Use of angiotensin II receptor blockers in children- a review of evidence

Background: The incidence of hypertension in the pediatric population has been increasing. Childhood blood pressure is predictive of adult BP. The renin angiotensin aldosterone system pathway is important in the mediation of pediatric hypertension. New therapies approved for adults are often used off label in children with little or no efficacy and safety data in the paediatric population The angiotensin receptor blockers has been shown to be effective and safe in the treatment of pediatric hypertension.Objective: The objective of this review is to highlight available clinical evidence on the efficacy, safety tolerability and kinetics of angiotensin receptor blockers in childhood hypertension and its antiproteinuric effect in renal disease.Method: The search strategy was based on Pubmed, Medline database, Cochrane Library, manual, Google and Yahoo searches. We summarized ten randomized controlled trials (RCTs) .The search was done in June 2014 and updated in January and May 2015 in English language .Results: A total of 120 publications were accessed from which 68 references were included in the review. The design and outcome of ten key randomised trials are summarised. Randomised trials have demonstrated the efficacy of angiotensin receptor blockers in the pediatric population aged 1–16 years. This class of drugs reduce blood pressures in pediatric patients with hypertension and proteinuria in renal disease. Safety pharmacokinetic, dosage, and palatability of adult formulations for the paediatric age group are highlightedConclusion: Angiotensin receptor antagonists are useful effective and safe alternatives to available antihypertensive therapy in paediatric population. Angiotensin receptor antagonists should however be prescribed cautiously for sexually active adolescent females due to concern about angiotensin receptor blocker fetopathy.Keywords: Angiotensin receptor blockers, childhood hypertension, drug safety, drug efficacy, pharmacokinetics and renal diseases

Extraction and physicochemical characterization of a potential multifunctional pharma-excipient from crab shell wastes

An efficient and beneficial waste disposal mechanism is highly desired. This study was carried out to extract and characterize a potential multifunctional pharmaceutical excipient from crab shell wastes. Shells of  Pachygrapsus mamoratus were obtained from Oron, a coastal town in Akwa Ibom State of Nigeria. Chitin was extracted from the powdered shell by deproteination and demineralization; and chitosan was derived by  alkaline deacetylation of the chitin. The polymer was subjected to Fourier transform infrared (FTIR)  spectroscopy and differential scanning calorimetry (DSC). It was also evaluated for flow properties, pH and  hydration and swelling characteristics. The shells gave a yield of 17% chitosan. FTIR analysis of the polymer showed C-H bond of substituted cyclic hydrocarbon, cyclic C-N bond, C-O bond of glucose molecules, C-H bond of side chain –CH2OH, presence of β-ester linkage, N-H of amides and bonded and free O-H groups. The last  transition in the thermogram of chitosan was a polymer degradation exotherm with a peak at 337.9°C. The  chitosan had higher bulk density, higher flow rate, lower Carr’s index and lower Hausner’s ratio compared to sodium carboxymethylcellulose. It also had lower hydration and swelling capacities. Therefore, the crab shell-derived chitosan has better thermal stability, better flow properties but poorer swelling properties compared to sodium carboxymethylcelluose.Key words: Crab shell, chitosan, physicochemical characteristics, pharmaceutical excipient

Correlating Antibiotic ConsumptionWith Antimicrobial Resistance Of Uropathogens In A University Teaching Hospital In Lagos, Nigeria

This study was carried out to correlate the antibiotic consumption rates with the antibiotic resistance rates of uropathogens in Lagos University Teaching Hospital. Urine specimens obtained over 18 months (between January 2005 and June 2006) were processed for microscopy culture and sensitivity, and records of antibiotics dispensed during the same periods were reviewed. Significant bacteriuriawas performed by the standard loopmethod. Isolation and identification of organisms was by standard laboratory methods. The antibiotic consumption calculator of Monnet (ABC calc version 3) was used to classify the antibiotics into ATC classes and to calculate the numbers of daily defined doses. The 6-monthly antibiotic resistance and consumption rates were compared using Pearson\'s correlation coefficient. For analysis, the period of studywas divided into three. Except for co-trimoxazole the rates of consumption of all antibioticswere higher in the second period than the first period of the study and highest in the 3 period for ciprofloxacin, and ceftazidime. This correlated with an increase in the rates of resistance for some antibiotics during the 2 and 3 periods. While a steady increase in consumption of ciprofloxacin correlatedwith a steady increase in the resistance rates from the 1 to the 3 periods, a steady increase in consumption of ceftazidimewas associatedwith an increased resistance rate fromthe 2 to 3 periods. Increased consumption of the antibiotics tested, most noticeably, ciprofloxacin and ceftazidime correlated with increased resistance rates. There is need for urgent interventions like formulation of antibiotic policies and education of staff on the appropriate use of antibiotics to reduce the development of resistance. Keywords: Antibiotic Resistance, Antibiotic Consumption Nigerian Jouranl of Clinical Practice Vol. 11 (4) 2008: pp. 305-30

Clinical outcomes in hypertensive or diabetes patients who concomitantly use complementary medicines in Lagos, Nigeria

Background: The use of complementary medicines in addition to medical prescription by patients with hypertension, diabetes and other chronic diseases presents a challenge for healthcare providers in Nigeria and globally. There is very little data on the clinical outcomes in these patients.Objectives: To evaluate clinical outcomes in hypertensive or diabetic patients who use complimentary medicines in Lagos Nigeria .Design: Observational cross-sectional study.Setting: Lagos University Teaching Hospital Medical Outpatient Clinics.Subjects: Five hundred patients attending Lagos University Teaching Hospital Medical out-patient clinics with a diagnosis of diabetes mellitus or hypertension or diabetic hypertensive were studied.Main outcome measures: The effect of complementary medicines use on blood pressure and blood glucose control were evaluated.Results: The mean arterial blood pressure of non-users of complementary medicine was 115.329 mmHg and that of users was 105.138mmHg. Also the mean fasting blood sugar of non-users was 129.515mg/dl and that of users was 131.453mg/dl. (P>0.05).Conclusion: Although not statistically significant, complimentary medicines were found to be of advantage to hypertensive patients but not diabetic patients

Pharmacoepidemiology of antiretroviral drugs in a teaching hospital in Lagos, Nigeria

Objective: Prescribing, adherence, and adverse drug events to HAART in a large antiretroviral programme in Lagos was evaluated.Design: A retrospective 5 year open cohort studySetting: The AIDS Prevention Initiative in Nigeria (APIN) clinic at LUTH is one of the United States Presidential Emergency Plan for AIDS Relief (PEPFAR) funded centers for HIV relief program in Nigeria Participants The case files of 390 patients on HAART and attending the APIN clinic were reviewed sequel to random selection.Main outcome measures: Demographics of the patients and pattern of antiretroviral (ARV) combination drugs prescribed were extracted from their case files. The details of the adverse drug events (ADEs) were extracted from drug toxicity forms regularly filled for each patient. A Chi-square test with Yates correction was used to determine the association between  adherence and therapeutic outcomeResults: A total of 2944 prescriptions were assessed. Zidovudine + lamivudine + nevirapine (35.87%) and stavudine + lamivudine + nevirapine (35.63%) were the most frequently prescribed combinations. Over 2000 ADEs were reported with cough (13.3%), fever (8.75%) and skin rashes (8.01%) being the most frequently reported. Drug adherence was associated with good therapeutic outcome (÷2 = 115.60, p<0.0001).Conclusions: Zidovudine + lamivudine + nevirapine was the most  frequently prescribed ARV combination. Cough was the most frequently reported ADE. Interventions aimed at rational prescribing of ARV drugsand improving adherence to antiretroviral drugs is essential for good therapeutic outcome in the treatment of HIV infection.Keywords: Pharmacoepidemiology, antiretroviral drugs, drug adherence, adverse event

Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania.

\ud \ud Non-adherence to tuberculosis (TB) treatment is the leading contributor to the selection of drug-resistant strains of Mycobacterium tuberculosis and subsequent treatment failure. Tanzania introduced a TB Patient Centred Treatment (PCT) approach which gives new TB patients the choice between home-based treatment supervised by a treatment supporter of their own choice, and health facility-based treatment observed by a medical professional. The aim of this study was to assess the extent and determinants of adherence to anti-TB therapy in patients opting for home-based treatment under the novel PCT approach. In this cross-sectional study, the primary outcome was the percentage of patients adherent to TB therapy as detected by the presence of isoniazid in urine (IsoScreen assay). The primary analysis followed a non-inferiority approach in which adherence could not be lower than 75%. Logistic regression was used to examine the influence of potentially predictive factors. A total of 651 new TB patients were included. Of these, 645 (99.1%) provided urine for testing and 617 patients (95.7%; 90%CI 94.3-96.9) showed a positive result. This result was statistically non-inferior to the postulated adherence level of 75% (p<0.001). Adherence to TB therapy under home-based Directly Observed Treatment can be ensured in programmatic settings. A reliable supply of medication and the careful selection of treatment supporters, who preferably live very close to the patient, are crucial success factors. Finally, we recommend a cohort study to assess the rate of adherence throughout the full course of TB treatment

Preparation and use of plant medicines for farmers' health in Southwest Nigeria: socio-cultural, magico-religious and economic aspects

Agrarian rural dwellers in Nigeria produce about 95% of locally grown food commodities. The low accessibility to and affordability of orthodox medicine by rural dwellers and their need to keep healthy to be economically productive, have led to their dependence on traditional medicine. This paper posits an increasing acceptance of traditional medicine country-wide and advanced reasons for this trend. The fact that traditional medicine practitioners' concept of disease is on a wider plane vis-à-vis orthodox medicine practitioners' has culminated in some socio-cultural and magico-religious practices observed in preparation and use of plant medicines for farmers' health management. Possible scientific reasons were advanced for some of these practices to show the nexus between traditional medicine and orthodox medicine. The paper concludes that the psychological aspect of traditional medicine are reflected in its socio-cultural and magico-religious practices and suggests that government should fund research into traditional medicine to identify components of it that can be integrated into the national health system

Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015)

Abstract Background Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015. Methods Systematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines. Results Forty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends. Conclusions Prescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences

The mediating effects of first call resolution on call centers’ performance

This article aims to examine and validate the prepositions of the mediating impacts of first call resolution (FCR) on caller satisfaction within the contact center industry.A survey of 168 call center managers was analyzed through structural equation modeling, constituting an overall 43.3 per cent response rate for this study.The results show that FCR positively mediates the relationship between knowledge management, technology-based CRM and caller satisfaction within the inbound customer contact centers.We have empirically assessed call centers/contact centers’ success through caller satisfaction (an observed variable through their 2009 customer survey in Malaysia).Consequently, this study cannot generalize its findings in all other countries.Our strong argument is that within the operational variables, FCR is statistically significant and positively mediates knowledge management applications. But very important to note is that the customer contact centers are first touch points to a company's goods or services, and that many other factors such as product quality, company policy, target markets, decision-making processes and so on are also determinants of caller satisfaction, but fall outside the operational control of contact center activities.This research has empirically established that a company's capability in effectively acquiring a valid understanding of its current and potential customers’ information through CRM technologies will positively impact its acquisitions, customization, management and retention of customers.It also avails both the academic and contact center management the benefits that are inherent in measuring the impact of knowledge management and technology-based CRM on inbound FCR and caller satisfaction.This study finally recommends alternative areas for future research