Pulmonary Aspergillosis: A Review on Diagnosis and Management

Aspergillosis is acquired by inhalation of spores of Aspergillus, a ubiquitous species in the environment. In normal hosts, spore inhalation rarely causes lung disease. Pulmonary aspergillosis covers a wide spectrum of clinical syndromes depending on the interaction between Aspergillus and the host (immune-status, prior bronchopulmonary disease). It runs the gamut from invasive aspergillosis to Aspergillus bronchitis and colonization. Invasive aspergillosis occurs in severely immunocompromised patients, typically with neutropenia. Chronic pulmonary aspergillosis affects patients with chronic structural lung disease such as chronic obstructive pulmonary disease, mycobacterial lung disease, but without significant immunocompromise. Aspergillus bronchitis affects patients with bronchial disease such as bronchiectasis. Allergic bronchopulmonary aspergillosis affects patients with bronchial asthma or cystic fibrosis, and is due to an allergic response to Aspergillus. In this review of literature, we discuss the pulmonary manifestations of Aspergillus infection, its diagnosis and treatments

Synthesis and Evaluation of Novel <i>S</i>-alkyl Phthalimide- and <i>S</i>-benzyl-oxadiazole-quinoline Hybrids as Inhibitors of Monoamine Oxidase and Acetylcholinesterase

New S-alkyl phthalimide 5a–f and S-benzyl 6a–d analogs of 5-(2-phenylquinolin-4-yl)-1,3,4-oxadiazole-2-thiol (4) were prepared by reacting 4 with N-bromoalkylphthalimide and CF3-substituted benzyl bromides in excellent yields. Spectroscopic techniques were employed to elucidate the structures of the synthesized molecules. The inhibition activity of newly synthesized molecules toward MAO-A, MAO-B, and AChE enzymes, was also assessed. All these compounds showed activity in the submicromolar range against all enzymes. Compounds 5a and 5f were found to be the most potent compounds against MAO-A (IC50 = 0.91 ± 0.15 nM) and MAO-B (IC50 = 0.84 ± 0.06 nM), while compound 5c showed the most efficient acetylcholinesterase inhibition (IC50 = 1.02± 0.65 μM). Docking predictions disclosed the docking poses of the synthesized molecules with all enzymes and demonstrated the outstanding potency of compounds 5a, 5f, and 5c (docking scores = −11.6, −15.3, and −14.0 kcal/mol against MAO-A, MAO-B, and AChE, respectively). These newly synthesized analogs act as up-and-coming candidates for the creation of safer curative use against Alzheimer’s illness

Використання глибокого навчання для розробки інтелектуального контролера вуличного освітлення і споживання електроенергії

Street lighting is very important now-days especially at dangerous areas and highways but it consume a lot of power and it became challenging for many researchers in the past few years. Enormous efforts have been placed on the issue of reducing power consumption in illuminating cities and streets, researchers had various approaches and methods in tackling this challenging matter, till now there is no ideal system that has been developed to reduce the electricity usage. In this paper intelligent controller based on deep learning proposed to control the light at the street from sunset to sunrise, the system will decrease the light used to illuminate the streets in the absence of movements, the network trained based on deep learning with several image of different objects to help the system detecting any moving objects in the street to provide the street with the exact amount of light needed in order to reduce the waste of electrical energy resulting from street lighting and to help reduce accidents hence high percentage of criminal activity and life threatening conditions occur in the absence of light. The system was trained with a vast and diverse dataset to assure the accuracy and efficiency of the proposed system, the trained system showed a result of 90 precision of detecting moving objects, the proposed system was tested with a new dataset to assure the reliability and dependency of the system and reducing the errors to the minimum, the system shows promising results in detecting movements and objects, after the detection being complete, the system will send a pulse width modulation causing a 20 % light dimming, leading to enormous reduction in the power consumption, adding to that the proposed system is easy to useВуличне освітлення дуже важливе в наші дні, особливо в небезпечних районах та на автомагістралях, але воно споживає багато енергії і останні кілька років стало проблемою для багатьох дослідників. Величезні зусилля були докладені до проблеми зниження енергоспоживання у висвітленні міст і вулиць, дослідники мали різні підходи та методи вирішення цього непростого завдання, досі не розроблено ідеальну систему, призначену для зниження енергоспоживання. У цій статті запропоновано інтелектуальний контролер керування на основі глибокого навчання світлом на вулиці від заходу сонця. Така система буде зменшувати світло, що використовується для освітлення вулиць при відсутності руху. Мережа навчена на основі глибокого навчання з кількома зображеннями різних об’єктів. Система виявляє будь-які рухомі об’єкти на вулиці, щоб забезпечити вулицю точною кількістю світла, необхідною для скорочення втрат електроенергії внаслідок вуличного освітлення та зменшення нещасних випадків, а також високого відсотку злочинної діяльності, що відбувається за відсутністю світла. Система була навчена на широкому і різноманітному наборі даних, щоб гарантувати її точність та ефективність. Система показала результат з точністю 90 при виявленні об’єктів, що рухаються. Система була протестована з новим набором даних, щоб гарантувати надійність і залежність. системи та зводячи помилки до мінімуму, система показує перспективні результати у виявленні рухів та об’єктів, після завершення виявлення система відправляє широтно-імпульсну модуляцію, що викликає затемнення світла на 20 %, що призведе до величезного зниження потужності споживання. Особливо слід зазначити, що запропонована система проста у використанн

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research