Search results for: sudden cardiac death

Authors: Lukas Ded

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Studying the tissue structure and histogenesis in the natural, 3D context is challenging but highly beneficial process. Contrary to classical approach of the physical tissue sectioning and subsequent imaging, it enables to study the relationships of individual cellular and histological structures in their native context. Recent developments in the tissue clearing approaches and microscopic volume imaging/data processing enable the application of these methods also in the areas of developmental and reproductive biology. Here, using the CLARITY tissue procedure and 3D confocal volume imaging we optimized the protocol for clearing, staining and imaging of the mice seminiferous tubules isolated from the testes without cardiac perfusion procedure. Our approach enables the high magnification and fine resolution axial imaging of the whole diameter of the seminiferous tubules with possible unlimited lateral length imaging. Hence, the large continuous pieces of the seminiferous tubule can be scanned and digitally reconstructed for the study of the single tubule seminiferous stages using nuclear dyes. Furthermore, the application of the antibodies and various molecular dyes can be used for molecular labeling of individual cellular and subcellular structures and resulting 3D images can highly increase our understanding of the spatiotemporal aspects of the seminiferous tubules development and sperm ultrastructure formation. Finally, our newly developed algorithms for 3D data processing enable the massive parallel processing of the large amount of individual cell and tissue fluorescent signatures and building the robust spermatogenic models under physiological and pathological conditions.

Keywords: CLARITY, spermatogenesis, testis, tissue clearing, volume imaging

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Authors: Sahar Heidary

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Breast cancer is a main public common obstacle global. Additionally, it is the second top reason for tumor death across women. Considering breast cancer cure choices can aid private doctors in precaution for their patients through future cancer treatment. This article reviews usual management centered on stage, histology, and biomarkers. The growth of breast cancer is a multi-stage procedure including numerous cell kinds and its inhibition residues stimulating in the universe. Timely identification of breast cancer is one of the finest methods to stop this illness. Entirely chief therapeutic administrations mention screening mammography for women aged 40 years and older. Breast cancer metastasis interpretations for the mainstream of deaths from breast cancer. The discovery of breast cancer metastasis at the initial step is essential for managing and estimate of breast cancer development. Developing methods consuming the exploration of flowing cancer cells illustrate talented outcomes in forecasting and classifying the initial steps of breast cancer metastasis in patients. In public, mammography residues are the key screening implement though the efficiency of medical breast checks and self-checkup is less. Innovative screening methods are doubtful to exchange mammography in the close upcoming for screening the overall people.

Keywords: breast cancer, screening, metastasis, methods

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Authors: Mary Rosa Espinosa-Ochoa

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Some constructions appear suddenly in children’s speech and are productive from the beginning. These constructions are supported by others, previously acquired, with which they share semantic and pragmatic features. Thus, for example, the acquisition of the passive voice in German is supported by other constructions with which it shares the lexical verb sein (“to be”). This also occurs in Spanish, in the acquisition of the progressive aspectual periphrasis estar (“to be”) + verb root + -ndo (present participle), supported by locative constructions acquired earlier with the same verb. The periphrasis shares with the locative constructions not only the lexical verb estar, but also pragmatic relations. Both constructions can be used to answer the question ¿Dónde está? (“Where is he/she/it?”), whose answer could be either Está aquí (“He/she/it is here”) or Se está bañando (“He/she/it is taking a bath”).This study is a corpus-based analysis of two children (1;08-2;08) and the input directed to them: it proposes that the pragmatic and semantic support from previously-acquired constructions comes from the input, during interaction with others. This hypothesis is based on analysis of constructions with estar, whose use to express temporal change (which differentiates it from its counterpart ser [“to be”]), is given in variation sets, similar to those described by Küntay and Slobin (2002), that allow the child to perceive the change of place experienced by nouns that function as its grammatical subject. For example, at different points during a bath, the mother says: El jabón está aquí “The soap is here” (beginning of bath); five minutes later, the soap has moved, and the mother says el jabón está ahí “the soap is there”; the soap moves again later on and she says: el jabón está abajo de ti “the soap is under you”. “The soap” is the grammatical subject of all of these utterances. The Spanish verb + -ndo is a progressive phase aspect encoder of a dynamic state that generates a token. The verb + -ndo is also combined with verb estar to encode. It is proposed here that the phases experienced in interaction with the adult, in events related to the verb estar, allow a child to generate this dynamicity and token reading of the verb + -ndo. In this way, children begin to produce the periphrasis suddenly and productively, even though neither the periphrasis nor the verb + -ndo itself are frequent in adult speech.

Keywords: child language acquisition, input, variation sets, Spanish language

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Authors: S. B. Otieno, Were Fred, E. W. Kabiru, K. Waza

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Background: HIV/AIDS is leading to the loss of labor through sickness and subsequent death, this is leading to the neglect of farm and off-farm activities, with the subsequent loss of potential income and food security. The situation is sensitive to seasonal labour peaks in agriculture. This study was done to determine the impact of high HIV prevalence in farming systems and food security in Pala Bondo District, Kenya. Methods: In this study, 386 respondents were randomly chosen in Pala Sub-Location. The respondents and key informants were interviewed using structured questionnaire. The data were entered and analyzed using SPSS version 16. Results: It was established that majority of respondents (67%) were between 18 and 35 years {χ² = (1, N = 386) = 13.430, p = 0.000} (chimney effect). The study also established that 83.5% of respondents were married {χ² = (1, N= 370) = 166.277 p = 0.000} and predominant occupation being farming and fishing (61%), while 52.8% of farm labour was by hand, 26% by oxen, and 4.9% mechanized. 73.2% of respondents only farm 0.25 to 2 acres, 48% mentioned lack of labour in land preparation {χ² ((1,N = 321) = 113.146, p = 0.000), in planting {χ² (1, N = 321) = 29.28, p = 0.000}. Majority of respondents lack food from January to June, during which 93% buy food. Conclusion: The high HIV prevalence in Pala has affected the farm labour leading to food insecurity.

Keywords: food security, HIV, AIDS, labour

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Authors: Paul M. H. J. Roekaerts

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In recent years, it became clear that much intensive care (ICU) survivors develop a post-intensive care syndrome (PICS) consisting of psychiatric, cognitive and physical problems for a prolonged period after their ICU stay. Physical inactivity and delirium during the ICU stay are the main determinants of the post-ICU PICS. This presentation will focus on delirium, its epidemiology, prevalence, effect on outcome, risk factors and the current standard of care for managing delirium. Because ICU delirium is a predictor of prolonged length-of-stay in the ICU and of death, the use of a delirium prevention bundle (DPB) becomes mandatory in every ICU. In this presentation, a DPB bundle will be discussed consisting of six components: pain, sedation, sleep, sensory and intellectual stimulation, early mobilization, and hydration. For every of the six components, what to do and what not to do will be discussed. The author will present his own institutional policy on pharmacological and non-pharmacological interventions in the management of delirium. The component ‘early mobilization’ will be discussed more in detail, as this component is extremely important in the prevention of delirium as well as in the prevention of the PICS. The author will conclude his presentation with the remaining areas of uncertainties/work and research to be done.

Keywords: delirium, delirium prevention bundle, early mobilisation in intensive care (ICU), post-intensive care syndrome (PICS)

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Authors: Dinoo Kirthinanda, Sujani Wijeratne

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Pseudohyperkalaemia is a common benign in vitro phenomenon caused by the release of potassium ions (K+) from cells during specimen processing. Analysis of haemolysed blood samples for predominantly intracellular electrolytes may lead to re-investigation and potentially harmful interventions. We report a case of a 52-year male with myeloproliferative disease manifested as Polycythaemia Rubra Vera, Hypertension and hypertensive nephropathy with stage 3 chronic kidney disease admitted to Neuro-intensive care unit (NICU) with an intra-cerebral haemorrhage secondary to hypertensive bleed. His initial blood investigations showed hyperkalemia with serum K+ 6.2 mmol/L yet the bedside arterial blood gas analysis yielded K+ of 4.6 mmol/L. The patient was however given hyperkalemia regime twice based on venous electrolyte analysis. The discrepancy between the bedside electrolyte analysis using arterial blood and venous blood prompted further evaluation. The 12 lead Electrocardiogram showed U waves and sinus bradycardia corresponding to the serum K+ of 2.8 mmol/L on arterial blood gas analysis. Immediate K+ replacement ensured the patient did not develop life-threatening cardiac complications. Pseudohyperkalaemia may pose diagnostic challenges in the absence of detectable haemolysis and should be suspected in susceptible patients with normal Electrocardiogram and Glomerular Filtration Rate to avoid potentially life-threatening interventions. When in doubt, rapid analysis of arterial blood gas may be useful for accurate quantification of potassium.

Keywords: patient safety, pseudohyperkalaemia, haemolysis, myeloproliferative disorder

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Authors: Se-Hwa Park, En-Kyung Han, Jae-Young Lim, Hye-Jung Ahn

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Purpose: The objective of this study is to provide basic data for understanding the substance of inpatient life with CRPS (Complex Regional Pain Syndrome) and developing efficient and effective nursing intervention. Methods: From September 2018 to November, we have interviewed 10 CRPS patients about inpatient experiences. To understand the implication of inpatient life experiences with CRPS and intrinsic structure, we have used the question: 'How about the inpatient experiences with CRPS'. For data analysis, the method suggested by Colaizzi was applied as a phenomenological method. Results: According to the analysis, the study participants' inpatient life process was structured in six categories: (a) breakthrough pain experience (b) the limitation of pain treatment, (c) worsen factors of pain during inpatient period, (d) treat method for pain, (e) positive experience for inpatient period, (f) requirements for medical team, family and people in hospital room. Conclusion: Inpatient with CRPS have experienced the breakthrough pain. They had expected immediate treatment for breakthrough pain, but they experienced severe pain because immediate treatment was not implemented. Pain-worsening factors which patients with CRPS are as follows: personal factors from negative emotions such as insomnia, stress, sensitive character, pain part touch or vibration stimulus on the bed, physical factors from high threshold or rapid speed during fast transfer, conflict with other people, climate factors such as humidity or low temperature, noise, smell, lack of space because of many visitors. Patients actively manage the pain committing into another tasks or diversion. And also, patients passively manage the pain, just suppress, give-up. They think positively about rehabilitation treatment. And they require the understanding and sympathy for other people, and emotional support, immediate intervention for medical team. Based on the results of this study, we suppose the guideline of systematic breakthrough pain management for the relaxation of sudden pain, using notice of informing caution for touch or vibration. And we need to develop non-medicine pain management nursing intervention.

Keywords: breakthrough pain, CRPS, complex regional pain syndrome, inpatient life experiences, phenomenological method

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Authors: Bahar Tunctan, Sefika Pinar Kucukkavruk, Meryem Temiz-Resitoglu, Demet Sinem Guden, Ayse Nihal Sari, Seyhan Sahan-Firat, Mahesh P. Paudyal, John R. Falck, Kafait U. Malik

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We hypothesized that 20-hydroxyeicosatetraenoic acid (20-HETE) mimetics such as N-(20-hydroxyeicosa-5[Z],14[Z]-dienoyl)glycine (5,14-HEDGE) may be beneficial for preventing mortality due to inflammation induced by lipopolysaccharide (LPS). This study aims to assess the effect of 5,14-HEDGE on the LPS-induced changes in nucleotide binding domain and leucine-rich repeat protein 3 (NLRP3)/apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC)/pro-caspase-1 inflammasome. Rats were injected with saline (4 ml/kg) or LPS (10 mg/kg) at time 0. Blood pressure and heart rate were measured using a tail-cuff device. 5,14-HEDGE (30 mg/kg) was administered to rats 1 h after injection of saline or LPS. The rats were sacrificed 4 h after saline or LPS injection and kidney, heart, thoracic aorta, and superior mesenteric artery were isolated for measurement of caspase-1/11 p20, NLRP3, ASC, and β-actin proteins as well as interleukin-1β (IL-1β) levels. Blood pressure decreased by 33 mmHg and heart rate increased by 63 bpm in the LPS-treated rats. In the LPS-treated rats, tissue protein expression of caspase-1/11 p20, NLRP3, and ASC in addition to IL-1β levels were increased. 5,14-HEDGE prevented the LPS-induced changes. Our findings suggest that inhibition of renal, cardiac, and vascular formation/activity of NLRP3/ASC/pro-caspase-1 inflammasome involved in the protective effect of 5,14-HEDGE on LPS-induced septic shock in rats. This work was financially supported by the Mersin University (2015-AP3-1343) and USPHS NIH (PO1 HL034300).

Keywords: 5, 14-HEDGE, lipopolysaccharide, NLRP3, inflammasome, septic shock

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Authors: Abraham J. Rizkalla, Tristan D. Yan

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Purpose: Durable mitral valve repair is preferred to a replacement, avoiding the need for anticoagulation or re-intervention, with a reduced risk of endocarditis. Robotic mitral repair has been gaining favour globally as a safe, effective, and reproducible method of minimally invasive valve repair. In this work, we showcase the use of the Davinci© Xi robotic platform to perform several advanced techniques, working synergistically to achieve successful mitral repair in advanced mitral disease. Techniques: We present the case of a Barlow type mitral valve disease with a tall and redundant posterior leaflet resulting in severe mitral regurgitation and systolic anterior motion. Firstly, quadrangular resection of P2 is performed to remove the excess and redundant leaflet. Secondly, a sliding leaflet plasty of P1 and P3 is used to reconstruct the posterior leaflet. To anchor the newly formed posterior leaflet to the papillary muscle, CV-4 Goretex neochordae are fashioned using the innovative string, ruler, and bulldog technique. Finally, mitral valve annuloplasty and closure of a patent foramen ovale complete the repair. Results: There was no significant residual mitral regurgitation and complete resolution of the systolic anterior motion of the mitral valve on post operative transoesophageal echocardiography. Conclusion: This work highlights the robotic approach to complex repair techniques for advanced mitral valve disease. Familiarity with resection and sliding plasty, neochord implantation, and annuloplasty allows the modern cardiac surgeon to achieve a minimally-invasive and durable mitral valve repair when faced with complex mitral valve pathology.

Keywords: robotic mitral valve repair, Barlow's valve, sliding plasty, neochord, annuloplasty, quadrangular resection

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Authors: Kankurize Josiane, Nizigama Mediatrice

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Introduction: Burundi records a still high infant mortality rate. Despite efforts to reduce it, prematurity is still the leading cause of death in the neonatal period. The objective of this study was to assess the quality of care for premature babies hospitalized in the neonatology unit of the Centre Hospitalier Universitaire de Kamenge. Method: This was a descriptive and evaluative prospective carried out in the neonatology unit of the CHUK (Centre Hospitalier Universitaire de Kamenge) from December 1, 2016, to May 31, 2017, including 70 premature babies, 65 mothers of premature babies and 15 providers including a pediatrician and 14 nurses. Using a tool developed by the World Health Organization and adapted to the local context by national experts, the quality of care for premature babies was assessed. Results: Prematurity accounted for 44.05% of hospitalizations in neonatology at the University Hospital of Kamenge. The assessment of the quality of care for premature babies was of low quality, with an average global score of 2/5 (50%), indicating that there is a considerable need for improvement to reach the standards. Conclusion: Efforts must be made to have infrastructures, materials, and human resources sufficient in quality and quantity so that the neonatology unit of the CHUK can be efficient and optimize the care of premature babies.

Keywords: quality of care, evaluation, premature, standards

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Authors: B. M. Moda, L. F. Secco

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Through free and fair elections and others less democratic processes, Latin America has been gradually turning into a right-wing political region. In order to understand these recent changes, this paper aims to discuss the origin and the traits of the pink wave in the subcontinent, the reasons for its current rollback and future projections for left-wing in the region. The methodology used in this paper will be descriptive and analytical combined with secondary sources mainly from the social and political sciences fields. The canons of the Washington Consensus was implemented by the majority of the Latin American governments in the 80s and 90s under the social democratic and right-wing parties. The neoliberal agenda caused political, social and economic dissatisfaction bursting into a new political configuration for the region. It started in 1998 when Hugo Chávez took the office in Venezuela through the Fifth Republic Movement under the socialist flag. From there on, Latin America was swiped by the so-called ‘pink wave’, term adopted to define the rising of self-designated left-wing or center-left parties with a progressive agenda. After Venezuela, countries like Chile, Brazil, Argentina, Uruguay, Bolivia, Equator, Nicaragua, Paraguay, El Salvador and Peru got into the pink wave. The success of these governments was due a post-neoliberal agenda focused on cash transfers programs, increasing of public spending, and the straightening of national market. The discontinuation of the preference for the left-wing started in 2012 with the coup against Fernando Lugo in Paraguay. In 2015, the chavismo in Venezuela lost the majority of the legislative seats. In 2016, an impeachment removed the Brazilian president Dilma Rousself from office who was replaced by the center-right vice-president Michel Temer. In the same year, Mauricio Macri representing the right-wing party Proposta Republicana was elected in Argentina. In 2016 center-right and liberal, Pedro Pablo Kuczynski was elected in Peru. In 2017, Sebastián Piñera was elected in Chile through the center-right party Renovación Nacional. The pink wave current rollback points towards some findings that can be arranged in two fields. Economically, the 2008 financial crisis affected the majority of the Latin American countries and the left-wing economic policies along with the end of the raw materials boom and the subsequent shrinking of economic performance opened a flank for popular dissatisfaction. In Venezuela, the 2014 oil crisis reduced the revenues for the State in more than 50% dropping social spending, creating an inflationary spiral, and consequently loss of popular support. Politically, the death of Hugo Chavez in 2013 weakened the ‘socialism of the twenty first century’ ideal, which was followed by the death of Fidel Castro, the last bastion of communism in the subcontinent. In addition, several cases of corruption revealed during the pink wave governments made the traditional politics unpopular. These issues challenge the left-wing to develop a future agenda based on innovation of its economic program, improve its legal and political compliance practices, and to regroup its electoral forces amid the social movements that supported its ascension back in the early 2000s.

Keywords: Latin America, political parties, left-wing, right-wing, pink wave

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Authors: Wen-Yu Lin, Yi-Ching Chung, Tzyy-Rong Jinn

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It is well known that enterovirus 71 (EV71) causes recurring outbreaks of hand, foot and mouth disease (HFMD) and encephalitis leading to complications or death in young children. And, several HFMD of EV71 with high mortalities occurred in Asia countries, such as Malaysia (1997), Taiwan (1998) and China (2008). Thus, more effective antiviral drugs are needed to prevent or reduce EV71-related complications. As reported, interferon-α protects mice from lethal EV71 challenge by the modulation of innate immunity and then degrade enterovirus protease 3Cᵖʳᵒ. On the other side, pleconaril by targeting enterovirus VP1 protein and then block virus entry and attachment. Thus, the aim of this study was to evaluate the synergistic antiviral activity of interferon-α and pleconaril against enterovirus 71 infection. In a preliminary study showed that pleconaril at concentrations of 50, 100 and 300 µg/mL reduced EV71-induced CPE to 52.0 ± 2.5%, 40.2 ± 3.5% and 26.5 ± 1.5%, respectively, of that of the EV71-infected RD control cells (taken as 100%). Notably, 1000 IU/mL of interferon-α in combination with pleconaril at concentrations of 50, 100 and 300µg/mL suppressed EV71-induced CPE by 30.2 ± 3.8%, 16.5 ± 1.3% and 2.8 ± 2.0%, respectively, of that of the pleconaril alone treated with the infected RD cells. These results indicated that interferon-α 1000 IU/mL combination with pleconaril (50, 100 and 300µg/mL) inhibited EV71-induced CPE more effectively than treated with pleconaril alone in the infected RD cells.

Keywords: enterovirus 71, interferon-α, pleconaril, RD cells

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Authors: Yujie Zhang

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There are debates around the legitimacy of capital punishment, i.e., whether death could serve as a proper execution in our legal system or not. Different arguments have been raised. However, none of them seem able to provide a determined answer to the issue; this results in a lack of instruction in the legal practice. This article, therefore, devotes itself to the effort to find such an answer. It takes the perspective of rights, through interpreting the concept of right to life, which capital punishment appears to be in confliction with in the two traditional approaches, to reveal a possibly best account of the right and its conclusion on capital punishment. However, this effort is not a normative one which focuses on what ought to be. It means the article does not try to work out which argument we should choose and solve the hot debate on whether capital punishment should be allowed or not. It, again, does not propose which perspective we should take to approach this issue or generally which account of right must be better; rather, it is more a thought experiment. It attempts to raise a new perspective to approach the issue of the legitimacy of capital punishment. Both its perspective and conclusion therefore are tentative: what if we view this issue in a way we have never tried before, for example the different accounts of right to life? In this sense, the perspective could be defied, while the conclusion could be rejected. Other perspectives and conclusions are also possible. Notwithstanding, this tentative perspective and account of the right still could not be denied from serving as a potential approach, since it does have the ability to provide us with a determined attitude toward capital punishment that is hard to achieve through existing arguments.

Keywords: capital punishment, right to life, theories of rights, the choice theory

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Authors: Ni Luh Putu Harta Wedari

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Background: Clostridium difficile has two main virulence factors, namely TcdA and TcdB. TcdA encoded by the tcdA gene acts as an enterotoxin, pro-inflammatory and fluid accumulation, while TcdB encoded by the tcdB gene is cytotoxic, causes disruption of the actin cytoskeleton, and causes disruption of tight junctions in colon cells. This study aims to explore the relationship between the tcdA and tcdB genes and the duration of diarrhea in elderly patients. Method: This research was an observational analytic with a prospective cross-sectional with samples of elderly diarrhea patients who met the inclusion criteria in Denpasar City health service facilities from 1 December 2022 until 30 June 2023, and then their feces were analyzed using the real-time PCR method. Results: In this study, 40 elderly diarrhea patients met the inclusion criteria and in accordance with the minimum sample size, 28 (70%) men and 12 (30%) women. 5 patients (12.5%) had a history of azithromycin, 4 (10%) levofloxacin, 17 (42.5%) ciprofloxacin, 8 (20%) metronidazole, 1 (2.5%) cefoperazone, 5 (12, 5%) doxycycline. Comorbids, namely 13 (32.5%) type II diabetes mellitus, 4 (10%) chronic kidney disease, 10 (25%) malignancies, 7 (17.5%) urinary tract infections, 3 (7.5%) %) immunocompromised, 2 (5%) cardiac heart failure, and 1 (2.5%) acute on chronic kidney disease. The overall diarrhea duration average was 5 days. 8 samples (20%) were positive for 16s rRNA, and there was no significant difference in diarrhea duration with negative samples (p=0.166). The relationship between the tcdA gene and the duration of diarrhea could not be performed because all samples were negative. Likewise, relationship analysis between the coexistence of tcdA and tcdB could not be performed. There was no significant difference between tcdB positive 3 (7.5%) and negative with diarrhea duration (p=0.739). Conclusion: There is no significant relationship between the presence of the 16s rRNA and tcdB C. difficile genes with the duration of diarrhea in elderly patients.

Keywords: clostridium, difficile, diarrhea, elderly, tcdA, tcdB

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Authors: Rochelyn Dona, Serdar Satar

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The aim of this study was to evaluate the biological parameters of A. fabae Scopoli (Hemiptera: Aphididae). Developmental, survival, and reproductive data were collected for Aphis fabae reared on detached bean leaves (Phaseolus vulgaris L.) ‘pinto beans’ at five temperature regimes (12, 16, 20, 24, and 28 °C), 65% relative humidity (RH), relative and a photoperiod of 16:8 (LD) h. The developmental times of immature stages ranged from 16, 65 days at 12°C to 5.70 days at 24°C, but a slight increase again at 28°C (6.62 days). At 24°C from this study presented the developmental threshold for A. fabae slightly to 24°C. The average longevity of mature females significantly decreased from 42.32 days at 12°C to 16.12 days at 28°C. The reproduction rate per female was 62.27 at 16°C and 12.72 at 28°C. The mean generation period of the population ranged from 29.24 at 12°C to 11.50 at 28°C. The highest intrinsic rate of increase (rm = 0.41) were recorded at 24°C, the lowest at 12°C (rm = 0.15). It was evident that temperatures over 28°C augmented the development time, accelerated the death ratio of the nymphal stages, Shrunk Adult longevity, and reduced fecundity. The optimal range of temperature for the population growth of A. fabae on the bean was 16°C-24°C, according to this study.

Keywords: developmental time, intrinsic rate, reproduction period, temperature dependence

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Authors: Nisha Nandlal Sharma, Julaluk Carmai, Saiprasit Koetniyom, Bernd Markert

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Whiplash Injuries are usually associated with car accidents. The sudden forward or backward jerk to head causes neck strain, which is the result of damage to the muscle or tendons. Neck pain and headaches are the two most common symptoms of whiplash. Symptoms of whiplash are commonly reported in studies but the Injury mechanism is poorly understood. Neck muscles are the most important factor to study the neck Injury. This study focuses on the development of finite element (FE) model of human neck muscle to study the whiplash injury mechanism and effect of active muscle contraction on occupant kinematics. A detailed study of Injury mechanism will promote development and evaluation of new safety systems in cars, hence reducing the occurrence of severe injuries to the occupant. In present study, an active human finite element (FE) model with 3D neck muscle model is developed. Neck muscle was modeled with a combination of solid tetrahedral elements and 1D beam elements. Muscle active properties were represented by beam elements whereas, passive properties by solid tetrahedral elements. To generate muscular force according to inputted activation levels, Hill-type muscle model was applied to beam elements. To simulate non-linear passive properties of muscle, solid elements were modeled with rubber/foam material model. Material properties were assigned from published experimental tests. Some important muscles were then inserted into THUMS (Total Human Model for Safety) 50th percentile male pedestrian model. To reduce the simulation time required, THUMS lower body parts were not included. Posterior to muscle insertion, THUMS was given a boundary conditions similar to experimental tests. The model was exposed to 4g and 7g rear impacts as these load impacts are close to low speed impacts causing whiplash. The effect of muscle activation level on occupant kinematics during whiplash was analyzed.

Keywords: finite element model, muscle activation, neck muscle, whiplash injury prevention

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Authors: Yasir Bashawri, Vincent N. Chigor James McDonald, Merfyn Williams, Davey Jones, A. Prysor Williams

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Resistance to antibiotics has become a threat to public health. As a result of their misuse and overuse, bacteria have become resistant to many common antibiotics. Βeta lactam (β-lactam) antibiotics are one of the most significant classes of antimicrobials in providing therapeutic benefits for the treatment of bacterial infections in both human and veterinary medicine, for approximately 60% of all antibiotics are used. In particular, some Enterobacteriaceae produce Extend Spectrum Beta Lactamases (ESBLs) that enable them to some break down multi-groups of antibiotics. CTX-M enzymes have rapidly become the most important ESBLs, with increases in mainly CTX-M 15 in many countries during the last decade. Global travel by intercontinental medical ‘tourists’, migrant employees and overseas students could theoretically be a risk factor for spreading antibiotic resistance genes in different parts of the world. Bangor city, North Wales, is subject to sudden demographic changes due to a large proportion (>25%) of the population being students, most of which arrive over a space of days. This makes it a suitable location to study the impacts of large demographic change on the presence of ESBLs. The aim of this study is to monitor the presence of ESBLs in Escherichia coli and faecal coliform bacteria isolated from Bangor wastewater treatment plant, before, during and after the arrival week of students to Bangor University. Over a five-week period, water samples were collected twice a week, from the influent, primary sedimentation tank, aeration tank and the final effluent. Isolation and counts for Escherichia coli and other faecal coliforms were done on selective agar (primary UTI agar). ESBL presence will be confirmed by phenotypic and genotypic methods. Sampling at all points of the tertiary treatment stages will indicate the effectiveness of wastewater treatment in reducing the spread of ESBLs genes. The study will yield valuable information to help tackle a problem which many regard to be the one of the biggest threats to modern-day society.

Keywords: extended spectrum β-lactamase, enterobacteriaceae, international travel, wastewater treatment plant

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Authors: Austin Jiang, Richard M. Salmon, Nicholas W. Morrell, Wei Li

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BMP10 is highly expressed in the developing heart and plays essential roles in cardiogenesis. BMP10 deletion in mice results in embryonic lethality due to impaired cardiac development. In adults, BMP10 expression is restricted to the right atrium, though ventricular hypertrophy is accompanied by increased BMP10 expression in a rat hypertension model. However, reports of BMP10 activity in the circulation are inconclusive. In particular it is not known whether in vivo secreted BMP10 is active or whether additional factors are required to achieve its bioactivity. It has been shown that high-affinity binding of the BMP10 prodomain to the mature ligand inhibits BMP10 signaling activity in C2C12 cells, and it was proposed that prodomain-bound BMP10 (pBMP10) complex is latent. In this study, we demonstrated that the BMP10 prodomain did not inhibit BMP10 signaling activity in multiple endothelial cells, and that recombinant human pBMP10 complex, expressed in mammalian cells and purified under native conditions, was fully active. In addition, both BMP10 in human plasma and BMP10 secreted from the mouse right atrium were fully active. Finally, we confirmed that active BMP10 secreted from mouse right atrium was in the prodomain-bound form. Our data suggest that circulating BMP10 in adults is fully active and that the reported vascular quiescence function of BMP10 in vivo is due to the direct activity of pBMP10 and does not require an additional activation step. Moreover, being an active ligand, recombinant pBMP10 may have therapeutic potential as an endothelial-selective BMP ligand, in conditions characterized by loss of BMP9/10 signaling.

Keywords: bone morphogenetic protein 10 (BMP10), endothelial cell, signal transduction, transforming growth factor beta (TGF-B)

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Authors: Parag Katira, Frederika Rentzeperis, Zuzanna Nowicka, Giada Fiandaca, Thomas Veith, Jack Farinhas, Noemi Andor

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Resource limitations shape the outcome of competitions between genetically heterogeneous pre-malignant cells. One example of such heterogeneity is in the ploidy (DNA content) of pre-malignant cells. A whole-genome duplication (WGD) transforms a diploid cell into a tetraploid one and has been detected in 28-56% of human cancers. If a tetraploid subclone expands, it consistently does so early in tumor evolution, when cell density is still low, and competition for nutrients is comparatively weak – an observation confirmed for several tumor types. WGD+ cells need more resources to synthesize increasing amounts of DNA, RNA, and proteins. To quantify resource limitations and how they relate to ploidy, we performed a PAN cancer analysis of WGD, PET/CT, and MRI scans. Segmentation of >20 different organs from >900 PET/CT scans were performed with MOOSE. We observed a strong correlation between organ-wide population-average estimates of Oxygen and the average ploidy of cancers growing in the respective organ (Pearson R = 0.66; P= 0.001). In-vitro experiments using near-diploid and near-tetraploid lineages derived from a breast cancer cell line supported the hypothesis that DNA content influences Glucose- and Oxygen-dependent proliferation-, death- and migration rates. To model how subpopulations with variable DNA content compete in the resource-limited environment of the human brain, we developed a stochastic state-space model of the brain (S3MB). The model discretizes the brain into voxels, whereby the state of each voxel is defined by 8+ variables that are updated over time: stiffness, Oxygen, phosphate, glucose, vasculature, dead cells, migrating cells and proliferating cells of various DNA content, and treat conditions such as radiotherapy and chemotherapy. Well-established Fokker-Planck partial differential equations govern the distribution of resources and cells across voxels. We applied S3MB on sequencing and imaging data obtained from a primary GBM patient. We performed whole genome sequencing (WGS) of four surgical specimens collected during the 1ˢᵗ and 2ⁿᵈ surgeries of the GBM and used HATCHET to quantify its clonal composition and how it changes between the two surgeries. HATCHET identified two aneuploid subpopulations of ploidy 1.98 and 2.29, respectively. The low-ploidy clone was dominant at the time of the first surgery and became even more dominant upon recurrence. MRI images were available before and after each surgery and registered to MNI space. The S3MB domain was initiated from 4mm³ voxels of the MNI space. T1 post and T2 flair scan acquired after the 1ˢᵗ surgery informed tumor cell densities per voxel. Magnetic Resonance Elastography scans and PET/CT scans informed stiffness and Glucose access per voxel. We performed a parameter search to recapitulate the GBM’s tumor cell density and ploidy composition before the 2ⁿᵈ surgery. Results suggest that the high-ploidy subpopulation had a higher Glucose-dependent proliferation rate (0.70 vs. 0.49), but a lower Glucose-dependent death rate (0.47 vs. 1.42). These differences resulted in spatial differences in the distribution of the two subpopulations. Our results contribute to a better understanding of how genomics and microenvironments interact to shape cell fate decisions and could help pave the way to therapeutic strategies that mimic prognostically favorable environments.

Keywords: tumor evolution, intra-tumor heterogeneity, whole-genome doubling, mathematical modeling

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Authors: Belyayev P. E., Makeyeva I. R., Mastyuk D. A., Pigasov E. E.

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Previously, the phrase ”hydrogen safety” was often used in terms of NPP safety. Due to the rise of interest to “green” and, particularly, hydrogen power engineering, the problem of hydrogen safety at industrial facilities has become ever more urgent. In Russia, the industrial production of hydrogen is meant to be performed by placing a chemical engineering plant near NPP, which supplies the plant with the necessary energy. In this approach, the production of hydrogen involves a wide range of combustible gases, such as methane, carbon monoxide, and hydrogen itself. Considering probable incidents, sudden combustible gas outburst into open space with further ignition is less dangerous by itself than ignition of the combustible mixture in the presence of many pipelines, reactor vessels, and any kind of fitting frames. Even ignition of 2100 cubic meters of the hydrogen-air mixture in open space gives velocity and pressure that are much lesser than velocity and pressure in Chapman-Jouguet condition and do not exceed 80 m/s and 6 kPa accordingly. However, the space blockage, the significant change of channel diameter on the way of flame propagation, and the presence of gas suspension lead to significant deflagration acceleration and to its transition into detonation or quasi-detonation. At the same time, process parameters acquired from the experiments at specific experimental facilities are not general, and their application to different facilities can only have a conventional and qualitative character. Yet, conducting deflagration and detonation experimental investigation for each specific industrial facility project in order to determine safe infrastructure unit placement does not seem feasible due to its high cost and hazard, while the conduction of numerical experiments is significantly cheaper and safer. Hence, the development of a numerical method that allows the description of reacting flows in domains with complex geometry seems promising. The base for this method is the modification of Kuropatenko method for calculating shock waves recently developed by authors, which allows using it in Eulerian coordinates. The current work contains the results of the development process. In addition, the comparison of numerical simulation results and experimental series with flame propagation in shock tubes with orifice plates is presented.

Keywords: CFD, reacting flow, DDT, gas explosion

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Authors: Anastasiia Kuptsevych, Robert J. Johnson, Olena Antonaccio, Ekaterina V. Botchkovar

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Ukraine has recently experienced one of the bloodiest conflicts taking place on the European continent. Many active duty personnel and civilians have died, and millions of people have been displaced. This situation can lead to disorder in the country characterized by acceptance of violence and crime. There is a gap in the literature addressing the issues related to attitudes towards violence resulting from war, as well as focusing on the world’s more vulnerable civilian populations – those that live in lower and middle-income countries, such as Ukraine. Using a random sample of 1200 adults from two major Ukrainian cities, this study explores the relationship between different types of war exposure (direct and vicarious) and attitudes to violence. Multivariate models reveal that multiple types of war exposure (e.g., being injured, being a witness of death, watching war events on TV) are significantly associated with the attitudes to political and interpersonal violence. In addition, the KHB decomposition procedure showed that experiencing certain mental illnesses serve as important mediating mechanisms between war exposure and attitudes towards violence. Finally, in order to prevent society from disorder and high levels of violence, future studies need to pay more attention to exploring how vital and traumatic life events can lead a population to find violent acts acceptable.

Keywords: attitudes, Ukraine, violence, war

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Authors: Espinoza S. Clara, Gamarra Q. Flor, Marianela F. Ramos Quispe S. Miguel, Flores R. Omar

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Tropaeolum majus L. is a native plant to South and Central America, used since ancient times by our ancestors to combat different diseases. Glucotropaeolonin is one of its main components, which when hydrolyzed, forms benzyl isothiocyanate (BIT) that promotes cellular apoptosis (programmed cell death in cancer cells). Therefore, the present research aims to evaluate the effect of the pressure and temperature of BIT extraction by supercritical CO₂ from Tropaeolum majus L. The extraction was carried out in a supercritical fluid extractor equipment Speed SFE BASIC Brand: Poly science, the leaves of Tropaeolum majus L. were ground for one hour and lyophilized until obtaining a humidity of 6%. The extraction with supercritical CO₂ was carried out with pressures of 200 bar and 300 bar, temperatures of 50°C, 60°C and 70°C, obtained by the conjugation of these six treatments. BIT was identified by thin layer chromatography using 98% BIT as the standard, and as the mobile phase hexane: dichloromethane (4:2). Subsequently, BIT quantification was performed by high performance liquid chromatography (HPLC). The highest yield of oleoresin by supercritical CO₂ extraction was obtained pressure 300 bar and temperature at 60°C; and the higher content of BIT at pressure 200 bar and 70°C for 30 minutes to obtain 113.615 ± 0.03 mg BIT/100 g dry matter was obtained.

Keywords: solvent extraction, Tropaeolum majus L., supercritical fluids, benzyl isothiocyanate

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Authors: P. S. Jagadeesh Kumar, Yang Yung, Mingmin Pan, Xianpei Li, Wenli Hu

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Glaucoma is impelled by optic nerve mutilation habitually represented as cupping and visual field injury frequently with an arcuate pattern of mid-peripheral loss, subordinate to retinal ganglion cell damage and death. Glaucoma is the second foremost cause of blindness and the chief cause of permanent blindness worldwide. Consequently, all-embracing study into the analysis and empathy of glaucoma is happening to escort deep learning based neural network intrusions to deliberate this substantial optic neuropathy. This paper advances an ophthalmic hashing based supervision of glaucoma and corneal disorders preeminent on deep graphical model. Ophthalmic hashing is a newly proposed method extending the efficacy of visual hash-coding to predict glaucoma corneal disorder matching, which is the faster than the existing methods. Deep graphical model is proficient of learning interior explications of corneal disorders in satisfactory time to solve hard combinatoric incongruities using deep Boltzmann machines.

Keywords: corneal disorders, deep Boltzmann machines, deep graphical model, glaucoma, neural networks, ophthalmic hashing

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Authors: Mahnoor Khan, Bashir Ahmad, Khizar Hayat, Saad Ahmad Khan, Laiba Ahmad, Shumaila Bashir, Abid Ali Khan

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The objective of this study was to synthesize the smallest possible size of ZnO NPs using a modified wet chemical synthesis method and to prepare core shell using polyethylene glycol (PEG) as shell material. Advanced and sophisticated techniques were used to confirm the synthesis, size, and shape of these NPs. Rounded, clustered NPs of size 5.343 nm were formed. Both the plain and core shell NPs were tested against MDR bacteria (E. cloacae, E. amnigenus, Shigella, S. odorifacae, Citrobacter, and E. coli). Both of the NPs showed excellent antibacterial properties, whereas E. cloacae showed maximum zone of inhibition of 16 mm, 27 mm, and 32 mm for 500 μg/ml, 1000 μg/ml, and 1500 μg/ml, respectively for plain ZnO NPs and 18 mm, 28 mm and 35 mm for 500 μg/ml, 1000 μg/ml and 1500 μg/ml for core shell NPs. These NPs were also biocompatible on human red blood cells showing little hemolysis of only 4% for 70 μg/ml for plain NPs and 1.5% for 70 μg/ml for core shell NPs. Core shell NPs were highly biocompatible because of the PEG. Their therapeutic effect as photosensitizers in photodynamic therapy (PDT) for cancer treatment was also monitored. The cytotoxicity of ZnO and PEG-ZnO was evaluated using MTT assay. Our results demonstrated that these NPs could generate ROS inside tumor cells after irradiation which in turn initiates an apoptotic pathway leading to cell death hence proving to be an effective candidate for PDT.

Keywords: ZnO, hemolysis, cytotoxiciy assay, photodynamic therapy, antibacterial

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Authors: Tania M. Guerrero, Ileana Cortes Santiago

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Estamos Unidos Asylum Project has served more than 2,000 asylum seekers and migrants who are under the Migrant Protection Protocols (MPP) policy in Ciudad Juarez, Mexico. The U.S. policy, implemented in January 2019, has stripped asylum seekers of their rights—forcing people fleeing violence and discrimination to wait in similar or worse conditions from which they fled and navigate their entire asylum process in a different country. Several civil rights groups, including the American Civil Liberties Union (ACLU), challenged MPP in U.S. federal courts in February 2019, arguing a violation of international U.S. obligations towards refugees and asylum-seekers under the 1951 Refugee Convention and the Refugee Act of 1980 in regards to the non-refoulement principle. MPP has influenced Mexico's policies, enforcement, and prioritization of the presence of asylum seekers and migrants; it has also altered the way international non-governmental organizations work at the Mexican Northern border. Estamos Unidos is a project situated in a logistical conundrum, as it provides needed legal services to a population in a legal and humanitarian void, i.e., a liminal space. The liminal space occupied by asylum seekers living under MPP is one that, in today's world, should not be overlooked; it dilutes asylum law and U.S. commitments to international protections. This paper provides analysis of and broader implications from a project whose main goal is to uphold the protections of asylum seekers and international refugee law. The authors identified and analyzed four critical points based on field work conducted since August 2019: (1) strategic coalition building with international, local, and national organizations; (2) brokering between domestic and international contexts and critical legal constraints; (3) flexibility to sudden policy changes and the diverse needs of the multiethnic groups of migrants and asylum seekers served by the project; and (4) the complexity of providing legal assistance to asylum seekers who are survivors of trauma. The authors concur with scholarship when highlighting the erosion of protections of asylum seekers and migrants as a dangerous and unjust global phenomenon.

Keywords: asylum, human rights, migrant protection protocols, refugees law

Procedia PDF Downloads 133

Authors: C. E. Ihejirika, M. I. Nwachukwu, R. F. Njoku-Tony, O. C. Ihejirika, U. O. Enwereuzoh, E. O. Imo, D. C. Ashiegbu

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Disposal of industrial solid wastes in the environment is a major environmental challenge. This study investigated the effects of calcium carbide waste dumpsites on soil quality. Soil samples were collected with hand auger from three different dumpsites at varying depths and made into composite samples. Samples were subjected to standard analytical procedures. pH varied from 10.38 to 8.28, nitrate from 5.6mg/kg to 9.3mg/kg, phosphate from 8.8mg/kg to 12.3mg/kg, calcium carbide reduced from 10% to to 3%. Calcium carbide was absent in control soil samples. Bacterial counts from dumpsites ranged from 1.8 x 105cfu/g - 2.5 x 105cfu/g while fungal ranged from 0.8 x 103cfu/g - 1.4 x 103cfu/g. Bacterial isolates included Pseudomonas spp, Flavobacterium spp, and Achromobacter spp, while fungal isolates include Penicillium notatum, Aspergillus niger, and Rhizopus stolonifer. No organism was isolated from the dumpsites at soil depth of 0-15 cm, while there were isolates from other soil depths. Toxicity might be due to alkaline condition of the dumpsite. Calcium carbide might be bactericidal and fungicidal leading to cellular physiology, growth retardation, death, general loss of biodiversity and reduction of ecosystem processes. Detoxification of calcium carbide waste before disposal on soil might be the best option in management.

Keywords: biodiversity, calcium-carbide, denitrification, toxicity

Procedia PDF Downloads 547

Authors: Woraprat Amnuaychaichana

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Several medicinal plants are well known to contain active constituents such as flavonoids and phenolic compounds with are plausible candidates for therapeutic purposes. An infectious disease caused by microbial infection is the leading cause of death. Antibiotics are typically used to eradicate these microbes, but recent evidence indicates that they are developing antibiotic-resistant effects. This study focused on antimicrobial activities of Phyllanthus emblica and Gracilaria fisheri using the agar disk diffusion method and broth microdilution to determine the minimum inhibitory concentration (MIC) value. The extracts were screened against Staphylococcus aureus. Five concentrations of plant extracts were used to determine the minimum inhibitory concentration (MIC) by 2-fold dilution of plant extract. The results indicated that G. fisheri extract gave the maximum zones of inhibition of 11.7 mm against S. aureus while P. emblica showed no effects. The MIC values of G. fisheri extract against S. aureus was 500 µg/ml. To summarise, G. fisheri extracts demonstrated high efficacy of antibacterial activity against Gram-positive S. aureus, which may pave the way for developing a formulation containing this plant. G. fisheri extract should be subjected to additional investigation in order to determine the mechanism of action of its antimicrobial activity.

Keywords: antibacterial activity, Staphylococcus aureus, gracilaria fishery, Phyllanthus emblica

Procedia PDF Downloads 189

Authors: Siva Chander Chabattula, Piyush Kumar Gupta, Debashis Chakraborty, Rama Shanker Verma

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Green nanoparticles have gotten a lot of attention because of their potential applications in tissue regeneration, bioimaging, wound healing, and cancer therapy. The physical and chemical methods to synthesize metal oxide nanoparticles have an environmental impact, necessitating the development of an environmentally friendly green strategy for nanoparticle synthesis. In this study, we used Annona muricata plant leaf extract to synthesize Zinc Oxide nanoparticles (Am-ZnO NPs), which were evaluated using UV/Visible spectroscopy, FTIR spectroscopy, X-Ray Diffraction, DLS, and Zeta potential. Nanoparticles had an optical absorbance of 355 nm and a net negative surface charge of ~ - 2.59 mV. Transmission Electron Microscope characterizes the Shape and size of the nanoparticles. The obtained Am-ZnO NPs are biocompatible and hemocompatible in nature. These nanoparticles caused an anti-cancer therapeutic effect in MIA PaCa2 and MOLT4 cancer cells by inducing oxidative stress, and a change in mitochondrial membrane potential leads to programmed cell death. Further, we observed a reduction in the size of lung cancer spheroids (act as tumor micro-environment) with doxorubicin as a positive control.

Keywords: Biomaterials, nanoparticle, anticancer activity, ZnO nanoparticles

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Authors: O. Ojeda Mena, Y. Cressault, P. Teulet, J. P. Gonnet, D. F. N. Santos, MD. Cunha, M. S. Benilov

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The assumption of plasma in local thermal equilibrium (LTE) is commonly used to perform electric arc simulations for industrial applications. This assumption allows to model the arc using a set of magneto-hydromagnetic equations that can be solved with a computational fluid dynamic code. However, the LTE description is only valid in the arc column, whereas in the regions close to the electrodes the plasma deviates from the LTE state. The importance of these near-electrode regions is non-trivial since they define the energy and current transfer between the arc and the electrodes. Therefore, any accurate modelling of the arc must include a good description of the arc-electrode phenomena. Due to the modelling complexity and computational cost of solving the near-electrode layers, a simplified description of the arc-electrode interaction was developed in a previous work to study a steady high-pressure arc discharge, where the near-electrode regions are introduced at the interface between arc and electrode as boundary conditions. The present work proposes a similar approach to simulate the arc ignition in a free-burning arc configuration following an LTE description of the plasma. To obtain the transient evolution of the arc characteristics, appropriate boundary conditions for both the near-cathode and the near-anode regions are used based on recent publications. The arc-cathode interaction is modeled using a non-linear surface heating approach considering the secondary electron emission. On the other hand, the interaction between the arc and the anode is taken into account by means of the heating voltage approach. From the numerical modelling, three main stages can be identified during the arc ignition. Initially, a glow discharge is observed, where the cold non-thermionic cathode is uniformly heated at its surface and the near-cathode voltage drop is in the order of a few hundred volts. Next, a spot with high temperature is formed at the cathode tip followed by a sudden decrease of the near-cathode voltage drop, marking the glow-to-arc discharge transition. During this stage, the LTE plasma also presents an important increase of the temperature in the region adjacent to the hot spot. Finally, the near-cathode voltage drop stabilizes at a few volts and both the electrode and plasma temperatures reach the steady solution. The results after some seconds are similar to those presented for thermionic cathodes.

Keywords: arc-electrode interaction, thermal plasmas, electric arc simulation, cold electrodes

Procedia PDF Downloads 122

Authors: Marina Nosik, Irina Rymanova, Konstantin Ryzhov, Joan Yarovaya, Alexander Sobkin

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Tuberculosis (TB) associated with HIV is one of the top causes of death worldwide. However, early detection and treatment of TB in HIV-infected individuals significantly reduces the risk of developing severe forms of TB and mortality. The goal of the study was to analyze the peculiarities of TB associated with HIV infection. Over the period of 2015-2016 a retrospective cohort study was conducted among 377 patients with TB/HIV co-infection who attended the Moscow Tuberculosis Clinic. The majority of the patients was male (64,5%). The median age was: men 37,9 (24÷62) and women 35,4 (22÷72) years. The most prevalent age group was 30-39 years both for men and women (73,3% and 54,7%, respectively). The ratio of patients in age group 50-59 and senior was 3,9%. Socioeconomic status of patients was rather low: only 2.3% of patients had a university degree; 76,1% was unemployed (of whom 21,7% were disabled). Most patients had disseminated pulmonary tuberculosis in the phase of infiltration/ decay (41,5%). The infiltrative TB was detected in 18,9% of patients; 20,1% patients had tuberculosis of intrathoracic lymph nodes. The occurrence of MDR-TB was 16,8% and XDR-TB – 17,9%. The number of HIV-positive patients with newly diagnosed TB was n=261(69,2%). The active TB-form (MbT+) among new TB/HIV cases was 44,7 %. The severe clinical forms of TB and a high TB incidence rate among HIV-infected individuals alongside with a large number of cases of newly diagnosed tuberculosis, indicate the need for more intense interaction with TB services for timely diagnosis of TB which will optimize treatment outcomes.

Keywords: HIV, tuberculosis (TB), TB associated with HIV, multidrug-resistant TB (MDR-TB)

Procedia PDF Downloads 243