Patients In Low-income Countries Research Articles

Formulation of category-2 hypoglycemic Improved Traditional Medicines from selected Cameroonian medicinal plants: <i>Mangifera indica, Persea americana</i> and <i>Ageratum conyzoides</i>

Diabetes mellitus is the fourth leading cause of death worldwide, and constitutes a major public health crisis. Management of the adverse condition relies mostly on synthetic drugs such as metformin, glibenclamide and insulin. However, treatment with synthetic drugs is challenged by side effects and high cost especially to patients in low-income countries like Cameroon. This study set out to formulate Improved Traditional Medicines (ITMs) in the form of capsules from lyophilized aqueous leaf extracts of Ageratum conyzoides, Mangifera indica and Persea americana, in combination, coded as ITM-1, and leaf extract of Mangifera indica alone, referred to as ITM-2. Phytochemical profiling of individual extracts was carried out using standard methods, while their antioxidant activity was evaluated in vitro by the 2,2-diphenyl-1-picryhadrazyl reducing (DPPH) assay and the Ferric (Iron) reducing antioxidant power assay (FRAP). Capsule formulation was guided by findings from prior Physicochemical and pharmacotechnical analysis of individual extracts and their combination. Safety studies were carried out both in vitro (cytotoxicity testing in Vero cells); and in vivo (acute toxicity tests using the mouse model). Preliminary evaluation of the antidiabetic potential of the formulated ITMs was achieved through determination of their acute hypoglycemic and antihyperglycemic properties in Wistar rats (Oral Glucose Tolerance Test). Major classes of phytochemicals detected were alkaloids, phenols, tannins, flavonoids, anthocyanins, tri-terpenes and anthraquinones. The DPPH and FRAP assays showed dose-dependent antioxidant activity for ITM-1 and ITM-2. Both ITMs showed no toxic effects, be it in vitro, (Cytotoxic Concentration 50% - CC50>1000 µg/mL in cells) or in vivo. At the dose of 25 mg/Kg, both ITMs exhibited significant hypoglycemic effects in Wistar rats. The ITM-2 capsules completely suppressed post-prandial glucose peak in rats as compared to the negative control (distilled water), ITM-1 capsule was able to cause restoration of the glucose levels to normal levels after 120 minutes

Perioperative mortality among trauma patients in Northwest Ethiopia: a prospective cohort study

Trauma is the leading cause of mortality in persons under 45 and a significant public health issue. Trauma is the most frequent cause of perioperative mortality among all surgical patients. Little is known about perioperative outcomes among trauma patients in low-income countries. This study aimed to assess the incidence and identify predictors of perioperative mortality among adult trauma victims at Tibebe Ghion Specialised Hospital. From June 1, 2019, to June 30, 2021, a prospective cohort study was conducted at Tibebe Ghion Specialized Hospital. Demographic, pre-hospital and perioperative clinical data were collected using an electronic data collection tool, Research Electronic Data Capture (REDCap). Cox proportional hazard model regression was used to assess the association between predictors and perioperative mortality among trauma victims. Crude and adjusted hazard ratio (HR) with a 95% confidence interval (CI) was computed; a p-value < 0.05 was a cutoff value to declare statistical significance. One thousand sixty-nine trauma patients were enrolled in this study. The overall incidence of perioperative mortality among trauma patients was 5.89%, with an incidence rate of 2.23 (95% CI 1.74 to 2.86) deaths per 1000 person-day observation. Age ≥ 65 years (AHR = 2.51, 95% CI: 1.04, 6.08), patients sustained blunt trauma (AHR = 3.28, 95% CI: 1.30, 8.29) and MVA (AHR = 2.96, 95% CI: 1.18, 7.43), trauma occurred at night time (AHR = 2.29, 95% CI: 1.15, 4.56), ASA physical status ≥ III (AHR = 3.84, 95% CI: 1.88, 7.82), and blood transfusion (AHR = 2.01, 95% CI: 1.08, 3.74) were identified as a significant predictor for perioperative mortality among trauma patients. In this trauma cohort, it was demonstrated that perioperative mortality is a healthcare burden. Risk factors for perioperative mortality among trauma patients were old age, patients sustaining blunt trauma and motor vehicle accidents, injuries at night, higher ASA physical status, and blood transfusion. Trauma care services need improvement in pre-hospital and perioperative care.

Treatment of bone infections in children in low-income countries – A practical guideline based on clinical cases

In low-income countries (LIC), the management of bone infections is a huge challenge. A high number of patients are in the pediatric age group. Children and adolescents exhibit good bone healing potential offering treatment options that mainly rely on the biological response of the infected bone. The purpose of this article is to highlight treatment options for these patients in LIC, which is based on clinical cases that illustrate the principles of the treatment, focusing on bone reaction and healing potential.First, identification of emergency cases is of importance. Sepsis of the patient due to bone infections is a life-threatening disease that requires immediate surgical attention with abscess incision. It should be tailored to the surgeon's experience and local conditions to avoid unwanted complications, such as excessive bleeding, fracture or bone loss.In non-septic patients, uncomplicated cases should be distinguished from complicated cases as the first might often require only abscess incision, particularly in small children, without any other major surgical intervention.Biomechanical stability and bone formation capacity, soft tissue conditions and joint involvement are decisive factors differentiating uncomplicated from complicated cases. Central treatment column is the immobilization of the infected bone with simple methods, such as plaster of Paris, braces or external fixation. This is intended to provide sufficient stability to allow for new bone formation that subsequently downsizes the infection site and that can bridge previously infected non-union sites or bone defects. In most cases, antibiotic treatment is not performed as antibiotics are not available or affordable.Severe soft tissue defects remain a major challenge as microvascular surgical experience is often required for reliable coverage, for which referral to one of the very few specialized centers is recommended. Major bone defects should also be treated in centers with sufficient expertise for bone reconstruction procedures. Regular follow-ups are important to ensure healing and to avoid aggravation of the disease.Encouraging success rates can be achieved by these treatment principles. However, it should not be forgotten that poverty in these countries, including limited access to health care, remains one of the world's most important problems.

Prevalence and factors associated with suboptimal blood pressure among ambulatory patients with diabetic kidney disease attending a tertiary hospital in Uganda.

Kidney failure prevalence is increasing among diabetic kidney disease (DKD) patients in low-income countries. Suboptimal blood pressure (BP) drives kidney failure and mortality. The burden of suboptimal BP and its associated factors among these patients are not well documented. To determine the prevalence of suboptimal BP and associated factors among those with DKD attending Kiruddu National Referral Hospital. In this cross-sectional study, recruited participants were screened for DKD using urine dipsticks from 6th May 2020 to 15th July 2020. A pretested questionnaire was administered, BP, height and weight were measured. Suboptimal BP was defined as systolic BP > 130mmHg and or diastolic BP > 80mmHg. A Poisson regression model analysed the associated factors. 250 participants with DKD, mean age of 52(11) years were included of whom 199 (79.6%) were female. Suboptimal BP prevalence was 84.4%, associated with past (p = 0.04) and current (p < 0.001) alcohol use, overweight (p < 0.001) and obesity (p < 0.001), wage earning (p < 0.001) and professionals (p = 0.048). The prevalence of suboptimal BP was high among the overweight, obese, unemployed and alcohol users. Thus, there is a need for better BP control interventions.

Some Medicinal Plants with Anti-breast Cancer Activity and the Input of Phytotherapy in the Treatment of Breast Cancer

Aim: Breast cancer is the most commonly diagnosed cancer leading to death among women worldwide. Despite the advances in the diagnosis skills and in the treatment of breast cancer, it has been observed that the recurrence rate experienced by breast cancer patients is quite high. Many plants have been reported to have anti-breast cancer properties. This paper focuses on determining the role of phytotherapy in the treatment of breast cancer.&#x0D; Methods: The following key search terms were used on Pubmed, Google scholar, and Researchgate: breast cancer, breast cancer cell lines, phytotherapy, medicinal plants in the treatment of breast cancer, treatment of breast cancer, cytotoxics effects of plant extracts on breast cancer in vitro/ in vivo, integrative oncology, and natural products as sources of drugs. Pertinent reviews in English language were examined.&#x0D; Results: It has been observed that many studies were conducted in vitro and in vivo to demonstrate the anti-breast cancer activities of a myriad of plants. While investigations are being made to prove the anti-breast cancer effects of many plants, the use of phytomedicine is not generating enough attention by mainstream practitioners. Some significant results were observed by patients with breast cancer history through the combination of phytotherapy and conventional medicines.&#x0D; Discussion: The conventional treatment of breast cancer is often accompanied with side effects. Many patients in low-income countries are faced off with the enormous cost of conventional treatment. Hence, there is a need to search for new bioactive substances in the treatments of breast cancer. Phytotherapy is a promising approach and herbal preparations are to be used in the same way as conventional medicine in the treatment of breast cancer.&#x0D; Conclusion: Phytotherapeutics products are used more often in the treatment of breast cancer as adjuvant therapy. In Africa, the use of herbal products in the treatment of breast cancer still remains in the hands of traditional-practitioners, without any control of quality and efficacy. Standard methods for the preparation of herbal products are to be determined in order to adopt phytotherapy in the treatment of breast cancer as much as conventional treatment.

Treatment of obstructive sleep apnea with a simple CPAP device

PurposeCPAP is the “gold standard” treatment for obstructive sleep apnea (OSA). Current CPAP models have developed additional functions including automatic CPAP and pressure relief. However, CPAP adherence has not improved over the last three decades. Many patients in low-income countries cannot afford these CPAP devices. A novel simple CPAP device with a fixed pressure without pressure controller was developed.MethodsManual CPAP pressure titration was performed in 127 patients with OSA. Six patients with a titration pressure higher than 11 cmH2O and 14 patients who could not tolerate CPAP were excluded, leaving 107 participating in the following 2 studies. In study one, 54 of 107 patients were treated by both conventional fixed CPAP and simple CPAP in random order. In the second study, another 53 patients were treated by both autoCPAP in automatic function and simple CPAP in random order. Simple CPAP was fixed at 10 cmH2O, 8 cmH2O, and 6 cmH2O for patients whose titration pressure was between 9–10, 7–8, and ≤ 6 cmH2O, respectively. Conventional fixed CPAP device was set exactly the same as manual titration pressure.ResultsAll patients whose manual titration pressure ≤ 10 cmH2O were effectively treated by simple CPAP (AHI 40.7 ± 2.3 events/h before vs 2.5 ± 0.3 events/h after, p < 0.001). Patients expressed similar preferences for simple CPAP, autoCPAP, and conventional fixed CPAP (p > 0.05).ConclusionsWe conclude that a novel simple CPAP is an alternative treatment for most patients with OSA, which may widen access to CPAP therapy in the developing countries because of its low cost.

Quantitative Assessment of Vacuolization of Myeloid Precursors in VEXAS Syndrome.

Quantitative Assessment of Vacuolization of Myeloid Precursors in VEXAS Syndrome.

SARS-CoV-2 Testing Strategies in the Diagnosis and Management of COVID-19 Patients in Low-Income Countries: A Scoping Review.

The accuracy of diagnostic laboratory tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can impact downstream clinical procedures in managing and controlling the outbreak of coronavirus disease 2019 (COVID-19). To assess the effectiveness of laboratory tools for managing COVID-19 patients in low-income countries (LICs), we systematically searched the PubMed, Embase, Scopus and CINHAL databases for reports published between January 2020 and June 2022. We found that 22 of 1303 articles reported the performance of various SARS-CoV-2 detection tools across 10 LICs. These tools were (1) real-time reverse transcriptase polymerase chain reaction (RT-PCR); (2) reverse transcription loop-mediated isothermal amplification (RT-LAMP); (3) rapid diagnostic tests (RDTs); (4) enzyme-linked immunosorbent assay (ELISA); and (5) dot-blot immunoassay. The detection of COVID-19 is largely divided into two main streams-direct virus (antigen) detection and serology (immunoglobulin)-based detection. Point-of-care testing using antigen-based RDTs is preferred in LICs because of cost effectiveness and simplicity in the test procedures. The nucleic acid amplification technology (RT-PCR and RT-LAMP) has the highest diagnostic performance among the available tests, but it is not broadly used in this context due to costs and shortage of facilities/trained staff. The serology-based test method is affected by antibody interferences and varying amounts of SARS-CoV-2 immunoglobulins expressed at different stages of disease onset. We further discuss the effectiveness and shortcomings of each of these tools in the diagnosis and management of COVID-19. Using the LICs as the study model, our findings highlight ways to improve the quality and turnaround time of COVID-19 testing in resource-constrained settings, notably through local/international collaborative efforts to refine the molecular-based or immunoassay-based testing technologies.

MagnEtophoretic Slider Assay (MeSA): A simple platform for point-of-care diagnostics

Infectious diseases account for millions of deaths each year. To reduce the number of infectious disease related deaths, diagnostic testing needs to be more accessible to patients in low-income countries as well as developed countries. Current diagnostic methods involve centralized laboratories, trained personnel, and are time-intensive, limiting translation to the point-of-care (POC). Microfluidic devices are a popular alternative for diagnostics due to reduced assay times, reduced sample volume, and lower cost. Microfluidic devices are small (&amp;lt;10 cm) and can perform complex assays. Microfluidic paper-based analytical devices (µPADs) are a popular approach to help translate diagnostics to the POC but historically suffer from poor sensitivity when compared to established laboratory methods. Magnetically labeling analytes allows samples to be sorted resulting in improved sensitivity and specificity. Microfluidic magnetophoresis is the process of manipulating magnetic particles in a magnetic field and offers the ability to wash and concentrate a sample during flow. However, until recently, magnetophoresis has not been used in conjunction with µPADs because magnetophoresis requires complex and expensive instrumentation to control flow. Coupling magnetophoresis with µPADs enables pump-free flow control, simple operation, and low cost. Early magnetophoresis µPADs showed detection limits similar to traditional methods but higher than targets for clinical use. In this work, we demonstrate a novel, simple MagnEtophoretic Slider Assay (MeSA) that is free of any external instrumentation and offers a new platform for POC diagnostics. We demonstrate the assay’s capability through biotin competitive assays and a sandwich immunoassay for E. coli detection. The calculated limit of detection for E. coli was 1.62 × 103 Colony Forming Units per mL (CFU/ml). The work described is a novel and simple microfluidic platform that has potential for a wide range of future applications.

Pancreaticoduodenectomies in a Low Volume, Small Island Eastern Caribbean State: A Retrospective Cohort Study

Background: Although pancreaticoduodenectomy (PD) is safe when performed in high-volume hospitals, many patients in low-income countries cannot access these hospitals. Barbados is a small island that does not have a high-volume pancreatic center. We sought to document peri-operative outcomes when PD was performed in Barbados. Methods: We carried out a retrospective cohort study of all consecutive patients who underwent PDs over from August 1, 2016 to October 30, 2022. Therapeutic outcomes, post-operative morbidity and mortality were evaluated. Statistical analyses were performed using SPSS ver 16.0. Results: Six patients at a mean age of 54.8 years underwent PD (mean annual case volume of 1). Two patients underwent planned vein resections and reconstruction. In this subset, the mean operating time was 325 minutes (Range 300-250; Median 325; SD ±35.4), mean estimated blood loss was 825mls (Range 750-900; Median 825; SD±106.1), and the mean transfusion requirement was 1 unit of packed cells (Range 0-2; Median 1; SD±1.41). In the four patients without vein resection, mean operating time was 308 minutes (Range 280-350; Median 300; SD±24.01), median blood loss was 575 ml (Range 150-900; Median 700; SD±320.6) and mean transfusion requirements were 0.5 units of packed cells (Range 0-2; Median 0; SD ±0.84). The mean ICU stay was 2.17 days (Range 1-3; Median 2.5; SD±0.98), and the mean duration of hospitalization was 9.3 days (Range 7-11; Median 9.5; SD±1.37). There were no recorded peri-operative deaths, but there was 1 (17%) minor complication (delayed gastric emptying) and 1 (17%) major complication (myocardial infarction). Conclusion: In Barbados, there are good peri-operative outcomes after PD despite the low volume and challenging healthcare environment. We believe that (1) surgeon experience (2) continuous adaptive hospital learning and (3) regular audit of hospital data are better indicators of PD quality than volume data alone.

Value of Nutritional Screening Tools Versus Anthropometric Measurements in Evaluating Nutritional Status of Children in a Low/Middle-Income Country.

Pediatric patients in low-income countries are at a high risk of malnutrition. Numerous screening tools have been developed to detect the risk of malnutrition, including the Subjective Global Nutritional Assessment (SGNA), Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Nutritional Status and Growth (STRONGkids). However, anthropometry remains the main tool for assessing malnutrition. We aimed to identify the value of four nutritional screening tools versus anthropometry for evaluating the nutritional status of children. We conducted a cross-sectional study of 1,000 children aged 1-12 years who visited the outpatient clinic of Cairo University Pediatric Hospital. Each participant was evaluated using anthropometric measurements (weight, length/height, and weight for length/height) as well as the PYMS, STAMP, STRONGkids, and SGNA screening tools. The sensitivities and specificities of these four tools were assessed using anthropometry as the gold standard. Of the patients, 1.7% were underweight, 10.2% were wasted, and 35% were stunted. STRONGkids demonstrated the highest sensitivity (79.4%) and a high specificity (80.2%) for detecting malnutrition compared with weight for height, followed by STAMP, which demonstrated lower sensitivity (73.5%) but higher specificity (81.4%). PYMS demonstrated the lowest sensitivity (66.7%) and the highest specificity (93.5%), whereas SAGA demonstrated higher sensitivity (77.5%) and lower specificity (85.4%) than PYMS. The use of nutritional screening tools to evaluate the nutritional status of children is valuable and recommended as a simple and rapid method for identifying the risk of malnutrition in pediatric patients.

Thalidomide and Sucralfate Reduce Gastrointestinal Bleeding in Adults with Hereditary Hemorrhagic Telangiectasia: The Mexican Experience

Introduction Hereditary hemorrhagic telangiectasia (HHT) is the second most common inherited bleeding disorder, occurring in 1/5,000 to 1/10,000 persons. Has an autosomal dominant transmission and can occur de novo. Telangiectases occurs at characteristics sites: lips, oral cavity, fingers and nose; but visceral lesions are common, affecting gastrointestinal tract (GIT), liver, lung, brain and spinal arteriovenous formations. Nosebleed and GIT can lead to iron deficiency anemia. HHT is an underrecognized disease and delay in diagnose can increase morbidity and mortality as more telangiectases develop with aging. Thalidomide treatment for moderate and severe bleedings, that are defined by requirements of intravenous iron replacement and/or transfusions, has been used since more than a decade with good results (Blood 2021;137:888-895 and Hematology Am Soc Educ Program 2021;1:469-477). Material and methods Anemic adults with HHT based in Curaçao clinical diagnosis criteria, three to four from: a) telangiectases, b) epistaxis, c) visceral involvement and d) direct family history (Am J Med Genet 2009;91:66-67); and positive endoscopic study with moderate to severe GIT bleeding; some patients had a full body CT Scan and showed telangiectasi in al GIT as in Figure 1, the bone window reveal fill blooded telangiectasia. Thalidomide was initiated at 100 mg daily for a month and increased to 200 mg daily if tolerated for 12 months; aspirin 100 mg daily for thrombosis prevention; and omeprazole 20 mg with sucralfate 1 gr twice a day for GIT mucosal protection; transfusion to maintain hemoglobin level at 7-8 g/L and iron carboxymaltose to increase Hb levels and maintain ferritin above 50 ng/mL End points before and after treatment: a) number of episodes of GIT bleeding, b) number of red blood cells transfusions, and c) hemoglobin levels. Results Fifteen patients were included, 9 men and 6 females. Age from 28 to 74 years, median 56. All patients tolerated thalidomide 200 mg daily with minimum side effects and no hematologic toxicity, and completed 12 months period. The number episodes per month of GIT bleeding for all the group before treatment were 28, all patients have at least one monthly episode and two patients more than three; after three months and until end of treatment the number of episodes per month reduced to 5 for all the group. The number of red blood cells transfusion for all the group before treatment were 65 units per month, after three months of treatment reduced to 9 units and at end of treatment to 4 units. The mean of Hb level before treatment were 5.86 g/L, after three months of treatment were 9.2 g/L, and at end of treatment were 11.7 g/L. As a secondary observation the nosebleed episodes were reduced to zero after three months of treatment, from 9 episodes before treatment. No thrombotic complications were observed. Median time to increase the GIT bleeding was 9 months after end of treatment. Discussion In HHT, GIT bleeding is a common symptom in older adults over than 50 years due many factors: nosebleed had received various lines of treatment, ageing of the GIT mucosa that leads to the development of more telangiectases and use of medications for chronic diseases, among others. In this case thalidomide with sucralfate are tolerated and have very good results diminishing the GIT bleeding and the red blood cells transfusions, allowing to increase the Hb levels using IV iron. The response is observed in the three first months of treatment and is maintained until nine months after the end of it. Thalidomide as antiangiogenic and Sucralfate as a local healing substance are useful as an option in this kind of patients in low income countries because Bevacizumab, Pomalidomide and other antiangiogenics are more expensive. More trials using thalidome alone or in combination would help to have strong data in results and improve the quality of life of these patients. Finally, after ellectronic search this is the only Mexican experience in the treatment of HHT. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Genetic Diagnosis of Inborn Errors of Immunity in an Emerging Country: a Retrospective Study of 216Moroccan Patients.

Genetic testing provides great support to validate the clinical diagnosis of inborn errors of immunity (IEI). However, the high cost and advanced technology make these tests inaccessible to a large proportion of patients in low-income countries. In the present study, we aim to evaluate the Moroccan experience in genetic testing and to report the main molecular features and difficulties encountered in genetic diagnosis. We performed a multi-center retrospective analysis of all patients with a molecular diagnosis and registered in the national registry between 2010 and 2022. To estimate the impact of the newly identified mutations, we calculated the Combined Annotation Dependent Depletion (CADD) score and the mutation significance cutoff (MSC) for each variant. A total of 216 (29%) patients received a genetic diagnosis out of 742 patients with IEI included in the registry. All genetic tests were performed in the context of thesis projects (40%) or international collaborations (60%). A set of 55 genetic defects were identified, including 7 newly reported: SNORA31, TBX21, SPPL2A, TYK2, RLTPR, ZNF341, and STAT2 GOF. Genetic diagnoses were more frequent in the defects of innate and intrinsic immunity with a percentage of 78%, while antibody deficiencies had a lower frequency with a percentage of 17.5%. Only one genetic diagnosis has been made in the complement deficiency group. The most commonly used molecular techniques were Sanger sequencing (37%) followed by targeted gene sequencing (31%). The thesis projects and collaborations were beneficial as they allowed us to provide a definitive genetic diagnosis to 29% of the patients and to contribute to the identification of new genetic defects and mutations. These results offer insight into the progress made in genetic diagnoses of IEI in Morocco, which would provide a baseline for improving the clinical management of patients with IEI.

Prolactinoma: Clinical Characteristics, Management and Outcome

Aim Prolactinoma, a prolactin (PRL) secreting functioning pituitary tumor, is the most common of all pituitary adenomas (PA) accounting for 40-60% and dopamine agonists (DA) are the cornerstone of treatment. The aim of this study was to review the clinical presentation, treatment modalities and therapeutic outcomes of patients with prolactinomas in the South Asia region. Methods This retrospective study was conducted in the Endocrinology Department of Shaukat Khanum Memorial Cancer Hospital and Research Centre from December 2011 till December 2019. Medical records were used to retrieve for patient's demographics, clinical features at diagnosis, PRL levels and size of prolactinoma on MRI at diagnosis and after start of dopamine agonists and outcome of medical management. Results A total of 107 patients were included in this study. Mean age at diagnosis was 35 (22-54) years for men and 32 (18-50) years for women and 66.4% (71) of the patients were females. Our study included 38 (35.5%) microadenoma, 50 (46.7%) macroadenoma and 19 (17.8%) giant adenomas. At presentation, the most common symptom among females was menstrual irregularity/amenorrhea seen in 73.2% of females and among males was visual disturbance (80.6%). A significant reduction in PRL levels was seen within six to 12 months of treatment. Mean PRL levels decreased from 3162.8 ng/ml to 1.52 ng/ml. A notable decrease in tumor size was seen with medical management, mean adenoma size decreased from 2.18 cm to 1.04 cm. With cabergoline (CAB) 83.3% biochemical cure was seen compared to bromocriptine (BRC) which has 60.4%. The radiological response rate in CAB and BRC groups was 65.45% and 60%, respectively. Complete resolution of adenoma was seen in 13 patients (nine were microadenoma, two macro and two giant adenomas). The prolactin level at diagnosis was positively correlated with maximum tumor diameter (r = 0.469, P = 0.001). Two patients developed cerebrospinal fluid (CSF) rhinorrhea and the defect was repaired in both patients. Median follow-up duration was 40 (12-288) months. Conclusion Clinical presentation and demographics of prolactinoma are the same in our region when compared to the rest of the world. Cabergoline is superior to bromocriptine in prolactin normalization and tumor shrinkage but still bromocriptine is being used in a significant number of patients in low-income countries as first-line due to its low cost.

Prevalence and Factors Associated with Diabetic Retinopathy among Adult Diabetes Patients in Southeast Ethiopia: A Hospital-Based Cross-Sectional Study.

BackgroundDiabetic retinopathy (DR) is the most prevalent microvascular consequence of diabetes mellitus, and it can result in blindness that is irreversible. Due to delayed diagnosis and limited access to diabetic care, the situation is even worse in developing countries. Scientific evidence on the prevalence of DR and its associated factors among diabetes patients in low-income countries, such as Ethiopia, is limited. This study aimed to determine the prevalence of DR and associated factors among adult diabetes patients in southeast Ethiopia.MethodsA hospital-based cross-sectional study was conducted among diabetes patients who visited Madda Walabu University Goba Referral Hospital. Fundus and slit-lamp examination were performed for screening of DR. Multivariate binary logistic regression was computed to identify factors associated with DR.ResultsA total of 256 patients (144 men, 56.2%) aged 50.15±15.71 years were included in the study. The prevalence of any DR was 19.9% (95% CI 15.4%–25.3%), mild nonproliferative diabetic retinopathy (NPDR) 10.9% (95% CI 7.6%–15.4%), moderate NPDR 5.9% (95% CI 3.5%–9.5%), severe NPDR 0.9% (95% CI 0.2%–3.9%), and proliferative DR 2.3% (95% CI 1.0%–5.1%). Duration of diabetes ≥10 years (AOR 10.22, 95% CI 1.70–61.44), central obesity (AOR 5.42, 95% CI 1.38–21.19), overweight/obese (AOR 2.65, 95% CI 1.02–6.92), lower high-density lipoprotein (HDL) cholesterol (AOR 5.82, 95% CI 1.86–18.24), moderate triglyceride:HDL cholesterol ratio (AOR 4.13, 95% CI 1.13–15.15), and urban dwelling (AOR 2.84, 95% CI 1.04–7.78) were significantly associated with DR.ConclusionOne in every five DM patients had DR. Sociodemographic, anthropometric, and blood lipids were independently associated with DR. To reduce the burden of diabetes, strategies that focus on lifestyle modifications targeted at identified modifiable risk factors are essential.

Epidemiological Characteristics, Antimicrobial Susceptibility Profile, and Surgical Outcome of Complicated Intra-Abdominal Infection at a Tertiary Hospital in Somalia.

BackgroundIntra-abdominal infections (IAIs) are common surgical emergencies and one of the leading causes of non-trauma deaths in hospitals worldwide. Because of limited resources, most patients in low-income countries experience delayed diagnosis and treatment. To the best of our knowledge, this is the first study to evaluate the epidemiological characteristics, antimicrobial susceptibility profile, and outcome of patients with complicated IAI at a tertiary hospital in Somalia.MethodsThis study included all patients with confirmed IAIs who underwent laparotomy or percutaneous drainage, either emergency or elective, and whose cultures showed growth. Sociodemographic and clinical characteristics, culture results, antimicrobial susceptibility profile, and the type of source control were reviewed.ResultsThe prevalence of CIAI was 5.3%, 144 (70%) were male, and 61 (30%) were female. The mean age was 38.6±8.5 years. Appendicitis was the most common source of infection, accounting for 32%, followed by bowel perforation in 37 (18%). Out of 15 patients with liver abscesses, ten patients had diabetes (67%). E. coli 82 (40%) was the most common isolated organism, followed by Klebsiella pneumonia (n = 44, 21.5%). The prevalence of extended-spectrum beta-lactamase-producing and multidrug-resistant pathogens was 6.8% and 5.9%, respectively. The pathogens revealed a higher antimicrobial resistance against penicillins in 62%, cephalosporins in 54%, and fluoroquinolones in 44%. E. coli showed 2.5–13% antimicrobial resistance against carbapenems, lower than Klebsiella pneumonia in about 4.5%. Tigecycline, teicoplanin, and linezolid revealed the highest sensitivity against pathogens, about 100%. Source control was achieved by laparotomy in 81%, while the 19% were managed in a percutaneous approach. The mortality rate in our study was 9.3%.ConclusionThe prevalence of CIAI in our study was 5.3%, with an increasing number of MDR microorganisms isolated from cultures. CIAI and intra-abdominal abscess are significant sources of high morbidity and mortality with sepsis and poor clinical outcome; thus, early detection and intervention are crucial.

Orbital myeloid sarcoma treated with low-dose venetoclax and a potent cytochrome P450 inhibitor.

We report the first case of orbital myeloid sarcoma that was successfully treated with a standard venetoclax dose of 25%. A 38-year-old man with acute myeloid leukemia (AML) post-haplo-hematopoietic stem cell transplantation (HSCT) presented with a nine-month history of progressive right proptosis and a visual acuity deficit. The patient was treated with venetoclax (100 mg orally on days 1-28), cytarabine (40 mg subcutaneously, days 1-10), and itraconazole (100 mg twice daily orally on days 1-28). The present case report shows that using cytochrome P450 (CYP) inhibitors is a helpful strategy to reduce the cost of expensive treatments. There are limited data on the use of CYP inhibitors as a strategy to reduce the costs of expensive drugs (i.e. venetoclax). This approach has some advantages over standard dose venetoclax (400 mg/day) such as significantly reduced costs (which is relevant for patients in low-income countries). In this case, we used itraconazole-a potent CYP3A4 inhibitor-which can theoretically reduce the dose to 100 mg/day without losing serum therapeutic concentrations.

Challenges Faced by Hospital Pharmacists in Low-Income Countries Before COVID-19 Vaccine Roll-Out: Handling Approaches and Implications for Future Pandemic Roles

Coronavirus disease-2019 (COVID-19) is one of the greatest pandemics of modern times. More than one hundred eleven million global deaths have already been associated with COVID-19. The incidence of COVID-19 as well as morbidity and mortality due to COVID-19 have increased in low-income countries (LICs). COVID-19 has further weakened health systems in LICs, that are already distressed by inadequate funding, lack of human resources, and poor infrastructure and service delivery. Despite the resource crunch, hospital LICs have been instrumental in treating COVID-19 patients. Pharmacists working in hospitals play an indispensable role in providing pharmaceutical services for infection prevention and control. This study discusses the contribution of hospital pharmacists and the challenges faced by them for treating COVID-19 patients in LICs before the COVID-19 vaccine roll-out.

Physical activity level and associated factors among adult HIV patients in Ethiopia

BackgroundPeople living with HIV, who take antiretroviral therapy (ART), often enjoy long and healthy lives, but this therapy has well known metabolic adverse effects. Physical activity is found to be an important factor in improving these physiological parameters. This study aimed to determine physical activity level and associated factors among HIV patients in Ethiopia.MethodsAn institutional based cross sectional study was conducted from May to June 2019. We selected a total of 422 adult HIV patients, attending antiretroviral therapy clinics in three selected hospitals in Southern Ethiopia. Data were collected at routine care consultations by nine trained nurses using a pre-tested structured questionnaire. The level of physical activity was measured by the international physical activity questionnaire (IPAQ).ResultThe mean age of participants was 38.7 ± 9.13 years. Of the participants, 68% were physically inactive, with a higher proportion of inactive women (74%) than men (61%) [(AOR = 1.64, 95% CI (1.07, 2.53)]. In addition, urban vs. rural residents [(AOR = 2.57, 95% CI (1.16, 5.72)] and patients who were on ART for ≥ 24 months [(AOR = 1.88, 95% CI (1.15, 3.08)] had higher odds of having a low physical activity level.ConclusionMost people living with HIV and receiving ART have low physical activity levels. Especially female and urban living patients and those with longer treatment duration have low levels of physical activity. More insight is needed on the reasons for physical inactivity among HIV patients and physical activity programs for HIV patients in low-income countries need to be developed.

Glycemic control among patients with type 2 diabetes in a low resource setting in Rwanda: a prospective cohort study.

diabetes is a leading cause of death, disability, and high healthcare costs, especially among patients with poor glycemic control. Providing decentralized diabetes care to patients in low-income countries remains a major challenge. We aimed to assess hemoglobin A1C (HbA1c) level of patients enrolled in primary-level non-communicable disease clinics of Rwamagana, Rwanda, and identify predictors associated with a) change in HbA1c level over a 6-month period or b) achieving HbA1c <7%. We also explored whether living in a community with a home-based care practitioner was associated with HbA1c-related outcomes. we conducted structured interviews and HbA1c testing among patients with type 2 diabetes at baseline and after six months. Multivariable linear regression and multivariable logistic regression were used. hundred and thirty (130) participants enrolled at baseline, and 123 patients remained in the study after six months. At baseline, 26% of patients had HbA1c <7%. After 6-months, 37% of patients had HbA1c <7%. Factors correlated with the greatest improvements in HbA1c were having HbA1c >9% at baseline, while factors associated with having HbA1c <7% after six months included older age and having HbA1c <7% at baseline. We did not find significant associations between home-based care practitioners and improvement in HbA1c level or achieving HbA1c <7. the number of patients with well-controlled glycemia improved over time during this study but was still low overall. Care provided by home-based care practitioners was not associated with six-month HbA1c outcomes. Enhanced care is needed to achieve glycemia control in primary healthcare settings.