Search results for: scalp cooling therapy

Authors: Liudmila Garzanova, Lidia Ananyeva, Olga Koneva, Olga Ovsyannikova, Oxana Desinova, Mayya Starovoytova, Rushana Shayahmetova, Anna Khelkovskaya-Sergeeva

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Objectives. There is very few data on changes of the musculoskeletal manifestations (artritis, arthralgia, muscle weakness, etc.) in systemic sclerosis (SSc) on rituximab (RTX) therapy. The aim of our study was to assess the severity of the musculoskeletal involvement in SSc patients (pts) and its changes during RTX therapy. Methods. Our study included 103 pts with SSc. The mean followup period was 12.6±10.7 months. The mean age was 47±12.9 years, female-87 pts (84%), the diffuse cutaneous subset of the disease had 55 pts (53%). The mean disease duration was 6.2±5.5 years. All pts had interstitial lung disease (ILD) and were positive for ANA, 67% of them were positive for antitopoisomerase-1. All patients received prednisolone at a dose of 11.3±4.5 mg/day, immunosuppressants at inclusion received 47% of them. Pts received RTX due to the ineffectiveness of previous therapy for ILD. The cumulative mean dose of RTX was 1.7±0.6 grams. Arthritis was observed in 22 pts (21%), arthralgias in 47 pts (46%). Muscle weakness was observed in 17 pts (17%). Tendon friction rubs was established in 7 pts (7%). The results at baseline and at the end of the follow up are presented in the form of mean values. Results. There was an improvement of all outcome parameters and musculoskeletal manifestations on RTX therapy. There was a decrease in the number of pts with arthritis from 22 (21%) to 10 (9%), a decrease in the number of pts with arthralgias from 47 (46%) to 31 (30%). The number of pts with muscle weakness decreased from 17 (17%) to 7 (7%). The number of pts with tendon friction rubs decreased from 7 (7%) to 3 (3%). The creatine phosphokinase decreased from 365.5±186 to 70.8±50.4 (p=0.00006). The C-reactive protein (CRP) decreased from 23.2±31.3 to 8.62±7.4 (p=0.001). The dose of prednisolone was reduced from 11.3±4.5 to 9.8±3.5 mg/day (p=0.0004). Conclusion. In our study, musculoskeletal involvement was detected in almost half of the patients with SSc-ILD. There was an improvement of musculoskeletal manifestations despite a small cumulative dose of RTX. We also managed to reduce the dose of glucocorticosteroids. The improvement of musculoskeletal manifestations was accompanied by a decrease in laboratory parameters - creatine phosphokinase and CRP. RTX is effective option for treatment of musculoskeletal manifestations in SSc.

Keywords: arthritis, musculoskeletal involvement, systemic sclerosis, rituximab

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Authors: Sanghoon Bae, Hanju Cha

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Failed fuel detector (FFD) in research reactor is a very crucial instrument to detect the anomaly from failed fuels in the early stage around primary cooling system (PCS) outlet prior to the decay tank. FFD is considered as a mandatory sensor to ensure the integrity of fuel assemblies and mitigate the consequence from a failed fuel accident. For the effective function of FFD, the location of them should be determined by contemplating the effect from coolant flow around two outlets. For this, the analysis on computational flow dynamics (CFD) should be first performed how the coolant outlet flow including radioactive materials from failed fuels are mixed and discharged through the outlet plenum within certain seconds. The analysis result shows that the outlet flow is well mixed regardless of the position of failed fuel and ultimately illustrates the effect of detector location.

Keywords: computational flow dynamics (CFD), failed fuel detector (FFD), fresh fuel assembly (FFA), spent fuel assembly (SFA)

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Authors: Bill D. Geis

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Even with significantly increased spending, suicide rates continue to climb—with alarming increases among traditionally low-risk groups. This has caused clinicians and researchers to call for a complete rethinking of all assumptions about suicide prevention, assessment, and intervention. A form of therapy--Internal Family Systems Therapy--affords tremendous promise in sustained diminishment of lethal suicide risk. Though a form of therapy that is most familiar to trauma therapists, Internal Family Systems Therapy, involving direct work with suicidal parts, is a promising therapy for meaningful and sustained reduction in suicide deaths. Developed by Richard Schwartz, Internal Family Systems Therapy proposes that we are all influenced greatly by internal parts, frozen by development adversities, and these often-contradictory parts contribute invisibly to mood, distress, and behavior. In making research videos of patients from our database and discussing their suicide attempts, it is clear that many persons who attempt suicide are in altered states at the time of their attempt and influenced by factors other than conscious intent. Suicide intervention using this therapy involves direct work with suicidal parts and other interacting parts that generate distress and despair. Internal Family Systems theory posits that deep experiences of pain, fear, aloneness, and distress are defended by a range of different parts that attempt to contain these experiences of pain through various internal activities that unwittingly push forward inhibition, fear, self-doubt, hopelessness, desires to cut and engage in destructive behavior, addictive behavior, and even suicidal actions. These suicidal parts are often created (and “frozen”) at young ages, and these very young parts do not understand the consequences of this influence. Experience suggests that suicidal parts can create impulsive risk behind the scenes when pain is high and emotional support reduced—with significant crisis potential. This understanding of latent suicide risk is consistent with many of our video accounts of serious suicidal acts—compiled in a database of 1104 subjects. Since 2016, consent has been obtained and records kept of 23 highly suicidal patients, with initial Intention-to-Die ratings (0= no intent, 10 = conviction to die) between 5 and 10. In 67% of these cases using IFST parts-work intervention, these highly suicidal patients’ risk was reduced to 0-1, and 83% of cases were reduced to 4 or lower. There were no suicide deaths. Case illustrations will be offered.

Keywords: suicide, internal family systems therapy, crisis management, suicide prevention

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Authors: Diab Z., Hamad A., Dixit A., Al-Rikabi M., Keshaverzi F.

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Introduction: According to the NICE guidelines, 2020Prasugrel is the recommended first line treatment in adults with acute coronary syndromes (ACS) in patients with ST-segment-elevation myocardial infarction (STEMI), defined as ST elevation or new left bundle branch block on ECG , that cardiologists intend to treat with primary percutaneous coronary intervention (PCI). The current literature suggests that this is largely due to safety and efficacy, and cost effectiveness. We wanted to do an audit to examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI. AIM: To examine the adherence of the MRI hospital with guidelines in using prasugrel as first-line therapy in patients with STEMI and undergoing PPCI Methods: We looked at the patients presented to MRI during1^st of January 2022 to 28th February 2022. We included all the people who were above 18 and were brought to the hospital through the PPCI pathway and diagnosed as ACS and underwent PPCI. We excluded Patients who were brought to the hospital through the PPCI pathway and underwent coronary angiography and their diagnosis was found other than STEMI or if the outcome was death before discharge or they were above age >75 (as per guideline increase bleeding risk of prasugrel in a person aged 75 or older). Results: The total number of patients was 100. There were a total of seventy patients who had STEMI and fit the criteria for inclusion. Out of these, only 72.9% (51) were given Prasugrel as a first line. Seventeen (17) 24.3% STEMI patients were candidates for prasugrel as first-line therapy but were instead offered (clopidogrel/ticagrelor). Two 2 (2.9%) STEMI patients were not given prasugrel as first-line therapy because of C/I (CVA) or the use of anticoagulant Nine 9 (9%) of them died before discharge. Eleven 11 (11%) were above the age of 75. Ten 10 (10%) of patients had a diagnosis other than STEMI. Conclusions and recommendations: Our audit has shown the need to increase awareness amongst staff re: the first line use of Prasugrel as per NICE guidelines. We aim to arrange awareness sessions for staff and increase visibility of the guidelines for the staff to encourage them to adhere to the guideline. Further research is needed to find the optimum treatment in patients above 75.

Keywords: pasurgrel, PCI, NICE, STEMI

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Authors: Gesti Prastiti, Maylina Adani, Yuyun darma A. N., M. Khilmi F., Yunita Wahyu Pratiwi

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Combination therapy may allow interaction on two drugs or more that can give adverse effects on patients. Simvastatin is a drug of antihyperlipidemia it can interact with drugs which work on cytochrome P450 CYP3A4 because it can interfere the performance of simvastatin. Flavonoid found in plants can inhibit the cytochrome P450 CYP3A4 if taken with simvastatin and can increase simvastatin levels in the body and increases the potential side effects of simvastatin such as myopati and rhabdomyolysis. Green tea leaves and mint are herbal medicine which has the effect of antihiperlipidemia. This study aims to determine the potential interaction of simvastatin with herbal drinks (green tea leaves and mint). This research method are experimental post-test only control design. Test subjects were divided into 5 groups: normal group, negative control group, simvastatin group, a combination of green tea group and the combination group mint leaves. The study was conducted over 32 days and total cholesterol levels were analyzed by enzymatic colorimetric test method. Results of this study is the obtainment of average value of total cholesterol in each group, the normal group (65.92 mg/dL), the negative control group the average total cholesterol test in the normal group was (69.86 mg/dL), simvastatin group (58.96 mg/dL), the combination of green tea group (58.96 mg/dL), and the combination of mint leaves (63.68 mg/dL). The conclusion is between simvastatin combination therapy with herbal drinks have the potential for pharmacodynamic interactions with a synergistic effect, antagonist, and a powerful additive, so the combination therapy are no more effective than a single administration of simvastatin therapy.

Keywords: hyperlipidemia, simvastatin, herbal drinks, green tea leaves, mint leaves, drug interactions

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Authors: Niyada Naksuk, Thoetchai Peeraphatdit, Vitaly Herasevich, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham

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Introduction: Little is known about the safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. Methods: Pre-study Confusion Assessment Method-Intensive Care Unit (CAM–ICU) criteria were implemented in screening consecutive patients admitted to Mayo Clinic, Rochester, the USA from 2004 through 2013. Death status was prospectively ascertained. Results: Of 11,079 study patients, the incidence of delirium was 8.3% (n=925). Delirium was associated with an increased risk of in-hospital mortality (adjusted OR 1.49; 95% CI, 1.08-2.08; P=.02) and one-year mortality among patients who survived from CCU admission (adjusted HR 1.46; 95% CI, 1.12-1.87; P=.005). A total of 792 doses of haloperidol (5 IQR [3-10] mg/day) or quetiapine (25 IQR [13-50] mg/day) were given to 244 patients with delirium. The clinical characteristics of patients with delirium who did and did not receive antipsychotic therapy were not different (baseline corrected QT [QTc] interval 460±61 ms vs. 457±58 ms, respectively; P = 0.57). In comparison to baseline, mean QTc intervals after the first and third doses of the antipsychotics were not significantly prolonged in haloperidol (448±56, 458±57, and 450±50 ms, respectively) or quetiapine groups (459±54, 467±68, and 462±46 ms, respectively) (P > 0.05 for all). Additionally, in-hospital mortality (adjusted OR 0.67; 95% CI, 0.42-1.04; P=.07), ventricular arrhythmia (adjusted OR 0.87; 95% CI, 0.17-3.62; P=.85) and one-year mortality among the hospital survivors (adjusted HR 0.86; 95% CI 0.62-1.17; P = 0.34) were not different in patients with delirium irrespective of whether or not they received antipsychotics. Conclusions: In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.

Keywords: arrhythmias, haloperidol, mortality, qtc interval, quetiapine

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Authors: Sarah Hamdan Al-Jahdali, Khaled Alsaad, Abdullah Al-Sayyari

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Objectives: To study the prevalence, clinicopathological features, risk factors and outcome of biopsy proven polyoma (BK) virus infection among Saudi kidney transplant recipients and compare them to negative BK virus group. Methods: We retrospectively reviewed the charts of all the patients with biopsy-proven polyoma (BK) virus infection in King Abdulaziz Medical City in Riyadh between 2005 and 2011. The details of clinical presentation, the indication for kidney biopsy, the laboratory findings at presentation, the natural history of the disease, thepathological findings, the prognosis as well as the response to therapy were all recorded. Results: Kidney biopsy was performed in 37 cases of unexplained graft dysfunction. BK virus was found in 10 (27%). Out of those 10, 3 (30%) ended with graft failure. BK virus occurred in all patients who received ATG induction therapy 100% versus 59.3% in the non BK virus patients (p=0.06). Furthermore, the risk of BK virus was much less in those who received acyclovir as an anti-viral prophylaxis as compared to those who did not receive it (p=0.01). Also, patients with BK virus weighed much less (mean 46.7±20.6 Kgs) than those without BK virus at time of transplantation (mean 64.3±12.1). Graft survival was better among deceased donor kidneys compared to living ones (P=0.016) and with older age (P=0.005). Conclusion: Our findings suggest the involvement of ATG induction therapy, the lack of antiviral prophylaxis therapy and lower weight at transplant as significant risk factors for the development of BK virus infection.

Keywords: BKVAN, BKV, kidney transpant, Saudi Arabia

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Authors: Wei-Po Wu, Wen-Yu Liu, Wei−Ting Lin, Hen-Yu Lien

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Introduction: Improving balance function for individuals after stroke is a crucial target in physiotherapy. Aquatic therapy which challenges individual’s postural control in an unstable fluid environment may be beneficial in enhancing balance functions. The purposes of the systematic review with meta-analyses were to validate the effects of aquatic therapy in improving balance functions for individuals with strokes in contrast to conventional physiotherapy. Method: Available studies were explored from three electronic databases: PubMed, Scopus, and Web of Science. During literature search, the published date of studies was not limited. The study design of the included studies should be randomized controlled trials (RCTs) and the studies should contain at least one outcome measurement of balance function. The PEDro scale was adopted to assess the quality of included studies, while the 'Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence' was used to evaluate the level of evidence. After the data extraction, studies with same outcome measures were pooled together for meta-analysis. Result: Ten studies with 282 participants were included in analyses. The research qualities of the studies were ranged from fair to good (4 to 8 points). Levels of evidence of the included studies were graded as level 2 and 3. Finally, scores of Berg Balance Scale (BBS), Eye closed force plate center of pressure velocity (anterior-posterior, medial-lateral axis) and Timed up and Go test were pooled and analyzed separately. The pooled results shown improvement in balance function (BBS mean difference (MD): 1.39 points; 95% confidence interval (CI): 0.05-2.29; p=0.002) (Eye closed force plate center of pressure velocity (anterior-posterior axis) MD: 1.39 mm/s; 95% confidence interval (CI): 0.93-1.86; p<0.001) (Eye closed force plate center of pressure velocity (medial-lateral) MD: 1.48 mm/s; 95% confidence interval (CI): 0.15-2.82; p=0.03) and mobility (MD: 0.9 seconds; 95% CI: 0.07-1.73; p=0.03) of stroke individuals after aquatic therapy compared to conventional therapy. Although there were significant differences between two treatment groups, the differences in improvement were relatively small. Conclusion: The aquatic therapy improved general balance function and mobility in the individuals with stroke better than conventional physiotherapy.

Keywords: aquatic therapy, balance function, meta-analysis, stroke, systematic review

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Authors: Yulistiani Yulistiani, Wenny Nilamsari, Laurin Winarso, Rizkiya Rizkiya, Zamrotul Izzah, Budi Suprapti, Arif Bachtiar

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Approximately, a million new cases of TB have been found out per year, making Indonesia as the second greatest country with TBC after India. Nevertheless, until now, there are still many patients failure to conventional therapy with oral anti tuberculosis. Thus, the discovery of supplement therapy is urgently needed. Many studies showed that probiotic had the positive impact in lung diseases, diarrhea, pneumonia and it was attributed to its capability to balance the level of cytokine pro-inflammatory and anti-inflammatory. It was demonstrated in active disease the production of IFN-γ is strongly depressed and IL-10 level increases. This study aimed to investigate the effect of probiotic (multi strains) and vitamin B complex supplementation on IFN-γ and IL-10 level in patients with TB infection during intensive phase therapy. A randomized controlled trial, open labeled was conducted in TB patients with the following criteria: 1) age 18-55 years old 2) receiving oral antituberculosis during intensive therapy 3) not using probiotic, vitamin B1, B6, B12 2 weeks before enrollment 4) willing to participate in this study and signed an informed consent. While, patients with HIV, pregnant, had the history of diabetes mellitus, using corticosteroid or other immunosuppressants were excluded. IFN-γ and IL-10 levels were drawn before observation and after a month observation. The assay was performed by ELISA. There were seven patients in treated group and five patients in controlled group obtained in this study. Between groups, there was no statistical difference in comorbid, age, and disease duration. The mean level of IFN-γ after a month observation increased in treated group and controlled group, which were 31.47 ± 105.46 pg/ml and 15.09 ± 24.23 pg/ml, respectively (p> 0.005). Although, there were not statistically different, treated group showed a greater increase of IFN-γ level than that of the controlled group. IFN-γ plays an important role in immune response to Mycobacterium Tuberculosis, by activating macrofag, monosit and furthermore killing Mycobacterium Tuberculosis. Thus the level was expected to increase after supplementation with probiotic and Vitamin B complex. While the mean level of IL-10 also increased after one month observation in the treated group and controlled group (4.28 ± 12.29 pg/ml and 5.77± 6.21 pg/ml, respectively) (p>0.005). To be compared, the increased level of IL-10 in the treated group were lower than the controlled group, although it was not statistically different. IL-10 is a cytokine anti-inflammatory, thus, the level after the observation was expected to decrease. In this study, a month therapy of probiotic and vitamin B complex was not able to demonstrate the decrease of the IL-10 level. It is suggested to prolong observation up to 2 months, because, in intensive phase, the level of cytokine anti-inflammatory is very high, so the longer therapy is needed. It is indicated that supplementation therapy with probiotic and vitamin B complex to Oral Anti-Tuberculosis may have a positive effect on increasing IFN-γ level and slowing the progression of IL-10.

Keywords: TB Infection, IFN-γ, IL-10, probiotic, vitamin B complex

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Authors: Raghad Alhusari, Farag Omar, Moustafa Fadel

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A traditional greenhouse is a metal frame agricultural building used for cultivation plants in a controlled environment isolated from external climatic changes. Using greenhouses in agriculture is an efficient way to reduce the water consumption, where agriculture field is considered the biggest water consumer world widely. Controlling greenhouse environment yields better productivity of plants but demands an increase of electric power. Although various control approaches have been used towards greenhouse automation, most of them are applied to traditional greenhouses with ventilation fans and/or evaporation cooling system. Such approaches are still demanding high energy and water consumption. The aim of this research is to develop a fuzzy control system that minimizes water and energy consumption by utilizing outside weather conditions and underground heat exchanger to maintain the optimum climate of the greenhouse. The proposed control system is implemented on an experimental model of thermally isolated greenhouse structure with dimensions of 6x5x2.8 meters. It uses fans for extracting heat from the ground heat exchanger system, motors for automatic open/close of the greenhouse windows and LED as lighting system. The controller is integrated also with environmental condition sensors. It was found that using the air-to-air horizontal ground heat exchanger with 90 mm diameter and 2 mm thickness placed 2.5 m below the ground surface results in decreasing the greenhouse temperature of 3.28 ˚C which saves around 3 kW of consumed energy. It also eliminated the water consumption needed in evaporation cooling systems which are traditionally used for cooling the greenhouse environment.

Keywords: automation, earth-to-air heat exchangers, fuzzy control, greenhouse, sustainable buildings

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Authors: Young Min Kim, Jeong Lak Sohn, Eui Soo Yoon

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This study describes the optimization of supercritical carbon dioxide (S-CO2) power cycle for recovering waste heat from a gas turbine. An S-CO2 cycle that recovers heat from small industrial and aeroderivative gas turbines can outperform a steam-bottoming cycle despite its simplicity and compactness. In using S-CO2 power cycles for waste heat recovery, a split cycle was studied to maximize the net output power by incorporating the utilization efficiency of the waste heat (lowering the temperature of the exhaust gas through the heater) along with the thermal efficiency of the cycle (minimizing the temperature difference for the heat transfer, exergy loss). The cooling condition of the S-CO2 WHR system has a great impact on the performance and the optimum low pressure of the system. Furthermore, the optimum high pressure of the S-CO2 WHR systems for the maximum power from the given heat sources is dependent on the temperature of the waste heat source.

Keywords: exergy loss, gas turbine, optimization, supercritical CO2 power cycle, split cycle, waste heat recovery

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Authors: Yasser Almazrua

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Terrorism is a multidimensional phenomenon that has increased recently. Many countries started combating terrorism through security forces; however, there has been relatively little attention given to rehabilitation programs for people involved in such terrorism acts. In Saudi Arabia, after facing so many terrorist attacks, they started understanding and countering terrorism differently by establishing Mohammad bin Naif Counselling and Care Center in 2006. The center now is considered one of the top experience centers in the world for terrorist rehabilitation and ideology correction. The center offers different programs such as training, educational, social, art and psychological programs. One of the approaches that have been used by psychological experts at the center is Narrative Therapy. It is a therapeutic approach that focuses on the ability of the client to identify their personal life story. The client during therapy works as a storyteller where he or she gets insight, meaning and better understanding of their own lives. Because each client at the center had a story, it can be better fit method for rehabilitation towards healing and personal development. The case describes a 34-years-old man who was involved in some terrorism activities locally by technically and financially supporting a terrorist group related to Al-Qaida. The beneficiary joined Mohammad bin Naif Counseling and Care Center after serving his sentence. Informed of consent has been given to the beneficiary before starting the therapeutic program. Both qualitative and quantitative data on the beneficiary are collected by self-reporting during the initial session, and by using a psychological measurement. The result found that the beneficiary was not insightful about himself, and he had a high level of repression which relatedly moved him to be targeted for recruitment in the terrorist group. With rehabilitation and by using the therapeutic approach, the beneficiary improved on the level of insight, specifically about himself and also about the experience. This case illustrates the importance of considering the effect of Narrative Therapy in terrorist rehabilitation programs.

Keywords: narrative therapy, rehabilitation, Saudi Arabia, terrorism

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Authors: M. R. Akbari, M. Sadeghi, R. Faghihi, M. A. Mosleh-Shirazi, A. R. Khorrami-Moghadam

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Proton radiotherapy (PRT) is becoming an established treatment modality for cancer. The localized tumors, the same as undifferentiated thyroid tumors are insufficiently handled by conventional radiotherapy, while protons would propose the prospect of increasing the tumor dose without exceeding the tolerance of the surrounding healthy tissues. In spite of relatively high advantages in giving localized radiation dose to the tumor region, in proton therapy, secondary neutron production can have significant contribution on integral dose and lessen advantages of this modality contrast to conventional radiotherapy techniques. Furthermore, neutrons have high quality factor, therefore, even a small physical dose can cause considerable biological effects. Measuring of this neutron dose is a very critical step in prediction of secondary cancer incidence. It has been found that FLUKA Monte Carlo code simulations have been used to evaluate dose due to secondaries in proton therapy. In this study, first, by validating simulated proton beam range in water phantom with CSDA range from NIST for the studied proton energy range (34-54 MeV), a proton therapy in thyroid gland cancer was simulated using FLUKA code. Secondary neutron dose equivalent of some organs and tissues after the target volume caused by 34 and 54 MeV proton interactions were calculated in order to evaluate secondary cancer incidence. A multilayer cylindrical neck phantom considering all the layers of neck tissues and a proton beam impinging normally on the phantom were also simulated. Trachea (accompanied by Larynx) had the greatest dose equivalent (1.24×10-1 and 1.45 pSv per primary 34 and 54 MeV protons, respectively) among the simulated tissues after the target volume in the neck region.

Keywords: FLUKA code, neutron dose equivalent, proton therapy, thyroid gland

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Authors: M. Abuqebitah, H. Tanyildizi, N. Yeyin, I. Cavdar, M. Demir, L. Kabasakal

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Aim: Targeted radionuclide therapy (TRT) is an increasingly used treatment modality for wide range of cancers. Presently dosimetry is highly required either to plan treatment or to ascertain the absorbed dose delivered to critical organs during treatment. Methods and Materials: The study comprised 7 patients suffered from prostate cancer with progressive disease and candidate to undergo Lu-177-DOTA-617 therapy following to PSMA- PET/CT imaging for all patients. (5.2±0.3 mCi) was intravenously injected. To evaluate bone marrow absorbed dose 2 cc blood samples were withdrawn in short variable times (3, 15, 30, 60, 180 minutes) after injection. Furthermore, whole body scans were performed using scintillation gama camera in 4, 24, 48, and 120 hours after injection and in order to quantify the activity taken up in the body, kidneys , liver, right parotid, and left parotid the geometric mean of anterior and posterior counts were determined through ROI analysis, after that background subtraction and attenuation correction were applied using patients PSMA- PET/CT images taking in a consideration: organ thickness, body thickness, and Hounsfield unites from CT scan. OLINDA/EXM dosimetry program was used for curve fitting, residence time calculation, and absorbed dose calculations. Findings: Absorbed doses of bone marrow, left kidney, right kidney, liver, left parotid, right parotid, total body were 1.28±0.52, 32.36±16.36, 32.7±13.68, 10.35±3.45, 38.67±21.29, 37.55±19.77, 2.25±0.95 (mGy/mCi), respectively. Conclusion: Our first results clarify that Lu-177-DOTA-617 is safe and reliable therapy as there were no complications seen. In the other hand, the observable variation in the absorbed dose of the critical organs among the patients necessitate patient-specific dosimetry approach to save body organs and particularly highly exposed kidneys and parotid gland.

Keywords: Lu-177-PSMA, prostate cancer, radionuclide therapy

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Authors: Daniele Zullino, Gabriel Thorens, Léonice Furtado, Federico Seragnoli, Radu Iuga, Louise Penzenstadler

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Context: Since the start of the 21st century, there has been a resurgence of interest in psychedelics, marked by a renewed focus on scientific investigations into their therapeutic potential. While psychedelic therapy has gained recognition for effectively treating depression and anxiety disorders, notable progress has been made in the clinical development of substances like psilocybin. Moreover, mounting evidence suggests promising applications of Lysergic acid diethylamide (LSD) and psilocybin in the field of addiction medicine. In Switzerland, compassionate treatment with LSD and psilocybin has been permitted since 2014 through exceptional licenses granted by the Federal Office of Public Health. This treatment approach is also available within the Geneva treatment program, extending its accessibility to patients undergoing opioid-assisted treatment involving substances like morphine and diacetylmorphine. The aim of this study is to assess the feasibility of psychedelic-assisted therapy in patients with opioid use disorder who are undergoing opioid-assisted treatment. This study addresses the question of whether psychedelic-assisted therapy can be successfully implemented in patients with opioid use disorder. It also explores the effects of psychedelic therapy on the patient's experiences and outcomes. Methodology: This is an open case series on six patients who have undergone at least one session with either LSD (100-200 micrograms) or psilocybin (20-40 mg). The patients were assessed using the Five Dimensional Altered States of Consciousness (5D-ASC)-Scale. The data were analyzed descriptively to identify patterns and trends in the patients' experiences. Results: The patients experienced substantial positive psychedelic effects during the psychedelic sessions without significant adverse effects. The patients reported positive experiences and improvements in their condition. Conclusion: The findings of this study support the feasibility and potential efficacy of psychedelic-assisted therapy in patients undergoing opioid-assisted treatment.

Keywords: psychedelics, psychedelic-assisted treatment, opioid use disorder, addiction, LSD, psilocybin

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Authors: A. D. Zikiryahodjaev, L. V. Bolotina, A. S. Sukhotko

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Purpose. To evaluate the expediency and timeliness of performance of surgical treatment as a component of multi-therapy treatment of patients with stage IV breast cancers. Materials and Methods. This investigation comparatively analyzed the results of complex treatment with or without surgery in patients with metastatic breast cancer. We analyzed retrospectively treatment experience of 196 patients with generalized breast cancer in the department of oncology and breast reconstructive surgery of P.A. Herzen Moscow Cancer Research Institute from 2000 to 2012. The average age was (58±1,1) years. Invasive ductul carcinoma was verified in128 patients (65,3%), invasive lobular carcinoma-33 (16,8%), complex form - 19 (9,7%). Complex palliative care involving drug and radiation therapies was performed in two patient groups. The first group includes 124 patients who underwent surgical intervention as complex treatment, the second group includes 72 patients with only medical therapy. Standard systemic therapy was given to all patients. Results. Overall, 3-and 5-year survival in fist group was 43,8 and 21%, in second - 15,1 and 9,3% respectively [p=0,00002 log-rank]. Median survival in patients with surgical treatment composed 32 months, in patients with only systemic therapy-21. The factors having influencing an influence on the prognosis and the quality of life outcomes for of patients with generalized breast cancer were are also studied: hormone-dependent tumor, Her2/neu hyper-expression, reproductive function status (age, menopause existence). Conclusion.Removing primary breast tumor in patients with generalized breast cancer improve long-term outcomes. Three- and five-year survival increased by 28,7 and 16,3% respectively, and median survival–for 11 months. These patients may benefit from resection of the breast tumor. One explanation for the effect of this resection is that reducing the tumor load influences metastatic growth.

Keywords: breast cancer, combination therapy, factors of prognosis, primary tumor

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Authors: J. D. Martínez-Vargas, C. Castro-Hoyos, G. Castellanos-Dominguez

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In this work, we propose a novel approach for measuring the stationarity level of a multichannel time-series. This measure is based on a stationarity definition over time-varying spectrum, and it is aimed to quantify the relation between local stationarity (single-channel) and global dynamic behavior (multichannel dynamics). To assess the proposed approach validity, we use a well known EEG-BCI database, that was constructed for separate between motor/imagery tasks. Thus, based on the statement that imagination of movements implies an increase on the EEG dynamics, we use as discriminant features the proposed measure computed over an estimation of the non-stationary components of input time-series. As measure of separability we use a t-student test, and the obtained results evidence that such measure is able to accurately detect the brain areas projected on the scalp where motor tasks are realized.

Keywords: stationary measure, entropy, sub-space projection, multichannel dynamics

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Authors: Alasdair Warwick, Luna Dhir

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Aim: To ascertain the efficacy of overcorrecting minus lens therapy in intermittent distance exotropia. Methods: Retrospective audit of all intermittent distance exotropia patients seen in the Chelsea and Westminster Hospital pediatric eye clinic between 1st January 2014 and 1st March 2016. Change in LogMAR visual acuity, stereopsis, near and distance angles of deviation, as well as the proportions of patients converting to exophoria or undergoing strabismus surgery, were recorded. Results: 22 patients were identified, 45% male, mean age 5 years (range 0.6 to 18.5 years). The median overminus prescription was -1.0 dioptres (range -0.5 to -1.75 dioptres) and mean follow-up was 15 months (range 3 to 54 months). Visual acuity, near and distance angles of deviation improved but were not statistically significant: -0.15 LogMAR, -0.2 prism dioptres and -1.2 prism dioptres respectively (p>0.05). However, a significant change in stereopsis was observed: -74'' (p<0.01). 27% underwent strabismus surgery and 36% converted to exophoria whilst wearing their overminus prescription. Conclusions: Overcorrecting minus lens therapy is an effective therapy for intermittent distance exotropia. There was no deterioration in visual acuity and a significant improvement in stereopsis was seen in our cohort, with many patients converting to an exophoria. The proportion of patients requiring strabismus surgery was comparable to other studies. Further, follow-up is needed to ascertain long-term outcomes.

Keywords: exotropia, overcorrecting minus lens, refraction, strabismus

Procedia PDF Downloads 243

Authors: Sergio Garcia, Alfredo Trueba, Luis M. Vega, Ernesto Madariaga

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Biofilms adhesion is one of the more important cost of industries plants on wide world, which use to water for cooling heat exchangers or are in contact with water. This study evaluated the effect of Electromagnetic Fields on biofilms in tubular heat exchangers using seawater cooling. The results showed an up to 40% reduction of the biofilm thickness compared to the untreated control tubes. The presence of organic matter was reduced by 75%, the inorganic mater was reduced by 87%, and 53% of the dissolved solids were eliminated. The biofilm thermal conductivity in the treated tube was reduced by 53% as compared to the control tube. The hardness in the effluent during the experimental period was decreased by 18% in the treated tubes compared with control tubes. Our results show that the electromagnetic fields treatment has a great potential in the process of removing biofilms in heat exchanger.

Keywords: biofilm, heat exchanger, electromagnetic fields, seawater

Procedia PDF Downloads 190

Authors: Andy Zhang, Awnik Roy, Trevor B. Chen, Bibik Oleksandar, Subodh Adhikari, Paul S. Hsu

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The durability of a combustor in gas-turbine engines is a strong function of its component temperatures and requires good control of these temperatures. Since the temperature of combustion gases frequently exceeds the melting point of the combustion liner walls, an efficient air-cooling system with optimized flow rates of cooling air is significantly important to elongate the lifetime of liner walls. To determine the effectiveness of the air-cooling system, accurate two-dimensional (2D) surface temperature measurement of combustor liner walls is crucial for advanced engine development. Traditional diagnostic techniques for temperature measurement in this application include the rmocouples, thermal wall paints, pyrometry, and phosphors. They have shown some disadvantages, including being intrusive and affecting local flame/flow dynamics, potential flame quenching, and physical damages to instrumentation due to harsh environments inside the combustor and strong optical interference from strong combustion emission in UV-Mid IR wavelength. To overcome these drawbacks, a compact and small borescope long-wave-infrared (LWIR) sensor is developed to achieve 2D high-spatial resolution, high-fidelity thermal imaging of 2D surface temperature in gas-turbine engines, providing the desired engine component temperature distribution. The compactLWIRborescope sensor makes it feasible to promote the durability of a combustor in gas-turbine engines and, furthermore, to develop more advanced gas-turbine engines.

Keywords: borescope, engine, low-wave-infrared, sensor

Procedia PDF Downloads 131

Authors: Mina Ganji Morad, Maziar Azadisoleimanieh, Sina Ganji Morad

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A green roof is formed by green plants alive and has many positive impacts in the regional climatic, as well as indoor. Green roof system to prevent solar radiation plays a role in the cooling space. The cooling is done by reducing thermal fluctuations on the exterior of the roof and by increasing the roof heat capacity which cause to keep the space under the roof cool in the summer and heating rate increases during the winter. A roof garden is one of the recommended ways to reduce energy consumption in large cities. Despite the scale of the city green roofs have effective functions, such as beautiful view of city and decontaminating the urban landscape and reduce mental stress, and in an exchange of energy and heat from outside to inside spaces. This article is based on a review of 20 articles and 10 books and valid survey results on the positive effects of green roofs to prevent energy waste in the building. According to these publications, three of the conventional roof, green roof typical and green roof with certain administrative details (layers of glass) and the use of resistant plants and shrubs have been analyzed and compared their heat transfer. The results of these studies showed that one of the best green roof systems for mountainous climate is tree and shrub system that in addition to being resistant to climate change in mountainous regions, will benefit from the other advantages of green roof. Due to the severity of climate change in mountainous areas it is essential to prevent the waste of buildings heating and cooling energy. Proper climate design can greatly help to reduce energy.

Keywords: green roof, heat transfer, reducing energy consumption, mountainous areas, sustainable architecture

Procedia PDF Downloads 396

Authors: Sadie Namani, Lindita Ajazaj, Arjeta Zogaj, Vera Berisha, Bahrije Halili, Luljeta Hasani, Ajete Aliu

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Background: The outcome of bacterial meningitis is strongly related to the resistance of bacterial pathogens to the initial antimicrobial therapy. The objective of the study was to analyze the initial antimicrobial therapy, the resistance of meningeal pathogens and the outcome of adults bacterial meningitis cases. Materials/methods: This prospective study enrolled 46 adults older than 16 years of age, treated for bacterial meningitis during the years 2009 and 2010 at the infectious diseases clinic in Prishtinë. Patients are categorized into specific age groups: > 16-26 years of age (10 patients), > 26-60 years of age (25 patients) and > 60 years of age (11 patients). All p-values < 0.05 were considered statistically significant. Data were analyzed using Stata 7.1 and SPSS 13. Results: During the two year study period 46 patients (28 males) were treated for bacterial meningitis. 33 patients (72%) had a confirmed bacterial etiology; 13 meningococci, 11 pneumococci, 7 gram-negative bacilli (Ps. aeruginosa 2, Proteus sp. 2, Acinetobacter sp. 2 and Klebsiella sp. 1 case) and 2 staphylococci isolates were found. Neurological complications developed in 17 patients (37%) and the overall mortality rate was 13% (6 deaths). Neurological complications observed were: cerebral abscess (7/46; 15.2%), cerebral edema (4/46; 8.7%); haemiparesis (3/46; 6.5%); recurrent seizures (2/46; 4.3%), and single cases of thrombosis sinus cavernosus, facial nerve palsy and decerebration (1/46; 2.1%). The most common meningeal pathogens were meningococcus in the youngest age group, gram negative-bacilli in second age group and pneumococcus in eldery age group. Initial single-agent antibiotic therapy (ceftriaxone) was used in 17 patients (37%): in 60% of patients in the youngest age group and in 44% of cases in the second age group. 29 patients (63%) were treated with initial dual-agent antibiotic therapy; ceftriaxone in combination with vancomycin or ampicillin. Ceftriaxone and ampicillin were the most commonly used antibiotics for the initial empirical therapy in adults > 50 years of age. All adults > 60 years of age were treated with the initial dual-agent antibiotic therapy as in this age group was recorded the highest mortality rate (M=27%) and adverse outcome (64%). Resistance of pathogens to antimicrobics was recorded in cases caused by gram-negative bacilli and was associated with greater risk for developing neurological complications (p=0.09). None of the gram-negative bacilli were resistant to carbapenems; all were resistant to ampicillin while 5/7 isolates were resistant to cefalosporins. Resistance of meningococci and pneumococci to beta-lactams was not recorded. There were no statistical differences in the occurrence of neurological complications (p > 0.05), resistance of meningeal pathogens to antimicrobics (p > 0.05) and the inital antimicrobial therapy (one vs. two antibiotics) concerning group-ages in adults. Conclusions: The initial antibiotic therapy with ceftriaxone alone or in combination with vancomycin or ampicillin did not cover cases caused by gram-negative bacilli.

Keywords: adults, bacterial meningitis, outcomes, therapy

Procedia PDF Downloads 172

Authors: Djalal Hamed

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The aim of this paper is to perform an analytic solution of steady state natural convection in a narrow rectangular channel between two vertical parallel MTR-type fuel plates, imposed under a cosine shape heat flux to determine the margin of the nuclear core power at which the natural convection cooling mode can ensure a safe core cooling, where the cladding temperature should not be reach the specific safety limits (90 °C). For this purpose, a simple computer program is developed to determine the principal parameter related to the nuclear core safety such as the temperature distribution in the fuel plate and in the coolant (light water) as a function of the reactor power. Our results are validated throughout a comparison against the results of another published work, which is considered like a reference of this study.

Keywords: buoyancy force, friction force, natural convection, thermal hydraulic analysis, vertical heated rectangular channel

Procedia PDF Downloads 313

Authors: Muluken Z. Getie, Francois Lanzetta, Sylvie Begot, Bimrew T. Admassu

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This study is aimed at the numerical analysis of the effects of phase angle and losses (shuttle heat loss and gas leakage to the crankcase) that could have an impact on the pressure and temperature of working fluid for a β-type Stirling cycle refrigerating machine. First, the developed numerical model incorporates into the ideal adiabatic analysis, the shuttle heat transfer (heat loss from compression space to expansion space), and gas leakage from the working space to the buffer space into the crankcase. The other losses that may not have a direct effect on the temperature and pressure of working fluid are simply incorporated in a simple analysis. The model is then validated by reversing the model to the engine model and compared with other literature results using (GPU-3) engine. After validating the model with other engine model and experiment results, analysis of the effect of phase angle, shuttle heat lose and gas leakage on temperature, pressure, and performance (power requirement, cooling capacity and coefficient of performance) of refrigerating machine considering the FEMTO 60 Stirling engine as a case study have been conducted. Shuttle heat loss has a greater effect on the temperature of working gas; gas leakage to the crankcase has more effect on the pressure of working spaces and hence both have a considerable impact on the performance of the Stirling cycle refrigerating machine. The optimum coefficient of performance exists between phase angles of 900-950, and optimum cooling capacity could be found between phase angles of 950-980.

Keywords: beta configuration, engine model, moderate cooling, stirling refrigerator, and validation

Procedia PDF Downloads 101

Authors: Sunidhi Sood, Drashti Narendrakumar Shah, Aakarsh Sharma, Nirali Harsh Panchal, Maria Karizhenskaia

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Cancer is a global health concern, causing a significant number of deaths, with chemotherapy being a standard treatment method. However, chemotherapy often induces side effects that profoundly impact the physical and emotional well-being of patients, lowering their overall quality of life (QoL). This research aims to investigate the potential of music and art therapy as holistic adjunctive therapy for cancer patients undergoing chemotherapy, offering non-pharmacological support. This is achieved through a comprehensive review of existing literature with a focus on the following themes, including stress and anxiety alleviation, emotional expression and coping skill development, transformative changes, and pain management with mood upliftment. A systematic search was conducted using Medline, Google Scholar, and St. Lawrence College Library, considering original, peer-reviewed research papers published from 2014 to 2023. The review solely incorporated studies focusing on the impact of music and art therapy on the health and overall well-being of cancer patients undergoing chemotherapy in North America. The findings from 16 studies involving pediatric oncology patients, females affected by breast cancer, and general oncology patients show that music and art therapies significantly reduce anxiety (standardized mean difference: -1.10) and improve perceived stress (median change: -4.0) and overall quality of life in cancer patients undergoing chemotherapy. Furthermore, music therapy has demonstrated the potential to decrease anxiety, depression, and pain during infusion treatments (average changes in resilience scale: 3.4 and 4.83 for instrumental and vocal music therapy, respectively). This data calls for consideration of the integration of music and art therapy into supportive care programs for cancer patients undergoing chemotherapy. Moreover, it provides guidance to healthcare professionals and policymakers, facilitating the development of patient-centered strategies for cancer care in Canada. Further research is needed in collaboration with qualified therapists to examine its applicability and explore and evaluate patients' perceptions and expectations in order to optimize the therapeutic benefits and overall patient experience. In conclusion, integrating music and art therapy in cancer care promises to substantially enhance the well-being and psychosocial state of patients undergoing chemotherapy. However, due to the small population size considered in existing studies, further research is needed to bridge the knowledge gap and ensure a comprehensive, patient-centered approach, ultimately enhancing the quality of life (QoL) for individuals facing the challenges of cancer treatment.

Keywords: anxiety, cancer, chemotherapy, depression, music and art therapy, pain management, quality of life

Procedia PDF Downloads 73

Authors: Nathalie Bolding, Marta Montero, Joaquim Cevallos, Juan F. Martin-Lazaro

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Background: Inhaled epoprostenol (iEPO) have been shown to improve PaO2:FiO2 (PF) in combination with bronchodilators (BD). However, there is not an available device to deliver these two therapies concomitantly. We describe a new method to provide this therapy successfully. Objective: To evaluate the response to continuous nebulization of iEPO and intermittent nebulization of Salbutamol/Ipratropium bromide in adults with severe respiratory failure through a double mesh nebulisation in tandem. Methods: This observational study included two mechanical ventilated adults under hourly ventilatory, gasometrical and clinical measurements during 48h. Both had severe respiratory failure treated with continuous iEPO (50 – 200 micrograms/h) and BD (Salbutamol 2.5 mg and Ipratropium bromide 500 mcg every 6 hours) through double mesh nebulisation (Aerogen solo®) placed in tandem in the dry side of the humidificator. The primary endpoints were the variables associated with a positive response to this tandem nebulised therapy (PaFiO2 index, ROX index). Secondary endpoints were laboratory (ABG) clinical and ventilatory variables. Statistical analysis (SPSS v29) included linear regression and ANOVA. Results: The patients included (n=2) survived, both extubated, one after ECMO therapy. Severe acute respiratory failure had a positive response rate to continuous iEPO and intermittent BD: PaFiO2 increased (7.40 to 30.91; P75: 27%) as well as ROX index (2.91 to 11.43; P75: 33%). There was a linear correlation of improvement between iEPO with PaFiO2 (ANOVA, r=0.393, p<0.002) and ROX (r=0.419, p<0.001). iEPO+BD therapy did not show any complications. Conclusion: Continuous and intermittent mesh tandem nebulisation can be effectively delivered with this method with a positive effect in ventilatory parameters without observed complications. Randomised studies will be able to provide reassurance in this new therapy.

Keywords: tandem, mesh, nebulisers, pulmonary, vasoldilators, bronchodilators, respiratory, failure

Procedia PDF Downloads 82

Authors: Isaura Bonneux

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District heating and cooling (DHC) is increasingly recognized as a viable path towards sustainable heating and cooling. While some countries like Sweden and Denmark have a longstanding tradition of DHC, Belgium is lacking behind. The Northern part of Belgium, Flanders, had only a total of 95 heating networks in July 2023. Nevertheless, it is increasingly exploring its possibilities to enhance the scope of DHC. DHC is a complex energy system, requiring a lot of collaboration between various stakeholders on various levels. Therefore, it is of interest to look closer at policy-related documents at the Flemish (regional) level, as these policies set the scene for DHC development in the Flemish region. This kind of analysis has not been undertaken so far. This paper has the following research question: “Who talks about DHC, and in which way and context is DHC discussed in Flemish policy-related documents?” To answer this question, the Overton policy database was used to search and retrieve relevant policy-related documents. Overton retrieves data from governments, think thanks, NGOs, and IGOs. In total, out of the 244 original results, 117 documents between 2009 and 2023 were analyzed. Every selected document included theme keywords, policymaking department(s), date, and document type. These elements were used for quantitative data description and visualization. Further, qualitative content analysis revealed patterns and main themes regarding DHC in Flanders. Four main conclusions can be drawn: First, it is obvious from the timeframe that DHC is a new topic in Flanders with still limited attention; 2014, 2016 and 2017 were the years with the most documents, yet this number is still only 12 documents. In addition, many documents talked about DHC but not much in depth and painted it as a future scenario with a lot of uncertainty around it. The largest part of the issuing government departments had a link to either energy or climate (e.g. Flemish Environmental Agency) or policy (e.g. Socio-Economic Council of Flanders) Second, DHC is mentioned most within an ‘Environment and Sustainability’ context, followed by ‘General Policy and Regulation’. This is intuitive, as DHC is perceived as a sustainable heating and cooling technique and this analysis compromises policy-related documents. Third, Flanders seems mostly interested in using waste or residual heat as a heating source for DHC. The harbors and waste incineration plants are identified as potential and promising supply sources. This approach tries to conciliate environmental and economic incentives. Last, local councils get assigned a central role and the initiative is mostly taken by them. The policy documents and policy advices demonstrate that Flanders opts for a bottom-up organization. As DHC is very dependent on local conditions, this seems a logic step. Nevertheless, this can impede smaller councils to create DHC networks and slow down systematic and fast implementation of DHC throughout Flanders.

Keywords: district heating and cooling, flanders, overton database, policy analysis

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Authors: Ambika Selvaraj

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Magnetic iron oxide nanoparticles (IO) of < 20nm (superparamagnetic) become promising tool in cancer therapy, and integrated nanodevices for cancer detection and screening. The obstacles include particle heterogeneity and cost. It can be overcome by developing monodispersed nanoparticles in economical approach. We have successfully synthesized < 7 nm IO by low temperature controlled technique, in which Fe0 is sandwiched between stabilizer and Fe2+. Size analysis showed the excellent size control from 31 nm at 33°C to 6.8 nm at 10°C. Resultant monodispersed IO were found to be stable for > 50 reuses, proved its applicability in biomedical applications.

Keywords: low temperature synthesis, hybrid iron nanoparticles, cancer therapy, biomedical applications

Procedia PDF Downloads 338

Authors: Jessica Gladden

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Yoga has been accepted in the majority of communities in the United States as a method of assisting individuals with improving their physical health. Both community yoga classes and yoga-based therapy have been shown to be highly useful for individual’s mental health. Yoga-based therapy has been supported by research to be an evidence-based practice for individuals experiencing anxiety, depression, and disordered eating and for those experiencing post traumatic stress disorder in the wake of trauma. Many individuals who have experienced trauma, as well as other mental health diagnoses, are either very disconnected from their physical bodies or feel unsafe in their bodies. Yoga can be a method of creating safety and control in the body. This is recommended by some of the leading researchers in trauma therapy as a beginning step towards finding safety in the body in order to begin to work on the additional mental health challenges before addressing other long-term challenges. Unfortunately, yoga for physical and mental health is underutilized in black and brown communities despite the research regarding the benefits. Very few studies have examined the barriers to access to yoga for black, brown, and indigenous individuals. This study interviewed 15 yoga practitioners who identified as black or brown and explored the barriers they see in their communities related to accessing yoga and yoga-based services. Several of the themes reported include not feeling welcome, cost of services, time, and cultural/ religious components. Methods for reducing barriers will also be discussed.

Keywords: yoga, sport, barrier, black

Procedia PDF Downloads 92

Authors: Esra Yuce, Isil D. S. Yamaner, Murude Yazan

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Aims and objective: Antiresorptive agents including bisphosphonates and denosumab as strong suppressors of osteoclasts are the most commonly used antiresorptive medications for the treatment of osteoporosis which counteract the negative quantitative alteration of trabecular and cortical bone by inhibition of bone turnover. Oral bisphosphonate therapy for the treatment of osteopenia, osteoporosis or Paget's disease is associated with the low-grade risk of osteonecrosis of the jaw, while higher-grade risk is associated with receiving intravenous bisphosphonates therapy in the treatment of multiple myeloma and bone metastases. On the other hand, there has been a remarkable increase in incidences of antiresorptive related osteonecrosis of the jaw (ARONJ) in oral bisphosphonate users. This clinical presentation will evaluate the healing outcomes via piezoelectric bone surgery under the irrigation of PVP-I solution irrigation in patients received bisphosphonate therapy. Material-Method: The study involved 8 female and 5 male patients that have been treated for ARONJ. Among 13 necrotic sites, 9 were in the mandible and 4 were in the maxilla. All of these 13 patients treated with surgical debridement via piezoelectric bone surgery under irrigation by solution with 3% PVP-I concentration in combination with long-term antibiotic therapy and 5 also underwent removal of mobile segments of bony sequestrum. All removable prosthesis in 8 patients were relined with soft liners during the healing periods in order to eliminate chronic minor traumas. Results: All patients were on oral bisphosphonate therapy for at least 2 years and 5 of which had received intravenous bisphosphonates up to 1 year before therapy with oral bisphosphonates was started. According to the AAOMS staging system, four cases were stage II, eight cases were stage I, and one case was stage III. The majority of lesions were identified at sites of dental prostheses (38%) and dental extractions (62%). All patients diagnosed with ARONJ stage I had used unadjusted removable prostheses. No recurrence of the symptoms was observed during the present follow-up (9–37 months). Conclusion: Despite their confirmed effectiveness, the prevention and treatment of osteonecrosis of the jaw secondary to oral bisphosphonate therapy remain major medical challenges. Treatment with piezoelectric bone surgery with irrigation of povidone-iodine solution was effective for management of bisphosphonate-related osteonecrosis of the jaw. Taking precautions for patients treated with oral bisphosphonates, especially also denture users, may allow for a reduction in the rate of developing osteonecrosis of the maxillofacial region.

Keywords: antiresorptive drug related osteonecrosis, bisphosphonate therapy, piezoelectric bone surgery, povidone iodine

Procedia PDF Downloads 262