Knockdown and recovery of malaria diagnosis and treatment in Liberia during and after the 2014 Ebola outbreak.

Setting: The malaria-endemic country of Liberia, before, during and after the 2014 Ebola outbreak. Objective: To describe the consequences of the Ebola outbreak on Liberia's National Malaria Programme and its post-Ebola recovery. Design: A retrospective cross-sectional study using routine countrywide programme data. Results: Malaria caseloads decreased by 47% during the Ebola outbreak and by 11% after, compared to the pre-Ebola period. In those counties most affected by Ebola, a caseload reduction of >20% was sustained for 12 consecutive months, while this lasted for only 4 consecutive months in the counties least affected by Ebola. Linear regression of monthly proportions of confirmed malaria cases-as a proxy indicator of programme performance-over the pre- and post-Ebola periods indicated that the malaria programme could require 26 months after the end of the acute phase of the Ebola outbreak to recover to pre-Ebola levels. Conclusions: The differential persistence of reduced caseloads in the least- and most-affected counties, all of which experienced similar emergency measures, suggest that factors other than Ebola-related security measures played a key role in the programme's reduced performance. Clear guidance on when to abandon the emergency measures after an outbreak may be needed to ensure faster recovery of malaria programme performance.

Contexte : Le Liberia, pays d'endémie palustre, avant, pendant et après l'épidémie d'Ebola de 2014.Objectif : Décrire les conséquences de l'épidémie d'Ebola sur le programme national de lutte contre le paludisme et sa récupération après Ebola.Schéma : Étude rétrospective transversale utilisant des données de routine du programme dans tout le pays.Résultats : Le nombre de cas de paludisme déclarés a baissé de 47% pendant et de 11% après l'épidémie d'Ebola, comparé à la période pré-Ebola. Dans les comtés les plus affectés par Ebola, une réduction de plus de 20% a été maintenue pendant plus de 12 mois consécutifs, tandis que celle-ci n'a duré que pendant 4 mois consécutifs dans les comtés les moins affectés par Ebola. Une régression linéaire des proportions mensuelles de cas de paludisme confirmés­comme indicateur indirect de la performance du programme­sur les périodes pré- et post-Ebola a montré que le programme paludisme pourrait avoir besoin de 26 mois après la fin de la phase aiguë de l'épidémie d'Ebola pour revenir aux niveaux d'avant Ebola.Conclusion: La persistance différentielle de réduction des cas déclarés dans les comtés les moins et les plus affectés, qui ont tous expérimenté des mesures d'urgence similaires, suggère que des facteurs autres que les mesures de sécurité liées à Ebola ont joué des rôles clés dans la réduction de la performance du programme. Des recommandations claires sur le moment auquel il faut abandonner les mesures d'urgence après une flambée pourraient être nécessaires pour assurer une récupération plus rapide de la performance du programme.

Marco de referencia: El país de Liberia, con una situación endémica de paludismo, antes de la epidemia de fiebre hemorrágica del Ébola, durante el brote y después del mismo en el 2014.Objetivos: Describir las consecuencias del brote epidémico del Ébola sobre el programa nacional contra el paludismo y su recuperación después de la epidemia.Método: Fue este un estudio transversal retrospectivo a partir de los datos corrientes del programa en todo el país.Resultados: La carga de morbilidad por paludismo disminuyó un 47% durante la epidemia y un 11% después de la misma, en comparación con el período anterior. En las provincias más afectadas por el brote se observó una disminución constante de más del 20% durante 12 meses consecutivos, comparada con 4 meses en las provincias menos afectadas. La regresión lineal de la proporción mensual de casos confirmados de paludismo, utilizada como indicador indirecto del desempeño del programa durante los períodos anterior y posterior a la epidemia del Ébola, puso de manifiesto que el programa precisó 26 meses después del final de la fase aguda de la epidemia hasta recuperar su nivel de desempeño anterior al brote.Conclusiones: La recuperación diferencial de la notificación en las provincias menos afectadas y las más afectadas por la epidemia, pese a que en todas las regiones se ejecutaron intervenciones de emergencia equivalentes, indica que factores diferentes a las medidas de seguridad desencadenadas por la epidemia influyeron de manera importante en la disminución del desempeño del programa. Se precisan orientaciones claras con respecto al momento más oportuno para interrumpir las intervenciones de emergencia después de los brotes epidémicos, con el propósito de facilitar una recuperación más rápida del funcionamiento del programa contra el paludismo.

Pre-exercise carbohydrate status and immune responses to prolonged cycling: I. Effect on neutrophil degranulation.

Ingesting carbohydrate (CHO) beverages during heavy exercise is associated with smaller shifts in numbers of circulating neutrophils and attenuated changes in neutrophil functional responses. The influence of dietary CHO availability on these responses has not been determined. Therefore, the present study investigated the influence of pre-exercise CHO status on circulating neutrophil and lipopolysaccharide (LPS)-stimulated neutrophil degranulation responses to prolonged cycling. Twelve trained male cyclists performed a glycogen-lowering bout of cycling and were randomly assigned to follow a diet ensuring either greater than 70% (HIGH) or less than 10% (LOW) of daily energy intake from CHO for the next 3 days. On day 4, subjects performed an exercise test that comprised cycling for 1 hour at 60% Wmax immediately followed by a time-trial (TT) ensuring an energy expenditure equivalent to cycling for 30 min at 80% Wmax. Subjects repeated the protocol after 7 days, this time following the second diet. The order of the trials was counterbalanced. At TT completion, the HIGH compared with the LOW trial was associated with higher plasma glucose concentration, lower plasma cortisol concentration, and lower circulating neutrophil count. LPS-stimulated neutrophil degranulation per cell fell similarly on both trials. These findings suggest that pre-exercise CHO status influences neutrophil trafficking but not function in response to prolonged cycling.

Pre-exercise carbohydrate status and immune responses to prolonged cycling: II. Effect on plasma cytokine concentration.

Ingesting carbohydrate (CHO) beverages during heavy exercise is associated with smaller changes in the plasma concentrations of several cytokines. The influence of dietary CHO availability on these responses has not been determined. Therefore, the present study investigated the influence of pre-exercise CHO status on plasma interleukin (IL)-6, IL-10, and IL-1 receptor antagonist (IL-1ra) responses to prolonged cycling. Seven trained male cyclists performed a glycogen-lowering bout of cycling and were randomly assigned to follow a diet ensuring either greater than 70% (HIGH) or less than 10% (LOW) of daily energy intake from CHO for the next 3 days. On day 4 subjects performed an exercise test that comprised cycling for 1 hour at 60% Wmax immediately followed by a time-trial (TT) ensuring an energy expenditure equivalent to cycling for 30 min at 80% Wmax. Subjects repeated the protocol after 7 days, this time following the second diet. The order of the trials was counterbalanced. At 1 and 2 hours post-TT, plasma concentrations of IL-6 and IL-10 were 2-fold greater on the LOW trial than on the HIGH trial, and peak plasma concentrations of IL-1ra were 9-fold greater on the LOW trial than on the HIGH trial. These findings suggest that pre-exercise CHO status can influence the plasma cytokine response to prolonged cycling.

Cariostatic and ultraconservative sealed restorations: nine-year results among children and adults.

The objective of this clinical study was to evaluate the long-term efficacy of placing sealed posterior composite restorations for arresting active caries. The tooth preparation for this bonded and sealed restoration was limited to placing a bevel in the enamel only, without the removal of the carious lesion. The radiographic and clinical performance of these ultraconservative sealed composite restorations placed over caries (CompS/C) was compared over a period of nine years with: 1) ultraconservative, localized sealed amalgam (AGS) restorations with no extension for prevention, and 2) traditional, unsealed amalgam restorations (AGU) with the usual extension for prevention outline form. Sealant retention with > 50 percent to 100 percent of the margins occurred in 64 percent of CompS/C and 82.5 percent of AGS restorations. After nine years the cumulative failure rates were 16 percent for CompS/C, 2.5 percent for AGS, and 17.1 percent for AGU restorations. Thus, the clinical performance of CompS/C restorations was slightly superior to that of the traditional AGU restorations. The AGS restorations were definitely superior to the traditional AGU restorations and to the CompS/C restorations in both children and adults alike. Complete sealant retention over CompS/C and AGS restorations was equivalent between children and adults (P = 0.14 and 0.74, respectively). A higher percentage of open margins in CompS/C restorations was seen, however, in children (17.4 percent) than adults (1.94 percent). This study has shown that Class I caries can be arrested by the CompS/C restoration.

Cariostatic and ultraconservative sealed restorations: six-year results.

The objective of this clinical study was to determine the ability of an ultraconservative, sealed composite resin restoration, without a traditional cavity preparation and without the removal of the carious lesion, to arrest Class I caries. Tooth preparation was limited to placing a bevel in the enamel. These restorations were compared, over 6 years, with (1) ultraconservative, localized, sealed amalgam restorations with no extension for prevention and (2) traditional, unsealed amalgam restorations with the usual extension for prevention outline form. Caries was arrested by the ultraconservative, sealed composite resin restorations for 6 years. Complete sealant retention on the sealed amalgam restorations was somewhat lower than that on the sealed composite resin restorations; conversely, partial sealant retention was higher for the sealed amalgam group. The marginal integrity of the sealed amalgam restorations was significantly superior to that of the unsealed amalgam restorations. The sealant also protected Class I posterior composite resin restorations against wear.

A modified light-cured denture identification technique.

Removable dental prostheses are lost frequently or stolen in nursing homes. Dental personnel may not be routinely available to many nursing home residents to place identification labels, and nursing staff members are not trained to use traditional denture marking techniques. This article describes a modified simple marking technique that may be used by either dental personnel or nursing staff members. Using ordinary sandpaper, lead pencil or ball pen, art and craft brush, direct light, and a mono-poly sealer of 1 part heat-cured clear methylmethacrylate powder mixed with 10 parts of autopolymerizing clear orthodontic methylmethacrylate liquid, 26 dentures were labeled for 19 nursing home residents. The technique was quick, cheap, easily applied, nonirritating to mouth tissues, and permanent.

Sealed restorations: 5-year results.

This clinical study determined the feasibility of a sealed resin composite restoration to arrest dental caries using a minimal tooth preparation: a bevel in enamel only without removal of the carious lesion. These ultra-conservative sealed composite restorations placed over caries (CompS/C) were compared with ultra-conservative sealed amalgam restorations (AGS) that had no "extension for prevention". The CompS/C restorations were also compared with the traditional (unsealed) amalgam restorations (AGU) with the "extension for prevention" outline form. Caries progress, as determined by standardized radiographs, revealed that after 5 years caries remained arrested under the CompS/C restorations; the marginal integrity was similar for the CompS/C and the AGS groups, and exhibited highly significant superiority to the AGU restorations (Chi square, P less than = 0.00004). Complete sealant retention over the amalgam restorations (AGS group) was less than over the composite restorations (CompS/C), and conversely, partial sealant retention was higher for the AGS group. Sealants also appeared to protect the posterior composite restorations against wear.

Sealed restorations: 4-year results.

The overall objective of this clinical study was to determine the feasibility of using a sealed composite restoration to arrest caries. This objective was to be achieved using minimal tooth preparation for Class I lesions, without the traditional Class I cavity preparation and without the removal of the carious lesion. The minimal tooth preparation consisted of no [corrected] removal of the carious lesion, bevel in enamel only, and usually not requiring any anesthetic injection. These ultra-conservative sealed composite restorations placed over caries (CompS/C) were compared with ultra-conservative sealed amalgam restorations (AGS) and with the traditional (unsealed) amalgam restorations (AGU). This study showed that: 1) caries is arrested under the CompS/C restoration for a period of 4 years; 2) sealant retention is similar in both the CompS/C and the AGS groups; 3) the marginal integrity of the AGS restorations is markedly superior to that of the AGU restorations; and 4) sealant appears to prevent wear of posterior composite restorations.