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Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment). This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.

This research investigated the effectiveness of a cognitive-behavioural intervention program (FRIENDS) in Hong Kong for reducing anxiety symptoms in children. The goal of FRIENDS is to increase resilience in children for coping with everyday problems and stresses. Its effectiveness has been established in a variety of research settings, but only limited research has been completed for the Hong Kong program. Participants were ethnic Chinese (n=8) or Western expatriate children (n=25) who received either a 12-week FRIENDS intervention called Fun FRIENDS (for children ages 4-6) or FRIENDS for Life (for children ages 7-9), or children with anxiety problems who participated in a no-treatment control condition (ethnic Chinese n=2 and nonChinese=10). Before and following the intervention or the no treatment waiting period, participants were interviewed to establish diagnosis based on the Anxiety Disorders Interview Schedule - IV (ADIS-IV). Participants and their parents also completed standardized measures of anxiety symptoms (Spence's Anxiety Scales), and a measure of socio-emotional and behavioural difficulties (Strengths and Difficulties Questionnaire). Mixed measure ANOVA analyses revealed that the FRIENDS program yielded significant reductions in total anxiety levels and overall stress for both age groups relative to the control sample, with larger effect sizes among Fun FRIENDS (Ages 4-6) participants relative to the FRIENDS for Life (Ages 7-9) group. Based on the ADIS-IV, the percentage of children meeting criteria for probable Social Phobia diminished from 86.8% at pretest to 47.8% at posttest for the younger Fun FRIENDS group and from 64% at pre-test to 38% at post-test for the older FRIENDS for Life group. For Generalised Anxiety Disorder, 30.4% of the younger participants met criteria at pretest and 13.04% participants met criteria at posttest, and 48% of the older participants met diagnostic criteria at pretest compared with 38% at posttest. This study provides support for the efficacy of the FRIENDS programs for reducing anxiety symptoms and associated socio-emotional problems among children in Hong Kong. The findings also provide support for the value of early intervention during preschool and early primary school.

Cognitive impairment is a progressive disorder that affects the ageing population. With the increase in the mean age of our population, it is becoming a public health problem. Homocysteinemia has been implicated in cognitive impairment. Whilst it is modulated by vitamins B12 and folate, it acts through MMPs 2 and 9. To assesses the relationship of cognitive impairment with homocysteine, B12, folate and MMPs 2 and 9, so as to detect cases of mild cognitive impairment which are potentially reversible, blood samples were drawn from 73 enrolled subjects, with and without cognitive impairment on basis of Montreal cognitive assessment (MoCA) score < 25 or ≥ 25, respectively. Homocysteine, B12, folate and MMPs2 and 9 were estimated. Correlation between MoCA score and these parameters was elucidated. After adjusting for age and gender, homocysteine was the only significant independent predictor of MoCA score. Cut-off of homocysteine for prediction of MoCA < 25 was derived at 13.5 µmol/L(PPV = 59.6%; NPV = 79.2%). The equation derived for calculation of MoCA score from homocysteine is: MoCA score = 32.893 + [(− 0.223)(homocysteine in μmol/L)]. Homocysteine > 13.5 μmol/L predicts low MoCA (< 25) with 84.8% sensitivity and 50% specificity. Hence, patients with an Hcy > 13.5 μmol/L should be administered B12 and folate to reduce homocysteine, a modifiable risk factor of cognitive decline. Also, a novel equation for calculating MoCA score from homocysteine has been derived. Using this derived equation to calculate MoCA score, it may be possible to identify asymptomatic subjects with early cognitive impairment.

In pregnant animals, communication between the mother and conceptus occurs via extracellular vesicles (EVs) that carry several biomolecules such as nucleic acids (miRNAs, mRNAs), proteins, and lipids. At the time of implantation, the endometrium undergoes several morphological and physiological changes, such as angiogenesis, apoptosis, and cell proliferation regulation at the implantation site, to attain a receptive state. This study was conducted to detect pregnancy-specific miRNAs derived from extracellular vesicles in the systemic circulation of Bubalus bubalis (water buffalo) and to assess their functional significance in the modulation of endometrial primary cells. The extracellular vesicles were isolated from the blood plasma using a precipitation-based method and further characterized by various methods such as Differential light scattering, Nanoparticle tracking assay, Western blot, and transmission electron microscopy. The relative expression of the selected extracellular vesicles associated miRNAs (EV-miRNA) at different intervals (days 15, 19, 25, and 30) post artificial insemination (AI) was analyzed using RT-qPCR, and expression of miR-195-5p was found to be significantly higher ( P  < 0.01) in pregnant animals on day 19 post AI (implantation window) as compared to day 15 post AI. The elevated expression might indicate the involvement of this miRNA in the maternal-conceptus cross-talk occurring during the implantation period. The KEGG pathway enrichment and Gene Ontology analyses of the miR-195-5p target genes revealed that these were mostly involved in the PI3-Akt, MAPK, cell cycle, ubiquitin-mediated proteolysis, and mTOR signaling pathways, which are related to the regulation of cell proliferation. Transfecting the in vitro cultured cells with miR-195-5p mimic significantly suppressed ( P  < 0.05) the expression of its target genes such as YWHAQ , CDC27, AKT-3, FGF-7, MAPK8, SGK1, VEGFA , CACAND1, CUL2, MKNK1, and CACAN2D1. Furthermore, the downregulation of the miR-195-5p target genes was positively correlated with a significant increase in the apoptotic rate and a decrease in the proliferation. In conclusion, the current findings provide vital information on the presence of EV miR-195-5p in maternal circulation during the implantation window indicating its important role in the modulation of buffalo endometrium epithelial cells via promoting cell death. Altogether, the milieu of miR-195-5p may serve as a novel and potential molecular factor facilitating the implantation of the early embryo during the establishment of pregnancy in buffaloes. Thus, miR-195-5p may be identified as a unique circulatory EV biomarker related to establishing pregnancy in buffaloes as early as day 19 post-AI.

Background Low conception rate (CR) despite insemination with morphologically normal spermatozoa is a common reproductive restraint that limits buffalo productivity. This accounts for a significant loss to the farmers and the dairy industry, especially in agriculture-based economies. The immune-related proteins on the sperm surface are known to regulate fertility by assisting the spermatozoa in their survival and performance in the female reproductive tract (FRT). Regardless of their importance, very few studies have specifically catalogued the buffalo sperm surface proteome. The study was designed to determine the identity of sperm surface proteins and to ascertain if the epididymal expressed beta-defensins (BDs), implicated in male fertility, are translated and applied onto buffalo sperm surface along with other immune-related proteins. Results The raw mass spectra data searched against an in-house generated proteome database from UniProt using Comet search engine identified more than 300 proteins on the ejaculated buffalo sperm surface which were bound either by non-covalent (ionic) interactions or by a glycosylphosphatidylinositol (GPI) anchor. The singular enrichment analysis (SEA) revealed that most of these proteins were extracellular with varied binding activities and were involved in either immune or reproductive processes. Flow cytometry using six FITC-labelled lectins confirmed the prediction of glycosylation of these proteins. Several beta-defensins (BDs), the anti-microbial peptides including the BuBD-129 and 126 were also identified amongst other buffalo sperm surface proteins. The presence of these proteins was subsequently confirmed by RT-qPCR, immunofluorescence and in vitro fertilization (IVF) experiments. Conclusions The surface of the buffalo spermatozoa is heavily glycosylated because of the epididymal secreted (glyco) proteins like BDs and the GPI-anchored proteins (GPI-APs). The glycosylation pattern of buffalo sperm-surface, however, could be perturbed in the presence of elevated salt concentration or incubation with PI-PLC. The identification of numerous BDs on the sperm surface strengthens our hypothesis that the buffalo BDs (BuBDs) assist the spermatozoa either in their survival or in performance in the FRT. Our results suggest that BuBD-129 is a sperm-surface BD that could have a role in buffalo sperm function. Further studies elucidating its exact physiological function are required to better understand its role in the regulation of male fertility.

The retinoids, the natural or synthetic derivatives of Vitamin A (retinol), are essential for the normal development of prostate and have been shown to modulate prostate cancer progression in vivo as well as to modulate growth of several prostate cancer cell lines. 9-cis-retinoic acid and all-trans-retinoic acid are the two most important metabolites of retinol. Gap junctions, formed of proteins called connexins, are ensembles of intercellular channels that permit the exchange of small growth regulatory molecules between adjoining cells. Gap junctional communication is instrumental in the control of cell growth. We examined the effect of 9-cis-retinoic acid and all-trans retinoic acid on the formation and degradation of gap junctions as well as on junctional communication in an androgen-responsive prostate cancer cell line, LNCaP, which expressed retrovirally introduced connexin32, a connexin expressed by the luminal cells and well-differentiated cells of prostate tumors. Our results showed that 9-cis-retinoic acid and all-trans retinoic acid enhanced the assembly of connexin32 into gap junctions. Our results further showed that 9-cis-retinoic acid and all-trans-retinoic acid prevented androgen-regulated degradation of gap junctions, post-translationally, independent of androgen receptor mediated signaling. Finally, our findings showed that formation of gap junctions sensitized connexin32-expressing LNCaP cells to the growth modifying effects of 9-cis-retinoic acid, all-trans-retinoic acid and androgens. Thus, the effects of retinoids and androgens on growth and the formation and degradation of gap junctions and their function might be related to their ability to modulate prostate growth and cancer.

In the modern era, the necessity of digitization is increasing in a rapid manner day-to-day. The healthcare industries are working towards operating in a paperless environment. Digitizing the medical lab records help the patients in hassle-free management of their medical data. It may also prove beneficial for insurance companies for designing various medical insurance policies which can be patient-centric rather than being generalized. Optical Character Recognition (OCR) technology is demonstrated its usefulness for such cases and thus, to know the best possible solution for digitizing the medical lab records, there is a need to perform an extensive comparative study on the different OCR techniques available for this purpose. It is observed that the current research is focused mainly on the pre-processing image techniques for OCR development, however, their effects on OCR performance specially for medical report digitization yet not been studied. Herein this work, three OCR Engines viz Tesseract, EasyOCR and DocTR, and six pre-processing techniques: image binarization, brightness transformations, gamma correction, sigmoid stretching, bilateral filtering and image sharpening are surveyed in detail. In addition, an extensive comparative study of the performance of the OCR Engines while applying the different combinations of the image pre-processing techniques, and their effect on the OCR accuracy is presented.

Background The microRNAs (miRs) secreted by the trophectoderm (TE) cells have recently been implicated in the conceptus‐endometrial cross talk during implantation and placentation. These miRs modulate various cellular processes during conception and throughout the pregnancy by regulating the gene expression in the foetal and maternal tissues. Objectives This study was undertaken to elucidate the function of TE secreted miRNAs in the maternal‐foetal cross‐talk during implantation/placentation in buffalo. Methods The in vitro produced blastocysts were cultured on a cumulus feeder layer for 21 days. The relative expression profiles of a selected panel of miRs was generated using the spent media collected on Days 0, 7, 12, 16, and 21. A custom‐designed mirVana™ miRNA mimic was used to transfect the endometrial epithelial cells (EECs) in order to determine the role of miRNA exhibiting highest expression on Days 21 and 21. Results The expression of miR‐1246 (p < 0.001) and let‐7b (p < 0.01) was found to be significantly higher on Day 21 of TE culture in comparison to the control (Day 0). This elevated expression indicated the involvement of these miRs in the maternal‐foetal cross‐talk. Interestingly, after the transfection of EECs with miRNA mimic for miR‐1246 (a novel molecule vis‐à‐vis implantation), the expression of beta‐catenin and mucin1 in these cells was found to be significantly (p < 0.05) downregulated vis‐à‐vis the control, that is, the IFN‐τ primed EECs (before transfection). Conclusions The TE secreted miR‐1246 appeared to lower the expression of the endometrial receptivity genes (mucin1 and beta‐catenin) which apparently assists the endometrium in preparing for placentation. This study was undertaken to elucidate the function of TE secreted miRNAs in the maternal‐fetal cross‐talk during implantation/placentation in buffalo. The transfection of TE secreted miR‐1246 in endometrial cells appeared to lower the expression of the endometrial receptivity genes (mucin1 and beta‐catenin) which apparently assists the endometrium in preparing for placentation.

Background Thyroid status has not been studied well in children with steroid resistant nephrotic syndrome (SRNS). Methods In this cross sectional study we recruited 20 children aged 1–16 years with SRNS and similar number of controls. Serum levels of FT3, FT4 and TSH were measured in all the subjects. Overt hypothyroidism was defined as low FT4 (normal values: 0.7–2.0 ng/mL) and elevated serum TSH above reference values (0.45–4.5 mIU/L). Subclinical hypothyroidism (SH) was defined as an elevation in serum TSH with a normal serum FT4 concentration. The primary outcome measure was serum levels of FT3, FT4 and TSH in children with SRNS. Results Thirty per cent of the children ( n  = 6) with SRNS had non-autoimmune subclinical hypothyroidism (2 children each with grade I, II and III). Children with SRNS had a median TSH value [3.9 mIU/L (0.5–13)] within normal range, but levels were high as compared to controls. Out of 6 children with SH, 3 were in partial remission, 3 were in complete remission. The TSH levels normalized on thyroxine supplementation in grades II and III subclinical hypothyroidism. Conclusion Subclinical non-autoimmune hypothyroidism is present in a significant proportion of children with SRNS despite partial or complete remission. Thyroid profile should be evaluated routinely in this subset of patients.

Aims: The study aims to quantity the variation in dental interns' self perceived levels toward cultural competence. Settings and Design: A cross-sectional study was conducted among 84 dental interns from dental college during December 2019. Subjects and Methods: 84 dental interns were participated from college during the month of December for this study. Data were collected through interview using pretested and prevalidated form, consisting of demographic variables such as age, gender, and community with cross-cultural care survey that concerning about the ability to deliver diverse patient's care. Statistical Analysis Used: The statistical analysis was done using SPSS software, and mean, standard deviation, paired t-test and Analysis of Variance (ANOVA) test were applied for the analysis of the data, and the level of significance was set at P < 0.05. Results: It showed that males had significantly higher mean ± SD knowledge (3.29 ± 0.60), skill (3.55 ± 0.52), and attitude (3.32 ± 0.51) scores, respectively, as compared to females; however, while comparing the various domains on the basis of religion factor, the difference was not found statistically significant. Conclusions: The current study suggests that cultural competence knowledge, skill, and attitude of the study participants were inadequate. Hence, there is a need to conduct training programs for interns to enlighten them on the sensitive issue of cross-cultural competency in oral health services.