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BACKGROUND: The incidence of resistance among currently available antimalarial drugs, as well as the high economic cost of malaria, has prompted researchers to look for novel antimalarial molecules. As a result, the current study was proposed to evaluate the antiplasmodial activity (in vivo) of Maytenus gracilipes based on the plant's traditional claims. METHODS: A cold maceration procedure using 80% methanol as a solvent was employed to obtain a crude extract from M. gracilipes leaves. Chloroform, n-butanol, and pure water were used to fractionate the hydromethanolic extract. Standard procedures were followed for an acute oral toxicity test. The antimalarial effects of the plant at 200, 400, and 600 mg/kg doses were investigated using three rodent malaria models (4-day suppressive, rane's, and repository tests). Thirty mice were utilized in each experiment (3 treatment and 2 control groups, each with six mice). Parasitemia, survival time, body weight, temperature, and packed cell volume were all used to assess the extracts' antiplasmodial activity. To compare results between groups, a one-way ANOVA with Post Hoc Tukey's HSD was used. RESULTS: In a 4-day suppressive investigation, all doses of the crude extract and fractions suppressed parasitemia significantly (P < 0.001) as compared to the negative control. The crude extract had the greatest chemosuppressive effect (74.15%) at 600 mg/kg dose. Chloroform had the greatest parasitemia suppression among the fractions; however it was less than the crude extract. In Rane's test, all doses of the crude extract produced substantial (P < 0.001) curative effects as compared to the negative control. CONCLUSION: According to this study, the crude extract and solvent fractions of M. gracilipes leaves contain antimalarial activity with a substantial suppressive effect. The antiplasmodial effects were more active in the chloroform and n-butanol fractions, indicating that the plant's non-polar and medium polar constituents are responsible. Nonetheless, further analysis is required to isolate and characterize the active compounds responsible for the study plant's antimalarial activity.
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One of the most difficult challenges in carrying out global health research in the developing world is the issue of copyright protection of questionnaires. The current reality is that research in the developing world is often hampered by inadequate or even non-existent budgetary support. From our point of view, an additional hindrance to carrying out research in developing countries is the insistence by holders of questionnaire copyrights that they are paid for the use of their testing instruments. One adverse consequence of demands for compensation by copyright holders may be that worthwhile research is impeded or even prevented. It is argued that the practice of charging non-funded research projects for the use of copyrighted questionnaires denies inclusion of data on world minorities, and thus prevents the potential benefits that such data could provide. In this commentary, we focus on copyrighted instruments and the restrictions that they often represent for researchers in the developing world. More broadly, we argue that to the extent that research in the developing world is impeded by demands for developed world levels of compensation for the use of proprietary tests, the development of vital health programs that are designed to serve these populations can be adversely affected. Several strategies for rectifying inequities posed by current copyright policies are suggested for the promotion of health research in the developing world.
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BACKGROUND: Although tenofovir (TDF)/emtricitabine (FTC)/efavirenz (EFV) and zidovudine (ZDV)/lamivudine (3TC)/efavirenz (EFV) are used as preferred first line regimen, their head-to-head comparison in terms of their efficacy and tolerability was limited. This review aimed to synthesize the best available evidence on the comparative efficacy and tolerability of the two regimens. METHODS: Seven sites and databases in addition to Google search until August 20, 2016, were searched. Only randomized clinical trials conducted on adult population were included in this study. Our primary outcome was viral load suppression while secondary outcomes were death and tolerability. Undetectable viral load is defined as <50 Human Immunodeficiency Virus (HIV) ribonucleic acid (RNA) copies/ml. Joanna Briggs institute meta-analysis of statistics assessment and review instrument (JBI-MAStARI) and critical appraisal and data extraction tool were applied for critical assessment and data extraction, respectively. We performed a random effect meta-analysis to pool the relative risk (RR) for viral load suppression (<50 HIV RNA copies/ml and <400 HIV RNA copies/ml), tolerability, and death. RESULT: Data was extracted from four articles, which included a total of 2381 participants. We found superior viral load suppression among tenofovir (TDF) arm compared to zidovudine (ZDV) arm. Tenofovir arm achieves viral load <50 HIV RNA copies/ml (RR = 1.12, 95% confidence interval (CI) [1.04, 1.21], I2 = 0%) higher than zidovudine arm. Similarly TDF arm is superior in viral load suppression to <400 HIV RNA copies/ml (RR = 1.19, 95% CI [1.11, 1.27], I2 = 0%). Moreover, TDF based regimens were more likely to be tolerated than ZDV based regimens (4 trials, 2381 participants (RR = 1.06, 95% CI [1.02, 1.10], I2 = 51%)). However, forest plot of death shows that it was not significant (RR = 0.91, 95% CI [0.51, 1.62]). CONCLUSION: The use of TDF/FTC/EFV as first line regimen for naïve HIV-1 infected adult patient showed superior viral load suppression and tolerability as compared to ZDV/3TC/EFV. In order to compare the death outcome of both ZDV/3TC/EFV and TDF/FTC/EFV further research is needed.
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BACKGROUND: Despite wide use of nevirapine- and efavirenz-based highly active antiretroviral therapy regimens in Ethiopia, their treatment outcome has not been well studied. The objective of this study was to compare treatment outcome of nevirapine- and efavirenz-based regimens. METHODS: This retrospective cohort study was conducted on antiretroviral-naive adult patients with human immunodeficiency virus (HIV) who had started antiretroviral therapy. Study participants were excluded after treatment failure, regimen change, loss to follow-up, or transfer to other health facility. The outcomes of interest included immunologic recovery, immunologic failure, clinical failure, and treatment failure. RESULTS: There were 1064 HIV patients in the study; an equal proportion (1:1) from both efavirenz- and nevirapine-based regimens was included. Patients in both regimens had similar baseline CD4 cells count ( P = .876). In multivariate analysis, efavirenz-based regimens showed more likelihood of immunologic recovery, whether defined as a CD4 cell count of >200 cells/mm3 (hazard ratio [HR] = 1.31 [95% CI, 1.05-1.59]), >350 cells/mm3 (HR = 1.26 [95% CI, 1.08-1.47]), or >500 cells/mm3 (HR = 1.95 [95% CI, 1.57-2.41]). Moreover, efavirenz-based regimens showed a lower hazard of treatment failure (HR = 0.66 [95% CI, 0.49-0.88]). CONCLUSION: Although the finding of retrospective study should be interpreted with caution, efavirenz-based regimens were associated with superior treatment outcome.