Early structural brain development in infants exposed to HIV and antiretroviral therapy in utero in a South African birth cohort

IntroductionThere is a growing population of children who are HIV‐exposed and uninfected (HEU) with the successful expansion of antiretroviral therapy (ART) use in pregnancy. Children who are HEU are at risk of delayed neurodevelopment; however, there is limited research on early brain growth and maturation. We aimed to investigate the effects of in utero exposure to HIV/ART on brain structure of infants who are HEU compared to HIV‐unexposed (HU).MethodsMagnetic resonance imaging using a T2‐weighted sequence was undertaken in a subgroup of infants aged 2–6 weeks enrolled in the Drakenstein Child Health Study birth cohort, South Africa, between 2012 and 2015. Mother–child pairs received antenatal and postnatal HIV testing and ART per local guidelines. We compared subcortical and total grey matter volumes between HEU and HU groups using multivariable linear regression adjusting for infant age, sex, intracranial volume and socio‐economic variables. We further assessed associations between brain volumes with maternal CD4 cell count and ART exposure.ResultsOne hundred forty‐six infants (40 HEU; 106 HU) with high‐resolution images were included in this analysis (mean age 3 weeks; 50.7% male). All infants who were HEU were exposed to ART (88% maternal triple ART). Infants who were HEU had smaller caudate volumes bilaterally (5.4% reduction, p < 0.05) compared to HU infants. There were no group differences in other subcortical volumes (all p > 0.2). Total grey matter volume was also reduced in infants who were HEU (2.1% reduction, p < 0.05). Exploratory analyses showed that low maternal CD4 cell count (<350 cells/mm³) was associated with decreased infant grey matter volumes. There was no relationship between timing of ART exposure and grey matter volumes.ConclusionsLower caudate and total grey matter volumes were found in infants who were HEU compared to HU in the first weeks of life, and maternal immunosuppression was associated with reduced volumes. These findings suggest that antenatal HIV exposure may impact early structural brain development and improved antenatal HIV management may have the potential to optimize neurodevelopmental outcomes of children who are HEU.     

Acute epiploic appendagitis mimicking symptoms of urinary tract infection: A diagnostic enigma in the emergency department

The epiploic appendages (also known as appendices epiploicae) are usually located on the anti‐mesenteric surface of the colon, extending from the caecum to the rectosigmoid, and epiploic appendagitis (EA) is the inflammation of these appendages. We report a clinical image of epiploic appendagitis creating a diagnostic challenge.     

Eco-Friendly Incorporation of Crumb Rubber and Waste Bagasse Ash in Bituminous Concrete Mix

The consumption of waste materials in the construction sector is a sustainable approach that helps in reducing the environmental pollution and decreases the construction cost. The present research work emphasizes the mechanical properties of bituminous concrete mix prepared with crumb rubber (CR) and waste sugarcane bagasse ash (SCBA). For the preparation of bituminous concrete mix specimens with CR and SCBA, the effective bitumen content was determined using the Marshall Mix design method. A total of 15 bituminous concrete mix specimens with 4%, 4.5%, 5%, 5.5% and 6% of bitumen content were prepared, and the effective bitumen content turned out to be 4.7%. The effect of five different CR samples of 2%, 4%, 6%, 8% and 10% by weight of total mix and SCBA samples of 25%, 50%, 75% and 100% by weight of filler were investigated on the performance of bituminous concrete. A total of 180 samples with different percentages of CR and SCBA were tested for indirect tensile strength (ITS) and Marshall Stability, and the results were compared with conventional bituminous concrete mix. It was observed that the stability values rose with an increase in CR percentage up to 6%, while the flow values rose as the percentage of SCBA increased in the mix. Maximum ITS results were observed at 4% CR and 25% SCBA replacement levels. However, a decrease in stability and ITS result was observed as the percentages of CR and SCBA increased beyond 4% and 25%, respectively. We concluded that the optimum CR and SCBA content of 4% and 25%, respectively, can be effectively used as a sustainable alternative in bituminous concrete mix.     

Cytotoxic and photocatalytic studies of hexagonal boron nitride nanotubes: a potential candidate for wastewater and air treatment

Boron nitride (BN) nanomaterials are rapidly being investigated for potential applications in biomedical sciences due to their exceptional physico-chemical characteristics. However, their safe use demands a thorough understanding of their possible environmental and toxicological effects. The cytotoxicity of boron nitride nanotubes (BNNTs) was explored to see if they could be used in living cell imaging. It was observed that the cytotoxicity of BNNTs is higher in cancer cells (65 and 80%) than in normal cell lines (40 and 60%) for 24 h and 48 h respectively. The influence of multiple experimental parameters such as pH, time, amount of catalyst, and initial dye concentration on percentage degradation efficiency was also examined for both catalyst and dye. The degradation effectiveness decreases (92 to 25%) as the original concentration of dye increases (5–50 ppm) due to a decrease in the availability of adsorption sites. Similarly, the degradation efficiency improves up to 90% as the concentration of catalyst increases (0.01–0.05 g) due to an increase in the adsorption sites. The influence of pH was also investigated, the highest degradation efficiency for MO dye was observed at pH 4. Our results show that lower concentrations of BNNTs can be employed in biomedical applications. Dye degradation properties of BNNTs suggest that it can be a potential candidate as a wastewater and air treatment material.

Photocatalytic degradation studies of methyl orange using BNNTs.     

Effect of COVID-19 lockdown on the pathway of care and treatment outcome among patients with tuberculosis in a rural part of northern India: a community-based study

Objectives: The coronavirus disease 2019 (COVID-19) pandemic affected routine healthcare services across all spectra, and tuberculosis (TB) care under the National Tuberculosis Elimination Program have been affected the most. However, evidence available at the community level is minimal. The clinical features, care cascade pathway, and treatment outcomes of TB patients pre- and during/post-COVID-19 pandemic lockdown in a rural community health block in northern India were assessed and compared.Materials and Methods: This was a retrospective cohort study that included all patients diagnosed with TB and initiated treatment under programmatic settings between January 1 and June 30, 2020, in a rural TB unit in northern India. The periods from January 1 to March 23 and March 24 to June 30 were marked as pre-lockdown and during/post-lockdown, respectively.Results: A total of 103 patients were diagnosed and treated for TB during the study period. A significantly higher proportion of pulmonary TB cases were reported during/post-lockdown (43, 82.7%) compared to that pre-lockdown (32, 62.7%), and a higher diagnostic delay was noted during/post-lockdown (35, 81.4%). Through adjusted analysis, patients diagnosed during/post-lockdown period (adjusted risk ratio [aRR], 0.85; 95% confidence interval [CI], 0.73–0.98) and previously treated (aRR, 0.77; 95% CI, 0.60–0.995) had significantly lower favorable treatment outcomes.Conclusions: The symptom and disease (pulmonary/extrapulmonary) pattern have changed during/post-lockdown. The care cascade delays are still high among TB patients, irrespective of the lockdown status. Lockdown had a significant adverse impact on the outcomes of TB treatment.     

Outcome analysis of 40 cases of vestibular schwannoma: A comparison of sitting and Park bench surgical position

The present study retrospectively reviews our experience in 40 cases of vestibular schwannoma, operated between the years 1995 and 2002. All the patients underwent tumour resection either in sitting or in the Park bench position via the suboccipital retromastoid route. The position of the patient was selected arbitrarily. Precordial Doppler echocardiography was used to monitor air embolism. Operative results, including the size of the tumour, completeness of resection, anatomical and functional preservation of the facial nerve, operative complications and mortality were analysed and compared in these two operative positions. There was no statistically significant difference in terms of surgical results between these two groups.      

Optimization,in vitro release and toxicity evaluation of novel pH sensitive itaconic acid-g-poly(acrylamide)/sterculia gum semi-interpenetrating networks

BackgroundIn recent era, pH sensitive polymeric carriers that combines the materials engineering and medicine is gaining researcher’s attention as they maximizes drug concentration at site of absorption and reduces side effects for e.g. orally administered cetirizine HCl (CTZ HCl) upsets the stomach and furthermore shows high intestinal absorption. Thus, development of pH sensitive hydrogels with sufficient mechanical strength will be good candidate to address this issue.MethodsHere, we developed pH sensitive itaconic acid-g-poly(acrylamide)/sterculia gum (IA-g-poly(AM)/sterculia gum) semi-interpenetrating network (semi-IPN) by free radical polymerization technique for intestinal delivery of CTZ HCL.ResultsOptimized formulation (I5) with 6% w/w IA showed negligible swelling at pH 1.2, and maximum swelling at pH 7.4. Solid state characterization of optimized formulation showed successful development of semi-IPN structure and incorporation of drug without any noticeable drug-carrier interaction. In vitro release study showed biphasic pH dependent release of CTZ HCl, where initial burst release was observed at acidic pH followed by sustained release at basic pH. Acute oral toxicity and histopathological studies confirmed the non-toxic nature of IA-g-poly(AM)/sterculia gum.ConclusionConclusively, developed biocompatible semi-IPN hydrogels with sufficient pH sensitivity and mechanical strength could serve as a potential carrier for intestinal delivery of CTZ HCL to maximize its absorption and reduce side effects.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s40199-021-00395-8.     

Assessment of biofilm removal capacity of a broad host range bacteriophage JHP against Pseudomonas aeruginosa

Pseudomonas aeruginosa is an efficient biofilm‐dwelling microbial pathogen, associated with nosocomial infections. These biofilm‐associated infections are resistant to antibiotics and immune defenses, therefore pose major problem against their treatment. This scenario demands alternative therapeutic regimens, and bacteriophage therapy is one among potential strategies for clinical management of multiple drug resistance. In this investigation, the efficacy of a bacteriophage, JHP, is evaluated to eradicate P. aeruginosa biofilms. Growth kinetics of P. aeruginosa biofilm revealed that the highest cell density biofilm (1.5 × 10¹⁶ CFU/mL) was established within the polystyrene microtiter plate at 72 h post inoculation. Pseudomonas aeruginosa biofilms of different ages, treated with JHP (0.6 MOI) for different post‐infection durations, reduced biomass from 2 to 4.5 logs (60–90%). JHP treatment before biofilm development reduced the bacterial load up to 9 logs (>95% bacterial load reduction) as compared with untreated control, which highlights its potential to prevent biofilm formation in indwelling medical devices. Combinations of JHP with other phages or antibiotics could be an efficient alternative for P. aeruginosa biofilm removal in clinical and industrial settings.