Ethiopian Journal of Health and Biomedical Sciences

Emergence and spread of carbapenemase producing Gram negative bacteria in Ethiopia: a call for action

Mizan Kindu — 2024-12-31

Carbapenems are considered last-resort antibiotics used for the treatment of multidrug-resistant (MDR) Gram negative bacterial (GNB) infection, particularly in hospital settings. However, the emergence of carbapenem resistant bacteria is threatening the effectiveness of these vital antibiotics (1). Globally, the most common resistance mechanism to carbapenems is the production of carbapenemase enzymes (2).

The worldwide distribution of carbapenemases is dynamic, with emerging resistance hotspots. The spread of carbapenem resistant bacteria is facilitated by factors such as travel, medical tourism, and antibiotic overuse. Globally, the most common carbapenemases include K. pneumoniae carbapenemases (KPC), New Delhi metallo-b-lactamases (NDM), Verona integronencoded metallo-b-lactamases (VIM), imipenemase (IMP) and oxacillinases (OXA), such as OXA-23, OXA-58, and OXA-48 (2). The distribution of these enzymes varies globally. NDM is prevalent in South Asia, the Middle East, and is increasingly found in Africa and Europe, while KPC dominates in North and South America, Southern Europe, and China. VIM and IMP are common in Europe, South America, and Asia. OXA-48 is widespread in Turkey, North Africa, and Europe, whereas OXA-23 and OXA-58 are frequently detected across Asia, South America, and Africa (3).

In Ethiopia, the occurrence of carbapenemase-producing GNB was first reported in 2017, with A. baumannii producing NDM (4). Since then, additional studies have revealed the presence of a variety of carbapenemases, including NDM, OXA-48, OXA-23, OXA-58, OXA-51-like, and KPC-42. These carbapenemases have been detected in a range of pathogens such as K. pneumoniae, A. baumannii, P. aeruginosa, E. coli, and other Enterobacteriaceae isolated from both patients and environmental samples (5-10). Among these, NDM is the most prevalent carbapenemase detected in Ethiopian isolates. Moreover, co-harboring of multiple carbapenemases, mostly in combination with NDM, has been frequently reported, particularly in K. pneumoniae and A. baumannii. This co-resistance significantly complicates treatment options, making it more challenging to manage infections (6, 7, 9, 10). The few available studies in Ethiopia reported an alarming rise in carbapenem-resistant pathogens in the country and recommended the urgent need for enhanced surveillance, infection control measures, and antimicrobial stewardship to mitigate the threat of MDR infections. Therefore, further research to better understand the epidemiology of carbapenem-resistant bacteria in Ethiopia, and capacity-building initiatives for healthcare providers are crucial for early detection and effective management of MDR infections.

Common chest radiographic patterns and associated factors of among drug-resistant tuberculosis patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2020

Samuel Addis Mihiretie — 2024-12-31

Background: Drug-Resistant Tuberculosis (DR-TB) is a multifaceted public health problem. Determining the common chest radiographic patterns, degree of lung damage, and associated factors is vital in the early detection and treatment of DR-TB. Despite the availability of x ray, there are gaps in chest radiographic patterns of DR-TB disease in Ethiopia.

Objectives: This study aimed to identify common radiologic patterns among pulmonary DR-TB patients.

Method: A hospital-based cross-sectional study was conducted among 182 DR-TB patients who had an archive of baseline chest radiographs at the University of Gondar Comprehensive Specialized Hospital from September 2010 to October 2020. The socio-demographic and radiographic patterns were depicted using descriptive statistics. A multivariable binary logistic regression model was applied to identify associated variables with extensive DR-TB diseases at a p < 0.05.

Result: Out of 182 DR-TB patients, 112 (61.54%) had patchy consolidation followed by focal fibrotic changes (37.91%) and focal nodular opacities (26.92%). Of all DR-TB patients, 19% had extensive pulmonary DR-TB disease. Patients’ marital status was significantly associated with extensive (advanced) DR-TB disease. The odds of having advanced TB disease were 0.15 among those with single marital status (AOR: 0.15, 95% CI: 0.03, 0.68).

Conclusion: This study highlighted that the most common chest radiographic feature of DR-TB was patchy consolidation followed by fibrosis and focal nodular opacities. Additionally, the study showed that close to one out of five DR-TB patients had extensive (advanced) DR-TB disease. Marital status had a significant association with extensive (advanced) DR-TB disease.

Antioxidant activity of the leaves extracts of Boscia coriacea Graells and Uvaria leptocladon Oliv

Sintayehu Tseha — 2024-12-31

Background: Synthetic antioxidants used for the management of oxidative stress have been shown to have severe side effects. Some medicinal plants that belong to the genus Uvaria and Boscia contain chemicals with antioxidant properties such as flavonoids and alkaloids.

Objective: This study was aimed to evaluate the antioxidant activities of the leaf extracts of Boscia coriacea Graells and Uvaria leptocladon Oliv.

Method: Fresh leaves of B. coriacea and U. leptocladon were collected in April 2021 from Alie and Konso, located in Southern Ethiopia. First, the leaves of the medicinal plants were dried in dark conditions. Maceration extraction method was used to extract the powdered leaf of Boscia coriacea and Uvaria leptocladon. The crude extract of B. coriacea was fractionated using chloroform (CHCl₃₎, methanol (CH₃OH), CHCl₃: CH₃OH(1:1 v/v) and petroleum ether. The crude extract of U. leptocladon was fractionated using CHCl₃, ethanol (C₂H₆OH), and ethyl acetate (C₄H₈O₂). Evaluation of the antioxidant activity was done using 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2’-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid (ABTS), and ferric reducing antioxidant power (FRAP) assays. Data analysis was done using one-way analysis of variance.

Result: The antioxidant evaluation demonstrated that the leaf extracts of B. coriacea and U. leptocladon have 2,2-diphenyl-1-picrylhydrazyl and 2,2’-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid radical scavenging activity. Based on IC₅₀ value, the CH₃OH: CHCl₃ (1:1) fraction of B. coriacea (IC₅₀=38.2 μg/mL) and the C₂H₆OH fraction of U. leptocladon (IC₅₀=30.5 μg/mL) are highly active in 2,2-diphenyl-1-picrylhydrazyl free radical scavenging activity. The total flavonoid content in the CH₃OH:CHCl₃ fraction of B.coricea and in the C₂H₆OH fraction of U.leptocladon were calculated to be 136.8±0.04 mg/g of extract and 172.9±0.41 mg/g of extract, respectively. The total phenol content in the CH₃OH: CHCl₃ fraction of B.coricea and in the C₂H₆OH fraction of U.leptocladon were calculated to be 145 ± 0.025 mg/g and 187.7 ± 0.055 mg/g, respectively. The CH₃OH: CHCl₃ (1:1) fraction of B. coriacea and the C₂H₆OH fraction of U. leptocladon showed the highest ferric reducing antioxidant power. The antioxidant effects of the leaf extract of B. coriacea are due to β-sitosterol and lucidine-type compound. The antioxidant effects of the leaf extract of U. leptocladon are attributed to β-sitosterol, β-sitosterol glucoside, and α-humulene.

Conclusion: The leaf extracts of B. coriacea and U. leptocladon have high antioxidant activity. Further study is needed to determine the mechanism of action of compounds isolated from the leaf extracts of B. coriacea and U. leptocladon.

Anatomic variation of the Palmaris longus muscle: A study using the Anatomage Table

Abebe Muche — 2024-12-31

Background: The palmaris longus muscle, located in the superficial anterior compartment of the forearm, plays a crucial role in wrist flexion.

Objective: This study aimed to investigate the anatomical variation (presence or absence) of the palmaris longus using the Anatomage Table 10.0, a cutting-edge virtual dissection tool.

Method: The research was conducted at the University of Global Health Equity's simulation laboratory in Rwanda from June 10 to June 15, 2024. Five cadavers (2 female, 3 male) with varying resolutions were used to examine the muscle's anatomy. Prior to data collection, instructors received training, and a pilot study ensured the reliability and validity of the research. Virtual dissection and labeling of the palmaris longus muscle and corresponding nerves were performed, while preserving key anatomical structures.

Result: The study revealed a bilateral absence of the palmaris longus muscle in one cadaver.

Conclusion: Our findings on palmaris longus muscle variability highlight the significance of anatomical variations in treatment outcomes and patient care, contributing to the growing understanding of their clinical implications. This variability is crucial for surgeons and clinicians to consider when performing forearm surgeries and diagnosing conditions like carpal tunnel syndrome.

Investigation of hepatotoxic effect of cement-dust in occupationally exposed individuals at Malete, Kwara State, North Central Nigeria

Akeem Olayinka Busari — 2024-12-31

Background: Cement is pivotal in advancing Nigeria's economic and infrastructural development amid rapid urbanization, where the demand for robust infrastructure underscores its integral contribution to meeting developmental requirements. While respiratory concerns have been extensively studied, the impact on the liver with the central role of detoxification remains a critical yet under explored dimension of occupational health.

Objective: Thus, this study investigated the hepatic effect of cement dust exposure among occupationally exposed individuals in North Central Nigeria.

Methods: A comparative cross-sectional study was conducted at Kwara State University Malete, Kwara State, North Central Nigeria, to compare the hepatic profiles of 60 individuals occupationally exposed to cement with 60 non-exposed who served as controls between June and October, 2022. Ethical approval was obtained from the Kwara State Ministry of Health, and informed consent was secured from each participant. Five (5) milliliters of blood were collected, and hepatic profiles were analyzed using standard spectrophotometric methods. Both descriptive and inferential statistics were used to investigate the comparison and correlation between the duration of exposure to cement dust and hepatic profiles among the study participants.

Results: The study revealed a significant increase in alanine aminotransaminase (ALT) and alkaline phosphatase (ALP) activities among individuals exposed to cement (ALT: 30.58 ± 11.54, ALP: 181.68 ± 26.25) compared to non-exposed controls (ALT: 19.90 ± 7.26; ALP: 163.68 ± 29.92) at a significance level of p < 0.05. Additionally, the duration of cement dust exposure demonstrated a significant positive correlation with gamma-glutamyl transferase (GGT) activity (r = 0.363; p = 0.004). Conversely, no significant positive correlation was observed between the duration of cement dust exposure and the activities of aspartate aminotransferase (AST) (r = 0.190; p = 0.147), ALT (r = 0.016; p = 0.904), ALP (r = 0.178; p = 0.175), and direct bilirubin (r = 0.057; p = 0.664). Furthermore, the duration of cement dust exposure showed a negative and non-significant correlation with total protein (r = -0.098; p = 0.455), albumin (r = -0.097; p = 0.461), and total bilirubin (r = -0.156; p = 0.233).

Conclusion: The study suggests that occupational exposure to cement dust may pose a risk of developing hepatotoxicity in the future.