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Age Determination at Tikur Anbessa Specialized Hospital, Addis Ababa University.
S Hailu, R Fikre, H Yohannes, A Daniel, LW Biruk
East and Central African Journal of Surgery , 2011,
Abstract: Background: African doctors, besides their enormous work load, are frequently involved in indirect clinical practices like age determination, disability evaluation and writing various kinds of certificates. This is a retrospective study aimed at assessing profile of subjects presenting for age determination. It determines different characteristics of subjects and the process of age determination. Age determination board/clinic of “Tikur-Anbessa” Specialized Hospital, School of Medicine, Addis Ababa University. Methods: This is a retrospective descriptive study from January 2008 to June 2010. Age is estimated at age determination board using medical and skeletal criteria’s by a committee consisting of physicians from internal medicine, radiology and orthopedic departments. All subjects were having elbow and wrist x-rays, sexual maturity assessment and dental examinations. The final age (also referred as “board-age”) is determined/assigned based on the consensus made between the three physicians. This document is signed and strictly/confidentially compiled by the head of outpatient department. Data was collected based on prepared questioner through retrieval of subjects’ records/documents. Results: A total of 976 subjects, with male predominance 67.7%, have been evaluated by the board in the two years. Almost all had stated age range 5-22 years. Majority’s stated age falls in the age group 9-15(66.1%). 92% of subjects claim they are below 18 years of age.838(85.9%) subjects are from Addis Ababa. The board decided that 461 (47.2%) were between 16 and 17 years of age. There was less agreement between stated age and board age with (Kappa) κ score of 0.147. Radiologic age and board age had excellent agreement with κ score of 0.976 Conclusion: Radiologic age is cornerstone of age determination in our circumstance. Age determination is crucial for prosecution of young population using skeletal and clinical method. Most subjects tend to lower their age, hence attention should be given for evidence based age determination.
Ultrasound Assessment of Normal Portal Vein Diameter in Ethiopians Done at Tikur Anbessa Specialized Hospital
Y Hawaz, D Admassie, T Kebede
East and Central African Journal of Surgery , 2012,
Abstract: Background: Portal hypertension occurs when the portal venous pressure exceeds 10mm Hg. Whatever the primary cause, the consequences of portal hypertension are similar. Liver cirrhosis is the commonest cause of portal hypertension. Because of its accessibility, lack of ionizing radiation and rapid assessment, sonography plays a major role in the assessment of portal hypertension. Even if the additional use of color and spectral Doppler improves the assessment of patients suspected of having portal hypertension, gray scale assessment of portal vein diameter is corner stone in the initial evaluation. Knowing the normal portal venous dimension in a specified population is so crucial. Methods: This is a prospective cross-sectional study done at Tikur Anbessa Specialized Hospital to sonographically determine the normal portal vein diameter. Data was collected from 502 patients on consecutive bases from May – September 2010. This includes 190 males and 312 females. Results: The mean portal vein diameter was 7.9 + 2mm with an increase in diameter with increase in age of the subject. Our study also revealed 21.5% increase in portal vein diameter with the phases of inspiration. Conclusion: This study has comparable results with studies done elsewhere so that it can be used as a baseline for future population based studies and clinical decision making.
Communication skills of physicians during patient interaction in an in-patient setting at Tikur Anbessa Specialized Teaching Hospital (TASH), Addis Ababa, Ethiopia, 2009
D Zewdneh, K W/Michael, S Kebede
Ethiopian Journal of Health Development , 2011,
Abstract: Background: Physician-patient relationship is foremost among the numerous qualities needed for sound patient care. In the Ethiopian clinical setting, a vast majority of patients complain that physicians do not interact with them properly. Objective: Assess behavior of physicians (verbal and nonverbal) when interacting with patients. Methods: Randomly selected physicians were observed in doctor-patient interactions in an inpatient setting using a standardized check list at Tikur Anbessa Hospital in November, 2009.Mean comparison of total scores of each category as well as mean interaction and biomedical exam times were made using Pearson’s Chi square, and Student’s T test. Results: 211 interactions were observed. 22.7% were consultants, 49.7% were residents and 26.5% were interns. Mean total score of observed behavior ranged from poor to satisfactory across category and showed statistically significant variations. Average interaction time was 7.87 minutes while average biomedical exam time was 5.05 minutes. The means showed a significant variation (p=0.001 at 95% CI). Conclusion: The study has shown that there is a reasonable ground to suggest that physician-patient interaction has deficiencies. Due attention should be given to improve communication skills of physicians.
Survival analysis of patients under chronic HIV-care and antiretroviral treatment at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
T Assefa, E Wencheko
Ethiopian Journal of Health Development , 2012,
Abstract: Background: Health care planning depends upon good knowledge of prevalence that requires a clear understanding of survival patterns of patients who receive medication, treatment and care. Survival analysis can bring to light the effect that some demographic, social, medical and clinical characteristics have on the mortality rate of HIV-patients. Objectives: The objective of this research undertaking was to estimate mortality rate and identify predictors that have significant impact on the survival status of a sample of patients who received antiretroviral treatment and care in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: The data for this research were collected during the follow-up time from 2005 to 2008. Out of a population of HIV-patients who were taking antiretroviral therapy in the hospital in that period, data on 1,000 patients were used for this study. The study subjects were people in the age range from 15 to 75 years. The Kaplan-Meier Method was employed to estimate mortality; the Cox Proportional Hazards Regression Method was used to identify determinants of mortality. Results: After initiation of the antiretroviral treatment, HIV-positive patients lived for an average of 5.65 years (CI: 3.69-7.61 years); the median survival age was found to be 3.98 years (CI: 2.98-4.97 years). The number of medications, baseline functional status, CD4 count, antiretroviral treatment, age, gender and weight impact the survival experience of the patients. Conclusions: Antiretroviral therapy treatment reduced death among AIDS patients by 50 percent. Providing treatment at health facilities outside big towns and in the country should be given due attention. Similar studies in the future need to consider predictors in addition to those considered in this study. [Ethiop. J. Health Dev. 2012;26(1):22-29]
Assessment of Renal Function among HIV-Infected Patients on Combination Antiretroviral Therapy at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia  [PDF]
Kassahun Eneyew, Daniel Seifu, Wondwossen Amogne, M. K. C. Menon
Technology and Investment (TI) , 2016, DOI: 10.4236/ti.2016.73013
Abstract: Background: Acquired immunodeficiency syndrome (AIDS) is a spectrum of disease states characterized by progressive immunosuppression. Sub-Saharan Africa is heavily affected by human immunodeficiency virus (HIV) and AIDS than any other region of the world. Renal complications are important component of advanced HIV disease, and these complications significantly contribute to morbidity and mortality in HIV/AIDS patients. Aim of the Study: To assess renal function abnormalities in HIV infected patients and compare with treatment-naive and HIV-negative control groups. Methods: A retrospective cross sectional study of comparative nature was designed and samples and biochemical data were collected from July 1/2012 to February 1/2013 in patients attending the ART clinic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Renal functions of 180 participants were assessed. The data obtained were analyzed using SPSS version 16.0. Result: A total of 180 participants grouped as HIV-negative controls (n = 60), HIV+ treatment-naive (n = 60) and HIV+ on HAART were recruited to participate in this study. Out of 180 participants included in the study, 59 (32.78%) were males and the remaining 121 (67.22%) were females. Mean serum total protein was higher in patients on HAART groups (5.78 ± 1.39) than treatment-naive (4.76 ± 2.19). There was significant reduction (p < 0.05) in serum total protein in both HIV+ groups as compared with the control groups. The mean serum creatinine level was not significantly different among three groups. The mean serum creatinine clearance in treatment-naive groups (111.05 ± 11.33) was lower than the control groups (115.05 ± 44.41) and patients on HAART (114.76 ± 28.54). There was a positive and significant correlation of glomerular filtration rate with BMI on treatment-naive groups. Conclusion: There are no statistically significant differences in the levels of Creatinine clearance and Estimated Glomerular Filtration Rate (eGFR) in HIV positive patients (naive as well as treated) as compared to the negative controls. The prevalence of renal impairment as defined by CrCl < 60 mL/min (eGFR < 60 ml/min/1.73 m2) is higher in treatment-naive participants than those on HAART and HIV-negative control groups.
Knowledge and attitude towards mother to child transmission of HIV and it's prevention among post natal mothers in Tikur Anbessa and Zewditu Memorial Hospitals, Addis Ababa
Solomie Jebessa, Telahun Teka
Ethiopian Journal of Health Development , 2005,
Abstract: Background: HIV/AIDS is currently a major public health problem in Ethiopia and mother to child transmission (MTCT) is responsible for 90% of childhood HIV infections. The transmission of HIV from infected mothers to babies could occur during antenatal period, as well as during delivery and breastfeeding (postnatal period). Since breastfeeding is essential for child survival, it is also necessary to assess mothers' knowledge and attitude towards HIV transmission and its prevention during breastfeeding. Objectives: This study attempts to assess mothers' knowledge of MTCT of HIV including breastfeeding, in two government hospitals in Addis Ababa. It also describes mothers' attitudes towards voluntary counseling and testing (VCT) services. Methods: A cross sectional, descriptive study was conducted to assess knowledge and attitude towards MTCT and its' preventive methods on postnatal mothers who delivered at Tikur Anbessa and Zewditu Memorial Hospitals, Addis Ababa, from January to March 2004. A structured, pre-tested questionnaire was used for data collection. Results: A total of 384 mothers were interviewed 78.4% of whom were from Addis Ababa. 87.0% were aged between 16-30 years. Of these mothers 54.9% were primipara, 89.9% were married, and 84.6% were Christians. Amhara (44.5%), Oromo (26.3%), Gurage (17.2%), and Tigre (7.0%) were the major ethnic groups in the study population. All the 384 respondents had heard about HIV/AIDS of which, 82.3 % mentioned the major routes of transmission and 89.8% knew that that HIV could be transmitted from an infected mother to her baby. Most of the respondents (76.8%) knew that MTCT of HIV is preventable, 64.6% knew the protective effect of prophylactic anti-retroviral drugs, 37.1% knew that abstinence from breastfeeding can prevent MTCT, 10.4% knew elective caesarean section (C/S) as a preventive method and 6.9% stated that protection of the mother from HIV is the same as protecting her baby. Those mothers who were from Addis Ababa, and whose educational level was secondary and above were found to be more knowledgeable about MTCT and PMTCT. Three hundred seventeen (82.6%) of the mothers knew what VCT meant and 76.8% of them have positive attitudes to wards VCT. 69.3% of the mother indicated that mothers should be tested before breastfeeding and 67.4% agreed to have VCT before breastfeeding their new babies. 60.2% planned to have VCT before their next pregnancy. Conclusion: This study showed that most mothers in this study knew that HIV could be transmitted from mother to child and that it can be prevented. A majority are of the opinion that VCT can be a preventive strategy and most of them have the intention to have counseling and testing before the next pregnancy. Hence well-organized VCT centers and PMTCT programs should be established to halt the epidemic from affecting the next generation. Ethiopian Journal of Health Development Vol. 19(3) 2005: 211-218
Kalayou Kidanu Berhe*, Asrat Demissie , Alemayoh Bayeray Kahsay and Haftu Berhe Gebru
International Journal of Pharmaceutical Sciences and Research , 2012,
Abstract: Background: Diabetes is a group of metabolic disorders that affect the body’s ability to process and use sugar (glucose) for energy. Type 2 diabetes mellitus resulting from the combination of resistance to insulin action and inadequate insulin secretion. The success of long-term maintenance therapy for diabetes depends largely on the patients’ adherence with self-care practices.Objective: The aim of this study was to assess diabetes self-care practices and associated factors among type 2 diabetic patients in Tikur Anbessa Specialized Hospital, Ethiopia. Method: institutional based cross sectional study was employed and 320 study subjects were selected using systematic random sampling technique. And the data was collected using interviewer administered structured questionnaire; data was analyzed and cleaned using SPSS version 16. Scoring method was employed to classify patients’ self-care practice level as adhered or not adhered to self-care practices.Results: Of all respondents 167(52.2%) female. Mean age of the respondents was 55.03±10.7 years with minimum age of 30 and maximum age of 85. The mean duration of diabetes was 12.3±7.6years with minimum of 6 months and maximum of 41 years. Respondents’ self-care practices were, the majority 270 (84.4%) respondents were not adhered to Self-Monitoring of blood glucose practice. A total of 311(97.2%) respondents were adhered to anti-diabetic medication. The majority 252 (78.8%) respondents were not adhered to recommended diet management practices. There was a significant association between Level of education, monthly income, Presence of glucometer at home, marital status, diabetic complication, age and gender and self-care practices. But there was no significant association between duration of diabetes, Occupation and family history of diabetic and self-care practices.Conclusion: findings of this study indicated that majority patients had poor adherence to self-care practices especially in self-monitoring of Blood Glucose and diet management practices.
Bladder Tumours at Tikur Anbessa Hospital in Ethiopia.
H Biluts, E Minas
East and Central African Journal of Surgery , 2011,
Abstract: Background: Bladder cancer is the fourth to fifth most common cancer in men, and the eighth in women These t umors are commonest in the 50 to 70 year age group The aim of this study was to review the pattern and surgical management of bladder tumors at TAS in Ethiopia. Methods: A hospital based retrospective cross sectional analysis was conducted in TASH, department of surgery, Addis Ababa, Ethiopia. Patients’ medical records and operation theater registers of 97 patients operated upon for bladder tumors, between January2006 and December 2008 were analyzed. Results: Sixty patients were male and 37 female (M: F of 1.6:1). Their age ranged from 20 to79 years, with mean age of 49.73±1.5.Duration of symptoms ranged between 1and 48 months (mean 13.9). The most common presenting symptoms were hematuria in 89(91.8%). cystoscopy and sonographic examination of the bladder were the main modalities of investigation in the diagnosis of bladder tumors in 100% and 96.9% patients respectively. Histopathologically, 87(89.7%) and 10(10.3%) patients had malignant and benign bladder tumors respectively. Of the patients with malignant bladder tumors, 78 (80.4%) had TCC, 5(5.2% SCC, and 3 (3.1%) adenocarcinoma. Common patterns of bladder masses were papillary 77(79.7%), sessile or mixed 10(10.3%), and nodular 6(6.2%).Upon presentation, 66(74.7%) of patients had lowgrade, whilst 20(23.0%) had high-grade disease, 85.5% of bladder tumors were nonmuscle invasive, while 14.9% were muscle invasive, and 2.4% metastatic. The commonest surgical technique employed for bladder tumor removal was TURBT in 80 (82.5%) patients. Forty-four (45%) of the patients had additional surgery such as repeated TURBT in 16(16.5%), cystectomy+ureterosigmoidostomy in 8(8.2%),radical cystectomy+neobladder in 5(5.2%), antiincontinence procedure in 4(4.1%),partial cystectomy in 4(4.1% ) and redo cystectomy+sigmoid bladder in 4( 4.1%). In 83(85.6%) patients the postoperative course was uneventful, while 17(17.5%) developed immediate postoperative complications. Twelve developed late complications. There were 6(6.2%) deaths. Post operative hospital stay of 1-70 days (mean 12.1) and a follow up period ranging from 1 to 26 month (mean 3.7 months) were also the outcome of this review. Conclusion: The most common type of bladder cancer in TASH is TCC.Bladder tumor is more frequent in men than in women. The commonest procedure for bladder tumors was TURBT (p<0.001) which is the golden standared for non-muscle invasive tumors.
X-ray reject analysis in Tikur Anbessa and Bethzatha hospitals
D Zewdeneh, S Teferi, D Admassie
Ethiopian Journal of Health Development , 2008,
Osteosarcoma of limb bones: a clinical, radiological and histopathological diagnostic agreement at Black Lion Teaching Hospital, Ethiopia
BL Wamisho, D Admasie, BE Negash, MW Tinsay
Malawi Medical Journal , 2009,
Abstract: Objectives: To measure the strength of agreement in clinical, radiological and histopathological diagnosis of osteosarcoma in a 5 year study period. Setting: Addis Ababa University, Black-Lion (‘Tikur Anbessa’) Hospital-BLH, is the country’s highest tertiary level referral and teaching hospital. The departments involved in this study (Radiology, Pathology and Orthopedics) receive referred patients from all over the country. Methods: All bone tumor patients, presenting to the three departments at BLH between the study period, December, 2003 – March, 2008 were recruited for the study. 51 patients with radiological diagnosis of osteosarcoma of the extremities were identified and their clinical and histopathological diagnoses reviewed in detail. All patients had a clinical examination, plain radiographs and biopsies of the affected part of the extremity. Radiographs of selected difficult cases were discussed at joint orthopedic & radiologic sessions every week. The radiological and histopathological diagnoses made were categorized separately using WHO classification of bone tumors. Strength of agreement between radiological and histopathological diagnoses was measured using Cohen’s Kappa test. Results: Of the total of 216 bone tumor patients presented and biopsied in the five year period, fifty one (51) had osteosarcoma of extremity bones. Commonest age affected by osteosarcoma was 16 (7-55years) and sex ratio was 1:1. Osteosarcoma was also the single most common clinical, radiological and histological diagnosis made. Considering all bone tumors presented together, the study indicated that radiological diagnosis was confirmed by similar histological diagnosis in 172 out 205 cases (84 %) and the corresponding Cohen’s Kappa value (0.82) showed excellent level of agreement between radiological and histological diagnoses of all bone tumors. The agreement between radiological and histopathological diagnoses of osteosarcoma of the limbs was 84.5%. Conclusion: There is an excellent agreement between clinical, radiological and histopathological diagnoses of bone tumors in general and osteosarcoma in particular. In setups where there is limited or no histopathological service, joint clinical and radiological decision could lead to a higher degree of accuracy in diagnosis of bone tumors, especially osteosarcoma. Radiological diagnosis of bone tumors at Black Lion Hospital, Addis Ababa is excellent.
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