HIV self-testing in India: implementation and qualitative evaluation of a web-based programme with virtual counsellor support.

INTRODUCTION: To achieve epidemic control of infectious diseases, engaging higher-burden populations with accessible diagnostic services is critical. HIV self-testing (HIVST) is a promising option. METHODS: We implemented an online HIVST programme for key populations across India. Eligible clients were 18 years or older, self-reported a negative or unknown HIV status and reported not taking antiretroviral therapy. Clients who reported a prior HIV diagnosis were not eligible to receive an HIVST kit. HIVST clients received kits via courier or in person at pre-determined pick-up points supported by trained counselling staff. Virtual counsellors engaged clients online and by phone and offered support to register, access, and complete HIVST free of cost. Virtual counsellors supported clients to report results and engage with follow-up services. Follow-up included linking clients with a positive result to confirmatory testing and HIV care services. We assessed programmatic data across HIV continuum outcomes and conducted a qualitative evaluation through interviews with purposively sampled clients. RESULTS: Between 30 June 2021 and 30 September 2022, 5324 clients ordered an HIVST kit (76% men, 13% women, 7% transgender people, 4% unknown gender). Of the 4282 clients reporting results (94% of those who received a kit), 6% screened positive, among whom 72% (n = 184) completed confirmatory testing. Themes from 41 client interviews included satisfaction about the convenience and privacy of services and the discreet nature of kit delivery. Respondents were drawn to the convenience of HIVST and appreciated gaining courage and comfort throughout the process from virtual counsellor support. For respondents who screened positive, challenges to care linkage included fearing judgemental questions from public providers and wanting more time before starting treatment. Clients shared concerns about kit accuracy and suggested that instructional materials be provided with more diverse language options. CONCLUSIONS: Web-based HIVST services with tailored support appeared to facilitate HIV service access and engagement of harder-to-reach populations across India. Assistance from a community-oriented counsellor proved important to overcome literacy barriers and mistrust  in order to support the HIVST process and service linkage. Learnings can inform global efforts to improve the critical step of diagnosis in achieving epidemic control for HIV and other infectious diseases.

Characterization of Titanium Corrosion and Its Association With Peri-Implantitis Using Energy Dispersive X-ray Spectroscopy: A Case Report.

Dental implant corrosion is now being recognized as a contributing factor in the onset and advancement of peri-implantitis, posing significant challenges to both the durability of implants and the well-being of patients. The dissemination of titanium microparticles due to corrosion raises concerns about plausible toxicity and biological effects, especially for patients with long-standing implant prostheses. This case report focuses on the release of titanium particles in the peri-implant mucosa due to corrosion and its association with peri-implantitis. It emphasizes the critical need for strategies to minimize corrosion and alleviate its detrimental effects in order to optimize patient outcomes in the field of implant dentistry. Additionally, there is a call for research into the increasing biochemical effects of these microparticles on oral soft tissues surrounding metallic implants to enhance the longevity and clinical outcomes of implants.

Bifunctional mesoporous glasses for bone tissue engineering: Biological effects of doping with cerium and polyphenols in 2D and 3D in vitro models.

This study evaluates the cytocompatibility of cerium-doped mesoporous bioactive glasses (Ce-MBGs) loaded with polyphenols (Ce-MBGs-Poly) for possible application in bone tissue engineering after tumour resection. We tested MBGs powders and pellets on 2D and 3D in vitro models using human bone marrow-derived mesenchymal stem cells (hMSCs), osteosarcoma cells (U2OS), and endothelial cells (EA.hy926). Promisingly, at a low concentration in culture medium, Poly-loaded MBGs powders containing 1.2 mol% of cerium inhibited U2OS metabolic activity, preserved hMSCs viability, and had no adverse effects on EA.hy926 migration. Moreover, the study discussed the possible interaction between cerium and Poly, influencing anti-cancer effects. In summary, this research provides insights into the complex interactions between Ce-MBGs, Poly, and various cell types in distinct 2D and 3D in vitro models, highlighting the potential of loaded Ce-MBGs for post-resection bone tissue engineering with a balance between pro-regenerative and anti-tumorigenic activities.

Epidemiology of coronavirus disease 2019 in pregnancy: risk factors and associations with adverse maternal and neonatal outcomes.

BACKGROUND: Coronavirus disease 2019 may be associated with adverse maternal and neonatal outcomes in pregnancy, but there are few controlled data to quantify the magnitude of these risks or to characterize the epidemiology and risk factors. OBJECTIVE: This study aimed to quantify the associations of coronavirus disease 2019 with adverse maternal and neonatal outcomes in pregnancy and to characterize the epidemiology and risk factors. STUDY DESIGN: We performed a matched case-control study of pregnant patients with confirmed coronavirus disease 2019 cases who delivered between 16 and 41 weeks' gestation from March 11 to June 11, 2020. Uninfected pregnant women (controls) were matched to coronavirus disease 2019 cases on a 2:1 ratio based on delivery date. Maternal demographic characteristics, coronavirus disease 2019 symptoms, laboratory evaluations, obstetrical and neonatal outcomes, and clinical management were chart abstracted. The primary outcomes included (1) a composite of adverse maternal outcome, defined as preeclampsia, venous thromboembolism, antepartum admission, maternal intensive care unit admission, need for mechanical ventilation, supplemental oxygen, or maternal death, and (2) a composite of adverse neonatal outcome, defined as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, 5-minute Apgar score of <5, persistent category 2 fetal heart rate tracing despite intrauterine resuscitation, or neonatal death. To quantify the associations between exposure to mild and severe or critical coronavirus disease 2019 and adverse maternal and neonatal outcomes, unadjusted and adjusted analyses were performed using conditional logistic regression (to account for matching), with matched-pair odds ratio and 95% confidence interval based on 1000 bias-corrected bootstrap resampling as the effect measure. Associations were adjusted for potential confounders. RESULTS: A total of 61 confirmed coronavirus disease 2019 cases were enrolled during the study period (mild disease, n=54 [88.5%]; severe disease, n=6 [9.8%]; critical disease, n=1 [1.6%]). The odds of adverse composite maternal outcome were 3.4 times higher among cases than controls (18.0% vs 8.2%; adjusted odds ratio, 3.4; 95% confidence interval, 1.2-13.4). The odds of adverse composite neonatal outcome were 1.7 times higher in the case group than to the control group (18.0% vs 13.9%; adjusted odds ratio, 1.7; 95% confidence interval, 0.8-4.8). Stratified analyses by disease severity indicated that the morbidity associated with coronavirus disease 2019 in pregnancy was largely driven by the severe or critical disease phenotype. Major risk factors for associated morbidity were black and Hispanic race, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019. CONCLUSION: Coronavirus disease 2019 during pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, an association that is primarily driven by morbidity associated with severe or critical coronavirus disease 2019. Black and Hispanic race, obesity, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019 are risk factors for associated morbidity.

Air Leak Syndrome in Two Very Preterm Infants Born to Mothers with Coronavirus Disease 2019: An Association or a Coincidence?

The novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mostly affects adults with limited information on possible vertical transmission from pregnant mothers. We present here two very preterm infants born to mothers with COVID-19, whose respiratory course was significant for initial mild respiratory distress syndrome who developed acute onset severe air leak syndrome at approximately 24 to 36 hours of age requiring thoracentesis. Their respiratory status improved gradually with resolution of air leak and respiratory failure by 2 weeks of age. Both infants tested negative for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction of multiple respiratory specimens collected beyond 24 hours after birth. As the incidence of severe air leak syndrome is relatively low in preterm infants without risk factors, this presentation in two very preterm infants born to mothers with COVID-19 is intriguing and needs to be further evaluated in larger cohorts. If confirmed, this data could potentially be the first step toward generating hypotheses for mechanisms of lung injury, intrauterine transmission, or how to detect COVID-19 in preterm infants. In addition, these data will be critical for developing evidence-based guidelines for perinatal management of these infants as we continue to battle against the COVID-19 pandemic for the foreseeable future.

Characteristics of Anorectal Malformations in Children at the United States-Mexico Border: A 3-Year Study.

BACKGROUND: Anorectal malformations (ARMs) are a group of congenital malformations affecting the lower gastrointestinal, urogenital, and/or gynecological systems. They occur in approximately 1 in 5000 live births, with a slight male predominance. ARMs can appear in isolation or in association with other anomalies. The literature contains little information about the characteristics of ARMs in United States Hispanic populations. METHODS: An institutional review board-approved chart review was conducted in all patients with ARMs seen at a single institution in El Paso, Texas, from January 2012 to December 2015. Data regarding demographics, types of ARMs, associated syndromes, and long-term complications were recorded using the Krickenbeck classification system. RESULTS: Of the 37 patients included in the study, 20 were boys and 17 were girls. The most common ARMs were rectoperineal fistula (46%), rectourethral fistula, and cloacal malformation. Constipation was the most common long-term complication, especially in patients with recto-perineal fistula. CONCLUSION: Children in the Borderland community may have a higher percentage of recto-perineal fistula than previously reported. Postoperative complications in Hispanic children with ARM were comparable to those reported in other populations.

Enamel Erosion: A Possible Preventive Approach by Casein Phosphopeptide Amorphous Calcium Phosphate-An In Vitro Study.

CONTEXT: Several efforts were made in order to alter the compositions of acidic food items concerning their properties to be able to reduce their erosivity potential. The addition of combinations of calcium and phosphate salts to these food products has grabbed great interest. AIM: In vitro evaluation of the effect of the addition of 0.2% w/v casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) to four commonly available beverages (of which two were carbonated) on enamel erosion. MATERIALS AND METHODS: Sound-extracted human third molar teeth were taken, and enamel sections (n = 270) were made and polished. Acid-resistant nail varnish was painted to create an exposed enamel window of 1 mm2, followed by testing of the four soft drinks and distilled deionized water (DDW). Every drink was evaluated with and without the addition of 0.2% w/v CPP-ACP. The enamel specimens were kept in 50 mL solution at 37°C for 30 minutes, rinsed, and then varnish was removed. All samples were then profiled using white-light profilometer, and erosive depths were recorded. STATISTICAL ANALYSIS: One-way analysis of variance test and post hoc Tukey test. RESULTS: Enamel erosion was created by all the soft drinks tested, but the addition of 0.2% w/v CPP-ACP has remarkably reduced (p value < 0.05) erosive depths in all test solutions compared to solutions without CPP-ACP. The erosive depths for solutions with DDW did not vary much from those with 0.2% CPP-ACP. CONCLUSION: Addition of 0.2% w/v CPP-ACP to the soft drinks has remarkably reduced their erosivity potential. HOW TO CITE THIS ARTICLE: Velagala D, Reddy VN, Achanta A, et al. Enamel Erosion: A Possible Preventive Approach by Casein Phosphopeptide Amorphous Calcium Phosphate-An In Vitro Study. Int J Clin Pediatr Dent 2020;13(5):486-492.

Getting to the First 90: Incentivized Peer Mobilizers Promote HIV Testing Services to Men Who Have Sex With Men Using Social Media in Mumbai, India.

Recent studies of Indian men who have sex with men (MSM) have shown widespread use of social media for seeking sex partners. We piloted a peer mobilization approach to explore the feasibility of engaging previously unreached MSM online to link them to HIV testing services (HTS). MSM were encouraged to seek HTS through messages posted on a popular dating website. Those who visited the designated HTS site and tested for HIV were recruited as peer mobilizers and given coupons with unique identifying codes to distribute to other men in their virtual networks. If a network member presented at the site with a coupon and tested for HIV, the peer mobilizer was given a small monetary incentive. Network members presenting at the testing site were also recruited as peer mobilizers and given coupons. In a 6-month period, 247 MSM were recruited and tested for HIV and syphilis, of whom 244 (99%) were first-time testers. Two-thirds were less than 25 years old and about half reported inconsistent or no condom use during the last 10 anal sex acts. Eight individuals (3.2%) tested positive for HIV, and 22 (8.9%) had a high titer for syphilis; all were referred to tertiary hospitals for treatment. Our approach was modestly successful in reaching and providing HTS to previously unreached MSM, but challenges included lower-than-expected recruitment, individuals not returning for posttest counseling, and loss to follow-up of individuals with HIV. The next phase of peer mobilization will aim to scale up these services through government-supported targeted interventions for this subpopulation of primarily young, unreached MSM at high risk. The challenges will be addressed by targeting more dating sites, increasing access to testing using rapid HIV tests at several community-based facilities, and offering peer navigation support for people living with HIV.

Optical reconstruction of murine colorectal mucosa at cellular resolution.

The mucosal layer of the colon is a unique and dynamic site where host cells interface with one another and the microbiome, with major implications for physiology and disease. However, the cellular mechanisms mediating colonic regeneration, inflammation, dysplasia, and dysbiosis remain undercharacterized, partly because the use of thin tissue sections in many studies removes important volumetric context. To address these challenges in visualization, we have developed the deep mucosal imaging (DMI) method to reconstruct continuous extended volumes of mouse colorectal mucosa at cellular resolution. Use of ScaleA2 and SeeDB clearing agents enabled full visualization of the colonic crypt, the fundamental unit of adult colon. Confocal imaging of large colorectal expanses revealed epithelial structures involved in repair, inflammation, tumorigenesis, and stem cell function, in fluorescent protein-labeled, immunostained, paraffin-embedded, or human biopsy samples. We provide freely available software to reconstruct and explore on computers with standard memory allocations the large DMI datasets containing in toto representations of distal colonic mucosal volume. Extended-volume imaging of colonic mucosa through the novel, extensible, and readily adopted DMI approach will expedite mechanistic investigations of intestinal physiology and pathophysiology at intracrypt to multicrypt length scales.

Evaluation of relative efficacy of ß-tricalcium phosphate with and without type I resorbable collagen membrane in periodontal infrabony defects: a clinical and radiographic study.

BACKGROUND AND OBJECTIVES: To compare clinically and radiographically, the regenerative potential of a ß-tricalcium phosphate bone graft, Cerasorb(®) with and without a bioresorbable type I collagen membrane, BioMend Extend™, in treating periodontal infrabony osseous defects. MATERIALS AND METHODS: A total of 20 sites from 10 patients showing bilateral infrabony defects were selected and selected sites were randomly divided into experimental site A (Cerasorb(®)) and experimental site B (Cerasorb(®) and BioMend Extend™) by using split mouth design. The clinical parameters like plaque index, gingival index, probing pocket depth, clinical attachment level and gingival recession were recorded at baseline, 6 weeks, 3, 6 and 9 months. Radiographic evaluation (Linear CADIA) at 6 and 9 months; and intrasurgical measurements at baseline and 9 months were carried out to evaluate the defect fill, change in alveolar crest height and defect resolution. RESULTS: Significant reduction in all clinical parameters was observed in both the groups. On comparison no statistical significance was observed between the two groups. Radiographically, in site A there was significant defect fill of 78.4 and 97.2% at 6 and 9 months respectively. Whereas in site B reduction was 78.4 and 97.2% at 6 and 9 months respectively. After surgical re-entry, there was significant defect fill of 89.2 and 74% in both groups. INTERPRETATION AND CONCLUSION: Individually both the graft and membrane have shown promising results in the management of periodontal intrabony defects. But the added benefit by combining Cerasorb(®) with BioMend Extend™ was not observed statistically in both clinical radiographic findings.

Evaluation of gingival inflammation in patients using ovulation induction drugs before and after scaling.

OBJECTIVES: To determine and correlate the effect of clomiphene citrate, Letrozole in women undergoing infertility treatment on the gingival inflammatory status. MATERIALS AND METHODS: The present study is a randomized controlled clinical trial which consisted of 26 women using CC for three menstrual cycles, 26 women using CC for more than three cycles, 26 women using Letrozole. All subjects were clinically examined for plaque levels (Plaque Index), gingival inflammation, bleeding on probing (Gingival Index, Sulcus Bleeding Index). Scaling was done to all patients and all periodontal parameters were reassessed 1 month after scaling. The results were compared with a control group of 26 women matched for age, educational status and professional level, and oral habits and who had never used ovulation drugs. RESULTS: Baseline scores of all the test groups showed higher amount of plaque levels and inflammation compared to control. (p < 0.05). After scaling a significant reduction in inflammation was observed in all the test groups along with the control group (p < 0.0001), but women using the drugs showed persistence of inflammation compared to control (p < 0.01). CONCLUSION: It can be concluded from the present study that the presence of elevated levels of hormones due to the effect of ovulation induction drugs may be the reason for the gingival inflammation in test groups.