High Prevalence of Tuberculosis and Serious Bloodstream Infections in Ambulatory Individuals Presenting for Antiretroviral Therapy in Malawi

Background Tuberculosis (TB) and serious bloodstream infections (BSI) may contribute to the high early mortality observed among patients qualifying for antiretroviral therapy (ART) with unexplained weight loss, chronic fever or chronic diarrhea. Methods and Findings A prospective cohort study determined the prevalence of undiagnosed TB or BSI among ambulatory HIV-infected adults with unexplained weight loss and/or chronic fever, or diarrhea in two routine program settings in Malawi. Subjects with positive expectorated sputum smears for AFB were excluded. Investigations Bacterial and mycobacterial blood cultures, cryptococcal antigen test (CrAg), induced sputum (IS) for TB microscopy and solid culture, full blood count and CD4 lymphocyte count. Among 469 subjects, 52 (11%) had microbiological evidence of TB; 50 (11%) had a positive (non-TB) blood culture and/or positive CrAg. Sixty-five additional TB cases were diagnosed on clinical and radiological grounds. Nontyphoidal Salmonellae (NTS) were the most common blood culture pathogens (29 cases; 6% of participants and 52% of bloodstream isolates). Multivariate analysis of baseline clinical and hematological characteristics found significant independent associations between oral candidiasis or lymphadenopathy and TB, marked CD4 lymphopenia and NTS infection, and severe anemia and either infection, but low positive likelihood ratios (<2 for all combinations). Conclusions We observed a high prevalence of TB and serious BSI, particularly NTS, in a program cohort of chronically ill HIV-infected outpatients. Baseline clinical and hematological characteristics were inadequate predictors of infection. HIV clinics need better rapid screening tools for TB and BSI. Clinical trials to evaluate empiric TB or NTS treatment are required in similar populations

Ordered nanoporous arrays of carbon supporting high dispersions of platinum nanoparticles

Nanostructured carbon materials are potentially of great technological interest for the development of electronic(1,2), catalytic(3,4) and hydrogen-storage systems(5,6). Here we describe a general strategy for the synthesis of highly ordered, rigid arrays of nanoporous carbon having uniform but tunable diameters (typically 6 nanometres inside and 9 nanometres outside). These structures are formed by using ordered mesoporous silicas as templates, the removal of which leaves a partially ordered graphitic framework. The resulting material supports a high dispersion of platinum nanoparticles, exceeding that of other common microporous carbon materials (such as carbon black, charcoal and activated carbon fibres). The platinum cluster diameter can be controlled to below 3 nanometres, and the high dispersion of these metal clusters gives rise to promising electrocatalytic activity for oxygen reduction, which could prove to be practically relevant for fuel-cell technologies. These nanomaterials can also be prepared in the form of free-standing films by using ordered silica films as the templates.close1649160

Adherence to HIV Care After Pregnancy Among Women in Sub-Saharan Africa: Falling Off the Cliff of the Treatment Cascade

Increased access to testing and treatment means HIV can be managed as a chronic illness, though successful management requires continued engagement with the healthcare system. Most of the global HIV burden is in sub-Saharan Africa where rates of new infections are consistently higher in women versus men. Pregnancy is often the point at which an HIV diagnosis is made. While PMTCT interventions significantly reduce the rate of vertical transmission of HIV, women must administer ARVs to their infants, adhere to breastfeeding recommendations, and test their infants for HIV after childbirth. Some women will be expected to remain on the ARVs initiated during the pregnancy period, while others are expected to engage in routine testing so treatment can be reinitiated when appropriate. The postpartum period presents many barriers to sustained treatment adherence and engagement in care. While some studies have examined adherence to postpartum PMTCT guidelines, few have focused on continued engagement in care by the mother, and very few examine adherence beyond the six week postpartum visit. Here, we attempt to identify gaps in the research literature and make recommendations on how to address barriers to ongoing postpartum HIV care

Catalytic activity of SBA-15-grafted indium tri-isopropoxide in chemoselective MPV reductions

WOS: 000357049300023Indium tri-isopropoxide-containing heterogeneous In(O (i) Pr)(3)-SBA-15 catalyst were synthesized by grafting method and were then used as catalyst in the Meerwein-Ponndorf-Verley (MPV) reduction of various carbonyl compounds using 2-propanol as the hydrogen transfer agent. The prepared new heterogeneous catalyst, In(O (i) Pr)(3)-SBA-15, was characterized in details by using XRD, Si-29 NMR,C-13 NMR, TEM, N-2 adsorption and ICP-OES. New heterogeneous catalyst has been studied in the chemoselective MPV reduction of unsaturated aldehydes and ketones. Good activity and selectivity to the reduced unsaturated alcohols, citronellol, cinnamalcohol, alpha-ionol, 3-methyl-2-butanol, geraniol, nerol were observed over indium tri-isopropoxide supported on silica. The In(O (i) Pr)(3)-SBA-15 catalyst is recyclable up to six cycles without any significant loss in its catalytic activity. Eventually, In(O (i) Pr)(3)-SBA-15 has been found that active catalyst in the MPV reactions of carbonyl compounds including unsaturated aldehydes and ketones with excellent conversion, selectivity and reusability.Scientific and Technical Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [113Z389]The financial support of Scientific and Technical Research Council of Turkey (TUBITAK) under Grant No. 113Z389 is gratefully acknowledged

Implementation Research for the Prevention of Mother-to-Child HIV Transmission in Sub-Saharan Africa: Existing Evidence, Current Gaps, and New Opportunities

Tremendous gains have been made in the prevention of mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa. Ambitious goals for the “virtual elimination” of pediatric HIV appear increasingly feasible, driven by new scientific advances, forward-thinking health policy, and substantial donor investment. To fulfill this promise, however, rapid and effective implementation of evidence-based practices must be brought to scale across a diversity of settings. The discipline of implementation research can facilitate this translation from policy into practice; however, to date, its core principles and frameworks have been inconsistently applied in the field. We reviewed the recent developments in implementation research across each of the four “prongs” of a comprehensive PMTCT approach. While significant progress continues to be made, a greater emphasis on context, fidelity, and scalability – in the design and dissemination of study results – would greatly enhance current efforts and provide the necessary foundation for future evidence-based programs