Applying Psychological and Educational Health Models to Determine the Effect of a Pharmacist-led Cognitive and Behavioral Intervention on Tuberculosis Treatment Outcomes in Plateau State, Nigeria.

Background: The prolonged multi-drug treatment regimen for tuberculosis (TB) can lead to non-adherence and unsuccessful treatment outcomes. Educational and psychological health models can be used to design cognitive and behavioral interventions to improve adherence and treatment outcomes. Objective: To determine the effect of cognitive and behavioral interventions on TB treatment outcomes. Methods: The quasi-experimental study conducted in six TB treatment centers involved reinforced medication education and adherence counseling (MEAC), designed from a structured validated psychometric scale. Data were collected three different times during the intensive and continuation phases of treatment from 463 TB patients (232 in the control and 231 in the intervention group). Baseline demographic and clinical characteristics were compared between the groups. The generalized estimating equation model was used to analyze the repeated measures by determining if treatment success was associated with the cognitive and behavioral interventions and medication adherence. Results: The males made up 290(62.6 %) of the population. The mean age was 36.75±13.9. Most of the TB patients were newly diagnosed 413(89.2%) and HIV negative 315(68%), with secondary level of education 216(46.6%). There was no significant difference in baseline characteristics between the groups. The intervention group was four times more likely to have treatment success (p<0.01; CI=1.5-8.4), compared to the control group. Medication-adherent TB patients were 24 times more likely to have treatment success than patients who did not adhere (p<0.001; 10.8-52.1). TB patients' emotions, attitudes, and perceptions of their medicines were predictors of treatment success (p<0.05; 1.0 - 1.1). Conclusion: The cognitive and behavioral interventions administered to TB patients improved successful treatment outcomes.

Application of the information-motivation-behavioral-skills model to validate a cognitive and behavioral intervention scale for tuberculosis patients in Jos, Nigeria.

Psychometric scales can be used to assess the cognition of and behavior toward tuberculosis (TB) disease and anti-TB medicines in TB patients by applying the Information-Motivation-Behavioral-Skills model. This study validated a psychometric scale from the responses of 115 TB patients using principal component (PCA) and reliability analyses. The Cronbach's-alpha was 0.864. The PCA identified 21 factors, with eigenvalues greater than one. Six factors, with factor loading >0.5 had more than two items loaded to a factor. Twenty-five items validated from six factors suggest that the scale can be used for cognitive and behavioral assessment and interventions in tuberculosis patients.

Draft Genome Sequence of Salmonella enterica Serovar Enteritidis from Jos, Plateau State, Nigeria.

Salmonella enterica serovar Enteritidis causes the highest incidence of human salmonellosis infections. Here, we describe the whole-genome sequence and annotation of Salmonella enterica serovar Enteritidis strain 1145s, isolated in Nigeria. The strain has a genome of 4.57 Mb with a GC content of 52% and contains one plasmid.

Complete Genome Sequence of Pseudomonas Phage Zikora.

Pseudomonas aeruginosa is a major pathogen in humans and other animals, frequently harboring mechanisms of resistance to commonly used antimicrobials. Here, we describe the isolation of Pseudomonas bacteriophage Zikora. The full 65,837-bp genome was annotated and demonstrates similarity to Pbunavirus phages, making Zikora a new member of this genus of the Myoviridae family.

Comparative incidence of adverse drug reaction during the first and subsequent year of antiretroviral therapy in a Nigerian HIV infected Cohort.

BACKGROUND: Despite close to two decades of antiretroviral therapy (ART) in Nigeria, data on late on-onset ART-associated adverse drug reactions (ADRs) are sparse. OBJECTIVES: To describe early and late-onset ADRs and compare their incidence in an outpatient HIV positive Cohort on ART. METHOD: We described the incidence of clinical ADRs identified and documented in an outpatient clinic cohort of HIV-positive patients treated between June 2004 and December 2015 at a tertiary health facility in Nigeria. Incidence rates of ADRs during the first and subsequent years of ART were compared. RESULTS: of the 13,983 patients' data analyzed, 9317 were females (66%), and those in the age bracket of 25 to 45 years made up 78% of the studied population. During 52,411 person-years (py) of ART, 1485 incident ADRs were recorded; Incidence rate (IR) 28.3 (95% confidence interval [CI] 26.9:29.8) ADRs per 1000 person-years (py) of ART. The IR of ADRs was about two times higher in the first year of ART compared to subsequent years of treatment; crude incidence rate ratio (IRR) 1.77 (95% CI 1.59:1.97). Anemia, hypersensitivity reactions, and nervous system disorders had 7, 23, and 5 times higher incidence, respectively, in the first year of therapy, compared to subsequent years. CONCLUSION: The first year of ART is the period of highest risk of ADRs. Individual and programmatic treatment success in resource-limited settings requires strategies for early identification and management of ADR during the period of greatest risk of ADRs.

Tuberculosis treatment outcomes: a fifteen-year retrospective study in Jos-North and Mangu, Plateau State, North - Central Nigeria.

BACKGROUND: Globally, tuberculosis (TB) is the leading cause of death from a single infectious agent. Adherence to TB therapy is an important factor in treatment outcomes, which is a critical indicator for evaluating TB treatment programs. This study assessed TB treatment outcomes using a fifteen-year record of tuberculosis patients who received treatment in Jos-North and Mangu Local Government Areas of Plateau State, North-Central Nigeria. METHODS: The retrospective facility based study was done in five TB treatment centers which account for more than half of data for tuberculosis patients in Plateau State. Data were collected from 10,156 TB patient's health records between 2001 and 2015. Treatment outcomes were categorized as successful (cured, treatment completed) or unsuccessful (non-adherent, treatment failure or death). A descriptive analysis was done to assess the factors associated with treatment outcomes. Relevant bivariate and multivariate logistic regression were done. All statistical analyses were performed on Stata version 11, College station, Texas, USA. RESULTS: During the study period, 58.1% (5904/10156) of the TB patients who received treatment were males. The Mean age ± SD was 35.5 ± 15.5 years. The overall treatment success rate was 67.4%; non-adherence/defaulting rate was 18.5%, with majority of patients defaulting at the end of intensive phase of treatment. The sputum conversion rate was 72.8% and mortality rate was 7.5%. A decrease in successful treatment outcomes rate from 83.8% in 2001 to 64.4% in 2015 was observed. The factors associated with treatment success were gender, age, year of enrollment, and HIV status. Extrapulmonary TB was less likely associated with treatment success (AOR:95% CI- 0.72:0.61-0.84, p < 0.001). CONCLUSION: With the decrease in treatment success rates, underlying reasons for medication non-adherence and treatment failure should be resolved through adherence counseling involving the patient and treatment supporters, with education on voluntary counseling and testing for HIV among TB patients.

Whole-Genome Sequencing of an Uncommon Cryptococcus neoformans MLST43 Genotype Isolated in Nigeria.

Cryptococcosis is a human infection caused mainly by two species of the Cryptococcus genus, Cryptococcus neoformans and Cryptococcus gattii, whose populations contain several phylogenetically related haploid (VN/VG-types) and hybrid genotypes. Here, we report the whole-genome sequencing of a Nigerian C. neoformans VNII, Mat-α, strain with a rare multilocus-sequence-type (MLST) genotype (ST43).

Prophylactic effect of Mucuna pruriens Linn (velvet bean) seed extract against experimental Naja sputatrix envenomation: gene expression studies.

Mucuna pruriens is widely used in traditional medicine for treatments of various diseases. In certain region of Nigeria, the seed is used as oral prophylactics for snakebite. Rats pretreated with the aqueous extract from M. pruriens seed (MPE) were protected against the lethal effects of Naja sputatrix (Javan spitting cobra) venom [Tan et al., J Ethnopharmacol, 123 (2009) 356]. The pretreatment also protected against venom-induced histopathological changes in rat heart. To contribute to the understanding of the mechanism of cardio-protective action, the present study examined the effects of MPE-pretreatment on gene expression profile of rat heart as well as effect of MPE-pretreatment on N. sputatrix venom-induced gene expression alterations in rat heart. The gene expression profiles were examined by microarray analysis and verified by real time PCR. The results showed that pretreatment with MPE caused 50 genes in the rat heart substantially up-regulated of which 19 were related to immune responses, 7 were related to energy production and metabolism. The up-regulation of genes related to energy metabolism probably plays a role in maintaining the viability of the heart. Four other genes that were up-regulated (alpha synuclein, natriuretic peptide precursor, calsequestrin and triadin) were involved in the maintenance of homeostasis of the heart or maintaining its viability, thereby contributing to the direct protective action. The results demonstrated that protective effect of MPE pretreatment against snake venom poisoning may involve a direct action on the heart.

Traditional medicine policy and regulation in Nigeria: an index of herbal medicine safety.

BACKGROUND: The requirements and methods for research and evaluation of the safety and efficacy of herbal medicines are more complex than those for conventional pharmaceuticals. In addition to the aforementioned and contrary to the general belief that herbal medicines are safe and despite the profound therapeutic advantages possessed by medicinal plants, some of their constituents have been shown to be potentially toxic, carcinogenic, mutagenic, and teratogenic. Thus, traditional medicine policy and regulation have been made an integral part of the WHO proposed critical determinants of herbal medicine safety. OBJECTIVE: Therefore, this study is designed to assess the policy and regulation guiding herbal medicine in Nigeria as this information may form a safety index of herbal medicine use in Nigeria. METHODOLOGY: Structured questionnaire adopted from WHO was used to obtain the opinions of relevant stakeholders in the field of herbal medicine on the policy and regulation of herbal medicine in Nigeria. RESULTS: The results show that 68.8% of respondents agreed that there is a national policy on TM with 31.2% disagreeing on this issue. 75% of respondents agreed that implementation of the manufacturing requirements of herbal medicines is ensured by control mechanisms while 25% disagreed. Only 25% said herbal medicines are sold by licensed practitioners, with 75% believing that herbal medicines are sold by non-licensed practitioners. 87.5% said support from the WHO is needed and should be in the form of workshops on national capacity building on safety monitoring of herbal medicines. CONCLUSION: There is need for the Federal Ministry of Health to harmonize the varying opinions on traditional medicine and policy as documented in this study through collaboration and workshops on traditional medicine. These proposed approaches may guarantee the safety and regulation of herbal medicine use in Nigeria.

Effects of Mucuna pruriens protease inhibitors on Echis carinatus venom.

The medicinal plant Mucuna pruriens, with reputed anti-snake venom properties has been reported to contain a kunitz-type trypsin inhibitor. This study was undertaken to further evaluate the protease inhibitory potential of gpMuc, a multiform glycoprotein, and other protein fractions from M. pruriens seeds against trypsin, chymotrypsin, Echis carinatus snake venom, ecarin and thrombin. The results showed that gpMuc inhibited both trypsin and chymotrypsin activities and was thermally stable, maintaining its trypsin inhibitory activity at temperatures of up to 50°C. Its structural conformation was also maintained at pH ranges of 4-7. Immunoreactivity study confirms that it contains protease-recognizing epitope on one of its isoforms. The whole protein extract of M. pruriens seeds inhibited prothrombin activation by ecarin and whole E. carinatus venom, and also thrombin-like activity using chromogenic assay.

Effect of Mucuna pruriens Seed Extract Pretreatment on the Responses of Spontaneously Beating Rat Atria and Aortic Ring to Naja sputatrix (Javan Spitting Cobra) Venom.

Mucuna pruriens Linn. (velvet bean) has been used by native Nigerians as a prophylactic for snakebite. Rats pretreated with M. pruriens seed extract (MPE) have been shown to protect against the lethal and cardiovascular depressant effects of Naja sputatrix (Javan spitting cobra) venoms, and the protective effect involved immunological neutralization of the venom toxins. To investigate further the mechanism of the protective effect of MPE pretreatment against cobra venom toxicity, the actions of Naja sputatrix venom on spontaneously beating rat atria and aortic rings isolated from both MPE pretreated and untreated rats were studied. Our results showed that the MPE pretreatment conferred protection against cobra venom-induced depression of atrial contractility and atrial rate in the isolated atrial preparations, but it had no effect on the venom-induced contractile response of aortic ring preparation. These observations suggested that the protective effect of MPE pretreatment against cobra venom toxicity involves a direct protective action of MPE on the heart function, in addition to the known immunological neutralization mechanism, and that the protective effect does not involve action on blood vessel contraction. The results also suggest that M. pruriens seed may contain novel cardioprotective agent with potential therapeutic value.

Analysis of some biochemical and haematological parameters for Mucuna pruriens (DC) seed powder in male rats.

The biochemical and haematological effects of the seed powder of Mucuna pruriens in male rats were evaluated to establish some biological properties of this potential biopesticide currently undergoing investigation. The result showed that Mucuna pruriens seed extract produced a significant (p<0.05) increase in white blood cell (WBC) count, as well as in bilirubin concentrations, alkaline phosphatase (ALP), protein and creatinine levels measured. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly reduced (P<0.05) in comparison with the experimental control. PCV, Hb, albumin level and WBC differential counts gave no significant difference between treated and control groups. The results revealed metabolic imbalance in the rats which suggests a mild cholestasis effect of the extract.

Mucuna pruriens Linn. seed extract pretreatment protects against cardiorespiratory and neuromuscular depressant effects of Naja sputatrix (Javan spitting cobra) venom in rats.

Mucuna pruriens has been used by native Nigerians as a prophylactic for snakebite. The protective effects of M. pruriens seed extract (MPE) were investigated against the pharmacological actions of N. sputatrix (Javan spitting cobra) venom in rats. The results showed that MPE-pretreatment protected against cardiorespiratory and, to a lesser extent, neuromuscular depressant effects of N. sputatrix venom. These may be explained at least in part by the neutralisation of the cobra venom toxins by anti-MPE antibodies elicited by the MPE pretreatment.

The protective effect of Mucuna pruriens seeds against snake venom poisoning.

ETHNOPHARMACOLOGICAL RELEVANCE: The seed, leaf and root of Mucuna pruriens have been used in traditional medicine for treatments of various diseases. In Nigeria, the seed is used as oral prophylactics for snakebite. AIM OF THE STUDY: To study the protective effects of Mucuna pruriens seed extract against the lethalities of various snake venoms. MATERIALS AND METHODS: Rats were pre-treated with Mucuna pruriens seed extract and challenged with various snake venoms. The effectiveness of anti-Mucuna pruriens (anti-MPE) antibody to neutralize the lethalities of snake venoms was investigated by in vitro neutralization. RESULTS: In rats, MPE pre-treatment conferred effective protection against lethality of Naja sputatrix venom and moderate protection against Calloselasma rhodostoma venom. Indirect ELISA and immunoblotting studies showed that there were extensive cross-reactions between anti-MPE IgG and venoms from many different genera of poisonous snakes, suggesting the involvement of immunological neutralization in the protective effect of MPE pre-treatment against snake venom poisoning. In vitro neutralization experiments showed that the anti-MPE antibodies effectively neutralized the lethalities of Asiatic cobra (Naja) venoms, but were not very effective against other venoms tested. CONCLUSIONS: The anti-MPE antibodies could be used in the antiserum therapy of Asiatic cobra (Naja) bites.

Proteomic analysis of the pathophysiological process involved in the antisnake venom effect of Mucuna pruriens extract.

Previously, we reported the antisnake venom properties of a Mucuna pruriens seed extract (MPE) and tested its in vivo efficacy against Echis carinatus venom (EV) in short- (1 injection) and long-term (three weekly injections) treatments. The aim of the present study was to investigate plasma proteome changes associated with MPE treatments and identify proteins responsible for survival of envenomated mice (CHALLENGED mice). Six treatment groups were studied. Three control groups: one saline, one short-term and one long-term MPE treatment. One group received EV alone. Two test groups received EV with either a short-term or long-term MPE treatment (CHALLENGED mice). The plasma from each group was analysed by 2-DE/MALDI-TOF MS. The most significant changes with treatment were: albumin, haptoglobin, fibrinogen, serum amyloid A and serum amyloid P. Most of these changes were explained by EV effects on coagulation, inflammation and haemolysis. However, MPE treatments prevented the EV-induced elevation in HPT. Consequently, HPT levels were similar to controls in the plasma of CHALLENGED mice. The plasma of CHALLENGED mice showed substantial proteomic modifications. This suggests the mechanism of MPE protection involves the activation of counterbalancing processes to compensate for the imbalances caused by EV.

Protection of Mucuna pruriens seeds against Echis carinatus venom is exerted through a multiform glycoprotein whose oligosaccharide chains are functional in this role.

In a previous paper we demonstrated that extracts of Mucuna pruriens seeds (MPE) protect mice against Echis carinatus venom (EV) by an immunological mechanism. In this paper we demonstrate that the MPE immunogen generating the antibody that cross-reacts with the venom proteins is a multiform glycoprotein (gpMuc) whose immunogenic properties mainly reside in its glycan-chains. The glycoprotein was purified from the protein extract of M. pruriens seeds using Concanavalin A affinity chromatography. Using 2-D gel electrophoresis it separated into seven isoforms having MWs in the range from 20.3 to 28.7 kDa and pIs from 4.8 to 6.5. N-terminal sequencing of these spots revealed close similarity since all of them contained the consensus sequence DDREPV-DT found in soybean Kunitz-type trypsin inhibitor. We suggest that gpMuc contains both N- and O-glycans. Mild alkaline treatment but not PNGase F led to loss of reactivity, indicating that O-glycans are probably involved in the antigenicity of gpMuc.

Proteins from Mucuna pruriens and enzymes from Echis carinatus venom: characterization and cross-reactions.

Mucuna pruriens seeds have been widely used against snakebite in traditional medicine. The antivenin property of a water extract of seeds was assessed in vivo in mice. The serum of mice treated with extract was tested for its immunological properties. Two proteins of Echis carinatus venom with apparent molecular masses of 25 and 16 kDa were detected by Western blot analysis carried out using IgG of mice immunized with extract or its partially purified protein fractions. By enzymatic in-gel digestion and electrospray ionization-mass spectrometry/mass spectrometry analysis of immunoreactive venom proteins, phospholipase A(2,) the most toxic enzyme of snake venom, was identified. These results demonstrate that the observed antivenin activity has an immune mechanism. Antibodies of mice treated with non-lethal doses of venom reacted against some proteins of M. pruriens extract. Proteins of E. carinatus venom and M. pruriens extract have at least one epitope in common as confirmed by immunodiffusion assay.