Non-Prescription Antibiotics Use and Associated Factors Among Drug Retail Outlets in Ambo, Ethiopia: A Cross-Sectional Study.

PURPOSE: To assess the non-prescription use of antibiotics and associated factors in Ambo Town, West Shoa, Oromia, Ethiopia. METHODS: An institutional-based cross-sectional study design supported with the qualitative study was conducted in Ambo Town from February 1 to March 1, 2020. Data were collected using a pretested semi-structured questionnaire and in-depth interview guide questions. Simple random sampling was used to select retail outlets and systematic random sampling to select study participants. The data analysis was done using SPSS and univariate and multivariate binary logistic regression analysis was performed to identify factors associated with non-prescription use of antibiotics. Thematic framework analysis was applied for the qualitative data. RESULTS: From the 421 study sample, a total of 399 participants were interviewed with a 94.8% response rate. Among the study participants, 214 (53.6) were males, 228 (57.1%) were married, 191 (47.9%) were orthodox by religion, and 343 (86%) were Oromo by ethnicity. One hundred seventy-two (43.1%; 95% CI: 38.6, 48.1) of the participants had used non-prescribed antibiotics. Being male [AOR=2.21 95% CI: 1.276, 3.835], residing in rural area [AOR=3.659, 95% CI: 1.479, 9.054], holding diploma [AOR=0.120, 95% CI: 0.025, 0.591], and hold BSC degree [AOR=0.050, 95% CI: 0.007, 0.378], and being farmer [AOR=0.034, 95% CI: 0.004, 0.285] showed significant association with the non-prescription use of antibiotics. CONCLUSION: This study concluded that the non-prescription use of antibiotics 172 (43.1%) was relatively high. Being male, residing in a rural area, holding a diploma, BSc degree, and being a farmer were significantly associated with non-prescription use of antibiotics. So, West Shoa Zone regulatory body should actively focus on the prevention of non-prescription use of antibiotics through health communication and public awareness on the demerits of non-prescription use of antibiotics.

Diabetic Ketoacidosis Management and Treatment Outcome at Medical Ward of Shashemene Referral Hospital, Ethiopia: A Retrospective Study.

BACKGROUND: Diabetic Ketoacidosis (DKA) is the most common and yet potentially life-threatening acute complication of diabetes that progresses rapidly to death and requires immediate medical intervention. OBJECTIVE: To assess the DKA management and treatment outcome/in-hospital mortality and its predictors among hospitalized patients with DKA at the Medical ward of Shashemene Referral Hospital (SRH). METHOD: A retrospective study was conducted at the Medical Ward of SRH from 01 February 2015 to 31 January 2017. A systematic random sampling technique was used to select study subjects based on the inclusion criteria. Thus, of 236 reviewed charts, only 225 patients with DKA fulfilled inclusion criteria. Treatment outcome was considered good for patients who have shown improvement at discharge, while poor for patients who left against medical advice or died in the hospital. Logistic regression analysis was done to determine independent predictors for treatment outcome/in-hospital mortality using SPSS version 20 with statistical significant at P ⩽ .05. RESULTS: Of 225 patients with DKA, 124 (55.1%) were male. Regular insulin was prescribed to all patients and antibiotics were administered to 87 (38.7%). Potassium supplementation was given only for 28 (12.4%). Non-adherence to insulin treatment (n = 91; 40.4%) and infection (n = 66; 29.3%) were the principal DKA precipitating factors. Even though 73.8% of hospitalized patients with DKA have shown good treatment outcomes, DKA contributed 12% in-hospital mortality. The result of multivariate logistic regression analysis shown that hypoglycemia is the only independent predictor for in-hospital mortality[P = .03]. Moreover, the independent predictors for poor DKA treatment outcome were found to be smoker [P = .04], Urinary tract infection (UTI) relative to other co-morbid condition [P < .001], severe hypokalemia which increase risk of poor treatment outcome by around 4 times [P = .02], and use of Metronidazole as a concurrent medication relative to other concurrent medication [P = .03]. CONCLUSION: There was a high in-hospital mortality rate due to correctable causes. This mortality is unacceptable as it was majorly related to the poor practice of potassium supplementation and hypoglycemia due to insulin. Thus, clinicians and stakeholders should have to focus on modifiable factors (hypokalemia, UTI, and hypoglycemia) to reduce poor treatment outcome/in-hospital mortality.

Study on the Interaction of 1,5-diaryl Pyrrole Derivatives with α- glucosidase; Synthesis, Molecular Docking, and Kinetic Study.

BACKGROUND: The delaying of absorption of glucose is one of the principal therapeutic approaches of type 2 diabetes. α-glucosidase inhibitors compete with the α-glucosidase enzyme activity, which helps to reduce the conversion of carbohydrates into glucose and thereby control the postprandial hyperglycemia incidence. OBJECTIVE: The aim of this study was to synthesize a series of novel 1,5-diphenyl pyrrole derivatives and evaluate their in vitro α-glucosidase inhibitory activities. METHODS: Compounds were synthesized through a multistep reaction and were evaluated for α- glucosidase inhibitory activities. Molecular docking and kinetic studies were carried out to predict the mode of binding and mechanism of inhibition for the most active compounds, 5g and 5b, against α-glucosidase. RESULTS: Synthesized compounds showed good in vitro α-glucosidase inhibitory activity with IC50 values in the range of (117.5 ± 3.8 to 426.0 ± 10.2 µM) as compared to acarbose, the standard drug, (750 ± 8.7 µM). Compound 5g (117.5 ± 3.8 µM) ascertained as the most potent inhibitor of α-glucosidase in a competitive mode. The binding energies of compounds 5g and 5b (119.0 ± 7.5 µM), as observed from the best docking conformations, indicate that they have a lower free binding energy (-3.26 kcal/mol and -3.0 kcal/mol, respectively) than acarbose (2.47 kcal/mol). CONCLUSION: The results of our study revealed that the synthesized compounds are a potential candidate for α-glucosidase inhibitors for the management of postprandial hyperglycemia for further investigation.

Coumarin-based Scaffold as α-glucosidase Inhibitory Activity: Implication for the Development of Potent Antidiabetic Agents.

BACKGROUND: Delaying the absorption of glucose through α-glucosidase enzyme inhibition is one of the therapeutic approaches in the management of Type 2 diabetes, which can reduce the incidence of postprandial hyperglycemia. The existence of chronic postprandial hyperglycemia impaired the endogenous antioxidant defense by inducing oxidative stress-induced pancreatic ß-cell destruction through uncontrolled generation of free radicals such as ROS, which in turn, leads to various macrovascular and microvascular complications. The currently available α -glucosidase inhibitors, for instance, acarbose, have some side effects such as hypoglycemia at higher doses, liver problems, meteorism, diarrhea, and lactic acidosis. Therefore, there is an urgent need to discover and develop potential α-glucosidase inhibitors. OBJECTIVE: Based on suchmotifs, researchers are intrigued to search for the best scaffold that displays various biological activities. Among them, coumarin scaffold has attracted great attention. The compound and its derivatives can be isolated from various natural products and/or synthesized for the development of novel α-glucosidase inhibitors. RESULTS: This study focused on coumarin and its derivatives as well as on their application as potent antidiabetic agents and has also concentrated on the structure-activity relationship. CONCLUSION: This review describes the applications of coumarin-containing derivatives as α - glucosidase inhibitors based on published reports which will be useful for innovative approaches in the search for novel coumarin-based antidiabetic drugs with less toxicity and more potency.

Herbal Immunomodulators - A Remedial Panacea for Designing and Developing Effective Drugs and Medicines: Current Scenario and Future Prospects.

BACKGROUND: Constant exposure to various stressors, such as immune pressure, rapidly increasing population, deleterious changes in the ecosystem, climate change, infection with emerging and re-emerging pathogens, and fast-paced lifestyle, is a critical factor in the globally increasing incidences of immunocompromising health conditions, as well as stress. Synthetic chemotherapeutic agents, which are widely available in the commercial market, may be highly efficacious, but most are immunosuppressive and exert many side effects. METHODS: Herein, we comprehensively reviewed current literature from various scientific databases such as Bentham Science, PubMed, Scopus, Elsevier, Springer, etc. The inclusion/exclusion criteria based on literature with high importance was adopted to analyze and compile salient information from the authentic bibliographic sources. RESULTS: Undoubtedly, the pivotal characteristics of immunostimulants and immunomodulators in the maintenance of the health and productivity of humans, as well as animals, cannot be overlooked. Numerous herbs used in ethnoveterinary medicine can be successfully employed as adjuvant rehabilitators to negate the deleterious effects of chemotherapeutics. The sources of these medicinal remedies are part of long traditions in different regions of the world, such as Indian Ayurveda and Traditional Chinese Medicine, which have been developed through empirical experience. Traditional medicine employs a holistic approach to the prevention of disease, and traditional herbal medicines are a source of many components with a high therapeutic value that are used in modern allopathic medicine. Globally, many studies have been conducted on these herbs and have revealed unique active constituents that activate the innate immune system through the stimulation of macrophages and lymphocytes, and modulation of the cytokine profile, which leads to a state of alertness with a subsequent reduction in the incidence of infection. Immunomodulatory constituents with herbal origins are termed as phytochemicals, including flavonoids, glycosides, polysaccharides, terpenoids, essential oils, various bitters, and alkaloids; all these compounds exert vital, multidimensional effects. Efforts have focused on screening plant preparations to identify adjuvant immune properties; furthermore, several potent phytol adjuvants have been experimentally proven to downregulate inflammatory reactions in addition to enhance specific adaptive responses to vaccines. CONCLUSIONS: In summary, this review summarizes the current status and future prospects regarding the immunomodulatory potential of various herbs and plants and their promising utility for designing and developing effective drugs and medicines in safeguarding the health of humans, animals, and poultry.

Microalgae as a source of high-value bioactive compounds.

Microalgae are one of the oldest microorganisms, that grow in various hostile environments, ranging from deserts to Antarctica. The microalgae sustain life in such harsh environments through generation of secondary metabolites. Microalgae biosynthesize a large number of diverse bioactive metabolites with activities on cancer, neurodegenerative diseases, and infectious diseases. Here, we highlight the bioactive compounds that are isolated from microalgae for the purpose of using them as food, and as chemicals in pharmaceutical industry as new agents with therapeutic benefits.