Role of Bronchoscopy in Diagnosis of Pulmonary Infections in Non-HIV Immunocompromised Host

INTRODUCTION: Immunocompromised patients are prone to develop pulmonary infections and appearance of lung infiltrate is not uncommon. Most causes are infectious but upto 30% may have non-infectious causes. Hence identifying the right cause and initiating specific therapy leads to avoidance of use of large number of empirical antimicrobials. Bronchoscopy and bronchoalveolar lavage is considered as fast and reliable procedure and has been extensively used. AIM OF THE STUDY: To evaluate the diagnostic efficacy and safety of bronchoscopy in non-HIV immunocompromised with pulmonary infiltrates. MATERIALS AND METHODS: We included 65 consecutive NON-HIV immunocompromised patients with new pulmonary infiltrates from DEC 2015 to JUNE 2016 who were sputum AFB smear negative. All patients were subjected to flexible bronchoscopy and BAL after CBC, BT, CT Chest Xray and CT Scan was done. The main indication of bronchoscopy was failure to respond to empirical antimicrobial therapy. BAL samples were sent Bacterial & Fungal Culture, KOH, grams & AFB stain, GeneXpert for MTB, cytology and special stains like Pneumocystis carini. RESULTS: The patients included in our study were cancer patients receiving chemotherapy, Post Renal Transplant on immunosuppresives, Chronic Kidney Disease On maintenance Haemodialysis, Haematological malignancies, Rheumatological disorders on treatment with immunosuppresants and Biological agents. An etiological diagnosis was obtained in 52 (80%) out of 65. Infectious causes were identified in 41 cases (63%) and non-infectious causes in 10 cases (17%). Bronchoscopy led to change of treatment in 37 cases (56%). Only minor complications like transient hypoxemia, minor bleeding were observed apart from one case of pneumothorax. CONCLUSION: FOB and BAL are useful and safe in immunocompromised patients led to 56% change in treatment plan in our study which was statistically significant

A BIBLIOMETRIC ANALYSIS OF CONTRIBUTIONS IN THE JOURNAL “NATURE”

The present study Bibliometric analysis of the Journal “Nature” covers 13499 articles of 59 volumes in five years from 2013 to 2017. The aim of study was to analyze the year wise distribution of articles & citations, authorship pattern of articles, group co-efficient values for collaborative author’s publications, ranking of authors based on publications and h-index score, most productive countries and institutions, type of document published, keyword distribution, impact factor and future growth of journal. Form the analysis the following Results has been found that, in the year 2015 highest number of 2944(21.81%) articles was published out of 13499 articles in five years. Average numbers of citations per article are 33.70. Single author contribution has more dominant with 7063(52.3%) articles. A total number of 88670 authors around the globe are contributing articles in this journal. The anonymous author has been ranked top contributing maximum 987 articles. Witze A is in the second position with 179 articles. Wang J has been influenced author contributed in “Nature” journal, who produced 54 articles with having h-index 41 with 17031 citations and ranked in first place. It is identified that distribution number of references is gradually decreased year by year. In geographical distribution articles, United States of America has contributed highest number of 5815 articles with 31.07%. Majority of the participants are from University of California with 980 (7.25%) articles. The maximum number of 4719(34.96%) records is Editorial Materials which is more than one-fourth of total publications. The word “Expression” was most occurred keyword in 359(2.65%) articles. Impact Factor of the previous year (2017) is 25.95 and five-year impact factor is 33.70. The future trend of growth of research articles in “Nature” journal may take increasing for upcoming years

Racial and Ethnic Variation in Lipoprotein (a) Levels among Asian Indian and Chinese Patients

Background. Lipoprotein (a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD) in Non-Hispanic Whites (NHW). There are known racial/ethnic differences in Lp(a) levels, and the association of Lp(a) with CVD outcomes has not been examined in Asian Americans in the USA. Objective. We hypothesized that Lp(a) levels would differ in Asian Indians and Chinese Americans when compared to NHW and that the relationship between Lp(a) and CVD outcomes would be different in these Asian racial/ethnic subgroups when compared to NHW. Methods. We studied the outpatient electronic health records of 2022 NHW, 295 Asian Indians, and 151 Chinese adults age ≥18 y in Northern California in whom Lp(a) levels were assessed during routine clinical care from 2001 to 2008, excluding those who had received prescriptions for niacin (14.6%). Nonparametric methods were used to compare median Lp(a) levels. Significance was assessed at the P < .0001 level to account for multiple comparisons. CVD outcomes were defined as ischemic heart disease (IHD) (265 events), stroke (122), or peripheral vascular disease (PVD) (87). We used logistic regression to determine the relationship between Lp(a) and CVD outcomes. Results. Both Asian Indians (36 nmol/L) and NHW (29 nmol/L) had higher median Lp(a) levels than Chinese (22 nmol/L, P ≤ .0001 and P = .0032). When stratified by sex, the differences in median Lp(a) between these groups persisted in the 1761 men (AI v CH: P = .001, NHW v CH: P = .0018) but were not statistically significant in the 1130 women (AI v CH: P = .0402, NHW v CH: P = .0761). Asian Indians (OR = 2.0) and Chinese (OR = 4.8) exhibited a trend towards greater risk of IHD with high Lp(a) levels than NHW (OR = 1.4), but no relationship was statistically significant. Conclusion. Asian Indian and NHW men have higher Lp(a) values than Chinese men, with a trend toward, similar associations in women. High Lp(a) may be more strongly associated with IHD in Asian Indians and Chinese, although we did not have a sufficient number of outcomes to confirm this. Further studies should strive to elucidate the relationship between Lp(a) levels, CVD, and race/ethnicity among Asian subgroups in the USA

Extraction and Physico-Chemical Characterization of Pineapple Crown Leaf Fibers (PCLF)

Apart from the widely discussed pineapple leaf fibers, normally referred to as PALF, fibers from other parts of the plant also exist, particularly those in the fruit crown, which are known as pineapple crown leaf fibers (PCLF). In this work, PCLF were characterized using thermogravimetric analysis (TGA), Fourier transform IR spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), and atomic force microscopy (AFM). The results indicated that the properties of PCLF do not greatly differ from those observed for PALF. In particular, a cellulose content of over 67% was observed, with approximately 76% crystallinity. The main degradation phenomena of the fibers took place between 230 and 380 degrees C, peaking at 324 degrees C, which is in line with observations in other fibers which have similar cellulose and crystalline contents. There was 13.4% residue at 680 degrees C. Bare mechanical retting of PCLF, although not allowing a full and thorough degumming, which would only be achieved through more aggressive chemical treatment, enabled aspect ratios of over 10(3) to be obtained. This indicates some potential for their application as short fibers in composites. In this respect, the considerable roughness of PCLF when compared to other leaf-extracted fibers, and in particular when compared to PALF, could suggest an ability to obtain a sufficiently sound fiber-matrix interface

Head and neck target delineation using a novel PET automatic segmentation algorithm

Purpose To evaluate the feasibility and impact of using a novel advanced PET auto-segmentation method in Head and Neck (H&N) radiotherapy treatment (RT) planning. Methods ATLAAS, Automatic decision Tree-based Learning Algorithm for Advanced Segmentation, previously developed and validated on pre-clinical data, was applied to 18F-FDG-PET/CT scans of 20 H&N patients undergoing Intensity Modulated Radiation Therapy. Primary Gross Tumour Volumes (GTVs) manually delineated on CT/MRI scans (GTVpCT/MRI), together with ATLAAS-generated contours (GTVpATLAAS) were used to derive the RT planning GTV (GTVpfinal). ATLAAS outlines were compared to CT/MRI and final GTVs qualitatively and quantitatively using a conformity metric. Results The ATLAAS contours were found to be reliable and useful. The volume of GTVpATLAAS was smaller than GTVpCT/MRI in 70% of the cases, with an average conformity index of 0.70. The information provided by ATLAAS was used to grow the GTVpCT/MRI in 10 cases (up to 10.6 mL) and to shrink the GTVpCT/MRI in 7 cases (up to 12.3 mL). ATLAAS provided complementary information to CT/MRI and GTVpATLAAS contributed to up to 33% of the final GTV volume across the patient cohort. Conclusions ATLAAS can deliver operator independent PET segmentation to augment clinical outlining using CT and MRI and could have utility in future clinical studies