Evaluation of microbial quality of selected blister-packed paracetamol tablets and paracetamol syrups marketed in Nigeria

Ten brands of blister-packed paracetamol tablet and twenty brands of paracetamol syrup marketed in Nigeria were evaluated for their microbial quality. While no microbial contaminant was isolated from all blistered-packed paracetamol tablets, ten of syrups were contaminated with organisms such as Escherichia coli, Klebsiellaspp, Pseudomonas aeruginosa and Staphylococcus aureus at 14.3, 21.4, 21.4 and 42.9% occurrence respectively. Penicilliumspp was isolated from two brands. Antibiotic susceptibility profile revealed all bacterial isolates to be multidrug resistant with Escherichia coli resistant to all antibiotics tested, while Staphylococcus aureus isolates were sensitive to Oxacillin, Cefuroxime and vancomycin. Pseudomonas aeruginosa isolates were sensitive to ofloxacin and gentamycin while Klebsiella isolates were sensitive to ofloxacin and nitrofurantoin. The study concluded that compliance with the provisions of good manufacturing practice as well as good quality control play role in determining the microbial bioburden of pharmaceutical products while isolation of multi-drug resistant organisms calls for establishment and adherence to antibiotics use policy in Nigeria.Keywords: Blister-pack, multidrug resistance, good manufacturing practice, quality control, bioburde

Biosurfactant Production by Rhizospheric Bacteria Isolated from Biochar Amended Soil Using Different Extraction Solvents

Microbial-derived surface-active compounds (biosurfactants) have attracted attention due to their low toxicity, cost-effectiveness, biodegradable nature and environment compatibility. Due to paucity of knowledge in the production of biosurfactant by microorganisms from other sources such as biochar-amended soil, the present study investigates the potential of rhizospheric bacteria isolated from biochar amended soil of okra plant in the production of biosurfactants using different recovery techniques. Rhizospheric bacteria were screened for biosurfactant production using Haemolytic, Oil spreading, Drop collapse, Methylene blue method, Bacterial adhesion to hydrocarbon and Emulsification activity. The biosurfactant was extracted using different extraction solvents (acid precipitation, ethyl acetate, acetone, dichloromethane and chloroform/methanol). Degradation of hydrocarbon (diesel) was determined spectrophotometrically. A total of twenty-three rhizospheric bacteria were isolated from the soil of Abelmoschus esculentus (okra plant).  Nine isolates were positive for haemolysis with values between 1.1±0.2 mm by Enterobacter cloaca and 23.0±0.6 mm by Alcaligenes faecalis. Two isolates were positive for the drop collapse test. Only one isolate was positive for the methylene blue method. In the oil spreading test, ten isolates were positive and five isolates had the ability to adhere to hydrocarbons. Six isolates exhibited emulsification potential after 24 h, with the highest and lowest (65.9%) and (40.7%) recorded by Alcaligenes faecalis and Citrobacter sp, respectively. The biosurfactant produced by Alcaligenes faecalis using different recovery solvents showed that chloroform and methanol are the best extraction solvents and Alcaligenes faecalis was also able to degrade diesel oil over a period of 10 d. Conclusively, Alcaligenes faecalis recovered from soil amended sawdust biochar of okra plant is both a potent biosurfactant producer and an agent for remediating hydrocarbon-contaminated soil environments

A feasibility study of educational tools for osteomalacia

Many people in the UK, particularly people of South Asian origin, are advised to supplement their vitamin D intake, yet most do not. This suggests an unmet educational need. The osteomalacia mind map was developed to meet this need. The mind map contains culturally sensitive images, translated into Urdu and made interactive on a DVD. This study explores the feasibility of a randomised controlled study to measure the effect of education on improving vitamin D knowledge and adherence. This was a pilot and feasibility study. Cluster randomisation was used to avoid inter person contamination. Two South Asian women’s groups were recruited to receive information about osteomalacia either by interactive DVD or an Arthritis Research UK leaflet. Knowledge and compliance were tested before and after the educational interventions via a knowledge questionnaire and the measurement of vitamin D and parathormone levels. The groups were found to be mismatched for knowledge, educational attainment and language at baseline. There were also organisational difficulties and possible confounding due to different tutors and translators. The DVD group had high knowledge at baseline which did not improve. The leaflet group had low knowledge at baseline that did improve. The DVD group had lower parathormone which did not change. The leaflet group had an increase in vitamin D but parathormone remained high. Performing a randomised study with this population utilising an educational intervention was difficult to execute. If cluster randomisation is used, extreme care must be taken to match the groups at baseline

Quality Assessment of Selected Public Recreational Waters in Sango-Ota Metropolis, Nigeria

The evaluation of selected public swimming pools within Sango-Ota metropolis was done to determine whether the pools adapt to the recommended WHO standard for swimming pool water. Six pools were selected based on the average population per use and user ratings. A total of 12 water samples were analysed physicochemical and microbial qualities using standard methods. The  physicochemical characterization results are as follows; pH, 5.00 - 5.73 with mean value of 5.3; Total Dissolved Solids (TDS), 44.00 - 48.50 mg/L with mean 46.0 mg/L; Alkalinity, 24.00 - 28.50 mg/L with mean 26.0 mg/L; total hardness, 0.80 - 1.23 mg/L with mean 1.0 mg/L; iron, 0.05 – 0.69 mg/L with mean 0.3 mg/L; residual chlorine, 1.06 – 3.25 mg/L with mean 1.9 mg/L. The microbial characterization results are as follows; Zero count for Salmonella-shigella; Total Aerobic Plate Count (TAPC),1360 - 7270 cfu/mL; Escherichia coli count, 0 - 7 cfu/mL; coliform count, 2 – 25 cfu/mL.  The isolated microorganisms from the pools were Escherichia coli, Proteus Vulgaris, Yersinia Enterocolitica, Proteus Mirabilis, Citrobacter Freundi and Vibro Chlorea occurred in 8.33%, respectively while Klebsiella Pneumonia, Entrobacter Aerogenes, Pseudonomas sp. occurred 16.67%. The pH of the analysed pools didn’t comply with the WHO standards while other physicochemical parameters conform to the standard except for pools C and F which had a higher concentration of iron. However, the existence of pathogenic microorganisms in the pools classified them as unsafe for swimming activities. This study recommends routine testing and comprehensive treatments with respect to regulatory standards.  Pool managers should strictly adhere to the bathing load limit and ensure the pool users take shower before using the swimming pools to forestall the outbreak of waterborne disease

Virtual patients design and its effect on clinical reasoning and student experience : a protocol for a randomised factorial multi-centre study

Background Virtual Patients (VPs) are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent) and structured clinical reasoning feedback (present or absent). Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent), and structured clinical reasoning feedback (present or absent).The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for both primary outcomes

A feasibility study of educational tools for osteomalacia

Many people in the UK, particularly people of South Asian origin, are advised to supplement their vitamin D intake, yet most do not. This suggests an unmet educational need. The osteomalacia mind map was developed to meet this need. The mind map contains culturally sensitive images, translated into Urdu and made interactive on a DVD. This study explores the feasibility of a randomised controlled study to measure the effect of education on improving vitamin D knowledge and adherence. This was a pilot and feasibility study. Cluster randomisation was used to avoid inter person contamination. Two South Asian women’s groups were recruited to receive information about osteomalacia either by interactive DVD or an Arthritis Research UK leaflet. Knowledge and compliance were tested before and after the educational interventions via a knowledge questionnaire and the measurement of vitamin D and parathormone levels. The groups were found to be mismatched for knowledge, educational attainment and language at baseline. There were also organisational difficulties and possible confounding due to different tutors and translators. The DVD group had high knowledge at baseline which did not improve. The leaflet group had low knowledge at baseline that did improve. The DVD group had lower parathormone which did not change. The leaflet group had an increase in vitamin D but parathormone remained high. Performing a randomised study with this population utilising an educational intervention was difficult to execute. If cluster randomisation is used, extreme care must be taken to match the groups at baseline

The evolution of South Africa's democracy promotion in Africa : from idealism to pragmatism

Abstract: South Africa is an emerging power with fairly strong democratic institutions that were crafted during the transition from minority to majority rule twenty years ago. How has South Africa used its position and power to promote democracy in Africa? Against the backdrop of debates on democracy promotion by emerging powers, this article probes attempts by successive post-apartheid governments to promote democracy in Africa. We argue that although democracy promotion featured prominently in South Africa’s policy toward Africa in the immediate post-apartheid period under Nelson Mandela, the administrations of Thabo Mbeki and Jacob Zuma faltered in advancing democratic norms. This is largely because South Africa has confronted pressures to maximize pragmatic national interests, which have compromised a democratic ethos in a continental environment where these values have yet to find steady footing

Patient empowerment : Apni Jung (our fight) against rheumatoid arthritis for South Asian population

Covid-19 has affected many populations in the UK, and ethnic minority communities in particular. People from ethnic minority communities living with long-term chronic diseases have shown to be less engaging with self-management and report having poor medication adherence. The main reason to this problem is the way information is delivered to non-English speaking patients. This editorial discusses an innovation to over this barriers in rheumatology practice