Showing papers in "The African Journal of Pharmacology and Therapeutics in 2015"

Determination of Pesticide Residues in Locally Consumed Vegetables in Kenya

Abstract: Background : Pesticides are being used today to control a variety of insects, weeds and plant diseases. Some of these pesticides can act as toxins to plants, animals and humans when found in significant concentrations. Objective: The purpose of this study was to determine pesticide residues in locally consumed vegetables. This was done by analyzing vegetable samples from supermarkets and local markets in Nairobi and its environs. Materials and methods: A total of 112 samples (kales 94, French beans 18) were collected from the study area and analyzed using gas chromatography for pesticide residues. Samples collection was done during the hot/dry season and cold/wet season. Results : The pesticide residues were found especially during the hot/dry season and were mainly organophosphates. However, on washing and cooking the residue levels reduced were by 17% and 40% -respectively. Adherence to recommended pre harvest intervals resulted in 99% reduction of the pesticide residues. Conclusion: This study clearly shows that adherence to good agricultural practice would significantly lower the levels of pesticide residues in vegetables. Keywords: Pesticides residues, vegetables

Antimicrobial susceptibility of bacteria that cause wound sepsis in the paediatric surgical patients at Kenyatta National Hospital

Abstract: Results: The prevalence of wound infection was 82%. Staphylococcus aureus (52.7%) was the most prevalent infective agent followed by Pseudomonas aeruginosa (17.3%). Staphylococcus aureus was the most resistant organism with susceptibility of less than 50% to most drugs. About 50.6% of the Staphylococcus isolates were methicillin resistant. Streptococcus was less resistant with more than 80% susceptibility to all tested drugs except cefuroxime. Escherichia coli were sensitive to ciprofloxacin. All gram negative bacteria were highly sensitive to ciprofloxacin with the following susceptibilities: Pseudomonas aeruginosa (92.3%), Proteus mirabilis (71.4%) and others 100%. Imipenem which is a new and relatively expensive monobactam demonstrated reduced activity with the following susceptibilities: Staphylococcus aureus (38%), Streptococcus (80%) and all the gram negative bacteria (70%). Conclusion: The most common causative agent was Staphylococcus aureus and less than 50% of the isolates were susceptible to all tested antibiotics.

Patterns of Prescribing Practices in Makueni County Referral Hospital, Kenya

Abstract: Background: Prescribing is said to be irrational if it does not conform to good standards of treatment. Irrational prescribing leads to increased cost of drug therapy, increased risk for adverse drug reactions and emergence of drug resistance. Objective: The study objective was to determine the quality and patterns of prescribing in Makueni County Referral Hospital, Kenya, using World Health Organization prescribing indicators. Methodology: The design was a descriptive retrospective cross-sectional study. Data was abstracted from 824 patient encounters selected through quasi-random sampling. Data was collected from the sampled prescriptions using a pre-tested data collection form, entered into and analyzed using Stata version 10.0 software. Results: The mean number of drugs per patient encounter was 2.7. Only 45.5% of the total drugs were prescribed using generic names. Antibiotics and injections were prescribed in 74% and 13.2% of the prescriptions surveyed respectively. Discussion: On average, inpatients received a higher number of drugs per encounter compared to outpatients, probably because they usually have more severe disease than outpatients which may require management with more drugs. Conclusion: The results showed a trend towards irrational prescribing, particularly polypharmacy, underuse of generic names and over-prescription of antibiotics. Relevant educational, managerial and regulatory interventions are recommended to remedy the problems. Keywords: Irrational prescribing, prescribing indicators, polypharmacy

In vitro and in vivo antiplasmodial activity of extracts of selected Kenyan medicinal plants

Abstract: Background : Malaria is one of the most important parasitic diseases in the world. It remains a major public health problem in Africa and is responsible for the annual death of over one million children below the age of five years. The Plasmodium falciparum is the most widespread etiological agent for human malaria and has become increasingly resistant to standard antimalarial drugs. Therefore, this necessitates a continuous effort to search for new drugs, particularly with novel modes of action. The medicinal plants have invariably been a rich source for new drugs and some antimalarial drugs in use today (quinine and artemisinin) were either obtained from plants or developed using their chemical structures as templates. Objective: The aim of the study was to screen seven selected medicinal plants from Kenya for antimalarial activity. Materials and methods: Twenty one ( 21) extracts from seven plants: C. myricoides, C. abyssinica, A. racemosus, A. remota, C . edulis , S . princeae and L. calostachys were selected for in vitro antimalarial screening out of which 10 extracts with good activity in vitro were tested further in a mouse model. In vitro antiplasmodial testing was done by measuring ability of the test sample to inhibit the incorporation of radio-labelled hypoxanthine into the malaria parasite. In vivo bioassay was done in mice using Peter’s 4-days suppressive test. Results: From the results achieved, 10 out of the 21 extracts tested, exhibited antiplasmodial activity, with IC 50 values ranging from 6.93μg/ml to 88.4μg/ml. when tested in vivo one of the extracts had high activity with chemosuppression of 82.17%, while the rest ranged between 39.93% and 61.86%. Conclusions: The activities observed especially with the methanol extracts indicate that these plants deserve to be investigated further as potential antimalarial agents. Keywords: Medicinal plants, Extracts, Antiplasmodial activity

Acute toxicity studies of Catharanthus roseus aqueous extract in male Wistar rats

Abstract: Background: The knowledge of the healing virtues of Catharanthus roseus and a host of other medicinal plants has been in existence since ancient times. Catharanthus roseus is traditionally used more commonly as anti-diabetic and anti-malaria remedy. Lack of adequate pharmacological and toxicological data of natural products to support their use is a major setback. Objective: To establish the acute toxicity effect of Catharanthus roseus crude aqueous extract on some hematological and biochemical parameters. Methodology: Catharanthus roseus aqueous extract was orally administered once to two groups of male rats at 1000 and 5000 mg/kg body weight respectively alongside a control group which received 2ml distilled water. Hematological and biochemical assays were done at 48 hours and the 14 th day . The data was analyzed using SPSS 17.0. Results: White blood cells (WBC), creatinine, urea, alanine aminotransferase and aspartate aminotransferase showed significant increase while mean cell volume reduced significantly at 48 hours in the high dose group. The body weight change was also significantly reduced. Discussion : The alterations of the body weight gain, various biochemical and hematological parameters reflect the effect of toxicity after exposure of the tested extract doses. Total proteins concentration was not altered suggesting that the renal and liver functions were not adversely affected. Key words: Catharanthus roseus , acute toxicity, rats

Traditional therapeutic uses and phytochemical screening of some selected indigenous medicinal plants from Northwest Ethiopia

Abstract: Background : Medicinal plants including Achyranthes aspera , Brucea antidysentrica and Croton macrostachyus in the Zegie and Lake Tana area are among the main herbal agents traditionally used to treat various illnesses. However, scientific investigations including their phytochemical screening have not been conducted. Objective : To survey the use of these selected medicinal plants by traditional healers and/or herbal medicine users in the Zegie and Lake Tana areas, and conduct phytochemical screening of such commonly used herbal agents. Methodology : Detailed interviews about the therapeutic uses of Achyranthes aspera , Brucea antidysentrica and Croton macrostachyus were conducted among the traditional healers and users in the study area. The plants were collected and separately extracted using water and ethanol and the crude extracts screened for phytochemical components by using standard procedures. Results : The interview results from the traditional healers and users in the study area on the selected medicinal plants pointed to the therapeutic usage of these herbal agents for a variety of disease conditions, including infectious and non-communicable diseases. Plant extracts from Achyranthes aspera and Brucea antidysentrica showed the presence of flavonoids, carbohydrates and vitamin C but the absence of saponins and proteins (peptides). Croton macrostachyus was found to have most of the screened phytochemical constituents (including saponins, flavonoids, carbohydrates, free amino acids and vitamin C) except proteins. Discussion : The herbal agents were found to have a variety of therapeutic uses for various illnesses in the area. The presence of the above mentioned phytoconstituents detected may be responsible for the therapeutic activities of these herbal agents. Key words : Traditional medicines, phytochemicals, Achyranthes aspera , Brucea antidysentrica , Croton macrostachyus

Incidence and Risk Factors of Renal Dysfunction in Patients on Nevirapine-Based Regimens at a Referral Hospital in Kenya

Abstract: Results : The incidence of renal dysfunction was 4.3% (95% C.I, 1.68-6.94).Five (2.1%) patients had a low eGFR at baseline, while ten (8.3%) patients had elevated serum creatinine (above 120µg/l). None of the patients developed severe renal dysfunction. Seventy (32%) and ten (4.6%) had mild and moderate renal dysfunction respectively. The females had a higher risk of developing renal dysfunction (adjusted O.R 0.48 (95% C.I 0.24-1.04; p=0.04). Alcohol consumption was a significant predictor of renal dysfunction (adjusted O.R 1.84 (95% C.I 1.01-3.29; p=0.04).All fifteen patients with a BMI of over 18.5 had elevated eGFR of below 50ml/min/1.73m. 2Patients who had been initiated on

Antimicrobial activity and cytotoxicity of selected medicinal plants found in Nandi County, Kenya

Abstract: Background : Medicinal plants are widely used by the local people to treat various human diseases cause by drug resistant microorganisms. For instance, Kigelia Africana fruits and barks are boiled in water and taken orally as a laxative in treating stomach ailments, Ekebergia capensis bark is boiled in water and use for the control of gonorrhea and tuberculosis while Fagaropsis angolensis stem bark is used to treat pneumonia, back ache and joins. The efficacy and safety of most of these plants has not been determined. Objective : The present study seeks to determine antimicrobial activities and cytotoxicity of the selected medicinal plants indicated above, that are commonly used to treat infectious diseases. Materials and Methods : Fresh plants were collected from the field; air dried ground and extracted using acetone and water. The extracts were screened for antibacterial and antifungal activities using Staphylococcus aureus , Methicillin resistant Staphylococcus aureus , Escherichia coli, Pseudomonas aeruginosa, Shigella dysentriae, Candida albicans, Cryptococcus neoformans , Microsporum gypseum and Trychophyton mentagrophytes. The methods were disc diffusion and broth dilution methods while in vitro cytotoxicity test was carried out following a modified rapid calorimetric assay, using actively dividing sub-confluent Vero E6 cells. Results : In disc diffusion assay, water extracts of E. capensis were the most active (14.7 mm) while those of Fagaropsis angolensis were the least (6.0 mm) against S. aureus . Acetone extracts of E. capensis and K. Africana had a Minimum Inhibitory Concentration of 3.125 mg/ml and 6.25 mg/ml respectively and were bactericidal. Cytotoxicity showed that K. africana was not cytotoxic against Vero cell lines while acetone extracts of E. capensis was moderately toxic with a CC 50 (µg/ml) of 12.5. Conclusion: These results support the use of the plants in the traditional medicine as antimicrobials and they can be exploited for novel drugs. Key words : Antimicrobial activity, cytotoxicity, Kigelia africana, Ekebergia capensis, Fagaropsis angolensis

Herbal remedies and other risk factors for preterm birth in rural Kenya

Abstract: Background: Premature infants contribute substantially to infant morbidity and mortality especially in low resource settings. Information on herbal remedy use, previous preterm birth and low social-economic status and their association with incidence of preterm birth in Kenya is scanty. Objectives : To determine the use of herbal remedy use in pregnancy, previous preterm birth and low socio-economic status as risk factors for Preterm Birth in Kitui County among the immediate post-partum mothers. Methods: Unmatched case control study with a 1:4 ratio of cases to controls. The study was done in Kitui and Mwingi District Hospitals. A total of 107 mothers with preterm birth (cases) and 453 mothers with term births (controls) were eligible and administered structured interviews. Results: Of the sample, 98% of cases resided in rural areas compared to 90% of controls. The cases had a higher parity and were more likely to belong to the lowest three and four levels of socio-economic status. On multivariate logistic regression analysis, predictors of preterm birth were: preeclampsia (OR=9.06 [2.60-31.63], p=0.001), previous preterm, (OR=9.31 [2.82-30.68], p<0.001), low socioeconomic status (OR=1.51 [1.05-2.16], p=0.03), herbal use in first trimester for 2-5 days (OR=11.10 [4.34-28.41], p<0.001), herbal use in first trimester for 6-10 days (OR=44.87,[4.99-403.87] p=0.001), and herbal use in second trimester for 6-10 days (OR=16.43 [4.53-59.57], p<0.001). Use of prescribed folic acid in second trimester for more than 31 days was associated with lower risk of preterm birth (OR=0.20 [0.12-0.34], p<0.001). Conclusion: Herbal use in pregnancy regardless of gestation, previous preterm birth and low socio-economic status and are risk factors for preterm birth in Kitui County Kenya. Interventions targeted to reduction of these risk factors will be an important additional prong in the reduction of preterm birth. Key words : Preterm birth, herbal remedy, risk factors

Influence of Aspilia pluriseta Schweinf (Asteraceae) on the healing of dermal excision wounds (mouse model) and skin sensitization activity (Guinea pig model)

Abstract: Background: The skin is highly predisposed to injury because of its direct contact with the environment. The aim of treating of wounds is to both hasten healing, and to minimise the occurrence of perturbations of the healing process. Many plants traditionally used to treat wounds have been proven to support the healing process using scientific models. Aspilia pluriseta has been used by a number of communities in East and Southern Africa to treat wounds. Objectives: This study aimed at testing ethnomedical claims of wound healing activity of A. pluriseta using preclinical models. Methods: Aerial parts of the plant were ground and incorporated into an ointment base (10% and 20% w/w) to evaluate the influence of the plant on the healing of acute excision wounds in mice compared to Silverex Cream ® and Simple Ointment (B.P.). The 20% ointment was tested for skin sensitization in guinea pigs. Results: The effects of the plant-based ointments on wound contraction and gross epithelialisation time were less than significantly different from the controls (p≥0.05), but histopathologic examination revealed remarkable epithelialisation and collagen deposition in the wounds treated with the these ointments. The 20% A. pluriseta -based ointment induced moderate allergic contact dermatitis.

Antimalarial activities and toxicity levels of selected medicinal plants used in Kenya

Abstract: Background: Resistance development to antimalarial drugs necessitates the look at traditional medicinal plants as sources of novel compounds that could have the otential to be developed into new antimalarial therapies. Four medicinal plants used in Kenya to treat malaria were investigated. Objective: To determine the in vitro and in vivo antimalarial activity and safety of four medicinal plants used in Kenya to treat malaria. Materials and Methods: Ximenia americana, Sericocomopsis hilderbrandtii, Pentas lanceolata and Fuerstia africana were collected from their habitat, dried, and extracted with methanol and aqueous solvents. In vitro antiplasmodial activity carried out using Plasmodium falciparum, In vivo antimalarial activity using Plasmodium berghei ANKA strain in Swiss albino mice. Cytotoxicity was carried out using MTT assay on VeroE99 cell lines, acute toxicity was investigated in Swiss albino mice. Results: All extracts had good in vitro activity against D6 strain of Plasmodium falciparum with IC 50 30% while three demonstrated low activity. Fuerstia africana was moderately cytotoxic. Except for Ximenia americana water extract, all the extracts were safe with LD 50 > 5000mg/Kg. Conclusion: Results of this study support medicinal use of these plants and indicate that useful compounds can be isolated for further exploitation, formulation and use. Keywords: Medicinal plants, antiplasmodial activity, cytotoxicity, acute toxicity

Determinants of Adherence to Anticonvulsants Therapy among Outpatient Epileptic Children in a Kenyan Referral Hospital

Abstract: Background: Epilepsy is a chronic disease requiring prolonged adherence to treatment. Adherence to anticonvulsants by epileptic children is important as studies have shown that about two-thirds of epileptic children can be completely freed from seizure if they persistently adhere to treatment for a period of 2-5 years. Conversely, non-adherence to anticonvulsants may lead to increased frequencies of status epilepticus and sudden unexplained death from epilepsy. There is scant literature on factors impacting on the adherence to anticonvulsants among children. Objectives: To determine rate of adherence and parents/caregivers’ factors influencing adherence to anticonvulsants among outpatient epileptic children attending neurology clinic. Methods: Cross-sectional study design was carried out at Kenyatta National Hospital from May to July 2014. Systematic sampling was used to recruit a sample of 176 parents/guardians of children with epilepsy. Predesigned questionnaires and Morisky tool for assessing medication adherence were used to capture participant’s sociodemographics and factors impacting on adherence to antiepileptics. Data were analysed using STATA software version 10. Discrete variables were summarized with frequencies and percentages while continuous variables were summarized using measures of central tendency and dispersion. Results: The rates of adherence, when classified in terms of high, medium and low, were 36.9 %, 39.8 % and 23.3 %, respectively. Adherence rate was associated with parents/guardian marital status (Adjusted OR= 5.72, 95% CI= (1.50, 21.78), p=0.01) and education level (Adjusted OR=5.16, 95% CI= (1.88, 14.02), p< 0.01). Unavailability and inaccessibility of drugs were also shown to influence adherence. Conclusion: Adherence to antiepileptic medication was poor. This was partly due to parents/guardian’s related factors. Health care workers should explore ways and means of minimising these factors to improve on adherence.

Antiplasmodial, Cytotoxic and Acute Toxicity Activities of Vernonia lasiopus O. Hoffman

Abstract: Background: Malaria continues to cause heavy morbidity and mortality and it is the fifth leading cause of death globally. The disease causes over one million deaths annually and affects many more, particularly due to increasing multi-drug resistant strains of Plasmodium falciparum . Sustained investigations in both curative and prophylactic interventions have supported the ethno-pharmacological approach to identify novel compounds as a major channel towards achieving a solution. Vernonia lasiopus has been used in traditional medicine for their antimalarial, antiviral and analgesic properties. Objective: To investigate the antiplasmodial activity and toxicity profile Vernonia lasiopus extracts. Methodology: Extraction of aerial parts and roots was done using dichloromethane:chloroform (1:1) and the resulting crude extracts each fractionated into six fractions by vacuum liquid chromatography using solvents of different polarities. The crude extract and fractions were investigated for antiplasmodial activity using the chloroquine (CQ) sensitive D6 and chloroquine (CQ) resistant W2 laboratory adapted Plasmodium falciparum strains. Cytotoxicity was evaluated on Vero 199 cells at starting concentrations of 100µg/ml, whereas acute toxicity (LD 50 ) determined on healthy female Swiss mice (20±2 gm.). Selectivity index was used as an indicator of antiplasmodial viability. Results: The fractions of V. lasiopus roots showed higher activity combined than individually. The crude V. lasiopus root extract had an IC 50 13.1 µg/ml and selectivity index >7.63. Fraction 1 of the crude root extract (VLR1) was the most viable fraction with an IC 50 of 16.8 µg/ml and S.I >5.95. Both had CC 50 >100 µg/ml and LD 50 >5000mg/kg. Conclusion: extracts of V. lasiopus aerial parts and roots were found to exhibit notable viable antiplasmodial effects, and had minimal acute toxicity in mice. Key words: Plasmodium falciparum , Vernonia lasiopus , antiplasmodial activity, toxicity, selectivity index.

Effect of Irbesartan on Glucose Tolerance in a Type 2 Diabetes Mellitus Mouse Model

Abstract: Background: Angiotensin receptor blockers (ARBs) have been reported to affect glycaemic control in both animals and humans. A few studies have evaluated the effects of irbesartan on blood glucose levels and ARBs are recommended in patients with comorbid diabetes and hypertension. However, the effect of irbesartan on insulin resistance and glucose tolerance is inconclusive and contradicting. Objectives: To evaluate the effect of irbesartan on blood glucose levels and glucose tolerance in diabetic and non-diabetic mice. Materials and methods: Diabetes was induced in 18 obese BALB/c mice fed on high fat diet using alloxan monohydrate 150mg/kg via the intra-peritoneal route. Non-diabetic mice were assigned to three treatment groups (n=6/group) and each group received either of the following treatments: 20mg/kg irbesartan or 75mg/kg irbesartan or vehicle. Diabetic mice were also divided into three groups and each group received one of the three treatments mentioned above. Drug administration was done daily via oral gavage for 14 days. Blood glucose levels were measured on day 1 (baseline values), day 8, and day 13 of treatment. An oral glucose tolerance test was carried out on day 14 after administration of 50% dextrose at the dose of 1g/kg body weight. Blood glucose levels at 15, 30, 60 and 120 minutes were measured during the oral glucose tolerance test. Results: Irbesartan at the dose of 20mg/kg (-39.44% ±8.96, p=0.0177) and 75mg/kg (-40.07% ±6.27, p=0.0111) significantly lowered blood glucose levels in diabetic mice. However, irbesartan 20mg/kg (-14.87% ±10.13, p>0.9999) and 75mg/kg (-9.07%±3.77, p>0.9999) did not significantly change blood glucose levels in non-diabetic mice. In non-diabetic mice there was only a modest difference in AUC in the irbesartan20mg/kg (AUC=28.73mmol/Lmin, p=0.6435), 75mg/kg (AUC=26.66mmol/Lmin, p>0.9999) compared to the non-diabetic control (AUC=26.63 mmol/Lmins). Although there was a slight improvement in glucose tolerance in diabetic mice, irbesartan 20mg/kg (AUC=55.35mmol/Lmin, p>0.9999) and 75mg/kg (AUC=45.54mmol/Lmin, p=0.1737) had no significant effect on glucose tolerance compared to the diabetic control group (AUC=63.53mmol/Lmin). Conclusion: At standard treatment doses, irbesartan had a significant hypoglycaemic effect without significantly improving glucose tolerance in diabetic mice. Key words: Irbesartan, glycemic effects, glucose tolerance, Type 2 diabetes, mouse model

Abandonment of treatment and loss to follow up: a potential cause of treatment failure in patients with AIDS-related Kaposi’s sarcoma

Abstract: Background: Management of patients with cancer is complex, multi-disciplinary, longitudinal and costly. Abandonment of treatment by patients and loss to follow up is a common scenario, especially in resource poor countries and severely compromises health outcomes. Objective: To assess the commitment to drug treatment protocol of patients with Acquired Immunodeficiency Syndrome (AIDS)-Related Kaposi’s Sarcoma at Kenyatta National Hospital, Kenya, over a 10 week period . Methods: The study design was prospective, observational, cross-sectional period prevalence study on patients infected with human immunodeficiency virus (HIV) with Kaposi’s sarcoma. Patients with histological diagnosis of Kaposi’s sarcoma were sequentially enrolled into the study as they attended either the Haematology or Radiotherapy clinic or during their admission in the wards. The choice of the treatment protocol was left at the discretion of the attending physician. A pretested data collection form was used to collect demographic and clinical information about the patients, including treatments prescribed and completion of follow up. Results: A total of 74 patients were enrolled into the study, 42 (56.8%) males and 32 (43.2%) females. The age ranged between 13 years to 55 years. Their treatment protocols included: Vincristine only, Vincristine plus Bleomycin, Vincristine plus Bleomycin plus Doxorubicin, Radiotherapy plus Vincristine and Radiotherapy only. Few of the patients were not assigned any antitumor treatment. Antiemetic and other conventional medicines were also prescribed when necessary. Fifty four (73%) of the patients abandoned treatment, five (6.8%) died, 15(20.3%) continued to attend clinic over the 10 week period. There was no significant association between sex and outcome (p=0.661). Discussion: The results of this study demonstrate that abandonment of treatment is a major problem among patients on treatment for cancer in Kenyatta National Hospital in Kenya. Abandonment of treatment heavily contributes to poor clinical outcome hence complicating the burden of cancer in the country. It is therefore important to develop and establish follow-up systems to improve adherence to treatment for the cancer patients at Kenyatta National Hospital. Key words: Abandonment of treatment, Loss to follow up, AIDS-Related Kaposi’s Sarcoma

Effect of Pesticide Exposure on Serum Cholinesterase Levels among Asthmatic Children in Naivasha Sub-County, Kenya

Abstract: Background: Pesticide exposure is a risk factor for asthma exacerbations in flower farm regions in the world. Data on levels of serum cholinesterase among asthmatic children exposed to pesticides in Kenya is scanty. Objectives: To compare and identify variables which affect the concentration of serum cholinesterases in children who are exposed and unexposed to pesticides. Methodology: The design was a comparative cross-sectional study that involved exposed and unexposed children. The study was conducted between May and July, 2014 in Naivasha, Kenya. Patients were interviewed and serum samples were analysed for cholinesterase levels. Multi-linear regression was done to identify variables that affected cholinesterase activity. Results: Children who were exposed to pesticides had a lower median ChE activity of 5828 [IQR 4863, 6443] compared to the unexposed arm whose median was 7133 [IQR 6063, 8179]. Five predictor variables were found to be significantly associated with depression of serum cholinesterase levels. The most important predictor variable for the levels of ChE in children, was not using protective clothing by the parent [adjusted β -1457.0 (95% CI - 2594, 1319.8)]. Others were not using household pesticides [adjusted β 96.3, (95% CI 22.6, 170.0)], female sex [adjusted β -695.7 (95% CI -1296.2, - 95.3)], non school attendance [adjusted β -1676.8 (95% CI -3371.6, 18.1)] and not taking a break after spraying [adjusted β 1105.5 (95% CI (315.0, 1895.2)]. Conclusion: Children who were exposed to pesticides had low cholinesterase levels. Parents should therefore be encouraged to wear protective gear as this conferred protection of children from the effects of pesticide exposure. Key words : asthma, exposure, children, pesticides, cholinesterase.

The lipid lowering effect of the aqueous root extract of Morinda lucida in albino rats fed on a high cholesterol diet

Abstract: Background : Morinda lucinda (Benth) Rubiaceae has been reported in folk medicine to be useful for the treatment of diabetes mellitus (DM) and hyperlipidemia. Previous studies have identified the hypoglycemic effect of this herb, but data on its lipid lowering effect is lacking. Objective: To evaluate the effect of Morinda lucinda on hyperlipidemia. Methods: Morinda lucinda roots were extracted via cold maceration using distilled water. It was administered to rats (n=6 per group) on a high cholesterol diet for 14 days (40 mg/rat/day). Five groups of rats were orally given the extract (100, 200 and 400 mg/kg), atorvastatin (5mg/kg), or distilled water (2ml/kg) for 14 days. Positive and negative control groups received cholesterol & distilled water and only distilled water respectively. After the 14 th day, blood samples were withdrawn and separated plasma was tested for HDL, LDL, triglycerides and total cholesterol. Results: Treatment with Morinda lucinda extract at all doses significantly reduced the levels of LDL (p <0.0001), while increasing the HDL levels (p<0.05) in the hyperlipidemic rats from 12.5 mg/dL to 24.2, 23.93, 26.67 mg/dL for the 3 doses respectively. Similarly, administered extract at all doses significantly reduced the total cholesterol (p<0.0001) and triglycerides (p = 0.001, p = 0.0005, and p<0.0001 for 100, 200 and 400 mg/kg respectively) in comparison with the positive control. The effect of the extract on total cholesterol and LDL were most prominent and was as effective as atorvastatin. Conclusions: The effect of the extract on total cholesterol and LDL were most prominent and was as effective as atorvastatin. Our results suggest Morinda lucinda as a useful remedy for lowering lipid level in patients with hyperlipidemia. Keywords: Triglycerides, High density lipoprotein, Low density lipoprotein, Total cholesterol

Evaluation of Steroid Utilization in Management of Asthma in a Tertiary Hospital in Northern Nigeria

Abstract: Background : There are concerns about the rational use of corticosteroids in asthma as they are associated with serious adverse drug reactions, abuse and are rarely evaluated in clinical settings. Objectives: The study set out to evaluate the drug utilization parameters of corticosteroids in the management of chronic asthma in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Method : A Retrospective study employing structured data collection form to obtain data from randomly selected folders of 120 asthmatic out-patients in a tertiary health care facility between July 2011 and June 2012. Prescribing, facility and complimentary drug use indicators were analyzed using descriptive and Chi-Square statistics. Results : Females accounted for 80% of study population, mainly housewives (51.6%). While 59.1% were aged 21-50 years. Mean number of drugs per prescription was 4.46±0.098. Generic prescriptions were 45.5% while antibiotics and injections were 30% and 28.4% respectively. The medications most utilized include inhaled Fluticasone/Salmeterol fixed combination in 71% and inhaled Salbutamol in 77.7% of patients respectively. Oral corticosteroid (prednisolone) was used in 25% of patient. The average cost per prescription was N5080 ($31). There was no significant association between severity of asthma and use of inhalational steroids (Chi-Square P>0.05), in contrast to a statistically significant difference (P=0.01) in use of oral corticosteroids. Conclusion : Sub maximal utilization of steroids in asthmatics as inhalational therapy was observed. Recommendations on the use of therapy that suit local conditions with respect to cost will promote adherence and ultimately improve rational drug use and outcomes in patients Key words : Steroid Utilization, Chronic Asthma, Fluticasone/Salmeterol, Salbutamol

CYP2D6*17 polymorphism and tardive dyskinesia in black psychotic patients on typical antipsychotics

Abstract: Background: Tardive dyskinesia is a debilitating, intractable, hyperkinetic movement disorder which contributes to an increase in psychiatric morbidity. Reduced function CYP2D6 alleles have been associated with tardive dyskinesia pathogenesis amongst Caucasians and Asians, with CYP2D*4 and *6 and CYP2D6*10 being implicated in these races respectively. No similar study has been successfully conducted in black Africans. Objective: To determine the relationship between tardive dyskinesia and CYP2D6*17 (the major reduced function CYP2D6 allele in Africans). Methodology: Abnormal Involuntary Movements Scale (AIMS) scoring and CYP2D6 genotyping were carried out on psychiatric patients exposed to typical antipsychotic medications in an unmatched case control study. A case of tardive dyskinesia was defined as a patient with an AIMS score ≥ 2 in two body areas OR ≥ 3 in one body area Results: A total of 18 cases and 32 controls made up the study sample.The sample’s mean age was 36.9±12.0 years with median treatment duration of 7.0 years (range: 0.25 to 38 years). Multiple logistic regression revealed no significant association between tardive dyskinesia and CYP2D6*17 (OR=0.252; 95% CI: 0.038 to 1.647; p=0.150). However, use of chlorpromazine (OR=5.754; 95% CI: 1.024 to 32.328; p=0.047) and age at treatment initiation (OR=1.146; 95% CI: 1.021 to 1.287; p=0.021) were independent predictors of tardive dyskinesia. Discussion: These findings suggest that there is no association between CYP2D6*17 and tardive dyskinesia in African psychotic patients on typical antipsychotics. However, more studies with larger sample sizes are required to provide more definitive conclusions regarding the nature of the relationship betweenCYP2D6*17 and tardive dyskinesia. Key words: Tardive dyskinesia, CYP2D*17, typical antipsychotics

Development of immunoassays for detection of Human Immunodeficiency Virus based on Consensus env gp41 Immunodominant Region Peptide from HIV-1 infections in Kenya

Abstract: Background : Human Immunodeficiency Virus (HIV) is characterized by high rates of genetic variability in vivo that could affect the performance of the HIV antibody-based detection kits. Objective : This study aimed at developing immunoassays for HIV based on Consensus env gp41 Immunodominant region (IDR) from HIV infections in Kenya. Methods : HIV RNA was extracted from 91 samples collected from 5 regional blood transfusion centers in Kenya. The RNA was reverse transcribed, sequenced in the env gp41-Immunodominant Region (IDR) and the Consensus sequence generated used to synthesize corresponding peptide. The Global HIV env gp41-IDR Consensus peptide was obtained from the literature and also synthesized. The two peptides were used to separately develop HIV immunoassays based on Enzyme-linked Immunosorbent Assay (ELISA) and Lateral Flow Assay (LFA) platforms and the performance of developed assays was evaluated. The same HIV env gp41 IDR peptides were used to develop ELISA-based immunoassays for determination HIV Incidence / Recency. Results : The study did not find significant difference between the performance of the immunoassays that were developed with Consensus env gp41-IDR peptide (Kenya) and those developed using Consensus env gp41-IDR peptide (Global). However, the study found a significant difference between the performance of HIV ELISA for HIV Incidence testing that was developed with Consensus env gp41-IDR peptide (Kenya) and that which was developed using Consensus env gp41-IDR peptide (Global) with the former displaying superior performance. Conclusions : The developed immunoassays demonstrated that both Consensus env gp41-IDR peptides (Kenya and Global) could be used to develop HIV immunoassays but Consensus env gp41-IDR peptide (Kenya) could be more suitable for development of HIV Incidence assays in Kenya. Keywords: HIV, Consensus sequence, env gp41-Immunodominant Region, Immunoassays

Patterns and Risk Factors for Alanine Aminotransferase Elevation among HIV Patients on Nevirapine Regimens

Abstract: Results : Risk factors for ALT elevation differed by gender. Predictor variables that were significantly associated with ALT elevation in both sexes included; elevated baseline ALT level [β=10.14 (95%CI 7.34- 12.96); P<0.001], [β=13.52 (95%CI 9.36 –17.68); P < 0.001] and renal disease [β=5.44 (95%CI 2.62 – 8.25); P <0.001], [β=11.52 (95%CI 3.46 – 19.60); P = 0.005] in females and males respectively. Ethnicity had a protective effect in both sexes; [β-6.61(95%CI9.28, -3.93); P< 0.001] in males and [β-1.20 (95% CI-2.39, -0.01); P= 0.048] in females. Among the different ethnic groups, Nilotes and Cushites had lower ALT levels compared to Bantus. Other factors that were significant included; smoking (P=0.001), concurrent illnesses (P=0.045), previous adverse drug reactions (P=0.040) in females and a longer duration of anti-retroviral therapy [β 1.81(95%CI 0.89 – 2.73); P < 0.001] in males. Poor adherence had a protective effect [β -1.62(95%CI -3.20, -0.04); P=0.045] among females, whereas initiation on AZT+3TC+NVP had a significant protective effect [β-7.80 (95%CI -13.96, -1.63); P=0.013] in males. Conclusion: Creatinine and transaminase testing should be done routinely to deal with delayed hepatotoxicity in patients with abnormal ALT baseline levels.

Toxicological Assessment of Co-treatment with Rifampicin and Tenofovir on Serum Electrolytes and Kidney Histology of Albino Rats

Abstract: Background: Tenofovir and rifampicin have been individually implicated in renal toxicity characterized by electrolytes imbalance; hence concurrent use in human immunodeficiency virus/tuberculosis co-infection might induced synergistic electrolytes imbalance and kidney damage. Objectives : This study comparatively evaluated the effects of treatment with tenofovir, rifampicin and a combination of tenofovir-rifampicin on serum electrolytes levels and kidney histology of male albino rats. Methodology: Healthy adult male albino rats used for this study were divided into five (5) groups of sixteen animals (16) each. Animals in group A (placebo control) were treated orally with water while animals in group B (solvent control) were treated orally with arachis oil. Animals in groups C-E were treated orally with 80mg/kg of rifampicin, 32 mg/kg of tenofovir and tenofovir-rifampicin combination for 1-8 weeks respectively. At the end of drug therapy the animals were sacrificed and blood samples collected. Serum was extracted from the blood samples and analyzed for chloride, sodium, calcium, potassium and bicarbonate levels. Animals were dissected, kidney collected and analyzed for histopathological changes. Results : Treatment with a combination of tenofovir-rifampicin for 1-8 weeks did not produce significant ( p> 0.05) time-dependent effects on serum electrolytes when compared to treatment using individual doses of these agents. Kidneys of animals treated with these agents showed tubular necrosis, collapsed glomerular and collection of fibrous material on bowman’s space. Discussion and Conclusion : Treatment with a combination of tenofovir-rifampicin did not produce synergistic effects on serum electrolytes and kidney damage. The use of tenofovir – rifampicin combination in human immunodeficiency virus/tuberculosis co-infection may not be associated with electrolytes imbalance and kidney damage considering the dose level used for this study. Keywords: Tenofovir, Rifampicin, Toxicity, Electrolytes, Kidney, Rats

Anti-inflammatory and Antinociceptive Effects of the Methanol Extract of Indigofera arrecta Hochst-Holl. in Rodents

Abstract: Background: Indigofera arrecta (Hoscht-Holl) is used traditionally in Nigeria for treating conditions associated with pain and inflammation. Based on the traditional use of the plant for the management of pain and inflammation, the present study was designed to evaluate scientifically the anti-inflammatory and analgesic activities of whole plant parts of Indigofera arrecta so as to generate data that could support such traditional applications. To the best of our knowledge, no similar studies on Indigofera arrecta have been undertaken previously. Objectives: To experimentally demonstrate the anti-inflammatory and analgesic effects of the whole plant parts of Indigofera arrecta . Methodology: The extract of I . arrecta was screened for the presence of phytochemicals. The methanol extract of the plant was tested orally for acute toxicity effect (median lethal dose; LD 50 ) at doses between 10 mg/kg and 5000 mg/kg. Similarly, the extract at 100, 400 and 1000 mg/kg was evaluated in vivo for anti-inflammatory and analgesic properties in rodent models. Results: Carbohydrates, cardiac glycosides, flavonoids, glycosides, saponins, steroids and triterpenes and tannins were detected in the extract. The extract is relatively safe when administered orally to rats with a median lethal dose (LD 50 ) of ≥ 5000 mg/kg. The plant exhibited significant (p< 0.05) in vivo anti-inflammatory and analgesic effects at all the tested doses. However, at 100 mg/kg, the extract did not produce significant effect against thermal-induced pain. Discussion: Phytochemical study showed the presence of flavonoids, glycosides, tannins, steroids and triterpenes in the extracts of Indigofera arrecta . One or more of these constituents either singly or in combination may be responsible for the pharmacological action of the plant. Flavonoids and phenolic compounds have been reported to have multiple biological effects such as antioxidant, analgesic, anti-inflammatory actions, inhibition of platelet aggregation, inhibition of mast cell histamine release and inhibitory actions on arachidonic acid metabolism as demonstrated by in vitro and in vivo tests. Flavonoids have been documented to have anti-inflammatory and analgesic effects. The analgesic and anti-inflammatory effects of steroids and tannins have also been reported. Key words: Indigofera arrecta , Methanol extract, Antinociceptive, Analgesic, Median lethal dose