RESUMO
In the current study, the texturizing properties of partially pectin-depleted cell wall material (CWM) of apple, carrot, onion and pumpkin, and the potential of functionalization by high-pressure homogenization (HPH) were addressed. This partially pectin-depleted CWM was obtained as the unextractable fraction after acid pectin extraction (AcUF) on the alcohol-insoluble residue. Chemical analysis was performed to gain insight into the polysaccharide composition of the AcUF. The microstructural and functional properties of the AcUF in suspension were studied before HPH and after HPH at 20 and 80 MPa. Before HPH, even after the pectin extraction, the particles showed a cell-like morphology and occurred separately in the apple, onion and pumpkin AcUF and in a clustered manner in the carrot AcUF. The extent of disruption by the HPH treatments at 20 and 80 MPa was dependent on the botanical origin. Only for the onion and pumpkin AcUF, the water binding capacity was increased by HPH. Before HPH, the texturizing potential of the AcUFs was greatly varying between the different matrices. Whereas HPH improved the texturizing potential of the pumpkin AcUF, no effect and even a decrease was observed for the onion AcUF and the apple and carrot AcUF, respectively.
RESUMO
BACKGROUND: As countries scale up adult voluntary medical male circumcision (VMMC) for HIV prevention, they are looking ahead to long term sustainable strategies, including introduction of early infant male circumcision (EIMC). Although a number of devices for EIMC are prequalified by the World Health Organization, evaluation of additional devices can provide policy-makers and clinicians the information required to make informed decisions. We undertook a field evaluation of the safety and acceptability of the AccuCirc device in Kisumu County, Kenya. METHODS: Procedures were performed by four trained clinicians in two public facilities. Participants were recruited from surrounding public health facilities through informational talks at antenatal clinics, maternity wards, and maternal neonatal child health clinics. Healthy infants ages 0-60 days, with no penile abnormality, without a family history of bleeding disorder, with current weight-for-age within -2 Z-scores of WHO growth standards, and whose mother was at least 16 years of age were eligible for EIMC. The procedure was performed after administration of a penile dorsal nerve block using 2% lidocaine and administration of Vitamin K. The mother was given post-operative instructions on wound care and asked to remain in the clinic with the baby for an observational period of one hour, during which a face-to-face questionnaire was administered. RESULTS: Of 1259 babies screened, 704 were enrolled and circumcised. Median age of the infants was 16 days (IQR: 7-32.5) and of the mothers was 26 years (IQR: 22-30). Median time for the procedure was 19 minutes (IQR: 15-23). There were no serious adverse events (AE), and 20 (2.8%) moderate AEs, all of which were due to bleeding that required application of one to three sutures. There were 22 (3.8%) procedures in which the device did not fully incise the entire circumference of the foreskin and had to be completed using sterile scissors. 89.9% of mothers had knowledge of EIMC, but few (8.1%) had any knowledge of devices used for EIMC. Protection against HIV/AIDS was the most cited reason to circumcise a baby (65.3%), while the baby being ill (38.1%) and pain (34.4%) were the most cited barriers to uptake. 99% of mothers were "very satisfied" or "completely satisfied" with the procedure. CONCLUSIONS: This evaluation of the AccuCirc device is the largest to date and indicates that the device is safe and acceptable, achieving high levels of parental satisfaction. The AccuCirc device should be considered for WHO prequalification to increase options for safe and sustainable provision of EIMC.