Epilepsy,poverty and early under-nutrition in rural Ethiopia

PurposeThe incidence of epilepsy in Ethiopia is high compared with industrialised countries, but in most cases the cause of epilepsy is unknown. Childhood malnutrition remains widespread. We performed a case–control study to determine whether epilepsy is associated with poverty and markers of early under-nutrition.MethodsPatients with epilepsy (n = 112), aged 18–45 years, were recruited from epilepsy clinics in and around two towns in Ethiopia. Controls with a similar age and gender distribution (n = 149) were recruited from patients and relatives attending general outpatient clinics. We administered a questionnaire to define the medical and social history of cases and controls, and then performed a series of anthropometric measurements. Unconditional logistic regression was used to estimate multivariate adjusted odds ratios. Multiple linear regression was used to estimate adjusted case–control differences for continuously distributed outcomes.ResultsEpilepsy was associated with illiteracy/low levels of education, odds ratio = 3.0 (95% confidence interval: 1.7–5.6), subsistence farming, odds ratio = 2.6 (1.2–5.6) and markers of poverty including poorer access to sanitation (p = 0.009), greater overcrowding (p = 0.008) and fewer possessions (p < 0.001). Epilepsy was also associated with the father's death during childhood, odds ratio = 2.2 (1.0–4.6). Body mass index was similar in cases and controls, but patients with epilepsy were shorter and lighter with reduced sitting height (p < 0.001), bitrochanteric diameter (p = 0.029) and hip size (p = 0.003). Patients with epilepsy also had lower mid-upper arm circumference (p = 0.011) and lean body mass (p = 0.037).ConclusionEpilepsy in Ethiopia is strongly associated with poor education and markers of poverty. Patients with epilepsy also had evidence of stunting and disproportionate skeletal growth, raising the possibility of a link between early under-nutrition and epilepsy.     

The Cost of Suspected and Confirmed Bacterial Meningitis Cases Treated at Jimma University Medical Center,Ethiopia

BackgroundInfections of the central nervous system (CNS) such as meningitis or encephalitis can be caused by myriad of microorganisms and may be life-threatening. In Ethiopia, it is an important cause of premature death and disability, being the 9^th most common cause of years of life lost and loss of disability-adjusted life years.The objective of this study was to estimate the cost of suspected and confirmed bacterial meningitis among inpatient managed patients at JUMC.MethodsA facility-based cross-sectional study was conducted from July 28 to September 12, 2018. A semi-structured questionnaire was used in this study. Checklists were used to collect the types of laboratory tests performed and prescribed medications. This cost of illness study was conducted from the patient perspectives. We employed a micro-costing bottom-up approach to estimate the direct cost of meningitis. The human capital approach was used for estimating wages lost.ResultAmong total patients admitted and treated in JUMC, higher proportions (69.8%) were suspected bacterial meningitis but have been treated as confirmed cases. Total median costs for both suspected and confirmed bacterial meningitis patients were estimated to be ETB 98,812.32 (US $ 3,593.2; IQR 1,303.0 to 5,734.0). Total median direct cost was ETB 79,248.02 (US $ 2,881.75; IQR 890.7 to 3,576.7). Moreover, 45.3% of the patients reported that they were either admitted or given medication at JUMC or nearby health facility before their current admissions.ConclusionThese findings indicate that most cases of bacterial meningitis were treated only empirically, and the cost of the treatment was high, especially for resource-limited countries like Ethiopia. To minimize the burden of meningitis and avoid unnecessary hospitalizations, the availability of diagnostic techniques is vitally important.     

Morphometrics and protein profiles of the salivary glands of Phlebotomus papatasi and Phlebotomus langeroni sand flies

Sand fly salivary fluid contains numerous proteins that modulate host immune responses to infection and facilitate blood-feeding and establishing Leishmania infection. Salivary proteins are differentially expressed in adaptation to the host, the meal type and ecological factors. We report on the morphometrics and protein composition of salivary glands of colonised Phlebotomus papatasi and P. langeroni sand flies from Egypt. Female glands were dissected at day 1 (D1, unfed), day 2 (D2, sugar-fed), day 3 (D3, blood-fed) and day 7 (D7, blood-digested). The salivary glands are composed of two lobes: heterogeneous in P. papatasi and homogeneous in P. langeroni. Lobe sizes varied considerably with fly age and feeding state; D3 flies had the largest lobe sizes and protein content. The P. papatasi flies had larger lobes and higher protein content than the P. langeroni flies. The P. papatasi D1 flies had 15 protein bands that decreased in the D2, D3 and D7 flies to 10 bands in the Sinai flies and 9 bands in the Alexandria flies. All P. langeroni flies had 12 protein bands but with different intensities. The results reveal inter-specific variation between P. papatasi and P. langeroni, while no intra-specific variation between P. papatasi strains. These results increase our understanding of salivary gland protein composition and blood-feeding behaviour in Old World sand flies with implications for leishmaniasis epidemiology and control.     

Thymoquinone-induced relaxation of guinea-pig isolated trachea

The effect of thymoquinone (TQ), the main constituent of the volatile oil of black seed (Nigella sativa), on the guinea-pig isolated tracheal zig-zag preparation was investigated. TQ caused a concentration-dependent decrease in the tension of the tracheal smooth muscle precontracted by carbachol. The effects of TQ were significantly potentiated by pretreatment of the tracheal preparations with quinacrine, a phospholipase A2 inhibitor, nordihydroguiaretic acid, a lipoxygenase inhibitor and by pretreatment with methylene blue, an inhibitor of soluble guanylyl cyclase. On the other hand, the effects of TQ were not influenced by pretreatment of the tracheal preparations with indomethacin, a cyclooxygenase inhibitor, propranolol, a non-selective beta-adrenoceptor blocker or by the pretreatment with theophylline, an adenosine receptors antagonist TQ totally abolished the pressor effects of histamine and serotonin on the guinea-pig isolated tracheal and ileum smooth muscles. The results of the present study suggest that TQ induced relaxation of precontracted tracheal preparation is probably mediated, at least in part, by inhibition of lipoxygenase products of arachidonic acid metabolism and possibly by non-selective blocking of the histamine and serotonin receptors. This relaxant effect of TQ, further support the traditional use of black seeds either alone or in combination with honey to treat bronchial asthma.     

Prevalence and associated factors of anemia among adolescent girls attending high schools in Dembia District,Northwest Ethiopia, 2017

Introduction

Anemia is a global public health problem affecting both developing and developed countries. In Ethiopia, Adolescent girls are more vulnerable to anemia because of gender norms can leave girls disproportionately impacted by food insecurity, increased iron requirements related to their rapid growth, and menstrual loss. However, evidence on the problem is scarce because it has not been given due attention in Ethiopia. Therefore, this study assessed the prevalence and associated factors of anemia among late adolescent girls attending high schools in Dembia District, northwest Ethiopia.

Methods

A school based cross-sectional study was conducted in Dembia District from March 1 to April 30/ 2017. Out of the randomly selected three high schools, 462 adolescents were included using the simple random sampling technique. A Standardized structured questionnaire was used to collect data. Capillary blood samples were drawn from adolescents using a portable Hb201+ instrument to measure hemoglobin. A bivariate and multivariable binary logistic regression analyses were employed to identify factors associated with anemia. Adjusted Odds Ratio (AOR) with a corresponding 95% Confidence Interval (CI) was computed to show the strength of associations.

Results

The overall prevalence of anaemia among adolescent girls was 25.5%, (95%CI, 21.4, and 29.2). Of the total anemic adolescents, 109(92.4%) had mild anaemia, while 7(5.9%) and 2(1.7%) were found with moderate and severe anaemia, respectively. Dietary diversity score ((AOR =4.2(95% CI;1.7, 10.5)), household food security status ((AOR?=?4.1(95% CI; 1.3, 13.2)), living status of adolescents with either of the two parents((AOR?=?2;(95%CI;1.14,3.6)) and guardians ((AOR?=?2.4;(95% CI;1.02,5.6)) showed statistically significant association with anemia.

Conclusion

Anemia is a moderate public health problem in Dembia District. Dietary diversity score, household food security status, and living status of adolescents were the key determinants of anemia. Therefore, the government should focus on preventing food insecurity with increasing productivity to improve dietary diversification of the adolescent girls.

Trial registration

Retrospectively registered.

     

Inhibition of nitric oxide synthase aggravates cisplatin-induced nephrotoxicity: effect of 2-amino-4-methylpyridine

BACKGROUND: Nitric oxide (NO) has been shown to play a role in maintaining normal renal function. However, the role of NO in cisplatin (CDDP)-induced nephrotoxicity is still unclear. The aim of the present work was to examine the effect of the NO synthase (NOS) inhibitor, 2-amino-4-methylpyridine, on the severity of CDDP-induced nephrotoxicity. METHODS: Male Wistar rats were divided into six groups. Three control groups received plain drinking water or water containing 1.5% L-arginine. One of the two groups receiving plain water was treated with an intraperitoneal injection of 2-amino-4-methylpyridine (1 mg/kg in normal saline), and the other two control groups were injected intraperitoneally with normal saline. Another three groups were treated in the same manner and injected with CDDP (6 mg/kg, i.p.). CDDP was injected 1 h after 2-amino-4-methylpyridine treatment. Rats were sacrificed 7 days after CDDP treatment, and serum as well as kidneys were isolated and analysed. RESULTS: CDDP-treated rats showed increases in the kidney weight as a percentage of the total body weight and serum creatinine and urea levels and decreases in serum albumin and calcium levels. Also, CDDP treatment induced reductions in the kidney total nitrate/nitrite (NO(x)), reduced glutathione (GSH) and glutathione peroxidase activity (GSH-Px) levels and an increase in the kidney malondialdehyde (MDA) production level. In contrast, 2-amino-4-methylpyridine treatment 1 h prior to CDDP injection induced marked exacerbation of CDDP-induced nephrotoxicity, as manifested by severe aggravation of the indices of nephrotoxicity. Also, 2-amino-4-methylpyridine plus CDDP-treated rats showed exaggeration of the reduction in the kidney total NO(x) content and GSH-Px activity and elevation of the kidney platinum accumulation level with normalization of the kidney MDA production level and rebound in the kidney GSH content. Histopathologically, CDDP-treated rats showed marked interstitial nephritis, tubular atrophy and tubular necrosis. However, treatment with 2-amino-4-methylpyridine 1 h prior to CDDP injection revealed marked exacerbation of CDDP-induced histopathological changes. CONCLUSIONS: The present findings suggest that NO plays a role in CDDP-induced nephrotoxicity. Administration of 2-amino-4-methylpyridine, an NOS inhibitor, exacerbates CDDP-induced nephrotoxicity.