Genetic Diversity of Merozoite Surface Protein-1 and -2 Genes in Plasmodium falciparum Isolates among Asymptomatic Population in Boset and Badewacho Districts, Southern Ethiopia.

Background: The genetic variation of Plasmodium falciparum has been studied to assess local malaria transmission genetic profile using evidence-based intervention measures. However, there are no known previous reports of P. falciparum polymorphism in Badewacho and Boset districts, Southern Ethiopia. The purpose of this study was to determine the genetic diversity of the merozoite surface protein-1 and -2 (msp-1 and msp-2) allelic families in P. falciparum isolates from an asymptomatic populations. Methods: This study was conducted from finger-prick blood samples spotted on 3 mm Whatman filter paper collected during a community-based cross-sectional study. Nested polymerase chain reaction amplification was used to type the allelic variants of msp-1 and msp-2. Results: From 669 asymptomatic study participants, a total of 50 samples positive for P. falciparum were included for molecular analysis. Of 50 positive samples, 43 P. falciparum isolates were successfully amplified for the msp-1 and msp-2 allelic families. A total of twelve different allele sizes (75-250 bp) were identified within the three allelic families of msp-1, whereas ten different allele sizes (250-500 bp) were detected within the two allelic families of msp-2. MAD20 had a higher allelic proportion, 65% among allelic families of msp-1, whereas the 3D7 allelic family 90.7% was higher in msp-2. A slightly higher frequency of polyclonal infection 53.5% was found in msp-2 allelic family, whereas a low proportion polyclonal infection 46.5% was found in msp-1 allelic family. The overall mean multiplicity of infection (MOI) for msp-1 and msp-2 was identical (MOI = 1.56). Correspondingly, the expected heterozygosity (He) value for msp-1 (He = 0.23) and msp-2 (He = 0.22) was almost similar. Conclusions: The findings of this study revealed low genetic diversity of the msp-1 and msp-2 allelic families in P. falciparum isolates. However, continued monitoring status of the local genetic diversity profile in the P. falciparum population is required to support current malaria control and elimination strategies.

Prevalence of Dyslipidemia among School-Age Children and Adolescents in Addis Ababa, Ethiopia.

Objective Lipid abnormalities during childhood might be associated with a higher risk of atherosclerosis development in adulthood. In Ethiopia, there were no data on this area. The present work was aimed at assessing the lipid profile abnormalities among children and adolescents aged between 5 and 17 years, in Addis Ababa, Ethiopia. Materials and Methods The present school-based cross-sectional study was done from March 2019 to October 2019 in the capital city, Addis Ababa. A total of 504 students were randomly recruited for this study. The total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein-cholesterol levels were determined using the Cobas c501 automated chemistry analyzer. The prevalence of lipid abnormalities was described in percentages. Bivariate and multivariate analyses were performed, and data with p -value less than 0.05 was considered statistically significant. Results Dyslipidemia in at least one of the lipid profiles was observed in 322 (63.9%) school children, whereas only one of the participants had an abnormality in all four lipid profile tests. The prevalence of total cholesterol 200 mg/dL or higher, low-density lipoprotein 130 mg/dL or higher, high-density lipoprotein less than 40 mg/dL, and triglycerides 130 mg/dL or higher was in 14 (2.8%), 16 (3.2%), 294 (58.4%), and 46 (19.1%) participants, respectively. Conclusion In the current work, the majority of the study participants had a normal lipid profile except increased prevalence of a reduced concentration of high-density lipoprotein-cholesterol. The overall prevalence of serum lipid abnormalities was 63.9%. Serum lipid levels did not show significant differences with sex, age, fasting habits, or obesity.

Establishment of Reference Intervals for Serum Protein Electrophoresis of Apparently Healthy Adults in Addis Ababa, Ethiopia.

Background: Even though several factors affect reference intervals (RIs), company-derived values are currently in use in many laboratories worldwide. However, few or no data are available regarding serum proteins RIs, especially in resource-limited countries such as Ethiopia. Objective: To establish RIs for serum protein electrophoresis of apparently healthy adults in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted on a total of 297 apparently healthy adults from April to October 2019 in four selected sub-cities (Akaki, Kirkos, Arada, and Yeka) of Addis Ababa, Ethiopia. Laboratory analysis of collected samples was performed using the Capillarys 2 Flex Piercing analyzer, while statistical analysis was conducted using SPSS version 23 and Med-Calc software. The Mann-Whitney test was used to check partitions. A non-parametric method of reference range establishment was performed as per CLSI guideline EP28A3C. Results: The established RIs were: albumin 53.83-64.59%, 52.24-63.55%; alpha-1 globulin 3.04-5.40%, 3.44-5.60%; alpha-2 globulin 8.0-12.67%, 8.44-12.87%; and beta-1 globulin 5.01-7.38%, 5.14-7.86%. Moreover, the albumin to globulin ratios were 1.16-1.8 and 1.09-1.74 for males and females, respectively. The combined RIs for beta-2 globulin and gamma globulin were 2.54-4.90% and 12.40-21.66%, respectively. Conclusion: The established reference interval for serum protein fractions revealed gender-specific differences, except for beta-2 globulin and gamma globulin.

The association of Helicobacter Pylori infection with dyslipidaemia and other atherogenic factors in dyspeptic patients at St. Paul's Hospital Millennium Medical College.

Background: Studies showed that more than half of Ethiopians were presumed to be chronically infected with H. pylori. Nowadays, evidence has come to the literature strongly suggesting the potential association between H. pylori and extra gastric disorders including atherosclerosis. Objective: To assess the association of helicobacter pylori infection with dyslipidaemia and other atherogenic factors in dyspeptic patients at St. Paul's Hospital Millennium Medical College, from November 2019 to June 2020. Materials and methods: This institution-based cross-sectional study was examining 346 dyspeptic patients at SPHMMC from November 2019 to June 2020. A structured questionnaire was used to collect socio-demography data and anthropometric measurement was taken. Biochemical parameters were measured in serum samples by using Cobas 6000 clinical chemistry analyzer. Data were coded and entered into a statistical package for social sciences (SPSS) version 23 for analysis. Risk factors were identified using logistic regression. Hence, a bivariate logistic regression analysis test was conducted and variables with a p < 0.25 were included in the multivariate logistic regression model. P-values ≤0.05 were considered as a cut point for statistical significance in the final model. Results: An overall prevalence of dyslipidemia among study participants was 253 (73.12 %). Among those who tested positive for H. pylori, 119/174 (68.39 %) had dyslipidemia in at least one lipid profile, while 8 (4.60%) had dyslipidemia in all four lipid profiles. After adjusting for traditional dyslipidemia risk factors, age >45 (AOR 4.864, 95% CI 2.281-4.080, P < 0.001), systolic blood pressure >120mmHg (AOR 1.036, 95% CI 1.009-1.065, P = 0.036) and being H. Pylori seropositive (AOR 0.555, 95% CI 0.318-0.967, P = 0.038) were an independent predictors of dyslipidemia. Conclusion: This study reported that more than two-thirds of the H. pylori seropositive groups had exhibited dyslipidemia in at least one lipid profile, which can accelerate the incidence of atherosclerosis process.

Comparison of syndromic versus laboratory-confirmed diagnosis of Neisseria gonorrhoeae and Treponema palladium, infections at the selected health centers in Addis Ababa, Ethiopia.

BACKGROUND: Sexually transmitted infections (STIs) are major infectious diseases worldwide. Around one million people get STIs every day and among them a high burden of the diseases seen in Sub-Saharan African countries. In most developing countries, including Ethiopia, STIs are diagnosed only using syndromic methods, although there seems to be no consensus between syndromic and laboratory-based research. OBJECTIVE: To compare the effectiveness of a syndromic versus laboratory-based approach in the diagnosis of sexually transmitted infections, especially Neisseria gonorrhoeae (NG) and Treponema palladium (TP), infections among those attending a public health center in Addis Ababa, Ethiopia. METHODS: a cross-sectional study was conducted from April 2019 to March 2020, at selected health centers STIs clinics in Addis Ababa, Ethiopia. A total of 325 study participants were involved. From each participant after having socio-demographic data, additional blood, urethral and vaginal discharge was collected. Then serological, Gram stain, culture, and biochemical tests were performed. SPSS version 23 was used to enter and analyze data. All relevant bodies provided ethical approval, and each study participant gave written informed consent. RESULTS: Among the total participants 167 (51.4%) were males; 177 (54.5%) between ages of 26 and 35; and 178(54.8%) single. Of the total 325 NG, and 125 TP syndromic managed suspected cases, only 163 (50%) and 38 (30.4%) were laboratory- confirmed positive cases respectively. However, there was no statistically significant difference between NG and TP syndromic versus laboratory diagnostic confirmed cases (P-value > 0.005). CONCLUSION: The present study indicated that even if, there were no statistical differences between syndromic versus Laboratory diagnosis confirmed NG and TP cases, more than half of syndromic cases could not be confirmed by laboratory diagnosed tests. Thus, to strengthen the present findings, further large-scale studies are recommended.

Sexually transmitted infections (STIs) are the leading infectious diseases worldwide, and the majority of cases are recorded in developing countries, including Ethiopia. However, diagnosis of STIs in most developing countries done syndromic based, since the laboratory-based tests are relatively expensive, need skilled manpower, and time taking. Therefore regular assessments on how closely related STIs syndromic versus laboratory-based diagnosis should be done, for the proper management of the diseases. In this regard, the present study demonstrated that there was no statistically significant difference between syndromic versus laboratory-based diagnosis of some certain STIs infections; Neisseria gonorrhoeae (NG) and Treponema pallidum (TP), in selected public health centers in Addis Ababa, Ethiopia. However, more than half of syndromic cases could not be confirmed by laboratory diagnosed tests. Thus, to narrow the gap between the two diagnostic approaches, regular training, updates, and similar studies need to cascade in the country. In the meantime, in other developing countries too, regular assessment on STIs syndromic versus laboratory-based diagnosis should be done, to control and prevent STIs infections worldwide.

Evaluating performance of multiplex real time PCR for the diagnosis of malaria at elimination targeted low transmission settings of Ethiopia.

BACKGROUND: Malaria incidence has declined in Ethiopia in the past 10 years. Current malaria diagnostic tests, including light microscopy and rapid antigen-detecting diagnostic tests (RDTs) cannot reliably detect low-density infections. Studies have shown that nucleic acid amplification tests are highly sensitive and specific in detecting malaria infection. This study took place with the aim of evaluating the performance of multiplex real time PCR for the diagnosis of malaria using patient samples collected from health facilities located at malaria elimination targeted low transmission settings in Ethiopia. METHODS: A health facility-based, cross-sectional survey was conducted in selected malaria sentinel sites. Malaria-suspected febrile outpatients referred to laboratory for malaria testing between December 2019 and March 2020 was enrolled into this study. Sociodemographic information and capillary blood samples were collected from the study participants and tested at spot with RDTs. Additionally, five circles of dry blood spot (DBS) samples on Whatman filter paper and thick and thin smear were prepared for molecular testing and microscopic examination, respectively. Multiplex real time PCR assay was performed at Ethiopian Public Health Institute (EPHI) malaria laboratory. The performance of multiplex real time PCR assay, microscopy and RDT for the diagnosis of malaria was compared and evaluated against each other. RESULTS: Out of 271 blood samples, multiplex real time PCR identified 69 malaria cases as Plasmodium falciparum infection, 16 as Plasmodium vivax and 3 as mixed infections. Of the total samples, light microscopy detected 33 as P. falciparum, 18 as P. vivax, and RDT detected 43 as P. falciparum, 17 as P. vivax, and one mixed infection. Using light microscopy as reference test, the sensitivity and specificity of multiplex real time PCR were 100% (95% CI (93-100)) and 83.2% (95% CI (77.6-87.9)), respectively. Using multiplex real time PCR as a reference, light microscopy and RDT had sensitivity of 58% (95% CI 46.9-68.4) and 67% (95% CI 56.2-76.7); and 100% (95% CI 98-100) and 98.9% (95% CI 96-99.9), respectively. Substantial level of agreement was reported between microscopy and multiplex real time PCR results with kappa value of 0.65. CONCLUSIONS: Multiplex real-time PCR had an advanced performance in parasite detection and species identification on febrile patients' samples than did microscopy and RDT in low malaria transmission settings. It is highly sensitive malaria diagnostic method that can be used in malaria elimination programme, particularly for community based epidemiological samples. Although microscopy and RDT had reduced performance when compared to multiplex real time PCR, still had an acceptable performance in diagnosis of malaria cases on patient samples at clinical facilities.

Effect of Gasoline Exposure on Hematological Parameters of Gas Station Workers in Mekelle City, Tigray Region, Northern Ethiopia.

BACKGROUND: The adverse health effects of chronic gasoline exposure may be related to impairment of the hematopoietic system with bone marrow suppression, an increased risk of blood cell morphology abnormality and developing cancer. OBJECTIVE: To assess the effect of gasoline exposure on hematological parameters among gas station workers in Mekelle City, Tigray Region, Northern Ethiopia. METHODS: This cross-sectional study was carried out on 43 subjects (exposed group) and 77 subjects (unexposed group) with matched age and sex. Socio-demographic characteristics and duration of exposure data were collected using a structured questionnaire and an observation checklist. Sysmex XP-300 was used for hematological analysis and stained peripheral blood smear was examined for any abnormality. Data were entered and analyzed using SPSS version 23. RESULTS: Of exposed individuals, 28/43 (65.1%) and 49/77 (63.6%) of controls were males. The average exposure time was 5.19±4.38 years, with an average working hour of 11.74±1.89 hours/day. The mean RBC count (1012/L), HCT (%), HGB (g/dl) and platelets count (109/L) of the exposed group were significantly lower (4.88±0.573, 43.29±3.71, 15.04±1.33 and 248.95±58.19) compared with controls (5.35±0.533, 44.95±3.10, 15.59±1.26 and 292.45±62.17) at p<0.05, respectively. The MCH (pg) (30.48±2.06 vs 29.52±1.66) and MCHC (g/dl) (34.83±0.988 vs 34.32±0.927) were significantly higher in the exposed group compared with controls (p<0.05). HCT, RBC, HGB and platelet counts were significantly decreased with increased years of exposure (p<0.05). The peripheral blood film examination revealed basophilic stippling and macrocytosis in 9.3% of the exposed group. CONCLUSION: Long-term exposure to gasoline at gas stations affected RBC parameters and platelet count. A significant negative correlation was noted between duration of exposure and HGB, HCT and platelet count, warranting implementation of protective measures at gas stations.

Thyroid Profile and Factors Associated with Hypothyroidism Among Multidrug-Resistant Tuberculosis Patients Attending Saint Peter's Specialized Hospital Addis Ababa, Ethiopia.

BACKGROUND: The emergence of MDR-TB is a global public health problem. Hypothyroidism is one of the severe adverse drug reactions (ADRs) in MDR-TB patients on treatment. Representative data on hypothyroidism and its associated factors among MDR-TB patients are lacking. OBJECTIVE: To determine thyroid profiles and associated risk factors among multidrug-resistant TB patients during therapy with anti-MDR-TB regimen in Saint Peter Specialized Hospital Addis Ababa, Ethiopia from January to November 2020. METHODS: A cross-sectional study was conducted in MDR-TB patients in Addis Ababa, Ethiopia. A total of 162 patients, who were older than 18 years, had bacteriologically confirmed MDR-TB and on treatment for more than one month were enrolled consecutively from the TB registration book. However, critically sick patients and those who were receiving additional drugs known to cause severe ADRs were excluded. Simple descriptive statistics were used to present the socio-demographic and clinical characteristics of the patients. A logistic regression model was used to assess the association between independent and dependent variables. A p-value <0.05 was considered as statistically significant in all analyses. RESULTS: Mean age of the study participant was 35.9 ± 13.6 years. The prevalence of hypothyroidism was 32 (19.8%). The presence of co-morbidity, being underweight, and prothionamide use were significantly associated with hypothyroidism in MDR-TB patients on treatment. CONCLUSION: Hypothyroidism occurs commonly among MDR-TB patients. Presence of co-morbidity, being underweight, and prothionamide drug use are the factors associated with hypothyroidism. Monitoring of thyroid function test during MDR-TB treatment and factors associated with hypothyroidism require attention to prevent complication.

Intestinal helminthic infection and allergic disorders among school children enrolled in mass deworming program, Sululta, Ethiopia.

BACKGROUND: Intestinal helminths have been proposed to have a protective role against allergic sensitization and atopic diseases. However, consistent data demonstrating this are lacking in Sub-Saharan countries. We aimed to assess the association between intestinal helminths and allergic disorders among school children enrolled in mass deworming program in Sululta, Ethiopia. METHODS: A cross sectional study was conducted among 526 school children aged 5 to 14 years old from primary government schools in Sululta district, Ethiopia. An interviewer-led questionnaire administered to parents provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were collected using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire 6 months following deworming treatments. Atopy was defined as a positive skin prick test reaction to one or both dust mite (Dermatophagoides) and German cockroach (Blatella germanica) allergens. Fresh stool samples were collected, processed, and examined by direct wet mount, Kato-Katz technique, and formol-ether concentration technique. Multivariate logistic regressions were used to assess the association between allergic disorder and helminths infection. RESULTS: Of the total 526 school children, 58.2% were females. Overall, 24% (126/526) had allergic symptoms, 5.1% (27/526) had atopy, and 16.9% (89/526) had intestinal helminths. There was no association between helminthic infection and self-reported allergic symptoms (P = 0.317), but Ascaris lumbricoides infection was positively associated with atopy (AOR = 4.307, 95% CI 1.143-16.222, P = 0.031). Atopy was related to increased allergy symptoms (AOR = 2.787, 95% CI 1.253-6.197, P = 0.012), and family history of allergy was associated with increased childhood allergy (AOR = 2.753, 95% CI 1.565-4.841, P = 0.001). Deworming in the past 6 months showed a reduced odd of self-reported allergic symptoms (AOR = 0.581, 95% CI 0.366-0.954, P = 0.034). CONCLUSION: While no significant association between self-reported allergy and helminths was found in this study, this may have been due to the low prevalence and intensity of helminthic infection in the sample. There was a positive association between Ascaris lumbricoides and atopy. To further examine the underlying mechanism behind this positive association, a longitudinal study is needed.

Distribution and determinants of serum high-sensitivity C-reactive protein in Ethiopian population.

BACKGROUND: C-reactive protein (CRP) is an important inflammatory marker associated with different disease conditions, and its concentration differs among ethnicity. This study aimed to determine the distribution and determinants of serum high-sensitive method CRP (hsCRP) that can measure the typically low concentrations, among the Ethiopian population, for which there is no data. METHODS: A cross-sectional community-based study was conducted in April-June 2015. A total of 5162 individuals aged 15-69 were included. Behavioral, physical, and biochemical measurements were taken using the WHO STEPS non-communicable diseases (NCDs) risk factors assessment tool. Serum hsCRP was determined using Cobas Integra 400 Plus (Roche). Factors associated with hsCRP levels were also considered. RESULTS: median hsCRP was 0.80 mg/L (Interquartile range, 0.19-2.12) (males: 0.91 mg/L, females: 0.74 mg/L). More than 18% of the study participants had hsCRP greater than 3 mg/L according to the American Heart Association and Centers for Diseases Control and Preventions cut off value. Higher BMI, living in Somali and in Dire Dawa region, and not consuming of fruit or vegetables were independent risk factors for high hsCRP levels. CONCLUSION: Serum hsCRP levels distribution is comparable to other studies. Until now, no data have been reported in the literature about the Ethiopian population.

Alteration of Clinical Chemistry Parameters Among Visceral Leishmaniasis Patients in Western Tigrai, Ethiopia, 2018/2019: A Comparative Cross-Sectional Study.

BACKGROUND: Visceral leishmaniasis causes alterations of lipid metabolism and it is associated with hypocholesterolemia and severe hypertriglyceridemia. Hepatic dysfunction and life-threatening hepatitis are associated with visceral leishmaniasis. Kidney damage is frequently associated with increased morbidity and mortality in visceral leishmaniasis patients. METHODS: A cross-sectional study was carried out to assess the alterations of clinical chemistry parameters among visceral leishmaniasis patients attending Kahsay Abera and Mearg hospitals, Northwest Ethiopia. A total of 100 visceral leishmaniasis patients and 100 healthy controls without visceral leishmaniasis were selected by using convenient sampling techniques. Data were entered and analyzed using statistical package for social sciences (SPSS) version 23. RESULTS: Results were showed that the mean value of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, and triglyceride was significantly higher in visceral leishmaniasis patients than in apparently healthy controls, but the mean value of serum urea and total cholesterol was significantly lower in visceral leishmaniasis patients than healthy controls. CONCLUSION: The finding of this study concluded that visceral leishmaniasis causes significant alterations of clinical chemistry tests like liver and lipid profile tests compared to healthy controls.

Community based reference interval of selected clinical chemistry parameters among apparently healthy Adolescents in Mekelle City, Tigrai, Northern Ethiopia.

BACKGROUND: Locally established clinical laboratory reference intervals (RIs) are required to interpret laboratory test results for screening, diagnosis and prognosis. The objective of this study was establishing reference interval of clinical chemistry parameters among apparently healthy adolescents aged between 12 and 17 years in Mekelle, Tigrai, northern part of Ethiopia. METHODS: Community based cross sectional study was employed from December 2018 to March 2019 in Mekelle city among 172 males and 172 females based on Multi stage sampling technique. Blood samples were tested for Fasting blood sugar (FBS), alanine aminino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP), Creatinine, urea, total protein, albumin (ALB), direct and indirect bilirubin (BIL.D and BIL.T) using 25 Bio system clinical chemistry analyzer. Results were analyzed using SPSS version 23 software and based on the Clinical Laboratory Standard Institute (CLSI)/ International Federation of Clinical Chemistry (IFCC) C 28-A3 Guideline which defines the reference interval as the 95% central range of 2.5th and 97.5th percentiles. Mann Whitney U test, descriptive statistics and box and whisker were statistical tools used for analysis. RESULTS: This study observed statistically significant differences between males and females in ALP, ALT, AST, Urea and Creatinine Reference intervals. The established reference intervals for males and females, respectively, were: ALP (U/L) 79.48-492.12 versus 63.56-253.34, ALT (U/L) 4.54-23.69 versus 5.1-20.03, AST 15.7-39.1 versus 13.3-28.5, Urea (mg/dL) 9.33-24.99 versus 7.43-23.11, and Creatinine (mg/dL) 0.393-0.957 versus 0.301-0.846. The combined RIs for Total Protein (g/dL) was 6.08-7.85, ALB (g/dL) 4.42-5.46, FBS(mg/dL) 65-110, BIL.D (mg/dL) 0.033-0.532, and BIL.T (mg/dL) 0.106-0.812. CONCLUSIONS: The result showed marked difference among sex and with the company derived values for selected clinical chemistry parameters. Thus, use of age and sex specific locally established reference intervals for clinical chemistry parameters is recommended.

Preparation of In-House Quality Control Human Serum for Urea and its Use in Clinical Chemistry.

BACKGROUND: Quality control materials play a vital role in the laboratory internal and external quality assessment program. However, Ethiopia and other developing countries are challenged by the unavailability and high cost of commercial control material. Therefore, preparing in-house quality control human serum will be a cost-effective way to obtain QC material for use in poor settings in a country like Ethiopia. To prepare urea in-house control human serum and scientifically evaluate it with commercially available sera already in use in the clinical chemistry laboratory of the Ethiopian Public Health Institute. METHODS: The urea in-house quality control human serum was prepared as per ISO Guide 80, a guideline document protocol from 57 participants' normal serum specimens at the Ethiopian Public Health Institute clinical chemistry laboratory. The quality control material was analyzed on a fully automated chemistry analyzer (Cobas 6000). The initial 20 values were used for calculation of means, standard deviation (SD) and coefficient of variation (CV). Results were compared with those of commercially available lyophilized human sera. RESULTS: The average concentrations of urea were found to be near the middle of the physiological range of healthy subjects and the in-house serum could be a good substitute for the commercial serum of normal range. The prepared in-house quality control human serum is stable for about three months without any alterations in the concentration of urea. CONCLUSIONS: Well prepared in-house quality control human serum is a good substitute for commercially available control serum of normal range, especially in a developing country like Ethiopia.

Human Monocytes/Macrophage Inflammatory Cytokine Changes Following in vivo and in vitro Schistomam manoni Infection.

INTRODUCTION: Epidemiological and animal studies indicate that helminth infections have positive effects due to their potential to protect against autoimmune diseases. Here, we aim to assess the effect of S. mansoni infection on immune modulation of human monocytes and their potential protection against autoimmune disease development both in vivo and in vitro. MATERIALS AND METHODS: Monocytes were isolated from helminth-infected Ethiopians (MHIE), and from Dutch healthy volunteers (MHV). The MHV were stimulated in vitro with S. mansoni soluble egg antigens (SEA) or soluble worm antigens (SWA). In addition, phenotypical changes were studied directly, as well as after culturing for 6 days in the presence of human serum to obtain macrophages. Q-PCR, flow cytometry, multiplex bead immunoassay, and live-cell imaging were employed during analysis. RESULTS: MHIE showed elevated transcripts of SOCS-1 and TNF-α compared to MHV. Similarly, MHV that were stimulated with SEA demonstrated enhanced levels of SOCS-1, IL-10, and IL-12 mRNA, compared to control MHV. Remarkably, the SEA-treated monocytes showed a much higher motility than control monocytes, a hallmark of a patrolling phenotype. Furthermore, in vitro cultured macrophages that were stimulated by SEA exhibited enhanced mRNA levels of SOCS-1, IL-10, TNF-α, IL-12 and TGF-ß, compared to control macrophages. CONCLUSION: Macrophages from MHIE as well as SEA-treated MHV show an intermediate activation phenotype with both pro-inflammatory and anti-inflammatory characteristics in vitro. The observed pro-inflammatory properties might reflect a recent response of the cells due to contact with a pathogen, whereas the anti-inflammatory properties might contribute to helminth-induced protection against inflammatory diseases. Large-scale study is recommended to consolidate the findings of the present study.

Evaluation of Laboratory Performance, Associated Factors and Staff Awareness Towards Achieving Turnaround Time in Tertiary Hospitals, Ethiopia.

BACKGROUND: WHO recommends that each laboratory should establish turnaround time (TAT) to monitor and evaluate performance throughout processes. The status of established TAT was not yet assessed in Ethiopian Armed Force Comprehensive Specialized Hospital. The aim of this study was to evaluate the laboratory performance and associated factors towards achieving TAT in clinical chemistry and hematology tests at Armed Force Comprehensive Specialized Hospital, Addis Ababa, Ethiopia. METHODS: Hospital-based cross-sectional study was conducted from April 2019 to June 2019. Standardized questionnaire was designed to collected data on awareness of laboratory staffs about TAT. The data was entered, cleaned and analyzed using SPSS version 24.0 Software. Logistic regression analysis was done to find out statistically significant association and strength of association between dependent and independent variables at pvalue <0.05. RESULT: A total of 422 test results were systematically selected with 100% response rates. Of these, 253(59.9%) were chemistry tests. From the expected < 90min TAT clinical chemistry tests, only 41(16.2%) and from < 60min TAT time for hematology tests, 37(21.9%) met the target. The laboratory TAT was affected by factors including high work load, laboratory information system problem, power interruption and sample collection time. Moreover, the level of knowledge, attitude and practices of laboratory staffs towards laboratory TAT were 60%, 85.7% and 62.9% respectively. CONCLUSION: Overall achievement of clinical Chemistry and hematology tests TAT was poor. The finding might reflect other public hospital situation in Addis Ababa. Thus, additional large scale studies need to conduct.

Evaluation of Visual Serum Indices Measurements and Potential False Result Risks in Routine Clinical Chemistry Tests in Addis Ababa, Ethiopia.

BACKGROUND: Serum indices (SI) including hemolyzed, lipemic, and icteric samples, affects the accuracy of test result. The aim of this study was to evaluate SI values done by visual inspections and potential false result risks by comparing with actual measurements done by Cobas 6000 Chemistry analyzer at Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia. METHODS: An observational, cross-sectional study was conducted from April to May 2017 on samples referred to Clinical Chemistry laboratory of EPHI, Ethiopia. These samples SI values, after visual inspection by three trained observers, was analyzed again on Roche Cobas 6000 analyzer (RCA). The generated data was analyzed by using weighted kappa methods on STAT statistical software version 20. RESULTS: From a total of 1509 samples, SI values identified by the RCA as hemolysis, icteric, and lipemic were 933 (62%), 74(5%) and 59(4%) respectively. The SI average weighted kappa between RCA and visual inspection were: 0.1870, 0.3421, and 0.1259 for hemolysis, icteric, and lipemic samples, respectively. Combined inter-observers variability among observers for hemolysis, Icterus, and lipemic samples were 0.4758, 0.3258, and 0.3628 respectively. The best agreement among observers was in the case of hemolysis (0 grades), while the lowest agreement was observed in the case of icterus (+3 grades). In addition, test parameters, such as CK-MB (22%), and LDH (20%) were falsely accepted, whereas Cl- and Na+ (up to 25%) were falsely rejected tests by observers. On the other hand, results rejected by Cobas SI assessments included CK-MB (22%), LDH (20%), and BIL-D (4%). CONCLUSION: Visual inspection of SI showed poorly agreement with automated system. Thus, there is genuine need for more training of Laboratory professionals on identification of SI, and as much as possible SI should be done by automated system to improve quality of test results.

The serum concentration of vitamin B12 as a biomarker of therapeutic response in tuberculosis patients with and without human immunodeficiency virus (HIV) infection.

BACKGROUND: Prior to clinical trials of new tuberculosis (TB) drugs or therapeutic vaccines, it is necessary to develop monitoring tools to predict treatment outcomes in TB patients. METHODS: Micronutrients concentration level was determined from a total of 262 study participants with five clinical groups: 57 TB patients coinfected with HIV (HIV+TB+), 87 active TB Patients (TB cases), 71 HIV infected without active and latent TB infection (HIV+TST-), 22 latent TB infection (TST+) and 25 healthy controls (TST-). Vitamin A concentration was measured using high-performance liquid chromatography (HPLC), whereas iron and vitamin B12 concentrations were measured using Cobas® 6000 analyzer. RESULT: The serum concentration levels of iron, vitamin A and vitamin B12 had a significant difference between active TB and latent (LTBI) or healthy controls. Six months after treatment, the serum concentration levels of vitamin A, vitamin B12 and iron in tuberculosis became indistinguishable from the levels of LTBIs and healthy control individuals. The concentration levels of iron and vitamin B12 in HIV+TB+patients at the end of TB treatment were normalized to the levels observed in healthy controls (TST-) regardless of HAART treatment. However, the concentration level of vitamin A in HIV+TB+patients HAART untreated at the end of TB treatment was not normalized to the levels observed in healthy controls (TST-) or HAART untreated HIV+TST-. CONCLUSION: Detecting serum concentration levels of vitamin B12 and vitamin A might be used as a biomarker of the diagnostic method of active TB regardless of HIV-infected individuals. Moreover, detecting serum concentration of vitamin B12 might also be used for TB treatment responses monitoring biomarker in TB-HIV-co-infected individuals regardless of HAART (in)eligibility and therapy.

Increased Prevalence of Cestode Infection Associated with History of Deworming among Primary School Children in Ethiopia.

Mass deworming of school-aged children with anthelmintics has been recognized as an effective approach for reducing the burden of soil-transmitted helminth (STH) infections. However, the consequences of this intervention on nontargeted parasite populations sharing the same gastrointestinal niche are unclear. We conducted a cross-sectional survey among three primary schools in Sululta town, Ethiopia, to examine the association between students' histories of deworming treatment in the past 6 months and the prevalence of cestode and protozoan infections. An interviewer-led questionnaire administered to parents provided information on sociodemographic factors, and deworming status was ascertained from school records. Stool samples were collected from 525 children for microscopic examination. The independent associations of "any cestode" (positive either for Hymenolepis nana or Taenia spp. eggs) and "any protozoan" (positive either for Giardia lamblia or Entamoeba histolytica/Entamoeba dispar) with history of deworming were examined using logistic regression. Overall, 25.9% of children were infected with at least one intestinal parasite of which H. nana was the most common. In multivariate analyses, deworming in the past 6 months was positively associated with increased odds of both "any protozoan" and "any cestode" infections; the latter reached statistical significance (AOR = 1.83, 95% CI: 0.69-4.86, P = 0.220, AOR = 3.82, 95% CI: 1.17-12.73, P = 0.029, respectively). If this observed association is causal, a greater understanding of interspecies interactions within the gastrointestinal niche may elucidate possible consequences of mass deworming treatments against STHs on coexisting nontargeted parasites.

Inverse Associations of Schistosoma mansoni Infection and Metabolic Syndromes in Humans: A Cross-Sectional Study in Northeast Ethiopia.

BACKGROUND: Recent animal and retrospective human studies have demonstrated that Schistosoma mansoni infection may have potential to protect against development of metabolic syndromes. Thus, the aim of this study was to assess metabolic panel among S. mansoni egg positives and egg negatives in stool examinations. This study was a cross-sectional study, conducted involving 120 participants from S. mansoni endemic town (Kemise) and 61 from non-endemic town (Kombolcha), Northeast Ethiopia. Stool samples were collected and examined for S. mansoni and other helminths using Kato-Katz method. Furthermore, blood samples were collected and used for determination of blood sugar, lipid profile tests, insulin, and C-reactive protein. Data were analyzed using SPSS software version 20. Chi-square test, independent mean t-test, and logistic regression models were employed on data. P values less than .05 were considered as statistically significant. RESULTS: S. mansoni infected participants (n = 41; all from Kemise) had significantly lower levels of fasting blood sugar, low prevalence of dyslipidemia (at least one or more abnormal lipid profile tests; total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) as compared with controls (n = 79 in Kemise and 61 in Kombolcha). Moreover, logistic regression model indicated that with the adjusted odds ratios, there was significant inverse association between S. mansoni infection and impaired fasting glucose (adjusted odds ratio -0.181, 95% confidence interval: 0.042-0.774). CONCLUSIONS: Low fasting blood sugar and reduced prevalence of dyslipidemia in S. mansoni egg positive participants might suggest inverse association of S. mansoni infection and development of metabolic syndromes. Furthermore, large-scale studies are recommended to assess the role of S. mansoni egg and/or worm antigens in modulating the host metabolic profile and reducing the risk of metabolic syndromes, including diabetes mellitus and cardiovascular diseases.