Unlocking the anti-prostate cancer potential of some tropical and sub-tropical plants

Prostate cancer is the third leading cause of cancer death among men worldwide and is the leading cause of cancer mortality in males greater than 60 years in Trinidad and Tobago. Although there are some treatment options for the metastatic disease, the impact on overall survival rate has not improved in the last two decades. In particular, the mortality rate from prostate cancer is high among men of African descent in Trinidad and Tobago and the Americas. These groups manifest aggressive cancers that are often less responsive to available therapies. We hypothesize that phytochemical screening of tropical plants, coupled to cell culture studies would identify other potential treatments for prostate cancer. In separate experiments, the roots or leaves of five plants indigenous to the Caribbean and the skin of the muscadine grape, indigenous to North America were dried, crushed and suspended in 100% methanol. The respective methanol extracts were fractionated and the fractions dried. Next the ability of the extracts to halt the growth of or kill PC-3 prostate cancer cells was assessed by MTT assays. Colony formation, cell migration studies, cell cycle studies and western blots were performed to determine probable mechanism of action. The categories of chemical compounds present in the extracts were determined by Thin Layer chromatography (TLC). Results from MTT assays showed that compared to the control cells (ie those treated with DMSO only), treatment with at least four plant extracts significantly (p<0.05) inhibited the growth of the cancer cells; decreases as large as 95 % were observed. On the other hand these extracts had a limited or delayed effect on the "normal" PNT1A cells. Results from the cell cycle assay demonstrated that one extract, now identified as plant-A extract, caused the arrest of the G1/S phase of PC-3 cells i.e. leading to an increase in the number of cells that remained in the growth phase. On the other hand the total ethanol extract of muscadine grape skin decreased the expression of heat shock protein-40, possibly causing deactivation of the androgen receptor. This suggests that extracts prepared from Plant A and the muscadine grape have the potential for use as anticancer drugs.

Evaluative research on pharmacist managed diabetes care: focus on self-monitoring of blood glucose

Diabetes, especially Type 2 Diabetes (90%) is an ongoing problem for many nations. The world-wide prevalence of diabetes estimated by World Health Organization was approximately 175 million in 2000 and is predicted to be at least 366 million by 2030 among adults ≥ 20 years of age. The WHO estimate for Trinidad and Tobago in 2000 was 60,000 and is projected to increase to 125,000 if current trends prevail. Recent data (unpublished) from the Ministry of Health indicate that the Chronic Disease Assistance Programme, since its inception in 2003 to 2009, has provided medicines for approximately 226,435 diabetic patients. The National Insurance Property Development Company procures and manages the distribution of medicines for Chronic Disease Assistance Programme on behalf of the Ministry of Health. The total cost of diabetes treatment amounted to 285 million USD, representing approximately 38% of the total patient population receiving treatment through the progamme in this period. Objective: The primary objective was to demonstrate that pharmacists can assist patients to achieve at least a 1% decrease in HbA1c. Methods: A randomized controlled Pharmacist Evaluative Research Study compared the efficacy of pharmacist managed care (the intervention), and routine standard management (control) of poorly controlled (abnormal glycosylated haemoglobin, blood pressure, blood glucose and lipid panel) adult diabetic patients. Participants in the intervention group met with the pharmacist at their respective primary care sites on a regular basis for an assessment of adherence to medications, barriers to adherence and education. Control group participants consisted of patients receiving routine care by their primary physician but, with no direct intervention by the pharmacist except for the filling of prescriptions. Results: Seventy-five (75) patients were initially recruited, of these forty-eight (48) [20 interventions and 28 control] met the inclusion criteria. It was only possible to analyse the result from twenty (20) patients: 14 (70%) intervention and 6 (21.4%) control because of incomplete collected data. A minimum decrease of at least 1% HbA1c was obtained by eight (57%) intervention participants compared to two (33%) in the control group; while HbA1c remained unchanged for two participants each in the intervention and control groups (14% and 33%, respectively). The patient cohort was too small, therefore better methods for recruitment needed to be explored. The failure of patients to document key measurements (SMGB, BP), as requested by the pharmacist, was responsible for the exclusion of these patients in the statistical analysis. All of these factors reinforced the importance of preventing patients from absconding in order to reduce the high attrition rate. Conclusion: The data supports the hypothesis that the use of pharmacists as adjunctive healthcare practitioners achieves better patient outcomes than the non-use of pharmacists.

An evaluation of treatment strategies for head and neck cancer in an African American population.

OBJECTIVE: This study evaluated treatment strategies for head and neck cancers in a predominantly African American population. METHODS: Data were collected utilizing medical records and the tumour registry at the Howard University Hospital. Kaplan-Meier method was used for survival analysis and Cox proportional hazards regression analysis predicted the hazard of death. RESULTS: Analysis revealed that the main treatment strategy was radiation combined with platinum for all stages except stage I. Cetuximab was employed in only 1% of cases. Kaplan-Meier analysis revealed stage II patients had poorer outcome than stage IV while Cox proportional hazard regression analysis (p = 0.4662) showed that stage I had a significantly lower hazard of death than stage IV (HR = 0.314; p = 0.0272). Contributory factors included tobacco and alcohol but body mass index (BMI) was inversely related to hazard of death. CONCLUSIONS: There was no difference in survival using any treatment modality for African Americans.