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A pragmatic trial with an optimized dose of rifampicin and moxifloxacin for the treatment of drug-susceptible pulmonary tuberculosis: A study protocol for open-label, randomized phase III trial (OptiRiMoxTB)
(Research Square, 2025-10-15) Mlyuka, Hamu; Liyoyo, Alphonce; Nyaulingo, Belinda; Mpolya, Emmanuel; Kaswaga, Oscar; Semvua, Hadija; Lwambura, Samwel; McHugh, Tim; Wildner, Leticia; Sabiiti, Wilber; Adegbite, Bayode; Nliwasa, Marriot; Khosa, Celso; Mbelele, Peter; Mbeya, Benno; Jeremiah, Kidola; Boeree, Martin; Gillespie, Stephen; Sloan, Derek; Mpagama, Stellah
Background
Current combination antibiotic treatment for drug-susceptible tuberculosis (DS-TB) usually takes six months to complete. This long duration can compromise clinical outcomes. Although a four-month regimen including an optimized dose of rifapentine plus moxifloxacin is non-inferior to standard therapy, rifapentine is hard to source globally and adoption of this regimen has been slow. This trial investigates the efficacy and safety of a four-month DS-TB treatment including the more readily available rifamycin, rifampicin 35mg/kg, with or without moxifloxacin 400mg.
Methods
This multi-centre phase III randomized open-label clinical trial will be conducted across four African countries (Gabon, Malawi, Mozambique, and Tanzania). A total of 414 newly diagnosed consenting adult participants will be block randomized, after stratification by chest radiograph cavitation, to two experimental and one control arm at a ratio of 1:1:1. The first experimental group will receive optimized dose rifampicin (35mg/kg) with routine weight-banded doses of isoniazid, pyrazinamide, and ethambutol once daily for four-months. The second experimental group will receive optimized dose rifampicin (35mg/kg) and moxifloxacin 400mg once daily alongside routine doses of isoniazid and pyrazinamide. The control group will receive six-month standard of care therapy: rifampicin (10mg/kg) plus weight banded dose of isoniazid, pyrazinamide, and ethambutol for two months, followed by the same doses of rifampicin and isoniazid for four months. Participants will be followed until the allocation of efficacy (TB-free survival) and safety (proportion of severe adverse events) outcomes. Secondary outcomes will also include the evaluation of the Tuberculosis Molecular Bacterial Load Assay (TB-MBLA) for microbiological treatment monitoring.
Discussion
This study will evaluate whether four-month duration multi-drug treatment including an optimized dose of rifampicin with or without moxifloxacin have non-inferior efficacy and safety outcomes compared to standard of care DS-TB therapy in Africa.
Medicinal plants used in the Maasai traditional healthcare system for diabetes and associated conditions in Monduli District, Arusha, Tanzania
(Elsevier B.V., 2025-12-29) Roman, Wilfrida; Martin, Haikael; Ismail, Huda; Islam, Shahidul
Diabetes mellitus is a growing global health concern, particularly in resource-limited countries where traditional medicine remains a primary source of healthcare. Despite its significant contribution, comprehensive documentation of indigenous medicinal plants used for diabetes management remains limited across various communities. This study aimed to document and analyze the ethnomedicinal knowledge of Maasai Traditional Practitioners (MTPs) in Monduli District, Tanzania, with an emphasis on plant-based remedies utilized for the treatment of diabetes and its associated complications. Ethnobotanical data were collected through semi-structured interviews with MTPs, followed by plant identification and literature review to assess the novelty and reported uses of the documented species. A total of 55 medicinal plant species belonging to 33 families were recorded. Notably, eight species, including Aasparagus africanus, Flueggea virosa, Cynodon dactylon, Malva verticillata, Ximenia caffra, Ziziphus mucronata, Scutia myrtina, and Corchorus olitorius were reported for the first time as antidiabetic remedies. Trees and shrubs were the dominant growth forms, with roots and bark being the most frequently utilized plant parts. Oral administration was the primary mode of remedy delivery, with dosage and frequency varying according to disease severity and patient condition. The findings highlight the importance of Maasai indigenous knowledge in diabetes management while raising sustainability concerns due to the extensive harvesting of roots and bark. Further research is recommended to support conservation and cultivation efforts and to evaluate the antidiabetic potential, bioactive compounds, and safety of newly identified species, thereby contributing to the development of novel plant-derived antidiabetic therapies and the preservation of indigenous knowledge.
rsenic removal from water using capacitive deionization electrode materials derived from Moringa oleifera seeds
(SAGE Publications, 2025-12-23) Mwangesi, Magdalena; Machunda, Revocatus L.; Jande,Yusufu Abeid Chande
Low-cost activated carbon electrodes derived from Moringa oleifera seeds were developed for the efficient removal of Arsenic from contaminated water by capacitive deionization (CDI). The elec-trodes were synthesized using a carbon slurry composed of Moringa oleifera powder (MOP), poly(vinylidene fluoride), and carbon black. Scanning electron microscopy was used to analyze the surface morphology. In contrast, their electrochemical properties, including capacitance and electrical conductivity, were analyzed through cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). The capacitance values, as determined from CV and EIS measure-
ments, were 201.3 Fg−1 and 122.62 Fg−1 for MOP (MOP-1:1 and MOP-1:2), respectively. The Arsenic removal efficiency was evaluated under optimized electrochemical conditions, achieving an efficiency of 89.38% when treating a 100 mg/L arsenite solution at an applied voltage of 1.2 V and pH 9. These findings highlight the potential of Moringa oleifera seeds-derived carbonelectrodes as sustainable, cost-effective materials for Arsenic removal through CDI.
Universal Characteristics of Landfill Leachate Generated from Food and Organic Wastes
(Science publishing group, 2025-10-28) Aluvihara,Suresh; Pestano-Gupta, Ferial; Omar, Mohammad Hamid; Hilonga, Askwar
The management of municipal solid waste (MSW) containing significant fractions of food and organic matter presents critical challenges, primarily due to the potent and dynamically evolving nature of the resultant landfill leachate. This study addresses the persistent variability observed in leachate composition across diverse geopolitical regions, which often complicates the design and optimization of robust treatment systems, leading to inefficient resource expenditure and environmental non compliance. Utilizing a comprehensive, comparative meta-analysis of leachate data derived exclusively from anaerobic decomposition phases of high-organic-content landfills globally, this research aimed to delineate the foundational physicochemical parameters that exhibit universal consistency, irrespective of confounding site-specific operational or climatic factors. This methodological approach involved the rigorous standardization and statistical integration of analytical metrics sourced from over fifty operational and closed landfill sites across four continents, focusing specifically on early to intermediate decomposition stages where the high initial organic loading remains the principal driver of chemical composition. The analysis conclusively identified several quantitative and qualitative characteristics intrinsic to high-organic-waste leachate that transcend geographic location or specific waste input details. Notably, a consistently high average BOD/COD ratio (ranging strictly from 0.45 to 0.70) was established as a definitive marker during the early acidogenic and intermediate methanogenic phases, signifying substantial initial biodegradability driven by massive concentrations of short-chain volatile fatty acids (VFAs), primarily acetic and propionic acid. Furthermore, ammonia nitrogen concentrations consistently ranked as the predominant inorganic constituent, often correlating directly with the initial protein input and exhibiting extreme resistance to conventional biological removal due to frequent co-occurrence with inhibitory high salinity levels. These findings collectively underscore the critical need for standardized pre-treatment strategies that specifically target VFA neutralization, recalcitrant ammonia stripping, and management of extremely high organic loading, offering a foundational, universal baseline for engineering design across disparate organic waste disposal scenarios.
Cost-Effective Materials and Technologies for the Removals of Metals and Heavy Metals from Leachate
(Science publishing group, 2025-10-11) Aluvihara,Suresh; Pestano-Gupta,Ferial; Hilonga,Askwar
Landfill leachate, a highly complex and toxic wastewater, which poses significant environmental and public health risks due to its heavy metal content. The ubiquitous presence of toxic metals such as lead, cadmium, mercury, arsenic, and chromium in leachate poses significant environmental and health risks, necessitating efficient and economical remediation strategies. Traditional methods, while effective, can be prohibitively expensive, especially for large-scale operations or in regions with limited financial resources. Consequently, there is a growing imperative to identify and implement treatment solutions that balance efficacy with affordability. This includes exploring the potential of widely available and low-cost adsorbents like agricultural by-products (e.g., rice husks, banana peels, sawdust), industrial wastes (e.g., fly ash, blast furnace slag), and natural minerals (e.g., zeolites, clays). Furthermore, innovative technologies such as constructed wetlands, bio-sorption using specific microbial communities, and electrochemical methods utilizing inexpensive electrodes are being investigated for their economic viability and environmental sustainability. The overarching goal is to develop practical, scalable, and cost-efficient approaches to mitigate metal pollution from leachate, thereby safeguarding water resources and public health. The focus on cost-effectiveness is intrinsically linked to the principles of sustainable waste management. Leachate treatment often represents a significant operational cost for landfill operators, and the economic burden can impede the adoption of necessary environmental protection measures. Therefore, research into low-cost materials and technologies is paramount. This abstract will critically review the performance of various cost-effective adsorbents, considering their adsorption capacity, selectivity for specific metals, regeneration potential, and operational stability. It will also delve into the technological aspects of implementing these solutions, evaluating factors such as energy consumption, land footprint, and ease of operation and maintenance. The integration of these affordable materials and technologies into existing leachate management infrastructure is explored, with an emphasis on their potential to reduce overall treatment costs and enhance the long-term sustainability of landfill operations. By highlighting these economically viable options, this work aims to provide a comprehensive overview for researchers, engineers, and policymakers seeking practical solutions for effective and affordable heavy metal removal from leachate.