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Tuberculosis (TB) is one of the main infectious diseases worldwide and accounts for many deaths. It is caused by Mycobacterium tuberculosis usually affecting the lungs of patients. Early diagnosis and treatment are essential to control the TB epidemic. Interferon-gamma (IFN-γ) is a cytokine that plays a part in the body’s immune response when fighting infection. Current conventional antibody-based TB sensing techniques which are commonly used include enzyme-linked immunosorbent assay (ELISA) and interferon-gamma release assays (IGRAs). However, these methods have major drawbacks, such as being time-consuming, low sensitivity, and inability to distinguish between the different stages of the TB disease. Several electrochemical biosensor systems have been reported for the detection of interferon-gamma with high sensitivity and selectivity. Microfluidic techniques coupled with multiplex analysis in regular format and as lab-on-chip platforms have also been reported for the detection of IFN-γ. This article is a review of the techniques for detection of interferon-gamma as a TB disease biomarker. The objective is to provide a concise assessment of the available IFN-γ detection techniques (including conventional assays, biosensors, microfluidics, and multiplex analysis) and their ability to distinguish the different stages of the TB disease.

Aims: Despite the established link between familial hypercholesterolemia (FH) and increased risk of coronary heart disease (CHD), its association with other common atherosclerotic and metabolic diseases has not been extensively studied. The aim of this study was to report the prevalence of peripheral arterial disease (PAD) [i.e., common carotid artery disease (CCAD) and lower extremity arterial disease (LEAD)], aortic valve stenosis, chronic kidney disease (CKD) and non-alcoholic fatty liver disease (NAFLD) in patients with FH. Materials & Methods: This was a cross-sectional study retrieving data from the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH). Results: A total of 1,633 adult patients (850 males) with heterozygous FH (HeFH) were included (mean age 51.3±14.6 years at registration and 44.3±15.9 years at diagnosis). Any common carotid artery stenosis (CCAS) was diagnosed in 124 out of 569 patients with available related data (21.8%), while the prevalence of CCAD (defined as a CCAS ≥50%) was 4.2%. The median (interquartile range - IQR) CCAS was 30% (20-40), whereas the median (IQR) carotid intima-media thickness (CIMT) was 0.7 (0.1-1.4) mm. LEAD was reported in 44 patients (prevalence 2.7%). The prevalence of aortic valve stenosis and CKD was 2.0% and 6.4%, respectively. NAFLD was present in 24% of study participants. Conclusions: HeFH is associated with a relatively high prevalence of any CCAS and CCAD. The prevalence of LEAD, CKD and aortic valve stenosis was relatively low, whereas the prevalence of NAFLD was similar to that of the general population.

Erectile dysfunction is the repeated inability to sustain erection firm enough for sexual intercourse while an aphrodisiac is an agent (food/drug) that arouses sexual activity. Various factors affect sexual performance in men, and include; psychological, hormonal abnormalities, aging, penile injury, chronic diseases, lifestyle, medications and radiation. Aphrodisiac medicinal plants could elicit their effect by providing essential nutrients such as vitamins, minerals and amino acids or could improve blood flow to the penile tissues, e.g. Kaempferia parviflora which could inhibit phosphodiesterase enzyme (PDE-5). Some medicinal plants stimulate or act on the central nervous system to derive their aphrodisiac effects, e.g. Pausinystalia yohimbe due to the presence of an alkaloid yohimbine. Medicinal plants could increase the serum level of cholesterol, testosterone, luteinizing hormone and follicle stimulating hormone and improving the overall male reproductive health. The aim of this research is to review the role of medicinal plants in the management of erectile disorders in men, which could lead to discovery of novel chemical scaffolds for the synthesis of potent aphrodisiac agents. Natural products particularly aphrodisiac medicinal plants remain an important source of new drugs, new drug leads and new chemical entities allowing the design, rational planning of new drug biomimetic, discovery of new therapeutic properties not yet attributed to known compounds and synthesis development.

With high absorption coefficient (104 cm−1), optimal bandgap (~1.5 eV), low toxicity and the abundance of its constituent elements, kesterite (Cu2ZnSnS4 or CZTS) displays the properties of an ideal photovoltaic material. Kesterite is structurally analogous to chalcopyrite (Cu2InGaS2 or CIGS) and can thus be produced through the already established techniques for the synthesis of commercial CIGS. Though CIGS- and CdTe-based thin-film solar cells have attained levels of power efficiency values (up to ~22%) that compare with that of crystalline silicon-based wafer solar cell, they contain rare earth elements (indium, tellurium and Cd) that are toxic. This article reviews the crystal structure formation and properties of CZTS. Material synthesis, thin-film deposition methodologies and different layers that have been developed for kesterite-based photovoltaic (PV) cell are reported. Factors that hinder high-power conversion efficiency, including large open-circuit voltage deficit (Voc,def), are discussed. Strategies, such as alloy formation, which have been employed to overcome the limitations of using kesterite in PV cell applications are presented, together with the future direction in the quest for improving the performance of kesterite PV cell devices.

Prostate cancer is the second most common cause of cancer related deaths in men. It is detected using many screening methods. Like every other cancer, there are risk factors associated with prostate cancer. This include but not limited to, Family History (FH) of the disease, smoking habit, alcohol intake, age and Body Mass Index (BMI). The survival of prostate cancer patients is dependent on many factors such as, early detection of the disease, age of patient and the aggressiveness of the cancer. Gleason score is used to measure the level of aggressiveness of a prostate cancer in a patient. the score ranges from 6 to 10. It is made up of two Gleason grades that ranges from 3 to 5. This study was carried out to determine whether there are significant differences in the mean of Gleason score by the various categories of BMI and FH of patients while controlling for the number of hospital visits. Gleason score was used as the dependent variable while FH and BMI and Number of hospital visits were used as the independent variables. Descriptive statistical measures were used to summarize the basic features of the data. Spearman correlation coefficient was used to measure if there is a significant statistical relationship between the Gleason score, age and BMI, while Analysis of Covariance (ANCOVA) was used to measure the differences in the mean of Gleason score by the categories of FH and BMI while controlling for number of hospital visits. The analysis was done using Statistical Programme for Social Science (SPSS 25.0) and Intellectus Statistics software. Results from the analyses were presented in tabular form. The results showed a significant effect of Body Mass Index (BMI) on Gleason score and that Gleason score increases, as age tends to increase.

Background: Haematological changes have been associated with physical activity (exercise) and these changes have been found to involve leucocytes, red blood cells and thrombocytes depending on variables such as the duration and intensity of the exercise. Objective: This experimental pre-post test study was designed to assess the changes in white blood cell, red blood cell and platelet parameters following short term exercise. Method: A total of 30 participants with an average age of 23.8 ± 1.98 years participated in the standard treadmill exercise (Bruce protocol) for 30 minutes on voluntary basis. Blood samples were collected from the subjects before exercise, immediately after exercise and 24 hours after exercise. Hematological parameters were analyzed using hematology auto-analyzer. Height, weight, body mass index and blood pressure of the participant were measured. Ethical approval was obtained from the Ethics committee of Faculty of Health Sciences and Technology and informed consent of the participants were obtained. Statistical Package for Social Sciences version 21 was used for statistical analysis. Results: The platelet count significantly increased post-exercise compared to pre-exercise and decreased 24hours post-exercise compared to postexercise value. Conversely, the Platelet distribution width (PDW) significantly decreased at post-exercise compared to pre-exercise, and significantly increased at 24hours post exercise compared to post-exercise value. Moreover, there was a significant increase in Mean platelet volume (MPV) at 24hours post-exercise compared to post exercise and a significant decrease in Plateletcrit (PCT) at 24hours post-exercise compared to post-exercise. At post-exercise and 24hours post-exercise, the total lymphocyte count was significantly higher in females while the granulocyte count was significantly higher in males. Also at 24 hours post exercise the MCHC was significantly higher in females compared to males. At post-exercise, there was a significant positive correlation between BMI and MCH (r=0.512, P=0.004) and BMI and MCHC (r=0.553, P=0.003) while there was a significant negative correlation between BMI and MPV (r=-0.367, P=0.046). Conclusion: Short term exercise causes significant alterations in platelet parameters than other hematological parameters.

Background: Acute pancreatitis is one of the most common gastrointestinal conditions requiring hospitalization. Even though its presentation during pregnancy is uncommon, it is a medical challenge. Currently, no studies compare the clinical outcomes between pregnant patients with acute pancreatitis and nonpregnant patients with acute pancreatitis. Our aim was to compare the characteristics and clinical outcomes of pregnant and nonpregnant women with acute pancreatitis. Methods: We conducted a retrospective study that included all patients admitted to our hospital with acute pancreatitis over a 10-year period. Demographics, general characteristics, and clinical outcomes were evaluated and compared between pregnant and nonpregnant women with acute pancreatitis, at a ratio of 1:5. Results: Over 10 years, 27 pregnant patients with acute pancreatitis were treated. Etiology was biliary in 96% and hypertriglyceridemia was the cause in 3.4% (1 patient). The mean patient age was 26.2 years (range 15-36 years). The main cause of acute pancreatitis was biliary disease (96%). Patients in the study group were in their first, second, or third trimester of pregnancy, at 7.4%, 33.3%, and 59.3%, respectively. In the comparison of pregnant versus nonpregnant patients with acute pancreatitis, there were no differences in age, hospital stay (7.37 vs. 10.8, p = 0.814), severity (severe 3.7% vs. 16.7%, p = 0.79), local complications (0% vs. 1.9%, p = 0.476), or mortality (0% vs. 1.9%, p = 0.476). Conclusions: The clinical evolution of both groups with biliary acute pancreatitis was similar, with low morbidity and mortality. Resumen: Antecedentes y objetivo: La pancreatitis aguda es una de las condiciones gastrointestinales más comunes que requieren hospitalización. Aunque su aparición durante el embarazo es poco común, representa un reto médico. Actualmente no existen estudios que comparen los desenlaces clínicos entre mujeres embarazadas con pancreatitis aguda y pacientes no embarazadas con pancreatitis aguda. Nuestro objetivo fue comparar las características y desenlaces clínicos de las mujeres embarazadas y no embarazadas con pancreatitis aguda. Métodos: Realizamos un estudio retrospectivo que incluyó a todas las pacientes admitidas en nuestro hospital con pancreatitis aguda durante un periodo de 10 años. Se evaluaron y compararon los datos demográficos, las características generales y los desenlaces clínicos entre las mujeres embarazadas y las mujeres no embarazadas con pancreatitis aguda, con una razón de 1:5. Resultados: Se trató a 27 pacientes embarazadas con pancreatitis aguda en un periodo de 10 años. La etiología fue biliar en 96% de los casos y en 3.4% de los casos la causa fue hipertrigliceridemia (1 paciente). La edad media de las pacientes fue de 26.2 años (rango de 15-36 años). La causa principal de la pancreatitis aguda fue la enfermedad biliar (96%). Las pacientes en el grupo de estudio cursaban su primer, segundo o tercer trimestre del embarazo, con una distribución del 7.4%, 33.3% y 59.3% respectivamente. En la comparación entre pacientes embarazadas y no embarazadas con pancreatitis aguda no existieron diferencias en edad, tiempo de hospitalización (7.37 vs. 10.8, p = 0.814), gravedad (grave, 3.7% vs. 16.7%, p = 0.79), complicaciones locales (0% vs. 1.9%, p = 0.476), o mortalidad (0% vs. 1.9%, p = 0.476). Conclusiones: La evolución clínica de ambos grupos con pancreatitis biliar aguda fue similar, con baja morbilidad y mortalidad.

Background and study aims The quality of screening-related colonoscopy depends on several physician- and patient-related factors. Adenoma detection rate (ADR) varies considerably between endoscopists. Educational interventions aim to improve endoscopists’ ADRs, but their overall impact is uncertain. We aimed to assess whether there is an association between educational interventions and colonoscopy quality indicators. Methods A comprehensive search was performed through August 2019 for studies reporting any associations between educational interventions and any colonoscopy quality indicators. Our primary outcome of interest was ADR. Two authors assessed eligibility criteria and extracted data independently. Risk of bias was also assessed for included studies. Pooled rate ratios (RR) with 95 % confidence intervals (CI) were reported using DerSimonian and Laird random effects models. Results From 2,253 initial studies, eight were included in the meta-analysis for ADR, representing 86,008 colonoscopies. Educational interventions were associated with improvements in overall ADR (RR 1.29, 95 % CI 1.25 to 1.42, 95 % prediction interval 1.09 to 1.53) and proximal ADR (RR 1.39, 95 % CI 1.29 to 1.48), with borderline increases in withdrawal time, ([WT], mean difference 0.29 minutes, 95 % CI – 0.12 to 0.70 minutes). Educational interventions did not affect cecal intubation rate ([CIR], RR 1.01, 95 % CI 1.00 to 1.01). Heterogeneity was considerable across many of the analyses. Conclusions Educational interventions are associated with significant improvements in ADR, in particular, proximal ADR, and are not associated with improvements in WT or CIR. Educational interventions should be considered an important option in quality improvement programs aiming to optimize the performance of screening-related colonoscopy.

Pancreatic fluid collections (PFCs), including walled-off necrosis (WON), are commonly described sequelae of pancreatitis. Endosonography-guided PFC drainage can be performed using plastic stents (PS), fully covered self-expanding metal stents (FCSEMS), or lumen-apposing metal stents (LAMS). We performed a retrospective study comparing clinical outcomes and adverse events by stent type. In this historical cohort, patients undergoing endosonography-guided PFC drainage from 2010 to 2019 were divided into groups: those treated with (1) PS, (2) FCSEMS, and (3) LAMS. Clinical success, the primary outcome, was defined as complete resolution or size reduction of ≥ 50%, with resolution of symptoms and no reintervention required at 3 months following the index procedure. Adverse events (AEs) and procedure times were also evaluated. Fifty-eight patients were included. Procedure times were significantly shorter with LAMS (21.4 ± 10.8 min versus 53.0 ± 24.4 min for FCSEMS and 65.9 ± 23.4 min for PS, p

Background Endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure in the management of pancreatic and biliary disease. While its role is firmly established, further well-designed prospective ERCP research is required, as a large portion of previous work has employed retrospective or administrative methodologies, both prone to potential biases. The aim of the Calgary Registry for Advanced and Therapeutic Endoscopy (CReATE) is to be a high-fidelity prospective multicentre registry. Methods The study population consisted of consecutive adult ERCP patients from September 2018 to September 2019. Informed consent was acquired for each patient. All relevant preprocedural, procedural, peri-procedural and postprocedural data were captured in real time by a full-time third-party research assistant directly observing procedures. Outcomes were ascertained by comprehensive medical record review and patient phone interview 30 days after the index procedure. Results Five endoscopists performed 895 ERCP procedures, 90.1% of which were deemed successful. Suspected choledocholithiasis was the most common indication for ERCP, followed by suspected or confirmed stricture(s), at 61.0% and 29.5%, respectively. 61.0% of procedures were performed on ERCP-naive patients. Post-ERCP pancreatitis occurred following 4.9% of procedures, with clinically significant bleeding or perforation occurring following 1.8% and 0.1% of procedures, respectively. Discussion Through 12 months, CReATE captured 895 procedures prospectively, with each entry containing over 300 data fields. Active expansion to additional tertiary centres is underway, and this will enhance the existing data pool. CReATE has the potential to improve multiple facets of ERCP, including training, optimal procedural techniques, mitigation of adverse events and personalized patient care.

This paper analyzes the roles and operations of the Bretton Woods institutions, the International Monetary Fund, and International Bank for Reconstruction and Development, as it relates to their modus operandi and dealings with the poor and needy underdeveloped countries of the South. The most common understanding of the roles of international organizations such as the IMF and the World Bank is that of a platform for the common good of members. Viewed however, from the perspective of the weak and poor states of the world, they are instruments in the hands of the dominant power players in the international system. Adopting the theoretical frameworks of realism and third world approach, this paper finds that though the international financial institutions have supplied funds aimed for development and for the handling or control of crisis, they leave so much to desire in the cases of the underdeveloped states. The paper concludes that the actual intentions of the IMF and World Bank are primarily directed at making the developing countries perform better in their client relationship with the west.

This study evaluated leucocyte mobilization and platelet aggregation effects of ciprofloxacin, lincomycin and Erythromycin in Wistar albino rats. Thirty-three female Wistar albino rats weighing 130-160 g and three male Wistar albino rats weighing 188-194 g, fed commercial growers’ mash and clean tap water were used. In leukocytes assay, thirty-three adult female Wistar rats were assigned into five treatments, eleven groups of three rats per group. First three groups were treated 10 mg kg-1, 20 mg kg-1 and 40 mg kg-1 of ciprofloxacin, next three groups same doses of lincomycin, next three groups same doses of Erythromycin, the tenth group received Indomethacin 5 mg kg-1 (reference drug), the last group 5 mg kg-1 normal saline. Assay on platelet aggregator activity involved collection of blood samples (10 ml each, 1% EDTA, centrifuged at 3000 rpm for 10 minutes), test drugs dissolved in 1 mg/ml distilled water and Indomethacin (the reference drug). The three antibiotics significantly reduced leucocyte mobilization into the affected tissue. They all had their maximum inhibitory effects at the highest dose (40 mg kg-1) compared with indomethacin. Erythromycin 40 mg kg-1 showed the highest inhibitory effect on leucocyte migration. Whereas ciprofloxacin and erythromycin had stepwise increase in absorbance from time 0 secs through to time 120 secs, lincomycin showed a sharp decrease in the absorbance at around 30 seconds followed by a continuous increase up to 120 seconds. The testing drugs prevented leukocyte mobilization also had stepwise increase in absorbance from time 0 secs through to time 120 secs in platelet aggregatory activity assay to some extent.

This study analyses the impact of particle polydispersity using the Eulerian-Eulerian (EE) and Lagrangian-Eulerian (LE) modelling approaches in the context of wellbore cleaning operations in the drilling industry. Spherical particles of sizes 0.5 mm, 0.75 mm and 1 mm are considered, whereas a Power Law rheological model is used for the fluid phase description. The EE approach implemented herein applies the Kinetic Theory of Granular Flow (KTGF) in ANSYS Fluent® and accounts for the particle size differences by representing them as different phases within the computational domain. With the LE approach, we employ the Dense Discrete Phase Model (DDPM) and capture this difference with the aid of a size distribution model (the Rosin-Rammler model). The findings of our computational experiments show considerable differences in key variables (the pressure drop, and particle deposition tendencies) between monodispersed and polydispersed transport scenarios.

Background Neonatal mortality has been reported as a major societal health menace across the globe. Hence, this study, which adopted a hospital-based cross-sectional type of experimental research design, aimed at examining the clinical indication of some selected cardiopulmonary and anthropometric indices as key predictive clinical biomarkers for neonatal survival. The subjects were divided into three groups; experimental Group 1 consisted of 80 pre-term neonates within 28 weeks; experimental Group 2 consisted of 80 pre-term neonates within 33 weeks; and the control group, which consisted of 80 apparently healthy, term neonates. For each subject selected, cardio-pulmonary parameters and anthropometric variables were obtained daily and compared. ANOVA, correlation coefficients, and linear regression were used to compare statistical measures. A discrimination accuracy test of previous records using cut points available from previous models was conducted for ease of estimating the possibility of neonatal survival from assayed variables. Results Following data collection, sorting, and analysis, the study found a statistically significant decrease (p < 0.05) in average systolic blood pressure (SBP) values of preterm neonates when compared with term neonates. This, however, was the reverse for DBP, which was proved to have increased in preterm neonates compared to term neonates. The study also observed a statistically significant decrease (p < 0.05) in RR and OSL levels of preterm neonates compared to term neonates. Conclusion In conclusion, cardiopulmonary and anthropometric status could be useful predictive biomarkers in clinical trials to provide insight into the extent of compromise in newborn health. This will help to minimize the death of neonates by ensuring a better treatment protocol/regimen is given. A corroborative study with an event-driven approach that assays more molecular or other non-physiological variables is recommended.

In the six Southeast Asian countries that make up the Greater Mekong Subregion,In this longitudinal study conducted in Northern Uganda, we treated patients who hadFrom 2017 through 2019, a total of 14 of 240 patients who received intravenous artesunate had evidence of in vivo artemisinin resistance (parasite clearance half-life,5 hours). Of these 14 patients, 13 were infected withThe independent emergence and local spread of clinically artemisinin-resistant

Hydrothermal gasification of biomass is an alternative method of producing hydrogen-rich syngas. Modeling and optimization of hydrothermal processes are important to evaluate the economic feasibility of the process. Furthermore, developing a mathematical model to represent the many underlying mechanisms during hydrothermal gasification could contribute to lower process expenditures, improve efficiency and provide an in-depth understanding of the process. The present study outlines different modeling and optimization strategies for hydrothermal gasification of biomass and waste materials to produce hydrogen-rich syngas. The modeling techniques (e.g. thermodynamic, kinetic and computational fluid dynamic modeling) and process optimization approaches (e.g. univariate, factorial, Taguchi, response surface methodology and mixture design of experiments) are discussed in this review comprehensively together with their merits and limitations. The knowledge gaps and prospects of modeling and optimization of hydrothermal conversion are also elucidated.

International audience; Wireless electrochemiluminescence is generated using interdigitated, 3D printed, titanium arrays as feeder electrodes to shape the electric field. Gold microparticles (45 µm diameter), functionalised with 11- mercaptoundecanoic acid, act as micro-emitters to generate electrochemiluminescence from [Ru(bpy)3]2+, (bpy is 2,20-bipyridine) where the co-reactant is tripropylamine. The oxide coated titanium allows intense electric fields,whose distribution depends on the geometry of the array, to be created in the absence of deliberately added electrolyte. COMSOL modelling and long exposure ECL imaging have been used to map the electric field distribution. Significantly, we demonstrate that bycontrolling the surface charge of the gold microparticles through the solution pH, the light intensity can be increased by a factor of morethan 10.; L'électrochimiluminescence sans fil est générée en utilisant des réseaux de titane interdigités, imprimés en 3D, comme électrodes d'alimentation pour former le champ électrique. Des microparticules d'or (45 µm de diamètre), fonctionnalisées avec de l'acide 11-mercaptoundécanoïque, agissent comme des micro-émetteurs pour générer l'électrochimioluminescence à partir de [Ru(bpy)3]2+, (bpy est la 2,20-bipyridine) où le coréactif est la tripropylamine. Le titane recouvert d'oxyde permet de générer des champs électriques intenses dont la distribution dépend de la géométrie du réseau, en l'absence d'électrolyte ajouté. LA MODÉLISATION COMSOL et l'imagerie ECL à longue exposition ont été utilisés pour cartographier la distribution du champ électrique. De manière significative, nous démontrons qu'encontrôlant la charge de surface des microparticules d'or par le biais du pH de la solution, l'intensité de la lumière peut être augmentée d'un facteur supérieur à 10.

Background: It is well established that SARS-CoV-2 is readily transmitted in indoor environments; however questions remain about the relative importance of different transmission mechanisms, the risks associated with non-clinical indoor environments and activities and the role of ventilation and plumbing systems in mitigating or amplifying transmission. This rapid evidence review identifies and integrates evidence from three distinct disciplines: epidemiology, microbiology and fluid dynamics. Objectives: This review addresses the following research questions: 1. What evidence is there for aerosolised transmission? 2. What evidence is there for faecal-oral transmission? 3. What evidence is there regarding the role of ventilation systems in indoor transmission? 4. What evidence is there regarding the role of plumbing systems in indoor transmission? 5. What evidence is there regarding transmission via different indoor surfaces (materials and specific objects)? 6. What evidence is there for the transmission in indoor residential settings? 7. What evidence is there for transmission in indoor workplace settings? 8. What evidence is there for transmission in other indoor settings (social, community, leisure, religious, public transport)? 9. Do particular activities convey greater risk (e.g. shouting, singing, eating together, sharing bedrooms)? 10. What evidence is there for the appropriate length of distancing between people? Data sources: Searches were conducted in PubMed, medRxiv, arXiv, Scopus, WHO COVID-19 database, Compendex & Inspec. Eligibility criteria: We included studies reporting data on any indoor setting except schools, any indoor activities and any potential means of transmission. Additional screening criteria were modified slightly for the three study disciplines. Title and abstract and full text screening was conducted by a single reviewer, with rejections assessed by a second reviewer. Data extraction, quality appraisal and data synthesis: We used Joanna Briggs Institute and Critical Appraisal Skills Programme tools for evaluating epidemiological studies and developed bespoke tools for the evaluation of study types not covered by these instruments. Data extraction was limited to a minimum set of items, given the rapid nature of this review. Data extraction and quality assessment were conducted by a single reviewer. We conducted a meta-analysis of secondary attack rates in household transmission. Otherwise, data were synthesised narratively. Results and conclusion: Literature searches yielded a total of 1573 unique articles. After screening and quality assessment, fifty-eight articles were retained for analysis. Experimental evidence from fluid mechanics and microbiological studies demonstrates that aerosolised transmission is theoretically possible; however, we found no conclusive epidemiological evidence of this occurring. The evidence suggests that ventilation systems have the potential to decrease virus transmission near the source through dilution but to increase transmission further away from the source through dispersal. There is compelling evidence that, if infectious virus is present in faeces, defective plumbing systems can amplify transmission within high-rise buildings. However, although viral RNA can be detected in stool samples, we found no evidence for the detection of live infectious virus in faeces, nor did we find any examples of faecal-oral transmission. Laboratory studies suggest that the virus survives for longer on smooth surfaces and at lower temperatures. Environmental sampling studies have recovered small amounts of viral RNA from a wide range of frequently touched objects and surfaces; however, we did not find any such studies which had successfully cultured live virus from collected samples and epidemiological studies are inconclusive on the extent of fomite transmission. We found many examples of transmission in settings characterised by close and prolonged indoor contact, such as households (pooled secondary attack rate 11%, 95 % confidence interval 9, 13), communal residential settings, workplaces and religious gatherings. There were insufficient data to evaluate the transmission risks associated with specific activities; however workplace challenges related to poverty, such as continuing to work whilst ill, especially when attendance is incentivised, warrant further attention. Finally, the physical properties of droplets generated by coughing, speaking and breathing are well characterised and reinforce the importance of maintaining 2 metres social distance to reduce droplet transmission.

First described in 1996, the drug reaction, eosinophilia, and systemic symptoms syndrome (DReSS) is considered, along with Stevens-Johnson syndrome and toxic epidermal necrolysis, a severe cutaneous drug reaction. It is characterized by the presence of a maculopapular erythematous skin eruption, fever, lymphadenopathy, influenza-like symptoms, eosinophilia, and visceral involvement such as hepatitis, pneumonitis, myocarditis, pericarditis, nephritis, and colitis. The prognosis of patients with DReSS is related to the severity of visceral involvement. The mortality ranges from approximately 5% to 10%, and death is mainly due to liver failure, which is also the organ most commonly involved in this syndrome. Although it was previously hypothesized in 1994, DReSS syndrome can lead to reactivation of one or more human herpesvirus family members. Now being included as diagnostic criteria in a proposed diagnostic score system, this reactivation can be detected up to 2-3 wk after DReSS syndrome onset. Other causes of mortality in DReSS syndrome include myocardial or pulmonary lesions and hemophagocytosis. We reviewed the literature of previously reported case-series of DReSS and liver involvement, highlighting the pattern of liver damage, the treatment used, and the outcome.

The paper examined politics of climate change, National Security and Development in Nigeria. The paper argued that the nature of politics of climate change which is couched in the nature and character of Nigerian state has adversely affected National Security and Development in Nigeria. Democratic elitism was adopted as analytical construct. The main assumption of democratic elitism is that the political elites who rule the people must rule within the purview of democratic tenets and values. The paper relied on secondary sources of data. The main objective of the paper is to critically examine the politics of climate change and its impact on National Security and Development in Nigeria. The paper noted that the sudden and seemingly forceful amalgamation of the 1914 coupled with the unbridled quest for primitive accumulation has not only infused fissiparous tendencies into the politics of Nigeria but has also militarized the political system in Nigeria. Consequently, National Security and Development are undermined. The paper recommended inter alia that democratic institutions should be strengthened and democratic values should be imbibed and demonstrated by Nigerians.

Hypertension is one of the commonest cause of chronic kidney disease (CKD) in Nigerians. We describe blood pressure (BP) control and kidney disease markers in patients with hypertension as part of measures to curb the burden of this chronic debilitating disease.Patients with hypertension in the main tertiary hospitals in three states in north central Nigeria were evaluated for indicators of CKD, including proteinuria and estimated glomerular filtration rate (eGFR)60 ml/min/1.73 mA total of 1063 subjects (63.1% females and 36.8% males) with a mean age of 55 ± 11 years were studied. Diabetes mellitus (DM) was present in 214 (20.6%) and 422 (39.7%) had optimal BP control. The median duration of hypertension was 6 years (range 1-44 years). Proteinuria occurred in 130 (12.2%), while 212 (19.9%) had reduced eGFR and 46 (4.3%) had proteinuria and reduced eGFR. The use of calcium channel blockers [adjusted odds ratio (AOR): 0.70, 95% Confidence Interval (CI) 0.50-0.99] and the use of more than two antihypertensive medications (AOR: 0.62, 95% CI 0.40-0.96) were associated with reduced odds of optimal BP control. Male sex (AOR: 1.75, 95% CI 1.14-2.70) and the use of renin-angiotensin-aldosterone system blocking medications (AOR: 2.07, 95% CI 1.18-3.64) were independently associated with proteinuria while DM (AOR: 1.69, 95% CI 1.06-2.55) and treatment with more than two medications (AOR: 1.86, 95% CI 1.09-3.17) were more likely to have reduced eGFR.A large proportion of hypertensive patients in north-central Nigeria have poorly controlled BP. Kidney damage is common among these patients.

Typical daily operations of oil and gas production systems are characterised by numerous decisions that must be carefully made if field profitability is to be sustained. These systems are usually nonlinear, nonconvex and involve binary decision variables; hence, the application of mathematical optimisation often results in an MINLP formulation. Piecewise linearisation techniques based on Special Ordered Sets of type 2 (SOS2) constraints have been used to approximate the nonlinear functions of the optimisation problem for complexity reduction. However, a computational analysis of these MILP-based formulations in comparison to their MINLP equivalents in oil production systems is scarce in literature. In this study, the benefits of MILP reformulation are applied to a synthetic but realistic case. In comparing both formulations, we evaluate solution sensitivity to the number of breakpoints, solution time, accuracy, and ease of automation.

Large investments are required for the positioning and drilling of oil and gas wells, implying that decisions related to these activities may be significantly aided by sound and proven mathematical-oriented methods. The use of intuitive engineering judgement alone cannot guarantee sustainable profitability over long periods, especially under geological (reservoir model) uncertainty. To capture significant uncertainty sources in the subsurface geology of the reservoir considered in this study, geostatistical model realisations are obtained using available information (permeabilities and porosities). We use specialised algorithms of the MATLAB Reservoir Simulation Toolbox (MRST, interfaced with PETREL™) in order to determine optimal petroleum production well locations and production rates and thus maximise the field oil recovery. The developed computational workflow has been applied to a realistic case study, for which robust optimality is demonstrated using the worst-case realisation for determining optimal well locations.

Wireless Sensor Networks (WSNs) consist mainly of resource constrained sensor nodes and gateways. Therefore, various lightweight communication protocols are emerging for Machine to Machine (M2M) communications. Among the various application layer protocols for data communication in WSNs, the two most popular protocols for constrained devices are the Message Queue Telemetry Transport Protocol (MQTT) with a variant for sensor nodes (MQTT-SN) and the Constrained Application Protocol (CoAP). Studies have shown that the performance of these different protocols are dependent on different network conditions. CoAP is more efficient in terms of message overhead and MQTT-SN is more efficient in terms of client complexity. Studies have further emphasized the levels of difficulties to implementing any of these protocols with regard to application requirements. In this paper we propose a hybrid MQTT-CoAP protocol technique using an abstraction layer that enables both MQTT-SN and CoAP protocol to be used in the sensor node. Performance evaluation of these protocols under the hybrid technique shows that the hybrid is feasible and while CoAP performs better in terms of energy consumption, the two protocols perform almost equally in latency. The observed values of latency and energy consumption in the developed hybrid technique was comparable to other studies.

Model-based oil production systems optimisation under pressure and facility routing constraints is a testing challenge, especially in the presence of complex downhole wellbore phenomena (water coning, slugging, phase separation). Nonlinearities and nonconvexities from underlying physics and binary decisions exacerbate model complexity, yielding Mixed Integer Nonlinear Programs (MINLP). To guarantee solvability of optimisation formulations and reduce MINLP complexity, piecewise linearisation techniques based on Special Ordered Sets of type 2 (SOS2) constraints are developed towards approximating nonlinear functions and transforming models to Mixed Integer Linear Programs (MILP). Nevertheless, computational analyses of MILP vs. MINLP formulations for oil production optimisation are scarce. This study explores the benefits of an MILP reformulation applied to three case studies of varying complexity. We compare MILP model results to the original MINLP formulation solutions with multiple solvers, evaluating the impact of the number of linearisation breakpoints used on solution time, accuracy, robustness, model development effort and ease of automation.

In hyperglycemia, hypertonicity results from solute (glucose) gain and loss of water in excess of sodium plus potassium through osmotic diuresis. Patients with stage 5 chronic kidney disease (CKD) and hyperglycemia have minimal or no osmotic diuresis; patients with preserved renal function and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) have often large osmotic diuresis. Hypertonicity from glucose gain is reversed with normalization of serum glucose ([Glu]); hypertonicity due to osmotic diuresis requires infusion of hypotonic solutions. Prediction of the serum sodium after [Glu] normalization (the corrected [Na]) estimates the part of hypertonicity caused by osmotic diuresis. Theoretical methods calculating the corrected [Na] and clinical reports allowing its calculation were reviewed. Corrected [Na] was computed separately in reports of DKA, HHS and hyperglycemia in CKD stage 5. The theoretical prediction of [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu] in most clinical settings, except in extreme hyperglycemia or profound hypervolemia, was supported by studies of hyperglycemia in CKD stage 5 treated only with insulin. Mean corrected [Na] was 139.0 mmol/L in 772 hyperglycemic episodes in CKD stage 5 patients. In patients with preserved renal function, mean corrected [Na] was within the eunatremic range (141.1 mmol/L) in 7,812 DKA cases, and in the range of severe hypernatremia (160.8 mmol/L) in 755 cases of HHS. However, in DKA corrected [Na] was in the hypernatremic range in several reports and rose during treatment with adverse neurological consequences in other reports. The corrected [Na], computed as [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu], provides a reasonable estimate of the degree of hypertonicity due to losses of hypotonic fluids through osmotic diuresis at presentation of DKH or HHS and should guide the tonicity of replacement solutions. However, the corrected [Na] may change during treatment because of ongoing fluid losses and should be monitored during treatment.

BACKGROUND: The morphology of the major papilla affects the difficulty of endoscopic retrograde cholangiopancreatography (ERCP), but no associations with adverse events have previously been established. We aimed to assess whether papillary morphology predicts ERCP adverse events. METHODS: A retrospective analysis was performed of a prospective registry of patients undergoing ERCP for biliary indications. The primary outcome was post-ERCP pancreatitis (PEP), with secondary outcomes including other adverse events and procedural outcomes such as inadvertent pancreatic duct cannulation, cannulation time, and attempts. Papillae were classified as normal (Type I), small or flat (Type II), bulging (Type IIIa), pendulous (Type IIIb), creased (Type IV), or peri-diverticular (Type D). Outcomes were ascertained prospectively at 30 days from index procedures. RESULTS: A total of 637 patients with native papillae were included. Compared to Type I papillae, Type II and Type IIIb papillae were associated with PEP, with adjusted odds ratios (AOR) of 7.28 (95% confidence intervals, CI, 1.84–28.74) and 4.25 (95% CI 1.26–14.32), respectively. Type II and IIIb papillae were associated with significantly longer cannulation times by 5.37 (95% CI 2.39–8.35) and 4.01 (95% CI 1.72–6.30) minutes, respectively. Type IIIb papillae were associated with lower deep cannulation success (AOR 0.17, 95% CI 0.06–0.48). CONCLUSION: Papillary morphology is an important factor influencing both ERCP success and outcomes. Understanding this is key for managing intraprocedural approaches and minimizing adverse events. PROSPECTIVE REGISTRY REGISTRATION: Clinicaltrials.gov identifier NCT04259580.

OBJECTIVE This study aimed to compare a "nonaggressive" hydration versus an "aggressive" hydration using Hartmann's solution in patients with acute pancreatitis (AP) with more than 24 hours from disease onset. METHODS We included 88 patients with AP with more than 24 hours from disease onset, and were randomized into 2 groups. Group I (n = 45) received a nonaggressive hydration (Hartmann's solution at 1.5 mL kg h for the first 24 hours and 30 mL kg during the next 24 hours), and group II (n = 43) received an aggressive hydration (bolus of Hartmann's solution 20 mL kg, followed by an infusion of 3 mL kg h for the first 24 hours and then 30 mL kg for the next 24 hours). RESULTS The mean volume of fluid administered was greater in group II (P < 0.001). We did not find differences when comparing both groups in reference to persistent systemic inflammatory response syndrome (P = 0.528), pancreatic necrosis (P = 0.710), respiratory complications (P = 0.999), acute kidney injury (P = 0.714), or length of hospital stay (P = 0.892). CONCLUSIONS Our study suggests that the clinical evolution of patients with AP with more than 24 hours from disease onset is similar using an aggressive or nonaggressive hydration.

Background. The burden of serious fungal diseases has significantly increased in the past few decades; however, the number of health-care workers with expertise in the management of fungal diseases remains low, especially in low- and middle-income countries (LMICs). This study aimed to evaluate the use of freely available online teaching material to enhance teaching and learning of medical mycology among medical students in Gulu University Medical School, Uganda. Methods. We conducted a cross-sectional study among second year medical students undertaking Medical Mycology course on antifungal agents in the department of Medical Microbiology and Immunology in the academic year 2017-2018. The materials were synthesized and peer-reviewed by experts in fungal diseases and were made freely available on the Leading International Fungal Education website (http://www.LIFE-Worldwide.org). A local faculty in the department delivered the lectures, and pre- and posttest scores were evaluated statistically. Results. Sixty medical students participated in the study of which 78% were male. The average score was 41% for the pretest and 52% for the posttest (p<0.0001). There was no significant difference in the scores of males and females. Majority of the students gave an above-average rating for the course material; however, 54% preferred prerecorded videos. Conclusion. Using freely available online materials on medical mycology can enhance teaching and learning of medical mycology. Because of this, there is need to incorporate up-to-date information about the subject into the curriculums of medical schools especially in LMICs.

Electrocatalysis stands as a heart for realization of hydrogen gas (H2) as a source of energy to replace conventional and traditional fossil fuel based energy. In this chapter, we present a comprehensive overview of the state-of-the-art molybdenum disulphide (MoS2) nanostructures for application in electrolytic hydrogen evolution reaction (HER). MoS2 is a crystalline compound consisting of Mo sandwiched between two sulfur atoms and can be identified in four poly-type structures, namely 1T, 1H, 2H and 3R. Firstly, the reaction accompanied with water splitting electrolysis, HER mechanisms as well as parameters to monitor HER reactions are discussed. Furthermore, the chapter describes different types of MoS2 poly-types, chemical synthetic routes and key approaches to activate inert S-containing basal plane of MoS2. This led to superior performance of new materials by combining the advantages of MoS2 components and others. Finally, future integration approaches which can be used to attain MoS2 with exposed edges and excellent electron transport channel are also outlined in this chapter.

Various national and international standards recommend potable water for mixing concrete; however, the availability of potable water is virtually a daunting task in some developing communities. Concrete workers in such environments tend to utilize any available water for mixing concrete, and this may be detrimental to the quality of the concrete being produced. This study investigates the rheological, mineralogical and strength variability of concrete due to construction water impurities. Water samples were collected from four different construction sites within Southwestern region of Nigeria for production of concrete. The physical and chemical properties of the waters were determined so as to measure their rate of contamination, prior to their use for mixing concrete. The rheological properties of the fresh concrete, compressive strength, split tensile strength, and microscale features of hardened concrete, that were produced with each water sample were determined. From the results, the rheological features of concrete were found not to be affected by water impurities, however, the mechanical test results revealed about 10% reduction in strength between concrete made with water having least and higher concentration of impurities. Also, it was evident from the microscale tests that the water impurities do alter the hydration rate of concrete, which results in strength reduction. The study suggests pretreatment of concrete mixing water before use in order to avoid its damaging effect on concrete life. Department of Civil Engineering, Covenant University, Ota, Nigeria; Centre for Construction Methods and Materials, S R Engineering College, Warangal, India; Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Department of Civil Engineering, Michael Okpara University of Agriculture, Umuahia, Nigeria

Objective MicroRNA-331 (miR-331) has shown regulatory activity against several genes whose expression has been claimed to be deregulated in breast tumors, including that of epidermal growth factor receptor 2 (HER2). Herein, the clinical value of miR-331 expression was investigated by analyzing its levels in breast benign and malignant tumors. Methods The expression levels of miR-331 were quantified via real-time PCR in 130 malignant and 66 benign breast tissue specimens collected after surgical resection of primary tumors. The generated data were analyzed by applying several statistical tests in order to examine the relationship of miR-331 expression with various established clinicopathological features and survival data of patients. Results Our data showed that miR-331 was overexpressed in malignant breast tumors compared to their benign counterparts both overall (P = 0.026) and individually when the subgroups of fibroadenoma and invasive ductal carcinoma were analyzed with each other (P = 0.001). ROC curve analysis confirmed the diagnostic value of these variations, providing an AUC value equal to 0.597 (P = 0.026) and 0.663 (P = 0.001), respectively. Furthermore, miR-331 levels were elevated (P = 0.026) in ductal cancerous specimens compared to the lobular ones but failed to correlate with other clinicopathological features or survival data of the breast cancer patients. Conclusions Our results provide evidence that miR-331 levels might provide valuable information regarding the differential diagnosis of benign and malignant breast tumors but present no prognostic value for breast cancer.

The ever‐increasing quest to identify, secure, access and operate oil and gas fields is continuously expanding to the far corners of the planet, facing extreme conditions towards exploring, securing and deriving maximum fluid benefits from established and unconventional fossil fuel sources alike: to this end, the unprecedented geological, climatic, technical and operational challenges have necessitated the development of revolutionary drilling and production methods. This review paper focuses on a technological field of great importance and formidable technical complexity ‐ that of well drilling for fossil fuel production. A vastly expanding body of literature addresses design and operation problems with remarkable success: what is even more interesting is that many recent contributions rely on multidisciplinary approaches and reusable Process Systems Engineering (PSE) methodologies ‐ a drastic departure from ad hoc/one‐use tools and methods of the past.The specific goals of this review are to first, review the state of art in active fields within drilling engineering, and explore currently pressing technical problems, which are in dire need, or have recently found, PSE‐and/or CFD‐relevant solutions. Then, we illustrate the methodological versatility of novel PSE‐based approaches for optimization and control, with an emphasis on contemporary problems. Finally, we highlight current challenges and opportunities for truly innovative research contributions, which require the combination of best‐in‐class methodological and software elements in order to deliver applicable solutions of industrial importance.

Diabetes mellitus (DM) is considered one of the most common metabolic disorders with an elevated morbidity and mortality rate. It is characterised by a deficiency in insulin secretion or degradation of secreted insulin. Many internal and external factors, such as oxidative stress, obesity and sedentary lifestyle, among others, have been suggested as the major causes of these cell alterations. Diabetes I and II are the most common types of diabetes. Treatment of type I requires insulin injection, while type II can be managed using different synthetic antidiabetic agents. However, their effectiveness is limited as a result of low bioavailability, high cost of drug production, and unfavourable side effects. There is a great need to develop alternative and more active antidiabetic drugs from natural sources. Different forms of natural products have been used since time immemorial as a source of medicine for the purpose of curing numerous human diseases, including diabetes. Secondary metabolites such as polyphenols, flavonoids, terpenoids, alkaloids and several other constituents have direct and indirect roles in controlling such diseases; among them, abietane diterpenes have been reported to display a broad spectrum of promising biological activities including diabetes. This review aimed to summarize existing data from SciFinder (2005-2018) on the biological importance of abietane diterpenes in the prevention and management of type 2 diabetes and closely related diseases.

The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, IFNectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

Understanding the intricacies of multiphase flows is paramount to any drilling operation, and this has been under continuing and intensive development for the past decades. A major complexity associated with this operation is the uncertainty in the transport phenomena of generated cuttings as drilling progresses under different attainable configurations and fluid rheological conditions. Increased transport efficiency of drill cuttings in most drilling operations is usually characterised by an increased mud circulation velocity; this creates complex turbulent interactions between the solid and liquid phases. The study of the dispersion of these cuttings, in relation to their axial, tangential and slip velocity profiles in the annulus is carefully investigated in this work under steady and transient conditions. Computational Fluid Dynamics models (Eulerian–Eulerian, Lagrangian–Eulerian/Discrete Element Method) are utilised for this purpose. The implementation of the Eulerian–Eulerian model provides a macroscopic description of the distribution of fundamental flow properties such as pressure, volume fractions and velocities of each phase. Furthermore, a direct description of the particulate flow, inherent transient motion, interparticle and particle-wall collisions are obtained with the particle tracking functionality of the Lagrangian–Eulerian/DEM technique. The results obtained using the Eulerian–Eulerian model reveal that particle slip velocities are lowest at the central regions of the annulus with the effect of asymmetry due to inner pipe rotation being more pronounced along the longitudinal plane. Particle diameter has tremendous effects on the alteration of turbulence properties of the continuous phase with very distinct velocity profiles. Cuttings trajectory analysis show some extra phenomena which have been physically observed in available experimental studies; one of which is the occurrence of ejections of coherent structures at the walls of the flow domain. The difficulty of carrying out transient and steady state experimental measurements of particle velocities is an area where CFD shows great potential. The few available data in literature are well predicted with errors less than 11%. Similarly, fluid axial and tangential velocity predictions carried out, yield reasonably accurate results, thus further validating the CFD approach employed in this work.

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance.

Background: Chronic kidney disease (CKD) is one of the important complications of human immunodeficiency virus (HIV) infection. The prevalence of CKD in HIV-infected Nigerians at presentation is currently unknown. Materials and Methods: This was a comparative study of 400 antiretroviral drug naïve HIV-infected patients attending the HIV clinic of a teaching hospital in North Central Nigeria and 140 apparently healthy individuals. CKD was defined as estimated glomerular filtration rate (eGFR)

Backround: Secondary hyperparathyroidism (SHPT) is a manifestation of chronic kidney disease mineral bone disorder (CKD-MBD). SHPT is common in patients with chronic kidney disease (CKD) and is associated with significant morbidity and mortality. Methods: A cross- sectional descriptive study involving 230 patients with CKD. Results: The mean age of the study population was 44.17±15.24 years. The median intact parathyroid hormone and alkaline phosphatase levels were 96pg/ml (range 4-953pg/ml) and 88 iu/l (range 10-800 iu/l) respectively. The mean (with standard deviation) calcium, serum phosphate, calcium phosphate product and haemoglobin levels were 2.22±0.29mmol/l, 1.8±0.62mmol/l, 3.94±1.42mmol2/l2 and 9.90±1.87g/dl respectively. Majority of patients had advanced CKD with 70.3% of patients in stage G5. The prevalence rates of SHPT, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase and elevated calcium phosphate product were 55.2%, 34.8%, 66.1%, 42.2% and 25.2% respectively. Univariate analysis revealed that SHPT was associated with hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase, proteinuria, anaemia, hypertension, left ventricular hypertrophy and stage of kidney disease; being worse with advancing kidney disease. Independently associated with SHPT were hypocalcaemia (OR=4.84), hyperphosphataemia (OR=3.06), and elevated alkaline phosphatase (OR=2.04). Conclusion: The prevalence of SHPT in CKD is high, occurs early and is independently associated with hypocalcaemia, hyperphosphataemia and elevated alkaline phosphatase. The prevalence of SHPT also increases with worsening renal function. Keywords: Secondary hyperparathyroidism, chronic kidney disease, intact parathyroid hormone, hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase.

BACKGROUND AND AIMS We compared the clinical outcome of diabetic versus nondiabetic patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) in the GReek AntiPlatElet (GRAPE) registry. PATIENTS AND METHODS GRAPE is a prospective observational study, focusing on contemporary antiplatelet use in moderate-risk to high-risk ACS patients receiving PCI. Major adverse cardiovascular events (MACE), (composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) and bleeding events (Bleeding Academic Research Consortium definition) at 1 year of follow-up were analyzed using propensity score adjustment. A subanalysis according to diabetes mellitus (DM) status was performed. RESULTS Out of 2047 registered patients, 469 (22.9%) were diabetic. Complete 1-year follow-up was available in 95.1% of patients. MACE occurred in 12.2 and 7.2% of those patients with and without DM, respectively [adjusted hazard ratio (HR), 95% confidence interval (CI)=1.27 (0.89-1.79), P=0.2]. Observed BARC type ≥3 bleeding risk was not higher in diabetic patients: adjusted HR (95% CI)=1.20 (0.79-1.84). In the subgroup of clopidogrel-treated patients (N=238), MACE rate was significantly higher in diabetic compared with nondiabetic cohort [13.4 vs. 9%, adjusted HR (95% CI)=1.68 (1.07-2.64), P=0.03]. In the subgroup of ticagrelor-treated or prasugrel-treated patients (N=228), MACE rate did not differ significantly between diabetic and nondiabetic patients: 9.6 versus 5%, adjusted HR (95% CI)=1.35 (0.77-2.37), P=0.38. CONCLUSION In 'real-life' ACS undergoing PCI, diabetic patients have higher - although not significantly - MACE rate and no difference in bleeding events. This difference in MACE was significant among clopidogrel-treated patients, whereas when newer antiplatelet agents were used the negative impact of DM on ischemic events was eliminated.

Bioethanol is widely perceived as a clean fuel that can be used directly as automobile fuel or blended with petrol without engine modification. Similarly, biomethane can be used as an environmentally friendly substitute to natural gas for diverse applications such as transportation, heating, and electricity generation. Recently, there has been a growing interest in the cost-effective and sustainable production of both these biofuels. The present study reveals a conceptual design for biomethane and bioethanol production from crude glycerol obtained from the biodiesel industry. The techno-economic feasibility of three different scenarios was assessed. Scenario 1 is based on bioethanol production by coupling hydrothermal gasification and syngas fermentation. Scenario 2 consists of hydrothermal gasification, syngas fermentation, and CO2 capture unit. In scenario 3, biomethanation and electrolytic unit were added to scenario 2 to convert CO2 to biomethane. The energy efficiency of the scenarios examined ranges from 30.2% to 35.1%. Scenario 3 had the highest energy efficiency of 35.1%. Moreover, the minimum selling price of bioethanol declined in the following order: scenario 2 (USD $1.4 per liter) > scenario 1 (USD $1.32 per liter) > scenario 3 (USD $0.31 per liter). The discounted cash flow analysis results indicated that scenario 3 is the most profitable because of its non-discounted net present value of USD $34.9 million compared to the other case studies. Sensitivity analysis reveals that electricity and glycerol cost had the most effect on the minimum selling price of bioethanol.

Objective High serum erythropoietin (EPO) levels have been reported in adult patients with obstructive sleep apnea (OSA), however there is a lack of related literature in children with OSA. The main objective of this study was to explore the potential use of EPO as a pediatric OSA biomarker by exploring the relationship between serum EPO levels and the presence of pediatric OSA. Methods and materials A prospective study was conducted on children (4–12 years old) referred for overnight PSG. Thirty (30) consecutive children with mild. 30 consecutives with moderate, and 30 consecutives with severe OSA (OSA group), as well as 30 consecutive children with AHI≤1 (non-OSA group) were recruited. Morning blood specimens after PSG studies were obtained in order to compare EPO levels. Results Finally, 115 children included for analysis. Non-OSA group consisted of 29 children (mean age: 6.93 ± 2.10) and OSA-group of 86 children (mean age: 6.78 ± 2.53). Mean EPO values for the non-OSA and OSA groups were 5.46 ± 2.29 mIU/ml and 8.33 ± 4.10 mIU/ml respectively. OSA-group had significant higher EPO levels than non-OSA (P: 0.01) while EPO levels were significantly correlated with AHI (p Conclusion Our study showed that serum EPO levels of children with OSA are significantly higher than those without OSA and correlate significantly with AHI. These results suggest that EPO may be considered as a biomarker candidate for pediatric OSA. Since this may be the first study on the topic further research is needed.

Eosinophilic esophagitis is a chronic antigen-mediated disease characterized by esophageal symptoms, esophageal eosinophilia, and the absence of response to proton pump inhibitors. It is the most frequent cause of dysphagia and food impaction in adults. Its incidence and prevalence is very high in the developed countries (USA, Europe, Australia), where its connotation is that of an emerging epidemic. While studies have been published with large case series in the developed countries, those published in Latin America are small or consist of isolated case reports. The differences in the prevalence of the disease between the developed and developing regions are unknown. Genetic or racial causes have been cited. Nevertheless, the epidemic nature of the disease suggests that environmental causes are the most powerful.Based on the published hypotheses, as well as on epidemiologic studies, the present review discusses some of the possible causes of the disparity in the prevalence of eosinophilic esophagitis between the two types of countries. The âhygiene hypothesisâ is reviewed, together with the possible relation of Helicobacter pylori, intestinal parasites, and modifications of the esophageal microbiota in patients with eosinophilic esophagitis. In reference to studies conducted in the United States, the clinical behavior and progression of eosinophilic esophagitis in Hispanics is reviewed and a possible predominant phenotype in Mexican and other Latin American patients is discussed. Finally, based on the above, an algorithm for studying the disease in the Latin American countries is proposed. Resumen: La esofagitis eosinofílica (EEo) es una enfermedad crónica mediada por alérgenos, caracterizada por síntomas esofágicos, eosinofilia esofágica y ausencia de respuesta favorable a inhibidores de la bomba de protones (IBP). En los adultos es la causa más frecuente de disfagia e impactación alimentaria. Su incidencia y prevalencia son muy altas en los países desarrollados (EUA, Europa y Australia), en donde ha alcanzado una connotación de epidemia. Mientras que en los países desarrollados se publican estudios con grandes series de pacientes, en nuestro subcontinente se reporta en series con pocos casos o en casos aislados. Las causas de las diferencias de la prevalencia de la enfermedad entre ambas regiones se desconocen. Se han invocado causas genéticas o raciales. No obstante, el carácter epidémico de la enfermedad sugiere que las causas ambientales son más poderosas.Con base en hipótesis publicadas, así como en los estudios epidemiológicos, en la presente revisión se discutirán algunas de las posibles causas de la disparidad de prevalencia de la EEo entre ambos tipos de países. Se revisará la «hipótesis de la higiene», así como la posible relación del Helicobacter pylori, los parásitos intestinales y las modificaciones de la microbiota esofágica con la EEo. Con base en estudios realizados en EUA, se revisará el comportamiento clínico y evolutivo de la EEo en individuos hispanos y se discutirá acerca de un posible fenotipo predominante en los pacientes de América Latina y México. Finalmente, sobre la base anterior, se propondrá un algoritmo de estudio de la enfermedad en nuestros países. Keywords: Eosinophilic esophagitis, Prevalence, Esophageal eosinophilia, Helicobacter pylori, Palabras clave: Esofagitis eosinofílica, Prevalencia, Eosinofilia esofágica, Helicobacter pylori

In Uganda, artemether-lumefantrine was introduced as an artemisinin-based combination therapy (ACT) for malaria in 2006. We have previously reported a moderate decrease in ex vivo efficacy of lumefantrine in Northern Uganda, where we also detected ex vivo artemisinin-resistant Plasmodium falciparum. Therefore, it is necessary to search for candidate partner alternatives for ACT. Here, we investigated ex vivo susceptibility to four ACT partner drugs as well as quinine and chloroquine, in 321 cases between 2013 and 2018. Drug-resistant mutations in pfcrt and pfmdr1 were also determined. Ex vivo susceptibility to amodiaquine, quinine, and chloroquine was well preserved, whereas resistance to mefloquine was found in 45.8%. There were few cases of multi-drug resistance. Reduced sensitivity to mefloquine and lumefantrine was significantly associated with the pfcrt K76 wild-type allele, in contrast to the association between chloroquine resistance and the K76T allele. Pfmdr1 duplication was not detected in any of the cases. Amodiaquine, a widely used partner drug for ACT in African countries, may be the first promising alternative in case lumefantrine resistance emerges. Therapeutic use of mefloquine may not be recommended in this area. This study also emphasizes the need for sustained monitoring of antimalarial susceptibility in Northern Uganda to develop proper treatment strategies.

Objectives Effective antiretroviral therapy has prolonged the survival of patients with HIV. Accordingly, studies of the consequences of ageing are increasingly important. We determined the prevalence of early menopause (EM) and its associated factors in a cohort of HIV-infected and HIV-negative controls in Jos, Nigeria. Methods HIV-infected women accessing care in an ambulatory setting and their negative counterparts from the general population were included. Menopause was defined as having gone one year since the last menstrual period. EM was defined as the onset of menopause at ≤45 years of age. Baseline characteristics were compared and logistic regression analyses were used to determine factors independently associated with EM. Results Out of a total of 253 women included, 58 attained menopause early, giving an EM prevalence of 22.9% (95% confidence interval [CI] 17.9–28.6%). Women with EM were younger (P

Objective To describe the prevalence of female sexual dysfunction (FSD) and its determinants among women with HIV infection enrolled for care and treatment in an ambulatory care setting. Methods A questionnaire-based cross-sectional survey was conducted among women attending the HIV clinic of Jos University Teaching Hospital, Nigeria, between March 2013 and February 2014. The self-administered Female Sexual Function Index (FSFI) was used to assess FSD; a score of less than 26.55 indicated FSD. Pearson coefficient was used to assess interdomain correlation, and multiple linear regression was used to identify factors associated with FSD. Results Among 370 participants, 330 (89.2%, 95% confidence interval [CI] 85.6%-92.2%) had FSD. The overall median FSFI score was 19.2 (interquartile range [IQR] 6.4-23.9). The arousal domain had the lowest subscore (median 2.7, IQR 0.0-3.6). The highest interdomain correlations were between lubrication and orgasm (r=0.87), arousal and lubrication (r=0.84), and arousal and orgasm (r=0.81) domains. Satisfactory health (β=3.34, 95% CI 1.16-5.52) and history of alcohol use (β=2.38, 95% CI 0.28-4.47) were independently associated with FSD. Conclusion FSD was prevalent among women with HIV infection. Care providers need to routinely address FSD as part of a comprehensive care package in the study setting.

Background According to consensus recommendations, for diagnosis of eosinophilic esophagitis (EoE) is required the presence of esophageal symptoms, ˃ 15 eosinophils/high power field and unresponsiveness to proton pump inhibitors . Nevertheless, lack of consistency with these guidelines has been reported in recent publications. Aims To assess consistency with EoE diagnostic guidelines in the published studies on prevalence and also evaluate other clinical and methodological parameters. Methods A systematic review of the articles published between 2008-2015 on the prevalence of EoE in unselected adults was conducted. Consistency of studies with EoE diagnostic definition was judged as follows: completely consistent, if it included the 3 components of the diagnostic definition, partially consistent if it included two and non-consistent if it included one or none. Esophageal biopsy protocol differences and description of demographic, clinical, and endoscopic features of patients were determined. Results Twenty studies were included. Eight were performed in hospital setting and twelve in general population. Only 40% of studies were completely-consistent, 35% were partially-consistent and 25% were non-consistent with the EoE diagnostic definition guidelines. In 60% of studies a PPI trial was not administered to patients. Only 30% adhered to recommendations in esophageal biopsy protocol. The lack of description of the history of atopia and endoscopic characteristics was observed in many studies. Conclusions Non- consistency with all components of EoE diagnostic definition was observed in most published prevalence studies after the publication of the first consensus. Results of these studies might be interpreted taking into account this context.