BackgroundOveruse and misuse of antibiotics is a serious global problem. While resistance to older antibiotics is increasing, development of newer molecules has stalled. Resistance to the existing antibiotics that is largely driven by their high-volume use is a global public health problem. Uganda is one of the countries where prescription-only drugs, including antibiotics, can be obtained over the counter. We determined the rate of antibiotic dispensing and use in Uganda.MethodsThe study utilized a descriptive cross-sectional study design to determine the number of antibiotic “prescribed” daily doses per 1,000 clients. Data were collected from one health center II, eight general/district hospitals, one national referral hospital, and 62 registered community pharmacies. From each study site, data were collected for five consecutive days over the months of November 2011 to January 2012.ResultsThe overall antibiotic issue rate was 43.2%. Amoxicillin, metronidazole, ciprofloxacin, sulfamethoxazole–trimethoprim, cloxacillin, and ampicillin, belonging to the WHO anatomical therapeutic chemical classifications of penicillin with extended spectra, imidazole derivatives, fluoroquinolones, and sulfonamide–trimethoprim combinations, constituted 70% of the issued antibiotics. About 41% of antibiotics were issued over the counter. At community pharmacies, where 30% of antibiotic dispensing occurred, the number of prescribed daily doses/1,000 antibiotic clients was 4,169 compared to 6,220, 7,350 and 7,500 at general/district hospitals, the national referral hospital, and the health center, respectively.ConclusionIn Uganda, at least four in every ten individuals that visit a health-care facility are treated with an antibiotic. Antibiotics are largely given as over-the-counter drugs at community pharmacies. The number of antibiotic prescribed daily doses/1,000 antibiotic clients does not significantly differ between categories of health-care facilities except at community pharmacies, where lower doses are dispensed compared to other health-care facilities.

Panax ginseng , known as Koran ginseng, one of the most commonly used traditional plants, has been demonstrated to show a wide range of pharmacological applications. Ginsenosides are the major active ingredients found in ginseng and are responsible for the biological and pharmacological activities, such as antioxidation, antiinflammation, vasorelaxation, and anticancer actions. Existing studies have mostly focused on identifying and purifying single ginsenosides and investigating pharmacological activities and molecular mechanisms in cells and animal models. However, ginsenoside studies based on clinical trials have been very limited. Therefore, this review aimed to discuss the currently available clinical trials on ginsenosides and provide insights and future directions for developing ginsenosides as efficacious and safe drugs for human disease.

Cancer is a complex, heterogeneic, and dynamic disease involving multiple gene-environment interactions, and affecting numerous biological pathways. As such, the development of reliable and robust non-invasive platforms constitutes a vital step toward realizing the potential of precision medicine. Distant metastases harbor unique genomic characteristics that are not detectable in the corresponding primary tumor of the same patient, and metastases located at different sites show considerable intra-patient heterogeneity. Thus, the analysis of the resected primary tumor alone or, if possible, re-evaluation of tumor characteristics based on the biopsy of the most accessible metastasis, may not reveal sufficient information for treatment decisions. Here, we propose that this dilemma can be solved by a new diagnostic concept: liquid biopsy, that is, the analysis of therapeutic targets and drug resistance-conferring gene mutations in or on circulating tumor cells (CTCs). Finally, the analysis of the resected primary tumor alone may provide misleading information with regard to the characteristics of metastases, the key target for systemic anticancer therapy. Liquid biopsies are noninvasive tests using blood or fluids that detect CTCs or the products of tumors, such as fragments of nucleotides or proteins that are shed into biological fluids from the primary or metastatic tumors. Such biopsies are expected to be informative or easily accessible tools to provide comprehensive information regarding cancers beyond conventional biopsies. Thus, this review addresses the use of CTCs in cancer detection, diagnosis and monitoring and discusses the direction of its clinical application in cancer patient care.

Background Our institution is the only tertiary paediatric oncology centre serving a low-income country with a population of over 35 million. Outcomes are limited by social factors, material resources and shortages of qualified health care workers. Many children do not benefit from available chemotherapy drugs due to high mortality from treatment-related toxicity. Objectives To improve in-patient supportive care Methods At the beginning of the intervention (July 2011) discussion among medical, nursing, and pharmacy staff identified sepsis as a top preventable cause of morbidity and mortality among paediatric in-patients. Monitoring of vital signs, safe systems for fluid and drug prescribing and administration, and a standardised approach to managing neutropaenic fever were identified as key areas for intervention. Several tools were designed and implemented to address these concerns, including a paediatric observation chart, modified Paediatric Early Warning Score, drug and fluid prescription charts, and local clinical guideline for management of febrile neutropaenia. Implementation of bedside charts and compliance with sepsis guideline were audited on ward round spot audits conducted on average twice per week over the course of three follow-up visits (April 2012 – July 2013). Results Previous to these interventions no children had observations charted at the bedside and vitals were rarely documented in notes. Post implementation of bedside charts, over 90% of children seen on ward rounds had bedside observation, drug, and fluid charts. Vitals were recorded on average once per day, more often in children on the febrile neutropaenia protocol. Pulse, oxygen saturation and blood pressure were documented at least once per day in 75–95% of instances, and respiratory rate <20% of the time. Intravenous medications were charted as prescribed in >90% of instances where the drug in question was an antibiotic. Over 95% of neutropaenic children with a documented episode of fever in the preceding 12 h had appropriate antibiotics prescribed and administered as per local guideline. Conclusion Our experience demonstrates that these simple interventions are sustainable and have improved the standard of patient care. This has been associated with earlier recognition and treatment of patients with febrile neutropaenia.

The study was cross sectional study. The patients were randomly selected by taking the 6th patient in the treatment / dispensing queue, to participate in the study. 25 patients per day were randomly selected out of the 98 patients who were receiving chemotherapy. The study population was of 385 patients . Results: The cost of medicines supplied by government, donations and out of pocket cost were Shs. 103,000,000 (€ 26,410), Shs.153,000,000 (€ 39,230) and Shs.30,700,000 (€ 7,871) respectively. The proportions of the frequency of out-of-pocket costs were found to be 109 (28.3%), donations was found to cover 24 (6.2%) and government was found to be 357 (92.7%) of the medicines used at the Uganda Cancer Institute. ConClusions: The cost of donated medicines is high. It serves a small number of patients who seek care. While Uganda Cancer Institute dispenses cancer medicines to all patients free of charge, low availability leads to patients to purchase medicine in private Pharmacies. Some medicines cost a lot of money, leading to high patients' expenditure and some patients do not buy at all. Progress will require a multi-faceted approach, as well as review of policies and regulations in place that focus on the availability and accessibility of cancer medicines in Uganda.