Large sharing networks and unusual injection practices explain the rapid rise in HIV among IDUs in Sargodha, Pakistan

<p>Abstract</p> <p>Background</p> <p>Of the nearly 100,000 street-based IDUs in Pakistan, 20% have HIV. We investigated the recent rise in HIV prevalence from 12 to 52% among IDUs in Sargodha despite > 70% coverage with syringe exchanges.</p> <p>Methods</p> <p>We interviewed approximately 150 IDUs and 30 outreach workers in focus group discussions.</p> <p>Results</p> <p>We found six rural and 28 urban injecting locations. Urban locations have about 20–30 people at any time and about 100 daily; rural locations have twice as many (national average: 4–15). About half of the IDUs started injecting within the past 2 years and are not proficient at injecting themselves. They use street injectors, who have 15–16 clients daily. Heroin is almost exclusively the drug used. Most inject 5–7 times daily.</p> <p>Nearly all injectors claim to use fresh syringes. However, they load, inject and share using a locally developed method called scale. Most Pakistani IDUs prefer to double pump drug the syringe, which allows mixing of blood with drug in the syringe. The injector injects 3 ml and keeps 2 ml (the scale) as injection fee. The injector usually pools all the leftover scale (now with some blood mixed with drug) either for his own use or to sell it. Most IDUs backload the scale they buy into their own fresh syringes.</p> <p>Discussion</p> <p>Use of an unprecedented method of injecting drugs that largely bypasses fresh syringes, larger size of sharing networks, higher injection frequency and near universal use of street injectors likely explain for the rapid rise in HIV prevalence among IDUs in Sargodha despite high level provision of fresh syringes. This had been missed by us and the national surveillance, which is quantitative. We have addressed this by hiring injectors as peer outreach workers and increasing syringe supply. Our findings highlight both the importance of qualitative research and operations research to enrich the quality of HIV prevention programs.</p

An epidemiological study of pleuropulmonary paragonimiasis among pupils in the peri-urban zone of Kumba town, Meme Division, Cameroon

BACKGROUND: Paragonimiasis have previously been reported in two zones of the Southwest Province of Cameroon including the Kupe mountain and Mundani foci. The aim of this study was to investigate the presence and epidemiology of paragonimiasis in the peri-urban zone of Kumba, Meme Division, located about 50 km away from the Kupe mountain focus. METHODS: Pupils of several government primary schools in 5 villages around Kumba underwent both parasitologic and clinical investigations in search of signs and symptoms of paragonimiasis. Mycobacterium tuberculosis was also searched for in the differential diagnosis.Freshwater crabs from neighbouring streams in the five villages were dissected in search of paragonimus metacercariae. RESULTS: Out of a total of 1482 pupils examined in all five villages, 309 individuals (147 males and 162 females) were recruited for this study based on the presence of one or more signs or symptoms of paragonimiasis. Eggs of Paragonimus africanus were found in stools and/or sputum of pupils from all five villages, giving an overall paragonimus prevalence of 2.56%. There was no significant difference in the disease prevalence between the villages (X(2 )= 8.36, P = 0.08). The prevalence of Paragonimus africanus eggs amongst pupils with symptoms of paragonimiasis was 12.3% (38 of 309). Males were infected more than females (17.0% versus 8.0%), but the difference was not significant (X(2 )= 5.76, P = 0.16). All the 38 paragonimus egg positive subjects presented with cough, 23 (60.53%) complained of chest pain while 16 (42.11%) had haemoptysis. Stool examinations also detected some intestinal parasites including Ascaris lumbricoides (29.45%), Trichuris trichiura (6.47%), Necator americanus (2.27%), Strongyloides stercoralis (1.62%), Enterobius vermicularis (0.65%), and Entamoeba histolytica (4.53%). No case of M. tuberculosis was noted. Out of a total of 85 dissected crabs (Sudanonautes africanus), 6.02 % were infected with paragonimus metacercariae. CONCLUSION: In addition to the two previously described paragonimiasis foci of Kupe mountain and Mundani, the identification of autochthonous cases of paragonimiasis in the peri-urban zone of Kumba town, makes the South West Province the most endemic zone of paragonimiasis in Cameroon at present

Energy-Efficient Service-Oriented Architecture for Mobile Cloud Handover

Mobile cloud computing uses features to deliver outsourcing data to remotely available mobile devices. However, the flexible nature of the mobile device is a critical challenge for the mobile cloud computing environment. The mobile phone significantly degrades the data transfer performance when initiating the handover process. Thus, an energy-efficient handover process could improve the quality of service (QoS). Here, we introduce a secure energy-efficient and quality-of-service architecture (EEQoSA) for the handover process in the mobile cloud computing environment. The proposed architecture involves four layers: application, the Internet protocol multimedia subsystem (IPMS), communication, and media with connectivity layers. These four layers collectively handle the energy-efficiency, security and QoS parameters. Existing service-oriented architectures designed for mobile cloud computing are based on the symmetric encryption cryptography to support different media services. However, this approach easily allows an adversary to expose the symmetric key and gain access to private data. Thus, our proposed architecture uses the secure and strong authentication (SSA) process at the IPMS layer by protecting the media services from unauthorized users, as the IPMS is the central layer that could be the entry point for an adversary. Furthermore, to extend the mobile lifetime during the handover process, an energy detection (ED) model is deployed at the communication layer to detect the energy level of the mobile device prior to the handover initialization process. The media with the connectivity layer supports the secure handover process using a priority enforcement module that allows only legitimate users to complete the re-registration process after initiating the handover. Finally, the architecture is tested using the CloudSim simulation environment and validated by a comparison with other known service-oriented architectures.https://doi.org/10.1186/s13677-017-0079-

NH4+-stimulated and -inhibited components of K+ transport in rice (Oryza sativa L.)

The disruption of K+ transport and accumulation is symptomatic of NH4+ toxicity in plants. In this study, the influence of K+ supply (0.02–40 mM) and nitrogen source (10 mM NH4+ or NO3–) on root plasma membrane K+ fluxes and cytosolic K+ pools, plant growth, and whole-plant K+ distribution in the NH4+-tolerant plant species rice (Oryza sativa L.) was examined. Using the radiotracer 42K+, tissue mineral analysis, and growth data, it is shown that rice is affected by NH4+ toxicity under high-affinity K+ transport conditions. Substantial recovery of growth was seen as [K+]ext was increased from 0.02 mM to 0.1 mM, and, at 1.5 mM, growth was superior on NH4+. Growth recovery at these concentrations was accompanied by greater influx of K+ into root cells, translocation of K+ to the shoot, and tissue K+. Elevating the K+ supply also resulted in a significant reduction of NH4+ influx, as measured by 13N radiotracing. In the low-affinity K+ transport range, NH4+ stimulated K+ influx relative to NO3– controls. It is concluded that rice, despite its well-known tolerance to NH4+, nevertheless displays considerable growth suppression and disruption of K+ homeostasis under this N regime at low [K+]ext, but displays efficient recovery from NH4+ inhibition, and indeed a stimulation of K+ acquisition, when [K+]ext is increased in the presence of NH4+

Non-reciprocal interactions between K+ and Na+ ions in barley (Hordeum vulgare L.)

The interaction of sodium and potassium ions in the context of the primary entry of Na+ into plant cells, and the subsequent development of sodium toxicity, has been the subject of much recent attention. In the present study, the technique of compartmental analysis with the radiotracers 42K+ and 24Na+ was applied in intact seedlings of barley (Hordeum vulgare L.) to test the hypothesis that elevated levels of K+ in the growth medium will reduce both rapid, futile Na+ cycling at the plasma membrane, and Na+ build-up in the cytosol of root cells, under saline conditions (100 mM NaCl). We reject this hypothesis, showing that, over a wide (400-fold) range of K+ supply, K+ neither reduces the primary fluxes of Na+ at the root plasma membrane nor suppresses Na+ accumulation in the cytosol. By contrast, 100 mM NaCl suppressed the cytosolic K+ pool by 47–73%, and also substantially decreased low-affinity K+ transport across the plasma membrane. We confirm that the cytosolic [K+]:[Na+] ratio is a poor predictor of growth performance under saline conditions, while a good correlation is seen between growth and the tissue ratios of the two ions. The data provide insight into the mechanisms that mediate the toxic influx of sodium across the root plasma membrane under salinity stress, demonstrating that, in the glycophyte barley, K+ and Na+ are unlikely to share a common low-affinity pathway for entry into the plant cell

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

A Mother Raped Twice

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THE INVESTIGATION OF OIL DEGRADING CAPACITY OF BACTERIAL STRAINS ISOLATED FROM DIFFERENT ENVIRONMENTS IN TURKEY

The analyses were carried out with the aim of determining the oil-degradation capacity of bacterial strains isolated from different locations in Turkey. A total of 103 wild bacterial strains isolated from different marine environments and from the soil surrounding petroleum refineries in the city of Batman, Turkey, were screened with respect to their MIC (Minimum Inhibition Concentration) in Batman crude oil. Five bacterial isolates and their mixed consortiums were selected and investigated to detect their degradation capabilities with respect to different parameters including hemolytic activities, pH values, the emulsification index and the oil layers' thickness during the 30 days of incubation. The growth profiles of the isolates in the media with and without crude oil were also studied. In order to better understand the oil degradation capacity of the isolates, their performance was compared with the standard oil degrading bacterial strains, Alcanivorax borkumensis and Vibrio cyclitrophicus. The degradation activities of all of the five strains (Escherichia coli MDK04, Bacillus subtilis BR02, Vibrio fluvialis MD03, Staphylococcus haemolyticus GA01, and Pseudomonas aeruginosa BR03) and their consortiums were better than the reference strains. The experimental results indicated that the isolates from this study were efficient in using crude oil as the sole source of carbon and energy. We suggest that natural bacteria isolates from oil-polluted areas are likely to be as suitable candidates as standard oil-degrading bacterial strains for the purpose of cleaning up oil spills. This study significantly contributed to our knowledge about the possibility of the use of natural bacterial isolates in situ bioremediation of crude oil spills