Diagnostic value of bronchoalveolar lavage in the subset of patients with negative sputum/smear and mycobacterial culture and a suspicion of pulmonary tuberculosis

Background: The diagnostic value of bronchoalveolar lavage in patients with negative sputum/smear for tuberculous bacilli has been well studied. However, its value in the subset of patients with both negative sputum/smear and culture is seldom reported. Methods: A retrospective study of patients referred for diagnostic bronchoscopy for the suspicion of pulmonary tuberculosis during the period from April 1st, 2015 to March 30th, 2016, and who had negative sputum/smear and culture for tuberculous bacilli. Results: One hundred and ninety patients fulfilled the inclusion criteria. Bronchoalveolar lavage detected further 61/190 (32.1%) pulmonary tuberculosis cases. Bronchoalveolar lavage mycobacterial culture and polymerase chain reaction (positive in 60/190 (31.6%) and 58/190 (30.5%) of patients respectively) provided the highest diagnostic yield, whereas direct smear provided the lowest yield. Bronchoalveolar lavage had a sensitivity of 89.7%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 94.6%, and a test accuracy of 96.3% in suspected pulmonary tuberculosis cases with negative sputum/smear and culture. Positive bronchoalveolar lavage yield for tuberculosis was significantly associated with a positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, radiological evidence of upper zone abnormality and patient's origin being from the Indian subcontinent. Conclusion: Bronchoalveolar lavage should be pursued as a useful diagnostic tool for suspected pulmonary tuberculosis cases when sputum/smear and culture are negative. Its value is higher in the subset of patients with positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, upper zone abnormality on radiograph or being from the Indian subcontinent.Scopu

Low switching power neuromorphic perovskite devices with quick relearning functionality

In the quest to reduce energy consumption, there is a growing demand for technology beyond silicon as electronic materials for neuromorphic artificial intelligence devices. Equipped with the criteria of energy efficiency and excellent adaptability, organohalide perovskites can emulate the characteristics of synaptic functions in the human brain. In this aspect, this study designs and develops CsFAPbI3-based memristive neuromorphic devices that can switch at low power and show larger endurance by adopting the powder engineering methodology. The neuromorphic characteristics of the CsFAPbI3-based devices exhibit an ultra-high paired-pulse facilitation index for an applied electric stimuli pulse. Moreover, the transition from short-term to long-term memory requires ultra-low energy with long relaxation times. The learning and training cycles illustrate that the CsFAPbI3-based devices exhibit faster learning and memorization process owing to their larger carrier lifetime compared to other perovskites. The results provide a pathway to attain low-power neuromorphic devices that are synchronic to the human brain's performance

A model for pushover analysis of confined masonry structures : implementation and validation

Confined masonry (CM) is a typical building technique in Latin American countries. This technique, due to its simplicity of construction and similarity with traditional practices of reinforced concrete building, presents a potential of use in European regions with moderate-to-high seismicity. However, most of the procedures for seismic design in codes for Latin America are force-based, which appears to be inadequate due to the high dissipative response observed for CM. This paper presents a simplified numerical-analytical approach to model CM structures using pushover analysis, aiming to apply performance-based design procedures. First, a data mining process is performed on a database of experimental results collected from lateral tests on CM walls to adjust prediction models for the wall shear strength and to determine the input relevance through a sensitivity analysis. Then, an analytical model of CM structures for pushover analysis is proposed with basis on a wide-column approach that employs an adaptive shear load-displacement constitutive relation. The proposed method is compared with a discrete element model that represents explicitly the confinements-masonry interaction, against the experimental results obtained in a quasi-static test of a full-scale tridimensional CM structure. The accuracy of the predictions from both methods is very satisfactory, allowing to capture the base shear-displacement envelope and also the damage patterns of the structure, thus, demonstrating the ability of the methods to be used in performance-based seismic assessment and design of CM buildings.The first author acknowledges the financial support from the Portuguese Foundation for Science and Technology (FCT) through the Ph.D. Grant SFRH/BD/41221/2007

Anti-inflammatory and anti-oxidant properties of Ipomoea nil (Linn.) Roth significantly alleviates cigarette smoke (CS)-induced acute lung injury via possibly inhibiting the NF-KB pathway

Acute respiratory distress syndrome (ARDS), a serious manifestation of acute lung injury (ALI), is a debilitating inflammatory lung disease that is caused by multiple risk factors. One of the primary causes that can lead to ALI/ ARDS is cigarette smoke (CS) and its primary mode of action is via oxidative stress. Despite extensive research, no appropriate therapy is currently available to treat ALI/ARDS, which means there is a dire need for new potential approaches. In our study we explored the protective effects of 70 % methanolic-aqueous extract of Ipomoea nil (Linn.) Roth, named as In.Mcx against CS-induced ALI mice models and RAW 264.7 macrophages because Ipomoea nil has traditionally been used to treat breathing irregularities. Male Swiss albino mice (20-25 +/- 2 g) were subjected to CS for 10 uninterrupted days in order to establish CS-induced ALI murine models. Dexamethasone (1 mg/kg), In.Mcx (100 200, and 300 mg/kg) and normal saline (10 mL/kg) were given to respective animal groups, 1 h before CS-exposure. 24 h after the last CS exposure, the lungs and bronchoalveolar lavage fluid (BALF) of all euthanized mice were harvested. Altered alveolar integrity and elevated lung weightcoefficient, total inflammatory cells, oxidative stress, expression of pro-inflammatory cytokines (IL-10 and IL-6) and chemokines (KC) were significantly decreased by In.Mcx in CS-exposed mice. In.Mcx also revealed significant lowering IL-10, IL-6 and KC expression in CSE (4 %)-activated RAW 264.7 macrophage. Additionally, In.Mcx showed marked enzyme inhibition activity against Acetylcholinesterase, Butyrylcholinesterase and Lipoxygenase. Importantly, In.Mcx dose-dependently and remarkably suppressed the CS-induced oxidative stress via not only reducing the MPO, TOS and MDA content but also improving TAC production in the lungs. Accordingly, HPLC analysis revealed the presence of many important antioxidant components. Finally, In.Mcx showed a marked decrease in the NF-KB expression both in in vivo and in vitro models. Our findings suggest that In.Mcx has positive therapeutic effects against CS-induced ALI via suppressing uncontrolled inflammatory response, oxidative stress, lipoxygenase and NF-KB p65 pathway

Patients' satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan – a cross sectional study

<p>Abstract</p> <p>Background</p> <p>It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients.</p> <p>Methods</p> <p>It was a cross sectional study carried out at a major tertiary care hospital of Karachi. Patients between the ages of 18 and 80 years admitted to the hospital for at least one day were included. Patients in the maternity, psychiatry and chemotherapy wards and those in the ICU/CCU were excluded. A pretested, peer reviewed translation of a validated patient satisfaction scale developed by the Picker Institute of Europe was administered.</p> <p>Results</p> <p>A total of 173 patients (response rate: 78.6 %) filled the questionnaire. Patient satisfaction was at levels comparable to European surveys for most aspects of hospital care. However, nearly half the patients (48%) felt they had to wait too long to get a bed in the hospital after presenting to the ER. 68.6% of the patients said that they were never asked for views on the quality of care provided. 20% of the patients did not find anyone in the staff to talk to about their worries and fears while 27.6% felt that they were given emotional support to only some extent. Up to one third of the patients said they were not provided enough information regarding their operative procedures beforehand.</p> <p>Conclusion</p> <p>Although several components of patient care equal the quality levels of the west, many sections require considerable improvement in order to improve health care provision. The healthcare team needs to get more involved with the patients, providing them greater support and keeping them informed and involved with their medical treatment. Efforts should be made to get regular feedback from the patients.</p

Increased HIV-1 transcriptional activity and infectious burden in peripheral blood and gut-associated CD4+ T cells expressing CD30

HIV-1-infected cells persist indefinitely despite the use of combination antiretroviral therapy (ART), and novel therapeutic strategies to target and purge residual infected cells in individuals on ART are urgently needed. Here, we demonstrate that CD4+ T cell-associated HIV-1 RNA is often highly enriched in cells expressing CD30, and that cells expressing this marker considerably contribute to the total pool of transcriptionally active CD4+ lymphocytes in individuals on suppressive ART. Using in situ RNA hybridization studies, we show co-localization of CD30 with HIV-1 transcriptional activity in gut-associated lymphoid tissues. We also demonstrate that ex vivo treatment with brentuximab vedotin, an antibody-drug conjugate (ADC) that targets CD30, significantly reduces the total amount of HIV-1 DNA in peripheral blood mononuclear cells obtained from infected, ART-suppressed individuals. Finally, we observed that an HIV-1-infected individual, who received repeated brentuximab vedotin infusions for lymphoma, had no detectable virus in peripheral blood mononuclear cells. Overall, CD30 may be a marker of residual, transcriptionally active HIV-1 infected cells in the setting of suppressive ART. Given that CD30 is only expressed on a small number of total mononuclear cells, it is a potential therapeutic target of persistent HIV-1 infection

Electrochromic device based on carbon nanotubes functionalized poly (methyl pyrrole) synthesized in hydrophobic ionic liquid medium

A facile approach of carbon nanotubes (CNTs) functionalized poly(methylpyrrole) [pMPy] electrosynthesized in hydrophobic ionic liquid for fabrication of electrochromic (EC) devices is discussed. Clear change from brown (oxidized) to pale yellow (neutral) color is demonstrated with robust cycle life. This synthesis route can be exploited to fabricate polymers from other organic conjugated systems and provide an avenue for applications requiring stable redox polymers in electrochromic devices

Effect of nano gamma-Al2O3 addition on ion dynamics in polymer electrolytes

Polymer electrolytes, which hold the key of successful operation of all solid state ionic devices, have been investigated. An amorphous polymer was used to facsimile fast ion transport in the gel polymer electrolytes (GPE) and room temperature conductivity >10−3 S/cm can be attained. Further, these electrolytes were transformed into composites by dispersing inorganic particles of γ-Al2O3 (11 nm in size) in varying wt.%. An enhancement in the conductivity for an optimum concentration using LiClO4 as a salt can be obtained and is described in terms of free charge carrier concentration, while the other family of Lithium salts viz. LiTf, LiIm, LiBETI decreases the conductivity marginally. FTIR spectroscopy supports the observed decrease in terms of more association between fillers and salts. It has been realized that the mechanical integrity of these composites increases manifold, without affecting the conductivity, significantly

Effect of salts on the fumed silica-based composite polymer electrolytes

Polymer electrolytes, which are ubiquitous and indispensable in all electrochemical devices, have been investigated and a study to explore their performance characteristics on salt type and salt concentration and different binary solvents has been performed. LiBETI salt exhibits less variation with change in molar concentration and is expected to form less ion pair formation. It has been realized that though the addition of inert ceramic fillers, i.e. fumed silica, enhances the mechanical integrity but decreases conductivity marginally in the LiIm, LiBETI and LiBF4 based salt. This decrease in conductivity is due to their more interaction with the PMMA as established by FTIR. Moreover these electrolytes were found to be exhibited high conductivity (>mS/cm) to warrant their practical applications. The glass transition temperature increases with the addition of fillers pointing towards the lower mobility of Li+ ions and these electrolytes also exhibit high-thermal stability