Search results for: day hospital care

Authors: Rana Praween Kumar

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Preterm-low birth weight delivery is a major cause of infant morbidity and mortality in developing countries and has been linked to poor periodontal health during pregnancy. Gingivitis and chronic periodontitis are highly prevalent chronic inflammatory oral diseases. The detection and diagnosis of these common diseases is a fundamentally important component of oral health care. This study is intended to investigate predisposing and enabling factors as determinants of oral health indicators in pregnancy as well as the association between periodontal problems during pregnancy with age and socio economic status of the individual. A community –based prospective cohort study will be conducted in Jamshedpur, Jharkhand, India among pregnant women using completed interviews and a full mouth oral clinical examination using the CPITN (Community Periodontal Index of Treatment Need) and OHI-S (Simplified Oral Hygiene) indices with adequate sample size and informed consent to the patient following proper inclusion and exclusion criteria. Multiple logistic regression analyses will be used to identify independent determinants of periodontal problems and use of dental services during pregnancy. Analysis of covariance (ANCOVA) will be used to investigate the relationship between periodontal problems with the age and socioeconomic status. The result will help in proper monitoring of periodontal health during pregnancy encouraging the delivery of healthy child and the maintenance of proper health of the mother.

Keywords: infant, periodontal problems, pregnancy, pre-term-low birth weight delivery

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Authors: S. Abera, T. Gidey, W. Terefe

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Introduction: Testing for HIV is the key entry point to HIV prevention, treatment, and care and support services. Hence, predictive data mining techniques can greatly benefit to analyze and discover new patterns from huge datasets like that of EDHS 2011 data. Objectives: The objective of this study is to build a predictive modeling for HIV testing and identify determinants of HIV testing for adults with age above fourteen years using data mining techniques. Methods: Cross-Industry Standard Process for Data Mining (CRISP-DM) was used to predict the model for HIV testing and explore association rules between HIV testing and the selected attributes among adult Ethiopians. Decision tree, Naïve-Bayes, logistic regression and artificial neural networks of data mining techniques were used to build the predictive models. Results: The target dataset contained 30,625 study participants; of which 16, 515 (53.9%) were women. Nearly two-fifth; 17,719 (58%), have never been tested for HIV while the rest 12,906 (42%) had been tested. Ethiopians with higher wealth index, higher educational level, belonging 20 to 29 years old, having no stigmatizing attitude towards HIV positive person, urban residents, having HIV related knowledge, information about family planning on mass media and knowing a place where to get testing for HIV showed an increased patterns with respect to HIV testing. Conclusion and Recommendation: Public health interventions should consider the identified determinants to promote people to get testing for HIV.

Keywords: data mining, HIV, testing, ethiopia

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Authors: Ganratchakan Ninlawan, Witthaya Mekhum

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The objective of this research was to investigate motivation needs in working of the employees in Rayong Province at Panakom Co., Ltd. The sample group included 59 operational employees of Panakom Co., Ltd divided into 2 main parts to complete the questionnaires. Part 1 dealt with personal information of the staff in the form of checklist questions. Part 2 was about the motivation needs in working in the form of 5 rating scales. The data were analyzed to find frequency, percentage, arithmetic mean, and SD with the results as follows. They reported their working conditions in the moderate level while the first aspect was on the regulation of the Working Support Department. The second rated aspect was on the modern facilities and office stationeries followed by the working environment such as lighting, temperature, sound system, and atmosphere. The last aspect was on the provision of enough working equipment. On the part of work stability and work progress, they rated this aspect at the moderate level with the details below. The first aspect was their satisfaction in work rotation followed by the encouragement in joining training and seminar to increase working knowledge. The third aspect was their perception on the progress of their careers. The last aspect was on the chance to get promoted in special cases. On the payment and fringe benefit, they rated this part in the moderate level with the highest aspect being on the provided fringe benefit such as health care. The second aspect was on the suitable salary compared to their knowledge and proficiency. The third aspect was on the satisfaction on the activities and seminars provided by the company. Finally, the last aspect was on the sufficient salary when compared with the current cost of living.

Keywords: motivation needs, working, employees, Rayong Province

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Authors: Rowland R. Ogunrinde, Yusmadi Y. Jusoh, Noraini Che Pa, Wan Nurhayati W. Rahman, Azizol B. Abdullah

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Enterprise Applications (EAs) aid the organizations achieve operational excellence and competitive advantage. Over time, most Small and Medium Enterprises (SMEs), which are known to be the major drivers of most thriving global economies, use the costly on-premise versions of these applications thereby making business difficult to competitively thrive in the same market environment with their large enterprise counterparts. The advent of cloud computing presents the SMEs an affordable offer and great opportunities as such EAs can be cloud-hosted and rented on a pay-per-use basis which does not require huge initial capital. However, as there are numerous Cloud Service Providers (CSPs) offering EAs as Software-as-a-Service (SaaS), there is a challenge of choosing a suitable provider with Quality of Service (QoS) that meet the organizations’ customized requirements. The proposed model takes care of that and goes a step further to select the most affordable among a selected few of the CSPs. In the earlier stage, before developing the instrument and conducting the pilot test, the researchers conducted a structured interview with three experts to validate the proposed model. In conclusion, the validity and reliability of the instrument were tested through experts, typical respondents, and analyzed with SPSS 22. Results confirmed the validity of the proposed model and the validity and reliability of the instrument.

Keywords: cloud service provider, enterprise application, quality of service, selection criteria, small and medium enterprise

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Authors: R. Alramyan, S. Alsalamah, R. Alrashed, R. Alakel, F. Altheyeb, M. Alessa

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Background: Nutritional support with total parenteral nutrition (TPN) is usually commenced with hematopoietic stem cell transplantation (HSCT) patients. However, it has its benefits and risks. Complications related to central venous catheter such as infections, and metabolic disturbances, including abnormal liver function, is usually of concern in such patients. Methods: A retrospective charts review of all pediatric patients who underwent HSCT between the period 2015-2018 in a tertiary hospital in Riyadh, Saudi Arabia. Patients' demographics, types of conditioning, type of nutrition, and patients' outcomes were collected. Statistical analysis was conducted using SPSS version 22. Frequencies and percentages were used to describe categorical variables. Mean, and standard deviation were used for continuous variables. A P value of less than 0.05 was considered as statically significant. Results: a total of 162 HSCTs were identified during the period mentioned. Indication of allogenic transplant included hemoglobinopathy in 50 patients (31%), acute lymphoblastic leukemia in 21 patients (13%). TPN was used in 96 patients (59.30%) for a median of 14 days, nasogastric tube feeding (NGT) in 16 (9.90%) patients for a median of 11 days, and 71 of patients (43.80%) were able to tolerate oral feeding. Out of the 96 patients (59.30%) who were dependent on TPN, 64 patients (66.7%) had severe mucositis in comparison to 17 patients (25.8%) who were either on NGT or tolerated oral intake. (P-value= 0.00). Sinusoidal obstruction syndrome (SOS) was seen in 14 patients (14.6%) who were receiving TPN compared to none in non-TPN patients (P=value 0.001). Moreover, majority of patients who had SOS received myeloablative conditioning therapy for non-malignant disease (hemoglobinopathy). However, there were no statistically significant differences in Graft-vs-Host Disease (both acute and chronic), bacteremia, and patient outcome between both groups. Conclusions: Nutritional support using TPN is used in majority of patients, especially post-myeloablative conditioning associated with severe mucositis. TPN was associated with VOD, especially in hemoglobinopathy patients who received myeloablative therapy. This may emphasize on use of preventative measures such as fluid restriction, use of diuretics, or defibrotide in high-risk patients.

Keywords: hematopoeitic stem cell transplant, HSCT, stem cell transplant, sinusoidal obstruction syndrome, total parenteral nutrition

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Authors: Nicholas Bayfield, Liam Bibo, Kaushelandra Rathore, Lucas Sanders, Mark Newman

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INTRODUCTION: Surgical pulmonary embolectomy is an established therapy for acute pulmonary embolism causing right heart dysfunction and haemodynamic instability. Massive intraoperative airway haemorrhage is a rare complication of pulmonary embolectomy. We present our institutional experience with massive airway haemorrhage complicating pulmonary embolectomy and discuss optimal therapeutic strategies. METHODS: A retrospective review of emergent surgical pulmonary embolectomy patients was undertaken. Cases complicated by massive intra-operative airway haemorrhage were identified. Intra- and peri-operative management strategies were analysed and discussed. RESULTS: Of 76 patients undergoing emergent or salvage pulmonary embolectomy, three cases (3.9%) of massive intraoperative airway haemorrhage were identified. Haemorrhage always began on weaning from cardiopulmonary bypass. Successful management strategies involved intraoperative isolation of the side of bleeding, occluding the affected airway with an endobronchial blocker, institution of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and reversal of anticoagulation. Running the ECMO without heparinisation allows coagulation to occur. Airway haemorrhage was controlled within 24 hours of operation in all patients, allowing re-institution of dual lung ventilation and decannulation from ECMO. One case in which positive end-expiratory airway pressure was trialled initially was complicated by air embolism. Although airway haemorrhage was controlled successfully in all cases, all patients died in-hospital for reasons unrelated to the airway haemorrhage. CONCLUSION: Massive intraoperative airway haemorrhage during pulmonary embolectomy is a rare complication with potentially catastrophic outcomes. Re-perfusion alveolar and capillary injury is the likely aetiology. With a systematic approach to management, airway haemorrhage can be well controlled intra-operatively and often resolves within 24 hours. Stopping blood flow to the pulmonary arteries and support of oxygenation by the institution of VA ECMO is important. This management has been successful in our 3 cases.

Keywords: pulmonary embolectomy, cardiopulmonary bypass, cardiac surgery, pulmonary embolism

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Authors: N. A. D. P. Niwunhella, W. G. R. C. K. Sirisena

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Appendicitis is one of the most encountered abdominal emergencies worldwide. Proper clinical diagnosis and appendicectomy with minimal post operative complications are therefore priorities. Aim of this study was to ascertain the overall management of acute appendicitis in Sri Lanka in special preference to delayed primary suturing of the surgical site, comparing other local and international treatment outcomes. Data were collected prospectively from 155 patients who underwent appendicectomy following clinical and radiological diagnosis with ultrasonography. Histological assessment was done for all the specimens. All perforated appendices were managed with delayed primary closure. Patients were followed up for 28 days to assess complications. Mean age of patient presentation was 27 years; mean pre-operative waiting time following admission was 24 hours; average hospital stay was 72 hours; accuracy of clinical diagnosis of appendicitis as confirmed by histology was 87.1%; post operative wound infection rate was 8.3%, and among them 5% had perforated appendices; 4 patients had post operative complications managed without re-opening. There was no fistula formation or mortality reported. Current study was compared with previously published data: a comparison on management of acute appendicitis in Sri Lanka vs. United Kingdom (UK). The diagnosis of current study was equally accurate, but post operative complications were significantly reduced - (current study-9.6%, compared Sri Lankan study-16.4%; compared UK study-14.1%). During the recent years, there has been an exponential rise in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. Even though, the diagnostic accuracy without using CT, and treatment outcome of acute appendicitis in this study match other local studies as well as with data compared to UK. Therefore CT usage has not increased the diagnostic accuracy of acute appendicitis significantly. Especially, delayed primary closure may have reduced post operative wound infection rate for ruptured appendices, therefore suggest this approach for further evaluation as a safer and an effective practice in other hospitals worldwide as well.

Keywords: acute appendicitis, computerised tomography, diagnostic accuracy, delayed primary closure

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Authors: Ching-Yuan Chen, Lung-Kwang Pan

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Objective: Back pain is a major health problem costing billions of health budgets annually in Taiwan. Thousands of back pain surgeries are performed annually with up to 40% of patients complaining of back pain at time of post-surgery causing failed back surgery syndrome (FBSS), although diagnosis in these patients may be complex. The aim of study is to assess the feasibility of using bone SPECT-CT imaging to localize the active lesions causing persistent, recurrent or new backache after spine surgery. Materials and Methods: Bone SPECT-CT imaging was performed after the intravenous injection of 20 mCi of 99mTc-MDP for all the patients with diagnosis of FBSS. Patients were evaluated using status of subjectively pain relief, functional improvement and degree of satisfaction by reviewing the medical records and questionnaires in a 2 more years’ follow-up. Results: We enrolled a total of 16 patients were surveyed in our hospital from Jan. 2015 to Dec. 2016. Four people on SPEC/CT imaging ensured significant lesions were undergone a revised surgery (surgical treatment group). The mean visual analogue scale (VAS) decreased 5.3 points and mean Oswestry disability index (ODI) improved 38 points in the surgical group. The remaining 12 on SPECT/CT imaging were diagnosed as no significant lesions then received drug treatment (medical treatment group). The mean VAS only decreased 2 .1 point and mean ODI improved 12.6 points in the medical treatment group. In the posttherapeutic evaluation, the pain of the surgical treatment group showed a satisfactory improvement. In the medical treatment group, 10 of the 12 were also satisfied with the symptom relief while the other 2 did not improve significantly. Conclusions: Findings on SPECT-CT imaging appears to be easily explained the patients' pain. We recommended that SPECT/CT imaging was a feasible and useful clinical tool to improve diagnostic confidence or specificity when evaluating patients with FBSS.

Keywords: failed back surgery syndrome, oswestry disability index, SPECT-CT imaging, 99mTc-MDP, visual analogue scale

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Authors: Lela Pintarić, Iva Rezić, Ana Vrsalović Presečki

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Considering an enormous increase of the use of metal nanoparticles with the exactly defined characteristics, the main goal of this research was to found the optimal and environmental friendly method of their synthesis. The synthesis of the inorganic core-shell nanoparticles was optimized as a model. The core-shell nanoparticles are composed of the enzyme core belted with the metal ions, oxides or salts as a shell. In this research, enzyme urease was the core catalyst and the shell nanoparticle was made of silver. Silver nanoparticles are widespread utilized and some of their common uses are: as an addition to disinfectants to ensure an aseptic environment for the patients, as a surface coating for neurosurgical shunts and venous catheters, as an addition to implants, in production of socks for diabetics and athletic clothing where they improve antibacterial characteristics, etc. Characteristics of synthesized nanoparticles directly depend on of their size, so the special care during this optimization was given to the determination of the size of the synthesized nanoparticles. For the purpose of the above mentioned optimization, sixteen experiments were generated by the Design of Experiments (DoE) method and conducted under various temperatures, with different initial concentration of the silver nitrate and constant concentration of the urease of two separate manufacturers. Synthesized nanoparticles were analyzed by the Nanoparticle Tracking Analysis (NTA) method on Malvern NanoSight NS300. Results showed that the initial concentration of the silver ions does not affect the concentration of the synthesized silver nanoparticles neither their size distribution. On the other hand, temperature of the experiments has affected both of the mentioned values.

Keywords: core-shell nanoparticles, optimization, silver, urease

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Authors: Alexander Rodríguez-Hernández, Arnulfo Rojas-Perez, Liz Diaz-Vazquez

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The rise in consumerism over the past century has resulted in the creation of higher amounts of plasticizers, personal care products and other chemical substances, which enter and accumulate in water systems. Other sources of pollutants in Neotropical regions experience large inputs of nutrients with these pollutants resulting in eutrophication of water which consume large quantities of oxygen, resulting in high fish mortality. This dilemma has created a need for the development of targeted detection in complex matrices and remediation of emerging contaminants. We have synthesized carbon nanoparticles from macro algae (Ulva fasciata) by oxidizing the graphitic carbon network under extreme acidic conditions. The resulting material was characterized by STEM, yielding a spherical 12 nm average diameter nanoparticles, which can be fixed into a polysaccharide aerogel synthesized from the same macro algae. Spectrophotometer analyses show a pH dependent fluorescent behavior varying from 450-620 nm in aqueous media. Heavily oxidized edges provide for easy functionalization with enzymes for a more targeted analysis and remediation technique. Given the optical properties of the carbon base nanoparticles and the numerous possibilities of functionalization, we have developed a selective and robust targeted bio-detection and bioremediation technique for the treatment of emerging contaminants in complex matrices like estuarine embayment.

Keywords: aerogels, carbon nanoparticles, fluorescent, targeted analysis

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Authors: Fergal Fouhy, Alan O’Keeffe, Sean Costelloe, Michael Clarkson

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Background: Sarcoidosis is a systemic, non-infectious disease of unknown aetiology, characterized by non-caseating granulomatous inflammation. The lung is most often affected (90%); however, the condition can affect all organs, including the kidneys. There is limited evidence describing the incidence and characteristics of renal involvement in sarcoidosis. Serum angiotensin-converting enzyme (ACE) is a recognised biomarker used in the diagnosis and monitoring of sarcoidosis. Methods: A single-centre, retrospective cohort study of patients presenting to Cork University Hospital (CUH) in 2015 with first-time elevations of serum ACE was performed. This included an initial database review of ACE and other biochemistry results, followed by a medical chart review to confirm the presence or absence of sarcoidosis and management thereof. Acute kidney injury (AKI) was staged using the AKIN criteria, and chronic kidney disease (CKD) was staged using the KDIGO criteria. Follow-up was assessed over five years tracking serum creatinine, serum calcium, and estimated glomerular filtration rates (eGFR). Results: 119 patients were identified as having a first raised serum ACE in 2015. Seventy-nine male patients and forty female patients were identified. The mean age of patients identified was 47 years old. 11% had CKD at baseline. 18% developed an AKI at least once within the next five years. A further 6% developed CKD during this time period. 13% developed hypercalcemia. The patients within the lowest quartile of serums ACE had an incidence of sarcoidosis of 5%. None of this group developed hypercalcemia, 23% developed AKI, and 7% developed CKD. Of the patients with a serum ACE in the highest quartile, almost all had documented diagnoses of sarcoidosis with an incidence of 96%. 3% of this group developed hypercalcemia, 13% AKI and 3% developed CKD. Conclusions: There was an unexpectedly high incidence of AKI in patients who had a raised serum ACE. Not all patients with a raised serum ACE had a confirmed diagnosis of sarcoidosis. There does not appear to be a relationship between increased serum ACE levels and increased incidence of hypercalcaemia, AKI, and CKD. Ideally, all patients should have biopsy-proven sarcoidosis. This is an initial study that should be replicated with larger numbers and including multiple centres.

Keywords: sarcoidosis, acute kidney injury, chronic kidney disease, hypercalcemia

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Authors: Shanza Akram, Samir Salah, Imran Saleem, Ashraf Alzaabi, Jassim Abdou

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Introduction: 300 million people worldwide are affected by asthma .In UAE, prevalence is around 10% (900,000 people).Patients with persistent symptoms despite using high dose ICS plus a second controller +/- OCS are considered to have severe asthma. Omalizumab (Xolaire) an IgE monoclonal antibody is approved as add on therapy for severe allergic asthma. Objective: To determine the efficacy of omalizumab based on clinical outcomes in our cohort of patient pre and post 52 weeks of treatment to assess safety and tolerability of treatment. Methods: Medical records of patients receiving omalizumab therapy for asthma at ZMH ,Abu Dhabi were retrospectively analyzed.Patients fulfilling the criteria of severe allergic asthma as per GINA guidelines were included. Asthma control over 12 months prior to and 12 months after commencement of omalizumab therapy was analysed by taking into account the number of exacerbations and hospitalizations in addition to maintenance of medication dosages, need for rescue reliever therapy and pulmonary function testing. Results: Total cohort of 21 patient (5 females), average age 41 years and av length of therapy 22 months were included. Seven patients (total 11/52%) managed to stop steroids on treatment while four were able to decrease the dosage. Mean exacerbation rate decreased from five/ year pre treatment to 1.36 while on treatment. Number of hospitalizations decreased from mean of two per year to 0.9 per year. Rescue reliever inhaler usage decreased from mean of 40 puffs to 15 puffs per week. 2 patients discontinued therapy, 1 due to lack of benefit (2 doses) and 2nd due to severe persistent side effects including local irritation, severe limb and joint pains after 6 months. Conclusion: Treatment with omalizumab showed effect in terms of reduced number of exacerbations, maintenance therapy and reliever medications. However, no improvement was seen in PFTs.There is room for improved documentation in terms of symptom recording and use of rescue medicationas as well as for better patient education and counselling in order to improve compliance.

Keywords: asthma, omalizumab, severe allergic asthma, UAE

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Authors: S. R. Shamili, C. Natarajan, J. Karthikeyan

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Rapid growth of world population and widespread urbanization has remarkably increased the development of the construction industry which caused a huge demand for sand and gravels. Environmental problems occur when the rate of extraction of sand, gravels, and other materials exceeds the rate of generation of natural resources; therefore, an alternative source is essential to replace the materials used in concrete. Now-a-days, electronic products have become an integral part of daily life which provides more comfort, security, and ease of exchange of information. These electronic waste (E-Waste) materials have serious human health concerns and require extreme care in its disposal to avoid any adverse impacts. Disposal or dumping of these E-Wastes also causes major issues because it is highly complex to handle and often contains highly toxic chemicals such as lead, cadmium, mercury, beryllium, brominates flame retardants (BFRs), polyvinyl chloride (PVC), and phosphorus compounds. Hence, E-Waste can be incorporated in concrete to make a sustainable environment. This paper deals with the composition, preparation, properties, classification of E-Waste. All these processes avoid dumping to landfills whilst conserving natural aggregate resources, and providing a better environmental option. This paper also provides a detailed literature review on the behaviour of concrete with incorporation of E-Wastes. Many research shows the strong possibility of using E-Waste as a substitute of aggregates eventually it reduces the use of natural aggregates in concrete.

Keywords: dumping, electronic waste, landfill, toxic chemicals

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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: Saima Hirani, Emmanuela Ojukwu, Nilanga Aki Bandara

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Background: Mental health challenges that begin during the youth age period may continue across the entire life course. One way to support youth mental health is to encourage youth engagement in prosocial activities. This study aimed to explore youth’s perceptions about helping others and mental well-being, barriers, and enablers for youth to initiate and continue prosocial activities, and strategies for developing the attribute of helping others in youth. Methods: We conducted a qualitative study using semi-structured, virtual interviews with 18 young individuals (aged 16-24 years) living in Vancouver, British Columbia, Canada. Results: Youth perceived helping others as a source of feeling peace and calm, finding meaning in life, experiencing social connection and promoting self-care, and relieving stress. Participants reported opportunities to learn new skills, the role of religion, social connections, previous positive experiences, and role modeling as enablers for their prosocial behaviour. Heavy time commitment, negative behaviour from others, self-doubt, and late exposure to such activities were considered barriers by youth when participating in prosocial activities. Youth also brought forward key recommendations for engaging youth in helping others. Conclusions: The findings of this study support the notion that youth have positive experiences when engaging in helping others and that involving young people in prosocial activities could be used as a protective intervention for promoting youth mental health and overall well-being.

Keywords: helping others, prosocial behaviour, youth, mental well-being

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Authors: Soumaya Mrabet, Taieb Ach, Imen Akkari, Amira Atig, Neirouz Ghannouchi, Koussay Ach, Elhem Ben Jazia

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Introduction: Celiac disease (CD) and type 1 diabetes mellitus (T1D) are complex disorders with shared genetic components. The association between CD and T1D has been reported in many pediatric series. The aim of our study is to describe the epidemiological, clinical and evolutive characteristics of adult patients presenting this association. Material and Methods: This is a retrospective study including patients diagnosed with CD and T1D, explored in Internal Medicine, Gastroenterology and Endocrinology and Diabetology Departments of the Farhat Hached University Hospital, between January 2005 and June 2016. Results: Among 57 patients with CD, 15 patients had also T1D (26.3%). There are 11 women and 4 men with a median age of 27 years (16-48). All patients developed T1D prior to the diagnosis of CD with an average duration of 47 months between the two diagnosis (6 months-5 years). CD was revealed by recurrent abdominal pain in 11 cases, diarrhea in 10 cases, bloating in 8 cases, constipation in 6 cases and vomiting in 2 cases. Three patients presented cycle disorders with secondary amenorrhea in 2 patients. Anti-Endomysium, anti-transglutaminase and Anti-gliadin antibodies were positive respectively in 57, 54 and 11 cases. The biological tests revealed anemia in 10 cases, secondary to iron deficiency in 6 cases and folate and vitamin B12 deficiency in 4 cases, hypoalbuminaemia in 4 cases, hypocalcemia in 3 cases and hypocholesterolemia in 1 patient. Upper gastrointestinal endoscopy showed an effacement of the folds of the duodenal mucosa in 6 cases and a congestive duodenal mucosa in 3 cases. The macroscopic appearance was normal in the others cases. Microscopic examination showed an aspect of villous atrophy in 57 cases, which was partial in 10 cases and total in 47 cases. After an average follow-up of 3 years 2 months, the evolution was favorable in all patients under gluten-free diet with the necessity of less important doses of insulin in 10 patients. Conclusion: In our study, the prevalence of T1D in adult patients with CD was 26.3%. This association can be attributed to overlapping genetic HLA risk loci. In recent studies, the role of gluten as an important player in the pathogenesis of CD and T1D has been also suggested.

Keywords: celiac disease, gluten, prevalence, type 1 diabetes

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Authors: Amin Padash, Javad Kazem Zadeh Khoiy, Hossein Vahidi

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Purpose: The mechanization system for the urban services was implemented in Tehran City in the year 2004 to promote the collection of domestic wastes; in 2010, in order to achieve the objectives of the project of urban services mechanization and qualitative promotion and improve the urban living environment, sustainable development and optimization of the recyclable solid wastes collection systems as well as other dry and non-organic wastes and conformity of the same to the modern urban management methods regarding integration of the mechanized urban services contractors and recycling contractors and in order to better and more correct fulfillment of the waste separation and considering the success of the mechanization plan of the dry wastes in most of the modern countries. The aim of this research is analyzing of Environmental Risk Assessment of the mechanization waste collection scheme in Tehran. Case Study: Tehran, the capital of Iran, with the population of 8.2 million people, occupies 730 km land expanse, which is 4% of total area of country. Tehran generated 2,788,912 ton (7,641 ton/day) of waste in year 2008. Hospital waste generation rate in Tehran reaches 83 ton/day. Almost 87% of total waste was disposed of by placing in a landfill located in Kahrizak region. This large amount of waste causes a significant challenge for the city. Methodology: To conduct the study, the methodology proposed in the standard Mil-St-88213 is used. This method is an efficient method to examine the position in opposition to the various processes and the action is effective. The method is based on the method of Military Standard and Specialized in the military to investigate and evaluate options to locate and identify the strengths and weaknesses of powers to decide on the best determining strategy has been used. Finding and Conclusion: In this study, the current status of mechanization systems to collect waste and identify its possible effects on the environment through a survey and assessment methodology Mil-St-88213, and then the best plan for action and mitigation of environmental risk has been proposed as Environmental Management Plan (EMP).

Keywords: environmental risk assessment, mechanization waste collection scheme, Mil-St-88213

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Authors: Lars Andersen

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The development of design and engineering in large construction projects are characterized by an increased degree of flattening out of formal structures, extended use of parallel and integrated processes (‘Integrated Concurrent Engineering’) and an increased number of expert disciplines. The integration process is based on ongoing collaborations, dialogues, intercommunication and comments on each other’s work (iterations). This process based on reciprocal communication between actors and disciplines triggers value creation. However, communication between equals is not in itself sufficient to create effective decision making. The complexity of the process and time pressure contribute to an increased risk of a deficit of decisions and loss of process control. The paper refers to a study that aims at developing a resilient decision-making system that does not come in conflict with communication processes based on equality between the disciplines in the process. The study includes the construction of a hospital, following the phases design, engineering and physical building. The Research method is a combination of formative process research, process tracking and phenomenological analyses. The study tracked challenges and problems in the building process to the projection substrates (drawing and models) and further to the organization of the engineering and design phase. A comparative analysis of traditional and new ways of organizing the projecting made it possible to uncover an implicit material order or structure in the process. This uncovering implied a development of a material process perspective. According to this perspective the complexity of the process is rooted in material-functional differentiation. This differentiation presupposes a structuring material (the skeleton of the building) that coordinates the other types of material. Each expert discipline´s competence is related to one or a set of materials. The architect, consulting engineer construction etc. have their competencies related to structuring material, and inherent in this; coordination competence. When dialogues between the disciplines concerning the coordination between them do not result in agreement, the disciplines with responsibility for the structuring material decide the interface issues. Based on these premises, this paper develops a self-organized expert-driven interdisciplinary decision-making system.

Keywords: collaboration, complexity, design, engineering, materiality

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Authors: Ghassan Kbar, Shady Aly, Ibrahim Alsharawy, Akshay Bhatia, Nur Alhasan, Ronaldo Enriquez

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The Smart Help for persons with disability (PWD) is a part of the project SMARTDISABLE which aims to develop relevant solution for PWD that target to provide an adequate workplace environment for them. It would support PWD needs smartly through smart help to allow them access to relevant information and communicate with other effectively and flexibly, and smart editor that assist them in their daily work. It will assist PWD in knowledge processing and creation as well as being able to be productive at the work place. The technical work of the project involves design of a technological scenario for the Ambient Intelligence (AmI) - based assistive technologies at the workplace consisting of an integrated universal smart solution that suits many different impairment conditions and will be designed to empower the Physically disabled persons (PDP) with the capability to access and effectively utilize the ICTs in order to execute knowledge rich working tasks with minimum efforts and with sufficient comfort level. The proposed technology solution for PWD will support voice recognition along with normal keyboard and mouse to control the smart help and smart editor with dynamic auto display interface that satisfies the requirements for different PWD group. In addition, a smart help will provide intelligent intervention based on the behavior of PWD to guide them and warn them about possible misbehavior. PWD can communicate with others using Voice over IP controlled by voice recognition. Moreover, Auto Emergency Help Response would be supported to assist PWD in case of emergency. This proposed technology solution intended to make PWD very effective at the work environment and flexible using voice to conduct their tasks at the work environment. The proposed solution aims to provide favorable outcomes that assist PWD at the work place, with the opportunity to participate in PWD assistive technology innovation market which is still small and rapidly growing as well as upgrading their quality of life to become similar to the normal people at the workplace. Finally, the proposed smart help solution is applicable in all workplace setting, including offices, manufacturing, hospital, etc.

Keywords: ambient intelligence, ICT, persons with disability PWD, smart application, SHW

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Authors: Etaf Khlaed Haroun Alkhlaifat

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When doctors and patients do not share the same first language, language barriers may exist, which may have negative effects on the quality of communication and care provided. Doctors’ use of medical jargon and patients’ inability to fully express their illness, to a potential loss of relevant information can often create misunderstanding. This study sought to examine the extent to which a lack of “common” language represents one of the linguistic obstacles that may adversely influence the quality of healthcare services in Jordan. Communication Accommodation Theory (CAT) was used to interpret the phenomena under study. Doctors (n=9) and patients (n=18) were observed and interviewed in natural Jordanian medical settings. A thematic qualitative approach was employed to analyse the data. The preliminary findings of the study revealed that most doctors appeared to have a good sense of appropriate ways to break through communication barriers by changing medical terminologies or jargons into lay terms. However, for some, there were two main challenges: 1) the use of medical jargon in explaining medication and side effects and 2) the lack of patients’ knowledge in providing a full explanation about their illnesses. The study revealed that language barriers adversely affect health outcomes for patients with limited fluency in the English language. It argues that it is doctors’ responsibility to guarantee mutual understanding, educate patients on their condition and improve their health outcomes.

Keywords: communication accommodation theory, doctor-patient interaction, language barrier, medical jargon, misunderstanding

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Authors: Nahida Sultana

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Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1.5 million new infections occurring per year. The hepatitis C virus is a blood-borne virus, and most infections occur through exposure to blood from unsafe injection practices, unsafe health care, unscreened blood transfusion, injection drug use, and sexual practices that lead to exposure to blood. Hepatitis C virus (HCV) causes chronic infections that mainly affect the liver leading to liver diseases. This study aimed to determine whether there is any significant association between HCV transmission risk factors in relation to genotypes in HCV-infected Bangladeshi patients. After quantification of HCV viral load, 36 samples were randomly selected for HCV genotyping and risk factor measurement. A greater proportion of genotype 1 (p > 0.05) patients (40%) underwent blood transfusion compared to patients (22.6%) with genotype 3 infections. More genotype 1 patient underwent surgery and invasive procedures (20%), and rather than those with genotype 3 patients (16.1%). The history of IDUs (25.8%) and sexual exposure (3.2%) are only prevalent in genotype 3 patients and absent in patients with genotype 1 (p >0.05). There was no significant statistical difference found in HCV transmission risk factors (blood transfusion, IDUs, Surgery& interventions, sexual transmission) between patients infected with genotypes 1 and 3. In HCV infection, genotype may have no relation to transmission risk factors among Bangladeshi patients.

Keywords: HCV genotype, alanine aminotransferase (ALT), HCV viral load, IDUs

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Authors: Mutshinye Manguvhewa, Maria Florence, Mansoo Yu, Elize Koch, Kamal Kamaloodien

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Substance use among pregnant women is a perennial problem in the Western Cape Province of South Africa. There are many influential factors are associated with substance use among women of childbearing age. The study explored factors associated with substance use among pregnant women using a qualitative research design and the bio-ecological theoretical framework to explore and guide the researcher throughout the study. Participants were selected using purposive sampling. Only participants accessed from the Department of Social Development meeting the inclusion criteria of the study were interviewed using semi structured interviews. Immediate referral for psychological intervention during the interview was available for participants who needed it. Braun and Clarke's six phases of thematic analysis were utilised to analyse the data. The study adheres to ethical guidelines for the participants' protection. Participants were informed about the study before the initiation of the interviews and the details of their voluntary participation were explained. The key findings from this study illustrate that socio-cultural factors, personal factors, emotional response and intimate relationships are the major contributing factors to substance use among pregnant women in this sample. The results outline the preventative measures that pregnant women implement. Lastly, the study reveals the positive and negative perceptions of substance use programmes that participants share. Some of the study findings are similar to the existing literature and some of the findings differed. Recommendations emanating from the study include that the stakeholders, rehabilitation centres, Department of Health and future researchers should act proactively against substance use during pregnancy.

Keywords: substance addiction, antenatal care, pregnancy, substance use

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Authors: Mohammed A. Alhoot, Rathika A/P Nagarajan

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Climate change and variability are affecting human health and diseases direct or indirectly through many mechanisms. Change in rain pattern, an increase of temperature and humidity are showing an increased trend in Malaysia. This will affect the biological, physical and chemical component of water through different pathways and will enhance the risk of waterborne diseases. Besides, the warm temperature and humid climate provide very suitable conditions for the growth of pathogenic bacteria. This study is intended to highlight the relationship between the climate changes and the incidence food and water associated infections. Incidences of food and water associated infection and climate data were collected from Malaysian Ministry of health and Malaysian Metrological Department respectively. Maximum and minimum temperature showed high correlation with incidence of typhoid, hepatitis A, dysentery, food poisoning (P value <0.05 significant with 2 tailed / 0.5<[r]). Heavy rainfall does not associated with any outbreaks. Climate change brings out new challenges in controlling food and water associated infections. Adaptation strategies should involve all key stakeholders with a strong regional cooperation to prevent and deal with cross-boundary health crises. Moreover, the role of health care personnel at local, state and national levels is important to ensure the success of these programmes. As has been shown herein, climate variability is an important element influencing the food and water associated epidemiology in Malaysia. The results of this study are crucial to implementing climate changes as a factor to reduce any future outbreaks.

Keywords: climate change, typhoid, hepatitis A, dysentery, food poisoning

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Authors: Leszek Szpakowski, Daniel Celiński, Sławomir Pilip, Grzegorz Michalak

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The aim of the study was to analyse the usefulness of the 'E-rescuer' pilot project planned to be implemented in a chosen area of Eastern Poland in the cases of suspected sudden cardiac arrests in the extra-urban areas. Inventing an application allowing to dispatch simultaneously both Medical Emergency Teams and the E-rescuer to the place of the accident is the crucial assumption of the mentioned pilot project. The E-rescuer is defined to be the trained person able to take effective basic life support and to use automated external defibrillator. Having logged in using a smartphone, the E-rescuer's readiness is reported online to provide cardiopulmonary resuscitation exactly at the given location. Due to the accurately defined location of the E-rescuer, his arrival time is possible to be precisely fixed, and the substantive support through the displayed algorithms is capable of being provided as well. Having analysed the medical records in the years 2015-2016, cardiopulmonary resuscitation was considered to be effective when an early indication of circulation was provided, and the patient was taken to hospital. In the mentioned term, there were 2.291 cases of a sudden cardiac arrest. Cardiopulmonary resuscitation was taken in 621 patients in total including 205 people in the urban area and 416 in the extra-urban areas. The effectiveness of cardiopulmonary resuscitation in the extra-urban areas was much lower (33,8%) than in the urban (50,7%). The average ambulance arrival time was respectively longer in the extra-urban areas, and it was 12,3 minutes while in the urban area 3,3 minutes. There was no significant difference in the average age of studied patients - 62,5 and 64,8 years old. However, the average ambulance arrival time was 7,6 minutes for effective resuscitations and 10,5 minutes for ineffective ones. Hence, the ambulance arrival time is a crucial factor influencing on the effectiveness of cardiopulmonary resuscitation, especially in the extra-urban areas where it is much longer than in the urban. The key role of trained E-rescuers being nearby taking basic life support before the ambulance arrival can effectively support Emergency Medical Services System in Poland.

Keywords: basic life support, bystander, effectiveness, resuscitation

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Authors: Rawan Masarwa, Merav Ben Natan, Yaron Berkovich

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Background: Hip fracture repair surgery carries a certain mortality risk, yet evidence suggests that orthopedic surgeons often refrain from discussing this issue with patients prior to surgery. Aim: This study aims to examine whether orthopedic surgeons address the issue of one-year post-surgery mortality before hip fracture repair surgery and to explore the factors influencing this decision. Method: The study uses a cross-sectional design, administering validated digital questionnaires to 150 orthopedic surgeons. Results: A minority of orthopedic surgeons reported consistently informing patients about the risk of mortality in the year following hip fracture surgery. The primary reasons for not discussing this risk were a desire to avoid frightening patients, time constraints, and concerns about undermining patient hope. Surgeons reported a medium-high level of perceived self-efficacy, with higher self-efficacy linked to a reduced likelihood of discussing one-year mortality risk. In contrast, older age and holding a specialist status in orthopedic surgery were associated with a higher likelihood of discussing this risk with patients. Conclusions: The findings suggest a need for interventions to address communication barriers and ensure consistent provision of essential information to patients undergoing hip fracture surgery. Additionally, they emphasize the importance of considering individual factors such as self-efficacy, age, and expertise in developing strategies to enhance patient-provider communication in orthopedic care settings.

Keywords: orthopedic surgeons, hip fracture surgery, mortality risk communication, patient information

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Authors: Ohoud Abdullatif Alshaiji

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Child-rearing is considered as the most important family role and with the modern lifestyle and busy families social institutions has taken this role from the family to encourage the individuals active's role in the social life, this study aimed to acknowledge the contributions of the social institutions in child-rearing the Saudi children and to acknowledge The Role of the community's partnership in activating the social child-rearing for the Saudi children. The research main question was how much the community's partnership is actually participating in activating the process of the social development of the Saudi children. The importance of this study comes from the massive care that has been given from all over the world, children international organizations, and this research is focusing on the participating of five social organization in child-rearing the Saudi children. The study was limited on the mothers of the children who are enrolled in the government's kindergarten the tool that has been used was the Questionnaire, using the descriptive and analytical approach. The important role of the family in encouraging the social development for the Saudi child, and the results has shown the importance of the mosque in encouraging the good social behaviors. And the kindergarten role has shown after the mosque because of the changes that made most of the families relying on the educational institutions to help the child to adapt in a different cultures. To spread the community's partnership in all the social actions, to support and encourage the role of community's partnership in activating the process of the social development of the Saudi children, to minimize the difficulties and the provide the need to fully support the community's partnership.

Keywords: child-rearing, social development, acknowledge the contributions

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Authors: Giovanni Matheus Rech, Gilberto Zan, Filipe P. Aguiar

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The current pandemic scenario raises questions that many times would have previously gone unnoticed. One of these issues is the quality of the air we breathe in the most diverse environments in which we are inserted in an everyday. It is plausible to suppose that, at times like this, there is apprehension regarding the possibility of contamination by pathological agents such as viruses and bacterias through the airways. However, the renewal of indoor air, combined with a properly sanitized air conditioning system, are important tools for the prevention of viral diseases, as is the case with COVID-19. The bus is an example of an environment where renovation is applied to improve the quality of indoor air, helping to reduce the possibility of spreading pathological agents. Together with other care, such as an alcohol gel dispenser, curtains to separate the passengers, cleaning the environment more frequently, and mandatory use of masks, help to reduce the transmission of pathologies, such as COVID-19. Knowing the reality of a large part of the population regarding the need for public transport, there are standards and devices dedicated to promoting air quality, ensuring greater comfort and safety for users. This paper seeks to present such standards and recommendations to improve the quality of indoor air, as well as the equipment responsible for the renewal of the air in the body of a bus. Experimental measurement of the flow rates of the renewal devices present in the bus body allows quantifying the average volume of external air admitted in each type of body. This way, it was possible to compare, in terms of airflow per person, the values of a bus in relation to a series of other environments, using recommendations for air renewal are described through the Brazilian standard ABNT NBR 16401.

Keywords: air quality, air renewal, buses, Covid-19

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Authors: Sarocha Vivatvakin, Thanaporn Ratchataswan, Thiratest Leesutipornchai, Komkrit Ruangritchankul, Somboon Keelawat, Virachai Kerekhanjanarong, Patnarin Mahattanasakul, Saknan Bongsebandhu-Phubhakdi

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In this globalization era, much attention has been drawn to various molecular biomarkers, which may have the potential to predict the progression of cancer. Epidermal growth factor receptor (EGFR) is the classic member of the ErbB family of membrane-associated intrinsic tyrosine kinase receptors. EGFR expression was found in several organs throughout the body as its roles involve in the regulation of cell proliferation, survival, and differentiation in normal physiologic conditions. However, anomalous expression, whether over- or under-expression is believed to be the underlying mechanism of pathologic conditions, including carcinogenesis. Even though numerous discussions regarding the EGFR as a prognostic tool in head and neck cancer have been established, the consensus has not yet been met. The aims of the present study are to assess the correlation between the level of EGFR expression and demographic data as well as clinicopathological features and to evaluate the ability of EGFR as a reliable prognostic marker. Furthermore, another aim of this study is to investigate the probable pathophysiology that explains the finding results. This retrospective study included 30 squamous cell laryngeal carcinoma patients treated at King Chulalongkorn Memorial Hospital from January 1, 2000, to December 31, 2004. EGFR expression level was observed to be significantly downregulated with the progression of the laryngeal cancer stage. (one way ANOVA, p = 0.001) A statistically significant lower EGFR expression in the late stage of the disease compared to the early stage was recorded. (unpaired t-test, p = 0.041) EGFR overexpression also showed the tendency to increase recurrence of cancer (unpaired t-test, p = 0.128). A significant downregulation of EGFR expression was documented in advanced stage laryngeal cancer. The results indicated that EGFR level correlates to prognosis in term of stage progression. Thus, EGFR expression might be used as a prevailing biomarker for laryngeal squamous cell carcinoma prognostic prediction.

Keywords: downregulation, epidermal growth factor receptor, immunohistochemistry, laryngeal squamous cell carcinoma

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Authors: N. Dlamini, Mpumelelo G. Ndlela, Philisiwe Dlamini, Nicholus Kisyeri, Bhekizitha Sithole

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Accessing health services during the COVID-19 pandemic have exacerbated scarcity to routine medication. To ensure continuous accessibility to services, Eswatini launched Community Health Commodities Distribution (CHCD). Eligible Antiretroviral Therapy(ART) stable clients (VL<1,000) and patients on Non-Communicable Disease (NCD) medications were attended at community pick up points (PUP) based on distance between clients’ residence and the public health facility. Services provided includes ART and Pre-Exposure prophylaxis (PrEP) refills and NCD drug refills). The number of community PUP was 14% higher than health facility visits. Among all medications and commodities distributed between April and October 2020 at the PUP, 64% were HIV-related (HIV rapid test, HIVST, VL test, PrEP meds), and 36% were NCD related. The rapid roll out of CHCD during COVID-19 pandemic reduced the risk of COVID-19 transmission to clients as travel to health facilities was eliminated. It Additionally increased access to commodities during COVID-19-driven lockdown, decongested health facilities, integrated model of care, and increase service coverage. It was also noted that CHCD added different curative and HIV related services based on client specific needs and availability of the commodities.

Keywords: community health commodities distribution, pick up points, antiretroviral therapy, pre-exposure prophylaxis

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Authors: Rachel M. Lørum, Henrik Eriksson, Frida Smith

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Purpose: In recent years, the use of benchmarks for the improvement of healthcare has become increasingly common. There has been an increasing interest in why improvement initiatives so often fail to eliminate the problems they aspire to solve. Benchmarking comes with its fair share of challenges and problems, such as capturing the dynamics and complexities of the care environments, among others. In this study, we demonstrate how learning-oriented, voluntary benchmarks in the complex environment of public healthcare could be designed. Findings: Our four most important findings were the following: first, important organizational learning (OL) regarding the complexity of the service and implications on how to design a benchmark for learning and improvement occurred during the process. Second, participation by a wide range of professionals and stakeholders was crucial for capturing the complexity of people and organizations and increasing the quality of the template. Third, the continuous dialogue between all organizations involved was an important tool for ongoing organizational learning throughout the process. The last important finding was the impact of the facilitator’s role through supporting progress, coordination, and dialogue. Design: We chose participatory design as the research design. Data were derived from written materials such as e-mails, protocols, observational notes, and reflection notes collected during a period of 1.5 years. Originality: Our main contributions are the identification of important strategies, initiatives, and actors to involve when designing voluntary benchmarks for learning and improvement.

Keywords: organizational learning, quality improvement, learning-oriented benchmark, healthcare, patient safety

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