Use of Mobile Phones for Monitoring Adverse Drug Reaction in Pharmacy and Drug Stores in Ishaka, Uganda - a Pilot Assessment of Willingness to Report.

Aim: We investigated reporting of Adverse Drug Reaction (ADR) following use of drugs purchased from open system pharmacy (OSP) and drug stores, and the effectiveness of mobile phones for reporting drug reactions and detection of drug interactions. Study Design: The study was descriptive and inceptional. Place and Duration of Study: Selected Pharmacies and drug stores in Ishaka Municipality, Bushenyi, Uganda, between January and April 2012. Methodology: A total of 190 participants purchasing prescription and non prescription drugs in the drug outlets were enrolled and drug purchases documented. Structured interviews were used to assess any existing system of ADR tracking. Possible interactions were assessed using electronic checkers software on drug combinations prescribed or purchased. Mobile phone calls were used to monitor the reporting potential, use of medication and events or reactions following drug use for ADRs. Results: No formalized pre-study system was found for tracking ADR in the OSP and drug stores studied. Participants purchased 420 different medications with 55.8% without prescription. Antibiotics, analgesics and antimalarials ranked most purchased medications. All participants carried at least a functional mobile phone and demonstrated interest to report ADRs. Mean Effective Mobile Phone Contact Ratio (MEMPCR) for ADR monitoring was 0.91+0.2 and follow-up was 96% (n=183) and 89.5% on days 0 and 4 respectively. Interactions predicted were in 24.8% (31). Significant reporting of at least one of 404 reactions occurred within 72hr compared to 96-120hr (P=0.003). Two participants had reaction leading to discontinued use of Cotrimoxazole. Conclusion: Use of mobile phones and drug interaction checker software may avail early detection of ADR and reporting. Facilitated toll free- call service may be an effective means of extending the scope of ADR tracking in addition to Yellow Card scheme, and augment involvement of pharmacists and consumers in safe use of drugs.

Volatile organic compounds production during spoilage of African horned cucumber fruits.

Microorganisms associated with the production of volatile organic compound in spoilt African horned cucumber have been isolated by standard plate count (SPC) and identified. The mean aerobic colony count observed for bacteria ranged from 3.3 to 8.3 x 107 CFU/g while those of fungi ranged from 4.0 x 103 to 1.1 x 104 CFU/g. The organisms isolated and identified included three species of bacteria (Bacillus lentus, Bacillus firmus and Paenibacillus alveii) while three of fungi (Rhizopus stolonifer, Mucor circinelloides, and Monascus ruber). GC-MS analysis revealed the presence of 11 volatile organic compounds in the healthy ripe African horned cucumber and 21 volatile organic compounds in spoilt African horned cucumber. Six volatile organic compounds were common to spoilt and healthy African horned cucumber while 1,2,3, trimethyl benzene, Decane 1,4-Dimethyl-2-ethyl benzene, tetralin, 6- methyl tetralin, phenyl benzene (Lemonene), 2,3-dimethylnaphthale (Guajen), (1- Ethyl-2-methyl-1-propenyl) benzene, Diphenyl methane (Ditan), Hexadecane, Heptadecane, 6- octadecanoic acid (Z) and 1-Nondecanol were unique to spoilt African horned cucumber fruits. This study suggests that these unique volatile organic compounds could provide baseline knowledge for curbing postharvest losses and the volatile organic compound could form the basis for constructing a metabolomics database for Nigeria.

Dados atuais de prevalência de fatores de risco cardiovascular entre populações de áreas urbana e rural do estudo PURE no Brasil / Actuals data of cardiovascular risk factors prevalence between populations of urbam and rural areas from PURE study in Brazil

O estudo PURE representa um dos maiores estudos de corte, envolvendo 150.000 indivíduos de áreas urbanas e rurais de 15 países. A má adaptação à urbanização, representada por variações no estilo de vida, fatores psicossociais e renda são determinantes independentes de fatores de risco cardiovascular

An evaluation of door to needle time (DNT) of thrombolytic therapy following acute myocardial infarction in three large tertiary referral hospitals in Dhaka City.

This study was conducted in three tertiary hospitals in Dhaka city at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH) and National Institute of Cardiovascular Disease (NICVD) as a part of Inter-Heart Study. Secondary data was obtained from the standard questionnaires to determine door to needle time (DNT) following thrombolytic therapy in patients with Acute Myocardial Infarction (AMI) in coronary care units at three large tertiary referral hospitals in Dhaka city. Of total 192 patients studied in three centres, 156 (81.2%) received thrombolytic therapy. In BSMMU, 33 out of 45 (73.33%) patients received thrombolysis. Mean DNT was 147 minutes. Eighteen (55%) patients received thrombolysis within 90 minutes and 9 patients (27%) received with in 91-180 minutes, 6 patients (18%) received thrombolysis after 180 minutes. In DMCH, 44 out of 57 patients (77.1%) received thrombolysis. Mean DNT was 210 minutes. Five patients (11%) received within 90 minutes, 19 (43%) received thrombolysis between 91 to 180 minutes and 20 patients (46%) received thrombolysis outside the range of 180 minutes. In the NICVD, 79 out of total 90 (87.7%) patients received thrombolysis. Mean DTN was 64 minutes. Sixty seven (82%) patients received therapy within 90 minutes, 6 patients (9%) received between thrombolysis 91-180 minutes and 6 (9%) patients received after 180 minutes of reaching hospital. Inspite of overall improvement in the management of patients with AMI in coronary care units of major teaching hospitals, there seem to remain certain difficulty in our system which causes delay in thrombolysing patients with AMI. In this study, the mean DNT for thrombolysis was quickest (64 minutes) at NICVD and slowest (210 minutes) at DMCH. Although the study was conducted almost four years ago, it gives some insight regarding strength and weaknesses in the infrastructure of public sector hospitals in our country.

Increased risk of acute myocardial infarction associated with beedi and cigarette smoking in Indians: final report on tobacco risks from a case-control study.

BACKGROUND: Tobacco smoking is an important risk factor for ischemic heart disease. In India, tobacco is smoked both as cigarettes and beedies. No studies have evaluated their importance as risk factors for ischemic heart disease among the Indian population. The present study explores the importance of smoking either cigarettes or beedies as risk factors for acute myocardial infarction. METHODS AND RESULTS: The study had a case-control design and was conducted in a tertiary teaching hospital in Bangalore. Three hundred subjects aged 30-60 years with a first acute myocardial infarction and 300 age- and sex-matched controls were recruited prospectively. Smoking, dietary and social history were recorded, body mass index and waist-hip ratio measured, and blood glucose, lipids, fasting plasma and insulin levels estimated. Cases and controls had a mean age of 47.2 years and 46.8 years, respectively. There were 279 (93%) males in each group. Diabetes mellitus (odds ratio 2.69, p<0.0009). hypertension (odds ratio 2.36, p=0.0009), fasting and post-load blood glucose (p<0.0001). and waist-hip ratio (p<0.0001) were found to be important risk factors for acute myocardial infarction. Smoking was an independent risk factor with a clear dose effect. Adjusted odds ratio for smoking > or = 10 cigarettes/day was 3.58 (p<0.0001) and was 4.36 (p<0.0001) for smoking > or = 10 beedies/day. CONCLUSIONS: Smoking > or = 10 cigarettes or beedies/day carries an independent four-fold increased risk of acute myocardial infarction. This reiterates the need for urgent tobacco control measures in India.

Differences in risk factors, atherosclerosis and cardiovascular disease between ethnic groups in Canada: the study of health assessment and risk in ethnic groups (SHARE).

Cardiovascular disease rates vary greatly between ethnic groups in Canada. To establish whether this variation can be explained by differences in disease risk factors and subclinical atherosclerosis, we undertook a population-based study of three ethnic groups in Canada: South Asians, Chinese and Europeans. A total of 985 participants were recruited from three cities (Hamilton, Toronto and Edmonton) by stratified random sampling. Clinical cardiovascular disease was defined by history or electrocardiographic findings. Carotid atherosclerosis was measured with B-mode ultrasonography. Conventional (smoking, hypertension, diabetes, raised cholesterol) and novel risk factors (markers of a prothrombotic state) were measured. Within each ethnic group and overall, the degree of carotid atherosclerosis was associated with a higher prevalence of cardiovascular disease. South Asians had the highest prevalence of this condition compared with Europeans and Chinese (11%, 5% and 2%, respectively; p=0.0004). Despite this finding, Europeans had more atherosclerosis (mean of the maximum intimal medial thickness 0.75 [0.16] mm) than South Asians (0.72 [0.15] mm) and Chinese (0.69 [0.16] mm). South Asians had an increased prevalence of glucose intolerance, higher total and low-density lipoprotein cholesterol, higher triglycerides and lower high-density lipoprotein cholesterol, and much greater abnormalities in novel risk factors including higher concentrations of fibrinogen, homocysteine, lipoprotein(a), and plasminogen activator inhibitor-1. Although there are differences in conventional and novel risk factors between ethnic groups, this variation and the degree of atherosclerosis only partly explains the higher rates of cardiovascular disease among South Asians compared with Europeans and Chinese. The increased risk of cardiovascular events could be due to factors affecting plaque rupture, the interaction between prothrombotic factors and atherosclerosis, or as yet undiscovered risk factors.

A comparison of practice patterns for acute myocardial infarction between hospitals in Canada and India.

The increasing burden of cardiovascular disease in India, and the established efficacy of mortality-reducing therapies in acute myocardial infarction (AMI) served as the impetus to compare the management practices of AMI in an Indian hospital and a similar hospital in Canada. A retrospective chart review in each hospital was conducted to identify differences in risk factors, presentation, and acute in-hospital management in patients with AMI. Indian patients were younger (47 +/- 9 years versus 54 +/- 8 years), more likely to have a history of diabetes (21/87 versus 6/69) and less likely to have a previous history of angina (5/87 versus 22/69) compared to Canadian patients (all p < 0.001). The delay from symptom onset to hospital arrival was greater in Bangalore, India (median time 330 min versus 101 min, p < 0.001), yet the in-hospital delay in receiving thrombolytic therapy was greater in Hamilton, Canada (70.5 min in Hamilton versus 30 min in Bangalore, p < 0.0001). There was similarity and appropriate use of thrombolytic therapy, aspirin, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in both centres. The pattern of presentation and risk factors differ in Indian and Canadian patients. However, once patients present, the patterns of practice appear to be similar.

Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America.

The prevalence of coronary heart disease (CHD) and its risk factors in first-generation Asian Indian immigrants to the United States of America (US) were compared with those of the native Caucasian population. A total of 1688 Asian Indian physicians and their family members (1131 men and 557 women, age > or = 20 years) completed a questionnaire and in 580 subjects serum lipoproteins were determined. The age-adjusted prevalence of myocardial infarction and/or angina was approximately three times more in Asian Indian men compared to the Framingham Offspring Study (7.2% versus 2.5%; P < 0.0001) but was similar in women (0.3% versus 1%; p = 0.64). Asian Indians had higher prevalence of noninsulin-dependent diabetes mellitus (NIDDM; 7.6% versus 1%; p < 0.0001) but markedly lower prevalence of cigarette smoking (1.3% versus 27%; p < 0.0001) and obesity (4.2% versus 22%; p < 0.0001). Hypertension was less prevalent in Asian Indian men 14.2% versus 19.1%, p < 0.008) but similar in women (11.3% versus 11.4%). The prevalence of elevated total a low-density lipoprotein (LDL) cholesterol levels was similar in men [17% versus 23.4% (p = 0.24) and 13.7% versus 22.3% (p = 0.22), respectively] but lower in women [15% versus 26.1% (p = 0.018) and 14.3% versus 19.6% (p = 0.047) respectively]. The mean levels of high-density lipoprotein (HDL) cholesterol were less in younger (30-39 years) Asian Indian men (mean: 0.98 versus 1.18 mmol/l; p < 0.001) and middle-aged (30-59 years) women (mean: 1.24 versus 1.45 mmol/l; p < 0.001). The prevalence of hypertriglyceridaemia was similar in men (18.5% versus 11.3%), but higher in Asian Indian women (8.3% versus 4.1%, p = 0.02). To conclude, immigrant Asian Indian men to the US have high prevalence of CHD, NIDDM, low HDL cholesterol levels and hypertriglyceridaemia. All these have "insulin resistance" as a common pathogenetic mechanism and seem to be the most important risk factors.