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Pharmaceutical Journal of Kenya, Volume 22, No. 3 (2015)

Volume: 22, No. 3 (2015)
Publisher: The Pharmaceutical Society of Kenya
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Articles in the journal

EDITORIAL: Review Articles: How should they be written?

Author: Orwa J.A.

Prevalence and Preventive Strategies of Nephrotoxicity in Patients Receiving Cisplatin Based Regimen in a Kenyan Referral Hospital

Author: Mwai G.O. , Nyamu D.G. , Menge T.B. , Karimi P.N.
Keywords: Cisplatin, Nephrotoxicity, Preventive Strategies, Normal Saline.
Cisplatin administration is associated with nephrotoxicity. There is scant literature on the renal toxicity profiles and their preventive strategies in Kenyatta National Hospital. A retrospective cohort study design was used to study the nephrotoxicity profiles and preventive strategies among three hundred and sixty seven adult patients in Kenyatta National Hospital’s radiotherapy clinic.
There was female preponderance of 62.6%. The median age of the study population was 51 years (ranging from 18-91). Prevalence of renal toxicities was found to be 58.5%, mostly grade 2 nephrotoxicity, with mean glomerular filtration rate of 59.3 ml/min/1.73m2 (±20.6). At a patient’s fifth visit, the odds ratio of developing grade three nephrotoxicity was twice as compared to the first visit (p=0.008). Postponement of doses of cisplatin retarded progression of nephrotoxicity in terms of deranged renal functions (p<0.0001). Medication change from cisplatin to carboplatin (p=0.181) and hydration with normal saline (p=0.486), however, did not prevent nephrotoxicity.
More than half of the patients exhibited nephrotoxic profiles despite employing preventive strategies suggesting that better ways of preventing nephrotoxicity ought to be sought.

Impact Of Medication Related Problems on Individualized Dispensing at Kenyatta National Hospital

Author: Rugendo A.B. ,Karimi P.N. ,Amugune B.K. ,Maima A.O.
Keywords: medication related problems, medication error, non adherence, adverse drug reactions and medication order.
Medication related problems occur when the outcome of medicine use is not optimal. This often results in a significant strain on the health delivery system and contributes to mortality, morbidity and escalation of healthcare costs. Potential and actual medication related problems can occur at any stage of the medicine use process.
This study assessed the effects and/or challenges of implementing individualized in-patient dispensing systems and medication related problems in Kenyatta National Hospital’s medical wards. A quasi experimental study design was applied and a systematic random sample of 236 patient files before, and 207 files after, the introduction of individualized dispensing system were selected. An incidental sample of 25 health workers were surveyed on challenges faced. Descriptive and inferential data analysis was performed.
Challenges faced included inadequate medicine storage facilities, patient management software anomalies, delay in ordering patient medicines and increased workload. There was a high prevalence of medication related problems (97.5 % vs.95.7 %) with potential drug interactions (80.9 % vs. 69.9 %) and non adherence (80.9 % vs.91.3 %) being most common.
There are several challenges encountered in implementation of individualized dispensing and many medication related problems at Kenyatta National Hospital.

Review of the Status of Alternative Medicine Practice in Kenya

Author: Muriuki B. ,Midiwo J.O. ,Mbugua P.M. ,Gikunju J.K.
Keywords: Traditional Medicine, Alternative Medicine, Herbalist, ethnomedicine.
The non mainstream medical practices in Kenya vary widely along cultural, religious and geographical lines. The methods adopted range from material administration, non-invasive physical and invasive surgical procedures to psychological and spiritual based procedures. The material-medical practice or herbalism may be the only one that can be subjected to uniform registration and regulatory procedures. Kenyan herbal medicine practice has largely remained uncontrolled and unregulated despite the fact that a large proportion of the Kenyan population could be relying on the same. Although some substantial data on alternative medical products has been generated by institutions and individual scientists, lack of necessary coordination has rendered practical progress, value addition and utilization difficult. There is now a constitutional requirement for formal incorporation of traditional and alternative medicine into the mainstream health sector and its implementation may enable development of an efficient regulatory mechanism for herbal medicine. This article is a summarized review of the current status of alternative medicine practice in Kenya. Issues of regulation and registration are mainly reviewed in the context of herbal or alternative material medicine.

Assessment Of The Pharmaceutical Manufacturing Industry In Kenya In Regard To Self Sufficiency In Essential Medicines

Author: Vugigi S. K. , Ogaji I. J. and Thoithi G. N.
Keywords: Essential medicines, local pharmaceutical industry, pharmaceutical product, self sufficiency.
Kenya National Pharmaceutical Policy (2012) encourages local production of essential medicines. Pharmaceutical manufacturing industry in Kenya currently consists of 30 companies accredited by the Pharmacy and Poisons Board of Kenya. The aim of this study was to assess the contribution of the pharmaceutical manufacturing industry in Kenya towards essential medicines demand.
Dosage forms produced locally, registered pharmaceutical products and pharmaceutical lists in Kenya were evaluated. Subsequently, pharmaceutical equivalents of 150 locally manufactured essential medicines were determined.
Solid dosage forms were the majority (54.9%) of local products. Locally manufactured products accounted for 14.5% of registered products. Local firms manufactured 38.4% of products listed as essential medicines. Ninety one percent (91.0%) of products stocked by Kenya Medical Supplies Authority were essential medicines. The overall percentage of local pharmaceutical equivalents was 32.4%.
Kenya depends heavily on imported pharmaceutical products for her essential medicines needs.

Sunscreen Creams

Author: Mungoma M.
Keywords: Ultra Violet (UV) filters, zinc oxide, nano particles, reactive oxygen species
Background: Sunscreen creams contain varying concentrations of UV filters in their formulations inhibiting direct exposure to damaging UV radiation which have a potential for toxicity, raising concerns over their safe use. Environmental toxicity from sunscreen creams is emerging with evidence of toxic ingredients reaching aquatic life, soil and possibly the food chain to man.
Aims of the study: This is a review highlighting the pros and cons of sunscreen use. It explores the controversies surrounding the use of sunscreen creams eliciting the benefits as well as the doubts around their efficacy in skin protection. By examining controversies, recent developments and the array of approaches surrounding the suncream use, this review confronts these opposing views and explains the contribution of ingredients and individual use as a stratified and very context-sensitive subject and provides a comprehensive picture on the potential toxicity of suncreams.
Search Methods: An electronic search of PUBMED database was undertaken on suncream articles. Cohort studies, retrospective studies, in vivo and in vitro studies and randomized controlled clinical trials referring to potential toxicity were evaluated.
Data Collection and Analysis: Data was extracted from articles and significant findings filtered to highlight the controversies surrounding the use of suncreams.
Main Results: Suncreams contain organic compounds known as UV filters which absorb UV radiation, reducing the adverse effects of sunlight exposure. Benzophenone-2 (BP-2) has an increased potential for ecological toxicity particularly on marine life. It similarly is toxic to both male and female reproductive systems. However the use of suncreams for protection against photodamaging effects of sunlight has been proven.
Conclusions: This review suggests that suncream potential toxicity to humans requires further exploration. There are several layers of arguments that are confounded by variation in use of end users. However its use in vulnerable people including those suffering albinism and those exposing themselves to long hours under the sun is supported.