A Novel Derivatization Ultraviolet Spectrophotometric Method for the Determination of Dihydroartemisinin using p- Nitroaniline

Purpose: To develop a novel ultraviolet (UV)–spectrophotometric method for the determination of dihydroartemisinin (DHA) in tablets using  p-nitroaniline (PNA) as a derivatizing agent.Methods: Derivatization was based on the reaction between methanol solutions of dihydroartemisinin (DHA) and p-nitroaniline (PNA) in acid medium (1M HCI) at elevated temperature and for a short reaction time. Optimal detector response was obtained within 15 min when the reaction was carried out at 90 0C in a molar ratio of 2:1 (DHA:PNA). The method used for analysis was validated and a linear calibration curve constructed in the range of 30 – 100 ìg/mL for the reaction mixture at an absorbanceof 290 nm.Results: Separation of adduct from PNA was better achieved on reversed phase thin layer chromatography (TLC) using acetonitrile : water (60:50) or on high performance liquid chromatography (HPLC) with retention times of 2.8 min for PNA and 5.8 min for the adduct. The limit of detection was 6ìg/mL. The method was precise and accurate in the range 100.70 - 100.96 %, with intraday and interday precisions of less than 2 % at concentrations of 40 and 80 ìg/mL, respectively. The new method was applied to the assay of two brands of dihydroartemisinin tablets with accuracy similar tothat of the International Pharmacopoeia (IP) UV-spectrophotometric method (p > 0.05).Conclusion: The derivatization method is simple, direct, devoid of dilutions and inexpensive in terms of reagent requirements and analyte volume, and has a shorter reaction time, cpmpared with IP method. Based on the foregoing, the method can be adopted as an alternative to the official assay method for routine quality control of dihydroartemisinin tablets.Keywords: Derivatization, Ultraviolet spectrophotometry,  Dihydroartemisinin, p-Nitroaniline, Analysis, Assay, Quality contro

Physicochemical Analysis of the Aqueous Extracts of Six Nigerian Medicinal Plants

Purpose: Extracts of Picralima nitida seeds, Detarium microcarpum stem bark, Aframomum melagueta seeds, Terminalia catappa leaves, Acacia nilotica pods, and Morinda lucida stem bark, are under consideration for development into suitable dosage forms for treating diabetes mellitus, sickle cell anemia and malaria. This study aimed at evaluating the extracts for features that would influence decisions on them in the course of the project.Methods: Physicochemical determinations, including proximate analysis, were done by sensory examination, and gravimetric and electrochemical techniques. Thin layer chromatography was carried out with normal silica plates using various solvent systems. Metallic content analyses were carried out by atomic absorption spectroscopy.Results: The extracts were dry but hygroscopic, with a loss on drying range of 0.26 – 12.00 %w/w. The pH of the 5 - 10 % solutions ranged 5 - 7. No harsh sensory effects, such as lacrimation, were detected in any of the extracts. Total ash ranged from 3.79 – 20.68 %w/w, while acid insoluble ash values were below detection. The extracts yielded reproducible chromatograms on normal silica plates developed with various solvent systems. Copper, present at 0.16 - 0.58 mg/100g, was the lowest occurring microelement while calcium content was highest, at 41 - 216 mg/100g. The level of lead, a heavy metal, was 0.05 - 0.22 mg/100g.Conclusion: The results confirm that the extracts require no special handling, possess characteristics that would allow their possible development into solid dosage forms, and that their lead contentscomplied with official limits.Keywords: Aqueous extract, Picralima nitida, Detarium microcarpum, Aframomum melagueta, Terminalia catappa, Acacia nilotica, Morinda lucida

“I attend at Vanguard and I attend here as well”: barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases

Background: HIV and non-communicable disease (NCD) are syndemic within sub-Saharan Africa especially among older persons. The two epidemics interact with one another within a context of poverty, inequality and inequitable access to healthcare resulting in an increase in those aged 50 and older living with HIV and experiencing an NCD comorbidity. We explore the challenges of navigating healthcare for older persons living with HIV and NCD co-morbidity. Methods: In-depth semi-structured interviews were conducted with a small sample of older persons living with HIV (OPLWH). The perspectives of key informants were also sought to triangulate the evidence of OPLWH. The research took place in two communities on the outskirts of Cape Town, South Africa. All interviews were conducted by a trained interviewer and transcribed and translated for analysis. Thematic content analysis guided data analysis. Results: OPLWH experienced an HIV-NCD syndemic. Our respondents sought care and accessed treatment for both HIV and other chronic (and acute) conditions, though these services were provided at different health facilities or by different health providers. Through the syndemic theory, it is possible to observe that OPLWH and NCDs face a number of physical and structural barriers to accessing the healthcare system. These barriers are compounded by separate appointments and spaces for each condition. These difficulties can exacerbate the impact of their ill-health and perpetuate structural vulnerabilities. Despite policy changes towards integrated care, this is not the experience of OPLWH in these communities. Conclusions: The population living with HIV is aging increasing the likelihood that those living with HIV will also be living with other chronic conditions including NCDs. Thus, it is essential that health policy address this basic need to integrate HIV and NCD care

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Plant natural products research in tuberculosis drug discovery and development: A situation report with focus on Nigerian biodiversity

Tuberculosis (TB) remains a disease of global importance with approximately two million deaths annually worldwide. Effective treatment of TB has been hampered by the emergence of drug resistant strains of Mycobacterium tuberculosis. The global resurgence of TB and the development of multidrug-resistant tuberculosis (MDR TB) and extensively drug-resistant tuberculosis (XDR-TB), call for the development of new anti-tuberculosis drugs to combat this disease. Plant natural products have a proven global history of treating diseases and ailments. This review aims to provide a situation report of on-going global efforts to discover and develop anti-TB drugs from plants, including plants found within Nigeria’s rich flora. For two decades, studies on different families and genera of the plant kingdom have shown the great potential of plants as antimycobacterial agents. These motifs, including those from within Nigeria’s flora, are discussed. Chemists, biochemists and molecular biologists have also employed technological developments in separation methods, hyphenated techniques, high throughput assays and microarray analysis, to drive the drug discovery process. Nigeria, and indeed, Africa, needs to look inwards to solve the burden of tuberculosis, by tapping on its rich biodiversity, which the continent is endowed with. There is need for the government to be committed and actively fund anti-tuberculosis research. Keywords: Plant natural product, antimycobacterial activity, drug discovery, drug development, Nigerian flora, biodiversity.African Journal of Biotechnology, Vol 13(23) 2307-232

Access to paediatric surgery: the geography of inequality in Nigeria

BACKGROUND: About 96.3 million children and adolescents aged 0-19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly treatable diseases, many face disability and increased risk of mortality. Due to this population's unique perioperative needs, increasing access to paediatric surgical care requires a situational evaluation of the distribution of paediatric surgeons and anaesthesiologists. This study's aim is to identify the percentage of Nigerian youth who reside within 2 hours of paediatric surgical care at the state and national level. METHODS: The Association of Paediatric Surgeons of Nigeria and the Nigeria Society of Anaesthetists provided surgical and anaesthesia workforce data by state. Health facilities with paediatric surgeons were converted to point locations and integrated with ancillary geospatial layers and population estimates from 2016 and 2017. Catchment areas of 2 hours of travel time around a facility were deployed as the benchmark indicator to establish timely access. RESULTS: Across Nigeria's 36 states and Federal Capital Territory, the percentage of Nigeria's 0-19 population residing within 2 hours of a health facility with a paediatric surgical and anaesthesia workforce ranges from less than 2% to 22.7%-30.5%. In 3 states, only 2.1%-4.8% of the population can access a facility within 2 hours, 12 have 4.9%-13.8%, and 8 have 13.9%-22.6%. CONCLUSION: There is significant variation across Nigerian states regarding access to surgical care, with 69.5%-98% of Nigeria's 0-19 population lacking access. Developing paediatric surgical services in underserved Nigerian states and investing in the training of paediatric surgical and anaesthesia workforce for those states are key components in improving the health of Nigeria's 0-19 population and reducing Nigeria's burden of surgical disease, in line with Nigeria's National Surgical, Obstetrics, Anaesthesia and Nursing Plan