Search results for: admission diagnosis
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2297

Search results for: admission diagnosis

1547 Clinicopathological and Immunohistochemical Study of Ovarian Sex Cord-Stromal Tumors and Their Histological Mimics

Authors: Ghada Esheba, Ebtisam Aljerayan, Afnan Al-Ghamdi, Atheer Alsharif, Hanan alzahrani

Abstract:

Background: Primary ovarian neoplasms comprise a heterogeneous group of tumors of three main subtypes: surface epithelial, germ cell, and sex cord-stromal. The wide morphological variation within and between these groups can result in diagnostic difficulties. Gonadal sex cord-stromal tumors (SCST) represent one of the most heterogeneous categories of human neoplasms, because they may contain various combinations of different gonadal sex cord and stromal element. Aim: The aim of this work is to highlight the clinicopathological characteristics of SCST and to assess the value of alpha-inhibin and calretinin in the distinction between SCST and their mimics. Material and methods: This study was carried out on 100 cases using full tissue sections; 70 cases were SCST and 30 cases were histological mimics of SCST. The cases were studied using immunohistochemically using alpha-inhibin. In addition, an ovarian tissue microarray containing 170 benign and malignant ovarian neoplasms was also studied immunohistochemically for calretinin expression. The ovarian microarray included 14 SCST, 59 ovarian serous borderline tumors, 17 mucinous borderline tumors, 10 mucinous adenocarcinomas, 32 endometrioid adenocarcinomas, 34 clear cell carcinomas, and 4 germ cell tumors. Results: 99% of SCST examined using full tissue sections exhibited positive cytoplasmic staining for inhibin. On the contrary, only 7% of the histological mimics (P value < 0.0001). 86% of SCST in the tissue microarray were positive for calretinin with nuclear and/or cytoplasmic staining compared to only 7% of the other tumor types (P value < 0.0001). Conclusions: SCST have characteristic clinicopathological and immunohistochemical features and their recognition is crucial for proper diagnosis and treatment. Alpha-inhibin and calretinin are of great help in the diagnosis of sex cord-stromal tumors.

Keywords: calretinin, granulosa cell tumor, inhibin, sex cord-stromal tumors

Procedia PDF Downloads 201
1546 Innovative Screening Tool Based on Physical Properties of Blood

Authors: Basant Singh Sikarwar, Mukesh Roy, Ayush Goyal, Priya Ranjan

Abstract:

This work combines two bodies of knowledge which includes biomedical basis of blood stain formation and fluid communities’ wisdom that such formation of blood stain depends heavily on physical properties. Moreover biomedical research tells that different patterns in stains of blood are robust indicator of blood donor’s health or lack thereof. Based on these valuable insights an innovative screening tool is proposed which can act as an aide in the diagnosis of diseases such Anemia, Hyperlipidaemia, Tuberculosis, Blood cancer, Leukemia, Malaria etc., with enhanced confidence in the proposed analysis. To realize this powerful technique, simple, robust and low-cost micro-fluidic devices, a micro-capillary viscometer and a pendant drop tensiometer are designed and proposed to be fabricated to measure the viscosity, surface tension and wettability of various blood samples. Once prognosis and diagnosis data has been generated, automated linear and nonlinear classifiers have been applied into the automated reasoning and presentation of results. A support vector machine (SVM) classifies data on a linear fashion. Discriminant analysis and nonlinear embedding’s are coupled with nonlinear manifold detection in data and detected decisions are made accordingly. In this way, physical properties can be used, using linear and non-linear classification techniques, for screening of various diseases in humans and cattle. Experiments are carried out to validate the physical properties measurement devices. This framework can be further developed towards a real life portable disease screening cum diagnostics tool. Small-scale production of screening cum diagnostic devices is proposed to carry out independent test.

Keywords: blood, physical properties, diagnostic, nonlinear, classifier, device, surface tension, viscosity, wettability

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1545 Audit of Urgent and Non-Urgent Patient Visits to the Emergency: A Case-Control Study

Authors: Peri Harish Kumar, Rafique Umer Harvitkar

Abstract:

Background: The emergency department mandates maximum efficacy in the utilization of the available resources. Non-urgent patient visits pose a serious concern to the treatment, patient triage, and resources available. Aims and Objectives: We conducted a retrospective case-control study of the emergency department patient list from October 2019 to November 2022. A total of 839 patients formed part of the study. Somatic complaints, vital signs, diagnostic test results, admission to the hospital, etc., were some of the criteria used for the categorization of patients. Results: The proportion of non-urgent visits varied from 7.2% to 43%, with a median of 21%. Somatic complaints were the least associated with further hospital admissions (n=28%), while diagnostic test results were the most significant indicator of further hospital admissions (n=74%). Effective triage helped minimize emergency department admissions by 36%. Conclusion: Our study shows that effective triaging, patient counselling, and round-the-clock consumable monitoring helped in the effective management of patients admitted and also significantly helped provide treatment to the patients most in need.

Keywords: urgent visits, non-urgent visits, traiging, emergency department admissions

Procedia PDF Downloads 107
1544 The Reliability of Management Earnings Forecasts in IPO Prospectuses: A Study of Managers’ Forecasting Preferences

Authors: Maha Hammami, Olfa Benouda Sioud

Abstract:

This study investigates the reliability of management earnings forecasts with reference to these two ingredients: verifiability and neutrality. Specifically, we examine the biasedness (or accuracy) of management earnings forecasts and company specific characteristics that can be associated with accuracy. Based on sample of 102 IPO prospectuses published for admission on NYSE Euronext Paris from 2002 to 2010, we found that these forecasts are on average optimistic and two of the five test variables, earnings variability and financial leverage are significant in explaining ex post bias. Acknowledging the possibility that the bias is the result of the managers’ forecasting behavior, we then examine whether managers decide to under-predict, over-predict or forecast accurately for self-serving purposes. Explicitly, we examine the role of financial distress, operating performance, ownership by insiders and the economy state in influencing managers’ forecasting preferences. We find that managers of distressed firms seem to over-predict future earnings. We also find that when managers are given more stock options, they tend to under-predict future earnings. Finally, we conclude that the management earnings forecasts are affected by an intentional bias due to managers’ forecasting preferences.

Keywords: intentional bias, management earnings forecasts, neutrality, verifiability

Procedia PDF Downloads 231
1543 Analytical Model of Multiphase Machines Under Electrical Faults: Application on Dual Stator Asynchronous Machine

Authors: Nacera Yassa, Abdelmalek Saidoune, Ghania Ouadfel, Hamza Houassine

Abstract:

The rapid advancement in electrical technologies has underscored the increasing importance of multiphase machines across various industrial sectors. These machines offer significant advantages in terms of efficiency, compactness, and reliability compared to their single-phase counterparts. However, early detection and diagnosis of electrical faults remain critical challenges to ensure the durability and safety of these complex systems. This paper presents an advanced analytical model for multiphase machines, with a particular focus on dual stator asynchronous machines. The primary objective is to develop a robust diagnostic tool capable of effectively detecting and locating electrical faults in these machines, including short circuits, winding faults, and voltage imbalances. The proposed methodology relies on an analytical approach combining electrical machine theory, modeling of magnetic and electrical circuits, and advanced signal analysis techniques. By employing detailed analytical equations, the developed model accurately simulates the behavior of multiphase machines in the presence of electrical faults. The effectiveness of the proposed model is demonstrated through a series of case studies and numerical simulations. In particular, special attention is given to analyzing the dynamic behavior of machines under different types of faults, as well as optimizing diagnostic and recovery strategies. The obtained results pave the way for new advancements in the field of multiphase machine diagnostics, with potential applications in various sectors such as automotive, aerospace, and renewable energies. By providing precise and reliable tools for early fault detection, this research contributes to improving the reliability and durability of complex electrical systems while reducing maintenance and operation costs.

Keywords: faults, diagnosis, modelling, multiphase machine

Procedia PDF Downloads 56
1542 The Question of Choice in an Achievement Test: A Study on the Sudanese Case

Authors: Mahmoud Abdelrazig Mahmoud Barakat

Abstract:

Achievement tests administered at national level play a significant role in the lives of test-takers as well as the whole society. This paper aims to investigate the effect of giving students a choice between two optional questions on their overall performance in a high stake achievement test for university admission. It is hypothesized that questions targeting writing-based productive skills and language system necessitate display of abilities which are different from fact-based questions designed around story content. The two items are assumed to reflect different constructs that require different criteria of assessment. Consequently, the student’s overall score is affected by the item they choose to answer, which might not be reflective of their real language abilities. An open-ended interview was carried out with ten teachers working with grade 3 students in model secondary schools to investigate the nature of the two test items and their impact on the student’s performance. The data has proved that giving choice in an achievement test generates different performances that are assessed differently. It is recommended that in order to address the question of fairness, it is important to clearly define and balance the construct of the items that affect the student’s choice and performance.

Keywords: achievement test, assessment, choice, fairness performance

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1541 Internal Power Recovery in Cryogenic Cooling Plants Part I: Expander Development

Authors: Ambra Giovannelli, Erika Maria Archilei

Abstract:

The amount of the electrical power required by refrigeration systems is relevant worldwide. It is evaluated in the order of 15% of the total electricity production taking refrigeration and air-conditioning into consideration. For this reason, in the last years several energy saving techniques have been proposed to reduce the power demand of such plants. The paper deals with the development of an innovative internal recovery system for cryogenic cooling plants. Such a system consists in a Compressor-Expander Group (CEG) designed on the basis of the automotive turbocharging technology. In particular, the paper is focused on the design of the expander, the critical component of the CEG system. Due to the low volumetric flow entering the expander and the high expansion ratio, a commercial turbocharger expander wheel was strongly modified. It was equipped with a transonic nozzle, designed to have a radially inflow full admission. To verify the performance of such a machine and suggest improvements, two different set of nozzles have been designed and modelled by means of the commercial Ansys-CFX software. steady-state 3D CFD simulations of the second-generation prototype are presented and compared with the initial ones.

Keywords: vapour cCompression systems, energy saving, refrigeration plant, organic fluids, radial turbine

Procedia PDF Downloads 205
1540 Implementing of Indoor Air Quality Index in Hong Kong

Authors: Kwok W. Mui, Ling T. Wong, Tsz W. Tsang

Abstract:

Many Hong Kong people nowadays spend most of their lifetime working indoor. Since poor Indoor Air Quality (IAQ) potentially leads to discomfort, ill health, low productivity and even absenteeism in workplaces, a call for establishing statutory IAQ control to safeguard the well-being of residents is urgently required. Although policies, strategies, and guidelines for workplace IAQ diagnosis have been developed elsewhere and followed with remedial works, some of those workplaces or buildings have relatively late stage of the IAQ problems when the investigation or remedial work started. Screening for IAQ problems should be initiated as it will provide information as a minimum provision of IAQ baseline requisite to the resolution of the problems. It is not practical to sample all air pollutants that exit. Nevertheless, as a statutory control, reliable, rapid screening is essential in accordance with a compromise strategy, which balances costs against detection of key pollutants. This study investigates the feasibility of using an IAQ index as a parameter of IAQ control in Hong Kong. The index is a screening parameter to identify the unsatisfactory workplace IAQ and will highlight where a fully effective IAQ monitoring and assessment is needed for an intensive diagnosis. There already exist a number of representative common indoor pollutants based on some extensive IAQ assessments. The selection of pollutants is surrogate to IAQ control consists of dilution, mitigation, and emission control. The IAQ Index and assessment will look at high fractional quantities of these common measurement parameters. With the support of the existing comprehensive regional IAQ database and the IAQ Index by the research team as the pre-assessment probability, and the unsatisfactory IAQ prevalence as the post-assessment probability from this study, thresholds of maintaining the current measures and performing a further IAQ test or IAQ remedial measures will be proposed. With justified resources, the proposed IAQ Index and assessment protocol might be a useful tool for setting up a practical public IAQ surveillance programme and policy in Hong Kong.

Keywords: assessment, index, indoor air quality, surveillance programme

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1539 Nursing Experience for a Lung Cancer Patient Undergoing First Time Concurrent Chemotherapy and Radiation Therapy

Authors: Hui Ling Chen

Abstract:

This article describes the experience of caring for a 68-year-old lung cancer patient undergoing the initial stage of concurrent chemotherapy and radiation therapy during the period of October 21 to November 16. In this study, the author collected data through observation, interviews, medical examination, and the use of Roy’s adaptation model as a guide for data collection and assessment. This study confirmed that chemotherapy induced nausea and vomiting, and radiation therapy impaired skin integrity. At the same time, the patient experienced an anxious reaction to the initial cancer diagnosis and the insertion of subcutaneous infusion ports at the start of medical treatment. Similarly, the patient’s wife shares his anxiety, not to mention the feeling of inadequacy from the lack of training in cancer care. In response, the nursing intervention strategy has included keeping the patient and his family informed of his treatment progress, transfer of cancer care knowledge, and providing them with spiritual support. For example, the nursing staff has helped them draw up a mutually agreeable dietary plan that best suits the wife’s cooking skills, provided them with knowledge in pre- and post-radiation skin care, as well as means to cope with nausea and vomiting reactions. The nursing staff has also worked on building rapport with the patient and his spouse, providing them with encouragement, caring attention and companionship. After the patient was discharged from the hospital, the nursing staff followed up with caring phone calls to help the patient and his family make life-style adjustments to normalcy. The author hopes that his distinctive nursing experience can be useful as a reference for the clinical care of lung cancer patients undergoing the initial stage of concurrent chemotherapy and radiation therapy treatment.

Keywords: lung cancer, initiate diagnosis, concurrent chemotherapy and radiation therapy, nursing care

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1538 Using Simulation Modeling Approach to Predict USMLE Steps 1 and 2 Performances

Authors: Chau-Kuang Chen, John Hughes, Jr., A. Dexter Samuels

Abstract:

The prediction models for the United States Medical Licensure Examination (USMLE) Steps 1 and 2 performances were constructed by the Monte Carlo simulation modeling approach via linear regression. The purpose of this study was to build robust simulation models to accurately identify the most important predictors and yield the valid range estimations of the Steps 1 and 2 scores. The application of simulation modeling approach was deemed an effective way in predicting student performances on licensure examinations. Also, sensitivity analysis (a/k/a what-if analysis) in the simulation models was used to predict the magnitudes of Steps 1 and 2 affected by changes in the National Board of Medical Examiners (NBME) Basic Science Subject Board scores. In addition, the study results indicated that the Medical College Admission Test (MCAT) Verbal Reasoning score and Step 1 score were significant predictors of the Step 2 performance. Hence, institutions could screen qualified student applicants for interviews and document the effectiveness of basic science education program based on the simulation results.

Keywords: prediction model, sensitivity analysis, simulation method, USMLE

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1537 Effects of Using Clinical Guidelines for Feeding through a Gastrostomy Tube in Critically ill Surgical Patients Songkla Hospital Thailand

Authors: Siriporn Sikkaphun

Abstract:

Food is essential for living, and receiving correct, suitable, and adequate food is advantageous to the body, especially for patients because it can enable good recovery. Feeding through a gastrostomy tube is one useful way that is widely used because it is easy, convenient, and economical.To compare the effectiveness of using the clinical guidelines for feeding through a gastrostomy tube in critically ill surgical patients.This is a pre-post quasi-experimental study on 15 critically ill surgical or accident patients who needed intubation and the gastrostomy tube from August 2011 to November 2012. The data were collected using the guidelines, and an evaluation form for effectiveness of guidelines for feeding through a gastrostomy tube in critically ill surgical patients. After using the guidelines for feeding through a gastrostomy tube in critically ill surgical patients, it was found that The average number of days from the admission date to the day the patients received food through the G-tube significantly reduced at the level .05. The number of personnel who practiced nursing activities correctly and suitably for patients with complications during feeding significantly increased at the level .05.The number of patients receiving energy to the target level significantly increased at the level .05. The results of this study indicated that the use of the guidelines for feeding through a gastrostomy tube in critically ill surgical patients was feasible in practice, and the outcomes were beneficial to the patients.

Keywords: clinical guidelines, feeding, gastrostomy tube, critically ill, surgical patients

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1536 Shaping and Improving the Human Resource Management in Small and Medium Enterprises in Poland

Authors: Małgorzata Smolarek

Abstract:

One of the barriers to the development of small and medium-sized enterprises (SME) are difficulties connected with management of human resources. The first part of article defines the specifics of staff management in small and medium enterprises. The practical part presents results of own studies in the area of diagnosis of the state of the human resources management in small and medium-sized enterprises in Poland. It takes into account its impact on the functioning of SME in a variable environment. This part presents findings of empirical studies, which enabled verification of the hypotheses and formulation of conclusions. The findings presented in this paper were obtained during the implementation of the project entitled 'Tendencies and challenges in strategic managing SME in Silesian Voivodeship.' The aim of the studies was to diagnose the state of strategic management and human resources management taking into account its impact on the functioning of small and medium enterprises operating in Silesian Voivodeship in Poland and to indicate improvement areas of the model under diagnosis. One of the specific objectives of the studies was to diagnose the state of the process of strategic management of human resources and to identify fundamental problems. In this area, the main hypothesis was formulated: The enterprises analysed do not have comprehensive strategies for management of human resources. The survey was conducted by questionnaire. Main Research Results: Human resource management in SMEs is characterized by simplicity of procedures, and the lack of sophisticated tools and its specificity depends on the size of the company. The process of human resources management in SME has to be adjusted to the structure of an organisation, result from its objectives, so that an organisation can fully implement its strategic plans and achieve success and competitive advantage on the market. A guarantee of success is an accurately developed policy of human resources management based on earlier analyses of the existing procedures and possessed human resources.

Keywords: human resources management, human resources policy, personnel strategy, small and medium enterprises

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1535 COVID-19 and Heart Failure Outcomes: Readmission Insights from the 2020 United States National Readmission Database

Authors: Induja R. Nimma, Anand Reddy Maligireddy, Artur Schneider, Melissa Lyle

Abstract:

Background: Although heart failure is one of the most common causes of hospitalization in adult patients, there is limited knowledge on outcomes following initial hospitalization for COVID-19 with heart failure (HCF-19). We felt it pertinent to analyze 30-day readmission causes and outcomes among patients with HCF-19 using the United States using real-world big data via the National readmission database. Objective: The aim is to describe the rate and causes of readmissions and morbidity of heart failure with coinciding COVID-19 (HFC-19) in the United States, using the 2020 National Readmission Database (NRD). Methods: A descriptive, retrospective study was conducted on the 2020 NRD, a nationally representative sample of all US hospitalizations. Adult (>18 years) inpatient admissions with COVID-19 with HF and readmissions in 30 days were selected based on the International Classification of Diseases-Tenth Revision, Procedure Code. Results: In 2020, 2,60,372 adult patients were hospitalized with COVID-19 and HF. The median age was 74 (IQR: 64-83), and 47% were female. The median length of stay was 7(4-13) days, and the total cost of stay was 62,025 (31,956 – 130,670) United States dollars, respectively. Among the index hospital admissions, 61,527 (23.6%) died, and 22,794 (11.5%) were readmitted within 30 days. The median age of patients readmitted in 30 days was 73 (63-82), 45% were female, and 1,962 (16%) died. The most common principal diagnosis for readmission in these patients was COVID-19= 34.8%, Sepsis= 16.5%, HF = 7.1%, AKI = 2.2%, respiratory failure with hypoxia =1.7%, and Pneumonia = 1%. Conclusion: The rate of readmission in patients with heart failure exacerbations is increasing yearly. COVID-19 was observed to be the most common principal diagnosis in patients readmitted within 30 days. Complicated hypertension, chronic pulmonary disease, complicated diabetes, renal failure, alcohol use, drug use, and peripheral vascular disorders are risk factors associated with readmission. Familiarity with the most common causes and predictors for readmission helps guide the development of initiatives to minimize adverse outcomes and the cost of medical care.

Keywords: Covid-19, heart failure, national readmission database, readmission outcomes

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1534 Audit on the Use of T-MACS Decision Aid for Patients Presenting to ED with Chest Pain

Authors: Saurav Dhawan, Sanchit Bansal

Abstract:

Background T-MACS is a computer-based decision aid that ‘rules in’ and ‘rules out’ ACS using a combination of the presence or absence of six clinical features with only one biomarker measured on arrival: hs-cTnT. T-MACS had 99.3% negative predictive value and 98.7% sensitivity for ACS, ‘ruling out’ ACS in 40% of patients while ‘ruling in’ 5% at the highest risk. We aim at benchmarking the use of T-MACS which could help to conserve healthcare resources, facilitate early discharges, and ensure safe practice. Methodology Randomized retrospective data collection (n=300) was done from ED electronic records across 3 hospital sites within MFT over a period of 2 months. Data was analysed and compared by percentage for the usage of T-MACS, number of admissions/discharges, and in days for length of stay in hospital. Results MRI A&E had the maximum compliance with the use of T-MACS in the trust at 66%, with minimum admissions (44%) and an average length of stay of 1.825 days. NMG A&E had an extremely low compliance rate (8 %), with 75% admission and 3.387 days as the average length of stay. WYT A&E had no TMACS recorded, with a maximum of 79% admissions and the longest average length of stay at 5.07 days. Conclusion All three hospital sites had a RAG rating of ‘RED’ as per the compliance levels. The assurance level was calculated as ‘Very Limited’ across all sites. There was a positive correlation observed between compliance with TMACS and direct discharges from ED, thereby reducing the average length of stay for patients in the hospital.

Keywords: ACS, discharges, ED, T-MACS

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1533 Τhe Importance of Previous Examination Results, in Futural Differential Diagnostic Procedures and Especially in the Era of Covid-19

Authors: Angelis P. Barlampas

Abstract:

Purpose or Learning Objective It is well known that previous examinations play a major role in futural diagnosis, thus avoiding unnecessary new exams that cost in time and money both for the patient and the health system. A case is presented in which past patient’s results, in combination with the least needed new tests, give an easy final diagnosis. Methods or Background A middle aged man visited the emergency department complaining of hard controlled, persisting fever for the last few days. Laboratory tests showed an elevated number of white blood cells with neutrophil shift and abnormal CRP. The patient was admitted to hospital a month ago for continuing lungs symptomatology after a recent covid-19 infection. Results or Findings Computed tomography scanning showed a solid mass with spiculating margins in right lower lobe. After intravenous iodine contrast administration, there was mildly peripheral enhancement and eccentric non enhancing area. A pneumonic cancer was suspected. Comparison with the patient’s latest computed tomography revealed no mass in the area of interest but only signs of recent post covid-19 lung parenchyma abnormalities. Any new mass that appears in a month’s time span can not be a cancer but a benign lesion. It was obvious that an abscess was the most suitable explanation. The patient was admitted to hospital, and antibiotic therapy was given, with very good results. After a few days, the patient was afebrile and in good condition. Conclusion In this case , a PET scan or a biopsy was avoided, thanks to the patient’s medical history and the availability of previous examinations. It is worthy encouraging the patients to keep their medical records and organizing more efficiently the health system with the current technology of archiving the medical examinations, too.

Keywords: covid-19, chest ct, cancer, abscess, fever

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1532 Applying ASHRAE Standards on the Hospital Buildings of UAE

Authors: Hanan M. Taleb

Abstract:

Energy consumption associated with buildings has a significant impact on the environment. To that end, and as a transaction between the inside and outside and between the building and urban space, the building skin plays an especially important role. It provides protection from the elements; demarcates private property and creates privacy. More importantly, it controls the admission of solar radiation. Therefore, designing the building skin sustainably will help to achieve optimal performance in terms of both energy consumption and thermal comfort. Unfortunately, with accelerating construction expansion, many recent buildings do not pay attention to the importance of the envelope design. This piece of research will highlight the importance of this part of the creation of buildings by providing evidence of a significant reduction in energy consumption if the envelopes are redesigned. Consequently, the aim of this paper is to enhance the performance of the hospital envelope in order to achieve sustainable performance. A hospital building sited in Abu Dhabi, in the UAE, has been chosen to act as a case study. A detailed analysis of the annual energy performance of the case study will be performed with the use of a computerised simulation; this is in order to explore their energy performance shortcomings. The energy consumption of the base case will then be compared with that resulting from the new proposed building skin. The results will inform architects and designers of the savings potential from various strategies.

Keywords: ASHREA, building skin, building envelopes, hospitals, Abu Dhabi, UAE, IES software

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1531 Uterine Leiomyomas and Urological Complications

Authors: Dharshini Selvarajah, Nicula Lui, Karen Kong

Abstract:

Background: Uterine fibroids are a common benign gynaecologic neoplasm in reproductive-aged women. Fibroids may become symptomatic in a vast majority of nulliparous women. Their diagnosis and management is often coordinated between gyneacologists, radiologists and urologists depending on the anatomical location, growth, size and the fibroids sarcomatous evolvement. Some patients may develop obstructive uropathy symptoms, either uni or bilateral secondary urethral obstruction causing hydronephrosis. Uterine artery emoblisation (UAE) has previously shown to effectively resolve symptoms as well as relieve urethral obstruction and resolve the hydronephrosis. UAE has now established itself as an organ preserving and minimally invasive procedure in the management of symptomatic uterine fibroids. It is a safe and effective alternative to hysterectomy for resolving fibroid related pressure symptoms. The case presented examines the clinical manifestations and impact of uterine fibroids on the urinary tract system. The therapeutic options to relieve the urological symptoms as well as preserve fertility are explored and presented. Case: The case is a 29-year-old Nepalese female admitted to hospital with recurrent urosepsis with multiresistant organisms. This was on a background of an enlarged uterus (measuring 17cm x11cm) with multiple subserosal, intramural and exophytic fibroids- causing external ureteric compression. She had bilateral ureteric stents insitu and required bilateral right and left nephrostomies during repeated episodes of urosepsis and bilateral ureteric obstruction. The left nephrostomy was removed a month prior to admission and her most recent CT KUB demonstrated hypofunctioning ureteric stents with bilateral hydronephrosis. Options of hysterectomy versus uterine artery emoblisation (UAE) were extensively explored. The patient was keen to preserve fertility. Risks associated with UAE such as expulsion of the submucosal component of the fibroids and the possibilities of sepsis in the setting of ongoing ureteric colonisation were particularly high. The patient opted to trial UAE even though the risks of recurrent hospital admissions with urosepsis were going to be particularly high. In the event, the uterus fails to shrink adequately enough to relieve the obstructed ureters a hysterectomy would inevitably be required in future. Day 3 post UAE the patient developed fevers, was hypotensive and tachycardic post-receiving prophylactic meropenem and fluconazole pre emoblisation. She was noted to have a CRP of 293 with the most recent urine culture during this time growing Candida albicans. The patient was recommenced on oral fluconazole and IV meropenem, with good effect. Her repeat renal tract ultrasound post-UAE showed ongoing marked left hydronephrosis relatively unchanged from the scan one month prior to the procedure, however the right-sided hydronephrosis had resolved. The patient was discharged on a 2-week course of antibiotics. The patient will have a repeat renal tract ultrasound and MRI of the ureters to re-evaluate the degree of hydronephrosis and progress- this was unavailable at the time of abstract submission and will be presented at the conference. Conclusion: Fibroids are a common benign tumour of the uterus and can frequently impact the lower urinary system resulting in significant uropathy. They often enlarge and compress the urinary bladder, urethra and lower end of the ureters. The effectiveness of UAE as a fertility preserving option is described.

Keywords: Uterine leiomyomas and urological complications, uterine artery embolisation for fibroids, Uterine fibroids and complications, Management of uterine fibroids

Procedia PDF Downloads 216
1530 Optic Nerve Sheath Measurement in Children with Head Trauma

Authors: Sabiha Sahin, Kursad Bora Carman, Coskun Yarar

Abstract:

Introduction: Measuring the diameter of the optic nerve sheath is a noninvasive and easy to use imaging technique to predict intracranial pressure in children and adults. The aim was to measure the diameter of the optic nerve sheath in pediatric head trauma. Methods: The study group consisted of 40 children with healthy and 40 patients with head trauma. Transorbital sonographic measurement of the optic nerve sheath diameter was performed. Conclusion: The mean diameters of the optic nerve sheath of right and left eyes were 0.408 ± 0.064 mm and 0.417 ± 0.065 mm, respectively, in the trauma group. These results were higher in patients than in control group. There was a negative correlation between optic nerve sheath diameters and Glasgow Coma Scales in patients with head trauma (p < 0.05). There was a positive correlation between optic nerve sheath diameters and positive CT findings, systolic blood pressure in patients with head trauma. The clinical status of the patients at admission, blood pH and lactate level were related to the optic nerve sheath diameter. Conclusion: Measuring the diameter of the optic nerve sheath is not an invasive technique and can be easily used to predict increased intracranial pressure and to prevent secondary brain injury.

Keywords: head trauma, intracranial pressure, optic nerve, sonography

Procedia PDF Downloads 150
1529 Management of Urological Complications Secondary to Uterine Fibroids

Authors: Dharshini Selvarajah, Karen Kong

Abstract:

Background: Uterine fibroids are a common benign gynaecologic neoplasm in reproductive-aged women. Fibroids may become symptomatic in a vast majority of nulliparous women. Their diagnosis and management are often coordinated between gyneacologists, radiologists and urologists depending on the anatomical location, growth, size and the fibroids' sarcomatous evolvement. Some patients may develop obstructive uropathy symptoms, either uni or bilateral secondary urethral obstruction causing hydronephrosis. Uterine artery embolization (UAE) has previously been shown to effectively resolve symptoms as well as relieve urethral obstruction and resolve hydronephrosis. UAE has now established itself as an organ-preserving and minimally invasive procedure in the management of symptomatic uterine fibroids. It is a safe and effective alternative to hysterectomy for resolving fibroid-related pressure symptoms. The case presented examines the clinical manifestations and impact of uterine fibroids on the urinary tract system. The therapeutic options to relieve the urological symptoms as well as preserve fertility are explored and presented. Case: The case is a 29-year-old Nepalese female admitted to the hospital with recurrent urosepsis with multiresistant organisms. This was on a background of an enlarged uterus (measuring 17cm x11cm) with multiple subserosal, intramural and exophytic fibroids- causing external ureteric compression. She had bilateral ureteric stents in situ and required bilateral right and left nephrostomies during repeated episodes of urosepsis and bilateral ureteric obstruction. The left nephrostomy was removed a month prior to admission, and her most recent CT KUB demonstrated hypofunctioning ureteric stents with bilateral hydronephrosis. Options of hysterectomy versus uterine artery embolization (UAE) were extensively explored. The patient was keen to preserve fertility. Risks associated with UAE, such as the expulsion of the submucosal component of the fibroids and the possibilities of sepsis in the setting of ongoing ureteric colonisation were particularly high. The patient opted to trial UAE even though the risks of recurrent hospital admissions with urosepsis were going to be particularly high. In the event, the uterus fails to shrink adequately enough to relieve the obstructed ureters, a hysterectomy would inevitably be required in the future. Day 3 post-UAE the patient developed fevers, was hypotensive and tachycardic post-receiving prophylactic meropenem and fluconazole pre emoblisation. She was noted to have a CRP of 293 with the most recent urine culture during this time growing Candida albicans. The patient was recommenced on oral fluconazole and IV meropenum, with good effect. Her repeat renal tract ultrasound post-UAE showed ongoing marked left hydronephrosis relatively unchanged from the scan one month prior to the procedure; however, the right-sided hydronephrosis had resolved. The patient was discharged on a 2-week course of antibiotics. The patient will have a repeat renal tract ultrasound and MRI of the ureters to re-evaluate the degree of hydronephrosis and progress- this was unavailable at the time of abstract submission and will be presented at the conference. Conclusion: Fibroids are a common benign tumor of the uterus and can frequently impact the lower urinary system resulting in significant uropathy. They often enlarge and compress the urinary bladder, urethra and lower end of the ureters. The effectiveness of the UAE as a fertility-preserving option is described.

Keywords: uterine artery embolisation for fibroids, urological complications from fibroids, uropathy of fibroids, obstructive fibroid management

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1528 Contribution to the Study of Automatic Epileptiform Pattern Recognition in Long Term EEG Signals

Authors: Christine F. Boos, Fernando M. Azevedo

Abstract:

Electroencephalogram (EEG) is a record of the electrical activity of the brain that has many applications, such as monitoring alertness, coma and brain death; locating damaged areas of the brain after head injury, stroke and tumor; monitoring anesthesia depth; researching physiology and sleep disorders; researching epilepsy and localizing the seizure focus. Epilepsy is a chronic condition, or a group of diseases of high prevalence, still poorly explained by science and whose diagnosis is still predominantly clinical. The EEG recording is considered an important test for epilepsy investigation and its visual analysis is very often applied for clinical confirmation of epilepsy diagnosis. Moreover, this EEG analysis can also be used to help define the types of epileptic syndrome, determine epileptiform zone, assist in the planning of drug treatment and provide additional information about the feasibility of surgical intervention. In the context of diagnosis confirmation the analysis is made using long term EEG recordings with at least 24 hours long and acquired by a minimum of 24 electrodes in which the neurophysiologists perform a thorough visual evaluation of EEG screens in search of specific electrographic patterns called epileptiform discharges. Considering that the EEG screens usually display 10 seconds of the recording, the neurophysiologist has to evaluate 360 screens per hour of EEG or a minimum of 8,640 screens per long term EEG recording. Analyzing thousands of EEG screens in search patterns that have a maximum duration of 200 ms is a very time consuming, complex and exhaustive task. Because of this, over the years several studies have proposed automated methodologies that could facilitate the neurophysiologists’ task of identifying epileptiform discharges and a large number of methodologies used neural networks for the pattern classification. One of the differences between all of these methodologies is the type of input stimuli presented to the networks, i.e., how the EEG signal is introduced in the network. Five types of input stimuli have been commonly found in literature: raw EEG signal, morphological descriptors (i.e. parameters related to the signal’s morphology), Fast Fourier Transform (FFT) spectrum, Short-Time Fourier Transform (STFT) spectrograms and Wavelet Transform features. This study evaluates the application of these five types of input stimuli and compares the classification results of neural networks that were implemented using each of these inputs. The performance of using raw signal varied between 43 and 84% efficiency. The results of FFT spectrum and STFT spectrograms were quite similar with average efficiency being 73 and 77%, respectively. The efficiency of Wavelet Transform features varied between 57 and 81% while the descriptors presented efficiency values between 62 and 93%. After simulations we could observe that the best results were achieved when either morphological descriptors or Wavelet features were used as input stimuli.

Keywords: Artificial neural network, electroencephalogram signal, pattern recognition, signal processing

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1527 Common Orthodontic Indices and Classification in the United Kingdom

Authors: Ashwini Mohan, Haris Batley

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An orthodontic index is used to rate or categorise an individual’s occlusion using a numeric or alphanumeric score. Indexing of malocclusions and their correction is important in epidemiology, diagnosis, communication between clinicians as well as their patients and assessing treatment outcomes. Many useful indices have been put forward, but to the author’s best knowledge, no one method to this day appears to be equally suitable for the use of epidemiologists, public health program planners and clinicians. This article describes the common clinical orthodontic indices and classifications used in United Kingdom.

Keywords: classification, indices, orthodontics, validity

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1526 Brain Atrophy in Alzheimer's Patients

Authors: Tansa Nisan Gunerhan

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Dementia comes in different forms, including Alzheimer's disease. The most common dementia diagnosis among elderly individuals is Alzheimer's disease. On average, for patients with Alzheimer’s, life expectancy is around 4-8 years after the diagnosis; however, expectancy can go as high as twenty years or more, depending on the shrinkage of the brain. Normally, along with aging, the brain shrinks at some level but doesn’t lose a vast amount of neurons. However, Alzheimer's patients' neurons are destroyed rapidly; hence problems with loss of memory, communication, and other metabolic activities begin. The toxic changes in the brain affect the stability of the neurons. Beta-amyloid and tau are two proteins that are believed to play a role in the development of Alzheimer's disease through their toxic changes. Beta-amyloid is a protein that is produced in the brain and is normally broken down and removed from the body. However, in people with Alzheimer's disease, the production of beta-amyloid increases, and it begins to accumulate in the brain. These plaques are thought to disrupt communication between nerve cells and may contribute to the death of brain cells. Tau is a protein that helps to stabilize microtubules, which are essential for the transportation of nutrients and other substances within brain cells. In people with Alzheimer's disease, tau becomes abnormal and begins to accumulate inside brain cells, forming neurofibrillary tangles. These tangles disrupt the normal functioning of brain cells and may contribute to their death, forming amyloid plaques which are deposits of a protein called amyloid-beta that build up between nerve cells in the brain. The accumulation of amyloid plaques and neurofibrillary tangles in the brain is thought to contribute to the shrinkage of brain tissue. As the brain shrinks, the size of the brain may decrease, leading to a reduction in brain volume. Brain atrophy in Alzheimer's disease is often accompanied by changes in the structure and function of brain cells and the connections between them, leading to a decline in brain function. These toxic changes that accumulate can cause symptoms such as memory loss, difficulty with thinking and problem-solving, and changes in behavior and personality.

Keywords: Alzheimer, amyloid-beta, brain atrophy, neuron, shrinkage

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1525 Diagnostic Yield of CT PA and Value of Pre Test Assessments in Predicting the Probability of Pulmonary Embolism

Authors: Shanza Akram, Sameen Toor, Heba Harb Abu Alkass, Zainab Abdulsalam Altaha, Sara Taha Abdulla, Saleem Imran

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Acute pulmonary embolism (PE) is a common disease and can be fatal. The clinical presentation is variable and nonspecific, making accurate diagnosis difficult. Testing patients with suspected acute PE has increased dramatically. However, the overuse of some tests, particularly CT and D-dimer measurement, may not improve care while potentially leading to patient harm and unnecessary expense. CTPA is the investigation of choice for PE. Its easy availability, accuracy and ability to provide alternative diagnosis has lowered the threshold for performing it, resulting in its overuse. Guidelines have recommended the use of clinical pretest probability tools such as ‘Wells score’ to assess risk of suspected PE. Unfortunately, implementation of guidelines in clinical practice is inconsistent. This has led to low risk patients being subjected to unnecessary imaging, exposure to radiation and possible contrast related complications. Aim: To study the diagnostic yield of CT PA, clinical pretest probability of patients according to wells score and to determine whether or not there was an overuse of CTPA in our service. Methods: CT scans done on patients with suspected P.E in our hospital from 1st January 2014 to 31st December 2014 were retrospectively reviewed. Medical records were reviewed to study demographics, clinical presentation, final diagnosis, and to establish if Wells score and D-Dimer were used correctly in predicting the probability of PE and the need for subsequent CTPA. Results: 100 patients (51male) underwent CT PA in the time period. Mean age was 57 years (24-91 years). Majority of patients presented with shortness of breath (52%). Other presenting symptoms included chest pain 34%, palpitations 6%, collapse 5% and haemoptysis 5%. D Dimer test was done in 69%. Overall Wells score was low (<2) in 28 %, moderate (>2 - < 6) in 47% and high (> 6) in 15% of patients. Wells score was documented in medical notes of only 20% patients. PE was confirmed in 12% (8 male) patients. 4 had bilateral PE’s. In high-risk group (Wells > 6) (n=15), there were 5 diagnosed PEs. In moderate risk group (Wells >2 - < 6) (n=47), there were 6 and in low risk group (Wells <2) (n=28), one case of PE was confirmed. CT scans negative for PE showed pleural effusion in 30, Consolidation in 20, atelactasis in 15 and pulmonary nodule in 4 patients. 31 scans were completely normal. Conclusion: Yield of CT for pulmonary embolism was low in our cohort at 12%. A significant number of our patients who underwent CT PA had low Wells score. This suggests that CT PA is over utilized in our institution. Wells score was poorly documented in medical notes. CT-PA was able to detect alternative pulmonary abnormalities explaining the patient's clinical presentation. CT-PA requires concomitant pretest clinical probability assessment to be an effective diagnostic tool for confirming or excluding PE. . Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being considered. Combining Wells scores with clinical and laboratory assessment may reduce the need for CTPA.

Keywords: CT PA, D dimer, pulmonary embolism, wells score

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1524 Bilateral Thalamic Hypodense Lesions in Computing Tomography

Authors: Angelis P. Barlampas

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Purpose of Learning Objective: This case depicts the need for cooperation between the emergency department and the radiologist to achieve the best diagnostic result for the patient. The clinical picture must correlate well with the radiology report and when it does not, this is not necessarily someone’s fault. Careful interpretation and good knowledge of the limitations, advantages and disadvantages of each imaging procedure are essential for the final diagnostic goal. Methods or Background: A patient was brought to the emergency department by their relatives. He was suddenly confused and his mental status was altered. He hadn't any history of mental illness and was otherwise healthy. A computing tomography scan without contrast was done, but it was unremarkable. Because of high clinical suspicion of probable neurologic disease, he was admitted to the hospital. Results or Findings: Another T was done after 48 hours. It showed a hypodense region in both thalamic areas. Taking into account that the first CT was normal, but the initial clinical picture of the patient was alerting of something wrong, the repetitive CT exam is highly suggestive of a probable diagnosis of bilateral thalamic infractions. Differential diagnosis: Primary bilateral thalamic glioma, Wernicke encephalopathy, osmotic myelinolysis, Fabry disease, Wilson disease, Leigh disease, West Nile encephalitis, Greutzfeldt Jacob disease, top of the basilar syndrome, deep venous thrombosis, mild to moderate cerebral hypotension, posterior reversible encephalopathy syndrome, Neurofibromatosis type 1. Conclusion: As is the case of limitations for any imaging procedure, the same applies to CT. The acute ischemic attack can not depict on CT. A period of 24 to 48 hours has to elapse before any abnormality can be seen. So, despite the fact that there are no obvious findings of an ischemic episode, like paresis or imiparesis, one must be careful not to attribute the patient’s clinical signs to other conditions, such as toxic effects, metabolic disorders, psychiatric symptoms, etc. Further investigation with MRI or at least a repeated CT must be done.

Keywords: CNS, CT, thalamus, emergency department

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1523 Educational Data Mining: The Case of the Department of Mathematics and Computing in the Period 2009-2018

Authors: Mário Ernesto Sitoe, Orlando Zacarias

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University education is influenced by several factors that range from the adoption of strategies to strengthen the whole process to the academic performance improvement of the students themselves. This work uses data mining techniques to develop a predictive model to identify students with a tendency to evasion and retention. To this end, a database of real students’ data from the Department of University Admission (DAU) and the Department of Mathematics and Informatics (DMI) was used. The data comprised 388 undergraduate students admitted in the years 2009 to 2014. The Weka tool was used for model building, using three different techniques, namely: K-nearest neighbor, random forest, and logistic regression. To allow for training on multiple train-test splits, a cross-validation approach was employed with a varying number of folds. To reduce bias variance and improve the performance of the models, ensemble methods of Bagging and Stacking were used. After comparing the results obtained by the three classifiers, Logistic Regression using Bagging with seven folds obtained the best performance, showing results above 90% in all evaluated metrics: accuracy, rate of true positives, and precision. Retention is the most common tendency.

Keywords: evasion and retention, cross-validation, bagging, stacking

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1522 A Cross-Sectional Study of Parents’ Knowledge, Attitude, and Health-Seeking Behaviour Towards Childhood Tuberculosis during COVID-19 Pandemic: Lessons Learned from Indonesia

Authors: Windy Rakhmawati, Suryani Suryani, Sri Hendrawati, Nenden Nur Asriyani Maryam

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Tuberculosis (TB) is one of the leading causes of death in the world. Fear of COVID-19 has made people reluctant to visit health facilities, leading to disruptions to childhood TB control programs, which may increase household transmission and delay diagnosis and treatment. This study aimed to describe parents' knowledge, attitudes, and health-seeking behaviour towards childhood TB during the COVID-19 pandemic. This cross-sectional study was performed on 392 parents with TB children in three provinces with the highest proportion of TB cases in Indonesia. This study was conducted from February to December 2022. The inclusion criteria of respondents were parents with a child aged 0-14 years old with TB diagnosis who live with their parents. Data were collected using the Knowledge, Attitude, and Practice (KAP) survey guidelines from the World Health Organization and analyzed descriptively, as well as Spearman’s correlation. Overall, 392 parents of children with TB had poor knowledge (51.8%) including about causes, risk factors, transmission, symptoms, treatment, and prevention, which about 52.3%, 55.1%, 61.2%, 69.6%, 100%, 59.2%, respectively. Parents' health service-seeking behaviour towards Child TB was not normally distributed (P < 0.05) with knowledge test results (.000) and Seeking Health Services (.000). Health-seeking behaviour of parents in pediatric TB care was self-medication or self-treatment (86.2%), Traditional health seeking behaviour (4.8%), and modern health seeking behaviour (8.9%). The correlation between knowledge and seeking health services (Sig= .609) means there is no correlation between knowledge about TB and parents' health-seeking behaviour. Furthermore, 60.2% of the respondents would be shocked if their child had TB. More than half of the families in this study have poor knowledge and did self-medication or self-treatment regarding health-seeking behaviour for TB disease. Therefore, health workers, especially nurses, must provide TB-related education and health promotion and emphasize the importance of early detection. Health workers can also optimize their role in caring for and providing care to patients by increasing their trust in health workers, which will impact health-seeking behaviour in the future.

Keywords: attitude, child, health seeking behaviour, knowledge, tuberculosis

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1521 Use of Giant Magneto Resistance Sensors to Detect Micron to Submicron Biologic Objects

Authors: Manon Giraud, Francois-Damien Delapierre, Guenaelle Jasmin-Lebras, Cecile Feraudet-Tarisse, Stephanie Simon, Claude Fermon

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Early diagnosis or detection of harmful substances at low level is a growing field of high interest. The ideal test should be cheap, easy to use, quick, reliable, specific, and with very low detection limit. Combining the high specificity of antibodies-functionalized magnetic beads used to immune-capture biologic objects and the high sensitivity of a GMR-based sensors, it is possible to even detect these biologic objects one by one, such as a cancerous cell, a bacteria or a disease biomarker. The simplicity of the detection process makes its use possible even for untrained staff. Giant Magneto Resistance (GMR) is a recently discovered effect consisting in the electrical resistance modification of some conductive layers when exposed to a magnetic field. This effect allows the detection of very low variations of magnetic field (typically a few tens of nanoTesla). Magnetic nanobeads coated with antibodies targeting the analytes are mixed with a biological sample (blood, saliva) and incubated for 45 min. Then the mixture is injected in a very simple microfluidic chip and circulates above a GMR sensor that detects changes in the surrounding magnetic field. Magnetic particles do not create a field sufficient to be detected. Therefore, only the biological objects surrounded by several antibodies-functionalized magnetic beads (that have been captured by the complementary antigens) are detected when they move above the sensor. Proof of concept has been carried out on NS1 mouse cancerous cells diluted in PBS which have been bonded to magnetic 200nm particles. Signals were detected in cells-containing samples while none were recorded for negative controls. Binary response was hence assessed for this first biological model. The precise quantification of the analytes and its detection in highly diluted solution is the step now in progress.

Keywords: early diagnosis, giant magnetoresistance, lab-on-a-chip, submicron particle

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1520 Restless Leg Syndrome as the Presenting Symptom of Neuroendocrine Tumor

Authors: Mustafa Cam, Nedim Ongun, Ufuk Kutluana

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Introduction: Restless LegsSyndrome (RLS) is a common, under-recognized disorder disrupts sleep and diminishes quality of life (1). The most common conditions highly associated with RLS include renalfailure, iron and folic acid deficiency, peripheral neuropathy, pregnancy, celiacdisease, Crohn’sdiseaseandrarelymalignancy (2).Despite a clear relation between low peripheral iron and increased prevalence and severity of RLS, the prevalence and clinical significance of RLS in iron-deficientanemic populations is unknown (2). We report here a case of RLS due to iron deficiency in the setting of neuroendocrinetumor. Report of Case: A 35 year-old man was referred to our clinic with general weakness, weight loss (10 kg in 2 months)and 2-month history of uncomfortable sensations in his legs with urge to move, partially relieved by movement. The symptoms were presented very day, worsening in the evening; the discomfort forced the patient to getup and walk around at night. RLS was severe, with a score of 22 at the International RLS ratingscale. The patient had no past medical history. The patient underwent a complete set of blood analyses and the following ab normal values were found (normal limitswithinbrackets): hemoglobin 9.9 g/dl (14-18), MCV 70 fL (80-94), ferritin 3,5 ng/mL (13-150). Brain and spinemagnetic resonance imaging was normal. The patient consultated with gastroenterology clinic and gastointestinal systemendoscopy was performed for theetiology of the iron deficiency anemia. After the gastricbiopsy, results allowed us to reach the diagnosis of neuroen docrine tumor and the patient referred to oncology clinic. Discussion: The first important consideration from this case report is that the patient was referred to our clinic because of his severe RLS symptoms dramatically reducing his quality of life. However, our clinical study clearly demonstrated that RLS was not the primary disease. Considering the information available for this patient, we believe that the most likely possibility is that RLS was secondary to iron deficiency, a very well-known and established cause of RLS in theliterature (3,4). Neuroendocrine tumors (NETs) are rare epithelial neoplasms with neuroendocrine differentiation that most commonly originate in the lungs and gastrointestinal tract (5). NETs vary widely in their clinical presentation; symptoms are often nonspecific and can be mistaken for those of other more common conditions (6). 50% of patients with reported disease stage have either regional or distant metastases at diagnosis (7). Accurate and earlier NET diagnosis is the first step in shortening the time to optimal care and improved outcomes for patients (8). The most important message from this case report is that RLS symptoms can sometimes be thesign of a life-threatening condition. Conclusion: Careful and complete collection of clinical and laboratory data should be carried out in RLS patients. Inparticular, if RLS onset coincides with weight loss and iron deficieny anemia, gastricendos copy should be performed. It is known about that malignancy is a rare etiology in RLS patients and to our knowledge; it is the first case with neuro endocrine tumor presenting with RLS.

Keywords: neurology, neuroendocrine tumor, restless legs syndrome, sleep

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1519 The Challenges Faced in Learning English as a Second Language in Sri Lanka: A Case Study of Ordinary Level Students in Kurunegala District

Authors: H. L. M. Fawzan

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Undoubtedly, learning English as a second language (ESL) is considered a challenging task. It is more difficult for students in far-away districts when compared with the students in the capital cities, where learning resources are easily available and where the environment is conducive to learning. Thus, this study is an analysis of the challenges faced by learners in learning English as the second language within kurunegala district in Sri Lanka. Even though various efforts have been taken by the Sri Lankan Educationalists for improving the situation of English language teaching for the past few decades, a disappointing situation still exist in the achievements of English learning among Sri Lankan students. So, it is necessary to explore real reasons behind the poor achievements of the students in the English Language. It is also an attempt to highlight what can be done to improve the situation significantly. Kurunegala is far away from the capital city of Sri Lanka and is a densely populated district. In the year 2020, state university admission was 45.87% from the Kurunegala district (Department of Examinations). The researcher strived to examine some of the likely challenges faced when teaching English in secondary schools in Kurunegala. The data was collected using a questionnaire from 35 students from schools within the Kurunegala education division. The result of the study reveals that students were highly motivated to learn English for their prospects and expectations such as local and international communication, academic advancement, and employment prospects.

Keywords: english, teaching, Kurunegala, Sri Lanka, challenges

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1518 Attenuation of Amyloid beta (Aβ) (1-42)-Induced Neurotoxicity by Luteolin

Authors: Dona Pamoda W. Jayatunga, Veer Bala Gupta, Eugene Hone, Ralph N. Martins

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Being a neurodegenerative disorder, Alzheimer’s disease (AD) affects a majority of the elderly demented worldwide. The key risk factors for AD are age, metabolic syndrome, allele status of APOE gene, head injuries and lifestyle. The progressive nature of AD is characterized by symptoms of multiple cognitive deficits exacerbated over time, leading to death within a decade from clinical diagnosis. However, it is revealed that AD originates via a prodromal phase that spans from one to few decades before symptoms first manifest. The key pathological hallmarks of AD brains are deposition of amyloid beta (Aβ) plaques and neurofibrillary tangles (NFT). However, the yet unknown etiology of the disease fails to distinguish mitochondrial dysfunction between a cause or an outcome. The absence of early diagnosis tools and definite therapies for AD have permitted recruits of nutraceutical-based approaches aimed at reducing the risk of AD by modulating lifestyle or be used as preventive tools during AD prodromal state before widespread neurodegeneration begins. The objective of the present study was to investigate beneficial effects of luteolin, a plant-based flavone compound, against AD. The neuroprotective effects of luteolin on amyloid beta (Aβ) (1-42)-induced neurotoxicity was measured using cultured human neuroblastoma BE(2)-M17 cells. After exposure to 20μM Aβ (1-42) for 48 h, the neuroblastoma cells exhibited marked apoptotic death. Co-treatment of 20μM Aβ (1-42) with luteolin (0.5-5μM) significantly protected the cells against Aβ (1-42)-induced toxicity, as assessed by the MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2(4sulfophenyl)-2H-tetrazolium, inner salt; MTS] reduction assay and the lactate dehydrogenase (LDH) cell death assay. The results suggest that luteolin prevents Aβ (1-42)-induced apoptotic neuronal death. However, further studies are underway to determine its protective mechanisms in AD including the activity against tau hyperphosphorylation and mitochondrial dysfunction.

Keywords: Aβ (1-42)-induced toxicity, Alzheimer’s disease, luteolin, neuroblastoma cells

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