Showing papers in "The African Journal of Pharmacology and Therapeutics in 2017"

Anticonvulsant activity of methanol stem bark extract of Boswellia dalzielii Hutch. (Burseraceae) in mice and chicks

Abstract: Background: Boswellia dalzielii is a widely used medicinal plant in African traditional medicine. The efficacy of its stem bark extract in management of convulsions is well acclaimed among communities of Northern Nigeria. Objective: To evaluate the anticonvulsant potentials of methanol stem bark extract of Boswellia dalzielii in mice and chicks. Methodology: Phytochemical screening, elemental analysis and acute toxicity studies was carried out. The extract was evaluated for anticonvulsant activity against electrically-induced seizures in chicks and against pentylenetetrazole, strychnine, picrotoxin and 4-aminopyridine-induced seizures in mice at doses of 20, 40 and 80 mg/kg. Results: The intraperitoneal LD 50 was estimated to be 280 and 570 mg/kg in mice and chicks respectively. The extract at 20 mg/kg provided 40% protection and significantly (p<0.05) increased the mean onset of seizure in MEST. A dose-dependent and significant (p<0.05) increase in the mean onsets of pentylenetetrazole and strychnine-induced seizures were produced by the extract at 80 mg/kg. Similarly, a dose-dependent and significant increase (p<0.05 and p<0.01) in latency to picrotoxin-induced convulsions was observed at 40 and 80 mg/kg respectively. Conclusion: These findings suggests the methanol stem bark extract of Boswellia dalzielii possesses anticonvulsant activities and thus supports the ethnomedical rationale for its use against convulsions. Keywords: Anticonvulsant, Boswellia dalzielii , Epilepsy, Pentylenetetrazole, Picrotoxin

In vitro antileishmanial activity and phytochemical analysis of Carissa edulis against Leishmania major

Abstract: Background: However, there is need to carry out scientific studies in order to confirm the medicinal properties of many plants used traditionally. Carissa edulis Forskk. (Gentiales: Apocynaceae) used by local communities for the treatment of various diseases has showed antiviral, antibacterial and antiprotozoal properties although there are no studies demonstrating its antileishmanial activity. Objective: To investigate in vitro antileishmanial activity of extracts of Carissa edulis on promastigote and amastigote forms of Leishmania major . Methodology: Solvent extraction of the stem parts of C. edulis was performed using water, methanol, petroleum ether, dichloromethane and ethyl acetate. Minimum inhibitory concentration (MIC), anti-amastigote and nitric oxide production assays were carried out to demonstrate antileishmanial activity of C. edulis extracts against the two forms of L. major parasite species: promastigote and amastigote. The extracts were also screened for phytochemical constituents present. Cytotoxicity assay was then done to assess their safe use as herbal medicinal products. Results: The C. edulis petroleum ether extract showed the strongest antileishmanial activity against L. major promastigotes (MIC=625μg/ml) with the water, dichloromethane and ethyl acetate extracts recording the weakest activity (MIC=2500μg/ml). The successive methanol extract reduced the number L. major amastigotes by 88.29% compared to the negative control (RPMI). The water (13.37μM), petroleum ether (12.93μM) and successive methanol extracts (12.82μM) produced nitrite values lower than the standard drugs Pentostam ® (14.35μM) and Amphotericin B (14.13μM). Discussion: All C. edulis extracts have potential antileishmanial activity against L. major . Preliminary phytochemical screening of these extracts showed presence of alkaloids, terpenoids, phenols, anthraquinones and saponins. These phytochemicals were previously reported to have antileishmanial activity. Therefore, the plant extracts could offer an opportunity to develop cheaper antileishmanial alternatives to the more expensive pentavalent antimonials. Key words : C. edulis , L. major , promastigote, amastigote

Prevalence and Risk Factors for Medication Discrepancies on Admission of Elderly Diabetics at Kenyatta National Hospital, Kenya

Abstract: Background: Medications discrepancies are defined as the variations in drug regimens during transition from one health care worker or hospital to another. The elderly diabetic patients are at risk of medication discrepancies due to their multiple comorbidities resulting in different medications from the many healthcare providers they are likely to see and physiological changes as a result of advanced age; hence the need for medication reconciliation. Objectives: The main objective of the study was to measure the prevalence and identify risk factors for medication discrepancies at admission of inpatient elderly diabetics at Kenyatta National Hospital (KNH). Methods: The study design was cross sectional descriptive study in which patients aged 60 years and above were recruited at the time of admission at the medical wards in 2016. Convenient sampling was conducted. A comparison of the medication used before and after admission was done to determine the number of discrepancies if any. Admitting clinicians were interviewed to determine if discrepancies were intentional or not. Linear regression was conducted to determine risk factors for the number of errors per patient. Results: Among the 163 patients recruited, 1089 medication discrepancies were identified, 63.2% of the patients had at least one unintentional discrepancy. The number of unintentional discrepancies per patient was 1.5 per patient. The most common discrepancy was omissions 236 (98.3%). Independent risk factors for discrepancies were the number of medications prior to admission (adjusted β coefficient 1.377 (95% CI: 0.767, 1.987)), hypertension (β 0.992 (95% CI: 0.094, 1.890)) and those with discharge forms from other facilities (β 0.701 (95% CI: 0.010, 1.392)). Age had a negative association with medication discrepancies (β -0.755 (95% CI: -1.284, -0.226)). Conclusion: The prevalence of medication discrepancies was high hence the need for medication reconciliation to reduce these discrepancies. Key words : Medication Reconciliation, Unintentional discrepancies, Diabetes, Elderly diabetics

Antioxidant and anti-inflammatory activities of selected medicinal plants from western Kenya

Abstract: Background: Globally, the increase in the burden of diseases related to oxidative damage and inflammation, coupled with the high cost of medication and the side effects of these therapies necessitates a need for more effective, affordable and safer remedies. Thus there still exists a demand for new antioxidant and anti-inflammatory agents. Objectives: To screen selected medicinal plants from Kakamega County for their antioxidant and anti-inflammatory activities. Methodology: Seven medicinal plants used to treat ailments related to oxidative damage and inflammation were selected and extraction was carried out using methanol. Antioxidant activity was screened using 2, 2-diphenyl-1-picrylhydrazyl assay while carrageenan induced rat paw edema assay was used to screen for their anti-inflammatory activity. Results: The methanolic leaf extracts of Rhus vulgaris and Phyllanthus fischeri displayed good antioxidant activity with percentage inhibition of 71.4% and 66.7 % respectively. Furthermore, the methanolic leaf extract of Rhus vulgaris displayed significant anti-inflammatory activity while Phyllanthus fischeri had mild activity. Results were considered to be statistically significant when (P <0.05). Conclusion: These results support the use of Rhus vulgaris and Phyllanthus fischeri in traditional medicine to remedy oxidative damage and inflammatory related diseases. These two plants are potential sources of natural antioxidant and anti-inflammatory agents. Key words : Medicinal plants, Kakamega County, Antioxidant, Anti-inflammatory

One-day out-patient prescribing patterns at a national referral hospital in Kenya

Abstract: Background : Poor prescribing habits lead to ineffective and unsafe treatment for patients, exacerbating or prolonging of illness as well as causing distress and harm to them. Drug utilization studies can help identifying gaps in prescribing and feed the results back to prescribers to enhance future rational use of medicines. Objective : Evaluate outpatient prescribing practices and patterns in a leading national Hospital in Kenya. Methods : A sample of 60 prescriptions was selected by quasi-random sampling. Data was abstracted using a pre-designed data collection form, entered into and analyzed using Excel software. Results : The average number of drugs prescribed per prescription was three with a polypharmacy rate (>4 drugs) of 20%. Only two-thirds (65%) of the prescribed drugs were actually dispensed at the hospital pharmacy due to shortages, principally shortages of originators. Slightly more than half (52%) of the drugs were prescribed by generic name. Prescribing by brand names was highest among medical interns (61%). Almost all drugs prescribed (95%) were consistent with the hospital tender list. Conclusions : There is a need to increase the rate of prescribing of generics to save costs as well as reduce stock-out levels. This can be helped by instigating a comprehensive generics policy. There is also a need to strengthen and empower drugs and therapeutic committees (DTCs) to improve selection and availability of quality generics to win the confidence of prescribers. Keywords : Drug utilisation studies, generics, prescribing patterns, prescribing indicators, polypharmacy, WHO indicators, Kenya

Ethyl linalool and diethyl phthalate from Pycnanthus angolensis (Welw.) Warb.

Abstract: Background : Pycnanthus angolensis (Welw.) Warb . belongs to the family, Myristiceae. Extracts of the plant are used in African ethno-medicine to treat diabetes, lumbago, wounds, arthritis, anemia, mouth-thrush, scabies, infertility and skin-fungal infections amongst many others. Flavonoids, terpenes, fatty acid derivatives and quinones had previously been isolated from different organs of the plant. Before now, very scanty literature exits on organic fractions from where specific compounds had been obtained. Objectives : To study the chemical and biological parameters of the ethyl acetate fraction obtained fractionation of crude ethanol extract of the leaves of Pycnanthus angolensis . Methodology: The leaves were to be extracted cold with 50 % ethanol and the obtained aqueous crude extract partitioned with ethyl acetate. Furthermore, the ethyl acetate fraction was to be subjected to silica gel column chromatography and the isolated compounds screened for both antibacterial and antifungal activities using the microbes namely, Staphylococcus aureus , Escherichia coli and Candida albicans . Results: Two isolates coded NG-2 (pale yellow compound; 62 mg; R f . (0.53); [α] D 20 (+3o); [n] D 20 (1.4009) and NG-4c (off-white compound; 36 mg, R f (0.24); [α] D 20 (0o); [n] D 20 (1.5006) whose identities have been revealed to be 3-ethoxy-3, 7-dimethyl-1, 6-octadiene (ethyl linalool) and diethyl phthalate (1, 2-benzenedicarboxylic acid diethyl ester) respectively using the MS and IR spectral techniques. Both NG-2 and NG-4c were strongly bacteriostatic against E. coli , but recorded no activity against S. aureus and C. albicans . Conclusion: The isolation of the two compounds is being reported for the first time from the ethyl acetate fraction of the plant. Hence, NG-2 and NG-4c would serve as chemotaxonomic markers for this species and the genus, Pycnanthus in general. Keywords : Pycnanthus angolensis; fraction; ethyl linalool; diethyl phthalate: antimicrobial

Evaluation of malaria rapid diagnostic tests among children in a malaria endemic region in coastal Kenya

Abstract: Background: In Kenya, malaria case management is based on clinical suspicion and detection of parasite in blood by parasitological or confirmatory diagnosis. Confirmatory diagnosis can be achieved with either microscopy or Rapid diagnostic tests (RDTs). RDTs are relatively new technologies, and their performance in actual conditions of use needs to be evaluated to provide information for appropriate use and to support decision making in procurement. Objectives: To evaluate performance and operational characteristics of three malaria RDTs: CareStart™, First Response®, and SD Bioline™ in the field for diagnosis of infection by Plasmodium falciparum monospecies as well as mixed infections with P. ovale and P. malariae . Methodology: A prospective study with blind comparisons to a gold standard was carried out at Pingilikani dispensary in Kilifi County, Kenya. Blood samples were obtained from 500 febrile children. Three RDTs: CareStart™, First Response® and SD Bioline™ were evaluated against microscopy of Giemsa stained blood films for detection of Plasmodium falciparum and non-falciparum malarial parasites. RDTs specific for P. falciparum only (HRP2 RDTs) and non-falciparum malarial parasites (HRP2/pLDH (Pf/pan) RDTs) were evaluated. Results: Plasmodium sp were detected by microscopy in 242 (48.40%) study participants. Plasmodium falciparum species were the most prevalent (93.3%) in comparison with other Plasmodium species: P. ovale and P. malariae whose prevalence were 2.89% and 3.71% respectively. Compared to microscopy the sensitivities of CareStart™, SD Bioline™, and First Response® RDTs for Plasmodium falciparum using Pf (mono species) kits were: 95.04% (95% CI: 92.34 - 97.73), 95.04% (95% CI: 92.34 - 97.73) and 94.21% (95% CI: 91.3 - 97.11) respectively while the specificities were 78.12% (95% CI: 72.98 - 83.25), 81.10% (95% CI: 76.23 - 85.96) and 78.74% (95% CI: 73.65 - 83.82) respectively. Sensitivities of CareStart™, SD Bioline™ and First Response® RDTs for Plasmodium falciparum using Pf/Pan kits were: 99.02% (95% CI: 98.92 - 99.15), 99.04% (95% CI: 98.92 – 99.15) and 97.56% (95% CI: 97.78 – 97.99), respectively while the specificities were 78.46% (95% CI: 77.61 - 79.30), 78.46% (95% CI: 75.78 - 81.13) and 80.28% (95% CI: 76.73 - 83.82) respectively. CareStart™, SD Bioline™, and First Response® RDTs for non-falciparum sp using Pf/Pan kits both had 100% sensitivity and specificity. Conclusion: Data from this study demonstrate that CareStart™, SD Bioline™ and First Response® RDTs have good operational characteristics and are reliable alternatives to microscopy for diagnosing malaria in children. Key words: malaria, rapid diagnostic tests, microscopy, Plasmodium

Predictors of Adequate Ambulatory Anticoagulation among Adult Patients in a Tertiary Teaching and Referral Hospital in Kenya

Abstract: Background : Local anticoagulation services are inadequate and substantially underutilized despite compelling evidence showing that their appropriate use significantly reduces the risk of thromboembolic complications. Objectives : To determine the predictors of adequate ambulatory anticoagulation services in Kenyatta National Hospital. Methodology : A cross sectional study between December 2014 and April 2015 among 102 adult outpatients on anticoagulation using consecutive sampling was done. Information abstracted into a predesigned data collection tool included participants’ sociodemographic characteristics, regular sources of supply of anticoagulant, clinic pre-appointment reminders, indications of treatment and international normalized ratio tests. Data were analyzed using IBM Statistical Package for Social Sciences version 21.0 and logistic regression was used to determine independent predictors of adequate anticoagulation, which was defined as international normalized ratio ranging 2 - 3. Results : Females were majority (76.5 %) and only 27.5 % of patients had adequate anticoagulation control. The indication of warfarin for heart valve surgery (p=0.014) and deep venous thrombosis (p=0.021) were associated with adequate anticoagulation. Age above 60 years was associated with poor anticoagulation (p=0.006). Logistic regression revealed that the independent predictor of adequate anticoagulation was warfarin use due to heart valve surgery (OR=3.1; 95% CI: 1.2 – 7.9, p=0.017). Conclusions: Ambulatory anticoagulation control in the hospital is poor. Further investigation is required to find out the reasons behind adequate anticoagulation in heart valve surgery patients. Key Words : Ambulatory anticoagulation, anticoagulant, outpatient, international normalized ratio tests.

Evaluation of Methanol Stem-bark Extract of Ximenia americana Linn (Olacaceae) for Phytoconstituents and Gastroprotection in Rats

Abstract: Background: The Hausa/Fulanis in northern Nigeria and other tribal-communities use different part s of Ximenia americana for several ailments such as malaria, infectious diseases, fever and constipation with the stem-bark used for gastric ulcers. The plant is one of eight species of Olacaceae family that grows mostly in the tropical countries and has common names as sour or monkey plum, known in the Northern part of Nigeria as ‘Tsada’ , in Eastern part as ‘Anya Nwona’ and in Western part as ‘Igo’. The study was an attempt to validate the purported ethnomedicinal use of the stem-bark of the plant in gastric ulcer. Objective: This study investigated the phytochemical constituents of stem-bark extract and its gastro-protective potential. Methods: Lorke’s acute toxicity-test for oral median lethal-dose (LD 50 ) estimation and preliminary phytochemical screening were conducted. The antiulcer effect was evaluated on indomethacin and ethanol induced ulcer-models using Wistar rats in two sets of 5-groups of 5 each, starved for 24h. Oral body-weight normal saline(1ml/kg), standard-drug (100mg/kg cimetidine or misoprostol) for the respective models and extract-doses (250, 500 and 1000mg/kg) administered for 30 minutes prior to body-weight 6h indomethacin ulceration or 1h absolute-ethanol(1ml) were used. Lesions and larger-diameter (≥3mm) ulcer-spots in isolated-stomachs of euthanized-rats were counted. Results : The extract contained alkaloids, anthraquinones, carbohydrates, flavonoids, saponins, steroidal-glycosides, tannins and terpenoids and significantly ( p≤0.05 ) and dose-dependently reduced mean ulcer-spots as with cimetidine and misoprostol. Reduction was significant only for 500 and 1000mg/kg extract-doses. Nine severe ulcer-spots in normal-control rats against 3 in 250 and 500mg/kg groups and none in the 1000mg/kg or cimetidine occurred with indomethacin ulcerogen. Severe ulcer-spots were not found with ethanol-ulcerogen even in normal-control rats. Conclusion: This study therefore, supported the folkloric use of Ximenia americana stembark in ulcer management. Keywords : Ximenia americana , gastric-ulcer, indomethacin, ethanol, anti-ulcer, gastroprotection

Anticonvulsant activity of methanol leaf extract of Celtis integrifolia Lam (Ulmaceae) in chicks and mice

Abstract: Background : Celtis integrifolia commonly known as (African Hackberry) and locally called Zuwo in Hausa, is a medicinal plant whose root, leaves and bark are used in northern Nigeria in the treatment epilepsy. Objective : The study evaluated the anticonvulsant activity of the methanol leaf extract of Celtis integrifolia in chicks and mice. Methodology : Preliminary phytochemical screening and acute toxicity studies were carried out. The anticonvulsant activity of methanol leaf extract of Celtis integrifolia (200, 400 and 800 mg/kg, intraperitoneally) was assessed using maximal electroshock seizure test in chicks, pentylenetetrazole, 4-aminopyridine and strychnine tests in mice. Results : Alkaloids, saponins, flavonoids, tannins and glycosides were detected in Celtis integrifolia , while the interperitoneal median lethal dose was estimated to be 2,154 mg/kg in mice. The methanol leaf extract of Celtis integrifolia significantly ( p < 0.01) delayed onset of seizure induced by MES and provided 20.0% protection to chicks at 200 mg/kg dose. The onset of seizure behavior and latency to death was significantly ( p < 0.01) increased by the extract, while 16.7 and 33.3% protection (200 and 400 mg/kg, respectively) was conferred to mice against pentylenetetrazole induced seizure. The extract at the dose of 200 mg/kg protected 50.0% of mice against 4-Aminopyridine induced seizure and significantly ( p < 0.01) delayed onset of seizure behavior. The extract did not show any activity in the strychnine induced seizure model. Conclusion: The study shows that Celtis integrifolia methanol leaf extract possess anticonvulsant activity, thus lending credence to the ethnomedicinal claim for the use of the plant in the management of epilepsy. Keywords : Celtis integrifolia , anticonvulsant, maximal electroshock seizure, pentylenetetrazole, 4-aminopyridine

Antioxidant activity of compounds isolated from the butanol fraction of Acalypha wilkesiana var. golden-yellow (Muell & Arg.)

Abstract: Background : Free radicals (FR) and other reactive oxygen species (ROS) are major sources of concern in some health conditions such as wounds, ulcers, inflammations, heart troubles and cancers amongst many others. These chemical species have been implicated as the causative agents of these and many more similar disease conditions. The cost of treating / managing these medical conditions has continued to take a huge toll on the socio-economic status of sufferers/patients. Many bio-resources such as plants are now being used to mitigate this worrisome health challenge. Objective : To investigate the antioxidant activity of Acalypha wilkesiana var. golden-yellow ( Muell & Arg.) syn. A. wilkesiana var. tropical tempest . Methods : The leaf crude extract, butanol fraction and three isolates (W-1, W-2 and W-3 previously obtained from the silica-gel column chromatographic separation of the butanol fraction) were to be screened for antioxidant activities using the rapid free-radical scavenging activity test and absorption spectrophotometry, both employing DPPH reagent. Results: The initial free-radical scavenging activity of the plant was confirmed when the DPPH reagent-sprayed spots of the plant extract/fraction/isolates (W-1, W-2 and W-3) showed white color on purple background. W-1 (an ester) gave a marginal IC 50 of 0.77 μg mL -1 as vitamin A at 0.79 μg mL -1 while W-2 (a diol) and W-3 (phenol) both demonstrated moderate antioxidant activities of 0.58 and 0.53 μg mL -1 respectively. However, W-3 was more antioxidant in its action and its value compare favorably with IC 50 value obtained with vitamin C (a standard antioxidant drug) at 0.41μg mL -1 . Conclusion : The results of the antioxidant assays have showed that the compounds obtained from the plant (especially W-2 and W-3) could be considered as lead antioxidant drug templates in further in-vitro [especially structural activity relationship studies (SARS)] and in-vivo studies with the aim of improving on their activities. Keywords : Free- radicals; antioxidant activity; DPPH assay; isolates; Acalypha wilkesiana var.golden-yellow

Evaluation of hepatoprotective activity of methanol stem bark extract of Haematostaphis barteri Hook. F. against paracetamol and carbon tetrachloride-induced liver injury in rats

Abstract: Background: The ethnomedical uses of Haematostaphis barteri commonly known as blood plum has been documented in literature. The efficacy of its stem bark extract in management of liver diseases is well acclaimed among communities of Northern Nigeria. Objective: To evaluate the hepatoprotective activity of methanol stem bark extract of Haematostaphis barteri against paracetamol and carbon tetrachloride (CCl 4 )-induced hepatotoxicity in Wistar rats. Methodology: Phytochemical and acute toxicity studies were carried out. Liver damage was induced in different groups of Wistar rats using paracetamol (3 g/kg) and 1 ml/kg of CCl 4 (1:1 in olive oil). The effect of Haematostaphis barteri extract was tested for hepatoprotective activity by evaluating serum biochemical parameters and liver histology. The extract was also tested for antioxidant activity using in-vitro DPPH free radical scavenging method. Results: Phytochemicals present include tannins, sterols, alkaloids, saponins, triterpenes, flavonoids and anthraquinones. Oral median lethal dose was estimated to be >5000 mg/kg. Pre-treatment with the extract (250, 500 and 1000 mg/kg) significantly ( p <0.05) reduced alanine aminotransferase and alkaline phosphatase levels compared to paracetamol and CCl 4 toxic groups respectively. These results were supported by the protection against hepatocellular necrosis in the extract treated groups as well as the DPPH radical scavenging activity. Conclusion: The results obtained suggest the stem bark extract of Haematostaphis barteri possesses hepatoprotective activity. Keywords: Haematostaphis barteri, Hepatoprotective, Paracetamol, Carbon tetrachloride

Acute toxicity and antihyperglycaemic effect of ethanol stem-bark extract of Annona senegalensis Pers. (Annonaceae) on alloxan induced diabetic rats

Abstract: Background: Diabetes is a common and very prevalent disease affecting the citizens of both developed and developing countries. Many oral hypoglycaemic agents available for the treatment have significant side effects and sometimes are found to be ineffective in chronic diabetic patients. Objective : To study the acute toxicity and effect of the ethanol stem-bark extract of Annona senegalensis on blood glucose in alloxan-induced diabetic rats. Material and Methods : Hypoglycaemic effect of the extract was studied in normal rats using oral glucose tolerance test and in alloxan-induced diabetic rats. Effects of 100, 200 and 300 mg/kg, i.p of ethanol stem-bark extract of Annona senegalensis , and glibenclamide (5 mg/kg, i.p) were studied on blood glucose. Results : The median lethal dose of the extract was found to be 1131.4 mg/kg by intraperitoneal route. In the normal rats (OGTT), from basal to 0 min, the extract did not show significant reduction in the fasting serum glucose level. However, the extract at 300 mg/kg and glibenclamide (5 mg/kg) significantly (p≤ 0.05) prevented glucose induced hyperglycemia at 30 to 90 min as compared to normal control. In the alloxan-induced diabetic rats, 100, 200 and 300 mg/kg of the extract produced significant (p≤0.05) reduction in blood glucose levels. Maximum effect was observed with the 300 mg/kg dose of stem-bark of Annona senegalensis . Conclusion : The results showed that the ethanol extract of the stem bark of the plant possessed antihyperglycaemic activity. Key Words : Hypoglacaemic effect, Annona senegalensis , diabetes mellitus, glibenclamide.

Analgesic and Anti-inflammatory Activities of the Residual Aqueous Fraction of Carissa edulis Root Bark (Vahl) in Experimental Animals

Abstract: Background : Carissa edulis is a spiny evergreen shrub that may reach a height of 5 feet and an equal breadth. The bark is grey and smooth with straight woody double-pronged spine often in pairs. The plant is a native of South Africa. It grows in tropical African region and Arabia. It has been used in the traditional treatment of malaria, headache, glandular inflammation, rheumatism and chest complaints among others for many years and their efficacy is widely acclaimed among the Hausa communities of northern Nigeria. Hence, there need for verification of these folkloric claims. Objectives : The current study aimed at evaluating the analgesic and anti-inflammatory activities of the residual aqueous fraction of the ethanol root bark extract of C edulis in mice and rat models. Methodology : Acetic acid-induced writhing and tail immersion test in mice were used to assess analgesic properties, while anti-inflammatory effect was tested using carrageenan-induced paw oedema in rats. Results: The fraction (150, 300 and 600 mg/kg) and standard drugs significantly (p<0.05) reduced the number of writhes and prolonged the pain reaction time, in acetic acid-induced writhing and tail immersion models respectively. Similarly, the fraction (300 and 600 mg/kg) and ketoprofen (10 mg/kg) exhibited significant (p<0.05) decrease in the paw oedema at 1, 2, 3 and 4 hour intervals, while at 150 mg/kg, the decrease was significant at only third hour. Discussion : The study has shown that the residual aqueous fraction of C. edulis possesses analgesic and anti-inflammatory activity, thus, justified the traditional use of the plant in pain and inflammatory conditions. Keywords : Carissa edulis, writhes, inflammation, analgesic, fraction

Hepatoprotective and nephroprotective activities of Solenostemon monostachyus P. Beauv (Lamiaceae) leaf extract

Abstract: Background: Solenostemon monostachyus P. Beauv (family Lamiaceae), a medicinal herb in West and Central Africa, is ethnomedically employed as an antidote for poison and for the treatment of different diseases and ailments. Objective: To investigate the hepatoprotective and renoprotective effects of S. monostachyus leaf extract against paracetamol- induced liver and kidney injuries in rats. Methodology: Hepato-renoprotective effects of S. monostachyus ethanol leaf extract was evaluated against paracetamol- induced liver and kidney injuries in rats. The liver protective property of the ethanol leaf extract (75-225 mg/kg) was investigated by the assessment of liver function parameters, liver antioxidant enzymes and histopathology, while the renoprotective property was evaluated by the assessment of some kidney function parameters, kidney antioxidant enzymes and histopathology. Silymarin (100mg/kg) was used as positive control. Results : The leaf extract exerted significant (p<0.05 – 0.001) dose-dependent decreases in elevated levels of liver enzymes (ALT, AST and ALP), total cholesterol, direct and total bilirubin as well as increases in serum levels of total protein, albumin and antioxidant enzymes (SOD, CAT, GPx) and GSH. Histopathological study of the liver sections of extract and silymarin-treated rats revealed reductions in the pathological features compared to the paracetamol- treated animals. Leaf extract pre-treatment also resulted in significant (p<0.05) dose-dependent decreases in increased levels of serum creatinine and urea without affecting the electrolytes levels. Histopathology of the kidney sections of extract and silymarin- treated rats showed decreases in the pathological features compared to the control group. The chemical pathological results in both liver and kidney agreed with histopathological observations indicating pronouced hepatoprotective and renoprotective effect of the leaf extract of S. monostachyus. Conclusion: The results of this study demonstrate that the leaf extract of S. monostachyus has the potentials to protect the liver and kidney against injury which may be due to its antioxidant activity of its constituents and this can be employed in the management of liver and kidney diseases. Keywords: Solenostemon monostachyus , medicinal plant, hepatoprotective, renoprotective, antioxidant.

Immune-mediated Anti-inflammatory Activity of Root Bark Extracts of Calotropis procera (Ait) R.Br. in Rodents

Abstract: Background : The root bark of Calotropis procera has been reported to be a part of herbal remedies for the management of allergic diseases like asthma. However, there is paucity of data on its anti-inflammatory activity in allergic disorders. Objectives : This study is aimed to investigate the immune mediated anti-inflammatory activity of root bark extracts of Calotropis procera in rats. Materials and Methods : Aqueous and methanol root bark extracts of Calotropis Procera were subjected to preliminary phytochemical screening and their oral median lethal doses were estimated in rats. The aqueous and methanol root bark extracts were investigated for anti-allergic activity using carageenan-induced leucocytosis (100 and 200 mg/kg doses) and egg albumin induced passive paw anaphylaxis (250 and 350 mg/kg doses) test in rats. Results : The oral median lethal doses of both extracts were found to be greater than 5000 mg/kg in wistar rats. Both extracts were found to contain alkaloids, flavonoids, tannins, saponins, cardiac glycosides, and triterpenes. Both extracts significantly (p˂0.001) decreased leucocyte count in carrageenan induced leucocytosis test at the dose of 100 and 200 mg/kg, with both aqueous and methanol extracts exhibiting the same level of decrease in leucocyte count. Equally, there was a statistically significant decrease (p < 0.05) in paw size at 250 mg/kg and 350 mg/kg in egg albumin-induced passive paw anaphylaxis compared to the peak increase for both standard and test groups, but with the aqueous extract exhibiting a greater level of decrease in paw size than methanol extract. Conclusion : The aqueous and methanol root bark extracts of Calotropis procera possesses Anti-inflammatory activity in in vivo anti-allergic tests on animal models, thus support the folkloric use of the plant in inflammatory and allergic conditions including asthma. Key words : Calotropis procera; Anti-inflammatory; Allergy; Carrageenan; Egg albumin.

Management of Type 2 Diabetes at Vihiga County referral hospital, Kenya: compliance with guidelines and prevalence of complications

Abstract: Background : In 2013, 382 million people suffered from diabetes globally, with 19.8 million in Africa and a Kenyan prevalence of 4.2%. Poor diabetic related outcomes such as complications, high blood sugar levels have resulted due to inadequate management of the condition. To ensure effective diagnosis, management and monitoring of Type 2 diabetic patients, the healthcare team should adopt and adhere to standard treatment guidelines that are valid and up-to date Objective : To assess the management, monitoring and complications of Type 2 diabetes among adult outpatients at Vihiga County Referral Hospital, Kenya. Methodology : A retrospective cross sectional study design was used to obtain data from 212 patient files selected through a systematic random sampling. Using a pre-designed data collection form, data on patient demographics, blood pressure, blood sugar, weight and complications was collected. Descriptive statistics were used to summarize findings to determine the proportion of adult Type 2 diabetic cases diagnosed, managed and monitored as per the Institute of Clinical Systems Improvement (ICSI) guidelines. Inferential analysis using t-test and chi square test were also carried out to ascertain extent of adherence to the guidelines. Results : Majority of the participants (31.1%) were aged 50 – 59 years (31.1%), and most were female (70.3%). Most, 39.6% had had diabetes for 1 to 5 years. Random blood sugar test was the most used method of diagnosis (58.5%) whilst fasting blood glucose test was performed in 34%. A compliance rate of 72.2% was reported in ensuring metformin was part of first line therapy as recommended. The recommended blood pressure, weight and cholesterol monitoring at initiation of treatment was observed in 96.7, 1.4 and 6.1% of the patients, respectively. Of the 141 patients monitored using fasting blood sugar, 113 (80.1%) had uncontrolled blood sugar levels (median blood sugar = 8.9(IQR.7.4, 12.75) mmol/L; P=0.741). The prevalence of reported neuropathy, retinopathy and nephropathy were 41, 33 and 0.9% respectively. Discussion : The diagnosis, management and monitoring of most patients fell short of the ICSI treatment guideline recommendations especially to monitoring of blood sugar, lipid levels and weight. The presence of anomalies calls for sensitization of healthcare workers on the importance of adoption and adherence to evidence based, up to date treatment guidelines and optimize patient health outcomes. Key words : Type 2 diabetes, treatment guidelines, healthcare providers

Accessibility of medicines used in the management of substance use disorders in selected hospitals in Nairobi

Abstract: Background: Substance use disorder is a complex chronic disease that requires a multidisciplinary approach in treatment. Pharmacotherapy is one of the components in the treatment of this condition. This study sought to assess the accessibility of medicines used in the treatment of substance use disorders in both a public and a private health facility in Nairobi. Methodology: This descriptive cross-sectional study with both qualitative and quantitative components was carried out in April and May 2015 at two hospitals in Nairobi, Mathare Mental Hospital (public) and Chiromo Lane Medical Centre (private). Data on availability and affordability was collected from the two sites and the WHO performance indicators for health facilities used to assess availability. Affordability was determined using the daily wage of the lowest paid government worker. Interviews with the key informants were conducted to determine factors that influence the accessibility of the medicines. Results: About 50% of medicines on the Kenya Essential Medicines List for management of substance use disorders were available in Mathare while Chiromo Lane had all of them. The mean stock out duration was 8 months and 0.5 months in Mathare and Chiromo Lane, respectively. More than 67 % of the medicines required less than a single day’s wage to buy a month’s supply in Mathare while in Chiromo Lane all the medicines required more than a single day’s wage to purchase. The cheapest medicine required 0.3 days wage to purchase while the most expensive drug required 50 days wage to purchase. Conclusion: Medicines for the treatment of substance use disorders had limited availability but were relatively affordable in Mathare while their availability was better in Chiromo Lane but with limited affordability. The Kenya Essential Medicines List for substance use disorders requires updating to include newer and more efficacious medicines. National guidelines for the treatment of substance use disorders should be developed and disseminated. Key words: Substance use disorders, pharmacotherapy, accessibility and affordability

The Potential for DPPIV/CD26 usage as a surrogate marker for Antiretroviral Therapy Efficacy in HIV Infected populations

Abstract: Background: Human Immunodeficiency Virus (HIV) viral load and CD4 + cell counts are the most commonly used markers for monitoring efficacy of anti-retroviral therapy (ART) in HIV infected individuals. The high cost of viral load monitoring limits its usage in resource limited countries, often leaving the use of CD4+ T cell counts as the only alternative. Though cheaper and more readily available, CD4+ cell counts as a measure of detecting treatment failure, is an unreliable predictor of disease progression. Hence, there is a need for more sensitive alternative, but less costly techniques for detecting treatment failure which can be used in resource limited settings. Objective: To evaluate the feasibility of using plasma CD26/Dipeptidyl peptidase IV (DPPIV) as a novel marker for clinical evaluation of treatment efficacy in HIV infected children. Method: Blood samples collected from HIV + children (n=76) before and after initiation on ART, were assessed for HIV RNA (viral load), CD4+ T-cell count and DPPIV/CD26 levels. Viral load levels were analyzed using Roche Amplicor HIV-1 Monitor Test kit; CD4+ T-Cell Counts were analyzed using BD FACS Calibur flow cytometer while DPPIV/CD 26 levels were analyzed using Human DPPIV/CD26 Quantikine ELISA kit (R&D Systems, Minneapolis MN). Results: The plasma DPPIV/CD26 levels increased significantly in children after ART initiation ( p = 0.017), while the viral load levels declined after ART initiation with subsequent CD4+ cell counts increase. The DPPIV/CD 26 increase positively correlated with viral load decrease while negatively correlating to the CD4+ cell count increase. Conclusion: These findings demonstrate an inverse relationship between DPPIV/CD26 levels and HIV viral load and the direct proportionality of CD4+ Cell counts and DPPIV/CD26 levels, suggesting potential for use of DPPIV/CD26 as a surrogate marker for evaluating HIV disease progression in children receiving anti-retroviral therapy. Key words: CD26/Dipeptidyl peptidase IV (DPPIV), ELISA, Surrogate marker, Viral Load, CD4 Count, antiretroviral.

Weight changes and associated factors among breast cancer patients receiving chemotherapy at a referral hospital in Kenya

Abstract: Background: Breast cancer patients experience weight changes during treatment, which adversely affect prognosis. However, cancer treatment in Kenya mainly focuses on tumor eradication with limited attention on weight management interventions. Objectives: To determine weight changes and associated factors among breast cancer patients receiving the first three cycles of chemotherapy at Kenyatta National Hospital. Methodology: A prospective cohort design was adopted. One hundred and forty two female participants aged 18-70 years diagnosed with stage 1, 2 and 3 breast cancers were followed up for three months during treatment. Data was collected after every visit using a structured questionnaire, individual dietary diversity tool and anthropometric assessments. Clinical data was extracted from participant’s medical records. Frequencies, proportions, measures of central tendency and chi square tests were utilized in analysis. Results: The majority of patients (59.2%) had stage 2 breast cancers. The prevalent type of cancer was ductal carcinoma (97.9%). Most of the patients were on adjuvant chemotherapy (66.9%). The mean weight (SD) was 66.6(13.6) kg, 65.9(13.4) kg and 66.1(13.2) kg at first, second and third cycles respectively. Overall (between the first and thirst cycle), the mean weight change (SD) was 0.4(1.6) kg. Majority (48.4%) gained weight and among them, 24.2% gained 2kg and 18.3% gained 1kg. Amidst the patients who lost weight, 19.2% and 11.7% lost 1kg and 2 kgs respectively. Weight gain was significantly (p<0.05) associated with being married and Body Mass Index (BMI) at baseline. On the other hand, weight loss was significantly (p<0.05) associated with diarrhea. .e will be a separate f Reproductive Age and Children unwill be usedg itessues where investibgators have minimal knowl Conclusion: Weight changes were observed among the patients with majority of them experiencing weight gain than weight loss hence a need for early initiation of weight management interventions after diagnosis of breast cancer. Key words : Breast cancer, weight gain, chemotherapy

Systematic Review, Meta-Analysis and Grading of Evidence on the Effectiveness of Antimicrobial Prophylaxis for Neurosurgical Site Infections

Abstract: Background: Antimicrobial prophylaxis is crucial for neurosurgical procedures, even though they are clean procedures. Observational studies have shown the effectiveness of different antibiotics in preventing neurosurgical site infections, but there remains paucity of systematic reviews and meta-analyses which have assessed their effectiveness in East Africa. Objectives: To generate and appraise the quality of evidence that would inform antimicrobial prophylaxis in neurosurgery. Methodology: A systematic review and meta-analysis was conducted between October 2014 and December 2015. Studies that involved the administration of systemic antibiotics for prophylaxis, use of antibiotic impregnated shunt catheters among adult patients aged over 18 years were included and subjected to abstract, title and full text screening. A meta-analysis was carried out using RevMan (Review Manager) version 5 software. The quality of evidence was evaluated using the GRADE system. Results: One systematic review of randomized controlled trials (n=17) and 11 randomised controlled trials were included in the study. From the first meta-analysis, use of systemic antibiotics demonstrated an overall protective effect of 52% from development of surgical site infections [OR 0.48 (95% CI 0.30, 0.79)]. In the second meta-analysis, the use of antibiotic impregnated shunt catheters was associated with a higher risk of mortality compared to use of the standard shunt [(OR 1.47(95% CI 0.82, 2.62)]. Following evaluation of quality of evidence, in the antibiotics versus placebo arm, the quality of evidence was moderate, while that for antimicrobial impregnated shunts was very low. Conclusion: Antimicrobial prophylaxis using systemic antibiotics or antimicrobial impregnated shunts is effective in preventing neurosurgical site infections. Antimicrobial impregnated shunts are too expensive for our study population. Key words: systematic review, meta-analysis, antimicrobial prophylaxis

Are antepartum urinary tract infections associated with adverse perinatal outcomes in Kenya

Abstract: Background: Pregnant women are considered immuno-compromised because of the physiologic changes associated with pregnancy. Consequently, they often host urinary tract infections which have been implicated as a risk factor for numerous complications. Objective: To investigate the antepartum urinary tract infection profile among pregnant women in Kenya and their association with perinatal outcomes. Methodology: A retrospective cohort of expectant women admitted at Kisii Level 5 hospital in 2012 were studied to determine the prevalence of urinary tract infections in pregnancy. The antenatal records were also correlated with adverse perinatal outcomes. Results: Out of the 2014 pregnant women attending clinic in this study, 14.4% were diagnosed with urinary tract infections in the third trimester. The prevalence rate of the infections was affected by the age, with pregnant women below 25 years showing higher susceptibility (P= 0.018) compared to pregnant women above 35 years age group. There was a significant association between preterm delivery, low birth weights and urinary tract infections in pregnant women (P<0.01). However, there was no significant correlation between maternal urinary tract infections and the incidence of neonatal sepsis at P=0.05. Discussion: Pregnant women under the age of 25 are vulnerable to urinary tract infections resulting in adverse perinatal outcomes in the study population. This reinforces the need for screening of pregnant women and treatment of urinary tract infections to reduce perinatal complications. Further research is required to elucidate the underlying risk factors for neonatal sepsis. Key Words: pregnancy, urinary tract infections, perinatal outcomes, preterm delivery, low birth weight

Chronic toxicity evaluation of ethanolic stem bark extract of Randia (Xeromphis) nilotica Stapf. (Rubiaceae) in Wistar rats

Abstract: Background : Randia nilotica is known in northern Nigeria as Gial-goti, but has also been reported to be widespread in Sudan and India. The plant is used traditionally for its ethno-medicinal claims in managing mental-illnesses, convulsion or epilepsy, jaundice, infertility, snake bites and other ailments. The leaf, root and stem bark of the plant had been scientifically validated for CNS depressant activity and the stembark is particularly used for CNS-related disorders. However, information related to the toxicity potential of the plant is not available. Objective : To investigate the effect of 90-days administration of ethanol stem-bark extract of the plant on some physiological-biomarkers and vital-organs’ histology. Methods : Oral median-lethal dose (LD 50 ) estimated from acute-toxicity test and extract doses of 250, 500, 1000mg/kg for 3-groups of 20-rats each and normal-saline control group were used. The rats were euthanized on the 90 th -day following daily oral treatments per-body-weight. Blood-samples in plain and anticoagulated (EDTA) sample-bottles for biochemical and haematological analyses were collected from each group and vital-organs isolated, weighed and kept in fixatives for histo-analyses. Result : The oral acute extract-administration up to 5000mg/kg caused no observable toxic-sign or mortality. PCV, Hb and RBC counts decreased significantly at 500 and 1000mg/kg, but only at 1000mg/kg for MCV, with no significant changes in other haematological-indices. Significant increase in blood-urea-nitrogen at all test-doses and in high-density lipoprotein at 250mg/kg occurred. Brain-weight was significantly decreased and all organs histologically showed blood-vessels congestion and inflammatory-cells’ infiltration, in addition to dose-dependent neuronal-degeneration and cerebral-oedema in brain, lymphocytes’ depletion in spleen, necrositic-hepatocytes, myocardial-haemorrhage with oedematous-fragmentations and glomerular-atrophy, haemorrhage, tubular-necrosis, glomerular hypercellular-vacuolation and Bowman’s-capsule adhesion to parietal surface. Conclusion : Haematological, biochemical and histological analysis revealed evidence of chronic toxicity to various major organ systems. In addition to dose, duration of use also contributes to the toxic effects of the plant. Key-words: Randia-nilotica, stem-bark, ethanol extract, chronic-toxicity, rats

Development of Dromedary Antibody-based Enzyme Linked Immunosorbent Assay for Detecting Chikungunya virus Infections

Abstract: Background: Chikungunya virus (CHIKV) is an arthropod-borne Togavirus belonging to the genus Alphavirus that is responsible for sporadic worldwide outbreaks of Chikungunya fever, an acute febrile illness often associated with severe polyarthralgia. In Kenya, Chikungunya virus is of great epidemiological concern, with the last major outbreak occurring in 2016 in North Eastern Kenya. Reliable detection of CHIKV infections is key to controlling this re-emerging pathogen, for which no cure currently exists. Current diagnostic methods for CHIKV employ a combination of tests, particularly immunologic, serologic or virologic techniques. However, the independent scientific reviews on the validity and sensitivity of currently available commercial assays have been conflicting. Objective: This study aimed to develop and validate a dromedary antibody-based enzyme linked immunosorbent assay for detecting Chikungunya virus infections. Methods: To produce sufficient antigen for camel immunization, Chikungunya virus (strain Lamu 33) was propagated in confluent C6-36 E2 cells using Cytodex microcarrier system. Purified and inactivated CHIKV immunogen was used to inoculate two camels reared at the University of Nairobi farm in Kibwezi, Kenya. Camel serum samples collected over the entire immunization period were assayed for the presence of anti-Chikungunya IgG by indirect ELISA. Purification of camel Heavy Chain IgG antibodies was performed by lectin affinity chromatography on protein A and protein G-Sepharose columns; then conjugated with horse radish peroxidase (HRP). The HRP-conjugated camel Heavy Chain IgG2 and IgG3 were optimized for ELISA, with optical density measured using a microplate reader set at 492nm. A total of 188 human sera samples were assayed using the developed dromedary-based enzyme linked immunosorbent assay to determine Chikungunya virus infections. Results: The sensitivity of the dromedary HCAb IgG2 assay was 91.3% (95% CI: 0.831 - 0.994); while that for HCAb IgG3 assay was 95.7% (95% CI: 0.898 - 1.01). The specificity of HCAb IgG2 assay was 92.3% (95% CI: 0.879 - 0.967); while the specificity of HCAb IgG3 method was 90% (95% CI: 0.851 - 0.949). For HCAb IgG2 and IgG3 based assays, the positive predictive values were 79.2% and 75.8 % respectively; while the negative predictive values were 97% and 98.4% for HCAb IgG2 and IgG3 based assays respectively. Conclusion: The camel antibody based assay was found to be reliable assay with very good sensitivity and specificity, and can be deployed for detection of Chikungunya virus infections. Key words : Chikungunya, ELISA, camel antibodies, diagnosis

Clinical audit of Heparin use in Rift Valley General Hospital, Nakuru County, Kenya.

Abstract: Background : Heparin is a high risk medicine that may cause significant harm if not used properly. It is ranked among the top 5 “high alert” medications by the Institute of Safe Medication Practices because of its low therapeutic index and potential for serious adverse outcomes. Adherence to guidelines and protocols, as well as careful monitoring of heparin use, is important in maximizing benefits of its use and minimizing on harm. Objective : The aim of this study was to examine the processes and outcomes of heparin use in adult in- patients at the Rift Valley General Hospital through the conduct of a clinical audit. Methodology : A structured clinical audit tool was developed through consolidation of information from various sources. The structures supporting heparin use were physically assessed, including the availability of policies, guidelines or protocols, protamine and laboratory reagents. The processes and outcomes of its use were audited through the prospective observation of heparin dosing, administration and monitoring among eligible adult in-patients. Results : Clinical audit revealed there were no policies, protocols or guidelines to guide heparin use at Rift Valley General Hospital. Delayed or lack of heparin monitoring were observed. Heparin termination was done well by introduction of warfarin at least three days before stopping heparin in majority of the patients. The overall clinical audit score at Rift Valley General Hospital was 60.6% which showed minimal compliance to the performance threshold/standard of heparin use. Conclusions : Clinical audit for heparin use in RVGH concluded inadequate compliance to the set standards. There is need to avail guidelines, protocols or policies in the institution and conduct regular monitoring to ensure use of heparin is improved and maximum benefit is realized. Key words : Heparin, clinical audit, monitoring.

Socio-demographic and treatment-related variables associated with CD4 cell counts in Kenyan HIV patients on second-line regimens

Abstract: Background : CD4 cell response in patients on second-line therapy has not been evaluated in Kenya. Patients failing second-line are changed to third-line, however, the drugs used for third-line are expensive and unavailable. Therefore, early identification of potential poor responders to treatment would lead to early intervention and thus improve therapy of patients on second-line. Objectives: To identify socio-demographic and treatment related variables that affect CD4 response of HIV-positive patients on second-line regimens in Kenyatta National Hospital (KNH). Methods: A historical cohort study carried out at KNH between January and April 2016 and entailed collection of patient data from the files. The main outcome variable was CD4 cell count. The predictor variables of interest were sex, age, education level, and ART regimens. Results: All the study participants were on a lopinavir-based regimen. The study involved 84 study participants, 59.5% female study participants and 40.5% male. Male patients had significantly lower baseline CD4 cell counts and lower CD4 cell counts at ART (antiretroviral therapy) switch to second line compared to female patients. Efavirenz-based regimens were significantly associated with low CD4 cell count at ART switch to second-line. Conclusion: Patients should be started on nevirapine-based regimens unless contraindicated. Keywords : CD4 cell count, ART switch, second-line

Psychopharmacological effects of ethanol leaf extract of Setaria megaphylla in mice

Abstract: Background: Setaria megaphylla (Steud) Dur & Schinz (Poaceae), a perennial grass used traditionally in the treatment of various diseases including central nervous system disorders. Objective: To evaluate the Setaria megaphylla ethanol leaf extract for psychopharmacological effects in mice. Materials and Methods : Antidepressant activity was evaluated in mice using open field, force swimming and tail suspension tests as well as phenobarbitone-induced sleeping time. Anticonvulsant activity was also tested against pentylenetetrazol and aminophylline-induced convulsions. Results: The leaf extract (200-600 mg/kg) increased significantly (p<0.05- 0.001) the line crossing, walling and rearing activities in open field test and reduced significantly (p<0.05-0.001) the immobility time in force swimming and tail suspension tests. The leaf extract antagonized the hypnotic effect of phenobarbitone sodium and offered no protection to animals against convulsions induced by pentylenetetrazol and aminophylline in mice. Conclusion: The leaf extract of S. megaphylla has prominent antidepressant and CNS stimulatory activities which is due to the activities of its phytochemical constituents. Keywords: Antidepressant, Setaria megaphylla , CNS stimulant

Patterns of antimicrobial use in the neurosurgical ward of Kenyatta National Hospital.

Abstract: Background: Antibiotics in neurosurgery are used for prophylaxis and treatment of already established infection. Guidelines state that prophylactic antibiotics should be given for up to 24 hours. For treatment of already established infections, empiric therapy with intravenous antibiotics for four to eight weeks is indicated. Studies have shown no distinction between antibiotic use for prophylaxis and treatment of established infection in neurosurgery. Objectives: To identify antibiotic use patterns and medication errors and their association with development of surgical site infections. Methods: A prospective cohort study involving adult neurosurgical patients was carried out at Kenyatta National Hospital, between April 2015 and July 2015. Patient demographic data as well as data on surgical procedures carried out, antibiotics used and medication errors was collected. Descriptive data analysis was done for all variables. To test for association between antibiotic use patterns and development of surgical site infections, the Fischer exact Chi square test was used. Results: Out of the 84 participants recruited in the study, 87.2% (n=68) used antibiotics. Ceftriaxone was the most commonly used (63.7%, n= 44), followed by metronidazole (40.4%, n=23). Medication errors that were noted involved inappropriate choice and use of antibiotics. There was no distinction between use of antibiotics for prophylaxis and treatment of infection. There was no statistically significant association between patterns of antibiotic use and development of surgical site infection. Conclusion: Antibiotic use patterns do not affect the incidence of neurosurgical site infections. Prescribing errors of various types were prominent. An antibiotic use protocol should guide antimicrobial selection and use in neurosurgery. Key words: antibiotic, prophylaxis, medication errors

In vitro anthelmintic activity of Albizia gummifera, Crotalaria axillaris, Manilkara discolor, Teclea trichocarpa and Zanthoxylum usambarense using sheep nematodes

Abstract: Background : Albizia gummifera, Crotalaria axillaris, Manilkara discolor, Teclea trichocarpa and Zanthoxylum usambarense are used to treat different ailments in many parts of the world. For instance, A. gummifera is used to treat stomach pains, malaria, diarrhoea and sleeping sickness while C. axillaris treats ophthalmic disorders and kidney problems. Manilkara discolor stem bark infusion is used to treat stomach disorders and as an astringent while T. trichocarpa has been used to treat malaria, helminth infections and fever. Zanthoxylum usambarense is used to treat rheumatism, backache, painful joints, fever, sore throat, tonsillitis, chest pains, malaria, abscesses and wounds. Objective : The aim was to determine whether the crude plant extracts have in vitro anthelmintic activity. Materials and methods : Different parts of the plants were acquired from Ngong Hills forest, Kajiado County, Kenya in May 2012, dried and macerated to exhaustion with dichloromethane: methanol (1:1, v/v) solution. Nematode eggs ( Haemonchus Spp, Trichostrongylus Spp and Oesophagostomum Spp) were obtained from infected sheep rectums at Department of Vet Farm, University of Nairobi based at Kabete. Varying concentrations of water solutions of the dry crude extracts were prepared. Egg hatch (EHA) and larvae development assays (LDA) were used to test the extracts’ effects on nematode egg hatching and larvae development, respectively Results : Albizia gummifera (root bark) and Zanthoxylum usambarense (stem bark) showed high activity (IC 50 below 300 μg / mL) in both tests. Albizia gummifera (root, stem bark and pods), Zanthoxylum usambarense root bark, Crotalaria axillaris twigs and Teclea trichocarpa root and stem bark showed high activity in LDAbut moderate activity (300 μg / mL 500 μg / mL) activity in EHA. Manilkara discolor extracts showed low activity in both tests. Conclusion: Different extracts of the plants tested may inhibit nematode growth and development and hence warrant in vivo tests would support their ethnomedicinal application. Key words: Anthelmintic activity, egg hatch, larval development, Haemonchus, Trichostrongylus, Oesophagostomum