Search results for: cardio-vascular diseases
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3005

Search results for: cardio-vascular diseases

2375 Discovering Traditional Plants Used by Indigenous People in the Tropical Rainforest of Malaysia for the Treatment of Malaria

Authors: Izdihar Ismail, Alona C. Linatoc, Maryati Mohamed

Abstract:

The tropical rainforest of Malaysia is known for its rich biological diversity and high endemicity. The potential for these forests to hold the cure for many diseases and illnesses is high and much is yet to be discovered. This study explores the richness of the tropical rainforest of Endau-Rompin National Park in Johor, Malaysia in search of plants traditionally used by the indigenous people in the treatment of malaria and malaria-like symptoms. Seven species of plants were evaluated and tested for antiplasmodial activities. Different plant parts were subjected to methanolic and aqueous extractions. A total of 24 extracts were evaluated by histidine-rich protein II (HRP2) assay against K1 strain of Plasmodium falciparum chloroquine-resistant. Ten extracts showed significant inhibition of the growth of P. falciparum. Phytochemical screening of the same extracts revealed the presence of alkaloids, flavonoids, terpenoids and anthraquinones. This study affirms that tropical rainforests may still hold undiscovered cures for many diseases and illnesses that have inflicted millions of people worldwide. The species studied herein have not known to have been studied elsewhere before.

Keywords: Endau-Rompin, malaria, Malaysia, tropical rainforest, traditional knowledge

Procedia PDF Downloads 272
2374 The Need for Including Hepatitis a Vaccine in Routine Childhood Immunization Programs in Europe as a Response to the Influx of Refugees from the Middle East and North Africa (MENA) Regions

Authors: S. Ramia, N. Melhem, K. Kreidieh

Abstract:

The world is facing an unprecedented displacement crisis. Recently, over 1.1 million asylum seekers have been granted protection status in the European Union (EU). The majority of these asylum seekers were from countries of the Middle East and North Africa (MENA) region.This influx carries with it a potential introduction of infectious diseases that have been eliminated in the EU, which poses a challenge for EU health authorities. Compared to MENA region countries where Hepatitis A Virus (HAV) endemicity is high to intermediate, member states of the EU show very low (Western Europe) to low (Eastern Europe) levels of HAV endemicity. Because of this situation, there is an ongoing public health concern in high-income countries, like members of the EU, that many adults remain susceptible to HAV outbreaks. The overwhelming majority of the EU members’ states do not include HAV vaccine in their immunization calendars. Hence, this paper urgently calls for the implementation of new policies regarding HAV in EU members’ states.

Keywords: European union, hepatitis A, MENA region refugees, vaccine preventable diseases

Procedia PDF Downloads 278
2373 Carotenoids a Biologically Important Bioactive Compound

Authors: Aarti Singh, Anees Ahmad

Abstract:

Carotenoids comprise a group of isoprenoid pigments. Carotenes, xanthophylls and their derivatives have been found to play an important role in all living beings through foods, neutraceuticals and pharmaceuticals. α-carotene, β-carotene and β-cryptoxanthin play a vital role in humans to provide vitamin A source for the growth, development and proper functioning of immune system and vision. They are very crucial for plants and humans as they protect from photooxidative damage and are excellent antioxidants quenching singlet molecular oxygen and peroxyl radicals. Diet including more intake of carotenoids results in reduced threat of various chronic diseases such as cancer (lung, breast, prostrate, colorectal and ovarian cancers) and coronary heart diseases. The blue light filtering efficiency of the carotenoids in liposomes have been reported to be maximum in lutein followed by zeaxanthin, β-carotene and lycopene. Lycopene plays a vital role for the protection from CVD. Lycopene in serum is directly related to reduced risk of osteoporosis in postmenopausal women. Carotenoids have major role in the treatment of skin disorders. There is need to identify and isolate novel carotenoids from diverse natural sources for human health benefits.

Keywords: antioxidants, carotenoids, neutraceuticals, osteoporosis, pharmaceuticals

Procedia PDF Downloads 376
2372 An Investigation of the Relevant Factors of Unplanned Readmission within 14 Days of Discharge in a Regional Teaching Hospital in South Taiwan

Authors: Xuan Hua Huang, Shu Fen Wu, Yi Ting Huang, Pi Yueh Lee

Abstract:

Background: In Taiwan, the Taiwan healthcare care Indicator Series regards the rate of hospital readmission as an important indicator of healthcare quality. Unplanned readmission not only effects patient’s condition but also increase healthcare utilization rate and healthcare costs. Purpose: The purpose of this study was explored the effects of adult unplanned readmission within 14 days of discharge at a regional teaching hospital in South Taiwan. Methods: The retrospectively review design was used. A total 495 participants of unplanned readmissions and 878 of non-readmissions within 14 days recruited from a regional teaching hospital in Southern Taiwan. The instruments used included the Charlson Comorbidity Index, and demographic characteristics, and disease-related variables. Statistical analyses were performed with SPSS version 22.0. The descriptive statistics were used (means, standard deviations, and percentage) and the inferential statistics were used T-test, Chi-square test and Logistic regression. Results: The unplanned readmissions within 14 days rate was 36%. The majorities were 268 males (54.1%), aged >65 were 318 (64.2%), and mean age was 68.8±14.65 years (23-98years). The mean score for the comorbidities was 3.77±2.73. The top three diagnosed of the readmission were digestive diseases (32.7%), respiratory diseases (15.2%), and genitourinary diseases (10.5%). There were significant relationships among the gender, age, marriage, comorbidity status, and discharge planning services (χ2: 3.816-16.474, p: 0.051~0.000). Logistic regression analysis showed that old age (OR = 1.012, 95% CI: 1.003, 1.021), had the multi-morbidity (OR = 0.712~4.040, 95% CI: 0.559~8.522), had been consult with discharge planning services (OR = 1.696, 95% CI: 1.105, 2.061) have a higher risk of readmission. Conclusions: This study finds that multi-morbidity was independent risk factor for unplanned readmissions at 14 days, recommended that the interventional treatment of the medical team be provided to provide integrated care for multi-morbidity to improve the patient's self-care ability and reduce the 14-day unplanned readmission rate.

Keywords: unplanned readmission, comorbidities, Charlson comorbidity index, logistic regression

Procedia PDF Downloads 147
2371 Awareness and Access to Rapid Diagnostic Tests of HIV, Malaria and Tuberculosis among Rural Pregnant Women of Savannakhet Province, Lao PDR

Authors: Vanphanom Sychareun, Viengnakhone Vongxay, Kongmany Chaleunvong, Pascale Hancart Petitet

Abstract:

Background: Lao PDR still has challenges in preventing and managing health against risk of emerging and re-emerging diseases, particularly HIV/AIDS, tuberculosis and malaria among pregnant women. Community-based intervention for mothers requires more evidences on awareness of such diseases and access to rapid diagnostic tests. The study aims to determine the awareness of pregnant women regarding HIV, TB and Malaria, the access to rapid diagnostic test of such diseases among pregnant women of local community and their factors related. Method: This is a cross sectional study using quantitative approach to explore the awareness of pregnant women on HIV/AIDS/TB and Malaria in Savannakhet province, Lao PDR in three remote districts (Phin, Thapangthong and Atsaphone) of Savannakhet province. The study targeted group was pregnant women at the community level. Sample size for primary data collection of pregnant women was 189. Face-to-face administered questionnaires were applied. Descriptive and inferential statistics were applied to determine the associated factors with awareness of pregnant women on HIV/AIDS/TB and Malaria. This study is under the HEALTH project/ Expertise France. Result: Most of our participants were pregnant at 28 – 42 weeks (50.3%); ranged 4 – 38 weeks. Mean age of pregnant women was 24.3 years old (range: 14 - 48 years old); 15.9% of whom were at age below 19 years. Around 94.2% of respondents works were farming, 54.5% were illiterate, 74.0% were Mon-Kmer ethnic, and 60% had income lower than average. Only 56.6% that have access to ANC, 39.1% started the access to ANC during the first trimester and only 19.6% had visited the ANC for at least four times. Almost pregnant women (and 92.1% and 93.1%) had low to moderate knowledge of HIV and TB respectively, while three-fourth of pregnant women (74.6%) had low to moderate knowledge of malaria. Slightly higher than half of participants (53.4% and 52.9%) had easy access to HIV and TB respectively ; while 72.5% had easy access to malaria. Majority of participants knew where to get tested for malaria (73.5%) and TB (54.5%), but 73.5% did not know where to get tested for HIV. Very few pregnant women (1.6%, 2.1% and 8.5%) experienced having tested for HIV/TB/malaria. respectively. Factors associated with awareness on HIV were occupation as staff, business (OR:5.9; 95% CI:1.2-28.1), upper secondary education (OR: 14.6; 95% CI:3.1-69.2); Mone-Khmer ethnic (OR: 0.4, 95% CI: 0.2-0.8); and attending ANC more than 4 times (OR:4.1, 95%:1.7-9.7). Factors associated with awareness on TB were occupation as staff, business (OR:2.4; 95% CI: 0.7-8.0), upper secondary education (OR: 6.2; 95% CI: 1.9-20.5); Mone-Khmer ethnic (OR: 0.5, 95% CI:0.3-0.9); attending ANC more than 4 times (OR:2.8, 95%:1.2-6.4). Factors associated with awareness on malaria were upper secondary education (OR: 18.1; 95% CI: 2.3-142.9); Mone-Khmer ethnic (OR: 0.2, 95% CI:0.1-0.4); attending ANC more than 4 times (OR:3.6, 95%:1.5-8.8). Conclusion: A very low awareness on HIV, TB and malaria among pregnant women in rural community of Savannakhet triggers the requirement of comprehensive public health intervention on awareness and access to prevention against emerging diseases for all pregnant women. Future intervention should focus on providing more knowledge to pregnant women during ANC and encouraging them to attend ANC more than 4 times.

Keywords: pregnant women, HIV, tuberculosis, malaria, awareness, Laos

Procedia PDF Downloads 87
2370 Diabetes Diagnosis Model Using Rough Set and K- Nearest Neighbor Classifier

Authors: Usiobaifo Agharese Rosemary, Osaseri Roseline Oghogho

Abstract:

Diabetes is a complex group of disease with a variety of causes; it is a disorder of the body metabolism in the digestion of carbohydrates food. The application of machine learning in the field of medical diagnosis has been the focus of many researchers and the use of recognition and classification model as a decision support tools has help the medical expert in diagnosis of diseases. Considering the large volume of medical data which require special techniques, experience, and high diagnostic skill in the diagnosis of diseases, the application of an artificial intelligent system to assist medical personnel in order to enhance their efficiency and accuracy in diagnosis will be an invaluable tool. In this study will propose a diabetes diagnosis model using rough set and K-nearest Neighbor classifier algorithm. The system consists of two modules: the feature extraction module and predictor module, rough data set is used to preprocess the attributes while K-nearest neighbor classifier is used to classify the given data. The dataset used for this model was taken for University of Benin Teaching Hospital (UBTH) database. Half of the data was used in the training while the other half was used in testing the system. The proposed model was able to achieve over 80% accuracy.

Keywords: classifier algorithm, diabetes, diagnostic model, machine learning

Procedia PDF Downloads 336
2369 Consumers’ Perceptions of Non-Communicable Diseases and Perceived Product Value Impacts on Healthy Food Purchasing Decisions

Authors: Khatesiree Sripoothon, Usanee Sengpanich, Rattana Sittioum

Abstract:

The objective of this study is to examine the factors influencing consumer purchasing decisions about healthy food. This model consists of two latent variables: Consumer Perception relating to NCDs and Consumer Perceived Product Value. The study was conducted in the northern provinces of Thailand, which are popular with tourists and have received support from the government for health tourism. A survey was used as the data collection method, and the questionnaire was applied to 385 tourists. An accidental sampling method was used to identify the sample. The statistics of frequency, percentage, mean, and structural equation model were used to analyze the data obtained. Additionally, all factors had a significant positive influence on healthy food purchasing decisions (p<0.01) and were predictive of healthy food purchasing decisions at 46.20 (R2=0.462). Also, these findings seem to underline a supposition that consumer perceptions of NCDs and perceived product value are key variables that strengthens the competitive effects of a healthy-friendly business entrepreneur. Moreover, reduce the country's public health costs for treating patients with the disease of NCDs in Thailand.

Keywords: healthy food, perceived product value, perception of non-communicable diseases, purchasing decisions

Procedia PDF Downloads 161
2368 Study of Early Diagnosis of Oral Cancer by Non-invasive Saliva-On-Chip Device: A Microfluidic Approach

Authors: Ragini Verma, J. Ponmozhi

Abstract:

The oral cavity is home to a wide variety of microorganisms that lead to various diseases and even oral cancer. Despite advancements in the diagnosis and detection at the initial phase, the situation hasn’t improved much. Saliva-on-a-chip is an innovative point-of-care platform for early diagnosis of oral cancer and other oral diseases in live and dead cells using a microfluidic device with a current perspective. Some of the major challenges, like real-time imaging of the oral cancer microbes, high throughput values, obtaining a high spatiotemporal resolution, etc. were faced by the scientific community. Integrated microfluidics and microscopy provide powerful approaches to studying the dynamics of oral pathology, microbe interaction, and the oral microenvironment. Here we have developed a saliva-on-chip (salivary microbes) device to monitor the effect on oral cancer. Adhesion of cancer-causing F. nucleatum; subsp. Nucleatum and Prevotella intermedia in the device was observed. We also observed a significant reduction in the oral cancer growth rate when mortality and morbidity were induced. These results show that this approach has the potential to transform the oral cancer and early diagnosis study.

Keywords: microfluidic device, oral cancer microbes, early diagnosis, saliva-on-chip

Procedia PDF Downloads 101
2367 A Review: Carotenoids a Biologically Important Bioactive Compound

Authors: Aarti Singh, Anees Ahmad

Abstract:

Carotenoids comprise a group of isoprenoid pigments. Carotenes, xanthophylls and their derivatives have been found to play an important role in all living beings through foods, neutraceuticals and pharmaceuticals. α-carotene, β-carotene and β-cryptoxanthin play a vital role in humans to provide vitamin A source for the growth, development and proper functioning of immune system and vision. They are very crucial for plants and humans as they protect from photooxidative damage and are excellent antioxidants quenching singlet molecular oxygen and peroxyl radicals. Diet including more intake of carotenoids results in reduced threat of various chronic diseases such as cancer (lung, breast, prostate, colorectal and ovarian cancers) and coronary heart diseases. The blue light filtering efficiency of the carotenoids in liposomes have been reported to be maximum in lutein followed by zeaxanthin, β-carotene and lycopene. Lycopene play a vital role for the protection from CVD. Lycopene in serum is directly related to reduced risk of osteoporosis in postmenopausal women. Carotenoids have the major role in the treatment of skin disorders. There is a need to identify and isolate novel carotenoids from diverse natural sources for human health benefits.

Keywords: antioxidants, carotenoids, neutraceuticals, osteoporosis, pharmaceuticals

Procedia PDF Downloads 361
2366 Fatty Acid Profile and Dietary Fibre Contents of Some Standardized Soups and Dishes Consumed in Nigeria

Authors: Olufunke O. Obanla, Oluseye O. Onabanjo, Silifat A. Sanni, Mojisola O. Adegunwa, Wasiu A. O. Afolabi, Omolola O. Oyawoye, Atinuke Titilola Lano-Maduagu

Abstract:

Background: Dietary fat is implicated in the increasing development of chronic diseases in developing countries while dietary fibre plays a major role in the management of these diseases. Accurate nutrient composition data for composite dishes unique to a population is essential for the development of a nutrient database and the calculation of dietary intake. Methods: Representative samples of standardized Nigerian soups and dishes were analyzed for fatty acids using gas chromatography-mass spectrophotometry (GC-MS) and dietary fibre using an enzymatic-gravimetric standard method of AOAC. Results: The total Saturated Fatty acids (SFAs) ranged from 0.74+0.3g/100g to 73.82+0.07g/100g. The total monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) ranged from 2.16+1.13g/100g for Yam pottage to 22.25+0.58g/100g for Okazi soup and eba, and from 0.42+0.10g/100g for Yam pottage to 10.22+0.1g/100g for Pounded yam with egusi ball soup, respectively. Trans fat was observed in Alapafubu and Tuwo shinkafa (2.80+0.2g/100g), Yam pottage (0.20+0.15g/100g), Steamed bean pudding (1.28+0.53g/100g) and Ikokore (5.33+0.41g/100g). The Total Dietary Fibre (TDF) contents of the dishes ranged from 12.95+2.99g/100g in Jollof rice to 62.00+0.94g/100g in Melon seed and vegetable soup, the Soluble Dietary Fibre (SDF) ranged from 2.05+0.32g/100g in Steamed bean pudding to 7.81+0.74g/100g in Ikokore while the Insoluble Dietary Fibre (IDF) ranged from 8.20+0.43g/100g in Jollof rice to 57.91+4.69g/100g in melon seed and vegetable soup. Conclusions: The study has indicated that some Nigerian dishes are characterized by high SFAs, TFAs and dietary fibre, moderate MUFAs and very low levels of PUFAs. High levels of SFAs in some soups and dishes are a major public health concern.

Keywords: healthy diet, dietary fibre, fatty acid profile, chronic diseases, Nigerian dishes

Procedia PDF Downloads 374
2365 Neuropalliative Care in Patients with Progressive Neurological Disease in Czech Republic: Study Protocol

Authors: R. Bužgová, R. Kozáková, M. Škutová, M. Bar, P. Ressner, P. Bártová

Abstract:

Introduction: Currently, there has been an increasing concern about the provision of palliative care in non-oncological patients in both professional literature and clinical practice. However, there is not much scientific information on how to provide neurological and palliative care together. The main objective of the project is to create and to verify a concept of neuro-palliative and rehabilitative care for patients with selected neurological diseases in an advanced stage of the disease and also to evaluate bio-psychosocial and spiritual needs of these patients and their caregivers related to the quality of life using created standardized tools. Methodology: Triangulation of research methods (qualitative and quantitative) will be used. A concept of care and assessment tools will be developed by analyzing interviews and focus groups. Qualitative data will be analyzed using grounded theory. The concept of care will be tested in the context of the intervention study. Using quantitative analysis, we will assess the effect of an intervention provided on the saturation of needs, quality of life, and quality of care. A research sample will be made up of the patients with selected neurological diseases (Parkinson´s syndrome, motor neuron disease, multiple sclerosis, Huntington’s disease), together with patients´ family members. Based on the results, educational materials and a certified course for health care professionals will be created. Findings: Based on qualitative data analysis, we will propose the concept of integrated care model combining neurological, rehabilitative and specialist palliative care for patients with selected neurological diseases in different settings of care and services. Patients´ needs related to quality of life will be described by newly created and validated measuring tools before the start of intervention (application of neuro-palliative and palliative approach) and then in the time interval. Conclusion: Based on the results, educational materials and a certified course for doctors and health care professionals will be created.

Keywords: multidisciplinary approach, neuropalliative care, research, quality of life

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2364 Resveratrol-Phospholipid Complex for Sustained Delivery of Resveratrol via the Skin for the Treatment of Inflammatory Diseases

Authors: Malay K. Das, Bhupen Kalita

Abstract:

The poor oral bioavailability of resveratrol (RSV) due to presystemic metabolism can be avoided via dermal route of administration. The hydrophilic-lipophilic nature of resveratrol-phospholipid complex (RSVPs) favors the delivery of resveratrol via the skin. The RSVPs embedded polymeric patch with moderate adhesiveness was developed for dermal application for sustained anti-inflammatory effect. The prepared patches were evaluated for various physicochemical properties, surface morphology by SEM, TEM, and compatibility of patch components by FT-IR and DSC studies. The dermal flux of the optimized patch formulation was found to be at 4.28 ± 0.48 mg/cm2/24 h. The analysis of skin extract after permeation study revealed the presence of resveratrol, which confirmed the localization of RSVPs in the skin. The stability of RSVPs in the polymeric patch and the physiologic environment was confirmed by FE-SEM studies on the patches after drug release and skin permeation studies. The RSVPs particles released from the polymer matrix maintaining the structural integrity and permeate the keratinized horney layer of skin. The optimized patch formulation showed sustained anti-inflammatory effect (84.10% inhibition of inflammation at 24 h) in carrageenan-induced rat paw edema model compared to marketed diclofenac sodium gel (39.58% inhibition of inflammation at 24 h). The CLSM study confirmed the localization of RSVPs for a longer period, thus enabling drug targeting to the dermis for sustained anti-inflammatory effect. Histological studies with phase contrast trinocular microscope suggested no alteration of skin integrity and no evidence of the presence of inflammatory cells after exposure to the permeants. The patch was found to be safe for skin application as evaluated by Draize method for skin irritation scoring in a rabbit model. These results suggest the therapeutic efficacy of the developed patch in both acute and chronic inflammatory diseases.

Keywords: resveratrol-phospholipid complex, skin delivery, sustained anti-inflammatory effect, inflammatory diseases, dermal patch

Procedia PDF Downloads 230
2363 A Case Study of Deep Learning for Disease Detection in Crops

Authors: Felipe A. Guth, Shane Ward, Kevin McDonnell

Abstract:

In the precision agriculture area, one of the main tasks is the automated detection of diseases in crops. Machine Learning algorithms have been studied in recent decades for such tasks in view of their potential for improving economic outcomes that automated disease detection may attain over crop fields. The latest generation of deep learning convolution neural networks has presented significant results in the area of image classification. In this way, this work has tested the implementation of an architecture of deep learning convolution neural network for the detection of diseases in different types of crops. A data augmentation strategy was used to meet the requirements of the algorithm implemented with a deep learning framework. Two test scenarios were deployed. The first scenario implemented a neural network under images extracted from a controlled environment while the second one took images both from the field and the controlled environment. The results evaluated the generalisation capacity of the neural networks in relation to the two types of images presented. Results yielded a general classification accuracy of 59% in scenario 1 and 96% in scenario 2.

Keywords: convolutional neural networks, deep learning, disease detection, precision agriculture

Procedia PDF Downloads 259
2362 T Cell Immunity Profile in Pediatric Obesity and Asthma

Authors: Mustafa M. Donma, Erkut Karasu, Burcu Ozdilek, Burhan Turgut, Birol Topcu, Burcin Nalbantoglu, Orkide Donma

Abstract:

The mechanisms underlying the association between obesity and asthma may be related to a decreased immunological tolerance induced by a defective function of regulatory T cells (Tregs). The aim of this study is to establish the potential link between these diseases and CD4+, CD25+ FoxP3+ Tregs as well as T helper cells (Ths) in children. This is a prospective case control study. Obese (n:40), asthmatic (n:40), asthmatic obese (n:40), and healthy children (n:40), who don't have any acute or chronic diseases, were included in this study. Obese children were evaluated according to WHO criteria. Asthmatic patients were chosen based on GINA criteria. Parents were asked to fill up the questionnaire. Informed consent forms were taken. Blood samples were marked with CD4+, CD25+ and FoxP3+ in order to determine Tregs and Ths by flow cytometric method. Statistical analyses were performed. p≤0.05 was chosen as meaningful threshold. Tregs exhibiting anti-inflammatory nature were significantly lower in obese (0,16%; p≤0,001), asthmatic (0,25%; p≤0,01) and asthmatic obese (0,29%; p≤0,05) groups than the control group (0,38%). Ths were counted higher in asthma group than the control (p≤0,01) and obese (p≤0,001)) groups. T cell immunity plays important roles in obesity and asthma pathogeneses. Decreased numbers of Tregs found in obese, asthmatic and asthmatic obese children may help to elucidate some questions in pathophysiology of these diseases. For HOMA-IR levels, any significant difference was not noted between control and obese groups, but statistically higher values were found for obese asthmatics. The values obtained in all groups were found to be below the critical cut off points. This finding has made the statistically significant difference observed between Tregs of obese, asthmatic, obese asthmatic, and control groups much more valuable. These findings will be useful in diagnosis and treatment of these disorders and future studies are needed. The production and propagation of Tregs may be promising in alternative asthma and obesity treatments.

Keywords: asthma, flow cytometry, pediatric obesity, T cells

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2361 Mycobacterium Genome Extraction from Lymph Nodes of Sarcoidosis Cases Using Transbronchial Needle Aspiration: A Cross-Sectional Descriptive Essay On 1223 Patients

Authors: Atefeh Abedini, Pegah Soltani, Arda Kiani

Abstract:

Background: Sarcoidosis and Tuberculosis are both considered granulomatous chronic diseases with some similar pulmonary and extra-pulmonary manifestations. It is hypothesized that given these morphological similarities, the genome of mycobacterium could have an impact on the development of Sarcoidosis. Identifying the potential correlation of these diseases may assist in the management of sarcoidosis. Herein, we aimed to inspect the lymph node biopsy of sarcoidosis patients for the existence of the HSP-65 mycobacterium DNA sequence. Methods: This cross-sectional survey was conducted on 1188 Sarcoidosis patients without active/latent tuberculosis infection who were diagnosed in Masih Daneshvari Hospital in Tehran, Iran, from January 2020 to January 2022. Trans-bronchial needle aspiration (TBNA) was performed due to bilateral hilar lymphadenopathy to take a specimen. Results: The under-evaluated patients were mainly women (N=815 (68.6%)), none-smoker (N=1016 (85.5%)), and middle-aged (50.1 (SD=4.22)) with average angiotensin-converting enzyme (ACE) index of 75.6 (SD=6.42). Dyslipidemias (n=314 (26.4%), Hypertension (n=295 (24.8%)), Diabetes mellitus (n=131 (11.0%)), and chronic heart diseases (n=97 (8.2%)) had the highest prevalence between comorbidities. Skin lesions (n= 655 (55.1%)), ophthalmic (n=341 (28.7%)), and cardiac involvement (n=229 (19.3%)) were obtained as the most common extra-pulmonary characteristics of the patients. Amongst 1188 enrolled patients who were not afflicted with Mycobacterium tuberculosis based on smear/culture essay, clinical symptoms, and Chest x-ray screening, 121 (10.2%) cases had detectable amplified DNA for Mycobacterium Tuberculosis extracted from mediastinal lung lymph nodes. Conclusion: In this survey, the mycobacterium genome was detected in almost 1 per 10 case biopsies of sarcoidosis. The remarkable number of cases (n=1188) evaluated in this study was the strength of this study which supported the hypothesis regarding sarcoidosis and mycobacterium genome correlation. Further investigation, such as case-control surveys, is required to better clarify this association.

Keywords: mycobacterium tuberculosis, sarcoidosis, genome, DNA, trans-bronchial needle aspiration

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2360 A Different Approach to Smart Phone-Based Wheat Disease Detection System Using Deep Learning for Ethiopia

Authors: Nathenal Thomas Lambamo

Abstract:

Based on the fact that more than 85% of the labor force and 90% of the export earnings are taken by agriculture in Ethiopia and it can be said that it is the backbone of the overall socio-economic activities in the country. Among the cereal crops that the agriculture sector provides for the country, wheat is the third-ranking one preceding teff and maize. In the present day, wheat is in higher demand related to the expansion of industries that use them as the main ingredient for their products. The local supply of wheat for these companies covers only 35 to 40% and the rest 60 to 65% percent is imported on behalf of potential customers that exhaust the country’s foreign currency reserves. The above facts show that the need for this crop in the country is too high and in reverse, the productivity of the crop is very less because of these reasons. Wheat disease is the most devastating disease that contributes a lot to this unbalance in the demand and supply status of the crop. It reduces both the yield and quality of the crop by 27% on average and up to 37% when it is severe. This study aims to detect the most frequent and degrading wheat diseases, Septoria and Leaf rust, using the most efficiently used subset of machine learning technology, deep learning. As a state of the art, a deep learning class classification technique called Convolutional Neural Network (CNN) has been used to detect diseases and has an accuracy of 99.01% is achieved.

Keywords: septoria, leaf rust, deep learning, CNN

Procedia PDF Downloads 76
2359 A Comparative Study to Evaluate Changes in Intraocular Pressure with Thiopentone Sodium and Etomidate in Patients Undergoing Surgery for Traumatic Brain Injury

Authors: Vasudha Govil, Prashant Kumar, Ishwar Singh, Kiranpreet Kaur

Abstract:

Traumatic brain injury leads to elevated intracranial pressure. Intraocular pressure (IOP) may also be affected by intracranial pressure. Increased venous pressure in the cavernous sinus is transmitted to the episcleral veins, resulting in an increase in IOP. All drugs used in anesthesia induction can change IOP. Irritation of the gag reflex after usage of the endotracheal tube can also increase IOP; therefore, the administration of anesthetic drugs, which make the lowest change in IOP, is important, while cardiovascular depression must also be avoided. Thiopentone decreases IOP by 40%, whereas etomidate decreases IOP by 30-60% for up to 5 minutes. Hundred patients (age 18-55 years) who underwent emergency craniotomy for TBI are selected for the study. Patients are randomly assigned to two groups of 50 patients each accord¬ing to the drugs used for induction: group T was given thiopentone sodium (5mg kg-1) and group E was given etomi¬date (0.3mg kg-1). Preanaesthesia intraocular pressure (IOP) was measured using Schiotz tonometer. Induction of anesthesia was achieved with etomidate (0.3mg kg-1) or thiopentone (5mg kg-1) along with fentanyl (2 mcg kg-1). Intravenous rocuronium (0.9mg kg-1) was given to facilitate intubation. Intraocular pressure was measured after 1 minute of induction agent administration and 5 minutes after intubation. Maintainance of anesthesia was done with isoflurane in 50% nitrous oxide with fresh gas flow of 5 litres. At the end of the surgery, the residual neuromuscular block was reversed and the patient was shifted to ward/ICU. Patients in both groups were comparable in terms of demographic profile. There was no significant difference between the groups for the hemody¬namic and respiratory variables prior to thiopentone or etomidate administration. Intraocular pressure in thiopentone group in left eye and right eye before induction was 14.97±3.94 mmHg and 14.72±3.75 mmHg respectively and for etomidate group was 15.28±3.69 mmHg and 15.54±4.46 mmHg respectively. After induction IOP decreased significantly in both the eyes (p<0.001) in both the groups. After 5 min of intubation IOP was significantly less than the baseline in both the eyes but it was more than the IOP after induction with the drug. It was found that there was no statistically significant difference in IOP between the two groups at any point of time. Both the drugs caused a significant decrease in IOP after induction and after 5 minutes of endotracheal intubation. The mechanism of decrease in IOP by intravenous induction agents is debatable. Systemic hypotension after the induction of anaesthesia has been shown to cause a decrease in intra-ocular pressure. A decrease in the tone of the extra-ocular muscles can also result in a decrease in intra-ocular pressure. We observed that it is appropriate to use etomidate as an induction agent when elevation of intra-ocular pressure is undesirable owing to the cardiovascular stability it confers in the patients.

Keywords: etomidate, intraocular pressure, thiopentone, traumatic

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2358 Microbiological Study of Two Spontaneous Plants of Algerian Sahara Septentrional: Cotula cinerea and Chamomilla recutita

Authors: Mehani Mouna, Boukhari Nadjet, Ladjal Segni

Abstract:

The aim of our study is to determine the antimicrobial effect of essential oils of two plants Cotula cinerea and Chamomilla recutita on some pathogenic bacteria. It is a medicinal plant used in traditional therapy. Essential oils have many therapeutic properties. In herbal medicine, they are used for their antiseptic properties against infectious diseases of fungal origin, against dermatophytes, those of bacterial origin. Essential oils have many therapeutic properties. In herbal medicine, they are used for their antiseptic properties against infectious diseases of fungal origin, against dermatophytes, those of bacterial origin. Humans use plants for thousands of years to treat various ailments, in many developing countries; much of the population relies on traditional doctors and their collections of medicinal plants to cure them. The test adopted is based on the diffusion method on solid medium (Antibiogram), this method allows to determine the susceptibility or resistance of an organism according to the sample studied. Our study reveals that the essential oil of the plants Cotula cinerea and Chamomilla recutita have a different effect on the resistance of germs.

Keywords: antibiogram, Chamomilla recutita, Cotula cinerea, essential oil, microorganism

Procedia PDF Downloads 316
2357 The Diversity of Black Flies in Peninsular Malaysia

Authors: C. D. Chen, H. Takaoka, Z. Ya’cob, V. L. Low, K. W. Lau, M. Sofian-Azirun

Abstract:

Adult black flies (Diptera: Simuliidae) are small (1.5-6.0 mm long), two-winged insects, and are well known as one of the biting flies of medical and veterinary importance. Female of certain species, when they bite and take blood, not only cause severe skin diseases to human and cattle but also play a role as vectors of viral, protozoan and filarial diseases in humans and animals. Black flies also attract environmental biologist and ecologist because their immature states breed only in clean running fresh waters, and larvae are one of the principal processors of plant debris in streams. All these researches on medical and ecological aspects of black flies could not be reliably proceeded without sufficient basic knowledge of the fauna of black flies established by traditional but still important morphotaxonomy. Previously, only 39 species of black flies were recorded from Peninsular Malaysia, all of which are classified into four subgenus (Daviesellum, Gomphostilbia, Nevermannia and Simulium) of the genus Simulium. We carried out faunal surveys and taxonomic works of black flies in Peninsular Malaysia since November 2010. A total of 17 new species and 4 newly recorded species were collected. This increased the number of the described species of black flies in Peninsular Malaysia from 39 to 60. Our results suggest that a much higher diverse nature of black flies in Peninsular Malaysia will be clarified by further extensive surveys.

Keywords: black flies, Simulium, Nevermannia, feuerborni species-group

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2356 Cylindrical Spacer Shape Optimization for Enhanced Inhalation Therapy

Authors: Shahab Azimi, Siamak Arzanpour, Anahita Sayyar

Abstract:

Asthma and Chronic obstructive pulmonary disease (COPD) are common lung diseases that have a significant global impact. Pressurized metered dose inhalers (pMDIs) are widely used for treatment, but they can have limitations such as high medication release speed resulting in drug deposition in the mouth or oral cavity and difficulty achieving proper synchronization with inhalation by users. Spacers are add-on devices that improve the efficiency of pMDIs by reducing the release speed and providing space for aerosol particle breakup to have finer and medically effective medication. The aim of this study is to optimize the size and cylindrical shape of spacers to enhance their drug delivery performance. The study was based on fluid dynamics theory and employed Ansys software for simulation and optimization. Results showed that optimization of the spacer's geometry greatly influenced its performance and improved drug delivery. This study provides a foundation for future research on enhancing the efficiency of inhalation therapy for lung diseases.

Keywords: asthma, COPD, pressurized metered dose inhalers, spacers, CFD, shape optimization

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2355 Application of Probiotics in the Management of Food Allergies: A Review

Authors: Amir Hosseinvand

Abstract:

Probiotics have health-giving effects on the human body, so by stimulating the immune system, they prevent many occurrences they are diseases and food allergies in humans. There are various bacteria in the human digestive system; some are useful, some are harmless, and other groups of bacteria are harmful to human health. These bacteria should be in balance in the body of people in a normal state. In certain conditions, such as a person's high stress, aging, continuous use of antibiotics, or improper diet, the intestinal microbial flora has changed, and these changes cause some diseases in people. Probiotics have health benefits for the human body and are often found in the digestive system of healthy people. Nevertheless, fermented foods such as fermented dairy products such as yogurt, cheese, buttermilk or fermented pickles contain some species of these bacteria that are useful. But the important point that should be noted is that due to modern and industrial life, high fat and high protein diets, and excessive use of antibiotics, the number of these bacteria in people's bodies has decreased, and it is necessary to consume probiotics either in the form of probiotic foods or in the form of supplements. Probiotics with mild stimulation of the immune system increase the immunity level of the body and prevent the occurrence of food allergies in people.

Keywords: human health, dairy products, food allergies, probiotic

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2354 Characteristics of Neonates and Child Health Outcomes after the Mamuju Earthquake Disaster

Authors: Dimas Tri Anantyo, Zsa-Zsa Ayu Laksmi, Adhie Nur Radityo, Arsita Eka Rini, Gatot Irawan Sarosa

Abstract:

A six-point-two-magnitude earthquake rocked Mamuju District, West Sulawesi Province, Indonesia, on 15 January 2021, causing significant health issues for the affected community, particularly among vulnerable populations such as neonates and children. The aim of this study is to examine and describe the diseases diagnosed in the pediatric population in Mamuju 14 days after the earthquake. This study uses a prospective observational study of the pediatric population presenting at West Sulawesi Regional Hospital, Mamuju Regional Public Hospital, and Bhayangkara Hospital for the period of 14 days after the earthquake. Demographic and clinical information were recorded. One hundred and fifty-three children were admitted to the health center. Children younger than six years old were the highest proportion (78%). Out of 153 children, 82 of them were male (54%). The most frequently diagnosed disease during the first and second weeks after the earthquake was respiratory problems, followed by gastrointestinal problems that showed an increase in incidence in the second week. This study found that age has a correlation with frequent disease in children after an earthquake. Respiratory and gastrointestinal problems were found to be the most common diseases among the pediatric population in Mamuju after the earthquake.

Keywords: health outcomes, pediatric population, earthquake, Mamuju

Procedia PDF Downloads 90
2353 Investigate the Side Effects of Patients With Severe COVID-19 and Choose the Appropriate Medication Regimens to Deal With Them

Authors: Rasha Ahmadi

Abstract:

In December 2019, a coronavirus, currently identified as SARS-CoV-2, produced a series of acute atypical respiratory illnesses in Wuhan, Hubei Province, China. The sickness induced by this virus was named COVID-19. The virus is transmittable between humans and has caused pandemics worldwide. The number of death tolls continues to climb and a huge number of countries have been obliged to perform social isolation and lockdown. Lack of focused therapy continues to be a problem. Epidemiological research showed that senior patients were more susceptible to severe diseases, whereas children tend to have milder symptoms. In this study, we focus on other possible side effects of COVID-19 and more detailed treatment strategies. Using bioinformatics analysis, we first isolated the gene expression profile of patients with severe COVID-19 from the GEO database. Patients' blood samples were used in the GSE183071 dataset. We then categorized the genes with high and low expression. In the next step, we uploaded the genes separately to the Enrichr database and evaluated our data for signs and symptoms as well as related medication regimens. The results showed that 138 genes with high expression and 108 genes with low expression were observed differentially in the severe COVID-19 VS control group. Symptoms and diseases such as embolism and thrombosis of the abdominal aorta, ankylosing spondylitis, suicidal ideation or attempt, regional enteritis were observed in genes with high expression and in genes with low expression of acute and subacute forms of ischemic heart, CNS infection and poliomyelitis, synovitis and tenosynovitis. Following the detection of diseases and possible signs and symptoms, Carmustine, Bithionol, Leflunomide were evaluated more significantly for high-expression genes and Chlorambucil, Ifosfamide, Hydroxyurea, Bisphenol for low-expression genes. In general, examining the different and invisible aspects of COVID-19 and identifying possible treatments can help us significantly in the emergency and hospitalization of patients.

Keywords: phenotypes, drug regimens, gene expression profiles, bioinformatics analysis, severe COVID-19

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2352 Xenografts: Successful Penetrating Keratoplasty Between Two Species

Authors: Francisco Alvarado, Luz Ramírez

Abstract:

Corneal diseases are one of the main causes of visual impairment and affect almost 4 million, and this study assesses the effects of deep anterior lamellar keratoplasty (DALK) with porcine corneal stroma and postoperative topical treatment with tacrolimus in patients with infectious keratitis. No patient was observed with clinical graft rejection. Among the cases: 2 were positive to fungal culture, 2 with Aspergillus and the other 8 cases were confirmed by bacteriological culture. Corneal diseases are one of the main causes of visual impairment and affect almost 4 million. This study assesses the effects of deep anterior lamellar keratoplasty (DALK) with porcine corneal stroma and postoperative topical treatment with tacrolimus in patients with infectious keratitis. Receiver bed diameters ranged from 7.00 to 9.00 mm. No incidents of Descemet's membrane perforation were observed during surgery. During the follow-up period, no corneal graft splitting, IOP increase, or intolerance to tacrolimus were observed. Deep anterior lamellar keratoplasty seems to be the best option to avoid xenograft rejection, and it could help new surgical techniques in humans.

Keywords: ophthalmology, cornea, corneal transplant, xenografts, surgical innovations

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2351 Medication Side Effects: Implications on the Mental Health and Adherence Behaviour of Patients with Hypertension

Authors: Irene Kretchy, Frances Owusu-Daaku, Samuel Danquah

Abstract:

Hypertension is the leading risk factor for cardiovascular diseases, and a major cause of death and disability worldwide. This study examined whether psychosocial variables influenced patients’ perception and experience of side effects of their medicines, how they coped with these experiences and the impact on mental health and medication adherence to conventional hypertension therapies. Methods: A hospital-based mixed methods study, using quantitative and qualitative approaches was conducted on hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms, and coping mechanisms with the aid of standard questionnaires. Information from the quantitative phase was analyzed with the Statistical Package for Social Sciences (SPSS) version 20. The interviews from the qualitative study were audio-taped with a digital audio recorder, manually transcribed and analyzed using thematic content analysis. The themes originated from participant interviews a posteriori. Results: The experiences of side effects – such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion - were categorized as no/low (39.75%), moderate (53.0%) and high (7.25%). Significant relationships between depression (x 2 = 24.21, P < 0.0001), anxiety (x 2 = 42.33, P < 0.0001), stress (x 2 = 39.73, P < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association are reported – depression [OR = 1.9 (1.03 – 3.57), p = 0.04], anxiety [OR = 1.5 (1.22 – 1.77), p = < 0.001], and stress [OR = 1.3 (1.02 – 1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95% CI 1.07 – 1.85), p = 0.04] with social factors, media influences and attitudes of primary caregivers further explaining this relationship. The personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments, and interventions made by clinicians were the main forms of coping with side effects. Conclusions: Results from this study show that contrary to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The result offers more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care. Additionally, medication side effects should be considered as a possible cause of non-adherence among hypertensive patients, thus addressing this problem from a Biopsychosocial perspective in any intervention may improve adherence and invariably control blood pressure.

Keywords: biopsychosocial, hypertension, medication adherence, psychological disorders

Procedia PDF Downloads 371
2350 The Evolution of the Strategic Plasma Industry

Authors: Zahra Ghasemi, Fatemeh Babaei

Abstract:

Plasma-derived medicinal products are vital categories of biological therapies. These products are used to treat rare, chronic, severe, and life-threatening conditions, such as bleeding disorders (Hemophilia A and B), hemolytic disease of the fetus and newborn, severe infections, burns and liver diseases, and other diseases caused by the absence or malfunction of certain proteins. In addition, they improve the patient’s quality of life. The process of producing plasma-derived medicinal products begins with the collection of human plasma from healthy donors. This initial stage is complex and is monitored with high precision and sensitivity by global authorities to maintain the quality and safety of the final products as well as the health of the donors. The amount of manufactured plasma-derived medicinal products depends on the availability of its raw material, human plasma, so collecting enough plasma for fractionation is essential. Therefore, adopting a suitable national policy regarding plasma donation, establishing collection centers, and increasing public awareness of the importance of plasma donation will improve any country’s conditions regarding the timely and sufficient supply of these medicines. In this study, we tried to briefly examine the importance of sustainability of the plasma industry and its situation in our beloved country of Iran.

Keywords: plasma, source plasma, plasma-derived medicinal products, fractionation

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2349 Enquiry into Psychological and Psychosocial Aspects in Cancer Care: Cancer Diseases Hospital, Zambia

Authors: Mubita Namuyamba

Abstract:

Despite an increase in the number of cancer programs and partnerships in cancer care provision, the burden of cancer in Zambia is increasingly having a significant impact on morbidity and mortality rates. The increase in cancer morbidity and mortality rates has given rise to psychological and psycho social implications (PPsI) in cancer care. Cancer patients, care givers and health care providers are faced with a multitude of PPsIs in cancer care that mainly impact negatively on the management of cancer patients. The study adopted a case study design and was purposively conducted at the Cancer Diseases Hospital in Lusaka (Zambia) after obtaining ethical clearance from the Ethics committee. The sample for this study included 70 cancer patients, 20 care givers and 5 hospital staff (4 nurses and 1 doctor). Data was collected using interviews guides, focus group discussion guides and questionnaires respectively. The qualitative data was analysed thematically. The various psychological and psychosocial challenges that conspire to deter the provision of effective cancer care nursing and improved methods of minimizing the psychological and psychosocial implications in cancer care are the products of this study.

Keywords: case study, enquiry, psychological and psycho social aspects, Zambia

Procedia PDF Downloads 338
2348 Study of Congenital Malformations in Newborns in the Pediatrics and Neonatology Department in the Wilaya of Batna, Algeria

Authors: Belhadi Kamilia, Bendaoud Fadhila, Zidani Abla

Abstract:

Birth defects are morphological abnormalities and functionally represent the main causes of morbidity and neonatal mortality. The aim was to analyze a number of maternal and newborn traits, assess the main causes and risk factors of abnormalities and describe the clinical aspects and different types of birth defects at the maternity of Batna. Our rate of congenital malformations is 19% of hospitalized newborns; mono malformations are the most common, mainly 28% neurological malformations predominated by Spina Bifida and hydrocephalus. Poly malformations accounted for only 15% of our study. 39,61% of newborns are premature. We found a male predominance. The sex ratio is 1.33 male to one girl, most by mothers over 35. The analysis of the pathological history has shown that the diseases encountered in mothers are pregnant HTA and diabetes, these are the most common diseases with a percentage of (19%, and 21%). The percentage of people who use medicine is 28%. In terms of diagnosis, prenatal ultrasounds are performed in 12% of cases, and the death rate is often fairly high at 45%. Congenital malformations remain a problem in terms of treatment and prognosis; this will make it possible to investigate other factors, to better understand the causes of congenital malformations and to develop effective prevention and treatment strategies.

Keywords: malformation, congenital, newborn, risk factors, Wilaya of Batna, Algeria.

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2347 Ethical Discussions on Prenatal Diagnosis: Iranian Case of Thalassemia Prevention Program

Authors: Sachiko Hosoya

Abstract:

Objectives: The purpose of this paper is to investigate the social policy of preventive genetic medicine in Iran, by following the legalization process of abortion law and the factors affecting the process in wider Iranian contexts. In this paper, ethical discussions of prenatal diagnosis and selective abortion in Iran will be presented, by exploring Iranian social policy to control genetic diseases, especially a genetic hemoglobin disorder called Thalassemia. The ethical dilemmas in application of genetic medicine into social policy will be focused. Method: In order to examine the role of the policy for prevention of genetic diseases and selective abortion in Iran, various resources have been sutudied, not only academic articles, but also discussion in the Parliament and documents related to a court case, as well as ethnographic data on living situation of Thalassemia patients. Results: Firstly, the discussion on prenatal diagnosis and selective abortion is overviewed from the viewpoints of ethics, disability rights activists, and public policy for lower-resources countries. As a result, it should be noted that the point more important in the discussion on prenatal diagnosis and selective abortion in Iran is the allocation of medical resources. Secondly, the process of implementation of national thalassemia screening program and legalization of ‘Therapeutic Abortion Law’ is analyzed, through scrutinizing documents such as the Majlis record, government documents and related laws and regulations. Although some western academics accuse that Iranian policy of selective abortion seems to be akin to eugenic public policy, Iranian government carefully avoid to distortions of the policy as ‘eugenic’. Thirdly, as a comparative example, discussions on an Iranian court case of patient’s ‘right not to be born’ will be introduced. Along with that, restrictive living environments of people with Thalassemia patients and the carriers are depicted, to understand some disabling social factors for people with genetic diseases in the local contexts of Iran.

Keywords: abortion, Iran, prenatal diagnosis, public health ethics, Thalassemia prevention program

Procedia PDF Downloads 346
2346 Attention Based Fully Convolutional Neural Network for Simultaneous Detection and Segmentation of Optic Disc in Retinal Fundus Images

Authors: Sandip Sadhukhan, Arpita Sarkar, Debprasad Sinha, Goutam Kumar Ghorai, Gautam Sarkar, Ashis K. Dhara

Abstract:

Accurate segmentation of the optic disc is very important for computer-aided diagnosis of several ocular diseases such as glaucoma, diabetic retinopathy, and hypertensive retinopathy. The paper presents an accurate and fast optic disc detection and segmentation method using an attention based fully convolutional network. The network is trained from scratch using the fundus images of extended MESSIDOR database and the trained model is used for segmentation of optic disc. The false positives are removed based on morphological operation and shape features. The result is evaluated using three-fold cross-validation on six public fundus image databases such as DIARETDB0, DIARETDB1, DRIVE, AV-INSPIRE, CHASE DB1 and MESSIDOR. The attention based fully convolutional network is robust and effective for detection and segmentation of optic disc in the images affected by diabetic retinopathy and it outperforms existing techniques.

Keywords: attention-based fully convolutional network, optic disc detection and segmentation, retinal fundus image, screening of ocular diseases

Procedia PDF Downloads 142