Search results for: cross infections
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4799

Search results for: cross infections

3449 Two Strain Dengue Dynamics Incorporating Temporary Cross Immunity with ADE Effect

Authors: Sunita Gakkhar, Arti Mishra

Abstract:

In this paper, a nonlinear host vector model has been proposed and analyzed for the two strain dengue dynamics incorporating ADE effect. The model considers that the asymptomatic infected people are more responsible for secondary infection than that of symptomatic ones and differentiates between them. The existence conditions are obtained for various equilibrium points. Basic reproduction number has been computed and analyzed to explore the effect of secondary infection enhancement parameter on dengue infection. Stability analyses of various equilibrium states have been performed. Numerical simulation has been done for the stability of endemic state.

Keywords: dengue, ade, stability, threshold, asymptomatic, infection

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3448 Quorum Quenching Activities of Bacteria Isolated from Red Sea Sediments

Authors: Zahid Rehman, TorOve Leiknes

Abstract:

Quorum sensing (QS) is the process by which bacteria communicate with each other through small signaling molecules, such as N-acylhomoserine lactones (AHLs). Also, certain bacteria have the ability to degrade AHL molecules by a process referred to as quorum quenching (QQ); therefore, QQ can be used to control bacterial infections and biofilm formation. In this study, we aimed to identify new species of bacteria with QQ activities. To achieve this, sediments from Red Sea were collected either in the close vicinity of Sea grass or from area with no vegetation. From these samples, we isolated 72 bacterial strains and tested their ability to degrade/inactivate AHL molecules. Chromobacterium violaceum based bioassay was used in initial screening of isolates for QQ activity. The QQ activity of the positive isolates was further confirmed and quantified by employing liquid chromatography and mass spectrometry. These analyses showed that isolated bacterial strain could degrade AHL molecules with different acyl chain length and modifications. Sequencing of 16S-rRNA genes of positive isolates revealed that they belong to three different genera. Specifically, two isolates belong to genus Erythrobacter, four to Labrenzia and one isolate belongs to Bacterioplanes. Time course experiment showed that isolate belonging to genus Erythrobacter could degrade AHLs faster than other isolates. Furthermore, these isolates were tested for their ability to inhibit formation of biofilm and degradation of 3OXO-C12 AHLs produced by P. aeruginosa PAO1. Our results showed that isolate VG12 is better at controlling biofilm formation. This aligns with the ability of VG12 to cause at least 10-fold reduction in the amount of different AHLs tested.

Keywords: quorum sensing, biofilm, quorum quenching, anti-biofouling

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3447 Sedimentological and Petrographical Studies on the Cored samples from Bentiu Formation Muglad Basin

Authors: Yousif M. Makeen

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This study presents the results of the sedimentological and petrographical analyses on the cored samples from the Bentiu Formation. The cored intervals consist of thick beds of sandstone, which are sometimes intercalated with beds of fine-grained sandstone and, in a minor case, with a siltstone bed. Detailed sedimentological facies analysis revealed the presence of six facies types, which can be clarified in order of their great percentage occurrences as follows: (i) Massive sandstone, (ii) Planar cross-bedded sandstone, (iii) Trough cross-bedded sandstone, (iv) Fine laminated sandstone (v) Fine laminated siltstone and (vi) Horizontally parted sandstone. The petrographical analyses under the plane polarized microscope and the scanning electron microscope (SEM) for the sandstone lithofacies types that exist within the cored intervals allowed classifying these lithofacies into Kaolinitic Subfeldspathic Arenites. Among the detrital components, quartz grains are the most abundant (mainly monocrystalline quartz), followed by feldspars, micas, detrital and authigenic clays, and carbonaceous debris. However, traces of lithic fragments, iron oxides and heavy minerals were observed in some of the analyzed samples, where they occur in minor amounts. Kaolinite is present mainly as an authigenic component in most of the analyzed samples, while quartz overgrowths occur in variable amounts in most of the investigated samples. Carbonates (calcite & siderite) are present in considerable amounts. The grain roundness in most of the investigated sandstone samples ranges from well-rounded to round, and, in fewer samples, is sub-angular to angular. Most of the sandstone samples are moderately compacted and display point, concavo-convex and long grain contacts, whereas the sutured grain contacts, which reflect a higher degree of compaction, are relatively observed in lesser amounts, while the float grain contact has also been observed in minor quantity. Pore types in the analyzed samples are dominantly primary and secondary interparticle forms. Point-counted porosity values range from 19.6% to 30%. Average pore sizes are highly variable and range from 20 to 350 microns. Pore interconnectivity ranges from good to very good.

Keywords: sandstone, sedimentological facies, porosity, quartz overgrowths

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3446 Development and Evaluation of Removable Shear Link with Perforated Web

Authors: Daniel Y. Abebe, Jaehyouk Choi

Abstract:

The objective of this paper is to investigate, through an analytical study, the behavior of both stiffened and un-stiffened removable shear link with perforated web considering different number and size of web openings. Removable shear link with perforated web is a novel shear link beam proposed to be used in eccentrically braced frame (EBF). The proposed link overcomes the difficulties during construction slab due to less cross-sectional areas of the link to control the plastic deformation on the conventional EBF with removable shear link. Finite element analyses were conducted under both cyclic and monotonic loading and from the results obtained design equations are developed.

Keywords: eccentrically braced frame, removable shear link, perforated web, non-linear FE analysis

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3445 Prevalence of Extended Spectrum of Beta Lactamase Producers among Gram Negative Uropathogens

Authors: Y. V. S. Annapurna, V. V. Lakshmi

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Urinary tract infection (UTI) is one of the most common infectious diseases at the community level with a high rate of morbidity . This is further augmented by increase in the number of resistant and multi resistant strains of bacteria particularly by those producing Extended spectrum of beta lactamases. The present study was aimed at analysis of antibiograms of E.coli and Klebsiella sp causing urinary tract infections. Between November 2011 and April 2013, a total of 1120 urine samples were analyzed,. Antibiotic sensitivity testing was done with 542(48%) isolates of E.coli and 446(39%) of Klebsiella sp using the standard disc diffusion method against eleven commonly used antibiotics .Organisms showed high susceptibility to Amikacin and Netilimicin and low susceptibility to Cephalosporins. MAR index was calculated for the multidrug resistant strains. Maximum MAR index detected among the isolates was 0.9. Phenotypic identification for ESBL production was confirmed by double disk synergy test (DDST) according to CLSI guidelines. Plasmid profile of the isolates was carried out using alkaline hydrolysis method. Agarose-gel electrophoresis showed presence of high-molecular weight plasmid DNA among the ESBL strains. This study emphasizes the importance of indiscriminate use of antibiotics which if discontinued, in turn would prevent further development of bacterial drug resistance. For this, a proper knowledge of susceptibility pattern of uropathogens is necessary before prescribing empirical antibiotic therapy and it should be made mandatory.

Keywords: escherichia coli, extended spectrum of beta lactamase, Klebsiella spp, Uropathogens

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3444 Physical Inactivity and Junk Food Consumption Consequent Obesity among University Girls: A Cross Sectional Study Unveils the Mayhem

Authors: Shahid Mahmood, Ghulam Mueen-Ud-Din, Farah Naz Akbar, Yousaf Quddoos, Syeda Mahvish Zahra, Wajiha Saeed, Tayyaba Sami Ullah

Abstract:

Obesity is an epidemic across the globe that affects all the segments of the population. Physical inactivity, passionate consumption of junk food, inadequate water intake and an unhealthy lifestyle are evident among university girls that are ruining their health gravely especially fat accumulation. The study was carried out to investigate the potential etiological factors of obesity development in university girls. The cross sectional study was carried out after approval of the Departmental Review Committee for Ethics (DRCE) as the par Declaration of Helsinki at Institute of Food Science and Nutrition (IFSN), University of Sargodha, Sargodha-Pakistan and Department of Food Science and Home Economics, G. C. Women University, Faisalabad-Pakistan. 400 girls were selected randomly from different departments of both universities. Nutritional status of the volunteers was assessed through approved protocols for demographics, anthropometrics, body composition, energetics, vital signs, clinical signs and symptoms, medical/family history, and dietary intake assessment (FFQ), water intake and physical activity level. The obesity was determined on body fat (%). Alarming and unheeded etiological factors for the development of obesity in girls were explored by the study. About 93 % girls had a sedentary level of physical activity, zealous consumption of junk food (5.31±1.23 servings), drank little water (1.09±0.26 L/day) that consequent high heaps of fat (35.06±3.02 %), measly body water (52.38±3.4 %), poor bone mass (05.14±0.31 Kg), and high BMI (26.68±1.14 Kg/m²) in 34% girls. The malnutrition also depicted by poor vital signs i.e. low body temperature (97.11±0.93 °F), slightly higher blood pressure (124.19±4.08 / 85.25±2.97 mmHg), rapid pulse rate (99.2 ± 6.85 beats/min), reduced blood O₂ saturation (96.53±0.96 %), scanty peak expiratory flow rate (297 ± 15.7 L /min). The outcomes of the research articulated that physical inactivity; extreme intakes of junk food, insufficient water consumption are etiological factors for obesity development among girls which are usually overlooked in Pakistan.

Keywords: informed consent, junk food, obesity, physical inactivity

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3443 Feature of Employment Injuries and Maintenance Works of Construction Machinery

Authors: Naoko Kanazawa, Tran Thi Bich Nguyet, Yoshiyuki Higuchi, Hideki Hamada

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Construction machines’ condition is maintained with the regularly inspections, preventive maintenance and repairs by skillful and qualified engineers. If an accident occurs, there will be enormous influence such as human injuries, delays in the term of construction. In this paper, we revealed the characteristics such as inspection, maintenance and repair works for construction machines, and we also clarified the trends of employment injuries based on actual data by simple and cross tabulation methods, and investigated the relation with their works, injured body parts and accident types.

Keywords: construction machines, employment injuries, maintenance and repair, safety and health

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3442 Synergistic Effect of Eugenol Acetate with Betalactam Antibiotic on Betalactamase and Its Bioinformatics Analysis

Authors: Vinod Nair, C. Sadasivan

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Beta-lactam antibiotics are the most frequently prescribed medications in modern medicine. The antibiotic resistance by the production of enzyme beta-lactamase is an important mechanism seen in microorganisms. Resistance to beta-lactams mediated by beta-lactamases can be overcome successfully with the use of beta-lactamase inhibitors. New generations of the antibiotics contain mostly synthetic compounds, and many side effects have been reported for them. Combinations of beta-lactam and beta-lactamase inhibitors have become one of the most successful antimicrobial strategies in the current scenario of bacterial infections. Plant-based drugs are very cheap and having lesser adverse effect than synthetic compounds. The synergistic effect of eugenol acetate with beta-lactams restores the activity of beta-lactams, allowing their continued clinical use. It is reported here the enhanced inhibitory effect of phytochemical, eugenol acetate, isolated from the plant Syzygium aromaticum with beta-lactams on beta-lactamase. The compound was found to have synergistic effect with the antibiotic amoxicillin against antibiotic-resistant strain of S.aureus. The enzyme was purified from the organism and incubated with the compound. The assay showed that the compound could inhibit the enzymatic activity of beta-lactamase. Modeling and molecular docking studies indicated that the compound can fit into the active site of beta-lactamase and can mask the important residue for hydrolysis of beta-lactams. The synergistic effects of eugenol acetate with beta-lactam antibiotics may justify, the use of these plant compounds for the preparation of β-lactamase inhibitors against β-lactam resistant S.aureus.

Keywords: betalactamase, eugenol acetate, synergistic effect, molecular modeling

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3441 The Measurement of the Multi-Period Efficiency of the Turkish Health Care Sector

Authors: Erhan Berk

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The purpose of this study is to examine the efficiency and productivity of the health care sector in Turkey based on four years of health care cross-sectional data. Efficiency measures are calculated by a nonparametric approach known as Data Envelopment Analysis (DEA). Productivity is measured by the Malmquist index. The research shows how DEA-based Malmquist productivity index can be operated to appraise the technology and productivity changes resulted in the Turkish hospitals which are located all across the country.

Keywords: data envelopment analysis, efficiency, health care, Malmquist Index

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3440 Child Feeding Practices Among Mothers in Urban Areas of Akure, Ondo State, Nigeria

Authors: Olufemi Samuel Shola, Oladapo Adenike Adesola

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Inadequate dietary intake has increased the susceptibility of under five children to malnutrition and infections. This study, therefore, assessed the feeding practices of children of 0-23 months of age among mothers in urban areas of Akure, Ondo State, Nigeria. Simple random sampling technique was used to select four hundred (400) mothers out of 710 mothers from 7 primary health care centres in Akure metropolis for the study. Data were collected using modified WHO 2003 Questionnaire on child feeding practices. Data were analyzed using descriptive statistics, while chi-square was used to determine the association between variables. Results showed that 52.0% of the children were males, with 47.5% in the 6-8 months age group. More than half (57.0%) of the mothers were between the ages of 20-29 years, and 45.0% had secondary education. Majority (94.3%) of the mothers breastfed their children in the last 24 hours preceding the survey. The feeding practices history of mothers showed that 28.0% and 53.7% of the mothers initiated breastfeeding less than 30 minutes and between 30 minutes to 1 hour after delivery, respectively. Also, 52.0% of mothers practiced exclusive breastfeeding for six months, while 26.2% breastfed from 6 months up to 2 years of age. Dietary diversity of the children age 6-23 months revealed that 68.7% of the children attained the minimum dietary diversity by consuming 4 or more food groups in the last 24 hours. There was a significant association (P < 0.05) between mothers’ education (n=180), occupation(n=41) and dietary diversity (n= 150) and meal frequency (n=209). Therefore, the study concluded that the duration of breastfeeding and time of introduction of complementary food did not meet WHO recommended guidelines. There is urgent need to launching more programmes.

Keywords: breastfeeding, mothers, child feeding, urban areas, ondo state, nigeria

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3439 Analysis of Short Counter-Flow Heat Exchanger (SCFHE) Using Non-Circular Micro-Tubes Operated on Water-CuO Nanofluid

Authors: Avdhesh K. Sharma

Abstract:

Key, in the development of energy-efficient micro-scale heat exchanger devices, is to select large heat transfer surface to volume ratio without much expanse on re-circulated pumps. The increased interest in short heat exchanger (SHE) is due to accessibility of advanced technologies for manufacturing of micro-tubes in range of 1 micron m - 1 mm. Such SHE using micro-tubes are highly effective for high flux heat transfer technologies. Nanofluids, are used to enhance the thermal conductivity of re-circulated coolant and thus enhances heat transfer rate further. Higher viscosity associated with nanofluid expands more pumping power. Thus, there is a trade-off between heat transfer rate and pressure drop with geometry of micro-tubes. Herein, a novel design of short counter flow heat exchanger (SCFHE) using non-circular micro-tubes flooded with CuO-water nanofluid is conceptualized by varying the ratio of surface area to cross-sectional area of micro-tubes. A framework for comparative analysis of SCFHE using micro-tubes non-circular shape flooded by CuO-water nanofluid is presented. In SCFHE concept, micro-tubes having various geometrical shapes (viz., triangular, rectangular and trapezoidal) has been arranged row-wise to facilitate two aspects: (1) allowing easy flow distribution for cold and hot stream, and (2) maximizing the thermal interactions with neighboring channels. Adequate distribution of rows for cold and hot flow streams enables above two aspects. For comparative analysis, a specific volume or cross-section area is assigned to each elemental cell (which includes flow area and area corresponds to half wall thickness). A specific volume or cross-section area is assumed to be constant for each elemental cell (which includes flow area and half wall thickness area) and variation in surface area is allowed by selecting different geometry of micro-tubes in SCFHE. Effective thermal conductivity model for CuO-water nanofluid has been adopted, while the viscosity values for water based nanofluids are obtained empirically. Correlations for Nusselt number (Nu) and Poiseuille number (Po) for micro-tubes have been derived or adopted. Entrance effect is accounted for. Thermal and hydrodynamic performances of SCFHE are defined in terms of effectiveness and pressure drop or pumping power, respectively. For defining the overall performance index of SCFHE, two links are employed. First one relates heat transfer between the fluid streams q and pumping power PP as (=qj/PPj); while another link relates effectiveness eff and pressure drop dP as (=effj/dPj). For analysis, the inlet temperatures of hot and cold streams are varied in usual range of 20dC-65dC. Fully turbulent regime is seldom encountered in micro-tubes and transition of flow regime occurs much early (i.e., ~Re=1000). Thus, Re is fixed at 900, however, the uncertainty in Re due to addition of nanoparticles in base fluid is quantified by averaging of Re. Moreover, for minimizing error, volumetric concentration is limited to range 0% to ≤4% only. Such framework may be helpful in utilizing maximum peripheral surface area of SCFHE without any serious severity on pumping power and towards developing advanced short heat exchangers.

Keywords: CuO-water nanofluid, non-circular micro-tubes, performance index, short counter flow heat exchanger

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3438 Conductivity and Selection of Copper Clad Steel Wires for Grounding Applications

Authors: George Eduful, Kingsford J. A. Atanga

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Copper clad steel wire (CCS) is primarily used for grounding applications to reduce the high incidence of copper ground conductor theft in electrical installations. The cross sectional area of the CCS is selected by relating the diameter equivalence to a copper conductor. The main difficulty is how to use a simple analytical relation to determine the right conductivity of CCS for a particular application. The use of Eddy-Current instrument for measuring conductivity is known but in most cases, the instrument is not readily available. The paper presents a simplified approach on how to size and determine CCS conductivity for a given application.

Keywords: copper clad steel wire, conductivity, grounding, skin effect

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3437 Medical Nutritional Therapy in Human Immunodeficiency Virus Infection with Tuberculosis and Severe Malnutrition: A Case Report

Authors: Lista Andriyati, Nurpudji A Taslim

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The human immunodeficiency virus (HIV) patients have potential nutritional and metabolic problems. HIV is a virus that attacks cells T helper and impairs the function of immune cells. Infected individuals gradually become immunodeficient, results in increased susceptibility to a wide range of infections such as tuberculosis (TB). Malnutrition has destructive effects on the immune system and host defense mechanisms. Effective and proper nutritional therapies are important to improve medical outcomes and quality of life, which is associated with functional improvement. A case of 38-years old man admitted to hospital with loss of consciousness and was diagnosed HIV infection and relapse lung TB with severe malnutrition, fever, oral candidiasis, anemia (6.3 g/dL), severe hypoalbuminemia (1.9 g/dL), severe hypokalemia (2.2 mmol/L), immune depletion (1085 /µL) and elevated liver enzyme (ALT 1198/AST 375 U/L). Nutritional intervention by giving 2300 kcal of energy, protein 2 g/IBW/day, carbohydrate 350 g, fat 104 g through enteral and parenteral nutrition. Supplementations administered are zinc, vitamin A, vitamin B1, vitamin B6, vitamin B12, vitamin C, vitamin D, and snakehead fish extract high content of protein albumin (Pujimin®). After 46 days, there are clinical and metabolic improvement in Hb (6.3 to 11.2 g/dL), potassium (2.2 to 3.4 mmol/L), albumin (1.9 to 2.3 g/dL), ALT 1198 to 47/AST 375 to 68 U/L) and improved awareness. In conclusion, nutritional therapy in HIV infection with adequate macronutrients and micronutrients fulfillment and immunonutrition is very important to avoid cachexia and to improve nutritional status and immune disfunction.

Keywords: HIV, hypoalbuminemia, malnutrition, tuberculosis

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3436 Factors Associated with Respiratory Distress Syndrome (RDS) in Preterm Neonates Admitted at FMIC in Kabul City: A Retrospective Cross-Sectional Study

Authors: Omid Ahmad Faizi

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INTRODUCTION: Prematurity is one of the primary causes of infant death in Afghanistan, and it complicates a variety of critical issues, such as respiratory distress syndrome (RDS). Although RDS has been associated with serious consequences, there is a lack of scientific information on the associated factors of this problem in Afghanistan; hence, this study was undertaken to fill that gap. OBJECTIVES: The purpose of this study was to find the occurrence rate and associated factors of RDS in premature neonates. METHODS: This retrospective cross-sectional study was conducted at the Neonatal Intensive Care Unit of the French Medical Institute for Mothers and Children Hospital in Kabul City, Afghanistan (01/01/2022-30/12/2022). Statistical analysis was performed by SPSS 24. RESULT: A total of 78 preterm newborns were enrolled in this study, and respiratory distress syndrome developed in 51.3% of them. Based on gestational age, the occurrence rates of RDS within groups of extremely, early, moderate and late preterm neonates were 100%, 55.6%, 44%, and 35.7%, respectively. The occurrence of RDS was found to be 100% in extremely low birth weight, 56.2% in very low birth weight, and 58.8% in low birth weight neonates. The gestational ages of these infants had a positive correlation with birth weight (r = 0.648, p = 0.01, n = 78). The preterm neonates in the RDS group versus the non-RDS group had a mean birth weight of (1610±314.4 g vs 1981±520.3 g), a mean gestational age of (31.65±2.2 w vs 33.18± 2.10 w) and a mean hemoglobin level of (13.85± 3.28 g vs16.09± 3.26 g). There was a significant association between RDS and neonatal anemia (AOR=5.9), neonatal sepsis (AOR=4.2), vaginal delivery (AOR=8.7), delivery at low-resourced settings (AOR=2.7), PROM (AOR=4), and antepartum hemorrhage (6.9). The mortality rate in preterm neonates was found to be 26.8% and was significantly associated with very and extremely low birth weights (AOR=8.2), early and extremely preterm births (AOR=6.3), female gender (AOR=3.8), antepartum hemorrhage (AOR=4.6,) and PROM (AOR=5.7). CONCLUSION: RDS was highly prevalent in preterm newborns, and the highest rates were seen within groups of extremely preterm and extremely low-birth-weight newborn babies. RDS was found to be associated with lower neonatal birth weight, gestational age, and hemoglobin level, as well as neonatal anemia, neonatal sepsis, vaginal delivery, birth in low-resource settings, PROM, and antepartum hemorrhage. The neonatal mortality in preterm neonates was higher than in high-income countries. Proper management of the aforementioned associated factors will reduce the incidence of RDS and neonatal mortality in preterm neonates.

Keywords: respiratory distress syndrome (RDS), preterm neonates, prematurity, neonatal mortality

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3435 Development of Wound Dressing System Based on Hydrogel Matrix Incorporated with pH-Sensitive Nanocarrier-Drug Systems

Authors: Dagmara Malina, Katarzyna Bialik-Wąs, Klaudia Pluta

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The growing significance of transdermal systems, in which skin is a route for systemic drug delivery, has generated a considerable amount of data which has resulted in a deeper understanding of the mechanisms of transport across the skin in the context of the controlled and prolonged release of active substances. One of such solutions may be the use of carrier systems based on intelligent polymers with different physicochemical properties. In these systems, active substances, e.g. drugs, can be conjugated (attached), immobilized, or encapsulated in a polymer matrix that is sensitive to specific environmental conditions (e.g. pH or temperature changes). Intelligent polymers can be divided according to their sensitivity to specific environmental stimuli such as temperature, pH, light, electric, magnetic, sound, or electromagnetic fields. Materials & methods—The first stage of the presented research concerned the synthesis of pH-sensitive polymeric carriers by a radical polymerization reaction. Then, the selected active substance (hydrocortisone) was introduced into polymeric carriers. In a further stage, bio-hybrid sodium alginate/poly(vinyl alcohol) – SA/PVA-based hydrogel matrices modified with various carrier-drug systems were prepared with the chemical cross-linking method. The conducted research included the assessment of physicochemical properties of obtained materials i.e. degree of hydrogel swelling and degradation studies as a function of pH in distilled water and phosphate-buffered saline (PBS) at 37°C in time. The gel fraction represents the insoluble gel fraction as a result of inter-molecule cross-linking formation was also measured. Additionally, the chemical structure of obtained hydrogels was confirmed using FT-IR spectroscopic technique. The dynamic light scattering (DLS) technique was used for the analysis of the average particle size of polymer-carriers and carrier-drug systems. The nanocarriers morphology was observed using SEM microscopy. Results & Discussion—The analysis of the encapsulated polymeric carriers showed that it was possible to obtain the time-stable empty pH-sensitive carrier with an average size 479 nm and the encapsulated system containing hydrocortisone with an average 543 nm, which was introduced into hydrogel structure. Bio-hybrid hydrogel matrices are stable materials, and the presence of an additional component: pH-sensitive carrier – hydrocortisone system, does not reduce the degree of cross-linking of the matrix nor its swelling ability. Moreover, the results of swelling tests indicate that systems containing higher concentrations of the drug have a slightly higher sorption capacity in each of the media used. All analyzed materials show stable and statically changing swelling values in simulated body fluids - there is no sudden fluid uptake and no rapid release from the material. The analysis of FT-IR spectra confirms the chemical structure of the obtained bio-hybrid hydrogel matrices. In the case of modifications with a pH-sensitive carrier, a much more intense band can be observed in the 3200-3500 cm⁻¹ range, which most likely originates from the strong hydrogen interactions that occur between individual components.

Keywords: hydrogels, polymer nanocarriers, sodium alginate/poly(vinyl alcohol) matrices, wound dressings.

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3434 In-silico Antimicrobial Activity of Bioactive Compounds of Ricinus communis against DNA Gyrase of Staphylococcus aureus as Molecular Target

Authors: S. Rajeswari

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Medicinal Plant extracts and their bioactive compounds have been used for antimicrobial activities and have significant remedial properties. In the recent years, a wide range of investigations have been carried out throughout the world to confirm antimicrobial properties of different medicinally important plants. A number of plants showed efficient antimicrobial activities, which were comparable to that of synthetic standard drugs or antimicrobial agents. The large family Euphorbiaceae contains nearly about 300 genera and 7,500 speciesand one among is Ricinus communis or castor plant which has high traditional and medicinal value for disease free healthy life. Traditionally the plant is used as laxative, purgative, fertilizer and fungicide etc. whereas the plant possess beneficial effects such as anti-oxidant, antihistamine, antinociceptive, antiasthmatic, antiulcer, immunomodulatory anti diabetic, hepatoprotective, anti inflammatory, antimicrobial, and many other medicinal properties. This activity of the plant possess due to the important phytochemical constituents like flavonoids, saponins, glycosides, alkaloids and steroids. The presents study includes the phytochemical properties of Ricinus communis and to prediction of the anti-microbial activity of Ricinus communis using DNA gyrase of Staphylococcus aureus as molecular target. Docking results of varies chemicals compounds of Ricinus communis against DNA gyrase of Staphylococcus aureus by maestro 9.8 of Schrodinger show that the phytochemicals are effective against the target protein DNA gyrase. our studies suggest that the phytochemical from Ricinus communis such has INDICAN (G.Score 4.98) and SUPLOPIN-2(G.Score 5.74) can be used as lead molecule against Staphylococcus infections.

Keywords: euphorbiaceae, antimicrobial activity, Ricinus communis, Staphylococcus aureus

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3433 Cold Flow Investigation of Silicon Carbide Cylindrical Filter Element

Authors: Mohammad Alhajeri

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This paper reports a computational fluid dynamics (CFD) investigation of cylindrical filter. Silicon carbide cylindrical filter elements have proven to be an effective mean of removing particulates to levels exceeding the new source performance standard. The CFD code is used here to understand the deposition process and the factors that affect the particles distribution over the filter element surface. Different approach cross flow velocity to filter face velocity ratios and different face velocities (ranging from 2 to 5 cm/s) are used in this study. Particles in the diameter range 1 to 100 microns are tracked through the domain. The radius of convergence (or the critical trajectory) is compared and plotted as a function of many parameters.

Keywords: filtration, CFD, CCF, hot gas filtration

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3432 Three-Dimensional Fluid-Structure-Thermal Coupling Dynamics Simulation Model of a Gas-Filled Fluid-Resistance Damper and Experimental Verification

Authors: Wenxue Xu

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Fluid resistance damper is an important damping element to attenuate vehicle vibration. It converts vibration energy into thermal energy dissipation through oil throttling. It is a typical fluid-solid-heat coupling problem. A complete three-dimensional flow-structure-thermal coupling dynamics simulation model of a gas-filled fluid-resistance damper was established. The flow-condition-based interpolation (FCBI) method and direct coupling calculation method, the unit's FCBI-C fluid numerical analysis method and iterative coupling calculation method are used to achieve the damper dynamic response of the piston rod under sinusoidal excitation; the air chamber inflation pressure, spring compression characteristics, constant flow passage cross-sectional area and oil parameters, etc. The system parameters, excitation frequency, and amplitude and other excitation parameters are analyzed and compared in detail for the effects of differential pressure characteristics, velocity characteristics, flow characteristics and dynamic response of valve opening, floating piston response and piston rod output force characteristics. Experiments were carried out on some simulation analysis conditions. The results show that the node-based FCBI (flow-condition-based interpolation) fluid numerical analysis method and direct coupling calculation method can better guarantee the conservation of flow field calculation, and the calculation step is larger, but the memory is also larger; if the chamber inflation pressure is too low, the damper will become cavitation. The inflation pressure will cause the speed characteristic hysteresis to increase, and the sealing requirements are too strict. The spring compression characteristics have a great influence on the damping characteristics of the damper, and reasonable damping characteristic needs to properly design the spring compression characteristics; the larger the cross-sectional area of the constant flow channel, the smaller the maximum output force, but the more stable when the valve plate is opening.

Keywords: damper, fluid-structure-thermal coupling, heat generation, heat transfer

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3431 Determining the Efficacy of Phenol, Sodium Hypochlorite and Ethanol for Inactivation of Carbapenem-Resistant Strain of Acinetobacter baumannii

Authors: Deepika Biswas

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Acinetobacter baumannii, a hospital-acquired pathogen, causes nosocomial infections including pneumonia, urinary tract infection, and secondary meningitis. Carbapenem is most effective antibiotics against it. Its increased resistance to carbapenems has been a rising global concern. Antibiotics such as carbapenem are unable to use on hospital setups to eradicate A. baumannii, hence different concentrations of disinfectants including phenol; sodium hypochlorite and ethanol are increasingly being used. The objective of the present study is to find an effective concentration of above disinfectants against carbapenem-resistant strain RS307 of A. baumannii. Growth kinetics of RS307 has been determined using UV-Vis spectrophotometer in the presence and absence of disinfectants in triplicate and its standard deviation has also been calculated which make the results more reliable. Differential growth curves were plotted, which showed the effective concentration among all the concentrations of phenol, sodium hypochlorite and ethanol. On disc diffusion assay, antimicrobial effect was observed by comparing all the concentrations of disinfectants to check its synergy with imipenem, most effective carbapenem. All the results collectively revealed that 0.5% phenol, 0.5% sodium hypochlorite, and 70% ethanol could preferably be used as disinfectant for hospital setup against the carbapenem-resistant strain of A. baumannii. SDS PAGE analysis showed differential expression in the protein profile of A. baumannii after treatment. The present study highlighted that few disinfectants even in low concentration had shown better antimicrobial activity hence may be recommended for regular use in the hospitals, which will be cost effective and less harmful.

Keywords: Acenatobacter bomunii, phenol, sodium hypoclirite, ethanol, carbapenem resistance, disinfectant

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3430 Genetic Diversity and Molecular Basis of Carbapenem Resistance in Acinetobacter Baumannii Isolates from Cattle

Authors: Minhas Alam, Muhammad Hidayat Rasool, Mohsin Khurshid, Bilal Aslam

Abstract:

Acinetobacter baumannii is a notorious bacterial pathogen that is an emerging nightmare in clinical settings and is mainly involved in severe nosocomial infections. However, the data related to carbapenem-resistant A. baumannii (CRAB) from veterinary settings is limited, especially in developing countries like Pakistan. To investigate the genetic diversity and molecular basis of carbapenem resistance in Acinetobacter baumannii isolates from Cattle, a total of 1960 samples were collected from cattle from Punjab, Pakistan. The isolates were analyzed by routine microbiological procedures and confirmed by polymerase chain reaction (PCR). The isolates were further screened for antimicrobial susceptibility and the presence of multiple antimicrobial-resistant determinants by PCR. Multilocus sequence typing (MLST) was performed. The results of the current study revealed that the overall prevalence of A. baumannii in cattle was 3.28% (65/1980). Among cattle 27.7% (18/65) were found CRAB strains. The CRAB isolates harbor class D β- lactamases genes, e-g, blaOXA-23 and blaOXA-51, 94.4% (17/18). CRAB isolates carry class B β- lactamases gene blaIMP, and only one isolate carries the blaNDM-1 gene. The MLST results of CRAB isolates from cattle demonstrated 5 STs and one new ST. The commonly found sequence types in CRAB isolates were ST2 (n=10, 55.5%), followed by ST642 (n=5, 27.8%) and ST600 & ST889 (n=1, 5.55%). The presence of CRAB isolates in cattle indicates an alarming situation in Punjab, Pakistan. Immediate control measures should be taken to stop the transmission of CRAB isolates within cattle, to the environment, and to clinical settings.

Keywords: acinetobacter baumannii, carbapenemases, veterinary, drug resistance

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3429 Data Access, AI Intensity, and Scale Advantages

Authors: Chuping Lo

Abstract:

This paper presents a simple model demonstrating that ceteris paribus countries with lower barriers to accessing global data tend to earn higher incomes than other countries. Therefore, large countries that inherently have greater data resources tend to have higher incomes than smaller countries, such that the former may be more hesitant than the latter to liberalize cross-border data flows to maintain this advantage. Furthermore, countries with higher artificial intelligence (AI) intensity in production technologies tend to benefit more from economies of scale in data aggregation, leading to higher income and more trade as they are better able to utilize global data.

Keywords: digital intensity, digital divide, international trade, scale of economics

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3428 Human Immune Response to Surgery: The Surrogate Prediction of Postoperative Outcomes

Authors: Husham Bayazed

Abstract:

Immune responses following surgical trauma play a pivotal role in predicting postoperative outcomes from healing and recovery to postoperative complications. Postoperative complications, including infections and protracted recovery, occur in a significant number of about 300 million surgeries performed annually worldwide. Complications cause personal suffering along with a significant economic burden on the healthcare system in any community. The accurate prediction of postoperative complications and patient-targeted interventions for their prevention remain major clinical provocations. Recent Findings: Recent studies are focusing on immune dysregulation mechanisms that occur in response to surgical trauma as a key determinant of postoperative complications. Antecedent studies mainly were plunging into the detection of inflammatory plasma markers, which facilitate in providing important clues regarding their pathogenesis. However, recent Single-cell technologies, such as mass cytometry or single-cell RNA sequencing, have markedly enhanced our ability to understand the immunological basis of postoperative immunological trauma complications and to identify their prognostic biological signatures. Summary: The advent of proteomic technologies has significantly advanced our ability to predict the risk of postoperative complications. Multiomic modeling of patients' immune states holds promise for the discovery of preoperative predictive biomarkers and providing patients and surgeons with information to improve surgical outcomes. However, more studies are required to accurately predict the risk of postoperative complications in individual patients.

Keywords: immune dysregulation, postoperative complications, surgical trauma, flow cytometry

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3427 Molecular Implication of Interaction of Human Enteric Pathogens with Phylloplane of Tomato

Authors: Shilpi, Indu Gaur, Neha Bhadauria, Susmita Goswami, Prabir K. Paul

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Cultivation and consumption of organically grown fruits and vegetables have increased by several folds. However, the presence of Human Enteric Pathogens on the surface of organically grown vegetables causing Gastro-intestinal diseases, are most likely due to contaminated water and fecal matter of farm animals. Human Enteric Pathogens are adapted to colonize the human gut, and also colonize plant surface. Microbes on plant surface communicate with each other to establish quorum sensing. The cross talk study is important because the enteric pathogens on phylloplane have been reported to mask the beneficial resident bacteria of plant. In the present study, HEPs and bacterial colonizers were identified using 16s rRNA sequencing. Microbial colonization patterns after interaction between Human Enteric Pathogens and natural bacterial residents on tomato phylloplane was studied. Tomato plants raised under aseptic conditions were inoculated with a mixture of Serratia fonticola and Klebsiella pneumoniae. The molecules involved in cross-talk between Human Enteric Pathogens and regular bacterial colonizers were isolated and identified using molecular techniques and HPLC. The colonization pattern was studied by leaf imprint method after 48 hours of incubation. The associated protein-protein interaction in the host cytoplasm was studied by use of crosslinkers. From treated leaves the crosstalk molecules and interaction proteins were separated on 1D SDS-PAGE and analyzed by MALDI-TOF-TOF analysis. The study is critical in understanding the molecular aspects of HEP’s adaption to phylloplane. The study revealed human enteric pathogens aggressively interact among themselves and resident bacteria. HEPs induced establishment of a signaling cascade through protein-protein interaction in the host cytoplasm. The study revealed that the adaptation of Human Enteric Pathogens on phylloplane of Solanum lycopersicum involves the establishment of complex molecular interaction between the microbe and the host including microbe-microbe interaction leading to an establishment of quorum sensing. The outcome will help in minimizing the HEP load on fresh farm produce, thereby curtailing incidences of food-borne diseases.

Keywords: crosslinkers, human enteric pathogens (HEPs), phylloplane, quorum sensing

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3426 A Review on the Re-Usage of Single-Use Medical Devices

Authors: Lucas B. Naves, Maria José Abreu

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Reprocessing single-use device has attracted interesting on the medical environment over the last decades. The reprocessing technique was sought in order to reduce the cost of purchasing the new medical device, which can achieve almost double of the price of the reprocessed product. In this manuscript, we have done a literature review, aiming the reuse of medical device that was firstly designed for single use only, but has become, more and more, effective on its reprocessing procedure. We also show the regulation, the countries which allows this procedure, the classification of these device and also the most important issue concerning the re-utilization of medical device, how to minimizing the risk of gram positive and negative bacteria, avoid cross-contamination, hepatitis B (HBV), and C (HCV) virus, and also human immunodeficiency virus (HIV).

Keywords: reusing, reprocessing, single-use medical device, HIV, hepatitis B and C

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3425 Cross-Cultural Collaboration Shaping Co-Creation Methodology to Enhance Disaster Risk Management Approaches

Authors: Jeannette Anniés, Panagiotis Michalis, Chrysoula Papathanasiou, Selby Knudsen

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RiskPACC project aims to bring together researchers, practitioners, and first responders from nine European countries following a co-creation approach aiming to develop customised solutions to meet the needs of end-users. The co-creation workshops target to enhance the communication pathways between local civil protection authorities (CPAs) and citizens, in an effort to close the risk perception-action gap (RPAG). The participants in the workshops include a variety of stakeholders, as well as citizens, fostering the dialogue between the groups and supporting citizen participation in disaster risk management (DRM). The co-creation methodology in place implements co-design elements due to the integration of four ICT tools. Such ICT tools include web-based and mobile application technical solutions in different development stages, ranging from formulation and validation of concepts to pilot demonstrations. In total, seven different case studies are foreseen in RiskPACC. The workflow of the workshops is designed to be adaptive to every of the seven case study countries and their cultures’ particular needs. This work aims to provide an overview of the the preparation and the conduction of the workshops in which researchers and practitioners focused on mapping these different needs from the end users. The latter included first responders but also volunteers and citizens who actively participated in the co-creation workshops. The strategies to improve communication between CPAs and citizens themselves differ in the countries, and the modules of the co-creation methodology are adapted in response to such differences. Moreover, the project partners experienced how the structure of such workshops is perceived differently in the seven case studies. Therefore, the co-creation methodology itself is a design method underlying several iterations, which are eventually shaped by cross-cultural collaboration. For example, some case studies applied other modules according to the participatory group recruited. The participants were technical experts, teachers, citizens, first responders, or volunteers, among others. This work aspires to present the divergent approaches of the seven case studies implementing the co-creation methodology proposed, in response to different perceptions of the modules. An analysis of the adaptations and implications will also be provided to assess where the case studies’ objective of improving disaster resilience has been obtained.

Keywords: citizen participation, co-creation, disaster resilience, risk perception, ICT tools

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3424 Tuberculosis and Associated Transient Hyperglycaemia in Peri-Urban South Africa: Implications for Diabetes Screening in High Tuberculosis/HIV Burden Settings

Authors: Mmamapudi Kubjane, Natacha Berkowitz, Rene Goliath, Naomi S. Levitt, Robert J. Wilkinson, Tolu Oni

Abstract:

Background: South Africa remains a high tuberculosis (TB) burden country globally and the burden of diabetes – a TB risk factor is growing rapidly. As an infectious disease, TB also induces transient hyperglycaemia. Therefore, screening for diabetes in newly diagnosed tuberculosis patients may result in misclassification of transient hyperglycaemia as diabetes. Objective: The objective of this study was to determine and compare the prevalence of hyperglycaemia (diabetes and impaired glucose regulation (IGR)) in TB patients and to assess the cross-sectional association between TB and hyperglycaemia at enrolment and after three months of follow-up. Methods: Consecutive adult TB and non-TB participants presenting at a TB clinic in Cape Town were enrolled in this cross-sectional study and follow-up between July 2013 and August 2015. Diabetes was defined as self-reported diabetes, fasting plasma glucose (FPG) ≥ 7.0 mmol·L⁻¹ or glycated haemoglobin (HbA1c) ≥ 6.5%. IGR was defined as FPG 5.5– < 7.0 mmol·L⁻¹ or HbA1c 5.7– < 6.5%. TB patients initiated treatment. After three months, all participants were followed up and screened for diabetes again. The association between TB and hyperglycaemia was assessed using logistic regression adjusting for potential confounders including sex, age, income, hypertension, waist circumference, previous prisoner, marital status, work status, HIV status. Results: Diabetes screening was performed in 852 participants (414 TB and 438 non-TB) at enrolment and in 639 (304 TB and 335 non-TB) at three-month follow-up. The prevalence of HIV-1 infection was 69.6% (95% confidence interval (CI), 64.9–73.8 %) among TB patients, and 58.2% (95% CI, 53.5–62.8 %) among the non-TB participants. Glycaemic levels were much higher in TB patients than in the non-TB participants but decreased over time. Among TB patients, the prevalence of IGR was 65.2% (95% CI 60.1 - 69.9) at enrollment and 21.5% (95% CI 17.2-26.5) at follow-up; and was 50% (45.1 - 54.94) and 32% (95% CI 27.9 - 38.0) respectively, among non-TB participants. The prevalence of diabetes in TB patients was 12.5% (95% CI 9.69 – 16.12%) at enrolment and 9.2% (95% CI, 6.43–13.03%) at follow-up; and was 10.04% (95% CI, 7.55–13.24%) and 8.06% (95% CI, 5.58–11.51) respectively, among non-TB participants. The association between TB and IGT was significant at enrolment (adjusted odds ratio (OR) 2.26 (95% CI, 1.55-3.31) but disappeared at follow-up 0.84 (0.53 - 1.36). However, the TB-diabetes association remained positive and significant both at enrolment (2.41 (95% CI, 1.3-4.34)) and follow-up (OR 3.31 (95% CI, 1.5 - 7.25)). Conclusion: Transient hyperglycaemia exists during tuberculosis. This has implications on diabetes screening in TB patients and suggests a need for diabetes confirmation tests during or after TB treatment. Nonetheless, the association between TB and diabetes noted at enrolment persists at 3 months highlighting the importance of diabetes control and prevention for TB control. Further research is required to investigate the impact of hyperglycaemia (transient or otherwise) on TB outcomes to ascertain the clinical significance of hyperglycemia at enrolment.

Keywords: diabetes, impaired glucose regulation, transient hyperglycaemia, tuberculosis

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3423 Histopathological Effects of Trichodiniasis in Farmed Freshwater Rainbow Trout, Oncorhynchus mykiss, in West of Iran

Authors: Zahra Khoshnood, Reza Khoshnood

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The aim of present study was to monitor the presence of Trichodina sp. in Rainbow trout, Oncorhynchus mykiss collected from various fish farms in the western provinces of Iran during January, 2013- January, 2014. Out of 675 sampled fish 335, (49.16%) were infested with Trichodina. The highest prevalence was observed in the spring and winter followed by autumn and summer. In general, the intensity of infection was low except in cases where outbreaks of Trichodiniasis endangered the survival of fish in some ponds. In light infestation Trichodina is usually present on gills, fins and skin of apparently healthy fish. Clinical signs of Trichodiniasis only appear on fish with heavy infections and cases of moderate ones that are usually exposed to one or more stress factors including, rough handling during transportation from ponds, overcrowdness, malnutrition, high of free ammonia and low of oxygen concentration. Clinical signs of Trichodiniasis in sampled fish were sluggish movement, loss of appetite, black coloration, necrosis and ulcer on different parts of the body, detached scales and excessive accumulation of mucous in gill pouches. The most obvious histopathological changes in diseased fish were sloughing of the epidermal layer, aggregation of leucocytes and melanine-carrying cells (between the dermis and hypodermis) and proliferative changes including hyperplasia and hypertrophy of the epithelial lining cells of gill filaments which resulted in fusion of secondary lamellae. Control of Trichodiniasis, has been achieved by formalin bath treatment at a concentration of 250 ppm for one hour.

Keywords: gill, histopathology, rainbow trout, Trichodina

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3422 Optimization of Chitosan Membrane Production Parameters for Zinc Ion Adsorption

Authors: Peter O. Osifo, Hein W. J. P. Neomagus, Hein V. D. Merwe

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Chitosan materials from different sources of raw materials were characterized in order to determine optimal preparation conditions and parameters for membrane production. The membrane parameters such as molecular weight, viscosity, and degree of deacetylation were used to evaluate the membrane performance for zinc ion adsorption. The molecular weight of the chitosan was found to influence the viscosity of the chitosan/acetic acid solution. An increase in molecular weight (60000-400000 kg.kmol-1) of the chitosan resulted in a higher viscosity (0.05-0.65 Pa.s) of the chitosan/acetic acid solution. The effect of the degree of deacetylation on the viscosity is not significant. The effect of the membrane production parameters (chitosan- and acetic acid concentration) on the viscosity is mainly determined by the chitosan concentration. For higher chitosan concentrations, a membrane with a better adsorption capacity was obtained. The membrane adsorption capacity increases from 20-130 mg Zn per gram of wet membrane for an increase in chitosan concentration from 2-7 mass %. Chitosan concentrations below 2 and above 7.5 mass % produced membranes that lack good mechanical properties. The optimum manufacturing conditions including chitosan concentration, acetic acid concentration, sodium hydroxide concentration and crosslinking for chitosan membranes within the workable range were defined by the criteria of adsorption capacity and flux. The adsorption increases (50-120 mg.g-1) as the acetic acid concentration increases (1-7 mass %). The sodium hydroxide concentration seems not to have a large effect on the adsorption characteristics of the membrane however, a maximum was reached at a concentration of 5 mass %. The adsorption capacity per gram of wet membrane strongly increases with the chitosan concentration in the acetic acid solution but remains constant per gram of dry chitosan. The optimum solution for membrane production consists of 7 mass % chitosan and 4 mass % acetic acid in de-ionised water. The sodium hydroxide concentration for phase inversion is at optimum at 5 mass %. The optimum cross-linking time was determined to be 6 hours (Percentage crosslinking of 18%). As the cross-linking time increases the adsorption of the zinc decreases (150-50 mg.g-1) in the time range of 0 to 12 hours. After a crosslinking time of 12 hours, the adsorption capacity remains constant. This trend is comparable to the effect on flux through the membrane. The flux decreases (10-3 L.m-2.hr-1) with an increase in crosslinking time range of 0 to 12 hours and reaches a constant minimum after 12 hours.

Keywords: chitosan, membrane, waste water, heavy metal ions, adsorption

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3421 High Prevalence of Multi-drug Resistant Diarrheagenic Escherichia coli among Hospitalised Diarrheal Patients in Kolkata, India

Authors: Debjani Ghosh, Goutam Chowdhury, Prosenjit Samanta, Asish Kumar Mukhopadhyay

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Acute diarrhoea caused by diarrheagenic Escherichia coli (DEC) is one of the major public health problem in developing countries, mainly in Asia and Africa. DEC consists of six pathogroups, but the majority of the cases were associated with the three pathogropus, enterotoxigenic E. coli (ETEC), enteroaggregative E. coli (EAEC), and enteropathogenic E. coli (EPEC). Hence, we studied the prevalence and antimicrobial resistance of these three major DEC pathogroups in hospitalized diarrheal patients in Kolkata, India, during 2012-2019 with a large sample size. 8,891 stool samples were processed, and 7.8% of them was identified as DEC infection screened by multiplex PCR, in which ETEC was most common (47.7%) followed by EAEC (38.4%) and EPEC (13.9%). Clinical patient history suggested that children <5 years of age were mostly affected with ETEC and EAEC, whereas people within >5-14 years of age were significantly associated with EPEC and ETEC infections. Antibiogram profile showed a high prevalence of multidrug resistant (MDR) isolates among DEC (56.9%), in which 9% were resistant to antibiotics of six different antimicrobial classes. Screening of the antibiotic resistance conferring genes in DEC showed the presence of blaCTX-M (30.2%) in highest number followed by blaTEM (27.5%), tetB (18%), sul2 (12.6%), strA (11.8%), aadA1 (9.8%), blaOXA-1 (9%), dfrA1 (1.6%) and blaSHV (1.2%) which indicates the existence of mobile genetic elements in those isolates. Therefore, the presence of MDR DEC strains in higher number alarms the public health authorities to take preventive measures before the upsurge of the DEC caused diarrhea cases in near future.

Keywords: diarrheagenic escherichia coli, ETEC, EAEC, EPEC

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3420 Improving the Detection of Depression in Sri Lanka: Cross-Sectional Study Evaluating the Efficacy of a 2-Question Screen for Depression

Authors: Prasad Urvashi, Wynn Yezarni, Williams Shehan, Ravindran Arun

Abstract:

Introduction: Primary health services are often the first point of contact that patients with mental illness have with the healthcare system. A number of tools have been developed to increase detection of depression in the context of primary care. However, one challenge amongst many includes utilizing these tools within the limited primary care consultation timeframe. Therefore, short questionnaires that screen for depression that are just as effective as more comprehensive diagnostic tools may be beneficial in improving detection rates of patients visiting a primary care setting. Objective: To develop and determine the sensitivity and specificity of a 2-Question Questionnaire (2-QQ) to screen for depression in in a suburban primary care clinic in Ragama, Sri Lanka. The purpose is to develop a short screening tool for depression that is culturally adapted in order to increase the detection of depression in the Sri Lankan patient population. Methods: This was a cross-sectional study involving two steps. Step one: verbal administration of 2-QQ to patients by their primary care physician. Step two: completion of the Peradeniya Depression Scale, a validated diagnostic tool for depression, the patient after their consultation with the primary care physician. The results from the PDS were then correlated to the results from the 2-QQ for each patient to determine sensitivity and specificity of the 2-QQ. Results: A score of 1/+ on the 2-QQ was most sensitive but least specific. Thus, setting the threshold at this level is effective for correctly identifying depressed patients, but also inaccurately captures patients who are not depressed. A score of 6 on the 2-QQ was most specific but least sensitive. Setting the threshold at this level is effective for correctly identifying patients without depression, but not very effective at capturing patients with depression. Discussion: In the context of primary care, it may be worthwhile setting the 2-QQ screen at a lower threshold for positivity (such as a score of 1 or above). This would generate a high test sensitivity and thus capture the majority of patients that have depression. On the other hand, by setting a low threshold for positivity, patients who do not have depression but score higher than 1 on the 2-QQ will also be falsely identified as testing positive for depression. However, the benefits of identifying patients who present with depression may outweigh the harms of falsely identifying a non-depressed patient. It is our hope that the 2-QQ will serve as a quick primary screen for depression in the primary care setting and serve as a catalyst to identify and treat individuals with depression.

Keywords: depression, primary care, screening tool, Sri Lanka

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