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Bitis arietans (Puff adder), Naja haje (Egyptian cobra), and Naja pallida (Red spitting cobra) venoms were tested for antimicrobial activity. This evaluation employed disc diffusion and microbroth dilution techniques. Gram-positive bacteria (Bacillus cereus and Staphylococcus aureus) and Gram-negative bacteria (Escherichia coli, Klebsiella pneumonia, and Salmonella typhi) were used. Aztreonam (30 µg), cefpodoxime (10 µg), cefoxitine (30 µg), streptomycin (25 µg), ceftriaxone (30 µg), nalidixic acid (30 µg), tetracycline (30 µg), and sulfamethoxazole (25 µg) were used as controls. All tests were conducted in triplicate (n = 3). Results. The activity of B. arietans venom against Gram-negative bacteria was significantly lower (p < 0.001) than that of controls. The efficacy of B. arietans venom and sulfamethoxazole against both Gram-positive and Gram-negative bacteria was not significantly different (p > 0.9999). The efficacy of B. arietans venom against Gram-positive bacteria was significantly lower (p < 0.001) than cefoxitin, streptomycin, and tetracycline. The efficacy of N. haje venom against Gram-negative bacteria was significantly lower (p < 0.001) than that of controls. There was no significant difference in the antimicrobial efficacy of N. haje venom and controls against Gram-positive bacteria (p=0.3927 to p=0.9998). There was no significant difference in the efficacy of N. pallida venom and controls against Gram-negative bacteria (p=0.3061 to p=0.9981). There was no significant difference in the efficacy of N. pallida venom and controls against Gram-positive bacteria (p=0.2368 to p > 0.9999). Conclusions. Of all the tested venoms, only Naja pallida venom showed good efficacy against both Gram-positive and Gram-negative bacteria.
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Background: The Mbeere South community of Embu County consume leaves of Catha edulis for its stimulant and euphoretic actions. Other indigenous uses of the plant are undocumented. Information on the pharmacology and safety of this plant is also scanty. This study aimed to document the ethnopharmacology, antimicrobial properties, and toxicity of C. edulis leaves collected from the Mbeere South community in Kenya. Methods: Ethnopharmacological data was collected from 35 informants using semi-structured questionnaires. Leaf extracts of C. edulis were prepared using acetone, water, and methanol. The antimicrobial properties of these extracts were evaluated against Bacillus cereus, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans. The toxicity of the aqueous extract was determined using hematological, biochemical, and histopathological parameters in male and female Sprague Dawley rats at 250 mg/kg, 500 mg/kg, and 1000 mg/kg doses over 28 days. p<0.05 was considered significant. Results: All informants were male, most were married, >50 years old, with >10 years of experience. The sources, local names, preparation, storage conditions, indications, frequency of use, dosage, and side effects of C. edulis were documented. All extracts were ineffective against E. coli, P. aeruginosa, and C. albicans. They had limited efficacy against B. cereus and S. aureus. Significant differences were observed in the hematological and biochemical parameters of rats at the tested doses. Low, intermediate, and high doses of the aqueous extract of C. edulis produced local congestion of the cardiac and hepatic vessels. Localized interstitial connective tissue proliferation, multifocal kidney interstitial hemorrhage, and localized tubular epithelium necrosis were also observed in female rats. Conclusions: The ethnobotanical uses of C. edulis among the Mbeere South community were documented for the first time. Limited antimicrobial efficacy and toxicity at high doses limit the use of leaves of C. edulis.
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Catha , Escherichia coli , Ratos , Animais , Etnofarmacologia , Ratos Sprague-Dawley , Staphylococcus aureus , Candida albicansRESUMO
Olea africana is used by some indigenous communities in Kenya to control gastrointestinal worms in animals. Plant-based anthelmintics are gaining popularity globally in the control of gastrointestinal worms in animals. The egg hatch inhibition assay was used to assess the in vitro anthelmintic efficacy of aqueous and ethanol leaf extracts of O. africana against the eggs of mixed gastrointestinal helminths in dogs. Probit regression was used to calculate the concentration of extracts that inhibited egg hatching by 50% (IC50). Albendazole was used as a control. Standard techniques were used to quantify the phytochemicals in the extracts. The aqueous extract had an IC50 of 1.85 mg/mL (1.64-2.10), and the ethanol extract had an IC50 of 0.25 mg/mL (0.23-0.26). Quantitative phytochemical analysis revealed that aqueous and ethanol extracts of O. africana contained alkaloids (19.40 and 61.60%), saponins (24.00 and 6.00%), phenols (0.95 and 1.28 mg/g gallic acid equivalents (GAE)), flavonoids (8.71 and 12.26 mg/g catechin equivalents (CE)), and tannins (67.30 and 76.30 mg/g of tannic acid equivalent (TAE)), respectively. O. africana has dose-dependent anthelmintic effects against mixed gastrointestinal worms in dogs. These findings support the traditional use of Olea africana as a treatment option for gastrointestinal worms in dogs.
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This study aimed to determine the efficacy of Inoserp, Vins bioproducts, and South African Institute of Medical Research (SAIMR) polyvalent antivenoms in neutralizing Naja ashei venom-induced lethality in mice. The neutralization efficacy of the antivenoms were expressed as effective dose, median effective ratio, potency, normalized potency, volume, and the number of vials of antivenom required to neutralize 100 mg of Naja ashei venom (NAV).
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OBJECTIVE: To determine the prevalence of vitamin D deficiency (VDD) in exclusively breastfed infants at the Aga Khan University Hospital Nairobi, Kenya (AKUHN). The relationships between 25-hydroxyvitamin D; 25OHD, parathyroid hormone (PTH), maternal vitamin D supplementation, and sunlight exposure were also determined. METHODS: Blood from 98 infants was assayed for 25OHD, calcium, phosphate, and PTH. Socio-demographic and clinical characteristics were analyzed using descriptive statistics and inferential analysis (p < 0.05). RESULTS: The prevalence of VDD (25OHD <12 ng/mL), vitamin D insufficiency (VDI, 25OHD 12-20 ng/mL) and vitamin D sufficiency (VDS, 25OHD >20 ng/mL) was 11.2% (95% CI 8.0%-14.4%), 12.2% (95% CI 8.9%-15.5%), and 76.5% (95% CI 72.3%-80.8%) respectively. There was no difference in the mean age, head circumference, length, or weight of infants in VDD, VDI, and VDS groups. PTH was elevated when 25OHD was <12 ng/mL and normal when 25OHD was between 12-20 ng/mL. 25OHD and PTH were normal in infants whose mothers received vitamin D supplements. Infants who received <30 minutes/day of exposure to sunlight were 5 times more likely to have VDI than infants who received ≥30 minutes/day (p = 0.042). CONCLUSION: The prevalence of VDD in exclusively breastfed infants at AKUHN is low. The current national policy that recommends exclusive breastfeeding of infants in the first 6 months of life appears to be effective in staving off vitamin D deficiency but those infants with < 30 minutes sunlight exposure may benefit from low dose supplemental vitamin D during times of low sunlight exposure.
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Aleitamento Materno , Deficiência de Vitamina D , Feminino , Humanos , Lactente , Quênia/epidemiologia , Hormônio Paratireóideo , Prevalência , Estações do Ano , Atenção Terciária à Saúde , Vitamina D , Deficiência de Vitamina D/epidemiologiaRESUMO
Lethality and cytotoxicity assays of snake venoms and their neutralization by antivenom require many mice for the experiments. Recent developments have prompted researchers to seek alternative strategies that minimize the use of mice in line with Russel and Burch's 3Rs philosophy (Replacement, Reduction, and Refinement). Artemia salina is an animal model widely used for toxicity screening. However, its use in snake venom toxinology is limited by a lack of data. The present study compared the toxicity of venoms from Bitis arietans, Naja ashei, and Naja subfulva using mice and Artemia salina. In the Artemia salina test at 24 h and the dermonecrotic test in mice, the toxicity of the venoms was in the order Naja ashei ~ Naja subfulva > Bitis arietans. In the lethality test in mice, the toxicity of the venoms was in the order Naja subfulva > Naja ashei > Bitis arietans. These findings suggest that the toxicity of the venoms in Artemia salina and the dermonecrotic bioassay in mice have a similar trend but differ from the lethality test in mice. Therefore, it may be relevant to further explore the Artemia salina bioassay as a potential surrogate test of dermonecrosis in mice. Studies with more venoms may be needed to establish the correlation between the Artemia salina bioassay and the dermonecrotic assay in mice.
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BACKGROUND: Poor access to healthcare in rural communities causes many people to seek herbalists who use medicinal plants for the treatment of various disease conditions. Most knowledge of traditional herbal medicine makes use of indigenous remedies which are often undocumented and are at risk of being lost. The preservation of this knowledge may facilitate scientific inquiry into promising new therapeutic molecules. METHODS: Semi-structured questionnaires were used to collect the sociodemographic information of 30 herbalists in Kisumu East Sub County. The local names of medicinal plants used in managing illnesses of the respiratory system, their habit, active parts, indications, methods of preparation, routes of administration, scientific identity, and conservation status were also recorded. Other reported traditional uses, pharmacological activities, and toxicological data were identified via a literature search. RESULTS: Most herbalists were female (86.7%), aged between 61 and 70 years (43.3%) with no formal education (56.7%), and had 21-30 years of practice (30%). 44 plant species, belonging to 43 genera and 28 families were identified. Leguminosae and Rutaceae plant families were predominant, leaves were frequently used (33%), and trees were the most common habit (44.4%). Most plants were collected in the wild (79.2%), preparation was mainly by decoction (68.8%), and the administration was mainly orally. The main indication was cough and 79.5% of all documented plant species had previously been reported to have a pharmacological activity relevant to the mitigation of respiratory illnesses. Toxicological data was available for 84.1% of the plant species identified. CONCLUSIONS: The predominant use of roots, root barks, and root tubers by herbalists in Kisumu East Sub County threatens to negatively impact the ecological survival of some plant species. The preservation of herbalists' knowledge of medicinal plants in the study area is a pressing concern considering their advanced age and little formal education. There is a need to conserve some of the medicinal plants documented in this study. The medicinal claims made by herbalists also warrant scientific scrutiny.
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OBJECTIVE: Naja ashei is a snake of medical importance in Kenya, Ethiopia, Somalia, Uganda, and Tanzania. Little is known about the enzymatic (snake venom phospholipases A2; svPLA2's) and toxic (lethal) activities of N. ashei venom and crucially, the safety and capacity of available antivenom to neutralize these effects. This study aimed to determine the enzymatic and toxic activities of N. ashei venom and the capacity of Indian and Mexican manufactured antivenoms to neutralize these effects. The protein content of the venom and the test antivenoms were also evaluated. A 12-point log concentration-response curve (0.5-22.5 µg/mL) was generated on an agarose-egg yolk model to predict the svPLA2 activity of the venom. The toxicity profiles of the venom and antivenoms were evaluated in the brine shrimp lethality assay. Lowry's method was used for protein estimation. RESULTS: Low and intermediate concentrations of the venom exhibited similar svPLA2 activities. The same was true for concentrations > 15 µg/mL. Intermediate and high doses of the venom exhibited similar mortalities in brine shrimp and test antivenoms were generally non-toxic but poorly neutralized svPLA2 activity. Mexican manufactured antivenom had lower protein content but neutralized venom-induced brine shrimp lethality much more effectively than Indian manufactured antivenom.
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Antivenenos , Venenos Elapídicos/enzimologia , Venenos Elapídicos/toxicidade , Naja , África Oriental , Animais , Artemia/efeitos dos fármacos , Venenos Elapídicos/antagonistas & inibidores , Fosfolipases A2/metabolismoRESUMO
Background: Data on the cost of snakebite injuries may inform key pillars of universal health coverage including proper planning, allocation, and utility of resources. This study evaluated the injuries, management, and costs resulting from snakebites at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kenya. Methods: In total, medical records of 127 snakebite victims attending JOOTRH between January 2011 and December 2016 were purposely selected and data on the age, gender, type of residence (urban or rural), part of the body bitten, time of bite, injuries, pre-hospital first aid, time to hospital, length of stay, treatment, and costs were collected. Regression analysis was used to predict the total indirect cost of snakebite injuries and p≤ 0.05 was considered significant. Mortality and loss of income of hospitalized victims were considered as direct costs. Results: It was found that 43 victims were 13-24 years of age, 64 were female, 94 were from rural areas, 92 were bitten on the lower limbs, 49 were bitten between 6.00 pm and midnight, 43 attempted pre-hospital first aid, and the median time to hospital was 4.5 hours. Antivenom, supportive therapy, antibiotics, antihistamines, corticosteroids, analgesics, and non-steroidal anti-inflammatory drugs were used. Cellulitis, compartment syndrome, gangrenous foot, psychiatric disorder, and death were the main complications. Most victims spent 1-5 days in hospital and the median cost of treating a snakebite was 2652 KES (~$26). Drugs, ward charges, and nursing procedures were the highest contributors to the total indirect cost. Victims hospitalized for 6-10 days and >10 days incurred 32% and 62% more costs, respectively, compared to those hospitalized for 1-5 days. Conclusions: The longer snakebite victims are hospitalized, the higher the cost incurred. Continuous medical education on the correct management of snakebites should be encouraged to minimize complications that may increase hospital stays and costs incurred.
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Encaminhamento e Consulta , População Rural , Mordeduras de Serpentes , Adolescente , Adulto , Antivenenos , Criança , Feminino , Custos de Cuidados de Saúde , Humanos , Quênia , Masculino , Mordeduras de Serpentes/economia , Mordeduras de Serpentes/terapia , Adulto JovemRESUMO
The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of effects of black mamba envenomation in a 13-year-old boy in the Jimba area of Malindi. The victim presented to Watamu Hospital, a low resource health facility with labored breathing, frothing at the mouth, severe ptosis and pupils non-responsive to light. His blood pressure was unrecordable, heart rate was 100 beats per minute but thready, his temperature was 35.5 °C, and oxygen saturation was 83%. Management involved suction to clear salivary secretions, several hours of mechanical ventilation via ambu-bagging, oxygen saturation monitoring, and the use of South African Vaccine Producers (SAVP) polyvalent antivenom. Subcutaneous adrenaline was used to stave off anaphylaxis. The victim went into cardiac arrest on two occasions and chest compressions lasting 3â»5 min was used to complement artificial ventilation. Hemodynamic instability was corrected using IV infusion of ringers lactate and normal saline (three liters over 24 h). Adequate mechanical ventilation and the use of specific antivenom remain key in the management of black mamba envenomation.
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The emergency department (ED) of the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) handles many cases of poisoning. However, there is scant information on the factors, agents, and outcomes of poisoning at the hospital. The aim of this work was to determine the factors, agents, and outcomes of poisoning at JOOTRH. Records of patients who presented to JOOTRH with symptoms of poisoning between January 2011 and December 2016 were retrieved. Data on age, gender, offending agents, time, and season of exposure were collected. Information on the route of exposure, motive, and clinical symptoms of poisoning was also included. Other information included the laboratory evaluation, first aid measures, period of hospitalization, and outcome of poisoning. Mean, standard deviation, frequencies and bar graphs were used to describe the demographic factors of the study population. Multivariate logistic regression was used to determine the strength of association between risk factors and outcome of poisoning among patients. The level of significance for inferential analysis was set at 5%. There were 385 cases of poisoning: 57.9% (223/385) were male, 31.9% (123/385) were 13â»24 years of age, and 83.9% (323/385) of exposures were in Kisumu County. The peak time of exposure was 6:00â»00:00, and 23.6% (91/385) presented 1â»4 h after exposure. About 62.9% (242/385) of the cases were due to accidental poisoning. Snakebites and organophosphates (OPPs) contributed to 33.0% (127/385) and 22.1% (85/385) of all cases, respectively. About 62.1% (239/385) of exposures were oral, and 63.9% (246/385) of all cases occurred in the rainy season. Additionally, 49.2% (60/122) of intentional poisoning was due to family disputes, and 16.1% (10/62) of pre-hospital first aid involved the use of tourniquets and herbal medicine. About 28.6% (110/385) of the victims were subjected to laboratory evaluation and 83.9% (323/385) were hospitalized for between 1â»5 days. Other results indicated that 80.0% (308/385) responded well to therapy, while 7.3% (28/385) died, 68% (19/28) of whom were male. Furthermore, 39.3% (11/28) of the deaths were related to OPPs. Our findings suggest that the earlier the victims of poisoning get to the hospital, the more likely they are to survive after treatment is initiated. Similarly, victims of poisoning due to parental negligence are more likely to survive after treatment compared to other causes of poisoning, including family disputes, love affairs, snakebites, and psychiatric disorders. The management of JOOTRH should consider allocating resources to support the development of poison management and control.
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INTRODUCTION: Snake bites are a silent public health problem in Kenya. Previous studies on snake bites in the country have mainly focused on identifying offending snake species, assessing the severity of envenomation and testing the efficacy of antivenom. Factors associated with snake bites in the country are yet to be fully understood. The aim of this work was to determine pharmaco-epidemiological factors associated with snake bites in areas of Kenya where incidence, severity and species responsible for snake bites have been reported. METHODS: Kakamega provincial hospital, Kabarnet, Kapenguria and, Makueni district hospitals were selected as study sites based on previous findings on incidence, severity and species responsible for snake bites in catchment areas of these hospitals. Persistent newspaper reports of snake bites in these areas and distribution of snakes in Kenya were also considered. Cases of snake bites reported between 2007-2009 were retrospectively reviewed and data on incidence, age, site of the bites, time of bite and antivenom use was collected. RESULTS: 176 bites were captured, 91 of which occurred in 2009. Individual incidence was between 2.7/100,000/year and 6.7/100,000/year. Bites peaked in the 1-15 year age group while 132/176 bites were in the lower limb area and 49/176 victims received antivenom. Most bites occurred during the dry season, in the bush and in the evening. Overall mortality was 2.27%. CONCLUSION: There is a need to sensitize the Kenyan public and healthcare personnel on preventive measures, first aid and treatment of snake bites.
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Antivenenos/administração & dosagem , Mordeduras de Serpentes/epidemiologia , Serpentes , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Saúde Pública , Estudos Retrospectivos , Estações do Ano , Índice de Gravidade de Doença , Mordeduras de Serpentes/mortalidade , Mordeduras de Serpentes/terapia , Fatores de Tempo , Adulto JovemRESUMO
Complementary and alternative medicine is an integral component of primary healthcare in Kenya. This is because the infrastructural health setup in the country is inadequate in catering for all the medical needs of the population. This particularly holds true in the rural areas where many rural folk rely on products of herbal origin to offset their healthcare needs. More often than not these products are an elaborate cacophony of several different substances of biological origin and thus need personnel adept in their preparation. Sadly, due to loopholes in legislation and regulation, quacks have a field day in the practice. Moreover, the process of planting, harvesting, preparation and storage of herbs and related products dictates that a significant number of people will ultimately be involved in the whole process. This is likely to set the stage for manipulation and compromise of the safety, quality and efficacy of these products. This state of affairs appears unabated especially in the context of the current legal and regulatory framework governing herbal medicine use and practice in Kenya. Not only are these laws inadequate, they are shrouded in ambiguity, open to interpretation and the authorities mandated to implement them often end up performing duplicate roles. The aim of this review is to critique the legal and regulatory provisions governing herbal medicine use and practice in Kenya. In conclusion, laws and regulations meant to control herbal medicine use and practice in Kenya are wanting. Clear and definitive legislation on herbal medicine use and practice coupled with effective implementation by mandated institutions will go a long way in inspiring confidence to all stakeholders of herbal medicine.
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Medicinas Tradicionais Africanas/normas , Fitoterapia/normas , Preparações de Plantas/uso terapêutico , Terapias Complementares/legislação & jurisprudência , Medicina Herbária/legislação & jurisprudência , Humanos , Quênia , Legislação de Medicamentos , Preparações de Plantas/normas , Plantas Medicinais/químicaRESUMO
ABSTRACT Objective: To determine the prevalence of vitamin D deficiency (VDD) in exclusively breastfed infants at the Aga Khan University Hospital Nairobi, Kenya (AKUHN). The relationships between 25-hydroxyvitamin D; 25OHD, parathyroid hormone (PTH), maternal vitamin D supplementation, and sunlight exposure were also determined. Subjects and methods: Blood from 98 infants was assayed for 25OHD, calcium, phosphate, and PTH. Socio-demographic and clinical characteristics were analyzed using descriptive statistics and inferential analysis (p < 0.05). Results: The prevalence of VDD (25OHD <12 ng/mL), vitamin D insufficiency (VDI, 25OHD 12-20 ng/mL) and vitamin D sufficiency (VDS, 25OHD >20 ng/mL) was 11.2% (95% CI 8.0%-14.4%), 12.2% (95% CI 8.9%-15.5%), and 76.5% (95% CI 72.3%-80.8%) respectively. There was no difference in the mean age, head circumference, length, or weight of infants in VDD, VDI, and VDS groups. PTH was elevated when 25OHD was <12 ng/mL and normal when 25OHD was between 12-20 ng/mL. 25OHD and PTH were normal in infants whose mothers received vitamin D supplements. Infants who received <30 minutes/day of exposure to sunlight were 5 times more likely to have VDI than infants who received ≥30 minutes/day (p = 0.042). Conclusions: The prevalence of VDD in exclusively breastfed infants at AKUHN is low. The current national policy that recommends exclusive breastfeeding of infants in the first 6 months of life appears to be effective in staving off vitamin D deficiency but those infants with < 30 minutes sunlight exposure may benefit from low dose supplemental vitamin D during times of low sunlight exposure.