Search results for: chronic stable angina

Authors: Zikora K. G. Anyaegbunam, Annabel A. Nnawuihe, Ngozi J. Anyaegbunam, Emmanuel A. Eze

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The discovery and production of new antibiotics is unavoidable in the fight against drug-resistant bacteria. However, this is only part of the problem; we have never really had medications that could completely eradicate an infection. All pathogens create a limited number of dormant persister cells that are resistant to antibiotic treatment. When the concentration of antibiotics decreases, surviving persisters repopulate the population, resulting in a recurrent chronic infection. Bacterial populations have an alternative survival strategy to withstand harsh conditions or antibiotic exposure, in addition to the well-known methods of antibiotic resistance and biofilm formation. Persister cells are a limited subset of transiently antibiotic-tolerant phenotypic variations capable of surviving high-dose antibiotic therapy. Persisters that flip back to a normal phenotype can restart growth when antibiotic pressure drops, assuring the bacterial population's survival. Persister cells have been found in every major pathogen, and they play a role in antibiotic tolerance in biofilms as well as the recalcitrance of chronic infections. Persister cells has been implicated to play a role in the establishment of antibiotic resistance, according to growing research. Thusthe need to basically elucidate the biology of persisters and how they are linked to antibiotic resistance, and as well it's link to diseases.

Keywords: persister cells, phenotypic variations, repopulation, mobile genetic transfers, antibiotic resistance

Procedia PDF Downloads 183

Authors: Petr Daniel Kovarik, Matt Kennedy, James Adams, Ajay Wilson, Andy Burns, Charles Kelly, Malcolm Jackson, Rahul Patil, Shahid Iqbal

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Introduction: Osteoradionecrosis (ORN) is a recognised toxicity of radiotherapy (RT) for head and neck cancer (HNC). Existing literature lacks any generally accepted definition and staging system for this toxicity. Objective: The objective is to analyse the outcome of the surgical and nonsurgical treatments of ORN. Material and Method: Data on 2303 patients treated for HNC with radical or adjuvant RT or RT-chemotherapy from January 2010 - December 2021 were retrospectively analysed. Median follow-up to the whole group of patients was 37 months (range 0–148 months). Results: ORN developed in 185 patients (8.1%). The location of ORN was as follows; mandible=170, maxilla=10, and extra oral cavity=5. Multiple ORNs developed in 7 patients. 5 patients with extra oral cavity ORN were excluded from treatment analysis as the management is different. In 180 patients with oral cavity ORN, median follow-up was 59 months (range 5–148 months). ORN healed in 106 patients, treatment failed in 74 patients (improving=10, stable=43, and deteriorating=21). Median healing time was 14 months (range 3-86 months). Notani staging is available in 158 patients with jaw ORN with no previous surgery to the mandible (Notani class I=56, Notani class II=27, and Notani class III=76). 28 ORN (mandible=27, maxilla=1; Notani class I=23, Notani II=3, Notani III=1) healed spontaneously with a median healing time 7 months (range 3–46 months). In 20 patients, ORN developed after dental extraction, in 1 patient in the neomandible after radical surgery as a part of the primary treatment. In 7 patients, ORN developed and spontaneously healed in irradiated bone with no previous surgical/dental intervention. Radical resection of the ORN (segmentectomy, hemi-mandibulectomy with fibula flap) was performed in 43 patients (all mandible; Notani II=1, Notani III=39, Notani class was not established in 3 patients as ORN developed in the neomandible). 27 patients healed (63%); 15 patients failed (improving=2, stable=5, deteriorating=8). The median time from resection to healing was 6 months (range 2–30 months). 109 patients (mandible=100, maxilla=9; Notani I=3, Notani II=23, Notani III=35, Notani class was not established in 9 patients as ORN developed in the maxilla/neomandible) were treated conservatively using a combination of debridement, antibiotics and Pentoclo. 50 patients healed (46%) with a median healing time 14 months (range 3–70 months), 59 patients are recorded with persistent ORN (improving=8, stable=38, deteriorating=13). Out of 109 patients treated conservatively, 13 patients were treated with Pentoclo only (all mandible; Notani I=6, Notani II=3, Notani III=3, 1 patient with neomandible). In total, 8 patients healed (61.5%), treatment failed in 5 patients (stable=4, deteriorating=1). Median healing time was 14 months (range 4–24 months). Extra orally (n=5), 3 cases of ORN were in the auditory canal and 2 in mastoid. ORN healed in one patient (auditory canal after 32 months. Treatment failed in 4 patients (improving=3, stable=1). Conclusion: The outcome of the treatment of ORN remains in general, poor. Every effort should therefore be made to minimise the risk of development of this devastating toxicity.

Keywords: head and neck cancer, radiotherapy, osteoradionecrosis, treatment outcome

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Authors: Zian Cheak Tiu, Harith Ahmad, Sulaiman Wadi Harun

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A simple multi-wavelength passively Q-switched Erbium-doped fiber laser (EDFL) is demonstrated using low cost multi-walled carbon nanotubes (MWCNTs) based saturable absorber (SA), which is prepared using polyvinyl alcohol (PVA) as a host polymer. The multi-wavelength operation is achieved based on nonlinear polarization rotation (NPR) effect by incorporating 50 m long photonic crystal fiber (PCF) in the ring cavity. The EDFL produces a stable multi-wavelength comb spectrum for more than 14 lines with a fixed spacing of 0.48 nm. The laser also demonstrates a stable pulse train with the repetition rate increases from 14.9 kHz to 25.4 kHz as the pump power increases from the threshold power of 69.0 mW to the maximum pump power of 133.8 mW. The minimum pulse width of 4.4 µs was obtained at the maximum pump power of 133.8 mW while the highest energy of 0.74 nJ was obtained at pump power of 69.0 mW.

Keywords: multi-wavelength Q-switched, multi-walled carbon nanotube, photonic crystal fiber

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Authors: Sumanpreet Kaur, Harjit Pal Singh, Vikas Khullar

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In Wireless Sensor Network (WSN), the sensor containing motes (nodes) incorporate batteries that can lament at some extent. To upgrade the energy utilization, clustering is one of the prototypical approaches for split sensor motes into a number of clusters where one mote (also called as node) proceeds as a Cluster Head (CH). CH selection is one of the optimization techniques for enlarging stability and network lifespan. Deterministic Stable Election Protocol (DSEP) is an effectual clustering protocol that makes use of three kinds of nodes with dissimilar residual energy for CH election. Fuzzy Logic technology is used to expand energy level of DSEP protocol by using fuzzy inference system. This paper presents protocol DSEP using Fuzzy Logic (DSEP-FL) CH by taking into account four linguistic variables such as energy, concentration, centrality and distance to base station. Simulation results show that our proposed method gives more effective results in term of a lifespan of network and stability as compared to the performance of other clustering protocols.

Keywords: DSEP, fuzzy logic, energy model, WSN

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Authors: Maria Giovanna Lupo, Marina Camera, Marcello Rattazzi, Nicola Ferri

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A complex interplay among chronic kidney disease, lipid metabolism and aortic calcification has been recognized starting from results of many clinical and experimental studies. Here we investigated the influence of kidney function on PCSK9 levels, both in uremic rats and in clinical observation study, and its potential direct action on cultured smooth muscle cells (SMCs) calcification. In a cohort of 594 subjects enrolled in a single centre, observational, cross-sectional and longitudinal study, a negative association between GFR and plasma PCSK9 was found. Atherosclerotic cardiovascular disease (ASCVD), as co-morbidity, further increased PCSK9 plasma levels. Diet-induced uremic condition in rats, induced aortic calcification and increased total cholesterol and PCSK9 levels in plasma, livers and kidneys. Immunohistochemical analysis confirmed PCSK9 expression in aortic SMCs. SMCs overexpressing PCSK9 (SMCsPCSK9), cultured for 7-days in a pro-calcification environment (2.0mM or 2.4mM inorganic phosphate, Pi) showed a significantly higher extracellular calcium (Ca2+) deposition compared to mocked SMCs. Under the same experimental conditions, the addition of exogenous recombinant PCSK9 did not increase the extracellular calcification of SMCs. By flow cytometry analysis we showed that SMCsPCSK9, in response to 2.4mM Pi, released higher number of extracellular vesicles (EVs) positive for three tetraspanin molecules, such as CD63, CD9, and CD81. EVs derived from SMCsPCSK9 tended to be more enriched in calcium and alkaline phosphatase (ALPL), compared to EVs from mocks SMCs. In conclusion, our study reveals a direct role of PCSK9 on vascular calcification induced by higher inorganic phosphate levels associated to CKD condition. This effect appears to be mediated by a positive effect of endogenous PCSK9 on the release of EVs containing Ca2+ and ALP, which facilitate the deposition inorganic calcium phosphate crystals.

Keywords: PCSK9, calcification, extracellular vesicles, chronic kidney disease

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Authors: Anita Paddy, Millicent Obodai, Lebbaeus Asamani

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The management of sickle cell disease requires a multidisciplinary team for better outcomes. Thus, literature on the application of the biopsychosocial model for the management and explanation of chronic pain in sickle cell disease (SCD) and other chronic diseases abound. However, there is limited research on the use of the biopsychosocial model, together with a spiritual component (biopsychosocial-spiritual model). The study investigated the extent to which healthcare providers utilized the biopsychosocial-spiritual model in the management of chronic pain to improve the quality of life (QoL) of patients with SCD. This study employed the descriptive survey design involving a consecutive sampling of 261 patients with SCD who were between the ages of 18 to 79 years and were accessing hematological services at the Clinical Genetics Department of the Korle Bu Teaching Hospital. These patients willingly consented to participate in the study by appending their signatures. The theory of integrated quality of life, the gate control theory of pain and the biopsychosocial(spiritual) model were tested. An instrument for the biopsychosocial-spiritual model was developed, with a basis from the literature reviewed, while the World Health Organisation Quality of Life BREF (WHOQoLBref) and the spirituality rating scale were adapted and used for data collection. Data were analyzed using descriptive statistics (means, standard deviations, frequencies, and percentages) and partial least square structural equation modeling. The study revealed that healthcare providers had a great leaning toward the biological domain of the model compared to the other domains. Hence, participants’ QoL was not fully improved as suggested by the biopsychosocial(spiritual) model. Again, the QoL and spirituality of patients with SCD were quite high. A significant negative impact of spirituality on QoL was also found. Finally, the biosocial domain of the biopsychosocial-spiritual model was the most significant predictor of QoL. It was recommended that policymakers train healthcare providers to integrate the psychosocial-spiritual component in health services. Also, education on SCD and its resultant impact from the domains of the model should be intensified while health practitioners consider utilizing these components fully in the management of the condition.

Keywords: biopsychosocial (spritual), sickle cell disease, quality of life, healthcare, accra

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Authors: Majid Bayatian, Mohammadreza Ashouri

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Releasing hazardous chemicals is one of the major problems for office buildings in the chemical industry and, therefore, environmental risks are inherent to these environments. The adverse health effects of the airborne concentration of benzene have been a matter of significant concern, especially in oil refineries. The chronic and acute adverse health effects caused by benzene exposure have attracted wide attention. Acute exposure to benzene through inhalation could cause headaches, dizziness, drowsiness, and irritation of the skin. Chronic exposures have reported causing aplastic anemia and leukemia at the occupational settings. Association between chronic occupational exposure to benzene and the development of aplastic anemia and leukemia were documented by several epidemiological studies. Numerous research works have investigated benzene emissions and determined benzene concentration at different locations of the refinery plant and stated considerable health risks. The high cost of industrial control measures requires justification through lifetime health risk assessment of exposed workers and the public. In the present study, a Computational Fluid Dynamics (CFD) model has been proposed to assess the exposure risk of office building around a refinery due to its release of benzene. For simulation, GAMBIT, FLUENT, and CFD Post software were used as pre-processor, processor, and post-processor, and the model was validated based on comparison with experimental results of benzene concentration and wind speed. Model validation results showed that the model is highly validated, and this model can be used for health risk assessment. The simulation and risk assessment results showed that benzene could be dispersion to an office building nearby, and the exposure risk has been unacceptable. According to the results of this study, a validated CFD model, could be very useful for decision-makers for control measures and possibly support them for emergency planning of probable accidents. Also, this model can be used to assess exposure to various types of accidents as well as other pollutants such as toluene, xylene, and ethylbenzene in different atmospheric conditions.

Keywords: health risk assessment, office building, Benzene, numerical simulation, CFD

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Authors: Chung Gun Lee

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Objectives: Certain life change events were shown to have strong effects on physical activity-related behavior, but more research is needed to investigate the longer-term effects of different life change events on physical activity-related behaviors. The purpose of this study is to examine the effect of experiencing physically or non-physically forced sexual activity on sports participation from adolescence to young adulthood. Methods: This study used the National Longitudinal Study of Adolescent Health (Add Health) data. Group-based trajectory modeling was utilized to examine the effect of experiencing sexual assault on trajectories of sports participation from adolescence to young adulthood. Results: Male participants were divided into three trajectory groups (i.e., Low-stable, High-decreasing, and High-stable) and female participants were divided into two trajectory groups (i.e., Low-stable and High-decreasing). The main finding of this study is that women who experienced non-physically forced sexual activity significantly decreases sports participation throughout the trajectory in ‘High-decreasing group.’ The effect of non-physically forced sexual activity on women’s sports participation was considerably weakened and became insignificant after including psychological depression in the model as a potential mediator. Discussion: Special attention should be paid to sport participation among women victims of non-physically forced sexual activity. Further studies are needed to examine other potential mediators in addition to psychological depression when examining the effect of non-physically forced sexual activity on sport participation in women.

Keywords: adolescent, group-based trajectory modeling, sexual assault, young adult

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Authors: Barsha Saha, Shouvik Chakravarty, Sukanta Ray, Kshaunish Das, Nidhan K. Biswas, Srikanta Goswami

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Pancreatic Ductal Adenocarcinoma is a well-recognised cause of cancer death with a five-year survival rate of about 9%, and its incidence in India has been found to be increased manifold in recent years. Due to delayed detection, this highly metastatic disease has a poor prognosis. Several molecular alterations happen during the progression of the disease from pre-cancerous conditions, and many such alterations could be investigated for their biomarker potential. MicroRNAs have been shown to be prognostic for PDAC patients in a variety of studies. We hereby used NGS technologies to evaluate the role of small RNA changes during pancreatic cancer development from chronic pancreatitis. Plasma samples were collected from pancreatic cancer patients (n=16), chronic pancreatitis patients (n=8), and also from normal individuals (n=16). Pancreatic tumour tissue (n=5) and adjacent normal tissue samples (n=5) were also collected. Sequencing of small RNAs was carried out after small RNAs were isolated from plasma samples and tissue samples. We find that certain microRNAs are highly deregulated in pancreatic cancer patients in comparison to normal samples. A combinatorial analysis of plasma and tissue microRNAs and subsequent exploration of their targets and altered molecular pathways could not only identify potential biomarkers for disease diagnosis but also help to understand the underlying mechanism.

Keywords: small RNA sequencing, pancreatic cancer, biomarkers, tissue sample

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Authors: Styliani Soulioti, Helen Fiddler

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The aim of this study was to investigate the approaches used by physiotherapists in the education of patients with chronic low back pain (cLBP) and the rationale that underpins their choice of approach. Therapeutic patient education (TPE) is considered to be an important aspect of modern physiotherapy practice, as it helps patients achieve better self-management and a better understanding of their problem. Previous studies have explored this subject, but the reasoning behind the choices physiotherapists make as educators has not been widely explored, thus making it difficult to understand areas that could be addressed in order to improve the application of TPE.A qualitative study design, guided by a constructivist epistemology was used in this research project. Semi-structured interviews were used to collect data from 7 physiotherapists. Inductive coding and thematic analysis were used, which allowed key themes to emerge. Data analysis revealed two overarching themes: 1) patient-centred versus therapist-centred educational approaches, and 2) behaviourist versus constructivist educational approaches. Physiotherapists appear to use a patient-centred-approach when they explore patients’ beliefs about cLBP and treatment expectations. However, treatment planning and goal-setting were guided by a therapist-centred approach, as physiotherapists appear to take on the role of the instructor/expert, whereas patients were viewed as students. Using a constructivist approach, physiotherapists aimed to provide guidance to patients by combining their professional knowledge with the patients’ individual knowledge, to help the patient better understand their problem, reflect upon it and find a possible solution. However, educating patients about scientific facts concerning cLBP followed a behaviourist approach, as an instructor/student relationship was observed and the learning content was predetermined and transmitted in a one-way manner. The results of this study suggest that a lack of consistency appears to exist in the educational approaches used by physiotherapists. Although patient-centeredness and constructivism appear to be the aims set by physiotherapists in order to optimise the education they provide, a student-teacher relationship appears to dominate when it comes to goal-setting and delivering scientific information.

Keywords: chronic low back pain, educational approaches, health education, patient education

Procedia PDF Downloads 187

Authors: Chouahda Salima, Soltani Noureddine

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The present study is a part of biological control against mosquitoes. It aims to assess the impact of two xenobiotics (a selective insect growth regulator: halofenozide and heavy metals: cadmium, more toxic and widespread in the region) in mosquitofish: Gambusia affinis. Several approaches were examined: Acute toxicity of cadmium and halofenozide: The acute toxicity of cadmium and halofenozide was examined in juvenile and adult males and females of G. affinis at different concentrations, cadmium causes mortality of the species studied with a relation dose-response. In laboratory conditions, the impact of cadmium was determined on two biomarkers of environmental stress: glutathione and acetylcholinesterase. The results show that the juvenile followed by adult males are more susceptible than adult females, while the halofenozide does not have any effect on the mortality of juvenile and adult males and females of G.affinis. Chronic toxicity of cadmium and halofenozide: both xenobiotics were added to the water fish raising at different doses tested in juveniles and adults males and females during two months of experience. Growth and metric indices; results show that halofenozide added to the water juveniles of G. affinis has no effect on their growth (length and weight). On the other side, the cadmium at the dose 5 µg/L shows a higher toxicity against juvenile, where he appears to reduce significantly their linear growth and weight. In females, the both xenobiotics have significant effects on metric indices, but these effects are more important on the hepatosomatic index that the gonadosomatic index and the coefficient of condition. Biomarkers; acetylcholinesterase (AChE), glutathione S-transferase (GST) and glutathione (GSH) used in assessing of environmental stress were measured in juveniles and adults males and females. The response of these biomarkers reveals an inhibition of AChE specific activity, an induction of GST activity, and decrease of GSH rates in juveniles in the end of experiment and during chronic treatment adult males and females. The effect of these biomarkers is more pronounced in females compared to males and juveniles. These different biomarkers have a similar profile for the duration of exposure.

Keywords: gambusia affinis, insecticide, heavy metal, morphology, biomarkers, chronic toxicity, acute toxicity, pollution

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Authors: Budsarin Padwang, Darunee Jongudomkarn, Thawan Nieamsup, Autchareeya Patumwan, Rutja Phuphaibul

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In Northern Thailand, a pilot study by the qualitative data, on caring for family members with chronic illness/bedridden based on in-depth interviews of the 12 elderly caregivers in family was carried out during November to December 2017. There are four families that living with three generations in the family. This report is part of a larger study of 'The intergenerational contract of the family in long-term care for older members' to understand the situation and context related to the research questions. Content analysis was obtained and the results revealed as followings. 1) No choice and no freedom: most caregivers were asked by their family members to do the care giving roles because of various appropriate reasons and they could not refuse and felt like having no freedom. 2) ‘Katanyu’ to the parents: The Thai ideology of making merit by taking care of parents was beliefs to do the best in their caregiver roles. 3) The family commitments: The issues of family caring and relationships were the key value of keeping family members to take care of older members with chronic illness/bedridden. The preliminary findings can be beneficial for other regions and will lead to in-depth explore to answer the research questions of the larger study in the future.

Keywords: intergenerational contract, long term care, older members, generational family

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Authors: Sanaa Mekdad, Leenah Alsayed

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Pharmacists play an important role in the CDTM in the care of patients with heart failure (HF). CDTM allows specialized, dedicated clinical pharmacists in a formal agreement in collaborative practice with physicians. Thus, the aim of this study is to investigate the role of cardiology clinical pharmacists in CDTM in decreasing hospitalization and cost. We studied patients with left ventricular systolic dysfunction in a cluster-randomized selection in a tertiary care center. We allocated 296 patients to pharmacist intervention from 1480 patients. Results: With an acceptance rate of 86%, we documented 696 interventions carried out by clinical pharmacists in cardiology. The average intervention was 2.4 patients, and the admission after interventions decreased from 0.79 to. 0.24 (p value = 0.001). Conclusions: In HF CDTM, clinical pharmacists play a crucial role in enhancing medication management, patient education, and lifestyle modification of patients with chronic heart failure. These efforts improve patients' outcomes and lower costs by reducing hospitalization and other associated expenses.

Keywords: cardiology, medication management, heart failure, outpatient therapy, pharmacist-based services, chronic heart failure, heart failure recommendations, CDTM, Middle East, pharmacist-based services, quality of life, pharmacist

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Authors: Dejene Ermias Mekango, Mussie Alemayehu, Gebremedhin Berhe Gebregergs, Araya Abrha Medhanye, Gelila Goba

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Background: Maternal near miss (MNM) can be used as a proxy indicator of maternal mortality ratio. There is a huge gap in life time risk between Sub-Saharan Africa and developed countries. In Ethiopia, a significant number of women die each year from complications during pregnancy, childbirth and the post-partum period. Besides, a few studies have been performed on MNM, and little is known regarding determinant factors. This study aims to identify determinants of MNM among women in Tigray region, Northern Ethiopia. Methods: a case-control study in hospital found in Tigray region, Ethiopia was conducted from January 30 - March 30, 2016. The sample included 103 cases and 205 controls recruited from women seeking obstetric care at six public hospitals. Clients having a life-threatening obstetric complication including haemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia or clinical signs of severe anemia in women without haemorrhage were taken as cases and those with normal obstetric outcomes were considered as controls. Cases were selected based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression (odds ratio) analyses were calculated with 95% CI. Results: The largest proportion of cases and controls was among the ages of20–29 years, accounting for37.9 %( 39) of cases and 31.7 %( 65) of controls. Roughly 90% of cases and controls were married. About two-thirds of controls and 45.6 %( 47) of cases had gestational age between 37-41 weeks. History of chronic medical conditions was reported in 55.3 %(57) of cases and 33.2%(68) of controls. Women with no formal education [AOR=3.2;95%CI:1.24, 8.12],being less than 16 years old at first pregnancy [AOR=2.5; 95%CI:1.12,5.63],induced labor[AOR=3; 95%CI:1.44, 6.17], history of Cesarean section (C-section) [AOR=4.6; 95%CI: 1.98, 7.61] or chronic medical disorder[AOR=3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR=2.8;95% CI: 1.19,6.35] all had higher odds of experiencing MNM. Conclusions: The Government of Ethiopia should continue its effort to address the lack of road and health facility access as well as education, which will help reduce MNM. Work should also be continued to educate women and providers about common predictors of MNM like the history of C-section, chronic illness, and teenage pregnancy. These efforts should be carried out at the facility, community, and individual levels. The targeted follow-up to women with a history of chronic disease and C-section could also be a practical way to reduce MNM.

Keywords: maternal near miss, severe obstetric hemorrhage, hypertensive disorder, c-section, Tigray, Ethiopia

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Authors: Riddhiman Sherlekar, Umang Paladia, Rachit Desai, Yash Patel

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A number of surfactants which exhibit ultra-low interfacial tension and an excellent microemulsion phase behavior with crude oils of low to medium gravity are not sufficiently soluble at optimum salinity to produce stable aqueous solutions. Such solutions often show phase separation after a few days at reservoir temperature, which does not suffice the purpose and the time is short when compared to the residence time in a reservoir for a surfactant flood. The addition of polymer often exacerbates the problem although the poor stability of the surfactant at high salinity remains a pivotal issue. Surfactants such as SDS, Ctab with large hydrophobes produce lowest IFT, but are often not sufficiently water soluble at desired salinity. Hydrophilic co-solvents and/or co-surfactants are needed to make the surfactant-polymer solution stable at the desired salinity. This study focuses on contrasting the effect of addition of a co-solvent in stability of a surfactant –oil emulsion. The idea is to use a co-surfactant to increase stability of an emulsion. Stability of the emulsion is enhanced because of creation of micro-emulsion which is verified both visually and with the help of particle size analyzer at varying concentration of salinity, surfactant and co-surfactant. A lab-experimental method description is provided and the method is described in detail to permit readers to emulate all results. The stability of the oil-water emulsion is visualized with respect to time, temperature, salinity of the brine and concentration of the surfactant. Nonionic surfactant TX-100 when used as a co-surfactant increases the stability of the oil-water emulsion. The stability of the prepared emulsion is checked by observing the particle size distribution. For stable emulsion in volume% vs particle size curve, the peak should be obtained for particle size of 5-50 nm while for the unstable emulsion a bigger sized particles are observed. The UV-Visible spectroscopy is also used to visualize the fraction of oil that plays important role in the formation of micelles in stable emulsion. This is important as the study will help us to decide applicability of the surfactant based EOR method for a reservoir that contains a specific type of crude. The use of nonionic surfactant as a co-surfactant would also increase the efficiency of surfactant EOR. With the decline in oil discoveries during the last decades it is believed that EOR technologies will play a key role to meet the energy demand in years to come. Taking this into consideration, the work focuses on the optimization of the secondary recovery(Water flooding) with the help of surfactant and/or co-surfactants by creating desired conditions in the reservoir.

Keywords: co-surfactant, enhanced oil recovery, micro-emulsion, surfactant flooding

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Authors: Saeid Bahiraei, Hassan Daneshmandi , Ali Asghar Norasteh

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The present study aims at the effects of 8 weeks of selected corrective exercise training in stable and unstable levels on the postural control people with ID. Problems and limitations of movement in individuals with intellectual disability (ID) are highly common, which particularly may cause the loss of basic performance and limitation of the person's independence in doing their daily activities. In the present study, thirty-four young adult intellectual disabilities were selected randomly and divided into three groups. In order to measure the balance variable indicators, BESTest was used. The intervention group did the selected performance exercise in 8 weeks (3 times of 45 to 50 minutes a week). Meanwhile, the control group did not experience any kind of exercise. Statistical analysis was performed in SPSS on a significant level (p<0/05). The results showed the compromise between time and the group in all the BESTest tests is significant (P=0/001). The results of the research test compared to the studied groups with time measurements showed that there is a significant difference in the unstable group in Biomechanical constraints (P<0/05). And also, a significant difference exists in the stable and unstable level instability limits/Vertically, Postural responses, and Anticipatory postural adjustment variables (except for the follow-up and pre-test levels), Stability in Gait and Sensory Orientation in the pre-test, post-test, and follow up- pre-test stage of the test (P<0/05). In the comparison between the times of measurement with the groups under study, the results showed that Biomechanical Constraints, Anticipatory Postural adjustment and Postural responses at the pre-test-follow upstage, there was a significant difference between unstable-stable and unstable-control groups (P<0/05), it was also significant between all groups in Stability Limits/Vertically, Sensory Orientation, Stability in Gait and Overall stability index variables (P<0/05). The findings showed that the practice group at an unstable level has move improvement compared to the practice group at a stable level. In conclusion, this study presents evidence that shows selected performative practices can be recognized as a comprehensive and effective mediator in the betterment and improvement of the balance in intellectually disabled people and also affect the performative and moving activities.

Keywords: intellectual disability, BSETest, rehabilitation, postural control

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Authors: S. H. Atef, N. H. Mahmoud, S. Abdrahman, A. Fattoh

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Background: The aim of the study is to assess the diagnostic value of fibrotest and hyaluronic acid in discriminate between insignificant and significant fibrosis. Also, to find out if these parameters could replace liver biopsy which is currently used for selection of chronic hepatitis C patients eligible for antiviral therapy. Study design: This study was conducted on 52 patients with HCV RNA detected by polymerase chain reaction (PCR) who had undergone liver biopsy and attending the internal medicine clinic at Ain Shams University Hospital. Liver fibrosis was evaluated according to the METAVIR scoring system on a scale of F0 to F4. Biochemical markers assessed were: alpha-2 macroglobulin (α2-MG), apolipoprotein A1 (Apo-A1), haptoglobin, gamma-glutamyl transferase (GGT), total bilirubin (TB) and hyaluronic acid (HA). The fibrotest score was computed after adjusting for age and gender. Predictive values and ROC curves were used to assess the accuracy of fibrotest and HA results. Results: For fibrotest, the observed area under curve for the discrimination between minimal or no fibrosis (F0-F1) and significant fibrosis (F2-F4) was 0.6736 for cutoff value 0.19 with sensitivity of 84.2% and specificity of 85.7%. For HA, the sensitivity was 89.5% and specificity was 85.7% and area under curve was 0.540 at the best cutoff value 71 mg/dL. Multi-use of both parameters, HA at 71 mg/dL with fibrotest score at 0.22 give a sensitivity 89.5%, specificity 100 and efficacy 92.3% (AUC 0.895). Conclusion: The use of both fibrotest score and HA could be as alternative to biopsy in most patients with chronic hepaitis C putting in consideration some limitations of the proposed markers in evaluating liver fibrosis.

Keywords: fibrotest, liver fibrosis, HCV RNA, biochemical markers

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Authors: K. Tesfamariam, S. Gebreyesus, C. Lachat, P. Kolsteren, S. De Saeger, M. De Boevre, A. Argaw

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Aflatoxins are toxic secondary metabolites produced by Aspergillus fungi, which are ubiquitously present in the food supplies of low- and middle-income countries. Studies of maternal aflatoxin exposure and fetal outcomes are mainly focused on size at birth and the effect on intrauterine fetal growth has not been assessed using repeated longitudinal fetal biometry across gestation. Therefore, this study intends to assess the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories in a rural Ethiopian setting. In a prospective cohort study, we enrolled 492 pregnant women. A phlebotomist collected 5 mL of a venous blood sample from eligible women before 28 completed weeks of gestation and aflatoxin B1-lysine concentration was determined using liquid chromatography-tandem mass spectrometry. The mean (±SD) gestational age was 19.1 (3.71) weeks at enrollment, and 28.5 (3.51) and 34.5 (2.44) weeks of gestation at the second and third rounds of ultrasound measurements, respectively. Estimated fetal weight was expressed in centiles using the INTERGROWTH-21st reference. We fitted a multivariable linear mixed-effects model to estimate the rate of fetal growth between aflatoxin-exposed (i.e., aflatoxin B1-lysine concentration above or equal to the limit of detection) and non-exposed mothers in the study. Mothers had a mean (±SD) age of 26.0 (4.58) years. The median (P25, P75) serum AFB1-lysine concentration was 12.6 (0.93, 96.9) pg/mg albumin, and aflatoxin exposure was observed in 86.6% of maternal blood samples. Eighty-five percent of the women enrolled provided at least two ultrasound measurements for analysis. On average, the aflatoxin-exposed group had a significantly lower change over time in fetal weight-for-gestational age centile than the unexposed group (ß = -1.01 centiles/week, 95% CI: -1.87, -0.15, p = 0.02). Chronic maternal AF exposure is associated with lower fetal weight gain over time. Our findings emphasize the importance of nutrition-sensitive strategies to mitigate dietary aflatoxin exposure as well as adopting food safety measures in low-income settings, particularly during the fetal period of development.

Keywords: aflatoxin, fetal growth, low-income setting, mycotoxins

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Authors: Juan Santos Garcia

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Introduction: Tuberculosis is a chronic granulomatous disease caused by a microorganism called Mycobacterium tuberculosis, it has the capacity to spread from the lungs to other parts of the body. Globally, the rate per 100 thousand inhabitants has varied from 136 in 2007 to 122 in 2012; while in the region of the Americas has been much lower: 32 cases per 100,000 in 2007, to 29 in 2012. In El Salvador have also varied incidence rates from 2007 to 2012, from 27.4 cases per 100 000 population to 32 in the period indicated. Methods: Screening was performed with smear and chest X-ray at 80 military personnel from Military Brigade # 5 of El Salvador. Besides HIV tests were taken at the positive cases, which are also made interview, investigating demographic, clinical, laboratory and risk factors data. Frequencies, percentages and rates were calculated using Excel page. The rates were calculated for each of the 5 military bedrooms (called A, B, C, D, and E). Results: Attack rate was 18.75% in the bedroom C. the index case was identified and two secondary cases, with an exposure period of 59 days. Only the index case presented symptoms: cough, fever and weight loss. The other two cases had no symptoms. Discussion: We found a rate of tuberculosis 526 times higher than the national rate. He was also 12.5 times higher than that found in other studies in closed populations such as school facilities. It was not possible to make association analysis.

Keywords: tuberculosis, outbreak, military brigade, chronic granulomatous disease

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Authors: Pooja Rawat, Rakhi Tyagi

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Globally, almost 3 billion people rely on biomass (wood, charcoal, dung and crop residues) and coal as their primary source of domestic energy. Cooking and heating with solid fuels on open fire give rise to major pollutants. Women are primarily affected by these pollutants as they spend most of their time in the house. The WHO World Health Report 2002 estimates that indoor air pollution (IAP) is responsible for 2.7% of the loss of disability adjusted life years (DALYs) worldwide and 3.7% in high mortality developing countries. Indoor air pollution has the potential to not only impact health, but also impact the general economic well-being of the household. Exposure to high level of household pollution lead to acute and chronic respiratory conditions (e.g.: pneumonia, chronic obstructive pulmonary disease, lung cancer and cataract). There has been many strategies for reducing IAP like subsidize cleaner fuel technologies, for example use of kerosene rather than traditional biomass fuels. Another example is development, promotion of 'improved cooking stoves'. India, likely ranks second- distributing over 12 million improved stoves in the first seven years of a national program to develop. IAP should be reduced by understanding the welfare effects of reducing IAP within households and to understanding the most cost effective way to reduce it.

Keywords: open fire, indoor pollution, lung diseases, indoor air pollution

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Authors: M. Umar Dahot, G. S. Mangrio

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In this study Agro-industrial waste was used as a carbon source, which is a low cost substrate. Along with this, various sugars and molasses of 2.5% and 5% were investigated as substrate/carbon source for the growth of A.niger and Pectinase production. Different nitrogen sources were also used. An overview of results obtained show that 5% sucrose, 5% molasses and 0.4% (NH4)2SO4 were found the best carbon and nitrogen sources for the production of pectinase by A. niger. The maximum production of pectinase (26.87units/ml) was observed at pH 6.0 after 72 hrs incubation. The optimum temperature for the maximum production of pectinase was achieved at 35ºC when maximum production of pectinase was obtained as 28.25Units/ml.Pectinase enzyme was purified with ammonium sulphate precipitation and dialyzed sample was finally applied on gel filtration chromatography (Sephadex G-100) and Ion Exchange DEAE A-50. The enzyme was purified 2.5 fold by gel chromatography on Sephadex G-100 and Four fractions were obtained, Fraction 1, 2, 4 showed single band while Fraction -3 showed multiple bands on SDS Page electrophoresis. Fraction -3 was pooled, dialyzed and separated on Sephdex A-50 and two fractions 3a and 3b showed single band. The molecular weights of the purified fractions were detected in the range of 33000 ± 2000 and 38000± 2000 Daltons. The purified enzyme was specifically most active with pure pectin, while pectin, Lemon pectin and orange peel given lower activity as compared to (control). The optimum pH and temperature for pectinase activity was found between pH 5.0 and 6.0 and 40°- 50°C, respectively. The enzyme was stable over the pH range 3.0-8.0. The thermostability of was determined and it was observed that the pectinase activity is heat stable and retains activity more than 40% when incubated at 90°C for 10 minutes. The pectinase activity of F3a and F3b was increased with different metal ions. The Pectinase activity was stimulated in the presence of CaCl2 up to 10-30%. ZnSO4, MnSO4 and Mg SO4 showed higher activity in fractions F3a and F3b, which indicates that the pectinase belongs to metalo-enzymes. It is concluded that A. niger is capable to produce pH stable and thermostable pectinase, which can be used for industrial purposes.

Keywords: pectinase, a. niger, production, purification, characterization

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Authors: Cheng-Kuang Hsu, Chih-Hsiang Chang, Chi-Chih Wang

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Black soybeans contain high amount of antioxidants including polyphenols, anthocyanins and flavones. The protective function of black soybean against CCl4 (a strong oxidant) induced acute and chronic liver damage was investigated in vivo using SD rats or ICR mouse. The evaluation of CCl4 induced oxidative stress in the liver tissues included the measurements of the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), the concentration of thiobarbituric acid reactive substances (TBARS), the activities of antioxidant enzymes (superoxide dismutase SOD, catalase, and glutathione peroxidase GPx), as well as the level of histological lesion in the liver tissues. For chronic experiment, a decoction at the concentration of 100 or 1000 mg/kg of body weight, produced by baking black soybean at 130°C for 5 min and followed by immerging in 100°C hot water for 20 min, showed the inhibitory effect against CCl4 induced liver damage in SD rats. Hot-water extract (80 °C for 30 min) from un-preheated black soybean at the concentration of 200 mg/kg of body weight could not reduce ALT and AST levels in CCl4 treated SD rats, but the hot-water extract from preheated black soybean did enhance antioxidant enzymes activities, decline ALT and AST levels. Specially, the hot-water extract from the seed cost of black soybean had the highest liver protective function since it can reduce vacuolization and necrosis in the liver tissues. For acute experiment, the hot-water extracts from black soybean and the seed coat, as well as pure cyanidin-3-glucoside (C3G) could reduce ALT and AST levels of CCl4 induced ICR mouse. The decoction and hot-water extract from the seed coat of black soybean had higher total polyphenols, anthocyanins and flavones contents than those extracts from whole black soybean. Such results agreed with high liver protective function in the decoction and hot-water from the seed coat of black soybean. Black soybean showed protective function only after preheating process (baking at 130°C for 5 to 10 min) because preheating treatment damaged the cell wall and made the extraction of the antioxidants more effectively.

Keywords: black soybean, liver protective function, antioxidant, antioxidative stress

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Authors: Zohreh Rostami, Arezoo Khosravi, Mohammad Nikpoor Aghdam, Mahmood Salesi

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Background: Cardiovascular mortality in chronic kidney disease (CKD) and end stage renal disease (ESRD) patients have a strong relationship with baseline or progressive left ventricular hypertrophy (LVH) meanwhile in hemodialysis patients 10% decrement in left ventricular mass was associated with 28% reduction in cardiovascular mortality risk. In consonance with these arguments, we designed a study to measure morphological and functional echocardiographic variations early after transplantation. Method: The patients with normal renal function underwent two advanced echocardiographic studies to examine the structural and functional changes in left ventricular mass before and 3-month after transplantation. Results: From a total of 23 participants 21(91.3%) presented with left ventricular hypertrophy, 60.9% in eccentric and 30.4% in concentric group. Diastolic dysfunction improved in concentric group after transplantation. Both in pre and post transplantation global longitudinal strain (GLS)- average in eccentric group was more than concentric (-17.45 ± 2.75 vs -14.3 ± 3.38 p=0.03) and (-18.08 ± 2.6 vs -16.1 ± 2.7 p= 0.04) respectively. Conclusion: Improvement and recovery of left ventricular function in concentric group was better and sooner than eccentric after kidney transplantation. Although fractional shortening and diastolic function and GLS-4C in pre-transplantation in concentric group was worse than eccentric, but therapeutic response to kidney transplantation in concentric was more and earlier than eccentric group.

Keywords: chronic kidney disease, end stage renal disease, left ventricular hypertrophy, global longitudinal strain

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Authors: Ibrahim M. Mehedi, Uzair Ansari, Ubaid M. Al-Saggaf, Abdulrahman H. Bajodah

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This paper presents a methodology for balancing a rotary inverted pendulum system using Robust Generalized Dynamic Inversion (RGDI) under influence of parametric variations and external disturbances. In GDI control, dynamic constraints are formulated in the form of asymptotically stable differential equation which encapsulates the control objectives. The constraint differential equations are based on the deviation function of the angular position and its rates from their reference values. The constraint dynamics are inverted using Moore-Penrose Generalized Inverse (MPGI) to realize the control expression. The GDI singularity problem is addressed by augmenting a dynamic scale factor in the interpretation of MPGI which guarantee asymptotically stable position tracking. An additional term based on Sliding Mode Control is appended within GDI control to make it robust against parametric variations, disturbances and tracking performance deterioration due to generalized inversion scaling. The stability of the closed loop system is ensured by using positive definite Lyapunov energy function that guarantees semi-global practically stable position tracking. Numerical simulations are conducted on the dynamic model of rotary inverted pendulum system to analyze the efficiency of proposed RGDI control law. The comparative study is also presented, in which the performance of RGDI control is compared with Linear Quadratic Regulator (LQR) and is verified through experiments. Numerical simulations and real-time experiments demonstrate better tracking performance abilities and robustness features of RGDI control in the presence of parametric uncertainties and disturbances.

Keywords: generalized dynamic inversion, lyapunov stability, rotary inverted pendulum system, sliding mode control

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Authors: Mingjiang Dai, Qian Shi, Fang Hu, Songsheng Lin, Huijun Hou, Chunbei Wei

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A diamond-like carbon (DLC) is considered as a promising protective film since its high hardness and excellent tribological properties. However, DLC films are very sensitive to the environmental condition, its friction coefficient could dramatic change in high humidity, therefore, limited their further application in aerospace, the watch industry, and micro/nano-electromechanical systems. Therefore, most studies focus on the low friction coefficient of DLC films at a high humid environment. However, this is out of satisfied in practical application. An important thing was ignored is that the DLC coated components are usually used in the diversed environment, which means its friction coefficient may evidently change in different humid condition. As a result, the invalidation of DLC coated components or even sometimes disaster occurred. For example, DLC coated minisize gears were used in the watch industry, and the customer may frequently transform their locations with different weather and humidity even in one day. If friction coefficient is not stable in dry and high moisture conditions, the watch will be inaccurate. Thus, it is necessary to investigate the stable tribological behavior of DLC films in various environments. In this study, a-C:H:Si films were deposited by multi-function magnetron sputtering system, containing one ion source device and a pair of SiC dual mid-frequent targets and two direct current Ti/C targets. Hydrogenated carbon layers were manufactured by sputtering the graphite target in argon and methane gasses. The silicon was doped in DLC coatings by sputtering silicon carbide targets and the doping content were adjusted by mid-frequent sputtering current. The microstructure of the film was characterized by Raman spectrometry, X-ray photoelectron spectroscopy, and transmission electron microscopy while its friction behavior under different humidity conditions was studied using a ball-on-disc tribometer. The a-C:H films with Si content from 0 to 17at.% were obtained and the influence of Si content on the structure and tribological properties under the relative humidity of 50% and 85% were investigated. Results show that the a-C:H:Si film has typical diamond-like characteristics, in which Si mainly existed in the form of Si, SiC, and SiO2. As expected, the friction coefficient of a-C:H films can be effectively changed after Si doping, from 0.302 to 0.176 in RH 50%. The further test shows that the friction coefficient value of a-C:H:Si film in RH 85% is first increase and then decrease as a function of Si content. We found that the a-C:H:Si films with a Si content of 3.75 at.% show a stable friction coefficient of 0.13 in different humidity environment. It is suggestion that the sp3/sp2 ratio of a-C:H films with 3.75 at.% Si was higher than others, which tend to form the silica-gel-like sacrificial layers during friction tests. Therefore, the films deliver stable low friction coefficient under controlled RH value of 50 and 85%.

Keywords: diamond-like carbon, Si doping, moisture environment, table low friction coefficient

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Authors: S. Rashidi, L. C. Abdullah, R. Walvekar, K. Mohammad, F-R. Ahmadun, M. Y. Faizah

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In this research, stability and rheology behavior of Multi-walled carbon nanotube (MWCNT) nanofluids by using Xanthan Gum as a dispersant were measured. This paper addresses the effects of Xanthan Gum (XG) concentration and nanoparticle loading on stability and viscosity of nanofluids. The stability of nanofluids is measured by Zeta Sizer Nano-ZS (Malvern Instruments, ZEN 3600). The zeta potential of the stable samples was analyzed. The rheological behavior of carbon nanotube CNT nanofluids was analyzed using rheometer (Model AR G2, TA Instrument). Both stability and viscosity of the nanofluids increased with increasing CNT and XG concentration. The experimental results indicated that the zeta potential of nanofluid samples is stable. The results demonstrated that the zeta potential was affected by the CNT concentration and is augmented in parallel with increasing CNT concentration. The rheology results showed that the viscosity of CNT/XG nanofluid was increased. The escalated viscosity of CNT/XG nanofluid is owing to the higher van der Waals interaction between the CNT nanoparticles. On the other hand, the viscosity of the CNT/XG nanofluid decreases with increasing temperature. In summary, this research provides useful insight into the behavior of CNT nanofluids.

Keywords: nanofluid, carbon nanotube, stability, rheology

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Authors: Oya Umit Yemisci, Nur Saracgil Cosar, Tubanur Ozturk Sisman, Selin Ozen

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Chronic autoimmune thyroiditis (AIT) may result in a wide spectrum of reversible abnormalities in the neuromuscular function. Usually, proximal muscle-related symptoms and neuropathic findings such as mild axonal peripheral neuropathy have been reported. Sympathetic skin responses are useful in evaluating sudomotor activity of the unmyelinated sympathetic fibers of the autonomic nervous system. Neurocognitive impairment may also be a prominent feature of hypothyroidism, particularly in elderly patients. Electromyographic reaction times as a highly sensitive parameter provides. Objective data concerning cognitive and motor functions. The aim of this study was to evaluate peripheral nerve functions, sympathetic skin response and electroneuromyographic (ENMG) reaction times in euthyroid and subclinically hypothyroid patients with a diagnosis of AIT and compare to those of a control group. Thirty-five euthyroid, 19 patients with subclinical hypothyroidism and 35 age and sex-matched healthy subjects were included in the study. Motor and sensory nerve conduction studies, sympathetic skin responses recorded from hand and foot by stimulating contralateral median nerve and simple reaction times by stimulating tibial nerve and recording from extensor indicis proprius muscle were performed to all patients and control group. Only median nerve sensory conduction velocities of the forearm were slower in patients with AIT compared to the control group (p=0.019). Otherwise, nerve conduction studies and sympathetic skin responses showed no significant difference between the patients and the control group. However, reaction times were shorter in the healthy subjects compared to AIT patients. Prolongation in the reaction times may be considered as a parameter reflecting the alterations in the cognitive functions related to the primary disease process in AIT. Combining sympathetic skin responses with more quantitative tests such as cardiovascular tests and sudomotor axon reflex testing may allow us to determine higher rates of involvement of the autonomic nervous system in AIT.

Keywords: sympathetic skin response, simple reaction time, chronic autoimmune thyroiditis

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Authors: Budi Hastuti, Mudasir, Dwi Siswanta, Triyono

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Biosorbent, such as pectin and chitosan, are usually produced with low physical stability, thus the materials need to be modified. In this research, the physical characteristic of adsorbent was increased by grafting chitosan using acetate carboxymetyl chitosan (CC). Further, CC and Pectin (Pec) were crosslinked using cross-linking agent BADGE (bis phenol A diglycidyl ether) to get CC-Pec-BADGE (CPB) adsorbent. The cross-linking processes aim to form stable structure and resistance on acidic media. Furthermore, in order to increase the adsorption capacity in removing Pb(II), the adsorbent was added with NaCl to form macroporous adsorbent named CCPec-BADGE-Na (CPB-Na). The physical and chemical characteristics of the porogenic adsorbent structure were characterized by scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR). The adsorption parameter of CPB-Na to adsorb Pb(II) ion was determined. The kinetics and thermodynamics of the bath sorption of Pb(II) on CPB-Na adsorbent and using chitosan and pectin as a comparison were also studied. The results showed that the CPB-Na biosorbent was stable on acidic media. It had a rough and porous surface area, increased and gave higher sorption capacity for removal of Pb(II) ion. The CPB-Na 1/1 and 1/3 adsorbent adsorbed Pb(II) with adsorption capacity of 45.48 mg/g and 45.97 mg/g respectively, whereas pectin and chitosan were of 39.20 mg /g and 24.67 mg /g respectively.

Keywords: porogen, Pectin, Carboxymethyl Chitosan (CC), CC- Pec-BADGE-Na

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Authors: Chowdhury Md. Navim Kabir

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Renal impairment is one of the most severe non-communicable diseases around the world. Especially patients with diagnosed/newly diagnosed renal impairment who need surgery are more focused on preoperative and postoperative preparation. Serum creatinine is the prime biochemical marker for assessing renal function, and the level of impairment is widely measured by this marker as well as Glomerular Filtration Rate (GFR). Objective: Factors responsible for fluctuating serum creatinine during preoperative and postoperative periods and minimizing the process of serum creatinine is the ultimate goal of this study. Method: 37 patients participated in this cross-sectional study who were previously diagnosed/newly diagnosed. They were admitted to different tertiary-level hospitals for emergency or elective surgery. Fifteen patients were admitted in the renal function impairment stage and 22 were admitted as normal patients’. Values of creatinine at the pre-admission stage and 2nd/3rd post-admission follow-up were compared. Results: 0.41 was the average of 22 patients' creatinine between pre-admission and 2nd/3rd follow-up. The responsible factor like prolonged staying, immobilization, co-morbidities, different preoperative antibiotics and Non-Steroidal Anti Inflammatory Drugs (NSAIDs) were also inducers for creatinine elevation. After postoperative hemodialysis rapid decrease of creatinine is seen in normal patients, but this decrease is very much minor in Chronic Kidney Disease (CKD) diagnosed patients.

Keywords: CKD, Meropenam, NSAID, comorbidities, immobilized

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Authors: Sanober Khanum, Barerah Siddiqui, Asim Qidwai

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Objective: To determine the risk factors and frequency of depressive trends in children and adolescents suffering from Beta-Thalassemia. Background: Thalassemia is a chronic disease affecting 10,000 people in 60 countries. Many studies show that prolonged medical conditions cause depression. Due to the invasive procedures and suffering, Beta-Thalassemia cause great psychological distress to both children and their caregivers. The study shows 14-24% prevalence of psychiatric problems in Thalassemic patients. Method: Sample consisted of 195 registered patients of A.M.T.F (Female=95 and Male=100). Based on age range the sample was divided into two groups, Group A = children (4-9 years) and Group B = adolescent (10-16 years). A detailed interview with a self-made screening measure was administered on parents to find out the level of depression in patients. Statistics: Chi-square and t-test was applied in order to analyze the data. Results show high prevalence of depression, depression n= 131(66.83%), no depression n=65(33.16%). Analyses reflect that age influences the level of depression Adolescent (71.05%) and Children (64.16%). The analysis also shows a difference in level of depression between both genders. (t=2.975, p < .05). Conclusion: There is a high possibility of developing depressive trend in children affected with Beta Thalassemia; especially females. Therefore, there is a dire need for psychological screening and appropriate treatment in order to improve physical; as well as mental health.

Keywords: childhood depression, chronic illness, psychopathology, Thalassemia

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