Dietary potassium intake and renal handling, and their impact on the cardiovascular health of normotensive afro-caribbeans.

OBJECTIVE: Recent nutritional profiles of dietary intake have indicated a shift from the ancient diet to the Western diet. The ancient diet provided a high potassium and low sodium intake, which in turn leads to sodium conservation and potassium excretion. This change in the dietary intake is expected to affect potassium and sodium handling in the kidneys. Numerous studies have been done to emphasize the importance of sodium handling by the kidneys and its impact on cardiovascular health. This study will investigate potassium intake and handling, and its impact on the cardiovascular health of a sample of normotensive Afro-Caribbeans by the possible modulation of the renin angiotensin aldosterone system (RAAS). METHODS: A sample of 51 normotensive Afro-Caribbean participants was recruited for the study. Participants were observed over a two-day period in which they were given a 24-hour ambulatory blood pressure monitor and a container to collect blood pressure data and a 24-hour urine sample. Anthropometric measurements were noted. Urinary electrolytes and supine plasma renin activity (PRA) were determined from the 24-hour urine collection and a blood sample. Dietary potassium intake was estimated based on dietary intake observations and calculated based on the urinary potassium excretion. SPSS version 19 was used to analyse the data to make inferences. RESULTS: The daily potassium intake was observed to be 2.95 g/day and measured intake from the urinary potassium was between 4.95 and 7.32 g/day. Urinary potassium excretion was 3.66 (± 1.40) g/day. The urinary potassium excretion in the Afro-Caribbean sample in Barbados was higher than the other population samples. The averaged PRA of the participants (supine) was 0.778 (± 1.072) ng/mL/hour. The averaged nocturnal systolic blood pressure dip of the participants was 5.97 (± 4.324) %. There was no significant correlation between urinary potassium excretion, blood pressure, nocturnal systolic blood pressure dip and PRA. CONCLUSIONS: The Afro-Caribbean sample has an inadequate daily potassium intake based on the observed intake and recommended values, with a high urinary excretion of the electrolyte compared to other values in the literature. This high potassium excretion could have been partly due to low plasma renin activity levels in the study participants. As a possible consequence, an increase in the nocturnal peripheral resistance is a likely cause for the diminished systolic dip. The lack of correlations between dietary potassium excretion and the blood pressure parameters does not allow any firm inference of the electrolyte's handling and its impact on cardiovascular health in the normotensive Afro-Caribbean participants. However, further research is needed to get a more accurate daily potassium intake value, and a more statistically robust sample to assess whether potassium handling and blood pressure would be affected by a change in potassium intake.

Predicting 24-hour urinary sodium excretion in Afro-Caribbean Barbadians by comparing urine sodium excretion over different durations versus spot collection.

AIM: Urinary sodium excretion is used as an assessment tool for salt intake and salt handling. Even though cumbersome, the most reliable and readily used method in clinical and epidemiological studies is the 24-hour urine collection. This study investigates other appropriate means ofpredicting 24-hour urinary sodium excretion in a sample of Afro-Caribbeans in Barbados by assessing the correlation of actual and estimated urinary sodium excretion between a 24-hour urine collection sample, 12-hour (AM and PM), and spot (AM and PM) urine collections. METHOD: A convenient sample of 30 healthy participants of Afro-Caribbean origin between the ages of 21 and 55 years was recruited for the study. The 24-hour urine samples and anthropometric data were collected as documented in the study's standard clinical procedure. A 24-hour urine sample was collected as two separate 12-hour AM and PM samples. In addition, two spot samples (AM and PM) were taken during each 12-hour sample collection period. Analysis of the urinary sodium and creatinine was done with a Roche/Hitachi Modular System (Roche Diagnostics, IN, USA). SPSS version 19 was used to analyse the data to make inferences. RESULTS: Thirty Afro-Caribbean subjects participated in this study: 16 females and 14 males. The average age and body mass index (BMI) were 38 +/- 17 years and 25.32 +/- 5.98 kg/m2, respectively. The greatest correlation of the estimated 24-hour sodium excretion to the measured 24-hour sodium excretion was observed in the 12-hour PM sample (Pearson's correlation, r = 0.786, p < 0.001) followed by the 12-hour AM sample (Pearson's correlation, r = 0.774, p < 0.001). The PM spot sample showed a weaker, but still statistically significant correlation to the 24-hour timed sample (Pearson 's correlation, r = 0.404, p < 0.045). The AM spot sample showed a very weak and insignificant correlation (Pearson 's correlation, r = 0.05, p = 0.807) to the 24-hour timed sample. Similarly to the whole sample, the gender analysis demonstrated that estimated 24-hour sodium excretion in the female's 12-hour PM sample had the greatest correlation (r = 0.819, p < 0.001) to the measured 24-hour sodium excretion, followed by the 12-hour AM (r = 0.793, p = 0.001) and the PM spot samples (r = 0.741, p = 0.02). The correlation between variables is weaker in males compared to the females. CONCLUSION: Overall, this study shows a clear correlation between the estimated 24-hour sodium excretion from the 12-hour timed PM sample and the measured 24-hour sodium excretion. Such findings support the thought of using other alternatives to determine sodium excretion, in view of replacing the cumbersome 24-hour urinary collection with a smaller timed sample. Nonetheless, a more robust and randomized population sample as well as a method to correct for high creatinine variability is required to further enhance the significance of the obtained results.

Predicting 24-hour urinary protein excretion in Afro-Caribbean Barbadians by comparing urine protein excretion over different durations versus spot collection.

AIM: The gold standard for the determination of proteinuria, an independent risk factor for cardiovascular and renal disease, is the measurement of protein in a 24-hour urine collection. However this method has been shown to be unreliable mainly due to poor compliance of sampling by patients. This study investigates other appropriate means of predicting 24-hour urinary protein excretion in a sample of Afro-Caribbeans in Barbados by assessing the correlation of actual and estimated urinary protein excretion between a 24-hour urine collection sample, 12-hour (AM and PM) and spot (AM and PM) urine collections. SUBJECTS AND METHOD: A convenient sample of 30 healthy participants of Afro-Caribbean origin between the ages of21 and 55 years was recruited for the study The 24-hour urine samples and anthropometric data were collected as documented in the study s standard clinical procedure. A 24-hour urine sample was collected as two separate 12-hour AM and PM samples. In addition, two spot samples (AM and PM) were taken during each 12-hour sample collection period. Analysis of the urinary protein and creatinine was done with a Roche/Hitachi Modular System (Roche Diagnostics, IN, USA). SPSS version 19 was used to analyse the data to make inferences. RESULTS: Thirty Afro-Caribbean persons participated in the study: 16 females and 14 males. The average age and body mass index (BMI) were 38 +/- 17 years and 25.32+/- 5.98 kg/m2, respectively. The Spearman Rho 's correlation was used to interpret associations of the urinary parameters in 24-hour collected sample and the other samples. The strongest correlation of the protein:creatinine ratio in the 24-hour collected sample to the other samples was observed with the 12-hour AM sample (r = + 0.743, p < O.01)followed by the 12-hour PM sample (r = +0.672, p < 0.01). On analysing gender, the more significant correlations found were among the males for the 12-hour timed samples with r = +0.945, p < 0.01 and r = +0.736, p < 0.01 for the AM and PM samples, respectively. There were very strong correlations between the 24-hour urinary protein excretion and the estimated 24-hour protein excretion from the 12-hour AM and PM samples (r = +0.846, p < 0.01 and r = +0.637, p < 0.01, respectively). Both males and females had the strongest correlation for the estimation of 24-hour protein excretion in the 12-hour AM sample (r = +0.795, p < 0.01 and r = +0.965, p < 0.01, respectively). CONCLUSION: The use ofa 12-hour timed sample, specifically the morning sample, may be a more convenient way to assess proteinuria in the Afro-Caribbean population. This method allows for a quicker assessment of proteinuria which not only allows earlier diagnosis of renal disease but may also reduce the clinical cost of the disease s management.

The impact of the healthcare system in Barbados (provision of health insurance and the benefit service scheme) on the use of herbal remedies by Christian churchgoers.

AIM: To determine the impact of health insurance and the government's Benefit Service Scheme, a system that provides free drugs to treat mostly chronic illnesses to persons aged 16 to 65 years, on the use of herbal remedies by Christian churchgoers in Barbados. METHODS: The eleven parishes of Barbados were sampled over a six-week period using a survey instrument developed and tested over a four-week period prior to administration. Persons were asked to participate and after written informed consent, they were interviewed by the research team. The data were analysed by the use of IBM SPSS version 19. The data were all nominal, so descriptive statistics including counts, the frequencies, odds ratios and percentages were calculated. RESULTS: More than half of the participants (59.2%) were female, a little less than a third (29.9%) were male, and one tenth of the participants (10.9%) did not indicate their gender The majority of the participants were between the ages of 41 and 70 years, with the age range of 51-60 years comprising 26.1% of the sample interviewed. Almost all of the participants were born in Barbados (92.5%). Approximately 33% of the respondents indicated that they used herbal remedies to treat various ailments including chronic conditions. The odds ratio of persons using herbal remedies and having health insurance to persons not using herbal remedies and having health insurance is 1.01 (95% CI 0.621, 1.632). There was an increase in the numbers of respondents using herbal remedies as age increased. This trend continued until the age group 71-80 years which showed a reduction in the use of herbal remedies, 32.6% of respondents compared with 38.3% of respondents in the 61-70-year category. CONCLUSIONS: The data demonstrated that only a third of the study population is using herbal remedies for ailments. Health insurance was not an indicator neither did it influence the use of herbal remedies by respondents. The use of herbal remedies may not be associated with affluence. The reduction in the use of herbal remedies in the age group 71-80 years could be due to primarily a lower response rate from this age group, and secondarily due to the Benefit Service Scheme offering free medication to persons who have passed the age of 65 years.

The antimicrobial screening of a Barbadian medicinal plant with indications for use in the treatment of diabetic wound infections.

OBJECTIVE: Diabetes mellitus is a chronic non-communicable disease with high prevalence in the North American and Caribbean region. Diabetic Foot Syndrome which is an associated complication can lead to the development of wounds and ulcers which can become infected. Justicia secunda, a plant known locally in Barbados as Bloodroot used in folklore for wound healing, was selected to test its ability to aid diabetic wound healing by antimicrobial activity. It was therefore tested against the bacteria Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, and Enterococcus feacalis (clincal strain) which are commonly found in diabetic wounds. METHODS: The plant was collected by local users. Methanol and acetone extracts of the plant were prepared with use of soxhlet extraction. The antimicrobial activity was assessed with the use of a modified Kirby-Baurer method. Concentrations of 200 mg/ml, 100 mg/ml, 10 mg/ml, and 1 mg/ml of the extract were used, with a standard ciprofloxacin 5 microg positive control, and a 5% dimethyl sulfoxide (DMSO) solution negative control. RESULTS: The J secunda methanol and acetone extracts with an extraction yield of 15.3% and 0.75%, respectively yielded no activity within the concentration range against the three strains of bacteria tested. In comparison with the positive control, relative inhibition zone diameter (RIZD) values of 0% resulted for both the negative control and the extracts, with the positive control having a value of 100%. CONCLUSION: The in vitro screen of the extracts prepared from J secunda, yielded no antimicrobial activity against the three strains of bacteria tested and therefore does not support the folklore claims by this mechanism of action.

Drug-herb interaction: database of medicinal plants of the Caribbean, their indications, toxicities and possible interactions with conventional medication.

OBJECTIVE: Healthcare professionals in the Caribbean today know very little about these drug-herb interactions of the popular West Indian medicinal herb practices linked to the immigrants from West Africa and India, and to the indigenous Amerindians. It is the intent of this project to produce a database which comprehensively summarizes indications and possible drug-herb interactions of these plants. METHOD: Using the database programme Epi Info 3.5.1, one hundred and eighty-three herbs used in the Caribbean as medicine by locals have been entered into the West Indian Drug Herb Interaction Database version 0.06 (WIDHID 0.06). RESULTS: A range of one to three common names have been entered with the family and scientific name of each herb, in addition to a range of one to six conditions/illnesses for which a particular plant was to be used as a medicinal herb. One to four bioactive compounds have been made to correlate with the typical herbal preparation methods and toxicity. Thirty of the most common and popular herbs have been researched for their drug herb interactions. CONCLUSION: West Indian Drug Herb Interaction Database version 0.06 for the first time allows easy access to Caribbean ethno-medicinal plant cures with their possible drug-herb interactions reference sources, a feature often absent although so important. In addition, WIDHID 0.06 will support pharmaco-epidemiological studies in the field. It will also ensure future public access to ethno-medicinal information through developed web pages or programmes.