Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.

Carbon nanodots (C-dots) show great potential as an important material for biochemical sensing, energy conversion, photocatalysis, and optoelectronics because of their water solubility, chemical inertness, low toxicity, and photo- and electronic properties. Numerous methods have been proposed for the preparation of C-dots. However, complex procedures and strong acid treatments are often required, and the as-prepared C-dots tend to be of low quality, and in particular, have a low efficiency for photoluminescence. Herein, a facile and general strategy involving the electrochemical carbonization of low-molecular-weight alcohols is proposed. As precursors, the alcohols transited into carbon-containing particles after electrochemical carbonization under basic conditions. The resultant C-dots exhibit excellent excitation- and size-dependent fluorescence without the need for complicated purification and passivation procedures. The sizes of the as-prepared C-dots can be adjusted by varying the applied potential. High-quality C-dots are prepared successfully from different small molecular alcohols, suggesting that this research provides a new, highly universal method for the preparation of fluorescent C-dots. In addition, luminescence microscopy of the C-dots is demonstrated in human cancer cells. The results indicate that the as-prepared C-dots have low toxicity and can be used in imaging applications.

A proportion of HIV patients beginning antiretroviral therapy (ART) develop immune restoration disease (IRD). Immunological characteristics of IRD were investigated in a cohort of HIV patients beginning therapy in Kuala Lumpur, Malaysia. MethodsPeripheral blood mononuclear cells were collected at weeks 0, 6, 12, 24 and 48 of ART from five patients experiencing IRD [two with cryptococcal and three with Mycobacterium tuberculosis (Mtb) disease], eight non-IRD controls who had begun ART with CD4 T-cell counts of o100 cells/mL and 17 healthy controls. Leukocytes producing interferon-gamma (IFNg) were quantified by enzymelinked immunospot assay after stimulation with purified protein derivative (PPD), early secretory antigenic target-6 (ESAT-6), Cryptococcus neoformans or Cytomegalovirus antigens. Plasma immunoglobulin (IgG) antibodies reactive with these antigens were assessed by enzyme-linked immunosorbent assay. Proportions of activated (HLA-DR hi ) and regulatory (CD25 CD127 lo and CTLA-4 1 ) CD4 T-cells were quantified by flow cytometry. ResultsPlasma HIV RNA declined and CD4 T-cell counts rose within 8-27 weeks on ART. Mtb IRD patients displayed elevated IFNg responses and/or plasma IgG to PPD, but none responded to ESAT-6. Cryptococcal IRD occurred in patients with low baseline CD4 T-cell counts and involved clear IFNg and antibody responses to cryptococcal antigen. Proportions of activated and regulatory CD4 T-cells declined on ART, but remained higher in patients than in healthy controls. At the time of IRD, proportions of activated CD4 T-cells and regulatory CD4 T-cells were generally elevated relative to other patients. ConclusionsCryptococcal and Mtb IRD generally coincide with peaks in the proportion of activated T-cells, pathogen-specific IFNg responses and reactive plasma IgG. IRD does not reflect a paucity of regulatory CD4 T-cells.

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