Reversal of tenofovir induced nephrotoxicity: case reports of two patients

The use of the antiretroviral drug tenofovir has been associated with nephrotoxicity. However, the overall impact of this adverse effect has not been comprehensively evaluated. Some researchers have reported that it is quite severe to warrant monitoring for renal toxicity, while others have concluded that the magnitude may not be that significant. We report two clinical cases seen in our renal clinic with high creatinine levels suggestive of nephrotoxicity who reverted back to normality upon withdrawal of tenofovir.Keywords: Case report, HIV/AIDS, tenofovir, nephrotoxicity, reversa

A study of the medicinal plants used by the Marakwet Community in Kenya.

BACKGROUND: The medicinal plants used by herbalists in Kenya have not been well documented, despite their widespread use. The threat of complete disappearance of the knowledge on herbal medicine from factors such as deforestation, lack of proper regulation, overexploitation and sociocultural issues warrants an urgent need to document the information. The purpose of the study was to document information on medicinal plants used by herbalists in Marakwet District towards the utilization of indigenous ethnobotanical knowledge for the advancement of biomedical research and development. METHODS: Semi- structured oral interviews were conducted with 112 practicing herbalists. The types of plants used were identified and the conditions treated recorded. RESULTS: Herbal practice is still common in the district, and 111 plants were identified to have medicinal or related uses. Different herbal preparations including fruits and healing vegetables are employed in the treatment of various medical conditions. Veterinary uses and pesticides were also recorded. CONCLUSION: The study provides comprehensive ethnobotanical information about herbal medicine and healing methods among the Marakwet community. The identification of the active ingredients of the plants used by the herbalists may provide some useful leads for the development of new drugs

Collateral benefits arising from mass administration of azithromycin in the control of active trachoma in resource limited settings.

INTRODUCTION: The benefits of the use of antibiotics in the mass treatment for active trachoma and other diseases have been documented, but the secondary effects arising from such a programme have not been fully elucidated. The purpose of this study was to investigate the potential secondary benefits arising from the use of azithromycin in mass treatment of active trachoma in an economically challenged Kenyan nomadic community. METHODS: Health information reports for January 2005 to December 2010 were reviewed to determine the annual trends of infectious diseases in the two districts, Narok and Transmara. The year 2007 was considered as the baseline for mass drug administration (MDA). Odds ratios (OR) were used to describe the association. RESULTS: The mass distribution coverage in Narok was 83% in 2008, 74% in 2009 and 63% in 2010. The odds for malaria (OR = 1.13; 95% CI 1.12-1.14), diarrhoeal diseases (OR = 1.04; 95% CI 1.01-1.06), urinary tract infections (UTIs) (OR = 1.21; 95% CI 1.17-1.26), intestinal worms (OR, 4.98; 95% CI 4.68-5.3), and respiratory diseases other than pneumonia (OR, 1.15; 95% CI 1.13-1.16) were higher after three rounds of mass treatment, indicating a better outcome. Before the intervention, there was a reducing trend in the odds for respiratory diseases. In Transmara (control), there was an increase in odds for malaria, respiratory infections, UTIs and intestinal worms. The odds for diarrhoeal diseases, skin diseases and pneumonia decreased throughout the study period. CONCLUSION: Mass distribution of azithromycin may have contributed to the decrease in the prevalence of the respiratory infections in Narok District

Ethnopharmacological survey of the medicinal plants used in Tindiret, Nandi County, Kenya

Background: An inventory of the medicinal plants used by herbalists to treat various ailments in Tindiret area of Nandi County, Kenya was conducted by a team comprising of medical researchers and botanists with a view to preserve indigenous ethnobotanical knowledge and potential research and development of new drugs.Materials and Methods: Data was collected from practicing herbalists through semi-structured interviews, group discussions and observations. The types of medical conditions treated, treatment methods as well as the plants used were recorded.Results and Conclusion: A total of 50 medicinal plants belonging to 28 families used for the treatment of 32 medical conditions were recorded. The disease conditions which were treated by the highest number of plants were abdominal/colic pains with 15 different plants recorded (13%), respiratory disorders 15(13%) and infertility14 (12%). The most widely used medicinal plants were Vernonia amygdalina 7(7%), Toddalia asiatica 6(6%), Aloe kedongensis 5(5%) and Zanthoxylum gilletii 5(5%); whereas the families with the highest number of plant usage were Fabaceae 8(14%), Lamiaceae 4(8%) and Solanaceae 4(8%) plants respectively. The study documents important ethno-medical knowledge on the plants used by herbalists in Tindiret sub-county.Keywords: Ethnopharmacology, Indigenous knowledge, Traditional medicine, Research, Conservatio

Current trends of Traditional Herbal Medicine Practice in Kenya: A review

The use of herbal medicine is increasingly finding more relevance today, especially with the recognition that we are facing more challenges in the treatment of some medical conditions such as diabetes and cancer. To date, there are not many publications or records on the traditional herbal medicine use among the various Kenyan communities despite the widespread use. There is therefore an urgent need to document traditional medicines in Kenya for future reference and research. The main objective of this review is to examine the current state of traditional herbal medicine practise in Kenya, the challenges facing the sector and the possible solutions to streamline the practice and maximize on the benefits. The method adopted in this research involved the analysis of the available records on herbal medicine in Kenya from various sources including internet and the available books. This information was then compared with those in other countries with established systems in order to establish the existing inadequacies. The various efforts to document herbal medicine incorporate into mainstream healthcare and the legal framework was also reviewed. Key words: Herbal medicine, documentation, researc

Association between psychosis and substance use in Kenya. Findings from the NeuroGAP-Psychosis study

Background: Substance use is prevalent among people with mental health issues, and patients with psychosis are more likely to use and misuse substances than the general population. Despite extensive research on substance abuse among the general public in Kenya, there is a scarcity of data comparing substance use among people with and without psychosis. This study investigates the association between psychosis and various substances in Kenya. Methods: This study utilized data from the Neuro-GAP Psychosis Case-Control Study between April 2018 and December 2022. The KEMRI-Wellcome Trust Research Programme recruited participants from various sites in Kenya, including Kilifi County, Malindi Sub-County, Port Reitz and Coast General Provincial Hospitals, and Moi Teaching and Referral Hospital, as well as affiliated sites in Webuye, Kapenguria, Kitale, Kapsabet, and Iten Kakamega. The collected data included sociodemographic information, substance use, and clinical diagnosis. We used the summary measures of frequency (percentages) and median (interquartile range) to describe the categorical and continuous data, respectively. We examined the association between categorical variables related to psychosis using the chi-square test. Logistic regression models were used to assess the factors associated with the odds of substance use, considering all relevant sociodemographic variables. Results: We assessed a total of 4,415 cases and 3,940 controls. Except for alcohol consumption (p-value=0.41), all forms of substance use showed statistically significant differences between the case and control groups. Cases had 16% higher odds of using any substance than controls (aOR: 1.16, 95%CI: 1.05-1.28, p=0.005). Moreover, males were 3.95 times more likely to use any substance than females (aOR:3.95; 95%CI: 3.43-4.56). All the categories of living arrangements were protective against substance use. Conclusion: The findings of this study suggest that psychotic illnesses are associated with an increased likelihood of using various substances. These findings are consistent with those of previous studies; however, it is crucial to investigate further the potential for reverse causality between psychosis and substance abuse using genetically informed methods

Prevalence of Potential Drug-Drug Interactions Involving Antiretroviral Drugs in a Large Kenyan Cohort

Background: Clinically significant drug-drug interactions (CSDIs) involving antiretrovirals are frequent and under-recognizedin developed countries, but data are lacking for developing countries. Methodology and Principal Findings: To investigate the prevalence of CSDIs between antiretrovirals and coadministered drugs, we surveyed prescriptions dispensed in a large HIV clinic in Kenya. Of 1040 consecutive patients screened, 996 were eligible for inclusion. CSDIs were defined as ‘major’ (capable of causing severe or permanent damage, contraindicated, avoid or not recommended by the manufacturer, or requiring dose modification) ‘moderate’ (manufacturers advise caution, or close monitoring, or capable of causing clinical deterioration). A total of 334 patients (33.5%) were at risk for a CSDI, potentially lowering antiretroviral drug concentrations in 120 (12%) patients. Major interactions most frequently involved rifampicin (12.4%, mostly with efavirenz) and azoles (2.7%) whereas moderate interactions were frequently azoles (13%), steroids (11%), and antimalarials (3%). Multivariable analyses suggested that patients at risk for CSDIs had lower CD4 counts (P = 0.006) and baseline weight (P = 0.023) and WHO Stage 3 or 4 disease (P#0.007). Risk for CSDIs was not associated with particular regimens, although only 116 (11.6%) patients were receiving WHO second line regimens. Conclusions: One in three patients receiving antiretrovirals in our programme were at risk of CSDIs. Strategies need to be urgently developed to avoid important drug interactions, to identify early markers of toxicity and to manage unavoidable interactions safely in order to reduce risk of harm, and to maximize the effectiveness of mass antiretroviral deployment in Africa

ETHNOPHARMACOLOGICAL SURVEY OF THE MEDICINAL PLANTS USED IN TINDIRET, NANDI COUNTY, KENYA

Background: An inventory of the medicinal plants used by herbalists to treat various ailments in Tindiret area of Nandi County, Kenya was conducted by a team comprising of medical researchers and botanists with a view to preserve indigenous ethnobotanical knowledge and potential research and development of new drugs. Materials and Methods: Data was collected from practicing herbalists through semi-structured interviews, group discussions and observations. The types of medical conditions treated, treatment methods as well as the plants used were recorded. Results and Conclusion: A total of 50 medicinal plants belonging to 28 families used for the treatment of 32 medical conditions were recorded. The disease conditions which were treated by the highest number of plants were abdominal/colic pains with 15 different plants recorded (13%), respiratory disorders 15(13%) and infertility14 (12%). The most widely used medicinal plants were Vernonia amygdalina 7(7%), Toddalia asiatica 6(6%), Aloe kedongensis 5(5%) and Zanthoxylum gilletii 5(5%); whereas the families with the highest number of plant usage were Fabaceae 8(14%), Lamiaceae 4(8%) and Solanaceae 4(8%) plants respectively. The study documents important ethno-medical knowledge on the plants used by herbalists in Tindiret sub-county

Genetic structure correlates with ethnolinguistic diversity in eastern and southern Africa.

African populations are the most diverse in the world yet are sorely underrepresented in medical genetics research. Here, we examine the structure of African populations using genetic and comprehensive multi-generational ethnolinguistic data from the Neuropsychiatric Genetics of African Populations-Psychosis study (NeuroGAP-Psychosis) consisting of 900 individuals from Ethiopia, Kenya, South Africa, and Uganda. We find that self-reported language classifications meaningfully tag underlying genetic variation that would be missed with consideration of geography alone, highlighting the importance of culture in shaping genetic diversity. Leveraging our uniquely rich multi-generational ethnolinguistic metadata, we track language transmission through the pedigree, observing the disappearance of several languages in our cohort as well as notable shifts in frequency over three generations. We find suggestive evidence for the rate of language transmission in matrilineal groups having been higher than that for patrilineal ones. We highlight both the diversity of variation within Africa as well as how within-Africa variation can be informative for broader variant interpretation; many variants that are rare elsewhere are common in parts of Africa. The work presented here improves the understanding of the spectrum of genetic variation in African populations and highlights the enormous and complex genetic and ethnolinguistic diversity across Africa