Sustained release local anesthetics for pain management: relevance and formulation approaches.

This review attempted to ascertain the rationale for the formulation of sustained-release local anesthetics and summarize the various formulation approaches designed to date to achieve sustained and localized local analgesic effects. The incidence of pain, which is the concern of patients as well as health care professionals, is increasing due to accidents, surgical procedures, and other diseases. Local anesthetics can be used for the management of moderate to severe acute and chronic pain. They also allow regional analgesia, in situations where the cause and source of the pain are limited to a particular site or region, without the need for loss of consciousness or systemic administration of other analgesics thereby decreasing the risk of potential toxicities. Though they have an interesting antipain efficacy, the short duration of action of local anesthetics makes the need for their multiple injections or opioid adjuvants mandatory. To overcome this problem, different formulations are being designed that help achieve prolonged analgesia with a single dose of administration. Combination with adjuvants, liposomal formulations, lipid-based nanoparticles, thermo-responsive nanogels, microspheres, microcapsules, complexation with multivalent counterions and HP-ß-CD, lipid-based nanoparticles, and bio-adhesive films, and polymeric matrices are among the approaches. Further safety studies are required to ensure the safe and effective utilization of sustained-release local anesthetics. Moreover, the release kinetics of the various formulations should be adequately established.

Validation of Blood Glucose and Lipid-Lowering Effect of Solvent Fractions of the Crinum Abyssinicum Shoot Tips in Streptozotocin-Induced Diabetic Mice.

Background: Diabetes mellitus prevalence has reached epidemic levels despite the existence of contemporary treatments. People thus started looking at the possible therapeutic value of natural therapies. Crushed shoot tips of Crinum abyssinicum (Amaryllidaceae) are mixed with water in Ethiopia to treat diabetes, yet this practice is not well supported by science. Objective: In this experiment, mice models were used to verify the blood sugar and lipid-lowering benefits of solvent fractions of C. abyssinicum shoot tips. Materials and Methods: In a single-dose treated Streptozotocin (STZ)-induced diabetic model, mice were randomly grouped into eleven categories which include diabetic negative control, diabetic positive control, and 9 diabetic treatment groups. In repeated daily doses treated STZ-induced model, Mice were divided into 6 groups which included normal and diabetic negative control (TW80), diabetic positive control (5 mg/kg glibenclamide), and three diabetic treatment groups 100, 200, and 400 mg/kg). Finally, blood glucose, lipid level, and body weight were examined. Results: In the single-dose treated diabetic model, there was a significant blood glucose reduction at 200 and 400 mg/kg doses of aqueous fraction and glibenclamide starting from the sixth-hour post-administration unlike ethyl acetate and chloroform fraction compared to baseline and negative control. In repeated daily dose-treated diabetic mice, all three doses (100, 200, and 400 mg/kg of aqueous fraction) resulted in a substantial reduction (P < .001) in blood glucose compared to baseline and negative control on the seventh day and 14th day. Besides the AQF shows improvement in lipid levels and body weight parameters. Conclusion: The results of the study demonstrated that C. abyssinicum shoot tip fractions have the greatest potential to lower blood sugar and lipid levels, supporting conventional claims for the treatment of diabetes.

Recent Advances in Messenger Ribonucleic Acid (mRNA) Vaccines and Their Delivery Systems: A Review.

Messenger ribonucleic acid (mRNA) was found as the intermediary that transfers genetic information from DNA to ribosomes for protein synthesis in 1961. The emergency use authorization of the two covid-19 mRNA vaccines, BNT162b2 and mRNA-1273, is a significant achievement in the history of vaccine development. Because they are generated in a cell-free environment using the in vitro transcription (IVT) process, mRNA vaccines are risk-free. Moreover, chemical modifications to the mRNA molecule, such as cap structures and changed nucleosides, have proved critical in overcoming immunogenicity concerns, achieving sustained stability, and achieving effective, accurate protein production in vivo. Several vaccine delivery strategies (including protamine, lipid nanoparticles (LNPs), polymers, nanoemulsions, and cell-based administration) were also optimized to load and transport RNA into the cytosol. LNPs, which are composed of a cationic or a pH-dependent ionizable lipid layer, a polyethylene glycol (PEG) component, phospholipids, and cholesterol, are the most advanced systems for delivering mRNA vaccines. Moreover, modifications of the four components that make up the LNPs showed to increase vaccine effectiveness and reduce side effects. Furthermore, the introduction of biodegradable lipids improved LNP biocompatibility. Furthermore, mRNA-based therapies are expected to be effective treatments for a variety of refractory conditions, including infectious diseases, metabolic genetic diseases, cancer, cardiovascular and cerebrovascular diseases. Therefore, the present review aims to provide the scientific community with up-to-date information on mRNA vaccines and their delivery systems.

Medicinal Plants Used for the Management of Hepatitis Over the Past 15 Years in Ethiopia: A Systematic Review.

Background: Treatment of human and animal ailments using botanical sources has obtained significant attention in Ethiopia. The compounds available in plants comprise a plentiful source of bioactive ingredients able to treat many complications. The review aimed to present an updated list of plants used for managing hepatitis over the past 15 years in Ethiopia. Methods: Systematic, comprehensive search was undertaken from electronic databases (PubMed, Google Scholar, Science Direct, and Scopus) between September 01 and October 15, 2022, using standard search terms. Original researches carried out in Ethiopia, written and published in English between January 01/2007 and December 31/2021, and reported hepatitis as a disease treated by medicinal plants were included in the review. Plants beyond the list of Ethiopian and Eritrean floral were excluded. Data were extracted from texts and tables of original papers on a Microsoft Excel. Quality was assessed by applying the Joanna Briggs Institute Critical Appraisal Checklist. Results: A total of 317 papers were obtained from the database search. After removing duplicates and screening, 15 articles fit the inclusion criteria and selected for final review. Of the 24 plants identified, 35.7% were herbs. Leaf and root (35.7% each) were the predominant plant parts used for remedy preparation. Combined use of leaf and root comprised 10.7%. The families Apocynaceae, Asteraceae, Euphorbiaceae, Cucurbitaceae, and Fabaceae comprise the highest number of plant species. About 89.3% of remedies were administered orally. Conclusion: The majority of plants belong to herbs and the frequently used plant parts are leaf and roots. Evidence generated from the present review indicated that lots of plants have been used to manage hepatitis. Moreover, the findings could serve as preliminary information to formulate new drugs acting against hepatitis. Therefore, it is desirable for scholars to recognize, document, and keep plants and the associated knowledge appropriately.

Systematic Review of Safety of RTS,S with AS01 and AS02 Adjuvant Systems Using Data from Randomized Controlled Trials in Infants, Children, and Adults.

Background: Emergence of antimalarial drugs and insecticides resistance alarms scientists to develop a safe and effective malaria vaccine. A pre-erythrocytic malaria vaccine called RTS,S has made great strides. Aim: The review was aimed to assess the safety of the candidate malaria vaccine RTS,S with AS01 and AS02 adjuvants using data from Phase I-III randomized controlled clinical trials (RCTs). Methods: This systematic review was conducted based on PRISMA 2020. Regardless of time of publication year, all articles related with safety of RTS,S, RCTs published in the English language were included in the study. The last search of databases, and registry was conducted on 30 May, 2022. Pubmed, Google Scholar, Cochrane Library, Wiley Online Library, and Clinical trials.gov were thoroughly searched for accessible RCTs on the safety of RTS,S malaria vaccine. The studies were screened in three steps: duplicate removal, title and abstract screening, and full-text review. The included studies' bias risk was assessed using the Cochrane risk of bias tool for RCTs. This systematic review is registered at Prospero (registration number: CRD42021285888). The qualitative descriptive findings from the included published studies were reported stratified by clinical trial phases. Findings: A total of thirty-five eligible safety studies were identified. Injection site pain and swelling, febrile convulsion, fever, headache, meningitis, fatigue, gastroenteritis, myalgia, pneumonia, reactogenicity, and anemia were the most commonly reported adverse events. Despite few clinical trials reported serious adverse events, none of them were related to vaccination. Conclusion: Most of the adverse events observed from RTS,S/AS01 and RTS,S/AS02 malaria vaccines were reported in the control group and shared by other vaccines. Hence, the authors concluded that both RTS,S/AS01 and RTS,S/AS02 malaria vaccines are safe.

Magnitude of anemia and associated factors among adult patients at Baso Liben District: a cross-sectional study.

BACKGROUND: Despite the fact that anemia is a common health problem with many consequences, its magnitude among adults and the different contributing factors have not been documented in the study setting. Hence, this study aimed to determine the magnitude of anemia and associated factors among adult patients of Baso Liben District. METHODS: A facility-based cross-sectional study was conducted from 1 December 2019, to February 30, 2020. A total of 347 adult patients attending Yejubie Hospital were enrolled in the study. Socio-demographic data were collected through face-to-face interview. Patients' hemoglobin level was determined by a Mindray BC-5800 CBC hematology analyzer. The presence of intestinal parasites and malaria infection were assessed. RESULTS: The overall magnitude of anemia was 25.94% with moderate severity according to the WHO anemia classification. The prevalence of mild, moderate, and severe anemia was 13.54%, 8.36%, and 4.03%, respectively. Anemia was associated with age range ≥55 years (AOR = 31.66), large family size (AOR = 6.62), being married (AOR = 0.24), intestinal parasite infections (AOR = 4.05), malaria infection (AOR = 4.61), and pregnancy (AOR = 4.09). CONCLUSION: The prevalence of anemia was moderate. Intestinal parasitic infection, age, malaria, family size, and pregnancy were associated factors with anemia.

Gram-negative bacteria isolates and their antibiotic-resistance patterns among pediatrics patients in Ethiopia: A systematic review.

Objective: Antimicrobial resistance is one of the serious threats in the world, including Ethiopia. Even though several studies were conducted to estimate common bacteria and their antibiotic-resistance profile in Ethiopia, it is difficult to estimate the overall resistant patterns due to the lack of a nationwide study. This systematic review aimed to determine the prevalence of gram-negative bacteria isolates and their antibiotic-resistance profile among pediatrics patients in Ethiopia. Methods: A web-based search using PubMed, EMBASE, Science Direct, the Cochrane Database for Systematic Reviews, Scopus, Hinari, Sci-Hub, African Journals Online Library, and free-text web searches using Google Scholar was conducted from August to September 16, 2021. Each of the original articles was searched by Boolean search technique using various keywords and was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The data were extracted using Microsoft Excel format and exported to STATA 14.0 for statistical analyses. Results: The database search delivered a total of 2,684 studies. After articles were removed by duplications, title, reading the abstract, and assessed for eligibility criteria, 19 articles were included in the systematic review. Of a total of 1372 (16.77%) culture-positive samples, 735 (53.57%) were gram-negative. Escherichia coli was the most frequently isolated bacteria followed by Klebsiella species, 139/1372 (10.13%), and 125/1372(9.11%), respectively. More than 66.67% of isolates were resistant to ampicillin except for Neisseria meningitidis which was 32.35% (11/34). Pseudomonas aeruginosa, Klebsiela species, and Citrobacter species were 100% resistance for cefepime. Haemophilus influenzae was 100% resistant to meropenem. Salmonella species were 93.30%, 78.26%, and 63.64% resistant to tetracycline, chloramphenicol, and cotrimoxazole, respectively. Conclusion: Gram-negative bacteria were identified as the common pathogen causing infection in pediatrics and the level of resistance to commonly prescribed antibiotics was significantly higher in Ethiopia. Culture and susceptibility tests and well-designed infection control programs are important measures.

Hookworm re-infection rate and efficacy of single-dose albendazole among pregnant women in Debre Elias District, Northwest Ethiopia: A single-arm trial.

Hookworm is one of the soil-transmitted nematodes causing anaemia and low birth weight in pregnant women. This study aimed to assess albendazole efficacy and re-infection rate among pregnant women. A community-based cross-sectional study was conducted from February to September 2021 in Debre Elias District. Albendazole (400mg) was administered to assess efficacy and hookworm re-infection rate. Though the cure rate of single-dose albendazole was 81.7%, with an overall egg reduction rate of 92.5%, the re-infection rate of hookworm 18-24 weeks post-treatment was substantial at 21.4%. More effective intervention measures are thus needed.

Integrated Pharmaceutical Logistics System Implementation in Chagni Primary Hospital and Injibara General Hospital, Awi Zone, Ethiopia.

BACKGROUND: Integrated Pharmaceutical Logistics System is the primary mechanism through which all public health facilities in Ethiopia get essential pharmaceutical products from their main supplier. Pharmaceuticals should be managed appropriately because they are part of the link between the patient and health services and account for up to half of the healthcare budget. This study aimed to assess the status of Integrated Pharmaceutical Logistics System implementation at both Chagni Primary Hospital and Injibara General Hospital. METHODS: Facility-based descriptive study design supported with a qualitative study design was used. Face-to-face interviews, observation of practices, and document review were conducted to gather quantitative data. Besides, the qualitative data were collected through in-depth face-to-face interviews. Frequency and percentage were computed, and the results were briefly described in text and displayed in tables and graphs. The qualitative data were transcribed manually, and thematic analysis was done. RESULTS: All IPLS materials were available in both hospitals, but the stock recording card was not available at Injibara General Hospital. About 90% and 100% of the dispensing units in Chagni Primary Hospital and Injibara general hospital were utilizing bin-cards, respectively. Besides, 50% and 80% of the bin-cards in Chagrin Primary Hospital and Injibara General Hospital were regularly updated, respectively. About 80% and 75% of the IFRRs in Chagni Primary Hospital and Injibara General Hospital reported valid data, respectively. Besides, 66.67% and 50% of the RRFs reviewed at Chagni Primary Hospital and Injibara General Hospital reported valid data, respectively. Medicine stockouts, poor staff commitment, and workload were the major bottlenecks for IPLS execution. CONCLUSION: The status of most of the IPLS implementation indicators in both hospitals was good. Especially, the availabilities of IPLS materials and the calculation accuracy of both RRFs and IFRRs were encouraging in both hospitals. However, the validity of the data reported in IFRRs and RRFs, and the status of the storage conditions in both hospitals need some improvement during the implementations of IPLS.