Overuse of medications in low- and middle-income countries: a scoping review

OBJECTIVE: To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. METHODS: We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. FINDINGS: We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries – with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2–64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit–feedback initiatives. CONCLUSION: Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications

A rare anomaly of the human spleen with nine notches associated with multiple accessory spleens:A case study, hypothesis on origin and review of clinical significance

In humans, the spleen is the body’s largest secondary lymphoid organ and filterer of blood. The trabeculated structure of the spleen, which is formed in its early embryonic development, provides its three-dimensional framework designed to remove senescent erythrocytes and eliminate blood-borne microorganisms and/or dubious antigens. At a later date this lobulated framework can develop into notches which usually manifest along its anterior (superior) border. This study addresses the clinical significance and developmental basis of both numerous notches and multiple accessory spleens observed in a male human cadaver. The nine notches were all observed on the anterior and inferior borders, whilst the accessory spleens numbered four, with two localized at the splenic hilum and the other two upon the splenorenal and splenocolic ligaments respectively. In the present study, we propose an aetiological origin for the anomalous multi-notches and accessory spleens, which will provide primary benefit for surgeons and radiologists because of clinical significance.Full Tex