Safety Aspects of Extemporaneous Prescriptions Prescribed by Latvian Healthcare Specialists

Until 1991, Latvia had been part of the Union of Soviet Socialist Republics, and medicines in Latvia were prepared in accordance with the Union of Soviet Socialist Republics Pharmacopoeia and standardized prescriptions. Latvia regained its independence 30 years ago, but Latvia still does not have its standardized prescriptions and official sources of information in the official language. So far, there have been no studies which would collect data about prescribed extemporaneous prescriptions and characterize the current situation in different Latvian regions. For this reason, we analyzed the extemporaneous prescriptions prepared in Latvian pharmacies in 2017. Previous studies identified specialties of those physicians who prescribed extemporaneous prescriptions most often, the most popular dosage forms, as well as identified the active substances, combinations of active substances, and excipients most commonly used in dermatology and rhinology. Having analyzed the compositions prescribed in dermatology and rhinology, our greatest concern was related to the fact that several substances were identified, the use of which in Germany was controversial or even unacceptable in certain dosage forms. The presence of such substances in Latvian prescriptions constitutes a risk to patient safety, and, since part of this article was to analyze all the collected extemporaneous prescriptions to identify unsafe substances. In order to gain insight into usage habits of these substances outside the European Union, information about them was searched in the U.S. As the history of the use of these substances in Latvia dates back to the Union of Soviet Socialist Republics, we wanted to learn whether they are mentioned in modern Russian professional literature. Having analyzed extemporaneous prescriptions of Latvian pharmacies, seven substances were identified: boric acid, borax, mercuric oxide, sodium bromide, potassium bromide, phenol, and formaldehyde. Boric acid, bromides, phenol, and formaldehyde were also found in modern U.S. and Russian professional literature. However, in this article, safety aspects in relation to the use of these substances in the preparation of medicines are emphasized. Preparations containing mercuric oxide are not found in the current U.S. or Russian professional literature.

Analysis of Extemporaneously Compounded Nasal Preparations Prescribed by Latvian Otorhinolaryngologists and General Practitioners and Comparison with German Formulations

It has been reported that sinusitis and rhinitis are included in the list of most common diagnoses made by general practitioners. Even though treatment of diseases of the nasal cavity and paranasal sinuses requires many manufactured medicines, several European countries, as well as the U.S. and Australia, still prescribe extemporaneous prescriptions for nose conditions. Germany created standardized compounded preparation monographs. Monographs allow prescription and preparation of medicines containing such active ingredients and combinations of active ingredients, the use of which is evidence-based. Latvia does not have any standardized compounded preparation monographs. The purpose of this survey was to analyze the active ingredients, combinations of active ingredients, and excipients of the extemporaneous prescriptions intended for administration to the nasal cavities which were prescribed by Latvian otorhinolaryngologists and general practitioners and to find out how many active ingredients are most often compounded in the analyzed dosage forms. To understand whether the extemporaneous formulations prescribed in Latvia are evidence based, they were compared with German formulations. A database was created entering data on all the prescriptions prepared in the selected pharmacies in 2017 to summarize information on extemporaneous prescriptions. The prescriptions prescribed by Latvian otorhinolaryngologists and general practitioners were selected and compared with German formulations. Data from 17 Latvian pharmacies were collected, and 1094 prescriptions of nasal preparations were analyzed. In preparation of nasal drops, 15 bulk drug substances and 10 manufactured preparations were used; in preparation of semi-solid nasal preparations, 14 bulk drug substances and 15 manufactured preparations were used. The analyzed prescriptions contained active ingredients and excipients currently used in Germany, as well as active ingredients and excipients, the use of which, in Germany, is limited or impermissible in the preparation of nasal preparations. More than 70% of analyzed nasal preparations contained two or more active ingredients. Several nasal drops prescribed in Latvia need isotonization to avoid damage to nasal mucosa.

Medicinal plants and their uses recorded in the Archives of Latvian Folklore from the 19th century

ETHNOPHARMACOLOGICAL RELEVANCE

The records of folk medicine present historical evidence of medicinal plant usage in the territory of Latvia and describe native and imported plants and plant products that were used as medicine.

AIM OF THE STUDY

To collect and analyse the ethnobotanical knowledge found in records of Latvian folk medicine available in the Archives of Latvian Folklore.

MATERIALS AND METHODS

Following the International Classification of Primary Care, plant uses were grouped into one of the 17 categories based on the body systems and psychological and social problems. Each plant was identified by its scientific name according to The Plant List website. Additionally, the plant parts used, dosage forms of herbal medicines and routes of administration were analysed.

RESULTS

In total, 211 genera belonging to 71 families were mentioned in the analysed materials. The most common health conditions were digestive system disorders, respiratory system disorders and skin disorders. The plant families with the largest number of taxa were Asteraceae, Rosaceae, Lamiaceae, and Apiaceae. The most frequently mentioned native plant taxa were Achillea millefolium L., Matricaria chamomilla L., Allium cepa L., Artemisia absinthium L., and Plantago sp. L. Leaves and flowers were the most commonly used parts, and herbal tea was the most common dosage form. Only 59 out of 211 taxa mentioned in this study are included in the official herbal monographs of the European Medicines Agency.

CONCLUSIONS

One hundred and fifty-two plant taxa mentioned in the records of Latvian folk medicine are not included in the European Union herbal monographs providing scientific information on the safety and efficacy and deserve further exploration as traditional herbal medicines.

Data on medicinal plants in the records of Latvian folk medicine from the 19th century

The data presented in this article is in support of the research paper "Medicinal plants and their uses recorded in the Archives of Latvian Folklore from the 19th century" [1]. This article provides the list of plant species and disorders treated with medicinal plants mentioned in the records of Latvian folk medicine and used by indigenous people of Latvia in the 19th century. In total, the data include 211 genera belonging to 71 plant families. The accepted scientific names of plant species, plant parts used, dosage forms of herbal medicines, and routes of administration are reported in the table. Plant uses are grouped into one of the 17 categories based on the body systems and psychological and social problems. The frequency of citations is indicated for each use of medicinal plant.

Trends of Extemporaneous Drug Prescription in Latvia in 2017

Despite the numerous industrially manufactured medicines available in the market, extemporaneously prepared drugs still have their niche among the services offered by the pharmacies. The physicians prescribe extemporaneously prepared drugs for special patient groups that require custom approach. Therefore, physicians' knowledge about extemporaneously prepared drugs and experience in prescribing them is the main precondition for satisfying patients' needs. The purpose of this article is to analyze the prescribing practice for extemporaneous formulations prepared in pharmacies in Latvia in order to identify the healthcare specialists who prescribe extemporaneously prepared drugs most frequently and the most common dosage forms. A database was created that includes the following data on each prescription form: 1) the name of the pharmacy where the medicine was prepared; 2) the region or the city where the pharmacy is located; 3) the month when the prescribed medicine was prepared; 4) the speciality of the healthcare professional who prescribed the medicine; 5) the dosage form; 6) all the active ingredients; 7) the number of active ingredients in the dosage form; 8) all the excipients. Data on 2,647 extemporaneously prepared drug prescriptions from 15 pharmacies in Latvia were collected. The extemporaneously prepared drugs were prescribed by physicians of 24 specialities, as well as dentists and physician assistants. The majority of the extemporaneously prepared drug prescriptions (87.5%) were from these 4 specialities: 1) general practitioners, 2) dermatovenereologists, 3) otorhinolaryngologists, and 4) pediatricians. General practitioners most commonly prescribed nasal drops, solutions for cutaneous application, and semisolid dosage forms. Dermatovenereologists mostly prescribed semi-solid dosage forms, suspensions, and solutions for cutaneous application. Otorhinolaryngologists most commonly prescribed nasal drops and semi-solid dosage forms. Pediatricians, as well as general practitioners and otorhinolaryngologists, favored nasal drops. To find out the opinion of general practitioners, dermatovenereologists, otorhinolaryngologists, and pediatricians on extemporaneously prepared drugs and the factors that hinder or facilitate their prescription, an extension of the study is planned that will include partially structured, in-depth, qualitative interviews.

The impact of the Baltic Germans' emigration on the pharmaceutical sector in Latvia (1939-1940)

For several hundred years, the Baltic German families of pharmacists have been the decisive creator of traditions in Latvian pharmacy. A large amount of the oldest pharmacies in Latvia, especially in Riga, were owned by pharmacists of Baltic German origin. Many of these ancient pharmacies ceased to exist in 1939, as a result of the emigration of the Baltic Germans. The agreement on the outward migration of German nationality citizens between Latvia and Germany was signed October 30, 1939. According to the information of the Pharmacy Board of Latvia, the number of employees in the pharmaceutical sector, registered in 1939, was 2068 persons. During the first wave of emigration, at the end of the year 1939, 306 persons, related to pharmacy, renounced the Latvian citizenship and emigrated. During the second wave of emigration, in spring of 1941, when Latvia had already lost its political independence, another 49 pharmaceutic employees left Latvia. In total 355 employees emigrated to Germany. As a result of the Baltic German emigration there was a decreased number of pharmacies in Latvia and the lack of pharmacists became a local issue. In rural areas quite often the only one pharmacy, which had been owned by a German origin pharmacist was liquidated or stayed closed for several months.

Factors related to poor asthma control in Latvian asthma patients between 2013 and 2015

OBJECTIVES

To investigate whether beliefs about asthma medication, cognitive and emotional factors are related to poor asthma control in a sample of Latvian asthma patients in 2015.

DESIGN

Cross-sectional, self-administered survey.

SUBJECTS

Three hundred and fifty two asthma patients (mean age 57.5 years) attending outpatient pulmonologist consultations in Riga, Latvia during September 2013 to December 2015. The sample size was calculated to detect a prevalence of poor asthma control of 50% with a margin of error of 5% and a power of 95%.

MAIN OUTCOME MEASURES

The validated Beliefs about Medication Questionnaire (BMQ) and the Brief Illness Perception Questionnaire (brief IPQ) were used. Good asthma control was assessed using the asthma control test (ACT), a validated five-item scale that reliably assesses asthma control over a recall period of four weeks. Logistic regression models were used to predict poor asthma control.

RESULTS

Patients who had a good control of asthma medication (OR 0.70; 95% CI 0.61-0.79) or were confident that their asthma medication improves illness (OR 0.84; 95% CI 0.74-0.95) had a reduced risk of poor asthma control. The more symptoms (OR 1.63; 95% CI 1.44-1.84) the asthma patients perceived or the more their illness affects their life, the higher the probability of poor asthma control (OR 1.47; 95% CI 1.31-1.65). Some beliefs of necessity and concerns of asthma medication were also statistically significantly related to poor asthma control.

CONCLUSIONS

Beliefs of necessity of asthma medication, cognitive and emotional illness perception factors correlate well with poor asthma control in Latvian patients.

Activities of Latvian pharmacists in the Latvian Red Cross organization in exile in Germany (1945-1976)

The Latvian Red Cross has performed its assistance mission outside the territory of Latvia for several decades. In the 40-s of the 20th century, the state of Latvia and its people went through one of the most tragic pages of their history. Due to the re-occupation made by the Soviet Union in 1944, many people of Latvia fled to exile and under exile conditions the Latvian societies, parishes and public organizations came into being, including the Latvian Red Cross. It started its activities in the second part of the 40-s of the 20th century in Germany and then representative offices emerged in the U.S.A., Sweden, France, Italy, Denmark, Belgium, Australia, New Zealand. Special attention should be paid to the fact that the activity under exile conditions was of a large scale, well-organized and long-lasting. Substantial work at that time has been done by a number of pharmacists. Among them, the pharmacist and doctor Hugo Skudins (1903-1976) should be emphasized, who organized the purveyance of medication and sending them to Latvians in the occupied Latvia and to the penal camps in Siberia.

Perception of the Professional Knowledge of and Education on the Medical Technology Products among the Pharmacists in the Baltic and Nordic Countries-A Cross-Sectional Exploratory Study

With increased development of medical technology (MT), new challenges emerge related to education and training of pharmacists and other healthcare specialists. Currently, only a few universities in the EU promote MT education and research. Objectives: The aim of this study was to evaluate the current status, views on, and need for the education on MT for the pharmacy students and practicing pharmacists in the Baltic and Nordic countries. Methods: The representatives of higher education institutions and community/hospital pharmacists from six Baltic and Nordic countries participated in a qualitative cross-sectional exploratory internet-based study from May to October 2014. Results: Approximately two-third of the respondents considered professional knowledge about MT products important for pharmacists, but half of them had never participated in any MT courses. More practicing pharmacists than representatives of academia underlined the need for increased MT education for pharmacy students in the future. Conclusions: The pharmacists in the Baltic and Nordic countries consider the professional knowledge about MT as pertinent in their education and work. The limited number and status of MT courses available today, however, is a major concern among both pharmacy students and practicing pharmacists in these countries. In the future, increasing education combining theory and practice about MT products would be one possible solution to overcome this challenge.

The national pharmacopoeias of the Baltic States

After Estonia, Latvia and Lithuania proclaimed their independence in 1918 and began to create their national health care systems, one of their stated priorities was the formulation and publication of national pharmacopoeias. In order to accomplish this, working groups as well as commissions composed of pharmacists, medical specialists and even linguists had to be formed. The process was long and difficult. New terminology in native languages had to be created. Sources for the monographs had to be chosen, researched, analyzed and compared. There were organizational and financial problems. Nevertheless, by the late 1930s, all three Baltic States published their national pharmacopoeias. Officially, they were not able to use them for long because during World War II all three were occupied and annexed by the Soviet Union. Pharmacists in those countries were obliged to use the Soviet pharmacopoeias, although unofficially, they also made good use of their national ones. Currently, the European Pharmacopoeia is in use in Estonia, Latvia and Lithuania.

Flow cytometric analysis of glyoxalase-1 expression in human leukocytes

Altered glyoxalase-1 (GLO-1) activity and expression is associated with the development of late diabetic complications, malignancy and oxidative stress- and aging-related diseases. In the present study, we developed a flow cytometry method for GLO-1 detection in human leukocytes isolated from peripheral blood samples to investigate GLO-1 expression in leukocyte subsets from type 1 and 2 diabetes mellitus patients (n = 11) and healthy subjects (n = 8). The flow cytometry analysis of GLO-1 in leukocytes showed that expression index of GLO-1-positive cells was slightly increased in mononuclear leukocytes from diabetic patients. This result correlated with the increase in GLO-1 activity in the whole blood samples of type 2 diabetes patients. In conclusion, the present study demonstrates that flow cytometry is suitable for the detection of the GLO-1 enzyme in human leukocytes and that this method could be used to investigate the fast adaptation of the glyoxalase system related to the pathogenesis of late complications of diabetes mellitus and other glycation stress-related disorders.