Patterns of drug use among type 2 diabetic patients with comorbidities attending a tertiary centre in Lagos Nigeria

Introduction – Diabetes care involves the use of drugs to control hyperglycaemia and treatment of comorbid disorders in order to prevent cardiovascular morbidity and other complications. This study investigated patterns of comorbidities and drug use among diabetic patients at a tertiary centre in Lagos, Nigeria. Method – This was a cross-sectional study carried out among 216 patients with type 2 DM attending Diabetes Clinic of a tertiary centre. Data was captured by using a questionnaire which documented biodata, number of comorbidities, number and combination of drugs for each participant and analysed using SPSS version 18. Results – Comorbidities were present among 215 out of 216 (99.54%) participants and hypertension and dyslipidaemia were the most common comorbid disorders. The number of pills consumed per patient ranged from 1 to10 with a mean of 4.78± 1.73 and 57.4% were on 5 pills or more. Fixed-dose combination was used in 37 (17.1%) of the patients. Majority of the patients were on metformin as monotherapy or in combination therapy. Antihypertensive most prescribed were renin-angiotensin system (RAS) blockers which was prescribed in 73% of participants. Antiplatelet drugs were used for both primary and secondary prevention of CVDs. Statin was used in less than 50% of the population. Double RAS blockade was also observed in 6% of participants. Conclusions – Comorbidities were common in the diabetic population. Pill load was high but appropriate in most patients. Statin uptake was suboptimal while there was increased uptake of antiplatelet drugs among participants

Antiretroviral Therapy‑related Problems among Human Immunodeficiency Virus‑infected Patients: A Focus on Medication Adherence and Pill Burden

Background: There are problems associated with antiretroviral therapy despite its achievement. Poor medication adherence and inability to tolerate large pill burden are major problems facing patients with chronic illnesses. These drug therapy problems are under-studied among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Nigeria. We evaluated adherence and pill burden among this set of patients in a tertiary hospital in Lagos. Methods: Data for eligible HIV‑infected adults were documented from case notes and through interviews using a well‑structured  questionnaire. Important details extracted were sociodemographics, pills information, and CD4 counts. The main outcome measures were drug adherence, as assessed by the four‑item Morisky Medication Adherence Scale and pill burden, as measured by daily pill >5. Results: Of the 296 patients, 219 (74%) were females. Median age (interquartile range) was 40 (35.0–47.7) years. Majority (262; 88.5%) were married, had at least a secondary education (142:48.0%), and CD4 count >500 cells/ml (215; 72.6%). Pill burden >5 pills/day was observed in 12.2% of the patients, while adherence was documented for 83.4% of the patients. Majority (259; 87.5%) were receiving fixed‑dose  combination of antiretroviral drugs. Forgetfulness (16.5%) and being too busy to take pills (10.5%) were the most common reasons for nonadherence. Pill burden in those who were not receiving fixed‑dose combination was significantly associated with medication nonadherence. However, only pill burden was found to be an independent prognosticator of non-adherance. (Odd ratio = 0.67, confidenceinterval = 0.03–1.66, P < 0.00). Conclusion: Medication nonadherence and pill burden were observed in more than one‑tenth of patients. These were the two major  antiretroviral therapy‑related problems reported in this study. Keywords: Adherence, antiretroviral therapy, human immunodeficiency virus, people living with human immunodeficiency virus/acquiredimmunodeficiency syndrome, pill burde

Outcome of the first Medicines Utilisation Research in Africa Group meeting to promote sustainable and rational medicine use in Africa

The first MURIA (Medicines Utilisation Research in Africa) group workshop and symposium brought researchers together from across Africa to improve their knowledge on drug utilisation (DU) methodologies as well as exchange ideas. As a result, progress DU research to formulate future strategies to enhance the rational use of medicines. Anti-infectives was the principal theme for the one day symposium following the workshops. This included presentations on the inappropriate use of antibiotics as well as ways to address this. Concerns with adverse drug reactions and adherence to anti-retroviral medicines was also discussed, with poor adherence remaining a challenge. There were also concerns with the underutilisation of generics. These discussions resulted in a number of agreed activities before the next conference in 2016

Adverse effects of carbamazepine monotherapy among patients in Nigeria: a pilot study and implications

AIM: Antiepileptic drugs do cause adverse effects, affecting patients' quality of life, adherence and seizures. Consequently, there is a need to study this among Nigerian patients.  METHODS: Descriptive cross-sectional study assessing the extent of adverse effects with carbamazepine monotherapy and potential factors.  RESULTS: 54 patients (64.3%) reported no adverse effects, while 30 did. The most common adverse effects were memory problems followed by headaches, restlessness, tiredness and depression. Adverse effects were significantly higher in females, with females with low educational levels having significantly higher rates. Dose, co-medications, seizure control and comorbid conditions did not significantly affect adverse effects.  CONCLUSION: Perception of adverse effects was common in patients on carbamazepine monotherapy, more common in women than men. Educational status was important in women

Effect of riboceine on neuropsychiatric symptoms and oxidative stress parameters in hippocampus and frontal lobe of 4-vinylcyclohexene diepoxide induced perimenopausal rats

Memory impairment and anxiety are common perimenopausal symptoms with pathophysiologic mechanisms linked to oxidative stress. The study investigated the effect of Riboceine (CGVT ), an antioxidant on memory impairment and anxiety during perimenopausal transition in rats.Immature female Sprague-Dawley rats were divided into 2 groups; PREMP injected with corn oil (2.5μl/g BW); VCD injected with 4-vinylcyclohexene diepoxide (160 mg/kg BW) in corn oil for 15 days. A 3rd group of older and matured female rats (AGING) at 90 days of age was left to age naturally till 200 days. Fourteen weeks after VCD/corn oil administrations, and 200 days in Aged group, rats were administered Riboceine (200mg/kg BW) and distilled water for additional 30 days. At 150–165 days in PREMP and VCD groups, 215–230 days in AGING group on diestrus morning, animals were subjected to cognitive Y maze and anxiety tests. The animals were humanely sacrificed, brains isolated, weighed and homogenized for measurement of GSH, SOD, catalase and MDA. There was no significant difference in percentage correct alternation in VCD PRM and AGING PRM groups on CGVT compared to distilled water. The closed versus open arm ratio was significantly higher in VCD PRM and AGING PRM groups compared to the PREMP group. Riboceine significantly reduced (p < 0.05) SOD and catalase activities in both frontal lobe and hippocampus of perimenopausal rats. It significantly reduced (p < 0.05) MDAlevels in frontal lobe of premenopausal and perimenopausal rats and had opposing effect in the hippocampus. Our results suggest that Riboceine at supra-therapeutic dose had no effect on memory and anxiety in the perimenopausal rats. AbstraitLes troubles de la mémoire et l'anxiété sont des symptômes courants de la périménopause avec des mécanismes physiopathologiques liés au stress oxydatif. L'étude a examiné l'effet de Riboceine® (CGVT), un antioxydant sur les troubles de la mémoire et l'anxiété pendant la transition périménopausique chez le rat. Les rats femelles immatures Sprague-Dawley ont été divisés en 2 groupes; PREMP injecté avec de l'huile de maïs (2,5 μl / g BW); VCD injecté avec du diépoxyde de 4-vinylcyclohexène (160 mg / kg pc) dans de l'huile de maïs pendant 15 jours. Un troisième groupe de rats femelles âgés et matures (VIEILLISSEMENT) à 90 jours a été laissé vieillir naturellement jusqu'à 200 jours. Quatorze semaines après l'administration de VCD / huile de maïs et 200 jours dans le groupe âgé, on a administré à des rats Riboceine® (200 mg / kg de poids corporel) et de l'eau distillée pendant 30 jours supplémentaires. À 150–165 jours dans les groupes PREMP et VCD, 215–230 jours dans le groupe AGING le matin du diestrus, les animaux ont été soumis à des tests de labyrinthe cognitif en Y et d'anxiété. Les animaux ont été sacrifiés sans cruauté, les cerveaux isolés, pesés et homogénéisés pour la mesure de GSH, SOD, catalase et MDA. Il n'y avait pas de différence significative dans le pourcentage d'alternance correcte dans les groupes VCD PRM et AGING PRM sur CGVT par rapport à l';eau distillée. Le ratio bras fermé / bras ouvert était significativement plus élevé dans les groupes VCD PRM et AGING PRM que dans le groupe PREMP. La riboceine® a réduit de manière significative (p <0,05) les activités de SOD et de catalase dans le lobe frontal et l'hippocampe de rats en périménopause. Il a significativement réduit (p <0,05) les taux de MDAdans le lobe frontal des rats préménopausiques et périménopausiques et a eu un effet opposé dans l'hippocampe. Nos résultats suggèrent que Riboceine® à dose supra-thérapeutique n'a eu aucun effet sur la mémoire et l'anxiété chez les rats périménopausiques