Assessment of liver function tests of women taking hormonal contraceptives at University of Gondar comprehensive specialized hospital and Family Guidance Association of Gondar (FGAE), 2022; a comparative cross-sectional study.

INTRODUCTION: Hormonal contraceptives are artificial preparations that contain artificial progestins and Ethinylestradiol; these preparations are utilized by women of reproductive age to prevent pregnancy. Roughly a billion women in the world use some form of contraceptive worldwide. Despite the utility of these preparations, they are linked with several adverse effects, including disturbances of liver functionality and integrity. However, previous studies conducted to assess the association between hormonal contraceptive utilization and liver function tests reported conflicting results, and the effects remained a matter of concern. METHODS: The study enrolled a total of 264 participants, who were allocated into two groups. One group of hormonal contraceptive users who use the medication for a minimum of six months: Depot medroxyprogesterone acetate (DMPA), combined oral contraceptives (COC), Norplant, and Implant users and another age-matched non-user control group in a ratio of 1:1. A semi-structured questionnaire was used to collect socio-demographic, behavioral, and clinical data. Five ml serum blood sample was collected for liver function test analysis on a Beckman Coulter Clinical Chemistry analyzer (DXC 700 AU). Independent t-test was used to compare liver function tests of hormonal contraceptive users and non-user controls, whereas ANOVA followed by a Bonferroni post hoc test was used for intra- (between classes of contraceptives) and inter-group (between each class of contraceptives and controls) comparisons and to identify factors associated. RESULTS: Hormonal contraceptive users were observed to have a statistically significant higher mean value of liver enzymes assessed compared to non-user control groups: aspartate aminotransferase (AST) (47.07±14.79 versus 25.92±7.37; p <0.001), alanine aminotransferase (ALT) (35.83±13.76 versus 16.56 ± 5.03; p <0.001), alkaline phosphatase (ALP) (63.34±14.74 versus 45.41±14.34, p <0.001) and for γ-glutamyl transferase (GGT) (47.37±24.32 versus 19.45 ± 6.86 p <0.001). Similarly, the mean value of total and direct bilirubin (mg/dL) among HC users showed a statistically significant elevation (0.68 ± 0.22 against 0.32 ± 0.13, p <0.001) for total bilirubin and (0.14 ± 0.06 against 0.06 ± 0.03, p <0.001) for direct bilirubin respectively. However, no statistically significant result was observed in the mean values of total protein and albumin. For total protein (6.7 ± 0.89 versus 6.5 ± 1.15, p 0.07) and for albumin (5.4 ± 0.92 versus 5.3 ± 1.08; p 0.30). The current study also indicates the level of hepatic function test alteration is related to the type of hormonal contraceptives, duration of usage, and level of adherence to a specific class of contraceptives. CONCLUSION AND RECOMMENDATION: Hormonal contraceptive use was observed to affect hepatic function. Based on this finding, we strongly recommend to closely monitor liver function tests in women using hormonal contraceptives.

The Association between Neutrophil-to-Lymphocyte Ratio and Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Background: Glycated hemoglobin (HbA1c) is a commonly used clinical marker to monitor the control of type 2 diabetes mellitus patients (T2DM). However, it is unable to identify the ongoing inflammatory changes in the body. These factors could be easily identified and monitored by the neutrophil-to-lymphocyte ratio (NLR). Therefore, this study is aimed at investigating the relationship between NLR and glycemic control in T2DM. Method: A comprehensive search of eligible studies was performed in various databases published until July 2021. A random effect model was used to estimate the standardized mean difference (SMD). A metaregression, subgroup, and sensitivity analysis were conducted to search for potential sources of heterogeneity. Result: A total of 13 studies were included in this study. Accordingly, the SMD of the NLR values between the poor and good glycemic control groups was 0.79 (95% CI, 0.46-1.12). Our study also showed that high NLR was significantly associated with poor glycemic control in T2DM patients (OR = 1.50, 95% CI: 1.30-1.93). Conclusion: The results of this study suggest an association between high NLR values and an elevated HbA1C in T2DM patients. Therefore, NLR should be considered a marker of glycemic control in addition to HbA1c in T2DM patients.

Assessment of Electrolyte Imbalance and Associated Factors Among Adult Diabetic Patients Attending the University of Gondar Comprehensive Specialized Hospital, Ethiopia: A Comparative Cross-Sectional Study.

Introduction: Electrolyte imbalance refers to altered electrolyte levels that predominantly affect diabetic patients due to hyperglycemia which rise plasma osmolality and impaired renal function, contributing to a change in electrolyte level. Therefore, this study aimed to assess the prevalence of electrolyte imbalance and its associated factors among diabetic patients and healthy control groups attending the University of Gondar Comprehensive Specialized Hospital. Patients and Methods: A comparative cross-sectional study was conducted on 130 diabetic patients and 130 diabetes-free controls. Sociodemographic, behavioral and clinical data were collected using a structured questionnaire. After measuring anthropometric parameters, 5mL of the blood sample was collected. Electrolytes were measured based on ion-selective electrode methods. Fasting blood glucose, and creatinine were measured by spectrophotometric enzyme hexokinase, and Jaffe reaction methods, respectively. The data was entered into Epi-data version 4.6 and analyzed using STATA version 14. Mann-Whitney U-tests and independent t-tests were used for comparison. Multiple logistic regression analysis was done to determine the factors associated with electrolyte imbalances. P-value <0.05 was considered statistically significant. Result: The overall prevalence of electrolyte imbalance among diabetic patients and controls were 83.07% and 52.31%, respectively. The mean of Na+ and the median level of Mg2+ and Ca2+ were significantly decreased. However, the mean level of Cl- was significantly increased in diabetic patients as compared to control groups. In multivariable logistic regression: alcohol consumption AOR = 3.34 [1.02-10.9], no formal education AOR = 5.38 [1.14-25.4], hyperglycemia AOR = 6.32 [2.04-19.5], and urbanization AOR = 5.6 [1.44-22.3] showed significant association with electrolyte imbalance. Conclusion: Diabetic patients have more likely to develop electrolyte imbalance than control groups. Diabetic participants showed significantly reduced Na+, Mg2+, and Ca2+ levels and significantly increasing CI- levels when compared to control groups. Hyperglycemia, alcohol drinking habits, urbanization, and no-formal education were statistically significantly associated with electrolyte imbalance.

Serum lipid profile of stroke patients attending at Dessie comprehensive specialized hospital, Dessie, Northeast Ethiopia: A comparative cross-sectional study.

Background: Stroke is a leading cause of adult disability and death worldwide. Serum lipid levels have established effects on short-term stroke mortality. To reduce the incidence of stroke and stroke-related mortality, it is important to assess lipid levels in subtypes of strokes. Hence, the main aim of this study was to assess lipid profile and associated factors among stroke patients. Methods: A comparative cross-sectional study was conducted by recruiting 278 (139 stroke patients and 139 controls) study participants selected by convenient sampling technique from March to July 2021. Socio-demographic, behavioral, and clinical data were collected using a semi-structured questionnaire. Ethical approval was obtained from University of Gondar. After obtaining informed consent, about 5 ml of venous blood was collected to perform lipid profile using DIRUI CS-T240 automated clinical chemistry analyzer. Independent t-test, Mann-Whitney U test, Kruskal-Wallis H test, correlation tests, and logistic regression were used during data analysis. A p-value of <0.05 was considered statistically significant. Results: The current study found that total cholesterol (170.24 ± 44.66) and low-density lipoprotein cholesterol (114.07 ± 35.82) were significantly higher in stroke patients than in the control group (155.22 ± 18.09) and (103.14 ± 15.65), respectively (P < 0.05). On the other hand, triglycerides (127 (104-141)) and high-density lipoprotein cholesterol (52 (48-57)) were significantly lower in stroke patients than in the control group (127 (104-141)) and (52 (48-57)), respectively (P < 0.05). Additionally, patients with ischemic stroke had significantly higher serum low-density lipoprotein than hemorrhagic stroke patients and controls (P < 0.05). Likewise, patients with hemorrhagic stroke had significantly lowered serum triglyceride levels than ischemic stroke patients and controls (P < 0.05). Dyslipidemia was found in 51.1% of stroke patients. Active smokers (AOR = 6.54, 95% CI = 1.56-27.33), being female (AOR = 3.64, 95% CI = 1.49-8.88), current alcohol drinkers (AOR = 3.51, 95% CI = 1.01-12.25), being diabetes patients (AOR = 3.65, 95% CI = 1.14-11.60) and high body max index (AOR = 4.07, 95% CI = 1.50-11.05) were significantly associated with dyslipidemia. Conclusions: The overall dyslipidemia and lipid fraction abnormalities were higher in stroke patients. Efforts should be focused towards addressing these lipid abnormalities through lifestyle modification, health education and lipid reduction therapies in order to reduce their adverse effects.

Assessment of Serum Uric Acid, Urea, and Glucose Levels and Associated Factors among Breast Cancer Patients Attending A Tertiary Hospital in Bahirdar, Ethiopia: A Comparative Cross-Sectional Study.

Background: Breast cancer is currently become a major public health problem in both developed and developing regions, it is one of the most common surgical problems in Ethiopia. Therefore, this study assessed serum uric acid, urea, and glucose levels and associated factors among benign, malignant breast cancer patients and apparently healthy women attending at Felege-Hiwot comprehensive Specialized Hospital. Methods: Hospital based comparative cross-sectional study was conducted among benign, malignant breast cancer patients and apparently healthy women attending at Felege-Hiwot Comprehensive Specialized Hospital. Out of 178 study participants 66 benign and 23 malignant fine needle aspirate cytology confirmed breast cancer patients and 89 apparently healthy women, included. Multivariable logistic regression models used to measure the strength of associations. A P value of < 0.05 was considered statistically significant. Results: Majority of the study participants, 81(91%) controls, 55(83.3%) benign, and 17(73.9%) malignant cases were premenopausal. Serum glucose 144.47±74.35 and uric acid 6.84±2.54 levels were significantly elevated in malignant cases than control (p-value< 0.05). Patients with malignant status were 4.38 times more likely to have hyperglycemia (AOR=4.38, 95%CI: 1.98-19.97) and 5.53 times more likely have hyperuricemia (AOR=20.43-95% CI: 6.80-61.23), 4 times more likely to have uremia (AOR=4.09, 95% CI: 1.06-15.91) compared to apparently healthy women. Conclusion: Serum glucose, and uric acid levels were significantly higher in malignant and benign cases compared with apparently healthy women. Family history of breast cancer, body mass index, systolic hypertension, comorbidity, residence and menopausal status were significantly associated with hyperglycemia, uremia and hyperuricemia.

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.

Assessment of Serum Uric Acid, Urea, and Glucose Levels and Associated Factors among Breast Cancer Patients Attending A Tertiary Hospital in Bahirdar, Ethiopia: A Comparative CrossSectional Study

BACKGROUND: Breast cancer is currently become a major public health problem in both developed and developing regions, it is one of the most common surgical problems in Ethiopia. Therefore, this study assessed serum uric acid, urea, and glucose levels and associated factors among benign, malignant breast cancer patients and apparently healthy women attending at Felege-Hiwot comprehensive Specialized Hospital. METHODS: Hospital based comparative cross-sectional study was conducted among benign, malignant breast cancer patients and apparently healthy women attending at Felege-Hiwot Comprehensive Specialized Hospital. Out of 178 study participants 66 benign and 23 malignant fine needle aspirate cytology confirmed breast cancer patients and 89 apparently healthy women, included. Multivariable logistic regression models used to measure the strength of associations. A P value of < 0.05 was considered statistically significant. RESULTS: Majority of the study participants, 81(91%) controls, 55(83.3%) benign, and 17(73.9%) malignant cases were premenopausal. Serum glucos144.47±74.35 and uric acid 6.84±2.54 levels were significantly elevated in malignant cases than control (p-value< 0.05). Patients with malignant status were 4.38 times more likely to have hyperglycemia (AOR=4.38, 95%CI: 1.98-19.97) and 5.53 times more likely have hyperuricemia (AOR=20.43-95% CI: 6.80- 61.23), 4 times more likely to have uremia (AOR=4.09, 95% CI: 1.06-15.91) compared to apparently healthy women. CONCLUSION: Serum glucose, and uric acid levels were significantly higher in malignant and benign cases compared with apparently healthy women. Family history of breast cancer, body mass index, systolic hypertension, comorbidity, residence and menopausal status were significantly associated with hyperglycemia, uremia and hyperuricemia.

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.

Knowledge, Attitudes and Practices Toward Prevention and Early Detection of COVID-19 and Associated Factors Among Religious Clerics and Traditional Healers in Gondar Town, Northwest Ethiopia: A Community-Based Study.

BACKGROUND: COVID-19 control measures efforts are affected by the knowledge, attitudes, and practices of the public, particularly religious clerics and traditional healers, who have close contact and are widely accepted by a significant number of community members. METHODS: A community-based cross-sectional study was conducted to determine knowledge, attitudes and practices towards COVID-19 and its associated factors among religious clerics and traditional healers in Gondar town. Study participants who met our inclusion criteria were selected using a simple random sampling technique. Data were collected by trained data collectors through face-to-face interviews. The reliability of the questionnaire was assessed using Cronbach's alpha. Knowledge, attitudes and practices scores were calculated to give the overall knowledge, attitude and practice score. Binary logistic regression was fitted to identify associated factors and odds ratio was used to measure the strength of the association. RESULTS: A total of 410 religious clerics and traditional healers were included in the study with a response rate of 97.1%. Of the total participants, 60.7% (95%: CI (56-65%)) had good knowledge, 34.1% (95%: CI (30-39%)) had a positive attitude and 15.6% (95%: CI (12-19%)) had good practices towards prevention and early detection of COVID-19. Less than one third of the participants practiced physical distancing (28%) and facemask use (17.8%). In multivariate logistic regression, age, educational status and marital status were significantly associated with knowledge score. Likewise, age and marital status were significantly associated with the positive attitude score. In addition, age, educational status, and the presence of underlying disease were significantly associated with the good practice score. CONCLUSION: Majority of the participants had poor practice and negative attitudes. Therefore, there should be a sensitization program to fill the gap in the knowledge, attitudes and practice measures of COVID-19 especially for elderly and illiterates.

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.

Knowledge and Practices towards Prevention and Early Detection of Chronic Kidney Disease and Associated Factors among Hypertensive Patients in Gondar Town, North West Ethiopia.

BACKGROUND: Chronic kidney disease is a global health problem with serious adverse effects, including kidney failure, cardiovascular disease, and premature death. Improving awareness and practice on the impact, prevention, and early detection of chronic kidney disease will reduce the significant economic and public health burden. METHODS: A cross-sectional study was conducted to determine knowledge and practice towards prevention and early detection of chronic kidney disease and its associated factors among hypertensive patients in Gondar town in 2019. The study included hypertensive patients visiting health institutions from February to March 2019. Data was collected using a semistructured questionnaire and individuals who fulfilled our inclusion criteria were selected using a systemic random sampling technique. Epi Info software version 7 was used for data entry, and SPSS version 20 was used for descriptive and logistic regression analysis. RESULT: Out of a total of 442 participants, 434 completed the questionnaire, with a response rate of 98.1%. Of the total, 298 (68.7%) had good knowledge of chronic kidney disease with a mean knowledge score of 8.78 ± 2.80 and 210 (48.4%) had good practice with mean practice score of 6.58 ± 1.61. Educational status, residence, and duration of hypertension were significantly associated with the knowledge and practice scores of the participants in the multivariate logistic regression analysis. CONCLUSION: More than half of the participants had good knowledge about chronic kidney disease and its risk factors. However, the level of preventive practice among participants was low. The educational status, residence, and duration of hypertension were significantly associated variables with knowledge and practice scores in multivariate logistic regression.

Tuberculosis and its association with CD4+ T cell count among adult HIV positive patients in Ethiopian settings: a systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) and HV have been intertwined and makeup a deadly human syndemic worldwide, especially in developing countries like Ethiopia. Previous studies have reported different TB incidences and its association with CD4+ T cell counts among HIV positive patients in Ethiopia. Thus, the goal of this meta-analysis was, first, to determine pooled incident TB among adult HIV positive patients, and second, to assess the association between incident TB and baseline CD4+ T cell count strata's. METHODS: We searched PubMed, Cochrane library, Science Direct and Google scholar databases from June 1 to 30, 2018. The I2 statistics and Egger's regression test was used to determine heterogeneity and publication bias among included studies respectively. A random effects model was used to estimate pooled incident TB and odds ratio with the respective 95% confidence intervals using Stata version 11.0 statistical software. RESULTS: A total of 403 research articles were identified, and 10 studies were included in the meta-analysis. The pooled incident TB among adult HIV infected patients in Ethiopia was 16.58% (95% CI; 13.25-19.91%). Specifically, TB incidence in Pre-ART and ART was 17.16% (95% CI; 7.95-26.37%) and 16.24% (95% CI; 12.63-19.84%) respectively. Moreover, incident TB among ART receiving patients with baseline CD4+ T cell count < and > 200 cells/mm3 was 28.86% (95% CI; 18.73-38.98%) and 13.7% (95% CI; 1.41-25.98%) correspondingly. The odds of getting incident TB was 2.88 (95% CI; 1.55-5.35%) for patients with baseline CD4+ T cell count < 200 cells/mm3 compared to patients with baseline CD4+ T cell count > 200 cells/mm3. CONCLUSION: High incident TB among adult HIV positive patients was estimated, especially in patients with CD4+ T cell count < 200 cells/mm3. Therefore, Early HIV screening and ART initiation, as well as strict compliance with ART and increasing the coverage of TB preventive therapy to more risky groups are important to prevent the problem. TRIAL REGISTRATION: Study protocol registration: CRD42018090802.

Epidemiology of podoconiosis in Ethiopia: a systematic review and meta-analysis protocol.

INTRODUCTION: Podoconiosis is a non-filarial swelling of the lower extremity endemic in tropical regions, North America and India. The aetiology and pathophysiology of the disease remain unknown. We propose conducting a systematic review and meta-analysis to evaluate the burden and risk factors of podoconiosis in Ethiopia reported in studies from 2009 to 2019. METHODS AND ANALYSIS: We will search the following electronic databases: PubMed (MEDLINE), EMBASE, Hinari, Cumulative Index to Nursing and Allied Health Literature, ISI (Web of Science) and Google Scholar. Medical subject headings will be used to extensively search relevant literature on electronic databases using related keywords such as epidemiology or prevalence, magnitude or burden, podoconiosis, and Ethiopia. Grey literature and manual search will also be performed to retrieve unindexed research articles. Two reviewers will screen all retrieved articles, conduct data extraction and then critically appraise all identified studies. We will analyse data using STATA V.14 statistical software. We will demonstrate pooled estimates of podoconiosis and associated factors with effect size and 95% CI. The presence of heterogeneity among studies will be examined by forest plot as well as the I2 heterogeneity test. Potential causes of heterogeneity will be explored by carrying out sensitivity and subgroup analyses. The presence of publication bias will also be examined by observing funnel plots and objectively by Egger's regression test. If the funnel plot is asymmetric and/or Egger's test was found to be statistically significant (p<0.05), the trim and fill (Duval and Tweedie's) analysis will be performed. ETHICS AND DISSEMINATION: The study will use publicly available data and will not identify the authors of the publication by name. In light of these and as has been indicated, research ethics clearance is not required for evidence syntheses in such reviews. The results of this study will be published in a peer-reviewed journal and presented at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42019127459.

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.

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.

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

Current treatment of multidrug resistant tuberculosis in Ethiopia: an aggregated and individual patients' data analysis for outcome and effectiveness of the current regimens.

BACKGROUND: The programmatic management of Multidrug-resistant tuberculosis (MDR-TB) is entirely based on a WHO recommended long-term, 18-24 month lasting treatment regimen. However, growing evidence shows that low treatment success rate and high rates of adverse events are associated with this regimen. Up to date, the MDR-TB treatment outcome is not sufficiently understood in Ethiopia. Therefore, this analysis aimed to determine the pooled estimates of successful (cure, completed, or both), and poor outcomes (death, failure, and lost to follow ups). METHOD: A systematic search was performed to identify eligible studies reporting MDR-TB treatment outcomes in Ethiopia. Relevant studies for our analysis were retrieved from PubMed database search, Google Scholar and institutional repository sites of Ethiopian universities up to March 15, 2018. The primary outcome was treatment success, referring to a composite of cure and treatment completion. A random effect model was used to calculate pooled estimates. RESULTS: Six studies reporting treatment outcome on the 1993 MDR-TB patients were included in this analysis. Of the cases, the 1288 and 442 patients had a successful and poor outcome, respectively. In the pooled analysis, treatment success was observed in 59.2% (95%CI, 48.1-70.4) of patients, while 23.3% (95%CI, 19.7-27.0%) of patients had a poor outcome. in sub-group analysis,46.1% (95%CI, 34.2-58.0) were cured, 12.8% (5.7-20.0) treatment completed, 14.3% (11.5-17.2) died, 7.5% (3.7-11.3) lost to follow up, and 1.6% (1.1-2.2%) experienced treatment failure. The 25.0% (14.6-35.5) patients whose treatment outcome was not assessed (on treatment or transfer-out). CONCLUSION: The result of this study highlight treatment success among MDR-TB is below acceptable range. To update the current treatment regimen, the levels of evidence need to be replicated through meticulous surveillance systems. TRIAL REGISTRATION: Study protocol registration: CRD42018090711 .