Assessment of effectiveness of traditional herbal medicine in managing HIV/AIDS patients in South Africa.

BACKGROUND: Very few clinical studies have been conducted in South Africa to assess the value and efficacy of traditional herbal medicines that are commonly used by traditional healers for the treatment of HIV-positive patients. OBJECTIVE: To assess efficacy of a South African traditional herbal medicine in reducing viral load and increasing CD4+T cell counts of HIV/AIDS patients. DESIGN: A descriptive, prospective, follow-up study of 33 HIV-positive volunteers over a one year period. Viral load and CD4 counts were taken three times from each participant. SETTING: From November 2001 to October 2002, patients were treated at the Rustenburg Community Based Centre for traditional therapy. Clinical and paraclinical treatments and screening of patients were done at Pretoria Gynaecological Hospital. PARTICIPANTS: Seven men and 26 women aged between 22 and 43 years took part in a 12-month long follow-up study. HIV monitoring was done at the beginning and after 4 and 8 months in symptomatic and asymptomatic patients with CD4 counts below 200 cells/mm3 or viral load counts above 10,000 copies. INTERVENTION AND ASSESSMENT: ab mitio and after 4-months, viral load, CD4+T cell count, FBC, LFT, glycaemia, U/E, cholesterol, pap smear, clinical and subjective assessment, modern drugs plus hospitalisation for opportunistic infections and resuscitation where needed, powder or suspension of herbal medicine followed by meals. MAIN OUTCOME MEASURES: Improvement in overall health condition and immune system, increase in CD4+T cell count and decrease in viral load count. The two sample paired t-test was used to compare initial and final counts at the 5% level of significance and power of 80%. Ninety five per cent confidence intervals were obtained for differences between mean values. RESULTS: After four and/or eight months of therapy, significant health improvement was achieved: better physical appearance (80% of patients), increased appetite (65%), feeling of well-being (60%), disappearance of skin marks (70%) and urogenital lesions (100%), resumption of workplace duties (60%), weight gain (80%), significant reduction in viral loads (85.4%, p = 0.0015) and significant increase in CD4+ T cell counts (226%, p = 0.0000). CONCLUSION: Achievement of health improvement within eight months indicates that herbal medicine can be used as supplementary or alternative treatment for HIV/AIDS patients, and that it is an obvious immune system booster and probable "virus-cidal" factor. The apparent safety and efficacy of herbal medication warrants further research with a larger sample size of study.

Maternal height and external pelvimetry to predict cephalopelvic disproportion in nulliparous African women: a cohort study.

OBJECTIVE: To assess external pelvimetry and maternal height, as predictors of cephalopelvic disproportion. DESIGN: Prospective cohort study. SETTING: Four hospitals in Zaire. POPULATION: Six hundred and five nulliparous women. METHODS: Maternal height and external pelvimetry were assessed during the third trimester antenatal visit. Cut off values for considering women at risk for cephalopelvic disproportion were height < 150 cm and external pelvic distances < 10th centile for the population. Logistic regression analysis, combining height and pelvic measurements, was performed to predict women at risk for cephalopelvic disproportion. MAIN OUTCOME MEASURE: Cephalopelvic disproportion was considered when there was caesarean section for failure to progress, vacuum or forceps delivery or intrapartum stillbirth. RESULTS: Cephalopelvic disproportion was present in 42 women. In univariate analysis, height, intertrochanteric diameter and the transverse diagonal of Michaelis sacral rhomboid area were found to be associated with cephalopelvic disproportion. Logistic regression analysis showed that maternal height < 150 cm and/or transverse diagonal < 9.5 cm were the variables most associated with cephalopelvic disproportion. The adjusted odds ratios were 2 x 2 (95% CI 0.9 to 5.4) and 6.5 (95% CI 3.2 to 13.2), respectively. The positive predictive value and likelihood ratio were 24% and 4.0 (95% CI 2.8 to 5.8), respectively. The addition of transverse diagonal to maternal height increased the sensitivity in predicting cephalopelvic disproportion from 21% to 52%. CONCLUSION: In addition to height, transverse diagonal measurement is able to predict one out of two cases of cephalopelvic disproportion in nulliparous women. After validation in a separate cohort, this simple predictive method may be used in peripheral centres for timely referral of pregnant women at risk for cephalopelvic disproportion.

[The characteristics of pregnancy-puerperium in central Africa. I. Cesarean section in 3 different areas in Zaire]. / Particularismes de la gravido-puerpéralité en Afrique centrale. I. Opération césarienne dans trois environnements différents au Zaïre.

A series of 5,127 deliveries carried out in rural (Boende), in semi-urban (Bonzola) and in the urban university teaching hospital units was studied from April to September 1986 to assess pregnancy and the puerperium in a Zairian population. In particular the Caesarean section rate was looked at. Two hundred and forty eight Caesareans were carried out--a rate of 4.8%. More were carried out in university centres (8.6%), than in semi-urban districts (2.2%) or in rural hospitals (1.3%). The maternal morbidity due to haemorrhage and infection and the mortality were also higher in the urban and teaching hospitals (5.9% and 2.3%) than in the other hospitals. In Bonzola it was 2.5% and 0.3%. These figures suggest overall that carrying out Caesarean operations in developing countries with poor equipment has to be considered much more seriously than in centres that are well equipped.

[Etiopathogenesis and type of congenital malformations observed in Kinshasa (Zaïre)]. / Etiopathogénie et type de malformations congénitales observées à Kinshasa, Zaïre.

The authors report on 115 malformed newborns, who are compared with 120 normal newborns from October 1985 up to September 1986 at the University Clinics of Kinshasa, Zaïre. There were 4,422 deliveries with 4,465 newborns, of whom 173 died during the perinatal period. The main results are: 1) the incidence of congenital defects is 2.5% births: a rate which is within the limits described by other authors: 2) polydactyly is the most frequent malformation; 3) two rare malformations were diagnosed: (1) a case of Arnold Chiari syndrome associated with polydactyly and (2) a case of temporal meningo-encephalocele; (4) factors for high risks of malformation are: advanced maternal age older than 35 years, consanguinity, a family history of birth defect and of stillbirths; 5) the diagnosis of even major congenital malformations is made macroscopically at birth in 95% because of lack of adequate instruments for antenatal diagnosis and the refusal of autopsy by the population (97%). For religious or mystical reasons, it is difficult to obtain a family's consent to perform autopsy in Kinshasa: people are convinced that life continues after death. So that a dead person needs the corporal integrity of his being.

[Anencephaly in underdeveloped countries. Apropos of 22 cases in Kinshasa, Záire]. / Anencéphalie en pays sous-équipés. A propos de 22 cas à Kinshasa, Zaïre.

There were 22 cases of anencephaly found out of 70,450 live births registered between 1973 and 1985 in the University Teaching Hospital of Kinshasa. The very low frequency of this abnormality (31 p. 100,000) is in contrast with that published for industrialised countries (180 to 590 p. 100,000). Is this difference due to feeding habits or to racial and geographical influences? Without either routine ultrasound or alphafetoprotein estimations and acetylcholinesterase levels, the diagnosis of anencephaly could only be made by X-raying cases with hydramnios (64%), and in the remaining cases on delivery. The pregnancies lasted on an average 36.8 weeks. All the deliveries were normal but only 23% of the babies were born alive and all of these died within the first hour of life. There was no case of postmaturity. In fact, 50% of the births were premature.

[Illicit abortion, a public health problem in Kinshasa (Zaire)]. / Avortement clandestin, problème de santé publique à Kinshasa (Zaïre).

Illegal (242), therapeutic (6), and spontaneous (836) abortions were treated in the years 1978 to 1979 in the University Clinics in Kinshasa (Zaire). Spontaneous abortions are more common after the age of 20, but their incidence diminishes as parity increases. As a whole, they did not have serious complications. In the illegal group, two categories of high risk women were discovered. The first, characterised in girls under the age of 20 with first or second pregnancies who were unmarried, at school or socially and economically poor. The second group were women of 20 years or more who were married, educated and professionally active. Illegal abortions were performed before the twelfth week of pregnancy, generally by unqualified people. Society seems to tolerate then more or less because only 5% are taken to court. Bleeding, infection, traumatic lesions and 13 maternal deaths show how common complications of illegal abortion were. Both at individual and national levels the cost is high. Sex education, improvement in contraception and revision of the abortion laws are suggested as prophylactic measures towards this public health problem.

[Histoenzymologic modifications of placental tissue in experimental fetal hypotrophy in the rat]. / Modifications histo-enzymologiques du tissu placentaire dans l'hypotrophie foetale expérimentale du rat

Chronic placental vascular insufficiency in the rat was achieved by ligature of the uterine and utero-placental arteries. The fetal and placental hypotrophy observed confirmed the previous observation. However, the placental enzymatic changes showed an increasing gradient of cellular hypoxy from decidua basalis to yolk sac placenta; this gradient is unfavourable to fetuses. The strong depletion of yolk sac enzyme activities demonstrates the reduction of fetomaternal exchanges which are usually predominant in this placental area. The other parts of rat placenta appear relatively less involved in fetal nutrition. Further studies are necessary to understand the changes observed in these activity stainings, such as: oxidoreductases II, acid phosphatase and 5-nucleotidase.

[Pharmacological suppression of gestation by beta-2-aminoethylisothiourea (AET) in rats]. / Suppression pharmacologique de la gestation par la 2-beta-aminoéthylisothiourée (AET) chez la Ratte

One I.P. injection of 2-beta-aminoethylisothiourea (150 or 200 mg/kg) given to rats on day 14 and eventually also on day 18 of gestation induced a maternal death rate ranging from 0 to 50%, together with frequent (1 dose) or systematic (2 doses) foetal resorption. This type of treatment also impairs further reproductive capacity.

Effects of massive doses of ergocalciferol plus cholesterol on pregnant rats and their offspring.

Ergocalciferol (320,000 or 480,000 IU/kg) plus cholesterol (60 mg/kg) in olive oil solution was administered daily on 1, 2, or 4 consecutive days to pregnant rats from 9,10, 14, or 18 of gestation. The control animals received only olive oil. Disseminated lesions of metastic calcinosis were found in various tissues, in the coronary arteries and myocardium, in the media of the abnormal aorta, in the lung and pleura, in the gastoinstestinal tract, and in the kidney. This is in contrast to the atherosclerosis described in nonpregnant rats fed a similiar diet. A significant decline in maternal weight as well as a high rate of morbidity and mortality was observed. In mothers killed on day 22 of pregnancy, fetal and placental growths appeared significantly retarded suggesting a direct effect of the steroid or its more active metabolite, 1,25-dihydroxycholecalciferol, on the fetus or the trophoblastic tissue. Fetal bone lesionsassociated with a generalized retardation of ossification, placental edema, or calcification accompanied by a loss of the normal structure of the placenta and degenerative manifestation at this level were observed. Moreover, we noted a striking alteration of the fetal face in 33-39% of experimental fetuses, called by us carnival fetuses.

Histochemical study of metrial gland cells through the last week of pregnancy in the albino rat.

The metrial gland cells of the rat were studied from day 16 to 21 of pregnancy through enzyme histochemistry. The following enzyme activities were tested: 2 carboxylic esterases, 4 phosphatases, 1 aminopeptidase and 10 dehydrogenases including 4 which are involved in steroid metabolism. Although acid phosphatase activity was strong in mesenchymal cells, it remained undetected in large, sometimes binucleate cells lining central and subplacental vessels of the mesometrial triangle. 5-Bromo-indoxyl acetate esterase was likewise absent from the parietal vascular cells of the central artery. The study of 6 enzyme activities, i.e., GPDH, 3-OU-BDH, G6PDH, 3-B-HSDH, primary and secondary alcohol dehydrogenases, allowed to conclude that metrial gland cells are actively involved in steroidogenesis and lipid catabolism. Maternal origin of this gland can be sustained with reference to the pattern of acid phosphatase, indoxyl-esterase and some oxidoreductases II activities distribution which appears to be different from what is found in the trophospongium area.

Effects of amethopterin (methotrexate) on the evolution of pregnancy in rats.

Amethopterin (4-amino-N-10-methyl-glutamic acid) was given to pregnant rats in varying doses at different periods of gestation to evaluate its effects upon both the mother and the fetoplacental unit. The maternal organism is more sensitive to this drug at days 14 to 17 than at a larger stage of gestation. When administered to rats from day 14 to day 18 of pregnancy the drug is capable of inducing a series of deleterious effects: maternal weight loss, resorption, abortion or hypotrophy of fetuses. Day 16 appears to be a critical moment in the evolution of rat pregnancy, after which injection of amethopterin does no longer impair fetoplacental growth. Before this date, the drug directly inhibits fetal weight gain, whereas the sensitivity of the placenta is only transient at day 16 resulting in maximum weight decrease of this organ 24 h later. Its action on rat pregnancy follows a direct dose-effect relationship reflecting increasing damage to the products of conception (resorption, abortion and hypotrophy).

PIP: Varying doses of amethopterin were injected intraperitoneally into S prague-Dawley and Wistar rats at different periods of gestation to evalu ate the effects on rat pregnancy and fetal outcome. Anorexia, diarrhea and vaginal bleeding were observed with repeated doses of more than .5 mg/kg. When administered for 5 consecutive days, a weight loss of up to 49.93 gm was observed. 5 daily doses of 1.5 mg/kg or more resulted in a 100% death rate of Sprague-Dawley rats. Abortions were common in Wistar rats given a dose higher than .5 mg/kg. A 100% resorption rate was observed in Wistern rats given 2.0 mg/kg for 5 days. Hypotrophic fetuses were observed in both strains when .5 mg/kg was administered for 5 days. Fetal growth rate was significantly lower from day 14 to day 17 of drug treatment, whcih seemed to be the time when the animals are most sensitive to the drug. The effects of amethopterin before day 17 follow a direct dose-effect relationship.