The Impact of Palliative Care on Health Status in HIV-Positive Children

HIV-positive children in sub-Saharan Africa have numerous challenges to overcome. These challenges increase psychosocial stress as well as symptom burden including fatigue, weight loss, pain, and mental changes. The symptoms may persist even after initiation of antiretroviral therapy, so such children need additional care. Palliative care lays emphasis on holistic patient-centered care, including physical, psychological, social, and spiritual symptoms, alongside antiretroviral therapy. There is limited data on the impact of integrating palliative care with standard HIV care and treatment in children. The purpose of this study was to fill the gap in the literature by investigating the impact of palliative care on health status in HIV-positive children on antiretroviral therapy. The theoretical framework was based on the humanistic nursing theory. Using the Mann Whitney U and logistic regression tests, the health-related quality of life of 97 children who received palliative care in addition to standard HIV care was compared to 180 HIV-positive children who received standard HIV care only through chart reviews. According to study results, children receiving palliative care alongside antiretroviral therapy have better physical and psychosocial health compared to children receiving only antiretroviral therapy. Increasing age was a contributing factor to better psychosocial and physical health in patients receiving palliative care. Emotional, social, and school functioning are important factors that determine treatment outcomes in children on antiretroviral therapy, and addressing those factors through palliative care will create a positive social change by improving treatment outcomes, quality of life, and longevity

Influence of micro jets on the flow development in the enlarged duct at supersonic Mach number

In this paper, Computational fluid dynamics method is used to simulate the supersonic flow. Convergent-divergent (C-D) nozzle have been used with sudden expansion. The base pressure controlled by using the microjets of 1 mm of orifice diameter is arranged at ninety degrees at PCD 13 mm. The Mach number is 1.87, and the area ratio of 3.24 was considered for the present study. The L/D of the duct was used 10, and the nozzle pressure ratio (NPR) considered for simulation was from 3, 5, 7, 9 and 11. The two-dimensional planar model has been used using ANSYS commercial software. The total wall pressure distribution and Mach number variation from the inlet to the outlet was observed. From the results, it is found that the microjets are capable of controlling the base pressure, the loss of pressure and decreases in the drag. In the present study, the C-D nozzle designed and modeled: K-ε standard wall function turbulence model has been used and validated with the commercial computational fluid dynamics (CFD)

Assessment of Plasma Cystatin C among Sudanese Patients with Type II Diabetes Mellitus

Background: Cystatin C is mainly used as a biomarker of kidney function. It is freely filtered by glomerulus, and does not return to the blood stream or secreted by renal tubules. It has been suggested to be closer to the “ideal” endogenous marker.Objectives: To assess the plasma levels of cystatin c, creatinine clearance, blood HbA1C% and body mass index among Sudanese with type 2  Diabetes.Materials and methods: This is a case-control study conducted in diabetic centers in Khartoum state, Sudan, from March 2010 to November 2013. A total of 300 Sudanese patients with type2 diabetes (49% males and 51% females) as a test group, and 150 healthy subjects (48%males and 52%females) as a control group were enrolled in this study. Both groups were matched for gender and age. The plasma levels of Cystatin C, creatinine and blood HbA1c were measured using Nephelometry technique. Creatinine clearance was calculated for each participant. SPSS was usedfor analysis of data.Results: The means of the plasma levels of Cystatin C, HbA1c% and the body mass index (BMI) were significantly raised in the diabetic group  compared to the control group (p<0.05).There is significant moderate negative correlation between Cystatin C and creatinine clearance (r=0.69,p=0.015) in the diabetic group, and there is a significant strong positive correlation between the plasma levels of Cystatin C and HbA1c%(r=o.78, p=0.044).Conclusion: The present data indicates that among Sudanese patients with Type 2 Diabetes Mellitus, plasma levels of Cystatin C are significantly raised and has a significant strong positive correlation with glycated  haemoglobin % and a significant moderate negative correlation with creatinine clearance.Key words: Type 2 Diabetes, Cystatin C, Glycated Heamoglobin, Sudan

Studying the Affect of Current on (MRR) and (EW) in Electrical Discharge Machining (EDM)

The experimental work of this study leads with electro discharge machining (EDM). A system for machining in this process has been developed. Many parameters are studied such as current, dielectric fluid, thickness of the workpiece. The main aim of this work is to calculate the metal removal rate (MRR), electrode wear (EW) using copper electrode when machining stainless steel 304 specimens of thickness (0.4, 0.5, 1mm). Different current rates are used ranging from (10, 15, 20, 25, 30)Amp, and using tap water as a dielectric solution, it found that low current gives a less material removal rate and electrode wear while high current gives a high material removal rate and electrode wear, the dielectric fluid is changed in order to enhance results. The results show that maximum MRR is achieved 1.01164mm3/min when machining thickness of workpiece 0.4mm and using electrode of copper metal which gives minimum EW 0.04gm, while when using thickness 0.5mm it gives MRR 0.43828mm3/min and EW 0.12gm, for thickness 1mm the MRR 0.33964mm3/min and EW is 0.11gm. The results show also that using distilled water as a dielectric fluid with copper electrode and thickness of workpiece 0.5mm gives minimum MRR 0.13854mm3/min and less EW 0.08gm compared with using tap water

High soluble CD163 levels correlate with disease progression and inflammation in Kenyan children with perinatal HIV-infection

Objectives: CD163 is a hemoglobin scavenger receptor on monocytes and macrophages, cleaved to soluble CD163 (sCD163) in the plasma following activation. In HIV+ adults, sCD163 is linked to non-AIDS morbidity and predicts mortality, but there is limited data in children. We investigated sCD163 levels in HIV+ children and their correlations with disease progression, immune activation and gut mucosal damage. Design and methods: We quantified sCD163 levels in Kenyan children aged 0–20 years with perinatal HIV infection, including 74 antiretroviral treatment (ART)-naïve (ART−) and 64 virally suppressed on ART (ART+), and 79 HIV unexposed-uninfected controls (HIV−). The cohort was divided into age groups 0–5 (younger) and 5–20 (older) years. Correlations between sCD163 and HIV viral load, %CD8+, CD4+ : CD8+ ratio, markers of T-cell activation and proliferation, and gut mucosal damage were also assessed. Results: ART− children have higher sCD163 levels compared with HIV− and ART+ children (P ≤ 0.01); ART+ have equivalent sCD163 levels to HIV− children. In a prospective analysis, sCD163 levels decreased in older ART− children after 12 months of treatment (P < 0.0001). Regardless of age, sCD163 levels correlate with clinical disease progression measured by %CD4+ T cells, CD4+ : CD8+ T-cell ratios and HIV viral load. sCD163 levels directly correlate with T-cell activation markers CD38, human leukocyte antigen-DR isotype, and Ki67 (P ≤ 0.01). Conclusion: High plasma sCD163 levels in HIV+ children correlate with advancing disease and T-cell activation. ART initiation normalizes sCD163 levels and may alleviate HIV-related morbidities and improve long-term pediatric outcomes

Numerical investigation of flow field of a non-circular cylinder

The study of the base flow field or the flow field in the wake region is not accessible by using only a theoretical method; mostly this study has been done experimentally. The problem statement of this study is to know the effect of flow past of a non-circular cylinder on the drag. At high Reynolds number, the flow past a bluff body is characterized by a large wake zone. Therefore, drag reduction of the flow field is an interesting problem with a wide range of application. The present paper presents the numerical simulation of the flow field of a non-circular cylinder. The shielding effect of the square-plate front body on the flow field of drag reduction and the pressure distribution of a three-dimensional bluff body is simulated by using a numerical method. The results obtained from the simulation are compared with the experimental results. The results indicate that the side faces and the rear faces are subjected to low pressure, whereas the front face is experiencing high positive pressure. With this flow pattern, the pressure drag coefficient assumes a substantially significant value in the range of 1.0-1.42. Such a high value of drag coefficient is particularly valid for bluff bodies with noncircular cross-sections with sharp corners. © 2019 PENERBIT AKADEMIA BARU. All rights reserved

Conducting experimental research in marginalised populations: clinical and methodological implications from a mixed-methods randomised controlled trial in Kenya.

Experimental studies to test interventions for people living with HIV in low- and middle-income countries are essential to ensure appropriate and effective clinical care. The implications of study participation on outcome data in such populations have been discussed theoretically, but rarely empirically examined. We aimed to explore the effects of participating in a randomised controlled trial conducted in an HIV clinic in Mombasa, Kenya. We report qualitative data from the Treatment Outcomes in Palliative Care trial, which evaluated the impact of a nurse-led palliative care intervention for HIV positive adults on antiretroviral therapy compared to standard care. Participants in both arms attended five monthly quantitative data collection appointments. Post-trial exit, 10 control and 20 intervention patients participated in semi-structured qualitative interviews, analysed using thematic analysis. We found benefit attributed to the compassion of the research team, social support, communication, completion of patient reported outcome measures (PROMs) and material support (transport reimbursement). Being treated with compassion and receiving social support enabled participants to build positive relationships with the research team, which improved mental health and well-being. Open and non-judgmental communication made participants feel accepted. Participants described how repeated completion of the PROMs was a prompt for reflection, through which they began to help themselves and self-care. Participant reimbursements relieved financial hardship and enabled them to fulfil their social responsibilities, enhancing self-worth. These findings emphasise the importance of compassion, support and effective communication in the clinical encounter, particularly in stigmatised and isolated populations, and the potential of the integration of simple PROMs to improve patient outcomes. Participation in research has unexpected positive benefits for participants, which should be taken into account when designing research in similar populations. Researchers should be aware of the effects of financial reimbursement and contact with researchers in isolated and impoverished communities

Clinicopathologic Spectrum of Nephrotic Syndrome in the Elderly

The elderly population is affected by a wide range of kidney diseases like young adult patients. However, their clinical course and morphological manifestations are affected by aging. Recognition, diagnosis, and management of glomerular disease in elderly persons have several unique challenges. We aimed to study the clinicopathologic spectrum of elderly patients with nephrotic syndrome (NS). In this retrospective study, we looked at 234 patients of adult NS who were biopsied during the last 5 years. Among them, 31 patients were above the age of 60 years (Elderly). Mean age in elderly patients was 67.48 ± 6.11 years, with age range from 60 to 86 years. Elderly NS patients constituted 13.2% of total adult NS patients. Nineteen patients (61.2%) were males and 12 (38.7%) were females. Hematuria was observed in 19% and hypertension in 48% patients. Mean serum albumin was 2.79 ± 0.39 g/dl and mean 24 h urinary protein was 3.77 ± 0.8 grams. Membranous nephropathy (MN) followed by minimal change disease (MCD) was the most common diagnosis. No major complication with biopsy was reported in our study as has been the case with most studies

Numerical analysis of cracks emanating from hole in plate repaired by composite patch

In aerospace engineering design, structures with holes and cracks have been widely considered, either separate or combined. However, these types of structures have chances to produce critical crack growth since the stress concentration/intensity is high. This paper uses finite element modeling (FEM)to analyze single composite patch repair in reducing the stress concentration factor(SCF) around the circular hole. Similarly, crack propagation has also been repaired by placing a composite patch on the crack. The stress intensity factor (SIF) has been evaluated with and without the circular hole. The study of adhesive characteristics as well as patch thickness was carried to find out the highest reduction in SIF

Research onFlows for NACA 2412 airfoil using computational Fluid dynamics method

The comparison between incompressible and compressible flow for aerodynamic coefficients and flow characteristics has been made for NACA 2412 airfoil. The FEM is used to obtain results. The fluid domain of 10C has been constructed to initialize the boundary conditions of incompressible and compressible flow conditions. The structured mesh has been applied in order to achieve accurate results. The Spallart-Allmaras turbulence model has been used to solve both incompressible and compressible flow conditions. The method validation that has been conducted at incompressible flow has shown close agreement between numerical and experimental lift coefficient. From velocity magnitude and static pressure, contours, the compressible flow has the highest-pressure distribution compared to incompressible flow. Therefore, it has been proven that the coefficient of force at ninety degrees to the direction of the flow direction of the airfoil subjected to a variable density flow was much higher compared to incompressible flow