Search results for: medical treatment

Authors: Yoon Chung Kim

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In this coming aging society, medical device industry is expected to become one of the major industries. Since developing medical devices usually requires technology convergence, research collaboration is important, especially for some small and medium enterprises (SMEs) that do not have enough R&D resources in each related field. Collaboration in medical device development has some unique properties. Since it requires convergence technology, collaboration with different fields, and different types of people are often required. Since it requires clinical test, the development process usually takes longer and collaboration with hospitals is also required. However, despite these importance and uniqueness, collaboration in medical device development has not yet been widely studied. Thus, our research focuses on investigating collaborations in medical device development. For our research, we conducted surveys and interviews, especially with SMEs’ perspective in Korea. The result and discussion will be presented with a major impact factors for collaboration result, as well as future strategies that will improve and strengthen collaboration process in medical devices.

Keywords: medical device, SME, research collaboration, development, clinical

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Authors: Hanifa Maryani Ahmad, Muslim Yusuf

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Background: Unilateral crossbite can be defined as an abnormal transverse relationship between the upper and lower teeth where the mandibular buccal cusp occluding to the maxillary buccal cusp and which involves only one side of the arch. This report describes the treatment of an adolescent female with Class III malocclussion unilateral crossbite resulting from a mildly constricted maxillary arch. The patient had a Class III skeletal relationship, Class III molar relationships, unilateral crossbite on the left side, and deviated midlines. Objectives: The treatment objectives were to correct the abnormal transverse relationship, achieve proper dental inclination, and correct the unilateral crossbites to improve the facial profile. Case management: The treatment protocol was using transpalatal arch with extension arm modification to expand the maxillary arch. Following the levelling and aligning stage of treatment, using a vertical loop while mandibular arch was expanded after getting an end to end relationship on the anterior side. Results: Corrections of the unilateral crossbite were achieved in 4 months. The treatment is still on process because the canines relationship were not corrected. Conclusions: This report highlights a treatment using transpalatal arch with extension arm modification that can be used to expand the transverse width of an arch to correct the discrepancy. Even though the treatment processes were still ongoing, the correction of the unilateral crossbite have been achieved in 4 months by only using the transpalatal arch.

Keywords: crossbite unilateral, late growing, non-extraction, transpalatal arch

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Authors: Sallehan Ismail, Mahyuddin Ramli

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This study examined the properties of fresh and hardened concretes as influenced by the moisture state of the coarse recycled concrete aggregates (RCA) after surface treatment. Surface treatment was performed by immersing the coarse RCA in a calcium metasilicate (CM) solution. The treated coarse RCA was maintained in three controlled moisture states, namely, air-dried, oven-dried, and saturated surface-dried (SSD), prior to its use in a concrete mix. The physical properties of coarse RCA were evaluated after surface treatment during the first phase of the experiment to determine the density and the water absorption characteristics of the RCA. The second phase involved the evaluation of the slump, slump loss, density, and compressive strength of the concretes that were prepared with different proportions of natural and treated coarse RCA. Controlling the moisture state of the coarse RCA after surface treatment was found to significantly influence the properties of the fresh and hardened concretes.

Keywords: moisture state, recycled concrete aggregate, surface treatment

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Authors: Y. El Kaissi, M. Allam, A. Koulou, M. Galai, M. Ebn Touhami

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The aim of our work is to develop an industrial bath of nickel alloy deposit on mild steel. The optimization of the operating parameters made it possible to obtain a stable Ni-P alloy deposition formulation. To understand the reaction mechanism of the deposition process, a kinetic study was performed by cyclic voltammetry and by electrochemical impedance spectroscopy (EIS). The coatings obtained have a very high corrosion resistance in a very aggressive acid medium which increases with the heat treatment.

Keywords: cyclic voltammetry, EIS, electroless Ni–P coating, heat treatment, potentiodynamic polarization

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Authors: Dorota Witkowska, Paweł Gosek, Lukasz Swiecicki, Wojciech Jernajczyk, Bruce J. West, Miroslaw Latka

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In clinical practice, the selection of an antidepressant often degrades to lengthy trial-and-error. In this work we employ a normalized wavelet power of alpha waves as a biomarker of antidepressant treatment response. This novel EEG metric takes into account both non-stationarity and intersubject variability of alpha waves. We recorded resting, 19-channel EEG (closed eyes) in 22 inpatients suffering from unipolar (UD, n=10) or bipolar (BD, n=12) depression. The EEG measurement was done at the end of the short washout period which followed previously unsuccessful pharmacotherapy. The normalized alpha wavelet power of 11 responders was markedly different than that of 11 nonresponders at several, mostly temporoparietal sites. Using the prediction of treatment response based on the normalized alpha wavelet power, we achieved 81.8% sensitivity and 81.8% specificity for channel T4.

Keywords: alpha waves, antidepressant, treatment outcome, wavelet

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Authors: C. W. Kan

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Cotton fibre is a commonly-used natural fibre because of its good fibre strength, high moisture absorption behaviour and minimal static problems. However, one of the main drawbacks of cotton fibre is wrinkling after washing, which is recently overcome by wrinkle-resistant treatment. 1,2,3,4-butanetetracarboxylic acid (BTCA) could improve the wrinkle-resistant properties of cotton fibre. Although the BTCA process is an effective method for wrinkle resistant application of cotton fabrics, reduced fabric strength was observed after treatment. Therefore, this paper would explore the use of atmospheric pressure plasma treatment under different discharge powers as a pretreatment process to enhance the application of BTCA process on cotton fabric without generating adverse effect. The aim of this study is to provide learning information to the users to know how the atmospheric pressure plasma treatment can be incorporated in textile finishing process with positive impact.

Keywords: learning materials, atmospheric pressure plasma treatment, cotton, wrinkle-resistant, BTCA

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Authors: Ibrahim Turfanda, Soniya Rai, Karan Vadher

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Objectives— The study aims to compare real-world adherence to and persistence with dulaglutide and liraglutide in patients with type 2 diabetes (T2D) initiating treatment in UAE. Methods— This was a retrospective, non-interventional study (observation period: 01 March 2017–31 August 2019) using the UAE Dubai e-Claims database. Included: adult patients initiating dulaglutide/liraglutide 01 September 2017–31 August 2018 (index period) with: ≥1 claim for T2D in the 6 months before index date (ID); ≥1 claim for dulaglutide/liraglutide during index period; and continuous medical enrolment for ≥6 months before and ≥12 months after ID. Key endpoints, assessed 3/6/12 months after ID: adherence to treatment (proportion of days covered [PDC; PDC ≥80% considered ‘adherent’], per-group mean±standard deviation [SD] PDC); and persistence (number of continuous therapy days from ID until discontinuation [i.e., >45 days gap] or end of observation period). Patients initiating dulaglutide/liraglutide were propensity score matched (1:1) based on baseline characteristics. Between-group comparison of adherence was analysed using the McNemar test (α=0.025). Persistence was analysed using Kaplan–Meier estimates with log-rank tests (α=0.025) for between-group comparisons. This study presents 12-month outcomes. Results— Following propensity score matching, 263 patients were included in each group. Mean±SD PDC for all patients at 12 months was significantly higher in the dulaglutide versus the liraglutide group (dulaglutide=0.48±0.30, liraglutide=0.39±0.28, p=0.0002). The proportion of adherent patients favored dulaglutide (dulaglutide=20.2%, liraglutide=12.9%, p=0.0302), as did the probability of being adherent to treatment (odds ratio [97.5% CI]: 1.70 [0.99, 2.91]; p=0.03). Proportion of persistent patients also favoured dulaglutide (dulaglutide=15.2%, liraglutide=9.1%, p=0.0528), as did the probability of discontinuing treatment 12 months after ID (p=0.027). Conclusions— Based on the UAE Dubai e-Claims database data, dulaglutide initiators exhibited significantly greater adherence in terms of mean PDC versus liraglutide initiators. The proportion of adherent patients and the probability of being adherent favored the dulaglutide group, as did treatment persistence.

Keywords: adherence, dulaglutide, effectiveness, liraglutide, persistence

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Authors: Gholamreza Madad

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The role of medical equipment in modern advanced hospitals is irrefutable. Despite limited financial resources, developing countries have taken an uncontrollable manner to the purchase of complex and expensive equipment, although they have not taken good maintenance to keep these huge capitals. In our country, limited studies have indicated that the irregularities exist in the management of medical equipment maintenance. Research method: The research was done as a cross-sectional one, and in this study, a questionnaire was used to collect data in 10 hospitals. After distributing and collecting questionnaires in person, the collected data were analyzed using descriptive statistics and SPSS software. Research findings: According to the obtained results from the four dimensions of the management of medical equipment maintenance, only (maintenance planning) was in a moderate position and other components with a score of less than 50% were at a low level. There was a direct relationship between the total score of maintenance management and guidance points and coordination of medical equipment maintenance, and as well as the age of hospital managers. Discussion and conclusion: In sum, we can say that problems such as lack of skilled staff in medical engineering departments of hospitals, lack of funds and unaware of the authorities of medical engineering units to their duties have caused that the maintenance situation of medical equipment maintenance is in poor condition (near average). The low inexperience of the authorities of the unit has also contributed to this problem.

Keywords: equipment, maintenance, medical equipment, hospitals

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Authors: Azam Najafkouchak, David Todem, Dorothy Pathak, Pramod Pathak, Joseph Gardiner

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Propensity score (PS) methods have recently become the standard analysis tool for causal inference in observational studies where exposure is not randomly assigned. Thus, confounding can impact the estimation of treatment effect on the outcome. Due to the dangers of discretizing continuous variables, the focus of this paper will be on how the variation in cut-points or boundaries will affect the average treatment effect utilizing the stratification of the PS method. In this study, we will develop a new methodology to improve the efficiency of the PS analysis through stratification and simulation study. We will also explore the property of empirical distribution of average treatment effect theoretically, including asymptotic distribution, variance estimation and 95% confident Intervals.

Keywords: propensity score, stratification, emprical distribution, average treatment effect

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Authors: Ana M. T. Mata, Alexiane Ligneul

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Textile effluents are usually heavily loaded with organic carbon and color compounds, the latter being azo dyes in an estimated 70% of the case effluent posing a major challenge in environmental protection. In this study, the ecotoxicity of simulated textile effluent after biological treatment with anaerobic and aerobic phase (aerobic granular sludge, AGS) and after advanced oxidation processes (AOP) namely ozonation and UV irradiation as post-treatment, were tested to evaluate the fitness of this treatments for ecotoxicity abatement. AGS treatment achieved an 80% removal in both COD and color. AOP was applied with the intention to mineralize the metabolites resulting from biodecolorization of the azo dye Acid Red 14, especially the stable aromatic amine (4-amino-1-naphthalenesulfonic acid, 4A1NS). The ecotoxicity evaluation was based on growth inhibition of the algae Pseudokirchneriella subcapitata following OECD TG 201 except regarding the medium, MBL medium was used instead. Five replicate control cultures and samples were performed with an average STD of 2.7% regarding specific algae growth rate determination. It was found that untreated textile effluent holds an inhibition of specific growth rate of 82%. AGS treatment by itself is able to lower ecotoxicity to 53%. This is probably due to the high color removal of the treatment. AOP post-treatment with Ozone and UV irradiation improves the ecotoxicity abatment to 49 and 43% inhibition respectively, less significantly than previously thought. Since over 85% of 4A1NS was removed by either of the AOP (followed by HPLC), an individual ecotoxicity test of 4A1NS was performed showing that 4A1NS does not inhibit algae growth (0% inhibition). It was concluded that AGS treatment is able by itself to achieve a significant ecotoxicity abatement of textile effluent. The cost-benefit of AOP as a post-treatment have to be better accessed since their application resulted in an improvement of only 10% regarding ecotoxicity effluent removal. It was also found that the 4A1NS amine had no apparent effect on ecotoxicity. Further studies will be conducted to study where ecotoxicity is coming from after AGS biological treatment and how to eliminate it.

Keywords: textile wastewate, ecotoxicity, aerobic granular sludge, AOP

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Authors: D. A. S. Gamage, B. F. A. Basnayake, W.A.J.M. De Costa

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Rice is the staple food of Sri Lankans thus; rice cultivation is the major agricultural activity of the country. The application of inorganic fertilizer has become a burden to the country. The excessive application of organic and inorganic fertilizers can potentially lead to deterioration of the quality of water. In mixing both urea and rice husk charcoal and rice straw compost in soils causes a slow release of nitrogen fertilizer, thus reducing the cost of importations of nitrogen based fertilizers per unit area of cultivation. Objective of this study was to evaluate rice husk charcoal coated urea as a slow releasing fertilizer and compare the total N,P, K, organic matter in soil and yield of rice production. Five treatments were used for twenty pots (pot size 30 cm diameter and 45 cm height) each replicated four times as: inorganic fertilizer only (Urea, TSP and MOP) (Treatment 1); rice husk charcoal coated urea, TSP and MOP (Treatment 2); inorganic fertilizer (Urea, TSP and MOP) with rice straw compost only (Treatment 3); rice husk charcoal urea, TSP and MOP with rice straw compost (Treatment 4); and no fertilizer as the control (Treatment 5). Rice grain yield was significantly higher in treatment 4 where rice husk charcoal coated urea, TSP and MOP with rice straw compost. The lowest yield was observed in control (treatment 5). The lower the value of the nitrogen to phosphorous ratio in soil, it indicates higher uptake of phosphorous. Charcoal can be used as a soil amendment and organic fertilizer, but adjustment of pH was required at high application rates. K content of soil of treatment 3 and 4 were the highest with compared to the treatment 1. Rice husk charcoal coated urea can potentially be used as a slow releasing nitrogen fertilizer.

Keywords: charcoal, rice husk, nitrogen to phosphorous ratio, soil amendment

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Authors: Alireza Moghtaderi, Negin Khakpour

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Hallux Valgus is a kind of Toes aberration where the Metatarsophalangeal joint that connects the big toe to the foot, leading to the inner side and a protrusion on the inner surface of toe arise. This study aimed to determine the effect of botulinum toxin A injection to reduce pain and deviation angle of the thumb in Hallux Valgus and to increase outcomes of treatment as an adjuvant therapy. Randomized clinical study was performed on 18 patients at the Clinic of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences. In this study the Halgvs valgus angle (HVA) between the metatarsals (IMA) and cartilage distal metatarsal angle (DMAA) and pain were assessed before and after injection. Average of Hallux Valgus angle before and after Botox injections were 28/89 ± 10/21 and 21/56 ± 8/22 degrees and the angle deviation in the 6 months after treatment was significantly improved (p <0.001). Injection of botulinum toxin A is a suitable and acceptable method to reform the skeleton deformities and also to reduce the pain in patients with Hallux valgus.

Keywords: metatasal, hallux valgus, pain, botulinum toxuin

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Authors: Ayman A. Al Hayek, Asirvatham A. Robert, Mohamed A. Al Dawish, Rim B. Braham, Hanouf S. Goudeh, Fahad S. Al Sabaan

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Introduction: The aim of this study was to explore the impact of insulin pump therapy on diabetes treatment satisfaction and glycemic control among patients with type 1 diabetes mellitus (T1DM) in Saudi Arabia. Methods: A 6-month, prospective study was conducted among 47 patients (aged17–24 years) with T1DM who attended the Insulin Pump Clinic at Prince Sultan Military Medical City, Riyadh, Saudi Arabia, between April 2014 and November 2014. The respondents were purposively and conveniently selected and were interviewed using the Arabic version of the Diabetes Treatment Satisfaction Questionnaire at baseline, 3, and 6 months. Demographics and clinical variables including hemoglobin A1c (HbA1c) were also collected. Results: The mean (±standard deviation) age of the study cohort was 19.1 ± 1.93 years. Seventeen patients were male (36.2%) and 30 were female (63.8%). Compared to baseline, significant positive differences were found in treatment satisfaction among female patients and patients with long-standing T1DM at 6 months. Frequency of hyperglycemia and hypoglycemia declined significantly in female patient’s at 6 months and in patients who had a shorter duration of T1DM. Furthermore, significant positive differences were found in HbA1c levels among female patients and among those who had a shorter duration of T1DM compared to baseline. Both female and male patients and those with a shorter duration of T1DM showed significant decline in insulin necessity at6months when compared to baseline. Conclusion: Although multiple daily injections is a feasible preference for insulin supply, insulin pumps should also be considered for patients with T1DM as it appears to increase patients’ treatment satisfaction, decrease the frequency of hypoglycemia, hyperglycemia, and reduce HbA1c levels.

Keywords: type 1 diabetes, insulin pump, Saudi Arabia, T1DM

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Authors: Cengiz Demir, Recep Keşli, Gülşah Aşık

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Objective: This study was carried out with the purpose of defining by using the E test method and determining the antibiotic resistance profiles of Gram-negative anaerobic bacilli isolated from various clinical specimens obtained from patients with suspected anaerobic infections and referred to Medical Microbiology Laboratory of Afyon Kocatepe University, ANS Application and Research Hospital. Methods: Two hundred and seventy eight clinical specimens were examined for isolation of the anaerobic bacteria in Medical Microbiology Laboratory between the 1st November 2014 and 30th October 2015. Specimens were cultivated by using Scheadler agar that 5% defibrinated sheep blood added, and Scheadler broth. The isolated anaerobic Gram-negative bacilli were identified conventional methods and Vitek 2 (ANC ID Card, bioMerieux, France) cards. Antibiotic resistance rates against to penicillin G, clindamycin, cefoxitin, metronidazole, moxifloxacin, imipenem, meropenem, ertapenem and doripenem were determined with E-test method for each isolate. Results: Of the isolated twenty-eight anaerobic gram negative bacilli fourteen were identified as the B. fragilis group, 9 were Prevotella group, and 5 were Fusobacterium group. The highest resistance rate was found against penicillin (78.5%) and resistance rates against clindamycin and cefoxitin were found as 17.8% and 21.4%, respectively. Against to the; metronidazole, moxifloxacin, imipenem, meropenem, ertapenem and doripenem, no resistance was found. Conclusion: Since high rate resistance has been detected against to penicillin in the study penicillin should not be preferred in empirical treatment. Cefoxitin can be preferred in empirical treatment; however, carrying out the antibiotic sensitivity testing will be more proper and beneficial. No resistance was observed against carbapenem group antibiotics and metronidazole; so that reason, these antibiotics should be reserved for treatment of infectious caused by resistant strains in the future.

Keywords: anaerobic gram-negative bacilli, anaerobe, antibiotics and resistance profiles, e-test method

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Authors: Syeda Mahnaz Hassan

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Social work as a specialized field, grounded in scientific knowledge and skills, is more inclined towards problem-solving process rather than charity focused approach. Medical social work, as a primary method, deals with the bio-psychosocial-spiritual elements of an individual with a problem and assesses the pliability and strength of the patients, social support systems, and their families, to assist the patients to resolve their problems independently. The medical social worker, also known as case-worker or care-worker, has to play a substantial role in the rehabilitation and retrieval of an affected person. This paper examines the roles played and responsibilities discharged by the Medical Social Workers internationally and specifically concerning Pakistan. The capacity constraints and challenges confronted by Medical Social Workers in hospitals have also been highlighted, and some policy implications have been suggested to enhance the capabilities of Medical Social Workers for serving the patients in a befitting manner.

Keywords: medical social work, Pakistan, patients, rehabilitation

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Authors: Huafeng Wei

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Dementia in Alzheimer’s Disease (AD) is the number one cause of dementia internationally, without effective treatments. Increasing evidence suggest that disruption of intracellular calcium homeostasis, primarily pathological elevation of cytosol and mitochondria but reduction of endoplasmic reticulum (ER) calcium concentrations, play critical upstream roles on multiple pathologies and associated neurodegeneration, impaired neurogenesis, synapse, and cognitive dysfunction in various AD preclinical studies. The last federal drug agency (FDA) approved drug for AD dementia treatment, memantine, exert its therapeutic effects by ameliorating N-methyl-D-aspartate (NMDA) glutamate receptor overactivation and subsequent calcium dysregulation. More research works are needed to develop other drugs targeting calcium dysregulation at multiple pharmacological acting sites for future effective AD dementia treatment. Particularly, calcium channel blockers for the treatment of hypertension and dantrolene for the treatment of muscle spasm and malignant hyperthermia can be repurposed for this purpose. In our own research work, intranasal administration of dantrolene significantly increased its brain concentrations and durations, rendering it a more effective therapeutic drug with less side effects for chronic AD dementia treatment. This review summarizesthe progress of various studies repurposing drugs targeting calcium dysregulation for future effective AD dementia treatment as potentially disease-modifying drugs.

Keywords: alzheimer, calcium, cognitive dysfunction, dementia, neurodegeneration, neurogenesis

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Authors: En-Tzu Wang, Ting-Ann Wang, Yi-Hui Shen, Yu-Min Chou, Chi-Tai Fang, Chin-Hui Yang

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Background and purpose: A mass varicella immunization program was established to provide free 1-dose vaccination for all 1-year-old children throughout Taiwan since 2004. The epidemiological characteristics and disease burden of varicella from 2000 to 2012 was investigated and the results will be essential to refine the national immunization policy. Method: We included patients (n = 17,838–164,245) with ICD-9-CM codes 052 (chickenpox) from the 2000 to 2012 National Health Insurance Database. The age, period, and cohort-specific incidence of varicella were calculated. The hospital admission rate, medical costs and indirect costs from the societal perspective of varicella including travel costs to the medical facility, registration fee, productivity losses of the patients and caregivers were also estimated. Result: There were 979,252 patients for medical treatment due to varicella from 2000 to 2012 in Taiwan. The implementation of a routine childhood varicella vaccination program has resulted in 87% decline in morbidity (881.49 to 115.17 per 100,000). The average age of patients increased from 7.9 years to 16.3 years. The overall varicella-related hospital admission rate was 15.5 per 1000 patients, and peaked in the groups of infants younger than 1 year, adults aged from 20 to 39 years and elders over 70 years. Among patients admitted to hospital, 33.5% of them had one or more complications. Patients with underlying diseases had higher admission rate (241.6 per 1,000) and longer duration of hospital stay (6.61 days vs. 4.76 days). The annual varicella-related medical expense declined after 2002 and the proportion of medical costs for admission has increased to 42%. The annual indirect costs from the societal perspective of varicella were 5.29 to 9.63 times higher than varicella-related medical costs. Every one dollar invested in the varicella immunization program, 2.97 dollars of medical and social costs were saved on average. Conclusion: The dramatic decline in morbidity, hospitalization, medical and social costs of varicella can be directly attributed to the implementation of the mass immunization program. Two-dose vaccination is recommended for both children with underlying diseases and susceptible adults to prevent serious complications and hospitalizations.

Keywords: disease burden, epidemiology, medical and social costs, varicella, varicella vaccine

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Authors: Z. Kolacinski, L. Szymanski. G. Raniszewski, D. Koza, L. Pietrzak

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Magnetic Bio-Nano-Fluid (BNF) can be composed of a buffer fluid such as plasma and magnetic nanoparticles such as iron, nickel, cobalt and their oxides. However iron is one of the best elements for magnetization by electromagnetic radiation. It can be used as a tool for medical diagnosis and treatment. Radio frequency (RF) radiation is able to heat iron nanoparticles due to magnetic hysteresis. Electromagnetic heating of iron nanoparticles and ferro-fluids BNF can be successfully used for non-invasive thermal ablation of cancer cells. Moreover iron atoms can be carried by carbon nanotubes (CNTs) if iron is used as catalyst for CNTs synthesis. Then CNTs became the iron containers and they screen the iron content against oxidation. We will present a method of CNTs addressing to the required cells. For thermal ablation of cancer cells we use radio frequencies for which the interaction with human body should be limited to minimum. Generally, the application of RF energy fields for medical treatment is justified by deep tissue penetration. The highly iron doped CNTs as the carriers creating magnetic fluid will be presented. An excessive catalyst injection method using electrical furnace and microwave plasma reactor will be presented. This way it is possible to grow the Fe filled CNTs on a moving surface in continuous synthesis process. This also allows producing uniform carpet of the Fe filled CNTs carriers. For the experimental work targeted to cell ablation we used RF generator to measure the increase in temperature for some samples like: solution of Fe2O3 in BNF which can be plasma-like buffer, solutions of pure iron of different concentrations in plasma-like buffer and in buffer used for a cell culture, solutions of carbon nanotubes (MWCNTs) of different concentrations in plasma-like buffer and in buffer used for a cell culture. Then the targeted therapies which can be effective if the carriers are able to distinguish the difference between cancerous and healthy cell’s physiology are considered. We have developed an approach based on ligand-receptor or antibody-antigen interactions for the case of colon cancer.

Keywords: cancer treatment, carbon nano tubes, drag delivery, hyperthermia, iron

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Authors: Takaaki Nemoto

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Case presentation: A 69-year-old Japanese man presented with a low-grade fever and fatigue that had persisted for one month. The patient had an aortic dissection on the aortic arch 13 years prior, an abdominal aortic aneurysm seven years prior, and an aortic dissection on the distal aortic arch one year prior, which were all treated with artificial blood-vessel replacement surgery. Laboratory tests revealed an inflammatory response (CRP 7.61 mg/dl), high serum creatinine (Cr 1.4 mg/dL), and elevated transaminase (AST 47 IU/L, ALT 45 IU/L). The patient was admitted to our hospital on suspicion of prosthetic vascular graft infection. Following further workups on the inflammatory response, an enhanced chest computed tomography (CT) and a non-enhanced chest DWI (MRI) were performed. The patient was diagnosed with a pulmonary fistula and a prosthetic vascular graft infection on the distal aortic arch. After admission, the patient was administered Ceftriaxion and Vancomycine for 10 days, but his fever and inflammatory response did not improve. On day 13 of hospitalization, a lung fistula repair surgery and an omental filling operation were performed, and Meropenem and Vancomycine were administered. The fever and inflammatory response continued, and therefore we took repeated blood cultures. M. fortuitum was detected in a blood culture on day 16 of hospitalization. As a result, we changed the treatment regimen to Amikacin (400 mg/day), Meropenem (2 g/day), and Cefmetazole (4 g/day), and the fever and inflammatory response began to decrease gradually. We performed a test of sensitivity for Mycobacterium fortuitum, and found that the MIC was low for fluoroquinolone antibacterial agent. The clinical course was good, and the patient was discharged after a total of 8 weeks of intravenous drug administration. At discharge, we changed the treatment regimen to Levofloxacin (500 mg/day) and Clarithromycin (800 mg/day), and prescribed these two drugs as a long life suppressive therapy. Discussion: There are few cases of prosthetic vascular graft infection caused by mycobacteria, and a standard therapy remains to be established. For prosthetic vascular graft infections, it is ideal to provide surgical and medical treatment in parallel, but in this case, surgical treatment was difficult and, therefore, a conservative treatment was chosen. We attempted to increase the treatment success rate of this refractory disease by conducting a susceptibility test for mycobacteria and treating with different combinations of antimicrobial agents, which was ultimately effective. With our treatment approach, a good clinical course was obtained and continues at the present stage. Conclusion: Although prosthetic vascular graft infection resulting from mycobacteria is a refractory infectious disease, it may be curative to administer appropriate antibiotics based on the susceptibility test in addition to surgical treatment.

Keywords: prosthetic vascular graft infection, lung fistula, Mycobacterium fortuitum, conservative treatment

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Authors: Daneal Rorke, Gueguim Kana

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The shift towards renewable energy sources for biofuel production has received increasing attention. However, the use and pre-treatment of lignocellulosic material are inundated with the generation of fermentation inhibitors which severely impact the feasibility of bioprocesses. This study reports the profiling of all volatile compounds generated during microwave assisted chemical pre-treatment of sorghum leaves. Furthermore, the optimization of reducing sugar (RS) from microwave assisted acid pre-treatment of sorghum leaves was assessed and gave a coefficient of determination (R2) of 0.76, producing an optimal RS yield of 2.74 g FS/g substrate. The development of an intelligent model to predict volatile compound fractions gave R2 values of up to 0.93 for 21 volatile compounds. Sensitivity analysis revealed that furfural and phenol exhibited high sensitivity to acid concentration, alkali concentration and S:L ratio, while phenol showed high sensitivity to microwave duration and intensity as well. These findings illustrate the potential of using an intelligent model to predict the volatile compound fraction profile of compounds generated during pre-treatment of sorghum leaves in order to establish a more robust and efficient pre-treatment regime for biofuel production.

Keywords: artificial neural networks, fermentation inhibitors, lignocellulosic pre-treatment, sorghum leaves

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Authors: Cherif Y., Ghariani R., Derbal S., Farhati S., Ben Dahmen F., Abdallah M.

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Introduction: Tuberculosis (TBC) is a frequent infection and is still a major public health problem in Tunisia. The aim of this work is to focus on diagnostic and therapeutic characteristics of TBC in patients referred to our internal medicine department. Patients and Methods: The study was retrospective and descriptive of a cohort of consecutive cases treated from January 2016 to December 2019, collecting patients with latent or patent TBC. Twenty-eight medical records of adults diagnosed with TBC were reviewed. Results: Twenty-eight patients, including 18 women and 10 men, were diagnosed with TBC. Their mean age is 48 years (range: 22-78 years). Five patients have a medical history of diabetes mellitus, 1 patient was followed for systemic lupus erythematosus treated with corticosteroids and immunosuppressant drugs, and another was treated with corticosteroids for Mac Duffy syndrome. The TBC is latent in 12 cases and patent in 16 cases. The most common symptoms were fever and weight loss and were found in 10 cases, a cough in 2 cases, sputum in 3 cases, lymph nodes in 4 cases, erythema nodosum in 2 cases, and neurological signs in 3 cases. Lymphopenia is noticed in 3 cases and a biological inflammatory syndrome in 18 of the cases. The purified protein derivate reaction was positive in 17 cases, anergic in 3 cases, negative in 5 cases, and not done in 3 cases. The acid-fast bacilli stain culture was strongly positive in one patient. The histopathological study was conclusive in 11 patients and showed granulomatosis with caseous necrosis. TBC was pulmonary in 7 patients, lymph node in 7 cases, peritoneal in 7 cases, digestive in 1 case, neuromeningeal in 3 cases, and thyroïd in 1 case. Seven patients had multifocal TBC. All the patients received anti-tuberculosis treatment with a mean duration of 8 months with no failure or relapse with an average follow-up time of 10.58 months. Conclusion: Diagnosis and management of TBC remain essential to avoid serious complications. The survey is necessary to ensure timely detection and treatment of infected adults to decrease its incidence. The best treatment remains preventive through vaccination and improving social and economic conditions.

Keywords: tuberculosis, infection, autoimmune disease, granulomatosis

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Authors: Stoyanka Georgieva Vladeva, Elena Kirilova Kirilova, Nikola Kirilov Kirilov

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Summary: WHO (World Health Organization) recommends the elder people a certain amount of regular physical activity in order to prevent some of the health issues. Postmenopausal osteoporosis is one of the chronic diseases which requires the maintaining of regular physical activity. The regular activity combined with an adequate medical treatment greatly improves the quality of life of the patient. Objectives: Assessment of the effect of the regular physical activity recommended by WHO on the quality of life in patients with postmenopausal osteoporosis. Material and methods: For the period of one year 68 female patients treated with Denosumab have been monitored. The bone density has been measured with the DEXA method in accordance to the T-score. No patients having any oncologic diseases and secondary osteoporosis have been included in the study. The subjects have been divided into groups by their age. The first group – women aged under 65 years (27 subjects) and the second group – women aged over 65 years (41 subjects). All patients have been advised to maintain regular physical activity included in the recommendations of the WHO in accordance with the age and the disease. The quality of life has been assessed in the beginning and at the end of the one-year period using the SF 36V2 questionnaire. Results: Only 31% of the subjects have engaged into regular increased physical activities for the whole period. Among them are mostly patients of the second group (aged over 65 years, 71%). The women from the both groups who were engaging into regular activities for this one-year period all experience an improvement of the quality of life. These results show that older patients understand the necessity of the physical activity for their health. The comparison of the output data to the scales of physical activity, durability, body pain, vitality, social activity and emotional stability has found an improvement at the end of the period in all patients. The osteodensitometry showed general improvement of the T-score. Patients with additional visits to their rheumatologist have better results. Conclusion: Combination of regular physical activity in accordance to the recommendations of WHO and medical treatment including anti-osteoporotic drugs improves the quality of life of women with postmenopausal osteoporosis.

Keywords: elderly patients, osteoporosis, physical activity, quality of life

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Authors: Abdesselam Babouri, Ahcène Lemzadmi, M Rahmane, B. Belhadi, N. Abouchi

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Medical monitoring aims at monitoring and remotely controlling the vital physiological parameters of the patient. The physiological sensors provide repetitive measurements of these parameters in the form of electrical signals that vary continuously over time. Various measures allow informing us about the health of the person's physiological data (weight, blood pressure, heart rate or specific to a disease), environmental conditions (temperature, humidity, light, noise level) and displacement and movements (physical efforts and the completion of major daily living activities). The collected data will allow monitoring the patient’s condition and alerting in case of modification. They are also used in the diagnosis and decision making on medical treatment and the health of the patient. This work presents the implementation of a monitoring system to be used for the control of physiological parameters.

Keywords: clinical monitoring, physiological parameters, biomedical sensors, personal health

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Authors: Rebecca Greenberg, Nipa Chauhan, Rashad Rehman

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Paternalism, in its traditional form, seems largely incompatible with Western medicine. In contrast, Family-Centred Care, a partial response to historically authoritative paternalism, carries its own challenges, particularly when operationalized as family-directed care. Specifically, in neonatology, decision-making is left entirely to Substitute Decision Makers (most commonly parents). Most models of shared decision-making employ both the parents’ and medical team’s perspectives but do not recognize the inherent asymmetry of information and experience – asking parents to act like physicians to evaluate technical data and encourage physicians to refrain from strong medical opinions and proposals. They also do not fully appreciate the difficulties in adjudicating which perspective to prioritize and, moreover, how to mitigate disagreement. Introducing a mild form of paternalism can harness the unique skillset both parents and clinicians bring to shared decision-making and ultimately work towards decision-making in the best interest of the child. The notion expressed here is that within the model of shared decision-making, mild paternalism is prioritized inasmuch as optimal care is prioritized. This mild form of paternalism is known as Beneficent Paternalism and justifies our encouragement for physicians to root down in their own medical expertise to propose treatment plans informed by medical expertise, standards of care, and the parents’ values. This does not mean that we forget that paternalism was historically justified on ‘beneficent’ grounds; however, our recommendation is that a re-integration of mild paternalism is appropriate within our current Western healthcare climate. Through illustrative examples from the NICU, this paper explores the appropriateness and merits of Beneficent Paternalism and ultimately its use in promoting family-centered care, patient’s best interests and reducing moral distress. A distinctive feature of the NICU is the fact that communication regarding a patient’s treatment is exclusively done with substitute decision-makers and not the patient, i.e., the neonate themselves. This leaves the burden of responsibility entirely on substitute decision-makers and the clinical team; the patient in the NICU does not have any prior wishes, values, or beliefs that can guide decision-making on their behalf. Therefore, the wishes, values, and beliefs of the parent become the map upon which clinical proposals are made, giving extra weight to the family’s decision-making responsibility. This leads to why Family Directed Care is common in the NICU, where shared decision-making is mandatory. However, the zone of parental discretion is not as all-encompassing as it is currently considered; there are appropriate times when the clinical team should strongly root down in medical expertise and perhaps take the lead in guiding family decision-making: this is just what it means to adopt Beneficent Paternalism.

Keywords: care, ethics, expertise, NICU, paternalism

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Authors: A. Benhadji, R. Maachi

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Environmental protection has become a major economic development issues. Indeed, the environment has become both market growth factor and element of competition. It is now an integral part of all industrial strategies. Ecosystem protection is based on the reduction of the pollution load in the treatment of liquid waste. The physicochemical techniques are commonly used which a transfer of pollution is generally found. Alternative to physicochemical methods is the use of microorganisms for cleaning up the waste waters. The objective of this research is the evaluation of the effects of exogenous added Pseudomonas strains on pollutants biodegradation. The influence of the critical parameters such as inoculums concentration and duration treatment are studied. The results show that Pseudomonas putida is found to give a maximum reduction in chemical organic demand (COD) in 4 days of incubation. However, toward to protect biological pollution of environment, the treatment is achieved by electro coagulation process using aluminium electrodes. The results indicate that this process allows disinfecting the water and improving the electro coagulated sludge quality.

Keywords: tannery, pseudomonas, biological treatment, electrocoagulation process, sludge quality

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Authors: Araujo J. F. Marina, Araujo F. Marcus Vinicius, Mulinari R. Daniella

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Due to the resultant leachate from waste decomposition in landfills has polluter potential hundred times greater than domestic sewage, this is considered a problem related to the depreciation of environment requiring pre-disposal treatment. In seeking to improve this situation, this project proposes the treatment of landfill leachate using natural fibers intercropped with advanced oxidation processes. The selected natural fibers were palm, coconut and banana fiber. These materials give sustainability to the project because, besides having adsorbent capacity, are often part of waste discarded. The study was conducted in laboratory scale. In trials, the effluents were characterized as Chemical Oxygen Demand (COD), Turbidity and Color. The results indicate that is technically promising since that there were extremely oxidative conditions, the use of certain natural fibers in the reduction of pollutants in leachate have been obtained results of COD removals between 67.9% and 90.9%, Turbidity between 88.0% and 99.7% and Color between 67.4% and 90.4%. The expectation generated is to continue evaluating the association of efficiency of other natural fibers with other landfill leachate treatment processes.

Keywords: lndfill leachate, chemical treatment, natural fibers, advanced oxidation processes

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Authors: Z. Herceg, V. Stulic, T. Vukusic, A. Rezek Jambrak

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Gas phase plasma treatment is a new nonthermal technology used for food and water decontamination. In this study, we have investigated influence of the gas phase plasma treatment on yeast cells of S. cerevisiae. Sample was composed of 10 mL of yeast suspension and 190 mL of 0.01 M NaNO₃ with a medium conductivity of 100 µS/cm. Samples were treated in a glass reactor with a point- to-plate electrode configuration (high voltage electrode-titanium wire in the gas phase and grounded electrode in the liquid phase). Air or argon were injected into the headspace of the reactor at the gas flow of 5 L/min. Frequency of 60, 90 and 120 Hz, time of 5 and 10 min and positive polarity were defined parameters. Inactivation was higher with the applied higher frequency, longer treatment time and injected argon. Inactivation was not complete which resulted in complete recovery. Cellular leakage (260 nm and 280 nm) was higher with a longer treatment time and higher frequency. Leakage at 280 nm which defines a leakage of proteins was higher than leakage at 260 nm which defines a leakage of nucleic acids. The authors would like to acknowledge the support by Croatian Science Foundation and research project 'Application of electrical discharge plasma for preservation of liquid foods'.

Keywords: Saccharomyces cerevisiae, inactivation, gas-phase plasma treatment, cellular leakage

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Authors: J. Bolobajev, M. Trapido, A. Goi

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The practical application of the Fenton-based treatment method for organic compounds-contaminated water purification is limited mainly because of the large amount of ferric sludge formed during the treatment, where ferrous iron (Fe(II)) is used as the activator of the hydrogen peroxide oxidation processes. Reuse of ferric sludge collected from clarifiers to substitute Fe(II) salts allows reducing the total cost of Fenton-type treatment technologies and minimizing the accumulation of hazardous ferric waste. Dissolution of ferric iron (Fe(III)) from the sludge to liquid phase at acidic pH and autocatalytic transformation of Fe(III) to Fe(II) by phenolic compounds (tannic acid, lignin, phenol, catechol, pyrogallol and hydroquinone) added or present as water/wastewater constituents were found to be essentially involved in the Fenton-based oxidation mechanism. Observed enhanced formation of highly reactive species, hydroxyl radicals, resulted in a substantial organic contaminant degradation increase. Sludge reuse at acidic pH and in the presence of ferric iron reductants is a novel strategy in the Fenton-based treatment application for organic compounds-contaminated water purification.

Keywords: ferric sludge recycling, ferric iron reductant, water treatment, organic pollutant

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Authors: Abbas Ebrahimi, Zohreh Pourhossein, Nariman Miraalami

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The experiment was conducted to evaluate the effects of different levels of dried citrus sinensis peel (DCSP) on the blood parameters of broilers. Four hundred Ross 308 strain day old broiler in a completely randomized design with five treatments (four replicates per treatment and each replicate had 20 chicks) were categorized. Each treatment used either regulatory diet including 1.5% and 3% DCSP in the base diet and in two periods of 1st to 21st day and 1st to 42nd day and base diet without any additive for six weeks. Data analysis was performed using SAS software and mean comparison was conducted by Duncan method. The results determined that using different level of DCSP has significant effects on blood plasma parameters (P<0.05). Cholesterol, glucose, triglyceride, low density lipoprotein (LDL) at the rearing period was significantly influenced by experimental treatments (P<0.05). However, uric acid, alkaline phosphatase and high density lipoprotein (HDL) was not affected by experimental treatments (P>0.05). The lowest rate of blood cholesterol was concerned to the treatment which was used 3% DCSP 1st to 42nd day and the highest mean of blood cholesterol were concerned to the control treatment. The lowest rate of blood triglyceride was concerned to the treatment which was used 3% DCSP 1st to 42nd day and the highest mean of blood triglyceride were concerned to the control treatment. The lowest rate of blood alkaline phosphatase was concerned to the treatment which was used 3% DCSP 1st to 42nd day and the highest mean of blood alkaline phosphatase were concerned to the treatment which was used 3% DCSP 1st to 21st day.

Keywords: blood parameters, broilers, dried citrus sinensis peel, regulatory diet

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Authors: E. Marei, A. Hammad, S. Ismail, A. El-Gindy

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This study aims to investigate the ability of different formula of mixed bacteria as a biological treatments of wastewater after primary treatment as a bio-treatment and bio-removal and bio-adsorbent of different heavy metals in natural circumstances. The wastewater was collected from Sarpium forest site-Ismailia Governorate, Egypt. These treatments were mixture of free cells and mixture of immobilized cells of different bacteria. These different formulas of mixed bacteria were prepared under Lab. condition. The obtained data indicated that, as a result of wastewater bio-treatment, the removal rate was found to be 76.92 and 76.70% for biological oxygen demand, 79.78 and 71.07% for chemical oxygen demand, 32.45 and 36.84 % for ammonia nitrogen as well as 91.67 and 50.0% for phosphate after 24 and 28 hrs with mixed free cells and mixed immobilized cells, respectively. Moreover, the bio-removals of different heavy metals were found to reach 90.0 and 50. 0% for Cu ion, 98.0 and 98.5% for Fe ion, 97.0 and 99.3% for Mn ion, 90.0 and 90.0% Pb, 80.0% and 75.0% for Zn ion after 24 and 28 hrs with mixed free cells and mixed immobilized cells, respectively. The results indicated that 13.86 and 17.43% of removal efficiency and reduction of total dissolved solids were achieved after 24 and 28 hrs with mixed free cells and mixed immobilized cells, respectively.

Keywords: wastewater bio-treatment , bio-sorption heavy metals, biological desalination, immobilized bacteria, free cell bacteria

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