Vanillic acid-Zn(II) complex: a novel complex with antihyperglycaemic and anti-oxidative activity.

OBJECTIVES: Our aim was to synthesize, characterize and evaluate the antihyperglycaemic and anti-oxidative properties of a new Zn(II) complex of vanillic acid. METHODS: The complex was synthesized using ZnSO4.7H2O and vanillic acid as precursors. NMR and FTIR techniques were used to characterize the synthesized complex. The cytotoxicity of the complex was measured. The antihyperglycemic and anti-oxidative properties of the complex were evaluated using in vitro, cell-based and ex vivo models and compared with those of its precursors. KEY FINDINGS: Zn(II) coordinated with vanillic acid via a Zn(O6) coordination, with the complex having three moieties of vanillic acid. The radical scavenging, Fe3+ reducing and hepatic antilipid peroxidative activity of the complex were, respectively, 2.3-, 1.8- and 9.7-folds more potent than vanillic acid. Complexation increased the α-glucosidase and glycation inhibitory activity of vanillic acid by 3- and 2.6-folds, respectively. Zn(II) conferred potent L-6 myotube (EC50 = 20.4 µm) and muscle tissue (EC50 = 612 µm) glucose uptake effects on vanillic acid. Cytotoxicity evaluation showed that the complex did not reduce the viability of L-6 myotubes and Chang liver cells. CONCLUSIONS: The data suggest that Zn(II)-vanillic acid complex had improved bioactivity relative to vanillic acid. Thus, Zn(II) may be further studied as an antihyperglycaemic and anti-oxidative adjuvant for bioactive phenolic acids.

A comprehensive review on zinc(II) complexes as anti-diabetic agents: The advances, scientific gaps and prospects.

Zinc has gained notable attention in the development of potent anti-diabetic agents, due to its role in insulin storage and secretion, as well as its reported insulin mimetic properties. Consequently, zinc(II) has been complexed with numerous organic ligands as an adjuvant to develop anti-diabetic agents with improved and/or broader scope of pharmacological properties. This review focuses on the research advances thus far to identify the major scientific gaps and prospects. Peer-reviewed published data on the anti-diabetic effects of zinc(II) complexes were sourced from different scientific search engines, including, but not limited to "PubMed", "Google Scholar", "Scopus" and ScienceDirect to identify potent anti-diabetic zinc(II) complexes. The complexes were subcategorized according to their precursor ligands. A critical analysis of the outcomes from published studies shows promising leads, with Zn(II) complexes having a "tri-facet" mode of exerting pharmacological effects. However, the promising leads have been flawed by some major scientific gaps. While zinc(II) complexes of synthetic ligands with little or no anti-diabetic pharmacological history remain the most studied (about 72 %), their toxicity profile was not reported, which raises safety concerns for clinical relevance. The zinc(II) complexes of plant polyphenols; natural ligands, such as maltol and hinokitiol; and supplements, such as ascorbic acid (a natural antioxidant), l-threonine and l-carnitine, showed promising insulin mimetic and glycemic control properties but remain understudied and lack clinical validation, in spite of their minimal safety concerns and health benefits. A paradigm shift toward probing (including clinical studies) supplements, plant polyphenol and natural ligands as anti-diabetic zinc(II) complex is, therefore, recommended. Also, promising anti-diabetic Zn(II) complexes of synthetic ligands should undergo critical toxicity evaluation to address possible safety concerns.

Cost-effectiveness of extracorporeal shock wave lithotripsy in a poor resource setting: The Okada, Nigeria experience.

BACKGROUND: The first extracorporeal shock wave lithotripsy (ESWL) used in Nigeria was at Igbinedion Hospital and Medical Research Centre (IHMRC), Okada in 1992 and it functioned for 6 consecutive years. The objectives of this study were to analyze the cost-effectiveness of the procedure and highlight the associated factors that led to its failure. METHODS: A retrospective study of medical records and publications associated with the use of ESWL at IHMRC, Okada, for the period of 1992 to 1998. The study was conducted between January 2003 and November 2008. Unclassified authentic information relating to the use of ESWL and treatment of upper urinary tract stones was obtained from the IHMRC Okada and some government hospitals on hospital bills. Relevant documents in public domains related to the national and international wages and emoluments of medical workers and socioeconomic development of Nigeria within the time the ESWL functioned were studied. RESULT: A total of 32 patients were treated with 51 treatment sessions which is an average of nine patients per year and an average of two treatment sessions per patient were involved. The reasons for the low patronage were the extremely low stone formation rate of Nigerians, poverty, and out-of-pocket payment system. In addition, each treatment session of ESWL at Okada cost an average of $681.8 compared to $227.3 for open nephrolithotomy in a nearby high profile teaching hospital. The IHMRC, Okada, paid an average annual salary of ₦180,000 ($8,181.8) for each medical consultant compared to ₦120,000 ($5,454.5) paid by federal teaching hospitals in Nigeria within the period. Expatriate consultant doctors from Europe and USA who initially manned the lithotriptor at IHMRC, Okada, were paid much higher salaries. Average annual income of $5,909 for each of the 6 years amounting to a total of $34,771.7 for the six years was realized which could not maintain staff salaries in the hospital leading to staff emigration, decline of the hospital services, and eventual closure of the ESWL procedure center in the hospital in 1998. CONCLUSION: ESWL at Okada was not cost-effective both to patients and the hospital management. Despite these, ESWL is desirable in poor-resource countries because of its noninvasiveness, low morbidity, and usability in patients who are unfit for open surgery. Purchasing high technological medical equipment as commodities by sub-Saharan Africans without considering the prevalence of diseases they are meant to cater for, their maintenance for steady function during useful lifespan, their cost-effectiveness and how to recoup the money spent on investments depletes the scarce foreign exchange reserve of the home countries and is eventually counterproductive as exemplified by this case.

Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges.

BACKGROUND: To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions. MATERIALS AND METHODS: A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008). Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed. RESULTS: Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer's patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis. CONCLUSION: Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of nosocomial transmission.

Brain sonography in African infants with complicated sporadic bacterial meningitis.

BACKGROUND: To determine the structural findings in brain sonography of African infants with complicated sporadic bacterial meningitis. MATERIALS AND METHODS: Retrospective assessment of medical records of patients who underwent brain sonography on account of complicated bacterial meningitis. The brain sonography was carried out over a 4-year period (between September 15, 2004 and September 14, 2008). RESULT: A total of 86 infants were studied (40 boys and 46 girls in a ratio of 1:1.1); more than 70% of the patients were aged below 6 months. Presenting complaint included convulsion with fever in 34 (39.53%), persistent fever 20 (23.26%), bulging fontanelles 8 (9.30%), coma 7 (8.14%) and sepsis with convulsion 6 (6.98%), among others. Patients' place of previous treatment included specialist hospitals 33 (38.37%), private hospitals 21 (24.42%), herbal home centres 12 (13.95%), nursing homes 8 (9.30%), patent medicine stores 7 (8.14%) and other non-doctor attended clinics 5 (5.81%) infants. The sonographic findings included hydrocephalus 36 (41.86%), cerebral infarction 12 (13.95%), encephalocoele 9 (10.49%) and intracerebral abscess 7 (8.14%) infants. Cerebritis 5 (5.81%), intracerebral hemorrhage 3 (3.49%), porocephalic cysts 2 (2.33%), cerebral oedema 2 (2.33%), intraventricular haemorrhage 1 (1.16%) and subdural collection 1 (1.16%) infants; 8 patients (9.30%) had normal findings. CONCLUSION: Hydrocephalus, cerebral infarction and intracerebral abscess were the most common complications elicited by sonography in this study. Early and adequate treatment with antibiotics in patients with persistent fever and convulsion with fever will reduce the complications of meningitis and its long-term neurological sequelae.

Complications and co-morbidities in radiographs of patients in traditional bone setters' homes in Ogwa, Edo State, Nigeria: a community-based study.

BACKGROUND: Musculoskeletal injuries are common in developing countries, but access to high quality orthopedic care is not. Traditional bone setters (TBS) serve to fill the gap, but the nature and quality of their treatment are largely understudied. Traditional bone setting in Idunmunkpaghan clan of Ogwa community, Edo State, Nigeria, was founded by Odion Ekhimere between about 1680 and 1705. The TBS practice in this community is studied to find out the complications and co-morbidities associated with it. METHODS: A prospective community-based study of the patients admitted in the traditional bone setters' homes was done at Ogwa over a -2-year period by studying the admission and discharge radiographs of patients treated in the community and by interviewing the TBS and patients. RESULT: Ninety patients with radiographs of the lesion sites were followed up from admission to discharge at the TBS homes, comprising 53 males (53.89%) and 37 females (41.11%) with a male to female ratio of 1.4:1. Sixty five patients (72.2%) had fracture or dislocation. Forty four of the 65 patients (67.7%) with fracture/dislocation had complications including mal-union 31(70.4%), secondary osteoarthritis 8 (18.2%), non-reduction of dislocation 7 (11.9%), non-union 8 (18.2%), and others 12 (27.2%). Co-morbidities were identified in 15 patients (16.7%) and included severe osteoarthritis 7 (46.7%), diabetic foot ulcer 4 (26.7%), severe hypertension with cardiomegaly 4 (26.7%), metastatic carcinoma of the prostate 3 (20.0%), septic arthritis 2 (13.3%), pulmonary tuberculosis 1 (6.7%) and others 3 (20.0%). CONCLUSION: The practice of traditional bone setting is well established in Idunmunkpaghan clan in Ukpogo quarter of Ogwa. Education and training of the TBS is the key to reduction of complications and co-morbidities seen in their practices as they have high patronage and the patients have high regards for them and will continue to patronize them.

Brain computed tomography of patients with HIV/AIDS before the advent of subsidized treatment program in Nigeria.

BACKGROUND: The objective is to study intracranial complications of HIV/AIDS using brain-computed tomography in patients who presented with neurological features before the advent of subsidized HIV/AIDS treatment program with highly active antiretroviral therapy (HAART) in Nigeria. MATERIALS AND METHODS: Retrospective study of patients' records retrieved from radiology and medical records departments of the hospital. The studied patients had HIV/AIDS and presented with neurological features and underwent CT scan. RESULTS: A total of 36 patients who tested positive for HIV and who presented with neurological features suspected to be complications of AIDS were examined with CT scan. They consisted of 24 male and 12 females. The male to female ratio was 2:1. The age of the patients ranged from 27 to 45 years. Seventeen patients (47.2%) were aged 30-34 years. Twenty-four patients (60%) were single while 12 (40%) were married. Twenty-seven patients (75%) were infected with HIV 1 and 2, five patients (13.9%) were infected only with HIV-1 while four were infected with only HIV-2. Presenting neurological complaints include left hemiplegia 13 (36.1%), right hemiplegia 6 (16.7%), coma 7 (19.4%), memory loss/dementia complex 5 (13.9%), convulsion with coma 2 (5.6%), left hemi-pariesis with memory loss 2 (5.6%), and staggering gait 1 (2.8%). The findings in CT scan include infarcts-like lesions 14 (38.9%), multiple ring-enhancing lesions 7 (19.4%), cerebral atrophy 5 (13.9%), multiple nodular lesions 4 (11.1%), acute intracerebral hemorrhage 3 (8.3%), cerebral hemiatrophy 2 (5.6%), and solitary ring-enhancing lesions 1 (2.8%). Eight patients with single or multiple ring enhancing lesions were treated with empirical treatment for toxoplasmosis but only three (37.5%) made full recovery. CONCLUSION: Brain CT scan showed extensive structural damages in patients with HIV/AIDS who were not treated with HAART. Out-of-pocket payment for investigations and treatment and absence of HAART could be partly responsible for high rate of advanced disease.

Brain Computed Tomography of Patients with HIV/AIDS before the Advent of Subsidized Treatment Program in Nigeria

Background: The objective is to study intracranial complications of HIV/AIDS using brain-computed tomography in patients who presented with neurological features before the advent of subsidized HIV/AIDS treatment program with highly active antiretroviral therapy (HAART) in Nigeria. Materials and Methods: Retrospective study of patients' records retrieved from radiology and medical records departments of the hospital. The studied patients had HIV/AIDS and presented with neurological features and underwent CT scan. Results: A total of 36 patients who tested positive for HIV and who presented with neurological features suspected to be complications of AIDS were examined with CT scan. They consisted of 24 male and 12 females. The male to female ratio was 2:1. The age of the patients ranged from 27 to 45 years. Seventeen patients (47.2) were aged 30-34 years. Twenty-four patients (60) were single while 12 (40) were married. Twenty-seven patients (75) were infected with HIV 1 and 2; five patients (13.9) were infected only with HIV-1 while four were infected with only HIV-2. Presenting neurological complaints include left hemiplegia 13 (36.1); right hemiplegia 6 (16.7); coma 7 (19.4); memory loss/dementia complex 5 (13.9); convulsion with coma 2 (5.6); left hemi-pariesis with memory loss 2 (5.6); and staggering gait 1 (2.8). The findings in CT scan include infarcts-like lesions 14 (38.9); multiple ring-enhancing lesions 7 (19.4); cerebral atrophy 5 (13.9); multiple nodular lesions 4 (11.1); acute intracerebral hemorrhage 3 (8.3); cerebral hemiatrophy 2 (5.6); and solitary ring-enhancing lesions 1 (2.8). Eight patients with single or multiple ring enhancing lesions were treated with empirical treatment for toxoplasmosis but only three (37.5) made full recovery. Conclusion: Brain CT scan showed extensive structural damages in patients with HIV/AIDS who were not treated with HAART. Out-of-pocket payment for investigations and treatment and absence of HAART could be partly responsible for high rate of advanced disease

Death patterns among Nigerian leaders.

BACKGROUND: The aim of this study is to establish the patterns of death amongst Nigerian leaders since independence, thus providing a feasible avenue to avoid their recurrence if possible especially amongst the political elite who currently hold power. METHODS: Using available unclassified authentic public information, all leaders who had ruled Nigeria since her independence on 1 October, 1960 until her 45th birthday on 1 October 2005, irrespective of whether they are dead or alive were included. Data was extracted and analyzed. RESULTS: On 1 October 2005, Nigeria celebrated 45 years as a sovereign nation. Within this period, the country has had eleven leaders, all of whom were men. Only three (27.3%) were civilians, while eight (72.7%) were army generals. Of the eleven leaders, four (36.4%) had died before Nigeria reached its 45th birthday and all of these four (100%) died while still in office. Three of the dead leaders (75%) were assassinated, while one (25%) died suddenly in mysterious circumstances, believed to be the result of poisoning by unknown external powerful interest groups. Three of the deaths (75%) occurred during violent periods of Nigeria's checkered history (1966-1970 and 1993-1999), showing that periods of national and international strife appeared to be the weakest link in chains of events that led to their death while in office. Autopsies were neither requested nor performed on any of the dead leaders, signifying an entrenched culture of nonchalance, a lack of a coordinated national coroner's law and contempt for accurate and detailed death records. Worse still, no valid tenable death certificate has ever been issued. In other words, no attempt has been made to determine the cause of death of four of the nation's former leaders. Only hurried national burials were accorded two (50%) of them while the other two (50%), who died in the coup and revenge coup of 1966, were completely neglected, and not even given a decent national burial. CONCLUSIONS: The facts identified above will serve as a landmark to highlight an existing problem, and thus bring the issue to the attention of policy-makers and the political elite. The overall expected benefit is that nations like Nigeria can focus on the issue of orderly succession and the peaceful handing-over of government to duly transparently elected national leaders and all efforts should be made to avoid holding on to power unnecessarily. The tenets of democracy shall be upheld and transparent elections take place so as to reduce national tension and strife to the barest minimum. We also strongly recommend a review and improvement of Nigeria's national coroner's laws.