LITERATURE REVIEW ON THE MANAGEMENT OF HYPERTENSION
SUPERVISOR: PROF. C.K. MAITAI
Hypertension in one of the most preventable causes of premature morbidity and mortality in developed and developing countries. The causes of hypertension are primary (90-95%) and secondary (5-10%). Hypertension plays a major etiologic role in the development of cerebrovascular disease, ischemic heart disease, cardiac and renal failure.
There is no acute clinical presentation of hypertension. Most patients are diagnosed as a routine check up during clinic visit. Hypertension is known to have an insidious onset producing short and long term effects on various organs. The end of organ effects of hypertension are on the brain, the heart, the kidney and the eye.
The management of hypertension involves: assessment of risk, non pharmacological approaches and pharmacological approaches. The most appropriate choice of initial drug therapy depends on the age and racial origin of the patients as well as the presence of other conditions.
Many patients with hypertension will not achieve blood pressure targets with monotherapy. Many people need combinations of drugs to achieve adequate blood pressure control.
KIRUTHI WAIGANJO NJENGA
LITERATURE REVIEW ON THE REVISED GUIDELINES IN THE TREATMENT OF HIV/AIDS IN ADULTS AND ADOLESCENTS
SUPERVISOR: PROF. C.K. MAITAI
HIV/AIDS continues to be a worldwide global pandemic. The introduction of the highly active antiretroviral therapy has been beneficial to many AIDS patients hence the constant need to review and recommend guidelines for the treatment of the condition. These guidelines were reviewed in the year 2009 by the World Health Organization body. To come up with the new recommendation, the body had to weigh out on the risk verses benefits, acceptability cost and financial implications, and feasibility aspects for the update. The last time the WHO releases its guidelines was 2006. Since then there has been development in the ARV therapy sector which necessitated the need to review its previous guidelines. The Kenyan guidelines were released in 2004 as book that is the Kenyan National Clinical Manual or ARV providers. The last guidelines were released in 2006 and since then there has not been any modification regarding to treatment. With the revised guidelines it is therefore important that the Kenyan guidelines adapt and review it to the recommended guidelines which are also relevant to our set up.
MONICA MIRIGO GICHUHI
INVESTIGATION OF THE ESSENTIAL OIL CONTENT AND ANTIMICROBIAL ACTIVITY OF Eucalyptus citriodora LEAF
SUPERVISOR: PROF. C.K. MAITAI
Alternatives/traditional/complementary medicines are terms used interchangeably to describe the use of methods other than the conventional methods in the management of symptoms of certain conditions and treatment.
The objectives of carrying out this project was to determine and activity present in the leaf extract of Eucalyptus citriodora leaves.
Some of the cited uses as per publications in journals and previous research have been indicated in this thesis as well as the constitution of the oil extract from the leaves.
The essential oil was extracted by steam distillation using the Clevenger-like apparatus. The extract was then dried using anhydrous sodium suplhate crystals. Dried oil volume was recorded and percentage yield calculated from the total weight of the leaves used to extract the oil. The percentage yield was then compared to that obtained from previous work done on E. citriodora.
About 15microliter of the oil was used for the antimicrobial assay suing a gram positive bacterium, a gram negative bacterium and a fungus. The zone diameters were noted and compared with those of control agents i.e. Gentamicin for the bacterial and Nystatin for the fungi. A discussion of the results then followed and conclusion drawn from the results were developed.
MAYAKA RACHEL KERUBO
USE OF ANTIEMETICS AMONG PATIENS RECEIVING CHEMOTHERAPY AT KENYATTA NATIONAL HOSPITAL
SUPERVISOR: PROF. C.K. MAITAI
Introduction: Chemotherapy induced nausea and vomiting (CINV) is one of the most common and distressing side effects of cancer treatment. It may lead to refusal of further treatment. The choice of antiemetic agents and the timing of administration are essential in managing CINV.
Goal of study: To establish the pattern of antiemetic prescription and use among patients receiving cancer chemotherapy in an outpatients clinic with the aim of informing policy making and development of an antiemetic treatment protocol.
- To describe the commonly prescribed antiemetic in the hemato-oncology clinic at KNH over the study period.
- To determine whether there is any relationship between antiemetic prescribed and the emetogenic potential of het chemotherapy regimen.
- To determine whether there is any relationship between antiemetic prescribed and the risk factors for emesis during cancer chemotherapy.
- To describe the factors influencing the choice of antiemetics by the prescribers over the study period.
Methodology: This was a hospital based prospective descriptive study. The files and prescriptions of 31 patients receiving chemotherapy at the out – patient hemato-oncology clinic (Clinic 23) at KNH were reviewed for chemotherapy regimen and the anti-emetic prescribed. Five prescribing doctors were also interviewed. The study was carried out on Mondays between 12 noon and 2 p.m. for a total of four weeks in July 2010.
Results: The most commonly prescribed antiemetic was kytril as single therapy which was administered to 11 patient (36%) 26% of the patients (8 patients) did not receive any antiemetic therapy. Zofran, Dexamethasone/plasil combination and plasis/Zofran combination gave equal percentages of 3% (1 patient) of the total patients while kytril plasis combination had a percentage of 19 (6 patients).
Most of the highly emetogenic cancer chemotherapy regimens were administered with a very strong antiemetic e.g. kytril, Regimens like CHOP which have highly emetogenic agents like cyclophosphamide were administered with kytril/plasil combination.most patients under fifty years of age received antiemetics were females (IN reference to gender most of the patients who received antiemetics were females.
BONIFASIUS SIYUKA SINGU
INVESTIGATION OF THE LEAF AND STEM EXTRACTS OF RUBUS STEUDNERI SCHWEINF. FOR OXYTOXIC ACTIVITY
SUPERSIVOR: PROF. J.W. MWANGI
The leaves of raspberry Rubus sp are known to have notable activity in supporting female systems, supporting health menstruation, strengthening the tone of the uterus and preparing the womb for childbirth. Traditionally, it has been used for diarrhea. The general objective of this research was to determine the nature of the compounds present in Rubus steudneri and to investigate the effects of the plant on smooth muscles using TLC., micro chemical tests and isolated smooth muscles namely rat uterus and rabbit ileum. The leaves gave an extract yield of 6.35% while that of the stems was 4.90%after extraction with 70% ethanol. Tannis were found to be present in both leaf and stem extracts while alkaloids and glycosides were absent in both extracts. The TLC results indicated that both the leaves and stems or Rubus steudneri contain the same compounds. In the experiments with the rate uterus the results show that the activity of the smooth muscle relaxation. As opposed to the increase in activity with reducing doses observed in the experiments with the uterus, in the case higher doses of the extract are required to cause relaxation of the smooth muscles. It can be deduced from these results that R. steudneri may be useful in the conditions used traditionally. However, more scientific work including clinical trials are required.
OMONDI FREDERICK ODHIAMBO
PHYTOCHEMICAL AND PHARMACOLOGICAL SCREENING OF DIPLOLOPHIUM AFRICANUM TURCS. LEAVES AND STEM
SUPERVISOR: PROF J.W. MWANGI
Diplolophium africanum is an aromatic herb found in upland grassland areas of the Eastern Africa region. The plant has occasionally been suspected of poisoning livestock and has been found in several farms where poisoning cases have occurred.
Phytochemical studies made on the powdered stem and leaves of this plant revealed tannin, glycosides, saponins and alkaloids
The extract made using chloroform and methanol showed various degrees of activity on the isolated rabbit heart and ileum and on the isolated rat uterus.
Thin layer chromatography (TLC) profiles on the extracts of chloroform and methanol of the leaves.
NJERU JOHN MUGAMBI
FORMULATION OF ALOE SECUNDIFLORA, CENTELLA ASIATICA AND PROPOLIS CREAM
SUPERVISOR: PROF. J.W. MWANGI
Aloe species have found widespread using in medicinal and cosmetic products such as lotions and creams. Recent incorporation of propolis to make aloe cream has led to the production of more useful products combining the emollient effects of aloe and wound healing effects of propolis. Addition of Centella asiatica in to the aloe propolis combination would produce an even better product. This is because Centella asiatica has wonderful results when used to boot circulation, improve the collagen foundation of the skin, and fight oxidation – thereby making it a superb ingredient for anti-ageing skin care products as well as improving firmness and elasticity.
This report describes the preparation of the aqueous cream abase and the incorporation of the Centella asiatica, Aloe Secundiflora powder and Propolis into the cream at varying proportions to determine the best concentration of the ingredients. This was determined by testing the grittiness of the creams, carrying out micro chemical tests and test for the biological activity of the cream. A non-gritty cream with moderate concentration of the powders is preferred. Also, several active plant powders can be incorporated into a single cream to serve as multipurpose cream of having several creams each containing a single ingredients.
DAVID KIMANI NJOROGE
SCREENING OF SOME KENYAN MEDICINAL PLANTS USING THE BRINE SHRIMP LETHALITY ASSAY AND CORRELATION WITH ANTICANCER ACTIVITY
SUPERVISOR: PROF. J.W. MWANGI
Objectives: To screen some Kenyan medicinal plants using the brine shrimp lethality assay and to carry out this layer chromatography on the extracts.
Methodology: extraction using chloroform and methanol brine shrimp lethality assay. Thin layer chromatography on the extracts.
Results: Chloroform extracts on Notonia abyssinica, Physalis peruviana, Schkuhria pinnata and Hypoestis forskaolii were toxic to brine shrimp while that of Parthenium hysterophorus was not. Methanol extracts of Notonia Abyssinia, parthenium hysterophorus, Schkuhria pinnata Hypoestis forskaolii were toxic to brine shrimp while that of Physalis peruviana was not.
A COMPARATIVE STUDY OF THE UTILIZATION PATTERNS OF PENICILLIN AND FLUOROQUINOLONE ANTIBIOTICS AT KENYATTA NATIONAL HOSPITAL (PRIVATE WING) FOR A PERIOD OF SIX MONTHS; BY FERDINAND SUPERVISOR
SUPERVISOR: DR K A SINEI
Penicillins and Fluoroquinolones are among the most widely used antibiotics today. The penicillin slass has a special standing due their historical significance. They were the first class of drugs used in management of previously fatal bacterial infections, and this discovery was made as early as 1929. Due to this, the following few decades saw a rush to develop the discovery to produce clinically useful compounds. In the following years, various derivatives were developed from the basic natural penicillin, making them the largest and most widely derivatized group of antibiotics. Other beta-lactam based drugs such as cephalosporins followed soon after. Fluoroquinolones, on the hand were discovered much later, in the early 1960s. They have however also undergone various modifications over the years to give a large group of drugs applicable to various infections. These agents also had the advantage of covering infections that were previously not amenable to treatment using the original penicillins (mainly persistent gram negative bacterial infections). It is on the basis of the various comparable and contrasting aspects concerning use of the two classes of drugs that the study sought to compare their utilization. This was done by comparison of prescription rates of the drugs in a suitable health institution, Kenyatta National Hospital. The main factors that determine the outcome of such a trend are also a point of interest of this study.
ERIC CHOMBA WANJOHI
ANTIMICOBIAL ACTIVITY OF VITEX DONIANA EXTRACT
SUPERVISOR: DR K A SINEI
Plants produce a diverse range of bioactive molecules, making them a rich source of different types of medicines. Most of the drugs used today are obtained from natural sources or semi-synthetic derivatives of natural products used in traditional systems of medicine. Thus it is a logical approach in drug discovery to screen traditional products. Stem bark specimens of Vitex doniana previously collected from Meru was sourced from Department of Pharmacognosy, School of Pharmacy University of Nairobi. Collected materials were washed thoroughly, shed dried in open air and ground into powder. The powder was sequentially extracted by maceration in ethyl acetate. The plant extract was concentrated using rotary vacuum evaporator and preserved at 4◦C in airtight bottle until assay. The stem bark of Vitex doniana extract was studied in vitro for antibacterial property using microbiologicalassay. The Vitex doniana extract was f ound to be active against Escherichia coli and Staphylococcus aureus but had no activity against Saccharomyces cerevisiae. The minimum inhibitory concentration for E. coli was 20 mg/ml while that for S. aureus was 15 mg/ml.
NDERITU ARTHUR GITHUKU
ANTIMICROBIOL ACTIVITY OF HAGRNIA ABYSSINIA EXTRACT
SUPERVISOR: DR K A SINEI.
Plants have a history of producing lead compounds in drug discovery since time immemorial. Many drugs used today are either sourced directly from plants or semi-synthetic products of plant compounds from plants. The main objective of this study was to screen Hagenia abyssinica extract for antibacterial and antifungal activity, and if found active, to estimate at what concentration it is effective. The study was carried out by agar disc method, where micro-organism, after being sub-cultured were incorporated into a nutrient agar on petri dish, wells were then made and the plant extract, put on the wells alongside a positive control (standard antibiotic) and a negative control (DMSO). The petri dish was then incubated and results recorded after 18 to 24 hours. From the study it was noted that the plant extract exhibited activity against E coli and Staph aureus, but no activity on Saccharomyces cerevisiae. In conclusion it was recommended that more studies should be carried out to investigate the toxicity profile and in vivo activity of the extract, so that it could be exploited to treat infections caused by the organisms.
EUTYCHUS MUCHIRA MUGUKU
ADVERSE DRUG REACTIONS ASSOCIATED WITH HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) AT KENYATTA NATIONAL HOSPITAL COMPREHENSIVE CARE CENTRE
SUPERVISOR: DR K A SINEI
BACKGROUND: Adverse drug reactions (ADRs) rank very highly in causes of death in hospitalized patients. ARVs have various ADRs associated with them that include: peripheral neuropathy, hyperlipidemia, lipodystrophy, lactic acidosis and hepatic steatosis, acute pancreaitis among other minor effects like headache, rash, nausea and elevated hepatic transaminases thar are not severe enough to cause discontinuation of the corresponding drug.
OBJECTIVE: To determine the prevalence, characteristics and management of adverse drug effects associated with ARVs among adult patients receiving ARVs at Kenyatta National Hospital (KNH), Comprehensive Care Centre.
STUDY DESIGN: The study will be a restrospective cohort study (hospital based).
STUDY POPULATION: HIV/AIDS adult patients who were initiated into HAART at KNH, CCC during 2 year period between Jauary 2007 and December 2008.
SAMPLE SIZE: A randomly selected sample size of 100 patients was taken for the study. DATA
QUALITY CONTROL: A pre-test review was first carried out to check out data quality control procedures.
DATA ANALYSIS: The data was extracted from the files and entered into a collection form and analyzed using SRSS 13.0 SOFTWARE.
INCLUSION AND EXCLUSION CRITERIA: Some files were included for research purposes while others were excluded.
ETHICAL CONSIDERATIONS: There were ethical considerations that were into account while collecting data.
GRACE WANGUI NGARIKO
A COST ANALYSIS OF OUT PATIENT MANAGEMENT OF TYPE 2 DIABETES MELLITUS
SUPERVISOR: DR. FAITH A. OKALEBO
Diabetes mellitus is a chronic disorder and in Kenya an estimated 3.5% of the populations suffer from this metabolic disorder. The most common type of diabetes is Type 2. It is a major public health problem with far reaching consequences not just for its adverse impact on the health of the world’s population but also for the economic burden it places on the health care systems management of diabetes has both direct and indirect costs.
The broad objectives of this study were to describe the health care direct cost for management of outpatients Type 2 diabetes mellitus and to determine the cost of different classes of anti-diabetic drugs. Data was collected for patients treated in different pharmacies located in South B estate in Makandara Division, Nairobi. Data was obtained directly from the patients filed prescriptions and by directly interviewing the pharmacy staff. The study area had nine pharmacies six agreed to participate. Access to prescription was granted by the pharmacy attendants but unfortunately only two pharmacies had prescriptions records. In these two all the prescriptions received from January to April were examined and any prescriptions containing antidiabetics medication were included. A total of about 250 prescriptions were examined and only 90 had antidiabetics medication. Out of 90 only 40 met the inclusion criteria. The data collected included; patients demographics, antidiabetics drugs consumed concurrent medications prescribed and their acquisition cost. An overwhelming proportion of the prescriptions were for the females as opposed to males. Prescriptions for female made up 62% of all the examined prescriptions. This reflects a high prevalence of type 2 diabetes mellitus among females. The median age for the study subjects was 54 years. Metformin was the most prescribed drug because its euglycemicand since it’s the drug of choice for obese patients. Glucophage 500mg was the most prescribed brand. Once daily of twice daily dosing was indicated to improve compliance. In general sulfonylureas were less popular first generation being contrary to the international treatment guidelines. The median expenditure for antidiabetics drugs was 11 shillings daily with the cost ranging from 3-149. The daily expenditure of concurrent medication was 12 shillings with the cost ranging from 2-450. The total daily prescription cost was typically 20.5 the cost ranging from 3-453 shillings. It was deduced that 25% of the population income goes to medications with 58.8% of this going to the antidiabetics.
DEBRA RABERA KENYANYA
ALTERNATIVE AND CONVENTIONAL MEDICINES USED IN THE MANAGEMENT OF BENIGN PROSTRATE HYPERPLASIA
SUPERVISOR: DR. FAITH A. OKALEBO
Benin prostrate hyperplasia (BPH) is a common problem of aging in men. It has been proposed that the disorder has two phases, one that involves no clinical signs and the other that is manifested as disorders of urination due to urinary tract obstruction by an enlarged prostate. The progression of the disease to manifestation of clinical symptoms is most often seen after the age of 60 years. It has been suggested that while nearly all men experience microscopic changes in the prostate if they live long enough, only about half will experience prostrate enlargement and of those only half will develop clinical symptoms.
The retrospective study was aimed at finding out the various management strategies employed in the treatment of BPH and the treatment outcomes. The management strategies include surgery, phytotherapy and conventional medications. The baseline characteristics of the study population such as the age bracket, occupation, education levels, residence, and the smoking and alcohol consumptions histories were studied. The study also involved determination of the clinical presentation of BPH, involving the disease staging and severity, past family history of the disease and the diagnostic criteria.
The study was conducted by obtaining permission from Kenyatta National Hospital, to access information from patients records in Room 19 of the KNH. Further review of articles on the sue of phytotherapy and conventional medicines in the management of BPH was conducted and descriptive data analysis was done.
Conclusions that were made showed that most patients to the hospital when the illness is at the advance stage. Information about the use of alternative medicines is not yet comprehensive and that the patients were not forthcoming about their use. Recommendations were made to create more awareness about BPH and for further studies to be conducted to determine the possible interactions between alternative and conventional medicines.
OBALA LESLEY NATO
A SYSTEMATIC REVIEW ON THE INTERACTIONS CAUSED BY CO- ADMINISTRATIONS OF NUTRACEUTICALS AND CONVENTIONAL MEDICINES FOR DIABETES MELLITUS ON THE PATIENTS
SUPERVISOR: DR. N. N. MUNGAI
Diabetes management presents a major challenge when conventional and herbal therapy are employed.
Objective: The main objective of the study is to carry out a systematic review on the side effects of nutraceuticals interaction with anti-diabetic drugs.
Method: The study was done by searching the literature on the published papers with the Google search engine within a time frame of between 1960-2011. The MeSH terminologies that will be used included CAM, alternative therapy, individual herbs, supplement names from popular sources, Diabetes and management, Diabetes and side effects. Alloxan or streptozocin induced diabetic animals were used. Supplements made from animal products were excluded from this study.
Results: Plants whose extract interacts with hypoglycemic included Allium species, Aloe species, Momodica charantia, Gymnema sylvestre and Silybum marianum.
Conclusion: Combination of both conventional and herbal therapy may be additive or antagonistic hence close monitoring is crucial for effective management.
MULATYA DAVID MAKAU
PHYTOCHEMICAL STUDY AND INVESTIGATION OF THE ANTIMICROBIAL ACTIVITY OF THE LEAF EXTRACT OF ACACIA BREVISPA.
SUPERVISOR: DR. N. N. MUNGAI
The main objective of this research was to investigate he antifungal activity of the leaf extracts of Acacia brevispica as well as to study the basic phytochemical composition of the leaf extract.
Both the antibiotic and antifungal activities of chloroform and methanolic leaf extracts of Acacia brevispica were tested against the bacteria Staphylococcus aureus and the Saccharomyces species of the fungi respectively in-vitro on the culture medium. A Phytochemical analysis was conducted to study the main components of the plant extracts.
Thin layer chromatography was done on the extracts to separate and visualize the various components of the extracts.
The results indicated that this species of Acacia did exhibit neither the antifungal nor the antimicrobial activity. The thin layer chromatographs indicated that the chloroform extract had seven compounds while the methanol had three major components that were separated. Due to the number of components separated it would be interesting to find out what the compounds were.