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Although many proposals have been developed for the sixth-generation (6G) technology, realizing 6G is fraught with numerous fundamental interdisciplinary, multidisciplinary, and transdisciplinary challenges. To mitigate some of these challenges, goal-oriented semantic communication (SemCom) has emerged as a promising 6G technology enabler. This enabler employs only semantically-relevant information for successful task execution while minimizing power usage, bandwidth consumption, and transmission delay. On the other hand, 6G is essential for realizing major goal-oriented SemCom use cases such as autonomous transportation. These paradigms of 6G for goal-oriented SemCom and goal-oriented SemCom for 6G call for a tighter integration of 6G and goal-oriented SemCom. To facilitate this purpose, this survey paper exposes the fundamental challenges of 6G; details the notion of goal-oriented SemCom and its state-of-the-art research landscape; presents state-of-the-art trends, use cases, and frameworks of goal-oriented SemCom; exposes the fundamental and major challenges of goal-oriented SemCom; and offers promising future research directions for goal-oriented SemCom. Consequently, this survey article stimulates numerous lines of research on goal-oriented SemCom theories, algorithms, and realization.

Tseganew Addisu,1 Mihret Tilahun,2 Shambel Wedajo,3 Bekele Sharew2 1Department of Dental Medicine, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 2Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 3School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaCorrespondence: Mihret Tilahun, Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, PO. BOX: 1145, Dessie, Ethiopia, Tel +251- 920988307, Fax +251 333115250, Email tilahunmihret21@gmail.comBackground: The persistent efforts of HIV/AIDS epidemiology remain one of the world’s most important community health threats. To avoid becoming an epidemic, UNAIDS has set three 90% fast-track targets for 2020, and Ethiopia has also changed its implementation since 2015. However, the achievement targets in the Amhara region have yet to be evaluated at the end of the programme period.Objective: The aim of this study was to assess the Trends of HIV Infection and Antiretroviral Treatment outcome in Eastern Amhara Regional from 2015 to 2021, Northeast Ethiopia.Methods: A retrospective study was conducted by reviewing the District Health Information System from 2015 to 2021. The collected data includes the trend of HIV testing services, the trend of HIV positivity, the yield of HIV testing approaches, the number of HIV positive patients linked to HIV care and treatment or access to lifelong antiretroviral therapy, viral load testing coverage, and viral suppression. A descriptive statistic and trend analysis were computed.Results: A total of 145,639 people accessed antiretroviral therapy. The trend of HIV test positivity has been declining since 2015, peaking at 0.76% in 2015 and declining to 0.60% in 2020. A high level of positivity was reported in volunteer counselling and testing as compared with provider-initiated testing and counselling services. Following an HIV positive, there was an increase in linkage to HIV care and treatment. High suppression rates of viral load indicate testing coverage grew over time. The viral load monitoring coverage was 70% in 2021, with a viral suppression rate of 94%.Conclusion and Recommendations: The trend in achievement in the first 90s was not consistent with predefined goals (90%). On the other hand, there was good achievement in the second and third goals. Hence, intensified case-finding approaches to HIV testing should be strengthened.Keywords: HIV, antiretroviral treatment outcome, trends

Ousman Mohammed, Ermiyas Alemayehu, Habtye Bisetegn, Habtu Debash, Alemu Gedefie, Hussen Ebrahim, Mihret Tilahun, Temesgen Fiseha Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, EthiopiaCorrespondence: Ousman Mohammed, Tel +251911641754, Email ousmanabum@gmail.comBackground: Microalbuminuria (MAU) is considered the earliest sign of diabetic nephropathy among diabetes patients. In order to effectively manage diabetic nephropathy and its consequences early, detection of microalbuminuria as soon as possible, especially for diabetes patients, is critical. Therefore, the present study aimed to determine the pooled prevalence of microalbuminuria among diabetes patients in Africa.Methods: Electronic databases such as Google Scholar, PubMed, African Journals Online, Web of Science, Cochrane Library, EMBASE, and ResearchGate were searched for articles and grey literature. The STATA version 14 software was used to conduct the meta-analysis. I2 and Cochran’s Q test were employed to assess the presence of heterogeneity between studies. Due to the presence of heterogeneity, a random effect model was used. The publication bias was assessed using the symmetry of the funnel plot and Egger’s test statistics. Moreover, subgroup analysis, trim and fill analysis, and sensitivity analysis were also done.Results: The overall pooled prevalence of microalbuminuria among diabetes patients in Africa was 37.11% (95% CI 31.27– 42.95). Substantial heterogeneity was observed between studies, with I2 values of 94.7%. Moreover, this meta-analysis showed that the pooled estimate of microalbuminuria among type 1 and type 2 diabetes patients was 35.34% (95% CI: 23.89– 46.80, I2=94.2), and 40.24% (95% CI: 32.0– 48.47, I2=94.9) respectively. MAU, on the other hand, was more common in people with diabetes for more than 5 years 38.73% (95% CI: 29.34– 48.13) than in people with diabetes for less than 5 years 31.48% (95% CI: 18.73– 44.23).Conclusion: This systematic review and meta-analysis found a high prevalence of microalbuminuria among diabetes patients. As a result, early detection of microalbuminuria is critical for preventing and treating microvascular complications such as diabetic nephropathy and the onset of end-stage renal disease.Keywords: microalbuminuria, diabetes, Africa, meta-analysis

Abay Atnafu,1 Liya Wassie,1 Melaku Tilahun,1,&ast; Selfu Girma,1 Yohannes Zenebe,2 Muluye Abebe Beyene,1 Ashenafi Alemu,1 Emnet Fisseha,1 Haymanot Agze,1 Tigist Desta,1 Kassu Desta,3,&ast; Kidist Bobosha1,&ast; 1Armauer Hansen Research Institute, Addis Ababa, Ethiopia; 2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 3Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia&ast;These authors contributed equally to this workCorrespondence: Abay Atnafu, Tel +251912205822, Email ayatab.ayele7@gmail.comBackground: Extrapulmonary tuberculosis (EPTB), particularly tubercular lymphadenitis (TBLN), remains to pose a huge public health problem in Ethiopia. A significant number of TBLN patients who completed a full course anti-TB treatment regimen were reported to have enlarged lymph nodes and other TB-like clinical presentations. This could either be from a paradoxical reaction or microbiological relapse, possibly due to mono/multi-drug resistance.Objective: To investigate the rate of mono and multidrug resistance patterns of Mycobacterium tuberculosis as a cause of the observed treatment failures in clinically diagnosed and anti-TB treatment (newly or previously)-initiated LN patients.Methods: A cross-sectional study was conducted on 126 TBLN-suspected and previously treated patients between March and September 2022. Data were analyzed using SPSS (Version 26.0). Descriptive statistics were used to determine the frequency, percentage, sensitivity, specificity, and positive and negative predictive values. The level of agreement was determined using Cohen’s kappa and a Chi-square test was used to measure the association between risk factors and laboratory test outcomes. A P-value < 0.05 was considered statistically significant.Results: Mycobacterium tuberculosis was confirmed in 28.6% (N=36) of the 126 cases using BACTEC MGIT 960 culture detection method. Approximately, 13% (N=16) of the samples were collected from previously treated TBLN patients, of which 5/16 (31.3%) were multi-drug resistant, 7/16 were drug-sensitive and 4/16 were culture negative. To rule out other non-tuberculous agents, all samples were grown on blood and Mycosel agar plates, and no growth was detected.Conclusion: The emergence of drug resistant (DR) TB seems to not just be limited to pulmonary form but also to TBLN. In this study we observed a considerable number of microbiologically confirmed relapses among previously treated cases, possibly indicating the need for confirmation of drug resistance using rapid molecular methods or phenotypical methods during treatment follow up.Keywords: tubercular lymphadenitis, relapse, drug sensitivity testing, DST, FNA

Hussen Ebrahim,1 Mihret Tilahun,1 Temesgen Fiseha,1 Habtu Debash,1 Habtye Bisetegn,1 Ermiyas Alemayehu,1 Mesfin Fiseha,1 Endris Ebrahim,1 Agumas Shibabaw,1 Abdurahaman Seid,1 Daniel Getacher Feleke,2 Ousman Mohammed1 1Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia; 2Department of Microbiology, Immunology, and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Hussen Ebrahim, Po.Box:1145, Tel +251921332772, Email husshosam@gmail.comBackground: Thyroid nodules are the most common thyroid disease and its incidence has been rising throughout the world. Thus, this study aimed to assess the patterns of fine needle aspiration cytology-diagnosed thyroid nodules among clinically suspected patients.Methods: A prospective cross-sectional study was conducted from April 2021 to March 2022 using 424 study participants who were referred to undergo fine needle aspiration cytology examination and were consecutively included. Moreover, two FNAC smears were prepared and stained using Wright and Giemsa staining solutions and then examined by an experienced licensed pathologist. Multivariate logistic regression was used to determine the association of socio-demographic and clinical variables with nodules. P-value < 0.05 was considered to be statistically significant.Results: The overall magnitude of benign and malignant nodules was 60.4% and 16.5% respectively. Moreover, the magnitude of atypical of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) and follicular neoplasm or suspicious of follicular neoplasm (FN/SFN) was 3.54% and 1.42% respectively. The magnitude of malignant thyroid nodules was 5.9% for malignant secondary adenocarcinoma, 3.5% for papillary thyroid carcinoma, 2.6% for Non-Hodgkin lymphoma, 2.4% for medullary thyroid carcinoma, 1.4% of an undifferentiated malignant thyroid tumor and 0.7% of Hodgkin lymphoma respectively. Multivariate logistic regression showed that age categories between 0 and 15 years and between 16 and 30 years, and nodule size > 2.5cm were significantly associated with malignant thyroid nodules.Conclusion: The magnitude of benign and malignant tumors was 60.4% and 16.5% respectively. Being younger and having nodule size > 2.5cm were significantly associated with malignant thyroid nodules. Therefore, fine needle aspiration cytology examination has a crucial role in the diagnosis and management of benign and malignant thyroid nodules.Keywords: benign, cytology, fine needle aspiration, malignant, thyroid tumors, thyroid gland, thyroid nodules, ultrasound, Ethiopia

Semantic communication (SemCom) aims to convey the meaning behind a transmitted message by transmitting only semantically-relevant information. This semantic-centric design helps to minimize power usage, bandwidth consumption, and transmission delay. SemCom and goal-oriented SemCom (or effectiveness-level SemCom) are therefore promising enablers of 6G and developing rapidly. Despite the surge in their swift development, the design, analysis, optimization, and realization of robust and intelligent SemCom as well as goal-oriented SemCom are fraught with many fundamental challenges. One of the challenges is that the lack of unified/universal metrics of SemCom and goal-oriented SemCom can stifle research progress on their respective algorithmic, theoretical, and implementation frontiers. Consequently, this survey paper documents the existing metrics– scattered in many references– of wireless SemCom, optical SemCom, quantum SemCom, and goal-oriented wireless SemCom. By doing so, this paper aims to inspire the design, analysis, and optimization of a wide variety of SemCom and goal-oriented SemCom systems. This article also stimulates the development of unified/universal performance assessment metrics of SemCom and goal-oriented SemCom, as the existing metrics are purely statistical and hardly applicable to reasoning-type tasks that constitute the heart of 6G and beyond.

Mihret Tilahun,1 Mesfin Fiseha,1 Endris Ebrahim,1 Seada Ali,1 Melaku Ashagrie Belete,1 Abdurahaman Seid,1 Wondmagegn Demsiss,1 Alemu Gedefie,1 Selamyhun Tadesse,2 Chernet Belayhun3 1Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia; 2Department of Medical Laboratory Science, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia; 3Department of Medical Laboratory Science, Mehal Meda Hospital, Mehal Meda, North Showa, EthiopiaCorrespondence: Mihret Tilahun, Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, 1145, Ethiopia, Tel +251- 913867849, Email tilahunmihret21@gmail.comBackground: Streptococcus pneumoniae infection is still the world’s most serious public health problem among children under the age of five. Nasopharyngeal carriage rate of Streptococcus pneumoniae has been identified as an important risk factor for the acquisition of community acquired respiratory tract infection. To date, little is known about the nasopharyngeal infection and antimicrobial susceptibility pattern of Streptococcus pneumoniae among preschool children in Ethiopia.Objective: The aim of this study was to assess the prevalence of nasopharyngeal carriage and antimicrobial susceptibility pattern of Streptococcus pneumoniae among preschool children.Methods: A cross-sectional study was conducted from September 2021 to April 2022. A total of 418 preschool children were enrolled using a multistage sampling technique. Nasopharyngeal swab was collected and transported to Medical Microbiology Laboratory at Debre Berhan comprehensive specialized hospital using skim-milk tryptone glucose glycerol transport media. The swab was inoculated on blood agar plates supplemented with 5μg/mL gentamycin and incubated at 37°C for 24– 48 hours under 5% CO2 using a candle jar. Identification of Streptococcus pneumoniae was performed using Gram stain, catalase test, optochin test and bile solubility test. Antimicrobial sensitivity tests were done using a modified Kirby-Bauer disk diffusion method. Data were entered into the statistical package Epi data 4.0.0.6 and transferred to and analyzed using SPSS software version-23. A P-value ≤ 0.05 with 95% CI was considered to be statistically significant.Results: The prevalence of Streptococcus pneumoniae nasopharyngeal carriage was 29.9% (125/418). The overall rate of multidrug resistance was 86 (68.8%), with tetracycline (68.8%) and TMP-SMX (68%). Among risk factors, young age and passive smoking were associated with pneumococcal carriage.Conclusion: The present study revealed a substantially lower prevalence of Streptococcus pneumoniae nasopharyngeal carriage. High antimicrobial resistance was observed for most antimicrobial drugs tested. Younger age groups and passive smokers were at risk of Streptococcus pneumoniae nasopharyngeal carriage.Keywords: Streptococcus pneumoniae, nasopharyngeal carriage, antimicrobial susceptibility

Mihret Tilahun Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaCorrespondence: Mihret Tilahun, Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie and Borumeda, PO.BOX 1145, Ethiopia, Tel +251 920988307, Fax +251 333115250, Email tilahunmihret21@gmail.comBackground: Antibiotic resistance is becoming a global issue, with estimated 2.8 million people in the United States developing antibiotic-resistant diseases each year. The carriage of ESBL and Carbapenemase-producing Enterobacteriaceae among hospitalized patients is a threat to the future of antibiotic treatment.Objective: Multi-drug resistance profile, prevalence of extended-spectrum beta-lactamase and Carbapenemase-producing Gram-negative bacilli among admitted patients after surgery with suspected surgical site nosocomial infection north east Ethiopia.Material and Methods: A hospital-based cross-sectional study was conducted from April 2021 to February 2022. Socio-demographic and clinical data were assessed using a structured questionnaire. A total of 384 relevant clinical samples (pus, pus aspirates, and wound swabs) were collected aseptically and processed within 30 min by placing the swabs into the sterile test tubes having 0.5 mL of sterile normal saline. The samples were cultured on MacConkey agar, chocolate agar and blood agar, and species identification was done using standard biochemical tests. Disk diffusion antimicrobial sensitivity test was done on Mueller–Hinton agar. All the cefoxitin resistant Enterobacteriaceae isolates were checked for the presence of AmpC beta-lactamase using four cartridges of disk diffusion tablets. ESBL output validation was conducted by the combination disk test. The production of Carbapenemase was checked using modified carbapenem inactivation method.Results: The prevalence of significant bacterial nosocomial infection among surgical site infection 343 (89.32%). S. aureus 125 (36.4%) was predominant followed by E. coli 80 (23.3%) P. aeruginosa 31 (9.03%). The overall MDR rate of isolated bacteria was 251 (73.3%). About 150 (73.9%) bacteria were suspected for ESBL production and 67 (33%) AmpC beta-lactamase and 27 (13.3%) Carbapenemase-producing Gram-negative bacterial, respectively.Conclusions and Recommendations: The severity of ESBL-PE was critical, and the CPE was alarming. Meropenem and imipenem were the most effective antibiotics against ESBL-producing Enterobacteriaceae. Therefore, strict infection prevention and control measures are needed.Keywords: carbapenemase, ESBL, Enterobacteriaceae, surgical site infection

Mihret Tilahun,1 Alemu Gedefie,1 Endris Ebrahim,1 Abdurahaman Seid,1 Abdurrahman Ali,1 Agumas Shibabaw,1 Melaku Ashagrie Belete,1 Mesfin Fiseha,1 Melkam Tesfaye,1 Hussen Ebrahim,1 Admasu Abera2 1Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 2Department of Medical Laboratory Science, Debre Birhan health Science college, North Showa, EthiopiaCorrespondence: Mihret Tilahun, Department of Medical Laboratory Science College of Medicine and Health Sciences, Wollo University, Po.Box: 1145, Dessie, Ethiopia, Tel +251-920988307, Fax +251 333115250, Email tilahunmihret21@gmail.comBackground: In people living with the human immunodeficiency virus, haematological abnormalities have been linked to an increased risk of disease progression and mortality. Hematological parameters may have a positive or negative impact on antiretroviral therapy. The aim of this study was to assess the immuno-haematological abnormalities of HIV-infected patients before and after the initiation of highly active antiretroviral therapy in the antiretroviral therapy clinics of six health facilities in Dessie, Northeast Ethiopia.Methods: A facility-based cross-sectional study was conducted from April to May 30, 2021, at the antiretroviral therapy clinics of six health facilities in Dessie Town. A total of 378 HIV-infected patients taking highly active antiretroviral treatment for at least 6 months by using a consecutive sampling technique were included. A well-organized questionnaire was used to collect socio-demographic and clinical information. Immune-haematological parameters were tested using a Mindray BS-300 hematology analyzer and a BD FACS count CD4 analyzer. Statistical analysis was performed using SPSS version 25 statistical software. Statistical significance was defined as a P-value of 0.05 with a 95% confidence interval.Results: Leukopenia was found in 26.7% and 16.5%, neutropenia in 16.5% and 9.4%, lymphopenia in 20% and 3.1%, and thrombocytopenia in 25.9% and 7.1% of HIV patients before and after HAART initiation, respectively. There was a significant difference in total white blood cell, absolute neutrophil, red blood cell, hemoglobin value, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, red cell distribution width, platelet and CD4+ T cell counts in HIV patients before and after the initiation of HAART with P < 0.05.Conclusion and Recommendation: Anemia, leukopenia, neutropenia, lymphopenia, and thrombocytopenia were the most common haematological abnormalities found in this study before and after HAART initiation. The prevalence of thrombocytopenia, immunosuppression, and viral load was reduced considerably after starting HAART.Keywords: HIV, anemia, leukopenia, thrombocytopenia, HAART

Mihret Tilahun, Alemu Gedefie, Habitye Bisetegn, Habtu Debash Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaCorrespondence: Mihret Tilahun, Department of Medical Laboratory Science College of Medicine and Health Sciences, Wollo University, PO.Box: 1145, Dessie, Ethiopia, Tel +251 920988307, Fax +251 333115250, Email tilahunmihret21@gmail.comBackground: The emergence of extended spectrum beta lactamase and carbapenemase production of Acinetobacter and Pseudomonas aeruginosa is a great concern and major cause of nosocomial infections due to its ability to production of extended spectrum beta lactamase and carbapenemase enzymes.Objective: To assess Emergence of high prevalence of extended-spectrum beta-lactamase and Carbapenemase producing Acinetobacter species and Pseudomonas aeruginosa among hospitalized patients at Dessie Comprehensive Specialized Hospital, North-East Ethiopia.Materials and Methods: A hospital-based cross-sectional study was conducted from February–August 2021 at Dessie Referral Hospital in the North eastern Ethiopia. A total of 423 clinical samples taken from admitted patients. Clinical specimens were collected aseptically and inoculated on blood agar and MacConkey agar media. Antimicrobial susceptibility test, ESBL and carbapenemase production were performed as CLSI guideline. The data were entered into the Epi-data and imported to Statistical Package for Social Science version 25. P value of < 0.05 with odds ratio and 95% confidence interval was considered as statistically significant.Results: Out of 423 clinical specimens 17.7% (75/423) were culture positive nosocomial infection. The proportions of nosocomial infection were higher in blood stream followed by wound infection which accounted 24.6%, 20.8%, respectively. Overall, 32/75 (42.7%) and 19/75 (25.3%) patients had infection with ESBL and CP producing bacterial infection. P. aeruginosa was the most predominant isolated bacteria 46/75 (52.9%). The overall multidrug resistance rate of the isolated bacteria was 88% (66/75). The majority of highest resistance rate was Piperacillin tazobactam 50 (66.7%) and Aztreonam 26 (56.5%), respectively, while least resistance rate was Amikacin 27 (36%).Conclusion: The incidence rates of ESBL, carbapenemase production and antimicrobial resistant Acinetobacter species and P. aeruginosa infections are high. Therefore, treatment should be based on culture and antimicrobial test result and minimize the use of antibiotics empirically.Keywords: nosocomial infections, extended-spectrum beta-lactamase, carbapenemase, Acinetobacter, Pseudomonas aeruginosa, drug resistance

Mihret Tilahun,1 Alemu Gedefie,1 Chernet Belayhun,2 Zenawork Sahle,3 Admasu Abera3 1Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 2Department of Medical Laboratory Science, Mehal Meda Hospital, North Showa, Ethiopia; 3Department of Medical Laboratory Science, Debre Birhan Health Science College, North Showa, EthiopiaCorrespondence: Mihret TilahunDepartment of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, PO.BOX: 1145, Dessie, EthiopiaTel +251 920988307Fax +251 333115250Email tilahunmihret21@gmail.comAbstract: Helicobacter pylori is a well-known human-specific stomach pathogen that infects more than half of the world’s population. The infection with this bacterium can cause a variety of gastrointestinal problems, including chronic gastritis, peptic ulcers, and even cancer. H. pylori is a highly infectious bacterium. H. pylori causes an increase in gastric mucosa pH or gastric mucosa intestinal metaplasia. These modifications in the stomach environment are necessary for G. lamblia colonization to occur. Giardia lamblia is a flagellate protozoan parasite that can cause giardiasis in humans and other mammals. It dwells in the duodenum and upper jejunum. Globally, over 280 million cases of human giardiasis are predicted to occur each year. Simultaneous human colonization by G. lamblia and H. pylori is a typical occurrence since the viruses’ predisposing factors are similar in both groups. Giardiasis is a parasitic infection that affects both children and adults worldwide. Infection with Giardia is more common in underdeveloped countries. Globally, more than 200 million cases of giardiasis are detected each year. In contrast, the presence of G. lamblia in the host body triggers an immunological response comparable to that of H. pylori, with lymphocytes strongly polarized towards Th1. As a result, their combined presence exacerbates host tissue damage. The major goal of this seminar is to describe the pathophysiology, immunology, and clinical aspects of G. lamblia and H. pylori coinfection using a comprehensive search of PubMed, Lancet, and Google Scholar sources. Upper gastrointestinal problems such as upper abdominal pain, abdominal bloating, nausea, vomiting, epigastric pain/burning, and belching are all caused by both organisms. Differentiation by physical examination is impossible in people infected with both bacteria. For this coinfection distinction, a laboratory diagnosis is required. G. lamblia and H. pylori, when present together, have a synergistic effect on the host and can cause serious damage. As a result, researchers should delve deeper into the mechanics underlying this potential microbial interaction.Keywords: Helicobacter pylori, pathogenicity islands, Giardia lamblia, coinfection

Mihret Tilahun, Yeshimebet kassa, Alemu Gedefie, Melaku Ashagire Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaCorrespondence: Mihret TilahunDepartment of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, PO.BOX: 1145, Dessie, EthiopiaTel +251 920988307Fax +251 333115250Email tilahunmihret21@gmail.comAbstract: Infections due to multidrug-resistant Enterobacteriaceae have become major international public health problem due to the inadequate treatment options and the historically lagged pace of development of novel antimicrobial drugs. Inappropriate antimicrobial use in humans and animals coupled with increased global connectivity aided to the transmission of drug-resistant Enterobacteriaceae infections. Carbapenems are the medications of choice for extended-spectrum beta-lactamase and AmpC producers, but alternatives are currently needed because carbapenem resistance is increasing globally. This review pointed to discuss emerging drug-resistant Enterobacteriaceae, its epidemiology and novel treatment options for infections, which date back from 2010 to 2019 by searching Google Scholar, PubMed, PMC, Hinari and other different websites. The occurrence of carbapenem-resistant Enterobacteriaceae is reported worldwide with great regional variability. The rise of carbapenem-resistant Enterobacteriaceae poses a threat to all nations. Enzyme synthesis, efflux pumps, and porin mutations are the main methods by which Enterobacteriaceae acquire resistance to carbapenems. The major resistance mechanism among these is enzyme synthesis. Most carbapenem resistance is caused by three enzyme groups: Klebsiella pneumoniae carbapenemase (Ambler class A), metallo-ß-lactamases (Ambler class B), and oxacillinase-48 (Ambler class D). Ceftazidime–avibactam, which was newly licensed for carbapenemase producers, is the most common treatment option for infections. Meropenem–vaborbactam, imipenem–relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam–avibactam are recently reported to be active against carbapenem-resistant Enterobacteriaceae; and are also in ongoing trials for different populations and combinations with other antibacterial agents. Overall, treatment must be tailored to the patient’s susceptibility profile, type and degree of infection, and personal characteristics.Keywords: multidrug resistance, antimicrobial therapy, carbapenemase, Enterobacteriaceae

Alemu Gedefie,1 Wondmagegn Demsis,1 Melaku Ashagrie,1 Yeshimebet Kassa,1 Melkam Tesfaye,1 Mihret Tilahun,1 Habtye Bisetegn,1 Zenawork Sahle2 1Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 2Department of Medical Laboratory Sciences, Debre Birhan Health Science College, Debre Birhan, EthiopiaCorrespondence: Alemu Gedefie Email alemugedefie@gmail.comAbstract: Acinetobacter species, particularly Acinetobacter baumannii, is the first pathogen on the critical priority list of pathogens for novel antibiotics to become a “red-alert” human pathogen. Acinetobacter baumannii is an emerging global antibiotic-resistant gram-negative bacteria that most typically causes biofilm-associated infections such as ventilator-associated pneumonia and catheter-related infection, both of which are resistant to antibiotic therapy. A. baumannii’s capacity to develop antibiotic resistance mechanisms allows the organism to thrive in hospital settings, facilitating the global spread of multidrug-resistant strains. Although Acinetobacter infections are quickly expanding throughout hospital environments around the world, the highest concentration of infections occurs in intensive care units (ICUs). Biofilms are populations of bacteria on biotic or abiotic surfaces that are encased in the extracellular matrix and play a crucial role in pathogenesis, making treatment options more difficult. Even though a variety of biological and environmental elements are involved in the production of A. baumannii biofilms, glucose is the most important component. Biofilm-mediated A. baumannii infections are the most common type of A. baumannii infection associated with medical equipment, and they are extremely difficult to treat. As a result, health care workers (HCWs) should focus on infection prevention and safety actions to avoid A. baumannii biofilm-related infections caused by medical devices, and they should be very selective when using treatments in combination with anti-biofilms. Therefore, this review discusses biofilm formation in A. baumannii, its role in disease pathogenesis, and its antimicrobial resistance mechanism.Keywords: biofilm, Acinetobacter, A. baumannii, pathogenesis, antibiotics resistance

Mitku Mammo Taderegew,1 Gashaw Garedew Woldeamanuel,1 Mamo Solomon Emeria,2 Melkamu Tilahun,3 Getachew Yideg Yitbarek,4 Betregiorgis Zegeye5 1Department of Biomedical Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia; 2Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia; 3Department of Biomedical Sciences (Medical Physiology), College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia; 4Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 5HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, EthiopiaCorrespondence: Mitku Mammo TaderegewDepartment of Biomedical Sciences, School of Medicine, College of Medicine and Health Sciences, Wolkite University, PO Box 07, Wolkite, EthiopiaEmail mitkumamo@gmail.comPurpose: Platelet indices have been shown to be associated with complications of diabetes mellitus (DM). However, the clinical relevance of platelet indices for assessing the risk of being microvascular complications among patients with DM is largely overlooked. Hence this study aimed to determine the association of platelet indices with microvascular complications among type 2 DM patients.Patients and Methods: A hospital-based cross-sectional study was conducted among 352 type 2 DM patients from April 1 to May 30/2019 at Debre Berhan Referral Hospital. Data were collected by interview, physical measurements, document review, and laboratory tests. Then the data were entered into Epi-data manager-4.4.1.0 and exported into SPSS-25 for analysis. Platelet indices were compared between participants with and without microvascular complications using an independent t-test. A logistic regression model was used to assess the association between microvascular complications and platelet indices. All inferences were considered statistically significant at P< 0.05.Results: One hundred seventeen (33.2%) of participants were suffering from at least one microvascular complications. The mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR) were significantly increased in DM patients with complications as compared to without complications (13.57± 2.17fl vs. 11.76± 1.93fl), (16.57± 2.49fl vs. 14.97± 2.41fl) and (28.09± 7.58% vs. 24.19± 6.46%), respectively (all are P˂0.001). In multivariate logistic regression analysis, MPV (AOR=1.68, 95% CI: 1.37– 2.05), PDW (AOR=1.37, 95% CI: 1.15– 1.63), P-LCR (AOR=1.07, 95% CI: 1.01– 1.14), age (AOR=1.07, 95% CI: 1.01– 1.12), and duration of DM (AOR=1.31, 95% CI: 1.18– 1.46) were significantly associated with the presence of microvascular complications.Conclusion: MPV, PDW, and P-LCR were significantly higher among type 2 DM patients with microvascular complications. This indicates that platelet indices can be used as prognostic markers of vascular complications and can be used as simple and cost-effective parameters to predict microvascular complications particularly in patients with old age and long duration of DM.Keywords: platelet indices, microvascular complication, type 2 DM, Ethiopia

Melkamu Tilahun,1 Teshome Gobena,2 Diriba Dereje,2 Mengistu Welde,2 Getachew Yideg3 1Department of Biomedical Sciences (Medical Physiology), College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia; 2Department of Biomedical Sciences, College of Medicine and Health Sciences, Jimma University, Jimma, Ethiopia; 3Department of Biomedical Sciences (Medical Physiology), College of Medicine and Health Sciences, Debre Tabur University, Debre Tabur, EthiopiaCorrespondence: Melkamu TilahunDepartment of Biomedical Sciences (Medical Physiology), College of Medicine and Health Sciences, Debre Markos University, PO Box 269, Debre Markos, EthiopiaTel +251 93-355-5884Fax + 0587780673Email melkamutilahunalamir@gmail.comBackground: Diabetic retinopathy is a well-known sight-threatening microvascular complication of diabetes mellitus. Currently, 93 million people live with diabetic retinopathy worldwide. There are insufficient studies addressing the prevalence of diabetic retinopathy and risk factors in Ethiopia.Objective: To assess the prevalence of diabetic retinopathy and its associated factors among diabetic patients on follow-up at Debre Markos Referral Hospital, northwest Ethiopia, 2019.Methods: This institution- based cross-sectional study was conducted among 302 patients. They were selected through systematic sampling. Explanatory data were extracted from medical records and interviews. Blood pressure, weight, height, and visual acuity tests were assessed. Retinal examination was performed with a Topcon TRC-NW7SF fundus camera. Data were entered in EpiData 3.1 and exported in to SPSS 20 for analyses. Binary logistic regression with 95% CIs was used for analyses. Simple binary logistic regression followed by multiple binary logistic regression analysis was conducted to identify associated factors.Results: There were 302 patients in this study, of which 57 (18.9%) had diabetic retinopathy. Among the diabetic retinopathy patients, 75.4% had the preproliferative type. Four in ten (37.7%) of the patients had visual acuity problems. Poor glycemic control (AOR 4.58, 95% CI 1.86– 11.31), > 10 years’ diabetes duration (AOR 3.91, 95% CI 1.86– 8.23), body-mass index > 25 kg/m2 (AOR 3.74, 95% CI 1.83– 7.66), and hypertension (AOR 3.39, 95% CI 1.64– 7.02) were factors significantly associated with diabetic retinopathy.Conclusion: About a-fifth of diabetic patients had diabetic retinopathy. Diabetic retinopathy was significantly associated with glycemic control, hypertension, body-mass index, and duration of illness. Routine assessment and early control of those associated factors may be important in reducing both the prevalence and impact of diabetic retinopathy, as evidenced in the current study.Keywords: diabetes mellitus, diabetic retinopathy, associated factor, Ethiopia

Background: Strengthening Laboratory Management Toward Accreditation (SLMTA) is a competency-based management training programme. Assessing health professionals’ views of SLMTA provides feedback to inform program planning, implementation and evaluation of SLMTA's training, communication and mentorship components. Objectives: To assess laboratory professionals’ and hospital chief executive officers’ (CEOs) perceptions and attitudes toward the SLMTA programme in Ethiopia. Methods: A cross-sectional descriptive survey was conducted in March 2013 using a structured questionnaire to collect qualitative data from 72 laboratory professionals and hospital CEOs from 17 health facilities, representing all regions and two city administrations in Ethiopia. Focus groups were conducted with laboratory professionals and hospital administration to gain insight into the strengths and challenges of the SLMTA programme so as to guide future planning and implementation. Results: Ethiopian laboratory professionals at all levels had a supportive attitude toward the SLMTA programme. They believed that SLMTA substantially improved laboratory services and acted as a catalyst for total healthcare reform and improvement. They also noted that the SLMTA programme achieved marked progress in laboratory supply chain, sample referral, instrument maintenance and data management systems. In contrast, nearly half of the participating hospital CEOs, especially those associated with low-scoring laboratories, were sceptical about the SLMTA programme, believing that the benefits of SLMTA were outweighed by the level of human resources and time commitment required. They also voiced concerns about the cost and sustainability of SLMTA. Conclusion: This study highlights the need for stronger engagement and advocacy with hospital administration and the importance of addressing concerns about the cost and sustainability of the SLMTA programme.

Background: In 2010, a National Laboratory Strategic Plan was set forth in Ethiopia to strengthen laboratory quality systems and set the stage for laboratory accreditation. As a result, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme was initiated in 45 Ethiopian laboratories. Objectives: This article discusses the implementation of the programme, the findings from the evaluation process and key challenges. Methods: The 45 laboratories were divided into two consecutive cohorts and staff from each laboratory participated in SLMTA training and improvement projects. The average amount of supportive supervision conducted in the laboratories was 68 hours for cohort I and two hoursfor cohort II. Baseline and exit audits were conducted in 44 of the laboratories and percent compliance was determined using a checklist with scores divided into zero- to five-star ratinglevels. Results: Improvements, ranging from < 1 to 51 percentage points, were noted in 42 laboratories, whilst decreases were recorded in two. The average scores at the baseline and exit audits were 40% and 58% for cohort I (p < 0.01); and 42% and 53% for cohort II (p < 0.01),respectively. The p-value for difference between cohorts was 0.07. At the exit audit, 61% ofthe first and 48% of the second cohort laboratories achieved an increase in star rating. Poor awareness, lack of harmonisation with other facility activities and the absence of a quality manual were challenges identified. Conclusion: Improvements resulting from SLMTA implementation are encouraging. Continuous advocacy at all levels of the health system is needed to ensure involvement of stakeholders and integration with other improvement initiatives and routine activities.