Endoscopic Diagnosis of Hookworm Disease in a Patient with Severe Iron Deficiency Anemia: A Case Report.

Hookworm infection is an important cause of iron deficiency anemia, especially in heavily infected high-risk populations residing in underdeveloped tropical countries. Stool examination is the main method used for hookworm diagnosis; however, its sensitivity is relatively low. Hookworm infections have been incidentally diagnosed during routine upper gastrointestinal endoscopies. We present the case of a 60-year-old Ethiopian farmer who had severe iron deficiency anemia and positive occult blood in the stool. Repeated stool examinations revealed no ova or parasites. Esophagogastroduodenoscopy revealed the presence of hookworms in the duodenum. The patient was treated with albendazole and ferrous sulfate. Careful endoscopic examination of the duodenum is crucial for identifying unsuspected hookworm infection responsible for chronic gastrointestinal bleeding and iron deficiency anemia.

Neural Tube Defect in a Resource Limited Setting: Clinical Profile and Short Term Outcome.

Background: There is a huge burden of neural tube defect (NTD) in Ethiopia, and surgical management is not readily available. We aimed to assess the clinical profile and hospital outcome of children with NTD that were operated in Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Methods: A retrospective cross-sectional study on 250 children with NTD that were treated in a tertiary hospital from March 2016 to May 2020 was conducted to describe the clinical profile and treatment outcome at discharge. Logistic regression analysis was carried out to evaluate factors that determine mortality. Results: Out of the 250 children, 50.4% were male. Myelomeningocele was the most common type of NTD (77.2%) followed by meningocele (10.4%). Only 3 mothers (1.2%) received periconceptional folic acid. Prenatal diagnosis of NTD was made in only 22 (8.8%) cases. 52.8% of the NTDs were ruptured at presentation and 50.8% had associated sepsis. At presentation, 42.4% were ≤72 hours of age and only 18 neonates (7.2%) were operated within 72 hours of admission. 54% had associated hydrocephalus, 31.6% had Chiari II malformation and 19.6% had club foot. Surgical site infection, post MMC repair hydrocephalus, and meningitis were seen in 8%, 14% and 16.8% of the participants, respectively. The mean duration of hospitalization was 24 ± 14.4 days. Twenty patients (8%) died before discharge from hospital. Prematurity [AOR: 26 (95% CI: 8.01, 86.04), P < 0.001] and the presence of meningitis [AOR: 3.8 (95% CI: 1.12,12.9), P = 0.03]were determinants of mortality. Conclusion: NTDs are substantial health problem in this part of the country. Periconceptional folic acid supplementation is almost non-existent. Prenatal detection of NTDs is very low and management is delayed in the majority of cases. Myelomeningocele is the most common type of NTD. There is high in-hospital mortality, and prematurity and the presence of meningitis are its determinants.

Pediatric Guillain-Barré Syndrome in a Resource Limited Setting: Clinical Features, Diagnostic and Management Challenges, and Hospital Outcome.

Background: Guillain-Barré syndrome (GBS) is an acute immune-mediated peripheral neuropathy with a highly variable clinical course and outcome. There remain diagnostic and treatment challenges in resource limited settings. This study aimed to describe the clinical presentation, diagnostic and management challenges, and hospital outcome of children with GBS in southern Ethiopia. Methods: A retrospective chart review of children aged ≤14 years who were admitted with a diagnosis of GBS to Hawassa University Comprehensive Specialized Hospital from 2017 to 2021 was done. Medical records of 102 children who fulfilled the Brighton Criteria for GBS were reviewed, and data on demographic, clinical characteristics, investigation findings, treatment, and outcome were collected. Logistic regression analysis was done to determine factors associated with mortality. Results: The mean age of the study subjects was 7.25±3.91 years and 63.7% were male. Antecedent event was present in 48% of the cases, and the most common triggering factor was upper respiratory tract infection (63.8%). The mean Hughes disability score was 4.23±0.54, 4.48±0.71, and 4.03±0.86 at admission, nadir and discharge from hospital, respectively. Cranial nerve involvement was present in 27.5% of patients and bulbar palsy was the most common finding. Dysautonomia was observed in 57.8% of the participants. Sixty-three patients (61.8%) needed ICU care but only 43 of them (68.3%) were admitted to ICU. Similarly, 31 patients (30.4%) required respiratory support but only 24 of them (77.4%) were on mechanical ventilator. No patient had nerve conduction study. Only 5.9% of patients received IVIG. Thirteen patients (12.7%) died of GBS and the presence of respiratory failure was the only determinant of mortality [AOR = 11.40 (95% CI: 1.818, 71.52), p = 0.009]. Conclusion: There is a gap in the diagnosis and management of children with GBS; and mortality from the disease is higher than reports from other settings.

Fulminant Hepatitis and Ulcerative Colitis: Case Report of Ethiopian Child with Schistosomiasis and Amebiasis Co-Infection.

Background: Schistosomiasis is a neglected tropical disease (NTD) that affects around 200 million people worldwide, the majority of whom are children aged 5 to 15 years. It is one of the most significant public health problems in tropical and subtropical regions. Entamoeba histolytica infection is common in areas where schistosomiasis is endemic because Schistosoma mansoni infection can reduce the host's immune response, resulting in increased morbidity. Case Presentation: This is the story of a 12-year-old male adolescent from the Guji zone of the Oromia regional state of Ethiopia who presented to Hawassa University Comprehensive Specialized Hospital (HUCSH) complaining of bloody diarrhea of 1 week associated with vomiting of ingested matter of 2 weeks. He also had history of fever, chills, rigors, arthralgia, and weight loss during a 2 weeks period. Further questioning revealed that he had previously swum in a pond and had a self-limited itchy skin condition. The family said that similar cases had occurred in their town that resolved with medications provided at a local health center. Conclusion: Schistosomiasis and amebiasis are major public health issues, especially in impoverished areas. Schistosomiasis presents differently clinically depending on the phase and clinical form in which it manifests, making diagnosis and management challenging. As a result, it necessitates an integrated collaboration involving clinicians, pathologists, and public health professionals. We describe ulcerative colitis (UC) ascribed to schistosomiasis and amoebiasis coinfection, and fulminant hepatitis due to schistosomiasis. As there was no report of liver abscess on sonographic scanning, hepatitis may not be due to coinfection. This case will be an alert to clinicians and public health personnel who are striving for the ultimate eradication of schistosomiasis and also teaches us that treating co-infections of both is beyond just giving praziquantel and antiamebics.

A Breakthrough in the Challenges of Tuberculosis Diagnosis: Lateral Flow Urine Lipoarabinomannan (LAM) Assay for the Diagnosis of Active Tuberculosis in a Subset of Human Immuno Deficiency Virus (HIV) Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.

Background: Tuberculosis is commonly detected late or not at all in HIV-positive people. Rapid and sensitive molecular tests like Gene X-pert have recently become available to replace or supplement existing conventional tests for detecting tuberculosis, and the World Health Organization (WHO) recommends that these rapid techniques be used as the initial diagnostic test for tuberculosis to avoid delays in starting appropriate treatment. The lipoarabinomannan was approved by the national ministry of health in August 2021 for the detection of active tuberculosis in specified groups. Case Summary: It is not uncommon for tuberculosis to be difficult to diagnose in this population, and we believe that our experiences with urine lipoarabinomannan for the detection of active tuberculosis will benefit other clinicians and, ultimately, patients. We discussed the experiences of two human immunodeficiency virus (HIV) patients with putative active tuberculosis, whose tuberculosis workups were negative by conventional methods, including gene expert but found to be positive by urine lipoarabinomannan and who were started on anti-tuberculosis medicines and improved. They are now in a good condition and are taking their medications regularly without any problems. Conclusion: Ending the suffering of HIV patients necessitates lobbying for more accurate tuberculosis diagnosis. The urine Lipoarabinomannan (LAM) assay will address the shortcomings of traditional sputum-based diagnostic tests including sputum Acid Fast Bacilli (AFB) and Gene X-pert, making it a credible alternative for diagnosing tuberculosis in people with HIV. The results of this case series demonstrated that TB LAM is a milestone for the difficulties in TB diagnosis in HIV patients. As of now, the national guideline only suggests urine LAM for HIV patients who fulfill the set criteria. We recommend the stakeholders to increase the availability, and extrapolate the recommendation to other populations including non-HIV patients.

Glycemic control among children and adolescents with diabetes in Southern Ethiopia: a cross-sectional study.

BACKGROUND: Glycemic control is an important part of diabetes management. Strict glycemic control has been shown to reduce the long-term complications of diabetes. However, achieving good glycemic control is challenging for people with diabetes especially in resource limited settings. The aim of this study was to assess glycemic control and identify its determinants among children and adolescents with diabetes. METHODS: A cross-sectional study among 116 children and adolescents with diabetes was done at a pediatric endocrine clinic in southern Ethiopia. Data on socioeconomic, demographic, nutrition, and diabetes related variables were collected. Glycemic control was assessed based on glycosylated hemoglobin level. Logistic regression analysis was used to identify predictors of glycemic control. RESULTS: The mean glycated hemoglobin (HbA1c) of the participants was 9.6 ± 2.4% (81 ± 3 mmol/mol). Ninety seven (83.6%) of the study participants had poor glycemic control [HbA1c ≥7.5% (58 mmol/mol)]. The presence of lipodystrophic change at injection sites (p =0.028) and being from a family that cannot afford for insulin when there is no free supply (p =0.009) were associated with poor glycemic control. CONCLUSIONS: The majority of children and adolescents with diabetes had poor glycemic control. Stakeholders shall focus on identifying strategies to improve the magnitude of poor glycemic control. More research is warranted to exhaustively list out factors contributing to poor glycemic control.

Antiepileptic drug adherence in children in southern Ethiopia: A cross sectional study.

BACKGROUND: Epilepsy is one of the commonest chronic neurological disorders with serious health consequences. Treatment adherence is one of the determinants of seizure control. This study was designed to determine factors affecting antiepileptic drug adherence among children with epilepsy. METHODS: A cross sectional study was conducted on 192 children with epilepsy (≤14 years of age) on follow-up at a pediatric neurology clinic in Southern Ethiopia from January 1st to August 30th, 2019. Medication Adherence was measured using the eight-item Morisky's medication adherence scale. Logistic regression analysis was done to determine factors associated with antiepileptic drug adherence. RESULT: One hundred twenty-five (65%) of the study subjects were adherent to their medication. On multivariable analysis, factors predictive of good adherence included family size of ≤5 [AOR = 2.34, (95% CI: 1.07, 5.10); P = 0.03] and duration of epilepsy (<1year [AOR = 5.83, (95% CI: 1.48, 22.92); P = 0.012] and 1-2year [AOR = 4.58, (95% CI: 1.12, 18.77); P = 0.035]). Monthly family income of <1000 Ethiopian Birr [AOR = 0.18, (95% CI: 0.06, 0.61); P = 0.005] and presence of seizure attack in the past 3months [AOR = 0.23, 95% (CI: 0.10, 0.55); P = 0.001] predicted poor antiepileptic drug adherence. CONCLUSION: Adherence to antiepileptic drugs in children is low in our setting; low family income and occurrence of seizures while on treatment predicted poor adherence. Supplying free antiepileptic drugs to poor children and regular provision of information about expected treatment response to children with epilepsy and their caretakers may help improve adherence.

The First Experience of Effective 3rd Line Antiretroviral Therapy - A Case of 40-Year-Old Female Retroviral-Infected Patient at Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia.

BACKGROUND: Treatment failure continues to be an impediment to the efficacy of highly active antiretroviral therapy (HART) in the treatment of human immunodeficiency virus type 1 infection (HIV-1). The World Health Organization (WHO) recommends third-line antiretroviral therapy (ART) for patients who have failed second-line ART. Darunavir (DRV) boosted with ritonavir (DRV/r) has a higher genetic barrier to resistance, is active against multidrug-resistant HIV isolates, retaining virological activity even when multiple protease mutations are present, and has been shown to be cost-effective when compared to other boosted protease inhibitors (PIs). CASE SUMMARY: This is a case of a 40-year-old female known HIV/AIDS patient who has been on ART for the last 14 years with good adherence and regular follow-up, and who is now on 3rd line ART medication with TLD (tenofovir/lamivudine/dolutegravir)+DRV/r (in her 11th month) after being diagnosed with second-line treatment failure. After 6 months and 1 week of therapy, the viral load (VL) was sent, and the result was undetectable. The patient's clinical conditions had greatly improved. CONCLUSION: Third-line ART therapy, which was once thought to be a salvageable treatment, is now the primary option for second-line ART failure. TLD in combination with ritonavir-boosted darunavir is found to be effective at lowering viral loads in the blood below detectable limits. Despite a lack of data on the use of third-line ART in Ethiopia, access to third-line ART containing ritonavir-boosted darunavir is recommended because it has been shown to be an effective alternative for patients who have failed second-line ART. We recommend that more research be done with a larger sample size, and that the findings in this paper be used with caution.

Empiric Treatment of Acute Meningitis Syndrome in a Resource-Limited Setting: Clinical Outcomes and Predictors of Survival or Death.

BACKGROUND: Bacterial meningitis is a significant cause of morbidity and mortality in the developing world. However, limited research has focused on the diagnosis and management of meningitis in resource-limited settings. METHODS: We designed a prospective case series of children admitted to a large, academic referral hospital with acute meningitis syndrome. Data were collected on age, time of presentation, prior antibiotics, cerebrospinal fluid (CSF) parameters, antibiotic and steroid prescription, and clinical outcome. RESULTS: Data on 99 patients were collected and analyzed. Most of the patients were males, n=69 (70%), and were from a rural area, n=83 (84%). Incomplete vaccination was common, n=36 (36%) and many have evidence of malnutrition, n=25 (38%). Most patients, n=64 (72%), had received antibiotics prior to admission with a mean duration of symptoms of 4.9 days prior to admission. The CSF white blood cell (WBC) count was higher in those who had not received prior antibiotics though it was elevated in both groups. The CSF WBC count was not associated with survival; malnutrition and length of symptoms prior to admission were both associated with decreased survival. CONCLUSIONS: While use of antibiotics prior to obtaining CSF in patients with acute meningitis syndrome may decrease their CSF WBC count, it is not clinically significant. Many patients had a significant delay in presentation that had an effect on survival, This is a potentially modifiable risk factor despite the resourcelimited setting.

Pediatric diabetic retinopathy: experience of a tertiary hospital in Ethiopia.

BACKGROUND: Diabetic retinopathy is one of the micro vascular complications of diabetes mellitus. To date there are no studies that show the magnitude of diabetic retinopathy in the pediatric population of Ethiopia with only very few in Africa. The purpose of this study was to determine the prevalence of diabetic retinopathy in children and adolescents at a tertiary center in Ethiopia. METHODS: This cross-sectional hospital based descriptive study included children aged between 9 and 17 years attending the endocrine follow-up clinic of Tikur Anbesa Specialized Hospital. A structured questionnaire was used for evaluating sociodemographic data and information pertinent to diabetes. The prevalence of diabetic retinopathy was determined by fundus photography of each eye. RESULTS: A total of 86 patients were examined with a mean age of 13.7 (SD = 1.8) years. At onset of diabetes, 95.6% of children presented with diabetic ketoacidosis(DKA); 22 children (25.6%) had at least two episodes of DKA, and 45 children (52.3%) had poor glycemic control. Background retinopathy was present in four children (4.7%) with a mean age of 14.25 (SD = 1.89) years and two of them also had maculopathy. CONCLUSION: Although there are some methodological limitations, this study highlights the difficulties of achieving good glycemic control and the early occurrence of diabetic retinopathy in Ethiopian diabetic children.