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Background Childhood multidrug-resistant TB (MDR-TB) still affects around 25000 children every year across the globe. Though the treatment success rates for drug-resistant TB (DR-TB) in children are better than adults, children and adolescents face unique hurdles during DR-TB (MDR-TB, Pre-XDR TB and XDR-TB) treatment. This study aimed to understand the patients, guardians and healthcare providers’ perspectives about DR-TB treatment journey of patients and caregivers. Methods This is a qualitative study involving in depth-interviews of purposively selected adolescents (n = 6), patients guardians (for children and adolescents, n = 5) and health care providers (n = 8) of Médecins Sans Frontières (MSF) clinic, Mumbai, India. In-depth face to face interviews were conducted in English or Hindi language using interview guides during September-November 2019. The interviews were audio-recorded after consent. Thematic network analysis was used to summarize textual data. ATLAS.ti (version 7) was used for analysis. Result The age of adolescent patients ranged from 15–19 years and four were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers (including clinicians- 2, DOT providers-2, counselors-2 and programme managers-2) were interviewed. The overarching theme of the analysis was: Challenging DR-TB treatment journey which consisted of four sub-themes: 1) physical-trauma, 2) emotional-trauma, 3) unavailable social-support and 4) non-adapted healthcare services. Difficulties in compounding of drugs were noted for children while adolescents shared experiences around disruption in social life due to disease and treatment. Most of the patients and caregivers experienced treatment fatigue and burnout during the DR-TB treatment. Participants during interviews gave recommendations to improve care. Discussion The TB programmes must consider the patient and family as one unit when designing the package of care for paediatric DR-TB. Child and adolescent friendly services (paediatric-formulations, age-specific counselling tools and regular interaction with patients and caregivers) will help minimizing burnout in patients and caregivers.

Working or WERKing on a wearable technology project in a transdisciplinary group can be an effective way of learning new skills and collaboration techniques. This paper describes a case study of running a wearable technology group project within an undergraduate course entitled Wearable Technology and Society. The computational media students in the class collaborated with outside performance artists (drag queens and a street dancer) to create interactive performance garments. Design methods such as the use of boundary objects aided in communication of ideas and cooperation across disciplines and cultural barriers. The requirement that the interactive garment function appropriately in a real performance lent urgency and gravity to the experience, motivating cohesive and expedited problem solving in the transdisciplinary group. The use of these methods on a project with real world outcomes and consequences facilitated an authentic learning experience for the students involved.

Inflammatory myofibroblastic tumours (IMT) are a rare cause of endobronchial masses in adults. Surgery has been the mainstay of treatment of endobronchial IMTs, based on the potential for recurrence. Interventional pulmonology has emerged as a minimally invasive and lung function preserving modality in management of airway obstruction due to tumours. We present a series of three adult patients with IMT treated endobronchially with a short discussion on its potential role. We also discuss how molecular analysis of IMTs for mutations in genes such as ALK and ROS1 might provide insights into clinical behaviour and potential targetable therapy in advanced, unresectable and metastatic cases., Inflammatory myofibroblastic tumours in central airways: bronchoscopic treatment of a “not so pseudo-” tumour https://bit.ly/2KgPntq

Manganese oxides of octahedral molecular sieve (OMS-2) type have important applications in oxidation catalysis, adsorption, and as battery materials. The synthesis methods employed determine their morphology and textural properties which markedly affect their catalytic activity. In this work, a room temperature ultrasonic atomization assisted synthesis of OMS-2 type materials is demonstrated. This synthesis differs from previously reported methods in that it is a simple, no-heat application that leads to a striking morphological characteristic of uniformly sized OMS-2 fibers and their self-assembly into dense as well as hollow spheres. Control of various parameters in the ultrasonic atomization assisted synthesis led to OMS-2 with high surface areas (between 136-160 m2 g-1) and mesoporosity. Catalytically these materials have higher activities in the oxidation of hydroxymethylfurfural (HMF), a bio-based chemical, (65% conversion of HMF vs. 14% with conventional OMS-2 catalyst) and a higher adsorption of lead from aqueous solutions (70% vs. 12% in conventional OMS-2 materials).

Background Childhood and adolescent drug-resistant TB (DR-TB) is one of the neglected infectious diseases. Limited evidence exists around programmatic outcomes of children and adolescents receiving DR-TB treatment. The study aimed to determine the final treatment outcomes, culture conversion rates and factors associated with unsuccessful treatment outcome in children and adolescents with DR-TB. Methods This is a descriptive study including children (0–9 years) and adolescents (10–19 years) with DR-TB were who were initiated on ambulatory based treatment between January 2017-June 2018 in Shatabdi hospital, Mumbai, India where National TB elimination programme(NTEP) Mumbai collaborates with chest physicians and Médecins Sans Frontières(MSF) in providing comprehensive care to DR-TB patients. The patients with available end-of-treatment outcomes were included. The data was censored on February 2020. Result A total of 268 patients were included; 16 (6%) of them were children (0–9 years). The median(min-max) age was 17(4–19) years and 192 (72%) were females. Majority (199, 74%) had pulmonary TB. Most (58%) had MDR-TB while 42% had fluoroquinolone-resistant TB. The median(IQR) duration of treatment (n = 239) was 24(10–25) months. Median(IQR) time for culture-conversion (n = 128) was 3(3–4) months. Of 268 patients, 166(62%) had successful end-of-treatment outcomes (cured-112; completed treatment-54). Children below 10 years had higher proportion of successful treatment outcomes (94% versus 60%) compared to adolescents. Patients with undernutrition [adjusted odds-ratio, aOR (95% Confidence Interval, 95%CI): 2.5 (1.3–4.8) or those with XDR-TB [aOR (95% CI): 4.3 (1.3–13.8)] had higher likelihood of having unsuccessful DR-TB treatment outcome. Conclusion High proportion of successful treatment outcome was reported, better than global reports. Further, the nutritional support and routine treatment follow up should be strengthened. All oral short and long regimens including systematic use of new TB drugs (Bedaquiline and Delamanid) should be rapidly scaled up in routine TB programme, especially for the paediatric and adolescent population.

Mesoporous iron oxides (2-line ferrihydrite, α-Fe2O3, γ-Fe2O3, and Fe3O4) are successfully synthesized by modifying the reaction temperatures and calcination atmospheres of the sol–gel-based inverse micelle method. Different characterization techniques, such as PXRD, N2 sorption, SEM, HRTEM, Raman spectroscopy, and XANES, are performed to determine the properties of the catalysts. Larger pore sizes can be obtained in mesoporous γ-Fe2O3 and Fe3O4 compared with mesoporous 2-line ferrihydrite and α-Fe2O3. The catalytic performance of mesoporous iron oxides are examined as Fenton catalysts in orange II degradation in the presence of oxidant H2O2 at neutral pH under visible light. Adsorption capacities of mesoporous iron oxides on orange II are greater than that of commercial Fe2O3. The greatest adsorption capacity is found to be 49.3 mg/g with mesoporous 2-line ferrihydrite. In addition, the degradation efficiency of orange II is found to be markedly improved by mesoporous iron oxides compared with the commer...

Primary pulmonary tuberculosis can involve regional lymph nodes which may resolve spontaneously or on treatment; or they may enlarge causing extrinsic bronchial compression; or cause endobronchial inflammation and ulceration; or a node may erode through the bronchial wall with extrusion of caseous materials into the bronchial tree, causing focal or lobar pneumonia. This erosion is seen radiologically as hilar lymphadenopathy, with atelectasis and consolidation and described as "epituberculosis". It is more common in infants than older children. We hereby describe the case of a 13-year-old child with right hilar lymphadenopathy and right upper lobe consolidation on chest x-ray. We demonstrated by fibreoptic bronchoscopy that this epituberculosis resulted from perforation of a lymph node and discharge of caseous material into the upper lobe bronchus with resultant endobronchial obstruction. Thus a tuberculous ruptured lymph node may lead to clinical and radiological worsening, but this does not indicate development of drug resistance in these patients and they respond well to the same treatment regimen.

A sucrose-mediated aqueous sol–gel procedure was developed to synthesize MgO–Y2O3 nanocomposite ceramics for potential optical applications. The synthesis involves the generation of a precursor foam containing Mg2+ and Y3+ cations via the chemical and thermal degradation of sucrose molecules in aqueous solution. Subsequent calcination and crushing of the foam gave MgO–Y2O3 nanocomposites in the form of thin mesoporous flake-like powder particles with uniform composition and surface areas of 27–85 m2 g−1, depending on calcination conditions. The flakes exhibited a homogeneous microstructure comprising intimately mixed nanoscale grains of the cubic MgO and Y2O3 phases. This microstructure was resistant to grain coarsening with average grain sizes of less than 100 nm for calcination temperatures of up to 1200°C. The results indicate that the sucrose-mediated sol–gel process is a simple effective method for making nanoscale mixed oxides.

Water oxidation is the bottleneck in artificial photosynthetic systems that aim to split water into hydrogen and oxygen. However, water oxidation occurs readily in plants, catalyzed by the Mn4O4Ca manganese cluster. In addition to this, manganese minerals are ubiquitous in nature displaying layered and tunnel structures. In this study, mixed valent porous amorphous manganese oxides (AMO), along with cryptomelane type tunnel manganese oxides (OMS-2) and layered birnessite (OL-1) have been used as water oxidation catalysts. Significantly higher turnovers were obtained with AMO (290 mmol O2/mol Mn) compared to tunnel structure OMS-2 (110 mmol O2/mol Mn) and layered structure OL-1 (27 mmol O2/mol Mn) in water oxidation tests with Ce4+. Oxygen evolution was also confirmed under photochemical conditions using Ru(bpy)3 2+ as a photosensitizer and persulfate as a sacrificial agent. The differences in catalytic activity among these catalysts have been probed using X-ray diffraction, transmission electron microscop...

Continuous-flow synthesis of one-dimensional (1D) metal oxide nanostructures and/or their integration into hierarchical structures under nonthermal conditions is still a challenge. In this work, a nonthermal, continuous-flow approach for the preparation of γ-manganese oxide (γ-MnO2) and cerium oxide (CeO2) microspheres has been developed. By this technique, γ-MnO2 materials with surface areas of 240, 98, and 87 m2/g and CeO2 microspheres with a surface area of 1 m2/g have been fabricated successfully. Characterization of the materials was carried out using powder X-ray diffraction, infrared and inductively coupled plasma optical emission spectrometer (ICP/OES), nitrogen sorption, scanning electron microscopy, transmission electron microscopy, and thermogravimetric analysis. The synthesized materials showed good catalytic activity in the oxidation of α-methyl styrene.

Short reaction times and morphology control in the synthesis of inorganic materials under nonthermal conditions remain a challenge. Herein we report a rapid, self-templating, and nonthermal method based on ultraviolet light to prepare metal oxide hierarchical structures. With this method, the morphology of the metal oxides was controlled readily without using templates.

Manganese oxide octahedral molecular sieves (OMS) are important materials in environmental chemistry, electrochemistry, and heterogeneous catalysis. Here, a rapid process to prepare cryptomelane-type octahedral molecular sieve (OMS-2) nanomaterials using a microwave assisted hydrothermal technique (MW-HT) is presented. With the assistance of microwaves in the hydrothermal reaction, the preparation time of OMS-2 can be as short as 10 s; up to 4 days are required in a conventional hydrothermal reaction. Direct observation of reaction temperature and pressure in the hydrothermal reaction can be achieved in real time in the reaction process. Reaction time and temperature are two parameters chosen to examine the formation conditions of OMS-2 materials. A reaction temperature below 80 °C resulted in the formation of amorphous manganese oxide material, whereas crystalline phase OMS-2 materials were formed at increased reaction temperatures to 100 °C or above. Studies by field emission scanning electron microscop...

Crystalline tunnel structure cryptomelane type manganese oxides (OMS-2) have been studied as photocatalysts for the selective oxidation of 2-propanol to acetone. The reaction is carried out with visible light irradiation at room temperature. The activities of various K-OMS-2 and metal doped OMS-2 (M-OMS-2) catalysts prepared by different synthesis procedures have been evaluated. K-OMS-2 and M-OMS-2 (M = Fe, Ni) with nanorod morphology were the most active photocatalysts. Conversions obtained for these catalysts ranged from 50 to 15%. K-OMS-2 fibers gave only 5–6% conversion. All reactions gave 100% selectivity to acetone. The reusability of the K-OMS-2 catalyst was also tested. Characterization of K-OMS-2 catalysts was done using several techniques like temperature programmed desorption, UV–vis spectroscopy, average oxidation state analysis, XRD, BET and FE-SEM. As suggested by the photochemical and characterization data, synthesis methodology, morphology, mixed valency and the release of oxygen from the OMS-2 structure are important factors for the design of active OMS-2 photocatalysts. XRD and FTIR were also used to study structural changes in the catalyst after photolysis.

Background: WHO 2014 Global report on tuberculosis- 97,000 patients were started on MDR-TB treatment in 2013. 2nd line drugs have a lot of side effects. Aims: Evaluate common and rare side effects of long term treatment of MDR and XDR TB. Methods: 26 patients diagnosed MDR (23) or XDR (3) TB at a tertiary hospital were followed up every month and side effects recorded. Treatment was given as per guidelines by Revised National tuberculosis control programme - India. Drugs used: MDR-Kanamycin,Levofloxacin,Ethambutol,Pyrizinamide,Cycloserine,Ethionamide. XDR-Capriomycin, PAS, Moxifloxacin, High Dose INH, Clofazamine, Linezolid, Amoxycillin+clavulunic acid Result: Common Side Effects- ![Figure][1] Uncommon side effects: | Side effects | Number of Patients(Percentage) | || | Hearing loss | 3(15%) | | Joint pain | 3(15%) | | Swelling | 2(10%) | | Itching | 2(10%) | | Redness | 2(10%) | | Flushing | 2(10%) | | Darkening of skin and Pruritus | 2(10%) | | Hepatitis | 1(5%) | | Mental Disorder | 1(5%) | | Anxiety | 1(5%) | Uncommon Side effects Conclusion: 1. Commonest side effects were gastrointestinal -Gastritis, Vomiting, Reduced Appetite 2. 25%-Peripheral Neuropathy due to Ethionamide 3. 25%-Depression, 20% suicidal tendencies due to cycloserine 4. 15%-Ototoxicity due to aminoglycosides which was reversible after discontinuation. Patients should be counselled regarding side effects especially hearing loss and psychiatric symptoms and regularly followed up to prevent permanent damage and ensure compliance. [1]: pending:yes

Background: Newer tests like GeneXpert and Line probe assay (LiPA) have replaced culture drug sensitivity for screening resistance to anti-tuberculous drugs. This study compared yield of diagnostic tests and their correlation with clinical scenario. Methods: Sputum samples from 57 TB suspects at a tertiary hospital in Navi Mumbai,India were subjected to AFB smear(ZN stain), culture(MGIT) and drug sensitivity by proportion method, GeneXpert and LiPA. Results: Comparative yield- Comparison with culture: 27 (47.36%) were diagnosed MDR. Comparison for MDR diagnosis- Resistance pattern by genotype assays were clinically compatible. Culture drug sensitivity by proportion method showed no resistance to INH and rifampicin in 5 cases that were detected resistant by GeneXpert and LiPA. These patients did not improve on first line drugs. Conclusions: 1. Line probe assay has a high diagnostic yield (91.42%). 2. In the event of discordance clinical correlation of genotype assays was better than culture and drug sensitivity testing .Though these numbers are too small to draw any conclusion this finding needs further evaluation on a larger scale.

Background: Silicosis is an ancient occupational illness reported in silica mill workers, agate stone workers, slate pen workers and mining industry. However its association in flour mill workers has not been established. Aims: To study the incidence of silicosis and respiratory morbidity in flour mill workers. Settings and Design: A prospective study of 56 flour mill workers working with open silica grinding stones was undertaken. Materials and Methods: 56 flour mill workers who volunteered following information regarding the study purpose were recruited from the community. Detailed clinical and occupational history, lung functions, chest x-ray, and high resolution computed tomography (HRCT) were done. Diagnosis was made on the basis of radiological findings. Statistical Analysis: Data analysis was done with the help of the statistical package for social sciences software. The Chi-square test was used for determining the relationship between qualitative data and descriptive statistics was used where required. Results: 93% had respiratory symptoms that included cough (66.1%), dyspnea (75%), chest pain (17.1%), and rhinorrhea (46.4%). Radiological abnormalities were noted in chest X-ray (60.7%) and HRCT (81.48%). A significant correlation was seen between duration of exposure and HRCT abnormalities. Lung functions revealed obstruction in 28.5% subjects, restriction in 19%, mixed ventilatory defects in 21.4%, while 18.9% had a reduced diffusion capacity. Conclusion: Incidence of silicosis in our study on flour mill workers working with silica containing grinding stones was 30.4%. They had high respiratory morbidity (93%) cough and dyspnea being predominant symptoms. Duration of exposure correlates with radiological findings and increased incidence of silicosis.