DRUG UTILIZATION BASED ADRS MONITORING OF ANTIHYPERTENSIVE AGENTS PRESCRIBED IN AL-QUWAYIYAH GENERAL HOSPITAL, SAUDI ARABIA

Objective: To monitor drug utilization based adverse drug reactions (ADRs) of antihypertensive agents prescribed in Al-Quwayiyah general hospital, Saudi Arabia.Methods: An open, non-comparative, observational study was conducted on hypertensive patients attending the medicine outpatient department of Al-Quwayyah general hospital, Al-Quwayyah, Saudi arabia. Data were collected by conducting patient interviews. Data were captured for adverse drug reaction monitoring based on Narinjo scale and WHO format.Results: 25 ADRs were observed out of 212 hypertensive patients. Incidence was found to be higher in patients more than 40 y age, and females experienced more ADRs (n = 16, 7.54%) than males, 9 (4.62%). Combination therapy was associated with more number of ADRs (64.0%) as against monotherapy (36.0%). Calcium channel blockers were found to be the most frequently associated drugs with ADRs (n = 8), followed by diuretics (n = 6), and β-blockers (n = 5). Among individual drugs, amlodipine was found to be the commonest drug associated with ADRs (n = 8), followed by torasemide (n = 4). ADRs associated with the central nervous system was found to be the most frequent (48.0%) followed by musculoskeletal complaints (20.0%) and respiratory system disorders (16.0%).Conclusion: ADRs were experienced by taking the antihypertensive drugs prescribed in Al-Quwayyah general hospital, Saudi arabia. The findings would be useful for physicians in rational prescribing. Calcium channel blockers were found to be the most frequently associated drugs with ADRs

DRUG UTILIZATION BASED ADRs DETECTION OF ANTIBIOTICS PRESCRIBED FOR LRTI IN TERTIARY CARE TEACHING HOSPITAL, NEW DELHI

Objective: Aim of to present study was to assess drug utilization pattern of antibiotics use in Lower respiratory tract infection and their adverse drug reaction assessment.Methods: The present study was an observational and prospective study. 110 patients fulfill the inclusion criteria were included in study. Physician prescription records, patient's medication profile types of antibiotics prescribed were recorded and analyzed.Results: Out of 110 LRTI patients, 74 (67.27%) patients were male and 36(32.72%) patients were female. 72 patients were suffered from bronchitis while 38 patients were suffering from pneumonia. 30 patients were in the age range of 56-65 y, followed by 21 patients who were in the age range of 66-75 y. It has been observed that among all the prescribed antibiotic agent's frequency of β-lactam 199(45.53%), quinolones115 (26.27%), macrolides 53(12.12%) chloramphenicol44 (10.06%) sulphonamide 17 (3.89%) and aminoglycosides 9(2.05%) were prescribed to all the patients. Average 3.97 antibiotic agents were prescribed to all the patients. Majority of drugs were given by oral route (68.19%) and Prescriptions are mainly ordered in brand names. The most frequent co-morbid condition was found to be diabetes mellitus (25.45%) followed by hypertension (16.36%) and coronary artery disease (11.81%).45.45%. Only 23 ADRs were detected in 110 patients. The most common culprit was an amoxicillin with clavulanic acid.Conclusion: The present study provides an overall pattern of antibiotic usage in different patients. The area of concern in the present study is polypharmacy and use of antibiotics in LRTI without following any guideline. ADRs monitoring is also required to prevent noxious effects of drugs by the use of antibiotics

The role of socio-economic factors responsible for non-compliance of directly observed treatment short-course among tuberculosis patients

Introduction: Tuberculosis has gone out of control in many parts of world. The therapeutic regimens given under direct observation as recommended by world Health Organization have been shown to be highly effective for both preventing and treating tuberculosis but poor compliance to anti-tuberculosis medication (ATT) is a major barrier to its global controls. Objectives: The role of socio-economic factors responsible for non-compliance of directly observed treatment short-course (DOTS) among Tuberculosis Patients. Materials and Methods: Cross sectional study, interviewed using a set of questionnaire. Participants were enrolled at DOTS centre of Lala Ram Sarup Institute of tuberculosis and Respiratory disease New Delhi, India. Patients who interrupted treatment for more than 2 months consecutively were classified as non-compliance cases. T-test was used for comparing the means of the control and case groups. Results: Majority of study population (45%) was in age group of 31 -45 years, which is the productive age. 85 % noncompliant patients believed anti TB drugs to be bad and 15 % accepted as good for them. Similarly 87 % believed to stop ATT very prematurely as soon as symptoms disappear while 13 % believed to continue as per DOTS volunteer advice. The study revealed that the non-compliance of DOTS was significantly high among those who were less educated, unskilled worker, low family income and upper lower class family. Conclusion: In Delhi region, the treatment of Tuberculosis was good and did not have much involvement of socio-economical role in the non-compliance of treatment. But still major hurdle is the inadequate education, occupation, and income

In-Vivo assessment of glucocorticoid loaded tea tree oil nanoemulsion gel

Optimized formulations were subjected to various in vivo studies like anti-inflammatory activity, Nickel induced dermatitis, irritation study and Acute and repeated dose dermal toxicity studies. Clobetasol propionate (CP) has anti-inflammatory, immunomodulatory, and antiproliferative activity. The aim of the present work was to test the hypothesis that the addition CP in nanoemulsions would result in enhancement CP delivery and leading to better antipsoriatic activity. Nanoemulsions were prepared by aqueous phase titration method, using Tea Tree oil, Tween 20, Transcutol P, and distilled water as the oil phase, surfactant, co-surfactant and aqueous phase, respectively.We developed a topical O/W nanoemulsion in which drug is incorporated in disperse phase of oil and evaluated its efficacy against different types of in vivostudies. It was also found that the significantly increased their anti-inflammatory activity. It was reported that CP-loaded nanoemulsion significantly increased NTPDase (Nucleoside triphosphate diphosphohydrolases) activity in lymphocytes. This membrane protein is responsible for the hydrolysis of extracellular ATP (Adenosine triphosphate) which is responsible for cell proliferation, differentiation and inflammatory processes. In vivoirritation studies did not show any irritation in spite of having high amount of surfactant. Group treated with CP loaded nanoemulsion gel showed no evident toxicity even on repeated exposure. On the basis of above in vivo study we conclude that developed nanoemulsion is safe for human. Keywords: Clobetasol propionate, In-vivo study, Nanoemulsion, Anti-inflammatory study, Toxicity stud

Effects of aliskiren on hemodynamic parametersin daunorubicin -induced acute cardiomyopathy in rats

Daunorubicin ((DNR)) used in oncological practice against a wide variety of solid organ tumors and hematologic malignancies, including leukemia, lymphoma, breast cancer, lung cancer, multiple myeloma and sarcoma. however clinical use of this agent is limited due to cardiomyopathy and cardiac heart failure. one of the important player in the development of cardic hypertrophy and reperfusion injury is renin-angiotensin system. Aliskiren (ALK) a recent drug of a direct inhibitor of the renin enzyme. It Protect cardiomyopathy by the inhibition of the renin activity. Present study is towards the evaluation of protective effcets of ALK 50 and 100 mg/kg/day in rats. The systolic, diastolic, mean BP and heart rate were significantly (P< 0.01) increased in DNR control group as compared to normal control group. Thus the results provide clear evidence that the ALK pretreatment offered significant protection against DNR-induced Hemodynamic parameters changes.  Keywords: Daunorubicin, Cardiomyopathy, Aliskiren, Telmisartan and Hemodynamic parameter

Formulation, Optimization and Evaluation of Eudragit RL 100 nanoparticles loaded with Quercetin for its Hypolipidemic action by using Animal Model

Quercetin, a potent pharmacological active phytocompound, plays a crucial role in drug therapy. However, its essential role is limited due to poor water solubility and low bioavailability. To overcome these limitations and enhance oral bioavailability, Quercetin loaded Eudragit nanoparticles were prepared using a single emulsification solvent evaporation method and optimized by applying Box-Behnken design. This study aimed to investigate the anti-hyperlipidemic potential of Quercetin in Triton WR-1339 induced hyperlipidemic rats. Hyperlipidemia was induced in rats using Triton WR-1339, and the hypolipidemic potential of Quercetin was evaluated at doses of 50 and 100 mg/kg. The results revealed that Quercetin significantly (p ≤ 0.005) altered the serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, bringing them close to normal levels in Triton WR-1339 induced hyperlipidemic rats. Furthermore, both doses of Quercetin (50 and 100 mg/kg) showed significant reductions in TC and TG levels when compared to the standard atorvastatin treatment. The novel formulation of Quercetin loaded Eudragit polymeric nanoparticles displayed remarkable potential as a green antihyperlipidemic agent. These findings suggest that Quercetin loaded Eudragit nanoparticles can effectively mitigate hyperlipidemia and have the potential to be a promising therapeutic option for lipid disorders. The enhanced bioavailability and bioactivity of Quercetin delivered through this novel formulation open new possibilities for its clinical application in managing hyperlipidemia. Further research and clinical studies are warranted to explore its translational potential and wider applications in drug therap

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 071 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 502% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.SUPPORTING INFORMATION : FIGURE S1. Data coverage by year. Here we visualise the volume of data used in the analysis by country and year. Larger circles indicate more data inputs. ‘NA’ indicates records for which no year was reported (eg, ‘pre-2000’). https://doi.org/10.1371/journal.pntd.0008824.s001FIGURE S2. Illustration of covariate values for year 2000. Maps were produced using ArcGIS Desktop 10.6. https://doi.org/10.1371/journal.pntd.0008824.s002FIGURE S3. Environmental suitability of onchocerciasis including locations that have received MDA for which no pre-intervention data are available. This plot shows suitability predictions from green (low = 0%) to pink (high = 100%), representing those areas where environmental conditions are most similar to prior pathogen detections. Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s003FIGURE S4. Environmental suitability prediction uncertainty including locations that have received MDA for which no pre-intervention data are available. This plot shows uncertainty associated with environmental suitability predictions colored from blue to red (least to most uncertain). Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s004FIGURE S5. Environmental suitability of onchocerciasis excluding morbidity data. This plot shows suitability predictions from green (low = 0%) to pink (high = 100%), representing those areas where environmental conditions are most similar to prior pathogen detections. Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s005FIGURE S6. Environmental suitability prediction uncertainty excluding morbidity data. This plot shows uncertainty associated with environmental suitability predictions colored from blue to red (least to most uncertain). Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. https://doi.org/10.1371/journal.pntd.0008824.s006FIGURE S7. Covariate Effect Curves for all onchocerciasis occurrences (measures of infection prevalence and disability). On the right set of axes we show the frequency density of the occurrences taking covariate values over 20 bins of the horizontal axis. The left set of axes shows the effect of each on the model, where the mean effect is plotted on the black line and its uncertainty is represented by the upper and lower confidence interval bounds plotted in dark grey. The figures show the fit per covariate relative to the data that correspond to specific values of the covariate. https://doi.org/10.1371/journal.pntd.0008824.s007FIGURE S8. Covariate Effect Curves for all onchocerciasis occurrences (measures of infection prevalence and disability). On the right set of axes we show the frequency density of the occurrences taking covariate values over 20 bins of the horizontal axis. The left set of axes shows the effect of each on the model, where the mean effect is plotted on the black line and its uncertainty is represented by the upper and lower confidence interval bounds plotted in dark grey. https://doi.org/10.1371/journal.pntd.0008824.s008FIGURE S9. ROC analysis for threshold. Results of the area under the receiver operating characteristic (ROC) curve analysis are presented below, with false positive rate (FPR) on the x-axis and true positive rate (TPR) on the y-axis. The red dot on the curve represents the location on the curve that corresponds to a threshold that most closely agreed with the input data. For each of the 100 BRT models, we estimated the optimal threshold that maximised agreement between occurrence inputs (considered true positives) and the mean model predictions as 0·71. https://doi.org/10.1371/journal.pntd.0008824.s009TABLE S1. Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) checklist. https://doi.org/10.1371/journal.pntd.0008824.s010TABLE S2. Total number of occurrence data classified as point and polygon inputs by diagnostic. We present the total number of occurrence points extracted from the input data sources by diagnostic type. ‘Other diagnostics’ include: DEC Patch test; Knott’s Method (Mazotti Test); 2 types of LAMP; blood smears; and urine tests. https://doi.org/10.1371/journal.pntd.0008824.s011TABLE S3. Total number of occurrence data classified as point and polygon inputs by location. https://doi.org/10.1371/journal.pntd.0008824.s012TABLE S4. Covariate information. https://doi.org/10.1371/journal.pntd.0008824.s013TEXT S1. Details outlining construction of occurrence dataset. https://doi.org/10.1371/journal.pntd.0008824.s014TEXT S2. Covariate rationale. https://doi.org/10.1371/journal.pntd.0008824.s015TEXT S3. Boosted regression tree methodology additional details. https://doi.org/10.1371/journal.pntd.0008824.s016APPENDIX S1. Country-level maps and data results. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s017This work was primarily supported by a grant from the Bill & Melinda Gates Foundation OPP1132415 (SIH). Financial support from the Neglected Tropical Disease Modelling Consortium (https://www.ntdmodelling.org/), which is funded by the Bill & Melinda Gates Foundation (grants No. OPP1184344 and OPP1186851), and joint centre funding (grant No. MR/R015600/1) by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union (MGB).The Neglected Tropical Disease Modelling Consortium which is funded by the Bill & Melinda Gates Foundation, the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union (MGB).http://www.plosNTDS.orgam2022Medical Microbiolog

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed