The Pattern of Medicine Use in Ethiopia Using the WHO Core Drug Use Indicators

Introduction. Rational medicine use is an appropriate prescribing, dispensing, and patient use of medicines for the diagnosis, prevention, and treatment of diseases. It is affected by several factors. Irrational use of medicine is a widespread problem at all levels of care. This review is aimed at assessing the medicine use pattern in health facilities of Ethiopia using the medicine use pattern developed by WHO/INRUD. Methods. Relevant literature was searched from Google Scholar, PubMed, Hinari, Web of Science, and Scopus using inclusion and exclusion criteria. A systematic review was used to summarize the medicine use pattern in health facilities of Ethiopia, and that WHO core drug use indicators were employed. Result. From 188 searched studies, 30 literatures were reviewed. The average number of drugs per encounter was 2.11. The percentage of encounters with antibiotics and injection was 57.16% and 22.39%, respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 91.56% and 90.19%, respectively. On average, patients spent 5.14 minutes for consultation and 106.52 seconds for dispensing. From prescribed drugs, 67.79% were dispensed, while only 32.25% were labeled adequately. The availability of key essential medicines was 64.87%. The index of rational drug use value was 7.26. Moreover, the index of rational drug prescribing, index of rational patient-care drug use, and index of rational facility-specific drug use were 3.74, 2.51, and 1.01, respectively. Conclusion. Ethiopian health facilities were faced with antibiotic overprescribing, short consultation, and dispensing times, poor labeling of medicines, poor availability of key drugs, and nonadherence to the essential drug list. Routine, multidisciplinary awareness creation, and regulation should be implemented to promote rational medicine use at a national level.

Evaluating antimicrobial prescribing in a Tertiary Healthcare Institution in Nigeria

Background Regular evaluation of antimicrobials prescriptions is important for optimal use. Objective This study determined the prescription patterns, class and costs of antimicrobials in the adult out-patient pharmacy of a Teaching Hospital in Nigeria. Methods A 1-year retrospective study from 1st January to 31st December 2018. The data, which included identification code, age, sex, antibiotics prescribed, number of antibiotics per prescription, number of medicines per prescription, dosage form, generic prescribing, drug on the essential drug list, and cost, were used in the analysis. The Chi-square test and Analysis of Variance were used to compare our data with the WHO–developed antimicrobial prescription Guidelines for Anatomical Therapeutic Chemical and Defined Daily Dose assignment of 2019. Results From 450 patient records, significantly more females (70%) were prescribed with antimicrobials (P = 0.0038). The prescription pattern showed that antimicrobials selection by class was significantly different (P < 0.0001) (top three being Amino-penicillin > Nitroimidazoles > Fluoroquinolone). In addition, age differed significantly (P < 0.0001) with 46–50 as the highest class. Dosage forms profile showed that the percentage of encounter with injections prescribed (1.8%) was less than WHO recommendation (13.4–24.1%). Most of the prescriptions (84.22%) were from the Essential Drug List. The average cost of prescriptions with two antimicrobials was the highest ($14.0807), then three ($10.7949), and one ($6.39858). The average number of drugs per prescription that had one (4.28), two (4.46), and three (5.55) antimicrobials, respectively, were more than double the average (2) recommended by WHO. Conclusion The study showed that most of the patterns are within limit, however, highlights the need for frequent evaluation.

COVID-19 Pandemic and the Debatable Use of Hydroxychloroquine

Healthcare professionals and scientists were not able to provide a good answer to the COVID-19 pandemic that shook the whole world. Hydroxychloroquine is an antimalarial drug with a good safety profile. It can be used in pediatric subjects as well as pregnant and breastfeeding women. Hydroxychloroquine is a widely used, essential drug in dermatology. It has got anti-inflammatory, antibacterial, antiviral and immunomodulatory properties. It was globally prescribed to prevent and treat COVID-19 caused by SARS-CoV-2 virus. The use of this drug in treating COVID-19 is debatable and for sure is not indicated in the labelling documents provided by the companies that manufacture this drug. The unnecessary use of this drug also led to short supply. We hereby review its properties, mechanism, safety profile and the issue COVID pandemic has caused to the supply of this drug.

A Computational Approach on Acetaminophen Drug using Degree-Based Topological Indices and M-Polynomials

Topological index is a numerical representation of a chemical structure. Based on these indices, physicochemical properties, thermodynamic behavior, chemical reactivity, and biological activity of chemical compounds are calculated. Acetaminophen is an essential drug to prevent/treat various types of viral fever, including malaria, flu, dengue, SARS, and even COVID-19. This paper computes the sum and multiplicative version of various topological indices such as General Zagreb, General Randić, General OGA, AG, ISI, SDD, Forgotten indices M-polynomials of Acetaminophen. To the best of our knowledge, for the Acetaminophen drugs, these indices have not been computed previously.

Essential Drug Targets and Pathways in PI-Resistant MM Cells

Background Proteasome inhibitors (PI) have emerged as a powerful, cell biology-based treatment option for multiple myeloma (MM) and build a central backbone for MM treatment with three proteasome-inhibiting drugs currently approved: bortezomib (BTZ), carfilzomib (CFZ) and ixazomib. However, despite the high anti-MM activity of PI, MM cells adapt to the selective pressure of PI treatment in most cases to date and most MM patients relapse during or after treatment with PI, develop PI-refractory disease and ultimately die. Therefore, understanding and overcoming PI resistance is a key challenge for MM therapy. Our previous in vitro studies on PI-resistant MM suggest that PI-adapted, MM cells show very distinct features of general metabolism and cell biology that differentiate them from PI-sensitive MM, derived from the same cell line. We hypothesize that this highly specialized and adapted nature of PI-resistant MM offers novel areas of vulnerability, that differ from the therapeutic targets in PI-sensitive MM. The aim of our study was to identify essential drug targets and pathways in PI-resistant MM using genome-wide functional screening with the CRISPR/Cas9 system that could serve as novel therapeutic targets in PI-resistant MM. Methods We used genome-wide CRISPR/Cas9-based loss-of-function screening with Brunello library in L363-BTZ and RPMI-8226-BTZ cells, adapted to grow in the presence of 90 nM BTZ. The overlapping bortezomib genetic sensitivity candidates were further validated in the set of BTZ-resistant cells (L363-BTZ, RPMI-8226-BTZ, MM1S-BTZ and AMO-BTZ) cells using shRNA silencing or single-gene specific knockout or genetic overexpression using CCK8 viability assay. Subsequent functional analysis of the highest ranking BTZ sensitivity candidates in BTZ-adapted cells included apoptosis and cell cycle analysis, qPCR and western blotting, SILAC, proteasome activity determination using activity-based probes and FRAP analysis. Results CRISPR/Cas9-screening identified two candidate genes for BTZ sensitivity, ECPAS (KIAA0368; Ecm29 Proteasome Adaptor and Scaffold protein) and PSME1 (an 11S regulator complex subunit), as consistent screening hits in two independent BTZ-adapted MM cell lines. Both genes are related to proteasome, but do not build the proteasome core particle and do not have a proteolytic activity. Specific knock-down or knock-out of ECPAS sensitized PI-naïve cells to BTZ and CFZ, while significantly more sensitizing BTZ-adapted cells to both PI. Likewise, overexpression of PSMF1, an inhibitor of 11S regulator complex, sensitized BTZ-resistant as well as sensitive cells to BTZ. ECPAS-depleted BTZ-adapted cells showed accumulation of poly-ubiquitinated proteasome substrate proteins, induction of the unfolded protein response, cell cycle arrest and induction of apoptosis, together with changes in protein synthesis after the treatment with 50 nM bortezomib, in contrast to BTZ-adapted control cells. FRAP analysis of cells with GFP-tagged PSMD6 revealed that the intracellular mobility of proteasomes in ECPAS-depleted cells was reduced. Importantly, proteasome activity determined by activity-based probes was not impaired in ECPAS-depleted cells. Conclusion In conclusion, BTZ-resistant MM cells uniquely show a high dependency on the proteasome adaptor and scaffold protein ECPAS, which has been shown to be involved in coupling of proteasome in different compartments and promotes proteasome dissociation under oxidative stress. Specifically in PI-resistant MM, ECPAS is important to ensure functional proteasome, is involved in controlling the intracellular mobility of proteasomes, likely to ensure high proteasome turnover. ECPAS therefore represents a novel candidate that may be targeted to specifically re-sensitize PI-resistant MM cells to proteasome inhibitor treatment. Disclosures No relevant conflicts of interest to declare.

Antiviral and antiretroviral drug shortages amidst COVID-19: How Africa is struggling

Antiviral drugs are of paramount importance in the accomplishment of the vision of zero new cases of COVID-19 globally, through sustainable retaliation against viral diseases. However, several challenges currently exist in Africa which include insufficient infrastructure, deteriorating health systems, and rising costs of healthcare delivery with concomitant rising inequity with regards to access to health services amid the COVID-19 pandemic. The pandemic itself has stimulated an increased use of phytotherapy in Africa as a result of essential drug shortages that have been attributed to a plethora of contributing factors such as travel restrictions, reduced per capita income as well as increased expenditure on transport. As a result, the paucity of antiviral along with antiretroviral drugs used to combat COVID-19 as well as several other endemic viral diseases in Africa has created a worrisome state. This article therefore discusses and aims to underscore the causes, effects, and implications of antiviral and antiretroviral shortages amid COVID-19 in Africa.

Assessment of veterinary drugs dispensing practices in veterinary clinics in Gondar town, North West Ethiopia: a cross sectional study

<p class="abstract"><strong>Background:</strong> Dispensing practice plays a major role in the provision of rational drug therapy. This study aimed to assess the veterinary drug dispensing practice by pharmacists and other veterinarian assistance in veterinary clinic Gondar town.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional prospective descriptive study was carried out in the OPD of three public veterinary clinics in Gondar town for three months. The health facility indicators were examined by ensuring the good dispensing practices in three veterinary clinic and availability of essential drug list.</p><p class="abstract"><strong>Results:</strong> The average consultation time was 13 min and 50 sec. The average dispensing time was 5 min and 3 sec calculated from 100 prescriptions. The percentage of drugs dispensed was 97.50% and percentage of drugs adequately labeled was high from the dispensed drugs (74.4%). The average patients with drug dosage knowledge were very low (25%). The result of the study revealed that the two veterinary clinic health facilities do not have any essential drug list. Out of three, one of them has a key drug from the WHO list 1 (30%) drug was available.</p><p class="abstract"><strong>Conclusions:</strong> The overall good dispensing practices at three veterinary clinics is low. Training, supportive supervision through continuous medical education, regular up-to-date medicine information and standard treatment guideline, and therapeutic audit are required for improvement of medicine use by prescriber and dispensers.</p>

Chemical injury induced by the use of topical imiquimod: case report

Chemical injury consists in damage caused by a substance when it comes into contact with living tissue. Certain drugs can cause this type of lesion in the oral mucosa. Imiquimod (INN) is an example. Erythema, edema, vesicles, erosions, ulcerations and inflammatory reactions are among the adverse effects associated with the use of INN. Nevertheless, since its effects disappear when terminating treatment, INN is still considered an essential drug in the treatment of condyloma acuminata, actinic cheilitis, superficial basal cell carcinoma and molluscum contagiosum. The objective of this work is to report a clinical case of a 34-year-old male patient presenting a symptomatic lesion on the lower and upper lip mucosa; while including a literature review on potential adverse effects when prescribing topical INN 5% for the oral mucosa.