ABSTRACT
BackgroundThe impact of COVID-19 in Africa remains poorly defined. We sought to describe trends in hospitalisation due to all medical causes, pneumonia-specific admissions, and inpatient mortality in Kenya before and during the first five waves of the COVID-19 pandemic in Kenya. MethodsWe conducted a hospital-based, multi-site, longitudinal observational study of patients admitted to 13 public referral facilities in Kenya from January 2018 to December 2021. The pre-COVID population included patients admitted before 1 March 2020. We fitted time series models to compare observed and predicted trends for each outcome. To estimate the impact of the COVID-19 pandemic, we calculated incidence rate ratios (IRR) and corresponding 95% confidence intervals (CI) from negative binomial mixed-effects models. ResultsOut of 302,703 patients hospitalised across the 13 surveillance sites (range 11547 to 57011), 117642 (39%) were admitted to adult wards. Compared with the pre-COVID period, hospitalisations declined markedly among adult (IRR 0.68, 95% CI 0.63 to 0.73) and paediatric (IRR 0.67, 95% CI 0.62 to 0.73) patients. Adjusted in-hospital mortality also declined among both adult (IRR 0.83, 95% CI 0.77 to 0.89) and paediatric (IRR 0.85, 95% CI 0.77 to 0.94) admissions. Pneumonia-specific admissions among adults increased during the pandemic (IRR 1.75, 95% CI 1.18 to 2.59). Paediatric pneumonia cases were lower than pre-pandemic levels in the first year of the pandemic and elevated in late 2021 (IRR 0.78, 95% CI 0.51 to 1.20). ConclusionsContrary to initial predictions, the COVID-19 pandemic was associated with lower hospitalisation rates and in-hospital mortality, despite increased pneumonia admissions among adults. These trends were sustained after the withdrawal of containment measures that disrupted essential health services, suggesting a role for additional factors that warrant further investigation.
ABSTRACT
Two new ursane-type triterpenes characterized as 3-oxo-24-acetoxy-11α-hydroxy-urs-12-ene (1) and methyl 3α-acetoxy-11α-methoxy-urs-12-en-24-oate (2), together with known compounds 3-11, were isolated from Boswellia rivae oleo-gum resin exudate. Their structural elucidation was accomplished using physical, chemical, and spectroscopic methods. The compounds exhibited weak to moderate antibacterial activities against some Gram-positive and Gram-negative bacteria.
Subject(s)
Anti-Bacterial Agents/isolation & purification , Boswellia/chemistry , Resins, Plant/chemistry , Triterpenes/chemistry , Anti-Bacterial Agents/chemistry , Anti-Bacterial Agents/pharmacology , Electron Spin Resonance Spectroscopy , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Kenya , Microbial Sensitivity Tests , Molecular StructureABSTRACT
Five new iridoid glycosides characterised as 6-keto-8-acetylharpagide (1), 6,7-dehydro-8-acetylharpagide (2), 7,8-dehydroharpagide (3), 8-acetylharpagide-6-O-beta-glucoside (4), harpagide-6-O-beta-glucoside (5) together with three flavonol glycosides, myricetin 3-O-rutinoside-4'-O-rutinoside (6), myricetin 3-O-rutinoside-3'-O-rutinoside (7) and isorhamnetin 3-O-rutinoside-7-O-rutinoside-4'-O-beta-glucoside (8) have been isolated from the aerial parts of Ajuga remota. Also isolated were two known compounds ajugarin IV and ajugarin V. Their structures were established using spectroscopic methods including UV, IR, FAB-MS, HR-MS, 1D and 2D NMR techniques.
Subject(s)
Ajuga/chemistry , Glycosides/isolation & purification , Glycosides/chemistry , Magnetic Resonance Spectroscopy , Mass SpectrometryABSTRACT
Six flavonol glycosides characterised as myricetin 3-O-alpha-rhamnosyl-(1'''-->2'')-alpha-rhamnoside-3'-O-alpha-rhamnoside, 5'-O-methylmyricetin 3-O-[alpha-rhamnosyl (1'''-->2'')][alpha-rhamnosyl (1''''-->4'')]-beta -glucoside-3'-O-beta-glucoside, 5'-O-methylmyricetin 3-O-alpha-rhamnosyl (1'''-->2'')-alpha-rhamnoside 3'-O-beta-galactoside, kaemferol 3-O-rutinoside-7-O-rutinoside, myricetin 3-O-rutinoside-3'-O-alpha-rhamnoside, myricetin 3-O-beta-glucosyl (1'''-->2'')-beta-glucoside-4'-O-beta-glucoside together with two iridoid glycosides identified as 6,8-diacetylharpagide and 6,8-diacetylharpagide-1-O-beta-(3',4'-di-O-acetylglucoside) have been isolated from extract of Ajuga remota aerial parts. Also isolated from the same extract were known compounds; kaempferol 3-O-alpha-rhamnoside, quercetin 3-O-beta-glucoside, quercetin 3-O-rutinoside, 8-acetylharpagide, ajugarin I and ajugarin II.
