A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy.

OBJECTIVES: This analysis compared adherence, cardiovascular (CV) events and all-cause mortality incidence, and healthcare costs among hypertensive patients treated with perindopril (PER)/indapamide (IND)/amlodipine (AML) in single-pill combination (SPC) vs. multiple-pill combination, in a real-world setting in Italy. METHODS: In this observational retrospective analysis of Italian administrative databases, adult patients treated with PER/IND/AML between 2010 and 2020 were divided into two cohorts: single-pill vs. multiple-pill. Patient data were available for at least one year before and after index date. Propensity score matching (PSM) was applied to reduce selection bias. Adherence was defined as proportion of days covered: non-adherence, <40%; partial adherence, 40-79%, and adherence ≥80%. Mortality incidence and CV events as single, or composite, endpoints were evaluated after first year of follow-up. Healthcare cost analyses were performed from the perspective of the Italian National Health Service. RESULTS: Following PSM, the single-pill cohort included 12 150 patients, and the multiple-pill cohort, 6105. The SPC cohort had a significantly higher percentage of adherent patients vs. the multiple-pill cohort (59.9% vs. 26.9%, P  < 0.001). Following the first year of follow-up, incidence of all-cause mortality, and combined endpoint of all-cause mortality and CV events were lower in the SPC cohort compared with multiple-pill cohort. Average annual direct healthcare costs were lower in the single-pill cohort (€2970) vs. multiple-pill cohort (€3642); cost of all drugs and all-cause hospitalizations were major contributors. CONCLUSION: The SPC of PER/IND/AML, compared with multiple-pill combination, is associated with higher adherence to medication, lower incidence of CV events and mortality, and reduced healthcare costs.

Comparing Cardiovascular Outcomes and Costs of Perindopril-, Enalapril- or Losartan-Based Antihypertensive Regimens in South Africa: Real-World Medical Claims Database Analysis.

INTRODUCTION: Differences in class or molecule-specific effects between renin-angiotensin-aldosterone system (RAAS) inhibitors have not been conclusively demonstrated. This study used South African data to assess clinical and cost outcomes of antihypertensive therapy with the three most common RAAS inhibitors: perindopril, losartan and enalapril. METHODS: Using a large, South African private health insurance claims database, we identified patients with a hypertension diagnosis in January 2015 receiving standard doses of perindopril, enalapril or losartan, alone or in combination with other agents. From claims over the subsequent 5 years, we calculated the risk-adjusted rate of the composite primary outcome of myocardial infarction, ischaemic heart disease, heart failure or stroke; rate of all-cause mortality; and costs per life per month (PLPM), with adjustments based on demographic characteristics, healthcare plan and comorbidity. RESULTS: Overall, 32,857 individuals received perindopril, 16,693 losartan and 13,939 enalapril. Perindopril-based regimens were associated with a significantly lower primary outcome rate (205 per 1000 patients over 5 years) versus losartan (221; P < 0.0001) or enalapril (223; P < 0.0001). The risk-adjusted all-cause mortality rate was lower with perindopril than enalapril (100 vs. 139 deaths per 1000 patients over 5 years; P = 0.007), but not losartan (100 vs. 94; P = 0.650). Mean (95% confidence interval) overall risk-adjusted cost PLPM was Rands (ZAR) 1342 (87-8973) for perindopril, ZAR 1466 (104-9365) for losartan (P = 0.0044) and ZAR 1540 (77-10,546) for enalapril (P = 0.0003). CONCLUSION: In South African individuals with private health insurance, a perindopril-based antihypertensive regimen provided better clinical and cost outcomes compared with other regimens.

Adherence to Triple Single-Pill Combination of Perindopril/Indapamide/Amlodipine: Findings from Real-World Analysis in Italy.

INTRODUCTION: Single-pill combination therapy for hypertension is recognized to improve adherence to treatment. However, less is known about the benefits of triple single-pill combinations. This retrospective observational analysis aimed to assess changes in adherence when treatment was switched from perindopril (PER)/indapamide (IND) + amlodipine (AML) to PER/IND/AML single-pill combination, in Italian clinical practice. METHODS: This analysis used data extracted from administrative databases of Italian healthcare entities. Adult patients receiving PER/IND/AML were selected, and the prescription date was considered as the index date. Among them, those who had a prescription for PER/IND + AML during the 12 months before the index date and a prescription of PER/IND/AML during 6 months of follow-up were included. Adherence was calculated as the proportion of days covered (PDC: PDC < 40%, non-adherent; PDC = 40-79%, partially adherent; PDC ≥ 80%, adherent). RESULTS: Among the identified patients, 158 were exposed users and were included in the analysis. When patients were compared before and after switch to triple single-pill combination, the proportion of adherent patients was significantly higher with PER/IND/AML single-pill combination (75.3%) than with PER/IND + AML combination (44.3%) (P < 0.05). Conversely, the proportion of non-adherent patients was lower with the PER/IND/AML single-pill combination (14.6%) vs PER/IND + AML (17.7%) (P < 0.001). CONCLUSION: This real-world analysis showed that switching to a triple single-pill combination could offer an opportunity to improve adherence to antihypertensive treatment in real-life clinical practice.

Medication adherence is defined by the World Health Organization as the "extent to which a person's behavior (in taking medication) corresponds with agreed recommendations from a healthcare provider". Low levels of medication adherence in hypertension have been linked with increased disease burden and with higher costs for patients. Patients with hypertension whose blood pressure is poorly controlled often need to receive more than one pill. Nevertheless, having to take many pills may result in poor adherence, i.e., patients not taking their treatment as prescribed. Combining multiple drugs into a single pill for the management of hypertension is known to improve adherence; however, limited evidence exists about the benefits of triple single-pill combinations compared with equivalent free combinations in real clinical practice. This analysis evaluated changes in adherence before and after patients switched from a three-drug therapy of perindopril/indapamide single-pill + amlodipine (PER/IND + AML) to perindopril/indapamide/amlodipine (PER/IND/AML) taken as a single pill. In this analysis, real-world data from Italian administrative databases covering around 11% of the Italian population were used. Overall, 158 patients were included. More patients were found to be adherent after switch to PER/IND/AML single pill (75.3% vs 44.3% of PER/IND + AML combination). Partially adherent and poorly adherent patients were fewer with PER/IND/AML single-pill combination (10.1% and 14.6%, respectively) compared to PER/IND + AML combination (38.0% and 17.7%, respectively). These findings indicate that switching to a simplified therapy in which all three drugs are taken in one pill may offer an opportunity for increasing the number of patients that are adherent to their medication.

Budget Impact Analysis of Empagliflozin in the Treatment of Patients With Type 2 Diabetes With Established Cardiovascular Disease in South Africa.

OBJECTIVES: This study aimed to estimate the budget impact and affordability of empagliflozin added to usual care compared with usual care alone, in a diabetic population with established cardiovascular disease, from a private healthcare payer perspective in South Africa. METHODS: A budget impact model was adapted and localized. Epidemiological data were obtained from the South African Council for Medical Schemes. Clinical event rates were sourced from the EMPA-REG OUTCOME trial and drug costs from list prices. Clinical event costs were derived from a claims data analysis of the South African private healthcare sector and microcosting. Scenario analyses were performed on select inputs. The modeled outcomes included annual budget impact of empagliflozin, the incremental cost per life per month, cardiovascular deaths averted, and incremental cost per life saved, over 3 years. RESULTS: A total of 9 503 patients were eligible for empagliflozin (year 1), 12 670 (year 2), and 16 947 (year 3). The incremental cost was $1 272 297, $1 764 705, and $2 455 235, for years 1 to 3, respectively. The incremental cost per beneficiary per month was calculated as $0.012 (year 1), $0.016 (year 2), and $0.023 (year 3). The model estimated a 38.6% reduction in cardiovascular deaths, 305 lives saved, and an incremental cost per life saved of $17 999. CONCLUSIONS: Adding empagliflozin to usual care has a marginal budget implication and is highly affordable for private healthcare payers, with an acceptable incremental cost based on clinical outcomes.

Need for Sustainable Packaging: An Overview.

Packaging materials are a significant part of our lives due to their daily usage at grocery stores, supermarkets, restaurants, pharmaceuticals, etc. Packaging plays an important role in ensuring that the products are preserved during handling, transporting, and storage. Similarly, it helps to maintain and prolong the shelf life of products. These materials are used for packaging meats, poultry and seafood products, food and beverages, cosmetics, and pharmaceutical products. Several applications of packaging materials have been discussed extensively, with little discussion on their end of life and continuous availability without impacting the environment. This study presents the need for sustainable packaging as a result of growing demands and the environmental impact of packaging materials after use. This study also presents the importance, types, and applications of packaging materials. Based on the findings of this study, sustainable packaging is made possible by using bio-based and recyclable materials. These materials contribute a great deal to protecting and ensuring a sustainable environment.

Wet ball milling of niobium by using ethanol, determination of the crystallite size and microstructures.

This study investigates the effect of using ethanol as the process control agent during the wet ball milling of niobium (Nb). Dried nanocrystal Nb powders, of high purity, with particle sizes, ranging from 8.5 to 14.3 nm, were synthesized by ball milling. Commercial Nb powder of particle sizes of - 44 µm was employed by using the planetary ball mill equipped with stainless still vials with still balls in ethanol. A ball-to-powder mass ratio of 10:1 was used at a rotation speed of 400 rpm, an interval of 15 min with an interval break of 5 s, and a milling time of 10 h. The powder was dried in vacutec at a temperature of 100 °C, using a speed of 15 rpm in the vacuum of 250 mbar at a time of approximately 653 min. The crystal phase of the dried powders was analyzed using X-ray diffraction (XRD) with CuKɑ radiation, and by modification of the Scherrer equation, a single crystallite size of 11.85 nm was obtained. The morphology of the particles was observed using scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS). The XRD results show that the pure crystal sizes in nanometre (nm), which decreases as the 2θ and the full width at half maximum (FWHM) increases.

Data on the engineering properties of aluminum dross as a filler in asphalt.

Pavement is the backbone of an effective and efficient transportation system. Data on the use of aluminium dross as filler material in the modification of asphalt for a sustainable pavement was espoused. Aluminium dross which is a solid waste from steel production industry was utilized. Data on the engineering and stability properties of the material in enhancing the strength of the asphalt mix design was espoused. This was achieved by adding the solid waste at 0%, 2.5%, 5%, 7.5%, 10% and 12.5% of aluminium dross to the asphalt concrete sample. Marshall Test was used to determine the stability of aluminium dross in flexible pavement and this was used for the selection of asphalt binder content with a suitable density which satisfies minimum stability and range of flow values using AASHTO specification. The data obtained will be of help to researchers, engineers, road construction workers and environmentalist on the use of this solid waste in the construction of sustainable long-lasting roads for national growth and solid waste reduction.

Frequency analysis of agricultural drought of maize in Sabie River catchment in South Africa.

Maize (Zea mays L.) is a staple food in South Africa. Under dryland farming, drought is a major limiting factor for maize production. The yield of maize is drastically reduced when rainfall is limited and erratic during the growing season. In order to formulate strategies of reducing the impact of drought on maize production, it is necessary to analyse the magnitude and frequency of drought. The objective of this study was to carry out the magnitude and frequency analysis of agricultural drought events of maize in the Sabie River catchment in order to formulate methods of reducing the impact of drought on maize production in the catchment. The maize growing season in the Sabie River catchment begins in October and ends in February the following year. In this study, the maize growing season was divided into three growing periods based on the month maize is planted. The growing periods were: October to December, November to January and December to February. Simple water balance model in the root zone was applied to determine the minimum amount of rainfall required to meet the water requirement of maize in each growing period in all the eight rainfall zones into which the Sabie River catchment is divided. Empirical frequency analysis and stochastic frequency analysis of the agricultural drought events of maize were carried out. From the study, the return period of agricultural drought events of maize was found to be different for each rainfall zone, and the growing period ranges from 1.78 years to 2.68 years. These results are important for hydrological modellers in that they show that it is necessary to determine the best fit probability distribution for frequency analysis of hydrological events rather than assuming one as the best fit. In all rainfall zones, maize was least prone to drought in the growing period of October to December. Based on the results of the study, development of water resource infrastructure for irrigation and adoption of drought-tolerant varieties of maize was recommended to reduce the high risk of agricultural drought of maize in the Sabie River catchment.

Statistical analysis of annual maximum daily rainfall for Nelspruit and its environs.

Nelspruit and its environs frequently experience extreme high annual maximum daily rainfall (AMDR) events resulting in flood hazards. These flood hazards have caused flood disasters that have resulted in loss of property and lives. The main objective of this study was to carry out statistical analysis of extreme high AMDR events that have caused flood hazards, which in turn have caused flood disasters in Nelspruit and its environs. Empirical continuous probability distribution functions (ECPDF) and theoretical continuous probability distribution functions (TCPDF) were applied to carry out the statistical analysis of the extreme high AMDR events. Annual maximum daily rainfall event of magnitude 100 mm was identified as a threshold. Events > 100 mm were considered as extreme high events resulting in flood disasters. The results of empirical frequency analysis showed that the return period of flood disasters was 10 years. The occurrence probability of flood disaster event at least once in 1, 2, 3, 4 and 5 years was 0.10, 0.19, 0.27, 0.34 and 0.41, respectively. Generalised logistic PDF was identified as the best-fit theoretical PDF for statistical analysis of the extreme high AMDR events in Nelspruit and its environs. The results of this study contributed to the understanding of frequency and magnitude of extreme high AMDR events that could lead to flood disasters. The results could be applied in developing flood disaster management strategies in Nelspruit and its environs.

A prospective, observational study comparing the PK/PD relationships of generic Meropenem (Mercide®) to the innovator brand in critically ill patients.

INTRODUCTION: Clinicians' skepticism, fueled by evidence of inferiority of some multisource generic antimicrobial products, results in the underutilization of more cost-effective generics, especially in critically ill patients. The aim of this observational study was to demonstrate equivalence between the generic or comparator brand of meropenem (Mercide®) and the leading innovator brand (Meronem®) by means of an ex vivo technique whereby antimicrobial activity is used to estimate plasma concentration of the active moiety. METHODS: Patients from different high care and intensive care units were recruited for observation when prescribed either of the meropenem brands under investigation. Blood samples were collected over 6 hours after a 30 minute infusion of the different brands. Meropenem concentration curves were established against United States Pharmacopeia standard meropenem (Sigma-Aldrich) by using standard laboratory techniques for culture of Klebsiella pneumoniae. Patients' plasma samples were tested ex vivo, using a disc diffusion assay, to confirm antimicrobial activity and estimate plasma concentrations of the two brands. RESULTS: Both brands of meropenem demonstrated similar curves in donor plasma when concentrations in vials were confirmed. Patient-specific serum concentrations were determined from zones of inhibition against a standard laboratory Klebsiella strain ex vivo, confirming at least similar in vivo concentrations as the concentration curves (90% confidence interval) overlapped; however, the upper limit of the area under the curve for the ratio comparator/innovator exceeded the 1.25-point estimate, i.e., 4% higher for comparator meropenem. CONCLUSION: This observational, in-practice study demonstrates similar ex vivo activity and in vivo plasma concentration time curves for the products under observation. Assay sensitivity is also confirmed. Current registration status of generic small molecules is in place. The products are therefore clinically interchangeable based on registration status as well as bioassay results, demonstrating sufficient overlap for clinical comfort. The slightly higher observed comparator meropenem concentration (4%) is still clinically acceptable due to the large therapeutic index and should ally fears of inferiority.

Hemoglobin glutamer-250 (bovine) in South Africa: consensus usage guidelines from clinician experts who have treated patients.

Hemopure (hemoglobin glutamer-250 [bovine]; HBOC-201) is a hemoglobin (Hb)-based oxygen carrier registered with the Medicines Control Council of South Africa. It is indicated for the treatment of adult patients who are acutely anemic, for the purpose of maintaining tissue oxygen delivery thus eliminating, delaying, or reducing the need for allogeneic red blood cells (RBCs). Hemopure is a volume expander, and circulatory volume must be carefully monitored for signs of fluid overload. Hemopure is not as effective as RBCs for restoring Hb content and concentration, but in cases of severe anemia where allogeneic blood is not an option or is unavailable, it may offer an immediate alternative for improving oxygen transport. This document provides clinical recommendations on the safe and effective use of Hemopure based on the postmarketing experience in South Africa as well as a better understanding of Hemopure properties reflected in recent publications.

Potentiated clinoptilolite reduces signs and symptoms associated with veisalgia.

INTRODUCTION: Abundant anecdotal evidence for products claiming to reduce veisalgia after alcohol overindulgence are available on the Internet and as many advertisements in journals. None of these claims are, however, substantiated by research. The aim of this research was to ascertain the validity of such claims for the substance Absorbatox™, a potentiated aluminosilicate (cation exchanger able to bind NH(4+), histamine, and other positively charged ions) by investigating the signs and symptoms, as well as blood or breath alcohol levels, in healthy volunteers. METHODS: Blood or breath alcohol levels were measured in all volunteers in initial controlled experiments, and symptoms were scored on a diary card for gastrointestinal tract symptoms, as well as other symptoms such as headache and light sensitivity. Eighteen volunteers completed the initial blood alcohol study, which investigated the effect of Absorbatox™ on blood alcohol levels after fasting. The follow-up studies researched the effects of the symptoms and signs of alcohol overindulgence. The "night out" study was completed by ten volunteers in a typical controlled environment, which was followed by the real-life four-leg crossover study. In the crossover study, volunteers (number =25 completers) had to fill matching diary cards to containers of two placebo and two active drugs after a night out where they themselves decided on the container (color coded) to be used and the amount of alcohol to be consumed. RESULTS: Absorbatox™ had no effect on blood alcohol levels, but it significantly reduced the symptoms and signs of veisalgia by approximately 40%-50%. CONCLUSION: This research indicates that Absorbatox™ does not have an effect on blood- or breath-alcohol levels. Furthermore, treatment with Absorbatox™ resulted in an overall significant reduction in central nervous system and gastrointestinal tract symptoms associated with veisalgia, warranting further investigation.

Potentiated clinoptilolite: artificially enhanced aluminosilicate reduces symptoms associated with endoscopically negative gastroesophageal reflux disease and nonsteroidal anti-inflammatory drug induced gastritis.

PURPOSE: The cation exchanger, a potentiated clinoptilolite (Absorbatox™ 2.4D), is a synthetically enhanced aluminosilicate. The aim of this study was to evaluate the possible benefits of a potentiated clinoptilolite as a gastroprotective agent in reducing the severity of clinical symptoms and signs associated with 1) endoscopically negative gastroesophageal reflux disease (ENGORD) and 2) nonsteroidal anti-inflammatory drug (NSAID) medication. METHODS AND PATIENTS: Two randomized, double-blind, placebo-controlled, pilot studies, the ENGORD and NSAID studies, were conducted. After initial negative gastroscopy, a total of 25 patients suffering from ENGORD were randomized to receive either placebo capsules or 750 mg Absorbatox twice daily for 14 days. The NSAID study recruited 23 healthy patients who received orally either 1,500 mg Absorbatox or placebo three times daily, plus 500 mg naproxen twice daily. Patients underwent gastroscopic evaluation of their stomach linings prior to and on day 14 of the study. Gastric biopsies were obtained and evaluated via the upgraded Sydney system, whereas visible gastric events and status of the gastric mucosa were evaluated via a 0-3 rating scale. During both studies, patients recorded gastric symptoms in a daily symptom diary. RESULTS: In the ENGORD study, patients who received the potentiated clinoptilolite reported a significant reduction (P≤0.05) in severity of symptoms including reduction in heartburn (44%), discomfort (54%), and pain (56%). Symptom-free days improved by 41% compared to the group who received placebo (not significant). This was over and above the benefits seen with the proton pump inhibitor. In the NSAID study, the reduction in gastric symptom severity was echoed in the group who received the potentiated clinoptilolite. Treatment with the potentiated clinoptilolite resulted in significant prevention (P≤0.05) of mucosal erosion severity as graded by the gastroenterologist. CONCLUSION: Absorbatox is a nonabsorbable aluminosilicate with potential gastroprotective benefits as it protected against ENGORD symptoms and NSAID-induced gastric events. The exact mechanism of action is not clear but may be due to its binding to hydrogen ions and biologically active amines and nitrates.

The psychosocial and financial impact of non-severe hypoglycemic events on people with diabetes: two international surveys.

OBJECTIVES: To understand the impact of nocturnal and daytime non-severe hypoglycemic events on healthcare systems, work productivity and quality of life in people with type 1 or type 2 diabetes. METHODS: People with diabetes who experienced a non-severe hypoglycemic event in the 4 weeks prior to the survey were eligible to participate in a nocturnal and/or daytime hypoglycemia survey. Surveys were conducted in Argentina, Australia, Brazil, Israel, Mexico and South Africa. RESULTS: In total, 300 respondents were included in nocturnal/daytime hypoglycemia surveys (50/participating country/survey). All respondents with type 1 diabetes and 68%/62% (nocturnal/daytime) with type 2 diabetes were on insulin treatment. After an event, 25%/30% (nocturnal/daytime) of respondents decreased their insulin dose and 39%/36% (nocturnal/daytime) contacted a healthcare professional. In the week after an event, respondents performed an average of 5.6/6.4 (nocturnal/daytime) additional blood glucose tests. Almost half of the respondents (44%) reported that the event had a high impact on the quality of their sleep. Among nocturnal survey respondents working for pay, 29% went to work late, 16% left work early and 12% reported missing one or more full work days due to the surveyed event. In addition, 50%/39% (nocturnal/daytime) indicated that the event had a high impact on their fear of future hypoglycemia. CONCLUSIONS: The findings suggest that nocturnal and daytime non-severe hypoglycemic events have a large financial and psychosocial impact. Diabetes management that minimizes hypoglycemia while maintaining good glycemic control may positively impact upon the psychological wellbeing of people with diabetes, as well as reducing healthcare costs and increasing work productivity.

Phase 1 clinical study of the acute and subacute safety and proof-of-concept efficacy of carbohydrate-derived fulvic acid.

BACKGROUND: The purpose of this research was to determine the acute and subacute safety and proof-of-concept efficacy of carbohydrate-derived fulvic acid (CHD-FA). METHODS: In this double-blind study, 30 male volunteers with predetermined atopy were randomly assigned to either Group A or Group B, each consisting of 15 participants. In part 1 of the study, the groups were administered increasing amounts of CHD-FA, ranging from 5 mL to 40 mL, provided that no adverse events had occurred at the previous dosage. In part 2, Group A participants received 20 mL of 3.8% CHD-FA twice daily for 3 days and were monitored for a week. Because no adverse events occurred, Group B received 40 mL of 3.8% CHD-FA twice daily for a period of 3 days. In part 3, both groups received either 40 mL of 3.8% CHD-FA or placebo twice daily for a period of one week, followed by a one-week washout period before crossover to the alternative treatment schedule. Parameters used to establish safety were electrocardiography, a physical examination, a health questionnaire, and hematology and biochemistry, determined at baseline, during regular calculated intervals, and at the end of each part of the study. A skin prick test was done as part of the screening process and, from the result, the allergen the participant was most allergic to was then selected, along with the positive histamine and negative control to be repeated at the start and end of each respective stage. RESULTS: Safety parameters remained constant throughout the trial. A significant decrease in skin prick test results was observed. CONCLUSION: No severe adverse events occurred, establishing that CHD-FA to be safe at doses up to 40 mL twice daily for a week and that at this dosage CHD-FA acts as an anti-inflammatory agent. These findings confirm earlier animal data.

Randomized, parallel-group, double-blind, controlled study to evaluate the efficacy and safety of carbohydrate-derived fulvic acid in topical treatment of eczema.

BACKGROUND: The purpose of this study was to evaluate the efficacy and safety of carbohydratederived fulvic acid (CHD-FA) in the treatment of eczema in patients two years and older. METHODS: In this single-center, double-blind, placebo-controlled, parallel-group comparative study, 36 volunteers with predetermined eczema were randomly assigned to receive either the study drug or placebo twice daily for four weeks. RESULTS: All safety parameters remained within normal limits, with no significant differences in either group. Significant differences were observed for both severity and erythema in the placebo and CHD-FA treated groups, and a significant difference was observed for scaling in the placebo-treated group. With regard to the investigator assessment of global response to treatment, a significant improvement was observed in the CHD-FA group when compared with the placebo group. A statistically significant decrease in visual analog scale score was observed in both groups, when comparing the baseline with the final results. CONCLUSION: CHD-FA was well tolerated, with no difference in reported side effects other than a short-lived burning sensation on application. CHD-FA significantly improved some aspects of eczema. Investigator assessment of global response to treatment with CHD-FA was significantly better than that with emollient therapy alone. The results of this small exploratory study suggest that CHD-FA warrants further investigation in the treatment of eczema.

Sustainability of composting as an alternative waste management option for developing countries: a case study of the City of Tshwane.

Excessive MSW production is a growing management problem for cities in developing countries, such as South Africa. This study addresses these challenges with particular focus on the City of Tshwane. A major problem in Tshwane is that all the MSW generated in the city, including garden waste, is currently being landfilled. A waste stream analysis of Tshwane reveals the largest fraction of MSW is organic and biodegradable, and therefore suitable for compost production. The study proposes that Tshwane will have to address composting the biodegradable fraction of the MSW stream. This study attempts to understand the economics of composting practices in Tshwane, whether composting in Tshwane is financially viable. A comparative study, applying the dome aeration technology on a conventional static windrow, was conducted with the objective of investigating and proposing alternative improved composting technologies for green waste. Although the study focused on Tshwane, it can be argued that the findings could be implemented in any other South African municipality, and even implemented in other emerging countries.

Towards zero waste: a case study in the City of Tshwane.

Tshwane is presently landfilling all of its municipal solid waste (MSW) with no pre-processing or minimization efforts. This is a result of the available capacity of its existing landfills, thought to be able to satisfy the city's needs for, at most, the next 10 years. It is possible that the authorities will not wake up to the problem before it is too late. This study addresses these challenges. This study first identified and evaluated technologies available in developed countries for processing the various components of the MSW stream, appropriate to local conditions, as an alternative to landfilling, to ensure that these components will be either reused, recycled or rendered harmless to the environment before disposal. Then most appropriate technologies for Tshwane were selected and assembled into an optimal configuration to achieve a zero waste situation in Tshwane within a decade or two. This represents a significant change in MSW management in Tshwane, from total landfill to zero waste to landfill. Although the study focused on Tshwane, it can be argued that the findings can be implemented in any other South African municipality, and even implemented in other emerging countries.

Intravenous fluid therapy: a randomized controlled trial to investigate the effectiveness of the IV(2) flow medical device.

OBJECTIVES: To investigate the hypothetical benefits of the IV(2) flow medical device. BACKGROUND: Intravenous fluid administration is a standard hospital procedure with assumed inadequacies. The IV-Event Study [Fraser N, Nel G, Snyman J & Wessels F (2004) IV-EVENT Study: Intravenous Infusion Therapy--Management and Adverse Events. Data on File: Varori International (Pty) Ltd., Centurion, South Africa] quantified these inadequacies; The 'Stargait' intervention trial investigated the effectiveness and possible cost-benefit of the IV(2) flow. The IV(2) flow is intended for routine use with gravitational intravenous infusion sets. The IV(2) flow should reduce the incidence rate of adverse events and maintain a set flow rate. METHOD: Nursing staff assisted by study assessors captured relevant data. Consented patients were enrolled for the period of their prescribed infusions. Intervention. The Stargait Trial compared the treatment group (standard gravitational sets with the IV(2) flow) with the control group (standard gravitational infusion sets without IV(2) flow). The difference in observed events and the cost benefit derived from this were measured. RESULTS: A total of 2387 drip hours were observed in 52 patients. The adverse event rates were: Control group (without IV(2) flow) 33.8%. The treatment group (IV(2) flow) 15.4%. This 55% reduction is statistically significant (p = 0.0069). Adverse event related monetary wastage (labour and consumables) is reduced by 76% for infusion bags in the intervention group (with IV(2) flow). There was a significant difference between the treatment group and control group as far as deviation in flow rate was concerned (p = 0.00818). The mean deviation of the IV(2) flow group was just more than 5 ml per hour. The standard line group had a mean deviation of more than 30 ml per hour. CONCLUSION: Gravitational intravenous therapy compromises quality of patient care. The Stargait Trial has proven the care-effectiveness and cost-effectiveness of the IV(2) flow. RELEVANCE TO CLINICAL PRACTICE: The IV(2) flow improves quality of patient care and reduces associated wastage.

Genetic polymorphism of cytochrome P450 1A1 (Cyp1A1) and glutathione transferases (M1, T1 and P1) among Africans.

The co-ordinate expression and regulation of the drug metabolising enzymes, cytochrome P4501A1 (CYPlAl) and glutathione transferases (GSTM1, GSTT1 and GSTP1), and their metabolic balance in the cells of target organs may determine whether exposure to carcinogens results in cancer. Besides showing variability in activity due to induction and inhibition, these enzymes also exhibit genetic polymorphism that alter enzyme levels and activity. We determined frequencies of common allelic variants of CYP1A1 and glutathione (M1, T1 and P1) among Tanzanians, South African Venda and Zimbabweans using PCR/restriction fragment length polymorphism techniques. The CYP1A1 Val462 mutant variant was found at a frequency of 1.3% among 114 subjects. The GSTM1*0 genotype was found at a frequency of 29% and 33% among Tanzanian psychiatric patients and healthy volunteers, respectively. Similarly, the GSTT1*0 polymorphism was present with a frequency of 25% in both the psychiatric patients and healthy controls. The frequency of GSTP1 Val105 variant was 16%, 12% and 21% among Tanzanians, South African Venda and Zimbabweans, respectively. We conclude here that CYP1A1 Val462 polymorphism is very rare among Africans. This is the first report of the GSTP1 Val105 variant frequency in African populations. We show here that there are no differences in frequencies of the variant alleles for CYP1A1, GSTM1, GSTT1 and GSTP1 in the three African populations.