Paragonimiasis Misdiagnosed as Pulmonary Tuberculosis: A Case Report

Paragonimiasis is a zoonosis caused by the ingestion of raw or undercooked crustaceans parasitized with metacercaria of Paragonimus spp. In Peru, Cajamarca is considered an endemic region for paragonimiasis. A 29-year-old man from the department of San Martín, Peru presented with a three-year history of cough, chest pain, fever, and hemoptysis. Treatment for tuberculosis (TB) was initiated even with negative results for sputum acid-fast bacillus (AFB), due to the patient\u27s clinical characteristics and the high prevalence of the condition in the region. After eight months, due to the lack of any clinical improvement, he was referred to a regional hospital, where Paragonimus eggs were evidenced in direct sputum cytology. The patient received treatment with triclabendazole and showed clinical and radiological improvement. It is important to consider eating habits, even in non-endemic areas, for diagnosing paragonimiasis in patients with TB symptoms who do not respond to a specific treatment

One-session bilateral sequential whole lung lavage (OSBSWLL) for the management of pulmonary alveolar proteinosis

BACKGROUND: Whole Lung Lavage (WLL) has been an important part in the management of Pulmonary Alveolar Proteinosis (PAP) since it improves radiologic and clinical parameters. Bilateral WLL is usually performed in two sessions on different days. Few case reports have described one-session bilateral sequential lung lavage (OSBSWLL), and none have described ambulatory management (same-day discharge). METHODS: Demographic characteristics, physiologic parameters, procedure details and outcomes were retrospectively collected on consecutive patients who underwent OSBSWLL for PAP following an ambulatory protocol stablished in our institution. RESULTS: A total of 13 patients underwent 30 OSBSWLL (61.5% male; mean age 40). The mean SpO2 was 90% (IQR 9) and 94% (IQR 6), before and after OSBSWLL respectively. In 63.3% of cases, patients were discharged home the same day of procedure. Only in two cases (6.6%), patients required post-procedure prolonged mechanical ventilation (\u3e 4 h) due to persistent hypoxia. CONCLUSIONS: OSBSWLL can be performed with same-day discharge

Diseño de un sistema logístico para reducir costos de la empresa Irza Ingenieros S. R. L, Cajamarca 2021

El objetivo principal de la presente investigación es diseñar un sistema logístico en la empresa IRZA INGENIEROS SRL, la cual se dedica al rubro de la construcción. Está localizada en la ciudad de Cajamarca; para identificar la situación actual de la empresa y área de estudio hicimos un organigrama y mapa de procesos del área, para poder abordar los problemas detectados, aplicamos herramientas metodológicas teniendo en cuenta nuestra experiencia de aprendizaje. Se utilizó la homologación y evaluación de proveedores, clasificación ABC, diseño Layout, programa de capacitaciones, fichas de órdenes de compras, ficha de control de existencias en el inventario. En los costos actuales de la empresa se realizando una evaluación económica para medir la viabilidad del diseño en la empresa, usando instrumentos para la recolección de datos confiables, luego se realizó un análisis de costo beneficio dando resultados óptimos para la empresa con valores actuales que consisten en actualizar los cobros y pagos de un proyecto o inversión. Por último, diseñar un sistema logístico para la medición de costos, los cuales se hicieron mediante historiales bibliográficos que sean favorables con el tiempo, y así finalmente la empresa ofrezca un servicio de calidad hacia sus clientes con un buen manejo de los recursos

Uplink Non-Orthogonal Multiple Access with Finite-Alphabet Inputs

This paper focuses on the non-orthogonal multiple access (NOMA) design for a classical two-user multiple access channel (MAC) with finite-alphabet inputs. We consider practical quadrature amplitude modulation (QAM) constellations at both transmitters, the sizes of which are assumed to be not necessarily identical. We propose to maximize the minimum Euclidean distance of the received sum-constellation with a maximum likelihood (ML) detector by adjusting the scaling factors (i.e., instantaneous transmitted powers and phases) of both users. The formulated problem is a mixed continuous-discrete optimization problem, which is nontrivial to resolve in general. By carefully observing the structure of the objective function, we discover that Farey sequence can be applied to tackle the formulated problem. However, the existing Farey sequence is not applicable when the constellation sizes of the two users are not the same. Motivated by this, we define a new type of Farey sequence, termed punched Farey sequence. Based on this, we manage to achieve a closed-form optimal solution to the original problem by first dividing the entire feasible region into a finite number of Farey intervals and then taking the maximum over all the possible intervals. The resulting sum-constellation is proved to be a regular QAM constellation of a larger size. Moreover, the superiority of NOMA over time-division multiple access (TDMA) in terms of minimum Euclidean distance is rigorously proved. Furthermore, the optimal rate allocation among the two users is obtained in closed-form to further maximize the obtained minimum Euclidean distance of the received signal subject to a total rate constraint. Finally, simulation results are provided to verify our theoretical analysis and demonstrate the merits of the proposed NOMA over existing orthogonal and non-orthogonal designs.Comment: Submitted for possible journal publicatio

Knowledge Transfer with a STEAM Educational Approach

El enfoque STEAM (Ciencia, Tecnología, Ingeniería, Arte y Matemáticas) ha adquirido una prominencia creciente en la educación contemporánea, subrayando la necesidad de desarrollar habilidades interdisciplinarias para afrontar los desafíos del mundo actual. A pesar de ello, un desafío crítico persiste en este contexto: la transferencia efectiva de conocimiento dentro del enfoque STEAM. El objetivo general de este ensayo consiste en analizar y destacar los aspectos que hacen que la metodología STEAM sea prioritaria para la transformación de los modelos educativos tradicionales, cuyas limitaciones obstaculizan la transferencia de conocimiento. La compartimentalización del conocimiento en disciplinas separadas se identifica como una de las principales causas de esta falta de transferencia. Para abordar este problema, se enfatiza la importancia de fomentar la interdisciplinariedad. Los resultados de este análisis resaltan la importancia de una pedagogía centrada en el estudiante, permiten la exploración y el descubrimiento como medio para potenciar la transferencia de conocimiento. Es relevante la formación docente en estrategias interdisciplinarias como un elemento crucial para abordar este desafío.The STEAM (Science, Technology, Engineering, Art and Mathematics) approach has gained increasing prominence in contemporary education, underscoring the need to develop interdisciplinary skills to meet the challenges of today's world. Despite this, a critical challenge persists in this context: the effective transfer of knowledge within the STEAM approach. The general objective of this essay is to analyze and highlight the aspects that make the STEAM methodology a priority for the transformation of traditional educational models, whose limitations hinder the transfer of knowledge. The compartmentalization of knowledge into separate disciplines is identified as one of the main causes of this lack of transfer. To address this problem, the importance of promoting interdisciplinarity is emphasized. The results of this analysis highlight the importance of a student-centered pedagogy, allowing exploration and discovery as a means to enhance knowledge transfer. Teacher training in interdisciplinary strategies is relevant as a crucial element to address this challenge

Bronchoalveolar Lavage Lymphocytes in the Diagnosis of Hypersensitivity Pneumonitis among Patients with Interstitial Lung Disease: A Systematic Review

RATIONALE: Hypersensitivity Pneumonitis (HP) is an interstitial lung disease (ILD) characterized by inflammation and/or fibrosis in response to an inhalational exposure. OBJECTIVE: To determine the value of bronchoalveolar lavage (BAL) fluid lymphocyte cellular analysis in the detection of HP among patients with newly detected ILD. METHODS: This systematic review was undertaken in the context of development of an American Thoracic Society (ATS), Japanese Respiratory Society (JRS), and Asociación Latinoamericana del Tórax (ALAT) clinical practice guideline. The clinical question was, should patients with newly detected ILD undergo BAL fluid lymphocyte analysis to diagnose HP? Medline, Embase, and grey literature were searched through October 2019. Studies that reported the percentage of BAL fluid lymphocytes for various ILDs were selected for inclusion. Meta-analyses compared the mean percentage of BAL fluid lymphocytes among patients with HP to that among patients with Idiopathic Pulmonary Fibrosis (IPF) or sarcoidosis. The sensitivity and specificity by which various percentages of BAL fluid lymphocytes distinguish HP from IPF and sarcoidosis were also evaluated. RESULTS: Eighty-four articles were selected. No randomized trials or observational studies were identified that compared BAL fluid lymphocyte analysis to no BAL fluid lymphocyte analysis in patients with ILD. Included studies were case series describing BAL fluid cell differentials in patients with various ILDs. The percentage of BAL fluid lymphocytes was significantly higher in both fibrotic and nonfibrotic HP compared to IPF. Similarly, the percentage of BAL fluid lymphocytes was significantly higher in both fibrotic and nonfibrotic HP compared to sarcoidosis. A threshold of 20% BAL fluid lymphocytes distinguished fibrotic HP from IPF with a sensitivity and specificity of 69% and 61% respectively, and nonfibrotic HP from IPF with a sensitivity and specificity of 95% and 61% respectively. It distinguished fibrotic HP from sarcoidosis with a sensitivity and specificity of 69% and 26% respectively, and nonfibrotic HP from sarcoidosis with a sensitivity and specificity of 95% and 26% respectively. CONCLUSION: The percentage of BAL fluid lymphocytes is higher in HP than IPF or sarcoidosis. However, a threshold that distinguishes HP from IPF or sarcoidosis with both high sensitivity and high specificity was not identified

Remoción del colorante azul marino directo sobre borra de café modificada

The presence of dyes in water bodies inhibits the penetration of light, affecting the flora and fauna of these ecosystems, which is why, greater efforts are made to eliminate them before being poured. This study allowed the removal of the direct navy-blue dye (DNB), using activated carbon prepared from coffee beans and H3PO4. The experimental methodology began with the preparation of three types of activated carbon by varying the concentration of H3PO4 (20, 40 and 60% m/v). Texture properties were evaluated by adsorption-desorption isotherms with N2 to 77 K, the identification and quantification of organic functional groups, mainly acids, with FTIR and the Boehm method, respectively. Batch adsorption experiments were performed by varying the initial dye concentration (5, 10, 50, 75, 100 and 200 mg/dm3) to 25 °C and, the adsorption kinetics was determined. Both coffee beans and activated carbons have an acidic nature with surface area development between 519 and 771 m2/g. With respect to the batch study, a monolayer and multilayer growth was observed on a heterogeneous surface. Activated carbon prepared with 20% of H3PO4 recorded the highest removal capacity with a value of 25.8 mg/g. The kinetic model of pseudo second order was the one that best fit to the experimental data (R2 > 0.98). It can be concluded that the coffee bean treated with H3PO4 is an efficient adsorbent to remove DNB from aqueous solutions.La presencia de colorantes en los cuerpos de agua inhibe la penetración de la luz, afectando la flora y la fauna de estos ecosistemas, razón por la cual se hacen cada vez esfuerzos mayores para eliminarlos antes de ser vertidos. Este estudio permitió remover el colorante azul marino directo (AMD), empleando carbón activado preparado a partir de la borra de café y H3PO4. La metodología experimental inició con la preparación de tres tipos de carbón activado, variando la concentración de H3PO4 (20, 40 y 60% m/v). Las propiedades de textura se evaluaron mediante isotermas de adsorción-desorción con N2 a 77 K; la identificación y cuantificación de grupos funcionales orgánicos, en especial ácidos, con FTIR, y el método de Boehm, respectivamente. Se realizaron experimentos de adsorción por lote, variando la concentración inicial del colorante (5, 10, 50, 75, 100 y 200 mg/dm3) a 25 °C y se determinó la cinética de adsorción. Tanto la borra de café como los carbones activados tienen naturaleza ácida con desarrollo de áreas superficiales entre 519 y 771 m2/g. Con respecto al estudio por lote, se observó un crecimiento en monocapa y multicapa sobre una superficie heterogénea. El carbón activado preparado con 20% de H3PO4 registró la mayor capacidad de remoción, con un valor de 25.8 mg/g. El modelo cinético de pseudo segundo orden fue el que mejor se ajustó a los datos experimentales (R2 > 0.98). Se puede concluir que la borra de café tratada con H3PO4 es un adsorbente eficiente para eliminar AMD de soluciones acuosas

Shape-sensing robotic-assisted bronchoscopy for pulmonary nodules: initial multicenter experience using the Ion™ Endoluminal System

BACKGROUND: Traditional bronchoscopy provides limited approach to peripheral nodules. Shape-sensing robotic-assisted bronchoscopy (SSRAB, Ion™ Endoluminal System) is a new tool for minimally invasive peripheral nodule biopsy. We sought to answer the research question: Does SSRAB facilitate sampling of pulmonary nodules during bronchoscopists\u27 initial experience? METHODS: The lead-in stage of a multicenter, single-arm, prospective evaluation of the Ion Endoluminal System (PRECIsE) is described. Enrolled subjects ≥ 18 years old had recent computed tomography evidence of one or more solid or semi-solid pulmonary nodules ≥ 1.0 to ≤ 3.5 cm in greatest dimension and in any part of the lung. Subjects were followed at 10- and 30-days post-procedure. This stage provided investigators and staff their first human experience with the SSRAB system; safety and procedure outcomes were analyzed descriptively. Neither diagnostic yield nor sensitivity for malignancy were assessed in this stage. Categorical variables are summarized by percentage; continuous variables are summarized by median/interquartile range (IQR). RESULTS: Sixty subjects were enrolled across 6 hospitals; 67 nodules were targeted for biopsy. Median axial, coronal and sagittal diameters were \u3c 18 mm with a largest cardinal diameter of 20.0 mm. Most nodules were extraluminal and distance from the outer edge of the nodule to the pleura or nearest fissure was 4.0 mm (IQR: 0.0, 15.0). Median bronchial generation count to the target location was 7.0 (IQR: 6.0, 8.0). Procedure duration (catheter-in to catheter-out) was 66.5 min (IQR: 50.0, 85.5). Distance from the catheter tip to the closest edge of the virtual nodule was 7.0 mm (IQR: 2.0, 12.0). Biopsy completion was 97.0%. No pneumothorax or airway bleeding of any grade was reported. CONCLUSIONS: Bronchoscopists leveraged the Ion SSRAB\u27s functionality to drive the catheter safely in close proximity of the virtual target and to obtain biopsies. This initial, multicenter experience is encouraging, suggesting that SSRAB may play a role in the management of pulmonary nodules. Clinical Trial Registration identifier and date NCT03893539; 28/03/2019

Microbial Diversity in the Midguts of Field and Lab-Reared Populations of the European Corn Borer Ostrinia nubilalis

Background: Insects are associated with microorganisms that contribute to the digestion and processing of nutrients. The European Corn Borer (ECB) is a moth present world-wide, causing severe economical damage as a pest on corn and other crops. In the present work, we give a detailed view of the complexity of the microorganisms forming the ECB midgut microbiota with the objective of comparing the biodiversity of the midgut-associated microbiota and explore their potential as a source of genes and enzymes with biotechnological applications. Methodological/Principal Findings: A high-throughput sequencing approach has been used to identify bacterial species, genes and metabolic pathways, particularly those involved in plant-matter degradation, in two different ECB populations (field-collected vs. lab-reared population with artificial diet). Analysis of the resulting sequences revealed the massive presence of Staphylococcus warneri and Weissella paramesenteroides in the lab-reared sample. This enabled us to reconstruct both genomes almost completely. Despite the apparently low diversity, 208 different genera were detected in the sample, although most of them at very low frequency. By contrast, the natural population exhibited an even higher taxonomic diversity along with a wider array of cellulolytic enzyme families. However, in spite of the differences in relative abundance of major taxonomic groups, not only did both metagenomes share a similar functional profile but also a similar distribution of non-redundant genes in different functional categories. Conclusions/Significance: Our results reveal a highly diverse pool of bacterial species in both O. nubilalis populations, with major differences: The lab-reared sample is rich in gram-positive species (two of which have almost fully sequenced genomes) while the field sample harbors mainly gram-negative species and has a larger set of cellulolytic enzymes. We have found a clear relationship between the diet and the midgut microbiota, which reveals the selection pressure of food on the community of intestinal bacteria. © 2011 Belda et al.The research was funded by the Spanish Ministerio de Ciencia e Innovacion, under grant agreement CIT-010000-2008-5 and by a MICINN (Ministerio de Ciencia e Innovacion) TIN2009-12359 ArtBioCom project. Arnau Montagud acknowledges Generalitat Valenciana grant BFPI/2007/283. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Belda Cuesta, EA.; Pedrola, L.; Peretó Magraner, J.; Martinez Blanch, JF.; Montagud Aquino, A.; Navarro-Peris, E.; Urchueguía Schölzel, JF.... (2011). Microbial Diversity in the Midguts of Field and Lab-Reared Populations of the European Corn Borer Ostrinia nubilalis. PLoS ONE. 6(6):21751-21751. https://doi.org/10.1371/journal.pone.0021751S21751217516