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Purpose Antimicrobial resistance is a major concern that we are facing nowadays. This is due to antibiotic misuse and bacteria developing resistance to the commonly used antibiotics. This may lead to increased mortality and consumption of country resources. Implementation of an antimicrobial stewardship program [ASP] can limit the use of unnecessary antibiotics and subsequently decrease the infection rates with better patient outcome. We aimed to control antibiotic misuse, reduce infection rate, decrease drug costs, and reduce length of hospital stay in the ICU. Methods We conducted a prospective study on the surgical neonatal ICU [SNICU] over a period of 6 months divided into pre-implementation phase, followed by an ASP phase, in which we applied the antibiotic guidelines approved by the ASP committee. Data were collected in the two phases and analyzed for demographics, compliance with guidelines, prescribed antibiotics, lab investigations, surgical site infection [SSI], length of stay and patient outcome. Results Compliance to the guidelines was encountered in 86% and SSI rate decreased to 20%. Days of Therapy (DOT) per 1000 patient days showed a significant decrease in Ampicillin Sulbactam by 296 (p = 0.024), Imipenem by 220.34 (p = 0.024) and Vancomycin by 287.34 (p = 0.048). Drug cost showed a 1185.97 EGP decrease in the ASP period compared to the pre-implementation period (p = 0.714). Average LOS decreased in the ASP period by a mean difference of 2.5 (p = 0.027). Conclusion ASP implementation can control antibiotic misuse, decrease the medical care expenses and improve patient outcome. Type of study Clinical research paper. Level of evidence Level one.

BACKGROUND: High antibiotics use in pediatric intensive care units (PICUs) results in antibiotic resistance, the unfavorable clinical outcome of patients, increase the length of hospital stay, and drug expenditure. AIM: This study aimed at setting clinical guidelines customized according to local diseases epidemiology and local cumulative antimicrobial susceptibility, implementing, and evaluating the Antimicrobial Stewardship Program (ASP) effect in; optimizing antibiotics use, decreasing antibiotics expenditure, decreasing the length of therapy and stay in hospitals, and improving patients’ clinical outcomes. METHODS: A prospective study was conducted at a PICU of the Specialized Pediatric Hospital, Cairo University. Facility-specific guidelines were set, and the ASP was implemented and evaluated through the following indicators; adherence of physicians to the guidelines, ASP recommendations and acceptance of them, the rate of mortality, length of stay, drug costs, antibiotics days of therapy, and length of therapy. RESULTS: The adherence to the ASP guidelines was positively correlated to the patient’s clinical outcome (p = 0.018). In post ASP period, the average length of stay and the length of therapy significantly decreased (p = 0.047, p = 0.001, respectively), the rate of adherence to the ASP guidelines was (91.9%), the days of therapy of ceftazidime, ceftriaxone, and amikacin decreased significantly (p = 0.041, p = 0.026, p = 0.004, respectively). The most common ASP recommendation was drug schedule/frequency change (26.1%) followed by drug discontinuation (17.8%) and the most common antibiotic required intervention was ampicillin-sulbactam (21.6%). CONCLUSION: The antimicrobial stewardship is very effective in optimizing antibiotics use and leads to favorable outcomes in terms of decreased length of therapy, hospital stay, and mortality rate of the patients.

The continuous increase in the level of greenhouse gas (GHG) emissions and the increase in fuel prices are the main driving force to utilize various source of renewable energy. Among the clean energy technologies, solar energy is recognized as one of the most promising choice since it is free and provides clean and environmentally friendly energy. The objective of this paper is to improve the heating capabilities of evacuated tubes solar cookers that operates based on a closed loop thermosyphon action, and utilize thermal oil as the heating medium. Two identical evacuated tube solar cookers have been designed and built to study the influence of inserting metallic wires or nanographene particles on the thermal performance of the cooker. Also, the study was based on the thermal transfer of natural convection of the thermal oil movement within the evacuated tubes. The metallic wires and the nanographene particles are inserted inside the evacuated tube, which is filled with the heat exchange oil. One cooker is always tested without any modifications, i.e. taken as a reference point. The other cooker is the developed cooker, i.e. with wires or particles. Steel, aluminum and copper wires have been examined, and the number of wires has been varied between 5, 10 and 15. It has been found that the copper wires improve the rate of heat transfer compared with steel wires, aluminum wires and the nanographene particles. It has been also obtained that there is a critical number of wires, i.e. 10 wires, above that the rate of heat transfer by natural convection decreases and this is due to the increased friction which resists the natural convection currents. Finally, adding nanographene particles increases the viscosity of the oil, which increases the resistance to natural convection currents and consequently decreases the rate of heat transfer by natural convection.

Background: The incidence of neonatal sepsis increased during the recent years, it may be due to frequent use of invasive procedures and the development of resistant organisms. Bacterial resistance to commonly used antibiotics has emerged and complicated the management of NS. Objective: Our study aimed at determining the prevalence and risk factors of MDRO and hand hygiene compliance (HHC) in the SNICU, of Cairo University Specialized Pediatric Hospital (CUSPH) postoperatively. Materials and Methods: A prospective, observational study was carried out from April 2015 to September 2015 in the tertiary-care level SNICU of CUSPH. Fifty- eight neonates who were infection free on admission and were having any surgical pathology were studied. Baseline data collected include Demographic history, evidence of sepsis, Complete examination and investigations including quantitative C-reactive protein (QCRP), WBCs counts, blood culture, and treatment were also included. Hand hygiene was also assessed among the HCWs using the WHO checklist “My Five Moments for Hand Hygiene”. Results: Ninety-five samples were sent to the microbiology laboratory for culture and sensitivity. Some neonates had more than one sample type analyzed. All samples were collected 48 h postoperatively. The most common site of infection was blood stream infection (BSI) representing 39/95 of samples (41%) followed by SSI 16/95 (16.8%), RTI 8/95 (8.4%), and CLABSI 3/95(3.1%), 29/95 (30.5%) samples revealed no growth. Out of 66 isolated microorganisms, Gram-negative bacteria were the most prevalent pathogens of nosocomial infection with 35/66 (53%), while Gram-positive bacteria were 25/66 (37.9%). We found coagulase-negative Staphylococcus aureus (CONS) to be the most common organism 19/66 (28.7%) cultured from blood, followed by Klebsiella 13/66 (19.6%) and Acinetobactor 9/66 (13.6%) of all isolates. Candida was isolated from only one case of SSI 1/66 (1.5%). MRSA were found to be less frequently isolated 3/66 (4.5%). Profile of blood culture and susceptibility patterns provide guidance to start empiric antibiotic treatment which is cornerstone in sepsis management. The most sensitive antibiotic among Gram positive isolates were Teicoplanin and Vancomycin with 100% sensitivity for both antibiotics in MRSA isolates, while they showed sensitivity of 94.7 and 89.5% respectively in CONS isolates, both Ciprofloxicin and Clindamycin showed 33.3% sensitivity to MRSA isolates, while no single MRSA isolate showed sensitivity to Erythromycin nor Amikacin. CONS sensitivity to other antibiotics was as follows; 74% in Amikacin, 79% in ciprofloxacin and 58% in Clindamycin. In Gram negative organisms; Polymexin B and Colistin revealed highest sensitivity (100%) in all Gram negative isolates, followed by Amikacin with 60% sensitivity to E-coli and only 25% sensitivity in both Pseudomonas and Enterobacter, then Meropenem which was 55.6% sensitive to Acenitobacter and 25% sensitivity to both Pseudomonas and Enterobacter. Ciprofloxacin showed 50% sensitivity with Pseutomonas and 25% with Enterobacter, while it was sensitive in 22.2% and 20% of Acenitobacter and E-coli isolates respectively. Gentamicin was 33.3%, 25% and 20% sensitive in Acenitobacter Enterobacter and E-coli isolates respectively. No E-coli isolates showed sensitivity to imipenem, while only 25%, 22.2% and 15.4% of Enterobacter, acenitobacter and klebsiella isolates respectively were sensitive to imipenem. Among 39 blood culture positive cases, 26 isolates were MDRO (66.7%) meanwhile non-MDRO accounted for 13/39 (33.3%) isolates.Overall hand hygiene compliance (HHC) among the HCWs was found to be (30.5%). Conclusion: Prevalence of MDRO among cases of sepsis was found to be (66.7%). Most isolated organisms were resistant to commonly used drugs. Antibiotic stewardship (ASP) program is essentially needed to stop abuse of antibiotics and accordingly development of MDROs. Strict infection control measures mainly HH procedures are needed, to minimize the spread of MDROs. Keywords: Bloodstream Infections (BSI), Surgical Neonatal Intensive Care Unit (NICU), Hand hygiene, MDRO

Al/ZnO: Al heterojunction was fabricated by depositing ZnO: Al film on Al substrate by spray pyrolysis technique at 220 °C substrate temperature. XRD, SEM and EDAX techniques were used to study the properties of thin films. Heterojunction properties were studied by I–V and C–V measurements. The fabricated Al/ZnO: Al junctions were rectifying in character. The room temperature ideality factors of Al/ZnO: Al junctions are found to vary from 2.56 to 5.45. The reverse saturation currents are 5.21 × 10−9, 1.35 × 10−6, 1.99 × 10−6, 9.99 × 10−7 and 1.02 × 10−7 A for Al/ZnO: Al junctions. Junction forward current depends on doping concentrations and temperature, whereas reverse saturation current remains independent for Al concentration. The built-in-potential calculated from capacitance for Al/ZnO: Al junctions are 2.74, 2.60, 2.0, 2.50 and 2.43 V corresponding to 1, 2, 3, 4 and 5 mol% of Al. X-ray diffraction study confirmed that the films are polycrystalline, orientated in (0 0 2) plane. Scanning electron microscopy study confirmed circular ring patterns with inside ribbon type structure for Al doped ZnO films.

Experimental and numerical investigation of the triple concentric-tube heat exchanger with inserted ribs has been carried out. The purpose is to evaluate the performance characteristics of the triple tube heat exchanger with rib inserts. The investigation key design parameters involve water mass flow rate, flow pattern, temperature variation, rib height and rib pitch. Numerical CFD modeling is developed using FLUENT commercial code and validation criteria is done to extend the study parameters with extra ranges. The results revealed that, the insertion of ribs to the inner annulus fluid flow of the triple tube heat exchanger participate a significant enhancement of the convective heat transfer. Higher performance index is obtained at higher rib pitch and lower rib height. A set of empirical expressions with the dimensionless design parameters have been predicted based on the obtained data.

The experimental and numerical investigations of the triple concentric-tube heat exchanger are presented with particular reference to double tube heat exchanger. The purpose is to present a clear view on the thermo-fluid characteristics of this type of heat exchangers with different key design parameters leading to design optimization. Three fluids being considered are chilled water in inner tube, hot water in inner annulus, and normal tap water in outer annulus. Numerical CFD model is developed using a finite volume discretization method. The numerical model is validated and then extended to cover more extra design parameters. Four flow patterns are conducted of counter current, co-current, counter current with co-current and co-current with counter current flow. Correlations of Nusselt number, friction factor and heat exchanger effectiveness with the dimensionless design parameters are also presented. The triple tube heat exchanger contributes higher heat exchanger effectiveness and more energy saving compared with double tube heat exchanger per unit length.

In this work, an experimental study on energy saving for air conditioning application has been conducted. Heat Pipe Heat Exchanger (HPHX) was installed between the fresh air and return air streams to cool the fresh air before entering the air handing unit. Three test sections of wickless HPHX of different pipe diameters were tested. The studied test section inner diameters were 7.9, 10.2 and 16.56 mm. The study was conducted at different fresh air inlet temperatures to check the effect of ambient temperature on fresh air cooling. The mass flow rate ratio between return and fresh air was chosen to be 1, 1.5, 2 and 3. The obtained results indicated that the effectiveness of HPHX, the ratio of actual rate of heat transfer by HPHX to the maximum possible heat transfer rate between the two air streams, increases with the increase of fresh air inlet temperature, the ratio between return and fresh air mass flow rate, and heat pipe diameter. An energy reduction of about 30% was resulted due to inserting a wickless HPHX in the system with inner diameter 10.2 mm, average fresh air inlet temperature 35 °C and equal masses of fresh and return air streams. Economic analysis showed that the energy-saving decreases electrical consumption cost with a payback period of about three years with lifetime about 20 years.

In this study, accurate and convenient prediction models of tubular solar still performance, expressed as hourly production, were developed by utilizing machine learning. Based on experimental data, the models were developed and compared, such as classical artificial neural network with/without Baysian optimization, random forest with/without Baysian optimization, and traditional multilinear regression. Before applying Bayesian optimization, both random forest and artificial neural network predict hourly production. But the superiority of random forest is well behaved with insignificant error. The prediction performance of random forest, artificial neural network and multilinear regression were calculated as 0.9758, 0.9614, 0.9267 for determination coefficients, and 5.21%, 7.697%, 10.911% for mean absolute percentage error, respectively. Additionally, when applying Bayesian optimization for searching most appropriate hyper parameters, the performance of artificial neural network was significantly improved by 35%. Moreover, optimization findings revealed that random forest was less sensitive to hyper parameters than artificial neural network. Based on the robustness performance and high accuracy, the random forest is recommended in predicting production of tubular solar still.

Fluoroscopy-induced chronic radiodermatitis is a rare complication that is now encountered more often owing to the increasing use of fluoroscopy in radiological procedures. The long duration between radiation exposure and development of condition, patient unawareness of exposure to radiation along with lack of clinical suspicion of the condition among dermatologists, all make the diagnosis difficult. We report three cases of male patients who presented with a clinical picture suggestive of fluoroscopy-induced chronic radiodermatitis backed up by history of cardiac catheterization procedures confirming the diagnosis. Awareness of this entity among dermatologists is important for early recognition and proper management.

Deposits of salts and extraneous materials occur during water desalination by heating, forming an insulating layer, which is known as fouling. Fouling reduces the rate of heat transfer between the heating medium and the water, subsequently decreases the desalination efficiency gradually and sometimes can lead to operation failure. The thermal shock is a fouling mitigation technique in water desalination units, which could be due to sudden decrease or increase in the heat transfer process. The objective of this research is to study the removal of fouling layers by the thermal shock in case of (i) smooth tubes, (ii) rough tubes and (iii) finned-rough tubes. It has been found that it is possible to remove the fouling layer by the thermal shock technique in case of smooth and rough tubes, but not in case of finned tubes. The thermal shock blows off the fouling layer in case of plain tubes, and the fouling process resumes after the thermal shock without any delays, i.e. no more induction period. Fins assist the sticking of crystals to the heat exchanger tubes and prevent its removal by thermal shock. Fins act as a heat sink during the thermal shock, which reduces the dissipation of heat to the surrounding water, i.e. cooling of the tubes, and prevent cracking of the fouling layer.

Objective. We aimed to study the effect of visual observation of bacterial growth from handprints on healthcare workers’ (HCWs) compliance with hand hygiene (HH).Settings. Medical and postoperative cardiac surgery units.Design. Prospective cohort study.Subject. The study included 40 HCWs.Intervention. Each HCW was interviewed on 3 separate occasions. The 1st interview was held to obtain a handprint culture before and after a session demonstrating the 7 steps of HH using alcohol-based hand rub, allowing comparison of results before and after HH. A 2nd interview was held 6 weeks later to obtain handprint culture after HH. A 3rd interview was held to obtain a handprint culture before HH. One month before implementation of handprint cultures and during the 12-week study period, monitoring of HCWs for compliance with HH was observed by 2 independent observers.Main Results. There was a significant improvement in HH compliance following handprint culture interview (p<0.001). The frequency of positive cultures, obtained from patients with suspected healthcare-associated infections, significantly declined (blood cultures:p=0.001; wound cultures:p= 0,003; sputum cultures:p=0.005).Conclusion. The visual message of handprint bacterial growth before and after HH seems an effective method to improve HH compliance.

Poor health care-seeking behaviour, access to services and availability of service delivery have implications for the health of the community. This study explored the perceptions, practices and challenges related to maternal and neonatal care in the teagarden community in Bangladesh. The study also identified service gaps and problems prevalent in teagarden health facilities. A qualitative study was conducted in five teagardens in the Moulvibazar district of Bangladesh. Six focus group discussions (FGDs) were completed with individuals from the teagarden community, and twelve in-depth interviews (IDIs) were performed with health facility staff working in those teagarden facilities. Misconceptions and harmful traditional practices were found to exist among the families in the teagardens, restricting them from accessing quality health care. Pregnant women are not aware of antenatal care, and deliveries are being conducted at home by untrained birth attendants. Unhygienic and harmful postnatal practices are used. Teagarden health facilities are not well equipped or prepared to provide good care. Inequities exist within the teagarden communities, with unregistered workers having even poorer access to care. Improvement of the quality of maternal health care for this marginalised community is needed to progress maternal health.

This work focused on the fabrication of p-type ZnO material by Ag–N co-doping using spray pyrolysis technique and the characterization of structural, surface morphology and opto-electrical properties. Hall measurements reveal that Ag–N co-doped ZnO thin films are p-type materials and highest mobility is obtained for 2.5 mol% of Ag doping, keeping the concentration of N unchanged. The resistivity of the films depends on doping level and shows a minimum value (ρ ~ 1.59 Ω-cm) with a carrier concentration of 4.09 × 10 16 cm − 3 for 2.5 mol% of Ag doping at the deposition temperature of 400 °C. X-ray diffraction study shows a single phase of ZnO up to 2.5 mol% of Ag doping level and after that a phase of silver oxide arises, which confirms that 2.5 mol% of Ag doping level is the optimum condition. The aging effect does not affect the p-type characteristics of the Ag–N co-doped ZnO films.

The nano-structural Al-doped ZnO thin films of different morphologies deposited on glass substrate were successfully fabricated at substrate temperature of 350 °C by an inexpensive spray pyrolysis method. The structural, electrical, optical and photoluminescence properties were investigated. X-ray diffraction study revealed the crystalline wurtzite (hexagonal) structure of the films with nano-grains. Scanning electron microscopy (SEM) micrographs indicated the formation of a large variety of nano-structures during film growth. The spectral absorption of the films occurred at the absorption edge of ∼410 nm. In the present study, the optical band gap energy 3.28 eV of ZnO decreased gradually to 3.05 eV for 4 mol% of Al doping. The deep level activation energy decreased and carrier concentrations increased substantially with increasing doping. Exciting with the energy 3.543 eV (λ=350 nm), a narrow and a broad characteristic photoluminescence peaks that correspond to the near band edge (NBE) and deep level emissions (DLE), respectively emerged.

While conversion of stable renal transplant recipients (RTR) from calcineurin inhibitors (CNI) to sirolimus (SRL) is safe and effective, it is still under investigation for recent, high-risk cases. We studied the long-term effects of conversion of high-risk subjects maintained on a CNI, mycophenolate mofetil, plus steroid regimen to SRL, mycophenolate mofetil, plus steroid on graft and patient outcomes. We retrospectively reviewed the first 100 RTR converted to SRL treatment over approximately 5 years. The main indications for conversion were biopsy-proven acute rejection (BPAR), CNI toxicity, CNI elimination, and acute-tubular necrosis (ATN). Exclusion criteria were limited to bone marrow suppression. The overall mean +/- SD age was 38.5 +/- 15.6 years, including pediatric and geriatric age groups. Mean +/- SD body mass index (BMI) was 28.99 +/- 8.0 and 40% had a BMI30. There were 40% RTR from deceased donors and 60% showed 4 to 6 HLA mismatches. Preconversion total BPAR and steroid-resistant rejection incidences were 35% and 14%, respectively. Mean +/- SD time to start of SRL was 11.9 +/- 22.8 months posttransplantation. Proteinuria2 g/d, leukopenia, and hyperlipidemia increased significantly after conversion (P = .001, P = .0003, and P = .0001, respectively). Patient and graft survivals were 95% and 90%, respectively. There was significant improvement in graft function postconversion (P.0001). There was a high incidence of side effects and cases of SRL discontinuation. Multivariate analysis demonstrated the influence of bone marrow suppression, obesity, hyperlipidemia, nutritional status, proteinuria, and graft function on graft and patient outcomes. We concluded that conversion from CNI to SRL was effective among high-risk RTR, but with a high incidence of adverse events during long-term follow-up.

Introduction Invasive fungal sinusitis is a rare but often fatal infection in immunocompromised patients. Aggressive antifungal treatment is mandatory, but is not without risk. Caspofungin, an antifungal agent that is a member of the echinocandin family, an inhibitor of glucan synthesis in the fungal wall, is active against Aspergillus and Candidae infections. Although it works on the fungal wall, it does not affect mammalian cells; hence, its toxicity is minimal. Case Summary This report describes a case of invasive Aspergillus sinusitis in a kidney transplant recipient with diabetes mellitus. The infection involved the apex of the right orbit causing optic nerve compression. The patient was treated with transnasal endoscopic decompression of the optic nerve and intravenous AmBisome (liposomal amphotericin B) for 2 weeks without clinical improvement. The combination of caspofungin and AmBisome administered for another 2 weeks yielded partial improvement. The AmBisome had to be discontinued due to deterioration of renal and hepatic function, but the patient completed a further 7-week course of caspofungin alone. Retro-orbital biopsy confirmed a complete response to treatment; the patient’s renal and hepatic function returned to normal. Conclusion This case indicates that caspofungin is effective to treat invasive Aspergillus sinusitis in kidney transplant recipients. This agent is well tolerated and safe with respect to renal and hepatic function.

Objective. The area under the concentration-time curve of cyclosporine microemulsion is the best measure of the absorption and beneficial effects in renal transplant recipients. We sought to determine the best method of monitoring cyclosporine levels in these patients. Methods. Prospective evaluation of peak cyclosporine blood levels and area under the curve monitoring were performed for 1 year in 65 renal transplant recipients (study group). Cyclosporine trough levels and peak cyclosporine blood levels were correlated with the calculated area under the curve. Cyclosporine trough levels were monitored in equal numbers of matched controls. Results. There were no significant differences in the incidence of acute rejection, cyclosporine nephrotoxicity, proteinuria, serum creatinine levels, or graft and patient outcomes between the groups (P = .1). Peak cyclosporine blood levels guided by calculating the area under the curve were found to be 27% to 32% lower than previously reported. The correlation coefficient was 90% for peak cyclosporine blood levels (P

Introduction Calcineurin inhibitor (CNI) induced HUS, although rare, can be a serious complication of renal transplantation. Classical syndrome of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury may not be fully manifested. Methods We retrospectively analyzed our data in 950 kidney recipients under follow-up in our center (1994 – 2008). We reviewed the kidney biopsies performed for these patients to exclude conflicting diagnoses like antibody mediated rejection. Results HUS was diagnosed in 12 patients (1.26%). None of them had HUS as the original kidney disease. Cyclosporine was the primary immunosuppression in 9 and tacrolimus in 3 patients. The median day of onset was 7 days. Manifestations were anemia (100%), thrombocytopenia (75%), elevated reticulocyte count (62.5%), fragmented red blood cells (8.3%), elevated lactate dehydrogenase (LDH) enzyme (83.3%), increased fibrin degradation product (FDP) (83.3%), reduced haptoglobin level (42.9%) and hyperbilirubinemia (25%). CNI elimination was the first step in the management. Transfusion of fresh frozen plasma (FFP) was used in 10 patients and plasma exchange with FFP in the other two. All grafts recovered function. Cyclosporine or tacrolimus were reintroduction in two patients after complete clinical and laboratory recovery. Both patients developed recurrence of HUS. While the former did not the latter did recover on further treatment of HUS. Conclusion Anemia, thrombocytopenia, elevated LDH and FDP are the most frequent manifestations of HUS. Early CNI elimination and fresh plasma transfusion can revert CNI induced HUS and save the graft. Reintroduction of CNI may be deleterious to the graft and should be avoided.

Background. High levels of soluble CD30 (sCD30), a marker for T-helper 2-type cytokine-producing T cells, pre or post-renal transplantation serves as a useful predictor of acute rejection episodes. Over the course of 1-year, we evaluated the accuracy of serial sCD30 tests to predict acute rejection episodes versus other pathologies that affect graft outcomes. Patients and methods. Fifty renal transplant recipients were randomly selected to examine sCD30 on days 0, 3, 5, 7, 14, and 21 followed by 1, 3, 6, and 12 months. The results were analyzed for development of an acute rejection episode, acute tubular necrosis (ATN), or other pathology as well as the graft outcome at 1 year. Results. Compared with pretransplantation sCD30, there was a significant reduction in the average sCD30 immediately posttransplantation from day 3 onward (P < .0001). Patients were divided into four groups: (1) uncomplicated courses (56%); (2) acute rejection episodes (18%); (3) ATN (16%); and (4) other diagnoses (10%). There was a significant reduction in sCD30 immediately posttransplantation for groups 1, 2, and 3 (P < .0001, .004, and .002 respectively) unlike group 4 (P = .387). Patients who developed an acute rejection episode after 1 month showed higher pretransplantation sCD30 values than these who displayed rejection before 1 month (P = .019). All groups experienced significant improvement in graft function over 1-year follow-up without any significant differences. Conclusion. Though a significant drop of sCD30 posttransplantation was recorded, serial measurements of sCD30 did not show a difference among subjects who displayed acute rejection episodes, ATN, or other diagnoses.

Background. We studied early sirolimus (SRL) therapy in renal transplant recipients at high risk after administration of antithymocyte globulin or interleukin-2 receptor blockade induction. Patients and Methods. In 45 patients, SRL therapy was started within 1 month after transplantation. The primary indications for conversion of treatment from calcineurin inhibitors (CNIs)―mycophenolate mofetil (MMF)-steroid to SRL-MMF-steroid were biopsy-proved rejection (after treatment), CNI toxicity, CNI elimination, and acute tubular necrosis. Pediatric, geriatric, and other patients with medical comorbidities were not excluded. Results. Post-SRL rejection episodes were reported in 22.2% of recipients including 15.6% who were resistant to steroid therapy. Mean (SD) follow-up after SRL therapy was 59.9 (8.1) months. Proteinuria greater than 2 g/d (P = .001), leukopenia (P < .001), hyperlipidemia (P < .001), and transaminases values (P = .02) increased significantly after SRL therapy. Graft survival was 88.8%, and patient survival was 93.3%. There was significant improvement in serum creatinine concentration and estimated creatinine clearance by the end of the study (P < .001). A high incidence of adverse effects and infections was noted post-SRL therapy, and the drug was discontinued in 31% of patients because of multiple adverse effects. At multivariate analysis, age, hypertension, nutritional status, bone marrow suppression, hyperlipidemia, and graft dysfunction were identified as risk factors for worse graft and patient outcome. Conclusion. Early treatment with combined SRL-MMF-steroid may be effective as a CNI-free immunosuppression regimen in patients at high risk; however, there is a high rate of adverse effects during long-term follow-up.

Background Hyperinfection strongyloidiasis is a potentially fatal syndrome associated with conditions of depressed host cellular immunity. A high degree of suspicion is required to detect cases early and thereby avoid a fatal outcome. Patients and Methods Three consecutive cadaveric kidney transplant recipients died within 2 months from hyperinfections with strongyloides. All members of the transplant team were involved in a campaign to localize the source of infection, identify and treat affected patients, and provide adequate prophylaxis to other transplant recipients. We reviewed cadaveric donor files and screened 61 hospital personnel, 27 hospital inpatients, and the 87 hospital outpatients transplanted in a year’s time before that event for a possible source. The screening test included analysis of fresh stool samples on 3 consecutive days for strongyloides larvae. The anti-helminthic drug albendazol was administered to all patients during screening. They were followed for possible development of the disease during the infectivity period. Results The first 2 recipients received their kidneys from 1 cadaveric donor, while the third received it from a different donor. Both donors came from areas endemic for strongyloidiasis. The 3 recipients were on tacrolimus-based immunosuppression. The twin recipient of the second kidney was on cyclosporine and did not manifest a disease. All stool samples taken for screening were negative for the infective larvae. None of the other recipients developed the disease. Conclusions Cadaveric donors were the possible source for this outbreak. Cyclosporine probably has a protective effect against strongyloides. In our setting, screening of cadaveric donors for strongyloides is mandatory before accepting them for donation, and oral prophylaxis is required for all recipients.

Cyclosporine (CsA) microemulsion has been the mainstay immunosuppressive agent for renal transplant recipients for years. A single daily dosing of cyclosporine (SD) is rarely used. The objective of this study was to evaluate the efficacy of SD versus twice daily dosing of CsA. Retrospective evaluation of SD use was conducted for 44 renal transplant recipients for 12 months (study group). Equal numbers of matched recipients were selected for age, sex, HLA mismatch, donor type, and immunosuppressive regimen (control group). We measured CsA trough (C0) and peak (C2) blood levels, 12-hour CsA profile, and the area under the concentration-time curve (AUC). There were significant differences in C0, C2, and calculated AUC after shifting to SD. In the study group, the mean AUC was 4619 ng/mL/h before versus 6567 ng/mL/h after shifting to SD (P=.004). This became more therapeutic and identical to the mean AUC in the control group, which was 6551 ng/mL/h. Total daily CsA dose was significantly lower in the study group compared with the control group (P

Introduction BK virus nephropathy (BKVN) is a significant cause of graft loss among renal transplant recipients. The treatment outcomes of BKVN have been variably reported in the literature. Patients and methods We prospectively investigated BKV infection and BKVN among a population of renal transplant recipients with suspected BKV infection. The 42 subjects who all had acute allograft dysfunction, were categorized in three groups: those with clinical, laboratory, and histological findings that did not suggest acute rejection, drug toxicity, or obstruction (group 1, n = 24); those with findings that suggested probable acute cellular rejection but did not respond to antirejection treatment (group 2, n = 10); and those whose renal histology suggested BKVN (group 3, n = 8). Polymerase chain reaction analysis was done to detect BKV DNA in urine and blood samples from each subject. BKV DNA was detected in 19 (45%) urine samples with 11 of these subjects (26.1% of total) having BK viremia as well. Results No evidence of BKVN was detected histologically in seven subjects with isolated BK viruria, while the others proved to be JC virus infections. Among the 11 subjects with BK viremia, eight had BKVN based on renal histology at the time of diagnosis with BKV infection, while the other three subsequently developed histological features of BKVN. BKVN developed after 5.3 ± 2.5 (2 to 44) months after transplantation. The serum creatinine at time of BKVN diagnosis was 158.9 ± 58 (87 to 285) μmol/L. All subjects were initially treated with a 50% reduction in immunosuppressive drug doses. Further decreases in immunosuppression were performed in all patients with close monitoring of renal function. All subjects were followed up for a of 18.2 ± 5 (12 to 26) months. Two grafts were lost not due to BKVN, and one patient was lost to follow-up during this period. The latest serum creatinine in eight recipients is 113 + 20 (81 to 138) μmol/L, which is better than the renal function at diagnosis. Conclusion The prevalence of BKVN in suspected BKV infection was 26%. Although the study period was short (30 months), BK viremia strongly correlated with BKVN, which seemed to be successfully treated with reduction in immunosuppression.

Introduction Cyclosporine microemulsion has been the mainstay immunosuppressive agent in renal transplantation for years. Since single daily dosing of cyclosporine is rarely used, the objective of this investigation was to evaluate the efficacy of a single daily dose versus twice daily dosing of cyclosporine in renal transplant recipients. Methods Retrospective evaluation of single-dose cyclosporine use was conducted for 15 renal transplant recipients for 12 months (study group). Equal numbers of matched renal transplant recipients were selected for age, sex, human leukocyte antigen mismatch, donor type, and immunosuppressive regimen (control group). Cyclosporine trough level and peak cyclosporine blood levels, 12-hour cyclosporine profile, and the area under the concentration-time curve were measured. Results There was a significant difference in cyclosporine peak blood level and calculated area under the curve after shifting to single-dose cyclosporine (P = .001). In the study group, the mean area under the curve was significantly below the average therapeutic range before (3154 ng/mL/ho) versus 5532 ng/mL/h after shifting to the single-dose regimen (which was therapeutic). This value was 5749 ng/mL/h in the control group. Total daily cyclosporine dose was lower in the study group when compared with the control group at 6 and 12 months (P = .01). There were significantly fewer adverse effects in patients in the study group than in patients in the control group. Conclusion We conclude that although cyclosporine dose should be individualized in renal transplant recipients, a single dose of cyclosporine has the added advantage of decreasing dosages and cyclosporine-related adverse effects while maintaining optimal graft function.

Background Renal allograft transplantation with multiple arteries (MRA) was always avoided as much as possible as it is technically demanding and carries a higher MSK for complications. This was a single-center study to explore the graft outcomes of kidney transplantation with MRA. Patients and Methods We retrospectively reviewed the medical records of 35 patients who received kidney grafts with MRA for the surgical technique, surgical complications, graft function, and graft survival. The results were compared with those achieved in recipients of kidney grafts with a single renal artery (SRA). Results Of 35 grafts, there were 2 renal arteries in 30 grafts, and 3 renal arteries in 5 grafts. In the MRA group, there were 7 instances of surgical complications, the mean serum creatinine levels were 122, 139, and 156 μmol/L at 1 month, 1 year, and 5 years, respectively, and the actuarial graft survival rates were 94.3%, 88.6%, and 83% at 1, 5, and 10 years, respectively. In the SRA group, there were 56 instances of surgical complications, the mean serum creatinine levels were 115, 121, and 141 μmol/L at 1 month, 1 year, and 5 years, respectively, and the actuarial graft survival rates were 93.7%, 88.1%, and 84.4% at 1, 5, and 10 years, respectively. Conclusion Although transplantation of MRA grafts might carry a relatively higher risk for complications, it is justified because it gives results comparable with those achieved in SRA.

The prevalence of inflammatory bowel disease (IBD) after renal transplantation is affected by the immune tolerance and the modality of immunosuppression. Mycophenolate mofetil (MMF) may have a promoting effect on the development of posttransplantation erosive enterocolitis and a Crohn's disease-like pattern of colitis. We have presented a 40-year-old man with end-stage renal disease due to chronic glomerulonephritis who commenced hemodialysis for 2 months before receipt of a live unrelated renal transplant. He developed early posttransplantation diabetes mellitus and an anti graft rejection episode, which responded to a methylprednisolone pulse and OKT3 treatment. His immunosuppressive regimen included prednisolone, MMF, and tacrolimus. Three years after transplantation, he developed mild constitutional symptoms, mouth ulcerations, and chronic intermittent bloody diarrhea. Colonoscopy showed active segmental colitis with aphthous ulcers, involving the proximal descending colon and the splenic flexure. Colonic biopsies showed distended and branched crypts in the ascending colon, moderate active chronic colitis with regenerative atypia, skipping appearance, and ulceration in the splenic flexure and descending colon. The edematous crypts were associated with ulcerations in the sigmoid colon and rectum. The features were highly suggestive of Crohn's disease. He was successfully treated with high-dose steroids and 5-aminosalicylic acid. Subsequently, he developed chronic transplant glomerulopathy and restarted hemodialysis. We concluded that de novo Crohn's disease may develop in renal transplant recipients despite immunosuppressive therapy especially with MMF immunosuppression.

Previous efforts in the simulation of crop-irrigation systems have been reviewed and carefully examined. A model based on the system dynamics approach of Forrester has been developed to assist farmers in determining the date and volume of water to apply to each field and the expected yields. The model effectively takes into account the feedback loops and non-linearity inherent in the real world system. The model has been based on a water balance of soil moisture, evapotranspiration, irrigation, precipitation and deep percolation, and the grain yield has been predicted. The validity of the model has been tested using experimental data of wheat grown in a lysimeter. The predicted soil moistures, cumulative evapotranspirations and grain yields were in good agreement with the actual observed values for different treatments of irrigation.

This study examines technical efficiency between Participatory & Non- Participatory farmers under Integrated Crop Management project (ICM) in the north-west region of Bangladesh. Sixty farmers of which 30 participatory & 30 non-participatory were selected following stratified random sampling technique from four villages under pirganj upazila in Thakurgaon district. ICM project participatory farmers received higher net returns than the non-participatory farmers from selected crop production. Participatory farmers were technically more efficient than non- participatory farmers. Getting membership status of non- participatory farmers was suggested to be an important factor in removing technical inefficiency. Keywords: Technical efficiency; Participatory; Non-participatory DOI: 10.3329/jbau.v7i2.4734 J. Bangladesh Agril. Univ. 7(2): 273-280, 2009

To evaluate the odd-mode fringing capacitance against strip gap width in a parallel-coupled thick-strip transmission-line filter, Cohn has proposed two equations, one valid for the narrow-gap region and the other for the wide-gap region. A simple technique to combine these equations into a single one valid for the entire range of gap widths is presented. It is shown that the results are similar to those obtained by Getsinger from a different approach, and are satisfactory for filter design, since they lead to good agreement with experiment.