Cardiovascular risk markers in premature canities.

BACKGROUND: An elevated cardiovascular risk has been demonstrated in middle-aged individuals with onset of hair greying before the age of 30 years. Increased serum levels of pro-inflammatory cytokines, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), indicate an ongoing state of chronic inflammation that is correlated with cardiovascular risk but have not been studied earlier in patients with early onset of hair greying. AIM/OBJECTIVE: To study various cardiovascular risk markers including pro-inflammatory cytokines interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) in patients with premature canities. METHODS: This was a hospital-based case-control study of 40 patients with premature canities (age between 19 and 25 years; >5 grey hair) and an equal number of age and gender-matched healthy controls. The blood pressure, pulse rate and body mass index were recorded, and investigations including fasting blood sugar, serum insulin, fasting lipid profile, high sensitivity c-reactive protein (hs-CRP), IL-6 and TNF-α were performed. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated for all the participants. RESULTS: The mean blood pressure, fasting blood sugar, serum insulin, hs-CRP and HOMA-IR were all significantly elevated in patients with premature canities and the serum HDL levels were significantly lower. A greater number of patients with premature canities had significantly elevated IL-6 as compared with the controls. LIMITATIONS: The sample size was small. A subjective scale was used for grading the severity of premature canities. Trichoscopic evaluation of severity of greying or modified phototrichogram could not be used in this study. CONCLUSION: Abnormalities in cardiovascular risk markers were found in patients with premature canities. Screening and counselling of patients with premature greying of hair is recommended in order to prevent future cardiovascular disease.

Correction: Thiadiazole containing N- and S-rich highly ordered periodic mesoporous organosilica for efficient removal of Hg(II) from polluted water.

Correction for 'Thiadiazole containing N- and S-rich highly ordered periodic mesoporous organosilica for efficient removal of Hg(II) from polluted water' by Asim Baumik et al., Chem. Commun., 2020, 56, 3963-3966, DOI 10.1039/D0CC00407C.

Ending the HIV epidemic using National HIV Behavioral Surveillance (NHBS): Recommendations based on DC model.

INTRODUCTION: Social network strategies have been used by health departments to identify undiagnosed cases of HIV. Heterosexual cycle (HET4) of National HIV Behavioral Surveillance (NHBS) is a social network strategy implemented in jurisdictions. The main objectives of this research are to 1) evaluate the utility of the NHBS HET cycle data for network analysis; 2) to apply statistical analysis in support of previous HIV research, as well as to develop new research results focused on demographic variables and prevention/intervention with respect to heterosexual HIV risk; and 3) to employ NHBS data to inform policy with respect to the EHE plan. METHOD: We used data from the 2016 NHBS HET4 (DC). A total of 747 surveys were collected. We used the free social-network analysis package, GEPHI, for all network visualization using adjacency matrix representation. We additionally conducted logistic regression analysis to examine the association of selected variables with HIV status in three models representing 1) demographic and economic effects, 2) behavioral effects, and 3) prevention-intervention effects. RESULTS: The results showed 3% were tested positive. Seed 1 initiated the largest networks with 426 nodes (15 positives); seed 4 with 273 nodes (6 positives). Seed 3 had 35 nodes (2 positives). All 23 HIV diagnoses were recruited from 4 zip-codes across DC. The risk of testing positive was higher among people high-school dropouts (Relative Risk (RR) (25.645); 95 CI% 5.699, 115.987), unemployed ((4.267); 1.295, 14.064), returning citizens ((14.319); 4.593, 44.645). We also found in the final model higher association of pre-exposure prophylaxis (PrEP) awareness among those tested negative ((4.783); 1.042, 21.944) and HIV intervention in the past 12 months with those tested positive ((17.887); 2.350,136.135). CONCLUSION: The network visualization was used to address the primary aim of the analysis-evaluate the success of the implementation of the NHBS as a social network strategy to find new diagnoses. NHBS remains one of the strongest behavioral supplements for DC's HIV planning activities. As part of the evaluation process our analysis helps to understand the impact of demographic, behavioral, and prevention efforts on peoples' HIV status. We strongly recommend other jurisdictions use network visualizations to evaluate the efficacy in reaching hidden populations.

A Spatial Approach for Ending the Human Immunodeficiency Virus Epidemic for the United States-A DC Model.

BACKGROUND: Mode of transmission-based hotspots is a smart approach to HIV mitigation, yet remains poorly evaluated and implemented in the United States. The primary aim was to identifying mode of transmission-based hotspots and populations at risk of lower viral suppression to assist in targeted planning and implementation of programs. METHODS: We implemented spatial statistics to identify global-local hotspots and regression analysis to find populations at risk of lower viral suppression within hotspots. Data were obtained from the District of Columbia's (DC's) active surveillance system, which were geocoded based on current residence address. RESULTS: The analysis identified 6001 HIV-positive men who have sex with men (MSM) and 6077 HIV-positive non-MSM (N = 12 078) living in DC at the end of 2018. The hotspots for MSM were central DC and non-MSM in south DC. Trends of viral suppression within MSM hotspots showed plateauing and, among non-MSM, showed decline. Regression analysis showed MSM aged 21-25 (RR: 3.199; 95% CI: 1.832-5.586) and not linked to care (8.592; 2.907-25.398) were at higher risk of being virally unsuppressed within the hotspots. For non-MSM we found those aged 12-18 (9.025; 3.314-2.581) and with unknown linkages (6.087; 3.346-13.848) were at higher risk of being virally unsuppressed within the hotspots. CONCLUSIONS: Our analysis provides a model that may be used by other jurisdictions to identify areas of priority and plan treatment-adherence programs using surveillance data. Attaining viral suppression is crucial in reducing new diagnoses; a spatial approach can be an important tool in Ending the HIV Epidemic.

Geographic Core Areas of Coinfections in Washington, District of Columbia: Recommendations for Planning Prevention-Intervention to Mitigate Human Immunodeficiency Virus Burden.

BACKGROUND: Research suggests that human immunodeficiency virus (HIV)-positive individuals with a sexually transmitted infection (STI) may be at increased risk of transmitting HIV to someone else through unprotected sex. The primary aim of the analysis is to identify the high-risk geographic areas of transmission of coinfections and factors that may be associated with poor outcomes of viral suppression within these higher-risk geographic areas, thus important in transmission prevention. METHODS: We used surveillance data reported by all providers and laboratories in the District of Columbia (DC). Applied discrete Poisson scan model in SaTScan to identify the geographic areas. The relative risk (RR) for the scan statistic was calculated based on events inside the cluster, and P values evaluated statistical significance. We used multinomial logistical regression to explore care and demographical characteristics associated with being virally unsuppressed within and outside the geographic areas. RESULTS: The coinfected areas (RR, >1; P < .001) were located in the tracts of central and southern DC. Black population (RR, 3.154 [95% confidence interval {CI}, 1.736-5.729]), age 13-19 years (RR, 4.598 [95% CI, 3.176-6.657]), repeat STIs (RR, 1.387 [95% CI, 1.096-1.754]), and not retained in care (RR, 2.546 [95% CI, 1.997-3.245]) were found to be at higher risk of being virally unsuppressed within the coinfected clusters. Those with unknown linkages were found to be at higher risk of being virally unsuppressed outside the coinfected clusters (RR, 5.162 [95% CI, 2.289-11.640]). CONCLUSIONS: This is DC's first effort to identify the geographic core areas of coinfections and factors that may be sustaining them. These results will be used by the health department to plan for prevention-intervention strategies. This model be replicated by any local jurisdiction similar.

Conducting Polymer-Based Nanohybrids for Fuel Cell Application.

Carbon materials such as carbon graphitic structures, carbon nanotubes, and graphene nanosheets are extensively used as supports for electrocatalysts in fuel cells. Alternatively, conducting polymers displayed ultrahigh electrical conductivity and high chemical stability havegenerated an intense research interest as catalysts support for polymer electrolyte membrane fuel cells (PEMFCs) as well as microbial fuel cells (MFCs). Moreover, metal or metal oxides catalysts can be immobilized on the pure polymer or the functionalized polymer surface to generate conducting polymer-based nanohybrids (CPNHs) with improved catalytic performance and stability. Metal oxides generally have large surface area and/or porous structures and showed unique synergistic effects with CPs. Therefore, a stable, environmentally friendly bio/electro-catalyst can be obtained with CPNHs along with better catalytic activity and enhanced electron-transfer rate. The mass activity of Pd/polypyrrole (PPy) CPNHs as an anode material for ethanol oxidation is 7.5 and 78 times higher than that of commercial Pd/C and bulk Pd/PPy. The Pd rich multimetallic alloys incorporated on PPy nanofibers exhibited an excellent electrocatalytic activity which is approximately 5.5 times higher than monometallic counter parts. Similarly, binary and ternary Pt-rich electrocatalysts demonstrated superior catalytic activity for the methanol oxidation, and the catalytic activity of Pt24Pd26Au50/PPy significantly improved up to 12.5 A per mg Pt, which is approximately15 times higher than commercial Pt/C (0.85 A per mg Pt). The recent progress on CPNH materials as anode/cathode and membranes for fuel cell has been systematically reviewed, with detailed understandings into the characteristics, modifications, and performances of the electrode materials.

Detecting Spatial Cores and Temporal Trends of Repeat STIs to Plan Pre-exposure Prophylaxis (PrEP) Scale-up in DC.

BACKGROUND: Repeat sexually transmitted infections (STIs) in DC primarily results from untreated sexual partners. This analysis aims to identify high-risk areas and temporal trends of repeat STIs for pre-exposure prophylaxis scale-up and STI mitigation in DC. METHODS: We identified repeat infections in the DC Department of Health STI and HIV data management systems, diagnosed from 2014 to 2018. The cases were geocoded and aggregated by census tracts. Poisson discrete scan statistic was implemented in SaTScan software to find clusters. Weighted moving average was used to compare temporal trends of repeat STIs. We used χ analysis to identify association with demographic variables. RESULTS: We identified 8535 repeat STIs from 2014 to 2018. Of these, 61.84% were among men, most cases were among blacks (34.75%) and 47.45% represented gonorrhea cases. The high-risk spatial clusters were identified as those tracts that had relative risk (relative risk > 1; P-value < 0.001). We identified one significant radius of risk covering tracts of wards 7 and 8 and parts of wards 5 and 6. We spotted positive temporal trends in cluster 1 and outside the cluster. We found significant associations of repeat STIs with gender (χ = 317.27, P < 0.001), age (χ = 539.26, P < 0.001), HIV coinfections (χ = 352.06, P < 0.001), and year of diagnoses (χ = 1.5, P < 0.01). CONCLUSIONS: Our findings indicate spatial disparities in DC for repeat STIs. This analysis is critical for pre-exposure prophylaxis planning, STI prevention strategies such as expedited partner therapies and condom distribution strategies in DC should prioritize the high-risk spatial cores.

Thiadiazole containing N- and S-rich highly ordered periodic mesoporous organosilica for efficient removal of Hg(ii) from polluted water.

A new N- and S-rich highly ordered periodic mesoporous organosilica material DMTZ-PMO bearing thiadiazole and thiol moieties inside the pore-wall of a 2D-hexagonal nanomaterial has been synthesized. DMTZ-PMO shows a very high surface area (971 m2 g-1), and can be used for efficient and fast removal of Hg2+ from polluted water with a very high Hg2+ uptake capacity of 2081 mg g-1.

Sulfonated graphene oxide and titanium dioxide coated with nanostructured polyaniline nanocomposites as an efficient cathode catalyst in microbial fuel cells.

In this study, sulfonated graphene oxide (SGO) was synthesized as potential conducting matrix to improve the properties of catalyst for single chamber microbial fuel cells (SC-MFCs). Here, TiO2 and Polyaniline (PAni) nanoparticles were anchored over SGO and the resulting SGO-TiO2-PAni nanocomposites were used as a potential cathode catalyst in MFCs. We have also examined the performance of SGO-TiO2-PAni compared to GO-TiO2-PAni and TiO2-PAni catalyst. The structural and morphological analyses were examined using a variety of characterization techniques. TiO2 nanoparticles bridged PAni and SGO through hydrogen bonding/electrostatic interaction and improved the thermal stability of SGO-TiO2-PAni catalyst. The electrochemical characterizations of these nanocatalysts suggest that the SGO-TiO2-PAni showed higher reduction current value (-0.46 mA), enhanced stability, and lower internal resistance (46.2 Ω) in comparison to GO-TiO2-PAni and TiO2-PAni towards oxygen reduction reactions (ORR). Consequently, MFC using SGO-TiO2-PAni demonstrated a maximum power density of 904.18 mWm-2 than that of GO-TiO2-PAni (734.12 mWm-2), TiO2-PAni (561.5 mWm-2) and Pt/C (483.5 mWm-2). The enhanced catalytic activity of SGO-TiO2-PAni catalyst was ascribed to the high electronic conductivity and long-term permanence of the nanocomposite. These superior electrochemical results suggested that the SGO-TiO2-PAni catalyst could be applied as a potential alternative to the commercial Pt/C cathode catalyst for the application of MFCs.

Unusual cranial infection caused by Citrobacter Koseri.

A 60-year-old female had a frontal bone intraosseous meningioma resected 10 years previously. On follow up CT head, an enlarging intraosseous frontal bone lesion was noted. This was thought to be a recurrent frontal meningioma. Intraooperatively, she was found to have an abscess deep to the cranioplasty.

Decompressive Hemicraniectomy in the Treatment of Malignant Middle Cerebral Artery Infarction: A Meta-Analysis.

BACKGROUND: Malignant middle cerebral artery infarctions are large space-occupying infarctions involving massive edema, herniation, and frequently death. Survivors are disabled. Management involves medical treatment, with or without decompressive hemicraniectomy and later duraplasty. This meta-analysis aimed to determine whether surgery is worthwhile with particular regard to views on quality of life of professionals and patients. METHODS: A Medline search was performed with the search terms "decompressive surgery," "craniectomy," "hemicraniectomy," "decompressive hemicraniectomy," and "middle cerebral artery," "MCA," "infarct,*" "stroke,*" "embolus," "emboli," "thrombosis," "occlusion," "infarction," and "middle cerebral artery stroke," A second search was also done for views on postoperative quality of life. Studies retrieved were randomized controlled trials, observational studies, and reviews. We compared patients who received only medical treatment with those who had decompressive surgery. Participants were adult patients presenting with malignant middle cerebral artery infarction. RESULTS: 270 abstracts were reviewed. 40 articles were identified: 8 randomized controlled trials and 4 observational studies. There were a total of 692 patients: 268 surgical and 424 medical. The 2 groups were comparable, with similar demographics. In most trials, mortality was lower with surgery. However, morbidity tended to be higher, particularly in the elderly population. Morbidity was lower with medical treatment. Twelve articles on postoperative quality of life were reviewed; views differed between professionals, and survivors and caregivers. A patient-level comparison could not be made between all studies. CONCLUSIONS: Surgical decompression results in lowered mortality but high morbidity, especially in the elderly. There is an increase in Quality Adjusted Life Years but at high costs. Professionals think that surgery is not worth the high disability rate. However, patients and caregivers are satisfied with their postoperative quality of life. Survey data from healthy study participants who are not professionals in stroke care were not available. The decision to treat surgically needs to be decided on an individual basis.

Detecting spatial clusters of HIV and hepatitis coinfections.

BACKGROUND: People with HIV infection in the United States are often affected by chronic viral hepatitis. These coinfected people with either HBV or HCV are at increased risk for serious, life-threatening complications. Coinfections with viral hepatitis may also complicate the delivery of anti-retroviral therapy (ART) by escalating the risk of drug-related hepatoxicity. According to the Centers for Disease Control and Prevention (CDC), approximately 10 percent of people with HIV in the United States also have HBV, and 25 percent also have HCV coinfection. With the advent of highly active antiretroviral therapy (HAART) and the increased life-expectancy of HIV patients, clinicians are more likely to be confronted with issues related to co-infection and the management challenges that they present, especially in resource-limited settings. The purpose of this analysis was to identify geographical clusters of HIV- (HBV/HCV) co-infection and compared to the geographical clusters of not co-infected using DC, Department of Health surveillance data. The results of the analysis will be used to target resources to areas at risk. METHODS: HIV and Hepatitis surveillance data were matched among cases diagnosed between 1980 and 2016. HIV-hepatitis co-infected and the not co-infected spatial clusters were detected using discrete Poisson model. Kulldorff's spatial scan statistic method was implemented in the free software tool called SaTScan which has been widely adopted for detecting disease cluster. The analysis was conducted by tracts, but for visualization, ease of interpretation and assist in policy making the tract map was overlaid with the ward map using ArcGIS 10.5.1. RESULTS: Between 1980 and 2016, there were 12,965 diagnosed cases of HIV, of which 2,316 HIV/Hepatitis matches were identified. Of the 2316 co-infected people living in DC, 25 percent (N = 590) of people had HBV, and 75 percent (N = 1,726) had HCV. Out of 12,965 diagnosed cases, remaining 10,649 did not have any co-infections (not co-infected). IDU (27.16 percent) and MSM (32.86 percent) were the highest mode of transmission for co-infected population. African-American were reported 83.64 percent (N = 1,937) among co-infection population. Three clusters were identified for both co-infected population in DC. The largest cluster radius for co-infected analysis covers wards 6, 7 and 8 as well as large parts of 2 and 5 (p < 0.001). Multiple clusters were identified for not co-infected population (p < 0.001). IDU (n = 450) was the highest mode of transmission for the co-infected clusters. For all clusters combined of not co-infected population highest mode of transmission were MSM (n = 2,534). This analysis also showed racial disparity, economic deprivation and lack of education were prominent in the co-infected clusters. CONCLUSION: We identified locations of high risk clusters where enhanced hepatitis and HIV prevention, treatment, and care can help combat the epidemic. The clusters radius expands into the neighboring state of Maryland as well. The findings from this analysis will be used to target area based public health policy and healthcare interventions for HIV-hepatitis. It is recommended based on the analysis that needle exchange programs can successfully control new HIV infections as well as hepatitis co-infections.

Geographic patterns of poor HIV/AIDS care continuum in District of Columbia.

BACKGROUND: Concurrent with the UNAIDS 90-90-90 and NHAS plans, the District of Columbia (DC) launched its 90/90/90/50 plan (Plan) in 2015. The Plan proposes that by 2020, 90% of all DC residents will know their HIV status; 90% of residents living with HIV will be in sustained treatment; 90% of those in treatment will reach "Viral Suppression" and DC will achieve 50% reduction of new HIV cases. To achieve these goals targeted prevention strategies are imperative for areas where the relative risk (RR) of not being linked to care (NL), not retained in any care (NRC) and low viral suppression (NVSP) are highest in the District. These outcomes are denoted in this study as poor outcomes of HIV care continuum. This study applies the Bayesian model for RR for area specific random effects to identify the census tracts with poor HIV care continuum outcomes for DC. METHODS: This analysis was conducted using cases diagnosed from 2010 to 2015 and reported to the surveillance system from the District of Columbia Department of Health (DC DOH), HIV/AIDS, Hepatitis, STD and TB Administration. The jurisdictions of the District of Columbia is divided into 179 census tracts. It is challenging to plot sparse data in 'small' local administrative areas, characteristically which may have a single-count datum for each geographic area. Bayesian methods overcome this problem by assimilating prior information to the underlying RR, making the predicted RR estimates robust. RESULTS: The RR of NL is higher in 59 (33%) out of 179 census tracts in DC. The RR of NRC was high in 46 (26%) of the census tracts while 52 census tracts (29%) show a high risk of having NVSP among its residents. This study also identifies clear correlated heterogeneity or clustering is evident in the northern tracts of the district. CONCLUSION: The study finds census tracts with higher RR of poor linkage to care outcomes in the District. These results will inform the Plan which aims to increase targeted testing leading to early initiation of antiretroviral therapy. The uniqueness of this study lies in its translational scope where surveillance data can be used to inform local public health programs and enhance the quality of health for the people with HIV.

Feasibility of Using HIV Care-Continuum Outcomes to Identify Geographic Areas for Targeted HIV Testing.

BACKGROUND: Improved detection and linkage to care of previously undiagnosed HIV infections require innovative approaches to testing. We sought to determine the feasibility of targeted HIV testing in geographic areas, defined by continuum of care parameters, to identify HIV-infected persons needing linkage or engagement in care. METHODS: Using HIV surveillance data from Washington, DC, we identified census tracts that had an HIV prevalence >1% and were either above (higher risk areas-HRAs) or below (lower risk areas-LRAs) the median for 3 indicators: monitored viral load, proportion of persons out of care (OOC), and never in care. Community-based HIV rapid testing and participant surveys were conducted in the 20 census tracts meeting the criteria. Areas were mapped using ArcGIS, and descriptive and univariate analyses were conducted comparing the areas and participants. RESULTS: Among 1471 persons tested, 28 (1.9%) tested HIV positive; 2.1% in HRAs vs. 1.7% in LRAs (P = 0.57). Higher proportions of men (63.7% vs. 56.7%, P = 0.007) and fewer blacks (91.0% vs. 94.6%, P = 0.008) were tested in LRAs vs. HRAs; no differences were observed in risk behaviors between the areas. Among HIV-positive participants, 54% were new diagnoses (n = 9) or OOC (n = 6), all were Black, 64% were men with a median age of 51 years. CONCLUSIONS: Although significant differences in HIV seropositivity were not observed between testing areas, our approach proved feasible and enabled identification of new diagnoses and OOC HIV-infected persons. This testing paradigm could be adapted in other locales to identify areas for targeted HIV testing and other reengagement efforts.

The poorest of the poor: composition and wealth of older person households in sub-Saharan Africa.

Linking household composition of older persons and material well-being is an important step toward understanding quality of life among elders in less developed settings. The association is particularly important in sub-Saharan Africa, given the poverty in the region. Ordinary least square regressions using data from 23 countries examine how age composition among all households and presence of offspring and grandchildren among older person households associates with a wealth index that is based on ownership of resources and housing characteristics, and whether the association is consistent across countries. Results indicate older-person-only households, and older persons with youth, have, generally, less wealth than households with other age compositions. Among older person households, those without offspring or grandchildren and skip-generation households fare worst in most countries. Findings highlight the importance of considering older persons households when assessing material well-being and chances of living in poverty in poor regions of the world.

A review of brain abscess surgical treatment--78 years: aspiration versus excision.

OBJECTIVE: The literature regarding surgical treatment of brain abscess was reviewed from 1990 to (and including) 2008 to supplement a previous literature review from 1930 to 1990. METHODS: The Ovid Medline database 1950-2009 with the year range limited to 1990-2009 was used to identify all articles relating to brain abscess. The results were compared with a previously published review from 1930-1990 by the senior author. RESULTS: The original finding was confirmed that the high mortality from aspiration in the pre-computer tomography era decreased dramatically after computer tomographic scanning became available. In the present review, the mean mortality for aspiration post-1990 was 6.6% for publications with more than five patients. With surgical excision by craniotomy, the mean mortality in the same period was 12.7%. CONCLUSIONS: The present review suggests that aspiration may be the first surgical choice in patients with supratentorial parenchymal brain abscesses.