A Systematic Review of the Stability of Extemporaneous Pediatric Oral Formulations.

BACKGROUND: Extemporaneous compounding is a pharmacy practice to produce suitable pharmaceutical preparations when there are no commercially available, licensed, and age-specific dosage forms. Compared to the use of authorized drugs, these preparations have significant risks. Stability issues are one of the major concerns during the preparation of extemporaneous formulations. AIM: The aim of this work was to study the stability of pediatric extemporaneous formulations of commercially available conventional solid dosage forms by reviewing systematically the currently available stability studies. METHOD: Articles were searched in the databases of the Web of Science, PubMed, Scopus, EMBASE, Cochrane Library, and Google Scholar. From all the searched articles, a total of 28 experimental studies reporting the stability of oral pediatric extemporaneous formulations were included based on the inclusion criteria. Oral extemporaneous formulations from commercially available dosage forms and pure drugs were considered. According to the United States and British Pharmacopeia (USP and BP), most extemporaneous formulations are accepted as chemically stable if they maintain ≥90% of the original drug amount, physically stable if there is no apparent change in physical property, and microbiologically stable if there is no growth of microorganisms in prepared formulations. Finding. In this study, most extemporaneous pediatric oral formulations were chemically, physically, and microbiologically stable and retained more than 90% of the initial content. Very few studies did not include either a physical stability test or a microbiological stability test. CONCLUSION: According to this systematic review, the chemical and physical instabilities as well as microbial growth on pediatric oral extemporaneous formulations are very rare in published experimental studies. Most studies show that extemporaneous preparations are stable at the ICH recommended storage conditions and duration. Generally, extemporaneously prepared oral formulations will be the promising option for child medications.

Perinatal mortality and its association with antenatal care visit, maternal tetanus toxoid immunization and partograph utilization in Ethiopia: a meta-analysis.

Despite remarkable progress in the reduction of under-five mortality; perinatal mortality is the major public health problem in Africa. In Ethiopia, the study findings on perinatal mortality and its predictors were inconsistent. Therefore, this systematic review and meta-analysis estimated the pooled perinatal mortality, and its association with antenatal care visit, maternal tetanus toxoid immunization, and partograph monitoring. International databases like PubMed, SCOPUS, Google Scholar and Science Direct were systematically searched. I squared statistics was used to determine the levels of heterogeneity across studies and the pooled estimate was computed using a random-effect model. The meta-analysis showed that a pooled prevalence of perinatal mortality in Ethiopia was 6.00% (95% CI 5.00%, 7.00%). The highest proportion of perinatal mortality was a stillbirth, 5.00% (95% CI 4.00%, 7.00%). Women who had antenatal care visit [OR = 0.20 (95% CI 0.12, 0.34)], maternal tetanus toxoid immunization [OR = 0.43 (95% CI 0.24, 0.77)] and partograph monitoring [POR = 0.22 (95% CI 0.06, 0.76)] reduced the risk of perinatal mortality. Whereas, previous history of perinatal mortality [POR = 7.95 (95% CI 5.59, 11.30)] and abortion history (POR = 2.02 (95% CI 1.18, 3.46)) significantly increased the risk of perinatal mortality. Therefore, antenatal care visit, maternal tetanus toxoid vaccination uptake, and partograph utilization should be an area of improvements to reduce perinatal mortality.

Drug-Drug interaction among admitted patients at primary, district and referral hospitals' medical wards in East Gojjam Zone, Amhara Regional State, Ethiopia.

OBJECTIVES: This study was aimed to assess the type, prevalence, characteristics of drug interaction and factors associated from admitted patients in medical wards at primary, district and referral hospitals in East Gojjam Zone, Amhara Regional State, Ethiopia. METHODS: A facility-based retrospective cross-sectional study design was conducted among admitted patients in medical wards at different hospitals of East Gojjam Zone from September 2019 to February 2020. Patient-specific data were extracted from patient medical prescription papers using a structured data collection tool. Potential drug-drug interaction was identified using www.drugs.com as drug-drug interaction checker. Data were analyzed using SPSS version 23.0. To identify the explanatory predictors of potential drug-drug interaction, logistic regression analysis was done at a statistical significance level of p-value < 0.05. RESULTS: Of the total 554 prescriptions, 51.1% were prescribed for females with a mean (±standard deviation) age of 40.85 ± 23.09 years. About 46.4% prescriptions of patients had one or more comorbid conditions, and the most frequent identified comorbid conditions were infectious (18.6%) and cardiac problems (6.3%) with 0.46 ± 0.499 average number of comorbid conditions per patient. Totally, 1516 drugs were prescribed with 2.74 ± 0.848 mean number per patient and range of 2-6. Two hundred and forty-two (43.7%) prescriptions had at least one potential drug-drug interaction, and it was found that 292 drug interactions were presented. Almost half of the drug-drug interaction identified was moderate (50%). Overall, the prevalence rate of drug-drug interaction was 43.7%. Older age (adjusted odds ratio = 8.301; 95% confidence interval (5.51-12.4), p = 0.000), presence of comorbidities (adjusted odds ratio = 1.72; 95% confidence interval (1.10-2.68), p = 0.000) and number of medications greater or equal to 3 (adjusted odds ratio = 2.69; 95% confidence interval (1.42-5.11), p = 0.000) were independent predictors for the occurrence of potential drug-drug interaction. CONCLUSION: The prevalence of potential drug-drug interaction among admitted patients was relatively high. Pharmacodynamic drug-drug interaction was the common mechanism of drug-drug interaction with moderate degree. Therefore, close follow-up of hospitalized patients is highly recommended.

Evaluation of the wound healing activity of the crude extract of root bark of Brucea antidysentrica, the leaves of Dodonaea angustifolia and Rhamnus prinoides in mice.

BACKGROUND: Wounds are major problems of developing countries that can be managed alternatively using traditional medicinal plants. Since majority of currently available drugs for wound management are expensive and pose problems such as allergy and drug resistance, it is pivotal for the world to have intensified inquiries on the claimed medicinal plants to come up with wound healing chemicals being affordable, effective and safe. Ethiopian traditional healers recruit a wide range of medicinal plants with wound healing activities. Root bark juice of Brucea antidysentrica, the leaves of Rhamnus prinoides and Dodonaea angustifolia are claimed among others in the folklore medicine. Therefore, the aim of this study was to evaluate the in vivo wound healing activities of the root bark juice of Brucea antidysentrica, the leaves of Rhamnus prinoides and Dodonaea angustifolia in mice. METHOD: The root bark juice of Brucea antidysentrica, the leaves of Rhamnus prinoides and Dodonaea angustifolia were collected, dried, ground to coarse powders. Then the crude extract was obtained by macerating with 80% methanol. The filtrate was dried, reconstituted in appropriate solvent and the wound healing activity was evaluated using excision and incision wound models. RESULTS: On the last day of treatment, 80% methanol extracts from the selected medicinal plants showed a significant wound healing activity against control as supported by an increase in % wound contraction and a decrease in Epithelialization period. Ten percent of Rhamnus prinoides showed significant wound contraction against the control (P < 0.05) on days 2 and 4. But on day 6; except 5% extracts of Brucea antidysentrica and Rhamnus prinoides; all doses of extracts contracted the wound significantly (P < 0.05). Extracts of Dodonea angustifolia (5% & 10%) and 10% of Rhamnus prinoides and Brucea antidysentrica increases wound contraction rate with increasing significant level on days 8 & 10 (P < 0.01) and 12 &14 (P < 0.001). Among the extracts, 10% of Dodonea angustifolia showed maximum percent (99.9%; P < 0.001) of wound contraction followed by 5% Dodonea angustifolia (99.15%; P < 0.001) and 10% Rhamnus prinoides (99.00%; P < 0.001) on the last day of treatment. In addition; significantly shorter healing time was attained by 5% &10% leaves of Dodonea angustifolia (P < 0.01), 10% leaves Rhamnus prinoides & root barks Brucea antidysentrica (P < 0.05). Ten percent of Rhamnus prinoides & Brucea antidysentrica (P < 0.05) and both doses (5% & 10%) of Dodonea angustifolia (P < 0.01) significantly increased the tensile strength by 54.10%, 56.58%, 63.04%, and 79.19%, respectively against the control. CONCLUSION: The 80% methanol crude extracts of the study plants support the traditional claims for healing of wounds as evidenced by an increase in wound contraction rate and tensile strength, decrease in Epithelialization period.

Medication Administration Errors and Associated Factors Among Nurses.

INTRODUCTION: Medication error has the potential to lead to harm to the patient. It is the leading cause of threatens trust in the healthcare system, induce corrective therapy, and prolong patients' hospitalization, produces extra costs and even death. This study aimed to assess medication administration error (MAE) and associated factors among nurses in referral hospitals of Ethiopia. METHODS: Institutional-based, cross-sectional study design was used, and 422 study participants were selected using a simple random sampling method. Data were collected using a semi-structured and pre-tested self-administered questionnaire and observational checklist. The collected data were analyzed using descriptive and analytical statistics and binary logistic regression was done to identify factors associated with medication administration errors. P-value ≤ 0.05 was considered statistically significant. RESULTS: Four hundred fourteen participants with a response rate of 98.1% were involved and 54.3% were females. The median age was 30 with IQR (28-34) years and the majority of them (83.8%) had BSc qualification in nursing. The prevalence of MAE in this study was 57.7% and 30.4% of them made it more than three times. Wrong time (38.6%), wrong assessment (27.5%), and wrong evaluation (26.1%) were the most frequently perpetuated medication administration errors. Significant association between medication administration errors and lack of training [AOR=2.20; 95% CI (1.09, 4.46)], unavailability of guideline [AOR=1.65; 95% CI (1.03, 2.79)], poor communication when face problem [AOR=3.31; 95% CI (2.04, 5.37)], interruption [AOR = 3.37, 95% CI (2.15, 5.28)] and failure to follow medication administration rights [AOR=1.647; 95% CI (1.00, 2.49)] was noticed. CONCLUSION: MAE was high in the study area as compared to studies from Jimma University Specialized Hospital, Adigrat and Mekelle University Hospital, and the University of Gondar Referral Hospital and hence developing guidelines, providing training, and develop strategies to minimize distracters are better to be undertaken.

Prevalence of HIV/AIDS Among Elderly People and Associated Factors in Habru Woreda, Amhara Region, Northeast Ethiopia.

INTRODUCTION: Sub-Saharan African countries are the most affected region by HIV/AIDS. Data from Demographic and Health Survey (DHS) indicated that in Ethiopia older adults who are HIV positive were 2.1% which accounted 17.7% from all HIV positive people aged ≥15. Scarce data are available regarding the prevalence of HIV and associated factors among elderly peoples in Habru district. OBJECTIVE: To assess the prevalence of HIV and associated factors among older people ≥50 years' age in the study area. METHODS: A community-based cross-sectional study was employed. A multi-stage simple random sampling technique was employed and a total of 1689 study subjects were involved. Data were collected by trained health professionals and analyzed using descriptive and analytical statistics. Binary and multivariate logistic regressions were used to identify factors associated with the prevalence of HIV. P-value ≤0.05 was considered statistically significant. RESULTS: Total of 1689 participants were involved and tested for HIV sero-status of which 51.1% were females and the mean age was 62.4±12.34 years. The prevalence for HIV+ was 6.2%. From the multivariate regression model, significant association between prevalence and condom use at last sexual intercourse [AOR= 11.099; 95% CI (2.357,52.268)], condom use at high-risk sexual intercourse [AOR=0.088; 95% CI (0.020, 0.398)], marital status [AOR= 0.409; 95% CI (0.252,0.666)], religion [AOR= 0.431; 95% CI (0.241, 773)], types of previous work [AOR= 0.301; 95% CI (0.117, 0.770)], older people self-perception to risk of HIV infection [AOR= 3.731; 95% CI (2.280, 6.104)], care for HIV infected and non-infected grand children [AOR= 0.434; 95% CI (0.235, 800)], presence of care and support program [AOR= 6.128; 95% CI (1.532, 24.514)] was noticed. CONCLUSION: The prevalence of HIV in Habru was higher (6.2%) than the national level (2.1%) and efforts should be concentrated on designing new HIV intervention programs targeting older people aged ≥50years.