Medication waste is defined as 'any pharmaceutical product that remains unused or is not fully consumed during the entire pharmaceutical supply chain'. Given the growing recognition of the environmental impact of healthcare waste, an understanding of the scale and sources of medicines waste generated in Ireland is required. This study aims to quantify the amount of patient-returned medicines and pharmacy-generated medication waste in a sample of community pharmacies in Ireland, and to explore underlying causes and potential economic impacts. A medicines waste audit was conducted in four community pharmacies in April/May 2025. The audit tool captured data on the type, form, quantity, ATC code, source and given reason for return or wastage. The value of the waste was calculated based on the wholesaler list price. The majority of wasted medicines was from patient returns (72%), and prescription medicines accounted for 90% of all wasted medicines. Patient death (21%), treatment discontinuation (13%) and non-adherence (13%) were the primary reasons for patient-returned medicines. Amendments to blister-packs (31%), expired medicines (27%) and uncollected medicines (16%) were the main drivers of pharmacy-generated waste. The mean value of medication waste per pharmacy was €1,512 over four weeks or €19,662 annually, extrapolating to a national estimate of €37.5 million. There is a clear need for targeted interventions to minimise medication waste across the medicines use phases involving key stakeholders. Moving towards a more sustainable healthcare system would not only lessen environmental harm, but also promote more efficient resource use and improve patient care.
An electrochemical sensor for the determination of ciprofloxacin (CPR) was developed using a glassy carbon electrode modified with MIL-101/reduced graphene oxide (MIL-101/rGO). MIL-101/rGO was synthesized via a facile ultrasonic-assisted method and characterized by various physicochemical techniques. The synergistic combination of MIL-101 with rGO significantly enhanced the electrocatalytic activity toward CPR oxidation. The electrochemical behavior of CPR on the MIL-101/rGO-modified electrode was systematically investigated using cyclic voltammetry and differential pulse voltammetry. Under optimized experimental conditions, the proposed sensor exhibited a linear response over 0.25-9.41 µM and a detection limit of 0.11 µM for CPR determination. The sensor also demonstrated good selectivity, satisfactory repeatability, and long-term stability. Furthermore, the method's practical applicability was validated by the determination of CPR in pharmaceutical samples, yielding acceptable recoveries. These results indicate that the MIL-101/rGO-modified electrode provides a promising and efficient platform for the electrochemical sensing of CPR in pharmaceutical and environmental analysis.
Acetoin is a natural compound and is widely used in various industries such as food, dairy, cosmetics, paint, and pharmaceutical industry. The study aimed to enhance acetoin production through Bacillus subtilis by employing strain selection, mutagenesis, nutritional evaluation, and utilization of cell immobilization for enhanced acetoin production. A strain coded as SFS-13 was isolated from agricultural soil and identified as B. subtilis SFS-13. The acetoin production and glucose-consuming efficiency by wild-type SFS-13 were 8.62 ± 0.04 g/L and 25.33 ± 0.02%, respectively. After chemical mutagenesis of SFS-13 with ethyl methyl sulphonate, 99 putative mutant survivors were picked through the shake flask fermentation selection procedure. The culture conditions and evaluation of medium components were performed by varying one factor at a time. The highest production of acetoin was achieved by the use of beads with a diameter of 3 mm and a quantity of 250, 5 beads per mL, that gave a yield of 0.457 ± 0.01 g/g glucose. Also, the effect of temperature and pH on the production of acetoin was tested, and the most significant yield was found at 37℃ and pH 6, with 45.03 ± 0.11% GCE. The findings provide a structural foundation for the potential industrial-scale production of acetoin and other metabolites, which is relevant in sustainable biotechnological use in the food, pharmaceutical and cosmetic sectors.
To evaluate the efficacy and safety of Lianxia Xiaopi Granules (LXXP) in treating functional dyspepsia (FD) with combined cold and heat pattern in Chinese medicine (CM). A multicenter, randomized, double-blind, and placebo-controlled trial was conducted at 11 centers between April 1, 2021, and October 24, 2022 in China. Using stratified block randomization at a 2:1 ratio, patients diagnosed with FD were randomly assigned to receive either LXXP (3.5 g/bag, equivalent to 8.337 g of raw herbs) or a placebo (3.5 g/bag) 3 times daily for 8 weeks. The primary outcome was dyspepsia symptom response rate. Secondary outcomes included individual dyspepsia symptom response rate, Chinese medicine syndrome efficacy evaluation scale including reduction rate of CM symptom total score, cure and effective rates, and safety analysis. Subgroup analyses were performed according to postprandial distress syndrome (PDS) or epigastric pain syndrome (EPS) subtypes and Helicobacter pylori (Hp) infection status. A total of 240 participants completed the trial, 160 in the LXXP group and 80 in the placebo group. At week 8, the dyspepsia symptom response rate was significantly higher in the LXXP group than in the placebo group [54.38% (87/160) vs. 32.50% (26/80), P=0.0013]. LXXP significantly improved postprandial fullness, early satiety, and bloating compared with the placebo group (P<0.05). Subgroup analysis showed greater efficacy in PDS and Hp-negative patients (P<0.05). Safety analysis revealed no significant differences in adverse events between the 2 groups. LXXP effectively improves FD symptoms, particularly in PDS and Hp-negative patients, supporting its application in CM-based treatment. (Trial registration No. ChiCTR2100041993).
Advanced therapy medicinal products (ATMPs) represent a paradigm shift in medicine; however, their implementation in European health systems is often hampered by EU regulations. Amidst a rapidly evolving and increasingly competitive global landscape, dominated by the US and China, it becomes imperative that Europe strengthens its position. This requires establishing a dialogue with European authorities to devise new regulatory mechanisms and incentives paving the way for innovation in drug development and implementation. Here, experts from the European University Hospitals Alliance (EUHA) specialising in ATMPs, share their vision on changes needed at the regulatory and organisational level to incentivise the development and clinical use of ATMPs and ensure an equitable and fast access for patients, largely inspired by the problems encountered in an academic environment and in developing ATMPs for rare diseases. To achieve real-world impact, these solutions should be supported by competent authorities at regional, national, and EU levels.
Pseudopodospermum szowitzii (DC.) Kuth. a member of the Asteraceae family, grows naturally in the Irano-Turanian phytogeographical area, including Anatolia. In Anatolia, P. szowitsii, known as "goftigoda," has edible young leaves and roots and is used in folk medicine for antidiabetic and analgesic properties. Nine compounds, including chlorogenic acid and derivatives from the ethyl acetate layer as well as 2,4,6-trimethoxyphenyl-1-O-β-glucopyranoside, 2,4,6-trimethoxyphenyl-1-O-β-apiofuranosyl-(1→6)-β-glucopyranoside, esculetin 6-O-β-glucopyranoside, and esculetin 6-O-β-apiofuranosyl-(1→6)-β-glucopyranoside from the water part of the methanolic extract, were isolated as known compounds. Notably, all esculetin derivatives have been isolated from the Pseudopodospermum for the first time, and among them, three compounds, esculetin 6-O-β-xylosyl-(1→6)-β-glucopyranoside, esculetin 6-O-β-glucopyranosyl-(1→3)-β-glucopyranoside, and esculetin 6-O-β-glucopyranosyl-(1→6)-β-glucopyranoside, were isolated as new esculetin heterosides that have not yet been isolated from any natural sources. The antioxidant activities of the total extract, phases, fractions, and compounds of P. szowitsii were also tested by evaluating their radical-scavenging capacities against DPPH and ABTS radicals. The ethyl acetate phase and the isolated compounds displayed significant antioxidant activity. The most active compound was caffeic acid, with IC50 values of 2.7 µg/mL and 3.4 µg/mL against DPPH and ABTS radicals, respectively, followed by dicaffeoylquinic acid derivatives and their methyl esters. On the other hand, none of the coumarin derivatives exhibited significant radical-scavenging activity.
Introduction Antiretroviral therapy (ART) compliance is essential for successful treatment outcomes of children living with human immunodeficiency virus (HIV) infection. The factors affecting adherence to ART, which have not yet been explored in Oman for children living with HIV infection, must thus be investigated. Methods A cross-sectional study was conducted that included all children living with HIV who were receiving care at the pediatric infectious disease clinics of Royal Hospital, a tertiary care center, and who had been on pediatric antiretroviral therapy (ART) formulations for more than one year. After receiving informed consent, 43 caregivers of HIV-positive children were interviewed using a questionnaire. Patients' characteristics, socioeconomic, pharmacological, and health care system factors were analyzed in correlation with adherence to ART using SPSS version 26 (IBM Corp., Armonk, USA). Results Thirty percent of patients (n=13) had high HIV viral loads, and among those, 19% (n=8) had suboptimal adherence. Young and non-educated caregivers, low income, and lack of transportation were significant factors for poor adherence to ART therapy, with a significant p-value. Other important factors noticed were medication not available at home, missed medication refills, and a child's busy schedule at school, and patients' caregivers did not always administer the prescribed medications. Conclusion The study results support the recommendation to provide a pediatric formulation of ART and supply it to peripheral secondary care hospitals for easy access to medications. Psychological assessments and counselling at the adolescent medicine clinic in the same centre would aid caretakers psychologically and gauge children with HIV's preparedness for disease disclosure.
Understanding the dynamic mechanical interaction between nanoparticles and cell membranes is essential for advancing nanomedicine, yet modeling these kinetics is often hindered by biological variability, experimental noise, and the limitations of traditional equilibrium-based frameworks. In this study, we present an advanced hybrid Physics-Informed Neural Network (PINN) framework designed to capture the early-stage adhesion dynamics. Our architecture integrates an analytical Standard Linear Solid model as a mechanistic backbone to represent baseline viscoelasticity, augmented by a neural residual term that captures nonlinear, stochastic, and nonequilibrium deviations. To handle heterogeneous experimental data, we incorporate an adaptive, uncertainty-aware loss weighting scheme and a physics-informed Bayesian framework utilizing a heteroscedastic likelihood for robust parameter inference. We validated this approach using single-nanoparticle force measurements on fibroblasts and MiaPaCa-2 cancer cells under a range of pharmacological treatments (Chlorpromazine, Genistein, and Nocodazole). Validated via leave-one-out cross-validation, the hybrid model demonstrates condition-dependent predictive improvements over classical models, most pronounced in severely perturbed biological states where cytoskeletal disruption renders adhesion dynamics highly irregular. This approach offers a framework for cross-condition phenotyping, providing physically consistent parameter estimates across the full spectrum of cytoskeletal perturbation severity studied here. This work introduces an interpretable approach for modeling complex biophysical adhesion processes and offers a potentially generalizable framework for analyzing noisy, heterogeneous biological systems.
Lonicerae japonicae Flos (LjF, honeysuckle) is a major component of beverages and healthcare products, as well as a key botanical resource in traditional Chinese medicine. Chlorogenic acids (CGAs) are the main bioactive components of LjF, possessing antioxidant, anti-inflammatory, antiviral, and other biological activities, among which CGA serves as the key marker compound for LjF quality evaluation. In the present work, LjF samples were subjected to controlled dry heating and analyzed by LC-DAD and UPLC-QTOF-MS. Progressive degradation of neochlorogenic acid, cryptochlorogenic acid, and isochlorogenic acid A was accompanied by concomitant accumulation of CGA, isochlorogenic acid B, and isochlorogenic acid C. Furthermore, the effects of temperature and time on thermal transformation, along with key chemical markers for different heat treatment conditions were clarified via principal component analysis of chemical changes. Mechanistic investigations revealed that isochlorogenic acid A undergoes competitive cleavage of the C-3 or C-5 caffeoyl ester bond to yield neochlorogenic acid (kinetic product) or CGA (thermodynamic product), followed by intramolecular acyl migration to form isochlorogenic acid B and isochlorogenic acid C, with isochlorogenic acid C identified as the most stable dicaffeoyl isomer. The interconversion of monocaffeoyl isomers leads to a dynamic equilibrium, with CGA being the predominant and most stable form. These results provide the comprehensive thermal-transformation map for CGAs in LjF and offer practical guidance for optimizing drying, roasting, and extraction protocols in the development of high-quality LjF, an edible and medicinal homologous resource.
The differentiation of HL-60 cells into neutrophil-like cells is widely used to study neutrophil functions, yet no comprehensive proteomic analysis has been conducted on dimethylformamide (DMF)-induced differentiation. This study provides the first detailed proteomic characterization of DMF-differentiated (df)-HL-60 cells, demonstrating its distinct molecular and functional profiles compared to the well-established dimethyl sulfoxide (DMSO)-df-HL-60 cell model. HL-60 cells were differentiated using 1.25% DMSO or 70 mM DMF for five days. Cell proliferation, granulocytic differentiation (CD11b expression), superoxide anion production, myeloperoxidase (MPO) protein expression and enzymatic activity, and neutrophil extracellular trap (NET) formation were evaluated. Proteomic profiling was performed using LC-MS/MS, followed by gene ontology and pathway enrichment analysis to identify key molecular changes associated with differentiation. DMF-df-HL-60 cells maintained higher proliferation rates than DMSO-df-HL-60 cells. Both agents successfully induced granulocytic differentiation, with DMSO producing greater CD11b expression. Functionally, both differentiation methods enhanced superoxide anion production, but DMF-df-HL-60 cells generated distinct superoxide radical spectra when evaluated with EPR spectroscopy. MPO protein expression and activity were significantly reduced in both differentiation models, indicating a transition to a mature neutrophil-like phenotype. Proteomic analysis revealed that neutrophil degranulation was the most significantly enriched pathway in DMF-df-HL-60 cells, alongside pathways involved in oxidant production and receptor tyrosine kinase signaling. Furthermore, S100 calcium-binding protein A9 (S100A9) abundance was significantly higher in DMF-df-HL-60 cells, suggesting a novel role of DMF in modulating neutrophil differentiation. DMF-df-HL-60 cells also showed activation of MAPK, Ras, and Rap1 signaling pathways, similar to the DMSO-df-HL-60 cell model, which is crucial for differentiation and immune responses. DMF-df-HL-60 cells generated more NETs than the DMSO-df-HL-60 cell model with phorbol myristate acetate. This study emphasizes the importance of selecting the appropriate differentiation model to accurately mimic neutrophil biology and highlights DMF's unique role in neutrophil differentiation, providing novel insights into differentiation-induced functional adaptations.
Fatty acids serve dual roles in cardiac physiology: as energy substrates and as precursors of bioactive lipid mediators (prostaglandins, leukotrienes, oxylipins) from n-3/n-6 PUFAs that regulate inflammation, thrombosis, and remodeling. Saturated, monounsaturated, and trans fatty acids modulate metabolism and membrane function, thereby shaping these pathways. Clinically, n-3 long-chain PUFAs (EPA and DHA) reduce cardiovascular mortality and aid postischemic remodeling; however, high doses increase the risk of atrial fibrillation. By contrast, trans and saturated fatty acids promote dyslipidemia, dysfunction, and higher rates of coronary artery disease and heart failure. Mechanistically, fatty acid uptake via FABPpm, CD36 (FAT), and FATPs, along with β-oxidation and PPAR signaling, regulates metabolism, while COX/LOX/CYP pathways generate eicosanoids and resolvins that influence inflammation and repair. This review synthesizes evidence on the roles of fatty acids and oxylipins in lipotoxicity, heart failure, ischemia-reperfusion, and arrhythmias, and evaluates dietary and supplemental interventions to optimize cardiac lipid metabolism, aligning with fatty acid signaling.
Glycated hemoglobin (HbA1c) is a well-established biomarker reflecting chronic glycemic control in diabetes. It accumulates through non-enzymatic glycation of hemoglobin under sustained hyperglycemia and serves as a surrogate of metabolic memory. Emerging in parallel, glycosylated RNA (glycoRNA), small noncoding RNAs bearing covalently attached N-linked glycans, has revealed unexpected roles in immune signaling and glycoimmunomodulation. While glycation and glycosylation represent distinct biochemical processes, both are modulated by glucose availability and cellular stress. This opinion paper aimed to explore the conceptual parallels between HbA1c and glycoRNA, proposing that hyperglycemia-induced metabolic changes may simultaneously influence both processes. In light of these, glycoRNA represents an emerging biomarker as a functional effector in metabolic disease, mirroring the hyperglycemia-driven immunological dimensions of HbA1c with a further advantage of a defined metabolic sequence, which can deepen diagnostics towards disease progression patterns. Though direct experimental evidence is currently limited, we outline plausible mechanistic intersections and suggest methodological frameworks for future research. Therefore, this perspective aims to stimulate interdisciplinary investigation into glycoRNA biology within the broader context of glycemic dysregulation and immune modulation in diabetes.
Polymeric films enable spatial and temporal control of drug release, improving therapeutic efficacy while reducing systemic side effects. While most studies focus on polymer blends, copolymer design, or chemical modification, this work investigates how geometry alone regulates degradation and drug release in micropatterned films. To this end, we exploit the μMESH platform, a dual-compartmentalized film composed of regularly patterned poly(lactic-co-glycolic acid) (PLGA) microfilaments arranged to form square openings deposited over a poly(vinyl alcohol) (PVA) microlayer. Four μMESH films with square openings of 5, 10, 20, and 50 μm were fabricated, along with a conventional unpatterned, solid PLGA film (FLAT). These films exhibited different surface area-to-volume ratios (Sa/V), ranging from 0.40 μm-1 (FLAT) to 1.02 μm-1 (μMESH with 20 μm openings). After extensive microscopy characterizations, PLGA mass loss (erosion) and molecular weight reduction (degradation) were evaluated for each film over several weeks in different media. Erosion and degradation rates strongly correlated with Sa/V (r = 0.99 and r = 0.92, respectively), with higher Sa/V resulting in slower mass loss and molecular weight decay. Electron microscopy analyses confirmed prolonged structural retention in high Sa/V films, with the μMESH exhibiting 20 μm openings preserving its architecture for at least 60 days, whereas lower Sa/V films (FLAT) showed heterogeneous degradation as early as 14 days. These observations were qualitatively confirmed by in vivo studies. From a pharmacological perspective, docetaxel-loaded films exhibited biphasic release profiles dominated by diffusion, with cumulative drug release increasing with Sa/V (r = 0.97). Overall, these findings demonstrate that the degradation, erosion, and drug release kinetics of PLGA films can be precisely tuned through geometry alone, providing a robust strategy for controlling the performance of implantable polymeric films.
Colored rice has been reported to contain bioactive compounds. This study investigated the phytochemical composition, antioxidant, antibacterial, anti-inflammatory, and cytotoxic properties of Oryza sativa L. Cv. MRQ 98 methanolic (M) and acetone (A) extracts, cultivated exclusively in Skuduk-Chupak, Sarawak, Malaysia. HPLC analysis identified several phenolic acids in both free and bound fraction forms. The DPPH assay showed strong antioxidant activities, with maximal scavenging observed at 10 mg/mL. Anti-inflammatory activity showed more than 50% protection with extract concentrations lower than 2.5 mg/mL. In contrast, antibacterial activity against Cutibacterium acnes, Staphylococcus aureus, and Staphylococcus epidermidis was weak, with IC50 exceeding 10 mg/mL. Cytotoxicity evaluation showed more than 90% cell viability at 0.3125-0.625 mg/mL concentrations, decreasing to 77% viability at higher doses. In conclusion, Oryza sativa L. Cv. MRQ 98 extracts exhibited good antioxidant and anti-inflammatory properties and were nontoxic; hence, their potential use for antiacne applications can further be explored.
A series of chalcone-based derivatives were synthesized and assessed for their ability to target neutrophil-driven inflammation. Strategic modifications on the 1,3-diaryl-prop-2-en-1-one scaffold, all bearing a methoxylated ring B, revealed two distinct anti-inflammatory profiles: inhibitors of both superoxide (SO) generation and elastase release, and selective SO inhibitors. Compound 17, featuring 3-methoxy and 2,4-dichlorophenyl substitutions, demonstrated the most potent dual inhibition (IC50 = 1.17 µM for SO and 2.60 µM for elastase), while compound 15 selectively suppressed SO production (IC50 = 2.63 µM) with minimal elastase impact. Compound 17 hampered neutrophil migration without inducing cytotoxicity, and mechanistically inhibited the phosphorylation of JNK, ERK, and FAK/paxillin-key signaling pathways in neutrophil migration and activation, without altering calcium flux. These findings highlight compound 17 as a promising lead for targeting neutrophil-mediated inflammatory disorders and underscore the potential of chalcone scaffolds for precise immunomodulation.
Cameroon bears a high malaria burden, and sulfadoxine-pyrimethamine (SP) remains widely used for intermittent preventive treatment in pregnancy despite the adoption of artemisinin-based combination therapies. Continued programmatic use of SP under sustained malaria transmission exerts selective pressure for resistant Plasmodium falciparum strains. This study investigated the molecular epidemiology of resistance-associated mutations in the P. falciparum dihydropteroate synthase (Pfdhps) gene in two health facilities in the Mbouda Health District, Cameroon. Blood samples were collected from consenting patients, and tested using a rapid diagnostic test (RDT) and thick blood smear to detect P. falciparum and determine parasite density. Positive samples were spotted onto Whatman filter paper for molecular analysis. Parasite DNA was extracted using the Chelex 100 method. The Pfdhps gene was amplified by semi-nested PCR, and restriction fragment length polymorphism (RFLP) analysis was performed using AvaII and BstUI to detect the A437G and A581G mutations, respectively. Among the 286 samples (198 women and 88 men aged 29 ± 20 years) were collected, P. falciparum was present in 87 (30.41%). Male participants had a slightly higher mean parasite density (2343 ± 1240 parasites/μL) compared to females (2283 ± 1483 parasites/μL). Education level was also significantly associated with positivity (p = 0.001), with the highest prevalence among participants with primary education only (41.66%) and the lowest among those with no formal schooling (10.34%). The frequency of the A581G mutant allele was 67.60%, while that of A437G was 45.07%. The wild-type allele frequencies were 48.87% for A437G and 22.53% for A581G. Mixed alleles were observed only for A437G (1.40%). The high frequency of Pfdhps mutations suggests substantial sulfadoxine resistance pressure in the study area. However, as dhfr mutations associated with pyrimethamine resistance were not assessed, overall sulfadoxine-pyrimethamine efficacy cannot be conclusively determined.
Therapeutic drug monitoring (TDM) of tacrolimus is essential due to its high inter- and intra-patient variability and narrow therapeutic window. Conventional venous blood sampling may limit sampling frequency and patient convenience. Capillary dried blood spot (DBS) sampling represents a patient-centric alternative that could enable decentralized monitoring and longitudinal follow-up in clinical practice. The aim of this study was to evaluate the clinical applicability of capillary finger prick sampling for tacrolimus TDM and creatinine determination in the hospital (part 1), and at home (part 2), using conventional DBS and Capitainer® qDBS devices. Previously validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis methods were used. Additionally, sample quality and patient experience were assessed. The assisted sampling part of the study revealed the clinical applicability of conventional DBS and Capitainer® qDBS sampling as a complementary tool for tacrolimus TDM and creatinine determination after capillary finger prick, with Capitainer® qDBS showing better clinical agreement (93 % of tacrolimus and 87 % of creatinine results within 15 % of the mean). Home sampling using Capitainer® qDBS devices was found to be feasible in allo-SCT patients, who also positively scored the user-friendliness of the device. Capillary qDBS show great potential as a complement to venous blood draws for tacrolimus and creatinine determination in TDM workflows. Integration of home-based sampling allows better longitudinal assessment of drug exposure and renal function, providing laboratory insight into intra-patient variability and adherence, contributing to more informed, individualized TDM.
Routinely continuing postoperative antibiotic prophylaxis beyond 24 hours runs against global standards and increases the risk of antimicrobial resistance (AMR). This study explored the effect of Value-Based Healthcare (VBHC)-influenced antimicrobial stewardship program (ASP) activities on postoperative oral antibiotic prescription at a tertiary hospital in Saudi Arabia. The Health Sector Transformation Program aims to shift the healthcare service in Saudi Arabia to value-based service by implementation of VBHC models. The intervention performed in SGH-Hail support the Vision 2030 objective of Saudi Arabia. VBHC is based on the premise that healthcare value should be measured by the health outcomes achieved relative to the cost (in dollars) incurred rather than by the number of services (volume) delivered. This pre-post design intervention study was conducted at the Saudi German Hospital in Hail. Data were obtained from all surgical patients (elective and emergency, analyzed jointly) both pre- and post-implementation of a fully VBHC-focused stewardship program that included educational activities, mandatory documentation, prospective audits and feedback, clinical decision support, and multidisciplinary stewardship. The primary outcome was the proportion of patients who received postoperative oral antibiotics beyond 24 hours of prophylaxis. Effect sizes were quantified using the Odds Ratio (OR) and Absolute Risk Reduction (ARR) with 95% confidence intervals. A total of 4,103 surgical patients were analyzed (pre-VBHC: n=633; post-VBHC: n=3,470). Post-operative antibiotic prescribing decreased significantly from 75.9% to 15.9% following implementation (p<0.001), with an OR of 0.060 (95% CI: 0.049-0.074) and an ARR of 60.0 percentage points. Documentation of clinical justification improved from 1.0% to 88.6% (p<0.001). The intervention effect was consistent across all major surgical departments (all p<0.001) and both genders. Surgical site infection rates remained below institutional and international benchmarks throughout the study period. The application of VBHC principles led to a clinically and statistically significant reduction in unnecessary postoperative antibiotic prescriptions (OR 0.060; ARR 60.0 percentage points) and a marked increase in guideline compliance. The components of this intervention provide a framework that other healthcare organizations can implement to make surgical prophylaxis practices evidence-informed.
Malnutrition-including undernutrition, micronutrient deficiencies and overweight-remains a major public health concern in sub-Saharan Africa, largely driven by food insecurity. Edible insects have been proposed as a sustainable, nutrient-dense dietary alternative with potential to improve food security and nutritional outcomes. This review analyses studies published until January 2024 in PubMed and Google Scholar assessing the prevalence, acceptability and nutritional impact of insect-based diets in sub-Saharan Africa. Thirteen original studies, predominantly qualitative, conducted in 8 of 47 countries in the region, met inclusion criteria. Two reviews provided additional evidence. Most studies focused on acceptability, which was strongly influenced by cultural and religious norms. Higher acceptance was observed among older individuals and those with lower educational attainment, while younger and more urbanized populations showed greater reluctance. Reported motivations for consumption included tradition, taste and perceived nutritional value. Some studies highlighted potential health risks related to food safety and the need for improved regulatory frameworks. The available nutritional analyses showed that edible insects are rich in protein and essential micronutrients, particularly iron and zinc, suggesting their potential to address common deficiencies. Although evidence on long-term nutritional impact remains limited, current findings support the feasibility and potential public health relevance of promoting insect-based diets in low-income settings.
Sinefungin is a nucleoside natural product isolated from several strains of Streptomyces. The chemical structure of sinefungin is characterized by an unusual C-C bond linkage between ornithine and adenosyl fragments. Previous studies suggested that pyridoxal 5'-phosphate (PLP)-dependent enzyme catalysis is involved in the key C-C bond-forming step. Here, we show that instead of PLP catalysis, sinefungin biosynthesis involves a B12-dependent radical S-adenosyl-l-methionine (SAM) enzyme, SnfB, that catalyzes the C-adenosylation of arginine. The amidino group in the resulting SnfB product is then hydrolyzed by SnfC to produce sinefungin via a cryptic phosphorylation step catalyzed by SnfH. This study highlights the catalytic versatility of the B12-dependent radical SAM enzyme family and unveils an unconventional assembly pathway for amino acid-nucleoside conjugates in nature.