A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh

<p>Abstract</p> <p>Background</p> <p>Understanding injection practices is crucial for evidence-based development of intervention initiatives. This study explored the extent of injection use and injection safety practices in primary care hospitals in Bangladesh.</p> <p>Methods</p> <p>The study employed both quantitative and qualitative research methods. The methods used were - a retrospective audit of prescriptions (n = 4320), focus group discussions (six with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined.</p> <p>Results</p> <p>As many as 78% of our study sample (n = 4230) received an injection. The most commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%), analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health providers' safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n = 2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the injection providers and 90% (n = 43/48) of the waste handlers were not trained in injection safety practices and infection prevention. Qualitative data further confirmed that both providers and patients preferred injections, believing that they provide quick relief. The doctors' perceived injection use as their prescribing norm that enabled them to prove their professional credibility and to remain popular in a competitive health care market. Additionally, persistent pressure from hospital administration to use up injections before their expiry dates also influenced doctors to prescribe injections regardless of actual indications.</p> <p>Conclusions</p> <p>As far as the patients and providers' safety is concerned, this study demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a context where a high level of injection use and unsafe practices were reported, immediate prevention initiatives need to be operated through continued intervention efforts and health providers' training in primary care hospitals in Bangladesh.</p

Stamford Journal of Pharmaceutical Sciences Formulation Development and Evaluation of Mouth Dissolving Tablets of Loratadine

Difficulty in swallowing (dysphagia) is common among all age groups, especially in elderly and pediatrics. Mouth dissolving tablets constitute an innovative dosage forms that overcome the problems of swallowing and provides a quick onset of action. The purpose of this study was to formulate and evaluate mouth dissolving tablet of loratadine using a special preparation technology (pharmaburst Technology) with a super disintegrating agent (Croscarmellose sodium). Tablets were prepared by direct compression technique. The granules were evaluated for angle of repose, bulk density, tapped density, bulkiness, compressibility index and hausners ratio. The tablets were evaluated for hardness, thickness, uniformity of weight, friability, wetting time, water absorption ratio, disintegration time and drug content. In vitro release studies were performed using USP-II (paddle method) in 900ml of pH 1.2 at 50rpm. The physical properties of the prepared tablets did not show any significant variations and were found to have good physical integrity. Tablets prepared with pharmaburst B2 and Croscarmellose sodium showed a lesser disintegration time and wetting time of 27±0.10 and 38±0.13 seconds respectively. The best formulations were subjected to stability studies at 40ºC/75 % RH for 60 days

Design, Fabrication and Evaluation of Drug Release Kinetics from Aceclofenac Matrix Tablets using Hydroxypropyl Methyl

ABSTRACT: The objective of this study was to develop a sustained release matrix tablet of aceclofenac using hydroxypropyl methylcellulose (HPMC K15M and HPMC K100M CR) in various proportions as release controlling factor by direct compression method. The powders for tableting were evaluated for angle of repose, loose bulk density, tapped bulk density, compressibility index, total porosity and drug content etc. The tablets were subjected to thickness, weight variation test, drug content, hardness, friability and in vitro release studies. The in vitro dissolution study was carried out for 24 hours using United States Pharmacopoeia (USP) 22 paddle-type dissolution apparatus in phosphate buffer (pH 7.4). The granules showed satisfactory flow properties, compressibility index and drug content etc. All the tablets complied with pharmacopoeial specifications. The results of dissolution studies indicated that the formulations F-2 and F-3 could extend the drug release up to 24 hours. By comparing the dissolution profiles with the marketed product, it revealed that the formulations exhibited similar drug release profile. From this study, a decrease in release kinetics of the drug was observed when the polymer concentration was increased. Kinetic modeling of in vitro dissolution profiles revealed the drug release mechanism ranges from diffusion controlled or Fickian transport to anomalous type or non-Fickian transport, which was only dependent on the type and amount of polymer used. The drug release followed both diffusion and erosion mechanism in all cases. The drug release from these formulations was satisfactory after 3 months storage in 40 0 C and 75 % RH. Besides, this study explored the optimum concentration and effect of polymer(s) on acelofenac release pattern from the tablet matrix for 24 hour period. Key words: Aceclofenac, sustained release, hydrophillic matrix, HPMC, direct compression

Adolescent Male Reproductive Health Knowledge and Practices in Bangladesh

Abstract: Opinions on reproductive health education at the onset of puberty at present were studied by using a structured questionnaire consisting of 13 questions with a view to know their conception about it. A total of 800 male students were randomly selected of which 400 were from two public and the rest 400 from private universities situated in Dhaka, Bangladesh. At least half of the university students (384, 48%) did not understand much about puberty and remained confused. A large number of adolescents felt shy (208, 26%), scared (56, 7%), least bothered (112, 14%) and were not at all aware (40, 5%) of their onset of puberty. The respondents reported to have discussion their pubertal changes mainly with their male peers (672, 84%) and a very little access to parents (16, 2%) and elder brothers (16, 2%). A few respondents talked with their teachers (40, 5%). Their shared feelings were not informative and rather incorrect for maintaining good reproductive health at a growing time. On the contrary, they were rather warned by the persons not to disclose it to others. Most of the respondents (672, 84%) felt sex education is essential for better reproductive health management, a few of them (88, 11%) opposed this idea and some of them remained silent (40, 5%). Half of the respondents (760, 50%) preferred reproductive health education should be included in secondary and higher secondary levels (375, 25%), in the university level (166, 11%) and very few wanted it to be included in primary level (93, 6%). A few number of respondents (92, 6%) preferred non-formal reproductive health education. Some of the respondents (785, 23%) wanted to learn through curriculum and discussion with partners o

Design and Formulation of Once Daily Naproxen SustainedRelease Tablet Matrix from Methocel K 15M CR and Methocel K 100M CR: Formulation of naproxen SR tablet matrix

The purpose of this work was to develop once daily sustained release (SR) matrix tablets of naproxen, an anti-inflammatory agent. The tablets were prepared by wet granulation method along with hydrophilic matrix materials like Methocel K 15M CR and Methocel K 100M CR. The granules were evaluated for bulk density, angle of repose, compressibility index, total porosity and drug content. The tablets subjected to thickness, diameter, weight variation test, drug content, hardness,friability, and in vitrorelease studies in buffer medium (pH, 7.4). The granules prepared either by Methocel K 15M CR or Methocel K 100M CR did not show satisfactory flow properties and compressibility, and had difficulty in sieving and individual in drug release. On the other hand, tablet matrix prepared along with Methocel K 15M CR and Mehtocel K 100 LVCR polymers of the proposed formulation F-8 showed desired drug release up to 24 h. All the formulations followed first order release kinetics (except F-2 and F-4), exhibited diffusion dominated drug release when data plotted into Korsmeyer Peppas equation. The matrix tablet of naproxen using hydroxypropyl methylcellulose derivatives controls the drug release effectively for 24 h; hence, the formulation can be considered as once daily sustained release tablet of naproxen in order to improve patient compliance

In-vitro Release Study of Carvedilol Phosphate Matrix Tablets Prepared with Hydroxypropyl Methylcellulose

Purpose: To evaluate the effect of two molecular weight grades of hydroxypropyl methylcellulose on the release characteristics of carvedilol phosphate matrix tablets. Methods: Matrix tablets containing carvedilol phosphate were prepared from 27 formulations in three batch series coded A, B and C, each containing 9 formulations. Each batch incorporated different ratios of two molecular weight grades of hydroxypropyl methylcellulose (Methocel® K4M CR and K15M CR) used as release retarding agents. Microcrystalline cellulose (Avicel PH 101), starch (Sta-Rx 1500) and lactose monohydrate were used as diluents in the formulations while the effect of sodium lauryl sulphate (wetting agent) was studied for some of the formulations. The tablets were characterized for carvedilol phosphate release in both simulated gastric and intestinal fluids. The data were subjected to different models in order to determine their release kinetics and mechanisms. Results: All the batches released more than 50 % of their carvedilol content in 12 h when Methocel® K4M CR and K15M CR constituted 18 % and 15 % of the matrix, respectively. Avicel® PH 101 decreased while Starch 1500 and lactose monohydrate increased drug release. Drug release mechanism was predominantly diffusion. Conclusion: By using varying combinations of two molecular weight grades of hydroxypropyl methylcellulose as the matrix, controlled or sustained release carvedilol tablets of varying release characteristics can be prepare

Chemical and Biological Investigation of Leaves of Polygonum plebejum

The cytotoxic and antimicrobial activity of methanol crude extract and column fractions of the extract of the leaves of P. plebejum were examined by brine shrimp lethality bioassay and disc diffusion method respectively. The extracts showed significant cytotoxic as well as antimicrobial activities. Silica gel column chromatography of methanol extract of P. plebejum afforded a steroid. The structure was elucidated on the basis of spectral analysis, including 1 H NMR and 13 C NMR and also by comparing with data in the literature

Stamford Journal of Pharmaceutical Sciences Simultaneous Estimation of Naproxen and Ranitidine HCl by Using UV Spectrophotometer

The development of a UV Spectrophotometric method for simultaneous estimation of Ranitidine HCl and Naproxen involves absorbance measurement of Ranitidine HCl at 313 nm in pH 7.4 phosphate buffer and 314 nm in both 0.1N HCl and in water and that of Naproxen at 229 nm in pH 7.4 phosphate buffer and 232 nm in both 0.1N HCl and in water corresponding to the respective absorption maxima. Both the drugs obey Beer- Lambert&apos;s law in the range of 5-25 µg/ml for Ranitidine HCl and 0.2-1.25 µg/ml for Naproxen. The method developed was validated to determine its linearity, precision, reproducibility and sensitivity. The tablet formulations were evaluated for the percent content of both the drugs at the selected wavelengths and the percent potency were 98.83 and 99.15 for Naproxen and Ranitidine HCl respectively