Gastroesophageal variceal hemorrhage in patients with chronic liver diseases attending university of Gondar Specialized comprehensive hospital in Ethiopia: Institutional based cross-sectional study.

Introduction: Rupture and bleeding from Gastroesophageal Varices (GEVs) are major complications among patients with chronic liver disease (CLD) and are associated with a high mortality rate. Hence, identifying factors of Gastroesophageal Variceal Hemorrhage (GEVH) is essential for the management and prevention of this fatal outcome. Objective: To assess the prevalence of GEVH and its associated factors among patients with CLD in Northwest Ethiopia. Methods: An institutional based cross-sectional study design was employed on a total of 262 patients. The data was entered into Epi-Data version 3.1, and then exported and analyzed using STATA version 14. The distribution of variables was checked using kolmogorov-smirnov test. Bivariable logistic regression model was fitted to select variables for multivariable analysis. In the final model, adjusted odds ratio with 95% confidence level and P-value less than 0.05 were used to assess degree of association. Results: The mean age of the study subjects was found to be 37.76 years (SD ± 11.62). The prevalence of GEVH was found to be 52% (95% CI: 49.6-54.2). Patients with grade F2 and F3 varices have 3.41 times (AOR: 3.41, 95% CI: 2.33-4.74) and 3.33 times (AOR: 3.33, 95% CI: 2.55-4.12) higher odds of bleeding, respectively. Patients not taking beta blocker have 2.38 times (AOR: 2.38, 95% CI: 1.82-3.90) increased odds of bleeding. Patients with more than three years of duration of illness have 2 times (AOR: 2.19, 95% CI: 1.39-3.99) increased odds of bleeding. Patients with platelet number less than 50,000/µl have 3.46 times (AOR: 3.46, 95% CI: 2.55-4.17) higher odds of bleeding. Conclusion: GEVH is found to be high in patients with CLD seen at university of Gondar Hospital. Higher grade of varices, non-use of beta blockers, presence of infection, platelet number and age are associated with higher occurrence of bleeding, pointing the possibility of averting this fatal complication, for most of the identified factors are preventable.

Peptic ulcer disease among dyspeptic patients at endoscopy unit, University of Gondar hospital, Northwest Ethiopia.

BACKGROUND: Dyspepsia is a common complaint in upper gastrointestinal disorders. It is described as predominant epigastric pain lasting for at least one month. Globally, peptic ulcer disease occurs in 3.5-32% of patients with dyspepsia. Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drugs/aspirin use are the widely known risk factors for peptic ulcer disease. There was no recent document on H. pylori infection rate among patients with peptic ulcer disease in Ethiopia. This study aimed to determine magnitude and associated factors of peptic ulcer disease among dyspeptic patients in Northwest Ethiopia. METHODS: An institutional-based cross sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit 218 study subjects. A pre-designed semi-structured questionnaire was used to extract clinical information. Olympus flexible fiber-optic endoscope (Olympus, GIF-E 600, Olympus Corp., Hamburg, Germany) was used to confirm the presence of peptic ulcer disease. Diagnosis of active H. pylori infection was made using the fecal H. pylori Antigen 25 T Card Test (Anamol Lab., Pvt. Ltd., Palghar, India). The Data were entered into EPI Info version 4.6.0.2, and then exported to SPSS version 20 for analysis. Explanatory variables associated with peptic ulcer disease were analyzed by applying logistic regression model. P value < 0.05 was used to declare significant association. RESULT: A total of 218 dyspeptic patients who underwent upper gastrointestinal endoscopic evaluations were included in the study. The mean (+ SD) age of patients was 42 ± 16.4 years. Forty nine percent (95% CI 42.4-56.2) of dyspeptic patients had active H. pylori infection. Peptic ulcer disease was diagnosed in 35% (95% CI 31.4-39.2) of patients with dyspepsia. H. pylori infection (AOR = 6.298, 95% CI 2.965-13.378, P value <  0.001) and NSAIDs/ASA use (AOR = 6.252, 95% CI 2.925-13.362, P value < 0.001) were identified as risk factors for peptic ulcer disease. CONCLUSION: Medical treatment of peptic ulcer disease should target treatment of H. pylori infection and cautious use of non-steroidal anti-inflammatory drugs/aspirin.

Hyperglycemia After Dolutegravir-Based Antiretroviral Therapy.

BACKGROUND: Antiretroviral therapies prolong life expectancy and improve the quality of life of HIV-infected patients. Despite the documented benefits of antiretroviral drugs, its use is not without side effects. Here, we report cases of new onset diabetes mellitus after taking a dolutegravir (DTG)-based ART regimen. CASE PRESENTATION: HIV-infected patients who had been on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART regimens for more than a decade were shifted to integrase strand transfer inhibitors (dolutegravir)-based ART regimen as recommended by the National Comprehensive HIV Care Guideline. They were diagnosed to have diabetes mellitus with or without diabetic ketoacidosis (DKA) as evidenced by polyuria, polydipsia and fatigue, severe hyperglycemia (plasma glucose level >250 mg/dl) with or without ketonuria (3+) after 1-12 months of DTG-based ART regimen. Two of the patients who presented with DKA were treated with intravenous fluids and regular insulin. NPH insulin was started following recovery from DKA, which later shifted to metformin. One of the patients who presented with severe hyperglycemia without DKA was started with NPH insulin, which later shifted to metformin. Good glycemic control was obtained with metformin, while the DTG-based ART regimen was continued. CONCLUSION: Hyperglycemia is a potential and noticed side effect of the DTG-based ART regimen. Baseline and periodic monitoring of plasma glucose might be required in ART regimens containing dolutegravir.

Compliance, Barriers, and Facilitators to Social Distancing Measures for Prevention of Coronavirus Disease 2019 in Northwest Ethiopia, 2020.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is the defining global health crisis of our time. To date, there is no curative treatment for COVID-19, and with vaccines only recently being rolled out predominantly in wealthy countries, prevention still remains the main strategy. Social distancing has been proven to mitigate the epidemic and limit disease spread. As is the case in many other countries, the Ethiopian government has declared a state of emergency and taken several measures to impose social distancing. The level of compliance with social distancing measures in Ethiopia is unknown. OBJECTIVE: The aim of this study was to assess the compliance, barriers, and facilitators to social distancing measures for the prevention of COVID-19 in Northwest Ethiopia. METHODS: A cross-sectional survey using telephone interview triangulated by a qualitative study was conducted over a period of 1 month from April 20 to May 20, 2020, at the University of Gondar Hospital in Gondar, Ethiopia. A total of 401 randomly selected participants, and 12 key representative informants selected by convenience were included for the quantitative and qualitative studies, respectively. Information on sociodemographic factors, knowledge about COVID-19, and practices concerning preventive measures--particularly social distancing--was collected. Respondents were asked what they believed were the barriers and facilitators of social distancing during in-depth face-to-face interviews. Data were entered and analyzed using Epi-data and Stata software, respectively. Frequencies and odds ratios were analyzed. P values < 0.05 were considered statistically significant, and a confidence level of 95% strength of association was used. RESULTS: A total of 425 potential participants were approached and 401 responded positively (response rate = 94.4%). Of the 401 study participants, 55.4% (95% CI, 50.4%-60.2%) reported poor compliance with social distancing measures. The mean (SD) age of participants was 36.4 (11.8) years. The majority of participants (63.84%) reported that they went to crowded places without putting on a face mask. Of the participants, 243 (60.6%) and 306 (76.3%) had good knowledge of COVID-19 transmission and prevention, respectively. Multivariate logistic regression analysis revealed that only age (adjusted odds ratio = 1.02; 95% CI, 1.00-1.04) was significantly associated with social distancing measures, with older persons more likely than younger to comply with social distancing guidelines. CONCLUSIONS: The majority of the study's participants reported poor compliance with social distancing measures set by the government and health authorities for prevention of COVID-19. Reported compliance with social distancing measures increased with increasing age. (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX) © 2021 Elsevier HS Journals, Inc.