RESUMEN

Globally, usage of non-steroidal anti-inflammatory drugs (NSAIDs) in elderly with chronic pain has been reported as frequent. Though NSAIDs are fundamental in maintaining their quality of life, the risk of polypharmacy, drug interactions and adverse effects is of paramount importance as the elderly usually require multiple medications for their co-morbidities. If prescriptions are not appropriately monitored and managed, they are likely to expose patients to serious drug interactions and potentially fatal adverse effects. This study was conducted to assess the appropriateness of NSAIDs use and determine the risk of NSAIDs related potential interactions in elderly. An analytical cross-sectional study was conducted among elderly out-patients (aged 60 and above) who visited three hospitals in Asmara, Eritrea, between August 22 and September 29, 2018. A stratified random sampling design was employed and data was collected using an interview-based questionnaire and by abstracting information from patients' prescriptions and medical cards. Descriptive and analytical statistics including chi-square test and logistic regression were employed using IBM SPSS (version 22). A total of 285 respondents were enrolled in the study with similar male to female ratio. One in four of all respondents were chronic NSAIDs users and NSAIDs risk practice was reported in 24%. Using chronic NSAIDs without prophylactic gastro-protective agents, self-medication, polypharmacy and drug-drug interactions were the main problems identified. A total of 322 potential interactions in 205 patients were identified and of which, 97.2% were classified as moderate, 0.6% severe and the rest were mild. Those who involved in self-medication were more likely to be exposed to drug interactions. Diabetes (AOR = 2.39, 95% CI: 1.14, 5.02) and hypertension (AOR = 9.06, 95% CI: 4.00, 20.51) were associated with chronic NSAIDs use and incidence of potential drug interactions (AOR = 3.5, 95%CI: 1.68, 4.3; AOR = 2.81, 95%CI: 1.61, 4.9 respectively), while diabetes AOR = 4.5, 95% CI: 2.43, 8.35) and cardiac problems (AOR = 4.29, 95% CI: 1.17, 15.73) were more likely to be associated with incidence of polypharmacy. In conclusion, chronic use of NSAIDs without gastro-protective agents and therapeutic duplication of NSAIDs were commonly which requires attention from programmers, health facility managers and healthcare professionals to safeguard elderlies from preventable harm.

Asunto(s)

Antiinflamatorios no Esteroideos/uso terapéutico , Polifarmacia , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Crónica , Estudios Transversales , Interacciones Farmacológicas , Eritrea , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Calidad de Vida , Automedicación/estadística & datos numéricos , Encuestas y Cuestionarios

RESUMEN

BACKGROUND: Monitoring the safety of antiretroviral therapy (ART) remains a challenge in resource-constrained countries such as Eritrea due to their serious adverse drug reactions (ADRs). This study was aimed at assessing the prevalence, nature, seriousness and possible risk factors of ART associated ADRs in Halibet National Referral Hospital in Eritrea. METHOD: A three month retrospective, longitudinal, descriptive study of patients treated with ART between September 2005 and December 2016 was conducted in Halibet National Referral Hospital. Demographic characteristics, treatment details, reaction and outcome details, laboratory investigations and other information was abstracted manually from patients' clinical cards. Statistical analysis was conducted using both univariate and multivariate analysis and statistical significance was tested using 95% confidence intervals and/or p-value. A P-value < 0.05 was regarded as being statistically significant. RESULTS: Of the 309 patients screened, 62.8% encountered at least one ADR and 29.8% of the reactions were serious with similar male to female ratio. Gastrointestinal symptoms were the most common ADR and were associated mostly with Atripla followed by AZT + 3TC + NVP drug combinations, but lipodystrophy followed by peripheral neuropathy which were both commonly associated with Stavudine and anemia associated with Zidovudine were the most serious. Patients with CD4 count below 200 were more likely to develop ADRs (p = 0.000). CONCLUSION: ADRs associated with ART drugs in Halibet hospital were found to be highly prevalent. Furthermore, CD4 count below 200, was identified as a major risk factor that predisposes patients to ADRs. This is burdensome to resource constrained countries such as Eritrea who have limited drug options and high HIV prevalence, therefore these findings will help patients and healthcare professionals understand the nature as well as seriousness of these ADRs and identify the risks involved with ART medications which can help minimize ART associated ADRs early on.

Asunto(s)

Antirretrovirales/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Adulto , Eritrea/epidemiología , Femenino , Infecciones por VIH/tratamiento farmacológico , Hospitales Públicos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos

RESUMEN

BACKGROUND: Although over the counter (OTC) drugs are believed to be relatively safe, their inappropriate use could have serious implications. The aim of the study was to assess the practice of self-medication, prevalence of risky practice and its associated factors in pharmacy outlets of Asmara, Eritrea. METHODS: A descriptive cross-sectional study was conducted among 609 customers in 20 pharmacy outlets in Asmara between August and September, 2017. Two-stage cluster sampling was employed and data were collected using a structured questionnaire through face to face exit interviews. Descriptive statistics and multivariate logistic regression were performed using SPSS (version 22). RESULTS: Of the 609 customers, 93.7% had practiced self-medication with OTC drugs; of which 81.8% were at risky practice. On average, each participant was using OTC drugs at least once a month (Median = 1, IQR = 3.67). Educational level (p < 0.0001), religion (p = 0.047), occupation (p = 0.027) and knowledge regarding OTC drugs (p = 0.019) were significantly associated with risky practice. Respondents with elementary and below educational level were fifteen times (AOR = 15.49, CI: 1.97, 121.80) at higher risk compared to those with higher education, and students were almost three times (AOR = 2.96, CI: 1.13, 7.73) at higher risk than governmental employees. Furthermore, respondents with below average score in knowledge were more likely to be engaged in risky practice (AOR = 1.83, CI: 1.11, 3.04) compared to those with above average score. The most frequently preferred OTC drug group was analgesics (34.3%) followed by antipyretics (15.7%) and cough and cold preparations (14.2%). About 14% of the respondents admitted that they had taken more than the recommended dose and 6.9% had experienced drug related problems following the consumption of OTC drugs. Always, 35% of the respondents read package insert(s) and 73.9% check expiry dates while purchasing OTC drugs. Refrigerating OTC drugs, where it is not recommended, was also one of the prominent risky practices. CONCLUSIONS: This study revealed that inappropriate self-medication practice with OTC drugs was prevalent requiring early intervention to minimize the risks.

Asunto(s)

Conductas de Riesgo para la Salud , Medicamentos sin Prescripción/uso terapéutico , Automedicación/psicología , Automedicación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Eritrea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/efectos adversos , Farmacias , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven

RESUMEN

BACKGROUND: Cyclic nucleotide Phosphodiesterases (PDEs) are ubiquitously distributed in mammalian tissues and play a major role in cell signaling by hydrolyzing cyclic Adenosine Monophosphate (cAMP) and cyclic Guanosine Monophosphate (cGMP). Impairments in signal transduction have been implicated as possible mechanism of reduced plasticity and neuronal survival in major depressive disorders. PDE inhibitors possess a potentially powerful means to manipulate secondary messengers involved in learning, memory and mood. Cilostazol is an antiplatelet agent indicated for the treatment of intermittent claudication with peripheral artery occlusion and for the prevention of ischemic stroke worldwide. Various animal studies have reported neuroprotective, anti apoptotic, cognition and cerebral blood flow improvement properties of cilostazol. MATERIALS AND METHODS: In this study, the antidepressant and anxiolytic effects of cilostazol were evaluated in mice using behavioral tests sensitive to clinically effective antidepressant compound. RESULTS: Cilostazol, administered intraperitoneally (20 mg/kg), decreased immobility time of mice when subjected to forced swim test and tail suspension test as compared to standard fluoxetine (20 mg/kg). Cilostazol also produced significant decrease in the number of marbles buried as compared to fluoxetine in marble burying model. CONCLUSION: The present study suggests that cilostazol possesses potential antidepressant and anxiolytic activity, which could be of therapeutic interest for use in patients with depressive disorders.