COVID-19, caused by SARS-CoV-2 is a tester of the immune system. While it spares the healthy, it brings severe morbidity and in a few cases, mortality to its victims. This article aims at critically reviewing the key virulence factors of COVID-19 which are the viremia, cellular oxidation and immune dysfunction. The averse economic effect of certain disease control measures such as national lock-downs and social distancing, though beneficial, makes them unsustainable. Worse still is the fact that wild animals and domestic pets are carriers of SARS-CoV-2 suggesting that the disease would take longer than expected to be eradicated globally. A better understanding of the pathological dynamics of COVID-19 would help the general populace to prepare for possible infection by the invisible enemy. While the world prospects for vaccines and therapeutic agents against the SARS-CoV-2, clinicians should also seek to modulate the immune system for optimum performance. Immunoprophylactic and immunomodulatory strategies are recommended for the different strata of stakeholders combating the pandemic with the hope that morbidities and mortalities associated with COVID-19 would be drastically reduced.

World Health Organization has recognized magnesium sulphate as the drug of choice for prevention and treatment of fits associated with preeclampsia and eclampsia which are amongst the leading causes of maternal morbidity and mortality. In this study, the pharmaceutical quality of magnesium sulphate injections marketed in Anambra state was assessed. Methods: Ninety samples of magnesium sulphate obtained from the 3 senatorial zones in Anambra state were subjected to identification tests, microbiological analysis consisting of Growth promotion test, sterility and endotoxin test. Content analysis using titrimetric method and pH analysis were also carried out on the samples. Results: Twenty percent (20%) of samples obtained from Onitsha failed identification test as they had no Registration number in Nigeria. All samples subjected to the microbiology tests (sterility and endotoxin test) passed. Twenty percent (20%) and thirty-three percent (33.3%) of samples sourced from Onitsha and Nnewi respectively failed the pH analysis test. All the samples passed microbiological tests and had their Active Pharmaceutical Ingredients (API) within the acceptable limit. Conclusions: This study reveals that there are still some substandard magnesium sulphate injections in circulation in the locality. The supply chain of these drugs should be monitored to ensure a reduction in the incidences of substandard magnesium sulphate and positive therapeutic outcome which translates to reduced maternal mortality associated with pre-eclampsia and eclampsia in Nigeria.

Kidney dysfunction is one of the most serious complications resulting from the use of traditional medicine which is common in Africa accounting for about 35% of renal damage in HIV-infected patients. In this cross sectional study, 250 HIV-infected patients were groups as follows: ART GrpA (100), ART + traditional medicine use GrpB (100) and ART treatment naïve + traditional medicine GrpC (50). Tubular dysfunctions were defined when at least two or more of the following abnormalities were repeatedly present: Uricosuria ≥ 0.05 mg/dl, Phosphaturia ≥ 20.0 mg/dl, Glucosuria ≥ 0.1 mg/dl, Proteinuria = positive protein on dipstick urine. Renal dysfunctions were found to be significantly high (P = 0.001) in the group of patients treated with ART + traditional medicine. 27 (64.29%) patients followed by ART treatment naïve patients + traditional medicine; 12 (28.57%) patients and only 4 (7.14%) patients developed renal toxicity in the ART treatment Grp. But strikingly CD4 counts were also significantly higher in Grp B (683 cell/ul) compared to group A (446 cell/ul) and C (206 cell/ul). Our results show that HIV-infected patients on ART combined with traditional medicine might develop renal abnormalities in the presence of high CD4 counts, in the course of incessant use of traditional medicine. Thus it is important that more research be conducted on its usage among the Black population with HIV infection.

INTRODUCTION Pharmaceutical products are subject to rigorous quality assurance checks in order to ensure that drug products are of required quality, are safe and have good efficacy. However, the emergence of substandard drug products have largely impacted both the health and perception of the public towards drug use. This work aims to identify those trends in public opinion among both prescribers and end-users within Anambra State, Nigeria. METHOD This was a descriptive cross-sectional study carried out in 2019. Data collection was quantitative using a pre-tested self-administered questionnaire to four hundred participants, comprising of medical doctors, nurses, pharmacists and end-users. Data analysis was done using SPSS version 16. Statistical significance was set at 5 percent (p<0.05). Ethical approval was obtained from Nnamdi Azikiwe University Teaching Hospital Ethics and Advisory Committee RESULTS Majority (57.9 %) of the respondents think that the drugs marketed in Anambra state are somewhat effective. About a quarter (23.5 %) of the respondents had no idea of what to look out for when checking substandard drugs. About two-third (65.4 %) of our participants had used substandard drugs at least once in the past two years, out of which 51.1 % of them chose to discard the drugs whenever in their possession, 32.3 % of them returns the drugs to the outlets from where they were purchased, while only 16.5 % reports the drugs to the regulatory authority. 42.1 % of the medical doctors and nurses had no knowledge about the storage conditions of magnesium sulphate injection and 57.1 % of them affirmed that there was no available means of documenting ineffective or substandard drugs in their facilities. CONCLUSION This study brings to light the possible contributions of poor-quality medicines. A high percentage of the respondents had no idea of what to look out for while checking for substandard medicinal product. More campaigns against fake/ substandard drugs should be carried out at intervals.