World Academy of Science, Engineering and Technology

Authors: Chia-Yu Lin, Yu-Hsiang Shen, Cing-Ciao Ke, Chia-Hao Chang, Fan-Pin Tseng, Yu-Ching Ni, Sheng-Pin Tseng

Abstract:

Tomosynthesis is an imaging system that generates a 3D image by scanning in a limited angular range. It could provide more depth information than traditional 2D X-ray single projection. Radiation dose in tomosynthesis is less than computed tomography (CT). Because of limited angular range scanning, there are many properties depending on scanning direction. Therefore, non-coplanar imaging technique was developed to improve image quality in traditional tomosynthesis. The purpose of this study was to establish the non-coplanar imaging technique of tomosynthesis system and evaluate this technique by the reconstructed image. INER prototype tomosynthesis system contains an X-ray tube, a flat panel detector, and a motion machine. This system could move X-ray tube in multiple directions during the acquisition. In this study, we investigated three different imaging techniques that were 2D X-ray single projection, traditional tomosynthesis, and non-coplanar tomosynthesis. An anthropopathic chest phantom was used to evaluate the image quality. It contained three different size lesions (3 mm, 5 mm and, 8 mm diameter). The traditional tomosynthesis acquired 61 projections over a 30 degrees angular range in one scanning direction. The non-coplanar tomosynthesis acquired 62 projections over 30 degrees angular range in two scanning directions. A 3D image was reconstructed by iterative image reconstruction algorithm (ML-EM). Our qualitative method was to evaluate artifacts in tomosynthesis reconstructed image. The quantitative method was used to calculate a peak-to-valley ratio (PVR) that means the intensity ratio of the lesion to the background. We used PVRs to evaluate the contrast of lesions. The qualitative results showed that in the reconstructed image of non-coplanar scanning, anatomic structures of chest and lesions could be identified clearly and no significant artifacts of scanning direction dependent could be discovered. In 2D X-ray single projection, anatomic structures overlapped and lesions could not be discovered. In traditional tomosynthesis image, anatomic structures and lesions could be identified clearly, but there were many artifacts of scanning direction dependent. The quantitative results of PVRs show that there were no significant differences between non-coplanar tomosynthesis and traditional tomosynthesis. The PVRs of the non-coplanar technique were slightly higher than traditional technique in 5 mm and 8 mm lesions. In non-coplanar tomosynthesis, artifacts of scanning direction dependent could be reduced and PVRs of lesions were not decreased. The reconstructed image was more isotropic uniformity in non-coplanar tomosynthesis than in traditional tomosynthesis. In the future, scan strategy and scan time will be the challenges of non-coplanar imaging technique.

Keywords: image reconstruction, non-coplanar imaging technique, tomosynthesis, X-ray imaging

Procedia PDF Downloads 363

Authors: Megha Ramnik Kotecha

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To study whether there is any clinical correlation between pterygium and dry eye and to evaluate the status of tear film in patients with pterygium. Methods: 100 eyes with pterygium were compared with 100 control eyes without pterygium. Patients between 20 – 70 years were included in the study. Detailed history was taken and Schirmer’s test and TBUT were performed on all to evaluate the status of dry eye. Schirmer’s test ˂10 mm and TBUT ˂10 seconds was considered abnormal. Results: Maximum number (52) of patients affected with dry eye in both the groups were in the age group 31-40 years which statistically showed age as a significant factor of association for both pterygium and dry eye (P<0.01).Schirmer’s test was slightly reduced in patients with pterygium(18.73±5.69 mm). TBUT was significantly reduced in the case group (12.26±2.24sec).TBUT decreased maximally in 51-60 yrs age group (13.00±2.77sec) with pterygium showing a tear film unstability. On comparision of pterygia and controls with normal and abnormal tear film, Odd’s Ratio was 1.14 showing risk of dry eye in pterygia patients to be 1.14 times higher than controls. Conclusion: Whether tear dysfunction is a precursor to pterygium growth or pterygium causes tear dysfunction is still not clear. Research and clinical evidence, however, suggest that there is a relationship between the two. This study is, therefore, undertaken to investigate the correlation between pterygium and dry eye. The patients with pterygia were compared with normals to evaluate their status regarding dryness. A close relationship exists between ocular irritation symptoms and functional evidence of tear instability. Schirmer’s test and TBUT should routinely be used in the outpatient department to diagnose dry eye in patients with pterygium and these patients should be promptly treated to prevent any sight threatening complications.

Keywords: dry eye, pterygium, Schirmer's test, tear break up time (TBUT)

Procedia PDF Downloads 295

Authors: Pampita Chakraborty, Sukumar Mukherjee

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The study was done to determine the microbiological profile and changing pattern of the pathogens causing UTI in the ICU patients. All the patients admitted to the ICU with urinary catheter insertion for more than 48hours were included in the study. Urine samples were collected in a sterile container with aseptic precaution using disposable syringe and was processed as per standards. Antimicrobial susceptibility test was done by Disc Diffusion method as per CLSI guidelines. A total of 100 urine samples were collected from ICU patients, out of which 30% showed significant bacterial growth and 7% showed growth of candida spp. Prevalence of UTI was more in female (73%) than male (27.%). Gram-negative bacilli 26(86.67%) were more common in our study followed by gram-positive cocci 4(13.33%). The most common uropathogens isolated were Escherichia coli 14 (46.67%), followed by Klebsiella spp 7(23.33%), Staphylococcus aureus 4(13.33%), Acinetobacter spp 3(10%), Enterococcus faecalis 1(3.33%) and Pseudomonas aeruginosa 1(3.33%). Most of the Gram-negative bacilli were sensitive to amikacin (80%) and nitrofurantoin (80%), where as all gram-positive organisms were sensitive to Vancomycin. A large number ESBL producers were also observed in this study. The study finding showed that E.coli is the predominant pathogen and has increasing resistance pattern to the commonly used antibiotics. The study proposes that the adherence to antibiotic policy is the key ingredients for successful outcome in ICU patients and also emphasizes that repeated evaluation of microbial characteristics and continuous surveillance of resistant bacteria is required for selection of appropriate antibiotic therapy.

Keywords: antimicrobial sensitivity, intensive care unit, nosocomial infection, urinary tract infection

Procedia PDF Downloads 263

Authors: Marzieh Ebrahimi, Vahid Changizi, Mohammad Reza Kardan, Seyed Mahdi Hosseini Pooya, Parham Geramifar

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Radiation exposure to the patient's family members is one of the major concerns during thyroid cancer radionuclide therapy. The aim of this study was to measure the total effective dose of the family members by means of thermoluminescence personal dosimeter, and compare with those calculated by analytical methods. Eighty-five adult family members of fifty-one patients volunteered to participate in this research study. Considering the minimum and maximum range of dose rate from 15 µsv/h to 120 µsv/h at patients' release time, the calculated mean and median dose values of family members were 0.45 mSv and 0.28 mSv, respectively. Moreover, almost all family members’ doses were measured to be less than the dose constraint of 5 mSv recommended by Basic Safety Standards. Considering the influence parameters such as patient dose rate and administrated activity, the total effective doses of family members were calculated by TEDE and NRC formulas and compared with those of experimental results. The results indicated that, it is fruitful to use the quantitative calculations for releasing patients treated with I-131 and correct estimation of patients' family doses.

Keywords: effective dose, thermoluminescence, I-131, thyroid cancer

Procedia PDF Downloads 393

Authors: Ae Ra Han, Taek Hoo Lee, Sun Zoo Kim, Hwa Young Lee

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Introduction: Ovarian endometrioma is one of the important causes of poor ovarian reserve and up to half of them have recurred. However, the treatment for recurrence prevention has limited efficiency and repeated surgical management makes worsen the ovarian reserve. To find better management for recurrence prevention, we investigated risk factors and biomarkers for the recurrence of ovarian endometrioma. Methods: The medical records of women with the history of surgical dissection for ovarian endometrioma were collected. After exclusion of the cases with concurrent hysterectomy, been menopaused during follow-up, incomplete medical record, and loss of follow-up, a total of 134 women were enrolled. Immunohistochemical staining for progesterone receptor isoform B (PR-B) and nuclear factor kappa B (NFκB) was done with the fixed tissue blocks of their endometriomas which were collected at the time of surgery. Results: Severity of dysmenorrhea and co-existence of adenomyosis had significant correlation with recurrence of endometrioma. Increased PR-B (P = .041) and decreased NFκB (P = .036) immunoreactivity were found in recurrent group. Serum CA-125 level at the time of recurrence was higher than the highest level of CA-125 during follow-up in unrecurred group (55.6 vs. 21.3 U/mL, P = .014). Conclusion: We found that the severity of dysmenorrhea and coexistence of adenomyosis are risk factors for recurrence of ovarian endometrioma, and serial follow-up of CA-125 is effective to detect and prevent the recurrence. However, to determine the possibility of immunoreactivity of PR-B and NFκB as biomarkers for ovarian endometrioma, further studies of various races and large numbers with prospective design are needed.

Keywords: endometriosis, recurrence, biomarker, risk factor

Procedia PDF Downloads 550

Authors: Mukurdipi Ray, Seema Singh

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Extrauterine endometrial stromal sarcoma (ESS) is a rare entity and typified by delayed recurrence of primary ESS. Here, we present an unusual case of uterine ESS in a woman with a history of hysterectomy. A 19-year-old girl, underwent a hysterectomy and bilateral salpingo-oophorectomy for uterine ESS 12 months ago and now after remaining disease free for nine months ago she presented with ascites along with pelvic and peritoneal mass. Intraoperatively, the large omental mass was found, and optimal cytoreduction with total omentomy (supracolic and infracolic ) total peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) was offered to the patient. Final histopathology report showed the involvement of only omentum by ESS cells. Immunohistochemistry (IHC) and receptor study were done and it was positive for CD-10 and desmin and negative for CK- 7. This case highlights the rarity of extrauterine ESS in the omentum with a known history of primary uterine ESS which was treated successfully with the above-mentioned procedure. Though active and long-term surveillance is recommended to monitor for late recurrences.

Keywords: endrometrial stromal sarcoma, complete cytoreduction, hyperthermic intra peritoneal chemotherapy, total omentectomy

Procedia PDF Downloads 203

Authors: Thi. A. D. Tran, Matthieu Arnold, Dominique Adolphe, Laurence Schcher, Guillaume Reys

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During daily oral health cares, dental surgeons are in contact with numerous potentially infectious germs from patients' saliva and blood. In order to take into account these risks, a product development process has been unrolled to propose to the dental surgeon a personal protection equipment that is suitable with their expectations in terms of images, protection and comfort. After a consumer study, to evaluate how the users wear the garment and their expectations, specifications have been carried out and technical solutions have been developed in order to answer to the maximum of the desiderata. Thermal studies and comfort studies have been performed. The obtained results lead to define the technical solutions concerning the design of the new scrub. Three main functions have been investigated, the ergonomic aspect, the protection and the thermal comfort. In terms of ergonomic aspect, instrumented garments have been worn and pressure measurements have been done. The results highlight that a raglan shape for the sleeves has to be selected for a better dynamic comfort. Moreover, spray tests helped us to localize the potential contamination area and therefore protection devices have been placed on the garment. Concerning the thermal comfort, an I-R study was conducted in consulting room under the real working conditions; the heating zones have been detected. Based on these results, solutions have been proposed and implemented in a new gown. This new gown is currently composed of three different parts; a protective layer placed in the chest area to avoid contamination; a breathable layer placed in the back and in the armpits and a normal PET/Cotton fabric for the rest of the gown. Through the fitting tests conducted in hospital, it was obtained that the new design was highly appreciated. Some points can nevertheless be further improved. A final product will be produced based on necessary improvements.

Keywords: comfort, dentists, garment, thermal

Procedia PDF Downloads 305

Authors: Made Kurnia Widiastuti Giri, Nyoman Kanca, Arie Swastini, Bambang Purwanto

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Aim: Waria transgenders are a phenomenon whose existence is undeniable. The sexual behaviours of waria transgenders belong to the groups of high-risk STDs infections, especially HIV/AIDS. The present study was aimed at finding out the general idea of the existence of waria transgenders in Singaraja, their sexual transactions, their sexual behaviours, and at exploring the factors affecting their sexual behaviours along with their participation in regular reproduction health control. Methods: The subjects of the present research were male-to-female transgenders living in the town of Singaraja. The research applied a qualitative approach. Data collection in this research was conducted through in-depth interview and observation. Results: The results of the study exposed 1) the existence of waria transgender community in Singaraja observed from their active participation in social events such as taking the roles of counsellors in the campaign of prevention and control of HIV/AIDS with the Local Commission of AIDS Control and other foundations; 2) the sexual services provided by waria transgenders which were performed in squeeze method, oral and anal sex which could be categorized as HIV/AIDS high-risk sexual behaviours, while the consistency in doing safe sex among the trangenders in Singaraja showed that most of the waria transgenders (80%) were aware of the urgency of using condoms during sexual intercourse; and 3) the low participation of the waria transgenders in Singaraja in regular reproduction health check up at the local Centre of Public Health Service was caused by their negative perception about being examined by female doctors. Conclucions: Waria in singaraja categorized as HIV/AIDS high-risk sexual behaviours but they do have consistency in doing safe sex by using condoms. They have a negative psychological perception about being examined by female doctors.

Keywords: waria transgenders, sexual behaviours, reproduction health, hiv/aids

Procedia PDF Downloads 333

Authors: Jennie Long, Marjorie Bock

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Although the professional literature related to Autism Spectrum Disorder (ASD) has focused on successful interventions and strategies, there is a lack of documentation regarding which of these methods and supports are most foundational and essential for classroom use. Specifically, literature does not define the core foundational interventions and strategies that would be elemental for educators to use with students with an ASD diagnosis. From the increase in prevalence of autism spectrum disorders, to the challenge students with ASD pose in classrooms, to the requirement to implement evidence-based practice, rises an enormous challenge in the field of education. Foundational interventions should be in place the first day the student enters the classroom. The nine interventions are foundational in nature and because of the dramatic increase in prevalence there is currently a need for classroom programs to provide the foundation of basic educational skills as well as the specialty skills specific to the area of ASD utilizing the most current research. This article presents nine evidence-based intervention categories for implementation with students on the spectrum.

Keywords: autism spectrum disorder, classroom, evidence-based, foundational

Procedia PDF Downloads 259

Authors: M. Van 'T Hof, R. V. Pasma, J. T. Bailly, H. W. Hoek, W. A. Ester

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Background: The transition into primary school can be challenging for children with an autism spectrum disorder (ASD). Due to the new demands that are made to children in this period, their limitations in social functioning and school achievements may manifest and appear faster. Detection of possible ASD signals mainly takes place by parents, teachers and during obligatory municipal maternal and child health centre visits. Physicians of municipal maternal and child health centres have limited education and instruments to detect ASD. Further education on detecting ASD is needed to optimally equip these doctors for this task. Most research aims to increase the early detection of ASD in children aged 0-3 years and shows positive results. However, there is a lack of research on educational interventions to detect ASD in children aged 4-6 years by municipal maternal and child health physicians. Aim: The aim of this study is to explore the effect of the online educational intervention: Detection of ASD in children aged 4-6 years for municipal maternal and child health physicians. This educational intervention is developed within The Reach-Aut Academic Centre for Autism; Transitions in education, and will be available throughout The Netherlands. Methods: Ninety-two participants will follow the educational intervention: Detection of ASD in children aged 4-6 years for municipal maternal and child health centre physicians. The educational intervention consists of three, one and a half hour sessions, which are offered through an online interactive classroom. The focus and content of the course has been developed in collaboration with three groups of stakeholders; autism scientists, clinical practitioners (municipal maternal and child health doctors and ASD experts) and parents of children with ASD. The primary outcome measure is knowledge about ASD: signals, early detection, communication with parents and referrals. The secondary outcome measures are the number of ASD related referrals, the attitude towards the mentally ill (CAMI), perceived competency about ASD knowledge and detection skills, and satisfaction about the educational intervention. Results and Conclusion: The study started in January 2016 and data collection will end mid 2017.

Keywords: ASD, child, detection, educational intervention, physicians

Procedia PDF Downloads 289

Authors: Claude Takenga, Rolf-Dietrich Berndt, Erling Si, Markus Diem, Guohui Qiao, Melanie Gau, Michael Brandstoetter, Martin Kampel, Michael Dworzak

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In patients with acute lymphoblastic leukaemia (ALL), treatment response is increasingly evaluated with minimal residual disease (MRD) analyses. Flow Cytometry (FCM) is a fast and sensitive method to detect MRD. However, the interpretation of these multi-parametric data requires intensive operator training and experience. This paper presents a pipeline-software, as a ready-to-use FCM-based MRD-assessment tool for the daily clinical practice for patients with ALL. The new tool increases accuracy in assessment of FCM-MRD in samples which are difficult to analyse by conventional operator-based gating since computer-aided analysis potentially has a superior resolution due to utilization of the whole multi-parametric FCM-data space at once instead of step-wise, two-dimensional plot-based visualization. The system developed as a telemedical network reduces the work-load and lab-costs, staff-time needed for training, continuous quality control, operator-based data interpretation. It allows dissemination of automated FCM-MRD analysis to medical centres which have no established expertise for the benefit of an even larger community of diseased children worldwide. We established a telemedical network system for analysis and clinical follow-up and treatment monitoring of Leukaemia. The system is scalable and adapted to link several centres and laboratories worldwide.

Keywords: data security, flow cytometry, leukaemia, telematics platform, telemedicine

Procedia PDF Downloads 977

Authors: Taku Numao, Kazu Amimoto, Tomoko Shimada, Kyohei Ichikawa

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Background: Unilateral spatial neglect (USN) is a common syndrome following damage to one hemisphere of the brain (usually the right side), in which a patient fails to report or respond to stimulation from the contralesional side. These symptoms are not due to primary sensory or motor deficits, but instead, reflect an inability to process input from that side of their environment. Prism adaptation (PA) is a therapeutic treatment for USN, wherein a patient’s visual field is artificially shifted laterally, resulting in a sensory-motor adaptation. However, patients with USN also tend to perceive a left-leaning subjective vertical in the frontal plane. The traditional PA cannot be used to correct a tilt in the subjective vertical, because a prism can only polarize, not twist, the surroundings. However, this can be accomplished using a head mounted display (HMD) and a web-camera. Therefore, this study investigated whether an HMD system could be used to correct the spatial perception of USN patients in the frontal as well as the horizontal plane. We recruited healthy subjects in order to collect data for the refinement of USN patient therapy. Methods: Eight healthy subjects sat on a chair wearing a HMD (Oculus rift DK2), with a web-camera (Ovrvision) displaying a 10 degree leftward rotation and a 10 degree counter-clockwise rotation along the frontal plane. Subjects attempted to point a finger at one of four targets, assigned randomly, a total of 48 times. Before and after the intervention, each subject’s body-centre judgment (BCJ) was tested by asking them to point a finger at a touch panel straight in front of their xiphisternum, 10 times sight unseen. Results: Intervention caused the location pointed to during the BCJ to shift 35 ± 17 mm (Ave ± SD) leftward in the horizontal plane, and 46 ± 29 mm downward in the frontal plane. The results in both planes were significant by paired-t-test (p<.01). Conclusions: The results in the horizontal plane are consistent with those observed following PA. Furthermore, the HMD and web-camera were able to elicit 3D effects, including in both the horizontal and frontal planes. Future work will focus on applying this method to patients with and without USN, and investigating whether subject posture is also affected by the HMD system.

Keywords: head mounted display, posture, prism adaptation, unilateral spatial neglect

Procedia PDF Downloads 276

Authors: Mikhail Panes, Sergei Pozniak, Nikolai Pozniak

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Purpose: To evaluate the effectiveness of intrastromal donor limbal segments implantation for treatment of progressive keratoconus considering on main characteristics of corneal endothelial cells. Setting: Outpatient ophthalmic clinic. Methods: Twenty patients (20 eyes) with progressive keratoconus II-III of Amsler classification were recruited. The worst eye was treated with the transplantation of donor limbal segments in the recipient corneal stroma, while the fellow eye was left untreated as a control of functional and morphological changes. Furthermore, twenty patients (20 eyes) without progressive keratoconus was used as a control of corneal endothelial cells changes. All patients underwent a complete ocular examination including uncorrected and corrected distance visual acuity (UDVA, CDVA), slit lamp examination fundus examination, corneal topography and pachymetry, auto-keratometry, Anterior Segment Optical Coherence Tomography and Corneal Endothelial Specular Microscopy. Results: After two years, statistically significant improvement in the UDVA and CDVA (on the average on two lines for UDVA and three-four lines for CDVA) were noted. Besides corneal astigmatism decreased from 5.82 ± 2.64 to 1.92 ± 1.4 D. Moreover there were no statistically significant differences in the changes of mean spherical equivalent, keratometry and pachymetry indicators. It should be noted that after two years there were no significant differences in the changes of the number and form of corneal endothelial cells. It can be regarded as a process stabilization. In untreated control eyes, there was a general trend towards worsening of UDVA, CDVA and corneal thickness, while corneal astigmatism was increased. Conclusion: Intrastromal donor segments implantation is a safe technique for keratoconus treatment. Intrastromal donor segments implantation is an efficient procedure to stabilize and improve progressive keratoconus.

Keywords: corneal endothelial cells, intrastromal donor limbal segments, progressive keratoconus, surgical treatment of keratoconus

Procedia PDF Downloads 275

Authors: Yuji Fujino, Kazu Amimoto, Kazuhiro Fukata, Masahide Inoue, Hidetoshi Takahashi, Shigeru Makita

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Aim: Pusher behavior (PB) is a disorder in which stroke patients shift their body weight toward the affected side of the body (the hemiparetic side) and push away from the non-hemiparetic side. These patients often use further pushing to resist any attempts to correct their position to upright. It is known that the subcortical white matter lesion (SWML) usually correlates of gait or balance function in stroke patients. However, it is unclear whether the SWML influences PB. The purpose of this study was to investigate if the damage of SWML affects the severity of PB on acute stroke patients. Methods: Fourteen PB patients without thalamic or cortical lesions (mean age 73.4 years, 17.5 days from onset) participated in this study. Evaluation of PB was performed according to the Scale for Contraversive Pushing (SCP) for sitting and/or standing. We used modified criteria wherein the SCP subscale scores in each section of the scale were >0. As a clinical measurement, patients were evaluated by the Stroke Impairment Assessment Set (SIAS). For the depiction of SWML, we used T2-weighted fluid-attenuated inversion-recovery imaging. The degree of damage on SWML was assessed using the Fazekas scale. Patients were divided into two groups in the presence of SWML (SWML+ group; Fazekas scale grade 1-3, SWML- group; Fazekas scale grade 0). The independent t-test was used to compare the SCP and SIAS. This retrospective study was approved by the Ethics Committee. Results: In SWML+ group, the SCP was 3.7±1.0 points (mean±SD), the SIAS was 28.0 points (median). In SWML- group, the SCP was 2.0±0.2 points, and the SIAS was 31.5 points. The SCP was significantly higher in SWML+ group than in SWML- group (p<0.05). The SIAS was not significant in both groups (p>0.05). Discussion: It has been considered that the posterior thalamus is the neural structures that process the afferent sensory signals mediating graviceptive information about upright body orientation in humans. Therefore, many studies reported that PB was typically associated with unilateral lesions of the posterior thalamus. However, the result indicates that these extra-thalamic brain areas also contribute to the network controlling upright body posture. Therefore, SMWL might induce dysfunction through malperfusion in distant thalamic or other structurally intact neural structures. This study had a small sample size. Therefore, future studies should be performed with a large number of PB patients. Conclusion: The present study suggests that SWML can be definitely associated with PB. The patients with SWML may be severely incapacitating.

Keywords: pushing behavior, subcortical white matter lesion, acute phase, stroke

Procedia PDF Downloads 243

Authors: Turki J. Alharbi, Jencia Wong, Dennis Yue, Tania P. Markovic, Julie Hetherington, Ted Wu, Belinda Brooks, Radhika Seimon, Alice Gibson, Stephanie L. Silviera, Amanda Sainsbury, Tanya J. Little

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Fasting has been practiced for centuries and is incorporated into the practices of different religions including Islam, whose followers intermittently fast throughout the month of Ramadan. Thus, Ramadan presents a unique model of prolonged intermittent fasting (IF). Despite a growing body of evidence for a cardio-metabolic and endocrine benefit of IF, detailed studies of the effects of IF on these indices in type 2 diabetes are scarce. We studied 5 subjects with type 2 diabetes (T2DM) and 7 healthy controls (C) at baseline (pre), and in the last week of Ramadan (post). Fasting circulating levels of glucose, HbA1c and lipids, as well as body composition (with DXA) and resting energy expenditure (REE) were measured. Plasma gut hormone levels and appetite responses to a mixed meal were also studied. Data are means±SEM. Ramadan decreased total fat mass (-907±92 g, p=0.001) and trunk fat (-778±190 g, p=0.014) in T2DM but not in controls, without any reductions in lean mass or REE. There was a trend towards a decline in plasma FFA in both groups. Ramadan had no effect on body weight, glycemia, blood pressure, or plasma lipids in either group. In T2DM only, the area under the curve for post-meal plasma ghrelin concentrations increased after Ramadan (pre:6632±1737 vs. post:9025±2518 pg/ml.min-1, p=0.045). Despite this increase in orexigenic ghrelin, subjective appetite scores were not altered by Ramadan. Meal-induced plasma concentrations of the satiety hormone pancreatic polypeptide did not change during Ramadan, but were higher in T2DM compared to controls (post: C: 23486±6677 vs. T2DM: 62193±6880 pg/ml.min-1, p=0.003. In conclusion, Ramadan, as a model for IF appears to have more favourable effects on body composition in T2DM, without adverse effects on metabolic control or subjective appetite. These data suggest that IF may be particularly beneficial in T2DM as a nutritional intervention. Larger studies are warranted.

Keywords: type 2 diabetes, obesity, intermittent fasting, appetite regulating hormones

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Authors: Morgane Chatard, Clémentine Puech, Nathalie Perek, Frédéric Roche

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Several neurological disorders are linked to repeated hypoxia. The impact of such repeated hypoxic stress, on endothelial cells function of the blood-brain barrier (BBB) is little studied in the literature. Indeed, the study of hypoxic stress in cellular pathways is complex using hypoxia exposure because HIF 1α (factor induced by hypoxia) has a short half life. Our study presents an innovative induction method of repeated hypoxic stress, more reproducible, which allows us to study its impacts on an in vitro contact co-culture BBB model. Repeated hypoxic stress was induced by hydralazine (a mimetic agent of hypoxia pathway) during two hours and repeated during 24 hours. Then, BBB integrity was assessed by permeability measurements (transendothelial electrical resistance and membrane permeability), tight junction protein expressions (cell-ELISA and confocal microscopy) and by studying expression and activity of efflux transporters. First, this study showed that repeated hypoxic stress leads to a BBB’s dysfunction illustrated by a significant increase in permeability. This loss of membrane integrity was linked to a significant decrease of tight junctions’ protein expressions, facilitating a possible transfer of potential cytotoxic compounds in the brain. Secondly, we demonstrated that brain microvascular endothelial cells had set-up defence mechanism. These endothelial cells significantly increased the activity of their efflux transporters which was associated with a significant increase in their expression. In conclusion, repeated hypoxic stress lead to a loss of BBB integrity with a decrease of tight junction proteins. In contrast, endothelial cells increased the expression of their efflux transporters to fight against cytotoxic compounds brain crossing. Unfortunately, enhanced efflux activity could also lead to reducing pharmacological drugs delivering to the brain in such hypoxic conditions.

Keywords: BBB model, efflux transporters, repeated hypoxic stress, tigh junction proteins

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Authors: S. Mamoucha, J. Rahul, N. Christodoulakis

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Introduction: Nature has been the source of medicinal agents since the dawn of the human existence on Earth. Currently, millions of people, in the developing world, rely on medicinal plants for primary health care, income generation and lifespan improvement. In Greece, more than 5500 plant taxa are reported while about 250 of them are considered to be of great pharmaceutical importance. Among the plants used for medical purposes, Vitex agnus-castus L. (Verbenaceae) is known since ancient times. It is a small tree or shrub, widely distributed in the Mediterranean basin up to the Central Asia. It is also known as chaste tree or monks pepper. Theophrastus mentioned the shrub several times, as ‘agnos’ in his ‘Enquiry into Plants’. Dioscorides mentioned the use of V. agnus-castus for the stimulation of lactation in nursing mothers and the treatment of several female disorders. The plant has important medicinal properties and a long tradition in folk medicine as an antimicrobial, diuretic, digestive and insecticidal agent. Materials and methods: Leaves were cleaned, detached, fixed, sectioned and investigated with light and Scanning Electron Microscopy (SEM). Histochemical tests were executed as well. Specific histochemical reagents (osmium tetroxide, H2SO4, vanillin/HCl, antimony trichloride, Wagner’ s reagent, Dittmar’ s reagent, potassium bichromate, nitroso reaction, ferric chloride and di methoxy benzaldehyde) were used for the sub cellular localization of secondary metabolites. Results: Light microscopical investigations of the elongated leaves of V. agnus-castus revealed three layers of palisade parenchyma, just below the single layered adaxial epidermis. The spongy parenchyma is rather loose. Adaxial epidermal cells are larger in magnitude, compared to those of the abaxial epidermis. Four different types of capitate, secreting trichomes, were localized among the abaxial epidermal cells. Stomata were observed at the abaxial epidermis as well. SEM revealed the interesting arrangement of trichomes. Histochemical treatment on fresh and plastic embedded tissue sections revealed the nature and the sites of secondary metabolites accumulation (flavonoids, steroids, terpenes). Acknowledgment: This work was supported by IKY - State Scholarship Foundation, Athens, Greece.

Keywords: Vitex agnus-castus, leaf anatomy, histochemical reagents, secondary metabolites

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Authors: Hyeon Su Kim, Sungjin Park, Hae Ryung Chang, Hae Rim Jung, Young Zoo Ahn, Yon Hui Kim, Seungyoon Nam

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Ependymoma, one of the most common parenchymal spinal cord tumor, represents 3-6% of all CNS tumor. Especially intracranial ependymomas, which are more frequent in childhood, have a more poor prognosis and more malignant than spinal ependymomas. Although there are growing needs to understand pathogenesis, detailed molecular understanding of pathogenesis remains to be explored. A cancer cell is composed of complex signaling pathway networks, and identifying interaction between genes and/or proteins are crucial for understanding these pathways. Therefore, we explored each ependymoma in terms of differential expressed genes and signaling networks. We used Microsoft Excel™ to manipulate microarray data gathered from NCBI’s GEO Database. To analyze and visualize signaling network, we used web-based PATHOME algorithm and Cytoscape. We show HOX family and NEFL are down-regulated but SCL family is up-regulated in cerebrum and posterior fossa cancers over a spinal cancer, and JAK/STAT signaling pathway and Chemokine signaling pathway are significantly different in the both intracranial ependymoma comparing to spinal ependymoma. We are considering there may be an age-dependent mechanism under different histological pathogenesis. We annotated mutation data of each gene subsequently in order to find potential target genes.

Keywords: systems biology, ependymoma, deg, network analysis

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Authors: Milad Pirali, Sohrab Keyhani, Mohhamad Ali Sanjari, Ali Ashraf Jamshidi

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Purpose: The effect of hamstring antagonist activity on the knee extensors torque of the Anterior Cruciate Ligament reconstruction (ACLR) is not clear and persistent muscle weakness is common after ACLR. Hamstring activation when acting as antagonist is considered very important for knee strengths. Therefore the purpose of this study was to examine hamstring antagonist coactivation during maximal effort of the isokinetic knee extension in ACLR athletes with hamstring autograft. Materials and Methods: We enrolled 20 professional athletes who underwent primary ACLR (hamstring tendon autograft)with 6-24 months postoperative and 20 healthy subjects as control group. Each subjects performed maximal effort isokinetic knee extension and flexion in 60/˚ s and 180/˚ s velocities for the involved and uninvolved limb. Synchronously, surface electromyography (EMG) was recorded of vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF) and biceps femoris (BF). The antagonist integrated EMG (IEMG) values were normalized to the IEMG of the same muscle during maximal isokinetic eccentric effort at the same velocities and ROM. Results: A one-way analysis of variance designs shows significantly greater IEMG coactivation of hamstring and decreased activation of Vm in ACLR when compared to uninvolved and control group leg in 60/˚ s and 180/˚ s velocities. Likewise peak torque to body weight was decreased in ACLR compared to uninvolved and control group during knee extension in both velocities (p < 0.05). Conclusions: Decreased extensors moment caused by decreased quadriceps inhibition and increased hamstring coactivation. In addition, these result indicated to decrease of motor unit recruitment in the VM (as a kinesiologicmonitore of the knee). It is appearing that strengthening of the quadriceps to be an important for rehabilitation program after ACLR for preparation in athletes endeavors. Therefore, we suggest that having more emphasis and focus on quadriceps strength and less emphasis on hamstring following ACLR.

Keywords: ACLR-coactivation, dynamometry, electromyography, isokinetic

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Authors: Hossam M. Abdallah, Ali M. El-Halawany, Gamal A. Mohamed, Khalid Z. Alshali, Zainy M. Banjar, Hany A. El-Bassossy

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Hypertension and vascular dysfunction are major components and complications of many diseases like metabolic syndrome. In addition, vascular dysfunction is considered the initial step in diabetic atherosclerosis, the main etiology for mortality and a great percent of morbidity in diabetic patients. In spite of the significant developments in antidiabetic therapy, diabetic complications, particularly seen in long-term diabetes, continue to be seriously deleterious. Herbal drugs are prescribed widely in treatment of different aliment because of their effectiveness, fewer side effects and relatively low cost. Nine plants belong to five different families grown in Kingdom of Saudi Arabia were evaluated for their effect on exaggerated vasoconstriction and impaired relaxation in aortae isolated from metabolic syndrome rats. The aerial parts of Onopordum ambiguum Fresen. (OA), Astragalus abyssinicus Steud. (AA), Pulicaria Arabica Cass. (PA), Echinops sheilae Kit Tan (ES), Aizoon canariense L. (AC), Cleome viscosa L. (CV), Chrozophora oblongifolia (Delile) A.Juss. ex Spreng (CO), Centaurea pseudosinaica Mouterde (CP) and Tephrosia nubica Baker (TN) were dried and extracted with methanol. The effect of thirty minute incubation with the total extracts (10-330 µg/ml) or their fractions on the exaggerated vasoconstriction response to phenylephrine (10nM to 10microM) and impaired vasodilation to acetylcholine (10-330 µg /ml) of aortae isolated from metabolic syndrome animals was studied. Incubating aortae isolated from metabolic syndrome animals with total methanol extract of OA, AA, PA, AC, CV, and TN at concentrations (10-330 microgram/ml) in the organ bath led to concentration dependent alleviation of exaggerated vasoconstriction response to phenylephrine without having beneficial effect on impaired vasodilation to acetylcholine. In conclusion, addition of OA, AA, PA, AC, CV and TN to the standard therapies may provide superior means to alleviate the associated vascular complications.

Keywords: vascular dysfunction, exaggerated vasoconstriction, metabolic syndrome, Saudi plants

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Authors: L. Donelle, S. Regan, R. Booth, M. Kerr, J. McMurray, D. Fitzsimmons

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Palliative home health care provision within the Canadian context is challenged by: (i) a shortage of registered nurses (RN) and RNs with palliative care expertise, (ii) an aging population, (iii) reliance on unpaid family caregivers to sustain home care services with limited support to conduct this ‘care work’, (iv) a model of healthcare that assumes client self-care, and (v) competing economic priorities. In response, an interprofessional team of service provider organizations, a software/technology provider, and health care providers developed and implemented a technology-enabled model of home care, the eShift model of palliative home care (eShift). The eShift model combines communication and documentation technology with non-traditional utilization of health human resources to meet patient needs for palliative care in the home. The purpose of this study was to investigate the structure, processes, and outcomes of the eShift model of care. Methodology: Guided by Donebedian’s evaluation framework for health care, this qualitative-descriptive study investigated the structure, processes, and outcomes care of the eShift model of palliative home care. Interviews and focus groups were conducted with health care providers (n= 45), decision-makers (n=13), technology providers (n=3) and family care givers (n=8). Interviews were recorded, transcribed, and a deductive analysis of transcripts was conducted. Study Findings (1) Structure: The eShift model consists of a remotely-situated RN using technology to direct care provision virtually to patients in their home. The remote RN is connected virtually to a health technician (an unregulated care provider) in the patient’s home using real-time communication. The health technician uses a smartphone modified with the eShift application and communicates with the RN who uses a computer with the eShift application/dashboard. Documentation and communication about patient observations and care activities occur in the eShift portal. The RN is typically accountable for four to six health technicians and patients over an 8-hour shift. The technology provider was identified as an important member of the healthcare team. Other members of the team include family members, care coordinators, nurse practitioners, physicians, and allied health. (2) Processes: Conventionally, patient needs are the focus of care; however within eShift, the patient and the family caregiver were the focus of care. Enhanced medication administration was seen as one of the most important processes, and family caregivers reported high satisfaction with the care provided. There was perceived enhanced teamwork among health care providers. (3) Outcomes: Patients were able to die at home. The eShift model enabled consistency and continuity of care, and effective management of patient symptoms and caregiver respite. Conclusion: More than a technology solution, the eShift model of care was viewed as transforming home care practice and an innovative way to resolve the shortage of palliative care nurses within home care.

Keywords: palliative home care, health information technology, patient-centred care, interprofessional health care team

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Authors: Elnaz Dabiri, Somayeh Hamidnezhad

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Background and Objective: This study aims at investigating the effect of whole word method on Mean Length of Utterance (MLU) of 3 to 6 years old children with cochlear implants having normal IQ. Materials and Methods: In this quasi-experimental and interventional study, 20 children with cochlear implants, aged between 3and 6 years, and normal IQ were selected from Tabriz cochlear implants center using convenience sampling. Afterward, they were randomly bifurcated. The first group was educated by whole-word reading method along with traditional methods and the second group by traditional methods. Both groups had three sessions of 45-minutes each, every week continuously for a period of 3 months. Pre-test and post-test language abilities of both groups were assessed using the TOLD test. Results: Both groups before training have the same age, IQ, and MLU, but after training the first group shows a considerable improvement in MLU in comparison with the second group. Conclusions: Reading training by the whole word method have more effect on MLU of children with cochlear implants in comparison of the traditional method.

Keywords: cochlear implants, reading training, traditional methods, language therapy, whole word method, Mean Length of Utterance (MLU)

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Authors: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal

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Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.

Keywords: end of life care, geriatrics, palliative care, residency training skill

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Authors: Sarit Rashkovits, Anat Drach- Zahavy

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The research considers the unresolved question regarding the link between nursing team accountability and team learning and the resulted team performance in nursing teams. Empirical findings reveal disappointing evidence regarding improvement in healthcare safety and quality. Therefore, there is a need in advancing managerial knowledge regarding the factors that enhance constant healthcare teams' proactive improvement efforts, meaning team learning. We first aim to identify the organizational resources that are needed for team learning in nursing teams; second, to test the moderating role of nursing teams' learning resources in the team accountability-team learning link; and third, to test the moderated mediation model suggesting that nursing teams' accountability affects team performance by enhancing team learning when relevant resources are available to the team. We point on the intervening role of three team learning resources, namely time availability, team autonomy and performance data on the relation between team accountability and team learning and test the proposed moderated mediation model on 44 nursing teams (462 nurses and 44 nursing managers). The results showed that, as was expected, there was a positive significant link between team accountability and team learning and the subsequent team performance when time availability and team autonomy were high rather than low. Nevertheless, the positive team accountability- team learning link was significant when team performance feedback was low rather than high. Accordingly, there was a positive mediated effect of team accountability on team performance via team learning when either time availability or team autonomy were high and the availability of team performance data was low. Nevertheless, this mediated effect was negative when time availability and team autonomy were low and the availability of team performance data was high. We conclude that nurturing team accountability is not enough for achieving nursing teams' learning and the subsequent improved team performance. Rather there is need to provide nursing teams with adequate time, autonomy, and be cautious with performance feedback, as the latter may motivate nursing teams to repeat routine work strategies rather than explore improved ones.

Keywords: nursing teams' accountability, nursing teams' learning, performance feedback, teams' autonomy

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Authors: Recep Kesli, Gulsah Asik, Cengiz Demir, Onur Turkyilmaz

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Objective: Stenotrophomonas maltophilia (S. maltophilia) has recently emerged as an important nosocomial microorganism. Treatment of invasive infections caused by this organism is problematic because this microorganism is usually resistant to a wide range of commonly used antimicrobials. We aimed to evaluate clinical isolates of S. maltophilia in respect to sampling sites and antimicrobial resistant. Method: During a two years period (October 2013 and September 2015) eighteen samples collected from the intensive care unit (ICU) patients hospitalized in Afyon Kocatepe University, ANS Practice and Research Hospital. Identification of the bacteria was determined by conventional methods and automated identification system-VITEK 2 (bio-Mérieux, Marcy l’toile, France). Antibacterial resistance tests were performed by Kirby Bauer disc (Oxoid, England) diffusion method following the recommendations of CLSI. Results: Eighteen S. maltophilia strains were identified as the causative agents of different infections. The main type of infection was lower respiratory tract infection (83,4 %); three patients (16,6 %) had bloodstream infection. While, none of the 18 S. maltophilia strains were found to be resistant against to trimethoprim sulfametaxasole (TMP-SXT) and levofloxacine, eight strains 66.6 % were found to be resistant against ceftazidim. Conclusion: The isolation of S.maltophilia starains resistant to TMP-SXT is vital. In order to prevent or minimize infections due to S. maltophilia such precuations should be utilized: Avoidance of inappropriate antibiotic use, prolonged implementation of foreign devices, reinforcement of hand hygiene practices and the application of appropriate infection control practices. Microbiology laboratories also may play important roles in controlling S. maltophilia infections by monitoring the prevalence, continuously, the provision of local antibiotic resistance paterns data and the performance of synergistic studies also may help to guide appropirate antimicrobial therapy choices.

Keywords: Stenotrophomonas maltophilia, trimethoprim-sulfamethoxazole, antimicrobial resistance, Stenotrophomonas spp.

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Authors: Pil Kyoo Jo, Youngmee Lee, Jee Young Kim, Yu Jin Oh, Sohyun Park, Young Ha Joo, Hye Suk Kim, Semi Kang

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A growing number of people are living alone and eating alone. People might have different dietary behaviors between eating alone and eating with others, it can influence their weight and health. The purpose of this study was to investigate the dietary behavior of eating alone in middle-aged populations in South Korea. We used the nationally representative data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES), 2010-2012 and a cross-sectional survey on the eating behaviors among adults (N=1318, 530 men, 788 women) aged from 20 to 54 years. Results showed that ‘underweight’ group ate more amount of food when eating with others compared to eating alone and ‘overweight’ and ‘obesity’ groups had opposite respondent (p<0.05). When having a meal alone, ‘underweight’ group ate food until didn’t feel hungry and ‘overweight’ and ‘obesity’ groups ate leftover food even they felt full (p<0.01). The ‘overweight’ and ‘obesity’ groups usually ate alone than ‘underweight’ group did (p<0.05). All groups had faster meal time when eating alone than eating with others and usually ate processed foods for convenience when eating alone. Younger people, aged 10-30, ate more processed food than older people did. South Koreans spend nearly 45% of their total food consumption from processed foods. This research was supported by the National Research Foundation of Korea for 2011 Korea-Japan Basic Scientific Cooperation Program (NRF-2011B00003). This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2015S1A5B6037369).

Keywords: BMI, dietary behavior, eating alone, middle-aged populations

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Authors: Devam Sheth

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Nuclear imaging with stress myocardial perfusion (stress test) is the preferred first line investigation for noninvasive evaluation of ischaemic heart condition. The sensitivity of this test is close to 90 % making it a very reliable test. However, rarely it gives a false negative result which can be explained by the phenomenon termed as “balanced ischaemia”. We present the case of a 78 year Caucasian female without any significant past cardiac history, who presents with chest pain and shortness of breath since one day. The initial ECG and cardiac enzymes were non-impressive. Few hours later, she had some substernal chest pain along with some ST segment depression in the lateral leads. Stress test comes back negative for any significant perfusion defects. However, given her typical symptoms, she underwent a cardiac catheterization which revealed significant triple vessel disease mandating her to get a bypass surgery. This unusual phenomenon of false nuclear stress test in the setting of positive ECG changes can be explained only by balanced ischemia wherein due to global myocardial ischemia, the stress test fails to reveal relative perfusion defects in the affected segments.

Keywords: balanced, false positive, ischemia, myocardial perfusion imaging

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Authors: Recep Kesli, Gulsah Asik, Cengiz Demir, Onur Turkyilmaz

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Objective: Pseudomonas aeruginosa (P. aeruginosa) is an important nosocomial pathogen which causes serious hospital infections and is resistant to many commonly used antibiotics. P. aeruginosa can develop resistance during therapy and also it is very resistant to disinfectant chemicals. It may be found in respiratory support devices in hospitals. In this study, the antibiotic resistance of P. aeruginosa strains isolated from bronchial aspiration samples was evaluated retrospectively. Methods: Between October 2013 and September 2015, a total of 318 P. aeruginosa were isolated from clinical samples obtained from various intensive care units and inpatient patients hospitalized at Afyon Kocatepe University, ANS Practice and Research Hospital. Isolated bacteria identified by using both the conventional methods and automated identification system-VITEK 2 (bioMerieux, Marcy l’etoile France). Antibacterial resistance tests were performed by using Kirby-Bauer disc (Oxoid, Hampshire, England) diffusion method following the recommendations of CLSI. Results: Antibiotic resistance rates of identified 318 P. aeruginosa strains were found as follows for tested antibiotics; 32 % amikacin, 42% gentamicin, 43% imipenem, 43% meropenem, 50% ciprofloxacin, 57% levofloxacin, 38% cefepime, 63% ceftazidime, and 85% piperacillin/tazobactam. Conclusion: Resistance profiles change according to years and provinces for P. aeruginosa, so these findings should be considered empirical treatment choices. In this study, the highest and lowest resistance rates found against piperacillin/tazobactam % 85, and amikacin %32.

Keywords: Pseudomonas aeruginosa, antibiotic resistance rates, intensive care unit, Pseudomonas spp.

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Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

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Objective: Proteus mirabilis (P. mirabilis) is one of Gram-negative pathogens in human and it causes urinary tract and nosocomial infections. P. mirabilis is susceptible to β-lactams, aminoglycosides, fluoroquinolones, and trimethoprim/sulfamethoxazole. It was aimed to investigate the resistance status to antimicrobial agents of Proteus mirabilis strains produced from samples sent to Afyon Kocatepe University, ANS Research and Practice Hospital, Microbiology Laboratory from different clinics and polyclinics during the period of 24 months. Methods: Between October 2013 and September 2015, a total of 30 Proteus were isolated from clinical samples of patients were hospitalized in intensive care units and in various departments of Afyon Kocatepe University, ANS Research and Practice Hospital. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bioMérieux, France) was used additionally. Antibacterial susceptibility tests were performed by Kirby Bauer disc (Oxoid, Hempshire, England) diffusion method following the recommendations of CLSI. Results: Of the total 30 Proteus strains isolated from clinical samples, 19 from urine, 7 from wound, 4 from tracheal aspiration materials were isolated. Antimicrobial resistant for these strains were determined to 24,3% for meropenem, 26.2% for imipenem, 20.2% for amikacin 10.5% for cefepim, 33.3% for ciprofloxacin and levofloxacine, 31.6% for ceftazidime, 20% for ceftriaxone, 15.2% for gentamicin and 26.6% for amoxicillin-clavulanate, 26.2% trimethoprim-sulfamethoxale. Conclusion: In the present study, the highest number of clinical isolates of P. mirabilis were isolated from urine (63,3%), followed by the others (36,6%). The distribution of samples P. mirabilis strains to the clinics were as fallows; 16,8% intensive care unit (ICU), 29,9% polyclinics, 53,3% hospital service units The most effective antibiotic on the total of strains were found to be cefepim, the least effective antibiotics on the total of strains were found to be trimethoprim-sulfamethoxale.

Keywords: proteus mirabilis, antibiotic resistance, intensive care unit, Proteus spp.

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Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

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Objective: Serratia species are identified as aerobic, motile Gram negative rods. The species Serratia marcescens (S. marcescens) causes both opportunistic and nosocomial infections. The genus Providencia is Gram-negative bacilli and includes urease-producing that is responsible for a wide range of human infections. Although most Providencia infections involve the urinary tract, they are also associated with gastroenteritis, wound infections, and bacteremia. The aim of this study was evaluate the antimicrobial resistance rates of S. marcescens and Providencia spp. strains which had been isolated from various clinical materials obtained from different patients who belongs to intensive care units (ICU) and inpatient clinics. Methods: A total of 35 S. marcescens and Providencia spp. strains isolated from various clinical samples admitted to Medical Microbiology Laboratory, ANS Research and Practice Hospital, Afyon Kocatepe University between October 2013 and September 2015 were included in the study. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bio-Merieux, Marcy l’etoile, France) was used additionally. Antibacterial resistance tests were performed by using Kirby Bauer disc (Oxoid, Hampshire, England) diffusion method following the recommendations of CLSI. Results: The distribution of clinical samples were as follows: upper and lower respiratory tract samples 26, 74.2 % wound specimen 6, 17.1 % blood cultures 3, 8.5%. Of the 35 S. marcescens and Providencia spp. strains; 28, 80% were isolated from clinical samples sent from ICU. The resistance rates of S. marcescens strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 8.5 %, 22.8 %, 11.4 %, 2.8 %, 17.1 %, 40 %, 28.5 % and 5.7 % respectively. Resistance rates of Providencia spp. strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 10.2 %, 33,3 %, 18.7 %, 8.7 %, 13.2 %, 38.6 %, 26.7%, and 11.8 % respectively. Conclusion: S. marcescens is usually resistant to ampicillin, amoxicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefuroxime, cephamycins, nitrofurantoin, and colistin. The most effective antibiotic on the total of S. marcescens strains was found to be gentamicin 2.8 %, of the totally tested strains the highest resistance rate found against to ceftazidime 40 %. The lowest and highest resistance rates were found against gentamiycin and ceftazidime with the rates of 8.7 % and 38.6 % for Providencia spp.

Keywords: Serratia marcescens, Providencia spp., antibiotic resistance, intensive care unit

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