Articles

Prevalence and Determinants of Thromboembolic Events among Adult Rheumatic Heart Disease Patients with Atrial Fibrillation at Tikur Anbessa Hospital Addis Ababa Ethiopia

/in /by

Background: Rheumatic heart disease (RHD) combined with atrial fibrillation (AF) significantly contributes to thromboembolic complications, including ischemic stroke. The coexistence of these conditions increases the risk of cardiovascular issues, underscoring the need for targeted management strategies.

Objective: This study aims to assess the prevalence and determinants of thromboembolic events among patients with RHD and AF at the Tikur Anbessa Specialized Hospital adult cardiac outpatient clinic in Addis Ababa, Ethiopia.

Methods: An institution-based retrospective chart review of adult patients with RHD and AF was conducted. Data were gathered from electronic medical records using structured data extraction check list. Descriptive analysis using frequency with percentage and mean with standard deviation was conducted. Binary logistic regression was employed to analyze the relationship between predictor variables and thromboembolic events.

Results: A total of 182 participants were included in this study. The mean age of participants was 40.37 (SD± 13.01) and majority of participants were female participants (70.9%). The overall rate of cardioembolic events was 19.78% (95% CI: 14.3-6.3), with stroke occurring in 18.1% (33) of the participants. Disease duration (AOR: 1.07, 95% CI: 1.03–1.13), left atrial size (AOR: 1.14, 95% CI: 1.07–1.24), presence of left atrial thrombus (AOR: 9.83, 95% CI: 1.53–63.21), mitral stenosis (AOR: 1.88, 95% CI: 1.21–17.14), and Subtheraputic INR levels (<2) (AOR: 4.27, 95% CI: 1.15–15.94) were significantly associated with cardioembolic events.

Conclusion and recommendation:  This study highlights the high prevalence of cardioembolic events in patients with RHD and AF, identifying both modifiable and non-modifiable factors that contribute to increased risk. Monitoring left atrial size and INR levels could help reduce the risk of thromboembolic complications. Further research is needed to develop preventive strategies and optimize management to improve patient outcomes.

Validation of Amharic Version of Confusion Assessment Method for Intensive Care Unit among Patients Admitted to ICU at Two Centers in Addis Ababa, Ethiopia: A Cross-Sectional Study

/in /by

Background: Confusion Assessment Method for Intensive Care Unit (CAM-ICU) is a widely accepted, easily available, and quick tool for assessment of delirium in ICU. Globally, multiple studies have been conducted to cross culturally translate and validate the tool to make it fit the local setting. However, to the best of our knowledge, it has not been cross-culturally translated and validated into Amharic. Therefore, this study aims to bridge this gap.

Objective: This study aimed to assess the Validity of the Amharic Version of Confusion Assessment Method for Intensive Care Unit (CAM-ICU) among patients admitted to adult ICU in two centers in Addis Ababa, Ethiopia.

Methods and materials: An institution based cross-sectional study was conducted at the intensive care unit of Tikur Anbessa Specialized Hospital and Menelik-II Hospital. A total of 132 eligible patients were included in this study. Data were collected by nurses and resident physicians using Google form from 1-December-2023 to 30-April-2024. Data analysis was performed using to SPSS V.27. Descriptive analyses were performed using frequency and percentage for categorical variables and mean with standard deviation for continuous variables. Reliability, inter-rater reliability (k), and acceptability of the tool were assessed.

Results: The Amharic version was translated by group of experts, including anesthesiologists, psychiatrists, language experts, and the primary investigator, ensuring content and face validity. A total of 132 patients participated in this study, with a response rate of 95.65%.  The Amharic version of CAM-ICU had high acceptance (100%), good reliability (Cronbach’s alpha=0.718), and substantial inter-rater agreement (k=0.762). 11 (8.3%) and 7(5.3%) of 132 patients were diagnosed with delirium by doctors and nurses, respectively, using CAM-ICU Amharic. Moreover, 7 of 132 patients (5.3%) were diagnosed with delirium concurrently by both physicians and nurses.

Conclusion: The Amharic version of CAM-ICU is an acceptable, valid, and reliable tool for delirium assessment in ICU. Utilization of CAM-ICU Amharic in clinical practice after provision of proper training would enable better detection of delirium in ICU.

Prevalence and Pattern of Thyrocardiac Disease among Patients with Hyperthyroidism in Ethiopia: A Systematic Review and Meta-Analysis

/in /by

Background: Thyrocardiac disease encompasses the spectrum of cardiovascular abnormalities that arise as complications of hyperthyroidism. Despite being clinically significant and potentially life-threatening, its burden in Ethiopia remains poorly defined.

Objective: To determine the pooled prevalence and pattern of thyrocardiac disease among hyperthyroid patients in Ethiopia.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches were carried out in PubMed, Google Scholar, AJOL, Hinari, Europe PMC, Cochrane library, and institutional repositories. Observational studies reporting cardiac outcomes in adults with hyperthyroidism in Ethiopia were included. Analysis was done using STATA version 17. Prevalence data were pooled using a random-effects model, and heterogeneity was assessed using the Cochrane Q and I² statistic.

Results: Seven studies with a total of 1,160 participants were included in the review. Sinus tachycardia (39.32%; 95% CI: 23.34%–55.31%), Heart failure (21.65%; 95% CI: 13.84–29.46%), and Pulmonary hypertension (19.43%; 95% CI: 6.78–32.09%) were the commonest presentations, while Dilated cardiomyopathy (12.35%; 95% CI: 6.16–18.53%) and Atrial fibrillation (16.27%; 95% CI: 12.17–20.38%) were the least common. Toxic multinodular goiter was the most common cause of hyperthyroidism among these patients accounting for 64.8% (95% CI: 53.2–75.3%).

Conclusion: Thyrocardiac disease is a frequent complication among hyperthyroid patients in Ethiopia, with sinus tachycardia and heart failure being the most common presentations. These findings highlight the importance of integrating routine cardiac evaluation into the clinical management of hyperthyroidism.

Patterns of Lower Gastrointestinal Endoscopic Findings at Jimma University Medical Center, Jimma, Ethiopia

/in /by

Background: Lower gastrointestinal (GI) disorders are common causes of morbidity worldwide, yet data on their prevalence and patterns within resource-limited settings like Ethiopia remain scarce. Endoscopy is a vital diagnostic and therapeutic tool for these conditions.

Objectives: To assess the patterns of lower GI endoscopic findings at Jimma University Medical Center (JUMC) and explore associations with demographic and clinical variables.

Methods: This retrospective, descriptive cross-sectional study included 216 adult patients (≥15 years) who underwent lower GI endoscopy at JUMC from September 9, 2021, to September 8, 2022. Patients with incomplete records or repeat procedures were excluded. Data on demographics, indications, and findings were collected using a structured tool and analyzed with SPSS v29.0. Descriptive statistics summarized the data; chi-square and multivariate logistic regression tested associations, with significance at p<0.05.

Results: Of 230 procedures, 216 met inclusion criteria. The mean age was 43.6 ± 16.2 years, with a male predominance (68.5%). The most common indication was lower GI bleeding (35.2%). Hemorrhoids were the most frequent endoscopic finding (46.3%), followed by colorectal polyps (21.2%) and colorectal cancer (11.1%). Benign lesions predominated, but the notable prevalence of polyps and cancers underscores the importance of early detection strategies.

Conclusions: Benign conditions, especially hemorrhoids, are prevalent among patients undergoing lower GI endoscopy at JUMC. However, the significant rates of polyps and cancers underscore the importance of expanding endoscopic services, enhancing training, and implementing community screening programs to improve early detection and management.

Time to Normalization of Thyroid Function Tests and Associated Factors Among Thyrotoxic Patients at Saint Paul’s Hospital Millennium Medical College Endocrine Clinic, Addis Ababa, Ethiopia, 2024

/in /by

Background: Thyrotoxicosis is characterized by excessively high tissue thyroid hormone levels. Untreated or inadequately managed thyrotoxicosis can lead to various complications. Understanding factors influencing the time to achieve thyroid function normalization is essential for improving treatment outcomes and patient care.

Objectives: This study aimed to assess the median time to normalization of thyroid function tests and identify factors associated with delayed euthyroidism among thyrotoxic patients attending the Endocrine Clinic at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, in 2023.

Methods: A hospital-based retrospective cohort study was conducted involving 181 patients diagnosed with thyrotoxicosis who attended the adult Endocrine Clinic from April 2023 to January 2024. Data were collected using a structured questionnaire and entered into EpiData version 7.1, then exported to STATA version 15 for analysis. Descriptive statistics summarized continuous variables as mean ± SD or median with interquartile range, and categorical variables as frequencies and percentages. The association between independent variables and time to euthyroidism was analyzed using Cox proportional hazards regression, with the log-rank test employed to compare median times across groups. Adjusted hazard ratios (AHR) with 95% confidence intervals (CI) were reported to quantify the strength of associations.

Results: Approximately 61% of patients achieved euthyroidism, with a median time of 7 months (Interquartile Range: 3–13 months). Factors significantly associated with delayed normalization included use of Propylthiouracil (AHR = 0.33; 95% CI: 0.12–0.89), poor medication adherence (AHR = 0.24; 95% CI: 0.13–0.42), higher baseline pulse rate (AHR = 0.97; 95% CI: 0.95–0.99), and elevated baseline free thyroxin levels (AHR = 0.99; 95% CI: 0.98–0.995).

Conclusion: Although more than half of the patients attained euthyroidism, the process took longer than expected. High baseline FT4 levels, elevated pulse rate, non-adherence to medication, and the use of PTU as the anti-thyroid drug delayed the achievement of euthyroidism. Patients with thyrotoxicosis require attentive and continuous monitoring until thyroid function normalizes to prevent complications.