Unusual presentation of a young man with disseminated tuberculosis and right ventricular mass

We report a 22-year-old man who presented to the emergency department with worsening shortness of breath and chronic fever for 2 months. Physical examination was unremarkable except for raised jugular venous pressure and palpable liver. Echocardiogram showed a large right ventricular mass causing obstruction at tricuspid valve. A subsequent chest CT scan confirmed the presence of a large mass in the right ventricle. There were multiple enlarged lymph nodes and consolidation in the right upper lobe. Diagnosis of disseminated tuberculosis(TB) was made and later confirmed by histopathology of lymph node biopsy along with positive sputum culture for acid-fast bacilli. Remarkable recovery was observed on antituberculous therapy, with complete disappearance of the cardiac mass on echocardiogram, at 1-year follow-up. Although unusual and rare, myocardial involvement as a large mass should be kept in mind while treating patients with disseminated TB

On the Flow of Generalized Burgers' Fluid Induced by Sawtooth Pulses

This paper presents a study for the MHD flow of an incompressible generalized Burgers' fluid through a rectangular duct in porous medium. The flow is generated due to the velocity sawtooth pulses applied on the duct. Exact solutions of the governing equations are obtained by using the Laplace transform and double finite Fourier sine transform in this order. The obtained solutions satisfy all the initial and boundary conditions and are written as a sum of steady and transient solutions. Graphs are plotted for both developing and retarding flows. The effects of magnetic parameter, porosity parameter, and various parameters of interest on the flow characteristics are discussed. The problem reduces to the flow between two plates in the absence of side walls

Effect of Heat Sink Configuration on the COP of Thermoelectric Vaccine Refrigerator

Polio vaccines are significantly sensitive to temperature and environment. During polio vaccination campaigns in far off villages of Pakistan, it is one of the biggest challenges to store and transport the vaccine without affecting its quality. Various refrigeration techniques are used to keep the vaccine below ambient temperature. The energy consumption of conventional refrigeration systems is too high and the refrigerants having CFCs are hazardous to environment, contributing to global warming by depleting ozone layer. These are also slightly difficult to be developed into a lightweight and portable solar devices used outside.  Solar Powered Thermoelectric Refrigerator (SPTR) is a distinct type of refrigeration system which runs on solar energy rather than that of conventional source of electrical energy, based upon the peltier effect to create hot and cold sides. The current research work was carried out at the Mechanical Engineering Department, U.E.T. Lahore (KSK Campus). The experimental results indicated the unit is capable to maintain a temperature of 6 0C at an ambient temperature below that of 50 0C. The maximum coefficient of performance was recorded as 0.78. Special configuration of heat sink was used to get maximum heat dissipation with minimum cost. An optimal value of solar irradiance let the cooling rate and coefficient of performance to attain maximum value. The designed SPTR would be of a great potential for cold storage in the areas where electricity supply is absent. It has the advantages of being small, lightweight, low running cost, noiseless, portable, reliable, and also low initial cost in mass production. &nbsp

Numerical simulation of lead-free vacancy ordered Cs 2 PtI 6 based perovskite solar cell using SCAPS-1D

In recent years, vacancy-ordered halide double perovskites have emerged as promising non-toxic and stable alternatives for their lead-based counterparts in optoelectronic applications. In particular, vacancy ordered Cs2PtI6 has emerged as a star material because of its high absorption coefficient, band gap of 1.37 eV, and long minority carrier lifetime. Despite substantial experimental research on this new class of material, theoretical simulations of their device properties remain scarce. In this work, a novel n-i-p device architecture (FTO/SnO2/Cs2PtI6/MoO3/C) is theoretically investigated using a solar cell capacitance simulator (SCAPS-1D). Theoretical investigations are carried out in order to optimize the device performance structure by varying the perovskite and selective charge transport layer thickness, absorber and interface defect density, operating temperature, back contact, series and shunt resistance, respectively. The optimized device showed an impressive power conversion efficiency (PCE) of 23.52% at 300 K, which is higher than the previously reported values. Subsequent analysis of the device's spectral response indicated that it possessed 98.9% quantum efficiency (QE) and was visibly active. These findings will provide theoretical guidelines for enhancing the performance of Cs2PtI6-based photovoltaic solar cells (PSCs) and pave the way for the widespread implementation of environmentally benign and stable perovskites

Antibacterial efficacy of indigenous Pakistani honey against extensively drug-resistant clinical isolates of Salmonella enterica serovar Typhi: an alternative option to combat antimicrobial resistance

Abstract Background Extensively drug-resistant (XDR) Salmonella enterica serovar Typhi (S. Typhi) poses a grave threat to public health due to increased mortality and morbidity caused by typhoid fever. Honey is a promising antibacterial agent, and we aimed to determine the antibacterial activity of honey against XDR S. Typhi. Methods We isolated 20 clinical isolates of XDR S. Typhi from pediatric septicemic patients and determined the minimum inhibitory concentrations (MICs) of diferent antibiotics against the pathogens using the VITEK 2 Compact system. Antimicrobial-resistant genes carried by the isolates were identifed using PCR. The antibacterial efcacy of fve Pakistani honeys was examined using agar well difusion assay, and their MICs and minimum bactericidal concentrations (MBCs) were determined with the broth microdilution method. Results All 20 isolates were confrmed as S. Typhi. The antibiogram phenotype was confrmed as XDR S. Typhi with resistance to ampicillin (≥32 µg/mL), ciprofoxacin (≥4 µg/mL), and ceftriaxone (≥4 µg/mL) and sensitivity to azithromycin (≤16 µg/mL) and carbapenems (≤1 µg/mL). Molecular conformation revealed the presence of blaTM-1, Sul1, qnrS, gyrA, gyrB, and blaCTX-M-15 genes in all isolates. Among the fve honeys, beri honey had the highest zone of inhibition of 7–15 mm and neem honey had a zone of inhibition of 7–12 mm. The MIC and MBC of beri honey against 3/20 (15%) XDR S. Typhi isolates were 3.125 and 6.25%, respectively, while the MIC and MBC of neem were 3.125 and 6.25%, respectively, against 3/20 (15%) isolates and 6.25 and 12.5%, respectively, against 7/20 (35%) isolates. Conclusion Indigenous honeys have an efective role in combating XDR S. Typhi. They are potential candidates for clinical trials as alternative therapeutic options against XDR S. Typhi isolates. Keywords Antimicrobial resistance, Natural antibiotics, XDR S. Typhi, MIC, Honey, Resistance gene

Strategies to improve coverage of typhoid conjugate vaccine (TCV) immunization campaign in Karachi, Pakistan

The emergence and spread of extensively drug-resistant (XDR) typhoid in Karachi, Pakistan led to an outbreak response in Lyari Town, Karachi utilizing a mass immunization campaign with typhoid conjugate vaccine (TCV), Typbar TCV®. The mass immunization campaign, targeted Lyari Town, Karachi, one of the worst affected towns during the XDR typhoid outbreak. Here we describe the strategies used to improve acceptance and coverage of Typbar TCV in Lyari Town, Karachi. The mass immunization campaign with Typbar TCV was started as a school- and hospital-based vaccination campaign targeting children between the age of 6 months to 15 years old. A dose of 0.5 mL Typbar TCV was administered intramuscularly. A mobile vaccination campaign was added to cope with high absenteeism and non-response from parents in schools and to cover children out of school. Different strategies were found to be effective in increasing the vaccination coverage and in tackling vaccine hesitancy. Community engagement was the most successful strategy to overcome refusals and helped to gain trust in the newly introduced vaccine. Community announcements and playing typhoid jingles helped to increase awareness regarding the ongoing typhoid outbreak. Mop-up activity in schools was helpful in increasing coverage. Networking with locally active groups, clubs and community workers were found to be the key factors in decreasing refusals

Effectiveness of typhoid conjugate vaccine against culture-confirmed salmonella enterica serotype typhi in an extensively drug-resistant outbreak setting of Hyderabad, Pakistan: A cohort study

Background: Salmonella enterica serotype Typhi (S Typhi) is a major public health problem in low-income and middle-income countries. We aimed to investigate the effectiveness and impact of the typhoid conjugate vaccine Typbar-TCV against S Typhi among children in an outbreak setting of extensively drug-resistant (XDR) S Typhi in Pakistan.Methods: This cohort study was done from Feb 21, 2018, to Dec 31, 2019. A census survey of all households located in the Qasimabad and Latifabad subdistricts of Hyderabad, Pakistan, was done at baseline, and 174 005 households were registered in the census. The Typbar-TCV immunisation campaign was initiated at temporary vaccination centres and 207 000 children aged 6 months to 10 years were vaccinated from Feb 21, 2018, to Dec 31, 2018. Social mobilisers informed parents about the vaccination process. Vaccination records were maintained electronically and linked with the household census surveys. Active surveillance for suspected and blood-culture-confirmed S Typhi was established in hospitals, clinics, and laboratories to assess the following outcomes: cases of suspected typhoid fever, culture-confirmed S Typhi, and antimicrobial resistance. An age-stratified cohort of 1100 vaccinated children was randomly selected from the vaccination registry, tested for Vi-IgG antibodies (data not reported), and followed up fortnightly (via telephone calls or household visits) until Dec 31, 2019, for ascertainment of outcomes during the study period. 20 847 vaccinated and unvaccinated children were randomly selected from the census registry as a quality control cohort and followed up from Oct 1 to Dec 31, 2019, for ascertainment of outcomes. Vaccine effectiveness against suspected, culture-confirmed, and XDR S Typhi was calculated.Findings: 23 407 children from the census registry and surveillance system were included in the vaccine effectiveness analysis. 13 436 (57·4%) children were vaccinated, 12 214 (52·2%) were male, and 10 168 (43·4%) were aged 6-59 months. 5378 (23·0%) of 23 407 children had suspected S Typhi, among whom 775 (14·4%) had culture-confirmed S Typhi and 361 (68·6%) of 526 had XDR S Typhi. Vaccine effectiveness was 55% (95% CI 52-57) against suspected S Typhi (regardless of culture confirmation), 95% (93-96) against culture-confirmed S Typhi, and 97% (95-98) against XDR S Typhi.Interpretation: Typbar-TCV is effective in protecting children against S Typhi infection in an outbreak setting, and was able, with moderate deployment, to curtail a major XDR S Typhi outbreak in a densely populated setting. The vaccine shows efficacy against S Typhi irrespective of antimicrobial resistance.Funding: Bill & Melinda Gates Foundation

Spatiotemporal Estimation of Reference Evapotranspiration for Agricultural Applications in Punjab, Pakistan

Estimation of reference evapotranspiration (ETo) is a key element in water resources management and crop water requirement which, in turn, affects irrigation scheduling. ETo is subject to the influence of various climatic parameters including minimum temperature (Tmin), maximum temperature (Tmax), relative humidity (RH), windspeed (WS), and sunshine hours (SH). Usually, the influence of the climatic parameters and a dominating climatic factor influencing ETo is estimated on yearly basis. However, in diverse climatic regions, ETo varies with the varying climate. Therefore, this study aims to estimate the spatiotemporal variation in the influence of the climatic parameters on ETo in Punjab, Pakistan, for the period 1950–2021, specifically focusing on decennial, annual, and monthly patterns. The study area was divided into five agroclimatic zones. The Penman–Monteith model was used to estimate ETo. The influence was assessed using geographic weighted regression (GWR) and multiscale geographic weighted regression (MGWR) as the primary methods. As per results from MGWR, ETo in Punjab was highly influenced by the Tmin, Tmax, and WS. Additionally, annual ETo exhibited a higher value in southern Punjab in comparison to northern Punjab, with a range of 2975 mm/year in the cotton–wheat zone to 1596 mm/year in the rain-fed zone. Over the course of the past seventy years, Punjab experienced an average increasing slope of 5.18 mm/year in ETo. Tmin was the highest monthly dominant factor throughout the year, whereas WS and SH were recorded to be the dominant factor in the winters, specifically. All in all, accurate estimation of ETo, which serves as an essential component for crop water requirement, could potentially help improve the irrigation scheduling of crops in the agroclimatic zones

Thermal Performance Analysis of Various Heat Sinks Based on Alumina NePCM for Passive Cooling of Electronic Components: An Experimental Study

In the modern digital world, electronic devices are being widely employed for various applications where thermal performance represents a significant technical challenge due to continued miniaturization, high heat generated in the system, and non-uniform high-temperature causing failure. Phase change materials (PCMs) owing to the immense heat of fusion are primarily considered for thermal management, but their insulating properties hedge their applications in electronics cooling. Nano-enhanced phase change materials (NePCMs) have the ability to improve the thermal conductivity of PCM, decrease system temperature and escalate the operating time of devices. Accordingly, the current study focused on the experimental investigations for the thermal performance of three heat sinks (HS) with different configurations such as a simple heat sink (SHS), a square pin-fins heat sink (S pfHS), and Cu foam integrated heat sink (Cu fmHS) with various alumina nanoparticles mass concentrations (0.15, 0.20 and 0.25 wt%) incorporated in PCM (RT-54HC) and at heat flux (0.98–2.94 kW/m 2). All HSs reduced the base temperature with the insertion of NePCM compared to the empty SHS. The experimental results identified that the thermal performance of Cu fmHS was found to be superior in reducing base temperature and enhancing working time at two different setpoint temperatures (SPTs). The maximum drop in base temperature was 36.95%, and a 288% maximum working time enhancement was observed for Cu fmHS. Therefore, NePCMs are highly recommended for the thermal management of the electronic cooling system