Search results for: medical nutrition therapy

Authors: Itee Chowdhury, Shikha Modi

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Introduction: Cancer is beginning to outpace cardiovascular disease as a cause of death affecting every major organ system with profound implications for perioperative management. Breast cancer is the most common cancer in women in India, accounting for 27% of all cancers. The small changes in analgesic management of cancer patients can greatly improve prognosis and reduce the risk of postsurgical cancer recurrence as opioid-based analgesia has a deleterious effect on cancer outcomes. Shortened postsurgical recovery time facilitates earlier return to intended oncological therapy maximising the chance of successful treatment. Literature reveals that the role of BIS since FDA approval has been assessed in various types of surgeries, but clinical data on its use in oncosurgical patients are scanty. Our study focuses on the role of BIS-guided anaesthesia for breast cancer surgery patients. Methods: A prospective randomized controlled study in patients aged 36-55years scheduled for modified radical mastectomy was conducted in 51 patients in each group who met the inclusion and exclusion criteria, and randomization was done by sealed envelope technique. In BIS guided anaesthesia group (B), sevoflurane was titrated to keep the BIS value 45-60, and thereafter if the patient showed hypertension/tachycardia, an opioid was given. In standard anaesthesia care (group C), sevoflurane was titrated to keep MAC in the range of 0.8-1, and fentanyl was given if the patient showed hypertension/tachycardia. Intraoperative opioid consumption was calculated. Postsurgery recovery characteristics, including Aldrete score, were assessed. Patients were questioned for pain, PONV, and recall of the intraoperative event. A comparison of age, BMI, ASA, recovery characteristics, opioid, and VAS score was made using the non-parametric Mann-Whitney U test. Categorical data like intraoperative awareness of surgery and PONV was studied using the Chi-square test. A comparison of heart rate and MAP was made by an independent sample t-test. #ggplot2 package was used to show the trend of the BIS index for all intraoperative time points for each patient. For a statistical test of significance, the cut-off p-value was set as <0.05. Conclusions: BIS monitoring led to reduced opioid consumption and early recovery from anaesthesia in breast cancer patients undergoing MRM resulting in less postoperative nausea and vomiting and less pain intensity in the immediate postoperative period without any recall of the intraoperative event. Thus, the use of a Bispectral index monitor allows for tailoring of anaesthesia administration with a good outcome.

Keywords: bispectral index, depth of anaesthesia, recovery, opioid consumption

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Authors: Maria Lucia G. Lourenco, Keylla H. N. P. Pereira, Vivane Y. Hibaru, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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Neonatal sepsis is a systemic response to the acute generalized infection caused by one or more bacterial agents, representing the main infectious cause of neonatal mortality in dogs during the first three weeks of life. This study aims to describe the incidence of sepsis in neonate dogs, as well as the main clinical signs and mortality rates. The study included 735 neonates admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, between January 2018 and November 2019. Seven hundred thirty-five neonates, 14% (98/703) presented neonatal sepsis. The main sources of infection for the neonates were intrauterine (72.5%, 71/98), lactogenic (13.2%, 13/98), umbilical (5.1%, 5/98) and unidentified sources (9.2%, 9/98). The main non-specific clinical signs observed in the newborns were weakness, depression, impaired or absent reflexes, hypothermia, hypoglycemia, dehydration, reduced muscle tonus and diarrhea. The newborns also manifested clinical signs of severe infection, such as hyperemia in the abdominal and anal regions, omphalitis, hematuria, abdomen and extremities with purplish-blue coloration necrosing injuries in the pads, bradycardia, dyspnea, epistaxis, hypotension and evolution to septic shock. Infections acquired during intrauterine life led to the onset of the clinical signs at the time of birth, with fast evolution during the first hours of life. On the other hand, infections acquired via milk or umbilical cord presented clinical signs later. The total mortality rate was 5.4% (38/703) and the mortality rate among the neonates with sepsis was 38.7% (38/98). The early mortality rate (0 to 2 days) accounted for 86.9% (33/38) and the late mortality rate (3 to 30 days) for 13.1% (5/38) of the deaths among the newborns with sepsis. The main bacterial agents observed were Staphylococcus spp., Streptococcus spp., Proteus spp. Mannheimia spp. and Escherichia coli. Neonatal sepsis evolves quickly and may lead to high mortality in a litter. The prognosis is usually favorable if the diagnosis is reached early and the antibiotic therapy instituted as soon as possible, even before the results of blood cultures and antibiograms. The therapeutic recommendations should meet the special physiological conditions of a neonate in terms of metabolism and excretion of medication. Therefore, it is of utmost importance that the veterinarian is knowledgeable regarding neonatology to provide effective intervention and improve the survival rates of these patients.

Keywords: Neonatal infection , bacteria, puppies, newborn

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Authors: Sudhir Kumar, V. R. Sinha

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Background: The topical and systemic toxicity associated with present nonmelanoma skin cancer (NMSC) treatment therapy using 5-Fluorouracil (5-FU) make it necessary to develop a novel delivery system having lesser toxicity and better control over drug release. Solid lipid nanoparticles offer many advantages like: controlled and localized release of entrapped actives, nontoxicity, and better tolerance. Aim:-To investigate safety and efficacy of 5-FU loaded solid lipid nanoparticles as a topical delivery system for the treatment of nonmelanoma skin cancer. Method: Topical solid lipid nanoparticles of 5-FU were prepared using Compritol 888 ATO (Glyceryl behenate) as lipid component and pluronic F68 (Poloxamer 188), Tween 80 (Polysorbate 80), Tyloxapol (4-(1,1,3,3-Tetramethylbutyl) phenol polymer with formaldehyde and oxirane) as surfactants. The SLNs were prepared with emulsification method. Different formulation parameters viz. type and ratio of surfactant, ratio of lipid and ratio of surfactant:lipid were investigated on particle size and drug entrapment efficiency. Results: Characterization of SLNs like–Transmission Electron Microscopy (TEM), Differential Scannig calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), Particle size determination, Polydispersity index, Entrapment efficiency, Drug loading, ex vivo skin permeation and skin retention studies, skin irritation and histopathology studies were performed. TEM results showed that shape of SLNs was spherical with size range 200-500nm. Higher encapsulation efficiency was obtained for batches having higher concentration of surfactant and lipid. It was found maximum 64.3% for SLN-6 batch with size of 400.1±9.22 nm and PDI 0.221±0.031. Optimized SLN batches and marketed 5-FU cream were compared for flux across rat skin and skin drug retention. The lesser flux and higher skin retention was obtained for SLN formulation in comparison to topical 5-FU cream, which ensures less systemic toxicity and better control of drug release across skin. Chronic skin irritation studies lacks serious erythema or inflammation and histopathology studies showed no significant change in physiology of epidermal layers of rat skin. So, these studies suggest that the optimized SLN formulation is efficient then marketed cream and safer for long term NMSC treatment regimens. Conclusion: Topical and systemic toxicity associated with long-term use of 5-FU, in the treatment of NMSC, can be minimized with its controlled release with significant drug retention with minimal flux across skin. The study may provide a better alternate for effective NMSC treatment.

Keywords: 5-FU, topical formulation, solid lipid nanoparticles, non melanoma skin cancer

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Authors: Shivayogi Charantimath

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Radiotherapy and chemotherapy are effective for treating malignancies but are associated with side effects like oral mucositis. Chlorhexidine gluconate is one of the most commonly used mouthwash in prevention of signs and symptoms of mucositis. Evidence shows that chlorhexidine gluconate has side effects in terms of colonization of bacteria, bad breadth and less healing properties. Thus, it is essential to find a suitable alternative therapy which is more effective with minimal side effects. Curcumin, an extract of turmeric is gradually being studied for its wide-ranging therapeutic properties such as antioxidant, analgesic, anti-inflammatory, antitumor, antimicrobial, antiseptic, chemo sensitizing and radio sensitizing properties. The present study was conducted to evaluate the efficacy and safety of topical curcumin gel on radio-chemotherapy induced oral mucositis in cancer patients. The aim of the study is to evaluate the efficacy and safety of curcumin gel in the management of oral mucositis in cancer patients undergoing radio chemotherapy and compare with chlorhexidine. The study was conducted in K.L.E. Society’s Belgaum cancer hospital. 40 oral cancer patients undergoing the radiochemotheraphy with oral mucositis was selected and randomly divided into two groups of 20 each. The study group A [20 patients] was advised Cure next gel for 2 weeks. The control group B [20 patients] was advised chlorhexidine gel for 2 weeks. The NRS, Oral Mucositis Assessment scale and WHO mucositis scale were used to determine the grading. The results obtained were calculated by using SPSS 20 software. The comparison of grading was done by applying Mann-Whitney U test and intergroup comparison was calculated by Wilcoxon matched pairs test. The NRS scores observed from baseline to 1^st and 2^nd week follow up in both the group showed significant difference. The percentage of change in erythema in respect to group A was 63.3% for first week and for second week, changes were 100.0% with p = 0.0003. The changes in Group A in respect to erythema was 34.6% for 1^st week and 57.7% in second week. The intergroup comparison was significant with p value of 0.0048 and 0.0006 in relation to group A and group B respectively. The size of the ulcer score was measured which showed 35.5% [P=0.0010] of change in Group A for 1^st and 2^nd week showed totally reduction i.e. 103.4% [P=0.0001]. Group B showed 24.7% change from baseline to 1^st week and 53.6% for 2^nd week follow up. The intergroup comparison with Wilcoxon matched pair test was significant with p=0.0001 in group A. The result obtained by WHO mucositis score in respect to group A shows 29.6% [p=0.0004] change in first week and 75.0% [p=0.0180] change in second week which is highly significant in comparison to group B. Group B showed minimum changes i.e. 20.1% in 1^st week and 33.3% in 2^nd week. The p value with Wilcoxon was significant with 0.0025 in Group A for 1^st week follow up and 0.000 for 2^nd week follow up. Curcumin gel appears to an effective and safer alternative to chlorhexidine gel in treatment of oral mucositis.

Keywords: curcumin, chemotheraphy, mucositis, radiotheraphy

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Authors: Geovana Soncin, Larissa Berti

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Some aspects of prosody acquisition remain still unclear, especially regarding atypical speech development processes. This work deals with prosody acquisition and its implications for clinical purposes. Therefore, we analyze speech samples produced by adult speakers, children in typical language development, and children with phonological disorders. Phonological disorder comprises deviating manifestations characterized by inconsistencies in the phonological representation of a linguistic system under acquisition. The clinical assessment is performed mostly based on contrasts whose manifestations occur in the segmental level of a phonological system. Prosodic organization of spoken utterances is not included in the standard assessment. However, assuming that prosody is part of the phonological system, it was hypothesized that children with Phonological Disorders could present inconsistencies that also occur at a prosodic level. Based on this hypothesis, the paper aims to analyze contrastive focus marking in the speech of children with Phonological Disorders in comparison with the speech of children under Typical Language Development and adults. The participants of all groups were native speakers of Brazilian Portuguese. The investigation was designed in such a way as to identify differences and similarities among the groups that could be interpreted as clues of normal or deviant processes of prosody acquisition. Contrastive focus in Brazilian Portuguese is marked by increasing duration, f0, and intensity on the focused element as well as by a particular type of pitch accent (L*+H). Thirty-nine subjects participated, thirteen from each group. Acoustic analysis was performed, considering duration, intensity, and intonation as parameters. Children with PD were recruited in sessions from a service provided by Speech-Language Pathology Therapy; children in TD, paired in age and sex with the first group, were recruited in a regular school; and 20-24 years old adults were recruited from a University class. In a game prepared to elicit focused sentences, all of them produced the sentence “Girls love red dress,” marking focus on different syntactic positions: subject, verb, and object. Results showed that adults, children in typical language development, and children with Phonological Disorders marked contrastive focus differently: typical children used all parameters like adults do; however, in comparison with them, they exaggerated duration and, in the opposite direction, they did not increase f0 in a sufficient magnitude as adults; children with Phonological Disorder presented inconsistencies in duration, not increasing it in some syntactic positions, and also in intonation, not producing the representative pitch accent of contrastive focus. The results suggest prosody is also affected by phonological disorder and give clues of developmental processes of prosody acquisition.

Keywords: Brazilian Portuguese, contrastive focus, phonological disorder, prosody acquisition

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Authors: N. H. Alias, S. A. Aziz, Y. Abdullah, H. M. Kamari, S. Sani, M. P. Ismail, N. U. Saidin, N. A. A. Salim, N. E. E. Abdullah

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Gamma (γ) irradiation study has been investigated on the 6 rectangular shape of the standard X-Ray lead glass with 5/16” thick, providing 2.00 mm lead shielding value; at selected Sievert doses (C1; 0, C2; 0.07, C3; 0.035, C4; 0.07, C5; 0.105 and C6; 0.14) by using (XRD) X-ray Diffraction techniques, ultrasonic and (UV-VIS) Ultraviolet-Visible Spectroscopy. Concentration of lead in 0.5 N acid nitric (HNO3) environments is then studied by means of Atomic Absorption Spectroscopy (AAS) as to observe the glass corrosion behavior after irradiation at room temperature. This type of commercial glass is commonly used as radiation shielding glass in medical application.

Keywords: gamma irradiation, lead glass, leaching, structural

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Authors: S. Ben Fredj, H. Ghali, M. Ben Rejeb, S. Layouni, S. Khefacha, L. Dhidah, H. Said

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Background: The Intensive Care Unit (ICU) provides continuous care and uses a high level of treatment technologies. Although developed country hospitals allocate only 5–10% of beds in critical care areas, approximately 20% of nosocomial infections (NI) occur among patients treated in ICUs. Whereas in the developing countries the situation is still less accurate. The aim of our study is to assess mortality rates in ICUs and to determine its predictive factors. Methods: We carried out a nested case-control study in a 630-beds public tertiary care hospital in Eastern Tunisia. We included in the study all patients hospitalized for more than two days in the surgical or medical ICU during the entire period of the surveillance. Cases were patients who died before ICU discharge, whereas controls were patients who survived to discharge. NIs were diagnosed according to the definitions of ‘Comité Technique des Infections Nosocomiales et les Infections Liées aux Soins’ (CTINLIS, France). Data collection was based on the protocol of Rea-RAISIN 2009 of the National Institute for Health Watch (InVS, France). Results: Overall, 301 patients were enrolled from medical and surgical ICUs. The mean age was 44.8 ± 21.3 years. The crude ICU mortality rate was 20.6% (62/301). It was 35.8% for patients who acquired at least one NI during their stay in ICU and 16.2% for those without any NI, yielding an overall crude excess mortality rate of 19.6% (OR= 2.9, 95% CI, 1.6 to 5.3). The population-attributable fraction due to ICU-NI in patients who died before ICU discharge was 23.46% (95% CI, 13.43%–29.04%). Overall, 62 case-patients were compared to 239 control patients for the final analysis. Case patients and control patients differed by age (p=0,003), simplified acute physiology score II (p < 10-3), NI (p < 10-3), nosocomial pneumonia (p=0.008), infection upon admission (p=0.002), immunosuppression (p=0.006), days of intubation (p < 10-3), tracheostomy (p=0.004), days with urinary catheterization (p < 10-3), days with CVC ( p=0.03), and length of stay in ICU (p=0.003). Multivariate analysis demonstrated 3 factors: age older than 65 years (OR, 5.78 [95% CI, 2.03-16.05] p=0.001), duration of intubation 1-10 days (OR, 6.82 [95% CI, [1.90-24.45] p=0.003), duration of intubation > 10 days (OR, 11.11 [95% CI, [2.85-43.28] p=0.001), duration of CVC 1-7 days (OR, 6.85[95% CI, [1.71-27.45] p=0.007) and duration of CVC > 7 days (OR, 5.55[95% CI, [1.70-18.04] p=0.004). Conclusion: While surveillance provides important baseline data, successful trials with more active intervention protocols, adopting multimodal approach for the prevention of nosocomial infection incited us to think about the feasibility of similar trial in our context. Therefore, the implementation of an efficient infection control strategy is a crucial step to improve the quality of care.

Keywords: intensive care unit, mortality, nosocomial infection, risk factors

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Authors: Gregor Moncrieff, Ursula Bahlmann

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A number of incident reports were filed from the intensive care unit with regards to adult patients admitted following operations who had a central venous catheter inserted of the incorrect length for the relevant anatomical site and catheters not compatible with pressurised injection inserted whilst in theatre. Incorrect catheter length can lead to a variety of complications and pressurised injection is a requirement for contrast enhanced computerised tomography scans. This led to several patients having a repeat procedure to insert a catheter of the correct length and also compatible with pressurised injection. This project aimed to identify the types of central venous catheters used in theatres and ensure the correct equipment would be stocked and used in future cases in accordance the existing Association of Anaesthetics of Great Britain and Northern Ireland guidelines. A questionnaire was sent out to all of the anaesthetic department in our hospital aiming to determine what types of central venous catheters were preferably used by anaesthetists and why these had been chosen. We also explored any concerns regarding introduction of standardised, pressure injectable central venous catheters to the theatre department which were already in use in other parts of the hospital and in keeping with national guidance. A total of 56 responses were collected. 64% of respondents routinely used a central venous catheter which was significantly shorter than the national recommended guidance with a further 4 different types of central venous catheters used which were different to other areas of the hospital and not pressure injectable. 75% of respondents were in agreement to standardised introduction of the pressure injectable catheters of the recommended length in accordance with national guidance. Reasons why 25% respondents were opposed to introduction of these catheters were explored and discussed. We were successfully able to introduce the standardised central catheters to the theatre department following presentation at the local anaesthetic quality and safety meeting. Reasons against introduction of the catheters were discussed and a compromise was reached that the existing catheters would continue to be stocked but would only be available on request, with a focus on encouraging use of the standardised catheters. Additional changes achieved included removing redundant catheters from the theatre stock. Ongoing data is being collected to analyse positive and negative feedback from use of the introduced catheters.

Keywords: central venous catheter, medical equipment, medical safety, quality improvement

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Authors: Gustavo Axel Elizalde-Velázquez

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Metformin is the first line of oral therapy to treat type II diabetes and is also employed as a treatment for other indications, such as polycystic ovary syndrome, cancer, and COVID-19. Recent data suggest it is the aspirin of the 21st century due to its antioxidant and anti-aging effects. However, increasingly current articles indicate its long-term consumption generates mitochondrial impairment. Up to date, it is known metformin increases the biogenesis of Alzheimer's amyloid peptides via up-regulating BACE1 transcription, but further information related to brain damage after its consumption is missing. Bearing in mind the above, this work aimed to establish whether or not chronic exposure to metformin may alter swimming behavior and induce neurotoxicity in Danio rerio adults. For this purpose, 250 Danio rerio grown-ups were assigned to six tanks of 50 L of capacity. Four of the six systems contained 50 fish, while the remaining two had 25 fish (≈1 male:1 female ratio). Every system with 50 fish was allocated one of the three metformin treatment concentrations (1, 20, and 40 μg/L), with one system as the control treatment. Systems with 25 fish, on the other hand, were used as positive controls for acetylcholinesterase (10 μg/L of Atrazine) and oxidative stress (3 μg/L of Atrazine). After four months of exposure, a mean of 32 fish (S.D. ± 2) per group of MET treatment survived, which were used for the evaluation of behavior with the Novel Tank test. Moreover, after the behavioral assessment, we aimed to collect the blood and brains of all fish from all treatment groups. For blood collection, fish were anesthetized with an MS-222 solution (150 mg/L), while for brain gathering, fish were euthanized using the hypothermic shock method (2–4 °C). Blood was employed to determine CASP3 activity and the percentage of apoptotic cells with the TUNEL assay, and brains were used to evaluate acetylcholinesterase activity, oxidative damage, and gene expression. After chronic exposure, MET-exposed fish exhibited less swimming activity when compared to control fish. Moreover, compared with the control group, MET significantly inhibited the activity of AChE and induced oxidative damage in the brain of fish. Concerning gene expression, MET significantly upregulated the expression of Nrf1, Nrf2, BAX, p53, BACE1, APP, PSEN1, and downregulated CASP3 and CASP9. Although MET did not overexpress the CASP3 gene, we saw a meaningful rise in the activity of this enzyme in the blood of fish exposed to MET compared to the control group, which we then confirmed by a high number of apoptotic cells in the TUNEL assay. To the best of our understanding, this is the first study that delivers evidence of oxidative impairment, apoptosis, AChE alteration, and overexpression of B- amyloid-related genes in the brain of fish exposed to metformin.

Keywords: AChE inhibition, CASP3 activity, NovelTank test, oxidative damage, TUNEL assay

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Authors: Satria B. Mahathma, Asri Hendrawati

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Background: Diabetes mellitus (DM) is a metabolic disorder syndrome characterized by chronic hyperglycemia. The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014. In general, almost 90% of the prevalence of DM is type 2 DM which marked by insulin resistance and decreased receptor sensitivity. Aside from conventional antidiabetic therapy, the utilization of medicinal plants as alternative medicine has beneficial effects in diabetic patients. Flavonoid contents in radish leaves such as quercetin, pelargonidin, and kaempferol are thought to have antidiabetic activity on decreasing blood glucose levels by tricyclic nucleotide modulation of pancreatic beta cells and ameliorating insulin resistance. This study aimed to determine the effect of variant concentration of radish leaves ethanol extract on blood glucose levels in diabetic rats. Method: This study used pretest-posttest control group design by using 16 male Wistar rats which were induced type-2 diabetic by streptozotocin 60 mg/kg BW-nicotinamide 120 mg/kg BW intraperitoneally. Rats who had developed type-2 DM later divided randomly into 4 groups; negative control received placebo, positive control received glibenclamide 5 mg/kg BW/day, rats intervention I and intervention II received 100% and 50% of radish leaves ethanol extract, respectively. Treatments were administered orally for four weeks. The blood glucose levels were measured using the Enzymatic Colorimetric Test “GOD-PAP”. Data were analyzed by the dependent t-test for pretest-posttest intervention difference and one-way ANOVA followed by post hoc test to determine the significant difference of each treatment to obtain the significant data. Result: The result revealed that intervention group had lower blood glucose levels mean than control group which the lowest was intervention II group (negative control: 540,9 ± 191,7 mg/dl, positive control: 494, 97 ± 64,91 mg/dl, intervention I: 301,92 ± 165,70 mg/dl, and intervention II group: 276,1 ± 139,02 mg/dl. Intervention II group had the highest antidiabetic activity, followed by the intervention I group with the amount of decrease in blood glucose levels were -151,85 ± 77,43 mg/dl and -11,08 ± 186,62 mg/dl, however negative and positive control group didn’t have antidiabetic activity. The dependent t-test result showed there is a significant difference in decreasing blood glucose levels in the intervention II pretest-posttest intervention (p=0,03) while the other group didn’t. Data analyzed by one-way ANOVA also revealed the intervention II group significantly declined blood glucose levels compared to the negative and positive control group (p = 0,033 and p=0,032, respectively). Conclusion: There is a significant effect of radish leaves ethanol extract on blood glucose levels in streptozotocin-nicotinamide-induced diabetic rats with the optimal therapeutic effect at a concentration of 50%.

Keywords: blood glucose levels, medicinal plant, radish leaves, type-2 diabetes mellitus

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Authors: Birendra Kumar Bista, Rhitik Bista, Prafulla Koirala, Lokendra Mandal, Nikrsh Raj Shrestha, Vivek Kattel

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Introduction: Poorly controlled diabetes is associated with cause and poor outcome of stroke. High blood sugar reduces cerebral blood flow, increases intracranial pressure, cerebral edema and neuronal death, especially among patients with poorly controlled diabetes.1 SGLT2 inhibitors are associated with 50% reduction in hemorrhagic stroke compared with placebo. SGLT2 inhibitors decrease cardiovascular events via reducing glucose, blood pressure, weight, arteriosclerosis, albuminuria and reduction of atrial fibrillation.2,3 No study has been documented in low income countries to see the role of post stroke SGLT2 inhibitors on diabetic patients at and after ICU admission. Aims: The aim of the study was to measure the 12 months outcome of diabetic patients with acute stroke admitted in ICU set up with naïve SGLT2 inhibitors add on therapy. Method: It was prospective cohort study carried out in a 250 bedded tertiary neurology care hospital at the province capital Biratnagar Nepal. Diabetic patient with acute stroke admitted in ICU from 1st January 2022 to 31st December 2022 who were not under SGLT2 inhibitors were included in the study. These patients were managed as per hospital protocol. Empagliflozin was added to the alternate enrolled patients. Empagliflozin was continued at the time of discharged and during follow up unless contraindicated. These patients were followed up for 12 months. Outcome measured were mortality, morbidity requiring readmission or hospital visit other than regular follow up, SGLT2 inhibitors related adverse events, neuropsychiatry comorbidity, functional status and biochemical parameters. Ethical permission was taken from hospital administration and ethical board. Results: Among 147 diabetic cases 68 were not treated with empagliflozin whereas 67 cases were started the SGLT2 inhibitors. HbA1c level and one year mortality was significantly low among patients on empaglifozin arm. Over a period of 12 months 427 acute stroke patients were admitted in the ICU. Out of them 44% were female, 61% hypertensive, 34% diabetic, 57% dyslipidemia, 26% smoker and with median age of 45 years. Among 427 cases 4% required neurosurgical interventions and 76% had hemorrhagic CVA. The most common reason for ICU admission was GCS<8 (51%). The median ICU stay was 5 days. ICU mortality was 21% whereas 1 year mortality was 41% with most common reason being pneumonia. Empaglifozin related adverse effect was seen in 11% most commonly lower urinary tract infection in 6%. Conclusion: Empagliflozin can safely be started among acute stroke with better Hba1C control and low mortality outcome compared to treatment without SGLT2 inhibitor.

Keywords: diabetes, ICU, mortality, SGLT2 inhibitors, stroke

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Authors: June Keeling, Christina Athanasiades, Vaiva Hendrixson, Delyth Wyndham

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Recognition and education in violence, abuse, and neglect for medical and healthcare practitioners (REVAMP) is a trans-European project aiming to introduce a training programme that has been specifically developed by partners across seven European countries to meet the needs of medical and healthcare practitioners. Amalgamating the knowledge and experience of clinicians, researchers, and educators from interdisciplinary and multi-professional backgrounds, REVAMP has tackled the under-resourced and underdeveloped area of domestic violence and abuse. The team designed an online training programme to support medical and healthcare practitioners to recognise and respond appropriately to survivors of domestic violence and abuse at their point of contact with a health provider. The REVAMP partner countries include Europe: France, Lithuania, Germany, Greece, Iceland, Norway, and the UK. The training is delivered through a series of interactive online modules, adapting evidence-based pedagogical approaches to learning. Capturing and addressing the complexities of the project impacted the methodological decisions and approaches to evaluation. The challenge was to find an evaluation methodology that captured valid data across all partner languages to demonstrate the extent of the change in knowledge and understanding. Co-development by all team members was a lengthy iterative process, challenged by a lack of consistency in terminology. A mixed methods approach enabled both qualitative and quantitative data to be collected, at the start, during, and at the conclusion of the training for the purposes of evaluation. The module content and evaluation instrument were accessible in each partner country's language. Collecting both types of data provided a high-level snapshot of attainment via the quantitative dataset and an in-depth understanding of the impact of the training from the qualitative dataset. The analysis was mixed methods, with integration at multiple interfaces. The primary focus of the analysis was to support the overall project evaluation for the funding agency. A key project outcome was identifying that the trans-European approach posed several challenges. Firstly, the project partners did not share a first language or a legal or professional approach to domestic abuse and neglect. This was negotiated through complex, systematic, and iterative interaction between team members so that consensus could be achieved. Secondly, the context of the data collection in several different cultural, educational, and healthcare systems across Europe challenged the development of a robust evaluation. The participants in the pilot evaluation shared that the training was contemporary, well-designed, and of great relevance to inform practice. Initial results from the evaluation indicated that the participants were drawn from more than eight partner countries due to the online nature of the training. The primary results indicated a high level of engagement with the content and achievement through the online assessment. The main finding was that the participants perceived the impact of domestic abuse and neglect in very different ways in their individual professional contexts. Most significantly, the participants recognised the need for the training and the gap that existed previously. It is notable that a mixed-methods evaluation of a trans-European project is unusual at this scale.

Keywords: domestic violence, e-learning, health professionals, trans-European

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Authors: Sameh Abaza, Mohamed Ibrahim, Tarek Mahmoud

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Due to the development in the digital image processing, its wide use in many applications such as medical, security, and others, the need for more accurate techniques that are reliable, fast and robust is vehemently demanded. In the field of security, in particular, speed is of the essence. In this paper, a pattern recognition technique that is based on the use of Hidden Markov Model (HMM), K-means and the Sobel operator method is developed. The proposed technique is proved to be fast with respect to some other techniques that are investigated for comparison. Moreover, it shows its capability of recognizing the normal face (center part) as well as face boundary.

Keywords: HMM, K-Means, Sobel, accuracy, face recognition

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Authors: Saleh Alumaran, Giampaolo Bella, Feng Chen

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The study of organisations’ information security cultures has attracted scholars as well as healthcare services industry to research the topic and find appropriate tools and approaches to develop a positive culture. The vast majority of studies in Saudi national health services are on the use of technology to protect and secure health services information. On the other hand, there is a lack of research on the role and impact of an organisation’s cultural dimensions on information security. This research investigated and analysed the role and impact of cultural dimensions on information security in Saudi Arabia health service. Hypotheses were tested and two surveys were carried out in order to collect data and information from three major hospitals in Saudi Arabia (SA). The first survey identified the main cultural-dimension problems in SA health services and developed an initial information security culture framework model. The second survey evaluated and tested the developed framework model to test its usefulness, reliability and applicability. The model is based on human behaviour theory, where the individual’s attitude is the key element of the individual’s intention to behave as well as of his or her actual behaviour. The research identified six cultural dimensions: Saudi national culture, Saudi health service leadership, employees’ trust, technology, multicultural interactions and employees’ job roles. The research also identified a set of cultural sub-dimensions. These include working values and norms, tribe values and norms, attitudes towards women, power sharing, vision, social interaction, respect and understanding, hospital intra-net, hospital employees’ language(s) used, multi-national culture, communication system, employees’ job satisfaction and job security. The research identified that (a) the human behaviour towards medical information in SA is one of the main threats to information security and one of the main challenges to SA health authority, (b) The current situation of SA hospitals’ IS cultures is falling short in protecting medical information due to the current value and norms towards information security, (c) Saudi national culture and employees’ job role are the main dimensions playing major roles in the employees’ attitude, and technology is the least important dimension playing a role in the employees’ attitudes.

Keywords: cultural dimension, electronic health record, information security, privacy

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Authors: Paola Causin, Andrea Aspri, Alessandro Benfenati

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Diffuse Optical Tomography (DOT) is an emergent medical imaging technique which employs NIR light to estimate the spatial distribution of optical coefficients in biological tissues for diagnostic purposes, in a noninvasive and non-ionizing manner. DOT reconstruction is a severely ill-conditioned problem due to prevalent scattering of light in the tissue. In this contribution, we present our research in adopting hybrid knowledgedriven/data-driven approaches which exploit the existence of well assessed physical models and build upon them neural networks integrating the availability of data. Namely, since in this context regularization procedures are mandatory to obtain a reasonable reconstruction [1], we explore the use of neural networks as tools to include prior information on the solution. 2. Materials and Methods The idea underlying our approach is to leverage neural networks to solve PDE-constrained inverse problems of the form 𝒒 ∗ = 𝒂𝒓𝒈 𝒎𝒊𝒏𝒒 𝐃(𝒚, 𝒚̃), (1) where D is a loss function which typically contains a discrepancy measure (or data fidelity) term plus other possible ad-hoc designed terms enforcing specific constraints. In the context of inverse problems like (1), one seeks the optimal set of physical parameters q, given the set of observations y. Moreover, 𝑦̃ is the computable approximation of y, which may be as well obtained from a neural network but also in a classic way via the resolution of a PDE with given input coefficients (forward problem, Fig.1 box ). Due to the severe ill conditioning of the reconstruction problem, we adopt a two-fold approach: i) we restrict the solutions (optical coefficients) to lie in a lower-dimensional subspace generated by auto-decoder type networks. This procedure forms priors of the solution (Fig.1 box ); ii) we use regularization procedures of type 𝒒̂ ∗ = 𝒂𝒓𝒈𝒎𝒊𝒏𝒒 𝐃(𝒚, 𝒚̃)+ 𝑹(𝒒), where 𝑹(𝒒) is a regularization functional depending on regularization parameters which can be fixed a-priori or learned via a neural network in a data-driven modality. To further improve the generalizability of the proposed framework, we also infuse physics knowledge via soft penalty constraints (Fig.1 box ) in the overall optimization procedure (Fig.1 box ). 3. Discussion and Conclusion DOT reconstruction is severely hindered by ill-conditioning. The combined use of data-driven and knowledgedriven elements is beneficial and allows to obtain improved results, especially with a restricted dataset and in presence of variable sources of noise.

Keywords: inverse problem in tomography, deep learning, diffuse optical tomography, regularization

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Authors: Tatiani D. Mousoura

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Specific learning disability (SLD) in higher education has been partially explored in Greece so far. Moreover, opinions on professional perspectives for university students with SLD, is scarcely encountered in Greek research. The perceptions of the hidden character of SLD along with the university policy towards it and professional perspectives that result from this policy have been examined in the present research. This study has applied the paradigm of a Greek Tertiary Pedagogical Education Department (Early Childhood Education). Via mixed methods, data have been collected from different groups of people in the Pedagogical Department: students with SLD and without SLD, academic staff and administration staff, all of which offer the opportunity for triangulation of the findings. Qualitative methods include ten interviews with students with SLD and 15 interviews with academic staff and 60 hours of observation of the students with SLD. Quantitative methods include 165 questionnaires completed by third and fourth-year students and five questionnaires completed by the administration staff. Thematic analyses of the interviews’ data and descriptive statistics on the questionnaires’ data have been applied for the processing of the results. The use of medical terms to define and understand SLD was common in the student cohort, regardless of them having an SLD diagnosis. However, this medical model approach is far more dominant in the group of students without SLD who, by majority, hold misconceptions on a definitional level. The academic staff group seems to be leaning towards a social approach concerning SLD. According to them, diagnoses may lead to social exclusion. The Pedagogical Department generally endorses the principles of inclusion and complies with the provision of oral exams for students with SLD. Nevertheless, in practice, there seems to be a lack of regular academic support for these students. When such support does exist, it is only through individual initiatives. With regards to their prospective profession, students with SLD can utilize their personal experience, as well as their empathy; these appear to be unique weapons in their hands –in comparison with other educators− when it comes to teaching students in the future. In the Department of Pedagogy, provision towards SLD results sporadic, however the vision of an inclusive department does exist. Based on their studies and their experience, pedagogy students with SLD claim that they have an experiential internalized advantage for their future career as educators.

Keywords: specific learning disability, SLD, dyslexia, pedagogy department, inclusion, professional role of SLDed educators, higher education, university policy

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Authors: Hossam N. Alhawatmeh, Areen I. Albustanji

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Hemodialysis negatively affects physical and psychological health. Pain, poor sleep quality, and low self-esteem are highly prevalent among patients with end-stage renal disease (ESRD) who receive hemodialysis, significantly increasing mortality and morbidity of those patients. Mind-body interventions (MBI), such as mindfulness meditation, have been recently gaining popularity that improved pain, sleep quality, and self-esteem in different populations. However, to our best knowledge, its effects on these health problems in patients receiving hemodialysis have not been studied in Jordan. Thus, the purpose of the study was to examine the effect of mindfulness meditation on pain, sleep quality, and self-esteem in patients with ESR receiving hemodialysis in Jordan. An experimental repeated-measures, randomized, parallel control design was conducted on (n =60) end-stage renal disease patients undergoing hemodialysis between March and June 2023 in the dialysis center at a public hospital in Jordan. Participants were randomly assigned to the experimental (n =30) and control groups (n =30) using a simple random assignment method. The experimental group practiced mindfulness meditation for 30 minutes three times per week for five weeks during their hemodialysis treatments. The control group's patients continued to receive hemodialysis treatment as usual for five weeks during hemodialysis sessions. The study variables for both groups were measured at baseline (Time 0), two weeks after intervention (Time 1), and at the end of intervention (Time 3). The numerical rating scale (NRS), the Rosenberg Self-Esteem Scale (RSES-M), and the Pittsburgh Sleep Quality Index (PSQI) were used to measure pain, self-esteem, and sleep quality, respectively. SPSS version 25 was used to analyze the study data. The sample was described by frequency, mean, and standard deviation as an appropriate. The repeated measures analysis of variance (ANOVA) tests were run to test the study hypotheses. The results of repeated measures ANOVA (within-subject) revealed that mindfulness meditation significantly decrease pain by the end of the intervention in the experimental group. Additionally, mindfulness meditation improved sleep quality and self-esteem in the experimental group, and these improvements occurred significantly after two weeks of the intervention and at the end of the intervention. The results of repeated measures ANOVA (within and between-subject) revealed that the experimental group, compared to the control group, experienced lower levels of pain and higher levels of sleep quality and self-esteem over time. In conclusion, the results provided substantial evidence supporting the positive impacts of mindfulness meditation on pain, sleep quality, and self-esteem in patients with ESRD undergoing hemodialysis. These results highlight the potential of mindfulness meditation as an adjunctive therapy in the comprehensive care of this patient population. Incorporating mindfulness meditation into the treatment plan for patients receiving hemodialysis may contribute to improved well-being and overall quality of life.

Keywords: hemodialysis, pain, sleep quality, self-esteem, mindfulness

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Authors: K. M. S. Weerasinghe, A. H. K. Balasooriya, S. L. Ransingha, G. D. Krishantha, R. S. Brhakamanagae, L. C. Wijethilke

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Tomato (Lycopersicon esculentum Mill.) is a major horticultural crop with an estimated global production of over 120 million metric tons and ranks first as a processing crop. The average tomato productivity in Sri Lanka (11 metric tons/ha) is much lower than the world average (24 metric tons/ha).To meet the tomato demand for the increasing population the productivity has to be intensified through the agronomic-techniques. Nutrition is one of the main factors which govern the growth and yield of tomato and the main nutrient source soil affect the plant growth and quality of the produce. Continuous cropping, improper fertilizer usage etc., cause widespread nutrient deficiencies. Therefore synthetic fertilizers and organic manures were introduced to enhance plant growth and maximize the crop yields. In this study, effects of macro and micronutrient supplementations on improvement of growth and yield of tomato were investigated. Selected tomato variety is Maheshi and plants were grown in Regional Agricultural and Research Centre Makadura under the Department of Agriculture recommended (DOA) macro nutrients and various combination of Ontario recommended dosages of secondary and micro fertilizer supplementations. There were six treatments in this experiment and each treatment was replicated in three times and each replicate consisted of six plants. Other than the DOA recommendation, five combinations of Ontario recommended dosage of secondary and micronutrients for tomato were also used as treatments. The treatments were arranged in a Randomized Complete Block Design. All cultural practices were carried out according to the DOA recommendations. The mean data was subjected to the statistical analysis using SAS package and mean separation (Duncan’s Multiple Range test at 5% probability level) procedures. Secondary and micronutrients containing treatments significantly increased most of the growth parameters. Plant height, plant girth, number of leaves, leaf area index etc. Fruits harvested from pots amended with macro, secondary and micronutrients performed best in terms of total yield; yield quality; to pots amended with DOA recommended dosage of fertilizer for tomato. It could be due to the application of all essential macro and micro nutrients that rise in photosynthetic activity, efficient translocation and utilization of photosynthates causing rapid cell elongation and cell division in actively growing region of the plant leading to stimulation of growth and yield were caused. The experiment revealed and highlighted the requirements of essential macro, secondary and micro nutrient fertilizer supplementations for tomato farming. The study indicated that, macro and micro nutrient supplementation practices can influence growth and yield performances of tomato fruits and it is a promising approach to get potential tomato yields.

Keywords: macro and micronutrients, tomato, SAS package, photosynthates

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Authors: Nizar Sakli, Chayma Bahar, Chokri Baccouch, Hedi Sakli

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If connected objects multiply, they are becoming a challenge in more than one way. In particular by their consumption and their supply of electricity. A large part of the new generations of connected objects will only be able to develop if it is possible to make them entirely autonomous in terms of energy. Some manufacturers are therefore developing products capable of recovering energy from their environment. Vital solutions in certain contexts, such as the medical industry. Energy recovery from the environment is a reliable solution to solve the problem of powering wireless connected objects. This paper presents and study a optically transparent solar patch antenna in frequency band of 2.4 GHz for connected objects in the future standard 5G for energy harvesting and RF transmission.

Keywords: antenna, IoT, solar cell, wireless communications

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Authors: Bassma A. Abdelhaleem, Mamdouh A. Abdulrhman, Nagwa I. Mohamed

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Malnutrition in children is an increasing problem worldwide which may result in both short and long-term irreversible negative health outcomes. Severe Acute Malnutrition (SAM) affects more than 18 million children each year, mostly living in low-income settings. SAM contributes to 45% of all deaths in children less than five years of age. Honey is a natural sweetener, containing mainly monosaccharides (up to 80%), disaccharides (3–5%), water (17–20%), and a wide range of minor constituents such as vitamins, minerals, proteins, amino acids, enzymes, and phytochemicals, mainly phenolic acids, and flavonoids. Honey has been used in many cultures around the world due to its known nutritional and medicinal benefits including the treatment of hypercholesterolemia. Despite its use since ancient times yet little is known about its potential benefits for malnourished children. Honey has the potential to be an affordable solution for malnourished low-income children as it is nutrient-dense and calorie dense food, easily absorbed, highly palatable, enhances appetite, and boosts immunity. This study assessed the effect of clover honey supplementation on the anthropometric measurements and lipid profile of malnourished infants and children. A prospective interventional clinical trial was conducted between November 2019 to November 2020, on 40 malnourished infants and children divided into two groups: Group A (20 children; 11 males and 9 females) received honey in a dose of 1.75ml/kg/dose, twice weekly for 12 weeks and Group B (20 children; 6 males and 14 females) received placebo. Written informed consent was obtained for parents/guardians. Patients were recruited from the Pediatric Nutrition Clinic at Ain Shams University. Anthropometric measurements (weight, height, body mass index, head circumference, and mid-arm circumference) and fasting serum cholesterol levels were measured at baseline and after 3 months. The 3-month honey consumption had a statistically highly significant effect on increasing weight, height, and body mass index and lowering fasting serum cholesterol levels in primary malnourished infants and children. Weight, height, body mass index, and fasting serum cholesterol level before honey consumption were (9.49 ± 2.03, 81.45 ± 8.31, 14.24 ± 2.15, 178.00 ± 20.91) and after 3 months of honey consumption were (10.91 ± 2.11, 84.80 ± 8.23, 15.07 ± 2.05, 162.45 ± 19.73) respectively with P-value < 0.01. Our results showed a significant desirable effect of honey consumption on changes in nutritional status based on weight, height, and body mass index, and has a favourable effect on lowering fasting serum cholesterol levels. These results propose the use of honey as an affordable solution to improve malnutrition, particularly in low-income countries. However, further research needs to weigh benefits against potential harms including the risk of botulinum toxin that is historically associated with honey consumption in early childhood.

Keywords: clinical trial, dyslipidemia, honey, malnutrition

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Authors: Hashem M. Alargha, Mohammad O. Hamdan, Waseem H. Aziz

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Aerobatic and military pilots are subjected to high gravitational forces that could cause blackout, physical injuries or death. A CFD simulation using fluid-solid interactions scheme has been conducted to investigate the gravitational effects and hazards inside cerebral aneurysms. Medical data have been used to derive the size and geometry of a simple aneurysm on a T-shaped bifurcation. The results show that gravitational force has no effect on maximum Wall Shear Stress (WSS); hence, it will not cause aneurysm initiation/formation. However, gravitational force cause causes hypertension which could contribute to aneurysm rupture.

Keywords: aneurysm, cfd, wall shear stress, gravity, fluid dynamics, bifurcation artery

Procedia PDF Downloads 357

Authors: Naima Fatehi

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The paper reports on 107 medicinal plants, traditionally used in the South-West of Algeria (Bechar region). The information has been documented by interviewing traditional herbalists, various elderly men and women following different ethnobotanical methods. Ethnobotanical data was arranged alphabetically by botanical name, followed by family name, vernacular name, and part used. The present paper represents significant ethnobotanical information on medical plants used extensively in Bechar region for treating various diseases and provides baseline data for future pharmacological and phytochemical studies.

Keywords: medicinal plants, ethnobotanical survey, South-West Algeria, Bechar region

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Authors: Prabhvir Singh Marway, Kai Lok Chan, Maria-Ruxandra Jinga, Rachel Bok Ying Lee, Matthew Bok Kit Lee, Krishan Nandapalan, Sze Yi Beh, Harry Carr, Christopher Kui

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We piloted a structured series of online workshops on the 3D segmentation of anatomical structures from CT scans. 33 participants were recruited from four UK universities for two-day workshops between 2020 and 2021. Open-source software (3D-Slicer) was used. We hypothesized that active participation via real-time screen-sharing and voice-communication via Discord would enable improved engagement and learning, despite national lockdowns. Written feedback indicated positive learning experiences, with subjective measures of anatomical understanding and software confidence improving.

Keywords: medical education, workshop, segmentation, anatomy

Procedia PDF Downloads 180

Authors: Muhammad Naveed Tahir, Wang Yingkuan, Huang Wenjiang, Raheel Osman

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Numerous models used in prediction and decision-making process but most of them are linear in natural environment, and linear models reach their limitations with non-linearity in data. Therefore accurate estimation is difficult. Artificial Neural Networks (ANN) found extensive acceptance to address the modeling of the complex real world for the non-linear environment. ANN’s have more general and flexible functional forms than traditional statistical methods can effectively deal with. The link between information technology and agriculture will become more firm in the near future. Monitoring crop biophysical properties non-destructively can provide a rapid and accurate understanding of its response to various environmental influences. Crop chlorophyll content is an important indicator of crop health and therefore the estimation of crop yield. In recent years, remote sensing has been accepted as a robust tool for site-specific management by detecting crop parameters at both local and large scales. The present research combined the ANN model with satellite-derived chlorophyll indices from LANDSAT 8 imagery for predicting real-time wheat chlorophyll estimation. The cloud-free scenes of LANDSAT 8 were acquired (Feb-March 2016-17) at the same time when ground-truthing campaign was performed for chlorophyll estimation by using SPAD-502. Different vegetation indices were derived from LANDSAT 8 imagery using ERADAS Imagine (v.2014) software for chlorophyll determination. The vegetation indices were including Normalized Difference Vegetation Index (NDVI), Green Normalized Difference Vegetation Index (GNDVI), Chlorophyll Absorbed Ratio Index (CARI), Modified Chlorophyll Absorbed Ratio Index (MCARI) and Transformed Chlorophyll Absorbed Ratio index (TCARI). For ANN modeling, MATLAB and SPSS (ANN) tools were used. Multilayer Perceptron (MLP) in MATLAB provided very satisfactory results. For training purpose of MLP 61.7% of the data, for validation purpose 28.3% of data and rest 10% of data were used to evaluate and validate the ANN model results. For error evaluation, sum of squares error and relative error were used. ANN model summery showed that sum of squares error of 10.786, the average overall relative error was .099. The MCARI and NDVI were revealed to be more sensitive indices for assessing wheat chlorophyll content with the highest coefficient of determination R²=0.93 and 0.90 respectively. The results suggested that use of high spatial resolution satellite imagery for the retrieval of crop chlorophyll content by using ANN model provides accurate, reliable assessment of crop health status at a larger scale which can help in managing crop nutrition requirement in real time.

Keywords: ANN, chlorophyll content, chlorophyll indices, satellite images, wheat

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Authors: Md. Abdul Karim, Syed Imran Ahmed, Pandora T. Hardtman

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Informed consent is one of the basic human and ethical rights for childbearing women. It plays a central role in promoting informed decision making between patients and service providers during the labor process. It gives mothers rights to accept or reject any examination and/or procedure, increases the respect and dignity of the mother during pregnancy, delivery and postpartum care. To assess the practices of this right during normal vaginal delivery and immediate postpartum care in tertiary level hospital setting in Bangladesh, a quantitative study with cross-sectional design was conducted in Dhaka Medical College & Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in Dhaka in November 2015. A prevalence-based sample size of 190 was calculated where prevalence, confidence interval and level of significance were at 9.7%, 98% and 5% respectively. The respondents were the mothers who gave normal vaginal childbirth within past 24 hours and received postpartum care there. They were selected through systematic random sampling technique and their face-to-face interview of 190 mothers was done using a structured questionnaire. Data were entered into the spreadsheet (MS Excel 2013 version) and descriptive analysis of findings was done. The result shows the complete absence of informed consent practices and mostly absence of consented care such as right to information, respect for choices of preferences for examination and/or procedure of childbearing women. Although 95% of the mothers were informed that they were being proceeded with normal vaginal delivery, their choice of preference was absent during the process. Only consent (not informed consent) was taken from 50%-72% mothers for examination (except breast examination ‘0%’) and 8%-83% for any procedures during postpartum care. Only one-ninth (11%) of the mothers could ask service providers regarding the services they received. No consent was taken from 3% of the mothers- neither in the labor process nor in postpartum care. This current practice doesn’t comply with the Respectful Maternity Care (RMC) Charter 2011. The issue is not even clarified in the current Standard Clinical Management Protocols of the country. So, improvement of the existing protocol and increased awareness are essential to address this right of child-bearing women and to practice it during normal vaginal delivery and postpartum care.

Keywords: informed consent, normal vaginal delivery, respectful maternity care, tertiary level hospital

Procedia PDF Downloads 139

Authors: Xiaoli Tian

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The recent growing interest in and use of complementary and alternative medicine is a global phenomenon. In many regions, traditional Chinese medicine (TCM), an important type of complementary and alternative medicine, has been formally integrated into the healthcare system. Consequently, today’s doctors face increasing requests and questions from patients regarding TCM. However, studies of TCM focus either on patients’ approaches to TCM and Western medicine (WM) or on the politics involved in the institutionalization of TCM. To our knowledge, sociological studies on doctors’ attitudes toward TCM are rare. This paper compares the receptivity of WM-trained Chinese doctors to TCM in Hong Kong and mainland China, in order to evaluate the interplay between professional training and dominant medical paradigms, on the one hand, and institutional legitimacy and government and client pressures to accept TCM, on the other. Based on survey and in-depth interviews with Western-medicine doctors in Hong Kong and mainland China, this research finds that: there is major difference between Western-medicine doctors’ attitude toward traditional Chinese medicine (TCM) in Hong Kong and mainland China. Doctors in Hong Kong are still suspicious toward TCM, no matter if they have exposure to TCM or not. Even some doctors who have much knowledge about TCM, such as got a diploma or certificate in TCM or tried TCM themselves, are still suspicious. This is because they hold up to the ideal of 'evidence-based medicine' and emphasize the kind of evidence based on randomized controlled trial (RCT). To Western medicine doctors in Hong Kong, this is the most reliable type of evidence for any medical practice, but it is lacking in TCM. This is the major reason why they do not trust TCM and would not refer patients to TCM in clinical practices. In contrast, western medicine doctors in mainland China also know about randomized controlled trial (RCT) and believe that’s the most reliable evidence, but they tend to think experience-based evidence is also reliable. On this basis, they think TCM also has clinical effectiveness. Research findings reveal that legitimacy based on institutional arrangements is a relevant factor, but how doctors understand their professional boundaries also play an important role. Doctors in Hong Kong are more serious about a strict professional boundary between Western medicine and TCM because they benefited from it, such as a very prestigious status and high income. Doctors in mainland China tend to be flexible about professional boundaries because they never benefited from a well-defined strict professional boundary. This is related to a long history of the lack of professionalism in China but is also aggravated by the increasing state support of TCM.

Keywords: evidence-based decision-making, institutional legitimacy, professional behavior, traditional Chinese medicine

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Authors: R. B. B. Samantha Ramachandra, L. D. J. Upul Senarath, S. H. Padmal De Silva

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Dietary pattern largely differs over countries and even within a country, it shows cultural differences. The dietary pattern changes the energy consumption and micronutrient intake, directly affects the pregnancy outcome. The dietary diversity was used as an indirect measure to assess micronutrient adequacy for pregnant mothers in this study. The study was conducted as a baseline survey with the objective of designing an intervention to improve the dietary diversity of pregnant mothers in Sri Lanka. The survey was conducted in Kalutara district of Sri Lanka in 2015 among 769 pregnant mothers at different gestational ages. Dietary diversity questionnaire developed by Food and Agricultural Organization’s (FAO) Food and Nutrition technical Assistance (FANTA) II project, recommended for cross-country use with adaptations was used for data collection. Trained data collectors met pregnant mothers at field ante-natal clinic and questioned on last 24hr dietary recall with portion size and coded food items to identify the diversity. Pregnant mothers were identified from randomly selected 21 clusters of public health midwife areas. 81.5% mothers (n=627) in the sample had been registered at Public Health Midwife (PHM) before 8 weeks of gestation. 24.4% of mothers were with low starting BMI and 22.7% mothers were with high starting BMI. 47.6% (n=388) mothers had abstained from at least one food item during the pregnancy. The food group with the highest consumption was rice (98.4%) followed by sugar (89.9%). 76.1% mothers had consumed milk, 73% consumed fish and sea foods. Consumption of green leaves was 52% and Vit A rich foods consumed only by 49% mothers. Animal organs, flesh meat and egg all showed low prevalence as 4.7%, 21.6% and 20% respectively. Consumption of locally grown roots, nut, legumes all showed very low prevalence. Consumption of 6 or more food groups was considered as good dietary diversity (DD), 4 to 5 food groups as moderate diversity and 3 or less food groups as poor diversity by FAO FANTA II project. 42.1% mothers demonstrated good DD while another 42.1% recorded moderate diversity. Working mothers showed better DD (51.6%, n=82/159) compared to housewives in the sample (chi = 10.656a,. df=2, p=0.005). The good DD showed gradual improvement from 43.1% to 55.5% along the poorest to richest wealth index (Chi=48.045, df=8 and p=0.000). DD showed significant association with the ethnicity and Moors showed the lowest DD. DD showed no association with the home gardening even though where better diversity expected among those who have home gardening (p=0.548). Sri Lanka is a country where many food items can be grown in the garden and semi-urban setting have adequate space for gardening. Many Sri Lankan mothers do not add homegrown items in their meal. At the same time, their consumption of animal food shows low prevalence. The DD of most of the mothers being either moderate or low (58%) may result from inadequate micro nutrient intake during pregnancy. It is recommended that adding green leaves, locally grown vegetables, roots, nuts and legumes can help increasing the DD of Sri Lankan mothers at low cost.

Keywords: dietary diversity, pregnant mothers, micro-nutrient, food groups

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Authors: Caroline Mendes, Mary McNamara, Orla Howe

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Drug delivery systems are proposed for use in cancer treatment to specifically target cancer cells and deliver a therapeutic dose without affecting normal cells. For that purpose, the use of folate receptors (FR) can be considered a key strategy, since they are commonly over-expressed in cancer cells. In this study, cyclodextrins (CD) have being used as vehicles to target FR and deliver the chemotherapeutic drug, methotrexate (MTX). CDs have the ability to form inclusion complexes, in which molecules of suitable dimensions are included within their cavities. Here, β-CD has been modified using folic acid so as to specifically target the FR. Thus, this drug delivery system consists of β-CD, folic acid and MTX (CDEnFA:MTX). Cellular uptake of folic acid is mediated with high affinity by folate receptors while the cellular uptake of antifolates, such as MTX, is mediated with high affinity by the reduced folate carriers (RFCs). This study addresses the gene (mRNA) and protein expression levels of FRs and RFCs in the cancer cell lines CaCo-2, SKOV-3, HeLa, MCF-7, A549 and the normal cell line BEAS-2B, quantified by real-time polymerase chain reaction (real-time PCR) and flow cytometry, respectively. From that, four cell lines with different levels of FRs, were chosen for cytotoxicity assays of MTX and CDEnFA:MTX using the MTT assay. Real-time PCR and flow cytometry data demonstrated that all cell lines ubiquitously express moderate levels of RFC. These experiments have also shown that levels of FR protein in CaCo-2 cells are high, while levels in SKOV-3, HeLa and MCF-7 cells are moderate. A549 and BEAS-2B cells express low levels of FR protein. FRs are highly expressed in all the cancer cell lines analysed when compared to the normal cell line BEAS-2B. The cell lines CaCo-2, MCF-7, A549 and BEAS-2B were used in the cell viability assays. 48 hours treatment with the free drug and the complex resulted in IC50 values of 93.9 µM ± 15.2 and 56.0 µM ± 4.0 for CaCo-2 for free MTX and CDEnFA:MTX respectively, 118.2 µM ± 16.8 and 97.8 µM ± 12.3 for MCF-7, 36.4 µM ± 6.9 and 75.0 µM ± 10.5 for A549 and 132.6 µM ± 16.1 and 288.1 µM ± 26.3 for BEAS-2B. These results demonstrate that free MTX is more toxic towards cell lines expressing low levels of FR, such as the BEAS-2B. More importantly, these results demonstrate that the inclusion complex CDEnFA:MTX showed greater cytotoxicity than the free drug towards the high FR expressing CaCo-2 cells, indicating that it has potential to target this receptor, enhancing the specificity and the efficiency of the drug. The use of cell imaging by confocal microscopy has allowed visualisation of FR targeting in cancer cells, as well as the identification of the interlisation pathway of the drug. Hence, the cellular uptake and internalisation process of this drug delivery system is being addressed.

Keywords: cancer treatment, cyclodextrins, drug delivery, folate receptors, reduced folate carriers

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Authors: Umair Shoukat Ali, Rashna Hoshang Sukhia, Mubassar Fida

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Introduction: The objective of the study was to compare outcomes in terms of Bleeding index (BI), Gingival Index (GI), and Orthodontic Plaque Index (OPI) with video graphics and plaque disclosing tablets (PDT) versus verbal instructions in adult orthodontic patients undergoing fixed appliance treatment (FAT). Materials and Methods: Adult orthodontic patients have recruited from outpatient orthodontic clinics who fulfilled the inclusion criteria and were randomly allocated to three groups i.e., video, PDT, and verbal groups. We included patients undergoing FAT for six months of both genders with all teeth bonded mesial to first molars having no co-morbid conditions such as rheumatic fever and diabetes mellitus. Subjects who had gingivitis as assessed by Bleeding Index (BI), Gingival Index (GI), and Orthodontic Plaque Index (OPI) were recruited. We excluded subjects having > 2 mm of clinical attachment loss, pregnant and lactating females, any history of periodontal therapy within the last six months, and any consumption of antibiotics or anti-inflammatory drugs within the last one month. Pre- and post-interventional measurements were taken at two intervals only for BI, GI, and OPI. The primary outcome of this trial was to evaluate the mean change in the BI, GI, and OPI in the three study groups. A computer-generated randomization list was used to allocate subjects to one of the three study groups using a random permuted block sampling of 6 and 9 to randomize the samples. No blinding of the investigator or the participants was performed. Results: A total of 99 subjects were assessed for eligibility, out of which 96 participants were randomized as three of the participants declined to be part of this trial. This resulted in an equal number of participants (32) that were analyzed in all three groups. The mean change in the oral hygiene indices score was assessed, and we found no statistically significant difference among the three interventional groups. Pre- and post-interventional results showed statistically significant improvement in the oral hygiene indices for the video and PDT groups. No statistically significant difference for age, gender, and education level on oral hygiene indices were found. Simple linear regression showed that the video group produced significantly higher mean OPI change as compared to other groups. No harm was observed during the trial. Conclusions: Visual aids performed better as compared to the verbal group. Gender, age, and education level had no statistically significant impact on the oral hygiene indices. Longer follow-ups will be required to see the long-term effects of these interventions. Trial Registration: NCT04386421 Funding: Aga Khan University and Hospital (URC 183022)

Keywords: oral hygiene, orthodontic treatment, adults, randomized clinical trial

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Authors: Sima E. Rugarabamu, Mecky I. Matee, Elison N. M. Simon

Abstract:

Background: In Tanzania bacteriological studies of etiological agents of oro-facial infections are very limited, and very few have investigated anaerobes. The aim of this study was to determine the spectrum of bacterial agents involved in oral and maxillofacial infections in patients attending Muhimbili National Hospital, Dar-es-salaam, Tanzania. Method: This was a hospital based descriptive cross-sectional study that was conducted in the Department of Oral and Maxillofacial Surgery of the Muhimbili National Hospital in Dar es Salaam, Tanzania from 1st January 2014 to 31st August 2014. Seventy (70) patients with various forms of oral and maxillofacial infections who were recruited for the study. The study participants were interviewed using a prepared questionnaire after getting their consent. Pus aspirate was cultured on Blood agar, Chocolate Agar, MacConkey agar and incubated aerobically at 37°C. Imported blood agar was used for anaerobic culture whereby they were incubated at 37°Cin anaerobic jars in an atmosphere of generated using commercial gas-generating kits in accordance with manufacturer’s instructions. Plates were incubated at 37°C for 24 hours (For aerobic culture and 48 hours for anaerobic cultures). Gram negative rods were identified using API 20E while all other isolates were identified by conventional biochemical tests. Antibiotic sensitivity testing for isolated aerobic and anaerobic bacteria was detected by the disk diffusion, agar dilution and E-test using routine and commercially available antibiotics used to treat oral facial infections. Results: This study comprised of 41 (58.5%) males and 29 (41.5%) females with a mean age of 32 years SD +/-15.1 and a range of 19 to 70 years. A total of 161 bacteria strains were isolated from specimens obtained from 70 patients which were an average of 2.3 isolates per patient. Of these 103 were aerobic organism and 58 were strict anaerobes. A complex mix of strict anaerobes and facultative anaerobes accounted for 87% of all infections.The most frequent aerobes isolated was streptococcus spp 70 (70%) followed by Staphylococcus spp 18 (18%). Other organisms such as Klebsiella spp 4 (4%), Proteus spp 5 (5%) and Pseudomonas spp 2 (2%) were also seen. The anaerobic group was dominated by Prevotella spp 25 (43%) followed by Peptostreptococcus spp 18 (31%); other isolates were Pseudomonas spp 2 (1%), black pigmented Pophyromonas spp 4 (5%), Fusobacterium spp 3 (3%) and Bacteroides spp 5 (8%). Majority of these organisms were sensitive to Amoxicillin (98%), Gentamycin (89%), and Ciprofloxacin (100%). A 40% resistance to metronidazole was observed in Bacteroides spp otherwise this drug and others displayed good activity against anaerobes. Conclusions: Oral and maxillofacial facial infections at Muhimbili National Hospital are mostly caused by streptococcus spp and Prevotella spp. Strict anaerobes accounted for 36% of all isolates. The profile of isolates should assist in selecting empiric therapy for infections of the oral and maxillofacial region. Inclusion of antimicrobial agents against anaerobic bacteria is highly recommended.

Keywords: bacteria, oral and maxillofacial infections, antibiotic susceptibility, Tanzania

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