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Benjamin D Sullivan,1 Marta Palazón de la Torre,2 Ines Yago,2 Raúl Duarte,3 Julie M Schallhorn,4 Lisa M Nijm,5 Darrell E White,6 Michael S Berg,1 Pablo Artal3 1Trukera Medical, Southlake, TX, USA; 2Oftalmología en Murcia, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; 3Laboratorio de Optica, Universidad de Murcia, Murcia, Spain; 4Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA; 5Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, IL, USA; 6SkyVision Centers, Westlake, OH, USACorrespondence: Benjamin D Sullivan, Email bdsulliv@trukera.comPurpose: To study the association between tear film hyperosmolarity and ocular light scatter in a cataract surgery population.Patients and Methods: Contiguous, 20-second objective scatter index (OSI) scans were recorded in hyperosmolar (≥ 320 mOsm/L) and normal subjects (< 308 mOsm/L) with cataract nuclear opacity ≥ 3. OSI was measured at screening, baseline and 90 days following surgery. Along with symptoms of ocular surface disease, slit-lamp examination included corneal staining (0– 3), tear film breakup time (TBUT) and evaluation of meibomian gland disease (MGD). An additional cohort of hyperosmolar subjects were measured for OSI at screening, baseline, and 5, 10, 15 and 30 minutes following instillation of 0.18% sodium hyaluronate (HA).Results: Thirty-one eyes of 31 patients were included. There was a significant difference in post-operative OSI variation when comparing hyperosmolar (0.65± 0.30, N=11) to normal subjects (0.33± 0.11, N=10, p=0.005). Of note, there were no significant differences in OSI variation when subjects were sorted by staining (p=0.9), TBUT (p=0.7), symptoms (p=0.7), or MGD status (p=0.9). Instillation of 0.18% HA (N=10) did not alter OSI at 5 minutes, but significant reductions in OSI of 28.8%, 38.5% and 36.7% (all p < 0.001) were observed at 10, 15 and 30 minutes.Conclusion: Hyperosmolar patients exhibited significantly increased variation in light scatter following cataract surgery that was undifferentiated by staining or TBUT. Elevated osmolarity may be indicative of light scatter equivalent to that of a grade 2– 3 cataract.Keywords: hyperosmolarity, light scatter, tear film, staining, TBUT, cataract

Studying parasites in captive wild birds is vital for their health, well-being, biodiversity preservation, species conservation, and safeguarding of both individual birds and ecosystems. It holds significance for public health by identifying potential zoonotic risks. We aimed to describe the occurrence of gastrointestinal parasites in captive wild birds from a Conservation Institute in Brazilian Cerrado biome. Fresh fecal samples were collected from 17 captive wild birds (Anodorhynchus hyacinthinus, Ara ararauna, Ara chloropterus, Ara macao, Megascops choliba, Pteroglossus castanotis, Ramphastos dicolorus, Ramphastos tucanus and Strix huhula) at a Conservation Institution in Mineiros, state of Goiás. The samples were processed for Willis’ simple flotation and Hoffman’s spontaneous sedimentation examinations to identify parasitic forms of gastrointestinal endoparasites. Macaw aviary birds (Ar. ararauna, Ar. chloropterus and Ar. macao) showed higher positivity, with all six fecal samples positive for helminths or protozoa. In contrast, captive toucans showed only two positive results (P. castanotis and R. dicolorus). An. hyacinthinus showed Ascarididae, Capillarinae and Trematoda eggs; whereas S. huhula had Ascarididae eggs. Regular parasitological examinations are essential for the timely detection and treatment of gastrointestinal infections in captive birds, thereby enhancing overall bird management.

Saraladevi Naicker,1,&ast; Therese Dix-Peek,2,&ast; Roland Manfred Klar,2 Glendah Kalunga,1 Pulane Mosiane,3 Caroline Dickens,2 Raquel Duarte2 1Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Department of Internal Medicine Laboratory, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 3Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa&ast;These authors contributed equally to this workCorrespondence: Saraladevi NaickerDepartment of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaTel +27 83 6429575Email saraladevi.naicker@wits.ac.zaBackground: There is a wide spectrum of kidney pathology in human immunodeficiency virus (HIV) infection, affecting all structures of the kidney. The histology of HIV chronic kidney disease (CKD) is diverse, ranging from HIV-associated nephropathy (HIVAN) to focal glomerulosclerosis (FSGS), HIV-immune complex disease (HIV-ICD), other glomerulopathies and tubulo-interstitial nephritis. Definitive diagnosis is by kidney biopsy, an invasive procedure. However, serum and urinary biomarkers may be useful in predicting the histological diagnosis of HIVAN.Purpose: We wished to determine the utility of serum and urinary biomarkers in predicting the histological diagnosis of HIVAN.Patients and Methods: We measured neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, transforming growth factor (TGF)-β isoforms and bone morphogenetic protein (BMP)-7 in the serum and urine in patients with different histological forms of HIV glomerular disease.Results: In HIVAN, we demonstrated increased levels of serum cystatin C and increased levels of serum and urinary NGAL. Urinary TGF-β 1 and TGF-β 2 levels were elevated in HIV-positive patients with CKD but were not significantly different in the different HIV histologies, while urinary BMP-7 levels were elevated in minimal change disease.Conclusion: This study confirmed the presence of increased serum and urinary biomarkers of tubular injury in patients with HIVAN, and increased urinary biomarkers of fibrosis in HIV CKD, and may indicate their value as a non-invasive diagnostic tool for the diagnosis of HIVAN.Keywords: cystatin C, neutrophil gelatinase-associated lipocalin, NGAL, transforming growth factor (TGF)-β isoforms, bone morphogenetic protein (BMP)-7, HIV chronic kidney disease

Aliyu Abdu,1 Akinfenwa Atanda,2 Sunusi M Bala,3 Babatunde Ademola,1 Aishat Nalado,1 Patience Obiagwu,4 Raquel Duarte,5 Saraladevi Naicker5 1Nephrology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria; 2Department of Histopathology, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria; 3Department of Medicine, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria; 4Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria; 5Department of Medicine, University of Witwatersrand, Johannesburg, South AfricaCorrespondence: Aliyu AbduNephrology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, NigeriaEmail aliyuabdu2000@yahoo.co.ukIntroduction: Kidney biopsy in patients with HIV-associated kidney diseases allows for histopathologic diagnosis and institution of appropriate treatment as well as proper prognostication. There is a paucity of data on the histopathological pattern of HIV-associated kidney diseases in most sub-Saharan African countries. This study was aimed at evaluating the histopathologic patterns of kidney diseases seen among HIV-infected treatment-naive patients in our center as this will allow for proper diagnosis and institution of appropriate treatment.Methods: In this cross-sectional study, consecutive patients who satisfied inclusion criteria and consented to participate were recruited. Percutaneous kidney biopsies were carried out as day procedures under real-time ultrasound guidance using an automatic spring-loaded biopsy gun as per our unit protocols. Baseline investigations including urea, creatinine, electrolytes, CD4 count, complete blood count, and glomerular filtration rate (eGFR) calculations, urinalysis and urine protein creatinine ratios were done on all the participants.Results: Fifty-five patients who satisfied the inclusion criteria were studied. The mean age of the study population was 38.34± 9.26 years, with 32% females. Mean serum creatinine was 249.6± 164.6 μmol/L, and mean CD4 count was 238 ± 210 cells/mL. The commonest histological type was FSGS seen in 20 patients (37.7%), followed by HIVAN seen in 17 (32.1%) patients; chronic interstitial nephritis in 7 patients (13.2%) and 6 (11%) had no significant pathological finding. Compared to non-HIVAN, HIVAN patients tended to have higher systolic BP (p= 0.05); higher serum creatinine levels (p= 0.05); lower eGFR (0.03) and higher urine protein to creatinine ratio [uPCR; p= 0.02].Conclusion: Kidney involvement is still a form of presentation among HIV-infected treatment-naïve patients and though a wide range of glomerular and tubulointerstitial lesions may be seen, FSGS and HIVAN are still the most common. We recommend assessment of kidney function, including urinalysis, as part of the routine evaluation of newly diagnosed HIV patients and biopsy where indicated to prognosticate and institute appropriate early treatment.Keywords: HIV, kidney disease, histology

Bala Waziri,1,2 Raquel Duarte,1 Saraladevi Naicker1 1Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Department of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Minna, NigeriaCorrespondence: Bala WaziriDepartment of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Km 10, Paiko Road, Minna, NigeriaEmail balawaziri@gmail.comAbstract: Despite the availability of global and regional guidelines to curtail the adverse clinical outcomes associated with chronic kidney disease–mineral and bone disorder (CKD-MBD), most CKD patients are still affected by the consequences of abnormalities of CKD-MBD. This important clinical complication of CKD continues to be studied, in order to improve the understanding and management of CKD-MBD. Some notable discoveries include the role of fibroblast growth factor 23 (FGF23) in the pathogenesis of CKD-MBD, leading to a shift from the previous well-established classic trade-off hypothesis to the updated trade-off hypothesis. More recently, there has been a shift from the treatment of CKD-MBD based on a single level of biomarkers to serial measurements of calcium, phosphate and parathyroid hormone (PTH). Furthermore, some clinical trials have emerged after the 2009 Kidney Disease-Improving Global Outcomes (KDIGO) Guidelines, leading to the 2017 KDIGO updated recommendations. Hence, this review gives an overview of the rapidly evolving trends in CKD-MBD, linking the past and current concepts of CKD-MBD.Keywords: chronic kidney disease–mineral and bone disorder, updated pathogenesis, emerging trends, management

Preenan Pillay,1 Manu Vatish,2 Raquel Duarte,3 Jack Moodley,4 Irene Mackraj51Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa; 2Nuffield Department of Women’s and Reproductive Health, Women’s Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK; 3Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 4Women’s Health and HIV Research Group, Department of Obstetrics and Gynaecology, University of Kwazulu-Natal, Durban, South Africa; 5School of Laboratory Medicine and Medical Sciences, University of Kwazulu-Natal, Durban, South AfricaBackground: Preeclampsia is the leading cause of maternal and fetal mortality due to the inability to diagnose and treat the disorder early in pregnancy. This is attributed to the complex pathophysiology and unknown etiology of the disorder, which is modulated by several known and unknown factors. Exosomes have recently been implicated as possible mediators of the pathogenesis of preeclampsia, with, however, no evidence linking these nanovesicles to the pathophysiology of preeclampsia and its subtypes.Methods: To better understand the pathophysiological role of exosomes in preeclampsia, we have analyzed the exosomal microRNA in early and late onset preeclamptic women in comparison to their gestationally matched normotensive controls using Digital Direct Detection (NanoString Technologies).Results: For the first time, distinct exosomal microRNA signatures in early and late onset preeclampsia have been identified. Moreover, these signatures indicate that exosomes are involved in key pathological features associated with preeclampsia and differentiate between the subtypes.Conclusion: This study forms the basis for the diagnostic and functional validation of the identified signatures as biomarkers of preeclampsia and its subtypes.Keywords: biomarkers, preeclampsia, exosomes, microRNA

Aishatu Mohammed Nalado,1,2 Johnny N Mahlangu,3 Bala Waziri,1 Raquel Duarte,1 Graham Paget,1 Gbenga Olorunfemi,4 Saraladevi Naicker1 1Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; 2Department of Internal Medicine, College of Health Sciences, Bayero University, Kano, Nigeria; 3School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 4Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa Introduction: Anemia is a complication of chronic kidney disease (CKD) that can greatly impact on its prognosis. However, the risk factors for anemia, including the influence of ethnicity, are not well established among the CKD population in Johannesburg.Methods: This was a cross-sectional study of 353 adult CKD patients attending the renal outpatient clinic of the Charlotte Maxeke Johannesburg Academic Hospital (Johannesburg, South Africa) from June 1, 2016 to December 30, 2016. Sociodemographic and clinical characteristics were obtained using a proforma. Blood samples were collected for serum electrolytes and hematological parameters. Predictors of low hemoglobin and iron deficiency anemia (IDA) were evaluated using multivariable binary logistic regression.Results: The mean age and prevalence of anemia among the CKD participants were 55.3±15.0 years and 43.18% (95% CI: 38.1%–48.4%), respectively. Blacks had the highest prevalence of anemia (46.9%), while Indians/Asians had the lowest (18.2%). Although the odds of anemia was 3.8-fold higher (odds ratio =3.8, P-value =0.059) among CKD stage V participants as compared to CKD stage I, the relationship between anemia and stages of CKD was non-linear. Diabetes mellitus (odds ratio =2.31, P-value =0.005) had a strong association with anemia among the CKD participants.Conclusion: Almost half of the CKD participants were anemic, and the odds of anemia did not increase linearly with increasing severity of CKD. There was a marked ethnic disparity in anemia prevalence. Our study highlights the need for risk-based management of anemia among CKD patients. Keywords: chronic kidney disease, hemoglobin, risk factors, iron deficiency anemia, ethnicity, Johannesburg, South Africa, kidney stage

Stephen Olawale Oguntola,1 Muzamil Olamide Hassan,2 Raquel Duarte,3,* Therese Dix-Peek,3 Caroline Dickens,3 Gbenga Olorunfemi,4 Ahmed Vachiat,5 Graham Paget,1 Pravin Manga,5 Saraladevi Naicker1,* 1Department of Internal Medicine, Division of Nephrology, University of Witwatersrand, Johannesburg, South Africa; 2Department of Internal Medicine, Dialysis Unit, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria; 3Department of Internal Medicine Laboratory, University of Witwatersrand, Johannesburg, South Africa; 4Department of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa; 5Department of Internal Medicine, Division of Cardiology, University of Witwatersrand, Johannesburg, South Africa *These authors contributed equally to this work Background: Despite remarkable improvement in renal function attributable to kidney transplantation, the burden of cardiovascular disease (CVD) among kidney transplant recipients (KTRs) remains high in the post-transplant period. Aggressive use of statins in KTRs may make lipoprotein ratios correlate better with atherosclerotic vascular disease (AsVD) when compared with traditional lipid profile parameters. We therefore evaluated the clinical and echocardiographic correlates of AsVD among non-diabetic, stable, black KTRs in South Africa.Methods: This was a cross-sectional study of 41 adult (18–65 years), non-diabetic, stable KTRs and 41 age- and sex-matched healthy controls. An interviewer-administered questionnaire was used to obtain information on participants’ sociodemographic and cardiovascular risk factors. Anthropometric parameters were measured. Urine and blood samples were obtained and analyzed. Echocardiography was performed and carotid intima media thickness (CIMT) was assessed in both right and left carotid arteries. Spearman’s rank correlation and binary logistic regression were performed to determine the relationship between CVD risk factors and AsVD. Results: AsVD was present in 46.3% of KTRs compared to 17.1% of healthy controls (p = 0.004). Left ventricular hypertrophy was present in 92.7% of the KTRs. There were statistically significant differences in waist–hip ratio, systolic blood pressure, mean arterial pressure, urine albumin–creatinine ratio, serum fibrinogen, serum creatinine, estimated glomerular filtration rate, left atrial diameter, left ventricular mass (LVM), and left ventricular mass index (LVMI) between KTRs and controls. A positive relationship was seen between CIMT and certain risk factors for CVD including LVM, LVMI, and mitral valve deceleration time, (p

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.

A momentum resolved resonant inelastic X-ray scattering (qRIXS) experimental station with continuously rotatable spectrometers and parallel detection is designed to operate at different beamlines at synchrotron and free electron laser (FEL) facilities. This endstation, currently located at the Advanced Light Source (ALS), has five emission ports on the experimental chamber for mounting the high-throughput modular soft X-ray spectrometers (MXS) [24]. Coupled to the rotation from the supporting hexapod, the scattered X-rays from 27.5° (forward scattering) to 152.5° (backward scattering) relative to the incident photon beam can be recorded, enabling the momentum-resolved RIXS spectroscopy. The components of this endstation are described in details, and the preliminary RIXS measurements on highly oriented pyrolytic graphite (HOPG) reveal the low energy vibronic excitations from the strong electron-phonon coupling at C K edge around σ* band. The grating upgrade option to enhance the performance at low photon energies is presented and the potential of this spectroscopy is discussed in summary.

In the American regions, Brazil accounts for 97% of visceral leishmaniasis (VL) cases, with a case fatality rate of approximately 10%. This study aimed to investigate the VL mortality distribution in Brazil and identify high-priority and high-risk areas for intervention strategies. This was an ecological study that analysed the spatial–temporal patterns of VL mortality in Brazilian municipalities. Age-standardised VL mortality rates from the Global Burden of Disease study from 2001 to 2018 were used. The distribution of mortality in the municipalities was assessed, and subsequently the Local Index of Spatial Autocorrelation (LISA) analysis was conducted to identify contiguous areas with high mortality rates. Scan analysis identified clusters of high spatial–temporal risks. The highest mortality rates and clusters were in municipalities located in the Northeast region and in the states of Tocantins and Roraima (North region), Mato Grosso do Sul (Central-West region), and Minas Gerais (Southeast region). According to LISA, there was an increase in the number of municipalities classified as high priority from the first 3-year period (n = 434) to the last 3-year period (n = 644). The spatio-temporal analysis identified 21 high-risk clusters for VL mortality. Areas with a high risk of VL mortality should prioritise preventing transmission, invest in early diagnosis and treatment, and promote the training of healthcare professionals. [ABSTRACT FROM AUTHOR]

The ALS-U upgrade promises to deliver diffraction limited performance throughout the soft x-ray range by lowering the horizontal emittance to about 50 pm resulting in 2-3 orders of brightness increase for soft x-rays compared to the current ALS. The design utilizes a multi bend achromat lattice with on-axis swap-out injection and an accumulator ring. One central design goal is to install and commission ALS-U within a short dark period. This paper summarizes the status of the conceptual design of the accelerator, as well as some results of the R&D program that has been ongoing for the last 3 years.

Improvements in brightness and coherent flux of about two orders of magnitude over operational storage ring based light sources are possible using multi bend achromat lattice designs [1]. These improvements can be implemented as upgrades of existing facilities, like the proposed upgrade of the Advanced Light Source, making use of the existing infrastructure, thereby reducing cost and time needed to reach full scientific productivity on a large number of beamlines. An R&D program was started at LBNL to further develop the technologies necessary for diffraction-limited storage rings. It involves many areas, and focuses on the specific needs of soft x-ray facilities [2]: NEG coating of small chambers, swap-out injection, bunch lengthening, magnets/radiation production, x-ray optics, and beam physics design optimization. Hardware prototypes have been built and concepts and equipment was tested in beam tests on the existing ALS.