A prospective pharmacovigilance study to evaluate adverse effect profile of first line anti-tubercular drugs in newly diagnosed sputum positive patients

Background: Tuberculosis (TB) continues to remain one of the most pressing health problems in India with highest TB burden country in the world. Anti-tubercular therapy (ATT) induced organ toxicities are potentially serious ADRs of first line ATT regimen. The underlying mechanism of ATT-induced ADRs especially hepatotoxicity and the factors predisposing to its incidence which is significantly high in Indians are not clearly understood. It's vital to emphasize on ATT induced ADRs as it has direct influence on therapeutic outcome; result in high dropout rate and potential to develop MDR/XDR cases. ADR monitoring help us to revise the treatment protocol thereby improve treatment adherence and therapeutic outcome. Objective of this study is therefore designed to explore and monitor ADRs of first line anti-TB drugs.Methods: In this prospective observational study 60 TB patients (18-70 yrs) of either sex, newly sputum positive with normal parameters were included. Patients were followed up for six months aiming primarily to assess rate of ADRs and to identify preventable and potentially serious ADRs of anti-TB drugs. The ADRs of ATT on various organ systems (heart, kidney and liver), biochemical and haematological parameters were assessed and compared after 2 and 6 months; gender and age specific adverse events were also studied. Data obtained was analysed using student’s t-test of OpenEpi statistical software.Results: Study clearly revealed that ATT exhibit significant increase in toxicity markers viz. liver enzymes (p<0.01), urea and creatinine (p<0.01), ESR (p<0.05) and PTINR (p<0.01), wherein decrease in Hb% (p<0.01) when compared to baseline.Conclusions: ATT related ADRs is the major cause of dropouts and development of MDR/XDR cases. It's crucial to develop strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely. The data obtained from present study may be helpful in developing these effective strategies

Recuperative parametric pumping in adsorptive membranes

Recuperative parametric pumping in adsorptive membranes, a cyclical adsorptive separation process, can lead to two distinct mechanisms of separation: rejection and preferential transport. During rejection, the adsorptive membrane rejects an adsorbing solute while permitting the transport of nonadsorbing solutes. During preferential transport the reverse occurs; the adsorptive membrane selectively transports an adsorbing solute while preventing the transport of nonadsorbing solutes. Switching from rejection to preferential transport can be accomplished by merely decreasing the ratio of the stroke volume (cyclical volume of solution pumped into and out of the membrane) to the membrane void volume. Preferential transport, earlier called an “inverse separation,” results from the adsorbing solute crossing over from an adsorbing to a desorbing region in the interior of the membrane and is governed by the shape of the equilibrium isotherms and by process variables. In experiments with lysozyme and a membrane chromatography cartridge, selectivities obtained by preferential transport were on the order of 5 and agreed with theoretical predictions. Theoretical predictions suggest that to further improve separation by preferential transport, experiments need to be conducted on low dispersion membranes (Pe > 10 4 ) and that both rejection and preferential transport can lead to continuous concentrated streams of the adsorbing solutes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37437/1/690420111_ftp.pd

Subspace Diagonalization on Quantum Computers using Eigenvector Continuation

Quantum subspace diagonalization (QSD) methods are quantum-classical hybrid methods, commonly used to find ground and excited state energies by projecting the Hamiltonian to a smaller subspace. In applying these, the choice of subspace basis is critical from the perspectives of basis completeness and efficiency of implementation on quantum computers. In this work, we present Eigenvector Continuation (EC) as a QSD method, where low-energy states of the Hamiltonian at different points in parameter space are chosen as the subspace basis. This unique choice enables rapid evaluation of low-energy spectra, including ground and nearby excited states, with minimal hardware effort. As a particular advantage, EC is able to capture the spectrum across ground state crossovers corresponding to different symmetry sectors of the problem. We demonstrate this method for interacting spin models and molecules.Comment: 13 pages, 10 figure

Diagnostic utility of endobronchial ultrasound features in differentiating malignant and benign lymph nodes

Endobronchial ultrasound (EBUS) features have been shown to be useful in predicting etiology of enlarged malignant lymph nodes. However, there is dearth of evidence especially from developing countries. We assessed the EBUS characteristics across various mediastinal and hilar lymphadenopathies. In this prospective study, all patients with mediastinal and hilar lymphadenopathy on CT Chest and who were planned for EBUS-FNA (Fine Needle Aspiration) were included. EBUS features of lymph nodes studied were shape, size, margins, echogenicity, central hilar structure (CHS), coagulation necrosis sign and colour power doppler index (CPDI). These were scored and compared between benign and malignant lymphadenopathies. A total of 86 lymph nodes in 46 patients were prospectively studied of which 23 (26.7%) were malignant, 27 (31.3%) tuberculosis and 36 (41.8%) sarcoidosis. There was significant difference between malignant and benign lymph nodes in terms of CHS [central hilar structutre] (p=0.011), margins (p=0.036) and coagulation necrosis sign (p<0.001). On comparison of features of malignancy and tuberculosis, there were significant differences in margins (p=0.016) and coagulation necrosis sign (p 0.001). However, when malignancy and sarcoidosis was compared, there were differences in echogenicity (p=0.002), CHS (p=0.009) and coagulation necrosis sign (p<0.001). Only coagulation necrosis sign was found to be highly consistent with malignant lymph nodes. The other features cannot be used to distinguish malignant from benign lymph nodes, especially in a developing country like India where tuberculosis is a common cause of mediastinal lymphadenopathy

Selective protein transport through adsorptive membranes.

This thesis details the investigation of a novel method for selective protein separations using an adsorptive membrane. The techniques used to obtain this selective protein transport through an adsorptive membrane are surface diffusion and recuperative parametric pumping. Our studies on surface diffusion of proteins conducted using a steady-state diffusion cell showed that selective protein flux due to enhanced diffusion is low (\approx10\sp{-3} mg/hr/cm\sp2); additionally, it could not be ascertained whether the enhanced diffusion was due to surface diffusion or to Donnan effects. On the other hand, studies on recuperative parametirc pumping, a cyclic adsorptive separation process, showed that selective protein flux due to the cyclic process is high $(\approx1$ mg/hr/cm\sp2). We have found that recuperative parametirc pumping in adsorptive membranes leads to two distinct mechanisms of separation, which we refer to as rejection and preferential transport. Rejection is simply a cyclic version of the two-step adsorption process; our results suggest that rejection can lead to a continuous concentrated stream of the adsorbing solute. Preferential transport, which is mechanistically more complicated than rejection, results from the adsorbing solute crossing over from the adsorbing to the desorbing region in the interior of the membrane. Using a protein mixture consisting of lysozyme and myoglobin we have found the conditions under which lysozyme is preferentially transported through an ion-exchange membrane cartridge while myoglobin is rejected by the membrane. Process variables were varied to optimize separation; experimental results agree with theoretical predictions. Additionally, we found that preferential transport can be used to selectively transport a solute up a concentration gradient. Preferential transport can lead to an integrated separation process because during preferential transport, an adsorbing protein is selectively transported across the membrane while non-adsorbing solutes and cells (larger than the membrane pore size) are retained by the membrane. We found that the oscillatory flows used in preferential transport alleviate the formation of cakes due to cell deposition on the membrane surface. This phenomenon was used to separate lysozyme directly from a feed containing lysozyme, myoglobin, and yeast. Theoretical results suggest that preferential transport can lead to continuous protein removal from a feed containing suspended solids.Ph.D.Applied SciencesChemical engineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129665/2/9610064.pd

In situ detection of an aerobic alkane metabolites in subsurface environments

Article deposited according to the Frontiers publishing policy for [Frontiers in Microbiological Chemistry]: http://www.frontiersin.org/about/faq, [June 10, 2013].YesFunding provided by the Open Access Authors Fund

Light-mesh — a pragmatic optical access network architecture for IP-centric service oriented communication

Contemporary deployments of optical access networks are based on the principles of Passive Optical Networks (PONs). PONs deploy a star topology and dual wavelength for communication between the center and ends of a star. The star topology requires that each end-user be connected to the star splitter (usually a passive coupler). We argue in this paper that while adhering to the requirements of access networks, we are able to provide a better topological solution in terms of the cost-factor and the ability to upgrade to a greater bandwidth. This solution, called a light-mesh, is based on the concept of pragmatic optical packet transport or light-frames results in a unique node architecture, interconnection matrix, and communication protocols. We begin by investigating into the node architecture that is required for a mesh network in the access area. The proposed node architecture has unique benefits in terms of being able to support the intermittent communication in the access area — nodes are not always powered ON, despite which, it is important to maintain mesh connectivity. Hence we propose the use of largely passive components in node architecture design. Passive components in a mesh lead to collisions of packets in the access area, for which we propose a unique collision detection and recovery scheme based on a logical time-overlap method. Collisions make the end-to-end delay uncertain. Analysis of the associated delay is performed. We then propose algorithms to build such a light-mesh network. These algorithms are investigated in terms of network built-out costs and these costs are compared to a PON topology. Cost differences and a performance comparison with PON are presented as part of the numerical analysis.© Elsevie

Longitudinal assessment of depression, stress, and burnout in medical students

Background: Medical students can and do suffer from mental disorders is a concept yet to get wide acceptance. There are few studies comprehensively evaluating depression, stress, and burnout in medical students, especially in a longitudinal way in India. The current study aims to assess the impact of medical education on the development of psychological morbidities and the role of personality. Materials and Methods: First-year medical students of a leading medical college of India were enrolled on admission and given anonymized, validated, self-administered questionnaires assessing depression, stress, burnout, and personality. This was repeated at the end of 1st year. Data were analyzed independently as questionnaires were anonymized. Results: We found that 1st year of medical college showed a significantly increasing depression (P < 0.01) and stress (P < 0.01). Overall burnout did not increase significantly. However, only disengagement dimension of burnout increased significantly. Personalities with weak capacity to adjust had a significant positive correlation with depression (r = 0.277, P< 0.001) and stress scores (r = 0.210, P = 0.008). However, burnout did not correlate with any of the personality dimensions. Conclusion: Right from the 1st year of medical education students perceive high-stress levels and have a high risk of depression. Burnout starts to creep in at least in the form of disengagement. This study provides a sound groundwork for planning interventions to reduce student’s mental morbidity and avoid burnout