Search results for: lung disease classification

Authors: Ljiljana Stojković, Manja Zec, Maja Zivkovic, Maja Bundalo, Marija Glibetić, Dragan Alavantić, Aleksandra Stankovic

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Cardiovascular disease (CVD) is associated with alterations in DNA methylation, the latter modulated by dietary polyphenols. The present pilot study (part of the original clinical study registered as NCT02800967 at www.clinicaltrials.gov) aimed to investigate the impact of 4-week daily consumption of polyphenol-rich Aronia melanocarpa juice on Long Interspersed Nucleotide Element-1 (LINE-1) methylation in peripheral blood leukocytes, in subjects (n=34, age of 41.1±6.6 years) at moderate CVD risk, including an increased body mass index, central obesity, high normal blood pressure and/or dyslipidemia. The goal was also to examine whether factors known to affect DNA methylation, such as folate intake levels, MTHFR C677T gene variant, as well as the anthropometric and metabolic parameters, modulated the LINE-1 methylation levels upon consumption of polyphenol-rich Aronia juice. The experimental analysis of LINE-1 methylation was done by the MethyLight method. MTHFR C677T genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism method. Folate intake was assessed by processing the data from the food frequency questionnaire and repeated 24-hour dietary recalls. Serum lipid profile was determined by using Roche Diagnostics kits. The statistical analyses were performed using the Statistica software package. In women, after vs. before the treatment period, a significant decrease in LINE-1 methylation levels was observed (97.54±1.50% vs. 98.39±0.86%, respectively; P=0.01). The change (after vs. before treatment) in LINE-1 methylation correlated directly with MTHFR 677T allele presence, average daily folate intake and the change in serum low-density lipoprotein cholesterol, while inversely with the change in serum triacylglycerols (R=0.72, R2=0.52, adjusted R2=0.36, P=0.03). The current results imply potential cardioprotective effects of habitual polyphenol-rich Aronia juice consumption achieved through the modifications of DNA methylation pattern in subjects at CVD risk, which should be further confirmed. Hence, the precision nutrition-driven modulations of DNA methylation may become targets for new approaches in the prevention and treatment of CVD.

Keywords: Aronia melanocarpa, cardiovascular risk, LINE-1, methylation, peripheral blood leukocytes, polyphenol

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Authors: Norimichi Nagano, Yoshio Hirano, Tsutomu Yasukawa

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Mesenchymal stem cells are thought to confer neuroprotection, facilitate tissue regeneration and exert their effects on retinal degenerative diseases, however, adverse events such as proliferative vitreoretinopathy and preretinal membrane disease associated with cell suspension transplantation have also been reported. We have recently developed human (allogeneic) adipose tissue-derived mesenchymal stem cell (adMSC) sheets through our proprietary sheet transformation technique, which could potentially mitigate these adverse events. To clarify the properties of our adMSC sheets named PAL-222, we performed in vitro studies such as viability testing, cytokine secretions by ELISA, immunohistochemical study, and migration assay. The viability of the cells exceeded 70%. Vascular Endothelial Growth Factor (VEGF) and Pigment Epithelium-Derived Factor (PEDF), which are quite important cytokines for the retinal area, were observed. PAL-222 expressed type I collagen, a strength marker, type IV collagen, a marker of the basement membrane, and elastin, an elasticity marker. Finally, the migration assay was performed and showed negative, which means that PAL-222 is stably kept in the topical area and does not come to pieces. Next, to evaluate the efficacy in vivo, we transplanted PAL-222 into the subretinal space of the eye of Royal College of Surgeons rats with congenital retinal degeneration and assessed it for three weeks after transplantation. We confirmed that PAL-222 suppressed the decrease in the thickness of the outer nuclear layer, which means that the photoreceptor protective effect treated with PAL-222 was significantly higher than that in the sham group. (p < 0.01). This finding demonstrates that PAL-222 showed their retinoprotective effect in a model of congenital retinal degeneration. As the study suggested the efficacy of PAL-222 in both in vitro and in vivo studies, we are presently engaged in clinical trials of PAL-222 for myopic chorioretinal atrophy, which is one of the retinal degenerative diseases, for the purpose of regenerative medicine.

Keywords: cell sheet, clinical trial, mesenchymal stem cell, myopic chorioretinal atrophy

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Authors: D. Pugazhenthi, B. Sree Vidya

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Cloud computing is one of the emerging technologies that enables end users to use the services of cloud on ‘pay per usage’ strategy. This technology grows in a fast pace and so is its security threat. One among the various services provided by cloud is storage. In this service, security plays a vital factor for both authenticating legitimate users and protection of information. This paper brings in efficient ways of authenticating users as well as securing information on the cloud. Initial phase proposed in this paper deals with an authentication technique using multi-factor and multi-dimensional authentication system with multi-level security. Unique identification and slow intrusive formulates an advanced reliability on user-behaviour based biometrics than conventional means of password authentication. By biometric systems, the accounts are accessed only by a legitimate user and not by a nonentity. The biometric templates employed here do not include single trait but multiple, viz., iris and finger prints. The coordinating stage of the authentication system functions on Ensemble Support Vector Machine (SVM) and optimization by assembling weights of base SVMs for SVM ensemble after individual SVM of ensemble is trained by the Artificial Fish Swarm Algorithm (AFSA). Thus it helps in generating a user-specific secure cryptographic key of the multimodal biometric template by fusion process. Data security problem is averted and enhanced security architecture is proposed using encryption and decryption system with double key cryptography based on Fuzzy Neural Network (FNN) for data storing and retrieval in cloud computing . The proposing scheme aims to protect the records from hackers by arresting the breaking of cipher text to original text. This improves the authentication performance that the proposed double cryptographic key scheme is capable of providing better user authentication and better security which distinguish between the genuine and fake users. Thus, there are three important modules in this proposed work such as 1) Feature extraction, 2) Multimodal biometric template generation and 3) Cryptographic key generation. The extraction of the feature and texture properties from the respective fingerprint and iris images has been done initially. Finally, with the help of fuzzy neural network and symmetric cryptography algorithm, the technique of double key encryption technique has been developed. As the proposed approach is based on neural networks, it has the advantage of not being decrypted by the hacker even though the data were hacked already. The results prove that authentication process is optimal and stored information is secured.

Keywords: artificial fish swarm algorithm (AFSA), biometric authentication, decryption, encryption, fingerprint, fusion, fuzzy neural network (FNN), iris, multi-modal, support vector machine classification

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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: Christine Y. Yeh, Brian D. Piening, Sarah M. Totten, Kimberly Kukurba, Wenyu Zhou, Kevin P. F. Contrepois, Gucci J. Gu, Sharon Pitteri, Michael Snyder

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Three million deaths worldwide are attributed to obesity. However, the biomolecular mechanisms that describe the link between adiposity and subsequent disease states are poorly understood. Insulin resistance characterizes approximately half of obese individuals and is a major cause of obesity-mediated diseases such as Type II diabetes, hypertension and other cardiovascular diseases. This study makes use of longitudinal quantitative and high-throughput multi-omics (genomics, epigenomics, transcriptomics, glycoproteomics etc.) methodologies on blood samples to develop multigenic and multi-analyte signatures associated with weight gain and insulin resistance. Participants of this study underwent a 30-day period of weight gain via excessive caloric intake followed by a 60-day period of restricted dieting and return to baseline weight. Blood samples were taken at three different time points per patient: baseline, peak-weight and post weight loss. Patients were characterized as either insulin resistant (IR) or insulin sensitive (IS) before having their samples processed via longitudinal multi-omic technologies. This comparative study revealed a wealth of biomolecular changes associated with weight gain after using methods in machine learning, clustering, network analysis etc. Pathways of interest included those involved in lipid remodeling, acute inflammatory response and glucose metabolism. Some of these biomolecules returned to baseline levels as the patient returned to normal weight whilst some remained elevated. IR patients exhibited key differences in inflammatory response regulation in comparison to IS patients at all time points. These signatures suggest differential metabolism and inflammatory pathways between IR and IS patients. Biomolecular differences associated with weight gain and insulin resistance were identified on various levels: in gene expression, epigenetic change, transcriptional regulation and glycosylation. This study was not only able to contribute to new biology that could be of use in preventing or predicting obesity-mediated diseases, but also matured novel biomedical informatics technologies to produce and process data on many comprehensive omics levels.

Keywords: insulin resistance, multi-omics, next generation sequencing, proteogenomics, type ii diabetes

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Authors: Mustafa Metin Donma, Orkide Donma

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Obesity is a disease with an ever-increasing prevalence throughout the world. The metabolic network associated with obesity is very complicated. In metabolic syndrome (MetS), it becomes even more difficult to understand. Within this context, hormones, cytokines, and many others participate in this complex matrix. The collaboration among all of these parameters is a matter of great wonder. Cortisol, as a stress hormone, is closely associated with obesity. Thyroid hormones are involved in the regulation of energy as well as glucose metabolism with all of its associates. Fetuin A is known for years; however, the involvement of this parameter in obesity discussions is rather new. Recently, it has been defined as one of the new generation markers of obesity. In this study, the aim was to introduce complex interactions among all to be able to make clear comparisons, at least for a part of this complicated matter. Morbid obese (MO) children participated in the study. Two groups with 46 MO children and 43 with MetS were constituted. All children included in the study were above 99th age- and sex-adjusted body mass index (BMI) percentiles according to World Health Organization criteria. Forty-three morbid obese children in the second group had also MetS components. Informed consent forms were filled by the parents of the participants. The institutional ethics committee has given approval for the study protocol. Data as well as the findings of the study were evaluated from a statistical point of view. Two groups were matched for their age and gender compositions. Significantly higher body mass index (BMI), waist circumference, thyrotropin, and insulin values were observed in the MetS group. Triiodothyronine concentrations did not differ between the groups. Elevated levels for thyroxin, cortisol, and fetuin-A were detected in the MetS group compared to the first group (p > 0.05). In MO MetS- group, cortisol was correlated with thyroxin and fetuin-A (p < 0.05). In the MO MetS+ group, none of these correlations were present. Instead, a correlation between cortisol and thyrotropin was found (p < 0.05). In conclusion, findings have shown that cortisol was the key player in severely obese children. The association of this hormone with the participants of thyroid hormone metabolism was quite important. The lack of association with fetuin A in the morbid obese MetS+ group has suggested the possible interference of MetS components in the behavior of this new generation obesity marker. The most remarkable finding of the study was the unique correlation between cortisol and thyrotropin in the morbid obese MetS+ group, suggesting that thyrotropin may serve as a target along with cortisol in the morbid obese MetS+ group. This association may deserve specific attention during the development of remedies against MetS in the pediatric population.

Keywords: children, cortisol, fetuin A, morbid obesity, thyrotropin

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Authors: Arpit Gite

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Purpose: We have evaluated the role of Total Neoadjuvant Therapy in patients with Locally Advanced Rectal cancer by giving Chemoradiotherapy followed by consolidation chemotherapy (CRT-CNCT) and, after that, the strategy of wait and watch. Methods: In this prospective case series, we evaluated the results of three locally advanced Rectal cancers, two cases Stage II (cT3N0) and one case Stage III ( cT4aN2). All three patients' growth was 4-6 cm from the anal verge. We have treated with Chemoradiotherapy to dose of 45Gy/25 Fractions to elective nodal regions (Inguinal node in anal canal Involvement)and Primary and mesorectum (Phase I) followed by 14.4Gy/8 Fractions to Primary and Mesorectum(Phase II) to a total dose of 59.4Gy/33 Fractions with concurrent chemotherapy Tab Capecitabine 825mg/m2 PO BD with Radiation therapy. After 6 weeks of completion of Chemoradiotherapy, advised six cycles of consolidative chemotherapy, CAPEOX regimen, Oxaliplatin 130mg/m2 on day 1 and Capecitabine 1000mg/m2 PO BD on days 1-14 repeated on a 21-day cycle for a total of six cycles. The primary endpoint is Disease-free survival (DFS); the secondary endpoint is adverse events related to chemoradiotherapy. Radiation toxicity is assessed by RTOG criteria, and chemotherapy toxicity is assessed by Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Results: After 6 weeks of completion of Chemoradiotherapy, we did PET-CT of all three patients; all three patients had a clinically complete response and we advised 6 cycles of consolidative chemotherapy. After completion of consolidative chemotherapy, again PET-CT and sigmoidoscopy, all three patients had complete response on PET-CT and no lesions on sigmoidoscopy and kept all three patients on wait and watch.2 patients had Grade 2 skin toxicities,1 patient had Grade 1 skin toxicity, .2 patients had Grade 2 lower GI toxicities, and 1 patient had Grade lower GI toxicity, both according to RTOG criteria. 3 patients had Grade 2 diarrhea due to capecitabine, and 1 patient had Grade 1 thrombocytopenia due to oxaliplatin assessed by Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Conclusion: Sphincter Preservation is possible with this regimen in those who don’t want to opt for surgery or in case of low-lying rectal cancer.

Keywords: locally advanced rectal cancer, sphincter preservation, chemoradiotherapy, consolidative chemotherapy

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Authors: Marin Kanarev, Delyan Stoyanov, Ivanna Popova, Nadezhda Petrova

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Thanks to increased survival rates in patients bearing oncological malignancies due to recent developments in anti-cancer therapies and diagnostic techniques, observation of clinical cases of metachronous cancers is more common and can provide more in-depth knowledge of their development and, as a result, help clinicians apply suitable therapy. This unusual case of three metachronous tumors presented the opportunity to follow their occurrence, progression, and treatment thoroughly. A 77-year-old male presented with carcinoma ventriculi of the pylorus region, which was surgically removed via upper subtotal stomach resection, a lateral antecolical gastro-enteroanastomosis, and a subsequent Braun anastomosis. An EOX chemotherapy regimen followed. A CT scan four months later showed no indication of recurrence or dissemination. The same scan, performed as a part of the follow-up plan two years later, showed an indication of neoplastic growth in the urinary bladder. After the patient had been directed to a urologist, the suspicion was confirmed, and the growth was histologically diagnosed as a carcinoma of the urinary bladder. An immunohistochemistry test showed an expression of PDL1 of less than 5%, which resulted in treatment with GemCis chemotherapy regimen that led to full remission. Two years and seven months after the first surgery, a CT scan showed again that the two carcinomas were gone. However, four months later, elevated tumor markers prompted a PET/CT scan, which showed data indicative of recurring neoplastic growth in the region of the stomach cardia. It was diagnosed as an adenocarcinoma infiltrating the esophagus. Preoperative chemotherapy with the ECF regimen was completed in four courses, and a CT scan showed no progression of the disease. In less than a month after therapy, the patient underwent laparotomy, debridement, gastrectomy, and a subsequent mechanical terminal-lateral esophago-jejunoanasthomosis. It was verified that the tumor originated from metastasis from the carcinoma ventriculi, which was located in the pylorus. In conclusion, this case report highlights the importance of patient follow-up and studying recurring neoplastic growth. Despite the absence of symptoms, clinicians should maintain a high level of suspicion when evaluating the patient data and choosing the most suitable therapy.

Keywords: carcinoma, follow-up, metachronous, neoplastic growth, recurrence

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Authors: Atefeh Abdollahi, Maryam Bahreini, Babak Choobi Anzali, Fatemeh Rasooli

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Introduction: Triage becomes the main part of organization of care in Emergency department (ED)s. It is used to describe the sorting of patients for treatment priority in ED. The accurate triage of injured patients has reduced fatalities and improved resource usage. Besides, the nurses’ knowledge and skill are important factors in triage decision-making. The ability to define an appropriate triage level and their need for intervention is crucial to guide to a safe and effective emergency care. Methods: This is a prospective cross-sectional study designed for emergency nurses working in four public university hospitals. Five triage workshops have been conducted every three months for emergency nurses based on a standard triage Emergency Severity Index (ESI) IV slide set - approved by Iranian Ministry of Health. Most influential items on triage performance were discussed through brainstorming in workshops which then, were peer reviewed by five emergency physicians and two head registered nurses expert panel. These factors that might distract nurse’ attention from proper decisions included patients’ past medical diseases, the natural tricks of triage and system failure. After permission had been taken, emergency nurses participated in the study and were given the structured questionnaire. Data were analysed by SPSS 21.0. Results: 92 emergency nurses enrolled in the study. 30 % of nurses reported the past history of chronic disease as the most influential confounding factor to ascertain triage level, other important factors were the history of prior admission, past history of myocardial infarction and heart failure to be 20, 17 and 11 %, respectively. Regarding the concept of difficulties in triage practice, 54.3 % reported that the discussion with patients and family members was difficult and 8.7 % declared that it is hard to stay in a single triage room whole day. Among the participants, 45.7 and 26.1 % evaluated the triage workshops as moderately and highly effective, respectively. 56.5 % reported overcrowding as the most important system-based difficulty. Nurses were mainly doubtful to differentiate between the triage levels 2 and 3 according to the ESI VI system. No significant correlation was found between the work record of nurses in triage and the uncertainty in determining the triage level and difficulties. Conclusion: The work record of nurses hardly seemed to be effective on the triage problems and issues. To correct the deficits, training workshops should be carried out, followed by continuous refresher training and supportive supervision.

Keywords: assessment, education, nurse, triage

Procedia PDF Downloads 211

Authors: Rosa Tsegaye Aga, Xuan Jiang, Pavel Vazquez Faci, Siqing Liu, Simon Rayner, Endalkachew Alemu, Markos Abebe

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Tuberculosis (TB) is a major cause of disease globally. In most cases, TB is treatable and curable, but only with the proper treatment. There is a time when drug-resistant TB occurs when bacteria become resistant to the drugs that are used to treat TB. Current strategies to identify drug-resistant TB bacteria are laboratory-based, and it takes a longer time to identify the drug-resistant bacteria and treat the patient accordingly. But machine learning (ML) and data science approaches can offer new approaches to the problem. In this study, we propose to develop an ML-based model to predict the antibiotic resistance phenotypes of TB isolates in minutes and give the right treatment to the patient immediately. The study has been using the whole genome sequence (WGS) of TB isolates as training data that have been extracted from the NCBI repository and contain different countries’ samples to build the ML models. The reason that different countries’ samples have been included is to generalize the large group of TB isolates from different regions in the world. This supports the model to train different behaviors of the TB bacteria and makes the model robust. The model training has been considering three pieces of information that have been extracted from the WGS data to train the model. These are all variants that have been found within the candidate genes (F1), predetermined resistance-associated variants (F2), and only resistance-associated gene information for the particular drug. Two major datasets have been constructed using these three information. F1 and F2 information have been considered as two independent datasets, and the third information is used as a class to label the two datasets. Five machine learning algorithms have been considered to train the model. These are Support Vector Machine (SVM), Random forest (RF), Logistic regression (LR), Gradient Boosting, and Ada boost algorithms. The models have been trained on the datasets F1, F2, and F1F2 that is the F1 and the F2 dataset merged. Additionally, an ensemble approach has been used to train the model. The ensemble approach has been considered to run F1 and F2 datasets on gradient boosting algorithm and use the output as one dataset that is called F1F2 ensemble dataset and train a model using this dataset on the five algorithms. As the experiment shows, the ensemble approach model that has been trained on the Gradient Boosting algorithm outperformed the rest of the models. In conclusion, this study suggests the ensemble approach, that is, the RF + Gradient boosting model, to predict the antibiotic resistance phenotypes of TB isolates by outperforming the rest of the models.

Keywords: machine learning, MTB, WGS, drug resistant TB

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Authors: C. Silveira, A. Ascenso, J. Ferreira, A. I. Miranda, P. Tuccella, G. Curci

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Poor air quality is one of the main environmental causes of premature deaths worldwide, and mainly in cities, where the majority of the population lives. It is a consequence of successive land cover (LC) and use changes, as a result of the intensification of human activities. Knowing these landscape modifications in a comprehensive spatiotemporal dimension is, therefore, essential for understanding variations in air pollutant concentrations. In this sense, the use of air quality models is very useful to simulate the physical and chemical processes that affect the dispersion and reaction of chemical species into the atmosphere. However, the modelling performance should always be evaluated since the resolution of the input datasets largely dictates the reliability of the air quality outcomes. Among these data, the updated LC is an important parameter to be considered in atmospheric models, since it takes into account the Earth’s surface changes due to natural and anthropic actions, and regulates the exchanges of fluxes (emissions, heat, moisture, etc.) between the soil and the air. This work aims to evaluate the performance of the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem), when different LC classifications are used as an input. The influence of two LC classifications was tested: i) the 24-classes USGS (United States Geological Survey) LC database included by default in the model, and the ii) CLC (Corine Land Cover) and specific high-resolution LC data for Portugal, reclassified according to the new USGS nomenclature (33-classes). Two distinct WRF-Chem simulations were carried out to assess the influence of the LC on air quality over Europe and Portugal, as a case study, for the year 2015, using the nesting technique over three simulation domains (25 km², 5 km² and 1 km² horizontal resolution). Based on the 33-classes LC approach, particular emphasis was attributed to Portugal, given the detail and higher LC spatial resolution (100 m x 100 m) than the CLC data (5000 m x 5000 m). As regards to the air quality, only the LC impacts on tropospheric ozone concentrations were evaluated, because ozone pollution episodes typically occur in Portugal, in particular during the spring/summer, and there are few research works relating to this pollutant with LC changes. The WRF-Chem results were validated by season and station typology using background measurements from the Portuguese air quality monitoring network. As expected, a better model performance was achieved in rural stations: moderate correlation (0.4 – 0.7), BIAS (10 – 21µg.m^-3) and RMSE (20 – 30 µg.m^-3), and where higher average ozone concentrations were estimated. Comparing both simulations, small differences grounded on the Leaf Area Index and air temperature values were found, although the high-resolution LC approach shows a slight enhancement in the model evaluation. This highlights the role of the LC on the exchange of atmospheric fluxes, and stresses the need to consider a high-resolution LC characterization combined with other detailed model inputs, such as the emission inventory, to improve air quality assessment.

Keywords: land use, spatial resolution, WRF-Chem, air quality assessment

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Authors: Kamrun Nahar Koly, Saimul Islam

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Overweight and obesity is increasing at an alarming rate and a leading risk factor for morbidity throughout the world. In a country like Bangladesh where under nutrition and overweight both co-exist at the same time, but this issue has been underexplored as expected. The aim of the present study was to assess the knowledge, attitudes and identify the barriers of the physicians regarding overweight and obesity management on an urban hospital of Dhaka city in Bangladesh. A simple cross sectional study was conducted at two selected government and two private hospital to assess the knowledge, attitude and common barriers regarding overweight and obesity management among healthcare professionals. One hundred and fifty five physicians were surveyed. A standard questionnaire was constructed in local language and interview was administrated. Among the 155 physicians, majority 53 (34.20%) were working on SMC, 36 (23.20%) from DMC, 33 (21.30%) were based on SSMC and the rest 33 (21.30%) were from HFRCMH. Mean age of the study physicians were 31.88±5.92. Majority of the physicians 80 (51.60%) were not able to answer the correct prevalence of obesity but also a substantial number of them 75(48.40%) could mark the right answer. Among the physicians 150 (96.77%) reported BMI as a diagnostic index for overweight and obesity, where as 43 (27.74%) waist circumference, 30 (19.35%) waist hip ratio and 26 (16.77%) marked mid-arm circumference. A substantial proportion 71 (46.70%) of the physicians thought that they do not have much to do controlling weight problem in Bangladesh context though it has been opposed by 42 (27.60%) of the physicians and 39(25.70%) was neutral to comment. The majority of them 147 (96.1%) thought that a family based education program would be beneficial followed by 145 (94.8%) physicians mentioned about raising awareness among mothers as she is the primary caregiver. The idea of a school based education program will also help to early intervene referred by 142 (92.8%) of the physicians. Community based education program was also appreciated by 136 (89.5%) of the physicians. About 74 (47.7%) of them think that the patients still lack in motivation to maintain their weight properly at the same time too many patients to deal with can be a barrier as well assumed by 73 (47.1%) of them. Lack of national policy or management guideline can act as an obstacle told by 60 (38.7%) of the physicians. The relationship of practicing as a part of the general examination and chronic disease management was statistically significant (p<0.05) with physician occupational status. As besides, perceived barriers like lack of parents support, lack of a national policy was statistically significant (p<0.05) with physician occupational status. For the young physician, more training programme will be needed to transform their knowledge and attitude into practice. However, several important barriers interface for the physician treatment efforts and need to address.

Keywords: obesity management, physician, awareness, barriers, Bangladesh

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Authors: Nicholas Fletcher, Zachary Houston, Yongmei Zhao, Christopher Howard, Kristofer Thurecht

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One promising approach to enhance nanomedicine therapeutic efficacy is to include a targeting agent, such as an antibody, to increase accumulation at the tumor site. However, the application of such targeted nanomedicines remains limited, in part due to difficulties involved with biomolecule conjugation to synthetic nanomaterials. One approach recently developed to overcome this has been to engineer bispecific antibodies (BsAbs) with dual specificity, whereby one portion binds to methoxy polyethyleneglycol (mPEG) epitopes present on synthetic nanomedicines, while the other binds to molecular disease markers of interest. In this way, noncovalent complexes of nanomedicine core, comprising a hyperbranched polymer (HBP) of primarily mPEG, decorated with targeting ligands are able to be produced by simple mixing. Further work in this area has now demonstrated such complexes targeting the breast cancer marker epidermal growth factor receptor (EGFR) to show enhanced binding to tumor cells both in vitro and in vivo. Indeed the enhanced accumulation at the tumor site resulted in improved therapeutic outcomes compared to untargeted nanomedicines and free chemotherapeutics. The current work on these BsAb-HBP conjugates focuses on further probing antibody-nanomaterial interactions and demonstrating broad applicability to a range of cancer types. Herein are reported BsAb-HBP materials targeted towards prostate-specific membrane antigen (PSMA) and study of their behavior in vivo using ⁸⁹Zr positron emission tomography (PET) in a dual-tumor prostate cancer xenograft model. In this model mice bearing both PSMA+ and PSMA- tumors allow for PET imaging to discriminate between nonspecific and targeted uptake in tumors, and better quantify the increased accumulation following BsAb conjugation. Also examined is the potential for formation of these targeted complexes in situ following injection of individual components? The aim of this approach being to avoid undesirable clearance of proteinaceous complexes upon injection limiting available therapeutic. Ultimately these results demonstrate BsAb functionalized nanomaterials as a powerful and versatile approach for producing targeted nanomedicines for a variety of cancers.

Keywords: bioengineering, cancer, nanomedicine, polymer chemistry

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Authors: Yuvraj Singh Dangi, Brajesh Kumar Tiwari, Ashok Kumar Jain, Kamta Prasad Namdeo

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The potential use of liposomes as drug carriers by i.v. injection is limited by their low stability in blood stream. Firstly, phospholipid exchange and transfer to lipoproteins, mainly HDL destabilizes and disintegrates liposomes with subsequent loss of content. To avoid the pain associated with injection and to obtain better patient compliance studies concerning various dosage forms, have been developed. Conventional liposomes (unilamellar and multilamellar) have certain drawbacks like low entrapment efficiency, stability and release of drug after single breach in external membrane, have led to the new type of liposomal systems. The challenge has been successfully met in the form of Double Liposomes (DL). DL is a recently developed type of liposome, consisting of smaller liposomes enveloped in lipid bilayers. The outer lipid layer of DL can protect inner liposomes against various enzymes, therefore DL was thought to be more effective than ordinary liposomes. This concept was also supported by in vitro release characteristics i.e. DL formation inhibited the release of drugs encapsulated in inner liposomes. DL consists of several small liposomes encapsulated in large liposomes, i.e., multivesicular vesicles (MVV), therefore, DL should be discriminated from ordinary classification of multilamellar vesicles (MLV), large unilamellar vesicles (LUV), small unilamellar vesicles (SUV). However, for these liposomes, the volume of inner phase is small and loading volume of water-soluble drugs is low. In the present study, the potential of phosphatidylethanolamine (PE) lipid anchored double liposomes (DL) to incorporate two drugs in a single system is exploited as a tool to augment the H. pylori eradication rate. Preparation of DL involves two steps, first formation of primary (inner) liposomes by thin film hydration method containing one drug, then addition of suspension of inner liposomes on thin film of lipid containing the other drug. The success of formation of DL was characterized by optical and transmission electron microscopy. Quantitation of DL-bacterial interaction was evaluated in terms of percent growth inhibition (%GI) on reference strain of H. pylori ATCC 26695. To confirm specific binding efficacy of DL to H. pylori PE surface receptor we performed an agglutination assay. Agglutination in DL treated H. pylori suspension suggested selectivity of DL towards the PE surface receptor of H. pylori. Monotherapy is generally not recommended for treatment of a H. pylori infection due to the danger of development of resistance and unacceptably low eradication rates. Therefore, combination therapy with amoxicillin trihydrate (AMOX) as anti-H. pylori agent and ranitidine bismuth citrate (RBC) as antisecretory agent were selected for the study with an expectation that this dual-drug delivery approach will exert acceptable anti-H. pylori activity.

Keywords: Helicobacter pylorI, amoxicillin trihydrate, Ranitidine Bismuth citrate, phosphatidylethanolamine, multi vesicular systems

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Authors: Madhvi Bhayani

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Introduction: Due to the rapid pace of urbanization, the urban health issues have become one of the significant threats to future development in India. It also poses serious repercussions on the citizen’s health. As urbanization in India is increasing at an unprecedented rate and it has generated the urban health crisis among the city dwellers especially the urban poor. The increasing proportion of the urban poor and vulnerable to the health indicators worse than the rural counterparts, they face social and financial barriers in accessing healthcare services and these conditions make human health at risk. The Local as well as the State and National governments are alike tackling with the challenges of urbanization as it has become very essential for the government to provide the basic necessities and better infrastructure that make life in cities safe and healthy. Thus, the paper argues that if no major realistic steps are taken with immediate effect, the citizens will face a huge burden of health hazards. Aim: This paper attempts to analyze the current infrastructure, government planning, and its future policy, it also discusses the challenges and outcomes of urbanization on health and its impact on it and it will also predict the future trend with regard to disease burden in the urban areas. Methods: The paper analyzes on the basis of the secondary data by taking into consideration the connection between the Rapid Urbanization and Public Health Challenges, health and health care system and its services delivery to the citizens especially to the urban poor. Extensive analyses of government census reports, health information and policy, the government health-related schemes, urban development and based on the past trends, the future status of urban infrastructure and health outcomes are predicted. The social-economic and political dimensions are also taken into consideration from regional, national and global perspectives, which are incorporated in the paper to make realistic predictions for the future. Findings and Conclusion: The findings of the paper show that India suffers a lot due to the double burden of rapidly increasing in diseases and also growing health inequalities and disparities in health outcomes. Existing tools of governance of urban health are falling short to provide the better health care services. They need to strengthen the collaboration and communication among the state, national and local governments and also with the non-governmental partners. Based on the findings the policy implications are then described and areas for future research are defined.

Keywords: health care, urbanization, urban health, service delivery

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Authors: Vipin Kumar Verma, Neeta Sehgal, Om Prakash

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Cyprinus carpio has a wide spread occurrence in the lakes and rivers of Europe and Asia. Heavy losses in natural environment due to anthropogenic activities, including pollution as well as pathogenic diseases have landed this fish in IUCN red list of vulnerable species. The significance of a suitable diet in preserving the health status of fish is widely recognized. In present study, artificial feed supplemented with leaves of two weed plants, Eichhornia crassipes and Ricinus communis were evaluated for their role on the fish immune system. To achieve this objective fish were acclimatized to laboratory conditions (25 ± 1 °C; 12 L: 12D) for 10 days prior to start of experiment and divided into 4 groups: non-challenged (negative control= A), challenged [positive control (B) and experimental (C & D)]. Group A, B were fed with non-supplemented feed while group C & D were fed with feed supplemented with 5% Eichhornia crassipes and 5% Ricinus communis respectively. Supplemented feeds were evaluated for their effect on growth, health, immune system and disease resistance in fish when challenged with Vibrio harveyi. Fingerlings of C. carpio (weight, 2.0±0.5 g) were exposed with fresh overnight culture of V. harveyi through bath immunization (concentration 2 Χ 105) for 2 hours on 10 days interval for 40 days. The growth was monitored through increase in their relative weight. The rate of mortality due to bacterial infection as well as due to effect of feed was recorded accordingly. Immune response of fish was analyzed through differential leucocyte count, percentage phagocytosis and phagocytic index. The effect of V. harveyi on fish organs were examined through histo-pathological examination of internal organs like spleen, liver and kidney. The change in the immune response was also observed through gene expression analysis. The antioxidant potential of plant extracts was measured through DPPH and FRAP assay and amount of total phenols and flavonoids were calculates through biochemical analysis. The chemical composition of plant’s methanol extracts was determined by GC-MS analysis, which showed presence of various secondary metabolites and other compounds. Investigation revealed immuno-modulatory effect of plants, when supplemented with the artificial feed of fish.

Keywords: immuno-modulation, gc-ms, Cyprinus carpio, Eichhornia crassipes, Ricinus communis

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Authors: Ahmed Slami, Med El Amine Brixi Nigassa, Nassima Labdelli, Sofiane Soulimane, Arnaud Pothier

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Many people suffer from diabetes, a disease marked by abnormal levels of sugar in the blood; 285 million people have diabetes, 6.6% of the world adult population (in 2010), according to the International Diabetes Federation. Insulin medicament is invented to be injected into the body. Generally, the injection requires the patient to do it manually. However, in many cases he will be unable to inject the drug, saw that among the side effects of hyperglycemia is the weakness of the whole body. The researchers designed a medical device that injects insulin too autonomously by using micro-pumps. Many micro-pumps of concepts have been investigated during the last two decades for injecting molecules in blood or in the body. However, all these micro-pumps are intended for slow infusion of drug (injection of few microliters by minute). Now, the challenge is to develop micro-pumps for fast injections (1 microliter in 10 seconds) with accuracy of the order of microliter. Recently, studies have shown that only piezoelectric actuators can achieve this performance, knowing that few systems at the microscopic level were presented. These reasons lead us to design new smart microsystems injection drugs. Therefore, many technological advances are still to achieve the improvement of materials to their uses, while going through their characterization and modeling action mechanisms themselves. Moreover, it remains to study the integration of the piezoelectric micro-pump in the microfluidic platform features to explore and evaluate the performance of these new micro devices. In this work, we propose a new micro-pump model based on piezoelectric actuation with a new design. Here, we use a finite element model with Comsol software. Our device is composed of two pumping chambers, two diaphragms and two actuators (piezoelectric disks). The latter parts will apply a mechanical force on the membrane in a periodic manner. The membrane deformation allows the fluid pumping, the suction and discharge of the liquid. In this study, we present the modeling results as function as device geometry properties, films thickness, and materials properties. Here, we demonstrate that we can achieve fast injection. The results of these simulations will provide quantitative performance of our micro-pumps. Concern the spatial actuation, fluid rate and allows optimization of the fabrication process in terms of materials and integration steps.

Keywords: COMSOL software, piezoelectric, micro-pump, microfluidic

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Authors: A. Gazdzinska, P. Jagielski, E. Kaniewska, S. P. Gazdzinski, M. Wylezol

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Background: In the multi-factor etiology of obesity, an increasing degree of importance is attributed to behavioral factors. Lifestyle and health-oriented behaviors heavily influence the treatment of multiple diseases, including obesity. However, only a few studies evaluated health-related behaviors exhibited by patients qualified for bariatric surgery. None of them was performed in Polish population. Aim: Assessment of health behaviors of obese patients according to the degree of mood disorders. Method: The study involved 93 patients (66 females) who were qualified for bariatric surgery in the Department of Surgery of the Military Institute of Aviation Medicine in Warsaw. Diagnostic instrument was the Juczynski’s Inventory of Health Behavior (HBI), which evaluates health behavior in four categories, i.e. proper nutrition habits (PNH), preventive behavior (PH), health practices (HP) and positive mental attitude (PMA). The average HBI falls in the range between 24 and 120 points, for each category of health behaviors fall between 1 and 5 (higher score means higher severity declared healthy behaviors). The depressive symptoms in patients were assessed with Beck Depression Inventory (BDI). All analyses were conducted using STATISTICA 12. Results: The average age was 44.2 ± 11.5 years, mean BMI was 44.3 ± 10.5 kg/m2 and 46.8 ± 7.6 kg/m2, in females and males respectively. According to BDI, 32% patients had mild level of depression, 10% moderate and 14% severe depression. BDI scores were not different between females and males. Low results with regard to the health behaviors declared were obtained by 35.5 % of patients, medium by 44.0%, while high ones by only 20.5%. On average, patients gained 3.28 points in PNH, 3.37 points in PH, 3.29 points in HP, while 3.42 in the PMA category, showing average intensity of these behaviors. These health behaviors were practiced significantly more often by women (p = 0.04). The average HBI was 80.2; with average score of 81.5 for females and 76.6 for males, respectively (p = 0.03). Women were better in the PNH category (p = 0.02). A positive correlation was found between age and all categories of health behaviors, in particular PNH (R = 0.38; p = 0.001), PH (R = 0.26; p = 0.01), HP (R = 0.27; p = 0.01) and PMA (R = 0.24; p = 0.02), independent of gender. The severity of depression had a significant impact only on the behaviors associated with proper eating habits, which saw a negative correlation between BDI scores and the PNH (R = -0.21; p = 0.04). Conclusions: Majority of morbidly obese patients qualified for bariatric surgery obtained low to average scores in health behavior questionnaire. However, these results are similar in comparison with the Polish adult population. In accordance to these results, it seems that healthy behaviors, among them eating behaviors, do not appear to be a cause of obesity epidemic or they might be acquired when the disease is already underway. Female gender and age had a positive effect, and depression had a negative effect on the level of health behaviors among patients qualified for bariatric surgery.

Keywords: depression, habits, health behaviours, obesity

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Authors: Taleb Lotfi, Benarbia Maheidine, Allam Hamza, Boutira Fatima, Boukerche Abdelbaki

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Introduction and purpose of the study: This is a retrospective single-center study with an analytical aim to determine the prognostic factors for relapse in patients treated with radiotherapy after total laryngectomy with lymph node dissection for laryngeal cancer at the Emir Abdelkader cancer center in Oran (Algeria). Material and methods: During the study period from January 2014 to December 2018, eighty-nine patients (n=89) with squamous cell carcinoma of the larynx were treated with postoperative radiotherapy. Relapse-free survival was studied in the univariate analysis according to pre-treatment criteria using Kaplan-Meier survival curves. We performed a univariate analysis to identify relapse factors. Statistically significant factors have been studied in the multifactorial analysis according to the Cox model. Results and statistical analysis: The average age was 62.7 years (40-86 years). It was a squamous cell carcinoma in all cases. Postoperatively, the tumor was classified as pT3 and pT4 in 93.3% of patients. Histological lymph node involvement was found in 36 cases (40.4%), with capsule rupture in 39% of cases, while the limits of surgical excision were microscopically infiltrated in 11 patients (12.3%). Chemotherapy concomitant with radiotherapy was used in 67.4% of patients. With a median follow-up of 57 months (23 to 104 months), the probabilities of relapse-free survival and five-year overall survival are 71.2% and 72.4%, respectively. The factors correlated with a high risk of relapse were locally advanced tumor stage pT4 (p=0.001), tumor site in case of subglottic extension (p=0.0003), infiltrated surgical limits R1 (p=0.001), l lymph node involvement (p=0.002), particularly in the event of lymph node capsular rupture (p=0.0003) as well as the time between surgery and adjuvant radiotherapy (p=0.001). However, in the subgroup analysis, the major prognostic factors for disease-free survival were subglottic tumor extension (p=0.001) and time from surgery to adjuvant radiotherapy (p=0.005). Conclusion: Combined surgery and postoperative radiation therapy are effective treatment modalities in the management of laryngeal cancer. Close cooperation of the entire cervicofacial oncology team is essential, expressed during a multidisciplinary consultation meeting, with the need to respect the time between surgery and radiotherapy.

Keywords: laryngeal cancer, laryngectomy, postoperative radiotherapy, survival

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Authors: Sajee A. Gamage, Champa J. Wijesinghe, Patricia Burtner, Ananda R. Wickremasinghe

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Background: Teachers working in the context of special education have an enormous responsibility of enhancing performance skills of children in their classroom settings. Fine Motor Skills (FMS) are essential functional skills for children to gain independence in Activities of Daily Living. Children with Down Syndrome (DS) are predisposed to specific challenges due to deficits in FMS. This study is aimed to determine the teachers’ experience on improving FMS of children with DS in the context of special education of Southern Province, Sri Lanka. Methodology: A cross-sectional study was conducted among all consenting eligible teachers (n=147) working in the context of special education in government schools of Southern Province of Sri Lanka. A self-administered questionnaire was developed based on literature and expert opinion to assess teachers’ experience regarding deficits of FMS, limitations of classroom activity performance and barriers to improve FMS of children with DS. Results: Approximately 93% of the teachers were females with a mean age ( ± SD) of 43.1 ( ± 10.1) years. Thirty percent of the teachers had training in special educationand 83% had children with DS in their classrooms. Major deficits of FMS reported were deficits in grasping (n=116; 79%), in-hand manipulation (n=103; 70%) and bilateral hand use (n=99; 67.3%). Paperwork (n=70; 47.6%), painting (n=58; 39.5%), scissor work (n=50; 34.0%), pencil use for writing (n=45; 30.6%) and use of tools in the classroom (n=41; 27.9%) were identified as major classroom performance limitations of children with DS. Parental factors (n=67; 45.6%), disease specific characteristics (n=58; 39.5%) and classroom factors (n=36; 24.5%), were identified as major barriers to improve FMS in the classroom setting. Lack of resources and standard tools, social stigma and late school admission were also identified as barriers to FMS training. Eighty nine percent of the teachers informed that training fine motor activities in a special education classroom was more successful than work with normal classroom setting. Conclusion: Major areas of FMS deficits were grasping, in-hand manipulation and bilateral hand use; classroom performance limitations included paperwork, painting and scissor work of children with DS. Teachers recommended regular practice of fine motor activities according to individual need. Further research is required to design a culturally specific FMS assessment tool and intervention methods to improve FMS of children with DS in Sri Lanka.

Keywords: classroom activities, Down syndrome, experience, fine motor skills, special education, teachers

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Authors: Suat Erel, Gozde Gur

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Background: Recently a supramalleolar type of dynamic ankle foot orthosis (DAFO) has been increasingly used to support all of the dynamic arches of the foot and redistribute the pressure under the plantar surface of the foot to reduce the muscle tone. DAFO helps to maintain balance and postural control by providing stability and proprioceptive feedback in children with disease like Cerebral Palsy, Muscular Dystrophies, Down syndrome, and congenital hypotonia. Aim: The aim of this study was to investigate the role of Dynamic ankle foot orthosis (DAFO) on temporo-spatial parameters of gait and balance in three children with hereditary spastic paraparesis (HSP). Material Method: 13, 14, and 8 years old three children with HSP were included in the study. To provide correction on weight bearing and to improve gait, DAFO was made. Lower extremity spasticity (including gastocnemius, hamstrings and hip adductor muscles) using modified Ashworth Scale (MAS) (0-5), The temporo-spatial gait parameters (walking speed, cadence, base of support, step length) and Timed Up & Go test (TUG) were evaluated. All of the assessments about gait were compared with (with DAFO and shoes) and without DAFO (with shoes only) situations. Also after six months follow up period, assessments were repeated by the same physical therapist. Results: MAS scores for lower extremity were between “2-3” for the first child, “0-2” for the second child and “1-2” for the third child. TUG scores (sec) decreased from 20.2 to 18 for case one, from 9.4 to 9 for case two and from 12,4 to 12 for case three in the condition with shoes only and also from 15,2 to 14 for case one, from 7,2 to 7,1 for case two and from 10 to 7,3 for case three in the condition with DAFO and shoes. Gait speed (m/sec) while wearing shoes only was similar but while wearing DAFO and shoes increased from 0,4 to 0,5 for case one, from 1,5 to 1,6 for case two and from 1,0 to 1,2 for case three. Base of support scores (cm) wearing shoes only decreased from 18,5 to 14 for case one, from 13 to 12 for case three and were similar as 11 for case two. While wearing DAFO and shoes, base of support decreased from 10 to 9 for case one, from 11,5 to 10 for case three and was similar as 8 for case two. Conclusion: The use of a DAFO in a patient with HSP normalized the temporo-spatial gait parameters and improved balance. Walking speed is a gold standard for evaluating gait quality. With the use of DAFO, walking speed increased in this three children with HSP. With DAFO, better TUG scores shows that functional ambulation improved. Reduction in base of support and more symmetrical step lengths with DAFO indicated better balance. These encouraging results warrant further study on wider series.

Keywords: dynamic ankle foot orthosis, gait, hereditary spastic paraparesis, balance in patient

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Madeleine Cox

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Objective: Discussion of diagnosis and management options for myometrial ectopic pregnancy Case: A 30 yo G1P0 presented to the emergency department with vaginal bleeding for the last 4 days. She had a positive home urine pregnancy test, confirmed with a serum HCG. When she presented for an ultrasound, there was no intrauterine pregnancy, no evidence of adnexal pregnancy, however, the anterior myometrium of the uterus was noted to be markedly abnormal. When she presented to the emergency department of a busy tertiary hospital in Queensland, she had a small amount of vaginal bleeding, was anxious but well, observations normal. Repeat blood testes demonstrated a serum HCG of 9246 IU/L, haemoglobin of 143g/L. The patient had an interesting history of a right oophorectomy and open myomectomy in another country. A repeat ultrasound again showed an abnormality within the myometrium of the uterus, which was initially reported as concerning for an AVM, or potentially invasive gestational trophoblastic disease. An MRI was organised 2 days later, which demonstrated a intramural/subserosal irregularity in the right lateral body measuring 35x38x42mm with peripheral enhancement and central cystic components, favouring a myometrial ectopic most likely at the site of previous myomectomy. Alternative diagnosis of AVM, GTD were considered less likely. After discussion with the patient, IV methotrexate was administered as an in patient 4 days after her initial presentation to emergency. After this, her HCG fell to 1236 IU/L on day 6 post treatment. Weekly reviews showed stable ultrasound appearances with a steadily dropping HCG level. A repeat MRI was performed 3 weeks after methotrexate administration which confirmed involution of the myometrial ectopic, however, showed ongoing progression of vascularity surrounding the site. Despite resolution of HCG, the patient persisted to have ongoing bleeding associated with this and went to have uterine artery embolisation. Follow up ultrasound showed resolution of abnormal vascularity and negative HCG levels. Conclusion: Myometrial ectopic pregnancies are a rare occurrence and require a multidisciplinary approach to achieve timely management for these patients. This patient was in a very well resourced setting with excellent access to Interventional Radiology and specialist Radiologists who could work together with the Obstetrics, Gynaecology, and Maternal Fetal Medicine team to provide multiple options of management which preserved her fertility. This case has a very good outcome, with the patient being referred back to our service 12 months later with an early intrauterine pregnancy.

Keywords: ectopic, pregnancy, miscarriage, gynaecology

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Authors: Mehrnaz Mostafavi

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Nanoliposomes, minute lipid-based vesicles at the nano-scale, show promise in the realm of photothermal therapy (PTT). This study presents an extensive overview of nanoliposomes in PTT, exploring their distinct attributes and the significant progress in this therapeutic methodology. The research delves into the fundamental traits of nanoliposomes, emphasizing their adaptability, compatibility with biological systems, and their capacity to encapsulate diverse therapeutic substances. Specifically, it examines the integration of light-absorbing materials, like gold nanoparticles or organic dyes, into nanoliposomal formulations, enabling their efficacy as proficient agents for photothermal treatment Additionally, this paper elucidates the mechanisms involved in nanoliposome-mediated PTT, highlighting their capability to convert light energy into localized heat, facilitating the precise targeting of diseased cells or tissues. This precise regulation of light absorption and heat generation by nanoliposomes presents a non-invasive and precisely focused therapeutic approach, particularly in conditions like cancer. The study explores advancements in nanoliposomal formulations aimed at optimizing PTT outcomes. These advancements include strategies for improved stability, enhanced drug loading, and the targeted delivery of therapeutic agents to specific cells or tissues. Furthermore, the paper discusses multifunctional nanoliposomal systems, integrating imaging components or targeting elements for real-time monitoring and improved accuracy in PTT. Moreover, the review highlights recent preclinical and clinical trials showcasing the effectiveness and safety of nanoliposome-based PTT across various disease models. It also addresses challenges in clinical implementation, such as scalability, regulatory considerations, and long-term safety assessments. In conclusion, this paper underscores the substantial potential of nanoliposomes in advancing PTT as a promising therapeutic approach. Their distinctive characteristics, combined with their precise ability to convert light into heat, offer a tailored and efficient method for treating targeted diseases. The encouraging outcomes from preclinical studies pave the way for further exploration and potential clinical applications of nanoliposome-based PTT.

Keywords: nanoliposomes, photothermal therapy, light absorption, heat conversion, therapeutic agents, targeted delivery, cancer therapy

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Authors: Sultan Çağırıcı, Arsida Bajrami, Beyza Aslan, Hacı Ali Erdoğan, Nejla Sözer Topçular, Dilek Bozkurt, Vildan Yayla

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Objective: Corticobasal syndrome (CBS) is phenotypically characterized by asymmetric rigidity, apraxia, alien-limb phenomenon, cortical sensory loss, dystonia and myoclonus. The underlying pathologies consists of corticobasal degeneration (CBD), progressive supra nuclear palsy, Alzheimer's, Creutzfeldt-Jakob and frontotemporal degeneration. CBD is a degenerative disease with clinical symptoms related to the prominent involvement of cerebral cortex and basal ganglia. CBD is a pathological diagnosis and antemortem clinical diagnosis may change many times. In this paper, we described the clinical features and discussed a cases diagnosed with symmetric CBS because of its rarity. Case: Seventy-five-year-old woman presented with a three years history of difficulty in speaking and reading. Involuntary hand jerks and slowness of movement also had began in the last six months. In the neurological examination the patient was alert but not fully oriented. The speech was non-fluent, word finding difficulties were present. Bilateral limited upgaze, bradimimia, bilateral positive cogwheel' rigidity but prominent in the right side, postural tremor and negative myoclonus during action on the left side were detected. Receptive language was normal but expressive language and repetition were impaired. Acalculia, alexia, agraphia and apraxia were also present. CSF findings were unremarkable except for elevated protein level (75 mg/dL). MRI revealed bilateral symmetric cortical atrophy prominent in the frontoparietal region. PET showed hypometabolism in the left caudate nucleus. Conclusion: The increase of data related to neurodegenerative disorders associated with dementia, movement disorders and other findings results in an expanded range of diagnosis and transitions between clinical diagnosis. When considered the age of onset, clinical symptoms, imaging findings and prognosis of this patient, clinical diagnosis was CBS and pathologic diagnosis as probable CBD. Imaging of CBD usually consist of typical asymmetry between hemispheres. Still few cases with clinical appearance of CBD may show symmetrical cortical cerebral atrophy. It is presented this case who was diagnosed with CBD although we found symmetrical cortical cerebral atrophy in MRI.

Keywords: symmetric cortical atrophy, corticobasal degeneration, corticobasal syndrome

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Authors: Lu-Chiu Huang, Pei-Pei Chen, Li-Chin Yu, Chiao-Wen Kuo, Tsui-Tao Liu, Rung-Chuang Feng

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Purpose: People put increasing emphasis on demands of medical quality and protecting their interests. Patients' or family's dissatisfaction with medical care may easily lead to medical dispute. Physician-family communication plays an essential role in medical care. A sound communication cannot only strengthen patients' belief in the medical team but make patient have definite insight into treatment course of the disease. A family meeting provides an effective platform for communication between clinical staff, patients and family. Decisions and consensuses formed in family meetings can promote patients' or family's satisfaction with medical care. Clinical staff's attitudes toward family meeting may determine behavioral intentions to hold family meeting. This study aims to explore clinical staff's difficulties in holding family meeting and evaluate how their attitudes and behavior influence the effect of family meetings. Methods: This was a cross-sectional study. It was conducted at a regional teaching hospital in Taipei city. The research team developed its own structural questionnaires, whose expert validity was checked by the nursing experts. Participants filled in the questionnaires online. Data were collected by convenience sampling. A total of 568 participants were invited. They included doctors, nurses, social workers, and so on. Results: 1) The average score of ‘clinical staff’s attitudes to family meetings’ was 5.15 (SD=0.898). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It indicated that clinical staff had positive attitudes toward family meetings, 2) The average score of ‘clinical staff’s behavior to family meetings’ was 5.61 (SD=0.937). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It meant clinical staff tended to have positive behavior at the family meeting, and 3) The average score of ‘Difficulty in conducting family meetings’ was 5.15 (SD=0.897). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. The higher the score was, the less difficulty the clinical staff felt. It demonstrated clinical staff felt less difficulty in conducting family meetings. Clinical staff's identification with family meetings brought favored effects. Persistent and active promotion for family meetings can bring patients and family more benefits. Implications for practice: Understanding clinical staff's difficulty in participating family meeting and exploring their attitudes or behavior toward physician-family communication are helpful to develop modes of interaction. Consequently, quality and satisfaction of physician-family communication can be increased.

Keywords: clinical staff, communication, family meeting, physician-family

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Authors: O. Katz-Shufan, T. Simon-Tuval, L. Sabag, L. Granek, D. R. Shahar

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Meals provided at catering systems are a common source of workers' nutrition and were found as contributing high amounts calories and fat. Thus, eating daily catering food can lead to overweight and chronic diseases. On the other hand, the institutional dining room may be an ideal environment for implementation of intervention programs that promote healthy eating. This may improve diners' lifestyle and reduce their prevalence of overweight, obesity and chronic diseases. The significance of this study is in developing an intervention program based on the diners’ dietary habits, preferences and their attitudes towards various intervention programs. In addition, a successful catering-based intervention program may have a significant effect simultaneously on a large group of diners, leading to improved nutrition, healthier lifestyle, and disease-prevention on a large scale. In order to develop the intervention program, we conducted a qualitative study. We interviewed 13 diners who eat regularly at catering systems, using a semi-structured interview. The interviews were recorded, transcribed and then analyzed by the thematic method, which identifies, analyzes and reports themes within the data. The interviews revealed several major themes, including expectation of diners to be provided with healthy food choices; their request for nutrition-expert involvement in planning the meals; the diners' feel that there is a conflict between sensory attractiveness of the food and its' nutritional quality. In the context of the catering-based intervention programs, the diners prefer scientific and clear messages focusing on labeling healthy dishes only, as opposed to the labeling of unhealthy dishes; they were interested in a nutritional education program to accompany the intervention program. Based on these findings, we have developed an intervention program that includes: changes in food served such as replacing several menu items and nutritional improvement of some of the recipes; as well as, environmental changes such as changing the location of some food items presented on the buffet, placing positive nutritional labels on healthy dishes and an ongoing healthy nutrition campaign, all accompanied by a nutrition education program. The intervention program is currently being tested for its impact on health outcomes and its cost-effectiveness.

Keywords: catering system, food services, intervention, nutrition policy, public health, qualitative research

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Authors: Siti Hajar Muhamad Rosli, Xin Yi Lim, Terence Yew Chin Tan, Muhammad nor Farhan Sa’At, Syazwani Sirdar Ali, Ami Fazlin Syed Mohamed

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A growing interest on therapeutic benefits of hemp (Cannabis sativa subsp. sativa) is evident in the pharmaceutical market, attributed to its lower levels of psychoactive constituent delta-9-tetrahydronannabidiol (THC). Deemed as a legal and safer alternative to its counterpart marijuana, the use of medicinal hemp is highly debatable as current scientific evidence on the efficacy for clinical use is yet to be established This study was aimed to provide an overview of the current landscape of hemp research, through recent clinical findings specific to the pharmacological properties of the hemp plant and its derived compounds. A systematic search was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis-ScR (PRISMA) checklist on electronic databases (MEDLINE, OVID, Cochrane Library Central, and Clinicaltrials.gov) for articles published from 2009 to 2019. With predetermined inclusion criteria, all human trials with hemp intervention were included. A total of 18 human trials were identified, investigating therapeutic effects on the neuronal, gastrointestinal, musculoskeletal and immune system, with sample sizes ranging from one to 194 subjects. Three randomised controlled trials showed hempseed pills (in Traditional Chinese Medicine formulation MaZiRenWan) consumption significantly improved spontaneous bowel movement in functional constipation. The use of commercial cannabidiol (CBD) sourced from hemp suggested benefits in cannabis dependence, epilepsy, and anxiety disorders. However, there was insufficient evidence to suggest analgesic or anxiolytics effects of hemp being equivalent to marijuana. All clinical trials reviewed varied in terms of test item formulation and standardisation, which made it challenging to confirm overall efficacy for a specific disease or condition. Published efficacy data on hemp are still at a preliminary level, with limited high quality clinical evidence for any specific therapeutic indication. With multiple variants of this plant having different phytochemical and bioactive compounds, future empirical research should focus on uniformity in experimental designs to further strengthen the notion of using medicinal hemp.

Keywords: cannabis, complementary medicine, hemp, herbal medicine.

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Authors: Xu Feifei

Abstract:

The prevalence of COVID-19 currently is the biggest challenge to improving people's quality of life. Its impact on the health-related quality of life (HRQoL) is highly uncertain and has not been summarized so far. The aim of the present systematic review was to assess and provide an up-to-date analysis of the impact of the COVID-19 pandemic on the HRQoL of participants who have been infected, have not been infected but isolated, frontline, with different diseases, and the general population. Therefore, an electronic search of the literature in PubMed databases was performed from 2019 to July 2022 (without date restriction). PRISMA guideline methodology was employed, and data regarding the HRQoL were extracted from eligible studies. Articles were included if they met the following inclusion criteria: (a) reports on the data collection of the health state utility values (HSUVs) related to COVID-19 from 2019 to 2021; (b) English language and peer-reviewed journals; and (c) original HSUV data; (d) using EQ-5D tool to quantify the HRQoL. To identify studies that reported the effects on COVID-19, data on the proportion of overall HSUVs of participants who had the outcome were collected and analyzed using a one-group meta-analysis. As a result, thirty-two studies fulfilled the inclusion criteria and, therefore, were included in the systematic review. A total of 45295 participants and provided 219 means of HSUVs during COVID-19 were included in this systematic review. The range of utility is from 0.224 to 1. The study included participants from Europe (n=16), North America (n=4), Asia (n=10), South America (n=1), and Africa (n=1). Twelve articles showed that the HRQoL of the participants who have been infected with COVID-19 (range of overall HSUVs from 0.6125 to 0.863). Two studies reported the population of frontline workers (the range of overall HSUVs from 0.82 to 0.93). Seven of the articles researched the participants who had not been infected with COVID-19 but suffered from morbidities during the pandemic (range of overall HSUVs from 0.5 to 0.96). Thirteen studies showed that the HRQoL of the respondents who have not been infected with COVID-19 and without any morbidities (range of overall HSUVs from 0.64 to 0.964). Moreover, eighteen articles reported the outcomes of overall HSUVs during the COVID-19 pandemic in different population groups. The estimate of overall HSUVs of direct COVID-19 experience population (n=1333) was 0.751 (95% CI 0.670 - 0.832, I2 = 98.64%); the estimate of frontline population (n=610) was 0.906 ((95% CI 0.854 – 0.957, I2 = 98.61%); participants with different disease (n=132) were 0.768 (95% CI 0.515 - 1.021, I2= 99.26%); general population without infection history (n=29,892) was 0.825 (95% CI 0.766 - 0.885, I2 =99.69%). Conclusively, taking into account these results, this systematic review might confirm that COVID-19 has a negative impact on the HRQoL of the infected population and illness population. It provides practical value for cost-effectiveness model analysis of health states related to COVID-19.

Keywords: COVID-19, health-related quality of life, meta-analysis, systematic review, utility value

Procedia PDF Downloads 63

Authors: Sandra K. Enriquez, Claudia Camargo, Jesús E. Olguín, Juan A. López, German Galindo

Abstract:

Currently companies have increased the number of disorders of cumulative trauma (CTDs), these are increasing significantly due to the Highly Repetitive Movements (HRM) performed in workstations, which causes economic losses to businesses, due to temporary and permanent disabilities of workers. This analysis focuses on the prevention of disorders caused by: repeatability, duration and effort; And focuses on reducing cumulative trauma disorders such as occupational diseases using sensory thermography as a noninvasive method, the above is to evaluate the injuries could have workers to perform repetitive motions. Objectives: The aim is to define rest periods or job rotation before they generate a CTD, this sensory thermography by analyzing changes in temperature patterns on wrists and elbows when the worker is performing HRM over a period of time 2 hours and 30 minutes. Information on non-work variables such as wrist and elbow injuries, weight, gender, age, among others, and work variables such as temperature workspace, repetitiveness and duration also met. Methodology: The analysis to 4 industrial designers, 2 men and 2 women to be specific was conducted in a business in normal health for a period of 12 days, using the following time ranges: the first day for every 90 minutes continuous work were asked to rest 5 minutes, the second day for every 90 minutes of continuous work were asked to rest 10 minutes, the same to work 60 and 30 minutes straight. Each worker was tested with 6 different ranges at least twice. This analysis was performed in a controlled room temperature between 20 and 25 ° C, and a time to stabilize the temperature of the wrists and elbows than 20 minutes at the beginning and end of the analysis. Results: The range time of 90 minutes working continuous and a rest of 5 minutes of activity is where the maximum temperature (Tmax) was registered in the wrists and elbows in the office, we found the Tmax was 35.79 ° C with a difference of 2.79 ° C between the initial and final temperature of the left elbow presented at the individual 4 during the 86 minutes, in of range in 90 minutes continuously working and rested for 5 minutes of your activity. Conclusions: It is possible with this alternative technology is sensory thermography predict ranges of rotation or rest for the prevention of CTD to perform HRM work activities, obtaining with this reduce occupational disease, quotas by health agencies and increasing the quality of life of workers, taking this technology a cost-benefit acceptable in the future.

Keywords: sensory thermography, temperature, cumulative trauma disorder (CTD), highly repetitive movement (HRM)

Procedia PDF Downloads 414