Chloroquine has shown high therapeutic efficacy against uncomplicated Plasmodium vivax malaria in southern Ethiopia: seven decades after its introduction.

BACKGROUND: Plasmodium vivax malaria is a leading cause of morbidity in Ethiopia. The first-line treatment for P. vivax is chloroquine (CQ) and primaquine (PQ), but there have been local reports of CQ resistance. A clinical study was conducted to determine the efficacy of CQ for the treatment of P. vivax malaria in southern Ethiopia. METHODS: In 2021, patients with P. vivax mono-infection and uncomplicated malaria were enrolled and treated with 25 mg/kg CQ for 3 consecutive days. Patients were followed for 28 days according to WHO guidelines. The data were analysed using per-protocol (PP) and Kaplan‒Meier (K‒M) analyses to estimate the risk of recurrent P. vivax parasitaemia on day 28. RESULTS: A total of 88 patients were enrolled, 78 (88.6%) of whom completed the 28 days of follow-up. Overall, 76 (97.4%) patients had adequate clinical and parasitological responses, and two patients had late parasitological failures. The initial therapeutic response was rapid, with 100% clearance of asexual parasitaemia within 48 h. CONCLUSION: Despite previous reports of declining chloroquine efficacy against P. vivax, CQ retains high therapeutic efficacy in southern Ethiopia, supporting the current national treatment guidelines. Ongoing clinical monitoring of CQ efficacy supported by advanced molecular methods is warranted to inform national surveillance and ensure optimal treatment guidelines.

Safety and therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria at Shecha health centre, Arba Minch, Ethiopia.

BACKGROUND: In 2004, Ethiopia adopted artemether-lumefantrine (AL, Coartem®) as first-line treatment for the management of uncomplicated Plasmodium falciparum malaria. Continuous monitoring of AL therapeutic efficacy is crucial in Ethiopia, as per the World Health Organization (WHO) recommendation. This study aimed to assess the therapeutic efficacy of AL in the treatment of uncomplicated P. falciparum infection. METHODS: A 28 day onearm, prospective evaluation of the clinical and parasitological response to AL was conducted at Shecha Health Centre, Arba Minch town, Southern Ethiopia. Patients were treated with six-dose regimen of AL over three days and monitored for 28 days with clinical and laboratory assessments. Participant recruitment and outcome classification was done in accordance with the 2009 WHO methods for surveillance of anti-malarial drug efficacy guidelines. RESULTS: A total of 88 study participants were enrolled and 69 of them completed the study with adequate clinical and parasitological response. Two late parasitological failures were observed, of which one was classified as a recrudescence by polymerase chain reaction (PCR). The PCRcorrected cure rate was 98.6% (95% CI 92.3-100). AL demonstrated a rapid parasite and fever clearance with no parasitaemia on day 2 and febrile cases on day 3. Gametocyte clearance was complete by day three. No serious adverse events were reported during the 28 days follow-up. CONCLUSION: The study demonstrated high therapeutic efficacy and good safety profile of AL. This suggests the continuation of AL as the first-line drug for the treatment of uncomplicated P. falciparum malaria in Ethiopia. Periodic therapeutic efficacy studies and monitoring of markers of resistance are recommended for early detection of resistant parasites.

Relationship between Characteristics of the Wound and Healing Duration among Patients Treated during Home-Visits.

In humans, wound healing is a vital but complex process governed by chronological yet overlapping stages, such as hemostasis, inflammation, proliferation, and remodeling. Because of the complexities of wound healing, it is prone to pausing at multiple levels. Wound healing can potentially be influenced by factors that affect cellular functions and physiologic responses. This research aimed to investigate the relationship between wound healing duration and demographic properties and characteristics of wounds among patients treated during home visits in Erbil, Iraq. To this end, a longitudinal correlational quantitative design was employed in the current study. A random sample of about 101 chronic wounds was found in 77 patients of both genders selected from all ages during home visits for around four years in Erbil. The professional nurse applied nursing management according to the nursing plan during home visits until the wound recovered. The total duration of wound healing was calculated and documented for each wound. Seventy-seven patients participated in the current study, with their mean±SD age being 58.02±16.29 years, ranging from 19 to 89. The median age was 60. More than half of the sample (54.5%) were ≥60 years, and 62.3% were males. Less than one-third of patients (31.2%) were of normal weight, 93.5% were married, 37.7% were housewives, and 35.1% were illiterate. Regarding the duration of wound healing, in more than one quarter (26.7%), it was delayed (took more than three months for healing). The longest mean healing time (20.06 weeks) was for pressure ulcers (P<0.001), which was significantly higher than all the mean healing times of other types of wounds. The study showed a significant (P=0.011) association between the mean healing time and the anatomic location of wounds, revealing that the highest mean healing time was for wounds located in the trochanteric area (21.10 weeks) or the sacrum (18.25 weeks). A significant association (P=0.002) was also detected between the mean healing time and the edge of the wound, with the highest mean healing time (18.64 weeks) found in wounds with undermined edges. Furthermore, the mean healing time was significantly higher among those with infected wounds (14.59 weeks) than the mean (6.50 weeks) among those with no infection (P<0.001). In conclusion, wound healing progression is an important but complicated process that healthcare providers use for patients during home visits. It is divided into phases, including hemostasis, inflammation, proliferation, and remodeling. The current study revealed that the healing time was affected by the anatomical site of the wound and took longer in pressure ulcers, undermined edge wounds, and infected wounds.

Cardiovascular Disease-Related Health Promotion and Prevention Services by Pharmacists in Saudi Arabia: How Well Are They Prepared?

BACKGROUND: Cardiovascular diseases (CVDs) have been identified as the leading reason for morbidity and mortality in Saudi Arabia. Pharmacists play a major role in CVD prevention and health promotion. We aimed to assess the knowledge, attitudes, and involvement of pharmacists in CVD prevention and evaluate the influence of continuing medical education in CVD-prevention services in Saudi Arabia. METHOD: A cross-sectional study was conducted to evaluate the involvement of pharmacists in CVD-related prevention services along with their knowledge and attitudes. A 34-item questionnaire was developed and distributed among the participants. RESULTS: A total of 324 responses were included in the study. More than 60% of pharmacists had provided counseling regarding the importance of healthy lifestyles and self-monitoring CVD risk factors. About half of the participants (49.1%) had never received any CVD-related continuing medical education. Overall, more than 60% of the participants reported positively towards their role in CVD prevention. Lack of time (66%) and lack of educational materials and tools (41%) were the top perceived barriers for providing CVD-prevention and health-promotion activities, followed by lack of skills in using tools (36%) and lack of privacy/space (33%). CONCLUSIONS: The involvement of pharmacists in the prevention of CVD is limited in this study. Further education and capacity building are required to strengthen pharmacists' involvement in CVD-prevention and health-promotion activities.

Risk of Depression and Suicide in Diabetic Patients.

Although mental disorders in diabetics are more prevalent than in the general population, an increased prevalence of depression, frequently leading to suicide, has been reported in individuals with diabetes mellitus. Therefore, the purpose of this review is to assess the risk of depression and suicide in diabetic patients. The prevalence of depression and suicide is high among diabetic individuals. Risk factors including history of depression, presence of comorbidity, younger age, lower education, low social support, presence of diabetic complications, poor glycemic control, and physical impairment, all increase the risk of depression among diabetics. On the other hand, female sex, the intensity of childhood trauma, a history of alcohol misuse, depression, lower level of education, comorbidities, higher blood glucose levels, and previous history of suicide, all increase the risk of suicide among diabetics. Additionally, a bidirectional relationship exists between depression and diabetes. For example, depression can cause diabetes due to the disease's psychological and psychosocial impact, microvascular brain lesions, higher glutamate levels, poor glycemic control, and medication adherence. On the other hand, diabetic patients develop depression due to the stress associated with disease management. This paper concluded that depression and suicide are both prevalent conditions among diabetic patients. The higher risk of depression and suicidality in diabetic patients emphasizes the critical need of integrating depression screening and treatment into primary healthcare settings to avoid fatal conditions in the future. However, more research is required in this area.