Comparative drug therapy problems and pharmacists' intervention in selected health facilities in Ogun State

Background - Regular medication reviews will reduce the occurrence of Drug Therapy Problems (DTPs). This study set out to identify, document DTPs and evaluate the impact of pharmacists´ interventions in selected health facilities. Methods - The study was carried out simultaneously at two tertiary and two secondary hospitals in Ogun States. Pharmacists were trained to document all identified DTPs in prescriptions and impacts of pharmacists' interventions for six months using the documentation form, PCNE V5.01. Data was analyzed and presented as frequencies with test of significance of main parameters. Results ­ One hundred and four (104) DTPs were reported in all the health facilities but with no significant difference in occurrence at the two hospital levels. Commonly occurring DTPs were drug choice problems (35.6%), dosing problems (33.9%), adverse drug reaction (22.8%), drug use problems (4.23%) and drug interactions (1.69%). Most proposed interventions (77.0%) were approved by prescribers with (77.2%) resolution of DTPs in tertiary hospitals. Conclusion- There was no significant difference in occurrence of DTPs in the hospitals but there was higher incidence of non-allergic ADR, contraindication, duration of drug use and duplication of drugs at the secondary level. Acceptance rate of proposed interventions by physicians was high (77.2%) confirming that pharmacists' intervention in rational pharmacotherapy is valuable

Chemotherapy – Induced Cardiotoxicity.

Use of chemotherapeutic agents in cancer patients have resulted in marked improvement in survival rates, chemoinduced cardiotoxicity is a well-known side effect of such several cytotoxic drugs, especially of the anthracyclines causing long term morbidity among cancer survivors. Formation of free radicals leading to oxidative stress leading to apoptosis of cardiac cells or immunologic reactions seems to be the mechanism of anthracycline induced cardiotoxicity. The risk for cardiotoxicity depends upon: cumulative dose, rate of drug administration, gender, age, pre-existing heart disease, hypertention and mediastinal radiation. Serial cardiac imaging studies remain as routine monitoring methods to assess left ventricular systolic function and cardiotoxicity. Cardiac biomarker like Troponin I may be a sensitive and specific marker for predicting the development and severity of ventricular dysfunction. Limitation of the cumulative dose, addition of the antioxidant and iron chelatordexrazoxane to anthracycline therapy have shown to be effective in lowering the incidence of anthracycline induced cardiotoxicity. This review-article is highlighting the paramount importance for awareness of risk factors among practitioners, timely communication and collaboration between oncologists and cardiologists within a multidisciplinary team for prevention, early detection and treatment of such cardiotoxicity.

comparison between zinc sulfate and chlorhexidine gluconate mouthwashes in the prevention of chemotherapy-induced oral mucositis

Patients undergoing high-dose chemotherapy for hematological malignancies are susceptible to development of oral mucositis, and no effective modality has been reported for its prophylaxis and treatment. The aim of this study was to evaluate the effectiveness of zinc mouthwash on chemotherapy-induced oral mucositis lesions. In this double-blind randomized trial, patients under chemotherapy for acute leukemia were divided into two test and control groups of 15 patients each. The groups were homogeneous with respect to medical history, tumor characteristics, and therapeutic details. The test group received 10ml 0.2% zinc sulfate mouthwash, and the control group received 10ml 0.2% chlorhexidine gluconate mouthwash, twice a day for a period of two weeks. Spijkervet scale was used to grade the severity of mucositis at every other week during eight weeks. The severity scores were analyzed with repeated measure ANOVA using SPSS 13.0 computer software. Mean severity scores were generally lower in the test group compared to the controls at all four time intervals evaluated; but only, the differences in weeks of 2 and 3 were statistically significant [P=0.025]. Zinc mouthwash used in conjunction with chemotherapy may reduce the severity of oral mucositis lesions in patients with leukaemia

efficacy of transcutaneous electrical nerve stimulation in control of nausea and vomiting in patients undergoing chemotherapy

Despite advances in antiemetic treatment, complications are still problematic for a significant number of patients after chemotherapy. This study was performed to determine the efficacy of transcutaneous electrical nerve stimulation [TENS] in the control of nausea and vomiting in patients undergoing chemotherapy at Nemazee Hospital in Shiraz, southern Iran.32 subjects with cancer from Outpatients Depatment in Nemazee Hospital affiliated to Shiraz University of Medical Sciences, in Shiraz, southern Iran were enrolled. The patients were randomly divided into two equal groups of TENS and placebo. Patients in both groups were matched for age, severity of nausea and vomiting and type of malignancy. Cisplatin or cyclophosphamide was used for chemotherapy and granistron along with dexametasone were used as antiemetic agents. In the test group, the p6 acupuncture point [acupoint] was stimulated by TENS when the antiemetic agent was administered and continued during wakening every 2 hours for 72 hours after chemotherapy. The placebo group was similarly treated but with an off mode stimulator. In regard to the severity of nausea, no statistically significant difference was observed between the two groups in the first 24 hours of chemotherapy but the intensity of nausea in the TENS group was significantly lower than those of the placebo group during 48 and 72 hours of chemotherapy. The mean frequency of vomiting during first, second and third 24 hours was significantly lower in the control group. TENS can be used as an adjunct with antiemetics for controlling nausea and vomiting induced by chemotherapy

Les complications cutanees de la chimiotherapie antitumorale dans les services de dermatologie et cancerologie du CHU de Treichville

L'etude prospective portant sur 100 cas de complications cutanees de la chimiotherapie anticancereuse observee en 12 mois avec une prevalence de 18;18pour cent fait ressortir un accroissement regulier de l'emploi des chimiotherapies. Le developpement de la chimiotherapie oblige a mieux connaitre les effets secondaires de la chimiotherapie anticancereuse. Parmi ceux-ci; les complications cutanees tiennent une place importante. En effet; les medicaments anticancereux sont avant tout actifs sur les cellules en division rapide; et de ce fait la peau represente une excellente cible. Au cours de notre etude prospective; nous avons decrit et evalue les aspects cliniques des complications cutanees de la chimiotherapie et la toxicite des medicaments anticancereux inherentes a l'utilisation des protocoles usuels de la chimiotherapie anticancereuse. Sur l'ensemble des protocoles; nous avons observe une predominance des toxicites phaneriennes : alopecie (45pour cent); muqueuse (32pour cent); cutanee (23pour cent). Il n'a pas ete note de toxicite grave a type de syndrome de LYELL ni de deces. Selon notre etude; cette toxicite est liee a des facteurs tels t~ue l'age; le terrain; le choix des protocoles; le nombre de cures; la compliance. L'action pour l'amelioration de la prise en charge des malades atteints de cancer en matiere de chimiotherapie devrait s'orienter vers: -une identification des complications les plus frequentes. -en fonction du nombre de cures. -le suivi de tout cancer doit concerner: ola muqueuse ; oles cheveux (phaneres) ; ola peau. Cependant; les toxicites cutaneo-muqueuses et phaneriennes observees au cours de notre etude n'ont jamais constitue un facteur limitant du traitement