OLAX SUBSCORPIOIDEA OLIV. (OLACACEAE): AN ETHNOMEDICINAL AND PHARMACOLOGICAL REVIEW

Background Olax subscorpioidea Oliv. (Olacaceae) is a woody shrub that is widely distributed in Africa. It has trado-medicinal importance and is used in the treatment of asthma, cancer, convulsion, diabetes, intestinal worm infections, jaundice, mental illnesses, neurodegenerative disorders, sexually transmitted infections, swellings and rheumatism, and yellow fever. Aims To review available literature on the phytochemistry, ethnobotany, pharmacology and toxicity of Olax subscorpioidea Oliv. Methods Published findings were searched in online databases such as Web of Science, Scopus, Pubmed, Google Scholar and other relevant sources, and the data were sorted by relevance.  Combinations of keywords used in the search include Olax subscorpioidea, Olacaceae, Olax, Ewe Ifon, and African medicinal plants. Results The presence of alkaloids, anthraquinones, cardiac glycosides, flavonoids, phenolic compounds, proanthocyanidins, saponins, tannins and triterpenes has been reported from O. subscorpioidea. Cytotoxic santalbic acid was isolated from the methanol extract of the seed of this plant, while GC-MS and HPLC analyses of the n-butanol and n-hexane extracts of the leaf revealed the presence of caffeic acid, quercetin, morin, rutin, n-hexadecanoic acid (palmitic acid), 7,10,13-hexadecatrienoic acid and methyl ester, hentriacontane, 9,17-octadecadienal (Z)-, 9,12-octadecadienoic acid (Z,Z)-, squalene, nonacosane, octadecanoic acid. Bioactivity studies on this plant demonstrated its medicinal potential mainly as an analgesic, anthelmintic, anti-arthritic, antidepressant, antihyperglycaemic, anti-inflammatory, antioxidant, antimalarial and antimicrobial agent. Oral acute toxicity of the leaf extracts in rats appeared to be greater than 5,000 mg/kg body weight. Conclusion Published literature available to date on O. subscorpioidea provides some preliminary scientific basis for the ethnomedicinal uses of this plant. However, some ethnomedicinal uses have not been scientifically validated yet, and similarly, only a limited amount of information is available on properly isolated and identified phytochemicals from this plant that link to its bioactivitie

Antibacterial activity of crude extracts of some South African medicinal plants against multidrug resistant etiological agents of diarrhoea

Abstract Background This study evaluated the antibacterial activity of some plants used in folklore medicine to treat diarrhoea in the Eastern Cape Province, South Africa. Methods The acetone extracts of Acacia mearnsii De Wild., Aloe arborescens Mill., A. striata Haw., Cyathula uncinulata (Schrad.) Schinz, Eucomis autumnalis (Mill.) Chitt., E. comosa (Houtt.) Wehrh., Hermbstaedtia odorata (Burch. ex Moq.) T.Cooke, Hydnora africana Thunb, Hypoxis latifolia Wight, Pelargonium sidoides DC, Psidium guajava L and Schizocarphus nervosus (Burch.) van der Merwe were screened against Staphylococcus aureus, Escherichia coli, Enterococcus faecalis, multi-resistant Salmonella enterica serovar Isangi, S. typhi, S. enterica serovar Typhimurium, Shigella flexneri type 1b and Sh. sonnei phase II. A qualitative phytochemical screening of the plants extracts was by thin layer chromatography. Plants extracts were screened for antibacterial activity using serial dilution microplate technique and bioautography. Results The TLC fingerprint indicated the presence of terpenoids and flavonoids in the herbs. Most of the tested organisms were sensitive to the crude acetone extracts with minimum inhibitory concentration (MIC) values ranging from 0.018–2.5 mg/mℓ. Extracts of A. striata, C. uncinulata, E. autumnalis and P. guajava were more active against enteropathogens. S. aureus and Sh. flexneri were the most sensitive isolates to the crude extracts but of significance is the antibacterial activity of A. arborescens and P. guajava against a confirmed extended spectrum betalactamase positive S. enterica serovar Typhimurium. Conclusion The presence of bioactive compounds and the antibacterial activity of some of the selected herbs against multidrug resistant enteric agents corroborate assertions by traditional healers on their efficacies

EPIDEMIOLOGY OF BACTERIA COLONIZATION AND ICU-ACQUIRED INFECTION IN A NIGERIAN TERTIARY HOSPITAL

Background: Health care associated infection (HCAI) or Hospital acquired infection is associated with significant morbidity, mortality and cost. The incidence is about 6% and disproportionately higher in critically ill patients who may have been immune-compromised with many invasive procedures already performed. Prevention of HCAI and appropriate management of patients in the intensive care unit (ICU) requires knowledge on the pattern of microbial colonization and infections. The aim of this preliminary study was to provide current data on the pattern of ICU acquired infections in our hospital. Patients and Methods: It was a cross sectional study of patients admitted into the ICU who were expected to stay longer than 48hrs between July 2011 and September 2012. Urine, blood, and tracheal aspirate were collected on days 1, 3 and 5 for microbiological studies. All patients involved in the study had urethral catheter in-situ and received mechanical ventilation in the ICU. Results: Fifty-nine patients were recruited into the study. The mean age of the patients was 30.08 + 19.9yr; while the reasons for admissions were respiratory failure (59.3%), cardiovascular instability, trauma and neurological diseases. About 30% of the samples taken from the study sites on arrival in the ICU had positive culture yields. Organisms cultured included Klebsiella oxytoca, Staphylococcus aureus, and Pseudomonas aeruginosa. The urinary tract had the highest number of isolated organisms- 9(60%), followed by equal number of isolated organisms-3(20%) in the blood and respiratory tract. Eleven (73.3%) of the organisms isolated were Gram-negative bacteria, and 4 (26.7%) were Gram-positive cocci. The commonest bacteria isolates were Staphylococcus aureus (4/26.7%) and Klebsiella oxytoca (4/ 26.7%). A total of 15 ICU- acquired infections were detected in 9 of 59 patients. Conclusion: The HCIA infection rate was 15%, and urinary tract infections (UTI) was the commonest hospital acquired infection in our ICU. Klebsiella oxytoca and Staphylococcus aureus were the commonest organisms

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Federated learning enables big data for rare cancer boundary detection.

Although machine learning (ML) has shown promise across disciplines, out-of-sample generalizability is concerning. This is currently addressed by sharing multi-site data, but such centralization is challenging/infeasible to scale due to various limitations. Federated ML (FL) provides an alternative paradigm for accurate and generalizable ML, by only sharing numerical model updates. Here we present the largest FL study to-date, involving data from 71 sites across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, reporting the largest such dataset in the literature (n = 6, 314). We demonstrate a 33% delineation improvement for the surgically targetable tumor, and 23% for the complete tumor extent, over a publicly trained model. We anticipate our study to: 1) enable more healthcare studies informed by large diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further analyses for glioblastoma by releasing our consensus model, and 3) demonstrate the FL effectiveness at such scale and task-complexity as a paradigm shift for multi-site collaborations, alleviating the need for data-sharing

Author Correction: Federated learning enables big data for rare cancer boundary detection.

10.1038/s41467-023-36188-7NATURE COMMUNICATIONS14