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Objective Anti-epileptic drugs (AEDs) are the primary therapeutic modalities for epilepsy management. However, one-third of epileptic patients continue to experience seizure even with appropriate AED use. Patients with epilepsy are at increased risk for seizure-related injury and they have higher incidences of home, street and work accidents. There is a paucity of data on AED use pattern and treatment outcomes among patients with epilepsy in the tertiary hospitals of Ethiopia. Therefore, the aim of this study was to assess AED use pattern, treatment outcome, and prevalence of seizure-related injury among patients with epilepsy in Tikur Anbessa specialized Hospital (TASH), Ethiopia. Patients and methods An institution-based cross-sectional study was carried out on 291 patients with epilepsy attending the neurology clinic of TASH. A semi-structured questionnaire and data abstraction format were used to collect data through patient interview and medical chart review. Binary logistic regression was utilized to identify the associated factors of treatment outcome. Results About 172 (59%) of the patients were taking a single AED, in which phenobarbital, 195 (67%), and phenytoin, 97 (33.3%), were the most frequently prescribed AEDs as monotherapy and combination therapy. Headache, depressed mood and epigastric pain were frequently reported as adverse drug reactions. Seizure-related injury was reported among 78 (26.8%) patients and head injury 15 (5.2%), desntal injury 15 (5.2%), soft tissue injury 14 (4.8%) and burns 10 (3.4%) were the commonest. About two-thirds (191, 65.6%) of the study participants had uncontrolled seizure. Medication adherence and multiple AEDs were significantly associated with treatment outcome. Conclusion All the study participants were put on old generation AEDs with phenobarbital being the most frequently used. About two-thirds of the patients had uncontrolled seizure and seizure-related injury is still a serious concern among patients with epilepsy.

Background Atherosclerotic Cardiovascular Disease (ASCVD) is an emerging problem among People living with HIV/AIDS (PLWHA). The current study aimed at determining the risk of ASCVD among PLWHA using the Pooled Cohort Equation (PCE) and the Framingham Risk score (FRS). Methods A hospital-based study was carried out from January 2019 to February 2020 in PLWHA. The prevalence of ASCVD risk was determined in individuals aged between 20 to 79 and 40 to 79 years using the FRS and PCE as appropriate. Chi-square, univariate and multivariate logistic regressions were employed for analysis. Results The prevalence of high-risk ASCVD for subjects aged 20 and above using both tools was 11.5 %. For those aged 40 to 79 years, PCE yielded an increased risk (28%) than FRS (17.7%). Using both tools; advanced age, male gender, smoking, and increased systolic blood pressure were associated with an increased risk of ASCVD. Younger age (adjusted odds ratio, AOR) 0.20, 95%CI: 0.004, 0.091; P< 0.001), lower systolic blood pressure (AOR 0.221, 95%CI: 0.074, 0.605 P< 0.004), and lower total cholesterol (AOR 0.270, 95%CI: 0.073, 0.997; p Conclusions A considerable number of PLWHA have been identified to be at risk for ASCVD. ASCVD risk was significantly associated with advanced age, male gender, higher blood pressure, and smoking using both FRS and PCE. These factors should therefore be taken into account for designing management strategies.

Deep vein thrombosis (DVT) is a major health problem affectinga significant portion of population. Primary complications are Pulmonary Embolism (PE) in the short term and Post-Thrombotic Syndrome (PTS) in the long term. Thrombolytic drugs act by activating plasminogen which in turn forms the enzyme plasmin. Plasmin consequently degrades blood clots by breaking down the fibrin molecules which make up the clots help to degrade the already formed clot. They can be used using different route of administration, doses and durations. The purpose of this systematic review was to assess the outcome of thrombolytic therapy in terms of the efficacy, safety and effectiveness of the medicines. Electronic searches of databases (MEDLINE and Google Scholar) were queried for articles written in English since 2000 GC. A total of 760 results were obtained using the search keys, and after excluding duplicates, 275 articles were selected. Finally, 9 randomized controlled trials (RCTs) which met the language of publication, study design and exclusion criteria were included in this systematic review. The data were obtained from nine trials (6 countries), providing a study-level data of 1309 participants. Almost all studies revealed that thrombolytic treatment was effective in the management of acute DVT. In most of the studies, the rate of rethrombosis was lower in case of thrombolytic than standard management. Hence, addition of thrombolytic results in persistence and increases the clinical benefits. Thrombolytic therapy was very effective in reversing closed veins, in boosting the patency rate,whilereflux was higher in patients treated with anticoagulants. Thrombolytic offers potential advantages over the standard treatment of DVT by reducing the proportion of patients with chronic disabling leg symptoms (such as PTS) by triple in the longer term. However, the incident of major bleeding was higher in patients receiving thrombolytics than anticoagulants.

Multiple Myeloma (MM) is the most common malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Clinical investigation of MM requires the evaluation of bone marrow for plasma cell infiltration, and detection and quantification of monoclonal protein in the serum or urine, and evidence for end-organ damage (i.e., hypercalcemia, renal insufficiency, anemia, or bone lesions). The overall goal of treatment of MM is to improve survival. The treatment landscape and clinical outcome of MM have changed in the last two decades, with an improved median survival of 8–10 years. Management of MM involves induction, consolidation, and maintenance therapy. Currently, Autologous stem cell transplant (ASCT) is considered as the standard care of treatment for newly diagnosed fit MM patients. Multiple combinations of proteasome inhibitors (PIs) and immunomodulatory drugs (IMIDs) such as Thalidomide, lenalidomide, and pomalidomide have been under evaluation in ASCT-eligible and ineligible settings, and studies are still ongoing. For patients with ASCT-eligible newly diagnosed MM, induction therapy with triple drugs should contain an IMiD, a PI, and a corticosteroid, usually lenalidomide-bortezomib-dexamethasone. For ASCT-ineligible patients on lenalidomide with dexamethasone (Rd), with addition of bortezomib or daratumumab can be considered.

Background With a much improved ART of the present day, most morbidities and mortalities in people living with HIV/AIDS (PLWHA) are associated with factors such as non-infectious diseases (NIDs) in the form of coronary heart disease (CHD). This study aimed at determining the prevalence and predictors of coronary heart disease (CHD) using the 10-year atherosclerotic cardiovascular disease (ASCVD) and Framingham risk score (FRS) tools among PLWHA. Methods A hospital-based, observational study was carried out from January 2019 to February 2020 in HIV infected adults. Prevalence of FRS (age 20 to 79) was determined using the National, Heart, Lung and Blood Institute (NHLBI) and prevalence of ASCVD (age 40 to 79) was determined using the peer-reviewed online (ClinCalc.com) tool. Results Using the 10-years ASCVD risk estimation 27.3% of the study participants had an elevated risk > 7.5 % CHD. Similarly using the 10-year FRS, 1.4 % had high-risk score of developing CHD. Using multiple linear regression analysis age (β = .061, p

Background: Psoriasis is a chronic inflammatory disease characterized by keratinocyte hyperproliferation and aberrant differentiation with great negative impact on patients’ quality of life (QoL). This study aimed at assessing management practice, and quality of life (QoL) and its associated factors among ambulatory psoriatic patients visiting All Africa Leprosy, Tuberculosis and Rehabilitation Training (ALERT) Center in Addis Ababa, Ethiopia.Materials and methods: A cross sectional study was conducted among 207 patients with psoriasis attending the dermatology clinic of ALERT Center in Addis Ababa, Ethiopia. Data were collected using structured questionnaire and patients’ chart review. Dermatology Life Quality Index (DLQI) was used to measure patients’ QoL. Data was analyzed entered and analyzed using Statistical Package for Social Sciences (SPSS®) version 25. Descriptive statistics like frequency, percent, mean and standard deviation were used to summarize patients’ characteristics while binary logistic regression was utilized to identify predictors of quality of life. Results: Among 207 study participants, 122(58.9%) were females. The mean age of the study population was 37.92(SD=14.86) years (ranging from 16 to 68 years). The mean age at which diagnosis of psoriasis made was 32.0(SD=13.7) years ranging from 10 to 62 years. The duration of the disease in 112(54.1%) patients were more than or equal to 5 years. Among study participants, the majority of them, 145(70.0%) had plaque psoriasis followed by sebopsoriasis, 24(11.6%). The majority of plaque psoriasis (80%) cases were managed by topical corticosteroids with or without salicylic acid or coal tar and only 21(14.5%) treated by methotrexate alone. Other forms of psoriasis were treated by only topical corticosteroids with or without salicylic acid. The mean DLQI was 6.25 corresponding to a moderate effect. Symptoms and feelings were the most affected domains of QoL. Factors associated with poor QoL were female gender [AOR=0.17 (95%CI: 0.06, 0.48)], low, above average and high family income ([AOR=0.12(95% CI: 0.02, 0.56)], [AOR=0.06(95% CI:0.01, 0.32)], and [AOR=0.03 (95% CI: 0.01, 0.22)]) respectively and primary education level [AOR=0.14 (95% CI: 0.03, 0.64)] while being on systemic therapy [AOR=4.26 (CI: 1.18, 15.35)] was predictor of better QoL.Conclusion: Topical corticosteroids were the mainstay of psoriasis treatment in our study. The mean DLQI was 6.25, corresponding to a moderate effect on QoL. Study participants with female gender, primary education level, and low, above average, and high monthly family income were considered to have worse QoL whereas receiving systemic therapy significantly associated with better QoL. Hence, future interventions targeting improving QoL and widening treatment options for psoriasis deemed to be necessary.

Background Although marked improvements in life expectancy have been observed with the rapid expansion of Antiretroviral Therapy (ART), Cardiometabolic Syndrome (CMetS) is becoming a serious challenge for People Living with HIV/AIDS (PLWHA). The present study aimed in determining biomarkers and prevalence of CMetS in PLWHA. Methods A hospital-based, observational study was carried out between January 2019 & February 2020 among HIV infected adults (n = 288). Binary logistic regression was used to estimate odds ratio (OR) and corresponding 95% confidence interval (CI) for the association between the outcomes against the predictor variables. Results The current study revealed that the prevalence of CMetS was 28.5% (82/288) using the National Cholesterol Education Program (NCEP)-2005 definition; and it was 43.5% (126/288) using the International Diabetes Federation (IDF)-2005. Male gender was less likely to be associated with CMetS (OR = .086, C.I. 0.025–0.292, p

BackgroundPsoriasis is a chronic inflammatory disease characterized by keratinocyte hyperproliferation and aberrant differentiation with great negative impact on patients’ quality of life (QoL). This study aimed at assessing factors influencing management practice, and QoL and its associated factors among ambulatory psoriatic patients visiting All Africa Leprosy, Tuberculosis and Rehabilitation Training (ALERT) Center in Addis Ababa, Ethiopia.Materials and methodsA cross sectional study was conducted in 207 patients with psoriasis attending the dermatology clinic of ALERT Center in Addis Ababa, Ethiopia. Data were collected using structured questionnaire and patients’ chart review. Dermatology Life Quality Index (DLQI) was used to measure patients’ QoL. Patients’ characteristics were summarized using descriptive statistics and predictors of QoL were identified by binary logistic regression.ResultsAmong 207 study participants, 122 (58.9%) were females. The mean age of the study population was 37.92 (SD = 14.86) years (ranging from 16 to 68 years). The mean age at which diagnosis of psoriasis made was 32 (SD = 13.7) years ranging from 10 to 62 years. The duration of the disease in 112 (54.1%) patients were more than or equal to 5 years. Majority of study participants 145 (70.0%) had plaque psoriasis followed by sebopsoriasis, 24 (11.6%). The majority of plaque psoriasis (80%) cases were managed by topical corticosteroids with or without salicylic acid or coal tar and only 21 (14.5%) treated by methotrexate alone. The mean DLQI was 6.25 corresponding to a moderate effect. Symptoms and feelings were the most affected domains of QoL. Factors associated with poor QoL were female [AOR = 0.17 (95%CI: 0.06, 0.48)], low, above average and high family income ([AOR = 0.12 (95% CI: 0.02, 0.56)], [AOR = 0.06 (95% CI:0.01, 0.32)], and [AOR = 0.03 (95% CI: 0.01, 0.22)]), respectively, and primary education level [AOR = 0.14 (95% CI: 0.03, 0.64)] while being on systemic therapy [AOR = 4.26 (CI: 1.18, 15.35)] was predictor of better QoL. Poor QoL was predominant in females [AOR = 0.17 (95%CI: 0.06, 0.48)], low income [AOR = 0.12 (95% CI: 0.02, 0.56] patients, and patients with primary education level [AOR = 0.14 (95% CI: 0.03, 0.64)]. Patients on systemic therapy [AOR = 4.26 (CI: 1.18, 15.35)] had good QoL.ConclusionOur study identified that topical corticosteroids were the mainstay of psoriasis treatment in the dermatology clinic of ALERT Center in Addis Ababa, Ethiopia. Moderate effect QoL was achieved by study participants based on DLQL score.

Background Diabetes mellitus (DM) patients are at increased risk of developing drug therapy problems (DTPs). The patients had a variety of comorbidities and complications, and they were given multiple medications. Medication therapy management (MTM) is a distinct service or group of services that optimize therapeutic outcomes for individual patients. The study assessed the impact of provision of MTM service on selected clinical and humanistic outcomes of diabetes patients at the diabetes mellitus clinic of Tikur Anbessa Specialized Hospital (TASH). Methods A pre-post interventional study design was carried out at DM clinic from July 2018 to April 2019. The intervention package included identifying and resolving drug therapy problems, counseling patients in person at the clinic or through telephone calls, and providing educational materials for six months. This was followed by four months of post-intervention assessment of clinical outcomes, DTPs, and treatment satisfaction. The interventions were provided by pharmacist in collaboration with physician and nurse. The study included all adult patients who had been diagnosed for diabetes (both type I & II) and had been taking anti-diabetes medications for at least three months. Patients with gestational diabetes, those who decided to change their follow-up clinic, and those who refused to participate in the study were excluded. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive statistics, t-test, and logistic regressions were performed for data analyses. Results Of the 423 enrolled patients, 409 fulfilled the criteria and included in the final data analysis. The intervention showed a decrease in average hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and systolic blood pressure (SBP) by 0.92%, 25.04 mg/dl, and 6.62 mmHg, respectively (p Conclusion Provision of MTM service had a potential to reduce DTPs, improve the clinical parameters, and treatment satisfaction in the post-intervention compared to the pre-intervention phase.

INTRODUCTION: HIV infected persons are twofold likely to experience a heart attack, stroke, and other forms of Cardiometabolic Syndrome (CMetS). METHODS: Electronic searches of databases (MEDLINE and Google Scholar) were queried for articles written in English from 2000 to 2019. RESULTS: In this review (16 publications), a total of 14,002 participants from 8 countries were included. Two continents contributed to 62.5% of the CMetS studies while 38.1% from Latin America and 24.4% from North America. The studies were conducted in 113 different centers, with an average study length of 2.8 years. The majority of the study designs were cross-sectional (62%) followed by a cohort study (25%) and clinical trials (12.5%). The mean age of the population enrolled was 41.9 years and 54.6% of the participants were males. The overall prevalence of CMetS using the National Cholesterol Education Adult Treatment Panel definition was 20.6%. Only 31.3% of the studies were reported using the International Diabetes Federation definition. Smoking and high blood pressure were reported as a risk factor in 62.5% of the studies, while diabetes (31.3%), family history of CMetS (25%), and cardiac vascular and cancer diseases were reported in 12.5% of the studies. The average duration of stay with HIV after confirmation was 5.23 + 1.4 (years + SD) and the median duration on HAART was 4.5 + 2.3 (years + SD). CONCLUSIONS: CMetS was a common problem among HIV infected persons. Several RFs can contribute to the development of CMetS with smoking and hypertension highly interrelated. PROSPERO-NUMBER: CRD42018107187.

BackgroundHospital-Acquired Infections (HAIs) are acquired when the patient is hospitalized for more than 48 hours. In Ethiopia data are scarce in management appropriateness of HAIs. Hence, this study was aimed to assess the prevalence and management of HAIs among patients admitted at Zewditu Memorial Hospital.MethodA facility based prospective cross sectional study was conducted from March 1, 2017 to August 30, 2017. The sample was proportionally allocated among (medical, pediatrics, gynecology and obstetrics and surgical) wards, based on patient flow. Data were collected using data abstraction format and supplemented by key informant interview. Interview was made on eight physicians and four microbiologists who have been working in the wards during study period. Management appropriateness was assessed using Infectious Disease Society of America guideline and experts opinion (Infectious disease specialist). A multivariate logistic regression was used to identify factors associated with HAIs.ResultThe prevalence of HAIs was 19.8%. Surgical Site Infection (SSI) and pneumonia accounted for 20 (24.7%) of the infections. Culture and sensitivity was done for 24 (29.6%) patients. Of the 81 patients who developed HAIs, 54 (66.67%) of them were treated inappropriately. Physicians' response for this variation was information gap, forgetfulness, affordability and availability issue of first line medications. Younger age (AOR (Adjusted odds ratio) = 8.53, 95% CI: 2.67-27.30); male gender (AOR = 2.06, 95% CI: 1.01-4.22); longer hospital stay (AOR = 0.17, 95% CI: 0.06-0.51); and previous hospital admission (AOR = 3.22, 95% CI: 1.76-5.89); were independent predictors of HAIs.ConclusionPrevalence of HAIs and inappropriate management were substantially high in this study. Pneumonia and SSI were the common types of HAIs. Locally conformable guidelines could help to correct such problems.

Objective Epilepsy management especially in developing country is challenging. Seizures recurrence can be caused by both drug and non-drug related problems such as inadequate antiepileptic regimens, adverse drug reaction and poor adherence. Patient treatment satisfaction also affects the treatment out comes by improving medication adherence. This study aimed to assess drug therapy problems (DTPs) and treatment satisfaction among ambulatory epileptic patients at Tikur Anbessa Specialized Hospital. Methods A prospective cross-sectional study was conducted on 291 epileptic patients. Data was collected through patient interview and medical charts review. DTPs were identified based on the standard treatment guidelines and Micromedex® was used as drug interaction checker. Cipolle DTPs classification was used to classify the DTPs and Treatment Satisfaction with Medicine Questionnaire (SATMED-Q) was used to assess treatment satisfaction. Binary logistic regressions were utilized to identify the associated factors. Results Phenobarbital 195 (67%) and phenytoin 97 (33.3%) were the most frequently prescribed antiepileptic medications as monotherapy or combination therapy. Only 54 (18.6%) of the study participants had controlled seizure. DTP was found in 205(70.4%) of the study participants. From 352 DTPs identified, adverse drug reaction 146 (41.5%) was the leading DTPs followed by ineffective drugs 98 (27.8%) drug interaction 45 (12.8%) and inappropriate dose 42(11.9%). Headache, depression and epigastric pain were frequently reported adverse drug reaction. Among the study participants 167 (57.3%) were adherent to their medications. The number of medications taken by the patients had significant association with occurrence of DTPs, whereas source of medication and seizure free periods were found to have significant association with poor adherence. The global patient satisfaction was (67.4%) and lower satisfaction rate was found with regard to impact on daily activities (62.0%), treatment effectiveness (64.7%) and medical care (65.9%). Conclusion Prevalence of DTPs among ambulatory epileptic patients was high and about half of the patients were nona-dherent for their medication. The overall treatment satisfaction of the patients was suboptimal.

A 9-year-old, 17 kg, female patient was admitted to pediatric ward of a large, teaching referral hospital in Addis Ababa, Ethiopia because of high grade fever (HGF), severe headache & abnormal body movement (ABM) of 1 month duration. The child was taking unspecified Highly Active Antiretroviral Therapy (HAART) regimen from another government hospital ART clinic and unspecified per os (PO) medicines and herbs ordered from private clinics and traditional herbalists, respectively. She was put on Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) fixed dose combination therapy since 8 months back and has been taking phenytoin 50mg PO BID for the last one and half year. The patient has no known drug allergy (NKDA) or allergic diseases. Brain Computed Tomography (CT) scan was done on 27/02/2017 and revealed the presence of Pyogenic Brain Abscess (PBA) with subfalcine Herniation. Abdominal ultrasound was done on 08/03/2017 and showed Hepatomegaly. Head Magnetic Resonant Imaging (MRI) was done on 09/03/2017 and showed Left Frontoparietal Multiloculated Ring Enhancing Lesion with calcification and extensive vasogenic edema & mass effect more likely a Tuberculosis Brain Abscess (TBA). Chest X-ray (CXR) was done on 09/03/2017 with anterioposterior & left lateral position and revealed Left Upper Lobe Opacity more likely Tuberculosis (TB). Patient’s hemoglobin (Hgb), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) all were below normal on two consecutive measurements indicating that patient was suffering from moderate microcytic anemia. The Erythrocyte sedimentation rate (ESR) was also elevated as indication of non specific chronic inflammatory conditions most probably due to TB. Urinalysis was done on date 06/03/2017 and showed slight elevation in Red Blood Cells (RBCs) and White Blood Cells (WBCs) count and serum electrolyte assessment showed potassium was slightly below normal and chloride was increased and serum pH was slightly high causing metabolic alkalosis. Furthermore, alkaline phosphatase (ALP) was slightly elevated indicating involvement of cranial bone and focal hepatic lesions. Based on the clinical, laboratory and imaging evidences, the final working diagnosis was Stage IV RVI on HAART plus Right Sided Hemiparesis Secondary to TBA and PBA plus Focal Seizure. The gradual worsening of ABM of right lower and upper extremities could be due to lack of appropriate titration of the dose of phenytoin. The Initial dose of phenytoin has to be initiated with 5 mg/kg/day orally in 2 or 3 equally divided doses, with subsequent dosage individualized to a maximum of 300 mg PO daily. The maintenance dose should be 4 to 8 mg/kg and for children over 6 years old and adolescents may require the minimum adult dose (300 mg/day). The major drug therapy problems identified in this case was the prescription of rifampin with dexamethasone or prednisolone. Rifampin has been known to decrease the level or effect of dexamethasone-prednisolone by affecting hepatic/intestinal CYP3A4 enzyme metabolism. Hence, avoiding the use or use of alternative drug was recommended. Based on subjective evidences from the patient, now the patient is feeling better. Imaging modalities and laboratory tests are expected to be repeated and further progress report will be reported in future correspondence as short communication or to the editorial note

Background: The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Cancer (CA) is an increasing public health burden for Ethiopia and Sub- Saharan Africa at large. In Ethiopia, hospital records show that there are more than 150,000 cancer cases per year and currently cancer accounts for 4% of all deaths. Objective: The present prospective cross-sectional study was designed to assess the prevalence of cancer and its associated risk factors in patients visiting Tikur Anbessa Specialized Hospital (TASH). Methods: A prospective cross-sectional study was carried out in patients of all age groups visiting oncology unit of TASH during the study period of November 2015 to June 2016. Sample size was computed using margin of error 5%, confidence level of 95% and estimating cancer patients visiting TASH per annum equal to 20000. The response distribution was taken 10%, considering the 2012 Cancer Prevalence Report of the WHO in East Africa 5% to 10%. The calculated sample size then was 142. Result and discussion: The mean age of the participants in our study was 42.27 year with a standard deviation of 16.8, and 2 and 86 years were the age range. More than half of the patients in the study (61.3%, n=87) were females and about (38.7%, n=55) were males. In the study area uterine, breast, cervical, colorectal and gastric CA were more prevalent in the age group between 25-49 years while Acute Lymphoblastic Leukemia (ALL) was more common in 13-18 years of age, Ewing sarcoma was seen in age between 19 and 24 years. In our findings, breast CA (14.8%, n=21) was the most frequent type of CA followed by uterine CA (14.1%, n=20), colorectal CA (11.3%, n=16), gastric cancer CA (7.7%, n=11), cervical and esophageal cancers (7%, n=10). ALL was commonly seen in students, while gastric, lung, AML, osteosarcoma; and squamous cell CA were common in farmers. Furthermore, among 20 patients who had breast CA, 65% (n=13) were used contraceptives at least once in their last 10 years period, while uterine cancer patients (40%, n=8) were used either oral or injectable contraceptives. The prevalence of breast CA was not affected by the duration of contraceptive use rather it was stable across the duration of use. Many patients who were developed colorectal CA 12 (8.5%) and gastric CA 9 (6.3%) were reported that they were regularly consuming uncooked red meat as their favorite meal. In our study, many patients were receiving radiation therapy for cases such as uterine, breast, cervical and colorectal CA while chemotherapy was predominantly used in cases such as colorectal, squamous cell, osteosarcoma, ALL, AML and lung cancer. The multinomial regression analysis result further revealed that there was a significant association between breast CA with age (25-49 year, P. value 0.016), Uterine and Cervical CA with gender (female, P. value 0.001); and eating of uncooked red raw meat with colorectal CA (P. value 0.011). Conclusion: Cancer prevalence in the study area looks greatly jeopardizing the life of many Ethiopians in association with life styles. Hence, further studies should be done. Awareness creation programs to the people, allocation of public health preventive medicine approaches and in-depth governmental involvement in the area are highly needed.

Caffeine crosses the placenta and causes a number of complications. This study aims to review the effect of caffeine during pregnancy. Because of ion trapping weak bases that are non-ionized and lipophilic like caffeine diffuse across the placental barrier and become ionized in the more acidic fetal blood. A number of studies have reported the effect of caffeine on pregnancy. Some of the effects are diminishing fetal skeleton growth; risk of low birth weight (LBW); retardation of fetal development and/or intrauterine growth retardation (IUGR); adverse offspring childhood body fat distribution; increased risk of obesity; risk of type two diabetes mellitus; and Increased risk abortion. Even though a number of effects of caffeine are reported to be associated with pregnancy there are only a limited data showing causal association. Hence, avoiding the consumption of coffee, chocolate and tea during pregnancy appears prudent until more reliable evidences are emerging.

The increasing clinical incidence of antibiotic-resistant bacteria is a major global health care issue. Among MDR pathogens, Klebsiella pneumoniae (KP) is one of the world's most dangerous superbugs; and becoming resistant to virtually every antibiotic available today. Published articles cited majorly from three sources were browsed using selected keywords. Screening technique was done based on article relevance, topic match and English language match. Duplication of findings was avoided. Prevalence of KP among isolates was determined in different study places and the most alarming figure was seen in study conducted in Nigeria (64.2%) followed by India (33.9%) and Denmark (17.4%). Based on our pooled data from a number of studies conducted at different part of the globe, antibiotic resistances among KP isolates were found to be 100% for Cephradin, 87.5% for Cefeclor, 84% for Tobramycin, 82.5% for Cefotaxime, and 80.4% for Norfloxacin. Whereas, K. pneumonia was found to be more sensitive to Impenem (92.5%), Meropenem (92.5%), Amoxicillin/Clavulanic acid (87.5%), Gatifloxacin (85%), Moxifloxacin (75%); and chloraphenicol (62.8%). Carbapenems have been regarded as the treatment of choice for serious infections caused by extended-spectrum βeta-lactamase (ESBL)-producers. The combination therapy of fosfomycin+colistin demonstrated synergistic and bactericidal effect against one metallobetalactamase producing KP strains that were resistant to fosfomycin. Some of the factors that are responsible for the decline in number of newly discovered antibiotic include reduced financial grant from funding agencies, closure of many major pharmaceutical and large biotech companies; and the lack of financial reward for large pharmaceutical companies to develop new ambitious projects. In conclusion, MDR bacteria are emerging worldwide causing many public health problems and challenges to healthcare. Based on the result from our pooled data, we can conclude that currently we have only few antibiotics that are effective to treat KP.

Background: Even though the proportion of previously treated TB patients’ (retreatment cases) is increasing at alarming rate, there is scarcity of data regarding their magnitude and treatment outcomes. Therefore, this study is meant to assess TB retreatment case rate and their treatment outcomes at Adama hospital medical college (AHMC) in Ethiopia. Methods: The study employed a retrospective cross-sectional survey where a total of 732 registered TB patients’ data were reviewed between Aprils to May 2014. Data analysis was done using SPSS version 20.0. Results: In this study, 147 (20%) of 732 TB cases were registered as retreatment cases. Of these, 16 (11%) relapse, 13 (9%) return after defaulted (RAD), 23 (16%) failure and 95 (64%) were categorized as ‘other’ among which 61 (64.9%) had sputum smear-negative pulmonary TB (PTB) and 34 (35.1%) had extra PTB (EPTB). Retreatment case is more likely to occur in HIV positive 48 (59%) individuals. Regarding their treatment outcomes, treatment success rate (cure plus treatment completed) of 65 (63.7%) was obtained. Whereas 13 (12.8%) registered as died, 10 (9.8%) as failure, 9 (8.8%) as defaulters and 5 (4.9%) as transferred out cases to other health facility. HIV positive individuals are more likely (54%) to have poor treatment outcomes. Conclusion: The prevalence of TB retreatment cases obtained in this study was higher as compared to similar studies. Similarly, their treatment success rate (TSR) was lower as compared to the national figure. Therefore, more attention should be given to the prevention and treatment of TB retreatment cases to avoid social and economic burden of tuberculosis in Ethiopia.

Myocardial infarction causes death worldwide with the greatest incidence being in the United States. Although there have been many advances in myocardial re-perfusion strategies and novel pharmacological approaches, therapies for treating acute and chronic myocardial ischemic damage remain limited. This means that no currently available heart failure treatment has demonstrated an ability to generate new muscle tissue within the scared regions of the heart. Stem cell, however, offers new hope to patients who have otherwise limited choices. Therefore, this review aims at exploring the use and peculiarities of stem cell therapy for myocardial infarction. But the success of stem cell therapy for clinical use needs the validation of several issues ranging from selection of appropriate stem cells, routes of transfer, establishment of conducive trans-differentiation milieu with associated cytokines, means to evaluate/track response to cell therapy to compliance with regulatory and ethical issues besides addressing biological and technical issues surrounding stem cell therapy.

Informatics is the science of information and the blending of people, biomedicine and technology. Medical informatics as a discipline is still young, in particular when compared to other medical disciplines. The American Medical Informatics Association defined medical informatics as "all aspects of understanding and promoting the effective organization, analysis, management, and use of information in health care". Drug informatics emphasizes the use of technology as an integral tool in effectively organizing, analyzing, and managing information on medication use in patients. Drug Informatics is a specialty area within the realm of clinical pharmacy that has evolved as technology and clinical practice have changed. The objective of this review is to make the reader familiar with the term, informatics, medical informatics and drug information; to describe the evolution of the informatics world; to describe the purpose, requirements and functions of drug information center (DIC). Effective drug information and evaluation skills are a vital part of routine pharmacy practice. Drug information specialists are trained individuals who have clinical knowledge and skills that allow them to provide clear, concise, and accurate recommendations regarding drug use. DIC is a unit designed for receiving, collecting, analyzing, and providing unbiased, accurate and up-to-date information about drugs and their use. Drug information Service (DIS) is the activities function and projects through which the DICs achieve their objectives and which constitute their programs of work. The Purposes of DIC include provision of comprehensive, meaningful and well evaluated information on drugs with a view to enhancing the rational use of drugs; disseminate technical, scientific & objective information to health care providers; disseminate appropriate drug information to the general public; generate, collect, analyze and maintain drug information data; design produce and distribute drug information materials and give appropriate information on toxicology and poisoning. In conclusion, even though the discipline is still young and expected to be stronger in the future, the involvement of pharmacist as a drug information provider has been limited to specific areas of activities. Therefore, it is on the shoulder of the pharmacist to act appropriately and to change the outlook of the activities in near future.

Background: Hepatotoxicity is historically the 3rd most common reason for ART toxicity related discontinuation. Liver toxicity leads to medical visit, work plan exams, and frequent hospital admissions all of which increases expenses. The objective of this study was to determine the risk of hepatotoxicity and identify the major predictors that may cause hepatotoxicity in the study place. Methods: A case-control study was done by reviewing a total of 105 TB/HIV co- infected patients' charts. Results: Of the total 105 patients included in the study, 21 (20%) developed hepatotoxicity. Fifty four (51.43%) of the participants were females. The mean CD4 count of the patients was 205.1 + 96.18 cells/μL and ranged from the lowest count of 51cells/μl to the highest recorded count of 559cells/μl. The most frequent anti-TB regimen prescribed was 2(INH, RIF, ETM, PZA)/4(INH, RIF). Ninety five (90.5%) of the participants were on the primarily prophylactic drugs. Of this figure, 49 (46.7%) were on cotrimoxazole. Number of female patients developed hepatotoxicity were 12 (57.1%). Most of the patients who had developed hepatotoxicity were in stage 3 of HIV/AIDS progression. Social drug use was significantly associated with development of hepatotoxicity (P=.005) with a 95% CI (0.01-311). Patients on TDF/3TC/EFV (OR= 121.7, P=.010) and D4T/3TC/NVP (OR= 47.4, P=.009) ART regimen were found to be more likely to develop hepatotoxicity compared to patients on D4T/3TC/EFV regimen. Similarly patients on 2(ERHZ)/4(RH) anti-TB regimen (OR= 575.96, P=.002) with a 95% CI (0.02-3.8), was found to be more likely to develop hepatotoxicity compared to the other types anti-Tb regimens. Conclusions: The risk of hepatotoxicity in TB/HIV coinfected patients can be due to a number of factors among which sex, the WHO clinical staging, use of Social drugs, type of ART regimen and type of anti-TB regimen are the major, according to the findings of this study.

Background: The incidence of neonatal sepsis (NS) varies from 6 to 9 cases per 1000 live births, but is higher among low-birth-weight neonates. Therefore, the purpose of this study was to examine the risk factors, antimicrobial use pattern and clinical outcomes of NS at Bishoftu General Hospital, neonatal intensive care unit, Debrezeit-Ethiopia. Methods: A prospective cross-sectional study was conducted using pretested and validated checklists. Results: Among the total 306 neonates (0-28 days of age) recruited, 249 (81.4%) were age ≤7 days, 169 (55.23%) were male, 251 (82%) were attended antenatal care, 136 (44.44%) were low in birth weight (≤2.5 kg) and 155 (50.7%) had total of white blood cell count ≥12000/mm 3 . 221 (72.2%) of the neonates diagnosed as sepsis received antibiotics while 74 (24.2%) received antibiotics for other diagnosis. The most frequently prescribed antibiotic was the combination of ‘ampicillin + gentamicin’ prescription 67 (21.9%) followed by the single antibiotic prescriptions of benzyl penicillin 33 (10.8%) and cloxacillin 8 (2.6%). A significant number of neonates ( p = 0.000) with 95% confidence interval of (1.934-8.967) were born in health center and developed sepsis. This value is 4.2 times higher when compared with the neonates born in the home. A significant number of neonates using instrument in hospitals were also developed sepsis ( p = 0.26). The risk of acquiring sepsis in neonates born using instrument was almost 6.2 times more common than children born vaginal in the natural way. A significant number of neonates born from mothers’ with urinary tract infections (UTI) developed sepsis ( p = 0.02) and this figure was almost 2.9 times higher compared to neonates born from mothers’ with no UTI diagnosis. Conclusions: In the present study, the most common risk factors were identified and place of delivery, mode of delivery and mother with UTI during delivery were the most common risk factors for the incidence of NS.

Background: In Ethiopia, particularly, in the study area data on knowledge, attitude and practice of emergence contraceptives among youth in school and college level is lacking. This could be evidenced by the high rates of unwanted pregnancies as well as sexually transmitted infections in these age groups. Therefore, in this study, we are meant to fill such gap in the study area. Methods: A cross-sectional survey was conducted among 305 female students at Ambo Technique College in Ethiopia from March to September 2013. Results: In this study, 80.7% of the respondent had ever heard about Emergence Contraceptives (EC). Yet majority of the respondent (84.6%) had not used the method despite the significant sexual practice they made. About 77.4% of the students have positive attitude towards EC. Conclusion: The respondents in this study had high level of knowledge and positive attitude about EC yet very low level of utilizing the method. Therefore, much work need to be done to identify the reasons behind this lower utilization rate and prompt addressing to increase its up take to the acceptable degree. Lastly, responsible stakeholders have to device structured reproductive health education at college level as one of the tool to achieve the country’s millennium development goal related to family planning.

Worldwide the role of clinical pharmacists is becoming valuable and expanding in an alarming rate especially in developed countries. However, it is at its infancy stage in low income countries like Ethiopia. Therefore, this particular case is meant to show how much clinical pharmacists are important in the identification and management of drug therapy related problems among hospitalized patients. Accordingly, it was found that clinical pharmacists were able to diagnosis drug related problems during the management of hypertensive urgencies and provide evidence based recommendation to address the problems identified. We recommend the need for more number of clinical pharmacists in the area as well as devotion from the policy makers in upgrading their knowledge.

Background: Hypertension is an extremely common clinical problem, affecting approximately 1 billion individuals worldwide. An estimated 1% to 2% of patients with chronic hypertension will at some time develop hypertensive crises (Hypertensive urgency and emergency). Hypertensive urgency and emergency are differentiated by the absence or presence of acute end-organ damage, respectively. The blood pressure of patients with hypertensive emergencies should be reduced rapidly during the treatment. It should not be reduced to the normal value, but by approximately 20-30% of the baseline value. The reason for a stepwise reduction in blood pressure is the fact that patients with chronic hypertension have an altered auto regulation curve. Case presentation: A 60 year old male patient, who has been a known hypertensive patient admitted due to sudden onset of body weakness, difficulty of speech, diverted lips towards the left side, difficulties in eating, moving, coughing and inability to move right side of his extremities since one day. On P/E the pt. was severely sick looking, and unconscious. Conclusion: A number of both parenteral and oral antihypertensive drugs can be used in these patients. Treatment of hypertensive crises in patients with hypertensive encephalopathy, intracranial haemorrhage, subarachnoid haemorrhage, and thrombotic stroke has been recommended to be initiated with nicardipine, fenoldopam, nimodipine, flunarizine or labetalol.

Background: Diabetes mellitus has reached epidemic proportions in many countries. Current challenges in diabetes mellitus management include: optimizing the use of currently available therapies to ensure adequate glycemic, blood pressure, and lipid control and to reduce complications. Aim of the review is to provide a brief overview of recent advancement in diabetes mellitus management. Method Different published articles were reviewed systematically. Result Current standard of care for Type 2 Diabetes mellitus consists of screening for elevated HbA1c levels or, in some cases, fasting plasma glucose, with diagnosis followed by management with lifestyle modifications and metformin. While Insulin, along with diet, is crucial to the survival of individuals with Type 1 Diabetes Mellitus. Despite the known benefits of lifestyle modification, and insulin therapy many individuals still find it harder to maintain a healthier life because of the higher possibilities of sedentary behavior and overeating in the modern world. The success of antidiabetes medication has also been limited by their mechanisms of action, and undesirable side effects. The past 10 years have seen an explosion in the number of new treatments available for diabetes and there are a number of exciting new drugs in development to achieve these goals including oral insulin, islet and pancreatic cell transplant, gene therapy, the incretins, dipeptidyl peptidase-4 inhibitors, peroxisome proliferator-activated receptor inhibitors, and sodium–glucose cotransporter inhibitors to treat Type 2 diabetes Mellitus. Conclusion Current standard of care for diabetes management is not sufficient to provide long run benefits to diabetes patients. Therefore, future remedies with the modifications in insulin delivery system and pharmacogenetic therapeutic approaches could possibly provide the much nodded effect and changes the outcome of diabetes management with new outlook.

Hypertension is an important worldwide public-health challenge because of its high frequency and risk factor for cerebrovascular, cardiovascular and kidney disease. Drug therapy problems are a significant challenge to health care providers. It severely compromises the effectiveness of treatment making this a critical issue in population health both from the perspective of quality of life and of health economics. Therefore, the objective of this study is to determine the pattern and magnitude of drug therapy problems in the study hospital and to find out risk factors for these problems. The study was questionnaire-based Cross sectional design which was conducted from April to May 2014 at Adama Hospital Medical College. A convenient sampling method was used and a total of 192 hypertensive patients were included in the study. Data were analyzed using SPSS software program. In this study 155 (80.7%) patients have at least one drug therapy problem and a total of 452 drug therapy problems were identified in them. The most common drug therapy problem identified in this study was drug interaction (n=259, 58.7%), followed by non-adherence and adverse drug interaction constituting 19.5% and 18.6% respectively. Under dose accounts only 0.9% of all drug therapy identified. Marital status, number of drugs and number of co morbidities significantly affect drug therapy problems. The study showed that 80.7% of the patients in the study have drug therapy problems. Number of complications and number of drugs significantly affect drug therapy problems. Therefore, patients with multiple diagnosis and patients using multiple drugs should be closely monitored for drug therapy problem, to avoid clinically significant harmful consequences.

Background: Poor and inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and major risk factor for the development of diabetes complications. Therefore, the purpose of this study was to determine factors associated with poor glycemic control among type 2 diabetes patients attending Ambo hospital chronic care service. Methods: A prospective cross sectional study was conducted. A 5% sample pretest was performed on randomly selected patients before the beginning of the study. A three month consecutive measurements of blood glucose was used to assess glycemic control. Results: A total of 102 type 2 diabetes patients were interviewed and their chart was checked using a structured check list format. Of the total 102 patients, 50% had a mean FBG level of > 126 mg/dl with three month consecutive measurement resulting in poor glycemic control. We have identified that patients with age in between 51-50 yr (p=0.038) and age 61-70 yr (p=.017) were poorly managed their blood glucose level compared to the other age groups under study. The most frequent comorbidity observed over type 2 diabetes was hypertension 41(40.6%) followed by renal disease and dyspepsia with 5 and 3 patients respectively. Furthermore, patients who had hyperlipidemia and peripheral neuropathy as a comorbidities had 5 and 579 more prone to develop poor blood glucose control compared to patients with no comorbidities with 95% C.I of (1.145-20.462 and 116.8-2870), respectively. Conclusion: The proportion of patients with poor glycemic control was high, which was nearly comparable to that reported from many countries. Age in between 51-70 yr and the presence of comorbidities like hyperlipidemia and peripheral neuropathy were associated with poor glycemic control.

Background: Treatment interruption and switch to a new Highly Active Antiretroviral Therapy (HAART) regimen act as competing risks for patient on HAART. Methods: The study was conducted in Mekelle hospital. A case-control study was conducted. Socio-demographic, immunologic and clinical characteristics were components of the checklist. Data was compiled, processed, and analyzed using Statistical Package for Social Sciences (SPSS) for windows version 16. Ethical consideration was obtained from Mekelle University. Results: 105 patients’ records were sampled and studied. Twenty one (20%) of the patients had changed their initial ART regimen and about three-fourth 15 (71.4%) of the reasons for change was attributable to toxicity while 3 and 2 were due to treatment failure and pregnancy respectively. The odds of Adverse Drug Reactions (ADRs) who had one initial ART change (cases) were 2.37 times greater than the odds who did not change (controls) Patients, initiated ZDV based ART regimen had 9.93 times greater chance of changing their initial ART regimen compared to those initiated with D4T based ART regimen and patient on ART for treatment duration of 12-36 months were relatively at higher risk compared to patients with lesser duration of treatment. Patients who’s ART had 99.94% lesser chance of changing their baseline ART regimen compared to those who did take other medications Conclusions: The main factor determining the change of initial ART regimen in our study was the occurrence of adverse drug reactions, with ZDV being the most dominant drug.

Diabetes mellitus (DM) has been known to mankind for more than 2000 years. DM is a group of metabolic disorder characterized by a complete lack of insulin, a relative lack of insulin, or insulin resistance. The increase in prevalence of DM is due to three influences: lifestyle, ethnicity, and age. Current challenges in diabetes management include: optimizing the use of the already available therapies to ensure adequate glycemic, blood pressure, and lipid control and to reduce complications. At present several researches have been focusing on new management options for diabetes. Among these options the use of nanomedicine is becoming an eye catching and most promising. The aim of the present review is to provide brief overview of the applications of nanoparticles (NPs) in diabetes management. The development of improved oral insulin administration is very essential for the treatment of DM to overcome the problem of daily subcutaneous injections. In diabetic patients oral administration of insulin can be beneficial not only to alleviate the pain and trauma caused by injections, but it can also mimic the physiological fate of insulin as well. It has been found that NPs of chitosan, calcium pectinate zinc oxide, alginate, casein and different polymers have been used as a carrier for oral insulin delivery. Buccal administration of insulin with absorption enhancers showed a maximum 12% pharmacological activity. Biodegradable Polymeric NPs for parenteral insulin delivery have also been used, where the insulin matrix surrounded by the nanoporous membrane containing grafted glucose oxidase. A rise in blood glucose level triggers a change in the surrounding nanoporous membrane, resulting in biodegradation and subsequent insulin delivery. Inhalable, polymeric NP-based drug delivery systems have also been tried earlier for the treatment of tuberculosis and cardiovascular disease treatment. Such approaches can be directed toward insulin delivery through inhalable NPs. All previous studies resulted in post treatment accumulation of the NPs in skin and eyes. These drug delivery technologies are in various stages of research and development. The medical applications for nanotechnology are enormous and could give medicine, including the treatment of diabetes, an entirely new outlook.

Human immunodeficiency virus continued to be the greatest challenge and killer disease of the 21st century despite the advent of potent highly active antiretroviral therapy which are limited by their severe adverse effects, significant drug interactions, frequent dosing, limited bioavailability, and less access to viral reservoir sites like macrophages. Nano-medicines are becoming new hopes in avoiding these shortcomings of conventional antiretroviral drugs. The emphasis of this review is mainly the application of polymers based nanomedicines in pharmacotherapy of HIV/AIDS. Most of the studies to date on this area are in vitro and human clinical trials are totally missed. However, many interesting points are uncovered through this review like the possibility of achieving high intracellular concentration of drugs, very good antiretroviral activity, improved bioavailability, reduced toxicity and release of the drugs from nanocarriers for long time reducing the need for frequent dosing. Indeed, a lot of assignments left behind for researchers to overcome the challenges hindering the wider application of nanomedicines in treatment of HIV/AIDS.