Plasma level distribution, effect and toxicity of antiepileptic drugs among Ethiopian epileptics

Plasma phenytoin and phenobarbitone levels were estimated in 123 adult Ethiopian epileptics by gas-liquid chromatography. Thirty four (38.2%) of the patients on phenytoin, and 52 (52%) of those on phenobarbitone, had plasma levels in the conventional therapeutic ranges of 10-20 micrograms/ml and 10-30 micrograms/ml respectively. Of the 89 patients who were taking phenytoin either singly or combined with phenobarbitone, motor disturbances (ataxia and nystagmus) were seen in 31 (34.8%) and dysmorphic and idiosyncratic side effects including gum hypertrophy, hirsutism, acne and skin rash in 37 (41.6%). Subnormal serum calcium levels were noted in 15 (30.6%) and high alkaline phosphatase was found in 13 (26.5%). Phenobarbitone was found to be an effective anticonvulsant (78.1% seizure control rate), with adverse effects of sedation and intellectual depression. Seizure control was achieved in 77.1% of patients on a single drug as opposed to 55.6% on combination of phenytoin and phenobarbitone (p less than 0.05). The overall seizure control rate was 66%.     

Modeling Time to Cure of Deep Vein Thrombosis Using Cox Proportional Model in Southwest of Ethiopia

BackgroundGlobally, there are about 10 million cases of deep vein thrombosis every year, and it is the third leading cardiovascular disease after myocardial infarction and stroke. The objective of the study is to assess risk factors of time to cure patients of deep vein thrombosis in southwest Ethiopia.MethodsA retrospective cohort study design was used. The study population was deep vein thrombosis patients at purposively selected hospitals in Southwest Ethiopia from January 2017 to December 2020. Cox proportional hazard model was used to identify risk factors associated with deep vein thrombosis.ResultsOut of the total 1068 registered as deep vein thrombosis patients, 263(24.6%) were cured during the study period, and 805(75.4%) were censored. Results of the Cox proportional hazard model show that; age, gender, family history of deep vein thrombosis, smoking status, immobilize and alcohol consumption were factors associated with deep vein thrombosis (p-value<0.05).ConclusionThe patients with a family history of deep vein thrombosis, prolonged immobilization, greater the 50 years, smoking cigarettes, female (non-pregnant) and alcohol users had a longer curing time of deep vein thrombosis compared to others.     

Recent advances in targeting the autotaxin-lysophosphatidate-lipid phosphate phosphatase axis in vivo

Extracellular lysophosphatidate(LPA) is a potent bioactive lipid that signals through six G-protein-coupled receptors.This signaling is required for embryogenesis,tissue repair and remodeling processes.LPA is produced from circulating lysophosphatidylcholine by autotaxin(ATX),and is degraded outside cells by a family of three enzymes called the lipid phosphate phosphatases(LPPs).In many pathological conditions,particularly in cancers,LPA concentrations are increased due to high ATX expression and low LPP activity.In cancers,LPA signaling drives tumor growth,angiogenesis,metastasis,resistance to chemotherapy and decreased efficacy of radiotherapy.Hence,targeting the ATX-LPA-LPP axis is an attractive strategy for introducing novel adjuvant therapeutic options.In this review,we will summarize current progress in targeting the ATX-LPA-LPP axis with inhibitors of autotaxin activity,LPA receptor antagonists,LPA monoclonal antibodies,and increasing low LPP expression.Some of these agents are already in clinical trials and have applications beyond cancer,including chronic inflammatory diseases.     

Low baseline serum creatinine concentration predicts mortality in critically ill patients independent of body mass index

OBJECTIVE: Malnutrition and low muscle mass reduce the ability of patients to fight critical illness. Low serum creatinine is a better surrogate marker of low muscle mass than a low body mass index and has been associated with poor outcome in some patient populations. We hypothesized that low baseline serum creatinine would predict poor outcome in the critically ill. DESIGN: In this retrospective cohort study, data including age, gender, race, postoperative status, and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were collected from the institutional APACHE III database. Baseline serum creatinine levels and body mass index were collected from the hospital laboratory database. The main outcomes measured were hospital mortality and intensive care unit length of stay. PATIENTS: Consecutive critically ill patients >18 yrs of age admitted to three ICUs from January 2003 to December 2006, excluding those who denied research authorization, did not have a baseline serum creatinine measured, were pregnant at the time of intensive care admission, had a history of chronic renal replacement, were in intensive care for <12 hrs, or were admitted for low-risk monitoring only. SETTING: Three intensive care units of two tertiary care hospitals. RESULTS: Of 11,291 patients who met the inclusion criteria, 1185 (10%) died in the hospital. Of the patients, 54% were male and 90% were white, with a mean age (+/-sd) of 63 +/- 17 yrs. Median body mass index was 27.3 (interquartile range [IQR], 23.5-32.1), median APACHE III score was 53 (IQR, 38-69), and median baseline serum creatinine was 1.1 (IQR, 0.9-1.4). When adjusted for APACHE III-predicted mortality, age, gender, postoperative state, and body mass index, low baseline creatinine was associated with increased mortality in a dose-response manner: odds ratio (OR) 2.59 (95% confidence interval [CI], 1.82-3.61) for baseline creatinine < or =0.6 mg/dL (p < .001) and OR 1.28 (95% CI, 1.03-1.60) for baseline creatinine 0.6-0.8 mg/dL (p = .023). Adjusted intensive care length of stay in survivors was 0.48 days (95% CI, 0-0.98) longer for patients with baseline creatinine < or =0.6 mg/dL (p = .058). CONCLUSION: Low baseline serum creatinine concentrations increase the risk of mortality in critically ill patients.     

Diabetes mellitus,metabolic syndrome,and physical activity among Ethiopians: A systematic review

Background and aimsThe incidence of diabetes mellitus (DM) is increasing worldwide, and there is growing appreciation for the impact of limited physical activity on the disease. This study aimed to determine whether the current research on DM in Ethiopia has sufficiently identified and focused on the importance of limited physical activity according to the Global Physical Activity Questionnaire (GPAQ) in the disease etiology.MethodsThis was a systematic review, performed according to the PRISMA checklist. We searched primary studies of diabetes, diabetes-related complications, determinants, and magnitude of related morbidities in Ethiopia in PubMed, Medline, and ISI Web of Science databases. Reviews, editorial communications, reports, and letters were excluded.ResultsAmong 363 articles that were identified from all databases, 28 were included. It was found that 39% of the studies measured and included limited physical activity as a predisposing lifestyle factor in diabetes, while 17.86% either did not report or did not include this variable at all. Although 42.86% of the studies identified limited physical activity as an etiological factor in diabetes, it was not measured according to the GPAQ guidelines.ConclusionsThese data suggest that Ethiopian researchers do not give sufficient attention to the role of physical activity and its definition per GPAQ as a preventative factor for reducing the severity of diabetes symptoms. We suggest that physical activity research and promotion should be advocated in Ethiopia, and that researchers should seek advice on how to re-frame their work in the future.