Endophytic fungi isolated from medicinal plants are important for production of antibiotics. They can produce secondary metabolites with diverse structures and activities. Debregeasia salicifolia is a plant of medicinal importance, and no report exists regarding isolation of endophytic fungi from it. This study was focused to isolate and identify culturable endophytic fungi from foliar parts of D. salicifolia and to determine their bioactivities. Molecular analysis resulted in identification of Fusarium fujikuroi, Aspergillus tubingensis and Rhizopus oryzae based on specific internal transcribed spacer primer (ITS1/ ITS4). Our analysis revealed that all fungal endophytes possess antibacterial activity against Gram-negative and Grampositive bacteria. Remarkably, Rhizopus oryzae at a concentration of 5 mg/mL efficiently restricted the growth of ATCC strain of E. coli in comparison with positive control ciprofloxacin. Rhizopus oryzae and F. fujikuroi at a concentration of 1000 µg/ml exhibited maximum antioxidant activity of 45% and 44%, respectively. They also showed antifungal activity ranging from 60 to 75% against Aspergillus flavus and Aspergillus niger. Our analysis of the fungal extracts through GC-MS indicated the presence of 21 compounds of diverse nature and structure. In conclusion, our study highlighted the potential of D. salicifolia to host a plethora of fungal endophytes that secrete potentially therapeutic bioactive metabolites
Qualitative primary study Methods: Semi structured in-depth interviews were conducted with 13 stakeholders selected using purposive sampling methods including officials from provincial government and district administration (legislators, district managers, deputy commissioners and assistant commissioners) and representatives from private sector organisations with direct or indirect role in implementation of PPP policy. Data were analysed using a thematic approach. Results: Participants had very limited in-depth understanding about the concept of PPP. They considered multifaceted corruption in the health system, and the success of existing PPP initiatives, as the main reasons for the PPP policy adoption. Resistance from healthcare staff was perceived as the main barrier for implementation of PPP. There was a common perception that better monitoring capacity in the private sector management can be a cause of concern for public sector employees who may have become used to less efficient working. A common theme found in the narratives was the possible apprehensions from healthcare staff about the loss of their jobs. Conclusion: Our findings indicated lack of effective engagement with key stakeholders and the resistance from healthcare staff as the key barriers for PPP implementation in Sindh, Pakistan. These findings provide useful insights for the successful implementation of such initiatives both in Pakistan as well as in other similar settings.
IntroductionFrailty poses a huge burden to individuals, their families and to healthcare systems. Several interventions have been evaluated for the improvement of outcomes for older people with frailty, including integrated care interventions. Reviews synthesising evidence on the effectiveness of integrated care for older people with frailty have treated them as a single population, without considering the heterogeneity between different frailty levels such as non-frail, mild frailty, moderate frailty and severe frailty. Findings from these studies have shown inconsistent results on the various outcomes assessed. People with different frailty status have different care needs, which should be addressed accordingly. The aim of this study is to synthesise evidence on the effectiveness of integrated care interventions on older people with different frailty status who are community dwelling or living in retirement housing or residential setting but not in care homes or in nursing homes.Methods and analysisThis is a protocol for a systematic review assessing the effectiveness of integrated chronic care interventions on older people with different frailty status. A literature search will be conducted on the databases Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and clinical trial registers. Two authors will independently conduct search and screening for eligible studies. Full-text screening will be used to include only studies that fulfil the inclusion criteria. Data extraction will be done on a data extraction form and methodological quality of studies will be assessed using the Effective Practice and Organisation of Care risk of bias tool. The interventions will be described following Wagner’s Chronic Care Model.Ethics and disseminationEthical approval for this study was obtained from the Institute for Health Research Ethics Committee of the University of Bedfordshire (IHREC934). The results of the review will be disseminated through a peer-reviewed journal article, conferences and also with local provider and user stakeholders.PROSPERO registration numberCRD42020166908.
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