Randomised primary health center based interventions to improve the diagnosis and treatment of undifferentiated fever and dengue in Vietnam

<p>Abstract</p> <p>Background</p> <p>Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengue, are the main causes of undifferentiated fever but they are often misdiagnosed and inappropriately treated with antibiotics.</p> <p>This study investigate if educating primary health center (PHC) staff or introducing rapid diagnostic tests (RDTs) improve diagnostic resolution and accuracy for acute undifferentiated fever (AUF) and reduce prescription of antibiotics and costs for patients.</p> <p>Methods</p> <p>In a PHC randomized intervention study in southern Vietnam, the presumptive diagnoses for AUF patients were recorded and confirmed by serology on paired (acute and convalescence) sera. After one year, PHCs were randomized to four intervention arms: training on infectious diseases (A), the provision of RDTs (B), the combination (AB) and control (C). The intervention lasted from 2002 until 2006.</p> <p>Results</p> <p>The frequency of the non-etiologic diagnosis "undifferentiated fever" decreased in group AB, and - with some delay- also in group B. The diagnosis "dengue" increased in group AB, but only temporarily, although dengue was the most common cause of fever. A correct diagnosis for dengue initially increased in groups AB and B but only for AB this was sustained. Antibiotics prescriptions increased in group C. During intervention it initially declined in AB with a tendency to increase afterwards; in B it gradually declined. There was a substantial increase of patients' costs in B.</p> <p>Conclusions</p> <p>The introduction of RDTs for infectious diseases such as dengue, through free market principles, does improve the quality of the diagnosis and decreases the prescription of antibiotics at the PHC level. However, the effect is more sustainable in combination with training; without it RDTs lead to an excess of costs.</p

Drug dosing during pregnancy—opportunities for physiologically based pharmacokinetic models

Drugs can have harmful effects on the embryo or the fetus at any point during pregnancy. Not all the damaging effects of intrauterine exposure to drugs are obvious at birth, some may only manifest later in life. Thus, drugs should be prescribed in pregnancy only if the expected benefit to the mother is thought to be greater than the risk to the fetus. Dosing of drugs during pregnancy is often empirically determined and based upon evidence from studies of non-pregnant subjects, which may lead to suboptimal dosing, particularly during the third trimester. This review collates examples of drugs with known recommendations for dose adjustment during pregnancy, in addition to providing an example of the potential use of PBPK models in dose adjustment recommendation during pregnancy within the context of drug-drug interactions. For many drugs, such as antidepressants and antiretroviral drugs, dose adjustment has been recommended based on pharmacokinetic studies demonstrating a reduction in drug concentrations. However, there is relatively limited (and sometimes inconsistent) information regarding the clinical impact of these pharmacokinetic changes during pregnancy and the effect of subsequent dose adjustments. Examples of using pregnancy PBPK models to predict feto-maternal drug exposures and their applications to facilitate and guide dose assessment throughout gestation are discussed

Interaction between Antimarial and Antibacterials as possible contributor to development of multi-drug resistant P. falciparum in a malaria endemic region

In recent times clinical outcomes following the use of the major anti malarial drugs such chloroquine and sulphadoxine – pyrimethamine, has become complicated and difficult to predict because of the increasing prevalence of multi-drug resistant P. falciparum malaria. Consequently, the armamentarium of sale and efficacious drugs required to wage a successful war against malaria is beginning to dwindle. Although newer chemotherapeutic strategies, such as the use of artemisinin combination regimen, have been employed to overcome this problem, there remains a need to safeguard the few compounds available from falling into the pitfalls arising from possible mistakes of the past. This paper reviews measures that have been take so far to tackle the malaria drug resistance problem and focuses on an aspect, which has remained largely under appreciated – the possible role of antimalarial-antibacterial interaction in the selection and spread of mutant strains of P. falciparum in a malaria endemic region where both classes of compounds are frequently co-administered. NQJHM Vol. 16 (1) 2005: pp. 30-3

Comparative double blind study of the efficacy and safety of tenoxicam vs. Piroxicam in extra - articular inflammatory conditions

No Abstract. NQJHM Vol. 8 (2) 1998: pp. 120-12

Orlistat vs Placebo in the Inhibition of Dietary Fat in Obese Adult Nigerian Volunteers

Objective: To compare the efficacy and safety of orlistat (120mg tid) versus placebo in the inhibition of dietary fat absorption in healthy adult Nigerian volunteers. Method: This was a double blind randomised cross-over study, with each arm of the cross-over lasting 4 weeks with a one week placebo run-in period before and in-between treatment. Four males and 16 females, with a mean BMI of 35.1 and a mean age of 40.08 years, participated in the study. Prior to allocation to treatment, subjects were given placebo for a 7-day period, while receiving a moderate hypocaloric supporting diet as prescribed for each individual by the dietician. During this period, a 72-hour faeces was collected from each subject for estimation of baseline faecal fat excretion. Additionally blood and urine samples were collected for evaluation of plasma lipid profile, haemogram, blood chemistry and urinalysis. Subjects were assigned to treatment according to their enrolment number i. e. subject no. 1 received treatment labelled DBN 1. Each subject was given a weekly pack of medication as specified in the label. The subjects took one capsule three times a day with the prescribed diet. At the end of each week of treatment, subjects were required to submit 24-hr faeces for faecal fat estimation. Blood samples were collected at week 5 and week 10 for haematological profile, lipid profile, blood chemistry and liver function tests. At each weekly clinical visit, subjects were questioned closely on the incidence of any adverse event, they also discussed their diet with the dietician. At the end of the study the emergency code envelopes were opened and the subjects were assigned into groups according to the treatment sequence, the sequence Placebo/ Orlistat were assigned group 1 and Orlistat/ Placebo group 2. Results: The difference in faecal fat excretion with orlistat compared to placebo was significant (