Surface modification of hybrid composite multilayers spin cold spraying for biomedical duplex stainless steel.

The performance of biomaterials in biological systems is of critical significance for advancing biomedical implants. Duplex Stainless Steel alloys are the major biomaterials due to their significant characteristics. Many functional coatings are deposited on DSS alloy surfaces utilizing numerous surface coating techniques to improve their bioactivity and protect them from corrosion degradations. Coatings of titanium dioxide (TiO2), Hydroxyapatite (HA), and zinc oxide (ZnO) have received considerable attention in the field of surface bioactive modification of DSS alloy implants. The coating techniques play a key role in increasing the required biological characteristics of DSS alloys, such as biocompatibility, mechanical properties, and corrosion resistance. In this regard, HA-ZnO, HA-TiO2, and TiO2-ZnO from each coating group are divided into single, double, and triple layers. These coatings were prepared by cold spray and deposited on the surface of the DSS alloy, followed by a heat treatment at 250 °C. The surface morphology of coated surfaces was analyzed utilizing field emission scanning electron microscopy (FESEM), atomic force microscopic (AFM), microhardness test, corrosion test in Ringer solution, and antibacterial test. The coatings showed nano-scale surface morphology with advanced crystallization and homogeneous structures; in the corrosion characteristics utilizing potentiodynamic polarization, triple layers of HA-ZnO coatings displayed advanced nanostructures with higher hardness values (514.75HV). The antibacterial test showed the triple layers of HA-TiO2 and two layers of TiO2-ZnO sensitivity to positive bacteria.

Community Behavioral and Perceived Responses in the COVID-19 Outbreak in Afghanistan: A Cross-Sectional Study.

OBJECTIVE: Community responses are important for the management of early-phase outbreaks of coronavirus disease 2019 (COVID-19). Perceived susceptibility and severity are considered key elements that motivate people to adopt nonpharmaceutical interventions. This study aimed to (i) explore perceived susceptibility and severity of the COVID-19 pandemic, (ii) examine the practice of nonpharmaceutical interventions, and (iii) assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions among people living in Afghanistan. METHODS: A cross-sectional design was used, using online surveys disseminated from April to May 2020. Convenience sampling was used to recruit the participants of this study. The previously developed scales were used to assess the participants' demographic information, perceived risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and perceived severity of COVID-19. Multivariate analyses were conducted to assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions. RESULTS: The Internet was the main source for obtaining COVID-19 information among participants in this study. While 45.8% of the participants believed it was "very unlikely" for them to get infected with COVID-19, 76.7% perceived COVID-19 as a severe disease. Similarly, 37.5% believed the chance of being cured if infected with COVID-19 is "unlikely/very unlikely." The majority of participants (95.6%) perceived their health to be in "good" and "very good" status. Overall, 74.2% mentioned that they stopped visiting public places, 49.7% started using gloves, and 70.4% started wearing a mask. Participants who believed they have a low probability of survival if infected with COVID-19 were more likely to wear masks and practice hand washing. CONCLUSIONS: It appears that communities' psychological and behavioral responses were affected by the early phase of the COVID-19 pandemic in Afghanistan, especially among young Internet users. The findings gained from a timely behavioral assessment of the community might be useful to develop interventions and risk communication strategies in epidemics within and beyond COVID-19.

Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015.

BACKGROUND: Impact evaluations allow countries to assess public health gains achieved through malaria investments. This study uses routine health management information system (HMIS) data from Zanzibar to describe changes in confirmed malaria incidence and impact of case management and vector control interventions during 2000-2015. METHODS: HMIS data from 129 (82%) public outpatient facilities were analyzed using interrupted time series models to estimate the impact of artemisinin-based combination therapy (ACT), indoor residual spray, and long-lasting insecticidal nets. Evaluation periods were defined as pre-intervention (January 2000 to August 2003), ACT-only (September 2003 to December 2005) and ACT plus vector control (2006-2015). FINDINGS: After accounting for climate, seasonality, diagnostic testing rates, and outpatient attendance, average monthly incidence of confirmed malaria showed no trend over the pre-intervention period 2000-2003 (incidence rate ratio (IRR) 0.998, 95% CI 0.995-1.000). During the ACT-only period (2003-2005), the average monthly malaria incidence rate declined compared to the pre-intervention period, showing an overall declining trend during the ACT-only period (IRR 0.984, 95% CI 0.978-0.990). There was no intercept change at the start of the ACT-only period (IRR 1.081, 95% CI 0.968-1.208), but a drop in intercept was identified at the start of the ACT plus vector control period (IRR 0.683, 95% CI 0.597-0.780). During the ACT plus vector control period (2006-2015), the rate of decline in average monthly malaria incidence slowed compared to the ACT-only period, but the incidence rate continued to show an overall slight declining trend during 2006-2015 (IRR 0.993, 95% CI 0.992-0.994). INTERPRETATION: This study presents a rigorous approach to the use of HMIS data in evaluating the impact of malaria control interventions. Evidence is presented for a rapid decline in malaria incidence during the period of ACT roll out compared to pre-intervention, with a rapid drop in malaria incidence following introduction of vector control and a slower declining incidence trend thereafter.

Determinación de aflatoxinas en maní y productos de maní en Sudán usando aflatest® y HPLC / Determination of aflatoxins in groundnut and groundnut products in Sudan using aflatest® and HPLC

Esta encuesta examinó 30 muestras de maní y 15 productos de maní de tres estados (Khartoum, Kordofan y Gadarif) de Sudán para determinar AFB1, AFB2, AFG1, and AFG2 usando cromatografía líquida de alta performance (HPLC) con detección de fluorescencia. La frecuencia de muestras de maní contaminadas con AFB1 de Khartoum, Gadarif y Kordofan fue 58,3%, 57,1%, y 66,7%, respectivamente. Ninguna muestra de maní o producto de maní estaba contaminado con AFG1 o AFG2. El límite de detecciones (LDD) y el límite de cuantificaciones (LDC) estuvieron en un rango de 0,01-0,02 ng g-1 y 0,03-0,05 ng g-1, respectivamente. Algunas muestras de maní contenían concentraciones de AFB1 por encima de los límites regulatorios UE. Las muestras más contaminadas con aflatoxinas fueron las del estado de Kordofan.

This survey examined 30 samples of groundnut and 15 groundnut products from threestates (Khartoum, Kordofan and Gadarif) of Sudan for AFB1, AFB2, AFG1, and AFG2 using high performance liquid chromatography (HPLC) method with fluorescence detection. The frequency of contaminated groundnut samples with AFB1 from Khartoum, Gadarif and Kordofan state was 58.3%, 57.1%, and 66.7%, respectively. No sample of groundnut orground nut product was contaminated with AFG1 or AFG2. The limit of detections (LODs)and limit of quantifications (LOQs) were found to be in a range between 0.01–0.02 ng g−1and 0.03–0.05 ng g−1, respectively. Some groundnut samples contained AFB1concentrations above the EU regulatory limits. The highest contaminated samples with aflatoxins were found in Kordofan state.

Field deployment of loop-mediated isothermal amplification for centralized mass-screening of asymptomatic malaria in Zanzibar: a pre-elimination setting.

BACKGROUND: Molecular tools for detection of low-density asymptomatic Plasmodium infections are needed in malaria elimination efforts. This study reports results from the hitherto largest implementation of loop-mediated isothermal amplification (LAMP) for centralized mass screening of asymptomatic malaria in Zanzibar. METHODS: Healthy individuals present and willing to participate in randomly selected households in 60 villages throughout Zanzibar were screened for malaria by rapid diagnostic tests (RDT). In 50% of the study households, participants were asked to provide 60 µL of finger-prick blood for additional LAMP screening. LAMP was conducted in two centralized laboratories in Zanzibar, by trained technicians with limited or no previous experience of molecular methods. The LAMP assay was performed with Loopamp(TM) MALARIA Pan/Pf Detection Kit (Eiken Chemical Company, Japan). Samples positive for Plasmodium genus (Pan)-LAMP were re-tested using Plasmodium falciparum-specific LAMP kits. RESULTS: Paired RDT and LAMP samples were available from 3983 individuals. The prevalence of asymptomatic malaria was 0.5% (CI 95% 0.1-0.8) and 1.6% (CI 95% 1.1-2.2) by RDT and Pan-LAMP, respectively. LAMP detected 3.4 (CI 95% 2.2-5.2) times more Plasmodium positive samples than RDT. DNA contamination was experienced, but solved by repetitive decontamination of all equipment and reagents. CONCLUSIONS: LAMP is a simple and sensitive molecular tool, and has potential in active surveillance and mass-screening programmes for detection of low-density asymptomatic malaria in pre-elimination settings. However, in order to deploy LAMP more effectively in field settings, protocols may need to be adapted for processing larger numbers of samples. A higher throughput, affordable closed system would be ideal to avoid contamination.

Features of Turner syndrome among a group of Cameroonian patients.

OBJECTIVE: To describe the features of Turner syndrome among a group of Cameroonian patients. METHODS: A descriptive cross-sectional study was conducted among patients with amenorrhea and/or short stature who attended the genetic unit of Yaoundé Gynecology, Obstetrics and Pediatric Hospital (Yaoundé, Cameroon) for a specialist consultation between July 1, 2007, and December 31, 2008. Sociodemographic, clinical, and cytogenetic data were collected. RESULTS: Turner syndrome was confirmed among 11 of the 14 participants (seven had monosomy of the X chromosome; four had mosaicism involving a structural abnormality of the second X chromosome). The mean age at diagnosis was 18.4±2.8years. The reasons for consultation were delayed puberty (n=10) and short stature (n=1). Nine patients had a short neck, nine had a forearm carrying-angle deformity, eight had a low hairline, and two had a webbed neck. Abdominal ultrasonography identified a horseshoe kidney in two patients and a rudimentary uterus in nine patients. None of the patients displayed cardiac abnormalities. Hypergonadotropic hypogonadism was reported among five patients. Eight patients did not receive hormonal treatment owing to advanced bone age or economic reasons. CONCLUSION: Late diagnosis and variable phenotypic expression were key features of Cameroonian patients with Turner syndrome.

Characterising temporal trends in asymptomatic Plasmodium infections and transporter polymorphisms during transition from high to low transmission in Zanzibar, 2005-2013.

BACKGROUND: Improved understanding of the asymptomatic malaria parasite reservoir is a prerequisite to pursue malaria elimination efforts. We therefore characterised temporal trends and transporter polymorphisms in asymptomatic Plasmodium infections during the transition from high to low transmission in Zanzibar. METHODS: Healthy individuals participating in cross-sectional surveys conducted 2005-2013 were screened for asymptomatic malaria by PCR. Complexity/diversity of infection and transporter polymorphisms were assessed in Plasmodium falciparum positive samples. Symptomatic samples were included for comparison of polymorphisms in 2013. RESULTS: PCR-determined parasite prevalence declined from 21.1% (CI95% 17.4-24.9) to 2.3% (CI95% 1.7-2.9) from 2005 to 2013. P. falciparum remained the predominant species; prevalence was highest in children and young adults aged 5-25 years. Parasite densities and complexity of infection, but not population genetic diversity of P. falciparum, decreased from 2005-2009. pfcrt 76T (99.2-64.7%, p < 0.001) and pfmdr1 86Y frequencies (89.4-66.7%, p = 0.03) decreased over time. Pfmdr1 (a.a.86,184,1246) YYY and YYD haplotypes were more frequent in asymptomatic than symptomatic infections in 2013 (p < 0.001). CONCLUSIONS: There is a declining, albeit persistent, reservoir of parasites present at low-densities in asymptomatic individuals in Zanzibar. This study revealed important characteristics of the remaining parasite population, including intriguing temporal trends in molecular markers associated with antimalarial resistance, which need to be further investigated.

Loop-mediated isothermal amplification (LAMP) for point-of-care detection of asymptomatic low-density malaria parasite carriers in Zanzibar.

BACKGROUND: Asymptomatic, low parasite density malaria infections are difficult to detect with currently available point-of-care diagnostics. This study piloted a loop-mediated isothermal amplification (LAMP) kit for field-friendly, high-throughput detection of asymptomatic malaria infections during mass screening and treatment (MSAT) in Zanzibar, a malaria pre-elimination setting. METHODS: Screening took place in three known hotspot areas prior to the short rains in November. Finger-prick blood was taken for screening by rapid diagnostic test (RDT) and LAMP and collected on filter paper for subsequent polymerase chain reaction (PCR) analyses. LAMP results were compared to RDT and to PCR using McNemar's test. RESULTS: Approximately 1,000 people were screened. RDT detected ten infections (1.0% (95% CI 0.3-1.6)) whilst both LAMP and PCR detected 18 (1.8% (95% CI 0.9-2.6)) infections. However, PCR identified three infections that LAMP did not detect and vice versa. LAMP testing was easy to scale-up in field conditions requiring minimal training and equipment, with results ready one to three hours after screening. CONCLUSIONS: Despite lower than expected prevalence, LAMP detected a higher number of infections than the currently used diagnostic, RDT. LAMP is a field-friendly, sensitive diagnostic test that could be useful for MSAT malaria campaigns which require quick results to enable prompt treatment.

Mass screening and treatment on the basis of results of a Plasmodium falciparum-specific rapid diagnostic test did not reduce malaria incidence in Zanzibar.

BACKGROUND: Seasonal increases in malaria continue in hot spots in Zanzibar. Mass screening and treatment (MSAT) may help reduce the reservoir of infection; however, it is unclear whether rapid diagnostic tests (RDTs) detect a sufficient proportion of low-density infections to influence subsequent transmission. METHODS: Two rounds of MSAT using Plasmodium falciparum-specific RDT were conducted in 5 hot spots (population, 12 000) in Zanzibar in 2012. In parallel, blood samples were collected on filter paper for polymerase chain reaction (PCR) analyses. Data on confirmed malarial parasite infections from health facilities in intervention and hot spot control areas were monitored as proxy for malaria transmission. RESULTS: Approximately 64% of the population (7859) were screened at least once. P. falciparum prevalence, as measured by RDT, was 0.2% (95% confidence interval [CI], .1%-.3%) in both rounds, compared with PCR measured prevalences (for all species) of 2.5% (95% CI, 2.1%-2.9%) and 3.8% (95% CI, 3.2%-4.4%) in rounds 1 and 2, respectively. Two fifths (40%) of infections detected by PCR included non-falciparum species. Treatment of RDT-positive individuals (4% of the PCR-detected parasite carriers) did not reduce subsequent malaria incidence, compared with control areas. CONCLUSIONS: Highly sensitive point-of-care diagnostic tools for detection of all human malaria species are needed to make MSAT an effective strategy in settings where malaria elimination programs are in the pre-elimination phase.

A qualitative study on caretakers' perceived need of bed-nets after reduced malaria transmission in Zanzibar, Tanzania.

BACKGROUND: The elimination of malaria in Zanzibar is highly dependent on sustained effective coverage of bed-nets to avoid malaria resurgence. The Health Belief Model (HBM) framework was used to explore the perceptions of malaria and bed-net use after a noticeable reduction in malaria incidence. METHODS: Nineteen in-depth interviews were conducted with female and male caretakers of children under five in North A district, Zanzibar. Deductive content analysis was used to identify meaning units that were condensed, coded and assigned to pre-determined elements of the HBM. RESULTS: Awareness of malaria among caretakers was high but the illness was now seen as easily curable and uncommon. In addition to the perceived advantage of providing protection against malaria, bed-nets were also thought to be useful for avoiding mosquito nuisance, especially during the rainy season when the malaria and mosquito burden is high. The discomfort of sleeping under a net during the hot season was the main barrier that interrupted consistent bed-net usage. The main cue to using a bed-net was high mosquito density, and children were prioritized when it came to bed-net usage. Caretakers had high perceived self-efficacy and did not find it difficult to use bed-nets. Indoor Residual Spraying (IRS), which was recognized as an additional means of mosquito prevention, was not identified as an alternative for bed-nets. A barrier to net ownership was the increasingly high cost of bed-nets. CONCLUSIONS: Despite the reduction in malaria incidence and the resulting low malaria risk perceptions among caretakers, the benefit of bed-nets as the most proficient protection against mosquito bites upholds their use. This, in combination with the perceived high self-efficacy of caretakers, supports bed-net usage, while seasonality interrupts consistent use. High effective coverage of bed-nets could be further improved by reinforcing the benefits of bed-nets, addressing the seasonal heat barrier by using nets with larger mesh sizes and ensuring high bed-net ownership rates through sustainable and affordable delivery mechanisms.

Effects of Intermittent Exercise on Cardiac Troponin I and Creatine Kinase-MB.

OBJECTIVES: The aim of this study was to examine the influence of high-intensity intermittent exercise and carbohydrate supplementation on cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) in soccer players. METHODS: Twelve elite soccer players were selected and divided equally into three groups of carbohydrate (CHO), placebo (P) and control (C). Blood samples were taken in six phases and were analyzed with the chemiluminescence method. RESULTS: Results showed that three bouts of 90-min exercise along with carbohydrate supplementation did not have any significant effect on the level of cTnI indices. However, there was a significant difference in CK-MB values after the second and third sessions compared with the first day (P < 0.05). CONCLUSION: In summary, exercises with less duration and intensity like soccer do not seem to be effective on cTnI and CK-MB. When the overall intensity of exercise was moderate, it appeared that carbohydrate supplementation had less effect on the alteration of biochemical markers of the myocardial muscle.

System effectiveness of a targeted free mass distribution of long lasting insecticidal nets in Zanzibar, Tanzania.

BACKGROUND: Insecticide-treated nets (ITN) and long-lasting insecticidal treated nets (LLIN) are important means of malaria prevention. Although there is consensus regarding their importance, there is uncertainty as to which delivery strategies are optimal for dispensing these life saving interventions. A targeted mass distribution of free LLINs to children under five and pregnant women was implemented in Zanzibar between August 2005 and January 2006. The outcomes of this distribution among children under five were evaluated, four to nine months after implementation. METHODS: Two cross-sectional surveys were conducted in May 2006 in two districts of Zanzibar: Micheweni (MI) on Pemba Island and North A (NA) on Unguja Island. Household interviews were conducted with 509 caretakers of under-five children, who were surveyed for socio-economic status, the net distribution process, perceptions and use of bed nets. Each step in the distribution process was assessed in all children one to five years of age for unconditional and conditional proportion of success. System effectiveness (the accumulated proportion of success) and equity effectiveness were calculated, and predictors for LLIN use were identified. RESULTS: The overall proportion of children under five sleeping under any type of treated net was 83.7% (318/380) in MI and 91.8% (357/389) in NA. The LLIN usage was 56.8% (216/380) in MI and 86.9% (338/389) in NA. Overall system effectiveness was 49% in MI and 87% in NA, and equity was found in the distribution scale-up in NA. In both districts, the predicting factor of a child sleeping under an LLIN was caretakers thinking that LLINs are better than conventional nets (OR = 2.8, p = 0.005 in MI and 2.5, p = 0.041 in NA), in addition to receiving an LLIN (OR = 4.9, p < 0.001 in MI and in OR = 30.1, p = 0.001 in NA). CONCLUSIONS: Targeted free mass distribution of LLINs can result in high and equitable bed net coverage among children under five. However, in order to sustain high effective coverage, there is need for complimentary distribution strategies between mass distribution campaigns. Considering the community's preferences prior to a mass distribution and addressing the communities concerns through information, education and communication, may improve the LLIN usage.

Polymorphism of tumor protein p53 codon 72 showed no association with oral lichen planus in Shiraz, Iran.

BACKGROUND: Oral lichen planus (OLP) is a chronic relapsing inflammatory disease involving T-lymphocyte aggression targeted to the basal layer of the oral mucosa. The tumor suppressor tumor protein p53 (TP53), located on chromosome 17, has been involved in various malignancies. OBJECTIVE: This study was undertaken to investigate the association of p53 codon 72 polymorphism with OLP in Southern Iranian patients. METHODS: Twenty-five patients with lichen planus and 93 healthy blood donors as control group were recruited. DNA from peripheral blood mononuclear cells was extracted and amplified using allele-specific polymerase chain reaction. RESULTS: The frequency of homozygotic arginine (Arg) at codon 72 was 44% in the patients and 37.6% in the controls; for homozygotic proline (Pro), it was 24% and 15.15%, respectively, and for heterozygotic arginine/proline, it was 32% and 47.3%, respectively. CONCLUSION: The polymorphism in codon 72 of the TP53 gene was not associated with the OLP in Iranian patients.

Adherence to artesunate-amodiaquine combination therapy for uncomplicated malaria in children in Zanzibar, Tanzania.

OBJECTIVES: To estimate caretaker adherence to co-blistered, but not co-formulated, artesunate-amodiaquine (AsAq) for uncomplicated malaria and identify factors associated with caretaker adherence. METHODS: Cross sectional household survey of caretakers of 210 children under 5 years of age who had been prescribed and dispensed AsAq at 21 public health facilities (HFs). The caretakers were interviewed in their homes on the 4th day of receiving the 3 day treatment. Adherence of caretakers was assessed by self report and pill count. RESULTS: Caretaker adherence to AsAq was 77% (95% CI: 67%-87%). Non-adherence resulted in under-dosing (3/4) of the time and was most often in the form of wrong daily doses due to misunderstanding or forgetting the correct dose regimens. Predictors of adherence were education exceeding 7 years (OR = 5.08, P = 0.008) and receiving the exact number of pills to complete the treatment regimen (OR = 4.09, P = 0.006). All caretakers of children who were administered the first dose at the HF had adhered to the treatment. CONCLUSION: We found moderate levels of caretaker adherence to AsAq. Further improvement could be achieved by producing dose-specific packaging for infants, providing clear instructions and giving the first dose under observation at the HF.

HAV in Isfahan province: a population-based study.

INTRODUCTION: Hepatitis A infection is caused by the hepatitis A virus (HAV). Improved sanitary conditions have resulted in a significant decline in the incidence of hepatitis A. There is inadequate data about the epidemiology of this infection in Iran. Therefore, this study was carried out to evaluate the anti-HAV seroprevalence in Isfahan Province in Iran in 2006. METHODS: In a cross-sectional study, 816 subjects over 6 years from urban and rural areas of the Isfahan Province in 2006 using the multi-stage cluster sampling method were selected. Demographic data and blood samples were collected and anti-HAV antibodies were measured by ELISA. Chi-square, odds ratio and logistic regression tests were used for statistical analysis and a p value<0.05 was considered significant. RESULTS: The subjects of this study included 428 female and 388 male subjects. The overall anti-HAV seroprevalence rate was 8.33%. There were statistical differences between HAV seropositivity in districts of Isfahan province; the highest seropositivity was seen in Borkhar and Meimeh (28.6%) (p<0.001). There was no significant difference in HAV seropositivity between the subjects grouped according to demographic factors. CONCLUSION: HAV seroprevalence in Isfahan province is not high that can caused by improved sanitary conditions. More studeis in other parts of Iran are needed to set new strategy for post exposure prophylaxis and hepatitis A vaccination.