Search results for: injectable filler complications

Authors: Chukwudalu C. Nwazojie, Wole W. Soboyejo, John Obayemi, Ali Salifu Azeko, Sandra M. Jusu, Chinyerem M. Onyekanne

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The conventional methods for the diagnosis and treatment of breast cancer include bulk systematic mammography, ultrasound, dynamic contrast-enhanced fast 3D gradient-echo (GRE) magnetic resonance imaging (MRI), surgery, chemotherapy, and radiotherapy. However, nanoparticles and drug-loaded polymer microspheres for disease (cancer) targeting and treatment have enormous potential to enhance the approaches that are used today. The goal is to produce an implantable biomedical device for localized breast cancer drug delivery within Africa and the world. The main advantage of localized delivery is that it reduces the amount of drug that is needed to have a therapeutic effect. Polymer blends of poly (D,L-lactide-co-glycolide) (PLGA) and polycaprolactone (PCL), which are biodegradable, is used as a drug excipient. This work focuses on the development of PLGA-PCL (poly (D,L-lactide-co-glycolide) (PLGA) blended with based injectable drug microspheres and are loaded with anticancer drugs (prodigiosin (PG), and paclitaxel (PTX) control) and also the conjugated forms of the drug functionalized with LHRH (luteinizing hormone-releasing hormone) (PG-LHRH, and PTX- LHRH control), using a single-emulsion solvent evaporation technique. The encapsulation was done in the presence of PLGA-PCL (as a polymer matrix) and poly-(vinyl alcohol) (PVA) (as an emulsifier). Comparative study of the various drugs release kinetics and degradation mechanisms of the PLGA-PCL with an encapsulated drug is achieved, and the implication of this study is for the potential application of prodigiosin PLGA-PCL loaded microparticles for controlled delivery of cancer drug and treatment to prevent the regrowth or locoregional recurrence, following surgical resection of triple-negative breast tumor.

Keywords: cancer, polymers, drug kinetics, nanoparticles

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Authors: Jul Endawati

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The composite element of 20 mm in thickness were manufactured using high volume fly ash, silica fume as alternative hydraulic binders and Portland cement Type II. Pine wood shavel as by product of local small wood working industries were used as the composite filler. The elements were given in situ wet and dry treatment for 9 months. Visually there is no fiber degradation as a result of the interaction of the environment. The assessment were done to the elements bending strength and dimensional properties. Increase in MoR after 180 days of exposure shown that mechanically this degradation is not seen yet. The increment of MoR (213%) compare to that of 28 days might be affected by the formation of calcium hydroxide (CH) or ettringite in the transition zone. The use of pozzolan showed also a delay or minimize degradation of composites while improving the pore structure, and minimize the mineralization of the fiber bond with the cement matrix. The water absorption is 4,22% at 180 days, 7,94% at 120 days and 12,38% at 28 days, in line with the 68% decrease in Thickness Swelling (TS). This unoccured degradation could also be affected by the presence of silica fume in the binder matrix. After 270 days of exposure under tropical condition, the flexural strength started to decrease.

Keywords: durability, fly ash, natural fibre, silica fume

Procedia PDF Downloads 262

Authors: Ojochenemi J. Onubi, Debbi Marais, Lorna Aucott, Friday Okonofua, Amudha Poobalan

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Background: Obesity is a worldwide epidemic with major health and economic consequences. Pregnancy is a trigger point for the development of obesity, and maternal obesity is associated with significant adverse effects in the mother and child. Nigeria is experiencing a double burden of under- and over-nutrition with rising levels of obesity particularly in women. However, there is scarcity of data on maternal obesity in Nigeria and other African countries. Aims and Objectives: This project aimed at identifying crucial components of potential interventions for maternal obesity in Nigeria. The objectives were to assess the prevalence, effects, and distribution of maternal obesity; knowledge, attitude and practice (KAP) of pregnant women and maternal healthcare providers; and identify existing interventions for maternal obesity in Nigeria. Methodology: A systematic review and meta-analysis were initially conducted to appraise the existing literature on maternal obesity in Africa. Following this, a quantitative questionnaire survey of the KAP of pregnant women and a qualitative interview study of the KAP of Health Care Workers (HCW) were conducted in seven secondary and tertiary hospitals across Nigeria. Quantitative data was analysed using SPSS statistical software, while thematic analysis was conducted for qualitative data. Results: Twenty-nine studies included in the systematic review showed significant prevalence, socio-demographic associations, and adverse effects of maternal obesity on labour, maternal, and child outcomes in Africa. The questionnaire survey of 435 mothers revealed a maternal obesity prevalence of 17.9% among mothers who registered for antenatal care in the first trimester. The mothers received nutrition information from different sources and had insufficient knowledge of their own weight category or recommended Gestational Weight Gain (GWG), causes, complications, and safe ways to manage maternal obesity. However, majority of the mothers were of the opinion that excess GWG is avoided in pregnancy and some practiced weight management (diet and exercise) during pregnancy. For the qualitative study, four main themes were identified: ‘Concerns about obesity in pregnancy’, ‘Barriers to care for obese pregnant women’, ‘Practice of care for obese pregnant women’, and ‘Improving care for obese pregnant women’. HCW expressed concerns about rising levels of maternal obesity, lack of guidelines for the management of obese pregnant women and worries about unintended consequences of antenatal interventions. ‘Barriers’ included lack of contact with obese women before pregnancy, late registration for antenatal care, and perceived maternal barriers such as socio-cultural beliefs of mothers and poverty. ‘Practice’ included anticipatory care and screening for possible complications, general nutrition education during antenatal care and interdisciplinary care for mothers with complications. HCW offered suggestions on improving care for obese women including timing, type, and settings of interventions; and the need for involvement of other stake holders in caring for obese pregnant women. Conclusions: Culturally adaptable/sensitive interventions should be developed for the management of obese pregnant women in Africa. Education and training of mothers and health care workers, and provision of guidelines are some of the components of potential interventions in Nigeria.

Keywords: Africa, maternal, obesity, pregnancy

Procedia PDF Downloads 266

Authors: Li Shihao, Dieter Trau

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Bilirubin is a yellow substance that is made when the body breaks down old red blood cells. High levels of bilirubin can cause jaundice, a condition that makes the newborn's skin and the white part of the eyes look yellow. Jaundice is a serial-killer in developing countries in Southeast Asia such as Myanmar and most parts of Africa where jaundice screening is largely unavailable. Worldwide, 60% of newborns experience infant jaundice. One in ten will require therapy to prevent serious complications and lifelong neurologic sequelae. Limitations of current solutions: - Blood test: Blood tests are painful may largely unavailable in poor areas of developing countries, and also can be costly and unsafe due to the insufficient investment and lack of access to health care systems. - Transcutaneous jaundice-meter: 1) can only provide reliable results to caucasian newborns, due to skin pigmentations since current technologies measure bilirubin by the color of the skin. Basically, the darker the skin is, the harder to measure, 2) current jaundice meters are not affordable for most underdeveloped areas in Africa like Kenya and Togo, 3) fat tissue under the skin also influences the accuracy, which will give overestimated results, 4) current jaundice meters are not reliable after treatment (phototherapy) because bilirubin levels underneath the skin will be reduced first, while overall levels may be quite high. Thus, there is an urgent need for a low-cost non-invasive device, which can be effective not only for caucasian babies but also Asian and African newborns, to save lives at the most vulnerable time and prevent any complications like brain damage. Instead of measuring bilirubin on skin, we proposed a new method to do the measurement on the sclera, which can avoid the difference of skin pigmentations and ethnicities, due to the necessity for the sclera to be white regardless of racial background. This is a novel approach for measuring bilirubin by an optical method of light reflection off the white part of the eye. Moreover, the device is connected to a smart device, which can provide a user-friendly interface and the ability to record the clinical data continuously A disposable eye cap will be provided avoiding contamination and fixing the distance to the eye.

Keywords: Jaundice, bilirubin, non-invasive, sclera

Procedia PDF Downloads 236

Authors: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan

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The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Keywords: anaemia, haemoglobinopathies, pregnancy, sickle cell disease

Procedia PDF Downloads 258

Authors: Mohamed Salah El-Din Mahmoud, Heba Radi Atta Allah

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Background: Our study assesses the safety profile and efficacy of toric Implantable Collamer Lens (T-ICL) and toric implantable phakic contact lens (IPCL) for the correction of high myopia with astigmatism. Methods: A prospective interventional randomized comparative study included 60 myopic eyes divided into 2 groups, group A including 30 eyes that were implanted with T-ICL, and group B including 30 eyes that were implanted with toric IPCL. The refractive results, visual acuity, corneal endothelial cell count, and intraocular pressure (IOP) were evaluated at baseline and at 1, 6, and 9 months post-surgery. Any complications either during or after surgery were assessed. Results: A significant reduction in both spherical and cylindrical refractive errors with good predictability was reported in both groups compared with preoperative values. Regarding the predictability, In T-ICL group (A), the median spherical and cylindrical errors were significantly improved from (-10 D & -4.5 D) pre-operatively to (-0.25 D & - 0.3 D) at the end of 9 months follow up period. Similarly, in the toric IPCL group (B), the median spherical and cylindrical errors were significantly improved from (-11 D & -4.5 D) pre-operatively to (-0.25 D & - 0.3 D) at the end of 9 months follow up period. A statistically significant improvement of UCDVA at 9 months postoperatively was found in both groups, as median preoperative Log Mar UCDVA was 1.1 and 1.3 in groups A and B respectively, which was significantly improved to 0.2 in both groups at the end of follow-up period. Regarding IOP, no significant difference was found between both groups, either pre-operatively or during the postoperative period. Regarding the endothelial count, no significant differences were found during the pre-operative and postoperative follow-up periods between the two groups. Fortunately, no intra or postoperative complications as cataract, keratitis or lens decentration had occurred. Conclusions: Toric IPCL is a suitable alternative to T-ICL for the management of high myopia with astigmatism, especially in developing countries, as it is cheaper and easier for implantation than T-ICL. However, data over longer follow-up periods are needed to confirm its safety and stability.

Keywords: T-ICL, Toric IPCL, IOP, corneal endothelium

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Authors: Ali A. Sayadi, Thomas R. Neitzert, G. Charles Clifton

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Lightweight concrete is being used in the construction industry as a building material in its own right. Ultra-lightweight concrete can be applied as a filler and support material for the manufacturing of composite building materials. This paper is about the development of a stable and reproducible ultra-lightweight concrete with the inclusion of poly-lactic acid (PLA) beads and assessing the feasibility of PLA as a lightweight aggregate that will deliver advantages such as a more eco-friendly concrete and a non-petroleum polymer aggregate. In total, sixty-three samples were prepared and the effectiveness of mineral admixture, curing conditions, water-cement ratio, PLA ratio, EPS ratio and perlite ratio on compressive strength of perlite concrete are studied. The results show that PLA particles are sensitive to alkali environment of cement paste and considerably shrank and lost their strength. A higher compressive strength and a lower density was observed when expanded polystyrene (EPS) particles replaced PLA beads. In addition, a set of equations is proposed to estimate the water-cement ratio, cement content and compressive strength of perlite concrete.

Keywords: perlite concrete, poly-lactic acid (pla), expanded polystyrene (eps), concrete

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Authors: Kulsum Maula, Md Kamrul Alam, Md Ibrahim Khalil, Md Nazmul Hasan, Mohammad Omar Faruq

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Background: Percutaneous Tube Thoracostomy (PTT) is an invasive procedure that can save a life now and then in different traumatic and non-traumatic conditions. But still, it is an enigma; how our trainee surgeons are at home in this procedure. Objectives: To evaluate the outcome of the percutaneous tube thoracostomy performed by trainees in both trauma and non-trauma patients. Study design: Prospective, Observational Study. The duration of the study was September 2018 to February 2019. Methods: All patients who need PTT in traumatic and non-traumatic conditions were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 96 patients were finalized. A pre-tested, observation-based, peer-reviewed data collection sheet was prepared before the study. Data regarding clinical and surgical outcome profiles were recorded. Data were compiled, edited, and analyzed. Results: Among 96 patients, the highest 32.29% belonged to age group 31-40 years and the lowest 9.37% belonged to the age group ≤20. The mean age of the respondents was 29.19±9.81. We found out of 96 patients, 70(72.91%) were indicated PTT for traumatic conditions and the rest 26(27.08%) were indicated PTT for non-traumatic chest conditions, where 36(37.5%) had simple penumothorax, 21(21.87%) haemothorax, 14(14.58%) massive pleural effusion, 13(13.54%) tension pneumothorax, 10(10.41%) haemopneumothorax, and 2(2.08%) had pyothorax respectively. In 53.12% of patients had right-sided intercostal chest tube (ICT) insertion, whereas 46.87% had left-sided ICT insertion. In our study, 89.55 % of the tube was placed at the normal anatomical position. Besides, 10.41% of tube thoracostomy were performed deviated from anatomical site. Among 96 patients 62.5% patients had length of incision 2-3cm, 35.41% had >3cm and 2.08% had <2cm respectively. Out of 96 patients, 75(78.13%) showed uneventful outcomes, whereas 21(21.87%) had complications, including 11.15%(11) each had wound infection, 4.46%(4) subcutaneous emphysema, 4.28%(3) drain auto expulsion, 2.85%(2) hemorrhage, 1.45%(1) had a non-functioning drain and empyema with ascending infection respectively (p=<0.05). Conclusion: PTT is a life-saving procedure that is most frequently implemented in chest trauma patients in our country. In the majority of cases, the outcome of PTT was uneventful (78.13). Besides this, more than one-third of patients had a length of incision more than 3 cm that needed extra stitches and 10.41% of cases of PTT were placed other than the normal anatomical site. Trainees of Dhaka Medical College Hospitals are doing well in their performance of PTT insertion, but still, some anatomical orientations are necessary to avoid operative and post-operative complications.

Keywords: PTT, trainee, trauma, non-chest trauma patients

Procedia PDF Downloads 121

Authors: S. Kershaw, P. J. Barry, K. Webb

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Background: Cystic Fibrosis (CF) is a chronic lung disease where patients have chronic lung infection punctuated by acute exacerbations that require intermittent intravenous (IV) antibiotics during their lives. With time, peripheral venous access can become difficult and limited. Accessing these veins can become arduous, traumatic, painful and unworkable. A permanent intravascular access device or Port is a small device that is inserted into the central venous system that allows the delivery of medicine eliminating the need for peripheral venous access. Ports represent a convenient and efficient method when venous access is required on a permanent basis however they are also associated with significant vascular complications. Superior Vena Cava Obstruction (SVCO) is a rare but significant vascular complication of ports in this setting. Objective: We aimed to look at a single CF centre’s experience of port-related SVCO over a thirty year period. Methods: Retrospective data was extracted using patient’s notes, electronic radiological reports and local databases over a period in excess of 30 years from 1982 to 2014. Results: 13 patients were identified with SVCO as a result of their port. 11 patients had CF (9 female, 2 male), one male patient had Primary Ciliary Dyskinesia and one female patient had severe Asthma. The mean port function was 1532 days (range 110 – 4049) and the mean age at SVCO was 24 years (range 11.1 to 36.5 years). The most common symptoms were facial oedema (n=8, 61.5%) and dilated veins (n=6, 46.2%). 7 patients had their Ports removed after SVCO. 6 patients underwent attempted stenting (46.2%) and 6 did not. 4 out of the 6 who underwent stenting required/had re-intervention. 3 of the 6 patients who underwent stenting had symptom resolution, however, 4 of the 6 patients who were not stented had symptom resolution also. Symptom resolution was not guaranteed with stenting and required re-intervention in two-thirds. Conclusion: This case series represents the experience of one of the longest established CF units in the UK and represents the largest cohort ever reported in the literature.

Keywords: ports, Superior Vena Cava Obstruction, cystic fibrosis, access devices

Procedia PDF Downloads 322

Authors: A. Gürses, Z. Eroğlu, E. Şahin, K. Güneş, Ç. Doğar

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In recent years, polymer/clay nanocomposites have generated great interest in the polymer industry as a new type of composite material because of their superior properties, which includes high heat deflection temperature, gas barrier performance, dimensional stability, enhanced mechanical properties, optical clarity and flame retardancy when compared with the pure polymer or conventional composites. The investigation of change of the tensile properties of organoclay/linear low density polyethylene (LLDPE) nanocomposites with the use of Dioctyl terephthalate (DOTP) (as plasticizer) and calcite (as filler) has been aimed. The composites and organoclay synthesized were characterized using the techniques such as XRD, HRTEM and FTIR techniques. The spectroscopic results indicate that platelets of organoclay were well dispersed within the polymeric matrix. The tensile properties of the composites were compared considering the stress-strain curve drawn for each composite and pure polymer. It was observed that the composites prepared by adding the plasticizer at different ratios and a certain amount of calcite exhibited different tensile behaviors compared to pure polymer.

Keywords: linear low density polyethylene, nanocomposite, organoclay, plasticizer

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Authors: A. Dashti, M. Eskandari, L. Farahmand, P. Parvin, A. Jafargholi

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Breast Cancer is one of the most considerable diseases in the United States and other countries and is the second leading cause of death in women. Common breast cancer treatments would lead to adverse side effects such as loss of hair, nausea, and weakness. These complications arise because these cancer treatments damage some healthy cells while eliminating the cancer cells. In an effort to address these complications, laser radiation was utilized and tested as a targeted cancer treatment for breast cancer. In this regard, tissue engineering approaches are being employed by using an electrospun scaffold in order to facilitate the growth of breast cancer cells. Polycaprolacton (PCL) was used as a material for scaffold fabricating because of its biocompatibility, biodegradability, and supporting cell growth. The specific breast cancer cells have the ability to create a three-dimensional cell cluster due to the spontaneous accumulation of cells in the porosity of the scaffold under some specific conditions. Therefore, we are looking for a higher density of porosity and larger pore size. Fibers showed uniform diameter distribution and final scaffold had optimum characteristics with approximately 40% porosity. The images were taken by SEM and the density and the size of the porosity were determined with the Image. After scaffold preparation, it has cross-linked by glutaraldehyde. Then, it has been washed with glycine and phosphate buffer saline (PBS), in order to neutralize the residual glutaraldehyde. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromidefor (MTT) results have represented approximately 91.13% viability of the scaffolds for cancer cells. In order to create a cluster, Michigan Cancer Foundation-7 (MCF-7, breast cancer cell line) and Michigan Cancer Foundation-10A (MCF-10A, human mammary epithelial cell line) cells were cultured on the scaffold in 24 well plate for five days. Then, we have exposed the cluster to the laser diode 808 nm radiation to investigate the effect of laser on the tumor with different power and time. Under the same conditions, cancer cells lost their viability more than the healthy ones. In conclusion, laser therapy is a viable method to destroy the target cells and has a minimum effect on the healthy tissues and cells and it can improve the other method of cancer treatments limitations.

Keywords: breast cancer, electrospun scaffold, polycaprolacton, laser diode, cancer treatment

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Authors: Mahla Azimi

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Introduction: Post-bladder catheter infection is a common and significant healthcare-associated infection that affects individuals with indwelling urinary catheters. These infections can lead to various complications, including urinary tract infections (UTIs), bacteremia, sepsis, and increased morbidity and mortality rates. This article aims to provide a comprehensive review of post-bladder catheter infections, including their causes, risk factors, clinical presentation, diagnosis, treatment options, and preventive measures. Causes and Risk Factors: Post-bladder catheter infections primarily occur due to the colonization of microorganisms on the surface of the urinary catheter. The most common pathogens involved are Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus species. Several risk factors contribute to the development of these infections, such as prolonged catheterization duration, improper insertion technique, poor hygiene practices during catheter care, compromised immune system function in patients with underlying conditions or immunosuppressive therapy. Clinical Presentation: Patients with post-bladder catheter infections may present with symptoms such as fever, chills, malaise, suprapubic pain or tenderness, and cloudy or foul-smelling urine. In severe cases or when left untreated for an extended period of time, patients may develop more severe symptoms like hematuria or signs of systemic infection. Diagnosis: The diagnosis of post-bladder catheter infection involves a combination of clinical evaluation and laboratory investigations. Urinalysis is crucial in identifying pyuria (presence of white blood cells) and bacteriuria (presence of bacteria). A urine culture is performed to identify the causative organism(s) and determine its antibiotic susceptibility profile. Treatment Options: Prompt initiation of appropriate antibiotic therapy is essential in managing post-bladder catheter infections. Empirical treatment should cover common pathogens until culture results are available. The choice of antibiotics should be guided by local antibiogram data to ensure optimal therapy. In some cases, catheter removal may be necessary, especially if the infection is recurrent or associated with severe complications. Preventive Measures: Prevention plays a vital role in reducing the incidence of post-bladder catheter infections. Strategies include proper hand hygiene, aseptic technique during catheter insertion and care, regular catheter maintenance, and timely removal of unnecessary catheters. Healthcare professionals should also promote patient education regarding self-care practices and signs of infection. Conclusion: Post-bladder catheter infections are a significant healthcare concern that can lead to severe complications and increased healthcare costs. Early recognition, appropriate diagnosis, and prompt treatment are crucial in managing these infections effectively. Implementing preventive measures can significantly reduce the incidence of post-bladder catheter infections and improve patient outcomes. Further research is needed to explore novel strategies for prevention and management in this field.

Keywords: post-bladder catheter infection, urinary tract infection, bacteriuria, indwelling urinary catheters, prevention

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Authors: R. W. Walker, J. M. Lynch, K. Anderson, R. G. Middleton

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Hip and knee arthritis are two of the commonest conditions that result in elective orthopaedic outpatient referral. At clinic appointments advice given regarding lifestyle modifications or treatment options may not be fully understood by patients. The majority of patients now use the internet to research their condition and use this to inform their decision about treatments. This study assessed the quality of patient information regarding hip and knee arthritis. To assess the quality of patient information regarding knee and hip arthritis available on the internet. Two internet searches were carried out one month apart using the search terms “knee arthritis” and “hip arthritis” on Google, a search engine that accounts for over 90% or internet searches in the UK. Sites were evaluated using the DISCERN instrument, a validated tool for measuring the quality of consumer health information. The first 50 results for each search were analysed by two different observers and discrepancies in scores were reviewed by both observers together and a score was agreed upon. In total 200 search result websites were assessed, of which 84 fulfilled the inclusion criteria. 53% (n=44) were funded directly by commercial healthcare businesses and of these, 70% (n=31) were funded by a surgeon/hospital promoting end-user purchase of surgical intervention. Overall 35% (n=29) websites were “for-profit” information websites where funding was from advertising revenues from pharmaceutical and prosthesis companies. 81% (n=67) offered information about surgical treatments however only 43% (n=36) mentioned the risk of complications of surgery. 67% (n=56) did not have any reference to sources for the information they detailed and 57% (n=47) had no apparent date for the production of the information they offered. Overall 17% (n=14) of websites were judged as being of high quality, with 29% (n=24) being of moderate quality and 54% (n=45) being of low quality. The quality of health information regarding hip and knee arthritis on the internet is highly variable and the majority of websites assessed were of poor quality. A preponderance of websites were funded by a commercial surgical service offering athroplasty at consumer cost, with a further third being funded indirectly via advertising revenues from commercial businesses. The vast majority of websites only mentioned surgery as a treatment and nearly half of all websites did not mention the risks or complications of surgical intervention at all. This has implications for the consent process. As such, Clinicians should be aware of the heterogeneous nature of patient information on the internet and be prepared to advise their patients about good quality websites where further reliable information can be sought.

Keywords: hip osteoarthritis, informed consent, knee osteoarthritis, patient information

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Authors: Ahmed M. Ashteyat

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Artificial Neural Network (ANN) models have been widely used in material modeling, inter-correlations, as well as behavior and trend predictions when the nonlinear relationship between system parameters cannot be quantified explicitly and mathematically. In this paper, ANN was used to predict the residual modulus of elasticity (RME) of self compacted concrete (SCC) damaged by heat. The ANN model was built, trained, tested and validated using a total of 112 experimental data sets, gathered from available literature. The data used in model development included temperature, relative humidity conditions, mix proportions, filler types, and fiber type. The result of ANN training, testing, and validation indicated that the RME of SCC, exposed to different temperature and relative humidity levels, could be predicted accurately with ANN techniques. The reliability between the predicated outputs and the actual experimental data was 99%. This show that ANN has strong potential as a feasible tool for predicting residual elastic modulus of SCC damaged by heat within the range of input parameter. The ANN model could be used to estimate the RME of SCC, as a rapid inexpensive substitute for the much more complicated and time consuming direct measurement of the RME of SCC.

Keywords: residual modulus of elasticity, artificial neural networks, self compacted-concrete, material modeling

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Authors: Fatemeh Mirakhorli

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Porosity is the main issue during welding of aluminum alloys, and surface cleaning has a critical influence to reduce the porosity level by removing the oxidized surface layer before fusion welding. Developing an optimum and economical surface cleaning method has an enormous benefit for aluminum welding industries to reduce costs related to repairing and repeating welds as well as increasing the mechanical properties of the joints. In this study, several mechanical and chemical surface cleaning methods were examined for butt joint welding of 2 mm thick AA6xxx alloys using ER5556 filler metal. The effects of each method on porosity formation and tensile properties are evaluated. It has been found that, compared to the conventional mechanical cleaning method, the use of chemical cleaning leads to an important reduction in porosity level even after a significant delay between cleaning and welding. The effect of the higher porosity level in the fusion zone to reduce the tensile strength of the welds is shown.

Keywords: gas metal arc welding (GMAW), aluminum alloy, surface cleaning, porosity formation, mechanical property

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Authors: Anika Zafiah M. Rus, Nik Normunira Mat Hassan

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Biopolymer made from renewable material are one of the most important group of polymer because of their versatility and they can be manufactured in a wide range of densities and stiffness. In this project, biopolymer based on waste vegetable oil were synthesized and crosslink with commercial polymethane polyphenyl isocyanate (known as BF).The BF was compressed by using hot compression moulding technique at 90 oC based on the evaporation of volatile matter and known as compress biopolymer (CB). The density, vibration and damping characteristic of CB were determined after UV irradiation. Treatment with titanium dioxide (TiO2) was found to affect the physical property of compress biopolymer composite (CBC). The density of CBC samples was steadily increased with an increase of UV irradiation time and TiO2 loading. The highest density of CBC samples is at 10 % of TiO2 loading of 1.1088 g/cm3 due to the amount of filler loading. The vibration and damping characteristic of CBC samples was generated at displacements of 1 mm and 1.5 mm and acceleration of 0.1 G and 0.15 G base excitation according to ASTM D3580-9. It was revealed that, the vibration and damping characteristic of CBC samples is significantly increased with the increasing of UV irradiation time, lowest thickness and percentages of TiO2 loading at the frequency range of 15 - 25 Hz. Therefore, this study indicated that the damping property of CBC could be improved upon prolonged exposure to UV irradiation.

Keywords: biopolymer flexible foam, TGA, UV irradiation, vibration and damping

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Authors: Kamil Dydek, Szymon Demski, Kamil Majchrowicz, Paulina Kozera, Bogna Sztorch, Dariusz Brząkalski, Zuzanna Krawczyk, Robert Przekop, Anna Boczkowska

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Thanks to their excellent properties, i.e. high stiffness and strength in relation to their weight, corrosion resistance, and low thermal expansion, Carbon Fiber Reinforced Polymers (CFRPs) are a group of materials readily used in many industrial sectors, e.g. aviation, automotive, wind energy. Conventional CFRPs also have their disadvantages, namely, relatively low electrical conductivity and brittle cracking. To counteract this, a thermoplastic acrylic resin was proposed, which was further modified by the addition of organosilicon compounds and multi-walled carbon nanotubes (MWCNTs). The addition of the organosilicon compounds was aimed at improving the dispersion of the MWCNTs and obtaining good adhesion between the resin and the carbon fibre, where the MWCNTs were used as a conductive filler. In addition, during the fabrication of laminates using the infusion method, thermoplastic nonwovens doped with MWCNTs were placed between the carbon reinforcement layers to achieve a synergistic effect with an increase in electrical and mechanical properties.

Keywords: CFRP, acrylic resin, organosilicon compounds, mechanical properties, electrical properties

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Authors: Anthony Chidi Ezika, Gbolahan Joseph Adekoya, Emmanuel Rotimi Sadiku, Yskandar Hamam, Suprakas Sinha Ray

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High-energy-density polymer/ceramic composites require a high breakdown strength and dielectric constant. Interface polarization and electric percolation are responsible for the high dielectric constant. In order to create composite dielectrics, high conductivity ceramic particles are combined with polymers to increase the dielectric constant. In this study, bonding and the non-uniform distribution of charges in the ceramic/ceramic interface zone are investigated using density functional theory (DFT) modeling. This non-uniform distribution of charges is intended to improve the ceramic/ceramic interface's dipole polarization (dielectric response). The interfacial chemical bond formation can also improve the structural stability of the hybrid filler and, consequently, of the composite films. To comprehend the electron-transfer process, the density of state and electron localization function of the PPy with hybrid fillers are also studied. The polymer nanocomposite is anticipated to provide a suitable dielectric response for energy storage applications.

Keywords: energy storage, V₂C/ ZnS hybrid, polypyrrole, MXene, nanocomposite, dielectric

Procedia PDF Downloads 117

Authors: Robert Kimutai Tewo, Hilary Limo Rutto, Tumisang Seodigeng

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The rheological and morphological properties of paraffin wax, linear low-density polyethylene (LLDPE), and poly (methyl methacrylate) (PMMA) microbeads formulations were prepared via an extrusion process. The blends were characterized by rheometry, scanning electron microscopy (SEM), and Fourier transform infrared (FTIR) spectroscopy. The results indicated that the viscosity of the blends increased as compared to that of neat wax. SEM confirmed that LLDPE alters the wax crystal habit at higher concentrations. The rheological experimental data fitted with predicted data using the modified Krieger and Dougherty expression. The SEM micrograph of wax/LLDPE/PMMA revealed a near-perfect spherical nature for the filler particles in the wax/EVA polymer matrix. The FT-IR spectra show the deformation vibrations stretch of a long-chain aliphatic hydrocarbon (C-H) and also the presence of carbonyls absorption group denoted by -C=O- stretch.

Keywords: investment casting pattern, paraffin wax, LLDPE, PMMA, rheological properties, modified Krieger and Dougherty expression

Procedia PDF Downloads 170

Authors: Shaghayegh Shajari, Mehdi Mahmoodi, Mahmood Rajabian, Uttandaraman Sundararaj, Les J. Sudak

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Although several strain sensors based on carbon nanotubes (CNTs) have been reported, the stretchability and sensitivity of these sensors have remained as a challenge. Highly stretchable and sensitive strain sensors are in great demand for human motion monitoring and human-machine interface. This paper reports the fabrication and characterization of a new type of strain sensors based on a stretchable fluoropolymer / CNT nanocomposite system made via melt-mixing technique. Electrical and mechanical characterizations were obtained. The results showed that this nanocomposite sensor has high stretchability up to 280% of strain at an optimum level of filler concentration. The piezoresistive properties and the strain sensing mechanism of the strain sensor were investigated using Electrochemical Impedance Spectroscopy (EIS). High sensitivity was obtained (gauge factor as large as 12000 under 120% applied strain) in particular at the concentrations above the percolation threshold. Due to the tunneling effect, a non- linear piezoresistivity was observed at high concentrations of CNT loading. The nanocomposites with good conductivity and lightweight could be a promising candidate for strain sensing applications.

Keywords: carbon nanotubes, fluoropolymer, piezoresistive, strain sensor

Procedia PDF Downloads 295

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

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

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

Procedia PDF Downloads 411

Authors: H. Alamri

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Natural fiber reinforced composites have attracted researchers for their desirable properties of toughness, high modulus, low density, recyclability, and renewability. In fact, the use of natural fibers in polymer composites has the potential to produce materials with higher specific strength and specific modulus due of their low density. Likewise, polymer-nano-filler composites have been widely investigated for their unique and significant improvement in strength, modulus, impact strength, barrier properties, heat resistance and thermal stability. In this paper, The addition of halloysite nanotubes (HNTs) with three different weight percentages (1%, 3% and 5%) on enhancing barrier and flexural strength and modulus of cellulose-fiber (CF) /epoxy composites after water treatment for six months was studied. Results indicated that water uptake decreased as HNT content increased. The presence of HNT improved flexural strength and flexural modulus of CF/epoxy composites. SEM results showed damages in fiber-matrix interfacial bonding due to water absorption. The addition of HNTs was found to enhance to adhesion between fibers and matrix.

Keywords: mechanical properties, epoxy, nanocomposites, halloysite nanotubes

Procedia PDF Downloads 327

Authors: J. Hemanth, B. G. Shivaprakash, S. V. Dinesh

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The locally available Lateritic soil in Dakshina Kanadda and Udupi districts are traditionally being used as building blocks for construction purpose but they do not meet the conventional requirements (L L ≤ 25% & P I ≤6%) and desired four days soaked CBR value to be used as a sub-base course material in pavements. In order to improve its properties to satisfy the Atterberg’s Limits, the soil is blended with sand, cement and quarry dust at various percentages and also to meet the CBR strength requirements, individual and combined gradation of various sized aggregates along with Laterite soil and other filler materials has been done for coarse graded granular sub-base materials (Grading II and Grading III). The effect of additives blended with lateritic soil and aggregates are studied in terms of Atterberg’s limits, compaction, California Bearing Ratio (CBR), and permeability. It has been observed that the addition of sand, cement and quarry dust are found to be effective in improving Atterberg’s limits, CBR values, and permeability values. The obtained CBR and permeability values of Grading III, and Grading II materials found to be sufficient to be used as sub-base course for low volume roads and high volume roads respectively.

Keywords: lateritic soil, sand, quarry dust, gradation, sub-base course, permeability

Procedia PDF Downloads 318

Authors: Pawandeep Kaur, Prashant Garg

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Red mud is a byproduct of aluminum extraction from Bauxite industry. It is dumped in a pond which not only uses thousands of acres of land but having very high pH, it pollutes the ground water and the soil also. Leaves are yet another big waste especially during autumn when they contribute immensely to the blockage of drains and can easily catch fire, among other risks hence also needs to be utilized effectively. The use of leaf ash and red mud in highway construction as a filling material may be an efficient way to dispose of leaf ash and red mud. In this study, leaf ash and lime were used as admixtures to improve the geotechnical engineering properties of red mud. The red mud was taken from National Aluminum Company Limited, Odisha, and leaf ash was locally collected. The aim of present study is to investigate the effect of lime and leaf ash on compaction characteristics and strength characteristics of red mud. California Bearing Ratio and Unconfined Compression Strength tests were performed on red mud by varying different percentages of lime and leaf ash. Leaf ash was added in proportion 2%,4%,6%,8% and 10% whereas lime was added in proportions of 5% to 15%. Optimized value of lime was decided with respect to maximum CBR (California Bearing Ratio) of red mud mixed with different proportions of lime. An increase of 300% in California Bearing ratio of red mud and an increase of 125% in Unconfined Compression Strength values were observed. It may, therefore, be concluded that red mud may be effectively utilized in the highway industry as a filler material.

Keywords: stabilization, lime, red mud, leaf ash

Procedia PDF Downloads 242

Authors: Khryslyn Araño, Dela Cruz, Michael Leo, Dela Pena, Eden May, Leslie Joy Diaz

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Montmorillonite (MMT) is a very abundant clay mineral and is versatile such that it can be chemically or physically altered by changing the ions between the sheets of its layered structure. This clay mineral can be prepared into functional nanoparticles that can be used as fillers in other nanomaterials such as nanofibers to achieve special properties. In this study, two types of iron-modified MMT, Iron-MMT (FeMMT) and Zero Valent Iron-MMT (ZVIMMT) were synthesized via ion exchange technique. The modified clay was incorporated in polymer nanofibers which were produced using a process called electrospinning. ICP analysis confirmed that clay modification was successful where there is an observed decrease in the concentration of Na and an increase in the concentration of Fe after ion exchange. XRD analysis also confirmed that modification took place because of the changes in the d-spacing of Na-MMT from 11.5 Å to 13.6 Å and 12.6 Å after synthesis of FeMMT and ZVIMMT, respectively. SEM images of the electrospun nanofibers revealed that the ZVIMMT-filled fibers have a smaller average diameter than the FeMMT-filled fibers because of the lower resistance of the suspensions of the former to the elongation force from the applied electric field. The resistance to the electric field was measured by getting the bulk voltage of the suspensions.

Keywords: electrospinning, nanofibers, montmorillonite, materials science

Procedia PDF Downloads 345

Authors: Mikailzade Parvin, Gurbanova Jamila, Alizade Samaya, Hasanova Afat

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It is known that in March 2020, the World Health Organization (WHO) declared a global pandemic of the 2019 coronovirus disease COVID-19, caused by the severe acute respiratory syndrome coronovirus (SARS-CoV-2). In this period, ensuring the safety of pregnancy and childbirth has become one of the necessary issues. The measures taken in this direction naturally consisted of strengthening and improving preventive measures among pregnant women. It should be noted that the lethality of SARS-CoV-2 infection among women reached 25%. The relevance of studying the effect of COVID-19 on reproductive health in women is due to its wide spread worldwide, severe clinical course, and the occurrence of numerous complications or lethality. It is of urgent importance to study the impact of the mentioned coronavirus infection on the health of pregnant women and the serious complications caused by it.Taking these into account, 230 pregnant women infected with the COVID-19 virus infection were registered. The average age of the pregnant women included in the study was: 29.24±6.0. The diagnosis of corona virus infection was made on the basis of polymerase chain reaction (PCR), serological tests (IgG, IgM). In 57.4% of cases, bilateral pneumonia was recorded in pregnant women and confirmed on the basis of radiological (RH) examination. RH examination revealed pneumonia with infiltrate in the lungs. Among clinical symptoms in pregnant women infected with COVID-19 virus infection: in 86 (37.4%) cases, symptoms such as high fever (t-39.0oC), shortness of breath, fatigue, and hypoxia were noted in pregnant women. A decrease in SpO2 to a minimal level was recorded. Laboratory-instrumental examinations were carried out. The obtained results showed: the average limit of D-dimer was 0.8±0.5; prothrombin time 13.2±1.1 seconds; INR 0.98±0.08, prothrombin index 104.3±19.5%, EHS - 34.8±13.6 mm/s. It should be noted that respiratory distress syndrome (RDS), premature birth, malformed and extremely malformed newborns, asphyxia or hypoxia have been reported in infants born to pregnant women infected with the coronavirus disease.Thus, from the obtained indicators, it is known that pregnant women infected with the virus have a high risk of serious illness and death for both themselves and their babies. It has been proven that the majority of babies born to SARS-CoV-2 positive mothers have a negative impact on their health.

Keywords: Covid 19, reproductive health, preqnancy, premature birth

Procedia PDF Downloads 87

Authors: Jee-Young Lee, Joaquim J. Ferreira, Hyeo-il Ma, José-Francisco Rocha, Beomseok Jeon

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The effective management of wearing-off is a key driver of medication changes for patients with Parkinson’s disease (PD) treated with levodopa (L-DOPA). While L-DOPA is well tolerated and efficacious, its clinical utility over time is often limited by the development of complications such as dyskinesia. Still, common first-line option includes adjusting the daily L-DOPA dose followed by adjunctive therapies usually counting for the L-DOPA equivalent daily dose (LEDD). The LEDD conversion formulae are a tool used to compare the equivalence of anti-PD medications. The aim of this work is to compare the effects of opicapone (OPC) 50 mg, a catechol-O-methyltransferase (COMT) inhibitor, and an additional 100 mg dose of L-DOPA in reducing the off time in PD patients with early motor fluctuations receiving different daily L-DOPA doses. OPC was found to be well tolerated and efficacious in advanced PD population. This work utilized patients' home diary data from a 4-week Phase 2 pharmacokinetics clinical study. The Korean ADOPTION study randomized (1:1) patients with PD and early motor fluctuations treated with up to 600 mg of L-DOPA given 3–4 times daily. The main endpoint was change from baseline in off time in the subgroup of patients receiving 300–400 mg/day L-DOPA at baseline plus OPC 50 mg and in the subgroup receiving >300 mg/day L-DOPA at baseline plus an additional dose of L-DOPA 100 mg. Of the 86 patients included in this subgroup analysis, 39 received OPC 50 mg and 47 L-DOPA 100 mg. At baseline, both L-DOPA total daily dose and LEDD were lower in the L-DOPA 300–400 mg/day plus OPC 50 mg group than in the L-DOPA >300 mg/day plus L-DOPA 100 mg. However, at Week 4, LEDD was similar between the two groups. The mean (±standard error) reduction in off time was approximately three-fold greater for the OPC 50 mg than for the L-DOPA 100 mg group, being -63.0 (14.6) minutes for patients treated with L-DOPA 300–400 mg/day plus OPC 50 mg, and -22.1 (9.3) minutes for those receiving L-DOPA >300 mg/day plus L-DOPA 100 mg. In conclusion, despite similar LEDD, OPC demonstrated a significantly greater reduction in off time when compared to an additional 100 mg L-DOPA dose. The effect of OPC appears to be LEDD independent, suggesting that caution should be exercised when employing LEDD to guide treatment decisions as this does not take into account the timing of each dose, onset, duration of therapeutic effect and individual responsiveness. Additionally, OPC could be used for keeping the L-DOPA dose as low as possible for as long as possible to avoid the development of motor complications which are a significant source of disability.

Keywords: opicapone, levodopa, pharmacokinetics, off-time

Procedia PDF Downloads 62

Authors: Sarah Holdren, Laura Crook, Anne Drapkin Lyerly

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Objective: The COVID-19 Pandemic has drawn new attention to long-existing bioethical questions around pregnancy, childbirth, and parenthood. Due to the increased risk of severe COVID-19, pregnant individuals may experience anxiety regarding medical decision-making. Especially in the case of hospital births, questions around the ethics of bringing healthy pregnant individuals into a high-risk environment for viral transmission illuminate gaps in the American maternal and child healthcare system. Limited research has sought to understand the experiences of those who gave birth outside hospitals during this time. This study aims to understand pregnant individuals’ conceptualization of risk during the COVID-19 pandemic. Methods: Individuals who gave birth after March 2020 were recruited through advertisements on social media. Participants completed a 1-hour semi-structured interview and a demographic questionnaire. Interviews were transcribed and coded by members of the research team using thematic narrative analysis. Results: A total of 18 participants were interviewed and completed the demographic questionnaire. The language of risk was utilized in birth narratives in three different ways, which highlighted the multileveled and nuanced ways in which risk is understood and mitigated by pregnant and birthing individuals. These included: 1. The risk of contracting COVID-19 before, during, and after birth, 2. The risk of birth complications requiring medical interventions dependent on selected birthing space (home, birthing center, hospital), and 3. The overall risk of creating life in the middle of a pandemic. The risk of contracting COVID-19 and risk of birth complications were often weighed in paradoxical ways throughout each individual’s pregnancy, while phrases such as “pandemic baby” and “apocalypse” appeared throughout narratives and highlighted the broader implications of pregnancy and childbirth during this momentous time. Conclusions: Healthcare professionals should consider the variety of ways that pregnant and birthing individuals understand the risk when counseling patients on healthcare decisions, especially during times of healthcare crisis such as COVID-19. Future work should look to understand how the language of risk fits into a broader understanding of the human experience of growing life in times of crisis.

Keywords: maternal and child health, thematic narrative analysis, COVID-19, risk mitigation

Procedia PDF Downloads 167

Authors: Tugrul Tulunay, Iyas Devran Celik

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When the materials used in structural steel industry are evaluated, box beam profiles are considerably preferred. As a result of the cross-sectional properties that these profiles possess, the connection of these profiles to each other and to profiles having different types of cross sections is becoming viable by means of additional measures. An important point to note in such combinations is continuous transfer of internal forces from element to element. At the beginning to ensure this continuity, header plate is needed to use. The connection of the plates to the elements works mainly through welds. In this study, it is aimed to determine the ideal welding thickness in box beam under bending effect and the joints exposed to local buckles that will form in the column. The connection with box column and box beam designed in this context was made by means of corner and circular filler welds. Corner welds of different thickness and analysis by types with different lengths depending on plate dimensions in numerical models were made with the help of ANSYS Workbench program and examined behaviours.

Keywords: welding thickness, box beam-column joints, design of steel structures, calculation and construction principles 2016, welded joints under local buckling

Procedia PDF Downloads 167

Authors: Amr Saeb, Khalid Al-Rubeaan, Mohamed Abouelhoda, Manojkumar Selvaraju, Hamsa Tayeb

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Background: P. mirabilis is a common uropathogenic bacterium that can cause major complications in patients with long-standing indwelling catheters or patients with urinary tract anomalies. In addition, P. mirabilis is a common cause of chronic osteomyelitis in diabetic foot ulcer (DFU) patients. Methodology: P. mirabilis SCDR1 was isolated from a diabetic ulcer patient. We examined P. mirabilis SCDR1 levels of resistance against nano-silver colloids, the commercial nano-silver and silver containing bandages and commonly used antibiotics. We utilized next generation sequencing techniques (NGS), bioinformatics, phylogenetic analysis and pathogenomics in the identification and characterization of the infectious pathogen. Results: P. mirabilis SCDR1 is a multi-drug resistant isolate that also showed high levels of resistance against nano-silver colloids, nano-silver chitosan composite and the commercially available nano-silver and silver bandages. The P. mirabilis-SCDR1 genome size is 3,815,621 bp with G+C content of 38.44%. P. mirabilis-SCDR1 genome contains a total of 3,533 genes, 3,414 coding DNA sequence genes, 11, 10, 18 rRNAs (5S, 16S, and 23S), and 76 tRNAs. Our isolate contains all the required pathogenicity and virulence factors to establish a successful infection. P. mirabilis SCDR1 isolate is a potential virulent pathogen that despite its original isolation site, wound, it can establish kidney infection and its associated complications. P. mirabilis SCDR1 contains several mechanisms for antibiotics and metals resistance including, biofilm formation, swarming mobility, efflux systems, and enzymatic detoxification. Conclusion: P. mirabilis SCDR1 is the spontaneous nano-silver resistant bacterial strain. P. mirabilis SCDR1 strain contains all reported pathogenic and virulence factors characteristic for the species. In addition, it possesses several mechanisms that may lead to the observed nano-silver resistance.

Keywords: Proteus mirabilis, multi-drug resistance, silver nanoparticles, resistance, next generation sequencing techniques, genome analysis, bioinformatics, phylogeny, pathogenomics, diabetic foot ulcer, xenobiotics, multidrug resistance efflux, biofilm formation, swarming mobility, resistome, glutathione S-transferase, copper/silver efflux system, altruism

Procedia PDF Downloads 333