Providing differentiated service delivery to the ageing population of people living with HIV

Introduction

Differentiated service delivery (DSD) models for HIV are a person‐centred approach to providing services across the HIV care cascade; DSD has an increasing policy and implementation support in high‐burden HIV countries. The life‐course approach to DSD for HIV treatment has focused on earlier life phases, childhood and adolescence, families, and supporting sexual and reproductive health during childbearing years. Older adults, defined as those over the age of 50, represent a growing proportion of HIV treatment cohorts with approximately 20% of those supported by PEPFAR in this age band and have specific health needs that differ from younger populations. Despite this, DSD models have not been designed or implemented to address the health needs of older adults.

Discussion

Older adults living with HIV are more likely to have significant co‐morbid medical conditions. In addition to the commonly discussed co‐morbidities of hypertension and diabetes, they are at increased risk of cognitive impairment, frailty and mental health conditions. Age and HIV‐related cognitive impairment may necessitate the development of adapted educational materials. Identifying the optimal package of differentiated services to this population, including the frequency of clinical visits, types and location of services is important as is capacitating the healthcare cadres to adapt to these challenges. Technological advances, which have made remote monitoring of adherence and other aspects of disease management easier for younger populations, may not be as readily available or as familiar to older adults. To date, adaptations to service delivery have not been scaled and are limited to nascent programmes working to integrate treatment of common co‐morbidities.

Conclusions

Older individuals living with HIV may benefit from a DSD approach that adapts care to the specific challenges of ageing with HIV. Models could be developed and validated using outcome measures, such as viral suppression and treatment continuity. DSD models for older adults should consider their specific health needs, such as high rates of co‐morbidities. This may require educational materials, health worker capacity building and outreach designed specifically to treat this age group.

Bioremediation: an alternative approach for detoxification of polymers from the contaminated environment

The industries and metropolitan wastes produced by anthropogenic activities are of great concern for nature as it causes soil contamination and deteriorate the environment. Plastic utilization is rapidly enhancing globally with passing days that last for a more extended period in the environment due to slow decomposition and natural degradation. Excessive use of polymer has risked the life of both marine, freshwater and terrestrial organisms. Lack of proper waste management and inappropriate disposal leads to environmental threats. Bioremediation processes involve microbes such as fungi, bacteria, etc. which contribute a crucial role in the breakdown of plastics. Extremophiles secrete extremozymes that are functionally active in extreme conditions and are highly crucial for polymer disaggregation in those conditions.

Bioremediation of heavy metals from wastewater: a current perspective on microalgae-based future

Heavy metals-containing drinking water and wastewater are posing a severe threat to the environment, and living beings on land, air and water. Different conventional, advanced nanomaterials-based and biological method has been employed for the treatment of heavy metals. Among the biological methods, microalgae are an important group of micro-organisms that have numerous environmental applications and can remediate heavy metals from wastewater. Also, it has numerous advantages over conventional remediation processes. Microalgae cells can uptake the heavy metal via different physiological and biological methods and are utilized as a nutrient source to regulate its metabolic process for the production of biomass. Furthermore, the enhancement in heavy metal removal efficiency can be improved using different strategies such as immobilization of algal cells, development of algal consortia and designing of microalgae-based nanocomposite materials. Also, it can significantly contribute towards environmental sustainability and future. Thus, the review provides a critical overview of heavy metals and their existence along with their negative effects on humans. This review provides insight on recent advanced nanomaterial approaches for the removal of heavy metals, overviews of microalgae-based heavy metal uptake mechanisms and their potential for the amputation of different heavy metals. Furthermore, the special focus is on recent strategies that enhance heavy metal removal efficiency and contribute towards sustainability for the development of a microalgae-based future.

A comprehensive review on application of bioreactor for industrial wastewater treatment

In the recent past, wastewater treatment processes performed a pivotal role in accordance with maintaining the sustainable environment and health of mankind at a proper hygiene level. It has been proved indispensable by government regulations throughout the world on account of the importance of preserving freshwater bodies. Human activities, predominantly from industrial sectors, generate an immeasurable amount of industrial wastewater loaded with toxic chemicals, which not only cause dreadful environmental problems, but also leave harmful impacts on public health. Hence, industrial wastewater effluent must be treated before being released into the environment to restrain the problems related to industrial wastewater discharged to the environment. Nowadays, biological wastewater treatment methods have been considered an excellent approach for industrial wastewater treatment process because of their cost-effectiveness in the treatment, high efficiency and their potential to counteract the drawbacks of conventional wastewater treatment methods. Recently, the treatment of industrial effluent through bioreactor has been proved as one of the best methods from the presently available methods. Reactors are the principal part of any biotechnology-based method for microbial or enzymatic biodegradation, biotransformation and bioremediation. This review aims to explore and compile the assessment of the most appropriate reactors such as packed bed reactor, membrane bioreactor, rotating biological contactor, up-flow anaerobic sludge blanket reactor, photobioreactor, biological fluidized bed reactor and continuous stirred tank bioreactor that are extensively used for distinct industrial wastewater treatment.

Rotavirus vaccine impact assessment surveillance in India: protocol and methods

INTRODUCTION

Rotavirus infection accounts for 39% of under-five diarrhoeal deaths globally and 22% of these deaths occur in India. Introduction of rotavirus vaccine in a national immunisation programme is considered to be the most effective intervention in preventing severe rotavirus disease. In 2016, India introduced an indigenous rotavirus vaccine (Rotavac) into the Universal Immunisation Programme in a phased manner. This paper describes the protocol for surveillance to monitor the performance of rotavirus vaccine following its introduction into the routine childhood immunisation programme.

METHODS

An active surveillance system was established to identify acute gastroenteritis cases among children less than 5 years of age. For all children enrolled at sentinel sites, case reporting forms are completed and a copy of vaccination record and a stool specimen obtained. The forms and specimens are sent to the referral laboratory for data entry, analysis, testing and storage. Data from sentinel sites in states that have introduced rotavirus vaccine into their routine immunisation schedule will be used to determine rotavirus vaccine impact and effectiveness.

ETHICS AND DISSEMINATION

The Institutional Review Board of Christian Medical College, Vellore, and all the site institutional ethics committees approved the project. Results will be disseminated in peer-reviewed journals and with stakeholders of the universal immunisation programme in India.

The independent effects of left ventricular ejection fraction on short-term outcomes and resource utilization following hospitalization for heart failure

BACKGROUND

While depressed left ventricular ejection fraction is clearly associated with poor long-term outcome in heart failure (HF), the effect of ejection fraction on short-term outcomes and resource utilization following hospitalization for HF remains unclear.

HYPOTHESIS

We evaluated the independent effect of depressed ejection fraction (< or = 40%) on short-term outcomes and resource utilization following hospitalization for HF.

METHODS

The study population included 443 consecutive patients hospitalized for DRG 127 (HF and shock) with known ejection fraction. For each patient, we assessed the hospitalization cost (1995 US$), length of stay, in-hospital mortality, 30-day mortality, and 30-day readmission rates.

RESULTS

Despite similar disease severity at admission, patients with ejection fraction < or = 40% (Group 1) had longer length of stay (4.0 vs. 3.7 days; p = 0.03), a tendency toward higher hospitalization cost ($3,054 vs. $2,770; p = 0.08), more readmissions for any cause (0.4 vs. 0.3; p = 0.05) and for HF (0.2 vs. 0.1; p = 0.01), but similar in-hospital (2.5 vs. 2.6%) and 30-day mortality (4.0 vs. 4.6%) compared with patients with ejection fraction > 40% (Group 2). In multivariate analyses, Group 1 patients were more likely to have higher than median hospitalization cost [odds ratio (OR) = 1.98; 95% confidence intervals (CI) = 1.02-3.91] and longer than median hospital stay (OR = 1.68; CI = 1.08-3.91); they were also more likely to be readmitted for any cause (OR = 2.07; CI = 1.15-3.78) or for HF (OR = 5.71; CI = 1.64-21.94), and they tended to have a higher 30-day incidence of death or readmission (OR = 1.65; CI = 0.96-2.84).

CONCLUSIONS

Depressed left ventricular ejection fraction is associated with higher resource utilization and readmission rates following hospitalization for HF. Greater focus on patients with depressed ejection fraction may increase cost savings from HF disease management programs.

Infra-red spectroscopic analyses of banana waste degraded by oyster mushroom

Carbon, hydrogen and nitrogen analyses of banana leaf and pseudostem biomass revealed their potentiality as substrates for microorganisms. Infra-red (IR) spectra of both biomass show presence of cellulose, xylan and lignin. IR spectra of leaf and pseudostem biomass degraded in solid state fermentation (SSF) by two Pleurotus species (P. sajor-caju and P. ostreatus) for 40 days showed the utilization of cellulose, xylan and lignin by these microbes. Dynamics of various lignocellulolytic enzymes of Pleurotus species and analyses of carbon, hydrogen and nitrogen contents of degraded biomass supported the same. Both the Pleurotus species exhibited lignin consumption ability on both the substrates.

Assessment of thyroid function in pesticide formulators

Thirty male pesticide formulators exposed to the dust and liquid formulation of endosulfan, quinalphos, chlorpyriphos, monocrotophos, lindane, parathion, phorate, and fenvalerate and 20 comparable control subjects from the same area of study were examined for the evaluation of thyroid function tests. The level of TSH was elevated (about 28%) in pesticide formulators as compared to a control group, but the increase was statistically insignificant. Based on the individual TSH measurement, 3 of 30 formulators had isolated elevated levels of TSH and seem to have acquired sub-clinical hypothyroidism; five had TSH values slightly elevated to the upper boarder line (4.03 muIU/ml); and the majority of formulators (N= 22) had TSH values in the normal range varying from 1.29 to 3.9 muIU/ml. Total T3 was suppressed significantly (P< 0.01) in formulators, while marginal decrease (about 7%) was noticed in T4 level. This study indicated thyroid function impairment in few pesticide formulators.

Primary cutaneous amyloidosis

Three cases of primary cutaneous amyloidosis are reported. Family history was negative. Systemic involvement was ruled out. Histopathology was confirmed by congored stain. Patients responded to oral colchicine.

Monilethrix in pedigree

A 30-year-old female patient presented with tiny papular scalp lesions with sparse, very short, curly hair of only 8 to 12 mm. Microscopic examination of hair revealed typical beaded or moniliform appearance. She also had typical lesions of psoriasis for past 2 months. Her father, 2 sisters and her 6-year-old daughter had similar types of beaded scalp hair.

Laser dye spectroscopy of some pyrromethene-BF(2) complexes

To improve the laser action properties of the pyrromethene-BF(2) (P-BF(2)) complexes, we studied substitution effects at different positions of the dye molecule on the electronic spectra of several derivatives. Specifically, we used laser photoselection spectroscopy to measure the triplet-triplet (T-T) absorption and polarization spectra as well as the fluorescence and visible absorption singlet-singlet (S-S) spectra of the following compounds: 1,2,3,5,6,7,8-heptamethyl; 8-acetoxymethyl-1,3,5,7-tetramethyl-2,6-diethyl; 1,3,5,7-tetramethyl-8-p-methoxyphenyl; 3,5-dimethyl-1,7-diphenyl; and 1,3,5,7,8-pentamethyl- 2,6-diphenyl P-BF(2) complexes. The 1,3,5,7-tetramethyl P-BF(2) complex itself exhibits weak T-T absorption, which stretches from the green to the near-IR spectral region. This band consists of two overlapping (differently polarized) T-T transitions. Short molecular axis (i.e., 8 and 1,7 positions) substitution causes the positively polarized T-T transition to gain considerably in intensity. Significantly, the negatively, long-axis-polarized T-T transition was unaffected by the long-axis 2,6- position disubstitution. Therefore, only the 2,6-position disubstitution is expected to produce superior new P-BF(2) complex laser dyes. Substitution effects from strongly interacting groups with chromophores on S-S as well as T-T absorption spectra, together with cw laser photoselection spectroscopy, are briefly reviewed.

Levels of dichlorodiphenyltrichloroethane and hexachlorocyclohexane in human adipose tissue of the Indian population

Concentrations of dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH) were determined in 313 human omental fat samples collected from subjects from all five zones of India during 1977-1980. The median concentration of 2,2-bis-(p-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE), total DDT, beta HCH, and total HCH were 3.4, 6.0, 1.3, and 1.9 mg/kg, respectively. The calculated national mean levels for DDT and HCH were 11.1 and 3.5 mg/kg, respectively. Although the values of DDT and HCH were not as high as those reported earlier, there is still a need for close monitoring of the bioaccumulation of these chemical residues in the Indian population.

Levels of organochlorine pesticides in human milk in Ahmedabad, India

Concentrations of organochlorine compounds, i.e., alpha HCH, gamma HCH, beta HCH, p,p'-DDE, p,p'-DDT, o,p'-DDT, p,p'-DDD and PCBs were determined in 50 human milk samples collected in Ahmedabad, India during 1981-1982. The mothers' ages ranged from 18 to 30 years (mean 24 years), and they were nursing their first or second child. All 50 samples contained alpha-HCH, gamma HCH, beta HCH, p,p'-DDE, and p,p'-DDT in a concentration of 17.51, 1.62, 205.48, 244.71, and 53.43, respectively (median micrograms/kg: whole-milk basis). o,p'-DDT was found in 48 samples whereas p,p'-DDD was detected in 44 samples. The concentration of o,p'-DDT and p,p'-DDD was 53.43 and 5.13 micrograms/kg (median), expressed on a whole-milk basis. PCBs were absent in all samples.

Changes in serum hexachlorocyclohexane (HCH) residues in malaria spraymen after short-term occupational exposure

The use of organochlorine insecticides for public health programs is indisputably necessary in developing countries. Thus, there is a need to evaluate human response to these chemicals under local field conditions. The effects of a short-term, 16-wk exposure to hexachlorocyclohexane has been evaluated and compared in malaria spraymen with and without any previous occupational exposure to this insecticide by measuring the pre- and post-exposure serum hexachlorocyclohexane concentration. A significant increase in original serum hexachlorocyclohexane concentration. A significant increase in original serum hexachlorocyclohexane concentration was observed in subjects on their first occupational exposure (5X), compared to those with previous exposure (3X). All workers reached approximately the same serum levels within 16 wk, regardless of their history of previous exposure.

Toxicological effects of intravenous administration of pyridine in anaesthetized dogs

In 17 anaesthetized dogs effects on blood pressure, respiration and biochemical changes in blood, i.e. serum glutamic oxaloacetic transaminase (SGOT), alkaline phosphatase (Alk.Pase), and urea, after intravenous administration of pyridine at various dose levels of 88 to 880 mg/kg body weight (LD5 to LD50) are reported. Commonly observed toxicity signs and symptoms are due to action of pyridine on the nervous system. There is no direct evidence of lowering of blood pressure. Lowering of blood pressure is noticed only at lethal doses and is accompanied by marked tachycardia. Death is due to respiratory failure. The significant biochemical changes are increase in SGOT and blood urea (p less than 0.01) and decrease in serum Alk,Pase (p less than 0.01).