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Zerihun Bogale,1 Yeweyenhareg Feleke2 1Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Endocrinology and Metabolism Unit, Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Zerihun Bogale, Tel +251-913-83-31-57, Email zerihunmed@gmail.comBackground: Rheumatoid arthritis (RA) is an a chronic inflammatory disease characterized by symmetric polyarticular inflammation that can lead to progressive joint damage. It is said to be rare among black Africans, even though there have been limited reports from some African countries and no study has been done on RA in Ethiopia. This study determined the prevalence, clinical features, and treatment of rheumatoid arthritis in Tikur Anbessa Specialized Hospital (TASH).Methods: A cross-sectional study design was conducted on diagnosed patients with RA attending the rheumatology clinic at TASH from November 2018 to February 2019. Data was collected through patient interviews and chart reviews. The dataset was subjected to descriptive statistical analysis using the Statistical Package for Social Sciences (SPSS) version 25.Results: A total of 1116 patients attended a rheumatologic clinic with rheumatologic complaints. The prevalence of rheumatoid arthritis was 18.5% (206/1116). Females were mostly affected (F:M 4.6:1). One hundred nineteen (57.8%) were between 35 and 64 years of age. The seropositivity for rheumatoid factor was 47.1%. Almost all patients had morning stiffness (89.8%) and joint pain (97.1%), with the majority (74.8%) having both small and large joint involvement. Nearly half of the patients, 99 (48.1%), had a joint deformity. Comorbid conditions seen in this study were hypertension (17%), overweight in 43 (20.9%), and obesity in 8 (3.9%). Methotrexate was the most prescribed agent (82.5%), both as monotherapy and along with other medications, but 139 (67.5%) of them were on prednisolone, which 2/3 (122) of patients took for 6 months in duration.Conclusion: RA accounted for nearly one-fifth of the patients coming to the rheumatology clinics, with females affected more, which is similar to reports from some African countries. Disease-modifying anti-rheumatic drugs are the most prescribed agents, but most patients are on a prolonged dose of prednisolone.Keywords: rheumatoid arthritis, rheumatology clinic, Tikur Anbessa Specialized Hospital, Ethiopia

ntroduction: Given the global prevalence of diabetes, diabetic nephropathy and its consequences are among the major causes of morbidity and mortality in diabetic populations. However, the prevalence and determinants of diabetic nephropathy in Ethiopia are little studied, and were the main objectives of this study. Methods: A cross-sectional study design was followed among 340 randomly selected diabetic patients attending the national diabetes referral clinics at the diabetes centre of Tikur Anbessa Specialized Hospital, Addis Ababa, using an interviewer-administered structured questionnaire. A total of 340 patients were involved, of whom 200 (59%) were females and 256 (75%) had type 2 diabetes mellitus. Urine and blood samples were drawn from the study population and the corresponding biochemical analyses were conducted at the Ethiopian Public Health Research Institute. Results: The mean age of the participants was 51.6 years (range 18–94 years). The median duration of their diabetes was 11 years (range 1–40 years). Forty-eight pecent of the patients were hypertensive. Only half of the hypertensive cases (53%) were using angiotensin-converting enzyme inhibitors, either alone or in combination with other antihypertensive medicines. Eighty-two percent of the participants had poorly controlled diabetes, with glycated haemoglobin >7%. None was using Sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide agonists. Some (109, 32%) of the participants were diagnosed with diabetic nephropathy in addition to reduced estimated glomerular filtration rate and albuminuria. Age, dyslipidaemia, educational status, presence of diabetic retinopathy, and elevated triglyceride levels were found to be significant predictors of the condition (P < 0.05). Conclusions: Diabetic nephropathy was present in nearly one-third of the diabetics in the study population. The management of diabetes with renoprotective agents, such as renin–angiotensin–aldosterone system inhibitors and SGLT2 inhibitors, are likely to be very important in this context. Keywords: diabetes mellitus, nephropathy, end-stage kidney disease, CKD

Background Vitamin D is essential for health and its shortage exacerbates overall mortality. Health care workers (HCWs) need to educate on its uses and sources although studies indicate their low level of practice. The main aim of this study is therefore to assess the knowledge, attitude and practice of measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs in Ethiopia. Methods This study was conducted in three ecologies covering lowland, midland and highland districts. A total of 405 health care workers with different levels were interviewed. Tablets were used for data collection to archiving in a cloud server. Data were exported to Stata version 14 software for cleaning and analysis. Rates were computed and the Chi-square test was used to compare differences between the two groups. Binary logistic regression was used to measure the strength, direction and significance of the association between different covariates and the practice of HCWs. Result The level of knowledge, positive attitude and good practice in measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs was 210 (51.8%), 261(63.5%) and 195(47.4%) respectively. The odds of good practice in the provision of adult vitamin D service were AOR = 6.87: 95% CI (3.57, 13.21) and AOR = 2.20: 95% CI (1.23, 3.92) times higher among HCWs in Addis Ababa and highlands compared with those working in lowlands. Good practice among clinicians was AOR = 4.26: 95% CI (1.48, 12.25) times higher compared with those working in leadership positions. The likelihood was AOR = 1.96: 95% CI (1.19, 3.23) times higher among those with good knowledge compared with those with poor knowledge. Besides, good practice in adult vitamin D service provision was AOR = 2.30: 95% CI (1.40, 3.78) times higher among those with positive attitude compared with those who had negative attitude. Conclusions A little over half of HCWs have good knowledge and close to two-thirds of them have positive attitude while less than half of them have good practice on adult vitamin D deficiency. Besides, HCWs’ residential ecology, clinical position, knowledge and attitude is associated with good practice on adult vitamin D. It is essential to provide rigorous and continuous training for HCWs focusing on their deployment ecology.

Background: Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.Methods: A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 hours of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as >140mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.Results: A total of 103 first-ever acute stroke patients were included (mean age = 55.5+15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10-19) compared to normoglycemic patients 11 (IQR 8-15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99-6.19) more likely to be functionally impaired (mRS = 3-5) at 30-days compared to normoglycemic patients (p = 0.041).Older age (≥ 65 years) (p = 0.017) and stroke severity (NIHSS >14) (p = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among the patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.Conclusions: Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-days of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

Background:- Although acute stroke accompanied by hyperglycemia is often associated with worse prognosis, the relationship between hyperglycemia and stroke outcome has not been studied in Ethiopian patients. As better understanding of this potentially adverse influence on stroke outcome would provide guidance for stroke management and acute care. This study aimed to determine frequency of admission hyperglycemia and its impact on thirty day functional outcome and case fatality among acute stroke patients in an urban setting in Ethiopia. Methods:- From July to December 2016, we collected information on 103 consecutive first ever acute stroke patients admitted within 72 hours of symptom onset to Tertiary hospital in Ethiopia. We obtained demographic, clinical and neuro-imaging data including capillary blood glucose at admission. National Institute of Health Stroke Scale and modified Rankin Scale were used to assess the baseline stroke severity and the degree of disability at thirty day. Results:- A total of 103 first ever acute stroke patients were enrolled with, mean age = 55.5+ 15.3 years, 64.1% male, 65% under the age of 65 years, and 31.1% were farmers by occupation . Fifty one (49.5%) patients had a documented hyperglycemia at admission with median National Institute of Health Stroke Scale score of 14 and 3(2.9%) of them were later diagnosed with diabetes mellitus. The mean modified Rankin score at 30-day was 3.6 + 1.45 while 34 (79.1%) of hyperglycemic stroke survivors scored between 3 and 5. Older age >65 years (p = 0.037), admission hyperglycemia (p = 0.04) and stroke severity (p

The prevalence of diabetes, dyslipidemias, and high blood pressure is increasing worldwide especially in low and middle income countries. World Health Organization has emphasized the importance of the assessment of the magnitude of the specific disease in each country. We determined the prevalence and determinant factors of high blood pressure, hyperglycemia, dyslipidemias and metabolic syndrome in Ethiopia. A community based survey was conducted from -April to June 2015 using WHO NCD STEPS instrument version 3.1. 2008. Multistage stratified systemic random sampling was used to select representative samples from 9 regions of the country. A total of 10,260 people aged 15–69 years participated in the study. Blood pressure (BP) was measured for 9788 individuals. A total of 9141 people underwent metabolic screening. The prevalence of raised blood pressure (SBP ≥140 and/or DBP ≥ 90 mmHg) was 15.8% (16.3% in females and 15.5% in males). The prevalence of diabetes mellitus (FBS ≥ 126 mg /dl) including those on medication was 3.2% (3.5% males and 3.0% females). The prevalence of impaired fasting glucose was 9.1% with ADA criteria and 3.8% with WHO criteria. Hypercholesterolemia was found in 5.2%, hypertriglyceridemia in 21.0%, high LDL cholesterol occurred in 14.1% and low HDL cholesterol occurred in 68.7%. The prevalence of metabolic syndrome using IDF definition was 4.8% (8.6% in females and vs. 1.8% in males). Advanced age, urban residence, lack of physical exercise, raised waist circumference, raised waist hip ratio, overweight or obesity, and total blood cholesterol were significantly associated with raised blood pressure (BP) and diabetes mellitus. Increased waist- hip ratio was an independent predictor of raised blood pressure, hyperglycemia and raised total cholesterol. Our study showed significantly high prevalence of raised blood pressure, hyperglycemia and dyslipidemia in Ethiopia. Community based interventions are recommended to control these risk factors.

Background: The major disorders of thyroid gland are hypothyroidism and hyperthyroidism and thyroid disorders are predominantly of autoimmune etiology in pregnant women. To date there is no study done in Ethiopia to show pattern and pregnancy outcomes of pregnant women with thyroid disorders. Objectives: To assess pattern of thyroid diseases, thyroid function test profiles, clinical presentations and pregnancy outcomes in pregnant women at National Endocrine Referral Clinics of Tikur Anbessa Specialized Hospital. Methods: A retrospective study was conducted at National Referral Endocrine Clinics of TASH from June 2010 to June 2015. All pregnant women with thyroid disorders were included in the study and patients’ charts were retrieved from follow up clinics and hospital archive by two trained residents of Internal medicine using pre-structured data collection tools. Results: Among a total of 1124 patients with endocrine disorders, 670 (59.6%) were patients with thyroid disorders and 9.25% (62) were pregnant women. Among pregnant women with thyroid disorders, majority, 51 (82.2%) were pregnant women with hyperthyroidism with mean (SD) age of 30 ± (6.45) years. Majority of patients with hyperthyroidism, 43(84.3%) were diagnosed to have TMNG followed by Graves’ disease. Among pregnant women with hypothyroidism, six were cases of iodine deficiency. The commonly seen symptoms of hyperthyroidism were, anterior neck swelling (94.1%), palpitation (47.1%) and heat intolerance (31.4%). Patients with hypothyroidism, accounted for 17.74% of thyroid diseases in pregnancy and the common symptoms were fatigue and cold intolerance each accounting for 9 (81.8%) of the cases. Most of pregnant women with hyperthyroidism, 37 (72.5%) gave birth to an alive neonate, 11 (21.6%) had abortion and the remaining 3 (5.9%) had IUFD. Conclusion: From our study, most of pregnant women with thyroid disorders were patients with hyperthyroidism. The pregnancy outcome of these patients was generally good. Recommendation: We recommend proper documentation and electronic medical recording to be practiced in the hospital and to have pre-pregnancy counseling for all reproductive age women who have follow up at endocrine referral clinics. We also recommend doing more comprehensive research on pregnancy outcomes of pregnant women with thyroid disorders and neonatal screening for congenital hypothyroidism.

Background: Hypoglycemia poses a barrier to optimum diabetes management especially among patients taking insulin therapy. However little is known about the magnitude and effect of hypoglycemia among diabetic patients in Ethiopia. Methods: A Cross-sectional study was conducted on diabetic patients who were above 14 years of age and attending National Diabetic referral clinic at Tikur Anbesa Specialized Hospital, between June and August 2016. Results: The study involved 562 diabetic patients (194 T1DM and 368 T2DM). Previous episode of hypoglycemia was experienced by 61.2% (344) of the patients. Hypoglycemia was reported by 88% T1DM and 69% of insulin treated T2DM .There were 523 episodes of hypoglycemia reported by 186(33.1%) of the patients in the last month, out of which 40(5.9%) episodes were sever hypoglycemia reported by 26 (14%) of the patients. Female gender, higher BMI, low educational status and higher FBS were associated with higher reported incident of previous hypoglycemia (p

Background Maximizing comprehension is a major challenge for informed consent processes in low-literacy and resource-limited settings. Application of rapid qualitative assessments to improve the informed consent process is increasingly considered useful. This study assessed the effects of Rapid Ethical Assessment (REA) on comprehension, retention and quality of the informed consent process. Methods A cluster randomized trial was conducted among participants of HPV sero-prevalence study in two districts of Northern Ethiopia, in 2013. A total of 300 study participants, 150 in the intervention and 150 in the control group, were included in the study. For the intervention group, the informed consent process was designed with further revisions based on REA findings. Informed consent comprehension levels and quality of the consent process were measured using the Modular Informed Consent Comprehension Assessment (MICCA) and Quality of Informed Consent (QuIC) process assessment tools, respectively. Result Study recruitment rates were 88.7 % and 80.7 % (p = 0.05), while study retention rates were 85.7 % and 70.3 % (p

Background: Diabetes mellitus (DM) affects connective tissues in many ways and causes different alterations in periarticular and skeletal systems. Methods: A cross-sectional study was conducted by interviewing and examining 402 consecutive diabetic patients followed at Tikur Anbessa Hospital OPD. Evaluation was performed according to the Short Musculoskeletal Function Assessment Questionnaire (SMFA). The diagnoses were established by Consultant Orthopedic Surgeon. Results: Average duration of diabetes is 143 months (12 Years) and majority, 66.7% (268/402) of them are currently on insulin therapy. Mean current FBS is 245mg%. Excluding OA (47, 11.7%) and CLBP (78, 19.4%), overall prevalence of 1 or more of musculoskeletal Diseases (MSD) is 41.5 %. Hands were the most affected (74, 18.5 %). Five had amputation. Hand involvement and sex of the patient and Type of diabetes is significantly associated, Duration of DM and shoulder involvement are significantly related. Conclusions: Musculoskeletal manifestations are very high in adult diabetic patients at the centre and need multidisciplinary clinical attention. Physicians should always consider examining the periarticular regions of the joints in the hands and feet. Duration of diabetes is associated with development of shoulder complications. Recommendations: Routine MSD screening, establishing a foot care clinic and strengthening diabetic education may prevent development or worsening of MSD. https://dx.doi.org/10.4314/ecajs.v22i2.6 This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.

Standard information sheet and Consent form for â HPV-Subtype Prevalence Studyâ . This version is the non-modified information sheet and consent form, the version initially approved by the IRB. This is the very version of information sheet and consent form administered used the control group. (DOCX 17 kb)

Data collection materials used for comprehension assessment in "HPV-subtypes Prevalence Study". These are the data collection material used for testing comprehension and quality of informed consent in both the control and intervention groups. The material were developed based on Modular Informed Consent Comprehension Assessment (MICCA), Brief Investigator Questionnaire (BIQ) and Quality of Informed Consent (QuIC) tools. (DOCX 28 kb)

Modified information sheet and consent form for ''HPV-Subtype Prevalence Study''. This is the modified version of information sheet and consent form administered for the intervention group. Modifications were done on the IRB approved version based on the REA (Rapid Ethical Assessment) conducted prior recruitment. (DOCX 21 kb)

The need for ethics review committees (ERCs) is imperative in the conduct of research to ensure the protection of the rights, safety and well-being of research participants. However, the capacities of most ERCs in Africa are limited in terms of trained experts, competence, resources as well as standard operating procedures. The aim of this report is to share experiences of one of the local institutional ERCs, the Armauer Hansen Research Institute (AHRI)/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center (ALERT) Ethics Review Committee (AAERC), to other ERCs found in academic and research institutions in the Country. In this report, we used an empirical approach to review archived documents of the AAERC Secretariat to assess the Committee's strengths and weaknesses. The experiences of the AAERC in terms of its composition, routine work activities, learning practices and pitfalls that require general attention are summarized. In spite of this summary, the Committee strongly acknowledges the functions and roles of other ERCs in the Country. In addition, an independent assessment of the Committee's activity in general is warranted to evaluate its performance and further assess the level of awareness or oversights among researchers about the roles of ERCs.

Mediccil malpractice is professional negligence by a healthcare provider in which the treatment provided falls below the starndard and causes injury or death to the patient.To describe the adverse medical events, claims and decisions taken by the Ethiopian Health Professionals Ethics Committee at the Federal level.A three-year report of the Ethics Committee and relevant documents of proclamations and regulations were reviewed.Between January 2011 and December 2013, the committee reviewed 60 complaints against health professionals. About one third of the complaints were filed by the patients and/or their families, about 32% by the police or court and the rest were filed by Addis Ababa health bureau, health professionals and other unrelateed observers. Thirty-nine complaints were related to death of the patient and 15 complaints were about disability. Twenty-five of the claims were against Obstetric and Gynecology specialists and 9 were against general surgeons. The committee verified that 14 of the 60 claims hadethical breach and/or negligence (incompetence). The committee took reasonable time to review complaints and respond the concerned authorities.The study showed that of the total claims lower than a quarter (23.3%) were proven beyond the benefit ofdoubt. More than 3/4 (76.7) of the complaints were wrong. Hospitals should lead in preventing patient injury. Creation of more awareness among Obstetrics and Gynecology specialists, General and Orthopaedic Surgeons about medical errors is needed and special training should be given.to those joining these specialities.

Health research in Ethiopia is increasing both in volume and type, accompanied with expansion of higher education and research since the past few years. This calls for a proportional competence in the governance of medical research ethics in Ethiopia in the respective research and higher learning institutes. The paper highlights the evolution and progress ofthe ethics review at Addis Ababa University - College of Health Sciences (AAU-CHS) in the given context of health research review system in Ethiopia. Reflections are made on the key lessons to be drawnfrom the formative experiences of the Institutional Review Board (IRB) and their implications to the Ethiopian health research review system. This article is a review paper based on review of published and un published documents on research ethics in Ethiopia and the AAU-CHS (2007-2012). Thematic summaries of review findings are presented in thematic areas - formation of ethics review and key factors in the evolution of ethics review and implications. The IRB at AAU-CHS has been pivotal in providing review and follow-up for important clinical studies in Ethiopia. It has been one of the first IRBs to get WHO/SIDCER recognition from Africa and Ethiopia. Important factors in the successes of the IRB among others included leadership commitment, its placement in institutional structure, and continued capacity building. Financial challenges and sustainability issues need to be addressed for the sustained gains registered so far. Similar factors are considered important for the new and younger IRBs within the emergent Universities and research centers in the country.

One of the challenges in the process of ethical medical research in developing countries, including Ethiopia, is translating universal principles of medical ethics into appropriate informed consent documents and their implementation. Rapid Ethical Assessment (REA) has been suggested as a feasible approach to meet this application gap. In the past few years REA has been employed in few research project in Ethiopia and have been found to be a useful and practical approach. Feasibility assessment of REA for the Ethiopian research setting was conducted between 2012-2013 in order to inform the subsequent introduction of REA into research ethics review and governance system in the country. REA was found to be an appropriate, relevant and feasible venture. We argue that REA can be integrated as part of the ethics review and governance system in Ethiopia. REA tools and techniques are considered relevant and acceptable to the Ethiopian research community, with few practical challenges anticipated in their implementation. REA are considered feasible for integration in the Ethiopian ethics review system.

Cardiovascular disorders vary throughout the world in type and distribution especially between the developed and the developing countries. Data on spectrum of cardiovascular diseases in Ethiopia is scarce.To assess the spectrum of cardiovascular disorders at Tikur Anbessa Specialized Tertiary Referral Hospital.A record review of patient registers from January 2001 to December 2012 was done for 3282 Ethiopian patients with confirmed cardiovascular disorders at adult Cardiology clinic and Neurology clinic of Tikur Anbessa Specialized hospital. Spectrum of valvular heart disease, heart failure, hypertension, ischemic heart disease, congenital heart disease, arrhythmias, cardiomyopathies, cerebrovascular diseases, and peripheral vascular diseases, defined by Physician International Classification of Diseases, Version 9, codes, were directly standardized to the population. Descriptive statitistics was applied to present results.The study population contained more women (n = 1937 [59.0%]) than men. The mean age of the patients was 31.6 +/- 16.6 years. Women were younger than men (mean 29.6 [SD 15.1] years vs 34.52 [18.3] years). Valvular Heart Disease was the most common primary diagnosis in 2036 (62.0%) with significantly higher proportion in the 3rd decade of life. About 300 (9.1%) of the patients were diagnosed with heart failure. Other major diagnoses included hypertension 482 (14.7%), cerebrovascular diseases or stroke 377 (11.5%), congenital heart disease 279 (8.5%) and ischemic heart disease 224 (7.4%). Fifty seven (26.5%) patients with ischemic heart disease had diabetes mellitus.While valvular heart disease is the commonest cardiovascular disorder in Ethiopian patients at the largest public hospital of the country, ischemic heart disease has dramatically increased over the years. It is high-time that effective population-based, health promotive strategies for primary prevention as well as secondary measures for the established cardiovascular disorders and risk factors are in place.

Background: Rapid Ethical Assessment (REA) is a form of rapid ethnographic assessment conducted at the beginning of research project to guide the consent process with the objective of reconciling universal ethical guidance with specific research contexts. The current study is conducted to assess the perceived relevance of introducing REA as a mainstream tool in Ethiopia.\ud \ud Methods: Mixed methods research using a sequential explanatory approach was conducted from July to September 2012, including 241 cross-sectional, self-administered and 19 qualitative, in-depth interviews among health researchers and regulators including ethics committee members in Ethiopian health research institutions and universities.\ud \ud Results: In their evaluation of the consent process, only 40.2% thought that the consent process and information given were adequately understood by study participants; 84.6% claimed they were not satisfied with the current consent process and 85.5% thought the best interests of study participants were not adequately considered. Commonly mentioned consent-related problems included lack of clarity (48.1%), inadequate information (34%), language barriers (28.2%), cultural differences (27.4%), undue expectations (26.6%) and power imbalances (20.7%). About 95.4% believed that consent should be contextualized to the study setting and 39.4% thought REA would be an appropriate approach to improve the perceived problems. Qualitative findings helped to further explore the gaps identified in the quantitative findings and to map-out concerns related to the current research consent process in Ethiopia. Suggestions included, conducting REA during the pre-test (pilot) phase of studies when applicable. The need for clear guidance for researchers on issues such as when and how to apply the REA tools was stressed.\ud \ud Conclusion: The study findings clearly indicated that there are perceived to be correctable gaps in the consent process of medical research in Ethiopia. REA is considered relevant by researchers and stakeholders to address these gaps. Exploring further the feasibility and applicability of REA is recommended.

Depression is a major factor in causing hospital admissions and deaths in persons with diabetes mellitus. So far there is no study available on depression among Ethiopian diabetic patients.This study aimed to determine the magnitude of clinical depression in diabetic patients and its association with the various clinical and sociodemographic factors related to diabetes mellitus.313 diabetic patients were selected from diabetic clinics of Black LionSt. Paul hospitals, using systematic randomized sampling technique and assessed for over a period of three months, October - December 2009. Presence and severity of depression was evaluated using clinical interviews and a structured questionnaire, the Hamilton Depression Rating Scale.Of the total 313 patients, females account for 58.8% (n = 184), patients having type I diabetes 37.2% (n = 116) and type 2 diabetes 62.8% (n = 197). The average duration of illness with diabetes among male patients is found to be 8.2 +/- 6 years and 10.3 +/- 8 years for female patients. The mean duration of diabetes is 9.4 +/- 7.2 years. The magnitude of depression was 61% (n = 188) with mild, moderate, severe depression occurring in 40.9%, 14.7% and 4.5% of patients respectively. In this study depression diagnosed in 52.6% (n = 61) of type 1 DM and 64.8% (n = 127) of type 2 DM, 63% (n = 116) of females and 55.8% (n = 72) males. Occurrence of depression was more in patients with diabetic complications 68.2% (n = 107) and among patients in 36-54 years age group 66.7% (n = 80) compared to the rest age groups. The diagnosis of depression was also more prevalent in those with educational status below secondary level 63.9% (n = 152), (X2 = 5.868, P = 0.0075), among those with duration of DM greater than 5 yrs, 64.2% (n = 140) (X2 = 58.52, p0.023).Depression is an important psychiatric co morbidity in diabetic patients. The magnitude of depression in our study is significantly higher than reports from other countries. Raising awareness about co morbid emotional disorders in such chronic illnesses and availing effective treatment for depression with the basic diabetic care at these clinics may improve glycemia and diabetic related complications.

Background: Insulin resistance, which precedes by many years the onset of and accompanies type II diabetes (T2D), is strongly associated with a clustering of cardiovascular risk factors, termed metabolic syndrome (MetS). Objectives: The aim of this study was to investigate the extent of MetS risk in T2D Ethiopian patients. Methods: A total of 72 T2D patients and 20 normal healthy controls without MetS were studied. Based on the world health organization criteria, 59.72% (43/72) of the patients had MetS. Results: Type 2 diabetic patients with MetS (0.953 ± 0.007) were significantly (P

Thyroid diseases are common endocrine abnormalities affecting the cellular metabolism of the body. There are limited recent studies addressing the different aspects of thyroid diseases in Ethiopia.To assess the pattern, clinical presentations, management and associated illnesses of thyroid diseases in endocrine referral clinics of Tikur Anbessa Specialized Tertiary Hospital (TASH).A cross-sectional study was conducted on consecutive thyroid patient attending endocrine referral clinics of TASH from Nov 2009 to March 2010. Patients with thyroid diseases, 14 years of age and above, thyroid patients with other endocrine diseases were included in the study. Data were collected by trained nurses and physicians using pre-constructed questionnaires. Review of charts for patients, presenting manifestations, date of diagnosis, laboratory investigation results, treatment and other pertinent information was conducted.Among 376 patients with thyroid diseases, females were 337 (90%) and males were 39 (10.4%). The mean (SD) age of female participants was 43.1 +/- 15.2 males was 37.3 +/- 17.3. Age 40 and above accounted for 59%. The prevalence of Hyperthyroidism and hypothyroidism in 376 patients were 233 (61.7%) and 129 (34.3%) respectively. Toxic Multinodular Goiter occurred in 135 (35.9%), Toxic nodules in 32 (8.5%) and of Graves' disease in 65 (17.3%), Seven patients progressed from Graves' disease to Hashimoto's thyroiditis. Subclinical hypothyroidism occurred in 5(1.32%), and secondary hypothyroidism in 4 patients. Palpitation (96%), goiter (99%) and hot intolerance (81.9%) were the commonest presentations of thyrotoxicosis, whereas hypothyroidism patients presented mostly with cold intolerance (50.4%) and goiter (38%). Autoimmune polyglandular syndrome occurred in 16 (4.3%) patients. 26 (7.0%) had history of pregnancy, 82 (22.2%) had family history of thyroid diseases and seven patients had history of alcohol intake. Thyrotoxicosis was treated with Propylthiouracil (96.8%) with or with out beta blockers, thyroidectomy was done in 16 (6.8%), few received radioiodine therapy. Hypothyroidism patients were treated with thyroxin.Thyroid diseases were more common in females and more prevalent in age group of 40-49. Toxic Multinodular Goiter, Graves' disease and Toxic Nodular Goiter were causes of thyrotoxicosis. The most common presenting feature of thyrotoxicosis was palpitation, and hypothyroidism was cold intolerance. A few Graves' disease cases were progressed to hypothyroidism. Autoimmune Polyglandular Syndrome was an important associated disease. There was limited access for radioiodine treatment.To conduct further studies in different aspects of thyroid disease, strengthening access for radioiodine therapy and introduce anti thyroid antibody tests.

Neuropathy is one of the common chronic complications of diabetes. There are many forms of diabetic neuropathy, one of which is distal symmetric polyneuropathy (DSP). There are only few data on diabetic neuropathy in Ethiopia.The objectives of this study were to determine the prevalence of peripheral neuropathy, describe the clinical features, identify risk factors and treatment of neuropathy among diabetic patients.A cross-sectional study was conducted at Tikur-Anbessa (TASH) and St. Paul's Specialized (SPH) University Hospitals in Addis Ababa. A total of 384 diabetic patients were selected using systematic random sampling method taking every third patients from clinics attendees from December 2009 to February 2010. Data were collected using structured questionnaires containing sociodemographic data, risk factors and UK neuropathy screening test score, Neurological examination for pain, Achilles tendon reflex, Vibration, and temperature.A total of 176 males and 208 females were included, 27% were type 1 and 73% were type 2 diabetic patients. The overall prevalence of distal symmetrical polyneuropathy (DSP) was 48.2% (53.6% in type 2 and 33.3% in type 1 diabetic patients). DSP was present in 37% of patient with duration of diabetes5yrs and 53% of those with diabetic duration10yrs. Autonomic neuropathy was identified in 30% of patients. Out of 185 patients with peripheral Neuropathy 136 (77%) had moderate and severe symptom scores; while 101 (58%) had moderate and severe sign scores. Type of Diabetes, duration of diabetes, systolic hypertension, and age were significantly associated with DSP (p0.05). Amitriptylline in 14 (28.6%), Carbamazepine in 4 (8.2%), and other NSAIDs 7 (12.2%) were used for treatment of painful neuropathy.Distal symmetrical polyneuropathy is common. The commonest presenting features are pain and loss of sensation. Duration of diabetes 10yrs, type 2 D, old age and hypertension were the major risk factors for DSP. Treatment of painful diabetic neuropathy was not optimal. RECOMMENDATIONSs: We recommend strengthening of routine screening for neuropathy, to emphasis on foot ulcer risk reduction, management of co-morbidities like hypertension and dyslipidemia, to optimize treatment of painful neuropathy.

Highly active antiretroviral therapy (HAART) improves the longevity of HIV patients. However, the side effect of the drugs leads to development of chronic metabolic and cardiovascular complications.The aim of the study was to determine the prevalence and risk factors of the metabolic abnormalities and lipodystrophy among adult Ethiopian HIV infected patients on ART for one year and above.A cross-sectional study was conducted among HIV infected patients on HAART for one year or more, attending the ART clinics of Tikur Anbessa Specialized hospital in Addis Ababa. A total of consecutive 356 HIV infected patients volunteered to participate in the study from July 2007 to January 2008. Data was collected using clinical interview technique on structured questionnaires and physical examination of the patient, 319 had biochemical tests performed.Three hundred fifty six HIV patients; 261 (73.1%) females and 95 (26%) males were studied. Two hundred nine (59.7%) patients were on Stavudine based and 135 (41.3%) were on Zidovudine based ART therapy. The overall prevalence of lipodystrophy was 68.3% (243), prevalence of hyperlipademia among 319 HIV patient was 56.9% Among these, the prevalence of hypercholesterolemia was 38.2%, high LDL cholesterol was 54.2% hypertryglyceredimeia was 15.2% Fasting hyperglycemia was 17.8% (IFG in 10.9% and overt diabetes in 6.9%). History of smoking was significantly associated with lipoatrophy and lipohypertrophy. ART regimen d4T was significantly associated with lipoatrophy. Duration of ART treatmentor = 1 yr was significantly associated with both lipoatrophy, lipohypertrophy and hypertriglyceredemia.Lipodystrophies occurred in majority of patients on ART treatment for longer than one year, hyperlipaedemia and hyperglycaemia were also seen commonly in Ethiopian HIV patients on HAART. We recommend careful monitoring of metabolic abnormalities, examination of the patient for early detection of the side effect, change of the offending agents management of metabolic abnormalities.

The risk of urinary tract infection in diabetic patients is higher and the etiology and the antibiotic resistance of uropathogens have been changing over the past years.The aim of this study was to determine the prevalence of symptomatic and asymptomatic bacteriuria and assess the antimicrobial susceptibility pattern of the isolates in diabetic patients.A prospective study was conducted during June to August 2009 on diabetic in and out-patients in Tikur Anbessa University Hospital. A total of 413 consented adult patients were enrolled in the study. Two consecutive clean-catch midstream urine samples from diabetic subjects were collected for culture. Disc diffusion method was used to assess the antimicrobial susceptibility patterns of the isolates.Of the 413 diabetic patients participated in the study, 181 (43.8%) were males and 232 (56.2%) were females. Of these, 107 (25.9%) were type 1 and 306 (74.1%) were type 2 diabetes mellitus. Nine (13.6%) of the symptomatic diabetic patients had bacteriuria compared with 36 (10.4%) of asymptomatic diabetes patients had bacteriuria. The overall prevalence of urinary tract infection in the diabetic patients was 45 (10.9%). The predominant isolates were Escherichia coli and Klebsiella pneumoniae isolated in 6% and 28% followed by 2% and 6% in symptomatic and asymptomatic diabetic patients, respectively. Over 85% of Escherichia coli isolates were sensitive to ciprofloxacin, amoxicillin-clavulanic acid, ceftazidime, nitrofuranton, ceftiraxone, norfloxacin and geamicin. Klebsiella pneumoniae were 100% sensitive to ciprofloxacin, ceftazidime, ceftriaxone. The rate of resistance to two or more antimicrobials was 33 (71.7%).The prevalence of urinary tract infection in this study was higher in women than in men. Escherichia coli was frequently isolated in both symptomatic and asymptomatic patients. Over 60% of the isolates were resistant to ampicillin, trimethoprim-sulphamethoxazole and tetracycline. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of the development of renal complications.

Adverse drug reactions (ADRs) are frequently encountered among patients taking Antiretroviral Treatment (ART). The aim of this study was to describe the type and frequency of ADRs among adult Ethiopians on ART.to describe the type and frequency of short term adverse drug reactions among adult Ethiopian patients on ART at Tikur Anbessa teaching Hospital in Addis Ababa, Ethiopia.From October 2008 to December 2009, 228 HIV positive patients were enrolled to a tertiary teaching hospital in Addis Ababa. Patients were closely monitored for ADRs for a median observation period of 18 weeks (79 total person-years of observation). Time-dependent occurrence of clinical adverse effects and abnormal laboratory values as defined by the AIDS Clinical Trial Group were analyzed (41).A total of 392 ARV drug related ADRs occurred Mild GI disturbances (36.8%) and headache (35.9%) were the most frequently reported symptoms. Thirty (7.7%) of the ADRs were severe requiring change or interruption of therapy (19 hematological and 11 hepatotoxic). Severe hematological complications were anemia (4.8%), neutropenia (2.6%) and thrombocytopenia (0.9%). Anemia occurred earl), in the first 4 weeks of ART treatment. Hepatic toxicity was also seen early but continued throughout the observation period, decreasing over time. Other ADRs encountered were grade I/II toxicities of rash, peripheral neuropathy, and metabolic disturbances.ADRs occurred frequently in patients receiving ART. Grade III/IV toxicity that required withholding or change of treatment occurred in nearly 10% of the patients. Regular clinical, and laboratory monitoring appropriate to centers with limited resources need to be devised to monitor toxicity of ART Patient education on the easily recognizable ADRs could also reduce severe drug toxicities.

The prevalence of diabetes has been shown to increase especially in developing countries, over the last decades.We investigated the trend of diabetic admissions, indications, chronic complications, comorbidities and outcomes in Ethiopian diabetic patients.A retrospective study was conducted in all diabetic admissions at the Department of Internal Medicine of Tikur Anbessa and St. Paul's Specialized University teaching hospitals from January 2005-December 2009. Data were collected from medical records, diabetic clinic registries, admissions, discharges and death certificates using structured questionnaires.Total of 724 admissions, 51.7% males and 48.3%females were analyzed Among them 375 (51.8%) patients were Type-1 diabetes, 345 (47.6%) were Type 2 diabetes and the rest three were associated with Hyperthyroidism, and one with Cushing's syndrome. The median and mean age was 27.5 years, 30.1 +/- 12.6 years and 56.00 years, 55.1 +/- 14.5 yrs (p0.001) for Types 1 and 2 Diabetes respectively. The median and mean duration of diabetes for Type 1 before admission was 6.00, 8.7 +/- 7.6 and for Type 2 was 10.00, 11.3 +/- 7.5.years (p0.001). The admission rate increased serially from 51 (7.1%) patients in year 2005 to 86 (12.0%) in 2006, 144 (20.0%) in 2007, 193 (26.8%) in 2008 and 245 (34.1%) in 2009. There was no statistical significance difference between the types of diabetes (P = 0. 73, X2 = 2.0). Eleven percent and 3.6% were admitted twice and three times respectively. Commonest cause for admission was Diabetic Ketoacidosis (DKA) (71.1%), followed by who had infections (36.3%). Among those with infection, pneumonia occurred in 67 (9.9%), UTI occurred in 55 (8.1%), diabetic foot ulcer in 70 (9.7%), tuberculosis in 42 (5.5%) other infections in 10 (1.4%) of patients. Cardiovascular diseases (CVD) occurred in 126 (18.4%) and Hypertension was found in 250 (34%), hypoglycemia in 1.2% diabetic patients. Diabetic nephropathy, retinopathy, and neuropathy accounted 32% 15.5% and 12.4% respectively. Of total deaths (10.6%), CVD accounted for 28% infections for 14.8% and DKA for 5.8% In each year of the studied period, DKA persisted to be the leading cause for admission followed by infections.This study showed the serial increment of diabetic admissions over the study period Commonest causes for admission were DKA followed by infection and cardiovascular diseases. Mainly Cardiovascular diseases were the leading causes of death in hospitalized diabetic patients. So we recommend the. health policy makers to be alarmed of the growing magnitude of Diabetes Mellitus and strengthen methods of prevention and control of Diabetes Mellitus and associated cardiovascular diseases.

Here, we report a case of Steroid cell tumour of ovary--Not otherwise specified variant, who presented with evidences of hyperandrogenism, hypercortisolismn and hyperprolactinemia and hyperestrogenemnia. All hormone abnormalities were resolved after Right Salpingo-Oopherectomy.

Oral lesions are often characteristic in HIV patients and in the majority of cases can be diagnosed by their clinical features alone. To date there is no study addressing the prevalence of oral and perioral lesions in HIV patients in Ethiopia.To assess prevalence of oral and perioral manifestations, the clinical symptoms of oral disease, and to assess the association of oral and perioral lesions to the socio- demographic status and CD4 count of ART naive HIV patients.A cross-sectional study on 384 consecutive HIV patients before initiation of ARV treatment was conducted. Oral and perioral lesions were diagnosed according to the EC-clearinghouse's classification and diagnostic criteria for oral lesions in HIV infection and WHO collaborating centre on oral manifestations of HIV, 1992.One hundred and twenty six (32.8%) of the study subjects were males and 258 (67.2%) were females and mean age was 35.4 +/- 9.94 years (range of 14-84 years). Overall prevalence of oral lesions was 64.3%, and perioral lesions was 15.4%. Nearly half (44%) had dental caries. Pseudomembraneous candidiasis (20.1%), linear gingival erythema (11.7%), and erythematous candidiasis (9.1%) were the three most common HIV associated oral lesions. Angular cheilitis (8%) and molluscum contagiosum (4%) were the two most common perioral conditions. The most common oral symptoms reported were dry mouth (34.4%), difficulty eating (27.9%), and oral pain (27.3%). Oral symptoms and a CD4 count200 mm(-3) were significantly (X2 = 22.4, P = 0.0001) associated with presence of oral and perioral lesions. Age above 40 years (31%) was significantly associated with oral lesions (P = 0.016), but not with perioral lesions (P = 0.26).Oral and perioral lesions were common in HIV positive adults at Tikur Anbessa Specialized hospital and represent a treatable morbidity associated with this disease. Thus, a comprehensive oral examination is important in the clinical evaluation, management, and follow up of patients with HIV.

Here, we report a case of tetanus who presented with five months of symptoms and signs suggesting the presence of unusual presentation of tetanus so called chronic tetanus. The available literature on this a typical presentation and difficulty in the diagnosis is briefly discussed.

Background: HIV patients have several habits that can produce oral lesions. However the association of oral habits and risk behaviors with oral and peri-oral lesions in HIV patients has not been studied in Ethiopia to date. Objective: To assess the relationship of oral and peri-oral lesions with oral habits risk behaviors socio-demographic factors and clinical stages of disease among HIV infected adult Ethiopians. Methodology A cross-sectional study was conducted on consecutive adult ART naive HIV patients at ART clinic of Tikur Anbessa Specialized University Hospital Addis Ababa Ethiopia during December 2005 to July 2006. The EC-clearing houses classification and diagnostic criteria for oral lesions in HIV infection was used. Written informed consent was obtained before enrollment to the study. Results A total of 384 patients 126 (33%) males and 258 (67%) females were evaluated. The mean + SD age of males was 39.9 +10.56 and females was 33.17 + 8.85 years. Fifty seven (15%) of the unit of analysis were smokers 178 (46%) alcohol consumers and 217(57.1%) khat chewers use tooth sticks for dental cleaning. Of which 132 (34.7%) clean their teeth at least once a day and 302 (79%) gave history of recent significant weight loss. Linear regression analysis showed association of oral and peri-oral lesions with less frequent cleaning (p=0.038 p=0.03 respectively) means of cleaning (p=0.004; p=0.001) broad-spectrum antibiotic use (p=0.019 p=0.008) advanced stage of HIV (p=0.016 p=0.001) and CD4 level below 200 Cells/mm3 (p=0.001 p=0.01). The oral lesions were seen more frequently among smokers (p=0.028) heavy alcohol consumers (p=0.041) those with age above 40 years (p=0.016) and recent weight loss (p=0.001). At the level of binary logistic regression analysis smoking (p=0.005) CD4 count less than 200 (p=0.039) and stage 3 (p=0.022) and stage 4 disease (p=0.046) were found to be independent risks while daily dental cleaning habit was found to be protective (p=0.021). Conclusion Oral and peri-oral diseases among HIV/AIDS patients and are significantly associated with correctable risk factors like smoking and poor oral cleaning habits. Lesions are also frequent with evidence of advanced HIV disease and low CD4 count. These findings demonstrate the need for oral health examination and education to improve on risk behaviors and oral care in HIV/AIDS patients.

In Ethiopia the problems passed by diabetes is increasing for the last two to three decades. This indicates that diabetes is becoming a major economic factor in drug use and bed occupancy. So far there has been no study conducted to evaluate the cost of care among Ethiopian diabetic patients. This study aimed at assessing the cost of hospitalization of diabetic patients.A case control study was conducted on consecutive 146 diabetic patients and 142 non diabetic controls admitted to the medical wards of Tikur Anbessa Specialized Hospital. Every first non-diabetic patient who was admitted to the same ward on the same day or in the subsequent days was taken as a control group.The average total cost of hospitalization of cases was significantly higher than the controls with mean cost of 1109.7 +/- 1026.4 for cases and 872.9 +/- 828.3 Birr for controls respectively, (p0.03). A large proportion (57%) of the total cost was utilized for treatment of acute and chronic complications of diabetes. The average treatment and laboratory cost were significantly higher among cases compared to controls (p = 0.013 and p =0.001 respectively). However, when adjusted by age, sex, address and history of hypertension and renal diseases, the average cost of laboratory investigation remained significantly higher for cases.The current study demonstrated that the direct cost of hospitalization of diabetic patient is significantly higher than non diabetics. The study showed that substantial proportion of the total cost of admission is utilized for treating acute and long term complications. This study warrants further research, attention of the health policy makers and health providers for future planning of prevention, diagnosis and treatment of diabetes.

Infection is the most serious complication of diabetes and recognized as causing significant morbidity and mortality.To assess the prevalence and pattern of infection, determine the causative organisms.A cross sectional study involved 179 diabetic patients admitted to the Department of Internal Medicine of Tikur Anbessa Specialized University Hospital performed between Nov. 2000 - Nov 2002, clinical data were documented, a total of 114 clinical specimens (40 pus, 23 blood and 51 urine) were submitted to bacteriology laboratory for bacterial isolation and identification.The mean +/- SD fasting blood sugar was 246.0 +/- 153.3 mg/dl. Fifty eight (32.4%) of patients were admitted in state of diabetic ketoacidosis. The prevalence of infection in diabetic patients was 44%. Diabetic foot infection (35%) was the commonest, followed by pulmonary tuberculosis 22%, urinary tract infection (14%), pneumonia (12.8%), skin and subcutaneous infection (12.8%). About 30% of bacterial isolates were Staphylococcus aureus followed by Klebsiella pnumeniae (23.4%), Escherichia coli (19%) and Pseduomonas spp (15%). The rest of the isolates were less frequent and ranged between 2 to 6.4%. More than one bacterial species were also isolated from 10% of the positive cultures. Main causes of deaths in hospitalized diabetic patients were cardiovascular diseases (6/15), end stage renal disease (3/15) and sepsis (2/15).Infections were the leading cause of morbidity while cardiovascular diseases were the leading cause of mortality. Diabetic foot ulcers were the major cause of infection followed by tuberculosis, skin and subcutaneous infections and pneumonia. The prevalence of tuberculosis in diabetic patient is increasing; S. aureus from wound infection and E. colifrom urinary tract infection were the common pathogens.

Background : During the past decade, diabetes mellitus has emerged as an important clinical and public health problem through out the world. WHO estimated the number of cases of diabetics in Ethiopia to be about 800,000 in 2000, and projected that it would increase to about 1.8 million by the year 2030. Care for diabetic patients may require close and sustained support from a health care team, adequate financial resources, and advanced patient knowledge and motivation. In this respect, there is lack of information in the country. Objective : This study was conducted with the aim of assessing the characteristics of the health care system for diabetic patients, how diabetic patients are cared for including medical care and adequacy of facilities for the prevention of complications and outcomes at primary health care and secondary health care levels. Methods : An assessment of the characteristics of the health care system (structure) for diabetic patients was conducted in 21 health centres (primary health care level) and 5 regional hospitals (secondary health care level) in Addis Ababa. Furthermore, a total of 106 diabetic patients drawn from six out of the 21 health centres and another 123 diabetic patients drawn from three of the six hospitals were consecutively interviewed. Results : All the Regional hospitals and one of the health centres were running established diabetic referral clinics. Similarly, a lack of professionals was observed in all the health institutions in general and the health centres, in particular. Only 21% of patients had access for blood glucose monitoring at the same health institutions. The emphasis given for diabetic education (24%) was less than expected. Only 11 (5%) of diabetic patients were able to do self blood glucose monitoring at home. Fifty one percents of patients didn't have urine analysis, BUN, creatinine and lipid profile in the previous 1-2 years. None of diabetic patients had haemoglobin Alc (HbA1c) determination. Nearly 75% of the patients required admissions directly or indirectly due to uncontrolled diabetes. About 87% of the diabetics had regular follow ups at their respective health centres and hospitals. Hypertension (34%), diabetes related eye disease (33%) and renal disease (21%) were the major associated illnesses observed among the diabetics. Sixty-six patients (23%) had a total of about 131 admissions. Conclusion : Although there is a well-established health infrastructure for diabetics care in Addis Ababa, the diabetic care is below the acceptable standard. The finding of this study may, thus, help to clarify issues related to potential changes in the health care system dealing with diabetes and for strengthening the referral system for diabetes health care. Ethiopian Journal of Health Development Vol. 19(3) 2005: 203-210

Serum lipids and lipoproteins were determined in 302 randomly selected diabetic patients attending the Tikur Anbessa Hospital diabetic clinic. The main objective of the study was to analyse lipid levels in type 1 and type 2 diabetic patients. Lipid measurement was done by cholesterol pap method. The mean age was 41.4 +/- 14.4 years (range 14-85 years). One hundred sixty (53%) were males and 142 (47%) were females. There were 140 (46.4%) type 1 and 162 (53.6%) type 2 patients. The mean duration of diabetes mellitus, haemoglobin A1c, fasting blood glucose and random blood glucose were 9.4 +/- 5.4 years, 10.4 +/- 2.2%, 195.5 +/- 79.9 mg/dl and 273.1 +/- 114.5 mg/dl respectively. The mean cholesterol, triglycerides, LDL, VLDL and HDL were 166.5 +/- 45.5 mg/dl, 129.9 +/- 92.4 mg/dl, 94.5 +/- 36.4 mg/dl, 24.4 +/- 15.1 mg/dl and 44.3 +/- 11.5 mg/dl respectively. Hypercholesterolemia and Hypertriglyceridemia were seen in 18.5% and 14.2% of the patients. Total cholesterol was significantly higher in females than in males and in type 2 than in type 1 patients (179.3 +/- 48.4 mg/dl versus 154.1 +/- 38.2 mg/dl, P0.01 and 183.2 +/- 43.7 mg/dl versus 145.9 +/- 37.6 mg/dl, P0.001) respectively. Triglycerides and LDL cholesterol were also significantly higher in type 2 diabetic patients than in type 1 diabetic patients (162.7 +/- 10.5 mg/dl versus 91.5 +/- 53.3 mg/dl, P0.001 and 105.6 +/- 36.2 mg/dl versus 81.9 +/- 32.2 mg/dl, P0.001), but HDL cholesterol was the same in both types of diabetic patients. Similarly, hyperlipidemia was associated with obesity and hypertension. The study confirms that lipid values are high particularly in type 2 diabetic patients. Hence our patients are at increased risk of developing atherosclerosis therefore periodic check up of lipids in diabetic patients and effective treatment of the dyslipidemia along with a tight metabolic control was recommended.