Effect of Surface Functional Groups on the Electronic Behavior and Optical Spectra of Mn2N Based MXenes.

The extensive applications of MXenes, a novel type of layered materials known for their favorable characteristics, have sparked significant interest. This research focuses on investigating the influence of surface functionalization on the behavior of Mn2NTx (Tx=O2, F2) MXenes monolayers using the "Density functional theory (DFT) based full-potential linearized augmented-plane-wave (FP-LAPW)" method. We elucidate the differences in the physical properties of Mn2NTx through the influence of F and O surface functional groups. We found that O-termination results in half-metallic behavior, whereas the F-termination evolves metallic characteristics within these MXene systems. Similarly, surface termination has effectively influenced their optical absorption efficiency. For instance, Mn2NO2 and Mn2NF2 effectively absorb UV light ~50.15×104 cm-1 and 37.71×104 cm-1, respectively. Additionally, they demonstrated prominent refraction and reflection characteristics, which are comprehensively discussed in the present work. Our predictions offer valuable perspectives into the optical and electronic characteristics of Mn2NTx-based MXenes, presenting the promising potential for implementing them in diverse optoelectronic devices.

Photocatalytic CO2 Reduction Using TiO2-Based Photocatalysts and TiO2 Z-Scheme Heterojunction Composites: A Review.

Photocatalytic CO2 reduction is a most promising technique to capture CO2 and reduce it to non-fossil fuel and other valuable compounds. Today, we are facing serious environmental issues due to the usage of excessive amounts of non-renewable energy resources. In this aspect, photocatalytic CO2 reduction will provide us with energy-enriched compounds and help to keep our environment clean and healthy. For this purpose, various photocatalysts have been designed to obtain selective products and improve efficiency of the system. Semiconductor materials have received great attention and have showed good performances for CO2 reduction. Titanium dioxide has been widely explored as a photocatalyst for CO2 reduction among the semiconductors due to its suitable electronic/optical properties, availability at low cost, thermal stability, low toxicity, and high photoactivity. Inspired by natural photosynthesis, the artificial Z-scheme of photocatalyst is constructed to provide an easy method to enhance efficiency of CO2 reduction. This review covers literature in this field, particularly the studies about the photocatalytic system, TiO2 Z-scheme heterojunction composites, and use of transition metals for CO2 photoreduction. Lastly, challenges and opportunities are described to open a new era in engineering and attain good performances with semiconductor materials for photocatalytic CO2 reduction.

Preparation of Y2O3 Coated CaO Ceramic Cores with Anti-Hydration Performance and High-Interface Stability Against Interface Reaction of Ti-6Al-4V Alloys.

In this study, we describe a novel method for preparing Y2O3@CaO ceramic cores with anti-hydration performance and high-interface stability against interface reaction of Ti-6Al-4V alloys. The effect of Y2O3 coating on microstructure, mechanical, anti-hydration properties of ceramic cores and interface reaction with Ti-6Al-4V alloys was studied. The results show that the surface charge of Y2O3 and CaO are opposite at the pH value of 13, which might result in an electrostatic force and become the main driving force of Y2O3 particles absorb on the surface of CaO particles. The Y2O3 coating improved the anti-hydration properties of the CaO-based ceramic cores after sintering at 1450 °C. Meanwhile, the flexural strength improved from 11.2 to 18.8 MPa. At last, the interaction between the ceramic cores and Ti-6Al-4V metal were studied by centrifugal investment casting. Y2O3 coating can effectively reduce the interface reaction and the thickness of the interaction layer in the casting was less than 10 µm. The results suggest that the Y2O3@CaO ceramic with anti-hydration performance provide excellent mechanical and high-interface stability against interface reaction of Ti-6Al-4V alloys.

The Diagnostic Value of Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) in Diagnosing FDG-PET-Avid Lymph Nodes in Extrapulmonary Malignancies.

Background and objective The accurate diagnosis of extrapulmonary malignancies with mediastinal lymphadenopathy is crucial for effective patient management. Endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) has emerged as a valuable tool in assessing fluorodeoxyglucose (FDG)-positron emission tomography (PET)-avid lymph nodes (LNs). In this study, we aimed to evaluate the diagnostic value of EBUS-FNA in patients with mediastinal lymphadenopathy in extrapulmonary malignancies and compare its efficacy with PET-CT.  Methodology This retrospective, cross-sectional study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, from February 2018 to February 2023. It included patients with extrapulmonary malignancies with mediastinal lymphadenopathy displaying abnormal PET-CT uptake, with LN diameters ≥5 mm, excluding lung cancer cases. Data on demographics, malignancy type, LN involvement, PET-CT findings, and EBUS-FNA histopathology were collected. EBUS-FNA procedures involved a 22-gauge needle, and samples were analyzed cytologically and histologically. SPSS Statistics version 20 (IBM Corp., Armonk, NY) was used to perform the statistical analysis. Results The study analyzed a total of 216 patients. Males comprised 56.3% of the cohort, and females 43.7%. The most common malignancy was lymphoma (33.0%), followed by breast cancer (12.6%). EBUS-FNA exhibited a sensitivity of 90.9% compared to PET-CT's sensitivity of 72.7%. Lymph node morphology on EBUS showed low echogenicity and irregular borders in malignant cases. Subcarinal and right hilar were the most frequently sampled lymph nodes. The study found significant differences in lymph node characteristics between non-malignant and malignant groups, with EBUS-FNA effectively identifying malignancies.  Conclusions EBUS-FNA demonstrates high sensitivity and diagnostic utility in identifying malignant lymph nodes in patients with extrapulmonary malignancies. Its effectiveness in detecting true positive cases highlights its importance as a complementary diagnostic tool to PET-CT in oncological diagnostics.

Experimental investigation of quarry rock dust incorporated fly ash and slag based fiber reinforced geopolymer concrete circular columns.

Manufacturing ordinary Portland cement (OPC) poses significant challenges for sustainable construction practices. OPC manufacturing emits substantial greenhouse gases into the atmosphere and demands extensive raw materials. In pursuit of greener alternatives, researchers explore geopolymer concrete (GPC), a revolutionary material that entirely replaces OPC, comprising industrial wastes/by-products activated through an alkaline solution. The study aims to investigate the feasibility of incorporating quarry rock dust (QRD) into GPC production for environmentally sustainable structural applications. Circular columns (200 mm diameter, 1000 mm length) were formulated using GPC blends with fly ash, slag (SG), and QRD as a partial SG replacement. The structural performance of these columns, with and without steel fiber reinforcement, was evaluated under varied loading conditions. Results show that QRD is a valuable ingredient in GPC for structural concrete elements, offering performance comparable to traditional OPC concrete. Furthermore, the incorporation of steel fibers significantly enhances the peak axial loads, displacement response, and overall performance of GPC columns with or without QRD. Fiber-reinforced GPC columns demonstrated approximately 8-10% higher ultimate load capacity than equivalent OPC columns. Eccentricity was found to significantly reduce ductility, but fiber reinforcement offers substantial ductility improvements (25-55%).

Investigating metal (M = Mn, Fe, and Ni)-doped Co(OH)2 nanofibers for electrocatalytic oxygen evolution and electrochemical biosensing performance.

To achieve efficient and cost-effective electrochemical water splitting, highly active and affordable nanostructured catalysts are the key requirement. The current study presents the investigations of the efficacy of metal (Mn, Fe and Ni)-doped Co(OH)2 nanofibers towards oxygen evolution via water splitting. Notably, Ni-doped Co(OH)2 demonstrates superior OER performance in KOH electrolyte, surpassing standard IrO2 with a modest potential of 1.62 V at 10 mA cm-2. The remarkable activity is attributed to the nanofiber structure, facilitating faster conduction and offering readily available active sites. Ni-doped Co(OH)2 nanofibers displayed enduring stability even after 1000 cycles. This work underscores the importance of transition-metal based catalysts as effective electrocatalysts, providing the groundwork for the development of cutting-edge catalysts. Additionally, the electrochemical sensing capability towards ascorbic acid is evaluated, with Ni-doped Co(OH)2 showing the most promising response, characterized by the lowest LOD and LOQ values. These findings highlight the potential of Ni-doped Co(OH)2 nanofibers for upcoming diagnostic detection devices.

Laser flash photolysis study of Nb2O5/g-C3N4 heterostructures as efficient photocatalyst for molecular H2 evolution.

Improvements of visible light activity, slow recombination rate, stability, and efficiency are major challenges facing photocatalyst technologies today. Utilizing heterostructures of g-C3N4 (bandgap ∼2.7eV) with Nb2O5 (bandgap ∼3.4eV) as an alternative materials for the first time, we tried to overcome such challenges in this work. Heterostructures of Nb2O5/g-C3N4 have been synthesized via hydrothermal technique. And then a time-resolved laser flash photolysis of those heterostructures has been analyzed, focusing on seeking how to improve photocatalytic efficiency for molecular hydrogen (H2) evolution. The transient absorption spectra and the lifetime of charge carriers at different wavelengths have been observed for Nb2O5/g-C3N4, where g-C3N4 was used for a control. The role of hole scavenger (methanol) has also been investigated for the purpose of boosting charge trapping and H2 evolution. The long lifetime of Nb2O5/g-C3N4 heterostructures (6.54165 µs) compared to g-C3N4 (3.1651897 µs) has successfully supported the increased H2 evolution of 75 mmol/h.g. An enhancement in the rate of H2 evolution (160 mmol/h.g) in the presence of methanol has been confirmed. This study not only deepens our understanding of the role of scavenger, but also enables a rigorous quantification of the recombination rate crucial for photocatalytic applications in relation with efficient H2 production.

Fabrication and electrical characterization of p-Cu2O/n-ZnO heterojunction.

The conducting metal oxide (ZnO, Cu2O) films were used for fabrication of p-n heterojunction by rf sputtering and electrodeposition techniques respectively. The as synthesized films were characterized by X-ray diffraction (XRD), scanning electron microscope (SEM), UV spectroscopy and electrical techniques. The electrical properties of the p-Cu2O/n-ZnO heterojunction were examined using the current-voltage measurements. The current-voltage (I-V) result showed that potential barrier was higher than the turn-on voltage, which was attributed to the presence of the interface defect states. The PN junction parameters such as ideality factor, barrier height, and series resistance were determined using conventional forward bias current-voltage characteristics. The annealing of Cu2O increase the crystallinity size and which enhance the photo current from 1.6 mA/cm2 to 3.7 mA/cm2. The annealing of respective film resulted in a decrease of these parameters with an increase in efficiency of solar cell from 0.14% to 0.3% at 350 degrees C.

A Rare Case of Chest Wall Abscess by Nocardia in a Patient With Sarcoidosis.

Nocardia is a rare gram-positive pathogen reported to cause infections in immunocompromised individuals. It usually involves the lungs but may also lead to abscess formation; cases of disseminated nocardiosis have also been reported. We are presenting a case of an Asian male who had sarcoidosis with pulmonary and skin involvement. The patient was on long-term immunosuppressive therapy with corticosteroids with good control of the disease. He developed a fever, weight loss, and right-sided chest pain. CT of the chest showed new nodular infiltrates. Worsening of sarcoidosis was suspected; the corticosteroid dose was increased and methotrexate was started. There was no favorable response to the increase in immunosuppressive therapy. Weight loss was followed by worsening shortness of breath and fluctuant swelling in the right lateral half of the chest. Bronchoalveolar lavage was done to rule out tuberculosis but it did not show any organism's growth. Ultrasound-guided needle aspiration from the abscess was done that showed growth of Nocardia species. Therapeutic dose co-trimoxazole (trimethoprim-sulphamethoxazole) was started as first-line therapy after confirming the organism's drug susceptibility pattern along with needle aspiration of the collection on the chest wall. Immunosuppressive agents were stopped. There was a good response to treatment with resolution of symptoms within two months. However, complete radiological recovery took 10 months. Co-trimoxazole (trimethoprim-sulphamethoxazole) therapy continued for two months after radiological recovery. Physicians, therefore, should keep Nocardia as an important differential diagnosis while treating the immunosuppressed population.

Sarcoidosis: epidemiology, characteristics, and outcomes over 10 years - a single-center study in Pakistan.

BACKGROUND: Sarcoidosis is a multisystem granulomatous inflammatory disease which remains under-diagnosed in a tuberculosis endemic region such as Pakistan. RATIONALE: To determine the distribution, clinical characteristics, diagnostic and treatment modalities and the disease course in the Pakistani population. METHODS: A cross-sectional review of sarcoidosis patients from Jan-1,2010 to Dec-31,2019 was done. Multivariable logistic and cox-regression models were used to identify the independent risk-factors associated with disease relapse. Kaplan-Meier curves were used to assess the DFS. RESULTS: 222 patients, with mean age 44 ± 12 years, predominantly females (57.7%) and mean BMI 29 ± 6 were diagnosed sarcoidosis. Significant co-morbidities affected 36.5%, 90% were nonsmokers, and 50.3% belonged to moderate SES. Total 178 (80.2%) were symptomatic with 115 (51.8%) having multi-organ involvement. Stage-I radiological disease was predominant (52.5%). Histopathological diagnosis was obtained in 161 (72.5%) patients. Out of 113 mediastinal lymph-nodes, NNGI was present in 99, with highest yield in Station-07 (68.6%). Treatment was instituted in 108/178 (60.7%) symptomatic patients with steroids alone and in 26 (14.6%) with S+IS, with better clinical and radiological response duration in patients receiving steroid monotherapy (p-values=0.01 and 0.001,respectively, along with overall higher survival time (p-value = 0.04). Risk factors identified for relapse included high SES (AOR5.52;95%CI(1.10-28.40),0.04), steroid monotherapy (AOR0.22; 95%CI(0.10-0.87),0.03), symptomatic response after one year (AOR3.40; 95%CI(1.02-11.10),0.04), and radiological response duration (AOR1.10; 95%CI(1.05-1.20),0.04). CONCLUSION: Sarcoidosis is a dynamic disease with a variable clinical and geographical spectrum but good overall prognosis.

Elucidating the Etiologies of 18F-fluorodeoxyglucose-Avid Mediastinal Lymph Nodes Among Cancer Patients in a Tuberculosis-Endemic Region Using Endobronchial Ultrasound.

Background Non-malignant conditions, including infections (such as tuberculosis [TB]), can mimic malignancy with regards to their uptake of 18F-fluorodeoxyglucose (18F-FDG) tracer utilized for positron emission tomography-computed tomography (PET-CT) scan, as part of the diagnostic and staging workup of cancer patients. This poses a diagnostic challenge, for which tissue sampling is decisive. In this study, we aimed to determine the underlying etiologies of 18F-FDG-avid mediastinal lymph nodes among cancer patients in a TB-endemic demographic using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and the respective sensitivity and specificity of PET-CT and EBUS in diagnosing malignancy. Methodology In this retrospective cross-sectional study, we analyzed the data of all cancer patients with 18F-FDG-avid mediastinal lymphadenopathy on diagnostic PET imaging, who later underwent EBUS-TBNA between July 2013 and December 2018 at our center. Logistic regression analysis was used to determine the relative risk of lymph node characteristics with malignant TBNA cytology, based on which a risk stratification model was formulated. Results A total of 178 patients were included in this study, comprising predominantly males (60.7%). The primary malignancy was lung cancer in 33 (18.5%) patients, while 145 (81.5%) had non-lung cancer. A total of 214 18F-FDG lymph nodes were sampled, out of which TBNA revealed malignant cytology in only 44 (20.6%). The final diagnosis was malignancy, TB, and sarcoidosis in 42 (23.6%), 16 (9%), and 12 (6.7%) patients, respectively. Among the remaining, 98 (55%) patients were determined to have only reactive lymphadenopathy, of which 24 (24.5%) had nodal anthracosis, while TBNA was inadequate for the diagnosis in 10 (5.6%) patients. An increased risk of malignancy was associated with the size of lymph node [odds ratio (OR): 1.58 (confidence interval (CI): 1.19, 2.11; p = 0.001], the standard uptake value (SUV) of the lymph node on PET-CT [OR: 1.30 (CI: 1.15, 1.45); p = 0.001], and with primary lung malignancy [OR: 4.44 (CI: 1.96, 10.06); p = 0.001]. At an SUV cut-off value of 6.0, PET-CT had the sensitivity, specificity, positive predictive value, and negative predictive value of 73%, 70%, 49.3%, and 91.8%, respectively, for diagnosing malignancy, while the same for EBUS was estimated to be 93.3%, 100%, 100%, and 97%, respectively. Conclusions In addition to TB, benign etiologies including nodal anthracosis and sarcoidosis predominate as causes of 18F-FDG-avid mediastinal lymphadenopathy in cancer patients of a TB-endemic demographic. The predictable risk of malignancy on PET imaging increases with nodal size, SUV, and lung primary malignancy; however, EBUS clearly demonstrates a higher sensitivity.

The Clinicopathological Features of Mediastinal Tuberculous Lymphadenitis in Cancer Patients and the Diagnostic Role of Endobronchial Ultrasound.

Introduction Mediastinal lymphadenopathy in cancer patients can be of both malignant and non-malignant (including infectious) etiology. Tuberculosis (TB) is an important differential in this regard, particularly in regions with high TB endemicity. Objectives To determine the incidence and clinical characteristics of mediastinal tuberculous lymphadenitis (MTBLA) in cancer patients of a TB-endemic region, and the diagnostic role of endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) in such patients, utilizing both cytopathological and microbiological parameters for diagnosing TB. Materials and methods We retrospectively analyzed the relevant clinical data of all cancer patients diagnosed with MTBLA after undergoing EBUS-TBNA at our center, between July 2013 till July 2018 (total five years). The diagnostic yield, sensitivity and specificity of cytopathological and microbiological investigations (including TB culture and Mycobacterium tuberculosis Gene Xpert assay) for diagnosis of MTBLA were determined. Results Of the total 493 cancer patients, MTBLA was diagnosed in 54 (11%), with mean age of 48 ± 12 years, and predominantly male gender (59.3%). Thirty-three (61.1%) patients were clinically asymptomatic at the time of presentation, while cough was reported by 13 (24.7%) patients and weight loss, shortness of breath and fever by only six (11.1%), six (11.1%) and five (9.2%) patients, respectively. Total 53% had an underlying gastrointestinal malignancy. Chest imaging revealed bilateral versus unilateral hilar lymph node enlargement in 32 (59.3%) against 22 (40.7%) patients, respectively, while only 14 (25.9%) had accompanying lung parenchymal findings. Granulomatous TBNA cytology was detected in 41 (77.3%) patients, giving a diagnostic yield of 70.3% for MTBLA, with an estimated sensitivity and specificity of 79.2% and 99%, respectively. TB culture and Gene Xpert had a respective sensitivity of 48% and 53%, with the combined diagnostic yield of 64.8%. Treatment response was achieved in 51 (94%) patients, based on which EBUS was estimated to have sensitivity and specificity of 89% and 99% respectively, with no reported complications. Conclusion Mediastinal TB can have diverse manifestations among cancer patients and can often be clinically occult, with overlapping radiological impressions. EBUS-TBNA can serve as a safe and reliable diagnostic tool in this regard.

Mechanical and Microstructural Characterization of Quarry Rock Dust Incorporated Steel Fiber Reinforced Geopolymer Concrete and Residual Properties after Exposure to Elevated Temperatures.

The purpose of this research is to study the effects of quarry rock dust (QRD) and steel fibers (SF) inclusion on the fresh, mechanical, and microstructural properties of fly ash (FA) and ground granulated blast furnace slag (SG)-based geopolymer concrete (GPC) exposed to elevated temperatures. Such types of ternary mixes were prepared by blending waste materials from different industries, including QRD, SG, and FA, with alkaline activator solutions. The multiphysical models show that the inclusion of steel fibers and binders can enhance the mechanical properties of GPC. In this study, a total of 18 different mix proportions were designed with different proportions of QRD (0%, 5%, 10%, 15%, and 20%) and steel fibers (0.75% and 1.5%). The slag was replaced by different proportions of QRD in fly ash, and SG-based GPC mixes to study the effect of QRD incorporation. The mechanical properties of specimens, i.e., compressive strength, splitting tensile strength, and flexural strength, were determined by testing cubes, cylinders, and prisms, respectively, at different ages (7, 28, and 56 days). The specimens were also heated up to 800 °C to evaluate the resistance of specimens to elevated temperature in terms of residual compressive strength and weight loss. The test results showed that the mechanical strength of GPC mixes (without steel fibers) increased by 6-11%, with an increase in QRD content up to 15% at the age of 28 days. In contrast, more than 15% of QRD contents resulted in decreasing the mechanical strength properties. Incorporating steel fibers in a fraction of 0.75% by volume increased the compressive, tensile, and flexural strength of GPC mixes by 15%, 23%, and 34%, respectively. However, further addition of steel fibers at 1.5% by volume lowered the mechanical strength properties. The optimal mixture of QRD incorporated FA-SG-based GPC (QFS-GPC) was observed with 15% QRD and 0.75% steel fibers contents considering the performance in workability and mechanical properties. The results also showed that under elevated temperatures up to 800 °C, the weight loss of QFS-GPC specimens persistently increased with a consistent decrease in the residual compressive strength for increasing QRD content and temperature. Furthermore, the microstructure characterization of QRD blended GPC mixes were also carried out by performing scanning electron microscopy (SEM), X-ray diffraction (XRD), and energy dispersive spectroscopy (EDS).

Influence of Bentonite on Mechanical and Durability Properties of High-Calcium Fly Ash Geopolymer Concrete with Natural and Recycled Aggregates.

In this study, bentonite (a naturally occurring pozzolana) was incorporated as a partial replacement (up to 20%) for high-calcium fly ash (HCFA)-based geopolymeric natural aggregate concrete (GNAC) and geopolymeric recycled aggregate concrete (GRAC). The mechanical (compressive strength and splitting tensile strength), durability (chloride migration coefficient, water absorption, and acid attack resistance), and rheological properties (slump test, fresh density, and workability) were investigated. The results revealed that incorporation of bentonite (10 wt % with ordinary Portland cement) showed appreciable improvement in the strength and durability of both the GNAC and GRAC, though its effect is more significant for GRAC than the GNAC.

Endobronchial Ultrasound Guided Transbronchial Needle Aspiration Of Mediastinal And Hilar Lymph Nodes- Five Years Of Experience At A Cancer Setting Hospital In Pakistan.

BACKGROUND: Endobronchial Ultrasound (EBUS) guided Transbronchial needle aspiration (TBNA) offers a minimally invasive diagnostic tool for mediastinal lymphadenopathy (ML). This study is done with the objective to determine the diagnostic utility of EBUS TBNA for ML in cancer and non-cancer patients. METHODS: This cross-sectional study, in which data was collected retrospectively included TBNA cytopathology and microbiology results of all patients who underwent EBUS at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore between July 2013 until July 2018. They were analysed to determine sensitivity and specificity of EBUS. RESULTS: Total 609 patients, comprising 362 (59%) male and 470 (77%) cancer patients were included. Mean age was 52±18 years. TBNA cytology was malignant in 118 (25%) cancer and 20 (14%) non-cancer patients. Percentage malignant ML was highest in small cell lung cancer (93%) among thoracic and renal cell carcinoma (35%) among extra thoracic cancers. Only 27% cancer patients with flourodeoxyglucose-18 avid ML had malignant cytology. Sarcoidosis was diagnosed in 115 (19%) patients (sensitivity 91%, specificity 97%) while tuberculosis in 76 (12%) (Sensitivity 87% and specificity 98%). Endobronchial Ultrasound changed management in 76% cancer patients via multidisciplinary meetings with no reported complications and estimated sensitivity and specificity of 98% and 100% respectively. CONCLUSIONS: Endobronchial Ultrasound is an accurate diagnostic tool for ML and can facilitate multidisciplinary cancer care.

The Diagnostic Utility and Clinical Implications of Bronchoalveolar Lavage in Cancer Patients With Febrile Neutropenia and Lung Infiltrates.

Introduction Febrile neutropenia (FN) is a dreaded complication of cancer chemotherapy and frequently associated with respiratory infections. Flexible bronchoscopy (FB) serves as a useful diagnostic tool in this regard. Objective To determine the diagnostic yield, safety and clinical implications of bronchoalveolar lavage (BAL) in cancer patients with FN, having lung infiltrates on radiographic chest imaging. Methods We reviewed medical records of FN patients who underwent FB at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from July 2015 till July 2018. The culture yield of BAL, resultant change of management and outcome over the subsequent 30 days were retrospectively analysed. Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY) was used for data analysis. Results Ninety FN patients, with mean age 26 ± 18 years and predominantly males (65.6%, n = 59) were included in the study. Seventy-seven (85.6%) had hematological and 13 (14.4%) solid organ malignancy. The mean absolute neutrophil count was 0.20 +/- 0.36/ µL. BAL cultures were diagnostic in 40 (44%) patients; the etiology was bacterial, fungal and mixed in 25 (62.5%), 14 (35%) and one (2.5%) patient, respectively. All patients were on empirical antibiotics prior to bronchoscopy: 32 (35.6%) on antibacterial alone and 58 (64.4%) on antibacterial plus antifungal therapy. Change of management occurred in 51 (56.7%) patients after BAL results, including de-escalation from dual antibiotics in 28 (55%) and initiation of new culture sensitive antibiotic in 23 (45%). FB-associated complications developed in three (5.6%) non-intensive care patients (ICU), including transient hypoxia in two and minor hemoptysis in one patient, while five (14.8%) mechanically ventilated patients in ICU experienced worsening of oxygenation parameters within 48 hours. Overall, 24 (26.7%) patients died. Mortality was 3.7% in non-ICU and 69% in ICU setting and significantly higher in patients with fungal pneumonias (p-value 0.01) and with prolonged neutropenia (p-value 0.001). Conclusions BAL is a safe diagnostic tool for FN patients with lung infiltrates, with minimal complications and sufficient diagnostic yield to improve diagnosis and management of such patients.

Indications and clinical outcomes of indwelling pleural catheter placement in patients with malignant pleural effusion in a cancer setting hospital.

BACKGROUND: The placement of indwelling pleural catheters (IPC) is an effective outpatient approach for the management of malignant pleural effusions (MPE). AIMS: The indications and outcome of IPC in patients with MPE. Risk stratifications, prevention and management of IPC-related complications. METHODS: We retrospectively reviewed the clinical data of patients with MPE who underwent IPC insertion from July 2011 to July 2019. The multivariable logistic regression model was used to identify the independent risk factors associated with IPC infection and the Kaplan-Meier method to determine the overall survival. RESULTS: A total of 102 patients underwent IPC insertion during the stipulated period and the mean age was 50.49 ± 14.36 years. Seventy-one (69.6%) were females. The indications were Trap Lung in 38 (37.3%), failed talc pleurodesis in 28 (27.5%) and as a primary intervention in 36 (35.3%). The infection rate was 25.5%, of which 65.4% patients had nosocomial infections. Post-IPC overall median survival time was 9.0 ± 2.50 weeks with highest in patients with trap lung (18 ± 1.50 weeks). In multivariable analysis, following variables were identified as a significant independent risk factor for IPC infection: Multiloculated MPE (AOR 2.80; 95%CI (1.00-9.93), 0.04), trap lung (AOR 7.57; 95%CI (1.39-41.25), 0.01), febrile neutropenia (FN) (AOR 28.55; 95%CI (4.23-19.74), 0.001), IPC domiciliary education (AOR 0.18; 95%CI (0.05-0.66), 0.001) and length of hospital stay (AOR 1.16; 95%CI (1.01-1.33), 0.03). CONCLUSION: IPC insertion is an effective management for MPE with reasonable survival benefits. Infection is the most common complication, of which mostly are nosocomial infections with higher incidence in multiloculated effusions, trap lung, FN and with lack of domiciliary IPC care education.

Predicting the survival in patients with malignant pleural effusion undergoing indwelling pleural catheter insertion.

CONTEXT: Malignant pleural effusion (MPE) is a common comorbid condition in advanced malignancies with variable survival. AIMS: The aim of this study was to predict the survival in patients with MPE undergoing indwelling pleural catheter (IPC) insertion. SETTINGS AND DESIGN: This was a cross-sectional study conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. METHODS: One hundred and ten patients with MPE who underwent IPC insertion from January 2011 to December 2019 were reviewed. Kaplan-Meier method was used to determine the overall survival (OS) of the patient's cohort with respect to LENT score. STATISTICAL ANALYSIS USED: The IBM SPSS version 20 was used for statistical analysis. RESULTS: We retrospectively reviewed 110 patients who underwent IPC insertion for MPE, with a mean age of 49 ± 15 years. 76 (69.1%) patients were females, of which majority 59 (53.6%) had a primary diagnosis of breast cancer. The LENT score was used for risk stratification, and Kaplan-Meier survival curves were used to predict the OS. The proportion of patients with low-risk LENT score had 91%, 58%, and 29% survival, the moderate-risk group had 76%, 52%, and 14% survival, and in the high-risk group, 61%, 15%, and 0% patients survived at 1, 3, and 6 months, respectively. In addition, there was a statistically significant survival difference (P = 0.05) in patients who received chemotherapy pre- and post-IPC insertion. CONCLUSIONS: LENT score seems to be an easy and attainable tool, capable of predicting the survival of the patients with MPE quite accurately. It can be helpful in palliating the symptoms of patients with advanced malignancies by modifying the treatment strategies.

Indications and clinical outcomes of fully covered self-expandable metallic tracheobronchial stents in patients with malignant airway diseases.

BACKGROUND: Airway stenting is an efficacious approach in management of malignant airway disease (MAD) with improvement in survival outcome. OBJECTIVE: To determine the indications and long-term clinical outcomes of tracheobronchial stenting in patients with MAD. METHODS: A cross-sectional review of 51 patients who underwent airway stenting from June 2011 to June 2019 was done. Paired t-test was used to compare mean difference of clinical characteristics between pre- and post-airway stenting. Kaplan-Meier curves were used to assess overall survival. RESULTS: A total of 51 patients had stent insertion with mean age 46.63±17.10years including 27(52.9%) females. Mainly 37(72.5%) patients had esophageal and 06(11.8%) had lung cancer. The main indications were bronchial stenosis 18(35.3%), tracheal stenosis 11(21.6%) and Tracheo-esophageal/bronchial fistula 13(25.5%). Obstruction was intrinsic, extrinsic and mixed in 20(39.2%), 13(25.5%) and 5(9.8%) patients, respectively. There was statistically significant mean difference in pre- and post-procedure oxygen saturation (mean (M)=89.8, standard deviation (SD)=6.70 vs M =95.5,SD=2.54.p =0.001) and performance status (M =3.65,SD =0.6 vs M =2.59, SD=0.83.p =0.001). Overall median survival was 16±3.44 weeks, highest amongst patients with intrinsic obstruction (27±6.51 weeks). CONCLUSION: Airway stenting is an effective endoscopic procedure to re-establish airway patency in MAD with minimal complications..

Synthesis of SPIONs-CNT Based Novel Nanocomposite for Effective Amperometric Sensing of First-Line Antituberculosis Drug Rifampicin.

It is necessary to study the possible interactions among various chemical surfaces and analytes before applying them to biological systems. We report the synthesis of carbon nanotubes-iron oxide (SPIONs-CNT) nanocomposite material by using lecithin stabilized superparamagnetic iron oxide nanoparticles (SPIONs) obtained by facile hydrothermal technique. Various characterizations of the obtained nanocomposite were carried out and electrochemical studies were performed further to study the interaction capabilities of the nanocomposite with anti-TB drug Rifampicin. Obtained results by cyclic voltammetric studies of SPIONs-CNT nanocomposite with limit of detection (LOD) of 1.178 µM showed the enhanced electrochemical sensitivity and selectivity of anti-tuberculosis (anti-TB) drug Rifampicin (RIF).