Background: Grewia bicolor (G. bicolor) root is used in traditional medicine in Sudan to treat diseases of the nervous system such as anxiety and epilepsy and also to tranquilize agitated patients.Objectives: To explore the anticonvulsant and anxiolytic activities of this medicinal plant in rats.Materials and Methods: The ethanolic extract of the root of G. bicolourat (200, 400 and 800 mg/kg, i.p was studied for its anticonvulsant effect on four in vivo rat models (Maximal Electroshock Seizure (MES), Pentylenetetrazole (PTZ)-, picrotoxin (PIC)- and Strychnine (STR) - induced seizures). Simple activity meter was used for the evaluation of the anxiolytic properties. Sodium valproate (400 mg kg) was used as a reference anticonvulsant drug for all models. The protection from tonic convulsions and the number of protected animals from seizures were noted. The numbers of movements between the squares in the activity meter were counted in the consecutive 5 minutes and the motor activity was observed.Results: G. bicolourroot extract showed marked anxiolytic effect and significant decrease in the motor activity (p&lt; 0.05) since the first dose (200mg/kg) in a dose-dependent manner. The doses (400-800 mg/kg) of the extract significantly (p &lt; 0.01 - p &lt; 0.001) reduced the duration of seizures induced by maximal electroshock (MES) and delayed the onset of tonic-clonic seizures produced by strychnine, whereas, all the tested doses significantly protected the animals (up to 100%) from pentylenetetrazole- and picrotoxin- induced seizures.Conclusion: G. bicolourroot seemed to possess anticonvulsant and anxiolytic effect in rats.Keywords: Anxiety, Epilepsy, Extract, G. bicolour, Seizures, Traditional medicine

El-Hadiyah, TM

Mohamed, AH

Shamoun, MI

English

AJOL - African Journals Online

Anticonvulsant and Anxiolytic Properties of the Roots of Grewia bicolor in Rats

Background: Diabetes control is elusive so great effort is needed to keep blood glucose normal or near the required level. Various factors are suspected for poor glycemic control. These factors included: aging, sex, duration of diabetes, medication adherence, clinical inertia, physical inactivity, patient knowledge, comorbidity and quality of medications.Objectives: To assess factors associated with poor glycemic control among patients with type2 diabetes.Materials and method: This was a descriptive cross sectional hospital-based study conducted in the National Ribat University (NRU) Diabetes Clinic, Khartoum state, Sudan.Results: Out of 398 diabetic patients attending NRU Diabetes Clinic 88.2% has type 2 DM, Of whom 31.4% (125 patients) had poor glycemic control and were shifted to insulin therapy. Female constituted 76.8% of the poor glycemic control patients and 88.8% of patients were above 40years of age. About 64.8% were shifted to insulin within 10 years of diabetes diagnosis. The majority (79.2%) were not having an exercise program, 84% were not having diet program, 70.4% their knowledge about hypoglycemia symptoms was not satisfactory and 61.6% their knowledge about medication usage was not satisfactory. About 66.4% were on mono anti diabetic therapy and need medications intensification, and 54.4% were not adherent to anti diabetic medications.Conclusion: Our findings showed that sedentary life, clinical inertia and longer diabetes duration were behind poor diabetes control.Key words: Type 2DM, diabetes control, poor glycemic contro

Madani, AM

EI-Hadiyah, TM

Abdelrahim, HM

© Sudan JMS Vol. 9, No.3. Sept 2014                193 bÜ|z|ÇtÄ TÜà|vÄx Study on Patients with Poor Control of Type II Diabetes Mellitus at National Ribat University Hospital Madani AM1*, EI-Hadiyah TM2, Abdelrahim HM3 ABSTRACT Background: Diabetes control is elusive so great effort is needed to keep blood glucose normal or near the required level. Various factors are suspected for poor glycemic control. These factors included: aging, sex, duration of diabetes, medication adherence, clinical inertia, physical inactivity, patient knowledge, comorbidity and quality of medications.  Objectives: To assess factors associated with poor glycemic control among patients with type2 diabetes. Materials and method: This was a descriptive cross sectional hospital-based study conducted in the National Ribat University (NRU) Diabetes Clinic, Khartoum state, Sudan. Results: Out of 398 diabetic patients attending NRU Diabetes Clinic 88.2% has type 2 DM, Of whom 31.4% (125 patients) had poor glycemic control and were shifted to insulin therapy. Female constituted 76.8% of the poor glycemic control patients and 88.8% of patients were above 40years of age. About 64.8% were shifted to insulin within 10 years of diabetes diagnosis. The majority (79.2%) were not having an exercise program, 84% were not having diet program, 70.4% their knowledge about hypoglycemia symptoms was not satisfactory and 61.6% their knowledge about medication usage was not satisfactory. About 66.4% were on mono anti diabetic therapy and need medications intensification, and 54.4% were not adherent to anti diabetic medications.  Conclusion: Our findings showed that sedentary life, clinical inertia and longer diabetes duration were behind poor diabetes control.   Key words: Type 2DM, diabetes control, poor glycemic control.  iabetes mellitus (DM) is a chronic metabolic disorder associated with hyperglycemia due to insulin deficiency, often conjugated with insulin resistance1. Type2 DM constitutes more than 90% 2 of total cases of DM, and can remain undetected for many years.   Type2DM control is complex and cost-effective process and requires an integrated multi-disciplinary medical team consists of at least physicians, pharmacists3, nurses, dietitians and behavioral scientists who were skilled in diabetes management.  Recent  researches  that  depend  on  evidence- __________________________________________________ 1. Clinical Pharmacist, Omdurman Teaching Hospital, Sudan. 2. Associate Professor of Pharmacology, University of Khartoum, Sudan. 3. Associate Professor of Medicine and Endocrinology, University of National Ribat, Sudan. *Correspondence to: helmi7011@gmail.com based clinical trials show that the most successful guidelines for treatment of type2 DM are patient-centered approach4. In patients- centered the medical providers should make the person as a partner in the clinical decision and the treatment recommendation should be tailored to fit with person’s needs, culture and educational level. Ongoing assessment for treatment goal, person’s willingness and readiness to change his habits to fit with the flexible treatment goal should be considered. Although American Diabetes Association (ADA) recommends maintaining glycated hemoglobin (HbA1c) to <7.0% in most patients, individualization of HbA1c to less stringent targets (up to 8% or higher) for some patients is important such as patients have history of severe hypoglycemia5. Individualization of HbA1c to more stringent targets (6-6.5%) can be suitable for some D Madani et al.                 Study on Patients with Poor Control of  Type II DM  at National Ribat U. H.  © Sudan JMS Vol. 9, No.3. Sept 2014                194 selected patients such as patients with short diabetes duration. Patient-centered approach is now adopted with many recognized organizations such as American Diabetes Association (ADA) and United Kingdom Diabetes (UK Diabetes)6.  MATERIALS AND METHODS: This is a cross sectional hospital based prospective and retrospective study. It was conducted in the National Ribat University Diabetes Clinic, Khartoum state, Sudan. Data collection: Structured questionnaires were distributed to collect data from patients, and patients’ cards were also used to extract some information or to understand some patients’ answers. Data analysis: Data were analyzed using the social package for social sciences (SPSS), version16. Chi square was used and P-value of < 0.05 was considered significant. RESULTS: Total patients were 398 and 88.2% have type 2DM. 56.8% of patients were on oral therapy, while 31.4% (125 patients) had poor glycemic control and were shifted to insulin according to definition and target of poor glycemic control at Ribat University Diabetes Clinic (no patient should be shifted to insulin unless HbA1c > 8%),  (Table 1). Females constituted 76.8% of the patients and 88.8% of patients were  above  40  years  of  age.  About   64.8%  Table (1): Distribution of types of diabetes among patients seen at Ribat diabetic clinic. Type of diabetes Frequency/ Percent P-value Type 2 on oral antidiabetic drugs         2269(56.8) <0.001 Type 2 shifted to insulin 125 (31.4)  Type 1 34 (8.5)  Gestational 7 (1.8)  Newly diagnosed patients 6 (1.5)  Total 398  Table (2): Personal factors before shifted to insulin among the studied patients. Factors Status Frequency/ Percent P-value Sex Male 29 (23.2)          <0.001  Female 96 (76.8)  Age 20-40 14 (11.2)   41-60 70 (56)   Above 60 41 (32.8)  Diabetes duration 0-5 45 (36)   6-10 36(28.8)   11-15 24 (19.2)   16-20 20 (16)  Total  125   were shifted to insulin within 10 years of diabetes diagnosis (Table 2). In this population 79.2% were not having an exercise program, 84% were not having diet program (Table 3), 70.4% needed education about hypoglycemia symptoms and 61.6% needed education about their medication (Tables 4). Co-morbidity in our patients was 64.8% (Figure 1) and 50 patients (40%) were hypertensive (Figure 2). Regarding pharmacological treatment, 54.4% were not adherent to their medications (Table 6), 66.4% were on mono anti diabetic therapy (Figure 3) and 62.4% were on glibenclamide (Table 5). DISCUSSION: Patients studied at Ribat University Diabetes Clinic showed the same reasons of diabetes Madani et al.                 Study on Patients with Poor Control of  Type II DM  at National Ribat U. H.  © Sudan JMS Vol. 9, No.3. Sept 2014                195 poor control known globally. However some differences in frequency and percentages of these reasons were detected upon comparing them with other studies from many countries.  This study showed that age affects diabetes control. Patients with older ages showed poor control and this is consistent with Al-Nuaim et.al 7, and disagrees with Maysaa et al findings8. Majority of our patients, were shifted to insulin when they were more than 40 years of age. American report from centre for disease control reported that poor control is common among adults aged 18–39 years9. Physical under activity may be one of the reasons that led to loss of control among older patients in Sudan. Females in our population had poorer control of sugar. This finding is consistent with Kautzky et al10. This is probably due to the low education level and physical under activity, which is higher among Table (3): Distribution according to life style modification among the studied patients. Question Answer Frequency/ Percent           P-value Have you diet program Yes 20 (16) < 0.001  No 105 (84)  Have you exercise program Yes 26 (20.8)   No 99 (79.2)  Total   125  Table (4): Distribution according to patients’ knowledge among the studied patients. Patient’s knowledge Knowledge level Frequency/Percent P-value Hypoglycemia Knowledge Sufficient 37 (29.6) < 0.001  Insufficient 88 (70.4)  Drugs use Knowledge Sufficient 48 (38.4)   Insufficient 77 (61.6)  Total  125   Table (5): Pharmacological treatment used by the studied patients. Therapy before shift to insulin Frequency/ Percent P-value Glibenclamide 78 (62.4) < 0.001 Glibenclamide+metformin 36 (28.8)  Glimepride+metformin 5 (4.0)  Glimepride 2 (1.6)  Metformin 2 (1.6)  Gliclazide+metformin 1 (0.8)  Gliclazide 1 (0.8)  Total 125  Table (6): Patients' distribution according to adherence to anti-diabetic medications. Patients adherance Frequency/Percent P-value Non adherent to medication  68 (54.4) 0.325 Adherent to medicateon 57 (45.6)  Total 125  females in this study. About 64.8 % of our patients with poor control had type 2 DM. One fifth of these were shifted to insulin within 10 years of diagnosis, whereas Meena et al11 reported that 50% of patients required insulin therapy within 10 years. This study showed diet as one of the reasons that hinder diabetes control and this agrees with many studies12. Madani et © Sudan JMMore thanstudy had when compof our patiand this fwith Aymaconsideredexercise pother reporto the factwere femaliterature15knowledgehypoglycemthis is proeducation patients anHospital. Iinitiate or one of thcontrol. Thwere shiftglibenclamreported thadding significant Figure (1)presence oFigure (2):type of co-patients. 35500204060HTal.              S Vol. 9, N three quano diet proaring withents were inding is n et al stud the daily rogram ants14. This lo that the mles. Unlike -16, this stu about theiia symptobably due tand, weed health enability of intensify the factors e majorityed to insuide as monat early tremetformin ly improve : Patients df co-morbid Patients' dimorbidity a%Como1Heart K   Study on o.3. Sept 2rters of pagram, and  others13. Oon an exerapproximay14. Majoractivities d this cow percent ajority ofwhat was rdy showed r medicatioms was noo low levek relationsducation thealth careerapy (clinithat prev (62.4%) olin after tro therapy. atment inteto sudiabetes coistribution aity. stribution among the s65%rbidty No c110idney EyePatients wi014            tients in ththis is highnly one ficise progrately identicity of patienis enough nsistent wis mainly d our patieneported in tthat patienns usage at satisfactol of patienhip betweeam in Rib providers cal inertia)ent diabetf our patieneatment wMany studnsification lphonylurentrol17. ccording toccording totudied omorbidty19Multipleth Poor Con    196 is er fth m, al ts as ith ue ts he ts’ nd ry ts’ en at to  is es ts ith ies by as   Hdeintrcohamthbe(5sthyofnoindi FtrCItpostinvaananloR1.2.3.trol of  Tyowever futermine rtensificatioeatment ntrol. Thislf of patiedications,an Wabe’stter than 9%)19. Coudy showepertensive Arauz.et ticed that sulin due tosease. igure (3): Peatment intONCLUSI can be conor glycemyle, longerertia. Carrrious branswer for thti-diabeticsner period EFERENC Rang HP,Individual Dale’s PLivingston World HeAgust 2011 Farsaei S, al. Effect glycemic ccontrolled 34%pe II DM  arther studeasons thn. Adheaffects s study showents were  and this fin study in EYusuff et morbidity d that 40, and this al20. Durisome pat cardiovasatients distensificationON: cluded thatic control duration oying bioeqds of anti-e debate a. Again caris required.ES:  Dale MM,variation anharmacologye, 2003,5th edalth Organiz. Sabzghabaeeof pharmacisontrol of Typtrial. J Res MMoCot National Ries are rat preventrence to ignificantlyed that monot adhereding is sligthiopia (51al study affects co% of patfinding goeng this stuients werecular, kidneribution acc.  the major  were sedf diabetes uivalence diabetic, wbout efficarying more  Ritter JM,d drug inter. Edinburghition: 385-388ation. Fact S AM, Zargat-led patient e 2 diabetics ed Sci 2011, 66%no antidiabetmbined antidiibat U. H.equired to treatmentdiabetes diabetesre than onent to theirhtly higher.3%)18, andin Nigeriantrol. Thisients weres with thatdy it was shifted toy and liverording to reasons forentary lifeand clinicastudies forill give ancy of some studies for Moore PKaction, Rang, Churchil. heet No312rzadeh AH,eeducation ona randomized16(1): 43–49. ic drugabetic drug                    l     .  l , t    Madani et al.                 Study on Patients with Poor Control of  Type II DM  at National Ribat U. H.  © Sudan JMS Vol. 9, No.3. Sept 2014                197 4. Inzucchi SE,Bergenstal RM,Buse JB,et al.Mangement of hyperglycemia type2 diabetes patients centered approach position statement of the American diabetes association(ADA) and the European association for the study of diabetes (EASD). Diabetes care 2012; 35(6): 1364-1379. 5. Teoh H, Home P, andLieter LA. Should A1C target be individualized for all people with diabetes? Diabetes Care 2011; 34 (suppl.2): 191-196. 6. U.K.diabetes. Evidence-based nutrition guidelines for the prevention and management of diabetes. Available at: htt/www diabetes org U.K/nutrition guidelines, Date of access 10-18-2013. 7. Nuaim AR, Mirdad S. Al-Rubeaan K,et al. Pattern and factors associated with glycemic control of Saudi diabetic patients. Ann. Saudi Med 1998; 18(2): 109-112. 8. Khattab M, Khader YS, Al-khawaldehA,et al. Factors associated with poor glycemic control among patients withType2 diabetes. Journal of Diabetes and its Complications 2010; 24(2): 84-89. 9. Characteristics Associated with Poor Glycemic Control among Adults with Self-Reported Diagnosed Diabetes — National Health and Nutrition Examination Survey, United States, 2007–2010. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion 2012;61: 32-37. 10. Kautzky-Willer A, Kamyar MR, Gerhat D,et al. 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Study on Patients with Poor Control of Type II Diabetes Mellitus at National Ribat University Hospital

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Anticonvulsant and Anxiolytic Properties of the Roots of Grewia bicolor in Rats

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