The use of dioxy MP 14 (stabilized aqueous chlorine dioxide) to control environmental airborne microorganisms

Magister Pharmaceuticae - MPharmDioxy MP 14 is a locally developed form of stabilized chlorine dioxide in an aqueous medium. It has all the sanitizing properties of chlorine dioxide gas, a neutral compound of chlorine in the +IV oxidation state, which has been used extensively as a non-toxic sterilizing agent with various applications. In this study, Dioxy MP14 was tested in a commercial chicken pen to determine its effectiveness as an environmental sanitizing agent. Control of environmental microbes in a chicken pen is important to ensure healthy birds and optimum egg production. The biocide was introduced via an overhead misting system with a variable dosing pump at various daily frequencies.The effectiveness of environmental microorganism control was determined with air settle plates. The health and performance of the chickens were evaluated and compared to chickens in a control pen.The results show a decrease in airborne microbial load in the treated pen. Better egg production and lower mortality of the chickens in the treated pen compared to the control pen, indicate effective environmental microbial control was achieved with a residual 7.46 ppm Dioxy MP 14 at a daily dose given for 5 minutes every 2 hours.This study was a pilot study, with encouraging results, for an extended study to investigate the feasibility of introducing Dioxy MP 14 through a misting system in a clinical environment (clinics and hospitals) to control airborne pathogens like Mycobacterium tuberculosis thereby reducing the infection risks for clinical workers and medical staff

Content levels, in vitro dissolution and predicted bioavailability of flavonoids from Sutherlandia frutescens leaf powder and aqueous extracts

Philosophiae Doctor - PhDVarious formulations of the popular South African medicinal plant, Sutherlandia frutescens,are commercially available, with no documented specifications for quality assessment. With plans already underway for a clinical trial to assess its efficacy in HIV patients, there is a need for scientifically validated tests for the quality control of products of this plant. Chemical constituents of the plant are many and varied but it is still unclear which might be the most appropriate ones to monitor for activity or to describe the quality of the plant’s products. For quality control and regulatory purposes, the content and dissolution of flavonoids in the plant products can be assessed. However, these compounds are not monitored for regulation and there are as yet no HPLC or dissolution methods that can be employed for quality control of herbals like S. frutescens. Therefore, the objectives of this study were to assess the suitability of its flavonoid constituents as quality control (QC) marker compounds, and the suitability of content levels and dissolution tests of flavonoids as QC tools for S. frutescens products. To realise the afore-mentioned objectives, non-commercially available flavonoid compounds (sutherlandins) that could be used as marker compounds were isolated from S. frutescens. An HPLC assay was developed and validated for determination of flavonoid content in solution. Five S. frutescens materials viz leaf powder (LP), spray-dried aqueous extract (SDAE) and freeze-dried aqueous extracts (FDAE) were analysed for flavonoid content and dissolution. Dissolution tests were conducted for different S. frutescens materials and dissolution profiles of flavonoids in capsules containing these materials were compared using Q-release values, the similarity factor (f2) and mathematical models. To predict in vivo bioavailability of the flavonoids, in silico assessment of in vivo bioavailability of flavonoids (glycosides and aglycones) that may be contained in different S. frutescens materials was conducted. Sutherlandins A, B, C and D were successfully isolated (percentage purity approximately99 % for sutherlandins A, C and D, and 90 % for sutherlandin B) and identified, and used, along with other flavonoid compounds, for the development of a simple and robust HPLC method. Content of sutherlandins A, B, C and D, quercetin and kaempferol in different plant materials were 0.4 ± 0.3, 0.8 ± 0.2, 1.3 ± 0.2, 0.6 ± 0.1, 0.01 ± 0.02 and 0.08 ±0.1 %,respectively, and differed significantly (p 45 minutes. The dissolution profiles of each flavonoid compared from different S. frutescens materials were different as signified by their f2 values which were all below 50. The mathematical models describing release were also different for each flavonoid from the different S. frutescens materials. For in vivo bioavailability modelling and prediction studies, the flavonoid aglycones met the conditions for oral bioavailability while the flavonoid glycosides did not. In conclusion, the sutherlandins isolated from S. frutescens proved to be good markers for HPLC assay and dissolution tests of S. frutescens materials. The HPLC method was suitable for assessing flavonoid levels in S. frutescens materials, and also showed differences in flavonoid content in these materials. The dissolution method was simple and reproducible, and Q-release values, the f2 and mathematical models proved to be good tools for differentiating between S. frutescens materials. In silico modelling showed that the flavonoid glycosides and aglycones differed in oral bioavailability. Although not presently required by the Medicines Control Council (MCC), quantification, release and dissolution studies and specifications may be employed as tools for routine analysis and for quality control of herbal drug formulations containing S. frutescens

Challenges relating to comparison of flavonoid glycosides dissolution profiles from Sutherlandia frutescens products

Unlike the case of conventional drug formulations, dissolution tests have hitherto not been required for herbal medicinal products commercially available in South Africa. This study investigated dissolution of the South African Sutherlandia frutescens using selected flavonoid glycosides as marker compounds. Dissolution of markers was assessed in three dissolution media at pH 1.2, 4.5 and 6.8, and samples were analysed using a validated HPLC method. The dissolution profile of each marker varied for the different materials investigated. All three media utilised showed differences in flavonoid glycoside dissolution between the S. frutescens products evaluated, with f2 values <50 for comparison of flavonoid dissolution from any two of the materials. Dissolution of S. frutescens materials could thus be characterised using the markers in all the media tested. This tool may be employed in the future for comparison of orally administered S. frutescens products, provided between batch variability is evaluated and found less than between-sample variability.IS

HPLC determination of selected flavonoid glycosides and their corresponding aglycones in Sutherlandia frutescens materials

Sutherlandia frutescens is a popular South African plant commercially available in a range of formulations. However, reference standards for quality and stability assessment are lacking. This work reports the development and validation of a reversed phase HPLC method for the analysis of flavonoid glycosides and their corresponding aglycones in S. frutescens products. Five materials containing either leaf powder (LP) or spray-dried aqueous extract (SDAE) of S. frutescens were analysed for flavonoid content. A primary objective was to isolate non-commercially available flavonoid glycoside compounds (sutherlandins) for use as reference standards. Sutherlandins A, B, C and D were successfully isolated, and used, with other flavonoid compounds for HPLC assay development. The developed HPLC method was linear in the range of 0.2 to 60 µg/ml for quercitrin; 0.2 to 120 µg/ml for quercetin and kaempferol; 0.2 to 200 µg/ml for rutin and kaempferol-3-O-rutinoside; 4 to 180 µg/ml for sutherlandins A and D; and 4 to 200 µg/ml for sutherlandins B and C. Percentage content of sutherlandins A, B, C and D, quercetin and kaempferol in different plant materials were significantly different (P<0.001). The developed HPLC method is simple, precise and robust; and can be employed for the simultaneous determination of flavonoid glycosides and aglycones for quality control of S. frutescens products

The use of imagery in global health: an analysis of infectious disease documents and a framework to guide practice.

We report an empirical analysis of the use of imagery by the key actors in global health who set policy and strategy, and we provide a comprehensive overview, particularly related to images used in reports on vaccination and antimicrobial resistance. The narrative currently depicted in imagery is one of power imbalances, depicting women and children from low-income and middle-income countries (LMICs) with less dignity, respect, and power than those from high-income countries. The absence of any evidence of consent for using intrusive and out-of-context images, particularly of children in LMICs, is concerning. The framework we have developed provides a platform for global health actors to redefine their intentions and recommission appropriate images that are relevant to the topic, respect the integrity of all individuals depicted, are accompanied by evidence of consent, and are equitable in representation. Adhering to these standards will help to avoid inherent biases that lead to insensitive content and misrepresentation, stigmatisation, and racial stereotyping

What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course

BACKGROUND Whilst antimicrobial stewardship (AMS) is being implemented globally, contextual differences exist. We describe how the use of a massive open online course (MOOC) platform provided an opportunity to gather diverse narratives on AMS from around the world. METHODS A free 3 week MOOC titled 'Tackling antimicrobial resistance: a social science approach' was launched in November 2019. Learners were asked specific questions about their experiences of AMS via 38 optional free-text prompts dispersed throughout the modules. Content analysis was used to identify key emerging themes from the learners' responses in the first three runs of the MOOC. RESULTS Between November 2019 and July 2020, 1464 learners enrolled from 114 countries. Overall, 199 individual learners provided a total of 1097 responses to the prompts. The diverse perspectives describe unique challenges present in different contexts including ill-defined roles for pharmacists and nurses in AMS; inadequate governance and policy inconsistencies in surveillance for antibiotic consumption and antimicrobial resistance (AMR) in some countries; lack of ownership of antibiotic decision-making and buy-in from different clinical specialties; and human resource and technological constraints. Patients' knowledge, experiences and perspectives were recognized as a valuable source of information that should be incorporated in AMS initiatives to overcome cultural barriers to the judicious use of antibiotics. CONCLUSIONS Analysis of learner comments and reflections identified a range of enablers and barriers to AMS implementation across different healthcare economies. Common challenges to AMS implementation included the role of non-physician healthcare workers, resource limitations, gaps in knowledge of AMR, and patient engagement and involvement in AMS

The elephant in the room: Exploring the influence and participation of patients in infection-related care across surgical pathways in South Africa and India

Data availability statement: Data on which this publication is based are available via a secure server. Access to the data can be provided upon reasonable request. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.Copyright © 2023 The Authors. Objective: The irrational use of antibiotics is a leading contributor to antibiotic resistance. Antibiotic stewardship (AS) interventions predominantly focus on prescribers. This study investigated the influence and participation of inpatients in infection-related care, including antibiotic decision-making, within and across two tertiary hospitals in South Africa (Cape Town) and India (Kerala). Methods: Through ethnographic enquiry of clinical practice in surgical pathways, including direct nonparticipant observation of clinical practices, healthcare worker (HCW), patient and carer interactions in surgical ward rounds and face-to-face interviews with participants (HCWs and patients), we sought to capture the implicit and explicit influence that patients and carers have in infection-related care. Field notes and interview transcripts were thematically coded, aided by NVivo 12® Pro software. Results: Whilst observational data revealed the nuanced roles that patients/carers play in antibiotic decision-making, HCWs did not recognize these roles. Patients and carers, though invested in patient care, are not routinely involved, nor are they aware of the opportunities for engagement in infection-related decision-making. Patients associated clinical improvement with antibiotic use and did not consider hospitalization to be associated with infection acquisition or transmission, highlighting a lack of understanding of the threat of infection and antibiotic resistance. Patients' economic and cultural positionalities may influence their infection-related behaviours. In the study site in India, cultural norms mean that carers play widespread but unrecognized roles in inpatient care, participating in infection prevention activities. Conclusion: For patients to have a valuable role in AS and make informed decisions regarding their infection-related care, a mutual understanding of their role in this process among HCWs and patients is crucial. The observed differences between the two study sites indicate the critical need for understanding and addressing the contextual drivers that impact effective patient-centred healthcare delivery. Patient or Public Contribution: Ethnographic observations and interviews conducted in this study involved patients as participants. Patients were recruited for interviews after obtaining signed informed consent forms. Patients' identities were completely anonymized when presenting the study findings.Economic and Social Research Council. Grant Number: ES/P008313/1

An analysis of existing national action plans for antimicrobial resistance-gaps and opportunities in strategies optimising antibiotic use in human populations.

At the 2015 World Health Assembly, UN member states adopted a resolution that committed to the development of national action plans (NAPs) for antimicrobial resistance (AMR). The political determination to commit to NAPs and the availability of robust governance structures to assure sustainable translation of the identified NAP objectives from policy to practice remain major barriers to progress. Inter-country variability in economic and political resilience and resource constraints could be fundamental barriers to progressing AMR NAPs. Although there have been regional and global analyses of NAPs from a One Health and policy perspective, a global assessment of the NAP objectives targeting antimicrobial use in human populations is needed. In this Health Policy, we report a systematic evidence synthesis of existing NAPs that are aimed at tackling AMR in human populations. We find marked gaps and variability in maturity of NAP development and operationalisation across the domains of: (1) policy and strategic planning; (2) medicines management and prescribing systems; (3) technology for optimised antimicrobial prescribing; (4) context, culture, and behaviours; (5) operational delivery and monitoring; and (6) patient and public engagement and involvement. The gaps identified in these domains highlight opportunities to facilitate sustainable delivery and operationalisation of NAPs. The findings from this analysis can be used at country, regional, and global levels to identify AMR-related priorities that are relevant to infrastructure needs and contexts

Awareness of infection care terms among outpatients and carers in a public health facility: a cross-sectional survey

Our research explored awareness of selected infection care terms among patients and carers in the out-patient department of a tertiary academic hospital. The file uploaded contains the research data, which were analysed to present the information in the submitted manuscript. </p