Search results for: coronary artery bypass grafting patients

Authors: Jerome Dalphinis, Vishal Patel

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The Bailiwick of Jersey is an island British crown dependency situated off the coast of France. Jersey General Hospital’s emergency department sees approximately 40,000 patients a year. It’s outside the NHS, with secondary care being free at the point of care. Sedation is a continuum which extends from a normal conscious level to being fully unresponsive. Procedural sedation produces a minimally depressed level of consciousness in which the patient retains the ability to maintain an airway, and they respond appropriately to physical stimulation. The goals of it are to improve patient comfort and tolerance of the procedure and alleviate associated anxiety. Indications can be stratified by acuity, emergency (cardioversion for life-threatening dysrhythmia), and urgency (joint reduction). In the emergency department, this is most often achieved using a combination of opioids and benzodiazepines. Some departments also use ketamine to produce dissociative sedation, a cataleptic state of profound analgesia and amnesia. The response to pharmacological agents is highly individual, and the drugs used occasionally have unpredictable pharmacokinetics and pharmacodynamics, which can always result in progression between levels of sedation irrespective of the intention. Therefore, practitioners must be able to ‘rescue’ patients from deeper sedation. These practitioners need to be senior clinicians with advanced airway skills (AAS) training. It can lead to adverse effects such as dangerous hypoxia and unintended loss of consciousness if incorrectly undertaken; studies by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) have reported avoidable deaths. The Royal College of Emergency Medicine, UK (RCEM) released an updated ‘Safe Sedation of Adults in the Emergency Department’ guidance in 2017 detailing a series of standards for staff competencies, and the required environment and equipment, which are required for each target sedation depth. The emergency department in Jersey undertook audit research in 2018 to assess their current practice. It showed gaps in clinical competency, the need for uniform care, and improved documentation. This spurred the development of a checklist incorporating the above RCEM standards, including contraindication for procedural sedation and difficult airway assessment. This was approved following discussion with the relevant heads of departments and the patient safety directorates. Following this, a second audit research was carried out in 2019 with 17 completed checklists (11 relocation of joints, 6 cardioversions). Data was obtained from looking at the controlled resuscitation drugs book containing documented use of ketamine, alfentanil, and fentanyl. TrakCare, which is the patient electronic record system, was then referenced to obtain further information. The results showed dramatic improvement compared to 2018, and they have been subdivided into six categories; pre-procedure assessment recording of significant medical history and ASA grade (2 fold increase), informed consent (100% documentation), pre-oxygenation (88%), staff (90% were AAS practitioners) and monitoring (92% use of non-invasive blood pressure, pulse oximetry, capnography, and cardiac rhythm monitoring) during procedure, and discharge instructions including the documented return of normal vitals and consciousness (82%). This procedural sedation checklist is a safe intervention that identifies pertinent information about the patient and provides a standardised checklist for the delivery of gold standard of care.

Keywords: advanced airway skills, checklist, procedural sedation, resuscitation

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Authors: Ahmed Gendia, Waseem Kamran

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Objective: Total Laparoscopic hysterectomy (TLH) remains a common approach among laparoscopic surgeons. However, this approach depends on the use of uterine manipulator to facilitate the surgery. Although many studies reported the effectiveness of TLH with uterine manipulator, only few reported TLH without the use of any uterine or vaginal manipulation. the aim of this report is to demonstrate our Technique (kamran's TLH) in performing TLH without the use of any uterine or vaginal manipulation in benign conditions and report our intra- and post-operative outcomes. Methodology : surgical technique will be demonstrated through a short video highlighting the easy and safe to learn surgical steps. Additionally, the data of 86 patients who underwent KTLH for benign condition were retrospectively analyzed. the data included intra- and postoperative finding and complications. Results : A total of 86 hysterectomies were performed utilizing the Kamran's TLH ( KTHL). Mean age was 52.2 (±11) years old and BMI was 28.2(±7). Mean operative time was 64.7(±27.9) minutes and estimated bloods loss was 46.2(±54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence. Conclusion & Significance: Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.

Keywords: laparoscopic hystrectomy, TLH, uterine manipulator, surgery

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Authors: Niousha Bagheri Khulenjani, Mohammad Saniee Abadeh

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Learning from very big datasets is a significant problem for most present data mining and machine learning algorithms. MicroRNA (miRNA) is one of the important big genomic and non-coding datasets presenting the genome sequences. In this paper, a hybrid method for the classification of the miRNA data is proposed. Due to the variety of cancers and high number of genes, analyzing the miRNA dataset has been a challenging problem for researchers. The number of features corresponding to the number of samples is high and the data suffer from being imbalanced. The feature selection method has been used to select features having more ability to distinguish classes and eliminating obscures features. Afterward, a Convolutional Neural Network (CNN) classifier for classification of cancer types is utilized, which employs a Genetic Algorithm to highlight optimized hyper-parameters of CNN. In order to make the process of classification by CNN faster, Graphics Processing Unit (GPU) is recommended for calculating the mathematic equation in a parallel way. The proposed method is tested on a real-world dataset with 8,129 patients, 29 different types of tumors, and 1,046 miRNA biomarkers, taken from The Cancer Genome Atlas (TCGA) database.

Keywords: cancer classification, feature selection, deep learning, genetic algorithm

Procedia PDF Downloads 95

Authors: Zayed Alsulami, Asma Aldosseri, Ahmed Ezziden, Abdulrahman Alonazi

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Children are more susceptible to medication errors than adults. Medication administration process is the last stage in the medication treatment process and most of the errors detected in this stage. Little research has been undertaken about medication errors in children in the Middle East countries. This study was aimed to evaluate how the paediatric nurses adhere to the medication administration policy and also to identify any medication preparation and administration errors or any risk factors. An observational, prospective study of medication administration process from when the nurses preparing patient medication until administration stage (May to August 2014) was conducted in Saudi Arabia. Twelve paediatric nurses serving 90 paediatric patients were observed. 456 drug administered doses were evaluated. Adherence rate was variable in 7 steps out of 16 steps. Patient allergy information, dose calculation, drug expiry date were the steps in medication administration with lowest adherence rates. 63 medication preparation and administration errors were identified with error rate 13.8% of medication administrations. No potentially life-threating errors were witnessed. Few logistic and administrative factors were reported. The results showed that the medication administration policy and procedure need an urgent revision to be more sensible for nurses in practice. Nurses’ knowledge and skills regarding the medication administration process should be improved.

Keywords: medication sasfety, paediatric, medication errors, paediatric ward

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Authors: Georgia Mills, Rachel Parsonage

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Thrombocytosis is a platelet count above the upper limit of the normal range. An urgent referral is advised for counts over 1000 x109 and if the count is between 600-1000 x109 with certain conditions/age. A non-urgent referral is warranted when the level is above 450 × 109/L (for more than 3 months) or over 600 × 109/L on at least two occasions (4–6 weeks apart) or within the range 450–600 × 109/L with other haematological abnormalities. The aim of this audit is the assess how well Roseneath's general practice has adhered to the National Institute for Health and Care Excellence (NICE) guidelines for investigations and management of high platelet counts. Through the filtering tool on Vision, all blood results in the surgery were filtered to only show those with a platelet count above 450 x 109 /L. These patients were then analyzed individually to see where they fall on the current NICE guidance pathway for management. The investigations and management of thrombocytosis were generally poor. 60% of those who needed an urgent referral did not have it done. 30% of those who needed a follow-up blood test did not have it done. 60% of those needing a routine referral from complete investigations did not have it done. To improve the knowledge of NICE guidelines within the practice, a teaching session was delivered. Percentages then reached 100% in the 2nd audit. There is a lack of awareness of guidelines and education on thrombocytosis in primary care. Teaching sessions will benefit outcomes greatly

Keywords: platelets, thrombocytosis, management, referral

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Authors: Nikhat Iqbal Tamboli

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INTRODUCTION: road traffic accidents (RTAs) are one of the leading and common causes of ocular injuries especially in developing countries like India which are preventable with certain measures and so it is of public health importance. AIM: To study incidence and clinical presentation of ocular morbidity in road traffic accidents. METHOD: Prospective cross-sectional study was conducted on 360 patients reported in department of ophthalmology. Detailed ocular examination and relevant investigations done. RESULTS: Incidence of ocular injuries is 23%. male:female ratio is 4.5:1.Cases having Sub conjunctival haemorrhage [74].eccymosis[217]. lid lcerations [164]orbital fracture[12] corneal tear [7]corneal abrasion[2] sclera tear[6] hyphaema[4] traumatic mydriasis [7]traumatic cataract [2]vitreous haemorrhage [1]traumatic optic neuropathy[1].Maximum cases in age group 20-40 years, with two wheeler vehicles 94.7% .Under influence of alcohol 13.3%. CONCLUSION: Younger age group with male preponderance is involved in ocular trauma due to road traffic accidents .maximum cases reported are with anterior segment injuries. Alcohol and two wheeler vehicles are common risk factors. Injuries involving cornea had bad prognosis and involving retina had worst prognosis.

Keywords: ocular morbidity, eye trauma, RTA, eye injury

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Authors: Ezeh Chukwunonso Peter Excel, Akruti Vg

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Aim/Background: To show that even after undergoing 1-5 courses of chemotherapy for Gestational Trophoblastic Disease (GTD) reproductive health of women is intact and they conceive successfully after it. Method: Retrospective cohort analysis using data from the Lugansk regional maternity hospital database of years 1993-2013, which shows n=18 females had GTD and underwent 1-5 courses of chemotherapy. Results and Discussion: Frequency of GTD was rare. All 18 patients (pts) belong to age group of 17-39 years, covering wide range of reproductive age. Out of 18 pts, 15 had hydatidiform mole (HM) while other 3 had choriocarcinoma (CC). In anamnesis, among CC pts, 1 had early pre-eclampsia at 24 weeks and 1 had 4th week of late postpartum (PP) bleeding, while all HM pts had genital inflammatory diseases, 1 pt of HM during follow-up had High hCG and 3 times curettage in 5 months. 18 women became pregnant for 25 times after chemotherapy. Chemotherapy was given under indication of either high level of HCG, luteal cyst >6cm or path-morphological results of curettage. CC 3 pts had (2 spontaneous abortions (SA), 2 term cesarean section (CS), 1 preterm CS). HM 15 pts had (3 artificial abortion, 2 SA, 7CS (5 term and 2 preterm), 8 vaginal deliveries (7 term and 1 preterm)). Conclusion: During our research we got 22.2% preterm deliveries and 55.6% CS which is higher than the normal cases, but still all the 18 women were able to have kids successfully after chemotherapy. So we can conclude that chemotherapy for GTD was successful in keeping the reproductive health of women intact.

Keywords: reproductive health, chemotherapy, gestational trophoblastic disease, women

Procedia PDF Downloads 369

Authors: Mohiuddin Ahsanul Kabir Chowdhury, Nafisa Lira Huq, Afroza Khanom, Rafiqul Islam, Abdullah Nurus Salam Khan, Farhana Karim, Nabila Zaka, Shams El Arifeen, Sk. Masum Billah

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After having astounding achievements in reducing maternal mortality and achieving the target for Millennium Development Goal (MDG) 5, the Government of Bangladesh has set new target to reduce Maternal Mortality Ratio (MMR) to 70 per 100,000 live births aligning with targets of Sustainable Development Goals (SDGs). Aversion of deaths from maternal complication by ensuring quality health care could be an important path to accelerate the rate of reduction of MMR. This formative research was aimed at exploring the provision of quality maternal health services at different level of health facilities. The study was conducted in 1 district hospital (DH) and 4 Upazila health complexes (UHC) of Kurigram district of Bangladesh, utilizing both quantitative and qualitative research methods. We conducted 14 key informant interviews with facility managers and 20 in-depth interviews with health care providers and support staff. Besides, we observed 387 normal deliveries from which we found 17 cases of post partum haemorrhage (PPH) and 2 cases of eclampsia during the data collection period extended from July-September 2016. The quantitative data were analyzed by using descriptive statistics, and the qualitative component underwent thematic analysis with the broad themes of facility readiness for maternal complication management, and management of complications. Inadequacy in human resources has been identified as the most important bottleneck to provide quality care to manage maternal complications. The DH had a particular paucity of human resources in medical officer cadre where about 61% posts were unfilled. On the other hand, in the UHCs the positions mostly empty were obstetricians (75%, paediatricians (75%), staff nurses (65%), and anaesthetists (100%). The workload on the existing staff is increased because of the persistence of vacant posts. Unavailability of anesthetists and consultants does not permit the health care providers (HCP) of lower cadres to perform emergency operative procedures and forces them to refer the patients although referral system is not well organized in rural Bangladesh. Insufficient bed capacity, inadequate training, shortage of emergency medicines etc. are other hindrance factors for facility readiness. Among the 387 observed delivery case, 17 (4.4%) were identified as PPH cases, and only 2 cases were found as eclampsia/pre-eclampsia. The majority of the patients were treated with uterine message (16 out of 17, 94.1%) and injectable Oxytocin (14 out of 17, 82.4%). The providers of DH mentioned that they can manage the PPH because of having provision for diagnostic and blood transfusion services, although not as 24/7 services. Regarding management of eclampsia/pre-eclampsia, HCPs provided Diazepam, MgSO4, and other anti-hypertensives. The UHCs did not have MgSO4 at stock even, and one facility manager admitted that they treat eclampsia with Diazepam only. The nurses of the UHCs were found to be afraid to handle eclampsia cases. The upcoming interventions must ensure refresher training of service providers, continuous availability of essential medicine and equipment needed for complication management, availability of skilled health workforce, availability of functioning blood transfusion unit and pairing of consultants and anaesthetists to reach the newly set targets altogether.

Keywords: Bangladesh, health facilities, maternal complications, quality of care

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Authors: Pankaj Prashar, Bimlesh Kumar, Ankita Sood, Anamika Gautam

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Pharmacovigilance (PV) is a rapidly growing discipline in pharmaceutical industries as an integral part of clinical research and drug development over the past few decades. PV carries a breadth of scope from drug manufacturing to its regulation with safer utilization. The fundamental steps of PV not only includes data collection and verification, coding of drugs with adverse drug reactions, causality assessment and timely reporting to the authorities but also monitoring drug manufacturing, safety issues, product quality and conduction of due diligence. Standardization of adverse event information, collaboration of multiple departments in different companies, preparation of documents in accordance to both governmental as well as non-governmental organizations (FDA, EMA, GVP, ICH) are the advancements in discipline of PV. De-harmonization, lack of predictive drug safety models, improper funding by government, non-reporting, and non-acceptability of ADRs by developing countries and reports directly from patients to the monitoring centres respectively are the major road backs of PV. Mandatory pharmacovigilance reporting, frequent inspections, funding by government, educating and training medical students, pharmacists and nurses in this segment can bring about empowerment in PV. This area needs to be addressed with a sense of urgency for the safe utilization of pharmaceuticals.

Keywords: pharmacovigilance, regulatory, adverse event, drug safety

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Authors: Salehah Tahkin, Norlaila Mustafa, Dayang Anita Abdul Aziz

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Knowledge of medical ethics is important to all practitioners so the best care can be delivered to all patients through safe practice. Surgeons are not exceptions to this. Knowledge, attitude, and practice (KAP) of medical ethics among paediatric surgeons and trainees in Malaysia has not been evaluated before. This study aims to determine the level of KAP regarding medical ethics among these groups. This was a cross-sectional study involving three groups of samples, i.e., paediatric surgeons (PS), paediatric surgical trainees (PST), and medical officers with a special interest in paediatric surgery (MO). A validated KAP questionnaire was used. Standard formulas were used to calculate objective indexes for measuring KAP, which were then compared for statistical significance across different sample groups; p less than 0.05 is taken as significant. The index is rated into 5 classes using a score of 0 to 10, i.e., poor (1-2.99), fair (3-4.99), good (5-6.99), very good (7-8.99), and excellent (9-10). There were 117 samples, i.e., PS n=45 (38.5%), PST n=25 (21.3%), and MO n=47 (40.2%). For knowledge, all three groups display a good index score (mean score of 5.44). For attitude, PS and MO also display an index score of good (mean score of 5.81), while the PST index score was fair (4.82). For practice, our study shows a highest score of 7.14 (very good) among PST. However, these differences were not statistically significant (p> 0.05). Conclusion: Training in paediatric surgery must continue to emphasize professionalism and medical ethics education to deliver the best health care services.

Keywords: KAP, medical ethics, paediatric, surgeons, trainees

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Authors: Mehdi Tavana, Seyedeh Zeinab Peighambarzadeh

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Pyelography is used for morphologic and especially functional studies of the urinary tracts. There are many indications for excretory Pyelography in humans and animals. Intravenous Pyelography is the most practical method; other Pyelography techniques were manipulated because of difficulties for finding veins in small size of the patients. At the best of times, the combination of small veins and abundant subcutaneous tissue makes vascular access difficult or impossible, therefore, another methods of administration of contrast media is desired. This study was performed to evaluate the feasibility of intraosseous injection of iodixanol in providing a safe and diagnostic urogram in Persian squirrel. Fourteen hundred mg iodine per kilogram body weight of iodixanol was injected subcutaneously over tibial tuberosity on ten clinically healthy adult Persian squirrels with no signs of urinary system disorder. Lateral and ventrodorsal radiographs were taken every 2 minutes until the pyelogram was finished. Intraosseous injection of iodixanol was successful to show nephrogram, pyelogram, uretrogram and cystogram clearly. There were no abnormal clinical signs after one week of experiments. Biochemical and hematological profiles were in normal ranges. It is concluded that intraosseous Pyelography is an effective and reliable method for Pyelography studies in squirrel. Microscopic examinations of the kidneys and the site of injection after one week were normal.

Keywords: pyelography, intraosseous injection, iodixanol, persian squirrel

Procedia PDF Downloads 512

Authors: Saima Suleman, Kalsoom Sughra, Naeem Mahmood Ashraf

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Mycobacterium tuberculosis is a communicable chronic illness. This disease is being highly focused by researchers as it is present approximately in one third of world population either in active or latent form. The genetic makeup of a person plays an important part in producing immunity against disease. And one important factor association is single nucleotide polymorphism of relevant gene. In this study, we have studied association between single nucleotide polymorphism of CD-209 gene (encode DC-SIGN receptor) and patients of tuberculosis. Dry lab (in silico) and wet lab (RFLP) analysis have been carried out. GWAS catalogue and GEO database have been searched to find out previous association data. No association study has been found related to CD-209 nsSNPs but role of CD-209 in pulmonary tuberculosis have been addressed in GEO database.Therefore, CD-209 has been selected for this study. Different databases like ENSEMBLE and 1000 Genome Project has been used to retrieve SNP data in form of VCF file which is further submitted to different software to sort SNPs into benign and deleterious. Selected SNPs are further annotated by using 3-D modeling techniques using I-TASSER online software. Furthermore, selected nsSNPs were checked in Gujrat and Faisalabad population through RFLP analysis. In this study population two SNPs are found to be associated with tuberculosis while one nsSNP is not found to be associated with the disease.

Keywords: association, CD209, DC-SIGN, tuberculosis

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Authors: Fatemeh Aghamohammadzadeh, Mahdi Asghari Ozma

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SARS-CoV-2 was transmitted from animals to humans in China and through air transport to almost all world countries, including Iran, creating the first pandemic of the 21st century. The virus was spread through droplets from sneezing, coughing, loud talking, and exhalation of sick and asymptomatic people, even during incubation. It was transmitted from human to human directly by inhalation of viruses in droplets or indirectly through contact with infected surfaces, resulting in the death of a significant number of patients, especially the elderly and those with underlying diseases. The virus is more likely to be transmitted in places with high population densities. The chain of transmission of infection can be broken by observing the following: risk perception, reduced travel, complete quarantine in a particular area, home quarantine, social distancing, use of personal protective equipment (PPE), prevention of gatherings, cleaning and disinfection of public utilities and busy places, identifying, isolating and treating infected people, tracking calls, continuing health education, following health principles by people, especially in poor areas, and washing their hands frequently with soap and water or disinfecting them with 70% ethanol.

Keywords: COVID-19, transmission, population density, home quarantine, social distancing

Procedia PDF Downloads 85

Authors: Vineel Inampudi, Arjun Prakash, Joseph Vinod

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Aims and Objectives: To evaluate the interrater reliability in grading ASPECTS score, between emergency medicine physician at first contact and radiologist among patients with acute ischemic stroke. Materials and Methods: We conducted a retrospective analysis of 86 acute ischemic stroke cases referred to the Department of Radiodiagnosis during November 2014 to January 2016. The imaging (plain CT scan) was performed using GE Bright Speed Elite 16 Slice CT Scanner. ASPECTS score was calculated separately by an emergency medicine physician and radiologist. Interrater reliability for total and dichotomized ASPECTS (≥ 6 and < 6) scores were assessed using statistical analysis (ICC and Cohen ĸ coefficients) on SPSS software (v17.0). Results: Interrater agreement for total and dichotomized ASPECTS was substantial (ICC 0.79 and Cohen ĸ 0.68) between the emergency physician and radiologist. Mean difference in ASPECTS between the two readers was only 0.15 with standard deviation of 1.58. No proportionality bias was detected. Bland Altman plot was constructed to demonstrate the distribution of ASPECT differences between the two readers. Conclusion: Substantial interrater agreement was noted in grading ASPECTS between emergency medicine physician at first contact and radiologist thereby confirming its robustness even in a rural setting.

Keywords: ASPECTS, computed tomography, MCA territory, stroke

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Authors: F. O. Adeosun, I. O. Orubuloye, O. O. Babalola

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Although caesarean section has greatly improved obstetric care throughout the world, in developing countries there is a great aversion to caesarean section. This study was carried out to examine the rate at which pregnant women with pre-eclampsia choose caesarean section over natural birth. A cross-sectional study was conducted among 500 pre-eclampsia antenatal clients seen at the States University Teaching Hospitals in the last one year. The sample selection was purposive. Information on their educational background, beliefs and attitudes were collected. Data analysis was presented using simple percentages. Out of 500 women studied, 38% favored caesarean section while 62% were against it. About 89% of them understood what caesarean section is, 57.3% of those who understood what caesarean section is will still not choose it as an option. Over 85% of the women believed caesarean section is done for medical reasons. If caesarean section is given as an option for childbirth, 38% would go for it, 29% would try religious intervention, 5.5% would not choose it because of fear, while 27.5% would reject it because they believe it is culturally wrong. Majority of respondents (85%) who favored caesarean delivery are aware of the risk attached to choosing virginal birth but go an extra mile in sourcing funds for a caesarean session while over 64% cannot afford the cost of caesarean delivery. It is therefore pertinent to encourage research in prediction methods and prevention of occurrence, since this would assist patients to plan on how to finance treatment.

Keywords: caesarean section, choice, cost, pre eclampsia, prediction methods

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Authors: Ebru Turgal, Beyza Doganay Erdogan

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Machine learning aims to model the relationship between the response and features. Medical decision-making researchers would like to make decisions about patients’ course and treatment, by examining the repeated measurements over time. Boosting approach is now being used in machine learning area for these aims as an influential tool. The aim of this study is to show the usage of multivariate tree boosting in this field. The main reason for utilizing this approach in the field of decision-making is the ease solutions of complex relationships. To show how multivariate tree boosting method can be used to identify important features and feature-time interaction, we used the data, which was collected retrospectively from Ankara University Chest Diseases Department records. Dataset includes repeated PF ratio measurements. The follow-up time is planned for 120 hours. A set of different models is tested. In conclusion, main idea of classification with weighed combination of classifiers is a reliable method which was shown with simulations several times. Furthermore, time varying variables will be taken into consideration within this concept and it could be possible to make accurate decisions about regression and survival problems.

Keywords: boosted multivariate trees, longitudinal data, multivariate regression tree, panel data

Procedia PDF Downloads 187

Authors: E. Solfaroli Camillocci, C. Mancini-Terracciano, V. Bocci, A. Carollo, M. Colandrea, F. Collamati, M. Cremonesi, M. E. Ferrari, P. Ferroli, F. Ghielmetti, C. M. Grana, M. Marafini, S. Morganti, M. Patane, G. Pedroli, B. Pollo, L. Recchia, A. Russomando, M. Schiariti, M. Toppi, G. Traini, R. Faccini

Abstract:

A Radio-Guided Surgery technique exploiting β− emitting radio-tracers has been suggested to overcome the impact of the large penetration of γ radiation. The detection of electrons in low radiation background provides a clearer delineation of the margins of lesioned tissues. As a start, the clinical cases were selected between the tumors known to express receptors to a β− emitting radio-tracer: 90Y-labelled DOTATOC. The results of tests on ex-vivo specimens of meningioma brain tumor and abdominal neuroendocrine tumors are presented. Voluntary patients were enrolled according to the standard uptake value (SUV > 2 g/ml) and the expected tumor-to-non-tumor ratios (TNR∼10) estimated from PET images after administration of 68Ga-DOTATOC. All these tests validated this technique yielding a significant signal on the bulk tumor and a negligible background from the nearby healthy tissue. Even injecting as low as 1.4 MBq/kg of radiotracer, tumor remnants of 0.1 ml would be detectable. The negligible medical staff exposure was confirmed and among the biological wastes only urine had a significant activity.

Keywords: ex-vivo test, meningioma, neuroendocrine tumor, radio-guided surgery

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Authors: Yahya Maeni

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It is well established that amblyopic patients have a reduced reading performance and oculomotor deficits. Word length has a significant impact on reading performance and eye movement behaviour during reading. As there no previous attempts to assess whether amblyopic eyes would be affected by word length while reading. This study aims to assess the effect of word length on amblyopic eye movement behaviour during reading including fixation duration, number of fixation and gaze duration. 21 adults with amblyopia and 21 age-matched controls participated in the study (age ± SD) (23.80 ± 4.66) for amblyopes and (24.20 ± 3.58) for Controls. Eye movement was recorded during reading binocularly using Eyelink 1000. Study was designed as 2 x 2 (amblyopia vs. control) x 2 lengths (4 letters, and 8 letters). Compared to controls, the amblyopic participants report significant longer duration of fixation, higher number of fixation and longer gaze duration for short words with far higher significant difference for long words. It could be concluded that eye movement in amblyopia during reading might be accounted for by the length of a word within a text and this could possible explanation of reduced reading performance among amblyopes. By understanding the effect of word length on amblyopia will shed light on reading deficits in amblyopia and help to determine the reading needs of amplyopes in educational and clinical settings.

Keywords: amblyopia, eye movement, reading, fixation

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Authors: Jason Maffia, Maria D’urso, Robert Crupi, Margaret Cartmell

Abstract:

The emotional aspects of traumatic events such as workplace violence are often ignored, causing low productivity, disillusionment, and resentment within an organization. As a result, if workplace violence, particularly in healthcare settings, is not adequately addressed, it will become a phenomenon, undermining the peace and stability among the active communities while also posing a risk to the population's health and well-being. This review intends to identify the risk factors and the implications of workplace violence in healthcare settings and highlight the collaborative efforts needed in sustaining control and prevention measures against workplace violence. It is essential that health care organizations are prepared physically and emotionally for traumatic situations. This study explores the theoretical nature of addressing work-related violence in healthcare settings as well as traumatic stress reactivity and the context within which reactions occur and recovery takes place. Cognitive, social, and organizational influences on response are identified and used to tentatively offer explanations for identifying security risks, development, and implementation of de-escalation teams, CISM programs and training staff in violence prevention are among strategies hospitals are employing to keep workers and patients safe. General conclusion regarding the implications for intervention effectiveness and design are discussed.

Keywords: healthcare settings, stress reactions, traumatic events, workplace violence

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Authors: Shirin Jalili, Ramin Ghasemi Shayan

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Atrial fibrillation is the foremost common arrhythmia around the world, with expanding recurrence famous with age. Thromboembolic occasions and strokes are the number one cause of mortality and morbidity. For patients who don't react to restorative treatment for rate and beat control, the maze method offers an elective treatment mediation. pharmaco-medical treatment for atrial fibrillation is pointed at the control of rate or cadence, intrusive treatment for atrial fibrillation is pointed at cadence control. An obtrusive approach may comprise of percutaneous catheter treatment, surgery, or a crossover approach. Since the maze method is recognized as the foremost successful way to dispense with AF, combining the maze strategy amid major cardiac surgeries has been received in clinical hone. the maze strategy, moreover known as Cox¬maze iii or the ‘cut¬and¬sew’ method, involves making different incisions within the atria to make an arrangement of scars that dispose of each potential zone of re¬entry. The electrical drive is constrained through a maze of scars that coordinates the electrical drive from the sinus node to the av node. By settling the headstrong period between ranges of scar, re¬entry is disposed of. in this article, we evaluate the Maze surgery method that's the surgical method of choice for the treatment of restorative atrial fibrillation.

Keywords: atrial fibrillation, congenital heart disease, procedure, maze surgery, treatment

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Authors: Divya Pathak, James Sloane

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Surgical treatment of midface fractures should ideally occur within two weeks of injury, after which bony healing and consolidation make the repair more difficult for the operating surgeon. The oral and maxillofacial unit at the Royal Surrey Hospital is the tertiary referral center for maxillofacial trauma from five regional hospitals. This is a complete audit cycle of midface trauma referrals managed over a one year period. The standard set was that clinical assessment of the midface fracture would take place in a consultant led outpatient clinic within 7 days, and when indicated, surgical fixation would occur within 10 days of referral. Retrospective data was collected over one year (01/11/2018 - 31/12/2019). Three key changes were implemented: an IT referral mailbox, standardization of an on-call trauma table, and creation of a trauma theatre list. Re-audit was carried out over six months completing the cycle. 283 midface fracture referrals were received, of which 22 patients needed surgical fixation. The average time from referral to outpatient follow-up improved from 14.5 days to 8.3 days, and time from referral to surgery improved from 21.5 days to 11.6 days. Changes implemented in this audit significantly improved patient prioritization to appropriate outpatient clinics and shortened time to surgical intervention.

Keywords: maxillofacial trauma, midface trauma, oral and maxillofacial surgery, surgery fixation

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Authors: Ilma Robo, Saimir Heta, Gerhard Nokaj

Abstract:

Introduction: The method of treatment and the treatment protocols of apical periodontitis are now known, but the ongoing debate remains on whether or not prescription antibiotics should be given to patients suffering from this type of pathology. In fact, as an indication for prescribing antibiotics, this type of pathology remains between clinical indication and contraindication. Material and Methods: This article is of the short-communication type and has the sole purpose of analyzing the clinical picture of apical periodontitis and the fact that the appearance and extent of this pathology in the periapex area passes the stage when the host or the immune cells of the organism of the affected individual, react against bacterial factors. Results: Determining whether or not to prescribe systemic antibiotics according to literature sources can be avoided. In some cases, research in this field about this pathology even indicates endodontic rinsers or irrigants, such as chlorhexidine, in typical cases, mainly in persistent apical periodontitis. Conclusions: In times when bacterial resistance is a hot topic in some fields of scientific research, it is important to divide dental pathologies of bacterial origin into those when systemic antibiotic prescriptions must be given and those when every clinical issue is resolved only with endodontic root canal treatment. Even certain sources of published literature show the specifics of the most effective antibiotics against the bacterial flora causing the pathology of apical periodontitis.

Keywords: endodontic treatment, apical periodontitis, antibiotics, chlorhexidine

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Authors: Grienggrai Rajchakit

Abstract:

As we all know that coronavirus is announced as a pandemic in the world by WHO. It is speeded all over the world with few days of time. To control this spreading, every citizen maintains social distance and self-preventive measures are the best strategies. As of now, many researchers and scientists are continuing their research in finding out the exact vaccine. The machine learning model finds that the coronavirus disease behaves in an exponential manner. To abolish the consequence of this pandemic, an efficient step should be taken to analyze this disease. In this paper, a recurrent neural network model is chosen to predict the number of active cases in a particular state. To make this prediction of active cases, we need a database. The database of COVID-19 is downloaded from the KAGGLE website and is analyzed by applying a recurrent LSTM neural network with univariant features to predict the number of active cases of patients suffering from the corona virus. The downloaded database is divided into training and testing the chosen neural network model. The model is trained with the training data set and tested with a testing dataset to predict the number of active cases in a particular state; here, we have concentrated on Andhra Pradesh state.

Keywords: COVID-19, coronavirus, KAGGLE, LSTM neural network, machine learning

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Authors: Farhood Rismanchian, Seong Hyeon Park, Young Hoon Lee

Abstract:

During the recent years, demand for healthcare services has dramatically increased. As the demand for healthcare services increases, so does the necessity of constructing new healthcare buildings and redesigning and renovating existing ones. Increasing demands necessitate the use of optimization techniques to improve the overall service efficiency in healthcare settings. However, high complexity of care processes remains the major challenge to accomplish this goal. This study proposes a method based on process mining results to address the high complexity of care processes and to find the optimal layout of the various medical centers in an emergency department. ProM framework is used to discover clinical pathway patterns and relationship between activities. Sequence clustering plug-in is used to remove infrequent events and to derive the process model in the form of Markov chain. The process mining results served as an input for the next phase which consists of the development of the optimization model. Comparison of the current ED design with the one obtained from the proposed method indicated that a carefully designed layout can significantly decrease the distances that patients must travel.

Keywords: Mixed Integer programming, Facility layout problem, Process Mining, Healthcare Operation Management

Procedia PDF Downloads 325

Authors: Khaled Soliman, Abdullah Alrushoud, Abdulrahman Alkhalifah, Raed Albathi, Salman Altymiat

Abstract:

Radiation dose received by patients undergoing Computed Tomography (CT) examination of the cervical spine was evaluated using Gafchromic XR-QA2 films and CT-EXPO software (ver. 2.3), in order to document our clinical dose values and to compare our results with other benchmarks reported in the current literature. Radiochromic films were recently used as practical dosimetry tool that provides dose profile information not available using the standard ionisation chamber routinely used in CT dosimetry. We have developed an in-house program to use the films in order to calculate the Entrance Dose Length Product (EDLP) in (mGy.cm) and to relate the EDLP to various organ doses calculated using the CT-EXPO software. We also calculated conversion factor in (mSv/mGy.cm) relating the EDLP to the effective dose (ED) from the examination using CT-EXPO software. Variability among different types of CT scanners and dose modulation methods are reported from at least three major CT brands available at our medical institution. Our work describes the dosimetry method and results are reported. The method can be used as in-vivo dosimetry method. But this work only reports results obtained from adult female anthropomorphic Phantom studies.

Keywords: CT dosimetry, gafchromic films, XR-QA2, CT-Expo software

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Authors: Eleni Peristeri, Georgia Fotiadou, Ianthi-Maria Tsimpli

Abstract:

The local-global dimension has been studied extensively in healthy controls and preference for globally processed stimuli has been validated in both the visual and auditory modalities. Critically, the local-global dimension has an inherent interference resolution component, a type of cognitive control, and left-prefrontal-cortex-damaged (LPFC) individuals have exhibited inability to override habitual response behaviors in item recognition tasks that involve representational interference. Eight patients with damage in the left PFC (age range: 32;5 to 69;0. Mean age: 54;6 yrs) and twenty age- and education-matched language-unimpaired adults (mean age: 56;7yrs) have participated in the study. Distinct performance patterns were found between the language-unimpaired and the LPFC-damaged group which have mainly stemmed from the latter’s difficulty with inhibiting global stimuli in incongruent trials. Overall, the local-global attentional dimension affects LPFC-damaged individuals with non-fluent aphasia in non-language domains implicating distinct types of inhibitory processes depending on the level of processing.

Keywords: left lateral prefrontal cortex damage (LPFC), local-global non-language attention, representational interference, non-fluent aphasia

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Authors: Awol Seid Ebrie

Abstract:

HIV results as an incurable disease, AIDS. After a person is infected with virus, the virus gradually destroys all the infection fighting cells called CD4 cells and makes the individual susceptible to opportunistic infections which cause severe or fatal health problems. Several studies show that the CD4 cells count is the most determinant indicator of the effectiveness of the treatment or progression of the disease. The objective of this paper is to investigate the progression of the disease over time among patient under HAART treatment. Two main approaches of the generalized multilevel ordinal models; namely the proportional odds model and the nonproportional odds model have been applied to the HAART data. Also, the multilevel part of both models includes random intercepts and random coefficients. In general, four models are explored in the analysis and then the models are compared using the deviance information criteria. Of these models, the random coefficients nonproportional odds model is selected as the best model for the HAART data used as it has the smallest DIC value. The selected model shows that the progression of the disease increases as the time under the treatment increases. In addition, it reveals that gender, baseline clinical stage and functional status of the patient have a significant association with the progression of the disease.

Keywords: nonproportional odds model, proportional odds model, random coefficients model, random intercepts model

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Authors: Reem Al-Shidhani, Isabelle S. R. Storer, Michael J. Bromley, Lydia Tabernero

Abstract:

Invasive fungal diseases are an increasing global health concern that contributes to the high mortality rates in immunocompromised patients. The rising of antifungal resistance severely lowers the efficacy of the limited antifungal agents available. New antifungal drugs that target new mechanisms are necessary to tackle the current shortfalls. Amongst post- modifications, phosphorylation is a predominant and an outstanding protein alteration in all eukaryotes. In fungi, protein phosphorylation plays a vital role in many signal transduction pathways, including cell cycle, cell growth, metabolism, transcription, differentiation, proliferation, and virulence. The investigation of Aspergillus fumigatus phosphatases revealed seven genes essential for viability. Inhibiting one of these phosphatases is a new interesting route to develop novel antifungal drugs. In this study, we carried out an early drug discovery process targeting oneessential phosphatase, GlcA. Here, we report the identification of new GlcA inhibitors that show antifungal activity. These important finding open a new avenue to the development of novel antifungals to expand the current narrow arsenal of clinical candidates.

Keywords: invasive fungal diseases, phosphatases, GlcA, competitive inhibitors

Procedia PDF Downloads 87

Authors: G. E. Okungbowa, H. O. Adams, S. E. Eze

Abstract:

This study is on the estimation of adult patient doses for Chest X-ray diagnostic examinations of new admitted undergraduate students attending a tertiary institution health centre as part of their routine clearance and check up on admitted into the institution. A total of 531 newly admitted undergraduate students were recruited for this survey in the first quarter of 2016 (January to March, 2016). CALDOSE_X 5.0 software was used to compute the Entrance Surface Dose (ESD) and Effective Dose (ED); while the Statistical Package for Social Sciences (SPSS) version 21.0 was used to carry out the statistical analyses. The basic patients' data and exposure parameters required for the software are age, sex, examination type, projection posture, tube potential and current-time product. The mean Entrance Surface Dose and Effective Doses of the undergraduate students were calculated using the software, and the values were compared with existing literature and internationally established diagnostic reference levels. The mean ESD calculated is 0.29 mGy, and the mean effective dose is 0.04 mSv. The values of ESD and ED obtained are below the internationally established diagnostic reference levels, which could be attributed to good radiographic techniques employed during the chest X-ray procedure for these students.

Keywords: x-ray, dose, examination, chest

Procedia PDF Downloads 164

Authors: Sara Mouffouk, Fatma Belaid, Asma Hechani, Chaima Mouffouk

Abstract:

Cancer of the cervix caused by HPV (human papillomavirus ) is for many years a real public health problem, it is ranked 2nd deadly female cancer kills more than 270 000 women each year worldwide. In Algeria, the mortality of cervical cancer decreases with the impact, but the prognosis of these cancers remains bleak: The 5-year relative survival is 60 %. The mode of transmission is usually sexuel. Our study was undertaken to show the link between HPV and cervical cancer and the importance of Pap smear screening in this type of pathology. On the total sample, 76.11 % showed abnormal cervical smears of which 13% have mild cases and hormonal reaction Change, and 44% represent inflammatory smears and normal cases 35%, while long seven years from 2005 to 2012. Thus, 43% of abnormal smear results between ASCUS, AGUS, low and high grade carcinoma and adenocarcinoma and 57 % of other cases of unknown origin. The average age of women at risk of developing adenocarcinoma is 45-50 with a 67% to 33% of the same risk in women of age group 41-45 years although the percentage of cases of HPV infected patients was 2% in the past seven years. We found that with increasing age, the risk is argued. Due to several factors such as multiparty can reduced the resistance of the uterine epithelium and even as the multi that promotes contamination HPV causes repeated infections with HPV.

Keywords: cervical cancer, human papillomavirus (HPV) screening, prevention, vaccines

Procedia PDF Downloads 497