The reporting of adverse drug reactions by healthcare providers in Kenya

Background: Spontaneous and consistent reporting is the cornerstone of adverse drug reaction (ADR) reporting. Under reporting is an enormous obstacle to effective pharmacovigilance (PV).Objective: To determine factors affecting ADR reporting by healthcare providers in selected hospitals in Kirinyaga County, Kenya.Methods: A cross-sectional study was conducted in four selected hospitals. A pretested self-administered questionnaire was utilised to collect data. Stratified sampling was used to recruit 224 healthcare providers. Statistical Package for Social Sciences (SPSS) version 23 analysed data. The Chi-squared test was used to determine association. Binary logistic regression assessed strength of association. Outcomes were considered significant at p-values of <0.05.Results: Of 224 questionnaires distributed 215 were completed, 159 (74%) healthcare providers had not reported ADRs to the Pharmacy and Poisons Board (PPB) within the last 3 months. In total, 92 (42.8%) healthcare providers knew about reporting guidelines; 194 (90.2%) were not trained in ADR reporting. Those aware of the reporting guidelines and those trained were more likely to report ADRs. Continuing medical education was the preferred source of information about ADRs. The main barriers to ADR reporting include inadequate training, delayed feedback, not knowing where or to whom to report, lack of a PV centre in the county and inadequate  access to ADR forms and guidelines.Conclusion: ADR reporting among healthcare providers could be improved. Age, profession, level of education, knowledge and  training affected ADR reporting. Healthcare provider centred training and promotion of ADR reporting tools are necessary to boost ADR reporting and increase patient safety. Keywords: adverse drug reaction; spontaneous reporting; healthcare provider; pharmacovigilance, Kenya

Coenzyme Q10 Protect Mice Against Inflammatory Responses During Experimental Cerebral Malaria

Malaria is a life threatening infectious diseases transmitted by the bite of infected female Anopheles mosquito and responsible for high morbidity and mortality rates. Cerebral malaria is a complex neurological syndrome, whose pathology is mediated by inflammatory processes triggered by the immune system of the host following infection with Plasmodium falciparum. Coenzyme Q10 is an obligatory cofactor in the electron transport chain. The reduced form of Coenzyme Q10 serves as a potent antioxidant additionally; Coenzyme Q10 has been identified as a modulator of gene expression, inflammation and apoptosis. However, the modulatory effects of Coenzyme Q10 Plasmodium berghei ANKA infection process and risk occurrence of experimental cerebral malaria (ECM) have not been determined. The aim of this study was to elucidate the putative impact of oral administration of Coenzyme-Q10 on the initiation or regulation of inflammatory immune response in ECM of C57BL/6 mice during Plasmodium berghei ANKA (PbA) infection. We observed that oral administration of Coenzyme-Q10 both before and after PbA infection significantly hampered infiltration of inflammatory monocytes into the brain. Furthermore, pro-inflammatory cytokine TNF-α, which is associated with inflammation during ECM, was down-regulated in Coenzyme-Q10 administered mice. Remarkably, Coenzyme-Q10 was very effective in inhibiting dendritic cell differentiation. These data collectively demonstrated the immuno-modulatory function of Coenzyme-Q10 on host inflammatory responses during ECM. Keywords: Plasmodium berghei ANKA, Coenzyme Q10, experimental cerebral malaria DOI: 10.7176/JNSR/9-2-05

Data Science for Justice: The Short-Term Effects of a Randomized Judicial Reform in Kenya

Can data science be used to improve the functioning of courts, and unlock the positive effects of institutions on economic development? In a nationwide randomized experiment in Kenya, we use algorithms to identify the greatest sources of court delay for each court and recommend actions. We randomly assign courts to receive no information, information, or an information and accountability intervention. Information and accountability reduces case duration by 22%. We find an effect on contracting behaviour, with more written labor contracts being signed by firms, and an effect on wage, since jobs with written labor contracts pay more. These results demonstrate a causal relationship between judicial institutions and development outcomes

The reporting of adverse drug reactions by healthcare providers in Kenya

Background: Spontaneous and consistent reporting is the cornerstone of adverse drug reaction (ADR) reporting. Under reporting is an enormous obstacle to effective pharmacovigilance (PV). Objective: To determine factors affecting ADR reporting by healthcare providers in selected hospitals in Kirinyaga County, Kenya. Methods: A cross-sectional study was conducted in four selected hospitals. A pretested self-administered questionnaire was utilised to collect data. Stratified sampling was used to recruit 224 healthcare providers. Statistical Package for Social Sciences (SPSS) version 23 analysed data. The Chi-squared test was used to determine association. Binary logistic regression assessed strength of association. Outcomes were considered significant at p-values of <0.05. Results: Of 224 questionnaires distributed 215 were completed, 159 (74%) healthcare providers had not reported ADRs to the Pharmacy and Poisons Board (PPB) within the last 3 months. In total, 92 (42.8%) healthcare providers knew about reporting guidelines; 194 (90.2%) were not trained in ADR reporting. Those aware of the reporting guidelines and those trained were more likely to report ADRs. Continuing medical education was the preferred source of information about ADRs. The main barriers to ADR reporting include inadequate training, delayed feedback, not knowing where or to whom to report, lack of a PV centre in the county and inadequate access to ADR forms and guidelines. Conclusion: ADR reporting among healthcare providers could be improved. Age, profession, level of education, knowledge and training affected ADR reporting. Healthcare provider centred training and promotion of ADR reporting tools are necessary to boost ADR reporting and increase patient safety

Can land use changes alter carbon, nitrogen and major ion transport in subtropical brazilian streams? Modificações no uso da terra podem alterar o transporte fluvial de carbono, nitrogênio e íons maiores?

Several studies in tropical watersheds have evaluated the impact of urbanization and agricultural practices on water quality. In Brazil, savannas (known regionally as Cerrados) represent 23% of the country's surface, representing an important share to the national primary growth product, especially due to intense agriculture. The purpose of this study is to present a comprehensive evaluation, on a yearly basis, of carbon, nitrogen and major ion fluxes in streams crossing areas under different land use (natural vegetation, sugar cane and eucalyptus) in a savanna region of SE Brazil. Eucalyptus and sugar cane alter the transport of the investigated elements in small watersheds. The highest concentration of all parameters (abiotic parameters, ions, dissolved organic carbon DOC - and dissolved inorganic carbon - DIC) were found in Sugar Cane Watersheds (SCW). The observed concentrations of major cations in Eucalyptus Watersheds (EW) (Mg, Ca, K, Na), as well as DIN and DOC, were found frequently to be intermediate values between those of Savanna Watersheds (SW) and SCW, suggesting a moderate impact of eucalyptus plantations on the streamwater. Same trends were found in relation to ion and nutrient fluxes, where the higher values corresponded to SCW. It is suggested that sugar cane plantations might be playing an important role in altering the chemistry of water bodies.<br>Diversos estudos têm sido desenvolvidos em bacias de drenagem tropicais no intuito de avaliar o impacto da urbanização e das práticas agrícolas na qualidade dos corpos d'água. No Brasil, as savanas (conhecidas regionalmente como Cerrado) representam 23% do território brasileiro, sendo uma região importante no crescimento nacional, especialmente devido às intensas atividades agrícolas. A finalidade deste trabalho é apresentar uma avaliação dos fluxos de carbono, nitrogênio e principais íons em córregos com diferentes usos do solo (vegetação, cana de açúcar e eucalipto) em uma região de Cerrado, SE Brasil. A cana de açúcar e o eucalipto alteram o transporte dos elementos investigados nessas pequenas bacias de drenagem. As concentrações mais elevadas de todos os parâmetros analisados (parâmetros abióticos, íons, carbono orgânico dissolvido e carbono inorgânico dissolvido) foram encontradas na bacia de cana de açúcar (SCW). As concentrações observadas para os cátions na bacia do eucalipto (EW) (Mg, Ca, K, Na), assim como Carbono Inorgânico Dissolvido (CID) e Carbono Orgânico Dissolvido (COD), apresentaram valores intermediários entre as bacias do Cerrado e da cana de açúcar, sugerindo um impacto moderado dessa plantação aos corpos d'água. Mesma tendência foi observada para os fluxos de íons e nutrientes, sendo, novamente, os maiores valores encontrados na bacia de cana-de-açúcar. Os autores sugerem que o cultivo da cana de açúcar representa um importante fator na modificação da química de pequenas bacias de drenagem

Different routes for preparing mesoporous organosilicas containing the Tröger's base and their textural and catalytic applications

Organosilica materials with different contents of Tr¿oger¿s base (TB) as builder moieties have been synthesized from previously synthesized bis-trialkoxysilylated Tr¿oger¿s base. Three well-nanostructured hybrid mesoporous materials were prepared through different approachs: (a) anchoring the TB on a preformed silica SBA-15 material by postsynthesis grafting, (b) incorporating the TB fragments into the rigid and ordered periodic mesoporous organosilica (PMO) with hexagonal structure (HMS) by self-assembling process, and (c) using anion fluoride as catalyst for a sol gel synthesis process in the absence of structural directing agents (SDAs), at neutral pH and low synthesis temperature, to introduce the TB units into the walls of high surface orderless mesoporous materials with flexible structure. The degree of long-range ordering of the materials was determined from X-ray diffraction and transmission electron microscopy and the texture of the various samples were analyzed by nitrogen sorption volumetry. The composition of the materials was determined by elemental analyses and thermogravimetry, and the integrity, topology and structuration level of the Tr¿oges base units were characterized by 13C NMR and 29Si MAS NMR spectroscopy. The materials were used as basic organocatalysts in Knoevenagel reaction. The disordered mesoporous hybrid materials show the highest catalytic activity due to the appropriate combination of high accessibility and structural flexibility. These mesoporous organosilica materials are stable upon recycling.We are thankful financial support by Consolider- Ingenio 2010 (MULTICAT project). E. M. thanks Ministerio de Ciencia y Innovacion by the support through Juan de la Cierva contract. The authors are indebted to Dr. Alejandro Vidal-Moya for technical assistance and fruitful discussion on 13C and 29Si MAS NMR spectroscopies.Poli ., E.; Merino Marcos, E.; Díaz Morales, UM.; Brunel, D.; Corma Canós, A. (2011). Different routes for preparing mesoporous organosilicas containing the Tröger's base and their textural and catalytic applications. Journal of Physical Chemistry C. 115(15):7573-7585. doi:10.1021/jp2002854S757375851151

Reactogenicity and immunogenicity after a late second dose or a third dose of ChAdOx1 nCoV-19 in the UK: a substudy of two randomised controlled trials (COV001 and COV002)

COVID-19 vaccine supply shortages are causing concerns about compromised immunity in some countries as the interval between the first and second dose becomes longer. Conversely, countries with no supply constraints are considering administering a third dose. We assessed the persistence of immunogenicity after a single dose of ChAdOx1 nCoV-19 (AZD1222), immunity after an extended interval (44–45 weeks) between the first and second dose, and response to a third dose as a booster given 28–38 weeks after the second dose.In this substudy, volunteers aged 18–55 years who were enrolled in the phase 1/2 (COV001) controlled trial in the UK and had received either a single dose or two doses of 5 × 1010 viral particles were invited back for vaccination. Here we report the reactogenicity and immunogenicity of a delayed second dose (44–45 weeks after first dose) or a third dose of the vaccine (28–38 weeks after second dose). Data from volunteers aged 18–55 years who were enrolled in either the phase 1/2 (COV001) or phase 2/3 (COV002), single-blinded, randomised controlled trials of ChAdOx1 nCoV-19 and who had previously received a single dose or two doses of 5 × 1010 viral particles are used for comparison purposes. COV001 is registered with ClinicalTrials.gov, NCT04324606, and ISRCTN, 15281137, and COV002 is registered with ClinicalTrials.gov, NCT04400838, and ISRCTN, 15281137, and both are continuing but not recruiting.Between March 11 and 21, 2021, 90 participants were enrolled in the third-dose boost substudy, of whom 80 (89%) were assessable for reactogenicity, 75 (83%) were assessable for evaluation of antibodies, and 15 (17%) were assessable for T-cells responses. The two-dose cohort comprised 321 participants who had reactogenicity data (with prime-boost interval of 8–12 weeks: 267 [83%] of 321; 15–25 weeks: 24 [7%]; or 44–45 weeks: 30 [9%]) and 261 who had immunogenicity data (interval of 8–12 weeks: 115 [44%] of 261; 15–25 weeks: 116 [44%]; and 44–45 weeks: 30 [11%]). 480 participants from the single-dose cohort were assessable for immunogenicity up to 44–45 weeks after vaccination. Antibody titres after a single dose measured approximately 320 days after vaccination remained higher than the titres measured at baseline (geometric mean titre of 66·00 ELISA units [EUs; 95% CI 47·83–91·08] vs 1·75 EUs [1·60–1·93]). 32 participants received a late second dose of vaccine 44–45 weeks after the first dose, of whom 30 were included in immunogenicity and reactogenicity analyses. Antibody titres were higher 28 days after vaccination in those with a longer interval between first and second dose than for those with a short interval (median total IgG titre: 923 EUs [IQR 525–1764] with an 8–12 week interval; 1860 EUs [917–4934] with a 15–25 week interval; and 3738 EUs [1824–6625] with a 44–45 week interval). Among participants who received a third dose of vaccine, antibody titres (measured in 73 [81%] participants for whom samples were available) were significantly higher 28 days after a third dose (median total IgG titre: 3746 EUs [IQR 2047–6420]) than 28 days after a second dose (median 1792 EUs [IQR 899–4634]; Wilcoxon signed rank test p=0·0043). T-cell responses were also boosted after a third dose (median response increased from 200 spot forming units [SFUs] per million peripheral blood mononuclear cells [PBMCs; IQR 127–389] immediately before the third dose to 399 SFUs per milion PBMCs [314–662] by day 28 after the third dose; Wilcoxon signed rank test p=0·012). Reactogenicity after a late second dose or a third dose was lower than reactogenicity after a first dose.An extended interval before the second dose of ChAdOx1 nCoV-19 leads to increased antibody titres. A third dose of ChAdOx1 nCoV-19 induces antibodies to a level that correlates with high efficacy after second dose and boosts T-cell responses.UK Research and Innovation, Engineering and Physical Sciences Research Council, National Institute for Health Research, Coalition for Epidemic Preparedness Innovations, National Institute for Health Research Oxford Biomedical Research Centre, Chinese Academy of Medical Sciences Innovation Fund for Medical Science, Thames Valley and South Midlands NIHR Clinical Research Network, AstraZeneca, and Wellcome