Search results for: clinical error
Commenced in January 2007
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Edition: International
Paper Count: 5330

Search results for: clinical error

1700 Dependence of the Photoelectric Exponent on the Source Spectrum of the CT

Authors: Rezvan Ravanfar Haghighi, V. C. Vani, Suresh Perumal, Sabyasachi Chatterjee, Pratik Kumar

Abstract:

X-ray attenuation coefficient [µ(E)] of any substance, for energy (E), is a sum of the contributions from the Compton scattering [ μCom(E)] and photoelectric effect [µPh(E)]. In terms of the, electron density (ρe) and the effective atomic number (Zeff) we have µCom(E) is proportional to [(ρe)fKN(E)] while µPh(E) is proportional to [(ρeZeffx)/Ey] with fKN(E) being the Klein-Nishina formula, with x and y being the exponents for photoelectric effect. By taking the sample's HU at two different excitation voltages (V=V1, V2) of the CT machine, we can solve for X=ρe, Y=ρeZeffx from these two independent equations, as is attempted in DECT inversion. Since µCom(E) and µPh(E) are both energy dependent, the coefficients of inversion are also dependent on (a) the source spectrum S(E,V) and (b) the detector efficiency D(E) of the CT machine. In the present paper we tabulate these coefficients of inversion for different practical manifestations of S(E,V) and D(E). The HU(V) values from the CT follow: <µ(V)>=<µw(V)>[1+HU(V)/1000] where the subscript 'w' refers to water and the averaging process <….> accounts for the source spectrum S(E,V) and the detector efficiency D(E). Linearity of μ(E) with respect to X and Y implies that (a) <µ(V)> is a linear combination of X and Y and (b) for inversion, X and Y can be written as linear combinations of two independent observations <µ(V1)>, <µ(V2)> with V1≠V2. These coefficients of inversion would naturally depend upon S(E, V) and D(E). We numerically investigate this dependence for some practical cases, by taking V = 100 , 140 kVp, as are used for cardiological investigations. The S(E,V) are generated by using the Boone-Seibert source spectrum, being superposed on aluminium filters of different thickness lAl with 7mm≤lAl≤12mm and the D(E) is considered to be that of a typical Si[Li] solid state and GdOS scintilator detector. In the values of X and Y, found by using the calculated inversion coefficients, errors are below 2% for data with solutions of glycerol, sucrose and glucose. For low Zeff materials like propionic acid, Zeffx is overestimated by 20% with X being within1%. For high Zeffx materials like KOH the value of Zeffx is underestimated by 22% while the error in X is + 15%. These imply that the source may have additional filtering than the aluminium filter specified by the manufacturer. Also it is found that the difference in the values of the inversion coefficients for the two types of detectors is negligible. The type of the detector does not affect on the DECT inversion algorithm to find the unknown chemical characteristic of the scanned materials. The effect of the source should be considered as an important factor to calculate the coefficients of inversion.

Keywords: attenuation coefficient, computed tomography, photoelectric effect, source spectrum

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1699 Criteria for Assessing Prostate Structure after Proton Radiotherapy for Prostate Cancer

Authors: Kuplevatsky V., Kuplevatskay, Cherkashin M., Berezina N.

Abstract:

After 6 months, a violation of the differentiation of the structure of the gland due to edema in 100%. 20% retained signs of a tumor according to DWI/ADC data. By 12 months, the reduction in the size of the gland is 100%. In all cases, no diffusion restriction was observed. The study after 18 months showed no significant changes in all (100%) patients. In the study, 24 months after treatment, the size of the gland was stable in all cases (+/- up to 5%). Diffuse decrease in T2VI signals from peripheral zones, without signs of diffusion restriction in 100%. After 30 months, signs of recovery of adenomatous changes in the transient zone were revealed in 85%. After 36 and 42 months, the restoration of organ differentiation was observed in 93% of patients. In 4 patients, by the 48th month, signs of biochemical relapse were clinically noted. According to the MRI data, signs of a local relapse were revealed. After 48 months, there were signs of restoration of organ differentiation, which allowed the use of PI-RADS criteria. The study after 54 months showed no changes compared to the control. 60 months after treatment, 97% of patients showed a restoration of differentiation of the gland structure, which allows evaluating the organ according to PI-RADS criteria Conclusions: The beginning of restoration of the structure of the prostate gland began 24 months after proton radiation therapy, the PI-RADS criteria can be fully applied after 48 months of treatment. Control studies every 6 months without clinical signs of relapse are not advisable. Local control of the prostate tumor after proton radiation therapy was achieved in 95% of patients during the entire follow-up period ( 60 months).

Keywords: proton therapy, prostate cancer, MRI imaging, PI-RADS

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1698 Pressure Relief in Prosthetic Sockets through Hole Implementation Using Different Materials

Authors: Gabi N. Nehme

Abstract:

Below-knee amputees commonly experience asymmetrical gait patterns. It is generally believed that ischemia is related to the formation of pressure sores due to uneven distribution of forces. Micro-vascular responses can reveal local malnutrition. Changes in local skin blood supply under various external loading conditions have been studied for a number of years. Radionuclide clearance, photo-plethysmography, trans-cutaneous oxygen tension along with other studies showed that the blood supply would be influenced by the epidermal forces, and the rate and the amount of blood supply would decrease with increased epidermal loads being shear forces or normal forces. Several cases of socket designs were investigated using Finite Element Model (FEM) and Design of Experiment (DOE) to increase flexibility and minimize the pressure at the limb/socket interface using ultra high molecular weight polyethylene (UHMWPE) and polyamide 6 (PA6) or Duraform. The pressure reliefs at designated areas where reducing thickness is involved are seen to be critical in determination of amputees’ comfort and are very important to clinical applications. Implementing a hole between the Patellar Tendon (PT) and Distal Tibia (DT) would decrease stiffness and increase prosthesis range of motion where flexibility is needed. In addition, displacement and prosthetic energy storage increased without compromising mechanical efficiency and prosthetic design integrity.

Keywords: patellar tendon, distal tibia, prosthetic socket relief areas, hole implementation

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1697 Investigation of an Approach in Drug Delivery: Orally Fast Disintegrating Tablets

Authors: Tansel Comoglu

Abstract:

Orally fast disintegrating tablets (FDTs or ODTs) have become popular during the last decade, and manufacturing of ODTs is getting a rapidly growing area in the pharmaceutical industry. The concept of ODTs has emerged from the desire to provide patients with more conventional means of taking their medication. Drugs, that have satisfactory absorption from the oral mucosa or aimed for immediate therapeutic activity can be formulated in ODTs. After placing the ODT into the mouth, these tablets dissolve or disintegrate in the mouth usullay less than a minute, in the absence of additional water. Even though the ODT technology has taken an important path, as proved by a large group of commercial products on the drug market, there are so many problems to be solved in ODT formulations such as; formulation of hydrophobic drugs is stil a challenge, especially when the amount of drug is high. As these tablets dissolve or disintegrate in the mouth without the need of additional water, taste masking of active ingredients becomes essential in these systems because the drug is entirely released in the mouth. In ODT technology, coping with the taste of drugs is still a challenge. Resins or sweeteners or other techniques are also used in the formulation to aid taste-masking of the API. Another important factor to consider is whether they can be manufactured using conventional equipment and processes, as this will have a positive influence on manufacturing costs. Some products, however, may require a more costly, special unitdose packaging if the dosage form is fragile. In this overview, benefits, various formulation technologies, clinical studies and some future research trends of ODTs will be discussed.

Keywords: orally fast disintegrating tablets, benefits, formulation technologies, future research trends

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1696 Pilot Trial of Evidence-Based Integrative Group Therapy to Improve Executive Functioning among Adults: Implications for Community Mental Health and Training Clinics

Authors: B. Parchem, M. Watanabe, D. Modrakovic, L. Mathew, A. Franklin, M. Cao, R. E. Broudy

Abstract:

Objective: Executive functioning (EF) deficits underlie several mental health diagnoses including ADHD, anxiety, and depression. Community mental health clinics face extensive waitlists for services with many referrals involving EF deficits. A pilot trial of a four-week group therapy was developed using key components from Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and mindfulness with an aim to improve EF skills and offer low-fee services. Method: Eight adults (M = 34.5) waiting for services at a community clinic were enrolled in a four-week group therapy at an in-house training clinic for doctoral trainees. Baseline EF, pre-/post-intervention ADHD and distress symptoms, group satisfaction, and curriculum helpfulness were assessed. Results: Downward trends in ADHD and distress symptoms pre/post-intervention were not significant. Favorable responses on group satisfaction and helpfulness suggest clinical utility. Conclusion: Preliminary pilot data from a brief group therapy to improve EF may be an efficacious, acceptable, and feasible intervention for adults waiting for services at community mental health and training clinics where there are high demands and limits to services and staffs.

Keywords: executive functioning, cognitive-behavioral therapy, dialectical behavior therapy, mindfulness, adult group therapy

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1695 Determining Components of Deflection of the Vertical in Owerri West Local Government, Imo State Nigeria Using Least Square Method

Authors: Chukwu Fidelis Ndubuisi, Madufor Michael Ozims, Asogwa Vivian Ndidiamaka, Egenamba Juliet Ngozi, Okonkwo Stephen C., Kamah Chukwudi David

Abstract:

Deflection of the vertical is a quantity used in reducing geodetic measurements related to geoidal networks to the ellipsoidal plane; and it is essential in Geoid modeling processes. Computing the deflection of the vertical component of a point in a given area is necessary in evaluating the standard errors along north-south and east-west direction. Using combined approach for the determination of deflection of the vertical component provides improved result but labor intensive without appropriate method. Least square method is a method that makes use of redundant observation in modeling a given sets of problem that obeys certain geometric condition. This research work is aimed to computing the deflection of vertical component of Owerri West local government area of Imo State using geometric method as field technique. In this method combination of Global Positioning System on static mode and precise leveling observation were utilized in determination of geodetic coordinate of points established within the study area by GPS observation and the orthometric heights through precise leveling. By least square using Matlab programme; the estimated deflections of vertical component parameters for the common station were -0.0286 and -0.0001 arc seconds for the north-south and east-west components respectively. The associated standard errors of the processed vectors of the network were computed. The computed standard errors of the North-south and East-west components were 5.5911e-005 and 1.4965e-004 arc seconds, respectively. Therefore, including the derived component of deflection of the vertical to the ellipsoidal model will yield high observational accuracy since an ellipsoidal model is not tenable due to its far observational error in the determination of high quality job. It is important to include the determined deflection of the vertical component for Owerri West Local Government in Imo State, Nigeria.

Keywords: deflection of vertical, ellipsoidal height, least square, orthometric height

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1694 Post Covid-19 Landscape of Global Pharmaceutical Industry

Authors: Abu Zafor Sadek

Abstract:

Pharmaceuticals were one of the least impacted business sectors during the corona pandemic as they are the center point of Covid-19 fight. Emergency use authorization, unproven indication of some commonly used drugs, self-medication, research and production capacity of an individual country, capacity of producing vaccine by many countries, Active Pharmaceutical Ingredients (APIs) related uncertainty, information gap among manufacturer, practitioners and user, export restriction, duration of lock-down, lack of harmony in transportation, disruption in the regulatory approval process, sudden increased demand of hospital items and protective equipment, panic buying, difficulties in in-person product promotion, e-prescription, geo-politics and associated issues added a new dimension to this industry. Although the industry maintains a reasonable growth throughout Covid-19 days; however, it has been characterized by both long- and short-term effects. Short-term effects have already been visible to so many countries, especially those who are import-dependent and have limited research capacity. On the other hand, it will take a few more time to see the long-term effects. Nevertheless, supply chain disruption, changes in strategic planning, new communication model, squeezing of job opportunity, rapid digitalization are the major short-term effects, whereas long-term effects include a shift towards self-sufficiency, growth pattern changes of certain products, special attention towards clinical studies, automation in operations, the increased arena of ethical issues etc. Therefore, this qualitative and exploratory study identifies the post-covid-19 landscape of the global pharmaceutical industry.

Keywords: covid-19, pharmaceutical, businees, landscape

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1693 The Relationship between Central Bank Independence and Inflation: Evidence from Africa

Authors: R. Bhattu Babajee, Marie Sandrine Estelle Benoit

Abstract:

The past decades have witnessed a considerable institutional shift towards Central Bank Independence across economies of the world. The motivation behind such a change is the acceptance that increased central bank autonomy has the power of alleviating inflation bias. Hence, studying whether Central Bank Independence acts as a significant factor behind the price stability in the African economies or whether this macroeconomic aim in these countries result from other economic, political or social factors is a pertinent issue. The main research objective of this paper is to assess the relationship between central bank autonomy and inflation in African economies where inflation has proved to be a serious problem. In this optic, we shall measure the degree of CBI in Africa by computing the turnover rates of central banks governors thereby studying whether decisions made by African central banks are affected by external forces. The purpose of this study is to investigate empirically the association between Central Bank Independence (CBI) and inflation for 10 African economies over a period of 17 years, from 1995 to 2012. The sample includes Botswana, Egypt, Ghana, Kenya, Madagascar, Mauritius, Mozambique, Nigeria, South Africa, and Uganda. In contrast to empirical research, we have not been using the usual static panel model for it is associated with potential mis specification arising from the absence of dynamics. To this issue a dynamic panel data model which integrates several control variables has been used. Firstly, the analysis includes dynamic terms to explain the tenacity of inflation. Given the confirmation of inflation inertia, that is very likely in African countries there exists the need for including lagged inflation in the empirical model. Secondly, due to known reverse causality between Central Bank Independence and inflation, the system generalized method of moments (GMM) is employed. With GMM estimators, the presence of unknown forms of heteroskedasticity is admissible as well as auto correlation in the error term. Thirdly, control variables have been used to enhance the efficiency of the model. The main finding of this paper is that central bank independence is negatively associated with inflation even after including control variables.

Keywords: central bank independence, inflation, macroeconomic variables, price stability

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1692 Investigation of Cold Atmospheric Plasma Exposure Protocol on Wound Healing in Diabetic Foot Ulcer

Authors: P. Akbartehrani, M. Khaledi Pour, M. Amini, M. Khani, M. Mohajeri Tehrani, E. Ghasemi, P. Charipoor, B. Shokri

Abstract:

A common problem between diabetic patients is foot ulcers which are chronic and require specialized treatment. Previous studies illustrate that Cold atmospheric plasma (CAP) has beneficial effects on wound healing and infection. Nevertheless, the comparison of different cap exposure protocols in diabetic ulcer wound healing remained to be studied. This study aims to determine the effect of two different exposure protocols on wound healing in diabetic ulcers. A prospective, randomized clinical trial was conducted at two clinics. Diabetic patients with G1 and G2 wanger classification diabetic foot ulcers were divided into two groups of study. One group was treated by the first protocol, which was treating wounds by argon-generated cold atmospheric plasma jet once a week for five weeks in a row. The other group was treated by the second protocol, which was treating wounds every three days for five weeks in a row. The wounds were treated for 40 seconds/cubic centimeter, while the nozzle tip was moved nonlocalized 1 cm above the wounds. A patient with one or more wounds could participate in different groups as wounds were separately randomized, which allow a participant to be treated several times during the study. The study's significant findings were two different reductions rate in wound size, microbial load, and two different healing speeds. This study concludes that CAP therapy by the second protocol yields more effective healing speeds, reduction in wound sizes, and microbial loads of foot ulcers in diabetic patients.

Keywords: wound healing, diabetic ulcers, cold atmospheric plasma, cold argon jet

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1691 Numerical Solution of Steady Magnetohydrodynamic Boundary Layer Flow Due to Gyrotactic Microorganism for Williamson Nanofluid over Stretched Surface in the Presence of Exponential Internal Heat Generation

Authors: M. A. Talha, M. Osman Gani, M. Ferdows

Abstract:

This paper focuses on the study of two dimensional magnetohydrodynamic (MHD) steady incompressible viscous Williamson nanofluid with exponential internal heat generation containing gyrotactic microorganism over a stretching sheet. The governing equations and auxiliary conditions are reduced to a set of non-linear coupled differential equations with the appropriate boundary conditions using similarity transformation. The transformed equations are solved numerically through spectral relaxation method. The influences of various parameters such as Williamson parameter γ, power constant λ, Prandtl number Pr, magnetic field parameter M, Peclet number Pe, Lewis number Le, Bioconvection Lewis number Lb, Brownian motion parameter Nb, thermophoresis parameter Nt, and bioconvection constant σ are studied to obtain the momentum, heat, mass and microorganism distributions. Moment, heat, mass and gyrotactic microorganism profiles are explored through graphs and tables. We computed the heat transfer rate, mass flux rate and the density number of the motile microorganism near the surface. Our numerical results are in better agreement in comparison with existing calculations. The Residual error of our obtained solutions is determined in order to see the convergence rate against iteration. Faster convergence is achieved when internal heat generation is absent. The effect of magnetic parameter M decreases the momentum boundary layer thickness but increases the thermal boundary layer thickness. It is apparent that bioconvection Lewis number and bioconvection parameter has a pronounced effect on microorganism boundary. Increasing brownian motion parameter and Lewis number decreases the thermal boundary layer. Furthermore, magnetic field parameter and thermophoresis parameter has an induced effect on concentration profiles.

Keywords: convection flow, similarity, numerical analysis, spectral method, Williamson nanofluid, internal heat generation

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1690 Narrative Review Evaluating Systematic Reviews Assessing the Effect of Probiotic Interventions on Depressive Symptoms

Authors: Ibrahim Nadeem, Mohammed Rahman, Yasser Ad-Dab’Bagh, Mahmood Akhtar

Abstract:

Depression is one of the most prevalent mental illnesses and is often associated with various other medical disorders. In this review, we aim to evaluate existing systematic reviews that investigate the use of probiotics as a treatment for depressive symptoms. Five online databases were searched for relevant studies up to December 2017. Systematic reviews that included randomized controlled trials assessing the efficacy of probiotics in the treatment of depressive symptoms were included. Seven systematic reviews met the inclusion criteria. Three of these reviews conducted meta-analyses, out of which, two found probiotics to significantly improve depressive symptoms in the sample population. Two meta-analyses conducted subgroup analysis based on health status, and both found probiotics to significantly decrease depressive symptoms in patients with major depressive disorder, but only one review found it to significantly decrease in healthy patients. Another subgroup analysis was conducted based on age, and found probiotics to produce significant effects on subjects under the age of 60, but close to no effect on patients over the age of 65. Out of the four reviews that conducted qualitative analysis, three reviews concluded that probiotics have the potential to be used as a treatment. Due to the differences in clinical trials, a definitive effect of probiotics on depressive symptoms cannot be concluded. Nonetheless, probiotics seem to produce a significant therapeutic effect for subjects with pre-existing depressive symptoms. Further studies are warranted for definitive conclusions.

Keywords: depression, gut-brain axis, gut microbiota, probiotic, psychobiotic

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1689 Evaluation of the Benefit of Anti-Endomysial IgA and Anti-Tissue Transglutaminase IgA Antibodies for the Diagnosis of Coeliac Disease in a University Hospital, 2010-2016

Authors: Recep Keşli, Onur Türkyılmaz, Hayriye Tokay, Kasım Demir

Abstract:

Objective: Coeliac disease (CD) is a primary small intestine disorder caused by high sensitivity to gluten which is present in the crops, characterized by inflammation in the small intestine mucosa. The goal of this study was to determine and to compare the sensitivity and specificity values of anti-endomysial IgA (EMA IgA) (IFA) and anti-tissue transglutaminase IgA (anti-tTG IgA) (ELISA) antibodies in the diagnosis of patients suspected with the CD. Methods: One thousand two hundred seventy three patients, who have applied to gastroenterology and pediatric disease polyclinics of Afyon Kocatepe University ANS Research and Practice Hospital were included into the study between 23.09.2010 and 30.05.2016. Sera samples were investigated by immunofluorescence method for EMA positiveness (Euroimmun, Luebeck, Germany). In order to determine quantitative value of Anti-tTG IgA (EIA) (Orgentec Mainz, Germany) fully automated ELISA device (Alisei, Seac, Firenze, Italy) were used. Results: Out of 1273 patients, 160 were diagnosed with coeliac disease according to ESPGHAN 2012 diagnosis criteria. Out of 160 CD patients, 120 were female, 40 were male. The EMA specificity and sensitivity were calculated as 98% and 80% respectively. Specificity and sensitivity of Anti-tTG IgA were determined as 99% and 96% respectively. Conclusion: The specificity of EMA for CD was excellent because all EMA-positive patients (n = 144) were diagnosed with CD. The presence of human anti-tTG IgA was found as a reliable marker for diagnosis and follow-up the CD. Diagnosis of CD should be established on both the clinical and serologic profiles together.

Keywords: anti-endomysial antibody, anti-tTG IgA, coeliac disease, immunofluorescence assay (IFA)

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1688 Cutaneous Sarcoidosis Treated with Narrow Band Ultraviolet B (NBUVB) Phototherapy

Authors: Hannah Riva, Sarah Mazal, Jessica L. Marquez, Michael Rains

Abstract:

A 70-year-old female with a Fitzpatrick skin phenotype II presented with a 13-year history of a scaly rash located on the left breast and bilateral pretibial regions. The patient’s past medical history was otherwise unremarkable, with the exception of surgery involving the left breast. Physical examination revealed infiltrative hyperpigmented scaly plaques and nodules located on the left breast and pretibial regions bilaterally. A negative systemic workup excluded organ involvement. A clinical diagnosis of cutaneous sarcoidosis was made. Prior treatments included triamcinolone 0.1% topical cream and clobetasol 0.05% ointment, which failed to show improvement. Full-body narrow-band UVB (NBUVB) treatment was performed on a tri-weekly basis for eight months. NBUVB dosage was slowly titrated from 300 mJ/cm2 to a final dose of 1800 mJ/cm2 to prevent discomfort and burning sensations. Throughout the duration of her treatment, the patient adhered to a regimen of clobetasol 0.05% topical ointment applied twice daily in two-week intervals. Improvement was noticed after two months, with continued improvement up to eight months. The patient is continuing NBUVB phototherapy treatments for maintenance. In our case, NBUVB phototherapy treatment demonstrated promising results with improvement after two months of treatment. Physicians should consider NBUVB phototherapy as an effective option for patients presenting with cutaneous sarcoidosis.

Keywords: dermatology, sarcoidosis, phototherapy, ultraviolet

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1687 The Role of Cognitive Impairment in Asthma Self-Management Behaviors and Outcomes in Older Adults

Authors: Gali Moritz, Jacqueline H. Becker, Jyoti V. Ankam, Kimberly Arcoleo, Matthew Wysocki, Roee Holtzer, Juan Wisnivesky, Paula J. Busse, Alex D. Federman, Sunit P. Jariwala, Jonathan M. Feldman

Abstract:

Objective: Cognitive impairment (CI), whose incidence is greater among ethnic/racial minorities, is a significant barrier to asthma self-management (SM) behaviors and outcomes in older adults. The aim of this study was to examine the relationships between CI, assessed using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Hispanic participants. Additionally, we evaluated whether using two different MoCA cutoff scores influenced the association between CI and study outcomes. Methods: Baseline cross-sectional data were extracted from a longitudinal study of older adults with asthma (N=165) age≥ 60 years and used for analysis. Cognition was assessed using the MoCA. Asthma control, asthma-related quality of life (QOL), inhaled corticosteroid (ICS) dosing, and ICS adherence were assessed using self-report. The inhaler technique was observed and rated. Results: Using established MoCA cutoff scores of 23 and 26 yielded 45% and 74% CI rates, respectively. CI, defined using the 23 cutoff score, was significantly associated with worse asthma control (p=.04) and worse ICS adherence (p=.01). With a cutoff score of 26, only asthma-related QOL was significantly associated with CI (p=.03). Race/ethnicity and education did not moderate the relationships between CI and asthma SM behaviors and outcomes. Conclusions: CI in older adults with asthma is associated with important clinical outcomes, but this relationship is influenced by the cutoff score used to define CI.

Keywords: cognition, respiratory, elderly, testing, adherence, validity

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1686 Growth Inhibition of Candida Albicans Strains Co-Cultured with Lactobacillus Strains in a Cereal Medium

Authors: Richard Nyanzi, Maupi E. Letsoalo, Jacobus N. Eloff, Piet J. Jooste

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Candida albicans naturally occurs in the gastrointestinal tract (GIT) of more than 50% of humans. Overgrowth of the fungus causes several forms of candidiasis including oral thrush. Overgrowth tends to occur in immunocompromised humans such as diabetic, cancer and HIV patients. Antifungal treatment is available, but not without shortcomings. In this study, inhibitory activity of five probiotic Lactobacillus strains was demonstrated against the growth of seven clinical strains of Candida albicans by co-culturing of the organisms in a maize gruel (MG) medium. Phenotypic tests, molecular techniques and phylogenetic analysis have enabled precise identification of the organisms used in the study. The quantitative pour plate technique was used to enumerate colonies of the yeasts and the lactobacilli and the Kruskal-Wallis test and ANOVA tests were employed to compare the distributions of the colonies of the organisms. The cereal medium, containing added carbon sources, was inoculated with a Candida and a Lactobacillus strain in combination and incubated at 37 °C for 168 h. Aliquots were regularly taken and subjected to pH determination and colony enumeration. Certain Lactobacillus strains proved to be inhibitory and also lethal to some Candida albicans strains. A low pH due to Lactobacillus acid production resulted in significant low Candida colony counts. Higher Lactobacillus colony counts did not necessarily result in lower Candida counts suggesting that inhibitory factors besides low pH and competitive growth by lactobacilli contributed to the reduction in Candida counts. Such anti-Candida efficacy however needs to be confirmed by in vivo studies.

Keywords: candida albicans, oral thrush, candidiasis, lactobacillus, probiotics

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1685 The Therapeutic Rise of Turmeric: From Spice to Medicine

Authors: Merzak Siham, Benguerine Zohra, Si Tayeb Fatima, Bouzian Chaimaa Affaf, Jou Siham, Belkessam Nafissa

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Introduction: Medicinal plants, particularly spices, are essential for pharmacological research due to their health benefits. This study focuses on Curcuma longa, a spice recognized for its therapeutic properties. Materials and Methods: This study is based on a thorough search conducted on Google Scholar, PubMed, and ScienceDirect. From an initial selection of 25 articles, five were chosen to extract relevant information on Curcuma longa. Results and Discussions: Clinical studies have indicated that curcumin is well tolerated at doses up to 12 g/day. Its anti-rheumatic efficacy was compared to phenylbutazone in 18 individuals. Each participant received a daily dose of either 1200 mg of curcumin or 300 mg of phenylbutazone for 2 weeks. Curcumin was well tolerated at this dose and demonstrated activity comparable to phenylbutazone. Additionally, a study on 62 patients showed that curcumin sustainably relieved symptoms without toxicity. Its effects included reduced itching, lesions, and pain. In ten volunteers, administering 500 mg of curcumin for seven days resulted in a 33% decrease in lipid peroxidation, a 29% increase in HDL cholesterol, and a 12% decrease in total cholesterol. It is important to note that curcumin is a potent, selective inhibitor of phosphorylase kinase, an increased marker in psoriasis. Conclusion: Curcumin is promising as a future drug for various diseases, but its bioavailability must be improved through techniques such as nano encapsulation. Additionally, exploring chemical derivatives of curcumin could lead to more potent and targeted molecules.

Keywords: turmeric, spice, medicinal plants, pharmacological activities.

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1684 Diagnostic Value of Different Noninvasive Criteria of Latent Myocarditis in Comparison with Myocardial Biopsy

Authors: Olga Blagova, Yuliya Osipova, Evgeniya Kogan, Alexander Nedostup

Abstract:

Purpose: to quantify the value of various clinical, laboratory and instrumental signs in the diagnosis of myocarditis in comparison with morphological studies of the myocardium. Methods: in 100 patients (65 men, 44.7±12.5 years) with «idiopathic» arrhythmias (n = 20) and dilated cardiomyopathy (DCM, n = 80) were performed 71 endomyocardial biopsy (EMB), 13 intraoperative biopsy, 5 study of explanted hearts, 11 autopsy with virus investigation (real-time PCR) of the blood and myocardium. Anti-heart antibodies (AHA) were also measured as well as cardiac CT (n = 45), MRI (n = 25), coronary angiography (n = 47). The comparison group included of 50 patients (25 men, 53.7±11.7 years) with non-inflammatory heart diseases who underwent open heart surgery. Results. Active/borderline myocarditis was diagnosed in 76.0% of the study group and in 21.6% of patients of the comparison group (p < 0.001). The myocardial viral genome was observed more frequently in patients of comparison group than in study group (group (65.0% and 40.2%; p < 0.01. Evaluated the diagnostic value of noninvasive markers of myocarditis. The panel of anti-heart antibodies had the greatest importance to identify myocarditis: sensitivity was 81.5%, positive and negative predictive value was 75.0 and 60.5%. It is defined diagnostic value of non-invasive markers of myocarditis and diagnostic algorithm providing an individual assessment of the likelihood of myocarditis is developed. Conclusion. The greatest significance in the diagnosis of latent myocarditis in patients with 'idiopathic' arrhythmias and DCM have AHA. The use of complex of noninvasive criteria allows estimate the probability of myocarditis and determine the indications for EMB.

Keywords: myocarditis, "idiopathic" arrhythmias, dilated cardiomyopathy, endomyocardial biopsy, viral genome, anti-heart antibodies

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1683 Robust Heart Rate Estimation from Multiple Cardiovascular and Non-Cardiovascular Physiological Signals Using Signal Quality Indices and Kalman Filter

Authors: Shalini Rankawat, Mansi Rankawat, Rahul Dubey, Mazad Zaveri

Abstract:

Physiological signals such as electrocardiogram (ECG) and arterial blood pressure (ABP) in the intensive care unit (ICU) are often seriously corrupted by noise, artifacts, and missing data, which lead to errors in the estimation of heart rate (HR) and incidences of false alarm from ICU monitors. Clinical support in ICU requires most reliable heart rate estimation. Cardiac activity, because of its relatively high electrical energy, may introduce artifacts in Electroencephalogram (EEG), Electrooculogram (EOG), and Electromyogram (EMG) recordings. This paper presents a robust heart rate estimation method by detection of R-peaks of ECG artifacts in EEG, EMG & EOG signals, using energy-based function and a novel Signal Quality Index (SQI) assessment technique. SQIs of physiological signals (EEG, EMG, & EOG) were obtained by correlation of nonlinear energy operator (teager energy) of these signals with either ECG or ABP signal. HR is estimated from ECG, ABP, EEG, EMG, and EOG signals from separate Kalman filter based upon individual SQIs. Data fusion of each HR estimate was then performed by weighing each estimate by the Kalman filters’ SQI modified innovations. The fused signal HR estimate is more accurate and robust than any of the individual HR estimate. This method was evaluated on MIMIC II data base of PhysioNet from bedside monitors of ICU patients. The method provides an accurate HR estimate even in the presence of noise and artifacts.

Keywords: ECG, ABP, EEG, EMG, EOG, ECG artifacts, Teager-Kaiser energy, heart rate, signal quality index, Kalman filter, data fusion

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1682 Role of Pakistani Physicians in the Pharmacotherapy of Obesity

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

Abstract:

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

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

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1681 The Clustering of Multiple Sclerosis Subgroups through L2 Norm Multifractal Denoising Technique

Authors: Yeliz Karaca, Rana Karabudak

Abstract:

Multifractal Denoising techniques are used in the identification of significant attributes by removing the noise of the dataset. Magnetic resonance (MR) image technique is the most sensitive method so as to identify chronic disorders of the nervous system such as Multiple Sclerosis. MRI and Expanded Disability Status Scale (EDSS) data belonging to 120 individuals who have one of the subgroups of MS (Relapsing Remitting MS (RRMS), Secondary Progressive MS (SPMS), Primary Progressive MS (PPMS)) as well as 19 healthy individuals in the control group have been used in this study. The study is comprised of the following stages: (i) L2 Norm Multifractal Denoising technique, one of the multifractal technique, has been used with the application on the MS data (MRI and EDSS). In this way, the new dataset has been obtained. (ii) The new MS dataset obtained from the MS dataset and L2 Multifractal Denoising technique has been applied to the K-Means and Fuzzy C Means clustering algorithms which are among the unsupervised methods. Thus, the clustering performances have been compared. (iii) In the identification of significant attributes in the MS dataset through the Multifractal denoising (L2 Norm) technique using K-Means and FCM algorithms on the MS subgroups and control group of healthy individuals, excellent performance outcome has been yielded. According to the clustering results based on the MS subgroups obtained in the study, successful clustering results have been obtained in the K-Means and FCM algorithms by applying the L2 norm of multifractal denoising technique for the MS dataset. Clustering performance has been more successful with the MS Dataset (L2_Norm MS Data Set) K-Means and FCM in which significant attributes are obtained by applying L2 Norm Denoising technique.

Keywords: clinical decision support, clustering algorithms, multiple sclerosis, multifractal techniques

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1680 Management Practices in Hypertension: Results of Win-Over-A Pan India Registry

Authors: Abhijit Trailokya, Kamlesh Patel

Abstract:

Background: Hypertension is a common disease seen in clinical practice and is associated with high morbidity and mortality. Many patients require combination therapy for the management of hypertension. Objective: To evaluate co-morbidities, risk factors and management practices of hypertension in Indian population. Material and methods: A total of 1596 hypertensive adult patients received anti-hypertensive medications were studied in a cross-sectional, multi-centric, non-interventional, observational registry. Statistical analysis: Categories or nominal data was expressed as numbers with percentages. Continuous variables were analyzed by descriptive statistics using mean, SD, and range Chi square test was used for in between group comparison. Results: The study included 73.50% males and 26.50% females. Overweight (50.50%) and obesity (30.01%) was common in the hypertensive patients (n=903). A total of 54.76% patients had history of smoking. Alcohol use (33.08%), sedentary life style (32.96%) and history of tobacco chewing (17.92%) were the other lifestyle habits of hypertensive patients. Diabetes (36.03%) and dyslipidemia (39.79%) history was common in these patients. Family history of hypertension and diabetes was seen in 82.21% and 45.99% patients respectively. Most (89.16%) patients were treated with combination of antihypertensive agents. ARBs were the by far most commonly used agents (91.98%) followed by calcium channel blockers (68.23%) and diuretics (60.21%). ARB was the most (80.35%) preferred agent as monotherapy. ARB was also the most common agent as a component of dual therapy, four drug and five drug combinations. Conclusion: Most of the hypertensive patients need combination treatment with antihypertensive agents. ARBs are the most preferred agents as monotherapy for the management of hypertension. ARBs are also very commonly used as a component of combination therapy during hypertension management.

Keywords: antihypertensive, hypertension, management, ARB

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1679 Patterns, Triggers, and Predictors of Relapses among Children with Steroid Sensitive Idiopathic Nephrotic Syndrome at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Authors: Emmanuel Ademola Anigilaje, Ibraheem Ishola

Abstract:

Background: Childhood steroid-sensitive idiopathic nephrotic syndrome (SSINS) is plagued with relapses that contribute to its morbidity and the cost of treatment. Materials and Methods: This is a retrospective review of relapses among children with SSINS at the University of Abuja Teaching Hospital from January 2016 to July 2020. Triggers related to relapse incidents were noted. Chi-square test was deployed for predictors (factors at the first clinical presentations that associate with subsequent relapses) of relapses. Predictors with p-values of less than 0.05 were considered significant and 95% confidence intervals (CI) and odd ratio (OR) were described. Results: Sixty SSINS comprising 52 males (86.7%), aged 23 months to 18 years, with a mean age of 7.04±4.16 years were studied. Thirty-eight (63.3%) subjects had 126 relapses including infrequent relapses in 30 (78.9%) and frequent relapses in 8 (21.1%). The commonest triggers were acute upper respiratory tract infections (68, 53.9%) and urinary tract infections (UTIs) in 25 (19.8%) relapses. In 4 (3.2%) relapses, no trigger was identified. The time-to-first relapse ranged 14 days to 365 days with a median time of 60 days. The significant predictors were hypertension (OR=3.4, 95% CI; 1.04-11.09, p=0.038), UTIs (OR=9.9, 95% CI; 1.16-80.71, p= 0.014), malaria fever (OR=8.0, 95% CI; 2.45-26.38, p˂0.001), micro-haematuria (OR=4.9, 95% CI; 11.58-15.16, p=0.004), elevated serum creatinine (OR=12.3, 95%CI; 1.48-101.20, p=0.005) and hypercholesterolaemia (OR=4.1, 95%CI; 1.35-12.63, p=0.011). Conclusion: While the pathogenesis of relapses remains unknown, it is prudent to consider relapse-specific preventive strategies against triggers and predictors of relapses in our setting.

Keywords: Patterns, triggers, predictors, steroid-sensitive idiopathic nephrotic syndrome, relapses, Nigeria

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1678 Dry Needling Treatment in 38 Cases of Chronic Sleep Disturbance

Authors: P. Gao, Z. Q. Li, Y. G. Jin

Abstract:

In the past 10 years, computers and cellphones have become one of the most important factors in our lives, and one which has a tremendously negative impact on our muscles. Muscle tension may be one of the causes of sleep disturbance. Tension in the shoulders and neck can affect blood circulation to the muscles. This research uses a dry needling treatment to reduce muscle tension in order to determine if the strain in the head and shoulders can influence sleep duration. All 38 patients taking part in the testing suffered from tinnitus and have been experiencing disturbed sleep for at least one to five years. Even after undergoing drug therapy treatments and traditional acupuncture therapies, their sleep disturbances have not shown any improvement. After five to 10 dry needling treatments, 24 of the patients reported an improvement in their sleep duration. Five patients considered themselves to be completely recovered, while 12 patients experienced no improvement. This study investigated these pathogenic and therapeutic problems. The standard treatment for sleep disturbances is drug-based therapy; the results of most standard treatments are unfortunately negative. The result of this clinical research has demonstrated that: The possible cause of sleep disturbance for a lot of patients is the result of tensions in the neck and shoulder muscles. Blood circulation to those muscles is also influenced by the duration of sleep. Hypertonic neck and shoulder muscles are considered to impact sleeping patterns and lead to disturbed sleep. Poor posture, often adopted while speaking on the phone, is one of the main causes of hypertonic neck and shoulder muscle problems. The dry needling treatment specifically focuses on the release of muscle tension.

Keywords: dry needling, muscle tension, sleep duration, hypertonic muscles

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1677 Psychological Characteristic Patients with Takotsubo - Etiology of Stress and Family Functioning

Authors: Treder Natalia, Siemiński Mariusz

Abstract:

Takotsubo cardiomyopathy (TC) is a recently defined clinical entity. First described by Japanese researchers, today is diagnosed worldwide in 1-2% of patients admitted with the preliminary diagnosis of Acute Coronary Syndrome. The etiology of takotsubo cardiomyopathy remains still largely unknown. Currently, the most likely cause of takotsubo is direct cytotoxicity caused by catecholamine surge triggered by emotional stress. There is a strong relation between recent severe emotional stress and TC. The aim of this study was to analysis the role of stress and personality as a risk factor of TT. The presented research involves 35 people who are diagnosed TC. All patients were women, mean age 60 years. The methods used in the research are popular psychological tests: Perceived Stress Scale, DS14 scale to measure type D personality, The Neo-Five Factor Inventory of Personality and psychological interview. The obtained results prove that stress events may directly precede or even release TC. The stressful events occurred directly before the symptoms in 75% examined. 65% assessed their family life as very stressful. Examiners have also a high level of experienced stress. Only 25% of the TC were classified as having type D personality but they have a high level of negative affectivity. The subjects had a high level of extraversion, openness to experiences and an average level of neuroticism. The results suggested that such a type of personality profile may predispose to the development of takotsubo cardiomyopathy. Patients with TT are the individuals who reveal joint tendency to the experience of negative emotions and very stressful family life.

Keywords: stress, personality trails, familiar problems, Takotsubo cardiomyopathy

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1676 Estimation of Dynamic Characteristics of a Middle Rise Steel Reinforced Concrete Building Using Long-Term

Authors: Fumiya Sugino, Naohiro Nakamura, Yuji Miyazu

Abstract:

In earthquake resistant design of buildings, evaluation of vibration characteristics is important. In recent years, due to the increment of super high-rise buildings, the evaluation of response is important for not only the first mode but also higher modes. The knowledge of vibration characteristics in buildings is mostly limited to the first mode and the knowledge of higher modes is still insufficient. In this paper, using earthquake observation records of a SRC building by applying frequency filter to ARX model, characteristics of first and second modes were studied. First, we studied the change of the eigen frequency and the damping ratio during the 3.11 earthquake. The eigen frequency gradually decreases from the time of earthquake occurrence, and it is almost stable after about 150 seconds have passed. At this time, the decreasing rates of the 1st and 2nd eigen frequencies are both about 0.7. Although the damping ratio has more large error than the eigen frequency, both the 1st and 2nd damping ratio are 3 to 5%. Also, there is a strong correlation between the 1st and 2nd eigen frequency, and the regression line is y=3.17x. In the damping ratio, the regression line is y=0.90x. Therefore 1st and 2nd damping ratios are approximately the same degree. Next, we study the eigen frequency and damping ratio from 1998 after 3.11 earthquakes, the final year is 2014. In all the considered earthquakes, they are connected in order of occurrence respectively. The eigen frequency slowly declined from immediately after completion, and tend to stabilize after several years. Although it has declined greatly after the 3.11 earthquake. Both the decresing rate of the 1st and 2nd eigen frequencies until about 7 years later are about 0.8. For the damping ratio, both the 1st and 2nd are about 1 to 6%. After the 3.11 earthquake, the 1st increases by about 1% and the 2nd increases by less than 1%. For the eigen frequency, there is a strong correlation between the 1st and 2nd, and the regression line is y=3.17x. For the damping ratio, the regression line is y=1.01x. Therefore, it can be said that the 1st and 2nd damping ratio is approximately the same degree. Based on the above results, changes in eigen frequency and damping ratio are summarized as follows. In the long-term study of the eigen frequency, both the 1st and 2nd gradually declined from immediately after completion, and tended to stabilize after a few years. Further it declined after the 3.11 earthquake. In addition, there is a strong correlation between the 1st and 2nd, and the declining time and the decreasing rate are the same degree. In the long-term study of the damping ratio, both the 1st and 2nd are about 1 to 6%. After the 3.11 earthquake, the 1st increases by about 1%, the 2nd increases by less than 1%. Also, the 1st and 2nd are approximately the same degree.

Keywords: eigenfrequency, damping ratio, ARX model, earthquake observation records

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1675 Bioinformatic Design of a Non-toxic Modified Adjuvant from the Native A1 Structure of Cholera Toxin with Membrane Synthetic Peptide of Naegleria fowleri

Authors: Frida Carrillo Morales, Maria Maricela Carrasco Yépez, Saúl Rojas Hernández

Abstract:

Naegleria fowleri is the causative agent of primary amebic meningoencephalitis, this disease is acute and fulminant that affects humans. It has been reported that despite the existence of therapeutic options against this disease, its mortality rate is 97%. Therefore, the need arises to have vaccines that confer protection against this disease and, in addition to developing adjuvants to enhance the immune response. In this regard, in our work group, we obtained a peptide designed from the membrane protein MP2CL5 of Naegleria fowleri called Smp145 that was shown to be immunogenic; however, it would be of great importance to enhance its immunological response, being able to co-administer it with a non-toxic adjuvant. Therefore, the objective of this work was to carry out the bioinformatic design of a peptide of the Naegleria fowleri membrane protein MP2CL5 conjugated with a non-toxic modified adjuvant from the native A1 structure of Cholera Toxin. For which different bioinformatics tools were used to obtain a model with a modification in amino acid 61 of the A1 subunit of the CT (CTA1), to which the Smp145 peptide was added and both molecules were joined with a 13-glycine linker. As for the results obtained, the modification in CTA1 bound to the peptide produces a reduction in the toxicity of the molecule in in silico experiments, likewise, the prediction in the binding of Smp145 to the receptor of B cells suggests that the molecule is directed in specifically to the BCR receptor, decreasing its native enzymatic activity. The stereochemical evaluation showed that the generated model has a high number of adequately predicted residues. In the ERRAT test, the confidence with which it is possible to reject regions that exceed the error values was evaluated, in the generated model, a high score was obtained, which determines that the model has a good structural resolution. Therefore, the design of the conjugated peptide in this work will allow us to proceed with its chemical synthesis and subsequently be able to use it in the mouse meningitis protection model caused by N. fowleri.

Keywords: immunology, vaccines, pathogens, infectious disease

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1674 Attitudes towards People with Disability and Career Interest in Disability Studies: A Study of Clinical Medical Students of a Tertiary Institution in Southeastern Nigeria

Authors: Ebele V. Okoli, Emmanuel Nwobi, Dozie Ezechukwu, Ijeoma Itanyi

Abstract:

One in seven people worldwide suffer from a disability. 80% of people with disabilities live in developing countries. Negative attitudes and misconceptions among health-care providers constitute barri¬ers to optimal health care for people with disabilities. This underscores the relevance of a study of the attitude of Nigerian medical students towards disability and their willingness to work in the disability sector. This was a descriptive cross-sectional study conducted among 254 penultimate and final year medical students of a university in southeastern Nigeria. The mean age of the students was 24.8 ± 3.12 years. Majority of the students were male (75.2%), single (96.9%), of the Igbo tribe (86.6%), Christian (97.6%) and grew up in urban areas (68.1%). Results indicated that the medical students had a predominantly positive attitude towards people with disability as 73.8% had a positive attitude and mean attitude score was 67.03 ± 0.14 (positive attitude = 61 – 120, negative attitude = 0 - 60). Chi-square analysis did not show any significant effect of demographic and social factors on the students’ attitude towards People with Disabilities. The students were mostly willing to work in areas that address the challenges of people with disability (70.4%) but a greater proportion had never heard about Disability Studies (67.5%). About a third of the students (33.2%) would like to travel abroad to practice in the disability sector. Conclusions: The students generally had a positive attitude towards people with disability and a greater percentage were willing to work in the disability sector in their future career. About two-thirds had however, never heard about disability studies. There was some potential for brain drain among the students as a third of the population intended to practice abroad on graduation.

Keywords: attitudes, career interest, disability, medical students

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1673 Prevalence and Associated Factors of Chronic Energy Malnutrition among Human Immune Deficiency Virus Infected Pregnant Women in Health Centers of Addis Ababa, Ethiopia

Authors: Getachew Adugna

Abstract:

Background: Chronic energy malnutrition and human immune deficiency virus among pregnant women are highly prevalent in Sub-Saharan Africa, and they are interrelated in a vicious cycle. However, the prevalence of chronic energy malnutrition and its determinant factors among human immune deficiency virus-positive pregnant women is not well studied in Ethiopia and Addis Ababa in particular. Objective: To determine the prevalence & associated factors of chronic energy malnutrition among human immune deficiency virus-positive pregnant women in health centres of Addis Ababa Ethiopia. Methods: An institution-based cross-sectional study was conducted and a systematic random sampling technique was used to select study subjects. A total of 253 study subjects were enrolled in the study—a structured and pre-tested questionnaire collected sociodemographic, maternal health-related, and nutritional-related variables. MUAC measurements were taken and medical charts were reviewed. Bi-variable and multi-variable logistic regression analyses were used to assess the effect of different factors on chronic energy malnutrition. Result: The overall prevalence of chronic energy malnutrition was 32.0%. It was significantly associated with dietary counselling (AOR: 0.062; 95%CI: 0.007, 0.549), CD4 level (AOR: 0.219; 95%CI: 0.025, 1.908), and clinical stage (AOR: 0.127; 95%CI: 0.053, 0.305). Conclusions: The prevalence of chronic energy malnutrition among Human Immune deficiency virus-infected pregnant women in Addis Ababa was high and Nutritional Intervention should be an integral part of the HIV care program.

Keywords: chronic energy malnutrition, HIV, MUAC, Addis Ababa

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1672 Orthostatic Hypotension among Patients Aged above 65 Years Admitted to Medical Wards in a Tertiary Care Hospital, Sri Lanka

Authors: G. R. Constantine, M.C.K. Thilakasiri, V.S. Mohottala, T.V. Soundaram, D.S. Rathnayake, E.G.H.E. De Silva, A.L.S. Mohamed, V.R. Weerasekara

Abstract:

Orthostatic hypotension is prevalent in the elderly population, and it is an important risk factor contributing to falls in the elderly. This study aims to evaluate the prevalence of orthostatic hypotension in hospitalized elderly patients, changes in blood pressure during the hospital stay, morbidities associated with it and its association with falls in the elderly. A cross-sectional descriptive study was conducted in the National Hospital of Sri Lanka (NHSL) in a sample of 120 patients of age 65 years or above who were admitted to the medical wards. The demographic, clinical data was obtained by an interviewer-administered questionnaire. Two validated questionnaires were used to assess symptoms and effects of orthostatic hypotension and risk factors associated with falls. Orthostatic hypotension on admission and after 3 days of hospital stay was measured by bed-side mercury sphygmomanometer. Prevalence of orthostatic hypotension among the study population was 63.3%(76 patients). But no significant change in the orthostatic hypotension noted after 3 days of hospital admission (SND 0.61, SE= 5.59, p=0.27). There was no significant association found between orthostatic hypotension and its symptoms (dizziness and vertigo, vision problems, malaise, fatigue, poor concentration, neck stiffness), impact on standing or walking and non-communicable diseases. Falls were experienced by 27.5 % (33 patients) of the study population and prevalence of patients with orthostatic hypotension who had experienced falls was 25.9% (28 patients). In conclusions, orthostatic hypotension is more prevalent among elderly patients, but It wasn’t associated with symptoms, and non-communicable diseases, or as a risk factor for falls in elderly.

Keywords: orthostatic hypotension, elderly falls, emergency geriatric, Sri Lanka

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1671 The Effects of Three Months of HIIT on Plasma Adiponectin on Overweight College Men

Authors: M. J. Pourvaghar, M. E. Bahram, M. Sayyah, Sh. Khoshemehry

Abstract:

Adiponectin is a cytokine secreted by the adipose tissue that functions as an anti-inflammatory, antiathrogenic and anti-diabetic substance. Its density is inversely correlated with body mass index. The purpose of this research was to examine the effect of 12 weeks of high intensity interval training (HIIT) with the level of serum adiponectin and some selected adiposity markers in overweight and fat college students. This was a clinical research in which 24 students with BMI between 25 kg/m2 to 30 kg/m2. The sample was purposefully selected and then randomly assigned into two groups of experimental (age =22.7±1.5 yr.; weight = 85.8±3.18 kg and height =178.7±3.29 cm) and control (age =23.1±1.1 yr.; weight = 79.1±2.4 kg and height =181.3±4.6 cm), respectively. The experimental group participated in an aerobic exercise program for 12 weeks, three sessions per weeks at a high intensity between 85% to 95% of maximum heart rate (considering the over load principle). Prior and after the termination of exercise protocol, the level of serum adiponectin, BMI, waist to hip ratio, and body fat percentages were calculated. The data were analyzed by using SPSS: PC 16.0 and statistical procedure such as ANCOVA, was used. The results indicated that 12 weeks of intensive interval training led to the increase of serum adiponectin level and decrease of body weight, body fat percent, body mass index and waist to hip ratio (P < 0.05). Based on the results of this research, it may be concluded that participation in intensive interval training for 12 weeks is a non-invasive treatment to increase the adiponectin level while decreasing some of the anthropometric indices associated with obesity or being overweight.

Keywords: adiponectin, cardiovascular, interval, overweight, training

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