Department of Internal Medicine

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    MAGNITUDE AND ASSOCIATED FACTORS OF POST TUBERCULOSIS COMPLICATIONS AMONG PATIENTS ATTENDING IN CHEST CLINIC AT AYDER COMPREHENSIVE SPECIALIZED HOSPITAL.
    (Mekelle University, 2024-09-01) MERHAWI GEBRIHANS
    Background: Pulmonary tuberculosis remains an important public health problem globally and one of most common infectious disease. A past history of pulmonary tuberculosis (TB) is a risk factor for longterm respiratory impairment. Post-TB lung dysfunction often goes unrecognized, despite its relatively high prevalence and its association with reduced quality of life. There is no data on the prevalence and associated factors of post tuberculosis complications in Ethiopia, particularly Tigray region. Objective: To determine the magnitude and associated factors of post tuberculosis complications among patients attending chest clinic at Ayder Comprehensive Specialized Hospital. Method: This was a retrospective, cross-sectional analysis of patients registered in a clinical database, charts and log book at the chest clinic of Ayder Comprehensive Specialized Hospital from September, 2022 –September, 2024 GC. The data was collected from the charts and smart care using prepared form. Analysis was made on SPSS 27 software. Descriptive statistics, frequency and proportions were utilized for Socio-demographic and clinical variables and bivariate and multivariate analyses were done to explore association between the dependent and independent variables. Results: a total of 367 TB treated patients were reviewed at the chest clinic of Ayder Comprehensive Specialized Hospital. Among these patients, 41.4 %( 152) had a diagnosis of post TB complications/ sequelae by imaging (chest CT and/ or chest x-ray), which was commented on by radiologist and pulmonologist. Statistical analysis indicated that older age(AOR: 4.401, 95% CI: 2.193-8.832, p =0.000), rural residency(AOR: 2.290, 95% CI: 1.424-3.681, P =0.001), smoking history(AOR=3.509, 95% CI: 1.810- 6.803, p-value=.000)and prolonged duration of TB illness (AOR:2.00,95% CI: 1.260-3.175, P= 0.003) were significantly associated with higher risk of post TB complications. Conclusion and recommendation: This study shows high-rate post TB complications/sequelae. Older age, rural residency, smoking and prolonged duration of tuberculosis illness significantly increase the riskx of developing these sequelae. These findings highlight the need for targeted follow up care and rehabilitation.
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    CLINICAL PROFILE, TREATMENT AND OUT COME PATTERN OF INFLAMATORY BOWEL DISEASE OF PATIENTS VISITING GASTRONTESTINAL CLINIC OF AYDER COMPREHENSIVE SPECIALLIZED HOSPITAL AND HIWOT SPECIALITY CLINIC FROM 2019 -2024.
    (Mekelle University, 2024-09-01) Beriha Belay
    BACKGROUND: inflammatory bowel disease (IBD) denotes a group of disorders Crohn’s disease (cd), ulcerative colitis (uc), and other forms known as indeterminate colitis (ic). These are characterized by chronic intestinal inflammation. IBD can cause significant morbidity and lead to complications such as strictures, fistulas, infections, and cancer. Though there were sufficient data gathered worldwide on IBD and a few more in the continent of Africa, to date there is scarcity reports from Ethiopia at a nationwide or hospital levels about the clinical profile and treatment pattern of IBD. OBJECTIVE: The purpose of this study is to describe the socio-demographic features, clinical characteristics and treatment pattern of inflammatory bowel disease in patients seen in GI clinic at ASCH and Hiwot specialty clinic 2019_2024, Mekelle, Tigray, Ethiopia. METHODS: A five-year retrospective cross sectional descriptive study was conducted to describe the socio-demographic features, clinical characteristics and treatment pattern of IBD in patients attending the GI clinic, at ASCH and Hiwot specialty clinic. RESULT; A total of 114 patients with IBD, 54 from ACSH and 70 from the private clinic were included in this study. Ulcerative colitis patients 74(64.9) were slightly higher than CD patients 40(35.1%). The mean age of patients was 39.48 ± 16.37(range 18-85) and the mean age at diagnosis was 35.8± 16.7(range 14-80) and there was no significant difference between the two groups. Majority, 43(58.1%) of UC and 26(65.0%) of CD patients were on the 18-40 age category and there was no significant difference between UC and CD, (P=0.795) CONCLUSION; Ulcerative colitis was more common than CD with a ratio of 1.85:1, and the mean age at diagnosis was in the mid-thirties for both groups. Both of these disease entities were slightly common in males, M:F ratio 1.19:1. Most of patients, (53.8%) with IBD presented within 6-12 months after symptom onset, yet medically responsive. Left-side colitis in UC and ileacolon involvement in CD are the predominant disease phenotypes. The major hindering factor in caring for these patients remains the availability of major drugs, biologics among others.
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    ENDOSCOPY AND THEIR PREDICATING VALUE OF UPPER GASTROINTESTINAL MALIGNANCY IN ACSH, NORTHERN ETHIOPIA.
    (Mekelle University, 2024-09-01) DR. AMANUEL KIROS
    Background: In a resource-limited setup like Ethiopia, Alarm symptoms are generally accepted as an indication for prompt endoscopy, and these are effective and inexpensive tools to optimize diagnostic yield and identify malignant lesions in patients with upper GI complaints. However, previous studies noted that the sensitivity of alarm features for predicting cases with upper GI malignancies is unsatisfactory (29). Some studies on other part of Ethiopia have yielded mixed results. So far, there has been no study done in Ayder that assessed to what extent the indications of upper GI endoscopy could help identify patients with significant UGI pathologies or malignancies. Methods: Facility based cross-sectional study was conducted in patients who underwent upper GI endoscopy at GI clinic in ACSH from Jan 2019 and Jun 2024 was included in the study. Descriptive statistics were used as appropriate.Data analysis was done using SPSS 27.0 statistical software. Bivariate and multivariate analysis was done to identify significant indications of upper GI malignancy, finally, statistical significance was declared at p-value <0.05. Results: A total of 1,484 patients underwent complete upper gastrointestinal tract endoscopic evaluation during the study period. The median age of the patients was 38 years. Males accounted for 70.4% of the patients. Dyspepsia (21.6%) was the most common indication for endoscopic evaluation. Esophagitis (15.2%) were the most common pathology. The prevalence of upper GI malignancy recorded in our endoscopy cases 11.2%, and of those, 71.1 % had confirmed cancer of the stomach, the esophagus and the duodenum. It was statistically significant giving our study subjects a 7.9% (p<0.001) prevalence of cancer. Gastric cancer was accounting 62.7%, esophageal cancer 27.1%, duodenal cancer 5.08 % and gastro esophageal junction cancer 5.08%. The majority 77.1% of them had one or more alarm symptoms. The sensitivity, specificity, PPV and NPV of having any alarm features for predicting malignancy were 77.1%, 62.1%, 16.4% and 96.6%, respectively. The individual alarm symptoms such as an unexplained loss of weight, persistent vomiting and dysphagia were statistically significant correlation with a UGI malignancy (P: - 0.001) .Based on receiver operating characteristic curve, the optimal age for screening of malignancy was 39.5 years in this population. Conclusion: Dyspepsia was the most common indication for EGD followed by screening varices of CLD patients. Clinically significant endoscopic findings were common. Esophagitis, pan gastropathy and esophageal varices were the common endoscopic finding. Of those, malignancies gastric CA followed by esophageal CA were common. Alarm symptoms were highly prevalent which was significantly higher among patients in the abnormal endoscopic group, particularly in upper GI malignancy group than in theix normal endoscopic group. There were inconsistent in finding between endoscopy and biopsy result. Being age above 39.5 and female, and certain alarm features (persistent vomiting, dysphagia, and unexplained weight loss) were independent predictor of UGI malignancy.