BACKGROUND:Due to exhaustive working climate, health-care professionals (HCPs) are highly exposed to emotional strain and work-related stress that leads to burnout syndrome (BOS).AIM:We aimed to explore the prevalence of BOS among HCPs and delineate the factors that contribute to developing this emerging threat in HCPs working in Gondar University Hospital (GUH).METHODS:A cross-sectional study was conducted among HCPs using a self-administered validated questionnaire containing sociodemographic and job characteristics, symptoms of burnout using Astudillo and Mendinueta questionnaire, and Maslach Burnout Inventory scale. The prevalence of BOS was assessed by summation of answers to all 19 items with a range of 0–57. HCPs who scored >23 were considered as burned out. Pearson's correlation analysis and multivariate logistic regression were used to assess the relationship between BOS and job factors. Data were analyzed using descriptive and inferential statistics.RESULTS:A total of 250 HCPs were approached out of which 248 responded (response rate –99.2%). The overall prevalence of burnout was 13.7% and majority of the respondents experienced debility (52.8%), self-criticism (56%), and depressive symptoms (46%). BOS symptoms were significant with age (P = 0.008), number of patients treated per day (P < 0.001), and HCPs working in shifts (P < 0.001). Higher mean levels of emotional exhaustion (5.4 ± 1.2) and inefficacy (5.1 ± 1.7) were noticed than cynicism (4.8 ± 2.0). Male HCPs, being single and years of experience, were determinant factors for all the three dimensions of BOS, whereas profession was significantly determinant for emotional exhaustion (P < 0.01).CONCLUSION:The prevalence of BOS among HCPs working in GUH was 13.7%. Being male, unmarried, and years of experience were significant risk factors for all the three dimensions of BOS. Pragmatic measures are recommended to prevent stressful challenges for the physical and mental well-being of the HCPs in GUH.

BackgroundDiabetic ketoacidosis is an acute life-threatening complication of diabetes mellitus. There was limited data on level of in-hospital mortality, hospital stay and factors associated with length of hospital stay among diabetic patients admitted to diabetic ketoacidosis at Debretabor General Hospital.ObjectiveThe aim of the study was to determine the length of hospital stay and in-hospital mortality of diabetic ketoacidosis patients and to assess determinants of long hospital stay among diabetic patients admitted with Diabetic ketoacidosis at Debretabor General Hospital.MethodA retrospective study was conducted at Debretabor General Hospital from June 1to 30, 2018. Participants included in the study were all diabetic patients with diabetic ketoacidosis admitted to the hospital from August 2010 to May 31, 2018 whose medical records contained complete pertinent data. The primary outcome was to determine the length of hospital stay and in-hospital mortality of diabetic ketoacidosis patients. All the statistical data was carried out using Statistical Package for Social Sciences (SPSS). Descriptive statistics was presented using means with standard deviation and percentages.ResultA total of 387 patients’ medical records contained pertinent complete information included in this study. Mean age of the patients was 33.30± 14.96 years. The majority of patients were females 244 (63.0%). The mean length of hospital stay was 4.64(±2.802) days. About twenty percent 79(20.41%) patients had long hospital stay (>7days). The majority 370 (95.60%) of patients improved and discharged and 17 (4.40%) patients died in the hospital. patients who had mild DKA; AOR: 0.16 [0.03-0.78] and patients between the age of 35-44years, AOR: 0.125[0.017-0.92] had reduced length of hospital stay. further, patients with DKA precipitated by infection were 4.59 times more likely to have long hospital stay than patients with DKA precipitated by unknown causes; AOR 4.59[1.08-19.42].ConclusionsIn the current study, the mean length of hospital stay was around five days. About twenty percent patients had long hospital stay. Nearly ninety five percent of patientsimproved and discharged. The presence of infection, frequent rebound hyperglycemia and severity of DKA were the major determinants of long hospital stay.

Background: Hypertension drives the global burden of cardiovascular disease and its prevalence is estimated to increase by 30% by the year 2025. Nonadherence to chronic medication regimens is common; approximately 43% to 65.5% of patients who fail to adhere to prescribed regimens are hypertensive patients. Nonadherence to medications is a potential contributing factor to the occurrence of concomitant diseases.Objective: This systematic review applied a meta-analytic procedure to investigate the medication nonadherence in adult hypertensive patients.Methods: Original research studies, conducted on adult hypertensive patients, using the 8-item Morisky medication adherence scale (MMAS-8) to assess the medication adherence between January 2009 and March 2016 were included. Comprehensive search strategies of 3 databases and MeSH keywords were used to locate eligible literature. Study characteristics, participant demographics, and medication adherence outcomes were recorded. Effect sizes for outcomes were calculated as standardized mean differences using random-effect model to estimate overall mean effects.Results: A total of 28 studies from 15 countries were identified, in total comprising of 13,688 hypertensive patients, were reviewed. Of 25 studies included in the meta-analysis involving 12,603 subjects, a significant number (45.2%) of the hypertensive patients and one-third (31.2%) of the hypertensive patients with comorbidities were nonadherent to medications. However, a higher proportion (83.7%) of medication nonadherence was noticed in uncontrolled blood pressure (BP) patients. Although a higher percentage (54%) of nonadherence to antihypertensive medications was noticed in females (P < 0.001), the risk of nonadherence was 1.3 times higher in males, with a relative risk of 0.883. Overall, nearly two-thirds (62.5%) of the medication nonadherence was noticed in Africans and Asians (43.5%).Conclusion: Nonadherence to antihypertensive medications was noticed in 45% of the subjects studied and a higher proportion of uncontrolled BP (83.7%) was nonadherent to medication. Intervention models aiming to improve adherence should be emphasized.Abbreviations: BP = blood pressure, CHD = coronary heart disease, CVD = cardiovascular disease, MMAS = Morisky medication adherence scale, PRISMA = Preferred Reporting Items for Systematic review and Meta-Analysis, STROBE = Strengthening the Reporting of Observational Studies in Epidemiology.

Background: Ethiopia is among countries with a high malaria burden. There are several studies that assessed the efficacy of anti-malarial agents in the country and this systematic review and meta-analysis was performed to obtain stronger evidence on treatment outcomes of malaria from the existing literature in Ethiopia. Methods:A systematic literature search using the preferred reporting items for systematic review and meta-analysis (PRISMA) statement was conducted on studies from Pubmed, Google Scholar, and ScienceDirect databases to identify published and unpublished literature. Comprehensive meta-analysis software was used to perform all meta-analyses. The Cochrane Q and the I 2 were used to evaluate heterogeneity of studies. Random effects model was used to combine studies showing heterogeneity of Cochrane Q p < 0.10 and I 2 > 50.Results: Twenty-one studies were included in the final analysis with a total number of 3123 study participants. Treatment outcomes were assessed clinically and parasitologically using World Health Organization guidelines. Adequate clinical and parasitological response was used to assess treatment success at the 28th day. Overall, a significant high treatment success of 92.9% (95% CI 89.1-96.6), p < 0.001, I 2 = 98.39% was noticed. However, treatment success was higher in falciparum malaria patients treated with artemether-lumefantrine than chloroquine for Plasmodium vivax patients [98.1% (97.0-99.2), p < 0.001, I 2 = 72.55 vs 94.7% (92.6-96.2), p < 0.001, I 2 = 53.62%]. Seven studies reported the adverse drug reactions to anti-malarial treatment; of 822 participants, 344 of them were exposed to adverse drug reactions with a pooled event rate of 39.8% (14.1-65.5), p = 0.002. Conclusions:On the basis of this review, anti-malarial treatment success was high (92.9%) and standard regimens showed good efficacy against Plasmodium falciparum (98.1%) and P. vivax (94.7%) infections in Ethiopia, but associated with high rates of adverse drug reactions (ADRs). However, these ADRs were not serious enough to discontinue anti-malarial treatment. The results of this study suggest that the current anti-malarial medications are effective and safe; however, greater priority should be placed on the discovery of new anti-malarial drugs to achieve successful outcomes as resistance seems inevitable since cases of anti-malarial drug resistance have been reported from other areas of the world.

Purpose:To assess the prevalence of phosphodiesterase 5 (PDE5) inhibitor use and associated factors among University of Gondar undergraduate students. Materials and Methods:An institution-based, cross-sectional study, using a survey questionnaire, was conducted from October to December 2015 to assess PDE5 inhibitor use and associated factors among male students at the University of Gondar. A Self-Esteem and Relationship questionnaire (14 items), an International Index of Erectile Function questionnaire (15 items) and a questionnaire on PDE5 inhibitor use (14 items) were included in the survey.Results: Across all respondents (age, 21.9±1.88 years), more than half (55.7%, n=233) had heard about PDE5 inhibitors, but only 23 men (5.5%) reported trying a PDE5 inhibitor drug at least once. Older students were more likely to use PDE5 inhibitors compared to younger students (adjusted odds ratio [AOR], 1.40; 95% confidence interval [CI], 1.109∼1.768). Those students who were smokers were 5.15 times more likely to use PDE5 inhibitors as compared to their non-smoking counterparts (AOR, 5.15; 95% CI, 2.096∼12.687). In addition, multivariate logistic regression showed that being in a relationship, alcohol use, greater number of cigarettes smoked per day, and more sexual partners were significantly associated with PDE5 inhibitor use. Conclusions:The prevalence of PDE5 inhibitor use among undergraduate students was 5.5%. Cigarette smoking and other substance use, older age, and greater number of sexual partners were significantly associated factors for PDE5 inhibitor use. These findings suggest that restricting access to PDE5 inhibitor drugs is essential to curtailing misuse among university students.

Objectives: To design and validate a simple, reliable and easy to use questionnaire to identify patients under vitamin K antagonists (VKA) treatment with sub-optimal time in therapeutic range (TTR; without needing the TTR values), in order to allow a closer follow-up of the actual anticoagulant treatment or guiding a possible treatment changes. MethOds: Non-interventional, cross-sectional, multicenter design. A cardiologist expert panel identified those clinical variables capable of forecasting a good TTR control. The 5 proposed indicators (ICUSI) were included in an electronic clinical record form along with thromboembolic (CHADS2 & CHA2DS2-VASc) and hemorrhagic (HAS-BLED) risk indexes. A patient diary collecting last 6 month INR measures was also included. Discriminant capabilities were assessed using binary logistic regression respect to TTR control (Rosendaal & direct methods), and discriminant validity using the area under the curve (AUC) of the ROC curve. A total of 870 patients with documented AF diagnosis, receiving VKA, and meeting the selection criteria were included. Patients were recruited at 54 Cardiology departments covering all the Spanish territory. Results: The final sample contained 777 (88.9%) of assessable cases: 45% women, 13% lived alone, and 67% did not have caregiver. Mean age was 75.3±9.2 years, mean TTR= 66.0±19.8% and 46.7% attained INR control between 2-3 (Rosendaal TTR≥ 65%). Individually, ICUSI indicators were statistically significant (p< 0.05) respect to Rosendaal or Direct non-optimal control, but one item was discarded in the overall estimation. The ICUSI index was statistically discriminant with respect to 6 months TTR< 65% with AUC= 0.705 (SE= 0.018). Using the cut-off value ICUSI≥ 1 the risk of TTR< 65%: sensitivity= 80.9%, specificity= 44.9%, positive predictive value= 62.6%, and negative predictive value= 67.4%. cOnclusiOns: Initial evidences on the ICUSI validity support a good predictive behavior on screening patients with bad anticoagulant control.

A933system for logistic control of medicines of the Brazilian National STD/Aids Program. Despite its administrative nature, this system contains specific information about antiretroviral dispensation providing a unique data source for adherence assessment. This study aimed to assess HAART adherence among patients followed up in a public outpatient facility located in Rio de Janeiro city, Brazil, using pharmacy refill data obtained from SICLOM. Methods: All patients that initiated HAART in 2011 were included and followed up until December 2013. Data about dispensed medicines, including amounts and dates, and demographic data was obtained from SICLOM. Therapy adherence was estimated using the medication possession ratio (MPR) calculated as the ratio between the number of days covered by a refill and treatment duration in days. The number of days without medication (gaps) was also calculated. Results: The analysis included 82 patients. The average age was 36.2 ±10.1 years old and 85.4% were male. Most of the patients (65.9%) were followed up at public facilities. The medians of the gaps and MPR were 66.5 days (28.75-130) and 94.6% (87.9-97.4) respectively. MPR was lower than 95% for 54.9% of the patients. ConClusions: According to the World Health Organization, HIV patients should take more than 95% of antiretroviral prescribed doses. However, the fact that 54.9% of the patients presented a MPR lower than 95% suggests a high prevalence of HAART non-adherence. SICLOM showed to be a powerful data source for adherence studies that could provide useful information in order to improve HAART effectiveness.

A885fewer relapses(0.24) than those on oral(0.29~0.43) or no treatment. The reduction in relapse was due to improved treatment persistence and better efficacy. Receiving either PP1M