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HIV-tuberculosis co-infection in an Indian scenario:The role of associated evidence of immunosuppression

Asian Pacific Journal of Tropical Medicine 2013年第4期6卷 320-324页

作者： kushal naha Sowjanya Dasari Mukhyaprana Prabhu Department of Medicine Kasturba HospitalManipal 576104KarnatakaIndia

Objective:To determine the relationship between tuberculosis and the degree of immunosuppression as determined by CD4 count.The impact of immunosuppression on the severity of tuberculosis was also studied.Methods:A retrospective analysis was performed in patients newly diagnosed with HIV infection and antiretroviral therapy(ART)-naive patients with known HIV seropositivity.All patients were diagnosed with active tuberculosis between January 2008 and December 2010,based on review of their medical records.Patients on chemoprophylaxis for opportunistic infection were excluded.Pattern and severity of tuberculosis,associated stigmata of immunosuppression,and CD4 counts were noted.Results:Of 140 patients satisfying the inclusion criteria.52 had mild tuberculosis with no other evidence of immunosuppression,52 had tuberculosis of variable severity with associated evidence of immunosuppression,and 36 had severe tuberculosis with no other evidence of immunosuppression.The CD4 count was highest in the first group[<109.2±99.9) cells/μL]and least in the second group[(58.4±39.8) cells/μL], and the difference was statistically significant(P=0.004).No statistical difference was observed in the CD4 count between those with mild tuberculosis and those with severe tuberculosis. Conclusions:In developing countries with a high prevalence of tuberculosis in the general population,the possibility of incidental tuberculosis in patients with HIV should always be considered.CD4 count does not appear to influence the severity of tuberculosis.The presence of concomitant evidence of immunosuppression in the form of category B and C conditions is indicative of underlying immunosuppression and associated with a significantly lower CD4 count.

关键词： HIV Tuberculosis Co-infection Immunosuppression

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Spectrum of complications associated with Plasmodium vivax infection in a tertiary hospital in South-Western India

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Asian Pacific Journal of Tropical Medicine 2012年第1期5卷 79-82页

作者： kushal naha Sowjanya Dasari Mukhyaprana Prabhu Department of Medicine Kasturba HospitalManipal-576 104KarnatakaIndia

Objective:To determine the range and incidence of complications associated with Plasmodium vivax[P.vivax) malaria.Methods:A retrospective analysis was performed of all patients of P.vivax malaria admitted in kasturba Medical College.Manipal between January and December,2010.Patients with mixed malarial infection were excluded by appropriate tests. Clinical presentation and laboratory parameters were studied.Results:Medical records of 213 individuals who satisfied the inclusion criteria were reviewed.Anaemia was seen in 65 (30.5%),leucopenia in 38(17.8%]and thrombocytopenia in 184(86.4%l patients.Aspartate and alanine aminotransferases were elevated in 86(40.4%).and 89(41.9%) patients respectively. Hypoalbuminemia was observed in 157(73.6%) cases.Elevated serum creatinine was noted in in 59(27.5%) patients.Creatine kinase was elevated in 30 nut of 59 patients(50.8%).Overall.107 (50.2%) patients fulfilled WHO criteria for sever=e malaria.None of the patients succumbed to the disease.Conclusion:P.vivax malaria is a potentially severe disease,and the term ’ benign" tertian malaria is a misnomer.Despite significant morbidity,with timely and appropriate treatment P.rirax malaria has an excellent outcome.

关键词： Plasmodium vivax malaria Complications Benign tertian malaria

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Brucellosis and tuberculosis:Clinical overlap and pitfalls

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Asian Pacific Journal of Tropical Medicine 2013年第10期6卷 823-825页

作者： Sowjanya Dasari kushal naha Mukhyaprana Prabhu Department of Medicine Kasturba HospitalManipal-576 104KarnatakaIndia

Objective:To identify characteristic features of tuberculosis in patients with culture proven brucellosis.Methods:A retrospective analysis was performed on patients diagnosed with culture proven brucellosis between January and December 2011,based on review of their medical records.Patients with demonstrable co-infection with tuberculosis were excluded.Clinical features,laboratory parameters and tissue histopathology reports where available were noted.Results:Thirty-two patients with brucellosis were included in the study.Twenty-one(65.63%)patients had chronic fever,thirteen(40.63%)had a productive cough,while significant weight loss,evening rise of temperature and night sweats were reported by eight(25.00%),eleven(34.38%)and five(15.63%)patients respectively.Nine(28.13%)patients had at least three of these symptoms.Lymphadenopathy,hepatomegaly and splenomegaly were noted on examination in seven(21.88%),fifteen(46.88%)and twelve(37.50%)patients respectively.Eight(25.00%)patients had hepatosplenomegaly,of these only two had associated significant lymphadenopathy.Respiratory examination was normal in all patients.Elevated ESR greater than 50 mm/hr was seen in eight(25.00%),it was greater than 100 mm/hr in five(15.63%)patients.Hypergammaglobulinemia was seen in eight(25.00%)cases.Bone marrow biopsy showed non-caseating granulomas in three(9.38%)cases,lymph node biopsy showed granulomas in one case.Overall,three(9.38%)patients had known risk factors for tuberculosis,while six(18.75%)had risk factors for brucellosis.Conclusions:There is a clear overlap between brucellosis and tuberculosis both in terms of clinical presentation and laboratory parameters.It is essential to c-arefully rule out tuberculosis in all cases of suspected or proven brucellosis before initiating antimicrobial therapy,in order to forestall development of drug-resistant tuberculosis.

关键词： Brucellosis Tuberculosis Overlap Drug resistance

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Colonization or spontaneous resolution:Expanding the role for Burkholderia pseudomallei

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Asian Pacific Journal of Tropical Medicine 2014年第3期7卷 250-252页

作者： kushal naha Barkur Ananthakrishna Shastry Kavitha Saravu Department of Medicine Kasturba Hospital

A 19-year-old Asian Indian female presented with productive cough since the past one month and low grade fever since the pasl two weeks.She was diagnosed with pulmonary tuberculosis and treated with anlilubercular drugs.Subsequently,delayed cultures of bronclioalveolar lavage fluid grew Burkholderia pseudomallei(B.pseudomallei).On follow up the patient reported significant subjective improvement and ESR progressively returned to normal.In summary',this case report raises two distinct and equally intriguing roles for B.pseudomallei,i.***.respiratory colonization and spontaneously resolving pulmonary infection.The pathogenic potential of B.pseudomallei,the eliologic agent of melioidosis,is well known.Confirmation of eilher colonization or spontaneous resolution,would potentially spare many patients unnecessary and oxpensivo therapy with broad-spectruin antibiotics,and contribute to more rational usage of antibiotics,especially in co-infecliou with Mycobacterium tuberculosis and B.pseudomallei-two bacterial diseases with closely similar clinical,radiologic and histopathologic features.

关键词： Burkholderia pseudomallei Tuberculosis Colonizer Coinfection Spontaneous resolution Melioidosis

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Polymyositis-like syndrome with rhabdomyolysis in association with brucellosis

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Asian Pacific Journal of Tropical Medicine 2012年第9期5卷 755-756页

作者： kushal naha Suman Karanth Sowjanya Dasari Mukhyaprana Prabhu Department of Medicine Kasturba HospitalManipal-576 104Manipal UniversityKarnatakaIndia

Diffuse myositis with progression to rhabdomynlysis has been reported in association with wide range of viral infections.We report a case of polvmvosilis-like svndrome complicated by rhabdomyolysis secondary to brucellosis.This case report thus contributes yet another atypical presentation to a disease already infamous for its protean manifestations.

关键词： Polymyositis Rhabdomyolysis Brucellosis Atypical presentation

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Dual infection with hepatitis A and E virus presenting with aseptic meningitis:A case report

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Asian Pacific Journal of Tropical Medicine 2012年第7期5卷 587-588页

作者： kushal naha Suman Karanth Mukhyaprana Prabhu Manpreet Singh Sidhu Department of Medicine Kasturba HospitalManipal-576 104KarnatakaIndia

We report the case of a young male who presented with features of aseptic meningitis and elevated serum liver enzymes,hut no symptoms or signs suggestive of an acute hepatitis. Subsequently,he was diagnosed with dual infection with hepatitis A and E viruses,and recovered completely with symptomatic therapy.Isolated aseptic meningitis,unaccompanied by hepatitic features is an unusual presentation of a hepatotrophic viral infection,and is yet to be reported with hepatitis A and E virus co-infection.

关键词： Dual infection Hepatitis A Hepatitis E Aseptic meningitis Atypical presentation

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有 multiorgan 机能障碍的自发的败血症为 Pantoe agglomerans 的一张新面孔？

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Asian Pacific Journal of Tropical Medicine 2012年第1期5卷 83-84页

作者： kushal naha Ramamoorthi Mukhyaprana Prabhu Department of Medicine Kasturba HospitalManipal-576 104KarnatakaIndia

Pantoe agglomerans(P.agglomerans) is an unusual cause for sepsis in immunocompetent individuals,especially in the absence of characterislic risk factors.We report one such case occurring in a farmer,manifesting with severe illness.The severe nature of illness and the apparently spontaneous origin of septicemia underline the pathogenic potential of this organism. When coupled with the ubiquity of the organism,there is a definite possibility that this disease may become increasingly frequent in the near future,especially in agronomic countries like India,further studies on the epidemiology and natural history of this disease are required.

关键词： Pantoe agglomerans Spontaneous septicemia Multi-organ dysfunction

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The Effect of Jet Grouting on Enhancing the Lateral Behavior of Piled Raft Foundation in Soft Clay(Numerical Investigation)

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Advances in Geological and Geotechnical Engineering Research 2023年第1期5卷 24-39页

作者： Mostafa Esawwaf Wasiem Azzam naha Eghrouby Faculty of Engineering Tanta UniversityTanta31511Egypt

Soft clay soils cannot usually support large lateral loads,so clay soils must be improved to increase lateral resistance.The jet grouting method is one of the methods used to improve weak soils.In this paper,a series of 3D finite element studies were conducted using Plaxis 3D software to investigate the lateral behavior of piled rafts in improved soft clay utilizing the jet grouting method.Parametric models were analyzed to explore the influence of the width,depth,and location of the grouted clay on the lateral resistance.Additionally,the effect of vertical loads on the lateral behavior of piled rafts in grouted clay was also investigated.The numerical results indicate that the lateral resistance increases by increasing the dimensions of the jet grouting beneath and around the piled raft.Typical increases in lateral resistance are 11.2%,65%,177%,and 35%for applying jet grouting beside the raft,below the raft,below and around the raft,and grouted strips parallel to lateral loads,respectively.It was also found that increasing the depth of grouted clay enhances lateral resistance up to a certain depth,about 6 to 10 times the pile diameter(6 to 10D).In contrast,the improvement ratio is limited beyond 10D.Furthermore,the results demonstrate that the presence of vertical loads has a significant impact on sideward resistance.

关键词： Finite element analysis Plaxis 3D Lateral bearing capacity Jet grouting Piled raft Soil improvement

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把聊天变成鬼画

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网友世界 2005年第13期 78-79页

作者： naha

一个自强不息的聊天爱好者兼骨灰级漫画迷随时都在注意革新。这次，她给大家带来了一种叫做“鬼画聊天”的发明，本着为人民服务的原则，她还没有去申请专利。说真话，小编觉得这项发明真是太瞥脚了。当然，这个蹩脚的发明也有它的一些... 详细信息

一个自强不息的聊天爱好者兼骨灰级漫画迷随时都在注意革新。这次，她给大家带来了一种叫做“鬼画聊天”的发明，本着为人民服务的原则，她还没有去申请专利。说真话，小编觉得这项发明真是太瞥脚了。当然，这个蹩脚的发明也有它的一些好处，所以，但凡想在上班时间聊天又不被察觉、情绪激昂表露于形，拿起笔就要手痒乱画、即使在网上也恨不得让所有人看见自己真实表情，觉得QQ贴图迁不够个性的人，欢迎你们像她一样……

关键词：聊天为人民服务发明

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操作参数对Corex铁水Si含量的影响

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世界钢铁 2010年第1期10卷 1-6+18页

作者： P Prachethan Kumar A V R P Dasu M Ranjan T K naha 张海洋金达尔钢公司研发部

优质低耗的钢铁产品需求低硅低硫的优质铁水。高硅铁水是炼钢处理所不希望的,它导致处理流程成本增加、产率降低,因此,需持续努力降低铁水中Si的含量。Corex是唯一确立并被证明已成功商业运行的改变传统高炉炼铁的熔融还原技术。尽管高... 详细信息

优质低耗的钢铁产品需求低硅低硫的优质铁水。高硅铁水是炼钢处理所不希望的,它导致处理流程成本增加、产率降低,因此,需持续努力降低铁水中Si的含量。Corex是唯一确立并被证明已成功商业运行的改变传统高炉炼铁的熔融还原技术。尽管高炉硅转移原理已被熟练掌握,但Corex工艺仍然需要进一步的操作指导来控制硅转移。对超过一年的工厂运行数据进行统计分析,可以了解铁水中Si含量的影响因素,提供预测和控制铁水Si含量的方法。用回归分析得出回归方程来预测Corex铁水Si含量。简要讨论了硅预测回归分析中所涉及的各种因素,并验证操作参数,阐述了各参数间的相互关系。数据分析表明高水分、低金属化率、高挥发分、高渣比、高煤粉率、低产能直接导致高燃料比,同时炉渣高碱度和高Al2O3含量会导致铁水Si含量升高。

关键词： Corex 燃料比灰分硅炉渣高炉熔融气化炉还原竖炉

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