Navigating the nutritional paradox: The impact of sustainable development targets on childhood wasting and overweight prevalence.

In 2015, the United Nations member states endorsed the 2030 Agenda for Sustainable Development to chart a path towards a better future for all. Childhood malnutrition, particularly wasting, remains a critical global health challenge, disproportionately affecting children under five in low- and middle-income countries. This study evaluates the impact of achieving selected Sustainable Development Goal (SDG) targets on reducing childhood malnutrition, with a specific focus on wasting and overweight. Utilizing multi-country DHS datasets, this study analyzed data from 138,782 children under five across 27 countries, nested within 13,788 neighborhoods. We simulated the predicted prevalence of wasting and overweight as selected SDG-related health inputs and determinant indicators reached their target values. Our findings reveal a baseline prevalence of 6.3% for wasting and 4.3% for overweight among the children studied. Progress towards the SDGs can potentially decrease wasting prevalence by a quarter (25%), translating to a reduction from 6.3% to 4.7%. This significant reduction in wasting is more pronounced in rural areas (29%) than in urban settings (7%). Conversely, a 14% increase in overweight prevalence was observed, with rural areas experiencing a higher rise (15%) than urban areas (13%). The study also highlighted variations in access to safe sanitation, improved water sources, healthcare services, income, maternal employment, and education levels, underscoring the complex interplay between these factors and malnutrition outcomes. Notably, the reduction in wasting prevalence was mainly attributable to input determinants rather than direct health inputs, suggesting the importance of broader socioeconomic factors in combating malnutrition. Achieving SDG targets presents a significant opportunity to mitigate wasting, particularly in rural communities. However, the uneven distribution of improvements underscores the need for targeted interventions in less affected areas. The concurrent rise in overweight prevalence, points to the emerging challenge of addressing the dual burden of malnutrition. This necessitates integrated, multi-sectoral strategies considering the diverse health determinants and nutritional status.

A multilevel analysis of the determinants of HIV testing among men in Sub-Saharan Africa: Evidence from Demographic and Health Surveys across 10 African countries.

Sub-Saharan Africa, the epicenter of the HIV epidemic, has seen significant reductions in new infections over the last decade. Although most new infections have been reported among women, particularly adolescent girls, men are still disadvantaged in accessing HIV testing, care, and treatment services. Globally, men have relatively poorer HIV testing, care, and treatment indices when compared with women. Gender norms and the associated concept of masculinity, strength, and stereotypes have been highlighted as hindering men's acceptance of HIV counseling and testing. Therefore, men's suboptimal uptake of HIV testing services will continue limiting efforts to achieve HIV epidemic control. Thus, this study aimed to identify individual, neighborhood, and country-level determinants of sub-optimal HIV testing among men in Sub-Saharan African countries. We analyzed demographic and health datasets from surveys conducted between 2016 and 2020 in Sub-Saharan African Countries. We conducted multivariable multilevel regression analysis on 52,641 men aged 15-49 years resident in 4,587 clusters across 10 countries. The primary outcome variable was ever tested for HIV. HIV testing services uptake among men in these ten Sub-Saharan African countries was 35.1%, with a high of 65.5% in Rwanda to a low of 10.2% in Guinea. HIV testing services uptake was more likely in men with increasing age, some form of formal education, in employment, ever married, and residents in relatively wealthier households. We also found that men who possessed health insurance, had some form of weekly media exposure, and had accessed the internet were more likely to have ever received an HIV test. Unlike those noted to be less likely to have ever received an HIV test if they had discriminatory attitudes towards HIV, comprehensive HIV knowledge, recent sexual activity, and risky sexual behavior were positive predictors of HIV testing services uptake among men. Furthermore, men in communities with high rurality and illiteracy were less likely to receive an HIV test. Individual and community-level factors influence the uptake of HIV testing among Sub-Saharan African men. There was evidence of geographical clustering in HIV testing uptake among men at the community level, with about two-thirds of the variability attributable to community-level factors. Therefore, HIV testing programs will need to design interventions that ensure equal access to HIV testing services informed by neighborhood socioeconomic conditions, peculiarities, and contexts.

A nomogram based on TFE3 IHC results and clinical factors as a preliminary screening scheme for TFE3-rearranged renal cell carcinoma.

BACKGROUND: TFE3 immunohistochemistry (TFE3-IHC) is controversial in the diagnosis of TFE3-rearranged renal cell carcinoma (TFE3-rearranged RCC). This study is to investigate the accuracy and sensitivity of IHC and establish a predictive model to diagnose TFE3-rearranged RCC. METHODS: Retrospective analysis was performed by collecting IHC and fluorescence in situ hybridization (FISH) results from 228 patients. IHC results were evaluated using three scoring systems. Scoring system 1 is graded based on nuclear staining intensity, scoring system 2 is graded based on the percentage of stained tumor cell nuclei, and scoring system 3 is graded based on both the nuclear staining intensity and the percentage. We collected patients' IHC results and clinical information. Important variables were screened based on univariate logistic regression analysis. Then, independent risk factors were established through multivariate logistic regression, and a nomogram model was constructed. The model was validated in internal test set and external validation set. The receiver operating characteristic curve (ROC curve), calibration curve, and decision curve analysis (DCA) were generated to assess discriminative ability of the model. RESULTS: The accuracy of IHC based on three scoring systems were 0.829, 0.772, and 0.807, respectively. The model included four factors including age, gender, lymph node metastasis and IHC results. Area under the curve (AUC) values were 0.935 for the training set, 0.934 for the internal test set, 0.933 for all 228 patients, and 0.916 for the external validation set. CONCLUSIONS: TFE3 IHC has high accuracy in the diagnosis of TFE3-rearranged RCC. Clinical information such as age and lymph node metastasis are independent risk factors, which can be used as a supplement to the results of TFE3 IHC. This study confirms the value of IHC in the diagnosis of TFE3-rearranged RCC. The accuracy of the diagnosis can be improved by incorporating IHC with other clinical risk factors.

Nigella sativa oil exhibits anti-aging effects in transgenic Alzheimer's Drosophila melanogaster via anti oxidant pathways: survival-rate and life span studies.

In this article we aime to investigate he anti-aging effect of Nigella sativa oil. Transgenic flies engineered under UAS/GAL4 system were acquired from the Bloomington Drosophila stock center. For methodology, (LC50), 30 flies 2-3 days old were divided into four groups, and exposed to diets of 30, 60, 90, and 120 µL/10 g in 3 replicates at a density of 30 flies per vial. Mortality was recorded daily for 7 consecutive days. For survival, (150) 2-3 days adult flies were divided into four groups (I-IV), 100 flies in each group. Group I which served as control fed on 10 g of diet only, group II was fed 10 g of diet only, group III (AB42 + low dose) was fed on 10 g diet +6.39ul NSO, group IV (AB42 + high dose) was fed 10 diet + 12.77ul NSO. The administration lasted for 28 days. For the third phase, a similar protocol was adopted with each group having (400) flies, this phase lasted f till the last fly died. The effect of NSO was assessed by; Studying the mortality daily. Results revealed the lethal concentration of LC50 NSO to be 25.54 mg it was also observed from the study that exposure to NSO in food media at low doses has increased the lifespan of AB-42 treated flies. In conclusion, findings from this study suggest the efficacy of low-dose NSO increased the survival and life span of the AB-42 flies.

Effects of Dietary Zinc on Growth, Haematological Indices, Digestive Enzyme Activity, Tissue Mineralization, Antioxidant and Immune Status of Fingerling Heteropneustes fossilis.

A 12 week feeding trial was conducted to evaluate the effects of dietary zinc levels on Heteropneustes fossilis. Triplicate groups of fish were fed isoproteic (CP; 400 g/kg) and isocaloric (GE; 17.89 kJ/g) diets increasing levels of zinc (0, 5, 10, 15, 20, 25, 30 mg/kg) achieved by supplementing zinc sulphate heptahydrate to basal diet. Analysed concentrations of zinc in diets were 10.68, 15.83, 21.34, 26.74, 30.61, 34.91 and 41.34 mg/kg. Growth indices increased linearly (P<0.05) up to 26.74 mg/kg Zn. The protein and ash content of whole body also improved significantly up to 26.74 mg/kg Zn. Whole body fat content showed inverse pattern. Haematological parameters also showed an improving trend with the increase in dietary zinc up to 26.74 mg/kg and then levelled off. Activities of antioxidant enzymes were improved with the increase in dietary zinc level up to 26.74 mg/kg followed by no significant change (P>0.05). Serum lysozyme activity also exhibited the similar pattern. Immune response in terms of the activities of lysozyme, alkaline phosphatase and myeloperoxidase was also improved with the increase in dietary zinc levels up to 26.74 mg/kg. Dietary zinc levels affected significantly the whole body as well as vertebrae mineralization. Broken-line regression analysis of weight gain, vertebrae zinc activity, serum superoxide dismutase and protease activity against increasing amounts of dietary zinc revealed that the inclusion of zinc in diet in the range of 26.82-29.84 mg/kg is optimum for growth, haematological indices, antioxidant status, immune response and tissue mineralization in fingerling H. fossilis. The information obtained from present study would be helpful in formulating the zinc-balanced commercial feeds to improve the growth and health status of this important fish, thus contributing to aquaculture production and strengthening the food security.

Measurement of portal vein indices and splenic index by ultrasound and their association with gastroesophageal varices in cirrhosis of liver.

Background and Objectives: Esophageal and gastric fundic varices are common in liver cirrhosis patients. Ultrasound with the Doppler study assesses liver cirrhosis severity, measuring portal vein and splenic indices' association with gastroesophageal varices. Methodology: This study was conducted on 64 subjects with sonographic features of chronic liver disease who were referred for routine follow-up scans. Portal vein diameter, average velocity, splenic index, congestion index (CI), and portal vein area and velocity were measured. Result: Subjects with gastroesophageal varices had significantly larger portal vein diameters (14.7±1.64 mm) compared to those without varices (12.05±1.26 mm) (P<0.05). Conversely, subjects without varices exhibited a higher portal vein velocity of (17.9±0.6 cm/s) than with varices (13.91±2.01 cm/s) (P=0.0005). The splenic index was higher in subjects with varices (1120±494 cm3) than those without varices (419 cm3) (P<0.05). The CI was also higher in subjects with varices. Portal vein velocity showed the highest sensitivity (94%) with a cutoff of 19 cm/s, while the CI had the highest diagnostic accuracy (93.75%) with a cutoff of 0.10 cm xsec. The splenic index demonstrated a sensitivity of 92.85% and diagnostic accuracy of 92.18% with a cutoff of 480 cm3. The splenic index followed by the CI is found to be a better predictor of esophageal varices (area under the curve of 96.8 and 96%, respectively). Conclusion: Ultrasonographic assessment of the portal vein and spleen is a reliable, noninvasive method for predicting gastroesophageal varices in liver cirrhosis. The splenic index and CI have high diagnostic accuracy.

Quantification and comparison of salivary neutrophils in periodontal health and disease.

Background: Neutrophils continuously migrate into the oral cavity from various sources like gingival crevicular fluid and saliva both in health and in inflammation. The migration of the neutrophils into the various tissues and into the oral cavity occurs when the host microbial interplay tips the balance favoring the initiation of the inflammatory and immune reactions which depending on the amount of the microbial load results in the development of acute and chronic infections in the susceptible host. Aim: The present study was designed to quantify and compare the oral salivary neutrophil levels in patients with gingivitis and chronic and aggressive periodontitis as well as in healthy controls, before and after scaling and root planing (SRP) and to compare the difference within the selected study groups. Materials and Methods: Forty subjects were classified into four groups, that is, healthy controls, gingivitis, and chronic and aggressive periodontitis. Oral rinse samples were collected using Hank's balanced salt solution from each patient before and after phase I periodontal therapy. Cells in the rinse samples were stained with Acridine orange, and neutrophil counts were carried out using a fluorescence microscope and a hemocytometer. Results: Baseline oral salivary neutrophil levels were maximum in the chronic periodontitis group followed by the aggressive group and then the gingivitis group. Oral salivary neutrophil levels also positively correlated to probing pocket depth, plaque index, calculus index, and gingival index in all four study groups. Maximum reduction in the oral salivary neutrophil levels after phase I periodontal therapy was seen in the gingivitis group. Conclusion: From our study, we conclude that the oral salivary neutrophil levels decreased significantly after SRP. Estimation of changes in the oral salivary neutrophil levels has the potential to aid in monitoring treatment outcomes. Thus, it suggests that it could be used as a simple, noninvasive laboratory technique to monitor the periodontal status and disease progression.

Characterization of Activated Carbon from Rice Husk for Enhanced Energy Storage Devices.

The production of activated carbon (AC) from lignocellulosic biomass through chemical activation is gaining global attention due to its scalability, economic viability, and environmental advantages. Chemical activation offers several benefits, including energy efficiency, reduced carbonization time, and lower temperature requirements. In this study, potassium hydroxide (KOH) was employed for chemical activation, resulting in activated carbon with a high specific surface area of ~3050 m2/g. The structural analysis revealed the presence of graphitized carbon in the activated carbon matrix, accounting for over 15%. The X-ray diffraction (XRD) technique was employed to investigate the activated carbon derived from rice husk (RH). The potential applications of activated carbon obtained from rice husks through chemical activation were explored, including its use for heavy metal removal, elimination of organic pollutants, and as an active material in hybrid energy storage devices. Furthermore, a scaling methodology for the production of activated carbon was proposed, facilitating its industrial implementation.

Cardiac Transthyretin Amyloidosis With Coincident Paget's Disease: A Case Report.

Cardiac amyloidosis is a condition that results from the accumulation of amyloid proteins in the extracellular matrix of the myocardium. The diagnosis of this disease was challenging as it lacked distinct clinical symptoms and required a biopsy to confirm amyloid deposition. However, there is increasing evidence of non-invasive diagnostic criteria for cardiac amyloidosis, especially for the transthyretin (TTR) type. We report a case of a patient with both cardiac transthyretin amyloidosis (ATTR) and Paget's disease, and we highlight the various radiological features of these two conditions using hybrid imaging techniques. In addition, we discuss the diagnostic imaging characteristics of ATTR cardiac amyloidosis.

HIV research output in African Countries between 1986-2020.

HIV literature has grown exponentially since it was named the virus that causes acquired immunodeficiency syndrome (AIDS). Bibliometric analysis is a practical approach for quantitatively and qualitatively assessing scientific research. This work aims to describe HIV research output in Africa by country from 1986 until 2020. We conducted a search of the PubMed database in June 2021 for a 35-year period spanning 1986 to 2020. We comparatively weighed for countries' populations, gross domestic product (GDP), and the number of persons living with HIV (PLHIV) by calculating the ratio of the number of publications from each country. We used Poisson regression models to explore the trends in countries' HIV research output over the study period. The Pearson correlation analysis assessed the association between research output, population size, GDP, and the number of PLHIV.A total of 83,527 articles from African countries on HIV indexed in PubMed were included for analysis. Republic of South Africa, Uganda, Kenya, and Nigeria account for 54% of the total indexed publications with 33.2% (26,907); 8.4% (7,045); 7.3% (6,118); and 5.1% (4,254), respectively. Africa's proportion of the world's total HIV publications increased from 5.1% in 1986 to 31.3% in 2020. There was a strong positive and statistically significant correlation between the total indexed HIV publications and countries' GDP (r = 0.59, P<0.01), population (r = 0.58, P<0.01), and the estimated number of PLHIV (r = 0.72, P<0.01). The study found that Africa's contribution to global HIV research output increased over the 35 years, but it remains relatively low compared to the continent's burden of HIV infections. Our findings also revealed major differences in research output across sub-regions in Africa, with the Republic of South Africa having the highest output. The factors associated with HIV research output were economic strength, disease epidemiology, and population size.

Dietary leucine requirement of fingerling Channa punctatus (Bloch) based on growth, feed conversion and leucine retention efficiency, hematological parameters, antioxidant and intestinal enzyme activities.

To find out the dietary leucine requirement of fingerling Channa punctatus (5.24 ± 0.07 g), six purified experimental diets (45% CP and 14.73 kJ/g DE) with various leucine concentrations (0.5, 1.0,1.5, 2.0, 2.5 and 3.0% diet) were fed to apparent satiation to triplicate groups for 12 weeks (714/02/a/CPCSEA). Absolute weight gain, specific growth rate, feed conversion ratio, protein efficiency ratio, protein and leucine retention efficiency, and RNA/DNA ratio improved up to 2.0% leucine in the diet. Carcass protein and fat increased significantly with increasing leucine levels up to a 2.0% dry diet. Moisture content showed a reverse pattern. Red blood corpuscles hemoglobin and hematocrit increased with incremental levels of leucine up to 2.0% diet. Significant changes were also noted in serum total protein, superoxide dismutase, aspartate aminotransferase, alanine aminotransferase, and lysozyme activity. Serum protein, superoxide dismutase and lysozyme activity were positively correlated with increasing leucine levels up to 2.0% diet, whereas aspartate aminotransferase and alanine aminotransferase showed the opposite trend. Based on the quadratic regression analysis of absolute weight gain, specific growth rate, feed conversion ratio, protein, and leucine retention efficiency, inclusion of 2.0% leucine is recommended for optimum growth of fingerling C. punctatus.

Pre-Existing Right Ventricular Dysfunction as an Independent Risk Factor for Post Intubation Cardiac Arrest and Hemodynamic Instability in Critically Ill Patients: A Retrospective Observational Study.

BACKGROUND: Post intubation cardiac arrest and hemodynamic instability are serious adverse events encountered in critically ill patients. The association of pre-existing right ventricular (RV) dysfunction with post intubation cardiac arrest and hemodynamic instability in critically ill patients is unknown. METHODS: This is a retrospective matched cohort study of adult critically ill patients who underwent intubation from July 2016 to December 2019. The study was conducted at a quaternary medical center in Houston, Texas. A total of 340 critically ill patients who underwent intubation in the intensive care units, wards, and the emergency room were included. The study cohort was categorized into 4 groups based on the pre-existing RV function: normal function, mild dysfunction, moderate dysfunction, and severe dysfunction. Cardiac arrest and/or hemodynamic instability within one hour post intubation were the primary study outcomes. Secondary outcomes included in hospital and 60-day mortality. RESULTS: Study patients were of mean age of 61.95 ± 14.28 years, including 132 (39%) females and 208 (61%) males. The primary outcomes were significantly worse in mild, moderate, and severe RV dysfunction groups compared to the normal RV function group (34.12%-P = 0.014, 47.06%-P < 0.001, 51.67%-P < 0.001, vs. 17.56%). In a multivariable logistic regression analysis, pre-existing moderate (OR = 2.65, P = 0.013) and severe RV dysfunction groups (OR = 2.66, P = 0.015) were associated with statistically significant higher cardiac arrest and hemodynamic instability post intubation. Pre-existing severe RV dysfunction was associated with statistically significant higher in hospital mortality (62.35%-P < 0.001). The multivariable Cox-regression analysis showed that pre-existing severe RV dysfunction was associated with a statistically significant higher 60-day mortality (HR = 2.57, P = 0.001). CONCLUSIONS: Pre-existing moderate and severe RV dysfunctions were independently associated with significantly higher cardiac arrest and/or hemodynamic instability post intubation in critically ill patients. Pre-existing RV function may serve as a mortality predictor in critically ill patients undergoing endotracheal intubation.

Individual and contextual factors associated with childhood malnutrition: a multilevel analysis of the double burden of childhood malnutrition in 27 countries.

BACKGROUND: Malnutrition is a key global health challenge and a major contributor to childhood morbidity and mortality. In recent times, the contrasting coexistence of undernutrition including micronutrient deficiencies and overweight/obesity called double burden of malnutrition has been noted at individual, household or population level and/or at different times in life. The objective of this study was to examine individual, neighborhood and country level factors that are associated with the double burden of childhood malnutrition. METHODS: We conducted multivariable multilevel logistic regression analyses on the most recent demographic and health datasets from surveys conducted between 2015 and 2020 in low- and middle-income countries. We analyzed data of 138,782 children (level 1) living in 13,788 communities (level 2) from 27 countries (level 3). RESULTS: The results of our analysis show variation in childhood malnutrition across the 27 countries from as low as 6.5% in Burundi to as high as 29.5% in Timor Leste. After adjusting for all level factors, we found that those who were wasted/overweight tended to have had an episode of diarrhea or fever in the last two weeks preceding the survey, were part of a multiple birth, were being breastfed at the time of the survey and born to mothers with more than one under 5-child resident in neighborhoods with high illiteracy and unemployment rates. The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance; 44.3% and 21.0% of variance in odds of double burden of childhood malnutrition are consequent upon neighborhood and country level factors respectively. CONCLUSIONS: Evidence of geographical clustering in childhood malnutrition at community and country levels was found in our study with variability due to neighborhood level factors twice that of country level factors. Therefore, strategies in tackling the double burden of malnutrition must consider these shared drivers, contextual barriers and geographical clustering effects.

Evaluation Method for Quality Risks of Safety in Prefabricated Building Construction Using SEM-SDM Approach.

The construction of prefabricated buildings is an effective and efficient approach to improving construction processes and productivity. However, there are practical problems in this approach, such as listing, safety risk levels, and quality control. This study aims to develop a systematic approach for determining the key factors affecting prefabricated building projects' quality and safety risk and assessing this risk. Based on the literature review, a structured questionnaire was distributed to 408 China-based construction organizations. Considering the factors of safety risk evaluation systems for construction, the safety risk model of prefabricated buildings is established and combined with structural equation modeling (SEM) and a system dynamic model (SDM). A detailed case study was conducted to verify the empirical findings. The results show that pre-construction, during-construction, and after-construction significantly influence the quality risk (from high to low). The final comprehensive score is 92.71, indicating that the construction safety of the residential building is generally controllable and the quality is guaranteed. Furthermore, the investment risk of such projects can be assessed using SEM and SDM. This study contributes to the literature by considering quality-risk-influencing factors in this field. Furthermore, the findings provide an understanding of implementation and quality risk control for prefabricated building projects and provide valuable information to departments in charge of improving the safety risk performance of such projects.

The impact of tumor size on the survival of patients with small renal masses: A population-based study.

BACKGROUND: Active surveillance (AS) with delayed intervention has gained acceptance as a management strategy for small renal masses (SRMs). However, during AS, there is a risk of tumor growth. Thus, we aim to investigate whether tumor growth in patients with SRMs leads to tumor progress. METHODS: In this study, we enrolled 16,070 patients from the Surveillance, Epidemiology, and End Results database with T1a renal cell carcinoma (RCC) between 2004 and 2017. The 16,070 patients were divided into three groups: 10,526 in the partial nephrectomy (PN) group, 2768 in the local ablation (LA) group, and 2776 in the AS group. Associations of tumor size with all-cause and cancer-specific mortality were evaluated using Kaplan-Meier analyses and Cox regression models. RESULTS: Four tumor size categories were delineated (≤1, >1-2, >2-3, and > 3-4 cm in diameter), and 10-year all-cause and cancer-specific mortality both significantly increased with increasing tumor size in the PN, LA, and AS groups (all p < 0.05). Tumors were substaged based on diameter: T1aA (≤2 cm) and T1aB (>2-4 cm). All-cause and cancer-specific mortality were significantly higher in T1aB tumors than T1aA tumors in each group (hazard ratio = 1.395 and 1.538, respectively; all p < 0.05). CONCLUSIONS: Tumor growth relates to worse prognosis of T1a RCC, and 2 cm serves as a size threshold that is prognostically relevant for patients with T1a RCC. Because of the lack of accurate predictors of tumor growth rate, AS for patients with SRMs incurs a risk of tumor progression.

Dietary thiamin requirement of fingerling major carp Catla catla (Hamilton).

Dietary thiamin requirement of fingerling Catla catla (3.5 ± 0.15 g) was evaluated by feeding casein-gelatin-based iso-nitrogenous (350 g/kg crude protein) and iso-caloric (16.72 kJ/g GE) diets containing six graded levels of thiamin (0, 0.2, 0.4, 0.8, 1.6 and 3.2 mg/kg dry diet) for 12 weeks. Significantly (p < 0.05) higher weight gain (AWG), best feed conversion ratio (FCR), protein retention efficiency (PRE), RNA/DNA ratio and haematological indices were recorded in fish fed diet containing 0.8 mg/kg thiamin. Dietary thiamin supplementation improved transketolase activity (TKA) and maximum value was recorded in fish fed 0.8 mg/kg thiamin beyond which stagnation in TKA activity was evident. Liver thiamin concentration was found to be maximum in fish fed diet containing 1.6 mg/kg thiamin. A significant (p < 0.05) consistent reduction in the hepatic thiobarbituric acid reactive substances (TBARS) activity was displayed with incremental concentration of thiamin up to 0.8 mg/kg, beyond which a reverse trend was evident. However, a significant (p < 0.05) improvement was noted in superoxide dismutase (SOD) and catalase (CAT) activity with the increasing level of dietary thiamin from 0 to 0.8 mg/kg. Broken-line regression analysis of AWG, FCR, PRE and TKA estimated the requirement in the range of 0.74-0.79 mg/kg dry diet.

Gaps and Opportunities in HIV Service Delivery in High Volume HIV Care Centers in Liberia: Lessons From the Field.

Background: Human Immunodeficiency Virus (HIV) infection continues to have a profound humanitarian and public health impact in western and central Africa, a region that risks being left behind in the global response to ending the AIDS epidemic. In Liberia, where the health system is being rebuilt following protracted civil wars and an Ebola virus disease outbreak, the Resilient and Responsive Health System (RRHS) is assisting with quality HIV services delivery through support from PEPFAR and HRSA but gaps remain across the cascade of care from diagnosis to viral load suppression. Objective: To highlight gaps in HIV service delivery in Liberia, identify opportunities and offer recommendations for improving the quality of service delivery. Methods: A narrative review of relevant literature was conducted following a search of all local and online databases known to the authors. Findings: Antiretroviral therapy (ART) has transformed the HIV response in Liberia by averting deaths, improving quality of life, and preventing new HIV infections but critical gaps remain. These include weak HIV prevention and testing strategies; suboptimal ART initiation and retention in care; low viral load testing volumes, commodity supply chain disruptions and a HIV workforce built on non-physician healthcare workers. In the context of the prevailing socioeconomic, heath system and programmatic challenges, these will impact achievement of the UNAIDS targets of 95-95-95 by 2030 and ending the epidemic. Conclusion: Combination prevention approaches are necessary to reach the most at risk populations, while a robust health workforce operating through facilities and communities will be needed to reach people with undiagnosed HIV earlier to provide efficient and effective services to ensure that people know their HIV status, receive and sustain ART to achieve viral suppression to maintain a long and healthy life within the framework of overall health system strengthening, achieving universal health coverage and the sustainable development goal.

Unilateral Condylar Hyperplasia With Active Bony Overgrowth: A Case Report.

Condylar hyperplasia (CH) is an overgrowth disorder of the temporomandibular joint bones caused by growth center overactivity of the mandibular condyle. Although the disorder is mostly idiopathic, several etiologies have been proposed. CH presents as progressive facial asymmetry with functional abnormalities. A combination of clinical, histopathological, and radiological findings is crucial to determine the diagnosis. Several diagnostic algorithms have been described in the literature. Management of CH is variable and depends on the growth of the bone. Here, we present the case of a 36-year-old female who presented with progressive facial asymmetry which was diagnosed as unilateral CH with active bony overgrowth.

Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: a case report.

BACKGROUND: SARS-CoV-2 is known to induce a cytokine storm, a hyperinflammatory state driven by up-regulation of interleukin 6 (IL-6) and immunomodulatory chemokines that may result in acute heart failure. CASE SUMMARY: A 65-year-old woman with confirmed SARS-CoV-2 developed shock with multiorgan system failure, including acute biventricular heart failure, 2 weeks after the initial onset of fever, cough, and shortness of breath. The patient experienced myocardial recovery within 48 h after administration of tocilizumab, a humanized monoclonal anti-IL-6 receptor antibody, and multiple supportive vasoactive medications. DISCUSSION: The differential diagnosis of acute heart failure in critically ill patients with COVID-19 infection is broad, including sepsis-induced cardiomyopathy, Takotsubo syndrome, viral lymphocytic myocarditis, and acute coronary syndrome. Immunomodulatory treatment with tocilizumab may benefit patients who develop cardiogenic shock associated with SARS-CoV-2-induced cytokine storm.