Search results for: patient's peak skin dose

Authors: Adrian Sebastian, Chris Gillespie

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We describe a case of diffuse rectal involvement with cap polyposis, manifesting with a protein-losing colopathy and occurring in the setting of advanced mechanical pelvic floor dysfunction. A 59-year-old male with a 5-year history of persistent excessive flatulence, defecatory difficulties, and diarrhea. He had extensive cap polyposis of the entire rectum endoscopically. His symptoms progressed to severe fecal incontinence with mucus leakage, pelvic pain, weight loss, and hypoalbuminemia. Clinical examination exhibited severe perineal descent, a large rectocele, poor anal squeeze, and a poor defecatory technique. After a trial of nonoperative therapies addressing his defecatory dysfunction, and Helicobacter pylori eradication, surgical resection was offered due to severe symptoms with ongoing incontinence and protein loss with no other reasonable options. A robotic abdominoperineal resection with a permanent colostomy was performed, followed by an uncomplicated recovery. Our observation of coexisting mechanical pelvic floor changes in this patient lends weight to the concept of a prolapse-related phenomenon in the pathophysiology of this rare condition.

Keywords: cap polyposis, pelvic dysfunction, fecal incontinence, case report

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Authors: J. Punj, R. K. Pandey, V. Darlong, K. Thangavel

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Background: Dural puncture epidural (DPE) technique has been introduced recently for labour analgesia however, no study has compared ropivacaine and levobupivacaine for the same. Methods: The primary aim of the study was to compare time to onset of the Numerical Pain Rating Score (NPRS) ≤ 1 in labour analgesia with both drugs. After obtaining ethics and patient consent, ASA I and ASA II parturient with single foetus in vertex presentation and cervical dilatation <5.0 cm were included. DPE was performed with 16/ 26 G combined spinal epidural (CSE) technique, and parturients randomized into two groups. In Group R ( Ropivacaine) 20 ml 0.125% ropivacaine+ fentanyl 2µg/ml was injected to a maximum of 20 ml in 20 minutes and in Group L (Levobupivacaine), 20 ml 0.125% levobupivacaine + fentanyl 2µg/ml was injected. Outcomes were assessed at 0.5,2,4,6,8,10,12,14,16,18,20 and 30 minutes, then every 90 minutes until delivery. Appropriate statistical analysis was done, and p value of <0.05 was considered statistically significant. Results: The median time to onset of NPRS ≤1 in both groups was comparable (group R= 16 minutes vs group L= 18 minutes (p = 0.076). Volume of drug for NPR ≤1 in both groups was also comparable (Group R 15.95± 2.03 ml vs Group L 16.35 ± 1.34 ml (p=0.47). Conclusion: DPE with 16 G epidural needle and 26 gauge spinal needle with both 0.125% ropivacaine and 0.125% levobupivacaine results in similar efficacy of labour analgesia.

Keywords: dural puncture epidural, labour analgesia, obstetric analgesia, hypotension

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Authors: Eugene Ivanov, Eduardo del-Rio, Igor Kapchenko, Maija Nystrӧm, Juha Kotila

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Series of low modulus beta Ti alloy billets and powders can be produced in commercial quantities using a combination of electron beam melting (EBM) and EIGA atomization processes. In the present study, TNZT alloy powder was produced and processed in the EOSINT M290 laser sintering system to produce parts for mechanical testing. Post heat treatments such as diffusion annealing to reduce internal stresses or hot isostatic pressing to remove closed pores were not applied. The density can visually be estimated to be > 99,9 %. According to EDS study Nb, Zr, and Ta are distributed homogeneously throughout the printed sample. There are no indications for any segregation or chemical inhomogeneity, i.e. variation of the element distribution. These points to the fact that under the applied experimental conditions the melt generated by the laser rapidly cools down in the SLM (Selective Laser Melting) process. The selective laser sintering yielded dense structures with relatively good surface quality. The mechanical properties, especially the elongation (24%) along with tensile strength ( > 500MPa) and modulus of elasticity (~60GPa), were found to be promising compared to titanium alloys in general.

Keywords: beta titanium alloys, additive manufacturing, powder, implants

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Authors: Komal Saini, S. K. Sahoo, B. S. Bajwa

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The Laser Fluorimetery Technique has been used for the microanalysis of uranium content in water samples collected from different sources like the hand pumps, tube wells in the drinking water samples of SW & NE Punjab, India. The geographic location of the study region in NE Punjab is between latitude 31.21º- 32.05º N and longitude 75.60º-76.14º E and for SW Punjab is between latitude 29.66º-30.48º N and longitude 74.69º-75.54º E. The purpose of this study was mainly to investigate the uranium concentration levels of ground water being used for drinking purposes and to determine its health effects, if any, to the local population of these regions. In the present study 131 samples of drinking water collected from different villages of SW and 95 samples from NE, Punjab state, India have been analyzed for chemical and radiological toxicity. In the present investigation, uranium content in water samples of SW Punjab ranges from 0.13 to 908 μgL−1 with an average of 82.1 μgL−1 whereas in samples collected from NE- Punjab, it ranges from 0 to 28.2 μgL−1 with an average of 4.84 μgL−1. Thus, revealing that in the SW- Punjab 54 % of drinking water samples have uranium concentration higher than international recommended limit of 30 µgl-1 (WHO, 2011) while 35 % of samples exceeds the threshold of 60 µgl-1 recommended by our national regulatory authority of Atomic Energy Regulatory Board (AERB), Department of Atomic Energy, India, 2004. On the other hand in the NE-Punjab region, none of the observed water sample has uranium content above the national/international recommendations. The observed radiological risk in terms of excess cancer risk ranges from 3.64x10-7 to 2.54x10-3 for SW-Punjab, whereas for NE region it ranges from 0 to 7.89x10-5. The chemical toxic effect in terms of Life-time average Daily Dose (LDD) and Hazard Quotient (HQ) have also been calculated. The LDD for SW-Punjab varies from 0.0098 to 68.46 with an average of 6.18 µg/ kg/day whereas for NE region it varies from 0 to 2.13 with average 0.365 µg/ kg/day, thus indicating presence of chemical toxicity in SW Punjab as 35% of the observed samples in the SW Punjab are above the recommendation limit of 4.53 µg/ kg/day given by AERB for 60 µgl-1 of uranium. Maximum & Minimum values for hazard quotient for SW Punjab is 0.002 & 15.11 with average 1.36 which is considerably high as compared to safe limit i.e. 1. But for NE Punjab HQ varies from 0 to 0.47. The possible sources of high uranium observed in the SW- Punjab will also be discussed.

Keywords: uranium, groundwater, radiological and chemical toxicity, Punjab, India

Procedia PDF Downloads 366

Authors: Ajit Kumar Sah, Rajesh Kumar Jha, Phoolgen Sah, Dev Kumar Shah

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Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The purpose of this study was to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department. Beers’ criteria are the most widely used tools to assess PIM to elderly patients. Prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a hospital of Bharatpur, Chitwan, Nepal during November 2011 to October 2012 to 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analyzed using Beers Criteria updated to 2013. In the 869 patients included the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with a number of medications prescribed. Further research is warranted to study the impact of PIMs towards health-related outcomes in these elderly.

Keywords: Beers criteria, elderly, polypharmacy, potentially inappropriate medicines

Procedia PDF Downloads 545

Authors: Luvindran Sugumaran, Mohd Nashrul Mohd Zubir, Kazi Md Salim Newaz, Tuan Zaharinie Tuan Zahari, Suazlan Mt Aznam, Aiman Mohd Halil

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Due to the rapid advancement of integrated circuits and the increasing trend towards miniaturizing electronic devices, the amount of heat produced by electronic devices has consistently exceeded the maximum limit for heat dissipation. Currently, the two-phase cooling technique based on phase change pool boiling heat transfer has received a lot of attention because of its potential to fully utilize the latent heat of the fluid and produce a highly effective heat dissipation capacity while keeping the equipment's operating temperature within an acceptable range. There are numerous strategies available for the alteration of heating surfaces, but to find the best, simplest, and most dependable one remains a challenge. Lately, surface texturing via laser ablation has been used in a variety of investigations, demonstrating its significant potential for enhancing the pool boiling heat transfer performance. In this research, the nucleate pool boiling heat transfer performance of laser-textured copper surfaces of different patterns was investigated. The bare copper surface serves as a reference to compare the performance of laser-structured surfaces. It was observed that the heat transfer coefficients were increased with the increase of surface area ratio and the ratio of the peak-to-valley height of the microstructure. Laser machined grain structure produced extra nucleation sites, which ultimately caused the improved pool boiling performance. Due to an increase in nucleation site density and surface area, the enhanced nucleate boiling served as the primary heat transfer mechanism. The pool boiling performance of the laser-textured copper surfaces is superior to the bare copper surface in all aspects.

Keywords: heat transfer coefficient, laser texturing, micro structured surface, pool boiling

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Authors: Arushi Singh, Anjana Jain, Prakash Vyavahare

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Recently, Li-Fi(light-fiedelity) has been launched based on VLC(visible light communication) technique, 100 times faster than WiFi. Now 5G mobile communication system is proposed to use VLC-OFDM as the transmission technique. The VLC system focused on visible rays, is considered for efficient spectrum use and easy intensity modulation through LEDs. The reason of high speed in VLC is LED, as they flicker incredibly fast(order of MHz). Another advantage of employing LED is-it acts as low pass filter results no out-of-band emission. The VLC system falls under the category of ‘green technology’ for utilizing LEDs. In present scenario, OFDM is used for high data-rates, interference immunity and high spectral efficiency. Inspite of the advantages OFDM suffers from large PAPR, ICI among carriers and frequency offset errors. Since, the data transmission technique used in VLC system is OFDM, the system suffers the drawbacks of OFDM as well as VLC, the non-linearity dues to non-linear characteristics of LED and PAPR of OFDM due to which the high power amplifier enters in non-linear region. The proposed paper focuses on reduction of PAPR in VLC-OFDM systems. Many techniques are applied to reduce PAPR such as-clipping-introduces distortion in the carrier; selective mapping technique-suffers wastage of bandwidth; partial transmit sequence-very complex due to exponentially increased number of sub-blocks. The paper discusses three companding techniques namely- µ-law, A-law and advance A-law companding technique. The analysis shows that the advance A-law companding techniques reduces the PAPR of the signal by adjusting the companding parameter within the range. VLC-OFDM systems are the future of the wireless communication but non-linearity in VLC-OFDM is a severe issue. The proposed paper discusses the techniques to reduce PAPR, one of the non-linearities of the system. The companding techniques mentioned in this paper provides better results without increasing the complexity of the system.

Keywords: non-linear companding techniques, peak to average power ratio (PAPR), visible light communication (VLC), VLC-OFDM

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Authors: Panarat Saengpanya

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There were five objectives in this study including the study of housing type with water environment, the physical and mechanical properties of the buoy material, the mechanical properties of the buoy models, the floating of the buoy models and the relationship between the civil engineering parameters and the floating of the buoy. The buoy examples made from Expanded Polystyrene (EPS) covered by 5 mm thickness of mortar with the equal thickness on each side. Specimens are 0.05 m cubes tested at a displacement rate of 0.005 m/min. The existing test method used to assess the parameters relationship is ASTM C 109 to provide comparative results. The results found that the three type of housing with water environment were Stilt Houses, Boat House, and Floating House. EPS is a lightweight material that has been used in engineering applications since at least the 1950s. Its density is about a hundredth of that of mortar, while the mortar strength was found 72 times of EPS. One of the advantage of composite is that two or more materials could be combined to take advantage of the good characteristics of each of the material. The strength of the buoy influenced by mortar while the floating influenced by EPS. Results showed the buoy example compressed under loading. The Stress-Strain curve showed the high secant modulus before reached the peak value. The failure occurred within 10% strain then the strength reduces while the strain was continuing. It was observed that the failure strength reduced by increasing the total volume of examples. For the buoy examples with same area, an increase of the failure strength is found when the high dimension is increased. The results showed the relationship between five parameters including the floating level, the bearing capacity, the volume, the high dimension and the unit weight. The study found increases in high of buoy lead to corresponding decreases in both modulus and compressive strength. The total volume and the unit weight had relationship with the bearing capacity of the buoy.

Keywords: floating house, buoy, floating structure, EPS

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Authors: Shaker Alsharif, Xavier Banquy

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Controlled drug delivery technology represents one of the most rapidly advancing areas of science in which chemists and chemical engineers are contributing to human health care. Such delivery systems provide numerous advantages compared to conventional dosage forms including improved efficacy, and improved patient compliance and convenience. Such systems often use synthetic polymers as carriers for the drugs. As a result, treatments that would not otherwise be possible are now in conventional use. The role of bilayered vesicles as efficient carriers for drugs, vaccines, diagnostic agents and other bioactive agents have led to a rapid advancement in the liposomal drug delivery system. Moreover, the site avoidance and site-specific drug targeting therapy could be achieved by formulating a liposomal product, so as to reduce the cytotoxicity of many potent therapeutic agents. Our project focuses on developing and building hydrogel with nanoinclusion of liposomes loaded with active compounds such as proteins and growth factors able to release them in a controlled fashion. In order to achieve that, we synthesize several liposomes of two different phospholipids concentrations encapsulating model drug. Then, formulating hydrogel with specific mechanical properties embedding the liposomes to manage the release of active compound.

Keywords: controlled release, hydrogel, liposomes, active compounds

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Authors: Griaznova Svetlana, Umedov Mekhroz

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The current healthcare facilities trend is the creation of multidisciplinary large-scale centers to provide the maximum possible services in one place, minimizing the number of possible instances in the path of patient treatment. The multifunctional medical centers are mainly designed in urban infrastructure for good accessibility. However, many functions and connections define the building shape, often make it inharmonious, that greatly destroys the city's appearance. The purpose of the research is to scientifically substantiate the factors influencing the shaping, the formation of architectural solutions principles, the formation of recommendations and principles for the multifunctional medical centers' design. The result of the research is the elaboration of architectural and planning solutions principles and the determination of factors affecting the multifunctional healthcare facilities shaping. Research method: Study and generalization of international experience in scientific research, literature, standards, teaching aids, and design materials on the topic of research. An integrated approach to the study of existing international experience of multidisciplinary medical centers. Elaboration of graphical analysis and diagrams based on the system analysis of the processed information. Identification of methods and principles of functional zoning of nuclear medicine centers.

Keywords: health care, multifunctionality, form, medical center, hospital, PET, CT scan

Procedia PDF Downloads 86

Authors: Mohamed N. Al-Arifi, Hessa Othman Al-Husein, Mostafa Q. Al Shamiri, Ragab Said, Syed Wajid, Salmeen D. Babelghaith

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Polypharmacy was defined as a taking more than 4 medications per single patients (minor polypharmacy), patients who are taking more than 10 medications we considered as a major polypharmacy. This study was aimed to evaluate the prevalence of polypharmacy in elderly Saudi cardiac patient. A retrospective observational study was carried out at the department of CCU and cardiology unit of the King Fahad cardiac centre (KFCC) in King Khalid university hospital from May 2012 to October 2012. All Parameters was analyzed by using Statistical Packages for Social Science (SPSS) to conclude the result; tests of association were performed using the chi-square statistic. The mean age of patients was 70.1 ± 7.75 years, more than half 83 (51.6%) were males. The highest frequency of chronic diseases found were hypertension (91.0%) followed by, dyslipidemia (74.9%), and diabetes mellitus. Results showed that 82% had polypharmacy (>4 drugs) during the study period, and 47.9% had major polypharmacy. The incidence of inappropriate drug use was found to be higher with men than female (p = 0.984). In conclusion, this study revealed that high prevalence of polypharmacy and potentially inappropriate medications in elderly Saudi cardiac inpatients.

Keywords: cardiac inpatients, medications, polypharmacy, prevalence

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Authors: Ahmed Hefny Mohamed El-Badwy

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This research aims to study of the surgery science and imaging in ancient Egypt, and how to diagnose the surgical cases, whether due to injuries or disease that requires surgical intervention, Medical diagnosis and how to treat it. The ancient Egyptian physician tried to change over from magic and theological thinking to become a stand-alone experimental science, they were able to distinguish between diseases, and they divide them into internal and external diseases even this division exists to date in modern medicine. There is no evidence to recognize the amount of human knowledge in the prehistoric knowledge of medicine and surgery except skeleton. It is not far from the human being in those times familiar with some means of treatment, Surgery in the Stone age was rudimentary, Flint stone was used after trimming in a certain way as a lancet to slit and open the skin. Wooden tree branches were used to make splints to treat bone fractures. Surgery developed further when copper was discovered, it led to the advancement of Egyptian civilization, then modern and advanced tools appeared in the operating theater, like a knife or a scalpel, there is evidence of surgery performed in ancient Egypt during the dynastic period (323 – 3200 BC). The climate and environmental conditions have preserved medical papyri and human remains that have confirmed their knowledge of surgical methods, including sedation. The ancient Egyptians reached a great importance in surgery, evidenced by the scenes that depict the pathological image and the surgical process, but the image alone is not sufficient to prove the pathology, its presence in ancient Egypt and its treatment method. As there are a number of medical papyri, especially Edwin Smith and Ebris, which prove the ancient Egyptian surgeon's knowledge of the pathological condition that It requires a surgical intervention, otherwise, its diagnosis and the method of treatment will not be described with such accuracy through these texts. Some surgeries are described in the department of surgery at Ebris papyrus (recipes from 863 to 877). The level of surgery in ancient Egypt was high, and they performed surgery such as hernias and Aneurysm, however, we have not received a lengthy explanation of the various surgeries, and the surgeon has usually only said “treated surgically”. It is evident in the Ebris papyrus that they used sharp surgical tools and cautery in operations where bleeding is expected, such as hernias, arterial sacs and tumors.

Keywords: ancientegypt, egypt, archaeology, the ancient egyptian

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Authors: Muhammad Umar Hassan

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Renal cell carcinoma is a subset of kidney cancer that arises in the lining of DCT and is present in parenchymal tissue. Diagnosis is based on lab reports, including urinalysis, renal function tests (RFTs), and electrolyte balance, along with imaging techniques. Organ failure and other complications have been commonly observed in these cases. Over the years, the presentation of patients has varied, so carcinoma was classified on the basis of site, shape, and consistency for detailed analysis. Lifestyle patterns and occupational history were inquired about and recorded. Methods: Data from 100 patients presenting to the oncology and nephrology department of Mayo Hospital in the year 2015-2020 were included in this retrospective study on a random basis. The study was specifically focused on three risk factors. Smoking, occupational exposures, and Hakim medicine are taken by the patient for any cause. After procurement of data, follow-up contacts of these patients were established, resulting in a detailed analysis of lifestyle. Conclusion: The inference drawn is a direct causal link between smoking, industrial workplace exposure, and Hakim medicine with the development of Renal Cell Carcinoma. It was shown in the majority of the patients and hence confirmed our hypothesis.

Keywords: renal cell carcinoma, kidney cancer, clear cell carcinoma

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Authors: Nuhi Arslani, Aleks Brumec

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Adhesive small bowel obstruction (ASBO) accounts for 20% of emergency surgical procedures and intraabdominal adhesions account for 65% of such cases. In a 10-year post-operative period of abdominal surgery patients, around 35% of them will be readmitted because of ASBO. The first step in approaching ASBOs is using the Bologna guidelines, which include a thorough initial evaluation to diagnose or rule out an ASBO and then proceed with either further imaging studies or emergency surgery, which can be either open or laparoscopic. The contraindications for a laparoscopic approach include hemodynamic instability of the patient and infections in the peritoneum or port sites. Studies have shown that a laparoscopic approach to adhesiolysis is linked with a significantly smaller risk of readmissions and reoperations as well as with faster recovery time and fewer postoperative infections, but has a higher risk of bowel injuries, so a careful selection of patients is required. Although studies favor a laparoscopic approach, many countries still prefer a laparotomy, often because a laparoscopic approach requires surgeons to be highly skilled in the procedure. In the US and UK, between 50 and 60% of surgeons would approach an ASBO with laparoscopy, while in Italy, this number is around 15% and it is most likely similar in Slovenia. We believe that in the right cases and in the right patients, a laparoscopic approach can be equally feasible for treating ASBOs and is associated with fewer intraoperative and postoperative complications.

Keywords: adhesive small bowel obstruction, laparoscopy, adhesions, adhesiolysis

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Authors: V. Howard, R. Maguire, S. Corrigan

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Background: Type 1 Diabetes (T1D) is a chronic autoimmune disease, typically diagnosed in childhood. T1D puts an enormous strain on families; controlling blood-glucose in children is difficult and the consequences of poor control for patient health are significant. Successful illness management and better health outcomes can be dependent on quality of caregiving. On diagnosis, parent-caregivers face a steep learning curve as T1D care requires a significant level of knowledge to inform complex decision making throughout the day. The majority of illness management is carried out in the home setting, independent of clinical health providers. Parent-caregivers vary in their level of knowledge and their level of engagement in applying this knowledge in the practice of illness management. Enabling researchers to quantify these aspects of the caregiver experience is key to identifying targets for psychosocial support interventions, which are desirable for reducing stress and anxiety in this highly burdened cohort, and supporting better health outcomes in children. Currently, there are limited tools available that are designed to capture this information. Where tools do exist, they are not comprehensive and do not adequately capture the lived experience. Objectives: Development of quantitative tools, informed by lived experience, to enable researchers gather data on parent-caregiver knowledge and engagement, which accurately represents the experience/cohort and enables exploration of questions that are of real-world value to the cohort themselves. Methods: This research employed an engaged approach to address the problem of quantifying two key aspects of caregiver diabetes management: Knowledge and engagement. The research process was multi-staged and iterative. Stage 1: Working from a constructivist standpoint, literature was reviewed to identify relevant questionnaires, scales and single-item measures of T1D caregiver knowledge and engagement, and harvest candidate questionnaire items. Stage 2: Aggregated findings from the review were circulated among a PPI (patient and public involvement) expert panel of caregivers (n=6), for discussion and feedback. Stage 3: In collaboration with the expert panel, data were interpreted through the lens of lived experience to create a long-list of candidate items for novel questionnaires. Items were categorized as either ‘knowledge’ or ‘engagement’. Stage 4: A Delphi-method process (iterative surveys) was used to prioritize question items and generate novel questions that further captured the lived experience. Stage 5: Both questionnaires were piloted to refine wording of text to increase accessibility and limit socially desirable responding. Stage 6: Tools were piloted using an online survey that was deployed using an online peer-support group for caregivers for Juveniles with T1D. Ongoing Research: 123 parent-caregivers completed the survey. Data analysis is ongoing to establish face and content validity qualitatively and through exploratory factor analysis. Reliability will be established using an alternative-form method and Cronbach’s alpha will assess internal consistency. Work will be completed by early 2024. Conclusion: These tools will enable researchers to gain deeper insights into caregiving practices among parents of juveniles with T1D. Development was driven by lived experience, illustrating the value of engaged research at all levels of the research process.

Keywords: caregiving, engaged research, juvenile type 1 diabetes, quantified engagement and knowledge

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Authors: E.Tskitisvili, L. Jgenti, I. Eliava, T. Tskitishvili, N. Bagathuria, M. Gigolashvili

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The fight against dangerous nematode diseases that have world economic importance requires accurate data about the prevalence of these pests. In the point of view of the International Convention on Biological Diversity, the identification of the plant invasion causing dangerous pathogen in the early stages of invasion on new territory is the most important part of the program, which aims to monitor the Bio-Agro Coenosis and Bio-Control. Citrus nematode-specific belongs to the pathogen species, which can cause epiphytotics particularly for large areas and cause irreparable damage to citrus plantations. This paper provides a brief tour of the spread of citrus nematodes on the Black Sea coast (Adjara and Abkhazia). Also the bio-ecological monitoring data to detect the potential sources of invasion for evaluating the current conditions of the citrus nematodes prevalence. Through 2006-2010, the material was gained by structural monitoring system during the citrus vegetation period on tangerines, lemon and oranges from nine points of the study area. Mature forms of Tylenchulus semipenetrans Cobb, 1913 were observed in almost all of the samples of the root system, the peak of larvae was observed in late spring and outumn. 92 forms of nematode has been detected in the rhizosphere belonging to 8 Orders: Areolaimida, Dorylaimida, Enoplida, Mononchida, Tylenshida, Monshysterida, Rhabditida, Aphelenchida, 23 families and 40 genera. 75 forms are identified as species. It is estimated the number of nematodes fauna and ecological groups. To detect possible sources of invasion we obtained additional materials in 2013-2014 from citrus plantations planted in 2011, where is planted tangerine trees introduced from Spain and Japan. The fauna of rhizosphere is identified and Tylenchulus semipenetrans Cobb, 1913 is not detected.

Keywords: Citrus nematodes, infection, bioecological monitoring, epiphytotics

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Authors: Asiri Wijesinghe, N. D. Kodikara, Damitha Sandaruwan

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The Diabetic Retinopathy (DR) is a rapidly growing interrogation around the world which can be annotated by abortive metabolism of glucose that causes long-term infection in human retina. This is one of the preliminary reason of visual impairment and blindness of adults. Information on retinal pathological mutation can be recognized using ocular fundus images. In this research, we are mainly focused on resurrecting an automated diagnosis system to detect DR anomalies such as severity level classification of DR patient (Non-proliferative Diabetic Retinopathy approach) and vessel tortuosity measurement of untwisted vessels to assessment of vessel anomalies (Proliferative Diabetic Retinopathy approach). Severity classification method is obtained better results according to the precision, recall, F-measure and accuracy (exceeds 94%) in all formats of cross validation. In ROC (Receiver Operating Characteristic) curves also visualized the higher AUC (Area Under Curve) percentage (exceeds 95%). User level evaluation of severity capturing is obtained higher accuracy (85%) result and fairly better values for each evaluation measurements. Untwisted vessel detection for tortuosity measurement also carried out the good results with respect to the sensitivity (85%), specificity (89%) and accuracy (87%).

Keywords: fundus image, exudates, microaneurisms, hemorrhages, tortuosity, diabetic retinopathy, optic disc, fovea

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Authors: Reza Eslami-Farsani, Hamed Khosravi, Saba Fayazzadeh

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Lightweight and efficient structures have the aim to enhance the efficiency of the components in various industries. Toward this end, composites are one of the most widely used materials because of durability, high strength and modulus, and low weight. One type of the advanced composites is grid-stiffened composite (GSC) structures which have been extensively considered in aerospace, automotive, and aircraft industries. They are one of the top candidates for replacing some of the traditional components which are used here. Although there are a good number of published surveys on the design aspects and fabrication of GSC structures, little systematic work has been reported on their material modification to improve their properties, to our knowledge. Matrix modification using nanoparticles is an effective method to enhance the flexural properties of the fibrous composites. In the present study, a silane coupling agent (3-glycidoxypropyltrimethoxysilane/3-GPTS) was introduced onto the silica (SiO2) nanoparticle surface and its effects on the three-point flexural response of isogrid E-glass/epoxy composites were assessed. Based on the fourier transform infrared spectrometer (FTIR) spectra, it was inferred that the 3-GPTS coupling agent was successfully grafted onto the surface of SiO2 nanoparticles after modification. Flexural test revealed an improvement of 16%, 14%, and 36% in stiffness, maximum load and energy absorption of the isogrid specimen filled with 3 wt.% 3-GPTS/SiO2 compared to the neat one. It would be worth mentioning that in these structures, a considerable energy absorption was observed after the primary failure related to the load peak. Also, 3-GPTMS functionalization had a positive effect on the flexural behavior of the multiscale isogrid composites. In conclusion, this study suggests that the addition of modified silica nanoparticles is a promising method to improve the flexural properties of the grid-stiffened fibrous composite structures.

Keywords: isogrid-stiffened composite panels, silica nanoparticles, surface modification, flexural properties, energy absorption

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Authors: Mehrnaz Mostafavi

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Lung cancer is one of the most harmful forms of cancer. The long-term survival rate of lung cancer patients treated by conventional modalities such as surgical resection, radiation, and chemotherapy remains far from satisfactory. Systemic drug delivery is rarely successful because only a limited amount of the chemotherapeutic drug targets lung tumor sites, even when administered at a high dose. Targeted delivery of drug molecules to organs or special sites is one of the most challenging research areas in pharmaceutical sciences. By developing colloidal delivery systems such as liposomes, micelles and nanoparticles a new frontier was opened for improving drug delivery. Nanoparticles with their special characteristics such as small particle size, large surface area and the capability of changing their surface properties have numerous advantages compared with other delivery systems. Targeted nanoparticle delivery to the lungs is an emerging area of interest.Multimodal or combination therapy represents a promising new method to fight disease. Therefore, a combination of different therapeutic strategies may be the best alternative to improve treatment outcomes for lung cancer. Photothermal therapy was proposed as a novel approach to treatment. In this work, photothermal therapy with gold nanoparticles and near infrared laser (NIR) irradiation was investigated.Four types of small (<100nm), NIR absorbing gold nanoparticles (nanospheres, nanorods) were synthesized using wet chemical methods and characterized by transmission electron microscopy, dynamic light scattering and UV-vis spectroscopy. Their synthesis and properties were evaluated, to determine their feasibility as a photothermal agent for clinical applications. In vitro cellular uptake studies of the nanoparticles into lung cancer cell lines was measured using light scattering microscopy.Small gold nanorods had good photothermal properties and the greatest cellular uptake, and were used in photothermal studies. Under 4W laser irradiation, an increase in temperature of 10°C and decrease in cell viability of up to 80% were obtained.

Keywords: photothermal, therapy, cancer, gold nanorods

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Authors: Suppawan Lertpongpakpoom, Anongnat Boonrat, Kunya BoontummoSuppawan

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This descriptive cost analysis aimed to analyze the unit cost of patients in medical intensive care unit. Purposive sampling was used to select 20 nurses, 6 practical nurses, 5 nurses aid and select samples 30 patients. Data were collected from both primary source (activity and average time of nursing care) and secondary source Z bill of payment and patient record). Instruments were cost recording form, activity observation form, and service recording form. Content validity of all instruments were evaluated by three experts (CVI = 0.87). Descriptive statistics was employed for data analysis. The results of the Activity-Based Costing Analysis showed that total activity cost of 4 service types for the patients was 14,776.92 Bath. The highest cost was nursing record was 5,674.78 Bath, followed direct nursing activity was 5,176.18 Bath, medical treatment was 1,976.6 Bath. The lowest cost was management activity was 1,003.64 Bath per visit. The result suggested that Activity-Base Costing Analysis could be applied to give better understanding of cost structure, enabling better consideration wasted expense and non-value-added activity, and improvement of effective utilization.

Keywords: activity-based costing, medical intensive care, nursing care, cost analysis

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Authors: Fengqing Li, Petra Schneider

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Failure of tailings management facilities (TMF) of radioactive residues is an enormous challenge worldwide and can result in major catastrophes. Particularly in transboundary regions, such failure is most likely to lead to international conflict. This risk occurs in Kyrgyzstan and Uzbekistan, where the current major challenge is the quantification of impacts due to pollution from uranium legacy sites and especially the impact on river basins after natural hazards (i.e., landslides). By means of GoldSim, a probabilistic simulation model, the amount of tailing material that flows into the river networks of Mailuu Suu in Kyrgyzstan after pond failure was simulated for three scenarios, namely 10%, 20%, and 30% of material inputs. Based on Muskingum-Cunge flood routing procedure, the peak value of uranium flood wave along the river network was simulated. Among the 23 TMF, 19 ponds are close to the river networks. The spatiotemporal distributions of uranium along the river networks were then simulated for all the 19 ponds under three scenarios. Taking the TP7 which is 30 km far from the Kyrgyzstan-Uzbekistan border as one example, the uranium concentration decreased continuously along the longitudinal gradient of the river network, the concentration of uranium was observed at the border after 45 min of the pond failure and the highest value was detected after 69 min. The highest concentration of uranium at the border were 16.5, 33, and 47.5 mg/L under scenarios of 10%, 20%, and 30% of material inputs, respectively. In comparison to the guideline value of uranium in drinking water (i.e., 30 µg/L) provided by the World Health Organization, the observed concentrations of uranium at the border were 550‒1583 times higher. In order to mitigate the transboundary impact of a radioactive pollutant release, an integrated framework consisting of three major strategies were proposed. Among, the short-term strategy can be used in case of emergency event, the medium-term strategy allows both countries handling the TMF efficiently based on the benefit-sharing concept, and the long-term strategy intends to rehabilitate the site through the relocation of all TMF.

Keywords: Central Asia, contaminant transport modelling, radioactive residue, transboundary conflict

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Authors: Deepa Kundu, Prabhakar Sharma, Sayan Bhattacharya, Jianying Shang

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The discharge of dye-containing effluents in the water bodies has raised concern due to the potential hazards related to their toxicity in the environment. There are various treatment technologies available for the removal of dyes from wastewaters. The use of biosorbent to remove dyes from wastewater is one of the effective and inexpensive techniques. In the study, the adsorption of phenothiazine dye methylene blue onto biosorbent prepared from Lantana camara L. has been studied in aqueous solutions. The batch adsorption experiments were conducted and the effects of various parameters such as pH (3-12), contact time, adsorbent dose (100-400 mg/L), initial dye concentration (5-20 mg/L), and temperature (303, 313 and 323 K) were investigated. The prepared leaf (BCL600) and shoot (BCS600) biochar of Lantana were characterized using FTIR, SEM, elemental analysis, and zeta potential (pH~7). A comparison between the adsorption potential of both the biosorbent was also evaluated. The results indicated that the amount of methylene blue dye (mg/g) adsorbed onto the surface of biochar was highly dependent on the pH of the dye solutions as it increased with an increase in pH from 3 to 12. It was observed that the dye treated with BCS600 and BCL600 attained an equilibrium within 60 and 100 minutes, respectively. The rate of the adsorption process was determined by performing the Lagergren pseudo-first-order and pseudo-second-order kinetics. It was found that dye treated with both BCS600 and BCL600 followed pseudo-second-order kinetics implying the multi-step nature of the adsorption process involving external adsorption and diffusion of dye molecules into the interior of the adsorbents. The data obtained from batch experiments were fitted well with Langmuir and Freundlich isotherms (R² > 0.98) to indicate the multilayer adsorption of dye over the biochar surfaces. The thermodynamic studies revealed that the adsorption process is favourable, spontaneous, and endothermic in nature. Based on the results, the inexpensive and easily available Lantana camara biomass can be used to remove methylene blue dye from wastewater. It can also help in managing the growth of the notorious weed in the environment.

Keywords: adsorption kinetics, biochar, Lantana camara, methylene blue dye, possible mechanism, thermodynamics

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Authors: Wisit Wichitkosoom

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Objectives: To find out the more effect of early cardiologist consultation using a simple technology on the diagnosis and early proper management of patients with Non-STEMI at emergency department of district hospitals without cardiologist on site before transferred. Methods: A cohort study was performed in Udonthani general hospital at Udonthani province. From 1 October 2012–30 September 2013 with 892 patients diagnosed with Non-STEMI. All patients mean aged 46.8 years of age who had been transferred because of Non-STEMI diagnosed, over a 12 week period of studied. Patients whose transferred, in addition to receiving proper care, were offered a cardiologist consultation with average time to Udonthani hospital 1.5 hour. The main outcome measure was length of hospital stay, mortality at 3 months, inpatient investigation, and transfer rate to the higher facilitated hospital were also studied. Results: Hospital stay was significantly shorter for those didn’t consult cardiologist (hazard ratio 1.19; approximate 95% CI 1.001 to 1.251; p = 0.039). The 136 cases were transferred to higher facilitated hospital. No statistically significant in overall mortality between the groups (p=0.068). Conclusions: Early cardiologist consultant can reduce length of hospital stay for patients with cardiovascular conditions outside of cardiac center. The new basic technology can apply for the safety patient.

Keywords: critical, telemedicine, safety, non STEMI

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Authors: Haitham Nabil Zaghlol Hasan

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This research aims to study of the surgery science and imaging in ancient Egypt and how to diagnose the surgical cases, whether due to injuries or disease that requires surgical intervention, Medical diagnosis and how to treat it. The ancient Egyptian physician tried to change over from magic and theological thinking to become a stand-alone experimental science, they were able to distinguish between diseases, and they divide them into internal and external diseases even though this division exists to date in modern medicine. There is no evidence to recognize the amount of human knowledge in the prehistoric knowledge of medicine and surgery except skeleton. It is not far from the human being in those times familiar with some means of treatment, Surgery in the Stone age was rudimentary, Flint stone was used after trimming in a certain way as a lancet to slit and open the skin. Wooden tree branches were used to make splints to treat bone fractures. Surgery developed further when copper was discovered, it led to the advancement of Egyptian civilization, then modern and advanced tools appeared in the operating theater, like a knife or a scalpel, there is evidence of surgery performed in ancient Egypt during the dynastic period (323 – 3200 BC). The climate and environmental conditions have preserved medical papyri and human remains that have confirmed their knowledge of surgical methods, including sedation. The ancient Egyptians reached great importance in surgery, evidenced by the scenes that depict the pathological image and the surgical process, but the image alone is not sufficient to prove the pathology, its presence in ancient Egypt and its treatment method. As there are a number of medical papyri, especially Edwin Smith and Ebris, which prove the ancient Egyptian surgeon's knowledge of the pathological condition that It requires surgical intervention, otherwise, its diagnosis and the method of treatment will not be described with such accuracy through these texts. Some surgeries are described in the department of surgery at Ebris papyrus (recipes from 863 to 877). The level of surgery in ancient Egypt was high, and they performed surgery such as hernias and Aneurysm, however, we have not received a lengthy explanation of the various surgeries, and the surgeon has usually only said: “treated surgically”. It is evident in the Ebris papyrus that they used sharp surgical tools and cautery in operations where bleeding is expected, such as hernias, arterial sacs and tumors.

Keywords: egypt, ancient_egypt, civilization, archaeology

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Authors: Ahmed Hamzi, Bryan Norman

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Having scribes help document patient records in electronic health record systems can improve hospitalists’ productivity. But hospitals need to determine the optimum number of scribes to hire to maximize scribe cost effectiveness. Scribe attendance uncertainty due to planned and unplanned absences is a primary challenge. This paper presents simulation and analytical models to determine the optimum number of scribes for a hospital to hire. Scribe staffing practices vary from one context to another; different staffing scenarios are considered where having extra attending scribes provides or does not provide additional value and utilizing on-call scribes to fill in for potentially absent scribes. These staffing scenarios are assessed for different scribe revenue ratios (ratio of the value of the scribe relative to scribe costs) ranging from 100% to 300%. The optimum solution depends on the absenteeism rate, revenue ratio, and desired service level. The analytical model obtains solutions easier and faster than the simulation model, but the simulation model is more accurate. Therefore, the analytical model’s solutions are compared with the simulation model’s solutions regarding both the number of scribes hired and cost-effectiveness. Additionally, an Excel tool has been developed to facilitate decision-makers in easily obtaining solutions using the analytical model.

Keywords: hospitalists, workload, optimization cost, economic analysis

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Authors: Venkataraman Sivasankar, Kiyoshi Omine, Hideaki Sano

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The leaching of fluoride from Plaster Board Waste (PBW) is quite feasible in soil and water environments. The Ministry of Environment, Japan recommended the standard limit of 0.8 mgL⁻¹ or less for fluoride. Although the utilization of PBW as a substitute for cement is rather meritorious, its fluoride leaching behavior deteriorates the quality of soil and water and therefore envisaged as a demerit. In view of this fluoride leaching problem, the present research is focused on immobilizing fluoride in PBW. The immobilization experiments were conducted with four chemical systems operated by DAHP (diammonium hydrogen phosphate) and phosphoric acid carbonization of bamboo mass coupled with certain inorganic reactions using reagents such as calcium hydroxide, sodium hydroxide, and aqueous ammonia. The fluoride immobilization was determined after shaking the reactor contents including the plaster board waste for 24 h at 25˚C. In the DAHP system, the immobilization of fluoride was evident from the leaching of fluoride in the range 0.071-0.12 mgL⁻¹, 0.026-0.14 mgL⁻¹ and 0.068-0.12 mgL⁻¹ for the reaction temperatures at 30˚C, 50˚C, and 90˚C, respectively, with final pH of 6.8. The other chemical systems designated as PACCa, PACAm, and PACNa could immobilize fluoride in PBW, and the resulting solution was analyzed with the fluoride less than the Japanese environmental standard of 0.8 mgL⁻¹. In the case of PACAm and PACCa systems, the calcium concentration was found undetectable and witnessed the formation of phosphate compounds. The immobilization of fluoride was found inversely proportional to the increase in the volume of leaching solvent and dose of PBW. Characterization studies of PBW and the solid after fluoride immobilization was done using FTIR (Fourier transform infrared spectroscopy), Raman spectroscopy, FE-SEM ( Field Emission Scanning Electron Microscopy) with EDAX (Energy Dispersive Spectroscopy), XRD (X-ray diffraction), and XPS (X-ray photoelectron spectroscopy). The results revealed the formation of new calcium phosphate compounds such as apatite, monetite, and hydroxylapatite. The participation of such new compounds in fluoride immobilization seems indispensable through the exchange mechanism of hydroxyl and fluoride groups. Acknowledgment: First author thanks to Japanese Society for the Promotion of Science (JSPS) for the award of the fellowship (ID No. 16544).

Keywords: characterization, fluoride, immobilization, plaster board waste

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Authors: Giancarlo La Marca, Engy Shokry, Fabio Villanelli

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Epilepsy is one of the most common neurological disorders, with an estimated prevalence of 50 million people worldwide. Twenty five percent of the epilepsy population is represented in children under the age of 15 years. For antiepileptic drugs (AED), there is a poor correlation between plasma concentration and dose especially in children. This was attributed to greater pharmacokinetic variability than adults. Hence, therapeutic drug monitoring (TDM) is recommended in controlling toxicity while drug exposure is maintained. Carbamazepine (CBZ) is a first-line AED and the drug of first choice in trigeminal neuralgia. CBZ is metabolised in the liver into carbamazepine-10,11-epoxide (CBZE), its major metabolite which is equipotent. This develops the need for an assay able to monitor the levels of both CBZ and CBZE. The aim of the present study was to develop and validate a LC-MS/MS method for simultaneous quantification of CBZ and CBZE in dried blood spots (DBS). DBS technique overcomes many logistical problems, ethical issues and technical challenges faced by classical plasma sampling. LC-MS/MS has been regarded as superior technique over immunoassays and HPLC/UV methods owing to its better specificity and sensitivity, lack of interference or matrix effects. Our method combines advantages of DBS technique and LC-MS/MS in clinical practice. The extraction process was done using methanol-water-formic acid (80:20:0.1, v/v/v). The chromatographic elution was achieved by using a linear gradient with a mobile phase consisting of acetonitrile-water-0.1% formic acid at a flow rate of 0.50 mL/min. The method was linear over the range 1-40 mg/L and 0.25-20 mg/L for CBZ and CBZE respectively. The limit of quantification was 1.00 mg/L and 0.25 mg/L for CBZ and CBZE, respectively. Intra-day and inter-day assay precisions were found to be less than 6.5% and 11.8%. An evaluation of DBS technique was performed, including effect of extraction solvent, spot homogeneity and stability in DBS. Results from a comparison with the plasma assay are also presented. The novelty of the present work lies in being the first to quantify CBZ and its metabolite from only one 3.2 mm DBS disc finger-prick sample (3.3-3.4 µl blood) by LC-MS/MS in a 10 min. chromatographic run.

Keywords: carbamazepine, carbamazepine-10, 11-epoxide, dried blood spots, LC-MS/MS, therapeutic drug monitoring

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Authors: Christian Fercher, Jiaul Islam, Simon R. Corrie

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Fluorescence-based immunodiagnostics are an emerging field in biosensor development and exhibit several advantages over traditional detection methods. While various affinity biosensors have been developed to generate a fluorescence signal upon sensing varying concentrations of analytes, reagentless, reversible, and continuous monitoring of complex biological samples remains challenging. Here, we aimed to genetically engineer biosensors based on single-chain antibody fragments (scFv) that are site-specifically labeled with environmentally sensitive fluorescent unnatural amino acids (UAA). A rational design approach resulted in quantifiable analyte-dependent changes in peak fluorescence emission wavelength and enabled antigen detection in vitro. Incorporation of a polarity indicator within the topological neighborhood of the antigen-binding interface generated a titratable wavelength blueshift with nanomolar detection limits. In order to ensure continuous analyte monitoring, scFv candidates with fast binding and dissociation kinetics were selected from a genetic library employing a high-throughput phage display and affinity screening approach. Initial rankings were further refined towards rapid dissociation kinetics using bio-layer interferometry (BLI) and surface plasmon resonance (SPR). The most promising candidates were expressed, purified to homogeneity, and tested for their potential to detect biomarkers in a continuous microfluidic-based assay. Variations of dissociation kinetics within an order of magnitude were achieved without compromising the specificity of the antibody fragments. This approach is generally applicable to numerous antibody/antigen combinations and currently awaits integration in a wide range of assay platforms for one-step protein quantification.

Keywords: antibody engineering, biosensor, phage display, unnatural amino acids

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Authors: Eric Beyegue, Boris Azantza, Judith Laure Ngondi, Julius E. Oben

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Background: Insulin resistance (IR) and oxidative stress are associated with obesity, diabetes mellitus, and other cardio metabolic disorders. The aim of this study was to investigate the effect of Coula edulis extracts (CEE) on insulin resistance and oxidative stress markers in high-fat/high sucrose diet-induced insulin resistance in rats. Materials and Methods: Thirty male rats were divided into 6 groups of 5 rats each fed, received daily oral administration of CE extracts for 8 weeks as follows: Group 1 or negative control group, fed with standard diet (SD); Group 2 fed with high-fat/high sucrose diet (HFHS) only; Group3 fed with HFHS + CEAq 200; Group 4 fed with HFHS + CEAq 400; Group 5 fed with HFHS + CEEt 200; Group 6 fed with HFHS + CEEt 400. At the end of the experiment (8 weeks), animals were sacrificed plasma lipid profile, glucose, insulin, oxidative marker and digestive enzyme activities were measured. The homeostasis model assessment for insulin resistance (HOMA-IR) was determined. Results: Feedings with HFHS significantly (p < 0.01) induced plasma hyperglycaemia, hyperinsulinaemia, increased triglyceride, total cholesterol, and low-density lipoprotein levels, decreased high-density lipoprotein levels, alterations of α amylase, and glucose-6-phosphatase activities, and oxidative stress. Daily oral administration with CEE for eight weeks after insulin resistance induction had a hypolipidaemic action, antioxidative activities and modulated metabolic markers. Ethanolic extract at the higher dose had the best effect on body weight gain and insulin resistance, whereas aqueous extract showed the better activity on hyperlipidemia. Conclusion: These results suggest that CEAq and CEEt at 400mg/kg are promising complementary supplements that can be used to protect better from metabolic disorders associated with HFHS.

Keywords: Coula edulis Baill, high-fat / high sucrose diet, insulin resistance, oxidative stress

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Authors: Lotfollah Rezagholizadeh

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Background and Aim: Diabetes mellitus is related to high mortality and morbidity caused by the early development of atherosclerosis correlated to diabetic macroangiopathy. The endothelium-derived vasodilator, nitric oxide (NO) has been implicated in the development of vascular complications via the regulation of blood flow, and various antiatherosclerotic actions. Patients with type 2 diabetes (T2D) have a decreased level of endothelial nitric oxide release. In this study we aimed to examine the effect of aquatic seed extract of Cichorium intybus L. (chicory) and metformin (a known prescription drug for diabetes) on NO levels in T2D rats. Methods: Five groups of adult male Wistar rats were used (n=6): Non-diabetic controls without extract treatment (Control), Non-diabetic controls with extract treatment (Chicory-control), T2D rats without extract treatment (NIA/STZ), T2D rats treated with the extract (Chicory-NIA/STZ), and T2D groups that received metformin (100 mg/kg) but no extract (Metformin-NIA/STZ). T2D was induced with intraperitoneal (i.p) injection of niacinamide (NIA, 200 mg/kg), 15 min after an i.p administration of streptozotocin (STZ, 55 mg/kg). Lyophilized chicory extract (125 mg/kg) was dissolved in 0.2 ml normal saline and administered one dose a day. The experiments lasted for 3 weeks after the diabetes induction. NO analysis was performed by assay based on the Griess reaction. Data were reported as the mean ± SD and statistical analysis was performed by ANOVA. Results: Serum nitric oxide levels decreased significantly in NIA/STZ group compared with Control and Chicory-control. Treatment with chicory extract caused a significant increase in serum levels of NO in Chicory-NIA/STZ group compare to NIA/STZ group (p<05). Metformin-NIA/STZ group did not show considerable difference when compared with NIA/STZ, with respect to NO levels. In a group of rats made diabetic by STZ alone (type 1 diabetic rats, T1D), chicory did not have a significant ameliorating effect. Conclusion: In this study, we clearly showed a relationship between low serum nitric oxide levels and diabetes mellitus in rats. The increase in serum nitric oxide by chicory extract is an indication of antiatherogenic effect of this plant. Chicory seed extract was more efficient than metformin in improving the NO levels in NO-deficient T2D diabetic rats.

Keywords: type 2 diabetes mellitus, nitric oxide, chicory, metformin

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