bluuebunny/crossref_metadata_2025 huggingface dataset:
CT medical image segmentation algorithm based on deep learning technology
Authors: Shen Tongping , Huang Fangliang , Zhang Xusong
Published: April 2023

For the problems of blurred edges, uneven background distribution, and many noise interferences in medical image segmentation, we proposed a medical image segmentation algorithm based on deep neural network technology, which adopts a similar U-Net backbone structure and includes two parts: encoding and decoding. Firstly, the images are passed through the encoder path with residual and convolutional structures for image feature information extraction. We added the attention mechanism module to the network jump connection to address the problems of redundant network channel dimensions and low spatial perception of complex lesions. Finally, the medical image segmentation results are obtained using the decoder path with residual and convolutional structures. To verify the validity of the model in this paper, we conducted the corresponding comparative experimental analysis, and the experimental results show that the DICE and IOU of the proposed model are 0.7826, 0.9683, 0.8904, 0.8069, and 0.9462, 0.9537 for DRIVE, ISIC2018 and COVID-19 CT datasets, respectively. The segmentation accuracy is effectively improved for medical images with complex shapes and adhesions between lesions and normal tissues.
Coliving, or the financialisation of houses in Brussels
Authors: Casier Charlotte
Published: April 2023

Le coliving à Bruxelles consiste en la location, au sein d’un même bâtiment, de chambres accompagnées d’espaces communs et de services, opérée par des sociétés privées. Par sa formule tout-inclus meublée et flexible, cette offre de niche mais en croissance rapide s’adresse particulièrement aux jeunes expatrié·es présent·es à Bruxelles. L’analyse du développement de cette offre immobilière récente montre comment la financiarisation du secteur résidentiel locatif privé s’appuie sur la création de nouveaux produits formatés afin que les investisseurs puissent facilement y injecter leurs capitaux et en tirer des rendements élevés. À Bruxelles, le coliving est établi avant tout dans des maisons unifamiliales des quartiers du sud-est de la première couronne urbaine.
La neutralité de l’Irlande face à la crise ukrainienne : l’heure de vérité
Authors: Joannon Pierre
Published: April 2023

La neutralité de l’Irlande est une neutralité sui generis qui ne saurait être comparée à la neutralité d’États européens comme la Suisse, l’Autriche ou la Suède. Tributaire de l’histoire et de la géographie, elle se veut essentiellement militaire et nullement idéologique. Au fil des ans, elle fut pour l’Irlande un test de sa souveraineté, une tentative de remise en cause de la partition, et un désir de faire entendre sa voix singulière dans le concert des nations. Le présent article examine la naissance du concept au lendemain de la signature du traité anglo-irlandais de 1921, son triomphe pendant la Seconde Guerre mondiale, et sa mise en perspective à des degrés divers au cours de la guerre froide, de la campagne d’adhésion au marché commun, et de la participation de l’Irlande à la construction de l’Union européenne depuis 1973. La crise ukrainienne, en faisant ressortir ses contradictions, semble appeler une clarification de la formulation théorique et pratique de la neutralité irlandaise.
Internetization and Digital Democracy
Authors: Passaris Constantine E.
Published: April 2023

This article explores the confluence of two subject areas that are at the forefront of technological change and the evolution of the democratic process. Internetization and digital democracy have emerged as game changers in the 21st century. Internetization has redefined global outreach and electronic connectivity. Digitalization has empowered democracy to explore new frontiers. Both have enhanced the scope and substance of electronic connectivity and digital democracy. Each is carving a large legacy footprint and discovering new operational horizons. Both have the capacity to lead transformational change in two core areas of human engagement.
Leveraging Social Sustainability in the Amazonian Forest
Authors: Borchardt Miriam , Amado da Silva Márcia Regina Marques , Pereira Giancarlo Medeiros , Scavarda Annibal J. , Filho Edmond A. Baruque
Published: April 2023

The social dimension of sustainability has not gained as much attention in bioeconomy (BE) literature as have the environmental and economic dimensions. Thus, this study's purpose is to analyze how social sustainability of the non-timber forest-based BE enterprise in the Amazonian Forest has been leveraged. A case study was performed in the largest enterprise in Latin America that produces babassu coconut-activated carbon for industrial use. This enterprise is a benefit corporation (B Corp) certified by B lab. The main contributions of the study are: (i) proposing a framework for social sustainability that considers its drivers and elements, for both internal and external stakeholders; (ii) indicating the impact of social sustainability on enterprises' business model; (iii) pointing out the contribution of technological innovations to the circular economy and preservation of traditions and environment; and (iv) studying an under-explored object such as a B Corp in the Amazonian Forest.
Watershed Management Prioritization in Paddy Land Uses: A Case Study in Hungamala Ela Sub-watershed of Mahaweli River Basin of Sri Lanka
Authors: Withanage N. S. , Abeysekara G. D. J. M.
Published: April 2023

Prioritization of watersheds is important for proper planning and management of soil and water resources for sustainable development. Morphometric analysis has been commonly used to for prioritization of watersheds for management. Hence, Hungamala Ela sub-watershed of Mahaweli Basin where paddy is grown extensively was selected for this study to identify and prioritize soil and water conservation in the sensitive areas via morphometric analysis and GIS based approach. Stream network, stream order and micro-watersheds were extracted from the DEM derived from the 20 m contour interval in the Arc GIS environment. The spatial data required for morphometric analysis were derived from Arc GIS tools. Watershed prioritization was completed following the methods proposed in published literature. Paddy land use analysis was carried out for 2003, 2012 and 2020. The results of the study revealed that 14 micro-watersheds, HE1 to HE14, could be identified within the Hungamala Ela sub-watershed area and its stream network extends up to the 7th order showing a dendritic drainage pattern. The results of watershed prioritization revealed that HE6, HE7, HE9 and HE11 fall under the high priority category for soil erosion susceptibility. Moreover, paddy landuses have increased drastically, by 83% from 2003 to 2020, even in the identified sensitive micro-watersheds. Therefore, the Hungamala Ela sub-watershed management should be prioritized by introducing proper soil conservation measures especially within the identified highly sensitive areas for sustainable paddy cultivation.
Comparison of performances of ML-Algorithms in the estimation of the execution time of non-parallel Java programs
Authors: De Ranasinghe I. M. Mihindu Pramantha , Munasinghe L.
Published: April 2023

Performance enhancement of a computer program is an important aspect of today's world. Developers produce programs, and there is a lack of accurate methods for predicting the execution time of a computer program prior to its execution in an executable environment. Predicting the execution time of a particular program before execution would be great for developing the program with the highest performance efficiency and with the lowest execution latency. This research introduces a Machine Learning based solution to predict an execution-time-based label for a given computer program. There are three main types of parameters in a computer program that affect the execution time, such as Static Code Features, HTTP Calls, and the Hardware Performance of the execution environment. In this research, the Machine Learning model was trained for the parameters of the above types (Programs with Static Programs & HTTP calls) by executing them on a fixed hardware infrastructure execution condition. We analyzed the number of if conditions, methods, breaks, switches, loops, nested-loop-depth, frequencies, and the behaviour of HTTP calls, kind of features of a computer program in order to generate an accurate execution time complexity prediction label of a computer program. Further, in the collected data set, the most prominent feature which affects the complexity among the features that we considered is the number of HTTP calls and nested loop depth, followed by loops. Accuracy Score, Precision, Recall, and F1 Score values of the ML model were generated for the traditional classification algorithms such as Decision Tree Classifier, K Nearest Neighbor Classifier, Random Forest Classifier, Naive Bayes Classifier, Support Vector Classifier, and MLP Classifiers in order to verify the effectiveness of the model. The best accuracy score was achieved with an overall 88% by using the approach of Random Forest. The findings of this research can be optimized for implementing an IDE plugin or a developer tool that can predict the exact execution time of a given computer program live by integrating the specifications of the execution device. It will help developers in terms of optimizing a particular computer program and developing it for a minimum execution latency and enhancing the performance of the program.
Pyrolysis of waste LDPE and waste PP plastics into fuel oil in a low-cost, lab-scale pyrolyzing unit
Authors: Uthpalani P. G. I. , De Silva D. S. M. , Weerasinghe V. P. A. , Premachandra J. K. , Sarathchandra T. V.
Published: April 2023

Plastics cause severe environmental and societal issues when post-consumer plastics are discarded in the environment without proper management. Pyrolysis of plastic waste is a promising method for plastic waste management due to its valuable by-products such as fuel oil. The objective of the present study was to pyrolysis waste polypropylene (PP) and waste low-density polyethylene (LDPE) plastics into fuel oil in a low-cost, lab-scale apparatus at the maximum temperatures of 330°C and 355°C, respectively, and in turn to assess the physical properties, gross calorific value, density, kinematic viscosity, flash point, ash content, and sulfur content, of resultant fuel oil. Commercially available, recycled grades of LDPE and PP pellets, 70.0 g of each, were obtained, and pyrolysis was done in a lab-scale, low-cost batch reactor. The experiment was triplicated, and the resultant fuel oil was analyzed for physical properties by ASTM standard methods. The properties of resultant fuel oil were also compared with diesel grade criteria. Results revealed that the highest yield of fuel oil was obtained from waste PP at 79.57 wt.% while the waste LDPE resulted at 74.06 wt.% of fuel oil. No wax formation was observed in the waste PP pyrolysis process, unlike in the waste LDPE pyrolysis. The gross calorific values of waste PP and waste LDPE were 12 016 kcal/kg and 11 961 kcal/kg, respectively. It was higher than the standard value of commercial diesel. The distillation results indicated that short-chain hydrocarbon content is higher in the waste PP fuel oil sample than in the waste LDPE fuel oil sample. The results indicated that the resultant fuel oil samples were nearly closer to the diesel grade criteria. Therefore, the fuel oil produced from waste plastics is a viable alternative to traditional fossil fuels, with potential applications in power generation and transportation.
Hub Flow Near-Wake Validation using CREATETM-AV Helios and UMD Mercury Framework
Authors:   US Army, Potsdam Mark ,   University of Maryland, Baeder James , Jung Yong , Lee Bumseok
Published: April 2023

Experimental near-wake flow field measurements from two Penn State University water tunnel tests of a defeatured helicopter hub are compared with two unsteady computational fluid dynamics (CFD) analyses, CREATE(TM)-AV Helios and University of Maryland Mercury. Both CFD frameworks employ an unstructured/Cartesian multi-mesh paradigm and turbulent Spalart-Allmaras Detached Eddy Simulation (SA-DES) modeling. Experimental velocimetry measurements of mean wake velocities, harmonic content, and Reynolds stresses provide valuable validation data for CFD. Overall, the two CFD solvers were in good agreement with each other and qualitatively captured the mean and harmonic content of the wake structures with accuracy. Flow feature dissimilarities between the advancing and retreating sides were differentiated and indicated dominant regions of harmonic flow disturbances biased toward the retreating side, in good agreement with experimental observations. Quantitatively, some variation in velocity deficits and downwash were noted, either in profile character, magnitude, and/or location. Encouragingly, there was little tendency of excessive dissipation in the CFD near wake, and the harmonic content actually tended towards a common overprediction. Reynolds number effects were minimal, and grid density effects were studied but inconclusive. These efforts were part of the 3rd PSU Rotor Hub Flow Workshop in 2020.
Feature-Driven Specification of VTOL Air-Taxis with the Use of the Model-Based System Engineering (MBSE) Methodology CUBE
Authors:   FEV Europe GmbH, Jäckel Nicolas ,   RWTH Aachen University, Andert Jakob , Karaduman Abdulsamed , Granrath Christian , Rumpe Bernhard , Wachtmeister Louis
Published: April 2023

Ground-bound transport systems in major cities are increasingly encountering their limits. Vertical Take-Off and Landing systems, in short VTOL systems, possibly autonomous and electrified, are a promising way to utilize urban space for public transportation. In this context, the application of the Compositional Unified system-Based Engineering (CUBE) methodology, enables the use of Model-Based Systems Engineering (MBSE) to develop suitable VTOLs. This methodology can be used to move from abstract artifacts to concrete architecture and from system to subsystem development. In this paper, the CUBE methodology is presented using a feature-driven specification to demonstrate its general applicability. The model-based description of the System of Interest (SoI, i.e., the VTOL system) from an abstract use case to a technical architecture is exemplified using three features. This methodology approaches the creation of system- and feature-based models with a tailored level of abstraction to better manage complexity.
Surface Tolerant Adhesives for Bonded Airframe Structures
Authors:   Huntsman Corporation, Sharifi Majid ,   AVX Aircraft Company, Brown Ian ,   U.S. Army Combat Capabilities Development Command Aviation & Missile Center, Jordan Delaney ,   University of Dayton Research Institute, Tandon Gyaneshwar
Published: April 2023

Structural adhesives with silicone-tolerant characteristics (surface tolerant adhesives) were developed, aiming to find solutions to overcome silicone contaminations present at bonding surfaces. This study overviews mechanical performance aspects of the surface tolerant adhesives with composite-to-composite and composite-to-titanium joints, where contaminated adherends were spray-coated with predetermined amounts of silicone (mold release) solutions. Shear strength values, in single lap shear mode, revealed a shear strength retention of up to nearly 80% in contaminated bonded joints with surface tolerant adhesives, when compared to nearly 20% strength retention with a control (standard aerospace-qualified) adhesive. In Mode I fracture, a substantially large resistance to fracture (cohesive-type failure) was observed with the surface tolerant adhesives, whereas a pure adhesive-type failure was observed in the control adhesive. Mechanical performance and relevant surface analyses of surface tolerant adhesives are detailed in this study.
Comprehensive Simulation Based Rotorcraft Loads/Fatigue Analysis and Alleviation Method
Authors:   Advanced Rotorcraft Technology Inc., He Chengian ,   Joby Aviation, Bae Eui ,   US Army Research Lab, Chen Tzikang , Lee Dooyong , Haile Mulugeta
Published: April 2023

Rotorcraft experience vibratory loads due to the constantly varying airloads under all flight conditions. Maximizing the fatigue life of their structural components is a vital factor for sustained operations with low-maintenance. Most existing fatigue analysis methods are empirical and, hence, are limited for use in investigating the effects of maneuvering f light as well as for exploring modern control methods (e.g., on-blade controls (OBC)) for alleviating fatigue. This paper discusses comprehensive simulation-based rotorcraft loads/stress analysis and fatigue alleviation control methods toward the goal of minimum maintenance for future vertical lift. The paper covers several aspects, including comprehensive modeling for loads prediction, blade stress analysis with the applied loads, fatigue estimation, and loads/stress reduction control formulation. The paper also presents simulation results that demonstrate the successful reduction of vibratory loads/stress using modern on-blade active control methods.
Knowledge, attitude, and practices of infection prevention and control among radiographers in a resource constraint setting in Namibia
Authors: Dihako Wako , Amkongo Mondjila , Karera Abel , Shilumba Moneni
Published: April 2023

Background: Radiographers’ role as healthcare workers places them at constant risk for hospital-acquired infections. Practical, evidence-based methods are necessary to reduce the transmission of pathogens to and from patients and healthcare workers.Objectives: The main objectives of this study were to determine knowledge, attitude, and practice levels regarding infection prevention and control (IPC) strategies among radiographers in Windhoek and Oshakati, and measure their relationships with other variables. Methods: A quantitative descriptive design was employed. To assess the knowledge, attitude, and practice levels among radiographers, a self-administered questionnaire was used. Twenty-seven radiographers took part in the study, producing a 68% response rate.Results: The study revealed that the majority of the radiographers showed an appropriate level of overall knowledge and attitude toward infection prevention and control. However, the majority of their practice levels were poor. Pearson rank correlation test revealed that the radiographers’ knowledge was significantly associated with attitudes (P= 0.004; r=0.53) and practices (P=0.03; r=-0.41) with a moderate positive and negative correlation, respectively. Conclusions: In conclusion, the study revealed that radiographers are knowledgeable about IPC strategies, and have good attitudes toward them. However, their practice was poor and inconsistent with the level of knowledge demonstrated. Therefore, it is recommended that healthcare service managers establish efficient and rigorous means of monitoring adherence to IPC strategies and improving practices to reduce incidences of health-acquired infections among radiographers, especially in the age of a pandemic.
Red Cell Requisition and Utilization Pattern in a Tertiary Care Hospital of South India
Authors: Tripathi Parmatma Prasad
Published: April 2023

Introduction:

The equilibrium between supply and demand for red blood cells is increasing unpredictably in many countries. An understanding of trends in blood usage profile and current usage can help predict future trends in demand and to put efforts to reduce use in particular areas. This study helps in analyzing the pattern of red blood cell utilization in a tertiary care hospital.

Materials and Methods:

This retrospective study was conducted in a blood bank, tertiary care hospital over a period of 6 months. All the requests coming to blood bank with information regarding patient's demographic details, diagnosis and indication for transfusion, type of request, blood transfused or returned were collected and reviewed. Crossmatch transfusion (CT) ratio, transfusion index (TI), and transfusion probability were also calculated.

Results:

A total of 10,364 patients (20,399 requests) utilized total 32,608 units of blood and its components, out of those 14,195 units of packed red cells units were utilized. March month had maximum number of requests and utilization. Most of the requests for blood were from the inpatients (wards) and were requested and utilized in the age group of 21–30 years with male predominance. Patients in the division of medicine utilized most blood. Although the division of surgery requested most of the blood, on an average, they utilized only one-third of the requested product. Overall, anemia was the most common indication for red cell utilization. In surgical group, spine surgery had a maximum CT ratio. Neurosurgery and hand surgery had the lowest TI in all specialties. Hand surgery and spine surgery had a lowest transfusion probability. Overall, utilization rate in our study was 59.8%.

Conclusion:

A regular review of blood unit's usage is very important to estimate the blood utilization pattern in any hospital. Profile of blood utilization will act as indicator for quality management of blood bank.
Outcome and Safety of Colistin Usage in Pediatric Cancer Patients with Carbapenem-Resistant Enterobacteriaceae Bacteremia at Children Cancer Hospital Egypt
Authors: Adel Nagla , Khedr Reham , Elanany Mervat , Zaki Hala F. , Hafez Hanafy , El-Abhar Hanan
Published: April 2023

Background:

Carbapenem resistant Enterobacteriacae (CRE) bloodstream infection (BSI) causes complicated infections, especially in immunocompromised patients. This study aimed to assess the renal toxicity and the efficacy of therapy with colistin in a cohort of pediatric cancer patients with BSIs due to CRE and sensitivity to colistin.

Patients and Methods:

This was an observational, prospective cohort study from May 2017 to October 2017 in Children's Cancer Hospital Egypt 57,357. All patients who had blood stream infections due to CRE receiving intravenous colistin were prospectively enrolled. We used a standardized case form to record patient characteristics, including age, sex, weight, underlying comorbidities, type of infection, causative organism, and antibiotic susceptibility testing. Daily doses, duration of colistin therapy, and co-administered antibiotics (aminoglycosides, vancomycin) were collected. Furthermore, clinical and microbiological responses to treatment were reported. The dosing schedule was based on a loading dose of 5 MU and a 5-MU twice-daily divided maintenance dose, titrated on renal function. Clinical cure, bacteriological clearance, and daily serum creatinine were recorded.

Results:

One hundred and forty-one Blood Stream infectious episodes mainly due to Klebsiella Species (pneumoniae and Oxytoca) (27%) and Escherichia coli (68%) were analyzed. All strains were susceptible to colistin with Minimum inhibitory concentration (MICs) of 0.19–1.5 mg/L. Patients were predominantly females (69%), with a mean age of 7 years. It was used as a combination therapy with carbapenems (69.2%) or aminoglycosides (80%). The median duration of treatment was 9 days (Range 1–50 days). Clinical and microbiological cure was observed in 110 cases (80%). Acute kidney injury developed during five treatment courses (4%) in which colistin was used in combination with amikacin. No renal replacement therapy was required and subsided within 7 days from colistin discontinuation.

Conclusions:

Our study showed that colistin had a high efficacy without significant renal toxicity in severe infections due to CRE Gram-negative bacteria.
Knowledge, Attitude, and Practice Regarding Prevention of Rheumatic Heart Disease among Primary Health-care Workers in Sokoto Metropolis, Sokoto State, Nigeria
Authors: Isezuo Khadijat Omeneke , Awosan Kehinde Joseph , Ango Umar Mohammed , Mohammed Yahaya , Sani Usman Muhammad , Waziri Usman Muhammad , Garba Bilkisu Ilah , Adamu Asma’u , Jiya Fatima Bello
Published: April 2023

Background:

Rheumatic heart disease (RHD) is the only preventable cardiovascular disease that still causes significant morbidity and mortality in low- and middle-income countries like Nigeria where it is classified as a neglected disease. The inciting agent causes pharyngitis often not properly treated.

Aim and Objectives:

To study the knowledge and preventive practices of RHD amongst primary healthcare workers who are in contact with larger ratio of populace in order to recommend appropriate interventions.

Methodology:

A cross-sectional study conducted among health workers in primary health centres in Sokoto metropolis. Multi-stage sampling technique was used to recruit the study participants. A structured questionnaire and focus group discussion guide was used to collect the information. Data was analysed using IBM SPSS version 25.

Results:

Majority (109/182; 59.8%) had RHD inadequate knowledge of causes, risk factors and treatment of pharyngitis which predisposes to RHD. Only 49 (26.9%) of the respondents knew the name of the causative agent. The knowledge gap was related to length of training and attendance at a training (x2 = 8.38; P=0.015 & x2 = 7.92; P=0.004). Majority of the respondents with 168 out of 182 (92.3%) had positive attitude. Practice grading was adequate in only less than half of the respondents (88/182; 48.4%). Male gender and negative attitude were predictors of adequacy of preventive practices (aOR= 0.49; 95% C.I =0.267-0.929; P=0.03 & aOR= 3.87; 95% C.I =1.027-14.586; P=0.046).

Conclusion:

The health workers had inadequate knowledge and poor practice on prevention of rheumatic heart disease. It is necessary to upscale information available to them by medical specialists and upgrade their curriculum.
Iron Supplementation and Blood Donation in Nigeria
Authors: Nwagha Theresa Ukamaka , Ugwu Angela Ogechukwu , Nwaekpe Chinenye Nkemakolam
Published: April 2023

Background:

Iron-deficiency anemia is an important limiting factor to a sustainable supply of blood units, especially in low- and middle-income countries. Blood transfusion practice in Nigeria is poorly developed and structured with paucity of voluntary nonremunerated blood donors and high rate of donor deferrals resulting from low hemoglobin (Hb) levels.

Aims:

This study aimed to assess the effect of daily supplementation of iron using Ranferon-12 on Hb level, red blood cell (RBC) indices, iron level, ferritin level, and Hb recovery in blood donors in Nigeria.

Methodology:

This longitudinal study was conducted at a tertiary hospital blood transfusion center from March to July 2020. Blood samples of regular donors were collected at three points in the study for the measurement of Hb and hematocrit (HCT); RBC indices including mean cell volume (MCV), mean cell hemoglobin (MCH), and Mean cell haemoglobin concentration (MCHC); and iron stores including serum iron, serum ferritin, and serum transferrin. The first point was at recruitment before donation of one unit of blood; the second point after the blood donation; and the third point at 6 weeks post blood donation. Following donation, participants were placed on Ranferon capsules (iron fumarate - 100 mg elemental iron) and 100 mg of tablet Vitamin C, for 6 weeks.

Results:

There was a moderate significant positive correlation between administration of Ranferon and change in the values of HCT, MCV, MCH, red cell distribution width, ferritin, and transferring (P< 0.05). Percentage recovery of Hb, red cell indices, and iron stores parameters after 6 weeks of daily Ranferon ranged between 89% and 100%.

Conclusion:

Iron supplementation using Ranferon capsule daily for 6 weeks enhances recovery of Hb, red cell indices, and iron stores with attainment of benchmark Hb levels for donation.
Prospective Study of Pyrexia with Pregnancy
Authors: Mewada Bhavana N. , Gandhi Dimple , Diwan Farheen , Panchal Paresh Naranbhai
Published: April 2023

Objectives:

Fever in pregnancy is a common clinical problem that increases the risk of morbidity for the mother and fetus. We studied variable medical complications of pregnant women suffering from fever and possible fetal complications.

Materials and Methods:

A prospective observational study of pyrexia with pregnancy in 50 patients admitted to our hospital irrespective of age, parity, reproductive characteristics, and socioeconomical conditions.

Results:

First, the majority group of the patients were of urinary tract infections and upper respiratory tract infections. The second majority group of the patients were of malaria, dengue, enteric fever, and pyrexia of unknown origin. Most of the etiologies of pyrexia were preventable. The majority of the patients had a low and moderate grade of pyrexia. Small for gestational age was the most common adverse pregnancy outcome and there were six perinatal deaths.

Conclusion:

Our study depicts that a wide range of maternal medical complications, as well as fetal and neonatal complications, occur due to pyrexia in pregnancy from various etiology.
The Effect of Collaborative Care on Treatment Outcomes of Newly Diagnosed Tuberculosis Patients with Type-2 Diabetes Mellitus and Adverse Drug Reaction Presentations
Authors: Ayeni Foluke Adenike , Oyetunde Olubukola O. , Aina Bolajoko A.
Published: April 2023

Background:

The burdens of tuberculosis (TB) and diabetes mellitus (DM) in Nigeria are high. DM often goes unrecognized in TB patients, resulting in poorer treatment outcomes compared with TB patients only. This study set out to compare TB treatment outcomes and associated factors in TB only and TBDM patients when a collaborative care (CC) model is in place.

Methods:

A prospective quasi-experimental study, modeled after the World Health Organization and The Union's Collaborative Framework for Care and Control of TB and DM was carried out among TB patients in two chest clinics in Lagos state. Patients were grouped into TB only, who received the usual TB care, directly observed treatment, short course (DOTS), and TBDM, who received DOTS and CC. Data were analyzed with IBM Statistical Package for the Social Sciences, version 23.0. Chi-square and multivariate analysis determined the association between treatment success and CC. Statistical tests were calculated at 95% confidence intervals and considered significant when P value is < 0.05.

Results:

Of 671 participants in the study, 52 (7.7%) had DM. At TB treatment completion, there was no statistically significant difference in outcomes between TBDM and TB-only patients (P = 0.40). Patients who received CC were about 32 (OR: 31.60, 95% CI: 3.38-293), and 5 times (OR: 5.08, 95% CI: 1.35-19.17) more likely to achieve success and cure, respectively, compared to those who did not.

Conclusion:

Provision of CC with DOTS ensured improved TB treatment outcomes in TBDM patients. Recommendations of WHO/The Union are feasible in our setting.
Iliopsoas Gravity Abscess Secondary to a Tuberculous Empyema
Authors: Tone Kazuya , Hirano Yuta , Kuwano Kazuyoshi
Published: April 2023

A 29-year-old Japanese man with a history of right-sided tuberculous pleurisy presented with fever and right flank pain. Computed tomography images revealed a right pleural effusion and an area of low attenuation in the right iliopsoas muscle. Percutaneous drainage of the iliopsoas lesion resulted in a bloody pyogenic discharge that tested positive for Mycobacterium tuberculosis by both acid-fast staining and polymerase chain reaction. Enhanced fluoroscopy revealed a perforation of the diaphragm between the thoracic region and the psoas muscle. The patient was diagnosed with an iliopsoas abscess secondary to tuberculous empyema.
The Effect of Glycemic Control on Clinico-Radiological Manifestations of Pulmonary Tuberculosis in Patients with Diabetes Mellitus
Authors: Saalai Kavin Mani , Mohanty Anita
Published: April 2023

Background:

The association between diabetes mellitus (DM) and tuberculosis (TB) and their synergistic role in causing human disease has been recognized for centuries. Despite the known synergy between DM and TB, the importance of atypical clinical, radiological presentation and DM as a risk factor for TB is largely unknown. This study was undertaken to know the effect of glycemic control on TB manifestations as it will contribute to the opportunities for detection and treatment of both disease conditions appropriately.

Methods:

This cross-sectional study included 50 patients attending the pulmonary medicine department in Ispat General Hospital with pulmonary TB and DM during 6 months' period. Clinical data, chest-X ray, HbA1c values were obtained and the effect of glycemic control studied and analyzed.

Results:

Five patients had good glycemic control (HbA1c ≤7%), 45 patients had poor glycemic control (HbA1c >7%). Cough was present in all patients. Weight loss and night sweats were present in poor glycemic group and sputum smear grade was higher in higher HbA1c patients and both were statistically significant. None of the good glycemic group had lower zone lesion. The commonest type of lesion was nonhomogenous opacity, followed by cavities in both poor and good glycemic groups. Cavities were usually present in lower zones. Size and number of cavities were more as the glycemic control is poor. So, that glycemic control did have an effect on pulmonary TB manifestations, hence achieving and maintaining glycemic control is necessary for DM with pulmonary TB.
Survival of Mycobacterium Abscessus Complex Organisms on Coins
Authors: Moore John E. , Millar Beverley Cherie
Published: April 2023

Background:

To date, there have been no reports on the occurrence of nontuberculous mycobacterial (NTM) organisms (nor tuberculosis [TB]) on money, currency, banknotes, or coins, where these may act as fomites in the potential transmission of mycobacterial organisms around communities, especially in developing nations, where physical currency is still the popular mainstay of the economy, compared to electronic and digital forms of currency transaction. It was therefore the aim of this study to examine the survival of the Mycobacterium abscessus complex organisms on coins.

Methods:

Coins from 17 countries were examined for the presence of M. abscessus complex organisms by broth enrichment in Middlebrook 7H9 for 2 months. Nickel-plated steel and copper-plated steel coins were artificially contaminated individually with M. abscessus complex (circa 107 [7 log10] organisms/coin), including M. abscessus subsp. massiliense (n = 2), M. abscessus subsp. bolletti (n = 2), and M. abscessus subsp. abscessus (n = 1) and their surviving cells enumerated at weekly period up to 5-week postinoculation.

Results:

NTM organisms were not isolated from coins from the 17 currencies examined. In all three subspecies of M. abscessus, the copper-plated steel coins caused a more rapid decline in organism numbers, which were statistically very significant (P < 0.0001), compared to the paired survival on the nickel-plated steel coins, whereby organisms were none detectable after 3-week storage on the copper-plated coins. NTM organisms survived better on the nickel-plated coins, with a mean count across all subspecies of log10 1.84 colony forming units per coin after 5 weeks of storage (range: 0.6–2.69 log10 cfu/coin). There was no statistically significant difference (P > 0.05; 5%) in the survival dynamics among the three subspecies with storage on either coin type.

Conclusions:

Health-care professionals should be aware of the survival of M. abscessus complex organisms on coins for up to 12 weeks, which may be particular relevant in high-risk areas of health-care institutions where TB or NTM is prevalent and where there are opportunities for the transmission of such organisms through contaminated fomites, including coins, through opportunities including payment for treatments/medicines/dressings, coin-operated payment facilities, such as hospital car parking, self-service vending machines, hospital canteens, coffee shops and dining halls and hospital shops, whether static or mobile onward visits. To mitigate potential infection consequences of handling coins contaminated with M. abscessus complex organisms, other NTMs organisms and TB, the authors support re-establishing the principles of basic hygiene, including proper handwashing and the avoidance of handling money when working with food or dressing wounds and skin lesions, as well as when working with respiratory devices, including nebulizers.
Tuberculosis with Multiarticular Involvement Diagnosed by Positive Acid-Fast Staining in Synovial Fluid
Authors: Chemello Diego , Londero Chemello Raissa Massaia , Jahnke Giovana Thomasi
Published: April 2023

Osteoarticular tuberculosis (TB) is an uncommon form of extrapulmonary TB, comprising approximately 5% of all TB and 10%–15% of extrapulmonary TB cases. Multifocal skeletal TB is rare and accounts for 10% of all osteoarticular TB cases. Sometimes, the diagnosis is difficult. The potential delay in the clinical diagnosis may be critical for patients since it can cause the spread of the infection from the bone to the adjacent joints and surrounding tissues. We present a rare case of military TB with multiarticular involvement in a patient with chronic tophaceous gout. The initial diagnosis was confirmed throughout the positive analysis for Ziehl–Nielsen acid-fast staining in synovial fluid of two different joints, which is unusual. The patient was treated with antituberculosis drugs and presented good recovery signs.
Co-Existence of Pulmonary Tuberculosis with Sarcoidosis
Authors: Kaur Harveen , Singh Dilbag , Pandhi Naveen
Published: April 2023

Tuberculosis (TB) and sarcoidosis are multisystem, chronic granulomatous diseases. Although characterized by similar clinical manifestations, these disease entities vary significantly in etiologies and management. Sarcoidosis is an immunological disorder of unknown etiology, characterized by the presence of noncaseating granulomas in the tissues involved. TB is the infectious disease caused by Mycobacterium tuberculosis, characterized by granulomas with caseous necrosis. It is rare to have both the diseases concomitantly. We present the case of a 38-year-old male with microbiological confirmation of coexistent pulmonary TB and sarcoidosis.
Pubic Symphysis Tuberculosis
Authors: Ahammadunny Reshma , Rathish Balram , Wilson Arun , Warrier Anup
Published: April 2023

Symphysis pubis tuberculosis (TB) is extremely rare in the reported literature. The diagnosis of pelvic TB is confounded by close differentials such as osteomyelitis as well as the low yield of TB bacilli in microbiological sampling in the initial stages of the disease. Pelvic TB should be suspected early on in areas with high TB burden, and prompt treatment with antitubercular treatment may help prevent disability associated with the disease. Here, we present a 49-year-old diabetic man with pubic symphysis TB which was diagnosed on the basis of clinical and radiological aspects, with near-total resolution following 9 months of anti-tubercular treatment.
Genetic Diversity of Mycobacterium avium sp. Paratuberculosis by Mycobacterial Interspersed Repetitive Unit–Variable Number Tandem Repeat and Multi-Locus Short-Sequence Repeat One-Sentence Summary
Authors: Moyano Roberto Damián , Imperiale Belén Rocío , Romero Magalí , de la Paz Santangelo María , Alvarado Pinedo María Fiorella , Travería Gabriel , Romano María Isabel
Published: April 2023

Background:

Paratuberculosis is an enteric disease caused by Mycobacterium avium sp. paratuberculosis (MAP) that affects mainly ruminant producing losses to the livestock industry. Many molecular epidemiological methods have been used to discriminate MAP isolates.

Method:

The aim of this study was to describe the genetic diversity of the Argentinean MAP isolates using a combination of two molecular systems, the mycobacterial interspersed repetitive unit–variable number tandem repeat (MIRU-VNTR) (“automated and “non-automated”) and the multi-locus short-sequence repeat (MLSSR) system.

Results:

Thirty-two isolates were identified as MAP of C type by IS900 polymerase chain reaction (PCA) and IS1311 PCA-restriction enzyme analysis. The main patterns found by both MIRU-VNTR systems were INMV1 (54.5%), INMV2 (24.2%) and INMV11 (9.1%). The INMV5, INMV8 and INMV16 were represented with one isolate each (3.0%). Only 4 MIRU-VNTR loci were polymorphic.

Conclusion:

Those isolates sharing the same INMV patterns were analyzed by MLSSR, being locus 2 the most polymorphic one showing isolates with 9, 10, 11, and more than 11 “G” repeats. Besides, the global discriminatory power among isolates could be increased using both techniques. Based on these results, a short version of the “automated” MIRU-VNTR could be used as a screening tool to group isolates genetically related and subsequently perform the SSR using locus 2 on those isolates sharing the same INMV pattern.
Investigation of Two General Venous Thromboembolism Risk-Stratification Models in Predicting Venous Thromboembolic Events in TB Patients
Authors: Sharif-Kashani Babak , Azimi Mojdeh , Tabarsi Payam , Sadr Makan , Shirzadi Shahriar
Published: April 2023

Background:

Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health concern. It is known that TB causes a hyper-coagulable state due to its infective nature. Thus, patients are prone to higher incidence rates of venous thromboembolism (VTE) in comparison with the general population. Although there are many risk assessment models (RAMs) that estimate the risk of VTE incidence in the general population, none have been proven to show significant prognostic value in early and accurate VTE prediction among TB patients. This study aims to investigate the accuracy of general RAMs in prediction of VTE incidence in the population of TB-positive patients.

Methods:

The following survey is a retrospective study among patients afflicted with TB, in whom VTE had occurred either during or at the onset of admission. A total number of 865 smear-positive TB cases were recorded in hospital in a 7-year timespan, among which a total sum of 37 patients (67.6% males, age: 56.19 ± 20 years) experienced at least one episode of thromboembolic incidence. We nominated Padua and Geneva RAMs and calculated the scores with regard to their inpatient hospital records.

Results:

Of 865 adult hospitalized smear-positive TB patients, 37 patients happened to develop VTE in the course of infection, after excluding the unacceptable data. The incidence of VTE was calculated at 4.27%. Of all VTEs, 73% turned out to be deep venous thromboembolism (DVT), 18.9% were pulmonary thromboembolism (PTE), and 8.1% of patients developed both DVT and PTE during the course of disease. Among all cases, 32.4% revealed Geneva score equivalent or >3. It conveys the meaning that these patients were at greater risk for VTE development and were indicated to receive prophylactic medication. Similarly, Padua model was capable of predicting 29.7% cases scoring >4, which is alarming for elevated VTE probability. 21.6% of TB patients, who had developed VTE during the course of their disease eventually passed away.

Conclusion:

Our statistics show minimal positive predictive value for Padua and Geneva RAMs, which are seemingly in sharp contrast with the excellent validation of these models verified by numerous surveys in general population. This fact could be attributable to failing to consider TB, or in general chronic infections, as independent indicators of VTE incidence. These findings indicate the need for revising the presenting RAMs or establishing a separate RAM for VTE prediction in TB patients, resembling the VTE risk assessment model for cancer patients.
Immunotherapeutic Potential of N-Terminally Formylated ESAT-6 Protein in Murine Tuberculosis
Authors: Mir Shabir Ahmad , Sharma Sadhna
Published: April 2023

Background:

The early secreted antigenic target-6 kDa (ESAT-6) being one of the important antigens expressed by Mycobacterium tuberculosis (MTB) has been widely investigated for its strong immunmodulatory effects. We have previously evaluated the immunotherapeutic efficacy of ESAT-6 in the murine model of experimental tuberculosis (TB). Now in the present study, we have evaluated the immunotherapeutic efficacy of N-terminally formylated form of ESAT-6 (f-ESAT-6) in murine TB.

Materials and Methods:

The production and purification of f-ESAT-6 have been discussed in our earlier report (Mir SA and Sharma S, 2014). In the present study, the MTB H37Rv-infected mice were treated with f-ESAT-6 alone or in combination with anti-TB drugs (ATDs). Four weeks postinitiation of the treatment, the experimental mice were sacrificed, and the colony-forming units (CFUs) were enumerated in their lungs and spleen as described in “materials and methods” section.

Results:

The N-terminally formylated ESAT-6 protein (f-ESAT-6) induced a moderate reduction in the bacterial load in the target organs of infected mice. Compared to the dimethyldioctadecyl ammonium bromide treated and untreated groups, the f-ESAT-6 treatment significantly reduced the CFU in the spleen and lungs of infected mice by 0.377 log10 units (P < 0.05) and 0.396 log10 units (P < 0.01), respectively. The administration of f-ESAT-6 in combination with ATDs revealed an additional immunotherapeutic effect and elicited higher therapeutic efficacy over drugs (ATDs) alone.

Conclusion:

The results of the present study clearly indicate that f-ESAT-6 protein alone as well as in combination with the conventional ATDs induce moderate therapeutic effect against experimental TB.
Genetic Polymorphism of Toll-Like Receptors in HIV-I Infected Patients with and without Tuberculosis Co-Infection
Authors: Kaushik Gaurav , Vashishtha Richa , Tripathi Himanshu , Yadav Raj Narayan
Published: April 2023

Background:

Toll-like receptors (TLRs) are identified as one of the key components of innate immune system due to their ability to sense conserved molecular motifs associated with several pathogens. It has been implicated from several evidence that mutations in genes encoding TLRs are associated with increased or decreased susceptibility to various infectious diseases.

Methods:

The study was prospective, cross-sectional, as well as longitudinal in nature, which includes 223 HIV-positive patients, 150 HIV-positive patients with latent tuberculosis (TB) infection, 150 HIV-positive patients with active TB, 200 HIV-negative newly diagnosed sputum smear positive pulmonary TB patients, and 205 healthy subjects.

Results:

A statistically significant difference was observed in allelic frequencies of TLR4 between healthy subjects and HIV + TB patients (P < 0.001), healthy subjects, and pulmonary TB (PTB) Category-I patients (P < 0.01) and between healthy subjects and HIV + TB patients (P < 0.001). TLR4 genotype frequencies were also significantly different between healthy subjects and PTB Cat I patients (P < 0.001) and HIV + and HIV + TB patients (P < 0.01). A statistically significant difference was also observed between HIV + and PTB Cat I patients (P = 0.04), HIV + LTBI and HIV + TB patients (P = 0.01), and between HIV + TB and PTB Cat I patients (P < 0.01).

Conclusion:

This study implicates that Asp299Gly polymorphism in TLR4 gene is associated with increased susceptibility to active TB in HIV-seropositive patients. Increased frequency of 'A' allele in TLR9 gene was also discovered at the time of active TB development in ART naïve HIV + patients, who developed active TB on follow-up.