Search results for: clinical guidelines

Authors: Naso Isaiah Thanavisuth

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Medical cannabis can be used for treatment including pain, multiple sclerosis, Parkinson's disease, and cancer. However, medical cannabis leads to adverse effects (AEs), which is delta-9-tetrahydrocannabinol (THC). In previous studies, the major of THC metabolism enzymes are CYP2C9. Especially, the variation of CYP2C9 gene consist of CYP2C9*2 on exon 3 and CYP2C9*3 on exon 7 to decrease enzyme activity. Notwithstanding, there is no data describing whether the variant of CYP2C9 genes are apharmacogenetics marker for the prediction of THC-induced AEs in Thai patients. We want to investigate the association between CYP2C9 gene and THC-induced AEs in Thai patients. We enrolled 39 Thai patients with medical cannabis treatment who were classified by clinical data. The CYP2C9*2 and *3 genotyping were conducted using the TaqMan real time PCR assay. All Thai patients who received the medical cannabis consist of twenty-four (61.54%) patients were female, and fifteen (38.46%) were male, with age range 27- 87 years. Moreover, the most AEs in Thai patients who were treated with medical cannabis between cases and controls were tachycardia, arrhythmia, dry mouth, and nausea. Particularly, thirteen (72.22%) medical cannabis-induced AEs were female and age range 33 – 69 years. In this study, none of the medical cannabis groups carried CYP2C9*2 variants in Thai patients. The CYP2C9*3 variants (*1/*3, intermediate metabolizer, IM) and (*3/*3, poor metabolizer, PM) were found, three of thirty-nine (7.69%) and one of thirty-nine (2.56%), respectively. Although, our results indicate that there is no found the CYP2C9*2. However, the variation of CYP2C9 allele might serve as a pharmacogenetics marker for screening before initiating the therapy with medical cannabis for the prevention of medical cannabis-induced AEs.

Keywords: CYP2C9, medical cannabis, adverse effects, THC, P450

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Authors: Mohammaad Afzal Khan, Ghazi Abdulmalik Ashoor , Fatimah Alanazi, Talal Shamma, Abdullah Altuhami, Hala Abdalrahman Ahmed, Abdullah Mohammed Assiri, Dieter Clemens Broering

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Microvascular injuries during inflammation are key causes of transplant malfunctioning and permanent failure, which play a major role in the development of chronic rejection of the transplanted organ. Inflammation-induced microvascular loss is a promising area to investigate the decisive roles of regulatory and effector responses. The present study was designed to investigate the impact of IL-10 on immunotolerance, in particular, the microenvironment of the allograft during rejection. Here, we investigated the effects of IL-10 blockade/ reconstitution and serially monitored regulatory T cells (Tregs), graft microvasculature, and airway epithelium in rejecting airway transplants. We demonstrated that the blocking/reconstitution of IL-10 significantly modulates CD4+FOXP3+ Tregs, microvasculature, and airway epithelium during rejection. Our findings further highlighted that blockade of IL-10 upregulated proinflammatory cytokines, IL-2, IL-1β, IFN-γ, IL-15, and IL-23, but suppressed IL-5 secretion during rejection; however, reconstitution of IL-10 significantly upregulated CD4+FOXP3+ Tregs, tissue oxygenation/blood flow and airway repair. Collectively, these findings demonstrate a potential reparative modulation of IL-10 during microvascular and epithelial repair, which could provide a vital therapeutic window to rejecting transplants in clinical practice.

Keywords: interleukin -10, regulatory T cells, allograft rejection, immunotolerance

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Authors: Jiaxin Shi, Kaifeng Hao, Qingfan An, Zeng Peng

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Due to a lack of data sources and data processing techniques, it has always been difficult to quantify public space quality, which includes urban construction quality and how it is perceived by people, especially in large urban areas. This study proposes a quantitative research method based on the consideration of emotional health and physical health of the built environment. It highlights the low quality of public areas in Tianjin, China, where there are many negative elements. Deep learning technology is then used to measure how effectively people perceive urban areas. First, this work suggests a deep learning model that might simulate how people can perceive the quality of urban construction. Second, we perform semantic segmentation on street images to identify visual elements influencing scene perception. Finally, this study correlated the scene perception score with the proportion of visual elements to determine the surrounding environmental elements that influence scene perception. Using a small-scale labeled Tianjin street view data set based on transfer learning, this study trains five negative spatial discriminant models in order to explore the negative space distribution and quality improvement of urban streets. Then it uses all Tianjin street-level imagery to make predictions and calculate the proportion of negative space. Visualizing the spatial distribution of negative space along the Tianjin Inner Ring Road reveals that the negative elements are mainly found close to the five key districts. The map of Tianjin was combined with the experimental data to perform the visual analysis. Based on the emotional assessment, the distribution of negative materials, and the direction of street guidelines, we suggest guidance content and design strategy points of the negative phenomena in Tianjin street space in the two dimensions of perception and substance. This work demonstrates the utilization of deep learning techniques to understand how people appreciate high-quality urban construction, and it complements both theory and practice in urban planning. It illustrates the connection between human perception and the actual physical public space environment, allowing researchers to make urban interventions.

Keywords: human perception, public space quality, deep learning, negative elements, street images

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Authors: T. Mcgraw, F. N. Morin, N. Desai

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Background: Antimicrobial resistance is a critical issue in global health care and a significant contributor to increased patient morbidity and mortality. Suspected urinary tract infection (UTI) is a key area of inappropriate antibiotic prescription in pediatrics. Management patterns of infectious diseases have been shown to vary by provider type within a single setting. The aim of this study was to assess compliance with national UTI management guidelines by nurse practitioners in a pediatric emergency department (ED). Methods: This was a post-hoc analysis of a retrospective cohort study to review and evaluate visits to a tertiary care freestanding pediatric emergency department. Patients were included if they were 60 days to 36 months old and discharged with a diagnosis of UTI or ‘rule-out UTI’ between July 2015 and July 2020. Primary outcome measure was proportion of visits seen by Nurse Practitioners (NP) which were associated with national guideline compliance in the diagnosis and treatment of suspected UTI. We performed descriptive statistics and comparative analyses to determine differences in practice patterns between NPs, and physicians. Results: A total of 636 charts were reviewed, of which 402 patients met inclusion criteria. 17 patients were treated by NPs, 385 were treated by either Pediatric Emergency Medicine physicians (PEM) or non-PEM physicians. Overall, the proportion of infants receiving guideline-compliant care was 25.9% (21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (74.7-83.8%) received first line guideline recommended therapy and 58.9% (53.8-63.8%) received fully compliant therapy with respect to age, dose, duration, and frequency. In patients treated by NPs, 16/17 (94%(95% CI:73.0-99.0)) required antibiotics, 15/16 (93%(95% CI: 71.7-98.9)) were treated with first line agent (cephalexin), 8/16 (50%(95% CI:28-72)) were guideline compliant of dose and duration. 5/8 (63%(95% CI:30.6-86.3)) were noncompliant for dose being too high. There was no difference in receiving guideline compliant empiric antibiotic therapy between physicians and nurse practitioners (OR: 0.837 CI: 0.302-2.69). Conclusion: In this post-hoc analysis, guideline noncompliance by nurse practitioners is common in children tested and treated for UTIs in a pediatric emergency department. Care by a Nurse Practitioner was not associated with greater rate of noncompliance than care by a Pediatric Emergency Medicine physician. Future appropriately powered studies may focus on confirming these results.

Keywords: antibiotic stewardship, infectious disease, nurse practitioner, urinary tract infection

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Authors: Nandini Mohan, Elayne Ahern

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Neurocognitive deficits, as well as psychosocial dysfunction, are typically observed in major depressive disorder (MDD). These deficits persist even after a significant reduction of symptoms and remission from MDD. These deficits have also been linked to greater relapse rates. The link between neurocognitive deficits, relapse, and psychosocial functioning in MDD, on the other hand, has received little attention. This review aimed to conduct an in-depth review of the literature on the association between neurocognitive deficits, relapse, and psychosocial functioning in MDD remission. We used search terms related to MDD, MDD remission, psychosocial functioning, neurocognitive impairments, and relapse to conduct a systematic review of English-language literature in PubMed, PsycArticles, PsycINFO, Medline, and Web of Science to identify relevant studies in the area from which 15 studies were identified for inclusion following an examination against inclusion/ exclusion criteria. Executive functioning, psychomotor speed, and memory were closely related to the psychosocial deficits in the phase of MDD remission. Similarly, Executive function, divided attention, and inhibition were closely related to the relapse in the phase of MDD remission. The limitations of the present review include limited and contradicting evidence that led to fewer studies being included. The implications of this review include an understanding of the difference between clinical and full-functional recovery. This evidence can be the basis for incorporating treatment measures that focus on neurocognitive and psychosocial deficits along with the affective symptoms of MDD.

Keywords: depression, MDD, remission, relapse, neurocognitive functioning, psychosocial deficits

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Authors: Seyed Mazyar Mortazavi, Masod Memari, Hasan Ali Ahmadi, Zhaleh Abed

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Introduction: VACTERL association is a rare disorder with various congenital malformations. The aetiology remains unknown. Combination of at least three congenital anomalies of the following criteria is required for diagnosis: vertebral defects, anal atresia, cardiac anomalies, tracheo-esophageal fistula, renal anomalies, and limb defects. Case presentation: The first case was 1-day old male neonate with multiple congenital anomalies was bore from 28 years old mother. The mother had history of pregnancy with lymphocyte therapy. His anomalies included: defects in thoracic and lumbar vertebral, anal atresia, bilateral hydronephrosis, atrial septal defect, and lower limb abnormality. Other anomalies were cryptorchidism and nasal canal narrowing. The second case was born with 32 weeks gestational age from mother with history of pregnancy with lymphocyte therapy. He had thoracic vertebral defect, cardiac anomalies and renal defect. Conclusion: diagnosis based on clinical finding is VACTERL association. Early diagnosis is very important to investigation and treatment of other coexistence anomalies. VACTERL association in mothers with history of pregnancy with lymphocyte therapy has suggested possibly of relationship between VACTERL association and this method of pregnancy.

Keywords: anal atresia, tracheo-esophageal fistula, atrial septal defect, lymphocyte therapy

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Authors: Young-Ji Kim, Jin-Hyeong Park, Hong-Seok Kim, Jung-Whan Chon, Kwang-Yeop Kim, Dong-Hyeon Kim, Il-Byeong Kang, Da-Na Jeong, Jin-Hyeok Yim, Ho-Seok Jang, Kwang-Young Song, Kun-Ho Seo

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Stenotrophomonas maltophilia is one of the emerging opportunistic pathogens, and also known to have extensive drug resistance intrinsically including carbepenems which is last resort for most serious infections. One possible way for S. maltophilia to infect human is via wastewater treatment plant (WWTP). In the period between October 2016 and February 2017, effluent samples of WWTP from 3 different pig farms were collected once a month and screened for isolation of S. maltophilia. Total 16 strains of S. maltophilia were isolated and, the antibiotic susceptibility phenotypes were determined by Vitek 2 system for 16 antibiotics, ampicillin (AMP), amoxicillin/clavulanic acid (AMC), piperacillin/tazobactam (TZP), cefazolin (CZ), cefoxitin (FOX), cefotaxime (CTX), ceftazidime (CAZ), cefepime (FEP), aztreonam (AZT), ertapenem (ETP), imipenem (IMP), amikacin (AK), gentamicin (GN), ciprofloxacin (CIP), tigecycline (TGC) and trimethoprim/sulfamethoxazole (SXT). All isolates showed high resistance to AMP (100%), CZ (100%), FOX (100%), CTX (100%), CAZ (100%), FEP (94%), AZT (100%), ETP (100%), IMP (100%), AK (100%), GN (100%) whereas were susceptible to CIP (0%), TGC (0%), SXT (6%). All strains harbored at least one of the antibiotic resistance determinant such as spgM, rmlA, and rpfF. Some isolates had similar MLST (multilocus sequence typing) types with clinical isolates, suggesting WWTP could have potential role in the transmission of S. maltophilia to aquatic environment and, possibly, to humans.

Keywords: Stenotrophomonas maltophilia, Carbapenem resistance, waste water treatment plant, pig farm

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Authors: Qurat-ul-Ain, Humaira Mehmood

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Background: HIV infection (a global pandemic) in pregnant women has turn out to be an emerging aspect of public health because of its role in the spread of HIV infection, predominantly among children. Aim: The aim was to analyze the trends of diagnosis with respect to gestational age and an overview of the mode of delivery over ten years. Methods: A retrospective data collection from clinical records of diagnosed HIV infected pregnant females attended at HIV antenatal clinic (special clinic), at Pakistan Institute of Medical Sciences, Islamabad, for various complaints during the period of 10 years from February 2007 to December 2016 was done. Results: A total of 113 pregnancies were reported with HIV infection in 10 years. Cases diagnosed at the 1st trimester (1-12 weeks) of pregnancy were (50.4%, 57/113), at the 2nd trimester (13-26 weeks) were (24.8%, 28/113), at the 3rd trimester (27-40+ weeks) were (24.7%, 28/113). Most deliveries were by caesarean section (53.1%, 60/113), elective caesarean sections were (58.3%, 35/60) and emergency caesarean sections were (41.6%,25/60). Vaginal deliveries were (26.5%, 30/113). Reported miscarriages were (17.7%, 20/113). Conclusion: At 1st trimester, 50% of the females were diagnosed with HIV infection, and 50% remained undiagnosed at their 1st trimester. Routine antenatal HIV testing throughout the country is vastly needed for timely diagnoses and prompt treatment(antiretroviral therapy), to suppress the virus, to reduce the risk of spread of HIV infection, to plan elective caesarean section delivery and to prevent mother-to-child transmission.

Keywords: gestational age, HIV infection, mode of delivery, pregnancy

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Authors: Jihane Bouabid

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The urgency to transition towards sustainable energy sources has revealed itself imperative. Today, in the 21st Century, the intellectual society have imposed technological advancements and improvements, and anticipates expeditious outcomes as an integral component of its relentless pursuit of an elevated standard of living. As a part of empowering human development, driving economic growth and meeting social needs, the access to energy services has become a necessity. As a part of these improvements, we are introducing the project "Mywindturbine" - an interactive web user interface for design and analysis in the field of wind energy, with a particular adherence to the IEC (International Electrotechnical Commission) standard 61400-2 "Wind turbines – Part 2: Design requirements for small wind turbines". Wind turbines play a pivotal role in Morocco's renewable energy strategy, leveraging the nation's abundant wind resources. The IEC 61400-2 standard ensures the safety and design integrity of small wind turbines deployed in Morocco, providing guidelines for performance and safety protocols. The conformity with this standard ensures turbine reliability, facilitates standards alignment, and accelerates the integration of wind energy into Morocco's energy landscape. The aim of the GUI (Graphical User Interface) for engineers and professionals from the field of wind energy systems who would like to design a small wind turbine system following the safety requirements of the international standards IEC 61400-2. The interface provides an easy way to analyze the structure of the turbine machine under normal and extreme load conditions based on the specific inputs provided by the user. The platform introduces an overview to sustainability and renewable energy, with a focus on wind turbines. It features a cross-examination of the input parameters provided from the user for the SLM (Simple Load Model) of small wind turbines, and results in an analysis according to the IEC 61400-2 standard. The analysis of the simple load model encompasses calculations for fatigue loads on blades and rotor shaft, yaw error load on blades, etc. for the small wind turbine performance. Through its structured framework and adherence to the IEC standard, "Mywindturbine" aims to empower professionals, engineers, and intellectuals with the knowledge and tools necessary to contribute towards a sustainable energy future.

Keywords: small wind turbine, IEC 61400-2 standard, user interface., simple load model

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Authors: Osama Shakeel

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The objective of the paper is to study the clinic-pathological factors, survival analyses, recurrence rate, metastatic rate, risk factors and the management of cutaneous malignant melanoma at Shaukat Khanum Memorial Cancer Hospital and Research Center. Methodology: From 2014 to 2017, all patients with a diagnosis of cutaneous malignant melanoma (CMM) were included in the study. Demographic variables were collected. Short and long term oncological outcomes were recorded. All data were entered and analyzed in SPSS version 21. Results: A total of 28 patients were included in the study. Median age was 46.5 +/-15.9 years. There were 16 male and 12 female patients. The family history of melanoma was present in 7.1% (n=2) of the patients. All patients had a mean survival of 13.43+/- 9.09 months. Lower limb was the commonest site among all which constitutes 46.4%(n=13). On histopathological analyses, ulceration was seen in 53.6% (n=15) patients. Unclassified tumor type was present in 75%(n=21) of the patients followed by nodular 21.4% (n=6) and superficial spreading 3.5%(n=1). Clark level IV was the commonest presentation constituting 46.4%(n=13). Metastases were seen in 50%(n=14) of the patients. Local recurrence was observed in 60.7%(n=17). 64.3%(n=18) lived after one year of treatment. Conclusion: CMM is a fatal disease. Although its disease of fair skin individuals, however, the incidence of CMM is also rising in this part of the world. Management includes early diagnoses and prompt management. However, mortality associated with this disease is still not favorable.

Keywords: malignant cancer of skin, cutaneous malignant melanoma, skin cancer, survival analyses

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Authors: Wajid Mumtaz, Aamir Saeed Malik, Syed Saad Azhar Ali, Mohd Azhar Mohd Yasin

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In this paper, a technique based on electroencephalogram (EEG) analysis is presented, aiming for diagnosing major depressive disorder (MDD) among a potential population of MDD patients and healthy controls. EEG is recognized as a clinical modality during applications such as seizure diagnosis, index for anesthesia, detection of brain death or stroke. However, its usability for psychiatric illnesses such as MDD is less studied. Therefore, in this study, for the sake of diagnosis, 2 groups of study participants were recruited, 1) MDD patients, 2) healthy people as controls. EEG data acquired from both groups were analyzed involving inter-hemispheric asymmetry and composite permutation entropy index (CPEI). To automate the process, derived quantities from EEG were utilized as inputs to classifier such as logistic regression (LR) and support vector machine (SVM). The learning of these classification models was tested with a test dataset. Their learning efficiency is provided as accuracy of classifying MDD patients from controls, their sensitivities and specificities were reported, accordingly (LR =81.7 % and SVM =81.5 %). Based on the results, it is concluded that the derived measures are indicators for diagnosing MDD from a potential population of normal controls. In addition, the results motivate further exploring other measures for the same purpose.

Keywords: major depressive disorder, diagnosis based on EEG, EEG derived features, CPEI, inter-hemispheric asymmetry

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Authors: M. Ridwanul Hassan, Samuel George

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Aims: Steroid injections are commonly used as a diagnostic tool or an alternative to surgical management of carpal tunnel syndrome (CTS) and are generally safe. Ischaemia is a rare complication with very few cases reported in the literature. Methods: We report a case of a 50-year-old female that presented with a necrotic wound to her left palm one month after a steroid injection into the carpal tunnel. She had a 2-year history of CTS in her left hand that was treated with six previous steroid injections in primary care during this period. The wound evolved from a blister to a necrotic ulcer which led to a painful, hollow defect in the centre of her palm. She did not report any history of trauma, nor did she have any co-morbidities. Clinical photographs were taken. Results: On examination, she had a 0.5 cmx1 cm defect in the palm of her left hand down to aponeurosis. There was purulent discharge in the wound with surrounding erythema but no spreading cellulitis. She had full function of her fingers but was very tender on movements and at rest. She was admitted for intravenous antibiotics and underwent a debridement, washout, and carpal tunnel release the next day. The defect was packed to heal by secondary intention and has now fully healed one month following her operation. Conclusions: This is an extremely rare complication of steroid injections to the carpal tunnel and may have been avoided by earlier referral for surgery rather than treatment using multiple steroid injections.

Keywords: hand surgery, complication, rare, carpal tunnel syndrome

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Authors: Halimah Al Hifzi, Waseem Al-Talalwah, Shorok Al Dorazi, Hassan Al Mousa, Zainab Al-Hashim, Roger Soames

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The obturator artery is one branches of anterior division of the internal iliac artery. It passes on the lateral wall of pelvis to escape into thigh region via obturator foremen. Based on previous research studies, it found to be extremely variable in origin and course. It may arise from internal or external iliac artery. The current study includes 82 dissected specimens to investigate the origin of the obturator artery and explain the clinical importance. The obturator artery arises from the internal iliac artery in 75% either from its anterior or posterior division in 46.9% or 25% respectively. Further, it arises neither from the anterior nor posterior division of the internal iliac artery but it arises between them in 3.1%. In 25%, the obturator artery arises from the external iliac artery. In case of aneurysmectomy of posterior division, carries a high risk of insufficient of vascular supply for demand structures such as proximal adductors attachment and hip joint. Therefore, vascular surgeons have to pay attention to the posterior division being an origin of the obturator artery beside its usual three classical branches: superior gluteal, iliolumbar and lateral sacral arteries. Further, the obturator artery arising from the external iliac system is in great dangerous of laceration in case of anterior pelvic fracture. Therefore, it may lead to haemorrhagic shock threatening life.

Keywords: obturator artery, external iliac, internal iliac artery, anterior division, posterior division, superior gluteal, iliolumbar and lateral sacral, pubic fracture, aneurysm, shock

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Authors: Aref Aasi, Sahar Ebrahimi Bajgani, Erfan Aasi

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Breast cancer (BC) continues to be the most frequent cancer in females and causes the highest number of cancer-related deaths in women worldwide. Inspired by recent advances in studying the relationship between different patient attributes and features and the disease, in this paper, we have tried to investigate the different classification methods for better diagnosis of BC in the early stages. In this regard, datasets from the University Hospital Centre of Coimbra were chosen, and different machine learning (ML)-based and neural network (NN) classifiers have been studied. For this purpose, we have selected favorable features among the nine provided attributes from the clinical dataset by using a random forest algorithm. This dataset consists of both healthy controls and BC patients, and it was noted that glucose, BMI, resistin, and age have the most importance, respectively. Moreover, we have analyzed these features with various ML-based classifier methods, including Decision Tree (DT), K-Nearest Neighbors (KNN), eXtreme Gradient Boosting (XGBoost), Logistic Regression (LR), Naive Bayes (NB), and Support Vector Machine (SVM) along with NN-based Multi-Layer Perceptron (MLP) classifier. The results revealed that among different techniques, the SVM and MLP classifiers have the most accuracy, with amounts of 96% and 92%, respectively. These results divulged that the adopted procedure could be used effectively for the classification of cancer cells, and also it encourages further experimental investigations with more collected data for other types of cancers.

Keywords: breast cancer, diagnosis, machine learning, biomarker classification, neural network

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Authors: Bahlous Afef, Bouzid Kahena, Bardkis Ahlem, Mrad Mehdi, Kalai Eya, Sonia Bahri, Abdelmoula Jaouida

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Diabetic nephropathy is the first cause of chronic renal failure and hemodialysis use in several countries including Tunisia. The role of hypertension (HT) as major risk factor for nephropathy is undeniable. The aim of our study was to determine the relationship between blood pressure and nephropathy in a population of diabetic type 2 recently discovered. Materials and methods: We conducted a prospective study focused on 60 patients with type 2 diabetes recently discovered (<5 years). Each patient have benefited from: -a full clinical examination with measurement of blood pressure - exploring a blood-glucose control and renal function -urinary exploration with the determination of proteinuria microalbuminumie of 24 hours with a immunoturbidimetric method using Architect (ABBOTT CI 8200). Results and discussion: Hypertension was present in 46.7% of cases. Twenty patients, 35% of the study population showed nephropathy. Four of these patients (6.66% of cases) had proteinuria, while 16 (26.6% of patients) had microalbuminuria (> 30mg/24 hours). Systolic blood pressure was significantly (p < 0.05) associated with the presence of nephropathy (139 +19.44) vs. for the group with normal renal function (128.65 +15.12 mmHg). Conclusion: The etiology of diabetic nephropathy is multifactorial. However, systolic blood pressure and glycemic control remains the major risk factors. Better glycemic control and treatment of hypertension allowed preventing and slowing the progression of diabetic nephropathy.

Keywords: hypertension, nephropathy, hemodialysis, diabetes

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Authors: Frantisek Kopriva, Kamila Michalkova, Radim Dudek, Jana Volejnikova

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Rationale: Diagnostic criteria of asthma–COPD overlap syndrome (ACOS) are controversial in pediatrics. Emphysema is characteristic of COPD and usually does not occur in typical asthma; its presence in patients with asthma suggests the concurrence with COPD. Low-dose chest computed tomography (CT) allows a non-invasive assessment of the lung tissue structure. Here we present CT findings of emphysematous changes in a child with ACOS. Patient and Methods: In a 6-year-old boy, atopy was confirmed by a skin prick test using common allergen extracts (grass and tree pollen, house dust mite, molds, cat, dog; manufacturer Stallergenes Greer, London, UK), where reactions over 3 mm were considered positive. Treatment with corticosteroids was started during the course of severe asthma. At 12 years of age, his spirometric parameters deteriorated despite treatment adjustment (VC 1.76 L=85%, FEV1 1.13 L=67%, TI%VCmax 64%, MEF25 19%, TLC 144%) and the bronchodilator test became negative. Results: Low-dose chest CT displayed irregular regions with increased radiolucency of pulmonary parenchyma (typical for hyperinflation in emphysematous changes) in both lungs. This was in accordance with the results of spirometric examination. Conclusions: ACOS is infrequent in children. However, low-dose chest CT scan can be considered to confirm this diagnosis or eliminate other diagnoses when the clinical condition is deteriorating and treatment response is poor.

Keywords: child, asthma, low-dose chest CT, ACOS

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Authors: Sareh Edalati, Nasrin Omidvar, Arezoo Haghighian Roudsari, Delaram Ghodsi, Azizollaah Zargaran

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Background and aim: Improving consumer’s food choices and providing a healthy food environment by governments is one of the essential approaches to prevent non-communicable diseases and to fulfill the sustainable development goals (SDGs). The present study aimed to provide an analysis of the nutrition labeling policy as one of the main components of the healthy food environment to provide learning lessons for the country and other low and middle-income countries. Methods: Data were collected by reviewing documents and conducting semi-structured interviews with stakeholders. Respondents were selected through purposive and snowball sampling and continued until data saturation. MAXQDA software was used to manage data analysis. A deductive content analysis was used by applying the Kingdon multiple streams and the policy triangulation framework. Results: Iran is the first country in the Middle East and North Africa region, which has implemented nutrition traffic light labeling. The implementation process has gone through two phases: voluntary and mandatory. In the voluntary labeling, volunteer food manufacturers who chose to have the labels would receive an honorary logo and this helped to reduce the food-sector resistance gradually. After this phase, the traffic light labeling became mandatory. Despite these efforts, there has been poor involvement of media for public awareness and sensitization. Also, the inconsistency of nutrition traffic light colors which are based on food standard guidelines, lack of consistency between nutrition traffic light colors, the healthy/unhealthy nature of some food products such as olive oil and diet cola and the absence of a comprehensive evaluation plan were among the pitfalls and policy challenges identified. Conclusions: Strengthening the governance through improving collaboration within health and non-health sectors for implementation, more transparency of truthfulness of nutrition traffic labeling initiating with real ingredients, and applying international and local scientific evidence or any further revision of the program is recommended. Also, developing public awareness campaigns and revising school curriculums to improve students’ skills on nutrition label applications should be highly emphasized.

Keywords: nutrition labeling, policy analysis, food environment, Iran

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Authors: W. Ling, Mohamed Saufi Bin Awang

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Introduction: Mycobacterium tuberculosis post a major health problem worldwide. Central nervous system (CNS) infection by mycobacterium tuberculosis is one of the most devastating complications of tuberculosis. Although with advancement in medical fields, we are yet to understand the pathophysiology of how mycobacterium tuberculosis was able to cross the blood-brain barrier (BBB) and infect the CNS. CNS TB may present with nonspecific clinical symptoms which can mimic other diseases/conditions; this is what makes the diagnosis relatively difficult and challenging. Public health has to be informed and educated about the spread of TB, and early identification of TB is important as it is a curable disease. Case Report: A young 21-year-old Malay gentleman was initially presented to us with symptoms of ear discharge, tinnitus, and right-sided headache for the past one year. Further history reveals that the symptoms have been mismanaged and neglected over the period of 1 year. Initial investigation reveals features of inflammation of the ear. Further imaging showed the feature of chronic inflammation of the otitis media and atypical right cerebral abscess, which has the same characteristic features and consistency. He further underwent a biopsy, and results reveal positive Mycobacterium tuberculosis of the otitis media. With the results and the available imaging, we were certain that this is likely a case of disseminated tuberculosis causing CNS TB. Conclusion: We aim to highlight the challenge and difficult face in our health care system and public health in early identification and treatment.

Keywords: central nervous system tuberculosis, intracranial tuberculosis, tuberculous encephalopathy, tuberculous meningitis

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Authors: Yarra Sulina, Nunna Tagore Sai Priya, Ankhi Banerjee

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With the rapid growth in tourist arrivals, there has been a huge demand for the growth of infrastructure in the destinations. With the increasing preference of tourists to stay near attractions, there has been a considerable change in the land use around tourist sites. However, with the inclusion of certain regulations and guidelines provided by the authorities based on the nature of tourism activity and geographical constraints, the pattern of growth of built form is different for various tourist sites. Therefore, this study explores the patterns of growth of built-up for a decade from 2009 to 2019 through two-dimensional and three-dimensional analysis. Land use maps are created through supervised classification of satellite images obtained from LANDSAT 4-5 and LANDSAT 8 for 2009 and 2019, respectively. The overall expansion of the built-up area in the region is analyzed in relation to the distance from the city's geographical center and the tourism-related growth regions are identified which are influenced by the proximity of tourist attractions. The primary tourist sites of various destinations with different geographical characteristics and tourism activities, that have undergone a significant increase in built-up area and are occupied with tourism-related infrastructure are selected for further study. Proximity analysis of the tourism-related growth sites is carried out to delineate the influence zone of the tourist site in a destination. Further, a temporal analysis of volumetric growth of built form is carried out to understand the morphology of the tourist precincts over time. The Digital Surface Model (DSM) and Digital Terrain Model (DTM) are used to extract the building footprints along with building height. Factors such as building height, and building density are evaluated to understand the patterns of three-dimensional growth of the built area in the region. The study also explores the underlying reasons for such changes in built form around various tourist sites and predicts the impact of such growth patterns in the region. The building height and building density around tourist site creates a huge impact on the appeal of the destination. The surroundings that are incompatible with the theme of the tourist site have a negative impact on the attractiveness of the destination that leads to negative feedback by the tourists, which is not a sustainable form of development. Therefore, proper spatial measures are necessary in terms of area and volume of the built environment for a healthy and sustainable environment around the tourist sites in the destination.

Keywords: sustainable tourism, growth patterns, land-use changes, 3-dimensional analysis of built-up area

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Authors: Lingxia Li, Frédéric Schnell, Thibault Lachard, Anne-Charlotte Dupont, Shuzhe Ding, Solène Le Douairon Lahaye

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Background: Repetitive participation in triathlon training results in significant myocardial changes. However, whether the cardiac remodeling in triathletes is related to the specificities of the sport (consisting of three sports) raises questions. Methods: Elite triathletes and cyclists registered on the French ministerial lists of high-level athletes were involved. The basic information and routine electrocardiogram records were obtained. Electrocardiograms were evaluated according to clinical criteria. Results: Of the 105 athletes included in the study, 42 were from the short-distance triathlon (40%), and 63 were from the road cycling (60%). The average age was 22.1±4.2 years. The P wave amplitude was significantly lower in triathletes than in cyclists (p=0.005), and no significant statistical difference was found in heart rate, RR interval, PR or PQ interval, QRS complex, QRS axe, QT interval, and QTc (p>0.05). All the measured parameters were within normal ranges. The most common electrical manifestations were early repolarization (60.95%) and incomplete right bundle branch block (43.81%); there was no statistical difference between the groups (p>0.05). Conclusions: Prolonged intensive endurance exercise training induces physiological cardiac remodeling in both triathletes and cyclists. The most common electrocardiogram manifestations were early repolarization and incomplete right bundle branch block.

Keywords: cardiac screening, electrocardiogram, triathlon, cycling, elite athletes

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Authors: A. Kourou, A. Ioakeimidou, A. Gakou

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Greece due to its location in the Eastern Mediterranean region is characterized by a high degree of seismicity and occurrence of severe earthquakes. It is generally accepted that preventive planning is vital in mitigating impacts, protecting those who are the most vulnerable namely children and increasing the degree of resilience of local communities. Worldwide, States have highlighted the need to ensure the safety of early childhood environments in case of disaster. A great number of children are enrolled in daycare facilities, so building and improving the preparedness of pre-primary schools to prevent injuries and fatalities in case of an earthquake becomes an important policy issue. It is more than evident that preparedness in early preschool level will be increased through awareness and education of the people who work to pre-primary classes and provide early childhood care. The aim of the present study is to assess the level of awareness and preparedness of the Greek pre-primary schools staff concerning earthquake protection issues, as well as their risk mitigation behaviors and earthquake management in case of a strong event. In this framework, specific questionnaire was developed and filled by the abovementioned target group at 30 different municipalities of Greece (2014-2016). Also in the framework of this study it is presented the Pre-Primary Schools’ Earthquake Safety Initiative that has been undertaken by Earthquake Planning and Protection Organization (EPPO) the last years. This initiative aims to develop disaster-resilient day care centers through awareness, self-help, cooperation and education. Recognizing the necessity of integration of the disaster safety concept at pre-primary environments, EPPO published practical guidelines that focused on earthquake planning of these workspaces. Furthermore, dozens of seminars are implemented in municipality or prefecture-level every year by EPPO, in order the early childhood schools’ staff to be appropriately educated and adequately trained to face the earthquake risk. Great progress has been made towards building awareness and increasing preschool preparedness in Greece but significant gaps still remain. Anyway, it is extremely important that the implementation of effective programs and practices and the broad collaboration of all involved parties have been recognized as essential in order to develop a comprehensive disaster management system at preschool environment.

Keywords: awareness, earthquake, education, emergency plans, preparedness, pre-primary schools

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Authors: Wendy Maddison

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This paper describes an Action Research project which was undertaken to inform professional practice in order to develop a newly created Centre for Student Success in the specific context of transnational medical and nursing education in the Middle East. The objectives were to enhance the academic performance, persistence, integration and personal and professional development of a multinational study body, in particular in relation to preclinical medical students, and to establish a comfortable, friendly and student-driven environment within an Irish medical university recently established in Bahrain. Expatriating a new part of itself into a corner of the world and within a context which could be perceived as the antithesis of itself, in particular in terms of traditional cultural and organisational values, the university has had to innovate in the range of services, programmes and other offerings which engages and supports the academic success of medical and nursing students as they “encounter the world in the classroom” in the context of an Arab Islamic culture but within a European institution of transnational education, engaging with a global learning environment locally. The outcomes of the project resulted in the development of a specific student success ‘signature’ for this particular transnational higher education context.

Keywords: transnational higher education, medical education, action research, student success, Middle Eastern context, student persistence in the global-local, student support mechanisms

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Authors: Dominika Pihikova, Stefan Belicky, Tomas Bertok, Roman Sokol, Petra Kubanikova, Jan Tkac

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Since aberrant glycosylation is frequently accompanied by both physiological and pathological processes in a human body (cancer, AIDS, inflammatory diseases, etc.), the analysis of tumor-associated glycan patterns have a great potential for the development of novel diagnostic approaches. Moreover, altered glycoforms may assist as a suitable tool for the specificity and sensitivity enhancement in early-stage prostate cancer diagnosis. In this paper we discuss the construction and optimization of ultrasensitive sandwich biosensor platform employing lectin as glycan-binding protein. We focus on the immunoassay development, reduction of non-specific interactions and final glycoprofiling of human serum samples including both prostate cancer (PCa) patients and healthy controls. The fabricated biosensor was measured by label-free electrochemical impedance spectroscopy (EIS) with further lectin microarray verification. Furthermore, we analyzed different biosensor interfaces with atomic force microscopy (AFM) in nanomechanical mapping mode showing a significant differences in the altitude. These preliminary results revealing an elevated content of α-2,3 linked sialic acid in PCa patients comparing with healthy controls. All these experiments are important step towards development of point-of-care devices and discovery of novel glyco-biomarkers applicable in cancer diagnosis.

Keywords: biosensor, glycan, lectin, prostate cancer

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Authors: Jiajia Peng, Jianqing Qiu, Jianjun Ren, Yu Zhao

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Background: We aimed to compare clinical and survival differences between B-cell (B-NHL) and NKT-cell non-Hodgkin lymphomas (NKT-NHL) located in the nasal cavity, nasopharynx and paranasal sinuses, which are always categorized as one sinonasal type. Methods: Patients diagnosed with primary B-NHL and NKT-NHL in the nasal cavity, nasopharynx, and paranasal sinuses from the SEER database were included. We identified these patients based on histological types and anatomical sites and subsequently conducted univariate and multivariate Cox regression and Kaplan–Meier analyses to examine cancer-special survival (CSS) outcomes. Results: Overall, most B-NHL cases originated from the nasopharynx, while the majority of NKT-NHL cases occurred in the nasal cavity. Notably, the CSS outcomes improved significantly in all sinonasal B-NHL cases over time, whereas no such improvement trend was observed in each sinonasal NKT-NHL type. Additionally, increasing age was linked with an elevated risk of death in B-NHL, particularly in the nasal cavity (HR:3.37), rather than in NKT-NHL. Compared with B-NHL, the adverse effect of the higher stage on CSS was more evident in NKT-NHL, particularly in its nasopharynx site (HR: 5.12). Furthermore, radiotherapy was beneficial for survival in patients with sinonasal B-NHL and NKT-NHL, except in those with NKT-NHL in the nasopharynx site. However, chemotherapy has only been beneficial for CSS in patients with B-NHL in paranasal sinuses (HR: 0.42) since 2010, rather than in other types of B-NHL or NKT-NHL. Conclusions: Although B-NHL and NKT-NHL in the nasal cavity, nasopharynx and paranasal sinuses have similar anatomical locations, their clinic demographics and prognoses are largely different and should be treated and studied as distinct diseases.

Keywords: B-cell non-Hodgkin lymphomas, NKT-cell non-Hodgkin lymphomas, nasal cavity lymphomas, nasal sinuses lymphomas, nasopharynx lymphomas

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Authors: Adnan Sahin, Ufuk Uylas, Ercument Pasaoglu, Tarik Caga, Enver Ihtiyar, Serdar Erkasap, Ersin Ates, Fatih Yasar

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Background: In this study, it was evaluated the demographic features, etiological factors and the management of acute pancreatitis. Methods: 106 patient hospitalized due to acute pancreatitis were retrospectively examined from 1 January 2015 to 31 December 2015 in Department of General Surgery of ESOGUMF. The data of gender, signs and symptoms, etiological factors, WBC, AST, ALT, Amilase, USG and CT findings treatment options ERCP, and complications, mortality rate were analysed. Results: The mean age of patients were 58.8 (53 men and 53 women). The causes of acute pancreatitis were as follows: gallbladder stone was 89, hyperlipidemia was 5 and idiopathic were 16 patients. Severe pancreatitis was developed in 16 patients in the biliary pancreatitis group and ERCP was performed. Cholecystectomy was performed to all biliary pancreatitis group patients after acute pancreatitis subside. The mean hospital stay period was 9.33 (2-37) day. Discussion and conclusion: Severe acute pancreatitis is a mortal disease. The most common etiological cause of acute pancreatitis is biliary origin. The first line treatment modality of acute pancreatitis is medical. Cholecystectomy should be planned to the all-biliary caused acute pancreatitis patients after the attack subside. ERCP is a useful treatment modality in the case of clinical worsening and suspicion of acute cholangitis. ERCP procedure used 16 patients in our series and these patients have a good morbidity and mean hospital period is lower than the others. We suppose that ERCP procedure should be planned selectively and conservatively.

Keywords: acute pancreatitis, ERCP, morbidity, treatment

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Authors: Mustarakh Gelfi, Tiedo Vellinga, Poonam Taneja, Delon Hamonangan

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The development of New Priok/Kalibaru as an expansion terminal of the old port has been being done by IPC (Indonesia Port Cooperation) together with the subsidiary company, Port Developer (PT Pengembangan Pelabuhan Indonesia). As stated in the master plan, from 2 phases that had been proposed, phase I has shown its form and even Container Terminal I has been operated in 2016. It was planned principally, the development will be divided into Phase I (2013-2018) consist of 3 container terminals and 2 product terminals and Phase II (2018-2023) consist of 4 container terminals. In fact, the master plan has to be changed due to some major uncertainties which were escaped in prediction. This study is focused on the design scenario of phase II (2035- onwards) to deal with future uncertainty. The outcome is the robust design of phase II of the Kalibaru Terminal taking into account the future changes. Flexibility has to be a major goal in such a large infrastructure project like New Priok in order to deal and manage future uncertainty. The phasing of project needs to be adapted and re-look frequently before being irrelevant to future challenges. One of the frameworks that have been developed by an expert in port planning is Adaptive Port Planning (APP) with scenario-based planning. The idea behind APP framework is the adaptation that might be needed at any moment as an answer to a challenge. It is a continuous procedure that basically aims to increase the lifespan of waterborne transport infrastructure by increasing flexibility in the planning, contracting and design phases. Other methods used in this study are brainstorming with the port authority, desk study, interview and site visit to the real project. The result of the study is expected to be the insight for the port authority of Tanjung Priok over the future look and how it will impact the design of the port. There will be guidelines to do the design in an uncertain environment as well. Solutions of flexibility can be divided into: 1 - Physical solutions, all the items related hard infrastructure in the projects. The common things in this type of solution are using modularity, standardization, multi-functional, shorter and longer design lifetime, reusability, etc. 2 - Non-physical solutions, usually related to the planning processes, decision making and management of the projects. To conclude, APP framework seems quite robust to deal with the problem of designing phase II of New Priok Project for such a long period.

Keywords: Indonesia port, port's design, port planning, scenario-based planning

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Authors: Rozhgar A. Khailany, Mehri Igci, Emine Bayraktar, Sakip Erturhan, Metin Karakok, Ahmet Arslan

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Kidney cancer is the most lethal urological cancer accounting for 3% of adult malignancies. VHL, a tumor-suppressor gene, is best known to be associated with renal cell carcinoma (RCC). The VHL functions as negative regulator of hypoxia inducible factors. Recent sequencing efforts have identified several novel frequent mutations of histone modifying and chromatin remodeling genes in ccRCC (clear cell RCC) including PBRM1 and SETD2. The PBRM1 gene encodes the BAF180 protein, which involved in transcriptional activation and repression of selected genes. SETD2 encodes a histone methyltransferase, which may play a role in suppressing tumor development. In this study, RNAs of 30 paired tumor and normal samples that were grouped according to the types of kidney cancer and clinical characteristics of patients, including gender and average age were examined by RT-PCR, SSCP and sequencing techniques. VHL, PBRM1 and SETD2 expressions were relatively down-regulated. However, statistically no significance was found (Wilcoxon signed rank test, p > 0.05). Interestingly, no mutation was observed on the contrary of previous studies. Understanding the molecular mechanisms involved in the pathogenesis of RCC has aided the development of molecular-targeted drugs for kidney cancer. Further analysis is required to identify the responsible genes rather than VHL, PBRM1 and SETD2 in kidney cancer.

Keywords: kidney cancer, molecular biomarker, expression analysis, mutation screening

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Authors: M. A. Fernández-Vilar, M. D. Galián, E. Ato

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The aim of this work was to analyze the relation between children´s effortful control and Maths achievement in a sample of 447 Spanish children aged between 6 and 8 years. Traditionally, the literature confirms that higher level of effortful control has been associated with higher academic achievement, but there are few studies that include the effect that children´s social competence exert to this relation. To measure children’s effortful control parents were given the TMCQ (Temperament in Middle Childhood Questionnaire), and Maths achievement was taken from teacher´s rates. To measure social competence, we used the nominations method in the classroom context. Results confirmed that higher effortful control predicted a better maths achievement, whereas lower effortful control scores predicted lower Maths scores. Using a statistical modeling approach, we tested a mediation model that revealed the mediating role of social competence (popularity and rejection) in the relation between effortful control and Maths achievement. Concretely, higher social competence (higher popularity and lower rejection) seems to mediate the better Maths achievement showed by better self´regulated children. Therefore, an adequate social competence mediates the positive effect that self-regulatory capacity exerts to academic achievement. The clinical implications of the present findings should be considered. Specifically, rejected children must be detected and evaluated in community settings, such as school or community programs, due the relevant role of social competence in the relation between temperament and academic achievement.

Keywords: effortful control, maths achievement, social competence, mediation

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Authors: Piamsiri Sawaisorn, Tienrat Tangchaikeeree, Waraporn Chan-On, Chaniya Leepiyasakulchai, Rachanee Udomsangpetch, Suradej Hongeng, Kulachart Jangpatarapongsa

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Human Vγ9Vδ2 T lymphocytes are regarded as promising effector cells for cancer immunotherapy since they have the ability to eliminate several tumor cells through non-peptide antigen recognition and non-major histocompatibility complex (MHC) restriction. An issue of recent interest is the capability to activate γδ T cells by use of a group of drugs, such as pamidronate, that cause accumulation of phosphoantigen which is recognized by γδ T cell receptors. Moreover, their antigen presenting cell-like phenotype and function have been confirmed in many clinical trials. In this study, Vγ9Vδ2 T cells derived from normal peripheral blood mononuclear cells were activated with pamidronate and the expanded Vγ9Vδ2 T cells can recognize and kill chronic myeloid leukemia (CML) cells treated with pamidronate through their cytotoxic activity. To support the strong role played by Vγ9Vδ2 T cells against cancer, we provide the evidence that Vγ9Vδ2 T cells activated with CML cell lysate antigen can efficiently express antigen presenting cell (APC) phenotype and function. In conclusion, pamidronate can be used in intentional activation of human Vγ9Vδ2 T cells and can increase the susceptibility of CML cells to cytotoxicity of Vγ9Vδ2 T cells. The activated Vγ9Vδ2 T cells by cancer cells lysate can show their APC characteristics, and so greatly increase the interest in exploring their therapeutic potential in hematologic malignancy.

Keywords: γδ T lymphocytes, antigen-presenting cells, chronic myeloid leukemia, cancer, immunotherapy

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Authors: Shekoufeh Behdad, Sahar Yadegari, Alireza Ghehrazad, Amirhossein Yadegari

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Background: In this study, we compared the effect of intravenous dexamethasone with placebo on hemodynamic variables and hypotension in patients undergoing cesarean section under spinal anesthesia. Materials and methods: This double-blind, randomized clinical trial was conducted with the approval of the university ethics committee. Written informed consent was obtained from all participating patients. Before spinal anesthesia, patients were randomly assigned to receive either dexamethasone (8 mg IV) or placebo (normal saline). Hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate, were measured before drug administration and every 3 minutes until the birth of the neonate and then every 5 minutes until the end of surgery. Side effects such as hypotension, bradycardia, nausea, and vomiting were assessed and recorded for all the patients. Results: There were no significant differences in mean systolic, diastolic, and mean arterial blood pressures before and after administration of the studied drugs in both groups (P.Value>0.05), but heart rate and the incidence of hypotension in the dexamethasone group were less than placebo significantly. Conclusions: Intravenous administration of 8 mg dexamethasone before spinal anesthesia in females undergoing cesarean section can reduce the incidence of post-spinal hypotension without causing serious side effects.

Keywords: cesarean section, hypotension, spinal anesthesia, dexamethasone

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