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Purpose: To identify the incidence of cataract and the outcomes of cataract surgery in eyes with ocular cicatricial pemphigoid (OCP)., Methods: Phakic eyes were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study and followed for the incidence of visually significant cataract defined as: newly reduced visual acuity 20/50 or worse attributed to cataract; and/or incident cataract surgery. Secondarily, all eyes with OCP that underwent cataract surgery and had a year of follow up thereafter, were included in an analysis of visual outcome., Results: Three hundred fifty-five phakic eyes (200 patients) with OCP were at risk. Eighty eyes developed visually significant cataract over 1064 eye years (incidence rate = 7.5%/eye-year, 95% confidence interval [CI] = 5.6 to 10.1). Higher age was associated with increased incidence of cataract (adjusted hazard ratio [aHR] = 4.47; 95% CI, 1.95-10.23 for age 60-75 inclusive and aHR = 8.37; 95% CI, 3.60-19.42 for age > 75, each compared with age <60 years). Seventy-nine eyes of 61 patients were monitored for > = 1 year following cataract surgery. Cataract surgery was associated with an improvement of vision around 4 lines, which was sustained through at least 48 months. Poorer pre-operative visual acuity was associated with poorer long-term visual outcome., Conclusions: The incidence of cataract was high in this older population. No factors predictive of cataract such as duration of OCP or use of corticosteroids were identified. Visual acuity improved after surgery by a median of 4 lines' gain at one year; poorer long-term outcome among those with initially poorer visual acuity may be secondary to corneal scarring.

This systematic review with meta-analysis explores the global demographic and etiological variations of retinal vasculitis (RV), focusing on differences in frequency, age, sex, and etiology across diverse geographic populations. RV is an inflammatory condition that can lead to visual impairment, making understanding its variations essential for targeted screening and management. Systematic searches were conducted in multiple databases up to February, 2023, following PRISMA guidelines. We included studies with at least 10 RV cases, such that a frequency measurement can be estimated, without restrictions on publication date or language. RV was categorized as Idiopathic RV in the absence of additional ocular or systemic disease, Syndromic RV for ocular involvement without systemic disease, and Secondary RV in those asssociated with systemic disease. The risk of bias was evaluated using standardized tools. A total of 95 studies, including 23,180 patients, were analyzed. The overall RV frequency among uveitis cohorts was 17 %, with European populations showing the highest frequency at 25 %. Idiopathic RV accounted for 1 % of uveitis cohorts and 38 % of RV cohorts, with significant differences across continents. Behçet disease had the highest RV frequency at 56 %. The median age of diagnosis was 33.5 years, and RV was more frequent in males (57 %). Our findings underscore the considerable geographic and demographic variability in RV, particularly in Idiopathic RV, tuberculosis-related RV, and Behçet disease, highlighting the need for tailored, region-specific, and gender-specific approaches to RV diagnosis and treatment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Purpose: We compared the distribution of the HLA-B27 allele among Ethiopian patients with acute anterior uveitis (AAU) and controls without that disease., Methods: The clinical features of patients were collected from their medical records. HLA-B27 genotyping was performed for 64 patients, with AAU using the real-time polymerase chain reaction (RT-PCR), and the results were compared to those from a panel of 192 healthy, unrelated volunteer control participants (refraction patients and volunteers) free of signs of anterior uveitis. Other outcomes were assessed comparing HLA-B27 positive vs. negative patients., Results: The histocompatibility antigen HLA-B27 was identified in 6 out of 64 (9.4%) AAU patients, compared with 1.0% in controls (Odds Ratio = 9.8, 95% CI (1.93, 50.01)). Sub-group analysis of the cases revealed that patients with HLA-B27 positivity had a higher incidence of ocular hypertension (Odds Ratio = 5.93, 95% CI (1.29, 27.2))., Conclusion: The antigen HLA-B27 was represented ~10-fold more frequently in the patient group than in the control group. HLA-B27 allele distribution in both cases and controls is lower than in reports from Caucasian and Asian populations, but similar to South Africa.

A supernumerary kidney is an extremely rare congenital renal anomaly that is characterized by the presence of one or more extra kidneys. Unilateral cases occur more commonly on the left side. Reporting such uncommon anomalies is important for several reasons, such as improving diagnosis and treatment, educating clinicians and radiologists about the identification and treatment of supernumerary kidneys, and comparing the case to existing literature to highlight similarities and differences in presentation, management, or outcomes. A 35-year-old male patient presented to our hospital in Addis Ababa, Ethiopia, with left lower flank pain. His blood pressure was elevated during the initial visit; however, the results of the physical examination and laboratory investigations were unremarkable. Abdominopelvic ultrasound and computed tomographic (CT) urography confirmed the diagnosis of a left-sided supernumerary kidney, with no associated abnormalities. In such cases, the diagnosis of a supernumerary kidney is made using an abdominal ultrasound scan, intravenous urography (IVU), CT urography, and magnetic resonance imaging (MRI). Treatment depends on the patient's symptoms. Asymptomatic cases must be followed up regularly. If a supernumerary kidney is nonfunctional or associated with other abnormalities, a nephrectomy is indicated. We treated our patient with adequate analgesia and scheduled a follow-up., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Getachew, Suga, Suga and Kiflemariam.)

Purpose: To analyze survival and its predictors among patients with hepatocellular carcinoma (HCC) receiving transarterial chemoembolization (TACE) in Ethiopia., Materials and Methods: We conducted a retrospective cohort study among patients who received TACE for HCC at MCM Hospital from December 1, 2016, to December 31, 2022. Data were extracted from patients' medical records, and vital status was ascertained from the patients' charts or by phone call to the next of kin. We used Kaplan-Meier estimator to determine survival functions and log-rank test to compare the survival functions in different groups. Predictors of survival were identified using a multivariable Cox proportional hazards regression model as expressed by adjusted hazard ratio (aHR)., Results: Of the total 257 patients included in the study, 68.9% were male, with a mean age of 56.5 (±14.06) years, and 86% were diagnosed at the advanced stage of the cancer (Barcelona Clinic Liver Cancer-C). The median overall survival was 12.7 months (95% CI, 10.57 to 14.85), and the overall survival rate at 1 year, 2 years, 3 years, 4 years, 5 years, and 6 years was found to be 58.0% (95% CI, 51.8% to 63.8%), 24.1% (95% CI, 19.1% to 29.6%), 8.2% (95% CI, 5.1% to 11.7%), 7.0% (95% CI, 3.9% to 10.1%), 1.6% (95% CI, 0.4% to 3.1%), and 1.2% (95% CI, 0.1% to 2.7%), respectively. The probability of death was significantly increased by alpha-fetoprotein level <400 ng/mL (aHR, 5.72 [95% CI, 1.52 to 21.51]), albumin level (aHR, 5.03 [95% CI, 1.41 to 18.01]), and bilobar distribution (aHR, 5.67 [95% CI, 1.40 to 23.04])., Conclusion: The findings of the study underscore the need for the expansion of preventive measures and treatment facilities to address the overwhelming burden of HCC in Ethiopia.

Purpose: The anti-inflammatory effect of therapeutic pars plana vitrectomy (PPV) in the management of posterior segment uveitis is incompletely quantified. In this study, we evaluated the change in total immunosuppression load (TIL) following PPV for the eyes of patients with non-infectious uveitis., Methods: Retrospective chart review of patients with non-infectious posterior segment uveitis on continuous anti-inflammatory therapy (systemic corticosteroids ± immunomodulatory therapy [IMT]) ±3 months, who received therapeutic PPV for non-resolving inflammation. The TIL scores were calculated by adding the total daily dose of prednisolone graded on a scale of 0-9, and of the IMT graded between 0 and 3, and calculating the mean values for the pre-operative and post-operative visits, respectively., Results: Sixty-five eyes of 65 patients were included. Mean follow-up was 19.1 ± 14.6 months pre-operatively and 9.4 ± 7.1 months post-operatively. Mean TIL scores for the post-operative visits (2.6 ± 1.9) were significantly lower than the pre-operative (4.4 ± 1.7) visits ( p  < 0.001). Mean logMAR BCVA was four lines better 1 month post-operatively (0.5 ± 0.4) than the immediate pre-operative vision (0.9 ± 0.6, p  < 0.001). On multivariate regression analyses, the reduction in mean TIL scores post-operatively was more with longer durations of pre-operative treatment (adjusted risk ratio [aRR] = -0.04, p  = 0.04), while the improvement in one-month post-operative BCVA was more if pre-operative vitreous haze was ≥2+ (aRR = -0.25, p  = 0.02). Post-operative adverse outcomes included new-onset cystoid macular edema ( n  = 6), raised intraocular pressure ( n  = 5), and intra-operative retinal break ( n  = 1). Eleven (16.9%) patients were off all immunosuppression during the final follow-up., Conclusions: Therapeutic PPV allowed control of intraocular inflammation on less intensive systemic anti-inflammatory therapy. Post-operative adverse outcomes observed were manageable.

Purpose: To report the design of FLuorometholone as Adjunctive MEdical therapy for TT surgery (FLAME) trial., Design: Parallel design, double-masked, placebo-controlled clinical trial with 1:1 randomization to fluorometholone 0.1% eye drops twice daily or placebo twice daily for 4 weeks in eyes undergoing trachomatous trichiasis (TT) surgery for assessing the efficacy, safety, and cost-effectiveness of fluorometholone 0.1% in preventing recurrent postoperative trichiasis (PTT)., Methods: Up to 2500 eligible persons with trachomatous trichiasis undergoing lid rotation surgery were enrolled in the Jimma zone, Ethiopia. Participants, surgeons, study field staff, and study supervisors leading operational aspects of the trial are masked to treatment assignment. Randomization is stratified by the surgeon and is simultaneously stratified by the district. Study visits (in addition to programmatic follow-ups) are at the baseline/enrollment, at four-week post-enrollment, and after 6 months and 1 year. The primary outcome is cumulative one-year PTT incidence, defined as: ≥1 lashes touching the globe, evidence of epilation, and/or repeat TT surgery. Secondary postoperative outcomes include the number of trichiatic lashes, location (touching the cornea or not), evidence of post-operative epilation, entropion, changes in corneal opacity, IOP elevation, need for cataract surgery, visual acuity change from the baseline, eyelid contour abnormality, granuloma, eyelid closure defect, and the occurrence of adverse events. Health economic analyses center on calculating the incremental cost per case of PTT avoided by fluorometholone treatment., Conclusion: The FLAME Trial is designed to provide evidence of the efficacy, safety, and cost-effectiveness of adjunctive topical peri-/postoperative fluorometholone 0.1% therapy with trichiasis surgery, which is hypothesized to reduce the risk of recurrent trichiasis while being acceptably safe., Clinical Trial Registration: https://www.clinicaltrials.gov/study/NCT04149210.

Purpose: Evaluation of longer-term effectiveness of 3 intravitreal therapies (methotrexate, ranibizumab, or dexamethasone implant) for participants enrolled in the randomized comparative effectiveness trial the Macular Edema Ranibizumab versus Intravitreal Anti-inflammatory Therapy (MERIT) Trial followed up for 24 weeks., Design: Multicenter randomized controlled clinical trial with masked evaluation of retinal thickness and visual acuity., Participants: Patients with persistent or recurrent uveitic macular edema., Methods: Participants from 33 centers were randomized 1:1:1 (stratified by presence or absence of concomitant systemic immunosuppression for uveitis) to receive a sequence of intravitreal treatments with dexamethasone implant, methotrexate, or ranibizumab. Participants with bilateral macular edema received the same treatment bilaterally. During 24 weeks of follow-up, nonassigned treatments were permitted beginning from 12 weeks for those meeting re-treatment criteria., Main Outcome Measures: Central subfield thickness (CST) change from baseline OCT measurement was the main outcome. Secondary outcomes included change in mean standard letters of baseline best-corrected visual acuity (BCVA). Analyses were conducted according to 2 principles: (1) as assigned, in which outcomes were analyzed according to their original randomized treatment, and (2) a supplementary censored analysis, in which data were excluded after an eye received a nonassigned treatment., Results: Among 194 enrolled participants (225 eligible eyes), 177 participants (207 eyes) completed 24 weeks of follow-up. Eyes assigned to methotrexate (55%) and ranibizumab (37%) more frequently received nonassigned treatments (88% dexamethasone implant or intravitreal corticosteroid injection) compared with eyes assigned to dexamethasone (7%). In the as-assigned analysis, dexamethasone showed superior improvement in macular edema compared with ranibizumab (CST, 34% vs. 19%; P = 0.01), but not compared with methotrexate (CST, 31%; P = 0.59) after being superior to both other regimens at 12 weeks. However, in the censored analysis, only dexamethasone was associated with improvements in macular edema (CST, 34% vs 8% [P < 0.001] and 5% [P < 0.001]) and BCVA improvement of > 5 letters compared with methotrexate and ranibizumab, respectively. Dexamethasone more often was associated with intraocular pressure elevations of ≥ 24 mmHg (32%) and of ≥ 30 mmHg (10%)., Conclusions: Dexamethasone was more effective than methotrexate and ranibizumab for the treatment of persistent or recurrent uveitic macular edema through 24 weeks, with manageable side effects., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: Giant cell arteritis (GCA) is a chronic inflammatory condition associated with a significantly increased risk of various cardiovascular and thromboembolic events. Existing studies suggest an increased risk of cardiovascular disease in GCA, but results vary. This meta-analysis aims to quantify the association between GCA and the risk of various cardiovascular outcomes, providing a comprehensive evaluation of the cardiovascular burden in patients with GCA., Methods: A comprehensive literature search was carried out using several databases. Studies were included based on predefined eligibility criteria. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to assess publication bias. The endpoint included any cardiovascular events, myocardial infarction (MI), coronary artery disease (CAD), aortic aneurysm/dissection, peripheral artery disease (PAD), stroke, and venous thromboembolism., Results: The meta-analysis included 14 studies with a combined sample size of 609,954 patients, where the mean age was 73.8 years and 72.2% were female. Patients with GCA had significantly higher odds of experiencing any cardiovascular event (OR = 1.81, 95% CI = 1.55-2.15), acute myocardial infarction (OR = 1.63, 95% CI = 1.34-1.97), coronary artery disease (OR = 1.51, 95% CI = 1.09-2.08), aortic aneurysm/dissection (OR = 1.95, 95% CI = 1.55-2.46), peripheral artery disease (OR = 2.02, 95% CI = 1.69-2.41), stroke (OR = 1.52, 95% CI = 1.25-1.84), venous thromboembolism (OR = 1.92, 95% CI = 1.73-2.12), deep vein thrombosis (OR = 2.09, 95% CI = 1.50-2.91) and pulmonary embolism (OR = 2.45, 95% CI = 1.38-4.36). The heterogeneity of the outcomes ranged from low to high across different analyses. No publication bias was evident in the analysis., Conclusion: The meta-analysis highlights the critical need for vigilant cardiovascular monitoring and proactive management strategies in GCA patients. Further research is needed to identify specific factors that contribute to cardiovascular complications in these patients., Competing Interests: Disclosure Authors have no potential conflicts of interest to disclose., (Copyright © 2024 Hellenic Society of Cardiology. Publishing services by Elsevier Inc. All rights reserved.)

Key Clinical Message: Early recognition and management of familial hypercholesterolemia (FH) are crucial, especially in patients with extensive xanthomas and premature coronary artery disease. Prompt diagnosis and aggressive lipid-lowering therapy can significantly reduce morbidity and mortality rates. Careful clinical assessment in resource-limited settings is essential for optimal outcomes., Abstract: Familial hypercholesterolemia (FH) is an autosomal dominant inherited disorder that causes chronically elevated levels of low-density lipoprotein (LDL) cholesterol. Based on LDL levels, FH can be heterozygous or homozygous, further established through clinical features, laboratory findings, and genetic analysis. Elevated cholesterol levels cause atherosclerosis, coronary artery disease, myocardial infarction, and sudden death. Xanthomas are a clinical manifestation of FH that reveal the underlying systemic genetic disease. We present the case of a 47-year-old male with triple vessel coronary artery disease and widespread xanthomas, diagnosed with homozygous FH based on "The Dutch Lipid Clinic Network Diagnostic Criteria for Familial Hypercholesterolemia." Lifelong therapy with lipid-lowering medications and lifestyle changes is necessary in such cases., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Intermediate uveitis is defined as inflammation of the vitreous and pars planitis. Etiology can be infectious, associated with a systemic disease, neoplastic or idiopathic. Pars planitis is the term used for idiopathic intermediate uveitis that presents with snowballs and snowbanks. While relatively rare, intermediate uveitis is present globally and typically affects adult females. Awareness of the presentation and a dilated fundus examination in patients presenting with floaters is essential to the diagnosis. PCR testing has enhanced the ability to diagnose infectious and neoplastic conditions that masquerade as intermediate uveitis. A structured review of systems and focused imaging, and laboratory testing will assist with early diagnosis and initiation of treatment.

Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To assess the diagnostic performance of two chatbots, ChatGPT and Glass, in uveitis diagnosis compared to renowned uveitis specialists, and evaluate clinicians' perception about utilizing artificial intelligence (AI) in ophthalmology practice., Methods: Six cases were presented to uveitis experts, ChatGPT (version 3.5 and 4.0) and Glass 1.0, and diagnostic accuracy was analyzed. Additionally, a survey about the emotions, confidence in utilizing AI-based tools, and the likelihood of incorporating such tools in clinical practice was done., Results: Uveitis experts accurately diagnosed all cases (100%), while ChatGPT achieved a diagnostic success rate of 66% and Glass 1.0 achieved 33%. Most attendees felt excited or optimistic about utilizing AI in ophthalmology practice. Older age and high level of education were positively correlated with increased inclination to adopt AI-based tools., Conclusions: ChatGPT demonstrated promising diagnostic capabilities in uveitis cases and ophthalmologist showed enthusiasm for the integration of AI into clinical practice.

Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Infectious diseases affecting the eye often cause unilateral or asymmetric visual loss in children and people of working age. This group of conditions includes viral, bacterial, fungal and parasitic diseases, both common and rare presentations which, in aggregate, may account for a significant portion of the global visual burden. Diagnosis is frequently challenging even in specialist centres, and many disease presentations are highly regional. In an age of globalisation, an understanding of the various modes of transmission and the geographic distribution of infections can be instructive to clinicians. The impact of eye infections on global disability is currently not sufficiently captured in global prevalence studies on visual impairment and blindness, which focus on bilateral disease in the over-50s. Moreover, in many cases it is hard to differentiate between infectious and immune-mediated diseases. Since infectious eye diseases can be preventable and frequently affect younger people, we argue that in future prevalence studies they should be considered as a separate category, including estimates of disability-adjusted life years (DALY) as a measure of overall disease burden. Numbers of ocular infections are uniquely affected by outbreaks as well as endemic transmission, and their control frequently relies on collaborative partnerships that go well beyond the remit of ophthalmology, encompassing domains as various as vaccination, antibiotic development, individual healthcare, vector control, mass drug administration, food supplementation, environmental and food hygiene, epidemiological mapping, and many more. Moreover, the anticipated impacts of global warming, conflict, food poverty, urbanisation and environmental degradation are likely to magnify their importance. While remote telemedicine can be a useful aide in the diagnosis of these conditions in resource-poor areas, enhanced global reporting networks and artificial intelligence systems may ultimately be required for disease surveillance and monitoring., (© 2024. Crown.)

The integration of artificial intelligence (AI) with healthcare has opened new avenues for diagnosing, treating, and managing medical conditions with remarkable precision. Uveitis, a diverse group of rare eye conditions characterized by inflammation of the uveal tract, exemplifies the complexities in ophthalmology due to its varied causes, clinical presentations, and responses to treatments. Uveitis, if not managed promptly and effectively, can lead to significant visual impairment. However, its management requires specialized knowledge, which is often lacking, particularly in regions with limited access to health services. AI's capabilities in pattern recognition, data analysis, and predictive modelling offer significant potential to revolutionize uveitis management. AI can classify disease etiologies, analyze multimodal imaging data, predict outcomes, and identify new therapeutic targets. However, transforming these AI models into clinical applications and meeting patient expectations involves overcoming challenges like acquiring extensive, annotated datasets, ensuring algorithmic transparency, and validating these models in real-world settings. This review delves into the complexities of uveitis and the current AI landscape, discussing the development, opportunities, and challenges of AI from theoretical models to bedside application. It also examines the epidemiology of uveitis, the global shortage of uveitis specialists, and the disease's socioeconomic impacts, underlining the critical need for AI-driven approaches. Furthermore, it explores the integration of AI in diagnostic imaging and future directions in ophthalmology, aiming to highlight emerging trends that could transform management of a patient with uveitis and suggesting collaborative efforts to enhance AI applications in clinical practice., (Copyright © 2024. Published by Elsevier Inc.)

Background: Venous thromboembolism (VTE) remains the commonest preventable cause of death in postoperative patients. VTE prophylaxis significantly reduces mortality risk, yet its utilization remains alarmingly low and variable (6-61 %) worldwide. This study aimed to compare VTE prophylaxis use among adult surgical patients in major hospitals in Addis Ababa, Ethiopia., Materials and Methods: A multicenter cross-sectional study was conducted in one private (Myungsung Christian Medical Center Comprehensive Specialized Hospital (MCM CSH)), and two public hospitals (Yekatit 12 Hospital Medical College and Menelik II Referral Hospital). Data was collected by chart review using standardized checklist. Caprini score was used for risk stratification, and associations was assessed using chi-square test with significance set at p < 0.05., Results: From a total of 423 patients, 222 (52.3 %) patients were male. The mean age of the patients is 43.3(±14.7 SD) years. 414 (98 %) patients were at risk for VTE with 257(61 %) having moderate to high risk, but only 31(7.5 %) were on prophylaxis. Prophylaxis use was 12.5 % in MCM CSH, but it was 5.5 % and 5.1 % in Yekatit 12 and Menelik II Referral Hospitals respectively. VTE prophylaxis use was significantly less in public hospitals (p < 0.05)., Conclusions: Despite the majority of surgical patients being at risk of developing VTE, VTE prophylaxis remains significantly underutilized across major private and public hospitals in Ethiopia, particularly in public settings. The current study suggests standard risk assessment model implementation to address this significant and understudied risk to patients' lives., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Background/aims: Trachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher training (RT) for experienced surgeons (1-22 years) on the outcomes of upper lid (UL) TT surgery in rural Ethiopia., Methods: Patients undergoing UL TT surgery in at least one eye by a participating surgeon were included. Patients were split into two cohorts: patients enrolled prior to (C1) and after (C2) RT. RT consisted of a 1-week programme with practice on a HEAD START mannequin and supportive supervision in live surgery by expert trainers. Data were collected at preoperative enrolment, and at 6-month and 12-month follow-up visits. The primary outcome was development of postoperative TT (PTT). A series of multivariate generalised estimating equations were fit to model PTT involving potential covariates of interest., Results: A total of 261 eyes contributed by 173 patients were studied between 2017 and 2019. By 1-year postoperatively, 37/128 eyes (28.9%) in C1 and 22/133 eyes (16.5%) in C2 had developed PTT (p=0.03). Other than surgeon RT participation, no factors studied were associated with differences in PTT., Conclusion: Our results indicate a significant reduction in the risk of PTT after experienced surgeons' participation in RT as compared with eyes receiving surgery before RT. This observation suggests a significant potential benefit of the RT with HEAD START mannequin practice and supportive supervision during surgery, and suggests RT may be a valuable strategy to improve surgical outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study aims to understand the practice patterns among ophthalmologists in North America who manage patients with acute, non-infectious anterior uveitis., Methods: An eight-question survey was designed to elucidate the practice patterns of ophthalmologists across various geographic locations and practice settings regarding the management of anterior uveitis. This survey was distributed via the American Uveitis Society and Young Uveitis Specialists email listserv to ophthalmologists who self-identify as uveitis specialists and have a patient population that is at least 30% uveitis., Results: A total of 102 responses were received and analyzed (37% response rate). Respondents practiced predominantly in North America, and 40% had received subspecialty training in uveitis. All respondents chose topical corticosteroid therapy as first-line treatment for acute, unilateral, or bilateral non-infectious idiopathic anterior uveitis. The most common initial frequency for prednisolone acetate administration was six times/day while the patient was awake (29.7%) and patients are typically seen in follow-up within a week (75% of respondents). If there is a lack of treatment response within 2-3 weeks with the initial topical treatment, 42 respondents (41.2%) chose to switch to difluprednate eye drops and 29 (28.4%) recommended switching to oral prednisone., Conclusion: Our results show that topical corticosteroid, most frequently prednisolone acetate 1%, is the treatment of choice for patients with acute noninfectious anterior uveitis. Reported initial medication dosing and follow-up care approaches are highly variable, which suggests heterogeneity in practice patterns. Further research on the optimal initial dosing is needed.

Background: Acute kidney injury (AKI) is a frequent complication in critical patients, leading to a worse prognosis. Although its consequences are worse among critical patients, AKI is also associated with less favorable outcomes in non-critical patients. Therefore, understanding the magnitude of the problem in these patients is crucial, yet there is a scarcity of evidence in non-critical settings, especially in resource limited countries. Hence, the study aimed at determining the incidence and predictors of hospital acquired acute kidney injury (HAAKI) in non-critical medical patients who were admitted at a large tertiary hospital in Ethiopia., Methods: A retrospective chart review study was conducted from September 25, 2022 to January 20, 2023 among 232 hospitalized non-critical medical patients admitted to St. Paul's Hospital Millennium Medical College between January 2020 and January 2022. The incidence of HAAKI was estimated using incidence density per total person day (PD) observation of the study participants. To identify predictors of HAAKI, a log binomial regression model was fitted at a p value of ≤0.05. The magnitude of association was measured using adjusted relative risk (ARR) with its 95% CI., Results: During the median follow-up duration of 11 days (IQR, 6-19 days), the incidence of HAAKI was estimated to be 6.0 per 100 PD (95% CI = 5.5 to 7.2). Significant predictors of HAAKI were found to be having type 2 diabetes mellitus (ARR = 2.36, 95% CI = 1.03, 5.39, p-value=0.042), and taking vancomycin (ARR = 3.04, 95% CI = 1.38, 6.72, p-value=0.006) and proton pump inhibitors (ARR = 3.80, 95% CI = 1.34,10.82, p-value=0.012)., Conclusion: HAAKI is a common complication in hospitalized non-critical medical patients, and is associated with a common medical condition and commonly prescribed medications. Therefore, it is important to remain vigilant in the prevention and timely identification of these cases and to establish a system of rational prescribing habits., Competing Interests: The authors declare that they have no known competing interests in this work., (© 2024 Mekonnen et al.)

Bile leak is an uncommon complication post cholecystectomy. The bile may originate from the cystic duct stump and less commonly from the aberrant ducts of Luschka. Such complications may occur when anatomical variations in the biliary tree go unnoticed. This case report presents a 24-year-old otherwise healthy female who presented with abdominal pain and distension that began 3 days after she underwent open cholecystectomy for symptomatic cholelithiasis. Imaging revealed choledocholelithiasis in the distal common bile duct, and free intrabdominal fluid collection. Endoscopic retrograde cholangiopancreatography done showed contrast leak from the duct of Luschka to the gall bladder bed. The biliary tree has many anatomic variations. These variations have clinical significance for surgical treatment of patients with biliary pathology. Surgeons should be aware of such variations to decrease the risk of bile leak post cholecystectomy., Competing Interests: The authors declare no conflicts of interest., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Purpose: To evaluate the effectiveness of 3 different intravitreal treatments for persistent or recurrent uveitic macular edema (ME): dexamethasone implant, methotrexate, and ranibizumab., Design: Single-masked, randomized controlled clinical trial., Participants: Patients with minimally active or inactive uveitis and persistent or recurrent uveitic ME in one or both eyes., Methods: Patients at 33 centers were randomized 1:1:1 to receive 1 of the 3 therapies. Patients with bilateral ME received the same treatment in both eyes., Main Outcome Measures: The primary outcome, measured at 12 weeks, was reduction in central subfield thickness (CST) expressed as a proportion of baseline (CST per CST at baseline) assessed with spectral-domain OCT by readers masked to treatment assignment. Secondary outcomes included improvement and resolution of ME, change in best-corrected visual acuity (BCVA), and elevations in intraocular pressure (IOP)., Results: One hundred ninety-four participants (225 eligible eyes) were randomized to dexamethasone (n = 65 participants and 77 eyes), methotrexate (n = 65 participants and 79 eyes), or ranibizumab (n = 64 participants and 69 eyes). All received at least 1 injection of the assigned treatment. At the 12-week primary outcome point, each group showed significant reductions in CST relative to baseline: 35%, 11%, and 22% for dexamethasone, methotrexate, and ranibizumab, respectively. Reduction of ME was significantly greater in the dexamethasone group than for either methotrexate (P < 0.01) or ranibizumab (P = 0.018). Only the dexamethasone group showed a statistically significant improvement in BCVA during follow-up (4.86 letters; P < 0.001). Elevations of IOP by 10 mmHg, to 24 mmHg or more, or both were more common in the dexamethasone group; IOP spikes to 30 mmHg or more were uncommon overall and were not significantly different among groups. Reductions in BCVA of 15 letters or more were more common in the methotrexate group and typically were attributable to persistent ME., Conclusions: At 12 weeks, in eyes with minimally active or inactive uveitis, dexamethasone was significantly better at treating persistent or recurrent ME than methotrexate or ranibizumab. Risk of IOP elevation was greater with dexamethasone, but elevations to levels of 30 mmHg or more were infrequent., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: Evaluate the association between cancer incidence and immunosuppressive treatment in patients with ocular inflammatory disease (OID)., Methods and Analysis: We performed a retrospective cohort study of patients from 10 US OID subspecialty practices. Patients with non-infectious OID were included; HIV-infected patients were excluded. Time-dependent exposure to drug classes (ie, antimetabolites, calcineurin inhibitors, alkylating agents, tumour necrosis factor (TNF) inhibitors) and drugs were evaluated. Cancer incidence was ascertained by linkage to 12 state cancer registries from 1996 to 2015. Cancer incidence was analysed using Cox regression survival analysis, using 0-year, 3-year and 5-year lags after immunosuppression began., Results: The cancer incidence cohort comprised 10 872 individuals at risk of incident cancer and residing in one of the 12 states covered; 812 primary cancers were identified through cancer incidence tracing with median follow-up time of 10 years. Neither TNF inhibitor, antimetabolite, calcineurin inhibitor nor alkylating agent classes were associated with statistically significant increases in cancer incidence adjusting for covariates. We found statistically significant reduced hazards in the systemic inflammatory disease (SID)-including cohort for adalimumab and chlorambucil, increased hazards for tacrolimus and etanercept in the non-SID cohort and reduced hazards for methotrexate in both. Other immunosuppressive drugs were not associated with overall cancer incidence., Conclusions: We found no increased risk of overall or site-specific cancer incidence associated with short-term (non-transplant) therapy with most commonly used immunosuppressive drug classes and many specific drugs. Further research may clarify potentially protective or harmful effects of specific agents that were not consistently associated with reduced or increased cancer incidence., Trial Registration Number: NCT00116090., Competing Interests: Competing interests: JHK: Betaliq (equity owner); Tarsier Pharma (equity owner). CSF: Aldeyra (consultant, grant support), Allakos (consultant), Bausch & Lomb (consultant, grant support), Eyegate (consultant, grant support, stock), Genentech (consultant), Novartis (consultant, grant support), pSivida (consultant, grant support), Aciont (grant support), Alcon (grant support, lecture fees), Clearside (grant support), Dompé (grant support), Mallinckrodt (grant support, lecture fees), Allergan (lecture fees). JTR: AbbVie (consultant); Gilead (consultant); Janssen (consultant); Eyevensys (consultant); UpToDate (consultant); Pfizer (financial support); Novartis (consultant); Roche (consultant); Alcon Research Institute (financial support); UCB (consultant); Horizon (consultant and finanicial support); Santen (consultant). GAL-C: AbbVie (consultant, lecture fees); Allergan (grant support); Mallinckrodt (consultant, grant support); Sanofi (grant support; lecture fees). EBS: Eyevensys (consultant); Santen (consultant); EyeGate (consultant, financial support); AbbVie (consultant, financial support); Clearside (consultant, financial support); EyePoint (consultant, financial support). JET: AbbVie (consultant); Canfield (consultant); Clearside (consultant); Gilead (consultant); Guidepoint (consultant); Roche (consultant); Tarsier Pharma (Scientific Advisory Board; equity owner); UptoDate (consultant). YIL: Research to Prevent Blindness (grant); Alcon (consultant); Microsurgical Guidance Solutions (equity owner); patents pending: WO2020163845 and USSN: 63/183424. HNS: Janssen (employee). ROK: Santen (employee)., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

A triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction has been called Zinner syndrome since its first description in 1914 by Zinner. It is a very rare congenital abnormality of the male genitourinary tract due to abnormal embryologic development of the Wolffian ducts. There have been several case reports from different parts of the world about the clinical and imaging findings of these anomaly. In this case report, we present the first case report of Zinner syndrome in a 28-year-old male Ethiopian patient., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Objective: Data on COVID-19 vaccine hesitancy is limited in Ethiopia and other parts of Africa. Therefore, the aim of this study was to determine the level of COVID-19 vaccine hesitancy and its associated factors in Addis Ababa, Ethiopia., Design: A community-based concurrent mixed-method study., Setting: In a community setting., Participants: Adult residents (n=422) of Akaki Kality subcity who were recruited by a two stage sampling technique and 24 adults who were selected purposively were included for the quantitative and qualitative part of the study respectively., Outcome Measures: Data were collected by face-to-face interview using a semistructured questionnaire. Factors associated with COVID-19 vaccine hesitancy were identified by multivariable binary logistic regression model., Results: One out five (19.1%, 95% CI 15.3% to 24.6%) participants were not willing to get vaccinated. In the multivariable analysis, vaccine hesitancy was significantly associated with being female (aOR=1.97; 95% CI 1.10 to 3.89), having negative attitude towards COVID-19 and its preventive measures (aOR=1.75; 95% CI 1.08 to 3.02), and primary information source being social media (internet) (aOR=3.59; 95% CI 1.75 to 7.37). Study participants have predominantly stated that they did not have enough information about the vaccine, feared it would not be effective or have too many side effects, and reflected their uncertainty towards the quality of the vaccine., Conclusions: A considerable proportion of the people in Addis Ababa have concerns on COVID-19 vaccines and unwilling to accept them. This was due to the misconceptions, negative attitudes and use of social media as their primary source of information. Providing the community with health education and consistent efforts to enhance the prevention measures are important, particularly using different medias including social media., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Cervical cancer is one of the most diagnosed and deadly cancers in women globally. Though vaccination is an effective way to reduce cervical cancer, people's knowledge and acceptance of the vaccination remains a challenge in low and middle-income countries. Therefore, the aim of this study was to assess the level of knowledge and acceptance of Human Papilloma Virus (HPV) vaccination and its associated factors among parents of daughters in Addis Ababa, Ethiopia., Methods: A community-based cross-sectional study was conducted among parents or guardians whose daughters are in the age group of 9-17 years and residing in Akaki-Kalty sub-city in Addis Ababa. A multistage sampling technique was used to select the study participants (n = 430). Face-to-face interview was conducted by using a structured questionnaire. Factors associated with the acceptance of HPV vaccination was identified by multivariable binary logistic regression and expressed by adjusted odds ratio (aOR), and respective 95% confidence interval., Results: Complete response was obtained from 422 (98.1%) of the participants and their mean age was 39.0 years (SD ± 9.9). Out of the study participants, 41.7% and 72.0% had poor knowledge on cervical cancer and HPV, respectively. More than a quarter (27.0%) of the participants has never heard about HPV vaccine. One-third (36.5%) of the participants had negative attitude towards the HPV vaccine. Overall, 94.3% of the study participants were willing to vaccinate their daughters for HPV. Vaccine acceptability was associated with higher monthly income (aOR = 2.48, 95% CI 1.08-6.34), good knowledge on HPV (aOR = 2.32, 95% CI 1.56-4.87) and the vaccine (aOR = 2.24, 95% CI 1.12-8.60), and positive attitude towards the vaccine (aOR = 5.03, 95% CI 1.63-9.56)., Conclusions: The overall HPV vaccine acceptance was high. However, two out of five and one-thirds of the parents had poor knowledge on cervical cancer and negative attitude towards the HPV vaccine, respectively. Higher monthly income, good knowledge on HPV and the vaccine, and positive attitude towards the vaccine were associated with acceptance of HPV vaccination. To ensure sustainable acceptance of HPV vaccination, it is crucial to increase the community awareness in a sustainable manner., (© 2021. The Author(s).)

Background: End-Stage Kidney Disease, the most severe form of chronic kidney disease, is fatal if not treated by renal replacement therapy. Thus, patients with End-Stage Kidney Disease depend on hemodialysis as a lifesaving treatment for the remainder of their lives. However, the health-related quality of life (HRQOL) of patients on hemodialysis is much more underappreciated in resource limited countries., Methods: A hospital based cross-sectional study was conducted in Addis Ababa, Ethiopia, from August 01 to October 31, 2019. All patients who were on hemodialysis in five randomly selected public and private hospitals (n = 125) were included in the study. Data were administered by trained nurses by using a standardized Kidney Disease Quality of Life questionnaire. Clinical data were extracted from the patients' medical charts. HRQOL was categorized as low, if the overall mean score was ≤ 50, or as high, if the overall mean score was > 50. Factors associated with lower HRQOL were identified by multi-variable binary logistic regression analysis and expressed by adjusted odds ratio (aOR) and its respective 95 % confidence interval., Results: The mean age of the study participants (n = 125) was 50.33 years (± 15.07) and more than two-thirds (68.8 %) of the participants were males. The mean score of HRQOL was 49.08 ± 11.09, with 48.0 % (95 % CI: 42.2 - 54.5 %) of them had lower HRQOL. Unemployed patients (aOR = 2.40, 95 % CI: 1.10-5.90) and patients who had hemodialysis 2 times per week (aOR = 1.71, 95 % CI: 1.07-3.83) had lower HRQOL. Elderly patients had higher odds of having lower mean score on the burden of kidney disease (aOR = 2.07; 95 % CI 1.18-4.13) as compared to the younger patients., Conclusions: Nearly half of the patients with ESKD on hemodialysis had lower overall HRQOL which is associated with their unemployment status and frequency of hemodialysis per week. Elderly patients had lower mean score of burden of kidney disease. Therefore, quality of life of patients with chronic dialysis should be given special attention during the patients' care. Measures should be taken by the government to ensure accessibility and affordability of the hemodialysis services in the country., (© 2021. The Author(s).)

Objective: To estimate 22-year trends in the prevalence and incidence of scleritis, and the associations of scleritis with infectious and immune-mediated inflammatory diseases (I-IMIDs) in the UK., Methods: The retrospective cross-sectional and population cohort study (1997-2018) included 10,939,823 patients (2,946 incident scleritis cases) in The Health Improvement Network, a nationally representative primary care records database. The case-control and matched cohort study (1995-2019) included 3,005 incident scleritis cases and 12,020 control patients matched by age, sex, region, and Townsend deprivation index. Data were analyzed using multivariable Poisson regression, multivariable logistic regression, and Cox proportional hazards multivariable models adjusted for age, sex, Townsend deprivation index, race/ethnicity, smoking status, nation within the UK, and body mass index. Incidence rate ratios (IRRs) and 95% confidence intervals (95% CIs) were calculated., Results: Scleritis incidence rates per 100,000 person-years declined from 4.23 (95% CI 2.16-6.31) to 2.79 (95% CI 2.19-3.39) between 1997 and 2018. The prevalence of scleritis per 100,000 person-years was 93.62 (95% CI 90.17-97.07) in 2018 (61,650 UK patients). Among 2,946 patients with incident scleritis, 1,831 (62.2%) were female, the mean ± SD age was 44.9 ± 17.6 years (range 1-93), and 1,257 (88.8%) were White. Higher risk of incident scleritis was associated with female sex (adjusted IRR 1.53 [95% CI 1.43-1.66], P < 0.001), Black race/ethnicity (adjusted IRR 1.52 [95% CI 1.14-2.01], P = 0.004 compared to White race/ethnicity), or South Asian race/ethnicity (adjusted IRR 1.50 [95% CI 1.19-1.90], P < 0.001 compared to White race/ethnicity), and older age (peak adjusted IRR 4.95 [95% CI 3.99-6.14], P < 0.001 for patients ages 51-60 years versus those ages ≤10 years). Compared to controls, scleritis patients had a 2-fold increased risk of a prior I-IMID diagnosis (17 I-IMIDs, P < 0.001) and significantly increased risk of subsequent diagnosis (13 I-IMIDs). The I-IMIDs most strongly associated with scleritis included granulomatosis with polyangiitis, Behçet's disease, and Sjögren's syndrome., Conclusion: From 1997 through 2018, the UK incidence of scleritis declined from 4.23 to 2.79/100,000 person-years. Incident scleritis was associated with 19 I-IMIDs, providing data for rational investigation and cross-specialty engagement., (© 2021 The Authors. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Background: Childhood undernutrition is a global problem contributing to more than a third of under-five mortality. Orphans and vulnerable children (OVC) fare worse than children living with their parents. However, the nutritional and healthcare needs of OVC are under-recognized in Ethiopia., Methods: A community-based cross-sectional study was conducted among OVC aged 6 to 59 months. Multi-stage sampling technique was applied to select the households and eligible children included in the study (n = 584). An interviewer-administered questionnaire and anthropometric measurements were carried out. The proportions of stunting, wasting and underweight were determined based on the WHO Z-score cut-off. Factors associated with stunting were identified by Multivariable binary logistic regression analysis., Results: The prevalence of stunting, wasting and underweight were 35.1% (95% CI; 31.3-39.1%), 4.7% (95% CI; 3.2-6.7%) and 12.0% (95% CI; 9.6-14.9%), respectively. Stunting was significantly associated with initiation of complementary feeding after 12 months of age (AOR = 3.61; 95% CI 1.16-14.11), household food insecurity (AOR = 1.90; 95% CI 1.10-3.17), unplanned pregnancy (AOR = 1.90; 95% CI 1.03-3.42), age ≥ 2 years (AOR = 1.80; 95% CI 1.25-2.67), caretaker's age ≤ 25 years (AOR = 1.50; 95% CI 1.03-2.16) and employment of the caretaker (AOR = 1.50; 95% CI 1.03-2.26)., Conclusion: The prevalence of all forms of undernutrition among OVC was significantly higher than the national estimate that has been reported by consecutive Ethiopian Demographic and Health Surveys (EDHS). Policy makers and programmers working on nutritional interventions should give due emphasis to address the unmet need of OVC and focus on interventions which enhance household food security and caretaker's awareness on child feeding and pregnancy planning.

Introduction: Diabetes is a global public health threat with a considerably high burden in low- and middle-income countries. The application of self-care practice by people living with diabetes helps to manage diabetes and its complications, and to lengthen their life. However, the level of diabetes self-care practice in Ethiopia is very low., Methods: A cross-sectional study was conducted among people living with type 2 diabetes who were on follow-up from January 01 to 31, 2019 at Yekatit 12 Hospital. A systematic sampling technique was employed to recruit 354 study participants. A face-to-face interview was administered by trained data collectors using a structured questionnaire. Diabetes self-care practice was assessed by using Summary of Diabetes Self-Care Activities (SDSCA) scale. Multi-variable binary logistic regression analysis was carried out to identify factors associated with diabetes self-care practice., Results: More than half (52.0%, 95% CI: 49.9% - 57.1%) of the people living with diabetes had poor diabetes self-care practice. Poor self-care practice was associated with being unemployed and retired (AOR= 3.57, 95% CI 1.65-7.72), having diabetes for ≥10 years (AOR= 1.78, 95% CI 1.07-2.95), having comorbidity (AOR= 2.15, 95% CI 1.35-3.43), not owning glucometer (AOR= 1.81, 95% CI 1.16-2.83), not receiving diabetes education (AOR= 1.95, 95% CI 1.20-3.18) and dissatisfaction with social support (AOR= 4.24, 95% CI 1.25-14.40)., Conclusion: Poor self-care practice was found to be substantial among people living with diabetes in Addis Ababa, with self-monitoring of blood glucose and regular exercise being the least performed. It is beneficial to focus more on lifestyle modifications and educating about the severity of the disease for better management of blood sugar levels and hindrance of complications., Competing Interests: The authors declare that they have no conflicts of interest for this work., (© 2021 Wolderufael and Dereje.)

Purpose: To provide an overview of the current knowledge on the Human Immunodeficiency Virus (HIV)-associated retinopathies., Methods: A PubMed search was performed, using the key terms "HIV Retinopathy OR Retinitis" and "HIV AND Retinitis" to find manuscripts published within the last ten years., Results: If left untreated, HIV infection causes a progressive immunodeficiency caused by depletion of CD4-positive T lymphocytes. Noninfectious HIV retinopathy, clinically manifested by cotton wool spots. Once the CD4 count drops below 200 c/μl, immunodeficiency creates a vulnerability for systemic opportunistic infections. Within the posterior segment of the eye, cytomegalovirus (CMV) retinitis has to be distinguished from infections with other members of the herpes virus family, as well as from toxoplasmosis, tuberculosis, and syphilis. Upon restoration of the immune system, immune recovery uveitis may manifest in one third of CMV affected eyes., Conclusion: Targeted antiviral treatment and secondary recurrence prophylaxis prevent vision loss of the retina prior to immune recovery.

Intraocular inflammation in patients with human immunodeficiency virus (HIV) infection is commonly due to infectious uveitis. Ocular lesions due to opportunistic infections (OI) are the most common and have been described extensively in the pre highly active antiretroviral therapy (HAART) era. Many eye lesions were classified as acquired immunodeficiency syndrome (AIDS) defining illnesses. HAART-associated improvement in immunity of the individual has changed the pattern of incidence of these hitherto reported known lesions leading to a marked reduction in the occurrence of ocular OI. Newer ocular lesions and newer ocular manifestations of known agents have been noted. Immune recovery uveitis (IRU), the new menace, which occurs as part of immune recovery inflammatory syndrome (IRIS) in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. Balancing the treatment of inflammation with the risk of reactivation of OI is a task by itself. Ocular involvement in the HAART era can be due to the adverse effects of some systemic drugs used in the management of HIV/AIDS. Drug-associated retinal toxicity and other ocular side effects are being increasingly reported. In this review, we discuss the ocular manifestations in HIV patients and its varied presentations following the introduction of HAART, drug-associated lesions, and the current treatment guidelines., Competing Interests: None

Background: Intrauterine Contraceptive Device (IUCD) is a highly effective and reversible modern contraceptive, which is still significantly underutilized in Ethiopia. The aim of this study was to identify factors affecting the use of IUCDs among women of reproductive age group in Addis Ababa., Methods: Facility-based, unmatched case-control study was employed among randomly selected cases and controls in selected health centers in Addis Ababa from August to October 2017. The cases (n = 128) were women of reproductive age group who were IUCD users and controls (n = 256) were women of reproductive age group who were users of oral or injectable contraceptives during the study period. After randomly selecting two health center from each sub-city the number of cases and controls were equally allocated to each of the selected health centers. In each selected health center, all eligible cases were enrolled consecutively until the sample size was achieved. Two consecutive controls were selected for each case. Data was collected face-to-face by trained nurses by using structured questionnaire. Factors associated with IUCD use were identified by multi-variable binary logistic regression models using the backward conditional stepwise method., Results: In the multi-variable analysis, IUCD use was strongly associated with husbands/partners being supportive of IUCD use (Adjusted OR = 13.24, 95% CI; 5.30-33.02), being literate women (Adjusted OR = 5.31, 95% CI; 1.05-26.93), women having a perception of IUCD does not cause infection (Adjusted OR = 4.38, 95% CI; 1.45-13.26) and the source of information about IUCD being mass-media (Adjusted OR = 3.81, 95% CI; 1.49-9.74)., Conclusions: The findings of the study reinforce the need of husbands/partners involvement in the interventions to enhance utilization of IUCD. Moreover, due attention should also be provided for delivering IUCD-related messages in the public mass-media., Competing Interests: The authors have declared that no competing interests exist.

Background: Determining the glycemic index and load of foods has significant impact on meal planning for diabetes. However, there is no data on the glycemic index (GI) and glycemic load (GL) of Ethiopian foods. Therefore, the aim of this study was to analyze the glycemic index and glycemic load of Teff Injera, Corn Injera, and White Wheat Bread., Methods: Experimental study design was conducted among selected healthy adults. Teff Injera, Corn Injera, and White Wheat Bread were selected as test foods for the study, and glucose was used as the reference food. The postprandial glucose concentrations in the blood were recorded at 0, 15, 30, 45, 90, and 120 minutes. The relative glycemic index of each food was calculated, and the presence of statistical difference in glycemic index among the three foods was analyzed., Results: The mean age of the participants was 23 years (±1.6 years). The glycemic indexes of Teff Injera, White Wheat Bread, and Corn Injera were 36 (low), 46 (low), and 97 (high), respectively, and the glycemic loads were 7 (low), 14 (moderate), and 22 (high), respectively. There was a significant difference in glycemic index and load among the three food items ( p < 0.001). Teff Injera had a much lower glycemic index and load compared with Corn Injera ( p < 0.001) and White Wheat Bread ( p = 0.03)., Conclusions: Teff Injera and White Wheat Bread have low glycemic index and are recommended to be consumed by diabetic patients, whereas Corn Injera has high glycemic index and is not recommended for diabetic patients. Therefore, Teff Injera should be considered globally in the dietary modification programs for diabetes., Competing Interests: The authors declare that they have no conflict of interests., (Copyright © 2019 Nebiyu Dereje et al.)

Purpose: Data comparing the burden of the opportunistic infections among the Pre-ART and On-ART HIV-infected patients in Ethiopia are scarce. Therefore, this study aimed to compare the prevalence and predictors of opportunistic infections in Pre-ART and On-ART HIV-infected patients., Methods: A comparative cross-sectional study was conducted among adult patients infected with HIV and who were on Pre-ART or On-ART and followed up from 2012 to 2016 in Zewditu Memorial Hospital, Addis Ababa. Those patients who were infected with HIV, but not eligible for ART were categorized under Pre-ART follow-up (n=192) and those patients who started taking ART were categorized under the On-ART follow-up group (n=192). Patients were included in the study by using simple random sampling technique from the list of the patients registered in the ART follow-up database. The presence of opportunistic infections along with clinical findings and baseline laboratory data was extracted from the ART follow-up database and the medical records of the patients using a standardized checklist. Factors associated with the development of opportunistic infections were analyzed using multi-variable binary logistic regression analysis., Results: The overall prevalence of opportunistic infections was found to be 33.6% (95% CI; 28.9-38.5). The prevalence of opportunistic infections among the Pre-ART group (38%) was higher than On-ART group (29.2%) ( P- value = 0.04). Pulmonary tuberculosis was the most common opportunistic infection observed in both Pre-ART and On-ART groups. Being in the WHO clinical Stage III (AOR = 2.1; 95% CI 1.1-3.9) or Stage IV (AOR = 3.6; 95% CI 1.7-7.7) were independent predictors for the development of opportunistic infections., Conclusion: The prevalence of opportunistic infections among the HIV-infected patients who were in Pre-ART was higher than On-ART group. This finding reinforces the need for early initiation of ART for HIV-infected patients irrespective of their CD4 counts., Competing Interests: The authors report no conflicts of interest in this work., (© 2019 Dereje et al.)

Background: The purpose of this study was to estimate the unmet burden of surgically correctable congenital anomalies in African low- and middle-income countries (LMICs)., Methods: We conducted a chart review of children operated for cryptorchidism, isolated cleft lip, hypospadias, bladder exstrophy and anorectal malformation at an Ethiopian referral hospital between January 2012 and July 2016 and a scoping review of the literature describing the management of congenital anomalies in African LMICs. Procedure numbers and age at surgery were collected to estimate mean surgical delays by country and extrapolate surgical backlog. The unmet surgical need was derived from incidence-based disease estimates, established disability weights, and actual surgical volumes., Results: The chart review yielded 210 procedures in 207 patients from Ethiopia. The scoping review generated 42 data sets, extracted from 36 publications, encompassing: Benin, Egypt, Ghana, Ivory Coast, Kenya, Nigeria, Madagascar, Malawi, Togo, Uganda, Zambia, and Zimbabwe. The largest national surgical backlog was noted in Nigeria for cryptorchidism (209,260 cases) and cleft lip (4154 cases), and Ethiopia for hypospadias (20,188 cases), bladder exstrophy (575 cases) and anorectal malformation (1349 cases)., Conclusion: These data support the need for upscaling pediatric surgical capacity in LMICs to address the significant surgical delay, surgical backlog, and unmet prevalent need., Type of Study: Retrospective study and review article LEVEL OF EVIDENCE: III., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Disclosure of HIV status to sexual partners can help HIV prevention efforts and enable HIV positive people to receive social support, as well as increasing access and adherence to treatment. This study was conducted to determine the rate, processes, outcomes, and correlates of HIV status disclosure to sexual partners among HIV positive individuals., Method: A cross-sectional study was conducted between September and November 2015 at two HIV outpatient clinics in Addis Ababa, Ethiopia. Data were collected using an interviewer- administered semi-structured questionnaire. Logistic analysis was used to determine the independent correlates of serostatus disclosure., Results: Of 742 participants, (371 men and 371 women), 727 (98%) were on antiretroviral therapy and 676 (91.1%) had at least one sexual partner since their HIV diagnosis, of whom 558 (82.5%) had disclosed their HIV status to their most recent sexual partner. Of those who reported having disclosed their status to their most recent sexual partner, 82 (14.7%) had at least one unprotected sexual encounter with the partner, after HIV diagnosis but prior to disclosure. The most commonly reported initial outcome of disclosure was gaining emotional and/or financial support. Some (11.3%) also reported that their disclosure immediately initiated their partner for HIV testing. Negative outcomes to disclosure, such as stigma and discrimination, were more common among females (26.2%) compared to males (12.7%). In the multiple regression analysis, disclosure was associated with greater condom use, greater social support, knowing the partner's HIV status, having a good relationship with the partner, and cohabiting with the partner., Conclusion: HIV disclosure was common amongst participants, although sometimes delayed, with possible consequences for onward transmission. Fear of negative outcomes, such as verbal abuse and physical violence, were major barriers to disclosure. Efforts to support disclosure have the potential to contribute to HIV control and prevention by encouraging safer sexual practice, initiating partners for HIV testing, and enhancing support for people living with HIV., Competing Interests: The authors have declared that no competing interests exist.

Background: In Afar, a pastoralist and remote area of Ethiopia, one in five children suffers from acute malnutrition. Investigation of the prevalence and associated factors of exclusive breastfeeding may provide insight into the current burden and nature of the problem, and offer help on how to direct prevention strategies. The aim of this study was to measure the prevalence and identify associated factors of exclusive breastfeeding (EBF) practice in Afar, Ethiopia., Methods: A community based cross-sectional study was conducted with qualitative inquiry from March to April 2015. Quantitative data were collected from 631 mother-infant pairs residing in Aysaita woreda with a pretested structured questionnaire using the modified expanded program on immunization cluster sampling procedure. Seven clusters were selected using probability proportional to size.The qualitative data were generated through two focus group discussions among purposely selected discussants: one group of eight health professionals and another group of mothers, fathers and traditional birth attendants ( n  = 10). Bivariate and multivariable analysis was done using binary logistic regression model while thematic framework analysis was employed for the qualitative data., Results: The prevalence of EBF under six months of age was 340/618 (55%). Infants whose mothers resided in an urban area [Adjusted Odds Ratio (AOR) 5.7; 95% Confidence Interval (CI) 3.5, 9.2), were knowledgeable about breastfeeding (AOR: 2.3; 95% CI 1.6, 3.5) and delivered at health facilities (AOR: 1.7; 95% CI 1.1, 2.7), were more likely to be exclusively breastfed than the referent group. In addition, mothers had a poor understanding of what constitutes exclusive breastfeeding. Traditional beliefs, myths and misconceptions about EBF and lack of support from husband and family were found to be barriers for proper EBF practice., Conclusions: The prevalence of EBF did not meet the World Health Organization recommendations. Factors related to infrastructure, service delivery, health education packages and traditional beliefs were associated with EBF practice., Competing Interests: Ethical clearance was obtained from ethical review committee of school of public health, Addis Ababa University with ERC ref. no. SPH/507/07. Permission letter were written for Afar Regional Health Bureau (ARHB) and the informed verbal consent were obtained from the respondents, after the necessary explanation about the purpose, benefits and risks of the study and also their right on decision of participating in the study. The assurance of confidentiality was performed by omitting name of the study participants from the questionnaire, by telling the safety of the place where the questionnaire was stored after data collection and also the analysis was not for an individual, it is for groups.Not applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Introduction: Cost-effectiveness analysis can be a powerful policy-making tool. In the two decades since the first cost-effectiveness analyses in global surgery, the methodology has established the cost-effectiveness of many types of surgery in low- and middle-income countries (LMICs). However, with the crescendo of cost-effectiveness analyses in global surgery has come vast disparities in methodology, with only 15% of studies adhering to published guidelines. This has led to results that have varied up to 150-fold., Methods: The theoretical basis, common pitfalls, and guidelines-based recommendations for cost-effectiveness analyses are reviewed, and a checklist to be used for cost-effectiveness analyses in global surgery is created., Results: Common pitfalls in global surgery cost-effectiveness analyses fall into five categories: the analytic perspective, cost measurement, effectiveness measurement, probability estimation, valuation of the counterfactual, and heterogeneity and uncertainty. These are reviewed in turn, and a checklist to avoid these pitfalls is developed., Conclusion: Cost-effectiveness analyses, when done rigorously, can be very useful for the development of efficient surgical systems in LMICs. This review highlights the common pitfalls in these analyses and methods to avoid these pitfalls.

Background: Burden of disease (BoD) as measured by Disability-Adjusted Life Years (DALYs) is one of the criteria for priority-setting in health care resource allocation. DALYs incorporate disability weights (DWs), which are currently expert-derived estimates or non-existent for most pediatric surgical conditions. The objective of this study is to establish DWs for a subset of key pediatric congenital anomalies using a range of health valuation metrics with caregivers in both high- and low-resource settings., Method: We described 15 health states to health professionals (physicians, nurses, social workers, and therapists) and community caregivers in Kenya and Canada. The health states summaries were expert- and community-derived, consisting of a narrated description of the disease and a functional profile described in EQ-5D-5 L style. DWs for each health state were elicited using four health valuation exercises (preference ranking, visual analogue scale (VAS), paired comparison (PC), and time trade-off (TTO)). The PC data were anchored internally to the TTO and externally to existing data to yield DWs for each health state on a scale from 0 (health) to 1 (dead). Any differences in DWs between the two countries were analyzed., Results: In total, 154 participants, matched by profession, were recruited from Kijabe, Kenya (n = 78) and Hamilton, Canada (n = 76). Overall calculated DWs for 15 health states ranged from 0.13 to 0.77, with little difference between countries (intra-class coefficient 0.97). However, DWs generated in Kenya for severe hypospadias and undescended testes were higher than Canadian-derived DWs (p = 0.04 and p < 0.003, respectively)., Conclusions: We have derived country-specific DWs for pediatric congenital anomalies using several low-cost methods and inter-professional and community caregivers. The TTO-anchored PC method appears best suited for future use. The majority of DWs do not appear to differ significantly between the two cultural contexts and could be used to inform further work of estimating the burden of global pediatric surgical disease. Care should be taken in comparing the DWs obtained in the current study to the existent list of DWs because methodological differences may impact on their compatibility.