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Objective Lipid abnormalities during childhood might be associated with a higher risk of atherosclerosis development in adulthood. In Ethiopia, there were no data on this area. The present work was aimed at assessing the lipid profile abnormalities among children and adolescents aged between 5 and 17 years, in Addis Ababa, Ethiopia. Materials and Methods The present school-based cross-sectional study was done from March 2019 to October 2019 in the capital city, Addis Ababa. A total of 504 students were randomly recruited for this study. The total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein-cholesterol levels were determined using the Cobas c501 automated chemistry analyzer. The prevalence of lipid abnormalities was described in percentages. Bivariate and multivariate analyses were performed, and data with p-value less than 0.05 was considered statistically significant. Results Dyslipidemia in at least one of the lipid profiles was observed in 322 (63.9%) school children, whereas only one of the participants had an abnormality in all four lipid profile tests. The prevalence of total cholesterol 200 mg/dL or higher, low-density lipoprotein 130 mg/dL or higher, high-density lipoprotein less than 40 mg/dL, and triglycerides 130 mg/dL or higher was in 14 (2.8%), 16 (3.2%), 294 (58.4%), and 46 (19.1%) participants, respectively. Conclusion In the current work, the majority of the study participants had a normal lipid profile except increased prevalence of a reduced concentration of high-density lipoprotein-cholesterol. The overall prevalence of serum lipid abnormalities was 63.9%. Serum lipid levels did not show significant differences with sex, age, fasting habits, or obesity.

Background Malaria incidence has declined in Ethiopia in the past 10 years. Current malaria diagnostic tests, including light microscopy and rapid antigen-detecting diagnostic tests (RDTs) cannot reliably detect low-density infections. Studies have shown that nucleic acid amplification tests are highly sensitive and specific in detecting malaria infection. This study took place with the aim of evaluating the performance of multiplex real time PCR for the diagnosis of malaria using patient samples collected from health facilities located at malaria elimination targeted low transmission settings in Ethiopia. Methods A health facility-based, cross-sectional survey was conducted in selected malaria sentinel sites. Malaria-suspected febrile outpatients referred to laboratory for malaria testing between December 2019 and March 2020 was enrolled into this study. Sociodemographic information and capillary blood samples were collected from the study participants and tested at spot with RDTs. Additionally, five circles of dry blood spot (DBS) samples on Whatman filter paper and thick and thin smear were prepared for molecular testing and microscopic examination, respectively. Multiplex real time PCR assay was performed at Ethiopian Public Health Institute (EPHI) malaria laboratory. The performance of multiplex real time PCR assay, microscopy and RDT for the diagnosis of malaria was compared and evaluated against each other. Results Out of 271 blood samples, multiplex real time PCR identified 69 malaria cases as Plasmodium falciparum infection, 16 as Plasmodium vivax and 3 as mixed infections. Of the total samples, light microscopy detected 33 as P. falciparum, 18 as P. vivax, and RDT detected 43 as P. falciparum, 17 as P. vivax, and one mixed infection. Using light microscopy as reference test, the sensitivity and specificity of multiplex real time PCR were 100% (95% CI (93–100)) and 83.2% (95% CI (77.6–87.9)), respectively. Using multiplex real time PCR as a reference, light microscopy and RDT had sensitivity of 58% (95% CI 46.9–68.4) and 67% (95% CI 56.2–76.7); and 100% (95% CI 98–100) and 98.9% (95% CI 96–99.9), respectively. Substantial level of agreement was reported between microscopy and multiplex real time PCR results with kappa value of 0.65. Conclusions Multiplex real-time PCR had an advanced performance in parasite detection and species identification on febrile patients’ samples than did microscopy and RDT in low malaria transmission settings. It is highly sensitive malaria diagnostic method that can be used in malaria elimination programme, particularly for community based epidemiological samples. Although microscopy and RDT had reduced performance when compared to multiplex real time PCR, still had an acceptable performance in diagnosis of malaria cases on patient samples at clinical facilities.

Background: The rise of multidrug-resistant tuberculosis (MDR-TB) has become a major public health concern around the world. Most patients with pulmonary tuberculosis have low body nutrients, hypocholesterolemia, and lower values were strongly associated with mortality in these patients. Representative data on lipid profile, fasting blood glucose abnormalities and their associated factors among MDR TB patients are lacking. Objective: To determine lipid profile, fasting blood glucose abnormalities and their associated factors among multi-drug resistant TB patients during therapy with anti-MDR-TB regimen in St.peter’s Specialized Hospital Addis Ababa, Ethiopia from January to November 2020. Methods and materials: A cross-sectional study was conducted among multi-drug resistant TB patients during MDR therapy regimen in St. Peter’s Specialized Hospital in Addis Ababa, Ethiopia from January to November 2020.Using the Consecutive sampling method a total of 162 blood samples was collected in SST tubes and analyzed by using the Cobas chemistry analyzer. Data were analyzed using SPSS software version 23 packages. Simple descriptive statistics were used to present the socio-demographic and clinical characteristics of the study participants. Other associations were performed with Pearson’s correlation coefficient. A p-value of

Gebre Teklu,1 Mikias Negash,2 Tsegay Asefaw,1 Feven Tesfay,1 Gebreslassie Gebremariam,1 Gebreyohannes Teklehaimanot,1 Mistire Wolde,2 Aster Tsegaye2 1Department of Medical Laboratory Science, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 2Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Gebre Teklu Email gebreteklu30@gmail.comAster Tsegaye Email tsegayeaster@yahoo.comBackground: The adverse health effects of chronic gasoline exposure may be related to impairment of the hematopoietic system with bone marrow suppression, an increased risk of blood cell morphology abnormality and developing cancer.Objective: To assess the effect of gasoline exposure on hematological parameters among gas station workers in Mekelle City, Tigray Region, Northern Ethiopia.Methods: This cross-sectional study was carried out on 43 subjects (exposed group) and 77 subjects (unexposed group) with matched age and sex. Socio-demographic characteristics and duration of exposure data were collected using a structured questionnaire and an observation checklist. Sysmex XP-300 was used for hematological analysis and stained peripheral blood smear was examined for any abnormality. Data were entered and analyzed using SPSS version 23.Results: Of exposed individuals, 28/43 (65.1%) and 49/77 (63.6%) of controls were males. The average exposure time was 5.19± 4.38 years, with an average working hour of 11.74± 1.89 hours/day. The mean RBC count (1012/L), HCT (%), HGB (g/dl) and platelets count (109/L) of the exposed group were significantly lower (4.88± 0.573, 43.29± 3.71, 15.04± 1.33 and 248.95± 58.19) compared with controls (5.35± 0.533, 44.95± 3.10, 15.59± 1.26 and 292.45± 62.17) at p< 0.05, respectively. The MCH (pg) (30.48± 2.06 vs 29.52± 1.66) and MCHC (g/dl) (34.83± 0.988 vs 34.32± 0.927) were significantly higher in the exposed group compared with controls (p< 0.05). HCT, RBC, HGB and platelet counts were significantly decreased with increased years of exposure (p< 0.05). The peripheral blood film examination revealed basophilic stippling and macrocytosis in 9.3% of the exposed group.Conclusion: Long-term exposure to gasoline at gas stations affected RBC parameters and platelet count. A significant negative correlation was noted between duration of exposure and HGB, HCT and platelet count, warranting implementation of protective measures at gas stations.Keywords: gas station, gasoline, hematological parameters, petroleum

Demiraw Bikila,1 Tadesse Lejisa,1 Yosef Tolcha,1 Chala Bashea,1 Mehari Meles,1 Tigist Getahun,1 Genet Ashebir,1 Wossene Habtu,1 Feyissa Challa,1 Ousman Mohammed,2 Melkitu Kassaw,3 Adisu Kebede,4 Letebrhan G/Egzeabher,5 Endalkachew Befekadu,6 Mistire Wolde,7 Aster Tsegaye7 1Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia; 2Department of Medical Laboratory Sciences, Wollo University, Dessie, Ethiopia; 3Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia; 4National Capacity Building Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia; 5Department of Medical Laboratory, Yekatit 12 General Hospital, Addis Ababa, Ethiopia; 6Department of Medical Laboratory, Saint Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia; 7Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Demiraw Bikila, Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia, Email demiraw1234@gmail.comBackground: Even though several factors affect reference intervals (RIs), company-derived values are currently in use in many laboratories worldwide. However, few or no data are available regarding serum proteins RIs, especially in resource-limited countries such as Ethiopia.Objective: To establish RIs for serum protein electrophoresis of apparently healthy adults in Addis Ababa, Ethiopia.Methods: A cross-sectional study was conducted on a total of 297 apparently healthy adults from April to October 2019 in four selected sub-cities (Akaki, Kirkos, Arada, and Yeka) of Addis Ababa, Ethiopia. Laboratory analysis of collected samples was performed using the Capillarys 2 Flex Piercing analyzer, while statistical analysis was conducted using SPSS version 23 and Med-Calc software. The Mann–Whitney test was used to check partitions. A non-parametric method of reference range establishment was performed as per CLSI guideline EP28A3C.Results: The established RIs were: albumin 53.83– 64.59%, 52.24– 63.55%; alpha-1 globulin 3.04– 5.40%, 3.44– 5.60%; alpha-2 globulin 8.0– 12.67%, 8.44– 12.87%; and beta-1 globulin 5.01– 7.38%, 5.14– 7.86%. Moreover, the albumin to globulin ratios were 1.16– 1.8 and 1.09– 1.74 for males and females, respectively. The combined RIs for beta-2 globulin and gamma globulin were 2.54– 4.90% and 12.40– 21.66%, respectively.Conclusion: The established reference interval for serum protein fractions revealed gender-specific differences, except for beta-2 globulin and gamma globulin.Keywords: serum protein electrophoresis, reference interval, Addis Ababa, Ethiopia

Pregnancy-induced hypertension has remained a significant cause of prenatal morbidity and mortality of mothers. So this study aims to assess renal function test, serum total protein, and lipid profile concentrations among pregnancy-induced hypertension women in Asrade Zewudie Memorable hospital (ASZMPH), Gojjam, Ethiopia. A case-control study was done on 200 pregnant women: 100 with pregnancy-induced hypertension (case group) and 100 normotensives (control group) at Asrade Zewudie Memorable Primary hospital Gojjam, Ethiopia from January 24, 2020 to April 30, 2020. 5 ml of venous blood was collected on the SST test tube and analyzed for serum lipid profile, renal function test, and serum total protein. The analysis was done by using SPPS software (version 20.0). The level significance was set at a 95% confidence interval (P-value less than 0.05 was considered clinically significant). In the present study, there was a significant increase in the serum TC, TGs, blood urea, serum creatinine, and LDL (p 0.05). The outcome of the final multiple logistic regression model indicate that factors like BMI, habits of doing scheduled exercise, habit of drinking alcohol, habit of fruit consumption, trimester and gravidity had significant association with lipid profile tests of the study participants. In the present study, the degree of association between different risk factors selected in multiple logistic regression and lipid profile tests was more significant in case group relative with control group. According to the result of this study, early detection of altered lipid profile and renal function test in preeclamptics showed the incidence of complications can be decreased, which in turn reduces the materno-fetal morbidity and mortality. Key words: Lipid profile, serum total protein, renal function test, PIH, and Ethiopia

Brhane Tesfanchal,1 Gebremedhin Gebremichail,2 Getachew Belay,1 Gebreslassie Gebremariam,3 Gebreyohannes Teklehaimanot,4 Hagos Haileslasie,2 Getachew Kahsu,1 Aderajew Gebrewahd,5 Fitsum Mardu,6 Gebre Adhanom,5 Brhane Berhe,6 Hirut Teame,7 Aster Tsegaye,8 Mistire Wolde9 1Unit of Clinical Chemistry, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia; 2Unit of Hematology and Immuno-Hematology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia; 3Unit of Clinical Chemistry, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Mekelle University, Mekelle, Ethiopia; 4Unit of Hematology and Immuno-Hematology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Mekelle University, Mekelle, Ethiopia; 5Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia; 6Unit of Medical Parasitology and Entomology, Department of Medical Laboratory Science, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia; 7Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia; 8Unit of Hematology and Immuno-Hematology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 9Unit of Clinical Chemistry, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Brhane Tesfanchal Tel +251-949604754Email birhanetesfanchal@gmail.comBackground: Visceral leishmaniasis causes alterations of lipid metabolism and it is associated with hypocholesterolemia and severe hypertriglyceridemia. Hepatic dysfunction and life-threatening hepatitis are associated with visceral leishmaniasis. Kidney damage is frequently associated with increased morbidity and mortality in visceral leishmaniasis patients.Methods: A cross-sectional study was carried out to assess the alterations of clinical chemistry parameters among visceral leishmaniasis patients attending Kahsay Abera and Mearg hospitals, Northwest Ethiopia. A total of 100 visceral leishmaniasis patients and 100 healthy controls without visceral leishmaniasis were selected by using convenient sampling techniques. Data were entered and analyzed using statistical package for social sciences (SPSS) version 23.Results: Results were showed that the mean value of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, and triglyceride was significantly higher in visceral leishmaniasis patients than in apparently healthy controls, but the mean value of serum urea and total cholesterol was significantly lower in visceral leishmaniasis patients than healthy controls.Conclusion: The finding of this study concluded that visceral leishmaniasis causes significant alterations of clinical chemistry tests like liver and lipid profile tests compared to healthy controls.Keywords: kidney function test, lipid profile test, liver function test, visceral leishmaniasis

Background: Neisseria gonorrhea (NG) is gram negative diplococcic bacteria that cause most important sexually transmitted infections (STIs) worldwide. In most developing countries including Ethiopia, NG infections are diagnosed syndromically, and its antibiotic susceptibility is rarely tested. Thus, the objective of the present study was to determine the prevalence and antimicrobial susceptibility patterns of N. gonorrhoeae among syndrome diagnosed and treated cases attending selected public health centers, in Addis Ababa, Ethiopia.Methods: a cross-sectional study was conducted from April 2019 to March 2020, at selected health centers STIs clinics in Addis Ababa, Ethiopia. Urethral discharge or vaginal discharge specimens were cultured on Modified Thayer Martín media and suspected gonococcal colonies were confirmed using Oxidase, Superoxol tests. Antimicrobial susceptibility testing was performed by Minimum Inhibitory Concentration (MIC) using concentration gradient strips (E-test) of the same antimicrobial agents of ciprofloxacin, penicillin, Ceftriaxone, Azytromicin, Cefoxitin, and SpectinomicinResults: Among the total 325 NG suspects 163 (50 %) were culture positive. Among the culture positive cases 126 were male and 37 females. Around 4% of isolates are non-susceptible to Ceftriaxone which is the current antimicrobial agent used for urethral discharge/ vaginal discharge syndrome treatment.Conclusion: In the current study, the proportion of N. gonorrhoeae culture positivity rate among male was found to be high. The antimicrobial agent ceftriaxone used for the treatment of gonococccal isolates found to become non susceptible. Antimicrobial agents outside of ciprofloxacin and natural penicillin antimicrobial agents are eligible for the national STI syndromic management.

Studies showed that more than half of Ethiopians were presumed to be chronically infected withTo assess the association ofThis institution-based cross-sectional study was examining 346 dyspeptic patients at SPHMMC from November 2019 to June 2020. A structured questionnaire was used to collect socio-demography data and anthropometric measurement was taken. Biochemical parameters were measured in serum samples by using Cobas 6000 clinical chemistry analyzer. Data were coded and entered into a statistical package for social sciences (SPSS) version 23 for analysis. Risk factors were identified using logistic regression. Hence, a bivariate logistic regression analysis test was conducted and variables with a p0.25 were included in the multivariate logistic regression model. P-values ≤0.05 were considered as a cut point for statistical significance in the final model.An overall prevalence of dyslipidemia among study participants was 253 (73.12 %). Among those who tested positive forThis study reported that more than two-thirds of the

Sexually transmitted infections (STIs) are major infectious diseases worldwide. Around one million people get STIs every day and among them a high burden of the diseases seen in Sub-Saharan African countries. In most developing countries, including Ethiopia, STIs are diagnosed only using syndromic methods, although there seems to be no consensus between syndromic and laboratory-based research.To compare the effectiveness of a syndromic versus laboratory-based approach in the diagnosis of sexually transmitted infections, especially Neisseria gonorrhoeae (NG) and Treponema palladium (TP), infections among those attending a public health center in Addis Ababa, Ethiopia.a cross-sectional study was conducted from April 2019 to March 2020, at selected health centers STIs clinics in Addis Ababa, Ethiopia. A total of 325 study participants were involved. From each participant after having socio-demographic data, additional blood, urethral and vaginal discharge was collected. Then serological, Gram stain, culture, and biochemical tests were performed. SPSS version 23 was used to enter and analyze data. All relevant bodies provided ethical approval, and each study participant gave written informed consent.Among the total participants 167 (51.4%) were males; 177 (54.5%) between ages of 26 and 35; and 178(54.8%) single. Of the total 325 NG, and 125 TP syndromic managed suspected cases, only 163 (50%) and 38 (30.4%) were laboratory- confirmed positive cases respectively. However, there was no statistically significant difference between NG and TP syndromic versus laboratory diagnostic confirmed cases (P-value 0.005).The present study indicated that even if, there were no statistical differences between syndromic versus Laboratory diagnosis confirmed NG and TP cases, more than half of syndromic cases could not be confirmed by laboratory diagnosed tests. Thus, to strengthen the present findings, further large-scale studies are recommended.Sexually transmitted infections (STIs) are the leading infectious diseases worldwide, and the majority of cases are recorded in developing countries, including Ethiopia. However, diagnosis of STIs in most developing countries done syndromic based, since the laboratory-based tests are relatively expensive, need skilled manpower, and time taking. Therefore regular assessments on how closely related STIs syndromic versus laboratory-based diagnosis should be done, for the proper management of the diseases. In this regard, the present study demonstrated that there was no statistically significant difference between syndromic versus laboratory-based diagnosis of some certain STIs infections; Neisseria gonorrhoeae (NG) and Treponema pallidum (TP), in selected public health centers in Addis Ababa, Ethiopia. However, more than half of syndromic cases could not be confirmed by laboratory diagnosed tests. Thus, to narrow the gap between the two diagnostic approaches, regular training, updates, and similar studies need to cascade in the country. In the meantime, in other developing countries too, regular assessment on STIs syndromic versus laboratory-based diagnosis should be done, to control and prevent STIs infections worldwide.

Introduction: Epidemiological and animal studies indicate that helminth infections have positive effects due to their potential to protect against autoimmune diseases. Here, we aim to assess the effect of S. mansoni infection on immune modulation of human monocytes and their potential protection against autoimmune disease development both in vivo and in vitro. Materials and Methods: Monocytes were isolated from helminth-infected Ethiopians (MHIE), and from Dutch healthy volunteers (MHV). The MHV were stimulated in vitro with S. mansoni soluble egg antigens (SEA) or soluble worm antigens (SWA). In addition, phenotypical changes were studied directly, as well as after culturing for 6 days in the presence of human serum to obtain macrophages. Q-PCR, flow cytometry, multiplex bead immunoassay, and live-cell imaging were employed during analysis. Results: MHIE showed elevated transcripts of SOCS-1 and TNF-α compared to MHV. Similarly, MHV that were stimulated with SEA demonstrated enhanced levels of SOCS-1, IL-10, and IL-12 mRNA, compared to control MHV. Remarkably, the SEA-treated monocytes showed a much higher motility than control monocytes, a hallmark of a patrolling phenotype. Furthermore, in vitro cultured macrophages that were stimulated by SEA exhibited enhanced mRNA levels of SOCS-1, IL-10, TNF-α, IL-12 and TGF-β, compared to control macrophages. Conclusion: Macrophages from MHIE as well as SEA-treated MHV show an intermediate activation phenotype with both pro-inflammatory and anti-inflammatory characteristics in vitro. The observed pro-inflammatory properties might reflect a recent response of the cells due to contact with a pathogen, whereas the anti-inflammatory properties might contribute to helminth-induced protection against inflammatory diseases. Large-scale study is recommended to consolidate the findings of the present study.

Mass deworming of school-aged children with anthelmintics has been recognized as an effective approach for reducing the burden of soil-transmitted helminth (STH) infections. However, the consequences of this intervention on nontargeted parasite populations sharing the same gastrointestinal niche are unclear. We conducted a cross-sectional survey among three primary schools in Sululta town, Ethiopia, to examine the association between students’ histories of deworming treatment in the past 6 months and the prevalence of cestode and protozoan infections. An interviewer-led questionnaire administered to parents provided information on sociodemographic factors, and deworming status was ascertained from school records. Stool samples were collected from 525 children for microscopic examination. The independent associations of “any cestode” (positive either for Hymenolepis nana or Taenia spp. eggs) and “any protozoan” (positive either for Giardia lamblia or Entamoeba histolytica/Entamoeba dispar) with history of deworming were examined using logistic regression. Overall, 25.9% of children were infected with at least one intestinal parasite of which H. nana was the most common. In multivariate analyses, deworming in the past 6 months was positively associated with increased odds of both “any protozoan” and “any cestode” infections; the latter reached statistical significance (AOR = 1.83, 95% CI: 0.69–4.86, P = 0.220, AOR = 3.82, 95% CI: 1.17–12.73, P = 0.029, respectively). If this observed association is causal, a greater understanding of interspecies interactions within the gastrointestinal niche may elucidate possible consequences of mass deworming treatments against STHs on coexisting nontargeted parasites.

Background Prior to clinical trials of new tuberculosis (TB) drugs or therapeutic vaccines, it is necessary to develop monitoring tools to predict treatment outcomes in TB patients. Methods Micronutrients concentration level was determined from a total of 262 study participants with five clinical groups: 57 TB patients coinfected with HIV (HIV+TB+), 87 active TB Patients (TB cases), 71 HIV infected without active and latent TB infection (HIV+TST-), 22 latent TB infection (TST+) and 25 healthy controls (TST-). Vitamin A concentration was measured using high-performance liquid chromatography (HPLC), whereas iron and vitamin B12 concentrations were measured using Cobas® 6000 analyzer. Result The serum concentration levels of iron, vitamin A and vitamin B12 had a significant difference between active TB and latent (LTBI) or healthy controls. Six months after treatment, the serum concentration levels of vitamin A, vitamin B12 and iron in tuberculosis became indistinguishable from the levels of LTBIs and healthy control individuals. The concentration levels of iron and vitamin B12 in HIV+TB+patients at the end of TB treatment were normalized to the levels observed in healthy controls (TST-) regardless of HAART treatment. However, the concentration level of vitamin A in HIV+TB+patients HAART untreated at the end of TB treatment was not normalized to the levels observed in healthy controls (TST-) or HAART untreated HIV+TST-. Conclusion Detecting serum concentration levels of vitamin B12 and vitamin A might be used as a biomarker of the diagnostic method of active TB regardless of HIV-infected individuals. Moreover, detecting serum concentration of vitamin B12 might also be used for TB treatment responses monitoring biomarker in TB-HIV-co-infected individuals regardless of HAART (in)eligibility and therapy.

Endalkchew Biranu,1,2 Mistire Wolde,1 Abebe Edao Negesso,1 Habteyes Hailu Tola,3 Million Molla Sisay2 1Addis Ababa University College of Health Sciences Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia; 2St. Peter’s Specialized Hospital, Research and Evidence Generation Directorate, Addis Ababa, Ethiopia; 3Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, Addis Ababa, EthiopiaCorrespondence: Mistire Wolde SnrDepartment of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, P.O. Box 30538, Addis Ababa, EthiopiaTel +251-911-69 97-10Email mistire08@gmail.comBackground: The emergence of MDR-TB is a global public health problem. Hypothyroidism is one of the severe adverse drug reactions (ADRs) in MDR-TB patients on treatment. Representative data on hypothyroidism and its associated factors among MDR-TB patients are lacking.Objective: To determine thyroid profiles and associated risk factors among multidrug-resistant TB patients during therapy with anti-MDR-TB regimen in Saint Peter Specialized Hospital Addis Ababa, Ethiopia from January to November 2020.Methods: A cross-sectional study was conducted in MDR-TB patients in Addis Ababa, Ethiopia. A total of 162 patients, who were older than 18 years, had bacteriologically confirmed MDR-TB and on treatment for more than one month were enrolled consecutively from the TB registration book. However, critically sick patients and those who were receiving additional drugs known to cause severe ADRs were excluded. Simple descriptive statistics were used to present the socio-demographic and clinical characteristics of the patients. A logistic regression model was used to assess the association between independent and dependent variables. A p-value < 0.05 was considered as statistically significant in all analyses.Results: Mean age of the study participant was 35.9 ± 13.6 years. The prevalence of hypothyroidism was 32 (19.8%). The presence of co-morbidity, being underweight, and prothionamide use were significantly associated with hypothyroidism in MDR-TB patients on treatment.Conclusion: Hypothyroidism occurs commonly among MDR-TB patients. Presence of co-morbidity, being underweight, and prothionamide drug use are the factors associated with hypothyroidism. Monitoring of thyroid function test during MDR-TB treatment and factors associated with hypothyroidism require attention to prevent complication.Keywords: multidrug-resistant, tuberculosis, thyroid profile, hypothyroidism

BackgroundHypertension is a silent killer that requires long term management to avoid complications. It is one of major public health problem in developing counties like Ethiopia. Hypertension increases the risk of morbidity and mortality and has negative consequences on the cognitive and physical fitness of productivity in adults.ObjectiveTo assess fasting blood glucose, serum electrolyte, albumin, creatinine, urea, and lipid profile among hypertensive patients and non-hypertensive participants at wolaita sodo teaching and referral hospital.MethodsA comparative cross-sectional study was conducted from December 2019 to February 2020. On the study a total of 156 study participants (78 cases and 78 controls) were involved. Each study participant, after signing informed consent, interviewed about the socio-demographic and anthropometric characteristic features. Then 5ml of the blood sample was collected from each 78 patients with hypertension and each 78 samples from apparently healthy subjects from WSUTRH during the period. Fasting blood glucose, serum electrolyte, albumin, creatinine, urea, and lipid profile level were measured in each group. The Data were analyzed by using Epi data version 3.1 and SPSS version 21.0 software (IBM Corporation, USA) and results were summarized using means and percentages and presented by using figures and tables. P-value < 0.05 was considered to be significant at 95% confidence level. Any abnormal laboratory results of study subjects dispatched and communicated with physicians for better management.ResultsThe mean age of hypertensives and control study groups were 50 ± 10.0 and 51 ±11.3 years respectively. The body mass index of hypertensives and control study groups were 53.4% and 34.2% overweighed respectively. The mean ± SD of fasting blood glucose, total cholesterol, LDL-C, TG, RFT were significantly increases while serum sodium, calcium, albumin, and HDL-Cholesterol significantly decreased in hypertensives when compared with non-hypertensives and serum potassium was no statistical significance among case and control groups.ConclusionIn present study, we observed that the hypertensive group was at risk for developing biochemical alteration in creatinine, urea, fasting blood glucose, lipid profile, electrolytes, and albumin test parameters with an increased period of time.RecommendationRegular measurements of biochemical parameters strongly needed for hypertensive patients.

BackgroundLactose intolerance (LI) is a pathological condition characterized by the inability to digest sugar, lactose, due to the absence or insufficient activity of the lactase enzyme (β-galactosidase). Currently, laboratory diagnostic procedures for LI are poorly practiced in Ethiopia, and so LI treatment is based on an empirical diagnosis. Thus, the objective of the study was to determine the magnitude and associated factors of lactose intolerance among malnourished under-five children in Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia from March 2018 – July 2018.MethodsA cross-sectional study was conducted among malnourished under-five children admitted in the pediatric unit, Yekatit 12 Hospital Medical College, Ethiopia. By using a convenient sampling technique structured questionnaire was administered to gather information on the socio-demographic characteristics of study participants and associated risk factors of LI. Moreover, a fresh stool sample was collected from the study participants to measure stool pH, reducing substances, and microscopy examination for intestinal parasites. Data entery and analysis was done using the Statistical Package for Social Sciences (SPSS 21) software.ResultsThe study included 169 malnourished under-five children. Among those 90 (53.3%) were male with a median age of 12 months. The magnitude of LI was 18.3%. Among the study participants, the highest numbers of LI cases were in the age group of less than 12 months; 17(10.1%) followed by 13-24 months; 13(7.7%). Factors that show significant association with LI on bi-variate logistic analysis were family history of lactose intolerance (P=0.043) and diarrhea (P=0.001). In addition; the problem after taking milk (P=0.007), type of therapeutic milk formula (P=0.001), and frequency of stool/24hr (P=0.023) were found to be independent predictors factors of lactose intolerance in the study population.ConclusionThe magnitude of LI was high in the study setting. Thus, more attention should be given on the proper laboratory diagnosis of LI, for better management of cases at the Yekatit 12 hospital. In addition, similar large scale studies at the molecular level are required to strengthen the present findings of LI in Ethiopia.

Background C-reactive protein (CRP) is an important inflammatory marker associated with different disease conditions, and its concentration differs among ethnicity. This study aimed to determine the distribution and determinants of serum high-sensitive method CRP (hsCRP) that can measure the typically low concentrations, among the Ethiopian population, for which there is no data. Methods A cross-sectional community-based study was conducted in April-June 2015. A total of 5162 individuals aged 15–69 were included. Behavioral, physical, and biochemical measurements were taken using the WHO STEPS non-communicable diseases (NCDs) risk factors assessment tool. Serum hsCRP was determined using Cobas Integra 400 Plus (Roche). Factors associated with hsCRP levels were also considered. Results median hsCRP was 0.80 mg/L (Interquartile range, 0.19–2.12) (males: 0.91 mg/L, females: 0.74 mg/L). More than 18% of the study participants had hsCRP greater than 3 mg/L according to the American Heart Association and Centers for Diseases Control and Preventions cut off value. Higher BMI, living in Somali and in Dire Dawa region, and not consuming of fruit or vegetables were independent risk factors for high hsCRP levels. Conclusion Serum hsCRP levels distribution is comparable to other studies. Until now, no data have been reported in the literature about the Ethiopian population.

Background Quality control materials play a vital role in the laboratory internal and external quality assessment program. However, Ethiopia and other developing countries are challenged by the unavailability and high cost of commercial control material. Therefore, preparing in-house quality control human serum will be a cost-effective way to obtain QC material for use in poor settings in a country like Ethiopia. To prepare urea in-house control human serum and scientifically evaluate it with commercially available sera already in use in the clinical chemistry laboratory of the Ethiopian Public Health Institute. Methods The urea in-house quality control human serum was prepared as per ISO Guide 80, a guideline document protocol from 57 participants' normal serum specimens at the Ethiopian Public Health Institute clinical chemistry laboratory. The quality control material was analyzed on a fully automated chemistry analyzer (Cobas 6000). The initial 20 values were used for calculation of means, standard deviation (SD) and coefficient of variation (CV). Results were compared with those of commercially available lyophilized human sera. Results The average concentrations of urea were found to be near the middle of the physiological range of healthy subjects and the in-house serum could be a good substitute for the commercial serum of normal range. The prepared in-house quality control human serum is stable for about three months without any alterations in the concentration of urea. Conclusions Well prepared in-house quality control human serum is a good substitute for commercially available control serum of normal range, especially in a developing country like Ethiopia.

Background: Point-of-care glucometer (PoCG) devices play a significant role in self-monitoring of the blood sugar level, particularly in the follow-up of high blood sugar therapeutic response. The aim of this study was to evaluate blood glucose test results performed with four randomly selected glucometers on diabetes and control subjects versus standard wet chemistry (hexokinase) methods in Addis Ababa, Ethiopia. Method: A prospective cross-sectional study was conducted on randomly selected 200 study participants (100 participants with diabetes and 100 healthy controls). Four randomly selected PoCG devices (CareSens N, DIAVUE Prudential, On Call Extra, i-QARE DS-W) were evaluated against hexokinase method and ISO 15197:2003 and ISO 15197:2013 standards. Results: The minimum and maximum blood sugar values were recorded by CareSens N (21 mg/dl) and hexokinase method (498.8 mg/dl), respectively. The mean sugar values of all PoCG devices except On Call Extra showed significant differences compared with the reference hexokinase method. Meanwhile, all four PoCG devices had strong positive relationship (>80%) with the reference method (hexokinase). On the other hand, none of the four PoCG devices fulfilled the minimum accuracy measurement set by ISO 15197:2003 and ISO 15197:2013 standards. In addition, the linear regression analysis revealed that all four selected PoCG overestimated the glucose concentrations. Conclusions: The overall evaluation of the selected four PoCG measurements were poorly correlated with standard reference method. Therefore, before introducing PoCG devices to the market, there should be a standardized evaluation platform for validation. Further similar large-scale studies on other PoCG devices also need to be undertaken.

Background Locally established clinical laboratory reference intervals (RIs) are required to interpret laboratory test results for screening, diagnosis and prognosis. The objective of this study was establishing reference interval of clinical chemistry parameters among apparently healthy adolescents aged between 12 and 17 years in Mekelle, Tigrai, northern part of Ethiopia. Methods Community based cross sectional study was employed from December 2018 to March 2019 in Mekelle city among 172 males and 172 females based on Multi stage sampling technique. Blood samples were tested for Fasting blood sugar (FBS), alanine aminino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP), Creatinine, urea, total protein, albumin (ALB), direct and indirect bilirubin (BIL.D and BIL.T) using 25 Bio system clinical chemistry analyzer. Results were analyzed using SPSS version 23 software and based on the Clinical Laboratory Standard Institute (CLSI)/ International Federation of Clinical Chemistry (IFCC) C 28-A3 Guideline which defines the reference interval as the 95% central range of 2.5th and 97.5th percentiles. Mann Whitney U test, descriptive statistics and box and whisker were statistical tools used for analysis. Results This study observed statistically significant differences between males and females in ALP, ALT, AST, Urea and Creatinine Reference intervals. The established reference intervals for males and females, respectively, were: ALP (U/L) 79.48–492.12 versus 63.56–253.34, ALT (U/L) 4.54–23.69 versus 5.1–20.03, AST 15.7–39.1 versus 13.3–28.5, Urea (mg/dL) 9.33–24.99 versus 7.43–23.11, and Creatinine (mg/dL) 0.393–0.957 versus 0.301–0.846. The combined RIs for Total Protein (g/dL) was 6.08–7.85, ALB (g/dL) 4.42–5.46, FBS(mg/dL) 65–110, BIL.D (mg/dL) 0.033–0.532, and BIL.T (mg/dL) 0.106–0.812. Conclusions The result showed marked difference among sex and with the company derived values for selected clinical chemistry parameters. Thus, use of age and sex specific locally established reference intervals for clinical chemistry parameters is recommended.

Introduction Epidemiological and animal studies indicate that helminth infections have positive effects due to their potential to protect against autoimmune diseases. Here, we aim to assess the effect of S. mansoni infection on immune modulation of human monocytes and their potential protection against autoimmune disease development both in vivo and in vitro. Materials and Methods Monocytes were isolated from helminth-infected Ethiopians (MHIE), and from Dutch healthy volunteers (MHV). The MHV were stimulated in vitro with S. mansoni soluble egg antigens (SEA) or soluble worm antigens (SWA). In addition, phenotypical changes were studied directly, as well as after culturing for 6 days in the presence of human serum to obtain macrophages. Q-PCR, flow cytometry, multiplex bead immunoassay, and live-cell imaging were employed during analysis. Results MHIE showed elevated transcripts of SOCS-1 and TNF-α compared to MHV. Similarly, MHV that were stimulated with SEA demonstrated enhanced levels of SOCS-1, IL-10, and IL-12 mRNA, compared to control MHV. Remarkably, the SEA-treated monocytes showed a much higher motility than control monocytes, a hallmark of a patrolling phenotype. Furthermore, in vitro cultured macrophages that were stimulated by SEA exhibited enhanced mRNA levels of SOCS-1, IL-10, TNF-α, IL-12 and TGF-β, compared to control macrophages. Conclusion Macrophages from MHIE as well as SEA-treated MHV show an intermediate activation phenotype with both pro-inflammatory and anti-inflammatory characteristics in vitro. The observed pro-inflammatory properties might reflect a recent response of the cells due to contact with a pathogen, whereas the anti-inflammatory properties might contribute to helminth-induced protection against inflammatory diseases. Large-scale study is recommended to consolidate the findings of the present study., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/SYOVExqwTRU

Objective Previous clinical studies in adults from developed countries have implicated Helicobacter pylori infections in the development of thrombocytopenia. However, studies in children, particularly those from low-income countries, are unusually scarce. We examined the association between H. pylori infection and platelet indices in young Ethiopian school children. Design Cross-sectional study Setting This study was conducted in five elementary schools located in central Ethiopia. Participants Blood and stool samples were collected from 971 children across five elementary schools in Ethiopia. H. pylori infection was diagnosed using stool antigen and serum antibody tests, and haematological parameters were measured using an automated haematological analyser. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. The independent effects of H. pylori infection on platelet indices were determined using multivariate linear and logistic regressions. Study outcomes H. pylori-infected children had a lower average platelet count and mean platelet volume than uninfected after adjusting the potential confounders (adjusted mean difference: −20.80×109/L; 95% CI −33.51 to −8.09×109, p=0.001 and adjusted mean difference: −0.236 fL; 95% CI −0.408 to −0.065, p=0.007, respectively). Additionally, H. pylori-infected children had lower red blood cell counts (adjusted mean difference: −0.118×1012/L; 95% CI −0.200 to −0.036, p=0.005) compared with non-infected. Conclusion Our study from a developing country provides further support for an association between H. pylori infections and reduced platelet indices in young Ethiopian school children, after controlling for potential confounders. Further research is needed, particularly longitudinal studies, to establish causality.

Background Intestinal helminths have been proposed to have a protective role against allergic sensitization and atopic diseases. However, consistent data demonstrating this are lacking in Sub-Saharan countries. We aimed to assess the association between intestinal helminths and allergic disorders among school children enrolled in mass deworming program in Sululta, Ethiopia. Methods A cross sectional study was conducted among 526 school children aged 5 to 14 years old from primary government schools in Sululta district, Ethiopia. An interviewer-led questionnaire administered to parents provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were collected using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire 6 months following deworming treatments. Atopy was defined as a positive skin prick test reaction to one or both dust mite (Dermatophagoides) and German cockroach (Blatella germanica) allergens. Fresh stool samples were collected, processed, and examined by direct wet mount, Kato-Katz technique, and formol-ether concentration technique. Multivariate logistic regressions were used to assess the association between allergic disorder and helminths infection. Results Of the total 526 school children, 58.2% were females. Overall, 24% (126/526) had allergic symptoms, 5.1% (27/526) had atopy, and 16.9% (89/526) had intestinal helminths. There was no association between helminthic infection and self-reported allergic symptoms (P = 0.317), but Ascaris lumbricoides infection was positively associated with atopy (AOR = 4.307, 95% CI 1.143–16.222, P = 0.031). Atopy was related to increased allergy symptoms (AOR = 2.787, 95% CI 1.253–6.197, P = 0.012), and family history of allergy was associated with increased childhood allergy (AOR = 2.753, 95% CI 1.565–4.841, P = 0.001). Deworming in the past 6 months showed a reduced odd of self-reported allergic symptoms (AOR = 0.581, 95% CI 0.366–0.954, P = 0.034). Conclusion While no significant association between self-reported allergy and helminths was found in this study, this may have been due to the low prevalence and intensity of helminthic infection in the sample. There was a positive association between Ascaris lumbricoides and atopy. To further examine the underlying mechanism behind this positive association, a longitudinal study is needed.

Background There has been a noticeable increase in the prevalence of allergy-related disorders (ARDs) in the modern era. Urbanization is believed to be a major environmental risk factor for the onset of ARDs but data from low- to middle-income countries is limited. Objective Our purpose was to assess the prevalence of ARDs and atopy among a population of rural Ethiopian school children and identify environmental and lifestyle factors associated with such disorders. Methods We performed a cross-sectional study on 541 school-children. An interviewer-led questionnaire administered to the mothers of each participant provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were based on the International Study of Asthma and Allergies in Children (ISAAC) core allergy and environmental questionnaire. Skin prick test for common allergens German cockroach (Blattella germanica) and dust mite (Dermatophagoides) was performed to define atopy. Multiple logistic regression analyses were performed to determine the odds ratio between ARDs and atopy with specific environmental and lifestyle habits. Results 541 children responded to the survey questions: the majority of participants were female (60.3%) and aged 10–15 years-old. The prevalence of any ARD was 27%, while the rates of ever-having eczema, rhinitis, and wheeze was found to be 16.8%, 9.6%, and 8.6% respectively. Only 3.6% (19 school-children) tested positive for any skin sensitization. Analysis of associated factors for ARDs found that a family history of allergic disorders (AOR: 2.80; p-value

Background Intestinal parasite infections are major public health problems in resource-limited countries that adversely affect the well-being of millions. Among these, intestinal schistosomiasis is a serious public health problem in tropical and sub-tropical countries. Methods A Community based cross sectional study was conducted from February to April 2017 in Addiremets town, Ethiopia. Socio-demographic associated risk factors and knowledge, attitude and practices of individuals regarding intestinal parasite infection including schistosomiasis were collected from 411 study participants using pretested structured questionnaires. From each study participant, a fresh stool sample was collected and direct microscopy, formol-ether concentration and Kato- Katz techniques were performed. Snails were checked and collected from the nearby study area river. The collected data was entered and analyzed using SPSS version 20. Bi-variant and multiple logistic regressions were used for correlation analysis. A P

ObjectivePrevious clinical studies in adults from developed countries have implicated Helicobacter pylori infections in the development of thrombocytopenia. However, studies in children, particularly those from low-income countries, are unusually scarce. We examined the association between H. pylori infection and platelet indices in young Ethiopian school children.DesignCross-sectional studySettingThis study was conducted in five elementary schools located in central Ethiopia.ParticipantsBlood and stool samples were collected from 971 children across five elementary schools in Ethiopia. H. pylori infection was diagnosed using stool antigen and serum antibody tests, and haematological parameters were measured using an automated haematological analyser. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. The independent effects of H. pylori infection on platelet indices were determined using multivariate linear and logistic regressions.Study outcomesH. pylori-infected children had a lower average platelet count and mean platelet volume than uninfected after adjusting the potential confounders (adjusted mean difference: −20.80×109/L; 95% CI −33.51 to −8.09×109, p=0.001 and adjusted mean difference: −0.236 fL; 95% CI −0.408 to −0.065, p=0.007, respectively). Additionally, H. pylori-infected children had lower red blood cell counts (adjusted mean difference: −0.118×1012/L; 95% CI −0.200 to −0.036, p=0.005) compared with non-infected.ConclusionOur study from a developing country provides further support for an association between H. pylori infections and reduced platelet indices in young Ethiopian school children, after controlling for potential confounders. Further research is needed, particularly longitudinal studies, to establish causality.

Background. Understanding whether the preceding low lipid profile leads to active tuberculosis (TB) or active TB leads to low lipid profile is crucial.Methods. Lipid profile concentrations were determined from 159 study participants composed of 93 active TB patients [44 HIV coinfected (HIV+TB+) and 49 HIV negative (HIV−TB+)], 41 tuberculin skin test (TST) positive cases [17 HIV coinfected (HIV+TST+) and 24 HIV negative (HIV−TST+)], and 25 healthy controls (HIV−TST−). Cobas Integra 400 Plus was used to determine lipid profiles concentration level.Results. The concentrations of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in HIV−TB+ patients were significantly lower compared to HIV−TST+ and to HIV−TST− individuals. Similarly, the concentrations of the TC, LDL-C, and HDL-C in HIV+TB+ were significantly lower compared to HIV−TB+ patients. After the 6 months of anti-TB treatment (ATT), the concentration levels of TC, LDL-C, and HDL-C in HIV−TB+ patients were higher compared to the baseline concentration levels, while they were not significantly different compared to that of HIV−TST+ concentration.Conclusion. The low concentration of lipid profiles in TB patients may be a consequence of the disease and significantly increased in TB patients after treatment.

Additional file 1. DM knowledge questions and DM prevention practice questions.

Background: Recent animal and retrospective human studies have demonstrated that Schistosoma mansoni infection may have potential to protect against development of metabolic syndromes. Thus, the aim of this study was to assess metabolic panel among S. mansoni egg positives and egg negatives in stool examinations. This study was a cross-sectional study, conducted involving 120 participants from S. mansoni endemic town (Kemise) and 61 from non-endemic town (Kombolcha), Northeast Ethiopia. Stool samples were collected and examined for S. mansoni and other helminths using Kato-Katz method. Furthermore, blood samples were collected and used for determination of blood sugar, lipid profile tests, insulin, and C-reactive protein. Data were analyzed using SPSS software version 20. Chi-square test, independent mean t-test, and logistic regression models were employed on data. P values less than .05 were considered as statistically significant. Results: S. mansoni infected participants (n = 41; all from Kemise) had significantly lower levels of fasting blood sugar, low prevalence of dyslipidemia (at least one or more abnormal lipid profile tests; total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) as compared with controls (n = 79 in Kemise and 61 in Kombolcha). Moreover, logistic regression model indicated that with the adjusted odds ratios, there was significant inverse association between S. mansoni infection and impaired fasting glucose (adjusted odds ratio −0.181, 95% confidence interval: 0.042-0.774). Conclusions: Low fasting blood sugar and reduced prevalence of dyslipidemia in S. mansoni egg positive participants might suggest inverse association of S. mansoni infection and development of metabolic syndromes. Furthermore, large-scale studies are recommended to assess the role of S. mansoni egg and/or worm antigens in modulating the host metabolic profile and reducing the risk of metabolic syndromes, including diabetes mellitus and cardiovascular diseases.

Background: Diabetes mellitus (DM) has significant public health importance and its prevalence is rising. Half of the DM patients are undiagnosed. Undiagnosed DM impose substantial implications because subjects remain untreated and at risk for complications. Objective: To determine the prevalence of undiagnosed DM and its risk factors in selected institutions at Bishoftu town, East Shoa, Ethiopia. Materials and methods: Cross-sectional study in selected institutions at Bishoftu town was conducted from December 2012 to February 2013. 422 volunteers proportionally from five institutions were involved. World Health Organization stepwise approach was employed to collect data on demographic, behavioral and physical characteristics. Blood sample after fasting for ≥ 8 hours was collected and serum was assayed for glucose, total cholesterol and triglycerides. Statistical analysis was performed by using STATA (Version 11 USA). Results: The overall prevalence of undiagnosed DM in the study was 5% [95% CI: 3-7%]. Though not statistically significant undiagnosed DM was higher in males (5.7% vs. 3.7%, P>0.05). Increased occurrence of undiagnosed DM was observed with increasing age but again not statistically significant (P>0.05). Univariate analysis showed undiagnosed DM was significantly associated (P