The Role of Pharmacogenomics Studies for Precision Medicine Among Ethiopian Patients and Their Clinical Implications: A Scoping Review.

Background: Pharmacogenomics research is currently revolutionizing treatment optimization by discovering molecular markers. Medicines are the cornerstone of treatment for both acute and chronic diseases. Pharmacogenomics associated treatment response varies from 20% to 95%, resulting in from lack of efficacy to serious toxicity. Pharmacogenomics has emerged as a useful tool for therapy optimization and plays a bigger role in clinical care going forward. However, in Africa, in particular in Ethiopia, such studies are scanty and not generalizing. Therefore, the objective of this review was to outline such studies, generating comprehensive evidence and identify studied variants' association with treatment responses in Ethiopian patients. Methods: The Joanna Briggs Institute's updated 2020 methodological guidelines for conducting and guidance for scoping reviews were used. We meticulously adhered to the systemic review reporting items checklist and scoping review meta-analyses extension. Results: Two hundred twenty-nine possibly relevant studies were searched. These include: 64, 54, 21, 48 and 42 from PubMed, Scopus, Google Scholar, EMBASE, and manual search, respectively. Seventy-seven duplicate studies were removed. Thirty-nine papers were rejected with justification, whereas 58 studies were qualified for full-text screening. Finally 19 studies were examined. The primary pharmacogene that was found to have a significant influence on the pharmacokinetics of efavirenz was CYP2B6. Drug-induced liver injury has frequently identified toxicity among studied medications. Conclusion and Future Perspectives: Pharmacogenomics studies in Ethiopian populations are less abundant. The studies conducted focused on infectious diseases, specifically on HAART commonly efavirenz and backbone first-line anti-tuberculosis drugs. There is a high need for further pharmacogenomics research to verify the discrepancies among the studies and for guiding precision medicine. Systematic review and meta-analysis are also recommended for pooled effects of different parameters in pharmacogenomics studies.

Poisoning cases and their management in Amhara National Regional State, Ethiopia: Hospital-based prospective study.

BACKGROUND: Poisoning is a significant public health problem globally. Ethiopia is a low-income country undergoing technological and social change that may increase access to drugs and chemicals, potentially increasing the incidence of poisoning. This study describes the epidemiology of hospital admissions due to poisoning in a region of Ethiopia. METHODS: An institution based prospective observational study was employed, as a study design, in selected hospitals of the region from January to December 2018. RESULTS: Of 442 poisoning cases, 78 (17.6%) died. Almost all poisoning cases were intentional self-poisonings. The most frequent poisonings were organophosphate compounds, 145 (32.8%), and metal phosphides (majorly aluminum phosphide), 115 (26.0%). The ingested poison was most frequently accessed from the patients' homes, 243 (55.0%), followed by purchases from local shops, 159 (36%). The median duration of admission was 24 hours. Of all the cases, 23 (5.2%) were admitted to intensive care units (ICU) requiring mechanical ventilation. Most of the cases admitted to the ICU were aluminum phosphide-poisoned patients. The majority of deaths (43 of 78) were due to metal phosphides. From the multivariate logistic regression analysis, altered level of consciousness on hospital arrival, metal phosphide poisoning, and no laboratory result as a part of the diagnosis process or investigation of the extent of toxicity were found to be significantly associated with the likelihood of poor treatment outcome. CONCLUSION: The majority of the poisoning cases were females. The most common reasons for the intent of self-poisoning were dispute-related, mainly family disharmonies, followed by psychiatric conditions. The poisoning agents were mostly obtained from households. Organophosphate compounds and metal phosphides were the first and the second most frequently encountered poisoning agents, respectively, and it was noted that the later ones were responsible for most of the fatal cases. Of the pharmacologic interventions, atropine was the only agent regarded as an antidote. The most commonly employed agent for supportive treatment was cimetidine followed by maintenance fluids, while gastric lavage was the only GI decontamination method used among others. The fatality rate of poisoning in this study was found to be much higher than in other similar studies. Impaired consciousness upon hospital arrival, metal phosphide poisoning, and no involvement of laboratory investigation were found to significantly associate with the likelihood of death. Generally, the results dictate the need for the design and implementation of strategies to create awareness, prevent, and manage poisoning incidences in the community.

Oral health-related quality of life and oral hygiene status among special need school students in amhara region, Ethiopia.

BACKGROUND: Oral conditions remain a substantial population health challenge worldwide. Poor oral health affects the quality of life as a result of pain or discomfort, tooth loss, impaired oral functioning, disfigurement, missing school time, loss of work hours, and sometimes even death. This study assessed the magnitude of Oral Health-Related Quality of Life (OHRQoL) and oral hygiene status and associated factors among special needs school students in the Amhara region. METHODS: An institution-based cross-sectional study was conducted from November 2020 to April 2021 in the Amhara Region, Ethiopia. A total of 443 randomly selected special needs students were included. A structured pretested interview-administered questionnaire was used for data collection. Bivariable and multivariable ordinal logistic regression models were fitted to identify the factors associated with oral hygiene status. The statistical significance of differences in mean OHIP-14 scores was assessed using the Kruskal-Wallis equality-of-populations rank and Wilcoxon rank-sum tests. Variables with a p-value less than 0.05 were considered statistically significant. RESULTS: Almost half 46.6% (95% CI: 42.1%, 51.4%) of the study participant had poor oral hygiene status. The median OHIP-14 score was 16 with an interquartile range from 14 to 20. The highest score was for functional limitation (mean: 1.45 (SD ± 0.70)) and the lowest score was for psychological disability (mean: 1.08 (SD ± 0.45)). Mother education, frequency of taking sugared foods, and the types of disabilities were significant predictors of the poor oral hygiene status of special needs students in the Amhara region. The students living in Dessie had higher OHIP-14 scores compared to those living in other places (Gondar, Bahir Dar, and Debre Markos). The students who never brush their teeth had lower OHIP-14 scores than those who brush sometime and once a day. Whereas, students affiliated with the orthodox religion had lower OHIP-14 scores compared to those affiliated with all other religions (Catholic, Muslim, and Protestant). CONCLUSION: A substantial amount of students with a disability had poor oral hygiene. The OHIP-14 scores indicated poor oral health-related quality of life. The study found that maternal education, frequency of taking sugared foods, and the types of disabilities were statistically significant factors associated with oral hygiene status.

Periodontal status of students living with disability in Amhara region, Ethiopia: a cross-sectional study.

BACKGROUND: Periodontal disease is the most common oral health problem among individuals living with disabilities. Any physical impairment and/or mental handicap can compromise the capability to perform oral health care. Individuals with poor oral hygiene practice were prone to dental caries, periodontal disease, and upper respiratory tract infections. Despite the high prevalence of disabled people in Ethiopia, data are scarce about their periodontal status. The aim of this study was to determine the prevalence and determinant factors of periodontal disease among students living with disability in the Amhara region. METHODS: A school-based cross-sectional study was done on eight special needs schools in Amhara regional state from November 30, 2020, to April 10, 2021. A simple random sampling technique using a computer random generator was employed to recruit the study participants. The participants were interviewed for sociodemographic characteristics, oral hygiene practice, type of disability, and medical condition through a pre-tested semi-structured questionnaire. The periodontal status of the participants was evaluated using the community periodontal index (CPI). Data entry was done using the Epi-data and analyzed using SPSS 26. Binary logistic regression analysis was used to identify the predictors of periodontal disease at a 5% level of significance. RESULTS: A total of 443 study participants were involved with a mean age of 15.84 ± 3.882. Among these, 27.5% (95%CI 23.4-32.0) had a periodontal pocket depth of ≥ 4 mm, and 56.7% had bleeding on probing. The prevalence of periodontal disease was higher in participants with poor oral health status (52.2%), dental caries (34.8%), class-2 malocclusion (46.1%), and low monthly income (30.4%), visually impaired (30%), and mentally disorder (29.9%). Age of above 18 years (AOR = 3.41, 95%CI 1.40, 8.28), low family monthly income (AOR = 2.21; 95%CI 1.22, 4.03), malocclusion (AOR = 1.59, 95%CI 1.01, 2.54), poor oral health status (AOR = 9.41; 95%CI 4.92, 17.98), and dental caries (AOR = 1.85, 95%CI 1.21, 2.82) were independent predictors of periodontal disease. CONCLUSIONS: A substantial amount of disabled school students in the study area had periodontal disease. The study found that there was a statistically significant association between age, family monthly income, malocclusion, oral health status, and dental caries with periodontal disease. The implementation of school oral health programs has a great benefit for the oral health status of disabled school students.

Evaluation of Wound Healing Activity of 80% Hydromethanolic Crude Extract and Solvent Fractions of the Leaves of Urtica simensis in Mice.

Background: Leaves of Urtica simensis (U. simensis) have been used traditionally for wound healing in different communities in Ethiopia. In spite of this, there were no scientific data documented regarding the wound healing activity of this plant. There is a need to investigate herbal remedies for the treatment of wounds in order to overcome the limitations of conventional drugs. Aim of the Study: Aim of the study was to evaluate the wound healing activity of extract and solvent fractions of the leaves of U. simensis in mice. Methods: Leaves of U. simensis were washed, dried under shade and ground into coarse powder and then extracted by 80% methanol with three consecutive macerations. Part of the extract was fractionated with n-hexane, chloroform and water. In excision and burn wounds, healing progress was measured by wound contraction, epithelialization period and histopathology investigation whereas incision wound healing was assessed by skin breaking strength. Results: In excision wound model, the 5% and 10% crude extract ointments showed significant (p < 0.001) wound contractions during day 8 to day 16 evaluations. Similarly, in burn wound model, both 5% and 10% crude extract ointments produced significant (p < 0.001) wound contractions starting from day 12 and 10, respectively. In both models, the periods of epithelialization were also significantly reduced and favorable histopathologic changes were produced by the crude extract ointments. The solvent fractions of the crude extract as well produced significant wound contractions as evaluated in excision wound model. The fractions also significantly reduced the period of epithelialization in this model. The aqueous fraction found to be more active than either chloroform or n-hexane fraction in wound healing. Conclusion: Results of this study indicated that methanol extract and aqueous fractions of the leaves of U. simensis possess dose-dependent wound healing activity, thus supporting traditional claims.

Oral Health Status of Hearing-Impaired Students Attending Special Need Schools in Amhara Region, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Oral health care is the most common unmet need among individuals with a disability. Individuals with a disability may have compromised oral health needs due to neglect from parents, socioeconomic problems, and communication barriers. In Ethiopia, there is a lack of data on oral health status of the hearing-impaired population. Therefore, this study aimed to assess the oral health status of hearing-impaired students in the Amhara region, Ethiopia. METHODS: A cross-sectional study was conducted from November 2020 to April 2021 on hearing-impaired students in Amhara region, Ethiopia. Data were collected using a pretested interview administered questionnaire and clinical examination. Oral cavity was evaluated using the simplified oral hygiene index, decayed, missed and filled teeth, and community periodontal index. Data analysis was done using SPSS 26.0, and logistic regression analysis was done to identify the risk factors of dental caries and periodontal disease. RESULTS: A total of 149 hearing impaired students with an age range of 7-30 years were involved in the study. The prevalence of periodontal disease and dental caries was 22.8% (95% CI: 16.8, 30.4) and 38.9% (95% CI; 32.2, 46.9), respectively. Being grade 1-4 student (AOR = 3.94, 95%: 1.16, 13.38), lack of formal education (AOR = 4.98, 95% CI: 1.00, 24.65), dental caries (AOR = 2.51, 95% CI: 1.08, 5.08) and bleeding on probing (AOR = 9.98, 95% CI: 3.69, 26.64) were statistically significant with periodontal disease. Grade level, parents' support during brushing, oral health status, and medication intake were independent factors for dental caries. CONCLUSION: In the present study, a significant number of hearing-impaired students had periodontal disease and dental caries. School oral health programs and caregivers assisted oral hygiene practices are essential to combat oral health problems in hearing-impaired students. Moreover, a nationwide prospective study with a large sample size will be required to reflect the oral health status of hearing-impaired individuals in the country.

Antimalarial Activity of Hydromethanolic Crude Extract and Chloroform Fraction of Brucea antidysenterica Leaves in Plasmodium berghei-Infected Mice.

BACKGROUND: Different parts of Brucea antidysenterica are used in traditional and alternative medicine in Ethiopia for the treatment of different health problems including malaria and have good in vitro antimalarial activity. However, no in vivo study was conducted to substantiate the claim. Our study planned to determine the antimalarial effect of B. antidysenterica extract. METHODS: Swiss albino mice (6-8 weeks old, 20-28 g) were inoculated with Plasmodium berghei. Different doses of both hydromethanolic extract and chloroform fraction were orally given at 100, 200, and 400 mg/kg/day. RESULTS: The parasitemia suppression percent of hydromethanolic crude extract and chloroform fraction in chemosuppressive tests ranged between 33.48 and 75.93% and 38.32 and 76.64%, respectively. The hydromethanolic crude extract and chloroform fraction exhibited the curative effect of 46.75-70.91% and 50.30-80.06% parasitemia suppression, respectively (p < 0.001), compared with negative control. CONCLUSION: From our study, it is concluded that the hydromethanolic crude extract and chloroform fraction of B. antidysenterica leaves showed promising antiplasmodial effects against Plasmodium berghei. This upholds the folkloric use of B. antidysenterica leaves and the thought of as a possible source to develop new antimalarial agents.

Dental health problems and treatment-seeking behavior among special need school students in Amhara region, Ethiopia.

BACKGROUND: Oral diseases are a public health concern with a significant impact on the quality of life of individuals. Children with special needs face significant challenges in carrying out oral hygiene due to their disability, and they are more prone to poor oral health and illnesses. This study assessed dental health problems and treatment-seeking behaviors of special needs school students in Amhara region, Ethiopia. METHODS: An institution-based cross-sectional study was conducted from November 2020 to April 2021, in eight special needs schools located in the Amhara Regional State, Ethiopia. A total of 443 randomly selected special needs students were included. Data were collected using a structured interview-administered questionnaire. Bivariable and multivariable logistic regression models were fitted to identify factors associated with oral health problems and treatment-seeking behavior. A p-value of less than 0.05 was used to declare statistical significance. RESULTS: The prevalence of self-reported dental health problems and treatment-seeking behaviors among special needs school students was 46.1% (95% CI: 41.4%, 50.7%) and 60.3% (95% CI: 53.4%, 66.8%), respectively. Place of residence, grade level, religious affiliation, years lived with disability, and knowledge of dental health-related risk behaviors were associated with dental health problems. Whereas, place of residence, being hearing impaired, and having prior information about dental health problems were associated with dental treatment-seeking behavior. CONCLUSIONS: A significant number of special needs students reported dental problems and about 40% of them did not seek dental treatment. Oral hygiene practice and access to dental care services are important in the prevention of dental problems. Hence, oral hygiene promotion programs focusing on oral hygiene practice and dental treatment services are needed in special needs schools. It is also strongly suggested to incorporate oral health related information in health-related academic lessons to enhance optimum oral health among special needs students.

Pesticide Residue Analysis of Khat Leaves and Health Risks among Khat Chewers in the Amhara Region, Northwestern Ethiopia.

Introduction: Farmers use a large number of pesticides to increase the productivity of Khat cultivation. Since Khat is consumed by many Ethiopians as a habit, there may be a significant concentration of pesticide residues in Khat leaves which result in adverse effects among the exposed population. Excess use of pesticides in Khat causes cancer, genotoxicity, and endocrine disturbances. The current study aimed to determine the concentration of selected pesticide residues on Khat leaves samples and to estimate the possible health risk on consumers. Methods: Thirty Khat samples were collected from Khat cultivators in the Amhara region, Ethiopia. Pesticide residue extraction and cleanup of Khat samples were performed using the QuEChERS method. Data were also collected about personal variables and Khat consumption habits. The pesticide concentrations were determined and the health risks were estimated. Results: Profenofos, dimethoate, and chlorpyrifos were detected in 6 (20%), 24 (80%), and 28 (93.3%) Khat samples, respectively. However, diazinon was detected in two samples and endosulfan I was not detected. The average concentration of chlorpyrifos, dimethoate, profenofos, and diazinon in Khat samples was 75.39 ± 20.26, 130 ± 48.94, 242.45 ± 119.79, and 81.5 ± 21.0 µg/kg, respectively. The HQ for diazinon was greater than 1 which shows the chronic health risks associated with intake of diazinon among Khat chewers. The acute health risks associated with intake of profenofos and diazinon were minimal. Discussion. Pesticide residue exposure is a risk factor for cardiac complications, reduction in antioxidant defense system, and developing neurological symptoms. All the pesticides were higher than the European Union Maximum Residue Levels (EU-MRL). Diazinon has the potential to cause higher chronic health risks. Chronic Khat chewers in the region may face potential health risks from pesticide residues. Awareness creation among people in the study area is necessary to avoid the adverse health effects of pesticide residues.

Depression, Anxiety, Stress, and Associated Factors among Khat Chewers in Amhara Region, Northwest Ethiopia.

Individuals with substance use disorder are prone to develop different psychiatric disorders. Substance abuse and associated problems are of current global concern that leads to mental health disorders which contributed about 14% of the global burden of the disease. It has become an epidemic in some parts of the African region with adolescents being the main victims of the ill health and social effects of substance use. This study is aimed at assessing the prevalence of depression, anxiety, and stress and associated factors among khat chewers in the Amhara region, 2019. A community-based cross-sectional study was done from February 14 to April 15, 2019. A purposive sampling technique was used to enroll the subjects. Data was collected using the face-to-face interview technique using the Depression Anxiety Stress Scale 21 (DASS-21) questionnaire. Descriptive statistics and bivariate and multivariate logistic regression were used to summarize the results. p value < 0.05 was considered statistically significant. A total of 478 participants were enrolled in the study with a response rate of 94.1%. The overall prevalence of depression, anxiety, and stress was 27.4%, 40.6%, and 18.8%, respectively. Around 43% of the respondents develop dependency from khat chewing. Working in a private sector, being self-employed, being jobless, spending 90 to 180 minutes and more, chewing 51-100 g and more, and chewing khat more than once per week were positively associated with stress. On the other hand, being a private sector worker, being jobless, completing secondary education, earning 1001-5000 ETB per month, chewing khat more than once per week, being khat dependent, and the presence of chronic illness were positively associated with anxiety. History of chronic illness and being khat dependent were positively associated with depression. The prevalence of depression, anxiety, and stress was high among khat chewers in the Amhara region. Special attention has to be given to khat chewers since khat chewing will double the burden of mental illness. Proper awareness and evaluation activities will reduce the impact of the problem.

Assessment of Knowledge, Attitude, and Utilization of Traditional Medicine among the Communities of Debre Tabor Town, Amhara Regional State, North Central Ethiopia: A Cross-Sectional Study.

BACKGROUND: Traditional medicine is used by about 80% of the Ethiopian people to meet their healthcare needs. The aim of this study was to assess the knowledge, attitude, and practice of the community on traditional medicine in Debre Tabor town. METHODS: A community-based cross-sectional study was carried out from November 1, 2018, to December 30, 2018, with a face-to-face interview method and involved 402 participants recruited by systematic random sampling technique. Data were analyzed using SPSS version 20.0. The association of independent and dependent variables was determined by binary logistic regression. RESULTS: Among the participants, 294 (73.13%) were females and 108 (26.87%) were males. The ages of participants ranged from 18 to 80 (mean age of the participants was 35.73 ± 0.59 years). Above three-fourths, 322 (80.1%) of the participants had good knowledge. 158 (39.3%) of the participants had a good attitude and 145 (36.1%) of the participants used traditional medicines in their lifetime for different ailments. From all the participants who use traditional medicine, 41 (28.3%) encountered minor adverse effects. CONCLUSIONS: The study participants in Debre Tabor have good knowledge but poor attitude and utilization of traditional medicine.

Antimalarial Activities of Hydromethanolic Crude Extract and Chloroform Fraction of Gardenia ternifolia Leaves in Plasmodium berghei Infected Mice.

BACKGROUND: Gardenia ternifolia is utilized in traditional medicine of Ethiopia for malaria treatment and possessing in vitro antimalarial activity. However, no in vivo study was conducted to substantiate the claim. The aim of this study was to judge the antimalarial activity of Gardenia ternifolia extract in vivo in Plasmodium berghei-infected mice. METHODS: Plasmodium berghei was inoculated to healthy mice, and hydromethanolic crude extract and chloroform fraction of G. ternifolia leaves at 100 mg/kg/day, 200 mg/kg/day, and 400 mg/kg/day were administered. Percent parasitemia inhibition, percent change in bodyweight, hemoglobin level, and mean survival time were determined. Data were analyzed using one-way ANOVA followed by post hoc Tukey HSD test with IBM SPSS software version 20.0 statistical package and P < 0.05 considered as statistically significant. RESULTS: The chemosuppressive test of hydromethanolic crude extract at 100 mg/kg/day, 200 mg/kg/day, and 400 mg/kg/day ranged from 27.09% to 67.72%, and chloroform fraction had 35.21%-78.19% parasitemia suppression, respectively. For curative test on day 5, hydromethanolic crude extract at 100 mg/kg/day, 200 mg/kg/day, and 400 mg/kg/day ranged from 25.58% to 48.76%, chloroform fraction at 100 mg/kg/day, 200 mg/kg/day, and 400 mg/kg/day and chloroquine base at 10 mg/kg showed 46.36%-74.42% and 92.87% percent parasitemia inhibition, respectively, and also the results to both tests were highly significant (P < 0.001) compared to the negative control. Maximum effects on chemosuppressive, curative, prevention of weight loss, and reduction in hemoglobin were observed at higher doses of the hydromethanolic crude extract and chloroform fraction. CONCLUSION: From this study, hydromethanolic crude extract and chloroform fraction of G. ternifolia leaves have shown promising antimalarial activity. The findings support the traditional claim of G. ternifolia leaves for malaria treatment; however, species variation could also limit such a straightforward extrapolation of the findings of this study in humans.