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Kivai JM, Guantai AN, Mwanda WO, Maitho TE. "Abandonment of treatment and loss to follow up: a potential cause of treatment failure in patients with AIDS-related Kaposi’s sarcoma." African Journal of Pharmacology and Therapeutics. 2015;4(4):156-160. Abstract2015_-_abandonment_of_treatment_and_ltfu_aids_karposis.pdf

Background: Management of patients with cancer is complex, multi-disciplinary, longitudinal and costly. Abandonment of treatment by patients and loss to follow up is a common scenario, especially in resource poor countries and severely compromises health outcomes.

Objective: To assess the commitment to drug treatment protocol of patients with Acquired Immunodeficiency Syndrome (AIDS)-Related Kaposi’s Sarcoma at Kenyatta National Hospital, Kenya, over a 10 week period .

Methods: The study design was prospective, observational, cross-sectional period prevalence study on patients infected with human immunodeficiency virus (HIV) with Kaposi’s sarcoma. Patients with histological diagnosis of Kaposi’s sarcoma were sequentially enrolled into the study as they attended either the Haematology or Radiotherapy clinic or during their admission in the wards. The choice of the treatment protocol was left at the discretion of the attending physician. A pretested data collection form was used to collect demographic and clinical information about the patients, including treatments prescribed and completion of follow up.

Results: A total of 74 patients were enrolled into the study, 42 (56.8%) males and 32 (43.2%) females. The age ranged between 13 years to 55 years. Their treatment protocols included: Vincristine only, Vincristine plus Bleomycin, Vincristine plus Bleomycin plus Doxorubicin, Radiotherapy plus Vincristine and Radiotherapy only. Few of the patients were not assigned any antitumor treatment. Antiemetic and other conventional medicines were also prescribed when necessary. Fifty four (73%) of the patients abandoned treatment, five (6.8%) died, 15(20.3%) continued to attend clinic over the 10 week period. There was no significant association between sex and outcome (p=0.661).

Discussion: The results of this study demonstrate that abandonment of treatment is a major problem among patients on treatment for cancer in Kenyatta National Hospital in Kenya. Abandonment of treatment heavily contributes to poor clinical outcome hence complicating the burden of cancer in the country. It is therefore important to develop and establish follow-up systems to improve adherence to treatment for the cancer patients at Kenyatta National Hospital.

Key words: Abandonment of treatment, Loss to follow up, AIDS-Related Kaposi’s Sarcoma

Nwaka S, Ochem A, Besson D, Ramirez B, Fakorede F, Botros S, Inyang U, Mgone C, Adae-Mensah I, Konde V, Nyasse B, Okole B, Guantai A, Loots G, Atadja P, Ndumbe P, Sanou I, Olesen O, Ridley R, Ilunga T. "Analysis of pan-African Centres of excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent." 12. 2012;11(12):2-15.analysis_of_pan-african_centres_of_excellence_in_health_innovation_highlights_opportunities_and_challenges_for_local_innovation_and_in.pdf
N PROFGUANTAIA. "Anti-infiammatory and Anti-Diarrimeai Activities of a Steroidal indoxy.". In: East and Central African Journal of Pharmaceutical Sciences 6. F. N. KAMAU., 1.0. KIBWAGE, A. N. GUANTAI, G. MURIUKI R. MUNENGE; 2003. Abstract

The anti-inflammatory and antidiarrhoeal activities of 3(1-Hydroxy-16. 17-seco-16- nor-5-androsten-15-(2-indoxyliden)-17-oic acid (I) are reported. After intraperitoneal administration, compound (I) gave an ED50 of 9.5 mg/kg using the carrageenan induced rat paw oedema anti-inflammatory assay method. Indomethacin had an ED50 of 5.8 mg/kg in this assay. Compound (I) and indomethacin caused comparable and dose-dependent varying degrees of delay in diarrhoea and also significantly reduced net colonic water flux into the colon of rats induced by castor oil. Key words: Steroidal Indoxyl, Anti-Inflammatory, Antidiarrhoeal.

Tarkang PA, Okalebo FA, Ayong LS, Agbor GA, Guantai AN. "Anti-malarial activity of a polyherbal product (Nefang) during early and established Plasmodium infection in rodent models." Malaria Journal. 2014;13:DOI: 10.1186/1475-2875-13-456. Abstract2014_-_antimalarial_activity_of_polyherbal_nefang.pdf

Background: The emerging resistance of Plasmodium species to currently available anti-malarials remains a public health concern, hence the need for new effective, safe and affordable drugs. Natural products remain a reliable source of drugs. Nefang is a polyherbal anti-malarial of the Cameroonian folklore medicine with demonstrated in vitro antiplasmodial and antioxidant activities. It is composed of Mangifera indica (bark and leaf), Psidium guajava, Carica papaya, Cymbopogon citratus, Citrus sinensis, Ocimum gratissimum (leaves). This study aimed at investigating the suppressive, prophylactic and curative activities of Nefang in Plasmodium infected rodent models.

Methods: Systemic acute oral toxicity of Nefang aqueous and ethanol extracts was assessed in mice up to a
dose of 5,000 mgkg−1 body weight. BALB/c mice and Wistar rats were inoculated with Plasmodium chabaudi
chabaudi and Plasmodium berghei, respectively, and treated with Nefang, the Mangifera indica bark/Psidium
guajava combination and a Psidium guajava leaf aqueous extracts (75, 150, 300 and 600 mgkg−1 bwt). Their
schizonticidal activity was then evaluated using the Peter’s 4-day suppressive test). The prophylactic and curative (Rane’s Test) activity of Nefang was also evaluated by determining the parasitaemia, survival time, body weight and temperature in pre-treated rodents.

Results: Acute oral toxicity of the extract did not cause any observed adverse effects. Percent suppressions of
parasitaemia at 600 mgkg−1 bwt were as follows (P. berghei/P. chabaudi): Nefang – 82.9/86.3, Mangifera indica bark/Psidium guajava leaf combination extract – 79.5/81.2 and Psidium guajava leaf – 58.9/67.4. Nefang exhibited a prophylactic activity of 79.5% and its chemotherapeutic effects ranged from 61.2 – 86.1% with maximum effect observed at the highest experimental dose.

Conclusion: These results indicate that Nefang has excellent in vivo anti-malarial activities against P. berghei
and P. chabaudi, upholding earlier in vitro antiplasmodial activities against multi-drug resistant P. falciparum
parasites as well as its traditional use. Hence, Nefang represents a promising source of new anti-malarial
agents.

Keywords: Medicinal Plants, Nefang, Acute toxicity, Malaria, In vivo antiplasmodial activity, Suppressive
activity, Prophylactic activity, Curative activity, Combination phytotherapy

N PROFGUANTAIA. "Antimalarial activity of some plants traditionally used in Meru district of Kenya.Muthaura CN, Rukunga GM, Chhabra SC, Omar SA, Guantai AN, Gathirwa JW, Tolo FM, Mwitari PG, Keter LK, Kirira PG, Kimani CW, Mungai GM, Njagi EN.Phytother Res. 2007 Sep;21(9).". In: Phytother Res. 2007 Sep;21(9):860-7. FA Okalebol , L Wiesner, AN Guantai, K Chibale, P Smith; 2007. Abstract

Ten plant extracts commonly used by the Meru community of Kenya were evaluated for the in vitro antiplasmodial, in vivo antimalarial, cytotoxicity and animal toxicity activities. The water and methanol extracts of Ludwigia erecta and the methanol extracts of Fuerstia africana and Schkuhria pinnata exhibited high antiplasmodial activity (IC(50) < 5 microg/mL) against chloroquine sensitive (D6) and resistant (W2) Plasmodium falciparum clones. The cytotoxicity of these highly active extracts on Vero E6 cells were in the range 161.5-4650.0 microg/mL with a selectivity index (SI) of 124.2-3530.7. In vivo studies of these extracts showed less activity with chemosuppression of parasitaemia in Plasmodium berghei infected mice of 49.64-65.28%. The methanol extract of Clerodendrum eriophyllum with a lower in vitro activity (IC(50) 9.51-10.56 microg/mL) exhibited the highest chemosuppression of 90.13%. The methanol and water extracts of Pittosporum viridiflorum were toxic to mice but at a lower dose prolonged survival of P. berghei infected mice (p < 0.05) with no overt signs of toxicity. However, the extracts were cytotoxic (SI, 0.96-2.51) on Vero E6 cells. These results suggest that there is potential to isolate active non-toxic antimalarial principles from these plants.

N PROFGUANTAIA. "Antimalarial activity of some plants traditionally used in treatment of malaria in Kwale district of Kenya.Muthaura CN, Rukunga GM, Chhabra SC, Omar SA, Guantai AN, Gathirwa JW, Tolo FM, Mwitari PG, Keter LK, Kirira PG, Kimani CW, Mungai GM, Njagi EN.J Et.". In: J Ethnopharmacol. 2007 Jul 25;112(3):545-51. Epub 2007 May 5. FA Okalebol , L Wiesner, AN Guantai, K Chibale, P Smith; 2007. Abstract

Methanolic and water extracts of five medicinal plant species used for treatment of malaria in traditional/cultural health systems of Kwale people in Kenya were tested for antimalarial activity against Plasmodium falciparum and Plasmodium berghei, respectively and for their cytotoxic effects. The most active extracts (IC(50)<10 microg/ml) screened against chloroquine (CQ) sensitive (D6) and resistant (W2) P. falciparum clones, were the water and methanol extracts of Maytenus undata (Thunb.) Blakelock (Celasteraceae), methanol extracts of Flueggea virosa (Willd.) Voigt (Euphorbiaceae), Maytenus putterlickioides (Loes.) Excell and Mendoca (Celastraceae), and Warburgia stuhlmannii Engl. (Canellaceae). These extracts showed various cytotoxic levels on Vero E6 cells with the water extract of M. undata exhibiting least cytotoxicity. At least one of the extracts of the plant species exhibited a high chemo suppression of parasitaemia >70% in a murine model of P. berghei infected mice. These results indicate that there is potential for isolation of a lead compound from the extracts of the five plants. W. stuhlmannii and M. putterlickioides have not been reported before for antiplasmodial activity.

N PROFGUANTAIA, N PROFGUANTAIA. "The Antimalarial and Antimicrobial Activity and Brine Shrimp Toxicity of Clematis Brachiata Extracts.". In: East and Central African Journal of Pharmaceutical Sciences Vol. 5. F.A. OKALEBO*, H.A. RABAHI, A.N. GUANTAII, C.K. MALTA', I.0. K1BWAGE, J.W. MWANGI AND W. MASENGO; 2002. Abstract

The in vitro antimalarial activity of the root extract in partly supports the ethnobotanical use of the plant to manage malaria. Clematis brachiata Thunberg (Ranunculaceae) is used in Kenya for the management of headaches, malaria and other febrile illnesses, abdominal disorders, yaws and for skin disorders. Old stems and leaves are chewed for the management of toothaches and sore throats. Extracts of the plant were subjected to tests for antimalarial, antibacterial and antifungal activity. The toxicity of the extracts was assessed using the brine shrimp lethality bioassay. The root extract gave the highest in vitro antimalarial activity against the inulitidrug resistant strain, Plasmodium falciparum VI/S (IC50=39.24 jig/nil). The stem and leaf extracts had insignificant antiplasmodial activity. The leaf, stein and root extracts had no bacterial or fungal inhibitory effects even at very high concentrations of 10 mg/ml. The Lll50 values of the stem and leaf methanol extracts against the brine shrimp larvae was 365.60 and 66.5 jig/ml, respectively. Key Words: Clematis brachiata, Ranuneulaceae, antimalarial, antibacterial, antifungal, brine shrimp.

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