An unusual cause of recurrent pneumonia in adults

Selective IgM deficiency is a rare primary immunodeficiency defined as isolated low levels of IgM. It presents with recurrent infections and has been described as first presenting in adulthood with recurrent respiratory tract infections. Unlike its better known counterpart of IgA deficiency, this particular immunodeficiency is often overlooked. We present a case of selective IgM deficiency who presented with recurrent respiratory infections

Intervention of Artificial Neural Network with an Improved Activation Function to Predict the Performance and Emission Characteristics of a Biogas Powered Dual Fuel Engine

Biogas is a significant renewable fuel derived by sources of biological origin. One of today’s research issues is the effect of biofuels on engine efficiency. The experiments on the engine are complicated, time consuming and expensive. Furthermore, the evaluation cannot be carried out beyond the permissible limit. The purpose of this research is to build an artificial neural network successfully for dual fuel diesel engine with a view to overcoming experimental difficulties. Authors used engine load, bio-gas flow rate and n-butanol concentration as input parameters to forecast target variables in this analysis, i.e., smoke, brake thermal efficiency (BTE), carbon monoxide (CO), hydrocarbon (HC), nitrous-oxide (NOx). Estimated values and results of experiments were compared. The error analysis showed that the built model has quite accurately predicted the experimental results. This has been described by the value of Coefficient of determination (R2), which varies between 0.8493 and 0.9863 with the value of normalized mean square error (NMSE) between 0.0071 and 0.1182. The potency of the Nash-Sutcliffe coefficient of efficiency (NSCE) ranges from 0.821 to 0.8898 for BTE, HC, NOx and Smoke. This research has effectively emulated the on-board efficiency, emission, and combustion features of a dual-fuel biogas diesel engine taking the Swish activation mechanism in artificial neural network (ANN) model

Intervention of Artificial Neural Network with an Improved Activation Function to Predict the Performance and Emission Characteristics of a Biogas Powered Dual Fuel Engine

Biogas is a significant renewable fuel derived by sources of biological origin. One of today’s research issues is the effect of biofuels on engine efficiency. The experiments on the engine are complicated, time consuming and expensive. Furthermore, the evaluation cannot be carried out beyond the permissible limit. The purpose of this research is to build an artificial neural network successfully for dual fuel diesel engine with a view to overcoming experimental difficulties. Authors used engine load, bio-gas flow rate and n-butanol concentration as input parameters to forecast target variables in this analysis, i.e., smoke, brake thermal efficiency (BTE), carbon monoxide (CO), hydrocarbon (HC), nitrous-oxide (NOx). Estimated values and results of experiments were compared. The error analysis showed that the built model has quite accurately predicted the experimental results. This has been described by the value of Coefficient of determination (R2), which varies between 0.8493 and 0.9863 with the value of normalized mean square error (NMSE) between 0.0071 and 0.1182. The potency of the Nash-Sutcliffe coefficient of efficiency (NSCE) ranges from 0.821 to 0.8898 for BTE, HC, NOx and Smoke. This research has effectively emulated the on-board efficiency, emission, and combustion features of a dual-fuel biogas diesel engine taking the Swish activation mechanism in artificial neural network (ANN) model

Endoscopic ultrasound-guided biliary drainage

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is emerging as a safe and effective alternative for endoscopic BD. The advantage of multiple access points from stomach and duodenum allows EUS-BD in patients with altered surgical anatomy and duodenal stenosis. EUS-BD is also useful in patients with failed endoscopic retrograde cholangiopancreatography or difficult biliary cannulation. Depending on the access and exit route of the stent, a variety of EUS-BD procedures have been described. Trans-papillary as well as trans-luminal stent placements are possible with EUS-BD. Recent studies have shown a clinical success rate in excess of 90% and complication rates of < 15%. Prospective studies are needed to know the long-term results and relative efficacy of this technique

Circulating levels of osteoprotegerin and sRANKL and the effect of methotrexate in patients with rheumatoid arthritis

Background: Receptor activator of nuclear factor κβ ligand (RANKL) and osteoprotegerin (OPG) are pivotal molecules involved in osteoclast activation and resorption. In RA, their alterations mediated through inflammatory cytokines are responsible for erosions and systemic bone loss. This study planned to look at the effect of methotrexate on circulating levels of OPG and RANKL in RA. Methods: Methotrexate-naive patients with active rheumatoid arthritis (RA) between 18 and 65 years of age were included. Controls were derived from voluntary healthy blood donors after written consent. All patients were started on methotrexate at 15 mg/week, increased by 5 mg every 4 weeks till maximum tolerated dose or 25 mg/week whichever was lower. Circulating plasma levels of OPG and RANKL were measured for cases (at baseline and 24 weeks) and controls (at baseline). Results: Fifty-one consecutive patients with RA and 57 controls were recruited. Circulating OPG (mean ± standard deviation) levels were higher in RA patients as compared to controls, 2879.6 ± 1037.9 and 2214.1 ± 705.3 pg/ml, respectively (P < 0.001). RANKL levels did not differ significantly between cases and controls. After treatment, circulating OPG levels fell significantly, from 2879.6 ± 1037.9 to 2059.8 ± 532.1 pg/ml (P < 0.001), however, no significant change in circulating RANKL levels. No difference was found in OPG and RANKL levels between patients with erosive and nonerosive disease. Conclusions: OPG levels are higher in RA patients and normalize in response to treatment with methotrexate. The initial higher levels of OPG may represent a compensatory mechanism to osteoclast activation; they normalize on reduction of disease activity