Heated tobacco products- well known or well understood? A national cross-sectional study on knowledge, attitudes and usage in Pakistan.

BACKGROUND: Heated tobacco products (HTPs) are reshaping the tobacco industry and just recently, a plan was sought to regularize HTPs in Pakistan. Pakistan provides an intriguing case study in this context, as tobacco use is deeply ingrained in public use. To ensure that future evidence-based policy recommendations are grounded in the public's knowledge, attitudes, and usage of HTPs, a nationwide survey must be conducted. METHODS: A cross-sectional study was conducted using an online-based questionnaire nationwide in Pakistan. The questionnaire was validated and distributed through convenience sampling. The questionnaire assessed participants' knowledge, attitudes, and usage of HTPs. Descriptive statistics was used to describe participants' response and linear regression was performed at a p-value of < 0.05 using SPSS version 26. RESULTS: In our sample of 1195 respondents (mean age of 33 years, 41.8% males and 58.2% females), 54.7% had previously heard about HTPs and 16.9% reported using HTPs at least once. Additionally, 38.24% were unsure of the legality of HTP use. Those with monthly household incomes of PKR 100,000 to 500,000, were more likely to have higher knowledge scores (OR:1.80[1.07-3.04]). On the other hand, males (OR:0.70 [0.55-0.89]) and respondents from Balochistan (OR:0.40 [0.22-0.71]) were more likely to have lower knowledge scores. The strongest motivators were the enjoyability of HTPs (55.73%) and usage as a cigarette alternative (54.64%), while the strongest deterrents were the negative health effects (82.68%) and potential for addiction (81.01%). CONCLUSION: Our study underscores the need for awareness campaigns and interventions concerning HTPs, given prevalent preconceived notions and mixed attitudes among respondents. It was found that women and households with higher incomes scored higher on knowledge. Subjective enjoyment and a substitute for cigarettes were important motivators, but the most mentioned deterrents were the possibility of addiction and the detrimental effects on health. These insights form the basis for informed policy making for non-cigarette tobacco products.

Allergic bronchopulmonary aspergillosis: radiological and microbiological profile of patients presented in an outpatient pulmonary clinic in a developing country.

There is limited data available about allergic bronchopulmonary aspergillosis (ABPA) in Pakistan. The aim of the study was to describe the radiological and microbiological profile of ABPA patients presenting to the outpatient pulmonary clinic of a tertiary care hospital in Karachi, Pakistan. A retrospective study was conducted on ABPA patients who presented to the pulmonary outpatient clinic at Aga Khan University Hospital, Karachi, Pakistan, from January 2017 to December 2019. Data was collected on microbiology and radiology features on predesigned proforma. A total of 7759 asthmatic patients presented at the outpatient pulmonology clinic during the study period. Of the 245 patients labeled as ABPA, 167 fulfilled the inclusion criteria, and 91 (54.5%) were female (mean age 41.9±13.0 years). A high resolution computed tomography scan of the chest was available for 126 patients. Of these, 104 (82.5%) patients had bronchiectasis. Central bronchiectasis was noted in 98 (94.2%), mucus plugging in 71 (56.3%), and hyperinflation was seen in 30 (23.4%) patients. Microbiological testing was available in 103/167 (61.7%) patients. The most common bacterial pathogen was Pseudomonas aeruginosa 32 (31.1%), followed by Hemophilus influenzae 16 (15.5%), and Moraxella catarrhalis 7 (9.7%). Aspergillus fumigatus 17 (23.6%) was the most common mold, followed by Aspergillus flavus 16 (22.2%) and Aspergillus niger 11 (15.3%). Co-infection (bacterial and fungal) was found in 18 (17.45%) patients. Bronchiectasis was frequently observed in our cohort of patients with ABPA. Pseudomonas aeruginosa was found to be common among bacterial pathogens. Isolation of fungus is not uncommon in these patients.

Post-COVID-19 sequelae of the respiratory system. A single-centre experience reporting the compromise of the airway, alveolar and vascular components.

The long-term sequelae of COVID-19 have now become more common and appreciable. The SARS-CoV-2 virus can cause a variety of infectious and non-infectious pulmonary complications. The purpose of this study is to raise awareness about post-COVID-19 pulmonary sequelae, both infectious and non-infectious, in this geographical area. A retrospective study was conducted from July 1st 2020 to December 20th 2020. A total of 1200 patients were evaluated, with 83 suffering from post-COVID-19 pulmonary complications. The patients' mean age was 62 years (IQR 55-69), with 63 (75.9%) being male. The most common co-morbid illnesses were hypertension (49, 59%) and diabetes (45, 54.2%). The majority of them (37, 44.6%) had severe COVID-19, followed by critical COVID-19 (33, 39.8%). There was no statistically significant difference in recurrence of respiratory symptoms or duration of current illness between non-severe, severe, and critical COVID-19 patients. Non-infectious complications were observed in the majority of patients (n=76, 91.5%), including organizing pneumonia/ground glass opacities in 71 (88%) patients, fibrosis in 44 (55%), pulmonary embolism in 10 (12.5%), pneumomediastinum in 6 (7.4%) and pneumothorax in 7 (8.6%). Infective complications (25, 30.1%) included aspergillus infection in 10 (12.0%) and bacterial infection in 5 (8.47%), with more gram-negative infections and one patient developing Mycobacterium tuberculosis. Post COVID-19 mortality was 11 (13.3%). The long-term pulmonary sequelae of COVID-19 are not rare. Cryptogenic organizing pneumonia, ground glass opacities, and fibrosis were common post-COVID-19 sequelae in our patients. This necessitates frequent close monitoring of these patients in order to initiate early appropriate management and prevent further morbidity and eventual mortality.

Post COVID-19 tuberculosis: An emerging threat of pandemic.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has hit the world hard. Millions of people have died due to the infection and several have suffered with what are now known as post COVID-19 squeal. Among these squeals one is immunosuppression which leaves patients prone to severe opportunistic infection. We here report a case of young female who was infected by COVID-19 and later developed cavitary pneumonia which upon investigation turned out to be due to mycobacterium tuberculosis.  Through this report we aim to highlight the importance of high index of suspicion for infection like Mycobacterium tuberculosis after COVID-19 infection which developed in a healthy immunocompetent patient.

Respiratory pathogens in patients with acute exacerbation of non-cystic fibrosis bronchiectasis from a developing country.

Bronchiectasis unrelated to cystic fibrosis (non-CF bronchiectasis) has become a major respiratory disease in developing nations. The dilated mucus filled airways promote bacterial overgrowth followed by chronic infection, bronchial inflammation, lung injury and re-infection. Accurate pathogen identification and antimicrobial susceptibility allowing appropriate treatment, in turn, may break this vicious cycle.  This study aimed to gain kowledge about the spectrum and antimicrobial spectrum of pathogen yielded from respiratory specimens in adult patients with acute exacerbation of non-cystic fibrosis (CF) bronchiectasis. This cross-sectional study was performed at the pulmonology clinics of the Aga Khan University, Karachi, Pakistan from 2016-2019. Respiratory specimens were collected from adult patients with acute exacerbation of non-CF bronchiectasis presenting in pulmonology clinics. Microbial cultures were performed using standard methodology. Susceptibility testing was performed and interpreted using Clinical Laboratory Standard Institute criteria.  A total of 345 positive cultures from 160 patients presenting with acute exacerbation were evaluated. The most frequent organisms were Pseudomonas aeruginosa (n=209) followed by Hemophilus influenzae (n=40) and Staphylococcus aureus (n=24). High rates of antimicrobial resistance were found in all these pathogens. Proportion of Pseudomonas aeruginosa strains resistant to ciprofloxacin, imipenem, ceftazidime and piperacillin-tazobactam were 27.1%, 16.8%, 14.8% and 13.1% respectively. 65% of Hemophilus influenzae strains were resistant to cotrimoxazole and ciprofloxacin and 66.7% of Staphylococcus aureus strains were resistant to methicillin. High antimicrobial resistance in non-CF bronchiectasis patients against commonly used antimicrobials is a concern and highlight need for urgent community level interventions to improve clinical outcome in these patients.

Comparative analysis of connective tissue disease-associated interstitial lung disease and idiopathic pulmonary fibrosis from a tertiary care centre in Pakistan.

OBJECTIVE: To compare the characteristics of connective tissue disease-associated interstitial lung disease with idiopathic pulmonary fibrosis at a tertiary care hospital. METHODS: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised demographical, clinical and radiological data of patients with interstitial lung disease between October 2016 and October 2017 accessed through the outpatient data registry. Data was compared in terms of characteristics and key features of patients with connective tissue disease-associated interstitial lung disease with those of idiopathic pulmonary fibrosis. Statistical analysis was done using STATA 12. RESULTS: Of the 184 patients, 52(29.3%) had connective tissue disease-associated interstitial lung disease and 62(35%) had idiopathic pulmonary fibrosis. The most prevalent conditions among connective tissue disease-associated interstitial lung disease patients were rheumatoid arthritis 22(42.3%) and scleroderma 13(25%). Compared to patients with idiopathic pulmonary fibrosis, those with connective tissue disease-associated interstitial lung disease were predominantly younger (p<0.001) and female (p<0.001). History of gastroesophageal reflux disease was also significantly lower in connective tissue disease-associated interstitial lung disease (p=0.05). CONCLUSIONS: Connective tissue disease-associated interstitial lung disease patients were found to be younger and predominantly female compared to patients of idiopathic pulmonary fibrosis.

Idiopathic pulmonary hemosiderosis - A rare cause of chronic anemia.

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease marked by alveolar bleeding and accumulation of hemosiderin in the lungs. Here we present three cases of IPH. The first case is of a 26-year-old male with anemia, hemoptysis and dyspnea. Bronchoscopy confirmed diffuse alveolar hemorrhage (DAH). A diagnosis of IPH was made after ruling out other causes of DAH and observing good response to steroids. The patient's condition improved with prednisolone and azathioprine. The second case is of 26-year-old female with severe anemia. Imaging suggested IPH and lung biopsy confirmed it. She died shortly afterwards. The third case is of a 7-year-old male with chronic anemia. CT was suggestive of IPH and lung biopsy confirmed the diagnosis. Later, patient developed posterior reversible encephalopathy syndrome (PRES). This patient is stable on azathioprine and prednisolone. We aim to emphasize the importance of considering IPH as a differential in patients with DAH or chronic anemia.

Matched-paired analysis of patients treated for invasive mucormycosis: standard treatment versus posaconazole new formulations (MoveOn).

BACKGROUND: First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability. OBJECTIVES: Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment. METHODS: We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction). RESULTS: Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp]. CONCLUSIONS: Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.

Cancer and how the patients see it; prevalence and perception of risk factors: a cross-sectional survey from a tertiary care centre of Karachi, Pakistan.

BACKGROUND: The incidence of cancer is rising but data available regarding prevalence of cancer and patient perception of the disease in Pakistan is limited. It is difficult to deal with Cancer if the main causes are negligence towards risk factors and bizarre myths. This study was aimed to investigate common cancer presentations at a government sector hospital and to gain insight into patient knowledge of the disease. METHODS: This was a cross-sectional study conducted on cancer patients from Jinnah Postgraduate Medical Centre. A self-made questionnaire was used to assess the norms related to cancer prevalence in our society, associated myths, and the most common risk factors per them. RESULTS: A total of 402 participants consented to participate in the study (mean age 42.3 ± 15.07 years), 204(50.7%) were females and 190(47.3%) were illiterate. Biomass exposure was found in 147(37%), drug abuse in 132(33%) and smoking in 63(16%). We found 103(25.6%) had positive family histories of cancer. The most common primary tumor site was breast for females 98(48%) and Head and neck 66(33.3%) for males. Patients considered fate 328(82%), gutka 284(71%) and injuries 282(70%) as the most common causes for cancer; while 222(55.5%) considered black magic and 236(58.75%) considered evil eye as a risk factor for cancer. Cancer treatment caused significant financial stress in 376(93.5%) patients. CONCLUSION: Breast and head and neck cancers were found to be prevalent among patients. It was noted that patients are negligent in daily life regarding the consumption of substances that commonly cause cancer. Individuals had diminished knowledge and majority linked cancer to unrelated causes and myths like black magic and fate. Almost all the patients complained of severe financial stress imposed by the disease.

Etiology and outcome of pulmonary renal syndrome: Retrospective study from a tertiary care hospitaln.

To determine the aetiology, clinical characteristics and outcome of patients admitted with pulmonary renal syndrome (PRS). This retrospective analysis was conducted at Aga Khan University Hospital from 2011 to 2015. A total of 17 adult patients admitted with PRS were included and followed up for a period of one year for the outcome of PRS as recovery, dialysis dependency or death. Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) was found to be the single most frequent cause in 13 (76.4%) patients. The c o mm o n e s t c a u s e o f A AV w a s fo u n d t o b e Granulomatous polyangitis (GPA) in 10 (58.8%) followed by Microscopic angitis in 3 (17.6%) patients. Around 12 (70.5%) patients survived, 11 (64.7%) recovered while 1 patient remained dialysis dependent. Mortality rate was 29.4% and all these patients had severe alveolar haemorrhages. None of our patient died or relapsed during one year follow up.

Water Pipe (shisha) Use and Legislation Awareness Against Shisha Smoking Among Medical Students: A study from Karachi, Pakistan.

The aim of the study was to determine the prevalence of shisha smoking; its associated factors and awareness among medical students of Karachi, Pakistan following the imposition of nationwide shisha ban. A cross sectional study was conducted among medical students of two medical universities, namely Sindh Medical College and Aga Khan University Karachi, Pakistan from October till December 2014. A total of 422 participants were included. Data was collected via a self-administered questionnaire. The mean age was 21 ± 1.6 years and 229 (54.26 %) were females. Shisha smoking was found to be relatively common among medical students; the prevalence being 21.5 % out of which 73.62 % were males and belonged to a private medical college p value < 0.001. Majority of those who smoked shisha were aware that it contains tobacco (59.34 %), it has no filtration system (42.85 %), it is harmful (91.20 %) and 47.25 % held the opinion that shisha was not any better than cigarettes. It was alarming that majority students were aware of its harmful effects. However, a significant lack of awareness of the legislation against shisha was found among students.

Fungal empyema thoracis, a rare but an emerging entity: a retrospective case series from Pakistan.

Background and objective: Fungal empyema is a rare entity which is associated with high mortality. It is mostly seen in immune-compromised hosts. However, there is limited data available on fungal empyema from developing countries regarding risk factors, treatment, and outcome. This study was conducted to determine the risk factors, clinical features, treatment, and outcome of fungal empyema. Methods: A retrospective observational study was performed on proven fungal empyema cases, admitted at Aga Khan University Hospital, Karachi, Pakistan during January 2018 to May 2021. We excluded all those patients with polymicrobial bacterial and fungal empyema or with negative pleural fluid cultures. A preformed questionnaire was filled out for each case. Results: A total of 26 patients were diagnosed with fungal empyema with a mean age of 43.6 ± 20.3 years. Of these, 16 (61.5%) patients were male. Diabetes mellitus was the most frequent comorbidity (n = 11, 42.3%), followed by hypertension (n = 9, 34.6%), malignancy (n = 6, 23.1%), and asthma (n = 1, 3.8%). Ten (38.5%) patients had multiple comorbidities. Candida spp. was isolated in 21 (80.8%) patients and Aspergillus spp. in 7 (26.9%) patients. Fusarium spp. was isolated from one (3.9%) patient. Video-assisted thoracoscopy surgery was done in 14 (53.8%) patients and 12 (46.1%) patients were managed with tube thoracostomy. Twenty-one (80.8%) patients received antifungal agents. Overall, in-hospital mortality was 38.5% (n = 10) and all patients developed respiratory failure. Clinical improvement was seen in 16 (61.5%) patients. Conclusion: Our data suggest that fungal empyema has a poor outcome as almost one-third of our patients died. Early diagnosis and intervention can improve outcome.

Fungal Empyema; A Case series from Pakistan • This study was carried out as there are limited data available globally on fungal empyema. • We conducted a retrospective case study of 26 patients and our findings suggest that the fungal empyema has a poor outcome. • One third of our patients died during hospital stay. • Early diagnosis and treatment are important in fungal empyema. • Diabetes mellitus was found as a possible risk factor for fungal empyema, which should be evaluated further in future studies.

Controlled Alignment of Carbon Black Nanoparticles in Electrospun Carbon Nanofibers for Flexible Films.

Carbon nanofiber (CNF) films or mats have great conductivity and thermal stability and are widely used in different technological processes. Among all the fabrication methods, electrospinning is a simple yet effective technique for preparing CNF mats, but the electrospun CNF mats are often brittle. Here, we report a feasible protocol by which to control the alignment of carbon black nanoparticles (CB NPs) within CNF to enhance the flexibility. The CB NPs (~45 nm) are treated with non-ionic surfactant Triton-X 100 (TX) prior to being blended with a solution containing poly(vinyl butyral) and polyacrylonitrile, followed by electrospinning and then carbonization. The optimized CB-TX@CNF mat has a boosted elongation from 2.25% of pure CNF to 2.49%. On the contrary, the untreated CB loaded in CNF displayed a lower elongation of 1.85% because of the aggregated CB spots created weak joints. The controlled and uniform dispersion of CB NPs helped to scatter the applied bending force in the softness test. This feasible protocol paves the way for using these facile surface-treated CB NPs as a commercial reinforcement for producing flexible CNF films.

Clinical characteristics, outcome, and factors associated with mortality of pulmonary mucormycosis: a retrospective single-center study from Pakistan.

Introduction and objective: Pulmonary mucormycosis is a rare but rapidly progressive fatal disease. Limited data exist on the outcomes and factors associated with poor prognosis of pulmonary mucormycosis. The objective of this study was to evaluate clinical characteristics, factors associated with mortality, and outcomes of pulmonary mucormycosis at a tertiary care hospital in Pakistan. Methods: This was a retrospective observational study conducted at a tertiary care hospital in Karachi, Pakistan. Medical records of hospitalized patients diagnosed with proven or probable pulmonary mucormycosis between January 2018 and December 2022 were reviewed. Univariate and regression analyses were performed to identify factors associated with mortality. Results: Fifty-three pulmonary mucormycosis patients (69.8% male) were included, with mean age of 51.19 ± 21.65 years. Diabetes mellitus was the most common comorbidity [n = 26 (49.1%)]. Chronic lung diseases were present in [n = 5 (9.4%)], and [n = 16 (30.2%)] had concurrent coronavirus disease 2019 (COVID-19) pneumonia. The predominant isolated Mucorales were Rhizopus [n = 32 (60.3%)] and Mucor species [n = 9 (17%)]. Main radiological findings included consolidation [n = 39 (73.6%)] and nodules [n = 14 (26.4%)]. Amphotericin B deoxycholate was prescribed in [n = 38 (71.7%)], and [n = 14 (26.4%)] of patients received combined medical and surgical treatment. The median [interquartile range (IQR)] hospital stay was 15.0 (10.0-21.5) days. Intensive care unit (ICU) care was required in [n = 30 (56.6%)] patients, with 26 (49.1%) needing mechanical ventilation. Overall mortality was seen in 29 (54.7%) patients. Significantly higher mortality was found among patients requiring mechanical ventilation 20/29 (69%, p = 0.002). Immunosuppression (p = 0.042), thrombocytopenia (p = 0.004), and mechanical ventilation (p = 0.018) were identified as risk factors for mortality on multivariable analysis. Conclusion: This study provides essential insights into the clinical characteristics, outcomes, and mortality factors associated with pulmonary mucormycosis. The mortality rate was high (54.7%), particularly in patients with immunosuppression, thrombocytopenia, and those who required mechanical ventilation.

Pre Dialysis care and types of Vascular Access Employed in Incident Hemodialysis Patients: A study from Pakistan.

OBJECTIVE: To determine frequency of different vascular access use in Incident hemodialysis (HD) patients and determine whether predialysis care in terms of timely advice for vascular access placement was better in the hands of nephrologist. METHODS: A cross sectional study was conducted. Data was collected on the type of access used for first HD, including temporary Central venous catheters (CVC), permanent CVC (Permacath), arteriovenous fistula (AVF), or arteriovenous graft (AVG). In addition, information was also gathered if patients were aware of their renal disease and was followed by other physicians or nephrologist. RESULTS: A total of 120 patients were enrolled in the study, 80% required CVC as their first access for HD (96/120 patients) out of which 74.2% were dialyzed through temporary catheter and 5.8% through Permacath. About 20% of patients were dialyzed through mature Arteriovenous (AV) access. Majority (95.8%) of patients were being followed by any health care provider. 68% of them were aware of their renal disease. About 55.8% were referred to nephrologist and 40% were followed by other physicians. About 83.5% of patients followed by nephrologist were advised AV access prior to commencing HD, compared to only 10.4% followed by other physicians (p<0.05). 24/61 (39.3%) patients that were advised AV access by both groups had timely made AV access and underwent HD by it. CONCLUSION: Very high incidence of temporary HD catheter was used in Incident HD patients. Moreover, pre dialysis care in terms of placement of AV access prior to initiating HD is better in the hands of nephrologist and patients should be timely referred to nephrologist especially when they have Stage 4 chronic kidney disease (CKD).

Bilateral pneumothorax in a patient with angiosarcoma of the scalp: a case report.

BACKGROUND: Angiosarcoma is a rare, vascular malignancy that arises from endothelial cells of blood vessels. This case report aims to create the awareness of its existence in the region and its mode of presentation. CASE PRESENTATION: A 63-year-old Pakistani man presented to the emergency department with sudden bilateral chest pain and shortness of breath for 2 days. On examination, a scalp lesion was seen which had been increasing in size over the last 6 weeks. The lesion was 8 × 10 cm in size with an irregular border, non-tender, violet and dome-shaped in elevation on the right occipito-parietal lobe of the skull. Chest computed tomography (CT) showed multiple cystic lesions on both lungs, patchy areas of ground-glass opacities, nodules of variable sizes and bilateral pneumothorax. Bilateral tube thoracostomy was performed which provided symptomatic relief for shortness of breath. His bronchoalveolar lavage (BAL) was negative for infection. He underwent biopsy of scalp lesion which was positive for aggressive angiosarcoma. CONCLUSION: Bilateral spontaneous pneumothorax can be the initial manifestation of aggressive cutaneous angiosarcoma and frequently leads to respiratory failure. Early recognition is essential to prevent delay in diagnosis and management.

One-step sonochemical fabrication of biomass-derived porous hard carbons; towards tuned-surface anodes of sodium-ion batteries.

A facile one-step sonochemical activation method is utilized to fabricate biomass-derived 3D porous hard carbon (PHC-1) with tuned-surface and is compared with the conventional two-step activation method. As raw biomass offers good KOH impregnation, ultrasonication power diffuses both K+ and OH- ions deep into its interior, creating various nanopores and attaching copious functional groups. In contrast, conventional activation lacks these features under the same carbonization/activation parameters. The high porosity (1599 m2/g), rich functional groups (O = 8.10%, N = 0.95%), and well-connected nanoporous network resulting from sonochemical activation, remarkably increased specific capacity, surface wettability, and electrode stability, consequently improved electrochemical performance. Benefiting from its suitable microstructure, PHC-1 possesses superior specific capacity (330 mAh/g at 20 mA/g), good capacity retention (89.5%), and excellent structural stability over 500 sodiation/desodiation cycles at high current density (1000 mA/g). Apart from modus operandi comparison, the two activation methods also provide mechanistic insights as the low-voltage plateau region and graphitic layers decrease simultaneously. This work suggests a scalable and economical approach for synthesizing large-scale activated porous carbons that are used in various applications, be it energy storage, water purification, or gas storage, to name a few.

Free-Standing, Self-Doped Porous Hard Carbon: Na-Ion Storage with Enhanced Initial Coulombic Efficiency.

The use of porous hard carbons (PHCs) as electrode materials in sodium-ion batteries has great potential; however, the exposure of large surface areas to electrolyte flow results in irregular and irreversible solid electrolyte interfaces (SEIs), leading to deteriorated ionic and electronic mobility and inferior initial Coulombic efficiency (ICE). These issues can be addressed through suitable structural modifications of PHC materials. Herein, the integration of high-surface-area PHCs with carbon nanofibers (CNFs) was accomplished by a simple electrospinning technique, which resulted in a uniform and reversible SEI layer. In the meantime, the CNFs' mesh provided connectivity and conductivity in the as-integrated electrodes, whereas PHCs offered fast diffusion kinetics and high Na+ ion storage capacity. Additionally, PHC integration with CNFs demonstrated an excellent ICE of 77% and a specific capacity of 505 mAh/g at 25 mA/g. Furthermore, the conjugated microstructure also provided flexibility and stability to the electrode (260 mAh/g after 500 cycles). This remarkable synergy may promote the development of free-standing, flexible, and highly porous properties in a single material for advanced energy storage applications.

"Allergic bronchopulmonary aspergillosis misdiagnosed as smear negative pulmonary tuberculosis; a retrospective study from Pakistan".

BACKGROUND: Undiagnosed allergic bronchopulmonary aspergillosis (ABPA) can lead to chronic persistent symptoms. In country like Pakistan where tuberculosis (TB) is endemic, a significant proportion of ABPA patients are misdiagnosed as smear negative TB before reaching a diagnosis of ABPA due to chronicity of symptoms.This lead to empiric use of ATT(Anti-tuberculous therapy) and delay in primary diagnosis. The aim of the study is to determine such proportion of ABPA patients. MATERIAL AND METHODS: This retrospective study was conducted at the outpatient pulmonology clinic of a tertiary care hospital in Karachi, Pakistan from January 2017 to December 2018. Xpert MTB/Rif, TB smear and culture were performed in all patients to rule out active TB. RESULTS: A total 167 of ABPA patients were included. Mean age of the patients was 41.9 ± 13.0 years, 91(54.5%) were female and 71 (42.5%) patients had received ATT in past. Out of these 71 patients, 63 (88.7%) patients were diagnosed as smear negative TB and received empiric ATT. Among 63 patients, 52 (82.5%) patient had received ATT once, 8 (12.6%) twice and 3 (4.7%) patients had received empiric ATT thrice. Of these 27 (16.16%) patients had already developed long term complications at the time of diagnosis of ABPA and 17 (62.96%) patients were in empiric TB treatment group. CONCLUSION: Patient with ABPA frequently received empiric ATT as smear negative TB in high TB burden country. This results in over diagnosis of TB and unnecessary use of global resource. When Gene Xpert negative alternate diagnosis should be considered.

Trichosporon Species and Fusarium Species as a Cause of Empyema Thoracis in a Diabetic Patient.

Of late, fungal infections are increasingly being recognized in diabetic patients. Here we present a case of polymicrobial fungal empyema due to Trichosporon species and Fusarium species developed after community-acquired pneumonia in a diabetic patient. Trichosporon species are basidiomycetous yeast and Fusarium species are soil saprophytes with a worldwide distribution. Fungal empyema cases are rare and are mostly caused by Aspergillus and Candida species. Polymicrobial fungal empyema with Trichosporon species and Fusarium species has not been reported previously. Our patient was successfully treated with antifungal therapy. This case highlights that fungal empyema should be considered in diabetic patients especially if they are not responding to antibiotics.