A Study on Communication Practices in Reducing Non-Communicable Diseases in Bahir Dar City, Ethiopia.

Background: Non-communicable diseases (NCDs) pose special challenges in developing countries In Ethiopia, the growing NCD burden has raised a public health concern with significant social, economic, and developmental effects. Thus, the study sought to examine health communication practices in addressing the NCDs in Bahir Dar City of the Amhara Region of Ethiopia. Methods: A qualitative case study was conducted from January to April 2023. The study employed in-depth interviews, focus group discussions, and observations to gather data from health extension workers, NCD experts, and NCD focal persons about their experiences and perspectives regarding NCD prevention and control. The participants were purposively selected, and a thematic analysis technique was employed to analyze the data. Results: The study found that several health communication strategies, such as health promotion, training and creating model households, screening, referrals, follow-ups, rehabilitation services, and activities reporting were employed. Nevertheless, there was a lack of consistent, reliable, and long-lasting and professional health communication regarding NCD prevention and management. Some of the challenges contributing to such deficient practices were overloading HEWs with various tasks, allocating many households to a single HEW, shortage of screening tools, shortage of financial and human resources, weak interdisciplinary collaboration, COVID-19, and recurrent conflicts in the city and the region. Above all, lack of health communication skills affected the health interventions. Concerning communication methods, one-to-one communication was frequently employed, while mass media and social media were rare. Generally, NCD communication, in particular, and health communication, in general, did not receive priority as other health-related activities in the city. Conclusion: The study found that there were poor health communication practices in preventing and controlling NCDs. Thus, professional practice of health communication about NCDs must be prioritized, and emphasis should be given to inter-sectoral collaborations. Prioritizing financial and human resources is also essential for effective NCD communication.

Benzo[b]naphtho[2,1-d]furans and 2-Phenylnaphthalenes from Streblus usambarensis.

Three new benzo[b]naphtho[2,1-d]furans, usambarins A-C (1-3), five new 2-phenylnaphthalenes, usambarins D-H (4-8), a new flavan (9), and a new phenyl-1-benzoxepin (10) as well as two known compounds (11 and 12) were isolated from the extract of the stem and roots of Streblus usambarensis (Moraceae). The structures were deduced using NMR spectroscopic and mass spectrometric analyses, and those of compounds 1 and 4 were confirmed by X-ray crystallography. Usambarin D (4) demonstrated moderate antibacterial activity (MIC 9.0 µM) against Bacillus subtilis, while none of the tested compounds were effective against Escherichia coli.

Persister control by leveraging dormancy associated reduction of antibiotic efflux.

Persistent bacterial infections do not respond to current antibiotic treatments and thus present a great medical challenge. These conditions have been linked to the formation of dormant subpopulations of bacteria, known as persister cells, that are growth-arrested and highly tolerant to conventional antibiotics. Here, we report a new strategy of persister control and demonstrate that minocycline, an amphiphilic antibiotic that does not require active transport to penetrate bacterial membranes, is effective in killing Escherichia coli persister cells [by 70.8 ± 5.9% (0.53 log) at 100 µg/mL], while being ineffective in killing normal cells. Further mechanistic studies revealed that persister cells have reduced drug efflux and accumulate more minocycline than normal cells, leading to effective killing of this dormant subpopulation upon wake-up. Consistently, eravacycline, which also targets the ribosome but has a stronger binding affinity than minocycline, kills persister cells by 3 logs when treated at 100 µg/mL. In summary, the findings of this study reveal that while dormancy is a well-known cause of antibiotic tolerance, it also provides an Achilles' heel for controlling persister cells by leveraging dormancy associated reduction of drug efflux.

Controlling Persister and Biofilm Cells of Gram-Negative Bacteria with a New 1,3,5-Triazine Derivative.

Infections caused by multidrug-resistant bacteria have been on the rise. This important issue presents a great challenge to the healthcare system and creates an urgent need for alternative therapeutic agents. As a potential solution to this problem, antimicrobial peptides (AMPs) have attracted increasing attention due to their broad spectrum of targeted microbes. However, most AMPs are expensive to synthesize, have relatively high cytotoxicity to mammalian cells, and are susceptible to proteolytic degradation. In order to overcome these limitations, novel synthetic AMPs are desired. Using 1,3,5-triazine (TN) as a template, several combinatorial libraries with varying cationic charge and lipophilicity were designed and screened by the Kallenbach lab. From this screening, TN-5 was identified as a potent lead. In the present study, this compound was tested for its antimicrobial activities on Escherichia coli and Pseudomonas aeruginosa. In addition to regular planktonic cells, the effects on biofilms and persister cells (metabolically inactive and antibiotic tolerant subpopulation) were also investigated. TN-5 was found to have a minimum inhibitory concentration (MIC) of 12.8 µM for both species and kill regular planktonic cells of both species dose dependently. TN-5 is also effective against persister cells of both E. coli and P. aeruginosa. The killing of biofilm cells of the mucoid P. aeruginosa PDO300 was enhanced by alginate lyase.

Synthetic dendrimeric peptide active against biofilm and persister cells of Pseudomonas aeruginosa.

Antimicrobial dendrimeric peptides (AMDP) are a relatively new class of agents displaying repetitive functional groups on a branched core. Previously, we have investigated the length requirement for antimicrobial activity of peptides consisting of repeated arginine (R) and tryptophan (W) side chains and found that even short linear RW repeats are active, providing a starting point for a de novo design of multivalent structures. In this study, we synthesized and tested a new synthetic dendrimer, 2D-24, for its antimicrobial activity against Pseudomonas aeruginosa, including the wild-type PAO1 and its mucoid mutant PDO300. This synthetic AMDP was found to kill planktonic cells of both PAO1 and PDO300 in a dose-dependent manner, with nearly complete killing of both strains observed when treated with 50 µM of this agent. In addition to planktonic cells, 2D-24 was also found to kill biofilm cells of both strains in a dose-dependent manner. For example, treatment with 30 µM 2D-24 led to 94.4 ± 1.4 and 93.9 ± 4.2 % killing of PAO1 and PDO300 biofilm cells, respectively. Furthermore, 2D-24 was effective in killing multidrug-tolerant persister cells of PAO1 and PDO300. While higher concentrations of 2D-24 were required to kill persister cells, combinations of 2D-24 with ciprofloxacin, tobramycin, or carbenicillin showed synergistic effects on killing persister cells of both strains. Based on hemolysis assays using sheep erythrocytes and a coculture model of PAO1 and human epithelial cells, 2D-24 was found to kill P. aeruginosa cells at concentrations that are not toxic to mammalian cells.

Antimicrobial peptides.

The rapid increase in drug-resistant infections has presented a serious challenge to antimicrobial therapies. The failure of the most potent antibiotics to kill "superbugs" emphasizes the urgent need to develop other control agents. Here we review the history and new development of antimicrobial peptides (AMPs), a growing class of natural and synthetic peptides with a wide spectrum of targets including viruses, bacteria, fungi, and parasites. We summarize the major types of AMPs, their modes of action, and the common mechanisms of AMP resistance. In addition, we discuss the principles for designing effective AMPs and the potential of using AMPs to control biofilms (multicellular structures of bacteria embedded in extracellular matrixes) and persister cells (dormant phenotypic variants of bacterial cells that are highly tolerant to antibiotics).

Patterns of mediastinal tumors operated at the Tikur Anbessa Hospital, Addis Ababa, Ethiopia over a six years period.

BACKGROUND: The mediastinum is the space that lies between the two pleural cavities containing many vital structures in it. When tumors or cysts arise in the mediastinum they can be either asymptomatic or present as space occupying lesions causing symptoms and signs by their effect on the neighboring organs. Though mediastinal tumors are routinely treated at the study center, there are no studies in Ethiopia concerning the patterns, and modes of treatments of Mediastinal space occupying lesions. OBJECTIVE: To review all the primary mediastinal tumors and cysts operated upon at the Tikur Anbessa Teaching Hospital, Addis Ababa University over a six year period, from August 2005-2011. METHODOLOGY: Clinical retrospective review. RESULTS: In the six years, 73 patients were operated, 49 (67.1%) were males, the and male to female ratio being 2.04:1. The mean age of patients was 35.9 +/- 10.5 years (range 14 to 74). Forty-five (61.6%) had lesions of the anterior mediastinum, 23 (31.5%) in the posterior mediastinum and 5 (6.8%) in the middle. The commonest anterior mediastinal tumors were thymic origin (24/45), and thymic lesions were found more common in females (17:7 ratio). From the 23 patients with posterior mediastinal tumors, 18 had benign neurogenic tumors (4 of which were dumbbell tumors). Chest pain and shortness of breath (dyspnea) were the two most common symptoms in 31 (42.4%) of the patients. Twenty three patients (31.5%) were asymptomatic, and all had benign lesions. None of the malignant lesions were asymptomatic. Eleven (15%) patients; eight with anterior and three with posterior mediastinal masses, had undergone pre-operative tissue diagnosis procedure by image guided FNAC. Fifty-nine (80.8%) patients were operated with intent of therapeutic surgical procedures. There were 28 (38.5%) midline sternotomies, 40 (54.7%) thoracotomies, four underwent a left sided mediastinotomies and one mediastinoscopy performed. The rate of malignancy in this study was 24 (32.8%), of which 19 (79.1%) were in the anterior compartment. A total of 13 (17.8%) patients had complications in the hospital and four (5.4%) of the patients died CONCLUSION: Primary mediastinal tumors are not so rare in the setting. We would also like to recommend further large scale prospective studies which also included long-term outcome so that we can further understand the situation in the country.

(Z)-4-bromo-5-(bromomethylene)-3-methylfuran-2(5H)-one sensitizes Escherichia coli persister cells to antibiotics.

Persisters are a small subpopulation of bacterial cells that are dormant and extremely tolerant to antibiotics. The intrinsic antibiotic tolerance of persisters also facilitates the development of multidrug resistance through acquired mechanisms based on drug resistance genes. In this study, we demonstrate that (Z)-4-bromo-5-(bromomethylene)-3-methylfuran-2(5H)-one (BF8) can reduce persistence during Escherichia coli growth and revert the antibiotic tolerance of its persister cells. The effects of BF8 were more profound when the pH was increased from 6 to 8.5. Although BF8 is a quorum sensing (QS) inhibitor, similar effects were observed for the wild-type E. coli RP437 and its ΔluxS mutant, suggesting that these effects did not occur solely through inhibition of AI-2-mediated QS. In addition to its effects on planktonic persisters, BF8 was also found to disperse RP437 biofilms and to render associated cells more sensitive to ofloxacin. At the doses that are effective against E. coli persister cells, BF8 appeared to be safe to the tested normal mammalian cells in vitro and exhibited no long-term cytotoxicity to normal mouse tissues in vivo. These findings broadened the activities of brominated furanones and shed new light on persister control.

Reverting antibiotic tolerance of Pseudomonas aeruginosa PAO1 persister cells by (Z)-4-bromo-5-(bromomethylene)-3-methylfuran-2(5H)-one.

BACKGROUND: Bacteria are well known to form dormant persister cells that are tolerant to most antibiotics. Such intrinsic tolerance also facilitates the development of multidrug resistance through acquired mechanisms. Thus persister cells are a promising target for developing more effective methods to control chronic infections and help prevent the development of multidrug-resistant bacteria. However, control of persister cells is still an unmet challenge. METHODOLOGY/PRINCIPAL FINDINGS: We show in this report that (Z)-4-bromo-5-(bromomethylene)-3-methylfuran-2(5H)-one (BF8) can restore the antibiotic susceptibility of Pseudomonas aeruginosa PAO1 persister cells at growth non-inhibitory concentrations. Persister control by BF8 was found to be effective against both planktonic and biofilm cells of P. aeruginosa PAO1. Interestingly, although BF8 is an inhibitor of quorum sensing (QS) in Gram-negative bacteria, the data in this study suggest that the activities of BF8 to revert antibiotic tolerance of P. aeruginosa PAO1 persister cells is not through QS inhibition and may involve other targets. CONCLUSION: BF8 can sensitize P. aeruginosa persister cells to antibiotics.

Surgically treated pulmonary tuberculosis: report on cases from Tikur Anbessa Hospital, Addis Ababa, Ethiopia.

BACKGROUND: The treatment of pulmonary tuberculosis has evolved through multiples of treatment modalities including pulmonary surgery. In Ethiopia, though the disease is very common, there is no information regarding the patterns of surgically treated pulmonary tuberculosis and its outcome. OBJECTIVE AND STUDY DESIGN: A retrospective clinical study was conducted to investigate the patterns and outcomes of surgically treated cases of pulmonary tuberculosis. Data was collected from the clinical records of all patients operated at the chest surgery unit with a confirmed diagnosis of pulmonary tuberculosis at the Tikur Anbessa teaching specialized referral hospital (26). RESULT: Twenty-six patients were admitted for surgery, 80.8% of these patients were males. The mean duration of illness before presenting to the hospital was 27.6 months. Cough and hemoptysis were the two most common presenting symptoms, occurring in 26 (100%) and 24 (92.3%). The most common feature seen in chest x-rays was a completely destroyed lung tissue in 10 (38.5%). The parts of the lung commonly involved were the left side in 16 (61.5%) and the upper lobes in 14 (53.8%). The Sputum examination for acid-fast tubercle bacilli tested positive for 24 (92.3%) of the patients. The most frequent indications for surgery were severe hemoptysis for 12 (46.2%), radiographic evidence of destroyed lung for 5 (19.2%) and strong evidence for Aspergilloma for 3 (11.5%). The most frequently performed procedure were left upper lobectomy in 10 (38%), left pneumonectomy in 7 (26.7%) and right pneumonectomy in 7 (26.7%). Nine significant (34.6%) complications occurred in the postoperative period, the commonest being postoperative pneumonia in 4 (15.4%). Two (7.7%) of the patients died. During the follow-up period six patients developed significant late postoperative complications. CONCLUSION: In the Ethiopian setting, though anti-tuberculous chemotherapy is the standard treatment for pulmonary tuberculosis in a majority of patients, there are still definite indications in which surgical management plays a vital role.

Surgical treatment of achalasia cardia in Tikur Anbessa Hospital, Ethiopia.

OBJECTIVE: This review aims to evaluate 61 patients with achalasia cardia treated with Heller's cardiomyotomy in Tikur Anbessa Hospital (TAH). METHODS: A hospital based cross sectional analysis was conducted in TAH, Department of Surgery, Addis Ababa, Ethiopia between January 1996 and December 2005. Medical records and operation theater registers of 61 patients operated upon for achalasia cardia were analyzed retrospectively. RESULTS: Thirty-four were male and twenty-seven female with mean age of 25 years (range 9-58). All had dysphagia to solid foods. Thirty-one (50.8%) patients had weight loss. The diagnosis of achalasia cardia was confirmed in 60 (98.4%) patients by barium swallow; in 23/25 (92.0%) by esophagoscopy. Cardiomyotomy was performed through transabdominal (83.6%) and transthoracic (16.4%) approaches. Immediate postoperative course was uneventful in 52 (85.2%) patients, while 9 (14.8%) patients developed immediate postoperative complication. There was no in-hospital mortality. Median operation time and hospital stay were 60 minutes and 7 days respectively. Late complications occurred in 7/52 (13.5%) patients, Gastroesophageal Reflux Disease (GERD) (9.6%) being the most common. A very good palliation of dysphagia was achieved in 88.5% of cases (p < 0.0001). CONCLUSION: Significant improvement in dysphagia of patients with achalasia cardia following modified Heller's myotomy alone is possible in majority of the patients.

Experience of surgical therapy in 72 patients with thoracic hydatidosis over a 10-year period.

OBJECTIVE: This review aims to evaluate retrospectively 72 patients diagnosed to have thoracic hydatid disease and treated surgically in Tikur Anbessa Hospital between December 1993 and November 2003. DESIGN: Retrospective Analysis hospital records. SETTINGS: Tikur Anbessa Hospital, Department of Surgery, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia. PATIENTS AND METHODS: Medical records and Operation theater registers of seventy-two Patients operated on for Thoracic hydatidosis were evaluated retrospectively. Chest Roentgenogram was the main diagnostic tool used Main surgical techniques employed were evacuation in 44 (52.4%) cysts, cystotomy in 30 (35.7%) cysts, and enucleation in 10 (12%) cysts. Additional palliative procedures (such as pericystectomy and Capitonnage) and radical procedures (such as resection of the lung) were also employed. RESULTS: forty of the patients were male and thirty-two female with a mean age of 31.4 years. The most Common presenting symptoms were cough in 60 (83.3%) patients, expectoration in 47 (65.3%) patients and chest pain in 38 (52.8%) patients. Chest radiography revealed a round opacity or shadow in 58 (80.6%) patients. All patients were treated surgically. The mean hospital stay was 38.3 days. Major postoperative Complications occurred in 12 (16.9%) patients; pneumonia, pleural effusion and prolonged air leak were the complications in order of their frequency. There was one postoperative death and one recurrence at 6-months follow-up period. CONCLUSION: Surgical excision of pulmonary hydatidosis with maximum preservation of lung parenchyma is possible in the majority of patients and should remain the mainstay of surgical treatment.

Complicated peptic ulcer disease in Tikur Anbessa Hospital, Addis Ababa.

There are few published surgical reports on peptic ulcer disease (PUD) in Ethiopia. Of 405 complicated peptic ulcer patients operated on in Tikur Anbessa Hospital, Addis Ababa, from 1997 to 2001, the records of 351 patients were retrieved and retrospectively analyzed to assess the pattern of PUD complication and the outcome of surgical treatment. During the study period, complicated PUD patients comprised 3.8% of the total major surgical procedures. The male to female ratio was 5.6: 1.0. The mean age was 36.5 +/- 12.7 years. Of 351 patients, 337 (96%) had abdominal pain, in most epigastric, and 330 (94%) had vomiting as presenting complaints. Dehydration was observed in 44 (12.5%). Gastric outlet obstruction (GOO) was the commonest complication followed by perforation that necessitated surgical intervention. The commonest operative procedure was truncal vagotomy and drainage. Nearly 5.0% died in hospital, most from complicated perforated peptic ulcer. Follow-up was possible in 262 patients for a mean of 16.2 +/- 15.0 months. Dumping and diarrhea were observed in 2.7% and 0.4% of the patients, respectively. Bile reflux gastritis was encountered in 1.5%. Truncal vagotomy and drainage remained to be easily learnable procedures with acceptable morbidity and mortality rates.

Thyroid disease in Tikur Anbessa Hospital: a five-year review.

Diseases of the thyroid are not uncommon particularly in the highlands of Ethiopia. To see the pattern of surgical thyroid disorders, a review of operated cases of thyroid diseases in the period 1997-2001 was conducted in Tikur Anbessa Hospital, Addis Ababa. During the period, 472 patients underwent surgery for goiter. Of these, records of 377 patients could be retrieved and form the basis for this analysis. The mean age was 35 (range, 15-73) years. The sex ratio, M : F was 1: 3.8. The mean duration of symptoms on admission was 7 years. The most frequent presenting feature was goiter. Symptoms of airway obstruction and hyperthyroidism were not rare. About 12% of patients were clinically and biochemically categorized toxic. Location of goiter was specified in 349 cases. Of these, 56.7% had bilateral disease. Nodular colloid goiter was the most common pathological type. Neoplasm of the thyroid appeared not to be rare. The mean pre- and postoperative hospital stays were 12 and 6 days, respectively. About 66% of patients had partial or subtotal thyroidectomy. Significant intraoperative hemorrhage requiring blood transfusion occurred in 12 (3%) patients. Some post operative complications including pneumonia, wound infection, recurrent nerve or parathyroid gland injury, and recurrent goiter or hyperthyroidism were noted. One case developed thyroid crisis. Less radical surgical procedures, we believe, are adequate for all benign and most malignant goiters in Ethiopia. In areas where thyroxin is in short supply and follow-up is erratic total thyroidectomy as is recommended else where should be reserved for only few selected cases.

Pulmonary hamartoma in an Ethiopian adult female: case report.

A 39 years old Ethiopian women presented to Tikur Anbessa Hospital with cough, chest pain, haemaptyis and dyspnea and was admitted with the clinical impression of bronchogenic carcinoma. Pneumonectomy was performed and tissue section from the specimen was reported as pulmonary hamartoma. A detailed description of the clinical findings, laboratory data, chest x-ray and pathologic findings presented along with a review of the available literature. This is the first case report of an endobronchial hamartoma in an Ethiopian patient.