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Background: This article uses case data from Operation Restore Hope to assess the effectiveness of models used during disaster response. Disasters take the form of emergencies and demand rapid response. As such, an understanding of models used in emergencies edifies knowledge on disaster preparedness and response. Objectives: This study aims to describe and assess the effectiveness and weaknesses of the intervention model used by Higherlife Foundation (HLF) in responding to disasters. Method: The four-tier approach used by HLF in this intervention. Secondary data were gathered using content and thematic analyses and primary data were gathered using key informant interviews, focus group discussions and participant observation. In each of the four phases, emphasis was placed on flagging out the role of HLF with the view of bringing to light what worked and what failed to work. Results: The four phases of the model enabled smooth execution of the intervention, with the last phase providing a good exit strategy. Furthermore, the model partly used indigenous voices to achieve its intended purpose. However, the model must have been prepared before the disaster to factor in the pre-disaster phase. Inclusion of such a phase must have seen the evacuation of people before the disaster following early warnings that were given. Conclusion: The model used is in this study comprised four phases that logically feed into and from each other, and the model concludes with a good exit strategy that empowers surviving victims. It recommended that a pre-disaster phase must have been part of the model to minimise on the extent and cost of damage.

This paper addresses the discrepancy between model findings and field data obtained and how it is minimized using the binning smoothing techniques: means, medians, and boundaries. Employing both the quantitative and the qualitative methods to examine the complex pattern involved in COVID-19 transmission dynamics reveals model variation and provides a boundary signature for the potential of the disease’s future spread across the country. To better understand the main underlying factor responsible for the epidemiology of COVID-19 infection in Ghana, the continuous inflow of foreigners, both with and without the disease, was incorporated into the classical Susceptible-Exposed-Quarantined-Recovered SEIQR model, which revealed the spread of the COVID-19 by these foreigners. Also, the diffusion model provided therein gives a threshold condition for the spatial spread of the COVID-19 infection in Ghana. Following the introduction of a new method for the construction of the Lyapunov function for global stability of the nonlinear system of ODEs was observed, overcoming the problem of guessing for the Lyapunov function.

The strength behavior of Corn Husk Ash polymer concrete reinforced with coconut fibre was investigated in this study. The study assessed the suitability of using coconut fibre in concrete to improve its strength properties. The concrete was prepared and cured based on British Standard. Different proportions of the coconut fibre as well as the Corn Husk Ash (CHA) polymer were used in the concrete mixes, with a total of nineteen different mix proportions. The specimens were cured for 28, 90 and 180 days. Compressive strength, tensile splitting strength, torsion and toughness were determined using specimens from the various mixes. Tests were conducted on the 28th, 90th and 180th days of curing, following (Compression) and (Tensile Splitting). Analysis of Variance (ANOVA) test was conducted to determine the differences in the behavior of the different mixes as well as the correlation between the different constructs. The addition of coconut fibre to the concrete improved the toughness, torsion and to some extent the tensile strength of the concrete at the standard curing age of 28 days. CHA as an additive to the concrete resulted in a positive relationship with the Torsion and Toughness properties of concrete at later curing age at 1% level of significance (r = 0.480 and r = 0.730, p

Category: Trauma; Ankle Introduction/Purpose: Intramedullary fixation of the distal fibula in unstable ankle fractures provides an alternative treatment strategy to traditional techniques and may reduce the complication profile. While often reserved for soft-tissue protection or elderly patients, the indications for this technique continue to expand. The purpose of this study was to evaluate the radiographic outcomes of ankle fractures treated with intramedullary fixation of the distal fibula with screw or flexible fixation of the syndesmosis. Methods: A retrospective case-series was performed of patients >18 years old with unstable ankle fractures treated at a single institution. Patients were treated with intramedullary fixation of the distal fibula and screw or suture-button fixation of the syndesmosis if indicated. Radiographic parameters measured included the medial clear space, tibiofibular overlap, tibiofibular clear space, talocrural angle, and fracture displacement. Fracture pattern, comorbidities, and postoperative complications were also assessed. Results: Fourteen patients (6 males, 8 females) with torsional ankle fractures (71% SER-IV patterns) were included in the study with a mean follow-up period of 5 months. Five patients had suture-button fixation and one patient had trans-syndesmotic screw fixation of the syndesmosis. All patients had improvement in radiographic parameters following surgical stabilization. Medial clear space decreased from a mean of 5.6 +- 3.1mm to 2.8 +- 0.79mm (p

Abstract Introduction Metformin is a widely prescribed biguanide antidiabetic drug that has been implicated as a cause of hemolytic anemia in three previous case reports. We report a case of rapidly fatal hemolysis that was temporally associated with the initiation of metformin treatment for diabetes. Clinicians need to be aware of this rare but potentially serious side effect of metformin. Case presentation A 56-year-old Caucasian man with type 2 diabetes mellitus was started on metformin to improve glycemic control. Shortly afterwards, he developed progressive fatigue, exertional dyspnea, cranberry-colored urine and jaundice. Laboratory studies showed severe hemolysis, with a drop in hemoglobin from 14.7 to 6.6 g/dl over 4 days, markedly elevated lactate dehydrogenase, bilirubin and reticulocyte counts, and a low haptoglobin level. A peripheral blood smear showed no schistocytes, and a direct Coombs test was positive for anti-IgG and negative for anti-C3. Despite corticosteroid treatment and transfusion of packed red blood cells, the patient developed increasing dyspnea, hypotension, further decline in hemoglobin to 3.3 g/dl, and fatal cardiorespiratory arrest 12 hours after admission. Conclusion The serologic findings in this case suggest an autoimmune hemolytic anemia, caused either by a drug-induced autoantibody or a warm autoantibody. Based on the temporal association with metformin and the lack of other clear precipitating causes, we propose that metformin-induced hemolysis with a drug-induced autoantibody is a strong possibility. This mechanism differs from a previously described case with a possible antibody to the erythrocyte-drug complex. It has been shown, however, that hemolysis may occur via multiple mechanisms from the same drug. Clinicians should consider the possibility of metformin-associated immune hemolytic anemia in patients with otherwise unexplained hemolysis.

Heavy metals environmental pollution has become a global menace requiring constant biomonitoring and concerted efforts towards its reduction. There are reports of heavy metals pollution of Usuma River, Gwagwalada, Federal Capital Territory, Nigeria. However, information on the direct and indirect health impacts of such pollution on inhabiting fish and on their human consumers are non-existent, especially in Oreochromis mossambicus. The analyses of the physicochemical parameters of Usuma River water, fish heavy metals, histopathological changes, and health risks were performed according to standard procedures. The physicochemical characteristics of the Usuma River water were within acceptable ranges. The Pb bioaccumulation at 2.5100 ± 0.42 mg/kg was significantly (p < 0.05) higher than the values recorded for Cd at 0.4267 ± 0.16 mg/kg and zinc at 0.6027 ± 0.02 mg/kg. Nevertheless, Pb and Cd bioaccumulated more than their recommended permissible levels. Human health risks assessment revealed no immediate carcinogenic risk at a target rate of between 1.2690 × 10 -5 - 2.3530 × 10 -5 . The current heavy metals' concentration posed no long-term non-carcinogenic risk at a hazard index of less than one. This is because the target rate figure above 1.0 × 10 -3 and the hazard index figure above one signifies great health risks. The recorded gills and hepatic cellular changes did not affect organ functionalities as their obtained degree of tissue change figures were all below 10 based on the protocol. Although there was a positive strong correlation between the water temperature and its biochemical oxygen demand as well as between the water dissolved oxygen content and gill cellular changes, a negative strong correlation existed between the water pH and its electrical conductivity and total dissolved solids. The findings highlighted the progressing volatility of heavy metals pollution dynamics within the study area that could pose great human health risks, if unchecked., Competing Interests: Declarations Ethical approval The University of Abuja Ethics Committee on Animal Use (UAECAU) approved the work with Reference no.: UAECAU/2021/004. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background/Objectives: Cancer-associated cachexia in head and neck squamous cell carcinoma (HNSCC) is challenging to diagnose due to its complex pathophysiology. This study aimed to identify metabolic biomarkers linked to cachexia and survival in HNSCC patients using [ 18 F]FDG-PET/CT imaging and machine learning (ML) techniques. Methods: We retrospectively analyzed 253 HNSCC patients from Vienna General Hospital and the MD Anderson Cancer Center. Automated organ segmentation was employed to quantify metabolic and volumetric data from [ 18 F]FDG-PET/CT scans across 29 tissues and organs. Patients were categorized into low weight loss (LoWL; grades 0-2) and high weight loss (HiWL; grades 3-4) groups, according to the weight loss grading system (WLGS). Machine learning models, combined with Cox regression, were used to identify survival predictors. Shapley additive explanation (SHAP) analysis was conducted to determine the significance of individual features. Results: The HiWL group exhibited increased glucose metabolism in skeletal muscle and adipose tissue ( p = 0.01), while the LoWL group showed higher lung metabolism. The one-year survival rate was 84.1% in the LoWL group compared to 69.2% in the HiWL group ( p < 0.01). Pancreatic volume emerged as a key biomarker associated with cachexia, with the ML model achieving an AUC of 0.79 (95% CI: 0.77-0.80) and an accuracy of 0.82 (95% CI: 0.81-0.83). Multivariate Cox regression confirmed pancreatic volume as an independent prognostic factor (HR: 0.66, 95% CI: 0.46-0.95; p < 0.05). Conclusions: The integration of metabolic and volumetric data provided a strong predictive model, highlighting pancreatic volume as a key imaging biomarker in the metabolic assessment of cachexia in HNSCC. This finding enhances our understanding and may improve prognostic evaluations and therapeutic strategies.

Background: Sinonasal malignancies with orbital invasion have dismal prognosis even when treated with orbital exenteration (OE). Sugawara et al. developed a surgical strategy called "extended-OE (EOE)," showing encouraging outcomes. We hypothesized that a similar resection is achievable under endoscopic guidance through the exenterated orbit (endoscopic-EOE)., Methods: The study was conducted in three institutions: University of Vienna; Mayo Clinic; University of Insubria; 48 orbital dissections were performed. A questionnaire was developed to evaluate feasibility and safety of each step, scoring from 1 to 10, ("impossible" to "easy," and "high risk" to "low risk," respectively), most likely complication(s) were hypothesized., Results: The step-by-step technique is thoroughly described. The questionnaire was answered by 25 anterior skull base surgeons from six countries. Mean, median, range, and interquartile range of both feasibility and safety scores are reported., Conclusions: Endoscopic-EOE is a challenging but feasible procedure. Clinical validation is required to assess real-life outcomes., (© 2024 Wiley Periodicals LLC.)

Background: Flaps have become an integral part of plastic and reconstructive surgery. The robust blood supply of such flaps is a prerequisite to reduce flap failure. Despite the reported versatility of the occipital flap, comprehensive anatomical studies on its perforators and perforasomes are lacking. Hence, we examined the perforators originating from the occipital artery and their associated perforasomes, aiming to fill this knowledge gap for reconstructive surgery techniques., Methods: 39 of 40 occipital arteries of 20 fresh anatomical head specimens were dissected. Perforators with a least an outer diameter of 0.50 mm were identified and injected with dye to color their respective perforasomes. Location and size of the colored skin areas were determined as well as the location of their perforators were documented and analyzed., Results: In total, 183 perforators were found and described. The mean diameter of these vessels was 0.88 ± 0.27 mm (0.5-2.1 mm). The mean area of the perforasomes was 1288.26 ± 662.51 mm 2 (144.60-3890.60 mm 2 ). They were localized over the whole nuchal and occipital area. Lastly, perforator diameters were significantly associated with the size of their resulting perforasomes., Conclusion: This study is the first comprehensive overview of perforators and associated perforasomes of the occipital artery on a respectable amount of specimen. The arterial supply of big portions of the occipital and nuchal area is provided solely by the perforators of the occipital artery. For flap surgery, perforator diameter is a crucial detail to be considered in the decision-making process., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Purpose: Human papilloma virus (HPV)-positive head and neck squamous cell carcinoma (HNSCC) displays distinct epidemiological, clinical, and molecular characteristics compared to the negative counterpart. Alterations in autophagy play an important role in cancer, and emerging evidence indicates an interplay of autophagy in HNSCC carcinogenesis and tumor promotion. However, the influence of HPV infection on autophagy in HNSCC has received less attention and has not been previously reviewed. Therefore, we here aimed to systematically review the role of autophagy explicitly in HPV + HNSCC., Methods: Studies accessible in PubMed, Embase, Scopus, and Web of Science investigating HNSCC, highlighting the molecular biological differences between HPV - and HPV + HNSCC and its influences on autophagy in HNSCC were analyzed according to the PRISMA statement. A total of 10 articles were identified, included, and summarized., Results: The HPV16 E7 oncoprotein was reported to be involved in the degradation of AMBRA1 and STING, and to enhance chemotherapy-induced cell death via lethal mitophagy in HNSCC cells. Autophagy-associated gene signatures correlated with HPV-subtype and overall survival. Additionally, immunohistochemical (IHC) analyses indicate that high LC3B expression correlates with poor overall survival in oropharyngeal HNSCC patients., Conclusion: HPV may dampen general bulk autophagic flux via degradation of AMBRA1 but may promote selective autophagic degradation of STING and mitochondria. Interpretations of correlations between autophagy-associated gene expressions or IHC analyses of autophagy-related (ATG) proteins in paraffin embedded tissue with clinicopathological features without biological validation need to be taken with caution., (© 2024. The Author(s).)

Background: Young patients with tongue squamous cell carcinoma (TSCC) mostly lack typical prognostic markers and face a dire prognosis. The aim of this study was to analyze the prognostic relevance of lymphocyte-to-monocyte ratio (LMR) in TSCC patients, with a special emphasis on patients under 45 years., Methods: This retrospective study included all patients primarily treated for TSCC. The prognostic relevance of LMR was investigated in terms of predicting the overallsurvival (OS) and disease-free survival (DFS)., Results: A total of 74 patients were included and the young cohort (<45 years) comprised 27 individuals. The mortality and recurrence rates were 39.2% ( n = 29) and 37.8% ( n = 28), respectively. OS and DFS were significantly shorter in the low LMR group within the whole cohort. Furthermore, low LMR was associated with worse prognosis, particularly inferior OS (median OS 1.7 vs. 14.6 years, p = 0.0156) and worse DFS (median DFS 0.8 years vs. not reached, p = 0.0405) in the young patient cohort., Conclusions: Our results reveal that pretreatment LMR might become a prognostic tool for young TSCC patients, especially due to its availability. However, further studies on larger cohorts are necessary to validate our results.

Background: The peroneus tertius muscle (PT) is one of the extensor muscles of the lower leg, often described as a variable separation from the extensor digitorum longus muscle (EDL). According to literature it has six different types of insertion, one of them (Olewnik Type IV) having two tendons inserting to the fifth metatarsal bone (FMTB). Morphometric data about this type of insertion is sparse, especially the relation between the two tendons, albeit the PT is suspected to contribute to stress fractures of the FMTB. Therefore, we examined this type of insertion to give detailed information on the tendons, the insertion points and the respective relations., Methods: We examined 27 lower extremities of embalmed human bodies (12 paired, 15 single sided; 12 right and 15 left) with a distinguishable PT with two tendons inserting to the FMTB (Olewnik IV). The specimens were obtained of an undergrad dissection program, which in turn obtained them from a body donation program. After dissection of the PT and photo documentation in situ, resection and measurement of morphological properties of the tendons were performed with the PT attached to the fifth metatarsal bone., Results: Results of the respective measurements yielded a wide range of variation, especially in the insertion point of the anterior tendon on the fifth metatarsal and the relation between the two tendons, but with no significant difference between sides or sex, except for the length of the posterior tendon between sex. The distance between the base of the FMTB and posterior tendon varies from 0 to 9 mm, with one outlier at 24 mm (mean = 3.9 ± 4.8 mm), the distance between the insertions from 0 to 15 mm (mean = 4.7 ± 4.7 mm), resulting in how far of the FMTB the anterior tendon reaches varying from 17 to 60 mm (mean = 39.6 ± 11.5 mm) or 22-98% (mean = 64 ± 19%)., Conclusion: Our findings give a detailed overview of the morphological features the PTT can have, when attached with two tendons to the FMTB. Especially the varying relationship between those two insertions and varying point of the anterior insertion are of interest, as they might support its complex role in the occurrence of fractures of the fifth metatarsal by providing different amounts of torsional stress and its tendons can be used as tendon-grafts., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Schistosomiasis is a worldwide snail-borne parasitic infestation of man and animals with acute or chronic phases having devastating sequelae. The present case report focused on post-mortem examination of a cachexic Dongola stallion ( Equus ferus caballus Linnaeus, 1758) in Abuja, Nigeria, that failed to respond to treatment. Typical dense collagenous granulomatous lesions with marked inflammatory responses and fibrosis occurred in the liver and several visceral organs of the horse along with other lesions indicative of systemic collapse. Special Ziehl-Neelsen and Periodic Acid-Schiff staining as well as microbial culture returned negative results to rule out acid-fast bacilli, fungal, and other bacterial involvement. In addition, the presence of a yellowish-brown eggshell within fibrosing granulomatous lesions led to the diagnosis of chronic schistosomiasis. Prolonged malnutrition under harsh and changing increment weather conditions with lack of medical care following the infection might have predisposed the horse to the recorded systemic collapse in the present case. The dearth of information on the ante-mortem evaluation of acute equine schistosomiasis cases notwithstanding, the observed lesions/cellular changes reinforced  associated multi-organ damages and systemic collapse in chronic cases. Our findings highlighted the pathological presentations and prognosis of chronic schistosomiasis and its triggers, especially in endemic areas, and in horses that often do not present obvious clinical manifestations., Competing Interests: Conflict of interestThe authors declare no conflict of interest., (© Indian Society for Parasitology 2023.)

Background: New chemotherapy agents are warranted for head and neck squamous cell carcinoma (HNSCC), particularly for incidence-rising HPV-positive tumors. Based on the evidence of Notch pathway involvement in cancer promotion and progression, we aimed to gain insights into the in vitro antineoplastic effects of gamma-secretase inhibition in HPV-positive and -negative HNSCC models., Methods: All in vitro experiments were conducted in two HPV-negative (Cal27 and FaDu) and one HPV-associated HNSCC cell line (SCC154). The influence of the gamma-secretase inhibitor PF03084014 (PF) on proliferation, migration, colony forming, and apoptosis was assessed., Results: We observed significant anti-proliferative, anti-migratory, anti-clonogenic, and pro-apoptotic effects in all three HNSCC cell lines. Furthermore, synergistic effects with concomitant radiation were observable in the proliferation assay. Interestingly, effects were slightly more potent in the HPV-positive cells., Conclusion: We provided novel insights into the potential therapeutic relevance of gamma-secretase inhibition in HNSCC cell lines in vitro. Therefore, PF may become a viable treatment option for patients with HNSCC, particularly for patients with HPV-induced malignancy. Indeed, further in vitro and in vivo experiments should be conducted to validate our results and decipher the mechanism behind the observed anti-neoplastic effects., (© 2023. The Author(s).)

There is heightening concern regarding heavy metals environmental pollution requiring renewed global attention because of their bioaccumulation and toxicity at varying levels. The concern is most important in the highly migratory Eidolon helvum (E. helvum) that is very common and traverses wide geographical areas within the sub-Saharan Africa. The present study aimed to evaluate levels of cadmium (Cd), lead (Pb), and zinc (Zn) bioaccumulation in 24 E. helvum of both sexes from Nigeria to assess their indirect health risks to the human consumers of the bats in addition to their direct bioaccumulation and toxic damages in the bats themselves based on standard procedures. Lead, Zn, and Cd bioaccumulation concentrations were 2.83 ± 0.35, 0.42 ± 0.03, and 0.05 ± 0.01 mg/kg, respectively, with significant (p < 0.05) Pb bioaccumulation compared to either Cd or Zn in the affected bats. However, only Pb (markedly) and Cd (marginally) bioaccumulated above small mammals' critical threshold levels as there are no existing established threshold levels for bats. Sex played no major role in their bioaccumulation levels. The bioaccumulation levels posed no life-long non-carcinogenic nor carcinogenic risks to the human consumers of the bats at detected concentrations. The observed lungs, liver, and kidney histopathological changes suggested the possible direct effects of the metals in the bats. Nevertheless, other anthropogenic factors might be responsible as no significant (p > 0.05) correlation existed between cellular changes and the bioaccumulation levels. The presence of the heavy metals and their bioaccumulations above critical threshold levels suggested some levels of environmental contamination and pollution, which might have direct and indirect health implications to the bats and their human consumers., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Trichoblastoma, which is common in dogs, is now occurring with other cellular changes outside the recognized forms to warrant their continuous evaluation for proper elucidation even as their causes largely remain unknown. A case at hand involved a 9-year-old Caucasian dog, which weighed 35 kg with chief complaint of a progressive bleeding mass on the scalp. The dog had an up-to-date vaccination record and all vital parameters were within optimum ranges. The surgical excision of the firm, solitary, and alopecic mass with traumatized upper surface revealed the presence of a well-demarcated and unencapsulated mass composed of grapes-like nests of basaloid epithelial cells within follicular stroma devoid of stromal necrosis, inflammatory cellular infiltration, and neoplastic epidermal connection. However, there was tissue necrosis, hemorrhages, and inflammatory cellular infiltrates on the exposed upper part of the traumatized growth. Immunohistochemical analysis showed positive reactivity to AE1/AE3, CK5/6, and p63 but negative immunoreactivity to CK7, CK20, CEA, and TTF-1. The histomorphological and immunohistochemical evaluation of the mass on the scalp of the dog suggested a solitary racemiform trichoblastoma with a traumatized exposed upper part despite basal cell carcinoma mimicry where histological diagnosis currently hold sway over immunohistochemical evaluation.

Background: Neonatal jaundice is a major reason babies are frequently re-admitted after hospital discharge following delivery. One means of improving neonatal care and reducing potential mortality associated with neonatal jaundice in resource-limited settings is to create awareness among caregivers. Caregivers who tend to have higher knowledge and awareness, also have positive attitudes, and are not guided by outmoded socio-cultural beliefs and practices are more likely to seek early care and treatment for neonatal jaundice., Objective: This study investigated caregivers' knowledge, attitude and practices regarding neonatal jaundice in a tertiary health facility in the Volta region of Ghana., Methods: This was a descriptive cross-sectional study that employed a quantitative approach for data collection. A total of 202 caregivers from the Ho Teaching Hospital in the Volta region of Ghana were sampled using a systematic random sampling strategy where quantitative data was collected using a questionnaire and analyzed with STATA version 14.0. Ordered logistic regression was used to determine the factors that were associated with caregivers' knowledge regarding neonatal jaundice and attitude after controlling for relevant covariates., Results: Less than half of the caregivers demonstrated good knowledge (45.5%) and attitude (47.5%) but 58.9% had good practices regarding neonatal jaundice. Caregivers who had prior awareness and education on neonatal jaundice were three times more likely to have good knowledge about jaundice than those without previous education [AOR = 3.02, (95%CI: 1.59-5.74), p = 0.001]. A caregiver employed in the public sector was two times more likely to have a good attitude about jaundice than those employed in the private sector [AOR = 2.08, (95%CI: 1.03-4.21), p = 0.042]., Conclusion: Less than two thirds of the caregivers demonstrated good practice with limited knowledge and poor attitude. Efforts to promote well informed and improved caregivers' attitude will advance positive maternal health-seeking behavior and reduce disabilities and death through early detection and intervention of infants with neonatal jaundice. Public awareness and education about neonatal jaundice especially among caregivers in the private sector should also be intensified., Competing Interests: The authors have declared that no competing interests exist.

By using Rh-H catalysis, we couple α-nitroesters and alkynes to prepare α-amino-acid precursors. This atom-economical strategy generates two contiguous stereocenters, with high enantio- and diastereocontrol. In this transformation, the alkyne undergoes isomerization to generate a Rh III -π-allyl electrophile, which is trapped by an α-nitroester nucleophile. A subsequent reduction with In powder transforms the allylic α-nitroesters to the corresponding α,α-disubstituted α-amino esters., (© 2021 Wiley-VCH GmbH.)

Objective: To determine if vaginal misoprostol is more effective than oral misoprostol for cervical ripening in obese women. Study design: A retrospective cohort study of obese women undergoing induction of labor from Jan 2013 to Dec 2016 with singleton, viable pregnancies beyond 37 completed weeks of gestational age. Women with an initial Bishop score of 7 or less, with a cervical dilatation of less than 2 cm, who received either vaginal or oral misoprostol as a cervical ripening agent, were included. Primary outcome was interval from the start of induction to the attainment of 3 cm cervical dilatation. Secondary outcomes included the interval from the start of induction to delivery and the rate of cesarean delivery (CD). Result: Of women who met the inclusion criteria, 966 (75.5%) women received oral misoprostol and 314 (24.5%) received vaginal misoprostol. The mean time-interval from the start of induction to attainment of 3-cm dilatation was shorter in the vaginal group (10.5 ± 10.4 h) compared to the oral group (17.2 ± 11.5 h), ( p  < .0001). Significantly shorter times to delivery were also noted in the vaginal group (17.4 h for vaginal vs. 24.8 h for oral, p  < .0001). In the subgroup analysis of nulliparous women, shorter time intervals from the start of induction to attainment of 3-cm dilatation, as well as to delivery, were noted in the vaginal misoprostol group ( p  < .0001 for both). Multiple linear regression model confirmed route of misoprostol administration as an independent variable in predicting the outcomes (time from start of induction to 3 cm as well as to delivery). Significant findings amongst neonatal outcomes included lower umbilical artery pH and higher rates of neonatal jaundice in the oral misoprostol group. Conclusion: In a population of obese women undergoing induction of labor, vaginal administration of misoprostol was associated shorter time intervals from the start of induction to the attainment of 3 cm of dilatation, as well as to delivery, without increasing the rate of cesarean deliveries or the incidence of adverse maternal and neonatal outcomes.

The etiology and impacts of human exposure to environmental pathogens are of major concern worldwide and, thus, the ability to assess exposure and infections using cost effective, high-throughput approaches would be indispensable. This manuscript describes the development and analysis of a bead-based multiplex immunoassay capable of measuring the presence of antibodies in human saliva to multiple pathogens simultaneously. Saliva is particularly attractive in this application because it is noninvasive, cheaper and easier to collect than serum. Antigens from environmental pathogens were coupled to carboxylated microspheres (beads) and used to measure antibodies in very small volumes of human saliva samples using a bead-based, solution-phase assay. Beads were coupled with antigens from Campylobacter jejuni, Helicobacter pylori, Toxoplasma gondii, noroviruses (G I.1 and G II.4) and hepatitis A virus. To ensure that the antigens were sufficiently coupled to the beads, coupling was confirmed using species-specific, animal-derived primary capture antibodies, followed by incubation with biotinylated anti-species secondary detection antibodies and streptavidin-R-phycoerythrin reporter (SAPE). As a control to measure non-specific binding, one bead set was treated identically to the others except it was not coupled to any antigen. The antigen-coupled and control beads were then incubated with prospectively-collected human saliva samples, measured on a high throughput analyzer based on the principles of flow cytometry, and the presence of antibodies to each antigen was measured in Median Fluorescence Intensity units (MFI). This multiplex immunoassay has a number of advantages, including more data with less sample; reduced costs and labor; and the ability to customize the assay to many targets of interest. Results indicate that the salivary multiplex immunoassay may be capable of identifying previous exposures and infections, which can be especially useful in surveillance studies involving large human populations.

The effect of UV exposure on Toxoplasma gondii oocysts has not been completely defined for use in water disinfection. This study evaluated UV-irradiated oocysts by three assays: a SCID mouse bioassay, an in vitro T. gondii oocyst plaque (TOP) assay, and a quantitative reverse transcriptase real-time PCR (RT-qPCR) assay. The results from the animal bioassay show that 1- and 3-log(10) inactivation is achieved with 4 mJ/cm(2) UV and 10 mJ/cm(2) low-pressure UV, respectively. TOP assay results, but not RT-qPCR results, correlate well with bioassay results. In conclusion, a 3-log(10) inactivation of T. gondii oocysts is achieved by 10-mJ/cm(2) low-pressure UV, and the in vitro TOP assay is a promising alternative to the mouse bioassay.

Toxoplasma gondii oocysts are highly resistant to many chemical sanitizers. Methods used to determine oocyst infectivity have relied primarily on mouse, chicken, and feline bioassays. Although considered gold standards, they only provide a qualitative assessment of oocyst viability. In this study, two alternative approaches were developed to quantitate viable T. gondii oocysts following treatment with several common sanitizers. The first is a quantitative reverse transcriptase real-time PCR (RT-qPCR) assay targeting the ACT1 and SporoSAG genes to enumerate viable T. gondii oocysts. RT-qPCR C(T) values between Wescodyne(R), acidified ethanol, or heat treated oocysts were not significantly different as compared with untreated controls. By contrast, treatment with formalin or Clorox(R) resulted in a 2-log(10) reduction in C(T) values. An in vitro T. gondii oocyst plaque assay (TOP-assay) was also developed to measure oocyst viability. This assay used a combination of bead milling and bile digestion, followed by culturing the excysted sporozoites in a confluent fibroblast cell monolayer. Results showed that no significant reduction in sporozoite viability was detected in acidified ethanol or Wescodyne(R) treated oocysts while at least a 2-log(10) reduction in plaques formed was observed with Clorox(R) treated oocysts. Moreover, formalin or heat treatment of oocysts resulted in at least a 5-log(10) reduction in plaques formed. This study demonstrates that an mRNA-based PCR viability assay targeting the ACT1 or SporoSAG genes is a relatively rapid technique compared to in vitro and in vivo assays. In addition, the TOP-assay proved very effective and sensitive at quantifying oocyst viability when compared with animal bioassays., (Published by Elsevier B.V.)

In this work, we report the cloning and characterization of the first cell surface casein kinase II (CKII) substrate (Tc-1) of Trypanosoma cruzi, the causative agent of Chagas' disease. Analysis of the gene sequence revealed a 1,653-bp open reading frame coding for 550 amino acid residues. Northern blot analysis showed a 4.5-kb transcript that is expressed in invasive trypomastigotes but not in noninvasive epimastigote forms of T. cruzi. Southern blot analysis indicates that Tc-1 is a single-copy gene. At the amino acid level, Tc-1 displayed 95% and 99% identity to two hypothetical proteins recently reported by the T. cruzi genome project. Analysis of the translated amino acid sequence indicates that the Tc-1 gene has a putative transmembrane domain with multiple cytoplasmic and extracellular CKII phosphosites. Exogenous human CKII was able to phosphorylate serine residues on both recombinant Tc-1 and Tc-1 of intact trypomastigotes. This phosphorylation was inhibited by the CKII inhibitors heparin and 4,5,6,7,-tetrabromo-2-azabenzimidazole. Immunoblots of solubilized trypomastigotes, epimastigotes, and amastigotes probed with anti-recombinant Tc-1 immunoglobulin G revealed a 62-kDa protein that is expressed only in infective trypomastigotes. Immunoprecipitation of labeled surface proteins of trypomastigotes indicated that the 62-kDa protein is a surface protein, and we found that the protein is uniformly distributed on the surface of trypomastigotes by direct immunofluorescence. Antibodies to Tc-1 effectively blocked trypomastigote invasion of host cells and consequently reduced parasite load. Preincubation of either trypomastigotes or myoblasts with CKII inhibitors blocked T. cruzi infection. Thus, for the first time, we describe a cell surface CKII substrate of a protozoan parasite that is phosphorylated by human CKII and that is involved in cellular infection.