Neurocritical Care Audit in A Tertiary Institution

Background: The ‘open’ intensive care unit (ICU) predominates in most low and middle economy societies. This is associated with paucity of personnel and cost challenges involved for its maintenance and smooth running despite the great public demand for this service. Data on neurocritical care in scare in Nigeria and the subregion as a whole. Our objective is to audit our neurocritical care facility, human resources, patient admission and outcome.Patients and Method: We conducted a retrospective audit of all patients admitted to our ‘open’ ICU following a neurological indication. This study was carried out over a one year period (January 2008-December 2008). In addition to patients’ boidata, we recorded date of admission, indication for admission, treatment (operative/non operative), ventilatory support if any, and outcome (Alive or dead).Results: One hundred and twenty-nine patients were admitted during the study period, 85 (65.9%) of which was due primarily to a Neurosurgical indication. The overall mortality was 25.9% while mortality of ventilated patients was 64.5%. Mortality rate was significantly by ventilation.Conclusion: Neurological patients account for most of our ICU admission. Hospitals with ICUs should ensure that they have a proper high dependency unit. We also recommend that appropriate equipments and staff training in the area of neurocritical care be incorporated into existing ‘open’ ICUs in our environment. The use of protocol for ventilated patients and managing common ICU cases and common procedures should enhance treatment outcomes

Novel colorimetric assay of mefenamic acid using 4-amino-3,5-dinitrobenzoic acid (ADBA)

Purpose: To develop a novel colorimetric assay method for mefenamic acid capsules. Method: The new method (aromatic ring derivatization technique) is based on a diazo coupling reaction using diazotized 4-amino-3,5-dinitrobenzoic acid (ADBA) as a chromogenic derivatizing reagent. Result: Optimization studies showed that the coupling reaction is very fast and completed in less than 1 minute. A 1:1 drug to reagent stoichiometric ratio was obtained for the azo dye formed. The azo adduct formed exhibits bathochromic shift with absorption maximum (lmax) at 490 nm, which was selected as the analytical wavelength. Lower limit of quantitation of mefenamic acid was 1 mg/ml. The assays were linear over the concentration range of 1 - 6 mg/ml and reproducible. This new method has been successfully applied in the assay of mefenamic acid capsules with accuracy similar to the official (B.P) titrimetric method of assay (p>0.05) and has the advantages of speed, high sensitivity, lower limit of detection and can be automated. Conclusion: The method developed could find application in in-process quality control of mefenamic acid capsules. Keywords: Mefenamic acid assay, 4-amino-3,5-dinitrobenzoic acid, colorimetry, diazotization Trop J Pharm Res, June 2002; 1(1): 15-2

Colorimetric Assay Of Naproxen Tablets by Derivatization Using 4-Carboxyl-2,6-Dinitrobenzene Diazonium Ion

A colorimetric assay of naproxen tablets based on chemical derivatization with the chromogenic reagent 4-carboxyl-2,6-dinitrobenzene diazonium ion was developed. The optimal reaction time was found to be 5 min at 30 oC after vortex mixing of the drug/reagent mixture for 10 s. The optimal analytical wavelength was found to be 470 nm and linearity of response was obtained between 1-7 μgml-1 of naproxen. The diazo coupling reaction occurred in a 2:1 reagent-drug stoichiometric ratio. The method is sensitive, accurate (mean recovery 101.06±3.06 %), reproducible (imprecision 3.03 % CV) and has a low limit of detection (0.95 μgm-1). It was applied in the assay of naproxen tablets with equivalent accuracy (p>0.05) to the official (BP) UV spectrophotometric method but combined the advantages of speed and more affordable instrumentation. The method can be applied in the in-process quality control of naproxen tablets.Keywords: Naproxen assay, 4-carboxyl-2,6-dintrobenzene diazonium ion (CDNBD), colorimetry, diazo coupling reactionEast and Central African Journal of Pharmaceutical Sciences Vol. 12 (2009) 8-1

Artificial Intelligence (AI) to the Rescue: Deploying Machine Learning to Bridge the Biorelevance Gap in Antioxidant Assays.

Oxidative stress induced by excessive levels of reactive oxygen species (ROS) underlies several diseases. Therapeutic strategies to combat oxidative damage are, therefore, a subject of intense scientific investigation to prevent and treat such diseases, with the use of phytochemical antioxidants, especially polyphenols, being a major part. Polyphenols, however, exhibit structural diversity that determines different mechanisms of antioxidant action, such as hydrogen atom transfer (HAT) and single-electron transfer (SET). They also suffer from inadequate in vivo bioavailability, with their antioxidant bioactivity governed by permeability, gut-wall and first-pass metabolism, and HAT-based ROS trapping. Unfortunately, no current antioxidant assay captures these multiple dimensions to be sufficiently "biorelevant," because the assays tend to be unidimensional, whereas biorelevance requires integration of several inputs. Finding a method to reliably evaluate the antioxidant capacity of these phytochemicals, therefore, remains an unmet need. To address this deficiency, we propose using artificial intelligence (AI)-based machine learning (ML) to relate a polyphenol's antioxidant action as the output variable to molecular descriptors (factors governing in vivo antioxidant activity) as input variables, in the context of a biomarker selectively produced by lipid peroxidation (a consequence of oxidative stress), for example F2-isoprostanes. Support vector machines, artificial neural networks, and Bayesian probabilistic learning are some key algorithms that could be deployed. Such a model will represent a robust predictive tool in assessing biorelevant antioxidant capacity of polyphenols, and thus facilitate the identification or design of antioxidant molecules. The approach will also help to fulfill the principles of the 3Rs (replacement, reduction, and refinement) in using animals in biomedical research

Have you seen a rape kit? A snapshot at the quality of care of rape survivors in Nigerian tertiary hospitals

Context: The rape kit has become a fundamental tool in the evaluation of the rape survivor in many countries. Itsavailability and use in Nigeria has however not been documented.Objective: To assess the current availability and usage of the rape kit in Nigerian tertiary hospitals, and evaluate the management of rape survivors.Methodology: Resident Doctors attending the Obstetrics and Gynaecology update course, held in Abuja in March,2009 were interviewed using a self-administered questionnaire assessing experience in rape management, knowledge about the rape kit and its availability, as well as current management of rape survivors.Results: There were 138 respondents from 25 tertiary hospitals, with a male-to-female ratio of 2.8:1 and a meanduration of 3.3 (SD 1.4) years in training. 120 (87%) had personally managed one or more rape survivor(s), but none of the respondents had ever seen a rape kit, and only 29% were aware of it. Although all the respondents indicated availability of emergency contraception, antibiotics and tetanus prophylaxis in their centres, only 32.4% had access to HBV vaccine, and about 8% indicated lack of HIV prophylaxis. Only 28.7% and 45.6% indicated access to clinical psychologists and medical social workers respectively.Conclusion: The rape kit is not available in Nigerian tertiary hospitals. We recommend its provision, and regulartraining of doctors, especially Obstetrics and Gynaecology Residents on rape management, to improve the care ofrape survivors in Nigeria.Key Words: Rape, Rape kit, Rape survivor, Nigeria

Anthelmintic activity and non-cytotoxicity of phaeophorbide-a isolated from the leaf of Spondias mombin L.

ETHNOPHARMACOLOGICAL RELEVANCE: Helminthosis (worm infection) is a disease of grazing livestock, with significant economic implications. Increasing resistance to existing synthetic anthelmintics used to control helminthosis and the unwanted presence of residues of the anthelmintics reported in meat and dairy products present a serious global health challenge. These challenges have necessitated the development of novel anthelmintics that could combat drug resistance and exhibit better safety profiles. Spondias mombin L. (Anacardiaceae) is a plant that has been used traditionally as a worm expeller. AIM OF STUDY: The aim of the work reported herein was to isolate and characterise anthelmintic compound(s) from S. mombin leaf, establishing their bioactivity and safety profile. MATERIALS AND METHODS: Adult Haemonchus placei motility assay was used to assess anthelmintic bioactivity. Bioassay-guided chromatographic fractionation of acetone extract of S. mombin leaf was carried out on a silica gel stationary phase. The structure of the compound was elucidated using spectroscopy (1H and 13C NMR) and Liquid Chromatography-Mass Spectrometry (LC-ESI-MS). Screening to exclude potential cytotoxicity against mammalian cells (H460, Caco-2, MC3T3-E1) was done using alamar blue (AB) and CellTitreGlo (CTG) viability reagents. RESULTS: The acetone extract yielded an active fraction 8 (Ethyl acetate: methanol 90:10; anthelmintic LC50: 3.97 mg/mL), which yielded an active sub-fraction (Ethyl acetate: Methanol 95:5; anthelmintic LC50: 53.8 μg/mL), from which active compound 1 was isolated and identified as phaeophorbide-a (LC50: 23.0 μg/mL or 38.8 μM). The compound was not toxic below 200 μM but weakly cytotoxic at 200 μM. CONCLUSIONS: Phaeophorbide-a (1) isolated from S. mombin leaf extract and reported in the plant for the first time in this species demonstrated anthelmintic activity. No significant toxicity to mammalian cells was observed. It therefore represents a novel anthelmintic pharmacophore as a potential lead for the development of novel anthelmintics

McCune-Albright syndrome

McCune-Albright syndrome (MAS) is classically defined by the clinical triad of fibrous dysplasia of bone (FD), café-au-lait skin spots, and precocious puberty (PP). It is a rare disease with estimated prevalence between 1/100,000 and 1/1,000,000. FD can involve a single or multiple skeletal sites and presents with a limp and/or pain, and, occasionally, a pathologic fracture. Scoliosis is common and may be progressive. In addition to PP (vaginal bleeding or spotting and development of breast tissue in girls, testicular and penile enlargement and precocious sexual behavior in boys), other hyperfunctioning endocrinopathies may be involved including hyperthyroidism, growth hormone excess, Cushing syndrome, and renal phosphate wasting. Café-au-lait spots usually appear in the neonatal period, but it is most often PP or FD that brings the child to medical attention. Renal involvement is seen in approximately 50% of the patients with MAS. The disease results from somatic mutations of the GNAS gene, specifically mutations in the cAMP regulating protein, Gs alpha. The extent of the disease is determined by the proliferation, migration and survival of the cell in which the mutation spontaneously occurs during embryonic development. Diagnosis of MAS is usually established on clinical grounds. Plain radiographs are often sufficient to make the diagnosis of FD and biopsy of FD lesions can confirm the diagnosis. The evaluation of patients with MAS should be guided by knowledge of the spectrum of tissues that may be involved, with specific testing for each. Genetic testing is possible, but is not routinely available. Genetic counseling, however, should be offered. Differential diagnoses include neurofibromatosis, osteofibrous dysplasia, non-ossifying fibromas, idiopathic central precocious puberty, and ovarian neoplasm. Treatment is dictated by the tissues affected, and the extent to which they are affected. Generally, some form of surgical intervention is recommended. Bisphosphonates are frequently used in the treatment of FD. Strengthening exercises are recommended to help maintaining the musculature around the FD bone and minimize the risk for fracture. Treatment of all endocrinopathies is required. Malignancies associated with MAS are distinctly rare occurrences. Malignant transformation of FD lesions occurs in probably less than 1% of the cases of MAS

New Corporate Responsibilities in the Digital Economy

Theories that relate to digital technology and CSR have been dominated by online CSR communication and disclosure practices. Almost entirely absent in such CSR research is a consideration of new areas of responsibility that are emerging from digital technologies and related online communication platforms. We argue that responsibility in the use of digital technologies requires more than just legal compliance. We therefore ask what it means to be a responsible corporation in the digital economy? We then establish an extended agenda for responsibility in the digital economy by identifying potential areas of irresponsibility and highlighting new responsibilities related to, for example: use of consumer data; service continuation; control of digital goods, and; the use of artificial intelligence. In doing so, we address a need to theorize responsibilities derived from the use of technologies that have been previously silent in CSR literature or only tangentially discussed within the domain of CSR communication, even as they are a focus in other fields (especially legal compliance, or organizational performance)

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups