BackgroundWarfarin is a widely used oral anticoagulant in clinical practice. It is used to prevent arterial emboli in patients with atrial fibrillation, or prevent and treat venous thromboembolism. The efficacy and safety of warfarin depends on maintaining the INR within the therapeutic range. The proportion of time spent in the therapeutic INR range (TTR) is used to evaluate quality of anticoagulation control.MethodsA hospital-based cross sectional study was conducted between November 1, 2019 and October 31, 2020 at Cardiac and Hematology Clinic, University of Gondar hospital. A consecutive sampling method was used to recruit 338 study subjects. Proportion of time spent in the therapeutic range (TTR) was calculated using the Rosendaal’s linear interpolation method. TTR ≥65% was described as ‘optimal’ International Normalized Ratio (INR) control. The Data were entered into EPI Info version 4.4.1 and transported to SPSS version 20 for analysis. Logistic regression analysis was used to identify associated factors with optimal anticoagulation outcome (TTR ≥65%). P-values <0.05 were used to declare significant association.ResultA total of 338 study subjects were included in the study. The mean age of patients was 49 years. The majority of study participants attended formal education (79%) and were urban dwellers (57%). Atrial fibrillation was the commonest indication for warfarin therapy. One-third (33%) of study subjects achieved the desired INRs (INR=2.0-3.0), while about one-tenth (13%) of patients attained optimal INR control (TTR≥65%). There were no significant association of socio-demographic characteristics including age, gender, educational level and monthly income with optimal INR control (TTR ≥65%). Likewise, clinical characteristics including dose of warfarin, warfarin adherence, frequency of INR determination, other concomitant drug intake, co-existing comorbidities, consumption of green leafy vegetables and alcohol intake didn’t show significant association with optimal INR control (TTR≥65%).ConclusionInstitution-based validated protocol might be required to overcome the poor TTR level. ‘Anticoagulation (INR) clinic’ would be required to ‘scale-up’ INR control.

Background: Epilepsy is characterized by two or more unprovoked recurrent seizures, which often respond to available antiseizure medications. However, seizure control among epileptic patients in the developing world is low. Factors determining seizure control among epileptic patients were not evidently explored in the study setting. Objectives: This study aimed to determine the magnitude of uncontrolled seizures and associated factors among epileptic patients at the University of Gondar hospital. Methods: This cross-sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit study subjects. Controlled seizure was defined as seizure freedom for the past 1 year. Logistic regression analysis was used to identify factors associated with seizure control. A p-value < 0.05 was used to declare a significant association. Results: A total of 320 study subjects were included in the study. The mean (±SD) age of patients was 27.5 ± 7.6 years. More than half (182/320, 57%) of epileptic patients had uncontrolled seizures. Five or more pretreatment seizure episodes (adjusted odds ratio = 3.98, 95% confidence interval: 1.81–8.75, p = 0.001), less than 2 years on anti-seizure medications (adjusted odds ratio = 8.64, 95% confidence interval: 3.27–22.85, p < 0.001), taking 2 or more ASMs (adjusted odds ratio = 2.48, 95% confidence interval: 1.23–5.02, p = 0.011), poor adherence to ASMs (adjusted odds ratio = 9.37, 95% confidence interval: 4.04–21.75, p < 0.001), and living at a single trip distance from hospital equaled 1 h or more (adjusted odds ratio = 4.20, 95% confidence interval: 2.11–8.41, p < 0.001) were significantly associated with uncontrolled seizures. Conclusion: The dose of a preferred anti-seizure medication should be optimized before combinations of anti-seizure medications are used. Adherence to anti-seizure medications should be reinforced for better seizure control. Epilepsy care should be integrated into primary health care services in the catchment region.

Background Neuromyelitis optica spectrum disorder is an autoimmune, astrocytopathic CNS disease, mainly involving the optic nerves, spinal cord, and brain stem regions. The “International Panel for NMOSD Diagnosis (IPND) Diagnostic Criteria” was implemented to define the disorder. Case Presentation A 38-year-old patient presented with visual loss of eight months' duration and weakness of the lower extremities of one week's duration. The patient had bilateral optic atrophy on fundoscopic examination, and flaccid paraplegia with sensory loss below T4 level. Serological tests for syphilis, HIV infection, and SLE were negative. Aquaporin-4 antibody test was not done due to limited clinical setup. T2-spine MRI revealed long central thoracic segment (T3 to T6) hyperintense lesion with mild cord expansion. Long segment central canal dilation (syrinx) was noted in the cord proximal to the lesion. Diagnosis of opticospinal variant, NMOSD was made using IPND diagnostic criteria. The patient was started on dexamethasone 50 mg, IV, four times daily (QID) for one week, and changed to prednisolone 1 mg/kg (40 mg) PO daily for one month, to be tapered over three-to-six months. The patient was scheduled to initiate azathioprine 50 mg PO twice daily. Conclusion The case emphasizes the existence of neuromyelitis optica spectrum disorder in clinical settings of the developing world. High index of suspicion of this rare disease is required to avoid delayed diagnosis and treatment.

Background Stroke is one of the most common causes of disability among adults. Post-stroke depression (PSD) is a frequent neuropsychiatric complication in stroke patients. Despite the increasing prevalence of stroke, there is a paucity of data on PSD and its determinants among stroke survivors in developing countries like Ethiopia. We aim to assess the factors associated with PSD in survivors of stroke. Method A hospital-based unmatched case-control study was conducted during the period of February to July 2020 at University of Gondar Hospital among stroke survivors. Study subjects were recruited consecutively. Socio-demographic and clinical data were obtained from patients’ interviews and medical record reviews. A diagnosis of PSD was made using the Patient Health Questionnaire (PHQ-9). EpiData version 3.1 was used to enter data, and SPSS version 26 was used to analyze it. Bivariate and multivariate logistic regressions were fitted to identify associated variables. The adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value 0.05 were used to determine the significance of the association. Result A total of 240 stroke survivors were included in the study (80 cases and 160 controls). The mean age was 60.8 years (SD ± 14.3) with an equal sex distribution. Variables statistically associated with PSD were male gender (AOR = 3.5, 95% CI: 1.64-7.46 C, P-value = 0.001), subcortical location of the largest lesion (AOR = 2.42, 95% CI: 1.06–5.56, p-value = 0.036), severity of the stroke (AOR = 52.34, 95% CI:10.64-256.87, p-value = 0.000), physical disability (AOR = 5.85. 95% CI:1.94–17.65, p-value = 0.002), previous history of stroke or transient ischemic attack (AOR = 5.90, 95% CI:2.04–17.10, p-value = 0.001) and ischemic heart disease (AOR = 9.97, 95% CI:3.4-29.22, p-value = 0.000). Conclusion Important factors in the occurrence of PSD in this study include prior history of stroke, physical disability, severity of the stroke, subcortical location of the lesion, male gender, and ischemic heart disease. Stroke patients with such factors need routine screening for PSD, particularly in LMICs where there is uncoordinated post-stroke care, a shortage of neurologists and mental health practitioners.

Introduction. Warfarin is a widely used oral anticoagulant in clinical practice. It has variable intraindividual and interindividual dose response and a narrow therapeutic index. Therefore, it requires frequent and regular international normalized ratio (INR) determination to maintain the INR within the therapeutic range. The study evaluated parameters of anticoagulation control among patients on warfarin. Methods. A cross-sectional study was conducted at University of Gondar hospital. A consecutive sampling method was used to recruit study subjects. The anticoagulation control was evaluated by determining the proportion of desired INRs and the proportion of time spent in the therapeutic range (TTR). Logistic regression analysis was used to identify associated factors with adequate TTR. A P value <0.05 was used to declare significant association. Result. A total of 338 study subjects were included in the study. The mean age of patients was 48.8 (SD = 16.4) years. Atrial fibrillation was the commonest indication for warfarin therapy. One-third (33%) of study subjects achieved the desired INRs of 2.0–3.0, while about one-tenth (13%) of patients attained good INR control (TTR ≥ 65%). Multivariate logistic regression analysis revealed no significant association of sociodemographic and clinical characteristics with good TTR outcome. Conclusion. The level of anticoagulation control with warfarin among study subjects was very low. The authors recommend to implement a validated warfarin-dose titration protocol and to establish anticoagulation clinics to mitigate the low anticoagulation level.