Factors underlying diagnostic delay in tuberculosis patients in a rural area in Tanzania: a qualitative approach

Background  

Diagnostic delay in patients with tuberculosis (TB) leads to ongoing TB transmission, higher mortality rates and increased patient and government health expenditure. Qualitative research focussed on patients’ self-perceptions of disease and their care-seeking behaviour helps to guide health education programmes by providing us with the understanding of the knowledge, attitudes and practices that underlie diagnostic delay.     

Anti-mycobacterial activity of five plant species used as traditional medicines in the Western Cape Province (South Africa)

ETHNOPHARMACOLOGICAL RELEVANCE: Five plants used in traditional medicine in the Western Cape Province of South Africa, have been investigated for anti-mycobacterial activity: Olea capensis, Tulbaghia alliacea, Dittrichia graveolens, Leysera gnaphalodes and Buddleja saligna. AIM OF THE STUDY: The aim was to assess antimycobacterial activity in plants used in treatment of symptoms of TB, and through activity-guided fractionation of extracts to isolate compounds or mixtures with potential as anti-TB drug leads. MATERIALS AND METHODS: Extracts and derived fractions were assayed against strains of Escherichia coli, Staphylococcus aureus, and Mycobacterium aurum A+. Isolated pure compounds were further tested against Mycobacterium species M. avium ATCC 25291, M. scrofulaceum ATCC 19981, M. microti ATCC 19422 and Mtb H37Rv, and for cytotoxicity against Chinese hamster ovarian cells. RESULTS: Extracts of B. saligna and L. gnaphaloides exhibited significant anti-mycobacterial activity, primarily associated with the presence of non-cytotoxic triterpenoids oleanolic acid in B. saligna and both oleanolic and ursolic acids in L. gnaphaloides. CONCLUSIONS: Anti-mycobacterial activity of extracts of selected plants is consistent with their traditional use. The identification of oleanolic and ursolic acids in these plants, and verification of their activity, underlines the potential for exploring structure-activity relationships of derivatives of these ubiquitous triterpenoids.     

Psoriasiform disorders with joint symptoms

We present a 49-year-old man seen at the dermatology outpatient department with a 3-year history of painful swollen digits of hands and feet. On enquiry he reported dysuria. On examination we saw extensive swelling of the digits, keratosis of the nails, and some psoriasiform skin lesions on the soles of the feet. The differential diagnosis included acrodermatitis continua suppurativa, reactive arthritis and psoriatic arthritis. Radiographic imaging revealed the presence of arthritis. Testing proved negative for rheumatoid factor and positive for HLA-B27 making spondyloarthropathy the most likely diagnosis, either in the form of reactive arthritis or psoriatic arthritis. The patient was treated with combination therapy of doxycycline, methotrexate and folic acid. Because of insufficient response to therapy, the methotrexate dose was raised and eventually etanercept was added. During the last visit to the outpatient clinic, the patient still showed insufficient response to therapy.     

Acute renal failure in a Caucasian traveler with severe malaria: a case report

Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation of hemodialysis proves to be useful in restoration of renal function.     

Evaluation of the effects of Olea europaea L. subsp. africana (Mill.) P.S. Green (Oleaceae) leaf methanol extract against castor oil‐induced diarrhoea in mice

Objectives Olea europaea L. subsp. africana (Mill.) P.S. Green is widely used in South Africa by traditional medicine practitioners to treat diarrhoea. However, little is known scientifically about this South African species in the treatment of diarrhoea. The main aim of the study therefore was to investigate the antidiarrhoeal effect of the leaf methanol extract of the plant species in mice. Methods The antidiarrhoeal activity of the leaf methanol extract of O. europaea subsp. africana was studied using a castor oil‐induced diarrhoeal test. The antipropulsive activity of the plant extract was also investigated using the charcoal meal transit test. Standard methods were used to investigate the acute toxicity and effect of O. europaea subsp. africana on castor oil‐induced intraluminal fluid accumulation. Results Leaf methanol extract of O. europaea subsp. africana and loperamide, a standard antidiarrhoeal drug, significantly reduced the number of diarrhoeal episodes induced by castor oil, significantly decreased the stool mass, significantly delayed the onset of the diarrhoea and protected the animals against castor oil‐induced diarrhoea. Both O. europaea subsp. africana and loperamide significantly decreased the gastrointestinal transit of charcoal meal and castor oil‐induced intraluminal fluid accumulation in mice. The LD50 value was found to be 3475 mg/kg (p.o.). Conclusions The results obtained suggest that the leaf methanol extract of O. europaea subsp. africana has an antidiarrhoeal property and that, given orally, it may be non‐toxic and/or safe in mice.