Costing of Community Health Service Packages - The Malawi Social Action Fund (MASAF) Experience

No Abstract Malawi Medical Journal Vol. 20 (1) 2008 pp. 7-1

Ultrasonic energy input influence on the production of sub-micron o/w emulsions containing whey protein and common stabilizers

Ultrasonication may be a cost-effective emulsion formation technique, but its impact on emulsion final structure and droplet size needs to be further investigated. Olive oil emulsions (20 wt%) were formulated (pH 7) using whey protein (3 wt%), three kinds of hydrocolloids (0.1–0.5 wt%) and two different emulsification energy inputs (single- and two-stage, methods A and B, respectively). Formula and energy input effects on emulsion performance are discussed. Emulsions stability was evaluated over a 10-day storage period at 5 C recording the turbidity profiles of the emulsions. Optical micrographs, droplet size and viscosity values were also obtained. A differential scanning calorimetric (DSC) multiple cool–heat cyclic method (40 to 40 C) was performed to examine stability via crystallization phenomena of the dispersed phase. Ultrasonication energy input duplication from 11 kJ to 25 kJ (method B) resulted in stable emulsions production (reduction of back scattering values, dBS 1% after 10 days of storage) at 0.5 wt% concentration of any of the stabilizers used. At lower gum amount samples became unstable due to depletion flocculation phenomena, regardless of emulsification energy input used. High energy input during ultrasonic emulsification also resulted in sub-micron oil-droplets emulsions (D50 = 0.615 lm compared to D50 = 1.3 lm using method A) with narrower particle size distribution and in viscosity reduction. DSC experiments revealed no presence of bulk oil formation, suggesting stability for XG 0.5 wt% emulsions prepared by both methods. Reduced enthalpy values found when method B was applied suggesting structural modifications produced by extensive ultrasonication. Change of ultrasonication conditions results in significant changes of oil droplet size and stability of the produced emulsions

Perawatan Gigitan Terbuka Anteroposterior Tipe Skeletal dengan Teknik Straightwire

Gigitan terbuka merupakan maloklusi yang bercirikan tidak terdapatnya tutup menutup gigi rahang atas dan bawah, dapat terjadi pada regio anterior maupun posterior dan dapat melibatkan dental maupun skeletal. Maloklusi ini memerlukan ketelitian dalam penentuan diagnosis dan perawatan untuk mendapatkan hasil perawatan yang baik dan kestabilan jangka panjang. Tujuan penulisan studi kasus ini adalah untuk menginformasikan manajemen pasien dengan gigitan terbuka tipe skeletal. Pasien pria berumur 19 tahun datang ke Klinik Ortodonsia FKG UGM dengan keluhan utama gigi depan yang tidak rata dan tidak dapat digunakan untuk menggigit. Pemeriksaan klinis menunjukkan pasien memiliki kebiasaan menelan dengan menjulurkan lidah. Pemeriksaan model studi menunjukkan maloklusi Angle kelas I dengan gigitan terbuka anterior dari regio premolar kedua kanan ke kiri sebesar 10,7 mm disertai malposisi gigi individual dan pergeseran garis tengah rahang bawah ke kiri. Pemeriksaan sefalometri menunjukkan relasi skeletal kelas II dengan retrusif bimaksila, rotasi mandibula searah jarum jam dan gigitan terbuka skeletal. Pasien menolak tindakan bedah ortognatik sehingga dilakukan perawatan ortodontik kamuflase. Perawatan diawali dengan latihan miofungsional untuk melatih cara penelanan yang benar dilanjutkan dengan perawatan ortodontik teknik straightwire dengan pencabutan empat gigi molar pertama. Penutupan gigitan terbuka menggunakan elastic box anterior. Hasil evaluasi menunjukkanpengurangan besar gigitan terbuka dari 10,7 mm menjadi 1,25 mm. Kesimpulannya elastic box anterior dapat digunakan untuk mengoreksi gigitan terbuka yang etiologinya melibatkan intrusi gigi anterior. Skeletal Anteroposterior Open Bite Treatment with Straight Wire Technique. Open bite is a malocclusion with characteristic no overlapping between maxillar and mandibular teeth. This malocclusion may occur in anterior or posterior region and involved dental or skeletal. This malocclusion needed precise diagnosis and treatment to get a good treatment result and long term stability. The aim of this case report was to inform management of patient with skeletal open bite. A 19 years old male came to orthodontic clinic Faculty of Dentistry Gadjah Mada University with the chief complaint anterior crowding, and anterior teeth cannot be used to bite. Clinical finding showed patient had tongue thrusting habit. Study model analysis showed class I Angle malocclusion with 10.7 mm anterior open bite from right second premolar to left second premolar, with individual teeth malposition and mandibular midline shifting to the left. Cephalometric finding showed class II skeletal relationship with bimaxillar retrusive, clockwise mandibular rotation and skeletal open bite. This patient refused orthognatic surgery, so he received camouflage orthodontic treatment. This treatment was started with monofunctional exercise to correct the swallowing action then continued with straight wire orthodontic treatment with four first molar extractions. Anterior box elastic was used to close the bite. Evaluation result showed open bite was decreased from 10.7 mm to 1.25 mm. The conclusion was anterior box elastic could be used in open bite correction that involved anterior teeth intrusion as an etiology

Southern Africa Consortium for Research Excellence (SACORE): successes and challenges

Copyright © Mandala et al. Open access article distributed under the terms of CC BY.Published Online November 13, 2014 http://dx.doi.org/10.1016/S2214-109X(14)70321-

Performance comparison of baseline routing protocols in pocket switched network

Pocket Switched Network (PSN) is a branch of Delay Tolerant Network (DTN) which is intended to work in a challenged network. Challenged network is network with lack of infrastructure such as disaster area. As such, the network has intermittent connectivity. PSN provides a new paradigm to distribute messages in the network by taking advantage of roaming nodes from one place to another. In this paper, network performances of eight PSN routing protocols are investigated namely, First Contact, Direct Delivery, Epidemic, PRotocol using History of Encounter and Transitivity (PRoPHET), Spray and Wait, Binary Spray and Wait, Fuzzy Spray, Adaptive Fuzzy Spray and Wait. The performance metrics are packet delivery ratio, overhead ratio and average latency. Opportunistic Network Environment (ONE) simulator is used to evaluate the network performance. Experiments show that Epidemic has the best performance in term of message delivery ratio, but it has the highest overhead ratio. Direct Delivery has the lowest overhead ratio (zero overhead ratio) and PRoPHET has the lowest latency average

Delayed acquisition of Plasmodium falciparum antigen-specific CD4+ T cell responses in HIV-exposed uninfected Malawian children receiving daily cotrimoxazole prophylaxis

BACKGROUND: Cotrimoxazole (CTX) prophylaxis, recommended in HIV-exposed uninfected (HEU) children primarily against HIV-related opportunistic infections, has been shown to have some efficacy against Plasmodium falciparum malaria. The effects of CTX prophylaxis on the acquisition of P. falciparum antigen specific CD4(+) T cells-mediated immunity in HEU children is still not fully understood. METHODS: Peripheral blood was collected from HEU and HIV-unexposed uninfected (HUU) children at 6, 12 and 18 months of age. Proportion of CD4(+) T cells subsets were determined by immunophenotyping. P. falciparum antigen-specific CD4(+) T cells responses were measured by intracellular cytokine staining assay. RESULTS: There were no differences in the proportions of naïve, effector and memory CD4(+) T cell subsets between HEU and HUU children at all ages. There was a trend showing acquisition of P. falciparum-specific IFN-γ and TNF-producing CD4(+) T cells with age in both HUU and HEU children. There was, however, lower frequency of P. falciparum-specific IFN-γ-producing CD4(+) T cells in HEU compared to HUU at 6 and 12 months, which normalized 6 months after stopping CTX prophylaxis. CONCLUSION: The results demonstrate that there is delayed acquisition of P. falciparum-specific IFN-γ-producing CD4(+) T cells in HEU children on daily cotrimoxazole prophylaxis, which is evident at 6 and 12 months of age in comparison to HUU age-matched controls. However, whether this delayed acquisition of P. falciparum-specific IFN-γ-producing CD4(+) T cells leads to higher risk to malaria disease remains unknown and warrants further investigation

Characterization of Lymphocyte Subsets in Lymph Node and Spleen Sections in Fatal Pediatric Malaria.

Secondary lymphoid tissues play a major role in the human immune response to P. falciparum infection. Previous studies have shown that acute falciparum malaria is associated with marked perturbations of the cellular immune system characterized by lowered frequency and absolute number of circulating T cell subsets. A temporary relocation of T cells, possibly by infiltration to secondary lymphoid tissue, or their permanent loss through apoptosis, are two proposed explanations for this observation. We conducted the present study to determine the phenotype of lymphocyte subsets that accumulate in the lymph node and spleen during acute stages of falciparum malaria infection in Malawian children, and to test the hypothesis that lymphocytes are relocated to lymphoid tissues during acute infection. We stained tissue sections from children who had died of the two common clinical forms of severe malaria in Malawi, namely severe malarial anemia (SMA, n = 1) and cerebral malaria (CM, n = 3), and used tissue sections from pediatric patients who had died of non-malaria sepsis (n = 2) as controls. Both lymph node and spleen tissue (red pulp) sections from CM patients had higher percentages of T cells (CD4+ and CD8+) compared to the SMA patient. In the latter, we observed a higher percentage of CD20+ B cells in the lymph nodes compared to CM patients, whereas the opposite was observed in the spleen. Both lymph node and spleen sections from CM patients had increased percentages of CD69+ and CD45RO+ cells compared to tissue sections from the SMA patient. These results support the hypothesis that the relocation of lymphocytes to spleen and lymph node may contribute to the pan-lymphopenia observed in acute CM

Performance of molecular methods for the detection of Salmonella in human stool specimens [version 2; peer review: 2 approved]

Background: The relationship between asymptomatic Salmonella exposure within the gastrointestinal tract and Salmonella bacteraemia is poorly understood, in part due to the low sensitivity of stool culture and the lack of validated molecular diagnostic tests for the detection of Salmonella in the stool. The study aimed to determine a reliable molecular diagnostic test for Salmonella in stool specimens. Methods: We optimised an in-house monoplex real-time polymerase chain reaction (PCR) for the detection of Salmonella ttr and InvA genes in stool by including a selenite broth pre-culture step for Salmonella before DNA extraction and validated their specificity against other local common pathogens. Then we assessed their performance against a well-validated multiplex PCR targeting the same ttr and InvA genes and against stool culture using clinical stool specimens collected from a cohort of 50 asymptomatic healthy Malawian children that were sampled at 1-month intervals over 12 months. We employed a latent Markov model to estimate the specificities and sensitivities of PCR methods. Results: Ttr and InvA primers were both able to detect all the different Salmonella serovars tested and had superior limits of detection when DNA was extracted after selenite pre-culture. Ttr sensitivity and specificity for monoplex-PCR were (99.53%, 95.46%) and for multiplex-PCR (90.30%, 99.30%) respectively. InvA specificity and specificity for using monoplex-PCR was (95.06%, 90.31%) and multiplex-PCRs (89.41%, 98.00%) respectively. Sensitivity and specificity for standard stool culture were 62.88% and 99.99%, respectively. Culture showed the highest PPV (99.73%), and monoplex-ttr had the highest NPV (99.67%). Conclusion: Test methods demonstrated high concordance, although stool culture and monoplexed ttr primers had superior specificity and sensitivity, respectively. The use of selenite pre-enrichment step increased Salmonella detection rate. Taken together, molecular detection methods used here could be used to reveal the true extent of both asymptomatic and symptomatic Salmonella exposure events

Structural modification of bacterial cellulose fibrils under ultrasonic irradiation

Ιn the present study we investigated ultrasounds as a pretreatment process for bacterial cellulose (BC) aqueous suspensions. BC suspensions (0.1–1% wt) subjected to an ultrasonic treatment for different time intervals. Untreated BC presented an extensively entangled fibril network. When a sonication time of 1 min was applied BC fibrils appeared less bundled and dropped in width from 110 nm to 60 nm. For a longer treatment (3–5 min) the width of the fibrils increased again to 100 nm attributed to an entanglement of their structure. The water holding capacity (WHC) and ζ-potnential of the suspensions was proportional to the sonication time. Their viscosity and stability were also affected; an increase could be seen at short treatments, while a decrease was obvious at longer ones. Concluding, a long ultrasonic irradiation led to similar BC characteristics as the untreated, but a short treatment may be a pre-handling method for improving BC properties