Search results for: nitrogen biological treatment
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10516

Search results for: nitrogen biological treatment

9256 The Economic Burden of Breast Cancer on Women in Nigeria: Implication for Socio-Economic Development

Authors: Tolulope Allo, Mofoluwake P. Ajayi, Adenike E. Idowu, Emmanuel O. Amoo, Fadeke Esther Olu-Owolabi

Abstract:

Breast cancer which was more prevalent in Europe and America in the past is gradually being mirrored across the world today with greater economic burden on low and middle income countries (LMCs). Breast cancer is the most common cancer among women globally and current studies have shown that a woman dies with the diagnosis of breast cancer every thirteen minutes. The economic cost of breast cancer is overwhelming particularly for developing economies. While it causes billion of dollar in losses of national income, it pushes millions of people below poverty line. This study examined the economic burden of breast cancer on Nigerian women, its impacts on their standard of living and its effects on Nigeria’s socio economic development. The study adopts a qualitative research approach using the in-depth interview technique to elicit valuable information from respondents with cancer experience from the Southern part of Nigeria. Respondents constituted women in their reproductive age (15-49 years) that have experienced and survived cancer and also those that are currently receiving treatment. Excerpts from the interviews revealed that the cost of treatment is one of the major factors contributing to the late presentation of breast cancer incidences among women as many of them could not afford to pay for their own treatment. The study also revealed that many women prefer to explore other options such as herbal treatments and spiritual consultations which is less expensive and affordable. The study therefore concludes that breast cancer diagnosis and treatment should be subsidized by the government in order to facilitate easy access and affordability thereby promoting early detection and reducing the economic burden of treatment on women.

Keywords: breast cancer, development, economic burden, women

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9255 Artificial Intelligence-Generated Previews of Hyaluronic Acid-Based Treatments

Authors: Ciro Cursio, Giulia Cursio, Pio Luigi Cursio, Luigi Cursio

Abstract:

Communication between practitioner and patient is of the utmost importance in aesthetic medicine: as of today, images of previous treatments are the most common tool used by doctors to describe and anticipate future results for their patients. However, using photos of other people often reduces the engagement of the prospective patient and is further limited by the number and quality of pictures available to the practitioner. Pre-existing work solves this issue in two ways: 3D scanning of the area with manual editing of the 3D model by the doctor or automatic prediction of the treatment by warping the image with hand-written parameters. The first approach requires the manual intervention of the doctor, while the second approach always generates results that aren’t always realistic. Thus, in one case, there is significant manual work required by the doctor, and in the other case, the prediction looks artificial. We propose an AI-based algorithm that autonomously generates a realistic prediction of treatment results. For the purpose of this study, we focus on hyaluronic acid treatments in the facial area. Our approach takes into account the individual characteristics of each face, and furthermore, the prediction system allows the patient to decide which area of the face she wants to modify. We show that the predictions generated by our system are realistic: first, the quality of the generated images is on par with real images; second, the prediction matches the actual results obtained after the treatment is completed. In conclusion, the proposed approach provides a valid tool for doctors to show patients what they will look like before deciding on the treatment.

Keywords: prediction, hyaluronic acid, treatment, artificial intelligence

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9254 The Effect of Video Using in Teaching Speaking on Students of Non-Native English Speakers at STIE Perbanas Surabaya

Authors: Kartika Marta Budiana

Abstract:

Low competence in speaking for the students of Non English native speakers have been crucial so far for the teachers in language teaching in Indonesia. This study attempts to explore the effect of video using in teaching speaking onstudents of non-native English speakers at STIE Perbanas Surabaya. This includes investigate the students` attitudes toward the video used in classroom. This is a quantitative research that is an experimental one based on analyses derived the concepts of from teaching speaking and the use of video. There are two classes observed, the experimental and the control one. The experimental consist of 28 students and the control class consists of 25 students. Before the treatment given, both of the group is given the pre-test to check their ability level. Then, after the treatment is given, the post-test is given to the both groups. Then, the students were given treatment how to conduct a meeting that they learnt from a video of business English. The post test was held after they undergone a treatment. The instruments to get the data are the oral test and questionnaire. The data of this study is students` score and from the tests` score it can be seen there is a positive significant difference in the experimental group. The t-test to test hypothesize also shows that it is accepted which said that there is an improvement on the students` speaking competence achievement. In conclusion, the video effects on the significant difference on the students speaking competence achievement.

Keywords: video, teaching, speaking, Indonesia

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9253 Effect of Chemical Treatment on Mechanical Properties of KENAF Fiber Reinforced Unsaturated Polyester Composites

Authors: S. S. Abdullahi, H. Musa, A. A. Salisu, A. Ismaila, A. H. Birniwa

Abstract:

In this study the treated and untreated kenaf fiber reinforced unsaturated polyester conventional composites were prepared. Hand lay-up technique was used with dump-bell shaped mold. The kenaf bast fiber was retted enzymatically, washed, dried and combed with a nylon brush. A portion of the kenaf fiber was mercerized and treated with benzoylchloride prior to composite fabrication. Untreated kenaf fiber was also used to prepare the composites to serve as control. The cured composites were subjected to various mechanical testes, such as hardness test, impact test and tensile strength test. The results obtained indicated an increase in all the parameters tested with the fiber treatment. This is because the lignin, hemi-celluloses, pectin and other impurities were removed during alkaline treatment (i.e mercerization). This shows that, the durability of the natural cellulosic fibers to different composite applications can be achieved via fiber treatments.

Keywords: composite, kenaf fibre, reinforce, retted

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9252 Characterising the Effects of Heat Treatment on 3CR12 and AISI 316 Stainless Steels

Authors: Esther T. Akinlabi, Stephen A. Akinlabi

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This paper reports on the effects of heat treatment on 3CR12 and AISI 316 stainless steel grades. Heat treatment was conducted on the steel grades and cooled using two different media; air and water in order to study the effect of each medium on the evolving properties of the samples. The heat treated samples were characterized through the evolving microstructure and hardness. It was found that there was a significant grain size reduction in both the heat treated stainless steel specimens compared to the parent materials. The finer grain sizes were achieved as a result of impediment to growth of one phase by the other. The Vickers micro-hardness values of the heat treated samples were higher compared to the parent materials due to the fact that each of the steel grades had a proportion of martensitic structures in their microstructures.

Keywords: austenite, ferrite, grain size, hardness, martensite, microstructure and stainless steel

Procedia PDF Downloads 266
9251 Effectiveness of Jackfruit Seed Starch as Coagulant Aid in Landfill Leachate Treatment

Authors: Mohd Suffian Yusoff, Noor Aina Mohamad Zuki, Mohd Faiz Muaz Ahmad Zamri

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Currently, aluminium sulphate (alum), ferric chloride and polyaluminium chloride (PAC) are the most common coagulants being used for leachate coagulation-flocculation treatment. However, the impact of these residual’s coagulants have sparked huge concern ceaselessly. Therefore, development of natural coagulant as an alternative coagulant for treatment process has been given full attentions. In this attempt jackfruit seed starch (JSS) was produce by extraction method. The removal efficiency was determined using jar test method. The removal of organic matter and ammonia were compared between JSS used in powder form and diluted form in leachate. The yield of starch from the extraction method was 33.17 % with light brown in colour. The removal of turbidity was the highest at pH 8 for both diluted and powdered JSS with 38% and 8.7% of removal. While for colour removal the diluted JSS showed 18.19% of removal compared to powdered JSS. The diluted JSS also showed the highest removal of suspended solid with 3.5% compared to powdered JSS with 2.8%. Instead of coagulant, JSS as coagulant aid has succeed to reduce the dosage of PAC from 900 mg/L to 528 mg/L by maintaining colour and turbidity removal up to 94% and 92 % respectively. The JSS coagulant also has decreased the negative charge of the leachate nearly to the neutral charge (0.209 mv). The result proved that JSS was more effective to be used as coagulant aid landfill leachate treatment.

Keywords: landfill leachate, natural coagulant, jackfruit seed starch, coagulant

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9250 Microfluidic Impedimetric Biochip and Related Methods for Measurement Chip Manufacture and Counting Cells

Authors: Amina Farooq, Nauman Zafar Butt

Abstract:

This paper is about methods and tools for counting particles of interest, such as cells. A microfluidic system with interconnected electronics on a flexible substrate, inlet-outlet ports and interface schemes, sensitive and selective detection of cells specificity, and processing of cell counting at polymer interfaces in a microscale biosensor for use in the detection of target biological and non-biological cells. The development of fluidic channels, planar fluidic contact ports, integrated metal electrodes on a flexible substrate for impedance measurements, and a surface modification plasma treatment as an intermediate bonding layer are all part of the fabrication process. Magnetron DC sputtering is used to deposit a double metal layer (Ti/Pt) over the polypropylene film. Using a photoresist layer, specified and etched zones are established. Small fluid volumes, a reduced detection region, and electrical impedance measurements over a range of frequencies for cell counts improve detection sensitivity and specificity. The procedure involves continuous flow of fluid samples that contain particles of interest through the microfluidic channels, counting all types of particles in a portion of the sample using the electrical differential counter to generate a bipolar pulse for each passing cell—calculating the total number of particles of interest originally in the fluid sample by using MATLAB program and signal processing. It's indeed potential to develop a robust and economical kit for cell counting in whole-blood samples using these methods and similar devices.

Keywords: impedance, biochip, cell counting, microfluidics

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9249 Brown Macroalgae L. hyperborea as Natural Cation Exchanger and Electron Donor for the Treatment of a Zinc and Hexavalent Chromium Containing Galvanization Wastewater

Authors: Luciana P. Mazur, Tatiana A. Pozdniakova, Rui A. R. Boaventura, Vitor J. P. Vilar

Abstract:

The electroplating industry requires a lot of process water, which generates a large volume of wastewater loaded with heavy metals. Two different wastewaters were collected in a company’s wastewater treatment plant, one after the use of zinc in the metal plating process and the other after the use of chromium. The main characteristics of the Zn(II) and Cr(VI) wastewaters are: pH = 6.7/5.9; chemical oxygen demand = 55/<5 mg/L; sodium, potassium, magnesium and calcium ions concentrations of 326/28, 4/28, 11/7 and 46/37 mg/L, respectively; zinc(II) = 11 mg/L and Cr(VI) = 39 mg/L. Batch studies showed that L. hyperborea can be established as a natural cation exchanger for heavy metals uptake mainly due to the presence of negatively charged functional groups in the surface of the biomass. Beyond that, L. hyperborea can be used as a natural electron donor for hexavalent chromium reduction to trivalent chromium at acidic medium through the oxidation of the biomass, and Cr(III) can be further bound to the negatively charged functional groups. The uptake capacity of Cr(III) by the oxidized biomass after Cr(VI) reduction was higher than by the algae in its original form. This can be attributed to the oxidation of the biomass during Cr(VI) reduction, turning other active sites available for Cr(III) binding. The brown macroalgae Laminaria hyperborea was packed in a fixed-bed column in order to evaluate the feasibility of the system for the continuous treatment of the two galvanization wastewaters. The column, with an internal diameter of 4.8 cm, was packed with 59 g of algae up to a bed height of 27 cm. The operation strategy adopted for the treatment of the two wastewaters consisted in: i) treatment of the Zn(II) wastewater in the first sorption cycle; ii) desorption of pre-loaded Zn(II) using an 1.0 M HCl solution; iii) treatment of the Cr(VI) wastewater, taking advantage of the acidic conditions of the column after the desorption cycle, for the reduction of the Cr(VI) to Cr(III), in the presence of the electrons resulting from the biomass oxidation. This cycle ends when all the oxidizing groups are used.

Keywords: biosorption, brown marine macroalgae, zinc, chromium

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9248 Effect of Probiotic (RE3) Supplement on Growth Performance, Diarrhea Incidence and Blood Parameters of N'dama Calves

Authors: Y. Abdul Aziz, E. L. K. Osafo, S. O. Apori, A. Osman

Abstract:

A sixteen week trial was conducted at the Research Farm (Technology Village) of the Department of Animal Science, School of Agriculture, University of Cape Coast, Cape Coast, Ghana. This study sought to investigate the effects of Probiotic (RE3) on growth performance, diarrhea incidence and blood parameters of N’dama calves. Sixteen N’dama calves aged 3 months of an average initial weight of 44.2 kg were randomly assigned to one of four dietary treatments according to their body weight, age, and sex. Treatment 1 (T1) serve as a control animal (No RE3 supplementation). Treatment 2 (T2) receives 0.03 ml RE3 per kg body weight. Treatment 3 (T3) receives 0.06 ml RE3 per kg body weight, and Treatment 4 (T4) also receives 0.09 ml RE3 per kg body weight in a Completely Randomize Design (CRD). There were 4 replicates per treatment. The calves were allowed access to feed and water ad libitum. The body weight of the calves was recorded at the start of the experiment and thereafter regularly at two weeks interval. Weighing was done early morning before the calves are allowed to access feed and water and were also observed in their pens for occurrence of diarrhea and faecal scores recorded. Blood samples were obtained from each calf at the end of the study through jugular vein puncture. Supplementation of RE3 to calves had showed a beneficial effect by reducing the incidence of diarrhea. The highest faecal score was recorded in T1 and the least faecal score was recorded in T3. There was significant difference (P < 0.05) in the faecal score between the treatment group and the control after two weeks of the experiment. There was no significant difference (P > 0.05) in the average daily gain of the animals. Hematological and biochemical indices of calves were all within the normal range except in treatments (1, 3 and 4) which recorded high White Blood Cell (WBC) count with no significant difference (P > 0.05).

Keywords: probiotics (RE3), diarrhea incidence, blood parameters, N’dama calves

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9247 The Relationship between Fluctuation of Biological Signal: Finger Plethysmogram in Conversation and Anthropophobic Tendency

Authors: Haruo Okabayashi

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Human biological signals (pulse wave and brain wave, etc.) have a rhythm which shows fluctuations. This study investigates the relationship between fluctuations of biological signals which are shown by a finger plethysmogram (i.e., finger pulse wave) in conversation and anthropophobic tendency, and identifies whether the fluctuation could be an index of mental health. 32 college students participated in the experiment. The finger plethysmogram of each subject was measured in the following conversation situations: Fun memory talking/listening situation and regrettable memory talking/ listening situation for three minutes each. Lyspect 3.5 was used to collect the data of the finger plethysmogram. Since Lyspect calculates the Lyapunov spectrum, it is possible to obtain the largest Lyapunov exponent (LLE). LLE is an indicator of the fluctuation and shows the degree to which a measure is going away from close proximity to the track in a dynamical system. Before the finger plethysmogram experiment, each participant took the psychological test questionnaire “Anthropophobic Scale.” The scale measures the social phobia trend close to the consciousness of social phobia. It is revealed that there is a remarkable relationship between the fluctuation of the finger plethysmography and anthropophobic tendency scale in talking about a regrettable story in conversation: The participants (N=15) who have a low anthropophobic tendency show significantly more fluctuation of finger pulse waves than the participants (N=17) who have a high anthropophobic tendency (F (1, 31) =5.66, p<0.05). That is, the participants who have a low anthropophobic tendency make conversation flexibly using large fluctuation of biological signal; on the other hand, the participants who have a high anthropophobic tendency constrain a conversation because of small fluctuation. Therefore, fluctuation is not an error but an important drive to make better relationships with others and go towards the development of interaction. In considering mental health, the fluctuation of biological signals would be an important indicator.

Keywords: anthropophobic tendency, finger plethymogram, fluctuation of biological signal, LLE

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9246 Inoculation of Cyanobacteria Improves the Lignin Content of Thymus vulgaris L.

Authors: Nasim Rasuli, Akram Ahmadi, Hossein Riahi, Zeinab Shariatmadari, Majid Ghorbani Nohooji, Pooyan Mehraban Joubani

Abstract:

Cyanobacteria are one of the most promising sources of new biostimulants and have received much attention due to their diverse applications in biotechnology. These microorganisms enhance the growth and productivity of plants by producing plant growth stimulants and fixing atmospheric nitrogen. Thymus vulgaris L., a valuable medicinal plant from the Lamiaceae family, is widely distributed across the globe. essential oil of T. vulgaris is best characterized by the prominence of phenols, making them the key compounds in its composition. Lignin biosynthesis as a natural plant polyphenol plays a crucial role in promoting plant growth, strengthening cell walls, and increasing resistance to pathogens. In this study, the bioelicitor activity of five cyanobacterial suspensions including Anabaena torulosa ISB213, Nostoc calcicola ISB215, Nostoc ellipsosporum ISB217, Trichormus doliolum ISB214, and Oscillatoria sp. ISB2116 on the lignin content of the T. vulgaris L. was investigated. Pot experiments were performed by inoculation of a %2 algal extract to the soil of treated plants one week before planting and then every 20 days. After four months, the lignin content in the leaves of both treated and control plants was evaluated. The results demonstrated that the application of cyanobacteria significantly increased the lignin content in the leaves of treated plants compared to the control. The treatment with Oscillatoria sp. ISB216 and N. ellipsosporum ISB217 resulted in the highest lignin content, with an increase of 93.33% and 86.67%, respectively. These findings highlight the potential of cyanobacteria as bioelicitors, offering a viable alternative for enhancing the production of secondary metabolites in T. vulgaris. Consequently, this could contribute to the economic value of this medicinal plant.

Keywords: cyanobacteria, bioelicitor, thymus vulgaris, lignin

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9245 Determination of Alkali Treatment Conditions Effects That Influence the Variability of Kenaf Fiber Mean Cross-Sectional Area

Authors: Mohd Yussni Hashim, Mohd Nazrul Roslan, Shahruddin Mahzan Mohd Zin, Saparudin Ariffin

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Fiber cross-sectional area value is a crucial factor in determining the strength properties of natural fiber. Furthermore, unlike synthetic fiber, a diameter and cross-sectional area of natural fiber has a large variation along and between the fibers. This study aims to determine the main and interaction effects of alkali treatment conditions that influence kenaf bast fiber mean cross-sectional area. Three alkali treatment conditions at two different levels were selected. The conditions setting were alkali concentrations at two and ten w/v %; fiber immersed temperature at room temperature and 1000C; and fiber immersed duration for 30 and 480 minute. Untreated kenaf fiber was used as a control unit. Kenaf bast fiber bundle mounting tab was prepared according to ASTM C1557-03. The cross-sectional area was measured using a Leica video analyzer. The study result showed that kenaf fiber bundle mean cross-sectional area was reduced 6.77% to 29.88% after alkali treatment. From the analysis of variance, it shows that the interaction of alkali concentration and immersed time has a higher magnitude at 0.1619 compared to alkali concentration and immersed temperature interaction that was 0.0896. For the main effect, alkali concentration factor contributes to the higher magnitude at 0.1372 which indicated the decrease pattern of variability when the level changed from lower to the higher level. Then, it was followed by immersed temperature at 0.1261 and immersed time at 0.0696 magnitudes.

Keywords: natural fiber, kenaf bast fiber bundles, alkali treatment, cross-sectional area

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9244 Internet-Delivered Cognitive Behaviour Therapy for Depression Comorbid with Diabetes: Preliminary Findings

Authors: Lisa Robins, Jill Newby, Kay Wilhelm, Therese Fletcher, Jessica Smith, Trevor Ma, Adam Finch, Lesley Campbell, Jerry Greenfield, Gavin Andrews

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Background:Depression treatment for people living with depression comorbid with diabetes is of critical importance for improving quality of life and diabetes self-management, however depression remains under-recognised and under-treated in this population. Cost—effective and accessible forms of depression treatment that can enhance the delivery of mental health services in routine diabetes care are needed. Provision of internet-delivered Cognitive Behaviour Therapy (iCBT) provides a promising way to deliver effective depression treatment to people with diabetes. Aims:To explore the outcomes of the clinician assisted iCBT program for people with comorbid Major Depressive Disorder (MDD) and diabetes compared to those who remain under usual care. The main hypotheses are that: (1) Participants in the treatment group would show a significant improvement on disorder specific measures (Patient Health Questionnaire; PHQ-9) relative to those in the control group; (2) Participants in the treatment group will show a decrease in diabetes-related distress relative to those in the control group. This study will also examine: (1) the effect of iCBT for MDD on disability (as measured by the SF-12 and SDS), general distress (as measured by the K10), (2) the feasibility of these treatments in terms of acceptability to diabetes patients and practicality for clinicians (as measured by the Credibility/Expectancy Questionnaire; CEQ). We hypothesise that associated disability, and general distress will reduce, and that patients with comorbid MDD and diabetes will rate the program as acceptable. Method:Recruit 100 people with MDD comorbid with diabetes (either Type 1 or Type 2), and randomly allocate to: iCBT (over 10 weeks) or treatment as usual (TAU) for 10 weeks, then iCBT. Measure pre- and post-intervention MDD severity, anxiety, diabetes-related distress, distress, disability, HbA1c, lifestyle, adherence, satisfaction with clinicians input and the treatment. Results:Preliminary results comparing MDD symptom levels, anxiety, diabetes-specific distress, distress, disability, HbA1c levels, and lifestyle factors from baseline to conclusion of treatment will be presented, as well as data on adherence to the lessons, homework downloads, satisfaction with the clinician's input and satisfaction with the mode of treatment generally.

Keywords: cognitive behaviour therapy, depression, diabetes, internet

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9243 Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance

Authors: Xin Li, Yan-Rong Guo, Jin-Fang Lin, Yi Feng, Håkan Billig, Ruijin Shao

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Background: Young women with polycystic ovary syndrome (PCOS) have a high risk of developing endometrial carcinoma. There is a need for the development of new medical therapies that can reduce the need for surgical intervention so as to preserve the fertility of these patients. The aim of the study was to describe and discuss cases of PCOS and insulin resistance (IR) women with early endometrial carcinoma while being co-treated with Diane-35 and metformin. Methods: Five PCOS-IR women who were scheduled for diagnosis and therapy for early endometrial carcinoma were recruited. The hospital records and endometrial pathology reports were reviewed. All patients were co-treated with Diane-35 and metformin for 6 months to reverse the endometrial carcinoma and preserve their fertility. Before, during, and after treatment, endometrial biopsies and blood samples were obtained and oral glucose tolerance tests were performed. Endometrial pathology was evaluated. Body weight (BW), body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), insulin area under curve (IAUC), and homeostasis model assessment of insulin resistance (HOMA-IR) were determined. Results: Clinical stage 1a, low grade endometrial carcinoma was confirmed before treatment. After 6 months of co-treatment, all patients showed normal epithelia. No evidence of atypical hyperplasia or endometrial carcinoma was found. Co-treatment resulted in significant decreases in BW, BMI, TT, FAI, IAUC, and HOMA-IR in parallel with a significant increase in SHBG. There were no differences in the FSH and LH levels after co-treatment. Conclusions: Combined treatment with Diane-35 and metformin has the potential to revert the endometrial carcinoma into normal endometrial cells in PCOS-IR women. The cellular and molecular mechanisms behind this effect merit further investigation.

Keywords: PCOS, progesterone resistance, insulin resistance, steroid hormone receptors, endometrial carcinoma

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9242 Biophysical Modeling of Anisotropic Brain Tumor Growth

Authors: Mutaz Dwairy

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Solid tumors have high interstitial fluid pressure (IFP), high mechanical stress, and low oxygen levels. Solid stresses may induce apoptosis, stimulate the invasiveness and metastasis of cancer cells, and lower their proliferation rate, while oxygen concentration may affect the response of cancer cells to treatment. Although tumors grow in a nonhomogeneous environment, many existing theoretical models assume homogeneous growth and tissue has uniform mechanical properties. For example, the brain consists of three primary materials: white matter, gray matter, and cerebrospinal fluid (CSF). Therefore, tissue inhomogeneity should be considered in the analysis. This study established a physical model based on convection-diffusion equations and continuum mechanics principles. The model considers the geometrical inhomogeneity of the brain by including the three different matters in the analysis: white matter, gray matter, and CSF. The model also considers fluid-solid interaction and explicitly describes the effect of mechanical factors, e.g., solid stresses and IFP, chemical factors, e.g., oxygen concentration, and biological factors, e.g., cancer cell concentration, on growing tumors. In this article, we applied the model on a brain tumor positioned within the white matter, considering the brain inhomogeneity to estimate solid stresses, IFP, the cancer cell concentration, oxygen concentration, and the deformation of the tissues within the neoplasm and the surrounding. Tumor size was estimated at different time points. This model might be clinically crucial for cancer detection and treatment planning by measuring mechanical stresses, IFP, and oxygen levels in the tissue.

Keywords: biomechanical model, interstitial fluid pressure, solid stress, tumor microenvironment

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9241 Efficacy of Celecoxib Adjunct Treatment on Bipolar Disorder: Systematic Review and Meta-Analysis

Authors: Daniela V. Bavaresco, Tamy Colonetti, Antonio Jose Grande, Francesc Colom, Joao Quevedo, Samira S. Valvassori, Maria Ines da Rosa

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Objective: Performed a systematic review and meta-analysis to evaluated the potential effect of the cyclo-oxygenases (Cox)-2 inhibitor Celecoxib adjunct treatment in Bipolar Disorder (BD), through of randomized controlled trials. Method: A search of the electronic databases was proceeded, on MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Biomed Central, Web of Science, IBECS, LILACS, PsycINFO (American Psychological Association), Congress Abstracts, and Grey literature (Google Scholar and the British Library) for studies published from January 1990 to February 2018. A search strategy was developed using the terms: 'Bipolar disorder' or 'Bipolar mania' or 'Bipolar depression' or 'Bipolar mixed' or 'Bipolar euthymic' and 'Celecoxib' or 'Cyclooxygenase-2 inhibitors' or 'Cox-2 inhibitors' as text words and Medical Subject Headings (i.e., MeSH and EMTREE) and searched. The therapeutic effects of adjunctive treatment with Celecoxib were analyzed, it was possible to carry out a meta-analysis of three studies included in the systematic review. The meta-analysis was performed including the final results of the Young Mania Rating Scale (YMRS) at the end of randomized controlled trials (RCT). Results: Three primary studies were included in the systematic review, with a total of 121 patients. The meta-analysis had significant effect in the YMRS scores from patients with BD who used Celecoxib adjuvant treatment in comparison to placebo. The weighted mean difference was 5.54 (95%CI=3.26-7.82); p < 0.001; I2 =0%). Conclusion: The systematic review suggests that adjuvant treatment with Celecoxib improves the response of major treatments in patients with BD when compared with adjuvant placebo treatment.

Keywords: bipolar disorder, Cox-2 inhibitors, Celecoxib, systematic review, meta-analysis

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9240 Screening of Plant Growth Promoting Rhizobacteria in the Rhizo- and Endosphere of Sunflower (Helianthus anus) and Their Role in Enhancing Growth and Yield Attriburing Trairs and Colonization Studies

Authors: A. Majeed, M.K. Abbasi, S. Hameed, A. Imran, T. Naqqash, M. K. Hanif

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Plant growth-promoting rhizobacteria (PGPR) are free-living soil bacteria that aggressively colonize the rhizosphere/plant roots, and enhance the growth and yield of plants when applied to seed or crops. Root associated (endophytic and rhizospheric) PGPR were isolated from Sunflower (Helianthus anus) grown in soils collected from 16 different sites of sub division Dhirkot, Poonch, Azad Jammu & Kashmir, Pakistan. A total of 150 bacterial isolates were isolated, purified, screened in vitro for their plant growth promoting (PGP) characteristics. 11 most effective isolates were selected on the basis of biochemical assays (nitrogen fixation, phosphate solubilization, growth hormone production, biocontrol assay, and carbon substrates utilization assay through gas chromatography (GCMS), spectrophotometry, high performance liquid chromatography HPLC, fungal and bacterial dual plate assay and BIOLOG GN2/GP2 microplate assay respectively) and were tested on the crop under controlled and field conditions. From the inoculation assay, the most promising 4 strains (on the basis of increased root/shoot weight, root/shoot length, seed oil content, and seed yield) were than selected for colonization studies through confocal laser scanning and transmission electron microscope. 16Sr RNA gene analysis showed that these bacterial isolates belong to Pseudononas, Enterobacter, Azospirrilum, and Citobacter genera. This study is the clear evident that such isolates have the potential for application as inoculants adapted to poor soils and local crops to minimize the chemical fertilizers harmful for soil and environment

Keywords: PGPR, nitrogen fixation, phosphate solubilization, colonization

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9239 Anterior Tooth Misalignment: Orthodontics or Restorative Treatment

Authors: Maryam Firouzmandi, Moosa Miri

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Smile is considered to be one of the most effective methods of influencing people. Increasing numbers of patients are requesting cosmetic dental procedures to achieve the perfect smile. Based on the patient’s age, oral and facial characteristics, and the dentist’s expertise, different concepts of treatment would be available. Orthodontics is the most conservative and the ideal treatment alternative for crowded anterior teeth; however, it may be rejected by patients due to occupational limitations of time, physical discomfort including pain and functional limitations, psychological discomfort, and appearance during treatment. In addition, orthodontic treatment will not resolve deficits of contour and color of the anterior teeth. In consequence, patients may demand restorative techniques to resolve their anterior mal-alignment instead, often called "instant orthodontics". Following its introduction, however, adhesive dentistry has suffered at times from overuse. Creating short-term attractive smiles at the expense of long-term dental health and optimal tooth biomechanics by using cosmetic techniques should not be considered an ethical approach. The objective of this narrative review was to investigate the literature for guidelines with regard to decision making and treatment planning for anterior tooth mal-alignment. In this regard, indications of orthodontic, restorative, combination of both treatments, and adjunctive periodontal surgery were discussed in clinical cases to achieve a proportional smile. Restorative modalities would include disking, cosmetic contouring, veneers, and crowns and were compared with limited or comprehensive orthodontic options. A rapid review was also presented on pros and cons of snap on smile to mask malalignments. Diagnostic tools such as mock up, wax up, and digital smile design were also considered to achieve more conservative and functional treatments with respect to biologic factors.

Keywords: crowding, misalignment, veneer, crown, orthodontics

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9238 Comparison of Adsorbents for Ammonia Removal from Mining Wastewater

Authors: F. Al-Sheikh, C. Moralejo, M. Pritzker, W. A. Anderson, A. Elkamel

Abstract:

Ammonia in mining wastewater is a significant problem, and treatment can be especially difficult in cold climates where biological treatment is not feasible. An adsorption process is one of the alternative processes that can be used to reduce ammonia concentrations to acceptable limits, and therefore a LEWATIT resin strongly acidic H+ form ion exchange resin and a Bowie Chabazite Na form AZLB-Na zeolite were tested to assess their effectiveness. For these adsorption tests, two packed bed columns (a mini-column constructed from a 32-cm long x 1-cm diameter piece of glass tubing, and a 60-cm long x 2.5-cm diameter Ace Glass chromatography column) were used containing varying quantities of the adsorbents. A mining wastewater with ammonia concentrations of 22.7 mg/L was fed through the columns at controlled flowrates. In the experimental work, maximum capacities of the LEWATIT ion exchange resin were 0.438, 0.448, and 1.472 mg/g for 3, 6, and 9 g respectively in a mini column and 1.739 mg/g for 141.5 g in a larger Ace column while the capacities for the AZLB-Na zeolite were 0.424, and 0.784 mg/g for 3, and 6 g respectively in the mini column and 1.1636 mg/g for 38.5 g in the Ace column. In the theoretical work, Thomas, Adams-Bohart, and Yoon-Nelson models were constructed to describe a breakthrough curve of the adsorption process and find the constants of the above-mentioned models. In the regeneration tests, 5% hydrochloric acid, HCl (v/v) and 10% sodium hydroxide, NaOH (w/v) were used to regenerate the LEWATIT resin and AZLB-Na zeolite with 44 and 63.8% recovery, respectively. In conclusion, continuous flow adsorption using a LEWATIT ion exchange resin and an AZLB-Na zeolite is efficient when using a co-flow technique for removal of the ammonia from wastewater. Thomas, Adams-Bohart, and Yoon-Nelson models satisfactorily fit the data with R2 closer to 1 in all cases.

Keywords: AZLB-Na zeolite, continuous adsorption, Lewatit resin, models, regeneration

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9237 Childhood Trauma and Borderline Personality: An Analysis of the Root Causes and Treatment Plans

Authors: Sidika McNeil

Abstract:

Borderline personality disorder (BPD) is a personality disorder that has been found to have strong origins in childhood trauma. One of the key symptoms of BPD is an association with irregular moods swings, as well as suicidal ideation (SI). Owing to the typically severe trauma patients experience during childhood, it is hard for them to control their emotions and thus makes it hard to emotionally regulate. It is then very common for those suffering from BPD to turn to unhealthy coping mechanisms, such as substance use, unhealthy relationships, and more, often unsuccessfully creating experiences that facilitate safety which leads to further negative experiences. With the high suicide rating among children, adolescents, and teens, and an ever-increasing number of children being diagnosed with BPD, it is very important that more research is done to find further treatments for patients who are currently suffering. Methods: Utilizing data found in prior studies, this paper will analyze the literature to focus on a comprehensive treatment plan for those with DBT. It is currently suggested that with the use of dialectical behavioral therapy (DBT), a therapy that focuses on changing negative thinking patterns and pushes for more positive ones is helpful for treatment for those with BPD. Though this therapy is not a cure to BPD, it does help mitigate the risk; this essay will explore other options that can further the treatment process, such as cognitive analytical therapy (CAT), which focuses on delving into the past to find the root causes of an issue to create coping strategies and harm reduction, a type of therapy used to aid patients in lowering the use of substances without complete cessation. Results: The research provides enough evidence to link between the treatment of BPD with the utilization of CAT.

Keywords: borderline personality disorder, cognitive analytical therapy, dialectical behavioral therapy, harm reduction, suicidal ideation

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9236 Psychosocial Determinants of Quality of Life After Treatment for Breast Cancer - A Systematic Review

Authors: Lakmali Anthony, Madeline Gillies

Abstract:

Purpose: Decreasing mortality has led to increased focus on patient-reported outcomes such as quality of life (QoL) in breast cancer. Breast cancer patients often have decreased QoL even after treatment is complete. This systematic review of the literature aims to identify psychosocial factors associated with decreased QoL in post-treatment breast cancer patients. Methodology: This systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search was conducted in MEDLINE, EMBASE, and PsychINFO using MeSH headings. The two authors screened studies for relevance and extracted data. Results: Seventeen studies were identified, including 3,150 total participants (mean = 197) with a mean age of 51.9 years. There was substantial heterogeneity in measures of QoL. The most common was the European Organisation for Research and Treatment of Cancer QLQ-C30 (n=7, 41.1%). Most studies (n=12, 70.5%) found that emotional distress correlated with poor QoL, while 3 found no significant association. The most common measure of emotional distress was the Hospital Anxiety and Depression Scale (n=12, 70.5%). Other psychosocial factors associated with QoL were unmet needs, problematic social support, and negative affect. Clinicopathologic determinants included mastectomy without reconstruction, stage IV disease, and adjuvant chemotherapy. Conclusion: This systematic review provides a summary of the psychosocial determinants of poor QoL in post-treatment breast cancer patients, as well as the most commonly reported measures of these. An understanding of these potentially modifiable determinants of poor outcome is pivotal to the provision of quality, patient-centred care in surgical oncology.

Keywords: breast cancer, quality of life, psychosocial determinants, cancer surgery

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9235 Integrated Waste-to-Energy Approach: An Overview

Authors: Tsietsi J. Pilusa, Tumisang G. Seodigeng

Abstract:

This study evaluates the benefits of advanced waste management practices in unlocking waste-to-energy opportunities within the solid waste industry. The key drivers of sustainable waste management practices, specifically with respect to packaging waste-to-energy technology options are discussed. The success of a waste-to-energy system depends significantly on the appropriateness of available technologies, including those that are well established as well as those that are less so. There are hard and soft interventions to be considered when packaging an integrated waste treatment solution. Technology compatibility with variation in feedstock (waste) quality and quantities remains a key factor. These factors influence the technology reliability in terms of production efficiencies and product consistency, which in turn, drives the supply and demand network. Waste treatment technologies rely on the waste material as feedstock; the feedstock varies in quality and quantities depending on several factors; hence, the technology fails, as a result. It is critical to design an advanced waste treatment technology in an integrated approach to minimize the possibility of technology failure due to unpredictable feedstock quality, quantities, conversion efficiencies, and inconsistent product yield or quality. An integrated waste-to-energy approach offers a secure system design that considers sustainable waste management practices.

Keywords: emerging markets, evaluation tool, interventions, waste treatment technologies

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9234 Hydrogen, a Novel Therapeutic Molecule, in Osteosarcoma Disease

Authors: Priyanka Sharma, Rajeshwar Nath Srivastava

Abstract:

Hydrogen has a high level of efficacy in suppressing tumour growth. The role of hydrogen in cancer treatment is unclear. This groundbreaking research will focus on the most effective therapeutic approach for osteosarcoma. Recent data reveals that hydrogen, a naturally occurring gaseous chemical, can protect cells from death. However, little is known about the signalling pathways that regulate cardiac cell death and individual apoptosis signalling by H2 and its downstream targets. According to certain research, the anti-tumor effect of H2 released by magnesium-based biomaterials is mediated by the P53-mediated lysosome-mitochondria apoptosis signalling pathway, bolstering the biomaterial's therapeutic potential as a localised anti-tumor treatment. The role of the H2 molecule in the signalling of apoptotic, autophagic, necroptotic, and pyroptotic cell death in Osteosarcoma is discussed in this paper. Potential Hydrogen-based therapy techniques will broaden the treatment horizon for Osteosarcoma.

Keywords: osteosarcoma, metastasis, hhydrogen, therapeutic

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9233 The Effect of Multiple Environmental Conditions on Acacia senegal Seedling’s Carbon, Nitrogen, and Hydrogen Contents: An Experimental Investigation

Authors: Abdelmoniem A. Attaelmanan, Ahmed A. H. Siddig

Abstract:

This study was conducted in light of continual global climate changes that projected increasing aridity, changes in soil fertility, and pollution. Plant growth and development largely depend on the combination of availing water and nutrients in the soil. Changes in the climate and atmospheric chemistry can cause serious effects on these growth factors. Plant carbon (C), nitrogen (N), and hydrogen (H) play a fundamental role in the maintenance of ecosystem structure and function. Hashab (Acacia senegal), which produces gum Arabic, supports dryland ecosystems in tropical zones by its potentiality to restore degraded soils; hence it is ecologically and economically important for the dry areas of sub-Saharan Africa. The study aims at investigating the effects of water stress (simulated drought) and poor soil type on Acacia senegal C, N, and H contents. Seven days old seedlings were assigned to the treatments in Split- plot design for four weeks. The main plot is irrigation interval (well-watered and water-stressed), and the subplot is soil types (silt and sand soils). Seedling's C%, N%, and H% were measured using CHNS-O Analyzer and applying Standard Test Method. Irrigation intervals and soil types had no effects on seedlings and leaves C%, N%, and H%, irrigation interval had affected stem C and H%, both irrigation intervals and soil types had affected root N% and interaction effect of water and soil was found on leaves and root's N%. Synthesis application of well-watered irrigation with soil that is rich in N and other nutrients would result in the greatest seedling C, N, and H content which will enhance growth and biomass accumulation and can play a crucial role in ecosystem productivity and services in the dryland regions.

Keywords: Acacia senegal, Africa, climate change, drylands, nutrients biomass, Sub-Saharan, Sudan

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9232 Corticomotor Excitability after Two Different Repetitive Transcranial Magnetic Stimulation Protocols in Ischemic Stroke Patients

Authors: Asrarul Fikri Abu Hassan, Muhammad Hafiz bin Hanafi, Jafri Malin Abdullah

Abstract:

This study is to compare the motor evoked potential (MEP) changes using different settings of repetitive transcranial magnetic stimulation (rTMS) in the post-haemorrhagic stroke patient which treated conservatively. The goal of the study is to determine changes in corticomotor excitability and functional outcome after repetitive transcranial magnetic stimulation (rTMS) therapy regime. 20 post-stroke patients with upper limb hemiparesis were studied due to haemorrhagic stroke. One of the three settings; (I) Inhibitory setting, or (II) facilitatory setting, or (III) control group, no excitatory or inhibitory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. Functional outcomes were evaluated using the Barthel index score. We found pre-treatment MEP values of the lesional side were lower compared to post-treatment values in both settings. In contrast, we found that the pre-treatment MEP values of the non-lesional side were higher compared to post-treatment values in both settings. Interestingly, patients with treatment, either facilitatory setting and inhibitory setting have faster motor recovery compared to the control group. Our data showed both settings might improve the MEP of the upper extremity and functional outcomes in the haemorrhagic stroke patient.

Keywords: Barthel index, corticomotor excitability, motor evoked potential, repetitive transcranial magnetic stimulation, stroke

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9231 Fumigant Insecticidal Efficacy of Ozone Gas (O₃) Towards Tribolium castaneum and Cryptolestes ferrugineus

Authors: S. Saleem, L. J. Mason, M. Hasan, M. Sagheer, Q. Ali, S. Akhtar, C. M. S. Hanif

Abstract:

Ozone has been documented as a potential fumigant against major insect pests of stored commodities due to its highly oxidative properties. Present studies were conducted in the Smith Hall (Department of Entomology), Purdue University, USA, to examine the fumigant toxicities of ozone gas (O₃) against stored grain insect pests. Adults of Tribolium castaneum and Cryptolestes ferrugineus were exposed to different concentrations (100, 200, 480, 700, and 800 ppm) of ozone gas. Test insects were fumigated by keeping a constant temperature of 27 ± 2 °C and 75 ± 5% relative humidity, while dead insects were recorded after 6, 12, 18, 24, 30, and 36 hr of treatment. C. ferrugineus was found susceptible, with mean mortality of 90.99% as compared to T. castaneum (53.22%). Fumigation, even with lower concentrations (100 ppm) of ozone gas for 36 hr, exhibited 100% mortality against C. ferrugineus. Mortality increased with the increase in concentration and exposure time. 100% mortality was achieved with 800 ppm concentration after 18hr of treatment against T. castaneum and with 700 ppm after 6 hr of treatment against C. ferrugineus.

Keywords: ozone gas, toxicity, O₃, Tribolium castaneum, Cryptolestes ferrugineus, stored grain insect pests

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9230 Supplementation of Leucahena leucochepala on Rice Straw Ammoniated Complete Feed on Fiber Digestibility and in vitro Rumen Fermentation Characteristics

Authors: Mardiati Zain, W. S. N. Rusmana, Erpomen, Malik Makmur, Ezi Masdia Putri

Abstract:

Background and Aim: The leaves of the Leucaenaleucocephala tree have potential as a nitrogen source for ruminants. Leucaena leaf meal as protein supplement has been shown to improve the feed quality of ruminants. The effects of different levels of Leucaena leucocephala supplementation as substitute of concentrate on fiber digestibility and in vitro rumen fermentation characteristics were investigated. This research was conducted in vitro. The study used a randomized block design consisting of 3 treatments and 5 replications. The treatments were A. 40% rice straw ammoniated + 60% concentrate, B. 40% rice straw ammoniated + 50% concentrate + 10% Leucaena leuchephala, C. 40% rice straw ammoniated + 40% concentrate + 20% Leucaena leuchephala, Result: The results showed that the addition of Leucaena leucocephala increased the digestibility of Neutral detergent Fiber NDF and Acid Detergent Fiber (ADF) (p < 0.05). In this study, rumen NH3, propionate, amount of escape protein and total Volatyl Fatty Acid (VFA) were found increased significantly at treatment B. No significant difference was observed in acetate and butyrate production. The populations of total protozoa and methane production had significantly decreased (P < .05) in supplemented group. Conclusion: Supplementation of leuchaena leucochepala on completed feed based on ammoniated rice straw in vitro can increase fiber digestibility, VFA production and decreased protozoa pupulataion and methane production. Supplementation of 10% and 20% L. leucochepala were suitable to be used for further studies, therefore in vivo experiment is required to study the effects on animal production.

Keywords: digestibility, Leucaena leucocephala, complete feed, rice straw ammoniated

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9229 Factors Contributing to Delayed Diagnosis and Treatment of Breast Cancer and Its Outcome in Jamhoriat Hospital Kabul, Afghanistan

Authors: Ahmad Jawad Fardin

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Over 60% of patients with breast cancer in Afghanistan present late with advanced stage III and IV, a major cause for the poor survival rate. The objectives of this study were to identify the contributing factors for the diagnosis and treatment delay and its outcome. This cross-sectional study was conducted on 318 patients with histologically confirmed breast cancer in the oncology department of Jamhoriat hospital, which is the first and only national cancer center in Afghanistan; data were collected from medical records and interviews conducted with women diagnosed with breast cancer, linear regression and logistic regression were used for analysis. Patient delay was defined as the time from first recognition of symptoms until first medical consultation and doctor form first consultation with a health care provider until histological confirmation of breast cancer. The mean age of patients was 49.2+_ 11.5years. The average time for the final diagnosis of breast cancer was 8.5 months; most patients had ductal carcinoma 260.7 (82%). Factors associated with delay were low education level 76% poor socioeconomic and cultural conditions 81% lack of cancer center 73% lack of screening 19%. The stage distribution was as follows stage IV 4 22% stage III 44.4% stage II 29.3% stage I 4.3%. Complex associated factors were identified to delayed the diagnosis of breast cancer and increased adverse outcomes consequently. Raising awareness and education in women, the establishment of cancer centers and providing accessible diagnosis service and screening, training of general practitioners; required to promote early detection, diagnosis and treatment.

Keywords: delayed diagnosis and poor outcome, breast cancer in Afghanistan, poor outcome of delayed breast cancer treatment, breast cancer delayed diagnosis and treatment in Afghanistan

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9228 Biodistribution of Fluorescence-Labelled Epidermal Growth Factor Protein from Slow Release Nanozolid Depots in Mouse

Authors: Stefan Gruden, Charlott Brunmark, Bo Holmqvist, Erwin D. Brenndorfer, Martin Johansson, Jian Liu, Ying Zhao, Niklas Axen, Moustapha Hassan

Abstract:

Aim: The study was designed to evaluate the ability of the calcium sulfate-based NanoZolid® drug delivery technology to locally release the epidermal growth factor (EGF) protein while maintaining its biological activity. Methods: NanoZolid-formulated EGF protein labelled with a near-infrared dye (EGF-NIR) depots or EGF-NIR dissolved in PBS were injected subcutaneously into mice bearing EGF receptor (EGFR) positive human A549 lung cancer tumors inoculated subcutaneously. The release and biodistribution of the EGF-NIR were investigated in vivo longitudinally up to 96 hours post-administration, utilizing whole-body fluorescence imaging. In order to confirm the in vivo findings, histological analysis of tumor cryosections was performed to investigate EGF-NIR fluorescent signal and EGFR expression level by immunofluorescence labelling. Results: The in vivo fluorescence imaging showed a controlled release profile of the EGF-NIR loaded in the NanoZolid depots compared to free EGF-NIR. Histological analysis of the tumors further demonstrated a prevailing distribution of EGF-NIR in regions with high levels of EGFR expression. Conclusion: Calcium sulfate based depots can be used to formulate EGF while maintaining its biological activity, e.g., receptor binding capability. This may have good clinical potential for local delivery of biomolecules to enhance treatment efficacy and minimize systemic adverse effects.

Keywords: bioresorbable, calcium sulfate, controlled release, NanoZolid

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9227 Risk of Fatal and Non-Fatal Coronary Heart Disease and Stroke Events among Adult Patients with Hypertension: Basic Markov Model Inputs for Evaluating Cost-Effectiveness of Hypertension Treatment: Systematic Review of Cohort Studies

Authors: Mende Mensa Sorato, Majid Davari, Abbas Kebriaeezadeh, Nizal Sarrafzadegan, Tamiru Shibru, Behzad Fatemi

Abstract:

Markov model, like cardiovascular disease (CVD) policy model based simulation, is being used for evaluating the cost-effectiveness of hypertension treatment. Stroke, angina, myocardial infarction (MI), cardiac arrest, and all-cause mortality were included in this model. Hypertension is a risk factor for a number of vascular and cardiac complications and CVD outcomes. Objective: This systematic review was conducted to evaluate the comprehensiveness of this model across different regions globally. Methods: We searched articles written in the English language from PubMed/Medline, Ovid/Medline, Embase, Scopus, Web of Science, and Google scholar with a systematic search query. Results: Thirteen cohort studies involving a total of 2,165,770 (1,666,554 hypertensive adult population and 499,226 adults with treatment-resistant hypertension) were included in this scoping review. Hypertension is clearly associated with coronary heart disease (CHD) and stroke mortality, unstable angina, stable angina, MI, heart failure (HF), sudden cardiac death, transient ischemic attack, ischemic stroke, subarachnoid hemorrhage, intracranial hemorrhage, peripheral arterial disease (PAD), and abdominal aortic aneurism (AAA). Association between HF and hypertension is variable across regions. Treatment resistant hypertension is associated with a higher relative risk of developing major cardiovascular events and all-cause mortality when compared with non-resistant hypertension. However, it is not included in the previous CVD policy model. Conclusion: The CVD policy model used can be used in most regions for the evaluation of the cost-effectiveness of hypertension treatment. However, hypertension is highly associated with HF in Latin America, the Caribbean, Eastern Europe, and Sub-Saharan Africa. Therefore, it is important to consider HF in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment in these regions. We do not suggest the inclusion of PAD and AAA in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment due to a lack of sufficient evidence. Researchers should consider the effect of treatment-resistant hypertension either by including it in the basic model or during setting the model assumptions.

Keywords: cardiovascular disease policy model, cost-effectiveness analysis, hypertension, systematic review, twelve major cardiovascular events

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