Anti-Malarial Activity and Toxicological Effect of Combined Corymbia Citriodora, Maytenus Senegalensis and Warbugia Ugandensis as Used in Traditional Medicine in Kenya

Malaria is majorly caused by Plasmodium falciparum resulting in thousands of deaths every year. In Africa, it is a key contributor to the disease burden notable in the disability adjusted life years (DALYs). About 243 million individuals are at a risk of contracting the disease and a higher rate of deaths are observed in children under the age of five. Conventional drugs are available at a subsidized rate but the rising problem is the resistance of the plasmodium parasite to these drugs. Hence, there is an urgent need for the development of new and alternative therapeutics for treatment of malaria. In some regions in Kenya, parts of locally available plants are harvested and used for treating malaria. It is estimated that locally, 30% of the population relies on traditional medicine for treating various ailments due to the lack of infrastructure and accessible medical facilities especially in the rural areas. Warbugia ugandensis, Maytenus senegalensis and Corymbia citriodora are amongst the plants used in herbal medicine for the treatment of malaria. However, their combinatorial antimalarial efficacy and safety is yet to be determined hence the aim of this study. The plants were harvested from their natural habitats and transported to the Centre of Traditional Medicine and Drug Research (CTMDR) at the Kenya Medical Research Institute (KEMRI), Nairobi. Antimalarial properties of single and combined extracts were analyzed against Plasmodium berghei in vivo. Cytotoxic properties of the plants were carried out against the vero cell-lines in vitro by the MTT assay. Acute oral toxicity was conducted according to the OECD protocol. Effective concentration (ED50), cytotoxicity concentration (CC50) and median lethal dose (LD50) were derived. The result indicated that the combination of M. senegalensis: W. ugandensis (1:1) had the most antimalarial activity at ED50 of 1.05mg/kg whereas among the single plants W. ugandensis had the highest antimalarial activity (ED50 of 3.3mg/kg). The combinations of C. citriodora: M. senegalensis: W. ugandensis (1:1:1), C. citriodora: M. senegalensis: W. ugandensis (1:0.5:1) and C. citriodora: M. senegalensis: W. ugandensis (0.5:1:0.5) showed cytotoxicity concentration (CC50) of 101.47±3.17 µg/ml, 213.55±3.47 µg/ml and 575.80±31.40 µg/ml respectively. All the plants combinations showed no cytotoxic effects. The synergistic antimalarial properties of combined C. citriodora: M. senegalensis, C. citriodora: W. ugandensis and M. senegalensis: W. ugandensis were confirmed as the extracts showed SFIC indexes of 0.67, 0.83 and 0.28 respectively. All the plant extracts demonstrated LD50 above 2000 mg/kg with no adverse effects hence recognized as safe. This study confirms the safety and antimalarial activities of these plants and justify their use in herbal medicine practices. The results of this study sets the precedence for the development of an antimalarial herbal formulation that is less toxic and more affordable.Keywords: Anti-Malarial Activity, Toxicological Effect, Traditional Medicine DOI: 10.7176/JNSR/12-22-04 Publication date: November 30th 202

The Effect of Imatinib Mesylate for Newly Diagnosed Philadelphia Chromosome-Positive, Chronic-Phase Myeloid Leukemia in Sub-Saharan African Patients: The Experience of Côte d'Ivoire

Imatinib mesylate, showed encouraging activity in chronic myelogenous leukemia. However, there are few data regarding his efficacy and response monitoring in Sub-Saharan African patients. Our objective was to assess response to imatinib mesylate (Glivec) in Côte d'Ivoire patients with newly diagnosed Chronic Myeloid Leukemia (CML). From May 2005 to September 2009, we treated 42 patients (40 years; range 16–69) with Philadelphia chromosome (Ph+) positive in chronic phase CML with oral imatinib mesylate at daily doses of 400 mg. Overall survival (OS) and frequency of complete or major cytogenetic remission (CCR/MCR) were evaluated. At a median follow up of 32 (range 7.6–113) months, the CHR rate in our study group was 76%. A major CR was found in 19 patients (45%) with 17% and 29% complete and partial CR respectively. There were no significant differences in the incidence of major cytogenetic response by known prognostics factors. Median time to CHR was 8 months (range 0.4–25), and 16 months (range: 0.1–36) for CR. Projected 5-year OS rate was 72% (95%CI 42–88). We conclude that imatinib therapy sub-Saharan African CML patients is very promising and has favorably changed the prognosis for black African patients with CML

Students Take Lead to Educate Faculty on the Use of Sex and Gender Terminology in Pre-clinical Courses

TOP WINNER Student leaders in the Lesbian, Gay, Bisexual and Transgender People in Medicine student run organization at the Medical College of Wisconsin noticed that curricular language around sex and gender was absent and/or incorrect in the pre-clinical medical school (M1/M2) courses. After reaching out to the M2 Endocrine/Repro Unit course director, students prepared a report to present to all M1/M2 Course Directors. Objectives: One goal of the report was to “educate the educators” so that faculty would have better understanding of the distinction between sex and gender. Ultimately this would translate to the students and improve overall future patient care. Methods: A presentation was developed and given at the quarterly M1/M2 course director meeting (Fall 2019). Information included statistics from the 2015 US Transgender Survey which underscored that ignorance surrounding sex versus gender terminology could result in an environment in which patients do not seek care. The student presentation comprehensively explained the definitions of sex, gender, cisgender and transgender. Course directors were given action items to evaluate their courses and afirm that terms were used appropriately. Student leaders provided contact information for faculty feedback. Conclusions/Impact: In February 2020, students reported of changes in some courses. For example, the M2 cardiovascular unit led off the session on women and heart disease with sex and gender definitions provided by students. Cardiovascular risks of hormonal therapy for transgender patients was included. Students noted that language around sex and gender in the M2 endocrine-repro unit was consistently correct (female not woman when discussing XX fetus). A M1 pharmacology lecture included the student\u27s definition slide as prelude to discussion of male/female differences in drug response. With little effort, students played an integral role in improving curricular content related to sex and gender medicine and further supporting the model that students are important drivers of change.https://jdc.jefferson.edu/sexandgenderhealth/1019/thumbnail.jp

Validation of Safety and Efficacy of Antitussive Herbal Formulations

Background: Cough is an important defensive pulmonary reflex that removes irritants, fluids or foreign materials from the airways. Frequently, cough is non-productive and requires suppression and opioid receptor agonists such as codeine are commonly used as antitussive agents. However, opioids produce side effects that include sedation, addiction potential and constipation. Novel cough suppressant therapies should maintain or improve upon the antitussive efficacy profile of opioids but with minimum or no side effects. Objective: To evaluate antitussive activity of combination of herbal medicines as formulations in sulphur dioxide - induced cough model in rats. Methodology: Wister rats of either sex, weighing 150 - 200 g, were divided into 7 groups (n = 6). Group 1 served as a control and received normal saline, groups 2 received codeine phosphate, group 3 and 4 received the coded market samples and groups 5, 6 and 7 received the test samples, respectively. Thirty or sixty minutes following administration, the rats were exposed to sulphur dioxide gas for 1 minute and then placed in an open chamber for counting of cough bouts. Results: The formulations exhibited cough inhibitions of between 15 and 27%, and 14 and 38%, with respect to the control group, 30 and 60 minutes after sample administration respectively. Conclusion: The herbal formulations demonstrated significant (p < 0.05) antitussive activity in sulphur dioxide induced cough model. Key words: Antitussive activity; herbal formulations; sulphur dioxide; coug

Extent and Dynamics of Polymorphism in the Malaria Vaccine Candidate Plasmodium falciparum Reticulocyte-Binding Protein Homologue-5 in Kalifabougou, Mali

Reticulocyte-binding homologues (RH) are a ligand family that mediates merozoite invasion of erythrocytes in Plasmodium falciparum. Among the five members of this family identified so far, only P. falciparum reticulocyte-binding homologue-5 (PfRH5) has been found to be essential for parasite survival across strains that differ in virulence and route of host-cell invasion. Based on its essential role in invasion and early evidence of sequence conservation, PfRH5 has been prioritized for development as a vaccine candidate. However, little is known about the extent of genetic variability of RH5 in the field and the potential impact of such diversity on clinical outcomes or on vaccine evasion. Samples collected during a prospective cohort study of malaria incidence conducted in Kalifabougou, in southwestern Mali, were used to estimate genetic diversity, measure haplotype prevalence, and assess the within-host dynamics of PfRH5 variants over time and in relation to clinical malaria. A total of 10 nonsynonymous polymorphic sites were identified in the Pfrh5 gene, resulting in 13 haplotypes encoding unique protein variants. Four of these variants have not been previously observed. Plasmodium falciparum reticulocyte-binding homologue-5 had low amino acid haplotype (h = 0.58) and nucleotide (π = 0.00061) diversity. By contrast to other leading blood-stage malaria vaccine candidate antigens, amino acid differences were not associated with changes in the risk of febrile malaria in consecutive infections. Conserved B- and T-cell epitopes were identified. These results support the prioritization of PfRH5 for possible inclusion in a broadly cross-protective vaccine

Use of Maerua Decumbens as a Natural Coagulant for Water Purification in the Dry Lands of Kenya

ABSTRACT: Indigenous management and utilization of naturally occurring tree species and shrubs/lianas is not a new culture worldwide. Various communities in the world use their indigenous tree /shrub / liana species to meet their needs for food (human and livestock), shelter and medicine among other diverse wood and non-wood forest products. Introduction of new exotic species has eroded the importance of some of these important indigenous plant species to great extends. It is however, important to consider that while these exotic species have multiple uses, most of them are not well adapted to our arid and semi-arid regions hence the need to promote the management and sustainable use of the indigenous species. Maerua decumbens is a shrub or woody herb species in the Capparaceae family and grows to a height of 0.5 to 3m with a large swollen root. It mostly occurs naturally in the arid and semiarid areas in Kenya and is used traditionally by rural communities for medicinal and water purification purposes. Members of the Mearua species are indicated as poisonous and probably a health risk and yet some of the communities chew the roots of Mearua decumbens against thirst and also use them for purifying water (Beenje H.1994). The study was done to enhance the use of Maerua decumbens as a natural coagulant for water purification by determining whether the plant used for water purification in Mutha in Kitui County is toxic or not. A reconnaissance survey was done to confirm its use for water purification and toxicity tests were done to determine the safety of the plant for human utilization as a natural coagulant for water purification. The results of the study revealed that M.decumbens is completely safe for human consumption and does not have any heavy metals that pose a risk to human health

Development of a nutraceutical from natural products: A case study of a herbal-based low sodium table salt

Background: Cyperus papyrus reed ash has been used traditionally as a salt substitute in Western Kenya. Previous work carried out at Kenya Medical Research Institute indicated that potassium salt substitution derived from local papyrus reed has a favourable potassium/sodium ratio that is suitable for use to regulate high blood pressure. Objective: To develop and design a process flow for pilot scale production and to develop suitable analytical methods for quality assurance for a herbal based low sodium table salt. Methodology: The plant material was collected from two study sites in Rift Valley then cleaned, chopped, dried, ashed and extracted at laboratory and optimized industrial scale to yield laboratory and pilot scale samples. Elemental analysis was determined using Atomic Absorption and Flame emission spectroscopy. Results: The herbal salt yield for the laboratory scale processing was about 10% for both samples but 13% and 22%, respectively, using the optimized industrial procedure. Elemental analysis results indicate the presence of both essential and non-essential elements and heavy metal was within the World Health Organization acceptable limits. The potassium/sodium ratios obtained were between 3 and 11. Discussion: The herbal salt has the capacity to preserve meat and is a source of other essential trace elements such as chromium, Zinc and manganese. Key words: Nutraceuticals; process optimization; low sodium; herbal salt; elemental compositio

Growth rates and the prevalence and progression of scoliosis in short-statured children on Australian growth hormone treatment programmes

STUDY DESIGN AND AIM: This was a longitudinal chart review of a diverse group (cohort) of patients undergoing HGH (Human Growth Hormone) treatment. Clinical and radiological examinations were performed with the aim to identify the presence and progression of scoliosis. METHODS AND COHORT: 185 patients were recruited and a database incorporating the age at commencement, dose and frequency of growth hormone treatment and growth charts was compiled from their Medical Records. The presence of any known syndrome and the clinical presence of scoliosis were included for analysis. Subsequently, skeletally immature patients identified with scoliosis were followed up over a period of a minimum four years and the radiologic type, progression and severity (Cobb angle) of scoliosis were recorded. RESULTS: Four (3.6%) of the 109 with idiopathic short stature or hormone deficiency had idiopathic scoliosis (within normal limits for a control population) and scoliosis progression was not prospectively observed. 13 (28.8%) of 45 with Turner syndrome had scoliosis radiologically similar to idiopathic scoliosis. 11 (48%) of 23 with varying syndromes, had scoliosis. In the entire cohort, the growth rates of those with and without scoliosis were not statistically different and HGH treatment was not ceased because of progression of scoliosis. CONCLUSION: In this study, there was no evidence of HGH treatment being responsible for progression of scoliosis in a small number of non-syndromic patients (four). An incidental finding was that scoliosis, similar to the idiopathic type, appears to be more prevalent in Turner syndrome than previously believed

SpineCor treatment for Juvenile Idiopathic Scoliosis: SOSORT award 2010 winner

<p>Introduction</p> <p>Juvenile idiopathic scoliosis is a condition used to describe patients who are least 4 years of age but younger than 10 when the deformity is first identified. In these patients, the condition is usually progressive and those that are diagnosed at five years or younger have a high chance of progression to a large curve, with additional pulmonary and cardiac complications. The main form of conservative treatment for juvenile scoliosis is the use of a bracing system. This prospective interventional study was conducted to evaluate the effectiveness of the Dynamic SpineCor orthosis for juvenile idiopathic scoliosis as well as to evaluate the stability of the spine after the weaning point.</p> <p>Material and Methods</p> <p>For this study, 150 juvenile patients were treated by the SpineCor orthosis between 1993 and 2009. Of these, 67 patients had a definite outcome and 83 are still actively being treated. To determine the effectiveness of the brace the <b>OUTCOME </b>criteria recommended by the SRS was used.</p> <p>Results</p> <p>The results from our study showed that of the 67 patients with a definite outcome, 32.9% corrected their Cobb angle by at least 5° and 10.5% had a stabilization of their Cobb angle. Within the patients with a definite outcome, 37.3% of patients where recommended for surgery before authorized end of treatment. For this group of patients, surgery was postponed. Looking at the stability of the curves 2 years after the end of the treatment, we found 12.5% of the patients continued their correction without the brace being used and 71.4% remained stable.</p> <p>Discussion</p> <p><b>From our study we can clearly see that the effectiveness of the SpineCor orthosis in obtaining and maintaining the neuromuscular integration of the corrective movement can be achieved effectively for juvenile patients</b>. Over 75% of all patients that finished the treatment had remained stable with a few continuing to correct their Cobb angle after the use of the SpineCor orthosis was discontinued.</p> <p>Conclusion</p> <p>Our conclusion from this study is that the SpineCor orthosis is a very effective method of treatment of juvenile idiopathic scoliosis. The results obtained also indicate that treatment outcomes are better with early bracing. Most encouraging perhaps is the fact that the positive outcome appears to be maintained in the long term, and that surgery can be avoided or at least postponed.</p