Tropical Journal of Pharmaceutical Research

Advancements in topical antifungal treatment: Cream and hydrogel nanosponge integration loaded with Palmarosa essential oil

Iwan Setiawan — 2025-01-17

Purpose: To optimize the preparation of hydrogel and creams integrated using nanosponge loaded with palmarosa essential oil.

Method: Palmarosa nanosponge essential oil was formulated by oil-in-water (o/w) emulsion solvent diffusion method using various ratios of drug to polymer; ethylcellulose (EC). Polyvinyl alcohol (PVA) and dichloromethane were used to create the aqueous and dispersed phases, respectively. Furthermore, nanosponge (NS) was studied for particle size and zeta potential, followed by integration into cream and hydrogel preparations. The preparations were evaluated for physicochemical characteristics and antifungal activity in vivo in animals induced by Candida albicans.

Results: Results showed that the physical testing for optimum preparation of hydrogel had a pH of 6.9 ± 0.10, adhesion of 1.43 ± 0.40 seconds, spreadability of 5.43 ± 0.55 cm and viscosity of 276 ± 25.16 dPa.s. Meanwhile, for cream preparation, pH, adhesion, spreadability and viscosity values were 6.6 ± 0.2, 2.25 ± 0.37 seconds, 7 ± 0.70 cm, and 1500 ± 5 dPa.s, respectively. The in vivo test for antifungal activity in test animals induced with Candida albicans showed that treatment had a significantly different effect on the healing process of candidiasis infection.

Conclusion: This study offers new knowledge regarding the development of hydrogel preparations and nanosponge integration cream containing palmarosa essential oil. The preparations had the advantages of efficacious ingredients, with good drug release and spreadability profile through the skin.

Lumefantrine-neusilin® based amorphous multicomponent solid dispersion: In vivo and in vitro characterization

Calister Ugwu — 2025-01-17

Purpose: To develop Neusilin-based amorphous multi-component solid dispersions (NAM-SDs) to improve poor aqueous solubility, low bioavailability and absorption of lumefantrine and enhance the antiplasmodial activity.
Methods: Solvent evaporation technique was adopted to produce second-generation SDs (N1 - N3); third-generation SDs (N4 - N6 and N10 - N12); and multi-component SDs, NAM-SDs, (N7 - N9 and N13 - N18). In vitro drug release, in vivo anti-plasmodial activity, differential scanning calorimetry (DSC), and wide-angle x-ray diffraction (WAXD) were carried out on the SDs.
Results: The highest drug release (80 %) was observed in multi-component SDs (NAM-SDs, formulation N17 containing Kollidon® VA 64). A significant antiplasmodial activity (p < 0.05) was observed in mice that received NAM-SDs. The DSC and WAXD studies showed that the formulations solubilized and exhibited an amorphous state.
Conclusion: Multi-component amorphous-based lumefantrine SDs (NAM-SDs) may serve as a potential alternative carrier system for oral lumefantrine delivery.

Inhibitory effect of PD173074 drug on DMBA-induced mammary carcinoma in female Swiss albino mice

Abeer Alghamdi — 2025-01-17

Purpose: To determine the effect of PD173074 on mammary carcinoma.

Methods: Virgin female mice were randomly divided into 4 groups of 10 mice per group. Group 1(control) received clean water, group 2 received an oral dose of 50 mg/kg PD173074 twice a week, group 3 received a single dose of 50 mg/kg 7,12-Dimethylbenz(a)anthracene (DMBA) in the breast for carcinoma induction, group 4 received DMBA and after that treated with PD173074 one week later for 4 weeks. Hormonal analysis, oxidative stress, levels of cytokines IL6 and TNF-α, and histopathological and immunohistochemical analysis were carried out.

Results: Treatment with PD173074 significantly lowered estrogen, progesterone, oxidative stress indices, cytokines IL6, and TNF-α levels (p < 0.05) raised due to carcinoma induction. Pyrido (2,3-d) pyrimidine derivative PD173074 lowered the Nottingham histopathological score and reduced the incidence of invasive ductal carcinoma. Furthermore, immunohistochemical analysis showed that posttreatment with PD173074 significantly decreased K167 expression (p < 0.05).

Conclusion: PD173074 significantly reduces estrogen, progesterone, oxidative stress indices, cytokines, TNF-α, Nottingham histopathological score, and KI-67 expression. Additional studies would be required to validate the actual mechanisms of this drug action.

Mechanistic insight into the cholinergic, muscarinic and antagonistic effects of Khat (Catha edulis) on native nicotinic acetylcholine receptors

Siddig Abdelwahab — 2025-01-17

Purpose: To investigate the cholinergic, muscarinic and antagonistic effects of Khat (Catha edulis) on native nicotinic acetylcholine receptors (nAChR) and understand its associated mechanism.
Methods: Fresh leaves of Catha edulis (50 g) were pulverized and subjected to extraction using 200mL of methanol and filtered. The filtrate was reconstituted with 0.02 N sulfuric acid, and then chloroform extraction. Properties of the crude alkaloid extract of khat (CAEK) were assessed in skeletal muscles isolated from frog rectus abdominis. In silico analysis of the effects of cathine (CAT) and cathinone (CATO) on muscle-type nicotinic acetylcholine receptors (nAChRs) and molecular docking to predict their potential binding sites on nAChR subunits were carried out.
Results: Pre-treatment of isolated muscles with CAEK inhibited carbachol-induced contractility in a dose-dependent manner. At 10, 20, 40 and 80 mg/mL concentrations of CAEK, inhibition percentages were 74.4, 85.2, 95.4 and 99.5 %, respectively. Molecular docking studies show that CAT and CATO modulate the function of nAChRs through competitive antagonism.
Conclusion: These results reveal that khat consumption could contribute to the development of skeletal muscle-associated ailments; hence, detailed studies emphasizing cardiac complications and muscular toxicity mechanisms should be conducted.

Utilizing network p harmacology to investigate the probable mechanism of Danshen chuanxiong drug pair in Kawasaki disease

Aiyuan Cai — 2025-01-17

Purpose: To investigate the primary components and effect of Danshen-Chuanxiong (DS-CX) in the treatment of Kawasaki disease.

Methods: Active ingredients of DS-CX and targets of action were screened via the Traditional Chinese Medicine Systematic Pharmacology (TCMSP) and SwissTargetPrediction databases. Targets of Kawasaki disease were queried in OMIM, GeneCards, DRUGBANK, and Disgenet databases, and intersected with drug targets. Protein-protein interaction maps (PPIs) were constructed using STRING database and Cytoscape software, and core genes of Kawasaki disease were screened. Pathway enrichment analyses (DAVID database, Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG)) were conducted for DS-CX targeting Kawasaki disease crossover targets.

Results: A total of 64 active ingredients and corresponding potential target genes of DS-CX were obtained. Also, 928 human genes related to Kawasaki disease were obtained from OMIM, DRUGBANK, GeneCards and Disgenet databases. Potential target genes of DS-CX was intersected with 928 human Kawasaki disease-related genes, and a total of 55 genes were screened. The PPI network was built using STRING database and Cyotoscape software, and overlapping genes were further screened. A total of 61 active ingredients were screened for their effects on Kawasaki disease-related targets. GO-function analysis revealed that DS-CX affected Kawasaki disease by positively regulating gene expression. Also, KEGG enrichment analysis found that DS-CX and Kawasaki disease was mainly enriched in pathways involved in cancer.

Conclusion: DS-CX regulates core genes (AKT1, IL6, and TP53) and other genes through active ingredients which in turn act on cancer pathway. Thus, DS-CX demonstrates anti-inflammatory and anti-platelet activities and helps blood vessel repair and remodeling in Kawasaki disease. Further studies to validate Danshen and Chuanxiong for the treatment of Kawasaki disease are needed to determine its mechanism of action.

Treatment of peripheral neuropathy in type 2 diabetes with epalrestat combined with sulodexide

Wenjun Chen — 2025-01-17

Purpose: To analyze the efficacy of epalrestat combined with Sulodexide in the treatment of diabetic peripheral neuropathy in type 2 diabetes.

Methods: A total of 140 patients with type 2 diabetic peripheral neuropathy, who were treated at the Zhanjiang Central People's Hospital between February 2022 and February 2023, were selected as subjects. They were randomly divided into two groups using a computer- generated random number table. The control group (n = 70) received epalrestat treatment, while the study group (n = 70) was treated with a combination of epalrestat and Sulodexide11. Efficacy, nerve conduction velocity, levels of inflammatory factors and oxidative stress markers were compared between groups.

Results: After treatment, total effective rate in study group was 97.14 %, which was higher than that of control group (85.71 %; p < 0.05). Sensory nerve conduction velocity (SCV) and motor nerve conduction velocity (MCV) of the common peroneal nerve and median nerve in study group were significantly faster than those in control group (p < 0.05). Levels of serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) in study group were significantly lower than those in control group (p < 0.05). Total antioxidant capacity (T-AOC) and superoxide dismutase (SOD) levels in study group were higher than those in control group, while malondialdehyde (MDA) level was lower than control group (p < 0.05).

Conclusions: Epalrestat combined with Sulodexide in treatment of diabetic peripheral neuropathy in type 2 diabetes improves efficacy, accelerates nerve conduction velocity, reduces inflammatory factor levels and decreases oxidative stress response. Further studies are necessary to accurately verify the combination therapy value using epalrestat and Sulodexide in treating peripheral neuropathy associated with type 2 diabetes.

Allicin-mediated renal protection in mitigating streptozotocin-induced diabetic nephropathy in rats through comprehensive restoration of kidney function and morphology

Sasikumar Dhanarasusa — 2025-01-17

Purpose: To evaluate the benefits of allicin, a vital garlic component, against streptozotocin-induced diabetic kidney damage in rats.

Methods: A total of thirty male albino Wistar rats were divided into five groups of six rats each, with groups II – IV induced with diabetes using a single intraperitoneal administration of streptozotocin (55 mg/kg). Group I served as normal control while Group II was untreated diabetic control, receiving vehicle injections. Diabetic rats in Groups III and IV were treated with allicin (diallyl thiosulfinate, DATS, 20 mg/kg/day orally for 15 days) and aminoguanidine (AG, 100 mg/kg/day orally for 15 days), respectively, while Group V rats served as normal control rats receiving DATS only. Various biochemical, and kidney marker assessments and histological examinations were conducted at the end of treatment.

Results: Streptozotocin-induced diabetic rats exhibited significant (p < 0.05) alterations in body weight, kidney metrics, kidney markers and renal histopathology compared to normal control (Group I). Treatment with DATS showed significant improvements in body weight, kidney metrics and biochemical markers (p < 0.05) indicating potential nephroprotective effect against diabetic nephropathy by significantly restoring kidney weight, protein levels, albumin, potassium, sodium and other urinary markers (p < 0.05). Furthermore, DATS effectively reversed STZ-induced renal damage with outcomes comparable to standard drug (aminoguanidine).

Conclusion: Administration of DATS in rats with nephropathy from diabetes may have kidney protective benefits. The study highlights allicin’s potential as a therapeutic agent in managing diabetic complications, particularly diabetic nephropathy, prompting further exploration prior to future use.

Anti-hyperglycemic activities of Lepisanthes rubiginosa (Roxb.) Leenh. leaf and pericarp extracts in streptozotocininduced diabetic rats

Ampa Konsue — 2025-01-17

Purpose: To evaluate the anti-hyperglycemic activities of Lepisanthes rubiginosa (Roxb.) Leenh. Leaf and pericarp extracts in streptozotocin-induced diabetic rats.
Methods: Doses of 500 mg/kg of the leaf and pericarp extracts were administered orally once daily to both control and streptozotocin (65 mg/kg)-induced diabetic rats for 28 days. Changes in body weight, blood glucose, triglycerides, liver and kidney function tests as well as histopathological examination of the liver cells post-administration of the extracts were evaluated and compared.
Results: Administration of 500 mg/kg of these two extracts to diabetic rats resulted in a significant increase (p < 0.05) in body weight, a significant reduction (p < 0.05) in fasting blood glucose, and a decrease in triglycerides after 4 weeks of treatment compared to diabetic controls, without affecting other hematological values. Liver function tests showed a decrease (p < 0.05) in aspartate aminotransferase levels, while kidney function tests indicated a significant reduction (p < 0.05) in blood urea nitrogen levels.
Conclusion: Lepisanthes rubiginosa (Roxb.) Leenh. Leaf and pericarp extract effectively lower blood glucose levels in diabetic rats by restoring pancreatic histopathology, resulting in an increase in the size of islets of Langerhans and promoting the cells thereby leading to increased insulin secretion.

Antiplasmodial and cytotoxic activities of Jussiaea linifolia G. Don extracts

Fabian Kuranen — 2025-01-17

Purpose: To evaluate the in vivo and in vitro antiplasmodial activity of Jussiaea linifolia extracts using validated models.
Methods: Methanol extract was partitioned into n-hexane, ethyl acetate and n-butanol fractions and subjected to antiplasmodial and cytotoxic activity assays. The in vivo assay adopted Peter’s four-day suppressive and Ranes curative tests to estimate Plasmodium berghei NK47 growth suppression while the in vitro antiplasmodial activities were performed using chloroquine-sensitive Plasmodium falciparum
NF54 and L6 mammalian myoblast to determine growth inhibition and cytotoxicity respectively.
Results: Acute toxicity test showed that the methanol extract displayed LD50 > 5000 mg/kg. The in vitro assays revealed that the extract and ethyl acetate fraction elicited significantly higher IC₅₀ of 1.15 μg/mL (L6 83.2 μg/mL) and 0.785 μg/mL (L6 > 100 μg/mL), respectively against P. falciparum compared with n-hexane (> 100 μg/mL; L6 5.89 μg/mL) and n-butanol (48.1 μg/mL; L6 12.84 μg/mL) fractions. In the in vivo suppressive model, 400 mg/kg of ethyl acetate soluble fraction elicited a 97.1 % (p < 0.05; mean survival time > 21 days) P. berghei suppression compared with untreated group. Also, the ethyl acetate soluble evoked the highest suppression of parasitemia (94.17 %) in the curative model when compared with untreated. The extract and fractions of J. linifolia were found to restore packed cell volume in infected mice to their respective baselines compared with continued decline in untreated group.
Conclusion: The study validates the traditional use of J. linifolia as an antimalarial decoction in some rural communities and shows that the ethyl acetate soluble fraction of methanol extract could be a source of lead antiplasmodial compounds.

Phytochemical screening and cytotoxic activities of Enhalus acoroides (L.f.) Royle and Halimeda macroloba Decaisne on cervical cancer cell lines

Raphatphorn Navakanitworakul — 2025-01-17

Purpose: To determine the cytotoxic effects of phytochemical compounds in Enhalus acoroides and Halimeda macroloba crude extracts on cervical carcinoma and normal kidney tissue cells.

Methods: Dried Enhalus acoroides and Halimeda macroloba were macerated in ethanol. Then, phytochemical screening was done using thin-layer chromatography (TLC). The cytotoxic activities of extracts against HeLa and SiHa cervical cancer cells were performed using MTT assay.

Results: The H. macroloba extract was highly active against SiHa cells, with an IC50 of 17.22 ± 3.93 μg/mL, and moderately active against HeLa cells, with an IC₅₀ of 36.57 ± 7.26 μg/mL. The E. acoroides extract was moderately active against both HeLa and SiHa cells. Moreover, both extracts exhibited lower toxicity against HEK293 normal kidney cells, with IC50 values of > 80 μg/mL.

Conclusion: These results suggest that E. acoroides and H. macroloba exert potent cytotoxic activity on cervical cancer cells. The mode of action associated with the cytotoxicity of these extracts, and the effect of the combination of the extracts with chemotherapy, should be investigated in subsequent studies.

Evaluating melatonin's neuroprotective effect on the cerebellar cortex of adult male albino rats following monosodium glutamate exposure: a comprehensive biochemical, histopathological and immunohistochemical study

Hoda Sayed — 2025-01-17

Purpose: To investigate neurotoxic effects of monosodium glutamate (MSG) on rat cerebellar cortices and evaluate potential neuroprotective action of melatonin.
Methods: Adult male albino rats (40) were randomly categorized into four groups of ten rats each comprising Group I (control), Group II (melatonin-treated, 6 mg/kg/day via intraperitoneal injection), Group III (MSG-treated, 4 mg/kg/day IP) and Group IV (co-treated with MSG and melatonin). After 14 days of injections, rats were sacrificed and blood samples were collected to determine serum glucose, total cholesterol (TC) and triglyceride (TG) levels. Cerebellar tissues were processed for histological examination, and homogenized specimens were used to estimate malondialdehyde (MDA), glutathione (GSH), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels. Results: Administration of MSG significantly (p < 0.05) increased serum glucose, TC, TG, MDA, TNF-α and IL-1β levels while significantly decreasing GSH level (p < 0.05). Histological analysis revealed that MSG exerted degenerative effects, including the presence of pyknotic Purkinje cells, with strong positive reactions for caspase-3 and glial fibrillary acidic protein as well as weak reactions for β-cell lymphoma-2 and synaptophysin. However, melatonin administration improved these parameters.
Conclusion: Monosodium glutamate induces neuronal injury in rat cerebellar cortex, but melatonin demonstrates a protective effect against these degenerative changes. There is a need for additional studies to understand the mechanisms of MSG and melatonin effects.

Evaluating the combination of amoxicillin, gemifloxacin and rabeprazole therapy for Helicobacter pylori eradication in young and older adult patients

Guner Kilic — 2025-01-17

Purpose: To assess the effectiveness, safety and adverse effects of treatment regimen combining amoxicillin, gemifloxacin and rabeprazole for eradicating Helicobacter pylori in adult population.
Methods: A total of 211 patients comprising 33 patients (15.6 %) from the older adult group and 178 patients (84.4 %) from the younger adult group who visited Van Training and Research Hospital, Turkey were included in this study. Treatment, made up of amoxicillin (1000 mg) and rabeprazole (20 mg), was administered 12 hourly and gemifloxacin (320 mg) once daily to all patients for 7 days. Thereafter, patients were evaluated for H. pylori eradication by examining antigens in feces (immunochromatographically based, qualitatively), drug compliance and treatment tolerance.
Results: Post-treatment investigations showed that H. pylori was completely eradicated in 187 patients (88.6 %), while eradication was not achieved in 24 patients (11.4 %). In the older adult group, H. pylori was successfully eradicated in 27 of 33 patients (81.8 %). Excluding a total of 9 patients who did not complete treatment due to side effects, H. pylori eradication was achieved in 184 of 202 patients (91 %). Conclusion: This combination of three antibiotics exhibits a high rate of eradication of H. pylori among adult patients, even when administered for a short period (one week). This investigation should be carried out using a larger and more diverse patient population to validate the outcomes reported in this study.

Growth optimizatio n and metabolite yield of non pathogenic Escherichia coli isolated from the gut of African catfish: Clarias gariepinus

Samuel Umma — 2025-01-17

Purpose: To investigate the optimum growth and metabolite yield of non-pathogenic Escherichia coli in the gut of African catfish for use as a substitute.

Methods: Optimization was statistically carried out for the growth and metabolite yield of non-pathogenic Escherichia coli. Response Surface Design was used to generate three levels of each of the following operational factors viz glucose, peptone water, potassium nitrate (KNO₃), Bambara nut, pH and temperature for the production of peptone water–glucose, KNO₃–glucose and Bambara nut culture media, respectively. The absorbance was read consecutively for 7 days using a UV-VIS double beam spectrophotometer while the metabolites were identified and analyzed using gas chromatography-MS.

Results: Optimum growth and metabolite yield of the non-pathogenic Escherichia coli occurred on the 4th and 7th day in Peptone water–glucose, KNO₃–glucose and Bambara nut media, with sequential p-values ranging from 0.115 (quadratic) – 0.002 (linear), 0.370 (linear) – 0.020 (quadratic), 0.470 (linear) – 0.040 (quadratic), respectively. The combination of peptone water (0.9 g), glucose (4.0 g) and pH (7.25) at 37 °C gave the optimum culture conditions for metabolite yield, with 19 classes of metabolites identified.

Conclusion: The quadratic model is the suitable predictive model and Peptone water–glucose has optimum metabolite yield. Therefore, it is ideal for therapeutic and nutritional purposes in aquaculture based on yield and quality of metabolites.

Antioxidant and α-glucosidase inhibitory activities of phytochemicals extracted from leaves, branches and roots of native and hybrid Thai mulberry (Morus alba, Linn.) cultivars

Teeraporn Katisart — 2025-01-17

Purpose: To determine the phytochemical compounds, in leaves, branches and roots of two mulberry cultivars, Monnoi and Buriram 60 (Br.60).

Methods: Both cultivars were grown under organic conditions. Extraction of plant parts was done using either distilled water (autoclave), 50 % ethanol or 95 % ethanol and the proximate chemical analysis including 1-Deoxynojirimycin (DNJ) content, total flavonoid (TFC) and total phenolic contents (TPC), antioxidant and α-glucosidase inhibitory properties of the plant extracts were analyzed.

Results: The proximate analysis showed that both cultivars had high protein content in leaves (21 – 25 %) compared to branches and roots. The carbohydrate content was high in all parts of both cultivars (32 – 50 %) and the DNJ content of all parts using 50 % ethanol extraction was higher compared to the other two methods, ranging from 10 – 17 mg/g Ext. Total phenolic content (TPC) in Monnoi branches extracted with distilled water (autoclave) was 13.45 ± 0.26 mg GE/g Ext while Br.60 roots with distilled water extraction (autoclave) showed the highest total flavonoid content (TFC) at 1.55 ± 0.02 mg QE/g Ext. Antioxidant activities of the extract on FRAP, DPPH radical and ABTS were high for both cultivars but the IC₅₀ value was higher and significantly different (p < 0.05) compared to two standards used as controls (Trolox and Ascorbic acid). The α-glucosidase assay showed that the leaves and branches of Monnoi had IC₅₀ values of 2.21 ± 0.09 and 2.45 ± 0.1, respectively, with the potential to reduce enzymatic activity but less than the standard substance Acarbose with an IC₅₀ of 0.31 ± 0.01.

Conclusion: Two mulberry cultivars, Monnoi and Br.60, show high potential for diabetes treatment owing to their bioactive compounds. Extraction with 50 % ethanol gives the highest yield. Further isolation and characterization and possible mechanism of action of phytoactive constituents such as 1- deoxynojirimycin (DNJ) would be necessary.

Evaluation of awareness, perceptions and opinions of artificial intelligence (AI) among healthcare students – A cross-sectional study in Saudi Arabia

Haifa Fadil — 2025-01-17

Purpose: To ascertain the views, knowledge and opinions of healthcare students (HCs) regarding artificial intelligence (AI).

Methods: The cross-sectional survey designed to assess awareness, perceptions and opinions of HCs towards AI was conducted between April to June 2023. A pre-tested, validated structured questionnaire was distributed electronically to HCs across different universities in Saudi Arabia. Responses were compiled using a 5-point Likert scale. Cronbach's alpha score of 0.80 was used to establish the reliability of the questionnaire. Mean scores were determined by calculating each item in the perceptions compiled.

Results: Majority of HCs had a positive perception towards AI in healthcare and agreed that AI could improve diagnostic accuracy (73.4 %), reduce errors in medical practice (65.2 %) and facilitate patient education (70.8 %). However, some concerns were expressed that AI has a harmful impact on healthcare practitioners' relationships with patients and potential ethical implications (44.3 %) and also allows patients to increase control over their health (51 %). Most students (85 %) believe that if AI is integrated into healthcare, there is a risk of losing jobs. The analysis of multiple linear regression shows that course of study (B = 0.311; SE = 0.132; t = 2.360; p = 0.019; CI = 0.052 to 0.570), awareness of AI (B = -1.822; SE = 0.785; t = -2.320; p = 0.021; CI = - 3.366 to -0.279) were predictors of perception score of AI.

Conclusion: Healthcare students show positive perceptions towards AI and agree that AI helps in various aspects of healthcare. However, students revealed some concerns about AI. Therefore, addressing concerns related to ethics, workforce impact and patient privacy is crucial for successful AI implementation in the healthcare sector.

Beliefs about and adherence to statin therapy among hyperlipidemic patients in Saudi Arabia: A cross-sectional study

Rania Magadm — 2025-01-17

Purpose: To assess patients' beliefs about the necessity and safety of statins and their impact on adherence in Jeddah, Saudi Arabia.
Methods: This cross-sectional study involved 150 hyperlipidemic patients undergoing statin therapy for at least six months. A structured questionnaire was used to assess sociodemographic data, statin adherence and beliefs about statin necessity and safety using a 5-level Likert scale.
Results: Over 40 % of participants were nonadherent by missing seven or more doses in the past month, 26.7 % often forgot medication when traveling and 45.3 % perceived themselves as noncompliant. The main noncompliance reasons were forgetfulness (28.0 %), perceived cholesterol control (14.7 %) and side effects like muscle aches (10.3 %). Less than 25 % agreed on statin necessity for health, with 45.0 % unsure. Higher belief scores correlated with longer statin use and fewer missed doses. About 27.0 % were concerned about adverse effects, but concerns showed no consistent effect on adherence.
Conclusion: Hyperlipidemic patients in Jeddah exhibit inadequate adherence to statin therapy, primarily due to forgetfulness, concerns about transporting medication and varying beliefs regarding the necessity and potential adverse effects of statins. These findings underscore the critical need for targeted educational interventions and enhancement of clinical practices.

Telemedicine promise for tomorrow: The role of video synchronous medical consultation in a primary health center (PHC) in a sub-Saharan Africa setting

Philip Osehobo — 2025-01-17

Purpose: To demonstrate the use of telemedicine electronic communications to exchange medical information from one site to another to improve a patient’s clinical and medical care during a remote clinical service. The goals and purpose of this research were centered around improving healthcare delivery in Edo State, Nigeria, by leveraging telemedicine technologies.

Methods: This 12-month retrospective case study involved a live, two-way telemedicine primary care service in three rural primary health centers (PHCs) in Edo State. Patients were identified through outreach efforts and met criteria including chronic conditions like hypertension or diabetes, lack of access to physicians, and financial barriers to care. Weekly telemedicine visits with USA-based physicians were documented in the electronic health records (EHR), capturing diagnoses, vital metrics, medication adherence, and patient satisfaction.

Results: Seventy-five patients (66 % female, mean age 66) participated. Among hypertensive patients, systolic blood pressure (SBP) reductions ranged from 22 mmHg (p < 0.0001) at Oredo and Ukpenu PHCs to 5 mmHg at Ugbor PHC, with diastolic blood pressure (DBP) improvements at most sites. Diabetic patients at Ukpenu PHC showed significant fasting glucose reductions (p < 0.002), but changes were minimal at other PHCs.

Conclusion: Telemedicine demonstrated its potential to enhance chronic disease management and healthcare access in resource- limited settings, yielding positive clinical outcomes and high patient satisfaction.

Health-related quality of life in patients with rheumatoid arthritis and the clinical associations of EQ-5D utility scores

Lydia Pok — 2025-01-17

Purpose: To assess health-related quality of life (HR-QoL) and the clinical associations in patients with Rheumatoid Arthritis (RA).

Methods: A cross-sectional study on multi-ethnic RA patients was performed. Disease activity was assessed using DAS28-ESR. HR-QoL was measured by EQ5D, functional disability by HAQ-DI and fatigue by FACIT-F.

Results: A total of 214 predominantly female (86.9 %) patients were recruited. Median age was 62 years; Inter-quartile range (IQR): 53 – 68 years. Median and mean EQ-5D scores were 0.793 (IQR: 0.647 – 0.879) and 0.752 (SD: 0.165) respectively. Median EQ-5D scores for patients in remission, low, moderate, and high disease activity were 0.879 (IQR: 0.742 – 0.933), 0.795 (IQR: 0.645 – 0.880), 0.742 (IQR: 0.564 – 0.818) and 0.653 (IQR: 0.323 – 0.775) respectively. Median EQ-5D scores for patients with mild to moderate, moderate to severe, and severe to very severe disability were 0.795 (IQR: 0.714 – 0.933), 0.728 (IQR: 0.564 – 0.818) and 0.554 (IQR: 0.287 – 0.765) respectively. DAS28-ESR, HAQDI, ethnicity and FACIT-F correlated with HR-QoL. EQ-5D scores were lowest in patients requiring biologic disease- modifying anti-rheumatic drugs (DMARDs) compared to none or conventional DMARDs, although this was not significant.

Conclusion: HR-QoL declined as RA disease activity and disability increased. Treat-to-target strategies and preventing joint destruction may improve health-related outcomes of RA patients. It is recommended that future studies be conducted in multiple health centers across Malaysia to capture variations in HR-QoL of RA patients nationally.

Therapeutic and clinico-biological significance of CREB3L4 expression in primary prostate cancer

Abdulaziz Alfahed — 2025-01-17

Purpose: To investigate the therapeutic, clinicopathological and biological relevancy of CREB3L4 expression in primary prostate cancer (PCa) and to determine the mechanisms underlying the deregulation of CREB3L4 expression in PCa.

Methods: The therapeutic, clinicopathological and biological significance of CREB3L4 expressions in two cohorts of PCa, and the mechanisms of deregulation of CREB3L4 expression using TCGA data were determined using integrative computational analyses of the clinico-genomic data of the cancer genome atlas (TCGA) and Deutsches Krebsforschungszentrum (DFKZ).

Result: Gene set enrichment analyses (GSEA) demonstrated enrichment of gene sets that predict biological responses to a range of approved inhibitors in the PCa subsets with low CREB3L4 expression, and at nominal and false discovery rates of p < 0.05 and p < 0.25, respectively. In addition, lower CREB3L4 expression in TCGA PCa cohort showed poorer outcomes following androgen deprivation therapy. Furthermore, GSEA demonstrated that cell proliferation, epithelial-mesenchymal transition, angiogenesis, inflammatory response and apoptosis gene sets were enriched in PCa subsets with low CREB3L4 expressions. Low CREB3L4 expression was associated with adverse clinicopathological features of PCa at adjusted p < 0.05. Multiple regression analysis of the methylation, microRNA expression and copy number data of CREB3L4 identified the methylation loci and miRNA expression which independently predicted the expression of CREB3L4 in PCa.

Conclusion: This study demonstrates the potential therapeutic relevance and clinico-biological significance of CREB3L4 expression in primary PCa.

Multidisciplinary telehealth interventions for autistic children in sub-Saharan Africa: challenges and recommendations

Emmanuel Agbamu — 2025-01-17

History of autism is plagued by misconceptions and distortions and it is mostly attributed to spiritual causes. A comprehensive literature search was conducted to identify studies of telehealth interventions in the management of autism in various countries, and related challenges in Sub-Saharan Africa. There were several obstacles in adopting multidisciplinary telehealth interventions (MTI) which include poor internet, epileptic power supply, cultural beliefs, and lack of political will. This commentary compiles historical misconceptions, MTI which could be scaled up to meet the health-care needs of autistic children in Sub-Saharan Africa and the challenges that follow. Furthermore, it presents some recommendations for integrating telemedicine into the healthcare system. This commentary advocates the need for incorporating telehealth in autism spectrum disorder (ASD) management to improve care accessibility in sub-Saharan Africa through a multidisciplinary telehealth approach involving health practitioners, caregivers, teachers, psychologists, behavioural therapists, policy-makers, information technology (IT) specialists, web and applications developers, and government officials. User- friendly, low-cost telehealth models such as Applied behavior analysis (ABA), Face your fears (FYF) model, Collaborative model for promoting competence and success (COMPASS), ImPACT program, Joint attention, symbolic play, engagement, and regulation (JASPER), and Early start Denver model (ESDM) improve health outcomes in various countries and may be reworked for implementation in Sub- Saharan Africa. Development of appropriate telehealth infrastructure, increasing education and training of healthcare professionals and patients, and the need for government support and funding would improve accessibility and practice of telehealth interventions.