Clinical, Laboratory Characteristics, and Treatment Outcomes of Histoplasmosis Among Patients Admitted to a Referral Tertiary Care Hospital in Bangladesh.

BACKGROUND: Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum (H. capsulatum). Systemic involvement of histoplasmosis usually occurs in immune-compromised patients, patients with AIDS, or those taking immunosuppressive therapy. The present study aims to describe the clinical and laboratory characteristics and treatment outcome of histoplasmosis as the diagnosis is challenging and management protocol differs. METHOD: This retrospective study was done using a data registry at the medicine department of Dhaka Medical College Hospital. Here, patients received the standard treatment of histoplasmosis. Here, patients received the standard treatment of histoplasmosis, and clinical outcome was assessed at 3 months following starting standard treatment. RESULT: A total of nine patients were enrolled, six (66.7%) had systemic histoplasmosis. Three were poultry workers, and the most common comorbidity was diabetes 3 (33.3%). Fever 7 (77.7%), weight loss 6 (66.7%), hyperpigmentation 5 (55.5%), cough 4 (44.4%), oral ulceration 4 (44.4%), lymphadenopathy 4 (44.4%), and hypotension 3 (33.3%) were the most common clinical presentations. Seven (77.7%) out of nine patients were cured of histoplasmosis; however, one died before initiating antifungal medications and another one died due to a hypersensitivity reaction to liposomal amphotericin B.  Conclusion: For local histoplasmosis, oral itraconazole is an effective antifungal medication. However, in disseminated Histoplasmosis, liposomal amphotericin B followed by oral itraconazole is still one of the preferable and effective treatment options. Clinicians should be aware of hypersensitivity reactions of liposomal amphotericin B and its management before giving an infusion.

Phycoremediation of pollutants from secondary treated coke-oven wastewater using poultry litter as nutrient source: a cost-effective polishing technique.

This article focuses on the phycoremediation of pollutants from secondary treated coke-oven effluent through a green and economical route. A microalgal sample was collected and identified as a consortium of Chlorella sp. and Synechococcus sp. The culture cost was reduced by using poultry litter extract as supplementary material to BG-11 medium. Since the major pollutants present in real secondary treated coke-oven wastewater are phenol, ammoniacal-N (NH4+) and cyanide, several matrices were designed with these three major pollutants by varying their initial concentrations such as phenol (2-10 mg/L), cyanide (0.3-1 mg/L) and NH4+ (100-200 mg/L), termed as simulated secondary treated coke-oven wastewater. Maximum removal was observed with individual solutions of phenol (4 mg/L), cyanide (0.6 mg/L) and NH4+ (175 mg/L), while maximum removal in simulated secondary treated coke-oven wastewater was observed at higher concentrations of phenol (8 mg/L) and cyanide (0.8 mg/L) and the same concentration of NH4+ (175 mg/L). A consortium was found effective to meet statutory limits of pollutants. Kinetic model was developed for predicting growth of consortium and observed that the poultry litter extract-enriched BG-11 medium showed higher values of maximum specific growth rate (0.56 per day) and carrying capacity (1,330 mg/L) than that in BG-11 medium only.

Measurement of vapour-liquid equilibrium and e-NRTL model development of CO2 absorption in aqueous dipropylenetriamine.

Vapour-liquid equilibrium (VLE) of CO2 in aqueous dipropylenetriamine (DPTA) is investigated experimentally using a stirred equilibrium cell setup. Equilibrium solubility of CO2 is measured in the temperature and pressure range of (313-333) K and (1-100) kPa respectively. Composition of aqueous DPTA solvent used for the absorption study is in the range of (5-15) mass%. Experimental data shows higher CO2 loading capacity of this solvent compared to conventional solvents like monoethanolamine (MEA), 2-amino-2-methyl-1-propanol (AMP), and N-methyldiethanolamine (MDEA) as well as recently developed polyamine solvents like aminoethylethanolamine (AEEA), piperazine (PZ), and hexamethylenediamine (HMDA). Experimental VLE data is then correlated using the electrolyte non-random two-liquid (e-NRTL) theory which is an activity coefficient-based model for the electrolyte system. Data regression system (DRS) in Aspen Plus® (V8.8) is employed to fit the e-NRTL model equation with the experimental data by regressing the model parameters. Model-predicted data is found to be in good agreement with the experimental VLE data with an average absolute deviation of 22.3%. Performance of aqueous DPTA solvent is also analysed by predicting solvent capacity, equilibrium liquid-phase speciation, and heat of CO2 absorption using the newly developed e-NRTL model for the investigated system.

Development of a simple high performance liquid chromatography (HPLC)/evaporative light scattering detector (ELSD) method to determine Polysorbate 80 in a pharmaceutical formulation.

The amount of polysorbate 80 in pharmaceutical formulations affects the product quality and efficacy. A reliable test method is required to quantify the amount of Polysorbate 80 present in the drug product formulations. The test method for the determination of Polysorbate 80 may be used during process development and final product quality assessment. A simple, fast and efficient quantitative method, making use of HPLC-ELSD and a C18 column without sample pretreatment was developed. The developed method demonstrated specificity to polysorbate 80 with high precision as indicated by percent relative standard deviation (%RSD) of 3.0% for six determinations. The accuracy of this method for the determination of polysorbate 80 in a pharmaceutical formulation was demonstrated with an overall recovery of 94.9%.

Identification of an Adduct Impurity of an Active Pharmaceutical Ingredient and a Leachable in an Ophthalmic Drug Product Using LC-QTOF.

Impurity investigations are important in pharmaceutical development to ensure drug purity and safety for the patient. The impurities typically found in drug products are degradants or reaction products of the active pharmaceutical ingredient (API) or leachable compounds from the container closure system. However, secondary reactions may also occur between API degradants, excipient impurities, residual solvents, and leachables to form adduct impurities. We hereby report an adduct-forming interaction of API (moxifloxacin) with a leachable compound (ethylene glycol monoformate) in moxifloxacin ophthalmic solution. The leachable compound originated from a low-density polyethylene bottle used in the packaging of drug products. The adduct impurity was tentatively identified as 1-cyclopropyl-6-fluoro-7-(1-(2-(formyloxy)ethyl) octahydro-6H-pyrrolo[3,4-b]pyridin-6-yl)-8-methoxy-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (C24H28FN3O6, MW = 473.19621) using accurate mass LC-QTOF analysis. The mass accuracy error between the theoretical mass and the experimental mass of an impurity was found to be 0.2 ppm. An MS/MS analysis was utilized to provide mass spectrometry fragments to support verification of the proposed structure.

Analysis of Carcinogenic Heavy Metals in Gallstones and its Role in Gallbladder Carcinogenesis.

PURPOSE: Gallstone is a high-risk factor for gallbladder pre-malignancy or malignancy (GB PM-M) but which substances of gallstones definitely assist to turn out in to GB PM-M, remains unclear. This study aimed to find out the presence of carcinogenic heavy metals in gallstones and to explore the aetiopathogenesis of gallbladder pre-malignancy and malignancy. METHODS: Presence of elements in gallstones was detected by energy dispersive X-ray spectroscopy (EDS) with scanning electron microscopy (SEM) and then level of carcinogenic heavy metals was estimated in gallstones using atomic absorption spectroscopy (AAS). The experiment was carried out in gallstone samples of 46 patients with gallbladder pre-malignant and malignant condition (PM-M group) and 65 sex and age-matched patients with chronic cholecystitis (C-C group). Gallstones were also classified in to three types such as cholesterol stone, mixed stone, and black pigment stone. RESULTS: EDS analysis detected presence of mercury, lead, and cobalt elements in all types of gallstones of both PM-M and C-C groups. AAS analysis revealed significantly higher amount of mercury (p < 0.001), lead (p < 0.0001), cobalt (p < 0.01), and cadmium (p < 0.01) in the gallstones of PM-M than C-C groups. The presence of these heavy metals also varied among stone types of both groups. EDS phase analysis showed 'dense deposits' of these metals in gallstones. CONCLUSIONS: Presence of significantly higher amount of mercury, lead, cobalt, and cadmium in gallstones may play a pivotal role as risk factors in the development of gallbladder malignancy or pre-malignancy. 'Dense deposits' of these metals in the gallstones which is the first observation, may act as crucial doses of carcinogens.

Fluorinated Photodynamic Therapy Device Tips and their Resistance to Fouling for In Vivo Sensitizer Release.

We describe progress on a one-step photodynamic therapy (PDT) technique that is simple: device tip delivery of sensitizer, oxygen and light simultaneously. Control is essential for their delivery to target sites to generate singlet oxygen. One potential problem is the silica device tip may suffer from biomaterial fouling and the pace of sensitizer photorelease is slowed. Here, we have used biomaterial (e.g. proteins, cells, etc.) from SQ20B head and neck tumors and whole blood for an assessment of fouling of the silica tips by adsorption. It was shown that by exchanging the native silica tip for a fluorinated tip, a better nonstick property led to an increased sensitizer output by ~10%. The fluorinated tip gave a sigmoidal photorelease where singlet oxygen is stabilized to physical quenching, whereas the native silica tip with unprotected SiO-H groups gave a slower (pseudolinear) photorelease. A further benefit from fluorinated silica is that 15% less biomaterial adheres to its surface compared to native silica based on a bicinchoninic acid assay (BCA) and X-ray photoelectron spectroscopy (XPS) measurements. We discuss how the fluorination of the device tip increases biofouling resistance and can contribute to a new pointsource PDT tool.

Design and Fabrication of a Hybrid Superhydrophobic-Hydrophilic Surface That Exhibits Stable Dropwise Condensation.

Condensation of water vapor is an essential process in power generation, water collection, and thermal management. Dropwise condensation, where condensed droplets are removed from the surface before coalescing into a film, has been shown to increase the heat transfer efficiency and water collection ability of many surfaces. Numerous efforts have been made to create surfaces which can promote dropwise condensation, including superhydrophobic surfaces on which water droplets are highly mobile. However, the challenge with using such surfaces in condensing environments is that hydrophobic coatings can degrade and/or water droplets on superhydrophobic surfaces transition from the mobile Cassie to the wetted Wenzel state over time and condensation shifts to a less-effective filmwise mechanism. To meet the need for a heat-transfer surface that can maintain stable dropwise condensation, we designed and fabricated a hybrid superhydrophobic-hydrophilic surface. An array of hydrophilic needles, thermally connected to a heat sink, was forced through a robust superhydrophobic polymer film. Condensation occurs preferentially on the needle surface due to differences in wettability and temperature. As the droplet grows, the liquid drop on the needle remains in the Cassie state and does not wet the underlying superhydrophobic surface. The water collection rate on this surface was studied using different surface tilt angles, needle array pitch values, and needle heights. Water condensation rates on the hybrid surface were shown to be 4 times greater than for a planar copper surface and twice as large for silanized silicon or superhydrophobic surfaces without hydrophilic features. A convection-conduction heat transfer model was developed; predicted water condensation rates were in good agreement with experimental observations. This type of hybrid superhydrophobic-hydrophilic surface with a larger array of needles is low-cost, robust, and scalable and so could be used for heat transfer and water collection applications.

Superhydrophobic TiO2-polymer nanocomposite surface with UV-induced reversible wettability and self-cleaning properties.

Multifunctional superhydrophobic nanocomposite surfaces based on photocatalytic materials, such as fluorosilane modified TiO2, have generated significant research interest. However, there are two challenges to forming such multifunctional surfaces with stable superhydrophobic properties: the photocatalytic oxidation of the hydrophobic functional groups, which leads to the permanent loss of superhydrophobicity, as well as the photoinduced reversible hydrolysis of the catalytic particle surface. Herein, we report a simple and inexpensive template lamination method to fabricate multifunctional TiO2-high-density polyethylene (HDPE) nanocomposite surfaces exhibiting superhydrophobicity, UV-induced reversible wettability, and self-cleaning properties. The laminated surface possesses a hierarchical roughness spanning the micro- to nanoscale range. This was achieved by using a wire mesh template to emboss the HDPE surface creating an array of polymeric posts while partially embedding untreated TiO2 nanoparticles selectively into the top surface of these features. The surface exhibits excellent superhydrophobic properties immediately after lamination without any chemical surface modification to the TiO2 nanoparticles. Exposure to UV light causes the surface to become hydrophilic. This change in wettability can be reversed by heating the surface to restore superhydrophobicity. The effect of TiO2 nanoparticle surface coverage and chemical composition on the mechanism and magnitude of wettability changes was studied by EDX and XPS. In addition, the ability of the surface to shed impacting water droplets as well as the ability of such droplets to clean away particulate contaminants was demonstrated.

A prospective randomised clinical trial comparing FARES method with the Eachempati external rotation method for reduction of acute anterior dislocation of shoulder.

OBJECTIVE: To compare the safety, efficacy and reliability of FARES (fast, reliable and safe) method with the Eachempati external rotation method for reduction of anterior dislocation of shoulder. METHODS: In a single centre, prospective, randomised clinical trial, conducted in our institution from January 2010 to October 2011, 160 patients with acute anterior dislocation of shoulder (with or without an associated fracture of the greater tuberosity of the humerus) who satisfy the inclusion and exclusion criteria were enrolled in the study. Patients were randomised to receive reduction of dislocation with one of the two methods (FARES and Eachempati method) with 80 patients in each group, according to a table of random numbers. Following successful reduction, the following information was recorded: (i) intensity of pain perceived during reduction by using a visual analogue scale (VAS) ranging from 0 (no pain) to 100 (worst pain possible), (ii) time interval between the dislocation and the first attempt of reduction, (iii) time interval between the start of the reduction manoeuvre and completion of the reduction, (iv) number of attempts taken to complete the reduction and (iv) any post-reduction complications. RESULTS: There were no significant differences between the two groups with regard to baseline characteristics. No post-reduction complications were noted in any of the patients in this study. Successful reduction of shoulder dislocation was achieved with the FARES method in 76 (95%) of 80 patients and with the Eachempati external rotation method in 73 (91.25%) of 80 patients. This difference was not statistically significant (p=0.53, Fisher's exact test). Post-reduction result analysis shows that there was a statistically significant difference between the two methods in favour of the FARES method in terms of speed of reduction, pain felt during reduction and number of attempts taken during reduction. CONCLUSIONS: FARES method, as compared with the Eachempati method, is significantly faster, less painful and less number of attempts required for reduction. As both the methods appeared to be safe and effective compared to the previous traditional techniques, we strongly recommend FARES method as the first-choice method compared to Eachempati method for reduction of acute anterior dislocation of shoulder. LEVEL OF EVIDENCE: Therapeutic Level I.

A prospective randomized, double-blind, controlled clinical trial comparing epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus.

OBJECTIVE: To compare the efficacy of up to 3 epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus. MATERIALS AND METHODS: In a randomized, double-blind controlled clinical trial, we administered up to 3 epidural injections of either 80 mg (2 mL) of methylprednisolone acetate and 1 mg (1 mL) of butorphanol diluted with 7 mL of isotonic saline or 80 mg (2 mL) of methylprednisolone acetate diluted with 8 mL of isotonic saline by a lumbar interlaminar approach under fluoroscopic guidance to 120 patients (60 patients in each group) with sciatica due to a herniated nucleus pulposus lasting for 4 weeks to 1 year. All patients had scores higher than 30 mm on visual analog scale (VAS). Information on the use of paracetamol, intensity of pain on a VAS ranging from 0 (no pain) to 100 mm (worst pain possible), Schober's test (cm), Straight Leg Raising test, neurologic examination assessing sensory deficits, motor deficits and reflex changes, and Oswestry Low Back Pain Disability Questionnaire were evaluated at 3 weeks, 6 weeks, and 3 months after the first injection. RESULTS: There were no significant differences between the 2 groups with regard to baseline characteristics, withdrawals, and complication rate. Three weeks, 6 weeks, and 3 months after the first injection, all the outcome measures in the butorphanol plus corticosteroid group were significantly different from that of the corticosteroid group. CONCLUSIONS: Epidural butorphanol plus corticosteroid injections, as compared with corticosteroid alone injections, offered marked improvement in pain, reflex, motor and sensory deficits, and functional status and reduced the need for analgesics. LEVEL OF EVIDENCE: Therapeutic Level I.

Prevalence of hemoglobinopathy, ABO and rhesus blood groups in rural areas of West Bengal, India.

BACKGROUND: Hemoglobinopathies are a group of inherited disorders of hemoglobin synthesis. It could be formed a fatal scenario in concern of lacking of actual information. Beside this, ABO and Rh blood grouping are also important matter in transfusion and forensic medicine and to reduce new born hemolytic disease (NHD). MATERIALS AND METHODS: The spectrum and prevalence of various hemoglobinopathies, ABO and rhesus (Rh) blood groups was screened among patients who visited B.S. Medical College and Hospital, Bankura, West Bengal, India. This study was carried out on 958 patients of different ages ranging from child to adults from January to June 2011. High-performance liquid chromatography (HPLC), complete blood count (CBC) and hemagglutination technique were performed for the assessment of abnormal hemoglobin variants, ABO and Rh blood groups, respectively. RESULTS: Results from this study had been shown that there was high prevalence of hemoglobinpathies (27.35%) where ß-thalassemia in heterozygous state occurred more frequent than other hemoglobinopathies. Out of 958 patients, 72.65% were HbAA and 27.35% were hemoglobinopathies individuals where 17.64% ß-thalassemia heterozygous, 2.92% ß-thalassemia homozygous, 3.86% HbAE, 1.15% HbAS trait, 1.25% HbE-ß thalassemia trait and 0.52% HbS-ß thalassemia trait were found. No incidence of HbSS, HbSC, HbCC, HbD and other variants of hemoglobinpathies were observed. The gene frequencies with respect to ABO systems had been shown as O > B > A > AB. Blood group O was the highest (35.8%) and the least percentage distribution was blood group AB (6.68%). Rhesus positive (Rh+) were 97.7%, while the remaining was 2.3% Rhesus negative (Rh-). The frequencies of A(+), B(+), AB(+,) and O(+) blood groups were 22.44%, 33.61%, 6.58%, and 35.07%, respectively. CONCLUSIONS: Remarkable percentages of hemoglobinopathies were prevalent from the present study. An extensive screening of the population is needed to assess the prevalence of hemoglobinopathies, which will help in identification of carriers of hemoglobinopathies and further it will be of assistance in taking adequate therapeutic and preventive measures.

Fabricating superhydrophobic polymer surfaces with excellent abrasion resistance by a simple lamination templating method.

Fabricating robust superhydrophobic surfaces for commercial applications is challenging as the fine-scale surface features, necessary to achieve superhydrophobicity, are susceptible to mechanical damage. Herein, we report a simple and inexpensive lamination templating method to create superhydrophobic polymer surfaces with excellent abrasion resistance and water pressure stability. To fabricate the surfaces, polyethylene films were laminated against woven wire mesh templates. After cooling, the mesh was peeled from the polymer creating a 3D array of ordered polymer microposts on the polymer surface. The resulting texture is monolithic with the polymer film and requires no chemical modification to exhibit superhydrophobicity. By controlling lamination parameters and mesh dimensions, polyethylene surfaces were fabricated that exhibit static contact angles of 160° and slip angles of 5°. Chemical and mechanical stability was evaluated using an array of manual tests as well as a standard reciprocating abraser test. Surfaces remained superhydrophobic after more than 5500 abrasion cycles at a pressure of 32.0 kPa. In addition, the surface remains dry after immersing into water for 5 h at 55 kPa. This method is environmental friendly, as it employs no solvents or harsh chemicals and may provide an economically viable path to manufacture large areas of mechanically robust superhydrophobic surfaces from inexpensive polymers and reusable templates.

Synthesis of drug/dye-incorporated polymer-protein hybrids.

We present here a general methodology for significantly increasing the number of dye/drug molecules that can be attached per protein molecule. As a demonstration of this approach, poly(acrylic acid) (PAA)-based near-infrared fluorescence (NIRF) dye- and glucose-incorporated novel copolymers were synthesized, which were further employed for bioconjugation to avidin and bovine serum albumin (BSA). In this method, azide-terminated poly(tert-butyl acrylate) was synthesized via atom transfer radical polymerization (ATRP). Subsequent deprotection was performed to yield poly(acrylic acid) (PAA) possessing a reactive chain-end. A one-pot sequential amidation of the PAA with the amine derivatives of a near-infrared fluorescent dye (ADS832WS) and glucose produced NIRF dye-incorporated water-soluble copolymers. End-group modifications were performed to produce alkyne/biotin-terminated copolymers, which were further employed to generate dye-incorporated polymer-protein hybrids via the biotin-avidin interaction with avidin or by "click" bioconjugation with azide-modified BSA.