Evaluation of antibiotic utilization pattern in the treatment of acute diarrheal diseases at Debre Tabor comprehensive specialized hospital, Debre Tabor, Ethiopia: A retrospective cross-sectional study.

Background: In clinical settings all across the world, including Ethiopia, the irrational use of antibiotics to treat acute diarrhea is common. The main causes of resistance are antibiotic abuse, misuse, and underuse, and among infectious diseases, antibiotic overuse is pervasive in diarrheal infections around the world. As a result, the primary goal of this study was to evaluate antibiotic use patterns for the treatment of acute diarrheal diseases at Debre Tabor Comprehensive Specialized Hospital in North-West Ethiopia. Methodology: A retrospective cross-sectional study was conducted to assess the antibiotic utilization pattern used to treat acute diarrheal illness, taken from the record cards of 243 patients who received treatment for acute diarrheal illness, employing structured questions from September 1 to September 30, 2022. The results are displayed using percentages and frequency distributions in tables along with figures. Results: A total of 243 patients were involved, 134 (55.1%) of whom were male and 134 (55.1%) were under the age of five. Out of the 103 cases of acute watery diarrhea, 83 received antibiotics that were given improperly. Additionally, 88 individuals had bloody diarrhea diagnoses, but 58 of them received the currently administered antibiotics. Amoxicillin and co-trimoxazole were the most frequently prescribed medications, with 193 (79.5%) of the 243 cases of patients receiving some form of antibiotic. Conclusion: The results of the study revealed that there is inappropriate antibiotic use in acute diarrheal disease at Debre Tabor Comprehensive Specialized Hospital, which might be the cause for the overall increase in antimicrobial resistance as well as the associated costs of treatment. The finding is helpful as evidence for prescribers' inappropriate use of antibiotics for the treatment of acute diarrheal sickness.

In vivo antidiarrheal activity of the crude extract and solvent fractions of Rhamnus prinoides (Rhamnaceae) leaves.

Background: Even though numerous conventional anti-diarrheal agents are available, the inherent toxicities of the drugs urge the search for alternative drugs that are safe and effective. Objective: To evaluate the in-vivo anti-diarrheal activity of crude extract and solvent fractions of Rhamnus prinoides leaves. Materials and methods: The Rhamnus prinoides leaves were macerated using absolute methanol and then fractionated using solvents of different polarity indexes. For in-vivo antidiarrheal activity evaluation of the crude extract and solvent fraction, castor oil-induced diarrhea, castor oil-induced anti-enteropolling, and intestinal transit models were used. One-way analysis of variance was used to analyze the data, followed by a Tukey post-test. The standard and negative control groups were treated with loperamide and 2% tween 80 respectively. Results: A significant (p˂0.01) reduction in the frequency of wet stools and watery content of diarrhea, intestinal motility, intestinal fluid accumulation, and delaying the onset of diarrhea as compared with controls were observed in mice treated with 200 mg/kg and 400 mg/kg methanol crude extract. However the effect increased dose-dependently, and the 400 mg/kg methanol crude extract produced a comparable effect with the standard drug in all models. Amongst the solvent fractions, n-BF significantly delayed the time of diarrheal onset and reduced the frequency of defecation, and intestinal motility at doses of 200 mg/kg and 400 mg/kg. Furthermore, the maximum percentage inhibition of intestinal fluid accumulation was observed in mice treated with 400 mg/kg n-butanol extract (p˂0.01; 61.05%). Conclusions: The results of this study showed that crude extract and solvent fractions of Rhamnus prinoides leaves showed a significant anti-diarrheal activity which supports its traditional use as a diarrhea treatment.

A Systematic Review of Ethnobotanical, Phytochemical, and Ethnopharmacological Studies of Urtica simensis (Stinging Nettle).

The Urticaceae family contains 54 genera and more than 2000 species that can be found in tropical, subtropical, and temperate climates all over the world. This family includes the largest genus in the world, Urtica, which is also known as stinging nettle. Stinging hairs are present on the lower surface of the leaves and beneath the stems of Urtica simensis, also known as the stinging nettle, herbal nettle that is dioecious, upright, and unbranched. For the treatment of conditions like gastritis, heart disease, diabetes, gonorrhea, and malaria, people employ various portions of Urtica simensis in a variety of ways in traditional medicine. The Urtica simensis leaves are rich in variety of active secondary phytochemical constituents including terpenoids, saponins, tannins, flavonoids, steroids, alkaloids, polyphenols, sterols, oxalate, and ascorbic acid (vitamin C). According to different reports, it possesses a variety of pharmacological properties, including antioxidant, antiproliferative, antidiabetic, cardioprotective, antiulcer, antibacterial, and antifungal actions. The current review summarizes published and unpublished information about the ethnobotanical, phytochemical, ethnopharmacological, and toxicological reports of Urtica simensis and summarizes all the research work carried out on this plant to provide updated information for future work.

Drug-drug interactions among hospitalized elderly in patients at medical wards of Northwest Ethiopia's Comprehensive Specialized Hospitals: A multicenter observational study.

Objective: Drug-drug interactions are of major concern due to links to untoward drug effects, hospitalizations, and serious health impacts. Elderly patients are more predisposed to drug interactions than younger patients. The present study aimed to find out the prevalence of drug-drug interactions at North West Ethiopian compressive specialized hospitals' Internal Medicine wards. Methods: From 30 April to 30 July 2021 GC, a multicenter prospective observational study was conducted at north Ethiopian specialized hospitals. Data was collected by using a structured questionnaire adapted from different literature and medical records at the North West Ethiopian Comprehensive Specialized Hospitals' Internal Medicine wards during the study period. Thereafter checked the completeness of the collected data was checked drug-drug interactions by using Medscape. Epi data version 4.6.2 software was used as data clearance and STATA version 14.1 was used for further data analysis. Result: A total of 389 subjects participated in the study of which more than half (55.53%) of them were female with a mean (SD) age of 68.9 ± 7.46 years. A total of 641 drug-drug interactions were detected in this investigation of which, 225(35.1%) were major, 299(46.6%) were significant interactions, and 117(18.3%) were minor interactions. Hospital stay (AOR = 5.95 CI: 3.49-10.12), retire (AOR = 6.71 CI: 1.26-35.78), 5-9 drugs (AOR = 5.30 CI: 2.91-9.67) and more than 10 drugs (AOR = 8.03 CI: 2.47-26.07) were important risk factors for drug-drug interactions. Conclusion: The findings of this study suggest that drug-drug interactions were high among hospitalized elderly patients. The presence of polypharmacy, to be retired, and hospital stayed were all found to be strongly linked with drug-drug interactions.

Review of Ethnobotanical and Ethnopharmacological Evidence of Some Ethiopian Medicinal Plants Traditionally Used for Peptic Ulcer Disease Treatment.

A peptic ulcer is described as the rupture of the mucosal integrity of the stomach, the duodenum, and, in certain cases, the lower esophagus as a result of contact with chloridopeptic secretions. The two most common kinds of peptic ulcer disorders are referred to as "gastric ulcer" and "duodenal ulcer." The name is derived from the location of the ulceration. Despite the promise of a wide range of antiulcer treatments, these therapies are associated with several adverse reactions, including hypersensitivity, arrhythmia, impotence, gynecomastia, galactorrhea, hematological abnormalities, and kidney disease, which are intolerable for many patients. Nowadays, there is a lot of emphasis on finding new and innovative agents. As a result, herbal medicines are commonly utilized in circumstances when drugs are used for long periods and are also cost-efficient, effective, and readily available. In this review paper, a total of 82 medicinal plants have been identified and reported for their use in the treatment of peptic ulcer disease. The majority of these medicinal plants are widely used throughout Ethiopia. However, only the safety and efficacy of Plantago lanceolata, Osyris quadripartita, Rumex nepalensis, Cordia africana, Croton macrostachyus, and Urtica simensis have been scientifically studied in animal models. Despite this, many medicinal plants' pharmacological effects and chemistry have not been well studied scientifically. As a result, further bioactive compound characterization, efficacy, mechanism of action evaluation, and toxicity evaluation of medicinal plants should be carried out. A study that can improve the documentation of indigenous knowledge and contribute to drug development and future self-reliance is also recommended.

Evaluation of Wound Healing Activity of 80% Methanol Root Crude Extract and Solvent Fractions of Stephania abyssinica (Dill. & A. Rich.) Walp. (Menispermaceae) in Mice.

Background: The root of Stephania abyssinica (Dill. and A. Rich.) Walp. (Menispermaceae) is traditionally used to treat wounds. Despite the fact that there have been in vitro studies and claims supporting wound healing, there has been no scientific data on the in vivo wound healing activities of the root of S. Abyssinica. Objective: The aim of the study was to evaluate the wound healing activity of 80% methanol root extract and solvent fractions of S. Abyssinica in mice. Methods: The roots of S. Abyssinica were air dried, ground and macerated by 80% methanol three times successively. The crude extract was fractionated by water, hexane and ethyl acetate separately. The acute dermal toxicity test was done by applying 2000 mg/kg of the 10% w/w crude extract. Wound healing activity of crude extract was evaluated on excision, incision and burn wound models, while the fractions were evaluated on excision wound model only. Results: In mice, an acute dermal toxicity test of 2000 mg/kg of the 10% w/w crude extract was found to be safe. The 10% w/w crude extract ointment (CEO) produced significant (p < 0.001) wound contraction from 4th to 16th post wounding days, and the 5% w/w CEO were significant (p < 0.01) wound contraction on 10th post wounding day as compared to simple ointment (SO) treated group on excision wound. On burn wound models, the CEO showed highly significant (p < 0.001) from the 6th post wounding days onwards. The tensile strength was increased significantly (p < 0.001) by the CEO treated mice as compared to the untreated group and SO group. Conclusion: The data obtained from this study showed 80% methanol crude extract, the aqueous and the 10% w/w ethyl acetate fraction possessed better wound healing activities, and decreased period of epithelialization.

Evaluation of antibiotic prescribing patterns among inpatients using World Health Organization indicators: A cross-sectional study.

Objective: Even though antibiotic resistance is one of the most serious threats to global public health, it is becoming more common due to inappropriate antibiotic prescribing patterns. Thus, the purpose of this study is to assess antibiotic prescribing patterns among inpatients at an Ethiopian comprehensive specialized hospital. Methods: An institutional-based cross-sectional study was used. During the study period, data were collected from the charts of admitted patients in selected wards of Debre Tabor comprehensive specialized hospital. The World Health Organization's developed questionnaire and conventional antibiotic prescribing indicators were used to assess rational drug usage, with an emphasis on antibiotic prescribing trends. The data were analyzed using SPSS 25.0 statistical software. Results: For 861 patients admitted to medical and pediatric wards, a total of 1444 antibiotics were prescribed. Overall, 60.6% of inpatients were prescribed at least one antibiotic, with an average (mean ± SD) number of antibiotics prescribed per patient of 1.7 ± 1.6. During their hospital stay, patients were given antibiotics for an average (mean ± SD) of 6.4 ± 2.7 days. Furthermore, 83.3% of antibiotics were prescribed for therapeutic purposes, whereas 100% were provided for empiric purposes. Ceftriaxone was the most commonly administered antibiotic in the study settings (49.2%). During the study period, Debre Tabor comprehensive specialized hospital had access to 67.5% of key antibiotics. Conclusion: The antibiotic prescribing pattern in our study diverged from the World Health Organization-recommended guidelines. Furthermore, all antibiotics were given without a culture or sensitivity test in every case. Setting up an antibiotic stewardship program, introducing antibiotic use based on culture and sensitivity tests, and adopting institutional guidelines could all help to address this issue.

Estimation of lifetime survival and predictors of mortality among TB with HIV co-infected children after test and treat strategies launched in Northwest, Ethiopia, 2021; a multicentre historical follow-up study.

INTRODUCTION: In resource-limited settings, the mortality rate among tuberculosis and human Immunodeficiency virus co-infected children is higher. However, there is no adequate evidence in Ethiopia in general and in the study area in particular. Hence, this study aims to estimate lifetime survival and predictors of mortality among TB with HIV co-infected children after test and treat strategies launched in Northwest Ethiopia Hospitals, 2021. METHODS: Institution-based historical follow-up study was conducted in Northwest Ethiopia Hospitals among 227 Tuberculosis and Human Immunodeficiency Virus co-infected children from March 1, 2014, to January 12, 2021. The data were entered into Epi info-7 and then exported to STATA version 14 for analysis. The log-rank test was used to estimate the curve difference of the predictor variables. Bivariable cox-proportional hazard models were employed for each predictor variable. Additionally, those variables having a p-value < 0.25 in bivariate analysis were fitted into a multivariable cox-proportional hazards model. P-value < 0.05 was used to declare significance associated with the dependent variable. RESULTS: From a total of 227 TB and HIV co-infected children, 39 died during the follow-up period. The overall mortality rate was 3.7 (95% CI (confidence interval): 2.9-4.7) per 100 person-years with a total of 1063.2-year observations. Cotrimoxazole preventive therapy (CPT) non-users [Adjusted Hazarded Ratio (AHR) = 3.8 (95% CI: 1.64-8.86)], presence of treatment failure [AHR = 3.0 (95% CI: 1.14-78.17)], and Cluster of differentiation 4(CD4) count below threshold [AHR = 2.7 (95% CI: 1.21-6.45)] were significant predictors of mortality. CONCLUSION: In this study, the mortality rate among TB and HIV co-infected children was found to be very high. The risk of mortality among TB and HIV co-infected children was associated with treatment failure, CD4 count below the threshold, and cotrimoxazole preventive therapy non-users. Further research should conduct to assess and improve the quality of ART service in Northwest Ethiopia Hospitals.

Evaluation of In Vivo Antidiarrheal Activity of Solvent Fractions of Hagenia abyssinica (Rosaceae) in Swiss Albino Mice.

BACKGROUND: Ethiopia has several medicinal plants that have been used for their antidiarrheal activity. Hagenia abyssinica is the most commonly used medicinal plant for the management of diarrhea in Ethiopia. Thus, this study's aim is to investigate the antidiarrheal effect of solvent fractions of H. abyssinica. METHODS: Antidiarrheal activity of extract fractions obtained from different solvents was evaluated by using small intestine transit, enteropooling, and castor oil-induced diarrhea animal models. In all animal models, the solvent fractions treated groups were treated with three different doses (100 mg/kg, 200 mg/kg, and 400 mg/kg) of the solvent fractions, while the negative control group was treated with a vehicle (distilled water), and positive control group was treated with loperamide. RESULTS: The acute toxicity test revealed that the LD50 of H. abyssinica is > 2000 mg/kg. In castor oil-induced, the solvent fractions of H. abyssinica (at 200 mg/kg and 400 mg/kg) significantly (P < 0.05-0.001) prolonged the stool frequency, reduced the weight of feces, and delayed diarrheal onset time as compared with the negative control group. The fractions produced a significant (P < 0.05) antimotility effect at the doses of 200 mg/kg and 400 mg/kg as compared to the negative control. All solvent fractions at the middle and higher doses showed a statistically significant dose-dependent reduction in the volume of intestinal contents and weight of the feces. However, the solvent fractions of H. abyssinica at a dose of 100 mg/kg failed to produce a statistically significant activity in all parameters (number of wet feces, the onset of diarrhea, and number of total feces) when compared with the negative control group. CONCLUSION: The extract fractions obtained from different solvents have shown significant antidiarrheal activity. Thus, this finding supports the claimed traditional use of H. abyssinica leaves for the treatment of diarrhea.