Oumer A Muhie

International Medical Case Reports Journal, Dec 1, 2021

Clinical Profiles and the causes of Ascites at University of Gondar Hospital, Northwest Ethiopia: Institution-Based Cross-Sectional Study

Ascites is a common clinical condition encountered by physicians in day-today practice. It is cau... more

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Is Aflatoxin a Threat to Human-Health in Ethiopia? A Systematic Review

International journal of collaborative research on internal medicine and public health, 2020

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Causes and Clinical Profiles of Ascites at University of Gondar Hospital, Northwest Ethiopia: Institution-Based Cross-Sectional Study

Canadian Journal of Gastroenterology & Hepatology, Jul 8, 2019

Background. Ascites is a common clinical condition encountered by physicians in day-today practic... more Background. Ascites is a common clinical condition encountered by physicians in day-today practice. It is caused by various underlying diseases. Knowing the etiologies is vital because further investigations and definitive treatment largely rely on the specific disease entity considered. Objective. The aim of this study was to determine the epidemiology of causes of ascites and complications among patients with ascites from the medical department at the University of Gondar Hospital. Methods. Data on sociodemography, major symptoms, and signs, risk factors, past medical illnesses, and results of important investigations were collected using pretested questionnaires among all patients with ascites in the University of Gondar Hospital in a sample size of 52. Data were collected by well-trained physicians and analyzed by using SPSS 16. Results were depicted descriptively with measures of central tendency, dispersion, and using tables and graphs. Results. A total of 52 patients were included in this study from November 1, 2018 to March 30, 2019. Thirty (57.7%) of them were males and the majority (77%) of the participants were fifty years old or younger. The mean age was 43.8 (± 14). The majority (86.5%) of the participants were from a rural area. Thirty-eight (73%) patients take alcohol occasionally while 11(21.2%) patients take alcohol frequently or massively. Eight (15.4%) patients reported a history of multiple sexual partners. Herbal medicine use was reported by 28 patients (53.8%). Only 5 (9.6%) patients were overweight. Chronic liver disease (CLD) was the major cause of ascites in this study in 24 (46.2%) patients. The other main causes of ascites were heart failure from various causes (19.2%), tuberculosis and hepatosplenic schistosomiasis contributing to 11.5% each and chronic kidney disease (5.8%). Five (20.8%) CLD patients had spontaneous bacterial peritonitis as a complication. Five (20.8%) and 4 (16.7%) CLD patients had hepatocellular carcinoma and hepatic encephalopathy as complications, respectively. Nine (17.3%) patients had variceal bleeding; six of the patients were diagnosed to have CLD while the remaining patients were having hepatosplenic schistosomiasis. Conclusion. In conclusion, liver cirrhosis is the major cause of ascites in Gondar, Ethiopia, while chronic viral hepatitis infections (hepatitis B (HBV) and C (HCV) viruses) are the main causes of liver cirrhosis. The other major causes included heart failure, tuberculosis, and hepatosplenic schistosomiasis. It is wise to consider and give priority to these diseases whenever one is evaluating a patient with ascites.

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Assessment of renal dysfunction and associated factors among patients on Tenofovir based antiretroviral treatment at Gondar University Hospital, North West Ethiopia: Retrospective institution based cross sectional study

Journal of AIDS and HIV Research, 2020

Tenofovir Disoproxil Fumarate a nucleotide reverse transcriptase inhibitor that was introduced as... more Tenofovir Disoproxil Fumarate a nucleotide reverse transcriptase inhibitor that was introduced as a preferred first line antiretroviral therapy in Ethiopia as of 2008. However, routine renal function assessment is recommended as it is known to cause renal failure and renal tubular dysfunction. To assess the practice of renal function monitoring of patients on TDF based ART regimen. The magnitude of renal dysfunction and its associated factors are also assessed. Institutional based retrospective record review was carried out to determine the magnitude of renal dysfunction and associated factors among HIV positive individuals who have been on TDF based ART regimen in Gondar university hospital. A total of 406 records were reviewed and 96.21% were found complete. From a total of 290 patients with Creatinine determination, renal dysfunction was found in 25.2%. Patients aged between 30-41years had AOR of 2.75(95%CI 1.18, 6.37), while those aged 42-53 years had AOR of 3.10 (95%CI 1.12, 8.55) as compared to those aged less than 30 years. Low body mass index (AOR 4.39(95%CI 2.24, 8.61), low CD4 (AOR 5.87(95%CI 2.73, 12.62)) were associated with increased risk of renal dysfunction. However Advanced WHO stages (stages 3 and 4), were associated with a lower incidence of renal dysfunction. About one fourth of patients who were on TDF regimen developed renal dysfunction. Twenty nine percent of participants had no renal function monitoring. Factors which influence the renal dysfunction in patients with TDF regimen in this study are age, low body mass index, low CD4 count and advanced WHO stage.

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Outcome of Septic Shock and Associated Factors at the University of Gondar Hospital: A Retrospective Cohort Study

Background: Septic shock is a medical emergency causing significant morbidity and mortality. Mult... more Background: Septic shock is a medical emergency causing significant morbidity and mortality. Multiple factors affect the outcome of septic shock in a particular clinical setting. Identifying factors associated with poor treatment outcomes is crucial for the improvement of medical care in patients with septic shock. Objectives: The aim of this study was to determine the outcome of septic shock treatment and to determine factors associated with poor outcome. Methods: A hospital based medical record review of patients admitted to the University of Gondar Hospital with the diagnosis of septic shock from January 2014 to October 2016 was conducted. Socio-demographic, clinical history and laboratory data were collected. Data entry and analysis was done using SPSS version 20. Results: Ninety eight cases of septic shock fulfilled the criteria for analysis. The most common source of infection was the gastrointestinal tract. The in Hospital mortality rate of septic shock is 42 %. Longer durati...

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Prevalence and predictors of anemia among adult HIV infected patients at the University of Gondar Hospital, Northwest Ethiopia

HIV/AIDS - Research and Palliative Care, 2019

Background: Anemia is the leading hematologic complication of HIV infection occurring in approxim... more Background: Anemia is the leading hematologic complication of HIV infection occurring in approximately 30% of patients with an asymptomatic infection and in as many as 75-80% of those with AIDS. Anemia increases morbidity and mortality among HIV infected patients. Objective: This study aimed to determine the prevalence of anemia in adult HIV infected patients and the associated factors. Method: Retrospective record review was conducted for a total of 404 HIV infected adult patients who were started on HAART from January 2010 up to September 2015 at the University of Gondar Hospital adult ART clinic. Descriptive analysis, bivariate and multivariate logistic regression was used to compute the different rates, proportions, and associations. Results: The prevalence of anemia was 32.9%, 14.4%, and 9.4% at baseline, after 6 and 12 months of HAART. Lower CD4 count (AOR=1.9; 95% CI: 1.1-3.2) and opportunistic infections (AOR=3.0; 95% CI: 1.8-5.0) were associated with the odds of being anemic at baseline. Baseline anemia was a predictor for being anemic after 6 months (AOR=3.6; 95% CI: 2.0-6.7). Similarly, being anemic after 6 months of HAART predicted the odds of being anemic after 12 months on HAART (AOR=9.1; 95% CI: 4.1-19.9). Zidovudine based regimen was also found to be a predictor of anemia at three months after HAART (AOR=6.0; 95% CI: 2.5-14.3). Conclusion: Anemia is a common problem in HIV patients at the University of Gondar Hospital, nearly a third of the HIV patients had anemia. A lower CD4 count and opportunistic infection were predictors of being anemic. Anemia during the early periods of HAART initiation was also a predictor of subsequent anemia in HIV patients.

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Isolated native tricuspid valve endocarditis due to group A b-hemolytic Streptococcus without drug addiction

We discuss a case of tricuspid valve endocarditis to group A Streptococcus in a middle-age man wi... more

A case report on a rare manifestation of hypothyroid patient; cardiac tamponade

Here presented is a patient admitted to our hospital with cardiac tamponade, a rare manifestation... more Here presented is a patient admitted to our hospital with cardiac tamponade, a rare manifestation of hypothyroidism. Her presentation was non-specific symptoms like easy fatigability, poor appetite and left anterior chest discomfort of 01 year duration. She was evaluated in our hospital before 05 months and was started on anti-tuberculous management. But despite the anti-tuberculous treatment her condition worsened and upon her current admission she has 01 episode of syncope. She was hypotensive and depressed. Pericardial fluid analysis showed a cell count of 200 cells per microliter but mycobacterium tuberculosis was not detected on AFB stain. Cytology of the pericardial fluid revealed just reactive effusion. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of peri...

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Update on COVID-19 Pandemic

Objective: This update is concerned on the coronavirus disease (COVID-19) pandemic that is affect... more Objective: This update is concerned on the coronavirus disease (COVID-19) pandemic that is affecting the globe. The aim of this update is to summarize the up-to-date knowledge about the virus, its way of transmission, clinical features, diagnosis, and treatment. Result: The COVID-19 is a public health threat affecting humankind currently after the emergence and spread of the novel coronavirus or the severe acute respiratory syndrome coronavirus 2. The virus is believed to have originated from bats and transmitted to humans. Around 1.5 million peoples are confirmed to have the COVID-19 and more than 83000 individuals have died of it by April 8, 2020, all over the world. It is transmitted by inhaling or having contact with droplets. The incubation period ranges from 2-14 days. It manifests mainly with fever, non-productive cough, and dyspnea. The polymerase chain reaction from various samples like throat swabs, nasal swabs, bronchoalveolar lavage fluid is used to confirm the diagnosis...

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Antibiotic Use and Resistance Pattern in Ethiopia: Systematic Review and Meta-Analysis

International Journal of Microbiology

Background. In the last decades, medicines have had an unprecedented positive effect on health, l... more Background. In the last decades, medicines have had an unprecedented positive effect on health, leading to reduced mortality and disease burden and consequently to an improved quality of life. The rapid and ongoing spread of antimicrobial-resistant organisms threatens our ability to successfully treat a growing number of infectious diseases. In the absence of the development of new generations of antibiotic drugs, appropriate use of existing antibiotics is needed to ensure the long-term availability of effective treatment for bacterial infections. Irrational use of antibiotics is an ongoing global public health problem that deserves more attention. This review is conducted to evaluate the prevalence of inappropriate antibiotic utilization and resistance to antibiotics in Ethiopia. Methods. Electronic search in PubMed/MEDLINE and Google was used to find published literature with reference lists of relevant articles searched manually. Titles and abstracts were initially screened for e...

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Update on COVID-19 Pandemic

International Journal of Health and Biological Sciences, 2020

Abstract Objective: This update is concerned with the coronavirus disease (COVID-19) pandemic tha... more Abstract
Objective: This update is concerned with the coronavirus disease (COVID-19) pandemic that is affecting the globe. The aim of this update is to summarize the up-to-date knowledge about the virus, its way of transmission, clinical features, diagnosis, and treatment.
Result: The COVID-19 is a public health threat affecting humankind currently after the emergence and spread of the novel coronavirus or the
severe acute respiratory syndrome coronavirus 2. The virus is believed to have originated from bats and transmitted to humans. Around 1.5 million peoples are confirmed to have the COVID-19 and more than 83000 individuals have died of it by April 8, 2020, all over the world. It is
transmitted by inhaling or having contact with droplets. The incubation period ranges from 2-14 days. It manifests mainly with fever, nonproductive cough, and dyspnea. The polymerase chain reaction from various samples like throat swabs, nasal swabs, bronchoalveolar lavage
fluid is used to confirm the diagnosis. High-resolution chest computerized tomography is abnormal in most patients, and typical findings are
ground glass patchy opacities on both lungs and sub-segmental consolidation. Treatment is largely supportive. However, trials are ongoing,
and chloroquine and hydroxychloroquine have got a lot of attention in the battle against COVID-19.
Keywords: COVID-19, RT-PCR, SARS-CoV-2, Treatment.

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Antibiotic Use and Resistance Pattern in Ethiopia: Systematic Review and Meta-Analysis

International Journal of Microbiology, 2019

Background. In the last decades, medicines have had an unprecedented positive effect on health, l... more Background. In the last decades, medicines have had an unprecedented positive effect on health, leading to reduced mortality and disease burden and consequently to an improved quality of life. e rapid and ongoing spread of antimicrobial-resistant organisms threatens our ability to successfully treat a growing number of infectious diseases. In the absence of the development of new generations of antibiotic drugs, appropriate use of existing antibiotics is needed to ensure the long-term availability of effective treatment for bacterial infections. Irrational use of antibiotics is an ongoing global public health problem that deserves more attention. is review is conducted to evaluate the prevalence of inappropriate antibiotic utilization and resistance to antibiotics in Ethiopia. Methods. Electronic search in PubMed/MEDLINE and Google was used to find published literature with reference lists of relevant articles searched manually. Titles and abstracts were initially screened for eligibility. e full texts of articles judged to be eligible were reviewed if they meet the inclusion criteria. Data were extracted on important variables like the sample size, region of the study, the inappropriate antibiotic use, bacterial detection rate, multidrug resistance pattern, and more other variables. Microsoft Excel was used for data extraction. Quantitative analysis was performed using STATA version 11. Results. e electronic searches identified 193 articles of which 33 were found eligible. e random-effects model was used to provide point estimates (with 95% confidence interval (CI)) of bacterial detection rate, inappropriate antibiotic use, and multidrug resistance rate to account for heterogeneity. e pooled bacteria detection rate was 29.1 with 95% CI (16.6-41.7). e pooled prevalence of multidrug resistant strains identified was 59.7% (95% CI: 43.5-75.9). e pooled estimate of inappropriate antibiotic use was 49.2% (95% CI: 32.2-66.2). e pooled proportion of self-antibiotic prescription was 43.3% (95% CI: 15.7-70.9). Other reasons for inappropriate antibiotic use included a wrong indication, wrong duration, improper route of administration, use of leftover antibiotics from a family member, and immature discontinuation of antibiotics. Conclusion and Recommendations. Inappropriate antibiotic use is a huge problem in Ethiopia, and many bacteria were resistant to commonly used antibiotics and similarly, multidrug-resistant bacterial strains are numerous. Appropriate antibiotic use should be ensured by prohibiting over-the-counter sale of antibiotics and strengthening antimicrobial stewardship.

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Cross-Sectional Study

original article, 2019

Background. Ascites is a common clinical condition encountered by physicians in day-today practic... more Background. Ascites is a common clinical condition encountered by physicians in day-today practice. It is caused by various underlying diseases. Knowing the etiologies is vital because further investigations and definitive treatment largely rely on the specific disease entity considered. Objective. The aim of this study was to determine the epidemiology of causes of ascites and complications among patients with ascites from the medical department at the University of Gondar Hospital. Methods. Data on sociodemography, major symptoms, and signs, risk factors, past medical illnesses, and results of important investigations were collected using pretested questionnaires among all patients with ascites in the University of Gondar Hospital in a sample size of 52. Data were collected by well-trained physicians and analyzed by using SPSS 16. Results were depicted descriptively with measures of central tendency, dispersion, and using tables and graphs. Results. A total of 52 patients were included in this study from November 1, 2018 to March 30, 2019. Thirty (57.7%) of them were males and the majority (77%) of the participants were fifty years old or younger. The mean age was 43.8 (± 14). The majority (86.5%) of the participants were from a rural area. Thirty-eight (73%) patients take alcohol occasionally while 11(21.2%) patients take alcohol frequently or massively. Eight (15.4%) patients reported a history of multiple sexual partners. Herbal medicine use was reported by 28 patients (53.8%). Only 5 (9.6%) patients were overweight. Chronic liver disease (CLD) was the major cause of ascites in this study in 24 (46.2%) patients. The other main causes of ascites were heart failure from various causes (19.2%), tuberculosis and hepatosplenic schistosomiasis contributing to 11.5% each and chronic kidney disease (5.8%). Five (20.8%) CLD patients had spontaneous bacterial peritonitis as a complication. Five (20.8%) and 4 (16.7%) CLD patients had hepatocellular carcinoma and hepatic encephalopathy as complications, respectively. Nine (17.3%) patients had variceal bleeding; six of the patients were diagnosed to have CLD while the remaining patients were having hepatosplenic schistosomiasis. Conclusion. In conclusion, liver cirrhosis is the major cause of ascites in Gondar, Ethiopia, while chronic viral hepatitis infections (hepatitis B (HBV) and C (HCV) viruses) are the main causes of liver cirrhosis. The other major causes included heart failure, tuberculosis, and hepatosplenic schistosomiasis. It is wise to consider and give priority to these diseases whenever one is evaluating a patient with ascites.

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Blood Pressure Control Among Hypertensive Patients in University of Gondar Hospital, Northwest Ethiopia: A Cross Sectional Study

original article, 2017

Hypertension is a common health problem worldwide. It doubles risk of stroke, myocardial infarcti... more Hypertension is a common health problem worldwide. It doubles risk of stroke, myocardial infarction, chronic kidney diseases and peripheral arterial disease. Good control of hypertension is important to decrease these complications. For Good control, life style modification (low salt diet, exercise, weight reduction and cessation of smoking) and Different antihypertensive medications are used. The medicines have to be taken adherently and one has to be consistent in life style modifications. Here the blood pressure control status of hypertensive patients on treatment was assessed. Cross sectional study was conducted collecting data using a pretested questionnaire among all hypertensive patients on treatment at the cardiovascular follow up clinic of University of Gondar Hospital from March 1, 2016 to October 30, 2106. A consecutive of 310 hypertensive patients on pharmacologic therapy for at least 6 months were included. Good blood pressure control was defined as BP< 150/90 for those aged 60 years or above and <140/90 if younger than 60 years. Data was entered and analyzed by using SPSS version 20. Results are depicted descriptively using tables and graphs. Logistic regression was used to evaluate associations.A total of 310 participants (118 males & 192 females) were evaluated. Poor blood pressure control was observed in 115 (37%) of the study participants. Presence of diabetes mellitus (OR: 3.6; CI (1.46-8.8)) and poor adherence to antihypertensive drugs (OR: 6.6; CI (1.5-28.5)) were associated with poor BP control. However duration of hypertension, type or number of antihypertensive medications used were not associated with BP control. Patient older than 60years had good BP control. More than one third of patients have poor BP control. Poor blood pressure control was associated with poor adherence to antihypertensive medications & the presence of diabetes. However, elderly people (≥ 60years) were found to be associated with good BP control.

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A case report on a rare manifestation of hypothyroid patient; cardiac tamponade

case report, 2018

Here presented is a patient admitted to our hospital with cardiac tamponade, a rare manifestation... more Here presented is a patient admitted to our hospital with cardiac tamponade, a rare manifestation of hypothyroidism. Her presentation was non-specific symptoms like easy fatigability, poor appetite and left anterior chest discomfort of 01 year duration. She was evaluated in our hospital before 05 months and was started on anti-tuberculous management. But despite the anti-tuberculous treatment her condition worsened and upon her current admission she has 01 episode of syncope. She was hypotensive and depressed. Pericardial fluid analysis showed a cell count of 200 cells per microliter but mycobacterium tuberculosis was not detected on AFB stain. Cytology of the pericardial fluid revealed just reactive effusion. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient. Our patient improved with levothyroxine treatment.

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A case report on a rare manifestation of hypothyroid patient; cardiac tamponade

Here presented is a patient admitted to our hospital with cardiac tamponade, a rare manifestation... more Here presented is a patient admitted to our hospital with cardiac tamponade, a rare manifestation of hypothyroidism. Her presentation was non-specific symptoms like easy fatigability, poor appetite and left anterior chest discomfort of 01 year duration. She was evaluated in our hospital before 05 months and was started on anti-tuberculous management. But despite the anti-tuberculous treatment her condition worsened and upon her current admission she has 01 episode of syncope. She was hypotensive and depressed. Pericardial fluid analysis showed a cell count of 200 cells per microliter but mycobacterium tuberculosis was not detected on AFB stain. Cytology of the pericardial fluid revealed just reactive effusion. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient. Our patient improved with levothyroxine treatment.

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Blood Pressure Control Among Hypertensive Patients in University of Gondar Hospital, Northwest Ethiopia: A Cross Sectional Study

Hypertension is a common health problem worldwide. It doubles risk of stroke, myocardial infarcti... more Hypertension is a common health problem worldwide. It doubles risk of stroke, myocardial infarction, chronic kidney diseases and peripheral arterial disease. Good control of hypertension is important to decrease these complications. For Good control, life style modification (low salt diet, exercise, weight reduction and cessation of smoking) and Different antihypertensive medications are used. The medicines have to be taken adherently and one has to be consistent in life style modifications. Here the blood pressure control status of hypertensive patients on treatment was assessed. Cross sectional study was conducted collecting data using a pretested questionnaire among all hypertensive patients on treatment at the cardiovascular follow up clinic of University of Gondar Hospital from March 1, 2016 to October 30, 2106. A consecutive of 310 hypertensive patients on pharmacologic therapy for at least 6 months were included. Good blood pressure control was defined as BP< 150/90 for those aged 60 years or above and <140/90 if younger than 60 years. Data was entered and analyzed by using SPSS version 20. Results are depicted descriptively using tables and graphs. Logistic regression was used to evaluate associations.A total of 310 participants (118 males & 192 females) were evaluated. Poor blood pressure control was observed in 115 (37%) of the study participants. Presence of diabetes mellitus (OR: 3.6; CI (1.46-8.8)) and poor adherence to antihypertensive drugs (OR: 6.6; CI (1.5-28.5)) were associated with poor BP control. However duration of hypertension, type or number of antihypertensive medications used were not associated with BP control. Patient older than 60years had good BP control. More than one third of patients have poor BP control. Poor blood pressure control was associated with poor adherence to antihypertensive medications & the presence of diabetes. However, elderly people (≥ 60years) were found to be associated with good BP control.

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