Search results for: mortality improvement

Authors: Harmeet Pal Singh Dhooria, Deepinder Chinna, UPS Sidhu, Alok Jain

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Serious infections caused by gram-negative bacteria are a significant cause of mortality and morbidity in the hospital setting. In acute care facilities like in intensive care units (ICUs), the intensity of antimicrobial use together with a population highly susceptible to infection, creates an environment, which facilitates both emergence and transmission of Extended Spectrum -lactamase (ESBL) producing Enterobacteriaceae species. The study was conducted in the Medical Intensive Care Unit (MICU) and the Pulmonary Critical Care Unit (PCCU) of the Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Out of a total of 1108 samples of urine, blood and respiratory tract secretions received for culture and sensitivity analysis from Medical Intensive Care Unit and Pulmonary Critical Care Unit, a total of 170 isolates of Enterobacteriaceae species were obtained which were then included in our study. Out of these 170 isolates, confirmed ESBL production was seen in 116 (68.24%) cases. E.coli was the most common species isolated (56.47%) followed by Klebsiella (32.94%), Enterobacter (5.88%), Citrobacter (3.53%), Enterobacter (0.59%) and Morganella (0.59%) among the total isolates. The rate of ESBL production was more in Klebsiella (78.57%) as compared to E.coli (60.42%). ESBL producers were found to be significantly more common in patients with prior history of hospitalization, antibiotic use, and prolonged ICU stay. Also significantly increased the prevalence of ESBL related infections was observed in patients with a history of catheterization or central line insertion but not in patients with the history of intubation. Patients who had an underlying malignancy had significantly higher prevalence of ESBL related infections as compared to other co-morbid illnesses. A slightly significant difference in the rate of mortality/LAMA was observed in the ESBL producer versus the non-ESBL producer group. The rate of mortality/LAMA was significantly higher in the ESBL related UTI but not in the ESBL related respiratory tract and bloodstream infections. ESBL producing isolates had significantly higher rates of resistance to Cefepime and Piperacillin/Tazobactum, and to non β-lactum antibiotics like Amikacin and Ciprofloxacin. The level of resistance to Imipenem was lower as compared to other antibiotics. However, it was noted that ESBL producing isolates had higher levels of resistance to Imipenem as compared to non-ESBL producing isolates. Conclusion- The prevalence of ESBL producing organisms was found to be very high (68.24%) among Enterobacteriaceae isolates in our ICU setting as among other ICU care settings around the world.

Keywords: enterobacteriaceae, extended spectrum B-lactamase (ESBL), ICU, antibiotic resistance

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Authors: M. J. Reis Lima, J. Oliveira, M. Brito, C. Lemos, A. Mascarenhas, E. Teixeira Lemos

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Hypertension is a common condition causing cardio and cerebrovascular complications. Portugal has one of the highest mortality rates from stroke and a high prevalence of hypertension. Systolic blood pressure (SBP) is an important risk factor for cardiovascular events (myocardial infarction and stroke) and premature mortality, particularly in the elderly population. The present study aims to estimate the prevalence of hypertension in a Portuguese population living in a coastal city and to identify some of its determinants (namely gender, age, the body mass index and physical activity frequency). A total of 91 adults who attended three pharmacies of a coastal city in the center of Portugal, between May and August of 2013 were evaluated. Attendants who reported to have diabetes or taking antihypertensive drugs in the 2 previous weeks were excluded from the study. Sociodemographic factors, BMI, habits of exercise and BP were assessed. Hypertension was defined as blood pressure ≥140/90 mmHg. The majority of the studied population was constituted by women (75.8%), with a mean age of 54.2±1.6 years old, married or living in civil union and that had completed secondary school or had higher education (40%). They presented a mean BMI of 26.2±4.76 Kg/m2. and were sedentary. The mean BP was 127.0±17.77mmHg- 74.69 ± 9.53. In this population, we found 4.3% of people with hypertension and 16.1% with normal high blood pressure. Men exhibit a tendency to present higher systolic blood pressure values than women. Of all the factors considered, SBP values also tended to be higher with age and higher BMI values. Despite the fact that the mean values of SBP did not present values higher than 140 mmHg we must be concerned because the studied population is undiagnosed for hypertension. Our study even with some limitations might be a prelude to the upcoming research about the underlying factors responsible for the occurrence of SBP.

Keywords: hypertension, age, exercise, obesity and gender

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Authors: M. Soltani, K. Pakzad, A. Haghigh-Khiyabani, M. Alavi, R. Naderi, M. Castex

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Effect of probiotic Bactocell (Pediococcus acidilactici) as a supplementary diet was studied on post-larvae 12-15 of white leg shrimp (Litopenaeus vannamei) (150000 PL/0.5 h pond, average body weight=0.02 g) growth performance under farm condition for 102 days at water quality parameters consisting of temperature at 30.5-36οC, dissolved oxygen 4.1-6.6 mg/l, salinity 40-54 g/l, turbidity 35-110 cm, ammonia 0.1-0.8 mg/l and nitrite 0.1-0.9 mg/l. Also, the resistance level of the treated shrimps was assessed against a virulent strain of Vibrio paraheamolyticus as intramuscular injection route at 1.4 x 106 cells/shrimp. Significantly higher growth rate (11.3±1.54 g) and lower feed conversion ratio (1.1) were obtained in shrimps fed diets supplemented with Bactocell at 350 g/ tone feed compared to other treatments of 250 g Bactocell/ton feed (10.8±2 g, 1.3), 500 g Bactocell/ton feed (10.3±1.7 g, 1.3) and untreated control (10.1±2 g, 1.4). Also, thermal growth coefficient (0.057%) and protein efficiency ratio (2.13) were significantly improved in shrimps fed diets supplemented with Bactocell at 350 g/ton feed compare to other groups. Shrimps fed diet supplemented with Bactocell at 350 g/tone feed showed significantly higher protein content (72.56%) in their carcass composition than treatments of 250 g/ton feed (65.9%), 500 g/ton feed (67.5%) and control group (65.9%), while the carcass contents of moisture, lipid and ash in all shrimp groups were not significantly affected by different concentrations of Bactocell. No mortality occurred in the experimentally infected shrimps fed with Bactocell at 500 g/tone feed after 7 hours post-challenge with V. parahemolyticus. The mortality levels of 100%, 40%, 50% and 70% were obtained in shrimps fed with 0.0, 500 g/tone feed, 350 g/ton feed and 250 g/ton feed, respectively 14 hours post-infection. Also, the cumulative mortalities were achieved in 100%, 92% and 81% in shrimps few with Bactocell at 500 g/ton feed, 250 g/ton feed and 350 g/ton feed, respectively.

Keywords: litopenaeus vannamei, vibrio paraheamolyticus, pediococcus acidilactici, growth performance, bactocell

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Authors: Pornthip Seangsanga

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Sepsis or septic shock needs urgent care because it is a cause of the high mortality rate if patients do not receive timely treatment. Songkhla Hospital does not have a clear system or clinical practice guidelines for treatment of patients with severe sepsis or septic shock, which contributes to the said problem.To compare clinical outcomes based on the protocol after using the clinical guidelines between the Emergency Room, Intensive Care Unit, and the Ward. This quasi-experimental study was conducted on the population and 50 subjects who were diagnosed with severe sepsis or septic shock from December 2013 to May 2014. The data were collected using a nursing care and referring record form for patients with severe sepsis or septic shock at Songkhla Hospital. The record form had been tested for its validity by three experts, and the IOC was 1.The mortality rate in patients with severe sepsis or septic shock who were moved from the ER to the ICU was significantly lower than that of those patients moved from the Ward to the ICU within 48 hours. This was because patients with severe sepsis or septic shock who were moved from the ER to the ICU received more fluid within the first six hours according to the protocol which helped patients to have adequate tissue perfusion within the first six hours, and that helped improve blood flow to the kidneys, and the patients’ urine was found to be with a higher quantity of 0.5 cc/kg/hr, than those patients who were moved from the Ward to the ICU. This study shows that patients with severe sepsis or septic shock need to be treated immediately. Using the clinical practice guidelines along with timely diagnosis and treatment based on the sepsis bundle in giving sufficient and suitable amount of fluid to help improve blood circulation and blood pressure can clearly prevent or reduce severity of complications.

Keywords: clinical practice guidelines, caring, septic shock, sepsis bundle protocol

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Authors: Fasil Wagnew, Kerri Viney, Kefyalew Addis Alene, Matthew Kelly, Darren Gray

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Background: Undernutrition is a risk factor for tuberculosis (TB), including poor treatment outcomes. However, evidence regarding the effect of undernutrition on TB treatment outcomes is not well understood. We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multi-drug resistance (MDR)-TB. Methods: We searched for publications in the Medline, Embase, Scopus, and Web of Science databases without restrictions on geography or year of publication. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Two reviewers independently assessed the study eligibility, extracted the necessary information, and assessed the risk of bias. Depending on the nature of the data, odds ratio (OR) and hazard ratio (HR) with 95% confidence intervals (CIs) were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger’s tests. Results: Of 2358 records screened, 59 studies comprising a total of 31,254 people with MDR-TB were included. Undernutrition was significantly associated with a lower sputum culture conversion rate (HR 0·7, 95% CI 0·6–0·9, I2=67·1%) and a higher rate of mortality (OR 2·9, 95%CI 2·1–3·8, I2=23·7%) and unfavourable treatment outcomes (OR 1·8, 95%CI 1·5–2·0, I2=72·7%). There was no statistically significant publication bias in the included studies. Three studies were low, forty-two studies were moderate, and fourteen studies were high quality. Interpretations: Undernutrition was significantly associated with unfavourable treatment outcomes, including mortality and lower sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardised second-line TB drugs.

Keywords: undernutrition, MDR-TB, sputum culture conversion, treatment outcomes, meta-analysis

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Authors: Nadia H. Mohammed, Anmar Al-Taie, Fadia H. Al-Sultany

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Although breast cancer prevalence continues to increase, mortality has been decreasing as a result of early detection and improvement in adjuvant systemic therapy. Nevertheless, this disease required further efforts to understand and identify the associated potential risk factors that could play a role in the prevalence of this malignancy among Iraqi women. The objective of this study was to assess the perception of certain predictive risk factors on the prevalence of breast cancer types among a sample of Iraqi women diagnosed with breast cancer. This was a retrospective observational study carried out at National Cancer Research Center in College of Medicine, Baghdad University from November 2017 to January 2018. Data of 100 patients with breast cancer whose biopsies examined in the National Cancer Research Center were included in this study. Data were collected to structure a detailed assessment regarding the patients’ demographic, medical and cancer records. The majority of study participants (94%) suffered from ductal breast cancer with mean age 49.57 years. Among those women, 48.9% were obese with body mass index (BMI) 35 kg/m². 68.1% of them had positive family history of breast cancer and 66% had low parity. 40.4% had stage II ductal breast cancer followed by 25.5% with stage III. It was found that 59.6% and 68.1% had positive oestrogen receptor sensitivity and positive human epidermal growth factor (HER2/neu) receptor sensitivity respectively. In regard to the impact of prediction of certain variables on the incidence of ductal breast cancer, positive family history of breast cancer (P < 0.0001), low parity (P< 0.0001), stage I and II breast cancer (P = 0.02) and positive HER2/neu status (P < 0.0001) were significant predictive factors among the study participants. The results from this study provide relevant evidence for a significant positive and potential association between certain risk factors and the prevalence of breast cancer among Iraqi women.

Keywords: Ductal Breast Cancer, Hormone Sensitivity, Iraq, Risk Factors

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Authors: Yi Shan Cheng, Ya Hui Yeh, Hsiao Wen Hsu

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Delirium is an acute state of confusion, which is mainly the result of the interaction of many factors, including: age>65 years, comorbidity, cognitive function and visual/auditory impairment, dehydration, pain, sleep disorder, pipeline retention, general anesthesia and major surgery… etc. Researches show the prevalence of delirium in hospitalized elderly patients over 50%. If it doesn't improve in time, may cause cognitive decline or impairment, not only prolong the length of hospital stay but also increase mortality. Some studies have shown that multiple nonpharmacological interventions are the most effective and common strategies, which are reorientation, early mobility, promoting sleep and nutritional support (including water intake), could improve or prevent delirium in the hospitalized elderly. In Taiwan, only one research to compare the delirium incidence of the older patients who have received orthopedic surgery between multi-nonpharmacological interventions and general routine care. Therefore, the purpose of this study is to address the prevention or improvement of delirium incidence density in medical hospitalized elderly, provide clinical nurses as a reference for clinical implementation, and develop follow-up related research. This study is a quasi-experimental design using purposive sampling. Samples are from two wards: the geriatric ward and the general medicine ward at a medical center in central Taiwan. The sample size estimated at least 100, and then the data will be collected through a self-administered structured questionnaire, including: demographic and professional evaluation items. Case recruiting from 5/13/2023. The research results will be analyzed by SPSS for Windows 22.0 software, including descriptive statistics and inferential statistics: logistic regression、Generalized Estimating Equation(GEE)、multivariate analysis of variance(MANOVA).

Keywords: multiple nonpharmacological interventions, hospitalized elderly, delirium incidence, delirium

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Authors: Le Quang Hanh

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Almost all big cities in Vietnam are often located in the river deltas. Therefore the ground condition on these cities is mostly soft soil. As a result, the soil strengthen works are mandatory in order to prevent the harmful to the third parties and tunnel structure itself in urban tunnel projects in Vietnam. This paper will particularly introduce the large diameter jet-grouted column technique that is recently being successfully applied in Ho Chi Minh City in Vietnam. The success application of this technique for protecting the historical sensitive building and for water cutoff objective of launching and arriving shafts in the urban tunnel project, will be analyzed from construction process, quality control and lessons learnt. From this situation, the large diameter jet-grouted column technique can extend to another urban tunnel projects in Vietnam and other countries which have similar soft soil conditions.

Keywords: large diameter, jet grouting, ground improvement, urban tunnel

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Authors: Isaac Diaka, Matsui Kenichi

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Ghana’s rice production has increased mainly because of increased cultivated areas. On this point, scholars who promoted crop production increase for food security have overlooked the fact that its per-acre yield has not increased. Also, Ghana’s domestic rice production has not contributed much to domestic rice consumption especially in major cities where consumers tend to rely on imported rice from Asia. Considering these points, the paper seeks to understand why smallholder rice farmers have not been able to increase per acre rice yield. It also examines smallholder rice farmers’ rice yield improvement needs, and the relationship that exist between rice farmers’ socioeconomic factors and their yield levels by rice varieties. The study adopted a simple random sampling technique to select 154 rice farmers for a questionnaire survey between October and November 2020. The data was analyzed by performing a correlation analysis, an independent t-test, and Kendall’s coefficient of concordance. The results showed that 58.4% of the respondents cultivated popular high-yield varieties like AGRA and Jasmine. The rest used local varieties. Regarding respondents’ yield differentials, AGRA and Jasmine had an average yield of 2.6 mt/ha, which is higher than that of local varieties (1.6mt/ha). The study found untimely availability of improved seed varieties and high cost of inputs some of the major reasons affecting yield in the area. For respondents’ yield improvement needs, Kendall’s coefficient of concordance showed that access to improved varieties, irrigation infrastructure, and row planting were respondents’ major technological needs. As to their non-technological needs, the respondents needed timely information about rice production, access to credit support options, and extension services. The correlation analysis revealed that farm size and off-farm income exhibited a positive and negative association towards respondents’ yield level, respectively. This paper then discusses recommendations for providing with improved rice production technologies to farmers.

Keywords: Ghana, rice, smallholder farmers, yield improvement.

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Authors: M. Farnush

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This study is concerned with the microstructural analysis and improvement of wear resistance of 356 aluminum alloy by a high energy electron beam. Shock hardening on material by high energy electron beam improved wear resistance. Particularly, in the surface of material by shock hardening, the wear resistance was greatly enhanced to 29% higher than that of the 356 aluminum alloy substrate. These findings suggested that surface shock hardening using high energy electron beam irradiation was economical and useful for the development of surface shock hardening with improved wear resistance.

Keywords: Al356 alloy, HEEB, wear resistance, frictional characteristics

Procedia PDF Downloads 300

Authors: Thinakar Mani Balusamy, Ratnakar S. Kini, Bharat Narasimhan, Venkateswaran A. R, Pugazhendi Thangavelu, Mohammed Ali, Prem Kumar K., Kani Sheikh M., Sibi Thooran Karmegam, Radhakrishnan N., Mohammed Noufal

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Introduction: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining nine presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed nonoperatively. Nine patients had a severe injury ( > grade 3) – of which four underwent endotherapy, three had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed nonoperatively, three underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Keywords: endotherapy, non-operative management, surgery, traumatic pancreatic injury

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Authors: Naser Shagerdi Esmaeli, Mohsen Hamidpour

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Background and Objective: Hematopoietic stem cell transplantation (HSCT) has been widely used for treating oncological and hematological diseases. Although HSCT has helped to improve patient survival, the risk of developing an infection during hospitalization is an important cause of morbidity and mortality. This study aimed to analyze the infection profile during hospitalization and the associated risk factors among patients undergoing autologous HSCT at the University Hospital, Shahid Ghazi Tabatabaei Hospital, Tabriz, Iran. Subjects and Methods: This was a cross-sectional study on patients undergoing autologous HSCT at a public university hospital. Methods: Patients with febrile neutropenia between 2015 and 2018 were retrospectively evaluated regarding their infection profile and associated risk factors. This survey included: bacterial culture and blood culture on specific media. Results: Infection occurred in 57.2% of 56 patients with febrile neutropenia. The main source of infection was the central venous catheter (25.9%). Infection was chiefly due to Gram-positive bacteria, although Gram-negative-related infections were more severe and caused a higher death rate. Sex, age, skin color, nutritional status, and underlying disease were not associated with the development of infection. Patients with severe mucositis (Grades III and IV) had a higher infection rate (P < 0.001). Patients who developed pulmonary complications during hospitalization had higher infection rates (P = 0.002). Infection was the main cause of death (57.1%) in the study sample. Conclusion: Strategies aimed at reducing infection-related mortality rates among patients undergoing autologous HSCT are necessary.

Keywords: hematopoietic stem cell, autologous bone marrow transplantation, infection profile, tabriz, Iran

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Authors: G. E. Gandomkar, E. Bekhradinassab, S. Sabbaghi, M. M. Zerafat

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The reduction of water content in crude oil emulsions reduces pipeline corrosion potential and increases the productivity. Chemical emulsification of crude oil emulsions is one of the methods available to reduce the water content. Presence of demulsifier causes the film layer between the crude oil emulsion and water droplets to become unstable leading to the acceleration of water coalescence. This research has been performed to study the improvement performance of a chemical demulsifier by silica nanoparticles. The silica nano-particles have been synthesized by sol-gel technique and precipitation using poly vinyl alcohol (PVA) and poly ethylene glycol (PEG) as surfactants and then nano-particles are added to the demulsifier. The silica nanoparticles were characterized by Particle Size Analyzer (PSA) and SEM. Upon the addition of nanoparticles, bottle tests have been carried out to separate and measure the water content. The results show that silica nano-particles increase the demulsifier efficiency by about 40%.

Keywords: demulsifier, dehydration, silicon dioxide, nanoparticle

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Authors: Noriyoshi Yamauchi, Etsuo Horikawa, Takunori Tsuji

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Training by exoskeleton robot is drawing attention as a rehabilitation method for body paralysis seen in many cases, and there are many forms that assist with the myoelectric signal generated by exercise commands from the brain. Rehabilitation requires more frequent training, but it is one of the reasons that the technology is required for the identification of the myoelectric potential derivation site and attachment of the device is preventing the spread of paralysis. In this research, we focus on improving the efficiency of gait training by exoskeleton type robots, improvement of myoelectric acquisition and analysis method using active matrix sensing method, and improvement of walking rehabilitation and walking by optimization of robot control.

Keywords: active matrix sensing, brain machine interface (BMI), the central pattern generator (CPG), myoelectric signal processing, robot rehabilitation

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Authors: Jeevan Jyoti, Bhanu Pratap Singh, S. R. Dhakate

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In the present study, multiwalled carbon nanotubes (MWCNTs) and reduced graphene oxide (RGO) were synthesized by chemical vapor deposition and Improved Hummer’s method, respectively and their composite with acrylonitrile butadiene styrene (ABS) were prepared by twin screw co rotating extrusion technique. The electromagnetic interference (EMI) shielding effectiveness of graphene oxide carbon nanotube (GCNTs) hybrid composites was investigated and the results were compared with EMI shielding of carbon nanotube (CNTs) and reduced graphene oxide (RGO) in the frequency range of 12.4-18 GHz (Ku-band). The experimental results indicate that the EMI shielding effectiveness of these composites is achieved up to –21 dB for 10 wt. % loading of GCNT loading. The mechanism of improvement in EMI shielding effectiveness is discussed by resolving their contribution in absorption and reflection loss. The main reason for such a high improved shielding effectiveness has been attributed to the significant improvement in the electrical conductivity of the composites. The electrical conductivity of these GCNT/ABS composites was increased from 10-13 S/cm to 10-7 S/cm showing the improvement of the 6 order of the magnitude. Scanning electron microscopic (SEM) and high resolution transmission electron microscopic (HRTEM) studies showed that the GCNTs were uniformly dispersed in the ABS polymer matrix. GCNTs form a network throughout the polymer matrix and promote the reinforcement.

Keywords: ABS, EMI shielding, multiwalled carbon nanotubes, reduced graphene oxide, graphene, oxide-carbon nanotube (GCNTs), twin screw extruder, multiwall carbon nanotube, electrical conductivity

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Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

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Authors: Bakytzhan Bimbetov, Abay Zhangabilov, Saule Aitbaeva, Galymzhan Meirambekov

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Mare’s milk (saumal) contains in total about 40 biological components necessary for the human body. The most significant among them are amino acids, fats, carbohydrates, enzymes (lysozyme, amylase), more minerals and vitamins which are well balanced with each other. In Kazakhstan, Company "Eurasia Invest Ltd.” produces a freeze-dried saumal in form of powder by the use of modern German innovative technology by means of evaporating at low temperature (-35°C) with an appropriate pasteurization. Research of freeze-dried biomilk for the qualitative content showed that main ingredients of freshly drown milk are being preserved. We are currently studying medical and dietary properties of freeze-dried mare's milk for diseases of the digestive system, including for nonalcoholic steatohepatitis (NASH) and liver cirrhosis (LC) viral etiology. The studied group consisted of 14 patients with NASH, and 7 patients with LC viral etiology of Class A severity degree as per Child-Pugh. Patients took freeze-dried saumal, preliminary dissolved in boiled warm water (24 g. powder per 200 ml water) 3-4 times a day for a month in conjunction with basic therapy. The results were compared to a control group (11 patients with NASH and LC) who received only basic therapy without mare’s milk. Results of preliminary research showed an improvement of subjective and objective conditions of all patients, but more significant improvement of clinical symptoms and syndromes were observed in the treatment group compared to the control one. Patients with NASH significantly over time compared to the beginning of therapy decreased asthenic and dyspeptic syndromes (p<0,01). Hepatomegaly, identified on the basis of ultrasound prior to treatment was observed in 92,8±2,4% of patients, and after combination therapy hepatomegaly the rate decreased by 14,3%, amounting to 78,5±2,8%. Patients with LC also noted the improvement of asthenic (p<0,01) and dyspeptic (p<0,05) syndromes and hemorrhagic syndrome (nosebleeds and bleeding gums when brushing your teeth, p<0,05), and jaundice. Laboratory study also showed improvement in the research group, but more significant changes were observed in the experimental group. Group of patients with NASH showed a significant improvement of index in cytolysis in conjunction with a combination therapy (p<0,05). In the control group, these indicators were also improved, but they were not statistically reliable (p>0,05). Markers of liver failure were additionally studied during the study of laboratory parameters in patients with liver cirrhosis, in particular, bilirubin, albumin and prothrombin index (PTI). Combined therapy with the use of basic treatment and mare's milk showed a significant improvement in cytolysis and bilirubin (p<0,05). In our opinion, a very important and interesting fact is that, in conjunction with basic therapy, the use of mare's milk revealed an improvement of liver function in the form of normalized PTI and albumin in patients with liver cirrhosis viral etiology. Results of this work have shown therapeutic efficiency of the use of mare's milk in complex treatment of patients with liver disease and require further in-depth study.

Keywords: liver cirrhosis, non-alcohol steatohepatitis, saumal, mare’s milk

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Authors: P. Gao, Z. Q. Li, Y. G. Jin

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In the past 10 years, computers and cellphones have become one of the most important factors in our lives, and one which has a tremendously negative impact on our muscles. Muscle tension may be one of the causes of sleep disturbance. Tension in the shoulders and neck can affect blood circulation to the muscles. This research uses a dry needling treatment to reduce muscle tension in order to determine if the strain in the head and shoulders can influence sleep duration. All 38 patients taking part in the testing suffered from tinnitus and have been experiencing disturbed sleep for at least one to five years. Even after undergoing drug therapy treatments and traditional acupuncture therapies, their sleep disturbances have not shown any improvement. After five to 10 dry needling treatments, 24 of the patients reported an improvement in their sleep duration. Five patients considered themselves to be completely recovered, while 12 patients experienced no improvement. This study investigated these pathogenic and therapeutic problems. The standard treatment for sleep disturbances is drug-based therapy; the results of most standard treatments are unfortunately negative. The result of this clinical research has demonstrated that: The possible cause of sleep disturbance for a lot of patients is the result of tensions in the neck and shoulder muscles. Blood circulation to those muscles is also influenced by the duration of sleep. Hypertonic neck and shoulder muscles are considered to impact sleeping patterns and lead to disturbed sleep. Poor posture, often adopted while speaking on the phone, is one of the main causes of hypertonic neck and shoulder muscle problems. The dry needling treatment specifically focuses on the release of muscle tension.

Keywords: dry needling, muscle tension, sleep duration, hypertonic muscles

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Authors: Oya Bulut, Oguzhan Avci, Zafer Bulut, Atilla Simsek

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Livestock breeders have focused on the improvement of production traits with little or no attention for improvement of disease resistance traits. In order to determine the association between the genetic structure of the individual gene loci with possibility of the occurrence and the development of diseases, MHC (major histocompatibility complex) are frequently used. Because of their importance in the immune system, MHC locus is considered as candidate genes for resistance/susceptibility against to different diseases. Major histocompatibility complex (MHC) molecules play a critical role in both innate and adaptive immunity and have been considered candidate molecular markers of an association between polymorphisms and resistance/susceptibility to diseases. The purpose of this study is to give some information about MHC genes become an important area of study in recent years in terms of animal husbandry and determine the relation between MHC genes and resistance/susceptibility to disease.

Keywords: MHC, polymorphism, disease, resistance

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Authors: Jorge Martinez, Brandon Roberts, Holly Payton Toca

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Background: Therapeutic hypothermia (TH) is the international standard of care for all comatose patients after cardiac arrest, but criticism focuses on poor outcomes. We sought to develop criteria to identify American urban patients more likely to benefit from TH. Methods: Retrospective chart review of 107 consecutive adults undergoing TH in downtown New Orleans from 2010-2014 yielded records for 99 patients with all 44 survivors or families contacted up to four years. Results: 69 males and 38 females with a mean age of 60.2 showed 63 dead (58%) and 44 survivors (42%). Presenting cardiac rhythm was divided into shockable (Pulseless Ventricular Tachycardia, Ventricular Fibrillation) and non-shockable (Pulseless Electrical Activity, Asystole). Presenting in shockable rhythms with ROSC <20 minutes were 21 patients with 15 (71%) survivors (p=.001). Time >20 minutes until ROSC in shockable rhythms had 5 patients with 3 survivors (78%, p=0.001). Presenting in non-shockable rhythms with ROSC <20 minutes were 54 patients with 18 survivors (33%, p=.001). ROSC >20 minutes in non-shockable rhythms had 19 patients with 2 survivors (8%, p=.001). Survivors of shockable rhythms showed 19 (100%) living post TH. 15 survivors (79%, n=19, p=.001) had CPC score 1 or 2 with 4 survivors (21%, n=19) having a CPC score of 3. A total of 25 survived non-shockable rhythm. Acute survival of patients with non-shockable rhythm showed 18 expired <72 hours (72%, n=25) with long-term survival of 4 patients (5%, n=74) and CPC scores of 1 or 2 (p=.001). Interestingly, patients with time to ROSC <20 minutes exhibiting more than one loss of sustained ROSC showed 100% mortality (p=.001). Patients presenting with shockable >20 minutes ROSC had overall survival of 70% (p=.001), but those undergoing >3 cardiac rhythm changes had 100% mortality (p=.001). Conclusion: Patients presenting with shockable rhythms undergoing TH had overall acute survival of 70% followed by long-term survival of 100% after 4 years. In contrast, patients presenting with non-shockable rhythm had long-term survival of 5%. TH is not recommended for patients presenting with non-shockable rhythm and requiring greater than 20 minutes for restoration of ROSC.

Keywords: cardiac rhythm changes, Pulseless Electrical Activity (PEA), Therapeutic Hypothermia (TH)

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Authors: Fatemeh Elmi, Zahra Etemadifar

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Improvement of soil mechanical properties is crucial before its use in construction, as the low mechanical strength and unstable structure of soil in many parts of the world can lead to the destruction of engineering infrastructure, resulting in financial and human losses. Although, conventional methods, such as chemical injection, are often utilized to enhance soil strength and stiffness, they are generally expensive, require heavy machinery, and cause significant environmental effects due to chemical usage, and also disrupt urban infrastructure. Moreover, they are not suitable for treating large volume of soil. Recently, an alternative method to improve various soil properties, including strength, hardness, and permeability, has received much attention: the application of biological methods. One of the most widely used is biocementation, which is based on the microbial precipitation of calcium carbonte crystalls using ureolytic bacteria However, there are still limitations to its large-scale use that need to be resolved before it can be commercialized. These issues have not received enough attention in prior research. One limitation of MICP (microbially induced calcium carbonate precipitation) is that microorganisms cannot operate effectively in harsh and variable environments, unlike the controlled conditions of a laboratory. Another limitation of applying this technique on a large scale is the high cost of producing a substantial amount of bacterial culture and reagents required for soil treatment. Therefore, the purpose of the present study was to investigate soil improvement using the biocementation activity of poly-extremophile, calcium carbonate crystal- producing bacterial strain, Bhargavaea cecembensis N1, in whey as an inexpensive medium. This strain was isolated and molecularly identified from sandy soils in our previous research, and its 16S rRNA gene sequences was deposited in the NCBI Gene Bank with an accession number MK420385. This strain exhibited a high level of urease activity (8.16 U/ml) and produced a large amount of calcium carbonate (4.1 mg/ ml). It was able to improve the soil by increasing the compressive strength up to 205 kPa and reducing permeability by 36%, with 20% of the improvement attributable of calcium carbonate production. This was achieved using this strain in a whey culture medium. This strain can be an eco-friendly and economical alternative to conventional methods in soil stabilization, and other MICP related applications.

Keywords: biocementation, Bhargavaea cecembensis, soil improvement, whey culture medium

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Authors: Lisa Bennett, Cynthia Walters, Cynthia Argani, Andy Satin, Geeta Sood, Kerri Huber, Lisa Grubb, Woodrow Noble, Melissa Eichelberger, Darlene Zinalabedini, Eric Ausby, Jeffrey Snyder, Kevin Kirchoff

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Background: Surgical site infections (SSIs) within the obstetric population pose a variety of complications, creating clinical and personal challenges for the new mother and her neonate during the postpartum period. Our journey to achieve compliance with the SSI core measure for cesarean sections revealed many opportunities to improve these outcomes. Objective: Achieve and sustain core measure compliance keeping surgical site infection rates below the national benchmark pooled mean of 1.8% in post-operative patients, who delivered via cesarean section at the Johns Hopkins Bayview Medical Center. Methods: A root cause analysis was performed and revealed several environmental, pharmacologic, and clinical practice opportunities for improvement. A multidisciplinary approach led by the OB Safety Nurse, OB Medical Director, and Infectious Disease Department resulted in the implementation of fourteen interventions over a twenty-month period. Interventions included: post-operative dressing changes, standardizing operating room attire, broadening pre-operative antibiotics, initiating vaginal preps, improving operating room terminal cleaning, testing air quality, and re-educating scrub technicians on technique. Results: Prior to the implementation of our interventions, the SSI quarterly rate in Obstetrics peaked at 6.10%. Although no single intervention resulted in dramatic improvement, after implementation of all fourteen interventions, the quarterly SSI rate has subsequently ranged from to 0.0% to 2.70%. Significance: Taking an introspective look at current practices can reveal opportunities for improvement which previously were not considered. Collectively the benefit of these interventions has shown a significant decrease in surgical site infection rates. The impact of this quality improvement project highlights the synergy created when members of the multidisciplinary team work in collaboration to improve patient safety, and achieve a high quality of care.

Keywords: cesarean section, surgical site infection, collaboration and teamwork, patient safety, quality improvement

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Authors: Ebrahim Izadi-Darbandi, Masoud Azad, Masumeh Dehghan

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In order to study the effects of nitrogen and phosphoruse management and wheat sowing method on wheat yield, two experiments was performed as factorial, based on completely randomized design with three replications at Research Farm, Faculty of Agriculture, Ferdowsi University of Mashhad, Iran in 2009. In the first experiment nitrogen application rates (100kg ha-1, 200 kg ha-1, 300 kg ha-1), phosphorus application rates (100 kg ha-1, 200 kg ha-1) and two levels of their application methods (Broadcast and Band) were studied. The second experiment treatments included of wheat sowing methods (single-row with 30 cm distance and twine row on 60 cm width ridges), as main plots and nitrogen and phosphorus application methods (Broadcast and Band) as sub plots (150 kg ha-1). Phosphorus and nitrogen sources for fertilization at both experiment were respectively super phosphate, applied before wheat sowing and incorporated with soil and urea, applied in two phases (50% pre plant) and (50%) near wheat shooting. Results from first experiment showed that the effect of fertilizers application methods were significant (p≤0.01) on wheat yield increasing. Band application of phosphorus and nitrogen were increased biomass and seed yield of wheat with nine and 15% respectively compared to their broadcast application. The interaction between the effects of nitrogen and phosphorus application rate with phosphorus and nitrogen application methods, showed that band application of fertilizers and the rate of application of 200kg/ha phosphorus and 300kg/ha nitrogen were the best methods in wheat yield improvement. The second experiment also showed that the effect of wheat sowing method and fertilizers application methods were significant (p≤0.01) on wheat seed and biomass yield improvement. Wheat twine row on 60 cm width ridges sowing method, increased its biomass and seed yield for 22% and 30% respectively compared to single-row with 30 cm. Wheat sowing method and fertilizers application methods interaction indicated that band application of fertilizers and wheat twine row on 60 cm width ridges sowing method was the best treatment on winter wheat yield improvement. In conclusion these results indicated that nitrogen and phosphorus management in wheat and modifying wheat sowing method have important role in increasing fertilizers use efficiency.

Keywords: band application, broadcast application, rate of fertilizer application, wheat seed yield, wheat biomass yield

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Authors: Parimalakrishnan Sundararjan, Madheswaran Murugan, Dhanya Dharman, Yatindra Kumar, Sudhir Singh Gangwar, Guru Prasad Mohanta

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Antibiotic resistance AR is a global issue, India started to redress the issues of antibiotic resistance late and it plans to have: active surveillance of microbial resistance and promote appropriate use of antibiotics. The present study attempted to achieve appropriate use of antibiotics through pharmacists’ intervention at practice point. In a quasi-experimental prospective cohort study, the cases with bacteremia from four hospitals were identified during 2015 and 2016 for intervention. The pharmacists centered intervention: active screening of each prescription and comparing with the selection of antibiotics with susceptibility of the bacteria. Wherever irrationality noticed, it was brought to the notice of the treating physician for making changes. There were two groups: intervention group and control group without intervention. The active screening and intervention in 915 patients has reduced therapeutic regimen time in patients with bacteremia. The intervention group showed the decreased duration of hospital stay 3.4 days from 5.1 days. Further, multivariate modeling of patients who were in control group showed that patients in the intervention group had a significant decrease in both duration of hospital stay and infection-related mortality. Unlike developed countries, pharmacists are not active partners in patient care in India. This unique attempt of pharmacist’ invention was planned in consultation with hospital authorities which proved beneficial in terms of reducing the duration of treatment, hospital stay, and infection-related mortality. This establishes the need for a collaborative decision making among the health workforce in patient care at least for promoting rational use of antibiotics, an attempt to combat resistance.

Keywords: antibiotics resistance, intervention, bacteremia, multivariate modeling

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Authors: N. Hadjigeorgiou, A. C. Tsalikidou, E. Hristoforou, P. P. Sotiriadis

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During the last few decades, the continuously increasing demand for accurate and reliable magnetic measurements has paved the way for the development of different types of magnetic sensing systems as well as different measurement techniques. Sensor sensitivity and linearity, signal-to-noise ratio, measurement range, cross-talk between sensors in multi-sensor applications are only some of the aspects that have been examined in the past. In this paper, a fully analog closed loop system in order to optimize the performance of AMR sensors has been developed. The operation of the proposed system has been tested using a Helmholtz coil calibration setup in order to control both the amplitude and direction of magnetic field in the vicinity of the AMR sensor. Experimental testing indicated that improved linearity of sensor response, as well as low noise levels can be achieved, when the system is employed.

Keywords: AMR sensor, closed loop, memory effects, chopper, linearity improvement, sensitivity improvement, magnetic noise, electronic noise

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Authors: Funmilola Ajani, I. A. Ayodele, O.A. Filade

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Tourism has direct, indirect and induced impacts on economic development and the industry is one of the most crucial tradable sectors in the world. The study was therefore carried out to assess the potentials of ecotourism to nature conservation and its contributions to the improvement of the livelihood of Oke- Ila Orangun community. One hundred and fifty residents were chosen by stratified random sampling as respondents. Respondents awareness of ecotourism was assessed using an 8-point scale while respondents acceptance of ecotourism was assessed using a 14-point scale. Contributions to improvement of livelihood of residents and perceived constraints identified by residents to the development of the water fall and socio-economic variables among others were also obtained. Also, in-depth interview was conducted with the king of Ayikunnugba. The data was analyzed using descriptive statistics such as frequency count, mean and percentages. Correlation analysis was used to determine whether or not a relationship exists between two variables at 0.05 level of significance. Perception of respondents based on the awareness of ecotourism and contributions to livelihood development was high (78.3%). A significant relationship exists between acceptance of ecotourism and its contributions to peoples’ livelihood. Also, relationship between constraints encountered by respondents and its contributions to peoples livelihood is highly significant(r =0.546; P =0.00). Majority (71.3%) of the respondents believed that the development of the area will not lead to environmental pollution. Public- Private- Partnership (PPP) is therefore recommended so as to enable the recreation site to meet international standard in terms of development and management.

Keywords: Ayikunnugba water fall, ecotourism constraints, nature conservation, awareness

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Authors: Waqas Mehdi, Muhammad Umar Hassan, Khadeeja Mustafa

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Objective: Post-concussion syndrome (PCS) is a medical term used to point out the complicated combination of physical, emotional, cognitive and behavioral signs and symptoms associated with Mild Traumatic Brain Injury(mTBI). This study was conducted to assess the improvement or debilitating effect of behavioral therapy in addition to the conventional treatment and to document these results for increasing the efficiency of treatment provided to such cases. Method: This was primarily an interventional prospective cohort study which was conducted in the Department of Neurosurgery, Mayo Hospital Lahore. The sample size was 200 patients who were randomly distributed into two groups. The interventional group with Cognitive behavioral therapy was added in addition to the conventional treatment regimen and the Control group receiving only conventional treatment. Results were noted initially as well as after two weeks of the follow-up period. Data were subsequently analyzed by Statistical Package for Social Sciences (SPSS) software and associations worked out. Result and conclusion: Among the patients that were given therapy sessions along with conventional medicine, there was a significant improvement in the symptoms and their overall quality of life. It is also important to notice that the time period taken for these effects to wane is cut down by psychiatric solutions too. So we can conclude that CBT sessions not only speed up recovery in patients with post-concussion syndrome they also aid in the efficiency improvement in functional capability and quality of life.

Keywords: neurosurgery, CBT, PCS, mTBI

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Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

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Authors: Yingyi Zhou, Tohru Kawabe

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With the spread of EVs (electric Vehicles), the ride comfort has been gaining a lot of attention. The influence of the lateral acceleration is important for the improvement of ride comfort of EVs as well as the longitudinal acceleration, especially upon turning of the vehicle. Therefore, this paper proposes a practical optimal speed control method to greatly improve the ride comfort in the vehicle turning situation. For consturcting this method, effective criteria that can appropriately evaluate deterioration of ride comfort is derived. The method can reduce the influence of both the longitudinal and the lateral speed changes for providing a confortable ride. From several simulation results, we can see the fact that the method can prevent aggravation of the ride comfort by suppressing the influence of longitudinal speed change in the turning situation. Hence, the effectiveness of the method is recognized.

Keywords: electric vehicle, speed control, ride comfort, optimal control theory, driving support system

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Authors: Randa M. Ali, Naguiba F. Loutfy, Osama M. Awad

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Background: Leishmaniasis is a worldwide disease, affecting 88 countries, it is estimated that about 350 million people are at risk of leishmaniasis. Overall prevalence is 12 million people with annual mortality of about 60,000. Annual incidence is 1,500,000 cases of cutaneous leishmaniasis (CL) worldwide and half million cases of visceral Leishmaniasis (VL). Objectives: The objective of this study was to assess primary health care physicians knowledge (PHP) and attitude about leishmaniasis and to assess awareness of local inhabitants about the disease and its vector in four areas in west Alexandria, Egypt. Methods: This study was a cross sectional survey that was conducted in four PHC units in west Alexandria. All physicians currently working in these units during the study period were invited to participate in the study, only 20 PHP completed the questionnaire. 60 local inhabitant were selected randomly from the four areas of the study, 15 from each area; Data was collected through two different specially designed questionnaires. Results: 11(55%) percent of the physicians had satisfactory knowledge, they answered more than 9 (60%) questions out of a total 14 questions about leishmaniasis and sandfly. The second part of the questionnaire is concerned with attitude of the primary health care physicians about leishmaniasis, 17 (85%) had good attitude and 3 (15%) had poor attitude. The second questionnaire showed that the awareness of local inhabitants about leishmaniasis and sandly as a vector of the disease is poor and needs to be corrected. Most of the respondents (90%) had not heard about leishmaniasis, Only 3 (5%) of the interviewed inhabitants said they know sandfly and its role in transmission of leishmaniasis. Conclusions: knowledge and attitudes of physicians are acceptable. However, there is, room for improvement and could be done through formal training courses and distribution of guidelines. In addition to raising the awareness of primary health care physicians about the importance of early detection and notification of cases of lesihmaniasis. Moreover, health education for raising awareness of the public regarding the vector and the disease is necessary because related studies have demonstrated that if the inhabitants do not perceive mosquitoes to be responsible for diseases such as malaria they do not take enough measures to protect themselves against the vector.

Keywords: leishmaniasis, PHP, knowledge, attitude, local inhabitants

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