Search results for: 5-fold lower dose.

Authors: Su Chul Han, Seungwoo Park

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As the increasing incidence of cancer, the technology and modality of radiotherapy have advanced and the importance of preclinical model is increasing in the cancer research. Furthermore, the small animal dosimetry is an essential part of the evaluation of the relationship between the absorbed dose in preclinical small animal and biological effect in preclinical study. In this study, we carried out realistic modeling of the preclinical small animal phantom possible to verify irradiated dose using commercial software. The small animal phantom was modeling from 4D Digital Mouse whole body phantom. To manipulate Moby phantom in commercial software (Mimics, Materialise, Leuven, Belgium), we converted Moby phantom to DICOM image file of CT by Matlab and two- dimensional of CT images were converted to the three-dimensional image and it is possible to segment and crop CT image in Sagittal, Coronal and axial view). The CT images of small animals were modeling following process. Based on the profile line value, the thresholding was carried out to make a mask that was connection of all the regions of the equal threshold range. Using thresholding method, we segmented into three part (bone, body (tissue). lung), to separate neighboring pixels between lung and body (tissue), we used region growing function of Mimics software. We acquired 3D object by 3D calculation in the segmented images. The generated 3D object was smoothing by remeshing operation and smoothing operation factor was 0.4, iteration value was 5. The edge mode was selected to perform triangle reduction. The parameters were that tolerance (0.1mm), edge angle (15 degrees) and the number of iteration (5). The image processing 3D object file was converted to an STL file to output with 3D printer. We modified 3D small animal file using 3- Matic research (Materialise, Leuven, Belgium) to make space for radiation dosimetry chips. We acquired 3D object of realistic small animal phantom. The width of small animal phantom was 2.631 cm, thickness was 2.361 cm, and length was 10.817. Mimics software supported efficiency about 3D object generation and usability of conversion to STL file for user. The development of small preclinical animal phantom would increase reliability of verification of absorbed dose in small animal for preclinical study.

Keywords: mimics, preclinical small animal, segmentation, 3D printer

Procedia PDF Downloads 366

Authors: Eyob Seife

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Immunization is a life-saving intervention which prevents needless suffering through sickness, disability, and death. Emphasis on data quality and use will become even stronger with the development of the immunization agenda 2030 (IA2030). Quality of data is a key factor in generating reliable health information that enables monitoring progress, financial planning, vaccine forecasting capacities, and making decisions for continuous improvement of the national immunization program. However, ensuring data of sufficient quality and promoting an information-use culture at the point of the collection remains critical and challenging, especially in hard-to-reach and pastoralist areas where Degehabur district is selected based on a hypothesis of ‘there is no difference in reported and recounted immunization data consistency. Data quality is dependent on different factors where organizational, behavioral, technical, and contextual factors are the mentioned ones. A cross-sectional quantitative study was conducted on September 2022 in the Degehabur district. The study used the world health organization (WHO) recommended data quality self-assessment (DQS) tools. Immunization tally sheets, registers, and reporting documents were reviewed at 5 health facilities (2 health centers and 3 health posts) of primary health care units for one fiscal year (12 months) to determine the accuracy ratio. The data was collected by trained DQS assessors to explore the quality of monitoring systems at health posts, health centers, and the district health office. A quality index (QI) was assessed, and the accuracy ratio formulated were: the first and third doses of pentavalent vaccines, fully immunized (FI), and the first dose of measles-containing vaccines (MCV). In this study, facility-level results showed both over-reporting and under-reporting were observed at health posts when computing the accuracy ratio of the tally sheet to health post reports found at health centers for almost all antigens verified where pentavalent 1 was 88.3%, 60.4%, and 125.6% for Health posts A, B, and C respectively. For first-dose measles-containing vaccines (MCV), similarly, the accuracy ratio was found to be 126.6%, 42.6%, and 140.9% for Health posts A, B, and C, respectively. The accuracy ratio for fully immunized children also showed 0% for health posts A and B and 100% for health post-C. A relatively better accuracy ratio was seen at health centers where the first pentavalent dose was 97.4% and 103.3% for health centers A and B, while a first dose of measles-containing vaccines (MCV) was 89.2% and 100.9% for health centers A and B, respectively. A quality index (QI) of all facilities also showed results between the maximum of 33.33% and a minimum of 0%. Most of the verified immunization data accuracy ratios were found to be relatively better at the health center level. However, the quality of the monitoring system is poor at all levels, besides poor data accuracy at all health posts. So attention should be given to improving the capacity of staff and quality of monitoring system components, namely recording, reporting, archiving, data analysis, and using information for decision at all levels, especially in pastoralist areas where such kinds of study findings need to be improved beside to improving the data quality at root and health posts level.

Keywords: accuracy ratio, Degehabur District, regular childhood immunization program, quality of monitoring system, Somali Region-Ethiopia

Procedia PDF Downloads 107

Authors: B. Medani Amna, M. A. Elbadwi Samia, E. Amin Ahmed

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Variable plants present in nature are used by simple rural and urban people, researchers and drug manufacturers for medicinal purposes. Garad is one of the most commonly used in Sudan for both treatment and prophylaxis of infections in the respiratory, urinogenital tracts and the skin. Water exctracts from Acacia nilotica bods were used in this very experiment to test for their toxicity to Nubian goats at two dose rates under proper experimental conditions. The clinical, pathological, haematological and biological changes in Nubian goats given daily oral doses of 1 and 5 g/kg body weight of Acacia nilotica to two groups of test goats. The goats of the control group were undosed with Acacia nilotica.Other than the dose co-related mortality rates, the clinical signs were observed to be salivation, staggered gait, intermittent loss of voice and low appetite. On histopathological testing, the main lesions were hepatic centrolobular necrosis and fatty changes associated with the significant changes in GGT and ALP are indicating hepatic dysfunction.Renal malfunction is indicated by haemorrhages in addition to the change in the urea concentration. The congested, haemorrhagic, emphysematous, edematous and cyanotic lungs may contribute to the development of dyspnea. Acacia nilotica poisoning may lead to an immunosuppression pointed out by the lymphocyte infiltration. On evaluation of the above results, Acacia nilotica was considered toxic to Nubian goats at the above mentioned doses. Future work for Acacia nilotica was forwarded and practical implications of the result were highlighted.

Keywords: Acaia nilotica, toxicity data, Nubian goats, Garad

Procedia PDF Downloads 459

Authors: Eunmi Koh, Bogyoung Choi, Dayeon Ryu, Jee-Yeon Lee, Sungok Kwon, Cho-Il Kim

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Ethyl carbamate(EC) is a probable human carcinogen (Group 2A) found in alcoholic beverages and fermented foods. A total of 351 samples including fermented foods and alcoholic beverages were chosen from 734 foods appeared in the pooled intake data of 2008, 2009, 2010, and 2011 Korea National Health & Nutrition Examination Survey (KNHANES). Sampling was carried out from September 2013 to July 2016 in 18 supermarkets of 9 metropolitan cities in Korea. The samples were pooled, prepared according to various cooking methods, and analyzed. A total of 1245 samples were analyzed using gas chromatograph-mass spectrometer. EC was detected in 13 items (1.0%), which ranged from not-detected to 151 g/kg. Alcoholic beverages (maesilju, whisky, and bokbunjaju) and fermented soy products (soy sauce and soybean paste) were the food items with relatively higher EC levels. Dietary intake of EC in the Korean population was estimated to be 2.11 ng/kg body weight (bw) per day for average population and 8.42 ng/kg bw per day for high consumers (the 97.5th percentile). When the estimated average dietary exposure to EC was compared with the Benchmark Dose Lower Confidence Limit 10% (BMDL10) of 0.3 mg/kg bw per day, margin of exposure (MOE) values of 1420000 to 28000000 were observed. This indicates that there is no health concern for the Korean population.

Keywords: ethyl carbamate, total diet study, dietary exposure, margin of exposure

Procedia PDF Downloads 236

Authors: Enkelejda Shkurti, Diamant Shtiza

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Background: Health-related quality of life (HRQoL) is a significant consequence in health care. The objective of our study was to recognize features related to lower HRQoL scores in children with anorectal malformation (ARM) and Hirschsprung disease (HD). Methods: Children younger than 18 years, with HD or ARM, that were assessed at our private clinic in Tirana, Albania, from December 2018 to October 2019, were acknowledged. The outcomes of broad questionnaires concerning diagnosis, symptoms, and preceding health/surgical history and authenticated tools to measure urinary status, stooling grade, and HRQoL were appraised. Results: In patients aged 0-6 years, vomiting and abdominal enlargement were allied with a substantial decrease in total HRQoL scores. In children > 6 years of age, vomiting, abdominal swelling, and abdominal discomfort were also linked to a considerably lower HRQoL. The main indicator of lower HRQoL scores on regression tree analysis in all age clusters was the occurrence of psychosomatic, behavioral, or progressive comorbidity. Conclusion: Children with both HD or ARM that have a psychosomatic, behavioral, or growing problem experience considerably lower HRQoL than patients deprived of such problems, proposing that establishment of behavioral/growing sustenance as part of the care of these patients may have a considerable influence on their HRQoL.

Keywords: anorectal malformation, Hirsch Sprung disease, quality of life, Albania

Procedia PDF Downloads 175

Authors: Marcela Jelicova, Anna Lierova, Zuzana Sinkorova, Radovan Metelka

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At present, electrochemical methods are used in various research fields, especially for analysis of biological molecules. The fact offers the possibility of using the detection of oxidative damage induced indirectly by γ rays in DNA in biodosimentry. The main goal of our study is to optimize the detection of 8-hydroxyguanine by differential pulse voltammetry. The level of this stable and specific indicator of DNA damage could be determined in DNA isolated from peripheral blood lymphocytes, plasma or urine of irradiated individuals. Screen-printed carbon electrodes modified with carboxy-functionalized multi-walled carbon nanotubes were utilized for highly sensitive electrochemical detection of 8-hydroxyguanine. Electrochemical oxidation of 8-hydroxoguanine monitored by differential pulse voltammetry was found pH-dependent and the most intensive signal was recorded at pH 7. After recalculating the current density, several times higher sensitivity was attained in comparison with already published results, which were obtained using screen-printed carbon electrodes with unmodified carbon ink. Subsequently, the modified electrochemical technique was used for the detection of 8-hydroxoguanine in calf thymus DNA samples irradiated by 60Co gamma source in the dose range from 0.5 to 20 Gy using by various types of sample pretreatment and measurement conditions. This method could serve for fast retrospective quantification of absorbed dose in cases of accidental exposure to ionizing radiation and may play an important role in biodosimetry.

Keywords: biodosimetry, electrochemical detection, voltametry, 8-hydroxyguanine

Procedia PDF Downloads 274

Authors: Fayad Ghawbar

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The significance of the Multiple Input Multiple Output (MIMO) system in the 5G wireless communication system is essential to enhance channel capacity and provide a high data rate resulting in a need for dual-polarization in vertical and horizontal. Furthermore, size reduction is critical in a MIMO system to deploy more antenna elements requiring a compact, low-profile design. A compact dual-band 4-MIMO antenna system has been presented in this paper with pattern and polarization diversity. The proposed single antenna structure has been designed using two antenna layers with a C shape in the front layer and a partial slot with a U-shaped cut in the ground to enhance isolation. The single antenna is printed on an FR4 dielectric substrate with an overall size of 18 mm×18 mm×1.6 mm. The 4-MIMO antenna elements were printed orthogonally on an FR4 substrate with a size dimension of 36 × 36 × 1.6 mm3 with zero edge-to-edge separation distance. The proposed compact 4-MIMO antenna elements resonate at 3.4-3.6 GHz and 4.8-5 GHz. The s-parameters measurement and simulation results agree, especially in the lower band with a slight frequency shift of the measurement results at the upper band due to fabrication imperfection. The proposed design shows isolation above -15 dB and -22 dB across the 4-MIMO elements. The MIMO diversity performance has been evaluated in terms of efficiency, ECC, DG, TARC, and CCL. The total and radiation efficiency were above 50 % across all parameters in both frequency bands. The ECC values were lower than 0.10, and the DG results were about 9.95 dB in all antenna elements. TARC results exhibited values lower than 0 dB with values lower than -25 dB in all MIMO elements at the dual-bands. Moreover, the channel capacity losses in the MIMO system were depicted using CCL with values lower than 0.4 Bits/s/Hz.

Keywords: compact antennas, MIMO antenna system, 5G communication, dual band, ECC, DG, TARC

Procedia PDF Downloads 143

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

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Objectives. The age of the disease onset could have an impact on the effect of therapy in systemic sclerosis(SSc). Late-age onset in SSc could have a more severe course of the disease and worse clinical effects on therapy. The aim of our study was to evaluate changes in skin fibrosis on rituximab(RTX) therapy in patients with SSc and different ages of the disease onset. Methods. 151 patients with SSc were included in this study. Patients were divided into groups depending on the age of the disease onset: group 1 - younger than 30 years (40 patients(26%), group 2 - 31-59 years (90 patients(60%) and group 3 – more than 60 years (21 patients(14%). The mean follow-up period was 13±2.3month. The mean age was 48±13years, female-83% of patients, and the diffuse cutaneous subset of the disease had 52% of patients. The mean disease duration was 6.4±5years. The cumulative mean dose of RTX was 1.5±0.6grams. Patients received RTX as a therapy for interstitial lung disease. All patients received prednisone at a dose of 11.6±4.8mg/day, immunosuppressants received 48% of them. The results at baseline and at the end of the follow-up are presented in the form of mean values. Results. There was a significant decrease of modified Rodnan skin score(mRss) in all groups: in group 1 - from 10.2±8 to 7.7±6.5(p=0.01); in group 2 - from 9±7.2 to 6.2±4.7(p=0.0001); in group 3 - from 20.5±14.1 to 10.8±9.4(p=0.001). There was a significant decrease of the activity index (EScSG-AI): in group 1 from 2.5±1.8 to 1.3±1.1; in group 2 – from 3.2±1.6 to 1.5±1.2; in group 3 – from 4.2±2.1 to 1.3±1. Conclusion. There was a significant improvement in skin fibrosis in a year after initiation of RTX therapy regardless of the age of the disease onset. The improvement was more pronounced in the group with late-age onset of the disease, but these data require further investigations.

Keywords: skin fibrosis, systemic sclerosis, rituximab, disease onset

Procedia PDF Downloads 32

Authors: Aimen Saleh

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The Silurian Lower Acacus sandstone is one of the main reservoirs in North West Libya. Our aim in this study is to grasp a robust understanding of the hydrocarbon potential and distribution in the area. To date, the depositional environment of the Lower Acacus reservoir still open to discussion and contradiction. Henceforth, building three dimensional (3D) property modelling is one way to support the analysis and description of the reservoir, its properties and characterizations, so this will be of great value in this project. The 3D model integrates different data set, these incorporates well logs data, petrophysical reservoir properties and seismic data as well. The finalized depositional environment model of the Lower Acacus concludes that the area is located in a deltaic transitional depositional setting, which ranges from a wave dominated delta into tide dominated delta type. This interpretation carried out through a series of steps of model generation, core description and Formation Microresistivity Image tool (FMI) interpretation. After the analysis of the core data, the Lower Acacus layers shows a strong effect of tidal energy. Whereas these traces found imprinted in different types of sedimentary structures, for examples; presence of some crossbedding, such as herringbones structures, wavy and flaser cross beddings. In spite of recognition of some minor marine transgression events in the area, on the contrary, the coarsening upward cycles of sand and shale layers in the Lower Acacus demonstrate presence of a major regressive phase of the sea level. However, consequently, we produced a final package of this model in a complemented set of facies distribution, porosity and oil presence. And also it shows the record of the petroleum system, and the procedure of Hydrocarbon migration and accumulation. Finally, this model suggests that the area can be outlined into three main segments of hydrocarbon potential, which can be a textbook guide for future exploration and production strategies in the area.

Keywords: Acacus, Ghadames , Libya, Silurian

Procedia PDF Downloads 143

Authors: Shang Yee Chong

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Perioperative pain is a complex mechanism activated by various nociceptive, neuropathic, and inflammatory pathways. Opioids have long been a mainstay for analgesia in this period, even as we are continuously moving towards a multimodal model to improve pain control while minimising side effects. Dexmedetomidine, a potent alpha-2 agonist, is a useful sedative and hypnotic agent. Its use in the intensive care unit has been well described, and it is increasingly an adjunct intraoperatively for its opioid sparing effects and to decrease pain scores. We describe a case of a general surgical patient in whom minimal opioids was required with dexmedetomidine use. The patient was a 61-year-old Indian gentleman with a history of hyperlipidaemia and type 2 diabetes mellitus, presenting with rectal adenocarcinoma detected on colonoscopy. He was scheduled for a robotic ultra-low anterior resection. The patient was induced with intravenous fentanyl 75mcg, propofol 160mg and atracurium 40mg. He was intubated conventionally and mechanically ventilated. Anaesthesia was maintained with inhalational desflurane and anaesthetic depth was measured with the Masimo EEG Sedline brain function monitor. An initial intravenous dexmedetomidine dose (bolus) of 1ug/kg for 10 minutes was given prior to anaesthetic induction and thereafter, an infusion of 0.2-0.4ug/kg/hr to the end of surgery. In addition, a bolus dose of intravenous lignocaine 1.5mg/kg followed by an infusion at 1mg/kg/hr throughout the surgery was administered. A total of 10mmol of magnesium sulphate and intravenous paracetamol 1000mg were also given for analgesia. There were no significant episodes of bradycardia or hypotension. A total of intravenous phenylephrine 650mcg was given throughout to maintain the patient’s mean arterial pressure within 10-15mmHg of baseline. The surgical time lasted for 5 hours and 40minutes. Postoperatively the patient was reversed and extubated successfully. He was alert and comfortable and pain scores were minimal in the immediate post op period in the postoperative recovery unit. Time to first analgesia was 4 hours postoperatively – with paracetamol 1g administered. This was given at 6 hourly intervals strictly for 5 days post surgery, along with celecoxib 200mg BD as prescribed by the surgeon regardless of pain scores. Oral oxycodone was prescribed as a rescue analgesic for pain scores > 3/10, but the patient did not require any dose. Neither was there nausea or vomiting. The patient was discharged on postoperative day 5. This case has reinforced the use of dexmedetomidine as an adjunct in general surgery cases, highlighting its excellent opioid-sparing effects. In the entire patient’s hospital stay, the only dose of opioid he received was 75mcg of fentanyl at the time of anaesthetic induction. The patient suffered no opioid adverse effects such as nausea, vomiting or postoperative ileus, and pain scores varied from 0-2/10. However, intravenous lignocaine infusion was also used in this instance, which would have helped improve pain scores. Paracetamol, lignocaine, and dexmedetomidine is thus an effective, opioid-sparing combination of multi-modal analgesia for major abdominal surgery cases.

Keywords: analgesia, dexmedetomidine, general surgery, opioid sparing

Procedia PDF Downloads 135

Authors: Maria L. G. Lourenco, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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Neonatal sepsis is a systemic response of acute infection by bacteria that may lead to high mortality in a litter. This study aims to report a case of sepsis by alpha-hemolytic Streptococcus and Mannheimia haemolytica in neonate dogs. A pregnant, mixed-breed bitch at approximately the 60th day of pregnancy was admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, and subjected to a c-section due to uterine atony and fetuses no heartbeats on the ultrasound examination. The mother presented leukopenia of 1.6 thousand leukocytes, and there was no other information regarding previous clinical history. Among the offspring, four were stillborn, and five were born alive. On clinical examination, neonates weighed between 312 and 384 grams. Reflexes were present, and the newborn's body temperature was between 89.9 ºF and 96.4 ºF. Neonates also presented clinical signs of neonatal infection: omphalitis, abdomen, and extremities with cyanotic color, hematuria, and diarrhea (meconium). Complementary tests revealed leukopenia. The presence of alpha hemolytic streptococcus and Mannheimia haemolytica was revealed in the bacterial culture. The bacteria were sensitive to cephalosporins and penicillin on the antibiogram. Treatment for sepsis was instituted with the drug ceftriaxone, at a dose of 50 mg per kilogram, administered intravenous (jugular vein). Subsequently administered subcutaneous, every 12 hours, for seven days. Heated fluid therapy was performed, with Ringer lactate, at a dose of 4 ml per 100 grams of weight, intravenous. Heating measures were instituted. Blood plasma was also administered, at a dose of 2 mL per 100 grams of weight, administered subcutaneous, as a source of passive immunity. A maternal milk substitute was instituted, and lactation was discontinued since the mother was unable to nurse due to the infection. The mother was neutered during the c-section and treated with ceftriaxone (50 mg/kg). After seven days, the newborns presented normal clinical signs and no alterations in the hemogram. Early diagnosis and intervention were essential for the survival of these patients.

Keywords: neonatal infection, puppies, bacteria, newborn

Procedia PDF Downloads 121

Authors: M. Farhaoui, M. Derraz

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Problem statement: In the water treatment processes, the coagulation and flocculation processes produce sludge according to the level of the water turbidity. The aluminum sulfate is the most common coagulant used in water treatment plants of Morocco as well as many countries. It is difficult to manage the sludge produced by the treatment plant. However, it can be used in the process to improve the quality of the treated water and reduce the aluminum sulfate dose. Approach: In this study, the effectiveness of sludge was evaluated at different turbidity levels (low, medium, and high turbidity) and coagulant dosage to find optimal operational conditions. The influence of settling time was also studied. A set of jar test experiments was conducted to find the sludge and aluminum sulfate dosages in order to improve the produced water quality for different turbidity levels. Results: Results demonstrated that using sludge produced by the treatment plant can improve the quality of the produced water and reduce the aluminum sulfate using. The aluminum sulfate dosage can be reduced from 40 to 50% according to the turbidity level (10, 20 and 40 NTU). Conclusions/Recommendations: Results show that sludge can be used in order to reduce the aluminum sulfate dosage and improve the quality of treated water. The highest turbidity removal efficiency is observed within 6 mg/l of aluminum sulfate and 35 mg/l of sludge in low turbidity, 20 mg/l of aluminum sulfate and 50 mg/l of sludge in medium turbidity and 20 mg/l of aluminum sulfate and 60 mg/l of sludge in high turbidity. The turbidity removal efficiency is 97.56%, 98.96% and 99.47% respectively for low, medium and high turbidity levels.

Keywords: coagulation process, coagulant dose, sludge, turbidity removal

Procedia PDF Downloads 336

Authors: Meenu Mehta, Munish Garg

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The use of oral anticancer drugs from AYUSH system of medicine is widely increased among the society due to their low cost, enhanced efficacy, increased patient preference, lack of inconveniences related to infusion and they provide an opportunity to develop chronic treatment regimens. However, oral delivery of these drugs usually laid down by the limited bioavailability of the drug, which is associated with a wide variation. As most of the cytotoxic agents have a narrow therapeutic window and are dosed at or near the maximum tolerated dose, a wide variability in the bioavailability can negatively affect treatment result. It is estimated that 40% of active substances are poorly soluble in water. The improvement of bio-availability of drugs with such properties presents one of the greatest challenges in drug formulations. There are several techniques reported in literature. Among all these Self Emulsifying Drug Delivery System (SEDDS) has gained more attention due to enhanced oral bio-availability enabling a reduction in dose. Thus, SEDDS anticancer drugs will have the increased bioavailability and efficacy. These dosage form will provide societal benefit in a cost-effective manner as compared to other oral dosage forms. Present study reflects on the formulation strategies as SEDDS for oral anticancer agents of AYUSH system for enhanced bioavailability with proven efficacy by cancer cell lines.

Keywords: anticancer agents, AYUSH system, bioavailability, SEDDS

Procedia PDF Downloads 306

Authors: Welawat Tienpratarn, Chaiyaporn Yuksen, Rungrawin Promkul, Chetsadakon Jenpanitpong, Pajit Bunta, Suthap Jaiboon

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Supraventricular tachycardia (SVT) is an abnormally fast atrial tachycardia characterized by narrow (≤ 120 ms) and constant QRS. Adenosine was the drug of choice; the first dose was 6 mg. It can be repeated with the second and third doses of 12 mg, with greater than 90% success. The study found that patients observed at 4 hours after normal sinus rhythm was no recurrence within 24 hours. The objective of this study was to investigate the factors that influence the recurrence of SVT after adenosine in the emergency department (ED). The study was conducted retrospectively exploratory model, prognostic study at the Emergency Department (ED) in Faculty of Medicine, Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand. The study was conducted for ten years period between 2010 and 2020. The inclusion criteria were age > 15 years, visiting the ED with SVT, and treating with adenosine. Those patients were recorded with the recurrence SVT in ED. The multivariable logistic regression model developed the predictive model and prediction score for recurrence PSVT. 264 patients met the study criteria. Of those, 24 patients (10%) had recurrence PSVT. Five independent factors were predictive of recurrence PSVT. There was age>65 years, heart rate (after adenosine) > 100 per min, structural heart disease, and dose of adenosine. The clinical risk score to predict recurrence PSVT is developed accuracy 74.41%. The score of >6 had the likelihood ratio of recurrence PSVT by 5.71 times. The clinical predictive score of > 6 was associated with recurrence PSVT in ED.

Keywords: supraventricular tachycardia, recurrance, emergency department, adenosine

Procedia PDF Downloads 117

Authors: R. K. Patel

Abstract:

The experiment entitled “Bionomics of Cryptophlebia ombrodelta Lower (Lepidoptera: Tortricidae), a Major Pest of Tamarind, Tamarindus indica in Bastar tribal belt of Chhattisgarh” was conducted at S. G. College of Agriculture and Research Station, Jagdalpur (Chhattisgarh) during 2014-15. The moth, Cryptophlebia ombrodelta (Lower) is very destructive pest to tamarind, Tamarindus indica. The mature larva is pinkish in colour whereas, the moth is generally grayish in colour and it lays pale yellowish - white, flat and round eggs near the peduncle joint of pod (fruit) or on the pod surface. The newly hatched larva enters into the fruit by making hole packed with excreta. It completes three to four generation in a year and can cause fourty two per cent loss to tamarind fruits. The morphological details of this pest were studied.

Keywords: bionomics, Cryptophlebia ombrodelta, loss, pest, Tamarind, Tamarindus indica

Procedia PDF Downloads 298

Authors: I. P. Ogbuewu, I. F. Etuk, V. U. Odoemelam, I. C. Okoli, M. U. Iloeje

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The effect of dietary ginger rhizome meal on libido and semen characteristics of post-pubertal rabbit bucks was investigated in an experiment that lasted for 12 weeks. Thirty-six post-pubertal bucks were randomly assigned to 4 dietary groups of 9 rabbits each in a completely randomized design. Four experimental diets were formulated to contain ginger rhizome meal at 0 g/kg feed (BT0), 5g/kg feed (BT5), 10 g/kg feed (BT10), and 15g/kg feed (BT15) were fed ad libitum to the experimental animals. Results revealed that semen colour changed from cream milky to milky. Data on semen pH and sperm concentration were similar (p>0.05) among the dietary groups. Semen volume for the bucks in BT0 (0.64 mL) and BT5 (0.60 mL) groups were significantly (p<0.05) higher than those in BT10 (0.44 mL) and BT15 (0.46 mL) groups. Total spermatozoa concentration value was significantly (p<0.05) higher in BT0 and BT5 groups than those in BT10 and BT15 groups. Sperm motility and percent live sperm declined (p<0.05) progressively among the treatment groups. Percent dead sperm were significantly (p<0.05) lower for bucks in BT0 group than in BT10 and BT15 groups. Reaction time had a dose-dependent increase; however, the observed difference was not significant (p>0.05). These results indicate that the inclusion of ginger rhizome meal at 5-15g per kg feed in ration for post-pubertal rabbit bucks could cause mild depressive effect on semen production and quality.

Keywords: rabbits, semen, libido, ginger

Procedia PDF Downloads 566

Authors: Mihai-Ionut Firescu, Mark A. P. Carson

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We present a case of inferior vena cava agenesis (IVCA) associated with bilateral deep venous thrombosis (DVT) in a patient with Beckwith-Wiedemann syndrome (BWS). In adult patients with BWS presenting with bilateral lower limb oedema, specific aetiological factors should be considered. These include cardiomyopathy and intraabdominal tumours. Congenital malformations of the IVC, through causing relative venous stasis, can lead to lower limb oedema either directly or indirectly by favouring lower limb venous thromboembolism; however, they are yet to be reported as an associated feature of BWS. Given its life-threatening potential, the prompt initiation of treatment for bilateral DVT is paramount. In BWS patients, however, this can prove more complicated. Due to overgrowth, the above-average birth weight can continue throughout childhood. In this case, the patient’s weight reached 170 kg, impacting on anticoagulation choice, as direct oral anticoagulants have a limited evidence base in patients with a body mass above 120 kg. Furthermore, the presence of IVCA leads to a long-term increased venous thrombosis risk. Therefore, patients with IVCA and bilateral DVT warrant specialist consideration and may benefit from multidisciplinary team management, with hematology and vascular surgery input. Conclusion: Here, we showcased a rare cause for bilateral lower limb oedema, respectively bilateral deep venous thrombosis complicating IVCA in a patient with Beckwith-Wiedemann syndrome. The importance of this case lies in its novelty, as the association between IVC agenesis and BWS has not yet been described. Furthermore, the treatment of DVT in such situations requires special consideration, taking into account the patient’s weight and the presence of a significant, predisposing vascular abnormality.

Keywords: Beckwith-Wiedemann syndrome, bilateral deep venous thrombosis, inferior vena cava agenesis, venous thromboembolism

Procedia PDF Downloads 237

Authors: D. M. El-Tanbouly, R. M. Abdelsalam, A. S. Attia, M. T. Abdel-Aziz

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Lipopolysaccharide (LPS) endotoxin, a component of the outer membrane of Gram-negative bacteria, is involved in the pathogenesis of sepsis. LPS administration induces systemic inflammation that mimics many of the initial clinical features of sepsis and has deleterious effects on several organs including the liver and eventually leading to septic shock and death. The present study aimed to investigate the protective effect of magnesium, a well-known cofactor in many enzymatic reactions and a critical component of the antioxidant system, on hepatic damage associated with LPS induced- endotoxima in mice. Mg (20 and 40 mg/kg, po) was administered for 7 consecutive days. Systemic inflammation was induced one hour after the last dose of Mg by a single dose of LPS (2 mg/kg, ip) and three hours thereafter plasma was separated, animals were sacrificed and their livers were isolated. LPS-treated mice suffered from hepatic dysfunction revealed by histological observation, elevation in plasma transaminases activities, C-reactive protein content and caspase-3, a critical marker of apoptosis. Liver inflammation was evident by elevation in liver cytokines contents (TNF-α and IL-10) and myeloperoxidase (MPO) activity. Additionally, oxidative stress was manifested by increased liver lipoperoxidation, glutathione depletion, elevated total nitrate/nitrite (NOx) content and glutathione peroxidase (GPx) activity. Pretreatment with Mg largely mitigated these alternations through its anti-inflammatory and antioxidant potentials. Mg, therefore, could be regarded as an effective strategy for prevention of liver damage associated with septicemia.

Keywords: LPS, liver damage, magnesium, septicemia

Procedia PDF Downloads 397

Authors: Mehdi Benlarbi, Dalila Oulhaci

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Several physical, human and economic factors come into play in the choice of an irrigation system for developing arid and semi-arid regions. Since it is impossible to define or weight quantitatively all the relevant factors in each case, the choice of the system is often based on subjective preferences rather than explicit analysis. Over the past decade, irrational irrigation in the Ouargla region has evolved to a certain extent based largely on water wastage and which may pose risks to the environment both off-site and at the site. In the whole region, the environment is damaged by excess water because the water tables that tend to be high form swamps that pollute nature on the surface. The purpose of our work is a comparison between sprinkler irrigation and drip irrigation using bottles. By irrigating with the aid of the bottle and giving a volume of 4 liters with a flow rate of one (1) liter per hour, the watering dose received varies between 6 and 7 mm without infiltration losses. And for the case of sprinkler irrigation, the dose received may not exceed 2.5mm. E in some cases, we have a quantity of water lost by infiltration. This shows that irrigation using the bottle is much more efficient than sprinkling. Because, on the one hand, a large amount of water is absorbed by the plant and on the other hand, there is no loss by infiltration. The results obtained are very significant because, on the one hand, we reuse local products, and on the other hand, as the bottles are buried, we avoid water losses by evaporation, especially in dry periods and salinization.

Keywords: resources, water, arid, evaporation, infiltration

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Authors: Sirirat Jangkorn, Pornsawai Praipipat

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Sugarcane bagasse ash of sugar factories is solid wastes that the richest source of silica. The alkali fusion method, quartz particles in material can be dissolved and they can be used as the silicon source for synthesizing silica-based materials such as zeolites. Zeolites have many advantages such as catalyst to improve the chemical reactions and they can also remove heavy metals in the water including lead. Therefore, this study attempts to synthesize zeolites from the sugarcane bagasse ash, investigate their structure characterizations and chemical components to confirm the happening of zeolites, and examine their lead removal efficiency through the batch test studies. In this study, the sugarcane bagasse ash was chosen as the silicon source to synthesize zeolites, X-ray diffraction (XRD) and X-ray fluorescence spectrometry (XRF) were used to verify the zeolite pattern structures and element compositions, respectively. The batch test studies in dose (0.05, 0.1, 0.15 g.), contact time (1, 2, 3), and pH (3, 5, 7) were used to investigate the lead removal efficiency by the synthesized zeolite. XRD analysis result showed the crystalline phase of zeolite pattern, and XRF result showed the main element compositions of the synthesized zeolite that were SiO₂ (50%) and Al₂O₃ (30%). The batch test results showed the best optimum conditions of the synthesized zeolite for lead removal were 0.1 g, 2 hrs., and 5 of dose, contact time, and pH, respectively. As a result, this study can conclude that the zeolites can synthesize from the sugarcane bagasse ash and they can remove lead in the water.

Keywords: sugarcane bagasse ash, solid wastes, zeolite, lead

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Authors: Ana-Maria Gheldiu, Bianca M. Abrudan, Maria A. Neag, Laurian Vlase, Dana M. Muntean

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Background information: The objective of this study was to investigate the effect of multiple-dose fluvoxamine on the pharmacokinetic profile of single-dose carvedilol in rats, in order to evaluate this possible drug-drug pharmacokinetic interaction. Methods: A preclinical study, in 28 white male Wistar rats, was conducted. Each rat was cannulated on the femoral vein, prior to being connected to BASi Culex ABC®. Carvedilol was orally administrated in rats (3.57 mg/kg body mass (b.m.)) in the absence of fluvoxamine or after a pre-treatment with multiple oral doses of fluvoxamine (14.28 mg/kg b.m.). The plasma concentrations of carvedilol were estimated by high performance liquid chromatography-tandem mass spectrometry. The pharmacokinetic parameters of carvedilol were analyzed by non-compartmental method. Results: After carvediol co-administration with fluvoxamine, an approximately 2-fold increase in the exposure of carvedilol was observed, considering the significantly elevated value of the total area under the concentration versus time curve (AUC₀₋∞). Moreover, an increase by approximately 145% of the peak plasma concentration was found, as well as an augmentation by approximately 230% of the half life time of carvedilol was observed. Conclusion: Fluvoxamine co-administration led to a significant alteration of carvedilol’s pharmacokinetic profile in rats, these effects could be explained by the existence of a drug-drug interaction mediated by CYP2D6 inhibition. Acknowledgement: This work was supported by CNCS Romania – project PNII-RU-TE-2014-4-0242.

Keywords: carvedilol, fluvoxamine, drug-drug pharmacokinetic interaction, rats

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Authors: Eva Tvrdá, Barbora Babečková, Michal Ďuračka, Róbert Kirchner, Július Árvay

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This study was designed to assess the in vitro effects of Origanum vulgare L. (oregano) extract on the testicular steroidogenesis. We focused on identifying major biomolecules present in the oregano extract, as well as to investigate its in vitro impact on the secretion of cholesterol, testosterone, dehydroepiandrosterone and androstenedione by murine testicular fragments. The extract was subjected to high performance liquid chromatography (HPLC) which identified cyranosid, daidzein, thymol, rosmarinic and trans-caffeic acid among the predominant biochemical components of oregano. For the in vitro experiments, testicular fragments from 20 sexually mature Institute of Cancer Research (ICR) mice were incubated in the absence (control group) or presence of the oregano extract at selected concentrations (10, 100 and 1000 μg/mL) for 24 h. Cholesterol levels were quantified using photometry and the hormones were assessed by ELISA (Enzyme-Linked Immunosorbent Assay). Our data revealed that the release of cholesterol and androstenedione (but not dehydroepiandrosterone and testosterone) by the testicular fragments was significantly impacted by the oregano extract in a dose-dependent fashion. Supplementation of the extract resulted in a significant decline of cholesterol (P < 0.05 in case of 100 μg/mL; P < 0.01 with respect 100 μg/mL extract), as well as androstenedione (P < 0.01 with respect to 100 and 1000 μg/mL extract). Our results suggest that the biomolecules present in Origanum vulgare L. could exhibit a dose-dependent impact on the secretion of male steroids, playing a role in the regulation of testicular steroidogenesis.

Keywords: mice, Origanum vulgare L., steroidogenesis, testes

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Authors: Chia Jui Hsieh, Jyh Cheng Chen, Chih Wei Kuo, Ruei Teng Wang, Woei Chyn Chu

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Compressed sensing (CS) based computed tomographic (CT) reconstruction algorithm utilizes total variation (TV) to transform CT image into sparse domain and minimizes L1-norm of sparse image for reconstruction. Different from the traditional CS based reconstruction which only calculates x-coordinate and y-coordinate TV to transform CT images into sparse domain, we propose a multi-directional TV to transform tomographic image into sparse domain for low-dose reconstruction. Our method considers all possible directions of TV calculations around a pixel, so the sparse transform for CS based reconstruction is more accurate. In 2D CT reconstruction, we use eight-directional TV to transform CT image into sparse domain. Furthermore, we also use 26-directional TV for 3D reconstruction. This multi-directional sparse transform method makes CS based reconstruction algorithm more powerful to reduce noise and increase image quality. To validate and evaluate the performance of this multi-directional sparse transform method, we use both Shepp-Logan phantom and a head phantom as the targets for reconstruction with the corresponding simulated sparse projection data (angular sampling interval is 5 deg and 6 deg, respectively). From the results, the multi-directional TV method can reconstruct images with relatively less artifacts compared with traditional CS based reconstruction algorithm which only calculates x-coordinate and y-coordinate TV. We also choose RMSE, PSNR, UQI to be the parameters for quantitative analysis. From the results of quantitative analysis, no matter which parameter is calculated, the multi-directional TV method, which we proposed, is better.

Keywords: compressed sensing (CS), low-dose CT reconstruction, total variation (TV), multi-directional gradient operator

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Authors: Manas Kotepui, Kwuntida Uthaisar, Phiman Thirarattanasunthon, Bhukdee PhunPhuech, Nuoil Phiwklam

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Introduction: Malaria due to Plasmodium vivax has placed huge burdens on the health, longevity, and general prosperity of large sections of the human population. This study aimed at prospectively collecting information on the clinical profile of Plasmodium vivax from subjects acutely infected with P. vivax residing in some of the highest malaria transmission regions in Thailand. Methods: A retrospective study of malaria cases, hospitalized between 2013 and 2015 was performed. Clinical characteristics, diagnosis, and parasitological results on admission, age, and gender were mined from medical records at Phop Phra Hospital located in endemic areas of Tak Province, Thailand. Venous blood samples were collected at the time of admission to the hospital to determine the present of parasite and also parasite count by thick and thin film examination, and also Complete blood count (CBC) parameters. Results: Results showed that patients infected with Plasmodium vivax (276 cases) had a high monocyte count (mean=390 cells/µL) during initial stage of infection and continuously lower during later stage (any stage with gametocyte, mean=230 cells/µL) of infection (P value=0.021) whereas, patients infected with Plasmodium vivax had a low basophil count (mean=20 cells/µL) during initial stage of infection and continuously higher during later stage of infection (mean at stage with gametocyte=70 cells/µL) (P value=0.033). In addition, patients with more than one stage infection tend to have lower lymphocyte count (mean=1180 cells/µL) than patients with only one stage infection (mean=1350 cells/µL)(P value=0.011) whereas, patients with more than one stage infection tend to have lower basophil count (mean=60 cells/µL) than patients with only one stage infection (mean=80 cells/µL) (P value=0.01). Conclusion: This study indicated that patients infected with Plasmodium vivax had high monocyte count and low basophil count during initial stage of infection which was continuously lower during later stage of infection. Patients with more than one stage infection tend to have lower lymphocyte count than patients with only one stage infection whereas, patients with more than one stage infection tend to have lower basophil count than patients with only one stage infection. This information contributes to better understanding of pathological characteristic of Plasmodium vivax infection.

Keywords: plasmodium vivax, Thailand, asexual erythrocytic stages, hematological parameters

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Authors: Annie Ramanbhai Mecwan

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Cleaning validation in a pharmaceutical manufacturing facility is documented evidence that a cleaning process has effectively removed contaminants, residues from previous drug products and cleaning agents below a pre-defined threshold from the reusable tools and parts of equipment. In shared manufacturing facilities more than one drug product is prepared. After cleaning of reusable tools and parts of equipment after one drug product manufacturing, there are chances that some residues of drug substance from previously manufactured drug products may be retained on the equipment and can carried forward to the next drug product and thus cause cross-contamination. Health-based limits through the derivation of a safe threshold value called permitted daily exposure (PDE) for the residues of drug substances should be employed to identify the risks posed at these manufacturing facilities. The PDE represents a substance-specific dose that is unlikely to cause an adverse effect if an individual is exposed to or below this dose every day for a lifetime. There are different practices to calculate PDE. Data for all APIs in the public domain are considered to calculate PDE value though, company to company may vary the final PDE value based on different toxicologist’s perspective or their subjective evaluation. Hence, Regulatory agencies should take responsibility for publishing PDE values for all APIs as it is done for elemental PDEs. This will harmonize the PDE values all over the world and prevent the unnecessary load on manufacturers for cleaning validation

Keywords: active pharmaceutical ingredient, good manufacturing practice, NOAEL, no observed adverse effect level, permitted daily exposure

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Authors: Adolfo Cangas, Noelia Navarro

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The current study shows the assessment made by university students of a video game entitled Stigma-Stop where the characters present different mental disorders. The objective is that players have more real information about mental disorders and empathize with them and thus reduce stigma. The sample consisted of 169 university students studying degrees related to education, social care and welfare (i.e., Social Education, Psychology, Early Childhood Education, Special Education, and Social Work). The participants valued the video game positively, especially in relation to utility, being somewhat lower the score awarded to the degree of entertainment. They detect the disorders and point out that in many occasions they felt the same (particularly in the case of depression, being lower in agoraphobia and bipolar disorder, and even lower in the case of schizophrenia), most students recommend the use of the video game. They emphasize that Stigma-Stop offers intervention strategies, information regarding the symptomatology and sensitizes against stigma.

Keywords: schizophrenia, social stigma, students, mental health

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Authors: Zwalnan Selfa Johnson, Caleb Nanchen Nimyel, Gideon Duvuna Ayuba

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Air conditioning accounts for a significant share of the overall energy consumed in residential buildings. Solar thermal gains in buildings account for a significant component of the air conditioning load in buildings. This study compares the solar thermal gain and air conditioning load of a proposed building design with a typical conventional building in the climatic conditions of Jos, Nigeria, using a combined experimental and computational method using TRNSYS software. According to the findings of this study, the proposed design building's annual average solar thermal gains are lower compared to the reference building's average solar heat gains. The study case building's decreased solar heat gain is mostly attributable to the lower temperature of the building zones because of the greater building volume and lower fenestration ratio (ratio external opening area to the area of the external walls). This result shows that the proposed building design adjusts to the local climate better than the standard conventional construction in Jos to maintain a suitable temperature within the building. This finding means that the air-conditioning electrical energy consumption per volume of the proposed building design will be lower than that of a conventional building design.

Keywords: solar heat gain, building zone, cooling energy, air conditioning, zone temperature

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Authors: T. Mcgraw, F. N. Morin, N. Desai

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Background: Antimicrobial resistance is a critical issue in global health care and a significant contributor to increased patient morbidity and mortality. Suspected urinary tract infection (UTI) is a key area of inappropriate antibiotic prescription in pediatrics. Management patterns of infectious diseases have been shown to vary by provider type within a single setting. The aim of this study was to assess compliance with national UTI management guidelines by nurse practitioners in a pediatric emergency department (ED). Methods: This was a post-hoc analysis of a retrospective cohort study to review and evaluate visits to a tertiary care freestanding pediatric emergency department. Patients were included if they were 60 days to 36 months old and discharged with a diagnosis of UTI or ‘rule-out UTI’ between July 2015 and July 2020. Primary outcome measure was proportion of visits seen by Nurse Practitioners (NP) which were associated with national guideline compliance in the diagnosis and treatment of suspected UTI. We performed descriptive statistics and comparative analyses to determine differences in practice patterns between NPs, and physicians. Results: A total of 636 charts were reviewed, of which 402 patients met inclusion criteria. 17 patients were treated by NPs, 385 were treated by either Pediatric Emergency Medicine physicians (PEM) or non-PEM physicians. Overall, the proportion of infants receiving guideline-compliant care was 25.9% (21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (74.7-83.8%) received first line guideline recommended therapy and 58.9% (53.8-63.8%) received fully compliant therapy with respect to age, dose, duration, and frequency. In patients treated by NPs, 16/17 (94%(95% CI:73.0-99.0)) required antibiotics, 15/16 (93%(95% CI: 71.7-98.9)) were treated with first line agent (cephalexin), 8/16 (50%(95% CI:28-72)) were guideline compliant of dose and duration. 5/8 (63%(95% CI:30.6-86.3)) were noncompliant for dose being too high. There was no difference in receiving guideline compliant empiric antibiotic therapy between physicians and nurse practitioners (OR: 0.837 CI: 0.302-2.69). Conclusion: In this post-hoc analysis, guideline noncompliance by nurse practitioners is common in children tested and treated for UTIs in a pediatric emergency department. Care by a Nurse Practitioner was not associated with greater rate of noncompliance than care by a Pediatric Emergency Medicine physician. Future appropriately powered studies may focus on confirming these results.

Keywords: antibiotic stewardship, infectious disease, nurse practitioner, urinary tract infection

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Authors: Shaila Bahl, S. P. Lochab, Pratik Kumar

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Nanotechnology and nanomaterials have attracted researchers from different fields, especially from the field of luminescence. Recent studies on various luminescent nanomaterials have shown their relevance in dosimetry of ionizing radiations for the measurements of high doses using the Thermoluminescence (TL) technique, where the conventional microcrystalline phosphors saturate. Ion beams have been used for diagnostic and therapeutic purposes due to their favorable profile of dose deposition at the end of the range known as the Bragg peak. While dealing with human beings, doses from these beams need to be measured with great precision and accuracy. Henceforth detailed investigations of suitable thermoluminescent dosimeters (TLD) for dose verification in ion beam irradiation are required. This paper investigates the TL response of nanocrystalline BaSO4 doped with Eu to 85 MeV carbon beam. The synthesis was done using Co-precipitation technique by mixing Barium chloride and ammonium sulphate solutions. To investigate the crystallinity and particle size, analytical techniques such as X-ray diffraction (XRD) and Transmission electron microscopy (TEM) were used which revealed the average particle sizes to 45 nm with orthorhombic structure. Samples in pellet form were irradiated by 85 MeV carbon beam in the fluence range of 1X1010-5X1013. TL glow curves of the irradiated samples show two prominent glow peaks at around 460 K and 495 K. The TL response is linear up to 1X1013 fluence after which saturation was observed. The wider linear TL response of nanocrystalline BaSO4: Eu and low fading make it a superior candidate as a dosimeter to be used for detecting the doses of carbon beam.

Keywords: radiation, dosimetry, carbon ions, thermoluminescence

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Authors: Omar Nouri, Wafa Mnejja, Fatma Dhouib, Syrine Zouari, Wicem Siala, Ilhem Charfeddine, Afef Khanfir, Leila Farhat, Nejla Fourati, Jamel Daoud

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Purpose and Objective: Intensity modulated radiation (IMRT) technique, associated with induction chemotherapy (IC) and/or concomitant chemotherapy (CC), is actually the recommended treatment modality for nasopharyngeal carcinomas (NPC). The aim of this study was to evaluate the therapeutic results and the patterns of relapse with this treatment protocol. Material and methods: A retrospective monocentric study of 145 patients with NPC treated between June 2016 and July 2021. All patients received IMRT with integrated simultaneous boost (SIB) of 33 daily fractions at a dose of 69.96 Gy for high-risk volume, 60 Gy for intermediate risk volume and 54 Gy for low-risk volume. The high-risk volume dose was 66.5 Gy in children. Survival analysis was performed according to the Kaplan-Meier method, and the Log-rank test was used to compare factors that may influence survival. Results: Median age was 48 years (11-80) with a sex ratio of 2.9. One hundred-twenty tumors (82.7%) were classified as stages III-IV according to the 2017 UICC TNM classification. Ten patients (6.9%) were metastatic at diagnosis. One hundred-thirty-five patient (93.1%) received IC, 104 of which (77%) were TPF-based (taxanes, cisplatin and 5 fluoro-uracil). One hundred-thirty-eight patient (95.2%) received CC, mostly cisplatin in 134 cases (97%). After a median follow-up of 50 months [22-82], 46 patients (31.7%) had a relapse: 12 (8.2%) experienced local and/or regional relapse after a median of 18 months [6-43], 29 (20%) experienced distant relapse after a median of 9 months [2-24] and 5 patients (3.4%) had both. Thirty-five patients (24.1%) died, including 5 (3.4%) from a cause other than their cancer. Three-year overall survival (OS), cancer specific survival, disease free survival, metastasis free survival and loco-regional free survival were respectively 78.1%, 81.3%, 67.8%, 74.5% and 88.1%. Anatomo-clinic factors predicting OS were age > 50 years (88.7 vs. 70.5%; p=0.004), diabetes history (81.2 vs. 66.7%; p=0.027), UICC N classification (100 vs. 95 vs. 77.5 vs. 68.8% respectively for N0, N1, N2 and N3; p=0.008), the practice of a lymph node biopsy (84.2 vs. 57%; p=0.05), and UICC TNM stages III-IV (93.8 vs. 73.6% respectively for stage I-II vs. III-IV; p=0.044). Therapeutic factors predicting OS were a number of CC courses (less than 4 courses: 65.8 vs. 86%; p=0.03, less than 5 courses: 71.5 vs. 89%; p=0.041), a weight loss > 10% during treatment (84.1 vs. 60.9%; p=0.021) and a total cumulative cisplatin dose, including IC and CC, < 380 mg/m² (64.4 vs. 87.6%; p=0.003). Radiotherapy delay and total duration did not significantly affect OS. No grade 3-4 late side effects were noted in the evaluable 127 patients (87.6%). The most common toxicity was dry mouth which was grade 2 in 47 cases (37%) and grade 1 in 55 cases (43.3%).Conclusion: IMRT for nasopharyngeal carcinoma granted a high loco-regional control rate for patients during the last five years. However, distant relapses remain frequent and conditionate the prognosis. We identified many anatomo-clinic and therapeutic prognosis factors. Therefore, high-risk patients require a more aggressive therapeutic approach, such as radiotherapy dose escalation or adding adjuvant chemotherapy.

Keywords: therapeutic results, prognostic factors, intensity-modulated radiotherapy, nasopharyngeal carcinoma

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