Prospective comparison of microbial culture and polymerase chain reaction in the diagnosis of corneal ulcer.

PURPOSE: To compare polymerase chain reaction (PCR) to microbial culture for the detection and identification of bacterial and fungal pathogens in microbial keratitis. DESIGN: Prospective cohort study. METHODS: A total of 108 consecutive corneal ulcers were cultured and analyzed by PCR using pan-bacterial and pan-fungal primers. PCR products were cloned, sequenced, and compared to culture results using standard bioinformatics tools. RESULTS: Of the 108 samples, 56 were culture-positive, 25 for bacteria and 31 for fungi; 52 were culture-negative. After eliminating false-positive PCR products, 94 of 108 were positive by PCR, 37 for bacteria and 57 for fungi. Nineteen of 25 bacterial culture-positive samples were positive by PCR, and 29 of 31 samples culture-positive for fungi were positive by PCR. The majority of sequenced PCR products matched the positive culture results. Of the 52 culture-negative samples, 46 (88%) yielded pathogen deoxyribonucleic acid (DNA) PCR products, 18 bacterial and 28 fungal. These represented a variety of species, including at least three novel previously uncultured microbes. CONCLUSIONS: PCR detects microbial DNA in the majority of bacterial and fungal corneal ulcers, and identifies potentially pathogenic organisms in a high proportion of culture-negative cases. Yield and concordance with culture are higher for fungal than bacterial ulcers. Practical use of the technique is limited by artefactual amplification of nonpathogenic organisms. PCR may be used as an adjunct to culture to identify potential pathogens in microbial keratitis

A review on development and application of plant-based bioflocculants and grafted bioflocculants

Flocculation is extensively employed for clarification through sedimentation. Application of eco-friendly plant-based bioflocculants in wastewater treatment has attracted significant attention lately with high removal capability in terms of solids, turbidity, color, and dye. However, moderate flocculating property and short shelf life restrict their development. To enhance the flocculating ability, natural polysaccharides derived from plants are chemically modified by inclusion of synthetic, nonbiodegradable monomers (e.g., acrylamide) onto their backbone to produce grafted bioflocculants. This review is aimed to provide an overview of the development and flocculating efficiencies of plant-based bioflocculants and grafted bioflocculants for the first time. Furthermore, the processing methods, flocculation mechanism, and the current challenges are discussed. All the reported studies about plant-derived bioflocculants are conducted under lab-scale conditions in wastewater treatment. Hence, the possibility to apply natural bioflocculants in food and beverage, mineral, paper and pulp, and oleo-chemical and biodiesel industries is discussed and evaluated

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Management of Oehler’s Type III Dens Invaginatus Using Cone Beam Computed Tomography

Dens Invaginatus is a dental malformation that poses diagnostic difficulties in the clinical context. This anomaly may increase the risk of pulp disease and can potentially complicate endodontic procedure due to the aberrant root canal anatomy. Compared to conventional radiographs, three-dimensional images obtained with Cone Beam Computed Tomography (CBCT) are invaluable in the diagnosis of the extent of this anomaly and in the appropriate treatment planning. Oehler’s classification (1957) for Dens Invaginatus (DI) into three types depending on the depth of the invagination has been used for treatment planning. Of the three types Type III DI is characterized by infolding of the enamel into the tooth up to the root apex and is considered as the most severe variant of DI and hence the most challenging to treat endodontically, due to the morphological complexities. This report describes a case of Oehler’s Type III DI in a necrotic permanent maxillary lateral incisor in which CBCT images played a key role in diagnosis and treatment planning. The case was managed successfully by a combination of nonsurgical and surgical endodontic therapy with orthograde and retrograde thermoplastic gutta percha obturation

Fuzzy Logic based Efficient Multipath Routing for Mobile Adhoc Networks

The reliable data delivery is the main problem of Mobile Ad-Hoc Networks (MANET). Due to node mobility, heavy packet dropping occurs, which leads to packet overhead and links break. The previous routing protocols are vulnerable to node mobility especially for large-scale networks. Due to this issue ,an Efficient Multipath Routing Protocol (EMRP) using fuzzy logic controller is proposed which takes advantage of the stateless property of geographic routing and the broadcast nature of wireless medium. In this protocol, both stability and mobility are calculated to determine network reliability. The reliable multipath is constructed based on network topology. Both link and node reliability is determined to enable novel routing based on calculation of stability. Fuzzy logic control procedure is implemented with reliability to increase the network performance. This system is used in ad hoc network to determine its reliability. The proposed protocol is simulated with Network Simulator (NS2.34) tool to attain better stability and network reliability and also improves the network life time compared to Existing protocols EMLARP

High-Throughput in Wireless Mesh Networks Using Different Routing Metrics

ABSTRACT-Wireless Mesh Networks (WMN) can be designed using a routing technique. There is lot of protocols developed for many packets delivery, but they fail in the path selection in the presence of selfish nodes. To overcome this problem, Cross layer metrics is developed which is used to select the path that delivers the highest packet. The Optimized Link State Routing Protocol (OLSR) is used by individual nodes to compute next hop destinations for all nodes in the network.Expected Forwarded Counter (EFW), and two further variants, handle with the problem of selfish behavior (i.e., packet dropping) of mesh routers in a WMN. EFW selects reliable and high-performance path for packet transmission. The results show that the path reliability and increase the performance of the network

Serological markers of sand fly exposure to evaluate insecticidal nets against visceral leishmaniasis in India and Nepal: a cluster-randomized trial.

BACKGROUND: Visceral leishmaniasis is the world' second largest vector-borne parasitic killer and a neglected tropical disease, prevalent in poor communities. Long-lasting insecticidal nets (LNs) are a low cost proven vector intervention method for malaria control; however, their effectiveness against visceral leishmaniasis (VL) is unknown. This study quantified the effect of LNs on exposure to the sand fly vector of VL in India and Nepal during a two year community intervention trial. METHODS: As part of a paired-cluster randomized controlled clinical trial in VL-endemic regions of India and Nepal we tested the effect of LNs on sand fly biting by measuring the antibody response of subjects to the saliva of Leishmania donovani vector Phlebotomus argentipes and the sympatric (non-vector) Phlebotomus papatasi. Fifteen to 20 individuals above 15 years of age from 26 VL endemic clusters were asked to provide a blood sample at baseline, 12 and 24 months post-intervention. RESULTS: A total of 305 individuals were included in the study, 68 participants provided two blood samples and 237 gave three samples. A random effect linear regression model showed that cluster-wide distribution of LNs reduced exposure to P. argentipes by 12% at 12 months (effect 0.88; 95% CI 0.83-0.94) and 9% at 24 months (effect 0.91; 95% CI 0.80-1.02) in the intervention group compared to control adjusting for baseline values and pair. Similar results were obtained for P. papatasi. CONCLUSIONS: This trial provides evidence that LNs have a limited effect on sand fly exposure in VL endemic communities in India and Nepal and supports the use of sand fly saliva antibodies as a marker to evaluate vector control interventions