Search results for: mixed viral infection
3487 Determination of the CCR5Δ32 Frequency in Emiratis and Tunisians and Screening of the CCR5 Gene for Novel Alleles in Emiratis
Authors: Sara A. Al-Jaberi, Salma Ben-Salem, Meriam Messedi, Fatma Ayadi, Lihadh Al-Gazali, Bassam R. Ali
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Background: The chemokine receptor components play crucial roles in the immune system and some of them serve as co-receptors for the HIV virus. Several studies have documented those variants in chemokine receptors are correlated with susceptibility and resistance to infection with HIV virus. For example, mutations in the chemokine receptor 5 gene (CCR5) resulting in loss-of-function (such as the homozygous CCR5Δ32) confer high degree of resistance to HIV infection. Heterozygotes for these variants exhibit slow progression to AIDS. The prevalence of CCR5 polymorphisms varies among ethnic and geographical groups. For example, the CCR5 Δ32 variant is present in 10–15% of north Europeans but is rarely encountered among Africans. This study aims to identify the prevalence of some CCR5 variants in two geographically distant Arab populations (namely Emiratis and Tunisians). Methodology: The prevalence of CCR5 gene variants including CCR5Δ32, FS299, C101X, A29S and C178R has been determined using PCR and direct DNA sequencing. A total of 403 unrelated healthy individuals (253 Emiratis and 150 Tunisians) were genotyped for the CCR5Δ32 variant using PCR amplification and gel electrophoresis. In addition, 200 Emiratis have been screened for other SNPs using Sanger DNA sequencing. Results: Among Emiratis, the allele frequency of the CCR5Δ32 variant has been found to be 0.002. In addition, two variants L55Q and A159 were found at a frequency of 0.002.Moreover, the prevalence of the CCR5Δ32 variant in Tunisians was estimated to be 0.013 which is relatively higher than its frequency in Emiratis but lower than Europeans. Conclusion: We conclude that the allele frequency of the most critical CCR5 polymorphism (Δ32) is extremely low among Emiratis compared to other Arabs and North Europeans. In addition, very low allele frequencies of other CCR5 polymorphisms have been detected among Emiratis.Keywords: chemokine receptors, CCR5Δ32, CCR5 polymorphisms, Emiratis, Arab populations
Procedia PDF Downloads 3803486 Understanding Community’s Perception and Willingness to Accept Fortified Foods: An Exploratory Mixed-Method Study in Sudan
Authors: Sara Bashir, Arthur Pagiwa, Merlyn Chapfunga, Ali Ahmad Khan, Gugulethu Moyo, Osman Hassan
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Micronutrient malnutrition (MNM) is a persistent health issue in Sudan, where food fortification (FF) has the potential to improve nutritional intake. However, community acceptance and understanding are critical to the success of fortification programs. This study aimed to explore community perspectives on food fortification in Sudan, assessing knowledge, acceptability, and misconceptions. Using a mixed-methods design, an online survey was conducted through social media, gathering responses from 1,118 participants from various demographic backgrounds. Approximately half of the respondents were not aware of what FF entails and there were prevalent misconceptions about FF, perceived health benefits, and acceptance influenced by individual beliefs and circumstances. The results highlight a considerable gap in understanding the purpose and benefits of FF, despite general awareness. This study underscores the need for targeted educational campaigns to address misconceptions and promote acceptance, with attention to gender and age-specific perspectives. Furthermore, the findings provide valuable insights for policymakers aiming to implement effective, culturally-sensitive FF initiatives and awareness campaigns in Sudan.Keywords: food fortification, malnutrition, micronutrients, Sudan
Procedia PDF Downloads 123485 Analysis of Heat Transfer in a Closed Cavity Ventilated Inside
Authors: Benseghir Omar, Bahmed Mohamed
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In this work, we presented a numerical study of the phenomenon of heat transfer through the laminar, incompressible and steady mixed convection in a closed square cavity with the left vertical wall of the cavity is subjected to a warm temperature, while the right wall is considered to be cold. The horizontal walls are assumed adiabatic. The governing equations were discretized by finite volume method on a staggered mesh and the SIMPLER algorithm was used for the treatment of velocity-pressure coupling. The numerical simulations were performed for a wide range of Reynolds numbers 1, 10, 100, and 1000 numbers are equal to 0.01,0.1 Richardson, 0.5,1 and 10.The analysis of the results shows a flow bicellular (two cells), one is created by the speed of the fan placed in the inner cavity, one on the left is due to the difference between the temperatures right wall and the left wall. Knowledge of the intensity of each of these cells allowed us to get an original result. And the values obtained from each of Nuselt convection which allow to know the rate of heat transfer in the cavity.Finally we find that there is a significant influence on the position of the fan on the heat transfer (Nusselt evolution) for values of Reynolds studied and for low values of Richardson handed this influence is negligible for high values of the latter.Keywords: thermal transfer, mixed convection, square cavity, finite volume method
Procedia PDF Downloads 4333484 Effects of Different Fungicide In-Crop Treatments on Plant Health Status of Sunflower (Helianthus annuus L.)
Authors: F. Pal-Fam, S. Keszthelyi
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Phytosanitary condition of sunflower (Helianthus annuus L.) was endangered by several phytopathogenic agents, mainly microfungi, such as Sclerotinia sclerotiorum, Diaporthe helianthi, Plasmopara halstedtii, Macrophomina phaseolina and so on. There are more agrotechnical and chemical technologies against them, for instance, tolerant hybrids, crop rotations and eventually several in-crop chemical treatments. There are different fungicide treatment methods in sunflower in Hungarian agricultural practice in the quest of obtaining healthy and economic plant products. Besides, there are many choices of useable active ingredients in Hungarian sunflower protection. This study carried out into the examination of the effect of five different fungicide active substances (found on the market) and three different application modes (early; late; and early and late treatments) in a total number of 9 sample plots, 0.1 ha each other. Five successive vegetation periods have been investigated in long term, between 2013 and 2017. The treatments were: 1)untreated control; 2) boscalid and dimoxystrobin late treatment (July); 3) boscalid and dimoxystrobin early treatment (June); 4) picoxystrobin and cyproconazole early treatment; 5) picoxystrobin and cymoxanil and famoxadone early treatment; 6) picoxystrobin and cyproconazole early; cymoxanil and famoxadone late treatments; 7) picoxystrobin and cyproconazole early; picoxystrobin and cymoxanil and famoxadone late treatments; 8) trifloxystrobin and cyproconazole early treatment; and 9) trifloxystrobin and cyproconazole both early and late treatments. Due to the very different yearly weather conditions different phytopathogenic fungi were dominant in the particular years: Diaporthe and Alternaria in 2013; Alternaria and Sclerotinia in 2014 and 2015; Alternaria, Sclerotinia and Diaporthe in 2016; and Alternaria in 2017. As a result of treatments ‘infection frequency’ and ‘infestation rate’ showed a significant decrease compared to the control plot. There were no significant differences between the efficacies of the different fungicide mixes; all were almost the same effective against the phytopathogenic fungi. The most dangerous Sclerotinia infection was practically eliminated in all of the treatments. Among the single treatments, the late treatment realised in July was the less efficient, followed by the early treatments effectuated in June. The most efficient was the double treatments realised in both June and July, resulting 70-80% decrease of the infection frequency, respectively 75-90% decrease of the infestation rate, comparing with the control plot in the particular years. The lowest yield quantity was observed in the control plot, followed by the late single treatment. The yield of the early single treatments was higher, while the double treatments showed the highest yield quantities (18.3-22.5% higher than the control plot in particular years). In total, according to our five years investigation, the most effective application mode is the double in-crop treatment per vegetation time, which is reflected by the yield surplus.Keywords: fungicides, treatments, phytopathogens, sunflower
Procedia PDF Downloads 1423483 One-Way Electric Vehicle Carsharing in an Urban Area with Vehicle-To-Grid Option
Authors: Cem Isik Dogru, Salih Tekin, Kursad Derinkuyu
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Electric vehicle (EV) carsharing is an alternative method to tackle urban transportation problems. This method can be applied by several options. One of the options is the one-way carsharing, which allow an EV to be taken at a designated location and leaving it on another specified location customer desires. Although it may increase users’ satisfaction, the issues, namely, demand dissatisfaction, relocation of EVs and charging schedules, must be dealt with. Also, excessive electricity has to be stored in batteries of EVs. To cope with aforementioned issues, two-step mixed integer programming (MIP) model is proposed. In first step, the integer programming model is used to determine amount of electricity to be sold to the grid in terms of time periods for extra profit. Determined amounts are provided from the batteries of EVs. Also, this step works in day-ahead electricity markets with forecast of periodical electricity prices. In second step, other MIP model optimizes daily operations of one-way carsharing: charging-discharging schedules, relocation of EVs to serve more demand and renting to maximize the profit of EV fleet owner. Due to complexity of the models, heuristic methods are introduced to attain a feasible solution and different price information scenarios are compared.Keywords: electric vehicles, forecasting, mixed integer programming, one-way carsharing
Procedia PDF Downloads 1303482 Oral Antibiotics in Trans-Rectal Prostate Biopsy and Its Efficacy to Reduce Infectious Complications: Systematic Review
Authors: Mohand Yaghi, O. Kehinde
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Background: For the diagnosis of prostate cancer Trans-rectal prostate biopsy (TRPB) is used commonly, the procedure is associated with infective complications. There is evidence that antibiotics (ABx) decrease infective events after TRPB, but different regimens are used. Aim: To systematically review different regimens of prophylactic oral antibiotics in TRPB. Design: Medline, Embase, Clinical trials site, and Cochrane library were searched, experts were consulted about relevant studies. Randomized clinical trials (RCT) conducted in the last twenty years, which investigated different oral antibiotic regimens in TRPB, and compared their efficacy to reduce infectious complications were analyzed. Measurements: Primary outcomes were bacteriuria, urinary tract infection (UTI), fever, bacteremia, sepsis. Secondary outcomes were hospitalization rate, and the prevalence of ABx-resistant bacteria. Results: Nine trials were eligible with 3012 patients. Antibiotics prevented bacteriuria (3.5% vs. 9.88%), UTI (4.46% vs. 9.75%), and hospitalization (0.21% vs. 2.13%) significantly in comparison with placebo or no treatment. No significant difference was found in all outcomes of the review between the single dose regimen and the 3 days. The single dose regimen was as effective as the multiple dose except in Bacteriuria (6.75% vs. 3.25%), and the prevalence of ABx-resistant bacteria (1.57% vs. 0.27%). Quinolones reduced only UTI significantly in comparison with other antibiotics. Lastly, Ciprofloxacin is the best Quinolone to prevent UTI, and hospitalization. Conclusion: it is essential to prescribe prophylactic Antibiotics in TRPB. No conclusive evidence could be claimed about the superiority of the multiple or the 3 days regimens to the single dose regimen. Unexpectedly, ABx-resistant bacteria was identified more often in the single dose cohorts.Keywords: infection, prostate cancer, sepsis, TRPB
Procedia PDF Downloads 3683481 Navigating States of Emergency: A Preliminary Comparison of Online Public Reaction to COVID-19 and Monkeypox on Twitter
Authors: Antonia Egli, Theo Lynn, Pierangelo Rosati, Gary Sinclair
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The World Health Organization (WHO) defines vaccine hesitancy as the postponement or complete denial of vaccines and estimates a direct linkage to approximately 1.5 million avoidable deaths annually. This figure is not immune to public health developments, as has become evident since the global spread of COVID-19 from Wuhan, China in early 2020. Since then, the proliferation of influential, but oftentimes inaccurate, outdated, incomplete, or false vaccine-related information on social media has impacted hesitancy levels to a degree described by the WHO as an infodemic. The COVID-19 pandemic and related vaccine hesitancy levels have in 2022 resulted in the largest drop in childhood vaccinations of the 21st century, while the prevalence of online stigma towards vaccine hesitant consumers continues to grow. Simultaneously, a second disease has risen to global importance: Monkeypox is an infection originating from west and central Africa and, due to racially motivated online hate, was in August 2022 set to be renamed by the WHO. To better understand public reactions towards two viral infections that became global threats to public health no two years apart, this research examines user replies to threads published by the WHO on Twitter. Replies to two Tweets from the @WHO account declaring COVID-19 and Monkeypox as ‘public health emergencies of international concern’ on January 30, 2020, and July 23, 2022, are gathered using the Twitter application programming interface and user mention timeline endpoint. Research methodology is unique in its analysis of stigmatizing, racist, and hateful content shared on social media within the vaccine discourse over the course of two disease outbreaks. Three distinct analyses are conducted to provide insight into (i) the most prevalent topics and sub-topics among user reactions, (ii) changes in sentiment towards the spread of the two diseases, and (iii) the presence of stigma, racism, and online hate. Findings indicate an increase in hesitancy to accept further vaccines and social distancing measures, the presence of stigmatizing content aimed primarily at anti-vaccine cohorts and racially motivated abusive messages, and a prevalent fatigue towards disease-related news overall. This research provides value to non-profit organizations or government agencies associated with vaccines and vaccination programs in emphasizing the need for public health communication fitted to consumers' vaccine sentiments, levels of health information literacy, and degrees of trust towards public health institutions. Considering the importance of addressing fears among the vaccine hesitant, findings also illustrate the risk of alienation through stigmatization, lead future research in probing the relatively underexamined field of online, vaccine-related stigma, and discuss the potential effects of stigma towards vaccine hesitant Twitter users in their decisions to vaccinate.Keywords: social marketing, social media, public health communication, vaccines
Procedia PDF Downloads 1003480 Fabrication and Characterization of Transdermal Spray Using Film Forming Polymer
Authors: Paresh Patel, Harshit Patel
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Superficial fungal skin infection is among the most common skin disease. The drug administration through skin has received attention due to several advantages: Avoidance of significant pre-systemic metabolism, drug levels within the therapeutic window, drugs with short biological half-lives, decreased side effects, the non-invasive character, and very high acceptance.Keywords: transdermal spray, ketoconazole, Eudragit® RLPO, therapeutic window
Procedia PDF Downloads 3993479 Analyzing Extended Reality Technologies for Human Space Exploration
Authors: Morgan Kuligowski, Marientina Gotsis
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Extended reality (XR) technologies share an intertwined history with spaceflight and innovation. New advancements in XR technologies offer expanding possibilities to advance the future of human space exploration with increased crew autonomy. This paper seeks to identify implementation gaps between existing and proposed XR space applications to inform future mission planning. A review of virtual reality, augmented reality, and mixed reality technologies implemented aboard the International Space Station revealed a total of 16 flown investigations. A secondary set of ground-tested XR human spaceflight applications were systematically retrieved from literature sources. The two sets of XR technologies, those flown and those existing in the literature were analyzed to characterize application domains and device types. Comparisons between these groups revealed untapped application areas for XR to support crew psychological health, in-flight training, and extravehicular operations on future flights. To fill these roles, integrating XR technologies with advancements in biometric sensors and machine learning tools is expected to transform crew capabilities.Keywords: augmented reality, extended reality, international space station, mixed reality, virtual reality
Procedia PDF Downloads 2163478 An Approach for Estimation in Hierarchical Clustered Data Applicable to Rare Diseases
Authors: Daniel C. Bonzo
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Practical considerations lead to the use of unit of analysis within subjects, e.g., bleeding episodes or treatment-related adverse events, in rare disease settings. This is coupled with data augmentation techniques such as extrapolation to enlarge the subject base. In general, one can think about extrapolation of data as extending information and conclusions from one estimand to another estimand. This approach induces hierarchichal clustered data with varying cluster sizes. Extrapolation of clinical trial data is being accepted increasingly by regulatory agencies as a means of generating data in diverse situations during drug development process. Under certain circumstances, data can be extrapolated to a different population, a different but related indication, and different but similar product. We consider here the problem of estimation (point and interval) using a mixed-models approach under an extrapolation. It is proposed that estimators (point and interval) be constructed using weighting schemes for the clusters, e.g., equally weighted and with weights proportional to cluster size. Simulated data generated under varying scenarios are then used to evaluate the performance of this approach. In conclusion, the evaluation result showed that the approach is a useful means for improving statistical inference in rare disease settings and thus aids not only signal detection but risk-benefit evaluation as well.Keywords: clustered data, estimand, extrapolation, mixed model
Procedia PDF Downloads 1373477 Interactive Winding Geometry Design of Power Transformers
Authors: Paffrath Meinhard, Zhou Yayun, Guo Yiqing, Ertl Harald
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Winding geometry design is an important part of power transformer electrical design. Conventionally, the winding geometry is designed manually, which is a time-consuming job because it involves many iteration steps in order to meet all cost, manufacturing and electrical requirements. Here a method is presented which automatically generates the winding geometry for given user parameters and allows the user to interactively set and change parameters. To achieve this goal, the winding problem is transferred to a mixed integer nonlinear optimization problem. The relevant geometrical design parameters are defined as optimization variables. The cost and other requirements are modeled as constraints. For the solution, a stochastic ant colony optimization algorithm is applied. It is well-known, that an optimizer can get stuck in a local minimum. For the winding problem, we present efficient strategies to come out of local minima, furthermore a reduced variable search range helps to accelerate the solution process. Numerical examples show that the optimization result is delivered within seconds such that the user can interactively change the variable search area and constraints to improve the design.Keywords: ant colony optimization, mixed integer nonlinear programming, power transformer, winding design
Procedia PDF Downloads 3803476 A Case Report on Neonatal Conjunctivitis in Pugs
Authors: Maria L. G. Lourenco, Viviane Y. Hibaru, Keylla H. N. P. Pereira, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado
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Neonatal conjunctivitis, or ophthalmia, is an infection of the conjunctiva or cornea before opening the eyelids. It is believed that immunodeficiency contributes to the development of the condition. This study aims at reporting a case of ophthalmia neonatorum in a dog, in addition to its diagnosis and treatment. A litter of five pug neonates was admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, with complaints of ocular secretion. The neonates were five days old. The clinical examination revealed that three newborns presented swelling in the ocular region and a purulent secretion in the medial corner of the eye that was exerting pressure on the ocular globes, which are compatible with the description of this disease. The diagnosis was made based on the clinical signs and bacterial culture of the secretion, which revealed the presence of bacteria belonging to the genus Staphylococcus sp. The laboratory assays did not reveal any alterations. The treatment was instituted gently, opening the eyelids early and cleaning the purulent ocular secretion with saline solution. An ophthalmic ointment with retinol, amino acids, methionine, and chloramphenicol (Epitezan®) was prescribed four times a day for seven days. Blood plasma (2 mL/100 g) was administered subcutaneously because bacterial infections in neonates may represent a failure in the transference of passive immunity. A more thorough cleaning of the environment was also recommended. Neonatal conjunctivitis has a simple diagnosis and treatment. If not treated early, it can evolve to adherence of the eyelids to the cornea, ulceration, and perforation of the cornea. Therefore, the prognosis is favorable as long as the condition is diagnosed early, and the treatment is instituted quickly.Keywords: ophthalmia neonatorum, neonatal infection, puppy, newborn
Procedia PDF Downloads 1403475 Experimental Studies of the Response of Single Piles Under Torsional and Vertical Combined Loads in Contaminated Sand
Authors: Ahmed Mohamed Nasr, Waseim Ragab Azzam, Nada Osama Ramadan
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Contaminated soil can weaken the stability of buildings and infrastructure, posing serious risks to their structural integrity. Therefore, this study aims to understand how oil contamination affects the torsion behavior of model steel piles at different soil densities. This research is crucial for evaluating the structural integrity and stability of piles in oil-contaminated environments. Clean sand samples and heavy motor oil were mixed in amounts ranging from 0 to 6% of the soil's dry weight. The mixture was thoroughly mixed to ensure uniform distribution of the oil throughout the sandy soil for simulating the field conditions. In these investigations, the relative densities (Dr), pile slenderness ratio (Lp/Dp), oil content (O.C%), and contaminated sand layer thickness (LC) were all different. Also, the paper presents an analysis of piles that are loaded both vertically and torsionally. The findings demonstrated that the pre-applied torsion load led to a decrease in the vertical bearing ability of the pile. Also, at Dr = 80%, the ultimate vertical load under combined load at constant torsional load T = (1/3Tu, 2/3Tu, and Tu) in the cases of (Lc/Lp) = 0.5 and (Lp/Dp) =13.3 was found to be reduced by (1.48, 2.78, and 4.15%) less than piles under independent vertical load, respectively so it is crucial to consider the torsion load during pile design.Keywords: torsion-vertical load, oil-contaminated sand, twist angle, steel pile
Procedia PDF Downloads 733474 The Role of Cholesterol Oxidase of Mycobacterium tuberculosis in the Down-Regulation of TLR2-Signaling Pathway in Human Macrophages during Infection Process
Authors: Michal Kielbik, Izabela Szulc-Kielbik, Anna Brzostek, Jaroslaw Dziadek, Magdalena Klink
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The goal of many research groups in the world is to find new components that are important for survival of mycobacteria in the host cells. Mycobacterium tuberculosis (Mtb) possesses a number of enzymes degrading cholesterol that are considered to be an important factor for its survival and persistence in host macrophages. One of them - cholesterol oxidase (ChoD), although not being essential for cholesterol degradation, is discussed as a virulence compound, however its involvement in macrophages’ response to Mtb is still not sufficiently determined. The recognition of tubercle bacilli antigens by pathogen recognition receptors is crucial for the initiation of the host innate immune response. An important receptor that has been implicated in the recognition and/or uptake of Mtb is Toll-like receptor type 2 (TLR2). Engagement of TLR2 results in the activation and phosphorylation of intracellular signaling proteins including IRAK-1 and -4, TRAF-6, which in turn leads to the activation of target kinases and transcription factors responsible for bactericidal and pro-inflammatory response of macrophages. The aim of these studies was a detailed clarification of the role of Mtb cholesterol oxidase as a virulence factor affecting the TLR2 signaling pathway in human macrophages. As human macrophages the THP-1 differentiated cells were applied. The virulent wild-type Mtb strain (H37Rv), its mutant lacking a functional copy of gene encoding cholesterol oxidase (∆choD), as well as complimented strain (∆choD–choD) were used. We tested the impact of Mtb strains on the expression of TLR2-depended signaling proteins (mRNA level, cytosolic level and phosphorylation status). The cytokine and bactericidal response of THP-1 derived macrophages infected with Mtb strains in relation to TLR2 signaling pathway dependence was also determined. We found that during the 24-hours of infection process the wild-type and complemented Mtb significantly reduced the cytosolic level and phosphorylation status of IRAK-4 and TRAF-6 proteins in macrophages, that was not observed in the case of ΔchoD mutant. Decreasement of TLR2-dependent signaling proteins, induced by wild-type Mtb, was not dependent on the activity of proteasome. Blocking of TLR2 expression, before infection, effectively prevented the induced by wild-type strain reduction of cytosolic level and phosphorylation of IRAK-4. None of the strains affected the surface expression of TLR2. The mRNA level of IRAK-4 and TRAF-6 genes were significantly increased in macrophages 24 hours post-infection with either of tested strains. However, the impact of wild-type Mtb strain on both examined genes was significantly stronger than its ΔchoD mutant. We also found that wild-type strain stimulated macrophages to release high amount of immunosuppressive IL-10, accompanied by low amount of pro-inflammatory IL-8 and bactericidal nitric oxide in comparison to mutant lacking cholesterol oxidase. The influence of wild-type Mtb on this type of macrophages' response strongly dependent on fully active IRAK-1 and IRAK-4 signaling proteins. In conclusion, Mtb using cholesterol oxidase causes the over-activation of TLR2 signaling proteins leading to the reduction of their cytosolic level and activity resulting in the modulation of macrophages response to allow its intracellular survival. Supported by grant: 2014/15/B/NZ6/01565, National Science Center, PolandKeywords: Mycobacterium tuberculosis, cholesterol oxidase, macrophages, TLR2-dependent signaling pathway
Procedia PDF Downloads 4203473 Laying Hens' Feed Fortified with Pectin, Xanthan Gum and Guar Gum Aims to Reduce the Cholesterol in Muscle and Egg Yolk
Authors: Novia Dwi Prabandari, Diah Ayu Asmarani
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Soluble fiber can accelerate the metabolism of cholesterol. Pectin and gum has been used in the form of substance additive for material stabilizer and emulsifier. Pectin supplementation in laying hens can decimate the cholesterol content in egg yolk and muscle. Therefore, this laying hens’ feed is regular feed chickens enriched with soluble fiber (Pectin, Xanthan gum, and Guar gum) to produce eggs and muscle with lower cholesterol than usual.The ingredients are mixed in the ratio of concentrate 45%, corn flour 25%, soybean meal 20%, and extract of soluble fiber 10%. Once all the ingredients are mixed and then evaporated with temperature < 80 °C. Then put in the grinding machine resulting in a circular shape with holes 2-3 mm in diameter, after it dried up the water content in the feed is less than 14%. Eggs from laying hen with soluble fiber fortification feed intake will have lower cholesterol levels in eggs than regular feed. So even with the cholesterol content in the muscle, it is because chicken feed fortified with soluble fiber will accelerate the metabolism of cholesterol and cause cholesterol deposits in the chicken less. The use of this kind of laying hens feed is produce eggs with high protein content can be consumed more for people who have hypercholesterolemia.Keywords: pectin, xanthan gum, guar gum, laying hen, cholesterol
Procedia PDF Downloads 4443472 Prevalence, Antimicrobial Susceptibility Pattern and Associated Risk Factors for Salmonella Species and Escherichia Coli from Raw Meat at Butchery Houses in Mekelle, Tigray, Northern Ethiopia
Authors: Haftay Abraha Tadesse, Dawit Gebreegziabiher Hagos, Atsebaha Gebrekidan Kahsay, Mahumd Abdulkader
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Background: Salmonella species and Escherichia coli (E. coli) are important foodborne pathogens affecting humans and animals. They are among the most important causes of infection that are associated with the consumption of contaminated food. This study was aimed to determine the prevalence, antimicrobial susceptibility patterns and associated risk factors for Salmonella species and E. coli in raw meat from butchery houses of Mekelle, Northern Ethiopia. Method: A cross-sectional study was conducted from January to December 2019. Socio-demographic data and risk factors were collected using a predesigned questionnaire. Meat samples were collected aseptically from the butchery houses and transported using icebox to Mekelle University, College of Veterinary Sciences for the isolation and identification of Salmonella species and E. coli. Antimicrobial susceptibility patterns were determined using Kirby disc diffusion method. Data obtained were cleaned and entered into Statistical Package for the Social Sciences version 22 and logistic regression models with odds ratio were calculated. P-value < 0.05 was considered as statistically significant. Results: A total of 153 out of 384 (39.8%) of the meat specimens were found to be contaminated. The contamination of Salmonella species and E. coli were 15.6% (n=60) and 20.8%) (n=80), respectively. Mixed contamination (Salmonella species and E. coli) was observed in 13 (3.4 %) of the analyzed. Poor washing hands regularly (AOR = 8.37; 95% CI: 2.75-25.50) and not using gloves during meat handling (AOR=11. 28; 95% CI:(4.69 27.10) were associated with overall bacterial contamination. About 100% of the tested isolates were sensitive to ciprofloxacin, gentamicin, Co trimoxazole , sulphamethoxazole, ceftriaxone, and trimethoprim and ciprofloxacin, gentamicin, and norfloxacine of E. coli and Salmonella species, respectively, while the resistance of amoxyclav_amoxicillin and erythromycin were both isolated bacteria species. The overall multidrug resistance pattern for Salmonella and E. coli were 51.4% (n=19) and 31.8% (14), respectively. Conclusion: Of the 153 (153/384) contaminated raw meat, 60 (15.6%) and 80 (20.8%) were contaminated by Salmonella species and E. coli, respectively. Poor handwashing practice and not using glove during meat handling showed a significant association with bacterial contamination. Multidrug-resistant showed in Salmonella species, and E. coli were 19 (51.4%) and 14 (31.8%), respectively.Keywords: antimicrobial susceptibility test, butchery houses, E. coli, raw meat, salmonella species
Procedia PDF Downloads 1743471 Two Efficient Heuristic Algorithms for the Integrated Production Planning and Warehouse Layout Problem
Authors: Mohammad Pourmohammadi Fallah, Maziar Salahi
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In the literature, a mixed-integer linear programming model for the integrated production planning and warehouse layout problem is proposed. To solve the model, the authors proposed a Lagrangian relax-and-fix heuristic that takes a significant amount of time to stop with gaps above 5$\%$ for large-scale instances. Here, we present two heuristic algorithms to solve the problem. In the first one, we use a greedy approach by allocating warehouse locations with less reservation costs and also less transportation costs from the production area to locations and from locations to the output point to items with higher demands. Then a smaller model is solved. In the second heuristic, first, we sort items in descending order according to the fraction of the sum of the demands for that item in the time horizon plus the maximum demand for that item in the time horizon and the sum of all its demands in the time horizon. Then we categorize the sorted items into groups of 3, 4, or 5 and solve a small-scale optimization problem for each group, hoping to improve the solution of the first heuristic. Our preliminary numerical results show the effectiveness of the proposed heuristics.Keywords: capacitated lot-sizing, warehouse layout, mixed-integer linear programming, heuristics algorithm
Procedia PDF Downloads 1973470 Positivity of Pathogenic Leptospira in Pigs from Rural Communities on the Coast of Ecuador
Authors: Veronica Barragan, Ligia Luna, Maria Patricia Zambrano, Carlos Bulnes, Eduardo Diaz, Talima Pearson
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Leptospirosis impacts animal production and is responsible for important economic losses in the pig industry. Infection is associated with reproductive failures that lead to abortions, stillbirth, and perinatal mortality. The leptospira serogroups that have been traditionally linked to disease in pigs are Pomona, Australis, and Tarassovi. Unfortunately, knowledge about pig leptospirosis is biased towards infection in large-scale commercial farms from developed countries, where exposure is usually limited to host-specific serotypes. The aim of our study is to describe leptospirosis in pigs from rural communities located in the coast of Ecuador-South America, where leptospirosis is endemic. A particularity of these pigs is that, because they are usually raised in the backyard of their owner’s houses, exposure to other leptospira excreted by other animals is likely to occur. Therefore, we collected 420 kidney samples from pigs sacrificed at a local slaughterhouse, and Leptospira positivity was tested in all samples by amplifying the Lipl32 gen. Our results show pathogenic Leptospira positivity in 19.3% (81/420) of pigs. Microaglutination test was performed in 60 PCR positive samples with titers >1:100 in 17 pigs, titers of 1:50 in 28 pigs, and no MAT titers in 15 pigs even though Leptospira DNA was found in their kidneys. Interestingly, reacting serovars were very diverse, with 18.3% of pig sera reacting with two or more serovars. Additionally, serovar Canicola was found in 16.7% of pigs followed by Tarassovi (10%), Australis (6.7%), Pyogenes (5%), Icterohaemorrhageae (1.7%), and Grippotyphosa (1.7%). It is also important to highlight that most of the analyzed animals came from small-scale farms where pigs may be exposed to the pathogen by exposure to other domestic and peridomestic animals such as rats, dogs, horses, donkeys, and even wildlife. This would explain the finding of non-pig adapted Leptospira serovars such as Canicola, which is commonly reported in dogs.Keywords: Leptospira, Lipl32, peridomestic, pig, serovar
Procedia PDF Downloads 1393469 The New Insight about Interspecies Transmission of Iranian H9N2 Influenza Viruses from Avian to Human
Authors: Masoud Soltanialvar, Ali Bagherpour
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Documented cases of human infection with H9N2 avian influenza viruses, first detected in 1999 in Hong Kong and China, indicate that these viruses can be directly transmitted from birds to humans. In this study, we characterized the mutation in the Hemagglutinin (HA) genes and proteins that correlates with a shift in affinity of the Hemagglutinin (HA) protein from the “avian” type sialic receptors to the “human” type in 10 Iranian isolates. We delineated the genomes and receptor binding profile of HA gene of some field isolates and established their phylogenetic relationship to the other Asian H9N2 sub lineages. A total of 1200 tissue samples collected from 40 farms located in various states of Iran during 2008 – 2010 as part of a program to monitor Avian Influenza Viruses (AIV) infection. To determine the genetic relationship of Iranian viruses, the Hemagglutinin (HA) genes from ten isolates were amplified and sequenced (by RT-PCR method). Nucleotide sequences (orf) of the (HA) genes were used for phylogenetic tree construction. Deduced amino acid sequences showed the presence of L226 (234 in H9 numbering) in all ten Iranian isolates which indicates a preference to binding of α (2–6) sialic acid receptors, so these Iranian H9N2 viruses have the potential to infect human beings. These isolates showed high degree of homology with 2 human H9N2 isolates A/HK/1073/99, A/HK/1074/99. Phylogenetic analysis of showed that all the HA genes of the Iranian H9N2 viruses fall into a single group within a G1-like sublineage which had contributed as donor of six internal genes to H5N1 highly pathogenic avian influenza. The results of this study indicated that all Iranian viruses have the potential to emerge as highly pathogenic influenza virus, and considering the homology of these isolates with human H9N2 strains, it seems that the potential of these avian influenza isolates to infect human should not be overlooked.Keywords: influenza virus, hemagglutinin, neuraminidase, Iran
Procedia PDF Downloads 4493468 Distribution of Micro Silica Powder at a Ready Mixed Concrete
Authors: Kyong-Ku Yun, Dae-Ae Kim, Kyeo-Re Lee, Kyong Namkung, Seung-Yeon Han
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Micro silica is collected as a by-product of the silicon and ferrosilicon alloy production in electric arc furnace using highly pure quartz, wood chips, coke and the like. It consists of about 85% of silicon which has spherical particles with an average particle size of 150 μm. The bulk density of micro silica varies from 150 to 700kg/m^3 and the fineness ranges from 150,000 to 300,000cm^2/g. An amorphous structure with a high silicon oxide content of micro silica induces an active reaction with calcium hydroxide (Ca(OH)₂) generated by the cement hydrate of a large surface area (about 20 m^² / g), and they are also known to form calcium, silicate, hydrate conjugate (C-S-H). Micro silica tends to act as a filler because of the fine particles and the spherical shape. These particles do not get covered by water and they fit well in the space between the relatively rough cement grains which does not freely fluidize concrete. On the contrary, water demand increases since micro silica particles have a tendency to absorb water because of the large surface area. The overall effect of micro silica depends on the amount of micro silica added with other parameters in the water-(cement + micro silica) ratio, and the availability of superplasticizer. In this research, it was studied on cellular sprayed concrete. This method involves a direct re-production of ready mixed concrete into a high performance at a job site. It could reduce the cost of construction by an adding a cellular and a micro silica into a ready mixed concrete truck in a field. Also, micro silica which is difficult with mixing due to high fineness in the field can be added and dispersed in concrete by increasing the fluidity of ready mixed concrete through the surface activity of cellular. Increased air content is converged to a certain level of air content by spraying and it also produces high-performance concrete by remixing of powders in the process of spraying. As it does not use a field mixing equipment the cost of construction decrease and it can be constructed after installing special spray machine in a commercial pump car. Therefore, use of special equipment is minimized, providing economic feasibility through the utilization of existing equipment. This study was carried out to evaluate a highly reliable method of confirming dispersion through a high performance cellular sprayed concrete. A mixture of 25mm coarse aggregate and river sand was applied to the concrete. In addition, by applying silica fume and foam, silica fume dispersion is confirmed in accordance with foam mixing, and the mean and standard deviation is obtained. Then variation coefficient is calculated to finally evaluate the dispersion. Comparison and analysis of before and after spraying were conducted on the experiment variables of 21L, 35L foam for each 7%, 14% silica fume respectively. Taking foam and silica fume as variables, the experiment proceed. Casting a specimen for each variable, a five-day sample is taken from each specimen for EDS test. In this study, it was examined by an experiment materials, plan and mix design, test methods, and equipment, for the evaluation of dispersion in accordance with micro silica and foam.Keywords: micro silica, distribution, ready mixed concrete, foam
Procedia PDF Downloads 2203467 Human Leukocyte Antigen Class 1 Phenotype Distribution and Analysis in Persons from Central Uganda with Active Tuberculosis and Latent Mycobacterium tuberculosis Infection
Authors: Helen K. Buteme, Rebecca Axelsson-Robertson, Moses L. Joloba, Henry W. Boom, Gunilla Kallenius, Markus Maeurer
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Background: The Ugandan population is heavily affected by infectious diseases and Human leukocyte antigen (HLA) diversity plays a crucial role in the host-pathogen interaction and affects the rates of disease acquisition and outcome. The identification of HLA class 1 alleles and determining which alleles are associated with tuberculosis (TB) outcomes would help in screening individuals in TB endemic areas for susceptibility to TB and to predict resistance or progression to TB which would inevitably lead to better clinical management of TB. Aims: To be able to determine the HLA class 1 phenotype distribution in a Ugandan TB cohort and to establish the relationship between these phenotypes and active and latent TB. Methods: Blood samples were drawn from 32 HIV negative individuals with active TB and 45 HIV negative individuals with latent MTB infection. DNA was extracted from the blood samples and the DNA samples HLA typed by the polymerase chain reaction-sequence specific primer method. The allelic frequencies were determined by direct count. Results: HLA-A*02, A*01, A*74, A*30, B*15, B*58, C*07, C*03 and C*04 were the dominant phenotypes in this Ugandan cohort. There were differences in the distribution of HLA types between the individuals with active TB and the individuals with LTBI with only HLA-A*03 allele showing a statistically significant difference (p=0.0136). However, after FDR computation the corresponding q-value is above the expected proportion of false discoveries (q-value 0.2176). Key findings: We identified a number of HLA class I alleles in a population from Central Uganda which will enable us to carry out a functional characterization of CD8+ T-cell mediated immune responses to MTB. Our results also suggest that there may be a positive association between the HLA-A*03 allele and TB implying that individuals with the HLA-A*03 allele are at a higher risk of developing active TB.Keywords: HLA, phenotype, tuberculosis, Uganda
Procedia PDF Downloads 4053466 Absent Theaters: A Virtual Reconstruction from Memories
Authors: P. Castillo Muñoz, A. Lara Ramírez
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Absent Theaters is a project that virtually reconstructs three theaters that existed in the twentieth century, demolished in the city of Medellin, Colombia: Circo España, Bolívar, and Junín. Virtual reconstruction is used as an excuse to talk with those who lived in their childhood and youth cultural spaces that formed a whole generation. Around 100 people who witnessed these theaters were interviewed. The means used to perform the oral history work was the virtual reconstruction of the interior of the theaters that were presented to the interviewees through the Virtual Reality glasses. The voices of people between 60 and 103 years old were used to generate a transmission of knowledge to the new generations about the importance of theaters as essential places for the city, as spaces generating social relations and knowledge of other cultures. Oral stories about events, the historical and social context of the city, were mixed with archive images and animations of the architectural transformations of these places. Oral stories about events, the historical and social context of the city, were mixed with archive images and animations of the architectural transformations of these places, with the purpose of compiling a collective discourse around cultural activities, heritage, and memory of Medellin.Keywords: culture, heritage, oral history, theaters, virtual reality
Procedia PDF Downloads 1353465 Investigation of Dry Ice Mixed Novel Hybrid Lubri-Coolant in Sustainable Machining of Ti-6AL-4V Alloy: A Comparison of Experimental and Modelling
Authors: Muhammad Jamil, Ning He, Aqib Mashood Khan, Munish Kumar Gupta
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Ti-6Al-4V has numerous applications in the medical, automobile, and aerospace industries due to corrosion resistivity, structural stability, and chemical inertness to most fluids at room temperature. These peculiar characteristics are beneficial for their application and present formidable challenges during machining. Machining of Ti-6Al-4V produces an elevated cutting temperature above 1000oC at dry conditions. This accelerates tool wear and reduces product quality. Therefore, there is always a need to employ sustainable/effective coolant/lubricant when machining such alloy. In this study, Finite Element Modeling (FEM) and experimental analysis when cutting Ti-6Al-4V under a distinctly developed dry ice mixed hybrid lubri-coolant are presented. This study aims to model the milling process of Ti-6Al-4V under a proposed novel hybrid lubri-coolant using different cutting speeds and feed per tooth DEFORM® software package was used to conduct the FEM and the numerical model was experimentally validated. A comparison of experimental and simulation results showed a maximum error of no more than 6% for all experimental conditions. In a nutshell, it can be said that the proposed model is effective in predicting the machining temperature precisely.Keywords: friction coefficient, heat transfer, finite element modeling (FEM), milling Ti-6Al-4V
Procedia PDF Downloads 603464 Efficacy of Defender 2% WS (Tebuconazole) and Imidal 70 WS (Imidacloprid) to Control Damping-Off Diseases and Early Insect Pests in Sesame in Rain Fed Areas, Sudan
Authors: Anas Fadlelmula, Elsafi M. M. Ahmed
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The efficacy of Defender 2% WS (tebuconazole) and Imidal 70 WS (imidacloprid) to control damping-off diseases and early insect pests in sesame crop under rain fed conditions at Damazine and Gedarif areas was evaluated. Defender 2% WS with dosage rates 0.5, 0.75, 1.0 and 1.25 g/kg of seeds and Imidal 70 WS at 2.25, 3.0, and 3.75 g/ kg of seeds were tested singly and as a mixture during 2010/2011 and 2012/013. Sesame seeds treated with Defender at the rates of 0.5 g and 0.75 g/ kg of seeds gave a high significant increase in percent seedlings emergence (84% and 85%) respectively. Imidal 70 WS at rate of 3g/kg seed showed the least percent damaged leaves by sesame webworm (1.7%). However, the mixed Defender at rate 0.75g with Imidal at 3 g/kg seed, significantly gave a highest percentage of sesame seedling emergence (85.1%) and reduced the incidence of post-emergence damping off and percent damaged leaves to the least per cent (2.1% and 0.4% ) respectively, compared to other treatments. Consequently, the mixed treatment of 0.75 g of Defender + 3 g of Imidal improved the crop stand and significantly gave the highest yield (405.2 kg and 418.8 kg/fed) respectively in both sites compared to the other treatments.Keywords: seed dressers, damage, daming off, insects
Procedia PDF Downloads 2713463 Molecularly Imprinted Nanoparticles (MIP NPs) as Non-Animal Antibodies Substitutes for Detection of Viruses
Authors: Alessandro Poma, Kal Karim, Sergey Piletsky, Giuseppe Battaglia
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The recent increasing emergency threat to public health of infectious influenza diseases has prompted interest in the detection of avian influenza virus (AIV) H5N1 in humans as well as animals. A variety of technologies for diagnosing AIV infection have been developed. However, various disadvantages (costs, lengthy analyses, and need for high-containment facilities) make these methods less than ideal in their practical application. Molecularly Imprinted Polymeric Nanoparticles (MIP NPs) are suitable to overcome these limitations by having high affinity, selectivity, versatility, scalability and cost-effectiveness with the versatility of post-modification (labeling – fluorescent, magnetic, optical) opening the way to the potential introduction of improved diagnostic tests capable of providing rapid differential diagnosis. Here we present our first results in the production and testing of MIP NPs for the detection of AIV H5N1. Recent developments in the solid-phase synthesis of MIP NPs mean that for the first time a reliable supply of ‘soluble’ synthetic antibodies can be made available for testing as potential biological or diagnostic active molecules. The MIP NPs have the potential to detect viruses that are widely circulating in farm animals and indeed humans. Early and accurate identification of the infectious agent will expedite appropriate control measures. Thus, diagnosis at an early stage of infection of a herd or flock or individual maximizes the efficiency with which containment, prevention and possibly treatment strategies can be implemented. More importantly, substantiating the practicability’s of these novel reagents should lead to an initial reduction and eventually to a potential total replacement of animals, both large and small, to raise such specific serological materials.Keywords: influenza virus, molecular imprinting, nanoparticles, polymers
Procedia PDF Downloads 3633462 Efficiency of Pre-Treatment Methods for Biodiesel Production from Mixed Culture of Microalgae
Authors: Malith Premarathne, Shehan Bandara, Kaushalya G. Batawala, Thilini U. Ariyadasa
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The rapid depletion of fossil fuel supplies and the emission of carbon dioxide by their continued combustion have paved the way for increased production of carbon-neutral biodiesel from naturally occurring oil sources. The high biomass growth rate and lipid production of microalgae make it a viable source for biodiesel production compared to conventional feedstock. In Sri Lanka, the production of biodiesel by employing indigenous microalgae species is at its emerging stage. This work was an attempt to compare the various pre-treatment methods before extracting lipids such as autoclaving, microwaving and sonication. A mixed culture of microalgae predominantly consisting of Chlorella sp. was obtained from Beire Lake which is an algae rich, organically polluted water body located in Colombo, Sri Lanka. After each pre-treatment method, a standard solvent extraction using Bligh and Dyer’s method was used to compare the total lipid content in percentage dry weight (% dwt). The fatty acid profiles of the oils extracted with each pretreatment method were analyzed using gas chromatography-mass spectrometry (GC-MS). The properties of the biodiesels were predicted by Biodiesel Analyzer© Version 1.1, in order to compare with ASTM 6751-08 biodiesel standard.Keywords: biodiesel, lipid extraction, microalgae, pre-treatment
Procedia PDF Downloads 1803461 Application of Box-Behnken Response Surface Design for Optimization of Essential Oil Based Disinfectant on Mixed Species Biofilm
Authors: Anita Vidacs, Robert Rajko, Csaba Vagvolgyi, Judit Krisch
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With the optimization of a new disinfectant the number of tests could be decreased and the cost of processing too. Good sanitizers are eco-friendly and allow no resistance evolvement of bacteria. The essential oils (EOs) are natural antimicrobials, and most of them have the Generally Recognized As Safe (GRAS) status. In our study, the effect of the EOs cinnamon, marjoram, and thyme was investigated against mixed species bacterial biofilms of Escherichia coli, Listeria monocytogenes, Pseudomonas putida, and Staphylococcus aureus. The optimal concentration of EOs, disinfection time and level of pH were evaluated with the aid of Response Surface Box-Behnken Design (RSD) on 1 day and 7 days old biofilms on metal, plastic, and wood surfaces. The variable factors were in the range of 1-3 times of minimum bactericide concentration (MBC); 10-110 minutes acting time and 4.5- 7.5 pH. The optimized EO disinfectant was compared to industrial used chemicals (HC-DPE, Hypo). The natural based disinfectants were applicable; the acting time was below 30 minutes. EOs were able to eliminate the biofilm from the used surfaces except from wood. The disinfection effect of the EO based natural solutions was in most cases equivalent or better compared to chemical sanitizers used in food industry.Keywords: biofilm, Box-Behnken design, disinfectant, essential oil
Procedia PDF Downloads 2203460 Numinous Luminosity: A Mixed Methods Study of Mystical Light Experiences
Authors: J. R. Dinsmore, R. W. Hood
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Experiences of a divine or mystical light are frequently reported in religious/spiritual experiences today, most notably in the context of mystical and near-death experiences. Light of a transcendental nature and its experiences of it are also widely present and highly valued in many religious and mystical traditions. Despite the significance of this luminosity to the topic of religious experience, efforts to study the phenomenon empirically have been minimal and scattered. This mixed methods study developed and validated a questionnaire for the measurement of numinous luminosity experience and investigated the dimensions and effects of this novel construct using both quantitative and qualitative methodologies. A sequential explanatory design (participant selection model) was used, which involved a scale development phase, followed by a correlational study testing hypotheses about its effects on beliefs and well-being derived from the literature, and lastly, a phenomenological study of a sample selected from the correlational phase results. The outcomes of the study are a unified theoretical model of numinous luminosity experience across multiple experiential contexts, initial correlational findings regarding the possible mechanism of its reported positive transformational effects, and a valid and reliable instrument for its further empirical study.Keywords: religious experience, mystical experience, near-death experience, scale development, questionnaire, divine light, mystical light, mystical luminosity
Procedia PDF Downloads 963459 A Sensitive Uric Acid Electrochemical Sensing in Biofluids Based on Ni/Zn Hydroxide Nanocatalyst
Authors: Nathalia Florencia Barros Azeredo, Josué Martins Gonçalves, Pamela De Oliveira Rossini, Koiti Araki, Lucio Angnes
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This work demonstrates the electroanalysis of uric acid (UA) at very low working potential (0 V vs Ag/AgCl) directly in body fluids such as saliva and sweat using electrodes modified with mixed -Ni0.75Zn0.25(OH)2 nanoparticles exhibiting stable electrocatalytic responses from alkaline down to weakly acidic media (pH 14 to 3 range). These materials were prepared for the first time and fully characterized by TEM, XRD, and spectroscopic techniques. The electrochemical properties of the modified electrodes were evaluated in a fast and simple procedure for uric acid analyses based on cyclic voltammetry and chronoamperometry, pushing down the detection and quantification limits (respectively of 2.3*10-8 and 7.6*10-8 mol L-1) with good repeatability (RSD = 3.2% for 30 successive analyses pH 14). Finally, the possibility of real application was demonstrated upon realization of unexpectedly robust and sensitive modified FTO (fluorine doped tin oxide) glass and screen-printed sensors for measurement of uric acid directly in real saliva and sweat samples, with no significant interference of usual concentrations of ascorbic acid, acetaminophen, lactate and glucose present in those body fluids (Fig. 1).Keywords: nickel hydroxide, mixed catalyst, uric acid sensors, biofluids
Procedia PDF Downloads 1283458 Comprehensive Literature Review of the Humanistic Burden of Clostridium (Clostridiodes) difficile Infection
Authors: Caroline Seo, Jennifer Stephens, Kirstin H. Heinrich
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Background: Clostridiodes (formerly Clostridium) difficile infection (CDI) is an anaerobic, spore-forming bacterium with manifestations including diarrhea, pseudomembranous colitis and toxic megacolon. Despite general understanding that CDI may be associated with marked burden on patients’ health, there has been limited information available on the humanistic burden of CDI. The objective of this literature review was to summarize the published data on the humanistic burden of CDI globally, in order to better inform future research efforts and increase awareness of the patient perspective in this disease. Methods: A comprehensive literature review of the past 15 years (2002-2017) was conducted using MEDLINE, Embase and Cumulative Index of Nursing and Allied Health Literature. Additional searches were conducted from conference proceedings (2015-2017). Articles selected were studies specifically designed to examine the humanistic burden of illness associated with adult patients with CDI. Results: Of 3,325 articles or abstracts identified, 33 remained after screening and full text review. Sixty percent (60%) were published in 2016 or 2017. Data from the United States or Western Europe were most common. Data from Brazil, Canada, China and Spain also exist. Thirteen (13) studies used validated patient-reported outcomes instruments, mostly EQ-5D utility and SF-36 generic instruments. Three (3) studies used CDI-specific instruments (CDiff32, CDI-DaySyms). The burden of CDI impacts patients in multiple health-related quality of life (HRQOL) domains. SF-36 domains with the largest decrements compared to other GI diarrheal diseases (IBS-D and Crohn’s) were role physical, physical functioning, vitality, social functioning, and role emotional. Reported EQ-5D utilities for CDI ranged from 0.35-0.42 compared to 0.65 in Crohn’s and 0.72 in IBS-D. The majority of papers addressed physical functioning and mental health domains (67% for both). Across various studies patients reported weakness, lack of appetite, sleep disturbance, functional dependence, and decreased activities of daily lives due to the continuous diarrhea. Due to lack of control over this infection, CDI also impacts the psychological and emotional quality of life of the patients. Patients reported feelings of fear, anxiety, frustration, depression, and embarrassment. Additionally, the type of disease (primary vs. recurrent) may impact mental health. One study indicated that there is a decrement in SF-36 mental scores in patients with recurrent CDI, in comparison to patients with primary CDI. Other domains highlighted by these studies include pain (27%), social isolation (27%), vitality and fatigue (24%), self-care (9%), and caregiver burden (0%). Two studies addressed work productivity, with 1 of these studies reporting that CDI patients had the highest work productivity and activity impairment scores among the gastrointestinal diseases. No study specifically included caregiver self-report. However, 3 studies did provide mention of patients’ worry on how their diagnosis of CDI would impact family, caregivers, and/or friends. Conclusions: Despite being a serious public health issue there has been a paucity of research on the HRQOL among those with CDI. While progress is being made, gaps exist in understanding the burden on patients, caregivers, and families. Future research is warranted to aid understanding of the CDI patient perspective.Keywords: burden, Clostridiodes, difficile, humanistic, infection
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