Human leptospirosis in patients with undifferentiated acute febrile illness in a tertiary care hospital in New Delhi

Background: Leptospirosis is an important cause of febrile illness with a widespread global distribution. Although endemic in the southern and western states of India, its true incidence in the northern states of the country remains underreported. The main objective of this study was to estimate the seropositivity of infections by Leptospira in patients presenting with undifferentiated acute fever, in a tertiary care hospital in New Delhi.Methods: This prospective observational study was conducted from November 2016 to March 2018 in a tertiary care hospital in New Delhi. Blood samples of the patients (n=370) having fever for more than one week and seronegative for typhoid, dengue, chikungunya and malaria were subjected to Leptospira IgM ELISA (DRG International Inc., USA). Data was analyzed using statistical software SPSS version 21.Results: Out of 370 patients, 142 (38.4%) were males and 228 (61.6%) were females; the mean age was 32.18 years. The most common symptom was headache (55.5%) and icterus (55.55%) whereas increased ALT/AST was the most common laboratory finding (88.8%) followed by anaemia (77.7%). On employing Leptospira IgM ELISA, 2.43% (9 cases, n=370) were strongly reactive (>1.0 OD) whereas 15.1% (56 cases) were weakly reactive (1.15-1.00 OD).Conclusions: There is a need to increase awareness and suspicion regarding diagnosis of leptospirosis. A positive IgM ELISA when correlated with patient’s clinical profile and epidemiological factors can aid in the timely diagnosis and treatment of these infections.

Prediction of Soil Anisotropic Stress-Strain Behaviour Incorporating Shear Strength Using Improvise Normalised Stress-Strain Method

Currently the soil anisotropic stress-strain behaviour can be predicted accurately at any effective stress using the Rotational Multiple Yield Surface Framework. This framework incorporates the developed of mobilised shear strength within the body of the soil mass whenever the soil is subjected to anisotropic compression. However the accuracy of the framework can be improvised since the failure axial strain is not unique but increases as the effective stress increases. This improved method s call normalised strain method. This method is applied to predict the stress-strain behaviour of granitic residual soil grade V from Kuala Kubu Baharu. The improve accuracy of this method will be presented in comparison with the conventional method

Numerical Assessment of Pipe Pile Axial Response under Seismic Excitation

In engineering, the ground in seismically active places may be subjected to static and seismic stresses. To avoid bearing capacity collapse, increasing the system's dynamic rigidity, and/or reducing dynamic fluctuations, it may be required to employ deep foundations instead of shallow ones. The axial aptitude and pipe pile distribution of load under static conditions have been well reported, but more study is needed to understand the dynamic axial response. Therefore, this research discusses the outputs of the 3D finite element models on the soil-pile behavior under different acceleration intensities and soil states by using MIDAS GTS NX. The pipe pile was represented as a simple elastic, and a modified Mohr-Coulomb model was used to describe the surrounding soil layers. When low acceleration was introduced in the early stages, positive frictional resistance (i.e., in dry soil, the FR was about 1.61, 1.98, and 0.9 Mpa under Kobe, Halabja, and Ali Algharbi earthquakes, respectively) was recorded. However, as the acceleration increased (from PGA = 0.1 g and 0.102 g to PGA = 0.82 g), the resistance reduced and eventually turned negative. In this study, both internal and exterior frictional resistance were measured. It was found that the soil state and acceleration intensity both have a noticeable effect on the failure process, i.e., the maximum plug soil resistance decreased by about 55% by changing the soil condition from a dry to a saturated state under the recorded data of the Kobe earthquake. A rough estimation of the long-term settlements at the shaken soil surface is meant to be included in the results of this research

Microbial fuel cells: a green and alternative source for bioenergy production

Microbial fuel cell (MFC) represents one of the green technologies for the production of bioenergy. MFCs using microalgae produce bioenergy by converting solar energy into electrical energy as a function of metabolic and anabolic pathways of the cells. In the MFCs with bacteria, bioenergy is generated as a result of the organic substrate oxidation. MFCs have received high attention from researchers in the last years due to the simplicity of the process, the absence in toxic by-products, and low requirements for the algae growth. Many studies have been conducted on MFC and investigated the factors affecting the MFC performance. In the current chapter, the performance of MFC in producing bioenergy as well as the factors which influence the efficacy of MFCs is discussed. It appears that the main factors affecting MFC’s performance include bacterial and algae species, pH, temperature, salinity, substrate, mechanism of electron transfer in an anodic chamber, electrodes materials, surface area, and electron acceptor in a cathodic chamber. These factors are becoming more influential and might lead to overproduction of bioenergy when they are optimized using response surface methodology (RSM)

Biofilter aquaponic system for nutrients removal from fresh market wastewater

Aquaponics is a significant wastewater treatment system which refers to the combination of conventional aquaculture (raising aquatic organism) with hydroponics (cultivating plants in water) in a symbiotic environment. This system has a high ability in removing nutrients compared to conventional methods because it is a natural and environmentally friendly system (aquaponics). The current chapter aimed to review the possible application of aquaponics system to treat fresh market wastewater with the intention to highlight the mechanism of phytoremediation occurs in aquaponic system. The literature revealed that aquaponic system was able to remove nutrients in terms of nitrogen and phosphorus

Serous cystic neoplasm of the pancreas: A multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas)

OBJECTIVES: Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN: Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS: 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58\u2005years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40\u2005mm (2-200)), 9% had resection beyond 1\u2005year of follow-up (3\u2005years (1-20), size at diagnosis: 25\u2005mm (4-140)) and 39% had no surgery (3.6\u2005years (1-23), 25.5\u2005mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1\u2005year (n=1271), size increased in 37% (growth rate: 4\u2005mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS: After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN

Activating mutations in genes related to TCR signaling in angioimmunoblastic and other follicular helper T-cell-derived lymphomas.

Angioimmunoblastic T-cell lymphoma (AITL) and other lymphomas derived from follicular T-helper cells (TFH) represent a large proportion of peripheral T-cell lymphomas (PTCLs) with poorly understood pathogenesis and unfavorable treatment results. We investigated a series of 85 patients with AITL (n = 72) or other TFH-derived PTCL (n = 13) by targeted deep sequencing of a gene panel enriched in T-cell receptor (TCR) signaling elements. RHOA mutations were identified in 51 of 85 cases (60%) consisting of the highly recurrent dominant negative G17V variant in most cases and a novel K18N in 3 cases, the latter showing activating properties in in vitro assays. Moreover, half of the patients carried virtually mutually exclusive mutations in other TCR-related genes, most frequently in PLCG1 (14.1%), CD28 (9.4%, exclusively in AITL), PI3K elements (7%), CTNNB1 (6%), and GTF2I (6%). Using in vitro assays in transfected cells, we demonstrated that 9 of 10 PLCG1 and 3 of 3 CARD11 variants induced MALT1 protease activity and increased transcription from NFAT or NF-κB response element reporters, respectively. Collectively, the vast majority of variants in TCR-related genes could be classified as gain-of-function. Accordingly, the samples with mutations in TCR-related genes other than RHOA had transcriptomic profiles enriched in signatures reflecting higher T-cell activation. Although no correlation with presenting clinical features nor significant impact on survival was observed, the presence of TCR-related mutations correlated with early disease progression. Thus, targeting of TCR-related events may hold promise for the treatment of TFH-derived lymphomas

Angioimmunoblastic T-cell lymphoma is the most common T-cell lymphoma in two distinct French information data sets.

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The role of molecular genetics in diagnosing familial hematuria(s)

Familial microscopic hematuria (MH) of glomerular origin represents a heterogeneous group of monogenic conditions involving several genes, some of which remain unknown. Recent advances have increased our understanding and our ability to use molecular genetics for diagnosing such patients, enabling us to study their clinical characteristics over time. Three collagen IV genes, COL4A3, COL4A4, and COL4A5 explain the autosomal and X-linked forms of Alport syndrome (AS), and a subset of thin basement membrane nephropathy (TBMN). A number of X-linked AS patients follow a milder course reminiscent of that of patients with heterozygous COL4A3/COL4A4 mutations and TBMN, while at the same time a significant subset of patients with TBMN and familial MH progress to chronic kidney disease (CKD) or end-stage kidney disease (ESKD). A mutation in CFHR5, a member of the complement factor H family of genes that regulate complement activation, was recently shown to cause isolated C3 glomerulopathy, presenting with MH in childhood and demonstrating a significant risk for CKD/ESKD after 40 years old. Through these results molecular genetics emerges as a powerful tool for a definite diagnosis when all the above conditions enter the differential diagnosis, while in many at-risk related family members, a molecular diagnosis may obviate the need for another renal biopsy