Phytochemical screening, antioxidant, antiulcer and toxicity studies on Desmodium adscendens (Sw) DC Fabaceae leaf and stem

Purpose: To assess the phytochemical profile, toxicity, as well as the antioxidant, and antiulcer activities of the methanol extracts of Desmodium adscendens stem and leaf.Methods: Maceration procedure was employed in the preparation of the methanol extracts. Phytochemical characterization of the extracts was carried out according to standard methods. In vitro antioxidant activity was evaluated using 2, 2-diphenyl-1-picryhyldrazy (DPPH l) and ferric reducing antioxidant power assay (FRAP). Antiulcer activity was investigated using ethanol-induced ulcer model, while toxicity was assessed by observing the mice for mortality.Results: Phytochemical analysis indicate the presence of glycosides, alkaloids, tannins, flavonoids, and saponins in the stem and leaf. Methanol extracts of the plant exhibited antioxidant activity, with DPPH assay results showing median inhibitory concentration (IC50) of 87.59 (leaf), 108.87 (stem), 28.52 (alpha-tocopherol), and 5.05 μg/mL (ascorbic acid). The FRAP assay results for the stem and leaf extracts were 1483 and 1953 μM Fe2+/g dry plant, respectively, while for ascorbic acid it was 3463 μMFe2+/g. The extracts showed significant antiulcer activity, with 14.27 and 15.18 % ulceration inhibition for the leaf extract, and 12.31 and 13.36 % for the stem extract at administered doses of 100 and 200 mg/kg, respectively. Cimetidine and omeprazole (standards) showed ulceration inhibition of 5.53, and 8.26 % at 5.7 and 0.57 mg/kg doses, respectively.Conclusion: The methanol extracts of Desmodium adscendens stem and leaf offer significant protective activity against ethanol-induced gastric ulceration in rats, and the activity may be related to their antioxidant effect.Keywords: Antioxidant, Antiulcer, Toxicity, Desmodium adscenden

FACTORS ASSOCIATED WITH TB/HIV CO-INFECTION AMONG DRUG SENSITIVE TUBERCULOSIS PATIENTS MANAGED IN A SECONDARY HEALTH FACILITY IN LAGOS, NIGERIA

Background: This study assessed factors associated with TB/HIV co-infection among TB patients managed in a secondary health facility in Lagos Nigeria. Materials and Methods: A retrospective review of treatment cards of patients seen at a secondary referral hospital between January 1 2014 and December 31 2014 was conducted. Treatment outcomes and factors associated with TB/HIV co-infection were assessed. Results: Of the 334 records of patients reviewed, the proportion of patients with TB/HIV co-infection was 21.6%. The odds of having TB/HIV co-infection was 2.7 times higher among patients above 40 years than patients less than 25 years (AOR 2.7 95% CI 1.1 – 6.5, p =0.030). In addition, the odds of having TB/HIV co-infection was 3.3 higher among extrapulmonary TB cases (AOR 3.3; 95% CI 1.2 – 9.5; p = 0.026) and 2.1 times higher among retreated patients (AOR 2.1; 95% CI 1.1 – 3.9; p = 0.017) than pulmonary TB and new patients respectively. The chance of having TB/HIV co-infection was 2.7-fold more in patients with poor treatment outcomes than patients with treatment success (AOR 2.7; 95%CI 1.3 – 5.4; p =0.006). Conclusion: TB/HIV co-infection rate was high in the study area. There is need to put measures in place to improve treatment outcomes of TB/HIV co-infected patients

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

Summary 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 middleincome 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 lowincome 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 lowincome, 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

Longitudinal Ambient PM<inf>2.5</inf> Measurement at Fifteen Locations in Eight Sub-Saharan African Countries Using Low-Cost Sensors

Peer reviewed: TrueFunder: Medical Research Council Doctoral Training Program scholarshipFunder: Aldama FoundationFunder: NIHR Global Health Research Unit on Lung Health and TB in Africa at LSTM— “IMPALA”Funder: National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health researchAir pollution is a major global public health issue causing considerable morbidity and mortality. Measuring levels of air pollutants and facilitating access to the data has been identified as a pathway to raise awareness and initiate dialogue between relevant stakeholders. Low-and middle-income countries (LMICs) urgently need simple, low-cost approaches to generate such data, especially in settings with no or unreliable data. We established a network of easy-to-use low-cost air quality sensors (PurpleAir-II-SD) to monitor fine particulate matter (PM2.5) concentrations at 15 sites, in 11 cities across eight sub-Saharan Africa (sSA) countries between February 2020 and January 2021. Annual PM2.5 concentrations, seasonal and temporal variability were determined. Time trends were modelled using harmonic regression. Annual PM2.5 concentrations ranged between 10 and 116 µg/m3 across study sites, exceeding the current WHO annual mean guideline level of 5 µg/m3. The largest degree of seasonal variation was seen in Nigeria, where seven sites showed higher PM2.5 levels during the dry than during the wet season. Other countries with less pronounced dry/wet season variations were Benin (20 µg/m3 versus 5 µg/m3), Uganda (50 µg/m3 versus 45 µg/m3), Sukuta (Gambia) (20 µg/m3 versus 15 µg/m3) and Kenya (30 µg/m3 versus 25 µg/m3). Diurnal variation was observed across all sites, with two daily PM2.5 peaks at about 06:00 and 18:00 local time. We identified high levels of air pollution in the 11 African cities included in this study. This calls for effective control measures to protect the health of African urban populations. The PM2.5 peaks around ‘rush hour’ suggest traffic-related emissions should be a particular area for attention.</jats:p

Active versus expectant management for premature rupture of membranes at term: A randomized, controlled study

Objective To compare the effects on feto-maternal outcomes of expectant versus active management for premature rupture of membranes (PROM) at term. Methods This was a prospective randomized (1:1) controlled study involving 86 pregnant-women who received either expectant management (n = 43) or active management with misoprostol (n = 43) for PROM at term. Primary outcome was route of delivery. Secondary outcomes were: PROM to presentation interval; latency period; PROM to delivery interval; recruitment to delivery interval; labour and delivery complications. Results Baseline-characteristics were similar between groups. There was no significant difference between active and expectant groups in mean PROM to presentation/admission, or PROM to delivery. However, mean latency period (11.1 ± 7.3 hours vs 8.8 ± 5.5 hours) and mean recruitment to delivery intervals after PROM (14.7 ± 5.2 hours vs 11.8 ± 5.0 hours) were significantly shorter for the active group compared with the expectant group. Although the rate of caesarean section was less in expectant management group (21%) compared with the active management group (30%), the difference was not statistically significant. There were no significant differences between groups in delivery or perinatal complications. Conclusion Active and expectant management for PROM at term gave comparable outcomes in terms of methods of delivery and complications. However, active management significantly shortened the latency period and induction to delivery intervals compared with expectant management. Trial-Registration: Pan-African-trial-registry-(PACTR)-approval-number PACTR20220679773408