Sustained release local anesthetics for pain management: relevance and formulation approaches

This review attempted to ascertain the rationale for the formulation of sustained-release local anesthetics and summarize the various formulation approaches designed to date to achieve sustained and localized local analgesic effects. The incidence of pain, which is the concern of patients as well as health care professionals, is increasing due to accidents, surgical procedures, and other diseases. Local anesthetics can be used for the management of moderate to severe acute and chronic pain. They also allow regional analgesia, in situations where the cause and source of the pain are limited to a particular site or region, without the need for loss of consciousness or systemic administration of other analgesics thereby decreasing the risk of potential toxicities. Though they have an interesting antipain efficacy, the short duration of action of local anesthetics makes the need for their multiple injections or opioid adjuvants mandatory. To overcome this problem, different formulations are being designed that help achieve prolonged analgesia with a single dose of administration. Combination with adjuvants, liposomal formulations, lipid-based nanoparticles, thermo-responsive nanogels, microspheres, microcapsules, complexation with multivalent counterions and HP-β-CD, lipid-based nanoparticles, and bio-adhesive films, and polymeric matrices are among the approaches. Further safety studies are required to ensure the safe and effective utilization of sustained-release local anesthetics. Moreover, the release kinetics of the various formulations should be adequately established.

Emergency department overcrowding and its associated factors at HARME medical emergency center in Eastern Ethiopia

Introduction

Emergency department (ED) overcrowding has become a significant concern as it can lead to compromised patient care in emergency settings. Various tools have been used to evaluate overcrowding in ED. However, there is a lack of data regarding this issue in resource-limited countries, including Ethiopia. This study aimed to validate NEDOCS, assess level of ED overcrowding and identify associated factors at HARME Medical Emergency Center, located in Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia.

Methods

A cross-sectional study was conducted at the HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, involving a total of 899 patients during 120 sampling intervals. The area under the receiver operating characteristic curves (AUC) was calculated to evaluate the agreement between objective and subjective assessments of ED overcrowding. A multivariable logistic regression analysis was employed to identify factors associated with ED overcrowding and statistically significant association was declared using 95 % confidence level and a p-value < 0.05.

Results

The interrater agreement showed a strong correlation with a Cohen's kappa (κ) of 0.80. The National Emergency Department Overcrowding Study Score demonstrated a strong association with subjective assessments from residents and case team nurses, with an AUC of 0.81 and 0.79, respectively. According to residents' perceptions, ED were considered overcrowded 65.8 % of the time. Factors significantly associated with ED overcrowding included waiting time for triage (AOR: 2.24; 95 % CI: 1.54-3.27), working time (AOR: 2.23; 95 % CI: 1.52-3.26), length of stay (AOR: 2.40; 95 % CI: 1.27-4.54), saturation level (AOR: 2.35; 95 % CI: 1.31-4.20), chronic illness (AOR: 2.19; 95 % CI: 1.37-3.53), and abnormal pulse rate (AOR: 1.52; 95 % CI: 1.06-2.16).

Conclusion

The study revealed that ED were overcrowded approximately two-thirds of the time.

In-hospital outcome and its predictors among patients with acute cardiogenic pulmonary oedema at a tertiary hospital in Harar, Eastern Ethiopia: a retrospective cohort study

Background

Acute cardiogenic pulmonary oedema is highly associated with poor in-hospital outcomes. This study aimed to determine the in-hospital outcome and its predictors among patients with acute cardiogenic pulmonary oedema at a tertiary hospital in Harar, Eastern Ethiopia, from May 1 to 20, 2023.

Methods

A retrospective cohort study was employed among 204 patients with acute cardiogenic pulmonary oedema who were admitted between 1st May 2018 and 30th April 2023. The collected data were entered into Excel, and analysed using theSTATA software version 17. The hazard ratio with its 95% confidence interval was used and a P-value < 0.05 was considered a statistically significant association.

Results

The overall mortality rate was 17.60 (95% CI: 11.59-26.72) per 1000 person-day observation with mean (±SD) time to death was 2.88 (±2.06) days. Age (AHR: 1.35; 95% CI: 1.04-1.74 for every 10 years), being smoker (AHR: 3.26; 95% CI: 1.05-10.10), having respiratory rate of ≥40 breaths per minute (AHR: 5.46; 95% CI: 1.71-17.45), and having anaemia (AHR: 4.35; 95% CI: 1.23-15.33) were significant predictors of in-hospital mortality.

Conclusion

More than one in ten patients in this study died in the hospital. Therefore, special attention needs to be considered for patients with those predictors of in-hospital mortality.

The Magnitude of Hypertension and Its Contributing Factors Among Patients Receiving Antiretroviral Therapy in Public Hospitals in Harar City, Eastern Ethiopia: A Cross-Sectional Study

Background

Although people living with HIV (PLHIV) are surviving longer due to the development of highly active antiretroviral therapy (HAART), hypertension continues to be a significant obstacle for human immunodeficiency virus (HIV) positive patients.

Purpose

This study aims to determine the prevalence of hypertension and its contributing factors among patients receiving HAART in public hospitals in Harar City, Eastern Ethiopia.

Patients and Methods

A hospital-based cross-sectional study was conducted among adult PLHIV who receive HAART in public hospitals in Harar City, Eastern Ethiopia, from 20 March to 14 April 2023. A simple random sampling technique was employed to select a total of 406 clients (382 participated in the study). Data were collected through patient interview and chart review using a questionnaire. The binary logistic regression was used for data analysis. The association was declared statistically significant at a p-value less than 0.05.

Results

The magnitude/prevalence of hypertension was 23% (95% CI: 19.1, 27.5) in study settings from a total of 382 adults who participated in this study. Factors significantly associated with hypertension in a multivariable binary logistic regression model include residence (rural residence, AOR = 1.95, 95% CI: 1.04, 3.65); body mass index (obese, AOR = 4.35, 95% CI: 1.08, 16.77); cigarette smoking (past cigarette smoking, AOR = 4.7, 95% CI: 1.10, 21.8); and HAART regimen change (AOR = 0.44, 95% CI: 0.20, 0.97).

Conclusion

The prevalence of hypertension observed among adult PLHIV in the study settings was high. Adults from rural areas, with a history of past smoking cigarette, and obesity need close attention during their clinic visits for more health education to reduce risk factors. The changed HAART regimen was associated with a reduced risk of hypertension. Generally, hypertensive PLHIV need consideration for their double burden of communicable and non-communicable diseases during disease management and hospital guideline development.

The Burden and Contributing Factors of Cardiogenic Pulmonary Edema Among Acute Heart Failure Patients Admitted to Tertiary Hospital, Eastern Ethiopia

Background

Despite cardiogenic pulmonary edema is the most common phenotype of acute heart failure (AHF), studies on its burden and associated factors are limited. This study aimed to assess the burden and contributing factors of cardiogenic pulmonary edema in patients with acute heart failure admitted to a tertiary hospital in eastern Ethiopia.

Patients and Methods

An institution-based cross-sectional study was conducted on the medical records (n = 276) of patients with AHF between February 01, 2018, and January 31, 2023. A simple random sampling technique was used to select participants from the study population. Bivariable and multivariable logistic regression analyses were used to assess factors associated with the development of cardiogenic pulmonary edema. A P-value ≤0.05 was considered as statistically significant.

Results

The prevalence of cardiogenic pulmonary edema was 47.8% in AHF patients. Rural residence (adjusted odds ratio (AOR),9.54), smoking (AOR,3.17), comorbidity (AOR,2.1), and underlying cardiovascular disease (ischemic heart disease, chronic rheumatic valvular heart disease, and hypertensive heart disease with AOR: 6.71, 8.47, and 12.07, respectively) were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF.

Conclusion

Nearly half of the patients with AHF had cardiogenic pulmonary edema. Being a rural dweller, cigarette smoking, comorbidities, and underlying cardiac illness were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF.

In-hospital mortality and length of stay of patients with hypertensive crisis treated at public hospitals in Harari Regional State, Eastern Ethiopia

Hypertensive crisis poses substantial cardiovascular morbidity and mortality. This study aimed to assess in-hospital mortality, length of stay (LOS), and their predictors among patients with hypertensive crisis treated at public hospitals in Harari Regional State, Eastern Ethiopia. An institutional-based retrospective cohort study was conducted from October 1 to 31, 2022. The medical records of 328 patients with hypertensive crisis treated at two public hospitals between September 1, 2017 and August 31, 2022 were reviewed. Cox proportional hazards regression and negative binomial regression were used to identify predictors of in-hospital mortality and LOS, respectively. The in-hospital mortality rate of patients with hypertensive crisis was 18.94 (95% confidence interval (CI): 12.08-29.70) per 1000 person-day observation. The median (interquartile range) LOS of these patients was 10 (4-120) hours. Age ≥65 years (adjusted hazard ratio (AHR): 3.30; 95% CI: 1.17- 9.33); increment in initial systolic blood pressure (AHR: 1.040; 95% CI: 1.014-1.066); and having acute brain-related damage (AHR: 4.02; 95% CI: 1.48-10.88) were predictors of in-hospital mortality. Rural residence (adjusted incident-rate ratio (IRR): 1.34; 95% CI: 1.03-1.75); having a history of medication discontinuation (adjusted IRR: 1.59; 95% CI: 1.16-2.18); comorbidity (adjusted IRR: 1.90; 95% CI: 1.49-2.43); acute brain-related damage (adjusted IRR: 13.32; 95% CI: 9.22-19.24), acute cardiac-related damage (adjusted IRR: 7.40; 95% CI: 4.90-11.16); and acute kidney injury (adjusted IRR: 7.64; 95% CI: 5.46-10.69) were predictors of LOS. Thus, it is necessary to develop strategies that allow early screening and follow-up of patients at risk.

Role of point of care ultrasound in the absence of radial pulse and unrecordable blood pressure during the assessment of shock: Case report

INTRODUCTION

Point-of-care ultrasound (POCUS) has been an integral part of patient evaluation in the Emergency Department. It has been used increasingly for the evaluation of critically ill and trauma patients.

CASE PRESENTATION

We report a case of 60-year-old male patient who presented to the Emergency department with flank pain and urinary symptoms suggesting pyelonephritis with unrecordable blood pressure indicating potential septic shock, but the absence of bilateral radial pulses triggered the use of POCUS which reveal bilateral radial artery occlusion.

CASE DISCUSSION

Assessment of the peripheral pulses (usually radial pulse) is an important clue to estimate the systolic blood pressure with presence of a pulse correlating to a systolic SBP of ≥80 mmHg. this case report showed there was an absent peripheral radial and brachial pulse despite the patient appearing hemodynamically stable and no other signs of shock. By utilizing vascular POCUS, the patient's diagnosis completely changed. The use of POCUS led to an instant diagnosis and appropriate patient management.

CONCLUSION

Point-of-Care ultrasound is a valuable diagnostic tool that can help narrow down differential diagnostics and guide early proper management and intervention.

The severity of mental health problems in healthcare professionals and its associated risk factors during COVID-19 pandemic

Objective: This study assesses the severity of mental health problems in healthcare professionals (HCPs) and its associated risk factors during COVID-19 pandemic at a tertiary hospital in Harar, Eastern Ethiopia. Methods: An institutional-based cross-sectional study was done from November 01 to 15, 2020. Data was collected by using a web-based self-administered questionnaire. Descriptive statistical analysis, cross tabs, and logistic regressions were utilized. Results: Out of 238 HCPs, 54.6% of them had a mental health problem. The prevalence of depression, anxiety, and stress was 44.1%, 48.3%, and 29.0%, respectively.  Cigarette smoking was the only factor associated with depression. Being female, a cigarette smoker, and previously diagnosed with COVID-19 were associated with anxiety, while cigarette smoking and previous COVID-19 suspect had a significant association with stress. Conclusion: The burden of mental health problems among HCPs is high. The Federal Ministry of Health should incorporate psychosocial support for healthcare professionals during pandemics. This study highlights the need for developing policies to decrease mental health problems among HCPs during the COVID-19 pandemic.

Knowledge of Drug–Food Interactions Among Healthcare Professionals Working in Public Hospitals in Ethiopia

Background

Drug–food interactions can result in unfavorable outcomes during the treatment of patients. Healthcare professionals (HCPs) should advise patients on drug–food interactions. Knowledge of such interactions is crucial to avoid their occurrence. However, there is no information regarding the knowledge of HCPs about drug–food interactions in Harari Regional State.

Objective

To assess knowledge of drug–food interactions and associated factors among HCPs working in public hospitals in Harari Regional State, Eastern Ethiopia from April 15 to May 15, 2022.

Methods

A cross-sectional study was conducted in public hospitals in Harari Regional State, Eastern Ethiopia, among 251 HCPs. After stratification was done based on profession (pharmacists, nurses, and doctors), the sample size was proportionally allocated for the respective groups. Data were collected using a standardized self-administered questionnaire, entered into Epi-Data 3.1 and analyzed using Statistical Package for Social Sciences 26.0. Descriptive statistics were used to summarize variables. Multivariable logistic regression was done to determine factors associated with knowledge of drug–food interactions. P < 0.05 was used to declare significant association.

Results

Among the HCPs who completed the questionnaire, 56 (22.3%), 36 (14.3%), and 159 (63.3%) were doctors, pharmacists, and nurses, respectively. The majority of the HCPs were males (174 (69.3%)). The mean age of the HCPs was 27.6±3.8. The mean knowledge score±SD of the HCPs was 28.6±6.6 out of an overall score of 59. The HCPs poorly identified drug–food interactions and the correct administration time of drugs relative to meals. Being a pharmacist (AOR: 2.8, CI: 1.3–6.4, p-value=0.012), and working at a tertiary hospital (AOR: 3.9, CI: 2.1–7.3, p-value <0.001), were associated with higher knowledge of drug-food interactions.

Conclusion

The HCPs in this study had inadequate knowledge of drug–food interactions. Thus, additional educational courses and training should be provided in order to improve knowledge regarding drug-food interaction.

One in Five Street Traditional Coffee Vendors Suffered from Depression During the COVID-19 Pandemic in Harar Town, Ethiopia

BACKGROUND

The COVID-19 crisis has already resulted in an economic and labor market shock and a rise of informal work sectors. Being an informal job, traditional coffee vending can predispose women to a myriad of mental disorders. Therefore, this study was aimed to assess depressive symptoms during the COVID-19 pandemic and associated factors among street traditional coffee vendors in Harar town, Eastern Ethiopia.

METHODS

A cross-sectional study was employed on 180 women engaged in street traditional coffee vending business in Harar town. Data were collected through a face-to-face interview using a Public Health Questionnaire and analyzed using SPSS version 20. Binary logistic regression was executed to identify factors associated with depression at a cut-off point of P < 0.05.

RESULTS

The mean age of the study participants was 31.83 (±10) years. The majority of the participants were currently married (n = 77, 42.8%), attended primary education (n = 68, 37.8%), had a family member of four or more (n = 60, 33.3%), and had two years or less work experience (n = 123, 68.3%). Most of the study participants obtained COVID-19-related information from television (n = 125, 69.4%). The prevalence of depression was found to be 18.9%. Attending primary education (AOR: 0.34; 95% CI: 0.12, 0.98), attending secondary education or higher (AOR: 0.23; 95% CI: 0.07, 0.69), and having four or more family members (AOR: 2.81; 95% CI: 1.14, 6.92) were significantly associated with depression.

CONCLUSION

One in five street traditional coffee vendors suffered from depression during the COVID-19 pandemic. Lower odds of being depressed were observed in those who attended a minimum of primary education. On the contrary, having a greater family size was associated with higher odds of being depressed. This finding will direct the government and other concerned bodies to be involved in the provision of psychological and material support for such informal workers during COVID-19.