Structural basis for the recognition of anthelmintic activity of bioactive metabolite in watery rose apple leaf through in silico investigation.

This research is part of the research umbrella regarding the use of watery rose apple leaf [Eugenia aqueum (Burm. F) Alston] in the health sector. Infectious diseases of worms, are still a health problem with a high burden based on the incidence and mortality rates in Southeast Asian countries. Therefore, we tried to create a 3D structure of vital receptors of worms including Nicotinic Cholinergic Receptor (NCR), Acetylcholinesterase Enzymes (AE), and Phosphorylase Enzymes (PE) using homology modeling method through the SWISS-MODEL webserver, then conducted a molecular dynamics simulations using active metabolite of watery rose apple leaf i.e. 2',4'­dihydroxy­6'­methoxy­3',5'­dimethylchalcone which was then compared with Piperazine Citrate and Pyrantel Pamoate which are anthelmintic drugs on the market. Based on the results of the study, the structure of the three receptors with high resolution was successfully obtained which was characterized by a good Ramachandran value, which was above 90%. Then the ligand structure was successfully modeled in a three-dimensional model and optimized geometrically using GaussView 5.0.8 and Gaussian09 software. In further, Root Mean Square Deviation (RMSD) and Root Mean Square Fluctuation (RMSF) analysis of molecular dynamics simulations ligand against the three receptors, compound 2',4'­dihydroxy­6'­methoxy­3',5'­dimethylchalcone showed better stability than Piperazine Citrate and Pyrantel Pamoate at 50 ns simulation, although from the calculation of binding free energy Molecular Mechanics Poisson-Boltzmann Surface Area (MM/PBSA) is not better than the two comparisons. It can be concluded that the compound 2',4'­dihydroxy­6'­methoxy­3',5'­dimethylchalcone from watery rose apple leaf showed potential as anthelmintic candidates.Communicated by Ramaswamy H. Sarma.

HIV Disclosure to Infected Children Involving Peers: A New Take on HIV Disclosure in the Democratic Republic of Congo.

Appropriately informing HIV-infected children of their diagnosis is a real challenge in sub-Saharan Africa. Until now, there is no consensus on who ought to disclose and how to disclose. This paper describes the model for HIV status disclosure in which HIV-positive children/adolescents are informed about their diagnosis in a process conducted by young peers under healthcare worker (HCW) supervision in a hospital in Kinshasa, the Democratic Republic of Congo. This new take on HIV status disclosure involving peers includes four stages that help the trained peer supporters to provide appropriate counseling, taking into account the age and level of maturity of the child/adolescent: the preliminary stage, the partial disclosure stage, the full disclosure stage, and the post-disclosure follow-up stage. Of all children/adolescents whose HIV status disclosure data were documented at Kalembelembe Pediatric Hospital (KLLPH) between 2004 and 2016, we found that disclosure by peers was highly accepted by parents, children/adolescents, and health workers. Compared to children/adolescents disclosed to by HCWs or parents, children/adolescents disclosed to by peers had (a) fewer depressive symptoms reported, (b) better drug adherence resulting in higher viral load suppression, and (c) a higher proportion of survivors on treatment. We found that involving peers in the disclosure process of HIV is an important approach to ensure adherence to treatment, resilience, and mental wellbeing of HIV-infected children/adolescents.

Caregivers' Perspective on the Psychological Burden of Living with Children Affected by Sickle Cell Disease in Kinshasa, the Democratic Republic of Congo.

There is limited information on knowledge, perceptions, and management of sickle cell disease (SCD) in Africa in general and in the Democratic Republic of the Congo (DRC) in particular. This study explored knowledge, perceptions, and burden of 26 parents/caregivers of children with SCD in three selected hospitals in Kinshasa, DRC. We conducted a focus group with in-depth interviews with parents/caregivers of children affected with SCD. Four themes were discussed, including knowledge and perceptions, diagnosis and management, society's perceptions, and the psychosocial burden and the quality of life of the family affected by SCD. The majority of participants/caregivers felt that society, in general, had negative perceptions of, attitudes toward, and knowledge about SCD. They reported that children with sickle cell are often marginalized, ignored, and excluded from society or school. They face a number of challenges related to care, management, financial difficulties, and a lack of psychological support. The results suggest the need to promote measures and strategies to improve knowledge and management of SCD in Kinshasa, DRC.

Lessons Learned from the Impact of HIV Status Disclosure to Children after First-Line Antiretroviral Treatment Failure in Kinshasa, DR Congo.

HIV status disclosure to children remains a challenge in sub-Saharan Africa. For sociocultural reasons, parents often delay disclosure with subsequent risks to treatment compliance and the child's psychological well-being. This article assesses the effects of HIV disclosure on second-line ART compliance after first-line failure. We conducted a retrospective study of 52 HIV-positive children at Kalembelembe Pediatric Hospital in Kinshasa who were unaware of their HIV status and had failed to respond to the first-line ART. Before starting second-line ART, some parents agreed to disclosure. All children were followed before and during the second-line ART. Conventional usual descriptive statistics were used. For analysis, the children were divided into two groups: disclosed to (n = 39) and not disclosed to (n = 13). Before starting the second-line ART, there was no difference in CD4 count between the two groups (p = 0.28). At the end of the first year of second-line ART, the difference was statistically significant between the two groups with regard to CD4% (p < 0.001) and deaths (p = 0.001). The children disclosed to also reported fewer depressive symptoms post-disclosure and had three times fewer clinic visits. HIV status disclosure to children is an important determinant of ART compliance and a child's psychological well-being.

"The Peer Educator Is the Game-Changer of My Life": Perceptions of Adolescents Living with HIV in DR Congo on Involving Peer Educators in the Process of HIV Disclosure.

Several approaches to the disclosure of HIV status to children and adolescents have been described. Each of these places particular emphasis on the role of parents and health care workers (HCWs) to mitigate the impact of disclosure on the adolescent without exploring the possible roles that other individuals might play in the process of disclosure. This article assesses the perceptions of adolescents living with HIV (ALHIV) about disclosure done by parents, guardians, HCWs, peer educators in the role of peer supporters, accidentally or by self-discovery, and the subsequent effects of disclosure method on their mental health. We used a qualitative study to conduct semi-structured interviews with 73 ALHIV at the Kalembelembe Paediatric Hospital, in DR Congo disclosed to by parents, guardians, HCWs, and/or peer educators, respectively, or disclosed to accidentally or by self-discovery. Microsoft Excel analysis matrix was used to organize the qualitative data. The majority of ALHIV whose disclosure involved a peer educator unanimously acknowledged the important role of the peer in accepting their HIV status, in their ART adherence, and their development of self-esteem. However, most ALHIV disclosed without involving peers declared that they had accepted their situation after a relatively long period followed by contact with the peer and integration in the self-support group. We found that the peer approach is the game-changer of the HIV status disclosure process that would allow ALHIV to accept their HIV status with minimum distress, it builds resilience, and allows them to adhere to treatment.

How the lower face soft tissue changes after mandibular advancement or setback.

To contribute as an auxiliary tool for orthodontic and orthognathic planning and treatment, short-term changes on the lower face soft and hard tissues were investigated. All subjects presented adequate maxillary relation with the cranial base. The treatment was done by mandibular advancement in patients with skeletal class II or setback in skeletal class III, by the same oral surgeon, using the same technique, and rigid internal fixation. Lateral cephalograms were traced at the following intervals: T0--immediately before the surgical procedure, T1--6 months after surgery, and T2--1 year after surgery. The postoperative data of the lower face revealed highly significant changes for the soft tissue pogonion and lower lip, in the mandible advancement cases, whereas the underlying bone and dental structures remained constant. For the mandible setback cases, just the hard tissue pogonion variable displayed a statistically significant change.

Our experience with virtual craniomaxillofacial surgery: planning, transference and validation.

Clinical application of virtual craniomaxillofacial surgery (VCMS) planning is demonstrated with four typical cases. An integral component to success is transferring the surgical plan to the operating environment within a reasonable time frame through the design and fabrication of surgical guides and implants.

Cranial base angulation in Brazilian patients seeking orthodontic treatment.

The relationship between cranial base flexion and facial prognathism has been of interest to orthodontists, orthognathic maxillofacial surgeons, and plastic surgeons. This study aimed to identify the cranial base flexion of adults with anteroposterior skeletal disharmony. Because the sample was representing a mixed racial population, the authors performed an investigation to confirm an association with other researches performed in different parts of the world. The results revealed an increase in the cranial base flexion in cases diagnosed as class II skeletal pattern and reduction in the group with class III skeletal pattern. These findings suggested that the characteristics of the Brazilian cases did not differ from some other studies despite various influences of different ethnicities in that population.

Treatment protocol to control Streptococcus mutans level in an orthodontic patient with high caries risk.

The purpose of this article is to report a protocol for treating an orthodontic patient with a high risk of developing caries. The salivary level of Streptococcus mutans was evaluated during various stages of orthodontic treatment. It was significantly high before professional application of 1% chlorhexidine collagen gel, daily mouth rinsing with 0.05% sodium fluoride solution, and bonding of the bands and brackets. Although there were no other changes in hygiene habits, microbiologic tests showed that the microbiota was in balance during the follow-up periods. At the end of orthodontic treatment, periodontal health was observed, and enamel surfaces showed signs of remineralization.

Three-dimensional computerized orthognathic surgical treatment planning.

Three-dimensional volumetric imaging allows better visualization of the morphologic deformity, planning the surgical approach, and evaluating the response not visualized previously with two-dimensional dentofacial records. This in time will replace conventional two-dimensional cephalometric planning and plaster cast model surgery. Three-dimensional craniofacial imaging requires application of various techniques from applied mathematics, computer sciences, and bioengineering. Although it is today in its infancy, it has the potential to accurately simulate the operative experience for surgical planning, with improved morphologic outcomes, patient-specific biomechanical modeling to allow functional assessment of the various outcomes, and accurate simulation for surgical resident training.