Skin disease profile of Syrian refugees in Jordan: a field-mission assessment.

BACKGROUND: Since the beginning of the Syrian war in 2011, the world has faced the most severe refugee crisis in history and 5.6 million Syrians have sought asylum in neighbouring countries or in Europe. According to recent estimates, more than 650 000 Syrian refugees are displaced in Jordan. OBJECTIVES: This article aims to assess the demographic characteristics and skin disease profile of Syrian displaced people residing in Al Za'atari camp and in communities in Jordan. Furthermore, the authors discuss the barriers to healthcare provision experienced during field missions. METHODS: This is a retrospective analysis of medical records collected during three medical missions in Jordan by an international dermatological team. Data on patient age, gender, country of origin and skin disease diagnoses were recorded both in Al Za'atari camp and Jordanian towns near the Syrian border. RESULTS: A total of 1197 patients were assessed during the field missions, with 67.7% female and 37.1% under the age of 14 years. Dermatitis was the leading dermatological condition in both refugee camp and community healthcare clinics. Infectious diseases were the second most common; however, fungal presentations were more common in the community as opposed to viral in Al Za'atari. CONCLUSIONS: High dermatitis presentations were likely secondary to the environment, living conditions and lack of access to emollients. Infectious diseases were postulated secondary to poor hygiene and sharing of overcrowded spaces. Barriers to health care included limited pharmacological formulary, difficulty in continuity of care and case referrals due to lack of specialized services. Better access to health care, improvement of living conditions and hygiene, and increased availability of medications including emollients and sunscreens are all interventions that should be carried out to reduce skin disease burden. Our findings should further urge the international community to uphold their commitments and uptake engagement in improving health care for Syrian displaced people.

Rubella (German measles) revisited.

Rubella is generally a mild and self-limited disease in children. During pregnancy, rubella can have potentially devastating effects on the developing fetus. Postnatal rubella is transmitted primarily by inhalation of virus-laden airborne droplets or direct contact with infected nasopharyngeal secretions. In susceptible pregnant women, the virus may cross the placenta and spread through the vascular system of the developing fetus. Postnatally acquired rubella typically begins with fever and lymphadenopathy, followed by an erythematous, maculopapular rash. The rash classically begins on the face, spreads cephalocaudally, becomes generalised within 24 hours, and disappears within 3 days. Maternal rubella, especially during early pregnancy, may lead to miscarriage, intrauterine fetal death, premature labour, intrauterine growth retardation, and congenital rubella syndrome. Cataracts, congenital heart defects, and sensorineural deafness are the classic triad of congenital rubella syndrome and they typically occur if the fetal infection occurs in the first 11 weeks of gestation. Laboratory confirmation of rubella virus infection can be based on a positive serological test for rubella-specific immunoglobulin M antibody; a four-fold or greater increase in rubella-specific immunoglobulin G titres between acute and convalescent sera; or detection of rubella virus RNA by reverse transcriptase-polymerase chain reaction. Treatment is mainly symptomatic. Universal childhood immunisation and vaccination of all susceptible patients with rubella vaccine to decrease circulation of the virus are cornerstones to prevention of rubella and, more importantly, congenital rubella syndrome.

Measles: a disease often forgotten but not gone.

Measles (rubeola) is a highly contagious vaccine-preventable disease caused by the measles virus-a virus of the Paramyxoviridae family. The illness typically begins with fever, runny nose, cough, and pathognomonic enanthem (Koplik spots) followed by a characteristic erythematous, maculopapular rash. The rash classically begins on the face and becomes more confluent as it spreads cephalocaudally. Laboratory confirmation of measles virus infection can be based on a positive serological test for measles-specific immunoglobulin M antibody, a four-fold or greater increase in measles-specific immunoglobulin G between acute and convalescent sera, isolation of measles virus in culture, or detection of measles virus ribonucleic acid by reverse transcriptase-polymerase chain reaction. Complications occur in 10% to 40% of patients, and treatment is mainly symptomatic. Bacterial superinfections, if present, should be properly treated with antibiotics. To eradicate measles, universal childhood immunisation and vaccination of all susceptible individuals with measles vaccine would be ideal. In developed countries, routine immunisation with measles-containing vaccine is recommended, with the first and second doses at ages 12 to 15 months and 4 to 6 years, respectively. The World Health Organization recommends that the first and second doses of measles-containing vaccine be given at ages 9 months and 15 to 18 months, respectively, in countries with high rates of measles transmission.

Fabrication of channeled scaffolds with ordered array of micro-pores through microsphere leaching and indirect Rapid Prototyping technique.

Advanced scaffold fabrication techniques such as Rapid Prototyping (RP) are generally recognized to be advantageous over conventional fabrication methods in terms architectural control and reproducibility. Yet, most RP techniques tend to suffer from resolution limitations which result in scaffolds with uncontrollable, random-size pores and low porosity, albeit having interconnected channels which is characteristically present in most RP scaffolds. With the increasing number of studies demonstrating the profound influences of scaffold pore architecture on cell behavior and overall tissue growth, a scaffold fabrication method with sufficient architectural control becomes imperative. The present study demonstrates the use of RP fabrication techniques to create scaffolds having interconnected channels as well as controllable micro-size pores. Adopted from the concepts of porogen leaching and indirect RP techniques, the proposed fabrication method uses monodisperse microspheres to create an ordered, hexagonal closed packed (HCP) array of micro-pores that surrounds the existing channels of the RP scaffold. The pore structure of the scaffold is shaped using a single sacrificial construct which comprises the microspheres and a dissolvable RP mold that were sintered together. As such, the size of pores as well as the channel configuration of the scaffold can be tailored based on the design of the RP mold and the size of microspheres used. The fabrication method developed in this work can be a promising alternative way of preparing scaffolds with customized pore structures that may be required for specific studies concerning cell-scaffold interactions.

Esophageal tissue engineering: an in-depth review on scaffold design.

Treatment of esophageal cancer often requires surgical procedures that involve removal. The current approaches to restore esophageal continuity however, are known to have limitations which may not result in full functional recovery. In theory, using a tissue engineered esophagus developed from the patient's own cells to replace the removed esophageal segment can be the ideal method of reconstruction. One of the key elements involved in the tissue engineering process is the scaffold which acts as a template for organization of cells and tissue development. While a number of scaffolds range from traditional non-biodegradable tubing to bioactive decellularized matrix have been proposed to engineer the esophagus in the past decade, results are still not yet favorable with many challenges relating to tissue quality need to be met improvements. The success of new esophageal tissue formation will ultimately depend on the success of the scaffold being able to meet the essential requirements specific to the esophageal tissue. Here, the design of the scaffold and its fabrication approaches are reviewed. In this paper, we review the current state of development in bioengineering the esophagus with particular emphasis on scaffold design.

Imported case ofLeishmania tropica cutaneous leishmaniasis in a 10-year-old child in Malaysia.

The present paper reported a first imported case of cutaneous leishmaniasis in a 10-year- old child who returned from Saudi Arabia to Malaysia. Six weeks after his travel to Malaysia, two erythematous dermal nodules were developed over his right cheek and chin. Occurrence of intracellular amastigote of Leishmania was observed through examination of skin biopsy with hematoxylin and eosin stain. Furthermore, molecular analysis of ribosomal internal transcribed spacer 1 (ITS1) of Leishmania spp. confirmed the child was infected with Leishmania tropica. The child was given oral fluconazole and he had a 80% recovery before he went back to Saudi Arabia.

Regression model for predicting knee flexion angles using ankle plantar flexion angles, body mass index and generalised joint laxity.

Increased knee flexion angles are associated with reduced non-contact anterior cruciate ligament (ACL) injury risks. Ankle plantar flexion angles and internal risk factors could influence knee flexion angles, but their correlations are unknown. This study aimed to establish and validate a regression model to predict knee flexion angles using ankle plantar flexion angles, body mass index (BMI) and generalised joint laxity (GJL) at initial contact of single-leg drop landings. Thirty-two participants performed single-leg drop landings from a 30-cm-high platform. Kinematics and vertical ground reaction forces were measured using a motion capture system and force plate. A multiple regression was performed, and it was validated using a separate data set. The prediction model explained 38% (adjusted R2) of the change in knee flexion angles at initial contact (p = 0.001, large effect size). However, only the ankle plantar flexion angle (p < 0.001) was found to be a significant predictor of knee flexion angles. External validation further showed that the model explained 26% of knee flexion angles (large effect size). The inverse relationship between ankle plantar flexion and knee flexion angles suggests that foot landing strategies could be used to increase knee flexion angles, thereby reducing non-contact ACL injury risks.

Melt flow behaviour of poly-epsilon-caprolactone in fused deposition modelling.

Fused deposition modelling (FDM) is an extrusion based Rapid prototyping (RP) technique which can be used to fabricate tissue engineering scaffolds. The present work focuses on the study of the melt flow behaviour (MFB) of Poly-epsilon-caprolactone (PCL) as a representative biomaterial, on the FDM. The MFB significantly affects the quality of the scaffold which depends not only on the pressure gradient, its velocity, and the temperature gradients but also physical properties like the melt temperature and rheology. The MFB is studied using two methods: mathematical modelling and finite element analysis (FEA) using Ansys(R). The MFB is studied using accurate channel geometry by varying filament velocity at the entry and by varying nozzle diameters and angles at the exit. The comparative results of both mathematical modelling and FEA suggest that the pressure drop and the velocities of the melt flow depend on the flow channel parameters. One inference of particular interest is the temperature gradient of the PCL melt, which shows that it liquefies within 35% of the channel length. These results are invaluable to better understand the MFB of biomaterials that affects the quality of the scaffold built via FDM and can also be used to predict the MFB of other biomaterials.

Compressive properties and degradability of poly(epsilon-caprolatone)/hydroxyapatite composites under accelerated hydrolytic degradation.

Hydroxyapatite (HA) was incorporated as filler into polycaprolactone (PCL) matrix to improve the bioactivity as well as the compressive properties of the polymer composites that can be typically used in tissue engineering scaffolds. The compressive properties of five PCL/HA composites of different compositions were investigated in conjunction with the study of their rate of degradation. As PCL has a slow degradation rate, the experiment was conducted in a concentrated 5M sodium hydroxide medium to accelerate the degradation process. The compressive strength and modulus of all PCL/HA compositions were observed to decrease as the degradation experiment progressed, with samples having high HA content degraded most significantly as compared with samples with lower HA content. Pure PCL samples, however, were found to retain their mechanical properties comparatively well in the same degradation experiments. Although the addition of HA as filler into the PCL matrix was shown to have improved mechanical properties and bioactivity initially, these results do raise concerns of material properties being compromise during hydrolytic degradation.

Poly-epsilon-caprolactone/hydroxyapatite for tissue engineering scaffold fabrication via selective laser sintering.

Rapid prototyping (RP) techniques are becoming more popular for fabricating tissue engineering (TE) scaffolds owing to their advantages over conventional methods, such as the ability to fabricate scaffolds with predetermined interconnected networks without the use of organic solvents. A versatile RP technique, selective laser sintering (SLS), offers good user control of scaffold microstructure by adjusting the process parameters. This research focuses on a the use of biocomposite material, consisting of poly-epsilon-caprolactone (PCL) and hydroxyapatite (HA), to fabricate TE scaffolds using SLS. Biocomposite blends with different percentage weights of HA were physically blended and sintered to assess their suitability for fabrication via SLS. Optimal sintering conditions for the powders were achieved by varying parameters such as laser power and scan speed. Studies of the sintered specimen morphology were performed by scanning electron microscopy. Thermogravimetric analysis confirmed the homogeneity of the biocomposite blend. Simulated body fluid (SBF) samples show the formation of hydroxy carbonate apatite, as a result of soaking HA in a SBF environment. Cell culture experiment showed that Saos-2 cells were able to live and replicate on the fabricated scaffolds. The results show the favorable potential of PCL/HA biocomposite as TE scaffolds that are fabricated via SLS.

Characterization of a poly-epsilon-caprolactone polymeric drug delivery device built by selective laser sintering.

Selective Laser Sintering (SLS), an established Rapid Prototyping (RP) process, is investigated for building controlled drug delivery devices (DDD). The drug and its matrix in a powder form were first mixed mechanically before being sintered on the SLS. Each cylindrical DDD is designed with a number of concentric rings separated from each other by a characteristic 'wall' created by the laser of the SLS. These rings act as diffusion obstacles to control the rate of release. Poly-epsilon-caprolactone (PCL) was used as the matrix and Methylene Blue (MB) as the drug model. Samples were built, characterized and tested for homogeneity using Thermogravimetric Analysis (TGA), Differential Scanning Calorimetry (DSC), and Fourier Transform Infrared Spectrophotometry (FTIR). Experimental results show that the matrices fabricated are not affected by sintering and the polymer and drug model are evenly distributed throughout the matrix. The initial burst effect has been reduced by the increase of the numbers of rings. The linear curve using the Higuchi equation confirmed that the DDD matrix release profile is by diffusion. These results show that the DDD matrix design has promising potential for application in controlled release drug delivery.

Effects of foot rotation positions on knee valgus during single-leg drop landing: Implications for ACL injury risk reduction.

BACKGROUND: Non-contact anterior cruciate ligament (ACL) injuries commonly occur when athletes land in high risk positions such as knee valgus. The position of the foot at landing may influence the transmission of forces from the ankle to the knee. Using an experimental approach to manipulate foot rotation positions, this study aimed to provide new insights on how knee valgus during single-leg landing may be influenced by foot positions. METHODS: Eleven male recreational basketball players performed single-leg drop landings from a 30-cm high platform in three foot rotation positions (toe-in, toe-forward and toe-out) at initial contact. A motion capture system and a force plate were used to measure lower extremity kinematics and kinetics. Knee valgus angles at initial contact (KVA) and maximum knee valgus moments (KVM), which were known risk factors associated with ACL injury, were measured. A one-way repeated measures Analysis of Variance was conducted (α=0.05) to compare among the three foot positions. RESULTS: Foot rotation positions were found to have a significant effect on KVA (p<0.001, η2=0.66) but the difference between conditions (about 1°) was small and not clinically meaningful. There was a significant effect of foot position on KVM (p<0.001, η2=0.55), with increased moment observed in the toe-out position as compared to toe-forward (p=0.012) or toe-in positions (p=0.002). CONCLUSIONS: When landing with one leg, athletes should avoid extreme toe-out foot rotation positions to minimise undesirable knee valgus loading associated with non-contact ACL injury risks.

Fabrication and characterization of three-dimensional poly(ether- ether- ketone)/-hydroxyapatite biocomposite scaffolds using laser sintering.

The ability to have precise control over porosity, scaffold shape, and internal pore architecture is critical in tissue engineering. For anchorage-dependent cells, the presence of three-dimensional scaffolds with interconnected pore networks is crucial to aid in the proliferation and reorganization of cells. This research explored the potential of rapid prototyping techniques such as selective laser sintering to fabricate solvent-free porous composite polymeric scaffolds comprising of different blends of poly(ether-ether-ketone) (PEEK) and hydroxyapatite (HA). The architecture of the scaffolds was created with a scaffold library of cellular units and a corresponding algorithm to generate the structure. Test specimens were produced and characterized by varying the weight percentage, starting with 10 wt% HA to 40 wt% HA, of physically mixed PEEK-HA powder blends. Characterization analyses including porosity, microstructure, composition of the scaffolds, bioactivity, and in vitro cell viability of the scaffolds were conducted. The results obtained showed a promising approach in fabricating scaffolds which can produce controlled microarchitecture and higher consistency.

Selective laser sintering of biocompatible polymers for applications in tissue engineering.

The ability to use biological substitutes to repair or replace damaged tissues lead to the development of Tissue Engineering (TE), a field that is growing in scope and importance within biomedical engineering. Anchorage dependent cell types often rely on the use of temporary three-dimensional scaffolds to guide cell proliferation. Computer-controlled fabrication techniques such as Rapid Prototyping (RP) processes have been recognised to have an edge over conventional manual-based scaffold fabrication techniques due to their ability to create structures with complex macro- and micro-architectures. Despite the immense capabilities of RP fabrication for scaffold production, commercial available RP modelling materials are not biocompatible and are not suitable for direct use in the fabrication of scaffolds. Work is carried out with several biocompatible polymers such as Polyetheretherketone (PEEK), Poly(vinyl alcohol) (PVA), Polycaprolactone (PCL) and Poly(L-lactic acid) (PLLA) and a bioceramic namely, Hydroxyapatite (HA). The parameters of the selective laser sintering (SLS) process are optimised to cater to the processing of these materials. SLS-fabricated scaffold specimens are examined using a Scanning Electron Microscope (SEM). Results observed from the micrographs indicate the viability of them being used for building TE scaffolds and ascertain the capabilities of the SLS process for creating highly porous scaffolds for Tissue Engineering applications.

Solid freeform fabrication of three-dimensional scaffolds for engineering replacement tissues and organs.

Most tissue engineering (TE) strategies for creating functional replacement tissues or organs rely on the application of temporary three-dimensional scaffolds to guide the proliferation and spread of seeded cells in vitro and in vivo. The characteristics of TE scaffolds are major concerns in the quest to fabricate ideal scaffolds. This paper identifies essential structural characteristics and the pre-requisites for fabrication techniques that can yield scaffolds that are capable of directing healthy and homogeneous tissue development. Emphasis is given to solid freeform (SFF), also known as rapid prototyping, technologies which are fast becoming the techniques of choice for scaffold fabrication with the potential to overcome the limitations of conventional manual-based fabrication techniques. SFF-fabricated scaffolds have been found to be able to address most, if not all the macro- and micro-architectural requirements for TE applications. This paper reviews the application/potential application of state-of-the-art SFF fabrication techniques in creating TE scaffolds. The advantages and limitations of the SFF techniques are compared. Related research carried out worldwide by different institutions, including the authors' research are discussed.

Scaffold development using selective laser sintering of polyetheretherketone-hydroxyapatite biocomposite blends.

In tissue engineering (TE), temporary three-dimensional scaffolds are essential to guide cell proliferation and to maintain native phenotypes in regenerating biologic tissues or organs. To create the scaffolds, rapid prototyping (RP) techniques are emerging as fabrication techniques of choice as they are capable of overcoming many of the limitations encountered with conventional manual-based fabrication processes. In this research, RP fabrication of solvent free porous polymeric and composite scaffolds was investigated. Biomaterials such as polyetheretherketone (PEEK) and hydroxyapatite (HA) were experimentally processed on a commercial selective laser sintering (SLS) RP system. The SLS technique is highly advantageous as it provides good user control over the microstructures of created scaffolds by adjusting the SLS process parameters. Different weight percentage (wt%) compositions of physically mixed PEEK/HA powder blends were sintered to assess their suitability for SLS processing. Microstructural assessments of the scaffolds were conducted using electron microscopy. The results ascertained the potential of SLS-fabricated TE scaffolds.

The design of scaffolds for use in tissue engineering. Part I. Traditional factors.

In tissue engineering, a highly porous artificial extracellular matrix or scaffold is required to accommodate mammalian cells and guide their growth and tissue regeneration in three dimensions. However, existing three-dimensional scaffolds for tissue engineering proved less than ideal for actual applications, not only because they lack mechanical strength, but they also do not guarantee interconnected channels. In this paper, the authors analyze the factors necessary to enhance the design and manufacture of scaffolds for use in tissue engineering in terms of materials, structure, and mechanical properties and review the traditional scaffold fabrication methods. Advantages and limitations of these traditional methods are also discussed.

Mass cardiopulmonary resuscitation 99--survey results of a multi-organisational effort in public education in cardiopulmonary resuscitation.

Mass cardiopulmonary resuscitation (CPR) 99 in Singapore was a large-scale multi-organisational effort to increase awareness and impart basic cardiac life support skills to the lay public. Mass CPR demonstrations followed by small group manikin practice with instructor guidance was conducted simultaneously in three centres, four times a day. The exercise enlisted 15 community organisations and received the support of 19 other organisations. Three hundred and ninety-eight manikins and 500 instructors ('I's) were mobilised to teach an audience of 6000 participants ('P's). Two surveys, for 'I's and 'P's were conducted with respondent rates of 65.8% and 50%, respectively. 73.6% of the P-respondents ('P-R's) indicated that they attended the event to increase their knowledge. 66.9% were willing to attend a more comprehensive CPR course. Concerns and perceptions in performing bystander CPR were assessed.

Characterization of microfeatures in selective laser sintered drug delivery devices.

From initial applications in the fields of prosthesis, implants, surgery planning, anthropology, paleontology and forensics, the scope of rapid prototyping (RP) biomedical applications has expanded to include areas in tissue engineering (TE) and controlled drug delivery. In the current investigation, the feasibility of utilizing selective laser sintering (SLS) to fabricate polymeric drug delivery devices (DDDs) that are difficult to make using conventional production methods was studied. Two features, namely porous microstructure and dense wall formation, inherent in SLS fabricated parts were investigated for their potential roles in drug storage and controlling the release of drugs through the diffusion process. A study to determine the influence of key SLS process parameters on dense wall formation and porous microstructure of SLS fabricated parts was carried out. Composite-type DDDs incorporating dense wall and porous matrix features were designed and fabricated using SLS. The characteristics of the fabricated devices were investigated through microstructural examination and in vitro release tests carried out using a drug model or dye in a simulated body environment.