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To determine prevalence of, seroprevalence of, and potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among a cohort of evacuees returning to the United States from Wuhan, China, in January 2020, we conducted a cross-sectional study of quarantined evacuees from 1 repatriation flight. Overall, 193 of 195 evacuees completed exposure surveys and submitted upper respiratory or serum specimens or both at arrival in the United States. Nearly all evacuees had taken preventive measures to limit potential exposure while in Wuhan, and none had detectable SARS-CoV-2 in upper respiratory tract specimens, suggesting the absence of asymptomatic respiratory shedding among this group at the time of testing. Evidence of antibodies to SARS-CoV-2 was detected in 1 evacuee, who reported experiencing no symptoms or high-risk exposures in the previous 2 months. These findings demonstrated that this group of evacuees posed a low risk of introducing SARS-CoV-2 to the United States.

Thymoquinone (TQ) is a bioactive phytochemical isolated from Nigella sativa and has been investigated for biochemical and biological activities in both in vitro and in vivo models. It is best known for its anticancer activities. Thymoquinone accomplishes anticancer activities through targeting multiple cancer markers including PPAR-γ, PTEN, P53, P73, STAT3, and generation of reactive oxygen species at the cancer cell surface. The radiolabeling of TQ with γ- and β-emitter radionuclide could be used as cancer diagnostic or therapeutic radiopharmaceutical, respectively. In this study, we are reporting the radiolabeling of TQ with technetium-99m ( 99m Tc), stability in saline and blood serum, internalization and externalization of 99m Tc-TQ using rhabdomyosarcoma cancer cells line. The quality control study revealed more than 95% labeling yield and stable in blood serum up to 4 hours. In vitro internalization rate was recorded 27.08% ± 0.95% at 1 hour post 2 hours internalization period and comparatively slow externalization. The results of this study are quite encourging and could be investigated for further key preclinical parameters to enter phase I clinical trials., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Cerebrovascular diseases are known as serious public health problem worldwide, which can be addressed more precisely through molecular imaging of non-functional brain cells. CDP-choline is an active cerebrovascular chemotherapeutic agent that can be used for diagnosis of cerebrovascular diseases post radiolabeling with γ-emitter radioisotopes. In this study we developed 99m Tc labeled CDP-choline for imaging of cerebrovascular diseases particularly alzheimer, stroke, and parkinson's diseases. The radiosynthesis reaction resulted 97.47±2.34% radiochemical with promising stability, that is, >95% up to 6 h in blood serum. The biodistribution study in healthy mice revealed non-accumulated uptake of radiochemical in key body organs; in brain it was 8.59±1.11% ID/g at 1h post-injection which washed-out leaving behind 0.87±0.61% ID/g at 24 h post-injection. The over-all data revealed the 99m Tc-CDP-choline could be a good candidate for further imaging investigations in diseased animal model.

Diethylenetriamine penta-acetic acid (DTPA), when complexed with a gamma (γ)-emitter radioisotope like 99m Tc, is used for renal function diagnosis and many other diagnostic applications. The main aim of this study was to develop a novel and versatile single-step methodology for the synthesis of a new 177 Lu-labeled radiopharmaceutical with high radiochemical yield, which can be used for diagnostic purposes and therapeutic purposes also. The single and well-defined 177 Lu-DTPA complex was radiochemically characterized by paper chromatography, thin-layer chromatography, high-performance liquid chromatography, and electrophoresis techniques. Dependence of the labeling yield of 177 Lu-DTPA complex on different factors was studied in detail. Biological evaluation was also performed in a normal rabbit by developing images under a γ camera at various time intervals. More than 99% labeling yield was obtained by reacting DTPA with 177 Lu at specific conditions (pH 7.0, 15 minutes reaction time at 100 °C). 177 Lu-DTPA complex showed high stability both at room temperature and in vitro. Biodistribution studies in normal mice indicated the fractional renal uptake of intravenously administered 177 Lu-DTPA complex, which reached in the kidneys within 2-3 minutes. Scintigraphy showed rapid clearance from the body. Based on these results, we propose that 177 Lu-DTPA complex might be used as an ideal candidate for functional evaluation of kidneys and the urinary tract, especially when needed to be transported to long-range consumer sites, because of its suitable half-life., (© 2019 Wiley Periodicals, Inc.)

99m Tc-ciprofloxacin scintigraphy is useful in the detection of gram-positive and gram-negative bacterial infections and also for differentiating the infection from aseptic inflammation. However, due to growing bacterial resistance to antibiotics, the 99m Tc-ciprofloxacin no longer can be effective in broad-spectrum infection imaging as it is gradually losing specificity. In this study, we are presenting our findings regarding the in vitro and in vivo susceptibility of 99m Tc-ciprofloxacin for multi-drug-resistant Staphylococcus aurous, Escherichia coli, and Pseudomonas aeruginosa bacterial strains which were isolated from clinical samples. The results of radiosynthesis of 99m Tc-ciprofloxacin showed more the 95% radiochemical purity and less than 5% radioactive impurities. In vitro 99m Tc-ciprofloxacin susceptibility test showed that E. coli offered more resistant to 99m Tc-ciprofloxacin as compared to S. aurous and P. aeruginosa. In vivo study using bacterial infection induced rabbit model also revealed lowest uptake by E. coli lesion. The T/NT values were obtained 1.96 ± 0.15 in the case of E. coli; 2.81 ± 0.51 in the case of S. aurous; and 2.32 ± 0.66 in the case of P. aeruginosa at 4 h post-injection. The SPECT infection imaging of S. aurous, E. coli, and P. aeruginosa bacterial infection induced rabbit models also indicated the clear accumulation in S. aurous and P. aeruginosa lesions while negligible uptake by E. coli lesion further verify the in vitro and in vivo susceptibility profile. On the bases of the results obtained, the 99m Tc-ciprofloxacin showed selective and poor broad spectrum SPECT infection imaging.

In this study we are presenting the development of technetium-99m ( 99m Tc) labeled ibuprofen for the imaging of aseptic inflammation. 99m Tc-Ibuprofen complex was developed by optimizing the radiolabeling conditions such as reaction time, ligand and reducing agent concentration, pH, reaction time and temperature. Following the addition of 600 µg of ibuprofen, 4 µg of stannous chloride as reducing agent and 300 MBq 99m Tc radioactivity; the pH of reaction mixture was adjusted to 11 and allowed to react for 15 min at room temperature. Chromatography analysis revealed > 94% 99m Tc-ibuprofen complex formation with promising stability in saline and blood serum up to 6 h. Biodistribution study using normal and sterile inflammation induced mice indicated low accumulation of labeled compound in key body organs; however, kidneys (14.76 ± 0.87% ID/g organ) and bladder (31.6 ± 3.0% ID/g organ) showed comparatively higher radioactivity due to main excretory path. Inflamed to normal tissues ratio (T/NT), at 1 h post-injection, showed promising value (4.57 ± 0.56). The SPECT imaging of artificially inflammation induced rabbit model also verified the biodistribution results. In conclusion, radiochemical purity and biological evaluation of 99m Tc-ibuprofen complex indicates the agent can be utilized for imaging of deep seated aseptic inflammation.

The development of functional imaging is a promising strategy for diagnosis and treatment of infectious and cancerous diseases. In this study, epirubicin was developed as a [ 99m Tc]-labeled radiopharmaceutical for the imaging of multi-drug-resistant Staphylococcus aureus infections. The labeling was carried out using sodium pertechnetate (Na 99m TcO 4 ; ~370 MBq). The other parameters such as amount of ligand, reducing agent (SnCl 2 .2H 2 O), and pH were optimized. The highest labeling yield ≥96.98% was achieved when 0.3 mg epirubicin, 13 μg SnCl 2 .2H 2 O, and ~370 MBq Na 99m TcO 4 were incubated at pH 7 for 15 min in the presence of ascorbic acid at room temperature. Radiochemical purity, stability, charge, and glomerular filtration rate were studied to evaluate the biological compatibility for in vivo administration. Biodistribution investigations showed radiotracer uptake (13.89 ± 1.56% ID/gm organ) by liver and 7.79 ± 0.38% ID/gm organ by kidneys at 30 min post-injection which promisingly wash out at 24 hr post-injection. Scintigraphy study showed selective uptake in S. aureus-infected tissues in contrast to turpentine oil-induced inflamed tissues. Target-to-non-target ratio (6.7 ± 0.05) was calculated at 1 hr post-injection using SPECT gamma camera. The results of this study reveal that the [ 99m Tc]-epirubicin can be a choice of imaging and monitoring the treatment process of multi-drug resistant S. aureus bacterial infections., (© 2018 John Wiley & Sons A/S.)

Treatment with radionuclide labeled regulatory peptides is a promising tool in the management of patients with inoperable receptor positive neuroendocrine tumors. Peptide receptor lutetium-177 radionuclide therapy currently has gained ample attention due to high specific accumulation of regulatory peptides at tumor cell surface and promising characteristics of β- and γ-energy photons of lutetium-177 radionuclide. In this study gastrin peptides analogues were labeled with lutetium-177 by subsequent mixing of 177 LuCl 3 (~ 185 MBq), ammonium acetate buffer of 5 pH, gentistic acid, aqueous solution of gastrin peptide analogues (1 mg/mL) and heating the reaction mixture at 98 °C which resulted in high radiochemical yield (> 96%). Chromatographic analysis was carried out to analyze the radiochemical purity. The shelf life and serum stability results showed the labeled peptides are sufficiently stable up to 4-h. Glomerular filtration rate study results showed moderate filtration through kidneys. The GFR values of 177 Lu-MGCL2 and 177 Lu-MGCL4 was noted 48 mL/min and 45 mL/min, respectively. Biodistribution and scintigraphy study using rat and rabbit models showed minimal non-target accumulation, moderate uptake by liver and kidneys. The promising radiochemical yield, stability, GFR values and biodistribution results of 177 Lu-MGCL2 & 4 indicate, the agents can be tested clinically for PRRT procedures.

Diagnosis of deep-seated bacterial infection remains a serious medical challenge. The situation is becoming more severe with the increasing prevalence of bacteria that are resistant to multiple antibiotic classes. Early efforts to develop imaging agents for infection, such as technetium-99m ( 99m Tc) labeled leukocytes, were encouraging, but they failed to differentiate between bacterial infection and sterile inflammation. Other diagnostic techniques, such as ultrasonography, magnetic resonance imaging, and computed tomography, also fail to distinguish between bacterial infection and sterile inflammation. In an attempt to bypass these problems, the potent, broad-spectrum antibiotic ciprofloxacin was labeled with 99m Tc to image bacterial infection. Initial results were encouraging, but excitement declined when controversial results were reported. Subsequent radiolabeling of ciprofloxacin with 99m Tc using tricarbonyl and nitrido core, fluorine and rhenium couldn't produce robust infection imaging agent and remained in discussion. The issue of developing a robust probe can be approached by reviewing the broad-spectrum activity of ciprofloxacin, labeling strategies, potential for imaging infection, and structure-activity (specificity) relationships. In this review we discuss ways to accelerate efforts to improve the specificity of ciprofloxacin-based imaging.

Here, we studied the protective effects of Satureja Khuzestanica essential oil (SKEO) as a potent anti-oxidant, against damage caused by chemotherapy with busulfan in testis and epididymal sperm of adult mice. The NMRI adult mice were assigned: G1: control, G2: was treated with busulfan (4 days, 3.2 mg/kg), G3: was treated with busulfan (4 days, 3.2 mg/kg) and SKEO (28 days, 225 mg/kg) at the same time, and G4: was pre-treated with SKEO (7 days, 225 mg/kg) and subsequently co-treated with busulfan (4 days, 3.2 mg/kg) and SKEO (28 days, 225 mg/kg). Apoptosis and Bcl-2 family gene expression were evaluated in sperm by the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay and Real-Time PCR, respectively. The level of oxidative stress was studied in sperm and testis by Superoxide Dismutase (SOD) and Glutathione Peroxidase (GPx) assays. Lactate Dehydrogenase (LDH), and Thiobarbituric assays were used for analyzing cytotoxicity and lipid peroxidation in testis and sperm of mice, (TBA) respectively. The results showed a significant decrease in the percentage of apoptotic sperm in G4 versus G2 and G3 (p < 0.05). SKEO pre-treatment potentially increased Bcl-2 expression and decreased BAX expression in sperm of G4 compared with G2 and G3. The activities of SOD and GPx were increased, also, LDH and TBA decreased significantly in testis and sperm of G4 compared with G2 and G3 (p < 0.05). SKEO pre-treatment had a notable role in reducing oxidative stress, apoptosis, cytotoxicity, and genotoxicity in sperm of busulfan-treated mice. In addition, cytotoxicity and oxidative stress were decreased significantly in testes of this group. Thereby, SKEO may inhibit busulfan-mediated apoptosis in sperm via decreasing oxidative stress and regulating Bcl-2 family genes expression. In conclusion, the beneficial properties of SKEO pre-treatment and co-treatment by its herbal potent anti-oxidants may reduce adverse effects of chemotherapy in the reproductive system in a rodent system., Abbreviations: SKEO: Satureja Khuzestanica essential oil; SOD: superoxide dismutase; GPx: glutathione peroxidase; LDH: lactate dehydrogenase; GC-MS: gas chromatography/mass spectrometry; TdT: terminal deoxynucleotidyl transferase; TUNEL: terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling; ROS: reactive oxygen species.

Epirubicin is an antineoplastic agent of anthracycline antibiotic, used for treating a variety of tumor types such as lymphoma, cancer of the breast, lung, ovary and stomach. The objective of this work was to demonstrate direct radiolabeling of epirubicin with 99m Tc, quality control, biological characterization and scientigraphic evaluation in tumor bearing mice. The 99mTc-epirubicin labeling was optimized by varying the amounts of ligand 100-350μg, stannous chloride dihydride 20-50μg and pH range 2-10 by using NaOH or HCl. The radiochemical purity of 99m Tc-epirubicin was evaluated by chromatographic techniques (Whatman No. 3 paper and ITLC-SG). HPLC analyses were performed to check purity of epirubicin and radiochemical purity of labeled 99m Tc- epirubicin. Biodistribution and scintigraphic imaging of 99m Tc-epirubicin was performed in normal and tumor bearing mice at various time intervals. The optimum conditions ensuring 99m Tc-epirubicin labeling yield as high as 99% by adding 35μg SnCl 2 .2H 2 O, 200μg of ligand at pH 6 for 30 min at room temperature (25°C±2°C). HPLC of 99m Tc-epirubicin shows about 99% binding of the compound with technetium-99m. Electrophoresis study indicated the neutral nature of 99m Tc-epirubicin. Biodistribution data and scintigraphic results showed that 99m Tc-epirubicin accumulated in the liver as well as in tumor with significant uptake and excellent retention. 99m Tc-epirubicin shows good stability in human serum. In vitro and in vivo studies revealed the significantly uptake of 99m Tc-epirubicin in the tumor, and also indicating the efficiency of 99m Tc-epirubicin as a tumor diagnostic agent.

Cancer is found to be the leading cause of death worldwide characterized by uncontrolled cell division. Nuclear medicines imaging using radiopharmaceuticals have pronounced potential for the diagnosis and treatment of cancers. Cyclophosphamide (CPH) is an antineoplastic drug which targets selectively cancer cells. In the present work, labeling of CPH with Tc-99m is performed for diagnostic purpose, which gave labeling yield as high as 99% using 20 μg SnCl 2 ·2H 2 O, 200 μg of ligand at pH 7 for 10 min reaction time at room temperature. The characterization of the prepared complex was performed using ITLC, electrophoresis, and HPLC. In vitro stability was analyzed in the presence of human serum at 37°C which has maximum value of 94 ± 0.5. The biodistribution studies of 99m Tc-CPH were performed in normal and tumor bearing Swiss Webster mice. The high accumulation of 99m Tc-CPH was observed in liver and tumours respectively at 4 hr after injection. Biodistribution results revealed that 99m Tc-CPH may be a potential tumour diagnostic agent simultaneously with chemotherapy., (© 2017 John Wiley & Sons A/S.)

Heart imaging radiopharmaceuticals could improve the diagnostic value of routine heart scanning for detecting cardiac disorders. The aim of the study was to prepare high radiochemical purity 99mTc-Digoxin in a yield of about 98%. The optimal conditions for labelling were as follows: 100μg of Digoxin, 2μg of SnCl2•2H2O, room temperature (25±1°C), reaction retention time of 30 min at pH 7. Under these conditions, the radiochemical yield of 99m Tc-Digoxin reaches 98%. In vivo bio distribution was performed in normal Swiss Albino mice at different time intervals after administration of 99m Tc-Digoxin.Scintigraphic study of 99m Tc-Digoxin was performed in rabbits. The heart uptake of 99m Tc-Digoxin was sufficiently high and thus may be a potential myocardial imaging radiopharmaceutical applicable in cardiology.

Kanamycin is an antibiotic, isolated from Streptomyces kanamyceticus, which is used to treat serious bacterial infections. The fact that the present radioligand 99m Tc-kanamycin used for diagnosis is short-lived, raised a need to label and study kanamycin with one of the most important beta (β) radiation emitting isotope 177 Lu. Labeling yield of 177 Lu-kanamycin was confirmed by different chromatography techniques such as paper chromatography, TLC, HPLC. Several experiments were performed to optimize labeling with changing reaction conditions such as pH, temperature, amount of ligand, and reaction time. In vitro stability analysis was performed incubation with human serum. Electrophoresis analysis was also conducted to determine the charge on 177 Lu-kanamycin. The biodistribution and scintigraphy were performed in normal mice and rabbit, respectively, at different time intervals of postinjection. 177 Lu-kanamycin was prepared with very high yield (~100%), with excellent stability in vivo and in vitro (>99% 6 hr postprep.), at pH 7. Maximum labeling was achieved at less reaction time (15 min), with maximum conjugation of the ligand (12.5 mg) with 177 Lu. Electrophoresis analysis showed net neutral charge. The radioligand showed rapid clearance from body in biodistribution and scintigraphy studies. The preparation 177 Lu-kanamycin could be used as a radio-pharmaceutical for infection imaging purpose, especially when transporting the radioligand to long-range distances., (© 2017 John Wiley & Sons A/S.)

Background: Influenza outbreaks can occur among passengers and crews during the Alaska summertime cruise season. Ill travellers represent a potential source for introduction of novel or antigenically drifted influenza virus strains to the United States. From May to September 2013-2015, the Alaska Division of Public Health, the Centers for Disease Control and Prevention (CDC), and two cruise lines implemented a laboratory-based public health surveillance project to detect influenza and other respiratory viruses among ill crew members and passengers on select cruise ships in Alaska., Methods: Cruise ship medical staff collected 2-3 nasopharyngeal swab specimens per week from passengers and crew members presenting to the ship infirmary with acute respiratory illness (ARI). Specimens were tested for respiratory viruses at the Alaska State Virology Laboratory (ASVL); a subset of specimens positive for influenza virus were sent to CDC for further antigenic characterization., Results: Of 410 nasopharyngeal specimens, 83% tested positive for at least one respiratory virus; 71% tested positive for influenza A or B virus. Antigenic characterization of pilot project specimens identified strains matching predominant circulating seasonal influenza virus strains, which were included in the northern or southern hemisphere influenza vaccines during those years. Results were relatively consistent across age groups, recent travel history, and influenza vaccination status. Onset dates of illness relative to date of boarding differed between northbound (occurring later in the voyage) and southbound (occurring within the first days of the voyage) cruises., Conclusions: The high yield of positive results indicated that influenza was common among passengers and crews sampled with ARI. This finding reinforces the need to bolster influenza prevention and control activities on cruise ships. Laboratory-based influenza surveillance on cruise ships may augment inland influenza surveillance and inform control activities. However, these benefits should be weighed against the costs and operational limitations of instituting laboratory-based surveillance programs on ships., (Published by Oxford University Press 2017. This work is written by [a] US Government employee[s] and is in the public domain in the US.)

Railway infrastructure monitoring is a vital task to ensure rail transportation safety. A rail failure could result in not only a considerable impact on train delays and maintenance costs, but also on safety of passengers. In this article, the aim is to assess the risk of a rail failure by analyzing a type of rail surface defect called squats that are detected automatically among the huge number of records from video cameras. We propose an image processing approach for automatic detection of squats, especially severe types that are prone to rail breaks. We measure the visual length of the squats and use them to model the failure risk. For the assessment of the rail failure risk, we estimate the probability of rail failure based on the growth of squats. Moreover, we perform severity and crack growth analyses to consider the impact of rail traffic loads on defects in three different growth scenarios. The failure risk estimations are provided for several samples of squats with different crack growth lengths on a busy rail track of the Dutch railway network. The results illustrate the practicality and efficiency of the proposed approach., (© 2017 The Authors Risk Analysis published by Wiley Periodicals, Inc. on behalf of Society for Risk Analysis.)

During the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC implemented travel and border health measures to prevent international spread of the disease, educate and protect travelers and communities, and minimize disruption of international travel and trade. CDC staff provided in-country technical assistance for exit screening in countries in West Africa with Ebola outbreaks, implemented an enhanced entry risk assessment and management program for travelers at U.S. ports of entry, and disseminated information and guidance for specific groups of travelers and relevant organizations. New and existing partnerships were crucial to the success of this response, including partnerships with international organizations, such as the World Health Organization, the International Organization for Migration, and nongovernment organizations, as well as domestic partnerships with the U.S. Department of Homeland Security and state and local health departments. Although difficult to assess, travel and border health measures might have helped control the epidemic's spread in West Africa by deterring or preventing travel by symptomatic or exposed persons and by educating travelers about protecting themselves. Enhanced entry risk assessment at U.S. airports facilitated management of travelers after arrival, including the recommended active monitoring. These measures also reassured airlines, shipping companies, port partners, and travelers that travel was safe and might have helped maintain continued flow of passenger traffic and resources needed for the response to the affected region. Travel and border health measures implemented in the countries with Ebola outbreaks laid the foundation for future reconstruction efforts related to borders and travel, including development of regional surveillance systems, cross-border coordination, and implementation of core capacities at designated official points of entry in accordance with the International Health Regulations (2005). New mechanisms developed during this response to target risk assessment and management of travelers arriving in the United States may enhance future public health responses. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

A complex of lincomycin was synthesized with technetium-99m. The synthesis was carried out by using SnCl2.2H2O as reducing agent and ascorbic acid as stabilizer. The effect of various parameters such as amount of ligand/reducing agent, pH value and reaction time on radio labeling process was studied. The characterization of the (99m)Tc-Lincomycin was performed by HPLC and electrophoresis Biodistribution studies were carried out by analyzing the model of bacterial infectious rats (Sprague-Dawley). The uptake of infectious lesions at different time interval was also studied by using scintigraphic technique. The complex showed effective target to non-target ratio for various inflammatory or infectious lesions. The (99m)Tc-Lincomycin effective binding to living bacteria and could be used successfully as an infection imaging agent.

Introduction: Laser dentistry is a one of the upcoming advanced treatment modality for oral mucosal lesions. Diode laser is a soft tissue laser that has found much acceptance in all branches of dentistry. Available compact size and feasibility has render diode laser an enhanced tool for today's clinical practice. The aim of this study is to determine the efficacy and safety of diode laser for the management of white lesions such as oral leukoplakia (OL) and oral lichen planus (OLP)., Methods: The study was conducted by using diode laser 980 nm on 10 patients with white lesions (5 OL and 5 OLP) aged between 35 to 65 years., Results: Of the 10 patients (5 OL and 5 OLP), 3 patients (30%) complained of moderate pain and 7 patients (70%) complained of mild pain, for first 3 days after laser irradiation, and pain disappeared at end of first week. There was no recurrence of the lesion during the 6-month follow up., Conclusion: Diode lasers provide acceptable clinical improvement of potentially malignant lesions with minimal side effects. It can be considered one of the best alternative treatment modality for oral mucosal lesions.

The Centers for Disease Control and Prevention (CDC) Quarantine Stations distribute select lifesaving drug products that are not commercially available or are in limited supply in the United States for emergency treatment of certain health conditions. Following a retrospective analysis of shipment records, the authors estimated an average of 6.66 hours saved per shipment when drug products were distributed from quarantine stations compared to a hypothetical centralized site from CDC headquarters in Atlanta, GA. This evaluation supports the continued use of a decentralized model which leverages CDC's regional presence and maximizes efficiency in the distribution of lifesaving drugs.

In response to the largest recognized Ebola virus disease epidemic now occurring in West Africa, the governments of affected countries, CDC, the World Health Organization (WHO), and other international organizations have collaborated to implement strategies to control spread of the virus. One strategy recommended by WHO calls for countries with Ebola transmission to screen all persons exiting the country for "unexplained febrile illness consistent with potential Ebola infection." Exit screening at points of departure is intended to reduce the likelihood of international spread of the virus. To initiate this strategy, CDC, WHO, and other global partners were invited by the ministries of health of Guinea, Liberia, and Sierra Leone to assist them in developing and implementing exit screening procedures. Since the program began in August 2014, an estimated 80,000 travelers, of whom approximately 12,000 were en route to the United States, have departed by air from the three countries with Ebola transmission. Procedures were implemented to deny boarding to ill travelers and persons who reported a high risk for exposure to Ebola; no international air traveler from these countries has been reported as symptomatic with Ebola during travel since these procedures were implemented.

Bacterial infection is found to be the cause of death throughout the world. Nuclear medicine imaging with the help of radiopharmaceuticals has great potential for treating infections. In the present work, clindamycin, a lincosamide antibiotic, was labeled with technetium-99 m (~380 MBq). Clindamycin has been proven to be efficient for treating serious infections caused by bacteria such as Staphylococcus aureus. Quality control, characterization, biodistribution, and scintigraphy of radiolabeled clindamycin were done, and labeling efficiency was determined by ascending paper chromatography. More than 95 % labeling efficiency with technetium-99 m ((99m)Tc) was achieved at pH 6-7 while using 2.5-3 μg SnCl2 · H2O as a reducing agent and 100 μg of ligand at room temperature. The characterization of the compound was performed by using electrophoresis, HPLC and shake flask assay. Electrophoresis indicates the neutral behavior of (99m)Tc-clindamycin. HPLC analysis confirms the single specie of the labeled compound, while shake flask assay confirms high lipophilicity. The biodistribution studies of (99m)Tc-clindamycin were performed Sprague Dawley rats bearing bacterial infection. Scintigraphy and biodistribution studies showed a high uptake of (99m)Tc-clindamycin in the liver, heart, lung, and stomach as well as at S. aureus-infected sites in rabbits.

Differentiation of bacterial and sterile inflammation will have a significant impact on the current clinical practice. Ceftriaxone (CTRX) was labelled with (99m) Tc and assessed for its ability to depict infection on scintigraphy. Stoichiometry was performed to optimize labelling parameters. Stability and bacterial binding was verified and biodistribution pattern was seen in normal, infected/inflamed animal models. (99m) Tc-CTRX prepared at pH 7 with stannous chloride of 50 µg, ligand of 30 mg, and boiling for 10 min gave labelling yield of 96.2 ± 0.2% with good stability. In vitro binding was higher for Escherichia coli than Staphylococcus aureus. Biodistribution in normal rats showed high uptake in hepatobiliary system, gut and urinary system. In animal models induced with infection or inflammation, lesion to normal ratios at 4 h were 2.36 ± 0.21, 12.66 ± 1.44 and 1.40 ± 0.01 with S. aureus infection, E. coli infection and turpentine oil inflammation, respectively. Infection specificity especially for E. coli was also confirmed on scintigraphic findings. Ceftriaxone can be labelled with (99m) Tc with high labelling yield at pH compatible with that of blood. Our preparation has shown stability in vitro and in human serum, and binds preferentially with bacteria. (99m) Tc-CTRX scintigraphy can be used to delineate sites of active infection and to differentiate infection and inflammation., (Copyright © 2014 John Wiley & Sons, Ltd.)

Purpose: Statistical shape models have shown improved reliability and consistency in cardiac image segmentation. They incorporate a sufficient amount of a priori knowledge from the training datasets and solve some major problems such as noise and image artifacts or partial volume effect. In this paper, we construct a 4D statistical model of the left ventricle using human cardiac short-axis MR images., Methods: Kernel PCA is utilized to explore the nonlinear variation of a population. The distribution of the landmarks is divided into the inter- and intra-subject subspaces. We compare the result of Kernel PCA with linear PCA and ICA for each of these subspaces. The initial atlas in natural coordinate system is built for the end-diastolic frame. The landmarks extracted from it are propagated to all frames of all datasets. We apply the 4D KPCA-based ASM for segmentation of all phases of a cardiac cycle and compare it with the conventional ASM., Results: The proposed statistical model is evaluated by calculating the compactness capacity, specificity and generalization ability measures. We investigate the behavior of the nonlinear model for different values of the kernel parameter. The results show that the model built by KPCA is less compact than PCA but more compact than ICA. Although for a constant number of modes the reconstruction error is a little higher for the KPCA-based statistical model, it produces a statistical model with substantially better specificity than PCA- and ICA-based models., Conclusion: Quantitative analysis of the results demonstrates that our method improves the segmentation accuracy.

Autologous nerve grafts to bridge nerve gaps have donor site morbidity and possible neuroma formation resulting in development of various methods of bridging nerve gaps without using autologous nerve grafts. We have fabricated an acellular muscle stuffed vein seeded with differentiated mesenchymal stem cells (MSCs) as a substitute for nerve autografts. Human vein and muscle were both decellularized by liquid nitrogen immersion with subsequent hydrolysis in hydrochloric acid. Human MSCs were subjected to a series of treatments with a reducing agent, retinoic acid, and a combination of trophic factors. The differentiated MSCs were seeded on the surface of acellular muscle tissue and then stuffed into the vein. Our study showed that 35-75% of the cells expressed neural markers such as S100b, glial fibrillary acidic protein (GFAP), p75 NGF receptor, and Nestin after differentiation. Histological and ultra structural analyses of muscle stuffed veins showed attachment of cells onto the surface of the acellular muscle and penetration of the cells into the hydrolyzed fraction of muscle fibers. We implanted these muscle stuffed veins into athymic mice and at 8 weeks post-implantation, the acellular muscle tissue had fully degraded and replaced with new matrix produced by the seeded cells. The vein was still intact and no inflammatory reactions were observed proving the biocompatibility and biodegradability of the conduit. In conclusion, we have successfully formed a stable living nerve conduit which may serve as a substitute for autologous nerves., (Copyright © 2012 Orthopaedic Research Society.)

This paper presents a model to assess the contribution of Human and Organizational Factor (HOF) to accidents. The proposed model is made up of two phases. The first phase is the qualitative analysis of HOF responsible for accidents, which utilizes Human Factors Analysis and Classification System (HFACS) to seek out latent HOFs. The hierarchy of HOFs identified in the first phase provides inputs for the analysis in the second phase, which is a quantitative analysis using Bayesian Network (BN). BN enhances the ability of HFACS by allowing investigators or domain experts to measure the degree of relationships among the HOFs. In order to estimate the conditional probabilities of BN, fuzzy analytical hierarchy process and decomposition method are applied in the model. Case studies show that the model is capable of seeking out critical latent human and organizational errors and carrying out quantitative analysis of accidents. Thereafter, corresponding safety prevention measures are derived., (Copyright © 2011 Elsevier B.V. All rights reserved.)

There are many medical image processing software tools available for research and diagnosis purposes. However, most of these tools are available only as local applications. This limits the accessibility of the software to a specific machine, and thus the data and processing power of that application are not available to other workstations. Further, there are operating system and processing power limitations which prevent such applications from running on every type of workstation. By developing web-based tools, it is possible for users to access the medical image processing functionalities wherever the internet is available. In this paper, we introduce a pure web-based, interactive, extendable, 2D and 3D medical image processing and visualization application that requires no client installation. Our software uses a four-layered design consisting of an algorithm layer, web-user-interface layer, server communication layer, and wrapper layer. To compete with extendibility of the current local medical image processing software, each layer is highly independent of other layers. A wide range of medical image preprocessing, registration, and segmentation methods are implemented using open source libraries. Desktop-like user interaction is provided by using AJAX technology in the web-user-interface. For the visualization functionality of the software, the VRML standard is used to provide 3D features over the web. Integration of these technologies has allowed implementation of our purely web-based software with high functionality without requiring powerful computational resources in the client side. The user-interface is designed such that the users can select appropriate parameters for practical research and clinical studies., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Heterotopic ossification (HO) is the abnormal development of bone within soft tissue and a rare complication in Guillain-Barré syndrome (GBS). Only a few cases had been reported so far. We present the case of a 39-year-old man who had been diagnosed to have GBS about 10 years ago, presenting with severe limitation of both active and passive range of motion in bilateral shoulder, elbow and hip joints and was found to have massive heterotopic ossification. In our patient, it could be a myriad of factors such as prolonged ICU stay with mechanical ventilation and hypoxia, long-standing immobilization and hypomobility with incomplete flaccid paralysis.

A 56-year-old man became quadriplegic, bed bound, and carer-dependent secondary to cervical osteomyelitis. Three years later, he presented with generalised spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his hips and knees prevented ischial sitting. Injections of botulinum toxin type A to both hamstrings and gastrosoleuii controlled the flexor spasticity of his lower limbs and facilitated rehabilitation and wound healing through proper positioning, wound care, stretching, and weight-bearing exercises. A few weeks later, the patient could better position himself in bed (prone lying) and on his wheelchair (ischial sitting). His spasm-related pain lessened and his mobility and activities of daily living improved. The sacral pressure sore healed completely a few months later. The patient could sleep better, feed with set-up and adaptive aids, groom, dress, and transfer himself with minimal assistance. The effects of botulinum toxin extended beyond just spasticity reduction. His upper extremity function, mobility, and social well-being were all improved through better positioning.

Bowel Dysfunction is one of the least looked at problems in Spinal Cord Injury (SCI). The goals of this study are to understand bowel dysfunction in SCI and its effects on quality of life (QOL). Cross-sectional study based on interview and assessment of 41 clients. A majority of them were dissatisfied. Bowel opening time was long in about 65% while 76.6% were incontinent. Socially, approximately half refrained from outings even though 90.3% of them carried out bowel evacuation before going out. Attention to bowel education is necessary to improve social continence.

Poor glycaemic control and the duration of diabetes mellitus are known to accelerate development and progression of neuropathy. Diabetic co-morbidities: hypertension and hyperlipidaemia, have been postulated to associate with development of neuropathy. A diabetic foot with low temperature and frequent exposure to low temperature environment has recently been hypothesized to be at higher risk to develop early neuropathy. This cross-sectional study is undertaken to identify risk factors for diabetic neuropathy and the association between foot temperature and development of diabetic neuropathy by using simple clinical examination in the outpatient setting. From April 18, to April 30, 2005, universal sampling method was used to select 134 diabetic patients (type 1 or type 2 for >1 year) with peripheral neuropathy. Excluded are those with chronic alcoholism, drug-induced neuropathy, dietary history of vitamin B deficiency and family history of porphyria and hereditary sensorimotor neuropathy. The patient's duration of diabetes, glycaemic control status and the presence of co-morbids: hypertension and hyperlipidemia, were recorded. The temperature of the foot was measured by using thermo buddy. Of 134 patients representing Malaysian ethnic distribution with an equal number of males and females, 20.1% were in the age group of 61 to 65 years and, 85.1% and 67.9% belonged to lower socioeconomic and educational groups respectively. Associations between diabetic neuropathy and glycaemic control (p = 0.018) and duration of diabetes (p < 0.05) were significant. However, hypertension, hyperlipidaemia and low foot temperature were not significantly associated with development of diabetic neuropathy. Poor glycaemic control is significantly associated with diabetic neuropathy. Foot temperature alteration is merely an effect of autonomic neuropathy with a cold foot is attributed to co-existing peripheral arterial disease.

The incidence of spinal injuries in Malaysia is on the rise following similar trend of rapid development and increasing number of building constructions sites, and motor vehicles. This epidemiological study was aimed at compiling local data with a view to identifying target areas for preventive measures as well as improvement strategies in the management of these potentially devastating injuries. Seventy eight patients admitted with spine trauma in 1998 in a level-one trauma centre were retrospectively reviewed. All records were traced from the admission and discharge books of the orthopaedic wards, accident and emergency wards, operative registration book, spinal rehabilitation ward and orthopaedic registration data of the Department of Orthopaedics, Hospital Kuala Lumpur. Details on pre-treatment neurological and radiological level of injury and post-treatment outcomes were recorded according to the American Spinal Injury Association (ASIA) impairment scale. Most patients (61.5%) were in the productive ages of less than 34 years with a 4:1 male to female ratio. Majority were due to motor vehicle accidents (57.7%) and fall from a height (28.3%). The thoraco-lumbar junction was the most common site of injury followed by the lower cervical region with 62.5% of which associated with neurological deficit. Neurological deficits: 11 ASIA-A, 1 ASIA-B, 6 ASIA-C, and 3 ASIA-D were detected in 21 (27%) patients with fall from height (50%) particularly landing on the feet (50%) and recreational sports (100%) were the risk factors. Less than 10% of patients were treated surgically and this explains an average 39.4 days of hospitalization (5 times longer in patients treated non-operatively). On discharge, four patients with incomplete neurology recovered to ASIA-E status and the remaining improved to ASIA-C and -D in one and five patients respectively. Only one patient with complete neurology improved to ASIA-B status following surgical treatment. The demographic profiles of our patients were comparable to other series in the literature but still inadequate to provide enough epidemiological data. A multicenter study to provide a larger pool of patients is needed.

The diagnosis of the different forms of thalassemia is one of the important applications of analysis of globin chains. These analyses are done by high performance liquid chromatography (HPLC) using a MONO-S cation exchange column and ether is used for washing the globin powder in the final step. The presence of peroxide impurities in ether could change the structure of the globin chains. In the chromatograms, these modified globins appear as separated peaks next to the unmodified globin peaks. In these cases, the alpha/beta ratio exceed by artifact the correct value. Our study demonstrates that diagnostic centers should ensure that the ether they use is pure.

Bioavailability refers to that fraction of nutrients which is utilized by the body out of the total indigested amount. Various direct and indirect methods for the determination of bioavailability are available. We determined the bioavailability of iron from fortified wheat flour using both in vitro and in vivo methods. The bioavailability data will be used to make the recommendation for a fortification strategy in Pakistan. The in vitro bioavailability of iron from fortified wheat flour was determined using in vitro enzymatic digestion and fermentation by simulating the condition of the small intestine and colon in the laboratory. Different products were prepared from the fortified ferrous sulfate (FeSO4) and unfortified wheat flour. The total iron of the samples was measured by the wet-digestion method and analyzed on an atomic absorption spectrometer (AAS). To obtain the percentage of iron released, the samples were subjected to pepsin digestion and dialysis. The dialysate was collected at 3, 6, 9, and 12 hours and read on an AAS. The retentates from the above were subjected to the fermentation condition of the colon by inoculating it with human fecal inoculum and incubating it for 24 hours at 37 degrees C under anerobic conditions. The dialysate was collected at 3- and 6-hour intervals and read on an AAS. More iron was released from fortified wheat flour (4.6%), leavened chapati (6.8%), and Nan (15.1%) than from the unfortified control samples. Fermentation and leavening resulted in a better release, which was evident from in vitro digestion results.

Colonoscopy is an integral part of the clinician armamentarium in the diagnosis of colorectal cancer and its precursor, the adenoma. Polypoid lesions when identified can be excised at colonoscopy and in turn reduce the risk of colorectal cancer. We prospectively evaluated the yield of colorectal cancer and adenomatous polyps by indication for colonoscopy over a one-year period. A total of 375 colonoscopies were carried out. The more common indications of colonoscopy were rectal bleeding, abdominal pain, surveillance of colorectal cancer and altered bowel habit. The highest yield for cancer was for rectal bleeding with 12.5% while surveillance of patients with a history of polyps yielded the highest percentage of new polyps. We conclude that rectal bleeding as an indication for colonoscopy yielded the highest number of cancers.

A retrospective review of thirty-eight patients (16 males and 22 females) with spinal infection between 1993 and 1998 revealed that the mean age was 39.9 years and the peak incidence was in the 5th decade of life. Infections in thirty-two patients (84.2%) were tuberculous in origin, 13.2% were pyogenic and 2.6% were fungal. Back pain was a symptom in 94.7% while 55.8% had neurological deficits, of which two-thirds were tuberculous in origin. Twenty-two patients (57.9%) had an impaired immune status secondary to pulmonary either tuberculosis, diabetes mellitus, intravenous drug abuse, prolonged steroid treatment, malnutrition, or advanced age. History of contact with tuberculous patients was elicited in 31.3%, extraskeletal tuberculosis was found in 28.1%, while Mantoux test was only positive in 53.1% of tuberculous patients. Majority of the cases (57.9%) involved lumbar vertebra. The histopathological examination was only positive in 22.2% from material taken via CT guided biopsy but 93.3% were found to be conclusive from open biopsy. 4 out of 5 patients who had a pyogenic infection were treated conservatively and produced a good result. There was no difference in outcome for tuberculosis patients treated with either the 3 drug or 4 drug regimen. Anterior decompression and bone grafting in tuberculous patients was superior in terms of a faster fusion rate, early pain relief and prevention of kvphotic deformity. The initial neurological deficit did not reflect the future prognosis of patients with spinal infection.

Uncomplicated falciparum malaria patients were randomly assigned to receive either 25 mg/kg chloroquine (CHL) over 3 d or a statim dose of 25 mg/kg sulfadoxine (SDX) plus 1.25 mg/kg pyrimethamine (PYR). Patients were followed up for 28 d and the parasite response graded according to World Health Organization criteria. Overall resistance to CHL was 63.3% and 47.4% to SDX/PYR. RI, RII and RIII rates were 9.1%, 42.4% and 12.1% for CHL and 10.5%, 21.1% and 15.8% for SDX/PYR, respectively. Degree and rates of resistance to CHL were significantly correlated with pre-treatment parasite density, but not those to SDX/PYR. Plasma CHL and SDX/PYR levels were within the reported ranges and were not significantly different in patients with sensitive and resistant responses.

A hazard analysis (which included watching operations, measuring temperatures of foods throughout preparation and display, and sampling and testing for microorganisms of concern) was conducted of a street vendor's operation. Chat is a popular dish in certain areas of Pakistan. It consists of sliced cooked potatoes, fried graham and pulse dough, and chick peas or red beans garnished with lasi (a fermented milk) and a fruit syrup. Staphylococci reached the cooked potatoes during peeling, cutting, and other handling. These bacteria increased up to 10 5 while the contaminated foods were held for several hours. Counts up to 10 5 Bacillus cereus were isolated from the cooked doughs after a 6-h or longer holding period. Large numbers (usually >10 5 ) of coliform bacteria and aerobic mesophilic colonies (10 6-9 ) were isolated from all foods after handling and holding for several hours. Ingestion of these foods must be considered high risk unless handling of cooked items can be kept to a minimum and the time of holding reduced to less than 6 h. Critical control points are handling after cooking and holding on display. Health agency personnel in developing countries, vendors, and consumers of these foods need to be informed of the hazards and appropriate preventive measures.

Hazard analyses were conducted in 13 homes in each of a village and a town in Pakistan. Pulses, lentils, chick peas, potatoes, rice, and combinations of them, curd, and weaning preparations were commonly prepared in both locations, and meat dishes were prepared in the town. Cooked foods were left, usually at room ambient temperature, overnight in over 50% of the homes. Samples of foods cooked in the morning and eaten at noon usually had mesophilic aerobic colony counts less than 10 4 CFU/g, but those left overnight usually ranged between 10 6-9 CFU/g. Coliform bacteria were isolated from 77% of samples; many of the counts exceeded 10 5 /g. Greater than 10 4 /g Staphylococci aureus were isolated from curd and buffalo milk which had been previously heated. Clostridium perfringens were isolated from 18% of samples; once from pulses left overnight in quantities exceeding 10 7 /g. Only three samples contained Bacillus cereus . Salmonella was not recovered from any of 28 samples. Hazards were primarily associated with holding the foods after preparation. Critical control points are cooking, manipulation of foods after cooking, holding cooked foods, and reheating.

Hazard analyses (which included watching operations, measuring temperatures of foods throughout preparation and display, and sampling and testing for microorganisms of concern) were conducted of vending operations of chicken, rice, pulse patties, and ice cream in a resort town in Pakistan. Salmonellae were isolated from ground meat, chicken flesh (from all operations surveyed), cutting boards, egg shells (eggs used in pulse patties), and buffalo milk (used for milk shakes). Greater than 10 5 coliform bacteria were isolated from raw milk, ice-cream mixes and products, and pulse-patty mix. Time-temperature exposure during cooking was adequate to kill salmonellae, but there were potentials for recontamination from cutting boards, knives, and hands of the vendor. Buffalo milk was held in a freezer and not boiled by the vendor as is usual in Pakistani homes to retard spoilage. Hence, because pathogens were not killed, milk shakes were a health risk. Pulse patties were not always thoroughly cooked, so pathogens could have survived. Holding stacks of them on a griddle for several hours would have allowed germination and growth of bacterial spores and growth of resulting cells. Health agency personnel in developing countries, vendors, and consumers of these foods need to be informed of the hazards and appropriate preventive measures.

Hazards of milk-based products were conducted in three confectionery manufacturing shops in a city in Pakistan. The incoming khoa (a heat-concentrated milk product having a water activity of approximately 0.97) was initially contaminated with staphylococci and contained enterotoxin. The confectionery was subsequently cooked to temperatures that would be lethal to staphylococci, but staphylococci were often found in high numbers in the finished products. Recontamination occurred during handling. Khoa -filled confectionery and confectionery made from renin-processed cheese were contaminated by salmonellae. The contaminants reached the products either during cooling or handling after cooking. Multiplication occurred in the warm environment of the shop and may continue in products having high water activity during transport and within retail outlets. Critical control points are source of ingredients (particularly khoa ), formulation, cooking (except for preformed enterotoxins), cooling, and cold storage. Milk-based products of the types evaluated pose a high risk of causing foodborne illness.

Hazard analyses (which included watching operations, measuring temperatures of foods throughout preparation and display, and sampling and testing for microorganisms of concern) were conducted of vending operations at a railway and a bus station in a large city in Pakistan. Commonly prepared foods which were surveyed included: rice, pulses, chick peas, ground meat and potato mixtures, meat stew, and okra. Temperatures were measured and samples were collected from a variety of other foods. Large numbers (10 4-7 ) of Clostridium perfringens were isolated from samples of pulses, ground meat dishes, and chick peas collected during display, 8 to 10 h after cooking. Aerobic colony counts were also high in these and other foods that were held for several hours, unless hot, at temperatures >55°C throughout the holding periods or periodic reheating practiced (which was done by a few vendors). Cooking was usually thorough, but spores survived which germinated during the display period. High temperature holding or periodic reheating maintained safe foods, and hence, are critical control points for these operations. Education about these matters ought to be directed at health and transportation authorities, vendors, and the public.