Search results for: respiratory disturbance index.

Authors: Sadia Suri Kashif, Raheeda Fatima, Maqsood Ahmed Khan

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Purpose of the study: The objective of this research was to determine the perception of Pakistani physicians (whether primary care, specialists or residents) in Karachi, being one of the largest and highly populated cities of Pakistan, regarding clinical approaches towards diet, exercise, and therapy in obese patients. This research determines their understanding of obesity and employability of obesity management in their daily practices. Research methodology: This is a questionnaire-based survey. A minimum of 300 questionnaires (N=300) were distributed and filled by practicing physicians in a random selection of medical setups in Karachi. Randomly 246 physicians responded to the survey. The survey tested their views regarding weight management, importance of general awareness and their strategies to control weight. Results: In the first part of survey the physicians responded to almost 66% regarding the seriousness of obesity management with advising diet modification, physical exercise and decreasing calorie intake; 57% failed to employ Body Mass Index and Waist Hip Ratio as weight measurement tools in their daily practice; 50% disagreed on using pharmacotherapy as an option; 67% were not sure about the proper dosage and indication of anti-obesity medication while almost same disagreed on using surgical options for management of obesity; 83.3% physicians agreed on the increased obesity pandemic in Pakistan. Conclusion: The findings indicate that there is a gap between awareness and knowledge among Pakistani practicing physicians regarding pharmacotherapy for obesity. There is a need to frequently update latest guidelines to help manage this condition, which is becoming more prevalent in our country day by day. Physicians should be obligated to use updated knowledge for managing obesity.

Keywords: obesity, physicians, BMI, weight management, obesity awareness

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Authors: Padmalochan Panda, R. Ramaseshan

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Aluminum nitride (AlN) is a potential candidate for semiconductor industry due to its wide band gap (6.2 eV), high thermal conductivity and low thermal coefficient of expansion. A-plane oriented AlN film finds an important role in deep UV-LED with higher isotropic light extraction efficiency. Also, Cr-doped AlN films exhibit dilute magnetic semiconductor property with high Curie temperature (300 K), and thus compatible with modern day microelectronics. In this work, highly a-axis oriented wurtzite AlN and Al1-xMxN (M = Cr, Ti) films have synthesized by reactive co-sputtering technique at different concentration. Crystal structure of these films is studied by Grazing incidence X-ray diffraction (GIXRD) and Transmission electron microscopy (TEM). Identification of binding energy and concentration (x) in these films is carried out by X-ray photoelectron spectroscopy (XPS). Local crystal structure around the Cr and Ti atom of these films are investigated by X-ray absorption spectroscopy (XAS). It is found that Cr and Ti replace the Al atom in AlN lattice and the bond lengths in first and second coordination sphere with N and Al, respectively, decrease concerning doping concentration due to strong p-d hybridization. The nano-indentation hardness of Cr and Ti-doped AlN films seems to increase from 17.5 GPa (AlN) to around 23 and 27.5 GPa, respectively. An-isotropic optical properties of these films are studied by the Spectroscopic Ellipsometry technique. Refractive index and extinction coefficient of these films are enhanced in normal dispersion region as compared to the parent AlN film. The optical band gap energies also seem to vary between deep UV to UV regions with the addition of Cr, thus by bringing out the usefulness of these films in the area of optoelectronic device applications.

Keywords: ellipsometry, GIXRD, hardness, XAS

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Authors: Mateusz Bilski, Jakub Klas, Emilia Kowalczyk, Sylwia Koziej, Katarzyna Kulszo, Ludmiła Grzybowska- Szatkowska

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Background: Liver metastases are a common complication of primary solid tumors and sig-nificantly reduce patient survival. In the era of increasing diagnosis of oligometastatic disease and oligoprogression, methods of local treatment of metastases, i.e. MDT, are becoming more important. Implementation of such treatment can be considered for liver metastases, which are a common complication of primary solid tumors and significantly reduce patient survival. To date, the mainstay of treatment for oligometastatic disease has been surgical resection, but not all patients qualify for the procedure. As an alternative to surgical resection, radiotherapy techniques have become available, including stereotactic body radiation therapy (SBRT) or high-dose interstitial brachytherapy (iBT). iBT is an invasive method that emits very high doses of radiation from the inside of the tumor to the outside. This technique provides better tumor coverage than SBRT while having little impact on surrounding healthy tissue and elim-inates some concerns involving respiratory motion. Methods: We conducted a systematic re-view of the scientific literature on the use of brachytherapy in the treatment of liver metasta-ses from 2018 - 2023 using PubMed and ResearchGate browsers according to PRISMA rules. Results: From 111 articles, 18 publications containing information on 729 patients with liver metastases were selected. iBT has been shown to provide high rates of tumor control. Among 14 patients with 54 unresectable RCC liver metastases, after iBT LTC was 92.6% during a median follow-up of 10.2 months, PFS was 3.4 months. In analysis of 167 patients after treatment with a single fractional dose of 15-25 Gy with brachytherapy at 6- and 12-month follow-up, LRFS rates of 88,4-88.7% and 70.7 - 71,5%, PFS of 78.1 and 53.8%, and OS of 92.3 - 96.7% and 76,3% - 79.6%, respectively, were achieved. No serious complications were observed in all patients. Distant intrahepatic progression occurred later in patients with unre-sectable liver metastases after brachytherapy (PFS: 19.80 months) than in HCC patients (PFS: 13.50 months). A significant difference in LRFS between CRC patients (84.1% vs. 50.6%) and other histologies (92.4% vs. 92.4%) was noted, suggesting a higher treatment dose is necessary for CRC patients. The average target dose for metastatic colorectal cancer was 40 - 60 Gy (compared to 100 - 250 Gy for HCC). To better assess sensitivity to therapy and pre-dict side effects, it has been suggested that humoral mediators be evaluated. It was also shown that baseline levels of TNF-α, MCP-1 and VEGF, as well as NGF and CX3CL corre-lated with both tumor volume and radiation-induced liver damage, one of the most serious complications of iBT, indicating their potential role as biomarkers of therapy outcome. Con-clusions: The use of brachytherapy methods in the treatment of liver metastases of various cancers appears to be an interesting and relatively safe therapeutic method alternative to sur-gery. An important challenge remains the selection of an appropriate brachytherapy method and radiation dose for the corresponding initial tumor type from which the metastasis origi-nated.

Keywords: liver metastases, brachytherapy, CT-HDRBT, iBT

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Authors: Rajkumar Ghosh

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The industrialization of coal mining and related activities has a significant impact on groundwater in the surrounding areas of the Damodar River. The Damodar River basin, located in eastern India, is known as the "Ruhr of India" due to its abundant coal reserves and extensive coal mining and industrial operations. One of the major consequences of collieries on groundwater is the contamination of water sources. Coal mining activities often involve the excavation and extraction of coal through underground or open-pit mining methods. These processes can release various pollutants and chemicals into the groundwater, including heavy metals, acid mine drainage, and other toxic substances. As a result, the quality of groundwater in the Damodar River region has deteriorated, making it unsuitable for drinking, irrigation, and other purposes. The high concentration of heavy metals, such as arsenic, lead, and mercury, in the groundwater has posed severe health risks to the local population. Prolonged exposure to contaminated water can lead to various health problems, including skin diseases, respiratory issues, and even long-term ailments like cancer. The contamination has also affected the aquatic ecosystem, harming fish populations and other organisms dependent on the river's water. Moreover, the excessive extraction of groundwater for industrial processes, including coal washing and cooling systems, has resulted in a decline in the water table and depletion of aquifers. This has led to water scarcity and reduced availability of water for agricultural activities, impacting the livelihoods of farmers in the region. Efforts have been made to mitigate these issues through the implementation of regulations and improved industrial practices. However, the historical legacy of coal industrialization continues to impact the groundwater in the Damodar River area. Remediation measures, such as the installation of water treatment plants and the promotion of sustainable mining practices, are essential to restore the quality of groundwater and ensure the well-being of the affected communities. In conclusion, the coal industrialization in the Damodar River surrounding has had a detrimental impact on groundwater. This research focuses on soil subsidence induced by the over-exploitation of ground water for dewatering open pit coal mines. Soil degradation happens in arid and semi-arid regions as a result of land subsidence in coal mining region, which reduces soil fertility. Depletion of aquifers, contamination, and water scarcity are some of the key challenges resulting from these activities. It is crucial to prioritize sustainable mining practices, environmental conservation, and the provision of clean drinking water to mitigate the long-lasting effects of collieries on the groundwater resources in the region.

Keywords: coal mining, groundwater, soil subsidence, water table, damodar river

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Authors: Behzad Ahdiharab, Senol Baskaya, Tamer Calisir

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Heat exchangers are one of the most widely used systems in factories, refineries etc. In this study, natural convection heat transfer using nano-fluids in between two cylinders is numerically investigated. The inner and outer cylinders are kept at constant temperatures. One of the most important assumptions in the project is that the working fluid is non-Newtonian. In recent years, the use of nano-fluids in industrial applications has increased profoundly. In this study, nano-Newtonian fluids containing metal particles with high heat transfer coefficients have been used. All fluid properties such as homogeneity has been calculated. In the present study, solutions have been obtained under unsteady conditions, base fluid was water, and effects of various parameters on heat transfer have been investigated. These parameters are Rayleigh number (103 < Ra < 106), power-law index (0.6 < n < 1.4), aspect ratio (0 < AR < 0.8), nano-particle composition, horizontal and vertical displacement of the inner cylinder, rotation of the inner cylinder, and volume fraction of nanoparticles. Results such as the internal cylinder average and local Nusselt number variations, contours of temperature, flow lines are presented. The results are also discussed in detail. From the validation study performed it was found that a very good agreement exists between the present results and those from the open literature. It was found out that the heat transfer is always affected by the investigated parameters. However, the degree to which the heat transfer is affected does change in a wide range.

Keywords: heat transfer, circular space, non-Newtonian, nano fluid, computational fluid dynamics.

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Authors: Hatem Ashur Masoud Shreha

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Aromatase inhibitors administered before sexual differentiation of the gonads in chicken embryo can induce sex reversal in female layer chickens (phenotypic male). To analyze the process of sex reversal, we have followed for several months the changes induced by Fadrozole, a nonsteroidal aromatase inhibitor on morphology of female sex-reversed and female sex-reversed supplemented with L-tyrosine which was previously shown to stimulate release of Gn Rh. Fadrozole (1mg/egg) was injected into eggs on day four of incubation before sex differentiation. phenotypic males and phenotypic males treated with L-tyrosine and males hatched from eggs injected Fadrozole were sacrificed by slaughtering at 16 weeks old and the remaining chicks were sacrificed at 28 weeks old. Both sexes from control chickens were sacrificed at the same age (16 &28 weeks). Hatchability, behavior, body weight, shank length, comb weight, testes weight, blood cells count and wattle weight of sex reversal were tested at 16 and 28 weeks. The results showed that body weight, comb weight, wattles weight and shank length of sex-reversed females were significantly different from control female. Behavior of phenotypic males and phenotypic males fed on L-tyrosine showed aggressive sexual behavior like that of control males and absence of laying behavior. In conclusion our results confirm that Fadrazole injection in eggs before sex differentiation produce a male behavior and morphological index of male in female chicken.

Keywords: sex-reversal, fadrozole, phenotypic male, L-tyrosine

Procedia PDF Downloads 435

Authors: Meixia Zhang, Chengjun Ji, Wenxuan Han

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Many wood traits are important functional attributes for tree species, connected with resource competition among species, community dynamics, and ecosystem functions. Large variations in these traits exist among taxonomic categories, but variation in these traits between gymnosperms and angiosperms is still poorly documented. This paper explores the systematic differences in 12 traits between the two tree categories and the potential effects of environmental factors and life form. Based on a database of wood traits for major gymnosperm and angiosperm tree species across China, the values of 12 wood traits and their driving factors in gymnosperms vs. angiosperms were compared. The results are summarized below: i) Means of wood traits were all significantly lower in gymnosperms than in angiosperms. ii) Air-dried density (ADD) and tangential shrinkage coefficient (TSC) reflect the basic information of wood traits for gymnosperms, while ADD and radial shrinkage coefficient (RSC) represent those for angiosperms, providing higher explanation power when used as the evaluation index of wood traits. iii) For both gymnosperm and angiosperm species, life form exhibits the largest explanation rate for large-scale spatial patterns of ADD, TSC (RSC), climatic factors the next, and edaphic factors have the least effect, suggesting that life form is the dominant factor controlling spatial patterns of wood traits. Variations in the magnitude and key traits between gymnosperms and angiosperms and the same dominant factors might indicate the evolutionary divergence and convergence in key functional traits among woody plants.

Keywords: allometry, functional traits, phylogeny, shrinkage coefficient, wood density

Procedia PDF Downloads 251

Authors: Ivandic Kreso, Spiranec Miljenko, Kavur Boris, Strelec Stjepan

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This article discusses the possibility of using dilatometer tests (DMT) together with in situ seismic tests (MASW) in order to get the shape of G-g degradation curve in cohesive soils (clay, silty clay, silt, clayey silt and sandy silt). MASW test provides the small soil stiffness (G_o from v_s) at very small strains and DMT provides the stiffness of the soil at ‘work strains’ (M_DMT). At different test locations, dilatometer shear stiffness of the soil has been determined by the theory of elasticity. Dilatometer shear stiffness has been compared with the theoretical G-g degradation curve in order to determine the typical range of shear deformation for different types of cohesive soil. The analysis also includes factors that influence the shape of the degradation curve (G-g) and dilatometer modulus (M_DMT), such as the overconsolidation ratio (OCR), plasticity index (IP) and the vertical effective stress in the soil (s_vo'). Parametric study in this article defines the range of shear strain g_DMT and G_DMT/G_o relation depending on the classification of a cohesive soil (clay, silty clay, clayey silt, silt and sandy silt), function of density (loose, medium dense and dense) and the stiffness of the soil (soft, medium hard and hard). The article illustrates the potential of using MASW and DMT to obtain G-g degradation curve in cohesive soils.

Keywords: dilatometer testing, MASW testing, shear wave, soil stiffness, stiffness reduction, shear strain

Procedia PDF Downloads 297

Authors: Senthil Rajan Dharmalingam, Shamala Nadaraju, Srinivasan Ramamurthy

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Doxorubicin is the most widely used anticancer drugs in chemotherapy treatment. However, problems related to the development of multidrug resistance (MDR) and acute cardiotoxicity have led researchers to investigate alternative forms of administering doxorubicin for cancer therapy. Several methods have been attempted to overcome MDR, including the co-administration of a chemosensitizer inhibiting the efflux caused by ATP binding cassette transporters with anticancer drugs, and the bypass of the efflux mechanism. Co encapsulation of doxorubicin (Dox) and cyclosporine A (CSA) into poly (DL-lactide-co-glycolide) nanoparticles was emulsification-solvent evaporation method using polyvinyl alcohol as emulsion stabilizers. The Dox-CSA loaded nanoparticles were evaluated for particle size, zeta potential and PDI by light scattering analysis and thermal characterizations by differential scanning calorimetry (DSC). Loading efficiency (LE %) and in-vitro dissolution samples were evaluated by developed and validated HPLC method. The optimum particle size obtained is 298.6.8±39.4 nm and polydispersity index (PDI) is 0.098±0.092. Zeta potential is found to be -29.9±4.23. Optimum pH to increase Dox LE% was found 7.1 which gave 42.5% and 58.9% increase of LE% for pH 6.6 and pH 8.6 compared respectively. LE% achieved for Dox is 0.07±0.01 % and CSA is 0.09±0.03%. Increased volume of PVA and weight of PLGA shows increase in size of nanoparticles. DSC thermograms showed shift in the melting peak for the nanoparticles compared to Dox and CSA indicating encapsulation of drugs. In conclusion, these preliminary studies showed the feasibility of PLGA nanoparticles to entrap Dox and CSA and require future in-vivo studies to be performed to establish its potential.

Keywords: doxorubicin, cyclosporine, PLGA, nanoparticles

Procedia PDF Downloads 443

Authors: Flavia Laffleur

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Summary: Biomaterials have gained immense interest in the pharmaceutical research in the last decades. Hyaluronic acid a carbohydrate and mucopolysaccharide was chemically modified in order to achieve and establish a promising platform for buccal drug delivery. Aim: Novel biomaterial was tested for its potential for buccal drug delivery. Background: Polysaccharide hyaluronic acid (HA) was chemically modified with cysteine ethyl ether (CYS). By immobilization of the thiol-bearing ligand on the polymeric backbone the thiolated bioconjugate HA-CYS was obtained. Methodology: Mucoadhesive, permeation enhancing and stability potential as well as mechanical, physicochemical properties further mucoadhesive strength, swelling index and residence time were investigated. The developed thiolated bioconjugate displayed enhanced mucoadhesiveness on buccal mucosa as well as permeation behavior and polymer stability. The near neutral pH and negative cytotoxicity studies indicated their non-irritability and biocompatible nature with biological tissues. Further, the model drug sulforhodamine 101 was incorporated to determine its drug release profiles. Results: The synthesized thiomer showed no toxicity. The mucoadhesion of thiolated hyaluronic acid on buccal mucosa was significantly improved in comparison to unmodified one. The biomaterial showed 2.5-fold higher stability in polymer structure. The release of sulforhodamine in the presence of thiolated hyaluronic acid was 2.3-fold increased compared to hyaluronic acid. Conclusion: Thus, the promising results encourage further investigations and exploitation of this versatile polysaccharide. So far, hyaluronic acid was not evaluated for buccal drug delivery.

Keywords: buccal delivery, hyaluronic acid, mucoadhesion, thiomers

Procedia PDF Downloads 487

Authors: Fabiana Franceschi, Martha Cobo, Manuel Figueredo

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Bogotá, the capital of Colombia, is its largest city and one of the most polluted in Latin America due to the fast economic growth over the last ten years. Bogotá has been affected by high pollution events which led to the high concentration of PM10 and NO2, exceeding the local 24-hour legal limits (100 and 150 g/m3 each). The most important pollutants in the city are PM10 and PM2.5 (which are associated with respiratory and cardiovascular problems) and it is known that their concentrations in the atmosphere depend on the local meteorological factors. Therefore, it is necessary to establish a relationship between the meteorological variables and the concentrations of the atmospheric pollutants such as PM10, PM2.5, CO, SO2, NO2 and O3. This study aims to determine the interrelations between meteorological variables and air pollutants in Bogotá, using data mining techniques. Data from 13 monitoring stations were collected from the Bogotá Air Quality Monitoring Network within the period 2010-2015. The Principal Component Analysis (PCA) algorithm was applied to obtain primary relations between all the parameters, and afterwards, the K-means clustering technique was implemented to corroborate those relations found previously and to find patterns in the data. PCA was also used on a per shift basis (morning, afternoon, night and early morning) to validate possible variation of the previous trends and a per year basis to verify that the identified trends have remained throughout the study time. Results demonstrated that wind speed, wind direction, temperature, and NO2 are the most influencing factors on PM10 concentrations. Furthermore, it was confirmed that high humidity episodes increased PM2,5 levels. It was also found that there are direct proportional relationships between O3 levels and wind speed and radiation, while there is an inverse relationship between O3 levels and humidity. Concentrations of SO2 increases with the presence of PM10 and decreases with the wind speed and wind direction. They proved as well that there is a decreasing trend of pollutant concentrations over the last five years. Also, in rainy periods (March-June and September-December) some trends regarding precipitations were stronger. Results obtained with K-means demonstrated that it was possible to find patterns on the data, and they also showed similar conditions and data distribution among Carvajal, Tunal and Puente Aranda stations, and also between Parque Simon Bolivar and las Ferias. It was verified that the aforementioned trends prevailed during the study period by applying the same technique per year. It was concluded that PCA algorithm is useful to establish preliminary relationships among variables, and K-means clustering to find patterns in the data and understanding its distribution. The discovery of patterns in the data allows using these clusters as an input to an Artificial Neural Network prediction model.

Keywords: air pollution, air quality modelling, data mining, particulate matter

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Authors: Inci Develioglu, Hasan Firat Pulat

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Sustainable development is one of the most important topics in today's world, and it is also an important research topic for geoenvironmental engineering. Dredging process is performed to expand the river and port channel, flood control and accessing harbors. Every year large amount of sediment are dredged for these purposes. Dredged marine soils can be reused as filling materials, road and foundation embankments, construction materials and wildlife habitat developments. In this study, geotechnical engineering properties and compressibility behavior of dredged soil obtained from the Izmir Bay were investigated. The samples with four different organic matter contents were obtained and particle size distributions, consistency limits, pH and specific gravity tests were performed. The consolidation tests were conducted to examine organic matter content (OMC) effects on compressibility behavior of dredged soil. This study has shown that the OMC has an important effect on the engineering properties of dredged soils. The liquid and plastic limits increased with increasing OMC. The lowest specific gravity belonged to sample which has the maximum OMC. The specific gravity values ranged between 2.76 and 2.52. The maximum void ratio difference belongs to sample with the highest OMC (De_11% = 0.38)_. As the organic matter content of the samples increases, the change in the void ratio has also increased. The compression index increases with increasing OMC.

Keywords: compressibility, consolidation, geotechnical properties, organic matter content, dredged soil

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Authors: Van-Thanh Ho, Hyoungsoon Lee, Jaiyoung Ryu

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Efficient pressure distribution within soft robotic systems, specifically to the pneumatic artificial muscle (PAM) regions, is essential to minimize energy consumption. This optimization involves adjusting reservoir pressure, pipe diameter, and branching network layout to reduce flow speed and pressure drop while enhancing flow efficiency. The outcome of this optimization is a lightweight power source and reduced mechanical impedance, enabling extended wear and movement. To achieve this, a branching network system was created by combining pipe components and intricate cross-sectional area variations, employing the principle of minimal work based on a complete virtual human exosuit. The results indicate that modifying the cross-sectional area of the branching network, gradually decreasing it, reduces velocity and enhances momentum compensation, preventing flow disturbances at separation regions. These optimized designs achieve uniform velocity distribution (uniformity index > 94%) prior to entering the connection pipe, with a pressure drop of less than 5%. The design must also consider the length-to-diameter ratio for fluid dynamic performance and production cost. This approach can be utilized to create a comprehensive PAM system, integrating well-designed tube networks and complex pneumatic models.

Keywords: pneumatic artificial muscles, pipe networks, pressure drop, compressible turbulent flow, uniformity flow, murray's law

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Authors: Jyoti Singh, Ranju Bansal

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Fighting pain and inflammation is a common problem faced by physicians while dealing with a wide variety of diseases. Since ancient time nonsteroidal anti-inflammatory agents (NSAIDs) and opioids have been the cornerstone of treatment therapy, however, the usefulness of both these classes is limited due to severe side effects. NSAIDs, which are mainly used to treat mild to moderate inflammatory pain, induce gastric irritation and nephrotoxicity whereas opioids show an array of adverse reactions such as respiratory depression, sedation, and constipation. Moreover, repeated administration of these drugs induces tolerance to the analgesic effects and physical dependence. Further discovery of selective COX-2 inhibitors (coxibs) suggested safety without any ulcerogenic side effects; however, long-term use of these drugs resulted in kidney and hepatic toxicity along with an increased risk of secondary cardiovascular effects. The basic approaches towards inflammation and pain treatment are constantly changing, and researchers are continuously trying to develop safer and effective anti-inflammatory drug candidates for the treatment of different inflammatory conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriasis and multiple sclerosis. Synthetic 3(2H)-pyridazinones constitute an important scaffold for drug discovery. Structure-activity relationship studies on pyridazinones have shown that attachment of a lactam at N-2 of the pyridazinone ring through a methylene spacer results in significantly increased anti-inflammatory and analgesic properties of the derivatives. Further introduction of the heterocyclic ring at lactam nitrogen results in improvement of biological activities. Keeping in mind these SAR studies, a new series of compounds were synthesized as shown in scheme 1 and investigated for anti-inflammatory, analgesic, anti-platelet activities and docking studies. The structures of newly synthesized compounds have been established by various spectroscopic techniques. All the synthesized pyridazinone derivatives exhibited potent anti-inflammatory and analgesic activity. Homoveratryl substituted derivative was found to possess highest anti-inflammatory and analgesic activity displaying 73.60 % inhibition of edema at 40 mg/kg with no ulcerogenic activity when compared to standard drugs indomethacin. Moreover, 2-substituted-4-benzo[d][1,3]dioxole-6-phenylpyridazin-3(2H)-ones derivatives did not produce significant changes in bleeding time and emerged as safe agents. Molecular docking studies also illustrated good binding interactions at the active site of the cyclooxygenase-2 (hCox-2) enzyme.

Keywords: anti-inflammatory, analgesic, pyridazin-3(2H)-one, selective COX-2 inhibitors

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Authors: Jamie R. Chua, Christina Irene D. Mejia, Regina P. Berba

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Disseminated tuberculosis is an infectious disease caused by Mycobacterium tuberculosis involving two or more non-contiguous sites identified through bacteriologic confirmation or clinical diagnosis. Over the five year period included in the study, the UP-PGH TB DOTS clinic had total of 3,967 referrals, and the prevalence of disseminated tuberculosis is 1% (68/3967). The mean age was 33.9 years (range 19-64 years) with a male: female ratio of 1:1. 67% (52 patients) had no predisposing comorbid illness or immune disorder. The most common presenting symptoms were abdominal pain (19%), back pain (13%), abdominal enlargement (11%) and mass (10.2%). Anemia, leukocytosis, hypoalbuminemia, and high-normal serum calcium were common biochemical and hematologic findings. Around 36% (25) of patients were diagnosed clinically with disseminated tuberculosis despite lacking bacteriologic evidence of multi-organ involvement. The lungs (86%) is still the most commonly involved site, followed by intestinal (22%), vertebral/Pott’s (27%), and pelvic/genital (19%). The mean time from presentation to initiation of therapy was 22 days (SD 32.7). Only 18 patients (29.3%) were properly recorded to have been referred to local TB DOTs facilities. Of the 68 patients, only 16% (11 patients) continued follow-up at PGH, and all had documented treatment completion. Treatment outcomes of the remaining were unknown. Due to the variety of involved sites, a high index of suspicion is required. Knowledge on clinical features, common radiographic findings, and histopathologic characteristics of disseminated TB is important as bacteriologic evidence of infection is not always apparent.

Keywords: disseminated tuberculosis, Mycobacterium tuberculosis, miliary tuberculosis, tuberculosis

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Authors: Nouira Mariem, Ben Rayana Hazem, Ennigrou Samir

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Background and aim: During the past decade, the frequency of extrapulmonary forms of tuberculosis has increased. These forms are under-diagnosed using conventional tests. The aim of this study was to evaluate the performance of the Tuberculin Skin Test (TST) for the diagnosis of tuberculosis, using the ROC curve and Fagan’s Nomogram methodology. Methods: This was a case-control, multicenter study in 11 anti-tuberculosis centers in Tunisia, during the period from June to November2014. The cases were adults aged between 18 and 55 years with confirmed tuberculosis. Controls were free from tuberculosis. A data collection sheet was filled out and a TST was performed for each participant. Diagnostic accuracy measures of TST were estimated using ROC curve and Area Under Curve to estimate sensitivity and specificity of a determined cut-off point. Fagan’s nomogram was used to estimate its predictive values. Results: Overall, 1053 patients were enrolled, composed of 339 cases (sex-ratio (M/F)=0.87) and 714 controls (sex-ratio (M/F)=0.99). The mean age was 38.3±11.8 years for cases and 33.6±11 years for controls. The mean diameter of the TST induration was significantly higher among cases than controls (13.7mm vs.6.2mm;p=10-6). Area Under Curve was 0.789 [95% CI: 0.758-0.819; p=0.01], corresponding to a moderate discriminating power for this test. The most discriminative cut-off value of the TST, which were associated with the best sensitivity (73.7%) and specificity (76.6%) couple was about 11 mm with a Youden index of 0.503. Positive and Negative predictive values were 3.11% and 99.52%, respectively. Conclusion: In view of these results, we can conclude that the TST can be used for tuberculosis diagnosis with a good sensitivity and specificity. However, the skin induration measurement and its interpretation is operator dependent and remains difficult and subjective. The combination of the TST with another test such as the Quantiferon test would be a good alternative.

Keywords: tuberculosis, tuberculin skin test, ROC curve, cut-off

Procedia PDF Downloads 52

Authors: Mi-Hyang Lee, Seung-Hoon Han

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Korean traditional residences have been built with deep design issues for various values such as social, cultural, and environmental influences to be started from a few thousand years ago, but its meaning is being vanished due to the different lifestyles these days. It is necessary, therefore, to grasp the meaning of the Korea traditional building called Hanok and to get Korean people understand its real advantages. The purpose of this study is to propose a standardization methodology for evaluating comfort features towards Korean traditional houses. This paper is also trying to build an official standard evaluation system and to integrate aesthetic and psychological values induced from Hanok. Its comfort performance values could be divided into two large categories that are physical and psychological, and fourteen methods have been defined as the Korean Standards (KS). For this research, field survey data from representative Hanok types were collected for each method. This study also contains a qualitative in-depth analysis of the Hanok comfort index by the professions using AHP (Analytical Hierarchy Process) and has examined the effect of the methods. As a result, this paper could define what methods can provide trustful outcomes and how to evaluate the own strengths in aspects of spatial comfort of Hanok using suggested procedures towards the spatial configuration of the traditional dwellings. This study has finally proposed an integrated development of a standardization methodology assessing the comfort performance for Korean traditional residences, and it is expected that they could evaluate inhabitants of the residents and interior environmental conditions especially structured by wood materials like Hanok.

Keywords: Hanok, comfort performance, human condition, analytical hierarchy process

Procedia PDF Downloads 139

Authors: Sandeep Thakur, Ismail Mondal, Phani Bhusan Ghosh, Papita Das, Tarun Kumar De

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Sundarbans Reserve forest of India has been undergoing major transformations in the recent past owing to population pressure and related changes. This has brought about major changes in the spatial landscape of the region especially in the western parts. This study attempts to assess the impacts of the Landcover changes on the mangrove habitats. Time series imageries of Landsat were used to analyze the Normalized Differential Vegetation Index (NDVI) patterns over the western parts of Indian Sundarbans forest in order to assess the heath of the mangroves in the region. The images were subjected to Land use Land cover (LULC) classification using sub-pixel classification techniques in ERDAS Imagine software and the changes were mapped. The spatial proliferation of aquaculture farms during the study period was also mapped. A multivariate regression analysis was carried out between the obtained NDVI values and the LULC classes. Similarly, the observed meteorological data sets (time series rainfall and minimum and maximum temperature) were also statistically correlated for regression. The study demonstrated the application of NDVI in assessing the environmental status of mangroves as the relationship between the changes in the environmental variables and the remote sensing based indices felicitate an efficient evaluation of environmental variables, which can be used in the coastal zone monitoring and development processes.

Keywords: aquaculture farms, LULC, Mangrove, NDVI

Procedia PDF Downloads 163

Authors: Mohammed-Hareef Asunramu, Sana Hashemi, Raja Ohri, Luc Worthington, Nadia Zaman, Junkai Zhu

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Background: The 2012 Health and Social Care Act committed to a ‘parity of esteem between mental and physical health services. Although this investment, aimed to both increase the quality of services and ensure the retention of mental health staff, questions remained regarding its ability to prevent mental health problems. One possible solution is a focus on the social determinants of health which have been shown to impact mental health. Aim: To examine the relationship between the index of multiple deprivations (IMD) and the prevalence of common mental health disorders (CMD) for CCGs in NHS England between 2019 and 2020. Design and setting: Cross-sectional analysis of 189 CCGs in NHS England. Methods: A multivariate linear regression model was utilized with CMD as outcome variable and IMD, age and ethnicity as explanatory variables. Datasets were obtained from Public Health England and the latest UK Census. Results: CCG IMD was found to have a significantly positive relationship with CMD. For every 1-point increase in IMD, CMD increases by 0.25%. Ethnicity had a significantly positive relationship with CMD. For every 1% increase in the population that identifies as BME, there is a 0.03% increase in CMD. Age had a significantly negative relationship with CMD. For every 1% increase in the population aged 60+, there is a 0.11% decrease in CMD. Conclusion: This study demonstrates that addressing mental health issues may require a multi-pronged approach. Beyond budget increases, it is essential to prioritize health equity, with careful considerations towards ethnic minorities and different age brackets.

Keywords: deprivation, health inequality, mental health, social determinants

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Authors: Rabeab Khunpukdee, Aranya Sukchoui, Nonluk Somgit, Chitima Bunnaul

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Endotracheal displacement is a major risk of life threatening among critically ill patients. Standard nursing protocol is needed to minimize this risk and to improve clinical outcomes. To evaluate the effectiveness of the endothacheal care nursing guideline. The incidence rates of endochacheal displacement, oxygen deficiency after extubation, re-intubation, and nurse’s satisfaction on the utilization of the endotracheal care nursing guideline. An evidence-based nursing practice framework was used to develop the endotracheal care nursing guideline. The guideline valid content was review by a 3 panel of experts. The index of item objective (IOC) of the guideline was 0.93. The guideline was implemented in 130 patients (guideline group) and 19 registered nurses at a medicine ward, Had Yai hospital, Thailand. Patient’s outcomes were evaluated by comparison with those 155 patients who received the routine nursing care (routine care group). Descriptive statistics, frequency, percentage, mean, standard deviation and Mann Whitney U-test was analyzed using the computer program. All significantly and better outcomes were found in the guideline group compared to the routine care group. The guideline group has less incidence rates of endotracheal displacement (1.54 % vs 9.03 %, p < 0.05), and none of the guideline group had oxygen deficiency after extubation (0 % vs 83.33%) compared to the routine care group. All of the 2 patients in the guideline group, compared to 6 of 14 patients in the routine care group were re-intubation. The overall rate of re-intubation in the total group (n = 130 vs 155) was seen less in the guideline group than the routine care group (1.54 % vs 3.87). Overall, nurses satisfaction was at high-level (89.50%) on the utilization of the guideline.

Keywords: endotracheal care, nursing guideline, re-intubation, satisfaction

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Authors: Era Dorihi Kale, Sabina Gero, Uly Agustine

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Asylum seekers are people who come to other countries to get asylum. In line with that, they also carry the culture and health behavior of their country, which is very different from the new country they currently live in. This situation raises problems, also in the health sector. The approach taken must also be a culturally sensitive approach, where the culture and habits of the refugee's home area are also valued so that the health services provided can be right on target. Some risk factors that already exist in this group are lack of activity, consumption of fast food, smoking, and stress levels that are quite high. Overall this condition will increase the risk of an increased incidence of cardiovascular disease. This research is a descriptive and experimental study. The purpose of this study is to identify health status and develop a culturally sensitive health promotion model, especially related to the risk of cardiovascular disease for asylum seekers in detention homes in the city of Kupang. This research was carried out in 3 stages, stage 1 was conducting a survey of health problems and the risk of asylum seeker cardiovascular disease, Stage 2 developed a health promotion model, and stage 3 conducted a testing model of health promotion carried out. There were 81 respondents involved in this study. The variables measured were: health status, risk of cardiovascular disease and, health promotion models. Method of data collection: Instruments (questionnaires) were distributed to respondents answered for anamnese health status; then, cardiovascular risk measurements were taken. After that, the preparation of information needs and the compilation of booklets on the prevention of cardiovascular disease is carried out. The compiled booklet was then translated into Farsi. After that, the booklet was tested. Respondent characteristics: average lived in Indonesia for 4.38 years, the majority were male (90.1%), and most were aged 15-34 years (90.1%). There are several diseases that are often suffered by asylum seekers, namely: gastritis, headaches, diarrhea, acute respiratory infections, skin allergies, sore throat, cough, and depression. The level of risk for asylum seekers experiencing cardiovascular problems is 4 high risk people, 6 moderate risk people, and 71 low risk people. This condition needs special attention because the number of people at risk is quite high when compared to the age group of refugees. This is very related to the level of stress experienced by the refugees. The health promotion model that can be used is the transactional stress and coping model, using Persian (oral) and English for written information. It is recommended for health practitioners who care for refugees to always pay attention to aspects of culture (especially language) as well as the psychological condition of asylum seekers to make it easier to conduct health care and promotion. As well for further research, it is recommended to conduct research, especially relating to the effect of psychological stress on the risk of cardiovascular disease in asylum seekers.

Keywords: asylum seekers, health status, cardiovascular disease, health promotion

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Authors: Ella Abaev, Shany Segal, Miri Gabay

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Background: Choking is a blockage of airways that prevents efficient breathing and air flow to the lungs. Choking may be partial or full and is an emergency situation. Complete or prolonged choking leads to apnea, lack of oxygen in the tissues of the body and brain, and can cause death. There are three mechanisms of choking: obstruction of internal respiratory tracts by food or object aspiration, any material that blocks or covers external air passages, external pressure on the neck or trapping between objects. Children's airways are narrower than that of adults and therefore the risk of choking is greater, due to the aspiration of food and other foreign bodies into the lungs. In the Child Development Center at Safra Children’s Hospital, Tel Hashomer in Israel are treated infants, toddlers, and children aged 0-18 years with various developmental disabilities. Due to the increase in reports of ‘almost an event’ of choking in the past year and the serious consequences of choking event, it was decided to give an emphasis to the issue. Incidence and methods: The number of reports of ‘almost an event’ or a choking event was examined at the center during the years 2013-2018 and a thorough research work was conducted on the subject in order to build a prevention program. Findings: Between 2013 and 2018 the center reported about ten cases of ‘almost choking events’. In the middle of 2018 alone three cases of ‘almost an event’ were reported. Objective: Providing knowledge leads to awareness raise, change of perception, change in behavior and prevention. The center employs more than 130 staff members from various sectors so that it is the work of multi-professional teams to promote the quality and safety of the treatment. The familiarity of the staff with risk factors, prevention guidelines, identification of choking signs, and treatment are most important and significant in determining the outcome of a choking event. Conclusions and recommendations: After in-depth research work was carried out in cooperation with the Risk Management Unit on the subject of choking, which include a description of the definitions, mechanisms, risk factors, treatment methods and extensive recommendations for prevention (e.g. using treatment and stimulation accessories with standards association stamps and adjustment of the type of food and the way it is served to match to the child's age and the ability to swallow). The expected stages of development and emphasis on the population of children with special needs were taken into account. The research findings will be published by the staff and parents of the patients, professional publications, and lectures and there is an expectation to decrease the number of choking events in the next years.

Keywords: children with special needs, choking, educational system, prevention guidelines

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Authors: Junhang Luo

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With the transformation of spatial structure and the deepening of urban development, the demand for a better life and the concerns for social resources equities of residents are increasing. As an important social resource, park plays an essential role in building environmentally sustainable cities. Thus, it is important to examine park accessibility for low-income and how it works in relative deprivation, so as to provide all residents with equitable services. Using the network and buffer methods of GIS, this paper analyzes urban park accessibility for low-income residents in Chongqing, China. And then conduct a satisfaction evaluation of park resource accessibility with low-incomes through questionnaire surveys from deprivation dimensions. Results show that the level of park accessibility in Chongqing varies significantly and the degree of relative deprivation is relatively high. Public transportation convenience improves and the number of community park increases contribute positively to improving park accessibility and alleviating the relative deprivation of public resources. Combined with the innovation pattern of social governance in China, it suggests that urban park accessibility needs to be jointly governed and optimized by multiple social resources from the government to the public, and the service efficiency needs the index system and planning standards according to local conditions to improve quality and promote equity. At the same time, building a perfect park system and complete legislation assurance system will also play a positive role in ensuring that all residents can enjoy the urban public space more fairly, especially low-income groups.

Keywords: urban park, accessibility, relative deprivation, GIS network analysis, chongqing

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Authors: Mahjabeen Akbar

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Dental aesthetics and its associated psychosocial influence have a significant impact on individuals. Correcting malocclusions is a key motivating factor for majority patients; however, psychosocial factors have been rarely incorporated in evaluating malocclusions. Therefore, it is necessary to study the psychosocial influence of malocclusion in patients. The study aimed to determine the psychosocial influence of dental aesthetics in dental students by the ‘Psychosocial Impact of Dental Aesthetics Questionnaire’ and self-rated Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN). This was a quantitative study using a cross-sectional study design. One hundred twenty dental students (71 females and 49 males; mean age 24.5) were selected via purposive sampling from July to August 2019. Dental students with no former orthodontic treatment were requested to fill out the ‘Psychosocial Impact of Dental Aesthetics Questionnaire.’ Variables including; self-confidence/insecurity, social influence, psychological influence and self-perception of the need of an orthodontic treatment were evaluated by a sequence of statements, while dental aesthetics were evaluated by using the IOTN Aesthetic Component. To determine the significance, the Kruskal-Wallis test was utilized. The results show that all four variables measuring psychosocial impact indicated significant correlations with the perceived malocclusions with a p-value of less than 0.01. The results conclude there is a strong psychological and social influence of altered dental aesthetics on an individual. Moreover, the relationship between the IOTN-AC grading with the psychosocial wellbeing of an individual stands proven, indicating that the perception of altered dental aesthetics is as important as a factor in treatment need as the amount of malocclusion.

Keywords: dental aesthetics, malocclusion, psychosocial influence, dental students

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Authors: Amina Aquil, Abdeljalil El Got

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Background: Sleep quality is one of the most important indicators related to the quality of life of patients suffering from cancer. Many factors could affect this quality of sleep and then be considered as associated predictors. Methods: The aim of this study was to assess the prevalence of sleep disorders and the associated factors with impaired sleep quality in Moroccan women with gynecological cancer. A cross-sectional study was carried out within the oncology department of the Ibn Rochd University Hospital, Casablanca, on Moroccan women who had undergone radical surgery for gynecological cancer (n=100). Translated and validated Arabic versions of the following international scales were used: Pittsburgh sleep quality index (PSQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg's self-esteem scale (RSES), and Body image scale (BIS). Results: 78% of participants were considered poor sleepers. Most of the patients exhibited very poor subjective quality, low sleep latency, a short period of sleep, and a low rate of usual sleep efficiency. The vast majority of these patients were in poor shape during the day and did not use sleep medication. Waking up in the middle of the night or early in the morning and getting up to use the bathroom were the main reasons for poor sleep quality. PSQI scores were positively correlated with anxiety, depression, body image dissatisfaction, and lower self-esteem (p < 0.001). Conclusion: Sleep quality and its predictors require a systematic evaluation and adequate management to prevent sleep disturbances and mental distress as well as to improve the quality of life of these patients.

Keywords: body image, gynecological cancer, self esteem, sleep quality

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Authors: Abdelmounaim Lahrech, Hajar Bousfiha

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This paper examines equity market integration between Morocco and France and its consequent implications on international portfolio diversification. In the absence of stock market linkages, Morocco can act as a diversification destination to European investors, allowing higher returns at a comparable level of risk in developed markets. In contrast, this attractiveness is limited if both financial markets show significant linkage. The research empirically measures financial market’s integration in by capturing the conditional correlation between the two markets using the Generalized Autoregressive Conditionally Heteroscedastic (GARCH) model. Then, the research uses the Dynamic Conditional Correlation (DCC) model of Engle (2002) to track the correlations. The research findings show that there is no important increase over the years in the correlation between the Moroccan and the French equity markets, even though France is considered Morocco’s first trading partner. Failing to prove evidence of the stock index linkage between the two countries, the volatility series of each market were assumed to change over time separately. Yet, the study reveals that despite the important historical and economic linkages between Morocco and France, there is no evidence that equity markets follow. The small correlations and their stationarity over time show that over the 10 years studied, correlations were fluctuating around a stable mean with no significant change at their level. Different explanations can be attributed to the absence of market linkage between the two equity markets.

Keywords: equity market linkage, DCC GARCH, international portfolio diversification, Morocco, France

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Authors: Mohammad Zainie Bin Hassan

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Background: Erectile dysfunction (ED) is a complication commonly seen among men with diabetes which can be assessed based upon International Index of Erectile Function (IIEF-5) questionnaire. Creatinine level is a blood test that indicates kidney functionality. Object: To evaluate the association between ED, determined by the IIEF-5scores and Creatinine level in diabetic men attending Temerloh Health Clinic, Pahang, Malaysia.Hence, to identify raising Creatinine level related with ED or not. Methods: All married diabetic patients will be investigated face to face after consented for answering the IIEF-5 questionnaire. Creatinine level will be taken by using standard method.Patients with no sexual partner, refuse to answer the questionnaire, cancer, stroke, heart disease and language barrier will be excluded.Data obtained from IIEF-5 score and Creatinine level will be analyzed by using Pearson correlation. All statistical value determined by p=0.05. ED will be categorized accordingly to IIEF-5 scores: no ED (22-25), mild (17-21), moderate (12-16), severe (8-11) and very severe (1-7). Results: A total of 450 patients were investigated with 385 patients were included (85.6% respondant rate) and 65 patients were excluded in this study with age range from 29 to 85 years old. 7% had no ED, 28% mild ED, 34% moderate ED, 16% severe ED and 15% had very severe ED. There was a significant negative correlation between Creatinine level and IIEF-5 scores (r=-0.218, p <0.001). This result implicated that poor kidney function which indicated by high Creatinine level associated significantly with erectile dysfunction. 93% had ED with a different range of severity which triggers for appropriate aggressive ED management among diabetics. Conclusion: The high level of Creatinine is associated with erectile dysfunction among diabetics in Temerloh Health Clinic.

Keywords: correlation, creatinine level, erectile dysfunction, ED, diabetes

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Authors: Odejayi Adedayo Olugbenga, Aina Adebisi

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Weather variables (rainfall and temperature) affect the diversity and abundance of both fauna and flora species. This study compared the weather variables with spider abundance in two ecological zones of Ogun State, Nigeria namely Ago-iwoye (Rainforest) in the Ijebu axis and Aiyetoro (Derived Savannah) in the Yewa axis. Seven study sites chosen by Simple Random Sampling in each ecosystem were used for the study. In each sampling area, a 60 m x 120 m land area was marked and sampled, spider collection techniques were; hand picking, use of sweep netting, and Pitfall trap. Adult spiders were identified to the species level. Species richness was estimated by a non-parametric species estimator while the diversity of spider species was assessed by Simpson Diversity Index and Species Richness by One-way Analysis of Variance. Results revealed that spiders were more abundant in rainforest zones than in derived savannah ecosystems. However, the pattern of spider abundance in rainforest zone and residential areas were similar. During high temperatures, the activities of spiders tended to increase according to this study. In contrast, results showed that there was a negative correlation between rainfall and spider species abundance in addition to a negative and weak correlation between rainfall and species richness. It was concluded that heavy downpour has lethal effects on both immature and sometimes matured spiders, which could lead to the extinction of some unknown species of spiders. Tree planting should be encouraged, as this shelters the spider.

Keywords: spider, abundance, species richness, species diversity

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Authors: Nuha Alamro

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Besides achieving of weight loss, Bariatric surgery (BS) shown metabolic improvement including reduction of cardiovascular disease, insulin resistance and diabetes. This study aimed to measure BS effects on Framingham Risk Score (FRS) and metabolic syndrome (MetS) among patients who underwent BS. Additionally, to determine the effect of BS on TSH among euthyroid obese patients. A Retrospective follow-up study was conducted in King Abdullah Medical City. A total of 160 participants who underwent BS and completed one year of follow ups. Medical history, biochemical, anthropometric, and hormonal parameters were evaluated at baseline and 3-12 months after BS. International Diabetes Federation (IDF) criteria were used to diagnose MetS pre and postoperative. The mean age of participants was 41.9 ± 10.6 with Body Mass Index (BMI) of 48.8 ± 7.3. After 3 months, Systolic, Diastolic blood pressure (SBP, DBP), glycated haemoglobin (HBA1C), Low-density lipoprotein (LDL), cholesterol, triglycerides and Thyroid stimulating hormone (TSH) were significantly decrease (P < 0.001). Significant decrease was seen in Mets, BMI, FRS, SBP, DBP, HBA1C, LDL, triglycerides, cholesterol, liver enzyme, with significant increase in high-density lipoprotein (HDL) level 12 months post-op (P < 0.001). After 1 year, the prevalence of MetS, DM, HTN, FRS were significantly decrease from 72.5%, 43.1%, 78.1%, 11.4 to 16.3%, 9.4%, 22.5% and 5.4, respectively. Besides achieving substantial weight loss, MetS resolution was linked to improvement in cardiovascular risk profile.

Keywords: bariatric surgery, cardiovascular disease, metabolic syndrome, thyroid stimulating hormone

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Authors: Kawthar F. Albasri, Abdullah M. AlHudaithi, Dana B. AlTurairi, Abdullaziz S. AlQuraini, Adoub Y. AlDerazi, Reem A. Hubail, Haitham A. Jahrami

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Several studies have found that medical students have a significant prevalence of anxiety. The purpose of this review paper is to carefully evaluate the current research on anxiety among medical students in the MENA region and, as a result, estimate the prevalence of these disturbances. Multiple databases, including the CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, Embase, MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, PsycINFO (Psychological Information Database), Scopus, Web of Science, UpToDate, ClinicalTrials.gov, WHO Global Health Library, EbscoHost, ProQuest, JAMA Network, and ScienceDirect, were searched. The retrieved article reference lists were rigorously searched and rated for quality. A random effects meta-analysis was performed to compute estimates. The current meta-analysis revealed an alarming estimated pooled prevalence of anxiety (K = 46, N = 27023) of 52.5% [95%CI: 43.3%–61.6%]. A total of 62.0% [95% CI 42.9%; 78.0%] of the students (K = 18, N = 16466) suffered from anxiety during the COVID-19 pandemic, while 52.5% [95% CI 43.3%; 61.6%] had anxiety before COVID-19. Based on the GAD-7 measure, a total of 55.7% [95%CI 30.5%; 78.3%] of the students (K = 10, N = 5830) had anxiety, and a total of 54.7% of the students (K = 18, N = 12154) [95%CI 42.8%; 66.0%] had anxiety using the DASS-21 or 42 measure. Anxiety is a common issue among medical students, making it a genuine problem. Further research should be conducted post-COVD 19, with a focus on anxiety prevention and intervention initiatives for medical students.

Keywords: anxiety, medical students, MENA, meta-analysis, prevalence

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