Enhancing care transition performance of community pharmacies in Nigeria.

Community pharmacies (CPs) represent a crucial source of primary care for the Nigerian population. Pharmacists in this setting provide essential primary care services to the public and, when required, facilitate care transitions or referrals for patients to higher levels of care. Given their accessibility and expanding roles in patient care, pharmacists are considered pivotal to meeting the transition of care (TOC) goals, that is, continuity, quality, and safety, especially at the community level. However, CPs in Nigeria face significant systemic and human-factor barriers that impede their TOC performance, especially with their exclusion from the national care referral framework. Removing these barriers is essential to avoid the health consequences of a breakdown in the TOC system for the patients receiving care at the CPs. This paper discusses the barriers to effective TOC performance of the CPs in Nigeria and offers recommendations to address the deficiencies to improve patient care delivery using an inclusive and collaborative referral model.

The COVID-19 Pandemic: Quantification of Temporal Variations in Air Pollutants Before, During and Post the Lockdown in Jeddah City, Saudi Arabia.

The government of Saudi Arabia imposed a strict lockdown between March and July 2020 to stop the spread of the coronavirus disease (COVID-19), which has led to a sharp decline in economic activities. The daily temporal variations of PM10, PM2.5, carbon monoxide (CO), nitrogen dioxide (NO2), and ozone (O3) were used to investigate the changes in air quality in response to COVID-19 lockdown control measures from January to December 2020 in Jeddah, Saudi Arabia. Meteorological parameters (wind speed, direction, temperature, relative humidity) were also analyzed to understand the changes during the pandemic. As a result, significant reductions in the concentrations of NO2 (- 44.5%), CO (- 41.5%), and PM2.5, PM10 (- 29.5%, each) were measured in the capital city of Jeddah during the quarantine compared to the pre-lockdown average. In contrast, the lockdown caused a significant increase in O3 by 41%. The changes in air quality during the COVID-19 outbreak by comparing the average pollutant concentration before lockdown (January 1-March 21, 2020) and the following 12 weeks during the partial lockdown (March 22-July 28, 2020), reveal a very significant decrease in pollutants, and consequently a significant improvement in air quality. Observed differences are attributable to changes in point source emissions associated with changes in localized activities, possibly related to decreased economic and industrial activity in response to the lockdown. The results of the present study show during the study period indicated a positive response to lockdown during the COVID-19 pandemic. Furthermore, the results can be used to establish future control measures and strategies to improve air quality.

Contamination of the marine environment in Egypt and Saudi Arabia with personal protective equipment during COVID-19 pandemic: A short focus.

Plastic pollution and its impact on marine ecosystems are major concerns globally, and the situation was exacerbated after the outbreak of COVID-19. Clean-up campaigns took place during the summer season (June-August 2020) in two coastal cities in Egypt (Alexandria and Hurghada) and Jeddah, Saudi Arabia to document the abundance of beach debris through public involvement, and then remove it. A total of 3673, 255, and 848 items were collected from Alexandria, Hurghada, and Jeddah daily, respectively. Gloves and face masks (personal protective equipment "PPE") represent represented 40-60% of the total plastic items collected from each of the three cities, while plastic bags represented 7-20% of the total plastics litter collected from the same cities. The results indicated the presence of 2.79, 0.29, and 0.86 PPE item m-2 in Alexandria, Hurghada and Jeddah, respectively. This short focus provides an assessment of the environmental impacts of single-use gloves and masks used for COVID-19 protection from June to August 2020. To the best of our knowledge, this study presents the first such information from the Middle East, specifically Egypt and Saudi Arabia. It highlights the need for further knowledge and action, such as safe, sustainable, and transparent waste management processes related to COVID-19 to reduce the negative impacts now, as well as in future events. Furthermore, this study helps in achieving key components of the United Nation's Sustainable Development Goals (SDGs). This short focus can serve as a multipurpose document, not only for scientists of different disciplines but for social media and citizens in general.

Lockdowns and reduction of economic activities during the COVID-19 pandemic improved air quality in Alexandria, Egypt.

Parallel reductions in atmospheric aerosols (particulate matter (PM)) and nitrogen dioxide (NO2) accompanied the drastic measures that were adopted to limit the spread of COVID-19. The results of this preliminary study conducted in northern Egypt revealed that ambient PM10, PM2.5, and NO2 levels decreased by 22.8%, 29.3%, and 25.9%, respectively, after the lockdown started on March 13, 2020. These reductions in concentrations significantly (p ˂ 0.01) correlated with the decrease in transportation and industrial and other economic activities. Furthermore, PM and NO2 concentrations radically reduced during the full lockdown on Easter, Ramadan, and Eid Al-Fitr. The findings of this study will help the World Health Organization (WHO) and other health regulators to combat COVID-19 in the world. This study is part of an ongoing research related to the current pandemic.

Proteomic Analysis of Exosome-Like Vesicles Isolated From Saliva of the Tick Haemaphysalis longicornis.

Extracellular vesicles (EVs), are considered as vehicles of cellular communication. Parasites usually release EVs in their excretory-secretory products to modulate host environment. However, little is known about the secretion of EVs by ticks. In this study, we show for the first time that the tick Haemaphysalis longicornis secretes EVs in saliva that resembles exosomes. EVs were purified from pilocarpine induced saliva of partially engorged H. longicornis ticks. Electron microscopy analysis revealed the presence of exosome-like vesicles with a size of 100 nm. Proteomic analysis by LC-MS/MS identified a total of 356 proteins in tick-derived EVs. Proteome data of tick-derived EVs was validated by Western blot analysis. Immunodetection of Hsp70 and GAPDH proteins indicated that the proteomics data of tick-derived EVs were highly reliable. Bioinformatics analysis (Gene Ontology) indicated association of certain biological and molecular functions with proteins which may be helpful during tick development. Likewise, KEGG database revealed involvement of vesicular proteins in proton transport, detoxification, ECM-receptor interaction, ribosome, RNA transport, ABC transporters, and oxidative phosphorylation. The results of this study provide evidence that EVs are being secreted in tick saliva and suggest that tick saliva-derived EVs could play important roles in host-parasite relationships. Moreover, EVs could be a useful tool in development of vaccines or therapeutics against ticks.

Post-Marketing Surveillance of Quality of Artemether Injection Marketed in Southwest Nigeria.

Access to good-quality medicines remains a contentious issue in developing countries. This development is worrisome, particularly in a setting with a high incidence of malaria. Monitoring of antimalarial drugs in the commercial domain becomes necessary; thus, we evaluated the quality of artemether injection marketed in Southwest Nigeria. A cross-sectional survey was conducted to obtain 22 different brands of artemether injections within Southwest Nigeria. The samples were examined for their sources, lot numbers, containers for injection, oil base used for preparation, and dates of expiration. Further analysis involved visual inspection, assessment of extractable volume, identity tests, and an assay of active pharmaceutical ingredient. The pharmaceutical quality of each sample was determined according to the criteria set in the International Pharmacopoeia 2019. None of the products had any particulate matter, but there were certain irregularities in their presentation. Eighteen of the 22 products (81.7%) were packaged in plain instead of amber-colored ampoules, and 77.3% (17/22) did not indicate the oil base used as the vehicle on the label as against the pharmacopoeial standard. Sixteen products (72.7%) passed the extractable volume test, although the remaining 22.3% did not conform to the extractable volume per unit dose. Artemether was present in all the samples, although only 40.9% (9/22) met the recommended percentage content of 90-110% of artemether. The study revealed the presence of a high percentage of substandard artemether injection products marketed in Nigeria. Further surveillance is warranted to confirm the quality of artemether injection circulated in other regions within Nigeria.

Modelling photovoltaic soiling losses through optical characterization.

The accumulation of soiling on photovoltaic (PV) modules affects PV systems worldwide. Soiling consists of mineral dust, soot particles, aerosols, pollen, fungi and/or other contaminants that deposit on the surface of PV modules. Soiling absorbs, scatters, and reflects a fraction of the incoming sunlight, reducing the intensity that reaches the active part of the solar cell. Here, we report on the comparison of naturally accumulated soiling on coupons of PV glass soiled at seven locations worldwide. The spectral hemispherical transmittance was measured. It was found that natural soiling disproportionately impacts the blue and ultraviolet (UV) portions of the spectrum compared to the visible and infrared (IR). Also, the general shape of the transmittance spectra was similar at all the studied sites and could adequately be described by a modified form of the Ångström turbidity equation. In addition, the distribution of particles sizes was found to follow the IEST-STD-CC 1246E cleanliness standard. The fractional coverage of the glass surface by particles could be determined directly or indirectly and, as expected, has a linear correlation with the transmittance. It thus becomes feasible to estimate the optical consequences of the soiling of PV modules from the particle size distribution and the cleanliness value.

Cross protection induced by combined Subolesin-based DNA and protein immunizations against adult Haemaphysalis longicornis.

Vaccination against ticks is an environmentally friendly alternative control method compared to chemical acaricide applications. Subolesin is a conserved protein in ticks, which can provide protection against some tick species. In this study, we evaluated the capacity of cocktail vaccination with Subolesin and ribosomal acidic protein 0 (P0) peptide against adults of Haemaphysalis longicornis. Priming with DNA vaccine expressing subolesin, followed by boosters of a single antigen (rRhSub) or a chimeric polypeptide (rRhSub/P0), provided cross protection. This treatment resulted in significant mortality, reduced blood ingestion and reduced reproduction in H. longicornis adults. Vaccination efficacies of 79.3% and 86.6% are reported in groups supplemented with rRhSub and rRhSub/P0, respectively. Conserved antigens, such as subolesin, formulated as DNA vaccine and enhanced with chimeric polypeptides, could be used as an anti-tick vaccine application, especially for control of infestation involving several tick species.

Localized expression and inhibition effect of miR-184 on blood digestion and oviposition in Haemaphysalis longicornis (Acari: Ixodidae).

BACKGROUND: The hard tick Haemaphysalis longicornis (Ixodidae) is widely distributed in East Asia, China, Australia and New Zealand. It can transmit many infectious pathogens, including the causative agents of human rickettsiosis, bovine theileriosis, bovine babesiosis and canine babesiosis. Therefore, a greater understanding of H. longicornis biology might aid in the development of more effective control measures against the tick and tick-borne pathogens. METHODS: We analyzed the expression of miR-184 in different developmental stages and various tissues of H. longicornis using real-time PCR (qRT-PCR). Antagomir (Ant-184) was used to knock-down miR-184, whilst Ms-Ant and non-injected ticks were used as the negative and blank controls, respectively. We used online software tools (RNAhybrid and TargetScan) to predict the putative target genes of miR-184. RESULTS: The expression of miR-184 was highest in unfed nymphs and lowest in unfed larvae. The tissue distribution of miR-184 showed abundant expression in the midgut. To investigate the probable roles of miR-184, antagomir (Ant-184) was used to knock-down miR-184 (t(4) = 12.32, P = 0.0002). After inhibiting miR-184, other biological factors were examined in each group. The engorged body weight was significantly reduced in the treated group (Ant-184) in contrast to control groups (t(22) = 2.19, P = 0.0388). The mean duration of the egg-laying days was significantly increased (33.5 ± 1.91) and the number of eggs (t(10) = 3.147, P = 0.0137), and egg mass (t(10) = 3.4472, P = 0.0063) were significantly reduced in the treated group. During oviposition, eggs were monitored and in half of the ticks of the Ant-184 group the eggs were completely desiccated, lacked embryo development and did not hatch. We analyzed the expression of Vg proteins (Vg1, Vg2, Vg3) in semi-engorged ticks, engorged ticks, ticks at day 2 after engorgement and egg stage in Ant-184, non-injected and Ms-Ant groups, and found significant variation. CONCLUSIONS: This study provides information on the role of miR-184 in H. longicornis ticks. The data suggest that miR-184 targets Vg proteins and affects blood digestion and oviposition.

A microRNA profile of saliva and role of miR-375 in Haemaphysalis longicornis (Ixodida: Ixodidae).

BACKGROUND: Tick saliva contains many bioactive molecules that are involved in attachment to the host, blood-feeding and transmission of pathogens. MicroRNAs (miRNAs) are a class of short non-coding RNAs with a length of 19-24 nucleotides. They act as regulators of gene expression by binding to their target mRNA at the post-transcriptional level and control a variety of cellular functions, including regulation of growth, metabolism and development. The detection and characterizations of miRNAs from tick saliva may help explain the molecular mechanisms involved in the interaction between ticks, pathogens and hosts. They may also contribute to the discovery of vaccines, which can control ticks and the pathogens they transmit. RESULTS: An RNA library was generated from the saliva of fed adult Haemaphysalis longicornis ticks, containing 17.4 million clean reads of 18-30 nucleotides. Overall, 319 known miRNAs and 1 novel miRNA were found. The 10 most abundantly expressed miRNAs present in tick saliva were miR-100_2, miR-315, miR-184_1, miR-100-5p_2, miR-5307, miR-184-3p_3, Let-7-5p_6, miR-71_5, miR-1-3p_6 and miR-10-5p_2. miR-375, one of the abundantly expressed, was subjected to quantitative real-time PCR analysis (qRT-PCR) in various tick developmental stages, as well as in different tissues isolated from adult ticks. The expression of miR-375 in different tick development stages was highest in unfed nymphs and lowest in the egg stage. In the tissues of adult ticks, miR-375 was most highly expressed in the salivary gland. To investigate the possible role of miR-375, Ant-375 was used to inhibit the miR-375. The treated group (Ant-375) had a reduced number of eggs (t(10) = 2.652, P = 0.0242), eggs that were partially desiccated, and reduced egg hatchability (t(10) = 2.272, P = 0.044) compared to Ms-Ant and the non-injected control. CONCLUSIONS: This is the first study to investigate the miRNA profile in tick saliva and the role of miR-375 in H. longicornis. The identification and characterization of miRNA in tick saliva may help to reveal the molecular mechanisms of interactions among ticks, pathogens and hosts, and suggest new vaccine strategies to control tick-borne diseases.

Antiseptics for burns.

BACKGROUND: Burn wounds cause high levels of morbidity and mortality worldwide. People with burns are particularly vulnerable to infections; over 75% of all burn deaths (after initial resuscitation) result from infection. Antiseptics are topical agents that act to prevent growth of micro-organisms. A wide range are used with the intention of preventing infection and promoting healing of burn wounds. OBJECTIVES: To assess the effects and safety of antiseptics for the treatment of burns in any care setting. SEARCH METHODS: In September 2016 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions based on language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that enrolled people with any burn wound and assessed the use of a topical treatment with antiseptic properties. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS: We included 56 RCTs with 5807 randomised participants. Almost all trials had poorly reported methodology, meaning that it is unclear whether they were at high risk of bias. In many cases the primary review outcomes, wound healing and infection, were not reported, or were reported incompletely.Most trials enrolled people with recent burns, described as second-degree and less than 40% of total body surface area; most participants were adults. Antiseptic agents assessed were: silver-based, honey, Aloe Vera, iodine-based, chlorhexidine or polyhexanide (biguanides), sodium hypochlorite, merbromin, ethacridine lactate, cerium nitrate and Arnebia euchroma. Most studies compared antiseptic with a topical antibiotic, primarily silver sulfadiazine (SSD); others compared antiseptic with a non-antibacterial treatment or another antiseptic. Most evidence was assessed as low or very low certainty, often because of imprecision resulting from few participants, low event rates, or both, often in single studies. Antiseptics versus topical antibioticsCompared with the topical antibiotic, SSD, there is low certainty evidence that, on average, there is no clear difference in the hazard of healing (chance of healing over time), between silver-based antiseptics and SSD (HR 1.25, 95% CI 0.94 to 1.67; I2 = 0%; 3 studies; 259 participants); silver-based antiseptics may, on average, increase the number of healing events over 21 or 28 days' follow-up (RR 1.17 95% CI 1.00 to 1.37; I2 = 45%; 5 studies; 408 participants) and may, on average, reduce mean time to healing (difference in means -3.33 days; 95% CI -4.96 to -1.70; I2 = 87%; 10 studies; 979 participants).There is moderate certainty evidence that, on average, burns treated with honey are probably more likely to heal over time compared with topical antibiotics (HR 2.45, 95% CI 1.71 to 3.52; I2 = 66%; 5 studies; 140 participants).There is low certainty evidence from single trials that sodium hypochlorite may, on average, slightly reduce mean time to healing compared with SSD (difference in means -2.10 days, 95% CI -3.87 to -0.33, 10 participants (20 burns)) as may merbromin compared with zinc sulfadiazine (difference in means -3.48 days, 95% CI -6.85 to -0.11, 50 relevant participants). Other comparisons with low or very low certainty evidence did not find clear differences between groups.Most comparisons did not report data on infection. Based on the available data we cannot be certain if antiseptic treatments increase or reduce the risk of infection compared with topical antibiotics (very low certainty evidence). Antiseptics versus alternative antisepticsThere may be some reduction in mean time to healing for wounds treated with povidone iodine compared with chlorhexidine (MD -2.21 days, 95% CI 0.34 to 4.08). Other evidence showed no clear differences and is of low or very low certainty. Antiseptics versus non-antibacterial comparatorsWe found high certainty evidence that treating burns with honey, on average, reduced mean times to healing in comparison with non-antibacterial treatments (difference in means -5.3 days, 95% CI -6.30 to -4.34; I2 = 71%; 4 studies; 1156 participants) but this comparison included some unconventional treatments such as amniotic membrane and potato peel. There is moderate certainty evidence that honey probably also increases the likelihood of wounds healing over time compared to unconventional anti-bacterial treatments (HR 2.86, 95% C 1.60 to 5.11; I2 = 50%; 2 studies; 154 participants).There is moderate certainty evidence that, on average, burns treated with nanocrystalline silver dressings probably have a slightly shorter mean time to healing than those treated with Vaseline gauze (difference in means -3.49 days, 95% CI -4.46 to -2.52; I2 = 0%; 2 studies, 204 participants), but low certainty evidence that there may be little or no difference in numbers of healing events at 14 days between burns treated with silver xenograft or paraffin gauze (RR 1.13, 95% CI 0.59 to 2.16 1 study; 32 participants). Other comparisons represented low or very low certainty evidence.It is uncertain whether infection rates in burns treated with either silver-based antiseptics or honey differ compared with non-antimicrobial treatments (very low certainty evidence). There is probably no difference in infection rates between an iodine-based treatment compared with moist exposed burn ointment (moderate certainty evidence). It is also uncertain whether infection rates differ for SSD plus cerium nitrate, compared with SSD alone (low certainty evidence).Mortality was low where reported. Most comparisons provided low certainty evidence that there may be little or no difference between many treatments. There may be fewer deaths in groups treated with cerium nitrate plus SSD compared with SSD alone (RR 0.22, 95% CI 0.05 to 0.99; I2 = 0%, 2 studies, 214 participants) (low certainty evidence). AUTHORS' CONCLUSIONS: It was often uncertain whether antiseptics were associated with any difference in healing, infections, or other outcomes. Where there is moderate or high certainty evidence, decision makers need to consider the applicability of the evidence from the comparison to their patients. Reporting was poor, to the extent that we are not confident that most trials are free from risk of bias.

Immunological changes induced by Toxoplasma gondii Glutathione-S-Transferase (TgGST) delivered as a DNA vaccine.

In this study, a DNA vaccine (pTgGST) encoding T. gondii antioxidant glutathione-S-transferase (TgGST) inserted into eukaryotic expression vector pVAX I was constructed and the immune protective efficacy of intramuscular vaccination of mice with pTgGST was analyzed. Mice immunized with pTgGST elicited high titers of total IgG, IgG1, IgG2a, IgA and IgM antibodies, while IgE showed no changes. Also, significant cytokine production of IFN-γ, IL-4 and IL-17 was detected in mice immunized with pTgGST, but not TGF-ß1. CD8(+) T cells subsets and MHC-I molecules showed significant increase in contrast to CD4(+) subsets. Immunization with pTgGST significantly prolonged survival time (14 days) after challenge infection with the virulent T. gondii RH strain, compared with the control groups which died within 8 days. These results suggested that TgGST DNA vaccine could trigger strong humoral and cellular responses and induce partial protection against acute toxoplasmosis.

DNA vaccination with a gene encoding Toxoplasma gondii Deoxyribose Phosphate Aldolase (TgDPA) induces partial protective immunity against lethal challenge in mice.

BACKGROUND: Toxoplasma gondii is an obligate intracellular parasite that causes a pathological status known as toxoplasmosis, which has a huge impact on human and animal health. Currently, the main control strategy depends on the usage of drugs that target the acute stage of the infection, however, drawbacks were encountered while applying this method; therefore, development of an alternative effective method would be important progress. Deoxyribose Phosphate Aldolase (TgDPA) plays an important role supporting cell invasion and providing energy for the parasite. METHODS: TgDPA was expressed in Escherichia coli and the purified recombinant protein was used to immunize rats. The antibodies obtained were used to verify in vitro expression of TgDPA. The vector pVAX1 was utilized to formulate a DNA vaccine designated as pTgDPA, which was used to evaluate the immunological changes and the level of protection against challenge with the virulent RH strain of T. gondii. RESULTS: DNA vaccine, TgDPA revealed that it can induce a strong humoral as well as cellular mediated response in mice. These responses were a contribution of TH1, TH2 and TH17 type of responses. Following challenge, mice immunized with TgDPA showed longer survival rates than did those in control groups. CONCLUSIONS: Further investigation regarding TgDPA is required to shed more light on its immunogenicity and its possible selection as a vaccine candidate.

Immunoglobulin and cytokine changes induced following immunization with a DNA vaccine encoding Toxoplasma gondii selenium-dependent glutathione reductase protein.

Toxoplasma gondii Glutathione Reductase (TgGR) plays important role during the survival of the parasite. In this investigation, immunological changes and protection efficiency of this protein delivered as a DNA vaccine (pTgGR) have been evaluated. Mice were immunized with pTgGR, followed by challenge with virulent T. gondii RH strain, 2 weeks after the booster immunization. Compared to the control groups pVAX1, PBS and Blank groups, the results showed that pTgGR stimulated specific humoral response defined by significant titers of total IgG, subclasses IgG1 and IgG2a, classes IgA and IgM, but not IgE. Analysis of IFN-γ, IL-4, IL-17 and TGF-ß1 cytokines after immunization and compared with the control groups showed significant increments in pTgGR group. Additionally, T lymphocytes subpopulation CD4(+) T was positively recruited with significant percentage detected, while subset CD8(+) appeared not to be involved in response to this antigen. Vaccinated mice showed a significantly longer survival time, 15 days, in contrast with control groups which died within 8-10 days after challenge. These results demonstrated that TgGR could induce significant humoral and cell mediated responses leading to a considerable level of resistance against toxoplasmosis infection.

Formation of low density hydrous iron oxide via conformal transformation of MIL-53(Fe).

Hydrous iron oxide materials with a predefined shape, photo-electrochemical activity, low density (estimated to be 0.32 g cm(-3)), and high fractal porosity (BET ca. 117 m(2) g(-1)) are formed via internal hydrolytic transformation of the crystalline metal-organic framework MIL-53(Fe) in dilute aqueous hydroxide.