Journal of Ethiopian Medical Practice

Prescribing pattern of drugs in medical wards of three hospitals in northwest Ethiopia

Teferra Abula — 2004-06-23

Appropriate drug utilization has a huge contribution to global reductions in morbidity and mortality with its consequent medical, social and economic benefits. Studies whether drugs are appropriately used or utilized are, however, lacking. This study was designed to investigate the prescribing pattern of drugs in three hospitals of north-west Ethiopia. A total of 882 medical records were reviewed retrospectively for the duration of one-year (1994).

The average admission diagnosis per patient was 1.4 in Gondar, 1.23 in Bahir Dar and 1.33 in Debre Tabor hospitals. Seven out of ten (70%) of top ten diagnoses were similar (except the rank order) in the three hospitals; tuberculosis being the leading diagnosis in all the three hospitals. The average number of drugs per patient during the hospitalization period was 5.2, 3.2, and 4.7 in Gondar, Bahir Dar and Debre Tabor hospital, respectively.

Anti-infective drugs (with preponderance of anti-bacterial drugs) accounted for almost half of the total prescription frequency and more than 70% of the medical inpatients received antibiotics mainly on empirical basis.

The prescribing pattern of individual drugs in the surveyed hospitals seemed to show some variation although the representation of the pharmacological classes (groups) showed some similarity. The prescribing patterns of the hospitals are discussed from the medical and economical points of view and the use of therapeutic guidelines with continued assessment of problems associated with drug resistance is recommended.

Key Words: Drugs, Medical in-patients, Prescribing pattern.

[J Ethiopia Med Pract. 2002;4(1):8– 13]

A Study of Surface Proteins, Other Adhesins and Iron Acquiring Mechanisms in the Pathogenesis of Neisseria gonorrhoea strains Isolated from STD Patients in Ethiopia

Aberra Geyid — 2004-06-23

Background information: Neisseria gonorrhoea is one of the most world wide prevalent Gram-negative diplococci bacteria causing the disease called Sexually Transmitted Disease on humans. Its stages of infection involve, first, colonization of columnar epithelial cells of mucosal surfaces; then an inflammatory response is elicited; and finally, the phagocytosis of the organisms by PMNs results in the formation of purulent discharges where the PMNs are found accumulated in it. The antigenic composition of N.gonorrhoea is complex with three major classes that are associated with the surface layers, namely, the pilus protein antigens, the polysaccharide component of cell wall and the outer membrane protein constitution. The pathogenicity determinant factors of N.gonorrhoea have been proved to include: Colonial Morphology which indicates that the virulence factors are based on the five major colony forms designated as T1, T2, T3, T4 and T5, indicating differences in surface antigens, virulence and in colony appearances; and, the Pili are the other pathogenesis determinant factors that are functioning by having adherence to the mucosal cell surface and serving as conjugal transfer of genetic material. It has been observed that piliated bacterial strains are resistant to phagocytosis, giving inefficient digestion ability to the macrophages compared to nonpiliated strains. Thus, types T1 and T2 are most virulent to humans because they are the piliated (fimbriated) strains.

The Ethiopian situation in relation to gonococcal infections indicates that it is known to be highly prevalent among both sexes of most age groups. However no work has been conducted to assess the prevalence of the different virulence factors of N.gonorrhoeae strains.

Objective : The aim of this study was thus to assess the prevalence of all the essential surface antigens as virulence factors of N.gonorrhoeae among the most vulnerable group of individuals for the infection and try to assess and recommend the possibility of getting important surface components to serve as vaccine candidates against gonococcal infections.

Patients & methods: a total of over 300 STD male and female patients from three study sites, Addis Ababa, Nazareth, and Awassa, were used as study subjects by collecting urogenital specimen after their clinical examination. The specimens were then used for the isolation of the N.gonorrhoea strains that were identified for their virulence types, tested for their antimicrobial sensitivity patterns and determined their surface antigenic components for the most prevalent virulence factors using haemagglutination and other detection assay methods.

Results: It was found that out of the total 335 specimens, N.gonorrhoea strains were isolated in 59% positive rate from males compared to the 43% positive rate was obtained from the females. The sensitivity pattern of these strains indicate that there were 19 different antibiogram patterns showing that only 12.3% were sensitive to all drugs while over 70% of the strains were resistant against more than two combined

drugs and above 90% of these multi-drug resistant strains showed to be PPNGs. Out the total N.gonorrhoea isolates, 200 were tested for their haemagglutination and Iron-binding protein production properties and 35% of them were found to be Mannose Resistant Haemagglutinating (MRHA) strains while 20% were Mannose Sensitive Haemaggluintating (MSHA) strains when tested using the human AB blood types of. By the use guinea pig blood cells this was found to be 15% MRHA and 25% MSHA strains. When tested for their iron-binding protein (IBP) production, the MRHAs were positive for IBPs while the MSHA were positive for this property in 10%. Finally, based on the results obtained conclusions and recommendations are given at the end of the paper.

[J Ethiopia Med Pract. 2002;4(1):14– 20]

Phychiatric problems of the blind: Anxiety, Somatoform, and Depressive Disorders. Menelik II Hospital, Addis Ababa, Ethiopia

Zerihun Tadesse — 2004-06-23

Objective: To determine the magnitude of anxiety, somatoform, and depressive disorders among blind people.

Methods: All blind patients (according to WHO definition) who attended the Out Patient Clinics of the Ophthalmology Department of Menelik II hospital from October 2000- February 2001 were interviewed using a fully structured instrument-Composite International Diagnostic Interview (CIDI) core version 2.1.

Results: 107 patients with visual loss were included in the study. 6 (5.6%) had acute onset Vs. 101 (94.4%) gradual. 48 (44.9%) had been blind for more than 1 year. The commonest cause of blindness was found to be cataract 59 (55.1%); followed by glaucoma 20 (18.7%) and retinal detachment 12 (11.2%). Only 5 (4.7%) patients were found to have psychiatric morbidity. Generalized Anxiety Disorder, Depressive Disorder and Somatoform Disorder each constituted one case. Two patients were found to have dysthymia and one patient social phobia.

Conclusion: The reported prevalence of psychiatric problems among the blind in this study is way below those of other studies conducted in medical settings as well as general population. Further studies to determine magnitude of psychiatric problems among blind people, by using instruments with Amharic version of known validity are recommended and the need to establish validity of the Amharic version of CIDI is stressed.

[J Ethiopia Med Pract. 2002;4(1):21– 27]

Entamoeba Histolytica Infection Among Patients at Wonji-Shoa Sugar Estate Hospital, Ethiopia

Fekede Balcha — 2004-06-23

Background and objective: Infection by Entamoeba histolytica is cosmopolitan but is more prevalent and causes serious public health and socioeconomic problems in developing countries of the tropics and subtropics. The objective of this study was to determine the magnitude of amoebiasis among inpatients and outpatients of Wonji-Shoa Sugar Estate hospital, Ethiopia.

Patients and methods: The study subjects were inpatients and outpatients of Wonji-Shoa Sugar Estate Hospital in Ethiopia. The study covered a a follow-up period of almost 17 years, from 1987 to 2003. Faecal specimens from the patients were microscopically examined by the direct smear method.

Results: The annual prevalence, which ranged from 12% to 32% showed an increasing trend from year 1987 to 2003. The monthly prevalence of infection among patients (both trophozoites and cysts combined) analyzed for 8 months in 1992 ranged from17% in 1999 to 43% in 2002, with higher rates occurring in the months of December to May and July to September in some years. Analysis by amoebic stages showed that 35% of the patients passed trophozoites in their faeces while only 6% passed cystic stage.

Conclusions: In the Wonji-Shoa Sugar Estate which is one of the major agroindustrial sites, amoebiasis tends to increase from year to year perhaps due to deterioration of water supply and sanitation as well as overcrowding.

Key Words: Amoebiasis, Entamoeba histolytica, Ethiopia

[J Ethiopia Med Pract. 2002;4(1): 28– 31]

Prevalence and management out comes of anti TB drugs induced hepatotoxicity, St.Peter TB Specialized Hospital

Temesgen Mekonnen — 2004-06-23

Back Ground and Objectives: Tuberculosis is a major public health problem in the world, according to MOH in Ethiopia, in 1995 TB was the leading cause of out patient morbidity ranking 4th with 37%. WHO designed a strategy of treatment under direct observation (DOTS), but most of the anti TB drugs affect the liver and causes drug-induced hepatitis. This side effect was usually observed in St. Peter TB Specialized Hospital and there was a debate weather to discontinue all anti TB drugs so that drug resistance could be possibly avoided or partially so that patient could be protected from worsening of the underlined disease. Taking the above concept as a rationale a prospective study was conducted for one year with an over all objective to determine the prevalence of anti Tb drug induced hepatitis and to suggest the management out comes.

Patients and Methods: All TB patients admitted in the Hospital during the study period are the source of population, the study groups were been selected by detecting the possible confounding factors for jaundice. Base line LFT before anti TB initiation was determined before developed jaundice. Those patients, whom the jaundice is expected to be of anti TB drugs, were classified into two groups to be managed by 1) total and 2) partial discontinuation of the anti TB drugs.

Results: 516 (83.8%) of the admitted TB patients were qualified as a study group. The majority were in reproductive age group (15-49 years old.) (55.8%) were males. 332(64.3%) of this TB patients were new where as 110 (21.3%) patients were re treatment cases. The prevalence of jaundice supposed to be due to anti TB drugs induced hepatitis was 8.9% (46 patients); observed mostly with in 2 weeks of time, after anti TB initiation

25(54.3%). Among the jaundiced patients 41(89.1%) were newly treated and four (8.6%) retreated TB patients. Hence, there was statistically significant association between newly treated patients and risk of hepato toxicity (p<0.05). 14 male and 32 females were jaundiced revealing statistically significant association (p<0.0001). Further more, risk of jaundice is significantly associated with age (p<0.000001). As a management anti TB was discontinued totally in 33(71.7%) patients and partially in 13(28.3%) where only 14(30,4%) and 9(19.6) patients are cured respectively and there was no statistically significant association between the measures taken and the out comes observed (p>0.05) More over death after jaundice was significantly associated. (p<0.000001)

Conclusion: Most of the admitted TB patients were in the reproductive age group; this will have a negative feedback on the country's economy. Hence, prevention and early case detection needs strengthened. Some specific groups were prone to develop anti TB drug induced hepatitis. Hence, revision on dose administration needs to be proposed at least for these risk groups. There was similar effects observed on total and partial discontinuation of anti TB drugs after commencing jaundice, so one can substantiate either of the alternatives and here it is recommended that on going study is vital to conclude the impact of these managements in potentiating the development of drug resistance.

[J Ethiopia Med Pract. 2002;4(1): 32–38]

Auto Amputation of the lower leg: Case Report

Gashaw Messele — 2004-06-23

Soft tissue cavernous haemangioma: Photo essay

Edom Girma — 2004-06-23

Plain Chest Radiograph in Diagnosis of cardiac diseases: review article

Asfaw Atnafu — 2004-06-23

CXR is a most important and helpful diagnostic tool in assessment of cardiopulmonary pathology. Anorganized systematic and disciplined approach will give enormous anatomic and physiologic information to make an accurate complete diagnosis. Good background knowledge on physiology and anatomy of the heart and the pulmonary vascular system is an important prerequisite.(5,6)

[J Ethiopia Med Pract. 2002;4(1):43– 55]

Pertussis: review article

Amha Mekasha — 2004-06-23

Rape in Present Scenario: A Review

Manoj Kumar Mohanty