Analyzing the Surface Topography of Hafnium Nitride Coating on Titanium Screws: An In Vitro Analysis.

Background The use of surface coatings to enhance the properties lacking in titanium has attracted significant focus in recent times. Hafnium nitride (HfN) coatings could be explored as promising in the osteoinductive properties of titanium implants. HfN exhibits excellent mechanical attributes, such as hardness and wear resistance, and is often used as a coating on high-end equipment for protection. The findings from this research may carve a new path for the production and optimization of HfN coatings to enhance the longevity and augment properties of implant materials. Thus, the present study was orchestrated to elucidate the surface morphology of HfN coating, ultimately contributing to the advancement of dental implant biomaterials. Materials and methods A total of twenty samples of medical grade commercially pure titanium screws (2 mm diameter and 7 mm length) were procured from G. R. Bioure Surgical System Pvt. Ltd., Ravali, Uttar Pradesh, India, and ten samples were reacted with HfN (0.1 M) (Nano Research Elements, Kurukshetra, Haryana, India) in 100% ethanol and stirred continuously for about 48 hours. Then these screw samples were immersed in the prepared colloidal suspension and sintered for two hours at 400 degrees centigrade. The implant screws were affixed onto metal supports. The magnifications for photomicrographs at ×30, ×200, ×1,500, ×3,000, and ×5,000 were standardized. Elementary semi-quantitative analysis of both dental implants was conducted using energy-dispersive X-ray spectrometry (EDX) coupled with the field emission scanning electron microscope (FE-SEM) equipment (JEOL Ltd., Akishima, Tokyo, Japan). The software used for the analysis of the obtained images is SEM Center. Results The surface analysis using the scanning electron microscope (SEM) showed the coating of HfN over titanium screws. The difference in surface morphology of both the group of implant screws can be visualized under 40.0 and 10.0 mm working distance (WD) for both groups. The surface analysis using the EDX of uncoated titanium screws shows five elements in the spectrum: titanium (Ti), oxygen (O), aluminum (Al), carbon (C), and vanadium (V). The EDX of the HfN-coated screws has two additional metals dispersed in the spectrum, hafnium (Hf). The element characteristics are tabulated with their apparent concentration, k ratio, line type, weight percentage, standard label, and factory label for uncoated titanium screws and HfN-coated titanium screws. Conclusion The study evaluated HfN coating over medical grade commercially pure titanium. The surface topography of coated versus uncoated was visualized. The scanning electron microscope (SEM) images showed a homogenous coating over the titanium surfaces, and the EDX showed elemental dispersion of the coated implant. The study aims to provide a comprehensive understanding of the coating's surface morphology, which will aid in the development of more durable and biocompatible implants. This thereby provides a promising scope for further research of this novel metal coating for use in the biomedical sectors, specifically for dental implants.

Microvascular Free Flap Outcomes in Maxillectomy Defects from Invasive Fungal Sinusitis.

OBJECTIVES: Microvascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to describe outcomes of free flap reconstruction for IFS defects, determine the optimal time to perform reconstruction, and if anti-fungal medications or other risk factors of an immunocompromised patient population affect reconstructive outcomes. METHODS: Retrospective review of reconstruction for IFS (2010-2022). Age, BMI, hemoglobin A1c, number of surgical debridements, and interval from the last debridement to reconstruction were compared between patients with delayed wound healing versus those without. Predictor variables for delayed wound healing and the effect of time on free flap reconstruction were analyzed. RESULTS: Twenty-seven patients underwent free flap reconstruction for IFS. Three patients were immunocompromised from leukemia and 21 had diabetes mellitus (DM). Patients underwent an average of four surgical debridements for treatment of IFS. The interval from the last IFS debridement to flap reconstruction was 5.58 months (±5.5). Seven flaps (25.9%) had delayed wound healing. A shorter interval of less than 2 months between the last debridement for IFS and reconstructive free flap procedure was associated with delayed wound healing (Fisher Exact Test p = 0.0062). Other factors including DM, BMI, HgA1c, and bone reconstruction were not associated with delayed wound healing. CONCLUSION: Patients with maxillectomy defects from IFS can undergo microvascular-free flap reconstruction with good outcomes while on anti-fungal medication. Early reconstruction in the first 2 months after the last IFS debridement is associated with delayed wound healing. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1642-1647, 2024.

Study of neoadjuvant chemotherapy in advanced malignant ovarian germ cell tumors at a tertiary center in western India.

OBJECTIVE: To study clinical characters and outcomes in patients of malignant ovarian germ cell tumor (MOGCT) undergoing surgery following neoadjuvant chemotherapy (NACT). METHODS: Retrospective study of patients undergoing surgery following NACT for MOGCT at our institute. Platinum based chemotherapy was given in all patients in NACT. RESULTS: Between March 2013 and February 2023, 30 patients had surgery after NACT. Patient's median age was 22 years (range, 12 to 35 years) and median follow up 42months (range, 6 to 132 months). Majority had endodermal sinus tumor (n=12), dysgerminoma (n=9) and mixed GCT (n=7). All had either International Federation of Gynecology and Obstetrics (FIGO) stage 3 (n=19) or FIGO stage 4 disease (n=11). Complete response to NACT seen in 5 patients and 23 patients had partial response. Fertility sparing surgery in 18 patients and complete surgery in 12 patients. Suboptimal surgery was seen in 4 patients. Currently, 20 of 30 patients are alive and disease free, 3 lost for follow up and 7 patients had progression after adjuvant therapy. Five patients had mortality-4 with progression and 1 with bleomycin toxicity. Fifteen of 17 eligible patients have resumed menstruation and one had successful pregnancy. Prognostic factors noted in study are stage, optimal surgery and viable tumor in histopathology. Dysgerminoma had better outcome than other histology. CONCLUSION: NACT may be a reasonable option in patients with extensive unresectable disease or in whom fertility sparing is not possible or in the poor general condition. Fertility sparing surgery can be attempted post neoadjuvant chemotherapy without adversely affecting prognosis.

Evaluation of Ear in Otologically Asymptomatic Patients of Chronic Rhinosinusitis.

Background: The aim of the study was to evaluate the ear in otologically asymptomatic patients of chronic rhinosinusitis and summarize the otological and audiological findings. Methods: This is a cross sectional study conducted in the Department of Otorhinolaryngology - Head & Neck Surgery, Jaipur Golden Hospital, New Delhi, from January 2019 to October 2019. 80 cases aged between 15 and 55 years with Chronic rhinosinusitis were included in the study. Detailed clinical examination and history was carried out followed by Diagnostic nasal endoscopy and Otoendoscopy. All the data collected was statistically analyzed. Results: In patients of Chronic rhinosinusitis, Nasal obstruction was the most common complaint. Out of 80 patients 47 had abnormal Tympanic Membrane finding in one or the other ear, among them Tympanosclerotic patch was the most common finding. Co-relation between Diagnostic nasal endoscopy in right and left ipsilateral nasal cavity and tympanic membrane showed statistically significant association between nasal polyp and presence of abnormal tympanic membrane. Statistically significant association between duration of chronic rhinosinusitis and presence of abnormal tympanic membrane finding on otoendoscopy was found. Conclusion: chronic rhinosinusitis affects the ears slowly and silently. Hence, the ears should always be proactively evaluated in every patient of chronic rhinosinusitis to diagnose inevident disease in ears and if necessary, initiate timely preventive and therapeutic intervention.

Nanoparticle-eluting stents for coronary intervention: formulation, characterization, and in vitro evaluation.

Coronary artery disease (CAD) is currently a leading cause of death worldwide. In the history of percutaneous coronary intervention for the treatment of CAD, a drug-eluting stent (DES) is recognized as a revolutionary technology that has the unique ability to significantly reduce restenosis and provide both mechanical and biological solutions simultaneously to the target lesion. The aim of the research work was to design and fabricate DES coated with a nanoparticulate drug formulation. Sirolimus, an inhibitor of the smooth muscle cell (SMC) proliferation and migration, was encapsulated in polymeric nanoparticles (NPs). The NP formulation was characterized for various physicochemical parameters. Cell viability and cell uptake studies were performed using human coronary artery smooth muscle cells (HCASMCs). The developed NP formulation showed enhanced efficacy compared to plain drug solution and exhibited time-dependent uptake into the HCASMCs. The developed NP formulation was coated on the Flexinnium™ ultra-thin cobalt-chromium alloy coronary stent platform. The NP-coated stents were characterized for morphology and residual solvent analysis. In vitro drug release was also evaluated. Ex vivo arterial permeation was carried out to evaluate the NP uptake from the surface of the stents. The characterization studies together corroborated that the developed NP coated stent can be a promising replacement of the current DESs.

Quinoline Derivative Enhances Human Sperm Motility and Improves the Functional Competence.

In this study, we aimed to explore the beneficial properties of novel quinoline derivatives on human sperm motility and its functional competence. Nine novel quinoline derivatives were screened for their effect on motility in human spermatozoa from normozoospermic ejaculates. Compounds with impressive sperm motility enhancement properties were further assessed for their effect on functional competence of human spermatozoa. To determine the effect on the fertilizing ability of spermatozoa processed with quinoline derivatives and to assess developmental competence of embryos derived, in vitro fertilization (IVF) was performed using mouse model. Among the nine quinoline derivatives, 2 compounds (6MQT and 2,6DQT) exhibited significant enhancement in sperm progressive motility and survival at 24 h. Further, non-significant increase in curvilinear velocity (VCL), straight line velocity (VSL), and amplitude of lateral head displacement (ALH) was observed. Capacitation, intracellular cAMP level and tyrosine phosphorylated sperm proteins were significantly higher in 6MQT (P < 0.05) and 2,6DQT (P < 0.001) compared to control. In vitro fertilization (IVF) experiments using Swiss albino mice revealed that spermatozoa processed with 6MQT had non-significantly higher blastocyst rate and a superior blastocyst quality, while, 2,6DQT resulted in significantly lower blastocyst rate (P < 0.05) compared to control. Quinoline derivative 6MQT has significant motility enhancement property under in vitro conditions. Graphical abstract.

Genotype × environment interactions for grain iron and zinc content in rice.

BACKGROUND: Nutrient deficiency in humans, especially in children and lactating women, is a major concern. Increasing the micronutrient concentration in staple crops like rice is one way to overcome this. The micronutrient content in rice, especially the iron (Fe) and zinc (Zn) content, is highly variable. The identification of rice genotypes in which there are naturally high Fe and Zn concentrations across environments is an important target towards the production of biofortified rice. RESULTS: Phenotypic correlations between grain Fe and Zn content were positive and significant in all environments but a significant negative association was observed between grain yield and grain Fe and Zn. Promising breeding lines with higher Zn or Fe content, or both, were: IR 82475-110-2-2-1-2 (Zn: 20.24-37.33 mg kg-1 ; Fe: 7.47-14.65 mg kg-1 ); IR 83294-66-2-2-3-2 (Zn: 22-37-41.97 mg kg-1 ; Fe: 9.43-17.16); IR 83668-35-2-2-2 (Zn: 27.15-42.73 mg kg-1 ; Fe: 6.01-14.71); IR 68144-2B-2-2-3-1-166 (Zn: 23.53-40.30 mg kg-1 ; Fe: 10.53-17.80 mg kg-1 ) and RP Bio 5478-185M7 (Zn: 22.60-40.07 mg kg-1 ; Fe: 7.64-14.73 mg kg-1 ). Among these, IR82475-110-2-2-1-2 (Zn: 20.24-37.33 mg kg-1 ; Fe: 7.47-14.65 mg kg-1 ) is also high yielding with 3.75 t ha-1 . Kelhrie Cha (Zn: 17.76-36.45 mg kg-1 ; Fe: 7.17-14.77 mg kg-1 ), Dzuluorhe (Zn: 17.48-39.68 mg kg-1 ; Fe: 7.89-19.90 mg kg-1 ), Nedu (Zn: 18.97-43.55 mg kg-1 Fe: 8.01-19.51 mg kg-1 ), Kuhusoi-Ri-Sareku (Zn: 17.37-44.14 mg kg-1 ; Fe: 8.99-14.30 mg kg-1 ) and Mima (Zn: 17.10-45.64 mg kg-1 ; Fe: 9.97-17.40 mg kg-1 ) were traditional donor genotypes that possessed both high grain Fe and high Zn content. CONCLUSION: Significant genotype × location (G × L) effects were observed in all traits except Fe. Genetic variance was significant and was considerably larger than the variance of G × L for grain Zn and Fe content traits, except grain yield. The G × L × year variance component was significant in all cases. © 2020 Society of Chemical Industry.

Retrospective Analysis of 32 Cases of Ovarian Granulosa Cell Tumours.

INTRODUCTION: Granulosa cell tumour (GCT) comprises 2-5% of ovarian malignancies. They are hormonally active tumours and may present with menstrual complaints, abdominal distension or infertility. Prognosis is generally favourable because of the early stage at diagnosis and less aggressive behaviour. MATERIALS AND METHODS: Medical records of 32 cases presenting from January 2008 to December 2014 were retrospectively analysed for the patient characteristics, tumour characteristics and the treatment received. RESULTS: The mean age was 42.75 ± 10.25 years (range: 22 to 70 years). The most common presenting symptom was abdominal distension (50.00%) followed by menstrual complaints. The mean tumour diameter was 15.24 cm (range: 4-25 cm). Endometrial pathology was found in 4 patients (12.50%), and all had simple hyperplasia without atypia. Twenty-four patients underwent primary staging surgery; one patient underwent interval debulking surgery after neo-adjuvant chemotherapy. Seven patients had undergone surgery elsewhere of which 4 underwent re-staging and three were given chemotherapy. All patients had the final histopathology of adult granulosa cell tumour except one patient with juvenile granulosa cell tumour. Most patients had stage I disease (81.25%). Post-operative chemotherapy was administered to 22 patients. The most commonly used regimen was paclitaxel and carboplatin. The overall 5-year survival rate was 90%. The mean overall survival was 36.95 ± 34.08 months (range: 0.50 to 112.00 months). Two patients had recurrence at 38 and 44 months, respectively. CONCLUSION: GCT of the ovary is a rare tumour with a tendency for late relapse. Survival is generally excellent as majority of the patients present in early stages.

Novel 5-(1-aryl-1H-pyrazol-3-yl)-1H-tetrazoles as glycogen phosphorylase inhibitors: An in vivo antihyperglycemic activity study.

In this study, we report the ring transformation of 3-arylsydnone into 1-aryl-1H-pyrazole-3-carbonitriles via [3 + 2] cycloaddition with acrylonitrile. 1-Aryl-1H-pyrazole-3-carbonitrile underwent [2 + 3] cycloaddition with sodium azide to afford 5-(1-aryl-1H-pyrazol-3-yl)-1H-tetrazoles which were further subjected to N-alkylation with aryl/heteroaryl alkyl halides to afford 1,5- and 2,5-disubstituted tetrazoles. Furthermore, the title compounds were screened for in vivo antihyperglycemic activity using albino Wistar rats of either sex. Compounds 4a, 6b, 7a, 7b, 8b, and 9b showed maximum fall in the blood glucose levels in streptozotocin-induced diabetic rats after 5-7 days of administration. In support of antidiabetic activity, we also performed the experimental in vivo studies, namely, effect of compounds on enzymes (serum glutamic oxaloacetic transaminase, serum glutamic-pyruvic transaminase, creatinine, urea, and total protein), antihyperlipidemic, and histopathology. Moreover, the molecular docking study has been performed for potent molecules among the series with glycogen phosphorylase as target enzyme, and this study corroborated the experimental in vivo results.

α-ZrP Nanoreinforcement Overcomes the Trade-Off between Phosphoric Acid Dopability and Thermomechanical Properties: Nanocomposite HTPEM with Stable Fuel Cell Performance.

In recent times, high-temperature polymer electrolyte membranes (HTPEMs) have emerged as viable alternatives to the Nafion-based low-temperature-operated polymer electrolyte membrane fuel cells. This is owing to their higher tolerance to fuel impurities, efficient water management, and higher cathode kinetics. However, the most efficacious HTPEMs such as poly(benzimidazole) (PBI) or 2,5-poly(benzimidazole) (ABPBI), which rely on the extent of phosphoric acid (PA) doping level for fuel cell performance, suffer from poor mechanical properties at higher acid doping levels and dopant leaching during continuous operation. To overcome these issues, we report the synthesis of ABPBI membranes and fabrication of ABPBI-zirconium pyrophosphate (α-ZrP)-based nanocomposite membranes by an ex situ methodology using methane sulfonic acid as the solvent. The incorporation of hydrophilic α-ZrP into the membrane resulted in higher dopability of PA (6.5 mol) and proton conductivity (46 mS/cm) of the membranes (10 wt % of α-ZrP) as against the corresponding values of 3.6 mol and 27 mS/cm, respectively, for the pristine membrane. More remarkably, these property improvements could be achieved while simultaneously augmenting the thermomechanical properties and oxidative stability of the membranes. The unit-cell tests showed a marked improvement in the maximum power density for the nanocomposite membrane (335 mW/cm2 at 10 wt % α-ZrP content) over the pristine ABPBI membrane (200 mW/cm2). We also report for the first time the feasibility of a 100 W HTPEM fuel cell (HTPEMFC) stack operated with the nanocomposite membrane with an active area of 39 cm2. The HTPEMFC stack delivered a stable voltage and power output, with a voltage drop rate of 0.84 µV/h over a run time of 730 h.

Click chemistry based regioselective one-pot synthesis of coumarin-3-yl-methyl-1,2,3-triazolyl-1,2,4-triazol-3(4H)-ones as newer potent antitubercular agents.

Coumarin-3-yl-methyl-1,2,3-triazolyl-1,2,4-triazol-3(4H)-ones (8k-z) were synthesized via copper(I)-catalyzed azide-alkyne cycloaddition click chemistry. The synthesized hybrid molecules were characterized by spectral studies. Compounds 8k-z were screened for their in vitro anti-TB activity by using the Microplate Alamar Blue assay and for cytotoxicity using the MTT assay. Some of the compounds were found to be most potent against the tested Mycobacterium tuberculosis H37Rv strain with a MIC of 1.60 µg/ml. Further, docking the compounds into the InhA binding pocket showed strong binding interactions and effective overall docking scores were recorded. The drug-likeness and toxicity studies were computed using Molinspiration and Protox, respectively.

Antibacterial activity of new atraumatic restorative treatment materials incorporated with Azadirachta indica (Neem) against Streptococcus mutans.

BACKGROUND: The antibacterial property of new atraumatic restorative treatment (ART) materials incorporated with Azadirachta indica (Neem) on Streptococcus mutans was carried out. MATERIALS AND METHODS: The study was carried out by using the agar diffusion method to determine the antibacterial property of ART materials (ART-I and ART-II). The zone of inhibition was tabulated, and the data was statistically analyzed using the student t-test. The minimum inhibitory concentrations (MIC) and the minimum bactericidal concentrations (MBC) of the ethanolic extract of Neem were recorded. RESULTS: The MIC and MBC of the mixture of the ethanolic extract of Neem was 3.13% and 12.5% respectively. The zone of inhibition of ART-I and ART-II was 11.81 mm and 11.97 mm respectively. Significant differences were observed between these two ART materials (P = 0,08). CONCLUSION: Both the new ART materials i.e. ART-I and ART-II have considerable antibacterial activity against S. mutans.

Efficacy of Three Types of Plaque Control Methods During Fixed Orthodontic Treatment: A Randomized Controlled Trial.

AIM: The aim of this study was to evaluate and compare the efficacy of three types of plaque control methods among 13- to 35-year-old subjects receiving fixed orthodontic treatment in Coorg Institute of Dental Sciences, Virajpet, Coorg district, Karnataka, India. MATERIALS AND METHODS: A total of 111 subjects who fulfilled the inclusion and exclusion criteria were randomly included in the study. The subjects were recalled after 1 month of the commencement of fixed orthodontic treatment for the recording of baseline data including plaque index (PI), gingival index (GI), and modified papillary bleeding index (MPBI). After recording of the baseline data, the subjects were randomly allocated into each of the intervention groups, i.e., group A (manual tooth brush), group B (powered tooth brush), and group C (manual tooth brush combined with mouthwash) by lottery method. Further, all the subjects were recalled after 1 and 2 months for recording the data. RESULTS: Regarding plaque levels, it was seen that there was a highly statistically significant difference between the three groups (P = 0.001), with the manual tooth brush combined with chlorhexidine mouthwash group recording the lowest mean PI score of 0.5 ± 0.39. A comparison of the mean GI scores among the groups at the end of 2 months shows a highly statistically significant difference (P = 0.001). The mean MPBI scores at the end of 2 months were highly statistically significant among the three groups (P = 0.001), with the group C recording the lowest mean MPBI score of 0.3 ± 0.3. CONCLUSION: The powered tooth brush group subjects exhibited significantly lesser PI, GI, and MPBI scores than the manual tooth brush group at the end of 2 months, whereas the manual tooth brush combined with chlorhexidine mouth wash group subjects showed maximum improvement, having significantly lesser PI and GI scores than the powered tooth brush group.

Negative-pressure Wound Therapy for Periocular Necrotizing Fasciitis.

Periocular necrotizing fasciitis is a rare, but potentially blinding, or even fatal disease. The authors report a case of a 44-year-old man who presented with quiescent bilateral periocular and facial necrotizing fasciitis. The patient was treated with antibiotics and surgical debridement, followed by negative-pressure wound therapy (NPWT), until the wound bed was thought to be healthy enough to support bilateral upper eyelid full-thickness skin grafts. NPWT appeared to decrease local edema; speed reperfusion and granulation tissue formation; and served to stabilize the skin grafts against the wound bed, while not causing any ocular complications. NPWT can be a safe and effective adjunct treatment for periocular necrotizing fasciitis.

Molecular Mapping of QTLs Associated with Lodging Resistance in Dry Direct-Seeded Rice (Oryza sativa L.).

Dry direct-seeded rice (DSR) is an alternative crop establishment method with less water and labor requirement through mechanization. It provides better opportunities for a second crop during the cropping season and therefore, a feasible alternative system to transplanted lowland rice. However, lodging is one of the major constraints in attaining high yield in DSR. Identification of QTLs for lodging resistance and their subsequent use in improving varieties under DSR will be an efficient breeding strategy to address the problem. In order to map the QTLs associated with lodging resistance, a set of 253 BC3F4 lines derived from a backcross between Swarna and Moroberekan were evaluated in two consecutive years. A total of 12 QTLs associated with lodging resistance traits [culm length (qCL), culm diameter (qCD), and culm strength (qCS)] were mapped on chromosomes 1, 2, 6, and 7 using 193 polymorphic SNP markers. Two major and consistent effect QTLs, namely qCD1.1 (with R2 of 10%) and qCS1.1 (with R2 of 14%) on chromosome 1 with id1003559 being the peak SNP marker (flanking markers; id1001973-id1006772) were identified as a common genomic region associated with important lodging resistance traits. In silico analysis revealed the presence of Gibberellic Acid 3 beta-hydroxylase along with 34 other putative candidate genes in the marker interval region of id1001973-id1006772. The positive alleles for culm length, culm diameter, and culm strength were contributed by the upland adaptive parent Moroberekan. Our results identified significant positive correlation between lodging related traits (culm length diameter and strength) and grain yield under DSR, indicating the role of lodging resistant traits in grain yield improvement under DSR. Deployment of the identified alleles influencing the culm strength and culm diameter in marker assisted introgression program may facilitate the lodging resistance under DSR.

Immunogenicity of virus-like Semliki Forest virus replicon particles expressing Indian HIV-1C gag, env and polRT genes.

Development of a vaccine targeting human immunodeficiency virus-1 subtype C (HIV-1C) is an important public health priority in regions with a high prevalence of the clade C virus. The present study demonstrates the immunogenicity of recombinant Semliki Forest virus (SFV)-based virus-like replicon particles (VRPs) expressing Indian HIV-1C env/gag/polRT genes. Immunization of mice with recombinant VRPs in a homologous prime-boost protocol, either individually or in combination, elicited significant antigen-specific IFN-γ T cell responses as detected by the ELISPOT assay. Additionally, Gag-specific TNF-α secreting CD8+ and CD4+ T cells and Env-specific IL-2 secreting T cells were also elicited by mice immunized with Gag and Env constructs, respectively, as estimated by intracellular cytokine staining assay. Moreover, an HIV Pol-specific TNF-α response was elicited in mice immunized with a combination of the three VRP constructs. Furthermore, HIV-1C Gag and Env-specific binding antibodies were elicited as verified by gp120 ELISA and p24 Gag ELISA, respectively. The immunogenicity of VRPs was found to be higher as compared to that of RNA replicons and VRPs may therefore be promising preventive and therapeutic candidate vaccines for the control and management of HIV/AIDS.