Search results for: hypertensive patients

Authors: Sonika Raj, Amarjeet Singh, Vijay Lakshmi Sharma

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Introduction: In 21st century, due to revolution in Information and Communication Technologies (ICTs), there has been phenomenal development in quality and quantity of knowledge in the field of medical science. So, the access to relevant information to physicians is critical to the delivery of effective healthcare services to patients. The study was conducted to assess the information needs and attitudes of the medical professionals; to determine the sources and channels of information used by them; to ascertain the current usage of ICTs and the barriers faced by them in utilization of ICTs in health information access. Methodology: This descriptive cross-sectional study was carried in 2015 on hundred medical professionals working in public and private sectors of Chandigarh. The study used both quantitative and qualitative method for data collection. A semi structured questionnaire and interview schedule was used to collect data on information seeking needs, access to ICTs and barriers to healthcare information access. Five Data analysis was done using SPSS-16 and qualitative data was analyzed using thematic approach. Results: The most preferred sources to access healthcare information were internet (85%), trainings (61%) and communication with colleagues (57%). They wanted information on new drug therapy and latest developments in respective fields. All had access to computer with but almost half assessed their computer knowledge as average and only 3% had received training regarding usage. Educational status (p=0.004), place of work (p=0.004), number of years in job (p=0.004) and sector of job (p=0.04) of doctors were found to be significantly associated with their active search for information. The major themes that emerged from in-views were need; types and sources of healthcare information; exchange of information among different levels of healthcare providers; usage of ICTs to obtain and share information; barriers to access of healthcare information and quality of health information materials and involvement in their development process Conclusion and Recommendations: The medical professionals need information in their in their due course of work. However, information needs of medical professionals were not being adequately met. There should be training of professional regarding internet skills and the course on bioinformatics should be incorporated in the curricula of medical students. The policy framework must be formulated that will encourage and promote the use of ICTs as tools for health information access and dissemination.

Keywords: health information, ICTs, medical professionals, qualitative

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Authors: Salima Taleb, Kafila Boulaba, Ahlem Yousfi, Nada Taleb, Difallah Basma

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Introduction: Obesity is recognized as a cardiovascular risk factor. It is associated with cardio-metabolic diseases. Its prevalence is increasing significantly in both rich and poor countries. However, there are obese people who have no metabolic disturbance. So we think obesity is not always a risk factor for an abnormal metabolic profile that increases the risk of cardiometabolic problems. However, there is no definition that allows us to identify the individual group Metabolically Healthy but Obese (MHO). Objective: The objective of this study is to evaluate the relationship between MHO and some factors associated with it. Methods: A longitudinal study is a prospective cohort study of 600 participants aged ≥18 years. Metabolic status was assessed by the following parameters: blood pressure, fasting glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. Body Mass Index (BMI) was calculated as weight (in kg) divided by height (m2), BMI = Weight/(Height)². According to the BMI value, our population was divided into four groups: underweight subjects with BMI <18.5 kg/m2, normal weight subjects with BMI = 18.5–24.9 kg/m², overweight subjects with BMI=25–29.9 kg/m², and obese subjects who have (BMI ≥ 30 kg/m²). A value of P < 0.05 was considered significant. Statistical processing was done using the SPSS 25 software. Results: During this study, 194 (32.33%) were identified as MHO among 416 (37%) obese individuals. The prevalence of the metabolically unhealthy phenotype among normal-weight individuals was (13.83%) vs. (37%) in obese individuals. Compared with metabolically healthy normal-weight individuals (10.93%), the prevalence of diabetes was (30.60%) in MHO, (20.59%) in metabolically unhealthy normal weight, and (52.29%) for metabolically unhealthy obese (p = 0.032). Blood pressure was significantly higher in MHO individuals than in metabolically healthy normal-weight individuals and in metabolically unhealthy obese than in metabolically unhealthy normal weight (P < 0.0001). Familial coronary artery disease does not appear to have an effect on the metabolic status of obese and normal-weight patients (P = 0.544). However, waist circumference appears to have an effect on the metabolic status of individuals (P < 0.0001). Conclusion: This study showed a high prevalence of metabolic profile disruption in normal-weight subjects and a high rate of overweight and/or obese people who are metabolically healthy. To understand the physiological mechanism related to these metabolic statuses, a thorough study is needed.

Keywords: metabolically health, obesity, factors associated, cardiovascular diseases

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Authors: Njabulo Ncube, Elena Kulinskaya, Nicholas Steel, Dmitry Pshezhetskiy

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Life expectancy in the United Kingdom (UK) has been near constant since 2010, particularly for the individuals of 65 years and older. This trend has been also noted in several other countries. This slowdown in the increase of life expectancy was concurrent with the increase in the number of deaths caused by non-communicable diseases. Of particular concern is the world-wide exponential increase in the number of diabetes related deaths. Previous studies have reported increased mortality hazards among diabetics compared to non-diabetics, and on the differing effects of antidiabetic drugs on mortality hazards. This study aimed to estimate the all-cause mortality hazards and related life expectancies among type 2 diabetes (T2DM) patients in the UK using the time-variant Gompertz-Cox model with frailty. The study also aimed to understand the major causes of the change in life expectancy growth in the last decade. A total of 221 182 (30.8% T2DM, 57.6% Males) individuals aged 50 years and above, born between 1930 and 1960, inclusive, and diagnosed between 2000 and 2016, were selected from The Health Improvement Network (THIN) database of the UK primary care data and followed up to 31 December 2016. About 13.4% of participants died during the follow-up period. The overall all-cause mortality hazard ratio of T2DM compared to non-diabetic controls was 1.467 (1.381-1.558) and 1.38 (1.307-1.457) when diagnosed between 50 to 59 years and 60 to 74 years, respectively. The estimated life expectancies among T2DM individuals without further comorbidities diagnosed at the age of 60 years were 2.43 (1930-1939 birth cohort), 2.53 (1940-1949 birth cohort) and 3.28 (1950-1960 birth cohort) years less than those of non-diabetic controls. However, the 1950-1960 birth cohort had a steeper hazard function compared to the 1940-1949 birth cohort for both T2DM and non-diabetic individuals. In conclusion, mortality hazards for people with T2DM continue to be higher than for non-diabetics. The steeper mortality hazard slope for the 1950-1960 birth cohort might indicate the sub-population contributing to a slowdown in the growth of the life expectancy.

Keywords: T2DM, Gompetz-Cox model with frailty, all-cause mortality, life expectancy

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Authors: Kyra Kannen, Sonja D. Roelen, Sebastian Schnieder, Jarek Krajewski, Steffen Holsteg, André Karger, Johanna Askeridis, Celina Slawik, Philip Mildner, Jens Piesk, Ruslan David, Holger Kürten, Benjamin Oster, Robert Malzan, Mike Ludemann

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Virtual Reality (VR) is increasingly recognized for its potential in transforming mental disorder treatment, offering advantages such as cost-effectiveness, time efficiency, accessibility, reduced stigma, and scalability. While the application of VR in the context of anxiety disorders has been extensively evaluated and demonstrated to be effective, the utilization of VR as a therapeutic treatment for depression remains under-investigated. Our goal is to pioneer immersive VR therapy modules for treating major depression, alongside a web-based system for home use. We develop a modular digital therapy platform grounded in psychodynamic therapy interventions which addresses stress reduction, exploration of social situations and relationship support, social skill training, avoidance behavior analysis, and psychoeducation. In addition, an automated depression monitoring system, based on acoustic voice analysis, is implemented in the form of a speech-based diary to track the affective state of the user and depression severity. The use of immersive VR facilitates patient immersion into complex and realistic interpersonal interactions with high emotional engagement, which may contribute to positive treatment acceptance and satisfaction. In a proof-of-concept study, 45 depressed patients were assigned to VR or web-platform modules, evaluating user experience, usability and additional metrics including depression severity, mindfulness, interpersonal problems, and treatment satisfaction. The findings provide valuable insights into the effectiveness and user-friendliness of VR and web modules for depression therapy and contribute to the refinement of more tailored digital interventions to improve mental health.

Keywords: virtual reality therapy, digital health, depression, psychotherapy

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Authors: Lancer Scott

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Purpose: High quality clinical disaster medicine requires providers working collaboratively to care for multiple patients in chaotic environments; however, many providers lack adequate training. To address this deficit, we created a competency-based, 5-hour Emergency Preparedness Training (EPT) curriculum using didactics, small-group discussion, and kinetic learning. The goal was to evaluate the effect of a short course on improving provider knowledge, confidence and skills in disaster scenarios. Methods: Diverse groups of medical university students, health care professionals, and community members were enrolled between 2011 and 2014. The course consisted of didactic lectures, small group exercises, and two live, multi-patient mass casualty incident (MCI) scenarios. The outcome measures were based on core competencies and performance objectives developed by a curriculum task force and assessed via trained facilitator observation, pre- and post-testing, and a course evaluation. Results: 708 participants completed were trained between November 2011 and August 2014, including 49.9% physicians, 31.9% medical students, 7.2% nurses, and 11% various other healthcare professions. 100% of participants completed the pre-test and 71.9% completed the post-test, with average correct answers increasing from 39% to 60%. Following didactics, trainees met 73% and 96% of performance objectives for the two small group exercises and 68.5% and 61.1% of performance objectives for the two MCI scenarios. Average trainee self-assessment of both overall knowledge and skill with clinical disasters improved from 33/100 to 74/100 (overall knowledge) and 33/100 to 77/100 (overall skill). The course assessment was completed by 34.3% participants, of whom 91.5% highly recommended the course. Conclusion: A relatively short, intensive EPT course can improve the ability of a diverse group of disaster care providers to respond effectively to mass casualty scenarios.

Keywords: clinical disaster medicine, training, hospital preparedness, surge capacity, education, curriculum, research, performance, training, student, physicians, nurses, health care providers, health care

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Authors: Hossein Rassi, Marjan Moradi Fard, Masoud Houshmand

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Background: Cervical cancer is multistep disease that is thought to result from an interaction between genetic background and environmental factors. Human papillomavirus (HPV) infection is the leading risk factor for cervical intraepithelial neoplasia (CIN) and cervical cancer. In other hand, some of p53 and miRNA polymorphism may plays an important role in carcinogenesis. This study attempts to clarify the relation of p53 genotypes and miR-146a rs2910164 polymorphism in cervical lesions. Method: Forty two archival samples with cervical lesion retired from Khatam hospital and 40 sample from healthy persons used as control group. A simple and rapid method was used to detect the simultaneous amplification of the HPV consensus L1 region and HPV-16,-18, -11, -31, 33 and -35 along with the b-globin gene as an internal control. We use Multiplex PCR for detection of P53 and miR-146a rs2910164 genotypes in our lab. Finally, data analysis was performed using the 7 version of the Epi Info(TM) 2012 software and test chi-square(x2) for trend. Results: Cervix lesions were collected from 42 patients with Squamous metaplasia, cervical intraepithelial neoplasia, and cervical carcinoma. Successful DNA extraction was assessed by PCR amplification of b-actin gene (99bp). According to the results, p53 GG genotype and miR-146a rs2910164 CC genotype was significantly associated with increased risk of cervical lesions in the study population. In this study, we detected 13 HPV 18 from 42 cervical cancer. Conclusion: The connection between several SNP polymorphism and human virus papilloma in rare researches were seen. The reason of these differences in researches' findings can result in different kinds of races and geographic situations and also differences in life grooves in every region. The present study provided preliminary evidence that a p53 GG genotype and miR-146a rs2910164 CC genotype may effect cervical cancer risk in the study population, interacting synergistically with HPV 18 genotype. Our results demonstrate that the testing of p53 codon 72 polymorphism genotypes and miR-146a rs2910164 polymorphism genotypes in combination with HPV18 can serve as major risk factors in the early identification of cervical cancers. Furthermore, the results indicate the possibility of primary prevention of cervical cancer by vaccination against HPV18 in Iran.

Keywords: cervical cancer, HPV18, p53 codon 72 polymorphism, miR-146a rs2910164 polymorphism

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Authors: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal

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Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.

Keywords: end of life care, geriatrics, palliative care, residency training skill

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Authors: Mohammed Eltayeb Salih Elamin

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This study discusses the concept of the artificial heart using engineering concepts, of the fluid mechanics and the characteristics of the non-Newtonian fluid. For the purpose to serve heart patients and improve aspects of their lives and since the Statistics review according to world health organization (WHO) says that heart disease and blood vessels are the first cause of death in the world. Statistics shows that 30% of the death cases in the world by the heart disease, so simply we can consider it as the number one leading cause of death in the entire world is heart failure. And since the heart implantation become a very difficult and not always available, the idea of the artificial heart become very essential. So it’s important that we participate in the developing this idea by searching and finding the weakness point in the earlier designs and hoping for improving it for the best of humanity. In this study a pump was designed in order to pump blood to the human body and taking into account all the factors that allows it to replace the human heart, in order to work at the same characteristics and the efficiency of the human heart. The pump was designed on the idea of the diaphragm pump. Three models of blood obtained from the blood real characteristics and all of these models were simulated in order to study the effect of the pumping work on the fluid. After that, we study the properties of this pump by using Ansys15 software to simulate blood flow inside the pump and the amount of stress that it will go under. The 3D geometries modeling was done using SOLID WORKS and the geometries then imported to Ansys design modeler which is used during the pre-processing procedure. The solver used throughout the study is Ansys FLUENT. This is a tool used to analysis the fluid flow troubles and the general well-known term used for this branch of science is known as Computational Fluid Dynamics (CFD). Basically, Design Modeler used during the pre-processing procedure which is a crucial step before the start of the fluid flow problem. Some of the key operations are the geometry creations which specify the domain of the fluid flow problem. Next is mesh generation which means discretization of the domain to solve governing equations at each cell and later, specify the boundary zones to apply boundary conditions for the problem. Finally, the pre–processed work will be saved at the Ansys workbench for future work continuation.

Keywords: Artificial heart, computational fluid dynamic heart chamber, design, pump

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Authors: Siobhan Hegarty, Michael Bloomfield, Kim Entholt, Dorothy Williams, Helen Kennerley

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Complex Post-Traumatic Stress Disorder (CPTSD) confers greater risk of poor outcomes than does Post-Traumatic Stress Disorder (PTSD). Despite this, the current treatment guidelines for CPTSD aim to reduce only the ‘core’ symptoms of re-experiencing, hyper-vigilance and avoidance, while not addressing the Disturbances of Self Organisation (DSO) symptoms that distinguish this novel diagnosis from PTSD. The Recovering from Child Abuse Programme (RCAP) is a group protocol, based on the principles of cognitive behavioural therapy (CBT). Preliminary evidence suggests the program is effective at reducing DSO symptoms. This pilot study is the first to investigate the potential effectiveness of the RCAP for the specific treatment of CPTSD. This study was conducted as a service evaluation in a secondary care, traumatic stress service. Treatment was delivered once a week, in two-hour sessions, to ten existing female CPTSD patients of the service, who had experienced sexual abuse in childhood. The programme was administered by two therapists and two additional facilitators, following the RCAP protocol manual. Symptom severity was measured before the administration of therapy and was tracked across a range of measures (International Trauma Questionnaire; Patient Health Questionnaire; Community Assessment of Psychic Experience; Work and Social Adjustment Scale) at five time points, over the course of treatment. Qualitative appraisal of the programme was gathered via weekly feedback forms and from audio-taped recordings of verbal feedback given during group sessions. Preliminary results suggest the programme causes a slight reduction in CPTSD and depressive symptom severity and preliminary qualitative analysis suggests that the RCAP is both helpful and acceptable to group members. Final results and conclusions will follow completed thematic analysis of results.

Keywords: Child sexual abuse, Cognitive behavioural therapy, Complex post-traumatic stress disorder, Recovering from child abuse programme

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Authors: Ahmed Torad

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Background: Knee osteoarthritis (OA) is a prevalent musculoskeletal condition characterized by pain and functional impairment. While various rehabilitation approaches have been employed, the effectiveness of high-intensity interval training (HIIT) compared to traditional rehabilitation exercises remains unclear. Objective: This randomized controlled trial aimed to compare the effects of HIIT and traditional rehabilitation exercises on pain reduction, functional improvement, and quality of life in individuals with knee OA. Methods: A total of 120 participants diagnosed with knee OA were randomly allocated into two groups: the HIIT group (n=60) and the traditional rehabilitation group (n=60). The HIIT group participated in a 12-week supervised program consisting of high-intensity interval exercises, while the traditional rehabilitation group followed a conventional physiotherapy regimen. Outcome measures included visual analog scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 Health Survey (SF-36) at baseline and after the intervention period. Results: Both groups showed significant improvements in pain scores, functional outcomes (WOMAC), and quality of life (SF-36) after 12 weeks of intervention. However, the HIIT group demonstrated superior pain reduction (p<0.001), functional improvement (p<0.001), and physical health-related quality of life (p=0.002) compared to the traditional rehabilitation group. No significant differences were observed in mental health-related quality of life between the two groups. Conclusion: High-intensity interval training appears to be a more effective rehabilitation approach than traditional exercises for individuals with knee osteoarthritis, resulting in greater pain reduction, improved function, and enhanced physical health-related quality of life. These findings suggest that HIIT may represent a promising intervention strategy for managing knee OA and enhancing the overall well-being of affected individuals.

Keywords: knee osteoarthritis, high-intensity interval training, traditional rehabilitation exercises, randomized controlled trial, pain reduction, functional improvement, quality of life

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Authors: Khemakhem Nahed, Hammami Fatma, Trabelsi Houaida, Neji Sourour, Sellami Hayet, Makni Fattouma, Turki Hamida, Ayadi Ali

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Dermatophytoses are considered a public health problem and represent 10% of dermatological consultations in our region. Their epidemiology is influenced by various factors, such as lifestyle, human migration patterns, changes in the environment and the host relationship. The understanding of epidemiology has a major impact on their prevention and treatment. The aim of the study is to determine the prevalence pattern of aetiological agents and to describe the clinical characteristics of dermatophytoses between 1999 and 2019. Out of 65 059 subjects suspected to have superficial mycoses, 36 220 (55.67%) were affected with dermatophytoses. The mean age was 40.1 years (range: 10 days to 99 years). The sex ratio was 0.8. Our patients were from urban regions in 80.9% of cases. The most common type of infection was onychomycosis (42.64%), followed by tinea pedis (20.8%), intertrigo (18.3%), tinea corporis (8.48%) and tinea capitis (7.87%). The most isolated dermatophyte was Trichophyton rubrum (76.5%), followed by T. mentagrophytes complex (6.3%), Microsporum canis (5.8%), T. violaceum (5.3%), T. verrucosum (0.83%) and Epidermophyton floccosum (0.3%). Zoophilic agents have become more prevalent and their frequency has been increased from 6.46% in 1999 to 13% in 2019. It is interesting to note that M. canis has been on the rise since 2010 and it was the first etiological agent of tinea capitis (48%), while infections caused by T. violaceum continued to decrease from 1999 (16.2%) to 2019 (4.7%). Other dermatophytes have been rarely isolated: T. tonsurans (9 cases), T. schoenleinii (3 cases), T. soudanense (2 cases), M. fulvum (1 case), M. audouinii (1 case) and M. ferrugineum (2 cases).T. mentagrophytes var. quinckeanum was isolated from an inflammatory tinea capitis lesion in an a-3-year-old girl. T. mentagrophytes var. erinacei was isolated from the first case of tinea manuum, in-a-10-year-old girl. The same fungus was isolated from the hair and scales of the hedgehog. Our study showed significant changes in the dermatophytes spectrum in our region. The prevalence of zoophilic species increased in recent years due to people's behavioral changes with the adoption of pets and animal husbandry in urban settings. Molecular methods are often crucial that help us to refine the identification strains of dermatophytes and to identify their origin of the contamination.

Keywords: dermatophytoses, PCR-sequencing, spectrum, Sfax, Tunisia

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Authors: Owonikoko Abayomi Dele

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Epilepsy is an unresolved disease that needs urgent attention. It is a brain disorder that affects over sixty-five (65) million people around the globe. Despite the availability of commercial anti-epileptic drugs, the war against this unmet condition is yet to be resolved. Most epilepsy patients are resistant to available anti-epileptic medications thus the need for affordable novel therapy against epilepsy is a necessity. Numerous phytochemicals have been reported for their potency, efficacy and safety as therapeutic agents against many diseases. This study investigated 99 isolated phytochemicals from Chasmanthera dependens and Carissa edulis against carbonic anhydrase (ii) drug target. The absorption, distribution, metabolism, excretion and toxicity (ADMET) of the isolated compounds were examined using admet SAR-2 web server while Swiss ADME was used to analyze the oral bioavailability, drug-likeness and lead-likeness properties of the selected leads. PASS web server was used to predict the biological activities of selected leads while other important physicochemical properties and interactions of the selected leads with the active site of the target after successful molecular docking simulation with the pyrx virtual screening tool were also examined. The results of these study identified seven lead compounds; C49- alpha-carissanol (-7.6 kcal/mol), C13- Catechin (-7.4 kcal/mol), C45- Salicin (-7.4 kcal/mol), C6- Bisnorargemonine (-7.3 kcal/mol), C36- Pallidine (-7.1 kcal/mol), S4- Lacosamide (-7.1 kcal/mol), and S7- Acetazolamide (-6.4 kcal/mol) for CA II (3HS4 receptor). These leads compounds are probable inhibitors of this drug target due to the observed good binding affinities and favourable interactions with the active site of the drug target, excellent ADMET profiles, PASS Properties, drug-likeness, lead-likeness and oral bioavailability properties. The identified leads have better binding energies as compared to the binding energies of the two standards. Thus, seven identified lead compounds can be developed further towards the development of new anti-epileptic medications.

Keywords: drug-likeness, phytochemicals, carbonic anhydrases, metalloeazymes, active site, ADMET

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Authors: Valeria Arcucci, Musarat Ishaq, Steven A. Stacker, Greg J. Goodall, Marc G. Achen

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Metastasis is the lethal aspect of cancer for most patients. Remodelling of lymphatic vessels associated with a tumour is a key initial step in metastasis because it facilitates the entry of cancer cells into the lymphatic vasculature and their spread to lymph nodes and distant organs. Although it is clear that vascular endothelial growth factors (VEGFs), such as VEGF-C and VEGF-D, are key drivers of lymphatic remodelling, the means by which many signaling pathways in endothelial cells are coordinately regulated to drive growth and remodelling of lymphatics in cancer is not understood. We seek to understand the broader molecular mechanisms that control cancer metastasis, and are focusing on microRNAs, which coordinately regulate signaling pathways involved in complex biological responses in health and disease. Here, using small RNA sequencing, we found that a specific microRNA, miR-132, is upregulated in expression in lymphatic endothelial cells (LECs) in response to the lymphangiogenic growth factors. Interestingly, ectopic expression of miR-132 in LECs in vitro stimulated proliferation and tube formation of these cells. Moreover, miR-132 is expressed in lymphatic vessels of a subset of human breast tumours which were previously found to express high levels of VEGF-D by immunohistochemical analysis on tumour tissue microarrays. In order to dissect the complexity of regulation by miR-132 in lymphatic biology, we performed Argonaute HITS-CLIP, which led us to identify the miR-132-mRNA interactome in LECs. We found that this microRNA in LECs is involved in the control of many different pathways mainly involved in cell proliferation and regulation of the extracellular matrix and cell-cell junctions. We are now exploring the functional significance of miR-132 targets in the biology of LECs using biochemical techniques, functional in vitro cell assays and in vivo lymphangiogenesis assays. This project will ultimately define the molecular regulation of lymphatic remodelling by miR-132, and thereby identify potential therapeutic targets for drugs designed to restrict the growth and remodelling of tumour lymphatics resulting in metastatic spread.

Keywords: argonaute HITS-CLIP, cancer, lymphatic remodelling, miR-132, VEGF

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Authors: Allan F. F. Alves, Fernando A. Bacchim Neto, Guilherme Giacomini, Marcela de Oliveira, Ana L. M. Pavan, Maria E. D. Rosa, Diana R. Pina

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Stroke is a worldwide concern, only in Brazil it accounts for 10% of all registered deaths. There are 2 stroke types, ischemic (87%) and hemorrhagic (13%). Early diagnosis is essential to avoid irreversible cerebral damage. Non-enhanced computed tomography (NECT) is one of the main diagnostic techniques used due to its wide availability and rapid diagnosis. Detection depends on the size and severity of lesions and the time spent between the first symptoms and examination. The Alberta Stroke Program Early CT Score (ASPECTS) is a subjective method that increases the detection rate. The aim of this work was to implement an image segmentation system to enhance ischemic stroke and to quantify the area of ischemic and hemorrhagic stroke lesions in CT scans. We evaluated 10 patients with NECT examinations diagnosed with ischemic stroke. Analyzes were performed in two axial slices, one at the level of the thalamus and basal ganglion and one adjacent to the top edge of the ganglionic structures with window width between 80 and 100 Hounsfield Units. We used different image processing techniques such as morphological filters, discrete wavelet transform and Fuzzy C-means clustering. Subjective analyzes were performed by a neuroradiologist according to the ASPECTS scale to quantify ischemic areas in the middle cerebral artery region. These subjective analysis results were compared with objective analyzes performed by the computational algorithm. Preliminary results indicate that the morphological filters actually improve the ischemic areas for subjective evaluations. The comparison in area of the ischemic region contoured by the neuroradiologist and the defined area by computational algorithm showed no deviations greater than 12% in any of the 10 examination tests. Although there is a tendency that the areas contoured by the neuroradiologist are smaller than those obtained by the algorithm. These results show the importance of a computer aided diagnosis software to assist neuroradiology decisions, especially in critical situations as the choice of treatment for ischemic stroke.

Keywords: ischemic stroke, image processing, CT scans, Fuzzy C-means

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Authors: Kumar Y., Suman D., Sumathi

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Introduction: Burns to the face account for between one-fourth and one-third of all burns. The loss of an eyebrow due to a burn or infection can have negative physical and psychological consequences for patients because eyebrows have a critical functional and aesthetic role on the face. Plastic surgeons face unique challenges in reconstructing eyebrows due to their complex anatomy and variations within genders. As a general rule, there are three techniques for reconstructing the eyebrow: superficial temporal artery island flap, a composite graft from the scalp, and mini or micro follicular grafts from the scalp. In situations where a sufficient amount of subcutaneous tissue is not available and the defect is big such as the case of burns, flaps like the superficial temporal artery scalp flap remain reliable options. In 2018, a 17-year-old female patient presented to the department of Burns Plastic and reconstructive Surgery of Guru Teg Bahadur Hospital, Delhi, India. A scald-burn injury to the face occurred two years before admission, resulting in bilateral eyebrow loss. We reconstructed the bilateral eyebrows using bilateral scalp island flaps based on the posterior branch of the superficial temporal artery. The reconstructed eyebrows successfully assumed a desirable shape and exhibited a natural appearance, which was consistent with preoperative expectations and the patient stated that she was more comfortable with her social relationships. Among the current treatment procedures, the superficial temporal artery island flap continues to be a versatile option for reconstructing the eyebrows after alopecia, especially in cases of burns. Results: During the 30 days follow-up period, the scalp island flap remained vascularised with normal hair growth, without complications. The reconstructed eyebrows successfully assumed a desirable shape and exhibited a natural appearance; the patient stated that she was more comfortable with her social relationships. Conclusion: In this case report, we demonstrated how scalp island flaps pedicled by the superficial temporal artery could be performed very safely and reliably to create new eyebrows.

Keywords: alopecia, burns, eyebrow, flap, superficial temporal artery

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Authors: Liaqat Ali, Hubert E. Blum, Türkân Sakinc

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Enterococcus faecium is an emerging multidrug-resistant nosocomial pathogen increased dramatically worldwide and causing bacteremia, endocarditis, urinary tract and surgical site infections in immunocomprised patients. The capsular polysaccharides that contribute to pathogenesis through evasion of the host innate immune system are also involved in hindering leukocyte killing of enterococci. The gene cluster (enterococcal polysaccharide antigen) of E. faecalis encoding homologues of many genes involved in polysaccharide biosynthesis. We identified two putative loci with 22 kb and 19 kb which contained 11 genes encoding for glycosyltransferases (GTFs); this was confirmed by using genome comparison of already sequenced strains that has no homology to known capsule genes and the epa-locus. The polysaccharide-conjugate vaccines have rapidly emerged as a suitable strategy to combat different pathogenic bacteria, therefore, we investigated a polysaccharide biosynthesis CapD protein in E. faecium contains 336 amino acids and had putative function for N-linked glycosylation. The deletion/knock-out capD mutant was constructed and complemented by homologues recombination method and confirmed by using PCR and sequencing. For further characterization and functional analysis, in-vitro cell culture and in-vivo a mouse infection models were used. Our ΔcapD mutant shows a strong hydrophobicity and all strains exhibited biofilm production. Subsequently, the opsonic activity was tested in an opsonophagocytic assay which shows increased in mutant compared complemented and wild type strains but more than two fold decreased in colonization and adherence was seen on surface of uroepithelial cells. However, a significant higher bacterial colonialization was observed in capD mutant during animal bacteremia infection. Unlike other polysaccharides biosynthesis proteins, CapD does not seems to be a major virulence factor in enterococci but further experiments and attention is needed to clarify its function, exact mechanism and involvement in pathogenesis of enteroccocal nosocomial infections eventually to develop a vaccine/ or targeted therapy.

Keywords: E. faecium, pathogenesis, polysaccharides, biofilm formation

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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Introduction: To improve early detection and mortality rate of In- Hospital Cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditions and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90mmHg, respiratory rate <8 or > 28 breaths per minute, O2 saturation < 90%, acute change in conscious state, acute chest pain or worried about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in In-Hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in In-Hospital cardiac arrest and overall hospital mortality rate. We conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed Chi -square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010 ,139 calls in 2011 and 245 calls in 2012.The number of ERT calls per 1000 admissions in year 2009-10 was 7.69, 5.61 in 2011 and 9.38 in 2013. The number of Code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, But we have not found difference in overall hospital mortality rate.

Keywords: emergency response team, ERT, cardiac arrest, emergency medicine

Procedia PDF Downloads 288

Authors: L. L. Tundisi, A. Pessoa Jr., E. B. Tambourgi, E. Silveira, P. G. Mazzola

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L-asparaginase (L-ASNase) is the gold standard treatment for acute lymphoblastic leukemia that mainly affects pediatric patients; treatment increases survival from 20% to 90%. The characterization of other L-Asparaginases, apart from the most used from Escherichia coli and Erwinia chrysanthemi, has been reported, but the choice of the most appropriate is still under debate. This choice should be based on its pharmacokinetics, immune hypersensitivity, doses, prices, pharmacodynamics. The main factors influencing the antileukemic activity of ASNase are enzymatic activity, Km, glutaminase activity, clearance of the enzyme and development of resistance. However, most of the commercialized enzyme present an intrinsic glutaminase activity, which is responsible for some side effects. In this study, glutaminase free asparaginase produced from Aspergillus oryzae was precipitated in different percentages of ethanol (0–80%), until optimum ethanol concentration of 60% (w/w) was found. Following, precipitation of crude L-ASNase was performed in a single step, using 60% (w/w) ethanol, under constant agitation and temperature. It presented activity of 135.45 U/mg and after gel filtration chromatography with Sephadex G-the enzymatic activity was 322.02 U/mg. The apparent molecular mass of the purified L-ASNase fraction was estimated by 10% SDS-PAGE. Proteins were stained with Coomassie Brilliant Blue R-250. The molar mass range was from 10 kDa to 250 kDa. L-ASNase from Aspergillus oryzae was characterized aiming possible therapeutic use. Four different buffers (phosphate-citrate buffer pH 2.6 to 5.8; phosphate buffer pH 5.8 to 7.4; Tris - HCl pH 7.4 to 9.0; and carbonate buffer pH 9.8 to 10.6) were used to measure the optimum pH for L-ASNase activity. The optimum temperature for enzyme activity was measured at optimal pH conditions (Tris-HCl and phosphate buffer, pH 7.4) at different temperatures ranging from 5 to 55°C. All activities were calculated by quantifying the free ammonia, using the Nessler reagent. The kinetic parameters calculation, e.g. Michaelis-Menten constant (Km), maximum velocity (Vmax) and Hills coefficient (n), were performed by incubating the enzyme in different concentrations of the substrate at optimum conditions of pH and fitted on Hill’s equation. This glutaminase free asparaginase showed a low Km (3.39 mM and 3.81 mM) and enzymatic activity of 135.45 U/mg after precipitation with ethanol. After gel filtration chromatography it rose to 322.02 U/mg. Optimum activity was found between pH 5.8 - 9.0, best activity results with phosphate buffer pH 7.4 and Tris-HCl pH 7.4 and showed activity from 5°C to 55°C. These results indicate that L-ASNase from A. oryzae has the potential for human use.

Keywords: biopharmaceuticals, bioprocessing, bioproducts, biotechnology, enzyme activity, ethanol precipitation

Procedia PDF Downloads 272

Authors: Nastja Utrosa, Matevz Juvancic

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Hospital buildings are complex public environments characterized by intricate functional arrangements and architectural layouts. Effective wayfinding is essential for patients, visitors, students, and staff. However, spatial orientation planning is often overlooked until after construction. While these environments meet functional needs, they frequently neglect the psychological aspects of user experience. This study investigates wayfinding within complex urban healthcare environments, focusing on the influences of spatial design, spatial cognition, and user experience. The inherent complexity of these environments, with extensive spatial dimensions and dispersed buildings, exacerbates the problem. Gradual expansions and additions contribute to disorientation and navigational difficulties for users. Effective route guidance in urban healthcare settings has become increasingly crucial. However, research on the environmental elements that influence wayfinding in such environments remains limited. To address this gap, we conducted a study at the University Medical Centre Ljubljana (UMCL), Slovenia's largest university hospital. Using a questionnaire, we assessed how individuals' perceptions and use of outdoor hospital spaces with a diverse sample (n=179). We evaluated the area’s usability by analyzing visit frequency, stops, modes of arrival, and parking patterns and examined the visitors' age distribution. Additionally, we investigated spatial aids and the use of color as an orientation element at three specific locations within the medical center. Our study explored the impact of color on entrance selection and the effectiveness of warm versus cool colors for wayfinding. Our findings highlight the significance of graphic adjustments in shaping perceptions of hospital outdoor spaces. Most participants preferred visually organized entrances, underscoring the importance of effective visual communication. Implementing these adaptations can substantially enhance the user experience, reducing stress and increasing satisfaction in hospital environments.

Keywords: hospital layout design, healthcare facilities, wayfinding, navigational aids, spatial orientation, color, signage

Procedia PDF Downloads 11

Authors: B. A. Alwahaby

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Background: The number of Total Knee Replacement (TKR) and Anterior Cruciate Ligament Reconstruction (ACLR) performed every year is increasing. The main aim of physiotherapy early recovery rehabilitation after these surgeries is to control pain and edema and regain Range of Motion (ROM) and physical activity. All of these outcomes need to be managed by safe and effective modalities. Kinesiotaping (KT) is an elastic non-invasive therapeutic tape that has become recognised in different physiotherapy situation as injury prevention, rehabilitation, and performance enhancement and been used with different conditions. However, there is still clinical doubt regarding the effectiveness of KT due to inconclusive supporting evidence. The aim of this systematic review is to collate all the available evidence on the effectiveness of KT in the early rehabilitation of ACLR and TKR patients and analyse whether the use of KT combined with standard rehabilitation would facilitate recovery of postoperative outcome than standard rehabilitation alone. Methodology: A systematic review was conducted. Medline, EMBASE, Scopus, AMED PEDro, CINAHL, and Web of Science databases were searched. Each study was assessed for inclusion and methodological quality appraisal was undertaken by two reviewers using the JBI critical appraisal tools. The studies were then synthesised qualitatively due to heterogeneity between studies. Results: Five moderate to low quality RCTs were located. All five studies demonstrated statistically significant improvements in pain, swelling, ROM, and functional outcomes (p < 0.05). Between group comparison, KT combined with standardised rehabilitation were shown to be significantly more effective than standardised rehabilitation alone for pain and swelling (p < 0.05). However, there were inconstant findings for ROM, and no statistically significant differences reported between groups for functional outcomes (p > 0.05). Conclusion: Research in the area is generally low quality; however, there is consistent evidence to support the use of KT combined with standardised post-operative rehabilitation for reducing pain and swelling. There is also some evidence that KT may be effective in combination with standardised rehabilitation to regain knee extension ROM faster than standardised rehabilitation alone, but further primary research is required to confirm this.

Keywords: anterior cruciate ligament reconstruction, ACLR, kinesio taping, KT, postoperative, total knee replacement, TKR

Procedia PDF Downloads 99

Authors: M. Shemis, O. Maher, G. Casterou, F. Gauffre

Abstract:

Hepatitis C virus (HCV) is a major cause of chronic liver disease with a global 170 million chronic carriers at risk of developing liver cirrhosis and/or liver cancer. Egypt reports the highest prevalence of HCV worldwide. Currently, two classes of assays are used in the diagnosis and management of HCV infection. Despite the high sensitivity and specificity of the available diagnostic assays, they are time-consuming, labor-intensive, expensive, and require specialized equipment and highly qualified personal. It is therefore important for clinical and economic terms to develop a low-tech assay for the direct detection of HCV RNA with acceptable sensitivity and specificity, short turnaround time, and cost-effectiveness. Such an assay would be critical to control HCV in developing countries with limited resources and high infection rates, such as Egypt. The unique optical and physical properties of gold nanoparticles (AuNPs) have allowed the use of these nanoparticles in developing simple and rapid colorimetric assays for clinical diagnosis offering higher sensitivity and specificity than current detection techniques. The current research aims to develop a detection assay for HCV RNA using gold nanoparticles (AuNPs). Methods: 200 anti-HCV positive samples and 50 anti-HCV negative plasma samples were collected from Egyptian patients. HCV viral load was quantified using m2000rt (Abbott Molecular Inc., Des Plaines, IL). HCV genotypes were determined using multiplex nested RT- PCR. The assay is based on the aggregation of AuNPs in presence of the target RNA. Aggregation of AuNPs causes a color shift from red to blue. AuNPs were synthesized using citrate reduction method. Different sets of probes within the 5’ UTR conserved region of the HCV genome were designed, grafted on AuNPs and optimized for the efficient detection of HCV RNA. Results: The nano-gold assay could colorimetrically detect HCV RNA down to 125 IU/ml with sensitivity and specificity of 91.1% and 93.8% respectively. The turnaround time of the assay is < 30 min. Conclusions: The assay allows sensitive and rapid detection of HCV RNA and represents an inexpensive and simple point-of-care assay for resource-limited settings.

Keywords: HCV, gold nanoparticles, point of care, viral load

Procedia PDF Downloads 185

Authors: E. Maoz

Abstract:

Background: As a teaching method, project-based learning is strongly linked to developing students’ critical thinking skills. It combines creative independent thinking, team work, and disciplinary subject-field integration. In the 'Introduction to Nursing Research Methods' course (year 3, Generic Track), project based learning is used to teach the topic of 'Evidence-Based Nursing'. This topic examines a clinical care issue encountered by students in the field. At the end of their project, students present proposals for managing the said issue. Proposals are the product of independent integrative thinking integrating a wide range of factors influencing the issue’s management. Method: Papers by 27 groups of students (165 students) were content analyzed to identify which themes emerged from the students' recommendations for managing the clinical issue. Findings: Five main themes emerged—current management approach; adapting procedures in line with current recent research recommendations; training for change (veteran nursing staff, beginner students, patients, significant others); analysis of 'economic benefit vs. patient benefit'; multidisciplinary team engagement in implementing change in practice. Two surprising themes also emerged: advertising and marketing using new technologies, which reflects how the new generation thinks. Summary and Recommendations: Among the main challenges in nursing education is training nursing graduates to think independently, integratively, and critically. Combining PBL with classical teaching methods stimulates students cognitively while opening new vistas with implications on all levels of the profession: management, research, education, and practice. Advanced students can successfully grasp and interpret the current state of clinical practice. They are competent and open to leading change and able to consider the diverse factors and interconnections that characterize the nurse's work.

Keywords: evidence based nursing, critical thinking skills, project based learning, students education

Procedia PDF Downloads 72

Authors: Sanjay Dhiraaj, Puneet Goyal, Aditya Kapoor, Gaurav Misra

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In electrocardiography, an ECG artefact is used to indicate something that is not heart-made. Although technological advancements have produced monitors with the potential of providing accurate information and reliable heart rate alarms, despite this, interference of the displayed electrocardiogram still occurs. These interferences can be from the various electrical gadgets present in the operating room or electrical signals from other parts of the body. Artefacts may also occur due to poor electrode contact with the body or due to machine malfunction. Knowing these artefacts is of utmost importance so as to avoid unnecessary and unwarranted diagnostic as well as interventional procedures. We report a case of ECG artefacts occurring due to patient warming blanket and its consequences. A 20-year-old male with a preoperative diagnosis of exstrophy epispadias complex was posted for surgery under epidural and general anaesthesia. Just after endotracheal intubation, we observed nonspecific ECG changes on the monitor. At a first glance, the monitor strip revealed broad QRs complexes suggesting a ventricular bigeminal rhythm. Closer analysis revealed these to be artefacts because although the complexes were looking broad on the first glance there was clear presence of normal sinus complexes which were immediately followed by 'broad complexes' or artefacts produced by some device or connection. These broad complexes were labeled as artefacts as they were originating in the absolute refractory period of the previous normal sinus beat. It would be physiologically impossible for the myocardium to depolarize so rapidly as to produce a second QRS complex. A search for the possible reason for the artefacts was made and after deepening the plane of anaesthesia, ruling out any possible electrolyte abnormalities, checking of ECG leads and its connections, changing monitors, checking all other monitoring connections, checking for proper grounding of anaesthesia machine and OT table, we found that after switching off the patient’s warming apparatus the rhythm returned to a normal sinus one and the 'broad complexes' or artefacts disappeared. As misdiagnosis of ECG artefacts may subject patients to unnecessary diagnostic and therapeutic interventions so a thorough knowledge of the patient and monitors allow for a quick interpretation and resolution of the problem.

Keywords: ECG artefacts, patient warming blanket, peri-operative arrhythmias, mobile messaging services

Procedia PDF Downloads 251

Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

Abstract:

Introduction: To improve early detection and mortality rate of in-hospital cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditons and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90 mmHg, respiratory rate <8 or >28 breaths per minute, O2 saturation <90%, acute change in conscious state, acute chest pain or worry about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in in-hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in in-hospital cardiac arrest and overall hospital mortality rate, we conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed chi-square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010, 139 calls in 2011 and 245 calls in 2012. The number of ERT calls per 1000 admissions in year 2009-10 was 7.69; 5.61 in 2011 and 9.38 in 2013. The number of code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001 ). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, but we have not found difference in overall hospital mortality rate.

Keywords: cardiac arrest, outcome, in-hospital, ERT

Procedia PDF Downloads 180

Authors: David C. Boettiger, Tracy Kuo Lin, Maram Almansour, Mariam M. Hamza, Reem Alsukait, Christopher H. Herbst, Nada Altheyab, Ayman Afghani, Faisal Kattan

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Background The number of people aged greater than 65 years per 100 people aged 20–64 years is expected to almost double in The Kingdom of Saudi Arabia (KSA) between 2020 and 2030. We therefore aimed to quantify the growing non-communicable disease (NCD) burden in KSA between 2020 and 2030, and the impact this will have on the national health budget. Methods Ten priority NCDs were selected: ischemic heart disease, stroke, type 2 diabetes, chronic obstructive pulmonary disease, chronic kidney disease, dementia, depression, osteoarthritis, colorectal cancer, and breast cancer. Age- and sex-specific prevalence was projected for each priority NCD between 2020 and 2030. Treatment coverage rates were applied to the projected prevalence estimates to calculate the number of patients incurring treatment costs for each condition. For each priority NCD, the average cost-of-illness was estimated based on published literature. The impact of changes to our base-case model in terms of assumed disease prevalence, treatment coverage, and costs of care, coming into effect from 2023 onwards, were explored. Results The prevalence estimates for colorectal cancer and stroke were estimated to almost double between 2020 and 2030 (97% and 88% increase, respectively). The only priority NCD prevalence projected to increase by less than 60% between 2020 and 2030 was for depression (22% increase). It is estimated that the total cost of managing priority NCDs in KSA will increase from USD 19.8 billion in 2020 to USD 32.4 billion in 2030 (an increase of USD 12.6 billion or 63%). The largest USD value increases were projected for osteoarthritis (USD 4.3 billion), diabetes (USD 2.4 billion), and dementia (USD 1.9 billion). In scenario analyses, our 2030 projection for the total cost of managing priority NCDs varied between USD 29.2 billion - USD 35.7 billion. Conclusions Managing the growing NCD burden in KSA’s aging population will require substantial healthcare spending increases over the coming years.

Keywords: aging, non communicable disease, costs, Saudi Arabia

Procedia PDF Downloads 25

Authors: Sharadha G., Suresh Kanakkanavar

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Background: Placenta previa is a condition characterized by partial or complete implantation of the placenta in the lower uterine segment. It is one of the main causes of vaginal bleeding in the third trimester and a significant cause of maternal and perinatal morbidity and mortality. Materials and Methods: This is an observational study involving 130 patients diagnosed with placenta previa and satisfying inclusion criteria. The demographic data, clinical, surgical, and treatment, along with maternal and neonatal outcome parameters, were noted in proforma. Results: The incidence of placenta previa among scarred uterus was 1.32%, and in unscarred uterus was 0.67%. The mean age of the study population was 27.12±4.426years. High parity, high abortion rate, multigravida status, and less gestational age at delivery were commonly seen in scarred uterus compared to unscarred uterus. Complete placenta previa, anterior placental position, and adherent placenta were significantly associated with a scarred uterus compared to an unscarred uterus. The rate of caesarean hysterectomy was higher in the scarred uterus, along with statistical association to previous lower-segment caesarean sections. Intraoperative procedures like uterine artery ligation, bakri balloon insertion, and iliac artery ligation were higher in the scarred group. The maternal intensive care unit admission rate was higher in the scarred group and also showed its statistical association with previous lower segment caesarean section. Neonatal outcomes in terms of pre-term birth, still birth, neonatal intensive care unit admission, and neonatal death, though higher in the scarred group, did not differ statistically among the groups. Conclusion: Advancing maternal age, multiparity, prior uterine surgeries, and abortions are independent risk factors for placenta previa. Maternal morbidity is higher in the scarred uterus group compared to the unscarred group. Neonatal outcomes did not differ statistically among the groups. This knowledge would help the obstetricians to take measures to reduce the incidence of placenta previa and scarred uterus which would improve the fetomaternal outcome of placenta previa.

Keywords: placenta previa, scarred uterus, unscarred uterus, adherent placenta

Procedia PDF Downloads 34

Authors: M. Mirmohammadi, S. Taghdisi, F. Anali

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Gossypol is a yellow anti-nutritional compound found in the cotton plant. This substance exists in the cottonseed and other parts of the cotton plant, such as bark, leaves, and stems. Chemically, gossypol is a very active polyphenolic aldehyde compound, and due to this polyphenolic structure, it has antioxidant and therapeutic properties. On the other hand, this compound, especially in free form, has many toxic effects, that its excessive consumption can be very dangerous for humans and animals. In this study, gossypol was extracted as a derivative compound of gossypol acetic acid from cottonseed using the n-hexane solvent with an efficiency of 0.84 ± 0.04, which compared to the Gossypol extracted from cottonseed oil with the same method (cold press) showed a significant difference with its efficiency of 1.14 ± 0.06. Therefore, it can be suggested to use cottonseed oil to extract this valuable compound. In the other part of this research, cottonseed extracts and cotton bolls extracts were obtained by two methods of soaking and Soxhlet with hydroalcoholic solvent taken with a ratio of (25:75), then by using extracts and corn starch powder, four herbal medicine code was created and after receiving the code of ethics (IR.SSU.REC.1398.136) the therapeutic effect of each one on the Cutaneous leishmaniasis resistant to drugs (caused by the leishmaniasis parasite) was investigated in real patients and its results was compared with the common drug glucantime (local ampoule) (n = 36). Statistical studies showed that the use of herbal medicines prepared with cottonseed extract and cotton bolls extract has a significant positive effect on the treatment of the disease’s wounds (p-value > 0.05) compared to the control group (only ethanol). Also, by comparing the average diameter of the wounds after a two-month treatment period, no significant difference was found between the use of ointment containing extracts and local glucantime ampoules (p-value < 0.05). Bolls extract extracted with the Soxhlet method showed the best therapeutic effects, although there was no significant difference between them (p-value < 0.05). Therefore, there is acceptable reliability to recommend this medicine for the treatment of Cutaneous leishmaniasis resistant to drugs without the side effects of the chemical drug glucantime and the pain of injecting the ampoule.

Keywords: cottonseed oil, gossypol, cotton boll, cutaneous leishmaniasis

Procedia PDF Downloads 72

Authors: Mustafa M. Donma, Orkide Donma

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Anthropometric obesity indices such as waist circumference (WC), indices derived from anthropometric measurements such as waist-to-hip ratio (WHR), and indices created from body fat mass composition such as trunk-to-leg fat ratio (TLFR) are commonly used for the evaluation of mild or severe forms of obesity. Their clinical utilities are being compared using body mass index (BMI) percentiles to classify obesity groups. The best of them is still being investigated to make a clear-cut discrimination between healthy normal individuals (N-BMI) and overweight or obese (OB) or morbid obese patients. The aim of this study is to derive a new index, which best suits the purpose for the discrimination of children with N-BMI from OB children. A total of eighty-three children participated in the study. Two groups were constituted. The first group comprised 42 children with N-BMI, and the second group was composed of 41 OB children, whose age- and sex- adjusted BMI percentile values vary between 95 and 99. The corresponding values for the first group were between 15 and 85. This classification was based upon the tables created by World Health Organization. The institutional ethics committee approved the study protocol. Informed consent forms were filled by the parents of the participants. Anthropometric measurements were taken and recorded following a detailed physical examination. Within this context, weight, height (Ht), WC, hip C (HC), neck C (NC) values were taken. Body mass index, WHR, (WC+HC)/2, WC/Ht, (WC/HC)/Ht, WC*NC were calculated. Bioelectrical impedance analysis was performed to obtain body’s fat compartments in terms of total fat, trunk fat, leg fat, arm fat masses. Trunk-to-leg fat ratio, trunk-to-appendicular fat ratio (TAFR), (trunk fat+leg fat)/2 ((TF+LF)/2) were calculated. Fat mass index (FMI) and diagnostic obesity notation model assessment-II (D2I) index values were calculated. Statistical analysis of the data was performed. Significantly increased values of (WC+HC)/2, (TF+LF)/2, D2I, and FMI were observed in OB group in comparison with those of N-BMI group. Significant correlations were calculated between BMI and WC, (WC+HC)/2, (TF+LF)/2, TLFR, TAFR, D2I as well as FMI both in N-BMI and OB groups. The same correlations were obtained for WC. (WC+HC)/2 was correlated with TLFR, TAFR, (TF+LF)/2, D2I, and FMI in N-BMI group. In OB group, the correlations were the same except those with TLFR and TAFR. These correlations were not present with WHR. Correlations were observed between TLFR and BMI, WC, (WC+HC)/2, (TF+LF)/2, D2I as well as FMI in N-BMI group. Same correlations were observed also with TAFR. In OB group, correlations between TLFR or TAFR and BMI, WC as well as (WC+HC)/2 were missing. None was noted with WHR. From these findings, it was concluded that (WC+HC)/2, but not WHR, was much more suitable as an anthropometric obesity index. The only correlation valid in both groups was that exists between (WC+HC)/2 and (TF+LF)/2. This index was suggested as a link between anthropometric and fat-based indices.

Keywords: children, hip circumference, obesity, waist circumference

Procedia PDF Downloads 151

Authors: Katalin Szöllősi, László Szabó

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Introduction and purpose: Even though female sexual dysfunctions are common among women in the postpartum period, the profile of these disturbances has not been well investigated in Hungary yet. The aim of the study was to evaluate the postpartum female sexual functions in Hungary. This research sought to investigate the possible predictor factors which can influence postpartum female sexual functions. Method and sample: This was a cross-sectional study, including patients from two maternity clinics in Budapest. 113 women were recruited into our study 3 months after their childbirth. 53 had vaginal birth, 60 had a caesarian section. Data were collected from medical reports in addition by using self-developed questions and validated questionnaires in order to measure important predictors which may be responsible for postpartum sexual dysfunctions such as mode of delivery, parity, urinary incontinence and body image. Sexual functions were evaluated by the Hungarian version of the Female Sexual Function Index (FSFI). The Hungarian version of Body Image Questionnaire-Short Form14 (BSQ-SF14) was applied for assessing body image. Results: 82,3% of the participants began to have sexual intercourse within three months postpartum. 53,98% of the participants reported sexual dysfunctions (cut-off FSFI score 26,55). According to our results mode of delivery, parity, hemorrhoids, time of intercourse, resumption was not associated with female sexual dysfunctions. We found correlation at a tendential level between urinary incontinence and sexual dysfunctions (p=0,003, R=0,26). We found a negative correlation at a tendential level between the total score of BSQ-SF14 and FSFI (p=0,03, R=-0,269). Only 32,74% of women reported discussing sexual life with health care professionals. However, 67,25% of them would have had the need to be asked about their postpartum health issues. Conclusions and recommendations: The prevalence of female sexual dysfunctions were relatively high after childbirth. We found that incontinence and body image was associated with sexual dysfunctions; other risk factors remained unknown. Despite regular contact with health care professionals, women rarely get any information about postpartum sexual health issues. The high prevalence of dysfunctions indicates the need for further investigation to address other risk factors and proper counselling of women after childbirth.

Keywords: body image, postpartum, sexual dysfunction, urinary incontinence

Procedia PDF Downloads 97

Authors: Anupam Sibal

Abstract:

Apollo Quality Program(AQP) was launched across the Apollo Group of Hospitals to address the four patient safety areas; Safety during Clinical Handovers, Medication Safety, Surgical Safety and the six International Patient Safety Goals(IPSGs) of JCI. A measurable, online, quality dashboard covering 20 process and outcome parameters was devised for monthly monitoring. The expected outcomes were also defined and categorized into green, yellow and red ranges. An audit methodology was also devised to check the processes for the measurable dashboard. Documented clinical handovers were introduced for the first time at many locations for in-house patient transfer, nursing-handover, and physician-handover. Prototype forms using the SBAR format were made. Patient-identifiers, read-back for verbal orders, safety of high-alert medications, site marking and time-outs and falls risk-assessment were introduced for all hospitals irrespective of accreditation status. Measurement of Surgical-Site-Infection (SSI) for 30 days postoperatively, was done. All hospitals now tracked the time of administration of antimicrobial prophylaxis before surgery. Situations with high risk of retention of foreign body were delineated and precautionary measures instituted. Audit of medications prescribed in the discharge summaries was made uniform. Formularies, prescription-audits and other means for reduction of medication errors were implemented. There is a marked increase in the compliance to processes and patient safety outcomes. Compliance to read-back for verbal orders rose from 86.83% in April’11 to 96.95% in June’15, to policy for high alert medications from 87.83% to 98.82%, to use of measures to prevent wrong-site, wrong-patient, wrong procedure surgery from 85.75% to 97.66%, to hand-washing from 69.18% to 92.54%, to antimicrobial prophylaxis within one hour before incision from 79.43% to 93.46%. Percentage of patients excluded from SSI calculation due to lack of follow-up for the requisite time frame decreased from 21.25% to 10.25%. The average AQP scores for all Apollo Hospitals improved from 62 in April’11 to 87.7 in Jun’15.

Keywords: clinical handovers, international patient safety goals, medication safety, surgical safety

Procedia PDF Downloads 241