Markers for predicting mortality in untreated HIV-infected children in resource-limited settings: a meta-analysis.

OBJECTIVES: To evaluate the prognostic value of selected laboratory and growth markers on the short-term risk of mortality in untreated HIV-infected children in resource-limited settings. DESIGN: A meta-analysis of individual longitudinal data on children aged 12 months onwards from 10 studies (nine African, one Brazilian in the 3Cs4kids collaboration). METHODS: The risk of death within 12 months based on age and the most recent measurements of laboratory and growth markers was estimated using Poisson regression models, adjusted for cotrimoxazole prophylaxis use and study effects. RESULTS: A total of 2510 children contributed 357 deaths during 3769 child-years-at-risk, with 81% follow-up occurring after start of cotrimoxazole. At first measurement, median age was 4.0 years (interquartile range, 2.2-7.0 years), median CD4% was 15% and weight-for-age z-score -1.9. CD4% and CD4 cell count were the strongest predictors of mortality, followed by weight-for-age and haemoglobin. After adjusting for these markers, the effects of total lymphocyte count and BMI-for-age were relatively small. Young children who were both severely malnourished and anaemic had high mortality regardless of CD4 values, particularly those aged 1-2 years. By contrast, high CD4% or CD4 cell count values predicted low mortality level amongst either children older than 5 years or those younger with neither severe malnutrition nor anaemia. CONCLUSIONS: CD4 measurements are the most important indicator of mortality and wider access to affordable tests is needed in resource-limited settings. Evaluation of antiretroviral initiation in children also needs to consider weight-for-age and haemoglobin. Prevention and treatment of malnutrition and anaemia is integral to HIV paediatric care and could improve survival

Antioxidant activity and cytotoxicity of the leaf and bark extracts of Tarchnanthus camphorates

Purpose: To investigate the antioxidant potential and cytotoxicity of the leaf and bark extracts of Tarchonanathus campharatus. Methods: The antioxidant activity of the aqueous leaf extract (Aq LF), methanol leaf extract (MET LF), dichloromethane leaf extract (DCM LF), methanol bark extract (MET BK), dichloromethane bark extract (DCM BK), and ethyl acetate bark extract (Et Ac BK) were examined by 1,1-Diphenyl-2-picryl-hydrazil (DPPH), 2’-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS.+), nitric oxide radical scavenging, reducing power and iron chelating activity methods. Brine shrimp lethality and MTT cytotoxicity tests were used to investigate the cytotoxicity of the extracts. Results: The Aq LF, DCM LF, MET LF and MET BK showed good DPPH, ABTS radical scavenging and total reducing power activities. Total reducing power was high and in the rank order of DCM LF > Aq LF > MET LF > MET BK. All the extracts, however, showed weak nitric oxide scavenging activity as well as weak iron chelating ability. Flavonoids, phenols, tannins and saponins were present in some of the extracts, but alkaloids, terpenoids, cardenolides and cardiac glycosides were absent in all the extracts. All the extracts did not show significant cytotoxic properties (p ≥ 0.05) with 50% inhibitory concentration IC50 values > 30 μg/ml in both cytotoxicity assays. Conclusion: The antioxidant activity and low cytotoxicity of Tarchonanthus camphoratus probably justify its use in folk medicin

Chemical composition, antioxidant activity and cytotoxicity of the essential oils of the leaves and stem of Tarchonanthus camphoratus

The aim of this study was to investigate the chemical composition, antioxidant potential and cytotoxicity of the essential oil of the fresh leaf, dry leaf and dry stem of Tarchonanathus campharatus. The antioxidant activity of the oils were examined by the 1,1-Diphenyl-2-picryl-hydrazil (DPPH), 2’-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS.+), nitric oxide radical scavenging and reducing power methods. The brine shrimp lethality test and the MTT cytotoxicity test were used to investigate the cytotoxicity of the oils. Sesquiterpene hydrocarbons are the major components in the essential oil of the fresh leaves (36.46%) and of the dry leaves (59.18) whereas an aldehyde, butanal (35.77%) is the major component in the essential oil of the dry stem. The oils did not show significant antioxidant activity as evidenced by their high LC50 values in all the antioxidant assays. The cytotoxicity results indicated that the oils had low toxicity with LC50 values ranging from 400 to 900 μg/ml and 400 to 1100 μg/ml for the brine shrimp lethality test and MTT cytotoxicity assay respectively

Chemical composition, antioxidant activity and cytotoxicity of the essential oils of the leaves and stem of Tarchonanthus camphoratus

The aim of this study was to investigate the chemical composition, antioxidant potential and cytotoxicity of the essential oil of the fresh leaf, dry leaf and dry stem of Tarchonanathus campharatus. The antioxidant activity of the oils were examined by the 1,1-Diphenyl-2-picryl-hydrazil (DPPH), 2’-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS.+), nitric oxide radical scavenging and reducing power methods. The brine shrimp lethality test and the MTT cytotoxicity test were used to investigate the cytotoxicity of the oils. Sesquiterpene hydrocarbons are the major components in the essential oil of the fresh leaves (36.46%) and of the dry leaves (59.18) whereas an aldehyde, butanal (35.77%) is the major component in the essential oil of the dry stem. The oils did not show significant antioxidant activity as evidenced by their high LC50 values in all the antioxidant assays. The cytotoxicity results indicated that the oils had low toxicity with LC50 values ranging from 400 to 900 μg/ml and 400 to 1100 μg/ml for the brine shrimp lethality test and MTT cytotoxicity assay respectively

Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: a qualitative study

Abstract Background Hypertension is the leading risk factor for mortality worldwide and is more common in sub-Saharan Africa than any other region. Work to date confirms that a lack of human and material resources for healthcare access contributes to this gap. The ways in which patients’ knowledge and attitudes toward hypertension determine their engagement with and adherence to available care, however, remains unclear. Methods We conducted an exploratory, qualitative descriptive study to assess awareness, knowledge, and attitudes towards hypertension and its management at a large private hospital in Kampala. We interviewed 64 participants (29 with hypertension and 34 without, 1 excluded) in English. General thematic analysis using the Integrated Conceptual Health Literacy Model was used to iteratively generate themes and categories. Results We identified three main themes: Timing of Hypertension Diagnosis, Aiming for Health Literacy, and the Influence of Knowledge on Behavior. Most participants with hypertension learned of their condition incidentally, speaking to the lack of awareness of hypertension as an asymptomatic condition. Drove nearly all participants to desire more information. However, many struggled to translate knowledge into self-management behaviors due to incomplete information and conflicting desires of participants regarding lifestyle and treatment. Conclusions Internal patient factors had a substantial impact on adherence, calling attention to the need for educational interventions. Systemic barriers such as cost still existed even for those with insurance and need to be recognized by treating providers. </jats:sec

The needs, challenges, and burden experienced by informal caregivers in Uganda: a scoping review

Abstract Background The impact of informal caregiving is increasingly recognised as an important but often particularly neglected area of research in low and middle income countries. It is important to understand not only the effect of care on patient outcomes, but also the impact of caring on caregivers’ health and wellbeing. Methods Guided by the Arksey and O’Malley (Res Methodol 8:19–32, 2005) framework, this scoping review sought to collate and chart existing research on the needs, burdens and challenges experienced by caregivers in Uganda. Results The results of this review indicate that research focusing on the needs of caregivers for individuals with communicable disease, particularly HIV, has been well developed in Uganda, however, there is a lack of research on caregiving related to non-communicable diseases. Research has been dominated by small qualitative studies that are informative for understanding roles, burdens and contextually-specific aspects of care, but there is a need for larger studies that develop and test interventions designed to support the needs of caregivers. Conclusions Recurrent themes identified within this review, such as challenges in providing physical support and accessing treatment services, financial costs of care, psychological and mental health impacts and the experience of stigma, should help to inform well targeted and contextually-appropriate future research and interventions. </jats:sec