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A method for obtaining non-isocyanate polyurethane (NIPU) foams from cyclic carbonate (CC) based on soybean oil was developed. For this purpose, cyclic carbonate was synthesized from epoxidized soybean oil and CO 2 using various ionic liquids (ILs) as catalysts. Among the tested ILs, the highest selectivity (100%) and CC yield (98%) were achieved for 1-ethyl-3-methylimidazolium ([emim]Br). Without any purification, the resulting cyclic carbonate was reacted directly with diethylenetriamine as a model crosslinking agent to produce NIPU foams. It was found that the soybean oil-based CC synthesized with bromide imidazolium ionic liquids exhibited significantly shorter gelling times (8 min 50 s for [emim]Br and 9 min 35 s for [bmim]Br) compared to those obtained with the conventional TBAB catalyst (26 min 15 s). A shorter gelling time is a crucial parameter for the crosslinking process in foams. The obtained foams were subjected to mechanical tests and a morphology analysis.

Background: The reporting of adverse drug reactions associated with drug-resistant tuberculosis (DR-TB) medication is important for pharmacovigilance, especially in high-burden countries such as South Africa. With DR-TB treatment being so dynamic, it is important to understand adverse event reporting practices at specialised facilities., Objectives: The study aimed to understand the adverse drug reaction (ADR) reporting practices at DR-TB treatment facilities in South Africa., Method: Interviews were conducted with healthcare workers at specialised DR-TB facilities. This was to collect data on demographics, pharmacovigilance training, and determine attitudes and practices towards reporting adverse events. A checklist was developed to review the most recent adverse event forms captured at the facility., Results: Most participants did not have adverse event reporting training since their initial training but were confident that they could complete a form themselves. Most participants could correctly identify the major adverse events associated with DR-TB medication, but some deemed non-adverse events as plausible. Adverse event report forms were not standardised with most participants deeming further training and regular feedback as reasons to report ADRs., Conclusion: Standardisation of adverse event report forms used and the establishment of regular reporting will increase adverse event reporting at DR-TB facilities. Continuous training, empowerment and expansion of staff categories eligible to report adverse events will enhance and sustain such practice., Contribution: The study highlights challenges faced by healthcare professionals in reporting adverse events., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2023. The Authors.)

Background: Amidst widespread public health recommendations and availability of COVID-19 vaccinations, half of South African adults are vaccinated against COVID-19. This study investigated the socio-behavioral determinants of vaccine hesitancy in South Africa, where vaccine hesitancy was separated into unwilling ness and uncertainty to take a COVID-19 vaccine., Methods: Data was collected from a large-scale public survey during June-October 2021 that included online and telephonic surveys. Vaccination hesitancy was based on the question "When available, would you take the COVID 19 vaccine?," with responses categorized into those who were willing, unwilling, and uncertain about taking a COVID-19 vaccine. Multinomial regression examined the association between socio-behavioral variables and vaccine hesitancy., Results: Overall, 73.8% reported they would definitely or probably take the vaccine, 16.4% were uncertain and 9.9% reported they probably or definitely would not ( n  = 16,988). Younger age, White and Colored population groups, no influenza vaccination history, previous vaccination refusal, knowing someone who experienced a serious vaccination side-effect, misperceptions about vaccine benefits, cultural or religious discouragement from taking a COVID-19 vaccination, lack of governmental confidence, concerns about side-effects, perceived lack of safety information, and lack of trust in the pharmaceutical industry and in the information from health care providers were all associated with higher odds of being uncertain and unwilling to take a COVID-19 vaccination. Strengths of association for unwillingness and uncertainty varied by the explanatory variables. Concern about effectiveness due to fast development was associated with uncertainty to take the vaccine but not with unwillingness. Concerns about side-effects had stronger associations with uncertainty than with unwillingness, while previous vaccine refusal, misperceptions of the protective benefits of vaccines, White population group, religious/cultural discouragement, and lack of trust in the pharmaceutical industry and health care providers' information had stronger associations with unwillingness than uncertainty., Conclusion: The determinants of COVID-19 vaccine hesitancy should be addressed in interventions to improve vaccine uptake. Public health interventions and health communication can be prioritized and tailored to the different forms of vaccination hesitancy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sewpaul, Sifunda, Gaida, Mokhele, Naidoo and Reddy.)

2-Azabicycloalkanes: 2-azabicyclo[2.2.1]heptane and 2-azabicyclo[3.2.1]octane were used as a chiral platform for the construction of a set of 1,2,3-triazole, thiourea, and ebselen derivatives. Cytotoxicity and antiviral activity studies revealed the most promising potency for selected thioureas., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: Vulvovaginal candidiasis is primarily caused by Candida albicans ( C. albicans ). Here, a novel organoselenium compound (G20) was synthesized and evaluated for anti- Candida activity. Methods: Growth-inhibition studies and medium acidification assays to assess the inhibition of the yeast plasma membrane H + -ATPase (Pma1p) were carried out in vitro using G20. A self-nanoemulsifying formulation (SNEP) of G20 was prepared and evaluated for antimycotic activity in a mouse model. Results: G20 inhibited the growth of C. albicans through a mechanism that, at least in part, involves the inhibition of Pma1p. The G20-SNEP formulation significantly reduced vaginal colonization and vaginal inflammation relative to yeast-infected but untreated control mice. Conclusion: G20-SNEP exhibits potent antimycotic activity in a mouse model of vulvovaginal candidiasis.

Background: Hospital readmissions increase healthcare system costs and can place additional strain on already sparse government funds and under-resourced hospitals. Few studies have investigated readmission of patients in mental health facilities in South Africa., Aim: The study aimed to identify the factors associated with readmission of patients discharged from an acute psychiatric public hospital in South Africa., Setting: The study was conducted at an acute psychiatric public hospital., Method: A retrospective review of medical records was conducted for all patients admitted and readmitted between January 2018 and December 2019., Results: From the pool of patient records analysed ( n = 516), 93 (18.02%) were readmitted, of which the majority (75.27%) were male. The average age of patients readmitted was 27.24 ± 11.16 years, which was significantly younger than the total sample ( p < 0.05; CI 1.095-7.105). Findings indicated that patients who completed lower levels of education, were unemployed and were diagnosed with substance (mono- or polysubstance) use disorder ( n = 93; 100%), schizophrenia ( n = 33; 35.48%), bipolar disorder ( n = 9; 9.68%) or intellectual disability ( n = 9; 9.68%) were more frequently readmitted, with the average length of stay varying widely between patients., Conclusion: Younger patients and those living with more complex psychiatric conditions, particularly those who are substance abusers, were readmitted more frequently, indicating that these patients may require special consideration for management., Contribution: The study revealed that patients living with complex psychiatric conditions such as schizophrenia and bipolar disorder were readmitted to hospital more frequently, indicating that management of these patients at the community level is challenging., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article, (© 2022. The Authors.)

Triboluminescence (TL) is a phenomenon of light emission resulting from the mechanical force applied to a substance. Although TL has been observed for many ages, the radiation mechanism is still under investigation. One of the exemplary compounds which possesses triboluminescent properties are copper(I) thiocyanate bipyridine triphenylphosphine complex [Cu(NCS)(py) 2 (PPh 3 )], europium tetrakis dibenzoylmethide triethylammonium EuD 4 TEA, tris(bipyridine)ruthenium(II) chloride [Ru(bpy) 3 ]Cl 2 , and bis(triphenylphosphine oxide)manganese(II) bromide Mn(Ph 3 PO) 2 Br 2 . Due to the effortless synthesis route and distinct photo- and triboluminescent properties, these compounds may be useful model substances for the research on the triboluminescence mechanism. The advance of TL studies may lead to the development of a new group of sensors based on force-responsive (mechanical stimuli) materials. This review constitutes a comprehensive theoretical study containing available information about the coordination of metal complex synthesis methodologies with their physical, chemical, and spectroscopic properties.

This study investigated the bacterial colonization in patients admitted for treatment of drug-resistant tuberculosis in a specialized TB hospital. Identification and antimicrobial susceptibility testing of bacterial isolates ( n  = 62) from nasal, groin, and rectal swabs [patient cohort ( n  = 37)] were determined by the VITEK-MS system. Resistance gene analysis was by PCR and DNA sequencing. Molecular typing of Klebsiella pneumoniae isolates was by Multilocus Sequencing Typing (MLST). Patients ( n  = 13/37; 35%) were colonized by multidrug-resistant (MDR) bacteria (ESBL and MRSA) on admission. Of the 24 patients who were not colonized by MDR bacteria on admission, 46% (17/37) became colonized by MDR bacteria within 1 month of admission, mostly with ESBL-producing Enterobacteriales and resistance to aminoglycosides and fluoroquinolones. ESBL Escherichia coli (41/62; 66%) and K. pneumoniae (14/62; 23%) predominated. Genes encoding for ESBLs ( bla CTX-M-14 , bla CTX-M-15 , bla SHV-28 , bla OXA-1 , and bla OXY-2 ) and plasmid-mediated quinolone resistant genes ( qnrB1 , qnrB4 , and qnrB10 ) were detected. MLST revealed genetic diversity among the K. pneumoniae isolates from hospitalized patients. This study provides insight into bacterial pathogen colonization in hospitalized TB patients with the first occurrence of the qnrB4 and qnrB10 genes and co-expression of genes: qnrB4+aac(6')-lb-cr, qnrB10+aac(6')-lb-cr , qnrB4+qnrS1 , and qnrB10+qnrS1 in fluoroquinolone-resistant E. coli isolates within South Africa. However, the source and colonization routes of these isolates could not be determined.

Background: The World Health Organization (WHO) declared the COVID-19 pandemic a public health emergency of international concern. South Africa, like many other countries, initiated a multifaceted national response to the pandemic. Self-isolation and quarantine are essential components of the public health response in the country. This paper examined perceptions and preparedness for self-isolation or quarantine during the initial phase of the pandemic in South Africa., Methods: The analysis used data obtained from an online quantitative survey conducted in all nine provinces using a data-free platform. Descriptive statistics and multivariable logistic regression models were used to analyse the data., Results: Of 55,823 respondents, 40.1% reported that they may end up in self-isolation or quarantine, 32.6% did not think that they would and 27.4% were unsure. Preparedness for self-isolation or quarantine was 59.0% for self, 53.8% for child and 59.9% for elderly. The odds of perceived possibility for self-isolation or quarantine were significantly higher among Coloureds, Whites, and Indians/Asians than Black Africans, and among those with moderate or high self-perceived risk of contracting COVID-19 than those with low risk perception. The odds were significantly lower among older age groups than those aged 18-29 years, and those unemployed than fully employed. The odds of preparedness for self-isolation or quarantine were significantly less likely among females than males. Preparedness for self, child and elderly isolation or quarantine was significantly more likely among other population groups than Black Africans and among older age groups than those aged 18-29 years. Preparedness for self, child and elderly isolation or quarantine was significantly less likely among those self-employed than fully employed and those residing in informal dwellings than formal dwellings. In addition, preparedness for self-isolation or quarantine was significantly less likely among those with moderate and high self-perceived risk of contracting COVID-19 than low risk perception., Conclusion: The findings highlight the challenge of implementing self-isolation or quarantine in a country with different and unique social contexts. There is a need for public awareness regarding the importance of self-isolation or quarantine as well as counter measures against contextual factors inhibiting this intervention, especially in impoverished communities.

Background: The World Health Organisation (WHO) guidelines recommend that, because of the resistance patterns of extensively drug-resistant (XDR) tuberculosis (TB) and its unique mechanism of action, bedaquiline be included in the regimen. Although the results of clinical trials have shown bedaquiline to be beneficial, it also carries the risk of adverse effects, some potentially life-threatening. The aim of the study was to determine the incidence of adverse effects caused by bedaquiline in patients diagnosed with XDR-TB. The subsequent management of these adverse effects was also analysed., Methods: The medical records of patients aged 18 years or older living with XDR-TB who were prescribed bedaquiline in combination with a background regimen at a public-sector drug-resistant TB hospital in the Eastern Cape were reviewed., Results: Thirty records were reviewed in September 2016. Female patients constituted 66.67% ( n = 20) of the sample. Nearly half (46.67%; n = 14) of the patients were living with human immunodeficiency virus, and six (42.86%) of them were female. Adverse effects were recorded for 26 patients (86.67%) including corrected QT prolongation (40%; n = 12), skin rash (33.33%; n = 10) and hyperlactataemia (33.33%; n = 10) as the most common. There were no treatment discontinuations or deaths. The management of adverse effects varied from omitting doses of bedaquiline to pharmacological intervention., Conclusion: All patients completed bedaquiline treatment, indicating that the adverse effects did not require discontinuation of the drug. However, when pharmacological intervention is required for the management of adverse effects, care should be taken to ensure that there is minimal interaction with other TB drugs and a low risk of further adverse effects., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2020. The Authors.)

Background: People with mental disorders are more vulnerable to human immunodeficiency virus (HIV) infection. A part of first-line treatment for HIV, efavirenz, is routinely avoided in patients with mental illness due to the risk of potential aggravation of the mental illness. This study aimed to determine the outcomes of people living with HIV/AIDS who were mental healthcare users admitted to two public-sector psychiatric facilities and who were prescribed an efavirenz-containing regimen., Materials and Methods: A retrospective drug utilization study was conducted at two public-sector psychiatric hospitals in the Eastern Cape of South Africa. Patients aged 18 years or older living with HIV were included in the study. Follow-up reviews were conducted at four, 12 and 24 weeks. The patients were seen by doctors at the hospital and notes on progress and medication were recorded in medical records. The files were then reviewed., Results: A total of 37 patients were enrolled. However, just 26 were reviewed at 24 weeks. A total of 43.2% (n=16) were female patients and the average age of the patients was 39.38±8.76 years. At the baseline, 32.4% (n=12) patients were diagnosed with schizophrenia. A total of 81.08% (n=30) of patients experienced an improvement in psychiatric symptoms after 24 weeks. Of these, 43.3% (n=13) were on an efavirenz-containing regimen., Conclusion: Majority of the patients demonstrated an improvement in their psychiatric conditions to the extent that they were discharged into the community. This finding suggests that patients with psychiatric disorders on efavirenz can experience stabilisation of their psychiatric symptoms., Competing Interests: Conflict of interest: The authors declare that they have no conflict of interest associated with this study., (Copyright: © 2020 Afr. J. Infect. Diseases.)

Objectives: Identify the incidence of haematological adverse effects associated with linezolid., Methods: Medical records of 27 hospitalised patients in South Africa with drug-resistant tuberculosis (DR-TB) and prescribed linezolid therapy were retrospectively reviewed., Key Findings: Approximately a quarter (n = 7) of patients experienced haematological adverse effects. These included anaemia (14.8%; n = 4), low haemoglobin (7.4%; n = 2) and macrocytosis (3.7%; n = 1). All patients who exhibited haematological adverse effects were living with HIV., Conclusion: The haematological effects of linezolid manifested in patients who were suffering from co-morbid HIV. Haematological monitoring should be done monthly in order to detect adverse effects timeously and intervene as appropriate., (© 2019 Royal Pharmaceutical Society.)

Background: Efavirenz is associated with neuropsychiatric side effects. The consequences of using efavirenz in human immunodeficiency virus (HIV)-positive patients with mental illness has not been conclusively established, the concern being that efavirenz may worsen the condition of an already mentally ill patient. The absence of guidelines and the lack of evidence for the use of efavirenz in this special population lead to uncertainty and, as a result, varying practices in the clinical setting., Aim: To determine the experiences of healthcare professionals caring for mentally ill people living with HIV (PLWH) who are using efavirenz, the associated neuropsychiatric side effects and the management thereof., Setting: Eastern Cape, South Africa., Method: A qualitative, descriptive, exploratory design was used to understand the phenomenon under study and to share the experiences of the participants. Semi-structured interviews were conducted. The data were analysed using thematic framework analysis and coded by the researcher as well as an independent coder., Results: There were conflicting feelings concerning the use of efavirenz in PLWH with active mental illnesses. Some healthcare professionals were willing to prescribe and use efavirenz whilst others were not. All participants indicated that further elucidation in the guidelines on the possible side effects associated with efavirenz and suggested management strategies would be useful., Conclusion: The expansion of the South African National Guidelines for the Treatment of HIV should include descriptions of the side effects caused by antiretrovirals and management strategies thereof to empower healthcare professionals to make informed decisions regarding patient care for mentally ill PLWH., Competing Interests: The authors confirm that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2018. The Authors.)

Background: Tenofovir disoproxil fumarate (TDF) and lopinavir/ritonavir (LPV/r) can cause renal impairment with this combination co-administered during second-line combination antiretroviral therapy (cART) potentially associated with greater risk of nephrotoxicity. As a result, the aim of this study is to assess effects of second-line cART on renal function., Methods: Retrospective longitudinal study in patients receiving cART., Results: 71 patients received TDF, zidovudine or stavudine, each combined with 3TC/NVP or 3TC/EFV. Before second-line cART, 46.5% had abnormal kidney function. First-line cART had no relationship with calculated creatinine clearance (CrCl). During second-line cART, more males than females had abnormal renal function and more females experienced increases in CrCl. Calculated CrCl during second-line cART related strongly with CrCl during first-line cART. Time spent on cART had a weak relationship with CrCl., Conclusion: Patients on first-line cART for several years without renal impairment may experience new onset impairment during second line cART. Patients with pre-existing renal impairment just before switching to second-line cART may experience a further decline.

Background: It is acknowledged that almost half of patients initiated on efavirenz will experience at least one neuropsychiatric side effect., Objectives: The aim was to determine the incidence and severity of neuropsychiatric side effects associated with efavirenz use in five public-sector primary healthcare clinics in the Eastern Cape., Method: The study was a prospective drug utilisation study. A total of 126 medical records were reviewed to obtain the required information. After baseline assessment, follow-up reviews were conducted at 4 weeks, 12 weeks and 24 weeks from 2014 to 2015., Results: The participant group was 74.60% female ( n = 94), and the average age was 37.57±10.60 years. There were no neuropsychiatric side effects recorded for any patient. After the full follow-up period, there were a total of 49 non-adherent patients and one patient had demised. A non-adherent patient was defined as a patient who did not return to the clinic for follow-up assessment and medication refills 30 days or more after the appointed date. Some patients ( n = 11) had sent a third party to the clinic to collect their antiretroviral therapy (ART). The clinic pharmacy would at times dispense a two-month supply of medication resulting in the patient presenting only every two months., Conclusion: Further pharmacovigilance studies need to be conducted to determine the true incidence of these side effects. Healthcare staff must be encouraged to keep complete records to ensure meaningful patient assessments. Patients being initiated on ART need to personally attend the clinic monthly for at least the first 6 months of treatment. Clinic staff should receive regular training concerning ART, including changes made to guidelines as well as reminders of side effects experienced., Competing Interests: The authors declare that they have no financial or personal relationships which may have inappropriately influenced them in writing this article.

Efavirenz is part of the first-line treatment for HIV patients including those in South Africa with approximately 50% experiencing neuropsychiatric side effects. A systematic review of papers reporting neuropsychiatric side effects with efavirenz published between January 2001 and December 2014 was performed, to provide guidance. 13 articles were reviewed. Patient ages ranged between 37 to 41 years, with a high percentage males. Scales used to measure incidence and severity of side effects were varied; with disease severity or stage not reported. Patients with psychoses were excluded. Most commonly reported side effects were a reduction in sleep quality, depression, dizziness and anxiety. These were generally mild and not warranting discontinuation of efavirenz. It is difficult to directly compare the studies. Standardised methods need to be introduced and all patient groups represented including the elderly, children, patients with active symptomatic illness and more women especially among the African population.