Liver Cirrhosis of Unknown Etiology and Its Predictors in Eastern Ethiopia.

Background: The global burden of liver cirrhosis is increasing, with 2.1 million incident cases and nearly 1.5 million deaths in 2019. Despite the enormous progress in our understanding of the etiology of liver cirrhosis, significant cases of the disease have been reported in Eastern Ethiopia due to unidentified causes. Hence, this study aimed to identify predictors of liver cirrhosis of unknown etiology in Eastern Ethiopia. Methods: A score of 7 out of 11 possible points on the ultrasound-based cirrhosis scale was used as a diagnostic criterion to include 127 liver cirrhosis patients. The study participants' demographic, dietary, lifestyle, and clinical data were gathered using a structured questionnaire and standardized reporting forms. The associations between the outcome (known and unknown etiology) and independent variables were modeled using binary logistic regression analysis. Results: The etiology of liver cirrhosis was known in only 23% of patients and attributed to hepatitis B virus (21%), hepatitis C virus (0.8%), and alcohol abuse (0.8%). Sorghum consumption as a staple food (adjusted odds ratio (AOR) =3.8; 95% CI: 1.2, 12.5), splenomegaly (AOR = 4.0; 95% CI: 1.1, 14.4), and a family history of liver disease (AOR = 0.24; 95% CI: 0.06, 0.91) were significantly associated with liver cirrhosis of unknown etiology. Conclusion: Sorghum consumption was found to be the determinant factor of liver cirrhosis of unknown etiology, suggesting it as a possible source of exposure to aflatoxin B1.

Gastroprotective Activities of Aqueous and 80% Methanol Leaf Extracts of Stephania abyssinica (Quart.-Dill. and A. Rich.) Walp. (Menispermaceae) in Rats.

Background: An ethnobotanical study showed that the leaf of Stephania abyssinica (S. abyssinica) is used for the treatment of gastritis, but there is no scientific investigation. Objective: The aim of this study was to evaluate the gastroprotective activities of both aqueous and 80% methanol leaf extracts of S. abyssinica in experimental rats. Methods: Decoction and maceration techniques were used to prepare aqueous and 80% methanol leaf extracts, respectively. The extracts were evaluated against pyloric ligation, indomethacin, and ethanol-induced gastric ulcer models at doses of 100, 200, and 400 mg/kg. Negative control received 2% tween 80, while positive controls received 20 mg/kg of omeprazole and 100 µg/kg of misoprostol. Parameters, such as ulcer index, gastric mucin content, gastric juice volume, pH, and free and total acidity were measured. Results: In the pyloric ligation induced gastric ulcer model, all doses of both extracts significantly reduced the ulcer index and gastric juice volume, while doses of 200 and 400 mg/kg exhibited a significant increment in mucus content and gastric juice pH as well as decrease in free and total acidity as compared to negative control. In indomethacin and ethanol induced gastric ulcer models, pretreatment with both extracts significantly reduced the ulcer index and enhanced gastric mucin content in a dose-dependent manner. Phytochemical screening of both extracts showed the existence of flavonoids, phenols, tannins, saponins, alkaloids, and coumarins with high contents of phenols, flavonoids, and alkaloids in 80% methanol extract. Conclusion: This study revealed that aqueous and 80% methanol leaf extracts of S. abyssinica possessed remarkable gastroprotective activities against experimentally induced gastric ulcer models, and this possibly justify the traditional use of S. abyssinica leaves to treat gastritis.

Copy Number Variation in the GSTM1 and GSTT1 Genes and the Risk of Liver Cirrhosis in Eastern Ethiopia.

Background: Polymorphisms in glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) can cause an entire gene deletion. The current methodology can accurately identify GSTM1 and GSTT1 copy number variants (CNVs), which may shed light on the true contribution of each gene copy to the cellular detoxification process and disease risk. Because liver cirrhosis is becoming a critical worldwide health issue, this study determined the CNVs of GSTM1 and GSTT1 and their relationship to the risk of liver cirrhosis. Methods: In this study, we compared 106 patients with liver cirrhosis to 104 healthy controls. Real-time PCR was used to identify the CNVs of GSTM1 and GSTT1. Logistic and linear regression models were used to estimate the relationship between liver cirrhosis and clinical chemistry variables with the CNVs, respectively. Results: In 3.3% of the study participants, >2 copies of the GSTM1 or GSTT1 genes were detected. GSTT1 carriers had a significantly lower risk of liver cirrhosis (p<0.05) compared with individuals who had homozygous deletion (adjusted odds ratio (AOR) = 0.47; 95% CI: 0.25, 0.86). This risk reduction was significant (p<0.05) in patients with a single copy of the GSTT1 gene (AOR = 0.48; 95% CI: 0.25, 0.91). Those with ≥2 copies of combined GSTM1 and GSTT1 also had a significantly (p<0.05) lower risk of developing liver cirrhosis compared with double null genotypes (AOR = 0.38; 95% CI: 0.16, 0.91, p trend <0.001). Moreover, ≥2 copies of combined GSTM1 and GSTT1 genes were associated with a substantial decrease in alanine amino transferase (ALT) and aspartate aminotransferase (AST) levels, respectively. Conclusion: A single copy number of GSTT1, and ≥2 copies of combined GSTM1 and GSTT1 genes were associated with a reduced risk of liver cirrhosis in Ethiopians. These findings underscore the importance of gene-environment interactions in the multifactorial development of liver cirrhosis.

Contribution of Aflatoxin B1 Exposure to Liver Cirrhosis in Eastern Ethiopia: A Case-Control Study.

Background: Liver cirrhosis is a global health problem due to a large number of disability-associated life years and mortality. However, evidence is scarce on its causes in Eastern-Ethiopia, a place where there is a high prevalence of liver cirrhosis of unknown etiology. This study attempted to identify the risk factors related to liver cirrhosis in the area. Methods: A case-control study was conducted at a tertiary care hospital from January 2020 to July 2021. Following diagnoses using an ultrasound-based cirrhosis scale, a total of 127 cases were identified and compared with 253 control patients. A structured questionnaire and data abstraction form were used to collect demographic, lifestyle, and clinical information. A blood sample was also taken from each participant for clinical chemistry, hepatitis B virus (HBV), and hepatitis C virus tests as well as for an aflatoxin B1 (AFB1) albumin adduct (AF-alb) assay. Binary logistic regression analysis was used to determine predictors of liver cirrhosis. Results: AF-alb levels were detected in 75% of the cases and 64% of the controls, with a median (IQR) level of 11 pg/mg (5.5-25) and 7.0 pg/mg (4.3-20.5), respectively (p<0.05). Moreover, the number of subjects with high AF-alb levels (≥8.6 pg/mg) was greater in cases (45%, p<0.05)) than controls (28%). Age ≥55 years (adjusted odds ratio (AOR)=0.4; 95% CI: 0.2, 0.8), being a farmer (AOR= 3.0; 95% CI: 1.5, 6.0), family history of liver disease (AOR= 2.9; 95% CI: 1.1, 7.9), HBV seropositivity (AOR=4.0; 95% CI: 1.9, 8.8), and exposure to high levels of AF-alb (AOR=2.0; 95% CI: 1.1, 3.7) were significantly associated with liver cirrhosis. Conclusion: This study found a strong link between AFB1 exposure and liver cirrhosis. Mitigation of aflatoxin exposure and a better understanding of additional environmental risk factors like pesticides may be necessary to reduce the disease burden in Ethiopia.

Medication related problems among ambulatory patients with chronic kidney disease at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

BACKGROUND: Medication related problem (MRP) is an event occurring, as a result, the medication therapy that actually or potentially interferes with desired health outcomes. Evidences reported that the prevalence of MRPs may result in a high burden of morbidity and decrease patients' quality of life. The problem is more significant among patients with chronic kidney disease (CKD) as a decline in kidney function and increase number of medications required to treat kidney disease and its complications. Thus, this study aimed to assess MRPs and its associated factors among patients with chronic kidney disease. METHOD: Hospital-based cross-sectional study was conducted among 248 adult ambulatory patients with CKD (stage 1-4) at St. Paul's Hospital Millennium Medical College. Data were collected through patient interview and medical chart review from 1st of June to 30th of August 2019. MRPs were identified based on the standard treatment guidelines. Cipolle MRPs classification was used to classify the MRPs and Micromedex® was used as drug interaction checker. Binary logistic regression was utilized to identify the associated factors and p value <0.05 was considered as statistically significant. RESULT: A total of 325 MRPs were identified from 204 (82.3%) study participants giving 1.6 MRPs per participant. One MRP was identified among 114 (55.9%) patients while two MRPs were identified among 64 (31.4%). The most common class of MRPs were need additional drugs 114 (35.1%) followed by non-compliance 54 (16.6%), unnecessary drug therapy 46 (14.2%) and dose too low 46 (14.2%). The two most common reasons for non-compliance were unaffordability of drugs 26(48.1%) and the lack of patient understanding about drug taking instruction 10 (18.5%). The study showed that only occupation (AOR = 5.2, 95% CI: 1.292-21.288, P = 0.020) and angiotensin converting enzyme inhibitor use (AOR = 6.6, 95% CI: 2.202-19.634, P = 0.001) had an association with the occurrence of MRPs. CONCLUSION: The prevalence of MRPs among ambulatory patients with CKD was high and need of additional drug therapy was the commonest MRPs.

Antidiarrheal and Antibacterial Activities of Calpurnia aurea: Benth Seed Different Extracts.

Background: Calpurnia aurea is believed to have antidiarrheal potential but with limited scientific evidence. This study aimed investigating antidiarrheal and antibacterial activity of aqueous and 80% methanol seed extracts of the plant in mice and selected diarrhea-causing bacterial strains, respectively. Methods: Castor oil-induced diarrhea, prostaglandin-induced enteropooling, and castor oil-induced charcoal meal test models in mice of either sex using three dose levels (60, 120, and 240 mg/kg) were applied to evaluate antidiarrheal activity. Parameters, including onset, number, wet stool weight, weight and volume of secretion, and intestinal motility, were taken into consideration. The antibacterial activity was assessed on Shigella soni, Salmonella typhimurium, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa using disk diffusion and microdilution techniques. Results: Compared to controls, pretreatment of mice at the graded dose (60, 120, and 240 mg/kg) resulted in a significant (p < 0.05) drop in frequency of wet stools and watery content of diarrhea as well as in delaying onset of diarrhea. Both extracts exhibited inhibition of diarrhea in a dose-dependent manner in all models used. The extracts also showed significant (p < 0.05) reduction in intestinal motility in castor oil-induced models. Both extracts showed a marginal activity against the selected bacterial strains; a better effect was seen with 80% methanol seed extract. Conclusion: Both extracts of the plant have beneficial effect in controlling diarrhea. This finding supports the use of the plant as a traditional antidiarrheal remedy.

Blood Pressure Control and Associated Factors Among Hypertensive Patients Attending Shashemene Referral Hospital, Oromia, Ethiopia.

Background: Hypertension is public health challenge worldwide. It is defined as persistently elevated arterial blood pressure (BP), systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg or use of antihypertensive medication in adults older than 18 years. The aim of this study was to assess blood pressure control and associated factors among hypertensive patients attending the outpatient department of Shashemene Referral Hospital. Methods: Hospital based cross sectional study was conducted to determine level of blood pressure control and associated factors among hypertensive patients on medical follow-up. A medical chart review and interview was conducted from July 1 to October 31 2018. Result: A total of 325 participants were included in this study with response rate of 320 (98.5%). More than half of study participants were males 171 (53.4%). The mean age of the respondents was 55.10 (SD ± 12.7) years and majority of the respondents 191 (59.7%) were within age of less than 60 years old. The mean Systolic blood pressure (SBP) was 131.80 mmHg (SD ± 20.92) while the mean diastolic blood pressure (DBP) was 82.30 mmHg (SD ± 10.52). About 51.30% of study participants had a controlled SBP and 54.7% had a controlled DBP. The overall control of BP was achieved in 40.3% of the study participants. Multivariable logistic regression analysis showed that age, experience of side effects, frequency of BP measuring, number of antihypertensive drugs used, duration on antihypertensive, source of medication and physical exercise showed significant association with blood pressure control. Conclusion: Blood pressure control level among chronic hypertensive patients at outpatient department was low. Age of patients, educational level, experience of side effects, and number of antihypertensive drugs used were important determinant factors associated with blood pressure control among study participants.

Evaluation of anti-gastric ulcer activity of aqueous and 80% methanol leaf extracts of Urtica simensis in rats.

Background: Gastric ulcer is a major public health problem globally and associated with severe complications including hemorrhages, perforations, gastrointestinal obstruction, and malignancy. Urtica simensis is widely used for traditional management of gastric ulcer in different parts of Ethiopia. The present study was undertaken to evaluate the anti-gastric ulcer activity of aqueous and 80% methanol extracts of U.simensis in rats. Methods: The leaf extracts were prepared using decoction (aqueous) and maceration (80% methanol) techniques and in vivo anti-gastric ulcer effects of various doses of U. simensis extracts and the effect were determined using the pylorus ligation, indomethacin and ethanol induced gastric ulcer models. Results: In pylorus ligation induced gastric ulcer model, both aqueous and 80% methanol extracts at doses of 200 and 400 mg/kg were exhibited significant reduction in total acidity, volume of gastric secretion (p < 0.001) and substansial rise in pH (p˂0.05) of the gastric secretion. In indomethacin induced ulcer model, both aqueous and methanol extracts were exhibited dose dependent increment in gastric wall mucus compared to control (p < 0.001). In ethanol induced ulcer model, all doses of extract produced significant increment in gastric wall mucus from 46.66 ± 0.96 (AQ100) to 75.87 ± 1.52 (ME 400) µg alcian blue/g wet stomach. Five days pre-treatment with 200 mg/kg of both and aqueous and methanolic extracts exhibited significant (P < 0.001) ulcer inhibition in both indomethacin and ethanol-induced ulcer models. Conclusion: Both extracts of U.simensis exhibited a promising anti-gastric ulcer activity in all of the three models and this findings supports for traditional claimed use of the leaf of U. simensis.

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia.

BACKGROUND: Nephrotic syndrome is a common glomerular disease in children with a relapsing course that leads to complications and steroid-related toxicities. In Ethiopia, data on the outcomes of steroid therapy in pediatric nephrotic syndrome patients are limited. OBJECTIVE: The aim of the study was to assess the treatment outcomes of pediatric nephrotic syndrome patients in Ayder Specialized Comprehensive and Mekelle General Hospitals. METHODS: A retrospective study was conducted among children treated for nephrotic syndrome from 2010 to 2017 in Ayder Comprehensive Specialized and Mekelle General Hospitals. Univariate and multivariate logic regression analyses were performed to identify determinants of treatment outcome with a p-value <0.05 considered statistically significant. RESULTS: A total of 159 pediatric patients treated for nephrotic syndrome in both hospitals were included in this study. The mean age of participants at the initial diagnosis was 5.21 ± 2.66 years. Most of the patients 150 (94.3%) achieved remission within 4 weeks of steroid therapy. Among initial responders, the majority of the patients 117 (78%) encountered relapses of which 65 (40.9%) were developed frequent relapse/steroid-dependent nephrotic syndrome. Also, the majority of patients 102 (64.5%) encountered steroid-related toxicities. The predictors of frequent relapse/steroid-dependent nephrotic syndrome were age of ≤6 years (AOR=3.16; p=0.00), hematuria (AOR=6.74; p=0.00), infection (AOR=3.28; p=0.01), acute renal failure (AOR=6.09; p=0.01), serum albumin below 1.5g/dl (8.38, p=0.01) and lack of remission within 2 weeks (AOR=3.69; p=0.00). CONCLUSION: Most of the pediatric NS patients treated in ACSH and MGH have achieved remission with initial to steroid therapy. However, there was a higher relapse rate and steroid-related toxicities among pediatric NS patients who achieved remission. Early age at diagnosis, hematuria, reduced GFR, infection, and remission time were the independent predictors of the frequent relapsing/steroid-dependent nephrotic disease course.

Correction: Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study.

[This corrects the article DOI: 10.1371/journal.pone.0228953.].

Evaluation of the Antimalarial Activity of the Hydroalcoholic Extract of Leaf of Leonotis ocymifolia (Burm. f.) Iwarsson (Lamiaceae) against Plasmodium berghei in Mice.

Malaria's global impact, fueled by resistance to several antimalarial drugs, has necessitated a quest to new antimalarial drugs from several sources with traditional medicinal plants being one of them. This study was conducted to assess the antimalarial activity of a traditionally used medicinal plant, Leonotis ocymifolia, against Plasmodium berghei. The plant has been extracted using maceration technique, and doses ranging from 100-800 mg/kg of Leonotis ocymifolia were used to test its antimalarial activity. Tween 80 (2% in water) and chloroquine 25 mg/kg were used as negative and positive controls, respectively. The antimalarial activities of the plant were determined by measuring parasitemia, survival time, packed cell volume, temperature, and weight. The plant's hydroalcoholic extract, as compared to negative control, maximally decreased parasite load by 41.4% at 800 mg/kg (p < 0.001). This parasite suppression was followed by longer survival time in the groups taking 400 mg/kg (p < 0.05) and 800 mg/kg (p < 0.05) in a four-day suppressive test and in those taking 800 mg/kg (p < 0.05) in Rane's test. The plant did not prevent weight and PCV reduction but prevented temperature reduction at 400 mg/kg (p < 0.05) and 800 mg/kg (p < 0.05) in a four-day suppressive model, and at 800 mg/kg (p < 0.05) in Rane's model. The average but consistent antimalarial activity of the plant across the test models corroborates the folkloric antimalarial use of the plant. The study recommends further pharmacological screenings, isolation, and identification of active compound(s) of the plant Leonotis ocymifolia.

Blood pressure control practice and determinants among ambulatory hypertensive patients attending primary health care facilities in Addis Ababa.

BACKGROUND: Hypertension is the major risk factor for cardiovascular diseases related morbidity and mortality. Blood pressure is often not adequately controlled in clinical practice. Information regarding blood pressure control in primary care settings is limited in Ethiopia. OBJECTIVES: This study aimed to assess blood pressure control practice and determinates among hypertensive patients attending primary health care facilities in Addis Ababa. METHODS: A cross-sectional study was conducted on 616 hypertension patients in 12 health centers in Addis Ababa city. Data were collected by interviewing patients and reviewing their medical records. Data were collected from 3 August to 30 October 2015. RESULTS: A complete information was obtained from 616 patients' medical records, and patients were then interviewed. The mean age was 58.90 (SD ± 13.04) years, and most of them (n = 321, 52.1%) were 60 years old or above, and more than three-fourth (n = 485) were on monotherapy. Methyldopa was the most monotherapy medication prescribed, 128 (20.8%). Only 31% (n = 191) of the patients had controlled blood pressure. Determinants for poor blood pressure control were age less than 60 years (adjusted odds ratio (AOR) = 3.06, 95% confidence interval (CI): 1.96, 4.78); work status: government employee (AOR = 2.41, 95% CI: 1.18, 4.90), retired (AOR = 1.79, 95% CI: 1.01, 3.18), and private business (AOR = 2.09, 95% CI: 1.17, 3.74); and being hypertensive for 10 or more years (AOR = 1.96, 95% CI: 1.11, 3.43). Significant predictors of achieving controlled blood pressure were weekly blood pressure measurement practice (AOR = 0.57, 95% CI: 0.36, 0.90) and tertiary-level education (AOR = 0.26, 95% CI: 0.13, 0.54). CONCLUSIONS: Only one-third of the patients had controlled blood pressure. Efforts should be made to address identified determinants including age, regular blood pressure monitoring practice, and level of education.

Assessment of the Management of Diarrhoea Among Children Under Five in Addis Ababa, Ethiopia.

PURPOSE: Irrational antibiotic use is a worldwide problem. One of the main reasons for excessive use of antibiotics is the failure to follow the clinical guidelines. Inappropriate use of antibiotics for infectious diarrhea is associated with the risk of increasing the development of antimicrobial resistance and the cost of health care. We therefore pursued to assess the appropriateness of the management of diarrhea in children in Addis Ababa. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted in the health centers of Addis Ababa, Ethiopia, between September 2014 and February 2015. Demographic characteristics, signs of dehydration, stool characteristics, drug types and other relevant information have been collected. Data analysis was performed using version 20 of the SPSS. Logistic regression was used to examine the association between dependent and independent variables. Indicators for the appropriateness of diarrhoea management have been established on the basis of the Standard Treatment Guideline and the guidelines of the World Health Organization. RESULTS: A total of 803 medical records of children have been checked. Of this, 54.4% had received inappropriate management. At least one antimicrobial was prescribed to 73.2% of the children who visited the health centres. Oral rehydration solution (ORS) and zinc were prescribed only in 66.7% and 47.5%, respectively. Appropriate management among children diagnosed with dysentery was found to be 6.38 times higher adjusted odds ratios (AOR=6.38 (3.11, 13.63)) than children with watery diarrhea. Although antibiotics are prescribed inappropriately for most children, it is appropriate when the diarrhea is bloody. Appropriate management of diarrhoea among infants aged 2-11 months was 54% less compared to children aged 12-59 months (AOR=0.46 (0.24, 0.90)). CONCLUSION: The magnitude of inadequate antibiotic prescription while managing diarrhoea in our setting was high. On the contrary, a low prescribing rate of ORS and zinc was observed. Our result highlights the need for urgent action to prevent the development of antibiotic-resistant microorganisms. Health-care professionals should have clear information on the risks of inadequate diarrhoea treatment in children under five.

Antimalarial activity of the aqueous extract of the latex of Aloe pirottae Berger. (Aloaceae) against Plasmodium berghei in mice.

ETHNOPHARMACOLOGICAL RELEVANCE: In spite of worldwide efforts, malaria remains one of the most devastating illnesses in the world. The huge number of lives it takes and the resistance of malaria parasites to current drugs necessitate the search for new effective antimalarial drugs. Medicinal plants have been the major source of such drugs and A. pirottae is one of these plants used traditionally for the treatment of malaria in Ethiopia. AIM: This study was aimed at evaluating the antimalarial activity of the aqueous extract of A. pirottae against chloroquine sensitive P. berghei in mice. MATERIALS AND METHODS: The extract was obtained by macerating the latex of A. pirottae with distilled water. To determine its antiplasmodial activity, a 4-day suppressive model was used by dividing 40 mice into five groups of 8 mice each and given 200, 400 & 600mg/kg of the extract, the standard drug (chloroquine 25mg/kg) and the vehicle (distilled water). Then parasite suppression by the extract, survival time and prevention of loss of body weight, rectal temperature and packed cell volume were assessed. All data were presented as the Mean ±â€¯SEM (Standard Error of the Mean) and analyzed using IBM SPSS version 20. RESULTS: The extract showed moderate antimalarial activity by significantly (p < 0.001) suppressing parasitemia at all dose levels with maximum parasitemia suppression of 47.0% and significantly (p < 0.01) increasing survival time. Furthermore, 400 mg/kg and 600 mg/kg doses showed significant (p < 0.01) prevention of loss in body weight, rectal temperature and packed cell volume. CONCLUSION: Based to the results of this study, A. pirottae is endowed with a moderate antimalarial activity that is in agreement with the traditional claim of A. pirottae, hence may be used as a basis for further studies to be conducted on antimalarial activity of the plant.

Antimalarial Activity of Aqueous and 80% Methanol Crude Seed Extracts and Solvent Fractions of Schinus molle Linnaeus (Anacardiaceae) in Plasmodium berghei-Infected Mice.

BACKGROUND: Malaria is among the leading causes of mortality and morbidity. Moreover, the emergence of resistance to antimalarial drugs is a major problem in controlling the disease. This makes the development of novel antimalarial drugs a necessity. Medicinal plants are important sources in discovering antimalarial drugs. Schinus molle is claimed for its antimalarial effect in Ethiopian folkloric medicine and endowed with in vitro antiplasmodial activity. In the present study, the in vivo antimalarial activity of the plant was investigated. METHODS: Acute toxicity was carried out using a standard procedure. To screen the in vivo antimalarial activity of the plant was investigated. S. molle against Plasmodium berghei (ANKA), a 4-day suppressive test was employed. The extracts and fractions were given to infected mice by oral gavage at 100, 200, and 400 mg/kg/day for four consecutive days. Parameters such as parasitemia were then evaluated. RESULTS: Any sign of toxicity was not observed in the oral acute toxicity test. The crude extracts and solvent fractions exerted a significant (p < 0.05) inhibition of parasite load compared to the negative control. The highest inhibition (66.91%) was exhibited by the 400 mg/kg/day dose of 80% methanolic crude extract. Among the fractions, chloroform fraction demonstrated maximal chemosuppressive effect (55.60%). Moreover, crude extracts and solvent fractions prevented body weight loss, reduction in temperature, and anemia compared to the negative control. Except the aqueous fraction, the tested plant extracts were able to significantly prolong the survival time of infected mice. CONCLUSION: The findings of the present study confirmed the safety and a promising in vivo antimalarial activity of S. molle, thus supporting the traditional claim and in vitro efficacy. In-depth investigations on the plant, however, are highly recommended.in vivo antimalarial activity of the plant was investigated. S. molle against in vitro antiplasmodial activity. In the present study, the.

Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study.

BACKGROUND: Acute coronary syndrome (ACS) is increasingly becoming a common cause of cardiovascular mortality in developing countries. Even though, there is an introduction of limited percutaneous coronary intervention and thrombolytic therapies, in-hospital mortality due to ACS still remains high in sub-Saharan countries. OBJECTIVE: The aim of the study was to assess treatment outcome of ACS patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. METHODS: A retrospective cross-sectional study was done by collecting data from patients' medical records using a data abstraction tool. Data were analyzed using logistic regression to determine crude and adjusted odds ratio. At 95% confidence interval, p-value<0.05 was considered as statistically significant. RESULTS: Of the total 151 patients, in-hospital mortality was found to be 24.5%, and hypertension was the most frequent (46.4%) risk factor of ACS. Concerning the management practice, catheterization and primary percutaneous coronary intervention were done in 27.1%, and 3.9% respectively. Additionally, in emergency setting loading dose of aspirin and clopidogrel were used in about 63.8% and 62.8%, respectively. The other frequently used medications were beta-blockers (86.9%), angiotensin converting enzymes/angiotensin receptor blockers (84.1%) and statins (84.1%). Streptokinase was administered in 6.3% of patients with ST-elevated myocardial infarction and heparins in 78.1% of them. The commonly prescribed discharge medications were aspirin (98.2%), statins (94.7%) and clopidogrel (92%). Non-use of beta-blockers (p = 0.014), in-hospital complication of cardiogenic shock (p = 0.001) and left ventricular ejection fraction of ≤ 30% (p = 0.032) were independent predictors of in-hospital mortality. CONCLUSION: The proportion of in-hospital mortality due to ACS was found to be high. Therefore, timely evidence based therapy should be implemented in the setup.

Treatment outcome and its predictors among patients of acute heart failure at a tertiary care hospital in Ethiopia: a prospective observational study.

BACKGROUND: Acute heart failure is a rapid onset of new or worsening of signs and symptoms of heart failure that requires hospitalization or a visit to the emergency department. The aim of this study was to evaluate treatment outcome and determine factors that predict a poor treatment outcome in acute heart failure patients at a Tertiary Care Hospital in Ethiopia. METHODS: A prospective observational study design was used. Data were collected using a structured questionnaire as a tool. Outcome variables were assessed at the time of discharge from the hospital. Bivariate and multivariate logistic regression analyses were used to determine factors that predict in-hospital mortality. A p-value ≤0.05 was considered as statistically significant. RESULTS: Out of the 169 patients, the median age of patients with acute heart failure was 34 years (IQR = 23 to 50) and median hospital stay was 4.0 days (IQR = 3.0 to 6.0). The leading precipitating factor and underlying disease at the time of admission were pneumonia (47.5%) and chronic rheumatic heart disease (48.5%), respectively. The in-hospital mortality was found to be 17.2%. Smoking (adjusted odds ratio (AOR) = 8.7, p = 0.006), diabetes mellitus (AOR = 10.2, p = 0.005), pulmonary hypertension (AOR = 4.3, p = 0.016), and the presence of adverse drug events (AOR = 4.2, p = 0.003) were predictors of in-hospital mortality. CONCLUSION: High in-hospital mortality was observed among acute heart failure patients admitted to a Tertiary Care Hospital in Ethiopia. Smoking, diabetes mellitus, pulmonary hypertension and the presence of adverse drug events were predictors of in-hospital mortality.

Evaluation of the anti-malarial activity of crude extract and solvent fractions of the leaves of Olea europaea (Oleaceae) in mice.

BACKGROUND: Drug resistance poses a challenge to malaria control measures. This calls for discovery & development of new chemotherapeutic agents. This study therefore was initiated to investigate the antimalarial activity of Olea europaea against Plasmodium berghei infected mice and to further ascertain in which fraction (s) the constituents responsible for anti-malarial activity are concentrated. METHODS: The leaves of Olea europaea were extracted by maceration using 80% methanol and the crude extract was then successively fractionated with solvents of differing polarity (chloroform, n-butanol and water). The anti-malarial activity of various doses of the extract and fractions (200, 400 and 600 mg/kg) was evaluated using chemo-suppressive, curative, and repository tests. Parameters, including parasitemia, rectal temperature, body weight, and packed cell volume were determined to establish the activity. RESULTS: The acute oral toxicity test result revealed that the LD50 values of the extract and fractions were greater than 2000 mg/kg in mice. The crude extract significantly reduced parasitemia (p < 0.001) and prolonged survival time (p < 0.001), in a dose-dependent manner, in all tests, as compared to the negative control group. Higher parasitemia suppression (58%) was achieved with the larger dose (600 mg/kg) in the 4-day suppressive test, suggesting that the crude extract has largely a chemo-suppressive activity. Parasitemia was significantly reduced (p < 0.001) by all fractions in all doses used when compared to the negative controls, with the rank order of n-butanol (51%) > chloroform>aqueous (21%) fractions. Larger (600 mg/kg) and middle (400 mg/kg) doses of the crude extract as well as the fractions ameliorated all the other parameters in a consistent manner, with the crude being more active than the fractions. Preliminary phytochemical analysis revealed the presence of secondary metabolites that were differentially distributed in the fractions. CONCLUSION: The findings collectively indicate that the plant is endowed with antimalarial activity, the activity being more in the crude extract than the fractions, owing to the presence of secondary metabolites that act independently or in synergy. The varying degree of antimalarial activity in the fractions suggests that non-polar and medium polar principles could be responsible for the observed activity.

Evaluation of Hypoglycemia and Associated Factors among Patients with Type 1 Diabetes on Follow-Up Care at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

BACKGROUND: Hypoglycemia is one of the most common acute complications of type 1 diabetes mellitus (T1DM). The knowledge of the factors associated with hypoglycemia will help in the prevention and management of the problem. Therefore, this study was conducted to assess hypoglycemia and its associated factors among T1DM patients who attended the diabetes outpatient clinic of St. Paul's Hospital Millennium Medical College (SPHMMC). METHODS: A cross-sectional study was conducted at the diabetes clinic of SPHMMC. Data on sociodemographic and clinical characteristics including duration of diabetes, type of insulin they have been taking, the factors associated with hypoglycemia, and the severity stage of hypoglycemia was obtained. Data was collected using a structured questionnaire and chart review. Multivariate logistic regression model was used to identify factors associated with hypoglycemia. RESULT: Out of the 247 participants who were recruited into the study, 233 (94.3%) of them experienced hypoglycemia. A total of 6.9 events of hypoglycemia per patient per year happened. Particularly, the events were categorized as 3.1 mild events, 2.3 moderate events, and 0.93 severe events of hypoglycemia. Shorter duration of diabetes history (<1 year) was significantly associated with less experience of hypoglycemia (AOR = 0.09, 95% CI: 0.01-0.90). However, blood glucose monitoring at home was found to be significantly associated with more report of hypoglycemia (AOR = 5.77, 95% CI: 1.16-28.66). CONCLUSION: The prevalence of hypoglycemia among T1DM patients was found as substantially high. Self/family blood glucose monitoring at home could not guarantee to minimize the occurrence of hypoglycemia events. Finger stick home blood glucose monitoring should be given a special attention. Therefore, the involvement of health care providers in diabetes care should be encouraged to address the occurrence of hypoglycemia in T1DM patients.

Treatment Outcomes of Patients with Acute Coronary Syndrome Admitted to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Acute coronary syndrome (ACS) refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction that are usually due to an abrupt reduction in coronary blood flow. OBJECTIVE: The objective of the study was to assess the treatment outcome and associated factors for ACS. METHODS: A retrospective cross-sectional study was conducted from January 1, 2012 to December 31, 2014. RESULTS: Of 124 ACS patients who were admitted during the 3 years' period, 90 (72.6%) were diagnosed with ST segment elevation myocardial infarction (STEMI). The mean age was 56.3 ± 13.7 years. The average length of hospital stay was 9.77 ± 6.42 days. The average time from onset of ACS symptoms to presentation in the emergency department was 3.8 days (91.7 hours). In about 76 (61.3%) patients, hypertension was the leading risk factor for development of ACS, and 36.4% of ACS patients were either Killip class III or IV. Biomarkers were measured for 118 (95.2%) patients, and 79.2% of patients had ejection fraction of less than 40% and 29.2% had less than 30%. In-hospital medication use includes loading dose of aspirin (79%), anticoagulants (77.4%), beta blockers (88.1%), statins (85.5%), morphine (12.9%), and nitrates (35.5%). The in-hospital mortality was 27.4%. The predictors for in-hospital mortality were age (P = .042), time from symptom onset to presentation (P = .001), previous history of hypertension (P = .025), being Killip class III and IV (P = .001), and STEMI diagnosis (P = .005). CONCLUSIONS: The medical management of ACS patients in Tikur Anbessa Specialized Hospital (TASH) was in line with the recommendations of international guidelines but in-hospital mortality was extremely high (27.4%).