Phytochemical screening, FTIR and GCMS analysis of Cucurbita pepo seeds cultivated in Kiambu county, Kenya.

Bioactive compounds and other constituents of plants have been shown to vary by cultivation region, species, environmental conditions and method of extraction among others. Phytochemical analysis of Cucurbita pepos farmed in Kiambu County, Kenya, or their seeds has not been documented. The present research aimed to bridge this knowledge gap by screening phytochemicals and characterizing the seed extracts of Cucurbita pepo cultivated in Kiambu County, Kenya. Cucurbita pepo seeds extracted using organic solvent extraction method employing methanol and preconcentrated in a vacuum rotatory evaporator. The extracts were characterized by GCMS and Fourier transform infrared (FTIR) techniques. Phytochemical analysis of the seeds revealed the presence of flavonoids, alkaloids, saponins, cardiac glycosides, and steroids. FT-IR analysis showed significant peaks for C-N, N-H, C-O, C-H, and CH3 functional groups. The GCMS studies revealed a significant number of fatty acids and their derivatives with 12-cis-octadecadienoate being the most abundant in the oil (53.93 %). A significant amount of the macrocyclic lactone 7,9-ditert-butyl-1-oxaspiro [4.5] deca-6,9-diene-2,8-dione (0.58 %) in the seeds was reported. Macrocyclic lactones are generally a class of anthelminthic drugs. These reported biologically active compounds have a wide range of medicinal and nutritional value. One interesting compound from the GCMS analysis of the seed extracts analyzed was the macrocyclic lactone providing a basis for further research on the anthelminthic actions of the seeds.

Air-soil cycling of oxygenated, nitrated and parent polycyclic aromatic hydrocarbons in source and receptor areas.

Polycyclic aromatic hydrocarbons (PAHs) and their oxygenated and nitrated derivatives, OPAHs and NPAHs, are semivolatile air pollutants which are distributed and cycling regionally. Subsequent to atmospheric deposition to and accumulation in soils they may re-volatilise, a secondary source which is understudied. We studied the direction of air-soil mass exchange fluxes of 12 OPAHs, 17 NPAHs, 25 PAHs and one alkylated PAH in two rural environments being influenced by the pollutant concentrations in soil and air, by season, and by land cover. The OPAHs and NPAHs in samples of topsoil, of ambient air particulate and gas phases and in the gas-phase equilibrated with soil were analysed by GC-APCI-MS/MS. The pollutants soil burdens show a pronounced seasonality, a winter maximum for NPAHs and PAHs and a summer maximum for OPAHs. One order of magnitude more OPAH and parent PAH are found stored in forest soil than in nearby grassland soil. Among a number of 3-4 ring PAHs, the OPAHs benzanthrone and 6H-benzo(c,d)pyren-6-one, and the NPAHs 1- and 2-nitronaphthalene, 9-nitrophenanthrene and 7-nitrobenz(a)anthracene are found to re-volatilise from soils at a rural background site in central Europe in summer. At a receptor site in northern Europe, net deposition of polycyclic aromatic compounds (PACs) prevails and re-volatilisation occurs only sporadic. Re-volatilisation of a number of PACs, including strong mutagens, from soils in summer and even in winter indicates that long-range atmospheric transport of primary PAC emissions from central Europe to receptor areas might be enhanced by secondary emissions from soils.

What makes joint assessment procedures attractive to the innovative industry: successes, challenges, and proposed improvements.

Regulatory harmonization and convergence have been identified as the key driver in promoting efficient evaluation of medicines, reducing workload, and supporting earlier access to medicines on the African continent. There has been great progress to date in enhancing regulatory harmonization and convergence on the African continent via the Regional Economic Communities (RECs) and with the establishment of the Africa Medicines Agency (AMA). In this article, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Africa Regulatory Network (ARN) presents its perspective based on the available literature review and results from a survey conducted with innovative biopharmaceutical companies to gather experiences using regional joint assessment procedures (JAPs) in Africa, such as the East African Community Medicines Regulatory Harmonization (EAC-MRH), the West African Medicines Regulatory Harmonization (WA-MRH), and the Southern African Development Community Medicines Regulatory Harmonization (SADC-MRH) initiative through the ZAZIBONA Collaborative Procedure for Medicines Registration (ZaZiBoNa), and provides best practices in this evolving landscape. The article also assesses other collaborative registration pathways available to facilitating registration of pharmaceutical products in African countries, such as WHO Collaborative Registration Procedures (CRP), Swissmedic's Marketing Authorisation for Global Health Products (MAGHP) and EU Medicines for All (EU-M4ALL). Benefits and challenges of each of the existing pathways are discussed in this article. Main benefits include building more expert capacity and improved collaboration amongst experts, as well as shorter review timelines in some cases. Key challenges include the lack of predictability in the adherence to procedural timelines as defined per guidelines, lengthy timeline to achieve national marketing authorization following joint assessment, the lack of dedicated personnel, administrative issues during the submission process as well as additional country-specific requirements on top of JAP-specific requirements. Our recommendations for improvements include harmonization of requirements across countries and regions and with international standards, appropriate resource allocation for JAP activities to ensure adherence to timelines, use of JAPs throughout the entire product lifecycle and all product categories, adequate use of digital technologies, and improved communication and transparency with applicants. These improvements will allow industry to better plan their filing strategies for the region which will lead to overall improved usability of the JAPs in Africa and enable faster patient access.

Inequity and disparities mar existing global research evidence on Long COVID.

Since the pandemic began in December 2019, SARS-Cov2 has accentuated the wide gap and disparities in socioeconomic and healthcare access at individual, community, country, and regional levels. More than two years into the current pandemic, up to three-fourths of the patients are reporting continued signs and symptoms beyond the acute phase of COVID-19, and Long COVID portends to be a major challenge in the future ahead. With a comprehensive overview of the literature, we found that most studies concerning long COVID came from high and upper-middle income countries, and people of low-income and lower-and-middle income regions and vulnerable groups with comorbid conditions have been neglected. Apart from the level of income, there is a significant geographical heterogeneity in investigating the Post-Acute Sequelae of COVID-19 (PASC) or what we call now, long COVID. We believe that these recognizing health disparities is crucial from equity perspective and is the first step toward global health promotion.

Belimumab in the Treatment of Connective Tissue Disease-Associated Interstitial Lung Disease: Case Report and Literature Review.

Interstitial lung disease or ILD can be described as inflammation, fibrosis, or scarring of the lung's interstitial, resulting in dyspnea. ILD represents a group of heterogeneous parenchymal lung disorders with complex pathophysiology, differentiated by the clinical and radiological patterns. ILD is one of the most serious pulmonary complications associated with connective tissue diseases (CTDs), resulting in significant morbidity and mortality. Nonspecific interstitial pneumonia is the most common morphological and pathological pattern of ILD seen in CTDs. There are limitations in the therapeutic options resulting in significant morbidity. Certain biologic therapies are being evaluated for the various forms of ILD. The ILD, in this case, is associated with systemic lupus erythematosus (SLE) and scleroderma overlap that was effectively treated with belimumab, a recombinant monoclonal antibody against the B-cell activating factor (B-lymphocyte stimulator).

Electrophoresis on a polyester thread coupled with an end-channel pencil electrode detector.

We present the design and characterization of a low cost, thread-based electrophoretic device with integrated electrochemical detection. The device has an end-channel pencil graphite electrode placement system for performing electrochemical detection on the thread electrophoresis platform with direct sample pipetting onto the thread. We also established the use of methylene blue and neutral red as a pair of reference migration markers for separation techniques coupled with electrochemical detection, as they have different colors for visual analysis and are both electroactive. Importantly, neutral red was also found to migrate at a similar rate to the EOF, indicating that it can be used as a visual identifier of EOF. The utility of our system was demonstrated by electrophoretic separation and electrochemical detection of physiologically relevant concentrations of pyocyanin in a solution containing multiple electroactive compounds. Pyocyanin is a biomarker for the detection of pathogenic Pseudomonas aeruginosa and has a redox potential that is similar to that of methylene blue. The system was able to effectively resolve methylene blue, neutral red, and pyocyanin in less than 7 min of electrophoretic separation. The theoretical limit of detection for pyocyanin was determined to be 559 nM. The electrophoretic mobilities of methylene blue (0.0236 ± 0.0007 mm2 /V·s), neutral red (0.0149 ± 0.0007 mm2 /V·s), and pyocyanin (0.0107 ± 0.0003 mm2 /V·s) were also determined.

Long COVID, a comprehensive systematic scoping review.

PURPOSE: To find out what is known from literature about Long COVID until January 30, 2021. METHODS: We undertook a four-step search with no language restriction. A preliminary search was made to identify the keywords. A search strategy of all electronic databases resulted in 66 eligible studies. A forward and backward search of the references and citations resulted in additional 54 publications. Non-English language articles were translated using Google Translate. We conducted our scoping review based on the PRISMA-ScR Checklist. RESULTS: Of 120 papers, we found only one randomized clinical trial. Of the 67 original studies, 22 were cohort, and 28 were cross-sectional studies. Of the total 120 publications, 49.1% focused on signs and symptoms, 23.3% on management, and 10.8% on pathophysiology. Ten publications focused on imaging studies. The results are also presented extensively in a narrative synthesis in separated sections (nomenclature, diagnosis, pathophysiology, risk factors, signs/symptoms, management). CONCLUSIONS: The controversies in its definition have impaired proper recognition and management. The predominant symptoms were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness.

Assessment of delayed tuberculosis diagnosis preceding diagnostic confirmation among tuberculosis patients attending Isiolo County level four hospital, Kenya.

INTRODUCTION: delayed diagnosis of Mycobacterium tuberculosis infection leads to accelerated individual to individual transmission. This study evaluated this aspect of delayed diagnosis among patients visiting Isiolo level four hospital in northern Kenya. METHODS: this was a cross-sectional cohort study conducted during January, 2018-January, 2019 with systematically sampled 172 tuberculosis (TB) patients. Epidemiological and clinical characteristics were abstracted from records to serve as independent variables. Outcome variable was delayed diagnosis dichotomised into < 21 or > 21 days and treated as a binary outcome. Pre-tested interviewer-administered questionnaires, focused group discussions, and key informant interview guides were used to collect relevant information. RESULTS: most (n=89, 57.8%) of the TB diagnosis fell in the category of > 21 day delay. Overall, among all patients, delay in days constituted a median of 27.6, a mean of 37.3 ± 57 days (range 0-414 days). Factors associated with delayed diagnosis (happening > 21 days) included (i) use of dispensary and private health facilities, (OR=4.3, 95% CI: 1.44,13.14; P=0.009) and (OR= 4.9, 95% CI: 1.64, 14.73; P=0.004), respectively (ii) Self-employed individuals (OR=21.7, 95% CI: 2.47,190.93; P=0.006) and employed individuals (OR=9.9, 95% CI: 1.14, 85.80; P=0.038) (iii) secondary-level education (OR=0.03, 95% CI: 0.01,0.21; P=0.000) and tertiary education (OR=0.033, 95% CI: 0.01, 0.23; P=0.001). CONCLUSION: delayed diagnosis of TB was found to be associated with health-seeking behaviour of TB patients, proxied by diagnosis facility, occupation, and education levels in our study area. Curtailment of local transmission of M. tuberculosis needs intensified health promotion and education in affected communities complemented with active case findings.

Changes in pulmonary artery systolic pressure and right ventricular function in patients with end-stage renal disease on maintenance dialysis.

AIM: Pulmonary hypertension is common in patients with end-stage renal disease, and portends a poor prognosis. There are little data in this population, and previous studies have not evaluated quantitative changes in haemodynamics over time while on maintenance dialysis. This study sought to estimate changes in pulmonary artery systolic pressure (PASP) and right ventricular function over time, and to predict PASP change using clinical variables routinely available at time of initial measurement, in patients on maintenance dialysis. METHODS: We retrospectively studied patients with end-stage renal disease at a university-affiliated dialysis centre who had two separate echocardiograms 1-4 years apart. RESULTS: Seventy-six patients (65 haemodialysis, 11 peritoneal dialysis) were included. PASP was estimated by echocardiography. Baseline PASP was predicted by left-sided valvular disease, anaemia, COPD, left-ventricular mass index, and haemodialysis modality (P = 0.07 for modality). Average increase in PASP was 2.41 mmHg per year. Higher rates of PASP change were predicted by E/e' ratio by tissue doppler on echocardiogram, diabetes mellitus, low LV mass, and left-sided valvular heart disease (P = 0.07 for valvular disease). Patients with higher PASP had higher incidence of new-onset right ventricular dysfunction. CONCLUSION: In patients with end-stage renal disease, PASP increases over time. Changes are moderately predictable. Higher PASP predicted development of right ventricular dysfunction.

Evaluating and Improving the Efficiency of Patient Flow in the Bronchoscopy Suite in a Tertiary Care Center: A QI Project!

PURPOSE: The bronchoscopy suite is where pulmonologists perform the majority of their procedures like bronchoscopy, endobronchial ultrasound, and navigational bronchoscopy among others. Faculty and fellows in our division have reported multiple delays in the procedure start time in our bronchoscopy. OBJECTIVES: Objectives of the study were (1) to identify the areas of delays in procedure start time, (2) to identify potential high-yield areas of interventions to reduce delays, (3) to assess the impact of interventions on efficacy of bronchoscopy suit. METHODS: We have conducted a quality improvement project aiming at identifying areas of delays and implemented an intervention aiming at minimizing those delays. We retrospectively collected the data about the patient flow from arrival to hospital to discharge between June and August 2016. We used fishbone technique to identify the potential reasons for delay in procedures and to identify low-effort high-yield areas. Our intervention was raising awareness and education among the personnel and designing the process to reduce time delays and improve efficacy. We collected the data about the patient flow prospectively after the invention was implemented. RESULTS: The study showed that 76.4% of our preintervention procedures had a late start time. The postintervention results revealed a statistically significant reduction in the procedure late start times by 24.4% (P = .02). Signing the procedure H and P was also identified as a major area of delay, which has improved postintervention (65.5 % vs 33.3%, P = 0.017). CONCLUSION: The faculty and fellows' perceptions were translated into objective data, which serves as a first step in our division to improve the patient flow process in the bronchoscopy suite. Areas of delays were identified and our intervention resulted in significant improvement, but more work needs to be done to achieve a more efficient patient flow in the bronchoscopy suite while maintaining a safe patient care.

Vascular Air Embolism During Bronchoscopy Procedures- Incidence, Pathophysiology, Diagnosis, Management and Outcomes.

Vascular air embolism (VAE) is a rare, but potentially fatal complication of invasive medical or surgical procedures. It is a very rare complication of bronchoscopy and is most frequently reported with therapeutic bronchoscopy with Argon plasma coagulation (APC) or neodymium-doped yttrium aluminum garnet (Nd-YAG) laser. Despite being rare, as a result of its high chance of mortality and morbidity, it is imperative that physicians have high clinical suspicion to allow for early recognition and treatment. In this article, we provide a concise review of the incidence, pathophysiology, diagnosis management and outcomes of air embolism during bronchoscopy procedures.

Persistent organic pollutants in the Antarctic coastal environment and their bioaccumulation in penguins.

Persistent organic pollutants (POPs), including polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), polybrominated dibenzo-p-dioxins and dibenzofurans (PBDD/Fs), polybrominated biphenyls (PBBs), and polybrominated diphenyl ethers (PBDEs), have been identified in penguins, lichens, soils, and ornithogenic soils in the Antarctic coastal environment in this study. To the best of our knowledge, no previous study has reported PBDD/F and PBB data from Antarctica. The POP mass contents in penguins were in the following order: PCBs >> PBDEs >> PCDD/Fs; PCBs were the dominant pollutants (6310-144,000 pg/g-lipid), with World Health Organization toxic equivalency values being 2-14 times higher than those of PCDD/Fs. Long-range atmospheric transport is the most primary route by which POPs travel to Antarctica; however, local sources, such as research activities and penguin colonies, also influence POP distribution in the local Antarctic environment. In penguins, the biomagnification factor (BMF) of PCBs was 61.3-3760, considerably higher than that for other POPs. According to BMF data in Adélie penguins, hydrophobic PBDE congeners were more biomagnified at log Kow > 6, and levels decreased at log Kow > 7.5 because larger molecular sizes inhibited transfer across cell membranes.

Long-term monitoring and modeling of polychlorinated dibenzo-p-dioxins and dibenzofurans from municipal solid waste incinerators and surrounding area in northern Taiwan.

Municipal solid waste incinerators (MSWIs) have long been the major contributors of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) to ambient air in Taiwan. After stringent MSWI emission standards were introduced in 2001, the long-term continuous monitoring of flue gas and ambient air quality became necessary to ensure the effectiveness of the related control strategies. Three MSWIs and the surrounding ambient air were investigated in the current study for PCDD/F characteristics during 2006 to 2011. The average concentrations in the flue gas ranged from 0.008 ~ 0.0488 ng I-TEQ/Nm(3), which is much less than the emission standard in Taiwan (0.1 ng I-TEQ/Nm(3)) (I-TEQ is the abbreviation of International Toxic Equivalent). This led to extremely low levels in the ambient air, 0.0255 pg I-TEQ/Nm(3), much less than the levels seen in most urban areas around the world. Additionally, the results obtained using the Industrial Source Complex Short-Term Dispersion Model (ISCST3) indicate that the PCDD/F contributions from the three MSWIs to the ambient air were only in the range from 0.164 ~ 0.723 %. Principal component analysis (PCA) showed that the PCDD/Fs in the air samples had very similar characteristics to those from mobile sources. The results thus show that stringent regulations have been an effective control strategy, especially for urban areas, such as Taipei City.