 0.014) more likely to adhere compared with patients who were farmers. CONCLUSION: Insulin and ACEIs based regimens were the most frequently used regimens in the treatment of diabetes mellitus and hypertension co-morbidities. Very low income, increased number of prescribed medications and being a farmer were the predictors of medication non-adherence.

Kidney Transplantation: The Challenge of Human Leukocyte Antigen and Its Therapeutic Strategies.

Kidney transplantation remains the treatment of choice for end-stage renal failure. When the immune system of the recipient recognizes the transplanted kidney as a foreign object, graft rejection occurs. As part of the host immune defense mechanism, human leukocyte antigen (HLA) is a major challenge for graft rejection in transplantation therapy. The impact of HLA mismatches between the donor and the potential recipient prolongs the time for renal transplantation therapy, tethered to dialysis, latter reduces graft survival, and increases mortality. The formation of pretransplant alloantibodies against HLA class I and II molecules can be sensitized through exposures to blood transfusions, prior transplants, and pregnancy. These preformed HLA antibodies are associated with rejection in kidney transplantation. On the other hand, the development of de novo antibodies may increase the risk for acute and chronic rejections. Allograft rejection results from a complex interplay involving both the innate and the adaptive immune systems. Thus, further insights into the mechanisms of tissue rejection and the risk of HLA sensitization is crucial in developing new therapies that may blunt the immune system against transplanted organs. Therefore, the purpose of this review is to highlight facts about HLA and its sensitization, various mechanisms of allograft rejection, the current immunosuppressive approaches, and the directions for future therapy.

Management Practice, and Adherence and Its Contributing Factors among Patients with Chronic Kidney Disease at Tikur Anbessa Specialized Hospital: A Hospital Based Cross-Sectional Study.

The objective of this study was to assess the management practice, medication adherence, and factors affecting medication adherence in CKD patients at Tikur Anbessa Specialized Hospital (TASH). Methods. A cross-sectional study was conducted at the nephrology clinic of TASH. A total of 256 CKD (stages 1 and 2=50, stage 3=88, stage 4=55, and stage 5=63) patients were recruited through systematic random sampling. Data were collected from medical records and interviewing patients. The rate of adherence was determined using 8-item Morisky medication adherence scale. The data were analyzed using SPSS version 20.0 statistical software. Univariate and multivariate binary logistic regression were used to investigate the potential predictors of medication nonadherence. Results. About 57.3% of diabetes mellitus with hypertension were treated with combination of insulin and ACEI based regimens. Other cardiovascular comorbidities were predominantly treated with Acetyl Salicylic Acid in combination with ß-blocker. Only 61.3% (stages 1 and 2=70%, stage 3=73.9%, stage 4=54.5%, and stage 5=43%) of the study population were adherent to their treatment regimens. Forgetfulness (79.8%) was the major reason for medication nonadherence. Patients who had an average and high monthly income were 4.14 (AOR=4.14, 95% CI: 1.45-11.84, p=0.008) and 6.17 times (AOR=6.17, 95% CI: 1.02-37.46, p=0.048) more likely to adhere as compared to those who had very low income. Patients who were prescribed with ≥5 drugs were 0.46 times (AOR= 0.54, 95% CI: 0.27-1.10, p=0.049) less likely to adhere compared to their counterpart. Patients who were students, drivers, or teachers working in private school were about 7.46 times (AOR=7.46, 95% CI: 1.49-37.26, p=0.014) more likely to adhere compared with patients who were farmers. Conclusion. Insulin and ACEIs based regimens were the most frequently used regimens in the treatment of diabetes mellitus and hypertension comorbidities. Very low income, increased number of prescribed medications, and being a farmer were the predictors of medication nonadherence.

Implementation and Evaluation of a Blended Learning Course on Tuberculosis for Front-Line Health Care Professionals.

OBJECTIVES: To implement and evaluate the effectiveness of a 10-module blended learning course on tuberculosis diagnosis for Ethiopian health care professionals. METHODS: This implementation science research was conducted within the routine in-service training for health care professionals in Ethiopia. A combined web-based and face-to-face acid-fast bacilli microscopy course was designed and its applicability studied after 6 weeks of enrollment of 108 medical laboratory professionals. A survey was conducted to capture participants' feedback on the course. RESULTS: Of 108 participants enrolled, 81 attended and 73 (90%) completed the course; 72 (94%) had no experience taking online courses. Mean percentages of quizzes, assignments/exercises, and hands-on scores were 88%, 70%, and 95%, respectively. No significant differences were found in scores between participants from public, private, and nongovernmental health facilities ( P = .386) or between higher and lower level facilities ( P = .533). Participants' overall satisfaction with the course was 88%. CONCLUSIONS: Blended learning was an effective pedagogic approach for this category of professionals because of the crucial need for hands-on training for practicing and translating knowledge into skills. This approach also had the advantages of keeping the costs of the entire course low and reaching a greater number of participants, all without significant disruption of work schedules.

PATTERNS OF COMPLICATIONS SEEN IN PATIENTS WITH HYPERTENSION ADMITTED TO TIKUR ANBESSA HOSPITAL: A RETROSPECTIVE ANALYSIS.

BACKGROUND: Complications due to undetected and uncontrolled hypertension have been recorded to be devastating. Among these are cerebrovascular, cardiovascular and renal complications. Lack of data on the patterns of these complications, combined with the notion that hypertension is only a problem of developed nations, has resulted in missed opportunities for early detection and treatment. METHOD: A retrospective cross-sectional study was performed through medical chart review of 106 hypertension patients who were admitted with complications of hypertension at Tikur Anbessa Specialized Hospital from Januaty 2013 to January 2014 E.C. RESULTS: A total of 106 medical charts of hypertensive patients were reviewed. Among the patients involved in the study, 51% were male, 45% were in their fifth and sixth decades and two third of them did not have any co morbidity. Sixty seven percent of these patients had cerebrovascular disease (stroke), 11% had stroke and hypertensive heart disease, 8% had stroke, hypertensive heart disease and chronic kidney disease (all three), and 5% had stroke with chronic kidney disease. However, there was no significant association between the considered variables and the outcome. CONCLUSION: This study has revealed most of the patients have stroke as a complication, therefore preventive or prophylactic measures should be encouraged to avail it.

Drug dosage adjustment in hospitalized patients with renal impairment at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia.

BACKGROUND: Dose adjustment for certain drugs is required in patients with reduced renal function to avoid toxicity as many drugs are eliminated by the kidneys. The aim of this study was to assess whether appropriate dosage adjustments were made in hospitalized patients with renal impairment. METHODS: A prospective cross-sectional study was carried out in the internal medicine wards of Tikur Anbessa Specialized Hospital. All patients with creatinine clearance ≤ 59 ml/min admitted to hospital between April and July, 2013 were included in the analysis. Data regarding serum creatinine level, age, sex and prescribed drugs and their dosage was collected from the patients' medical records. Serum creatinine level ≥ 1.2 mg/dL was used as a cutoff point in pre-selection of patients. The estimated creatinine clearance was calculated using the Cockcroft- Gault (CG) equation. Guideline for Drug prescribing in renal failure provided by the American College of Physicians was used as the standard for dose adjustment. RESULTS: Nine percent (73/810) of medical admissions were found to have renal impairment (CrCl ≤ 59 ml/min). There were 372 prescription entries for 73 patients with renal impairment. Dose adjustment was required in 31 % (115/372) of prescription entries and fifty eight (51 %) prescription entries requiring dose adjustment were found to be inappropriate. Of 73 patients, 54 patient received ≥ 1 drug that required dose adjustment (median 2; range 1-6). Fifteen (28 %) patients had all of their drugs appropriately adjusted while twenty two (41 %) patients had some drugs appropriately adjusted, and seventeen (31 %) of patients had no drugs appropriately adjusted. No patients were documented to have received dialysis. CONCLUSION: The findings indicate that dosing errors were common among hospitalized patients with renal impairment. Improving the quality of drug prescription in patients with renal impairment could be of importance for improving the quality of care.

Acute kidney injury risk factor recognition in three teaching hospitals in Ethiopia.

BACKGROUND: A key objective of the Nephrology Sister Centre Programme between the renal units in Cardiff and Addis Ababa, sponsored by the International Society of Nephrology, is to facilitate development of the local clinical service in Ethiopia specifically focused on the management of acute kidney injury (AKI). OBJECTIVES: To examine the relationship between AKI risk factor recognition and monitoring of renal function in three hospitals in Ethiopia. METHODS: Cross-sectional data were gathered regarding renal function monitoring, recording the presence of AKI risk-associated comorbidities and prescription of nephrotoxic medications across the disciplines of medicine, surgery, obstetrics and gynaecology. Results. Patients were more likely to have their renal function checked at the hospital with specialist services. Across all centres, the highest proportion of patients who had renal function measurements were those admitted to a medical ward. There was a positive relationship between documented comorbidities and the measurement of renal function but not between the prescription of nephrotoxic drugs and measurement of renal function. CONCLUSION: There was great variability in the extent to which doctors recognised the presence of risk factors for the development of AKI. Failure to identify these risk factors represents a lost opportunity to identify patients at high risk of developing renal injury who would benefit from renal function monitoring.

Renal impairment among acute hospital admissions in a rural Ethiopian hospital.

AIM: Acute renal injury (AKI) is a relatively common clinical condition, reported to be associated with high rates of in-hospital mortality. Although here is an extensive literature on the nature and consequence of AKI in the developed World, much less is known in the developing World and more specifically in sub-Saharan Africa, which is addressed directly in this study. METHODS: We describe the prevalence, clinical characteristics and impact of AKI in patients admitted to a single centre in Ethiopia with no dedicated renal services. RESULTS: Renal function tests are not preformed routinely in many Ethiopian hospitals. This occurred in 32% of all patients in this study, falling to 23% on surgical wards. As a consequence no cases of AKI were identified in the context of surgical admissions. AKI was only identified in a cohort of patients on medical wards, with a prevalence of roughly 20% of medical patients in which renal function was measured. The patients with AKI were younger than those at risk of AKI in studies from the developed World but were older than those who did not develop AKI in this study. In the majority of cases AKI could be considered to be pre-renal in its origin. In contrast to studies in the developed World, AKI did not adversely impact on either duration of hospital stay or on patient mortality. Residual renal impairment was, however, common at the point of discharge. CONCLUSION: The data suggest subtle differences in the nature and impact of AKI between those published and mainly derived from the developed world and patients in sub-Saharan Africa.