Pattern of adverse drug reaction to antiepileptic drugs in a tertiary care hospital

Background: Adverse drug reactions (ADRs) are a major cause of morbidity and mortality, and are the leading cause of hospital admission. The overall rate of ADRs is estimated to be 6.5% and 28% of these ADRs are preventable. Antiepileptic drugs (AEDs) are authorized for several therapeutic indications and are highly prescribed. ADRs due to AEDs range from minor maculopapular exanthem (MPE) to severe life-threatening reactions like Drug reaction eosinophilia and systemic symptoms (DRESS) and Stevens-Johnson syndrome (SJS). Objective of the study was to evaluate the pattern of ADRs reported with AEDs in an adverse drug reaction monitoring centre (AMC) of a tertiary care hospital.Methods: Retrospective analysis of the records was done for a period 48 months from January 2013 to December 2016. During this period, all the ADRs caused by AEDs reported to the AMC were included in the study. The study evaluated the pattern of ADRs due to AEDs. The study also assessed the gender-wise distribution, predilection for various systems, causality, severity, and preventability of ADRs. Data was analysed using descriptive statistics.Results: A total of 319 ADRs were reported by spontaneous reporting during the entire study period. Out of the total 319 ADR reports received, antiepileptic drugs related ADRs were 35 (11%). Antiepileptic drugs which caused the ADRs included phenytoin, carbamazepine, clobazam and lorazepam. The most common system affected was dermatological (60%), followed by gastrointestinal system (17.14%), vascular system (11.42%), blood (5.8%), respiratory system (5.8%) and central nervous system (2.9%). Among the dermatological ADRs, SJS accounted for 11 cases of which 10 cases were due to phenytoin and one case was due to carbamazepine. DRESS syndrome due to phenytoin was documented in one case.Conclusions: AEDs are the most commonly prescribed drugs for various indications. Uses of AEDs are accompanied by ADRs which vary from mild rashes and itching to SJS and DRESS/TEN. Post-marketing surveillance of the AEDs is important for compliance, therapeutic efficacy and ultimately safety of the patient

Nutritional status of children in food insecure households in two districts of north Showa zone, Ethiopia

Malnutrition is one of the leading causes of morbidity and mortality of children in Ethiopia. However, little information is available on nutritional status of the lower socioeconomic segment of the community to devise targeted tackling solutions and overcome severe malnutrition. Therefore, the objective of this study is to assess nutritional status of children and other related information in food insecure households. Two hundred food insecure households (HHs) were selected from two districts of North Showa zone of Amhara in 2007. The criteria for inclusion were being landless, oxen-less, and/ or female headed. Anthropometric and clinical data were collected from a total of 239 (151 < 5yrs and 88, 6-12yrs) children. Data on demographic, childcare, feeding practices and morbidity status of children were collected using an interview, community focus group discussion and secondary data from district offices. The overall prevalence of stunting, underweight and wasting was 54.2%, 40.2% and 10.6 %, respectively. Prevalence of night blindness and Bitot's spot were 3.1% and 3.5%, respectively. The median level of urinary iodine excretion by 6-12 years children was 1.5μg/L. Seventeen percent of the children were found iron deficient. Exclusive breastfeeding up to 6 month was practiced by less than 20% of the households. About fifty six percent of the households have cropland less than half a hectare and 50.8% of the households are getting water from unprotected well or spring. The main type of toilet facility being used was open bush/field (84.5%). The main income of the households was agriculture. The majority (45-50%) of the household heads in both districts are in the age ranges of 20-30 years. Fifty percent of the household heads can read and write. Lack of enough arable land, unreliable rain fall, extension of desertification, lack of scientific agricultural knowledge, absence of irrigation schemes, and shortage of skill in land use and management are some of the problems reported to contribute to food insecurity. The households are under severe malnutrition, food insecurity and poor childcare. Therefore, improvement of household resources by initiation of income generating livelihood options and knowledge based agriculture is needed

Pattern of adverse drug reactions due to antibiotics in a tertiary care hospital

Background: Adverse reactions are known to occur with all classes of drugs and the incidence of adverse drug reactions (ADRs) due to antibiotics has increased with rise in infectious diseases contributing significantly to the increased health care costs.Methods: This retrospective observational study analysed the ADRs due to antibiotics that were reported by spontaneous reporting to ADR monitoring centre (AMC), functioning from Department of Pharmacology, ESIC-MC and PGIMSR. The total study period was 48 months from January 2013 to December 2016. During this period, all the ADRs due to antibiotics reported to the AMC were included in the study. This study analysed the retrospective data to find out the pattern of adverse drug reactions due to antibiotic drug class. Causality, severity and preventability were assessed using standard scales.Results: During the study period, a total of 228 ADRs due to antibiotic use were reported among 179 patients. Gender-wise distribution showed that males were slightly more affected than females by the ADRs due to antibiotics [93(52%) Vs. 86 (48%)]. Out of the total 179 antibiotics administered to the patients, beta-lactam antibiotics dominated followed by nitroimidazoles, quinolones and glycopeptide antibiotics in causing ADRs. Rashes and itching were most common ADRs followed by breathlessness and hypotensive episodes. Causality was assessed by Naranjo algorithm scale and causality was definite in 16 (7%), probable in 87 (38%) and possible in 125 (55%). Severity of the ADRs was assessed by Hartwig and Siegel scale and it was found that most of the ADRs 198 (87%) were of mild severity and 30 (13%) were of moderate severity and none of them were severe or lethal. Preventability was assessed by Schumock and Thornton scale and it was found that only 24 (11%) were preventable, 74 (32%) were probably preventable and 130 (57%) were not preventable.Conclusions: The study concluded that ADRs due to antibiotics are common and few of them resulted in increased healthcare cost due to the need for some interventions and increased length of hospital stay. The health system should promote the spontaneous reporting of ADRs due to antibiotics, proper documentation and periodic reporting to regional pharmacovigilance centers to ensure drug safety

Awareness of antibiotic usage and antimicrobial resistance among interns in a tertiary care hospital

Background: Antibiotic resistance is a global threat and new resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. Reducing the incidence of drug resistant infections is crucial and is a top priority at global and national levels. A study was conducted among interns to assess the awareness related to antibiotic usage and resistance.Methods: The questionnaire was administered to a batch of 75 medical interns whereby their awareness regarding antibiotic use and resistance was assessed by a five point Likert scale, whose responses ranged from “strongly agree” to “strongly disagree”, and always to never. Some questions were of true and false type. The data was analysed by using simple descriptive statistics.Results: Out of the 78 interns, 75 participated in the study and completed the questionnaires. All the 75 (100%) interns believed that indiscriminate antibiotic use leads to antimicrobial resistance and 78.6% (n=59) believed that if antimicrobials are taken too often, they are less likely to work in the future. Majority (90.6%) of the interns knew of the fact that common cold and influenza are due to viral aetiology and not bacterial. Regarding the antibiotic practices of the interns, questionnaire addressed questions related to their practices related to use of antimicrobials, 66.6% (n=50) of the interns disagreed on the question that antibiotics are safe drugs, hence can be commonly used while 62.6% (n=47) do not believe that skipping one or two doses of the drug does not lead to antibiotic resistance.Conclusions: The antibiotic resistance crisis has been attributed to the overuse and misuse of these medications. Judicious use of antibiotics is the only solution for which awareness is required at the level of both health care providers and patients. Our study provides an important insight regarding the regarding awareness of antibiotic usage and antibiotic resistance among interns

The effects of dual micronutrient supplementation on thyroid function in school children: An experimental study

Background: The presence of iron and or vitamin A deficiency in children limits the effectiveness of the iodine intervention program in areas where iodine deficiency is endemic. This study was aimed at assessing the role of dual micronutrient supplementation on thyroid function in severe iodine deficient school children age 6-16 years in Ethiopia.Methods: From 2006 to 2007 an experimental study was conducted on 397 children, all with visible goiter grade of which 6.1% and 10.3% vitamin A and iron deficient respectively. A week after baseline data collection and de-worming, all children with visible goitre (n=332) but without iron and vitamin A deficiency were randomly grouped into four, A to D groups. Vitamin A deficient children (n=24) were randomly allocated to group A and group B while anaemic children (n=41) were distributed into group C and group D. Group A received 400mg oral iodized oil and group B received 200,000IU vitamin A plus 400mg oral iodized oil. Group C received 400mg oral iodized oil while group D received 100mg iron sulphate with folic acid and 400 mg oral iodized oil. Iron supplementation was continued two doses per day for six weeks. Vitamin A supplemented group received additional dose at six month. Post intervention data on iodine, vitamin A and iron status were collected at 6 and 11 month.Results: Children supplemented with iron + oral iodized oil capsule had significant goitre reduction than oral iodized oil supplemented group. The mean concentrations of thyroid hormone (T4) and Urinary iodine excretion (UIE) in iron + iodine supplemented group were significantly higher than the iodine alone supplemented group at 6 months after the intervention. Hemoglobin level at baseline in all study subjects and at 11 month after intervention in group D (iron + iodine supplemented group) significantly (P<0.05) correlated with T4 level. The significant goitre reduction in iron + iodine supplemented group than iodine alone supplemented group and significant correlation between level hemoglobin and T4 at baseline and at 11 month after intervention probably indicate that iron and iodine have a functional interaction in thyroid iodine metabolism.Conclusion: Supplementation of iodized oil with Iron is more effective in goitre reduction than iodine alone and this should be taken into consideration by iodine deficiency disorders (IDD) intervention programs

Retrospective review of antiretroviral therapy program data in accredited private hospitals in Addis Ababa City Administration, Ethiopia

Background: Ethiopia is committed to improving access to human immunodeficiency virus (HIV) care and antiretroviral therapy (ART) service. In May 2005, some private hospitals in Addis Ababa City Administration received accreditation to provide ART services to eligible patients.Objective: To examine and describe the achievements of the ART Program in accredited private hospitals.Methods: Descriptive retrospective analyses of reported ART Program Data from accredited private hospitals, between May 2005 and 31st December 2009. The aggregate data was obtained from Addis Ababa Regional Health Bureau and consisted of information about patients enrolled for care, those who started ART, and those presently are on ART.Results: During the study period, 10,849 patients were enrolled for care, 9,442 who had just started ART and 5,608 already on it across the study private facilities. In general close to 75% of the total patients enrolled for  care at five facilities. Although the majority (87%) had started treatment in the past, only 59.4% were currently on treatment. Overall, the program retained 66.4% of the patients (n=6,270) and attrition was 32% (n=3,021).Conclusions: Differences in patient enrollment for care, ART initiation and retention were observed across facilities. A significant number of patients discontinued treatment and their outcome status was unclear. A better monitoring and reporting of ART Program Data will improve program quality. An effective strategy is needed to enhance patient retention and tracing in the accredited private hospitals in Addis Ababa City Administration. [Ethiop J Health Dev. 2011;25(2):110-115

Antibiogram of Escherichia coli Isolated from Dairy Cattle and in-Contact Humans in Selected Areas of Central Ethiopia

Tekalign Tadesse,1,* Haile Alemayehu,2 Girmay Medhin,2 Aberaw Akalu,3 Tadesse Eguale2,4,* 1Department of Veterinary Science, Mattu University, Mattu, Ethiopia; 2Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; 3Food, Medicine and Healthcare Administration and Control, Addis Ababa, Ethiopia; 4The Ohio State University, Global One Health LLC, Addis Ababa, Ethiopia*These authors contributed equally to this workCorrespondence: Tekalign Tadesse, Department of Veterinary Science, Mattu University, P.O Box 318, Mattu, Ethiopia, Email [email protected]: Antimicrobial resistance (AMR) is a global threat to public and animal health. Escherichia coli is considered an indicator organism for monitoring AMR among gram-negative Enterobacteriaceae in humans and animals. The current study aims to assess the antibiogram profile of E. coli isolated from dairy cattle and in-contact humans in central Ethiopia and to identify risk factors associated with multidrug resistance (MDR).Methods: A cross-sectional study was conducted in which 58 farms were recruited from selected districts of central Ethiopia. E. coli was isolated using standard bacteriological techniques. A total of 200 representative isolates (140 from cattle and 60 from humans in contact) were randomly selected and tested for susceptibility to a panel of 13 antimicrobials using the Kirby-Bauer disc diffusion assay.Results: The highest rate of resistance was observed for sulfamethoxazole+trimethoprim (58.6%, 82/140) and amoxicillin+clavulanic acid (70.0%, 42/60) among E. coli isolates from cattle and hmans, respectively. In contrast, resistance rates in isolates from in contact humans with the cattle were 30%, 33.3%, and 66.7%, respectively. Resistance to tetracycline (p=0.02), streptomycin (p=0.03), and sulfamethoxazole+trimethoprim (p=0.007) was significantly high in E. coli isolated from cattle on commercial dairy farms than in those isolated from cattle on smallholder farms. There was no significant difference (p> 0.05) in the rate of resistance between E. coli isolated from in contact humans with smallholder and commercial dairy farms. Antimicrobial use for treatment purpose (p=0.04) and non-compliance with the drug withdrawal period (p=0.03) were significantly associated with the farm-level occurrence of MDR.Conclusion: A high rate of resistance was detected in E. coli isolated from the feces of dairy cattle and in-contact humans. This necessitates an effective intervention through a one-health approach and further molecular studies are required to establish source attribution.Keywords: antimicrobial resistance, dairy cattle, E. coli, human

World radiocommunication conference 12 : implications for the spectrum eco-system

Spectrum allocation is once more a key issue facing the global telecommunications industry. Largely overlooked in current debates, however, is the World Radiocommunication Conference (WRC). Decisions taken by WRC shape the future roadmap of the telecommunications industry, not least because it has the ability to shape the global spectrum allocation framework. In the debates of WRC-12 it is possible to identify three main issues: enhancement of the international spectrum regulatory framework, regulatory measures required to introduce Cognitive Radio Systems (CRS) technologies; and, additional spectrum allocation to mobile service. WRC-12 eventually decided not to change the current international radio regulations with regard to the first two issues and agreed to the third issue. The main implications of WRC-12 on the spectrum ecosystem are that most of actors are not in support of the concept of spectrum flexibility associated with trading and that the concept of spectrum open access is not under consideration. This is explained by the observation that spectrum trading and spectrum commons weaken state control over spectrum and challenge the main principles and norms of the international spectrum management regime. In addition, the mobile allocation issue has shown the lack of conformity with the main rules of the regime: regional spectrum allocation in the International Telecommunication Union (ITU) three regions, and the resistance to the slow decision making procedures. In conclusion, while the rules and decision-making procedures of the international spectrum management regime were challenged in the WRC-12, the main principles and norms are still accepted by the majority of countries

Past, present and future mathematical models for buildings (i)

This is the first of two articles presenting a detailed review of the historical evolution of mathematical models applied in the development of building technology, including conventional buildings and intelligent buildings. After presenting the technical differences between conventional and intelligent buildings, this article reviews the existing mathematical models, the abstract levels of these models, and their links to the literature for intelligent buildings. The advantages and limitations of the applied mathematical models are identified and the models are classified in terms of their application range and goal. We then describe how the early mathematical models, mainly physical models applied to conventional buildings, have faced new challenges for the design and management of intelligent buildings and led to the use of models which offer more flexibility to better cope with various uncertainties. In contrast with the early modelling techniques, model approaches adopted in neural networks, expert systems, fuzzy logic and genetic models provide a promising method to accommodate these complications as intelligent buildings now need integrated technologies which involve solving complex, multi-objective and integrated decision problems