Search results for: latent tuberculosis
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 586

Search results for: latent tuberculosis

376 Application of Latent Class Analysis and Self-Organizing Maps for the Prediction of Treatment Outcomes for Chronic Fatigue Syndrome

Authors: Ben Clapperton, Daniel Stahl, Kimberley Goldsmith, Trudie Chalder

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Chronic fatigue syndrome (CFS) is a condition characterised by chronic disabling fatigue and other symptoms that currently can't be explained by any underlying medical condition. Although clinical trials support the effectiveness of cognitive behaviour therapy (CBT), the success rate for individual patients is modest. Patients vary in their response and little is known which factors predict or moderate treatment outcomes. The aim of the project is to develop a prediction model from baseline characteristics of patients, such as demographics, clinical and psychological variables, which may predict likely treatment outcome and provide guidance for clinical decision making and help clinicians to recommend the best treatment. The project is aimed at identifying subgroups of patients with similar baseline characteristics that are predictive of treatment effects using modern cluster analyses and data mining machine learning algorithms. The characteristics of these groups will then be used to inform the types of individuals who benefit from a specific treatment. In addition, results will provide a better understanding of for whom the treatment works. The suitability of different clustering methods to identify subgroups and their response to different treatments of CFS patients is compared.

Keywords: chronic fatigue syndrome, latent class analysis, prediction modelling, self-organizing maps

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375 Latent Heat Storage Using Phase Change Materials

Authors: Debashree Ghosh, Preethi Sridhar, Shloka Atul Dhavle

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The judicious and economic consumption of energy for sustainable growth and development is nowadays a thing of primary importance; Phase Change Materials (PCM) provide an ingenious option of storing energy in the form of Latent Heat. Energy storing mechanism incorporating phase change material increases the efficiency of the process by minimizing the difference between supply and demand; PCM heat exchangers are used to storing the heat or non-convectional energy within the PCM as the heat of fusion. The experimental study evaluates the effect of thermo-physical properties, variation in inlet temperature, and flow rate on charging period of a coiled heat exchanger. Secondly, a numerical study is performed on a PCM double pipe heat exchanger packed with two different PCMs, namely, RT50 and Fatty Acid, in the annular region. In this work, the simulation of charging of paraffin wax (RT50) using water as high-temperature fluid (HTF) is performed. Commercial software Ansys-Fluent 15 is used for simulation, and hence charging of PCM is studied. In the Enthalpy-porosity model, a single momentum equation is applicable to describe the motion of both solid and liquid phases. The details of the progress of phase change with time are presented through the contours of melt-fraction, temperature. The velocity contour is shown to describe the motion of the liquid phase. The experimental study revealed that paraffin wax melts with almost the same temperature variation at the two Intermediate positions. Fatty acid, on the other hand, melts faster owing to greater thermal conductivity and low melting temperature. It was also observed that an increase in flow rate leads to a reduction in the charging period. The numerical study also supports some of the observations found in the experimental study like the significant dependence of driving force on the process of melting. The numerical study also clarifies the melting pattern of the PCM, which cannot be observed in the experimental study.

Keywords: latent heat storage, charging period, discharging period, coiled heat exchanger

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374 Application of Gamma Frailty Model in Survival of Liver Cirrhosis Patients

Authors: Elnaz Saeedi, Jamileh Abolaghasemi, Mohsen Nasiri Tousi, Saeedeh Khosravi

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Goals and Objectives: A typical analysis of survival data involves the modeling of time-to-event data, such as the time till death. A frailty model is a random effect model for time-to-event data, where the random effect has a multiplicative influence on the baseline hazard function. This article aims to investigate the use of gamma frailty model with concomitant variable in order to individualize the prognostic factors that influence the liver cirrhosis patients’ survival times. Methods: During the one-year study period (May 2008-May 2009), data have been used from the recorded information of patients with liver cirrhosis who were scheduled for liver transplantation and were followed up for at least seven years in Imam Khomeini Hospital in Iran. In order to determine the effective factors for cirrhotic patients’ survival in the presence of latent variables, the gamma frailty distribution has been applied. In this article, it was considering the parametric model, such as Exponential and Weibull distributions for survival time. Data analysis is performed using R software, and the error level of 0.05 was considered for all tests. Results: 305 patients with liver cirrhosis including 180 (59%) men and 125 (41%) women were studied. The age average of patients was 39.8 years. At the end of the study, 82 (26%) patients died, among them 48 (58%) were men and 34 (42%) women. The main cause of liver cirrhosis was found hepatitis 'B' with 23%, followed by cryptogenic with 22.6% were identified as the second factor. Generally, 7-year’s survival was 28.44 months, for dead patients and for censoring was 19.33 and 31.79 months, respectively. Using multi-parametric survival models of progressive and regressive, Exponential and Weibull models with regard to the gamma frailty distribution were fitted to the cirrhosis data. In both models, factors including, age, bilirubin serum, albumin serum, and encephalopathy had a significant effect on survival time of cirrhotic patients. Conclusion: To investigate the effective factors for the time of patients’ death with liver cirrhosis in the presence of latent variables, gamma frailty model with parametric distributions seems desirable.

Keywords: frailty model, latent variables, liver cirrhosis, parametric distribution

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373 Diagnostic Delays and Treatment Dilemmas: A Case of Drug-Resistant HIV and Tuberculosis

Authors: Christi Jackson, Chuka Onaga

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Introduction: We report a case of delayed diagnosis of extra-pulmonary INH-mono-resistant Tuberculosis (TB) in a South African patient with drug-resistant HIV. Case Presentation: A 36-year old male was initiated on 1st line (NNRTI-based) anti-retroviral therapy (ART) in September 2009 and switched to 2nd line (PI-based) ART in 2011, according to local guidelines. He was following up at the outpatient wellness unit of a public hospital, where he was diagnosed with Protease Inhibitor resistant HIV in March 2016. He had an HIV viral load (HIVVL) of 737000 copies/mL, CD4-count of 10 cells/µL and presented with complaints of productive cough, weight loss, chronic diarrhoea and a septic buttock wound. Several investigations were done on sputum, stool and pus samples but all were negative for TB. The patient was treated with antibiotics and the cough and the buttock wound improved. He was subsequently started on a 3rd-line ART regimen of Darunavir, Ritonavir, Etravirine, Raltegravir, Tenofovir and Emtricitabine in May 2016. He continued losing weight, became too weak to stand unsupported and started complaining of abdominal pain. Further investigations were done in September 2016, including a urine specimen for Line Probe Assay (LPA), which showed M. tuberculosis sensitive to Rifampicin but resistant to INH. A lymph node biopsy also showed histological confirmation of TB. Management and outcome: He was started on Rifabutin, Pyrazinamide and Ethambutol in September 2016, and Etravirine was discontinued. After 6 months on ART and 2 months on TB treatment, his HIVVL had dropped to 286 copies/mL, CD4 improved to 179 cells/µL and he showed clinical improvement. Pharmacy supply of his individualised drugs was unreliable and presented some challenges to continuity of treatment. He successfully completed his treatment in June 2017 while still maintaining virological suppression. Discussion: Several laboratory-related factors delayed the diagnosis of TB, including the unavailability of urine-lipoarabinomannan (LAM) and urine-GeneXpert (GXP) tests at this facility. Once the diagnosis was made, it presented a treatment dilemma due to the expected drug-drug interactions between his 3rd-line ART regimen and his INH-resistant TB regimen, and specialist input was required. Conclusion: TB is more difficult to diagnose in patients with severe immunosuppression, therefore additional tests like urine-LAM and urine-GXP can be helpful in expediting the diagnosis in these cases. Patients with non-standard drug regimens should always be discussed with a specialist in order to avoid potentially harmful drug-drug interactions.

Keywords: drug-resistance, HIV, line probe assay, tuberculosis

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372 Role of Toll Like Receptor-2 in Female Genital Tuberculosis Disease Infection and Its Severity

Authors: Swati Gautam, Salman Akhtar, S. P. Jaiswar, Amita Jain

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Background: FGTB is now a major global health problem mostly in developing countries including India. In humans, Mycobacterium Tuberculosis (M.tb) is a causating agent of infection. High index of suspicion is required for early diagnosis due to asymptomatic presentation of FGTB disease. In macrophages Toll Like Receptor-2 (TLR-2) is one which mediated host’s immune response to M.tb. The expression of TLR-2 on macrophages is important to determine the fate of innate immune responses to M.tb. TLR-2 have two work. First its high expression on macrophages worsen the outer of infection and another side, it maintains M.tb to its dormant stage avoids activation of M.tb from latent phase. Single Nucleotide Polymorphism (SNP) of TLR-2 gene plays an important role in susceptibility to TB among different populations and subsequently, in the development of infertility. Methodology: This Case-Control study was done in the Department of Obs and Gynae and Department of Microbiology at King George’s Medical University, U.P, Lucknow, India. Total 300 subjects (150 Cases and 150 Controls) were enrolled in the study. All subjects were enrolled only after fulfilling the given inclusion and exclusion criteria. Inclusion criteria: Age 20-35 years, menstrual-irregularities, positive on Acid-Fast Bacilli (AFB), TB-PCR, (LJ/MGIT) culture in Endometrial Aspiration (EA). Exclusion criteria: Koch’s active, on ATT, PCOS, and Endometriosis fibroid women, positive on Gonococal and Chlamydia. Blood samples were collected in EDTA tubes from cases and healthy control women (HCW) and genomic DNA extraction was carried out by salting-out method. Genotyping of TLR2 genetic variants (Arg753Gln and Arg677Trp) were performed by using single amplification refractory mutation system (ARMS) PCR technique. PCR products were analyzed by electrophoresis on 1.2% agarose gel and visualized by gel-doc. Statistical analysis of the data was performed using the SPSS 16.3 software and computing odds ratio (OR) with 95% CI. Linkage Disequiliribium (LD) analysis was done by SNP stats online software. Results: In TLR-2 (Arg753Gln) polymorphism significant risk of FGTB observed with GG homozygous mutant genotype (OR=13, CI=0.71-237.7, p=0.05), AG heterozygous mutant genotype (OR=13.7, CI=0.76-248.06, p=0.03) however, G allele (OR=1.09, CI=0.78-1.52, p=0.67) individually was not associated with FGTB. In TLR-2 (Arg677Trp) polymorphism a significant risk of FGTB observed with TT homozygous mutant genotype (OR= 0.020, CI=0.001-0.341, p < 0.001), CT heterozygous mutant genotype (OR=0.53, CI=0.33-0.86, p=0.014) and T allele (OR=0.463, CI=0.32-0.66, p < 0.001). TT mutant genotype was only found in FGTB cases and frequency of CT heterozygous more in control group as compared to FGTB group. So, CT genotype worked as protective mutation for FGTB susceptibility group. In haplotype analysis of TLR-2 genetic variants, four possible combinations, i.e. (G-T, A-C, G-C, and A-T) were obtained. The frequency of haplotype A-C was significantly higher in FGTB cases (0.32). Control group did not show A-C haplotype and only found in FGTB cases. Conclusion: In conclusion, study showed a significant association with both genetic variants of TLR-2 of FGTB disease. Moreover, the presence of specific associated genotype/alleles suggest the possibility of disease severity and clinical approach aimed to prevent extensive damage by disease and also helpful for early detection of disease.

Keywords: ARMS, EDTA, FGTB, TLR

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371 A Longitudinal Study of Psychological Capital, Parent-Child Relationships, and Subjective Well-Beings in Economically Disadvantaged Adolescents

Authors: Chang Li-Yu

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Purposes: The present research focuses on exploring the latent growth model of psychological capital in disadvantaged adolescents and assessing its relationship with subjective well-being. Methods: Longitudinal study design was utilized and the data was from Taiwan Database of Children and Youth in Poverty (TDCYP), using the student questionnaires from 2009, 2011, and 2013. Data analysis was conducted using both univariate and multivariate latent growth curve models. Results: This study finds that: (1) The initial state and growth rate of individual factors such as parent-child relationships, psychological capital, and subjective wellbeing in economically disadvantaged adolescents have a predictive impact; (2) There are positive interactive effects in the development among factors like parentchild relationships, psychological capital, and subjective well-being in economically disadvantaged adolescents; and (3) The initial state and growth rate of parent-child relationships and psychological capital in economically disadvantaged adolescents positively affect the initial state and growth rate of their subjective well-being. Recommendations: Based on these findings, this study concretely discusses the significance of psychological capital and family cohesion for the mental health of economically disadvantaged youth and offers suggestions for counseling, psychological therapy, and future research.

Keywords: economically disadvantaged adolescents, psychological capital, parent-child relationships, subjective well-beings

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370 Alcohols as a Phase Change Material with Excellent Thermal Storage Properties in Buildings

Authors: Dehong Li, Yuchen Chen, Alireza Kaboorani, Denis Rodrigue, Xiaodong (Alice) Wang

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Utilizing solar energy for thermal energy storage has emerged as an appealing option for lowering the amount of energy that is consumed by buildings. Due to their high heat storage density, and non-corrosive and non-polluting properties, alcohols can be a good alternative to petroleum-derived paraffin phase change materials (PCMs). In this paper, ternary eutectic PCMs with suitable phase change temperatures were designed and prepared using lauryl alcohol (LA), cetyl alcohol (CA), stearyl alcohol (SA), and xylitol (X). The differential scanning calorimetry (DSC) results revealed that the phase change temperatures of LA-CA-SA, LA-CA-X, and LA-SA-X were 20.52°C, 20.37°C, and 22.18°C, respectively. The latent heat of phase change of the ternary eutectic PCMs was all stronger than that of the paraffinic PCMs at roughly the same temperature. The highest latent heat was 195 J/g. It had good thermal energy storage capacity. The preparation mechanism was investigated using Fourier-transform Infrared Spectroscopy (FTIR), and it was found that the ternary eutectic PCMs were only physically mixed among the components. Ternary eutectic PCMs had a simple preparation process, suitable phase change temperature, and high energy storage density. They are suitable for low-temperature architectural packaging applications.

Keywords: thermal energy storage, buildings, phase change materials, alcohols

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369 Zinc Oxide Nanoparticle-Doped Poly (8-Anilino-1-Napthalene Sulphonic Acid/Nat Nanobiosensors for TB Drugs

Authors: Rachel Fanelwa Ajayi, Anovuyo Jonnas, Emmanuel I. Iwuoha

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Tuberculosis (TB) is an infectious disease caused by the bacterium (Mycobacterium tuberculosis) which has a predilection for lung tissue due to its rich oxygen supply. The mycobacterial cell has a unique innate characteristic which allows it to resist human immune systems and drug treatments; hence, it is one of the most difficult of all bacterial infections to treat, let alone to cure. At the same time, multi-drug resistance TB (MDR-TB) caused by poorly managed TB treatment, is a growing problem and requires the administration of expensive and less effective second line drugs which take much longer treatment duration than fist line drugs. Therefore, to acknowledge the issues of patients falling ill as a result of inappropriate dosing of treatment and inadequate treatment administration, a device with a fast response time coupled with enhanced performance and increased sensitivity is essential. This study involved the synthesis of electroactive platforms for application in the development of nano-biosensors suitable for the appropriate dosing of clinically diagnosed patients by promptly quantifying the levels of the TB drug; Isonaizid. These nano-biosensors systems were developed on gold surfaces using the enzyme N-acetyletransferase 2 coupled to the cysteamine modified poly(8-anilino-1-napthalene sulphonic acid)/zinc oxide nanocomposites. The morphology of ZnO nanoparticles, PANSA/ZnO nano-composite and nano-biosensors platforms were characterized using High-Resolution Transmission Electron Microscopy (HRTEM) and High-Resolution Scanning Electron Microscopy (HRSEM). On the other hand, the elemental composition of the developed nanocomposites and nano-biosensors were studied using Fourier Transform Infra-Red Spectroscopy (FTIR) and Energy Dispersive X-Ray (EDX). The electrochemical studies showed an increase in electron conductivity for the PANSA/ZnO nanocomposite which was an indication that it was suitable as a platform towards biosensor development.

Keywords: N-acetyletransferase 2, isonaizid, tuberculosis, zinc oxide

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368 The Effect of Internal Electrical Ion Mobility on Molten Salts through Atomistic Simulations

Authors: Carlos F. Sanz-Navarro, Sonia Fereres

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Binary and ternary mixtures of molten salts are excellent thermal energy storage systems and have been widely used in commercial tanks both in nuclear and solar thermal applications. However, the energy density of the commercially used mixtures is still insufficient, and therefore, new systems based on latent heat storage (or phase change materials, PCM) are currently being investigated. In order to shed some light on the macroscopic physical properties of the molten salt phases, knowledge of the microscopic structure and dynamics is required. Several molecular dynamics (MD) simulations have been performed to model the thermal behavior of (Li,K)2CO3 mixtures. Up to this date, this particular molten salt mixture has not been extensively studied but it is of fundamental interest for understanding the behavior of other commercial salts. Molten salt diffusivities, the internal electrical ion mobility, and the physical properties of the solid-liquid phase transition have been calculated and compared to available data from literature. The effect of anion polarization and the application of a strong external electric field have also been investigated. The influence of electrical ion mobility on local composition is explained through the Chemla effect, well known in electrochemistry. These results open a new way to design optimal high temperature energy storage materials.

Keywords: atomistic simulations, thermal storage, latent heat, molten salt, ion mobility

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367 A Joinpoint Regression Analysis of Trends in Tuberculosis Notifications in Two Urban Regions in Namibia

Authors: Anna M. N. Shifotoka, Richard Walker, Katie Haighton, Richard McNally

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An analysis of trends in Case Notification Rates (CNR) can be used to monitor the impact of Tuberculosis (TB) control interventions over time in order to inform the implementation of current and future TB interventions. A retrospective analysis of trends in TB CNR for two urban regions in Namibia, namely Khomas and Erongo regions, was conducted. TB case notification data were obtained from annual TB reports of the national TB programme, Ministry of Health and Social Services, covering the period from 1997 to 2015. Joinpoint regression was used to analyse trends in CNR for different types of TB groups. A trend was considered to be statistically significant when a p-value was less than 0.05. During the period under review, the crude CNR for all forms of TB declined from 808 to 400 per 100 000 population in Khomas, and from 1051 to 611 per 100 000 population in Erongo. In both regions, significant change points in trends were observed for all types of TB groups examined. In Khomas region, the trend for new smear positive pulmonary TB increased significantly by an annual rate of 4.1% (95% Confidence Interval (CI): 0.3% to 8.2%) during the period 1997 to 2004, and thereafter declined significantly by -6.2% (95%CI: -7.7% to -4.3%) per year until 2015. Similarly, the trend for smear negative pulmonary TB increased significantly by 23.7% (95%CI: 9.7 to 39.5) per year from 1997 to 2004 and thereafter declined significantly by an annual change of -26.4% (95%CI: -33.1% to -19.8%). The trend for all forms of TB CNR in Khomas region increased significantly by 8.1% (95%CI: 3.7 to 12.7) per year from 1997 to 2004 and thereafter declined significantly a rate of -8.7% (95%CI: -10.6 to -6.8). In Erongo region, the trend for smear positive pulmonary TB increased at a rate of 1.2% (95%CI: -1.2% to 3.6%) annually during the earlier years (1997 to 2008), and thereafter declined significantly by -9.3% (95%CI: -13.3% to -5.0%) per year from 2008 to 2015. Also in Erongo, the trend for all forms of TB CNR increased significantly by an annual rate of 4.0% (95%CI: 1.4% to 6.6%) during the years between 1997 to 2006 and thereafter declined significantly by -10.4% (95%CI: -12.7% to -8.0%) per year during 2006 to 2015. The trend for extra-pulmonary TB CNR declined but did not reach statistical significance in both regions. In conclusion, CNRs declined for all types of TB examined in both regions. Further research is needed to study trends for other TB dimensions such as treatment outcomes and notification of drug resistant TB cases.

Keywords: epidemiology, Namibia, temporal trends, tuberculosis

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366 Exploring Public Opinions Toward the Use of Generative Artificial Intelligence Chatbot in Higher Education: An Insight from Topic Modelling and Sentiment Analysis

Authors: Samer Muthana Sarsam, Abdul Samad Shibghatullah, Chit Su Mon, Abd Aziz Alias, Hosam Al-Samarraie

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Generative Artificial Intelligence chatbots (GAI chatbots) have emerged as promising tools in various domains, including higher education. However, their specific role within the educational context and the level of legal support for their implementation remain unclear. Therefore, this study aims to investigate the role of Bard, a newly developed GAI chatbot, in higher education. To achieve this objective, English tweets were collected from Twitter's free streaming Application Programming Interface (API). The Latent Dirichlet Allocation (LDA) algorithm was applied to extract latent topics from the collected tweets. User sentiments, including disgust, surprise, sadness, anger, fear, joy, anticipation, and trust, as well as positive and negative sentiments, were extracted using the NRC Affect Intensity Lexicon and SentiStrength tools. This study explored the benefits, challenges, and future implications of integrating GAI chatbots in higher education. The findings shed light on the potential power of such tools, exemplified by Bard, in enhancing the learning process and providing support to students throughout their educational journey.

Keywords: generative artificial intelligence chatbots, bard, higher education, topic modelling, sentiment analysis

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365 Designing Automated Embedded Assessment to Assess Student Learning in a 3D Educational Video Game

Authors: Mehmet Oren, Susan Pedersen, Sevket C. Cetin

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Despite the frequently criticized disadvantages of the traditional used paper and pencil assessment, it is the most frequently used method in our schools. Although assessments do an acceptable measurement, they are not capable of measuring all the aspects and the richness of learning and knowledge. Also, many assessments used in schools decontextualize the assessment from the learning, and they focus on learners’ standing on a particular topic but do not concentrate on how student learning changes over time. For these reasons, many scholars advocate that using simulations and games (S&G) as a tool for assessment has significant potentials to overcome the problems in traditionally used methods. S&G can benefit from the change in technology and provide a contextualized medium for assessment and teaching. Furthermore, S&G can serve as an instructional tool rather than a method to test students’ learning at a particular time point. To investigate the potentials of using educational games as an assessment and teaching tool, this study presents the implementation and the validation of an automated embedded assessment (AEA), which can constantly monitor student learning in the game and assess their performance without intervening their learning. The experiment was conducted on an undergraduate level engineering course (Digital Circuit Design) with 99 participant students over a period of five weeks in Spring 2016 school semester. The purpose of this research study is to examine if the proposed method of AEA is valid to assess student learning in a 3D Educational game and present the implementation steps. To address this question, this study inspects three aspects of the AEA for the validation. First, the evidence-centered design model was used to lay out the design and measurement steps of the assessment. Then, a confirmatory factor analysis was conducted to test if the assessment can measure the targeted latent constructs. Finally, the scores of the assessment were compared with an external measure (a validated test measuring student learning on digital circuit design) to evaluate the convergent validity of the assessment. The results of the confirmatory factor analysis showed that the fit of the model with three latent factors with one higher order factor was acceptable (RMSEA < 0.00, CFI =1, TLI=1.013, WRMR=0.390). All of the observed variables significantly loaded to the latent factors in the latent factor model. In the second analysis, a multiple regression analysis was used to test if the external measure significantly predicts students’ performance in the game. The results of the regression indicated the two predictors explained 36.3% of the variance (R2=.36, F(2,96)=27.42.56, p<.00). It was found that students’ posttest scores significantly predicted game performance (β = .60, p < .000). The statistical results of the analyses show that the AEA can distinctly measure three major components of the digital circuit design course. It was aimed that this study can help researchers understand how to design an AEA, and showcase an implementation by providing an example methodology to validate this type of assessment.

Keywords: educational video games, automated embedded assessment, assessment validation, game-based assessment, assessment design

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364 Unbranched, Saturated, Carboxylic Esters as Phase-Change Materials

Authors: Anastasia Stamatiou, Melissa Obermeyer, Ludger J. Fischer, Philipp Schuetz, Jörg Worlitschek

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This study evaluates unbranched, saturated carboxylic esters with respect to their suitability to be used as storage media for latent heat storage applications. Important thermophysical properties are gathered both by means of literature research as well as by experimental measurements. Additionally, esters are critically evaluated against other common phase-change materials in terms of their environmental impact and their economic potential. The experimental investigations are performed for eleven selected ester samples with a focus on the determination of their melting temperature and their enthalpy of fusion using differential scanning calorimetry. Transient Hot Bridge was used to determine the thermal conductivity of the liquid samples while thermogravimetric analysis was employed for the evaluation of the 5% weight loss temperature as well as of the decomposition temperature of the non-volatile samples. Both experimental results and literature data reveal the high potential of esters as phase-change materials. Their good thermal and environmental properties as well as the possibility for production from natural sources (e.g. vegetable oils) render esters as very promising for future storage applications. A particularly high short term application potential of esters could lie in low temperature storage applications where the main alternative is using salt hydrates as phase-change material.

Keywords: esters, phase-change materials, thermal properties, latent heat storage

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363 Analysis of the Annual Proficiency Testing Procedure for Intermediate Reference Laboratories Conducted by the National Reference Laboratory from 2013 to 2017

Authors: Reena K., Mamatha H. G., Somshekarayya, P. Kumar

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Objectives: The annual proficiency testing of intermediate reference laboratories is conducted by the National Reference Laboratory (NRL) to assess the efficiency of the laboratories to correctly identify Mycobacterium tuberculosis and to determine its drug susceptibility pattern. The proficiency testing results from 2013 to 2017 were analyzed to determine laboratories that were consistent in reporting quality results and those that had difficulty in doing so. Methods: A panel of twenty cultures were sent out to each of these laboratories. The laboratories were expected to grow the cultures in their own laboratories, set up drug susceptibly testing by all the methods they were certified for and report the results within the stipulated time period. The turnaround time for reporting results, specificity, sensitivity positive and negative predictive values and efficiency of the laboratory in identifying the cultures were analyzed. Results: Most of the laboratories had reported their results within the stipulated time period. However, there was enormous delay in reporting results from few of the laboratories. This was mainly due to improper functioning of the biosafety level III laboratory. Only 40% of the laboratories had 100% efficiency in solid culture using Lowenstein Jensen medium. This was expected as a solid culture, and drug susceptibility testing is not used for diagnosing drug resistance. Rapid molecular methods such as Line probe assay and Genexpert are used to determine drug resistance. Automated liquid culture system such as the Mycobacterial growth indicator tube is used to determine prognosis of the patient while on treatment. It was observed that 90% of the laboratories had achieved 100% in the liquid culture method. Almost all laboratories had achieved 100% efficiency in the line probe assay method which is the method of choice for determining drug-resistant tuberculosis. Conclusion: Since the liquid culture and line probe assay technologies are routinely used for the detection of drug-resistant tuberculosis the laboratories exhibited higher level of efficiency as compared to solid culture and drug susceptibility testing which are rarely used. The infrastructure of the laboratory should be maintained properly so that samples can be processed safely and results could be declared on time.

Keywords: annual proficiency testing, drug susceptibility testing, intermediate reference laboratory, national reference laboratory

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362 Analysis of Anti-Tuberculosis Immune Response Induced in Lungs by Intranasal Immunization with Mycobacterium indicus pranii

Authors: Ananya Gupta, Sangeeta Bhaskar

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Mycobacterium indicus pranii (MIP) is a saprophytic mycobacterium. It is a predecessor of M. avium complex (MAC). Whole genome analysis and growth kinetics studies have placed MIP in between pathogenic and non-pathogenic species. It shares significant antigenic repertoire with M. tuberculosis and have unique immunomodulatory properties. MIP provides better protection than BCG against pulmonary tuberculosis in animal models. Immunization with MIP by aerosol route provides significantly higher protection as compared to immunization by subcutaneous (s.c.) route. However, mechanism behind differential protection has not been studied. In this study, using mice model we have evaluated and compared the M.tb specific immune response in lung compartments (airway lumen / lung interstitium) as well as spleen following MIP immunization via nasal (i.n.) and s.c. route. MIP i.n. vaccination resulted in increased seeding of memory T cells (CD4+ and CD8+ T-cells) in the airway lumen. Frequency of CD4+ T cells expressing Th1 migratory marker (CXCR3) and activation marker (CD69) were also high in airway lumen of MIP i.n. group. Significantly high ex vivo secretion of cytokines- IFN-, IL-12, IL-17 and TNF- from cells of airway luminal spaces provides evidence of antigen-specific lung immune response, besides generating systemic immunity comparable to MIP s.c. group. Analysis of T cell response on per cell basis revealed that antigen specific T-cells of MIP i.n. group were functionally superior as higher percentage of these cells simultaneously secreted IFN-gamma, IL-2 and TNF-alpha cytokines as compared to MIP s.c. group. T-cells secreting more than one of the cytokines simultaneously are believed to have robust effector response and crucial for protection, compared with single cytokine secreting T-cells. Adoptive transfer of airway luminal T-cells from MIP i.n. group into trachea of naive B6 mice revealed that MIP induced CD8 T-cells play crucial role in providing long term protection. Thus the study demonstrates that MIP intranasal vaccination induces M.tb specific memory T-cells in the airway lumen that results in an early and robust recall response against M.tb infection.

Keywords: airway lumen, Mycobacterium indicus pranii, Th1 migratory markers, vaccination

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361 Nontuberculous Mycobacterium Infection – Still An Important Disease Among People With Late HIV Diagnosis

Authors: Jakub Młoźniak, Adam Szymański, Gabriela Stondzik, Dagny Krankowska, Tomasz Mikuła

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Nontuberculous mycobacteria (NTM) are bacterial species that cause diversely manifesting diseases mainly in immunocompromised patients. In people with HIV, NTM infection is an AIDS-defining disease and usually appears when the lymphocyte T CD4 count is below 50 cells/μl. The usage of antiretroviral therapy has decreased the prevalence of NTM among people with HIV, but the disease can still be observed especially among patients with late HIV diagnosis. Common presence in environment, human colonization, clinical similarity with tuberculosis and slow growth on culture makes NTM especially hard to diagnose. The study aimed to analyze the epidemiology and clinical course of NTM among patients with HIV. This study included patients with NTM and HIV admitted to our department between 2017 and 2023. Medical records of patients were analyzed and data on age, sex, median time from HIV diagnosis to identification of NTM infection, median CD4 count at NTM diagnosis, methods of determining NTM infection, type of species of mycobacteria identified, clinical symptoms and treatment course were gathered. Twenty-four patients (20 men, 4 women) with identified NTM were included in this study. Among them, 20 were HIV late presenters. The patients' median age was 40. The main symptoms which patients presented were fever, weight loss and cough. Pulmonary disease confirmed with positive cultures from sputum/bronchoalveolar lavage was present in 18 patients. M. avium was the most common species identified. M. marinum caused disseminated skin lesions in 1 patient. Out of all, 5 people were not treated for NTM caused by lack of symptoms and suspicion of colonization with mycobacterium. Concomitant tuberculosis was present in 6 patients. The median diagnostic time from HIV to NTM infections was 3.5 months. The median CD4 count at NTM identification was 69.5 cells/μl. Median NTM treatment time was 16 months but 7 patients haven’t finished their treatment yet. The most commonly used medications were ethambutol and clarithromycin. Among analyzed patients, 4 of them have died. NTM infections are still an important disease among patients who are HIV late presenters. This disease should be taken into consideration during the differential diagnosis of fever, weight loss and cough in people with HIV with lymphocyte T CD4 count <100 cells/μl. Presence of tuberculosis does not exclude nontuberculous mycobacterium coinfection.

Keywords: mycobacteriosis, HIV, late presenter, epidemiology

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360 Synthesis, Crystallography and Anti-TB Activity of Substituted Benzothiazole Analogues

Authors: Katharigatta N. Venugopala, Melendhran Pillay, Bander E. Al-Dhubiab

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Tuberculosis (TB) infection is caused mainly by Mycobacterium tuberculosis (MTB) and it is one of the most threatening and wide spread infectious diseases in the world. Benzothiazole derivatives are found to have diverse chemical reactivity and broad spectrum of pharmacological activity. Some of the important pharmacological activities shown by the benzothiazole analogues are antitumor, anti-inflammatory, antimicrobial, anti-tubercular, anti-leishmanial, anticonvulsant and anti-HIV properties. Keeping all these facts in mind in the present investigation it was envisaged to synthesize a series of novel {2-(benzo[d]-thiazol-2-yl-methoxy)-substitutedaryl}-(substitutedaryl)-methanones (4a-f) and characterize by IR, NMR (1H and 13C), HRMS and single crystal x-ray studies. The title compounds are investigated for in vitro anti-tubercular activity against two TB strains such as H37Rv (ATCC 25177) and MDR-MTB (multi drug resistant MTB resistant to Isoniazid, Rifampicin and Ethambutol) by agar diffusion method. Among the synthesized compounds in the series, test compound {2-(benzo[d]thiazol-2-yl-methoxy)-5-fluorophenyl}-(4-chlorophenyl)-methanone (2c) was found to exhibit significant activity with MICs of 1 µg/mL and 2 µg/mL against H37Rv and MDR-MTB, respectively when compared to standard drugs. Single crystal x-ray studies was used to study intra and intermolecular interactions, including polymorphism behavior of the test compounds, but none of the compounds exhibited polymorphism behavior.

Keywords: benzothiazole analogues, characterization, crystallography, anti-TB activity

Procedia PDF Downloads 281
359 Modeling Visual Memorability Assessment with Autoencoders Reveals Characteristics of Memorable Images

Authors: Elham Bagheri, Yalda Mohsenzadeh

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Image memorability refers to the phenomenon where certain images are more likely to be remembered by humans than others. It is a quantifiable and intrinsic attribute of an image. Understanding how visual perception and memory interact is important in both cognitive science and artificial intelligence. It reveals the complex processes that support human cognition and helps to improve machine learning algorithms by mimicking the brain's efficient data processing and storage mechanisms. To explore the computational underpinnings of image memorability, this study examines the relationship between an image's reconstruction error, distinctiveness in latent space, and its memorability score. A trained autoencoder is used to replicate human-like memorability assessment inspired by the visual memory game employed in memorability estimations. This study leverages a VGG-based autoencoder that is pre-trained on the vast ImageNet dataset, enabling it to recognize patterns and features that are common to a wide and diverse range of images. An empirical analysis is conducted using the MemCat dataset, which includes 10,000 images from five broad categories: animals, sports, food, landscapes, and vehicles, along with their corresponding memorability scores. The memorability score assigned to each image represents the probability of that image being remembered by participants after a single exposure. The autoencoder is finetuned for one epoch with a batch size of one, attempting to create a scenario similar to human memorability experiments where memorability is quantified by the likelihood of an image being remembered after being seen only once. The reconstruction error, which is quantified as the difference between the original and reconstructed images, serves as a measure of how well the autoencoder has learned to represent the data. The reconstruction error of each image, the error reduction, and its distinctiveness in latent space are calculated and correlated with the memorability score. Distinctiveness is measured as the Euclidean distance between each image's latent representation and its nearest neighbor within the autoencoder's latent space. Different structural and perceptual loss functions are considered to quantify the reconstruction error. The results indicate that there is a strong correlation between the reconstruction error and the distinctiveness of images and their memorability scores. This suggests that images with more unique distinct features that challenge the autoencoder's compressive capacities are inherently more memorable. There is also a negative correlation between the reduction in reconstruction error compared to the autoencoder pre-trained on ImageNet, which suggests that highly memorable images are harder to reconstruct, probably due to having features that are more difficult to learn by the autoencoder. These insights suggest a new pathway for evaluating image memorability, which could potentially impact industries reliant on visual content and mark a step forward in merging the fields of artificial intelligence and cognitive science. The current research opens avenues for utilizing neural representations as instruments for understanding and predicting visual memory.

Keywords: autoencoder, computational vision, image memorability, image reconstruction, memory retention, reconstruction error, visual perception

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358 A Comparative Study: Comparison of Two Different Fluorescent Stains -Auramine and Rhodamine- with Ehrlich-Ziehl-Neelsen, Kinyoun Staining, and Culture in the Determination of Acid Resistant Bacilli

Authors: Recep Keşli, Hayriye Tokay, Cengiz Demir, İsmail Ceyhan

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Objective: In many countries, tuberculosis (TB) is still one of the most important diseases. Tuberculosis is among top 10 causes of death worldwide. The early diagnosis of active tuberculosis still depends on the presence of acid resistant bacilli (ARB) in stained smears. In this study, we aimed to investigate the diagnostic performances of Erlich Ziehl Neelsen (EZN), Kinyoun and two different fluorescent stains. Methods: The specimens were obtained from the patients who applied to Chest Diseases Departments of Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, and Afyon Kocatepe University, ANS Research and Practice Hospital. The study was carried out in the Medical Microbiology Laboratory, School of Medicine, Afyon Kocatepe University. All the non-sterile specimens were homogenized and decontaminated according to the EUCAST instructions. Samples were inoculated onto the Löwenstein-Jensen agars (bio-Merieux Marcy l'Etoile, France) and then incubated at 37˚C, for 40 days. Four smears were prepared from each specimen. Slides were stained with commercial EZN (BD, Sparks, USA), Kinyoun (SALUBRIS Istanbul, Turkey), Auramine (SALUBRIS Istanbul, Turkey) and Rhodamine (SALUBRIS Istanbul, Turkey) kit. While EZN and Kinyoun stainings were examined by light microscope, Auramine and Rhodamine slides were examined by fluorescence microscopy. Results: A total of 158 respiratory system samples (sputum, broncho alveolar lavage fluid…etc) were enrolled into the study. A hundred and two of the samples that processed were found as culture positive. The sensitivity, specificity, positive predictive, and negative predictive values were detected as 100%, 67.5%, 73.5%, and 100% for EZN, 100%, 70.9%, 77.4%, and 100% for Kinyoun, 100%,77.8%, 84.3%, 100% for Auramine, and 100%, 80% , 86.3%, and 100% for Rhodamine respectively. Conclusions: According to our study auramine and rhodamine staining methods showed the best diagnostic performance among the four investigated staining methods. In conclusion, the fluorochrome staining method may be accepted as the most reliable, rapid and useful method for diagnosis of the mycobacterial infections truly.

Keywords: acid resistant bacilli (ARB), auramine, Ehrlich-Ziehl-Neelsen (EZN), Kinyoun, Rhodamine

Procedia PDF Downloads 276
357 Mining User-Generated Contents to Detect Service Failures with Topic Model

Authors: Kyung Bae Park, Sung Ho Ha

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Online user-generated contents (UGC) significantly change the way customers behave (e.g., shop, travel), and a pressing need to handle the overwhelmingly plethora amount of various UGC is one of the paramount issues for management. However, a current approach (e.g., sentiment analysis) is often ineffective for leveraging textual information to detect the problems or issues that a certain management suffers from. In this paper, we employ text mining of Latent Dirichlet Allocation (LDA) on a popular online review site dedicated to complaint from users. We find that the employed LDA efficiently detects customer complaints, and a further inspection with the visualization technique is effective to categorize the problems or issues. As such, management can identify the issues at stake and prioritize them accordingly in a timely manner given the limited amount of resources. The findings provide managerial insights into how analytics on social media can help maintain and improve their reputation management. Our interdisciplinary approach also highlights several insights by applying machine learning techniques in marketing research domain. On a broader technical note, this paper illustrates the details of how to implement LDA in R program from a beginning (data collection in R) to an end (LDA analysis in R) since the instruction is still largely undocumented. In this regard, it will help lower the boundary for interdisciplinary researcher to conduct related research.

Keywords: latent dirichlet allocation, R program, text mining, topic model, user generated contents, visualization

Procedia PDF Downloads 187
356 Comparative Study of Vertical and Horizontal Triplex Tube Latent Heat Storage Units

Authors: Hamid El Qarnia

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This study investigates the impact of the eccentricity of the central tube on the thermal and fluid characteristics of a triplex tube used in latent heat energy storage technologies. Two triplex tube orientations are considered in the proposed study: vertical and horizontal. The energy storage material, which is a phase change material (PCM), is placed in the space between the inside and outside tubes. During the thermal energy storage period, a heat transfer fluid (HTF) flows inside the two tubes, transmitting the heat to the PCM through two heat exchange surfaces instead of one heat exchange surface as it is the case for double tube heat storage systems. A CFD model is developed and validated against experimental data available in the literature. The mesh independency study is carried out to select the appropriate mesh. In addition, different time steps are examined to determine a time step ensuring accuracy of the numerical results and reduction in the computational time. The numerical model is then used to conduct numerical investigations of the thermal behavior and thermal performance of the storage unit. The effects of eccentricity of the central tube and HTF mass flow rate on thermal characteristics and performance indicators are examined for two flow arrangements: co-current and counter current flows. The results are given in terms of isotherm plots, streamlines, melting time and thermal energy storage efficiency.

Keywords: energy storage, heat transfer, melting, solidification

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355 Classification of Digital Chest Radiographs Using Image Processing Techniques to Aid in Diagnosis of Pulmonary Tuberculosis

Authors: A. J. S. P. Nileema, S. Kulatunga , S. H. Palihawadana

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Computer aided detection (CAD) system was developed for the diagnosis of pulmonary tuberculosis using digital chest X-rays with MATLAB image processing techniques using a statistical approach. The study comprised of 200 digital chest radiographs collected from the National Hospital for Respiratory Diseases - Welisara, Sri Lanka. Pre-processing was done to remove identification details. Lung fields were segmented and then divided into four quadrants; right upper quadrant, left upper quadrant, right lower quadrant, and left lower quadrant using the image processing techniques in MATLAB. Contrast, correlation, homogeneity, energy, entropy, and maximum probability texture features were extracted using the gray level co-occurrence matrix method. Descriptive statistics and normal distribution analysis were performed using SPSS. Depending on the radiologists’ interpretation, chest radiographs were classified manually into PTB - positive (PTBP) and PTB - negative (PTBN) classes. Features with standard normal distribution were analyzed using an independent sample T-test for PTBP and PTBN chest radiographs. Among the six features tested, contrast, correlation, energy, entropy, and maximum probability features showed a statistically significant difference between the two classes at 95% confidence interval; therefore, could be used in the classification of chest radiograph for PTB diagnosis. With the resulting value ranges of the five texture features with normal distribution, a classification algorithm was then defined to recognize and classify the quadrant images; if the texture feature values of the quadrant image being tested falls within the defined region, it will be identified as a PTBP – abnormal quadrant and will be labeled as ‘Abnormal’ in red color with its border being highlighted in red color whereas if the texture feature values of the quadrant image being tested falls outside of the defined value range, it will be identified as PTBN–normal and labeled as ‘Normal’ in blue color but there will be no changes to the image outline. The developed classification algorithm has shown a high sensitivity of 92% which makes it an efficient CAD system and with a modest specificity of 70%.

Keywords: chest radiographs, computer aided detection, image processing, pulmonary tuberculosis

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354 Factors Associated with Death during Tuberculosis Treatment of Patients Co-Infected with HIV at a Tertiary Care Setting in Cameroon: An 8-Year Hospital-Based Retrospective Cohort Study (2006-2013)

Authors: A. A. Agbor, Jean Joel R. Bigna, Serges Clotaire Billong, Mathurin Cyrille Tejiokem, Gabriel L. Ekali, Claudia S. Plottel, Jean Jacques N. Noubiap, Hortence Abessolo, Roselyne Toby, Sinata Koulla-Shiro

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Background: Contributors to fatal outcomes in patients undergoing tuberculosis (TB) treatment in the setting of HIV co-infection are poorly characterized, especially in sub-Saharan Africa. Our study’s aim was to assess factors associated with death in TB/HIV co-infected patients during the first 6 months their TB treatment. Methods: We conducted a tertiary-care hospital-based retrospective cohort study from January 2006 to December 2013 at the Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify hospitalized co-infected TB/HIV patients aged 15 years and older. Death was defined as any death occurring during TB treatment, as per the World Health Organization’s recommendations. Logistic regression analysis identified factors associated with death. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval. A p value < 0.05 was considered statistically significant. Results: The 337 patients enrolled had a mean age of 39.3 (+/- 10.3) years and more (54.3%) were women. TB treatment outcomes included: treatment success in 60.8% (n=205), death in 29.4% (n=99), not evaluated in 5.3% (n=18), loss to follow-up in 5.3% (n=14), and failure in 0.3% (n=1) . After exclusion of patients lost to follow-up and not evaluated, death in TB/HIV co-infected patients during TB treatment was associated with: a TB diagnosis made before national implementation of guidelines regarding initiation of antiretroviral therapy (aOR = 2.50 [1.31-4.78]; p = 0.006), the presence of other AIDS-defining infections (aOR = 2.73 [1.27-5.86]; p = 0.010), non-AIDS comorbidities (aOR = 3.35 [1.37-8.21]; p = 0.008), not receiving co-trimoxazole prophylaxis (aOR = 3.61 [1.71-7.63]; p = 0.001), not receiving antiretroviral therapy (aOR = 2.45 [1.18-5.08]; p = 0.016), and CD4 cell counts < 50 cells/mm3 (aOR = 16.43 [1.05-258.04]; p = 0.047). Conclusions: The success rate of anti-tuberculosis treatment among hospitalized TB/HIV co-infected patients in our setting is low. Mortality in the first 6 months of treatment was high and strongly associated with specific clinical factors including states of greater immunosuppression, highlighting the urgent need for targeted interventions, including provision of anti-retroviral therapy and co-trimoxazole prophylaxis in order to enhance patient outcomes.

Keywords: TB/HIV co-infection, death, treatment outcomes, factors

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353 The Silent Tuberculosis: A Case Study to Highlight Awareness of a Global Health Disease and Difficulties in Diagnosis

Authors: Susan Scott, Dina Hanna, Bassel Zebian, Gary Ruiz, Sreena Das

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Although the number of cases of TB in England has fallen over the last 4 years, it remains an important public health burden with 1 in 20 cases dying annually. The vast majority of cases present in non-UK born individuals with social risk factors. We present a case of non-pulmonary TB presenting in a healthy child born in the UK to professional parents. We present a case of a healthy 10 year old boy who developed acute back pain during school PE. Over the next 5 months, he was seen by various health and allied professionals with worsening back pain and kyphosis. He became increasing unsteady and for the 10 days prior to admission to our hospital, he developed fevers. He was admitted to his local hospital for tonsillitis where he suffered two falls on account of his leg weakness. A spinal X-ray revealed a pathological fracture and gibbus formation. He was transferred to our unit for further management. On arrival, the patient had lower motor neurone signs of his left leg. He underwent spinal fixture, laminectomy and decompression. Microbiology samples taken intra-operatively confirmed Mycobacterium Tuberculosis. He had a positive Mantoux and T-spot and treatment were commenced. There was no evidence of immune compromise. The patient was born in the UK, had a BCG scar and his only travel history had been two years prior to presentation when he travelled to the Phillipines for a short holiday. The patient continues to have issues around neuropathic pain, mobility, pill burden and mild liver side effects from treatment. Discussion: There is a paucity of case reports on spinal TB in paediatrics and diagnosis is often difficult due to the non-specific symptomatology. Although prognosis on treatment is good, a delayed diagnosis can have devastating consequences. This case highlights the continued need for higher index of suspicion and diagnosis in a world with changing patterns of migration and increase global travel. Surgical intervention is limited to the most serious cases to minimise further neurological damage and improve prognosis. There remains the need for a multi-disciplinary approach to deal with challenges of treatment and rehabilitation.

Keywords: tuberculosis, non-pulmonary TB, public health burden, diagnostic challenge

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352 Investigation of the Association of Vitamin D Receptor Gene Polymorphism in Female Genital: Tuberculosis Cases

Authors: Swati Gautam, Amita Jain, Shyampyari Jaiswar

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Objective: To elucidate the role of (ApaI&TaqI) VDR gene polymorphism in the pathogenesis of female genital tuberculosis (FGTB) cases. Background: Female genital TB represents about 15-20% of total extra-pulmonary TB (EPTB). Female subjects with vitamin D deficiency have been shown to be at higher risk of pulmonary TB as well as FGTB. In same context few functional polymorphism in vitamin D receptor (VDR) gene has been considered as an important genetic risk factor that modulate the development of FGTB. Therefore we aimed, to elucidate the role of (ApaI&TaqI) VDR gene polymorphism in the pathogenesis of FGTB. Study design: Case-Control study. Sample size: Cases (60) and Controls (60). Study site: Department of Obstetrics & Gynecology & Department of Microbiology, K.G.M.U. Lucknow, (UP). Inclusion criteria: Cases: Women with age group 20-35 years, premenstrual endometrial aspiration collected and included in the study, those were positive with acid-fast bacilli (AFB)/ TB-PCR/ LJ culture/ liquid culture. Controls: Women with age group 20-35 years having no history of ATT and all test negative for TB recruited as control. Exclusion criteria: -Women with endometriosis, polycystic ovaries (PCOD), positive on Chlamydia & gonorrhea, already on anti-tubercular therapy (ATT) excluded. Materials and Methods: Blood samples were collected in EDTA tubes from cases and controls stored at -20ºC. Genomic DNA extraction was carried out by salting-out method. Genotyping of VDR gene (ApaI&TaqI) polymorphism was performed by using single amplification refractory mutation system (ARMS) PCR technique. PCR products were analyzed by electrophoresis on 2% agarose gel. Statistical analysis was done by SPSS16.3 software & computing odds ratio (OR) with 95% CI. Results: Increased risk of female genital tuberculosis was observed in AA genotype (OR =1.1419-6.212 95% CI, P*<0.036) and A allele (OR =1.255-3.518, 95% CI, P* < 0.006) in FGTB as compared to controls. Moreover A allele was found more frequent in FGTB patients. No significant difference was observed in TaqI gene polymorphism of VDR gene. Conclusion: The ApaI polymorphism is significantly associated with etiology of FGTB and plays an important role as a genetic risk factor in FGTB women.

Keywords: ARMS, ATT, EPTB, FGTB, VDR

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351 Diagnostic Value of Different Noninvasive Criteria of Latent Myocarditis in Comparison with Myocardial Biopsy

Authors: Olga Blagova, Yuliya Osipova, Evgeniya Kogan, Alexander Nedostup

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Purpose: to quantify the value of various clinical, laboratory and instrumental signs in the diagnosis of myocarditis in comparison with morphological studies of the myocardium. Methods: in 100 patients (65 men, 44.7±12.5 years) with «idiopathic» arrhythmias (n = 20) and dilated cardiomyopathy (DCM, n = 80) were performed 71 endomyocardial biopsy (EMB), 13 intraoperative biopsy, 5 study of explanted hearts, 11 autopsy with virus investigation (real-time PCR) of the blood and myocardium. Anti-heart antibodies (AHA) were also measured as well as cardiac CT (n = 45), MRI (n = 25), coronary angiography (n = 47). The comparison group included of 50 patients (25 men, 53.7±11.7 years) with non-inflammatory heart diseases who underwent open heart surgery. Results. Active/borderline myocarditis was diagnosed in 76.0% of the study group and in 21.6% of patients of the comparison group (p < 0.001). The myocardial viral genome was observed more frequently in patients of comparison group than in study group (group (65.0% and 40.2%; p < 0.01. Evaluated the diagnostic value of noninvasive markers of myocarditis. The panel of anti-heart antibodies had the greatest importance to identify myocarditis: sensitivity was 81.5%, positive and negative predictive value was 75.0 and 60.5%. It is defined diagnostic value of non-invasive markers of myocarditis and diagnostic algorithm providing an individual assessment of the likelihood of myocarditis is developed. Conclusion. The greatest significance in the diagnosis of latent myocarditis in patients with 'idiopathic' arrhythmias and DCM have AHA. The use of complex of noninvasive criteria allows estimate the probability of myocarditis and determine the indications for EMB.

Keywords: myocarditis, "idiopathic" arrhythmias, dilated cardiomyopathy, endomyocardial biopsy, viral genome, anti-heart antibodies

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350 Applying the Quad Model to Estimate the Implicit Self-Esteem of Patients with Depressive Disorders: Comparing the Psychometric Properties with the Implicit Association Test Effect

Authors: Yi-Tung Lin

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Researchers commonly assess implicit self-esteem with the Implicit Association Test (IAT). The IAT’s measure, often referred to as the IAT effect, indicates the strengths of automatic preferences for the self relative to others, which is often considered an index of implicit self-esteem. However, based on the Dual-process theory, the IAT does not rely entirely on the automatic process; it is also influenced by a controlled process. The present study, therefore, analyzed the IAT data with the Quad model, separating four processes on the IAT performance: the likelihood that automatic association is activated by the stimulus in the trial (AC); that a correct response is discriminated in the trial (D); that the automatic bias is overcome in favor of a deliberate response (OB); and that when the association is not activated, and the individual fails to discriminate a correct answer, there is a guessing or response bias drives the response (G). The AC and G processes are automatic, while the D and OB processes are controlled. The AC parameter is considered as the strength of the association activated by the stimulus, which reflects what implicit measures of social cognition aim to assess. The stronger the automatic association between self and positive valence, the more likely it will be activated by a relevant stimulus. Therefore, the AC parameter was used as the index of implicit self-esteem in the present study. Meanwhile, the relationship between implicit self-esteem and depression is not fully investigated. In the cognitive theory of depression, it is assumed that the negative self-schema is crucial in depression. Based on this point of view, implicit self-esteem would be negatively associated with depression. However, the results among empirical studies are inconsistent. The aims of the present study were to examine the psychometric properties of the AC (i.e., test-retest reliability and its correlations with explicit self-esteem and depression) and compare it with that of the IAT effect. The present study had 105 patients with depressive disorders completing the Rosenberg Self-Esteem Scale, Beck Depression Inventory-II and the IAT on the pretest. After at least 3 weeks, the participants completed the second IAT. The data were analyzed by the latent-trait multinomial processing tree model (latent-trait MPT) with the TreeBUGS package in R. The result showed that the latent-trait MPT had a satisfactory model fit. The effect size of test-retest reliability of the AC and the IAT effect were medium (r = .43, p < .0001) and small (r = .29, p < .01) respectively. Only the AC showed a significant correlation with explicit self-esteem (r = .19, p < .05). Neither of the two indexes was correlated with depression. Collectively, the AC parameter was a satisfactory index of implicit self-esteem compared with the IAT effect. Also, the present study supported the results that implicit self-esteem was not correlated with depression.

Keywords: cognitive modeling, implicit association test, implicit self-esteem, quad model

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349 Pharmacokinetics of First-Line Tuberculosis Drugs in South African Patients from Kwazulu-Natal: Effects of Pharmacogenetic Variation on Rifampicin and Isoniazid Concentrations

Authors: Anushka Naidoo, Veron Ramsuran, Maxwell Chirehwa, Paolo Denti, Kogieleum Naidoo, Helen McIlleron, Nonhlanhla Yende-Zuma, Ravesh Singh, Sinaye Ngcapu, Nesri Padayatachi

Abstract:

Background: Despite efforts to introduce new drugs and shorter drug regimens for drug-susceptible tuberculosis (TB), the standard first-line treatment has not changed in over 50 years. Rifampicin, isoniazid, and pyrazinamide are critical components of the current standard treatment regimens. Some studies suggest that microbiologic failure and acquired drug resistance are primarily driven by low drug concentrations that result from pharmacokinetic (PK) variability independent of adherence to treatment. Wide between-patient pharmacokinetic variability for rifampin, isoniazid, and pyrazinamide has been reported in prior studies. There may be several reasons for this variability. However, genetic variability in genes coding for drug metabolizing and transporter enzymes have been shown to be a contributing factor for variable tuberculosis drug exposures. Objective: We describe the pharmacokinetics of first-line TB drugs rifampicin, isoniazid, and pyrazinamide and assess the effect of genetic variability in relevant selected drug metabolizing and transporter enzymes on pharmacokinetic parameters of isoniazid and rifampicin. Methods: We conducted the randomized-controlled Improving retreatment success TB trial in Durban, South Africa. The drug regimen included rifampicin, isoniazid, and pyrazinamide. Drug concentrations were measured in plasma, and concentration-time data were analysed using nonlinear-mixed-effects models to quantify the effects of relevant covariates and single nucleotide polymorphisms (SNP’s) of drug metabolizing and transporter genes on rifampicin, isoniazid and pyrazinamide exposure. A total of 25 SNP’s: four NAT2 (used to determine acetylator status), four SLCO1B1, three Pregnane X receptor (NR1), six ABCB1 and eight UGT1A, were selected for analysis in this study. Genotypes were determined for each of the SNP’s using a TaqMan® Genotyping OpenArray™. Results: Among fifty-eight patients studied; 41 (70.7%) were male, 97% black African, 42 (72.4%) HIV co-infected and 40 (95%) on efavirenz-based ART. Median weight, fat-free mass (FFM), and age at baseline were 56.9 kg (interquartile range, IQR: 51.1-65.2), 46.8 kg (IQR: 42.5-50.3) and 37 years (IQR: 31-42), respectively. The pharmacokinetics of rifampicin and pyrazinamide was best described using one-compartment models with first-order absorption and elimination, while for isoniazid two-compartment disposition was used. The median (interquartile range: IQR) AUC (h·mg/L) and Cmax (mg/L) for rifampicin, isoniazid, and pyrazinamide were; 25.62 (23.01-28.53) and 4.85 (4.36-5.40), 10.62 (9.20-12.25) and 2.79 (2.61-2.97), 345.74 (312.03-383.10) and 28.06 (25.01-31.52), respectively. Eighteen percent of patients were classified as rapid acetylators, and 34% and 43% as slow and intermediate acetylators, respectively. Rapid and intermediate acetylator status based on NAT 2 genotype resulted in 2.3 and 1.6 times higher isoniazid clearance than slow acetylators. We found no effects of the SLCO1B1 genotypes on rifampicin pharmacokinetics. Conclusion: Plasma concentrations of rifampicin, isoniazid, and pyrazinamide were low overall in our patients. Isoniazid clearance was high overall and as expected higher in rapid and intermediate acetylators resulting in lower drug exposures. In contrast to reports from previous South African or Ugandan studies, we did not find any effects of the SLCO1B1 or other genotypes tested on rifampicin PK. However, our findings are in keeping with more recent studies from Malawi and India emphasizing the need for geographically diverse and adequately powered studies. The clinical relevance of the low tuberculosis drug concentrations warrants further investigation.

Keywords: rifampicin, isoniazid pharmacokinetics, genetics, NAT2, SLCO1B1, tuberculosis

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348 Theoretical Framework for Value Creation in Project Oriented Companies

Authors: Mariusz Hofman

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The paper ‘Theoretical framework for value creation in Project-Oriented Companies’ is designed to determine, how organisations create value and whether this allows them to achieve market success. An assumption has been made that there are two routes to achieving this value. The first one is to create intangible assets (i.e. the resources of human, structural and relational capital), while the other one is to create added value (understood as the surplus of revenue over costs). It has also been assumed that the combination of the achieved added value and unique intangible assets translates to the success of a project-oriented company. The purpose of the paper is to present hypothetical and deductive model which describing the modus operandi of such companies and approach to model operationalisation. All the latent variables included in the model are theoretical constructs with observational indicators (measures). The existence of a latent variable (construct) and also submodels will be confirmed based on a covariance matrix which in turn is based on empirical data, being a set of observational indicators (measures). This will be achieved with a confirmatory factor analysis (CFA). Due to this statistical procedure, it will be verified whether the matrix arising from the adopted theoretical model differs statistically from the empirical matrix of covariance arising from the system of equations. The fit of the model with the empirical data will be evaluated using χ2, RMSEA and CFI (Comparative Fit Index). How well the theoretical model fits the empirical data is assessed through a number of indicators. If the theoretical conjectures are confirmed, an interesting development path can be defined for project-oriented companies. This will let such organisations perform efficiently in the face of the growing competition and pressure on innovation.

Keywords: value creation, project-oriented company, structural equation modelling

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347 Iron-Metal-Organic Frameworks: Potential Application as Theranostics for Inhalable Therapy of Tuberculosis

Authors: Gabriela Wyszogrodzka, Przemyslaw Dorozynski, Barbara Gil, Maciej Strzempek, Bartosz Marszalek, Piotr Kulinowski, Wladyslaw Piotr Weglarz, Elzbieta Menaszek

Abstract:

MOFs (Metal-Organic Frameworks) belong to a new group of porous materials with a hybrid organic-inorganic construction. Their structure is a network consisting of metal cations or clusters (acting as metallic centers, nodes) and the organic linkers between nodes. The interest in MOFs is primarily associated with the use of their well-developed surface and large porous. Possibility to build MOFs of biocompatible components let to use them as potential drug carriers. Furthermore, forming MOFs structure from cations possessing paramagnetic properties (e.g. iron cations) allows to use them as MRI (Magnetic Resonance Imaging) contrast agents. The concept of formation of particles that combine the ability to transfer active substance with imaging properties has been called theranostic (from words combination therapy and diagnostics). By building MOF structure from iron cations it is possible to use them as theranostic agents and monitoring the distribution of the active substance after administration in real time. In the study iron-MOF: Fe-MIL-101-NH2 was chosen, consisting of iron cluster in nodes of the structure and amino-terephthalic acid as a linker. The aim of the study was to investigate the possibility of applying Fe-MIL-101-NH2 as inhalable theranostic particulate system for the first-line anti-tuberculosis antibiotic – isoniazid. The drug content incorporated into Fe-MIL-101-NH2 was evaluated by dissolution study using spectrophotometric method. Results showed isoniazid encapsulation efficiency – ca. 12.5% wt. Possibility of Fe-MIL-101-NH2 application as the MRI contrast agent was demonstrated by magnetic resonance tomography. FeMIL-101-NH2 effectively shortening T1 and T2 relaxation times (increasing R1 and R2 relaxation rates) linearly with the concentrations of suspended material. Images obtained using multi-echo magnetic resonance imaging sequence revealed possibility to use FeMIL-101-NH2 as positive and negative contrasts depending on applied repetition time. MOFs micronization via ultrasound was evaluated by XRD, nitrogen adsorption, FTIR, SEM imaging and did not influence their crystal shape and size. Ultrasonication let to break the aggregates and achieve very homogeneously looking SEM images. MOFs cytotoxicity was evaluated in in vitro test with a highly sensitive resazurin based reagent PrestoBlue™ on L929 fibroblast cell line. After 24h no inhibition of cell proliferation was observed. All results proved potential possibility of application of ironMOFs as an isoniazid carrier and as MRI contrast agent in inhalatory treatment of tuberculosis. Acknowledgments: Authors gratefully acknowledge the National Science Center Poland for providing financial support, grant no 2014/15/B/ST5/04498.

Keywords: imaging agents, metal-organic frameworks, theranostics, tuberculosis

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