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Dhiig-yarida dadka qaangaarka ah ee qaba xanuunka macaanka ee tagaya cisbitaalka guud ee bariga Itoobiya: daraasad-qaybeed
Teshome Tujuba, 1 Behailu Hawulte Ayele, 2 Sagni Girma Fage, 3 Fitsum Weldegebreal41, Medical Laboratory, Guelmsau General Hospital, Guelmsau City, Ethiopia 2 School of Public Health, Faculty of Health and Medicine, Haramaya University, Harala State, Ethiopia; 3 School of Nursing and Midwifery, Faculty of Health and Medicine, Haramaya University, Ethiopia; 4 Faculty of Health and Medicine, Haramaya University, Harar City, Ethiopia News Agency: Sagni Girma Fage, Faculty of Health and Medical Sciences, Haral University, Ethiopia, Harar, Ethiopia POBox 235 Email giruu06@gmail.com Background: Although anemia is a common disease among diabetic patients, there is very little evidence of anemia in this part of the population in Ethiopia, especially in the research environment. Therefore, the purpose of this study was to evaluate the degree of anemia and related factors in adult diabetic patients treated in a general hospital in eastern Ethiopia. Methods: A cross-sectional study of health basics was conducted on 325 randomly selected adult diabetic patients. Follow-up clinic at the Gramsoe General Hospital in eastern Ethiopia. Use pre-tested structured questionnaires to collect data through interviews and then perform physical and laboratory measurements. Then enter the data into EpiData version 3.1, and use STATA version 16.0 for analysis. Fit a binary logistic regression model to identify factors related to anemia. When p-value<0.05, all statistical tests are declared significant. Results: The degree of anemia in adult diabetic patients was 30.2% (95% confidence interval (CI): 25.4%-35.4%). Men (36%) have higher anemia than women (20.5%). Male (adjusted odds ratio (AOR) = 2.1, 95% CI: 1.2, 3.8), DM ≥ 5 years (AOR = 1.9, 95% CI: 1.0, 3.7), comorbidities (AOR = 1.9, 95) %CI : 1.0, 3.7) and suffering from diabetic complications (AOR = 2.3, 95% CI: 1.3, 4.2) were significantly associated with anemia. Conclusion: Anemia is a moderate to moderate public health problem among adult DM patients in the study subjects. Male gender, the duration of DM, the presence of DM complications, and DM comorbidities are factors related to anemia. Therefore, routine screening and appropriate management should be designed for men, DM patients with long DM duration, and anemia patients with complications and comorbidities, so as to improve the quality of life of patients. Early diagnosis and regular monitoring of diabetes may also help minimize complications. Keywords: Anemia, Diabetes, General Hospital, Eastern Ethiopia
Dhiig-yaraantu waxa loola jeedaa hoos u dhaca tirada unugyada dhiigga cas ee wareega (RBC) iyo/ama hoos u dhigista awoodda qaadista ogsijiinta, taas oo aan ku filnayn daboolida baahiyaha jireed ee jidhka bini'aadamka.1,2 Waxay saamaysaa wadamada soo koraya iyo kuwa horumaray, caafimaadka dadka, horumarka bulshada iyo dhaqaalaha.3 Waxaa jira ku dhawaad 1.62 bilyan oo qof oo qaba dhiig-yaraan adduunka, taasoo ka dhigan 24.8% dadweynaha adduunka.4
Sonkorowga mellitus (DM) waa cudur dheef-shiid kiimikaad ah, oo qiyaas ahaan u qaybsan nooca I_juvenile ama sonkorowga insulin-ku-tiirsan iyo nooca II_non-insulin-ku-tiirsanaanta.5 Bukaanka macaanka qaba, dhiig-yaraantu waxay inta badan sabab u tahay caabuq, daroogooyinka, nafaqo-xumada, cudurrada kelyaha, cudurrada difaaca jirka ee la socda, 6,7 hoos u dhac ku yimaada wax soo saarka erythropoietin, yaraanta ama birta shaqaynaysa, iyo badbaadada unugyada dhiigga cas ee gaaban.8,9 Sidaa darteed, dhiig-yaraantu waxay ku badan tahay bukaanka macaanka.10,11 Dadka waaweyn, heerka dhiig-yaraantu waa 24% dumarka da'da dhalmada (15-49 sano) iyo 15% ragga da'doodu u dhaxayso 15-49.12
Bukaanada qaba DM, gaar ahaan kuwa qaba kelyo xanuunada muuqda ama kelyaha oo yaraada, baahsanaanta dhiig-yaraantu waxay 2 ilaa 3 jeer ka badan tahay bukaanka aan lahayn DM.13,14 Dhiig-yaraan iyo sonkorow, sida nephropathy, retinopathy, neuropathy, bogsashada dhaawaca liidata, iyo cudurka macrovascular [15,16], waxay saameyn xun ku leeyihiin tayada nolosha bukaanka.17-19 Inkastoo xaqiiqooyinkaas jira, warbixinaha cilmi-baaristu waxay muujinayaan in ilaa 25% bukaannada macaanka aan weli aqoonsan karin dhiig-yarida.20,21
Aqoonsiga hore iyo daawaynta dhiig-yarida bukaanka DM waxay kaa caawin kartaa yaraynta cudurrada iyo dhimashada, iyo hagaajinta tayada noloshooda.22 Si kastaba ha ahaatee, guud ahaan, qiimaynta dhiig-yarida bukaanka macaanka ee Itoobiya waa mid aad u hooseeya, ilaa hadda, ma jirto cilmi-baaris ku habboon.Tani waxay si gaar ah run uga tahay goobta daraasadda.Sidaa darteed, daraasaddan waxay ujeedadeedu tahay in lagu qiyaaso heerka dhiig-yaraan ee bukaannada macaanka qaba ee isbitaalka guud ee Gramsoe ee bariga Itoobiya iyo in la go'aamiyo arrimaha la xiriira.
Daraasadan ayaa lagu sameeyay cisbitaalka guud ee Glymso (GGH) oo ku yaala magaalada Glymso ee degmada Habro ee dawlad goboleedka Oromada ee bariga Itoobiya.Isbitaalka ayaa ku yaala meel qiyaastii 390 KM dhanka bari kaga beegan magaalada Addis Ababa ee xarunta dalka Itoobiya.23 Sida lagu sheegay warbixin uu soo saaray xafiiska caafimaadka ee degmada Habro, GGH waa xarun gudbineed oo lagu qiyaasay 1.4 milyan oo qof oo ku nool agagaarka biyo-qabatinka.Waxay siisaa adeegyo daryeel caafimaad in ka badan 90,000 bukaan oo ku jira waaxaheeda kala duwan iyo rugaha caafimaadka sannad kasta.Rugta caafimaadka macaanku waa mid ka mid ah qaybaha xirfadlayaasha ah ee bixiya adeegyada ku dhawaad 660 bukaan oo qaba cudurka macaanka.Degmada Habro waxay ku taal joog dhan 1800-2000 mitir.
Daraasad isdhaafsi ah oo isbitaal ku saleysan ayaa la sameeyay laga bilaabo Juun 9, 2020 ilaa Ogosto 10, 2020. Kaqeybgaleyaasha xaqa u leh waa qaangaar (≥18 sano) bukaannada sokorowga kuwaas oo lala socdo GGH.Dadka waaweyn ee qaba xanuunka macaanka ee dhiiga lagu shubay 3-dii bilood ee la soo dhaafay, kuwa uur leh ama dhawaan umushay ama la ildaran xanuunada dhimirka, bukaan lagu sameeyay qaliin ama dhiig sabab kasta, iyo bukaanada la siiyay daawaynta dulinka mindhicirka. .Baro.
Baaxadda muunada waxaa lagu go'aamiyay iyadoo la isticmaalayo hal qaacido saamiga dadwaynaha iyadoo lagu saleeyay fikradaha soo socda: 95% kalsoonida, 5% heerka khaladka, iyo dhiig-yarida bukaanada sonkorowga qaba ee ka imanaya Cisbitaalka Gudbinta Dessie ee Waqooyi Bari Itoobiya (p = 26.7) %).24 Ka dib marka lagu daro 10% kuwa aan ka jawaabin, cabbirka muunada kama dambaysta ahi waa 331.
660 bukaan oo sonkorowga qaba ayaa si firfircoon loogala socday rugta caafimaadka sonkorowga ee GGH.U qaybi tirada guud ee bukaannada qaba sonkorowga (660) cabbirka muunadda kama dambaysta ah (331) si aad u hesho laba muunad oo kala duwan.Anaga oo adeegsanayna diiwaanka bukaanada macaanka qaba ee helaya adeegyada la socodka xanuunka macaanka ee cisbitaalka qaab muunad ahaan, waxaanu isticmaalnay farsamo muunado random oo nidaamsan si loogu daro dhammaan bukaanada kale ee daraasadda.Sii ka-qaybgale kasta lambar aqoonsi oo gaar ah si looga fogaado isku-duubnida, haddii ay dhacdo in isla bukaan-socodka uu dib u soo baxo inta daraasaddu socoto dabagal kale.
Uruurinta xogta doorsoomayaal bulsho, cabbitaan khamri, sigaar cabbid, iyo sifooyin cunto adiga oo isticmaalaya xog-waraysi habaysan oo laga soo qaatay hab-tallaabo-tallaabo ee buugga la socodka khatarta cudurrada daba dheeraada ee WHO.25 Isticmaalka shaaha iyo kafeega, isticmaalka dhuumaha biyaha, xog-ururinta Carter, isticmaalka ka hortagga uurka, iyo taariikhda caadada ayaa la helay iyadoo dib loo eegay suugaan kala duwan.Su'aalo-ururinta 26-30 waxay ku qornayd Ingiriisi waxaana lagu turjumay luqadda maxalliga ah (Afaan Oromoo), ka dibna waxay dib ugu turjumeen Ingiriisi khabiiro luuqado kala duwan si ay u hubiyaan joogteynta.Ka hel xogta bukaan-socodka sida muddada cudurka macaanka, nooca sonkorowga, dhibaatooyinka sonkorowga, iyo heerarka gulukoosta dhiigga ee soonka ee diiwaannada caafimaadka bukaanka.Xogta waxaa aruuriyay labo kalkaaliye caafimaad oo xirfadlayaal ah iyo farsamayaqaan sheybaar, waxaana kormeerayay macalin ka qalin jabiyay caafimaadka bulshada.
Cabbir cadaadiska dhiigga (BP) adigoo isticmaalaya mitirka cadaadiska dhiigga dhijitaalka ah (Heuer) oo si joogto ah loo xaqiijiyo.Kahor inta aan la cabbirin cadaadiska dhiigga, maadada ma aysan cabbin wax cabitaan ah oo kulul, sida shaaha, kafeega ama tubaakada la cabbo, Caterpillar la calaliyo, ama ma samayn jimicsi xooggan 30kii daqiiqo ee u dambeeyay.Ka dib markii mawduuca nastay ugu yaraan shan daqiiqo oo la duubay celceliska akhriska BP, saddex cabbir oo madaxbannaan ayaa laga qaaday gacanta bidix.Cabbirrada labaad iyo saddexaad ayaa la qaaday shan iyo toban daqiiqo ka dib cabbirada koowaad iyo labaad, siday u kala horreeyaan.Dhiig-karka waxaa lagu qeexaa sida bukaanada qaba kor u kaca BP (SBP≥140 ama DBP≥90mmHg) ama kuwa hore loo ogaaday inay qaataan daawooyinka dhiig-karka.31,32
Si loo go'aamiyo heerka nafaqada iyada oo loo marayo index mass index (BMI), waxaan cabbirnay dhererka iyo miisaanka bukaanka.Marka ka qaybgalayaashu ay si toos ah u istaagaan derbiga, cidhibtoodu waxay taabteen derbiga wadajirka ah, ma xidhin kabo, madaxooda toosan, oo waxay cabbireen dhererkooda taliye waxayna diiwaangeliyeen 0.1 cm ee ugu dhow.Isticmaal miisaan dhijitaal ah oo ku calaamadsan 0-130 kg si aad u cabbirto miisaankaaga.Cabbir kasta ka hor, cabbir miisaanka ilaa heerka eber.Cabbir miisaanka ka qaybqaataha marka aad xidhan tahay dhar fudud oo aan kabo lahayn, oo duub 0.1 kg ee kuugu dhow.33,34 tusmada cufka jirka (BMI) waxaa lagu xisaabiyaa iyadoo loo qaybinayo miisaanka jidhka (kg) dhererka (m).Markaa heerka nafaqada waxaa lagu qeexaa sida: haddii BMI <18.5, miisaan yar;haddii BMI = 18.5-24.9, miisaan yar;haddii BMI = 25-29.9, miisaan xad dhaaf ah;haddii BMI ≥30.35,36, cayilka
Meel u dhow barta dhexe ee u dhaxaysa cidhifka hoose ee feeraha la dareemi karo iyo xagga sare ee dhamaadka, isticmaal cabbir sharooto aan laastik ahayn si aad u cabbirto wareegga dhexda oo u duub 0.1cm ee ugu dhow.Cayilka dhexe waxaa lagu qeexaa heerka wareegga dhexda ee ragga ≥ 94 cm, iyo heerka wareegga dhexda dumarka ≥ 80 cm.30,36 Inta lagu jiro mudada tababarka, 10 bukaan oo qaangaar ah oo qaba sonkorowga ayaa lagu sameeyay khalad cabbir farsamo oo qaraabo ah (%TEM) si loo yareeyo khaladaadka cabbirka anthropometric random.Khaladaadka cabbiraadda farsamada ee la aqoonsan yahay ee gudaha iyo inta u dhaxaysa goobjoogayaashu waxay ka yar yihiin 1.5% iyo in ka yar 2%, siday u kala horreeyaan.
Farsamoyaqaannada shaybaadhka ayaa ka soo ururiyay ku dhawaad laba millilitir (2 ml) oo muunado dhiig ah dhammaan ka qaybgalayaasha waxayna ku rideen tuubo tijaabo ah oo ay ku jirto tripotassium ethylenediaminetetraacetic acid (EDTA K3) xinjirowga lidka ku ah go'aaminta hemoglobin.Si sax ah isku qas dhammaan dhiigga la ururiyey oo isticmaal Sysmex XN-550 falanqeeyaha hematology si loo baaro.Cabbirka hemoglobin waxaa lagu hagaajiyay iyadoo la dhimay dhererka dhammaan ka qaybgalayaasha iyadoo laga jaray 0.8 g/dl iyo heerka sigaarka iyadoo laga jaray 0.03 g/dl.Ka dib u qeex dhiig-yarida heerka haemoglobin ee dheddigga <12g/dl iyo lab <13g/dl.Darnaanta dhiig-yaraantu waxay u qaybsantaa: heerarka hemoglobin ee ragga iyo dumarka waa 11-12.9 g/dl iyo 11-11.9 g/dl, siday u kala horreeyaan, kuwaas oo ah dhiig-yaraan fudud, halka heerarka hemoglobin ee dhexdhexaad ah iyo dhiig-yaraan daran ay yihiin 8-10.9 g/dl, siday u kala horreeyaan dl iyo <8 mg/dl.lab iyo dhedig
Ku ururi shan millilitir (5 mL) oo dhiig xidid ah tuubo tijaabo ah oo aan lahayn xinjirowga lidka ku ah si loo go'aamiyo creatinine iyo urea.Dhiigga oo dhan oo aan lahayn xinjirowga lidka ku ah ayaa xinjirooba 20-30 daqiiqo waxaana la bartaa 3000 rpm 5 daqiiqo si loo kala saaro serumka.Ka dib, Mindray BS-200E (Shiinaha Mindray Biomedical Electronics Co., Ltd.) falanqeeye kimistari kiliinikada ayaa loo adeegsaday si loo go'aamiyo serum creatinine iyo urea iyadoo la adeegsanayo picrine acid iyo hababka enzymatic.37 Isticmaal heerka nadiifinta creatinine si aad u qiyaasto heerka sifaynta glomerular.Adeegso saamiga Cudurka kelyaha ee daba-dheeraada (CKD) (GFR), oo lagu muujiyay qaabka CKD-EPI Cockroft-Gault ee lagu muujiyay 1.73 mitir oo laba jibbaaran.
Heerarka gulukoosta dhiigga ee soonka (ugu yaraan 8 saacadood) waxaa lagu cabbiraa farta laga mudayo iyadoo la isticmaalayo mitirka gulukoosta dhiigga ee loo qoondeeyay gulukoosta dhiigga.38 Haddii heerka gulukoosta dhiigga ee soonka uu yahay <80 ama> 130mg/dl, markaa koodhka waa xakamaynta gulukoosta dhiigga oo aan la xakamayn.Xakamee marka qiimaha gulukoosta dhiigga ee soonka uu u dhaxeeyo 80-130mg/dl 39
Ka qaybgalayaasha daraasadda waxaa la siiyay ul alwaax ah oo nadiif ah iyo koob caag ah oo nadiif ah, qalalan, oo aan dareerin oo ay ku qoran tahay lambarka taxanaha mawduuca si loogu baaro dulinka saxarada.Far iyaga inay keenaan saxaro cusub oo laba garaam ah (qiyaastii cabbirka suulka).Ka dib markii la ogaado gooryaanka (ukun iyo/ama dirxiga) iyadoo la isticmaalayo farsamooyin qoyan oo toos ah, shaybaarada waxaa lagu hubiyay 30 daqiiqo gudahood ka dib ururinta muunada.Shaybooyinka soo hadhay waxaa lagu kaydiyay tuubo tijaabo ah oo ka kooban 10 ml oo ah 10% formalin ah si loo hagaajiyo heerka ogaanshaha dulinnada, ka dib markii lagu daaweeyay tignoolajiyada fiirsashada formalin-ether, Microscope Olympus ayaa loo isticmaalay kormeerka.
Isticmaal lancet nadiif ah si aad faraha uga qaaddo shaybaarka dhiigga xididdada si aad u ogaato duumada.Ku diyaari filim dhiig khafiif ah oo isla galaas nadiif ah oo aan dufan lahayn, ka dibna hawo qallaji.Bogagga waxaa lagu wasakheeyay 10% Giemsa ilaa 10 daqiiqo, waxaana la baaray noocyada dulinnada duumada.Markii 100 goob koronto oo sarreeya lagu baadhay ujeeddada gelinta saliidda, duleelka waxaa loo tixgeliyey mid xun.40
Tababar laba maalmood socday oo ku saabsanaa qalabka iyo hababka xog ururinta ayaa la siiyay xog-ururinta iyo kormeerayaasha.Kahor inta aan Isbitaalka Guud ee Chiro ururin xogta dhabta ah ee 30 bukaan oo qaba sonkorowga, su'aal-ururinta ayaa horay loo tijaabiyay oo wax ka beddello lagama maarmaan ah ayaa la sameeyay.Cabbirka jireed waxaa lagu jaangooyay qaladka farsamada ee cabbirka (%TEM).Intaa waxaa dheer, nidaamyada hawlgalka caadiga ah ayaa la raacaa dhammaan ururinta muunadda shaybaadhka, kaydinta, falanqaynta iyo hababka duubista.
Ogolaanshaha anshaxa waxaa laga helay Guddiga Dib-u-eegista Anshaxa Cilmi-baarista Caafimaadka Hay'adda (IHRERC) ee Dugsigii hore ee Caafimaadka iyo Daawada ee Jaamacadda Am Valley (IHRERC 115/2020).Kulliyaddu waxay soo saartay warqad taageero ah oo rasmi ah GGH waxayna ogolaansho ka heshay madaxa isbitaalka.Kahor intaanad uruurin xogta, ka hel ogolaansho xog ogaal ah, ikhtiyaari ah, qoraal ah oo saxeexan ka qaybgale kasta.Ka qaybgalayaasha ayaa loo sheegay in dhammaan xogta laga soo ururiyo iyaga lagu ilaalin doono sir iyadoo la isticmaalayo koodhadhka, oo aan la isticmaali doonin aqoonsi shakhsiyeed, oo loo isticmaali doono ujeeddooyin cilmi-baaris oo keliya.Cilmi-baaristan waxaa loo sameeyay si waafaqsan "Baaqa Helsinki".
Hubi daacadnimada xogta la ururiyey, geli oo geli nooca EpiData 3.1, ka dibna u dhoofi STATA nooca 16.0 si loo maareeyo xogta iyo falanqaynta.Isticmaal boqolleyda, saamiga, celceliska, iyo weecashooyinka caadiga ah si aad u qeexdo xogta.Ka dib markii la hagaajiyay heerka hemoglobin iyadoo loo eegayo heerka sigaar cabbista ka qaybgalayaasha iyo joogitaanka aagga, heerka dhiig-yaraanta ayaa la go'aamiyay iyadoo loo eegayo heerka kala soocida cusub ee WHO.Hagaaji qaabka dib-u-celinta saadka ee laba-isbedelka leh si loo aqoonsado doorsoomayaasha falanqaynta dib-u-celinta saadka ee ugu dambeeya.Dib-u-celinta saadka laba-geesoodka ah, doorsoomayaasha leh p-qiimaha ≤ 0.25 ayaa loo arkaa inay yihiin musharraxiinta dib-u-celinta saadka ee kala duwan.Samee qaabka dib u noqoshada saadka ee kala duwan si loo aqoonsado arrimaha aan la xiriirin dhiig-yarida.Isticmaal saamiga is-dhaafsiga iyo 95% muddada kalsoonida si aad u cabbirto xoogga ururka.Heerka muhiimka ah ee tirakoobka waxaa lagu dhawaaqay inuu yahay p-qiimaha <0.05.
Daraasaddan, wadarta 325 bukaannada DM ee qaangaarka ah ayaa ka qaybqaatay kulanka, heerka jawaabtana wuxuu ahaa 98.2%.Inta badan ka qaybgalayaasha;ragga reer miyiga ah waa 203 (62.5%), 247 (76%), 204 (62.8%) iyo 279 (85.5%) waa rag guursaday, isirkooduna waa Oromo.Da'da dhexdhexaadka ah ee ka qaybgalayaashu waxay ahayd 40 sano, iyo inta u dhaxaysa afar-geesoodka (IQR) waxay ahayd 20 sano.Ku dhawaad 62% kaqeybgalayaashu weligood ma helin waxbarasho rasmi ah, 52.6% kaqeybgalayaashuna waa beeraley xirfadlayaal ah (Shaxda 1).
Shaxda 1 Sifooyinka-bulsheed ee bukaanada DM qaangaarka ah ee lagu daweeyay cisbitaalka guud ee bariga Itoobiya sanadka 2020 (N = 325)
Ka qaybgalayaasha daraasadda, 74 (22.8%) waxay sheegeen inay sigaar cabbeen ugu yaraan hal mar noloshooda, marka la barbardhigo 13 sigaar cabbayaal ah (4%).Intaa waxaa dheer, 12 qof (3.7%) waa kuwa hadda cabba, iyo 64.3% ka qaybgalayaasha daraasadda waa shaaha madow.In ka badan saddex-meelood meel (68.3%) ka qaybgalayaasha daraasadda ayaa sheegay in ay had iyo jeer cabbaan kafeega cuntada ka dib.Boqol iyo soddon iyo saddex (96.3%) iyo 310 (95.4%) ka qaybgalayaashu waxay cuneen miraha iyo khudaarta in ka yar shan jeer toddobaadkii.Marka la eego xaaladdooda nafaqeynta, 92 (28.3%) iyo 164 (50.5%) ka qaybgalayaashu waxay ahaayeen kuwo cayilan oo dhexdhexaad ah (Shaxda 2).
Shaxda 2 dabeecadaha iyo nafaqeynta ee bukaanada DM ee qaangaarka ah ee lagu daaweeyay Isbitaalka Guud ee Bariga Itoobiya sanadka 2020 (N = 325)
In ka badan 170 (52.3%) bukaanada qaba nooca II DM waxay lahaayeen celcelis ahaan muddada DM ee 4.5 (SD± 4.0) sano.Ku dhawaad 50% bukaannada DM waxay qaadanayaan dawooyinka hypoglycemic ee afka laga qaato (glibenclamide iyo/ama metformin), ku dhawaad saddex meelood meel ka mid ah ka qaybgalayaasha daraasadda waxay leeyihiin gulukoos dhiig oo aan la xakameynin (Shaxda 3).Marka la eego cudurrada isku-dhafan, 2% ka qaybgalayaashu waxay lahaayeen cudurrada faafa.80 (24.6%) iyo 173 (53.2%) bukaanada qaba DM oo aan lahayn hypertension waxay ahaayeen dhiig-yaraan iyo kuwa aan dhiig-yaraan siday u kala horreeyaan.Dhanka kale, bukaannada DM ee laga helay dhiig-karka, 189 (5.5%) iyo 54 (16.6%) waxay ahaayeen dhiig-yaraan siday u kala horreeyaan.
Shaxda 3 Astaamaha caafimaad ee bukaanada DM qaangaarka ah ee lagu daweeyay cisbitaalka guud ee bariga Itoobiya sanadka 2020 (N = 325)
Heerarka dhiig-yaraanta ee bukaannada sonkorowga qaba waa 30.2% (95% CI: 25.4-35.4%), celceliska heerka hemoglobin waa 13.2 ± 2.3g / dl dl)Marka la eego darnaanta dhiig-yarida bukaanka DM ee qaba dhiig-yaraan, waxaa jiray 64 xaaladood oo dhiig-yaraan fudud (65.3%), 26 xaaladood oo dhiig-yaraan dhexdhexaad ah (26.5%), iyo 8 xaaladood oo dhiig-yaraan daran (8.2%).Dhiig-yarida ragga (36.0%) aad ayuu uga sarreeyaa dumarka (20.5%) (p = 0.003) (Jaantuska 1).Waxaan helnay xiriir togan oo weyn oo udhaxeeya darnaanta dhiig-yarida iyo muddada sonkorowga (r = 0.1556, p = 0.0049).Tani waxay ka dhigan tahay in marka muddada DM ay korodho, darnaanta dhiig-yaraantu waxay u egtahay inay korodho.
Jaantuska 1 Heerka dhiig-yaraan ee jinsiga ee bukaanka DM ee qaangaarka ah ayaa lagu daweeyey cisbitaalka guud ee bariga Itoobiya 2020 (N = 325)
Bukaannada DM, 64% ragga iyo 79.5% dumarku waa kuwa aan dhiig-yaraan, halka 28.7% iyo 71.3% dadka qaadka cuna ay yihiin dhiig-yaraan.67% bukaanada DM qaangaarka ah ee isticmaala qaxwada cuntada ka dib waxay ahaayeen kuwa aan dhiig-yaraan, iyo 32.9% iyaga ayaa la ogaaday inay qabaan dhiig-yaraan.Marka la eego jiritaanka cudurrada isku-dhafan, 72.2% bukaannada qaba DM oo aan lahayn cillad-xumo waxay ahaayeen dhiig-yaraan, iyo 36.3% bukaannada qaba cudurrada DM waxay ahaayeen dhiig-yaraan.Bukaannada sokorowga qaba dhibaatooyinka DM waxay lahaayeen dhiig-yaraan sare (47.4%) marka loo eego kuwa aan lahayn dhibaatooyinka DM (24.9%) (Shaxda 4).
Shaxda 4 Qodobbada la xidhiidha dhiig-yarida dadka waaweyn ee DM bukaanada ah ayaa lagu daweeyey cisbitaalka guud ee bariga Itoobiya sanadka 2020 (N = 325)
Hagaaji qaababka dib-u-celinta saadka ee kala-duwan iyo kala-duwan si loo baadho xidhiidhka ka dhexeeya dhiig-yarida iyo doorsoomayaasha sharraxaadda.Falanqaynta laba-geesoodka ah;da'da, jinsiga, xaaladda guurka, Qaadka cunista, qaxwada cuntada ka dib, cudurrada faafa, dhibaatooyinka sonkorowga, muddada DM iyo heerka nafaqada (BMI) waxay si weyn ula xiriiraan dhiig-yaraan oo leh p value <0.25, waana Multivariate musharaxa dib u noqoshada.
Falanqaynta dib-u-celinta saadka ee kala duwan, ragga qaba DM ≥ 5 sano oo dherer ah, joogitaanka cudurrada iyo dhibaatooyinka DM ayaa si weyn loola xiriiriyay dhiig-yaraan.Bukaannada DM ee qaangaarka ah ee ragga ah waxay 2.1 jeer uga dhowdahay inay ku dhacaan dhiig-yaraan marka loo eego dumarka (AOR = 2.1, 95% CI: 1.2, 3.8).Marka la barbardhigo bukaannada DM ee aan lahayn cillado-xumo, bukaannada DM ee qaba isku-dhafka ayaa 1.9 jeer ka badan inay noqdaan dhiig-yaraan (AOR = 1.9, 95% CI: 1.0, 3.7).Marka la barbardhigo bukaanada qaba muddada DM ee 1-5 sano, bukaanada DM ee muddada DM ≥ 5 sano waxay u badan tahay 1.8 jeer inay ku dhacaan dhiig-yaraan (AOR = 1.8, 95% CI: 1.1, 3.3).Khatarta dhiig-yarida bukaanada qaba dhibaatooyinka DM waa 2.3 jeer marka loo eego asxaabta (AOR = 2.3, 95% CI: 1.3, 4.2) (Shaxda 4).
Daraasaddan ayaa lagu qiimeeyay darnaanta dhiig-yarida iyo arrimaha la xiriira bukaannada DM ee lagala socday cusbitaalka guud ee Gelemso cudurka macaanka.Heerka dhiig-yaraanta ee daraasadda hadda jirta waa 30.2%.Marka loo eego kala soocidda WHO ee muhiimadda caafimaadka dadweynaha, deegaanka cilmi-baarista, dhiig-yaraantu waa dhibaato caafimaad oo dhexdhexaad ah oo ka dhex jirta bukaannada qaangaarka ah ee qaba DM.Jinsiga, muddada DM, joogitaanka dhibaatooyinka DM, iyo ragga qaba cilladaha DM ayaa loo aqoonsaday inay yihiin arrimo la xiriira dhiig-yaraan.
Heerka dhiig-yarida ee daraasaddan waxay la mid tahay ta Isbitalka Itoobiya ee Dessie Referral [24], laakiin ka sarreeya kan Fenote Selam Hospital ee Itoobiya [41] ee daraasad maxalli ah oo lagu sameeyay Shiinaha, 42 Australia, 43 iyo India [44] ]., Kaas oo ka hooseeya daraasadaha lagu sameeyay Thailand [45], Saudi Arabia [46] iyo Cameroon [47].Farqigani waxa uu sabab u noqon karaa kala duwanaanshaha da'da ee dadka daraasadda.Tusaale ahaan, si ka duwan daraasadda hadda jirta oo aan ku jirin dadka waaweyn ee ka weyn 18 sano, daraasad ka dhacday Thailand waxaa ku jiray dadka waaweyn ee ka weyn 60 sano, halka daraasad lagu sameeyay Cameroon ay ku jiraan dadka waaweyn ee ka weyn 50 sano.Farqiga ayaa sidoo kale laga yaabaa inay sabab u tahay hoos u dhaca shaqada kelyaha, bararka, xakameynta dhuuxa lafta, iyo nafaqo-xumada (kordhinta da'da)17.
Waxaan la yaabnay in daraasaddeenna, dhiig-yarida ragga ay aad uga badan tahay dumarka.Natiijooyinkani waxay ka soo horjeedaan warbixinnada kale ee cilmi-baarista [42,48], taas oo haweenku ay u badan tahay inay la kulmaan dhiig-yaraan marka loo eego ragga qaba xanuunka macaanka.Sababta suurtogalka ah ee kala duwanaanshiyahan ayaa laga yaabaa inay tahay ragga daraasaddan ku jira oo lahaa caadooyinka cunista qaadka oo aad u sarreeya, taas oo keeni karta inay lumiso rabitaanka cuntada49, qaadka waxaa ku jira maaddo tannins-ah oo yaraysa bioavailability ee birta aan heme ahayn ee cuntada.50 Sababta kale ee suurtogalka ah ayaa ah in qaadashada kafeega iyo shaaha ee ragga ee daraasaddan ay joojisay nuugista birta ee mindhicirka.51-54
Waxaan ogaanay in bukaanada qaba DM ≥ 5 sano ay aad ugu dhow yihiin inay ku dhacaan dhiig-yaraan marka loo eego bukaanada qaba DM ee leh koorsada 1-5 sano.Tani waxay la socotaa daraasado lagu sameeyay Isbitaalka Fenote Selam ee Itoobiya, 41 Ciraaq 55 iyo Boqortooyada Ingiriiska.17 Tani waxaa laga yaabaa inay sabab u tahay soo-gaadhista dheeraadka ah ee hyperglycemia, taasoo keenta kororka cytokines bararka leh saamaynta anti-erythropoietin, taasoo keentay hoos u dhaca tirada.Yaraynta unugyada dhiigga cas ee wareegaya waxay keenaysaa hoos u dhaca haemoglobin wareegaya.35
Iyadoo la raacayo daraasado lagu sameeyay Shiinaha, 13 dhiig-yaraan ayaa daraasaddan ku badan tahay bukaannada DM ee leh dhibaatooyin.Bayoloji ahaan, dhibaatooyinka sonkorowga ayaa si ba'an u dhaawici kara unugyada iyo qaab dhismeedka xididdada dhiigga ee kelyaha, caabuqa habdhiska, iyo kicinta erythropoietin inhibitors waxay keeni kartaa dhiig-yaraan sonkorowga.56 Hypoxia waxay saamayn kartaa muujinta hidda-wadaha, dheef-shiid kiimikaadka, qulqulka xididada iyo badbaadada unugyada
Intaa waxaa dheer, bukaannada DM ee qaba cudurrada laf-dhabarka waxay aad ugu nugul yihiin dhiig-yarida marka loo eego bukaannada DM ee aan lahayn isku-dhafan.Tani waxay la mid tahay daraasadihii hore ee la midka ahaa [35,59], taas oo laga yaabo inay sabab u tahay saameynta isku-dhafka (sida dhiig-karka) ee keena dhibaatooyinka wadnaha, taas oo kordhinaysa khatarta dhiig-yaraanta.60
Iyada oo ka mid ah daraasadihii aadka u yaraa ee ku salaysan shaybaadhka ee lagu sameeyay Itoobiya, cudurrada daba-dheeraada sida DM ayaa aad u soo badanaya, taas oo ka dhigan xoogga cilmi-baaristan.Dhanka kale, daraasaddan ayaa ah hal daraasad oo ku saleysan isbitaal waxaana laga yaabaa inaysan matalin dhammaan bukaannada qaba DM ama bukaannada lagala socdo xarumaha kale ee caafimaadka.Dabeecadda isdhaafsan ee naqshadaynta daraasadda ee aan isticmaalnay ma ogola in la sameeyo xiriir ku meel gaar ah oo u dhexeeya dhiig-yarida iyo arrimaha.Daraasadaha mustaqbalka ayaa laga yaabaa inay u baahdaan inay isticmaalaan kontaroolada kiisaska, daraasado kooxeed ama naqshado kale oo cilmi baaris ah si loo tixgeliyo calaamadaha iyo calaamadaha dhiig-yaraanta, RBC morphology, birta serum, fitamiin B12, iyo heerarka folic acid.
Deegaanka cilmi-baarista, dhiig-yaraantu waa dhibaato caafimaad oo dhexdhexaad ah oo ka dhex jirta bukaannada DM qaangaarka ah.Jinsiga, muddada DM, joogitaanka dhibaatooyinka DM, iyo cudurrada isku dhafan ayaa ahaa rag waxaana loo aqoonsaday arrimo la xiriira dhiig-yaraan.Sidaa darteed, baaritaanka joogtada ah ee dhiig-yarida iyo maareynta ku habboon bukaannada DM ee leh muddada dheer ee DM, cudurrada faafa iyo dhibaatooyinka waa in loo qaabeeyaa si kor loogu qaado tayada nolosha bukaanka.Ogaanshaha hore iyo la socodka joogtada ah ee DM waxay kaloo kaa caawin kartaa yaraynta dhibaatooyinka.
Xogta taageeraya natiijooyinka lagu sheegay qoraal-gacmeedka waxaa laga heli karaa qoraaga u dhigma iyadoo loo eegayo shuruudaha macquulka ah.
Waxaan u mahadcelineynaa madaxa isbitaalka guud ee Gelemso, hawl-wadeennada rugta caafimaadka macaanka, ka-qaybgalayaasha daraasadda, xog-ururinta iyo gacan-yareyaasha cilmi-baarista.
Dhammaan qorayaashu waxay gacan weyn ka geysteen shaqada warbixinta, hadday ahaan lahayd fikradda, naqshadaynta cilmi-baarista, fulinta, helitaanka xogta, falanqaynta iyo tafsiirka, ama dhammaan dhinacyadan;ka qaybqaatay diyaarinta, dib-u-eegista ama dib-u-eegista adag ee qodobkan;ugu dambayntii la ansixiyay nuqulka la daabacayo;waxa lagu gaadhay heshiis ku saabsan joornaalka maqaalka loo gudbiyay;waxaana lagu heshiiyey in uu masuul ka noqdo dhammaan dhinacyada shaqada.
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