Time to culture conversion in smokers with pulmonary tuberculosis

Background and objective. It has been reported that tobacco smoking slows the sterilisation of sputum culture in pulmonary tuberculosis, but the factors that could delay culture conversion in patients who smoke are not known. Our aim is to identify the factors influencing sputum culture conversion in smokers with pulmonary tuberculosis. Methods. Ninety-nine patients with a smoking history and diagnosed with pulmonary tuberculosis were analysed retrospectively. The relationship between sputum culture status at the second month and the following variables: age, gender, pack-years index, comorbid diseases, number acid-fast bacilli (AFB) in sputum smear examination, radiological findings (cavitary, extensive or limited disease), drug susceptibility pattern and initial treatment, was analysed. The Student t-test, chi-square test and logistic regression model with forward stepwise conditional methods were used for statistical analysis. A p value of <0.05 was considered to be statistically significant. Results. Twenty six patients (26.2%): 18 males (22.2%) and 8 females (44%) were sputum culture positive at the end of the second month of treatment. In univariate analysis, culture conversion time was significantly associated with female gender and extensive disease, but in a logistic regression analysis was only correlated with female gender (OR=5.63 95% CI 1.21-20.64-p=0.02). Conclusion. In current smokers with pulmonary tuberculosis, the ‘time to culture’ conversion relates only to the female gender

Effect of phosphorus on the attenuation of lead and chromium

This study analyses the adsorption of Pb(II) and Cr(III) in soils. These metals are commonly found together in nature in urban wastes or industrial spillages, and the theoretical approach of the work was to evaluate the response of the soil to continuous Cr and Pb spillages to soil in terms of several physicochemical parameters. The influence of an anthropogenic input of phosphorus was evaluated. Continuous flow experiments were run in duplicates in acrylic columns (25 cm × 3.2 cm). The influent Cr(III) and Pb(II) solutions of 10 mg l−1 and 25 mg l−1 at pH 5 were pumped upward through the bottom of the columns to ensure saturation flow conditions. Also, successive experiments were run with the above concentrations of Cr(III) and Pb(II) and NaH2PO4, keeping metal to phosphorus ratio of 1:0, 1:0.1 and 1:1. Modelling parameters included Freundlich and Langmuir equations, together with the Two-site adsorption model using CXTFIT code. Results obtained allowed concluding that Pb(II) adsorption presents a certain degree of irreversibility and the continued spillages over soil increment the fraction which is not easily desorbed. Cr(III) desorption was almost complete, evidencing its high mobility in nature. The presence of an anthropogenic input of phosphorus leads to a marked increase of both Pb(II) and Cr(III) adsorption in soils. Z-potential measurements allow to discard the electrostatic attraction of Cr(III) and Pb(II) with the surface charged soil as the dominant process of metal sorption. Instead, CheaqsPro simulation allows to identify PbH2PO4 +, PbHPO4 (aq) and CrHPO4 + as the dominant species which regulate Cr(III) and Pb(II) transport in soils.Fundação para a Ciência e a Tecnologi

Utility of a safety switch to abrogate CD19.CAR T-cell–associated neurotoxicity

Chimeric antigen receptor (CAR)-modified T cells targeting the CD19 antigen are approved to treat relapsed and refractory B-cell malignancies.Despite durable objective responses, most patients experience acute toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Although many cases of ICANS resolve with supportive measures, high-grade ICANS may result in status epilepticus, lasting neurologic deficits, cerebral edema, and death. Therefore, novel approaches for severe ICANS fill an urgent unmet need to enhance the use of adoptive cellular therapy

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Highlights From the Annual Meeting of the American Epilepsy Society 2022

With more than 6000 attendees between in-person and virtual offerings, the American Epilepsy Society Meeting 2022 in Nashville, felt as busy as in prepandemic times. An ever-growing number of physicians, scientists, and allied health professionals gathered to learn a variety of topics about epilepsy. The program was carefully tailored to meet the needs of professionals with different interests and career stages. This article summarizes the different symposia presented at the meeting. Basic science lectures addressed the primary elements of seizure generation and pathophysiology of epilepsy in different disease states. Scientists congregated to learn about anti-seizure medications, mechanisms of action, and new tools to treat epilepsy including surgery and neurostimulation. Some symposia were also dedicated to discuss epilepsy comorbidities and practical issues regarding epilepsy care. An increasing number of patient advocates discussing their stories were intertwined within scientific activities. Many smaller group sessions targeted more specific topics to encourage member participation, including Special Interest Groups, Investigator, and Skills Workshops. Special lectures included the renown Hoyer and Lombroso, an ILAE/IBE joint session, a spotlight on the impact of Dobbs v. Jackson on reproductive health in epilepsy, and a joint session with the NAEC on coding and reimbursement policies. The hot topics symposium was focused on traumatic brain injury and post-traumatic epilepsy. A balanced collaboration with the industry allowed presentations of the latest pharmaceutical and engineering advances in satellite symposia

Strain localization of reinforced alkali-activated concrete under corrosion using digital image correlation

Ordinary port land cement (OPC) is one of the most commonly used material in the construction industry. However, its production produces harmful pollutants that largely contribute to global greenhouse emissions, as well as consumes a significant amount of natural resources such as limestone. Studies have found alkali-activated concrete (AAC) to be viable alternative for cement, and one of the greatest advantages of AAC against OPC is it corrosion resistance. In this study, the strain localization of reinforced alkali-activated concrete (AAC) with low-calcium coal fly ash (CFA) and ordinary port land cement (OPC) concrete beams under flexural bending tests with cyclic load has been investigated through digital image correlation (DIC) technique. The strain values obtained from both concrete types were compared and it was concluded that AAC strains are consistently higher than that of OPC Prior to testing the beams, compression tests were conducted on cylindrical samples of the two concrete types wherein it was found that both AAC and OPC are both ductile. Furthermore, the sensitivity of DIC and conventional strain gauges in measuring the strain for both AAC and OPC was investigated, and it was found that both techniques are sensitive for OPC while otherwise for AAC due to strain localization. The strain localization of AAC may be linked to its ductile characterization