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More Nigerians will succumb to kidney failure, say experts

Want enactment of Organ Transplant Act,renal registry • ‘NHIS should cover treatment’

UNLESS certain measures are taken and quickly too, many more Nigerians may succumb to kidney failure. A urologist at the Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute in Mumbai, India, Sanjay Pandey who made the dire prediction blamed lack of early diagnosis of diabetes and high blood pressure for the growing cases of kidney failure in Nigeria.

He warned also, that until all the tiers of government critically addressed the infrastructural and manpower deficit in the health sector, Nigerians would continue to seek medical treatment abroad in order to stay healthy.

Also, a team of medical experts led by the President-elect of the Nigerian Association of Nephrology (NAN) and Head of the Dialysis/Transplant Unit and Clinical Director of St. Nicholas Hospital, Lagos, Dr. Ebun Bamgboye, has warned that certain urgent steps need to be taken to prevent more Nigerians from going down with Chronic Kidney Disease (CKD) and End State Renal Disease (ESRD).

The reasons include: persons of black African heritage are four times more likely to develop CKD than people of other races; the prevalence of three major diseases associated with kidney failure –hypertension, glomerulonephritis and diabetes – is on the rise in the country; growing indiscriminate use of herbal concoctions, bleaching creams and soaps, alcohol, hard drugs and smoking; increasing number of persons living with Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and low socio- economic status of most Nigerians -that is low Gross Domestic Product (GDP) associated with high CKD burden, among others.

Most common is Glomerulonephritis, a type of kidney disease in which the part of human kidney that helps filter waste and fluids from the blood is damaged. The following may increase risk of this condition: blood or lymphatic system disorders; exposure to hydrocarbon solvents; history of cancer and infections such as strep infections, viruses, heart infections, or abscesses.

To address the situation, the medical experts recommended among other things that government should urgently look at how to improve the socio economic status of Nigerians; ensure good sanitation and literacy; enact a solid Organ Transplant Act; establish a National Renal Registry and Kidney Transplant Programme; extending the National Health Insurance Scheme (NHIS) to support patients with kidney failure; regular public enlightenment sessions; development of data bank for disease donor transplant; subsidy of some sorts for immunosuppressive drugs.

Other members of the team include: Eminent Urologist and Transplant Surgeon at Fortis Hospital, Bangalore, India, Dr. Mohan Keshavamurthy; Consultant Nephrologist and Medical Director Ibadan Hypertension Clinic, Emeritus Professor Oladipo Olujimi Akinkugbe; Professor of Medical Microbiology and Provost, College of Medicine, University of Lagos (CMUL), Prof. Folashade Tolulope Ogunsola; Professor of Forensic Pathology and Vice Chancellor, Lagos State University (LASU), Prof. John Oladapo Obafunwa; former Lagos State Commissioner for Health, Dr. Jide Idris; former Ogun State Commissioner for Health, Dr. Olaokun Soyinka; and Medical Director of St. Nicholas Hospital, Dr. Dapo Majekodunmi.

Meanwhile, in an interview with The Guardian in Port Harcourt, Pandey identified the two common problems that bring about kidney failure among Nigerians as diabetes and hypertension.

According to him, these are epidemiological diseases of modern era mainly associated with a patient’s life style issues. “So diabetes and hypertension are the commonest hammers or disaster for the kidney in the long term. Anybody who is having diabetes or hypertension for 10 years or more with key and satisfactory control, will still suffer microscopic injury of the kidney that will be happening regularly,” he said.

According to him, kidney treatment is not a treatment of choice in Nigeria due to lack of infrastructure as a result of which patients are left with the only option of dialysis which is a temporary treatment that does not result in a permanent cure .

Pandey advocated a boost in the medical infrastructure of the country and the improvement in the capacity of the doctors so that patients could easily get renal replacement therapy, which is beyond dialysis that merely happens to be a stopgap.

The urologist who is also an expert in robotic surgery, kidney cancer treatment and transplant recommended that persons suffering from kidney problem, prostrate, urinary leakages and blockage should never postpone their urinary treatment to avoid compromising their health further.

He urged Nigerian doctors to begin to network with their colleagues around the world to help Nigeria prevent some diseases like hypertension and diabetes , both lifestyle diseases that give the patients long-term disasters that can never be reversed.

For him, because India has been able to invest heavily in the area of medical infrastructure and has some of the best medical training in the world, it has become a destination for medical tourists drawn mainly from countries like Nigeria, Europe and the Americas.

According to him, except Nigeria invests heavily in medical infrastructure, patients from the country will continue to seek better treatment outside for succour from diseases they have been suffering for so long. “I use robots to carry out surgery which may not be happening in Nigeria and many parts of the world. Nigerian patients who can afford the relatively cheap medial expense in India will continue to go there because they want to live healthy lives and not die everyday of what some local doctors will I say ‘I cannot treat you.’ That is not the end of the world,” he maintained.

On his part, Bamgboye said: “We need to start looking at our socio- economic status. We need to ensure good sanitation and literacy. There is an urgent need to enact a solid Organ Transplant Act. There is the need for us to have a renal registry, which does not exist in Nigeria at present. I know government is looking into it but we have to make sure that it should be able to provide for the less-privileged members of the society. There is absolutely no reason why the National Health Insurance Scheme (NHIS) should not be extended to support patients with kidney failure.

We need to cooperate more. We need to have regular public enlightenment sessions. We need to develop data bank because we should be looking at disease donor transplant in the near future. “More importantly, there is the need for subsidy of some sorts for some of the drugs that are used, which are quite expensive. In Sudan once you have a transplant the government provides you with the drugs for free plus other support. There is no reason why we should not be able to do that in Nigeria,” he said.

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NAFDAC probes Galant bitters

Expert urges caution on use of packaged products

THE National Agency for Food Drug Administration and Control (NAFDAC) has alerted the general public to the proliferation of methanol-contaminated alcoholic herbal bitters in the Nigerian market therefore, the agency warns Nigerians to be careful on consumption of such products.

According to NAFDAC, “Methanol poisoning causes neurological problems, including visual disturbances, blurred vision, blindness, nerve damage and insomnia. Ingestion of high levels of methanol often causes death.”

Director-General of NAFDAC, Dr. Paul Orhii, told The Guardian, in a telephone chat that the agency, after extensive laboratory investigation, has identified ‘killer’ bitters in the Nigeria market and has sent public alert even as it has placed the products on hold.

The Guardian, last month, took a sample of alleged killer bitters, Galant bitters, to NAFDAC and lodged a formal complaint after some concerned Nigerians came to Rutam House alleging that their relatives died after taking the product.

Orhii explained: “We did laboratory test and found that the bitters drink contains high levels of methanol. We are mopping up the drink from the market and we want Nigerians to stay away from the bitters. The bitters were registered as imported product but it looks like somebody is adulterating and faking it somewhere here. We have sent out a public alert.”

The public alert notes: “NAFDAC hereby alerts the general public on the circulation of a possible fake and adulterated drink, Galant bitters, found to be contaminated with high levels of methanol.

“The Galant bitters registered by the agency is manufactured by Rita Food and Drink Limited, 30 Street, 4 Singapore Industrial Park, Thijan An District, Bing Doing Province, Vietnam.

“Methanol poisoning causes neurological problems, including visual disturbances, blurred vision, blindness, nerve damage and insomnia. Ingestion of high levels of methanol often causes death.

“NAFDAC has placed all Galant bitters on hold nationwide and currently conducting an investigation to determine the source of the contamination. Any useful information should be forwarded to the nearest NAFDAC office.

“The general public is hereby advised to desist from the consumption of Galant bitters pending the outcome of the investigation.”

According to Wikipedia, a bitters is traditionally an alcoholic preparation flavoured with botanical matter such that the end result is characterised by a bitter, sour, or bittersweet flavour. Numerous longstanding brands of bitters were originally developed as patent medicines, but are now sold as digestives and cocktail flavourings.

The botanical ingredients used in preparing bitters historically consist of aromatic herbs, bark, roots, and or fruit for their flavour and medicinal properties. Some of the more common ingredients are cascarilla, cassia, gentian, orange peel, and cinchona bark.

Most bitters contain water and alcohol, the latter of which functions as a solvent for botanical extracts as well as a preservative. The alcoholic strength of bitters varies widely across different brands and styles.

Indeed, plant extracts, now popularised as ‘herbal medicines,’ have been shown to prevent, treat, manage and cure several diseases from cough to cancer.

This proven efficacy has resulted in great patronage for any product that comes with the name ‘herbal’. Most companies are capitalising on this window to rip in more profits. From toothpaste to creams, health drinks to bread, the story is same. The latest craze is herbal bitters.

The manufacturers in an aggressive marketing drive claim they are recipes for indigestion, weight loss, youthfulness, strength among others.

According to a Professor of Phytomedicine at the University of Benin, Edo State, MacDonald Idu, “If you are suffering wound infections and rashes, foods containing bitter principles are the best antidotes, while bitters are also indicated for treating skin disorders, fever, jaundice and loss of appetite.”

Idu said that several bitters components were bactericidal, germicidal and anti viral in their nature, as well anti inflammatory in effect. “Bitter foods are known to elevate the air mass element in your body and reduce the excess amount of ills in other elements. Oriental herbal texts indicate that herbal bitters are very light and cold in their nature and the typical taste is due to the presence of various components like caffeine, alkaloids and a bitter principle called berberine. The extreme dryness of bitters assists your body to get rid of excessive mucus, watery storage particles and help remove pus from the wounds,” he said.

Idu, however, urged caution on the use of packaged herbal bitters. He recommended home-made bitters, a combination of scent leaf, bitter leaf, Telfairia occidentalis leaf (ugu), Gongronema latifolium leaf (utazi in Igbo)) and lime peels blended into a juice and taken first thing in the morning and last thing at night.

“Avoid herbal bitters if you are pregnant or nursing and do not treat children with bitters. You should also avoid or stop taking bitters if you have been diagnosed with the following conditions: kidney disease, Irritable Bowel Syndrome (IBS), Crohn’s disease and chronic gall bladder issues,” Idu said.

He said that bitters could also cause adverse reactions if taken in combination with other drugs like sedatives, antidepressants and tetracycline antibiotics.

“Read the instructions and recommendations on the bottle carefully before you begin treatment and do not exceed the recommended dosage for bitters or any other herbal medication. You should always consult a physician before beginning treatment,” he said.

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Zobo kills prostate, skin cancer cells

Can drinking the popular zobo tea be the next novel cure for prostate and skin cancers? Scientists, led by Chun-Tang Chui from the Institute of Biochemistry and Biotechnology in Taiwan, in a recent study published in OPEN ACCESS found that Hibiscus sabdariffa leaf extract inhibits human prostate cancer cell invasion.

Another study by the same team of researchers, published in the Journal of Food Science, found that the polyphenols present in hibiscus leaves may inhibit growth of and destroy melanoma cancer cells without damaging healthy human skin cells, scientists from Taiwan have found.

Hibiscus leaf is a rich source of polyphenols, which are thought to have hypolipidemic (lipid-lowering) and antioxidant effects.

The scientists claimed that this was the first study focusing on the polyphenols and their anti-melanoma mechanisms.

Commonly called roselle or zobo, Hibiscus sabdariffa belongs to the plant family Malvaceae. In folk herbal medicine, it is used to treat hypertension, pyrexia, and liver disorders, and is used for its immune-modulating effect in Asia.

An aqueous extract of dried flowers of H. sabdariffa L. has been used as an effective treatment against leukemia and gastric carcinoma, due to its high content in polyphenols. Previous studies have demonstrated that leaves of H. sabdariffa possess hypoglycemic, hypolipidemic, antioxidant, and estrogenic-like effects.

Recent studies suggested that H. sabdariffa is an interesting nutri-medicinal plant with multiple pharmacological activities, and H. sabdariffa leaf extract (HLE) has the potential to be developed as a chemotherapeutic agent. In anticancer studies, HLE-induced apoptosis through mediated intrinsic and extrinsic apoptotic pathways in human prostate cancer cells.

Chui and his team of researchers wrote: “Hibiscus sabdariffa leaf has been previously shown to possess hypoglycemic, hypolipidemic, and antioxidant effects, and induce tumor cell apoptosis. However, the molecular mechanisms involved in the anticancer activity of H. sabdariffa leaf extract (HLE) are poorly understood. The object of the study was to examine the anti-invasive potential of HLE. First, HLE was demonstrated to be rich in polyphenols.

“The results of wound-healing assay and in vitro transwell assay revealed that HLE dose-dependently inhibited the migration and invasion of human prostate cancer LNCaP (lymph node carcinoma of the prostate) cells under non-cytotoxic concentrations. Our results further showed that HLE exerted an inhibitory effect on the activity and expressions of matrix metalloproteinase-9 (MMP-9). The HLE-inhibited MMP-9 expression appeared to be a consequence of nuclear factor-kappaB (NF-?B) inactivation because its DNA-binding activity was suppressed by HLE. Molecular data showed all these influences of HLE might be mediated via inhibition of protein kinase B (PKB, also known as Akt)/NF-?B/MMP-9 cascade pathway, as demonstrated by the transfection of Akt1 overexpression vector.

“Finally, the inhibitory effect of HLE was proven by its inhibition on the growth of LNCaP cells and the expressions of metastasis-related molecular proteins in vivo. These findings suggested that the inhibition of MMP-9 expression by HLE may act through the suppression of the Akt/NF-?B signaling pathway, which in turn led to the reduced invasiveness of the cancer cells.”

Prostate cancer (CaP) is a very common male-specific malignancy, and the second most common cancer among men in the world. Thus, developing novel treatment options for CaP has become an important medical need. Since CaP is so highly sensitive to androgens, the intrinsic androgenic, glucocorticoid, and estrogenic-like activities of nutri-medicinal plants or herbs have potential for use in the treatment of CaP. In recent years, many anticancer agents appeared to target signaling intermediates in metastatic pathways. Current reports revealed that the inhibition of metastasis in CaP cells by tea polyphenols and curcumin was related to the signal transduction regulation.

Tumor metastasis occurs by a series of steps, including vessel formation, cell attachment, invasion, and cell proliferation, and is regulated by extremely complicated mechanisms. The degradation of basement membranes and the stromal extracellular matrix (ECM) are crucial steps for tumor invasion and metastasis. The matrix metalloproteinases (MMPs) family of human zinc-dependent endopeptidases is responsible for the degradation of the ECM. Among them, gelatinases (MMP-2 and MMP-9) efficiently degrade native collagen types IV and V, fibronectin, and elastin. The expression of the MMPs gene is primarily regulated at the transcriptional (through activator protein-1 (AP-1) or nuclear factor-kappaB (NF-?B) via mitogen-activated protein kinase (MAPK) or phosphatidylinositol 3-kinase (PI3K)/protein kinase B (PKB, also known as Akt) pathways) and posttranscriptional levels, and at the protein level via their activators or inhibitors, and their cell surface localization. MMPs and their regulatory pathways have been considered promising targets for anticancer drugs and chemotherapeutic agents.

Previous studies on functions of HLE have been mainly focused on its antioxidant and apoptosis-inducing activities, whereas the effect of HLE on metastasis and invasion of tumor cells has not been clearly clarified. Since cancer metastasis and invasion are highly related to the degradation of the ECM, intercellular adhesion, and cellular motility, this study explored the effects of HLE on MMPs expression, as well as the activities of Akt, MAPK, and transcriptional factors (AP-1 and NF-?B) on LNCaP (lymph node carcinoma of the prostate) cells, an androgen-responsive human CaP cell line, to explore the underlying mechanism for the action of HLE in cancer cell invasion in vitro. Additionally, the effect of HLE was shown by its inhibition of the growth of LNCaP cells in xenograft tumor studies. The detailed signaling pathway involved in HLE-inhibited CaP metastasis in vivo is also included.

Melanoma is the least common but most fatal form of skin cancer and is resistant to most forms of treatment including chemotherapy. Rates of melanoma have doubled in the past 20 years.

“Melanoma has become an increasingly important public health issue and novel treatment options have become an important medical need,” say the researchers.

“Regarding the effect of Hibiscus leaf in vitro and in vivo studies, the effect of the polyphenolic extract in cancer is rarely reported. Thus, it is important to evaluate the potential of Hibiscus leaf polyphenols (HLP) as a functional food for anticancer.”

Chui and his team of researchers said that hibiscus leaf was consumed as a vegetable in Africa but ignored elsewhere around the world. They suggested that based on these results, published in the Journal of Food Science, HLP might be a useful anti-melanoma agent.

Using human melanoma cells, mice melanoma cells and normal human skin fibroblasts as a control, the researchers treated them with various concentrations of HLP for 24 hours in order to determine the effect on the cancer cells as well the mechanisms behind this.

They found that HLP, and, in particular, the polyphenol epicatechin gallate (ECG), had an inhibitory effect on the growth of both the human and mouse cancer cells – inhibiting 50 per cent of cancer cell viability when treated for 24 hours at a 250 microgram (µg) per millilitre (mL) dose. Significantly, the normal human skin cells did not change.

“These findings indicate that the HLP is likely to be a useful chemotherapeutic agent to eliminate cancer cells without significant harmful effects on normal cells,” said the researchers.

They also found that HPL and ECG led to “dose dependent and significant” levels of cancer cell death in the human cancer cells, in two ways – apoptosis, or programmed cell death and autophagy, or the catabolic breakdown of cells.

The scientists have called for more research into the extraction methods to yield a maximum amount of HLP.

They used methanol, hexane and ethyl acetate to extract the polyphenols from dried hibiscus sabdariffa leaves at 50°C.

Other health benefits of Zobo Due to their perceived potential health benefits, commercial preparations of H. sabdariffa extracts (HSE) are currently marketed as supplements and these extracts have gained an important position in some local soft drink markets. In folk herbal medicine, it is used to treat hypertension, pyrexia, and liver disorders and it is also taken for its immunemodulating effects. The leaf of the plant is usually discarded around the world, except in Africa, where it is consumed as a vegetable. An ethanol extract of the dried leaves has been shown to reduce aflatoxin formation, and to have an in vitro inhibitory effect against some fungi that include Aspergillus fumigatus, Rhizopus nigricans, and Trichophyton mentagrophytes.

Studies with laboratory animals have demonstrated that an aqueous extract of H. sabdariffa leaves (HLE) caused a significant decrease in epididymal sperm counts, histological distortion of tubules, disruption of normal testicular epithelial organization, and disintegration of sperm cells. The authors postulated that these effects were related to interference of spermatogenesis by the extract, which may have been caused by an estrogenic-like action of the extract.

The Heart Insurance Tea, HIT A professor of pharmacognosy and Chairman Bioresources Development Group (BDG) and Intercedd Health Products (IHP), Maurice Iwu, told The Guardian that zobo tea is an insurance cover for the heart. Iwu said: “Bissap Tea is a herbal Tea drink of an infusion made from the dried calyces of Hibiscus sabdariffa ?ower which can be consumed both hot or cold by people around the world.

“The drink has been used as a home remedy in many Asian, African and the Caribbean countries for years. The Tea contains vitamin C, minerals and about 15 to 30 per cent organic acids.

“Bissap Tea promotes general good health through antioxidant which ?ghts cellular damage and support the immune system. The natural chemicals in the drink also promote good cardiac function and prevent heart diseases, including hypertension.

“They also promote digestive and bowel regularity, water control, and weight loss and management.”

Zobo reduces diabetes-induced kidney disease risk Results of a recent study suggest that aqueous extract of Hibiscus sabdariffa (HSE) has no harmful effect on the liver but when consumed in high doses could be harmful to the kidney. “Further research aimed at identifying the chemical composition and potential toxic agent(s) in HS is recommended,” the researchers wrote.

The study titled: “Toxicilogical effects of aqueous extract of Hibiscus Sabdariffa on the liver and kidney,” was published in Journal of College of Medicine.

The aim of the study is to show the effect of graded doses of aqueous extract of HS on major excretory organs (liver and kidney) of albino Wistar rats. This may be helpful in determining the safety or otherwise of its consumption at different concentrations.

The researchers wrote: “There were no significant changes in the histology of the liver throughout the period of HS administration in all the groups.

However, there were significant histological changes in the kidney, which were more pronounced at higher doses (80 and 160mg/kg). There was shrinkage of glomerular tuft, increase in urinary pole, an increase in the size of the tubular lumen and tubular damage.

These effects were more marked as the duration of administration of the extract progressed with the greatest effect observed at 12th week.”

Zobo tea bursts kidney stones Another study found that Hibiscus sabdariffa might help treat kidney stones via uricosuric activity. The study titled: “Uricosuric effect of Roselle (Hibiscus sabdariffa) in normal and renal-stone former subjects,” was published in Journal of Ethnopharmacology.

Uricosuric agents are used to lowering the uric acid level in the blood and to prevent the formation of uric acid crystals in the joints and kidneys. These drugs are often used to treat gout, a disease in which uric acid crystals deposit in joints and cause pain. By decreasing plasma uric acid levels, these drugs decrease the deposition of crystals in joints, eventually decreasing inflammation and thereby reducing the pain of gout.

Researchers from Thailand conducted a study with nine subjects with no history of kidney stones and nine with a history of kidney stones. A cup of tea made from 1.5 grams of dry roselle was provided to subjects twice daily (morning and evening) for 15 days.

After taking the tea, both groups showed increases in oxalate and citrate. In the non-kidney stone group, increases in uric acid excretion and clearance were observed. In the patients with kidney stones, both uric acid excretion and clearance were significantly increased.

The study authors concluded that roselle has a uricosuric effect and they suggested that the chemical constituents exerting this effect should be identified.

Also, researchers have shown that aqueous (water) extracts of HSE is capable of reducing lipid peroxidation, increasing catalase and glutathione activities significantly in diabetic kidney, and decreasing the plasma levels of triglyceride, low-density lipoprotein (LDL) and increasing high-density lipoprotein (HDL) value.

The researchers concluded: “In conclusion, our results show that HSE possesses the potential effects to ameliorate diabetic nephropathy via improving the oxidative status and regulating Akt/Bad/14-3-3? signaling.” Hibiscus tea lowers blood pressure, ‘bad’ cholesterol

Nigerian researchers have confirmed that drinking tea made with flower extracts of Hibiscus rosa-Sinensis (popularly called Hibiscus flower)- a close relative of Hibiscus sabdariffa (zobo)- lowered blood pressure in hypertensive patients.

Researchers have also demonstrated how the flower extracts of hibiscus could be used to reduce weight, prevent obesity and coronary heart diseases like atherosclerosis by lowering the blood levels of low density lipo-protein (LDL) ‘bad’ cholesterol.

Atherosclerosis, which involves deposits of fatty substances, cellular waste products, calcium and fibrin (is a fibrous protein involved in the clotting of blood); and is the leading cause of illness and death in most countries.

However, a local study has found that although hibiscus leaf extracts reduced blood pressure, the integrity of the kidney may be compromised if it is used in high doses for the treatment of hypertension.

Botanically called Hibiscus rosa-Sinensis, hibiscus belongs to the plant family Malvaceae. Hibiscus has many species and is a primary ingredient in many herbal teas.

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