Peter Waweru Mwangi

Pattern, knowledge and practices of HbA1C testing among diabetic patients in a Kenyan tertiary referral hospital

BackgroundGlycated haemoglobin (HbA1C) measurement is the currently accepted gold standard biochemical indicator of long-term glycemic control in diabetic patients. The level of knowledge as well as the frequency of use of this test among diabetic patients in Kenya is unknown. The current study aimed to document this among patients attending the diabetes clinic at a national referral hospital in Kenya.MethodsOne hundred and ninety eight diabetic patients (59 male and 139 female) attending the outpatient diabetes clinic at the Kenyatta National Hospital were interviewed on their level of knowledge and use of the HbA1C test, as well as their last HbA1C level. The respondent answers were tabulated, analyzed and summarized. The sample mean, standard deviation and percentages were calculated.ResultsOf the 198 patients interviewed, 11 (5.6%) had type I diabetes mellitus (DM) while 187 (94.4%) had type II DM. One hundred and thirty four patients (67.7%) had heard of the HbA1C test while 64 patients (32.3%) had never heard of the test. Forty patients (20.2%) had at one point done the test while 158 (79.8%) had never done the test. The mean HbA1C level of the 40 patients who had at any one time done the test was 8.5 ± 1.7%, with more than 90% having HbA1C > 8%.ConclusionUsing self-reported accounts, the current study indicates inadequate knowledge and infrequent testing of HbA1C among diabetic outpatients in Kenya. This lack of knowledge and awareness may lead to increased susceptibility to the development of diabetic complications, and potentially higher healthcare costs among these patients. It is our recommendation that policy makers focus on strategies that address HbA1C test accessibility in Kenya, including financial coverage by the national insurance to access the test in public facilities, so as to effectively monitor and combat DM.

Freeze dried extracts of Bidens biternata (Lour.) Merr. and Sheriff. show significant antidiarrheal activity in in-vivo models of diarrhea

ETHNOPHARMACOLOGICAL RELEVANCE OF THE STUDY Diarrhea remains one of the main killers of children aged below five years. Traditional antidiarrheal remedies form a potentially viable source of novel low cost efficacious treatments in low resource settings. There is therefore a pressing need to scientifically evaluate these remedies. AIM OF THE STUDY This study aimed to investigate the in vivo and in vitro antidiarrheal activity of freeze dried Bidens biternata, a herb used in traditional Ayurvedic medicine in the management of diarrhea. MATERIALS AND METHODS In the castor oil test, twenty (20) adult Sprague-Dawley rats were randomized to a negative control (normal saline, n=5), a positive control (5mg/kg loperamide, n=5), and two test groups. The low dose test group received 200mg/kg Bidens biternata extract (n=5) while the high dose test group received 400mg/kg B. biternata extract (n=5). Castor oil (4ml/kg) was then administered to the animals one hour after administration of the respective treatments after which the total mass of fecal output excreted after four (4) hours was determined. In the charcoal meal test fifteen (15) Sprague Dawley rats were randomized to a control group (normal saline 5ml/kg orally, n=5), a positive control group (atropine sulfate 0.1mg/kg i.p., n=5) and a test group (400mg/kg B. biternata extract, n=5). Charcoal meal was then administered via oral gavage to each rat thirty (30) minutes after the administration of the various treatments. The distance covered by the charcoal meal from the pylorus was then determined after sacrifice of the animals thirty minutes after the meal. In the enteropooling test twenty (20) Sprague-Dawley rats were randomized to a control group (5% v/v ethanol in normal saline, n=5), a positive control group (5mg/kg loperamide, n=5) and a test group (400mg/kg B. biternata extract, n=5). For each group prostaglandin E2 (PGE2) (100μg/kg) was administered immediately after the treatments. The animals were then sacrificed half an hour later and the volume of the small intestine contents determined. The effects of different concentrations of B. biternata extract (0.5. 1.0, 2.0, 3.0 and 5.0mg/ml) on jejunal contraction were investigated and a dose-response curve constructed using the experimental data after which The ED50 dose was determined. The effect of tamsulosin (α1 adrenergic blocker), yohimbine (α2 adrenergic blocker), propranolol (β adrenergic blocker) and naloxone (μ opioid blocker) on the contractile activity of the extract were also investigated. The experimental data were expressed as mean±standard error of mean (SEM) and then analyzed using one-way ANOVA followed by Tukeys post hoc test in cases of significance (set at p<0.05). RESULTS The freeze dried extracts of B. biternata had significant antidiarrheal effects in the castor oil induced diarrhea model (p<0.01) with the highest activity being observed at the 400mg/kg dosage level (1.66±0.81g vs. 4.54±0.51g control, p=0.01). B. biternata extract had significant effects on intestinal motility in the charcoal meal test compared to the control group (43.61±4.42% vs. 60.54±3.33%: p<0.05). B. biternata extract had a significant effect on PGE2 induced enteropooling (3.06±0.07ml vs. 4.74±0.10ml; p<0.001). The freeze dried extracts of B. biternata had a significant negative effect on the contractility of the isolated rabbit jejunum (p<0.001). The effects of the extract were significantly attenuated by tamsulosin (53.94±4.20% vs. 80.57±4.09%; p<0.01) and naloxone (53.94±4.20% vs. 73.89±7.26%; p<0.05). Yohimbine (p>0.05) and propranolol (p>0.05) however did not have any significant effect on the contractile activity of the extract. CONCLUSIONS The freeze dried extract of B. biternata possess significant antidiarrheal activity in both in vitro and in vivo models which appears to be mediated by modulating both the intestinal motility as well as the secretory activity. The results of this study also validate its traditional use as an antidiarrheal remedy.

The freeze-dried extracts of Salvia coccinea Juss. Ex Murray attenuate myocardial ischemia reperfusion injury in a global ischemia Rat model

Background Ischemia reperfusion injury is the leading cause of myocardial cell death in Ischemic Heart Disease. Thus intensive research efforts are geared at discovering pharmacological approaches that prevent it. Over twenty species from the genus Salvia are widely applied in traditional Chinese medicine in the management of heart diseases with Salvia miltiorrhiza (Danshen) being a canonical example. Our study aimed to investigate the cardio-protective effects of the freeze-dried extracts of salvia coccinea against ischemia reperfusion injury in a rodent in-vitro model of global ischemia. Methods Forty two (42) Sprague Dawley rats were randomly assigned into five groups: positive control (Glucosamine 1000mg/kg), negative control group (Krebs Henseleit buffer), low dose test (50 mg/100ml), medium dose test (100 mg/100ml), and high dose test (200 mg/100ml). The cardio-protective effects of the different treatments were evaluated in a global ischemia model using isolated rat hearts mounted on a Langendorff system. Naloxone 2.2 μmol/L (μ opioid receptor blocker), and theophylline 1000 μmol/L (non-specific adenosine receptor blocker) were co-administered with 50 mg of S.coccinea in the mechanism of action experiments. The following indices of cardiac function were recorded pre- and post-ischemia: left ventricular developed pressure (LVDP), heart rate, and maximum rate of contraction and relaxation. All data were expressed as Mean ± Standard Error of Mean and analyzed using one-way ANOVA and Tukey post-hoc tests. Significance was set at p < 0.05. Results The freeze-dried extracts of S. coccinea had significant effects on post-ischemic contractile function recovery in the early [51.4 ± 9.7% (low dose test) vs. 14.9 ± 3.3% (medium dose test) vs. 12.7 ± 2.6% (high dose test) vs. 13.7 ± 5.7% (negative control): p<0.05] and late [38.6 ± 8.9% (low dose test) vs. 22.0± 7.1% (medium dose test) vs. 14.6 ± 5.8 (high dose test) vs. 12.5 ± 4.2% (negative control): p< 0.05]. Reperfusion phases with the highest LVDP recovery were observed at the 50 mg dosage level. The freeze-dried extracts of S. coccinea had significant negative chronotropic effects on heart rate [234.0 ± 2.4 beats/min to 90.0 ± 7.0 beats/min, 50 mg vs. 102.0 ± 13.9 beats/min to 135.0 ± 25.9 beats/min, control P<0.05]. The cardioprotective effects of S. coccinea displayed an inverted U-shaped dose-response curve with low dose stimulation and high dose inhibition. Naloxone completely abolished the LVDP recovery afforded by the freeze-dried extracts of S. coccinea at the 50 mg dosage level while adenosine only partly abolished the LVDP recovery (9.5 ± 3.2% (naloxone) vs. 15.5 ± 5.8% (adenosine): P>0.05). Conclusion The freeze-dried extracts of S. coccinea possessed significant cardioprotective effects which appear to be mediated by activation of the opioidergic pathway in the heart.

Pre-treatment with the methanol extract of Withania somnifera prevents Diazinon -induced cardiotoxic effects of organophosphate poisoning

Organophosphate poisoning represents a major and growing global health problem especially in the developing countries and cardiotoxicity is the major cause of death. Thus, a compelling need to develop novel low cost efficacious agents to manage this condition. Objective To evaluate the methanol extract of Withania somnifera as a pre-treatment agent in the prevention of the cardiotoxic effects of diazinon in Sprague Dawley rats Materials and Methods Twenty one (21) adult rats were randomized to receive 200 mg/kg methanol extract of Withania somnifera (test group), vehicle (negative control) or 200 [mu]g/kg Neostigmine as pre-treatment 30 minutes prior to the oral administration of 200 mg/kg Diazinon. Baseline and post-treatment electrocardiograms (ECGs) were recorded by the Powerlab data acquisition system (ML865 AD instruments, Sydney, Australia). The experimental data were expressed as median [plusmn] the inter-quartile range and analysed using the Kruskal [minus] Wallis non[minus]parametric test and followed by Mann[minus]Whitney U post hoc test in cases of significance, which was set at p < 0.05. Statistical Package for Social Sciences (SPSS) version 17 software was used for analysis. Results Pre-treatment with the methanol extract of W. somnifera had significant effect on the following diazinon-induced electrocardiographic changes; RR interval (0.026 (0.007 [minus] 0.065) vs. 0.035 (0.019 [minus] 0.050) vs. 0.090 (0.071 [minus] 0.01), p = 0.031),heart rate ([minus]54.235 (115.317 [minus] ([minus]19.857)) vs. [minus]96.136 ([minus]96.472 [minus] ([minus]43.879)) vs. [minus]174.361 ([minus]189.775 [minus] ([minus]129.469)), p = 0.014), PR interval (0.006 (0.004 [minus] 0.008) vs. 0.003 (0.001 [minus] 0.004) vs. 0.009 (0.006 [minus] 0.015), p = 0.019), QRS interval (0.005 (0.001 [minus] 0.008) vs. [minus]0.002 ([minus]0.005 [minus] 0.001) vs. 0.007 (0.003 [minus] 0.011), p = 0.023) and ST height ([minus]34.830 ([minus]63.578 [minus] 4.215) vs. [minus]22.330 ([minus]38.383[minus]([minus]4.159)) vs. [minus]73.156 ([minus]214.022[minus] ([minus]52.449)), p = 0.023). It however had no significant effect on the QTc interval changes ([minus]0.005 ([minus]0.011 [minus] 0.003) vs. [minus]0.005 ([minus]0.015 [minus] 0.065) vs. [minus]0.021 ([minus]0.060[minus] ([minus]0.006)), p = 0.174). Conclusion The efficacy of pre-treatment with the methanol extract of Withania somnifera was comparable to that of pre-treatment with Neostigmine a commonly used carbamate drug. Thus, it is a potentially viable low cost treatment option for organophosphate poisoning in resource-limited settings.Organophosphate poisoning represents a major and growing global health problem especially in the developing countries and cardiotoxicity is the major cause of death. Thus, a compelling need to develop novel low cost efficacious agents to manage this condition. Objective To evaluate the methanol extract of Withania somnifera as a pre-treatment agent in the prevention of the cardiotoxic effects of diazinon in Sprague Dawley rats Materials and Methods Twenty one (21) adult rats were randomized to receive 200 mg/kg methanol extract of Withania somnifera (test group), vehicle (negative control) or 200 μg/kg Neostigmine as pre-treatment 30 minutes prior to the oral administration of 200 mg/kg Diazinon. Baseline and post-treatment electrocardiograms (ECGs) were recorded by the Powerlab data acquisition system (ML865 AD instruments, Sydney, Australia). The experimental data were expressed as median ± the inter-quartile range and analysed using the Kruskal – Wallis non-parametric test and followed by Mann–Whitney U post hoc test in cases of significance, which was set at p < 0.05. Statistical Package for Social Sciences (SPSS) version 17 software was used for analysis. Results Pre-treatment with the methanol extract of W. somnifera had significant effect on the following diazinon-induced electrocardiographic changes; RR interval (0.026 (0.007 – 0.065) vs. 0.035 (0.019 – 0.050) vs. 0.090 (0.071 – 0.01), p = 0.031),heart rate (-54.235 (-115.317 – (-19.857)) vs. -−96.136 (-96.472 – (-43.879)) vs. -−174.361 (-189.775 – (-129.469)), p = 0.014), PR interval (0.006 (0.004 – 0.008) vs. 0.003 (0.001 – 0.004) vs. 0.009 (0.006 – 0.015), p = 0.019), QRS interval (0.005 (0.001 – 0.008) vs. -−0.002 (-0.005 – 0.001) vs. 0.007 (0.003 – 0.011), p = 0.023) and ST height (-34.830 (-63.578 – 4.215) vs. -−22.330 (-38.383– (-4.159)) vs. -−73.156 (-214.022– (-52.449)), p = 0.023). It however had no significant effect on the QTc interval changes (-0.005 (-0.011 – 0.003) vs. -−0.005 (-0.015 – 0.065) vs. -−0.021 (-0.060– (-0.006)), p = 0.174). Conclusion The efficacy of pre-treatment with the methanol extract of Withania somnifera was comparable to that of pre-treatment with Neostigmine a commonly used carbamate drug. Thus, it is a potentially viable low cost treatment option for organophosphate poisoning in resource-limited settings.