The Prevalence and Determinants of Inappropriate Oral Anticoagulant Use in Patients with Atrial Fibrillation, in Resource-Limited Setting.

Introduction: Anticoagulation treatment is routinely underused in patients with atrial fibrillation (AF), particularly in settings with limited resources. The current study is aimed at evaluating the appropriateness of oral anticoagulation treatment among AF patients at the Yekatit 12 Hospital Medical College (Y12HMC), Addis Ababa, Ethiopia. Methods: Institutional-based retrospective cross-sectional study conducted in Y12HMC from November 2019 to March 2020. During the study period, 256 patients' medical records were found; 231 of them met the eligibility criteria and were included in the study. The data were analyzed using SPSS version 25, descriptive statistics were used to summarize the data, and binary logistic regression was performed to identify predictors of inappropriate anticoagulation management. Results: The majority of study participants were males (55.8%), and over half of them (57.6%) had a nonvalvular type of AF. The majority of patients (61.9%) were receiving anticoagulant treatment, and of them, warfarin was prescribed to most of the study subjects (71.3%). Nearly half (47.6%) of the study participants had inappropriate anticoagulation treatment; among these, the majority of them (69.1%) were from a valvular type of AF. Patients with a valvular type of AF and having the diagnosis of congestive heart disease as comorbidity showed a statistically significant association towards inappropriate anticoagulation management. Conclusion: According to the study, a significant portion of AF patients received inappropriate anticoagulant treatment, which may play a significant role for the increased risk of stroke in these groups of patients. All of the inappropriate cases were due to failure to start anticoagulant treatment.

Evaluation of Anti-Diarrheal Activities of the 80% Methanol Extract and Solvent Fractions of Maesa lanceolata Forssk (Myrsinaceae) Leaves in Mice.

Background: Due to the limits of present antidiarrheal medications, it is critical to seek novel, safe, and inexpensive antidiarrheal agents. Thus, the goal of this study was to assess the antidiarrheal activity of 80% methanol crude extract and solvent fractions of Maesa lanceolata leaves in mice. Methods: Leaf powder was extracted by 80% methanol and then fractionated with n-hexane, ethyl acetate, and distilled water. At 100, 200, and 400 mg/kg, the effects of the crude extract on castor oil-induced diarrhea, enteropooling, and gastrointestinal motility tests were investigated. Tween 2% and atropine used as negative and positive controls, respectively. A gastrointestinal motility test was used to explore the anti-motility effects. Data were analyzed with SPSS V. 26, and the significance was established with a one-way ANOVA followed by a post hoc Tukey's test. Results: The crude extract delayed the onset of diarrhea and significantly reduced the number of fecal drops at 100 (p<0.05), 200 and 400 mg/kg (p<0.001). Similarly, the number and weight of wet feces, as well as total fresh feces, were reduced at 200 (p<0.05) and 400 mg/kg (p<0.001) compared to Tween 2%. The enteropooling test demonstrated that the extracts significantly reduced the volume and weight of intestine content at 200 (p<0.05) and 400 mg/kg (p<0.001). The anti-motility activity test revealed that the all extracts decreased gastrointestinal motility significantly (p<0.001). The ethyl acetate fraction significantly reduced gastrointestinal transit time at all doses (p<0.001). At 400 mg/kg, the activities of the n-hexane fraction were significant (p<0.01). The efficacy of the residual aqueous fraction on gastrointestinal motility was significant at 200 (p<0.05) and 400 mg/kg (p<0.001). Conclusion: The 80% methanol extract of Maesa lanceolata Forssk leaf and solvent fractions were shown to exhibit potent antidiarrheal activity in the current study.

Anti-Diarrheal Activities of Hydromethanolic Crude Extract and Solvent Fractions of Acacia seyal (Fabaceae) Roots in Mice.

Background: Traditionally, the root of Acacia seyal is used for the treatment of diarrhea. However, its efficacy has not been scientifically evaluated. Thus, this study aimed to validate the antidiarrheal activities using hydromethanolic crude extract and solvent fractions of Acacia seyal roots in mice. Methods: In each model, mice were divided into five groups of six mice at random. Group I mice (negative controls) were given 1mL/100 g distilled water for hydromethanolic crude extract tests as well as n-hexane, ethyl acetate and aqueous fractions, while groups II, III, and IV were given 100 mg/kg, 200 mg/kg, and 400 mg/kg of hydromethanolic crude extract or solvent fractions. Group V mice (positive control) were given 3 mg/kg Loperamide for the castor oil-induced diarrhea and enteropooling test. All of the doses were taken orally. However, Atropine sulfate, 5 mg/kg, was given intraperitoneally for the gastrointestinal motility test. Statistical Package for the Social Sciences (SPSS) version 26 was used to examine the statistical significance of differences in the number and weight of wet and total feces, distance traveled by a charcoal meal, and intestinal fluid accumulation across groups. Results: When compared to the vehicle-treated group, the crude extract and n-hexane fraction notably delayed the onset of diarrhea, reduced the weight and volume of intestinal contents, and hindered the intestinal transit at all tested doses (P < 0.001). The ethyl acetate fraction also significantly (P < 0.001) decreased the weight of intestinal content at all doses examined. Only at 400 mg/kg did the aqueous fraction statistically (P < 0.01) prolonged the onset of diarrhea and impeded gastrointestinal motility. Conclusion: According to this study, the hydromethanolic crude extract and solvent fractions of Acacia seyal roots have promising antidiarrheal effects.

Pharmacological evaluation of medicinal plants with antidiabetic activities in Ethiopia: A review.

Diabetes mellitus is a serious, chronic disease that occurs either when the pancreas does not produce enough insulin, or when the body can't effectively use insulin. Herbal medicines have been commonly used by diabetic patients for the treatment of diabetes mellitus. To include findings from different studies, publications related to in vivo and invitro antidiabetic activities of medicinal plants in Ethiopia were searched from different databases, such as Web of Science, Google Scholar, Medline, Scopus, and PubMed, using English key terms. Different medicinal plant parts were used experimentally for antidiabetic effects in Ethiopia. Among these, leaves (69%) were the most commonly investigated medicinal plant parts followed by roots (14%) and seeds (7%). Most of the investigations were completed with hydro-methanolic extracts to obtain a higher percentage of yield. Medicinal plants such as Thymus schemperi R, Thymus vulgaris L, Hagenia abyssinica, Aloe megalacantha baker, Aloe moticola Reyonolds, Aloe pulecherrima Gilbert & sebseb, Bersama abyssinica fresen, and Rubus Erlangeri Engl have shown in vitro α-amylase inhibitory activity. However, only Hagenia abyssinica, Thymus schemperi R, and Thymus vulgaris L have exhibited α-glucosidase inhibitory activity. Likewise, only the extract of Aloe pulecherrima Gilbert & sebseb posses' maltase and sucrose inhibitory activity. In vivo antidiabetic activity were conducted for the extract of medicinal plants such as A. remota, S. rebaudiani, T. schemperi, T. vulgaris, H. abyssinica, C. aurea, D. stramonium, A. megalacantha, A. moticola, A.integrifolia, A. pulecherrima, B. grandiflorum, B. abyssinica, P. schimperiana, M. stenopetala, C. aure, J. schimperiana, T. brownie, C. macrostachys, I. spicata, O. integrifolia, C. abyssinica, R. Erlangeri, L. culinaris, A. camperi, A. polystachyus, A. ilicifalius, C. tomentosa, and C. Edulis. This review gives collective evidence on the potential antidiabetic activities of medicinal plants in Ethiopia. Moreover, further studies are recommended to substantiate the use of these medicinal plants as an antidiabetic agent.

Assessment of lifestyle changes during coronavirus disease 2019 pandemic in Gondar town, Northwest Ethiopia.

BACKGROUND: Coronavirus disease 2019 has had a global effect on people's lifestyles. Many people have developed irregular eating patterns and become physically inactive, which leads to an aggravation of lifestyle-related diseases and unhealthier lifestyles; these, subsequently raise the severity of coronavirus disease 2019. This study aimed to assess lifestyle changes during coronavirus disease 2019 pandemic in Gondar town, North West, Ethiopia. METHOD: Community-based cross-sectional study design was conducted among households at Gondar town from June to August 2021. The study participants were selected by a systematic random sampling technique from proportionally allocated kebeles. Data were collected using face-to-face interview techniques and were entered and analyzed by using a statistical package for the social sciences version 24; P-values < 0.05 were considered as statistically significant. RESULT: Overall, 348 study participants were included in the study. Among those respondents, 52.3% (182) were female study participants and the mean age of the respondents was 30.95±14.4. In this study, there was a significant decrement in non-homemade food from 20.4% to 13.4% at (P = <0.001). Concerning water intake, 11.5% (40) of respondents consumed ≥8 cups/day before the coronavirus disease 2019 pandemic, and the percentage increased to 14.7% (51) during the coronavirus disease 2019 pandemic (p = 0.01). Of the participants, 46% participants were reported never engaging in any physical activity before the coronavirus pandemic, and the percentage decreased to 29.9% during the pandemic (P = 0.002). The respondents also exhibited increment tension in large from 4.9% to 22.7% before and during the coronavirus disease 2019 pandemic, respectively. Furthermore, about 6.3% of the study participants slept badly before the coronavirus disease 2019 pandemics and the effects of sleeping badly and restlessly increased to 25.9% during the coronavirus disease 2019 pandemic (P = <0.001). CONCLUSION: The current study demonstrates that there is a noticeable alteration in food consumption, food choices, regular mealtime, sleeping habits, mental exhaustion, and practice of physical activity.

Prevalence and predictors of dyslipidemia among hypertensive patients in Lumame Primary Hospital, Amhara, Ethiopia: A cross-sectional study.

BACKGROUND: Serum lipid profile abnormalities are major predictors for coronary artery diseases. The relationship between demographic factors and dyslipidemia in Ethiopia is not completely explored. Thus, this study aimed to assess the prevalence and predictors of dyslipidemia among hypertensive patients in Lumame Primary Hospital. METHODS: A cross-sectional study was conducted from June to August 30, 2020, on the hypertensive patients in Lumame Primary Hospital. All adult hypertensive patients who visited the adult hypertensive care services during the study period were included. Interview-guided self-administered questionnaire and a chart review were used for data collection. Statistical Package for the Social Sciences (SPSS) software version 24.0 was used for data analysis. RESULTS: Out of 372 hypertensive patients, 190(51.1%) were females and the mean age of the study participants was 43.56 years (SD ± 4.31). The overall prevalence of dyslipidemia in this study was 48.4%. Besides the overall prevalence, the prevalence of TC, TG, LDL-c, and HDL-c was 73(19.6%), 91(24.5%), 60(16.1%), and 115(30.9%), respectively. Females were at higher risk for having high levels of TC (AOR = 2.31, 95% CI = 1.54-3.13), TG (AOR = 1.70, 95% CI = 1.34-3.79), LDL-c (AOR = 2.15, 95% CI = 1.56-2.86), and HDL-c (AOR = 2.67, 95% CI = 1.44-5.67) than males. Respondents who were from urban were at higher risk for having high levels of TC (AOR = 1.98, 95% CI = 1.04-6.83), TG (AOR = 1.78, 95% CI = 1.09-2.86), LDL-c (AOR = 3.01, 95% CI = 1.45-7.43), and HDL-c (AOR = 2.01, 95% CI = 1.94-4.55) than respondents who were from rural. Similarly, obese respondents were at higher risk for having high levels of TC (AOR = 2.03, 95% CI = 1.64-2.00), TG (AOR = 3.78, 95% CI = 1.06-6.42), LDL-c (AOR = 1.92, 95% CI = 1.66-2.12), and HDL-c (AOR = 4.23, 95% CI = 2.84-4.32) than to respondents who were underweight. CONCLUSION: The prevalence of dyslipidemia among hypertensive patients was high. Independent variables such as age, gender, residence, family history of HTN, smoking, alcohol drinking, fruit diet habits, physical activity, DM, and BMI were significant determinants of dyslipidemia.

Pharmacological Evaluation of Antipyretic and Antioxidant Activities of 80% Methanol Root Extract and Derived Solvent Fraction of Echinops kebericho M. (Asteraceae) in Mice Model.

BACKGROUND: Toxicity and untoward effects are very ostensible in most standard drugs including antipyretic agents. Searching for conceivable antipyretic drugs with minimal toxicities and side effects from traditional plants is a growing concern to date. Echinops kebericho M. (Asteraceae) is one of the most prominent traditional medicinal plants, which is frequently testified for its traditionally claimed uses of treating fever and different infectious and noninfectious disorders by traditional healers in Ethiopian folk medicine. However, this plant has not been scientifically assessed for its traditionally claimed uses. This study therefore is aimed at investigating the antipyretic and antioxidant activities of 80% methanol root extract and the derived solvent fraction of Echinops kebericho M. in mouse models. METHODS: Successive solvent maceration with increased polarity was used as the method of extractions, and chloroform, ethyl acetate, methanol, and water were used as solvents. After extraction, the crude extract and its derived solvent fractions were assessed for their antipyretic activities using yeast-induced pyrexia while, the antioxidant activities were measured in vitro using the diphenyl-2-picrylhydrazyl (DPPH) assay method. Both the extract and solvent fractions were evaluated at the doses of 100, 200, and 400 mg/kg for its antipyretic activities, and the antioxidant activity was evaluated at the doses of 50, 100, 200, 400, 600, 800, and 1000 mg/kg. The positive control group was treated with standard drug (ASA 100 mg/kg), while normal saline-receiving groups were assigned as negative control. RESULT: E. kebericho crude extract along with its derived solvent fractions showed statistically significant (p < 0.05, 0.01, and 0.001) temperature reduction activities. The maximum percentage of temperature reduction was observed by the highest dose (400 mg/kg) of the crude extract. The aqueous fraction also showed significantly (p < 0.05 and 0.01) higher temperature reduction than those of ethyl acetate and chloroform fractions. The free radical scavenging activities of the crude extract were also significantly high at the maximum dose, and the aqueous fraction showed the significantly highest antioxidant activity. CONCLUSION: In general, the data obtained from the present study clarified that the extract possessed significant antipyretic and antioxidant activities, upholding the traditionally claimed use of the plant.

Knowledge, Attitude, and Practices of Unused Medications Disposal among Patients Visiting Public Health Centers in Gondar Town, Ethiopia: A Cross-Sectional Study.

Background: The improvement of healthcare systems has brought the subsequent increase in people access to medications. The consumers are not able to use all the dispensed medications because of various reasons. The improper disposal of these unused medicines has led to environmental contamination to an alarming extent. Therefore, the study was conducted to assess the knowledge, attitude, and practice of unused medications disposal among patients visiting public health centers in Gondar town, Ethiopia. Methods: A descriptive cross-sectional study was conducted among 404 patients visiting public health centers in Gondar town, Ethiopia, from August to September 2021, by using standardized and a locally translated semistructured questionnaire. The data were entered and analyzed by using the SPSS version of 21.0. The variable of interest was described in the form of statements and tables. Result: Out of 404 respondents included in the study, 221 (54.7%) of them were female. More than half (226 (55.9%)) of the respondents had unused medicine at home. The common methods of disposal practice were throwing into a household garbage (150 (31.4%)), followed by flushed into toilet/sinks (88 (21.8%)). More than half (286 (70.8%)) of the respondents knew about medication waste and 239 (59.2%) of them checked their medication expiry date. More than half (215 (53.5%)) of the participants strongly agreed that unused medicine can cause potential risk at home and 279 (69.1%) of study participants strongly agreed that children are more vulnerable to the potential risk of unused medicine at home. Conclusion: There was a high practice of keeping medication at home, and most disposal approach indicated by the participants was not recommended methods. Awareness about the proper disposal of unused medicines among the public should be created. Guidelines on safe disposal are required, and an organized method of collecting unused and expired pharmaceuticals needs to be introduced.

Evaluation of Analgesic and Anti-Inflammatory Activities of 80% Methanol Root Extract of Echinops kebericho M. (Asteraceae).

BACKGROUND: Pain and inflammation are the major devastating health problems commonly treated with traditional medicinal plants in Ethiopia. Echinops kebericho M. (Asteraceae) is the one which is frequently used to treat pain and inflammation by traditional healers in Ethiopian folk medicine. However, the plant has not been scientifically evaluated for its traditionally claimed use. The present study aimed at the investigation of analgesic and anti-inflammatory activities of 80% methanol root extract of Echinops kebericho M. in mice model. METHODS: Successive maceration was used as a method of extraction using solvents of increasing polarity: methanol and water. After extraction of the roots with 80% hydro methanol, the crude extract was evaluated for its peripheral and central analgesic activities using acetic acid-induced writhing test and hot plate method, respectively, while its anti-inflammatory activity was evaluated using carrageenan- and formalin-induced paw edema. The extract was evaluated at 100, 200 and 400 mg/kg doses. The positive control groups were treated with ASA 150 mg/kg for writhing test, morphine 10 mg/kg for hot plat method, indomethacin 25 mg/kg and diclofenac 10 mg/kg for paw edema tests and vehicle, distilled water (10 mL/kg) treated mice were assigned as negative controls. All treatment administrations were performed orally. RESULTS: E. kebericho extract at all test doses showed statistically significant antinociceptive activity in both chemicals-induced peripheral and thermal-induced central pain in a dose dependent manner (p < 0.01 and p < 0.001). The greater analgesic activity was observed by the maximum dose of the extract (400 mg/kg) in both acetic acids-induced writhing test (57.84%) and hot plate method (69.40%). The effect of the extract was also statistically significant (p < 0.01 and p < 0.001) in both carrageenan and formalin-induced paw edema in dose dependent manner. Greater edema inhibition was observed by the highest dose (400 mg/kg) in both observations with the respective percentage values of 70.00% and 79.87%, respectively. CONCLUSION: In general, the data obtained from the present study elucidated that the extract possessed a significant analgesic and anti-inflammatory activities and recommended for further studies.

Ten year trend analysis of malaria prevalence in Kola Diba, North Gondar, Northwest Ethiopia.

BACKGROUND: Malaria is caused by protozoan parasites of the genus Plasmodium. It is one of the leading causes of illness and death in the world. It is a major public health problem in Ethiopia. Over the past years, the disease has been consistently reported as the first leading cause of outpatient visits, hospitalization and death in health facilities across the country. METHODS: A retrospective study was conducted to determine the prevalence of malaria from peripheral blood smear examinations from the Kola Diba Health Center of Ethiopia. The case notes of all malaria cases reported between 2002-2011 were carefully reviewed and analyzed. Additionally, any malaria intervention activities that had been taken to control malaria were collected using a well-prepared checklist from the study area. RESULTS: Within the last decade (2002-2011) a total of 59, 208 blood films were requested for malaria diagnosis in Kola Diba health center and 23,473 (39.6%) microscopically confirmed malaria cases were reported in the town with a fluctuating trend. Regarding the identified plasmodium species, Plasmodium falciparum and Plasmodium vivax accounted for 75% and 25% of malaria morbidity, respectively. Malaria was reported in all age groups and both sexes, but the 15-44 year age group and males were more affected. Despite the apparent fluctuation of malaria trends in the area, the highest peak of malaria cases was reported during spring seasons. CONCLUSION: Comparatively, after the introduction of the current malaria control strategies, the morbidity and mortality by malaria is decreasing but malaria is still a major health problem and the deadly species P. falciparium is predominant. Therefore, control activities should be continued in a strengthened manner in the study area considering both P. falciparium and P. vivax.