Search results for: complex pain
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6277

Search results for: complex pain

5137 Multi-Resistant Enterobacter Cloacae Dacryocystitis and Preseptal Cellulitis: Case and Review of Literature

Authors: Michael Kvopka, Ezekiel Kingston

Abstract:

A 61-year-old man with no significant past medical history presented to a quaternary ophthalmic referral center with acute right-sided medial canthal pain, periorbital edema, and erythema despite oral antibiotic therapy. CT imaging confirmed the presence of right preseptal cellulitis and lacrimal sac aspiration identified multi-resistant Enterobacter cloacae. A diagnosis of acute right-sided dacryocystitis with preseptal cellulitis was made. He was successfully treated with broadening of antibiotic therapy to intravenous meropenem. The symptomatic resolution was noted on follow-up without evidence of disease recurrence. To the Authors’ best knowledge, this is the first reported case of multi-resistant E. cloacae dacryocystitis and preseptal cellulitis. The management of this patient required a multi-disciplinary approach, so the Authors believe this report is relevant to general ophthalmologists and oculoplastic sub-specialists.

Keywords: enterobacter, dacryocystitis, preseptal cellulitis, antibiotic resistance

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5136 Long Waves Inundating through and around an Array of Circular Cylinders

Authors: Christian Klettner, Ian Eames, Tristan Robinson

Abstract:

Tsunami is characterised by their very long time periods and can have devastating consequences when these inundate through built-up coastal regions as in the 2004 Indian Ocean and 2011 Tohoku Tsunami. This work aims to investigate the effect of these long waves on the flow through and around a group of buildings, which are abstracted to circular cylinders. The research approach used in this study was using experiments and numerical simulations. Large-scale experiments were carried out at HR Wallingford. The novelty of these experiments is (I) the number of bodies present (up to 64), (II) the long wavelength of the input waves (80 seconds) and (III) the width of the tank (4m) which gives the unique opportunity to investigate three length scales, namely the diameter of the building, the diameter of the array and the width of the tank. To complement the experiments, dam break flow past the same arrays is investigated using three-dimensional numerical simulations in OpenFOAM. Dam break flow was chosen as it is often used as a surrogate for the tsunami in previous research and is used here as there are well defined initial conditions and high quality previous experimental data for the case of a single cylinder is available. The focus of this work is to better understand the effect of the solid void fraction on the force and flow through and around the array. New qualitative and quantitative diagnostics are developed and tested to analyse the complex coupled interaction between the cylinders.

Keywords: computational fluid dynamics, tsunami, forces, complex geometry

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5135 Psychosocial Factors in Relation to Musculoskeletal Disorders among Nursing Professionals in Kurdistan Region, Iraq

Authors: Karwan Khudhir

Abstract:

A cross-sectional study was carried out to determine the prevalence of musculoskeletal disorders (MSDs) and psychosocial factors associated with it, among Kurdistan nursing professionals. Simple random sampling was used to select 220 nurses and data were collected by self-administrative questionnaire. Results of the study showed that the overall prevalence of MSDs among Kurdistan nurses was 74% in different body regions and, by body regions, neck pain was reported to be the highest complaint of twelve-month MSDs (48.4%) compared to other body parts. Logistic regression analysis indicated 6 variables that are significantly associated with musculoskeletal disorders: smoking (OR=19.472, 95% CI: 5.396, 70.273), BMI (OR= 5.106, 95% CI: 1.735, 15.025), physical activity (OR=8.639, 95% CI: 3.075, 24.271), psychological demand (OR=6.685, 95% CI: 3.318, 13.468), social support (OR=3.143, 95% CI: 1.202, 4.814) and job satisfaction (OR=2.44, 95% CI: 1.04, 5.63). Prevention strategies and health education which emphasizes on psychosocial risk factors and how to improve working conditions should be introduced.

Keywords: Kurdistan Region, Iraq, musculoskeletal disorders, nurses, psycho-social factors

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5134 Association of Major Histocompatibility Complex Alleles with Antibody Response to Newcastle Vaccine in Chicken

Authors: Atefeh Esmailnejad, Gholam Reza Nikbakht Brujeni

Abstract:

The major histocompatibility complex (MHC) is the best-characterized genetic region associated with susceptibility and/or resistance to a wide range of infectious diseases, autoimmune diseases and immune responses to vaccines. It has been demonstrated that there is an association between the MHC and resistance to Marek disease, Newcastle disease, Rous sarcoma tumor, Avian leucosis, Fowl cholera, Salmonellosis and Pasteurellosis in chicken. The present study evaluated the MHC polymorphism and its association with antibody response to Newcastle (ND) vaccine in Iranian native chickens. The MHC polymorphism was investigated using LEI0258 microsatellite locus by PCR-based fragment analysis. LEI0258 microsatellite marker is a genetic indicator for MHC, which is located on microchromosome 16 and strongly associated with serologically defined MHC haplotypes. Antibody titer against ND vaccine was measured by Haemaglutination Inhibition (HI) assay. Statistical analysis was performed using SPSS software (version 21). Total of 13 LEI0258 microsatellite alleles were identified in 72 samples which indicated a high genetic diversity in the population. The association study revealed a significant influence of MHC alleles on immune responses to Newcastle vaccine. 311 and 313 bp alleles were significantly associated with elevated immune responses to Newcastle vaccine (p<0.05). These results would be applicable in designing and improving the populations under selective breeding.

Keywords: chicken, LEI0258, MHC, Newcastle vaccine

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5133 Combined Pneumomediastinum and Pneumothorax Due to Hyperemesis Gravidarum

Authors: Fayez Hanna, Viet Tran

Abstract:

A 20 years old lady- primigravida 6 weeks pregnant with unremarkable past history, presented to the emergency department at the Royal Hobart Hospital, Tasmania, Australia, with hyperemesis gravidarum associated with, dehydration and complicated with hematemesis and chest pain resistant. Accordingly, we conducted laboratory investigations which revealed: FBC: WBC 23.9, unremarkable U&E, LFT, lipase and her VBG showed a pH 7.4, pCo2 36.7, cK+ 3.2, cNa+ 142. The decision was made to do a chest X-ray (CXR) after explaining the risks/benefit of performing radiographic investigations during pregnancy and considering the patient's plan for the termination of the pregnancy as she was not ready for motherhood for shared decision-making and consent to look for pneumoperitoneum to suggest perforated viscus that might cause the hematemesis. However, the CXR showed pneumomediastinum but no evidence of pneumoperitoneum or pneumothorax. Consequently, a decision was made to proceed with CT oesophagography with imaging pre and post oral contrast administration to identify a potential oesophageal tear since it could not be excluded using a plain film of the CXR. The CT oesophagography could not find a leak for the administered oral contrast and thus, no oesophageal tear could be confirmed but could not exclude the Mallory-Weiss tear (lower oesophageal tear). Further, the CT oesophagography showed an extensive pneumomediastinum that could not be confirmed to be pulmonary in origin noting the presence of bilateral pulmonary interstitial emphysema and pneumothorax in the apex of the right lung that was small. The patient was admitted to the Emergency Department Inpatient Unit for monitoring, supportive therapy, and symptomatic management. Her hyperemesis was well controlled with ondansetron 8mg IV, metoclopramide 10mg IV, doxylamine 25mg PO, pyridoxine 25mg PO, esomeprazole 40mg IV and oxycodone 5mg PO was given for pain control and 2 litter of IV fluid. The patient was stabilized after 24 hours and discharged home on ondansetron 8mg every 8 hours whereas the patient had a plan for medical termination of pregnancy. Three weeks later, the patient represented with nausea and vomiting complicated by a frank hematemesis. Her observation chart showed HR 117- other vital signs were normal. Pathology showed WBC 14.3 with normal U&E and Hb. The patient was managed in the Emergency Department with the same previous regimen and was discharged home on same previous regimes. Five days later, she presented again with nausea, vomiting and hematemesis and was admitted under obstetrics and gynaecology for stabilization then discharged home with a plan for surgical termination of pregnancy after 3-days rather than the previously planned medical termination of pregnancy to avoid extension of potential oesophageal tear. The surgical termination and follow up period were uneventful. The case is considered rare as pneumomediastinum is a very rare complication of hyperemesis gravidarum where vomiting-induced barotrauma leads to a ruptured oesophagus and air leak into the mediastinum. However no rupture oesophagus in our case. Although the combination of pneumothorax and pneumomediastinum without oesophageal tear was reported only 8 times in the literature, but none of them was due to hyperemesis gravidarum.

Keywords: Pneumothorax, pneumomediastinum, hyperemesis gravidarum, pneumopericardium

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5132 A Neural Network Approach to Understanding Turbulent Jet Formations

Authors: Nurul Bin Ibrahim

Abstract:

Advancements in neural networks have offered valuable insights into Fluid Dynamics, notably in addressing turbulence-related challenges. In this research, we introduce multiple applications of models of neural networks, namely Feed-Forward and Recurrent Neural Networks, to explore the relationship between jet formations and stratified turbulence within stochastically excited Boussinesq systems. Using machine learning tools like TensorFlow and PyTorch, the study has created models that effectively mimic and show the underlying features of the complex patterns of jet formation and stratified turbulence. These models do more than just help us understand these patterns; they also offer a faster way to solve problems in stochastic systems, improving upon traditional numerical techniques to solve stochastic differential equations such as the Euler-Maruyama method. In addition, the research includes a thorough comparison with the Statistical State Dynamics (SSD) approach, which is a well-established method for studying chaotic systems. This comparison helps evaluate how well neural networks can help us understand the complex relationship between jet formations and stratified turbulence. The results of this study underscore the potential of neural networks in computational physics and fluid dynamics, opening up new possibilities for more efficient and accurate simulations in these fields.

Keywords: neural networks, machine learning, computational fluid dynamics, stochastic systems, simulation, stratified turbulence

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5131 Multi-Factor Optimization Method through Machine Learning in Building Envelope Design: Focusing on Perforated Metal Façade

Authors: Jinwooung Kim, Jae-Hwan Jung, Seong-Jun Kim, Sung-Ah Kim

Abstract:

Because the building envelope has a significant impact on the operation and maintenance stage of the building, designing the facade considering the performance can improve the performance of the building and lower the maintenance cost of the building. In general, however, optimizing two or more performance factors confronts the limits of time and computational tools. The optimization phase typically repeats infinitely until a series of processes that generate alternatives and analyze the generated alternatives achieve the desired performance. In particular, as complex geometry or precision increases, computational resources and time are prohibitive to find the required performance, so an optimization methodology is needed to deal with this. Instead of directly analyzing all the alternatives in the optimization process, applying experimental techniques (heuristic method) learned through experimentation and experience can reduce resource waste. This study proposes and verifies a method to optimize the double envelope of a building composed of a perforated panel using machine learning to the design geometry and quantitative performance. The proposed method is to achieve the required performance with fewer resources by supplementing the existing method which cannot calculate the complex shape of the perforated panel.

Keywords: building envelope, machine learning, perforated metal, multi-factor optimization, façade

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5130 Challenges and Problems of the Implementation of the Individual's Right to a Safe and Clean Environment

Authors: Dalia Perkumiene

Abstract:

The process of globalization has several unforeseen negative effects on the quality of the environment, including increased pollution, climate change, and the depletion and destruction of natural resources. The impact of these processes makes it difficult to guarantee citizens' rights to a clean environment, and complex legal solutions are needed to implement this right. In order to implement human rights in a clean and safe environment, international legal documents and court rulings are analyzed. It is important to find a balance between the legal context: the right to a clean environment and environmental challenges such as climate change and global warming. Research Methods: The following methods were used in this study: analytical, analysis, and synthesis of scientific literature and legal documents, comparative analysis of legal acts, and generalization. Major Findings: It is difficult to implement the right to a clean, safe and sustainable environment. The successful implementation of this right depends on the application of various complex ideas and rational, not only legal solutions. Legislative measures aim to maximize the implementation of citizens' rights in the face of climate change and other environmental challenges. This area remains problematic, especially in international law. Concluding Statement: The right to a clean environment should allow a person to live in a harmonious system, where environmental factors do not pose a risk to human health and well-being.

Keywords: clean and safe and clean environmen, environmen, persons’ rights, right to a clean and safe and clean environment

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5129 Using Q-Learning to Auto-Tune PID Controller Gains for Online Quadcopter Altitude Stabilization

Authors: Y. Alrubyli

Abstract:

Unmanned Arial Vehicles (UAVs), and more specifically, quadcopters need to be stable during their flights. Altitude stability is usually achieved by using a PID controller that is built into the flight controller software. Furthermore, the PID controller has gains that need to be tuned to reach optimal altitude stabilization during the quadcopter’s flight. For that, control system engineers need to tune those gains by using extensive modeling of the environment, which might change from one environment and condition to another. As quadcopters penetrate more sectors, from the military to the consumer sectors, they have been put into complex and challenging environments more than ever before. Hence, intelligent self-stabilizing quadcopters are needed to maneuver through those complex environments and situations. Here we show that by using online reinforcement learning with minimal background knowledge, the altitude stability of the quadcopter can be achieved using a model-free approach. We found that by using background knowledge instead of letting the online reinforcement learning algorithm wander for a while to tune the PID gains, altitude stabilization can be achieved faster. In addition, using this approach will accelerate development by avoiding extensive simulations before applying the PID gains to the real-world quadcopter. Our results demonstrate the possibility of using the trial and error approach of reinforcement learning combined with background knowledge to achieve faster quadcopter altitude stabilization in different environments and conditions.

Keywords: reinforcement learning, Q-leanring, online learning, PID tuning, unmanned aerial vehicle, quadcopter

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5128 Mood Symptom Severity in Service Members with Posttraumatic Stress Symptoms after Service Dog Training

Authors: Tiffany Riggleman, Andrea Schultheis, Kalyn Jannace, Jerika Taylor, Michelle Nordstrom, Paul F. Pasquina

Abstract:

Introduction: Posttraumatic Stress (PTS) and Posttraumatic Stress Disorder (PTSD) remain significant problems for military and veteran communities. Symptoms of PTSD often include poor sleep, intrusive thoughts, difficulty concentrating, and trouble with emotional regulation. Unfortunately, despite its high prevalence, service members diagnosed with PTSD often do not seek help, usually because of the perceived stigma surrounding behavioral health care. To help address these challenges, non-pharmacological, therapeutic approaches are being developed to help improve care and enhance compliance. The Service Dog Training Program (SDTP), which involves teaching patients how to train puppies to become mobility service dogs, has been successfully implemented into PTS/PTSD care programs with anecdotal reports of improved outcomes. This study was designed to assess the biopsychosocial effects of SDTP from military beneficiaries with PTS symptoms. Methods: Individuals between the ages of 18 and 65 with PTS symptom were recruited to participate in this prospective study. Each subject completes 4 weeks of baseline testing, followed by 6 weeks of active service dog training (twice per week for one hour sessions) with a professional service dog trainer. Outcome measures included the Posttraumatic Stress Checklist for the DSM-5 (PCL-5), Generalized Anxiety Disorder questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), social support/interaction, anthropometrics, blood/serum biomarkers, and qualitative interviews. Preliminary analysis of 17 participants examined mean scores on the GAD-7, PCL-5, and PHQ-9, pre- and post-SDTP, and changes were assessed using Wilcoxon Signed-Rank tests. Results: Post-SDTP, there was a statistically significant mean decrease in PCL-5 scores of 13.5 on an 80-point scale (p=0.03) and a significant mean decrease of 2.2 in PHQ-9 scores on a 27 point scale (p=0.04), suggestive of decreased PTSD and depression symptoms. While there was a decrease in mean GAD-7 scores post-SDTP, the difference was not significant (p=0.20). Recurring themes among results from the qualitative interviews include decreased pain, forgetting about stressors, improved sense of calm, increased confidence, improved communication, and establishing a connection with the service dog. Conclusion: Preliminary results of the first 17 participants in this study suggest that individuals who received SDTP had a statistically significant decrease in PTS symptom, as measured by the PCL-5 and PHQ-9. This ongoing study seeks to enroll a total of 156 military beneficiaries with PTS symptoms. Future analyses will include additional psychological outcomes, pain scores, blood/serum biomarkers, and other measures of the social aspects of PTSD, such as relationship satisfaction and sleep hygiene.

Keywords: post-concussive syndrome, posttraumatic stress, service dog, service dog training program, traumatic brain injury

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5127 A Biomechanical Perfusion System for Microfluidic 3D Bioprinted Structure

Authors: M. Dimitri, M. Ricci, F. Bigi, M. Romiti, A. Corvi

Abstract:

Tissue engineering has reached a significant milestone with the integration of 3D printing for the creation of complex bioconstructs equipped with vascular networks, crucial for cell maintenance and growth. This study aims to demonstrate the effectiveness of a portable microperfusion system designed to adapt dynamically to the evolving conditions of cell growth within 3D-printed bioconstructs. The microperfusion system was developed to provide a constant and controlled flow of nutrients and oxygen through the integrated vessels in the bioconstruct, replicating in vivo physiological conditions. Through a series of preliminary experiments, we evaluated the system's ability to maintain a favorable environment for cell proliferation and differentiation. Measurements of cell density and viability were performed to monitor the health and functionality of the tissue over time. Preliminary results indicate that the portable microperfusion system not only supports but optimizes cell growth, effectively adapting to changes in metabolic needs during the bioconstruct maturation process. This research opens perspectives in tissue engineering, demonstrating that a portable microperfusion system can be successfully integrated into 3D-printed bioconstructs, promoting sustainable and uniform cell growth. The implications of this study are far-reaching, with potential applications in regenerative medicine and pharmacological research, providing a platform for the development of functional and complex tissues.

Keywords: biofabrication, microfluidic perfusion system, 4D bioprinting

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5126 Essential Oil Encapsulated into Succinic Acid Modified Beta-Cyclodextrin: Characterization, Docking Study, and Antifungal Activity

Authors: Amine Ez-Zoubi, Abdellah Farah

Abstract:

Because of their effectiveness and environmental safety, many essential oils have been investigated as biopesticides. Nevertheless, the encapsulation process is necessary to improve its physical, chemical, and biological properties. Therefore, the purpose of this paper was to study the physicochemical characteristics, and antifungal activity of the Artemisia Herba-Alba essential oil (HAEO) encapsulated in succinic acid modified β-CD (SACD). A yellowish oil was obtained from plant A. Herba-Alba using hydrodistillation and GC-MS was used to identify the chemical composition, in which α-Thujone (65.0%) was the main component in HAEO. The succinic acid has been esterified via the hydroxyl groups in β-CD to produce SACD. In addition, the inclusion complex formation of HAEO and SACD was generated according to the co-precipitation method and was analyzed by several techniques. The antifungal activity in vitro was examined against Botrytis cinerea by direct contact with a potato dextrose agar culture medium. At a 0.1 % concentration, the HAEO in encapsulated form showed higher potential for the control of B. cinerea when compared to the EO in free form (38.34 to 12%). Thus, these results produced evidence that the encapsulation of EOs in SACD can be useful for the development of B.cinerea inhibitors and a promising alternative biopesticide.

Keywords: Artemisia Herba-Alba essential oil, succinic acid modified β-cyclodextrin, inclusion complex, co-precipitation, Botrytis cinerea, direct contact

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5125 Factors Associated with Hand Functional Disability in People with Rheumatoid Arthritis: A Systematic Review and Best-Evidence Synthesis

Authors: Hisham Arab Alkabeya, A. M. Hughes, J. Adams

Abstract:

Background: People with Rheumatoid Arthritis (RA) continue to experience problems with hand function despite new drug advances and targeted medical treatment. Consequently, it is important to identify the factors that influence the impact of RA disease on hand function. This systematic review identified observational studies that reported factors that influenced the impact of RA on hand function. Methods: MEDLINE, EMBASE, CINAL, AMED, PsychINFO, and Web of Science database were searched from January 1990 up to March 2017. Full-text articles published in English that described factors related to hand functional disability in people with RA were selected following predetermined inclusion and exclusion criteria. Pertinent data were thoroughly extracted and documented using a pre-designed data extraction form by the lead author, and cross-checked by the review team for completion and accuracy. Factors related to hand function were classified under the domains of the International Classification of Functioning, Disability, and Health (ICF) framework and health-related factors. Three reviewers independently assessed the methodological quality of the included articles using the quality of cross-sectional studies (AXIS) tool. Factors related to hand function that was investigated in two or more studies were explored using a best-evidence synthesis. Results: Twenty articles form 19 studies met the inclusion criteria from 1,271 citations; all presented cross-sectional data (five high quality and 15 low quality studies), resulting in at best limited evidence in the best-evidence synthesis. For the factors classified under the ICF domains, the best-evidence synthesis indicates that there was a range of body structure and function factors that were related with hand functional disability. However, key factors were hand strength, disease activity, and pain intensity. Low functional status (physical, emotional and social) level was found to be related with limited hand function. For personal factors, there is limited evidence that gender is not related with hand function; whereas, conflicting evidence was found regarding the relationship between age and hand function. In the domain of environmental factors, there was limited evidence that work activity was not related with hand function. Regarding health-related factors, there was limited evidence that the level of the rheumatoid factor (RF) was not related to hand function. Finally, conflicting evidence was found regarding the relationship between hand function and disease duration and general health status. Conclusion: Studies focused on body structure and function factors, highlighting a lack of investigation into personal and environmental factors when considering the impact of RA on hand function. The level of evidence which exists was limited, but identified that modifiable factors such as grip or pinch strength, disease activity and pain are the most influential factors on hand function in people with RA. The review findings suggest that important personal and environmental factors that impact on hand function in people with RA are not yet considered or reported in clinical research. Well-designed longitudinal, preferably cohort, studies are now needed to better understand the causality between personal and environmental factors and hand functional disability in people with RA.

Keywords: factors, hand function, rheumatoid arthritis, systematic review

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5124 Exploring the Influence of Culture on Dietary Practices and Ethnic Inequality in Health among Migrant Nigerians in the UK

Authors: Babatunde Johnson

Abstract:

The rate of diseases and death from preventable diseases among ethnic minority groups is high when compared with the wider white population in the UK. This can be due in part to the diet consumed and various cultural reasons. Changes in dietary practices and the health of ethnic minority groups can be caused by the adoption of food practices of the host culture after migration (acculturation) and generational differences among migrants. However, understanding how and why these changes occur is limited due to the challenges of data collection in research. This research utilizes the interpretive phenomenological approach, coupled with Bourdieu’s theory used as the conceptual framework, and seeks an in-depth understanding of how adult immigrant Nigerians in the UK interpret their experience of the influence of ethnic and prevailing cultures on their dietary practice. Recruiting participants from a close-knit community, such as the Nigerian population in the UK, can be complex and problematic and is determined by the accessibility to the community. Although complex, the researcher leveraged the principles of Patient and Public Involvement (PPI) in gaining access to participants within the Nigerian community. This study emphasizes the need for a culturally tailored and community-centered approach to interventions geared toward the reduction of ethnic health inequality in the UK other than the existing practice, which focuses on better healthy eating through the improvement of skills and knowledge about food groups.

Keywords: culture, dietary practice, ethnic minority, health inequality

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5123 A Flexible Bayesian State-Space Modelling for Population Dynamics of Wildlife and Livestock Populations

Authors: Sabyasachi Mukhopadhyay, Joseph Ogutu, Hans-Peter Piepho

Abstract:

We aim to model dynamics of wildlife or pastoral livestock population for understanding of their population change and hence for wildlife conservation and promoting human welfare. The study is motivated by an age-sex structured population counts in different regions of Serengeti-Mara during the period 1989-2003. Developing reliable and realistic models for population dynamics of large herbivore population can be a very complex and challenging exercise. However, the Bayesian statistical domain offers some flexible computational methods that enable the development and efficient implementation of complex population dynamics models. In this work, we have used a novel Bayesian state-space model to analyse the dynamics of topi and hartebeest populations in the Serengeti-Mara Ecosystem of East Africa. The state-space model involves survival probabilities of the animals which further depend on various factors like monthly rainfall, size of habitat, etc. that cause recent declines in numbers of the herbivore populations and potentially threaten their future population viability in the ecosystem. Our study shows that seasonal rainfall is the most important factors shaping the population size of animals and indicates the age-class which most severely affected by any change in weather conditions.

Keywords: bayesian state-space model, Markov Chain Monte Carlo, population dynamics, conservation

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5122 Expand Rabies Post-Exposure Prophylaxis to Where It Is Needed the Most

Authors: Henry Wilde, Thiravat Hemachudha

Abstract:

Human rabies deaths are underreported worldwide at 55,000 annual cases; more than of dengue and Japanese encephalitis. Almost half are children. A recent study from the Philippines of nearly 2,000 rabies deaths revealed that none of had received incomplete or no post exposure prophylaxis. Coming from a canine rabies endemic country, this is not unique. There are two major barriers to reducing human rabies deaths: 1) the large number of unvaccinated dogs and 2) post-exposure prophylaxis (PEP) that is not available, incomplete, not affordable, or not within reach for bite victims travel means. Only the first barrier, inadequate vaccination of dogs, is now being seriously addressed. It is also often not done effectively or sustainably. Rabies PEP has evolved as a complex, prolonged process, usually delegated to centers in larger cities. It is virtually unavailable in villages or small communities where most dog bites occur, victims are poor and usually unable to travel a long distance multiple times to receive PEP. Reseacrh that led to better understanding of the pathophysiology of rabies and immune responses to potent vaccines and immunoglobulin have allowed shortening and making PEP more evidence based. This knowledge needs to be adopted and applied so that PEP can be rendered safely and affordably where needed the most: by village health care workers who have long performed more complex services after appropriate training. Recent research makes this an important and long neglected goal that is now within our means to implement.

Keywords: rabies, post-exposure prophylaxis, availability, immunoglobulin

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5121 The Use of Nuclear Generation to Provide Power System Stability

Authors: Heather Wyman-Pain, Yuankai Bian, Furong Li

Abstract:

The decreasing use of fossil fuel power stations has a negative effect on the stability of the electricity systems in many countries. Nuclear power stations have traditionally provided minimal ancillary services to support the system but this must change in the future as they replace fossil fuel generators. This paper explains the development of the four most popular reactor types still in regular operation across the world which have formed the basis for most reactor development since their commercialisation in the 1950s. The use of nuclear power in four countries with varying levels of capacity provided by nuclear generators is investigated, using the primary frequency response provided by generators as a measure for the electricity networks stability, to assess the need for nuclear generators to provide additional support as their share of the generation capacity increases.

Keywords: frequency control, nuclear power generation, power system stability, system inertia

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5120 De Novo Design of a Minimal Catalytic Di-Nickel Peptide Capable of Sustained Hydrogen Evolution

Authors: Saroj Poudel, Joshua Mancini, Douglas Pike, Jennifer Timm, Alexei Tyryshkin, Vikas Nanda, Paul Falkowski

Abstract:

On the early Earth, protein-metal complexes likely harvested energy from a reduced environment. These complexes would have been precursors to the metabolic enzymes of ancient organisms. Hydrogenase is an essential enzyme in most anaerobic organisms for the reduction and oxidation of hydrogen in the environment and is likely one of the earliest evolved enzymes. To attempt to reinvent a precursor to modern hydrogenase, we computationally designed a short thirteen amino acid peptide that binds the often-required catalytic transition metal Nickel in hydrogenase. This simple complex can achieve hundreds of hydrogen evolution cycles using light energy in a broad range of temperature and pH. Biophysical and structural investigations strongly indicate the peptide forms a di-nickel active site analogous to Acetyl-CoA synthase, an ancient protein central to carbon reduction in the Wood-Ljungdahl pathway and capable of hydrogen evolution. This work demonstrates that prior to the complex evolution of multidomain enzymes, early peptide-metal complexes could have catalyzed energy transfer from the environment on the early Earth and enabled the evolution of modern metabolism

Keywords: hydrogenase, prebiotic enzyme, metalloenzyme, computational design

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5119 Model Order Reduction of Complex Airframes Using Component Mode Synthesis for Dynamic Aeroelasticity Load Analysis

Authors: Paul V. Thomas, Mostafa S. A. Elsayed, Denis Walch

Abstract:

Airframe structural optimization at different design stages results in new mass and stiffness distributions which modify the critical design loads envelop. Determination of aircraft critical loads is an extensive analysis procedure which involves simulating the aircraft at thousands of load cases as defined in the certification requirements. It is computationally prohibitive to use a Global Finite Element Model (GFEM) for the load analysis, hence reduced order structural models are required which closely represent the dynamic characteristics of the GFEM. This paper presents the implementation of Component Mode Synthesis (CMS) method for the generation of high fidelity Reduced Order Model (ROM) of complex airframes. Here, sub-structuring technique is used to divide the complex higher order airframe dynamical system into a set of subsystems. Each subsystem is reduced to fewer degrees of freedom using matrix projection onto a carefully chosen reduced order basis subspace. The reduced structural matrices are assembled for all the subsystems through interface coupling and the dynamic response of the total system is solved. The CMS method is employed to develop the ROM of a Bombardier Aerospace business jet which is coupled with an aerodynamic model for dynamic aeroelasticity loads analysis under gust turbulence. Another set of dynamic aeroelastic loads is also generated employing a stick model of the same aircraft. Stick model is the reduced order modelling methodology commonly used in the aerospace industry based on stiffness generation by unitary loading application. The extracted aeroelastic loads from both models are compared against those generated employing the GFEM. Critical loads Modal participation factors and modal characteristics of the different ROMs are investigated and compared against those of the GFEM. Results obtained show that the ROM generated using Craig Bampton CMS reduction process has a superior dynamic characteristics compared to the stick model.

Keywords: component mode synthesis, craig bampton reduction method, dynamic aeroelasticity analysis, model order reduction

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5118 Predictors of Sexually Transmitted Infection of Korean Adolescent Females: Analysis of Pooled Data from Korean Nationwide Survey

Authors: Jaeyoung Lee, Minji Je

Abstract:

Objectives: In adolescence, adolescents are curious about sex, but sexual experience before becoming an adult can cause the risk of high probability of sexually transmitted infection. Therefore, it is very important to prevent sexually transmitted infections so that adolescents can grow in healthy and upright way. Adolescent females, especially, have sexual behavior distinguished from that of male adolescents. Protecting female adolescents’ reproductive health is even more important since it is directly related to the childbirth of the next generation. This study, thus, investigated the predictors of sexually transmitted infection in adolescent females with sexual experiences based on the National Health Statistics in Korea. Methods: This study was conducted based on the National Health Statistics in Korea. The 11th Korea Youth Behavior Web-based Survey in 2016 was conducted in the type of anonymous self-reported survey in order to find out the health behavior of adolescents. The target recruitment group was middle and high school students nationwide as of April 2016, and 65,528 students from a total of 800 middle and high schools participated. The study was conducted in 537 female high school students (Grades 10–12) among them. The collected data were analyzed as complex sampling design using SPSS statistics 22. The strata, cluster, weight, and finite population correction provided by Korea Center for Disease Control & Prevention (KCDC) were reflected to constitute complex sample design files, which were used in the statistical analysis. The analysis methods included Rao-Scott chi-square test, complex samples general linear model, and complex samples multiple logistic regression analysis. Results: Out of 537 female adolescents, 11.9% (53 adolescents) had experiences of venereal infection. The predictors for venereal infection of the subjects were ‘age at first intercourse’ and ‘sexual intercourse after drinking’. The sexually transmitted infection of the subjects was decreased by 0.31 times (p=.006, 95%CI=0.13-0.71) for middle school students and 0.13 times (p<.001, 95%CI=0.05-0.32) for high school students whereas the age of the first sexual experience was under elementary school age. In addition, the sexually transmitted infection of the subjects was 3.54 times (p < .001, 95%CI=1.76-7.14) increased when they have experience of sexual relation after drinking alcohol, compared to those without the experience of sexual relation after drinking alcohol. Conclusions: The female adolescents had high probability of sexually transmitted infection if their age for the first sexual experience was low. Therefore, the female adolescents who start sexual experience earlier shall have practical sex education appropriate for their developmental stage. In addition, since the sexually transmitted infection increases, if they have sexual relations after drinking alcohol, the consideration for prevention of alcohol use or intervention of sex education shall be required. When health education intervention is conducted for health promotion for female adolescents in the future, it is necessary to reflect the result of this study.

Keywords: adolescent, coitus, female, sexually transmitted diseases

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5117 Effective Stiffness, Permeability, and Reduced Wall Shear Stress of Highly Porous Tissue Engineering Scaffolds

Authors: Hassan Mohammadi Khujin

Abstract:

Tissue engineering is the science of tissues and complex organs creation using scaffolds, cells and biologically active components. Most cells require scaffolds to grow and proliferate. These temporary support structures for tissue regeneration are later replaced with extracellular matrix produced inside the body. Recent advances in additive manufacturing methods allow production of highly porous, complex three dimensional scaffolds suitable for cell growth and proliferation. The current paper investigates the mechanical properties, including elastic modulus and compressive strength, as well as fluid flow dynamics, including permeability and flow-induced shear stress of scaffolds with four triply periodic minimal surface (TPMS) configurations, namely the Schwarz primitive, the Schwarz diamond, the gyroid, and the Neovius structures. Higher porosity in all scaffold types resulted in lower mechanical properties. The permeability of the scaffolds was determined using Darcy's law with reference to geometrical parameters and the pressure drop derived from the computational fluid dynamics (CFD) analysis. Higher porosity enhanced permeability and reduced wall shear stress in all scaffold designs.

Keywords: highly porous scaffolds, tissue engineering, finite elements analysis, CFD analysis

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5116 Identification of Microbial Community in an Anaerobic Reactor Treating Brewery Wastewater

Authors: Abimbola M. Enitan, John O. Odiyo, Feroz M. Swalaha

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The study of microbial ecology and their function in anaerobic digestion processes are essential to control the biological processes. This is to know the symbiotic relationship between the microorganisms that are involved in the conversion of complex organic matter in the industrial wastewater to simple molecules. In this study, diversity and quantity of bacterial community in the granular sludge taken from the different compartments of a full-scale upflow anaerobic sludge blanket (UASB) reactor treating brewery wastewater was investigated using polymerase chain reaction (PCR) and real-time quantitative PCR (qPCR). The phylogenetic analysis showed three major eubacteria phyla that belong to Proteobacteria, Firmicutes and Chloroflexi in the full-scale UASB reactor, with different groups populating different compartment. The result of qPCR assay showed high amount of eubacteria with increase in concentration along the reactor’s compartment. This study extends our understanding on the diverse, topological distribution and shifts in concentration of microbial communities in the different compartments of a full-scale UASB reactor treating brewery wastewater. The colonization and the trophic interactions among these microbial populations in reducing and transforming complex organic matter within the UASB reactors were established.

Keywords: bacteria, brewery wastewater, real-time quantitative PCR, UASB reactor

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5115 Foresight in Food Supply System in Bogota

Authors: Suarez-Puello Alejandro, Baquero-Ruiz Andrés F, Suarez-Puello Rodrigo

Abstract:

This paper discusses the results of a foresight exercise which analyzes Bogota’s fruit, vegetable and tuber supply chain strategy- described at the Food Supply and Security Master Plan (FSSMP)-to provide the inhabitants of Bogotá, Colombia, with basic food products at a fair price. The methodology consisted of using quantitative and qualitative foresight tools such as system dynamics and variable selection methods to better represent interactions among stakeholders and obtain more integral results that could shed light on this complex situation. At first, the Master Plan is an input to establish the objectives and scope of the exercise. Then, stakeholders and their relationships are identified. Later, system dynamics is used to model product, information and money flow along the fruit, vegetable and tuber supply chain. Two scenarios are presented, discussing actions by the public sector and the reactions that could be expected from the whole food supply system. Finally, these impacts are compared to the Food Supply and Security Master Plan’s objectives suggesting recommendations that could improve its execution. This foresight exercise performed at a governmental level is intended to promote the widen the use of foresight as an anticipatory, decision-making tool that offers solutions to complex problems.

Keywords: decision making, foresight, public policies, supply chain, system dynamics

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5114 A Fermatean Fuzzy MAIRCA Approach for Maintenance Strategy Selection of Process Plant Gearbox Using Sustainability Criteria

Authors: Soumava Boral, Sanjay K. Chaturvedi, Ian Howard, Kristoffer McKee, V. N. A. Naikan

Abstract:

Due to strict regulations from government to enhance the possibilities of sustainability practices in industries, and noting the advances in sustainable manufacturing practices, it is necessary that the associated processes are also sustainable. Maintenance of large scale and complex machines is a pivotal task to maintain the uninterrupted flow of manufacturing processes. Appropriate maintenance practices can prolong the lifetime of machines, and prevent associated breakdowns, which subsequently reduces different cost heads. Selection of the best maintenance strategies for such machines are considered as a burdensome task, as they require the consideration of multiple technical criteria, complex mathematical calculations, previous fault data, maintenance records, etc. In the era of the fourth industrial revolution, organizations are rapidly changing their way of business, and they are giving their utmost importance to sensor technologies, artificial intelligence, data analytics, automations, etc. In this work, the effectiveness of several maintenance strategies (e.g., preventive, failure-based, reliability centered, condition based, total productive maintenance, etc.) related to a large scale and complex gearbox, operating in a steel processing plant is evaluated in terms of economic, social, environmental and technical criteria. As it is not possible to obtain/describe some criteria by exact numerical values, these criteria are evaluated linguistically by cross-functional experts. Fuzzy sets are potential soft-computing technique, which has been useful to deal with linguistic data and to provide inferences in many complex situations. To prioritize different maintenance practices based on the identified sustainable criteria, multi-criteria decision making (MCDM) approaches can be considered as potential tools. Multi-Attributive Ideal Real Comparative Analysis (MAIRCA) is a recent addition in the MCDM family and has proven its superiority over some well-known MCDM approaches, like TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) and ELECTRE (ELimination Et Choix Traduisant la REalité). It has a simple but robust mathematical approach, which is easy to comprehend. On the other side, due to some inherent drawbacks of Intuitionistic Fuzzy Sets (IFS) and Pythagorean Fuzzy Sets (PFS), recently, the use of Fermatean Fuzzy Sets (FFSs) has been proposed. In this work, we propose the novel concept of FF-MAIRCA. We obtain the weights of the criteria by experts’ evaluation and use them to prioritize the different maintenance practices according to their suitability by FF-MAIRCA approach. Finally, a sensitivity analysis is carried out to highlight the robustness of the approach.

Keywords: Fermatean fuzzy sets, Fermatean fuzzy MAIRCA, maintenance strategy selection, sustainable manufacturing, MCDM

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5113 Formulation and Evaluation of Curcumin-Zn (II) Microparticulate Drug Delivery System for Antimalarial Activity

Authors: M. R. Aher, R. B. Laware, G. S. Asane, B. S. Kuchekar

Abstract:

Objective: Studies have shown that a new combination therapy with Artemisinin derivatives and curcumin is unique, with potential advantages over known ACTs. In present study an attempt was made to prepare microparticulate drug delivery system of Curcumin-Zn complex and evaluate it in combination with artemether for antimalarial activity. Material and method: Curcumin Zn complex was prepared and encapsulated using sodium alginate. Microparticles thus obtained are further coated with various enteric polymers at different coating thickness to control the release. Microparticles are evaluated for encapsulation efficiency, drug loading and in vitro drug release. Roentgenographic Studies was conducted in rabbits with BaSO 4 tagged formulation. Optimized formulation was screened for antimalarial activity using P. berghei-infected mice survival test and % paracetemia inhibition, alone (three oral dose of 5mg/day) and in combination with arthemether (i.p. 500, 1000 and 1500µg). Curcumin-Zn(II) was estimated in serum after oral administration to rats by using spectroflurometry. Result: Microparticles coated with Cellulose acetate phthalate showed most satisfactory and controlled release with 479 min time for 60% drug release. X-ray images taken at different time intervals confirmed the retention of formulation in GI tract. Estimation of curcumin in serum by spectroflurometry showed that drug concentration is maintained in the blood for longer time with tmax of 6 hours. The survival time (40 days post treatment) of mice infected with P. berghei was compared to survival after treatment with either Curcumin-Zn(II) microparticles artemether combination, curcumin-Zn complex and artemether. Oral administration of Curcumin-Zn(II)-artemether prolonged the survival of P.berghei-infected mice. All the mice treated with Curcumin-Zn(II) microparticles (5mg/day) artemether (1000µg) survived for more than 40 days and recovered with no detectable parasitemia. Administration of Curcumin-Zn(II) artemether combination reduced the parasitemia in mice by more than 90% compared to that in control mice for the first 3 days after treatment. Conclusion: Antimalarial activity of the curcumin Zn-artemether combination was more pronounced than mono therapy. A single dose of 1000µg of artemether in curcumin-Zn combination gives complete protection in P. berghei-infected mice. This may reduce the chances of drug resistance in malaria management.

Keywords: formulation, microparticulate drug delivery, antimalarial, pharmaceutics

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5112 Effects of Small Amount of Poly(D-Lactic Acid) on the Properties of Poly(L-Lactic Acid)/Microcrystalline Cellulose/Poly(D-Lactic Acid) Blends

Authors: Md. Hafezur Rahaman, Md. Sagor Hosen, Md. Abdul Gafur, Rasel Habib

Abstract:

This research is a systematic study of effects of poly(D-lactic acid) (PDLA) on the properties of poly(L-lactic acid)(PLLA)/microcrystalline cellulose (MCC)/PDLA blends by stereo complex crystallization. Blends were prepared with constant percentage of (3 percent) MCC and different percentage of PDLA by solution casting methods. These blends were characterized by Fourier Transform Infrared Spectroscopy (FTIR) for the confirmation of blends compatibility, Wide-Angle X-ray Scattering (WAXS) and scanning electron microscope (SEM) for the analysis of morphology, thermo-gravimetric analysis (TGA) and differential thermal analysis (DTA) for thermal properties measurement. FTIR Analysis results confirm no new characteristic absorption peaks appeared in the spectrum instead shifting of peaks due to hydrogen bonding help to have compatibility of blends component. Development of three new peaks from XRD analysis indicates strongly the formation of stereo complex crystallinity in the PLLA structure with the addition of PDLA. TGA and DTG results indicate that PDLA can improve the heat resistivity of the PLLA/MCC blends by increasing its degradation temperature. Comparison of DTA peaks also ensure developed thermal properties. Image of SEM shows the improvement of surface morphology.

Keywords: microcrystalline cellulose, poly(l-lactic acid), stereocomplex crystallization, thermal stability

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5111 The Collective Memory, Node Reconstruction and Local Belongingness in the Settlement of Outlying Islands: By Taking the Important Architectural Complex of Wang-an Hua-Zhai Settlement as an Example

Authors: Shu-Yen Wang, Shyh-Huei Hwang

Abstract:

Designated as an important architectural complex of settlement by the Ministry of Culture, Hua-Zhai Settlement located in Wang-An Township, Peng-Hu County, of Taiwan has been progressively restored year by year and is now at the revitalization and reutilization stage. Over the last 5 years, YunTech has participated in the restoration project while being in compliance with the Bureau of Cultural Heritage’s spirit of 'Living Heritage Conservation'. In this study, reflections have been made to evaluate the contemporariness of traditional settlement development from the aspects of revitalization and reutilization. On the one hand, the connection between settlers’ experiences and emotions have been clarified through the living nodes, collective memory, and social-cultural connotation. On the other hand, activity design has promoted the reconstruction of living nodes and facilitated the reconnection of collective memory, enabling us to explore the contemporariness of living nodes after the reconstruction. With the adoption of literature review, participant observation, and interview analysis methods, this study concludes the following results: 1) The node reconstruction brings back the memories and makes emotional connections: the spatial collective memory is composed of different components. During the reconstruction of node space, villagers participated not only in the narration of the history but also in the restoration of the space. This process enables villagers to bring back their memories and make emotional connections thereto. 2) Villagers’ understanding towards revitalization has been facilitated through node reconstruction: as a medium of this project, activity design has facilitated node reconstruction by offering villagers a natural environment to build up emotional connections to the settlement. This also enables us to better understand the meaning of settlement activation for the local community. 3) New connections are established in life between villagers and the university through the construction of living nodes: through the local implementation of node reconstruction, new connections have been established in life between villagers who participated in the project and the university. In the meantime, the university’s entrance to the community has also been revalued.

Keywords: collective memory, local sense of belonging, reconstruction of living nodes, the important architectural complex of Wang-An Hua-Zhai settlement

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5110 SARS-CoV-2: Prediction of Critical Charged Amino Acid Mutations

Authors: Atlal El-Assaad

Abstract:

Viruses change with time through mutations and result in new variants that may persist or disappear. A Mutation refers to an actual change in the virus genetic sequence, and a variant is a viral genome that may contain one or more mutations. Critical mutations may cause the virus to be more transmissible, with high disease severity, and more vulnerable to diagnostics, therapeutics, and vaccines. Thus, variants carrying such mutations may increase the risk to human health and are considered variants of concern (VOC). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - the contagious in humans, positive-sense single-stranded RNA virus that caused coronavirus disease 2019 (COVID-19) - has been studied thoroughly, and several variants were revealed across the world with their corresponding mutations. SARS-CoV-2 has four structural proteins, known as the S (spike), E (envelope), M (membrane), and N (nucleocapsid) proteins, but prior study and vaccines development focused on genetic mutations in the S protein due to its vital role in allowing the virus to attach and fuse with the membrane of a host cell. Specifically, subunit S1 catalyzes attachment, whereas subunit S2 mediates fusion. In this perspective, we studied all charged amino acid mutations of the SARS-CoV-2 viral spike protein S1 when bound to Antibody CC12.1 in a crystal structure and assessed the effect of different mutations. We generated all missense mutants of SARS-CoV-2 protein amino acids (AAs) within the SARS-CoV-2:CC12.1 complex model. To generate the family of mutants in each complex, we mutated every charged amino acid with all other charged amino acids (Lysine (K), Arginine (R), Glutamic Acid (E), and Aspartic Acid (D)) and studied the new binding of the complex after each mutation. We applied Poisson-Boltzmann electrostatic calculations feeding into free energy calculations to determine the effect of each mutation on binding. After analyzing our data, we identified charged amino acids keys for binding. Furthermore, we validated those findings against published experimental genetic data. Our results are the first to propose in silico potential life-threatening mutations of SARS-CoV-2 beyond the present mutations found in the five common variants found worldwide.

Keywords: SARS-CoV-2, variant, ionic amino acid, protein-protein interactions, missense mutation, AESOP

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5109 Evaluation of Cellulase and Xylanase Production by Micrococcus Sp. Isolated from Decaying Lignocellulosic Biomass Obtained from Alice Environment in the Eastern Cape of South Africa

Authors: Z. Mmango, U. Nwodo, L. V. Mabinya, A. I. Okoh

Abstract:

Cellulose and hemicellulose account for a large portion of the world‘s plant biomass. In nature, these polysaccharides are intertwined forming complex materials that requires multiple and expensive treatment processes to free up the raw materials trapped in the matrix. Enzymatic degradation remains as the preferred technique as it is inexpensive and eco-friendly. However, the insufficiencies of enzyme battery systems in the degradation of lignocellulosic complex motivate the search for effective degrading enzymes from bacterial isolates from uncommon environment. The study aimed at the evaluation of actinomycetes isolated from saw dust samples collected from wood factory under bed. Cellulase and xylanase production was screened through organism culture on carboxyl methyl cellulose agar and Birchwood xylan. Halo zone indicating lignocellose utilization was shown by an isolate identified through 16S rRNA gene as Micrococcus luteus. The optimum condition for the production of cellulase and xylanase were incubation temperature of 25 °C, fermentation medium pH 5 and 10, agitation speed of 50 and 200 (rpm) and fermentation incubation time of 96 and 84 (h) respectively. The high cellulose and xylanase activity obtained from this isolate portends industrial relevance.

Keywords: carboxyl methyl cellulose, birchwood xylan, optimization, cellulase, xylanase, micrococcus, DNS method

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5108 Mesalazine-Induced Myopericarditis in a Professional Athlete

Authors: Tristan R. Fraser, Christopher D. Steadman, Christopher J. Boos

Abstract:

Myopericarditis is an inflammation syndrome characterised by clinical diagnostic criteria for pericarditis, such as chest pain, combined with evidence of myocardial involvement, such as elevation of biomarkers of myocardial damage, e.g., troponins. It can rarely be a complication of therapeutics used for dysregulated immune-mediated diseases such as inflammatory bowel disease (IBD), for example, mesalazine. The infrequency of mesalazine-induced myopericarditis adds to the challenge in its recognition. Rapid diagnosis and the early introduction of treatment are crucial. This case report follows a 24-year-old professional footballer with a past medical history of ulcerative colitis, recently started on mesalazine for disease control. Three weeks after mesalazine was initiated, he was admitted with fever, shortness of breath, and chest pain worse whilst supine and on deep inspiration, as well as elevated venous blood cardiac troponin T level (cTnT, 288ng/L; normal: <13ng/L). Myocarditis was confirmed on initial inpatient cardiac MRI, revealing the presence of florid myocarditis with preserved left ventricular systolic function and an ejection fraction of 67%. This was a longitudinal case study following the progress of a single individual with myopericarditis over four acute hospital admissions over nine weeks, with admissions ranging from two to five days. Parameters examined included clinical signs and symptoms, serum troponin, transthoracic echocardiogram, and cardiac MRI. Serial measurements of cardiac function, including cardiac MRI and transthoracic echocardiogram, showed progressive deterioration of cardiac function whilst mesalazine was continued. Prior to cessation of mesalazine, transthoracic echocardiography revealed a small global pericardial effusion of < 1cm and worsening left ventricular systolic function with an ejection fraction of 45%. After recognition of mesalazine as a potential cause and consequent cessation of the drug, symptoms resolved, with cardiac MRI performed as an outpatient showing resolution of myocardial oedema. The patient plans to make a return to competitive sport. Patients suffering from myopericarditis are advised to refrain from competitive sport for at least six months in order to reduce the risk of cardiac remodelling and sudden cardiac death. Additional considerations must be taken in individuals for whom competitive sport is an essential component of their livelihood, such as professional athletes. Myopericarditis is an uncommon, however potentially serious medical condition with a wide variety of aetiologies, including viral, autoimmune, and drug-related causes. Management is mainly supportive and relies on prompt recognition and removal of the aetiological process. Mesalazine-induced myopericarditis is a rare condition; as such increasing awareness of mesalazine as a precipitant of myopericarditis is vital for optimising the management of these patients.

Keywords: myopericarditis, mesalazine, inflammatory bowel disease, professional athlete

Procedia PDF Downloads 135