Equitable access to quality trauma systems in low-income and middle-income countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa.

Injuries in low-income and middle-income countries are prevalent and their number is expected to increase. Death and disability after injury can be reduced if people reach healthcare facilities in a timely manner. Knowledge of barriers to access to quality injury care is necessary to intervene to improve outcomes. We combined a four-delay framework with WHO Building Blocks and Institution of Medicine Quality Outcomes Frameworks to describe barriers to trauma care in three countries in sub-Saharan Africa: Ghana, South Africa and Rwanda. We used a parallel convergent mixed-methods research design, integrating the results to enable a holistic analysis of the barriers to access to quality injury care. Data were collected using surveys of patient experiences of injury care, interviews and focus group discussions with patients and community leaders, and a survey of policy-makers and healthcare leaders on the governance context for injury care. We identified 121 barriers across all three countries. Of these, 31 (25.6%) were shared across countries. More than half (18/31, 58%) were predominantly related to delay 3 ('Delays to receiving quality care'). The majority of the barriers were captured using just one of the multiple methods, emphasising the need to use multiple methods to identify all barriers. Given there are many barriers to access to quality care for people who have been injured in Rwanda, Ghana and South Africa, but few of these are shared across countries, solutions to overcome these barriers may also be contextually dependent. This suggests the need for rigorous assessments of contexts using multiple data collection methods before developing interventions to improve access to quality care.

Vitamin D Deficiency and Associated Risk Factors in Muslim Housewives of Quetta, Pakistan: A Cross-Sectional Study.

Background Vitamin D (Vit-D) plays a central role in calcium homeostasis and maintains skeletal integrity. Housewives in Quetta, Pakistan are at increased risk of vitamin D deficiency (VDD). They spend a greater part of their day in cleaning, washing, cooking, managing daily groceries, and other household chores. Thus, little time is left for self-care and outdoor activities. They wear hijab and have very little exposure to sunlight. In addition, their diet is deficient in Vit-D-rich food items, rendering them at high risk of VDD. Fear of getting tanned, melasma, and preference for a fair complexion further limit their sun exposure. This study evaluates the prevalence of VDD in housewives and determines its various risk factors to recommend screening guidelines for VDD. Methods A cross-sectional study was performed between November 2020 and April 2021 and recruited housewives aged >18 from the outpatient department of a tertiary care hospital in Quetta. Informed consent was obtained from all participants. VDD was defined as a serum 25(OH)-D level <20 ng/mL (50 nmol/L). Sociodemographic variables and information about the dietary habits, perception, attitudes towards sunlight, and daily duration of sunlight exposure were collected. Mean and standard deviation (SD) were calculated for continuous variables and counts, and proportions were calculated for categorical variables like education, age. Univariate and multivariate logistic regression analyses were performed to determine the risk factors and associations of VDD. Data were analyzed by SAS/STAT software (version 9.4). Results Among 151 housewives, 58.9% of housewives had VDD. VDD group had a higher proportion of females aged 18-30 years and a lower proportion of graduates. The reported use of Vit-D supplements was much lower in the VDD group compared with the non-deficient group, 38.2% versus 71.0 %, P-value <0.001. History of fragility fractures was reported by 10.1% of housewives in the VDD group compared to 4.8% in the non-deficient group, P-value: 0.03. Around 77.5% of housewives in the VDD group spent 15 minutes or less outdoors versus 51.6% in the non-deficient group; 55.1% of housewives in the VDD group reported that they never consumed milk versus 17.7 % in the non-deficient group, P-value <0.00001. In the univariate logistic regression model, housewives with an 11-12th grade of education had 4.80-fold higher odds of VDD compared to those who had undergraduate or graduate degrees (OR: 4.80, 95 % CI: 1.07-21.45). Housewives who never consumed milk had 9.72-fold (95 % CI: 3.69-25.58) higher odds of VDD compared to those who consumed milk on daily basis. Odds of VDD were 3.61-fold (95% CI: 1.06-12.31) higher in those who never consumed fish as compared to those who ate fish at least 1-2 days/week. In multivariate logistic regression, age group 18-30 (OR: 17.07, 95% CI: 1.18-246.86), and never consuming milk (OR: 7.33, 95 % CI: 1.99-26.89) were independently associated with VDD. Conclusion VDD is highly prevalent (58.9%) in housewives of Quetta. It is the need of time to increase awareness regarding the health benefits, sources, and deficiency symptoms of Vit-D. Our study revealed VDD in housewives irrespective of education and income. Dietary supplementations were greater predictors of VDD. Daily sun exposure should be encouraged, and food items should be fortified with Vit-D. Recommendations for Vitamin D screening would be a good step, especially in Muslim housewives.

Green synthesis of silver and gold nanoparticles using Crataegus oxyacantha extract and their urease inhibitory activities.

This study reports the green synthesis and urease inhibitory activities of Ag and Au nanoparticles (NPs) using Crataegus oxyacantha extract. The synthesized NPs were characterized by UV-visible, FT-IR spectroscopy, atomic force microscopy, and scanning electron microscopy. The obtained NPs were spherical in shape, and their size was around 85 nm. A strong correlation between the phytochemicals present in the extract and their capability for the synthesis of NPs was observed. Furthermore, the shape, size, stability, and bioactivity of the NPs were strongly influenced by the stabilizing phytochemicals. The experimental analysis suggested that these NPs have substantial stability in a diverse range of physiological conditions such as pH, salinity, and temperature. The NPs exhibited potent urease enzyme inhibitory activities with percent inhibition of 99.25 and IC50 value of 1.38 ± 0.3, comparable to the standard (thiourea percent inhibition, that is, 98.2% and IC50 value 5.3 ± 0.04). These results suggested that the proposed NPs could be used in the homeopathic and pharmaceutical industries for biomedical applications.

Evaluation of neuroprotective and anti-amnesic effects of Elaeagnus umbellata Thunb. On scopolamine-induced memory impairment in mice.

BACKGROUND: Elaeagnus umbellata is abundantly found in Himalayan regions of Pakistan which is traditionally used to treat various health disorders. However, the experimental evidence supporting the anti-amnesic effect is limited. Therefore the study was aimed to evaluate the prospective beneficial effect of E. umbellata on learning and memory in mice. OBJECTIVES: To assess neuroprotective and anti-amnesic effects of E. umbellata fruit extracts and isolated compounds on the central nervous system. METHODS: Major phytochemical groups present in methanolic extract of E. umbellata were qualitatively determined. The total phenolic and flavonoid contents were also determined in extract/fractions of E. umbellata. On the basis of in vitro promising anticholinesterases (AChE & BChE) and antioxidant activities observed for CHF. Ext and isolated compound-I (Chlorogenic acid = CGA), they were further evaluated for learning and memory in normal and scopolamine-induced cognitive impairment in mice using memory behavioral tests such as the Y maze and Novel object recognition using standard procedures. The test sample were further assessed for in vivo anticholinesterases (AChE & BChE) and DPPH free radical scavenging activities in mice brain sample and finally validated by molecular docking study using GOLD software. RESULTS: The extract/fractions and isolated compounds were tested for their anticholinesterase and antioxidant potentials. The CHF. Ext and CGA showed maximum % inhibition of tested cholinesterases and free radicals. The CHF. Ext and CGA reversed the effects of scopolamine in mice. The CHF. Ext and CGA significantly increased the alternate arm returns and % spontaneous alteration performance while escape latency times (second) significantly decreased in Y maze test. The CHF. Ext and CGA significantly increased the time spent with novel object and also increased the discrimination index in the Novel object recognition test. Furthermore, molecular docking was used to validate the mechanism of cholinesterases inhibition of isolated compounds. CONCLUSION: The data obtained from behavioral and biochemical studies (AChE/BChE and DPPH/ABTS inhibition) have shown that E. umbellata possessed significant memory enhancing potency. These results suggest that E. umbellata extract possess potential antiamnesic effects and amongst the isolated compounds, compound I could be more effective anti-amnesic therapeutics. However, further studies are needed to identify the exact mechanism of action.

Antimalarial diterpenoids from Vitex rotundifolia: Isolation, structure elucidation, and in vitro antiplasmodial activity.

Vitex rotundifolia is an important medicinal plant frequently employed in traditional medicines for the treatment of various ailments. Although this plant species has been under exploration for its constituents by various research groups including our own group, no reports were found regarding the antimalarial potential of this plant or of its purified phytochemicals. Phytochemical investigation of this plant yielded three new (1-3) and five known (4-8) diterpenoids. These compounds were purified by modern chromatographic techniques and their structures were determined by advanced spectroscopic techniques such as nuclear magnetic resonance (NMR) and high-resolution mass spectrometry (HRMS). The in vitro antiplasmodial activities were encouraging, as compounds 2, 6, and 8 were found to have significant IC50 values of 1.2, 1.3 and 11.0 µM, respectively against Plasmodium falciparum.

Evaluation of antioxidant and antimicrobial activities on various extracts of Himalayan medicinal plants.

The DPPH radical scavenging potentials of the fractions were determined in comparison to positive controls such as quercetin with EC50 = 4.12±1.27, ascorbic acid with EC50 = 6.20±1.67, gallic acid with EC50 = 4.75±1.24 and α-tocopherol with EC50 = 32.50±1.57 µg/mL. The experiment showed that aqueous fractions of the bark extracts of Abies pindrow (fraction: C2) and Cedrus deodara (fraction: E2) showed significantly lower EC50 values of 2.5±0.5 and 2.5±0.6 µg/mL, respectively. In reducing power assay, lower EC50 values of 5.5 and 4.5µg/mL were recorded for the aqueous fraction (fraction: C 2) and final residue (fraction: C5), of Abies pindrow, respectively. The ethyl acetate, acetone and final fractions of knot wood of Picea smithiana were found significantly active against all bacterial strains. Of the most sensitive fractions towards all the fungal strains was ethyl acetate fraction obtained from the bark of Cedrus deodara with a zone of inhibition ranging from 75 to 88 % that was more than the standard fluconazole.

Norditerpenoid alkaloids of Delphinium denudatum as cholinesterase inhibitors.

Three new norditerpenoids alkaloids, 1ß-hydroxy,14ß-acetyl condelphine (1), jadwarine-A (2), jadwarine-B (3) along with two known alkaloids isotalatizidine hydrate (4) and dihydropentagynine (5) were isolated from medicinal plant Delphinium denudatum. The structures of natural products 1-5 were established on the basis of HR-EIMS, 1H and 13C NMR (1D & 2D) spectroscopic data as well as by comparison from literature data. The structures of compound 1 and 4 were also confirmed by single crystal X-ray diffraction studies. In-vitro AChE and BChE enzyme inhibitory activities of compounds 1-5 and molecular docking studies were performed to investigate the possible molecular inhibitory mechanism of the isolated natural products. Compound 2, 4 and 5 showed competitive inhibitory effects by inhibiting AChE and BChE, respectively, while 1 and 3 showed non-competitive inhibition. This work is the first report that provides a supporting evidence about the use of constituents of Delphinium denudatum in cerebral dementia and Alzheimer diseases.

Bioactive Neolignans and Other Compounds from Magnolia grandiflora L.: Isolation and Antiplasmodial Activity.

Bioassay-guided fractionation of a methanol extract of Magnolia grandiflora against Plasmodium falciparum yielded two new (1 and 2) and six known (3 - 8) bioactive compounds. The structures of the new compounds were assigned by mass spectrometric and 1D- and 2D-NMR data. Known compounds were identified by comparison of 1 H-NMR and MS data with literature data. The two known neolignans 3 and 4 showed moderate antiplasmodial activity with the IC50 values of 2.8 ± 0.1 and 3.4 ± 0.1 µm, respectively. Weak antiplasmodial activity was recorded for compounds 1, 2, 5, 6, 7, and 8, with the IC50 values of 38 ± 2, 23 ± 2, 16.5 ± 0.2, 86 ± 1, 44 ± 4, and 114 ± 9 µm, respectively.

Spectrophotometric determination of the total phenolic content, spectral and fluorescence study of the herbal Unani drug Gul-e-Zoofa (Nepeta bracteata Benth).

OBJECTIVES: This study quantitatively determined the total phenolic contents in ethanolic and aqueous extracts of Gul-e-Zoofa (flowers of Nepeta bracteata Benth) using a spectrophotometric method. We also performed a spectral study (UV and IR) of the ethanolic extract and a fluorescence study of the powdered drug and successive extracts to identify and characterize the genuine herbal drug, which has not been previously performed. METHODS: The total phenolic content was determined quantitatively using the Folin Ciocalteu reagent, with Gallic acid as the standard. The fluorescence characteristics of the powdered drug and successive extracts with and without chemical treatment during the day and under a UV light were recorded. The UV and IR spectra of the alcoholic extract of Gul-e-Zoofa were recorded using a spectrometer. RESULTS: The total phenolic contents of the alcoholic and aqueous extracts were found to be 326.28 and 319.14 mg/g of the Gallic acid equivalent (GAE), respectively. The wavelength of the maximum absorption in the UV spectrum was 320 nm, and the characteristic frequencies in the IR spectrum were 3465.31, 3220.07, 2927.3, 2856.1, 1709.07, 1610.19, 1404.5, 1250.2, 1056.42, 823.04, 775.58, 577.81, and 463.10 cm-1. The fluorescence characteristics of the powdered drug were also observed. CONCLUSION: This spectral and fluorescence study of the drug will be helpful for confirming the identity and purity of the genuine drug. The total phenolic content will be helpful for developing new drugs and standardizing the drug. The presence of a high total phenolic content shows that the flowers of N. bracteata Benth may possess antioxidant properties, which could lead to a new field of research in the future.

Anti-ulcer xanthones from the roots of Hypericum oblongifolium Wall.

Three new xanthones, hypericorin C (1), hypericorin D (2) and 3,4-dihydroxy-5-methoxyxanthone (3), along with eight known compounds; 2,3-dimethoxyxanthone (4), 3,4-dihydroxy-2-methoxyxanthone (5), 3,5-dihydroxy-1-methoxyxanthone (6), 3-acetylbetulinic acid (7), 10H-1,3-dioxolo[4,5-b]xanthen-10-one (8), 3-hydroxy-2-methoxyxanthone (9), 3,4,5-trihydroxyxanthone (10) and betulinic acid (11) were isolated from the roots of Hypericum oblongifolium. The structures of the new compounds 1, 2 and 3 were deduced by spectroscopic techniques [ESI MS, (1)H NMR, (13)C NMR, and 2D NMR (HMQC, HMBC, COSY and NOESY)]. The entire series of compounds were evaluated for anti-ulcer activity.

Activity of solvent extracts of Prosopis spicigera, Zingiber officinale and Trachyspermum ammi against multidrug resistant bacterial and fungal strains.

BACKGROUND: The emerging trends of multidrug resistance among several groups of microorganisms against different classes of antibiotics led different researchers to develop efficient drugs from plant sources to counter multidrug resistant strains. This study investigated different solvent extracts of Prosopis spicigera (P. Spicigera), Zingiber officinale, and Trachyspermum ammi (T. ammi) to determine their efficacy against multidrug resistant microbes. METHODOLOGY: Successive extractions of these plants were performed using a Soxhlet apparatus, using solvents with increasing polarities. Preliminary phytochemical analysis was also performed. Minimum inhibitory concentration was determined by a two-fold serial dilution method followed by determination of minimum bactericidal/fungicidal concentration. Multidrug resistant (MDR) strains of Candida albicans, Candida krusei, Candida tropicalis, Candida glabrata, Escherichia coli and reference strains of Streptococcus mutans and Streptococcus bovis were used in the study. RESULTS: The ethanolic fraction of P. spicigera (least minimum inhibitory concentration [MIC] - 4.88 microg/ml) demonstrated a remarkable inhibition of the microorganisms while fractions obtained from those of Zingiber officinale (least MIC-78.125 microg/ml) exhibited little activity. The petroleum ether fraction of T. ammi (least MIC- 625 microg/ml) showed best activity when compared to its other fractions. Qualitative analysis of the phytoconstituents was also performed. CONCLUSIONS: The potency shown by these extracts recommends their use against multidrug resistant microorganisms. This study also showed that P. spicigera could be a potential source of new antimicrobial agents.

An experimental study of sexual function improving effect of Myristica fragrans Houtt. (nutmeg).

BACKGROUND: Myristica fragrans Houtt. (nutmeg) has been mentioned in Unani medicine to be of value in the management of male sexual disorders. The present study was undertaken to evaluate the aphrodisiac effect of 50% ethanolic extract of nutmeg along with its likely adverse effects and acute toxicity using various animal models. METHODS: The suspension of the extract was administered (100, 250 and 500 mg/kg, p.o.) to different groups of male rats daily for seven days. The female rats involved in mating were made receptive by hormonal treatment. The general mating behaviour, libido and potency were studied and compared with the standard reference drug sildenafil citrate. Likely adverse effects and acute toxicity of the extract were also evaluated. RESULTS: Oral administration of the extract at the dose of 500 mg/kg, produced significant augmentation of sexual activity in male rats. It significantly increased the Mounting Frequency, Intromission Frequency, Intromission Latency and caused significant reduction in the Mounting Latency and Post Ejaculatory Interval. It also significantly increased Mounting Frequency with penile anaesthetization as well as Erections, Quick Flips, Long Flips and the aggregate of penile reflexes with penile stimulation. The extract was also observed to be devoid of any adverse effects and acute toxicity. CONCLUSION: The resultant significant and sustained increase in the sexual activity of normal male rats without any conspicuous adverse effects indicates that the 50% ethanolic extract of nutmeg possesses aphrodisiac activity, increasing both libido and potency, which might be attributed to its nervous stimulating property. The present study thus provides a scientific rationale for the traditional use of nutmeg in the management of male sexual disorders.

Effect of 50% ethanolic extract of Syzygium aromaticum (L.) Merr. & Perry. (clove) on sexual behaviour of normal male rats.

BACKGROUND: The flower bud of Syzygium aromaticum (L.) Merr. & Perry. (clove) has been used in Unani medicine since ancient times for the treatment of male sexual disorders. The present study is aimed to investigate the effect of 50% ethanolic extract of clove on general mating behaviour, libido, potency along with its likely gastric ulceration and adverse effects on sexually normal male albino rats. METHODS: The suspension of the extract was administered orally at the dose of 100, 250, and 500 mg / kg, to different groups of male rats (n = 6) once a day for seven days. The female albino rats involved in mating were made receptive by hormonal treatment. The general mating behaviour, libido and potency were determined and compared with the standard reference drug sildenafil citrate. The probable gastric ulceration and adverse effects of the extract were also evaluated. RESULTS: Oral administration of the extract significantly increased the Mounting Frequency, Intromission Frequency; Intromission Latency, Erections; Quick Flips, Long Flips as well as aggregate of penile reflexes and caused significant reduction in the Mounting Latency and Post Ejaculatory Interval. The most appreciable effect of the extract was observed at the dose of 500 mg/kg. The test drug was also found to be devoid of any conspicuous gastric ulceration and adverse effects. CONCLUSION: The results indicated that the 50% ethanolic extract of clove produced a significant and sustained increase in the sexual activity of normal male rats, without any conspicuous gastric ulceration and adverse effects. Thus, the resultant aphrodisiac effectivity of the extract lends support to the claims for its traditional usage in sexual disorders.

Outpatient laser tonsillar ablation under local anaesthetic.

Outpatient laser ablation of the palatine tonsils under local anaesthetic is an alternative technique to capsular tonsillectomy for recurrent tonsillitis under general anaesthetic. Laser tonsillotomy ablates up to 70% of the tonsillar tissue and is performed when patients choose not to have a conventional tonsillectomy, or are unfit for a general anaesthetic. The technique described here is an adaptation of Krespis' laser-assisted serial tonsillectomy (LAST) whereby only one sitting is required. Krespis' technique effectively eliminates recurrent tonsillitis in 96% of the cases over a 4-year follow-up period and represents the only substantial study looking at treating recurrent tonsillitis with outpatient laser ablation. This study is a retrospective postal survey of 19 patients who underwent laser tonsillar ablation under local anaesthetic for recurrent chronic tonsillitis from 1997 to 2001 and was performed in liaison with the clinical audit department at Basildon Hospital. We had a response rate of 74% and an admission rate of 0%, which compares favourably with day case tonsillectomy surgery. Of the patients, 75% did not experience further episodes of tonsillitis 12 months after the procedure and 77% of the patients were glad they had the operation. Although this technique does not completely eliminate tonsillitis, it offers an alternative for those patients who prefer a procedure that is done quickly in an outpatient setting without the additional problems of general anaesthesia, overnight hospital admission and long waiting lists.

Aphrodisiac activity of 50% ethanolic extracts of Myristica fragrans Houtt. (nutmeg) and Syzygium aromaticum (L) Merr. & Perry. (clove) in male mice: a comparative study.

BACKGROUND: Spices are considered as sexual invigorators in the Unani System of Medicine. In order to explore the sexual function improving effect of Myristica fragrans Houtt. (nutmeg) and Syzygium aromaticum (L) Merr. & Perry. (clove) an experimental study was conducted in normal male mice. METHODS: The extracts (50% ethanolic) of nutmeg and clove were administered (500 mg/kg; p.o.) to different groups of male Swiss mice. Mounting behaviour, mating performance, and general short term toxicity of the test drugs were determined and compared with the standard drug Penegra (Sildenafil citrate). RESULTS: The extracts of the nutmeg and clove were found to stimulate the mounting behaviour of male mice, and also to significantly increase their mating performance. The drugs were devoid of any conspicuous general short term toxicity. CONCLUSION: The extracts (50% ethanolic) of nutmeg and clove enhanced the sexual behaviour of male mice.