Search results for: joint pain
1406 Effectiveness of Participatory Ergonomic Education on Pain Due to Work Related Musculoskeletal Disorders in Food Processing Industrial Workers
Authors: Salima Bijapuri, Shweta Bhatbolan, Sejalben Patel
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Ergonomics concerns the fitting of the environment and the equipment to the worker. Ergonomic principles can be employed in different dimensions of the industrial sector. Participation of all the stakeholders is the key to the formulation of a multifaceted and comprehensive approach to lessen the burden of occupational hazards. Taking responsibility for one’s own work activities by acquiring sufficient knowledge and potential to influence the practices and outcomes is the basis of participatory ergonomics and even hastens the process to identify workplace hazards. The study was aimed to check how participatory ergonomics can be effective in the management of work-related musculoskeletal disorders. Method: A mega kitchen was identified in a twin city of Karnataka, India. Consent was taken, and the screening of workers was done using observation methods. Kitchen work was structured to include different tasks, which included preparation, cooking, distributing, and serving food, packing food to be delivered to schools, dishwashing, cleaning and maintenance of kitchen and equipment, and receiving and storing raw material. Total 100 workers attended the education session on participatory ergonomics and its role in implementing the correct ergonomic practices, thus preventing WRMSDs. Demographic details and baseline data on related musculoskeletal pain and discomfort were collected using the Nordic pain questionnaire and VAS score pre- and post-study. Monthly visits were made, and the education sessions were reiterated on each visit, thus reminding, correcting, and problem-solving of each worker. After 9 months with a total of 4 such education session, the post education data was collected. The software SPSS 20 was used to analyse the collected data. Results: The majority of them (78%), depending on the availability and feasibility, participated in the intervention workshops were arranged four times. The average age of the participants was 39 years. The percentage of female participants was 79.49%, and 20.51% of participants comprised of males. The Nordic Musculoskeletal Questionnaire (NMQ) showed that knee pain was the most commonly reported complaint (62%) from the last 12 months with a mean VAS of 6.27, followed by low back pain. Post intervention, the mean VAS Score was reduced significantly to 2.38. The comparison of pre-post scores was made using Wilcoxon matched pairs test. Upon enquiring, it was found that, the participants learned the importance of applying ergonomics at their workplace which inturn was beneficial for them to handle any problems arising at their workplace on their own with self confidence. Conclusion: The participatory ergonomics proved effective with workers of mega kitchen, and it is a feasible and practical approach. The advantage of the given study area was that it had a sophisticated and ergonomically designed workstation; thus it was the lack of education and practical knowledge to use these stations was of utmost need. There was a significant reduction in VAS scores with the implementation of changes in the working style, and the knowledge of ergonomics helped to decrease physical load and improve musculoskeletal health.Keywords: ergonomic awareness session, mega kitchen, participatory ergonomics, work related musculoskeletal disorders
Procedia PDF Downloads 1381405 Extra-Pulmonary Mycoplasma Pneumoniae Infection in a Healthy 25-Year-Old Female: A Case Report
Authors: Minna Chang
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Introduction: M. pneumoniae is a respiratory pathogen, which commonly causes upper and lower respiratory infections. It primarily affects children and young adults. Respiratory symptoms are well recognized, but extrapulmonary involvement is also common. Other systems that have been implicated in the disease include: skin, mucus membranes, central, peripheral nervous systems, cardiovascular, haematological, renal, and musculoskeletal systems. Here, we report a case of an otherwise healthy, young female with M. pneumonia, who presented with right upper quadrant abdominal pain. Case presentation: a healthy 25-year-old female was referred to A&E by her general practitioner, after presenting with fever, malaise, and right upper quadrant pain. M. pneumoniae was confirmed retrospectively by serology. The patient made a full recovery after a six-day course of doxycycline 100mg. Conclusion: M. pneumonia is a well-established cause of respiratory infections in children and young adults. Febrile illness with multisystem involvement, even in the absence of respiratory symptoms, should raise suspicion of M. pneumoniae infection in healthy, young adults. Our case illustrates the multi-system involvement of M. pneumoniae, which was initially missed, due to paucity of respiratory symptoms at presentation.Keywords: infectious diseases, mycoplasma pneumoniae, respiratory infections, extra-pulmonary manifestations
Procedia PDF Downloads 1431404 Care Experience of a Female Breast Cancer Patient Undergoing Modified Radical Mastectomy
Authors: Ting-I Lin
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Purpose: This article explores the care experience of a 34-year-old female breast cancer patient who was admitted to the intensive care unit after undergoing a modified radical mastectomy. The patient discovered a lump in her right breast during a self-examination and, after mammography and ultrasound-guided biopsy, was diagnosed with a malignant tumor in the right breast. The tumor measured 1.5 x 1.4 x 2 cm, and the patient underwent a modified radical mastectomy. Postoperatively, she exhibited feelings of inferiority due to changes in her appearance. Method: During the care period, we engaged in conversations, observations, and active listening, using Gordon's Eleven Functional Health Patterns for a comprehensive assessment. In collaboration with the critical care team, a psychologist, and an oncology case manager, we conducted an interdisciplinary discussion and reached a consensus on key nursing issues. These included pain related to postoperative tumor excision and disturbed body image due to changes in appearance after surgery. Result: During the care period, a private space was provided to encourage the patient to express her feelings about her altered body image. Communication was conducted through active listening and a non-judgmental approach. The patient's anxiety level, as measured by the depression and anxiety scale, decreased from moderate to mild, and she was able to sleep for 6-8 hours at night. The oncology case manager was invited to provide education on breast reconstruction using breast models and videos to both the patient and her husband. This helped rebuild the patient's confidence. With the patient's consent, a support group was arranged where a peer with a similar experience shared her journey, offering emotional support and encouragement. This helped alleviate the psychological stress and shock caused by the cancer diagnosis. Additionally, pain management was achieved through adjusting the dosage of analgesics, administering Ultracet 37.5 mg/325 mg 1# Q6H PO, along with distraction techniques and acupressure therapy. These interventions helped the patient relax and alleviate discomfort, maintaining her pain score at a manageable level of 3, indicating mild pain. Conclusion: Disturbance in body image can cause significant psychological stress for patients. Through support group discussions, encouraging patients to express their feelings, and providing appropriate education on breast reconstruction and dressing techniques, the patient's self-concept was positively reinforced, and her emotions were stabilized. This led to renewed self-worth and confidence.Keywords: breast cancer, modified radical mastectomy, acupressure therapy, Gordon's 11 functional health patterns
Procedia PDF Downloads 281403 The Interventional, Prospective, Real-World Post-Marketing Clinical Follow-Up Trial of a Polycarbophil Vaginal Moisturising Gel in Women Affected by Vaginal Dryness in Late Menopausal Transition and Postmenopause: A Triple Investigation
Authors: A. Cagnacci, D. F. Barattini, E. Casolati, M. Mangrella, E. Piccolo, S. Rosu, L. C. Pătrașcu
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This Triple study aimed to evaluate the efficacy of polycarbophil vaginal gel (PCV) in treating symptoms of vaginal atrophy (VA) in peri- and post-menopausal women. Women in peri- (n=29) and postmenopause (n=54) diagnosed with VA were progressively enrolled and treated once a day for 30 days. Thereafter, those wishing to continue (n=73) received the PCV treatment for an additional 180 days. The vaginal health index (VHI) and vaginal dryness, irritation, and pain at intercourse, along with treatment safety, were evaluated at baseline, 30 days of treatment, and after additional 180 days. At baseline, the VHI (p<0.056) and VAS of vaginal dryness (p=0.0001,) irritation (p=0.002), and pain at intercourse (p=0.0001) were worse in postmenopausal women than in perimenopausal women. VHI and VA symptoms improved in all women, and after 30 days of PCV administration, they were similar between peri-and postmenopausal women. After an additional 180 days of treatment, VHI further increased (p=0.0001), VAS of all symptoms (P=0.0001) and the Global Symptom Score (P=0.0001) further decreased. The treatment was safe. Treatment with PCV improves VA symptoms in both peri- and post-menopausal women. Prolongation of treatment up to 6 months increases the efficacy of treatment with no side effects.Keywords: late menopausal transition, postmenopause, polycarbophil, sexuality, vaginal dryness
Procedia PDF Downloads 541402 Mechanical Responses to Hip Versus Knee Induced Muscle Fatigue in Patellofemoral Pain Syndrome
Authors: Eman Ahmed Ahmed, Ghada Abdelmoneim Mohamed, Hamada Ahmed Hamada, Nagui Sobhi Nassif
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Impaired skeletal muscle endurance may be an important causal factor in the development of patellofemoral pain syndrome (PFPS). However, there is lack of information regarding the effect of hip versus knee muscle fatigue on isokinetic parameters, and myoelectric activity of hip and knee muscles in these patients. Purpose: The study was conducted to investigate the effect of hip abductors versus knee extensors fatigue protocol on knee proprioception, hip and knee muscle strength and their myoelectric activity in patients with PFPS. Methods: Fifteen female patients with PFPS participated in the study. They were tested randomly under two fatiguing conditions; hip abductors and knee extensors fatigue protocols. Isolated muscle fatigue of two muscles was induced isokinetically on the affected side in a two separate sessions with a rest interval of at least three days. After determining peak torque, patients performed continuous maximal concentric-eccentric contraction of the selected muscle until the torque output dropped below 50% of peak torque value for 3 consecutive repetitions. Knee proprioception, eccentric hip abductors' peak torque, eccentric knee extensors' peak torque, EMG ratio of vastus medialis obliquus (VMO) / vastus lateralis (VL), and EMG activity of gluteus medius (GM) muscle, were recorded before and immediately after each fatigue protocol using the Biodex Isokinetic system and EMG Myosystem. Results: Two-way within subject MANOVA revealed that eccentric knee extensors’ peak torque decreased significantly after hip abductors fatigue protocol compared to pre fatigue condition (p<0.05). On the other hand, there was no statistically significant difference in the eccentric hip abductors’ peak torque after admitting knee extensors fatigue protocol (p > 0.05). Moreover, no significant difference was found in knee proprioception, EMG ratio of VMO/VL, and EMG activity of GM muscle, after either hip or knee fatigue protocol (p>0.05). Conclusion: A hip focused rehabilitation program may be beneficial in improving knee function through correcting faulty kinematics and hence decrease knee loading in patients with PFPS.Keywords: electromyography, knee proprioception, mechanical responses, muscle fatigue, patellofemoral pain syndrome
Procedia PDF Downloads 3111401 Determination of Bromides, Chlorides and Fluorides in Case of Their Joint Presence in Ion-Conducting Electrolyte
Authors: V. Golubeva, O. Vakhnina, I. Konopkina, N. Gerasimova, N. Taturina, K. Zhogova
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To improve chemical current sources, the ion-conducting electrolytes based on Li halides (LiCl-KCl, LiCl-LiBr-KBr, LiCl-LiBr-LiF) are developed. It is necessary to have chemical analytical methods for determination of halides to control the electrolytes technology. The methods of classical analytical chemistry are of interest, as they are characterized by high accuracy. Using these methods is a difficult task because halides have similar chemical properties. The objective of this work is to develop a titrimetric method for determining the content of bromides, chlorides, and fluorides in their joint presence in an ion-conducting electrolyte. In accordance with the developed method of analysis to determine fluorides, electrolyte sample is dissolved in diluted HCl acid; fluorides are titrated by La(NO₃)₃ solution with potentiometric indication of equivalence point, fluoride ion-selective electrode is used as sensor. Chlorides and bromides do not form a hardly soluble compound with La and do not interfere in result of analysis. To determine the bromides, the sample is dissolved in a diluted H₂SO₄ acid. The bromides are oxidized with a solution of KIO₃ to Br₂, which is removed from the reaction zone by boiling. Excess of KIO₃ is titrated by iodometric method. The content of bromides is calculated from the amount of KIO₃ spent on Br₂ oxidation. Chlorides and fluorides are not oxidized by KIO₃ and do not interfere in result of analysis. To determine the chlorides, the sample is dissolved in diluted HNO₃ acid and the total content of chlorides and bromides is determined by method of visual mercurometric titration with diphenylcarbazone indicator. Fluorides do not form a hardly soluble compound with mercury and do not interfere with determination. The content of chlorides is calculated taking into account the content of bromides in the sample of electrolyte. The validation of the developed analytical method was evaluated by analyzing internal reference material with known chlorides, bromides and fluorides content. The analytical method allows to determine chlorides, bromides and fluorides in case of their joint presence in ion-conducting electrolyte within the range and with relative total error (δ): for bromides from 60.0 to 65.0 %, δ = ± 2.1 %; for chlorides from 8.0 to 15.0 %, δ = ± 3.6 %; for fluorides from 5.0 to 8.0%, ± 1.5% . The analytical method allows to analyze electrolytes and mixtures that contain chlorides, bromides, fluorides of alkali metals and their mixtures (K, Na, Li).Keywords: bromides, chlorides, fluorides, ion-conducting electrolyte
Procedia PDF Downloads 1271400 Structural Characteristics of HPDSP Concrete on Beam Column Joints
Authors: Hari Krishan Sharma, Sanjay Kumar Sharma, Sushil Kumar Swar
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Inadequate transverse reinforcement is considered as the main reason for the beam column joint shear failure observed during recent earthquakes. DSP matrix consists of cement and high content of micro-silica with low water to cement ratio while the aggregates are graded quartz sand. The use of reinforcing fibres leads not only to the increase of tensile/bending strength and specific fracture energy, but also to reduction of brittleness and, consequently, to production of non-explosive ruptures. Besides, fibre-reinforced materials are more homogeneous and less sensitive to small defects and flaws. Recent works on the freeze-thaw durability (also in the presence of de-icing salts) of fibre-reinforced DSP confirm the excellent behaviour in the expected long term service life.DSP materials, including fibre-reinforced DSP and CRC (Compact Reinforced Composites) are obtained by using high quantities of super plasticizers and high volumes of micro-silica. Steel fibres with high tensile yield strength of smaller diameter and short length in different fibre volume percentage and aspect ratio tilized to improve the performance by reducing the brittleness of matrix material. In the case of High Performance Densified Small Particle Concrete (HPDSPC), concrete is dense at the micro-structure level, tensile strain would be much higher than that of the conventional SFRC, SIFCON & SIMCON. Beam-column sub-assemblages used as moment resisting constructed using HPDSPC in the joint region with varying quantities of steel fibres, fibre aspect ratio and fibre orientation in the critical section. These HPDSPC in the joint region sub-assemblages tested under cyclic/earthquake loading. Besides loading measurements, frame displacements, diagonal joint strain and rebar strain adjacent to the joint will also be measured to investigate stress-strain behaviour, load deformation characteristics, joint shear strength, failure mechanism, ductility associated parameters, stiffness and energy dissipated parameters of the beam column sub-assemblages also evaluated. Finally a design procedure for the optimum design of HPDSPC corresponding to moment, shear forces and axial forces for the reinforced concrete beam-column joint sub-assemblage proposed. The fact that the implementation of material brittleness measure in the design of RC structures can improve structural reliability by providing uniform safety margins over a wide range of structural sizes and material compositions well recognized in the structural design and research. This lead to the development of high performance concrete for the optimized combination of various structural ratios in concrete for the optimized combination of various structural properties. The structural applications of HPDSPC, because of extremely high strength, will reduce dead load significantly as compared to normal weight concrete thereby offering substantial cost saving and by providing improved seismic response, longer spans, and thinner sections, less reinforcing steel and lower foundation cost. These cost effective parameters will make this material more versatile for use in various structural applications like beam-column joints in industries, airports, parking areas, docks, harbours, and also containers for hazardous material, safety boxes and mould & tools for polymer composites and metals.Keywords: high performance densified small particle concrete (HPDSPC), steel fibre reinforced concrete (SFRC), slurry infiltrated concrete (SIFCON), Slurry infiltrated mat concrete (SIMCON)
Procedia PDF Downloads 3031399 The Comparison of Joint Simulation and Estimation Methods for the Geometallurgical Modeling
Authors: Farzaneh Khorram
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This paper endeavors to construct a block model to assess grinding energy consumption (CCE) and pinpoint blocks with the highest potential for energy usage during the grinding process within a specified region. Leveraging geostatistical techniques, particularly joint estimation, or simulation, based on geometallurgical data from various mineral processing stages, our objective is to forecast CCE across the study area. The dataset encompasses variables obtained from 2754 drill samples and a block model comprising 4680 blocks. The initial analysis encompassed exploratory data examination, variography, multivariate analysis, and the delineation of geological and structural units. Subsequent analysis involved the assessment of contacts between these units and the estimation of CCE via cokriging, considering its correlation with SPI. The selection of blocks exhibiting maximum CCE holds paramount importance for cost estimation, production planning, and risk mitigation. The study conducted exploratory data analysis on lithology, rock type, and failure variables, revealing seamless boundaries between geometallurgical units. Simulation methods, such as Plurigaussian and Turning band, demonstrated more realistic outcomes compared to cokriging, owing to the inherent characteristics of geometallurgical data and the limitations of kriging methods.Keywords: geometallurgy, multivariate analysis, plurigaussian, turning band method, cokriging
Procedia PDF Downloads 701398 An Unusual Presentation of Uveal Melanoma
Authors: Natasha Goh, Sebastian Brown
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Purpose: This case report describes an unusual presentation of uveal melanoma. Method: Case notes, imaging, and histopathological specimen were reviewed for this case report. Result: The patient is a 62-year-old lady of Chinese heritage who had been receiving follow-up at the eye clinic of a tertiary hospital. She had a longstanding history of poor vision in her right eye after sustaining trauma to the eye at age 3. She was found to have a carotid-cavernous sinus fistula in the right eye in 2009 and underwent stenting in China. Unfortunately, this was unsuccessful and resulted in a painful blind eye. She had represented with headaches, worsening eye pain, and ptosis in Sydney in 2016. Her CT angiogram showed a calcified vascular structure in the orbit and globe, and she was offered a digital subtraction angiography by the neurosurgical team, which she ultimately declined. She had since been followed up at the eye clinic for the pthisical eye. Due to chronic ocular pain and recurrent conjunctivitis, the decision was made for an evisceration in 2021. The specimen was sent for routine histopathological examination and returned positive for uveal melanoma. The patient was subsequently referred to a melanoma center for further follow-up, which comprised serial imaging and radiotherapy treatment. Conclusion: Clinicians should bear in mind that uveal melanomas may present in a longstanding phthisical eye and in patients with no or little apparent risk factors.Keywords: uveal melanoma, pthisical eye, carotid cavernous fistula, uveal melanoma risk factors
Procedia PDF Downloads 821397 Correlation between Dynamic Knee Valgus with Isometric Hip Abductors Strength during Single-Leg Landing
Authors: Ahmed Fawzy, Khaled Ayad, Gh. M. Koura, W. Reda
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The knee joint complex is one of the most commonly injured areas of the body in athletes. Excessive frontal plane knee excursion is considered a risk factor for multiple knee pathologies such as anterior cruciate ligament and patellofemoral joint injuries, however, little is known about the biomechanical factors that contribute to this loading pattern. Objectives: The purpose of this study was to investigate if there is a relationship between hip abductors isometric strength and the value of FPPA during single leg landing tasks in normal male subjects. Methods: One hundred (male) subjects free from lower extremity injuries for at least six months ago participated in this study. Their mean age was (23.25 ± 2.88) years, mean weight was (74.76 ± 13.54) (Kg), mean height was (174.23 ± 6.56) (Cm). The knee frontal plane projection angle was measured by digital video camera using single leg landing task. Hip abductors isometric strength were assessed by portable hand-held dynamometer. Muscle strength had been normalized to the body weight to obtain more accurate measurements. Results: The results demonstrated that there was no significant relationship between hip abductors isometric strength and the value of FPPA during single leg landing tasks in normal male subjects. Conclusion: It can be concluded that there is no relationship between hip abductors isometric strength and the value of FPPA during functional activities in normal male subjects.Keywords: 2-dimensional motion analysis, hip strength, kinematics, knee injuries
Procedia PDF Downloads 2481396 Assessment of Academic Knowledge Transfer Channels in Field of Environment
Authors: Jagul Huma Lashari, Arabella Bhutto
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Last few years have shown increased an interest of researchers in knowledge and technology transfer. However, facts show fewer types of knowledge transfer practices in the developing countries. This article focuses on assessment transfer channels of academic research produced by highly qualified academicians working in universities in Sindh offering degrees in field of an Environment in Sindh Pakistan. The academic field has been chosen because in field of the environment there is alarming need of research into practice for sustainable development. Using case study approach; in this research qualitative interviews have been conducted from PhD faculty members working in the universities offering degrees in field of environment. Obtained data is analyzed using descriptive statistics and chi-square test with the help of statistical packages for social sciences (SPSS). Research explored 31 channels of academic knowledge transfer from detailed review of literature and exploratory interviews with participants. Identified knowledge transfer channels have been grouped together in 6 groups of knowledge transfer channels; As knowledge transfer through publications, networking, mobility of researchers, joint research, intellectual property and co-operations. Results revealed that academic knowledge have been transferred through publications, networking, and co-operation. However, less number of academic knowledge has been transferred through groups of knowledge transfer channels such as Intellectual Property and joint research.Keywords: environment, research knowledge, transfer channels, universities
Procedia PDF Downloads 3361395 Real-Time Finger Tracking: Evaluating YOLOv8 and MediaPipe for Enhanced HCI
Authors: Zahra Alipour, Amirreza Moheb Afzali
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In the field of human-computer interaction (HCI), hand gestures play a crucial role in facilitating communication by expressing emotions and intentions. The precise tracking of the index finger and the estimation of joint positions are essential for developing effective gesture recognition systems. However, various challenges, such as anatomical variations, occlusions, and environmental influences, hinder optimal functionality. This study investigates the performance of the YOLOv8m model for hand detection using the EgoHands dataset, which comprises diverse hand gesture images captured in various environments. Over three training processes, the model demonstrated significant improvements in precision (from 88.8% to 96.1%) and recall (from 83.5% to 93.5%), achieving a mean average precision (mAP) of 97.3% at an IoU threshold of 0.7. We also compared YOLOv8m with MediaPipe and an integrated YOLOv8 + MediaPipe approach. The combined method outperformed the individual models, achieving an accuracy of 99% and a recall of 99%. These findings underscore the benefits of model integration in enhancing gesture recognition accuracy and localization for real-time applications. The results suggest promising avenues for future research in HCI, particularly in augmented reality and assistive technologies, where improved gesture recognition can significantly enhance user experience.Keywords: YOLOv8, mediapipe, finger tracking, joint estimation, human-computer interaction (HCI)
Procedia PDF Downloads 51394 The Application of the Biopsychosocial-Spiritual Model to the Quality of Life of People Living with Sickle Cell Disease
Authors: Anita Paddy, Millicent Obodai, Lebbaeus Asamani
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The management of sickle cell disease requires a multidisciplinary team for better outcomes. Thus, literature on the application of the biopsychosocial model for the management and explanation of chronic pain in sickle cell disease (SCD) and other chronic diseases abound. However, there is limited research on the use of the biopsychosocial model, together with a spiritual component (biopsychosocial-spiritual model). The study investigated the extent to which healthcare providers utilized the biopsychosocial-spiritual model in the management of chronic pain to improve the quality of life (QoL) of patients with SCD. This study employed the descriptive survey design involving a consecutive sampling of 261 patients with SCD who were between the ages of 18 to 79 years and were accessing hematological services at the Clinical Genetics Department of the Korle Bu Teaching Hospital. These patients willingly consented to participate in the study by appending their signatures. The theory of integrated quality of life, the gate control theory of pain and the biopsychosocial(spiritual) model were tested. An instrument for the biopsychosocial-spiritual model was developed, with a basis from the literature reviewed, while the World Health Organisation Quality of Life BREF (WHOQoLBref) and the spirituality rating scale were adapted and used for data collection. Data were analyzed using descriptive statistics (means, standard deviations, frequencies, and percentages) and partial least square structural equation modeling. The study revealed that healthcare providers had a great leaning toward the biological domain of the model compared to the other domains. Hence, participants’ QoL was not fully improved as suggested by the biopsychosocial(spiritual) model. Again, the QoL and spirituality of patients with SCD were quite high. A significant negative impact of spirituality on QoL was also found. Finally, the biosocial domain of the biopsychosocial-spiritual model was the most significant predictor of QoL. It was recommended that policymakers train healthcare providers to integrate the psychosocial-spiritual component in health services. Also, education on SCD and its resultant impact from the domains of the model should be intensified while health practitioners consider utilizing these components fully in the management of the condition.Keywords: biopsychosocial (spritual), sickle cell disease, quality of life, healthcare, accra
Procedia PDF Downloads 731393 Family Medicine Residents in End-of-Life Care
Authors: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal
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Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.Keywords: end of life care, geriatrics, palliative care, residency training skill
Procedia PDF Downloads 2571392 A Qualitative Study of Approaches Used by Physiotherapists to Educate Patients with Chronic Low Back Pain
Authors: Styliani Soulioti, Helen Fiddler
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The aim of this study was to investigate the approaches used by physiotherapists in the education of patients with chronic low back pain (cLBP) and the rationale that underpins their choice of approach. Therapeutic patient education (TPE) is considered to be an important aspect of modern physiotherapy practice, as it helps patients achieve better self-management and a better understanding of their problem. Previous studies have explored this subject, but the reasoning behind the choices physiotherapists make as educators has not been widely explored, thus making it difficult to understand areas that could be addressed in order to improve the application of TPE.A qualitative study design, guided by a constructivist epistemology was used in this research project. Semi-structured interviews were used to collect data from 7 physiotherapists. Inductive coding and thematic analysis were used, which allowed key themes to emerge. Data analysis revealed two overarching themes: 1) patient-centred versus therapist-centred educational approaches, and 2) behaviourist versus constructivist educational approaches. Physiotherapists appear to use a patient-centred-approach when they explore patients’ beliefs about cLBP and treatment expectations. However, treatment planning and goal-setting were guided by a therapist-centred approach, as physiotherapists appear to take on the role of the instructor/expert, whereas patients were viewed as students. Using a constructivist approach, physiotherapists aimed to provide guidance to patients by combining their professional knowledge with the patients’ individual knowledge, to help the patient better understand their problem, reflect upon it and find a possible solution. However, educating patients about scientific facts concerning cLBP followed a behaviourist approach, as an instructor/student relationship was observed and the learning content was predetermined and transmitted in a one-way manner. The results of this study suggest that a lack of consistency appears to exist in the educational approaches used by physiotherapists. Although patient-centeredness and constructivism appear to be the aims set by physiotherapists in order to optimise the education they provide, a student-teacher relationship appears to dominate when it comes to goal-setting and delivering scientific information.Keywords: chronic low back pain, educational approaches, health education, patient education
Procedia PDF Downloads 2061391 Is Socio-Economic Characteristic is Associated with Health-Related Quality of Life among Elderly: Evidence from SAGE Data in India
Authors: Mili Dutta, Lokender Prashad
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Introduction: Population ageing is a phenomenon that can be observed around the globe. The health-related quality of life (HRQOL) is a measurement of health status of an individual, and it describes the effect of physical and mental health disorders on the well-being of a person. The present study is aimed to describe the influence of socio-economic characteristics of elderly on their health-related quality of life in India. Methods: EQ-5D instrument and population-based EQ-5D index score has been measured to access the HRQOL among elderly. Present study utilized the Study on Global Ageing and Adult Health (SAGE) data which was conducted in 2007 in India. Multiple Logistic Regression model and Multivariate Linear Regression model has been employed. Result: In the present study, it was found that the female are more likely to have problems in mobility (OR=1.41, 95% Cl: 1.14 to 1.74), self-care (OR=1.26, 95% Cl: 1.01 to 1.56) and pain or discomfort (OR=1.50, 95% Cl: 1.16 to 1.94). Elderly residing in rural area are more likely to have problems in pain/discomfort (OR=1.28, 95% Cl: 1.01 to 1.62). More older and non-working elderly are more likely whereas higher educated and highest wealth quintile elderly are less likely to have problems in all the dimensions of EQ-5D viz. mobility, self-care, usual activity, pain/discomfort and anxiety/depression. The present study has also shown that oldest old people, residing in rural area and currently not working elderly are more likely to report low EQ-5D index score whereas elderly with high education level and high wealth quintile are more likely to report high EQ-5D index score than their counterparts. Conclusion: The present study has found EQ-5D instrument as the valid measure for assessing the HRQOL of elderly in India. The study indicates socio-economic characteristics of elderly such as female, more older people, residing in rural area, non-educated, poor and currently non-working as the major risk groups of having poor HRQOL in India. Findings of the study will be helpful for the programmes and policy makers, researchers, academician and social workers who are working in the field of ageing.Keywords: ageing, HRQOL, India, EQ-5D, SAGE, socio-economic characteristics
Procedia PDF Downloads 4001390 Is Sodium Channel Nav1.7 an Ideal Therapeutically Analgesic Target? A Systematic Review
Authors: Yutong Wan, John N. Wood
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Introduction: SCN9A encoded Nav1.7 is an ideal therapeutic target with minimal side effects for the pharmaceutical industry because SCN9A variants can cause both human gains of function pain-related mutations and loss of function pain-free mutations. This study reviews the clinical effectiveness of existing Nav1.7 inhibitors, which theoretically should be powerful analgesics. Methods: A systematic review is conducted on the effectiveness of current Nav1.7 blockers undergoing clinical trials. Studies were mainly extracted from PubMed, U.S. National Library of Medicine Clinical Trials, World Health Organization International Clinical Trials Registry, ISRCTN registry platform, and Integrated Research Approval System by NHS. Only studies with full text available and those conducted using double-blinded, placebo controlled, and randomised designs and reporting at least one analgesic measurement were included. Results: Overall, 61 trials were screened, and eight studies covering PF 05089771 (Pfizer), TV 45070 (Teva & Xenon), and BIIB074 (Biogen) met the inclusion criteria. Most studies were excluded because results were not published. All three compounds demonstrated insignificant analgesic effects, and the comparison between PF 05089771 and pregabalin/ibuprofen showed that PF 05089771 was a much weaker analgesic. All three drug candidates only have mild side effects, indicating the potentials for further investigation of Nav1.7 antagonists. Discussion: The failure of current Nav1.7 small molecule inhibitors might attribute to ignorance of the key role of endogenous systems in Nav1.7 null mutants, the lack of selectivity and blocking potency, and central impermeability. The synergistic combination of analgesic drugs, a recent UCL patent, combining a small dose of Nav1.7 blockers and opioids or enkephalinase inhibitors dramatically enhanced the analgesic effects. Conclusion: The current clinical testing Nav1.7 blockers are generally disappointing. However, the newer generation of Nav1.7 targeting analgesics has overcome the major constraints of its predecessors.Keywords: chronic pain, Nav1.7 blockers, SCN9A, systematic review
Procedia PDF Downloads 1311389 Role of Interlukin-18 in Primary Knee Osteoarthritis: Clinical, Laboratory and Radiological Study
Authors: Ibrahim Khalil Ibrahim, Enas Mohamed Shahine, Abeer Shawky El Hadedy, Emmanuel Kamal Aziz Saba, Ghada Salah Attia Hussein
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Osteoarthritis (OA) is a multifactorial disease characterized by a progressive degradation of articular cartilage and is the leading cause of disability in elderly persons. IL-18 contributes to the destruction of cartilage and bone in the disease process of arthritis. The aim of the study was to investigate the role of IL-18 in primary knee OA patients. Serum level of IL-18 was assessed by enzyme-linked immunosorbent assay in 30 primary knee OA patients and compared to 20 age and gender-matched healthy volunteers as a control group. Radiographic severity of OA was assessed by Kellgren and Lawrence (KL) global scale. Pain, stiffness and functional assessment were done using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). OA patients had significantly higher serum IL-18 level than in control group (420.93 ± 345.4 versus 151.03 ± 144.16 pg/ml, P=0.001). Serum level of IL-18 was positively correlated with KL global scale (P=0.001). There were no statistically significant correlations between serum level of IL-18 and pain, stiffness, function subscales and total WOMAC index scores among the studied patients. In conclusions, IL-18 has a role in the pathogenesis of OA and it is positively correlated with the radiographic damage of OA.Keywords: Interlukin-18, knee osteoarthritis, primary osteoarthritis, WOMAC scale
Procedia PDF Downloads 3841388 Failure Load Investigations in Adhesively Bonded Single-Strap Joints of Dissimilar Materials Using Cohesive Zone Model
Authors: B. Paygozar, S.A. Dizaji
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Adhesive bonding is a highly valued type of fastening mechanical parts in complex structures, where joining some simple components is always needed. This method is of several merits, such as uniform stress distribution, appropriate bonding strength, and fatigue performance, and lightness, thereby outweighing other sorts of bonding methods. This study is to investigate the failure load of adhesive single-strap joints, including adherends of different sizes and materials. This kind of adhesive joint is very practical in different industries, especially when repairing the existing joints or attaching substrates of dissimilar materials. In this research, experimentally validated numerical analyses carried out in a commercial finite element package, ABAQUS, are utilized to extract the failure loads of the joints, based on the cohesive zone model. In addition, the stress analyses of the substrates are performed in order to acquire the effects of lowering the thickness of the substrates on the stress distribution inside them to avoid designs suffering from the necking or failure of the adherends. It was found out that this method of bonding is really feasible in joining dissimilar materials which can be utilized in a variety of applications. Moreover, the stress analyses indicated the minimum thickness for the adherends so as to avoid the failure of them.Keywords: cohesive zone model, dissimilar materials, failure load, single strap joint
Procedia PDF Downloads 1231387 Resistance Spot Welding of Boron Steel 22MnB5 with Complex Welding Programs
Authors: Szymon Kowieski, Zygmunt Mikno
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The study involved the optimization of process parameters during resistance spot welding of Al-coated martensitic boron steel 22MnB5, applied in hot stamping, performed using a programme with a multiple current impulse mode and a programme with variable pressure force. The aim of this research work was to determine the possibilities of a growth in welded joint strength and to identify the expansion of a welding lobe. The process parameters were adjusted on the basis of welding process simulation and confronted with experimental data. 22MnB5 steel is known for its tendency to obtain high hardness values in weld nuggets, often leading to interfacial failures (observed in the study-related tests). In addition, during resistance spot welding, many production-related factors can affect process stability, e.g. welding lobe narrowing, and lead to the deterioration of quality. Resistance spot welding performed using the above-named welding programme featuring 3 levels of force made it possible to achieve 82% of welding lobe extension. Joints made using the multiple current impulse program, where the total welding time was below 1.4s, revealed a change in a peeling mode (to full plug) and an increase in weld tensile shear strength of 10%.Keywords: 22MnB5, hot stamping, interfacial fracture, resistance spot welding, simulation, single lap joint, welding lobe
Procedia PDF Downloads 3871386 A Numerical Investigation of Segmental Lining Joints Interactions in Tunnels
Authors: M. H. Ahmadi, A. Mortazavi, H. Zarei
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Several authors have described the main mechanism of formation of cracks in the segment lining during the construction of tunnels with tunnel boring machines. A comprehensive analysis of segmental lining joints may help to guarantee a safe construction during Tunneling and serviceable stages. The most frequent types of segment damage are caused by a condition of uneven segment matching due to contact deficiencies. This paper investigated the interaction mechanism of precast concrete lining joints in tunnels. The Discrete Element Method (DEM) was used to analyze a typical segmental lining model consisting of six segment rings. In the analyses, typical segmental lining design parameters of the Ghomrood water conveyance tunnel, Iran were employed in the study. In the conducted analysis, the worst-case scenario of loading faced during the boring of Ghomrood tunnel was considered. This was associated with the existence of a crushed zone dipping at 75 degree at the location of the key segment. In the analysis, moreover, the effect of changes in horizontal stress ratio on the loads on the segment was assessed. The boundary condition associated with K (ratio of the horizontal to the vertical stress) values of 0.5, 1, 1.5 and 2 were applied to the model and separate analysis was conducted for each case. Important parameters such as stress, moments, and displacements were measured at joint locations and the surrounding rock. Accordingly, the segment joint interactions were assessed and analyzed. Moreover, rock mass properties of the Ghomrood in Ghom were adopted. In this study, the load acting on segments joints are included a crushed zone stratum force that intersect tunnel with 75 slopes in the location of the key segment, gravity force of segments and earth pressures. A numerical investigation was used for different coefficients of stress concentration of 0.5, 1, 1.5, 2 and different geological conditions of saturated crushed zone under the critical scenario. The numerical results also demonstrate that maximum bending moments in longitudinal joints occurred for crushed zone with the weaken strengths (Sandstone). Besides that, increasing the load in segment-stratum interfaces affected radial stress in longitudinal joints and finally the opening of joints occurred.Keywords: joint, interface, segment, contact
Procedia PDF Downloads 2581385 Work-Related Risk Factors and Preventive Measures among Nurses and Dentists at Faculty of Oral and Dental Medicine
Authors: Marwa Mamdouh Shaban, Nagat Saied Habib, Shireen Ezz El-Din Taha, Eman Mahmoud Seif El-Naser
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Background: Dental nurses and dentists were constantly exposed to a number of specific work related health risk factors which develop and intensify with years. Awareness regarding these work-related health risk factors and implementation of preventive health care measures could provide a safe work environment for all dental nurses and dentists. Aim of the study: to assess the work-related health risk factors among dental nurses and dentists and preventive health care measures applied among dental nurses and dentists. Research design: A descriptive design was utilized. Sample: Convenience sample of 50 dental nurses and 150 dentists were included in the current study. Setting: This study was conducted at the dental clinics at faculty of oral and dental medicine, Al-Kasr Al Ainy Hospital. Tools of data collection: Three tools were developed, tested for clarity, and feasibility: a-Socio-demographic data sheet, b-Work-related health risk factors questionnaire, and c-structured observational checklist. Results: The most common work risk factors prevailing among dental nurses were emotional exhaustion (82%), low back pain (76%) and latex allergy (62%) and the most common work risk factors prevailing among dentists were percutaneous exposure incident (100%), emotional exhaustion (100%) and low back pain (93.3%). Also, statistically significant negative correlation (r=-0.274, at p = 0.045) between the incidence of chemical health risk factors and application of chemical preventive measures among dental nurses. A statistically significant negative correlation (r=-0.177, at p = 0.030) between the incidences of mechanical health risk factors among dentists and application of mechanical preventive measures. Conclusion: The studied dental nurses and dentists exposed to many work related health risk factors as latex allergy, percutaneous exposure incidents, low back pain and emotional exhaustion related to inappropriate application of preventive health care measures. Recommendation: Raise awareness of dental nurses and dentists about work-related health risk factors, design and implement health education program for preventive health care measures.Keywords: work-related risk factors, preventive measures, nurses, dentists
Procedia PDF Downloads 4011384 CAG Repeat Polymorphism of Androgen Receptor and Female Sexual Functions in Egyptian Female Population
Authors: Azza Gaber Farag, Yasser Atta Shehata, Sara Elsayed Elghazouly, Mustafa Elsayed Elshaib, Nesreen Gamal Elden Elhelbawy
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Background: Androgen receptor (AR) polymorphism in cytosine adenineguanine (CAG) repeat has an effect on the functional capacity of AR in males. However, little researches in this field are available regarding female sexual function. Aim: To investigate the possible link between polymorphism in the CAG repeat of AR gene and female sexual function in a sample of the Egyptian population. Materials and methods: 500 Egyptian married females completed a questionnaire regarding sociodemographic, reproductive, and sexual data. AR CAG repeat length was analyzed for those having female sexual dysfunctions (FSD) using real-time PCR. Results: The most sensitive domain to AR CAG repeat length was the orgasm domain that showed significant positive correlations with short allele (p=0.001), long allele (p=.015), biallellic mean (p=.000), and X weighted biallelic mean (p=.000). The satisfaction domain had significant positive correlations with the biallelic mean (p=.035), and the X weighted biallelic mean (p=. 032). However, the pain domain was of significant negative correlations with AR polymorphism of short allele (p=.002), biallelic mean (p=.013), and X weighted biallelic mean (p = . 011). Conclusions: AR polymorphism could represent a non-negligible aspect in female sexual function. The lower AR CAG repeat polymorphism was of significant impact on FSD, affecting mainly female orgasm followed by pain disorders that finally reflected On her sexual satisfaction.Keywords: female sexual dysfunction, androgen receptor, CAG repeat polymorphism, androgen
Procedia PDF Downloads 1821383 Optimal Sliding Mode Controller for Knee Flexion during Walking
Authors: Gabriel Sitler, Yousef Sardahi, Asad Salem
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This paper presents an optimal and robust sliding mode controller (SMC) to regulate the position of the knee joint angle for patients suffering from knee injuries. The controller imitates the role of active orthoses that produce the joint torques required to overcome gravity and loading forces and regain natural human movements. To this end, a mathematical model of the shank, the lower part of the leg, is derived first and then used for the control system design and computer simulations. The design of the controller is carried out in optimal and multi-objective settings. Four objectives are considered: minimization of the control effort and tracking error; and maximization of the control signal smoothness and closed-loop system’s speed of response. Optimal solutions in terms of the Pareto set and its image, the Pareto front, are obtained. The results show that there are trade-offs among the design objectives and many optimal solutions from which the decision-maker can choose to implement. Also, computer simulations conducted at different points from the Pareto set and assuming knee squat movement demonstrate competing relationships among the design goals. In addition, the proposed control algorithm shows robustness in tracking a standard gait signal when accounting for uncertainty in the shank’s parameters.Keywords: optimal control, multi-objective optimization, sliding mode control, wearable knee exoskeletons
Procedia PDF Downloads 821382 Defect Identification in Partial Discharge Patterns of Gas Insulated Switchgear and Straight Cable Joint
Authors: Chien-Kuo Chang, Yu-Hsiang Lin, Yi-Yun Tang, Min-Chiu Wu
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With the trend of technological advancement, the harm caused by power outages is substantial, mostly due to problems in the power grid. This highlights the necessity for further improvement in the reliability of the power system. In the power system, gas-insulated switches (GIS) and power cables play a crucial role. Long-term operation under high voltage can cause insulation materials in the equipment to crack, potentially leading to partial discharges. If these partial discharges (PD) can be analyzed, preventative maintenance and replacement of equipment can be carried out, there by improving the reliability of the power grid. This research will diagnose defects by identifying three different defects in GIS and three different defects in straight cable joints, for a total of six types of defects. The partial discharge data measured will be converted through phase analysis diagrams and pulse sequence analysis. Discharge features will be extracted using convolutional image processing, and three different deep learning models, CNN, ResNet18, and MobileNet, will be used for training and evaluation. Class Activation Mapping will be utilized to interpret the black-box problem of deep learning models, with each model achieving an accuracy rate of over 95%. Lastly, the overall model performance will be enhanced through an ensemble learning voting method.Keywords: partial discharge, gas-insulated switches, straight cable joint, defect identification, deep learning, ensemble learning
Procedia PDF Downloads 781381 Case of A Huge Retroperitoneal Abscess Spanning from the Diaphragm to the Pelvic Brim
Authors: Christopher Leung, Tony Kim, Rebecca Lendzion, Scott Mackenzie
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Retroperitoneal abscesses are a rare but serious condition with often delayed diagnosis, non-specific symptoms, multiple causes and high morbidity/mortality. With the advent of more readily available cross-sectional imaging, retroperitoneal abscesses are treated earlier and better outcomes are achieved. Occasionally, a retroperitoneal abscess is present as a huge retroperitoneal abscess, as evident in this 53-year-old male. With a background of chronic renal disease and left partial nephrectomy, this gentleman presented with a one-month history of left flank pain without any other symptoms, including fevers or abdominal pain. CT abdomen and pelvis demonstrated a huge retroperitoneal abscess spanning from the diaphragm, abutting the spleen, down to the iliopsoas muscle and abutting the iliac vessels at the pelvic brim. This large retroperitoneal abscess required open drainage as well as drainage by interventional radiology. A long course of intravenous antibiotics and multiple drainages was required to drain the abscess. His blood culture and fluid culture grew Proteus species suggesting a urinary source, likely from his non-functioning kidney, which had a partial nephrectomy. Such a huge retroperitoneal abscess has rarely been described in the literature. The learning point here is that the basic principle of source control and antibiotics is paramount in treating retroperitoneal abscesses regardless of the size of the abscess.Keywords: retroperitoneal abscess, retroperitoneal mass, sepsis, genitourinary infection
Procedia PDF Downloads 2211380 An Assessment of the Performance of Local Government in Ondo State Nigeria: A Capital Budgeting Approach
Authors: Olurankinse Felix
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Local governments in Ondo State Nigeria are the third tier of government saddled with the responsibility of providing governance and economic services at the grassroots. To be able to do this, the Constitution of the Federal Republic of Nigeria provided that a proportion of Federation Account be allocated to them in addition to their internally generated revenue. From the allocation and other incidental sources of revenue, the local governments are expected to provide basic infrastructures and other social amenities to better the lots of the rural dwellers. Nevertheless, local governments’ performances in terms of provision of social amenities are without questioning and quite not encouraging. Assessing the performance of local governments in this period of dearth and scarcity of resources is highly indispensable more so that the activities of local governments’ staff are bedeviled and characterized with fraud, corruption and mismanagement. Considering the direct impact of the consequences of their action on the living standard of the rural dwellers therefore calls for the need to evaluate their level of performances using capital budgeting approach. The paper being a time series study adopts the survey design. Data were obtained through secondary source mainly from the Annual financial statements and publication of approved budgets estimates covering the period of study (2008-2012). The use of ratio analysis was employed in analyzing the comparative level of performances of the local governments under study. The result of the study shows that less than 30% of the local governments were able to harness the budgetary allocation to provide amenities to the beneficiaries while majority of the local governments were involved in unethical conduct ranging from theft of fund, corruption, diversion of funds and extra-budgetary activities. Also, there is poor internally generated revenue to complement the statutory allocation and besides, the monthly withholding of larger portions of local government share by the state in the name of joint account were also seen as contributory factors. The study recommends the need for transparency and accountability in public fund management through the oversight function of the state house of assembly. Also local government should be made to be autonomous and independent of the state by jettisoning the idea of joint account.Keywords: performance, transparency and accountability, capital budgeting, joint account, local government autonomy
Procedia PDF Downloads 3311379 Punica granatum (Pomegranate) of a Libyan Variety Exhibits in vitro Anti-Inflammatory Potential
Authors: Lamees A. Ben Saad, Kah Hwi Kim, Chin Chew Quah, Mustafa Shahimi
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Background: Punica granatum (pomegranate) was used as a traditional medicine in different parts of the world. It has been used in the treatment of pain and inflammatory conditions such as peptic ulcer. The numerous risks associated with nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of pain and inflammation give rise to using medicinal herbs as alternative therapies. This study aimed to evaluate the anti-inflammatory effect of the ethyl acetate pomegranate fraction (EtOAc) by determination of its inhibitory effects on lipopolysaccharide (LPS), stimulated nitric oxide (NO), prostaglandin E2 (PGE-2), interleukin-6 (IL-6) and cyclooxxgenase-2 (COX2) release from RAW264.7cells. Methods: The inhibitory effect of EtOAc was evaluated on (LPS) induced NO production, PGE2, and IL-6 quantified by immunoassay kit and prostaglandin E2 competitive ELISA kit. COX2 production is an in vitro indication of possible anti-inflammatory activity and was estimated by Western blotting. Results: EtOAc potentially inhibited LPS-induced nitric oxide, prostaglandin, and IL-6 production. With these findings, it was evident that the EtOAc could reduce the LPS-induced cyclooxygenase-2 (COX-2) at the protein level in a dose-dependent manner as determined by Western blotting. Conclusion: The results emphasize potential therapeutic applications of Punica granatum in the treatment of inflammation.Keywords: inflammation, Punica granatum, cytotoxicity, cytokines
Procedia PDF Downloads 6601378 The Association Between CYP2C19 Gene Distribution and Medical Cannabis Treatment
Authors: Vichayada Laohapiboolkul
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Introduction: As the legal use of cannabis is being widely accepted throughout the world, medical cannabis has been explored in order to become an alternative cure for patients. Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are natural cannabinoids found in the Cannabis plant which is proved to have positive treatment for various diseases and symptoms such as chronic pain, neuropathic pain, spasticity resulting from multiple sclerosis, reduce cancer-associated pain, autism spectrum disorders (ASD), dementia, cannabis and opioid dependence, psychoses/schizophrenia, general social anxiety, posttraumatic stress disorder, anorexia nervosa, attention-deficit hyperactivity disorder, and Tourette's disorder. Regardless of all the medical benefits, THC, if not metabolized, can lead to mild up to severe adverse drug reactions (ADR). The enzyme CYP2C19 was found to be one of the metabolizers of THC. However, the suballele CYP2C19*2 manifests as a poor metabolizer which could lead to higher levels of THC than usual, possibly leading to various ADRs. Objective: The aim of this study was to investigate the distribution of CYP2C19, specifically CYP2C19*2, genes in Thai patients treated with medical cannabis along with adverse drug reactions. Materials and Methods: Clinical data and EDTA whole blood for DNA extraction and genotyping were collected from patients for this study. CYP2C19*2 (681G>A, rs4244285) genotyping was conducted using the Real-time PCR (ABI, Foster City, CA, USA). Results: There were 42 medical cannabis-induced ADRs cases and 18 medical cannabis tolerance controls who were included in this study. A total of 60 patients were observed where 38 (63.3%) patients were female and 22 (36.7%) were male, with a range of age approximately 19 - 87 years. The most apparent ADRs for medical cannabis treatment were dry mouth/dry throat (76.7%), followed by tachycardia (70%), nausea (30%) and a few arrhythmias (10%). In the total of 27 cases, we found a frequency of 18 CYP2C19*1/*1 alleles (normal metabolizers, 66.7%), 8 CYP2C19*1/*2 alleles (intermediate metabolizers, 29.6%) and 1 CYP2C19*2/*2 alleles (poor metabolizers, 3.7%). Meanwhile, 63.6% of CYP2C19*1/*1, 36.3% and 0% of CYP2C19*1/*2 and *2/*2 in the tolerance controls group, respectively. Conclusions: This is the first study to confirm the distribution of CYP2C19*2 allele and the prevalence of poor metabolizer genes in Thai patients who received medical cannabis for treatment. Thus, CYP2C19 allele might serve as a pharmacogenetics marker for screening before initiating treatment.Keywords: medical cannabis, adverse drug reactions, CYP2C19, tetrahydrocannabinol, poor metabolizer
Procedia PDF Downloads 1031377 Comparison Between Vegans and Omnivores on the Recovery of Delayed Onset Muscle Soreness in Young Females
Authors: Njeim Pressila, Hajj-Boutros Guy, Antony D. Karelis
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Background: Acute resistance exercise is associated with an elevated inflammation response, which could lead to delayed onset muscle soreness (DOMS). There is evidence that suggests that ingesting foods that have anti-inflammation properties may help reduce DOMS. A vegan diet has also been shown to be an anti-inflammatory diet which could, in turn, decrease DOMS. Objective and hypothesis: The purpose of the present study will be to compare markers of DOMS between vegans and omnivores after acute resistance exercise in young females. We hypothesize that vegans will have a better recovery of DOMS markers after a resistance exercise session compared to omnivores. Methods: Population: We will recruit30 vegans and 30 omnivores to participate in this study. Allvolunteers will follow either a vegan or an omnivore diet for at least 2 years. Anthropometric measurements, body composition, musclestrength (leg and chest press), markers of DOMS (swelling, pain, and stiffness), and dietary factors, as well as a wellness and anxiety questionnaire will be measured. All participants will also perform an acute resistance exercise session in order to induce DOMS. Pertinence: This project will give us a better understanding on the recovery process of vegans after a resistance training session and, as such, provide useful information to health professionals and athletes/coaches (kinesiologists and nutritionists)Keywords: vgeans, omnivores, delayed onset muscle soreness, pain, stifness
Procedia PDF Downloads 127