Gondar University Hospital Research Articles

Prevalence of orthostatic hypotension and associated factors among older people with hypertension in Northern Ethiopia.

The prevalence of hypertension increases with age, and older people with this condition are at increased risk of developing orthostatic hypotension (OH) due to age-related changes in blood pressure regulation mechanisms as well as prescribed medications. OH increases the risk of falls, often with subsequent fractures as well as other morbidity and even mortality. The prevalence and characteristics of OH in older people with hypertension in Low-Income Countries have not been well characterized. This study aims to determine the prevalence of OH and associated factors among older people with hypertension in northern Ethiopia. A hospital-based cross-sectional study was conducted using a convenience sample of patients aged 60 years and older with hypertension receiving pharmacotherapy and followed up at the University of Gondar Hospital, Ethiopia. Blood pressure (BP) was measured in the supine position, and after 3min of standing; the level of BP drop (> 20/10) was used to define measured OH. Data regarding symptoms of OH were also collected using the Orthostatic Hypotension Questionnaire (OHQ). The data were entered into Microsoft Excel version 2016 and exported to SPSS version 20 for statistical analysis. Logistic regression analysis was conducted to assess the factors associated with OH. A total of 240 participants were included, with a mean age of 68.8 ± 7.1 years. The prevalence of OH was 23.8% (CI: 21.5%, 26.1%). Of the medications used, calcium channel blocker (CCBs) treatment was strongly associated with OH (AOR = 2.03[95%CI = 1.08-3.8]). Two-thirds (61.4%) of participants with measured OH experienced relevant symptoms of OH. There was a high prevalence of OH among older patients with hypertension attending a tertiary care hospital in Gondar, with one in four affected. The use of CCBs was identified as an independent risk factor for OH. Most patients with OH experienced relevant symptoms, so monitoring this condition in this group may help prevent adverse consequences.

CARD8 polymorphisms among bacterial meningitis patients in North-West Ethiopia

BackgroundThe severity of infectious disease outcomes is dependent on the virulence factors of the pathogen and the host immune response. CARD8 is a major regulator of the innate immune proinflammatory response and has been suggested to modulate the host response to common inflammatory diseases. In the present study, the C10X genetic polymorphism in the CARD8 gene was investigated in relation to bacterial meningitis.MethodsA total of 400 clinically suspected meningitis patients hospitalized at the University of Gondar Hospital were enrolled in the study. Cerebrospinal fluid (CSF) and blood samples were collected for laboratory investigations. The collected CSF was cultured, and all the results obtained from the culture were confirmed using direct RT‒PCR. Genotyping of whole-blood samples was performed using a TaqMan assay. The results were compared with apparently healthy controls and with PCR-negative meningitis suspected patients.ResultsOf the included patients, 57% were men and the most common clinical signs and symptoms were fever (81%), headache (80%), neck stiffness (76%), nausea (68%), and vomiting (67%). Microbiology culture identified 7 patients with bacterial meningitis caused by Neisseria meningitidis (n = 4) and Streptococcus pneumoniae (n = 3). The RT-PCR revealed 39 positive samples for N. meningitidis (n = 10) and S. pneumoniae (n = 29). A total of 332 whole-blood samples were genotyped with the following results: 151 (45.5%) C10X heterozygotes, 59 (17.7%) C10X homozygotes and 122 (36.7%) wild genotypes. The polymorphic gene carriers among laboratory confirmed, clinically diagnosed meningitis and healthy controls were 23(46%), 246(40%), and 1526(39%), respectively with OR = 1.27 (0.7–2.3) and OR = 1.34 (0.76–2.4). The presence of the C10X polymorphism in the CARD8 gene was more prevalent in suspected meningitis patients than in healthy controls (OR 1.2; 1.00-1.5). Homozygote C10X polymorphic gene carriers were more susceptible to infectious disease. The presence of viable or active bacterial infection was found to be associated with the presence of heterozygous C10X carriers.ConclusionsA greater proportion of C10X in the CARD8 gene in confirmed bacterial meningitis patients and clinically diagnosed meningitis patients than in healthy controls. Homozygote C10X polymorphic gene carriers were more susceptible to infectious disease than heterozygote gene carriers and healthy controls.

Magnitude and antimicrobial susceptibility profile of bacteria isolated from pediatric sepsis cases at University of Gondar Hospital, Northwest Ethiopia

BackgroundSepsis is one of the major causes of morbidity and mortality among pediatric patients throughout the world. The varying microbiological pattern of sepsis warrants the need for researches on the causative organisms and their antimicrobial susceptibility pattern. The epidemiology of neonatal and pediatric sepsis in Ethiopia is under-research. The objective of this study was to evaluate the burden of bacterial pathogens and their antimicrobial susceptibility patterns among children suspected of sepsis.MethodsAn institutional-based prospective cross-sectional study was conducted on 370 pediatric(age birth-15 years) patients suspected of sepsis at the University of Gondar Comprehensive Specialized hospital from December 2020 to November 2021. Blood samples were collected aseptically and inoculated into Tryptone Soya Broth for culture. The organisms grown were identified by standard microbiological methods and subjected to antibiotic susceptibility testing by modified Kirby-Bauer disk diffusion method recommended by Clinical laboratory and standard institute. Methicillin resistance was confirmed using Cefoxitin disk diffusion method. Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) version 26 software. A p-value less than 0.05 at 95% confidence interval was considered statically significant.ResultsOut of the total 370 study subjects, 21.6% (80/370) of them were culture positive. Of these, 43 (53.8%) and 37 (46.3%) were Gram-positive and Gram-negative bacterial pathogens, respectively. The most prevalent Gram-positive bacterial isolate was Staphylococcus aureus (n = 24; 30%) and coagulase negative staphylococci (n = 7; 8.8%). Among the Gram-negative bacterial isolates, the leading bacteria was Klebsiella pneumoniae (n = 20; 25%) followed by Escherichia coli (n = 7; 8.8%). Clindamycin, Chloramphenicol, Gentamicin and Ciprofloxacin were the most effective antibiotics against Gram-positive bacterial isolates while Amikacin, Meropenem and Chloramphenicol were effective against Gram-negative pathogens. Methicillin resistance was detected in 45.8% of Staphylococcus aureus. Multi-drug resistance (MDR) antimicrobial susceptibility pattern was observed in 76% of the bacterial isolates.ConclusionGram positive bacteria were the predominant isolates among pediatric sepsis cases and most of the bacterial isolates showed MDR. Staphylococcus aureus and Klebsiella pneumoniae were frequently isolated bacteria. The high prevalence of drug resistance warrants rational use of antibiotics and the need for regular antibiotic susceptibility surveillance studies.

Renal diseases in children at the university of Gondar hospital, Ethiopia: pattern and outcome

Background: In developing countries, renal diseases in children are becoming common causes of morbidity and mortality. In Ethiopia, there are no adequate data about patterns and outcome of these disorders. We conducted this study to provide evidences on patterns and outcome of renal diseases in children admitted to a tertiary hospital in Gondar, Ethiopia. Methods: A retrospective record review of all pediatric patients admitted with renal diseases over a period of two-years (January 2022-December 2023) to the university of Gondar hospital (UoGH), was conducted. Results: A total of 456, comprising 231 (50.7%) females and 225 (49.3%) males, patients were studied. Majority (37.7%) of patients were below 5 years of age. Renal diseases accounted for 3.6% of all admissions during the 2-years period. Common renal problems were urinary tract infection (UTI) (29%), acute glomerulonephritis (AGN) (24.1%), nephrotic syndrome (18.6%), acute kidney injury (AKI) (14.3%), nephroblastoma (9%) and chronic kidney diseases (CKD) (2.4%). Finally; 71.9% were discharged improved and 10.5% died. The highest case fatality rates were in patients with rapidly progressive glomerulonephritis (36.7%) followed by CKD (36.4%), and AKI (21.5%). Conclusions: This study revealed high prevalence and mortality rate of renal diseases in children. The major causes of death were AGN/RPGN, CKD and AKI. All the above evidences clearly disclosed that establishment of a pediatric nephrology unit and get a trained pediatric nephrologist in our university hospital is critical.

Assessment of Knowledge and Attitude of General Practitioners Regarding Autism and Associated Factors at Gondar University Hospital, Gondar, Ethiopia.

Background: The neurodevelopmental conditions known as autism spectrum disorders (ASDs) start in early childhood and last the entirety of a person's life. They are characterized by distorted social interaction, difficulties communicating, and repetitive, stereotypical behavior. Objective: This study sought to evaluate general practitioners (GPs)' attitudes and knowledge of ASDs and related factors at Gondar University Hospital. Methods: An institutional-based cross-sectional study design was used. Using a convenience-sample method, three-hundred sixty individuals were chosen for this study. Data were collected using a self-administered questionnaire. The GPs who took part in this survey were characterized by descriptive statistics. The relationship between the dependent variables (knowledge and attitude) and the sociodemographic characteristics was examined using an independent two-sample t-test and Pearson correlation analysis. The Statistical Package for the Social Sciences Version 25 was used for all data analyses. Results: In this study, the GPs had an average age of 31.82 years, with an average of 18 years since graduation and 16 years of practice. Participants' average overall knowledge and attitude scores on autism were 15.83 (SD = 3.27) and 29.54 (SD = 3.21), respectively, both falling within the moderate range. Using an independent t-test, we found a significant difference (p < 0.001) between the attitudes of male and female GPs regarding autism. The study also identified weakly significant correlations between GPs' age and their attitudes toward autism (r = 0.271⁣∗∗, p < 0.001) and between years of practice and attitudes (r = 0.105⁣∗, p=0.046). However, no significant correlations emerged between GPs' knowledge and their age, years since graduation, or years of practice (r = 0.069, p=0.194; r = 0.069, p=0.193; and r = -0.053, p=0.312, respectively). In addition, we observed a weakly significant association (r = 0.004⁣∗∗, p < 0.001) between GPs' knowledge and their attitudes about autism. Conclusion: Based on their total scores, the participants had a moderate level of knowledge and attitudes toward autism. There was a favorable correlation found between the study subjects' attitudes regarding autism and their age, as well as their practice year. Furthermore, a clear correlation was observed between GPs' attitudes and their understanding of autism.

Health-related quality of life and associated factors in heart failure with reduced ejection fraction patients at University of Gondar Hospital, Ethiopia.

Living with heart failure poses challenges due to its poor prognosis and impact on quality of life, making it crucial to assess how it affects patients for better patient-centered management. This study aimed to assess quality of life and associated factors in heart failure with reduced ejection fraction patients at University of Gondar Comprehensive Specialized Hospital in Ethiopia, 2023. An "institution-based" cross-sectional study was conducted at the University of Gondar Comprehensive Specialised Hospital. The data were collected using an interviewer-administered questionnaire. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. Sociodemographic, behavioral, clinical, biochemical, and echocardiographic characteristics were included in the questionnaire. The collected data were entered into EpiData version 4.6 and exported into SPSS version 25 for analysis. Multiple linear regression analysis (p < 0.05) was used to measure the degree of association between quality of life and independent variables. A total of 240 patients with heart failure and reduced ejection fraction participated in the study. The health-related quality of life scores for the physical, emotional, and total were 17.60 ± 10.33, 10.58 ± 6.33 and 46.12 ± 26.06, respectively. Health-related quality of life was significantly associated with age, marital status, occupation, income, heart failure duration, recent hospitalization, New York Heart Association functional class, heart failure etiology, atrial fibrillation comorbidity, systolic blood pressure, heart rate, heart failure medications, severe left ventricular systolic dysfunction, and severe or moderate pulmonary hypertension. This study found that patients with heart failure and reduced ejection fraction had poor health-related quality of life, influenced by identified factors. These findings aid professionals in assessing and identifying interventions that improve these patients' quality of life.

Clinical features and outcomes of patients with preeclampsia and eclampsia at Gondar University hospital, Amhara, Ethiopia 2021

ObjectiveThe aim of this study was to investigate the clinical features, and treatment outcome of women with preeclampsia and eclampsia at Gondar University Comprehensive Specialized Hospital in Amhara, Northern Ethiopia, in 2021. MethodsAn institutional-based retrospective chart review was conducted at Gondar University Specialized Hospital from March to June 2021. The study participants were chosen using a simple, systematic random sampling method. A pretested check list was used to collect data from medical records. The collected data was coded, entered into Epi-data version 4.6, and exported to SPSS version 26 for descriptive and inferential analysis. A Fisher’s exact test was used to determine statistically significant factors at a p-value of < 0.05. ResultsOf the 311 study participants, more than half (53 %) of mothers have illiterate, nearly half (49.8 %) had preeclampsia with severe features. Eclampsia accounted for 18.6 % of females in the study setting. For various reasons, more than half of the mothers required immediate intervention to terminate the pregnancy via cesarean section. Unfavorable maternal outcomes were present in more than 25 % of cases; the observed unfavorable maternal outcomes were aspiration pneumonia (10.6 %), hemolytic elevated liver function test and low platelet count syndrome (8.7 %), and maternal death (0.6 %). The severity of the disease, mode of delivery, aspartate transaminase, gravidity, gestational age, and antenatal care were all statistically significant predictors of pregnancy outcome. ConclusionThe prevalence of unfavorable maternal and perinatal outcomes of preeclampsia and eclampsia is considerable in the study area. To prevent these perinatal and postnatal effects, maternal outcomes of pregnancy, antenatal care services, emergency obstetrics, and new born care should be expanded and strengthened.

Prevalence and Associated Factors of Ocular Manifestations of Acquired Immune Deficiency Syndrome Among Adults at University of Gondar Hospital, North West Ethiopia, 2021.

Acquired immune deficiency syndrome is a disease with common clinical ocular manifestations. Ocular manifestations lead to blindness, which has a common social and economic impact. This study aimed to assess the prevalence and associated factors of ocular manifestations of acquired immune deficiency syndrome among adults at the University of Gondar Hospital, North West Ethiopia, 2021. A cross-sectional study was conducted on 401 patients from June to August 2021. Samples were selected based on a systematic random sampling technique. Data collection was done using structured questionnaires. Data extraction format was used to collect the clinical characteristics of patients including ocular manifestations. Data entry was done by EpiData version 4.6.0.6 and exported to the Statistical Package for the Social Sciences version 26 for data analysis. Associated factors were analyzed by binary logistic regression. P-value <0.05 with a 95% confidence level was used to declare a significant association. A total of 401 patients were involved with a response rate of 91.5%. The overall prevalence of ocular manifestations of acquired immune deficiency syndrome was 28.9%. The common ocular manifestations were seborrheic blepharitis at 16.4% and squamoid conjunctival growth at 4.5%. Age >35 years (AOR=2.52, 95% CI: 1.19, 5.35), Clusters of differentiation 4 count <200 cells/µL (AOR=4.76, 95% CI:2.50, 9.09), World Health Organization stage II (AOR=2.60, 95% CI: 1.23, 5.50), history of eye disease (AOR=3.05, 95% CI: 1.38, 6.72), and duration of Human Immunodeficiency Virus >5 years (AOR=2.79, 95% CI: 1.29, 6.05) were statistically associated with the ocular manifestation of acquired immune deficiency syndrome. In this study, the prevalence of ocular manifestation of acquired immune deficiency syndrome was high. Age, CD4 count, duration of HIV, eye disease history, and WHO clinical staging were the significant factors. Early eye checkups and regular ocular examinations of HIV patients would be helpful.

Triage, Trauma, and Civil Unrest: Decreasing Critical Care Overcrowding and Nursing 'Undertriage' Praxes at the University of Gondar Public Hospital, Ethiopia

Introduction:In March of 2022, the Washington Post reported that the: “Deadliest war isn’t in Ukraine, it’s in Ethiopia.” Current death toll estimates are around 600,000: 50,000-100,000 (warfare); 150,000-200,000 (starvation), and 100,000 (lack of medical treatment). Due to increasing civil unrest, a mixed-methods study began at the University of Gondar Hospital in Gondar, Ethiopia. Between 2018-2022, the estimated (daily average) of patients was reported to have quadrupled, from 100 to 400. The global research team implemented 12 new systemic revisions in overcrowding, triage nursing praxes, and resuscitations. Patient data from 521 hospital records was evaluated, as well as resource allocation(s) in staffing, equipment, and training.Method:The study’s inclusion criteria for A&amp;E data included all patients who sought emergency care at UoG Teaching Hospital’s Emergency Department between May 13, 2018, and June 29, 2018, primarily during the normal daytime working hours between 9am and 2pm, as nighttime security and road travel were deemed less secure for data collectors.Results:After the 12-benchmark implementation, there was an approximate 15%-25% decrease in direct-from-triage ‘Red’ patient admission; congestion dropped 50%-70%; and the occurrences of successful resuscitations increased. The study revealed that over 75% of patients presented with symptoms indicative of illness(es), and 24.4% presented with trauma (remaining psychiatric). Of the trauma cases, approximately 28.3% were ‘intentional’ injuries. The patients’ mean TEWS triage score was 3.294, with a standard deviation from the mean of 1.9938.Conclusion:The overall prevalence of patients necessitating surgical evaluation, the elevated use of triage discriminators due to space, equipment, and staff concerns, and the predominant use of ‘Yellow Zone’ services–all pointed to the vital need for resource re-allocation(s), stricter ECCN adherences to TEWS triage indices, as well as future Mass Casualty Planning, Triage, and Response, and Mass Casualty Medical Operations training.

Incidence of HIV Infection among HIV-Exposed Iinfants at Gondar University Hospital from 2019-2021: A Prospective Cohort Study.

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is decreasing worldwide; however, achieving the MTCT elimination target of 2% by 2020 and 0% by 2030 is challenging in resource-limited countries. Preventing mother-to-child transmission (PMTCT) is a key strategy in eliminating new pediatric human immunodeficiency virus (HIV) infection Strengthening PMTCT program is one of the key mechanisms for the elimination of Pediatric HIV infection and improving maternal and newborn survival. Assessing the incidence of HIV infection among HIV exposed infants is critical to devise an important preventive strategy which was the main objective of this study. A prospective Cohort study was conducted at Gondar University Comprehensive Specialized Hospital, PMTCT clinic to assess the incidence of HIV infection among HIV exposed infants from 2019-2021. The overall incidence of HIV infection among HIV exposed infants was 3.6%. HIV infection rate was significantly increased among HIV exposed infants coming out of Gondar, Infants with developmental failure and Infants with Unknown fathers' HIV status compared to their counterpart. The incidence of HIV infection among 307 HIV-exposed infants was 3.6% which is higher than the expected standard. The lost to follow up rate was also significant (9.4%). These finding showed that strengthening the PMCT service is mandatory.

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

IntroductionRupture 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. ObjectiveTo assess the prevalence of GEVH and its associated factors among patients with CLD in Northwest Ethiopia. MethodsAn 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. ResultsThe 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. ConclusionGEVH 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.

Prevalence and forms of workplace violence against nurses

IntroductionNurses are one of the professional groups highly vulnerable to workplace violence. This study was conducted to assess the prevalence and form of workplace violence against Professional Nurses. MethodsInstitution-based cross-sectional study design was used to study 385 nurses working at the University of Gondar hospital, from July to October 2019. A stratified random sampling technique was used. The data were entered into Epi info version 7.2.1 and analyzed by using SPSS version 23. Descriptive statistics were used to present the finding. ResultThree hundred eighty-five participants were involved in this study. Nearly half of the participants 198 (51.4 %) had been the victim of one form of violence or another in their workplace. Most of the victims of workplace violence, 118(59.6 %), have experienced verbal violence and around 23.2 % reported physical violence in the last 12 months. ConclusionNurses working at University of Gondar Hospital are at risk of workplace violence. Most violent incidents were verbal and a significant number of nurses have faced physical violence. The most common perpetrators of violence were relatives of patients and a significant share of violence occurred by patients themselves. Most participants were dissatisfied with the way the administrators dealt with the violent incident.

Determinants of post-stroke depression among stroke survivors at University of Gondar Hospital, Northwest Ethiopia: a case-control study

BackgroundStroke is one of the most common causes of disability among adults. Post-stroke depression (PSD) is a frequent neuropsychiatric complication in stroke patients. Despite the increasing prevalence of stroke, there is a paucity of data on PSD and its determinants among stroke survivors in developing countries like Ethiopia. We aim to assess the factors associated with PSD in survivors of stroke.MethodA hospital-based unmatched case-control study was conducted during the period of February to July 2020 at University of Gondar Hospital among stroke survivors. Study subjects were recruited consecutively. Socio-demographic and clinical data were obtained from patients’ interviews and medical record reviews. A diagnosis of PSD was made using the Patient Health Questionnaire (PHQ-9). EpiData version 3.1 was used to enter data, and SPSS version 26 was used to analyze it. Bivariate and multivariate logistic regressions were fitted to identify associated variables. The adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value 0.05 were used to determine the significance of the association.ResultA total of 240 stroke survivors were included in the study (80 cases and 160 controls). The mean age was 60.8 years (SD ± 14.3) with an equal sex distribution. Variables statistically associated with PSD were male gender (AOR = 3.5, 95% CI: 1.64-7.46 C, P-value = 0.001), subcortical location of the largest lesion (AOR = 2.42, 95% CI: 1.06–5.56, p-value = 0.036), severity of the stroke (AOR = 52.34, 95% CI:10.64-256.87, p-value = 0.000), physical disability (AOR = 5.85. 95% CI:1.94–17.65, p-value = 0.002), previous history of stroke or transient ischemic attack (AOR = 5.90, 95% CI:2.04–17.10, p-value = 0.001) and ischemic heart disease (AOR = 9.97, 95% CI:3.4-29.22, p-value = 0.000).ConclusionImportant factors in the occurrence of PSD in this study include prior history of stroke, physical disability, severity of the stroke, subcortical location of the lesion, male gender, and ischemic heart disease. Stroke patients with such factors need routine screening for PSD, particularly in LMICs where there is uncoordinated post-stroke care, a shortage of neurologists and mental health practitioners.

Undernutrition was a prevalent clinical problem among older adult patients with heart failure in a hospital setting in Northwest Ethiopia.

Undernutrition is a frequently noticed medical problem in patients with heart failure. It is caused by poor nutrient intake, malabsorption, systemic inflammation, neurohumoral activation, oxidative stress, and hypermetabolic state. Undernutrition results in a decrease in the quality of life and the survival rate in patients with heart failure. There is a paucity of documentation on undernutrition among patients with heart failure in sub-Saharan African countries. The study aimed to determine the magnitude and associated factors of undernutrition among older adult patients with heart failure in the hospital setting in Northwest Ethiopia. An institutional-based cross-sectional study was conducted at the University of Gondar Hospital, Northwest Ethiopia, between 1 June 2021 and 31 October 2021. A consecutive sampling method was used to recruit 262 study subjects. A Mini-nutritional assessment-full form (MNA-FL) Questionnaire was used to extract nutritional information among patients with heart failure. Patients with heart failure, who scored MNA-FL score <17, were declared to have undernutrition. The data were entered into EPI Info version 4.6.0.0 and then exported to SPSS version 26 for analysis. Explanatory variables associated with undernutrition in patients with heart failure were analyzed by applying a logistic regression model. A P-value of <0.05 was used to declare a significant association. A total of 262 patients with heart failure were included in the study. The mean age (± SD) of the study subjects was 64.6 (± 9.2) years. Hypertensive heart disease (111/262, 42%) was the most common cause of heart failure. Hypertension was the frequently observed comorbid disease. Based on the MNA-FL score for nutritional status, 75 out of 262 (28.6%, 95% CI: 22.9-34.4%) were undernourished (MNA-FL < 17), while 124 out of 262 (47.3%, CI: 41.5-53.1%) were at risk of undernutrition (MNA-FL = 17-23.5). The remaining 63 out of 262 (24.1%, 95% CI: 18.2-29.8%) study subjects were well nourished (MNA-FL > 24). On a multivariate analysis, patients with severe heart failure (New York Heart Association (NYHA) functional class III/IV) (AOR = 4.287, CI: 2.012-9.134, P-value < 0.001), with a duration of illness of 3-5 years (AOR = 3.225, CI: 1.138-9.137, P-value = 0.028), with a duration of illness of >5 years (AOR = 4.349, CI: 1.592-11.879, P-value = 0.001), presence of comorbidities (AOR = 2.29, CI: 1.06-4.96, P-value = 0.036), who underwent treatment with loop diuretics (AOR = 2.983, CI: 1.407-6.326, P-value = 0.040), and who reside in a rural area (AOR = 5.119, CI: 2.481-10.560, P-value < 0.001) were at risk of developing undernutrition. Undernutrition was a significant clinical problem in older patients with heart failure. Nutritional interventions should be prioritized for patients with chronic and severe heart failure.

Time to Discharge and its Predictors among Children Aged 1-60 Months with Severe Acute Malnutrition Admitted to the Therapeutic Feeding Center in A Tertiary Hospital, North West Ethiopia.

Standard treatment of severe acute malnutrition with medical complication and/or failed appetite test is admission in therapeutic feeding centers for stabilization. Once stabilized, patients will be linked to Outpatient treatment program for rehabilitation. Information regarding time to discharge from inpatient therapeutic feeding centers is limited in Ethiopia. The main objective of this study was to assess the time to discharge and its predictors among children 1-60 months with Severe Acute Malnutrition admitted to University of Gondar Hospital. Hospital Based retrospective follow up study was conducted in Gondar University Hospital among 282 children aged 1-60 months admitted to inpatient Therapeutic Feeding Center from June 2018 to December 2020. Participants were selected by Simple random sampling technique. Time to discharge from inpatient treatment was estimated using Kaplan-Meir procedure and Log Rank test was used to test observed difference between covariates. Identification of predictors for time to discharge was done by Stratified cox regression model. Overall 282 children were studied; 242 (85.8%) were discharged improved and 40 (14.2%) were censored. The median time to Discharge was 13 days (IQR: 9-18) and the Incidence of discharge was found to be 6.4 (95% CI: 5.6-7.2) per 100 person- day observations. Kwash-dermatosis (AHR=2.4, 95% CI: 1.17-4.8), Anemia (AHR=1.7, 95% CI: 1.1-2.6), pneumonia at admission (AHR=1.6, 95% CI: 1.01-2.63) and Hospital acquired infection (AHR=4.4, 95% CI: 2.4-8.2) were predictors of time to discharge. Hospital stay at the stabilization center was prolonged. Pneumonia, anemia, kwash dermatosis and Nosocomial infections were significant predictors of time to discharge.

Prevalence of mesial temporal sclerosis in patients with epilepsy who underwent magnetic resonance imaging in Gondar university hospital, North-West Ethiopia 2020

Background- Mesial temporal lobe sclerosis is commonly associated with intractable temporal lobe epilepsy and is seen in about 60% to 80% of cases. This study is aimed at determining the prevalence of mesial temporal sclerosis on MRI among all epilepsy patients. Methods- Hospital based retrospective cross-sectional study in adult patients referred for MRI of the brain from January 2019 - September 2020 were conducted. The study is carried out at the University of Gondar Referral Hospital with a 1.5T Philips MRI machine, in Gondar town located 741 k.m. northwest of Addis Ababa. Results - A total of 77 patients were included, out of which 61 had generalized tonic clonic epilepsy, 7 had focal impaired awareness seizures, 6 had focal to bilateral tonic clonic and 2 had focal aware. Features of mesial temporal sclerosis were identified in 8 of 77 (10.4 %) of the cases, all of them had generalized tonic-clonic epilepsy &amp; none of our participants with mesial temporal sclerosis had focal impaired awareness seizures. Mesial temporal sclerosis in our study is found to equally involve the right (50 %) and left (50 %) sides and none of our patients have bilateral involvement, and the most common findings are hippocampal atrophy in 6 out of 8 (75 %) of the cases and increased hippocampal signal intensity in 5 of 8 (62.5 %). Conclusion - The prevalence of mesial temporal sclerosis in patients with epilepsy is found to be less than what is documented in most literatures.

Snakebite case management: a cohort study in Northwest Ethiopia, 2012-2020.

Timely and appropriate management of snakebites in the tropics is a lifesaver. Many snakebite patients are being bitten in remote rural areas and do not manage to get in due time to healthcare facilities. This study assessed the clinical features and the risk factors associated with treatment outcomes of snakebite patients admitted at two hospitals in the Northwest of Ethiopia. In a retrospective cohort study, routinely collected data from 250 patients' medical charts at University of Gondar Hospital and Metema Hospital, between September 2012 and August 2020, were reviewed. The median age of the snakebite cases was 24 years (95% CI = 22-26), with 80.8% male patients. At admission 148/250 patients presented in Clinical stage 1 or 2 (local symptoms only) and 73.7% presented more than 12 hours after the bite, 80.2% received antibiotics and 79.0% antivenom. The median duration of hospitalization was 3 days (95% CI = 3-4); 72% of the patients recovered and were discharged, 10.8% died and 0.5% underwent an amputation. On logistic regression analysis, residence in rural areas (AOR = 2.52, 95 % CI = 1.2-5.3), sign of bacterial superinfection on the bite site (AOR = 4.69. 95% CI = 1.4-15.4), clinical stage 3 or 4 with systemic symptoms or toxic signs at admission (AOR = 4.84, 95% CI = 1.3-18.0) and no treatment with antivenoms (AOR = 6.65, 95% CI = 1.6-27.7) were associated with bad outcome (death, amputation and/or referred/ went against medical advice). Timely presentation at early clinical stage, appropriate clinical management and availability of antivenoms are cornerstones to reduce snakebite morbidity and mortality.

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

BackgroundDyspepsia 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.MethodsAn 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.ResultA 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.ConclusionMedical treatment of peptic ulcer disease should target treatment of H. pylori infection and cautious use of non-steroidal anti-inflammatory drugs/aspirin.

Insufficient Supply, Diagnostic Services, and Lack of Trained Personnel in Primary Hospitals in North-West Ethiopia Worsened Trauma Care: A Mixed-Method Study.

Although there has been a massive expansion of hospitals in Ethiopia in the last 2 decades, most are primary-level hospitals. Assessing the capability of the hospitals in managing trauma victims is essential to strengthening the hospitals. We employed a mixed-method approach using quantitative descriptive design triangulated with qualitative research. We audited 10 hospitals using WHO essential trauma care checklist. We interviewed 37 health care professionals, 9 hospital managers, and 12 decision-makers using a semi-structured interview guide. We used the COREQ checklist to report the qualitative finding. The physical structures of the hospitals were good in all cases. Airway, breathing and circulation management were partially available, with a score ranging from 0 - 3. The extent of injury, lack of radiology service, and scarcity of drugs and supplies were common causes for the referral of trauma victims to Gondar University hospital. Unavailability of drugs and supplies, lack of diagnostic services, inability to recruit specialist professionals, lack of training, and inconvenient working and living environment were stated as the main barriers to providing trauma care. In the study area, the gaps in trauma care in the primary hospitals can be improved by further commitment of the hospitals, the district, zonal administrators, and the regional health bureau.

Prevalence and factors associated with preoperative anemia among adult patients scheduled for major elective surgery at University hospital in Northwest Ethiopia; a cross-sectional study

BackgroundAnemia is the most common hematological finding in surgical patients. One-third of surgical patients were anemic during preoperative assessment. The presence of preoperative anemia was found to be related with increased morbidity, mortality, length of hospital stay, intensive care unit admissions and postoperative infections. ObjectiveTo determine the prevalence and factors associated with preoperative anemia among adult patients scheduled for major elective surgery at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2020. MethodsAfter obtaining an ethical approval, hospital-based cross-sectional quantitative study was conducted from June to August 2020 in University of Gondar Hospital. Full blood count within two weeks of preoperative period was considered valid if there were no any factors that affect the hematologic system Descriptive statistics, cross-tabulations and binary logistic regression analysis were performed to identify factors associated withpreoperative anemia. The strength of the association was presented using AOR with 95% confidence interval and p-value < 0.05 was considered as statistically significant. ResultA total of 185 patients enrolled with 100% response rate. We observed preoperative anemia in 36.8% patients. The multi-variable binary logistic analysis showed that ASA II and III [AOR: 3.8, CI: 1.6–9.2], recent prior surgery [AOR: 3.3, CI: 1.3–8.5], history of malignancy [AOR: 9.4, CI: 2.0–43.4], orthopedic procedure [AOR: 11.2, CI: 4.0–31.6] and gynecologic procedure [AOR: 5.2, CI: 1.7–14.5] were significantly associated with preoperative anemia. ConclusionThe prevalence of preoperative anemia was high and ASA ≥2, recent prior surgery, history of malignancy, orthopedic surgery and gynecologic procedure were significantly associated with preoperative anemia. We recommend to clinicians to aim prevention, early detection and treatment of preoperative anemia among adult patients scheduled for major elective surgery to reduce risk of anemia and related adverse outcomes.