Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad

BACKGROUND: The increasing global popularity of herbal remedies requires further investigation to determine the probable factors driving this burgeoning phenomenon. We propose that the users' perception of efficacy is an important factor and assessed the perceived efficacy of herbal remedies by users accessing primary health facilities throughout Trinidad. Additionally, we determined how these users rated herbal remedies compared to conventional allopathic medicines as being less, equally or more efficacious. METHODS: A descriptive cross-sectional study was undertaken at 16 randomly selected primary healthcare facilities throughout Trinidad during June-August 2005. A de novo, pilot-tested questionnaire was interviewer-administered to confirmed herbal users (previous or current). Stepwise multiple regression analysis was done to determine the influence of predictor variables on perceived efficacy and comparative efficacy with conventional medicines. RESULTS: 265 herbal users entered the study and cited over 100 herbs for the promotion of health/wellness and the management of specific health concerns. Garlic was the most popular herb (in 48.3% of the sample) and was used for the common cold, cough, fever, as 'blood cleansers' and carminatives. It was also used in 20% of hypertension patients. 230 users (86.8%) indicated that herbs were efficacious and perceived that they had equal or greater efficacy than conventional allopathic medicines. Gender, ethnicity, income and years of formal education did not influence patients' perception of herb efficacy; however, age did (p = 0.036). Concomitant use of herbs and allopathic medicines was relatively high at 30%; and most users did not inform their attending physician. CONCLUSION: Most users perceived that herbs were efficacious, and in some instances, more efficacious than conventional medicines. We suggest that this perception may be a major contributing factor influencing the sustained and increasing popularity of herbs. Evidence-based research in the form of randomized controlled clinical trials should direct the proper use of herbs to validate (or otherwise) efficacy and determine safety. In the Caribbean, most indigenous herbs are not well investigated and this points to the urgent need for biomedical investigations to assess the safety profile and efficacy of our popular medicinal herbs.

Helicobacter pylori infection in the Caribbean: update in management

Helicobacter pylori infection of the stomach is one of the commonest chronic infections world wide and in the Caribbean, over 50 of the population are affected. H pylori is probably transmitted from person to person by oro-fecal and oro-oral means. H pylori is directly associated wirh peptic ulcer disease, chronic antral gastritis, gastric carcinoma and B-cell lymphoma of the stomach. In patients with peptic ulcer and H pylori infection, eradication of infection with antibiotics significantly decreases recurrence of ulcers. All patients with H pylori related disease should be tested and treated if positive. The treatment of H pylori infection has evolved over the years but at present triple therapy which includes two antibiotics is recomended.(AU)

The efficacy of acarbose in type 2 diabetes mellitus in Jamaica

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8 percent) did not complete the study and were excluded from further analysis. Six (13 percent) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n=15), [Gp B], oral hypoglycaemic agents, OHAs (n=17), [Gp C], or insulin (n=8), Gp D]. In addition, during the run in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3 month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 ñ 1.1 to 8.4 ñ 0.9 (p<0.027) and, from 11.0 ñ 1.0 to 8.7 ñ 0.7 (p<0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 ñ 1.1 percent to 12.2 ñ 1.0 percent (p<0.016) in Gp B, from 14.8 ñ 1.1 to 11.9 ñ 1.1 percent (p<0.002) in Gp C, and from 14.1 ñ 1.4 to 11.8 ñ 1.4 (p<0.02) in Gp D. Twenty-three per cent (23 percent) of the patients experienced flatulence; 7.5 percent changes in bowel habits and 5 percent, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.(Au)

Relapse rates following Leprosy multidrug therapy

This is a retrospective study of relapses among leprosy patients who received multiple drug therapy in Trinidad and Tobago between January 1982 and Decembe 1994. The results of the study reveal a relapse of 0.65 percent for multibacillary cases and 1.5 percent for paucibacillary cases. These results are comparable to the relapse rates reported by the World Health Organisation.(Au)

The prophylaxis of acute rheumatic fever in a pair of monozygotic twins: the public health implications

Recurrent acute rheumatic fever and rheumatic heart disease can be prevented by antibiotic intervention. We report the case of genetically identical twins, one of whom had overt rheumatic fever, received penicillin prophylaxis and did not have rheumatic heart disease. The other must have had inapparent rheumatic fever, received no chemotherapy prophylaxis and proceeded to develop rheumatic heart disease. A greater clinical and laboratory vigilance is required for the diagnosis of acute rheumatic fever in the asymptomatic identical twin of a patient with rheumatic fever. This case provides further evidence of a genetic predisposition of rheumatic fever and demonstrates the continued value of penicillin in the prophylaxis of acute rhuematic fever. It emphasises the need to maintain the integrity of preventive programmes against rheumatic fever worldwide. Studies which explores the HLA and other genetic linkages with rheumatic fever should be encouraged.(AU)

Severe aplastic anaemia - complete response to antilymphocyte globulin and cyclosporin

Severe aplastic anaemia is uniformly fatal unless treated with immunosuppressive therapy or bone marrow transplantation. The latter is curative in 65 percent of patients and is the treatment of choice in children and young adults. Antilymphocyte globulin (ALG) and cyclosporin may be used successfully in the absence of an HLA matched sibling donor. We report the case of a twelve year old boy with severe aplastic anaemia who received immunosuppressive with ALG and cyclosporin and is alive and well three years an six months post treatment.(AU)

Methicillin resistant Staphylococcus aureus

The prevalence of methicillin resistant Staphylococcus aureus (MRSA) at the General Hospital, Port-of-Spain, between June 1995 and May 1996 was determined. The MRSA prevalence rate was 4.6 percent of all S aureus isolates, with all but one nosocomially acquired. 15 isolates were associated with infections, and three were colonizing strains. 17 of the 18 patients with MRSA had received antibiotics previously, including 13 who had received multiple antibiotics. Skin and soft tissue were the sites of infection and colonization in 12 cases; and surgical wards and the Intensive Care Unit (ICU) accounted for 16 MRSA isolates. All isolates were sensitive to vancomycin and all but one were resistant to gentamicin. MRSA occurred sporadically in a wide distribution of wards and physicians' services, although the isolation of three strains from the ICU and three strains from a surgical ward were temporally related. Only one of two deaths was attributable to MRSA. Control of the spread of MRSA in this hospital must include the reinforcement of the appropriate use of antibiotics, hand washing and appropriate isolation of patients in the surgical and intensive care wards.(Au)

Zidovudine and interferon therapy for adult T-cell leukaemia/lymphoma: results of a preliminary study at UHWI-Mona

Seven patients with adult T-cell leukaemia/lymphoma(ATL) were treated with a combination of zidovudine (AZT) and interferon after failed chemotherapy. One patient showed a major response for nine months. The remainder showed progressive disease further complicated by drug toxicity. The poor responses could be explained by patient selection, since most patients had advanced disease refractory to chemotherapy. A larger more protracted study is required for further evaluation of this treatment option. (AU)

Failure of combined choroquine and high-dose primaquine therapy for Plasmodium vivax malaria acquired in Guyana, South America

The presence of chloroquine-resistant Plasmodium vivax malaria in the New World has been suspected but not confirmed. We report the cases of three patients who acquired vivax malaria in Guyana, South America, and for whom standard chloroquine therapy (25mg/kg) failed despite therapeutic blood levels. The optimal treatment of Chloroquine-resistant P. vivax malaria is unknown, but recent studies suggest that a combination of chloroquine (25 mg/kg) and high-dose primaquine (2.5 mg/kg over 48 hours) is effective therapy. Two of our patients had recurrences of P. vivax malaria 6-8 weeks after receiving directly observed therapy with this combination. These cases confirm the presence of chloroquine-resistant P. vivax in Guyana and emphasize the need for better treatment regimens for chloroquine-resistant and primaquine-resistant P. vivax malaria.(AU)

Preventing opportunistic infections in human immunodeficiency virus-infected persons: implications for the developing world

More than 18 million persons in the the world are estimated to have been infected with human immunodefeiciency virus (HIV), the cause of the acquired immunodeficiency syndrome (AIDS). As immunodeficiency progresses, these persons become susceptible to a wide variety of opportunistic infections (OIs). The spectrum of OIs varies among regions of the world. Tuberculosis is the most common serious OI in sub-Saharan Africa and is also more common in Latin America and in Asia than in the United States. Bacterial infections such as toxoplasmosis, cryptosporidiosis, and isosporaisis are also common in Latin America. Fungal infections, including cryptococcosis and Penicillium marneffei infection, appear to be prevalent in Southeast Asia. Despite limited health resources in these regions, some measures that are recommended to prevent OIs in the United States may be useful for prolonging and improving the quality of life of HIV-infected persons. These include trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia, toxoplasmosis, and bacterial infections; isoniazid to prevent tuberculosis; and 23-valent pnemococcal vaccine to prevent disease due to Streptococcus pneumoniae. Research is needed to determine the spectrum of OIs and the efficacy of various prevention measures in resource-poor nations, and health officials need to determine a minimum standard of care for HIV-infected persons. An increasing problem in the developing world, HIV/AIDS should receive attention comparable to other tropical diseases (AU).

A second report on multidrug therapy for leprosy in Trinidad and Tobago

Multidrug therapy consisting of rifampicin, ciofazimine and dapsone, was introduced to Trinidad and Tobago in January 1982. This was with slight modification of the WHO regimens. Since then 717 patients have completed multidrug therapy up to the end of December 1987. Of these, 272 patients have completed surveillance and have been discharged from clinic attendance. Thirty-four patients died before completing surveillance and three are known to have migrated. Of the remaining 408 cases still under surveillance, the majority are multibacillary. This paper reviews the outcome of multidrug therapy in Trinidad and Tobago between January 1982 and December 1987--a period of 6 years, and presents some of the statistics related to the newly diagnosed patients within the same period. (AU)

ACTH - inosine pranobex in the treatment of AIDS: encouraging results

Twenty patients with acquired immune deficiency syndrome (AIDS) received treatment with inosine pranobex and specific antibacterial andanti-parasitic therapy. Five died shortly after hospitalization, but a further fifteen who also received ACTH, survived, gained weight and improved clinically, biochemically and haematologically (AU)

Changes in red cell sodium content and blood pressure levels with potassium supplementation in black hypertensive patients

Red cell sodium and potassium content were measured in 24 black hypertensive patients while they were hypokalaemic on thiazide diuretic therapy and again after potassium supplements (48 meq elemental K+/day). Mean and diastolic blood pressure levels fell by 4.1-4.4 and 4.5-5.2 mm Hg respectively with potassium supplementation, while both urinary excretion of potassium and serum potassium rose. Urinary sodium excretion was unchanged. Red cell potasssium remained within the normal range but red cell sodium, initially high, fell with potassium therapy. This study confirms the importance of potassium supplementation where hypokalaemic results from diuretic therapy (AU)

The efficacy of short course chemotherapy for tuberculosis in Jamaica - abstract

The use of rifampicin has reduced the duration of therapy in tuberculosis considerably. Short course chemotherapy aims at reducing the dutation of therapy while maintaining optimum efficacy. The regime used in this study was: Isoniazid (H) 300 mg, Rifampicin (R) 450-600 mg and Pyrazinamide (Z) 800-1200 mg as a single oral dose daily with Streptomycin (S) 1 gm intramuscularly daily for two months as hospitalized therapy, followed by Isoniazid 300 mg and Thiacetazone (T) 150 mg daily for six months after discharge. Between 1979 and 1981, 38 cases with AFB positivity were treated with 2SHRZ/6HT. There were 15 males and 23 females with a mean age of 31 years. In 37 patients, cough was the predominant symptom, with expectoration in 14. Loss of weight was seen in 21 and fever in 15. In all cases, there was radiological evidence of cavitation in the upper lobes. Therapeutic evaluation showed weight gain and return of appetite within two months. Sputum conversion to culture negatively was seen in 1 to 14 weeks with a mean of 46 days for males and 55 days for females. In 17 cases, there was a transient rise in uric acid level, a side-effect of Pyrazinamide, with no clinical consequence. One case of arthralgia was seen. We recommend the 2SHRZ/6HT regime as the most effective, and the cheapest short duration therapy for tuberculosis in Jamaica (AU)

The management of severe hypertension with Minoxidil in a once-a-day treatment regimen

We evaluated the antihypertensive efficacy of "once-a-day" minoxidil, given in conjunction with a diuretic and sympatholytic, and the effect of this simple regimen on patient compliance. Twenty-one severely hypertensive patients and their existing antihypertensive regimens changed to a single daily dose of chlorthalidone (50-100mg) and either nadolol (160 mg) or reserpine (.25mg) for a 3-week period. After stabilization on these two drugs, a single daily dose of minoxidil (2.5 mg) was added to each patient's regimen. Doses were titrated as necessary to achieve diastolic blood pressures of <90 mmHg. After 3 and 6 months of maintenance therapy, blood pressures were measured 24 hours after the previous day's dosing to evaluate the persistence of the antihypertensive effect. Twenty-four-hour blood pressure control was achieved on 76 percent of these occasions, and on at least one occasion in 90 percent of the patients. In addition, compliance was excellent (AU)

High dosage cyclophosphamide and dexamethasone treatment of paraquat poisoning with 75 percent survival

The mortality from paraquat poisoning is usually very high, and even in the best centres it exceeds 60 percent. In this paper, we report a treatment regimen with the surival of fifteen of twenty patients (75 percent) who had ingested 15 ml to 250ml of 20 percent and 24 percent paraquat. They were treated for 2 weeks with high doses of cyclophosphamide amd dexamethasone, forced diuresis with intravenous frusemide, triamterine and hydrochlorothiazide and liberal potassium supplements in addition to the routine measures for the elimination of paraquat from the gut with Fuller's Earth, activated charcoal and magnesium sulphate. The regimen is based on our hypothesis that the damage to the pulmonary alveolar capillary membrane is caused by superoxide produced by paraquat, and that this process triggers off further immunological changes with the activation of neutrophils and production of toxic oxygen metabolites by the immune complexes, and that the immunological mechanisms causing activation of the neutrophils are suppressed by cyclophosphamide and dexamethasone (AU)

Comparison of the effectiveness of a beta blocker (Atenolol) and a diuretic (Chlorthalidone) in black hypertensive patients

A double-blind crossover trial of atenolol and chlorthalidone was done in black Jamaican hypertensive patients. After an initial four weeks of single drug therapy, the beta blocker and thiazide diuretic were used in combination. Chlorthalidone at a daily dose of 25 mg produced a significant (p<0.05) fall in the mean systolic and diastolic pressures (19.4 mm Hg and 12.2 mm Hg respectively); atenolol produced a significant fall in th ediastolic blood pressure (6.5 mm Hg); and combination therapy produced a reduction systolic and diastolic blood pressures (27.8 mm Hg and 17.8 mm Hg, respectively). The study showed that combination therapy using a low dose of thiazide diuretic and a beta blocker was synergic, but that a thiazide was more effective than a beta blocker in lowering the blood pressure in black hypertensive patients. (AU)

Pregnancy complicated by thyrotoxicosis

Of 17 pregnancies complicated by thyrotoxicosis, detection and treatment commenced in 11 before conception, and in 6 during pregnancy. Treatment consisted of carbimazole alone in 13, and carbimazole and propanolol in 4 pregnancies. There was one abortion in the group treated with carbimazole. In the four pregnancies managed with carbimazole and propanolol, there were two perinatal deaths. There was adequate response with minimal doses of anti-thyroid drugs, supported by clinical assessment and assays of thyroid hormones (AU)

Laboratory studies of a multiple-antibiotic spray

A spray delivering neomycin, bacitracin and polypmyxin in powder form was tested for its effect upon potentially pathogenic bacteria under laboratory conditions. Cultures of all of the 168 bacterial strains tested were inhibited by the spray. Agar-diffusion methods were employed to demonstrate various interactions between the component antibiotics. The various bacterial groups studied revealed different antibiotic-interaction patterns. Tube tests confirmed that the majority of these were not diffusion artefacts. No evidence was found of antagonism sufficiently pronounced to contraindicate the use of this antibiotic triad. It is possible, though by no means certain, that neomycin alone would be as useful as the triad.(AU)