Anticoagulant and antiplatelet properties of the latex of unripe fruits of Carica papaya L. (Caricaceae)

Background: Anticoagulants have found use clinically in the management of coagulation disorders. The aim of this study therefore was to ascertain the anticoagulant and antiplatelet properties of the latex of the unripe fruits of Carica papaya (CPUFL) using in vitro and in vivo models.Methods: CPUFL was screened for phytochemicals. The time taken, for 100 μL quantities of plasma or whole blood mixed with 100, 300, and 600 μg of CPUFL and standard assay reagents, to form clots in the prothrombin time (PT), activated partial thromboplastin time (aPTT), and clotting time tests were determined (using 1 mg rivaroxaban, 50 IU heparin, or plasma as references). The time taken for cessation of induced marginal ear vein bleeding of New Zealand White rabbits pre-treated orally with either CPUFL (4-12 mg/kg), 2 mg/kg aspirin, or 1 ml/kg distilled water, or 1.5 mg/kg heparin intraperitoneally for 30 mins was also determined.Results: Saponins, tannins, glycosides, terpenoids, flavonoids, and alkaloids were present in CPUFL. Treatment with CPUFL (100-600 µg), increased both PT and aPTT significantly (p≤0.01-0.0001). There was also a significant increase (p≤0.0001) in clotting time of whole blood at 600 µg/100 µL. CPUFL treatment (4, 8, and 12 mg/kg) showed a dose-dependent increase (p≤0.0001) in bleeding time. Effect between CPUFL, heparin, and aspirin treatment were not significantly different.Conclusion: The latex of unripe fruits of C. papaya L. exhibited anticoagulant and antiplatelet properties suggesting its potential usefulness in the management of blood coagulation disorders

Adequacy of pain management in oncology patients at a tertiary hospital in Ghana

Background: Although cancer pain is well documented, efficient management is largely inadequate in most patients especially in developing countries. This study evaluated the adequacy of pain management as well as potential social factors that may be associated with inadequate pain management.Methods: 204 ambulatory oncology patients (82% female; mean age 53.5) attending clinic at the Oncology Directorate, of a tertiary hospital in Ghana from January to December, 2015 were recruited and their pain severity and functional interference assessed with the Brief Pain Inventory (BPI). The adequacy of pain management was computed as the pain management index (PMI) using the BPI.Results: Although 62% of respondents were prescribed high potency opioids, 56.9% of them exhibited significant pain while 34.9% required a stronger analgesic to manage their pain. Majority of patients (56%) were over-managed for their pain (had PMI score >0). Only 26.4% had optimal cancer pain management. Pain interfered mostly with patients’ sleep (46.2%) and general activity (42.5%). Patients with high pain intensity were more likely to have it affect their daily activity (P<0.0001). Men were more likely to have inadequate pain management than females.Conclusions: This study has shown that whereas pain management may be adequate, there is the tendency for opioid tolerance and abuse as over 50% of patients receive more analgesics than required. The tenets of the WHO 3-step analgesic ladder should be strictly adhered to achieve optimum cancer pain relief