Browsing by Author "Tusiimire, Jonans"

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    Antimicrobial resistance and rational prescription practices: knowledge, perceptions and confidence of health profession interns in Uganda
    (JAC-Antimicrobial Resistance, 2023-10-03) Nabidda, Shamim; Ssennyonjo, Rogers; Atwaru, Joseph; Kanyike, Andrew Marvin; Baryayaka, Shiellah; Tusiimire, Jonans
    Antimicrobial resistance (AMR) is significantly driven by misuse and overuse of antibiotics. Graduate health profession interns often prescribe antimicrobials under minimum supervision. This study explored the knowledge, perceptions and confidence of health profession interns in Uganda regarding AMR and rational prescription practices. This was a cross-sectional survey employing quantitative techniques carried out between October and November 2022 at six tertiary hospitals in Uganda. Health profession interns including doctors, nurses, midwives and pharmacists were recruited as study participants. Data were collected using online Kobo toolbox software. Data analysis was performed using STATA (StataCorp) version 16. Bivariate analysis and multivariable logistic regression were performed. P < 0.05 was considered statistically significant. We recruited 281 participants with a mean age of 27 ± 3.8 years, of which few (n = 53; 19%) had good knowledge about AMR and rational prescription. The use of professional organization guidelines as a source of information was significantly associated with good knowledge (adjusted OR = 1.9; 95% CI: 1.0–3.5; P = 0.046). Nurses had the least knowledge compared with doctors and pharmacists. Continuous medical education (99%) and availability of clinical guidelines (98%) were identified as the most helpful intervention to improve knowledge. Most participants were confident about accurately diagnosing infections and sepsis and selecting appropriate antimicrobials. Continuous medical education and availability of clinical and professional organization guidelines should be leveraged to improve the knowledge of AMR and rational prescription among health profession interns. Their high confidence in rational prescription practices should be pivotal to the fight against AMR.
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    Association between Pre-Hospital Antibiotic Exposure and Level of Bacterial Resistance (PHAE Study): A Matched Case Control Study at the Medical and Paediatric wards of Mbarara Regional Referral Hospital-South Western Uganda
    (2022) Buzaare, Peter; Tusiimire, Jonans; Namugambe, Juliet; Muzoora, Conrad
    This study aimed to determine the association between pre-hospital antibiotic exposure and level of bacterial resistance among adult and paediatric patients. Methods: In the study, 79 antibiotic pre-exposed patients (cases) were compared with 79 non-pre-exposed patients (controls) hospitalized at medical and paediatric wards at Mbarara Regional Referral Hospital (MRRH) for various bacterial diagnoses. Data collected included participant demographics, previous medications and bacterial culture and sensitivity results. Data was analysed to determine the odds ratios for the occurrence of bacterial resistance between the cases and controls. Results: Results from the study showed that there was no statistically significant difference in terms of antibiotic resistance between pre-exposed and non-pre-exposed participants (OR: 0.5, 95%CI: 0.045 - 5.51, P = 0.571), whereby “no resistance” was defined as zero antibiotics resisted and “resistance” defined as 1 or more antibiotics resisted. However, when we adjusted the definition of “no resistance” and “resistance” to mean “one or less antibiotics resisted” and “two or more antibiotics resisted” respectively, there was a statistically significant more resistance in pre-exposed participants (cases) compared to non-pre-exposed participants (OR: 7, 95% CI: 1.59 - 30.8; p = 0.010). When the definition of resistance was further adjusted upwards to “three or more antibiotics resisted”, the resistance in cases was still significantly higher compared to controls (OR: 5.4, 95%CI: 2.42 - 12.2, p = 0.000) and when the definition of resistance was further adjusted to “four or more antibiotics resisted”, the OR increased even further (OR: 7.14, 95%CI: 3.24 - 15.8, p = 0.000). Ceftriaxone (17.6%) and amoxicillin (14.1%) were the commonest antibiotics to which participants were pre-exposed.
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    The Chemical and Biological Properties of Propolis
    (Springer, Cham, 2017) Siheri, Weam; Alenezi, Sameah; Tusiimire, Jonans; Watson, David G.
    Bees produce several different products which have health benefits. There is no doubt that honey has a highly significant status in medical treatments, while other apian materials, such as wax, royal jelly and propolis, have fewer medical applications, despite the fact that propolis has been used by people since ancient times (Burdock 1998; Ghisalberti 1979). The term propolis comes from two Greek words, (which means for or in defence of) and polis (which means the city); thus propolis means in defence of the city or beehive (Ghisalberti 1979). Propolis is a sticky resinous substance, which is gathered from buds and the bark of trees. It is also known as “bee glue” as bees use it to cover surfaces, seal holes and close gaps in their hives, thus providing a sterile environment that protects them from microbes
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    Effects of the Oral Administration of Aqueous and Methanolic Leaf Extracts of Chenopodium ambrosioides L. (Amaranthaceae) on Blood Glucose Levels in Wistar Rats
    (Journal of Experimental Pharmacology, 2022) Kasali, Félicien M.; Kadima, Justin N.; Tusiimire, Jonans; Ajayi, Clement O.; Agaba, Amon G.
    Background: Diabetes mellitus is a metabolic disorder that poses a major global health threat. The current diabetes mellitus uses insulin and oral hypoglycemic agents, which have limitations, including adverse effects and secondary failures. Herbal medicine is being evaluated for its role in the pharmacotherapy of diabetes. This study was aimed to assess the anti-diabetic potential and shortterm toxicity level of Chenopodium ambrosioides collected from Bukavu in Democratic Republic of Congo. Methods: Leaves of C. ambrosioides were extracted by infusion and maceration with distilled water and 95% methanol, respectively. Hypoglycemic and antihyperglycemic potentials of the aqueous and methanolic were investigated in normoglycemic and intraperitoneal glucose-loaded rats at 100, 200, and 400 mg/kg body weight. An oral acute toxicity test was carried out on healthy female Wistar rats. Results: Acute toxicity test showed the mean lethal dose (LD50) for both aqueous and methanol extracts of C. ambrosioides to be more than 2000 mg/kg. The group treated with glibenclamide (5 mg/kg b.w) and aqueous extract of the plant (200 mg/kg b.w) showed a significant reduction (p< 0.0001 and p< 0.05) of fasting blood glucose by 46.91% and 16.72%, respectively, compared to control and all other treatment groups. In acute conditions, a single oral administration of the aqueous and methanolic extracts lowered fasting blood glucose in rats. Any manifestation and signs of toxicity and mortality have been recorded for 14 days of observation. Conclusion: Leaf aqueous and methanolic extracts of C. ambrosioides appeared safe at 2000 mg/kg. The plant demonstrated some anti-diabetic potential in rats, explaining its use as an anti-diabetic remedy locally.
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    Ethnomedical uses, chemical constituents, and evidence-based pharmacological properties of Chenopodium ambrosioides L.: extensive overview
    (Future Journal of Pharmaceutical Sciences, 2021) Kasali, Félicien M.; Tusiimire, Jonans; Kadima, Justin N.; Agaba, Amon G.
    The Chenopodium genus is a plant family widely spread worldwide that includes various plant species reputed to possess several medicinal virtues in folk medicines. Chenopodium ambrosioides L. is among the most used plants in traditional medicines worldwide. This review aimed to highlight ethnomedicinal uses, phytochemical status, and pharmacological properties of C. ambrosioides L. Main body of the abstract: The analysis of relevant data highlights various ethnomedicinal uses against human and veterinary diseases in forty countries. Most indications consisted of gastrointestinal tract dysfunctioning troubles and worms parasitemia. Around 330 chemical compounds have been identified in different plant parts, especially in its essential oil fractions (59.84%). However, only a few compounds—mainly monoterpenes and glycosides—have been isolated and characterized. Experimental pharmacological studies validated a large scale of significant health benefits. It appeared that many monoterpenes are antioxidant, insecticidal, trypanocidal, analgesic, antifungal, antiinflammatory, anti-arthritic, acaricidal, amoebicidal, anthelmintic, anticancer, antibacterial, antidiabetic, antidiarrheal, antifertility, antifungal, anti-leishmanial, antimalarial, antipyretic, antisickling, antischistosomal, antiulcer, anxiolytic, immunomodulatory, molluscicidal, and vasorelaxant agents. Short conclusion: Thus, the Chenopodium ambrosioides species necessitates further chemical studies to isolate and new bioactive secondary metabolites and pharmacological investigations to precise the mechanisms of action before clinical trials.
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    Ethnotherapeutic Uses and Phytochemical Composition of Physalis peruviana L.: An Overview
    (The Scientific World Journal, 2021) Kasali, F´elicien M.; Tusiimire, Jonans; Kadima, Justin N.; Tolo, Casim U.; Weisheit, Anke; Agaba, Amon G.
    Background. Plant-derived medicines are widespread and continue to increase in traditional and modern medicine, especially in developing countries. Physalis peruviana L. is among the most used plants in conventional medication worldwide. +is review aimed to highlight the ethnotherapeutic uses and phytochemical status of identified compounds in P. peruviana. Methods. Data were collected from Google Scholar, PubMed/Medline, SciFinder, Science Direct, Scopus, the Wiley Online Library, Web of Science, and any other helpful search engine using Physalis peruviana as the primary keyword. Results. Some countries, worldwide, use P. peruviana in their traditional medicine system to manage diverse ailments, mainly diseases and gastrointestinal tract disorders (25.33%). Leaf was the mostly used part (49.28%), prepared by decoction (31.58%) and overall administrated orally (53.57%) as the main route of admission. Around 502 phytoconstituents were identified in different plant parts, especially fruit (38.19%) ethanol/ethyl acetate extract. In most cases (36.17%), the solvent of the extract was not specified. Several phytochemical classes were found in the plant, especially terpenes (26.09%) and phenolic compounds (14.94%). Esters were also abundant (11.55%). In the terpenes category, carotenoids were the most abundant (11.15% followed by monoterpenes (8.76%) and diterpenes (3.18%). However, flavonoids (5.17%) followed by cinnamic acid derivatives (3.99%), monophenolic compounds (1.79%), and phenolic acids (1.33M) are the most reported phenolic compounds. Hexadecanoic acid (palmitic acid) was the most cited (five times). Conclusion. P. peruviana plays an essential role in managing diseases in some countries and is rich in chemical compounds, which need to be isolated and investigated pharmacologically before clinical trials
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    Hypoglycemic, Antihyperglycemic, and Toxic Effects of Physalis peruviana L. Aqueous and Methanolic Leaf Extracts in Wistar Rats
    (Journal of Experimental Pharmacology, 2022) Kasali, Félicien M.; Kadima, Justin N.; Tusiimire, Jonans; Agaba, Amon G.
    Physalis peruviana L. (Solanaceae) is a plant widely used in traditional medicine systems to manage various diseases, including diabetes mellitus, which remains a global health problem in developing and developed countries. This study aimed to scientifically evaluate its antidiabetic bioactivity and short-term toxicity in rats. Methods: We prepared various doses (100, 200, 400 mg/kg) of aqueous and methanolic leaf extracts for the antidiabetic study, and a dose of 2000 mg/Kg was prepared for the acute toxicity test. The first group that evaluated the hypoglycemic effect consisted of forty normoglycemic Wistar rats aged 7–8 months old with a weighted average of 265.8 ± 24.6 g. The second group consisted of intraperitoneal glucose-loaded male animals to evaluate the antihyperglycemic effect. The third group contained two groups of normoglycemic female rats (n = 3), aged 3 and 4 months old (weight average: 187.45 ± 14.82 g), treated for 14 days with aqueous and methanolic extracts (2 g/kg b.w) to assess mortality and toxic effects. Blood samples were taken at 30, 60, 90, and 120 min posttreatment in hypoglycemic and antihyperglycemic evaluations. Glibenclamide (5 mg/kg) was used as a reference drug. The control animals in each group did not receive the extracts. Results: In hypoglycemic rats, 100 mg/kg of aqueous and methanolic extracts significantly lowered the fasting blood glucose level by 13.92% (p < 0.0001) and 21.95% (p < 0.01), respectively, compared to the control group. In glucose tolerance test group, methanolic extracts significantly reduced hyperglycemia by 54.55% (p < 0.0001), 46.50% (p < 0.0001), 39.78% (p < 0.0001) at 400, 200 and 100 mg/kg b.w, respectively, compared to control; aqueous extract 400 mg/kg reduced hyperglycemia by 39.44% (p < 0.05). At the 2000 mg/kg dose, leaf aqueous and methanolic extracts did not show any signs of intoxication and mortality. Conclusion: Crude aqueous and methanolic leaf extracts of P. peruviana ambrosioides appeared safe at 2000 mg/kg and have bioactivity in controlling the blood glucose levels, supporting their use in treating diabetes.
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    Impact of Global Health Scholarship Programs in the Faculty of Medicine at Mbarara University of Science and Technology
    (International Medical Education, 2024-04-24) Tusiimire, Jonans; Nakiwala, Miriam Josephine; Turigye, Brian; Kembabazi, Annet; Asiimwe, Stephen; Ngonzi, Joseph
    In recognition of the critical role of residency programs in narrowing healthcare inequalities, Global Health scholarships were introduced at Mbarara University of Science and Technology (MUST) in 2011. Since then, at least 154 postgraduate students in priority programs have benefited. We conducted an online cross-sectional survey to examine how the scholarships and beneficiaries have impacted MUST and the community. Fifty (50) beneficiaries, representing 32.5%, responded, of whom 36 (72%) were alumni. Most respondents were males (n = 30; 60%) pursing Master of Medicine (n = 29; 58%) or Master of Nursing Science (n = 20; 40%) programs. The scholarship schemes included First Mile (n = 29; 58%), Kayanja (n = 12; 24%), Paiko (n = 5; 10%) and Seed (n = 4; 8%). The majority of the scholarships supported both tuition and research fees (n = 41; 82%), the rest being partial. Career advancement was undertaken by eight (16%) of the scholars in the form of fellowships (n = 3; 6%), other masters (n = 3; 6%) and PhDs (n = 3; 6%), with some students having attained a combination of these. All scholars belonged to at least one health professional association. Over 88% (n = 32) of the alumni and 28% (n = 4) of the students were employed. The majority of those employed were in the public sector (n = 24; 66.7%), mainly the health sector (n = 18; 50%), academia (n = 14; 38.9) or both (n = 4; 11.1%). There was a high impact on health care provision, undergraduate training and research carried out by the scholars both during training and post-graduation. High levels of career satisfaction, scholarship impact and academic program relevance were reported. The findings provide insights on how low-fund specialty scholarships can have a far-reaching impact on local training, health care and research in low- and middle-income countries.
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    In vivo aphrodisiac efficacy of aqueous and hydroalcoholic extracts of the leaf and root bark of Citropsis articulata in male Wistar rats
    (Research Article, 2024) Amutuhaire, Treasure Angie; Tusiimire, Jonans; Amito, Vivian Sharon; Ajayi, Clement Olusoji; Angupale, Jimmy Ronald; Abdelgadir, Alamin Abdelgadir; Anywar, Godwin; Ogwang, Patrick Engeu; Amaza, Anyase Ronald
    Background The African cherry orange tree Citropsis articulata Swingle & Kellerman (family Rutaceae) is traditionally used to manage erectile dysfunction. This study aimed to determine the aphrodisiac activity of C. articulata leaves and root bark in male Wistar rats. Methods Aqueous and hydroalcoholic extracts of leaves and root bark were prepared via decoction and soxhlation, respectively. Extracts were administered to the animals at three dose levels, i.e., 100, 500 and 1000 mg/kg. Six male animals (aged 8–12 weeks, weighing 140–200 g) were used in each of the groups. Three animals per group (group B), unlike those immediately sacrificed at the end of 28 days (group A), were left for an extra 14 days without dosing to look out for delayed or sustained efficacy signs. Male sexual behavior, including attraction towards the female, penile erection, mount frequency, and mount latency, was monitored on days 0, 3, 7, 14, 21, 28, 35 and 42. At the end of both 28 days and the extra 14 days, the animals were humanely sacrificed via anesthesia with halothane, and their blood was collected for testosterone level analysis, while the sexual organs harvested were assessed grossly and histologically. Results Citropsis articulata root bark and leaves increased the attraction towards the female, penile erection, and mount frequency while lowering the mount latency. The plant extracts also increased testosterone levels after 28 days of daily extract administration but greatly lowered the testosterone levels in the animals that were left for an extra 14 days without dosing. Even histologically, there was the first evidence of very active spermatogenesis, which disappeared when the administration of the extract ceased. The administration of C. articulata leaf decoction at a dose of 500 mg/kg significantly increased the testosterone level (14.50 ± 2.53 ng/ml) compared with that of the positive control (4.00 ± 2.70 ng/ml), with a p-value of 0.021 (confidence interval: -19.45 to -1.533). Conclusion This study revealed that both the root bark and leaf of Citropsis articulata have aphrodisiac efficacy in male Wistar rats in vitro.
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    Metabolomic Profiling of the Effects of Melittin on Cisplatin Resistant and Cisplatin Sensitive Ovarian Cancer Cells Using Mass Spectrometry and Biolog Microarray Technology
    (Metabolites, 2016) Alonezi, Sanad; Tusiimire, Jonans; Wallace, Jennifer; Dufton, Mark J.; Parkinson, John A.; Young, Louise C.; Clements, Carol J.; Park, Jin K.; Jeon, Jong W.; Ferro, Valerie A.; Watson, David G.
    In the present study, liquid chromatography-mass spectrometry (LC-MS) was employed to characterise the metabolic profiles of two human ovarian cancer cell lines A2780 (cisplatin-sensitive)and A2780CR (cisplatin-resistant) in response to their exposure to melittin, a cytotoxic peptide from bee venom. In addition, the metabolomics data were supported by application of Biolog microarray technology to examine the utilisation of carbon sources by the two cell lines. Data extraction with MZmine 2.14 and database searching were applied to provide metabolite lists. Principal component analysis (PCA) gave clear separation between the cisplatin-sensitive and resistant strains and their respective controls. The cisplatin-resistant cells were slightly more sensitive to melittin than the sensitive cells with IC50 values of 4.5 and 6.8 g/mL respectively, although the latter cell line exhibited the greatest metabolic perturbation upon treatment. The changes induced by melittin in the cisplatin-sensitive cells led mostly to reduced levels of amino acids in the proline/glutamine/arginine pathway, as well as to decreased levels of carnitines, polyamines, adenosine triphosphate (ATP) and nicotinamide adenine dinucleotide (NAD+). The effects on energy metabolism were supported by the data from the Biolog assays. The lipid compositions of the two cell lines were quite different with the A2780 cells having higher levels of several ether lipids than the A2780CR cells. Melittin also had some effect on the lipid composition of the cells. Overall, this study suggests that melittin might have some potential as an adjuvant therapy in cancer treatment.
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    A method for the analysis of sugars in biological systems using reductive amination in combination with hydrophilic interaction chromatography and high resolution mass spectrometry
    (Talanta, 2017) Bawazeer, Sami; Muhsen, Ali; Alhawiti, Ali A.; Khalaf, Abedawn; Gibson, Colin; Tusiimire, Jonans; Watson, David G.
    Separation of sugar isomers extracted from biological samples is challenging because of their natural occurrence as alpha and beta anomers and, in the case of hexoses, in their pyranose and furanose forms. A reductive amination method was developed for the tagging of sugars with the aim of it becoming part of a metabolomics work flow. The best separation of the common hexoses (glucose, fructose, mannose and galactose) was achieved when 2H5-aniline was used as the tagging reagent in combination with separation on a ZICHILIC column. The method was used to tag a range of sugars including pentoses and uronic acids. The method was simple to perform and was able to improve both the separation of sugars and their response to electrospray ionisation. The method was applied to the profiling of sugars in urine where a number of hexose and pentose isomers could be observed. It was also applied to the quantification of sugars in post-mortem brain samples from three control samples and three samples from individuals who had suffered from bipolar disorder.
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    Prevalence and Factors Associated with Non-Adherence to Antidiabetic Medication Among Patients at Mbarara Regional Referral Hospital, Mbarara, Uganda
    (Patient preference and adherence, 2022) Karekoona, Faisal; Tusiimire, Jonans; Yadesa, Tadele M.
    Non-adherence is a major concern in the treatment of diabetes mellitus and undermines the goals of treatment. The objective of this study was to determine the magnitude of non-adherence and its contributing factors among diabetes mellitus patients attending the diabetes mellitus clinic at Mbarara Regional Referral Hospital.Objective: To assess prevalence and factors contributing to non-adherence to antidiabetic medication among diabetes mellitus patients in the diabetic clinic at Mbarara Regional Referral Hospital. Methods: A descriptive cross-sectional study was adopted at the diabetes clinic, Mbarara Regional Referral Hospital, between July and October 2020. Study participants were systemically sampled, and data regarding their medication non-adherence was collected using a structured questionnaire, based on the Hill-Bone medication adherence scale. Data entry was done using Microsoft Excel Version 2010, and analysis was carried out using STATA version 13. The odds ratio was used to determine the strength of association between diabetic medication non-adherence and associated factors. The cutoff value for all statistical significance tests was set at p < 0.05 with a confidence interval of 95%. Results: A total of 257 participants were recruited with a 100% response rate. More than one-third (98, 38.1%) of the participants were non-adherent to their antidiabetic medication. Age above 60 years (AOR = 6.26, 95% CI = 1.009–39.241, P = 0.049) and duration of diabetes mellitus above 5 years (AOR = 1.87, 95% CI = 1.034–3.392, P = 0.038) were independently associated with nonadherence to antidiabetic medication. Conclusion: The prevalence of non-adherence to antidiabetic medication was higher than that revealed in previous studies in Uganda. Patients with age above 60 years were six times more likely to be non-adherent to their anti-diabetic medications. Patient education is important to address the challenges of medication non-adherence.
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    Registration and local production of essential medicines in Uganda
    (Journal of pharmaceutical policy and practice, 2020) Brhlikova, Petra; Maigetter, Karen; Murison, Jude; Agaba, Amon G.; Tusiimire, Jonans; Pollock, Allyson M.
    Universal access to high quality essential medicines is critical to sustainable development (SDG 3.8). However low- and middle-income countries struggle to ensure access to all medicines on their national essential medicines lists (EML). Market registration is the first step in determining both access and availability yet the extent to which essential medicines are registered for use at country level is not known. Companies apply for a marketing authorisation, however low price or lack of a market is a disincentive. Local production has been promoted to ensure availability of essential medicines but research in this area is also limited. Methods: The study took place between 2011 and 2015. We systematically examined the registration status of medicines and vaccines listed in the Ugandan 2012 EML and conducted 20 interviews with regulators, ministry of health representatives, donors, and pharmaceutical producers and analysed quality assurance issues affecting registration, procurement, and local production of medicines in Uganda. In 2017 we conducted a further three interviews to clarify issues around non-registration of essential medicines highlighted by our analysis. Results: Of the 566 essential medicines and vaccines nearly half (49%; 275/566) had no registered product in 2012. Of the 3130 registered products, just over a quarter (28%; 880/3130) were listed on the EML. Six local producers had registered 138 products of which 40 corresponded to 32 unique essential medicines. Interviews highlighted alternative routes to availability other than registration. Local producers faced considerable barriers to achieving international quality standards required for international procurement of medicines for the domestic market. Conclusions: Monitoring and audit of the registration of essential and non-essential medicines should be a priority nationally and, regionally through harmonisation of registration requirements in the East African Community. National and regional manufacturing plans should consider local production of unregistered essential medicines.