ABSTRACT
BACKGROUND: Antiretrovirals have been associated with serious adverse drug reactions. Several factors have been suggested as independent risk factors for their development. Identification of these factors may help in prevention and management of the adverse drug reactions. OBJECTIVE: To describe the factors associated with adverse drug reactions, their management, and the clinical outcomes. DESIGN: A retrospective cohort study. SETTING: Kenyatta National Hospital, Comprehensive Care Centre. SUBJECTS: Adult patients receiving antiretrovirals from 2003 to 2006. MAIN OUTCOME MEASURES: The primary outcomes were the risk-factors, interventions and outcomes of documented adverse drug reaction after exposure to antiretrovirals. RESULTS: Systematic random sampling was used to pick 350 patients' files. The risk factors for experiencing at least one adverse drug reaction were: having a baseline CD4 count less than 123 (odds ratio [OR] = 1.82, 95% confidence interval [CI: 1.18 to 2.79; p = 0.006); treatment with antiretrovirals for more than 32 months (OR = 1.76, CI: 1.15 to 2.71; p = 0.010), using didanosine containing regimens (OR = 3.7, CI: 1.40 to 9.70; p = 0.008) or being on stavudine containing regimens (OR = 4.4, CI: 2.53 to 7.71; p = 0.001). The most common intervention was addition of a non-antiretroviral while 41% of events resulted in a change of anti-retroviral therapy. CONCLUSIONS: Current standard regimens in resource-limited countries are associated with an increased risk of adverse drug reactions. Almost half of adverse reactions are managed by addition of a non-anti-retroviral drug alone but 41% necessitated a change of anti-retrovirals.
Subject(s)
Anti-Retroviral Agents/adverse effects , Drug-Related Side Effects and Adverse Reactions/diagnosis , Drug-Related Side Effects and Adverse Reactions/therapy , HIV Infections/drug therapy , Adult , Drug-Related Side Effects and Adverse Reactions/etiology , Female , HIV Infections/complications , Humans , Kenya , Male , Outcome and Process Assessment, Health Care , Retrospective Studies , Risk FactorsABSTRACT
Myrica salicifolia Hoechst (Myricaceae) root extract was found to have analgesic activity in mice. In rats there was antipyretic but no antiinflammatory activity.
Subject(s)
Analgesics/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Fever/prevention & control , Myricaceae , Pain/prevention & control , Phytotherapy , Plant Extracts/therapeutic use , Analgesics/pharmacology , Animals , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Male , Mice , Pain Measurement/drug effects , Plant Extracts/pharmacology , Plant Roots , Rats , Rats, Sprague-Dawley , Rats, WistarABSTRACT
Field trips to herbalists' practices in an area about 200 miles around Nairobi (Kenya) enabled us to make a list of medicinal plant species preferentially used to treat malaria. Ajuga remota and Caesalpinia volkensii were further investigated as being the most frequently used species. Aqueous decoctions, ethanol macerates, and petroleum ether, methanol and water Soxhlet extracts of these plants were further tested for their in vitro antimalarial properties in a chloroquine sensitive (FCA/20GHA) and resistant (W2) strain of Plasmodium falciparum. The activity was assessed by the parasite lactate dehydrogenase (pLDH) assay method. There was a concentration-dependent inhibition by the vegetal extracts of both plants. The IC(50) of the most active A. remota extract (ethanol macerate) was 55 and 57 microg/ml against FCA/20GHA and W2, respectively. For C. volkensii, it was the Soxhlet-water extract which was most active against FCA/20GHA with an IC(50) of 404 microg/ml while the petroleum ether extract exhibited the most activity against W2 with an IC(50) of 250 microg/ml. Further phytochemical work is being done in order to identify the active principles.
Subject(s)
Antimalarials/pharmacology , Ethnopharmacology , Plants, Medicinal/chemistry , Animals , Ethers , Kenya , L-Lactate Dehydrogenase/metabolism , Methanol , Plant Extracts/pharmacology , Plasmodium falciparum/drug effects , Plasmodium falciparum/enzymology , Solvents , WaterABSTRACT
(-)-Cathinone and d-norpseudoephedrine (DNE) in the dose range 0.2-1.2 mg/ml produced a reduction in contractions of skeletal muscle, evoked by direct and indirect electrical stimulation and antagonised the facilitatory action of physostigmine on the neuromuscular junction; but failed to antagonise a partial blockade induced by d-tubocurarine (dTb) as occurs with norepinephrine or epinephrine. The local anaesthetic actions of (-)-cathinone and DNE were found to be almost equivalent to that of lignocaine. These results indicate that (-)-cathinone and DNE may have a direct blocking action on the neuromuscular junction, which is independent of cholinergic and adrenergic transmission.
