Biodegradation of Aflatoxin B1 in Maize Grains and Suppression of Its Biosynthesis-Related Genes Using Endophytic Trichoderma harzianum AYM3.

Aflatoxin B1 is one of the most deleterious types of mycotoxins. The application of an endophytic fungus for biodegradation or biosuppression of AFB1 production by Aspergillus flavus was investigated. About 10 endophytic fungal species, isolated from healthy maize plants, were screened for their in vitro AFs-degrading activity using coumarin medium. The highest degradation potential was recorded for Trichoderma sp. (76.8%). This endophyte was identified using the rDNA-ITS sequence as Trichoderma harzianum AYM3 and assigned an accession no. of ON203053. It caused a 65% inhibition in the growth of A. flavus AYM2 in vitro. HPLC analysis revealed that T. harzianum AYM3 had a biodegradation potential against AFB1. Co-culturing of T. harazianum AYM3 and A. flavus AYM2 on maize grains led to a significant suppression (67%) in AFB1 production. GC-MS analysis identified two AFB1-suppressing compounds, acetic acid and n-propyl acetate. Investigating effect on the transcriptional expression of five AFB1 biosynthesis-related genes in A. flavus AYM2 revealed the downregulating effects of T. harzianum AYM3 metabolites on expression of aflP and aflS genes. Using HepaRG cell line, the cytotoxicity assay indicated that T. harazianum AYM3 metabolites were safe. Based on these results, it can be concluded that T. harzianum AYM3 may be used to suppress AFB1 production in maize grains.

Curcumin nanoparticles loaded hydrogels protects against aflatoxin B1-induced genotoxicity in rat liver.

The current study aimed to evaluate the protective role of curcumin nanoparticles loaded hydrogels (Cur-NPs-Hgs) against AFB1-induced genotoxicity in rat liver. Animals were divided into 7 treatment groups and treated orally for 3 weeks as follow: the control group, the group treated with Hgs alone (0.5 ml/rat), the groups treated with low or high dose of Cur-NPs-Hgs (100 or 200 mg/kg b.w), the group treated with AFB1 (0.125 mg/kg b.w) and the groups treated with AFB1 plus the low or high dose of Cur-NPs-Hgs. Blood ant liver samples were collected for different biochemical, genetical, histological and histochemical analysis. The results revealed that the prepared Cur-NPs have nearly spherical shape with average size of 140 ± 20 nm and negative zeta potential value of 30.7 ± 2.57 mV. The in vivo results showed that treatment with AFB1 decreased the body weight accompanied biochemical, genotoxicity and histological disturbances. The combined treatment with AFB1 and Cur-Nps-Hgs at the two tested doses succeeded to induce a significant protection against AFB1. It could be concluded that Cur-NPs-Hgs is a promise candidate to protect against AFB1-induce liver damage in the high incidence area. Moreover, Hgs are excellent candidates as drug delivery system.

Effect of occupational exposure to aflatoxins on some liver tumor markers in textile workers.

BACKGROUND: In a study of textile workers, the effects of occupational exposure to cotton dust-with possible exposure to aflatoxin-on levels of some liver tumor biomarkers were explored. METHODS: The study included 58 textile workers and 64 controls. Skin prick tests, urinary Aflatoxin M1 (AFM1) and the tumor biomarkers (alpha-fetoprotein (AFP), alpha-L-fucosidase (AFU), insulin-like growth factors (IGF-1) were measured. RESULTS: Positive reactants to Aspergillus niger, Aspergillus flavus, and cotton dust were significantly higher in pre-spinning (14.3%, 28.6%, and 28.6%, respectively) and spinning workers (25.0%, 33.3%, and 25.0%, respectively) compared to controls (4.7%, 7.8%, and 3.1%, respectively). Urinary AFM1 was significantly higher in the pre-spinning, spinning, and weaving groups compared to controls (554.2 ± 346.2 pg/ml, 459.1 ± 781.6 pg/ml, 296.5 ± 336.5 pg/ml and 68.5 ± 136.8 pg/ml, respectively). We found a highly significant increase in levels of serum AFU in textile workers, compared to the control group. CONCLUSION: Exposure to fungi had a significant effect on AFM1 measurements and tumor biomarkers, especially in allergic textile workers (with the exception of the arginase biomarker), though results were generally within normal limits.

Compliance with legal requirements at community pharmacies: a cross sectional study from Pakistan.

OBJECTIVES: The study evaluated the compliance of community pharmacies with legal requirements as laid down by the drug regulatory framework in Pakistan. METHODS: An exploratory cross sectional survey was conducted with a total of 371 randomly selected community pharmacies in three cities in Pakistan, namely Islamabad (n = 118), Peshawar (n = 120) and Lahore (n = 133). A questionnaire was developed and finalized by focus-group discussions and pilot testing. The questionnaire included background information and a legal requirement scale consisting of six subscales: licensing requirements, premises requirements, storage requirements, documentation requirements, narcotics section requirements and prescription checking. The data were coded, entered and analysed using SPSS software (version 16). Kruskal-Wallis, Mann-Whitney and chi square tests were used for analysis. KEY FINDINGS: The pharmacies were operating with one of the three licence types operating in Pakistan: type A (n = 96, 25.9%), type B (n = 186, 50.1%) and type C (n = 89, 24.0%). A narcotics licence was issued to 133 (35.8%) pharmacies; licences of 66 (17.8%) pharmacies were expired while the validity of 87 (23.0%) licences could not be determined. Only 113 (30.5%) pharmacies were totally clean. Eighty percent of the pharmacies had a refrigerator for storage of medicines, but only 284 (76%) of the refrigerators were in working condition. Complete medicine purchase records with warranties were available at 210 (56.6%) pharmacies. CONCLUSIONS: None of the pharmacies completely complied with the legal requirements in terms of licensing, premises, storage, documentation, narcotics section, drug labelling and prescription checking. This speaks of poor regulation and control by health authorities on the sale and dispensing of medicines in Pakistan. This study will serve as a baseline for policy makers, managers, researchers and other stakeholders in developing designs for future interventions as well as for methods of accountability and control.

Co-occurrence of mycoflora, aflatoxins and fumonisins in maize and rice seeds from markets of different districts in Cairo, Egypt.

The mycoflora and mycotoxins contamination of commercial maize and rice grains collected from local markets of the major five zones of the province of Cairo, Egypt, represented by 20 different districts were studied. A total number of about 23 species belonging to 12 different genera of fungi were isolated and identified. About 70% of the samples were infected with Aspergillus flavus and Aspergillus niger, with percentages of 33%, 40% recovered from maize and 46%, 27% recovered from rice, respectively. The percentages of infection of maize ranged from 16% to 142%. The percentages of infection of rice seeds ranged from 6% to 93%. Total aflatoxins and fumonisins detected in maize averaged 9.75 and 33 µg/kg, respectively. Total aflatoxins and fumonisins detected in rice averaged 5.15 and 1014 µg/kg, respectively.

Medication storage and self-medication behaviour amongst female students in Malaysia / Almacenamiento de medicación y comportamientos en auto-medicación entre mujeres estudiantes en Malasia

Objectives: The aims of this study are to determine the prevalence, attitudes and behaviours of medication storage and self-medication amongst female students at Universiti Sains Malaysia (USM). Methods: A cross-sectional survey was conducted and cluster random sampling technique was used for respondent selection. A pre-piloted questionnaire was administered to female respondents so as to collect the data. Data was analyzed using SPSS version 12 and analysis was conducted using descriptive analysis procedures. Results: Of the 481 participants (mean age; SD was 22.1; 3.3), 93.1% (n=448) students stated that they stored medicine in their rooms, while 70.7% (n=340) stated that they stopped taking a prescribed medicine without consulting a doctor. The prevalence of self-medication was 80.9% (n=389). The most common reasons for self-medication were related to their knowledge of their ailment and its treatment (58.0%), 14.4% thought it saved time and 8.5% mentioned that medication given by provider was not effective. The most common symptoms were otorhinolaryngology problems (22.5%), followed by respiratory disease (19.6%), Gastro Intestinal Tract (GIT) disease (18.1%) and headache/fever (16.8%). Commonly used medicines were analgesics & antipyretics (30.2%), ear, nose & throat drugs (10.8%), vitamins & minerals (10.8%), GIT drugs (8.5%), anti-infections (7.3%) and herbal medicines (3.5%). Prevalence of medicine storage and self-medication practice is high among educated female students in USM. Conclusions: There is a need to educate the students to ensure safe practice by increasing their awareness. Strict policies need to be implemented on the unrestricted availability of medicines so as to prevent the wastage of medicines (AU)

Objetivos: Los objetivos de este estudio son determinar la prevalencia, actitudes y comportamiento en el almacenamiento de medicamentos y la auto-medicación entre mujeres jóvenes estudiantes en la Universiti Sains Malaysia (USM). Métodos: Se realizó un estudio transversal y se utilizó una técnica de muestreo por cluster para la selección de respondentes. Para recoger los datos, se administró un cuestionario pre-pilotado a las mujeres que respondieron. Los datos fueron analizados utilizando el SPSS versión 12 y el análisis se realizó utilizando procedimientos descriptivos. Resultados: De los 481 participantes (edad media; DE era 22,1; 3,3), el 93,1% (n=448) afirmaron que almacenaban medicamentos en sus habitaciones, mientras que el 70,7% (n=340) afirmó que pararon de tomar un medicamento prescrito sin consultar al médico. La prevalencia de auto-medicación era del 80,9% (n=389). Entre las razones más frecuentes para auto-medicación estaban relacionadas con sus conocimientos de su enfermedad y su tratamiento (58,0%), el 14,4% pensaba que ahorraba tiempo y el 8,5% mencionó que la medicación proporcionada no era efectiva. Los síntomas más frecuentes fueron problemas otorrinolaringológicos (22,5%), seguidos de enfermedades respiratorias (19,6%), del tracto gastrointestinal (TGI) (18,1% y dolor de cabeza/fiebre (16,8%). Los medicamentos frecuentemente utilizados eran analgésicos y antipiréticos (30,2%), medicamentos para nariz, garganta y oídos (10,8%), vitaminas y minerales (10,8%) y plantas medicinales (3,5%). La prevalencia del hábito de almacenar medicamentos y de auto-medicación es alta entre las mujeres estudiantes de la USM. Conclusiones: Existe la necesidad de educar a los estudiantes para garantizar la práctica segura aumentando sus conocimientos. Se necesita implantar políticas estrictas sobre la disponibilidad irrestricta de medicamentos así como para prevenir el desperdicio de medicamentos (AU)

Pattern and quality of scientific communications on drug safety produced by a regional pharmacovigilance center in Nepal / Patrón y calidad de las comunicaciones científicas sobre seguridad de medicamentos producidas por un centro regional de farmacovigilancia en Nepal

Analyzing the pattern and quality of scientific communications on pharmacovigilance can help the regional centers in Nepal and other developing countries to develop approaches for communicating effectively medicine safety issues. This kind of research is lacking in developing countries. Objectives: To analyze the pattern and quality of scientific communications on drug safety produced by the regional pharmacovigilance center at western Nepal. Methods: Various conference abstracts and journal publications produced by the center during its initial four years of establishment (14th September 2004 till 13th September 2008) were identified. These communications were categorized in to case reports, review articles, conference presentations, short communications, newsletter and bulletin articles, original research and case series. In addition, the quality of the case reports were evaluated as per International Society of Pharmacovigilance/International Society of Pharmacoepidemiology (ISoP/ISPE) guidelines on the requirements for submitting case reports on adverse event reports in biomedical journals. Results: During the study period, 53 scientific communications were produced by the staff of the regional pharmacovigilance center in relation with drug safety. Among these, 18 (34%) were related to case reports and letters. The median (interquartile range) age of the patients described in the case reports was 46.5 (21.7-51.2) years. Among the total 18 ADRs, four were fixed drug eruptions, followed by contact dermatitis (n=2). Majority of the published case reports were related to skin (n=13; 72.2%). Antimicrobials were responsible for 27.8% (n=5) of the case reports. Among the 18 case reports published by the pharmacovigilance center, a majority followed the ISoP/ISPE guidelines. Few parameters like physical examination of the patient experiencing ADR, patient disposition, dosage and administration of the suspected drugs, and drug-reaction interface were missing in few of the cases. Conclusion: A high percentage of the scientific communications were «case reports». A high proportion of the case reports produced by the center were of international standards. There were lacunae in «patient disposition» in few of the reports (AU)

Analizar el patrón y la calidad de las comunicaciones científicas en farmacovigilancia puede ayudar a los centros regionales de Nepal y de otros países en desarrollo a desarrollar abordajes de comunicación efectiva de los problemas de seguridad de los medicamentos. Este tipo de investigación no existe en los países en desarrollo. Objetivos: Analizar el patrón y la calidad de las comunicaciones científicas sobre seguridad de medicamentos producidas por el centro regional de farmacovigilancia de Nepal oriental. Métodos: Se identificaron los resúmenes de conferencias y las publicaciones en revistas producidas pro el centro durante sus cuatro años iniciales desde el establecimiento (14 de septiembre de 2004 a 13 de septiembre de 2008). Estas comunicaciones fueron clasificadas en reporte de casos, artículos de revisión, presentaciones en conferencias, comunicaciones breves, newsletter y artículos de boletín, investigaciones originales y series de casos. Además, se evaluó la calidad de los reportes de casos según las guías requisitos para enviar a revistas biomédicas los reportes de casos sobre comunicaciones de eventos adversos de la International Society of Pharmacovigilance / International Society of Pharmaepidemiology (ISoP/ISPE). Resultados: Durante el periodo de estudio, se produjeron 53 comunicaciones científicas por el personal del centro regional de farmacovigilancia sobre seguridad de medicamentos. De estas, 18 (34%) estaban relacionadas con reportes de casos y cartas. La media (rango inter-cuartilico) de edad de los pacientes descritos en los reportes de casos fue de 46,5 (21,7 - 51,2) años. Del total de 18 RAM, 4 fueron erupciones de medicamentos, seguidas de dermatitis de contacto (n=2). La mayoría de los reportes de casos publicados estaban relacionados con la piel (n=13; 72,2%). Los antimicrobianos fueron responsables por el 27,8% (n=5) de los reportes de casos. Entre los 18 reportes publicados por el centro de farmacovigilancia, la mayoría siguió las guías de la ISoP/ISPE. En unos pocos casos faltaban algunos elementos como examen físico del paciente que sufrió la RAM, disposición del paciente, dosis y administración del medicamento sospechoso, y medio de la reacción medicamentosa. Conclusión: Un elevado porcentaje de las comunicaciones científicas eran reportes de casos. Una alta proporción de los reportes producidos por el centro seguían los estándares internacionales. Existe una laguna en «la disposición del paciente» en algunos de los reportes (AU)

Pattern of adverse drug reactions reported by the community pharmacists in Nepal / Patrón de las reacciones adversas comunicadas por farmacéuticos comunitarios en Nepal

The pharmacovigilance program in Nepal is less than a decade old, and is hospital centered. This study highlights the findings of a community based pharmacovigilance program involving the community pharmacists. Objectives: To collect the demographic details of the patients experiencing adverse drug reactions (ADR) reported by the community pharmacists; to identify the common drugs causing the ADRs, the common types of ADRs; and to carry out the causality, severity and preventability assessments of the reported ADRs. Methods: The baseline Knowledge-Attitude-Practices (KAP) of 116 community pharmacists from Pokhara valley towards drug safety was evaluated using a validated (Cronbach alpha=0.61) KAP questionnaire having 20 questions [(knowledge 11, attitude 5 and practice 4) maximum possible score 40]. Thirty community pharmacists with high scores were selected for three training sessions, each session lasting for one to two hours, covering the basic knowledge required for the community pharmacists for ADR reporting. Pharmacist from the regional pharmacovigilance center visited the trained community pharmacists every alternate day and collected the filled ADR reporting forms. Results: Altogether 71 ADRs, from 71 patients (37 males) were reported. Antibiotics/ antibacterials caused 42% (n=37) of the total ADRs followed by non steroidal anti-inflammatory drugs [25% (n=22)]. Ibuprofen/paracetamol combination accounted for ten ADRs. The most common type of ADR was itching [17.2 % (n=20), followed by generalized edema [8.6 % (n=10)]. In order to manage the ADRs, the patients needed medical treatment in 69% (n=49) of the cases. Over two third (69%) of the ADRs had a «possible» association with the suspected drugs and a high percentage (70.4%) were of «mild (level 2)» type. Nearly two third [64.7 % (n=46)] of the ADRs were «definitely preventable». Conclusion: The common class of drugs known to cause ADRs was antibacterial/ antibiotics. Ibuprofen/ Paracetamol combination use of the drug was responsible for more number of ADRs and the most common ADRs were related to dermatological system. Strengthening this program might improve safe use of medicines in the community (AU)

El programa de farmacovigilancia de Nepal tiene menos de una década de antigüedad, y está centrado en los hospitales. Este estudio muestra los resultados de un programa de farmacovigilancia comunitario, que involucra a farmacéuticos comunitarios. Objetivos: Recoger detalles demográficos del número de pacientes que sufren reacciones adversas a medicamentos (RAM) comunicadas por farmacéuticos comunitarios; identificar los medicamentos que causan las RAM y los tipos comunes de RAM; y realizar las evaluaciones de causalidad, gravedad y preventabilidad de las RAM reportadas. Métodos: Se evaluó, mediante un cuestionario validado (Cronbach alfa=0.61) 20 preguntas [(conocimiento 11, actitud 5 and práctica 4) máxima puntuación posible score 40], el valor inicial de Conocimiento-Actitudes-Práctica (KAP) de 116 farmacéuticos comunitarios del valle de Pokhara. Se selección a los 30 farmacéuticos comunitarios con puntuaciones más altas para realizar 3 sesiones formativas, cada sesión duraba de una a dos horas, que cubrían los conocimientos básicos que requerían los farmacéuticos para comunicar RAM. Los farmacéuticos del centro regional de farmacovigilancia visitaron a los farmacéuticos comunitarios formados en días alternos y recogieron las comunicaciones rellenas. Resultados: Se comunicaron 71 RAM de 71 pacientes (37 hombres). Los antibióticos/antibacterianos causaron el 42% (n=37) del total de RAM, seguidos de los antiinflamatorios no esteroidicos [25% (n=22)]. La combinación ibuprofeno/paracetamol totalizó 10 RAM. El tipo de RAM más frecuente fue el picor [17.2 % (n=20)], seguido del edema generalizado [8.6 % (n=10)]. Para resolver las RAM, el 69% del total de los pacientes (n=49) requirió tratamiento médico. Mas de 2 tercios de las RAM (69%) tenia una «posible» asociación con el medicamento sospechoso, y un alto porcentaje (70.4%) eran de tipo «suave (nivel 2)». Cerca de 2 tercios de las RAM [64.7 % (n=46)] eran «claramente prevenibles». Conclusión: El grupo más común que causo RAM fueron los antibacterianos/antibióticos. La combinación ibuprofeno/paracetamol fue responsable del mayor numero de RAM y las RAM más frecuentes estaban relacionadas con el sistema dermatológico. Reforzar este programa podría mejorar el uso seguro de medicamentos en la comunidad (AU)

Parent’s knowledge and management of their children’s ailments in Malaysia / Conocimiento y manejo de los padres de las dolencias de sus hijos en Malasia

Minor ailments like sore throat, fever, cough and diarrhea can be relieved with over-the-counter (OTC) medications such as paracetamol or other traditional remedies, without seeking for consultation from general practitioners. Parents usually take the responsibility to come up with some kind of treatment for their children. Objective: (1) to evaluate the parents' medical knowledge about OTC medicines which are usually used by the parents to treat their children and (2) to evaluate the parents' management in dealing with their children's ailments, and (3) to evaluate the association between medical knowledge and the management of children's ailments related to medicine use among the parents. Methods: A cross-sectional survey was conducted to measure the parents' knowledge about their children's ailments. Subjects were selected and information was obtained in September 2008. Non-probability convenient sampling method was used. Parents were recruited from the general public to answer the questionnaires. Results: 197 parents filled in the questionnaires. From the total respondents, 48.2% of them were male. This study showed that most respondents have medium knowledge (6.11 SD=3.6) and a moderate management (4.39 SD=2.7). The results showed that there is a significant difference between the knowledge and the management level of ailments (P=0.033). Regarding the education level of the parents and the socioeconomic status, the p-value showed there was a significant difference between parents' knowledge and their education level (P=0.012). Conclusion: This study showed that parents have inadequate knowledge and some misconception about how to go about treating their children when they are unwell. It is hoped that by identifying weak areas in parents' management to their children's ailments, better planned educational and behavioral modification efforts can be made to elevate the knowledge level among the parents when they medically treat their children (AU)

Las dolencias menores como irritación de garganta, fiebre, tos y diarrea pueden aliviarse con medicamentos over-the-counter (OTC) como el paracetamol u otros remedios tradicionales, sin posterior consulta al médico general. Los padres, generalmente, toman la responsabilidad de identificar algún tipo de tratamiento para sus hijos. Objetivo: (1) evaluar los conocimientos médicos de los padres sobre los medicamentos OTC que usan habitualmente para tratar a sus hijos; (2) evaluar el manejo de los pares al tratar las dolencias menores de sus hijos; y (3) evaluar la asociación entre los conocimientos médicos y el manejo de las dolencias menores de los niños en relación al uso de medicamentos entre los padres. Métodos: Se realizó un estudio transversal para medir los conocimientos de los padres sobre las dolencias de sus hijos. Se seleccionó a los individuos y se obtuvo la información en septiembre de 2008. Se utilizó un muestreo no probabilístico de conveniencia. Se reclutó a los padres para responder los cuestionarios entre el público general. Resultados: 197 padres rellenaron el cuestionario. Del total de respondentes, el 48,2% eran hombres. Este estudio mostró que la mayoría de los respondentes tenían un conocimiento medio (6,11; DE=3,6) y un manejo moderado (4,39; DE=2,7). Los resultados mostraron que hay una diferencia significativa entre nivel de conocimiento y manejo de las dolencias (P=0,033). En relación al nivel educativo de los padres y el estado socio-económico, los valores p mostraron que había una diferencia significativa entre el conocimiento de los padres y su nivel educativo (P=0,012). Conclusión: Este estudio mostró que los padres tienen un conocimiento inadecuado y algunos malos entendidos sobre cómo tratar a sus hijos cuando no se encuentran bien. Se espera que identificando los puntos débiles del manejo de los padres de las dolencias de sus hijos, se puedan realizar planes educativos y esfuerzos de modificaciones actitudinales para elevar el nivel de conocimiento entre los padres cuando tratan médicamente a sus hijos (AU)

Pattern and quality of scientific communications on drug safety produced by a regional pharmacovigilance center in Nepal.

UNLABELLED: Analyzing the pattern and quality of scientific communications on pharmacovigilance can help the regional centers in Nepal and other developing countries to develop approaches for communicating effectively medicine safety issues. This kind of research is lacking in developing countries. OBJECTIVES: To analyze the pattern and quality of scientific communications on drug safety produced by the regional pharmacovigilance center at western Nepal. METHODOLOGY: Various conference abstracts and journal publications produced by the center during its initial four years of establishment (14th September 2004 till 13th September 2008) were identified. These communications were categorized in to case reports, review articles, conference presentations, short communications, newsletter and bulletin articles, original research and case series. In addition, the quality of the case reports were evaluated as per International Society of Pharmacovigilance/International Society of Pharmacoepidemiology (ISoP/ISPE) guidelines on the requirements for submitting case reports on adverse event reports in biomedical journals. RESULTS: During the study period, 53 scientific communications were produced by the staff of the regional pharmacovigilance center in relation with drug safety. Among these, 18 (34%) were related to case reports and letters. The median (interquartile range) age of the patients described in the case reports was 46.5 (21.7-51.2) years. Among the total 18 ADRs, four were fixed drug eruptions, followed by contact dermatitis (n=2). Majority of the published case reports were related to skin (n=13; 72.2%). Antimicrobials were responsible for 27.8% (n=5) of the case reports. Among the 18 case reports published by the pharmacovigilance center, a majority followed the ISoP/ISPE guidelines. Few parameters like physical examination of the patient experiencing ADR, patient disposition, dosage and administration of the suspected drugs, and drug-reaction interface were missing in few of the cases. CONCLUSION: A high percentage of the scientific communications were 'case reports'. A high proportion of the case reports produced by the center were of international standards. There were lacunae in 'patient disposition' in few of the reports.

Pattern of adverse drug reactions reported by the community pharmacists in Nepal.

UNLABELLED: The pharmacovigilance program in Nepal is less than a decade old, and is hospital centered. This study highlights the findings of a community based pharmacovigilance program involving the community pharmacists. OBJECTIVES: To collect the demographic details of the patients experiencing adverse drug reactions (ADR) reported by the community pharmacists; to identify the common drugs causing the ADRs, the common types of ADRs; and to carry out the causality, severity and preventability assessments of the reported ADRs. METHODS: The baseline Knowledge-Attitude-Practices (KAP) of 116 community pharmacists from Pokhara valley towards drug safety was evaluated using a validated (Cronbach alpha=0.61) KAP questionnaire having 20 questions [(knowledge 11, attitude 5 and practice 4) maximum possible score 40]. Thirty community pharmacists with high scores were selected for three training sessions, each session lasting for one to two hours, covering the basic knowledge required for the community pharmacists for ADR reporting. Pharmacist from the regional pharmacovigilance center visited the trained community pharmacists every alternate day and collected the filled ADR reporting forms. RESULTS: Altogether 71 ADRs, from 71 patients (37 males) were reported. Antibiotics/ antibacterials caused 42% (n=37) of the total ADRs followed by non steroidal anti-inflammatory drugs [25% (n=22)]. Ibuprofen/paracetamol combination accounted for ten ADRs. The most common type of ADR was itching [17.2 % (n=20), followed by generalized edema [8.6 % (n=10)]. In order to manage the ADRs, the patients needed medical treatment in 69% (n=49) of the cases. Over two third (69%) of the ADRs had a 'possible' association with the suspected drugs and a high percentage (70.4%) were of 'mild (level 2)' type. Nearly two third [64.7 % (n=46)] of the ADRs were 'definitely preventable'. CONCLUSION: The common class of drugs known to cause ADRs was antibacterial/ antibiotics. Ibuprofen/ Paracetamol combination use of the drug was responsible for more number of ADRs and the most common ADRs were related to dermatological system. Strengthening this program might improve safe use of medicines in the community.

Medication storage and self-medication behaviour amongst female students in Malaysia.

OBJECTIVES: The aims of this study are to determine the prevalence, attitudes and behaviours of medication storage and self-medication amongst female students at Universiti Sains Malaysia (USM). METHODS: A cross-sectional survey was conducted and cluster random sampling technique was used for respondent selection. A pre-piloted questionnaire was administered to female respondents so as to collect the data. Data was analyzed using SPSS version 12 and analysis was conducted using descriptive analysis procedures. RESULTS: Of the 481 participants (mean age; SD was 22.1; 3.3), 93.1% (n=448) students stated that they stored medicine in their rooms, while 70.7% (n=340) stated that they stopped taking a prescribed medicine without consulting a doctor. The prevalence of self-medication was 80.9% (n=389). The most common reasons for self-medication were related to their knowledge of their ailment and its treatment (58.0%), 14.4% thought it saved time and 8.5% mentioned that medication given by provider was not effective. The most common symptoms were otorhinolaryngology problems (22.5%), followed by respiratory disease (19.6%), Gastro Intestinal Tract (GIT) disease (18.1%) and headache/fever (16.8%). Commonly used medicines were analgesics & antipyretics (30.2%), ear, nose & throat drugs (10.8%), vitamins & minerals (10.8%), GIT drugs (8.5%), anti-infections (7.3%) and herbal medicines (3.5%). Prevalence of medicine storage and self-medication practice is high among educated female students in USM. CONCLUSIONS: There is a need to educate the students to ensure safe practice by increasing their awareness. Strict policies need to be implemented on the unrestricted availability of medicines so as to prevent the wastage of medicines.

Parent's knowledge and management of their children's ailments in Malaysia.

UNLABELLED: Minor ailments like sore throat, fever, cough and diarrhea can be relieved with over-the-counter (OTC) medications such as paracetamol or other traditional remedies, without seeking for consultation from general practitioners. Parents usually take the responsibility to come up with some kind of treatment for their children. OBJECTIVE: (1) to evaluate the parents' medical knowledge about OTC medicines which are usually used by the parents to treat their children and (2) to evaluate the parents' management in dealing with their children's ailments, and (3) to evaluate the association between medical knowledge and the management of children's ailments related to medicine use among the parents. METHODS: A cross-sectional survey was conducted to measure the parents' knowledge about their children's ailments. Subjects were selected and information was obtained in September 2008. Non-probability convenient sampling method was used. Parents were recruited from the general public to answer the questionnaires. RESULTS: 197 parents filled in the questionnaires. From the total respondents, 48.2% of them were male. This study showed that most respondents have medium knowledge (6.11 SD=3.6) and a moderate management (4.39 SD=2.7). The results showed that there is a significant difference between the knowledge and the management level of ailments (P=0.033). Regarding the education level of the parents and the socioeconomic status, the p-value showed there was a significant difference between parents' knowledge and their education level (P=0.012). CONCLUSION: This study showed that parents have inadequate knowledge and some misconception about how to go about treating their children when they are unwell. It is hoped that by identifying weak areas in parents' management to their children's ailments, better planned educational and behavioral modification efforts can be made to elevate the knowledge level among the parents when they medically treat their children.

Consumers' views on generic medicines: a review of the literature.

OBJECTIVES: To review the literature on consumers' knowledge, attitudes and opinions of the use of generic medicines. METHOD: A narrative review of studies conducted from 1970 to 2008 on consumers perceptions and views towards generic medicines was performed. An extensive literature search was undertaken using indexing services available at the authors' institution library. The following keywords were used for the search: brand, generic, multisource, medications, medicines, drugs, pharmaceuticals and consumers, customers, and patients. Electronic databases searched were Medline, Inside Web, ISI Web of Knowledge, Science Direct, Springer Link, JSTOR, Proquest, Ebsco Host and Google Scholar. These electronic databases were searched for full text papers published in English from 1970 to October 2008. KEY FINDINGS: Twenty studies were identified. Eleven were from the USA, four were from Europe, two were from Canada and one each was from Australia, Brazil and Malaysia. In general, consumers showed mixed reactions towards the use of generic medicines. This was evident from the divergence of views observed by country development level, consumers' socioeconomic characteristics, drug product characteristics, pharmaceutical reimbursement system, policy environment, contact with health care professionals, past experience with medications, and knowledge of the seriousness of a medical condition. CONCLUSIONS: Patient confidence and knowledge pertaining to generic medicines use have increased over the past four decades, especially in developed countries. Mass educational efforts, financial incentives, and greater communication among patients and health care professionals were seen as major drivers to the uptake of generic medicines among consumers.

Linolenic acid and folate in wild-growing African dark leafy vegetables (morogo).

BACKGROUND: Transition from a low-fat vegetable-rich rural diet to a high-fat Westernised diet is considered a factor in the escalating occurrence of vascular-related diseases and type 2 diabetes in urban black South Africans. Consumption of morogo is a distinguishing feature of rural African diets. OBJECTIVE: To determine fatty acid profiles and folate contents of three widely consumed, wild-growing, African dark green leafy vegetables (morogo). DESIGN: GC-MS was applied for analysis of fatty acid composition and a validated microbiological assay conducted to determine folic acid contents of wild-growing morogo sampled from deep rural villages in three different geographical regions of South Africa. RESULTS: Measured fatty acids ranged from 1610.2 to 2941.6 mg/100 g dry mass, with PUFA concentrations 1.4 to 2.8 times those of SFA. Calculated from the relative percentages of linoleic acid (18:2n-6) and linolenic acid (18:3n-3), the ratio of 18:2n-6 to 18:3n-3 PUFA was 1.0:3.4 to 1.0:8.9. The only MUFA was palmitoleic acid (16:1), measured at 34.7 (sd 0.3) to 79.0 (sd 9.3) mg/100 g dry mass, and the predominant SFA was palmitic acid (16:0), measured at 420.6 (sd 83.3) to 662.0 (sd 21.2) mg/100 g dry mass. Folic acid concentration varied from 72 to 217 microg/100 g fresh sample. CONCLUSION: Morogo is low-fat food item high in folate and with 18:3n-3 in excess of 18:2n-6, the proposed anti-inflammatory effects of which may lower risks of vascular-related chronic diseases and type 2 diabetes.

Are essential medicines in Malaysia accessible, affordable and available?

OBJECTIVE: To assess the pharmaceutical sector to know whether people have access to essential medicines. SETTING: The study was conducted in 20 public health clinics, five public district drug stores and 20 private retail pharmacies selected randomly in five different areas randomly selected (four states and a federal territory). METHOD: The methodology used was adopted from the World Health Organization study protocol. The degree of attainment of the strategic pharmaceutical objectives of improved access is measured by a list of tested indicators. Access is measured in terms of the availability and affordability of essential medicines, especially to the poor and in the public sector. The first survey in the public health clinics and public district drug stores gathered information about current availability of essential medicines, prevalence of stock-outs and affordability of treatment (except drug stores). The second survey assessed affordability of treatment in public health clinics and private retail pharmacies. MAIN OUTCOME MEASURE: Availability, stock-out duration, percent of medicines dispensed, accessibility and affordability of key medicines. RESULTS: The average availability of key medicines in the public health clinics for the country was 95.4%. The average stock-out duration of key medicines was 6.5 days. However, average availability of key medicines in the public district drug stores was 89.2%; with an average stock-out duration of 32.4 days. Medicines prescribed were 100% dispensed to the patients. Average affordability for public health clinics was 1.5 weeks salary and for the private pharmacies, 3.7 weeks salary. CONCLUSIONS: The present pharmaceutical situation in the context of essential medicines list implementation reflected that the majority of the population in Malaysia had access to affordable essential medicines. If medicines need to be obtained from the private sector, they are hardly affordable. Although the average availability of essential medicines in Malaysia was high being more than 95.0%, in certain areas in Sabah availability was less than 80.0% and still a problem.