Smart Assistive mHealth System for Medication Adherence in Patients with Alzheimer's Disease

Cognitive impairment in patients with mild Alzheimer’s disease often times require medication management to prevent forgetfulness due to the diversity of medication involved in the treatment. Traditional interventions to mitigate non-adherence to medication have been largely unsuccessful. However, the programmability and intelligibility of modern electronic systems and Information and Communication Technology (ICT) can be exploited to solve this problem. In this paper, we designed and developed an intelligent assistive mHealth system to facilitate medication adherence in elderly patients with Alzheimer’s disease. This system achieve medication adherence by creating an audiovisual alert for the user with ‘memory loss’ disability to take the right doses of medication at required frequency. The drug prescriptions are keyed in by the physician and the medication schedule is stored in the non-volatile memory of the system. At the set time, the Liquid Crystal Display (LCD) unit shows the drug to be taken in the right dosage. The buzzer in the electronic device provides a sound effect to get the attention of the patient. In any case of non-adherence, the system automatically sends a text message to the physician via SMS using the integrated GSM modem and Subscriber Identity Module (SIM) in the system. This system can be miniaturized into a wearable device for optimal performanc

Human Hair as a Testing Substrate in the Era of Precision Medicine: Potential Role of ‘Omics-Based Approaches

Minimally and noninvasive investigation of pathology and treatment monitoring is highly attractive in medicine. The use of human hair samples as a non-invasive testing substrate is potentially poised to improve diagnostic and forensic medicine. Hair has the unique ability to capture long-term information about health and disease in an individual as compared to urine and blood. Testing long hair offers a potential means of long-term monitoring of drug compliance, drug abuse, chronic alcohol abuse, and diagnostic biomarker discovery. Even though human hair is mostly composed of keratin and keratin-associated proteins, very little literature has been published on human hair proteomics. Emerging high throughput omics based techniques such as proteomics are increasingly improving our depth of knowledge about the diagnosis, prognosis and prediction of diseases globally. Although many aspects of the use of these novel molecular aids to improve disease diagnosis and patient management remains elusive; it is evident that these techniques have improved precision medicine tremendously. This chapter aims to discuss current plausible application of human hair omics-based approaches to the field of pathology, diagnostics and precision/individualized medicine

Seven year review of retention in HIV care and treatment in federal medical centre Ido-Ekiti

Introduction: Poor retention of patients in care is a major driver of poor performance and increased  morbidity and mortality in HIV/AIDS programme despite the expansion and advancement Anti-retroviral Therapy (ART). The objective of this study is to assess retention rates and possible determining factors in People Living with HIV (PLHIV) on ART. Methods: This is a descriptive, cross-sectional study conducted in Federal Medical Center, Ido-Ekiti, Nigeria. Medical records of clients who were enrolled in ART Care and support unit (HIV Clinic) of the health facility from 2005 to 2012 were reviewed and analyzed using SPSS version 16. A total of 621 client records were reviewed for basic demographic information, CD4 count, WHO stage, number of follow-up visit, client ART status and client retention status (defined as client attending at least one clinic visit in 2012. Results: A total of 347(63%) patients were retained in care and 208(37%) were not retained over the seven year review period. Retention was statistically significant with age (P-value 0.031), ART status (P-value 0.000) baseline CD4 (P-value 0.004), year of diagnosis and ART initiation (P-value= 0.027). Poor retention was associated decreasing age, pre-ART client, HIV stage 1&IV client and baseline CD4 above 400cell/mm3. Conclusion: Retention in care of PLHIV is a minimum necessary condition for maintaining or restoring health in the long run. The strategies to sustain and improve retention rate should be adopted to maximize ART benefits. A follow-up study on other factors affecting retention from diagnosis to long term retention ART programme is recommended.Key words: AIDS, antiretroviral, CD4, HIV, retentio

Knowledge of and Attitude Towards Epilepsy Among Women in Ile-Ife, Nigeria

Background: Epilepsy is a non-contagious chronic disease with sufferers experiencing embarrassments amidst other challenges. Family caregivers are mainly women with some of them suffering from the disease. This study assessed the knowledge and attitude of women residents in an urban community towards epilepsy. Materials and methods: This descriptive cross-sectional study recruited 400 randomly selected women in Ile-Ife. The data was collected with the use of a pre-tested interviewer-administered questionnaire on knowledge of and attitude to epilepsy. Data was analysed using descriptive and inferential statistics. Results: Most respondents (99.3%) were aware of the disease with their main sources of information from their parents, friends, and neighbours. Only 15.3% of respondents had good knowledge of epilepsy, while 35% had positive attitude to epilepsy. Factors associated with good knowledge of epilepsy among respondents include having higher education (OR = 3.154, 95%CI = 1.574–6.323, p = 0.001) and higher income (OR = 3.055, 95%CI = 1.404–6.651, p = 0.005), while factors associated with positive attitude towards epilepsy include older age group (OR = 1.943, 95%CI = 1.281–2.945,p = 0.002) and higher income (OR = 2.932, 95%CI = 1.345–6.386, p = 0.007). Conclusions: Although the level of awareness is high, respondents’ knowledgeand attitude were inadequate. There is a need for a community education about epilepsy, targeting women who are major stakeholders with the aim of improving their knowledge and attitude towards the disease

Towards onset prevention of cognition decline in adults with Down syndrome (The TOP-COG study): A pilot randomised controlled trial.

BACKGROUND: Dementia is very common in Down syndrome (trisomy 21) adults. Statins may slow brain amyloid β (Aβ, coded on chromosome 21) deposition and, therefore, delay Alzheimer disease onset. One prospective cohort study with Down syndrome adults found participants on statins had reduced risk of incident dementia, but there are no randomised controlled trials (RCTs) on this issue. Evidence is sparse on the best instruments to detect longitudinal cognitive decline in older Down syndrome adults. METHODS: TOP-COG was a feasibility/pilot, double-blind RCT of 12 months simvastatin 40 mg versus placebo for the primary prevention of dementia in Alzheimer disease in Down syndrome adults aged 50 years or older. Group allocation was stratified by age, apolipoprotein E (APOE) ε4 allele status, and cholesterol level. Recruitment was from multiple general community sources over 12 months. Adults with dementia, or simvastatin contraindications, were excluded. Main outcomes were recruitment and retention rates. Cognitive decline was measured with a battery of tests; secondary measures were adaptive behaviour skills, general health, and quality of life. Assessments were conducted pre randomisation and at 12 months post randomisation. Blood Aβ40/Aβ42 levels were investigated as a putative biomarker. Results were analysed on an intention-to-treat basis. A qualitative sub-study was conducted and analysed using the Framework Approach to determine recruitment motivators/barriers, and participation experience. RESULTS: We identified 181 (78 %) of the likely eligible Down syndrome population, and recruited 21 (11.6 %), from an area with a general population size of 3,135,974. Recruitment was highly labour-intensive. Thirteen (62 %) participants completed the full year. Results favoured the simvastatin group. The most appropriate cognitive instrument (regarding ease of completion and detecting change over time) was the Memory for Objects test from the Neuropsychological Assessment of Dementia in Individuals with Intellectual Disabilities battery. Cognitive testing appeared more sensitive than proxy-rated adaptive behaviour, quality of life, or general health scores. Aβ40 levels changed less for the simvastatin group (not statistically significant). People mostly declined to participate because of not wanting to take medication, and not knowing if they would receive simvastatin or placebo. Participants reported enjoying taking part. CONCLUSION: A full-scale RCT is feasible. It will need 37 % UK population coverage to recruit the required 160 participants. Information/education about the importance of RCT participation is needed for this population. TRIAL REGISTRATION: ISRCTN67338640 .This study was funded by the Chief Scientist Office, Scottish Government Health Department (reference: CZH/4/626). JS is funded by the NHS Lothian R&D Directorate. The study was supported by Down Syndrome Scotland, and we thank them, and all members of the Trial Steering Committee and Data Management and Ethics Committee.This is the final version of the article. It first appeared from BioMed Central via https://doi.org/10.1186/s13063-016-1370-

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Ameliorative Potential of Hydroethanolic Leaf Extract of Parquetina nigrescens on d-Galactose-Induced Testicular Injury

Background: There is an increasing need for botanicals to be used as an alternative and complementary medicine in the management of male infertility. Male infertility has been a major health/social challenge to people all over the world. This study, therefore, investigated the ameliorative potential of hydroethanolic leaf extract of Parquetina nigrescens (HELEPN) against d-galactose-induced testicular injury. Methods: Thirty male Wistar rats were randomly allotted into six groups (n = 5). Group I (Normal control), Group II (300 mg/kg b.w. d-galactose), Group III and IV (250 and 500 mg/kg b.w. HELEPN, respectively), Group V and VI (both received 300 mg/kg b.w. of d-galactose with 250 and 500 mg/kg b.w of HELEPN, respectively). d-galactose administration started two weeks prior to HELEPN treatment which lasted for six weeks. All assays were carried out using established protocols. Results: Administration of HELEPN at 250mg/kg and 500mg/kg concomitantly with d-galactose improved paired and relative testicular weights, levels of gonadotropins (LH and FSH) and testosterone, and poor sperm quality. HELEPN treatment reduced the levels of oxidative stress biomarkers (MDA, 8-OHDG, and AGEs) and inflammatory response (TNF-alpha and NO) to normal, as well as restoring the reduced activities of antioxidant enzymes (glutathione peroxidase, superoxide dismutase, and catalase). In addition, HELEPN treatment mitigated testicular DNA fragmentation and down-regulated caspase 3-activities. HELEPN at 500 mg/kg was observed to have the greatest ameliorative effect. Conclusion: HELEPN protects against d-galactose-induced testicular injury through antioxidative, anti-inflammatory, and antiapoptotic mechanisms

Karyotypic analysis of Labeo Coubie (Ruppell, 1832) (African Carp) from University of Ilorin Dam, Ilorin, Nigeria

Karyotypic information is a useful endpoint in environmental monitoring and breeding programme. Data on karyotype of Labeo coubie is needful for environmental assessment and genetic improvement breeding projects. This study was aimed at determining the karyotype of L. coubie. 10 specimens were obtained from the University of Ilorin dam, Ilorin, Nigeria. Each specimen received intraperitoneally 0.02% colchicine (1ml/100g body weight) and left for 4 hours before sacrificing. Chromosome preparation was made from the kidney and liver. A total of 200 metaphase spreads were scored. The diploid chromosome numbers ranged from 2n = 44 to 2n = 50. The modal diploid number was found to be 2n = 50 and this represents 56 %. The kidney tissue gave better chromosome preparation. These results contribute to the karyotypic data on L. coubie.Keywords: Labeo coubie, Karyotype, Chromosom

Potential Effect of Syzygium aromaticum (Cloves) Extract on Serum Antioxidant Status and Lipid Profiles in Wistar Rats with Artesunate Toxicity

Artesunate toxicity has been linked to increased production of reactive oxygen species resulting in oxidative stress, which has been implicated in the pathogenesis of many chronic diseases. This study evaluated the effects of hydroethanolic extract of Syzygium aromaticum buds (HESAB) on serum antioxidant status and lipid profiles in Wistar rats with artesunate toxicity. Forty-eight male Wistar rats (150–200 g) randomized into six groups (n = 8) were treated as follows for 21 days: Group 1 (Control; DMSO); Group 2 (Artesunate, 15 mg/kg only); Group 3 (HESAB only, 400 mg/kg); Group 4 (HESAB only, 800 mg/kg); Group 5 (Artesunate, 15 mg/kg + HESAB, 400 mg/kg); Group 6 (Artesunate, 15 mg/kg + HESAB, 800 mg/kg). Antioxidant parameters—such as malondialdehyde (MDA), superoxide dismutase (SOD), nitric oxide (NO), glutathione (GSH), glutathione peroxidase (GPx), and catalase (CAT)—were assayed in the serum using established methods. Serum lipid profiles—which include total cholesterol (TC), triglyceride (TAG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) assays—were performed using kits. The findings showed a significant increase in lipid profile of the artesunate-induced group compared to the control and treated groups. Administration of HESAB reversed the toxic effects of artesunate. The levels of TC (69.42 ± 8.03 mg/dL, TAG (34.43 ± 6.04 mg/dL), and LDL (45.1 ± 9.66 mg/dL) in the untreated group were significantly higher than the control group TC (41.42 ± 7.57 mg/dL), TAG (28.18 ± 1.58 mg/dL), and LDL (27.73 ± 5.00 mg/dL). The antioxidant profile however was significantly reduced in the diseased (artesunate) group compared to control and treated groups. MDA, NO, and GSH levels in the untreated group were 5.032 ± 1.25 µmol/L, 10.65 ± 3.84 µmol/L, and 0.20 ± 0.145 μM respectively and 2.237 ± 0.95 µmol/L, 6.20 ± 2.21 µmol/L, and 0.49 ± 0.068 μM in control group respectively. Treatment with HESAB raised the GSH level to 0.38 ± 0.19 μM. Furthermore, CAT, SOD, and GPX were 7.62 ± 2.15, 2.76 ± 1.52, and 3.54 ± 1.91 μmol/mL in untreated group respectively and 19.03 ± 4.25, 8.05 ± 2.91, and 10.62 ± 3.24 μmol/mL in control group respectively. Treatment with HESAB raised the CAT, SOD, and GPX to 18.866 ± 2.59, 5.020 ± 0.89, and 5.05 ± 2.01 μmol/mL respectively. In conclusion, artesunate toxicity caused a significant increase in lipid profiles and decrease in antioxidant level in the rats’ serum while administration of S. aromaticum bud extract lowered lipid levels and raised the antioxidant status