Polymyxin-induced nephrotoxicity and its predictors: a systematic review and meta-analysis of studies conducted using RIFLE criteria of acute kidney injury.

Polymyxins are last-resort antibiotics re-emerged to treat infections caused by multidrug resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacterial infections. However, polymyxin-associated nephrotoxicity has become the main safety concern. Therefore, we conducted this systematic review and meta-analysis on polymyxin-induced nephrotoxicity and its predictors using studies conducted based on the validated RIFLE (Risk, Injury, Failure, Loss of Function and End-stage renal disease) criteria of acute kidney damage. Literature search was carried out through visiting legitimate databases and indexing services including PubMed, MEDLINE (Ovid®), EMBASE (Ovid®), and Scopus to retrieve relevant studies. Following screening and eligibility evaluation, relevant data were extracted from included studies and analyzed using STATA 15.0 and Rev-Man 5.3. Inverse variance method with random effects pooling model was used for the analysis of outcome measures at 95% confidence interval. Besides, meta-regression, meta-influence, and publication bias analyses were conducted. A total of 48 studies involving 6,199 adult patients aged ≥ 18 years were included for systematic review and meta-analysis. The pooled incidence of polymyxin-induced nephrotoxicity was found to be 45% (95% CI: 41- 49%; I2 = 92.52%). Stratifying with RIFLE severity scales, pooled estimates of polymyxin-treated patients identified as 'risk', 'injury' and 'failure' were 17% (95% CI: 14-20%), 13% (95% CI: 11-15%), and 10% (95% CI: 9-11%), respectively. Besides, the pooled incidence of colistin-induced nephrotoxicity was about 48% (95% CI: 42-54%), whereas that of polymyxin B was 38% (95% CI: 32-44%). Likewise, colistin had 37% increased risk of developing nephrotoxicity compared to the polymyxin B treated cohorts (RR = 1.37, 95% CI: 1.13-1.67; I2 = 57%). Older age (AOR = 1.03, 95% CI: 1.01-1.05), daily dose (AOR = 1.46, 95% CI: 1.09-1.96), underlying diabetes mellitus (AOR = 1.81, 95% CI: 1.25-2.63), and concomitant nephrotoxic drugs (AOR = 2.31, 95% CI: 1.79-3.00) were independent risk factors for polymyxin-induced nephrotoxicity. Patients with high serum albumin level were less likely (AOR = 0.69, 95% CI: 0.56-0.85] to experience nephrotoxicity compared to those with low albumin level. Despite the resurgence of these antibiotics for the chemotherapy of MDR/XDR-Gram-negative superbugs, the high incidence of nephrotoxicity has become a contemporary clinical concern. Being elderly, high daily dose, having underlying diseases such as diabetes, and use of concomitant nephrotoxic drugs were independent predictors of nephrotoxicity. Therefore, therapeutic drug monitoring should be done to these patients to outweigh the potential benefits of polymyxin therapy from its risk.

Assessment of Knowledge, Attitude, Practice and Associated Factors Towards Post-Exposure Prophylaxis for HIV/AIDS among Health Professionals in Health Centers Found in Harari Region, Eastern Ethiopia.

BACKGROUND: Healthcare workers are at risk of acquiring human immunodeficiency virus (HIV) infections, because of occupational exposure to blood and other body fluids. Post-exposure prophylaxis (PEP) is a short-term antiretroviral treatment used to reduce the likelihood of viral infection after exposure to the blood or body fluids of an infected person. Timely PEP after exposure to high-risk body fluids in the working area can reduce the rate of transmission of HIV significantly. OBJECTIVE: To assess the knowledge, attitude, practice, and associated factors towards PEP for HIV/AIDS among health professionals in health centers in the Harari region, Eastern Ethiopia. METHODOLOGY: A retrospective cross-sectional study was conducted using structured questionnaires from March to April 2019. The collected data were analyzed by using SPSS version 20, and the result was presented in the form of tables and figures. RESULTS: Of 217 participants, 51.6% were male and 75.2% were in the age group of 20-30 years. One hundred thirty (59.9%) respondents had a year of service less than 5 years, and nearly half (45.2%) of the participants had a Diploma. The study revealed that 35.02% of the participants had inadequate knowledge of PEP. About 32.26% had an unfavorable attitude towards PEP. Of 124 (57.1%) exposed respondents, 54 (68.4%) tried to get PEP service and 49 (90.7%) started to use PEP. Twenty-six (48.1%) respondents started to use PEP within 6 to 24 hours after exposure. Sex, qualification, and attitude status were found to have a significant association with knowledge regarding PEP. CONCLUSION: The findings of this study indicated that a significant number of health professionals had poor knowledge and poor attitude towards PEP. Occupational exposures were common among health professionals. However, the practice of using PEP was low among health professionals. As a result, health facilities should strengthen and integrate routine PEP services by providing training to all health professionals.

Prevalence of metabolic syndrome and associated factors among psychiatric patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

BACKGROUND: Psychiatric patients are at increased risk of being overweight or obese, and subsequently develop metabolic syndrome. Nevertheless, data regarding associated factors for weight gain are limited and inconsistent. OBJECTIVE: The present study aimed to determine the risk of metabolic syndrome and its associated factors among psychiatric patients. METHOD: A cross-sectional quantitative study was conducted among all psychiatric patients at the Psychiatric Unit of the University of Gondar Comprehensive Specialized Hospital from March 1- April 1, 2018. All eligible psychiatric patients were interviewed about their socio-demographic status,and clinical characteristics and useful parameters for the study were recorded from the medical records of the patients and by measuring waist to height ratio. Descriptive statistics were used to summarize baseline information.Binary logistic regression was used to determine the associated factors and P-value <0.05 and confidence interval (CI) of 95% were used as cut off points for determining statistical significance. RESULT: From 300 patients included in the study, 168(56%) patients were females,and around 50.3% of the study participants had low literacy levels. As per waist to a height ratio scale, 58% (174) of the patients had a risk of metabolic syndrome. The Binary logistic regression analysis indicated that sex (p-<0.0001), occupation (p -0.032), marital status (p-0.006), and distance from the hospital (p<0.0001) were statistically significant determinants of metabolic syndrome risk in the psychiatric patient in our setting. CONCLUSION: The majority of the psychiatric patients in the study setting had a risk of metabolic syndrome. Sex, marital status, employment status, and distance to the hospital were significantly associated with metabolic syndrome. Routine physical and laboratory investigations to detect metabolic syndrome are indispensable in psychiatric patients to prevent cardiovascular complications.

Epidemiology of Hypertension in Ethiopia: A Systematic Review.

BACKGROUND: Hypertension is one of the leading causes of disease in the world. This study is a systematic review paper, intended to provide compressive evidence on the prevalence, distribution, determinants, and burden of hypertension in Ethiopia. METHODS: A quantitative epidemiological literature review was conducted by searching different articles in different databases, including PubMed, Cochrane, and Google scholar. The search involved population-based, hospital-based, and institution-based studies on hypertension conducted in Ethiopia. All data were extracted independently by two reviewers using data collection formats. Finally, this review included 22 studies. RESULTS: Different studies reported varied prevalence of hypertension because of the differences in participant's mean ages, source population, and study settings. Population-based studies revealed the prevalence of hypertension to be 9.3-30.3%, institution-based studies revealed 7-37%, whereas hospital-based studies revealed 13.2-18.8%. In studies included in this review, about 37-78% of hypertensive patients were not aware of their blood pressure condition. There was a high prevalence of hypertension in urban residents, and different factors were associated with hypertension, including being overweight, family history of hypertension, age, sex, diabetes mellitus, alcohol intake, physical inactivity, and obesity. CONCLUSION AND RECOMMENDATION: Hypertension was substantially prevalent in Ethiopia, which calls for the implementation of timely and appropriate strategies for the prevention and control of the disease.

Knowledge and Beliefs of Health Care Professionals Towards Antimicrobial Resistance in Hiwot Fana Specialized University Hospital, in Harar, Ethiopia.

BACKGROUND: Antimicrobial resistance (AMR) results in treatment failure and spread of the infection, which will cause prolonged illness, increased mortality, and financial burdens. Some factors that are responsible for inappropriate use of antimicrobials include lack of expertise by health care professionals and problems in diagnosis. OBJECTIVE: To assess the knowledge and belief related to AMR among health care professionals in HFSUH in Harar, Ethiopia. METHODOLOGY: A cross-sectional study was conducted on 153 physicians, nurses, and pharmacists from HFSUH, which were selected using stratified sampling with proportional allocation. Data were collected from March 1 to March 30, 2017, and were analyzed using the Statistical Package for Social Sciences (SPSS 20.0). RESULTS: Only 132 participants were willing to participate from the 153 health care providers; of whom, 35 (26.5%) were physicians, 86 (65.2%) were nurses, and 11 (8.3%) were pharmacists. MRSA was mentioned as the prominent resistant bacteria by 74.3% of the physician, 59.3% of the nurses, and 63.6% of the pharmacists. The majority consider the overuse of antibiotics, poor infection control, sub-standard antibiotic, and patients' poor adherence as factors for AMR. AMR was considered a problem worldwide, country, and hospital level. Forty percent of the physicians, 32.6% of the nurses, and 63.6% of the pharmacists consider the patient influence on the prescriber as the cause; whereas, 31.4% of the physician, 48.8% nurses, and 36.4% of the pharmacists consider the failure of previous treatment as the major cause of unnecessary antimicrobial prescription. CONCLUSION: The information the health care professionals have about the different resistant bacteria, on the different factors that cause unnecessary antibiotic prescription and on how to use susceptibility testing is low. All professionals should take regular AMR training and select antibiotics based on tests and minimize the risk of AMR.

Level of Adherence to the Dietary Recommendation and Glycemic Control Among Patients with Type 2 Diabetes Mellitus in Eastern Ethiopia: A Cross-Sectional Study.

BACKGROUND: Dietary modification is the cornerstone and initial recommendation in the management of diabetes mellitus. Adhering to the recommended dietary practice has a significant role in diabetic control, but not uniformly practised. OBJECTIVE: To assess dietary adherence and glycemic control among type 2 diabetic patients on follow-up at Dilchora Referral Hospital (DRH), Dire Dawa, Eastern Ethiopia. METHODS: A hospital-based cross-sectional study was conducted from 22 August to 23 October 2019, at DRH. Data were collected through an interviewer-administered questionnaire. The Perceived Dietary Adherence Questionnaire (PDAQ) was used to estimate the level of dietary adherence. Glycemic control was measured using fasting blood glucose. Multivariate logistic regression analyses were employed to identify factors associated with dietary adherence. RESULTS: Of the 307 included patients, 62.5% were poorly adherent to the recommended diet. Lack of dietary education (83.38%) and inability to afford a healthy diet (71.33%) were the perceived barriers to practice dietary recommendation. More than half (54.7%) failed to achieve the recommended fasting blood glucose target. In multivariate logistic regression, patients who were adherent to dietary recommendations were 3.56 times more likely to have good glycemic control. Those patients living in urban areas, having monthly income greater than 1000 Ethiopia Birr, family history of the disease, duration of treatment greater than 10 years and who received counseling were more likely to have good dietary adherence. CONCLUSION: The level of adherence to the dietary recommendation and glycemic control was low. Healthcare providers should be proactive in tackling the barrier for non-adherence and should promote adherence to dietary recommendations in T2DM patients.

Assessment of drug-related problems among type 2 diabetic patients on follow up at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia.

OBJECTIVES: To assess the drug-related problem among patients with type 2 diabetes at Hiwot Fana Specialized University Hospital. RESULTS: In this study, a total of 148 patient medication records were included. More than half, 83 (57.4%) were men and the rest 65 (42.6%) were women. The mean age of the study participants was 51.26 ± 7.08. Around one-third (74.3%) of the participants had urban residency. A total of 127 drug-related problems were identified, of which dosage too low was the most common type of DRP encountered, 46 (36.2%), followed by unnecessary drug therapy, 25 (19.7%) and ineffective drug therapy, 25 (19.7%). 95 (64.2%) of the patients had at least one drug-related problem. Among patients with DRP, more than half of them, 59 (62.1%) had a single DRP. Out of the total participants, 85 (57.4%) of them were taking one anti-diabetic medication and 63 (42.6%) of them dual anti-diabetic medications. Only half of the patients have attained the desired FBG level. There was no patient who had experienced more than two types of drug-related problems at a time. Less than 10% of patients were taking five or more drugs at a time.

Analgesic and anti-inflammatory activities of 80% methanol root extract of Jasminum abyssinicum Hochst. ex. Dc. (Oleaceae) in mice.

BACKGROUND: Pain and inflammation are associated with the pathophysiology of various clinical conditions. Most analgesic and anti-inflammatory drugs available in the market present a wide range of problems. The current study was aimed at investigating the analgesic and anti-inflammatory activity of 80% methanol extract of J. abyssinicum root. METHODS: The analgesic activity was determined using tail-flick test and acetic acid induced writhing, whereas anti-inflammatory activity was determined by carrageenan induced paw edema and formalin induced pedal edema, carried out in vivo. The test group received three different doses of the extract (50mg/kg, 100mg/kg and 200mg/kg) orally. The positive control group received diclofenac (10mg/kg), aspirin (100mg/kg or 150mg/kg) or morphine (20mg/kg) orally. The negative control group received vehicle (2% Tween 80, 10ml/kg) orally. Furthermore, preliminary phytochemical screening was carried out. RESULTS: Oral administration of J. abbysinicum 80% methanol extract (at all doses) significantly (p<0.001) inhibit pain sensation in the pain models. Similarly, the extract demonstrated anti-inflammatory effect in the inflammation models in mice. Preliminary phytochemical screening showed the presence of saponins, flavonoids, terpenoids, triterpenens and glycosides. CONCLUSION: The data obtained from the present study indicates that the extract possessed a significant analgesic and anti-inflammatory activity, upholding the folkloric use of the plant.