A clinical prediction rule to identify patients with tuberculosis at high risk for HIV co-infection

Background & Objective: Many patients presenting with tuberculosis (TB) have underlying human immunodeficiency virus (HIV) co-infection. Routine HIV testing, however, is not a component of the national TB control programme in India. We sought to derive and validate a clinical prediction rule, based on clinical and laboratory parameters, to identify patients at high risk for HIV co-infection among those treated for active TB. Methods: Case records of adult patients with active TB treated between 1997 and 2003 at the All India Institute of Medical Sciences hospital, New Delhi were retrospectively reviewed. The data set was randomly split into a training set and a testing set. First a clinical prediction rule was derived by multivariable logistic regression on the training set and was subsequently validated on the testing set. Results: The study group comprised 1074 patients [training set 711 (66%), HIV co-infected 66 (9%); testing set 363 (34%), HIV co-infected 30 (8%)]. In the training set, male gender [odds ratio (95% CI) 5.31(1.52- 18.61)], axillary lymphadenopathy [9.71 (3.24-29.10)], anaemia [7.56 (2.48-23.05)], hypoalbuminaemia [3.67(1.31-10.26)], and reduced triceps skinfold thickness [2.91(0.95-8.89)] were independently associated with HIV co-infection. In the testing set, presence of any two of these five features was 94 per cent (95% CI 84-100%) sensitive and 54 per cent (49-60%) specific for predicting HIV co-infection; negative predictive value was 99 per cent (98-100%). Area under the receiver-operating characteristic curve was 0.93 (0.86-1.0) in the testing set. Interpretation & Conclusion: A simple clinical prediction rule based on clinical and laboratory parameters could be used to identify a subgroup of patients, among those treated for active TB in a hospital setting, for targeted HIV testing

Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome

Background & Objectives: Awareness regarding obstructive sleep apnoea (OSA) among general public as well as practicing physicians is low in India. The present study was undertaken to test the utility of modified Berlin questionnaire for risk categorization of OSA in Indian setting. Methods: The modified Berlin questionnaire was administered in 180 middle aged adults (of 320 screened), of whom, 104 underwent overnight polysomnograhy, in a cross-sectional study at a tertiary care, referral center in north India. Questionnaire addressed the presence of frequency of snoring, wake time sleepiness, fatigue, obesity and hypertension. Subjects with persistent and frequent symptoms in any two of these three domains were considered in high risk category for obstructive sleep apnoea. Overnight polysomnograhy was performed to measure apnoea and hypopnoea index (AHI). Results: Questions about the symptoms demonstrated internal consistency (Cronbach alpha correlations 0.92-0.96). Of the 180 respondents to the screening questions, 80 were in the high risk and the rest were in low risk group. For 104 subjects who underwent polysomnograhy, risk grouping was useful in prediction of AHI. High risk category predicted an AHI > 5 with a sensitivity of 86 per cent, specificity of 95 per cent, positive and negative predictive values of 96 and 82 per cent respectively. These results were comparable to Berlin questionnaire study done in the western population for validation. Interpretation & Conclusion: On the basis of the findings of present study it is concluded that administration of modified Berlin questionnaire prior to a polysomnography study can identify high risk subjects and can thus avoid unnecessary polysomnography studies especially in resource-limited settings. To identify subjects at risk for OSA syndrome in general population, this questionnaire can be applied. However, the findings of the present study need to be confirmed further in a large number of subjects in a community-based setting

Dentinal microcracks after root canal instrumentation using instruments manufactured with different NiTi alloys and the SAF system: A systematic review

Aim: The aim of this systematic analysis was to assess the prevalence of dentinal microcracks at various levels (3, 6, and 9mm from the apex) after using instruments made with conventional, R-Phase, and M-Wire NiTi alloys and the SAF system. Materials and Methods: Electronic searches were conducted in the databases Embase, Cochrane Library, Scopus, PubMed, andWeb of Science. To arrange search methods, “MeSH” terms and/or keywords typically associated with the subject were paired with the Boolean operators “AND” and “OR.” Additional searches were conducted on the websites of four separate endodontic journals. After reading the titles and excluding duplicates, 1000 of the 1343 documents originally found were eliminated. Upon reviewing the abstracts, 310 of the remaining 343 experiments were also eliminated. Based on qualifying requirements, only 13 of the remaining 33 articles were included in the qualitative review. Results: All systems triggered dentinal microcracks; however, when chemo-mechanical preparation was performed using Self-Adjusting File (SAF) and systems manufactured with R-phase technology—K3XF and Twisted File Adaptive (TFA)—less of these defects were found when compared to those manufactured with traditional NiTi—ProTaper Universal and Mtwo—and with M-Wire—ProTaper Next, Reciproc, and WaveOne. Conclusions: A lower prevalence of dentinal microcracks was observed after using SAF and endodontic systems manufactured with R-phase

Effet de la Substitution Partielle du Tourteau de Glycine max (L.) Merr (Soja) par le Tourteau de la Pulpe de Dacryodes edulis (Safou) H.J. Lam. (1932) dans l’Alimentation des Poules Pondeuses au Congo-Brazzaville

La substitution des résidus de graines de soja ou tourteau par des intrants locaux est  souvent proposée comme une alternative dans l’amélioration de la productivité avicole. Pour tester cette hypothèse, les résidus de la pulpe de Dacryodes edulis a été expérimenté chez des poules pondeuses âgées de 24 semaines. L’étude avait pour but de substituer partiellement les résidus de soja par les résidus de la pulpe de Dacryodes edulis  à 7 % dans l’alimentation des poules pondeuses. Au cours de cette étude, un échantillon de 60 poules pondeuses avait été réparti en deux  lots ; les résidus de Dacryodes edulis a été incorporé à 7 % dans le premier lot  et le second groupe a servi de témoin. Les deux groupes ont été comparés sur des paramètres zootechniques et économiques. Le  traitement a amélioré significativement  (p< 0,05), l’efficacité alimentaire (4,03 contre 3,11) quoi qu’on ait observé une baisse de la consommation volontaire d’aliment et d’eau respectivement de 16,7 % et 17,4%.  De même, l’incorporation des résidus de la pulpe de Dacryodes edulis à 7% a amélioré significativement la ponte, en l’occurrence le nombre moyen d’œufs pondus par poule  (43,12 contre 46,62), le poids moyen de l’œuf (54,41 g contre 56,48 g), le taux de ponte au pic de ponte, (71,42% contre 74,30%)  et la production des œufs commercialisables  (744 œufs contre 876 œufs). Sur le plan économique, le traitement a amélioré significativement  le coût de revient  du kg d’aliment  (299, 82 FCFA contre 275,95 FCFA), le  prix de production de l’œuf  (95,17 FCFA contre 68,10 FCFA). L'hypothèse formulée au début de cette étude a été vérifiée. L’incorporation des résidus des graines ou tourteau de Dacryodes edulis dans l’alimentation des poules pondeuses est une alternative en aviculture fermière. Cette étude ouvre des perspectives intéressantes   en arboriculture fruitière et en aviculture fermière  au Congo.   Substitution of soybean or meal residue with local inputs is often proposed as an alternative in improving poultry productivity. To test this hypothesis, Dacryodes edulis residues were tested in 24-week-old laying hens. The aim of the study was to partially replace soybean residues with Dacryodes edulis pulp residues at 7% in the diet of laying hens. During this study, a sample of 60 laying hens was divided into two groups; Dacryodes edulis residues were incorporated at 7% in the first batch and the second group served as a control. The two groups were compared on zootechnical and economic parameters. The treatment significantly (p<0.05) improved feed efficiency (4.03 versus 3.11), although a drop in voluntary food and water consumption of 16.7 was observed respectively. % and 17.4%. Likewise, the incorporation of Dacryodes edulis pulp residues at 7% significantly improved laying, in this case the average number of eggs laid per hen (43.12 versus 46.62), the average weight of the egg (54.41 g versus 56.48 g), the laying rate at peak laying (71.42% versus 74.30%) and the production of marketable eggs (744 eggs versus 876 eggs). Concerning the economic level, the treatment significantly improved the cost  per kg of food (299.82 FCFA vs  275.95 FCFA), the production price of the egg (95.17 FCFA vs 68.10 FCFA) . The hypothesis formulated at the beginning of this study was verified. Incorporating residues of Dacryodes edulis seeds or cake into the feed of laying hens is an alternative in free-range poultry farming. This study points interesting perspectives in fruit cultivation  and oultry farming in Congo

Effects of sex and stocking density on the performance of broiler chickens in a sub-tropical environment

The current study investigated the effects of sex and stocking density and their interaction on growth performance and carcass characteristics of broiler chickens in a semi-arid sub-tropical environment. A total of 1008 day-old Cobb Avian48 chicks, namely 462 males and 546 females, were reared at final stocking densities of 30, 35, and 40 kg bodyweight per square metre (BW/m2) corresponding to 44, 51 and 59, and 52, 61 and 69 chicks per pen for males and females, respectively, during a 42-day production period. The experiment was a 2 × 3 factorial completely randomized design, with each sex-stocking density combination being replicated three times. After the initial weighing, the birds were weighed individually [grams (g)] each week until the 42nd day. At day 42, four birds from each pen were randomly sampled and slaughtered, and carcass characteristics were measured after 48 hours, and expressed as percentages of bodyweight. Growth performance and carcass characteristic parameters were subjected to analysis of variance using the general linear model procedures of Minitab statistical software version 17. Treatment means were compared using Tukey’s test (at α = 0.05). Males gained more weight and were significantly heavier at slaughter age (2649 ± 43.1 g) than females (2270 ± 43.1 g). There was a progressive reduction in feed intake with increasing stocking density, but neither sex nor stocking density influenced feed conversion ratio and mortality rate. Sex significantly affected dressing percentage and carcass parts percentages, namely breast, neck, shank, heart and abdominal fat and thigh, liver and gizzard. On the other hand, stocking density significantly influenced dressing percentage and carcass parts percentages such as breast, thigh, drumstick, neck, shank, liver and gizzard. There was a significant sex x stocking density interaction effect on percentages of thigh and liver. It is therefore suggested that for efficient 42-day production cycles of broilers in the subtropics, Cobb Avian48 males reared at the stocking density of 40 kg BW/m2 could be considered the best option.Keywords: Carcass characteristics, Cobb Avian48, feed conversion ratio, mortalit

A prospective study of risk factor profile & incidence of deep venous thrombosis among medically-ill hospitalized patients at a tertiary care hospital in Northern India

Background & Objective: Hospitalization for medical-illness is associated with an increased risk of deep venous thrombosis (DVT). However, there are no published data from India addressing at this issue. We sought to study the risk factor profile and the incidence of DVT among hospitalized medically-ill patients, a tertiary care hospital in northern India. Methods: All adults admitted to the medical wards and intensive care unit with level 1 or 2 mobility over a period of two years (July 2006 to July 2008) at the All India Institute of Medical Sciences hospital, New Delhi, were prospectively studied. Patients having DVT at admission or an anticipated hospital stay less than 48 h were excluded. The presence of clinical risk factors for DVT was recorded and laboratory evaluation was done for hypercoagulable state. A routine surveillance venous compression Doppler ultrasonography was performed 12 ± 8 days after hospital admission. Results: Of the 163 patients, 77 (47%) had more than one risk factor for DVT. Five (3%) patients developed DVT; none of them had symptomatic DVT. None of these patients received anticoagulation prior to the development of DVT. The mean age of those who developed DVT was 40 ± 13 (25-50) yr; two of five were male. The incidence rate of DVT was 2.7 per 1000 person-days of hospital stay [95% confidence interval (CI): 0.87 to 6.27]. None of the factors was found to be significantly associated with the risk of DVT. Interpretation & Conclusion: In our setting, although many hospitalized medically-ill patients had risk factors for DVT, the absolute risk of DVT was low compared to the western population but clearly elevated compared to non hospitalized patients. Large studies from India are required to confirm our findings

Implementing Parallel Differential Evolution on Spark

[Abstract] Metaheuristics are gaining increased attention as an efficient way of solving hard global optimization problems. Differential Evolution (DE) is one of the most popular algorithms in that class. However, its application to realistic problems results in excessive computation times. Therefore, several parallel DE schemes have been proposed, most of them focused on traditional parallel programming interfaces and infrastruc- tures. However, with the emergence of Cloud Computing, new program- ming models, like Spark, have appeared to suit with large-scale data processing on clouds. In this paper we investigate the applicability of Spark to develop parallel DE schemes to be executed in a distributed environment. Both the master-slave and the island-based DE schemes usually found in the literature have been implemented using Spark. The speedup and efficiency of all the implementations were evaluated on the Amazon Web Services (AWS) public cloud, concluding that the island- based solution is the best suited to the distributed nature of Spark. It achieves a good speedup versus the serial implementation, and shows a decent scalability when the number of nodes grows.[Resumen] Las metaheurísticas están recibiendo una atención creciente como técnica eficiente en la resolución de problemas difíciles de optimización global. Differential Evolution (DE) es una de las metaheurísticas más populares, sin embargo su aplicación en problemas reales deriva en tiempos de cómputo excesivos. Por ello se han realizado diferentes propuestas para la paralelización del DE, en su mayoría utilizando infraestructuras e interfaces de programación paralela tradicionales. Con la aparición de la computación en la nube también se han propuesto nuevos modelos de programación, como Spark, que permiten manejar el procesamiento de datos a gran escala en la nube. En este artículo investigamos la aplicabilidad de Spark en el desarrollo de implementaciones paralelas del DE para su ejecución en entornos distribuidos. Se han implementado tanto la aproximación master-slave como la basada en islas, que son las más comunes. También se han evaluado la aceleración y la eficiencia de todas las implementaciones usando el cloud público de Amazon (AWS, Amazon Web Services), concluyéndose que la implementación basada en islas es la más adecuada para el esquema de distribución usado por Spark. Esta implementación obtiene una buena aceleración en relación a la implementación serie y muestra una escalabilidad bastante buena cuando el número de nodos aumenta.[Resume] As metaheurísticas están recibindo unha atención a cada vez maior como técnica eficiente na resolución de problemas difíciles de optimización global. Differential Evolution (DE) é unha das metaheurísticas mais populares, ainda que a sua aplicación a problemas reais deriva en tempos de cómputo excesivos. É por iso que se propuxeron diferentes esquemas para a paralelización do DE, na sua maioría utilizando infraestruturas e interfaces de programación paralela tradicionais. Coa aparición da computación na nube tamén se propuxeron novos modelos de programación, como Spark, que permiten manexar o procesamento de datos a grande escala na nube. Neste artigo investigamos a aplicabilidade de Spark no desenvolvimento de implementacións paralelas do DE para a sua execución en contornas distribuidas. Implementáronse tanto a aproximación master-slave como a baseada en illas, que son as mais comúns. Tamén se avaliaron a aceleración e a eficiencia de todas as implementacións usando o cloud público de Amazon (AWS, Amazon Web Services), tirando como conclusión que a implementación baseada en illas é a mais acaida para o esquema de distribución usado por Spark. Esta implementación obtén unha boa aceleración en relación á implementación serie e amosa unha escalabilidade bastante boa cando o número de nos aumenta.Ministerio de Economía y Competitividad; DPI2014-55276-C5-2-RXunta de Galicia; GRC2013/055Xunta de Galicia; R2014/04

Active PD-L1 incorporation within HIV virions functionally impairs T follicular helper cells.

The limited development of broadly neutralizing antibodies (BnAbs) during HIV infection is classically attributed to an inadequate B-cell help brought by functionally impaired T follicular helper (Tfh) cells. However, the determinants of Tfh-cell functional impairment and the signals contributing to this condition remain elusive. In the present study, we showed that PD-L1 is incorporated within HIV virions through an active mechanism involving p17 HIV matrix protein. We subsequently showed that in vitro produced PD-L1high but not PD-L1low HIV virions, significantly reduced Tfh-cell proliferation and IL-21 production, ultimately leading to a decreased of IgG1 secretion from GC B cells. Interestingly, Tfh-cell functions were fully restored in presence of anti-PD-L1/2 blocking mAbs treatment, demonstrating that the incorporated PD-L1 proteins were functionally active. Taken together, the present study unveils an immunovirological mechanism by which HIV specifically exploits the regulatory potential of PD-L1 to suppress the immune system during the course of HIV infection

Phenotypic Characterization According to the Feather Color of Indigenous Muscovy Ducks Bred in the Back Yard in Brazzaville, the Congo

. In Congo, waterfowl genetic resources are constituted by native population of Muscovy ducks that play an important role in food security. The present study aimed to identify and to characterize strains bred in the back yard in the households in Brazzaville. A sample of 154 households drawn over seven districts of Brazzaville was enrolled in the survey. Adults ducks found in the households were identified, pictured by a key of determination and then compared by using the multi resolution analysis image method. The survey recorded 13 strains in which four were considered as newly since they have never been reported elsewhere. These strains received temporally the name of the districts where they have been identified for the first time Makelékélé 1 (0.34%, n=6), Makélékélé 2 (0.11%, n =2), Poto poto 1 (0.28%, n=5) and in Poto poto 2 (0.11%, n=2). Finally, the survey reported nine classical strains such as black plumage, duclair, white, tortora, sepia, chocolate, lavender, grey and canizie. The apparent wide variation in plumage colors is an indication that the duck populations have not been ‘purified' through selective breeding. In the context of the valorization of poultry biodiversity, this work represents a step toward a better knowledge of the production abilities of local ducks breeds in Congo

Mortality rates in transplant recipients and transplantation candidates in a high prevalence COVID-19 environment

Background: The risk of COVID-19 infection in transplant recipients (TRs) is unknown. Patients on dialysis may be exposed to greater risk of infection due to an inability to isolate. Consideration of these competing risks is important before restarting suspended transplant programs. This study compared outcomes in kidney and kidney/pancreas TRs with those on the waiting list, following admission with COVID-19 in a high-prevalence region. Methods: Audit data from all 6 London transplant centers were amalgamated. Demographic and laboratory data were collected and outcomes included mortality, intensive care (ITU) admission, and ventilation. Adult patients who had undergone a kidney or kidney/pancreas transplant, and those active on the transplant waiting list at the start of the pandemic were included. Results: One hundred twenty-one TRs and 52 waiting list patients (WL) were admitted to hospital with COVID-19. Thirty-six TR died (30%), while 14 WL patients died (27% P = 0.71). There was no difference in rates of admission to ITU or ventilation. Twenty-four percent of TR required renal replacement therapy, and 12% lost their grafts. Lymphocyte nadir and D-dimer peak showed no difference in those who did and did not die. No other comorbidities or demographic factors were associated with mortality, except for age (odds ratio of 4.3 [95% CI 1.8-10.2] for mortality if aged over 60 y) in TR. Conclusions: TRs and waiting list patients have similar mortality rates after hospital admission with COVID-19. Mortality was higher in older TRs. These data should inform decisions about transplantation in the COVID era