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Pharmaceutical Journal of Kenya, Volume 24, No. 1 (2019)

Volume: 24, No. 1 (2019)
ISSN: 2411-6386;
Publisher: The Pharmaceutical Society of Kenya
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Articles in the journal

Editorial: Universal Health Coverage and the Crucial Role of Pharmacists

Author: Eric Koome & Nadia Butt

In-Vitro Anticancer Efficacy of Kenyan Ruellia prostrata (Acanthaceae) Against Breast, Prostrate and Human Hepatocellular Carcinoma Cell Lines

Author: Wangia C. O. , Kibet Ngetich , Kipyegon Cheruiyot and Guantai E.
Keywords: Cancer cell lines, Anticancer, Extracts, Proliferation, Phytochemicals
Abstract:
Background: According to the World Health Organization, cancer is currently a global health problem and is projected to increase devastatingly by 70% in the next two decades. Reported toxicity and high economic burden of current conventional drugs has prompted research into evaluation of medicinal plants as alternative options in the management of cancer.
Objective: The objective of this study was to evaluate in-vitro anticancer properties of methanolic and aqueous extracts of Ruellia prostrata against breast, prostate and human hepatocellular carcinoma, vis a vis Vero (normal) cell line using the 3- (4, 5- dimethyl thiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT). Cell proliferation assay was used to evaluate the antiproliferative potential for whole plant parts of R. prostrata.
Methods: The experiment was done in duplicate and data analyzed by miniTab software version 17.0 and Microsoft Excel-2010. It was noted that R. prostrata possesses anticancer activity in both methanolic and aqueous extracts which were not statistically significant (p>0.05). The methanolic extract showed the lowest proliferation against 4T1 (breast cancer cell line) with IC50 value of 17.36 μg/mL, while the highest proliferation rate was generally observed in Vero (normal) cell line with IC50 of 426.32 μg/mL. Prostate cancer (22RV1) and HCC cell lines (hepatocellular carcinoma) showed higher proliferation with IC50 values of 228.75 and 168.60 μg/ml respectively. Aqueous extract on the other hand demonstrated lower anticancer activity compared to the methanolic extract, with IC50 values of 393.67μg/mL, 2691.32μg/mL, 669000μg/mL, 107.94μg/mL, and 45.79μg/mL against 4T1, DU145, HCC, 22RV1 and Vero cell lines respectively.
Results and Discussion: In Conclusion, it was noted that the methanolic extracts of Ruellia prostrata had the highest activity against breast cancer and prostate cancer cell lines. The activity observed could be related to the presence of identified phytochemicals. To the best of our knowledge we report anticancer potential of R. prostrata for the first time. Therefore, extracts of R. prostrata can be developed further as alternative options for management of cancers of the breast, prostate, and the liver.


Prevalence of Nutritional and Herbal Medicine use and its Impact on Warfarin Dose and Response in a Tertiary Referral Hospital in Kenya

Author: Nyamu D. G , Guantai N.A. , Osanjo G.O. , Aklilu E. , Tele A.K.
Keywords: Anticoagulation, herbal medicine use, nutritional supplements, warfarin response, warfarin dose, Kenya
Abstract:
Background: Warfarin is the most extensively prescribed oral anticoagulant drug in Kenya and the rest of the world, owing to its demonstrated efficacy and affordability. Dosing and the response to warfarin are complicated by the fact that it is affected by nutrition status as well as commonly used herbal products.
Objective: To determine the prevalence of nutritional and herbal medicine use and its impact on warfarin dose and response among outpatients on anticoagulation therapy.
Study Area and Setting: Kenyatta National Hospital Anticoagulation Clinics.
Study Designs: Cross-sectional study.
Participants and Sample sizes: One hundred and eighty patients aged ≥18 years, who voluntarily signed informed consent to participate. Patients had to be on long term warfarin therapy (≥ 28 days), did not suffer from uncontrolled hypertension, peptic ulcer, and inherited coagulopathies or liver diseases. Mentally challenged patients and pregnant women were excluded.
Methods: The participants’ clinical data such as details of sociodemographic characteristics and dietary habits such as type of food consumed, frequency of consumption, herbal and nutritional supplementation were obtained through direct patient interviews. The data on clinical indication and warfarin doses were acquired from patients’ medical records. Warfarin response was determined by measurements of international normalized ratios (INRs), whose therapeutic range was set at 2-3 as recommended in the international guidelines.
Data Management: Data was analyzed using IBM Statistical Package for Social Sciences version 23. Frequencies were done to describe the prevalence of use of the nutritional and herbal substances. Student t-test and Chi-square tests were used to determine the strength of associations between warfarin maintenance doses and consumption of various foods or nutritional supplements as well as INR therapeutic levels, while setting the threshold for statistical significance at p≤0.05.
Results: Patients were generally middle aged at 43.4 (±13.2) years, and majority, 77.0 %( n=138) were females and in the 3rd to 5th decades (55.5 %) of their lives. The median duration of warfarin therapy was 753 (range 31-11433) days. The mean maintenance dose of warfarin was 6.17 ±2.75mg per day. The prevalence of use of garlic and ginger herbal medicine was 18.9% and 12.2%, respectively. Majority of patients (70 %) were consuming vegetables and fruits for 3-7 times in a week. Dietary and herbal medicine use did not significantly impact on warfarin doses and level of anticoagulation (P>0.05).
Conclusion: The prevalence of herbal medicine use among the patients on long term warfarin therapy is low. Dietary habits did not affect warfarin dose and response. Similar correlation studies with the inclusion of conventional drugs and comorbidities may improve warfarin dosing and determine anticoagulation response among patients.


A review on the role of the pharmacist in a patient–centered healthcare system: Re-aligning healthcare to people’s needs

Author: Orwa J.A.
Keywords: role, pharmacist, patient-centred healthcare system
Abstract:
Background: Patient-centered care model of healthcare acknowledges inter-profession team-based care and the need of care that is respectful of and responsive to individual patient preferences, needs and values. The contribution of the pharmacist in this paradigm can provide important benefits within primary healthcare systems through collaborative medication therapy management, providing education and drug information, promotion of patient self-management, improved effective communication and personalized medicine.
Aim of the Review: The main aim of this review was to assess the impact of the pharmacist in a collaborative patient centered healthcare system.
Method: The review involved keyword searches of electronic databases, including MEDLINE, PsycINFO and Google Scholar. Review search terms included ‘patient centered healthcare’, ‘role of pharmacist in patient centered healthcare’, ‘impact of pharmacists’ intervention on medication discrepancies’ and ‘collaborative healthcare’. Using the search outputs, the impact of pharmacists in collaborative patient–centered healthcare system is described.
Results: Inclusion of pharmacists in collaborative healthcare programs have shown improved management of chronic diseases and reduced healthcare cost. A number of publications reported the importance of the pharmacist as valuable health care personnel in the collaborative healthcare model albeit others recognizing limitations and the need for the pharmacist to know more about the patient population and the unique healthcare provider needs of every team.
Conclusion: Contributions of pharmacists to the Health Care team is essential toward improving the quality of patient care, improving the coordination of medicines and pharmaceutical care, ensuring rational use of medicines and reducing medicines waste. The pharmacist being able to identify distinctiveness of every heath provider in a team and patient needs to facilitate improved participation may well be a stimulus for further research.


HERBAL MEDICINES REQUIRE REGULATION LIKE CONVENTIONAL MEDICINES

Author: Ndwigah S.
Keywords: Herbal Medicines, Regulation