PRO-Act: a healthcare provider workshop outlining the added value of implementing PROs in routine HIV practice.

Patient Reported Outcomes (PROs) are an evidenced way of adding value to routine clinical care. As a source of unique information on the effect of a medical condition and its treatment from the patients' perspective (Mercieca-Bebber et al. in Patient Relat Outcome Meas 9: 353-367, https://doi.org/10.2147/PROM.S156279 , 2018), PROs allow for an improved assessment in routine clinical care of symptoms, side effects, functional outcomes (physical, sexual, social, emotional, cognitive functioning), and health-related quality of life (HRQoL). By helping to align healthcare providers' interventions with what matters most to the patient, PROs contribute to the individualized choice of Anti-Retroviral Therapy (Carfora et al. in PLoS ONE 17(4): e0267030, https://doi.org/10.1371/journal.pone.0267030 , 2022) as a paramount component of tailored and person-centred care management, in routine clinical practice. This article outlines a practical framework and process tested in Portugal to raise awareness of PROs' added value, and to help guide first steps in the implementation and seamless integration of PROs, in routine HIV care.

Maternal mortality trends in Spain during the 2000-2018 period: the role of maternal origin.

BACKGROUND: The available literature indicates that there are significant differences in maternal mortality according to maternal origin in high income countries. The aim of this study was to examine the trend in the maternal mortality rate and its most common causes in Spain in recent years and to analyse its relationship with maternal origin. METHODS: This was a cross-sectional study of all live births as well as those resulting in maternal death in Spain during the period between 2000 and 2018. A descriptive analysis of the maternal mortality rate by cause, region of birth, maternal age, marital status, human development index and continent of maternal origin was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analyses, with adjustment for certain variables included in the descriptive analysis. RESULTS: There was a total of 293 maternal deaths and 8,439,324 live births during the study period. The most common cause of maternal death was hypertensive disorders of pregnancy. The average maternal death rate was 3.47 per 100,000 live births. The risk of suffering from this complication was higher for immigrant women from less developed countries. The adjusted effect of maternal HDI score over maternal mortality was OR = 0.976; 95% CI 0.95 - 0.99; p = 0.048; therefore, a decrease of 0.01 in the maternal human development index score significantly increased the risk of this complication by 2.4%. CONCLUSIONS: The results of this study indicate that there are inequalities in maternal mortality according to maternal origin in Spain. The human development index of the country of maternal origin could be a useful tool when estimating the risk of this complication, taking into account the origin of the pregnant woman.

Interfacial and Solution Aggregation Behavior of a Series of Bioinspired Rhamnolipid Congeners Rha-C14-Cx (x = 6, 8, 10, 12, 14).

Rhamnolipids are glycolipids produced by microorganisms with outstanding surfactant properties. They are a class of biosurfactants that are potential candidates for biodegradable and nontoxic replacements of current specialty synthetic surfactants. Building on our previous efforts in developing an efficient and practical chemical methodology to synthesize rhamnolipids allows us to now explore the tunability of rhamnolipid properties. Here, we explore the impact on solution self-assembly and adsorption at the air/water interface of symmetry of the two lipid tails for diastereomeric mixtures of a series of monorhamnolipids of the generic structure Rha-C14-Cx. Surface activity of the anionic forms of these molecules at pH 8 is described by surface tensiometry. Characteristics of their aggregation behavior in aqueous solutions including hydrodynamic radius, aggregation number, and aggregate morphology are determined using dynamic light scattering and time-resolved fluorescence quenching spectroscopy. The solution aggregation behavior of this series is found to unexpectedly vary in a nonmonotonic fashion. This is explained by molecular structural attributes of each series member that result in differences in the respective intermolecular interactions of various parts of these surfactants.

Parámetros productivos del cultivo de cachama blanca Piaractus orinoquensis, en jaulas flotantes / Productive parameters of white cachama culture, Piaractus orinoquensis, in floating cages

RESUMEN La región de la Orinoquia, se caracteriza por poseer espejos de agua que se mantienen durante todo el año, aportando peces para consumo local. La pesca artesanal constituye la principal actividad económica de sustento de comunidades ribereñas, quienes están siendo amenazadas en su seguridad alimentaria, por la disminución del recurso íctico, debido a múltiples causas atribuidas a la actividad humana. Por lo anterior, sistemas de producción en jaulas flotantes, elaboradas con materiales de bajo costo y ubicadas en cursos de aguas naturales, constituyen una alternativa económica para estas comunidades. El objetivo fue evaluar el rendimiento productivo de la cachama blanca en jaulas flotantes, ubicadas en el río Manacacias, manejando tres densidades: 150, 200 y 250 peces/m3. Se sembraron alevinos en jaulas, con dimensiones de 10,2 m³ (3 x 2 x 1,7 m). Los peces fueron alimentados con alimento balanceado, durante 126 días. Al final del experimento, los individuos fueron cosechados. Se produjo una biomasa promedio por densidad de 47,42 kg/m3, en la densidad 150; 45,11 kg/m3, en 200 peces/m3 y 79,65 kg/m3, en la densidad 250. Su conversión alimenticia fue 1,1; 1,32 y 0,8, la sobrevivencia de 83,51, 78,98 y 93,72 %, respectivamente. Se concluye, que la cachama blanca puede ser cultivada en jaulas flotantes a altas densidades, obteniendo parámetros productivos óptimos y, adicionalmente, puede ser una fuente de ingresos significativa para las comunidades.

ABSTRACT The Orinoquia region is characterized by having water bodies that are maintained throughout the year, providing fish for local consumption. Artisanal fishing constitutes the main economic activity for the livelihood of riverine communities, which are being threatened in their food security by the decrease in the fish resource due to multiple causes attributed to human activity. Therefore, production systems in floating cages, made with low-cost materials and located in natural water courses, constitute an economic alternative for these communities. The objective of this work was to evaluate the productive performance of white cachama in floating cages located in the Manacacias river, managing three densities 150, 200 and 250 fish/m3. Fingerlings were sown in cages with dimensions of 10.2 m³ (3 x 2 x 1.7 m). The fish were fed with balanced feed for 126 days. At the end of the experiment the individuals were harvested in three cages for the three densities. An average biomass by density of 47.22 kg/m3 was produced at density 45.11 kg/m3 in 200 fish/m3 and 79.65 kg/m3 at density 250. Its feed conversion was 1.1, 1.32 and 0.8, the survival of 83.51, 78.98 and 93.72 % respectively. It is concluded that cachama blanca can be cultivated in floating cages at high densities, obtaining optimal productive parameters and additionally, it can be a significant source of income for the communities.

Invasive aspergillosis of the skull base in an immunocompetent patient: a diagnostic challenge.

We describe the case of a 32-year-old man from Cape Verde having headache and increasing visual loss. Clinical and radiological investigations disclosed a massive destructive lesion involving the anterior and central skull base, orbit and nasoethmoid region initially interpreted as a malignant small round cell tumour. Surgical biopsies were negative for neoplasm, showing an intense inflammatory infiltrate together with fungus, later characterised as Aspergillus flavus spp. The patient was immunocompetent with no evidence of congenital or acquired immunodeficiencies. Invasive fungal infections in immunocompetent patients are rare and can be a diagnostic challenge. The best diagnostic clues include the patient's origin from tropical climates, imaging features and the identification of fungal hyphae on pathology specimens. Although a devastating disease in immunocompromised patients, craniocerebral aspergillosis in immunocompetent patients carries a better prognosis. Available literature supports the combined used of 'conservative' surgical resection and antifungal therapy as the best treatment option.

Unnecessary magnetic resonance imaging of the knee: How much is it really costing the NHS?

AIMS AND OBJECTIVES: The aim of this study was to evaluate the indications for patients undergoing magnetic resonance imaging (MRI) of the knee prior to referral to an orthopaedic specialist and to ascertain whether these scans altered initial management. MATERIALS AND METHOD: A retrospective review of all referrals received by a single specialist knee surgeon over a 1-year period was performed. Patient demographics, relevant history, examination findings and past surgical procedures were documented. Patients having undergone Magnetic resonance imaging (MRI) prior to referral were identified and indications for the scans recorded. These were reviewed against The National health services (NHS) guidelines for Primary Care Physicians to identify if the imaging performed was appropriate in each case. RESULTS: A total of two sixty-one (261) patients were referred between 1st July 2018 and 30th June 2019. Eight seven out of two hundred and sixty-one patients (87/261) patients underwent knee MRI prior to referral. The average patient age was 53 years with male predominance (52 verses 35 females). Twenty-one out of eight seven patients under review (24%) underwent appropriate imaging prior to referral as per guidelines. However, only thirteen percent of patients underwent plain radiograph of knee before their scan. In cases where magnetic resonance imaging was not indicated, patients waited an average of twelve weeks between their scan and for a referral to be sent to a knee surgeon. CONCLUSION: Seventy six percent of patients referred to orthopaedics had inappropriate Magnetic resonance imaging arranged by their primary care physician. For a single consultant's referrals over 1 year these unnecessary MRI (magnetic resonance imaging) of knee cost National Health Services (NHS) £13,200. Closer adherence to the guidelines by primary care physicians will result in a financial saving, better patient experience and a more effective use of resources.

When it is time to decide: factors associated to the choice of a medical specialty / Cuando es tiempo de decidir: factores asociados a la elección de especialidades médicas

Abstract After finishing their initial education, physicians can enter post-graduate training programs. In Chile, there are multiple medical specialties options. This review synthesizes the factors associated with the choice of specialty, according to international publications. Students coming from rural areas or small towns would tend to choose Family Medicine. Men prefer specialties such as Surgery. Having relatives in the medical profession, specializing in a specific field, also influence the choice. Concerning interests and preferences, these are linked to personal traits and some biological variables. The inclination towards clinical or surgical fields could be predicted. Academically, the curriculum, good learning experiences and teacher models favor choice, while the harassment suffered could contribute to avoidance. Besides, both prestige and economic prospects are influential factors in the choice and specialties such as Surgery are preferred. The choice of specialty must reach a balance between the students' interests and public health needs. Identifying these factors would allow a better understanding of the present shortfall (or surplus) in certain fields and contribute to the definition of policies and decision-making.

Concluida su formación, los médicos pueden acceder a programas de formación de postgrado; en Chile existen múltiples opciones de especialización médica. Esta revisión narrativa busca sintetizar los diversos factores asociados con la elección de especialidad médica según la literatura internacional. Entre los resultados se observa que los alumnos provenientes de zonas rurales o ciudades pequeñas tenderían a elegir Medicina Familiar. Los hombres tendrían mayor predilección por especialidades como Cirugía. También influiría ser hijos de médicos especialistas en un área específica. En cuanto a los intereses y preferencias, éstas se conjugan con rasgos de personalidad y algunas variables biológicas, que podrían predecir la elección de especialidades hacia el tipo clínico o quirúrgico. En lo académico, el curriculum, una buena experiencia y modelos docentes favorecen la elección, mientras el maltrato sufrido podría contribuir al descarte. Además, tanto el prestigio como el potencial económico de ciertas especialidades ha sido un factor influyente en la elección: se prefieren especialidades como Cirugía. La elección de especialidad debería encontrar un equilibrio entre los intereses del estudiante y las necesidades de salud pública. Identificar todos estos factores, permitiría una mejor comprensión de la actual escasez o sobrecarga en determinados campos, y contribuiría en la construcción de políticas y toma de decisiones, con el fin de mejorar el reclutamiento de estudiantes.

Molecular barcode and morphological analysis of Smilax purhampuy Ruiz, Ecuador.

Smilax plants are distributed in tropical, subtropical, and temperate regions in both hemispheres of the world. They are used extensively in traditional medicines in a number of countries. However, morphological and molecular barcodes analysis, which may assist in the taxonomic identification of species, are lacking in Ecuador. In order to evaluate the micromorphological characteristics of these plants, cross sections of Smilax purhampuy leaves were obtained manually. The rhizome powder, which is typically used in traditional medicines, was analyzed for micromorphological characteristics. All samples were clarified with 1% sodium hypochlorite. Tissues were colored with 1% safranin in water and were fixed with glycerinated gelatin. DNA was extracted from the leaves using a modified CTAB method for molecular barcode characterization and PCR was performed using primers to amplify the different loci including the plastid genome regions atpF-atpH spacer, matK gene, rbcL gene, rpoB gene, rpoC1 gene, psbK-psbI spacer, and trnH-psbA spacer; and the nuclear DNA sequence ITS2. A DNA sequence similarity search was performed using BLAST in the GenBank nr database and phylogenetic analysis was performed using the maximum likelihood method according to the best model identified by MEGAX using a bootstrap test with 1,000 replicates. Results showed that the micromorphological evaluation of a leaf cross section depicted a concave arrangement of the central vein, which was more pronounced in the lower section and had a slight protuberance. The micromorphological analysis of the rhizome powder allowed the visualization of a group of cells with variable sizes in the parenchyma and revealed thickened xylematic vessels associated with other elements of the vascular system. Specific amplicons were detected in DNA barcoding for all the barcodes tested except for the trnH-psbA spacer. BLAST analysis revealed that the Smilax species was predominant in all the samples for each barcode; therefore, the genus Smilax was confirmed through DNA barcode analysis. The barcode sequences psbK-psbI, atpF-atpH, and ITS2 had a better resolution at the species level in phylogenetic analysis than the other barcodes we tested.

Comparison of N-Acetyl-Glucosamine to Other Monosaccharides Reveals Structural Differences for the Inhibition of α-Synuclein Aggregation.

O-GlcNAc modification of the microtubule associated protein tau and α-synuclein can directly inhibit the formation of the associated amyloid fibers associated with major classes of neurodegenerative diseases. However, the mechanism(s) by which this posttranslational modification (PTM) inhibit amyloid aggregation are still murky. One hypothesis is that O-GlcNAc simply acts as a polyhydroxylated steric impediment to the formation of amyloid oligomers and fibers. Here, we begin to test this hypothesis by comparing the effects of O-GlcNAc to other similar monosaccharides-glucose, N-acetyl-galactosamine (GalNAc), or mannose-on α-synuclein amyloid formation. Interestingly, we find that this quite reasonable hypothesis is not entirely correct. More specifically, we used four types of biochemical and biophysical assays to discover that the different sugars display different effects on the inhibition of amyloid formation, despite only small differences between the structures of the monosaccharides. These results further support a more detailed investigation into the mechanism of amyloid inhibition by O-GlcNAc and has potential implications for the evolution of N-acetyl-glucosamine as the monosaccharide of choice for widespread intracellular glycosylation.

Solitary neurofibroma of the larynx: a diagnostic challenge.

Solitary neurofibromas of the larynx are extremely rare, with a total of 15 cases described in the literature. Nonetheless, acquaintance with this diagnosis is important, as misdiagnoses can have negative consequences. Presenting symptoms are non-specific and depend on tumour size and location. As well-defined submucosal masses with a broad differential diagnosis, they remain a clinical and radiological challenge. While some characteristics might favour a benign nature and subtle signs might help narrow the differential diagnosis, imaging alone is not sufficient for differentiation and definitive diagnosis requires a biopsy. Complete surgical resection and long-term follow-up is indicated. We share our experience on a case of a solitary laryngeal neurofibroma in a middle-aged woman, presenting with a large well-defined paraglottic lesion.

When it is time to decide: factors associated to the choice of a medical specialty.

After finishing their initial education, physicians can enter post-graduate training programs. In Chile, there are multiple medical specialties options. This review synthesizes the factors associated with the choice of specialty, according to international publications. Students coming from rural areas or small towns would tend to choose Family Medicine. Men prefer specialties such as Surgery. Having relatives in the medical profession, specializing in a specific field, also influence the choice. Concerning interests and preferences, these are linked to personal traits and some biological variables. The inclination towards clinical or surgical fields could be predicted. Academically, the curriculum, good learning experiences and teacher models favor choice, while the harassment suffered could contribute to avoidance. Besides, both prestige and economic prospects are influential factors in the choice and specialties such as Surgery are preferred. The choice of specialty must reach a balance between the students' interests and public health needs. Identifying these factors would allow a better understanding of the present shortfall (or surplus) in certain fields and contribute to the definition of policies and decision-making.

Supporting elimination of lymphatic filariasis in Samoa by predicting locations of residual infection using machine learning and geostatistics.

The global elimination of lymphatic filariasis (LF) is a major focus of the World Health Organization. One key challenge is locating residual infections that can perpetuate the transmission cycle. We show how a targeted sampling strategy using predictions from a geospatial model, combining random forests and geostatistics, can improve the sampling efficiency for identifying locations with high infection prevalence. Predictions were made based on the household locations of infected persons identified from previous surveys, and environmental variables relevant to mosquito density. Results show that targeting sampling using model predictions would have allowed 52% of infections to be identified by sampling just 17.7% of households. The odds ratio for identifying an infected individual in a household at a predicted high risk compared to a predicted low risk location was 10.2 (95% CI 4.2-22.8). This study provides evidence that a 'one size fits all' approach is unlikely to yield optimal results when making programmatic decisions based on model predictions. Instead, model assumptions and definitions should be tailored to each situation based on the objective of the surveillance program. When predictions are used in the context of the program objectives, they can result in a dramatic improvement in the efficiency of locating infected individuals.

Finding hotspots: development of an adaptive spatial sampling approach.

The identification of disease hotspots is an increasingly important public health problem. While geospatial modeling offers an opportunity to predict the locations of hotspots using suitable environmental and climatological data, little attention has been paid to optimizing the design of surveys used to inform such models. Here we introduce an adaptive sampling scheme optimized to identify hotspot locations where prevalence exceeds a relevant threshold. Our approach incorporates ideas from Bayesian optimization theory to adaptively select sample batches. We present an experimental simulation study based on survey data of schistosomiasis and lymphatic filariasis across four countries. Results across all scenarios explored show that adaptive sampling produces superior results and suggest that similar performance to random sampling can be achieved with a fraction of the sample size.

Enfermedad pulmonar obstructiva crónica (EPOC). Bases para el médico general / Chronic Obstructive Pulmonary Disease (COPD). Bases for the General Practitioner

Resumen La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad crónico-degenerativa frecuente, prevenible y tratable, caracterizada por persistentes síntomas respiratorios y limitación del flujo aéreo. En 2016, el Instituto Nacional de Enfermedades Respiratorias (INER) la ubicó en el cuarto lugar en la tabla de morbi-mortalidad anual en México. Su prevalencia está directamente relacionada con la del tabaquismo; sin embargo, su desarrollo es multifactorial. Para el estudio de la EPOC es importante conocer los antecedentes de exposición a factores de riesgo y la presencia de los principales síntomas; es esencial una historia clínica bien detallada, donde se recabe la mayor cantidad de datos de todo nuevo paciente en el que se conozca o se sospeche de la enfermedad, así como una espirometría para establecer el diagnóstico. Debido a la gran variabilidad que existe entre los pacientes con EPOC, es necesario establecer tratamiento farmacológico individualizado. Los fármacos utilizados en su tratamiento reducen los síntomas, la frecuencia y la gravedad de las exacerbaciones; sin embargo, no hay ningún medicamento que modifique el deterioro a largo plazo de la función pulmonar. Por lo tanto, el conocimiento básico de este padecimiento por el médico de primer contacto es esencial para la sospecha en una etapa inicial, y así ofrecer al paciente una intervención médica inmediata. El presente trabajo tiene la finalidad de acercar al médico general una visión básica de la EPOC.

Abstract Chronic obstructive pulmonary disease (COPD) is a chronic degenerative disease. It is a frequent, preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation. The National Institute of Respiratory Diseases (INER), ranked COPD in 2016 in fourth place in the table of annual morbidity and mortality in Mexico. The prevalence of COPD is directly related to smoking; however, its development is multifactorial. For its study it is important to know of any prior exposure to risk factors and of any manifestation of the main symptoms. To make a diagnosis, a detailed clinical history, where the largest amount of data is collected from every new possible COPD patient, and a spirometry are essential. Individual pharmacological treatment is necessary due to the great variability among COPD patients. The drugs used in the treatment of COPD reduce the symptoms, the frequency and severity of exacerbations; however, there is no medication that modifies the long-term deterioration of the lung function. Therefore, a basic knowledge of this condition by the medical doctor first contacted, is essential for the suspicion of COPD in its initial stage and thus, offer the patient immediate medical intervention. The objective of the present work is to provide a basic overview of COPD to the general practitioner.

Morphological and molecular barcode analysis of the medicinal tree Mimusops coriacea (A.DC.) Miq. collected in Ecuador.

BACKGROUND: Mimusops coriacea (A.DC.) Miq., (Sapotaceae), originated from Africa, were introduced to coastal areas in Ecuador where it is not extensively used as a traditional medicine to treat various human diseases. Different therapeutically uses of the species include: analgesic, antimicrobial, hypoglycemic, inflammation and pain relieve associated with bone and articulation-related diseases. Furthermore, Mimusops coriacea could be used as anti-oxidant agent. However, botanical, chemical or molecular barcode information related to this much used species is not available from Ecuador. In this study, morphological characterization was performed from leaves, stem and seeds. Furthermore, genetic characterization was performed using molecular barcodes for rbcL, matk, ITS1 and ITS2 using DNA extracted from leaves. METHODS: Macro-morphological description was performed on fresh leaves, stem and seeds. For anatomical evaluation, tissues were embedded in paraffin and transversal dissections were done following incubation with sodium hypochlorite and safranin for coloration and fixated later in glycerinated gelatin. DNA extraction was performed using a modified CTAB protocol from leaf tissues, while amplification by PCR was accomplished for the molecular barcodes rbcL, matK, ITS1 and ITS2. Sequence analysis was performed using blast in the GenBank. Phylogenetic analysis was performed with accessions queried in the GenBank belonging to the subfamily Sapotoideae. RESULTS: Leaf size was 13.56 ± 1.46 × 7.49 ± 0.65 cm; where is a macro-morphological description of the stem (see Methods). The peel of the seeds is dark brown. Sequence analysis revealed that amplicons were generated using the four barcodes selected. Phylogenetic analysis indicated that the barcodes rbcL and matK, were not discriminated between species within the same genus of the subfamily Sapotoideae. On the other hand, the ITS1 and ITS2 were discriminative at the level of genus and species of the Sapotoideae.

Desarrollo de una bebida mixta tipo néctar con cápsulas de Aloe vera (L.) Burm. f. y vitamina C / Development of a nectar-type mixed drink with Aloe vera (L.) Burm. f. and vitamin C capsules

RESUMEN El mercado de productos naturales, a nivel alimenticio, medicinal e industrial, se ha incrementado notablemente, promoviendo la innovación e investigación y el uso de materias primas vegetales y animales. La presente investigación tuvo como objetivo diseñar un néctar, con una combinación de matrices de frutas y de vegetales, como uva, espinaca, mora, agraz, yacón, enriquecida con cápsulas de Aloe vera y vitamina C. Se plantearon tres formulaciones, variando la cantidad de ingredientes en la mezcla; se seleccionó el tratamiento más aceptable, mediante evaluación sensorial en panel no entrenado. Todos los néctares tuvieron una buena aceptación organoléptica; no obstante, el 50% de los panelistas mostraron preferencias por el tratamiento 1, que contenía 13% de uva, 4% de espinaca, 3% de agraz y mora, 2% de yacón; el porcentaje restante correspondió a la cantidad de agua y azúcar empleada en la formulación. Al tratamiento con mayor aceptación (T1), se le analizaron los atributos físico químicos, mostrando un pH de 2,96, 12,11°Brix, color, olor y apariencia normales y estables; asimismo, se evaluó la presencia de bacterias mesófilas, hongos y levaduras, E. coli y Salmonella. Con el fin de enriquecer el producto, se elaboraron cápsulas de A. vera y vitamina C, para ser incorporadas en el néctar. Este tipo de producto promueve el consumo de frutas y de vegetales en alimentos procesados de uso frecuente, como los néctares.

ABSTRACT The market of natural products at a nutritional, medicinal and industrial level, has increased remarkably, promoting innovation and research and the use of vegetable and animal raw materials. The objective of this research was to design a nectar, with a combination of fruit and vegetable matrices such as grape, spinach, blackberry, blueberry, yacon, enriched with Aloe vera capsules and vitamin C. Three formulations were proposed varying the number of ingredients in the mixture; the most acceptable treatment was selected through sensory evaluation in an untrained panel. All the nectars had a good organoleptic acceptance, however, 50% of the panelists showed preferences for the treatment 1, it contained 13% of grape, 4% of spinach, 3% of blueberry and blackberry, 2% of yacon, the remaining percentage corresponded to the amount of water and sugar used in the formulation. To the treatment with greater acceptance (T1) the physical-chemical attributes were analyzed, showing a pH of 2.96; 12.11°Brix, color, smell and appearance normal and stable, likewise the presence of mesophilic bacteria, fungi and yeasts, E. coli and Salmonella was evaluated. In order to enrich the product, capsules of A. vera and vitamin C were prepared to be incorporated into the nectar. This type of product promotes the consumption of fruits and vegetables in processed foods of frequent use such as nectars.

Designing malaria surveillance strategies for mobile and migrant populations in Nepal: a mixed-methods study.

BACKGROUND: As malaria cases have declined throughout Nepal, imported cases comprise an increasing share of the remaining malaria caseload, yet how to effectively target mobile and migrant populations (MMPs) at greatest risk is not well understood. This formative research aimed to confirm the link between imported and indigenous cases, characterize high-risk MMPs, and identify opportunities to adapt surveillance and intervention strategies to them. METHODS: The study used a mixed-methods approach in three districts in far and mid-western Nepal, including (i) a retrospective analysis of passive surveillance data, (ii) a quantitative health facility-based survey of imported cases and their MMP social contacts recruited by peer-referral, and (iii) focus group (FG) discussions and key informant interviews (KIIs) with a subset of survey participants. Retrospective case data were summarised and the association between monthly indigenous case counts and importation rates in the previous month was investigated using Bayesian spatio-temporal regression models. Quantitative data from structured interviews were summarised to develop profiles of imported cases and MMP contacts, including travel characteristics and malaria knowledge, attitudes and practice. Descriptive statistics of the size of cases' MMP social networks are presented as a measure of potential programme reach. To explore opportunities and barriers for targeted malaria surveillance, data from FGs and KIIs were formally analysed using a thematic content analysis approach. RESULTS: More than half (54.1%) of malaria cases between 2013 and 2016 were classified as imported and there was a positive association between monthly indigenous cases (incidence rate ratio (IRR) 1.02 95% CI 1.01-1.03) and the previous month's case importation rate. High-risk MMPs were identified as predominantly adult male labourers, who travel to malaria endemic areas of India, often lack a basic understanding of malaria transmission and prevention, rarely use ITNs while travelling and tend not to seek treatment when ill or prefer informal private providers. Important obstacles were identified to accessing Nepali MMPs at border crossings and at workplaces within India. However, strong social connectivity during travel and while in India, as well as return to Nepal for large seasonal festivals, provide opportunities for peer-referral-based and venue-based surveillance and intervention approaches, respectively. CONCLUSIONS: Population mobility and imported malaria cases from India may help to drive local transmission in border areas of far and mid-western Nepal. Enhanced surveillance targeting high-risk MMP subgroups would improve early malaria diagnosis and treatment, as well as provide a platform for education and intervention campaigns. A combination of community-based approaches is likely necessary to achieve malaria elimination in Nepal.

Household electricity access in Africa (2000-2013): Closing information gaps with model-based geostatistics.

Household electricity access data in Africa are scarce, particularly at the subnational level. We followed a model-based Geostatistics approach to produce maps of electricity access between 2000 and 2013 at a 5 km resolution. We collated data from 69 nationally representative household surveys conducted in Africa and incorporated nighttime lights imagery as well as land use and land cover data to produce maps of electricity access between 2000 and 2013. The information produced here can be an aid for understanding of how electricity access has changed in the region during this 14 year period. The resolution and the continental scale makes it possible to combine these data with other sources in applications in the socio-economic field, both at a local or regional level.

Hypertriglyceridemia and Its Association with HbA1c Test: A Prospective In Vivo Controlled Study.

BACKGROUND: Hypertriglyceridemia and hyperglycemia coexist in 30-60% of patients with diabetes. The impact of hypertriglyceridemia regarding HbA1c assay reliability remains uncertain. Therefore, we conducted a prospective in vivo controlled study with the aim of defining the association between triglyceride levels and HbA1c. METHODS: A total of 44 patients with an index-hospital admission diagnosis of diabetic ketoacidosis or hypertriglyceridemia-induced pancreatitis, as a model for acute elevation of triglycerides, were recruited. Blood samples were drawn for the measurement of HbA1c, triglycerides, glucose, and hemoglobin at baseline and subsequently 24 and 48 hours after admission. HbA1c analysis was performed with high-performance liquid chromatography Bio-Rad D10 (NGSP approved). RESULTS: All patients completed the study protocol. A difference between mean triglycerides from day 0 (baseline) to day 2 of 1567.2 mg/dL was observed. We found a difference between mean serum HbA1c from days 0 to 2 of 0.09% [1 mmol/mol] (p = 0.004). Moreover, a weak correlation between the mean difference of HbA1c and triglycerides from baseline to day 2 was found to be statistically significant (r = 0.256, p = 0.015). None of these findings, however, are clinically significant. CONCLUSION: Triglycerides do not impair the interpretation of HbA1c assay. Patients and clinicians can now be confident that hypertriglyceridemia is not an important factor when interpreting HbA1c results.

Biodegradability and toxicity of monorhamnolipid biosurfactant diastereomers.

Synthetic monorhamnolipids differ from biologically produced material because they are produced as single congeners, depending on the ß-hydroxyalkanoic acid used during synthesis. Each congener is produced as one of four possible diastereomers resulting from two chiral centers at the carbinols of the lipid tails [(R,R), (R,S), (S,R) and (S,S)]. We compare the biodegradability (CO2 respirometry), acute toxicity (Microtox assay), embryo toxicity (Zebrafish assay), and cytotoxicity (xCELLigence and MTS assays) of synthetic rhamnosyl-ß-hydroxydecanoyl-ß-hydroxydecanoate (Rha-C10-C10) monorhamnolipids against biosynthesized monorhamnolipid mixtures (bio-mRL). All Rha-C10-C10 diastereomers and bio-mRL were inherently biodegradable ranging from 34 to 92% mineralized. The Microtox assay showed all Rha-C10-C10 diastereomers and bio-mRL are slightly toxic according to the US EPA ecotoxicity categories with 5 min EC50 values ranging from 39.6 to 87.5 µM. The zebrafish assay showed that of 22 developmental endpoints tested, only mortality was observed at 120 h post fertilization; all Rha-C10-C10 diastereomers and bio-mRL caused significant mortality at 640 µM, except the Rha-C10-C10 (R,R) which showed no developmental effects. xCELLigence and MTS showed IC50 values ranging from 103.4 to 191.1 µM for human lung cell line H1299 after 72 h exposure. These data provide key information regarding Rha-C10-C10 diastereomers that is pertinent when considering potential applications.