Evaluation and Comparison of the Indices of Systemic Oxidative Stress among Black-Africans with Age-related Cataracts or Primary Glaucoma.

PURPOSE: Oxidative stress has been implicated in the pathophysiology of glaucoma, cataract, and many degenerative diseases. The purpose of this study is to evaluate the systemic oxidative stress in black-African patients diagnosed with primary glaucoma or age-related cataract (ARC) and compare these indices to normal control patients and between the two conditions. METHODS: This was a descriptive cross-sectional study of consecutive recruited subjects attending a tertiary care facility. One hundred adults were enrolled and sub-grouped into: Normal controls (n = 20), patients with primary glaucoma (n = 40), and patients with cataract (n = 40). The data were collected on patient demographics and clinical information. Ten milliliters of the venous blood was taken from each subject for the evaluation of serum biochemical indices of oxidative stress. Laboratory measurements of enzymatic and nonenzymic anti-oxidants, as well as lipid peroxidation, were conducted using established and validated spectrophotometric methods. The systemic oxidative stress was measured by the serum levels of anti-oxidant enzymes and lipid peroxidation, and compared between the groups and to a control group of patients. RESULTS: Statistically, significantly reduced serum levels of glutathione, glutathione-S-transferase, superoxide dismutase, catalase, and ascorbic acid were found in the patients with glaucoma or cataract when compared with controls (P < 0.05 for all). Differences in serum lipid peroxidation levels across or between the groups were nonsignificant. Serum protein levels were significantly higher among the subjects with cataract or glaucoma than in controls. CONCLUSION: Our results concur with findings in Caucasian study cohorts. This indicates that in black-Africans, primary glaucoma, and ARC are associated with increased systemic oxidative stress. This supports the existing evidence on the role of oxidative stress in these ocular disorders and reinforces the rationale for the use of anti-oxidants in the management and possible prevention of these conditions.

Antidepressant and anxiolytic effects of the methanol root extract of Capparis thonningii: involvement of monoaminergic, cholinergic and GABAergic systems.

BACKGROUND: Capparis thonningii Schum. (Capparaceae) is used in traditional African Medicine for the treatment of mood disorders. OBJECTIVE: The study investigates antidepressant and anxiolytic activities of methanol root extract of C. thonningii (CT). METHODS: CT (25-100 mg/kg, p. o.) was administered 1 h before behavioral studies were carried out in mice. Antidepressant effect was investigated using the forced swimming test (FST) and tail suspension test (TST). The anxiolytic effect was evaluated using the elevated-plus maze test (EPM), hole-board test (HBT), and light-dark test. RESULTS: CT (25 and 50 mg/kg) increased swimming activity (P<0.05) by 92.73% and attenuated immobility time by 35.72%, similar to anti-immobility effect of imipramine (33.87%) in FST. In addition, CT (50 mg/kg) significantly (P<0.01) reduced immobility time by 30.24% in TST. -However, the antidepressant-like effect elicited by CT was reversed by metergoline, cyproheptadine, and sulpiride (40.81, 45.93, and 48.52%, respectively) pretreatment but prazosin, and yohimbine failed to reverse this antidepressant-like effect. Similar to diazepam, CT (25 mg/kg) increased duration of open arms exploration (P<0.05) by 43.73% in EPM, number of head-dips (HBT) (90.32%), and time spent in the light compartment by 45.77% in light/dark test indicating anxiolytic-like effect. The anxiolytic-like effect of CT was reversed by flumazenil pretreatment. CONCLUSION: The findings from this study suggest antidepressant-like effect of C. thonningii involving interaction with serotonergic (5-HT2), dopaminergic (D2), noradrenergic (α1 and α2), and muscarinic cholinergic systems; and anxiolytic effect through an interaction with GABAA benzodiazepine receptor.

Pharmacoepidemiology of antiretroviral drugs in a teaching hospital in Lagos, Nigeria.

OBJECTIVE: Prescribing, adherence, and adverse drug events to HAART in a large antiretroviral programme in Lagos was evaluated. DESIGN: A retrospective 5 year open cohort study. SETTING: The AIDS Prevention Initiative in Nigeria (APIN) clinic at LUTH is one of the United States Presidential Emergency Plan for AIDS Relief (PEP-FAR) funded centers for HIV relief program in Nigeria Participants The case files of 390 patients on HAART and attending the APIN clinic were reviewed sequel to random selection. MAIN OUTCOME MEASURES: Demographics of the patients and pattern of antiretroviral (ARV) combination drugs prescribed were extracted from their case files. The details of the adverse drug events (ADEs) were extracted from drug toxicity forms regularly filled for each patient. A Chi-square test with Yates correction was used to determine the association between adherence and therapeutic outcome. RESULTS: A total of 2944 prescriptions were assessed. Zidovudine + lamivudine + nevirapine (35.87%) and stavudine + lamivudine + nevirapine (35.63%) were the most frequently prescribed combinations. Over 2000 ADEs were reported with cough (13.3%), fever (8.75%) and skin rashes (8.01%) being the most frequently reported. Drug adherence was associated with good therapeutic outcome (χ(2) = 115.60, p<0.0001). CONCLUSIONS: Zidovudine + lamivudine + nevirapine was the most frequently prescribed ARV combination. Cough was the most frequently reported ADE. Interventions aimed at rational prescribing of ARV drugs and improving adherence to antiretroviral drugs is essential for good therapeutic outcome in the treatment of HIV infection.

Medication administration errors among paediatric nurses in Lagos public hospitals: an opinion survey.

OBJECTIVE: There is paucity of data on paediatric medicine administration error (MAE) in developing countries. This study aimed to investigate the experience of MAEs among paediatric nurses working in public hospitals in Lagos, Nigeria. DESIGN: A confidential, self-reporting questionnaire was the instrument for the study. SETTING: Public hospitals in Lagos, Nigeria with established paediatric services and departments. PARTICIPANTS: Paediatric nurses. METHODS: The questionnaire was administered to 75 nurses working in public hospitals in Lagos to obtain information on the experience of medication errors during their entire career, as well as to know their views on the nature of MAEs and the contributing factors. RESULTS: Fifty nurses responded to give a response rate of 66.7%. All the participants were females with a mean ± s.d age of 35.3 ± 10.7 years. Thirty two (64%) had committed at least one medication error over the course of their career. Wrong dose error (24; 48%) and wrong timing of medicine administration (20; 40%) were the MAEs frequently committed by the participants. The consequences of the errors included shock (23; 46%), restlessness (21; 42%), disorientation (11; 22%), and respiratory depression (10; 20%). Increased workload (26; 52%) and not double checking medicine doses (12; 24%) were the major factors the nurses perceived to be contributing to MAEs. Only 15(30%) nurses had reported MAEs to their superiors. Fear of intimidation, retribution or being punished (11; 22%) and lack of policies in place to report errors (13; 26%) were the two major barriers to reporting MAEs. Half (50%) of the nurses indicated that policies were available in their work places to prevent medication errors. CONCLUSIONS: Medication administration errors were frequently committed by the participants and resulted in some inconsequential effects, morbidity and deaths. Appropriate measures should be implemented to prevent future occurrences of MAEs.

The physicochemical equivalence of eight brands of amlodipine tablets in Lagos, Nigeria.

BACKGROUND: Amlodipine is a dihydropyridine calcium channel antagonist that is useful in the treatment of hypertension and angina pectoris. In addition to the innovator brand of this molecule, several generic brands are marketed in Nigeria. OBJECTIVE: To evaluate the physicochemical equivalence of eight brands of amlodipine tablets marketed in Lagos, Nigeria. METHODS: Physicochemical properties such as identity, weight uniformity, friability, hardness test, disintegration test, dissolution test and assay of active ingredients were performed using the methods described in the British and the United States Pharmacopoeia. Ultra-violet spectrophotometric and High performance liquid chromatographic methods were used for assay of the labelled amount of amlodipine in the products. RESULTS: All the products passed weight uniformity and disintegration tests. Only one brand failed the friability test. Two brands had mean crushing strength less than 4 kg/cm²; while only 4 brands passed dissolution test by releasing >75% of the labelled amlodipine within 45 minutes. One brand failed both assay and dissolution tests by returning less than official specifications in the general monograph for conventional tablets. In all, four of the eight sample products analyzed passed all the tests. These can be said to be physicochemically equivalent and may be clinically interchangeable or substituted. CONCLUSION: This study further highlights the concerns over the quality of drug products marketed in a developing country.

The knowledge, perceptions and practice of pharmacovigilance amongst community pharmacists in Lagos state, south west Nigeria.

PURPOSE: Community Pharmacists both have an important responsibility in monitoring the ongoing safety of medicines and are widely accessible to do it. This study aims to investigate the knowledge, perceptions and practice of Pharmacovigilance amongst community pharmacists in Lagos State, South West Nigeria METHODS: A cross-sectional observational survey was used in this study. A multistage random sampling technique was employed in the selection of 420 community pharmacies in Lagos. RESULTS: About 55% of respondents have ever heard of the word 'Pharmacovigilance' out of which less than half (representing only 18% of all respondents) could define the term 'Pharmacovigilance'. Forty percent of the respondents stated that patients reported ADRs to them at least once a month, and 20% reported to the relevant authorities. However only 3% of respondents actually reported an ADR to the National Pharmacovigilance Centre. The most important reason for poor reporting was lack of knowledge about how to report ADRs (44.6%).Meanwhile, 90% of respondents believed that the role of the pharmacists in ADR reporting was important. Most community pharmacists were willing to practice pharmacovigilance if they were trained. CONCLUSION: Community pharmacists in Lagos had poor knowledge about pharmacovigilance. Reporting rate was also poor. There is an urgent need for educational programs to train pharmacists about pharmacovigilance and ADR reporting.

Educational intervention and the health seeking attitude and adherence to therapy by tuberculosis patients from an urban slum in lagos Nigeria.

BACKGROUND: Community based participation has been advocated by a number of international health organisations including the World Health Organization (WHO) as a solution to the problems of poor patient adherence and default from Directly Observed Treatment Short course [DOTs] programmes for tuberculosis control. OBJECTIVES: To determine the impact of a health educational intervention on the management of tuberculosis in relation to the outcome and adherence to therapy by Tuberculosis patients residing in a densely populated urban slum in Lagos, Nigeria. METHODS: The study was conducted using forty tuberculosis patients (confirmed by acid fast bacilli positive sputum), and selected randomly from those who attend the Mainland Hospital in Lagos. They were divided into two groups of twenty each made up of those to be provided with education intervention at the community level and the control groups followed up at the hospital level only. An initial assessment of the knowledge about tuberculosis management was done through a structured questionnaire for both groups. This was followed by continuous health talks for intervention group in form of neighbourhood self help approach. RESULTS: The results showed that the intervention had a significant impact on the understanding of disease and its management (X(2) =11.842 p<0.05), DOTS and increased awareness (X(2) =17.289 p<0.05, X(2) =10.461 p<0.05), knowing the side effects of anti-TB drugs (X(2) =10.157 p<0.05), the meaning of resistance to anti-Tuberculosis drugs (X(2) =19.798 p<0.05, X(2) =11.192 p<0.05) and importance of contact tracing (X(2) =32.4 p<0.05, X(2) =3.360 p<0.05). CONCLUSION: An effective health education is therefore beneficial for TB control in Nigeria.

Ascorbic acid and the effect of cigarette smoke on tissues--a preliminary report.

BACKGROUND: Smoke from the average cigarette contains chemicals, which are highly toxic, causing chronic airways diseases in smokers as well as non-smokers exposed to environmental tobacco smoke (ETS). It is associated with an increased risk of developing asthma, pneumonia, bronchitis and cancer. OBJECTIVE: To investigate the effect of ascorbic acid on the degenerative effect of passive cigarette smoke on some vital organs. METHODS: A total of 16 male rabbits divided into four groups (A, B, C, D) of 4 rabbits each, were used. Group A rabbits were exposed to passive cigarette smoke for 45-60 minutes daily; group B was treated similarly but also had 5 mg/g body weight of ascorbic acid daily. Group C had ascorbic acid only and Group D was the untreated control group. After six weeks of the above treatment, the animals were sacrificed for histological investigation of some of their vital organs. RESULTS: Tobacco smoke had deleterious effects on the lungs, testes and kidneys; no significant changes were seen in the liver, brain and.heart. Ascorbic acid appeared to have some attenuating effect on inflammatory processes as observed in the lungs. Varying degrees of hypospermatogenesis were observed in the seminiferous tubules while the epididymis contained no spermatocytes in both groups A and B. CONCLUSION: Ascorbic acid has some attenuating effect on inflammatory processes but it neither stops inflammation (as seen in the lungs) nor declining function (as signified by hypospermatogenesis in the testes). Therefore, it is doubtful that the long-term effects of tobacco smoke can be prevented by the use of ascorbic acid.

The use of artemisinin-based combination therapies (ACTs) in public secondary health facilities in Lagos, Nigeria.

OBJECTIVES: The objectives of the study were to assess the prescription pattern of Artemisinin Combination Therapies (ACTs) in uncomplicated malaria and the knowledge, attitude and practice of physicians as regards use of ACTs in the outpatient clinics of public secondary health facilities in Lagos State. PATIENTS AND METHODS: All the ten General Hospitals under the Lagos State Health Management Board were studied and classified as either rural or urban. 1878 retrospective antimalarial prescriptions of outpatients between March, 2005--March, 2006 were systematically sampled and questionnaires were distributed to prescribers in April--May, 2006. Prescription assessment was based on the recent Nigerian National Antimalarial Treatment Policy and WHO/INRUD drug use indicators. RESULTS: The percentage of prescriptions containing ACTs was found to be rather small (5.9%) inspite of the high proportion (59.2%) of prescribers who were favourably disposed to the National antimalarial policy change from Chloroquine to ACTs as first line. There was no statistically significant difference in frequency of ACTs prescription between the rural and urban health facilities. The prescription of Artemisinin derivatives as monotherapy was 18.2%. The prescription of Chloroquine was found to be more predominant, (48.8%) in all the health facilities. CONCLUSION: Despite the national policy change from Chloroquine to (ACTs) as the first line antimalarial, their use in the public secondary health facilities in Lagos State does not reflect this policy change and it appears that Chloroquine still remains the choice antimalarial drug.

Correlating antibiotic consumption with antimicrobial resistance of uropathogens in a university teaching hospital in Lagos, Nigeria.

OBJECTIVE: This study was carried out to correlate the antibiotic consumption rates with the antibiotic resistance rates of uropathogens in Lagos University Teaching Hospital. METHODOLOGY: Urine specimens obtained over 18 months (between January 2005 and June 2006) were processed for microscopy culture and sensitivity, and records of antibiotics dispensed during the same periods were reviewed. Significant bacteriuria was performed by the standard loop method. Isolation and identification of organisms was by standard laboratory methods. The antibiotic consumption calculator of Monnet (ABC calc version 3) was used to classify the antibiotics into ATC classes and to calculate the numbers of daily defined doses. The 6-monthly antibiotic resistance and consumption rates were compared using Pearson's correlation coefficient. For analysis, the period of study was divided into three. RESULTS: Except for co-trimoxazole the rates of consumption of all antibiotics were higher in the second period than the first period of the study and highest in the 3rd period for ciprofloxacin, and ceftazidime. This correlated with an increase in the rates of resistance for some antibiotics during the 2nd and 3rd periods. While a steady increase in consumption of ciprofloxacin correlated with a steady increase in the resistance rates from the 1st to the 3rd periods, a steady increase in consumption of ceftazidime was associated with an increased resistance rate from the 2nd to 3rd periods. CONCLUSION: Increased consumption of the antibiotics tested, most noticeably, ciprofloxacin and ceftazidime correlated with increased resistance rates. There is need for urgent interventions like formulation of antibiotic policies and education of staff on the appropriate use of antibiotics to reduce the development of resistance.

Prescription pattern at primary health care centres in Lagos State.

Health care received in health facilities depends on adequate consultation, correct prescription and dispensing with relevant information given to the patient. These are some of the indicators for rational drug use. The objective of the study was to determine the pattern of prescription among prescribers in twenty Primary Health Care Centers of Lagos State using some of these indicators used in investigating health facilities by the World Health Organisation and International Network for Rational Use of Drugs. The study was carried out using multi-stage random sampling in selecting the Primary Health Care Centers from each of the twenty Local Government Areas of Lagos State. Both prospective and retrospective data were collected and analysed using Epi-Info version 6. The results showed that there was polypharmacy, misuse of antibiotics and injections. There was no statistically significant difference between the retrospective and prospective indicators of mean drugs prescribed per encounter, percentage antibiotics prescribed and percentage of generic prescription. It was concluded that there was irrational prescription pattern in all the selected health facilities as evidenced by poly-pharmacy, misuse of antibiotics and low generic prescriptions. There is need for educational intervention to improve the prescribing habits of health professionals in these health facilities.

Comparative study of salt taste threshold of hypertensives, their normotensive relatives and non-relatives.

The role of salt in the genesis of hypertension has been well documented. Earlier studies have demonstrated higher salt taste threshold among hypertensives compared to normotensives. The aim of this study is to compare the salt taste thresholds of normotensive relatives of hypertensive patients with those of normotensives without family history of hypertension. Twenty-one hypertensives, 52 first degree relatives of these hypertensives and 99 normotensives without family history of hypertension were studied. They were made to taste different concentrations of solution from distilled water to 280 mmol of saline. The results showed that hypertensives had higher salt taste thresholds--detection (p < 0.0001), recognition (p < 0.0001) and maximum tolerable threshold (p < 0.05)--compared with normotensive relatives. The normotensive relatives of hypertensive patients in turn had higher salt taste thresholds--detection (p < 0.01), recognition (p < 0.0001) and maximum tolerable threshold (p < 0.001)--compared with normotensive controls; they also had significantly higher mean arterial pressure (p < 0.001). Health education with intervention directed at the hypertensives and their first degree normotensive relatives to willfully modify their desire and appetite for salt is of paramount importance.