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Bacterial isolates from cerebrospinal fluids and their antibiotic susceptibility patterns in Gondar University Teaching Hospital, Northwest Ethiopia
Andargachew Mulu, Afework Kassu, Belay Tassema
Ethiopian Journal of Health Development , 2005,
Immune restoration disease and changes in CD4+ T-cell count in HIV- infected patients during highly active antiretroviral therapy at Zewditu memorial hospital, Addis Ababa, Ethiopia
Kahsay Huruy, Afework Kassu, Andargachew Mulu, Yemataw Wondie
AIDS Research and Therapy , 2010, DOI: 10.1186/1742-6405-7-46
Abstract: A retrospective study of all HIV- infected patients starting HAART between September 1, 2005 and August 31, 2006 at Zewditu memorial hospital HIV clinic, Addis Ababa, Ethiopia was conducted. All laboratory and clinical data were extracted from computerized clinic records and patient charts.A total of 1166 HIV- infected patients with mean ± SD age of 36 ± 9.3 years were on HAART. IRD was identified in 170 (14.6%) patients. OIs diagnosed in the IRD patients were tuberculosis (66.5%, 113/170), toxoplasmosis (12.9%, 22/170), herpes zoster rash (12.9%, 22/170), Pneumocystis jirovecii pneumonia (4.1%, 7/170), and cryptococcosis (3.5%, 6/170). Of the 170 patients with IRD, 124 (72.9%) patients developed IRD within the first 3 months of HAART initiation. Low baseline CD4+ T-cell count (odds ratio [OR], 3.16, 95% confidence interval [CI], 2.19-4.58) and baseline extra pulmonary tuberculosis (OR, 7.7, 95% CI, 3.36-17.65) were associated with development of IRD. Twenty nine (17.1%) of the IRD patients needed to use systemic anti-inflammatory treatment where as 19(11.2%) patients required hospitalization associated to the IRD occurrence. There was a total of 8 (4.7%) deaths attributable to IRD.The proportion and risk factors of IRD and the pattern of OIs mirrored reports from other countries. Close monitoring of patients during the first three months of HAART initiation is important to minimize clinical deterioration related to IRD.Highly active antiretroviral therapy (HAART) improves the immune function and decreases morbidity, mortality and opportunistic infections (OIs) in HIV-infected patients [1,2]. However, the introduction of HAART presents new clinical problems, including adverse drug effects, and the event of diseases that are as the result of the restoration of the immune response. When clinical deterioration occurs during immune recovery and is associated with the host inflammatory response to pathogens, the clinical presentation has been described as immune restorat
Frequent detection of ‘azole’ resistant Candida species among late presenting AIDS patients in northwest Ethiopia
Mulu Andargachew,Kassu Afework,Anagaw Belay,Moges Beyene
BMC Infectious Diseases , 2013, DOI: 10.1186/1471-2334-13-82
Abstract: Background The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient’s leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. This study determines the species diversity and in vitro susceptibility of Candida isolates from late presenting AIDS patients in northwest Ethiopia. Methods Two hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and Candida species identification were made following standard microbiological techniques. In vitro drug susceptibility tests were made using broth microdilution method. Results The colonization rate of Candida species was found to be 82.3% (177/215). C. albicans was the predominant species isolated from 139 (81%) patients but there was a diversity of other species. C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non-albicans species. Irrespective of the Candida species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent. Conclusion HIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans Candida species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining Candida epidemiology and resistance to antifungal drugs.
Magnitude and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy among people living with HIV/AIDS in Northwest Ethiopia: a cross - sectional study
Belay Tessema, Fantahun Biadglegne, Andargachew Mulu, Assefa Getachew, Frank Emmrich, Ulrich Sack
AIDS Research and Therapy , 2010, DOI: 10.1186/1742-6405-7-2
Abstract: A cross-sectional study was conducted between July and September 2008 using structured interviewer-administered questionnaire. All consecutive adult outpatients who were receiving antiretroviral treatment for at least three months, seen at both hospitals during the study period and able to give informed consent were included in the study. Multivariate logistic regression was used to determine factors associated with nonadherence and nonreadiness.A total of 504 study subjects were included in this study. The prevalence rates of nonadherence and nonreadiness to HAART were 87 (17.3%) and 70 (13.9%) respectively. Multivariate logistic regression analysis revealed that medication adverse effects, nonreadiness to HAART, contact with psychiatric care service and having no goal had statistically significant association with nonadherence. Moreover, unwillingness to disclose HIV status was significantly associated with nonreadiness to HAART.In this study the level of nonadherence and nonreadiness to HAART seems to be encouraging. Several factors associated with nonadherance and nonreadiness to HAART were identified. Efforts to minimize nonadherence and nonreadiness to HAART should be integrated in to regular clinical follow up of patients.HIV/AIDS is the fourth most common cause of death in the world [1] and is estimated to have killed 3.1 million individuals and infected 4.9 million persons in 2005 alone. The number of people infected by HIV is steadily rising and sub-Saharan Africa is the most affected region in the world [2]. Ethiopia has the fifth largest population of HIV-infected individuals living in Africa, which accounts approximately 4% of the world's HIV/AIDS cases [3].Highly Active Antiretroviral Treatment (HAART) has dramatically reduced mortality and morbidity due to HIV [4,5]. It is effective because it reduces HIV replication and hence allows the regeneration of CD4+ T-lymphocyte mediated immune responses [6,7]. It cannot, however, totally eradicate HIV [8,9]
Seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors at Gondar University Teaching Hospital, Northwest Ethiopia: declining trends over a period of five years
Belay Tessema, Gizachew Yismaw, Afework Kassu, Anteneh Amsalu, Andargachew Mulu, Frank Emmrich, Ulrich Sack
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-111
Abstract: A retrospective analysis of consecutive blood donors' records covering the period between January 2003 and December 2007 was conducted. Logistic regression analysis was used to determine risk factors associated with HIV, HBV, HCV and syphilis infections.From the total of 6361 consecutive blood donors, 607 (9.5%) had serological evidence of infection with at least one pathogen and 50 (0.8%) had multiple infections. The overall seroprevalence of HIV, HBV, HCV and syphilis was 3.8%, 4.7%, 0.7%, and 1.3% respectively. Among those with multiple infections, the most common combinations were HIV - syphilis 19 (38%) and HIV - HBV 17 (34%). The seropositivity of HIV was significantly increased among female blood donors, first time donors, housewives, merchants, soldiers, drivers and construction workers. Significantly increased HBV seropositivity was observed among farmers, first time donors and age groups of 26 - 35 and 36 - 45 years. Similarly, the seroprevalence of syphilis was significantly increased among daily labourers and construction workers. Statistically significant association was observed between syphilis and HIV infections, and HCV and HIV infections. Moreover, significantly declining trends of HIV, HCV and syphilis seropositivity were observed over the study period.A substantial percentage of the blood donors harbour HIV, HBV, HCV and syphilis infections. Strict selection of blood donors and comprehensive screening of donors' blood using standard methods are highly recommended to ensure the safety of blood for recipient.The discovery of transfusion-transmissible infections (TTIs) has heralded a new era in blood transfusion practice worldwide with emphasis on two fundamental objectives, safety and protection of human life [1]. Blood safety remains an issue of major concern in transfusion medicine in Ethiopia where national blood transfusion services and policies, appropriate infrastructure, trained personnel and financial resources are inadequate.Human immunode
Seroprevalence of hepatitis B and C viruses among medical waste handlers at Gondar town Health institutions, Northwest Ethiopia
Belay Anagaw, Yitayal Shiferaw, Berhanu Anagaw, Yeshambel Belyhun, Woldearegay Erku, Fantahun Biadgelegn, Beyene Moges, Agersew Alemu, Feleke Moges, Andargachew Mulu
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-55
Abstract: A cross-sectional study was conducted from April, 2011 to June, 2011 in government health institutions at Gondar town. Socio-demographic and possible risk factors data from medical waste handlers were collected using pre-tested and well structured questionnaires. Venous bloods were collected and the serums were tested for hepatitis B surface antigen and anti-hepatitis C antibody using rapid Immunochromatography assay. Data was entered and analyzed using SPSS software package (version16). Chi-square and Fisher exact tests were used to assess risk of association. A p-value of < 0.05 was considered statistical significance.A total of 100 medical waste handlers and 100 non-clinical waste handlers were examined for HBV and HCV viruses. HBV was detected in 6 (6.0%) and 1 (1.0%) and HCV in 1 (1.0%) and 0 (0.0%) of medical waste handlers and non-clinical waste handlers, respectively. Significant differences were observed in the detection rates of HBV (OR = 6.3; X2 = 4.1; P = 0.04) and overall infection rate (HBV + HCV) (OR = 7.5; X2 = 5.2; P: 0.02) in medical waste handlers when compared with non-clinical waste handlers. It was found that none of the observed risk factors significantly associated with rate of hepatitis infection compared to others.Prevalence of HBV and HCV were significantly higher in medical waste in relation to non-clinical waste handlers. There were poor waste management system which contributed for occurrence of higher degree of sharps injury and blood and body fluids splash.Viral hepatitis is an inflammation of the liver due to viral infections and there are groups of viruses that affects the liver [1,2]. The most common types are hepatitis B virus (HBV) and hepatitis C virus (HCV) [2]. Viral hepatitis is a major health problem worldwide and cause acute and/or chronic hepatitis which can leads to the development of extensive liver scarring (cirrhosis), liver failure, liver cancer and death. Viral hepatitis is the tenth leading cause of death and the le
Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia
Andargachew Mulu, Afework Kassu, Kahsay Huruy, Birhanemeskel Tegene, Gashaw Yitayaw, Masayo Nakamori, Nguyen Van Nhien, Assegedech Bekele, Yared Wondimhun, Shigeru Yamamoto, Fusao Ota
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-569
Abstract: In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography.After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002).The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection.Vitamin A deficiency (VAD) is known to be a significant public health problem around the world and it is particularly serious among women of reproductive age in South-East Asia and Africa [1-4]. It has now become evident that VAD in women has negative consequences on their health status as well as on their infants [3,4]. The link between VAD morbidity and mortality from infectious diseases [5] and non-infectious diseases [6-8] has been known for several years.VAD in pregnant women is associated with night blindness, severe anaemia, wasting, malnutrition, and reproductive and infectious morbidity [9], and increased risk of mortality 1-2 years following delivery [4].
Nutritional status, intestinal parasite infection and allergy among school children in Northwest Ethiopia
Bemnet Amare, Jemal Ali, Beyene Moges, Gizachew Yismaw, Yeshambel Belyhun, Simon Gebretsadik, Desalegn Woldeyohannes, Ketema Tafess, Ebba Abate, Mengistu Endris, Desalegn Tegabu, Andargachew Mulu, Fusao Ota, Bereket Fantahun, Afework Kassu
BMC Pediatrics , 2013, DOI: 10.1186/1471-2431-13-7
Abstract: A cross sectional study was performed involving school children in two elementary schools in Gondar, Ethiopia. Nutritional status of these children was determined using anthropometric parameters (weight-for-age, height-for-age and BMI-for-age). Epi-Info software was used to calculate z-scores. Stool samples were examined using standard parasitological procedures. The serum IgE levels were quantified by total IgE ELISA kit following the manufacturer’s instruction.A total of 405 children (with mean age of 12.09.1?±?2.54 years) completed a self-administered allergy questionnaire and provided stool samples for analysis. Overall prevalence of underweight, stunting and thinness/wasting was 15.1%, 25.2%, 8.9%, respectively. Of the total, 22.7% were found to be positive for intestinal parasites. The most prevalent intestinal parasite detected was Ascaris lumbricoides (31/405, 7.6%). There was no statistically significant association between prevalence of malnutrition and the prevalence of parasitic infections. Median total serum IgE level was 344 IU/ml (IQR 117–2076, n?=?80) and 610 IU/ml (143–1833, n?=?20), respectively, in children without and with intestinal parasite infection (Z?=??0.198, P?>?0.8). The prevalence of self reported allergy among the subset was 8%. IgE concentration was not associated either with the presence of parasitic infection or history of allergy.The prevalence of malnutrition, intestinal parasitism and allergy was not negligible in this population. In addition, there was no significant association between the prevalence of allergy and their nutritional status, and parasite infection. Further research prospective observational and intervention studies are required to address the question of causality between nutritional factors, parasites, and allergy.According to the World Health Organization (WHO), approximately 2 billion people are affected by helminthic infection worldwide [1]. These infections are responsible for high levels of morbidity and mo
Intestinal parasitosis and shigellosis among diarrheal patients in Gondar teaching hospital, northwest Ethiopia
Kahsay Huruy, Afework Kassu, Andargachew Mulu, Netsanet Worku, Teshome Fetene, Simon Gebretsadik, Fantahun Biadglegne, Yeshambel Belyhun, Abebe Muche, Aschalew Gelaw, Belay Anagaw, Sisay Yifru, Yemataw Wondie, Assegedech Bekele, Moges Tiruneh, Dieter Reissig, Feleke Moges
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-472
Abstract: A cross-sectional study involving 384 consecutive diarrheal patients who visited Gondar teaching hospital, Gondar, Ethiopia from October 2006 to March 2007 was conducted. Stool specimens were collected and examined for intestinal parasites and enteropathogenic bacteria following standard parasitological and microbiological procedures.Intestinal parasites were diagnosed in 36.5% of the patients. The most frequently encountered protozoan parasite was Entamoeba histolytica/dispar (7.3%) followed by Giardia lamblia (5.0%), Cryptosporidium parvum (1.8%) and Isospora belli (1.3%). The dominant helminthic parasite identified was Ascaris lumbricoides (5.5%) followed by Strongyloides stercoralis and Schistosoma mansoni (3.1% each), hookworm infection (1.8%), and Hymenolepis species (1.3%). Multiple infections of intestinal parasites were also observed in 6.3% of the patients. Among the enteropathogenic bacteria Shigella and Salmonella species were isolated from 15.6% and 1.6%, respectively, of the patients. Escherichia coli O57:H7 was not found in any of the stool samples tested. Eighty eight percent and 83.3% of the Shigella and Salmonella isolates were resistant to one or more commonly used antibiotics, respectively.Intestinal parasitosis was higher in patients who live in rural area, in patients who were washing their hands after visiting toilet either irregularly with soap and without soap or not at all, in patients who used well and spring water for household consumption, and in patients who had nausea (P < 0.05). Statistically significant associations were also observed between Shigella infections and patients who were using well and spring water for household consumption, and patients who had dysentery and mucoid stool (P < 0.05).The high prevalence of intestinal parasites and Shigella species in diarrheic patients calls for institution of appropriate public health intervention measures to reduce morbidity and mortality associated with these diseases. The rational use
Varying Response Ratio Priority: A Preemptive CPU Scheduling Algorithm (VRRP)  [PDF]
Pawan Singh, Amit Pandey, Andargachew Mekonnen
Journal of Computer and Communications (JCC) , 2015, DOI: 10.4236/jcc.2015.34005
Abstract: In present era, one of the most important resources of computer machine is CPU. With the increasing number of application, there exist a large number of processes in the computer system at the same time. Many processes in system simultaneously raise a challenging circumstance of managing the CPU in such a manner that the CPU utilization and processes execution gets optimal performance. The world is still waiting for most efficient algorithm which remains a challenging issue. In this manuscript, we have proposed a new algorithm Progressively Varying Response Ratio Priority a preemptive CPU scheduling algorithm based on the Priority Algorithm and Shortest Remaining Time First. In this scheduling algorithm, the priority is been calculated and the processes with high priority get CPU first or next. For new process, the priority of it becomes equal to inverse of burst time and for the old processes the priority calculation takes place as a ratio of waiting time and remaining burst time. The objective is to get all the processes executed with minimum average waiting time and no starvation. Experiment and comparison show that the VRRP outperforms other CPU scheduling algorithms. It gives better evaluation results in the form of scheduling criteria. We have used the deterministic model to compare the different algorithms.
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