A novel branched polyamine (polyethyleneimine, PEI) functionalized mesoporous silica (MS) adsorbent is developed via a facile "grafting-to" approach. X-ray photoelectron spectroscopy (XPS) and Fourier transform infrared (FT-IR) spectroscopy verified the effective surface functionalization of MS with monolayer and polymer. The transmission electron microscopy (TEM) was employed to reveal the morphology of the fabricated materials. The adsorption behavior of the polyamine functionalized mesoporous silica (MS-PEI) is assessed against anionic dyes. The adsorbent characteristics of MS-PEI are compared with a monolayer platform comprising of 3-aminopropyltriethoxy silane (APTES) functionalized mesoporous silica (MS-APTES). The adsorption behavior of the MS-PEI and MS-APTES toward anionic dyes is further evaluated by studying the effect of adsorbent dosage, pH, contact time, and temperature. Langmuir and Freundlich isotherm models are employed to understand the adsorption mechanism. The obtained kinetic data support a pseudo-second-order adsorption behavior for both monolayer and polymer functionalized MS. The associated thermodynamic parameters (ΔG°, ΔH°, and ΔS°) reveal that the process of adsorption with MS-PEI is more spontaneous and energetically favored as compared to the adsorption with MS-APTES. Taken together, the novel adsorbent system derived from a combination of MS and branched polymer (MS-PEI) shows the higher absorption efficiency and capacity toward the anionic dyes than the monolayer based adsorbent (MS-APTES).
Objective To assess the impact of rapid diagnostic tests on the diagnostic accuracy and treatment of malaria and non-severe fever in an Asian setting.Design Patient randomised trial in primary level clinics.Setting Two areas of Afghanistan where Plasmodium vivax and Plasmodium falciparum are endemic; one area with moderate transmission (eastern region) and one with low transmission (northern region).Participants 5794 patients of all ages with suspected malaria enrolled by 80 clinicians in 22 clinics.Interventions Malaria rapid diagnostic tests were compared with clinical diagnosis where no parasite diagnostic test was available, longer established field microscopy, and recently introduced microscopy.Main outcome measures Proportion of patients appropriately treated with an antimalarial, defined as patients with P vivax who received chloroquine, patients with P falciparum who received artemisinin based combination therapy, and patients with no malaria parasites who did not receive an antimalarial. Secondary outcomes included diagnostic test accuracy and the proportion of patients negative for malaria who received antibiotics and antimalarials.Results In the low transmission area, comparing rapid diagnostic tests with clinical diagnosis, 65% (212/325) versus 12% (40/321) of febrile patients were appropriately treated for malaria (adjusted odds ratio 92.7, 95% confidence interval 12.4 to 694.1, P<0.001). The proportion of patients who were negative for malaria and received an antibiotic was 57% (185/325) in the rapid diagnostic test arm compared with 14% (46/321) in the clinical diagnosis arm (16.9, 3.8 to 75.4, P<0.001). In the comparison of rapid diagnostic test with microscopy in the moderate transmission area, 83.6% (1696/2028) versus 76.3% (1512/1983) of patients were appropriately treated for malaria (1.70, 1.30 to 2.23, P<0.001). A higher proportion of P falciparum cases received appropriate treatment with artemisinin based combination therapy when malaria was diagnosed by rapid diagnostic test (82%, 58/71 v 32%, 24/76; 9.2, 3.88 to 21.66, P<0.001).Conclusions In South and central Asian regions of low to moderate malaria transmission where clinics lack capacity for diagnosis with rapid diagnostic tests or microscopy, the introduction of the tests should be considered to improve clinical care, reduce the overuse of antimalarials, and improve disease surveillance.
In this public hospital setting, laparoscopic sleeve gastrectomy has achieved satisfactory weight loss results with an acceptable complication rate in the medium-term.
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