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445 Assessment of Low Income Housing Delivery, Accessibility and Affordability Problem in Nigeria
Authors: Asimiyu Mohammed Jinadu
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Housing is a basic necessity of life. Housing plays a central role in the life of living organisms as it provides the basic platform for the life support systems in human settlements. It is considered a social service and a basic right. Despite the importance of housing, Nigeria as a nation is faced with the problem of quantitative and qualitative shortfall in the number of housing units required to accommodate the citizens. This study examined the accessibility and affordability problems of low-income housing in Nigeria. It relied on secondary data obtained for the records of government ministries and agencies. Descriptive statistics were used in the analysis, and the information was presented in simple tables and charts. The findings show that over the years the government has provided serviced plots of land, owner occupier houses and mortgage loans for the people. As at 2016, the Federal Housing Authority (FHA) has completed a total of 23,038 housing units while another 14, 488 units were on-going under the Public Private Partnership scheme across the country. The study revealed that a total of 910, 671 housing units were proposed by the Government under the various low-income housing programmes between 1960 and 2017, but only 156, 336 units were delivered within the period, representing 17.17% success rate. Amongst others, the low-income group faced the problems of low access to and unaffordability of the few low-income housing delivered in Nigeria. The study recommended that all abandoned housing projects should be reviewed, rationalized, completed and made available to the targeted low-income people. Investment in micro housing finance, design and implementation of pro-poor housing programme and massive investment in innovative slum upgrading programmes by both the government and private sector are also recommended to ameliorate the housing problems of the low-income group in Nigeria.Keywords: housing, low income group, problem, programme
Procedia PDF Downloads 256444 Explaining the Role of Iran Health System in Polypharmacy among the Elderly
Authors: Mohsen Shati, Seyede Salehe Mortazavi, Seyed Kazem Malakouti, Hamidreza Khanke Fazlollah Ahmadi
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Taking unnecessary or excessive medication or using drugs with no indication (polypharmacy) by people of all ages, especially the elderly, is associated with increased adverse drug reactions (ADR), medical errors, hospitalization and escalating the costs. It may be facilitated or impeded by the healthcare system. In this study, we are going to describe the role of the health system in the practice of polypharmacy in Iranian elderly. In this Inductive qualitative content analysis using Graneheim and Lundman methods, purposeful sample selection until saturation has been made. Participants have been selected from doctors, pharmacists, policy-makers and the elderly. A total of 25 persons (9 men and 16 women) have participated in this study. Data analysis after incorporating codes with similar characteristics revealed 14 subcategories and six main categories of the referral system, physicians’ accessibility, health data management, drug market, laws enforcement, and social protection. Some of the conditions of the healthcare system have given rise to polypharmacy in the elderly. In the absence of a comprehensive specialty and subspecialty referral system, patients may go to any physician office so may well be confused about numerous doctors' prescriptions. Electronic records not being prepared for the patients, failure to comply with laws, lack of robust enforcement for the existing laws and close surveillance are among the contributing factors. Inadequate insurance and supportive services are also evident. Age-specific care providing has not yet been institutionalized, while, inadequate specialist workforce playing a major role. So, one may not ignore the health system as contributing factor in designing effective interventions to fix the problem.Keywords: elderly, polypharmacy, health system, qualitative study
Procedia PDF Downloads 151443 Influence of Local Soil Conditions on Optimal Load Factors for Seismic Design of Buildings
Authors: Miguel A. Orellana, Sonia E. Ruiz, Juan Bojórquez
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Optimal load factors (dead, live and seismic) used for the design of buildings may be different, depending of the seismic ground motion characteristics to which they are subjected, which are closely related to the type of soil conditions where the structures are located. The influence of the type of soil on those load factors, is analyzed in the present study. A methodology that is useful for establishing optimal load factors that minimize the cost over the life cycle of the structure is employed; and as a restriction, it is established that the probability of structural failure must be less than or equal to a prescribed value. The life-cycle cost model used here includes different types of costs. The optimization methodology is applied to two groups of reinforced concrete buildings. One set (consisting on 4-, 7-, and 10-story buildings) is located on firm ground (with a dominant period Ts=0.5 s) and the other (consisting on 6-, 12-, and 16-story buildings) on soft soil (Ts=1.5 s) of Mexico City. Each group of buildings is designed using different combinations of load factors. The statistics of the maximums inter-story drifts (associated with the structural capacity) are found by means of incremental dynamic analyses. The buildings located on firm zone are analyzed under the action of 10 strong seismic records, and those on soft zone, under 13 strong ground motions. All the motions correspond to seismic subduction events with magnitudes M=6.9. Then, the structural damage and the expected total costs, corresponding to each group of buildings, are estimated. It is concluded that the optimal load factors combination is different for the design of buildings located on firm ground than that for buildings located on soft soil.Keywords: life-cycle cost, optimal load factors, reinforced concrete buildings, total costs, type of soil
Procedia PDF Downloads 306442 Long-Term Cohort of Patients with Beta Thalassemia; Prevailing Role of Serum Ferritin Levels in Hypocalcemia and Growth Retardation
Authors: Shervin Rashidinia, Sara Shahmoradi, Seyyed Shahin Eftekhari, Mohsen Talebizadeh, Mohammad Saleh Sadeghi
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Background: Beta-thalassemia Major (BTM) is a kind of hereditary hemolytic anemia which depended on regular monthly blood transfusion. However, iron deposition into the organs leads to multi-organ damage. The present study is the first study which aimed to evaluate the average of five-years serum ferritin level and compared by the prevalence of short stature and hypocalcemia. Materials/Methods: A cross-sectional retrospective study which a total of 140 patients with beta-thalassemia who were referred to Qom Thalassemia Clinic between February 2011 and July 2016 were enrolled to be reviewed. The exclusion criteria were consisting of incomplete medical records, diagnosis less than 2-years-ago and the blood transfusion less than every 4 weeks. The data including age, gender, weight, height, age of initial blood transfusion, age of initial chelation therapy, ferritin, and calcium were collected and analysis by SPSS version 24. Results: A total of 140 patients were enrolled. Of them, 75 (53.4%) were female. The mean age of the patients was 13.4±4.6 years.The mean age of initial diagnosis was 20.2±7.4 months. Hypocalcemia and short stature were occurred in 41 (29.3%) and 37 (26.4%) patients, respectively. The mean five-years serum ferritin level was significantly higher in the patients with short stature and hypocalcemia (P<0.0001). However, rise in serum ferritin level significantly increases the risk of short-stature and hypocalcemia (1.0004- and 1.0029 fold, respectively). Conclusion: We demonstrated that prevalence of short stature and hypocalcemia were significantly higher in the BTM.However, ferritin significantly increases the risk of short stature and hypocalcemia.Keywords: beta-thalassemia, ferritin, growth retardation, hypocalcemia
Procedia PDF Downloads 328441 The Early Discovery and Confirmation of the Indus Valley Civilization
Authors: Muhammad Ishaqa, Quanchao Zhanga, Qian Wangb
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The Indus Valley Civilization is predominantly found in the northeast of Afghanistan, Pakistan, and the northwest of India and is considered one of the four ancient civilizations of the Old World, as well as the first urban civilization in South Asia. In 1920, John Marshall and other archaeologists established the existence of this civilization. Over the course of a century, India and Pakistan have made significant advancements in their joint archaeological investigation and excavation, contributing to the study of the Indus Valley Civilization. Given the importance of early discovery and confirmation of this civilization, our research focuses on the academic history of its archaeology by gathering published research material. Our research begins by collecting research data associated with the Indus Valley Civilization and documenting the process of archaeological investigations and excavations from the 19th century until the present day. We also summarize the archaeological works conducted during different periods. Furthermore, we present the primary academic views on the Indus Civilization from the 19th century until the present, explaining their developmental process and highlighting recent research. This forms a foundation for further study. We discovered that the archaeological research of the Indus Civilization is significantly influenced by Western archaeology and has yet to establish an independent, local research system. We delve into the three primary sites of the Indus Valley Civilization - Harappa, Mohenjo-Daro, and Chanhudaro - discussing their history and archaeological excavation records. Our findings indicate that the Indus Civilization is solely dependent on archaeology, distinguishing it from the Sumerian Civilization and verifying that it originates from the Bronze Age of the Indus Valley. Lastly, we examine the primary academic issues associated with the Indus Civilization in greater depth. These issues include climate environment, political system, primitive religion, and academic contribution.Keywords: Indus Valley civilization, archaeology, Harappa, Mohenjo-Daro
Procedia PDF Downloads 53440 Performance of Growing Rahaji Bulls Fed Diets Containing Similar Concentrates and Different Crop Residues in a Semi-Arid Environment
Authors: Husaini Sama
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The study was conducted, in a 120 - day’s trial, to monitor the performance of growing Rahaji bulls fed different crop residues. There were four experimental treatments, each containing three (3) bull-calves. The first three (experimental) diets were prepared with rice straw, millet stalks and a combination of the two in equal proportions. These 3 diets were supplemented with concentrates. Treatments 1, 2 and 3 consisted of rice straw, millet stalk and combination of rice straw and millet stalk in equal ratio, respectively as basal feeds, while, Treatment 4 (containing standard diet of cow pea haulms, rice straw and wheat offal) served as control to compare with the other treatments. Data on feed intake and livability was collected on daily basis and that of live weight gain and feed conversion ratio were collected fortnightly, but data on apparent nutrient retention trial was collected towards the end of the experiment. Water was offered ad libitum. Records obtained were subjected to statistical analysis using SPSS (1988) software package in accordance with a Completely Randomized Design (CRD). Results obtained indicated that feed intake was significantly higher (P<0.05) for calves on treatments 3 and 4 compared to those on treatments 1and 2. The study observed that it was cheaper to formulate diets 2 and 3 than the other 2 diets. The control diet (T4) was observed to be relatively more expensive than the other 3 formulated diets. It was concluded from the findings that, concentrate containing combination of rice straw and cereal stalks was economical and satisfactory for feeding growing Rahaji bulls in this ecological zone (Semi-arid environment).Keywords: rahaji bulls, crop residues, concentrates, semi-arid environment
Procedia PDF Downloads 187439 Iot-Based Interactive Patient Identification and Safety Management System
Authors: Jonghoon Chun, Insung Kim, Jonghyun Lim, Gun Ro
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We believe that it is possible to provide a solution to reduce patient safety accidents by displaying correct medical records and prescription information through interactive patient identification. Our system is based on the use of smart bands worn by patients and these bands communicate with the hybrid gateways which understand both BLE and Wifi communication protocols. Through the convergence of low-power Bluetooth (BLE) and hybrid gateway technology, which is one of short-range wireless communication technologies, we implement ‘Intelligent Patient Identification and Location Tracking System’ to prevent medical malfunction frequently occurring in medical institutions. Based on big data and IOT technology using MongoDB, smart band (BLE, NFC function) and hybrid gateway, we develop a system to enable two-way communication between medical staff and hospitalized patients as well as to store locational information of the patients in minutes. Based on the precise information provided using big data systems, such as location tracking and movement of in-hospital patients wearing smart bands, our findings include the fact that a patient-specific location tracking algorithm can more efficiently operate HIS (Hospital Information System) and other related systems. Through the system, we can always correctly identify patients using identification tags. In addition, the system automatically determines whether the patient is a scheduled for medical service by the system in use at the medical institution, and displays the appropriateness of the medical treatment and the medical information (medical record and prescription information) on the screen and voice. This work was supported in part by the Korea Technology and Information Promotion Agency for SMEs (TIPA) grant funded by the Korean Small and Medium Business Administration (No. S2410390).Keywords: BLE, hybrid gateway, patient identification, IoT, safety management, smart band
Procedia PDF Downloads 311438 Profile of the Elderly Users of Alcohol and Other Drugs Attended at the Psychosocial Care Centers in the Federal District
Authors: J. S. P. Barbosa, L. C. Pereira, K. R. Garcia, P. C. P. Bouchardet, S. C. T. Vieira, A. O. Gomes, S. S. Funghetto, M. G. O. Kanikowski
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For this population, height seems to be a good predictor of strength and body composition. This increase in life expectancy of the Brazilian's population is associated with sociodemographic variables, but also to more access to health services in the prevention and better living conditions. With the growth of elderly population, a problem that has been a concern to health's professionals and public health at all is the use of psychoactive substances. The purpose of this study was to identify the sociodemographic profile of the elderly people who was attended at the Center of Psychosocial Care of alcohol and other drugs in the Federal District of Brazil. 408 medical records of people aged 60 years or over were evaluated, and it is possible to know that most of them were males (85.3%), with a mean age of 64 years (DP ± 4.16), 60 and 84 years and a mean age of 64 years (DP ± 4.42); 88.2% have some family ties, are married and have children, with relatives living in masonry housing. The educational level of drug users was considered low with more emphasis on those who had elementary education being the majority retired or unemployed. Regarding the street situation, there was no significance (p = 0.084), and the women (OR = 2.98) had few chances of street situations compared to men (OR = 0.89). As for substance consumption, the highest quantity of drug consumption bids in relation to the number of illicit. It did not present significant statistical value, and there is a greater probability of consumption/abuse of legal and/or illicit drugs for both sexes (OR = 0.96) for men and (OR = 1.32) for women. In relation to the use of multiple drugs, there was no significant difference between the sexes, (OR = 1.1) male sex and (OR = 0.74) female sex. Based on the results found in the present study, it was concluded that alcohol consumption is the main agent that causes vulnerability in the elderly and predisposes the latter to the consumption of other associated drugs.Keywords: centers of attention psychosocial alcohol and drugs, elderly, mental disorder due to drug use, street situations
Procedia PDF Downloads 212437 Pregnant Women in Substance Abuse: Transition of Characteristics and Mining of Association from Teds-a 2011 to 2018
Authors: Md Tareq Ferdous Khan, Shrabanti Mazumder, MB Rao
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Background: Substance use during pregnancy is a longstanding public health problem that results in severe consequences for pregnant women and fetuses. Methods: Eight (2011-2018) datasets on pregnant women’s admissions are extracted from TEDS-A. Distributions of sociodemographic, substance abuse behaviors, and clinical characteristics are constructed and compared over the years for trends by the Cochran-Armitage test. Market basket analysis is used in mining the association among polysubstance abuse. Results: Over the years, pregnant woman admissions as the percentage of total and female admissions remain stable, where total annual admissions range from 1.54 to about 2 million with the female share of 33.30% to 35.61%. Pregnant women aged 21-29, 12 or more years of education, white race, unemployed, holding independent living status are among the most vulnerable. Concerns prevail on a significant number of polysubstance users, young age at first use, frequency of daily users, and records of prior admissions (60%). Trends of abused primary substances show a significant rise in heroin (66%) and methamphetamine (46%) over the years, although the latest year shows a considerable downturn. On the other hand, significant decreasing patterns are evident for alcohol (43%), marijuana or hashish (24%), cocaine or crack (23%), other opiates or synthetics (36%), and benzodiazepines (29%). Basket analysis reveals some patterns of co-occurrence of substances consistent over the years. Conclusions: This comprehensive study can work as a reference to identify the most vulnerable groups based on their characteristics and deal with the most hazardous substances from their evidence of co-occurrence.Keywords: basket analysis, pregnant women, substance abuse, trend analysis
Procedia PDF Downloads 195436 Reducing Ambulance Offload Delay: A Quality Improvement Project at Princess Royal University Hospital
Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah
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Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.Keywords: ambulance offload, district general hospital, handover, quality improvement
Procedia PDF Downloads 105435 Adjusting Electricity Demand Data to Account for the Impact of Loadshedding in Forecasting Models
Authors: Migael van Zyl, Stefanie Visser, Awelani Phaswana
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The electricity landscape in South Africa is characterized by frequent occurrences of loadshedding, a measure implemented by Eskom to manage electricity generation shortages by curtailing demand. Loadshedding, classified into stages ranging from 1 to 8 based on severity, involves the systematic rotation of power cuts across municipalities according to predefined schedules. However, this practice introduces distortions in recorded electricity demand, posing challenges to accurate forecasting essential for budgeting, network planning, and generation scheduling. Addressing this challenge requires the development of a methodology to quantify the impact of loadshedding and integrate it back into metered electricity demand data. Fortunately, comprehensive records of loadshedding impacts are maintained in a database, enabling the alignment of Loadshedding effects with hourly demand data. This adjustment ensures that forecasts accurately reflect true demand patterns, independent of loadshedding's influence, thereby enhancing the reliability of electricity supply management in South Africa. This paper presents a methodology for determining the hourly impact of load scheduling and subsequently adjusting historical demand data to account for it. Furthermore, two forecasting models are developed: one utilizing the original dataset and the other using the adjusted data. A comparative analysis is conducted to evaluate forecast accuracy improvements resulting from the adjustment process. By implementing this methodology, stakeholders can make more informed decisions regarding electricity infrastructure investments, resource allocation, and operational planning, contributing to the overall stability and efficiency of South Africa's electricity supply system.Keywords: electricity demand forecasting, load shedding, demand side management, data science
Procedia PDF Downloads 61434 Associations and Interactions of Delivery Mode and Antibiotic Exposure with Infant Cortisol Level: A Correlational Study
Authors: Samarpreet Singh, Gerald Giesbrecht
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Both c-section and antibiotic exposure are linked to gut microbiota imbalance in infants. Such disturbance is associated with the Hypothalamic-Pituitary-Adrenal (HPA) axis function. However, the literature only has contradicting evidence for the association between c-sections and the HPA axis. Therefore, this study aims to test if the mode of delivery and antibiotics exposure is associated with the HPA axis. Also, whether exposure to both interacts with the HPA-axis. It was hypothesized that associations and interactions would be observed. Secondary data analysis was used for this co-relational study. Data for the mode of delivery and antibiotics exposure variables were documented from hospital records or self-questionnaires. In addition, cortisol levels (Area under the curve with respect to increasing (AUCi) and Area under the curve with respect to ground (AUCg)) were based on saliva collected from three months old during the infant’s visit to the lab and after drawing blood. One-way and between-subject ANOVA analyses were run on data. No significant association between delivery mode and infant cortisol level was found, AUCi and AUCg, p > .05. Only the infant’s AUCg was found to be significantly higher if there were antibiotics exposure at delivery (p = .001) or their mothers were exposed during pregnancy (p < .05). Infants born by c-section and exposed to antibiotics at three months had higher AUCi than those born vaginally, p < .02. These results imply that antibiotic exposure before three months is associated with an infant’s stress response. The association might increase if antibiotic exposure occurs three months after a c-section birth. However, more robust and causal evidence in future studies is needed, given a variable group’s statistically weak sample size. Nevertheless, the results of this study still highlight the unintended consequences of antibiotic exposure during delivery and pregnancy.Keywords: HPA-axis, antibiotics, c-section, gut-microbiota, development, stress
Procedia PDF Downloads 72433 Eco-Cities in Challenging Environments: Pollution As A Polylemma in The Uae
Authors: Shaima A. Al Mansoori
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Eco-cities have become part of the broader and universal discourse and embrace of sustainable communities. Given the ideals and ‘potential’ benefits of eco-cities for people, the environment and prosperity, hardly can an argument be made against the desirability of eco-cities. Yet, this paper posits that it is necessary for urban scholars, technocrats and policy makers to engage in discussions of the pragmatism of implementing the ideals of eco-cities, for example, from the political, budgetary, cultural and other dimensions. In the context of such discourse, this paper examines the feasibility of one of the cardinal principles and goals of eco-cities, which is the reduction or elimination of pollution through various creative and innovative initiatives, in the UAE. This paper contends and argues that, laudable and desirable as this goal is, it is a polylemma and, therefore, overly ambitious and practically unattainable in the UAE. The paper uses the mixed method research strategy, in which data is sourced from secondary and general sources through desktop research, from public records in governmental agencies, and from the conceptual academic and professional literature. Information from these sources will be used, first, to define and review pollution as a concept and multifaceted phenomenon with multidimensional impacts. Second, the paper will use society’s five goal clusters as a framework to identify key causes and impacts of pollution in the UAE. Third, the paper will identify and analyze specific public policies, programs and projects that make pollution in the UAE a polylemma. Fourth, the paper will argue that the phenomenal rates of population increase, urbanization, economic growth, consumerism and development in the UAE make pollution an inevitable product and burden that society must live with. This ‘reality’ makes the goal and desire of pollution-free cities pursuable but unattainable. The paper will conclude by identifying and advocating creative and innovative initiatives that can be taken by the various stakeholders in the country to reduce and mitigate pollution in the short- and long-term.Keywords: goal clusters, pollution, polylemma, sustainable communities
Procedia PDF Downloads 385432 Comparison of Clinical Profiles of Patients Seen in a Women and Children Protection Unit in a Local Government Hospital in Makati, Philippines Before and During the COVID-19 Pandemic Between January 2018 to February 2020 and March 2020 to December 2021
Authors: Margaret Denise P. Del Rosario, Geraldine Alcantara
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Background: The declaration of the COVID-19 pandemic has impacted hospital visits of child abuse cases with less consults but more severe injuries. Objective: The study aims to identify the clinical profiles of patients seen in the hospital ng Makati Women and Children Protection Unit before and during the pandemic. Design: A cross-sectional analytic study design through review of records that underwent quantitative analysis. Results: 264 cases pre-pandemic and 208 cases during the pandemic were reviewed. Most reported cases were neglect comprising of 47% of the pre-pandemic cases and 68% of cases during the pandemic. Supervisory neglect was most commonly reported. An equal distribution between males and females were seen among victims and alleged perpetrators. The age group of both victims and alleged perpetrators during the pandemic was significantly younger compared to the pre-pandemic period. Children belonging to larger family groups were commonly encountered with most of them being the eldest amongst siblings. Alleged perpetrators were mostly secondary graduates for both time periods. A significant increase of cases during the pandemic occurred at home. More patients required hospitalization during the pandemic period with 37% compared to the 23% of admissions prior to the pandemic. Furthermore, a three-fold increase of injuries sustained during the pandemic required intensive care. Conclusion: The study reflects increased severity of injuries related to abuse during the pandemic compared to pre-pandemic times. A significant increase in injuries requiring intensive care were also seen despite less reported cases.Keywords: child abuse, COVID-19, violence against children, WCPU, neglect
Procedia PDF Downloads 55431 A Retrospective Cross-Sectional Study on the Prevalence and Factors Associated with Virological Non-Suppression among HIV-Positive Adult Patients on Antiretroviral Therapy in Woliso Town, Oromia, Ethiopia
Authors: Teka Haile, Behailu Hawulte, Solomon Alemayehu
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Background: HIV virological failure still remains a problem in HV/AIDS treatment and care. This study aimed to describe the prevalence and identify the factors associated with viral non-suppression among HIV-positive adult patients on antiretroviral therapy in Woliso Town, Oromia, Ethiopia. Methods: A retrospective cross-sectional study was conducted among 424 HIV-positive patient’s attending antiretroviral therapy (ART) in Woliso Town during the period from August 25, 2020 to August 30, 2020. Data collected from patient medical records were entered into Epi Info version 2.3.2.1 and exported to SPSS version 21.0 for analysis. Logistic regression analysis was done to identify factors associated with viral load non-suppression, and statistical significance of odds ratios were declared using 95% confidence interval and p-value < 0.05. Results: A total of 424 patients were included in this study. The mean age (± SD) of the study participants was 39.88 (± 9.995) years. The prevalence of HIV viral load non-suppression was 55 (13.0%) with 95% CI (9.9-16.5). Second-line ART treatment regimen (Adjusted Odds Ratio (AOR) = 8.98, 95% Confidence Interval (CI): 2.64, 30.58) and routine viral load testing (AOR = 0.01, 95% CI: 0.001, 0.02) were significantly associated with virological non-suppression. Conclusion: Virological non-suppression was high, which hinders the achievement of the third global 95 target. The second-line regimen and routine viral load testing were significantly associated with virological non-suppression. It suggests the need to assess the effectiveness of antiretroviral drugs for epidemic control. It also clearly shows the need to decentralize third-line ART treatment for those patients in need.Keywords: virological non-suppression, HIV-positive, ART, Woliso town, Ethiopia
Procedia PDF Downloads 150430 A Comparison of Clinical and Pathological TNM Staging in a COVID-19 Era
Authors: Sophie Mills, Leila L. Touil, Richard Sisson
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Introduction: The TNM classification is the global standard for the staging of head and neck cancers. Accurate clinical-radiological staging of tumours (cTNM) is essential to predict prognosis, facilitate surgical planning and determine the need for other therapeutic modalities. This study aims to determine the accuracy of pre-operative cTNM staging using pathological TNM (pTNM) and consider possible causes of TNM stage migration, noting any variation throughout the COVID-19 pandemic. Materials and Methods: A retrospective cohort study examined records of patients with surgical management of head and neck cancer at a tertiary head and neck centre from November 2019 to November 2020. Data was extracted from Somerset Cancer Registry and histopathology reports. cTNM and pTNM were compared before and during the first wave of COVID-19, as well as with other potential prognostic factors such as tumour site and tumour stage. Results: 119 cases were identified, of which 52.1% (n=62) were male, and 47.9% (n=57) were female with a mean age of 67 years. Clinical and pathological staging differed in 54.6% (n=65) of cases. Of the patients with stage migration, 40.4% (n=23) were up-staged and 59.6% (n=34) were down-staged compared with pTNM. There was no significant difference in the accuracy of cTNM staging compared with age, sex, or tumour site. There was a statistically highly significant (p < 0.001) correlation between cTNM accuracy and tumour stage, with the accuracy of cTNM staging decreasing with the advancement of pTNM staging. No statistically significant variation was noted between patients staged prior to and during COVID-19. Conclusions: Discrepancies in staging can impact management and outcomes for patients. This study found that the higher the pTNM, the more likely stage migration will occur. These findings are concordant with the oncology literature, which highlights the need to improve the accuracy of cTNM staging for more advanced tumours.Keywords: COVID-19, head and neck cancer, stage migration, TNM staging
Procedia PDF Downloads 109429 Evaluating the Management of Febrile Infants (Less than 90 Days) Presenting to Tallaght Ed- Completed Audit Cycle
Authors: Amel Osman, Stewart McKenna
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Aim: Fever may present as the sole sign of a serious underlying infection in young infants. Febrile Infants aged less than 90 days are at an elevated susceptibility to invasive bacterial infections, thus presenting a challenge in ensuring the appropriate management of these cases. This study aims to ensure strict adherence to NICE guidelines for the management of fever in infants between 0 and 90 days presenting to Tallaght Hospital ED. A comprehensive audit, followed by a re-audit, was conducted to enhance the quality of care delivered to these patients. In accordance with NICE guidelines, all febrile infants should undergo blood tests. Additionally, LP should be performed in all neonates under 28 days, infants displaying signs of illness, and those with WCC below 5 or above 15. Method: A retrospective case review was performed, encompassing all patients aged between 0 to 90 days who presented with fever at Tallaght ED. Data retrieval was conducted from electronic records on two separate occasions, six months apart. The evaluation encompassed the assessment of body temperature as well as both partial and full septic workups. Results: Over the study period, 150 infants presented to the ED with fever in the initial audit, and 120 in the re-audit. In the first study, 81 patients warranted a full septic workup as per NICE, but only 48 received it. Conversely, 40 patients met criteria for a partial septic workup, with 12 undergoing blood tests. In the second study, 73 patients qualified for a full septic workup, of which 52 were completed. Additionally, 27 patients were indicated for a partial workup, with 20 undergoing blood tests. Conclusion: Managing febrile infants under three months of age presenting to Tallaght ED remains a persistent challenge, underscoring the need for continuous educational initiatives to guarantee that these patients receive the requisite assessments and treatments.Keywords: infants, fever, septic workup, tallaght
Procedia PDF Downloads 52428 From Parchment to Pixels: Digital Preservation for the Future
Authors: Abida Khatoon
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This study provides an overview of ancient manuscripts, including their historical significance, current digital preservation methods, and the challenges we face in safeguarding these invaluable resources. India has a long-standing tradition of manuscript preservation, with texts that span a wide range of subjects, from religious scriptures to scientific treatises. These manuscripts were written on various materials, including palm leaves, parchment, metal, bark, wood, animal skin, and paper. These manuscripts offer a deep insight into India's cultural and intellectual history. Ancient manuscripts are crucial historical records, providing valuable insights into past civilizations and knowledge systems. As these physical documents become increasingly fragile, digital preservation methods have become essential to ensure their continued accessibility. Digital preservation involves several key techniques. Scanning and digitization create high-resolution digital images of manuscripts, while reprography produces copies to reduce wear on originals. Digital archiving ensures proper storage and management of these digital files, and preservation of electronic data addresses modern formats like web pages and emails. Despite its benefits, digital preservation faces several challenges. Technological obsolescence, data integrity issues, and the resource-intensive nature of the process are significant hurdles. Securing adequate funding is particularly challenging due to high initial costs and ongoing expenses. Looking ahead, the future of digital preservation is promising. Advancements in technology, increased collaboration among institutions, and the development of sustainable funding models will enhance the preservation and accessibility of these important historical documents.Keywords: preservation strategies, Indian manuscript, cultural heritage, archiving
Procedia PDF Downloads 18427 Influence of Environment-Friendly Organic Wastes on the Properties of Sandy Soil under Growing Zea mays L. in Arid Regions
Authors: Mohamed Rashad, Mohamed Hafez, Mohamed Emran, Emad Aboukila, Ibrahim Nassar
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Environment-friendly organic wastes of Brewers' spent grain, a byproduct of the brewing process, have recently used as soil amendment to improve soil fertility and plant production. In this work, treatments of 1% (T1) and 2% (T2) of spent grains, 1% (C1) and 2% (C2) of compost and mix of both sources (C1T1) were used and compared to the control for growing Zea mays L. on sandy soil under arid Mediterranean climate. Soils were previously incubated at 65% saturation capacity for a month. The most relevant soil physical and chemical parameters were analysed. Water holding capacity and soil organic matter (OM) increased significantly along the treatments with the highest values in T2. Soil pH decreased along the treatments and the lowest pH was in C1T1. Bicarbonate decreased by 69% in C1T1 comparing to control. Total nitrogen (TN) and available P varied significantly among all treatments and T2, C1T1 and C2 treatments increased 25, 17 and 11 folds in TN and 1.2, 0.6 and 0.3 folds in P, respectively related to control. Available K showed the highest values in C1T1. Soil micronutrients increased significantly along all treatments with the highest values in T2. After corn germination, significant variation was observed in the velocity of germination coefficients (VGC) among all treatments in the order of C1T1>T2>T1>C2>C1>control. The highest records of final germination and germination index were in C1T1 and T2. The spent grains may compensate deficiencies of macro and micronutrients in newly reclaimed sandy soils without adverse effects to sustain crop production with a rider that excessive or continuous use need to be circumvented.Keywords: corn and squash germination, environmentally friendly organic wastes, soil carbon sequestration, spent grains as soil amendment, water holding capacity
Procedia PDF Downloads 508426 Blood Pressure Level, Targeted Blood Pressure Control Rate, and Factors Related to Blood Pressure Control in Post-Acute Ischemic Stroke Patients
Authors: Nannapus Saramad, Rewwadee Petsirasan, Jom Suwanno
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Background: This retrospective study design was to describe average blood pressure, blood pressure level, target blood pressure control rate post-stroke BP control in the year following discharge from Sichon hospital, Sichon District, Nakhon Si Thammarat province. The secondary data analysis was employed from the patient’s health records with patient or caregiver interview. A total of 232 eligible post-acute ischemic strokes in the year following discharge (2017-2018) were recruited. Methods: Data analyses were applied to identify the relationship values of single variables were determined through univariate analyses: The Chi-square test, Fisher exact test, the variables found to have a p-value < 0.2 were analyzed by the binary logistic regression Results: Most of the patients in this study were men 61.6%, an average age of 65.4 ± 14.8 years. Systolic blood pressure levels were in the grade 1-2 hypertension and diastolic pressure at optimal and normal at all times during the initial treatment through the present. The results revealed 25% among the groups under the age of 60 achieved BP control; 36.3% for older than 60 years group; and 27.9% for diabetic group. The multivariate analysis revealed the final relationship of four significant variables: 1) receiving calcium-channel blocker (p =.027); 2) medication adherence of antihypertensive (p = .024) 3) medication adherence of antiplatelet ( p = .020); and 4) medication behavior ( p = . 010) . Conclusion: The medical nurse and health care provider should promote their adherence to behavior to improve their blood pressure control.Keywords: acute ischemic stroke, target blood pressure control, medication adherence, recurrence stroke
Procedia PDF Downloads 122425 Negative Pressure Wound Therapy in Complex Injuries of the Limbs
Authors: Mihail Nagea, Olivera Lupescu, Nicolae Ciurea, Alexandru Dimitriu, Alina Grosu
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Introduction: As severe open injuries are more and more frequent in modern traumatology, threatening not only the integrity of the affected limb but even the life of the patients, new methods desired to cope with the consequences of these traumas were described. Vacuum therapy is one such method which has been described as enhancing healing in trauma with extensive soft-tissue injuries, included those with septic complications. Material and methods: Authors prospectively analyze 15 patients with severe lower limb trauma with MESS less than 6, with considerable soft tissue loss following initial debridement and fracture fixation. The patients needed serial debridements and vacuum therapy was applied after delayed healing due to initial severity of the trauma, for an average period of 12 days (7 - 23 days).In 7 cases vacuum therapy was applied for septic complications. Results: Within the study group, there were no local complications; secondary debridements were performed for all the patients and vacuum system was re-installed after these debridements. No amputations were needed. Medical records were reviewed in order to compare the outcome of the patients: the hospital stay, anti-microbial therapy, time to healing of the bone and soft tissues (there is no standard group to be compared with) and the result showed considerable improvements in the outcome of the patients. Conclusion: Vacuum therapy improves healing of the soft tissues, including those infected; hospital stay and the number of secondary necessary procedures are reduced. Therefore it is considered a valuable support in treating trauma of the limbs with severe soft tissue injuries.Keywords: complex injuries, negative pressure, open fractures, wound therapy
Procedia PDF Downloads 295424 The Recording of Personal Data in the Spanish Criminal Justice System and Its Impact on the Right to Privacy
Authors: Deborah García-Magna
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When a person goes through the criminal justice system, either as a suspect, arrested, prosecuted or convicted, certain personal data are recorded, and a wide range of persons and organizations may have access to it. The recording of data can have a great impact on the daily life of the person concerned during the period of time determined by the legislation. In addition, this registered information can refer to various aspects not strictly related directly to the alleged or actually committed infraction. In some areas, the Spanish legislation does not clearly determine the cancellation period of the registers nor what happens when they are cancelled since some of the files are not really erased and remain recorded, even if their consultation is no more allowed or it is stated that they should not be taken into account. Thus, access to the recorded data of arrested or convicted persons may reduce their possibilities of reintegration into society. In this research, some of the areas in which data recording has a special impact on the lives of affected persons are analyzed in a critical manner, taking into account Spanish legislation and jurisprudence, and the influence of the European Court of Human Rights, the Council of Europe and other supranational instruments. In particular, the analysis cover the scope of video-surveillance in public spaces, the police record, the recording of personal data for the purposes of police investigation (especially DNA and psychological profiles), the registry of administrative and minor offenses (especially as they are taken into account to impose aggravating circumstaces), criminal records (of adults, minors and legal entities), and the registration of special circumstances occurred during the execution of the sentence (files of inmates under special surveillance –FIES–, disciplinary sanctions, special therapies in prison, etc.).Keywords: ECHR jurisprudence, formal and informal criminal control, privacy, disciplinary sanctions, social reintegration
Procedia PDF Downloads 144423 Advanced Biosensor Characterization of Phage-Mediated Lysis in Real-Time and under Native Conditions
Authors: Radka Obořilová, Hana Šimečková, Matěj Pastucha, Jan Přibyl, Petr Skládal, Ivana Mašlaňová, Zdeněk Farka
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Due to the spreading of antimicrobial resistance, alternative approaches to combat superinfections are being sought, both in the field of lysing agents and methods for studying bacterial lysis. A suitable alternative to antibiotics is phage therapy and enzybiotics, for which it is also necessary to study the mechanism of their action. Biosensor-based techniques allow rapid detection of pathogens in real time, verification of sensitivity to commonly used antimicrobial agents, and selection of suitable lysis agents. The detection of lysis takes place on the surface of the biosensor with immobilized bacteria, which has the potential to be used to study biofilms. An example of such a biosensor is surface plasmon resonance (SPR), which records the kinetics of bacterial lysis based on a change in the resonance angle. The bacteria are immobilized on the surface of the SPR chip, and the action of phage as the mass loss is monitored after a typical lytic cycle delay. Atomic force microscopy (AFM) is a technique for imaging of samples on the surface. In contrast to electron microscopy, it has the advantage of real-time imaging in the native conditions of the nutrient medium. In our case, Staphylococcus aureus was lysed using the enzyme lysostaphin and phage P68 from the familyPodoviridae at 37 ° C. In addition to visualization, AFM was used to study changes in mechanical properties during lysis, which resulted in a reduction of Young’s modulus (E) after disruption of the bacterial wall. Changes in E reflect the stiffness of the bacterium. These advanced methods provide deeper insight into bacterial lysis and can help to fight against bacterial diseases.Keywords: biosensors, atomic force microscopy, surface plasmon resonance, bacterial lysis, staphylococcus aureus, phage P68
Procedia PDF Downloads 134422 The Minimum Age of Criminal Responsibility in the Philippines: Balancing International Standards and Domestic Concerns
Authors: Harold P. Pareja
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This paper answers the question whether the minimum age of criminal responsibility under the Republic Act No. 9344 (Juvenile Justice Act) as amended by Republic Act No. 10630 should be lowered to 15 years of age or not in the light of international standards and domestic concerns both of which will definitely elicit strong views. It also explores the specific provision on the minimum age of criminal responsibility under the Republic Act No. 9344 (Juvenile Justice Act) and traces the bases of such law by discussing its presented evidences and justifications as reflected in the records of proceedings in the law-making phase. On one hand, the paper discusses the impact of lowering the minimum age to the state of juvenile delinquencies and to the rate of rehabilitation for those CICL who have undergone the DSWD-supervised recovery programs. On the other hand, it presents its impact to the international community specifically to the Committee of the Rights of the Child and the UNICEF considering that the even the current minimum age set in RA 9344 is lower than the international standards. Document review and content analysis are the major research tools. Primary and secondary sources were used as references such as Philippine laws on juvenile justice and from the different states international think-tanks. The absence of reliable evidences on criminal capacity made the arguments in increasing the MACR in the harder position. Studies on criminal capacity vary from different countries and from practitioners in in the fields of psychology, psychiatry and forensics. Juvenile delinquency is mainly contributed by poverty and dysfunctional families. On the other hand, the science of the criminal mind specifically among children has not been established yet. Philippines have the legal obligations to be faithful to the CRC and other related international instruments for the juvenile justice and welfare system. Decreasing MACR does not only send wrong message to the international community but the Philippines is violating its own laws.Keywords: juvenile justice, minimum age of responsibility (MAR), juvenile justice act of the Philippines, children in conflict with the law, international standards on juvenile justice
Procedia PDF Downloads 407421 Assessment of Vehicular Accidents and Possible Mitigation Measures: A Case of Ahmedabad, Gujarat, India
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Rapid urbanization is one of the consequences of rapid population explosion, which has also led to massive increase in number of motorized vehicles essential for carrying out all activities needed for sustaining urban livelihood. With this increased use of motorized vehicles over the time there has also been an increase in number of accidents. Study of road network and geometric features are essential to tackle problems of road accidents in any district or town. The increase in road accidents is one of the burning issues in the present society. Records show that there is one death at every 3.7 minutes because of road accident. It has been found from the research that, accidents occur due to, mistakes of the driver (86%) followed by bad street condition (5%), mistake of pedestrian (4%), as well as technical and maintenance defects (1%). Here, case study of Ahmedabad, Gujarat is taken up where first road safety level is assessed considering various parameters. The study confined to accident characteristics of all types of vehicles. For deeper analysis, road safety index for various stretches in Ahmedabad was found out. Crash rate for same stretches was found out. Based on various parameters priority was decided so that which stretch should be look out first to minimize road accidents on that stretch and which stretch should look out last. The major findings of the study are that accident severity of Ahmedabad has increased, but accident fatality risk has decreased; thus there is need to undertake some traffic engineering measures or make some traffic rules that are strictly followed by traffic. From the above study and literature studied it is found that Ahmedabad is suffering from similar problem of accidents and injuries and deaths caused by them, after properly investigating the issue short-term and long-term solutions to minimize road accidents have been presented in this paper.Keywords: accident severity index, accident fatality rate, accident fatality risk, accident risk, road safety index
Procedia PDF Downloads 142420 Machine Learning Techniques in Bank Credit Analysis
Authors: Fernanda M. Assef, Maria Teresinha A. Steiner
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The aim of this paper is to compare and discuss better classifier algorithm options for credit risk assessment by applying different Machine Learning techniques. Using records from a Brazilian financial institution, this study uses a database of 5,432 companies that are clients of the bank, where 2,600 clients are classified as non-defaulters, 1,551 are classified as defaulters and 1,281 are temporarily defaulters, meaning that the clients are overdue on their payments for up 180 days. For each case, a total of 15 attributes was considered for a one-against-all assessment using four different techniques: Artificial Neural Networks Multilayer Perceptron (ANN-MLP), Artificial Neural Networks Radial Basis Functions (ANN-RBF), Logistic Regression (LR) and finally Support Vector Machines (SVM). For each method, different parameters were analyzed in order to obtain different results when the best of each technique was compared. Initially the data were coded in thermometer code (numerical attributes) or dummy coding (for nominal attributes). The methods were then evaluated for each parameter and the best result of each technique was compared in terms of accuracy, false positives, false negatives, true positives and true negatives. This comparison showed that the best method, in terms of accuracy, was ANN-RBF (79.20% for non-defaulter classification, 97.74% for defaulters and 75.37% for the temporarily defaulter classification). However, the best accuracy does not always represent the best technique. For instance, on the classification of temporarily defaulters, this technique, in terms of false positives, was surpassed by SVM, which had the lowest rate (0.07%) of false positive classifications. All these intrinsic details are discussed considering the results found, and an overview of what was presented is shown in the conclusion of this study.Keywords: artificial neural networks (ANNs), classifier algorithms, credit risk assessment, logistic regression, machine Learning, support vector machines
Procedia PDF Downloads 103419 Evaluation of NASA POWER and CRU Precipitation and Temperature Datasets over a Desert-prone Yobe River Basin: An Investigation of the Impact of Drought in the North-East Arid Zone of Nigeria
Authors: Yusuf Dawa Sidi, Abdulrahman Bulama Bizi
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The most dependable and precise source of climate data is often gauge observation. However, long-term records of gauge observations, on the other hand, are unavailable in many regions around the world. In recent years, a number of gridded climate datasets with high spatial and temporal resolutions have emerged as viable alternatives to gauge-based measurements. However, it is crucial to thoroughly evaluate their performance prior to utilising them in hydroclimatic applications. Therefore, this study aims to assess the effectiveness of NASA Prediction of Worldwide Energy Resources (NASA POWER) and Climate Research Unit (CRU) datasets in accurately estimating precipitation and temperature patterns within the dry region of Nigeria from 1990 to 2020. The study employs widely used statistical metrics and the Standardised Precipitation Index (SPI) to effectively capture the monthly variability of precipitation and temperature and inter-annual anomalies in rainfall. The findings suggest that CRU exhibited superior performance compared to NASA POWER in terms of monthly precipitation and minimum and maximum temperatures, demonstrating a high correlation and much lower error values for both RMSE and MAE. Nevertheless, NASA POWER has exhibited a moderate agreement with gauge observations in accurately replicating monthly precipitation. The analysis of the SPI reveals that the CRU product exhibits superior performance compared to NASA POWER in accurately reflecting inter-annual variations in rainfall anomalies. The findings of this study indicate that the CRU gridded product is often regarded as the most favourable gridded precipitation product.Keywords: CRU, climate change, precipitation, SPI, temperature
Procedia PDF Downloads 89418 The Effect of Undernutrition on Sputum Culture Conversion and Treatment Outcomes among People with Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis
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
Procedia PDF Downloads 152417 The Continuation of Trauma through Transcribing: Second Generation Survivors and the Inability for a 'Post-Holocaust'
Authors: Sarah Snyder
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Historians use the term ‘post-Holocaust’ to indicate the period from 1945 onward; however, for survivors of the Holocaust and their families, the Holocaust did not end in 1945. In fact, for some, it was just the beginning of their struggles. There are those who could not return to their homes, find loved ones, or fight off night terrors. Additionally, they continue to suffer from mental illness or physical disease stemming from the Holocaust. In order for historians to have a clearer understanding of the trauma survivors have endured, it is must to approach time differently. Trauma does not operate on a timeline and thereby, our understanding of ‘before,’ ‘during’ and ‘after’ are flawed. In order to convey this flaw, this study will examine memoirs of second and third-generation survivors and of child survivors. Within the second and third generation group, there are two types of generational memoirs that are scrutinized for this case study. The first being when a child or grandchild records the stories of their parent(s) or grandparent(s) without any of the second or third generation’s stories implicitly written. ‘Implicitly’ is used in the context that it is impossible for any writer to not impose at least some stylistic portion of themselves into writing, but the intent was to focus on the parent or grandparent. The other type of memoir is when they write their parent(s) or grandparent(s) story intertwined with their own story. Additionally, the child survivor has a unique role in memory and trauma studies. Much like later generations who write about the Holocaust but have not experienced the trauma firsthand, the child survivor must write about what they lived through and experienced but cannot remember without the assistance of research or other survivors. This study shows that survivors continue to demonstrate trauma-related paranoia. They fear experiencing another Holocaust. In their minds, they replay the horrors that they had experienced. A pilgrimage to a 20th century Europe, unlike one of the 1940s, causes uncertainty, confusion, and additional paranoia. It is through these findings that it becomes evident that historians must learn to study trauma without placing strict timelines that prevent understanding of how trauma impacts those who have experienced complex trauma.Keywords: holocaust, generational, memoirs, trauma
Procedia PDF Downloads 203416 Ventriculo-Gallbladder Shunt: Case Series and Literature Review
Authors: Sandrieli Afornali, Adriano Keijiro Maeda, Renato Fedatto Beraldo, Carlos Alberto Mattozo, Ricardo Nascimento Brito
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BACKGROUND: The most used variety in hydrocephalus treatment is the ventriculoperitoneal shunt (VPS). However, it may fails in 20 to 70% of cases. It makes necessary to have alternative cavities for the implantation of the distal catheter. Ventriculo-atrial shunting (VAS) is described as the second option. To our knowledge, there are 121 reported cases of VGB shunt in children until 2020 and a highly variable success rate, from 25 to 100%, with an average of 63% of patients presenting good long-term results. Our goal is to evaluate the epidemiological profile of patients submitted to ventriculo-gallbladder (VGB) shunt and, through a review of literature, to compare our results with others series. METHODS: a retrospective cross-sectional observational study of a case series of nine patients. The medical records of all patients were reviewed, who underwent VGB shunt at the Hospital Pequeno Príncipe from Curitiba, Paraná, Brazil, from January 2014 to October 2022. The inclusion criteria were: patients under 17 years of age with hydrocephalus of any etiology, currently using or prior to VGB shunt. RESULTS: There were 6 (66,7%) male and 3 (33,3%) female. The average age of 73.6 months or 6.1 years at the time of surgery. They were submitted on average 5.1 VPS reviews previous to VGB shunt. Five (55,5%) had complications of VGB shunt: infection (11.1%), atony (11.1%), hypodrainage due to kinking the distal catheter in the solution (11.1%) and ventriculoenteric fistula (22.2%); all these patients were cured at surgical reapproach, and in 2 of them the VGB shunt was reimplanted. Two patients died (22.2%), and five (55,5%) patients maintained the use of VGB shunt in the follow-up period; and in 4 (44.4%) there was never need for review. CONCLUSION: VGB shunt tends to be underestimated because it is still unconventional and little publicized in literature. Our article shows a lower risk of death and similar risk of complications when compared to others altenatives shunts. We emphasize VGB shunt as a safe procedure to be the second option when VPS fails or has contraindications.Keywords: hydrocephalus, ventricular-gallbladder shunt, VGB shunt, VPS, ventriculoperitoneal shunt, ventriculoatrial shunt
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