65 research outputs found

    Dean\u27s Update, October 2023

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    Dean\u27s Research Newsletter, November 2023

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    Dean\u27s Research Newsletter, August 2023

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    Pleurisy and bilateral pleural effusions after administration of atorvastatin

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    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

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    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

    National trends in emergency room diagnosis of pulmonary embolism, 2001–2010: a cross-sectional study

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    Background: Little is known about the United States diagnosis and burden of pulmonary embolism (PE) in the emergency department (ED), and their evolution over the past decade. We examined nationally representative data to evaluate factors associated with and trends in ED diagnosis of PE. Methods: We conducted a cross-sectional study using National Hospital Ambulatory Medical Care Survey (NHAMCS) data from January 1, 2001 to December 31, 2010. We identified all ED patient visits where PE was diagnosed and corresponding demographic, hemodynamic, testing and disposition data. Analyses were performed using descriptive statistics and multivariable logistic regression. Results: During the study period 988,000 weighted patient visits with diagnosis of PE were identified. Among patients with an ED visit, the likelihood of having a diagnosis of PE per year increased significantly from 2001 to 2010 (odds ratio [OR] 1.091, 95% confidence interval [CI] 1.034-1.152, P = 0.002 for trend) when adjusted for demographic and hospital information. In contrast, when further adjusted for the use of computed tomography (CT) among patients in the ED, the likelihood of having a diagnosis of PE per year did not change (OR 1.041, 95% CI 0.987-1.097, P = 0.14). Overall, 75.1% of patients seen with a diagnosis of PE were hemodynamically stable; 86% were admitted with an in-hospital death rate under 3%. Conclusions: The proportion of ED visits with a diagnosis of PE increased significantly from 2001 to 2010 and this rise can be attributed in large part to the increased availability and use of CT. Most of these patients were admitted with low in-hospital mortality. Keywords: Pulmonary embolism Emergency department Computed Tomography (CT) pulmonary angiograph

    Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

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    Objectives: The objectives of the study were to evaluate the benefit of awake prone positioning in COVID-19 patients hospitalized at Eka Kotebe General Hospital, Addis Ababa, Ethiopia.Materials and Methods: Consecutive patients with COVID-19 who require supplemental oxygen to maintain oxygen saturation of ≥90% during the month of October 2020 were enrolled. Structured questionnaires were employed to collect data. Admission oxygen saturation was recorded for each patient before and after their first proning session. Analysis of descriptive and comparison statistics was done using SPSS version 25.Results: A total of 61 patients were included in the study. The mean age (+SD) for the cohort was 55.4 (+16.9) years. The average duration of proning was 5+2.5 h/session and 8+6 h/day. The average oxygen saturation before proning was 89% (SD 5.2) and 93% (SD 2.8) 1 h after proning (P < 0.001); supplemental oxygen requirements significantly decreased with prone ventilation, before proning: FiO2 0.33 (+0.14) versus 1 h after prone ventilation: FiO2 0.31 (+0.13) (P < 0.001). Oxygen improvement with prone ventilation was not associated with duration of illness or total prone position hours. When assessed at 28 days after admission, 55.7% (n = 34) had been discharged home, 1.6% (n = 1) had died, and 42.6 (n = 26) were still hospitalized.Conclusion: Awake prone positioning demonstrated improved oxygen saturation in our oxygen requiring COVID-19 patients. Even though further studies are needed to support causality and determine the effect of proning on disease severity and mortality, early institution of prone ventilation in appropriate oxygen requiring COVID-19 patients should be encouraged

    Identifying risk factors associated with smear positivity of pulmonary tuberculosis in Kazakhstan

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    Background Sputum smear-positive tuberculosis (TB) patients have a high risk of transmission and are of great epidemiological and infection control significance. Little is known about the smearpositive populations in high TB burden regions, such as Kazakhstan. The objective of this study is to characterize the smear-positive population in Kazakhstan and identify associated modifiable risk factors. Methods Data on incident TB cases’ (identified between April 2012 and March 2014) socio-demographic, risk behavior, and comorbidity characteristics were collected in four regions of Kazakhstan through structured survey and medical record review. We used multivariable logistic regression to determine factors associated with smear positivity. Results Of the total sample, 193 (34.3%) of the 562 study participants tested smear-positive. In the final adjusted multivariable logistic regression model, sex (adjusted odds ratio (aOR) = 2.0, 95% CI:1.3–3.1, p < 0.01), incarceration (aOR = 3.6, 95% CI:1.2–11.1, p = 0.03), alcohol dependence (aOR = 2.6, 95% CI:1.2–5.7, p = 0.02), diabetes (aOR = 5.0, 95% CI:2.4–10.7, p < 0.01), and physician access (aOR = 2.7, 95% CI:1.3–5.5p < 0.01) were associated with smear-positivity. Conclusions Incarceration, alcohol dependence, diabetes, and physician access are associated with smear positivity among incident TB cases in Kazakhstan. To stem the TB epidemic, screening, treatment and prevention policies should address these factors

    Tuberculosis in Kazakhstan: analysis of risk determinants in national surveillance data

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    Background: Development of tuberculosis (TB) is determined by various risk factors and the interactions of temporal and spatial distributions. The aim of this study was to identify the most salient risk factors for TB disease as well as multidrug resistant TB (MDR-TB) at the oblast (provincial) level in Kazakhstan. Methods: Correlational and descriptive analyses were conducted at the oblast and national level using data provided by the country’s National Institute of Geography (NIG) and the National Tuberculosis Program (NTP). Reported incident case notification rates (CNRs) and prevalence vary by oblast, thus the study investigated which determinants contributed to this regional variation and compared burdens among oblasts. Results: The results showed that while tuberculosis CNRs decreased over the study period, MDR-TB conversely increased. Two oblasts -Atyrauskaya and Mangystauskaya - presented especially significant anomalies with large decreases in TB incident CNRs coupled with comparatively large increases in MDR-TB incident CNRs. Conclusion: Understanding the distribution of TB and MDR-TB cases and associated risk factors, especially the “unknown risk factor” categorization points to the need for future research
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