Pulmonary tuberculosis followed by sarcoidosis in an HIV-infected patient: a case report and a simplified diagnostic flowchart for diagnosis and treatment of sarcoidosis

The diagnosis of sarcoidosis in a patient living with HIV infection is an uncommon event and a challenge for clinicians. Clinical manifestations are variable and fluctuating depending to adherence to ARV therapy and to the level of CD4 count. We analyze here one chronic case in which sarcoidosis appeared clinically two years after pulmonary tuberculosis. The course of the disease was influenced and prolonged by frequent interruptions of antiretroviral therapy. Moreover the diagnosis and the decision to treat have been delayed by the need of exclusion of other pathologies, principally tuberculosis reactivation/reinfection, other mycobacterial diseases, hematologic malignancies. We propose a simplified flowchart for diagnosis and follow up of sarcoidosis, which may also be applied to patients with HIV infection. Diagnosis of latent tuberculosis infection (LTBI) may be difficult in these patients, because the immunological paradox of sarcoidosis. For this reason, following exclusion of active tuberculosis, we advise to submit all sarcoidosis patients to IPT (isoniazid preventive therapy), when immunosuppressive therapy is started

Clustering of educational building load data for defining healthy and energy-efficient management solutions of integrated HVAC systems

The COVID-19 pandemic is changing the way individuals, worldwide, feel about staying in public indoor spaces. A strict control of indoor air quality and of people's presence in buildings will be the new normal, to ensure a healthy and safe environment. Higher ventilation rates with fresh air are expected to be a requirement, especially in educational buildings, due to their high crowding index and social importance. Yet, in this framework, an increased use of primary energy may be overlooked. This paper offers a methodology to efficiently manage complex HVAC systems in educational buildings, concurrently considering the fundamental goals of occupants' health and energy sustainability. The proposed fourstep procedure includes: dynamic simulation of the building, to generate synthetic energy loads; clustering of the energy data, to identify and predict typical building use profiles; day-ahead planning of energy dispatch, to optimize energy efficiency; dynamic adjustment of air changes, to guarantee a safe indoor air quality. Clustering and forecasting energy needs are expected to become particularly effective in a highly regulated context. The technique has been tested on two university classroom buildings, considering pre-lockdown attendance. This notwithstanding, quality and significance of the obtained thermal energy clusters push towards a benchmark post-pandemic application

Influence of Different Dry-Mixing Techniques on the Mechanical, Thermal and Electrical Behavior of Ultra High Molecular Weight Polyethylene/Exhausted Tire Carbon Composites

The mechanical, thermal and electrical behavior of ultra high molecular weight (UHMWPE) composites containing different amount of pyrolyzed exhausted tire carbon (ETC) is investigated. Composites were obtained by dry-mixing the powders with a homogenizer and an impact mill. The results clearly indicate that, by changing the mixing method, it is possible to tune the rheological and morphological characteristics of the composites and in turn their mechanical, thermal and electrical properties. Better performances were observed for the composites obtained with the impact mill, which showed improved Young modulus, reduced electrical and thermal resistance with respect to those of homogenized counterparts. All the composites exhibited a relevant decrease of electrical resistivity

Model of the meniscus of an ionic liquid ion source.

A simple model of the transfer of charge and ion evaporation in the meniscus of an ionic-liquid ion source working in the purely ionic regime is proposed on the basis of order-of-magnitude estimates which show that, in this regime, _i_ the flow in the meniscus is dominated by the viscosity of the liquid and is affected very little by the mass flux accompanying ion evaporation, and _ii_ the effect of the space charge around the evaporating surface is negligible and the evaporation current is controlled by the finite electrical conductivity of the liquid. The model predicts that a stationary meniscus of a very polar liquid undergoing ion evaporation is nearly hydrostatic and can exist only below a certain value of the applied electric field, at which the meniscus attains its maximum elongation but stays smooth. The electric current vs applied electric field characteristic displays a frozen regime of negligible ion evaporation at low fields and a conduction-controlled regime at higher fields, with a sharp transition between the two regimes owing to the high sensitivity of the ion evaporation rate to the electric field. A simplified treatment of the flow in the capillary or liquid layer through which liquid is delivered to the meniscus shows that the size of the meniscus decreases and the maximum attainable current increases when the feeding pressure is decreased, and that appropriate combinations of feeding pressure and pressure drop may lead to high maximum currents

Impact of Dietary Fiber on Inflammation and Insulin Resistance in Older Patients: A Narrative Review

The beneficial impact of dietary fiber on the prevention and management of several chronic conditions associated with aging, including diabetes, neurodegenerative, cardiovascular diseases, and cancer, is well-known. High fiber intake has been associated with reduced inflammatory mediators counteracting the low-grade chronic inflammation typical of older age. In addition, dietary fiber improves postprandial glucose response and insulin resistance. In contrast, during acute diseases, its effects on insulin resistance and modulation of immune response are unclear. The aim of this narrative is to summarize the evidence for the potential impact of dietary fiber on inflammation and insulin resistance in older adults, with a particular focus on those acutely ill. Available evidence suggests that dietary fiber has the potential to counteract acute inflammation and to improve metabolic health. In addition, modulation of gut microbiota composition may contribute to improved immune function, particularly in the setting of aging-associated dysbiosis. This phenomenon has relevant implications in those acutely ill, in whom dysbiosis can be exacerbated. Our review leads to the conclusion that dietary interventions based on fiber manipulation could exploit its beneficial effects on inflammation and insulin resistance, if conducted from a precision nutrition perspective. This could also be true for the acutely ill patient, even though strong evidence is lacking

Seasonal cycle of benthic denitrification and DNRA in the aphotic coastal zone, northern Baltic Sea

Current knowledge on the seasonality of benthic nitrate reduction pathways in the aphotic, density stratified coastal zone of the Baltic Sea is largely based on data from muddy sediments, neglecting the potential contribution of sandy sediments. To gain a more comprehensive understanding of seasonality in this part of the Baltic Sea coast, we measured rates of benthic denitrification, anammox and dissimilatory nitrate reduction to ammonium (DNRA) monthly in the ice-free period of 2016 in both sandy and muddy aphotic sediments, northwestern Gulf of Finland. No anammox was observed. The seasonal cycle of denitrification in both sediment types was related to the hydrography-driven development of bottom water temperature. The seasonal cycle of DNRA was less clear and likely connected to a combination of bottom water temperature, carbon to nitrogen ratio, and substrate competition with denitrification. Denitrification and DNRA rates were 50-80 and 20% lower in the sandy than in the muddy sediment. The share of DNRA in total nitrate reduction, however, was higher in the sandy than in the muddy sediment, being (by similar to 50%) the highest DNRA share in sandy sediments so far measured. Our data add to the small pool of published studies showing significant DNRA in both cold and/or sandy sediments and suggest that DNRA is currently underestimated in the Baltic coastal nitrogen filter. Our results furthermore emphasize that the various environmental conditions of a coastal habitat (light regime, hydrography, and geomorphology) affect biogeochemical element cycling and thus need to be considered in data interpretation.Peer reviewe

Sedimentary organic matter, prokaryotes, and meiofauna across a river-lagoon-sea gradient

In benthic ecosystems, organic matter (OM), prokaryotes, and meiofauna represent a functional bottleneck in the energy transfer towards higher trophic levels and all respond to a variety of natural and anthropogenic disturbances. The relationships between OM and the different components of benthic communities are influenced by multiple environmental variables, which can vary across different habitats. However, analyses of these relationships have mostly been conducted by considering the different habitats separately, even though freshwater, transitional, and marine ecosystems, physically linked to each other, are not worlds apart. Here, we investigated the quantity and nutritional quality of sedimentary OM, along with the prokaryotic and meiofauna abundance, biomass, and biodiversity, in two sampling periods, corresponding to high vs. low freshwater inputs to the sea, along a river-to-sea transect. The highest values of sedimentary organic loads and their nutritional quality, prokaryotic and meiofaunal abundance, and biomass were consistently observed in lagoon systems. Differences in the prokaryotic Operational Taxonomic Units (OTUs) and meiofaunal taxonomic composition, rather than changes in the richness of taxa, were observed among the three habitats and, in each habitat, between sampling periods. Such differences were driven by either physical or trophic variables, though with differences between seasons. Overall, our results indicate that the apparent positive relationship between sedimentary OM, prokaryote and meiofaunal abundance, and biomass across the river-lagoon-sea transect under scrutiny is more the result of a pattern of specifically adapted prokaryotic and meiofaunal communities to different habitats, rather than an actually positive 'response' to OM enrichment. We conclude that the synoptic analysis of prokaryotes and meiofauna can provide useful information on the relative effect of organic enrichment and environmental settings across gradients of environmental continuums, including rivers, lagoons, and marine coastal ecosystems