Search results for: medical oxygen
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4791

Search results for: medical oxygen

3741 Operation and Management System of New Ahmadi Hospital Facility

Authors: Abdulrahman H. Alrashidi

Abstract:

Kuwait Oil Company provides health care services through Ahmadi hospital for oil sector employee and their families. Due to increasing number of entitled patients in Ahmadi hospital, the company starts health insurance option in 2010. In addition, a new Ahmadi hospital decided to build to accumulate all entitled patients. Operation and management of new Ahmadi hospital investigated in this research. In order to maintain the high quality of medical services and satisfaction rate among oil sector community and reducing the operation cost. Six operation and management options evaluated in order to implement in new Ahmadi hospital. Qualitative Risk assessment method used to investigate proposed options for operation and management of new Ahmadi hospital. Evaluation criteria consist of quality of medical services, operation cost and satisfaction rate among oil sector community. Results show that using the same operation and management system in existing Ahmadi hospital with new Ahmadi hospital will bring cost higher. This approach brings risk to KOC. Results from risk assessment show that partially operated new Ahmadi hospital is the best opportunity to meet the objectives of KOC’s medical group.

Keywords: Kuwait Oil Company, new Ahmadi hospital, operation and management, risk assessment

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3740 The Roles of Non-Codified Traditional Medicine in a Suburban Village in Kerala, India

Authors: Sachi Matsuoka

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This study aimed at implicating a current community health in South India focusing on a Vaidya, a non-codified traditional doctor, based on long-term field works. As the prevalence of colonic diseases is increasing in all over the world, it is needed to know the potential of non-codified medicines and how they can effectively take in a part in community health. Describing the people’s treatment seeking behaviours in a suburban village which is susceptible to modernization can give us a new insight for studying Indian medicines, that is included not only non-codified but also codified traditional ones, affected by global, national and local communities. Both qualitative and quantitative data were gathered via participatory fieldworks and open-ended interviews to a Vaidya and his 97 patients and 31 individuals who lived in a community near the Vaidya’s station. It was found that the community members seldom consulted the Vaidya while a number of patients outside the village (mainly from urban nearby area) daily visited the Vaidya. Thus, the role of the Vaidya as the community’ s primary health care provider had nearly disappeared. Nonetheless, the Vaidya was deeply respected as one of the community’ s leaders by its members because of the spiritual and financial support he provided to them. The reasons for choosing the Vaidya for the patients from urban area are characterized by several social factors of the patients such as their religious belief, seriousness, occupation and medical history. Meanwhile, not only the Vaidya but also other codified traditional medicines, e.g., Ayurveda, were less popular among the community members. It sounds paradoxical given that the traditional Indian medical system has been becoming popular as an alternative medicine in societies outside of India, such as in Europe. The community members who are less educated and engaged in religious activities in daily life preferred to allopathy, the biomedicine in Indian context. It is thus concluded that roles of non-codified medicine has changed depending on its cultural and social contexts, even though its medical system is not authorized by the government. Nowadays, traditional medical effectiveness is recognized as evidenced by scientific survey and the codified medical doctors treats diseases rather than people. However, this study implicated that people’s treatment seeking behaviors are likely based on the social context in which people live their lives even though evidenced based codified medicine is provided in their community.

Keywords: medical pluralism, non-codified medicine, south india, treatment-seeking behaviours

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3739 Anesthesia for Spinal Stabilization Using Neuromuscular Blocking Agents in Dog: Case Report

Authors: Agata Migdalska, Joanna Berczynska, Ewa Bieniek, Jacek Sterna

Abstract:

Muscle relaxation is considered important during general anesthesia for spine stabilization. In a presented case peripherally acting muscle relaxant was applied during general anesthesia for spine stabilization surgery. The patient was a dog, 11-years old, 26 kg, male, mix breed. Spine fracture was situated between Th13-L1-L2, probably due to the car accident. Preanesthetic physical examination revealed no sign underlying health issues. The dog was premedicated with midazolam 0.2 mg IM and butorphanol 2.4 mg IM. General anesthesia was induced with propofol IV. After the induction, the dog was intubated with an endotracheal tube and connected to an open-ended rebreathing system and maintained with the use of inhalation anesthesia with isoflurane in oxygen. 0,5 mg/ kg of rocuronium was given IV. Use of muscle relaxant was accompanied by an assessment of the degree of neuromuscular blockade by peripheral nerve stimulator. Electrodes were attached to the skin overlying at the peroneal nerve at the lateral cranial tibia. Four electrical pulses were applied to the nerve over a 2 second period. When satisfying nerve block was detected dog was prepared for the surgery. No further monitoring of the effectiveness of blockade was performed during surgery. Mechanical ventilation was kept during anesthesia. During surgery dog maintain stable, and no anesthesiological complication occur. Intraoperatively surgeon claimed that neuromuscular blockade results in a better approach to the spine and easier muscle manipulation which was helpful in order to see the fracture and replace bone fragments. Finally, euthanasia was performed intraoperatively as a result of vast myelomalacia process of the spinal cord. This prevented examination of the recovering process. Neuromuscular blocking agents act at the neuromuscular junction to provide profound muscle relaxation throughout the body. Muscle blocking agents are neither anesthetic nor analgesic; therefore inappropriately used may cause paralysis in fully conscious and feeling pain patient. They cause paralysis of all skeletal muscles, also diaphragm and intercostal muscles when given in higher doses. Intraoperative management includes maintaining stable physiological conditions, which involves adjusting hemodynamic parameters, ensuring proper ventilation, avoiding variations in temperature, maintain normal blood flow to promote proper oxygen exchange. Neuromuscular blocking agent can cause many side effects like residual paralysis, anaphylactic or anaphylactoid reactions, delayed recovery from anesthesia, histamine release, recurarization. Therefore reverse drug like neostigmine (with glikopyrolat) or edrofonium (with atropine) should be used in case of a life-threatening situation. Another useful drug is sugammadex, although the cost of this drug strongly limits its use. Muscle relaxant improves surgical conditions during spinal surgery, especially in heavily muscled individuals. They are also used to facilitate the replacement of dislocated joints as they improve conditions during fracture reduction. It is important to emphasize that in a patient with muscle weakness neuromuscular blocking agents may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. This should not appear in patients with recent spine fracture or luxation. Therefore it is believed that neuromuscular blockers could be useful during spine stabilization procedures.

Keywords: anesthesia, dog, neuromuscular block, spine surgery

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3738 N₂O₂ Salphen-Like Ligand and Its Pd(II), Ag(I) and Cu(II) Complexes as Potentially Anticancer Agents: Design, Synthesis, Antimicrobial, CT-DNA Binding and Molecular Docking

Authors: Laila H. Abdel-Rahman, Mohamed Shaker S. Adam, Ahmed M. Abu-Dief, Hanan El-Sayed Ahmed

Abstract:

In this investigation, Cu(II), Pd(II) and Ag(I) complexes with the tetra-dentate DSPH Schiff base ligand were synthesized. The DSPH Schiff base and its complexes were characterized by using different physicochemical and spectral analysis. The results revealed that the metal ions coordinated with DSPH ligand through azomethine nitrogen and phenolic oxygen. Cu(II), Pd(II) and Ag(I) complexes are present in a 1:1 molar ratio. Pd(II) and Ag(I) complexes have square planar geometries while, Cu(II) has a distorted octahedral (Oh) geometry. All investigated complexes are nonelectrolytes. The investigated compounds were tested against different strains of bacteria and fungi. Both prepared compounds showed good results of inhibition against the selected pathogenic microorganism. Moreover, the interaction of investigated complexes with CT-DNA was studied via various techniques and the binding modes are mainly intercalative and grooving modes. Operating Environment MOE package was used to do docking studies for the investigated complexes to explore the potential binding mode and energy. Furthermore, the growth inhibitory effect of the investigated compounds was examined on some cancer cells lines.

Keywords: tetradentate, antimicrobial, CT-DNA interaction, docking, anticancer

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3737 Diversity and Structure of Trichoptera Communities and Water Quality Variables in Streams, Northern Thailand

Authors: T. Prommi, P. Thamsenanupap

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The influence of physicochemical water quality parameters on the abundance and diversity of caddisfly larvae was studied in seven sampling stations in Mae Tao and Mae Ku watersheds, Mae Sot District, Tak Province, northern Thailand. The streams: MK2 and MK8 as reference site, and impacted streams (MT1-MT5) were sampled bi-monthly during July 2011 to May 2012. A total of 4,584 individual of caddisfly larvae belonging to 10 family and 17 genera were found. The larvae of family Hydropsychidae were the most abundance, followed by Philopotamidae, Odontoceridae, and Leptoceridae, respectively. The genus Cheumatopsyche, Hydropsyche, and Chimarra were the most abundance genera in this study. Results of CCA ordination showed the total dissolved solids, sulfate, water temperature, dissolved oxygen and pH were the most important physicochemical factors to affect distribution of caddisflies communities. Changes in the caddisfly fauna may indicate changes in physicochemical factors owing to agricultural pollution, urbanization, or other human activities. Results revealed that the order Trichoptera, identified to species or genus, can be potentially used to assess environmental water quality status in freshwater ecosystems.

Keywords: Caddisfly larvae, environmental variables, diversity, streams

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3736 Nanocharacterization of PIII Treated 7075 Aluminum Alloy

Authors: Bruno Bacci Fernandes, Stephan Mändl, Ataíde Ribeiro da Silva Junior, José Osvaldo Rossi, Mário Ueda

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Nitrogen implantation in aluminum and its alloys is acquainted for the difficulties in obtaining modified layers deeper than 200 nm. The present work addresses a new method to overcome such a problem; although, the coating with nitrogen and oxygen obtained by plasma immersion ion implantation (PIII) into a 7075 aluminum alloy surface was too shallow. This alloy is commonly used for structural parts in aerospace applications. Such a layer was characterized by secondary ion mass spectroscopy, electron microscopy, and nanoindentation experiments reciprocating wear tests. From the results, one can assume that the wear of this aluminum alloy starts presenting severe abrasive wear followed by an additional adhesive mechanism. PIII produced a slight difference, as shown in all characterizations carried out in this work. The results shown here can be used as the scientific basis for further nitrogen PIII experiments in aluminum alloys which have the goal to produce thicker modified layers or to improve their surface properties.

Keywords: aluminum alloys, plasma immersion ion implantation, tribological properties, hardness, nanofatigue

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3735 Biological Activity of Hibiscus sabdariffa Extract

Authors: Chanasit Chaocharoenphat

Abstract:

Hibiscus sabdariffa is a herbal plant that is commonly used for home remedies in Thailand. This study aims to determine the antioxidant activity of polyphenols, as oxidative stress plays a vital role in the development of cancer, and H. sabdariffa was used in this study. The total flavonoids content was determined using the aluminium chloride colourimetric method and expressed as quercetin equivalents (QE)/g and the antioxidant capacity of the flavonoids using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging capacity assays. The IC50 values of H. sabdariffa extract were 167.14 μg/mL ± 0.843 and 77.59 μg/mL ± 0.798, respectively. In the DPPH assay, vitamin C was used as a positive control, whereas Trolox was used as a positive control in the ABTS assay. To summarise, H. sabdariffa extract contains a high concentration of total flavonoids and exhibits potent antioxidant activity. However, additional antioxidant activity assays such as superoxide dismutase (SOD), reactive oxygen species (ROS), and reactive nitrogen species (RNS) scavenging assays and in vitro antioxidant experiments should be carried out to investigate the molecular mechanism of the compound.

Keywords: ABTS assay, antioxidant activity, Gracilaria fisheri, DPPH assays, total flavonoid content

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3734 Hypoxia Tolerance, Longevity and Cancer-Resistance in the Mole Rat Spalax – a Liver Transcriptomics Approach

Authors: Hanno Schmidt, Assaf Malik, Anne Bicker, Gesa Poetzsch, Aaron Avivi, Imad Shams, Thomas Hankeln

Abstract:

The blind subterranean mole rat Spalax shows a remarkable tolerance to hypoxia, cancer-resistance and longevity. Unravelling the genomic basis of these adaptations will be important for biomedical applications. RNA-Seq gene expression data were obtained from normoxic and hypoxic Spalax and rat liver tissue. Hypoxic Spalax broadly downregulates genes from major liver function pathways. This energy-saving response is likely a crucial adaptation to low oxygen levels. In contrast, the hypoxiasensitive rat shows massive upregulation of energy metabolism genes. Candidate genes with plausible connections to the mole rat’s phenotype, such as important key genes related to hypoxia-tolerance, DNA damage repair, tumourigenesis and ageing, are substantially higher expressed in Spalax than in rat. Comparative liver transcriptomics highlights the importance of molecular adaptations at the gene regulatory level in Spalax and pinpoints a variety of starting points for subsequent functional studies.

Keywords: cancer, hypoxia, longevity, transcriptomics

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3733 The Missing Link in Holistic Health Care: Value-Based Medicine in Entrustable Professional Activities for Doctor-Patient Relationship

Authors: Ling-Lang Huang

Abstract:

Background: The holistic health care should ideally cover physical, mental, spiritual, and social aspects of a patient. With very constrained time in current clinical practice system, medical decisions often tip the balance in favor of evidence-based medicine (EBM) in comparison to patient's personal values. Even in the era of competence-based medical education (CBME), when scrutinizing the items of entrustable professional activities (EPAs), we found that EPAs of establishing doctor-patient relationship remained incomplete or even missing. This phenomenon prompted us to raise this project aiming at advocating value-based medicine (VBM), which emphasizes the importance of patient’s values in medical decisions. A true and effective doctor-patient communication and relationship should be a well-balanced harmony of EBM and VBM. By constructing VBM into current EPAs, we can further promote genuine shared decision making (SDM) and fix the missing link in holistic health care. Methods: In this project, we are going to find out EPA elements crucial for establishing an ideal doctor-patient relationship through three distinct pairs of doctor-patient relationships: patients with pulmonary arterial hypertension (relatively young but with grave disease), patients undergoing surgery (facing critical medical decisions), and patients with terminal diseases (facing forthcoming death). We’ll search for important EPA elements through the following steps: 1. Narrative approach to delineate patients’ values among 2. distinct groups. 3.Hermeneutics-based interview: semi-structured interview will be conducted for both patients and physicians, followed by qualitative analysis of collected information by compiling, disassembling, reassembling, interpreting, and concluding. 4. Preliminarily construct those VBM elements into EPAs for doctor-patient relationships in 3 groups. Expected Outcomes: The results of this project are going to give us invaluable information regarding the impact of patients’ values, while facing different medical situations, on the final medical decision. The competence of well-blending and -balanced both values from patients and evidence from clinical sciences is the missing link in holistic health care and should be established in future EPAs to enhance an effective SDM.

Keywords: value-based medicine, shared decision making, entrustable professional activities, holistic health care

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3732 Biosynthesis of a Nanoparticle-Antibody Phthalocyanine Photosensitizer for Use in Targeted Photodynamic Therapy of Cervical Cancer

Authors: Elvin P. Chizenga, Heidi Abrahamse

Abstract:

Cancer cell resistance to therapy is the main cause of treatment failures and the poor prognosis of cancer convalescence. The progression of cervical cancer to other parts of the genitourinary system and the reported recurrence rates are overwhelming. Current treatments, including surgery, chemo and radiation have been inefficient in eradicating the tumor cells. These treatments are also associated with poor prognosis and reduced quality of life, including fertility loss. This has inspired the need for the development of new treatment modalities to eradicate cervical cancer successfully. Photodynamic Therapy (PDT) is a modern treatment modality that induces cell death by photochemical interactions of light and a photosensitizer, which in the presence of molecular oxygen, yields a set of chemical reactions that generate Reactive Oxygen Species (ROS) and other free radical species causing cell damage. Enhancing PDT using modified drug delivery can increase the concentration of the photosensitizer in the tumor cells, and this has the potential to maximize its therapeutic efficacy. In cervical cancer, all infected cells constitutively express genes of the E6 and E7 HPV viral oncoproteins, resulting in high concentrations of E6 and E7 in the cytoplasm. This provides an opportunity for active targeting of cervical cancer cells using immune-mediated drug delivery to maximize therapeutic efficacy. The use of nanoparticles in PDT has also proven effective in enhancing therapeutic efficacy. Gold nanoparticles (AuNps) in particular, are explored for their use in biomedicine due to their biocompatibility, low toxicity, and enhancement of drug uptake by tumor cells. In this present study, a biomolecule comprising of AuNPs, anti-E6 monoclonal antibodies, and Aluminium Phthalocyanine photosensitizer was synthesized for use in targeted PDT of cervical cancer. The AuNp-Anti-E6-Sulfonated Aluminium Phthalocyanine mix (AlPcSmix) photosensitizing biomolecule was synthesized by coupling AuNps and anti-E6 monoclonal antibodies to the AlPcSmix via Polyethylene Glycol (PEG) chemical links. The final product was characterized using Transmission Electron Microscope (TEM), Zeta Potential, Uv-Vis Spectrophotometry, Fourier Transform Infrared Spectroscopy (FTIR), and X-ray diffraction (XRD), to confirm its chemical structure and functionality. To observe its therapeutic role in treating cervical cancer, cervical cancer cells, HeLa cells were seeded in 3.4 cm² diameter culture dishes at a concentration of 5x10⁵ cells/ml, in vitro. The cells were treated with varying concentrations of the photosensitizing biomolecule and irradiated using a 673.2 nm wavelength of laser light. Post irradiation cellular responses were performed to observe changes in morphology, viability, proliferation, cytotoxicity, and cell death pathways induced. Dose-Dependent response of the cells to treatment was demonstrated as significant morphologic changes, increased cytotoxicity, and decreased cell viability and proliferation This study presented a synthetic biomolecule for targeted PDT of cervical cancer. The study suggested that PDT using this AuNp- Anti-E6- AlPcSmix photosensitizing biomolecule is a very effective treatment method for the eradication of cervical cancer cells, in vitro. Further studies in vivo need to be conducted to support the use of this biomolecule in treating cervical cancer in clinical settings.

Keywords: anti-E6 monoclonal antibody, cervical cancer, gold nanoparticles, photodynamic therapy

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3731 Knowledge, Attitude and Practice of Anemia among Females Attending Bolan Medical Complex Quetta, Balochistan

Authors: A. Abdullah, N. ul Haq, A. Nasim

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Objectives: This study was aimed to assess the knowledge, attitude, and practice of anemia among females attending Bolan Medical Complex Quetta, Balochistan. Methods: A quantitative cross-sectional study by adopting a questionnaire containing 3 dimensions knowledge (15 questions), Attitude (5 questions), and Practice (4 questions) for the assessment of knowledge, attitude and practice of anemia among females was conducted. All females attending Bolan Medical Complex Quetta, Balochistan were approached for the study. Descriptive statistics were used to describe demographic and KAP related characteristics of the females regarding anemia.All data were analyzed by using SPSS (Statistical Package of Social Sciences) software program version 20.0. Results: Data was collected from six hundred and thirteen (613) participants. Majority of the respondents (n=180, 29.4%) were categorized in the age group of 29-33 years. Participants had knowledge regarding anemia was (n= 564, 91.9%), and attitude was (n= 516, 84.0%) whereas practice was (n=437, 71.3%). Multitative analysis revealed the negative correlation between Attitude-practice (P= -0.040) and a significant figure (0.001) was present between knowledge-attitude. Occupation and reason of diagnosis were not predictive of better KAP. Conclusions: Knowledge, attitude, and practice of Anemia shows a satisfactory response in this study. Furthermore, study finding implicates the need for health promotion among females. Improving nutritional knowledge and information related Anemia can result in better control and management.

Keywords: anemia, knowledge attitude and practice, females, college

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3730 Development of a Thermodynamic Model for Ladle Metallurgy Steel Making Processes Using Factsage and Its Macro Facility

Authors: Prasenjit Singha, Ajay Kumar Shukla

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To produce high-quality steel in larger volumes, dynamic control of composition and temperature throughout the process is essential. In this paper, we developed a mass transfer model based on thermodynamics to simulate the ladle metallurgy steel-making process using FactSage and its macro facility. The overall heat and mass transfer processes consist of one equilibrium chamber, two non-equilibrium chambers, and one adiabatic reactor. The flow of material, as well as heat transfer, occurs across four interconnected unit chambers and a reactor. We used the macro programming facility of FactSage™ software to understand the thermochemical model of the secondary steel making process. In our model, we varied the oxygen content during the process and studied their effect on the composition of the final hot metal and slag. The model has been validated with respect to the plant data for the steel composition, which is similar to the ladle metallurgy steel-making process in the industry. The resulting composition profile serves as a guiding tool to optimize the process of ladle metallurgy in steel-making industries.

Keywords: desulphurization, degassing, factsage, reactor

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3729 Efficacy and Safety of Sublingual Sufentanil for the Management of Acute Pain

Authors: Neil Singla, Derek Muse, Karen DiDonato, Pamela Palmer

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Introduction: Pain is the most common reason people visit emergency rooms. Studies indicate however, that Emergency Department (ED) physicians often do not provide adequate analgesia to their patients as a result of gender and age bias, opiophobia and insufficient knowledge of and formal training in acute pain management. Novel classes of analgesics have recently been introduced, but many patients suffer from acute pain in settings where the availability of intravenous (IV) access may be limited, so there remains a clinical need for rapid-acting, potent analgesics that do not require an invasive route of delivery. A sublingual sufentanil tablet (SST), dispensed using a single-dose applicator, is in development for treatment of moderate-to-severe acute pain in a medically-supervised setting. Objective: The primary objective of this study was to demonstrate the repeat-dose efficacy, safety and tolerability of sufentanil 20 mcg and 30 mcg sublingual tablets compared to placebo for the management of acute pain as determined by the time-weighted sum of pain intensity differences (SPID) to baseline over the 12-hour study period (SPID12). Key secondary efficacy variables included SPID over the first hour (SPID1), Total pain relief over the 12-hour study period (TOTPAR12), time to perceived pain relief (PR) and time to meaningful PR. Safety variables consisted of adverse events (AE), vital signs, oxygen saturation and early termination. Methods: In this Phase 2, double-blind, dose-finding study, an equal number of male and female patients were randomly assigned in a 2:2:1 ratio to SST 20 mcg, SS 30 mcg or placebo, respectively, following bunionectomy. Study drug was dosed as needed, but not more frequently than hourly. Rescue medication was available as needed. The primary endpoint was the Summed Pain Intensity Difference to baseline over 12h (SPIDI2). Safety was assessed by continuous oxygen saturation monitoring and adverse event reporting. Results: 101 patients (51 Male/50 Female) were randomized, 100 received study treatment (intent-to-treat [ITT] population), and 91 completed the study. Reasons for early discontinuation were lack of efficacy (6), adverse events (2) and drug-dosing error (1). Mean age was 42.5 years. For the ITT population, SST 30 mcg was superior to placebo (p=0.003) for the SPID12. SPID12 scores in the active groups were superior for both male (ANOVA overall p-value =0.038) and female (ANOVA overall p-value=0.005) patients. Statistically significant differences in favour of sublingual sufentanil were also observed between the SST 30mcg and placebo group for SPID1(p<0.001), TOTPAR12(p=0.002), time to perceived PR (p=0.023) and time to meaningful PR (p=0.010). Nausea, vomiting and somnolence were more frequent in the sufentanil groups but there were no significant differences between treatment arms for the proportion of patients who prematurely terminated due to AE or inadequate analgesia. Conclusions: Sufentanil tablets dispensed sublingually using a single-dose applicator is in development for treatment of patients with moderate-to-severe acute pain in a medically-supervised setting where immediate IV access is limited. When administered sublingually, sufentanil’s pharmacokinetic profile and non-invasive delivery makes it a useful alternative to IM or IV dosing.

Keywords: acute pain, pain management, sublingual, sufentanil

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3728 A Model for Diagnosis and Prediction of Coronavirus Using Neural Network

Authors: Sajjad Baghernezhad

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Meta-heuristic and hybrid algorithms have high adeer in modeling medical problems. In this study, a neural network was used to predict covid-19 among high-risk and low-risk patients. This study was conducted to collect the applied method and its target population consisting of 550 high-risk and low-risk patients from the Kerman University of medical sciences medical center to predict the coronavirus. In this study, the memetic algorithm, which is a combination of a genetic algorithm and a local search algorithm, has been used to update the weights of the neural network and develop the accuracy of the neural network. The initial study showed that the accuracy of the neural network was 88%. After updating the weights, the memetic algorithm increased by 93%. For the proposed model, sensitivity, specificity, positive predictivity value, value/accuracy to 97.4, 92.3, 95.8, 96.2, and 0.918, respectively; for the genetic algorithm model, 87.05, 9.20 7, 89.45, 97.30 and 0.967 and for logistic regression model were 87.40, 95.20, 93.79, 0.87 and 0.916. Based on the findings of this study, neural network models have a lower error rate in the diagnosis of patients based on individual variables and vital signs compared to the regression model. The findings of this study can help planners and health care providers in signing programs and early diagnosis of COVID-19 or Corona.

Keywords: COVID-19, decision support technique, neural network, genetic algorithm, memetic algorithm

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3727 Coal Fly Ash Based Ceramic Membrane for Water Purification via Ultrafiltration

Authors: Obsi Terfasa, Bhanupriya Das, Shiao-Shing Chen

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Converting coal fly ash (CFA) waste into ceramic membranes presents a promising alternative to traditional disposal methods, offering potential economic and environmental advantages that warrant further investigation. This research focuses on the creation of ceramic membranes exclusively from CFA using a uniaxial compaction technique. The membranes' properties were examined through various analytical methods: Scanning Electron Microscopy (SEM) revealed a porous and flawless membrane surface, X-Ray Diffraction (XRD) identified mullite and quartz crystalline structures, and Fourier-Transform Infrared Spectroscopy (FTIR) characterized the membrane's functional groups. Thermogravimetric analysis (TGA) determined the ideal sintering temperature to be 800°C. To evaluate its separation capabilities, the synthesized membrane was tested on wastewater from denim jeans production at 0.2 bar pressure. The results were impressive, with 97.42% removal of Chemical Oxygen Demand (COD), 95% color elimination, and a pure water flux of 4.5 Lm⁻²h⁻¹bar⁻¹. These findings suggest that CFA, a byproduct of thermal power plants, can be effectively repurposed to produce ultrafiltration membranes suitable for various industrial purification and separations.

Keywords: wastewater treatment, separator, coal fly ash, ceramic membrane, ultrafiltration

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3726 Mobility of Metallic Trace Elements (MTE) in Water and Sediment of the Rivers: Case of Nil River, North-Eastern Algerian

Authors: S. Benessam, T. H. Debieche, S. Amiour, A. Chine, S. Khelili

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The metallic trace elements (MTE) are present in water and sediments of the rivers with weak concentrations. Several physicochemical parameters (Eh, pH and oxygen dissolved) and chemical processes (adsorption, absorption, complexation and precipitation) as well as nature of the sediments control their mobility. In order to determine the effect of these factors on the mobility of some MTE (Cd, Cr, Cu, Fe, Pb and Zn) in water of the rivers, a two-monthly monitoring of the physicochemical parameters and chemistry of water and sediments of the Nil wadi (Algeria) was carried out during the period from November 2013 to January 2015. The results show that each MTE has its own conditions of mobility and generally are very influence by the variations of the pH and Eh. Under the natural conditions, neutral pH with basic and medium oxidizing, only the lead presented in water with raised values, indicating its solubility in water and its salting out of the sediments. The other MTE present raised concentrations in the sediments, indicating their trapping by adsorption and/or chemical precipitation. The chemical form of each ETM was given by Eh-pH diagrams. The spatio-temporal monitoring of these ETM shows the effect of the rains, the dry periods and the rejects in the variation of their concentrations.

Keywords: chemistry, metallic trace elements, sediment, water

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3725 Fabrication and Characterization of Glass Nanofibers through Electrospinning of Silica Sol-Gel along with in situ Synthesis of Ag Nanoparticles

Authors: Mahsa Kangazian Kangazi, Ali Akbar Ghareh Aghaji, Majid Montazer

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Nowadays, silica nanofibers are highly regarded among the inorganic nanofibers due to the high reactivity and availability of silicon compounds in nature. Sol-gel process is required for electrospinning of silica nanofibers in which a metal alkoxide is hydrolyzed, and the viscosity is increased. In this study, silica nanofibers containing silver nanoparticles were synthesized and electrospun from a mixture of silica sol with an easy spinnable polymer (PVA) as an additive. The silica sol contains tetraethyl orthosilicate (TEOS), silver nitrate, distilled water, nitric acid, and ethanol. Nanofibers were formed through electrospinning setup. The nanofibers were calcinated to remove the solvent and additive polymer. Consequently, pure silica nanofibers were produced. FTIR analysis indicated entire removal of polyvinyl alcohol from the structure and formation of silan groups. The presence of silver, silica and oxygen was confirmed by EDX. Also, XRD patterns revealed the presence of silver nanoparticles with a mean crystal size of 18 nm. FESEM images showed that adding silver nitrate into the sol-gel, resulted in lower nanofibers diameter from 286 to 136 nm. Furthermore, the electrospun nanofibers were more resistance in acidic media than alkaline media.

Keywords: in situ synthesis of silver nanoparticles, silica nanofibers, sol-gel, tetraethyl orthosilicate

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3724 Polarization of Glass with Positive and Negative Charge Carriers

Authors: Valentina V. Zhurikhina, Mihail I. Petrov, Alexandra A. Rtischeva, Mark Dussauze, Thierry Cardinal, Andrey A. Lipovskii

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Polarization of glass, often referred to as thermal poling, is a well-known method to modify the glass physical and chemical properties, that manifest themselves in loosing central symmetry of the medium, glass structure and refractive index modification. The usage of the poling for second optical harmonic generation, fabrication of optical waveguides and electrooptic modulators was also reported. Nevertheless, the detailed description of the poling of glasses, containing multiple charge carriers is still under discussion. In particular, the role of possible migration of electrons in the space charge formation usually remains out of the question. In this work, we performed the numerical simulation of thermal poling of a silicate glass, containing Na, K, Mg, and Ca. We took into consideration the contribution of electrons in the polarization process. The possible explanation of migration of electrons can be the break of non-bridging oxygen bonds. It was found, that the modeled depth of the space charge region is about 10 times higher if the migration of the negative charges is taken under consideration. The simulated profiles of cations, participating in the polarization process, are in a good agreement with the experimental data, obtained by glow discharge spectroscopy.

Keywords: glass poling, charge transport, modeling, concentration profiles

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3723 Carbapenem Usage in Medical Wards: An Antibiotic Stewardship Feedback Project

Authors: Choon Seong Ng, P. Petrick, C. L. Lau

Abstract:

Background: Carbapenem-resistant isolates have been increasingly reported recently. Carbapenem stewardship is designed to optimize its usage particularly among medical wards with high prevalence of carbapenem prescriptions to combat such emerging resistance. Carbapenem stewardship programmes (CSP) can reduce antibiotic use but clinical outcome of such measures needs further evaluation. We examined this in a prospective manner using feedback mechanism. Methods: Our single-center prospective cohort study involved all carbapenem prescriptions across the medical wards (including medical patients admitted to intensive care unit) in a tertiary university hospital setting. The impact of such stewardship was analysed according to the accepted and the rejected groups. The primary endpoint was safety. Safety measure applied in this study was the death at 1 month. Secondary endpoints included length of hospitalisation and readmission. Results: Over the 19 months’ period, input from 144 carbapenem prescriptions was analysed on the basis of acceptance of our CSP recommendations on the use of carbapenems. Recommendations made were as follows : de-escalation of carbapenem; stopping the carbapenem; use for a short duration of 5-7 days; required prolonged duration in the case of carbapenem-sensitive Extended Spectrum Beta-Lactamases bacteremia; dose adjustment; and surgical intervention for removal of septic foci. De-escalation, shorten duration of carbapenem and carbapenem cessation comprised 79% of the recommendations. Acceptance rate was 57%. Those who accepted CSP recommendations had no increase in mortality (p = 0.92), had a shorter length of hospital stay (LOS) and had cost-saving. Infection-related deaths were found to be higher among those in the rejected group. Moreover, three rejected cases (6%) among all non-indicated cases (n = 50) were found to have developed carbapenem-resistant isolates. Lastly, Pitt’s bacteremia score appeared to be a key element affecting the carbapenem prescription’s behaviour in this trial. Conclusions: Carbapenem stewardship program in the medical wards not only saves money, but most importantly it is safe and does not harm the patients with added benefits of reducing the length of hospital stay. However, more time is needed to engage the primary clinical teams by formal clinical presentation and immediate personal feedback by senior Infectious Disease (ID) personnel to increase its acceptance.

Keywords: audit and feedback, carbapenem stewardship, medical wards, university hospital

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3722 Improving the Emergency Medicine Teaching from the Perspective of Faculty Training

Authors: Qin-Min Ge, Shu-Ming Pan

Abstract:

Emergency clinicians usually get teaching qualification after graduating from medical universities without special faculty training in China mainland. Emergency departments are overcrowded places, with large numbers of patients suffering undifferentiated illness. In the field of emergency medicine (EM), improving the faculty competencies and developing the teaching skills are important for medical education, they could enhance learners outcomes and hence affect the patients prognosis indirectly. This article highlights the necessities of faculty training in EM, illustrates the qualities a good clinical educator should qualify, advances the skills as educators in an academic setting and discusses the ways to be good clinical teachers.

Keywords: emergency education, competence, faculty training, teaching, emergency medicine

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3721 An Approach for Coagulant Dosage Optimization Using Soft Jar Test: A Case Study of Bangkhen Water Treatment Plant

Authors: Ninlawat Phuangchoke, Waraporn Viyanon, Setta Sasananan

Abstract:

The most important process of the water treatment plant process is the coagulation using alum and poly aluminum chloride (PACL), and the value of usage per day is a hundred thousand baht. Therefore, determining the dosage of alum and PACL are the most important factors to be prescribed. Water production is economical and valuable. This research applies an artificial neural network (ANN), which uses the Levenberg–Marquardt algorithm to create a mathematical model (Soft Jar Test) for prediction chemical dose used to coagulation such as alum and PACL, which input data consists of turbidity, pH, alkalinity, conductivity, and, oxygen consumption (OC) of Bangkhen water treatment plant (BKWTP) Metropolitan Waterworks Authority. The data collected from 1 January 2019 to 31 December 2019 cover changing seasons of Thailand. The input data of ANN is divided into three groups training set, test set, and validation set, which the best model performance with a coefficient of determination and mean absolute error of alum are 0.73, 3.18, and PACL is 0.59, 3.21 respectively.

Keywords: soft jar test, jar test, water treatment plant process, artificial neural network

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3720 Flame Spread along Fuel Cylinders in High Pressures

Authors: Yanli Zhao, Jian Chen, Shouxiang Lu

Abstract:

Flame spread over solid fuels in high pressure situations such as nuclear containment shells and hyperbaric oxygen chamber has potential to result in catastrophic disaster, thus requiring best knowledge. This paper reveals experimentally the flame spread behaviors over fuel cylinders in high pressures. The fuel used in this study is polyethylene and polymethyl methacrylate cylinders with 4mm diameter. Ambient gas is fixed as air and total pressures are varied from naturally normal pressure (100kPa) to elevated pressure (400kPa). Flame appearance, burning rate and flame spread were investigated experimentally and theoretically. Results show that high pressure significantly affects the flame appearance, which is as the pressure increases, flame color changes from luminous yellow to orange and the orange part extends down towards the base of flame. Besides, the average flame width and height, and the burning rate are proved to increase with increasing pressure. What is more, flame spread rates become higher as pressure increases due to the enhancement of heat transfer from flame to solid surface in elevated pressure by performing a simplified heat balance analysis.

Keywords: cylinder fuel, flame spread, heat transfer, high pressure

Procedia PDF Downloads 375
3719 Lipid-polymer Nanocarrier Platform Enables X-Ray Induced Photodynamic Therapy against Human Colorectal Cancer Cells

Authors: Rui Sang, Fei Deng, Alexander Engel, Ewa M. Goldys, Wei Deng

Abstract:

In this study, we brought together X-ray induced photodynamic therapy (X-PDT) and chemo-drug (5-FU) for the treatment on colorectal cancer cells. This was achieved by developing a lipid-polymer hybrid nanoparticle delivery system (FA-LPNPs-VP-5-FU). It was prepared by incorporating a photosensitizer (verteporfin), chemotherapy drug (5-FU), and a targeting moiety (folic acid) into one platform. The average size of these nanoparticles was around 100 nm with low polydispersity. When exposed to clinical doses of 4 Gy X-ray radiation, FA-LPNPs-VP-5-FU generated sufficient amounts of reactive oxygen species, triggering the apoptosis and necrosis pathway of cancer cells. Our combined X-PDT and chemo-drug strategy was effective in inhibiting cancer cells’ growth and proliferation. Cell cycle analyses revealed that our treatment induced G2/M and S phase arrest in HCT116 cells. Our results indicate that this combined treatment provides better antitumour effect in colorectal cancer cells than each of these modalities alone. This may offer a novel approach for effective colorectal cancer treatment with reduced off-target effect and drug toxicity.

Keywords: pdt, targeted lipid-polymer nanoparticles, verteporfin, colorectal cancer

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3718 Geotechnical Challenges for the Use of Sand-sludge Mixtures in Covers for the Rehabilitation of Acid-Generating Mine Sites

Authors: Mamert Mbonimpa, Ousseynou Kanteye, Élysée Tshibangu Ngabu, Rachid Amrou, Abdelkabir Maqsoud, Tikou Belem

Abstract:

The management of mine wastes (waste rocks and tailings) containing sulphide minerals such as pyrite and pyrrhotite represents the main environmental challenge for the mining industry. Indeed, acid mine drainage (AMD) can be generated when these wastes are exposed to water and air. AMD is characterized by low pH and high concentrations of heavy metals, which are toxic to plants, animals, and humans. It affects the quality of the ecosystem through water and soil pollution. Different techniques involving soil materials can be used to control AMD generation, including impermeable covers (compacted clays) and oxygen barriers. The latter group includes covers with capillary barrier effects (CCBE), a multilayered cover that include the moisture retention layer playing the role of an oxygen barrier. Once AMD is produced at a mine site, it must be treated so that the final effluent at the mine site complies with regulations and can be discharged into the environment. Active neutralization with lime is one of the treatment methods used. This treatment produces sludge that is usually stored in sedimentation ponds. Other sludge management alternatives have been examined in recent years, including sludge co-disposal with tailings or waste rocks, disposal in underground mine excavations, and storage in technical landfill sites. Considering the ability of AMD neutralization sludge to maintain an alkaline to neutral pH for decades or even centuries, due to the excess alkalinity induced by residual lime within the sludge, valorization of sludge in specific applications could be an interesting management option. If done efficiently, the reuse of sludge could free up storage ponds and thus reduce the environmental impact. It should be noted that mixtures of sludge and soils could potentially constitute usable materials in CCBE for the rehabilitation of acid-generating mine sites, while sludge alone is not suitable for this purpose. The high sludge water content (up to 300%), even after sedimentation, can, however, constitute a geotechnical challenge. Adding lime to the mixtures can reduce the water content and improve the geotechnical properties. The objective of this paper is to investigate the impact of the sludge content (30, 40 and 50%) in sand-sludge mixtures (SSM) on their hydrogeotechnical properties (compaction, shrinkage behaviour, saturated hydraulic conductivity, and water retention curve). The impact of lime addition (dosages from 2% to 6%) on the moisture content, dry density after compaction and saturated hydraulic conductivity of SSM was also investigated. Results showed that sludge adding to sand significantly improves the saturated hydraulic conductivity and water retention capacity, but the shrinkage increased with sludge content. The dry density after compaction of lime-treated SSM increases with the lime dosage but remains lower than the optimal dry density of the untreated mixtures. The saturated hydraulic conductivity of lime-treated SSM after 24 hours of cure decreases by 3 orders of magnitude. Considering the hydrogeotechnical properties obtained with these mixtures, it would be possible to design CCBE whose moisture retention layer is made of SSM. Physical laboratory models confirmed the performance of such CCBE.

Keywords: mine waste, AMD neutralization sludge, sand-sludge mixture, hydrogeotechnical properties, mine site reclamation, CCBE

Procedia PDF Downloads 47
3717 Chemical Composition and Insecticidal Activity of Three Essential Oil and Beauvericin Nanogel on Plodia Interpunctella (Lepidoptera: Pyralidae)

Authors: Magda Mahmoud Amin Sabbour, El-Sayed H. Shaurub

Abstract:

The Indian meal moth Plodia interpunctella (Hübner) (Lepidoptera: Pyralidae), of stored grain pests which destroy the seed completely. Their larval stages feed on the nutrient germinating kernels part found in the seeds grain. This leads to a reduction causing a badness to seed germination and seed viability. It controlled by many insecticides which pollute and cusses a harmful diseases to human being. Three tested oils were evaluated on this target pests. Plant extracts, essential oils and medical oils are materials which used to control many stored pests. Plant oils extracts have a lower effects on parasites and predators and not pollute the medium. By using the apparatus gas chromatography flame ionization detector gas chromatography–analysis of three essential oil tested. This research was point to explore and appreciation the activity of three oils and nano gel Beauvericin against P. interpunctella in the laboratory conditions and in the store conditions. The three essential oil tested proved that, percentage of α-Pinene recoded 7.76, 7.72 and 6.66 for C. cyminum, A. squamosal and G. officinale respectively. The composition of the β-Pinene recoded 4.61, 8.92 and 30.63 for the corresponding oils tested. Results showed that after analytically the oils tested, the effective compound of C. cyminum oil are p-cyinene and Terpinene. Results obtained show that the LC50 recorded 125, 112, 55 and 20 ppm after P. interpunctella treated with medical oils of Guaiacum officinale, Annona squamosa, Cuminum cyminum and Beauvericin 3% respectively. The accumulative mortality of P. interpunctella after treated with A.squamosa oil-loaded nanogels which showed that it is the highest oils from infestations recoded when the seed treated with 3% after 48 days, the accumulations obtained 44% at followed by 24 after24 days of storage. Results, cleared that the seed protection by G. officinale recorded 40% at concentrations of 3% after 48 days of storage seeds. C. cyminum was the highest mortality by 98, at concentrations 3%. The highest seed protection proved after C. cyminum oil-loaded nanogels 14% followed by G. officinale 29% and A.squamosa 44%.when the seeds treated with Beauvericin 3%. Results of this work cleared that the essential medical oils have a useful action effect on target insects. Plant essential and medical oils, their active ingredient have potentially high bioactivity against on P. interpunctella. The medical and essential oils incorporation and usage the nano-formulation release stopped the highly degradation vaporization and the increasing in the constancy, and save the lower effectiveness of the dosage/application. The research results proved that the highest seed protection obtained after C. cyminum oil-loaded nanogels followed by G. officinale and A.squamosa. It could be complemented that P. interpunctella were more susceptible to medical oils loaded nanogel (MOLNs ) than medical oils only (MO). MOLNs had best lower amount of the residual activity than MO only. MOLNs might mend the insecticidal action of the medical oil tested by the slow effective release of the medical oils to control P. interpunctella mostly at the lower doses.

Keywords: Cuminum cyminum, annona squamosa, guaiacum officinale, beauvericin 3 %, plodia interpunctella

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3716 Dietary Ergosan as a Supplemental Nutrient on Growth Performance, and Stress in Zebrafish (Danio Rerio)

Authors: Ehsan Ahmadifar, Mohammad Ali Yousefi, Zahra Roohi

Abstract:

In this study, the effects of different levels of Ergosan (control group (0), 2, 4 and 6 gr Ergosan per Kg diet) as a nutritional supplement were investigated on growth indices and stress in Zebrafish for 3 months. Larvae (4-day-old after hatching) were fed with experimental diet from the beginning of feeding until adult (adolescence) (average weight: 69.3 g, length: 5.1 cm). Different levels of Ergosan had no significant effect on rate survival (P < 0.05). The results showed that diet containing 6 gr Ergosan significantly caused the best FCR in Zebrafish (P < 0.05). By increasing the Ergosan diet, specific growth rate increased. Body weight gain and condition factor had significant differences (P < 0.05) as the highest and the lowest were observed in treatment 3 gr of Ergosan and control, respectively. The results showed that fish fed with experimental diet, had the highest resistance to environmental stresses compared to control, and the test temperature, oxygen, salinity and alkalinity samples containing 6 gr/kg, was significantly more resistance compared to the other treatments (P < 0.05). Overall, to achieve high resistance to environmental stress and increase final biomass using 6 gr/kg Ergosan in diet fish Zebrafish.

Keywords: Ergosan, stress, growth performance, Danio rerio

Procedia PDF Downloads 245
3715 Instability of H2-O2-CO2 Premixed Flames on Flat Burner

Authors: Kaewpradap Amornrat, Endo Takahiro, Kadowaki Satoshi

Abstract:

The combustion of hydrogen-oxygen (H2-O2) mixtures was investigated to consider the reduction of carbon dioxide (CO2) and nitrogen oxide (NOx) as the greenhouse emission. Normally, the flame speed of combustion H2-O2 mixtures are very fast thus it is necessary to control the limit of mixtures with CO2 addition as H2-O2-CO2 combustion. The limit of hydrogen was set and replaced by CO2 with O2:CO2 ratio as 1:3.76, 1:4 and 1:5 for this study. In this study, the combustion of H2-O2 -CO2 on flat burner at equivalence ratio =0.5 was investigated for 10, 15 and 20 L/min of flow rate mixtures. When the ratio of CO2 increases, the power spectral density is lower, the size of attractor and cellular flame become larger because the decrease of hydrogen replaced by CO2 affects the diffusive-thermal instability. Moreover, the flow rate mixtures increases, the power spectral density increases, the size of reconstructed attractor and cell size become smaller due to decreasing of instability. The results show that the variation of CO2 and mixture flow rate affects the instability of cellular premixed flames on flat burner.

Keywords: instability, H2-O2-CO2 combustion, flat burner, diffusive-thermal instability

Procedia PDF Downloads 357
3714 Mechanism of Charge Transport in the Interface of CsSnI₃-FASnI₃ Perovskite Based Solar Cell

Authors: Seyedeh Mozhgan Seyed-Talebi, Weng-Kent Chan, Hsin-Yi Tiffany Chen

Abstract:

Lead-free perovskite photovoltaic (PV) technology employing non-toxic tin halide perovskite absorbers is pivotal for advancing perovskite solar cell (PSC) commercialization. Despite challenges posed by perovskite sensitivity to oxygen and humidity, our study utilizes DFT calculations using VASP and NanoDCAL software and SCAPS-1D simulations to elucidate the charge transport mechanism at the interface of CsSnI₃-FASnI₃ heterojunction. Results reveal how inherent electric fields facilitate efficient carrier transport, reducing recombination losses. We predict optimized power conversion efficiencies (PCEs) and highlight the potential of CsSnI3-FASnI3 heterojunctions for cost-effective and efficient charge transport layer-free (CTLF) photovoltaic devices. Our study provides insights into the future direction of recognizing more efficient, nontoxic heterojunction perovskite devices.

Keywords: charge transport layer free, CsSnI₃-FASnI₃ heterojunction, lead-free perovskite solar cell, tin halide perovskite., Charge transport layer free

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3713 Development of an Aerosol Protection Capsule for Patients with COVID-19

Authors: Isomar Lima da Silva, Aristeu Jonatas Leite de Oliveira, Roberto Maia Augusto

Abstract:

Biological isolation capsules are equipment commonly used in the control and prevention of infectious diseases in the hospital environment. This type of equipment, combined with pre-established medical protocols, contributes significantly to the containment of highly transmissible pathogens such as COVID-19. Due to its hermetic isolation, it allows more excellent patient safety, protecting companions and the health team. In this context, this work presents the development, testing, and validation of a medical capsule to treat patients affected by COVID-19. To this end, requirements such as low cost and easy handling were considered to meet the demand of people infected with the virus in remote locations in the Amazon region and/or where there are no ICU beds and mechanical ventilators for orotracheal intubation. Conceived and developed in a partnership between SAMEL Planos de Saúde and Instituto Conecthus, the device entitled "Vanessa Capsule" was designed to be used together with the NIV protocol (non-invasive ventilation), has an automatic exhaust system and filters performing the CO2 exchange, in addition to having BiPaps ventilatory support equipment (mechanical fans) in the Cabin Kit. The results show that the degree of effectiveness in protecting against infection by aerosols, with the protection cabin, is satisfactory, implying the consideration of the Vanessa capsule as an auxiliary method to be evaluated by the health team. It should also be noted that the medical observation of the evaluated patients found that the treatment against the COVID-19 virus started earlier with non-invasive mechanical ventilation reduces the patient's suffering and contributes positively to their recovery, in association with isolation through the Vanessa capsule.

Keywords: COVID-19, mechanical ventilators, medical capsule, non-invasive ventilation

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3712 Management of First Trimester Miscarriage

Authors: Madeleine Cox

Abstract:

Objective; analyse patient choices in management of first trimester miscarriage, rates of complications including repeat procedure. Design: all first trimester miscarriages from a tertiary institution on the Gold Coast in a 6 month time frame (July to December 2021) were reviewed, including choice of management, histopathology, any representations or admissions, and potential complications. Results: a total of 224 first trimester miscarriages were identified. Of these, 183 (81%) opted to have surgical management in the first instance. Of the remaining patients, 18 (8%) opted to have medical management, and 28 (12.5%) opted to have expectant management. In total, 33(15%) patients required a repeat treatment for retained products. 1 had medical management for a small volume PROC post suction curette. A significant number of these patients initially opted for medical management but then elected to have shorter follow up than usual and went on to have retained products noted. 5 women who had small volumes of RPOC post medical or surgical management had repeat suction curette, however, had very small volumes of products on scan and on curette and may have had a good result with repeated misoprostol administration. It is important to note that whilst a common procedure, suction curettes are not without risk. 2 women had significant blood loss of 1L and 1.5L. A third women had a uterine perforation, a rare but recognised complication, she went on to require a laparoscopy which identified a small serosal bowel injury which was closed by the colorectal team. Conclusion: Management of first trimester miscarriage should be guided by patient preference. It is important to be able to provide patients with their choice of management, however, it is also important to have a good understanding of the risks of each management choice, chances of repeated procedure, appropriate time frame for follow up. Women who choose to undertake medical or expectant management should be supported through this time, with appropriate time frame between taking misoprostol and repeat scan so that the true effects can be evaluated. Patients returning for scans within 2-3 days are more likely to be booked for further surgery, however, may reflect patients who did not have adequate counselling or simply changed their mind on their preferred management options.

Keywords: miscarriage, gynaecology, obstetrics, first trimester

Procedia PDF Downloads 95