Pleurisy and bilateral pleural effusions after administration of atorvastatin

Atorvastatin is a widely used cholesterol-lowering agent. Although generally safe and well tolerated, a number of drug side effects have been reported. We report only the second case of atorvastatin-induced pleural effusions, presenting as pleurisy, and the first case from Ethiopia. We believe our patient had this association based on the temporal onset of symptoms, the otherwise negative evaluation, and the resolution of findings once atorvastatin was discontinued. Clinicians need to consider this relationship when evaluating unexplained pleurisy and pleural effusions in patients taking atorvastatin

Value of Adenosine Deaminase in the diagnosis of tuberculous pleurisy at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

Objectives: Tuberculous (TB) pleurisy is a common form of extrapulmonary tuberculosis in high burden countries including Ethiopia. Adenosine deaminase (ADA) has been used in the early diagnosis of TB pleurisy. This study was designed to evaluate the diagnostic role of ADA in TB pleurisy at Tikur Anbessa Specialized Hospital (TASH). Materials and Methods: A cross-sectional hospital-based study was designed to evaluate the diagnostic value of ADA in consecutive adult patients with unexplained pleural effusions presenting to Chest Clinic at TASH from June 2016 to August 2018. All referred patients underwent thorough clinical and laboratory examinations including assessment of pleural fluid ADA, where a value of ≥40 IU/I was used to suggest TB pleurisy (per manufacturer’s recommendation). A final diagnosis of TB pleurisy was made based on pleural fluid Gene Xpert, AFB smear, pleural biopsy, and cytology results in addition to a clinical and radiologic response to anti-TB therapy. Results: A total of 67 patients were included in the study. The median age was 38.5(±14.5) years; 36 (53.7%) of the participants were males. TB pleurisy was confirmed in 38 (56.7%) subjects. The mean pleural fluid ADA levels was significantly higher in those with TB pleurisy as compared to those without TB pleurisy, 65.8 IU/l versus 28 IU/I (P < 0.05), respectively. Pleural fluid ADA had a sensitivity of 84% and specificity of 79%, resulting in a positive predictive value of 84.2%, a negative predictive value of 79.3%, and an overall test accuracy of 82% in our study population. Conclusion: In our study, pleural fluid ADA played a useful role in the diagnosis of TB pleurisy

Letter to the Editor - Resumption of pulmonary function testing (Spirometry) at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, during the COVID-19 pandemic

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Unintended consequences of the COVID-19 pandemic in Africa

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Chronic respiratory disease in adult outpatients in three African countries: a cross-sectional study

BACKGROUND: The greatest burden of chronic respiratory disease is in low- and middle-income countries, with recent population-based studies reporting substantial levels of obstructive and restrictive lung function. OBJECTIVE: To characterise the common chronic respiratory diseases encountered in hospital outpatient clinics in three African countries. METHODS This was a cross-sectional study of consecutive adult patients with chronic respiratory symptoms (>8 weeks) attending hospital outpatient departments in Ethiopia, Kenya and Sudan. Patients were assessed using a respiratory questionnaire, spirometry and chest radiography. The diagnoses of the reviewing clinicians were ascertained. RESULT: A total of 519 patients (209 Kenya, 170 Ethiopia, 140 Sudan) participated; the mean age was 45.2 years (SD 16.2); 53% were women, 83% had never smoked. Reviewing clinicians considered that 36% (95% CI 32-40) of patients had asthma, 25% (95% CI 21-29) had chronic bronchitis, 8% (95% CI 6-11) chronic obstructive pulmonary disease (COPD), 5% (95% CI 4-8) bronchiectasis and 4% (95% CI 3-6) post-TB lung disease. Spirometry consistent with COPD was present in 35% (95% CI 30-39). Restriction was evident in 38% (95% CI 33-43). There was evidence of sub-optimal diagnosis of asthma and COPD. CONCLUSION: In Ethiopia, Kenya and Sudan, asthma, COPD and chronic bronchitis account for the majority of diagnoses in non-TB patients with chronic respiratory symptoms. The suboptimal diagnosis of these conditions will require the widespread use of spirometry

Epidemiology of trachoma and its implications for implementing the "SAFE" strategy in Somali Region, Ethiopia: results of 14 population-based prevalence surveys.

PURPOSE: Ethiopia is highly trachoma endemic. Baseline mapping was needed in Ethiopia's Somali Region to guide elimination efforts. METHODS: Cross-sectional community-based surveys were conducted in 34 suspected trachoma-endemic woredas, grouped as 14 evaluation units (EUs), using a standardised mapping methodology developed for the Global Trachoma Mapping Project. RESULTS: In total, 53,467 individuals were enumerated. A total of 48,058 (89.9%) were present at the time of survey teams' visits and consented to examination. The prevalence of trachomatous inflammation-follicular (TF) among children aged 1-9 years ranged from 4.1% in the EU covering Danot, Boh, and Geladin woredas in Doolo Subzone to 38.1% in the EU covering Kebribeyah and Hareshen woredas in Fafan Subzone (East). The trichiasis prevalence among adults aged over 15 years varied from 0.1% in the EU covering Afder, Bare, and Dolobay woredas in Afder Subzone (West) to 1.2% in the EU covering Awbere in Fafan Subzone (West). CONCLUSION: Mass drug administration (MDA) with azithromycin is needed in 13 EUs (population 2,845,818). Two EUs (population 667,599) had TF prevalences in 1-9-year-olds of ≥30% and will require at least 5 years of MDA; 5 EUs (population 1,1193,032) had TF prevalences of 10-29.9% and need at least three years of MDA; 6 EUs (population 985,187) had TF prevalences of 5-9.9% and need at least one round of azithromycin distribution before re-survey. In all 13 of these EUs, implementation of facial cleanliness and environmental improvement measures is also needed. Surveys are still needed in the remaining 34 unmapped woredas of Somali Region

Study protocol: analysis of regional lung health policies and stakeholders in Africa

Background Lung health is a critical area for research in sub-Saharan Africa. The International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA) is a collaborative programme that seeks to fill evidence gaps to address high-burden lung health issues in Africa. In order to generate demand for and facilitate use of IMPALA research by policy-makers and other decision-makers at the regional level, an analysis of regional lung health policies and stakeholders will be undertaken to inform a programmatic strategy for policy engagement. Methods and analysis This analysis will be conducted in three phases. The first phase will be a rapid desk review of regional lung health policies and stakeholders that seeks to understand the regional lung health policy landscape, which issues are prioritised in existing regional policy, key regional actors, and opportunities for engagement with key stakeholders. The second phase will be a rapid desk review of the scientific literature, expanding on the work in the first phase by looking at the external factors that influence regional lung health policy, the ways in which regional bodies influence policy at the national level, investments in lung health, structures for discussion and advocacy, and the role of evidence at the regional level. The third phase will involve a survey of IMPALA partners and researchers as well as interviews with key regional stakeholders to further shed light on regional policies, including policy priorities and gaps, policy implementation status and challenges, stakeholders, and platforms for engagement and promoting uptake of evidence. Discussion Health policy analysis provides insights into power dynamics and the political nature of the prioritisation of health issues, which are often overlooked. In order to ensure the uptake of new knowledge and evidence generated by IMPALA, it is important to consider these complex factors

Unintended consequences of the COVID-19 pandemic in Africa

As we write this, a patient is in a local South African Hospital on a ventilator following a cardiac arrest after a massive pulmonary embolus. He recently returned from overseas. When he arrived, he had a cough and phoned his doctor, who instructed him to be tested for COVID-19 before a consultation. The results were delayed for a few days. Before the patient received the results which were negative, he had his pulmonary embolus, was admitted where he had a cardiac arrest with anoxic brain injury. This was an unintended and unreported consequence of the COVID-19 pandemic. The law of intended consequences has been defined as “The actions of people, and especially of governments, always have effects that are unanticipated or unintended.”https://patsjournal.orghj2021CardiologySurger

Level of asthma control and risk factors for poor asthma control among clinic patients seen at a Referral Hospital in Addis Ababa, Ethiopia

Abstract Objective Uncontrolled asthma negatively impacts patients, families, and the community. The level of symptom control among asthmatics in Ethiopia has not been well studied. We investigated the level of asthma control and risk factors for poor asthma control in clinic patients seen in the largest public hospital in Ethiopia. Results In this cross-sectional study, we studied all 182 consecutive subjects with a physician diagnosis of asthma who were seen in chest clinic at Tikur Anbessa Specialized Hospital between July and December 2015. Of the 182 subjects, 68.1% were female. The mean age was 52 ± 12 years and the median duration of asthma was 20 ± 12.7 years. One hundred and seventeen subjects (64.3%) had nighttime awakening due to asthma. Fifty-eight (31%) were not using controller medications and 62 (34.6%) had improper inhaler technique. Only 44 (24.2%) subjects had well-controlled asthma. On multivariate analysis, variables associated with uncontrolled asthma included: use of biomass fuel for cooking, longer duration of asthma (> 30 year), incorrect inhalation technique, and asthma exacerbation in the last 12 months. Most asthmatics attending in the largest public hospital in Ethiopia, had uncontrolled asthma. Several risk factors for poor asthma control were identified. Improved asthma control is possible through directed interventions

Rationale and design of a screening study to detect schistosomiasis-associated pulmonary hypertension in Ethiopia and Zambia.

Schistosomiasis is a major cause of pulmonary arterial hypertension (PAH) worldwide, but the prevalence and risk factors for schistosomiasis-associated PAH (SchPAH) development are not well understood. Schistosomiasis-associated hepatosplenic disease (SchHSD) is thought to be a major risk factor for PAH development. Herein, we describe our plans for prospectively screening SchHSD subjects for clinical evidence of PAH at two major academic medical centers and national referral hospitals in Addis Ababa, Ethiopia and Lusaka, Zambia. The screening study will primarily be conducted by echocardiography, in addition to clinical assessments. Plasma samples will be drawn and banked for subsequent analysis based on preclinical animal model rationale. If successful, this study will demonstrate feasibility of conducting prospective cohort studies of SchPAH screening in schistosomiasis-endemic regions of Africa, and provide initial data on clinic-based disease prevalence and potential mechanistic biomarkers underlying disease pathogenesis