Pharmacy professionals' knowledge, attitude and practice towards doping in sports: A Cross-sectional study in Ethiopia.

Background: Doping is appearing as a major problem in Ethiopia, a country decorated with medium and long-distance runners. To protect athletes from doping, pharmacists can be the first port of call for advising athletes on drug treatment. Hence, to fuel the anti-doping movement, it is crucial to explore the knowledge, attitude, and practice of community pharmacy professionals. Therefore, this study aimed to assess the community pharmacy professionals' knowledge, attitude, and practices towards doping in sports in Addis Ababa, Ethiopia. Materials and methods: A cross-sectional survey, involving 336 study participants, was conducted in selected community pharmacies of Addis Ababa, Ethiopia from April to May 2018. Results: Of 336 study participants, most of them knew the word "doping" and out of these, 51.9 % of them wrote the definition of doping correctly. Most respondents classified narcotics, hormone modulators, growth factors, and ß-2 agonists correctly. Almost one-third of the professionals agreed that they have adequate information about doping and that doping is a public health problem. Among the participants, only 33.4 % were confronted with "suspicious of doping substance" without a prescription over the last 12 months. Conclusions: Although most pharmacy professionals lack doping-specific knowledge and adequate training required to be operative in doping prevention, most of them perceive doping as a public health problem although the curriculum does not have good coverage about doping.

Prevalence and Factors Associated with Dyslipidemia Among People Living with HIV/AIDS on Follow-Up Care at a Tertiary Care Hospital in Ethiopia: A Cross-Sectional Study.

Background: Despite its importance as a major risk factor for cardiovascular disease, dyslipidemia remains poorly characterized in the African population. Objective: To assess the prevalence and factors associated with dyslipidemia in people with HIV/AIDS in follow-up at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. Materials and Methods: A hospital-based retrospective cross-sectional study evaluated the charts of 288 people living with HIV/AIDS who had received Highly Active Antiretroviral Treatment for at least six months at Zewditu Memorial Hospital from July to September 2021. Sociodemographic and clinical data were collected from the patient's charts. Statistical analysis was performed using the Statistical Package for Social Sciences software version 25. Results: The overall prevalence of dyslipidemia was 55.2% in people living with HIV/AIDS. The prevalence of high-density lipoprotein cholesterol <40 mg/dl in men and <50 in women was 46.9%; total cholesterol ≥200 mg/dl was 22.6%; triglycerides ≥150 mg/dl was 18.8%, and low-density lipoprotein ≥130 mg/dl was 4.9%. Sex [Female adjusted odds ratio (AOR) = 0.595, 95% CI: 0.37-0.956], age greater than 40 years (AOR = 1.026, 95% CI: 1.005-1.048), body mass index >25 kg/m2 (AOR = 1.767, 95% CI: 1.099-2.84), viral load >50 (AOR = 0.477, 95% CI: 0.27-0.842), and CD4 <500 (AOR = 1.938, 95% CI: 1.18-3.183) were identified as determinants of dyslipidemia. Conclusion: There was a high prevalence of dyslipidemia among study participants compared to several studies published in a similar population. Being male, older age, higher BMI, low CD4 count, and viral load of < 50 copies/mL were associated with dyslipidemia in people living with HIV/AIDS. Therefore, lipid profile measurements at baseline must be part of routine care to prevent the devastating effects of dyslipidemia.

Nanocellulose/Fe3O4/Ag Nanozyme with Robust Peroxidase Activity for Enhanced Antibacterial and Wound Healing Applications.

Peroxidase memetic nanozymes with their free radical-mediated catalytic actions proved as efficacious antibacterial agents for combating bacterial resistance. Herein, nanocellulose (NC) extracted from Eragrostis teff straw was used to prepare NC/Fe3O4/Ag peroxidase nanozyme as an antibacterial and wound healing agent. Characterization of the nanozyme with XRD, FTIR, SEM-EDX, and XPS confirmed the presence of silver NPs and the magnetite phase of iron oxide dispersed on nanocellulose. The peroxidase activity of the prepared nanozyme was examined using TMB and H2O2 as substrates which turned blue in acidic pH (λmax = 652 nm). With a lower Km (0.387 mM), the nanozyme showed a comparable affinity for TMB with that reported for the HRP enzyme. Furthermore, the nanozyme remained efficient over a broader temperature range while maintaining 61.53% of its activity after the fourth cycle. In vitro, antibacterial tests against Escherichia coli (Gram-negative) and Staphylococcus aureus (Gram-positive) bacterial strains showed that NC/Fe3O4/Ag exhibits concentration-dependent and enhanced antibacterial effect for Escherichia coli compared to NC and NC-Fe3O4 and negative control. Furthermore, the wound-healing performance of the NC-Fe3O4-Ag nanozyme was investigated in vivo using an animal model (mice). The nanozyme showed 30% higher wound healing performance compared to the control base ointment and is comparable with the commercial nitrofurazone ointment. The results show the potential of the prepared nanozyme for wound-healing purposes.

COVID-19 Vaccine Hesitancy and its Reasons in Addis Ababa, Ethiopia: A Cross-Sectional Study.

Background: Coronavirus disease (COVID-19) vaccine hesitancy becomes the major bottleneck to the global healthcare system in minimizing the spread of the virus. This study aimed at assessing COVID-19 vaccine hesitancy and its reasons among residents of Addis Ababa, Ethiopia. Methods: A community-based cross-sectional survey was conducted between May 16 to 29, 2021 in purposively selected four districts of Addis Ababa, Ethiopia. A structured questionnaire was developed and then designed on Google Forms platforms to collect data from study participants after obtaining a verbal consent form. A total of 422 study participants were included in the survey. Data were entered into Microsoft Excel and then exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Results: Face masks and alcohol hand rub/ sanitizer are used by 50. 7 and 24.9% of respondents when required. COVID-19 was thought to have been generated by humans by a substantial percentage of study participants (38.2%). About half (50.7%) and 24.9% of respondents use face masks and alcohol hand rub/sanitizer always when it is required, respectively. A large number of study participants (38.2%) believed that origin of COVID-19 is man-made. Overall, 242 (57.4%) of study participants reported COVID-19 vaccine hesitancy. Fear of vaccine side effects (49.6%) was the most common reason for hesitancy. Doubt about its effectiveness (33.9%), not having enough information about the COVID-19 vaccine, preferring another way of protection, and unreliable of the vaccine (due to its short development period) were also the most frequently mentioned reasons for not receiving the COVID-19 vaccine. Conclusions: COVID-19 vaccine hesitancy rate was high in Addis Ababa, Ethiopia during the study period. Fear of side effects, doubts about its effectiveness, and not having enough information about the COVID-19 vaccine were major reasons for hesitancy. Continuous awareness creation to the community on the importance of vaccination is warranted by health professionals and healthcare cadres.

Health-related quality of life and its predictors among people living with epilepsy at Dessie Referral Hospital, Amhara, Ethiopia: A cross-sectional study.

Objectives: Health-related quality of life of people living with epilepsy is significantly impaired. The disease causes a significant psychological and social impact on daily living conditions and usually has lifelong consequences for the patient and family. Therefore, this study aimed to investigate the health-related quality of life of people living with epilepsy and its predictors in Dessie Referral Hospital, Dessie, Ethiopia. Methods: A facility-based cross-sectional study was conducted from April to June 2020. Systematic random sampling was used to recruit a total of 385 study participants. Written informed consent was obtained for each participant, and data were collected using World Health Organization Quality of Life Brief Version and Hospital Anxiety and Depression Scale questionnaires. Descriptive statistics were used to summarize the data, while multivariate logistic regression analyses were used to examine factors affecting the quality of life. P value ⩽ 0.05 was considered statistically significant. Results: About 95.80% of the study participants had a generalized seizure, and 64.30% were on two antiepileptic drugs. Of the total, 12.20% and 37.00% suffered from depression and anxiety, respectively, based on the Hospital Anxiety and Depression Scale score. The mean total health-related quality of life score was 51.98 (standard deviation: ± 10.08; 95% confidence interval: 41.90-62.06) out of 100. Age, education level, marital status, occupation, residence, current comorbidity, family support, and recreational activities were associated with good health-related quality of life (p ⩽ 0.05). Conclusion: The average overall quality of life of people living with epilepsy in the Dessie Referral Hospital was low. Therefore, concerted efforts must be made to improve the quality of life of patients over the healthcare services provided.

Wound Healing and Antioxidant Properties of 80% Methanol Leaf Extract of Verbascum sinaiticum (Scrophulariaceae): An Ethiopian Medicinal Plant.

Wounds account for severe morbidity, socioeconomic distress, and mortality around the globe. For several years, various herbal products are used to expedite and augment the innate wound healing process. In Ethiopian folkloric medicine, Verbascum sinaiticum L. (V. sinaiticum) is commonly applied as a wound-healing agent. The present study investigated the potential wound healing and antioxidant properties of hydroalcoholic leaf extract of V. sinaiticum. The 80% methanol extract, formulated as 5% (w/w) and 10% (w/w) ointments, was evaluated in excision and incision wound models using nitrofurazone and simple ointment as positive and negative controls, respectively. Parameters such as wound contraction, period of epithelialization, and tensile strength were determined. Moreover, its in vitro antioxidant property was evaluated using a DPPH assay. In the excision model, both doses (5% and 10% w/w) of the extract showed a significant (p < 0.001) wound healing efficacy compared to the negative control as evidenced by enhanced wound contraction rate and shorter epithelialization time records. In the incision model, the lower dose (5% w/w) ointment formulation of the extract exhibited the maximum increment in tensile strength (85.6%) that was significant (p < 0.001) compared to negative and untreated controls. Animals treated with 5% w/w ointment, furthermore, showed a significantly (p < 0.05) higher percentage of tensile strength than nitrofurazone treated ones. Moreover, the hydroalcoholic extract of the plant showed a noticeable free radical scavenging property. The result of the present study upholds the folkloric use of V. sinaiticum in the treatment of wounds.

Challenges of Anticoagulation Management Service and Need of Establishing Pharmacist-Led Anticoagulation Clinic in Tertiary Care Teaching Hospital, Ethiopia: A Qualitative Study.

Pupose: To explore the challenges of anticoagulation management (AMS) and assess the need for establishing a pharmacist-led anticoagulation clinic (PLAC) at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Methods: We conducted a qualitative study at TASH. Using a semistructured interview guide, we interviewed 15 physicians from different specialties, heads of pharmacy and laboratory departments. We also included 20 patients to explore their general perceptions, and experiences with and challenges of AMS; and the need to implement PLAC in the hospital. Results: Only three physicians responded that they had protocols for initiating and maintaining warfarin dosing. Having protocols for venous thromboembolism (VTE) risk assessment, VTE prophylaxis and treatment, bleeding risk assessment, and contraindication to anticoagulant therapy were reported by seven, six, four, and three participants, respectively. Lack of trained healthcare professionals and a separate AMS clinic, inconsistency in INR testing and anticoagulant availability, and longer appointment times were the biggest challenges of the existing AMS, according to 80% of respondents. Fourteen patient respondents indicated that their satisfaction with the AMS was affected by long wait times and inconsistent availability of anticoagulants and INR testing. The head of the laboratory stated that the facilities for INR testing are inadequate and affect the quality of AMS and customer satisfaction, and supplemented by the head of the pharmacy by adding irregularities of supplies and inadequate counseling on anticoagulants. Respondents suggested that there is a need to establish a PLAC with well-adopted standard operating procedures, qualified manpower, adequate training of assigned staff, and sustained supply of anticoagulants and INR testing. Conclusion: The hospital's AMS is not optimal to provide adequate services during the study period. Based on these findings and recommendations, the supporting literature, and the experiences of other facilities, the PLAC was established in TASH.

Antidiarrheal and Antisecretory Effect of 80% Hydromethanolic Leaf Extract of Moringa stenopetala Baker f. in Mice.

INTRODUCTION: In Ethiopia, different medicinal plants have been claimed and used to treat diarrheal diseases. However, these claimed effects for most medicinal plants have not been scientifically verified. One of such plants in Ethiopian folkloric medicine is Moringa stenopetala, which is usually consumed as a vegetable in southern Ethiopia. Thus, this study aimed to evaluate the antidiarrheal and antisecretory effects of 80% methanolic leaf extract of Moringa stenopetala in different mice models. METHOD: Using Swiss albino mice, castor oil-induced diarrhea, charcoal meal-based gastrointestinal motility, and castor oil-induced secretion models were employed to assess antidiarrheal activity. In all of the test models, animals were randomly assigned into five groups consisting of six animals in each group. Group I received 0.5 ml of the vehicle (2% tween-80), while group II was treated with standard drug (3 mg/kg loperamide) in the respective models, whereas groups III to V received 150, 300, and 450 mg/kg of the methanolic leaf extracts of Moringa stenopetala. Onset, frequency, consistency, and weight of stool (diarrhea) were recorded, and different parameters and percentage proportions were calculated. Data were analyzed using one-way ANOVA followed by Tukey's test, and p < 0.05 was considered statistically significant at 95% confidence of interval. RESULT: In the castor oil-induced diarrheal model, the percentage inhibition of diarrhea was 48.5, 58.6, and 60% for the respective doses of 150, 300, and 450 mg/kg of the extract. And, the extract showed a 36.8, 54.4, and 55.9% reduction of peristalsis in charcoal meal-based gastrointestinal motility test compared to the negative control group. Moreover, in the antisecretory assay, the 150, 300, and 450 mg/kg doses of MEMS inhibited fluid contents of the stool by 11.5, 54.54, and 61.82%, respectively, relative to the vehicle-treated group. CONCLUSION: The findings revealed that the 80% methanolic leaf extract of Moringa stenopetala extract has shown antidiarrheal activity.

Anticoagulation Control, Outcomes, and Associated Factors in Patients with Atrial Fibrillation Receiving Warfarin at Tertiary Care Hospital in Ethiopia.

Anticoagulation is the cornerstone in the prevention of stroke in atrial fibrillation. This study aimed at assessing the anticoagulation control and outcome and predictive factors in atrial fibrillation patients on warfarin therapy. A retrospective chart review was used to evaluate patients with atrial fibrillation who were on warfarin during two years follow up at the anticoagulation clinic of the hospital. The time in therapeutic range (TTR) was calculated using Rosendaal's method. Data were analyzed using SPSS software version 25. Univariable and multivariable analyses were computed to determine factors affecting TTR and bleeding events. We included 300 patients in this study. The mean percentage TTR was 42.03 ± 18.75. Only 38 (12.67%) patients achieved a TTR of above 65%. The average international normalized ratio (INR) testing frequency was 35 days (16.3-67.2 days). Taking 1 or 2 drugs along with warfarin was found to be better in achieving good TTR as compared to taking more than two drugs (p = .014). Having heart failure was associated with a 2.45 times odds of poor anticoagulation control (TTR< 65%) (p = .047). Male study participants were 2.53 times more likely of developing bleeding events than females (p = .009). Bleeding events were observed in 62 (20.67%) patients. Study participants, who didn't have Diabetic Mellitus and those not receiving aspirin were at lower odds developing bleeding events (AOR = .196; C.I. = .060-.638; p-.007 and AOR = .099; CI. = .024-.416; p-.02), respectively. In summary, the time spent in the therapeutic range was minimal in this population of patients with AF on warfarin managed at a hospital run anticoagulation clinic in Ethiopia. Moreover, the number of co-prescribed medications, and having heart failure were associated with poor TTR. Bleeding events were high and affected by male sex, having DM comorbidity, and using aspirin.

Enteric-Coated Aspirin and the Risk of Gastrointestinal Side Effects: A Systematic Review.

INTRODUCTION: Aspirin appeared as a medicine to deal with aches and inflammation, but due to its antiplatelet properties, it has evolved into a drug mainly used to avert cardiovascular disease. Regardless of its therapeutic uses, the limiting aspect for aspirin use has been its affiliation with gastrointestinal (GI) toxicity, classifying from acute mucosal damage to GI problems and death. OBJECTIVE: The aim of this systematic review is to address the question regarding the ECA effect on the gastric mucosa. METHODS: A systematic search of the literature was conducted in the PubMed electronic databases from April 10th to April 23rd, 2020. Eligibility has been set, and based on those criteria, initially a total of 637 results were obtained, from these 58 of them were not written in English. Then, 168 articles which were free from duplication were screened and all the included articles were RCTs published after 2000. Based on these, final number of articles included on this review was 6. RESULTS: Data were obtained from 6 published articles which reported on 15,621 participants. The reports were from 3 different countries. Most of the studies revealed that enteric-coated aspirin (ECA) treatment was not an effective mechanism against GI protection. ECA administration with omeprazole can hugely reduce the incidence of endoscopic GI damage compared to the impact of ECA used alone. Even short-term administration of a low dose of ECA was significantly associated with an apparent small bowel injury. CONCLUSION: ECA treatment is not an effective mechanism against GI protection, and it is highly associated with small bowel injury. So the coating does not reduce risk of GI complications.

Venous Thromboembolism Risk and Thromboprophylaxis Assessment in Surgical Patients Based on Caprini Risk Assessment Model.

PURPOSE: Venous thromboembolism (VTE) is the most common preventable cause of hospitalization-associated mortality. In the absence of optimal prophylaxis and depending on the type of surgery and patient-related factors, the risk of developing VTE increases by 10% to 50%. We aimed to assess VTE risk and thromboprophylaxis among surgical patients hospitalized at surgical wards of Tikur Anbessa Specialized Hospital (TASH). Addis Ababa, Ethiopia. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted from September 1, 2018 to February 28, 2019. Data were collected using a pretested observational checklist which is prepared based on the VTE Caprini risk assessment model. Then, the collected data were checked for completeness and finally entered and analyzed using Statistical Package for Social Sciences (SPSS) version 25. RESULTS: Out of 155 admitted patients, almost equal numbers of males (49.68%) and females (50.32%) participated in the study with a mean age of 41.87±16.84 and an age range of 13 to 89 years. Undergoing major surgery, resting in bed for more than 3 days and having acute infections (including pneumonia) were the most frequently seen VTE risk factors. Most of the study participants (135, 87.10%) were at risk of developing VTE (>1 Caprini risk score), and 47.11% were in the highest risk category (≥5 Caprini score). The maximum and minimum total risk scores were 19 and 1, respectively with a mean score of 4.53±2.31. Among patients who were at risk of developing VTE and eligible for thromboprophylaxis, only 17.78% received thromboprophylaxis and two ineligible patients received prophylaxis. Parental unfractionated heparin twice or three times per day was the most widely used thromboprophylaxis regimen. A total of 29 (18.71%) patients had one or more contraindication(s) for thromboprophylaxis and three of them took prophylaxis despite the contraindications. Only 3 (1.93%) patients admitted to surgical wards developed VTE during hospitalization. CONCLUSION: As per the Caprini risk assessment model, the majority of surgical patients treated at TASH were at risk of developing VTE. However, thromboprophylaxis was underutilized. The incidence of VTE was 1.93% in our study.

Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital.

PURPOSE: Benzathine penicillin G (BPG) monthly administration is the most effective method for secondary prophylaxis against acute rheumatic fever (ARF). BPG's efficacy largely depends on adherence to treatment. This study was aimed at assessing adherence to BPG prophylaxis and its determinants among adult patients with rheumatic heart disease. PATIENTS AND METHODS: An institutional cross-sectional study design was used. One hundred and forty-five patients receiving monthly BPG at the Adult Cardiac Clinic of Tikur Anbessa Specialized Hospital (TASH) were interviewed. Their 1-year BPG prophylaxis administration record was also reviewed. The rate of adherence to BPG injection was determined by calculating the percentage of the administered drug from the total expected doses. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) software version 25. Both descriptive and logistic regression analyses were computed to describe different variables and assess factors associated with adherence, respectively. A p-value <0.05 was used to declare association. RESULTS: Among a total of 145 study participants involved, the majority (76.6%) of them had been receiving BPG for the last 10 years. The average adherence rate to monthly BPG injection was 80.60% with a range of 0% to 100%. However, only 101 (69.7%) of participants were taking ≥80% of their prescribed monthly BPG prophylaxis doses. Study participants with informal education 1.10 (0.023-46.96) and secondary school education 0.89 (0.10-8.11) were more and less likely to adhere to BPG injection, respectively, when compared with those who attended higher education programs. The regression analysis showed patients who were not admitted to the hospital (AOR: 26.22; CI: 2.55-269.70; p=0.006) and once admitted patients (AOR: 50.08; CI: 2.87-873.77; p=0.007) were more likely to adhere to their BPG injections than those admitted twice or more. The study participants who waited until the next appointment were also less adherent (AOR: 0.02; CI: 0.00-0.13; p=0.000) than those who went a few days later for receiving the missed/late dose. CONCLUSION: The adherence rate to BPG injection among RHD patients was found to be high (80.60%). Patients' admission status and their action on missed and/or late doses were found to be important determinants of adherence in this study.

Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infections at Ethiopian Tertiary-Care Teaching Hospital.

BACKGROUND: Surgical site infections (SSIs) are infections that develop within 30 days after an operation or surveillance of surgical wound infection implementation within 90 days after surgery when an implant is placed. The objective of this study was to assess preoperative and postoperative antimicrobial use in St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. METHODS: A hospital-based cross-sectional study was undertaken in surgery wards of SPHMMC for 4 months by reviewing 413 patients' charts. All patients 13 years and older who were admitted and underwent different types of surgical procedures were included in the study. Epi info 7 was used for data entry, and then data were exported to Statistical Package for Social Sciences (SPSS) version 20.0 software for analysis. Descriptive analyses were computed and rate of SSI was calculated in this study. Moreover, bivariate analysis was done to examine the relationship between the outcome variable and predictor variables with a value of P < .2 retained for subsequent multivariate analyses using multiple logistic regressions. P value of <.05 was considered as statistically significant. RESULTS: Out of 413 patients, 152 (36.8%) were operated for general surgery, and the remaining were for other types of surgeries. Most of the patients, 196 (79.7%), were managed by a single surgical antibiotic agent, followed by 2 agents (20.3%) for surgical prophylaxis indication. Surgical site infections occurred in 46 (11.1%) patients before discharge from the hospital. In those patients who need treatment for SSIs, almost half of them (49.5%) received combination therapy of ceftriaxone and metronidazole. Emergency surgical cases were 2.647 times more likely to develop SSIs than the elective surgical cases (adjusted odds ratio [AOR] = 2.647; 95% confidence interval [CI] = 1.406-4.983; P = .003). Patients who did not receive antibiotic prophylaxis were 2.572 times more likely to develop SSIs compared to those who received antibiotic prophylaxis (AOR = 2.572; 95% CI = 1.02-6.485; P = .045). Clean-contaminated and contaminated types of wound were a protective factor against SSI in our study. CONCLUSIONS: This study indicated that most of the patients (72.1%) received surgical antimicrobial prophylaxis. The overall incidence rate of SSIs was 11.1% in the studied hospital. Ceftriaxone was the most commonly used drug. Being not receiving prophylaxis, wound class, and surgery types were significantly associated with the development of SSI.