Effects of metformin on arterial elasticity and pro-inflammatory markers in black diabetes patients.

Background: Pro-inflammatory markers are linked with the development and progression of type 2 diabetes mellitus and arterial stiffening. Pulse Wave Velocity (PWV) and Augmentation Index (Aix) are non-invasive standard markers of arterial elasticity and predictors of cardiovascular mortality and morbidity. Aim: To investigate the effects of metformin alone and in combination with glimepiride on arterial elasticity, pro-inflammatory cytokines in black type 2 diabetes mellitus patients. Settings: Participants were enrolled from Sefako Makgatho Health Sciences University community, Gauteng, South Africa. Methods: PWV and Aix were measured using the AtCor SphygmoCor® system (AtCor Medical, Inc., Sydney, Australia). Cytokines levels were measured using Multiplexing with Bio-Plex Pro™ human inflammation panel I assay. Treatment naïve type 2 diabetes participants were divided into two groups: metformin (M) (n = 10) and metformin glimepiride (MS) (n = 14). The study participants were followed up at 4 and 8 months after treatment initiation. Results: In the M and MS, IL-1ß increased significantly at four months (58.19 ± 0.03 pg/ml, 58.35 ± 0.30 pg/ml) when compared to baseline (33.05 ± 18.56 pg/ml, 34.79 ± 18.77 pg/ml) then decreased significantly at eight months (29.25 ± 11.64 pg/ml, 32.54 ± 14.26 pg/ml) when compared to four months (58.19 ± 0.03 pg/ml, 58.35 ± 0.3 pg/ml) (p < 0.05). There were no significant changes in PWV, Aix, IL-1ra, IL-2, IL-6, IL-8, TNF-α and hs-CRP levels at both treatment intervals. Conclusion: Metformin alone or in combination with glimepiride did not improve arterial elasticity and did not reduce pro-inflammatory cytokines levels in T2DM black South African patients. Contribution: The context-based knowledge generated by the current study is expected to enhance the continuum of care for T2DM patients.

Chemotherapy-related subjective cognitive impairment in breast cancer patients in semi-rural South Africa.

BACKGROUND: Breast cancer is the most commonly diagnosed cancer amongst women worldwide. Whilst current evidence indicates the therapeutic benefits from the use of chemotherapy, self-perceived cognitive difficulties emerged as a frequent occurrence during and after chemotherapy treatment in breast cancer patients. AIM: The current study sought to investigate self-perceived cognitive impairment in a group of breast cancer patients in semi-rural South Africa. SETTING: The patients were recruited from an outpatient oncology clinic at a semi-rural, tertiary academic hospital in Gauteng, South Africa. METHODS: In a randomised, quantitative, time-based series study, 30 female patients aged 21-60 years (mean age = 50 years) diagnosed with stages II and III breast cancer on CMF (cyclophosphamide, methotrexate, fluorouracil) (n = 10) and FAC (fluorouracil, adriamycin, cyclophosphamide) (n = 20) chemotherapy regimens, completed the self-reported Functional Assessment of Cancer Therapy-Cognition (Fact-Cog) test as a measure of subjective cognitive functioning at three points during the course of treatment (T0, T1, T2). RESULTS: The results of the paired sample t-tests showed the scores on the Fact-Cog test confirmed significant cognitive decline for both treatment groups from baseline (T0) to completion (T2) of chemotherapy; CMF group, t (9) = 2.91, p = 0.017 and the FAC group t (19) = 4.66, p < 0.001. CONCLUSION: This study confirms that self-reported subjective cognitive impairment is common in breast cancer patients who received chemotherapy in a sample of South African patients. The results have implications for the overall care of cancer patients. CONTRIBUTION: The context-based knowledge engendered by the current study is expected to augment the continuum of care for breast cancer patients.

Evaluation of the in vitro effects of commercial herbal preparations significant in African traditional medicine on platelets.

BACKGROUND: Commercial herbal medicines (CHMs) marketed as immune boosters are gaining wide popularity in South Africa, in the absence of control and regulatory guidelines. These commercially packaged and labelled herbal preparations, acquired in various retail outlets, are used without consulting either a conventional health provider or a traditional health practitioner. Although they are indicated for immune-boosting purposes, they might exert many other beneficial and unwanted effects on physiological systems. Platelets are crucial in haemostasis and important for the immunological system. The aim was to investigate the effect of the CHMs used to strengthen the immune system on the activity of human platelets. METHODS: Six CHMs commonly used as African traditional medicines in Pretoria, South Africa, were tested for their effects on healthy, isolated human platelets, using a bioluminescence method. The tested herbal medicines were Intlamba Zifo™, Maphilisa™ Herbal medicine, Matla™ African medicine for all diseases, Ngoma™ Herbal Tonic Immune Booster, Stametta™ Body Healing Liquid, and Vuka Uphile™ Immune Booster and serial-diluted standards of each from 10 to 10,000 times. The luminol-enhanced luminescence activity of the platelets was measured after incubation with the herbal medicines and activation with phorbol myristate acetate (PMA) or N-formyl-methionyl-leucyl-phenylalanine (fMLP). RESULTS: Five herbal medicines, namely Intlamba Zifo™, Maphilisa™ Herbal medicine, Matla™ African medicine for all diseases, Stametta™ Body Healing Liquid, and Vuka Uphile™ Immune Booster exerted comparable weak inhibitory effects on both PMA and fMLP-induced platelets, which were concentration dependent at high doses, and inversely related to concentration at low doses. Intlamba Zifo™, Matla™ African medicine for all diseases, Stametta™ Body Healing Liquid, and Vuka Uphile™ exhibited weak, but non-systematic stimulatory effects at low doses, which were not statistically significant. Ngoma™ Herbal Tonic Immune Booster had weak, inhibitory effects at high doses and weak stimulatory effects that were inversely related to concentration at low doses. CONCLUSION: The findings suggest a potential beneficial role of the CHMs in the suppression of platelets' reactivity and in enhancing the immune system. Caution, however, should be exercised as platelet inhibition and stimulation predispose to the risk of bleeding and thrombosis, respectively.

IN VITRO EFFECTS OF A COMMERCIAL HERBAL MEDICINE USED AS AFRICAN TRADITIONAL MEDICINE ON HUMAN NEUTROPHILS.

BACKGROUND: Commercial herbal medicines (CHMs) being marketed as immune boosters or tonics, have gained widespread popularity. The many herbal mixtures sold have not been tested for efficacy and safety, despite their modern packaging and presentations. It is imperative that these herbal mixtures be investigated for their effects on human neutrophils. METHODS: The selected herbal mixture (HM), Stametta™ Body healing liquid, is common in retail outlets in Pretoria, South Africa (SA) and is used as an immune booster or intended to strengthen the body. Isolated neutrophils as well as those in whole blood phagocytes were obtained from blood samples collected from consenting healthy adult volunteers. The neutrophils were incubated with the HM at different strengths, and taken through a luminol-enhanced luminescence assay, using activators- phorbol myristate acetate and N-formyl-methionyl-leucyl-phenylalanine. RESULTS: The HM had variable stimulatory and inhibitory effects on the luminescence activity of healthy isolated and non-isolated human neutrophils. The effects, ranging from weak to potent were either directly or inversely related to the concentration of the HM and were mediated through a direct protein kinase C activating mechanism and an indirect formyl peptide receptor-linked mechanism. CONCLUSION: The findings have shown the immunomodulatory potential of Stametta™. The in vitro inhibitory and stimulatory effects on neutrophils which are furthermore time-based, suggest variable effects on the immune system, which may be beneficial as well as risky. The effects at different concentrations highlight the importance of appropriate dosing. It would therefore be prudent to caution users of this commercial herbal medicine accordingly.

Effect of perindopril on pulse-wave velocity and endothelin-1 in black hypertensive patients.

INTRODUCTION: We investigated the effect of perindopril on pulse-wave velocity (as indicator of arterial elasticity) and endothelin-1 (ET-1) levels in black hypertensive patients. METHODS: Forty-four newly diagnosed hypertensive patients who received 4 mg perindopril daily were monitored for nine months. Pulse-wave velocity (PWV) was measured noninvasively along the carotid-femoral arterial segment (high elastic content) and the brachial-ulnar segment (low elastic content). RESULTS: There was a significant increase in arterial elasticity, as indicated by a slower PWV in the carotid-femoral segment of the treatment group, from 11.6 to 7.5 m/s after nine months. The PWV of the treatment group (7.5 m/s) after nine months was lower than that of the healthy volunteer group (8.2 m/s) but it was not statistically significant. No correlation between ET-1 and PWV could be found. CONCLUSION: In addition to its blood pressure-lowering effect, our study confirmed the improvement in arterial elasticity in patients on perindopril therapy, without involvement of ET-1.