Search results for: medical care

Authors: Zayd Parekh, Amish Prasad, Baraa Souman

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Postural orthostatic tachycardia syndrome (POTS) is characterized by orthostatic intolerance due to an exaggerated tachycardia in response to standing upright. This exaggerated orthostatic tachycardia is defined as the heart rate (HR) rising 30 beats above a baseline value while supine or seated within ten minutes. The tachycardia can lead to symptoms of orthostatic intolerance such as palpitations, lightheadedness, exercise intolerance, fatigue, and anxiety. POTS can go undiagnosed for many years due to its similarities with other cardiac and psychiatric conditions and nonspecific presentation, making it crucial to raise awareness for it in the medical field. The following case study discusses a 30-year-old female who was evaluated in the emergency room several times before being referred to the clinic for POTS. An overview of what tests are performed with this patient is also provided, highlighting the diagnostic work-up for POTS and the process of ruling out other differentials being considered. Finally, the epidemiology, the various theories regarding its pathophysiology, the diagnostic process, and pharmacological and non-pharmacological management for POTS are reviewed.

Keywords: orthostatic intolerance, postural orthostatic tachycardia syndrome, syncope, tachycardia

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Authors: Seydou Drabo

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This paper examines how traditional contraceptives and abortion practices challenges the use of modern contraceptives in Burkina Faso. It demonstrates how fears and ‘superstitions’ interact with knowledge about modern contraceptives methods to determine use in a context where other way of controlling fertility (traditional contraceptives, abortion) are available to women in the public, private and traditional health sectors. Furthermore, these issues come at the time when Burkina Faso is among countries with a high fertility rate which (6.0 in 2010) and a very low used of contraceptives as only 16% of married women of childbearing age were using a contraceptive method in 2010. The country also has a young population since 33 % of the population is between 10-24 years old and this number is expected to increase by 2050, generating fears that a growing population of youth will put excessive pressure on available resources, including access to education, health services, and employment. Despite over two decades of dedicated policy attention, 24% of women of reproductive age (15-49) was estimated to have an unmet need for contraception in 2010. This paper draws on ethnographic fieldwork conducted since march 2016 (The research is still in progress) in Burkina Faso. Data were collected from 25 women (users and non-users of modern contraceptives and /or traditional contraceptives, post abortion care patients), 4 street drugs vendors and 3 traditional healers through formal and informal interviews, as well as direct observation. The findings show that a variety of contraceptives methods and abortion drugs or methods, both traditional and modern circulate and are available to women. Traditional contraceptives called African contraceptives by some of our participants refer to several birth control method including plants decoction, magical ring, waist necklace, a ritual done with a mixture of lay coming from termite mound and menses. Abortion is a practice that is done in secret through the use of abortion drugs or through intra uterine manoeuvres. Modern contraceptives include Oral contraceptive, implants, injectable. Stereotypes about modern contraceptives, having regular menstrual cycles and adopt of natural birth control methods, bad experience with modern contraceptives methods, the side effect of modern contraceptives, irregularity of sexual activities and the availability of emergency contraceptives are among factors that limit their use among women. In addition, a negative perception is built around modern contraceptives seen as the drug of ‘white people’. In general, the information on these drugs circulates in women’s social network (first line of information on contraceptive). Some women prefer using what they call African contraceptives or inducing an abortion over modern contraceptives because of their side effect. Furthermore, the findings show that women practices and attitudes in controlling birth varies throughout different phases of their lives. Beyond global discourses and technical solution, the issue of Family planning is all about social practices.

Keywords: abortion, Burkina Faso, contraception, culture, women

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Authors: Karolina Rutkowska, Hubert Pausch, Jolanta Oprzadek, Krzysztof Flisikowski

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The placenta is one of the most important organs that plays a crucial role in the fetal growth and development. Placenta dysfunction is one of the primary cause of the intrauterine growth restriction (IUGR). Cattle have the cotyledonary placenta which consists of two anatomical parts: fetal and maternal. In the case of cattle during the first months of pregnancy, it is very easy to separate maternal caruncle from fetal cotyledon tissue, easier in fact than removing an ordinary glove from one's hand. Which in fact make easier to conduct tissue-specific molecular studies. Typically, animal models for the study of IUGR are created using surgical methods and malnutrition of the pregnant mother or in the case of mice by genetic modifications. However, proposed cattle model with MIMT1Del/WT deletion is unique because it was created without any surgical methods what significantly distinguish it from the other animal models. The primary objective of the study was to identify differential expression of selected miRNAs in the placenta from normal and intrauterine growth restricted fetuses. There was examined the expression of miRNA in the fetal and maternal part of the placenta from 24 fetuses (12 samples from the fetal part of the placenta and 12 samples from maternal part of the placenta). In the study, there was done miRNAs sequencing in the placenta of MIMT1Del/WT fetuses and MIMT1WT/WT fetuses. Then, there were selected miRNAs that are involved in fetal growth and development. Analysis of miRNAs expression was conducted on ABI7500 machine. miRNAs expression was analyzed by reverse-transcription polymerase chain reaction (RT-PCR). As the reference gene was used SNORD47. The results were expressed as 2ΔΔCt: ΔΔCt = (Ctij − CtSNORD47j) − (Cti1 − CtSNORD471). Where Ctij and CtSNORD47j are the Ct values for gene i and for SNORD47 in a sample (named j); Cti1 and CtSNORD471 are the Ct values in sample 1. Differences between groups were evaluated with analysis of variance by using One-Way ANOVA. Bonferroni’s tests were used for interpretation of the data. All normalised miRNA expression values are expressed on a value of natural logarithm. The data were expressed as least squares mean with standard errors. Significance was declared when P < 0.05. The study shows that miRNAs expression depends on the part of the placenta where they origin (fetal or maternal) and on the genotype of the animal. miRNAs offer a particularly new approach to study IUGR. Corresponding tissue samples were collected according to the standard veterinary protocols according to the European Union Normative for Care and Use of Experimental Animals. All animal experiments were approved by the Animal Ethics Committee of the State Provincial Office of Southern Finland (ESAVI-2010-08583/YM-23).

Keywords: placenta, intrauterine growth restriction, miRNA, cattle

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Authors: Diana F. Lopes, Jorge Simoes, José Martins, Eduardo Castro

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Health professionals are the keystone of any health system, by delivering health services to the population. Given the time and cost involved in training new health professionals, the planning process of the health workforce is particularly important as it ensures a proper balance between the supply and demand of these professionals and it plays a central role on the Health 2020 policy. In the past 40 years, the planning of the health workforce in Portugal has been conducted in a reactive way lacking a prospective vision based on an integrated, comprehensive and valid analysis. This situation may compromise not only the productivity and the overall socio-economic development but the quality of the healthcare services delivered to patients. This is even more critical given the expected shortage of the health workforce in the future. Furthermore, Portugal is facing an aging context of some professional classes (physicians and nurses). In 2015, 54% of physicians in Portugal were over 50 years old, and 30% of all members were over 60 years old. This phenomenon associated to an increasing emigration of young health professionals and a change in the citizens’ illness profiles and expectations must be considered when planning resources in healthcare. The perspective of sudden retirement of large groups of professionals in a short time is also a major problem to address. Another challenge to embrace is the health workforce imbalances, in which Portugal has one of the lowest nurse to physician ratio, 1.5, below the European Region and the OECD averages (2.2 and 2.8, respectively). Within the scope of the HEALTH 2040 project – which aims to estimate the ‘Future needs of human health resources in Portugal till 2040’ – the present study intends to get a comprehensive dynamic approach of the problem, by (i) estimating the needs of physicians and nurses in Portugal, by specialties and by quinquenium till 2040; (ii) identifying the training needs of physicians and nurses, in medium and long term, till 2040, and (iii) estimating the number of students that must be admitted into medicine and nursing training systems, each year, considering the different categories of specialties. The development of such approach is significantly more critical in the context of limited budget resources and changing health care needs. In this context, this study presents the drivers of the healthcare needs’ evolution (such as the demographic and technological evolution, the future expectations of the users of the health systems) and it proposes a Bayesian methodology, combining the best available data with experts opinion, to model such evolution. Preliminary results considering different plausible scenarios are presented. The proposed methodology will be integrated in a user-friendly decision support system so it can be used by politicians, with the potential to measure the impact of health policies, both at the regional and the national level.

Keywords: bayesian estimation, health economics, health workforce planning, human health resources planning

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Authors: C. S. Chen, F. Y. Hui, B. S. Farhana, J. De Leon

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Introduction: Stroke can lead to long-term disability, affecting one’s quality of life. Providing stroke education to patient and family members is essential to optimize stroke recovery and prevent recurrent stroke. Currently, nurses conduct stroke education by handing out pamphlets and explaining their contents to patients. However, this is not always effective as nurses have varying levels of knowledge and depth of content discussed with the patient may not be consistent. With the advancement of information technology, health education is increasingly being disseminated via electronic software and studies have shown this to have benefitted patients. Hence, a multi-disciplinary team consisting of doctors, nurses and allied health professionals was formed to create the stroke journey map software to deliver consistent and concise stroke education. Research Objectives: To evaluate the effectiveness of using a stroke journey map software in improving patients’ perceived knowledge in the acute stroke unit during hospitalization. Methods: Patients admitted to the acute stroke unit were given stroke journey map software during patient education. The software consists of 31 interactive slides that are brightly coloured and 4 videos, based on input provided by the multi-disciplinary team. Participants were then assessed with pre-and-post survey questionnaires before and after viewing the software. The questionnaire consists of 10 questions with a 5-point Likert scale which sums up to a total score of 50. The inclusion criteria are patients diagnosed with ischemic stroke and are cognitively alert and oriented. This study was conducted between May 2017 to October 2017. Participation was voluntary. Results: A total of 33 participants participated in the study. The results demonstrated that the use of a stroke journey map as a stroke education medium was effective in improving patients’ perceived knowledge. A comparison of pre- and post-implementation data of stroke journey map revealed an overall mean increase in patients’ perceived knowledge from 24.06 to 40.06. The data is further broken down to evaluate patients’ perceived knowledge in 3 domains: (1) Understanding of disease process; (2) Management and treatment plans; (3) Post-discharge care. Each domain saw an increase in mean score from 10.7 to 16.2, 6.9 to 11.9 and 6.6 to 11.7 respectively. Project Impact: The implementation of stroke journey map has a positive impact in terms of (1) Increasing patient’s perceived knowledge which could contribute to greater empowerment of health; (2) Reducing need for stroke education material printouts making it environmentally friendly; (3) Decreasing time nurses spent on giving education resulting in more time to attend to patients’ needs. Conclusion: This study has demonstrated the benefit of using stroke journey map as a platform for stroke education. Overall, it has increased patients’ perceived knowledge in understanding their disease process, the management and treatment plans as well as the discharge process.

Keywords: acute stroke, education, ischemic stroke, knowledge, stroke

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Authors: Hossam N. Alhawatmeh, Areen I. Albustanji

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Hemodialysis negatively affects physical and psychological health. Pain, poor sleep quality, and low self-esteem are highly prevalent among patients with end-stage renal disease (ESRD) who receive hemodialysis, significantly increasing mortality and morbidity of those patients. Mind-body interventions (MBI), such as mindfulness meditation, have been recently gaining popularity that improved pain, sleep quality, and self-esteem in different populations. However, to our best knowledge, its effects on these health problems in patients receiving hemodialysis have not been studied in Jordan. Thus, the purpose of the study was to examine the effect of mindfulness meditation on pain, sleep quality, and self-esteem in patients with ESR receiving hemodialysis in Jordan. An experimental repeated-measures, randomized, parallel control design was conducted on (n =60) end-stage renal disease patients undergoing hemodialysis between March and June 2023 in the dialysis center at a public hospital in Jordan. Participants were randomly assigned to the experimental (n =30) and control groups (n =30) using a simple random assignment method. The experimental group practiced mindfulness meditation for 30 minutes three times per week for five weeks during their hemodialysis treatments. The control group's patients continued to receive hemodialysis treatment as usual for five weeks during hemodialysis sessions. The study variables for both groups were measured at baseline (Time 0), two weeks after intervention (Time 1), and at the end of intervention (Time 3). The numerical rating scale (NRS), the Rosenberg Self-Esteem Scale (RSES-M), and the Pittsburgh Sleep Quality Index (PSQI) were used to measure pain, self-esteem, and sleep quality, respectively. SPSS version 25 was used to analyze the study data. The sample was described by frequency, mean, and standard deviation as an appropriate. The repeated measures analysis of variance (ANOVA) tests were run to test the study hypotheses. The results of repeated measures ANOVA (within-subject) revealed that mindfulness meditation significantly decrease pain by the end of the intervention in the experimental group. Additionally, mindfulness meditation improved sleep quality and self-esteem in the experimental group, and these improvements occurred significantly after two weeks of the intervention and at the end of the intervention. The results of repeated measures ANOVA (within and between-subject) revealed that the experimental group, compared to the control group, experienced lower levels of pain and higher levels of sleep quality and self-esteem over time. In conclusion, the results provided substantial evidence supporting the positive impacts of mindfulness meditation on pain, sleep quality, and self-esteem in patients with ESRD undergoing hemodialysis. These results highlight the potential of mindfulness meditation as an adjunctive therapy in the comprehensive care of this patient population. Incorporating mindfulness meditation into the treatment plan for patients receiving hemodialysis may contribute to improved well-being and overall quality of life.

Keywords: hemodialysis, pain, sleep quality, self-esteem, mindfulness

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Authors: Manik Sharma, Ganapathy Krishnamurthi

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The cost of some drugs and medical treatments has risen in recent years, that many patients are having to go without. A classification project could make researchers more efficient. One of the more surprising reasons behind the cost is how long it takes to bring new treatments to market. Despite improvements in technology and science, research and development continues to lag. In fact, finding new treatment takes, on average, more than 10 years and costs hundreds of millions of dollars. If successful, we could dramatically improve the industry's ability to model cellular images according to their relevant biology. In turn, greatly decreasing the cost of treatments and ensure these treatments get to patients faster. This work aims at solving a part of this problem by creating a cellular image classification model which can decipher the genetic perturbations in cell (occurring naturally or artificially). Another interesting question addressed is what makes the deep-learning model decide in a particular fashion, which can further help in demystifying the mechanism of action of certain perturbations and paves a way towards the explainability of the deep-learning model.

Keywords: cellular images, genetic perturbations, deep-learning, explainability

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Authors: Qian Zhang, Dongkai Shen, Yan Shi

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A new mechanical ventilator with automatic secretion clearance function can improve the secretion clearance safely and efficiently. However, in recent modeling studies on various mechanical ventilators, it was considered that human had one lung, and the coupling effect of double lungs was never illustrated. In this paper, to expound the coupling effect of double lungs, a mathematical model of a ventilation system of a bi-level positive airway pressure (BiPAP) controlled ventilator with secretion clearance was set up. Moreover, an experimental study about the mechanical ventilation system of double lungs on BiPAP ventilator was conducted to verify the mathematical model. Finally, the coupling effect of double lungs of the mathematical ventilation was studied by simulation and orthogonal experimental design. This paper adds to previous studies and can be referred to optimization methods in medical researches.

Keywords: double lungs, coupling effect, secretion clearance, orthogonal experimental design

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Authors: Adam Gushgari

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The SARS-CoV-2 pandemic has catalyzed the rapid adoption of wastewater-based epidemiology (WBE) methodologies both domestically and internationally. To support the rapid scale-up of pandemic-response wastewater surveillance systems, multiple federal agencies (i.e. US CDC), non-government organizations (i.e. Water Environment Federation), and private charities (i.e. Bill and Melinda Gates Foundation) have funded over $220 million USD supporting development and expanding equitable access of surveillance methods. Funds were primarily distributed directly to municipalities under the CARES Act (90.6%), followed by academic projects (7.6%), and initiatives developed by private companies (1.8%). In addition to federal funding for wastewater monitoring primarily conducted at wastewater treatment plants, state/local governments and private companies have leveraged wastewater sampling to obtain health and lifestyle data on student, prison inmate, and employee populations. We explore the viable paths for expansion of the WBE m1ethodology across a variety of analytical methods; the development of WBE-specific samplers and real-time wastewater sensors; and their application to various governments and private sector industries. Considerable investment in, and public acceptance of WBE suggests the methodology will be applied to other future notifiable diseases and health risks. Early research suggests that WBE methods can be applied to a host of additional “biological insults” including communicable diseases and pathogens, such as influenza, Cryptosporidium, Giardia, mycotoxin exposure, hepatitis, dengue, West Nile, Zika, and yellow fever. Interest in chemical insults is also likely, providing community health and lifestyle data on narcotics consumption, use of pharmaceutical and personal care products (PPCP), PFAS and hazardous chemical exposure, and microplastic exposure. Successful application of WBE to monitor analytes correlated with carcinogen exposure, community stress prevalence, and dietary indicators has also been shown. Additionally, technology developments of in situ wastewater sensors, WBE-specific wastewater samplers, and integration of artificial intelligence will drastically change the landscape of WBE through the development of “smart sewer” networks. The rapid expansion of the WBE field is creating significant business opportunities for professionals across the scientific, engineering, and technology industries ultimately focused on community health improvement.

Keywords: wastewater surveillance, wastewater-based epidemiology, smart cities, public health, pandemic management, substance abuse

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Authors: Jaewoo Choi, Ki-Tae Hwang, Eunyoung Ko

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Backgrounds/Aims: Patients with breast cancer are currently classified according to TNM stage. Nevertheless, the actual volume would be mis-estimated, and it would bring on inappropriate diagnosis. Tridimensional volume-stage derived from the ellipsoid formula was presented as useful measure. Methods: The medical records of 480 consecutive breast cancer between January 2001 and March 2013 were retrospectively reviewed. All patients were divided into three groups according to tumor volume by receiver operating characteristic analysis, and the ranges of each volume-stage were that V1 was below 2.5 cc, V2 was exceeded 2.5 and below 10.9 cc, and V3 was exceeded 10.9 cc. We analyzed outcomes of volume-stage and compared disease-free survival (DFS) and overall survival (OS) between size-stage and volume-stage with variant intrinsic factor. Results: In the T2 stage, there were patients who had a smaller volume than 4.2 cc known as maximum value of T1. These findings presented that patients in T1c had poorer DFS than T2-lesser (mean of DFS 48.7 vs. 51.8, p = 0.011). Such is also the case in OS (mean of OS 51.1 vs. 55.3, p = 0.006). The cumulative survival curves for V1, V2 compared T1, T2 showed similarity in DFS (HR 1.9 vs. 1.9), and so did it for V3 compared T3 (HR 3.5 vs. 2.6) significantly. Conclusion: This study demonstrated that tumor volume had good feasibility on the prognosis of patients with breast cancer. We proposed that volume-stage should be considered for an additional stage indicator, particularly in early breast cancer.

Keywords: breast cancer, tridimensional volume of tumor, TNM stage, volume stage

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Authors: D. Glamowska, K. Szymkowska, K. Mojsiewicz- Pieńkowska, K. Cal, Z. Jankowski

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Introduction: The integrity of the outermost layer of skin (stratum corneum) is vital to the penetration of various compounds, including toxic substances. Barrier function of skin depends of its structure. The barrier function of the stratum corneum is provided by patterned lipid lamellae (binlayer). However, a lot of substances, including the low molecular methyl siloxanes (volatile methyl siloxanes, VMS) have an impact on alteration the skin barrier due to damage of stratum corneum structure. VMS belong to silicones. They are widely used in the pharmaceutical as well as cosmetic industry. Silicones fulfill the role of ingredient or excipient in medicinal products and the excipient in personal care products. Due to the significant human exposure to this group of compounds, an important aspect is toxicology of the compounds and safety assessment of products. Silicones in general opinion are considered as a non-toxic substances, but there are some data about their negative effect on living organisms through the inhaled or oral application. However, the transdermal route has not been described in the literature as a possible alternative route of penetration. The aim of the study was to verify the possibility of penetration of the stratum corneum, further permeation into the deeper layers of the skin (epidermis and dermis) as well as to the fluid acceptor by VMS. Methods: Research methodology was developed based on the OECD and WHO guidelines. In ex-vivo study, the fluorescence microscope and ATR FT-IR spectroscopy was used. The Franz- type diffusion cells were used to application of the VMS on the sample of human skin (A=0.65 cm) for 24h. The stratum corneum at the application site was tape-stripped. After separation of epidermis, relevant dyes: fluorescein, sulforhodamine B, rhodamine B hexyl ester were put on and observations were carried in the microscope. To confirm the penetration and permeation of the cyclic or linear VMS and thus the presence of silicone in the individual layers of the skin, spectra ATR FT-IR of the sample after application of silicone and H2O (control sample) were recorded. The research included comparison of the intesity of bands in characteristic positions for silicones (1263 cm-1, 1052 cm-1 and 800 cm-1). Results: and Conclusions The results present that cyclic and linear VMS are able to overcome the barrier of the skin. Influence of them on damage of corneocytes of the stratum corneum was observed. This phenomenon was due to distinct disturbances in the lipid structure of the stratum corneum. The presence of cyclic and linear VMS were identified in the stratum corneum, epidermis as well as in the dermis by both fluorescence microscope and ATR FT-IR spectroscopy. This confirms that the cyclic and linear VMS can penetrate to stratum corneum and permeate through the human skin layers. Apart from this they cause changes in the structure of the skin. Results show to possible absorption into the blood and lymphathic vessels by the VMS with linear and cyclic structure.

Keywords: low molecular methyl siloxanes, volatile methyl siloxanes, linear and cyclic siloxanes, skin penetration, skin permeation

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Authors: Zoirov Amirdin Olimovich, Akbarov Elbek Elmurodovich

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Introduction: Pneumonia that occurs during COVID-19 infection is common among patients. This research was conducted to determine the frequency of symptoms occurring during pneumonia according to the purpose. Objective and Task: The goal of our research is to develop clinical concepts of pneumonia that occur during COVID-19 infection. Our main task is to analyze the results of blood tests and understand the progression of the disease. Research Materials and Methods: The research was conducted among patients admitted to the Tashkent Medical Academy multi-profile clinic in the department of infectious diseases undergoing stationary treatment with a diagnosis of COVID-19. The analyzed patients had an average age of 46, with a total of 48 patients, 23 of whom were female and 25 were male. Research Results: The research results showed the development of pneumonia within three days in 27 patients after COVID-19 infection. During the observation period, 24 patients (88.8%) recovered completely. The X-ray revealed no signs of pneumonia in those who fully recovered. The remaining three patients showed a persistent form of pneumonia. Conclusion: The conclusion of the research indicates that pneumonia during COVID-19 infection develops in many patients, and 88.8% of patients recover completely without any lingering symptoms.

Keywords: COVID-19, pneumonia, the X-ray, blood, TTA

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Authors: Min Han, Di Wu, Lin Yuan, Fei Liu

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Mechanical sensors have undergone a continuous evolution and have become an important part of many industries, ranging from manufacturing to process, chemicals, machinery, health-care, environmental monitoring, automotive, avionics, and household appliances. Concurrently, the microelectronics and microfabrication technology have provided us with the means of producing mechanical microsensors characterized by high sensitivity, small size, integrated electronics, on board calibration, and low cost. Here we report a new kind of mechanical sensors based on the quantum transport process of electrons in the closely spaced nanoparticle films covering a flexible polymer sheet. The nanoparticle films were fabricated by gas phase depositing of preformed metal nanoparticles with a controlled coverage on the electrodes. To amplify the conductance of the nanoparticle array, we fabricated silver interdigital electrodes on polyethylene terephthalate(PET) by mask evaporation deposition. The gaps of the electrodes ranged from 3 to 30μm. Metal nanoparticles were generated from a magnetron plasma gas aggregation cluster source and deposited on the interdigital electrodes. Closely spaced nanoparticle arrays with different coverage could be gained through real-time monitoring the conductance. In the film coulomb blockade and quantum, tunneling/hopping dominate the electronic conduction mechanism. The basic principle of the mechanical sensors relies on the mechanical deformation of the fabricated devices which are translated into electrical signals. Several kinds of sensing devices have been explored. As a strain sensor, the device showed a high sensitivity as well as a very wide dynamic range. A gauge factor as large as 100 or more was demonstrated, which can be at least one order of magnitude higher than that of the conventional metal foil gauges or even better than that of the semiconductor-based gauges with a workable maximum applied strain beyond 3%. And the strain sensors have a workable maximum applied strain larger than 3%. They provide the potential to be a new generation of strain sensors with performance superior to that of the currently existing strain sensors including metallic strain gauges and semiconductor strain gauges. When integrated into a pressure gauge, the devices demonstrated the ability to measure tiny pressure change as small as 20Pa near the atmospheric pressure. Quantitative vibration measurements were realized on a free-standing cantilever structure fabricated with closely-spaced nanoparticle array sensing element. What is more, the mechanical sensor elements can be easily scaled down, which is feasible for MEMS and NEMS applications.

Keywords: gas phase deposition, mechanical sensors, metallic nanoparticle arrays, quantum conductance

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Authors: T. Nalowa, L. Foncha, S. Eposi

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Prostate enlargement, prostate cancer are major global health problems affecting many men as they advance in age. It is highly recommended to encourage older men to get Prostate Specific Antigen test screening frequently. Conventional treatments like radiation, chemotherapy are associated with many side effects. And this situation is a call for concern. Traditional medicine is affordable, easily prepared with little or no side effects and it contains many phytochemicals. The study aims to find the cure for prostate cancer and prostate enlargement by extracting products from plant tissues of specific herbs to determine anti-inflammatory, anti-cancer, and anti-hematuria properties. Descriptive statistical analysis was applied to describe the data process. The commonly used method of preparation was extraction. Overall, 40 patients were classified based on their medical conditions on their underlying user report. Rural communities in Fako are rich sources of plants with medicinal properties. The used plants consequently provide basic information and aid to investigate the cure of prostate cancer and prostate enlargement, with great significance.

Keywords: cancer, enlargement, metastases, prostate

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Authors: Canan Gunay Yazici, Zubeyir Sarı, Devrim Tarakci

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Background: Hippotherapy considered as global techniques used in rehabilitation of children with cerebral palsy as it improved gait pattern, balance, postural control, balance and gross motor skills development but it encounters some problems (such as the excess of the cost of horses' care, nutrition, housing). Hippotherapy simulator is being developed in recent years to overcome these problems. These devices aim to create the effects of hippotherapy made with a real horse on patients by simulating the movements of a real horse. Objectives: To evaluate the efficacy of hippotherapy simulator on gross motor functions, sitting postural control and dynamic balance of children with cerebral palsy (CP). Methods: Fourteen children with CP, aged 6–15 years, seven with a diagnosis of spastic hemiplegia, five of diplegia, two of triplegia, Gross Motor Function Classification System level I-III. The Horse Riding Simulator (HRS), including four-speed program (warm-up, level 1-2-3), was used for hippotherapy simulator. Firstly, each child received Neurodevelopmental Therapy (NDT; 45min twice weekly eight weeks). Subsequently, the same children completed HRS+NDT (30min and 15min respectively, twice weekly eight weeks). Children were assessed pre-treatment, at the end of 8th and 16th week. Gross motor function, sitting postural control, dynamic sitting and standing balance were evaluated by Gross Motor Function Measure-88 (GMFM-88, Dimension B, D, E and Total Score), Trunk Impairment Scale (TIS), Pedalo® Sensamove Balance Test and Pediatric Balance Scale (PBS) respectively. Unit of Scientific Research Project of Marmara University supported our study. Results: All measured variables were a significant increase compared to baseline values after both intervention (NDT and HRS+NDT), except for dynamic sitting balance evaluated by Pedalo®. Especially HRS+NDT, increase in the measured variables was considerably higher than NDT. After NDT, the Total scores of GMFM-88 (mean baseline 62,2 ± 23,5; mean NDT: 66,6 ± 22,2; p < 0,05), TIS (10,4 ± 3,4; 12,1 ± 3; p < 0,05), PBS (37,4 ± 14,6; 39,6 ± 12,9; p < 0,05), Pedalo® sitting (91,2 ± 6,7; 92,3 ± 5,2; p > 0,05) and Pedalo® standing balance points (80,2 ± 10,8; 82,5 ± 11,5; p < 0,05) increased by 7,1%, 2%, 3,9%, 5,2% and 6 % respectively. After HRS+NDT treatment, the total scores of GMFM-88 (mean baseline: 62,2 ± 23,5; mean HRS+NDT: 71,6 ± 21,4; p < 0,05), TIS (10,4 ± 3,4; 15,6 ± 2,9; p < 0,05), PBS (37,4 ± 14,6; 42,5 ± 12; p < 0,05), Pedalo® sitting (91,2 ± 6,7; 93,8 ± 3,7; p > 0,05) and standing balance points (80,2 ± 10,8; 86,2 ± 5,6; p < 0,05) increased by 15,2%, 6%, 7,3%, 6,4%, and 11,9%, respectively, compared to the initial values. Conclusion: Neurodevelopmental therapy provided significant improvements in gross motor functions, sitting postural control, sitting and standing balance of children with CP. When the hippotherapy simulator added to the treatment program, it was observed that these functions were further developed (especially with gross motor functions and dynamic balance). As a result, this pilot study showed that the hippotherapy simulator could be a useful alternative to neurodevelopmental therapy for the improvement of gross motor function, sitting postural control and dynamic balance of children with CP.

Keywords: balance, cerebral palsy, hippotherapy, rehabilitation

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Authors: Reim A. Almotiri, Manal M. Alkhamisi

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Ternary nanocomposites based on hydroxyapatite (HAP) and alumina (Al2O3) were embedded through graphene oxide (GO) nanosheets to be investigated for medical applications. The composition of the preparations has been confirmed by X-ray photoelectron spectroscopy, energy-dispersive X-ray analysis, and Fourier-Transform infrared spectroscopy. Scanning and transmission electron microscopy have shown the typical morphologies of the components of the nanocomposites with hydroxyapatite nanorods reaching an average diameter of 22.26±2 nm and an average length of 69.56±19.25 nm in the ternary nanocomposites. The ternary nanocomposite has a microhardness of 5.8±0.1 GPa and a higher average roughness of 6.5 nm compared to pure HAP preparation with an average roughness of 2.7 nm. All preparations have shown an acceptable cytotoxicity profile with a percent osteoblasts cell viability of 98.6±1.3% after culturing with the ternary nanocomposite. The TNC has also shown the highest antibacterial activity compared to preparations of each of its constituents and their nanocomposites, with a zone of inhibition’s diameter of 14.1±0.8 mm and 13.6±0.6 mm against Staphylococcus aureus and Escherichia coli, respectively, compared to no zone of inhibition for the pure hydroxyapatite preparation.

Keywords: hydroxypatite, cytotoxicity, nanocomposites, X-ray analysis

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Authors: Rania Abdulkareem Aboubakr Mahdaly Ammar

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The aortic valve (AV) is a complex mechanical environment that includes flexure, tension, pressure and shear stress forces to blood flow during cardiac cycle. This mechanical environment regulates AV tissue structure by constantly renewing and remodeling the phenotype. In vitro, ex vivo and in vivo studies have explained that pathological states such as hypertension and congenital defects like bicuspid AV ( BAV ) can potentially alter the AV’s mechanical environment, triggering a cascade of remodeling, inflammation and calcification activities in AV tissue. Changes in mechanical environments are first sent by the endothelium that induces changes in the extracellular matrix, and triggers cell differentiation and activation. However, the molecular mechanism of this process is not very well understood. Understanding these mechanisms is critical for the development of effective medical based therapies. Recently, there have been some interesting studies on characterizing the hemodynamics associated with AV, especially in pathologies like BAV, using different experimental and numerical methods. Here, we review the current knowledge of the local AV mechanical environment and its effect on valve biology, focusing on in vitro and ex vivo approaches.

Keywords: aortic valve mechanobiology, bicuspid calcification, pressure stretch, shear stress

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Authors: Merav Meiron-Goren, Orna Braun-Lewensohn, Tal Litvak-Hirsh

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In recent years, there has been an increasing tendency towards separation and divorce in relationships. Nevertheless, many couples in a first marriage do not anticipate this as a probable possibility and do not make any preparation for it. Same sex couples establishing a family encounter a much more complicated situation than do heterosexual couples. Although there is a trend towards legal recognition of same sex marriage, many countries, including Israel, do not recognize it. The absence of legal recognition or the existence of partial recognition creates complexity for these couples. They have to fight for their right to establish a family, like the recognition of the biological child of a woman, as a child of her woman spouse too, or the option of surrogacy for a male couple who want children, and more. The lack of legal recognition is burden on the lives of these couples. In the absence of clear norms regarding the conduct of the family unit, the couples must define for themselves the family structure, and deal with everyday dilemmas that lack institutional solutions. This may increase the friction between the two couple members, and it is one of the factors that make it difficult for them to maintain the relationship. This complexity exists, perhaps even more so, in separation. The end of relationship is often accompanied by a deep crisis, causing pain and stress. In most cases, there are also other conflicts that must be settled. These are more complicated when rights are in doubt or do not exist at all. Complex issues for separating same sex couples may include matters of property, recognition of parenthood, and care and support for the children. The significance of the study is based on the fact that same sex relationships are becoming more and more widespread, and are an integral part of the society. Even so, there is still an absence of research focusing on such relationships and their ending. The objective of the study is to research the perceptions of same sex couples regarding the possibility of separation, preparing for it, conflict management and resolving disputes through the separation process. It is also important to understand the point of view of couples that have gone through separation, how they coped with the emotional and practical difficulties involved in the separation process. The doctoral research will use a qualitative research method in a phenomenological approach, based on semi-structured in-depth interviews. The interviewees will be divided into three groups- at the beginning of a relationship, during the separation crisis and after separation, with a time perspective, with about 10 couples from each group. The main theoretical model serving as the basis of the study will be the Lazarus and Folkman theory of coping with stress. This model deals with the coping process, including cognitive appraisal of an experience as stressful, appraisal of the coping resources, and using strategies of coping. The strategies are divided into two main groups, emotion-focused forms of coping and problem-focused forms of coping.

Keywords: conflict management, coping, legal recognition, same-sex relationship, separation

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Authors: Soowon Park, Min-Ji Kim, Jun-Young Lee

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Motivation: The stigma of mental illness has been studied in many disciplines, including social psychology, counseling psychology, sociology, psychiatry, public health care, and related areas, because individuals labeled as ‘mentally ill’ are often deprived of their rights and their life opportunities. To understand the factors that deepen the stigma of mental illness, it is important to understand the influencing factors of the stigma. Problem statement: Depression is a common disorder in adults, but the incidence of help-seeking is low. Researchers have believed that this poor help-seeking behavior is related to the stigma of mental illness, which results from low mental health literacy. However, it is uncertain that increasing mental health literacy decreases mental health stigmatization. Furthermore, even though decreasing stigmatization is important, the stigma of mental illness is still a stable and long-lasting phenomenon. Thus, factors other than knowledge about mental disorders have the power to maintain the stigma. Investigating the influencing factors that facilitate the stigma of psychiatric disease could help lower the social stigmatization. Approach: Face-to-face interviews were conducted with a multi-clustering sample. A total of 700 Korean participants (38% male), ranging in age from 18 to 78 (M(SD)age= 48.5(15.7)) answered demographical questions, Korean version of Link’s Perceived Devaluation and Discrimination (PDD) scale for the assessment of social stigmatization against depression, and the Korean version of the WHO-Composite International Diagnostic Interview for the assessment of mental disorders. Multiple-regression was conducted to find the predicting factors of social stigmatization against depression. Ages, sex, years of education, income, living location, and experience of mental illness were used as the predictors. Results: Predictors accounted for 14% of the variance in the stigma of depressive disorders (F(6, 693) = 20.27, p < .001). Among those, only age, years of education, and experience of mental illness significantly predicted social stigmatization against depression. The standardized regression coefficient of age had a negative association with stigmatization (β = -.20, p < .001), but years of education (β = .20, p < .001) and experience of mental illness (β = .08, p < .05) positively predicted depression stigmatization. Conclusions: The present study clearly demonstrates the association between personal factors and depressive disorder stigmatization. Younger age, more education, and self-stigma appeared to increase the stigmatization. Young, highly educated, and mentally ill people tend to reject patients with depressive disorder as friends, teachers, or babysitters; they also tend to think that those patients have lower intelligence and abilities. These results suggest the possibility that people from a high social class, or highly educated people, who have the power to make decisions, help maintain the social stigma against mental illness patients. To increase the awareness that people from high social classes have more stigmatization against depressive disorders will help decrease the biased attitudes against mentally ill patients.

Keywords: depressive disorder stigmatization, age, education, self-stigma

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Authors: Hossam Abdelrahman, Sama Rostom, Reem Yassein, Yara Mohamed, Salma Salah, Nour Awny

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In today’s environment, people are becoming increasingly interested in their appearance. However, they are afraid of their unknown appearance after a plastic surgery or treatment. Accidents, burns and genetic problems such as bowing of body parts of people have a negative impact on their mental health with their appearance and this makes them feel uncomfortable and underestimated. The approach presents a revolutionary deep learning-based image inpainting method that analyses the various picture structures and corrects damaged images. In this study, A model is proposed based on the in-painting of medical images with Stable Diffusion Inpainting method. Reconstructing missing and damaged sections of an image is known as image inpainting is a key progress facilitated by deep neural networks. The system uses the input of the user of an image to indicate a problem, the system will then modify the image and output the fixed image, facilitating for the patient to see the final result.

Keywords: generative adversarial network, large mask inpainting, stable diffusion inpainting, plastic surgery

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Authors: Mustafa Malki, Ewan R. Pearson

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Tools utilized by health care practitioners to flag potential adverse drug reactions secondary to drug-drug interactions ignore individual genetic variation, which has the potential to markedly alter the severity of these interactions. To our best knowledge, there have been limited published studies on the impact of genetic variation on drug-drug interactions. Therefore, our aim in this project is the discovery of previously unrecognized, clinically important drug-drug-gene interactions (DDGIs) within the list of most commonly used drug combinations in the UK. The UKBB database was utilized to identify the top most frequently prescribed drug combinations in the UK with at least one route of interaction (over than 200 combinations were identified). We have recognised 37 common and unique interacting genes considering all of our drug combinations. Out of around 600 potential genetic variants found in these 37 genes, 100 variants have met the selection criteria (common variant with minor allele frequency ≥ 5%, independence, and has passed HWE test). The association between these variants and the use of each of our top drug combinations has been tested with a case-control analysis under the log-additive model. As the data is cross-sectional, drug intolerance has been identified from the genotype distribution as presented by the lower percentage of patients carrying the risky allele and on the drug combination compared to those free of these risk factors and vice versa with drug tolerance. In GoDARTs database, the same list of common drug combinations identified by the UKBB was utilized here with the same list of candidate genetic variants but with the addition of 14 new SNPs so that we have a total of 114 variants which have met the selection criteria in GoDARTs. From the list of the top 200 drug combinations, we have selected 28 combinations where the two drugs in each combination are known to be used chronically. For each of our 28 combinations, three drug response phenotypes have been identified (drug stop/switch, dose decrease, or dose increase of any of the two drugs during their interaction). The association between each of the three phenotypes belonging to each of our 28 drug combinations has been tested against our 114 candidate genetic variants. The results show replication of four findings between both databases : (1) Omeprazole +Amitriptyline +rs2246709 (A > G) variant in CYP3A4 gene (p-values and ORs with the UKBB and GoDARTs respectively = 0.048,0.037,0.92,and 0.52 (dose increase phenotype)) (2) Simvastatin + Ranitidine + rs9332197 (T > C) variant in CYP2C9 gene (0.024,0.032,0.81, and 5.75 (drug stop/switch phenotype)) (3) Atorvastatin + Doxazosin + rs9282564 (T > C) variant in ABCB1 gene (0.0015,0.0095,1.58,and 3.14 (drug stop/switch phenotype)) (4) Simvastatin + Nifedipine + rs2257401 (C > G) variant in CYP3A7 gene (0.025,0.019,0.77,and 0.30 (drug stop/switch phenotype)). In addition, some other non-replicated, but interesting, significant findings were detected. Our work also provides a great source of information for researchers interested in DD, DG, or DDG interactions studies as it has highlighted the top common drug combinations in the UK with recognizing 114 significant genetic variants related to drugs' pharmacokinetic.

Keywords: adverse drug reactions, common drug combinations, drug-drug-gene interactions, pharmacogenomics

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Authors: Seyed Ahmad Hosseini, Makan Cheraghpour, Saeed Shirali, Roya Rafie, Matin Ghanavati, Arezoo Amjadi, Meysam Alipour

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Background: There is a mutual relationship between sleep duration and obesity. We studied the relationship between sleep duration with obesity and dietary Intake. Methods: This cross-sectional study was conducted on 444 male students in Ahvaz Jundishapur University of Medical Science. Dietary intake was analyzed by food frequency questionnaire (FFQ). Anthropometric indices were analyzed. Participants were being asked about their sleep duration and they were categorized into three groups according to their responses (less than six hours, between six and eight hours, and more than eight hours). Results: Macronutrient, micronutrient, and antioxidant intake did not show significant difference between three groups. Moreover, we did not observe any significant difference between anthropometric indices (weight, body mass index, waist circumference, and percentage body fat). Conclusions: Our study results show no significant relationship between sleep duration, nutrition pattern, and obesity. Further study is recommended.

Keywords: sleep duration, obesity, dietary intake, cross-sectional

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Authors: Vitaliy Petrov, Natalia Shusharina, Vitaliy Kasymov, Maksim Patrushev, Evgeny Bogdanov

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The leading worldwide death reasons are ischemic heart disease and other cardiovascular illnesses. Generally, the common symptom is high blood pressure. Long-time blood pressure control is very important for the prophylaxis, correct diagnosis and timely therapy. Non-invasive methods which are based on Korotkoff sounds are impossible to apply often and for a long time. Implantable devices can combine longtime monitoring with high accuracy of measurements. The main purpose of this work is to create a real-time monitoring system for decreasing the death rate from cardiovascular diseases. These days implantable electronic devices began to play an important role in medicine. Usually implantable devices consist of a transmitter, powering which could be wireless with a special made battery and measurement circuit. Common problems in making implantable devices are short lifetime of the battery, big size and biocompatibility. In these work, blood pressure measure will be the focus because it’s one of the main symptoms of cardiovascular diseases. Our device will consist of three parts: the implantable pressure sensor, external transmitter and automated workstation in a hospital. The Implantable part of pressure sensors could be based on piezoresistive or capacitive technologies. Both sensors have some advantages and some limitations. The Developed circuit is based on a small capacitive sensor which is made of the technology of microelectromechanical systems (MEMS). The Capacitive sensor can provide high sensitivity, low power consumption and minimum hysteresis compared to the piezoresistive sensor. For this device, it was selected the oscillator-based circuit where frequency depends from the capacitance of sensor hence from capacitance one can calculate pressure. The external device (transmitter) used for wireless charging and signal transmission. Some implant devices for these applications are passive, the external device sends radio wave signal on internal LC circuit device. The external device gets reflected the signal from the implant and from a change of frequency is possible to calculate changing of capacitance and then blood pressure. However, this method has some disadvantages, such as the patient position dependence and static using. Developed implantable device doesn’t have these disadvantages and sends blood pressure data to the external part in real-time. The external device continuously sends information about blood pressure to hospital cloud service for analysis by a physician. Doctor’s automated workstation at the hospital also acts as a dashboard, which displays actual medical data of patients (which require attention) and stores it in cloud service. Usually, critical heart conditions occur few hours before heart attack but the device is able to send an alarm signal to the hospital for an early action of medical service. The system was tested with wireless charging and data transmission. These results can be used for ASIC design for MEMS pressure sensor.

Keywords: MEMS sensor, RF power, wireless data, oscillator-based circuit

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Authors: Dieudonne Uwizeye, Reuben Muhayiteto

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Teenage pregnancy is a challenging problem for sustainable development due to restrictions it poses to socioeconomic opportunities for young mothers, their children and families. Being unable to take appropriate economic and social responsibilities, teen mothers get trapped into poverty and become economic burden to their family and country. Besides, teenage pregnancy is also a health problem because children born to very young mothers are vulnerable with greater risk of illnesses and deaths, and teenage mothers are more likely to be exposed to greater risk of maternal mortality and to other health and psychological problems. In Kigali city, in Rwanda, teenage pregnancy rate is currently high and its increase in recent years is worrisome. However, only individual factors influencing the teenage pregnancy tend to be the basis of interventions. It is important to understand the important socioeconomic factors at the household level that are associated with teenage pregnancy to help government, parents, and other stakeholders to appropriately address the problem with sustainable measures. This study analyzed secondary data from the Fifth Rwanda Demographic and Health Survey (RDHS-V 2014-2015) conducted by the National Institute of Statistics of Rwanda (NISR). The aim was to examine household socio-economic factors that are associated with incidence of teenage pregnancies in Kigali city. In addition to descriptive analysis, Pearson’s Chi Square and Binary Logistic Regression were used in the analysis. Findings indicate that marital status and age of household head, number of members in a household, number of rooms used for sleeping, educational level of the household head and household's wealth are significantly associated with teenage pregnancy in Rwanda ( p< 0.05). It was found that teenagers living with parents, those having parents with higher education and those from richer families are less likely to become pregnant. Age of household head was pinpointed as factor to teenage pregnancy, with teenage-headed households being more vulnerable. The findings also revealed that household composition correlates with the probability of teenage pregnancy (p < 0.05) with teenagers from households with less number of members being more vulnerable. Regarding the size of the house, the study suggested that the more rooms available in households, the less incidences of teenage pregnancy are likely to be observed (p < 0.05). However, teenage pregnancy was not significantly associated with physical violence among parents (p = 0.65) and sex of household heads (p = 0.52), except in teen-headed households of which female are predominantly heads. The study concludes that teenage pregnancy remains a serious social, economic and health problem in Rwanda. The study informs government officials, parents and other stakeholders to take interventions and preventive measures through community sex education, policies and strategies to foster effective parental guidance, care and control of young girls through meeting their necessary social and financial needs within households.

Keywords: household socio-economic factors, Rwanda, Rwanda demographic and health survey, teenage pregnancy

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Authors: Purnima K Bajre, Rujula Talloo

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A variety of vehicles are driven on roads such as private vehicles, commercial vehicles, public vehicles, and emergency service vehicles (EMV). Drivers driving different vehicles can have attitude differences towards emergency service vehicles which in turn affects their likelihood to give way to them. The present review aims to understand the factors that mediate this yielding behavior of drivers towards EMVs. Through extensive review of available literature, factors such as effects of lights and sirens, cognitive load, age of the driver, driving general experience, traffic load, drivers’ experience and training with EMVs and drivers’ attitude towards EMV drivers, have emerged as mediating factors. Whereas cognitive load is the most researched area and is observed to be associated negatively with on road drivers’ attitudes towards EMVs, there is a paucity of research to understand the relationships between empathy, pro-social skills, and on road drivers’ attitude towards EMVs.

Keywords: cognitive load, emergency service vehicle, empathy, traffic load

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Authors: Parvesh Singh, Vipan Kumar, Vishu Mehra

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Quinoline-4-ones represent an important class of heterocyclic scaffolds that have attracted significant interest due to their various biological and pharmacological activities. This heterocyclic unit also constitutes an integral component in drugs used for the treatment of neurodegenerative diseases, sleep disorders and in antibiotics viz. norfloxacin and ciprofloxacin. The synthetic accessibility and possibility of fictionalization at varied positions in quinoline-4-ones exemplifies an elegant platform for the designing of combinatorial libraries of functionally enriched scaffolds with a range of pharmacological profles. They are also considered to be attractive precursors for the synthesis of medicinally imperative molecules such as non-steroidal androgen receptor antagonists, antimalarial drug Chloroquine and martinellines with antibacterial activity. 2-Aryl-2,3-dihydroquinolin-4(1H)-ones are present in many natural and non-natural compounds and are considered to be the aza-analogs of favanones. The β-lactam class of antibiotics is generally recognized to be a cornerstone of human health care due to the unparalleled clinical efficacy and safety of this type of antibacterial compound. In addition to their biological relevance as potential antibiotics, β-lactams have also acquired a prominent place in organic chemistry as synthons and provide highly efficient routes to a variety of non-protein amino acids, such as oligopeptides, peptidomimetics, nitrogen-heterocycles, as well as biologically active natural and unnatural products of medicinal interest such as indolizidine alkaloids, paclitaxel, docetaxel, taxoids, cyptophycins, lankacidins, etc. A straight forward route toward the synthesis of quinoline-4-ones via the triflic acid assisted Fries rearrangement of N-aryl-βlactams has been reported by Tepe and co-workers. The ring expansion observed in this case was solely attributed to the inherent ring strain in β-lactam ring because -lactam failed to undergo rearrangement under reaction conditions. Theabovementioned protocol has been recently extended by our group for the synthesis of benzo[b]-azocinon-6-ones via a tandem Michael addition–Fries rearrangement of sorbyl anilides as well as for the single-pot synthesis of 2-aryl-quinolin-4(3H)-ones through the Fries rearrangement of 3-dienyl-βlactams. In continuation with our synthetic endeavours with the β-lactam ring and in view of the lack of convenient approaches for the synthesis of C-3 functionalized quinolin-4(1H)-ones, the present work describes the single-pot synthesis of C-3 functionalized quinolin-4(1H)-ones via the trific acid promoted Fries rearrangement of C-3 vinyl/isopropenyl substituted β-lactams. In addition, DFT calculations and MD simulations were performed to investigate the stability profles of synthetic compounds.

Keywords: dihydroquinoline, fries rearrangement, azetidin-2-ones, quinoline-4-ones

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Authors: Tatjana Pekmezovic, Milica Jecmenica-Lukic, Igor Petrovic, Vladimir Kostic

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Background: A group of atypical parkinsonian syndromes (APS) includes a variety of rare neurodegenerative disorders characterized by reduced life expectancy, increasing disability, and considerable impact on health-related quality of life (HRQoL). Aim: In this study we wanted to answer two questions: a) which demographic and clinical factors are main contributors of HRQoL in our cohort of patients with APS, and b) how does quality of life of these patients change over 1-year follow-up period. Patients and Methods: We conducted a prospective cohort study in hospital settings. The initial study comprised all consecutive patients who were referred to the Department of Movement Disorders, Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade (Serbia), from January 31, 2000 to July 31, 2013, with the initial diagnoses of ‘Parkinson’s disease’, ‘parkinsonism’, ‘atypical parkinsonism’ and ‘parkinsonism plus’ during the first 8 months from the appearance of first symptom(s). The patients were afterwards regularly followed in 4-6 month intervals and eventually the diagnoses were established for 46 patients fulfilling the criteria for clinically probable progressive supranuclear palsy (PSP) and 36 patients for probable multiple system atrophy (MSA). The health-related quality of life was assessed by using the SF-36 questionnaire (Serbian translation). Hierarchical multiple regression analysis was conducted to identify predictors of composite scores of SF-36. The importance of changes in quality of life scores of patients with APS between baseline and follow-up time-point were quantified using Wilcoxon Signed Ranks Test. The magnitude of any differences for the quality of life changes was calculated as an effect size (ES). Results: The final models of hierarchical regression analysis showed that apathy measured by the Apathy evaluation scale (AES) score accounted for 59% of the variance in the Physical Health Composite Score of SF-36 and 14% of the variance in the Mental Health Composite Score of SF-36 (p<0.01). The changes in HRQoL were assessed in 52 patients with APS who completed 1-year follow-up period. The analysis of magnitude for changes in HRQoL during one-year follow-up period have shown sustained medium ES (0.50-0.79) for both Physical and Mental health composite scores, total quality of life as well as for the Physical Health, Vitality, Role Emotional and Social Functioning. Conclusion: This study provides insight into new potential predictors of HRQoL and its changes over time in patients with APS. Additionally, identification of both prognostic markers of a poor HRQoL and magnitude of its changes should be considered when developing comprehensive treatment-related strategies and health care programs aimed at improving HRQoL and well-being in patients with APS.

Keywords: atypical parkinsonian syndromes, follow-up study, quality of life, APS

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Authors: Katie Dolaghan, Christina Tran, Kim Hamilton, Amanda Beresford, Vicky Adams, Jamie Toole, John Marley

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During the Covid 19 pandemic routine outpatient appointments were not possible face to face. That resulted in many branches of healthcare starting virtual clinics. These clinics have continued following the return to face to face patient appointments. With these new types of clinic it is important to ensure that a high standard of patient care is maintained. In order to improve patient and clinician experience of the telephone clinics a quality improvement project was carried out to ensure the patient and clinician experience of these clinics was enhanced whilst remaining a safe, effective and an efficient use of resources. The project began by developing a process map for the consultation process and agreed on the design of a driver diagram and tests of change. In plan do study act (PDSA) cycle1 a single consultant completed an online survey after every patient encounter over a 5 week period. Baseline patient responses were collected using a follow-up telephone survey for each patient. Piloting led to several iterations of both survey designs. Salient results of PDSA1 included; patients not receiving appointment letters, patients feeling more anxious about a virtual appointment and many would prefer a face to face appointment. The initial clinician data showed a positive response with a provisional diagnosis being reached in 96.4% of encounters. PDSA cycle 2 included provision of a patient information sheet and information leaflets relevant to the patients’ conditions were developed and sent following new patient telephone clinics with follow-up survey analysis as before to monitor for signals of change. We also introduced the ability for patients to send an images of their lesion prior to the consultation. Following the changes implemented we noted an improvement in patient satisfaction and, in fact, many patients preferring virtual clinics as it lead to less disruption of their working lives. The extra reading material both before and after the appointments eased patients’ anxiety around virtual clinics and helped them to prepare for their appointment. Following the patient feedback virtual clinics are now used for review patients as well, with all four consultants within the department continuing to utilise virtual clinics. During this presentation the progression of these clinics and the reasons that these clinics are still operating following the return to face to face appointments will be explored. The lessons that have been gained using a QI approach have helped to deliver an optimal service that is valid and reliable as well as being safe, effective and efficient for the patient along with helping reduce the pressures from ever increasing waiting lists. In summary our work in improving the quality of virtual clinics has resulted in improved patient satisfaction along with reduced pressures on the facilities of the health trust.

Keywords: clinic, satisfaction, telephone, virtual

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Authors: R. Simide, T. Miard

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Integrated multi-trophic aquaculture (IMTA) is used to reduce waste from aquaculture and increase productivity by co-cultured species. In this study, we designed a recirculating multi-trophic aquaculture system which requires low energy consumption, low water renewal and easy-care. European seabass (Dicentrarchus labrax) were raised with co-cultured sea urchin (Paracentrotus lividus), deteritivorous polychaete fed on settled particulate matter, mussels (Mytilus galloprovincialis) used to extract suspended matters, macroalgae (Ulva sp.) used to uptake dissolved nutrients and gastropod (Phorcus turbinatus) used to clean the series of 4 tanks from fouling. Experiment was performed in triplicate during one month in autumn under an experimental greenhouse at the Institute Océanographique Paul Ricard (IOPR). Thanks to the absence of a physical filter, any pomp was needed to pressure water and the water flow was carried out by a single air-lift followed by gravity flow.Total suspended solids (TSS), biochemical oxygen demand (BOD5), turbidity, phytoplankton estimation and dissolved nutrients (ammonium NH₄, nitrite NO₂⁻, nitrate NO₃⁻ and phosphorus PO₄³⁻) were measured weekly while dissolved oxygen and pH were continuously recorded. Dissolved nutrients stay under the detectable threshold during the experiment. BOD5 decreased between fish and macroalgae tanks. TSS highly increased after 2 weeks and then decreased at the end of the experiment. Those results show that bioremediation can be well used for aquaculture system to keep optimum growing conditions. Fish were the only feeding species by an external product (commercial fish pellet) in the system. The others species (extractive species) were fed from waste streams from the tank above or from Ulva produced by the system for the sea urchin. In this way, between the fish aquaculture only and the addition of the extractive species, the biomass productivity increase by 5.7. In other words, the food conversion ratio dropped from 1.08 with fish only to 0.189 including all species. This experimental recirculating multi-trophic aquaculture system was efficient enough to reduce waste and increase productivity. In a second time, this technology has been reproduced at a commercial scale. The IOPR in collaboration with Les 4 Marais company run for 6 month a recirculating IMTA in 8000 m² of water allocate between 4 marsh ponds. A similar air-lift and gravity recirculating system was design and only one feeding species of shrimp (Palaemon sp.) was growth for 3 extractive species. Thanks to this joint work at the laboratory and commercial scales we will be able to challenge IMTA system and discuss about this sustainable aquaculture technology.

Keywords: bioremediation, integrated multi-trophic aquaculture (IMTA), laboratory and commercial scales, recirculating aquaculture, sustainable

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Authors: Mohammad J. J. Taha, Mohammad T. Abuawwad, Warda A. Alrubasy, Shams Khalid Sameer, Taleb Alsafi, Yaqeen Al-Bustanji, Luai Abu-Ismail, Abdulqadir J. Nashwan

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Viral pandemics often take the world by storm, urging the medical community to prioritize the most evident systemic manifestations, often causing ocular manifestations to go unnoticed. This literature review aims to highlight the ocular complications of monkeypox, SARS-CoV-2, MERS, ebola, H1N1, and zika viruses as the most recent viral pandemics. Since the emergence of the newly resurfacing monkeypox and the novel SARS-CoV-2, research aiming to uncover the effects of these pandemics began right away. Moreover, it also discusses the ocular complications of the vaccines and treatments that were used in the scope of the viral pandemics. To add, this work discussed the role of the eye as an important route of viral transmission, and thereafter, the American Academy of Ophthalmology (AAO) recommendations to reduce the incidence of viral transmission were mentioned. Finally, this paper aims to outline a platform for researchers who are interested in further investigating eye-related viral manifestations.

Keywords: ophthalmology, monkeypox, ebola, zika, MERS, H1N1, influenza, COVID-19

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