Antileishmanial Activity of Tamoxifen by Targeting Sphingolipid Metabolism: A Review.

Leishmaniasis is a widespread group of neglected parasitic diseases caused by protozoa of the genus Leishmania. Around 2 million new cases are reported each year and around 12 million people are at risk of being infected. Although various therapies have been used to treat leishmaniasis, they have been associated with increased cytotoxicity and drug resistance problems. Hence, the present review was intended to show the potential of tamoxifen as an alternative option for the treatment of leishmaniasis. Tamoxifen is a known selective estrogen receptor modulator and has been widely used for the treatment of early-stage breast cancer. Various experimental and clinical studies revealed that it has an antileishmanial effect by decreasing parasitic burden, with low cost and few side effects. The antileishmanial action of tamoxifen has been related to its potential effect on sphingolipid metabolism. Besides, it affects mitochondrial function by inducing alterations in the plasma membrane potential. However, further detailed studies are required to show the ultimate effects on health outcomes.

Evaluation of Medication Package Inserts in Ethiopia.

BACKGROUND: Patients require accurate and reliable information to help them use their medications safely and effectively. Inadequate patient knowledge may contribute to medication nonadherence which could negatively affect treatment outcomes. The purpose of this study was to evaluate the presentation and completeness of medication package inserts (MPIs) which are available in the Ethiopian market. METHODS: A cross-sectional document review was performed in February and March of 2019. All MPIs which were authorized by EFDA to sell in the Ethiopian market and available during the data collection period were considered. RESULTS: The mean overall completeness score of 200 MPIs was 18.39 ± 4.30. Of the 200 MPIs, only 20% were from domestic pharmaceutical companies. Antimicrobials represented 24% of the total MPIs. Topical preparations, cardiovascular drugs, gastrointestinal drugs, and nonsteroidal anti-inflammatory drugs, accounted for 12.5%,12.5%, 11%, and 9% of the MPIs, respectively. The majority of the MPIs presented information about the drug's use during pregnancy and lactation, 77.0% and 74.0%, respectively. However, only half of the MPIs, 49.5%, gave information about special warnings and precautions. Only a few of the MPIs provided information about instructions to convert tablets or capsules into liquid forms and the possibility of tablet splitting, 4.8% and 8.7%, respectively. Furthermore, only 1.0% had local language translation. CONCLUSION: The MPIs available in Ethiopia provide inadequate information including about the safety of drug products and local language translation. Regulatory authorities should implement stringent regulations to ensure the provision of vital information which extends beyond checking the mere presence of an MPI. They should also act to the possible standardization of MPIs.

Assessment of Potential Drug-Drug Interactions and Their Predictors in Chronic Outpatient Department of Dessie Referral Hospital, Dessie, Northeast Ethiopia.

OBJECTIVE: To assess the prevalence and predictors of Potential drug-drug interactions (DDIs) at the chronic outpatient department of Dessie Referral Hospital, Dessie, Northeast Ethiopia. PATIENTS AND METHODS: A cross-sectional study was carried out on the medical records of patients treated in the chronic ambulatory department of Dessie Referral Hospital (DRH), from March 1/2019 to May 30/2019. Ethical clearance was granted from the department of pharmacy, college of medicine, and health sciences, Wollo University. Lexi-comp computer program database was used to detect pDDIs. SPSS version 22 was used to produce a descriptive analysis of the background data and logistic regression to identify predictors of pDDIs. RESULTS: In this study, the medical record of 300 patients has been reviewed and 489 pDDIs have been identified. The prevalence of pDDIs per patient was 1.63. Of all the identified pDDIs, the moderate severity interactions were the majority, 88.55% (n=433) followed by 8.38% (n=41) of minor, 2.66% (n=13) of major, and 0.41% (n=2) of contraindicated drug interactions. Taking three or more drugs at a time has been found as a statistically significant predictor of the occurrence of pDDIs. CONCLUSION: A high rate of moderate severity pDDIs have been recorded. A system of checks and balances should be developed and executed for all those who are involved in prescribing, dispensing, and administration of medications for effective identification and prevention of pDDIs.

Montelukast: The New Therapeutic Option for the Treatment of Epilepsy.

Currently, there is no definitive cure for epilepsy. The available medications relieve symptoms and reduce seizure attacks. The major challenge with the available antiepileptic medication is safety and affordability. The repurposing of montelukast for epilepsy can be an alternative medication with a better safety profile. Montelukast is a leukotriene receptor antagonist that binds to the cysteinyl leukotrienes (CysLT) receptors used in the treatment of bronchial asthma and seasonal allergies. Emerging evidence suggests that montelukast's anti-inflammatory effect can help to maintain BBB integrity. The drug has also neuroprotective and anti-oxidative activities to reduce seizure incidence and epilepsy. The present review summarizes the neuropharmacological actions of montelukast in epilepsy with an emphasis on the recent findings associated with CysLT and cell-specific effects.

In Vivo Diuretic Activity of Hydromethanolic Extract and Solvent Fractions of the Root Bark of Clerodendrum myricoides Hochst. (Lamiaceae).

INTRODUCTION: Clerodendrum myricoides (Lamiaceae) has been traditionally used for the treatment of various ailments, including body swelling and urine retention. The present study aimed to evaluate the diuretic activity of a crude extract and solvent fractions of the root bark of C. myricoides. Methodology. The coarsely powdered root bark of C. myricoides was extracted by a cold maceration method using 80% methanol. A portion of the extract was fractionated based on the polarity index of solvents to obtain chloroform, ethyl acetate, and aqueous fractions. To investigate the diuretic activity of the plant, rats were divided into fifteen groups. The normal control groups received either water or 2% tween 80, the standard group received furosemide (10 mg/kg), and the test groups were administered the hydromethanolic extract and solvent fractions at the doses of 100, 200, and 400 mg/kg by the oral route. The urine volume, urine pH, urine, and serum electrolytes were determined and compared with the standard and normal control groups. RESULTS: The crude hydromethanolic extract, ethyl acetate, and chloroform fractions induced significant diuresis at a dose of 400 mg/kg (P < 0.001) compared to the aqueous fraction. The hydromethanolic extract at 200 mg/kg and 400 mg/kg also caused noticeable diuresis (P < 0.001) compared to the standard, furosemide. Rats treated with hydromethanolic extract, ethyl acetate, and chloroform fractions showed delayed onset and prolonged diuresis in a dose-dependent fashion compared to the aqueous fraction (P < 0.05). The hydromethanolic extract and solvent fractions produced the highest saliuretic and natriuretic index compared to the standard, furosemide. The crude hydromethanolic extract also failed to produce any sign of toxicity up to 2000 mg/kg. CONCLUSION: From this study, the hydromethanolic extract and ethyl acetate fraction of the root bark of C. myricoides produced a prominent diuretic effect in rats.

Adequacy of Cancer-Related Pain Treatments and Factors Affecting Proper Management in Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia.

BACKGROUND: Cancer-related pain (CRP) is a major problem with a potential negative impact on quality of life of the patients and their caregivers. PURPOSE: To assess the adequacy of cancer-related pain management in Ayder Comprehensive Specialized Hospital (ACSH). Methodology. A facility-based cross-sectional study design was conducted in ACSH from January to March 2019. A well-structured professional-assisted questionnaire using Brief Pain Inventory-Short Form (BPI-SF) was used to collect data concerning the severity of pain, functioning interference, and adequacy of pain management in cancer patients. Data were analyzed using SPSS v.21. RESULT: Out of 91 participants, 47 (51.6%) were male and 52 (57.1%) were between the age group of 18-45, with the mean age of 44.8 ± 13.6 years. According to the pain assessment tool (BPI), 85 (93.4%) patients experienced pain and 90 (98.9%) patients had activity interference; negative pain management index (PMI) was observed in 40 (43.95%) patients, showing that 43.95% were receiving inadequate pain management. Out of 38 patients who received no analgesics, 35.2% were found to have inadequate pain management, whereas those who took strong opioids had 100% effective pain management and the majority of the patients were in stage III. Among 38 (41.76%) only 20 (52.63%) received adequate pain management, based on patients' self-report in which 18.7% of the participants stated that they got 30% pain relief and only 1.1% got 90% relief. The predictors of undertreatment were presence of severe pain, metastasis, comorbidity, and stage of the cancer and could also be due to the educational level and monthly income, as evidenced by significant association. CONCLUSION: This study suggests that cancer pain management in ACSH was sufficient for only 56%. However, large numbers of individuals are suffering from a manageable pain. Hence, remedial action should be taken, including increasing awareness of symptom management in medical staff and incorporating existing knowledge into routine clinical practice.

Evaluation of patient safety culture among community pharmacists in Ethiopia: A cross-sectional study.

OBJECTIVE: The study was aimed to explore patient safety culture of community pharmacists working in Dessie and Gondar towns, Northern Ethiopia. METHODS: A cross-sectional study was conducted from 1st to 31st March 2018. In this cross-sectional survey, the Pharmacy Survey on Patient Safety Culture (PSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ), was used to collect data. PSOPSC is a self-administered questionnaire. The questionnaire was distributed among staffs who work in community pharmacies of Dessie and Gondar towns. All staffs available on data collection period in the pharmacy were included. The Statistical Package for Social Science (SPSS) software version 25 was used to enter and analyze the data. RESULTS: A total of 120 participants were approached and completed the questionnaire. Results from the study showed that high positive response rate was demonstrated in the domains of "Teamwork" (90.2%) followed by physical space and environment (83.1%). On the other hand, the result also identified that there is an enormous problem related to mistake communication (44.8%) and work pressure (45%). In addition, significant difference of percent positive responses were obtained across towns and staff working hours. CONCLUSIONS: The patient safety culture of community pharmacists is appreciable especially with respect to their teamwork. Besides, urgent attention should be given to areas of weakness, mainly in the domain of "mistake communication" and "staffing and work pressure".

Critical evaluation of the validity of drug promotion materials in Ethiopia.

PURPOSE: This study was conducted to evaluate the validity of drug promotion materials (DPMs) in Ethiopia. METHODS: A cross sectional document review was done. DPMs were evaluated for fulfilment of the World Health Organization's (WHO) criteria for ethical promotion of drugs. They were also evaluated for font size, type of formulation, claims made, pictures depicted, retrievability and source of references used. RESULTS: A total of 235 DPMs were collected from the community and hospital pharmacies. Documents promoting devices and equipment, orthopedic appliances, reminder cards and drug lists were excluded, leaving 173 promotional materials. Antimicrobials were the most promoted drugs (27.2%) followed by respiratory drugs (11.0%) and gastrointestinal drugs (9.8%). Brand name was written in all of the DPMs while approved generic names, indication and active ingredient per dosage form were written in 94.8%, 92.5% and 62.4% respectively. Side effects and contraindications were written in 27.2% and 18.5% of the DPMs. A total of 223 claims were made. Efficacy was the dominant claim (62.3%) followed by safety (8.5%). Pictorial demonstrations were used in 84.4% of the DPMs. Almost half of the pictures depicted, 47.3%, were the cover of the drug products. Only 48.6% of the DPMs has supported their claims with references. Review articles account for 23.3% of the references. Only 5.8% of the journal articles were published after the year 2013. CONCLUSION: We conclude that the design and content of studied drug promotional materials are most effective as sales materials rather than thorough informational vehicles. The WHO and Food, Medicine and Health Care Administration and Control Authority of Ethiopia recommendations are rarely met.

Evaluation of Knowledge and Practice of Pharmacy Professionals regarding the Risk of Medication Use during Pregnancy in Dessie Town, Northeast Ethiopia: A Cross-Sectional Study.

BACKGROUND: The developing organism is unique in its responsiveness to drugs and predictability of therapeutic effectiveness based on the adult which can lead to grave consequences in the neonate and child. Moreover, uncertainty about the risks of drug use in pregnancy could result in restrictive attitudes towards prescribing and dispensing medicines and their use. Pharmacists have huge duties to improve medication use, especially among pregnant women. The objective of this study is, hence, to assess the knowledge and practice of pharmacy professionals (PPs) towards the risk of medication use during pregnancy. METHODOLOGY: A questionnaire-based cross-sectional study was carried out over practicing community and hospital pharmacy professionals in Dessie town. They were asked about the safety of common drugs during pregnancy. It involves both prescription-only medications (POM) and over-the-counter (OTC) medications. Secondly, they were asked about their practice towards the risk of medication use during pregnancy. Both descriptive and analytical statistics were utilized. For descriptive analysis, results were expressed as numbers, percentages, and mean (± SD and 95% CI). RESULT: Seventy-six pharmacy professionals in Dessie, Northeast Ethiopia, took part in the study. Most of the respondents (64.5%) believed that amoxicillin is safe in all trimesters. 26 (34.2%) of participants knew that isotretinoin is unsafe for use by pregnant women. About dietary supplements, 32.9% of PPs reported that Vitamin A supplements are safe in all trimesters. There was a significant difference observed for study college and years of experience of the PPs in their score of knowledge test (p=0.020 and p=0.024, respectively). Additionally, there was a difference seen for gender (p=0.030), study college (p=0.036), and working institution (p=0.013) in their advice to pregnant women. CONCLUSION AND RECOMMENDATION: Overall, PPs exhibited very low knowledge about drug safety during pregnancy. The absence of obligatory continuing pharmacy education for pharmacists is expected to have negatively affected the level of medication knowledge and consequently the pharmaceutical care services delivered in community and hospital pharmacies. As medication knowledge of PPs is poor, a multitude of strategies (educational, economic, managerial, and regulatory) should be designed by the government, universities, and pharmaceutical associations to improve the pharmacy professionals' role in the healthcare system by providing them with continuous and up-to-date medication knowledge.