UJI AKTIVITAS ANTIHIPERLIPIDEMIA EKSTRAK ETANOL BUAH PINANG YAKI (Areca vestiaria) PADA TIKUS PUTIH JANTAN GALUR WISTAR (Rattus norvegicus) YANG DIINDUKSI PAKAN HIPERLIPIDEMIA

ABSTRACT Pinang Yaki (Areca vestiaria) is a plan originating from the North Sulawesi region. Pinang Yaki nut containds flavonoide which can act as anti-hyperlipidemia. The study aims to identify the anti-hyperlipidemic actibity of ethanol extract of Pinang Yaki (Areca vestiaria)  fruit on wistar strain rats induced by hyperlipidemic. Total cholesterol level is a parameter on this study. The method used was laboratory experimental with a completely randomized design. The result of the study were obtained from 2 stagxes of measuring blood cholesterol, namely pre and post. The treatment was started by giving high-fat feed for 28 days. On the 29th day pre measurementswere taken. Furthermore, treatment was given to each group, namely CMC in the negative control group, simvastatin in the positive control groups, and ethanol extract of Pinang Yaki Fruit with doses of each group of PS2 (200 mg), PS4 (400 mg), and PS8 (800 mg). Post measurement are cerried out after 2 hours of administration. Data were analyzed by Paired T-test. Statistical results indicate a significant difference between the pre and post groups. From the percentage point of view, the dose of 400 mg ethanol extract of Pinang Yaki Fruit gives the best reduction in blood cholesterol levelKeywords: Pinang Yaki Fruit, Antihyperlipidemia, Male White Rat. ABSTRAK Pinang Yaki (Areca vesitaria) merupakan tanaman yang berasal dari daerah Sulawesi Utara. Buah Pinang Yaki mengandung flavonoid yang dapat berperan sebagai antihiperlipidemia. Penelitian ini bertujuan untuk mengidentifikasi aktifitas antihiperlipidemia Ekstrak etanol buah Pinang Yaki (Areca vestiaria) terhadap tikus galur wistar yang diinduksi hiperlipidemia. Kadar kolesterol total merupakan parameter dalam penelitian ini. Metode yang digunakan eksperimental laboratorium dengan rancangan acak lengkap. Hasil penelitian diperoleh dari 2 tahap pengukuran kolesterol darah, yaitu pre dan post. Perlakuan dimulai dengan memberi pakan tinggi lemak selama 28 hari. Pada hari ke 29 dilakukan pengukuran pre. Selanjutnya diberikan perlakuan pada tiap kelompok, yaitu CMC pada kelompok Kontrol negatif, simvastatin pada kelompok Kontrol positif, dan ekstrak etanol buah pinang yaki dengan dosis masing-masing kelompok PS2 (200 mg), PS4 (400 mg), dan PS8 (800 mg). Pengukuran Post dilakukan setelah 2 jam pemberian. Data dianalisis dengan Paired T-test. Hasil statistika menunjukkan adanya perbedaan yang signifikan antara kelompok pre dan post. dilihat dari presentase, dosis ekstrak etanol buah pinang yaki 400 mg memberikan penurunan kadar kolesterol darah terbaik.Kata kunci : Buah Pinang Yaki, Antihiperlipidemia, Tikus Putih Janta

Factors Associated With Pulmonary Tuberculosis-HIV Co-Infection in Treatment-Naive Adults in Jos, North Central Nigeria

Background: Co-infection with tuberculosis and human immunodeficiency virus (TB-HIV) remains a major global health problem, with about 1.1 million new cases of TB in HIV-positive persons reported in 2011; 79% of the reported cases were amongst patients living in Africa. Advanced immune suppression remains the most important risk factor for tuberculosis in those with HIV, but epidemiological and clinical factors have also been identified. We sought to determine the prevalence and factors associated with pulmonary tuberculosis (PTB) in antiretroviral therapy (ART)- naive HIV-infected patients seeking HIV care services at a tertiary health facility in North Central Nigeria. Methods: We compared clinical and laboratory data for 218 HIV-1 positive adults with and without a diagnosis of pulmonary tuberculosis. Results from univariate analyses informed the selection of predictors to conduct multivariate analysis to determine which factors were associated with presence of PTB-HIV co-infection. Results: The prevalence of PTB-HIV co-infection in the evaluated cohort was 9.6%. Lower CD4+ cell count and the presence of oropharyngeal candidiasis were independently associated with PTB-HIV co-infection. CD4+ cell count was strongly associated with PTB-HIV co-infection (p=0.002) with the odds of co-infection reduced by 85% in those with a CD4+ cell count >100 cells/mm3 compared to those with <100 cells/ mm3. There was a strong association between oropharyngeal candidiasis and PTB-HIV co-infection, where the odds of co-infection are about 4.5 times higher in those with oropharyngeal candidiasis than those without candidiasis (p=0.008). Conclusion: PTB was prevalent among HIV patients seeking care in our setting. Severe immune suppression and oropharyngeal candidiasis were associated with PTB-HIV co-infection in our patients at presentation. Potential implications for severe immune suppression and advanced HIV disease are a poor clinical outcome and further spread of PTB. Strategies to encourage the early diagnosis of both HIV and TB should be considere

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries

Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Method: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. Results: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Conclusions: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments

Identifying approaches and tools for evaluating community-based medical education programmes in Africa

Background: The US President's Emergency Plan for AIDS Relief (PEPFAR)-funded Medical Education Partnership Initiative (MEPI) aims to support medical education and research in sub-Saharan African institutions. The intention is to increase the quantity, quality and retention of graduates with specific skills addressing the health needs of their populations. While many MEPI programmes include elements of community-based education (CBE), such as community placements, clinical rotations in underserved locations, community medicine, or primary healthcare, the challenge identified by MEPI-supported schools was the need for appropriate approaches and tools to evaluate these activities. This article outlines the process of identifying tools that, with modification, could assist in the evaluation of CBE programmes in participating MEPI schools.Methods: A literature search was carried out to identify approaches and tools that could be used in Africa to evaluate CBE programmes. The search included published, peer-reviewed literature as well as grey literature and websites. Evaluation tools considered appropriate were obtained from the articles or their authors for inclusion in a compendium of example CBE evaluation tools. All tools sourced through the search were entered into a CBE evaluation matrix, which included an analysis of the tool in relation to Kirkpatrick’s four levels of evaluation.Results: Out of 37 sources included as appropriate, 8 sets of CBE evaluation tools were obtained for the compendium. Most of the evaluations were quantitative, relied on Likert-type scales, and focused on measuring CBE activities and intermediate outcomes in terms of student learning. When categorised according to the level of the evaluation, the evaluations largely focused on levels 1 and 2 of the Kirkpatrick model, as measured through students’ reactions to and learning from the CBE programmes. Tools that focused on student assessment, rather than programme evaluation, were excluded from the final set.Conclusion: With the shortage of published literature on CBE evaluation, the findings of this literature review will assist African medical schools in developing appropriate evaluation approaches and tools

Characterization of HIV type 1 reverse transcriptase mutations in infants infected by mothers who received peripartum nevirapine prophylaxis in Jos, Nigeria

This study was carried out to characterize HIV-1 reverse transcriptase (RT) mutations in vertically infected infants in Jos, Nigeria. DNA was extracted from peripheral blood mononuclear cells of 102 infants, aged 0 to 6 months, born to HIV-1-infected mothers who had received peripartum single-dose nevirapine prophylaxis. PCR-based diagnosis revealed that 14 infants (13.7%) were infected with HIV-1. Phylogenetic analyses of RT revealed wide viral diversity, with CRF02_AG, subtype G, subsubtype A3, CRF06_cpx, and a subtype D recombinant present in the population. Four of 13 (31%) infants had NNRTI resistance mutations-V1791 (2 infants), Y181C, and V179E. Intriguingly, subtype G sequences did not have NNRTI mutations but rather carried a Q207N mutation, which may undergo negative selection under drug pressure. Our data suggest wide diversity for vertically transmitted HIV-1 viruses in Nigeria and highlight the potential significance of transmitting rare mutations in subtype G

An Audit of Perineal Trauma and Vertical Transmisson Of HIV

Restrictive episiotomy is recommended for the prevention of vertical transmission of HIV. The study compared the frequency of episiotomy use and the occurrence of perineal tears; and related factors in HIV positive and HIV negative women and to assess their effect on Mother-to-child transmission (MTCT) of HIV. A total of 110 HIV positive and 134 HIV negative parturients were enrolled in the study. The incidence of episiotomy was more in the HIV negative group (p=0.0000) while that of perineal tear was not affected by HIV status (p=0.17). The rate of episiotomy was significantly affected by primigravidity in HIV negative subjects (OR= 0.032, 95% CI 0.0072-0.13). The rate of perineal tear was significantly affected by primigravidity in HIV positive subjects (OR=8.55, 95% CI 1.91-38.7) and multigravidity in HIV negative subjects (OR= 0.030, 95% CI 0.133-0.71). Gestational age and mean birth weight had no effect on the rate of episiotomy (p value =0.57 and 0.30) and perineal tear (p value= 0.79 and 0.061). There was no mother-to-child HIV transmission. Episiotomies should be given when needed irrespective of HIV status because of the risk of consequent perineal tear and with HAART the risk of MTCT from perineal trauma is minimal.Keywords: HIV positive; perineal trauma; episiotomy; perineal tear; MTC