Tuberculosis diagnosis and treatment practices of private physicians in Karachi, Pakistan

In a densely populated urban area of Karachi, Pakistan, a questionnaire survey was made of the knowledge and practices of 120 private general practitioners about the diagnosis and treatment of tuberculosis (TB). The majority knew that cough, fever and weight loss were the main symptoms of TB, but less than half knew that blood in sputum, poor appetite and chest pain were associated with the disease. Only 58.3% of physicians used sputum microscopy for diagnosing TB and 35.0% used it as a follow-up test. Only 41.7% treated TB patients themselves, the remaining referring their patients to specialists. Around 73.3% of the doctors were aware of the 4 first-line anti-TB drugs. Efforts to improve the knowledge of private practitioners, and strategies to enhance public-private collaboration forTB control in urban areas are urgently required

Review on automated follicle identification for polycystic ovarian syndrome

Polycystic Ovarian Syndrome (PCOS), is a condition of the ovary consisting numerous follicles. Accurate size and number of follicles detected are crucial for treatment. Hence the diagnosis of this condition is by measuring and calculating the size and number of follicles existed in the ovary. To diagnosis, ultrasound imaging has become an effective tool as it is non invasive, inexpensive and portable. However, the presence of speckle noise in ultrasound imaging has caused an obstruction for manual diagnosis which are high time consumption and often produce errors. Thus, image segmentation for ultrasound imaging is critical to identify follicles for PCOS diagnosis and proper health treatment. This paper presents different methods proposed and applied in automated follicle identification for PCOS diagnosis by previous researchers. In this paper, the methods and performance evaluation are identified and compared. Finally, this paper also provided suggestions in developing methods for future research

Optimised combinatorial control strategy for active anti-roll bar system for ground vehicle

The objective of this paper is to optimise the proposed control strategy for an active anti-roll bar system using non-dominated sorting genetic algorithm (NSGA-II) tuning method. By using an active anti-roll control strategy, the controller can adapt to current road conditions and manoeuvres unlike a passive anti-roll bar. The optimisation solution offers a rather noticeable improvement results compared to the manually-tuned method. From the application point of view, both tuning process can be used. However, using optimisation method gives a multiple choice of solutions and provides the optimal parameters compared to manual tuning method

Air cavity-based vibrational piezoelectric energy harvesters

Introduction. Known vibrational energy harvesting methods use a source of vibration to harvest electric energy. Piezoelectric material works as a sensing element converted mechanical energy (vibration) to electrical energy (electric field). The existing piezoelectric energy harvesting (PEHs) devices have low sensitivity, low energy conversion, and low bandwidth. The novelty of the proposed work consists of the design of PEH’s structure. Air cavity was implemented in the design where it is located under the sensing membrane to improve sensitivity. Another novelty is also consisting in the design structure where the flexural membrane was located at the top of electrodes. The third novelty is a new design structure of printed circuit board (PCB). The purpose of improvised design is to increase the stress in between the edges of PEH and increase energy conversion. With the new structure of PCB, it will work as a substrate that absorbs surrounding vibration energy and transfers it to sensing element. Methods. Three techniques were successfully designed in PEH and fabricated namely PEH A, PEH B, and PEH C were characterized by two experiments: load and vibration. The load experiment measured load pressure towards the PEH, whereas the vibration experiment measured stress towards the PEH. Results. PEH C has the highest induced voltage for a weight of 5.2 kg at the frequency of 50 Hz and the highest stored voltage for a period of 4 min. The three techniques applied in PEHs were showed improvement in transducer sensitivity and energy conversion. Practical value. A piezoelectric acoustic generator was used in the experiment to compare the performance of the designed PEH with available piezoelectric transducers in the market. The new flexible membrane worked as a sensing element was worked as a cantilever beam. PVDF was used as a sensing element due to the flexibility of the polymer material, which is expected to improve sensitivity and operating bandwidth.Вступ. Відомі методи збору вібраційної енергії використовують джерело вібрації для збору електричної енергії. П’єзоелектричний матеріал працює як чутливий елемент, перетворюючи механічну енергію (вібрацію) в електричну енергію (електричне поле). Існуючі пристрої збору п’єзоелектричної енергії (ЗПЕ) мають низьку чутливість, низьке перетворення енергії і малу смугу пропускання. Новизна запропонованої роботи полягає в проектуванні конструкції ЗПЕ. У конструкції реалізована повітряна порожнина, яка розташована під чутливої мембраною для підвищення чутливості. Ще один елемент новизни полягає в конструкції, в якій вигиниста мембрана розташована у верхній частині електродів. Третя новизна - це нова конструкція друкованої плати. Мета запропонованої конструкції - збільшити механічну напругу між краями ЗПЕ і підвищити перетворення енергії. Завдяки новій конструкції друкованої плати вона буде працювати як підкладка, яка поглинає навколишню енергію вібрації і передає її на чутливий елемент. Методи. Три методи були успішно використані для проектування ЗПЕ,  і відповідно названі виготовлені ЗПЕ A, ЗПЕ Б і ЗПЕ В були описані двома експериментальними характеристиками: навантаження і вібрація. В експерименті з навантаженням вимірювався тиск навантаження на ЗПЕ, в той час як в експерименті з вібрацією вимірювалася механічна напруга на ЗПЕ. Результати. ЗПЕ В має найвищу індуковану напругу для ваги 5,2 кг при частоті 50 Гц і найвищу збережену напругу протягом 4 хвилин. Три методи, що застосовуються для ЗПЕ, показали поліпшення чутливості перетворювача і перетворення енергії. Практична цінність. В експерименті використовувався п’єзоелектричний акустичний генератор для порівняння характеристик розробленого ЗПЕ з доступними на ринку п’єзоелектричними перетворювачами. Нова гнучка мембрана працювала як чутливий елемент, що представляв собою консольну балка. В якості чутливого елемента використовувався полівініліден фторид завдяки гнучкості полімерного матеріалу, який, як очікується, поліпшить чутливість і робочу смугу пропускання

Roles of Cholesteryl--Glucoside Transferase and Cholesteryl Glucosides in Maintenance of Helicobacter pylori Morphology, Cell Wall Integrity, and Resistance to Antibiotics

ABSTRACT Infection of the human stomach caused by Helicobacter pylori is very common, as the pathogen colonizes more than half of the world’s population. It is associated with varied outcomes of infection, such as peptic ulcer disease, gastric ulcers, and mucosa-associated lymphoid tissue lymphoma, and is generally considered a risk factor for the development of gastric adenocarcinoma. Cholesteryl glucosides (CGs) constitute a vital component of the cell wall of H. pylori and contribute to its pathogenicity and virulence. The hp0421 gene, which encodes cholesteryl-α-glucoside transferase (CGT), appears critical for the enzymatic function of integrating unique CGs into the cell wall of H. pylori, and deletion of this gene leads to depletion of CGs and their variants. Herein, we report that the deletion of hp0421 and consequent deficiency of cholesterol alter the morphology, shape, and cell wall composition of H. pylori cells, as demonstrated by high-resolution confocal microscopy and flow cytometry analyses of two different type strains of H. pylori, their isogenic knockouts as well as a reconstituted strain. Moreover, measurement of ethidium bromide (EtBr) influx by flow cytometry showed that lack of CGs increased cell wall permeability. Antimicrobial susceptibility testing revealed that the hp0421 isogenic knockout strains (Hp26695Δ421 and Hp76Δ421) were sensitive to antibiotics, such as fosfomycin, polymyxin B, colistin, tetracycline, and ciprofloxacin, in contrast to the wild-type strains that were resistant to the above antibiotics and tended to form denser biofilms. Lipid profile analysis of both Hp76 and Hp76Δ421 strains showed an aberrant profile of lipopolysaccharides (LPS) in the Hp76Δ421 strain. Taken together, we herein provide a set of mechanistic evidences to demonstrate that CGs play critical roles in the maintenance of the typical spiral morphology of H. pylori and its cell wall integrity, and any alteration in CG content affects the characteristic morphological features and renders the H. pylori susceptible to various antibiotics. IMPORTANCE Helicobacter pylori is an important cause of chronic gastritis leading to peptic ulcer and is a major risk factor for gastric malignancies. Failure in the eradication of H. pylori infection and increasing antibiotic resistance are two major problems in preventing H. pylori colonization. Hence, a deeper understanding of the bacterial survival strategies is needed to tackle the increasing burden of H. pylori infection by an appropriate intervention. Our study demonstrated that the lack of cholesteryl glucosides (CGs) remarkably altered the morphology of H. pylori and increased permeability of the bacterial cell wall. Further, this study highlighted the substantial role of CGs in maintaining the typical H. pylori morphology that is essential for retaining its pathogenic potential. We also demonstrated that the loss of CGs in H. pylori renders the bacterium susceptible to different antibiotics

601 metal-on-metal total hip replacements with 36 mm heads a 5 minimum year follow up: Levels of ARMD remain low despite a comprehensive screening program

BACKGROUND: We conducted a retrospective study to assess the clinical outcome, failure rate, and reason for failure of a large consecutive series of 36 mm MoM Corail/Pinnacle total hip replacements (THRs). METHODS: Between 2006 and 2011, 601 consecutive 36 mm MoM THRs were performed (585 patients). Patients were followed according to the UK Medicines and Healthcare Products Regulatory Agency (MHRA) guidelines. All patients were accounted for and 469 patients (78%) were clinically and radiographically assessed. 328 females and 141 males with a median age of 73 (range 36-94 years) and a median follow up of 7.2 years (range 5.2-9.7 years) were followed. Clinical data included blood cobalt and chromium, Oxford Hip Score (OHS), plain radiograph, ultrasound of hip and intra-operative findings in those patients who had revision surgery. RESULTS: 56 patients died of causes unrelated to their hip replacement. The mean survivorship of the implant was 92.8% (range 91.6-94%, 95% CI) at a median time to follow up of 84 months (62-113 months). The functional outcome was good with a median OHS of 38 out of 48 (23-44). The dislocation rate was 0.99%, with all these 6 cases requiring revision. 476 patients had blood tests. 100 patients (21%) had elevated levels of either cobalt above MHRA guidelines of 7 parts per billion (120 and 135 nmol/L respectively for cobalt and chromium). Cobalt was elevated independently of chromium in 75% of the cases (but never vice versa). The mean cup inclination angle was 42°. Each incremental stem size increase resulted in a decrease in cobalt by 11 nmol/L. The most common reason for revision was adverse reaction to metal debris (ARMD) (12 cases). CONCLUSION: This paper is the largest and longest follow up of 36 mm MoM THRs. Using the MHRA guidelines for follow up, the revision rates of this cohort has remained low compared to other studies, but unacceptably higher than that of other bearing surfaces. LEVEL OF EVIDENCE: III