The Wellbeing of Healthcare Workers during COVID-19 Era in Public Primary Health Facilities in Johannesburg, South Africa.

As the world grappled with the COVID-19 pandemic, healthcare workers (HCWs) continued to provide uninterrupted health care service delivery; therefore, this disproportionately affected their wellbeing. Our study explored the wellbeing of HCWs during the COVID-19 era in public health facilities in the City of Johannesburg, Gauteng province, South Africa. A qualitative study was conducted among twenty (20) HCWs through face-to-face in-depth interviews (IDIs) in the form of semi-structured interviews, audiotapes, and transcribed verbatim, and thematically analyzed with NVivo version 10. The findings showed that over half of HCWs (aged between 27 and 60 years) tested positive for COVID-19. Also, one third of HCWs' family members tested positive while some died due to COVID-19 infection. Informed by the workers' wellbeing framework, four themes emerged with fourteen sub-themes. Firstly, unsafe work environment was characterized by human resource related challenges such as increased workload; staff shortage; insufficient resources, e.g., personal protective equipment (PPE); poor policies in terms of compensation/allowance for being infected with COVID-19; poor health services; and death of colleagues. Secondly, poor health outcomes were described as strained emotional (psychosocial distress) and physical (respiratory related conditions) wellbeing. Thirdly, home and community environments were negatively impacted by interrupted relationships with family and friends, and experiences of deaths of loved ones. Finally, HCWs engaged personal wellbeing strategies through self-motivation; staying positive; family support; and participating in resilience-promoting extra mural activities to cope during the pandemic. In conclusion, the wellbeing of HCWs was aggravated during the COVID-19 era and led to low morale and compromised healthcare quality. This study advocates for promotion of greater resilience, and psychological and physical safety of HCWs through evidence-based, multilevel-multicomponent interventions at the workplace, home, and community environments in addition to strengthening public health policies and response to future pandemics.

A Systematic Review on Cardiometabolic Risks and Perinatal Outcomes among Pregnant Women Living with HIV in the Era of Antiretroviral Therapy.

Antiretroviral therapy (ART) regimens have been shown to cause metabolic changes in people living with HIV (PLWH), predisposing them to cardiometabolic disease (CVMD). However, such evidence is less established in pregnant women living with HIV (pWLWH) on ART. Pregnancy-induced cardiometabolic risks (CMR) can predispose to unfavourable pregnancy outcomes and further persist in the postpartum period, resolve, and recur in subsequent pregnancies, or emerge as newly diagnosed chronic diseases of ageing. Therefore, this systematic review aimed at synthesizing evidence on CMR and perinatal outcomes among pWLWH in the era of ART. We considered prospective and retrospective cohorts, case-control, cross-sectional, and interventional studies published in English. Specific keywords were used to conduct a thorough literature search on PubMed-Medline and Scopus following the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. Two investigators independently screened the search outputs and reviewed full texts of potentially eligible articles. Data extraction was conducted by one investigator and verified by the second investigator. Thirty-one relevant studies conducted on 20,904 pWLWH on ART across Africa, Asia, Europe, and America were included. Studies demonstrate inconclusive findings, especially on perinatal outcomes, but significant risks of gestational hypertension and dyslipidemia were reported in pWLWH on ART compared to the control group. Therefore, future studies should focus more on these perinatal outcomes, and their impact on postpartum maternal health and growth trajectories of uninfected infants born from pWLWH who are either on ART or ART-naïve in comparison to infants born of HIV-negative mothers over the life course, especially in HIV-burdened African countries.

A Systematic Review and Meta-Analysis on the Impact of Statin Treatment in HIV Patients on Antiretroviral Therapy.

The rate of new human immunodeficiency virus (HIV) infections globally is alarming. Although antiretroviral therapy (ART) improves the quality of life among this group of patients, ARTs are associated with risk of cardiovascular diseases (CVD). Moreover, virally suppressed patients still experience immune activation associated with HIV migration from reservoir sites. Statins are widely recommended as therapeutic agents to control ART-related CVD; however, their impacts on the cluster of differentiation (CD)4 count and viral load are inconsistent. To assess the effect of statins on markers of HIV infections, immune activation and cholesterol, we thoroughly reviewed evidence from randomised controlled trials. We found 20 relevant trials from three databases with 1802 people living with HIV (PLHIV) on statin-placebo treatment. Our evidence showed no significant effect on CD4 T-cell count standardised mean difference (SMD): (-0.59, 95% confidence intervals (CI): (-1.38, 0.19), p = 0.14) following statin intervention in PLHIV on ART. We also found no significant difference in baseline CD4 T-cell count (SD: (-0.01, 95%CI: (-0.25, 0.23), p = 0.95). Our findings revealed no significant association between statins and risk of viral rebound in PLHIV with undetectable viral load risk ratio (RR): (1.01, 95% CI: (0.98, 1.04), p = 0.65). Additionally, we found a significant increase in CD8+CD38+HLA-DR+ T-cells (SMD (1.10, 95% CI: (0.93, 1.28), p < 0.00001) and CD4+CD38+HLA-DR+ T-cells (SMD (0.92, 95% CI: (0.32, 1.52), p = 0.003). Finally, compared to placebo, statins significantly reduced total cholesterol (SMD: (-2.87, 95% CI: (-4.08, -1.65), p < 0.0001)). Our results suggest that the statin lipid-lowering effect in PLHIV on ART may elevate immune activation without influencing the viral load and CD4 count. However, due to the limited evidence synthesised in this meta-analysis, we recommend that future powered trials with sufficient sample sizes evaluate statins' effect on CD4 count and viral load, especially in virally suppressed patients.

A Comprehensive Review on Pharmacological Activities of Pachypodol: A Bioactive Compound of an Aromatic Medicinal Plant Pogostemon Cablin Benth.

As is well known, plant products have been increasingly utilized in the pharmaceutical industry in recent years. By combining conventional techniques and modern methodology, the future of phytomedicines appears promising. Pogostemon Cablin (patchouli) is an important herb used frequently in the fragrance industries and has various therapeutic benefits. Traditional medicine has long used the essential oil of patchouli (P. cablin) as a flavoring agent recognized by the FDA. This is a gold mine for battling pathogens in China and India. In recent years, this plant has seen a significant surge in use, and approximately 90% of the world's patchouli oil is produced by Indonesia. In traditional therapies, it is used for the treatment of colds, fever, vomiting, headaches, and stomachaches. Patchouli oil is used in curing many diseases and in aromatherapy to treat depression and stress, soothe nerves, regulate appetite, and enhance sexual attraction. More than 140 substances, including alcohols, terpenoids, flavonoids, organic acids, phytosterols, lignins, aldehydes, alkaloids, and glycosides, have been identified in P. cablin. Pachypodol (C18H16O7) is an important bioactive compound found in P. cablin. Pachypodol (C18H16O7) and many other biologically essential chemicals have been separated from the leaves of P. cablin and many other medicinally significant plants using repeated column chromatography on silica gel. Pachypodol's bioactive potential has been shown by a variety of assays and methodologies. It has been found to have a number of biological activities, including anti-inflammatory, antioxidant, anti-mutagenic, antimicrobial, antidepressant, anticancer, antiemetic, antiviral, and cytotoxic ones. The current study, which is based on the currently available scientific literature, intends to close the knowledge gap regarding the pharmacological effects of patchouli essential oil and pachypodol, a key bioactive molecule found in this plant.

Okra ameliorates hyperglycaemia in pre-diabetic and type 2 diabetic patients: A systematic review and meta-analysis of the clinical evidence.

Background: Despite the use of available pharmaceutical drugs, high rates of metabolic diseases and cardiovascular disorders are alarming. This calls for alternative therapies that can attenuate these complications. Therefore, we investigated the beneficial effects of okra on glycaemic control in pre-diabetes and type 2 diabetes mellitus (T2D). Methods: MEDLINE and Scopus were searched for relevant studies. Collected data were analysed using RevMan and reported as mean difference and 95% confidence intervals (CI). Eight studies, including 331 patients with pre-diabetes or T2D, were eligible. Results: Our findings showed that okra treatment reduced the levels of fasting blood glucose: mean difference (MD) = -14.63 mg/dL; 95% CI (-25.25, -4.00, p = 0.007); I 2 = 33%, p = 0.17 compared to placebo. Glycated haemoglobin, however, did not differ significantly between the groups: MD = 0.01%; 95%CI (-0.51, 0.54, p = 0.96); I 2 = 23%, p = 0.28. Conclusion: this systematic review and meta-analysis found that okra treatment improves glycaemic control in patients with pre-diabetes or T2D. The findings suggest that okra may be used as a supplemental dietary nutrient, especially in pre-diabetic and T2D patients due to its potential to regulate hyperglycaemia.

Pinostrobin alleviates testicular and spermatological damage induced by polystyrene microplastics in adult albino rats.

BACKGROUND: Polystyrene microplastics (PS-MPs) have become major environmental pollutants that adversely effects multiple organs specifically testicles. Pinostrobin (PN) is an important flavonoid which, shows several pharmacological potentials. PURPOSE: The current study was designed to elucidate the mitigative effects of PN against PS-MPs induced testicular toxicities in rats. METHODS: 48 male albino rats were randomly distributed into 4 groups, control, PS-MPs group (0.01 mg/kg), PS-MPs + PN group (0.01 mg/kg of PS-MPs; 40 mg/kg of PN) and PN group (40 mg/kg). RESULTS: PS-MPs intoxication substantially lessened the activities of glutathione peroxidase (GPx), glutathione reductase (GSR), superoxide dismutase (SOD) along with catalase (CAT) while, raised the level of malondialdehyde (MDA) as well as reactive oxygen species (ROS). Additionally, PS-MPs reduced luteinizing hormone (LH), plasma testosterone, follicle-stimulating hormone (FSH) concentration, sperm motility, sperm count, expression of steroidogenic enzymes and Bcl-2 (anti-apoptotic protein) along with the count of spermatogenic cells. While, dead sperm count, sperm abnormalities (tail, neck and head), Bax and caspase-3 (apoptotic proteins) expression along with histopathological anomalies were elevated. Moreover, PS-MPs exposure increased the level of inflammatory markers. However, PN treatment considerably decreased oxidative stress (OS) by reducing ROS as well as increased sperm motility and alleviated all the damages induced by the PS-MPs. CONCLUSION: Therefore, it is concluded that PN may prove a potential therapeutic candidate to restore all the PS-MPs-induced testicular toxicities.

Phytochemical-Stabilized Platinum-Decorated Silver Nanocubes INHIBIT Adenocarcinoma Cells and Enhance Antioxidant Effects by Promoting Apoptosis via Cell Cycle Arrest.

(1) Background: The increasing use of silver and platinum bimetallic nanoparticles in the diagnosis and treatment of cancer presents significant advances in biomedical applications due to their extraordinary physicochemical properties. This study investigated the role of aqueous phytochemical extract in stabilizing platinum nanodots-decorated silver nanocubes (w-Pt@AgNPs) for enhancing antioxidant activities and their mechanism. (2) Methods: UV-Vis, Fourier transform infrared (FTIR) spectroscopy, and transmission electron microscopy (TEM) were used to characterize the formed w-Pt@AgNPs. LC-QToF-MS/MS was used to analyze the bioactive compounds, while DPPH, ABTS, and FRAP were used to detect the scavenging potential. Flow cytometric assays were performed to investigate the cytotoxicity and the mechanism of cell death. (3) Results: Morphological studies indicated that w-Pt@AgNPs were cube in shape, decorated by platinum nanodots on the surfaces. Compared to ethanolic extract-synthesized e-Pt@AgNPs, w-Pt@AgNPs exhibited the strongest antioxidant and cytotoxic activity, as data from Annexin V and Dead cell labeling indicated higher induction of apoptosis. Despite the high proportion of early apoptotic cells, the w-Pt@AgNPs triggered a decrease in G1/G0 cell cycle phase distribution, thereby initiating a G2/M arrest. (4) Conclusions: By enhancing the antioxidant properties and promoting apoptosis, w-Pt@AgNPs exhibited remarkable potential for improved cancer therapy outcomes.

Medicinal uses, pharmacological activities, phytochemistry, and the molecular mechanisms of Punica granatum L. (pomegranate) plant extracts: A review.

Punica granatum L (pomegranate) is one of the Mediterranean medicinal plants that has been used for generations in treating ulcers, diarrhea, and male infertility. Increasing evidence has revealed that pomegranate possesses myriads of pharmacological activities such as anti-diabetic, anti-tumor, anti-inflammatory, anti-malaria, anti-fibrotic, anti-fungal, anti-bacterial, and other effects. Consumption of pomegranate could be used to improve gut microbiota, and therefore prevent obesity and diabetes. The mechanisms of actions of pomegranate, mainly involve nuclear factor-erythroid factor 2-related factor 2 (Nrf2), nuclear factor kappa B (NF-kB), and mitogen-activated protein kinase (MAPK) signaling pathways. In recent times, in silico molecular docking studies demonstrated that pomegranate extract and or its phytochemicals are potential inhibitors of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) spike protein and angiotensin-converting enzyme 2 (ACE2) receptor contact. Also, some clinical trials have indicated that pomegranate can be consumed for alleviation of non-alcoholic fatty liver disease, metabolic syndrome, dental infections, and menopausal symptoms. To date, active compounds, viz. alkaloids, anthocyanidins, tannins, flavonoids, phenolics, proanthocyanidins, sterols, terpenes, terpenoids, xanthonoids, fatty acids, organic acids, lignans, saccharides, and vitamin C have been isolated from pomegranate. Therefore, the current review article aimed to gather and presents an update on the ethnomedicinal uses, pharmacological activities, phytochemistry, and molecular mechanisms of Punica granatum L. This knowledge is of paramount importance in the future in drug discovery for the development of novel natural drugs for the treatment of various ailments.

Evaluation of the GeneXpert MTB/RIF assay performance in sputum samples with various characteristics from presumed pulmonary tuberculosis patients in Shiselweni region, Eswatini.

BACKGROUND: Tuberculosis is a global health concern and has become more complex to diagnose due to mutations in the causative agent, Mycobacterium tuberculosis. In a setting with high TB prevalence, having a rapid and accurate diagnosis may reduce the rate of infections. The study aimed to evaluate the diagnostic performance of GeneXpert MTB/RIF assay in sputum samples from suspected tuberculosis patients. METHODS: A total of 1 328 sputum samples were collected from patients, across 12 clinics in the Shiselweni region, Eswatini. One thousand one hundred and ten (1110; 84%) samples were simultaneously processed on GeneXpert MTB/RIF assay and MGIT culture. RESULTS: Two hundred and ninety-seven (297) samples tested GeneXpert positive and 813 GeneXpert negatives, while 310 samples tested positive and 800 tested negative on the MGIT culture method. The positive predictive value on GeneXpert MTB/RIF assay was 83% while the negative predictive value was 97.80%. At p-value = .796, sputum quality did not affect the positivity of the GeneXpert MTB/RIF results. Sputum volume had a significant impact on the performance of the GeneXpert MTB/RIF with increased sensitivity in 4 ml and 6 ml samples. CONCLUSIONS: Although detection of tuberculosis using the GeneXpert MTB/RIF assay in sputum samples is not limited to one specific characteristic, sputum volume assessment should be considered as an integral part of routine laboratory diagnosis of tuberculosis especially in high tuberculosis prevalent settings. However, the ability of the GeneXpert MTB/RIF to provide rapid TB diagnosis is not dependent on sputum quality.

Ginger from Farmyard to Town: Nutritional and Pharmacological Applications.

Ginger (Zingiber officinale) is one of the most widely used natural products consumed as a spice and medicine for treating diabetes, flatulent intestinal colic, indigestion, infertility, inflammation, insomnia, a memory booster, nausea, rheumatism, stomach ache, and urinary tract infections. To date, over 400 bioactive components, such as diarylheptanoids, gingerol analogues, phenylalkanoids, sulfonates, monoterpenoid glycosides, steroids, and terpene compounds have been derived from ginger. Increasing evidence has revealed that ginger possesses a broad range of biological activities, especially protective effects against male infertility, nausea and vomiting, analgesic, anti-diabetic, anti-inflammatory, anti-obesity, and other effects. The pharmacological activities of ginger were mainly attributed to its active phytoconstituents such as 6-gingerol, gingerdiol, gingerol, gingerdione, paradols, shogaols, sesquiterpenes, zingerone, besides other phenolics and flavonoids. In recent years, in silico molecular docking studies revealed that gingerol (6-gingerol, 8-gingerol, and 10-gingerol) and Shogaol (6-shogaol, 8-shogaol, 10-shogaol) had the best binding affinities to the receptor protein in disease conditions such as diabetes, inflammation, obesity, and SARS-CoV-2. Furthermore, some clinical trials have indicated that ginger can be consumed for alleviation of nausea and vomiting induced by surgery, pain, diabetes, obesity, inflammation, male infertility. This review provides an updated understanding of the scientific evidence on the development of ginger and its active compounds as health beneficial agents in future clinical trials.

Advances in Nanoparticle Delivery System for Erectile Dysfunction: An Updated Review.

INTRODUCTION: The use of current available treatment for male erectile dysfunction (ED) has some limitations that are related to efficacy and adverse effects. Nanotechnology has been used as a new tool in medicine to improve these limitations and new medications potentially to alleviate and cure ED. AIM: To review the currently literature on new nano medications for ED based on scientific and clinical studies, efficacy, safety, mechanisms of action, and to identify gaps for future research. METHODS: A comprehensive literature review was conducted via Google Scholar, Science Direct, and PubMed on English publications using different keywords such as "erectile dysfunction", "emerging treatments", "nanotechnology", and "herbal medicine". The retrieved papers were organized into groups according to the sections covered in this review paper. MAIN OUTCOMES MEASURES: We reviewed novel ED treatments such as nanotechnological phosphodiesterase inhibitors, papaverine hydrochloride, sialorphin, adipose tissue-derived stem cells, sonic hedgehog, and herbal medicine. RESULTS: Numerous preclinical studies have addressed novel phosphodiesterase 5 inhibitors nanoparticle, and their recent delivery systems. Nitric oxide, sialorphin, sonic hedgehog, and herbal medicine loaded nanoparticles and nano adipose tissue-derived stem cells as a potential new treatment for ED. In addition, papaverine-containing nanoparticles have been reported. A limited number of randomized clinical studies have determined the mechanism of these treatments. CONCLUSION: A literature review on the application of nanotechnology in ED therapy was successfully conducted. New nano medications are promising to treat ED. However, further studies are warranted to further assess their efficacy and safety. Masuku NP, Unuofin JO, Lebelo SL. Advances in Nanoparticle Delivery System for Erectile Dysfunction: An Updated Review. Sex Med 2021;9:100420.

Body Roundness Index, A Body Shape Index, Conicity Index, and Their Association with Nutritional Status and Cardiovascular Risk Factors in South African Rural Young Adults.

BACKGROUND: The study aimed to investigate the association of Body Roundness Index (BRI), A Body Shape Index (ABSI), and Conicity Index with nutritional status and cardiovascular risk factors in South African rural young adults. METHODS: The study included a total of 624 young adults aged 21-30 years from the Ellisras rural area. Anthropometric indices, blood pressure (BP), and biochemical measurements were measured. RESULTS: BRI was significantly correlated with insulin (0.252 males, females 0.255), homeostatic model assessment (HOMA)-ß (0.250 males, females 0.245), and TG (0.310 males, females 0.216). Conicity Index was significantly associated with pulse rate (PR) (ß 0.099, 95% confidence interval (CI) 0.017, 0.143, p < 0.013; ß 0.081, 95% CI 0.000 0.130, p < 0.048), insulin (ß 0.149, 95% CI 0.286 0.908, p < 0.001; ß 0.110, 95% CI 0.123 0.757, p < 0.007). Conicity Index is associated with insulin resistance (IR) (odds ratio (OR) 7.761, 95% CI 5.783 96.442, p < 0.001; OR 4.646, 95% CI 2.792 74.331, p < 0.007), underweight (OR 0.023, 95% CI 0.251 0.433, p < 0.001; OR 0.031, 95% CI 0.411 0.612, p < 0.001), and obesity (OR 1.058, 95% CI 271.5 4.119, p < 0.001; OR 1.271, 95% CI 0.672 1.099, p < 0.001). CONCLUSION: Conicity Index was positively associated with insulin resistance, hypertension and dyslipidaemia. Further investigation of these indices and their association with nutritional status and cardiovascular diseases (CVDs) could assist in efforts to prevent CVD in the rural South African population.

Promising role of medicinal plants in the regulation and management of male erectile dysfunction.

Male erectile dysfunction (ED) refers to incompetency to reaching and retaining adequate penile tumescence for sexual intercourse. Over 152 million men globally suffer from ED and by 2025, the number of affected individuals is anticipated to be around 322 million. Pharmacological and nonpharmacological therapies such as phosphodiesterase (PDE) inhibitors, alprostadil, penile prosthesis surgery, and hormonal replacement are available for management and recuperation of ED. Nevertheless, such therapies are reported to have adverse effects as well as life-threatening. Accordingly, diversity of medicinal plant species and bioactive active compounds are preferred as therapeutic options because they are natural, abundant, available, low-cost and cause fewer or no side effects. This current review will emphasise the aetiology, risk factors, mechanisms underlying the pathophysiology of ED, treatments of ED as well as their side effects. It also provides medicinal plants that are proven effective in vivo and in vitro for the mitigation and treatment of male ED. This knowledge could be used in the future in drug discovery for the development of more natural drugs with no side effects.

Antioxidant Effects and Mechanisms of Medicinal Plants and Their Bioactive Compounds for the Prevention and Treatment of Type 2 Diabetes: An Updated Review.

Diabetes mellitus is a metabolic disorder that majorly affects the endocrine gland, and it is symbolized by hyperglycemia and glucose intolerance owing to deficient insulin secretory responses and beta cell dysfunction. This ailment affects as many as 451 million people worldwide, and it is also one of the leading causes of death. In spite of the immense advances made in the development of orthodox antidiabetic drugs, these drugs are often considered not successful for the management and treatment of T2DM due to the myriad side effects associated with them. Thus, the exploration of medicinal herbs and natural products as therapeutic sources for the treatment of T2DM is promoted because they have little or no side effects. Bioactive molecules isolated from natural sources have been proven to lower blood glucose levels via regulating one or more of the following mechanisms: improvement of beta cell function, insulin resistance, glucose (re)absorption, and glucagon-like peptide-1 homeostasis. In recent times, the mechanisms of action of different bioactive molecules with antidiabetic properties and phytochemistry are gaining a lot of attention in the area of drug discovery. This review article presents an update of the findings from clinical research into medicinal plant therapy for T2DM.

Prevalence of Hypertension and Associated Risk Factors among Rural Bapedi Women in Sekhukhune Area, Limpopo Province, South Africa.

The study investigated the prevalence of hypertension and identified risk factors in the Bapedi women of Sekhukhune area. Fifty (50) women diagnosed with hypertension and receiving treatment from local clinics were recruited. Questionnaires and focus group discussions were used. Most participants were at the average age of 50.50 ± 7.93 years and weight of 81.17 ± 9.96 kg. Blood pressure measurements recorded were systolic blood pressure (SBP) 163 ± 22.41 mmHg and diastolic blood pressure (DBP) 91 ± 5.41 mmHg. An insignificant number of participants had smoking or drinking habits (0% and 2%, respectively). The largest group of women (46%) had primary level of education, 14% completed junior secondary education, 6% completed matric, and 2% had basic education. All women consumed cereal; a large number of women (50%) consumed oils and fats; 44% flesh meats; 30% fruits and vegetables; 26% tubers and roots; 22% organ meats; 10% fish, 10% eggs, and 8% milk. Results showed a high prevalence of hypertension in the Bapedi women in the Sekhukhune area. Changes in diet and lifestyle could significantly improve the health of most women in the area.