Improving early infant diagnosis for HIV-exposed infants using unmanned aerial vehicles for blood sample transportation in Conakry, Guinea: a comparative cost-effectiveness analysis.

BACKGROUND: Early infant diagnosis (EID) for HIV-exposed infants is essential due to high mortality during the first months of their lives. In Conakry (Guinea), timely EID is difficult as traffic congestion prevents the rapid transport of blood samples to the central laboratory. We investigated the cost-effectiveness of transporting EID blood samples by unmanned aerial vehicles (UAV), also known as drones. METHODS AND FINDINGS: Using Monte Carlo simulations, we conducted a cost-effectiveness comparative analysis between EID blood samples transportation by on-demand UAV transportation versus the baseline scenario (ie, van with irregular collection schedules) and compared with a hypothetic on-demand motorcycle transportation system. Incremental cost-effectiveness ratio (ICER) per life-year gained was computed. Simulation models included parameters such as consultation timing (eg, time of arrival), motorcycle and UAV characteristics, weather and traffic conditions. Over the 5-year period programme, the UAV and motorcycle strategies were able to save a cumulative additional 834.8 life-years (585.1-1084.5) and 794.7 life-years (550.3-1039.0), respectively, compared with the baseline scenario. The ICER per life-year gained found were US$535 for the UAV strategy versus baseline scenario, US$504 for the motorcycle strategy versus baseline scenario and US$1137 per additional life-year gained for the UAV versus motorcycle strategy. Respectively, those ICERs represented 44.8%, 42.2% and 95.2% of the national gross domestic product (GDP) per capita in Guinea-that is, US$1194. CONCLUSION: Compared with the baseline strategy, both transportation of EID blood samples by UAVs or motorcycles had a cost per additional life-year gained below half of the national GDP per capita and could be seen as cost-effective in Conakry. A UAV strategy can save more lives than a motorcycle one although the cost needed per additional life-year gained might need to consider alongside budget impact and feasibility considerations.

Assessment of potential health risks from heavy metal pollution of surface water for drinking in a multi-industry area in Mali using a multi-indices approach.

The Niger River, Bamako's population's primary drinking water source, is threatened by human activities. This study examines the Niger River pollution trend using heavy metals pollution indexes and Bamako's population's non-carcinogenic and carcinogenic related health risks. Parameters were monitored at fifteen sampling locations in low and high flow seasons. pH (7.30-7.50) and fluoride (0.15-0.26 mg/L) were within the normal drinking water range. Among seven heavy metals (copper, zinc, cadmium, nickel, iron, manganese, and lead), the latter three were above the drinking water standard. The degree of contamination was negative, pointing to better water quality. However, the heavy metal evaluation index (HEI) was below the mean (5.88), between the mean and twice the mean, indicating a low and medium degree of pollution. Besides, heavy metal pollution indexes (HPI) were above the standard value (100), explaining a low-medium pollution level. High values of HPI could be explained by the industrial units' intensive activities coupled with the runoff effect. The hazard index (HI) indicated a low and medium non-carcinogenic health risk for adults and children. The probability of cancer risk (PCR) of nickel showed a cancer risk. Therefore, the river was polluted with trace elements and could not be used for drinking water without any treatment.

HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study.

BACKGROUND: Nearly half of HIV-infected children worldwide are born in West and Central African countries where access to prevention of mother-to-child transmission of HIV (PMTCT) programmes is still limited. WHO recommends reinforced antiretroviral prophylaxis for infants at high risk of mother-to-child transmission of HIV (MTCT) but its implementation needs further investigation in the field. METHODS: The prospective ANRS 12344-DIAVINA study evaluated the feasibility of a strategy combining early infant diagnosis (EID) and reinforced antiretroviral prophylaxis in high-risk infants as identified by interviews with mothers at Ignace Deen Hospital, Conakry, Guinea. RESULTS: 6493 women were admitted for delivery, 6141 (94.6%) accepted HIV testing and 114 (1.9%) were HIV positive. Among these, 51 high-risk women and their 56 infants were included. At birth, a blood sample was collected for infant EID and reinforced antiretroviral prophylaxis was initiated in 48/56 infants (86%, 95% CI 77%-95%). Iron supplementation was given to 35% of infants for non-severe anaemia. Retrospective measurement of maternal plasma viral load (pVL) at delivery revealed that 52% of women had pVL < 400 copies/mL attributable to undisclosed HIV status and/or antiretroviral intake. Undisclosed HIV status was associated with self-stigmatization (85% versus 44%, P = 0.02). Based on the results of maternal pVL at delivery, 'real' high-risk infants were more frequently lost to follow-up (44% versus 8%, P < 0.01) in comparison with low-risk infants, and this was associated with mothers' stigmatization (69% versus 31%, P < 0.01). CONCLUSIONS: Reinforced antiretroviral prophylaxis and EID at birth are widely feasible. However, mothers' self-disclosure of HIV status and antiretroviral intake do not allow adequate evaluation of MTCT risk, which argues for maternal pVL measurement near delivery. Furthermore, actions against stigmatization are crucial to improve PMTCT.

Mortalité maternelle chez les adolescentes au service de Gynécologie-Obstétrique de l'Hôpital National Ignace Deen / Maternal mortality among adolescents in the Gynecology-Obstetrics department of Ignace Deen National Hospital

Introduction. L'objectif de cette étude était de contribuer à l'étude de la mortalité maternelle chez les adolescentes. Méthodes. Il s'agissait d'une étude retro-prospective descriptive et analytique cas témoin, d'une durée de trois ans. La collecte rétrospective avait porté sur deux (2) ans allant du 1er Janvier 2018 au 31 Décembre 2019 et celle prospective sur un (1) an allant du 1er Janvier 2020 au 31 Décembre 2020. Résultats. Durant la période d'étude nous avons enregistré 38 cas de décès maternels sur 16175 naissances vivantes soit un ratio de 235 décès pour 100000 naissances vivantes. Le décès concerne l'adolescente de 18-19 ans (65,8%), mariée (63,2%), non scolarisé (42,1%), et nullipare (65,8%). La majorité des adolescentes avait effectué 1-3 CPN (44,7%), et provenait d'une maternité périphérique (84,2%) et avait accouché par voie basse (78,4%). Le moyen de transport le plus utilisé était le transport en commun (63,2%). La cause de décès était dominée par l'hémorragie (44,7%). Le post-partum a été la période la plus pourvoyeuse de décès (52,6%). Conclusion. La mortalité maternelle constitue un problème de santé majeure dans notre pays, sa réduction nécessite la mobilisation de tous les acteurs de la société et implique une bonne éducation pour la santé, l'amélioration de la qualité du suivi prénatal et celle des soins obstétricaux d'urgence.

Introduction. The objective of this study was to contribute to the study of adolescent maternal mortality. Methods. This was a retrospective descriptive and analytical case-control study, lasting three years. The retrospective data collection covered two (2) years from January 1, 2018 to December 31, 2019 and the prospective one over one (1) year from January 1, 2020 to December 31, 2020. Results. During the study period we recorded 38 cases of maternal deaths out of 16,175 live births, ie a ratio of 235 deaths per 100,000 live births. The death concerns an adolescent girl aged 18-19 (65.8%), married (63.2%), out of school (42.1%), and nulliparous (65.8%). The majority of adolescent girls had performed 1-3 ANC (44.7%), and had come from a peripheral maternity hospital (84.2%) and had given birth vaginally (78.4%). The most used mode of transportation was public transit (63.2%) The cause of death was dominated by hemorrhage (44.7%). The postpartum period was the most significant period of death (52.6%). Conclusion: Maternal mortality is a major health problem in our country, its reduction requires the mobilization of all actors in society and involves good health education, improving the quality of prenatal care and that of obstetric care emergency

A method to test weak-form market efficiency from sectoral indices of the WAEMU stock exchange: A wavelet analysis.

This study assesses the efficiency of the West African Economic and Monetary Union (WAEMU) regional stock exchange using daily data on its seven (7) sectoral indices from December 31, 2013, to January 4, 2019. To this end, we analyze the market structure and calculate the generalized Hurst index by using the discrete wavelet transformation (DWT) and wavelet leader transformation (WLT) approaches. Our conclusions can be summarized as follows: first, this study highlights the multifractal nature of the WAEMU stock market. Second, the Hurst generalized index reveals a persistent or nonpersistent process depending on the sector, according to the q chosen or the method used (DWT or WLT). The dynamics of the indices reveal the characteristics of short memory or, in some cases, long memory, and the efficient market hypothesis is rejected.

Dilute-sulfuric acid pretreatment of cattails for cellulose conversion.

The use of aquatic plant cattails to produce biofuel will add value to land and reduce emissions of greenhouse gases by replacing petroleum products. Dilute-sulfuric acid pretreatment of cattails was studied using a Dionex accelerated solvent extractor (ASE) varying acid concentration (0.1-1%), treatment temperature (140-180 °C), and residence time (5-10 min). The highest total glucose yield for both the pretreatment and enzyme hydrolysis stages (97.1% of the cellulose) was reached at a temperature of 180 °C, a sulfuric acid concentration of 0.5%, and a time of 5 min. Cattails pretreated with 0.5% sulfuric acid are digestible with similar results at enzyme loadings above 15 FPU/g glucan. Glucose from cattails cellulose can be efficiently fermented to ethanol with an approximately 90% of the theoretical yield. The results in this study indicate that cattails are a promising source of feedstock for advanced renewable fuel production.

Hot-water pretreatment of cattails for extraction of cellulose.

To date in the US, production of renewable fuels, particularly ethanol, is primarily from food crops that are high in sugar and starch. The use of arable land for fuel rather than food production and the use of a food source for fuel rather than food have created issues in pricing and availability of traditional foods and feed. The use of cattails to produce biofuel will add value to land and also reduce emissions of greenhouse gases by replacing petroleum products. In order to investigate the feasibility of converting cattails into cellulosic ethanol, a hot-water pretreatment process was studied using a Dionex accelerated solvent extractor (ASE) varying treatment temperature and time. The pretreatment at 190°C for more than 10 min could effectively dissolve the xylan fraction of cattails as soluble oligomers. Both the glucose yield and xylose yield obtained from the pretreated cattails increased with the escalation of the final pretreatment temperature, treatment time or enzyme loading. When cattails were pretreated at 190°C for 15 min, the highest glucose yield of 77.6% from the cellulose was achieved in 48 h using a cellulase loading of 60 FPU/g glucan. The yeast Saccharomyces cerevisiae (ATCC 24858) was able to ferment glucose released by cattail cellulose, resulting in approximately 88.7 ± 2.8% of the theoretical ethanol yield. The higher enzyme loading of 60 FPU/g glucan will significantly increase costs. It is recommended that further studies be carried out using cattails as a feedstock for bio-fuels, especially to optimize the economics of biological conversion processes for cattails with regard to reducing enzyme usage, energy input, glucose yield and xylose yield.

CK2 modulation of NF-kappaB, TP53, and the malignant phenotype in head and neck cancer by anti-CK2 oligonucleotides in vitro or in vivo via sub-50-nm nanocapsules.

PURPOSE: The aim of this study is to investigate the expression of CK2 subunits and CK2 effects on NF-kappaB-mediated and TP53-mediated signal activation and gene expression, the malignant phenotype, and chemosensitivity in head and neck squamous cell carcinoma (HNSCC) in vitro and in vivo. EXPERIMENTAL DESIGN: Protein expression of CK2 subunits was investigated by Western blot and immunohistochemistry. CK2 subunits were knocked down by small interfering RNA, and NF-kappaB activation was examined using DNA binding, Western blot, and luciferase reporter assays. Gene expression was measured by quantitative reverse transcription-PCR. Cell growth, survival, motility, and sensitivity to cisplatin were measured by MTT, flow cytometry, and migration assays. In vivo targeting of CK2alpha/alpha' in HNSCC xenograft models was achieved using anti-CK2alpha/alpha' oligodeoxynucleotide encapsulated in sub-50-nm tenfibgen nanocapsules. RESULTS: CK2 subunit proteins were overexpressed in HNSCC lines and tissues. Knockdown of CK2 subunits differentially inhibited IkappaBalpha degradation, NF-kappaB nuclear localization, phosphorylation, DNA binding, and reporter activity. CK2 subunits modulated gene expression and the malignant phenotype involved in cell cycle and migration, whereas CK2alpha is critical to promote proliferation, antiapoptosis, and cisplatin resistance in vitro. Furthermore, in vivo delivery of anti-CK2alpha/alpha' oligodeoxynucleotide nanocapsules significantly suppressed tumor growth in HNSCC xenograft models, in association with modulation of CK2 and NF-kappaB regulated molecules, TP53 family proteins, and induction of apoptosis. CONCLUSIONS: Our study reveals a novel role of CK2 in coregulating NF-kappaB activation, TP53/p63 expression, and downstream gene expression. Downregulation of CK2 in HNSCC models in vitro and in vivo shows antitumor effects as well as sensitization to cisplatin.

Attenuated transforming growth factor beta signaling promotes nuclear factor-kappaB activation in head and neck cancer.

Although constitutively activated nuclear factor-kappaB (NF-kappaB), attenuated transforming growth factor beta (TGFbeta) signaling, and TP53 mutations frequently occur in human cancers, how these pathways interact and together contribute to malignancy remains uncertain. Here, we found an association between overexpression of NF-kappaB-related genes, reduced expression of TGFbeta receptor (TbetaR) subunits and downstream targets, and TP53 genotype in head and neck squamous cell carcinoma (HNSCC). In response to recombinant TGFbeta1, both growth inhibition and TGFbeta target gene modulation were attenuated or absent in a panel of human HNSCC lines. However, in HNSCC cells that retained residual TGFbeta signaling, TGFbeta1 inhibited both constitutive and tumor necrosis factor alpha-stimulated NF-kappaB activity. Furthermore, HNSCC lines overexpressing mutant (mt) TP53 and human tumor specimens with positive TP53 nuclear staining exhibited reduced TbetaRII and knocking down mtTP53 induced TbetaRII, increasing TGFbeta downstream gene expression while inhibiting proinflammatory NF-kappaB target gene expression. Transfection of ectopic TbetaRII directly restored TGFbeta signaling while inhibiting inhibitor kappaBalpha degradation and suppressing serine-536 phosphorylation of NF-kappaB p65 and NF-kappaB transcriptional activation, linking these alterations. Finally, experiments with TbetaRII conditional knockout mice show that abrogation of TGFbeta signaling promotes the sustained induction of NF-kappaB and its proinflammatory target genes during HNSCC tumorigenesis and progression. Together, these findings elucidate a regulatory framework in which attenuated TGFbeta signaling promotes NF-kappaB activation and squamous epithelial malignancy in the setting of altered TP53 status.