The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Malaria is one of the most important causes of morbidity and mortality in sub-Saharan Africa. The disease is prevalent in over 75% of the country’s area making it the leading public health problems in the country. Information on the prevalence of malaria and its associated factors is vital to focus and improve malaria interventions. A cross-sectional study was carried out from October to November 2012 in East Shewa zone of Oromia Regional State, Ethiopia. Adults aged 16 or more years with suspected malaria attending five health centers were eligible for the study. Logistic regression models were used to examine the effect of each independent variable on risk of subsequent diagnosis of malaria. Of 810 suspected adult malaria patients who participated in the study, 204 (25%) had microscopically confirmed malaria parasites. The dominant Plasmodium species were P. vivax (54%) and P. falciparum (45%), with mixed infection of both species in one patient. A positive microscopic result was significantly associated with being in the age group of 16 to 24 years [Adjusted Odds Ratio aOR 6.7; 95% CI: 2.3 to 19.5], 25 to 34 years [aOR 4.2; 95% CI: 1.4 to 12.4], and 35 to 44 years [aOR 3.7; 95% CI: 1.2–11.4] compared to 45 years or older; being treated at Meki health center [aOR 4.1; 95% CI: 2.4 to 7.1], being in Shashemene health center [aOR = 2.3; 95% CI: 1.5 to 4.5], and living in a rural area compared to an urban area [aOR 1.7; 95% CI: 1.1 to 2.6)]. Malaria is an important public health problem among adults in the study area with a predominance of P. vivax and P. falciparum infection. Thus, appropriate health interventions should be implemented to prevent and control the disease.

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Prevalence and associated risk factors of malaria among adults in East Shewa Zone of Oromia Regional State, Ethiopia: a cross-sectional study

Background Type 2 diabetes mellitus (T2DM) is associated with a high risk of early mortality and morbidity from hypertension. Even though Ethiopia is Africa's first country among the top five in the prevalence of DM, there is a paucity of data on hypertension and its associated factors among patients with type 2 diabetes mellitus. Therefore, this study aimed to determine the prevalence and associated factors of hypertension among type 2 diabetes mellitus patients at Debre Tabor General Hospital, 2019. Methods and materials An institution-based cross-sectional study was employed on 378 T2DM patients. Data were collected using an interviewer-administered questionnaire and analyzed by Stata 14. A multivariable logistic regression model was used to identify associated factors of hypertension among T2DM patients. Associated factors were declared at p Results The prevalence of hypertension among T2DM patients was 59.5% (95% CI: 54.5-64.5). Stage 1 hypertension was the most common (30.95%). The odds of hypertension was higher among age group of 50-60 years (adjusted odds ratio (AOR)=2.5, 95% confidence interval (CI) (1.27-4.90)), patients from urban area (AOR = 2.8, 95% CI (1.08-7.18)), with longer duration of T2DM (AOR =1.16, 95% CI (1.08-1.25)), with BMI ≥25 kg/m2 (AOR = 3.2, 95% CI (1.71-5.96)), with poor glycemic control (AOR = 3.0, 95% CI (1.75-5.19)), and patients who were current cigarette smokers (AOR = 3.8, 95% CI (1.98-14.96)). Conclusion The prevalence of hypertension is high and the majority have poor blood pressure control. Hence, DM care providers and other health sector stakeholders have to work in collaboration to prevent it through designing appropriate strategies especially for those at higher risk of developing hypertension.

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Hypertension and Its Associated Factors Among Type 2 Diabetes Mellitus Patients at Debre Tabor General Hospital, Northwest Ethiopia.

Background Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Despite these facts, little information is available with regard to old age hypertension in Ethiopia. Thus, this study assessed old age hypertension and associated factors among older adults in rural Ethiopia. Methods A community-based cross-sectional study design was employed among 418 selected permanent residents of Chiro town aged 50 years and older using simple random sampling technique. Data were collected face to face using a structured questionnaire which is adapted from the WHO Stepwise approach to surveillance of non communicable disease instrument, and was used to collect data on risk factors. Physical measurements were taken as per WHO STEP guidelines. The data were entered into Epi Data version 3.1 and exported to SPSS Version 20 for analysis. Bivariate and multivariable logistic regression analysis were conducted and statistical significance was declared at a p-value ≤0.05. Results The overall prevalence of old age hypertension was 41.9% (95% CI: 37.2-46.6). Age ≥70 years (AOR: 1.91; 95% CI: 1.12-3.27), low intake of fruits (AOR: 2.45; 95% CI: 1.55-3.86), overweight/obese (AOR: 4.29; 95% CI: 2.48-7.42) and family history of hypertension (AOR: 2.95; 95% CI: 1.70-5.12) were significantly associated risk factors of hypertension. Conclusion The prevalence of hypertension among older adults was high. Older age ≥70 years, low intake of fruits, overweight/obese and having a family history of hypertension were significantly associated with hypertension. Consideration should be given for community-based screening of hypertension among older adults. In addition, fruit consumption habits and maintaining normal weight should be encouraged.

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Prevalence of old age hypertension and associated factors among older adults in rural Ethiopia.

Background Geographical variation may likely influence the effectiveness of prevention efforts for malaria across Indonesia, in addition to factors at the individual level, household level, and contextual factors. This study aimed to describe preventive practices at individual and a household levels applied by rural communities in five provinces in eastern Indonesia and its association with the incidence of malaria among adult (≥15 years) populations. Methods This study analyzed a subset of data of nationally representative community-based survey 2018 Riset Kesehatan Dasar (Riskesdas). Data for socio-demographic (age, gender, education and occupation) and preventive behaviors (use of mosquito bed nets while slept, insecticide-treated mosquito nets (ITNs), mosquito repellent, mosquito electric rackets, mosquito coil/electric anti-mosquito mats, and mosquito window screen) were collected. Data were analyzed using bivariate and multivariable logistic regression model. Results Total of 56,159 respondents (n = 23,070 households) living in rural areas in Maluku (n = 8044), North Maluku (n = 7356), East Nusa Tenggara (n = 23,254), West Papua (n = 5759) and Papua (n = 11,746) were included in the study. In the multivariable models, using a bed net while slept likely reduced the odds of self-reported malaria among Maluku participants. Reduced odds ratios of self-reported malaria were identified in those participants who used ITNs (North Maluku, ENT, Papua), repellent (Maluku, West Papua, Papua), anti-mosquito racket (ENT), coil (Maluku, North Maluku, Papua) and window screen (West Papua, Papua). Conclusion Our study concluded that the protective effects of preventive practices were varied among localities, suggesting the need for specific intervention programs.

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Variation of preventive practices and its association with malaria infection in eastern Indonesia: Findings from community-based survey.

Hypertension is a growing public health problem in many developing countries including Ethiopia. It is a silent killer and most patients are detected to have it incidentally when they are admitted to hospital for unrelated disease or subjected to pre-employment or preoperative medical checkups. Information on the prevalence of hypertension and its associated factors is to be considered vital to focus and improve prevention and control of cardiovascular diseases. The study design was a cross-sectional survey. The study population consisted of adults aged 25–65 years who lived in Jigjiga city of eastern Ethiopia for at least 6 months. Data were collected using a pretested structured questionnaire, and blood pressure was measured using standardized instruments by trained clinical nurses. Hypertension was defined as having Systolic BP ≥ 140 mmHg or Diastolic BP ≥ 90 mmHg or reported use of regular anti-hypertensive medications prescribed by professionals for raised BP. Data were entered into a computer using Epi Info Version 3.5.1 and exported to SPSS version 16.0 for analysis. Multiple logistic regressions were fitted and Odds ratios with 95% confidence intervals were calculated to identify independently associated factors. The prevalence of hypertension was 28.3%. Family history of Hypertension [Adjusted OR 5.7; 95% CI (2.9, 10.9)], having high level of income [Adjusted OR 3.1; 95% CI (1.5, 6.3)], being male [Adjusted OR 2.4; 95% CI (1.3, 4.3)], being above grade 12 [Adjusted OR 2.2; 95% CI (1.2, 3.9)], and having BMI ≥ 25 [Adjusted OR 2.0; 95% CI (1.1, 3.5)] were significantly associated with hypertension. Consistent with the literatures, the prevalence of hypertension was high and may show a hidden epidemic in this population. If established with more robust and nationally representative studies, the finding calls for efficient health screening and regular checkups as well as interventions promoting healthy lifestyles. Accordingly, health promotion regarding hypertension should be provided in the population as means of primary prevention.

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Prevalence and associated factors of hypertension among adults in Ethiopia: a community based cross-sectional study.

Lack of exclusive breastfeeding is the most important risk factor for infant and young child morbidity and mortality. A better understanding of the factors that influence EBF is important in order to promote appropriate infant feeding practices. The return to work due to short maternity leave time may hinder employed mothers from breastfeeding their infants exclusively for the recommended six months duration. A community based comparative cross-sectional study was conducted from January to February 2016 in the Fafan zone, of the Somali Regional State, of Ethiopia. A total of 558 mothers with infants from ages 3–5 months, living in the five districts (Jigjiga city, Kebribeyah town, Aubere town, Bombas town and Babile) were included in the analysis. Logistic regression models were used to examine the effect of maternal employment on EBF practice. This study has demonstrated a 24.8 and 82.9% prevalence of EBF practices among employed and unemployed mothers of index infants of 3–5 months respectively in the 24 h preceding the survey. Unemployed mothers were accounted for thusly: [Adjusted OR = 26.5; 95% CI (13.6, 51.6). Other adjustments included monthly income of 500–2000 birr [Adjusted OR = 2.7; 95% CI (1.4, 5.2)]; monthly income of 2001–3500 birr [Adjusted OR = 2.2; 95% CI (1.2, 4.0)]; timely initiation of breastfeeding [Adjusted OR = 2.6; 95% CI (1.4, 4.8)]; maternal education (secondary and higher) [Adjusted OR = 3.8; 95% CI (1.5, 9.5)]; having an index infant aged 3 months [Adjusted OR = 2.2; 95% CI (1.2, 4.1)], and having an index infant aged 4 months [Adjusted OR = 2.2; 95% CI (1.2, 3.8)] were found to be significantly associated with exclusive breastfeeding practice. Exclusive breastfeeding practices were very low among mothers employed in governmental and non-governmental organizations in the study area. Therefore, maternal employment may be hindering Exclusive breastfeeding practices. Thus, establishing breastfeeding-friendly working environment; and Information, Education and Communication programs should be provided, particularly for working mothers to promote exclusive breastfeeding practices.

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Exclusive breastfeeding and maternal employment among mothers of infants from three to five months old in the Fafan zone, Somali regional state of Ethiopia: a comparative cross-sectional study

Background Police officers are grouped among the most at-risk population for HIV. Most police officers who are mobile related to work behavior might be at risk of HIV for themselves and/or the main source of infection in transmitting the disease to the police members. So the basic aim of this study was to determine the magnitude of condom use and associated factors among police force riot control in Addis Ababa in September 2015. Materials and Methods An institutional-based cross-sectional quantitative survey was conducted among a sample of 400 police officers. The sample size was calculated using a single size proportion formula by considering 52% prevalence of multiple sexual partners. A systematic random sampling technique was used to get study subjects from the institution. A pretested structured questionnaire was employed to obtain the necessary information after getting both written and verbal consent from the concerned body and study subjects. The collected data were checked for completeness and consistency and was coded before data entry. Data were entered and cleaned analyzed using SPSS statistical package. Results Some 379 individuals provided data. Most of the respondents 348 (95.3%) had been sexually active during the past 12 months and 280 (84.1%) of them had more than one sexual partner. Seventy-five (19.8%) of the sexually active respondents used condoms consistently in the last 12 months. Had sex after drinking alcohol (adjusted OR=2.23; 95% CI (1.08, 4.61)),ever used substance (adjusted OR=4.37; 95% CI (1.18, 16.27)), had sex after consuming substance (Adjusted OR=4.37; 95% CI (1.18, 16.27)) and less education status (adjusted OR=0.38; 95% CI (0.16, 0.93)) were significantly associated with inconsistent condom use. Conclusion There is a high inconsistency of condom use among federal police riot control. This indicates that the study populations are at higher risk of acquiring HIV infection. Substance use like khat, consuming alcohol, and low educational status was the significant predictor of inconsistent condom use among federal police riot control.

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Assessment of Magnitude of Consistent Condom Use and Associated Factors Among Police Force at Riot Control, Addis Ababa, Ethiopia: A Cross-Sectional Study.

Municipal solid waste treatment and disposal have become one of the major concerns in waste management due to the excessive production of waste and higher levels of pollution. To address these challenges and protect the environment in sustainable ways, the hydrothermal pretreatment (HTP) technique coupled with anaerobic digestion (AD) becomes a preferred alternative technology that can be used for municipal solid waste stabilization and the production of renewable energy. However, the impact of HTP parameters such as temperature, retention time, pH, and solid content on the fermentation of TWAS is yet to be well studied and analyzed. Hence this study was conducted to review the effect of hydrothermal pretreatment of thickened waste-activated sludge (TWAS) on fermentation and anaerobic digestion processes. Many studies reported that fermentation of TWAS at pretreatment temperature ranges from 160 °C to 180 °C resulted in a 50% increase in volatile fatty acid (VFA) yields compared to no pretreatment. However, for the AD process, HTP in the range of 175 °C to 200 °C with a 30–60 min retention time was considered the optimal condition for higher biogas production, with 30% increase in biodegradability and greater than 55% increase in biogas production. Even though there is a direct relationship between increased HTP temperature and the hydrolysis of TWAS, a pretreatment temperature range beyond 200 °C alters the biogas production. The solid content (SC) of sludge plays a crucial role in HTP, where in practice up to 16% SC has been utilized for HTP. Further, a combined alkaline-HTP enhances the process performance.

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Frew Tadesse

Papers

Prevalence and associated factors of hypertension among adults in Ethiopia: a community based cross-sectional study.

Prevalence and associated risk factors of malaria among adults in East Shewa Zone of Oromia Regional State, Ethiopia: a cross-sectional study

Exclusive breastfeeding and maternal employment among mothers of infants from three to five months old in the Fafan zone, Somali regional state of Ethiopia: a comparative cross-sectional study

Assessment of Magnitude of Consistent Condom Use and Associated Factors Among Police Force at Riot Control, Addis Ababa, Ethiopia: A Cross-Sectional Study.

Comprehensive Review of Hydrothermal Pretreatment Parameters Affecting Fermentation and Anaerobic Digestion of Municipal Sludge