The question of the early diagnosis of asymptomatic and subpatent malaria in pregnancy: Implications for diagnostic tools in a malaria endemic area.

Objectives: Malaria in pregnancy (MIP) is a major healthcare challenge in low-income countries with high malaria endemicity. Early but accurate diagnosis and appropriate treatment is the hallmark of preventing disease progression/adverse outcomes in the mother, foetus and neonates. We assessed the comparative diagnostic performance of Malaria Rapid Diagnostic Test (mRDT), microscopy and PCR for malaria diagnosis in pregnant women for early detection of asymptomatic malaria in pregnant women. Study design: Five hundred and twenty Pregnant women attending study clinics within Ikene and Remo North LGAs with gestational age between 16 and 29 weeks, willing and consented; were enrolled into the study. Blood samples collected via venepuncture were screened for malaria using microscopy, mRDTs kits, and PCR techniques on their first visit (V1) and at delivery. The parasite positivity rates, sensitivity and specificity were calculated and compared for each technique using PCR as the standard. Data was entered into REDCap® online database and analysis done using Stata and MedCalc®. Results and conclusions: Average age of enrolled women was 28.8 years and mean gestational age was 21.0 weeks. The parasite positivity rates were 4.3%, 8.8% and 25.0% for microscopy, mRDT and PCR at V1 and was 2.4%, 3.4% and 43.4% at delivery, respectively. Sensitivity for microscopy and mRDT was 11.2% and 30.3% respectively at V1, while specificity was 98.2% and 98.5%. At delivery, the sensitivity reduced to 1.6% and 4.9%; while specificity was 96.9% and 97.6% respectively. Only 2.3% cases correlated with all three diagnostic methods. Our data showed a decrease in sensitivity of the diagnostic methods as pregnancy progressed, which may be due to very low parasitaemia, but high specificity. Our study demonstrated a high rate of subpatent parasitaemia amongst pregnant women. This finding therefore raises the question of the effect of subpatent parasitaemia on the health of the mother and foetus.

Diastereomeric Mixture of Calophyllic and Isocalophyllic Acid Ameliorates Scopolamine-Induced Memory Impairment in Mice: Involvement of Antioxidant Defense and Cholinergic Systems.

Dementia of Alzheimer disease type (AD) and type 2 diabetes mellitus (T2D) are two most common diseases of aging which has reached epidemic proportions. Moreover, there is a shared mechanism of pathogenesis between metabolic disorders and AD. Hence, the need for discivery of effective prevention and treatment strategies. Diastereomeric mixture of calophyllic acid and isocalophyllic acid (ISO) has been shown to stimulate glucose uptake through GLUT4- translocation. In this study, an attempt was made to investigate the effect of ISO on scopolamine-induced memory deficit in mice. ISO (5, 25 or 50 mg/kg, p.o.) or vehicle (10 ml/kg, p.o.) was administered for 3 consecutive days. One hour post-treatment on day 3, scopolamine (3 mg/kg, i.p.) was given before the animals were subjected to Y-maze, open field, novel object recognition (NOR) or Morris water maze (MWM; 5 consecutive days) paradigms. The mice were sacrificed 45 min after MWM test on day 8. The hippocampus and prefrontal cortex were rapidly isolated on ice for assay of biochemical markers of oxidative stress and acetylcholinesterase activity. Scopolamine reduced the percentage alternation behaviour in the Y-maze and discrimination index in NOR tests with no significant change in escape latency time in MWM task suggestive of deficit in learning and memory. However, the pretreatment of mice with ISO produced a dose-dependent improvement in learning and memory. Moreover, ISO administration attenuated scopolamine-induced increase in malondialdehyde/nitrite generation and acetylcholinesterase activity and deficit in antioxidant enzyme activity in the hippocampus and prefrontal cortex. Findings from this study showed that the diastereomeric mixture of calophyllic acid and isocalophyllic acid possesses anti-amnesic effect through enhancement of antioxidant defense and cholinergic signaling pathway.

Novel action of vinpocetine in the prevention of paraquat-induced parkinsonism in mice: involvement of oxidative stress and neuroinflammation.

Parkinson's disease (PD) is a multifactorial chronic progressive neurodegenerative disease caused by age, genetic and environmental factors such as paraquat (PQT). PQT (a quartenary nitrogen herbicide) is implicated in some form of idiopathic PD. This study sought to investigate the protective effect of vinpocetine on paraquat-induced Parkinsonism in mice. Forty-eight male albino mice were randomly divided into 6 groups and treated orally as follows for 21 days; Group 1: vehicle normal (10 ml/kg), group 2: vehicle control (10 ml/kg); groups 3-5: vinpocetine (5, 10 or 20 mg/kg); group 6: vinpocetine (20 mg/kg). Animals in groups 2-5 were given PQT (10 mg/kg, i.p.) every 3 days for 3 weeks. The effect of treatments on spontaneous motor activity (open field test), muscle coordination (rotarod tests), cataleptic behaviour (bar test), and working memory (Y-maze test) were assayed. After the behavioural assay on day 21, the midbrain was isolated for estimation of oxidative stress and TNF-α. Intraperitoneal injection of paraquat significantly induced motor deficits, muscle incoordination, catalepsy and working memory impairment which was ameliorated by the pretreatment of mice with vinpocetine. In addition, paraquat injection caused marked increase in nitroso-oxidative stress markers with concomitant deficits in antioxidant enzymes activities (GSH and SOD) as well as induction of tumour necrotic factor-α (TNF-α) in the mid-brain which were attenuated by the pretreatment of mice with vinpocetine. Findings from this study showed that vinpocetine prevented paraquat-induced motor deficits, memory impairment, oxidative stress and neuroinflammation through enhancement of antioxidant defense system and inhibition of neuroinflammatory cytokine. Thus, could be a potential drug in the management of Parkinsonism.

Hepatoprotective and antioxidant activities of Hepacare®, a herbal formulation against carbon tetrachloride-induced liver injury.

BACKGROUND: Hepacare(®) is a herbal formulation used to treat patients with sickle-cell anaemia complicated with jaundice, also recommended as a protective agent against liver damage due to chronic ingestion of alcohol. METHODS: In vitro antioxidant properties of Hepacare(®) was determined using 1, 1- diphenyl-2-picryl-hydrazyl (DPPH), total antioxidant capacity, reducing power ability, and nitric oxide assays. Hepatoprotective effect of Hepacare(®) (50-400 mg/kg/day for 7 days, p.o.) was investigated in male Sprague Dawley rats against carbon tetrachloride (CCl(4) /olive oil, 1:1, 0.7 ml/kg, i.p.)-induced liver damage. At the end of the study, blood samples and liver tissue were assayed for biochemical and antioxidants parameters. RESULTS: Hepacare produced concentration dependent inhibition of DPPH and nitric oxide activity with IC(50) of 48.50 and 55.00 µg/ml, respectively, it suppressed the absorbance of ABTS(.+) with total antioxidant capacity of 423.47±8.37 mg QUE/g. CCl(4) administration induced significant (P<0.001) elevation of serum aspartate transaminase (1.70 fold), alanine transaminase (1.60 fold), alkaline phosphatase (2.90 fold) and bilirubin (2.00 fold) in comparison to control. The increase in serum biomarker were dose-depen-dently reversed by Hepacare(®) pretreatment. More-over, CCl(4) pretreatment increased (P<0.001) malondialdehyde (MDA) (73.98%) and decreased (P<0.001) antioxidant enzymes level but Hepacare pretreatment produced dose-dependent attenuation of the increased MDA (3.84 fold) with enhancement of glutathione (3.08 fold), superoxide dismutase (2.08 fold), and catalase (3.14 folds) levels in comparison to CCl(4) treated group, similar to those of silymarin reference standard. CONCLUSION: Hepacare was beneficial in the prevention of CCl(4)-induced hepatocellular injury, possibly by scavenging reactive free radicals, and boosting endogenous antioxidant systems.

Antidepressant and anxiolytic properties of the methanolic extract of Momordica charantia Linn (Cucurbitaceae) and its mechanism of action.

BACKGROUND: The whole plant of Momordica charantia Linn (Cucurbitaceae) is used in traditional African medicine in the management of depressive illness. METHODS: Momordica charantia (MC) (50-400 mg/kg, p.o.) was administered 1 h before behavioural studies using the forced swimming test (FST) and tail suspension test (TST) to investigate antidepressant-like effect while the anxiolytic-like effect was evaluated with elevated plus maze test (EPM), hole-board test (HBT), and light-dark test (LDT). RESULTS: Acute treatment with MC (50-400 mg/kg) significantly increased swimming time (86.51%) and reduced the duration of immobility (52.35%) in FST and TST with peak effects observed at 200 mg/kg, respectively, in comparison to control. The pretreatment of mice with either sulpiride (dopamine D2 receptor antagonist), or metergoline (5-HT2 receptor antagonist), or cyproheptadine (5-HT2 receptor antagonist), or prazosin (α1-adrenoceptor antagonist), or yohimbine (α2-adrenoceptor antagonist), and atropine (muscarinic cholinergic receptor antagonist) 15 min before oral administration of MC (200 mg/kg) significantly blocked its anti-immobility effect. Similarly, MC (200 mg/kg) significantly reduced anxiety by increasing the open arm exploration (64.27%) in EPM, number of head-dips in HBT (34.38%), and time spent in light compartment (29.38%) in the LDT. However, pretreatment with flumazenil (GABAA receptor antagonist) 15 min before MC (200 mg/kg) significantly blocked (54.76%) its anxiolytic effect. CONCLUSION: The findings in this study showed that MC possesses antidepressant-like effect that is dependent on the serotonergic (5-HT2 receptor), noradrenergic (α1- and α2-adrenoceptors), dopaminergic (D2 receptor), and muscarinic cholinergic systems and an anxiolytic-like effect that might involve an action on benzodiazepine-type receptor.

Educational intervention and the health seeking attitude and adherence to therapy by tuberculosis patients from an urban slum in lagos Nigeria.

BACKGROUND: Community based participation has been advocated by a number of international health organisations including the World Health Organization (WHO) as a solution to the problems of poor patient adherence and default from Directly Observed Treatment Short course [DOTs] programmes for tuberculosis control. OBJECTIVES: To determine the impact of a health educational intervention on the management of tuberculosis in relation to the outcome and adherence to therapy by Tuberculosis patients residing in a densely populated urban slum in Lagos, Nigeria. METHODS: The study was conducted using forty tuberculosis patients (confirmed by acid fast bacilli positive sputum), and selected randomly from those who attend the Mainland Hospital in Lagos. They were divided into two groups of twenty each made up of those to be provided with education intervention at the community level and the control groups followed up at the hospital level only. An initial assessment of the knowledge about tuberculosis management was done through a structured questionnaire for both groups. This was followed by continuous health talks for intervention group in form of neighbourhood self help approach. RESULTS: The results showed that the intervention had a significant impact on the understanding of disease and its management (X(2) =11.842 p<0.05), DOTS and increased awareness (X(2) =17.289 p<0.05, X(2) =10.461 p<0.05), knowing the side effects of anti-TB drugs (X(2) =10.157 p<0.05), the meaning of resistance to anti-Tuberculosis drugs (X(2) =19.798 p<0.05, X(2) =11.192 p<0.05) and importance of contact tracing (X(2) =32.4 p<0.05, X(2) =3.360 p<0.05). CONCLUSION: An effective health education is therefore beneficial for TB control in Nigeria.

The use of artemisinin-based combination therapies (ACTs) in public secondary health facilities in Lagos, Nigeria.

OBJECTIVES: The objectives of the study were to assess the prescription pattern of Artemisinin Combination Therapies (ACTs) in uncomplicated malaria and the knowledge, attitude and practice of physicians as regards use of ACTs in the outpatient clinics of public secondary health facilities in Lagos State. PATIENTS AND METHODS: All the ten General Hospitals under the Lagos State Health Management Board were studied and classified as either rural or urban. 1878 retrospective antimalarial prescriptions of outpatients between March, 2005--March, 2006 were systematically sampled and questionnaires were distributed to prescribers in April--May, 2006. Prescription assessment was based on the recent Nigerian National Antimalarial Treatment Policy and WHO/INRUD drug use indicators. RESULTS: The percentage of prescriptions containing ACTs was found to be rather small (5.9%) inspite of the high proportion (59.2%) of prescribers who were favourably disposed to the National antimalarial policy change from Chloroquine to ACTs as first line. There was no statistically significant difference in frequency of ACTs prescription between the rural and urban health facilities. The prescription of Artemisinin derivatives as monotherapy was 18.2%. The prescription of Chloroquine was found to be more predominant, (48.8%) in all the health facilities. CONCLUSION: Despite the national policy change from Chloroquine to (ACTs) as the first line antimalarial, their use in the public secondary health facilities in Lagos State does not reflect this policy change and it appears that Chloroquine still remains the choice antimalarial drug.

Prescription pattern at primary health care centres in Lagos State.

Health care received in health facilities depends on adequate consultation, correct prescription and dispensing with relevant information given to the patient. These are some of the indicators for rational drug use. The objective of the study was to determine the pattern of prescription among prescribers in twenty Primary Health Care Centers of Lagos State using some of these indicators used in investigating health facilities by the World Health Organisation and International Network for Rational Use of Drugs. The study was carried out using multi-stage random sampling in selecting the Primary Health Care Centers from each of the twenty Local Government Areas of Lagos State. Both prospective and retrospective data were collected and analysed using Epi-Info version 6. The results showed that there was polypharmacy, misuse of antibiotics and injections. There was no statistically significant difference between the retrospective and prospective indicators of mean drugs prescribed per encounter, percentage antibiotics prescribed and percentage of generic prescription. It was concluded that there was irrational prescription pattern in all the selected health facilities as evidenced by poly-pharmacy, misuse of antibiotics and low generic prescriptions. There is need for educational intervention to improve the prescribing habits of health professionals in these health facilities.