Cellulosic on Transdermal Drug Delivery System: A Review

Transdermal patch is a medicated adhesive patch that is placed on the skin to deliver the drug through the skin in order to achieve systemic absorption of drug at a predetermined rate over a prolonged period of time. The amalgamation of polymer and pharmaceutical sciences led to the introduction of polymer in the design and development of drug delivery systems. Polymeric delivery systems are mainly intended to achieve controlled or sustained drug delivery. Polysaccharides fabricated into hydrophilic matrices remain popular biomaterials for controlled-release dosage forms and the most abundant naturally occurring biopolymer is cellulose; thus, hydroxypropyl methylcellulose (HPMC), hydroxypropyl cellulose (HPC), microcrystalline cellulose (MCC) and ethyl cellulose (EC) can be used for production of controlled transdermal drug delivery systems (TDDS). This paper assembles the current knowledge on the structure and chemistry of cellulose, and in the development of innovative cellulose esters and ethers for controlled release TDDS. In addition, bacterial cellulose applications through chemical modiï¬cation as a new TDDS will be discussed. Key words: Cellulosic, Transdermal Drug Delivery System, Bacterial Cellulose, Adhesive Patc

INTERVENTIONS TO IMPROVE ADHERENCE TO ANTIRETROVIRAL MEDICATIONS

Background Antiretroviral  therapy  has  led  to  a substantial  reduction  in  HIV associated  morbidity and  mortality. Efficacy  of  antiretroviral  treatment  in HIV/AIDS is showing inhibition of viral  replication and  reduction  of  viral  load  to  a  point  where  viral particles  are  undetectable  in  the  blood  of  infected individuals. Increasing recognition of medication adherence is a crucial factor in treatment outcomes.  This has led to the realization that HIV/AIDS is a  chronic  illness  and  hence the  quality of  life  of  PLWHA  needs  to  be  enhanced. The maintenance of viral suppression requires maximum adherence (at least 95%) to ART. Objective The objective of this review was to assess the recent literatures regarding interventions to improve antiretroviral medication adherence; to know factors affecting adherence, strategies to measure adherence to ART by reviewing research works done recently (2008-2013) on intervention to improve ARV adherence (adherence improving tools and strategies). Method This literature review was obtained from electronic search on pubmed, AIDS LINES, MEDILINE, PyschInfo and also search was conducted on individual journals and manuals. Conclusion Adherence to ART is closely tied to virologic, immunologic, and clinical outcomes. Improving adherence requires collaborating with the patient in an effort to understand and ameliorate individual impediments to adherence, generally by establishing dedicated time with every patient to educate, plan for adherence, and maintain support and collaboration throughout the course of treatment

Review of ethnobotanical and ethnopharmacological evidences of some Ethiopian medicinal plants traditionally used for the treatment of cancer

Background: Ethiopia is endowed with enormous diversity of plants. However, the majority of these plants have not been scientifically investigated. Traditional knowledge on the use of plants as medicinal agents has been transferred from generation to generation, as guarded secrets, through the word of mouth, and scientific studies on these herbs have not been properly compiled.Objectives: The main objective of this study was to review published ethnobotanical and ethnopharmacological evidences of Ethiopian medicinal plants with anticancer potentials.Material and methods: A total of 92 articles have been reviewed. They were obtained from search engines such as PubMed, Science Direct and Google Scholar. The following keywords were used to search for the literature inside the databases: plant extract, anticancer, Ethiopia, antioxidant compounds, cytotoxic compounds and in vivo toxicity.Results: The current literature review revealed that about 136 anticancer plants belonging to 57 families have been identified in Ethiopia. Among these, 98 plant species were reported for their traditional use to treat different types of symptomatic cancers. However, only 29 species were scientifically studied for their in vitro cytotoxic or free radical scavenging activities. Plant parts commonly used for preparation of anticancer remedies were leaves (41.4%) and roots (32.8%). Among the reported plant species, whilst the crude extracts of Artemisia annua, Acokanthera schimperi and Catha edulis were found to be potent cytotoxic agents (IC50<15 g/ml), the total extracts of Cassia arereh, Rubus steudneri and Thymus schimperi showed strong radical scavenging activity (IC50 <15 g/ml). Chronic administration of Syzygium guineense hydroalcoholic leaf extract, on the other hand, induced pathological changes in liver and kidney of mice.Conclusions: Although several Ethiopian plants traditionally used for the treatment of cancer were shown to possess cytotoxic and free radical scavenging activities, in most cases compounds responsible for such activities have not been identified. Therefore, activity-guided detailed phytochemical studies coupled with evaluation of the safety particularly on those plant extracts that demonstrated potent activities should be carried out as this may lead to the discovery of safe and cost effective anticancer agents. [Ethiop. J. Health Dev. 2017;31 (3):161-187]Keywords: Ethiopian medicinal plants, Antioxidant, Anticancer, Ethnopharmacology, Traditional us

PATTERN OF ANTIDIABETIC MEDICATION UTILIZATION IN PATIENTS ATTENDING DIABETIC CLINIC IN HIWOT FANA SPECIALIZED UNIVERSITY HOSPITAL, HARAR, ETHIOPIA

Purpose: Diabetes mellitus (DM) is a chronic condition that can have a major impact on life expectancy and quality of life, especially if undetected or poorly controlled. Glycaemic control and management of co-morbid conditions and diabetes complications are alarmingly sub-optimal and perhaps one of the worst conditions in the world. This study aimed to assess the utilization pattern of antidiabetic medications in Hiwot Fana Specialized University Hospital (HFSUH). Methods: A cross sectional study was conducted from April 1 to May 31, 2014 and data were collected using structured questionnaire and data collection format. The data were entered and analyzed with the help of SPSS version 16. Descriptive statistics was used for most variables and Chi-square test was used. Resultsá¡ A total of 296 diabetes patients were involved in this study, 42.6% and 57.4% were males and females, respectively. Large proportion of the patients (42.4%) was unable to read and write. Majority of the respondents (64.9%) were from urban. Two hundred and twenty three (75.3%) of the respondents were diagnosed with type-2 diabetes. Almost all patients were on pharmacological therapy at the time of the study. Among those who were on pharmacological therapy, majority of them (42.9%) were taking insulin. Conclusionsá¡ The most prescribed antidiabetic medication was insulin, followed by glibenclamide and metformin, respectively. More than half of the patients used two syringes for monthly consumption. Most of the patients rotated major injection site and some of them also injected on lipodystrophied site. The incidence of microvascular complication was higher. What this study adds: It adds on the current trend of utilization of antidiabetic medications as well as indicates the widespread of diabetes in the study setting, which will be a baseline for the government and different stakeholders to intervene. What is already known about this subject: In the study setting, such a study has never been conducted. Key words: Antidiabetic medications, Diabetes mellitus, Co-morbid conditions, Glycaemic control, Hiwot Fana Specialized University Hospital.Â

PREPARATION AND EVALUATION OF CARBOXYMETHYL ENSET AND CASSAVA STARCHES AS PHARMACEUTICAL GELLING AGENTS

Starch is usually modified either chemically, physically or enzymatically to augment its convenience for industrial use. In the current study, starches from Enset and cassava plants were carboxymethylated, and factors which affect the carboxymethylation process and degree of substitution (DS) were studied. The application of the carboxymethyl starches as alternative pharmaceutical gelling agents for topical delivery of drugs was also investigated. Accordingly, nine different topical gel formulations of ibuprofen were prepared. All formulations were evaluated with respect to cosmetic qualities, pH, drug content, viscosity, spreadability, extrudability, in vitro drug release, anti-inflammatory activity and stability. The results showed that carboxymethylation was significantly affected by the starch source, reaction medium, temperature and time. All ibuprofen gel formulations showed homogeneous appearance, smooth texture and pleasant odor. The pH values of the formulations ranged from 6.80 to 7.22. Ibuprofen content ranged between 98.76 and 100.20% ensuring the uniformity of the drug content. The cumulative percent ibuprofen released over 12 h across cellulose membrane ranged from 43.8% cm-2 to 84.5% cm-2. Spreadability, extrudability, the cumulative drug release and diffusion coefficient of ibuprofen were influenced not only by the rheological properties of the formulations but also by the nature of the modified starches. Physicochemically stable ibuprofen gels were obtained with potent anti-inflammatory activities.   Keywords: Enset starch, cassava starch, carboxymethylation, degree of substitution, ibuprofen gel, in vitro drug release, anti-inflammatory activity, stability stud

COMPARATIVE IN VITRO EVALUATION OF DIFFERENT BRANDS OF NIFEDIPINE 20mg RETARD TABLET PRODUCTS MARKETED IN ADDIS ABABA, ETHIOPIA

Nifedipine has been formulated and marketed as extended-release-film coated tablet. A certain degree of success has been achieved in reducing the incidence of adverse effects by the use of slow-release formulations such as nifedipine retard. The aim of the present study was to evaluate the physicochemical quality attributes and in vitro equivalence of six brands of nifedipine retard tablets available in different retail outlets in Addis Ababa, Ethiopia. After constructing the calibration curve, the in vitro drug release studies were carried out using USP type I dissolution apparatus at 100 rpm. The dissolution was done in a medium of 0.1N HCl containing 0.5% sodium lauryl sulfate for 12 hrs. All the tablets met the requirement for tablet weight uniformity. The mean crushing strengths of sample tablets ranged from 49.2 to 111.2 N. All the brands  studied released more than 80% within 12 hours which is within the tolerance limit.  However the release profile revealed that five of the brands showed over 15% drug release at 1st hour except product F which released only 14.32%. In conclusion, all the brands of tablets had uniform thickness and good hardness. Despite all the brands could sustained the release for over 12 hours recommended for such formulations, five of them showed higher release in the first hour which may affect their in vivo performance.†Keywords: nifedipine, retard tablets, physicochemical properties, crushing strengths, in vitro drug releas

COMPARATIVE IN VITRO EVALUATION OF BRANDS OF CLOTRIMAZOLE CREAM FORMULATIONS MARKETED IN ETHIOPIA

The aim of present work was to undertake comparative in vitro quality evaluation of six marketed clotrimazole cream formulations in Ethiopia with respect to physico-chemical properties like viscosity, spreadability, extrudability, pH and drug content. In vitro clotrimazole release from cream formulations was also studied using synthetic cellulose acetate membrane at 37 ºC in a solvent containing methanol and PBS 7.4 in the ratio of 75:25 as receiver medium. The cumulative amounts of the drug released over 12 h (µg mm-2) were analyzed. All clotrimazole cream formulations showed good and smooth homogeneous appearance with white color. The pH of clotrimazole cream formulations ranged from 4-7, which is a physiologically acceptable pH range and in principle devoid of any skin irritation. Clotrimazole content ranged from 90-110%, ensuring the uniformity of the drug content in all formulations. The increase in diameter of clotrimazole cream formulations following the spreadability test was found to range from 4-6 cm. Cream formulation D (Clotri-Denk) exhibited highest viscosity values than other formulations, whereas formulation E (Chinese Clotrimazole BP) showed lowest viscosity value. Cream formulation F (Mycoril) showed better extrudability and spreadability as compared to other formulations. Drug release from all formulations was slow in the first 6 hrs. After the 6th hr, steady drug release continued for formulation D and E. Fast drug release was observed in formulations A (Candid) and B (Candigen), whereas for the formulations C (Canesten), D and E, steady drug release pattern was observed after the 6th hr. It can be concluded that all clotrimazole cream formulations fulfilled the quality criteria of in-house and pharmacopeias specifications. Keywords: In Vitro Evaluation, Clotrimazole, Cream, Spreadability, Extrudability, Ethiopi

Effect of Sotagliflozin on Total Hospitalizations in Patients With Type 2 Diabetes and Worsening Heart Failure A Randomized Trial

In the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure) trial, sotagliflozin, a sodium-glucose cotransporter-1 and sodium-glucose cotransporter-2 inhibitor, reduced total occurrences of cardiovascular deaths, hospitalizations for heart failure, and urgent visits for heart failure relative to placebo by 33%

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe