Breast Nurse Intervention to Improve Adherence to Endocrine Therapy Among Breast Cancer Patients in South Ethiopia

IntroductionMany women in rural Ethiopia do not receive adjuvant therapy following breast cancer surgery despite the majority being diagnosed with estrogen-receptor-positive breast cancer and tamoxifen being available in the country. We aimed to compare a breast nurse intervention to improve adherence to tamoxifen therapy for breast cancer patients.Methods and MaterialsThe 8 hospitals were randomized to intervention and control sites. Between February 2018 and December 2019, patients with breast cancer were recruited after their initial surgery. The primary outcome of the study was adherence to tamoxifen therapy by evaluating 12-month medication-refill data with medication possession ratio (MPR) and using a simplified medication adherence scale (SMAQ) in a subjective assessment.ResultsA total of 162 patients were recruited (87 intervention and 75 control). Trained nurses delivered education and provided literacy material, gave additional empathetic counselling, phone call reminders, and monitoring of medication refill at the intervention hospitals. Adherence according to MPR at 12 months was high in both the intervention (90%) and control sites (79.3%) (P = .302). The SMAQ revealed that adherence at intervention sites was 70% compared with 44.8% in the control sites (P = .036) at 12 months. Persistence to therapy was found to be 91.2% in the intervention and 77.8% in the control sites during the one-year period (P = .010).ConclusionBreast nurses can improve cost-effective endocrine therapy adherence at peripheral hospitals in low-resource settings. We recommend such task sharing to overcome the shortage of oncologists and distances to central cancer centers.     

Immune response to Staphylococcus aureus endophthalmitis in a rabbit model

Staphylococcus aureus is an important cause of severe bacterial endophthalmitis. Both immunoglobulin (Ig) G and A antibody titers to ribitol teichoic acid (RTA), the major antigenic determinant of the S. aureus cell wall, were measured by an enzyme-linked immunosorbent assay in serum, tears, aqueous, and vitreous on days 3, 7, 10, 14, 21, and 30 after intravitreal injection of viable S. aureus in rabbits. Clinical examination showed vitreous opacification in all rabbits from days 7-30. Histopathologic examination showed acute inflammation on day 3 and chronic inflammation on days 7-30 in the conjunctiva, cornea, iris, ciliary body, and trabecular meshwork. The vitreous cavity contained neutrophils and necrotic cells on all days. Retinal necrosis was present on days 14-30. Lymphoid follicles with plasma cells were identified in the conjunctiva, ciliary body, and choroid. The vitreous of experimental eyes showed increasing numbers of bacteria from days 3-14, followed by a decrease in numbers on day 21 and absence of viable bacteria on day 30. Increases in IgG antibody levels to RTA were first detected in serum where they were higher than in tears, aqueous, and vitreous until day 14. Vitreous IgG antibody levels to RTA in experimental eyes exceeded all other samples on day 14 and progressively increased thereafter; the other samples declined. The IgA antibody levels were increased in tears on day 14 and in the vitreous of experimental eyes on days 14, 21, and 30. Vitreous IgG antibody levels to RTA were substantially higher than vitreous IgA antibody levels. An inverse correlation was found between vitreous IgG antibody levels and positive vitreous cultures, suggesting that the humoral immune response may be important in the spontaneous sterilization of the vitreous in this model.     

Immune response to Staphylococcus epidermidis-induced endophthalmitis in a rabbit model.

Although Staphylococcus epidermidis is the most common cause of postoperative pseudophakic endophthalmitis, little is known about the immune response to S. epidermidis-induced endophthalmitis. Using a rabbit model, the immune response to an intravitreal injection of 7000 S. epidermidis (group 1) or 30,000 S. epidermidis (group 2) organisms was investigated. Clinical evaluations showed that rabbits in group 2 had a more severe inflammatory reaction in the conjunctiva, cornea, iris, and vitreous than those in group 1. The inflammatory reaction in group 1 largely resolved by day 30; group 2 continued to show a severe inflammatory response. Histopathologic findings correlated with clinical findings, with rabbits in group 2 showing a more severe inflammatory reaction in both the anterior and posterior segments of the globe. Positive vitreous cultures for S. epidermidis were present in rabbits in group 1 on days 3, 7, 10, 14, and 21 but not thereafter. However, group 2 had higher vitreous colony counts at days 3, 7, and 14 and negative vitreous cultures thereafter. Neither group showed delayed hypersensitivity to S. epidermidis antigens (evaluated by skin tests). Serum immunoglobulin (Ig) G antibody levels to phenol-inactivated S. epidermidis and glycerol teichoic acid (GTA) increased progressively, reached a peak at days 10-14, and then declined in both groups. Serum IgA antibody levels to these antigens were not detected. Group 2 had a more prolonged IgG antibody response in vitreous and aqueous than group 1. Tear fluid showed the weakest IgG and IgA antibody response to S. epidermidis and GTA. S. epidermidis-induced endophthalmitis was associated with a humoral but not a delayed hypersensitivity response to this organism.     

Anticonvulsant properties of saponins from Ficus platyphylla stem bark

Preparations of Ficus platyphylla have been used in Nigerian traditional medicine for the management of epilepsy for many years and their efficacy is widely acclaimed among the Hausa communities of northern Nigeria. The anticonvulsant properties of the saponin rich fraction (SFG) obtained from the methanol extract of F. platyphylla stem bark were studied on pentylenetetrazole-, strychnine- and maximal electroshock seizures in mice. Effects of SFG were also examined in murine models for neurological disease and on relevant in vitro targets for anticonvulsant drugs. SFG protected mice against pentylenetetrazole- and strychnine-induced seizures; and significantly delayed the onset of myoclonic jerks and tonic seizures. SFG failed to protect mice against maximal electroshock seizures at doses tested. SFG neither abolished the spontaneous discharges induced by 4-aminopyridine in a neonatal rat brain slice model of tonic–clonic epilepsy nor could it modulate chloride currents through GABA_A receptor channel complex in cultured cortical cells. However, it was able to non-selectively suppress excitatory and inhibitory synaptic traffic, blocked sustained repetitive firing (SRF) and spontaneous action potential firing in these cultured cells. Our results provide scientific evidence that F. platyphylla stem bark may contain psychoactive principles with potential anticonvulsant properties. SFG impaired membrane excitability; a property shared by most anticonvulsants particularly the voltage-gated sodium channel (VGSC) blocking drugs, thus supporting the isolation and development of the saponin components of this plant as anticonvulsant agents.     

Participation in medical research as a resource‐seeking strategy in socio‐economically vulnerable communities: call for research and action

The freedom to consent to participate in medical research is a complex subject, particularly in socio‐economically vulnerable communities, where numerous factors may limit the efficacy of the informed consent process. Informal consultation among members of the Switching the Poles Clinical Research Network coming from various sub‐Saharan African countries, that is Burkina Faso, The Gambia, Rwanda, Ethiopia, the Democratic Republic of Congo (DRC) and Benin, seems to support the hypothesis that in socio‐economical vulnerable communities with inadequate access to health care, the decision to participate in research is often taken irrespectively of the contents of the informed consent interview, and it is largely driven by the opportunity to access free or better quality care and other indirect benefits. Populations' vulnerability due to poverty and/or social exclusion should obviously not lead to exclusion from medical research, which is most often crucially needed to address their health problems. Nonetheless, to reduce the possibility of exploitation, there is the need to further investigate the complex links between socio‐economical vulnerability, access to health care and individual freedom to decide on participation in medical research. This needs bringing together clinical researchers, social scientists and bioethicists in transdisciplinary collaborative research efforts that require the collective input from researchers, research sponsors and funders.     

Malaria and HIV co-infection in Hadya Zone, southern Ethiopia

BACKGROUND: Malaria and human immunodeficiency virus (HIV) are the major priority medical challenges currently facing sub-Saharan Africa, and yet little has been known on the clinical and public health implications of their co-infections. OBJECTIVES: To determine the prevalence of malaria and HIV co-infections and to describe the clinical manifestations of malaria in HIV-positive and negative malaria patients. METHODS: A cross-sectional study was conducted from October 2003 through January 2004 in three health facilities located in Hadya Zone, Southern Ethiopia. A total of 337 microscopically confirmed Plasmodium falciparum malaria patients in the age group of 15-34 years were included in the study. Anonymous HIV testing was done on the blood samples of the patients using a single enzyme linked immunosorbent assay (ELISA) technique. RESULTS: The HIV serostatus assessment revealed that 14 (4.2%) of the P. falciparum patients were seropositive for a single ELISA HIV test. No socio-demographic difference was observed between HIV positive and HIV negative malaria patients. The proportion of HIV-positives (71.4%) among patients who reported two or more malaria attacks during the last year was higher than those who only reported the current attack (28.6%). However, all patients with signs of cerebral malaria and prostration were negative for HIV test. The frequently reported symptoms of severe malaria included cerebral manifestation (76.7%), persistent vomniting (35.3%), dark urine (21.6%), inability to eat or drink (18.0%), and prostration (16.8%). Pallor (44.8%) and splenomegally (19.9%) were the most frequently detected physicalfindings. CONCLUSIONS: The HIV prevalence among malaria patients was not different from HIV prevalence in the general population. Further studies with carefully designed methodologies are recommended     

Effect of oral administration of aqueous whole extract of Cassytha filiformis on haematograms and plasma biochemical parameters in rats

Introduction

We evaluated the sub-chronic toxicity of the aqueous herbal extract prepared fromCassytha filiformis and administered daily for 28 days at dose levels (250, 500, and 1000 mg/kg bw) in male wistar albino rats. The LD₅₀ of the aqueous extract was determined.

Methods

The effects on body weights, organ weights, and certain haematological and plasma biochemical parameters were measured as indices of organ toxicity.

Results

The aqueous extract did not affect plasma glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT); however, a significant reduction in alkaline phosphatase (ALP) level occurred in all the treated groups. It also did not affect the electrolytes (Na+, Cl? and K+), total and direct bilirubin, creatinine, and glucose level. The aqueous extract elicited hypercholesterolaemic effects, but it did not affect the Hb, WBC, RBC, PVC, platelets, MCH, MCHC, MCV levels and differential counts (lympocytes, neutrophils, monocytes, eosinophils and basophils). It also reduced the body weight gain and absolute weight of the kidneys. The relative weights of the heart and lungs in some animal groups were equally reduced. The acute toxicological evaluation of the plant extract revealed an oral LD₅₀ value greater than 500 mg/kg bw.

Conclusion

This study suggests that aqueous extract ofC. filiformis administered at normal therapeutic doses is not likely to produce severe toxic effects on some organs or haematological and biochemical indices in rats.