Search results for: lower back pain

Authors: Ammar Asma, Bouafia Nabiha, Dhahri Meriem, Ben Cheikh Asma, Ezzi Olfa, Chafai Rim, Njah Mansour

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Despite recent advances in treatment of the lung cancer patients, the prognosis remains poor. Information is limited regarding health related quality of life (QOL) status of advanced lung cancer patients. The purposes of this study were: to assess patient reported symptom burden, to measure their QOL, and to identify determinant factors associated with QOL. Materials/Methods: A cross sectional study of 60 patients was carried out from over the period of 03 months from February 1st to 30 April 2016. Patients were recruited in two department of health care: Pneumology department in a university hospital in Sousse and an oncology unit in a University Hospital in Kairouan. Patients with advanced stage (III and IV) of lung cancer who were hospitalized or admitted in the day hospital were recruited by convenience sampling. We used a questionnaire administrated and completed by a trained interviewer. This questionnaire is composed of three parts: demographic, clinical and therapeutic information’s, QOL measurements: based on the SF-36 questionnaire, Symptom’s burden measurement using the Lung Cancer Symptom Scale (LCSS). To assess Correlation between symptoms burden and QOL, we compared the scores of two scales two by two using the Pearson correlation. To identify factors influencing QOL in Lung cancer, a univariate statistical analysis then, a stepwise backward approach, wherein the variables with p< 0.2, were carried out to determine the association between SF-36 scores and different variables. Results: During the study period, 60 patients consented to complete symptom and quality of life questionnaires at a single point time (72% were recruited from day hospital). The majority of patients were male (88%), age ranged from 21 to 79 years with a mean of 60.5 years. Among patients, 48 (80%) were diagnosed as having non-small cell lung carcinoma (NSCLC). Approximately, 60 % (n=36) of patients were in stage IV, 25 % in stage IIIa and 15 % in stage IIIb. For symptom burden, the symptom burden index was 43.07 (Standard Deviation, 21.45). Loss of appetite and fatigue were rated as the most severe symptoms with mean scores (SD): 49.6 (25.7) and 58.2 (15.5). The average overall score of SF36 was 39.3 (SD, 15.4). The physical and emotional limitations had the lowest scores. Univariate analysis showed that factors which influence negatively QOL were: married status (p<0.03), smoking cessation after diagnosis (p<0.024), LCSS total score (p<0.001), LCSS symptom burden index (p<0.001), fatigue (p<0.001), loss of appetite (p<0.001), dyspnea (p<0.001), pain (p<0.002), and metastatic stage (p<0.01). In multivariate analysis, unemployment (p<0.014), smoking cessation after diagnosis (p<0.013), consumption of analgesic (p<0.002) and the indication of an analgesic radiotherapy (p<0.001) are revealed as independent determinants of QOL. The result of the correlation analyses between total LCSS scores and the total and individual domain SF36 scores was significant (p<0.001); the higher total LCSS score is, the poorer QOL is. Conclusion: A built in support of lung cancer patients would better control the symptoms and promote the QOL of these patients.

Keywords: quality of life, lung cancer, metastasis, symptoms burden

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Authors: Ayodele James Akinola

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This study examines how social and linguistic variables influenced communication between neurologists and patients in selected university teaching hospitals (UTHs) in southwestern Nigeria. Jacob Mey’s Pragmatic Acts, complemented by Emanuel and Emanuel’s model of doctor-patient relationship, served as the theoretical framework. Data comprising 22 audio-recorded neurologist-patient interactions were collected from two UTHs in the southwestern region of Nigeria. Data revealed that educational attainment of patients has insignificant influence on the interaction where the linguistic prowess of the patient has been impaired for consultative communication. However, the status influenced the degree of attention paid to patients by neurologists and determines the amount of time 'trying to help patients to communicate'. Patients with lower educational status and who could not communicate in English spent more time narrating their ailment to neurologists. Patients with higher educational status and could communicate in English saves consultation time as they express themselves briefly unlike those who were of little or no education in the clinics. Through this, diagnoses and therapeutic processes took eight to 12 minutes. 20 minutes was the longest duration recorded. Neurologist-patient interaction in the observed hospitals is shaped by neurologists’ experience, patients’ social variables and language.

Keywords: medical pragmatics, neurologist-patient interaction, nigeria, socio-linguistic influence

Procedia PDF Downloads 249

Authors: Agoubi Belgacem, Adel Kharroubi

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Geothermal groundwater is the main water source to supply various sectors in El Hamma city, southeastern Tunisia. This region was long the destination of thousands of people from Tunisia and neighboring countries for care and bathing. The main objective of this study is to understand the groundwater mineralization origins and factors that control. The second goal is the appraisal of radon in geothermal groundwater in the study area. For this aim, geothermal groundwater was sampled and collected from different locations (thermal baths and deep wells). Physical parameters were measured and major ions were analyzed. Results reveal three water types. The water first type has Na-Mg-Ca-SO4-Cl facies and T>55°C. The second water type dominated by Na-Ca-Cl-SO4 facies with a temperature < 45 °C. However the third water type is dominated by Ca-SO4-Na-Cl-Mg. The three water types may be controlled by depth and geology. The first represent groundwater from deep aquifer (lower cretaceous), the second type was the shallow aquifer and the first is mixed water from deep and shallow water with a temperature ranging from 45 to 55°C. Measured Radon shows that shallow aquifer has a higher 222Rn concentration (677 to 2903 Bq.m-3) than deep water (203 to 1100 Bq.m-3). R-222 in El Hamma thermal aquifer was controlled by structures, porosity and permeability of aquifers. Geostatistical analyses of hydrogeological data and radon activities confirm the vertical flow and communication between deep and shallow aquifers through vertical faults system.

Keywords: Radon-222, geothermal, water, environment, Tunisia

Procedia PDF Downloads 350

Authors: Szymon Kuczynski, Krystian Liszka, Mariusz Laciak, Andrii Oliinyk, Adam Szurlej

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The history of gaseous fuel use in the motive power of vehicles dates back to the second half of the nineteenth century, and thus the beginnings of the automotive industry. The engines were powered by coal gas and became the prototype for internal combustion engines built so far. It can thus be considered that this construction gave rise to the automotive industry. As the socio-economic development advances, so does the number of motor vehicles. Although, due to technological progress in recent decades, the emissions generated by internal combustion engines of cars have been reduced, a sharp increase in the number of cars and the rapidly growing traffic are an important source of air pollution and a major cause of acoustic threat, in particular in large urban agglomerations. One of the solutions, in terms of reducing exhaust emissions and improving air quality, is a more extensive use of alternative fuels: CNG, LNG, electricity and hydrogen. In the case of electricity use for transport, it should be noted that the environmental outcome depends on the structure of electricity generation. The paper shows selected regulations affecting the use of alternative fuels for transport (including Directive 2014/94/EU) and its dynamics between 2000 and 2015 in Poland and selected EU countries. The paper also gives a focus on the impact of alternative fuels on the environment by comparing the volume of individual emissions (compared to the emissions from conventional fuels: petrol and diesel oil). Bearing in mind that the extent of various alternative fuel use is determined in first place by economic conditions, the article describes the price relationships between alternative and conventional fuels in Poland and selected EU countries. It is pointed out that although Poland has a wealth of experience in using methane alternative fuels for transport, one of the main barriers to their development in Poland is the extensive use of LPG. In addition, a poorly developed network of CNG stations in Poland, which does not allow easy transport, especially in the northern part of the country, is a serious problem to a further development of CNG use as fuel for transport. An interesting solution to this problem seems to be the use of home CNG filling stations: Home Refuelling Appliance (HRA, refuelling time 8-10 hours) and Home Refuelling Station (HRS, refuelling time 8-10 minutes). The team is working on HRA and HRS technologies. The article also highlights the impact of alternative fuel use on energy security by reducing reliance on imports of crude oil and petroleum products.

Keywords: alternative fuels, CNG (Compressed Natural Gas), CNG stations, LNG (Liquefied Natural Gas), NGVs (Natural Gas Vehicles), pollutant emissions

Procedia PDF Downloads 217

Authors: Sam Bahreini, Payam Hayati

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Metal-organic coordination [Cu(L)₄(SCN)₂] was synthesized applying ultrasonic irradiation, and its photocatalytic performance for the degradation of Remdesivir (RS) under sunlight irradiation was systematically explored for the first time in this study. The physicochemical properties of the synthesized photocatalyst were investigated using Fourier-transform infrared (FT-IR), field emission scanning electron microscopy (FE-SEM), powder x-ray diffraction (PXRD), energy-dispersive x-ray (EDX), thermal gravimetric analysis (TGA), diffuse reflectance spectroscopy (DRS) techniques. Systematic examinations were carried out by changing irradiation time, temperature, solution pH value, contact time, RS concentration, and catalyst dosage. The photodegradation kinetic profiles were modeled in pseudo-first order, pseudo-second-order, and intraparticle diffusion models reflected that photodegradation onto [Cu(L)₄(SCN)₂] catalyst follows pseudo-first order kinetic model. The fabricated [Cu(L)₄(SCN)₂] nanostructure bandgap was determined as 2.60 eV utilizing the Kubelka-Munk formula from the diffuse reflectance spectroscopy method. Decreasing chemical oxygen demand (COD) (from 70.5 mgL-1 to 36.4 mgL-1) under optimal conditions well confirmed mineralizing of the RS drug. The values of ΔH° and ΔS° was negative, implying the process of adsorption is spontaneous and more favorable in lower temperatures.

Keywords: Photocatalytic degradation, COVID-19, density functional theory (DFT), molecular electrostatic potential (MEP)

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Authors: S. Sharma, U. Batra, S. Kapoor, A. Dua

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In this study, the effects and interactions of reaction time and capping agent assistance during sol-gel synthesis of magnesium substituted hydroxyapatite nanopowder (MgHA) on hydroxyapatite (HA) to β-tricalcium phosphate (β-TCP) ratio, Ca/P ratio and mean crystallite size was examined experimentally as well as through statistical analysis. MgHA nanopowders were synthesized by sol-gel technique at room temperature using aqueous solution of calcium nitrate tetrahydrate, magnesium nitrate hexahydrate and potassium dihydrogen phosphate as starting materials. The reaction time for sol-gel synthesis was varied between 15 to 60 minutes. Two process routes were followed with and without addition of triethanolamine (TEA) in the solutions. The elemental compositions of as-synthesized powders were determined using X-ray fluorescence (XRF) spectroscopy. The functional groups present in the as-synthesized MgHA nanopowders were established through Fourier Transform Infrared Spectroscopy (FTIR). The amounts of phases present, Ca/P ratio and mean crystallite sizes of MgHA nanopowders were determined using X-ray diffraction (XRD). The HA content in biphasic mixture of HA and β-TCP and Ca/P ratio in as-synthesized MgHA nanopowders increased effectively with reaction time of sols (p < 0.0001, two way Anova), however, these were independent of TEA addition (p > 0.15, two way Anova). The MgHA nanopowders synthesized with TEA assistance exhibited 14 nm lower crystallite size (p < 0.018, 2 sample t-test) compared to the powder synthesized without TEA assistance.

Keywords: capping agent, hydroxyapatite, regression analysis, sol-gel, 2- sample t-test, two-way analysis of variance (ANOVA)

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Authors: Ermelinda Bloise, Giuseppe Mele

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In recent years, Cashew Nut Shell Liquid (CNSL) has received great attention from researchers because it is an abundant waste material from the agri-food industry that fits perfectly into the idea of reusing waste from renewable resources for the production of new functional materials. The different components of this waste showed a certain chemical versatility and, above all, various biological activities. Take advantage of their surface-active capacity in particular conditions, various amphiphilic nanostructures have been prepared through sustainable chemical processes using cardanol (CA) and anacardic acid (AA) as two main components of the CNSL. In-batch solvent-free method has been developed to obtain new versatile green nanovesicles capable of effectively incorporating and stabilizing both hydrophobic and hydrophilic bioactive molecules. Furthermore, these nanosystems have shown antioxidant and cytotoxic properties and, in vitroinvestigations, established that they efficiently taken-up some human cells. With the idea of meeting the principles of green chemistry, even more, some improvements of the synthetic procedure have been implemented in terms of milder temperature and pH conditions, producing one-component nanovesicles, in which the AA and CA-derivatives are the sole building block of the green nanosystems. Finally, a new experimental approach has been carried out by a microfluidic route, with the advantage to operate at continuous flows, with a reduced amount of reagents, waste, and at lower temperatures, ensuring the achievement of size-monodisperse amphiphilic nanostructures that do not need further purification steps.

Keywords: bioactive nanosystems, bio-based renewables, cashew oil, green nanoformulations

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Authors: Zelalem Bitew, Adane Kassa, Beyene Misgan

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In this study, a sensitive and selective voltammetric method based on poly(diphenylamine-4-sulfonic acid) modified glassy carbon electrode (poly(DPASA)/GCE) was developed for determination of gallic acid. Appearance of an irreversible oxidative peak at both bare GCE and poly(DPASA)/GCE for gallic acid with about three folds current enhancement and much reduced potential at poly(DPASA)/GCE showed catalytic property of the modifier towards oxidation of gallic acid. Under optimized conditions, Adsorptive stripping square wave voltammetric peak current response of the poly(DPASA)/GCE showed linear dependence with gallic acid concentration in the range 5.00 × 10-7 − 3.00 × 10-4 mol L-1 with limit of detection of 4.35 × 10-9. Spike recovery results between 94.62-99.63, 95.00-99.80 and 97.25-103.20% of gallic acid in honey, raw peanut, and commercial peanut butter samples respectively, interference recovery results with less than 4.11% error in the presence of uric acid and ascorbic acid, lower LOD and relatively wider dynamic range than most of the previously reported methods validated the potential applicability of the method based on poly(DPASA)/GCE for determination of gallic acid real samples including in honey and peanut samples.

Keywords: gallic acid, diphenyl amine sulfonic acid, adsorptive anodic striping square wave voltammetry, honey, peanut

Procedia PDF Downloads 58

Authors: Daniel Francis, Mo Yassin

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Transverse patella fractures are routinely fixed using tension band wiring (TBW) using Kirschner wires and a wire in the shape of a figure of 8. The idea of the study was to compare the outcomes of the traditional technique against the more recently used cannulated screws and fiber tape in the shape of a figure of 8. We performed a retrospective cohort study of all the surgically fixed patella fractures from the year 2019 to 2022. The patients were divided into two groups TBW group and cannulated screws group. The primary outcome measure was the failure of fixation and the need for the removal of metalwork. Twenty-six patellar fractures were studied. TBW was used in 14 (53.8%), and cannulated screws were used for fixation in 12 (46.2%). There was one incident of metalwork failure in the TBW and one incident in the cannulated screws group. Five (35.7%) of patients in the TBW needed symptomatic metal work removed and One (8.3%) in the cannulated screw group. In both groups, the rate of fixation failure was low. Symptomatic implants, the most common complication observed, were higher in the TBW group in our practice. Although the small numbers in both groups, the hope of this study is to shine the light on the use of cannulated screws for patella fractures as it would reduce the need for a second operation and reduce the load on the already stretched services as well as improving the patient experience by not requiring further surgery. Although this is not a brand-new technique, it is not commonly used as there have not yet been any studies that demonstrate the lower rates of second surgery needed.

Keywords: patella, tension band wiring, randomised, new technique

Procedia PDF Downloads 61

Authors: K. C. M. Wong, C. P. Y. Cheng, K. Y. Chan, G. S. C. Fung, T. F. O. Lau, K. F. C. Leung, J. P. C. Fok

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Hospital Authority (HA) is the statutory body to manage all public hospitals in Hong Kong. Occupational Care Medicine Service (OMCS) is an in-house multi-disciplinary team responsible for injury management in HA. Hospital administrative services (AS) provides essential support in hospital daily operation to facilitate the provision of quality healthcare services. An occupational health enhancement program in Tai Po Hospital (TPH) domestic service supporting unit (DSSU) was piloted in 2013 with satisfactory outcome, the keys to success were staff engagement and management support. Riding on the success, the program was rolled out to another 5 AS departments of Alice Ho Miu Ling Nethersole Hospital (AHNH) and TPH in 2015. This paper highlights the indispensable components of disability management and occupational health enhancement program in hospital settings. Objectives: 1) Facilitate workplace to support staff with health affecting work problem, 2) Enhance staff’s occupational health. Methodology: Hospital Occupational Safety and Health (OSH) team and AS departments (catering, linen services, and DSSU) of AHNH and TPH worked closely with OMCS. Focus group meetings and worksite visits were conducted with frontline staff engagement. OSH hazards were identified with corresponding OSH improvement measures introduced, e.g., invention of high dusting device to minimize working at height; tailor-made linen cart to minimize back bending at work, etc. Specific MHO trainings were offered to each AS department. A disability management workshop was provided to supervisors in order to enhance their knowledge and skills in return-to-work (RTW) facilitation. Based on injured staff's health condition, OMCS would provide work recommendation, and RTW plan was formulated with engagement of staff and their supervisors. Genuine communication among stakeholders with expectation management paved the way for realistic goals setting and success in our program. Outcome: After implementation of the program, a significant drop of 26% in musculoskeletal disorders related sickness absence day was noted in 2016 as compared to the average of 2013-2015. The improvement was postulated by innovative OSH improvement measures, teamwork, staff engagement and management support. Staff and supervisors’ feedback were very encouraging that 90% respondents rated very satisfactory in program evaluation. This program exemplified good work sharing among departments to support staff in need.

Keywords: disability management, occupational health, return to work, occupational medicine

Procedia PDF Downloads 188

Authors: Salah Hassab Elnaby, Omnia Hamdy, Aziza Ahmed Hassan, Salwa Abdelkawi, Ibrahim Abdelhalim

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Laser corneal reshaping has been proposed as a successful treatment of many refraction disorders. However, some physical and chemical demonstrations of the laser effect upon interaction with the corneal tissue are still not fully explained. Therefore, different computational and mathematical models have been implemented to predict the depth of the ablated channel and calculate the ablation threshold and the local temperature rise. In the current paper, we present a modified model that aims to answer some of the open questions about the ablation threshold, the ablation rate, and the physical and chemical mechanisms of that action. The proposed model consists of three parts. The first part deals with possible photochemical reactions between the incident photons and various components of the cornea (collagen, water, etc.). Such photochemical reactions may end by photo-ablation or just the electronic excitation of molecules. Then a chemical reaction is responsible for the ablation threshold. Finally, another chemical reaction produces fragments that can be cleared out. The model takes into account all processes at the same time with different probabilities. Moreover, the effect of applying different laser wavelengths that have been studied before, namely the common excimer laser (193-nm) and the solid state lasers (213-nm & 266-nm), has been investigated. Despite the success and ubiquity of the ArF laser, the presented results reveal that a carefully designed 213-nm laser gives the same results with lower operational drawbacks. Moreover, the use of mode locked laser could also decrease the risk of heat generation and diffusion.

Keywords: UV lasers, mathematical model, corneal ablation, photochemical ablation

Procedia PDF Downloads 66

Authors: Flavia Oliveira de A. M. Cruz, Edison Tostes Faria, Paula Elaine D. Reis

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When the breast is submitted to radiation therapy (RT), the most common effects are pain, skin changes, mobility restrictions, local sensory alteration, and fatigue. These effects, if not managed properly, may reduce the quality of life of cancer patients and may lead to the treatment discontinuation. Therefore, promoting knowledge and guidelines for symptom management remain a high priority for patients and a challenge for health professionals, due to the need to handle side effects in a population with a life-threatening disease. Printed materials are important strategies for supporting educative activities since they help the individual to assimilate and understand the amount of information transmitted. Nurses' behavior can be systematized through the use of an educative manual, which may be effective in promoting information regarding the treatment, self-care and how to control the effects of RT at home. In view of the importance of guaranteeing the validity of the material before its use, the objective of this research was to validate the content and appearance of an educative manual for breast cancer patients undergoing RT. The Theory of Psychometrics was used for the validation process in this descriptive methodological research. A minimum agreement rate (AR) of 80% was considered to guarantee the validity of the material. The data were collected from October to December 2017, by means of two assessments tools, constructed in the form of a Likert scale, with five levels of understanding. These instruments addressed different aspects of the evaluation, in view of two different groups of participants; 17 experts in the theme area of the educative manual, and 12 women that received RT previously to treat breast cancer. The manual was titled 'Orientation Manual: radiation therapy in breast', and was focused on breast cancer patients attended at the Department of Oncology of the Brasília University Hospital (UNACON/HUB). The research project was submitted to the Research Ethics Committee at the School of Health Sciences of the University of Brasília (CAAE: 24592213.1.0000.0030). Only two items of the assessment tool for the experts, one related to the manual's ability to promote behavioral and attitude changes and the other related to the extent of its use for other health services, obtained AR < 80% and were reformulated based on the participants' suggestions and in the literature. All other items were considered appropriate and/or complete appropriate in the three blocks proposed for the experts: objectives - 89%, structure and form - 93%, and relevance - 93%; and good and/or very good in the five blocks of analysis proposed for patients: objectives - 100%, organization - 100%, writing style - 100%, appearance - 100%, and motivation. The appearance and content validation of the educative manual proposed were attended to. The educative manual was considered relevant and pertinent and may contribute to the understanding of the therapeutic process by breast cancer patients during RT, as well as support clinical practice through the nursing consultation.

Keywords: oncology nursing, nursing care, validation studies, educational technology

Procedia PDF Downloads 114

Authors: Anette Alén

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Intellectual property (IP) regimes have traditionally been designed to integrate various conflicting elements stemming from private entitlement and the public good. In IP laws and regulations, this design takes the form of specific uses of protected subject-matter without the right-holder’s consent, or exhaustion of exclusive rights upon market release, and the like. More recently, the pursuit of ‘balance’ has gained ground in the conceptualization of these conflicting elements both in terms of IP law and related policy. This can be seen, for example, in European Union (EU) copyright regime, where ‘balance’ has become a key element in argumentation, backed up by fundamental rights reasoning. This development also entails an ever-expanding dialogue between the IP regime and the constitutional safeguards for property, free speech, and privacy, among others. This study analyses the concept of ‘balance’ in EU copyright law: the research task is to examine the contents of the concept of ‘balance’ and the way it is operationalized and pursued, thereby producing new knowledge on the role and manifestations of ‘balance’ in recent copyright case law and regulatory instruments in the EU. The study discusses two particular pieces of legislation, the EU Digital Single Market (DSM) Copyright Directive (EU) 2019/790 and the finalized EU Artificial Intelligence (AI) Act, including some of the key preparatory materials, as well as EU Court of Justice (CJEU) case law pertaining to copyright in the digital era. The material is examined by means of document analysis, mapping the ways ‘balance’ is approached and conceptualized in the documents. Similarly, the interaction of fundamental rights as part of the balancing act is also analyzed. Doctrinal study of law is also employed in the analysis of legal sources. This study suggests that the pursuit of balance is, for its part, conducive to new battles, largely due to the advancement of digitalization and more recent developments in artificial intelligence. Indeed, the ‘balancing act’ rather presents itself as a way to bypass or even solidify some of the conflicting interests in a complex global digital economy. Indeed, such a conceptualization, especially when accompanied by non-critical or strategically driven fundamental rights argumentation, runs counter to the genuine acknowledgment of new types of conflicting interests in the copyright regime. Therefore, a more radical approach, including critical analysis of the normative basis and fundamental rights implications of the concept of ‘balance’, is required to readjust copyright law and regulations for the digital era. Notwithstanding the focus on executing the study in the context of the EU copyright regime, the results bear wider significance for the digital economy, especially due to the platform liability regime in the DSM Directive and with the AI Act including objectives of a ‘level playing field’ whereby compliance with EU copyright rules seems to be expected among system providers.

Keywords: balance, copyright, fundamental rights, platform liability, artificial intelligence

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Authors: B. Kodedova, E. Filova, M. Kralovic, E. Amler

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Vitiligo is the most common depigmentation disorder of the skin characterized by loss of melanocyte in the epidermis that leads to white lesions. One of the possible treatments is autologous transplantation of melanocytes. Biodegradable electrospun polymeric nanofibers provide good mechanical properties and could serve as suitable scaffold for epithelial cells cultivation and follow up transplantation. Moreover the microarchitecture of nanofibers mimics the structure of extracellular matrix and its porosity allows nutrients and waste exchange. The aim of this work was to develop biocompatible and biodegradable polymeric scaffolds suitable for autologous melanocytes transplantation. Electrospun polyvinyl alcohol (PVA) nanofibers were modified by cold methane plasma to lower their hydrofility and to achieve better adhesion, proliferation and viability of the murine melanocyte (Melan-a). Cells were seeded on the modified scaffolds and their adhesion, metabolic activity, proliferation and melanin synthesis was evaluated and compared to non-modified scaffolds. Results clearly indicate that cold methane plasma modified PVA nanofibers are suitable for melanocyte cultivation and may be future candidate for vitiligo treatment. Furthermore, the nanofibers can be functionalized with various bioactive substances, for enhancement of the melanocyte proliferation, melanogenesis or healing and regenerative processes. The project was supported by the Ministry of Education, Youth and Sports NPU I: LO1309 and by Grant Agency of Charles University (grant No. 1228214).

Keywords: melanocyte, nanofibers, polyvinyl alcohol, plasma modification

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Authors: Azizza Mala, Babo Fadlalla, Elnour Mohamed, Siran Wang, Junfeng Li, Tao Shao

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Sweet sorghum is considered one of the best plants for silage production and is now a more important feed crop in many countries worldwide. It is simple to ensile because of its high water-soluble carbohydrates (WSC) concentration and low buffer capacity. This study investigated the effect of adding Pediococcus acidilactici AZZ5 and Lactobacillus plantarum AZZ4 isolated from elephant grass on the fermentation quality of sweet sorghum silage. One commercial bacteria Lactobacillus Plantarum, Ecosyl MTD/1(C.B.)), and two strains were used as additives Pediococcus acidilactici (AZZ5), Lactobacillus plantarum subsp. Plantarum (AZZ4) at 6 log colony forming units (cfu)/g of fresh sweet sorghum grass in laboratory silos (1000g). After 15, 30, and 60 days, the silos for each treatment were opened. All of the isolated strains enhanced the silage quality of sweet sorghum silage compared to the control, as evidenced by significantly (P < 0.05) lower ammonia nitrogen (NH3-N) content and undesirable microbial counts, as well as greater lactic acid (L.A.) contents and lactic acid/acetic acid (LA/AA) ratios. In addition, AZZ4 performed better than all other inoculants during ensiling, as evidenced by a significant (P < 0.05) reduction in pH and ammonia-N contents and a significant increase in lactic acid contents.

Keywords: fermentation, lactobacillus plantarum, lactic acid bacteria, pediococcus acidilactic, sweet sorghum

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Authors: Stephen Vera, Tabitha Black, Charalambos Cleanthous, Ryan Sain

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A gender comparison of USA commercial pilots’ demographics and views of CRM, social desirability and locus of control were surveyed. The Aviation safety locus of control (ASLOC) was used to measure external (ASLOC-E) or internal (ASLOC-I) aviation safety locus of control. The gender differences were explored using the ASLOC scores as a categorical variable. A differential comparison of crew resource management (CRM), based on the Federal Aviation Administration’s (FAA) guidelines was conducted. The results indicated that the proportion of female to male respondents matches the current ratio of USA commercial pilots. Moreover, there were no significant differences regarding overall education and the total number of communication classes one took. Regarding CRM issues, there were no significant differences on their views regarding the roles of the PIC, stress, time management, and managing a flight team. The females scored significantly lower on aeronautical decision making (ADM) and communications. There were no significant differences on either the Balanced Inventory of Desirable Responding (BIDR) impression management (IM) or self-deceptive enhancement (SDE). Although there were no overall significant differences on the ASLOC, the females did score higher on the internal subscale than did the males. An additional comparison of socially desirable responding indicates that all scores may be invalid, especially from the female respondents.

Keywords: social desirability, safety locus of control, crew resource management, commercial pilots

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Authors: Husmaini, Rijal Zein, Zulkarnain, Marlito Latifa, Syahrul E. Rambee

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The present study was conducted to evaluate the effects of probiotics–fermented purple sweet potato (PPSP) on performance and cholesterol meat of local ducks. One hundred two weeks old male local ducks placed in 4 treatment doses for ten weeks. The treatments were the dosage of PPSP, i.e., 0, 1, 2 and 3 grams of PPSP/bird/week. One gram PPSP contains 1.3 x 108 colony form unit. Data were analyzed statistically using SPSS and DMRT. The results showed that PPSP administration in local ducks did not affect intestinal villi height and fed consumption (P > 0.05), but highly significant (P < 0.01) increasing duodenum thickness, body weight, carcass yield and reducing both feed conversion and cholesterol meat content. The difference in PPSP dosage (1.2 and 3 grams) had the same effect on body weight gain. However, it has a different impact on feed conversion and meat cholesterol levels. The higher the PPSP dose given, the lower the feed conversion and meat cholesterol level. This study has shown that administration of PPSP can improve performance and reduce cholesterol levels of local duck meat. Giving PPSP as much as 3 grams per bird every week has provided the best results.

Keywords: cholesterol, local duck, performance, probiotics, purple sweet potato

Procedia PDF Downloads 164

Authors: Mohammed Al-Bloushi, Sanghyun Jeong, Torove Leiknes

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Biofouling in the open recirculating cooling water systems may cause biological corrosion, which can reduce the performance, increase the energy consummation and lower heat exchange efficiencies of the cooling tower. Seawater cooling towers are prone to biofouling due to the presences of organic and inorganic compounds in the seawater. The availability of organic and inorganic nutrients, along with sunlight and continuous aeration of the cooling tower contributes to an environment that is ideal for microbial growth. Various microorganisms (algae, fungi, and bacteria) can grow in a cooling tower system under certain environmental conditions. The most commonly being used method to control the biofouling in the cooling tower is the addition of biocides such as chlorination. In this study, algae containing diatom and green algae were added to the cooling tower basin, and its viability was monitored in the recirculating cooling seawater loop as well as in the cooling tower basin. Continuous addition of biocides was employed in pilot-scale seawater cooling towers, and it was operated continuously for 2 months. Three different types of oxidizing biocides, namely chlorine, chlorine dioxide and ozone, were tested. The results showed that all biocides were effective in keeping the biological growth to the minimum regardless of algal addition. Amongst the biocides, ozone could reduce 99% of total live cells of bacteria and algae, followed by chlorine dioxide at 97%, while the conventional chlorine showed only 89% reduction in the bioactivities.

Keywords: algae, biocide, biofouling, seawater cooling tower

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Authors: Hieu Duy Nguyen, Chitsan Lin Jr., Dung Duc Tran

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Nowadays, drought and salinity intrusion becomes a severe problem in the Lower Mekong region due to climate change, especially in coastal provinces. Freshwater resources are decreased due to sea-level rise and the decline in water flow from upstream in the dry season. The combination of the above issues can lead to many effects on the environment and human health in affected areas such as the pathological of digestive or decreased the immune system. Tidal cycle and upstream flows are the two main factors affecting the saline intrusion process and the former salt-wedge in the estuary. Under suitable conditions, salt-wedge can be going further upstream under the water surface and affected groundwater. In order to have a proper plan for the mitigation of the above adverse effects, we need to understand the characteristics of this process. In this study, 3D model is used to investigate the movement of salt-wedge under different conditions of tidal and flow discharge. The salinity in the vertical profile is also measured in the dry season of 2017 and 2018 for model calibrating. The data has proved that there is the presence of salt-wedge in the study area. The obtained results will help strategic planners to use and preserve water resources more effectively and serve as a basis for new research directions on saline intrusion and human health.

Keywords: salt-wedge, salinity intrusion, human health, 3D model

Procedia PDF Downloads 99

Authors: Tjipta Lesmana

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Terrorist attacks quickly penetrated Indonesia following the downfall of Soeharto regime in May 1998. Reform era was officially proclaimed. Indonesia turned to 'heaven state' from 'authoritarian state'. For the first time since 1966, the country experienced a full-scale freedom of expression, including freedom of the press, and heavy acknowledgement of human rights practice. Some religious extremists previously run away to neighbor countries to escape from security apparatus secretly backed home. Quickly they consolidated the power to continue their long aspiration and dream to establish 'Shariah Indonesia', Indonesia based on Khilafah ideology. Bali bombings I which shocked world community occurred on 12 October 2002 in the famous tourist district of Kuta on the Indonesian island of Bali, killing 202 people (including 88 Australians, 38 Indonesians, and people from more than 20 other nationalities). In the capital, Jakarta, successive bombings were blasted in Marriott hotel, Australian Embassy, residence of the Philippine Ambassador and stock exchange office. A 'drunken Indonesia' is far from ready to combat nationwide sudden and massive terrorist attacks. Police Detachment 88 (Densus 88) Indonesian counter-terrorism squad, was quickly formed following 2002 Bali Bombing. Anti-terrorism Provisional Act was immediately erected, as well, due to urgent need to fight terrorism. Some Bali bombings criminals were deadly executed after sentenced by the court. But a series of terrorist suicide attacks and another Bali bombings (the second one) in Bali, again, shocked world community. Terrorism network is undoubtedly spreading nationwide. Suspicion is high that they had close connection with Al Qaeda’s groups. Even 'Afghanistan alumni' and 'Syria alumni' returned to Indonesia to back up the local mujahidins in their fights to topple Indonesia constitutional government and set up Islamic state (Khilafah). Supported by massive aids from friendly nations, especially Australia and United States, Indonesia launched large scale operations to crush terrorism consisted of various radical groups such as JAD, JAS, and JAADI. Huge energy, money, and souls were dedicated. Terrorism is, however, persistently entrenched. High ranking officials from Detachment 88 squad and military intelligence believe that terrorism is still one the most deadly enemy of Indonesia.

Keywords: counter-radicalization, de-radicalization, Khalifah, Union State, Al Qaedah, ISIS

Procedia PDF Downloads 167

Authors: Celine Shi Ying Lee, Jong Jian Lee

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Background: Infectious keratitis is one of the leading causes of blindness worldwide. Prompt treatment with effective medication will control the infection early, preventing corneal scarring and visual loss. fluoroquinolones ophthalmic medication is used because of its broad-spectrum properties, potency, good intraocular penetration, and low toxicity. The study aims to evaluate the treatment outcome of corneal ulcers using Levofloxacin 1.5% ophthalmic solution (LVFX) with adjuvant oral ciprofloxacin when indicated and apply this treatment strategy in primary health care as first-line treatment. Methods: Patients with infective corneal ulcer treated in an eye center were recruited. Inclusion criteria includes Corneal infection consistent with bacterial keratitis, single or multiple small corneal ulcers. Treatment regime: LVFX hourly for the first 2 days, 2 hourly from the 3rd day, and 3 hourly on the 5th day of review. Adjuvant oral ciprofloxacin 500mg BD was administered for 5 days if there were multiple corneal ulcers or when the location of the cornea ulcer was central or paracentral. Results: 47 subjects were recruited. There were 16 (34%) males and 31 (66%) females. 40 subjects (85%) were contact lens (CL) related to corneal ulcer, and 7 subjects (15%) were non-contact lens related. 42 subjects (89%) presented with one ulcer, of which 20 of them (48%) needed adjuvant therapy. 5 subjects presented with 2 or 3 ulcers, of which 3 needed adjuvant therapy. A total of 23 subjects (49%) was given adjuvant therapy (oral ciprofloxacin 500mg BD for 5 days).21 of them (91%) were CL related. All subjects recovered fully, and the average duration of treatment was 3.7 days, with 49% of the subjects resolved on the 3rd day, 38% on the 5thday of and 13% on the 7thday. All subjects showed symptoms of relief of pain, light-sensitivity, and redness on the 3rd day with full visual recovery post-treatment. No adverse drug reactions were recorded. Conclusion: Our treatment regime demonstrated good clinical outcome as first-line treatment for corneal ulcers. A corneal ulcer is a common eye condition in Singapore, mainly due to CL wear. Pseudomonas aeruginosa is the most frequent and potentially sight-threatening pathogen involved in CL related corneal ulcer. Coagulase-negative Staphylococci, Staphylococcus aureus, and Streptococcus Pneumoniae were seen in non-CL users. All these bacteria exhibit good sensitivity rates to ciprofloxacin and levofloxacin. It is therefore logical in our study to use LVFX Eyedrops and adjuvant ciprofloxacin oral antibiotics when indicated as first line treatment for most corneal ulcers. Our study of patients, both CL related and non-CL related, have shown good clinical response and full recovery using the above treatment strategy. There was also a full restoration of visual acuity in all the patients. Eye-trained primary Healthcare practitioners can consider adopting this treatment strategy as first line treatment in patients with corneal ulcers. This is relevant during the COVID pandemic, where hospitals are overwhelmed with patients and in regions with limited access to specialist eye care. This strategy would enable early treatment with better clinical outcome.

Keywords: corneal ulcer, levofloxacin hydrate, treatment strategy, ciprofloxacin

Procedia PDF Downloads 160

Authors: Bastien Batardière, Joon Kwon

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For finite-sum optimization, variance-reduced gradient methods (VR) compute at each iteration the gradient of a single function (or of a mini-batch), and yet achieve faster convergence than SGD thanks to a carefully crafted lower-variance stochastic gradient estimator that reuses past gradients. Another important line of research of the past decade in continuous optimization is the adaptive algorithms such as AdaGrad, that dynamically adjust the (possibly coordinate-wise) learning rate to past gradients and thereby adapt to the geometry of the objective function. Variants such as RMSprop and Adam demonstrate outstanding practical performance that have contributed to the success of deep learning. In this work, we present AdaLVR, which combines the AdaGrad algorithm with loopless variance-reduced gradient estimators such as SAGA or L-SVRG that benefits from a straightforward construction and a streamlined analysis. We assess that AdaLVR inherits both good convergence properties from VR methods and the adaptive nature of AdaGrad: in the case of L-smooth convex functions we establish a gradient complexity of O(n + (L + √ nL)/ε) without prior knowledge of L. Numerical experiments demonstrate the superiority of AdaLVR over state-of-the-art methods. Moreover, we empirically show that the RMSprop and Adam algorithm combined with variance-reduced gradients estimators achieve even faster convergence.

Keywords: convex optimization, variance reduction, adaptive algorithms, loopless

Procedia PDF Downloads 55

Authors: Chang-Liang Shih, Kuei-Min Liao, Ya-Yuan Wang, Wu-Chun Tu

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Forcipomyia taiwana, an important vexing pest, influences the development of the industry of Taiwan tourism and the quality of country life. Using human-attractant method to investigate the blood-sucking behavior of Forcipomyia taiwana in three districts in Taichung, it revealed that female F. taiwana only exhibits blood-sucking behavior in daytime, not in nighttime. The blooding-sucking behavior of female F. taiwana was affected by some factors, i.e., season and atmospheric factors. During 2008 to 2010, our study revealed that blood-sucking behavior commenced from 7:00 to 8:00 in the spring equinox, the summer solstice and the autumnal equinox, but from 8:00 to 9:00 in the winter solstice. However, regardless of any seasons, it revealed that blood-sucking behavior reached the acme between 13:00 and 15:00, and then descending. In those four seasons, the summer solstice had longer lighting and higher temperature, the average sucking activity was around 12 hours, on the contrary, the winter solstice had shorter lighting and lower temperature, the average sucking activity bridled to around 8 hours whilst it retrenched to 11 hours in the spring equinox and the autumnal equinox. To analyze the correlation between blood-sucking behavior and atmospheric factors, it revealed that female blood-sucking behavior was correlated positively to temperature and lighting but negatively to humidity. In addition, our study also showed that there is no blood-sucking behavior under 18ºC.

Keywords: Forcipomyia taiwana, circadian rhythm, blood-sucking behavior, season

Procedia PDF Downloads 416

Authors: El Mehdi Haily, Lahcen Bih, Mohammed Azrour, Bouchaib Manoun

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The effects of xBi₂O₃-yBaO-zP₂O₅ (BBP) glass addition on the sintering, structural, and dielectric properties of BaTiO₃ ceramic (BT) are studied. The BT ceramic was synthesized by the conventional solid-state reaction method while the glasses BaO-Bi₂O₃-P₂O₅ (BBP) were elaborated by melting and quenching process. Different composites BT-xBBP were formed by mixing the BBP glasses with BT ceramic. For each glass composition, where the ratio (x:y:z) is maintained constant, we have developed three composites with different glass weight percentage (x = 2.5, 5, and 7.5 wt %). Addition of the glass helps in better sintering at lower temperatures with the presence of liquid phase at the respective sintering temperatures. The results showed that the sintering temperature decreased from more than 1300°C to 900°C. Density measurements of the composites are performed using the standard Archimedean method with water as medium liquid. It is found that their density and molar volume decrease and increase with glass content, respectively. Raman spectroscopy is used to characterize their structural approach. This technique has allowed the identification of different structural units of phosphate and the characteristic vibration modes of the BT. The electrical properties of the composite samples are carried out by impedance spectroscopy in the frequency range of 10 Hz to 1 MHz under various temperatures from 300 to 473 K. The obtained results show that their dielectric properties depend both on the content of the glass in the composite and the Bi/P ratio in the glasses.

Keywords: phosphate, glasses, composite, Raman spectroscopy, dielectric properties

Procedia PDF Downloads 150

Authors: Sareh Rajabi, Salwa Bheiry

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In general, Covid-19 created many financial and non-financial damages to the economy and community. Level and severity of covid-19 as pandemic case varies over the region and due to different types of the projects. Covid-19 virus emerged as one of the most imperative risk management factors word-wide recently. Therefore, as part of portfolio management assessment, it is essential to evaluate severity of such risk on the project and program in portfolio management level to avoid any risky portfolio. Covid-19 appeared very effectively in South America, part of Europe and Middle East. Such pandemic infection affected the whole universe, due to lock down, interruption in supply chain management, health and safety requirements, transportations and commercial impacts. Therefore, this research proposes Analytical Hierarchy Process (AHP) to analyze and assess such pandemic case like Covid-19 and its impacts on the construction projects. The AHP technique uses four sub-criteria: Health and safety, commercial risk, completion risk and contractual risk to evaluate the project and program. The result will provide the decision makers with information which project has higher or lower risk in case of Covid-19 and pandemic scenario. Therefore, the decision makers can have most feasible solution based on effective weighted criteria for project selection within their portfolio to match with the organization’s strategies.

Keywords: portfolio management, risk management, COVID-19, analytical hierarchy process technique

Procedia PDF Downloads 99

Authors: Oren Shtayermman

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The current investigation expended on research among parents caring for a child who is diagnosed with an autism spectrum disorder (ASD). An online web survey was used to collect data from 253 parents caring for a child with a diagnosis of ASD. Both parents reported on elevated levels of parental stress associated with caring for the child on the spectrum. In addition, lower levels of marital satisfaction were found in both parents. About 13% of the parents in the sample met the diagnostic criteria for Major Depressive Disorder and About 15% of the parents met the diagnostic criteria for Generalized Anxiety Disorder. Although the majority of the sample was females (94%) significant differences were found between males and females in relation to meeting the diagnostic criteria for Major Depressive Disorder and for Generalized Anxiety Disorder. Higher levels of stress were associated with higher number of Generalized Anxiety Disorder symptoms and higher number of Major Depressive Disorder symptoms. Findings from this study indicate how vulnerable parents and especially females are in relation to caring to a child diagnosed with ASD. Educational Objectives: At the conclusion of the paper, the readers should be able to: -Identify levels of stress and marital satisfaction among parents caring for a child diagnosed with autism spectrum disorder, -Recognize the impact of stress on the development of mental health issues, -Name the two most common mood and anxiety related disorders associated with caring for a child diagnosed with an autism spectrum disorder.

Keywords: autism, stress, parents, children

Procedia PDF Downloads 302

Authors: Vishwas Goel, Kapil Surve, Somnath Basu

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In-situ alloying in steel during the electro-slag remelting (ESR) process has already been achieved by the addition of necessary ferroalloys into the electro-slag remelting mold. However, the use of commercially available ferroalloys during ESR processing is often found to be financially less favorable, in comparison with the conventional alloying techniques. However, a process of alloying steel with elements like chromium and manganese using the electro-slag remelting route is under development without any ferrochrome addition. The process utilizes in-situ reduction of refined mineral chromite (Cr₂O₃) and resultant enrichment of chromium in the steel ingot produced. It was established in course of this work that this process can become more advantageous over conventional alloying techniques, both economically and environmentally, for applications which inherently demand the use of the electro-slag remelting process, such as manufacturing of superalloys. A key advantage is the lower overall CO₂ footprint of this process relative to the conventional route of production, storage, and the addition of ferrochrome. In addition to experimentally validating the feasibility of the envisaged reactions, a mathematical model to simulate the reduction of chromium (III) oxide and transfer to chromium to the molten steel droplets was also developed as part of the current work. The developed model helps to correlate the amount of chromite input and the magnitude of chromium alloying that can be achieved through this process. Experiments are in progress to validate the predictions made by this model and to fine-tune its parameters.

Keywords: alloying element, chromite, electro-slag remelting, ferrochrome

Procedia PDF Downloads 207

Authors: M. Eckert, D. Mendes, J P. Gonçalves, C. Moço, M. Oliveira

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The intensive extraction of natural aggregates leads to both depletion of natural resources and unwanted environmental impacts. On the other hand, uncontrolled disposal of Construction and Demolition Wastes (C&DW) causes the lifetime reduction of landfills. It is known that the European Union produces, each year, about 850 million tons of C&DW. For all the member States of the European Union, one of the milestones to be reached by 2020, according to the Resource Efficiency Roadmap (COM (2011) 571) of the European Commission, is to recycle 70% of the C&DW. In this work, properties of different types of recycled C&DW aggregates and natural aggregates were compared. Assays were performed according to European Standards (EN 13285; EN 13242+A1; EN 12457-4; EN 12620; EN 13139) for the characterization of there: physical, mechanical and chemical properties. Not standardized tests such as water absorption over time, mass stability and post compaction sieve analysis were also carried out. The tested recycled C&DW aggregates were classified according to the requirements of the European Standards regarding there potential use in concrete, mortar, unbound layers of road pavements and embankments. The results of the physical and mechanical properties of recycled C&DW aggregates indicated, in general, lower quality properties when compared to natural aggregates, particularly, for concrete preparation and unbound layers of road pavements. The results of the chemical properties attested that the C&DW aggregates constitute no environmental risk. It was concluded that recycled aggregates produced from C&DW have the potential to be used in many applications.

Keywords: recycled aggregate, sustainability, aggregate properties, European Standard Classification

Procedia PDF Downloads 649

Authors: T. Hadj Sadok, R. Hattab Bey, K. Rebiha

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The valuation of juice from prickly pear of Opuntia ficus indica inermis as cocktails appears an attractive alternative because of their nutritional intake and functional compound has anti-radical activity (polyphenols, vitamin C, carotenoids, Betalaines, fiber and minerals). The juice from the fruit pulp is characterized by a high pH 5.85 which makes it difficult for its conservation and preservation requires a thermal treatment at high temperatures (over 100 °C) harmful for bioactive constituents compared to juice orange more acidic and processed at temperatures < 100 °C. The valuation as fig cocktails-orange is particularly interesting thanks to the contribution of polyph2nols, fiber, vitamin C, reducing sugar (sweetener) and betalaine, minerals while allowing lower temperature processing to decrease pH. The heat treatment of these juices: orange alone or in cocktails showed that the antioxidant power decreases by 12% in presence of 30% of juice treated by the heat and of 28 and 32% in the presence of 10 and 20% juice which shows the effect prickly pear juice of Opuntia. During storage for 4 weeks the loss of vitamin C is 40 and 38% in the presence of 10 and 20% juice and 33% in the presence of 30% pear juice parallel, a treatment of stabilization by heat affects relatively the polyphenols rate which decreases from 10.5% to 30% in the cocktail, and 6.11-6.71pour cocktails at 10% and 20%. Vitamin C decreases to 12 to 24 % after a heat treatment at 85°C for 30 minutes respectively for the orange juice and pear juice; this reduction is higher when the juice is in the form of cocktails composed of 10 to 30 % pear juice.

Keywords: prickly pear juice, orange cocktail, polyphenol, Opuntia ficus indica, vitamin

Procedia PDF Downloads 365

Authors: Anna Demian, Levi Howard, L. Ng, Leslie Simon, Mark Dragon, A. Desai, Timothy Devlantes, W. David Freeman

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Introduction: Out-of-hospital cardiac arrest (OHCA) can carry a high mortality. For survivors, the most common complication is hypoxic-ischemic brain injury (HIBI). Rarely, lumbosacral spinal cord and/or other spinal cord artery ischemia can occur due to anatomic variation and variable mean arterial pressure after the return of spontaneous circulation. We present a case of an OHCA survivor who later woke up with bilateral leg weakness with preserved sensation (ASIA grade B, L2 level). Methods: We describe a clinical, radiographic, and laboratory presentation, as well as a National Library of Medicine (NLM) search engine methodology, characterizing incidence/prevalence of this entity is discussed. A 70-year-old male, a longtime smoker, and alcohol user, suddenly collapsed at a bar surrounded by friends. He had complained of chest pain before collapsing. 911 was called. EMS arrived, and the patient was in pulseless electrical activity (PEA), cardiopulmonary resuscitation (CPR) was initiated, and the patient was intubated, and a LUCAS device was applied for continuous, high-quality CPR in the field by EMS. In the ED, central lines were placed, and thrombolysis was administered for a suspected Pulmonary Embolism (PE). It was a prolonged code that lasted 90 minutes. The code continued with the eventual return of spontaneous circulation. The patient was placed on an epinephrine and norepinephrine drip to maintain blood pressure. ECHO was performed and showed a “D-shaped” ventricle worrisome for PE as well as an ejection fraction around 30%. A CT with PE protocol was performed and confirmed bilateral PE. Results: The patient woke up 24 hours later, following commands, and was extubated. He was found paraplegic below L2 with preserved sensation, with hypotonia and areflexia consistent with “spinal shock” or anterior spinal cord syndrome. MRI thoracic and lumbar spine showed a conus medullaris level spinal cord infarction. The patient was given IV steroids upon initial discovery of cord infarct. NLM search using “cardiac arrest” and “spinal cord infarction” revealed 57 results, with only 8 review articles. Risk factors include age, atherosclerotic disease, and intraaortic balloon pump placement. AoA (Artery of Adamkiewicz) anatomic variation along with existing atherosclerotic factors and low perfusion were also known risk factors. Conclusion: Acute paraplegia from anterior spinal cord infarction of the AoA territory after cardiac arrest is rare. Larger prospective, multicenter trials are needed to examine potential interventions of hypothermia, lumbar drains, which are sometimes used in aortic surgery to reduce ischemia and/or other neuroprotectants.

Keywords: cardiac arrest, spinal cord infarction, artery of Adamkiewicz, paraplegia

Procedia PDF Downloads 175