Neurocognitive function in HIV infected patients on antiretroviral therapy

OBJECTIVE To describe factors associated with neurocognitive (NC) function in HIV-positive patients on stable combination antiretroviral therapy. DESIGN We undertook a cross-sectional analysis assessing NC data obtained at baseline in patients entering the Protease-Inhibitor-Monotherapy-Versus-Ongoing-Triple therapy (PIVOT) trial. MAIN OUTCOME MEASURE NC testing comprised of 5 domains. Raw results were z-transformed using standard and demographically adjusted normative datasets (ND). Global z-scores (NPZ-5) were derived from averaging the 5 domains and percentage of subjects with test scores >1 standard deviation (SD) below population means in at least two domains (abnormal Frascati score) calculated. Patient characteristics associated with NC results were assessed using multivariable linear regression. RESULTS Of the 587 patients in PIVOT, 557 had full NC results and were included. 77% were male, 68% Caucasian and 28% of Black ethnicity. Mean (SD) baseline and nadir CD4+ lymphocyte counts were 553(217) and 177(117) cells/µL, respectively, and HIV RNA was <50 copies/mL in all. Median (IQR) NPZ-5 score was -0.5 (-1.2/-0) overall, and -0.3 (-0.7/0.1) and -1.4 (-2/-0.8) in subjects of Caucasian and Black ethnicity, respectively. Abnormal Frascati scores using the standard-ND were observed in 51%, 38%, and 81%, respectively, of subjects overall, Caucasian and Black ethnicity (p<0.001), but in 62% and 69% of Caucasian and Black subjects using demographically adjusted-ND (p = 0.20). In the multivariate analysis, only Black ethnicity was associated with poorer NPZ-5 scores (P<0.001). CONCLUSIONS In this large group of HIV-infected subjects with viral load suppression, ethnicity but not HIV-disease factors is closely associated with NC results. The prevalence of abnormal results is highly dependent on control datasets utilised. TRIAL REGISTRY ClinicalTrials.gov, NCT01230580

Evaluation of the antibacterial and anticancer activities of some South African medicinal plants

<p>Abstract</p> <p>Background</p> <p>Several herbs are traditionally used in the treatment of a variety of ailments particularly in the rural areas of South Africa where herbal medicine is mainly the source of health care system. Many of these herbs have not been assessed for safety or toxicity to tissue or organs of the mammalian recipients.</p> <p>Methods</p> <p>This study evaluated the cytotoxicity of some medicinal plants used, inter alia, in the treatment of diarrhoea, and stomach disorders. Six selected medicinal plants were assessed for their antibacterial activities against ampicillin-resistant and kanamycin-resistant strains of <it>Escherichia coli </it>by the broth micro-dilution methods. The cytotoxicities of methanol extracts and fractions of the six selected plants were determined using a modified tetrazolium-based colorimetric assay (3-(4, 5-dimethylthiazol)-2, 5-diphenyl tetrazolium bromide (MTT) assay).</p> <p>Results</p> <p>The average minimum inhibitory concentration (MIC) values of the plants extracts ranged from 0.027 mg/mℓ to 2.5 mg/mℓ after 24 h of incubation. <it>Eucomis autumnalis </it>and <it>Cyathula uncinulata </it>had the most significant biological activity with the least MIC values. The in vitro cytotoxicity assay on human hepatocarcinoma cell line (Huh-7) revealed that the methanol extract of <it>E. autumnalis </it>had the strongest cytotoxicity with IC₅₀of 7.8 μg/mℓ. Ethyl acetate and butanol fractions of <it>C. uncinulata, Hypoxis latifolia, E. autumnalis </it>and <it>Lantana camara </it>had lower cytotoxic effects on the cancer cell lines tested with IC₅₀values ranging from 24.8 to 44.1 μg/mℓ; while all the fractions of <it>Aloe arborescens </it>and <it>A. striatula </it>had insignificant or no cytotoxic effects after 72 h of treatment.</p> <p>Conclusions</p> <p>Our results indicate that the methanol fraction of <it>E. autumnalis </it>had a profound cytotoxic effect even though it possessed very significant antibacterial activity. This puts a query on its safety and hence a call for caution in its usage, thus a product being natural is not tantamount to being entirely safe. However, the antibacterial activities and non-cytotoxic effects of <it>A. arborescens </it>and <it>A. striatula </it>validates their continuous usage in ethnomedicine.</p

The use of plants in the traditional management of diabetes in Nigeria: Pharmacological and toxicological considerations

Ethnopharmacological relevance: The prevalence of diabetes is on a steady increase worldwide and it is now identified as one of the main threats to human health in the 21st century. In Nigeria, the use of herbal medicine alone or alongside prescription drugs for its management is quite common. We hereby carry out a review of medicinal plants traditionally used for diabetes management in Nigeria. Based on the available evidence on the species׳ pharmacology and safety, we highlight ways in which their therapeutic potential can be properly harnessed for possible integration into the country׳s healthcare system. Materials and methods: Ethnobotanical information was obtained from a literature search of electronic databases such as Google Scholar, Pubmed and Scopus up to 2013 for publications on medicinal plants used in diabetes management, in which the place of use and/or sample collection was identified as Nigeria. ‘Diabetes’ and ‘Nigeria’ were used as keywords for the primary searches; and then ‘Plant name – accepted or synonyms’, ‘Constituents’, ‘Drug interaction’ and/or ‘Toxicity’ for the secondary searches. Results: The hypoglycemic effect of over a hundred out of the 115 plants reviewed in this paper is backed by preclinical experimental evidence, either in vivo or in vitro. One-third of the plants have been studied for their mechanism of action, while isolation of the bioactive constituent(s) has been accomplished for twenty three plants. Some plants showed specific organ toxicity, mostly nephrotoxic or hepatotoxic, with direct effects on the levels of some liver function enzymes. Twenty eight plants have been identified as in vitro modulators of P-glycoprotein and/or one or more of the cytochrome P450 enzymes, while eleven plants altered the levels of phase 2 metabolic enzymes, chiefly glutathione, with the potential to alter the pharmacokinetics of co-administered drugs. Conclusion: This review, therefore, provides a useful resource to enable a thorough assessment of the profile of plants used in diabetes management so as to ensure a more rational use. By anticipating potential toxicities or possible herb–drug interactions, significant risks which would otherwise represent a burden on the country׳s healthcare system can be avoided

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Isolation and Characterization of Antioxidative Constituents of Ceiba Pentandra (Kapok) Leaves Extract

Ceiba pentandra widely employed in the management of inflammatory conditions, infections and oxidative stress related diseases was investigated for its active constituents. A DPPH-directed fractionation of the ethyl acetate solvent fraction of a 20% aqueous methanol leaves extract of Ceiba pentandra afforded a clovamide derivative, N-trans-caffeoyl-DOPA-methyl ester (1) together with a flavonoid, acacetin-7-O-rutinoside, Linarin (2) and 3,4- dihydroxybenzoic acid, protocatechuic acid (3). Structure elucidation of the isolated compounds was carried out using spectroscopic techniques: mass spectrometry (ESI-TOF-MS), 1D NMR (1H, 13C and DEPT) as well as 2D experiments (GCOSY, GHSQC and GHMBC). In the qualitative antioxidant assay, compounds 1- 3 bleached the DPPH purple colour indicating free radical scavenging potential (antioxidant activity). Isolation of these antioxidant compounds could provide rationale for the use of this plant in traditional medicine in the management of the oxidative stress related diseases and  infections.Keywords: Ceiba Pentandra, Bombacaceae, Clovamide, Antioxidan

Antioxidant and Antimicrobial Activities of Flavonoid Glycosides from Dennettia Tripetala G. Baker Leaf Extract

Dennettia tripetala a Nigerian medicinal plant widely employed in the management of oxidative stress related diseases and infections was investigated for its active constituents. A DPPH (1,1-diphenyl-2-picrylhydrazine) guided fractionation was used to target and isolate the antioxidant constituents of the ethyl acetate solvent fraction of a 20% aqueous methanol leaf extract. Two flavonoid glycosides were isolated and identified by spectral data (1H, and 13C NMR, along with ESI-TOF-MS spectrometry) as: quercetin-3-O-arabinofuranoside, avicularin (1) and vitexin-2'&#8217;-O-rhamnoside (2). In the qualitative antioxidant assay, the compounds instantly bleached the DPPH purple colour indicating free radical scavenging potential (antioxidant activity). In the micro-well dilution assay, Compound (1) was the most active with MIC values of 0.081 mg/mL against Staphylococcus aureus NCTC 6571 and 2.50 mg/mL against Escherichia coli NCTC 8196 compared to the standard drug streptomycin which had MICs of 0.039 mg/mL and 0.156 mg/mL respectively against the two organisms. None of the compounds was able to inhibit the growth of the fungi strain used at the tested concentrations. Isolation of these antioxidant and antimicrobial compounds could provide rationale for the ethnomedicinal use of this plant in traditional medicine in the management of the oxidative stress related diseases and infections

Isolation of two flavonoids from Bauhinia Monandra (KURZ) leaves and their antioxidative effects

Bauhinia monandra (Kurz), traditionally use in the treatment of diabetes with established significant anti-diabetic activity was investigated for its antioxidant constituents since the activity demonstrated can be linked to the presence of antioxidant compounds. Bioassay directed fractionation of the ethyl acetate soluble leaves extract has led to isolation of two active compounds identified as: Quercetin-3-O-rutinoside (1) and Quercetin (2). The molecular structures elucidations of both compounds were carried out using spectroscopic studies (1H NMR, 13C NMR and MS). These compounds are reported from this species for the first time. A DPPH spectrophotometric assay was used to evaluate the antioxidant potential of the compounds. Compound 2 had higher antioxidant activity while Compound 1 had lower activity than L-ascorbic acid which was used as standard. African Journal of Traditional, Complementary and Alternative Medicines Vol. 3(4) 2006: 59-6

Antioxidant lignans from the leaves of ficus exasperata

No Abstract.Nigerian Journal of Natural Products and Medicine Vol. 10 () 2006: pp.111-11

Cytotoxicity Study Of Antioxidant Flavonoids From Bauhinia Tomentosa Leaf Extract

A 1, 1-diphenyl-2-picrylhydrazyl (DPPH) activity-guided fractionation procedure was used to isolate the antioxidant constituents of a 50% ethanol dried leaf extract of Bauhinia tomentosa. Four flavonol glycosides: kaempferol-7-O-rhamnoside (1), kaempferol-3-O-glucoside (2), quercetin-3-O-glucoside (3) and quercetin-3-Orutinoside (4) were isolated by accelerated gradient chromatography (AGC) and Sephadex LH-20 column chromatography. Compounds 1-3 are reported for the first time from this species. The structures of the compounds were established by spectroscopic methods (1H NMR, 13C NMR and MS). A DPPH spectrophotometric assay was employed to evaluate the antioxidant activity of the isolated compounds. Compound 3 had higher antioxidant activity than L-ascorbic acid while 1 and 4 similarand 2 lower activities. Compounds 2-4 were non-cytotoxic, but kaempferol-7-O-rhamnoside (compound 1) displayed slight cytotoxicity to bovine dermal cells (LC50 = 116.58 &mu;g/ml) in the tetrazolium (MTT) based assa

6-C-METHYLQUERCETIN-3, 3', 4'-TRIMETHYL ETHER FROM THE LEAVES EXTRACT OF PILIOSTIGMA RETICULATUM

From the leaves of Piliostigma reticulatum, three C-methylflavonols: 6-C-methylquercetin-3, 3', 4'-trimethyl ether, a new natural product; 6-C-methylkaempferol-3-methyl ether, 6,8-di-C-methylkaempferol-3,7-dimethyl ether and a 2-phenoxychromone ( Piliostigmin) and were isolated along with quercetin, quercetrin and quercetin-3-O-glucoside. The chemotaxonomic significance of the findings is briefly discussed. Key Words: Piliostigma reticulatum; Caesalpinaceae; leaves; 2-phenoxychromone; C- methylflavonols; chemotaxonomy. Nigerian Journal of Natural Products and Medicine Vol.7 2003: 37-3