ACUTE TOXICITY STUDIES AND ANTIDOTAL THERAPY OF ETHANOL EXTRACT OF JATROPHA CURCAS SEEDS IN EXPERIMENTAL ANIMALS

In spite of the myriad of ethno medical uses and agro-feed potential of Jatropha curcas (JC) seeds and the potential for production of biodiesel, toxic properties have been adduced to the plant, especially the seeds. Thus, the current study was done with the aim of investigating the toxicity of the ethanol seed extract of JC in rats, mice, and chicks; and also to use conventional antidotes to treat intoxication in rats due to JC poisoning.The LD50 of the ethanol extract of the JC seed was determined by the method initially described by Lorke. In addition, acute behavioral and CNS toxicity studies of JC including antidotal therapy against JC poisoning were done. The data was analysed using SPSS and results were expressed as mean ± SEM. p < 0.05 was considered significant.The LD50 of IPJC extract ranged from 177.48 to 288.53 mg/kg (moderately toxic) for the adult female rat, adult male mouse, and young male rat. For the adult male rats, the LD50 values were 565.69 mg/kg (IP, slightly toxic) and >5000 mg/kg (oral, slightly toxic) and the LD50 of the JC extract for the chicks was 28.28 mg/kg (IP, highly toxic). JC produced a fairly dose-dependent behavioral and CNS depressant effects which were reduced by atropine, EDTA and a combination of atropine, sodium nitrite & sodium thiosulphate, and EDTA. Also, these antidotes either singly or in combination reduced mortality among the rats by 25-50%.In conclusion, the ethanol extract of JC seeds produces behavioral changes in experimental animals possibly in part by CNS depression which were ameliorated by atropine or EDTA and a combination of antidotes. Thus, these antidotes particularly atropine, may be exploited in the management of JC poisoning

Establishing an antimicrobial stewardship program in Sierra Leone: a report of the experience of a low-income country in West Africa

Antimicrobial Resistance (AMR) is a growing global health challenge that threatens to undo gains in human and animal health. Prevention and control of AMR requires functional antimicrobial stewardship (AMS) program, which is complex and often difficult to implement in low- and middle-income countries. We aimed to describe the processes of establishing and implementing an AMS program at Connaught Hospital in Sierra Leone. The project involved the setting up of an AMS program, capacity building and performing a global point prevalence survey (GPPS) at Sierra Leone's national referral hospital. Connaught Hospital established a multidisciplinary AMS subcommittee in 2021 to provide AMS services such as awareness campaigns, education and training and review of guidelines. We performed a GPPS on 175 patients, of whom more than half (98, 56.0%) were prescribed an antibiotic: 63 (69.2%) in the surgical wards and 53 (51.2%) in the medical wards. Ceftriaxone (60, 34.3%) and metronidazole (53, 30.3%) were the most common antibiotics prescribed to patients. In conclusion, it is feasible to establish and implement an AMS program in low-income countries, where most hospitalized patients were prescribed an antibiotic

An Assessment of Medication Errors Among Pediatric Patients in Three Hospitals in Freetown Sierra Leone: Findings and Implications for a Low-Income Country

Onome T Abiri,1,2 Alex Ninka,3 Joshua Coker,4 Fawzi Thomas,2,5 Isaac O Smalle,6 Sulaiman Lakoh,4 Foday Umaro Turay,7 James Komeh,2,3 Mohamed Sesay,2,7 Joseph Sam Kanu,8 Ayeshatu M Mustapha,9 Nellie VT Bell,9 Thomas Ansumus Conteh,2,5 Sarah Kadijatu Conteh,10 Alhaji Alusine Jalloh,10 James BW Russell,4 Noah Sesay,3 Mohamed Bawoh,1 Mohamed Samai,1 Michael Lahai7 1Department of Pharmacology and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 2Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone; 3Department of Clinical Pharmacy and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 4Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 5Department of Pharmaceutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 6Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 7Department of Pharmaceutical Chemistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 8Department of Community Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 9Department of Pediatrics, Ola During Children Hospital, Freetown, Sierra Leone; 10Department of Pediatrics, King Harman Road Maternity and Children Hospital, Freetown, Sierra LeoneCorrespondence: Onome T Abiri, Department of Pharmacology and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone Freetown, Sierra Leone/Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone, Tel +23276370315, Email [email protected]: Pediatric patients are prone to medicine-related problems like medication errors (MEs), which can potentially cause harm. Yet, this has not been studied in this population in Sierra Leone. Therefore, this study investigated the prevalence and nature of MEs, including potential drug-drug interactions (pDDIs), in pediatric patients.Methods: The study was conducted in three hospitals among pediatric patients in Freetown and consisted of two phases. Phase one was a cross-sectional retrospective review of prescriptions for completeness and accuracy based on the global accuracy score against standard prescription writing guidelines. Phase two was a point prevalence inpatient chart review of MEs categorized into prescription, administration, and dispensing errors and pDDIs. Data was analyzed using frequency, percentages, median, and interquartile range. Kruskal–Wallis H and Mann–Whitney U-tests were used to compare the prescription accuracy between the hospitals, with p< 0.05 considered statistically significant.Results: Three hundred and sixty-six (366) pediatric prescriptions and 132 inpatient charts were reviewed in phases one and two of the study, respectively. In phase one, while no prescription attained the global accuracy score (GAS) gold standard of 100%, 106 (29.0%) achieved the 80– 100% mark. The patient 63 (17.2%), treatment 228 (62.3%), and prescriber 33 (9.0%) identifiers achieved an overall GAS range of 80– 100%. Although the total GAS was not statistically significant (p=0.065), the date (p=0.041), patient (p=< 0.001), treatment (p=0.022), and prescriber (p=< 0.001) identifiers were statistically significant across the different hospitals. For phase two, the prevalence of MEs was 74 (56.1%), while that of pDDIs was 54 (40.9%). There was a statistically positive correlation between the occurrence of pDDI and number of medicines prescribed (r=0.211, P=0.015).Conclusion: A Low GAS indicates poor compliance with prescription writing guidelines and high prescription errors. Medication errors were observed at each phase of the medication use cycle, while clinically significant pDDIs were also reported. Thus, there is a need for training on prescription writing guidelines and medication errors.Keywords: pediatrics, prescription, medication errors, drug-drug interactions, Sierra Leon

The Sierra Leone Trial to Introduce a Vaccine Against Ebola: An Evaluation of rVSVΔG-ZEBOV-GP Vaccine Tolerability and Safety during the West Africa Ebola Outbreak

The West Africa Ebola epidemic stimulated rapid implementation of Ebola vaccine trials in the 3 highly affected countries. In Sierra Leone, we studied the recombinant vesicular stomatitis virus Ebola vaccine (rVSVΔG-ZEBOV-GP) safety and efficacy. The Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE) was a randomized, unblinded Phase 2/3 trial with phased vaccine introduction, no placebo, and concurrent evaluation of vaccine safety and efficacy. Healthcare and frontline response workers in 5 districts were randomized to immediate or deferred (18-24 weeks later) vaccination and followed for 6 months postvaccination. We enrolled 8651 participants from April through August 2015; 7998 were vaccinated. No participants developed Ebola virus disease so an efficacy assessment was not possible. Overall, 132 (1.5%) participants experienced serious adverse events (SAEs); none were vaccine-related. In a detailed safety substudy (N = 436), vaccinated participants reported significantly more systemic adverse events (AEs) within 7 days than unvaccinated participants including fever higher than 38°C (20.5% vs 3.9%), headache (71.2% vs 22.1%), fatigue (50.7% vs 10.4%), and joint pain (31.7% vs 6.5%); most AEs were mild to moderate severity and resolved within 5 days. During days 5-28, vaccinated participants more commonly reported joint pain (17.0% vs 4.8%) and rash (7.8% vs 1.7%) (P<.05 for both comparisons). Vaccinated participants also more commonly reported skin vesicles (2.0% vs 0%) and mouth ulcers (2.0% vs 0%) but only during days 8-14 (P<.05 for both comparisons). Among almost 8000 high-risk workers vaccinated during the Sierra Leone Ebola epidemic, rVSVΔG-ZEBOV-GP was generally well tolerated with no vaccine-related SAEs. Reported joint pain, rash, skin vesicles, and mouth ulcers postvaccination are consistent with conditions associated with transient viral replication described among participants in other trials