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Risk Assessment of Co-treatment with Rifampicin and Tenofovir on Renal Function of Male Albino Rats
No full textBackground: Tuberculosis is one of the comorbid infections commonly associated with human immunodeficiency virus which could necessitate the concurrent use of tenofovir and rifampicin (TDF-RIF). These drugs are individually associated with renal toxicity; hence concurrent use might be detrimental to renal function. Objectives: This study, comparatively evaluated the toxicological effects of treatments with tenofovir, rifampicin and tenofovir- rifampicin combination on renal function of male albino rats. Materials and Methods: Healthy adult male albino rats used for this study were divided into five (5) groups of sixteen animals (16) each. Animals in group A (placebo control) and group B (solvent control) were treated orally with water and arachis oil respectively. Animals in groups C-E were treated orally with 80mg/kg of rifampicin, 32 mg/kg of tenofovir and tenofovir-rifampicin combination for 1-8 weeks respectively. Animals were weighed and sacrificed at the end of drug treatment, blood samples were collected, centrifuged and serum extracted for creatinine, urea, uric acid, albumin, total protein and glucose evaluation. Animals were dissected kidneys were collected and weights determined. Results: Treatment with tenofovir-rifampicin combination did not produce significant (p>0.05) effects on body and relative kidney weights, albumin, total protein and glucose levels when compared to their individual doses. Furthermore, insignificant (p>0.05) and time-dependent increases in serum creatinine, urea and uric acid levels were obtained in animals treated with combined doses of TDF-RIF when compared to their individual doses. Conclusion: These results showed that concurrent use of tenofovir and rifampicin in the management of human immunodeficiency virus and tuberculosis co-infection may not be associated with synergistic renal toxicity at the dose levels used. Keywords: Renal, Toxicity, Co- treatment, Tenofovir, Rifampicin, Rat
Mother-To-Child HIV Transmission using Single, Dual and Triple ARV Prophylaxis Regimens and their Correlates in Western Kenya: Chart Review - SUPPORTING INFORMATION
No full textBackground: It is estimated that 2.1 million individuals worldwide became newly infected with HIV in 2013, and this included 240,000 children (<15 years). Most of these children live in sub-Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Objective: This study sought to ascertain the different PMTCT approaches or regimens that mothers and infants receive, their Mother-To-Child Transmission of HIV (MTCT) rates and associated correlates in Western Kenya. Methods: A retrospective cohort study using prospectively collected data in Ministry of Health HIV-Exposed Infant (HEI) register from 24 health facilities. The study population was HIV-positive mothers enrolled from January 2012 to June 2013. The main outcomes were infant HIV status at 6 weeks, 9 to <18 months and 18-24 months. The correlates were maternal haemoglobin levels, WHO staging, CD4 counts, duration between enrolment and delivery, duration between enrolment and ART initiation, TB status, place of delivery, mode of delivery, and infant feeding options at 6 weeks, 9 to <18 months and 18-24 months. Proportions were analyzed using Chi-square tests while associations between MTCT correlates and outcomes were established using logistic regression. Results: 1,751 HIV mother-baby pairs were enrolled in the 24 health facilities: 78.1% received Highly Active Antiretroviral Therapy (HAART), 14.2% received Zidovudine (AZT), 1.7% received Single-dose Nevirapine (SdNVP), and 4.3% received no prophylaxis. MTCT rates were 5.5%, 7.4% and 5.6% at 6 weeks, 9 to <18 months and 18-24 months, respectively. MTCT rate at 18-24 months showed a significant difference (p<0.001) across PMTCT regimens. Women with CD4 cells between 350 to 500 cells/mm3 were about twice as likely to have HIV-negative babies compared to those with CD4 cells count <350cells/mm3. Women on TB treatment are less likely to have HIV-negative babies compared to those without TB. Exclusive breastfeeding at 6 weeks was associated with lower MTCT rates. Feeding option at 6 weeks is a strong predictor of HIV status (p<0.001) as compared to babies on exclusive breastfeeding (EBF). Conclusion: Most of the mother-baby pairs received HAART. AZT depicted the lowest MTCT rate at 18-24 months. Higher CD4 counts, no TB signs, and EBF at 6 weeks were associated with lower MTCT rates at 18-24 months Key words: Antiretroviral prophylaxis, Mother-To-Child Transmission of HIV rates
Molecular characterization of fluoroquinolone resistance genes in isolates obtained from patients with diarrhea in Machakos District Hospital, Kenya
Get PDFBackground: Diarrhea caused by Enterobacteriaceae such as Shigella species and Escherichia coli (E. coli) is endemic throughout the world, and is one of the most important causes of global childhood mortality and morbidity. There is a range of antibiotics that can be used for treatment among them quinolones. However, there is emerging increase in microbial resistance to quinolones use, with E. coli and Shigellae among the species of bacteria commonly associated with quinolone resistance. Objective: To investigate the prevalence of quinolone resistance genes in Shigellae and E. coli from patients presenting with diarrhea in Machakos District Hospital. Methods: Bacteria isolates were identified to species level by biochemical methods and serology and thereafter tested for 12 different antibiotics including quinolones, cephalosporins and aminoglycosides. Those resistant to quinolones with a zone diameter of ≤20 mm were tested for the presence of quinolone resistance genes using PCR. The gyrA resistance genes were further analyzed by sequencing to determine mutations within the quinolone resistance regions. Results: There were different E. coli pathotypes and Shigellae spp. They resisted more than four antibiotics: Ciprofloxacin (4%), (Chloramphenical (28%), Cotrimoxazole (78%), Co-amoxilav (70%) Erythromycin (98%) Cefotoxime (18%) and Tetracycline (56%). Mutations responsible for fluoroquinolone resistance in the gyrA, gyrB, parC, and parE genes of E. coli and Shigella spp were: gyrA (17/30, 36%) gyrB (7/30, 23.3%) topoisomerase (parC 3/30, 10%) parE (3/30, 10%). Discussion: There is an increase in fluoroquinolone resistance in Shigellae and E.coli which points to a major challenge in current treatment strategies. In addition, detection of high resistance found to commonly used antibiotics should serve as a warning call for close surveillance and understanding of the epidemiology of the resistance. Key words: Quinolone antibiotics, resistance, Shigella, Escherichia col
Biochemical parameters in alloxan induced diabetic rats treated with glibenclamide, metformin and two polyherbal bitters
Get PDFBackground: Manufacturers and promoters of various polyherbal bitters claim that, being of natural origin, they could be co-administered with therapeutic drugs with no adverse effects, and that it could be used to treat a wide array of ailments including diabetics. Most Nigerians use the bitters and their conventional drugs concurrently. Objectives: To assess the effects(s) or otherwise of the co-administration of two popular bitters in Nigeria market S-bitter and Y-bitter with two therapeutic antidiabetic drugs glibenclamide and metformin on some liver and kidney biochemicals and lipid profile. Methodology: Therapeutic doses of glibenclamide, metformin and the bitters alone and a combination of the drugs and the bitters corresponding to the body weight of the rats were administered orally to different groups daily for fourteen days. On the 15th day, the rats were sacrificed and plasma collected was analyzed for the hepatic biochemicals (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, albumin, total and direct bilirubin), lipid biochemical (high density lipid cholesterol, low density lipid cholesterol, total cholesterol and triglycerides) and renal biochemicals (creatinine and urea). Results: When metformin, glibenclamide and the bitters were administered alone, there was a marginal decrees in the levels of alanine aminotransferase, and a significant increase (p<0.05) in the plasma levels of creatinine and blood urea nitrogen. A combination of the bitters with metformin and glibenclamide caused a significant decrease (P<0.05) in the levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and bilirubin, but there was an increase in the levels of total cholesterol, high density lipid cholesterol, low density lipid cholesterol, triglycerides and albumin. Conclusion: From the results, we conclude that the co-administration of the bitters with therapeutic drugs is hepatoprotective by reducing the levels of liver enzymes and bilirubin, and by increasing levels of lipid biochemicals, it could lead to the development of heart disease. We therefore advise users of the bitters to do so separately and not in combination with conventional drugs. Key words: Polyherbal bitters, biochemicals, glibenclamide, metformin
The prevalence of TEM and SHV genes among Extended-Spectrum Beta-Lactamase-producing Klebsiella pneumoniae and Escherichia coli
Get PDFBackground: Antimicrobial resistance to cephalosporin, penicillin and aztreonam is mediated by Extended-Spectrum Beta-Lactamases (ESBL) via hydrolysis of antibiotics. The most common bacteria associated with ESBL among the Enterobacteriaceae are Escherichia coli and Klebsiella pneumonia. Pathogenic Escherichia coli is associated with diarrhoea affecting mostly elderly, children under five years and the immunocompromised. There are a number of antibiotic regimens for treatment among them cephalosporins. There is reported increase in microbial resistance to cephalosporin use and the resistance is mediated by either TEM or SHV genes. Objective: To investigate the prevalence of ESBL-producing E. coli and Klebsiella pneumonia from patients presenting with diarrhea in Machakos District Hospital, Kenya. Methods: Bacterial isolates were identified to species level by biochemical methods and tested for sensitivity to twelve different antibiotics including cephalosporins, aminoglycosides and quinolones. Those resistant to cephalosporins with a zone diameter of ≤20 mm were tested phenotypically for Extended Spectrum Beta Lactamase (ESBL) phantom development and confirmed by MicroScan. Resistant strains to cephalosporin were further tested for presence and frequency of TEM and SHV genes. Results: Out of the 200 K. pneumonia and 100 E.coli tested, 18 (6%) were positive for ESBL production phenotypically. These 18 (100 %) isolates demonstrated phantom phenomena phenotypically. Eight (4%) and 2 (1%) of the 200 K. pneumonia isolates had TEM and SHV resistant genes, respectively. There were 5 (5%) TEM and 3 (3%) SHV detected from 100 E. coli isolates. The 18 phenotypically detected and E-test-positive strains (10 Klebsiella spp. and 8 E. coli) were retested with VITEK (GNS-532 card), and 17 of these strains (94.4%) were subsequently found to be ESBL positive. One strain (5.6%) tested ESBL negative by VITEK. The cefotaxime ESBL strip detected the presence of ESBL activity in these 18 phenotypically-positive strains. Discussion: The detection of ESBL-producing E. coli and Klebsiella isolates from Machakos District Hospital was 6%. The findings point out the need for continuous surveillance to determine prevalence of ESBL-producing Enterobacteria strains for better management of diarrheal illness. Key words: Extended spectrum Beta Lactamases; Cephalosporin resistance genes; Enterobacteriacea
Performance of selected HIV testing centers in a HIV Proficiency Testing Scheme in Kenya: a case study
Get PDFBackground: The Proficiency Testing (PT) for Human Immunodeficiency Virus (HIV) using Lateral flow assays provides an avenue for participating institutions/individuals to assess their technical competence in testing for HIV using LFAs that are recommended in the National HIV Testing Algorithm (NHTA) in Kenya. It also provides confidence to the participating institutions and potential users of their services besides giving the institutions an opportunity for improvement. Objective: To determine the performance of selected HIV testing centers in a HIV PT Scheme in Kenya Methods: Fifty one participants (51) in Kenya were selected from 7 sites (Kisumu, Mombasa, Kilifi, Nairobi and Malindi) to participate in this PT round. The sites comprised both private sector and institutions that do not participate in the National HIV referral Lab-PT scheme. They were provided with panels containing six samples to analyze using the current NHTA in Kenya. Obtained results were sent to our laboratory electronically. Results: Eighty nine percent (89.0%) of the panels were correctly identified by the participants as positive or negative. Of the 11.0% errors, 74.2% were committed in one or more test result obtained while 12.9% committed in failure to follow NHTA. Two minor errors repeated by participants were; failure to record the final results in spite of obtaining correct tests and correct reactive results with the first and second test kits but in conclusion the participant recorded negative (12.9%). Root cause analysis revealed that the error committed by participants were as a result of failure to observe the kit manufactures’ instructions and NHTA guidelines. Conclusion: The results of this PT Scheme enhance the need for constant training of personnel conducting HIV testing and Counseling in Kenya on proper techniques of carrying out HIV testing using Lateral flow assays in the NHTA. Key words: HIV, Proficiency Testing, errors, false negative, false positive
Antimalarial activities of crude stembark fractions of Cylicodiscus gabunensis
Get PDFBackground: Malaria is one of the greatest health challenges worldwide threatening millions of people especially children in sub Saharan Africa. Cylicodiscus gabunensis (Taub.) Harms (Mimosaceae) is a tree plant of Tropical Africa used in traditional medicine for the treatment of malaria and other diseases. Objective: The objective of this work was to evaluate the antimalarial activities of Cylicodiscus gabunensis stembark fractions to ascertain the folkloric claim of its antimalarial activity. Methodology: The stembark fractions of Cylicodiscus gabunensis (n-hexane, dichloromethane, ethyl acetate and methanol; 40 mg/kg) of C. gabunensis were investigated for antimalarial activities against chloroquine-sensitive Plasmodium berghei infections in Swiss albino mice. Chloroquine (5 mg/kg) and pyrimethamine (1.2 mg/kg) were used as positive controls. Thin films made from tail blood of each mouse were used to assess the level of parasitaemia. Results: The fractions significantly (p<0.01-0.001) reduced parasitaemia in suppressive, prophylactic and curative antimalarial mouse models with the chloroform and ethyl acetate fractions exerting the most significant activities (p<0.05-0.01) than other fractions. The mean survival time (MST) was significantly (p<0.01-0.001) improved to 20.0 days compared to control (10.00 days). Conclusion: The results indicate that chloroform and ethyl acetate fractions of C. gabunenesis stembark are the most potent antimalarial fractions with active antimalarial compounds that can be use as lead to the development of new antimalarial drug. Keyword: Antiplasmodial, Cylicodiscus gabunensis, medicinal plant, ethnomedicin
Migration Theories Versus Remittance Behaviour of Migrant Women in Kenya
Get PDFThe linkages between development and migration have received increasing attention by international institutions and donor agencies alike. With approximately half of all migrants being women, the impact of financial and social remittances is presumably mediated by gender relations. Interestingly, women‟s socio-economic contributions and unique experiences have not been given the prominence they deserve, especially in migration and remittance studies. Women have always been present in migratory flows, traditionally as spouses, daughters and dependents of male migrants.However, in the most recent decades there has been an increase in women's autonomous migratory behaviour.Notwithstanding other factors such as the migrants‟ marital and migration status, it has been argued that gender affects the volume of remittances, with women sending back home more than men do. Given the fact that migration has reached beyond national boundaries, the significance of remittances as a key driver of national development, especially in developing countries such as Kenya, cannot be ignored. This paper will attempt to make a theoretical case that, even though no substantive data may exist, current thinking isthat migrant women are potential agents of development via pecuniary remittances. They do not only send remittances but also return to their country of origin with newly acquired skills and valuable knowledge. Indeed, previous studies have established that Kenya and Nigeria are among the leading countries in sending money through wire services. But most studies on remittance do not take a gender approach and have not questioned the decision-making processes involved in remittance behaviour. The migrant women‟s remittance behaviour in Kenya will be reviewed based on a broader social development perspective as it relates to issues of education, health, social welfare and political participation.Gendered aspects of remittances will also be approached from the senders‟ as well as recipients‟ perspective. The theoretical findings will contribute towards building knowledge in women‟s experiences as potential agents of change and development as well as in the shaping of feminist perspective in remittance studies in Africa
Evaluation of the anticonvulsant activity of aqueous leaf extract of Emilia praetermissa Milne-Redh (Asteraceae) in rats and mice
Get PDFBackground: Emilia praetermissa has been used for the treatment of convulsive disorders in children by herbalists in Eastern Nigeria. It is also used for the treatment of ulcers, fever, splenomegaly, filarial infections, bacterial infections and ringworms. Objective: This objective was to investigate the inhibitory property of the aqueous leaf extract of E. praetermissa (AEP) against electrically and chemically induced convulsions in rats and mice. Methodology: Groups of rats were administered 5, 10 and 20 mg/kg aqueous leaf extract of E. praetermissa and after one hour they were subjected to maximal electroshock. Groups of mice treated with same doses of the extract were subjected to chemically-induced convulsion using pentylentetrazol or strychnine. Phenobarbitone (30 mg/kg) and/or diazepam (0.5 mg/kg) were used as standards. Comparisons were made by use of Student’s t-test. All data were analyzed using GraphPad Instat software (USA). P < 0.05 indicated statistically significant difference. Results: The doses of aqueous leaf extract of E. praetermissa significantly (P< 0.05) reduced the extensor seizure latency in maximal electroshock model, and onset of tonic convulsion in the chemical models. Aqueous leaf extract of E. praetermissa (20mg/kg; P< 0.007) was significantly superior to diazepam (0.5 mg/kg; P< 0.04) in reducing the onset of strychnine-induced seizure. Conclusion: These results suggest that the ethnomedicinal application of E. praetermissa in Eastern Nigeria has scientific basis that requires further investigation. Key words: Emilia praetermissa, aqueous extract, anticonvulsant activity