Evaluation of Aloe elegans Mucilage as a Suspending Agent in Paracetamol Suspension.

BACKGROUND: There are various natural excipients which have been used as suspending agents in pharmaceutical suspensions due to the presence of mucilage in their specialized cells and their capacity to form a colloidal gel in an aqueous medium. OBJECTIVE: The purpose of this study was to evaluate the suspending capacity of Aloe elegans mucilage in suspension formulations. MATERIALS AND METHODS: Aloe elegans mucilage (AEM) was evaluated as a suspending agent in comparison with xanthan gum (XG) in paracetamol suspensions at 1, 2, 3, 4, and 5% (w/v) concentrations. The resulting suspensions were evaluated for their sedimentation volume, apparent viscosity, flow rate, rate of redispersibility, pH, assay, and dissolution profile. RESULTS: The volume of sedimentation, apparent viscosity, and redispersibility rate of the formulations were significantly increased (p < 0.05), with the concentration of the suspending agents. Meanwhile, the apparent viscosity for all formulations has significantly decreased (p < 0.05) with an increase in shear rates. Volume of sedimentation, apparent viscosity, and redispersibility degree of the formulations prepared with AEM were significantly (p < 0.05) lower than XG-containing formulations at the same concentration. Nevertheless, the sedimentation volume of all formulations with AEM was significantly (p < 0.05) higher than the suspension without any suspending agent. With regard to drug content and pH values, all formulations showed an acceptable result with the standards. All formulations showed a release of greater than 85% of drug content within 45 min. CONCLUSION: Aloe elegans mucilage could have a potential to be utilized as an alternative suspending agent in pharmaceutical suspensions.

Prescribing Pattern of Antibiotics Using WHO Prescribing Indicators Among Inpatients in Ethiopia: A Need for Antibiotic Stewardship Program.

BACKGROUND: Irrational prescribing of antibiotics is a universal public health problem, leading to antibiotic resistance. Understanding the prescribing pattern of antibiotics is crucial to tackling irrational prescription. Yet, comprehensive studies regarding the prescribing pattern of antibiotics among inpatients and the need for an Antibiotic Stewardship Program (ASP) are lacking in Ethiopia. This study aimed to evaluate prescribing patterns of antibiotics and the need for an ASP. METHODS: A hospital-based prospective observational study was carried out from February 2019 to December 2019. This study was conducted among patients admitted to Aksum University Comprehensive Specialized Hospital, Ethiopia. Data were collected using a data abstraction format generated by World Health Organization (WHO) prescribing indicators. Data analysis was carried out using SPSS version 25.0. RESULTS: A total of 1653 antibiotics were prescribed for 822 inpatients. Overall, 52.3% of patients had at least one oral and/or injectable antibiotic prescribed, for a mean duration of 4.2 (SD=2.3) days. The average number of prescribed antibiotics per patient was 2.01 (SD=1.9). The majority (97.6%) of antibiotics were prescribed by their generic name, and all prescribed antibiotics were from the national Essential Medicine List (EML). Frequently prescribed injectable and oral antibiotics were ceftriaxone (24.5%) and azithromycin (12.9%), respectively. Culture and sensitivity testing were not performed in any of the cases. During the study period, 65.2% of key antibiotics were available in stock. CONCLUSION: In this study, more than half of patients were on at least one antibiotic, and all antibiotics were prescribed from the national EML. However, all antibiotics were prescribed empirically. This result shows that the prescribing pattern of antibiotics in the hospital deviates from and is non-compliant with the standard endorsed by WHO. This study provides evidence for the necessity and a way forward for the establishment of an ASP in the hospital that may help to introduce the prescribing of antibiotics with the aid of culture and sensitivity tests, and to develop institutional guidelines.

Predictors of poor adherence to antidiabetic therapy in patients with type 2 diabetes: a cross-sectional study insight from Ethiopia.

BACKGROUND: Poor adherence to the medical regimen is a major clinical problem in the management of patients with diabetes. This study sought to investigate the level of medication adherence to antidiabetic therapy and to identify possible predictors of poor adherence. METHODS: A hospital based cross-sectional study was conducted from July 2018 to June 2019 among randomly selected follow-up T2D patients at a hospital diabetes clinic. Data were collected through patient interviews, followed by medical chart review. Adherence to antidiabetic therapy that we assessed patients' responses using validated Brief Medication Questionnaire (BMQ). To identify predictors of poor medication adherence, binary logistic regression analyses were performed using SPSS version 25. Statistical significance was set at p value ≤ 0.05. RESULTS: Of the total 357 study participants, 25% were non-adherent to their antidiabetic therapy. Predictors statistically associated with poor adherence were; being female gender (AOR = 1.71, 95% CI 1.01-2.76), and presence of at least one diabetic complication (AOR = 2.02, 95% CI 1.02-3.22). Participants with having at least primary level of education were more likely to adhere to anti-diabetes medication (AOR = 0.42, 95% CI 0.18-0.96). The most common self-reported reasons for non-adherence were forgetfulness, unavailability of medication plus the unaffordability of anti-diabetes medications. CONCLUSIONS: The proportion of participants' adherent to anti-diabetes therapies was suboptimal. Being female, the presence of chronic diabetic complications and having no formal education were the main predictors of poor adherence. Strategies that aimed at improving adherence to antidiabetic medications deemed to be compulsory.

Preparation, Optimization, and Evaluation of Epichlorohydrin Cross-Linked Enset (Ensete ventricosum (Welw.) Cheeseman) Starch as Drug Release Sustaining Excipient in Microsphere Formulation.

Ensete ventricosum (Welw.) cheeseman which belongs to the family of Musaceae is one of the main sources of starch in Ethiopia. This study aimed at evaluating epichlorohydrin cross-linked enset starch as a drug release sustaining excipient in microsphere formulations of theophylline. Extracted enset starch was cross-linked using epichlorohydrin as a cross-linking agent. The effect of cross-linker concentration, cross-linking duration, and cross-linking temperature on the degree of cross-linking and release rate of microspheres prepared by emulsion solvent evaporation method was investigated using the two-level full factorial design. Accordingly, the concentration of epichlorohydrin and duration of cross-linking were the most significant factors affecting both the degree of cross-linking and drug release rate. Thus, the effects of these two factors were further studied and optimized using the central composite design. As per the numerical method of central composite design, the optimal points were obtained at epichlorohydrin concentration of 13.70% and cross-linking time of 3.82 h. Under these optimal conditions, the model predicts the degree of cross-linking of 74.70% and drug release rate of 28.00 h1/2. The validity of these optimal points was confirmed experimentally. The microspheres of the optimum formulation also exhibited minimum burst release with sustained release for 12 h. Besides, the optimized formulation followed the Higuchi square root kinetic model with non-Fickian diffusion release mechanism. The finding of this study suggested that cross-linked enset starch can be used as an alternative drug-release-sustaining pharmaceutical excipient in microsphere formulation.

Predictors of poor glycemic control among patients with type 2 diabetes on follow-up care at a tertiary healthcare setting in Ethiopia.

OBJECTIVE: Contemporary clinical guidelines endorsed that glycemic control is the ultimate goal in the management patients with diabetes. The aim of this study was to assess the prevalence of glycemic control and to identify predictors of poor glycemic control in patients with type 2 diabetes (T2D). A cross-sectional study was conducted among systematically selected 357 diabetic patients. Data were collected through direct patients' interviews and medical chart review. Binary logistic regression analyses were performed and analyzed using SPSS version 22.0. RESULTS: Participants' mean age was (± SD) 56.1 ± 11.6 years. Nearly four in five (77.9%) of the participants had comorbidities, mainly of hypertension, and 60.2% had diabetic complications, mainly diabetes neuropathy. Poor glycemic control was found in 68.3% of the participants with a mean (± SD) FBG of 174.1 ± 48.9 mg/dL. Being female gender, having greater body mass index and low medication adherence was significantly associated with poor glycemic control. In conclusion, the overall aspects of glycemic control level of patients were far from the standards. Being female, greater body mass index and poor medication adherence were predictors of poor glycemic control. In response to this finding, an aggressive intervention that targets in improving the glycemic control is required.