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In this article the author discusses an art gallery and bookstore which was created to help successfully integrate military veterans and civilians with traumatic brain injury (TBI) back into the community. Many veterans returning from the wars in Iraq and Afghanistan have experienced a TBI and Virginia NeuroCare (VANC) and its art gallery and used bookstore called Paintings and Prose have been helping veterans and civilians with TBI reacquire the skills and confidence to reenter the workforce.

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Background: Drug use evaluation is a systematic approach to determining the appropriateness of drug use, identifying drug therapy problems, and proposing interventions. Ceftriaxone is one of the most widely used drugs in hospitals, requiring the performance of drug use evaluation. This study was aimed at evaluating the appropriateness of ceftriaxone use at Kahsay Abera and Mearg hospitals in the Western zone of Tigray, Ethiopia., Methods: An institution-based retrospective cross-sectional study design was conducted in both hospitals from December 2015 to August 2016 using standardized and pretested data collection formats. Systematic random sampling was used, and a total of 800 patients' medication records (patients who took ceftriaxone) from both hospitals (400 each) were assessed in this study. Statistical analysis was performed by using the statistical package for social sciences (version 20)., Results: The overall appropriateness of ceftriaxone use in Kahsay Abera and Mearg hospitals was 247 (61.75%) and 252 (63.0%), respectively. The majority of inappropriate use of ceftriaxone was noted in indication errors at both Kahsay Abera (71.2%) and Mearg hospitals (52.0%). The treatment duration in Kahsay Abera (69%) and Mearg hospitals (88%) was in the range of 2-7 days. Mostly, a 2-gram ceftriaxone daily dose was prescribed in both Kahsay Abera and Mearg hospitals, accounting for 285 (71.25%) and 318 (79.5%), respectively. In this study, the top three diseases, indicated for ceftriaxone in both hospitals, were typhoid fever, urinary tract infection, and pneumonia in descending order. Among the medications coadministered with ceftriaxone, the top three coprescribed drugs with ceftriaxone in Kahsay Abera Hospital were metronidazole (17.25%), tramadol 68 (11.28%), and diclofenac (8.96%), but in Mearg Hospital, next to metronidazole, drugs like paracetamol and doxycycline were the most common coprescribed medicines along with ceftriaxone., Conclusion: The appropriateness of ceftriaxone use in Kahsay Abera and Mearg hospitals was 247 (61.8%) and 252 (63%), respectively, in which about one-third of patients' charts were not compliant with the standard treatment guidelines of Ethiopia for general hospitals. In Kahsay Abera and Mearg hospitals, the empiric use of ceftriaxone was 262 (65.5%) and 375 (93.8%), respectively., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 Tewodros Shegute et al.)

Background: The burden of Klebsiella drug resistance to antimicrobials is a major public health concern worldwide; particularly the problem is severe in developing countries including Ethiopia. Therefore, the aim of this systematic review and meta-analysis is to establish the pooled estimate of Klebsiella drug resistance; and antimicrobial-specific resistance pattern among Klebsiella clinical isoaltes in Ethiopia., Methods: Articles were searched from PubMed, Google Scholar, and Science direct and grey literature from 2009 to 2019. Four authors have independently extracted data on the prevalence and antimicrobial resistance pattern of the isolates. Statistical analysis was conducted by using Open meta-analyst (version 3.13) and Comprehensive meta-analysis (version 3.3). The main outcome measures were the overall Klebsiella resistance; and drug-specific resistance patterns. A random-effects model was used to determine the pooled resistance prevalence with 95% confidence interval (CI), and significant heterogeneity was considered at p < 0.1; and I 2  > 50% using DerSimonian and Laird method. In addition, subgroup analyses were conducted to improve the outcome., Result: We obtained 174 potentially relevant studies through searching electronic databases, and finally, 35 eligible studies were included for meta-analysis. A total of 13,269 study samples participated, from which 1017 Klebsiella species were isolated. The overall Klebsiella resistance in Ethiopia was found to stand at 53.75% (95% CI: 48.35-58.94%). Based on the subgroup analyses; the highest (64.39%); and lowest (46.16%) values were seen in Southern Nations, Nationalities, and Peoples of Ethiopia; and Tigray regions respectively; and the highest Klebsiella resistance was reported to ampicillin (90.56%), followed by amoxicillin (76.01%) and trimethoprim-sulfamethoxazole (66.91%). A relatively low level of resistance rate was observed to amikacin (16.74%) and cefoxitin (29.73%)., Conclusion: The pooled Klebsiella resistance was found to be considerably high (53.75%) to most of the essential antibiotics in Ethiopia. Klebsiella was highly resistant to ampicillin and amoxicillin but relatively lower to amikacin. Therefore, appropriate interventional strategies need to be taken to address the emerging resistance of Klebsiella species., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Training and work experience are critical inputs for delivering quality health services. However, no nationwide assessment has been conducted on the status of training and the competency of Health Extension Workers (HEWs). Therefore, this study aimed to assess HEWs' pre-service training status and perceived competency in Ethiopia., Methods: The study was conducted in all regions and all HEWs training institutions in Ethiopia. We used cross-sectional study design with a mixed method approach that included 585 HEWs, 1,245 HEW trainees, 192 instructors, and 43 key informants. Descriptive statistics and thematic analysis were used to analyse quantitative and quantitative data respectively., Result: Twenty-six percent of the HEWs said that they were competent to deliver all the HEP activities, and 73% of the HEWs said that they could confidently deliver 75% of the HEP activities. Receiving in-service training and having level III/IV qualifications are positively associated with the competency of HEWs. Similarly, HEP trainees perceived themselves as highly competent in executing their professional work, except in using computer and mobile health technology. Both instructors and trainees rated the quality of the curriculum and course materials positively. However, basic services and facilities in most training institutions were perceived to be inadequate. Additionally, individual learning, problem-solving, case-analysis, and assessment methods such as project work and portfolios were rarely practiced., Conclusions: Although the perceived competence of HEW trainees is high, the HEWs' training is not provided as per the curriculum because of limited resources. All the necessary resources should be made available to produce competent HEWs., (© 2023 Mekdes Demissie, et al.)

Background: Hypotension and bradycardia are the most common complications associated with spinal anesthesia and more common in patients with a history of hypertension. Regular use of antihypertensive medications can prevent these complications. The occurrence of hypotension under spinal anesthesia among controlled hypertensive and normotensive patients with age 40 years and above is still debated. The objective of the study was to compare blood pressure and heart rate changes following spinal anesthesia between controlled hypertensive and normotensive patients undergoing surgery below the umbilicus at Black lion hospital, Addis Ababa, Ethiopia, 2020., Method: A hospital-based prospective cohort study was conducted. A total of 110 elective patients with controlled hypertension (55) and normotensive (55) patients who underwent surgery with spinal anesthesia at black lion hospital during the study period were included. The sample was selected using a systematic random sampling technique. Continuous data of independent and dependent variables were analyzed using an independent sample t -test for normally distributed and Mann-Whitney U -test for nonnormally distributed between the study groups. Categorical variables between the study groups were analyzed using the chi-square test. Descriptive data were displayed using tables and figures. For continuous and categorical variables, a p value <0.05 was considered statistically significant., Results: The incidence of hypotension in the controlled hypertension group (23.6%) was higher than the normotensive group (7.3%) with p value of 0.018. The occurrence of bradycardia was seen to be 12.7% in each group with a p value >0.05. There was a statistically significant difference in the mean systolic blood pressure, mean arterial pressure, mean heart rate, and vasopressor consumption at the measurement time interval between controlled hypertension and normotensive groups., Conclusion: Under spinal anesthesia, patients with controlled hypertension are more likely to develop hypotension than normotensive patients, but on the occurrence of bradycardia, there was no statistically significant difference between the two groups., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Leake Gebrargs et al.)

Background: Cancer-related pain (CRP) is a major problem with a potential negative impact on quality of life of the patients and their caregivers., Purpose: To assess the adequacy of cancer-related pain management in Ayder Comprehensive Specialized Hospital (ACSH). Methodology . A facility-based cross-sectional study design was conducted in ACSH from January to March 2019. A well-structured professional-assisted questionnaire using Brief Pain Inventory-Short Form (BPI-SF) was used to collect data concerning the severity of pain, functioning interference, and adequacy of pain management in cancer patients. Data were analyzed using SPSS v.21., Result: Out of 91 participants, 47 (51.6%) were male and 52 (57.1%) were between the age group of 18-45, with the mean age of 44.8 ± 13.6 years. According to the pain assessment tool (BPI), 85 (93.4%) patients experienced pain and 90 (98.9%) patients had activity interference; negative pain management index (PMI) was observed in 40 (43.95%) patients, showing that 43.95% were receiving inadequate pain management. Out of 38 patients who received no analgesics, 35.2% were found to have inadequate pain management, whereas those who took strong opioids had 100% effective pain management and the majority of the patients were in stage III. Among 38 (41.76%) only 20 (52.63%) received adequate pain management, based on patients' self-report in which 18.7% of the participants stated that they got 30% pain relief and only 1.1% got 90% relief. The predictors of undertreatment were presence of severe pain, metastasis, comorbidity, and stage of the cancer and could also be due to the educational level and monthly income, as evidenced by significant association., Conclusion: This study suggests that cancer pain management in ACSH was sufficient for only 56%. However, large numbers of individuals are suffering from a manageable pain. Hence, remedial action should be taken, including increasing awareness of symptom management in medical staff and incorporating existing knowledge into routine clinical practice., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Kald Beshir Tuem et al.)

Malaria's global impact, fueled by resistance to several antimalarial drugs, has necessitated a quest to new antimalarial drugs from several sources with traditional medicinal plants being one of them. This study was conducted to assess the antimalarial activity of a traditionally used medicinal plant, Leonotis ocymifolia, against Plasmodium berghei . The plant has been extracted using maceration technique, and doses ranging from 100-800 mg/kg of Leonotis ocymifolia were used to test its antimalarial activity. Tween 80 (2% in water) and chloroquine 25 mg/kg were used as negative and positive controls, respectively. The antimalarial activities of the plant were determined by measuring parasitemia, survival time, packed cell volume, temperature, and weight. The plant's hydroalcoholic extract, as compared to negative control, maximally decreased parasite load by 41.4% at 800 mg/kg ( p  < 0.001). This parasite suppression was followed by longer survival time in the groups taking 400 mg/kg ( p  < 0.05) and 800 mg/kg ( p  < 0.05) in a four-day suppressive test and in those taking 800 mg/kg ( p  < 0.05) in Rane's test. The plant did not prevent weight and PCV reduction but prevented temperature reduction at 400 mg/kg ( p  < 0.05) and 800 mg/kg ( p  < 0.05) in a four-day suppressive model, and at 800 mg/kg ( p  < 0.05) in Rane's model. The average but consistent antimalarial activity of the plant across the test models corroborates the folkloric antimalarial use of the plant. The study recommends further pharmacological screenings, isolation, and identification of active compound(s) of the plant Leonotis ocymifolia ., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2020 Tewolde Teklu et al.)

Background: Becium grandiflorum has been used traditionally for treatment of different ailments including diabetes mellitus although it lacks scientific evidence. Thus, the present study was aimed at evaluating the antidiabetic effect of Becium grandiflorum in streptozotocin (STZ)-induced diabetic mice., Methods: The antidiabetic activity of hydro-ethanolic (30:70) leaf extract of Becium grandiflorum was evaluated in STZ (45 mg/kg)-induced diabetic and normal mice. Antihyperglycemic, hypoglycemic, oral glucose tolerance and body weight change effects of the extract were assessed after administering three doses of the extract (200, 400 and 600 mg/kg), glibenclamide 5 mg/kg (reference drug) and 2% Tween 80 (vehicle). One-way analysis of variance and Tukey's post hoc test were used for data analysis., Results: All doses of the extract (200 mg/kg ( p <0.05), 400 mg/kg ( p <0.05) and 600 mg/kg ( p <0.01)) and glibenclamide 5 mg/kg ( p <0.001) showed statistically significant blood glucose level reduction in normal mice as compared to Tween 80. The hydroalcoholic extract at a dose of 200 mg/kg ( p <0.05), 400 mg/kg ( p <0.01) and 600 mg/kg ( p <0.001) showed better blood glucose tolerance after 60, 120 and 180-minute treatment duration in normal mice as compared to negative control. In diabetic mice, Becium grandiflorum doses and the reference drug caused maximum reduction in blood glucose level at the end of the 15th day of treatment by 17.61%, 22.52%, 24.62% and 34.12%, respectively. The extract's doses and the standard drug showed significant ( p <0.05) improvement in body weight while the diabetic control continued to lose their body weight., Conclusion: Thus, Becium grandiflorum exhibits antihyperglycemic activity in STZ-induced diabetic mice, and shows improvement in oral glucose tolerance and body weight, which justifies the claimed use of the plant in ameliorating diabetes mellitus in Ethiopian folk medicine., Competing Interests: The authors declare that they have no competing interests., (© 2020 Gebremeskel et al.)

Background: Aloe megalacantha Baker (Xanthorrhoeaceae) is one of the Aloe species widely distributed in Ethiopia. The leaf latex of the plant is used for treatment of wounds, inflammation, and other multiple ailments in Ethiopian traditional medicine., Purpose: The aim of this study was to evaluate in vivo wound healing and anti-inflammatory activities of the leaf latex of Aloe megalacantha in mice., Methods: The wound healing activity of the leaf latex of the plant was studied topically by incorporating the latex in simple ointment base in a concentration of 5% (w/w) and 10% (w/w) using excision and incision models. In these models, wound contraction, period of epithelialization, and breaking strength of the wounded skin were determined. Carrageenan induced inflammation of paw model was also used to assess the anti-inflammatory activity of the leaf latex at doses of 200 mg/kg, 400mg/kg, and 600 mg/kg. The level of inflammation suppressions were measured at 1, 2, 3, and 4 hrs after carrageenan injection, and then the percentages of inflammation inhibition were computed as compared with the negative control., Result: In both wound models, mice treated with 5% (w/w) and 10% (w/w) latex ointment showed a significant (p<0.05) increment in the rate of wound contraction, reduction in epithelialization time, and higher skin breaking strength. Besides, the latex also exhibited a dose-dependent significant (p<0.05) reductions of inflammation as compared to negative control groups., Conclusion: The overall results of this study demonstrate that the leaf latex of A. megalacantha possesses wound healing and anti-inflammatory activities which can scientifically substantiate the traditional use of the plant as a wound healing agent.

The presence and distribution of putative nitric oxide synthase (NOS)-containing cells in whole-mount preparations of the central nervous system of the leech, Hirudo medicinalis, were studied using NADPH-diaphorase (NADPH-d) histochemistry. Specific staining occurred mainly in somata of some central neurones but NADPH-d-reactive branches and terminals were found in peripheral nerves and connectives: neuropile areas were stained weakly or unstained. Intense staining was located in many neurones on the ventral side of the segmental ganglia, including primary sensory neurones, motoneurones and interneurones, and in the anterior root ganglion. The sex ganglia contained some extra NADPH-d-positive cells. Head and tail ganglia and the dorsal side of the segmental ganglia showed less staining. Specific activity was not detected in salivary glands, crop or intestine. Controls using beta-NADPH or nitro blue tetrazolium (NBT) alone or with NBT plus alpha-NADPH, beta-NAD+, beta-NADH or beta-NADP+ did not induce specific staining. A potential NOS inhibitor, 2,6-dichlorophenol-indophenol (DPiP) at 10(-3) M, totally abolished NADPH-d-positive staining. Long-term fixation did not change the pattern of distribution of NADPH-d-positive cells. We conclude that (i) fixative-resistant NADPH-diaphorase is a characteristic marker of 12-15% of neurones in the leech CNS, and (ii) the specific distribution of the putative NOS-containing neurones suggests that NO may be a natural signal molecule in leeches.

An hypothesis for the presence of nitric oxide synthase (NOS) and the involvement of nitric oxide (NO) in neuronal signaling in the leach (Hirudo medicinalis) CNS is based on (i) the presence of fixative resistant NADPH-diaphorase (NADPH-d) in a specific neuronal population in the segmental ganglion; (ii) direct measurements with NO-sensitive electrodes giving an estimated NO concentration of 400-600 nM; (iii) biochemical assay for NOS using L-arginine/L-citrulline conversion in the CNS which gave a comparable value to that of the rat cerebellum and (iv) specific pharmacological effects of the NO precursor L-arginine and a NOS inhibitor (NG-Nitro-L-arginine) in modulation of chemical connections between NADPH-d-positive and NADPH-d-negative neurones. The very high value of estimated NO concentration and NOS activity and the relatively small number of putative NOS-containing (NADPH-d-positive) cells, including identified sensory (N, P, T cells), motor (AE) and interneurones (151) with known monosynaptic connections, make these neurones an ideal preparation on which to study the possible effects of NO on synaptic interactions.

Study Objectives: To investigate the time of onset and incidence of complications in patients presenting to the emergency department with an IV heroin overdose and the need for routine admission of such patients., Methods: A retrospective chart review of hospital and emergency medical service records of 124 patient visits involving IV heroin overdose over a five-month period. We also reviewed the death certificates of 115 persons having succumbed to a narcotic overdose over a 44-month period and compared these with our hospital records., Setting: Urban county hospital., Type of Participants: Patients presenting to the ED with an IV heroin overdose., Results: There were five deaths in the ED, 12 hospital admissions, and 107 patients who were discharged home. Neither delayed onset of pulmonary edema nor recurrence of respiratory depression was observed. Of the 115 persons having succumbed to a narcotic overdose, eight had been seen previously at our hospital for a heroin overdose. There is no evidence that any of these eight deaths would have been prevented by a 24-hour hospital observation period., Conclusion: Complications arising from an IV overdose of heroin are usually evident on arrival in the ED or shortly thereafter. On retrospective review we have found no evidence that admission to the hospital and 24 hours of observation are of benefit to patients who are awake, alert, and lacking evidence of pulmonary complications after an IV heroin overdose.

Chloral hydrate has been time honored for pediatric procedural sedation, but its efficacy in sedation for emergency department (ED) procedures is unreported. It is hypothesized that chloral hydrate is safe and effective for ED pediatric sedation. Ninety-five consecutive children ranging from 1-10 years and requiring procedural intervention in a municipal teaching hospital ED were included in a nonrandomized controlled trial. Patients with respiratory depression, somnolence, allergy, multisystem trauma, head injury, or abdominal pain were excluded. Forty-two subjects received chloral hydrate 25 to 50 mg/kg orally at physician discretion, and 53 subjects served as controls. Cooperation with procedural completion was rated by the treating physician using the four-point sedation scoring system modified from Moody et al (1 = poor, 4 = excellent). The two groups' sedation scores were compared by the Mann Whitney U test with significance at P less than .05. Age-related subgroups of children were similarly compared. The treatment group achieved sedation score of 2.86, whereas controls had sedation score of 2.75 (P = 0.63, beta error 20% at 0.37 score difference). Subgroup analysis of children less than 6 years old (2.95 experimental versus 2.57 control) and less than 4 years old (3.00 experimental versus 2.32 control) reveals statistically significant differences (P less than .0001 and P = .01, respectively) in favor of higher sedation scores in the chloral hydrate group. Time to sedation was 42.7 minutes, time to recovery was 42.0 minutes, and no adverse drug effects were noted.(ABSTRACT TRUNCATED AT 250 WORDS)

1. Reserpine, chronic guanethidine denervation and alpha-adrenoceptor antagonists were used to distinguish between presynaptic and postsynaptic actions of exogenous dopamine (DA), octopamine (OA), tyramine (TA) and noradrenaline (NA) on the rat vas deferens. 2. TA has only a presynaptic action while DA and OA have mixed presynaptic actions (releasing endogenous NA) and postsynaptic actions. 3. The postsynaptic actions of DA and OA are likely to be mediated by alpha-adrenoceptors rather than by specific receptors.

Octopamine (OA) hyperpolarizes leech Leydig neurones but response amplitudes and thresholds vary. Associations between response, OA dose and other variables [initial resting potential, action potential (AP) frequency and amplitude, temperature, microelectrode resistance, position of ganglion along nerve cord, animal, treatment order] were examined using canonical correlation. A complex response was expressed by summing changes in membrane potential and AP frequency over 2 min of OA treatment. Only dose and ganglion position influenced this response. One significant canonical variate related dose to immediate changes in membrane potential and summed changes in AP frequency throughout the OA effect. Response to OA was greater in cells in posterior ganglia.