Chronic hepatitis B virus infection in Eastern Ethiopia:Clinical characteristics and determinants of cirrhosis

BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia.AIM To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment.METHODS This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019.Baseline assessments included chemistry,serologic,and viral markers.χ^(2) tests,Mann-Whitney U tests,and logistic regression analyses were used to identify the determinants of cirrhosis.Tenofovir disoproxil fumarate(TDF)was initiated using treatment criteria from the Ethiopian CHB pilot program.RESULTS A total of 132 patients(68.4%)were men,with a median age of 30 years[interquartile range(IQR):24-38].At enrollment,60(31.1%)patients had cirrhosis,of whom 35(58.3%)had decompensated cirrhosis.Khat use,hepatitis B envelope antigen positivity,and a high viral load were independently associated with cirrhosis.Additionally,66 patients(33.4%)fulfilled the treatment criteria and 59(30.6%)started TDF.Among 29 patients who completed 24 months of treatment,the median aspartate aminotransferase to platelet ratio index declined from 1.54(IQR:0.66-2.91)to 1.10(IQR:0.75-2.53)(P=0.002),and viral suppression was achieved in 80.9%and 100%of patients after 12 months and 24 months of treatment,respectively.Among the treated patients,12(20.3%)died within the first 6 months of treatment,of whom 8 had decompensated cirrhosis.CONCLUSION This study highlights the high prevalence of cirrhosis,initial mortality,and the efficacy of TDF treatment.Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.

Anaesthetic Management and Challenges for Carotid Body Tumour Excision in a Young Nigerian: A Case Report and Review of Literature

Background: Carotid body tumours (CBTs) are rare tumours that arise from chemoreceptor cells at the bifurcation of carotid artery. Excision of CBT poses several anesthetic challenges and may be complicated with marked intraoperative hemodynamic instability and turbulent postoperative recovery. Attention to details and a meticulous anesthetic plan are essential for successful anesthetic management. Aim: To present anaesthetic management and challenges for carotid body tumour excision in a young Nigerian. Case Presentation: A 26-year-old man presented with left sided slow growing neck tumour. The tumour was completely excised with no anaesthetic or surgical complication. Histology and immunohistochemistry of the excised tumour confirmed paraganglioma. He was discharged fifteenth post-operative day. Conclusion: General anesthesia is the preferred technique. The basic elements of anesthetic management are protection of hemodynamic stability and maintenance of cerebral perfusion pressure (CPP).

Poly (ADP-ribose): A double-edged sword governing cancer cell survival and death

Poly(ADP-ribose)(PAR),a polymer of ADP-ribose,is synthesized by PAR po-lymerase and is crucial for the survival of cancer cells due to its vital functions in DNA repair and post-translational modifications.Beyond its supportive role,PAR also triggers cancer cell death by excessive accumulation of PAR leading to an energy crisis and parthanatos.This phenomenon underscores the potential of targeting PAR regulation as a novel anticancer strategy,and the rationale would present an engaging topic in the field of anticancer research.Therefore,this editorial provides an overview of the mechanisms determining cancer cell fate,emphasizing the central role of PAR.It further introduces promising methods for modulating PAR concentrations that may pave the way for innovative anticancer therapies.

Proteomics and Its Applications in Diagnosis of Auto Immune Diseases

Although the proteomics and its applications in detecting autoimmune diseases are a prominently discussed issue, this review will focus particularly some prominent aspects regarding clinical utility of these techniques in prognosis, diagnosis, and treatment of these diseases. The impact of immunofluorescent techniques, enzyme immunoassays and use of proteomics biomarkers in the characterization of the auto immune diseases is briefly discussed. The necessity of adopting existing technologies of protein chemistry, predisposition testing, targeted monitoring and prevention of diseases through nutrition coupled with lifestyle changes will be focused as modern diagnostic tools in realizing the changeover from isolated medicine to personalized medicine. Use of biological fluids, in order to identify low abundance proteins as biomarkers in detecting autoimmune diseases is attempted in the study of serum/plasma proteomics.

Effect of simulation-based teaching on nursing skill performance: a systematic review and meta-analysis

Objective:To summarize and produce aggregated evidence on the effect of simulation-based teaching on skill performance in the nursing profession.Simulation is an active learning strategy involving the use of various resources to assimilate the real situation.It enables learners to improve their skills and knowledge in a coordinated environment.Methods:Systematic literature search of original research ar ticles was carried out through Google Scholar,Medline,and Cochrane Cumulative Index to Nursing and Allied Health Literature(CINAHL)databases.Studies conducted on simulation-based teaching and skill performance among nursing students or clinical nursing staff from 2010 to 2019,and published in the English language,were included in this study.Methodological quality was assessed by Joanna Briggs Institute,and the risk of bias was also assessed by Cochrane risk of bias and the risk of bias assessment tool for non-randomized studies(ROBINS-I)checklists.Results:Initially,638 titles were obtained from 3 sources,and 24 original studies with 2209 study par ticipants were taken for the final analysis.Of the total studies,14(58.3%)used single group prep post design,7(29.1%)used high fidelity simulator(HFS),and 7(29.1%)used a virtual simulator(VS).Twenty(83.3%)studies reported improved skill performance following simulation-based teaching.Simulation-based teaching improves skill performance among types of groups(single or double),study regions,high fidelity(HF),low fidelity(LF),and standard patient(SP)users.But the effect over virtual and medium fidelity simulators was not statistically significant.Overall,simulation-based teaching improves the skill performance score among the experimental group(d=1.01,95%confidence interval[CI][0.69–1.33],Z=6.18,P<0.01,93.9%).Significant heterogeneity and publication bias were observed during the pooled analysis.Conclusions:Simulation did improve skill performance among the intervention groups,but the conclusion is uncer tain due to the significant heterogeneity.The large extent of difference among original research has necessitated the development of well-defined assessment methods for skills and standardized simulation set-up for proper assessment of their effects.

Prelacteal Feeding Practice and Associated Factors among Mothers Attending Immunization Clinic in Harari Region Public Health Facilities, Eastern Ethiopia

Background: Breast feeding will have the intended outcome when it is initiated timely and exclusive for the first six months. Introducing prelacteal feeding and inadequate amount of breast milk contributes to over a million avoidable infant deaths each year in developing countries. The purpose of this study was to assess prelacteal feeding practice and associated factors among mothers attending immunization clinic in Harari region government health institutions. Methods: An institutional based cross-sectional study design was conducted among 634 mothers and infants dyads attending ten public health facilities. Systematic random sampling method was used to select the study participants. An exit interview using pretested structured questionnaire was conducted about their experience on prelacteal feeding and related experience. Logistic regressions with OR and 95% confidence interval were computed. Result: Two hundred seventy eight (45.4%) of mothers gave prelacteal liquids for their infants. The common pre-lacteal food includes sugar or glucose water 121 (43.5%) followed by milk other than breast milk 70 (25.1%). Home delivery, failure to attend ANC, late breastfeeding initiation and influence by friends were significantly associated with prelacteal feeding. Conclusion: The prevalence of prelacteal feeding was relatively high in the area. Failure to attend ANC, giving birth at home, late initiation of breast feeding and influence of friends and relatives to give prelacteal feeds for their new born infants were found to be positively associated with prelacteal feeding.

Food insecurity and other possible factors contributing to low birth weight: A case control study in Addis Ababa, Ethiopia

Objective: To determine the association between low birth weight and household food insecurity at government hospitals in Addis Ababa, Ethiopia.Methods: A case control study was carried out on 468 mothers with term neonates from February 1, 2017 to May 15, 2017. The cases were women who gave term babies weighing less than 2500 g and the controls were those having 2500 g or above. In the included hospitals, choices of cases were done as the cases found and the next three eligible newborns in the maternity room were the controls. Data were collected by using pretested and structured questionnaire. Standard beam balance was used to measure the neonatal weight by trained midwifery. The data were entered into a computer using Epi-Data 3.1 and exported to Stata version 14 for data management and analysis. Results: Mothers having food insecurity [adjusted odd ratio (AOR) 3.58;95% confidence interval (CI) (1.79-7.16)], mid-upper arm circumference [AOR 7.70;95% CI (4.39-13.60)], hypertension [AOR 4.81;95% CI (2.33-9.93)], and early age [AOR 3.88;95% CI (1.35-11.15)] showed statistically significant association with low birth weight. Conclusions: Household food insecurity, hypertension, mid-upper arm circumference and early age in women were significant predictors of low birth weight. The provision of adequate nutrient for pregnant mothers having household food insecurity should be assured in order to prevent adverse birth weight outcomes.

Primary Laryngeal Tuberculosis as a Cause of Persistent Hoarseness—A Case Report

Laryngeal tuberculosis is an uncommon disease of the larynx that can easily be missed. It is however the commonest granulomatous laryngeal pathology. Laryngeal tuberculosis and laryngeal cancer both have similar modes of clinical presentation. We present a case of isolated laryngeal tuberculosis in a 38-year-old Nigerian female, who presented with persistent hoarseness of 3 months duration with no respiratory symptoms and signs. Fiberoptic laryngoscopy showed hyperemia and oedema of the endolarynx, mucoid exudate and thickening of both false and true vocal cords. Tuberculosis was confirmed by gene Xpert. She was placed on rifampicin, isoniazid, pyrazinamide and ethambutol for two months intensive phase and rifampicin and isoniazid for four months continuation phase. There was complete resolution of hoarseness after completion of anti-tuberculous therapy.

Early esophagus cancer segmentation from gastrointestinal endoscopic images based on U-Net++model

Automatic segmentation of early esophagus cancer(EEC)in gastrointestinal endoscopy(GIE)images is a critical and challenging task in clinical settings,which relies primarily on labor-intensive and time-consuming routines.EEC has often been diagnosed at the late stage since early signs of cancer are not obvious,resulting in low survival rates.This work proposes a deep learning approach based on the U-Net++method to segment EEC in GIE images.A total of 2690 GIE images collected from 617 patients at the Digestive Endoscopy Center,West China Hospital of Sichuan University,China,have been utilized.The experimental result shows that our proposed method achieved promising results.Furthermore,the comparison has been made between the proposed and other U-Net-related methods using the same dataset.The mean and standard deviation(SD)of the dice similarity coefficient(DSC),intersection over union(IoU),precision(Pre),and recall(Rec)achieved by the proposed framework were DSC(%)=94.62±0.02,IoU(%)=90.99±0.04,Pre(%)=94.61±0.04,and Rec(%)=95.00±0.02,respectively,outperforming the others.The proposed method has the potential to be applied in EEC automatic diagnoses.

Effect of household water treatment with chlorine on diarrhea among children under the age of five years in rural areas of Dire Dawa,eastern Ethiopia:a cluster randomized controlled trial

Background:Diarrheal disease is a leading cause of child mortality and morbidity worldwide.Household water treatment with chlorine significantly reduces morbidity due to waterborne diseases.However,the effect of point-ofuse(POU)water treatment in improving the quality of water in areas where POU is not provided free of charge and the effectiveness of home visits in inspiring household members to use POU regularly have not been studied.The objective of this study was to evaluate the effectiveness of drinking water disinfection by chlorination on diarrheal disease reduction among children under the age of 5 years in rural eastern Ethiopia.Methods:A cluster randomized controlled trial was carried out in rural Dire Dawa from October 2018 through January 2019.The 405 households were randomized to intervention and control arms and intervention materials were distributed after conducting a baseline survey.This trial evaluated the effectiveness of household drinking water disinfection by chlorination in reducing incidence of diarrhea among children under the age of 5 years.Intervention households received 1.2%sodium hypochlorite with demonstration of its proper use.Participants in the control households continued with their usual habits of water collection and water storage.Generalized estimation equations(GEE)with log link Poisson distribution family and exchangeable correlation matrix was used to compute crude incidence rate ratio(IRR),adjusted IRR and the corresponding 95%confidence intervals.Results:In the intervention households,in total,281 cases of diarrhea were documented(8.7 cases per 100 personweeks observation);in the control households,in total 446 cases of diarrhea were documented(13.8 cases per 100 person-weeks observation).A 36.0%(adjusted IRR=0.64,95%CI:0.57–0.73)reduction in incidence of diarrhea was observed in the intervention arm when compared with the control arm.The highest and the lowest reductions were obtained in children of age ranges 1 to 2 years and 3 to 4 years,42.7 and 30.4%,respectively.Adherence to the intervention was 81.3%as measured by free residual chlorine test.Conclusions:In rural areas where diarrhea is the second leading cause of morbidity,water chlorination at the household level using liquid bleach considerably reduced episodes of diarrhea among children under the age of 5 years.Therefore,chlorinating drinking water at the household level may be a valuable interim solution for reducing the incidence of diarrheal diseases until potable water is made accessible to the majority of the population in Dire Dawa Administration and other Ethiopian communities.

Evaluation of Costus afer Ker Gawl.in vitro anti-inflammatory activity and its chemical constituents identified using gas chromatography-mass spectrometry analysis

Objective:To evaluate the anti-inflammatory activity of a tropical African medicinal plant,Costus afer(C.afer)Ker Gawl.in vitro and identify the chemical constituents in the most active fraction.Methods:Hexane,ethyl acetate,n-butanol and aqueous fractions obtained through successive solvent partitioning of 70%methanolic leaf or stem extracts of C.afer were subjected to in vitro anti-inflammatory screening assays viz.anti-denaturation of protein,stabilization of human red blood cell(HRBC)membrane against hypotonicity-induced hemolysis and anti-proteinase activities.Diclofenac sodium was used as a standard drug.The chemical compounds in the most active fraction were determined using quantitative phytochemical and gas chromatography-mass spectrometry(GC/MS)analytical methods,comparing the mass spectra of the GC/MS identified compounds with those of the National Institute of Standards and Technology(NIST)database library.Results:The hexane fraction of C.afer leaf(HFCAL)with an IC50 of 33.36μg/mL,33μg/mL and 212.77μg/mL exhibited the highest anti-denaturation of protein,stabilization of HRBC membrane and anti-proteinase activities respectively when compared with other test fractions.The GC/MS identified compounds in HFCAL known to possess anti-inflammatory property were terpenoids(naphthalene 1,6-dimethyl-;naphthalene 2,3-dimethyl-;phytol),phenol[phenol 2,4-bis(1,1-dimethylethyl)],coumaran[2(4H)-benzofuranone,5,6,7,7a-tetrahydro-4,4,7atrimethyl and fatty acids(pentadecanoic acid;hexadecanoic acid;n-hexadecanoic acid;9,12-octadecanoic acid-methyl ester;9,12,15 octadecatrienoic acid and cis-vaccenic acid)].Conclusion:Therefore,HFCAL could be considered as a potential source of anti-inflammatory agents for herbal formulation or pharmaceutical drug production.