Search results for: World Health Organisation

Authors: Abeer M. Orabi

Abstract:

Midwives are being seen as a key factor in returning birth care to a normal physiologic process that is woman-centered. On the other hand, more needs to be done to increase access for every woman to professional midwifery care. Because of the nature of the midwifery specialty, the magnitude of the effect that can result from a lack of knowledge if midwives make a mistake in their care has the potential to affect a large number of the birthing population. So, the development, running, and management of midwifery educational programs should follow international standards and come after a thorough community needs assessment. At the same time, the number of accredited midwifery educational programs needs to be increased so that larger numbers of midwives will be educated and qualified, as well as access to skilled midwifery care will be increased. Indeed, the selection of promising midwives is important for the successful completion of an educational program, achievement of the program goals, and retention of graduates in the field. Further, the number of schooled midwives in midwifery education programs, their background, and their experience constitute some concerns in the higher education industry. Basically, preceptors and clinical sites are major contributors to the midwifery education process, as educational programs rely on them to provide clinical practice opportunities. In this regard, the selection of clinical training sites should be based on certain criteria to ensure their readiness for the intended training experiences. After that, communication, collaboration, and liaison between teaching faculty and field staff should be maintained. However, the shortage of clinical preceptors and the massive reduction in the number of practicing midwives, in addition to unmanageable workloads, act as significant barriers to midwifery education. Moreover, the medicalized approach inherent in the hospital setting makes it difficult to practice the midwifery model of care, such as watchful waiting, non-interference in normal processes, and judicious use of interventions. Furthermore, creating a motivating study environment is crucial for avoiding unnecessary withdrawal and retention in any educational program. It is well understood that research is an essential component of any profession for achieving its optimal goal and providing a foundation and evidence for its practices, and midwifery is no exception. Midwives have been playing an important role in generating their own research. However, the selection of novel, researchable, and sustainable topics considering community health needs is also a challenge. In conclusion, ongoing education and research are the lifeblood of the midwifery profession to offer a highly competent and qualified workforce. However, many challenges are being faced, and barriers are hindering their improvement.

Keywords: barriers, challenges, midwifery education, educational programs

Procedia PDF Downloads 113

Authors: Vallence Ngabo Maniragaba

Abstract:

This study aimed at examining the variations of undernutrition among children below 5 years of age in Uganda. The approach of spatial and spatiotemporal analysis helped in identifying cluster patterns, hot spots and emerging hot spots. Data from the 6 Uganda Demographic and Health Surveys spanning from 1990 to 2016 were used with the main outcome variable being undernutrition among children <5 years of age. All data that were relevant to this study were retrieved from the survey datasets and combined with the 214 shape files for the districts of Uganda to enable spatial and spatiotemporal analysis. Spatial maps with the spatial distribution of the prevalence of undernutrition, both in space and time, were generated using ArcGIS Pro version 2.8. Moran’s I, an index of spatial autocorrelation, rules out doubts of spatial randomness in order to identify spatially clustered patterns of hot or cold spot areas. Furthermore, space-time cubes were generated to establish the trend in undernutrition as well as to mirror its variations over time and across Uganda. Moreover, emerging hot spot analysis was done to help identify the patterns of undernutrition over time. The results indicate a heterogeneous distribution of undernutrition across Uganda and the same variations were also evident over time. Moran’s I index confirmed spatial clustered patterns as opposed to random distributions of undernutrition prevalence. Four hot spot areas, namely; the Karamoja, the Sebei, the West Nile and the Toro regions were significantly evident, most of the central parts of Uganda were identified as cold spot clusters, while most of Western Uganda, the Acholi and the Lango regions had no statistically significant spatial patterns by the year 2016. The spatio-temporal analysis identified the Karamoja and Sebei regions as clusters of persistent, consecutive and intensifying hot spots, West Nile region was identified as a sporadic hot spot area while the Toro region was identified with both sporadic and emerging hotspots. In conclusion, undernutrition is a silent pandemic that needs to be handled with both hands. At 31.2 percent, the prevalence is still very high and unpleasant. The distribution across the country is nonuniform with some areas such as the Karamoja, the West Nile, the Sebei and the Toro regions being epicenters of undernutrition in Uganda. Over time, the same areas have experienced and exhibited high undernutrition prevalence. Policymakers, as well as the implementers, should bear in mind the spatial variations across the country and prioritize hot spot areas in order to have efficient, timely and region-specific interventions.

Keywords: undernutrition, spatial autocorrelation, hotspots analysis, geographically weighted regressions, emerging hotspots analysis, under-fives, Uganda

Procedia PDF Downloads 85

Authors: Gunjan Razdan, Priyanka Sreenath, Jagannath Behera, S. K. Mishra, Sunil Mehra

Abstract:

Uttar Pradesh is one of the poor performing states with high Malnutrition and Anaemia among adolescent girls resulting in high MMR, IMR and low birth weight rate. The rate of anaemia among adolescent girls has doubled in the past decade. Adolescents gain around 15-20% of their optimum height, 25-50% of the ideal adult weight and 45% of the skeletal mass by the age of 19. Poor intake of energy, protein and other nutrients is one of the factors for malnutrition and anaemia. METHODS: The cross-sectional survey using a mixed method (quantitative and qualitative) was adopted in this study. The respondents (adolescents, parents and frontline health workers) were selected randomly from 30 villages and surveyed through a semi-structured questionnaire for qualitative information and FGDs and IDIs for qualitative information. A 24 hours dietary recall method was adopted to estimate their dietary practices. A total of 1069 adolescent girls, 1067 boys, 1774 parents and 69 frontline functionaries were covered under the study. Percentages and mean were calculated for quantitative variable, and content analysis was carried out for qualitative data. RESULTS: Over 80 % of parents provided assertions that they understood the term balanced diet and strongly felt that their children were having balanced diet. However, only negligible 1.5 % of parents could correctly recount essential eight food groups and 22% could tell about four groups which was the minimum response expected to say respondents had fair knowledge on a balanced diet. Only 10 percent of parents could tell that balanced diet helps in physical and mental growth and only 2% said it has a protective role. Besides, qualitative data shows that the perception regarding balanced diet is having costly food items like nuts and fruits. The dietary intake of adolescents is very low despite the increased iron needs associated with physical growth and puberty.The consumption of green leafy vegetables (less than 35 %) and citrus fruits (less than 50%) was found to be low. CONCLUSIONS: The assertions on an understanding of term balanced diet are contradictory to the actual knowledge and practices. Knowledge on essential food groups and nutrients is crucial to inculcate healthy eating practices among adolescents. This calls for comprehensive communication efforts to improve the knowledge and dietary practices among adolescents.

Keywords: anemia, knowledge, malnutrition, perceptions

Procedia PDF Downloads 399

Authors: N. Khursheed, M. Fatima, S. Jamal, A. Raza, S. Rattani, Q. Ahsan, A. Rasheed, M. Jawed

Abstract:

Introduction: Antibiotics are among the commonly prescribed medicines to treat bacterial infections. Their misuse intensifies resistance, and overuse incurs heavy losses to the healthcare system in terms of increased treatment costs and enhanced disease burden. Studies show that 40% of empirically used antibiotics are irrationally utilized. The objective of this study was to evaluate prescribing pattern of antibiotics at six public sector tertiary care hospitals across Pakistan. Methods: A multicenter cross-sectional point prevalence survey (PPS) was conducted in selected wards of six public sector tertiary care hospitals in Pakistan as part of the Clinical Engagement program by Fleming Fund Country Grant Pakistan in collaboration with Indus Hospital & Health Network (IHHN) from February to March 2021, these included Jinnah Postgraduate Medical Center and Dr. Ruth K. M. Pfau Civil Hospital from Karachi, Sheikh Zayed Hospital Lahore, Nishtar Medical University Hospital Multan, Medical Teaching Institute Hayatabad Medical Complex Peshawar, and Provincial Headquarters Hospital Gilgit. WHO PPS methodology was used for data collection (Hospital, ward, and patient level data was collected). Data was entered into the open-source Kobo Collect application and was analyzed using SPSS (version 22.0). Findings: Medical records of 837 in-patients were surveyed, of which the prevalence of antibiotics use was 78.5%. The most commonly prescribed antimicrobial was Ceftriaxone (21.7%) which is categorized in the Watch group of WHO AWaRe Classification, followed by Metronidazole (17.3%), Cefoperazone/Sulbactam (8.4%), Co-Amoxiclav (6.3%) and Piperacillin/Tazobactam (5.9%). The antibiotics were prescribed largely for surgical prophylaxis (36.7%), followed by community-acquired infections (24.7%). One antibiotic was prescribed to 46.7%, two to 39.9%, and three or more to 12.5 %. Two of six (30%) hospitals had functional drug and therapeutic committees, three (50%) had infection prevention and control committees, and one facility had an antibiotic formulary. Conclusion: Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasizes the importance of expanding the antimicrobial stewardship program. Mentoring clinical teams will help to rationalize antimicrobial use.

Keywords: antimicrobial resistance, antimicrobial stewardship, point prevalence survey, antibiotics

Procedia PDF Downloads 103

Authors: Zorica Tomičić, Ružica Tomičić, Peter Raspor

Abstract:

Growing resistance of pathogenic yeast Candida glabrata to many classes of antifungal drugs has stimulated efforts to discover new agents to combat a rising number of invasive C. glabrata infections, which deserves a great deal of concern due to the high mortality rate in immunocompromised populations. One promising strategy is the use of probiotic microorganisms, which, when administered in adequate amounts, confers a health benefit. A selected number of probiotic organisms, Saccharomyces boulardii among them, have been tested as potential biotherapeutic agents. The aim of this study was to investigate the effect of the probiotic yeast S. boulardii on the adhesion of clinical isolates of C. glabrata at different temperatures, pH values, and in the presence of three clinically important antifungal drugs, such as fluconazole, itraconazole and amphotericin B. The method used to assess adhesion was crystal violet staining. The selection of antimycotics concentrations used in the adhesion assay was based on minimum inhibitory concentrations (MICs) obtained by the preliminarily performed microdilution modification of the Reference method for broth dilution antifungal susceptibility testing of yeast (Clinical and Laboratory Standards Institute (CLSI), standard M27-A2). the results showed that despite the nonadhesiveness of S. boulardii cells, probiotic yeast significantly suppressed the adhesion of C. glabrata strains. Besides, at specific strain ratios, a slight stimulatory effect was observed in some C. glabrata strains, which highlights the importance of strain specificity and opens up further research interests. When environmental conditions are considered, temperature and pH significantly influenced co-culture adhesion of C. glabrata and S. boulardii. The adhesion of C. glabrata strains was relatively equally reduced over all tested temperature range (28°C, 37°C, 39°C and 42°C) in the presence of S. boulardii cells, while the adhesion of a few C. glabrata strains were significantly stimulated at 28°C and suppressed at 42°C. Further, the adhesion was highly dependent on pH, with the highest adherence at pH 4 and lowest at pH 8.5. It was observed that S. boulardii did not manage to suppress the adhesion of C. glabrata strains at high pH. Antimycotics on the other hand showed a greater impact, since S. boulardii failed to affect co-culture adhesion at higher antimycotics concentrations. As expected, exposure to various concentrations of amphotericin B significantly reduced the adherence ability of C.glabrata strains both in a single culture and co-culture with S. boulardii. Therefore, it can be speculated that S. boulardii could substitute the effect of antimycotics in a range concentrations and with specific type of strains. This would certainly change the view on the treatment of yeast infections in the future.

Keywords: adhesion, antimycotics, candida glabrata, saccharomyces boulardii

Procedia PDF Downloads 67

Authors: Linneth Nkateko Mabila, Patrick Hulisani Demana, Tebogo Maria Mothiba

Abstract:

Background: Sustaining adherence to antiretroviral therapy (ART) over the long term by people, especially children living with Human-Immunodeficiency Virus (HIV), requires accurate and consistent monitoring, and this is a particular challenge for countries in sub-Saharan Africa. However, the regularity and punctuality in monthly antiretroviral treatment collections indicate medication adherence to a certain extent since it has been revealed to be a significant determinant of the outcome of ART. Aim: This study assessed and described the pattern of monthly antiretroviral treatment collections among a cohort of virally unsuppressed HIV-positive children initiated and managed on ART in the rural public clinics of Mopani District, Limpopo, and explored the nurses' perceptions and views of the findings. Methods: A facility-based mixed-methods study was conducted to assess the honoring of scheduled monthly treatment collection practices by a cohort of HIV-positive children under 15 years initiated and managed on ART by Nurse Initiated Management of Antiretroviral Treatment (NIMART)-trained professional nurses (PNs) from 01 January 2015 to 31 December 2015 in public PHC clinics of Mopani District Municipality. This was followed by the exploration of the nurses' perceptions and views regarding this issue to share their experiences and knowledge acquired through managing these children on ART. Results: From a total of 7105 analysable visits, only 44% (3134) were honored as scheduled, with 40% (2828) of children presenting to the clinics after the scheduled appointment date – they missed their appointments, and 11% (768) of treatment collections that took place before the scheduled appointment date. This finding was further confirmed by 90% (97) of the nurses, who reported that they have children who miss scheduled appointments in their public clinics. The primary reasons for children missing appointments were related to caregivers' forgetfulness and conflict between the school schedule and the dates of clinic visits. Conclusion: We confirmed a high prevalence of non-adherence to scheduled monthly ART collections and the existence of health system, social, and caregiver-related factors that threaten treatment adherence and proper clinical outcomes. These findings suggest an urgent need for intervention since non-adherence to ARV therapy can be life-threatening to the child and poses the danger of reduced life expectancy.

Keywords: antiretroviral therapy (art), nimart, virally unsuppressed children, missed appointments

Procedia PDF Downloads 100

Authors: Jianuo Sun, Jinghan Wang, Sirui Zhang, Chenhan Xu, Hongxia Hao, Hong Zhou

Abstract:

In recent years, the diversification and industrialization of drug-related crimes have posed significant threats to public health and safety globally. The widespread and increasingly younger demographics of drug users and the persistence of drug-impaired driving incidents underscore the urgency of this issue. Drug detection, a specialized forensic activity, is pivotal in identifying and analyzing substances involved in drug crimes. It relies on pharmacological and chemical knowledge and employs analytical chemistry and modern detection techniques. However, current drug detection methods are limited by their inability to perform semi-quantitative, real-time field analyses. They require extensive, complex laboratory-based preprocessing, expensive equipment, and specialized personnel and are hindered by long processing times. This study introduces an alternative approach using nucleic acid aptamers and Aggregation-Induced Emission (AIE) technology. Nucleic acid aptamers, selected artificially for their specific binding to target molecules and stable spatial structures, represent a new generation of biosensors following antibodies. Rapid advancements in AIE technology, particularly in tetraphenyl ethene-based luminous, offer simplicity in synthesis and versatility in modifications, making them ideal for fluorescence analysis. This work successfully synthesized, isolated, and purified an AIE molecule and constructed a probe comprising the AIE molecule, nucleic acid aptamers, and exonuclease for cocaine detection. The probe demonstrated significant relative fluorescence intensity changes and selectivity towards cocaine over other drugs. Using 4-Butoxytriethylammonium Bromide Tetraphenylethene (TPE-TTA) as the fluorescent probe, the aptamer as the recognition unit, and Exo I as an auxiliary, the system achieved rapid detection of cocaine within 5 mins in aqueous and urine, with detection limits of 1.0 and 5.0 µmol/L respectively. The probe-maintained stability and interference resistance in urine, enabling quantitative cocaine detection within a certain concentration range. This fluorescent sensor significantly reduces sample preprocessing time, offers a basis for rapid onsite cocaine detection, and promises potential for miniaturized testing setups.

Keywords: drug detection, aggregation-induced emission (AIE), nucleic acid aptamer, exonuclease, cocaine

Procedia PDF Downloads 59

Authors: Guillermo E. Quintero, Edwin G. Perez, Oriel Sanchez, Christian Espinosa-Bustos, Denis Fuentealba, Margarita E. Aliaga

Abstract:

Bisulfite ion (HSO3-) has been used as a preservative in food, drinks, and medication. However, it is well-known that HSO3- can cause health problems like asthma and allergic reactions in people. Due to the above, the development of analytical methods for detecting this ion has gained great interest. In line with the above, the current use of colorimetric and/or fluorescent probes as a detection technique has acquired great relevance due to their high sensitivity and accuracy. In this context, 2-quinolinone derivatives have been found to possess promising activity as antiviral agents, sensitizers in solar cells, antifungals, antioxidants, and sensors. In particular, 7-(diethylamino)-2-quinolinone derivatives have attracted attention in recent years since their suitable photophysical properties become promising fluorescent probes. In Addition, there is evidence that photophysical properties and reactivity can be affected by the study medium, such as micellar media. Based on the above background, 7-(diethylamino)-2-quinolinone derivatives based chalcone will be able to be incorporated into a cationic micellar environment (Cetyltrimethylammonium bromide, CTAB). Furthermore, the supramolecular control induced by the micellar environment will increase the reactivity of these derivatives towards nucleophilic analytes such as HSO3- (Michael-type addition reaction), leading to the generation of new colorimetric and/or fluorescent probes. In the present study, two derivatives of 7-(diethylamino)-2-quinolinone based chalcone DQD1-2 were synthesized according to the method reported by the literature. These derivatives were structurally characterized by 1H, 13C NMR, and HRMS-ESI. In addition, UV-VIS and fluorescence studies determined absorption bands near 450 nm, emission bands near 600 nm, fluorescence quantum yields near 0.01, and fluorescence lifetimes of 5 ps. In line with the foregoing, these photophysical properties aforementioned were improved in the presence of a cationic micellar medium using CTAB thanks to the formation of adducts presenting association constants of the order of 2,5x105 M-1, increasing the quantum yields to 0.12 and the fluorescence lifetimes corresponding to two lifetimes near to 120 and 400 ps for DQD1 and DQD2. Besides, thanks to the presence of the micellar medium, the reactivity of these derivatives with nucleophilic analytes, such as HSO3-, was increased. This was achieved through kinetic studies, which demonstrated an increase in the bimolecular rate constants in the presence of a micellar medium. Finally, probe DQD1 was chosen as the best sensor since it was assessed to detect HSO3- with excellent results.

Keywords: bisulfite detection, cationic micelle, colorimetric probes, quinolinone derivatives

Procedia PDF Downloads 92

Authors: Tsu-Yun Chiu, Tsung-Hsueh Lu, Tain-Junn Cheng

Abstract:

Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.

Keywords: catchment area of healthcare, chronic disease management, Geographic information system, quality of diabetes care

Procedia PDF Downloads 281

Authors: Binay Pattanayak

Abstract:

More than 9 out of every 10 children in Jharkhand struggle to understand the texts and teachers in public schools. The medium of learning in the schools is Hindi, which is very different in structure and vocabulary than those in children’s home languages. Hence around 3 out of 10 children enrolled in early grades drop out in these schools. The state realized the cause of children’s high dropout in 2013-14 when the M-TALL, the language research shared the findings of a state-wide socio-linguistic study. The study findings suggested that there was a great need for initiating a mother-tongue based multilingual education (MTB-MLE) programme for the state in early grades starting from pre-school level. Accordingly, M-TALL in partnership with department of education designed two learning packages: Bhasha Puliya pre-school education programme for 3-6-year-old children for their school readiness with bilingual picture dictionaries in 9 tribal and regional languages. This was followed by a plan for MTB-MLE programme for early primary grades. For this textbooks in five tribal and two regional languages were developed under the guidance of the author. These books were printed and circulated in the 1000 schools of the state for each child. Teachers and community members were trained for facilitating culturally sensitive mother-tongue based learning activities in and around the schools. The mother-tongue based approach of learning has worked very effectively in enabling them to acquire the basic literacy and numeracy skills in own mother-tongues. Using this basic early grade reading skills, these children are able to learn Hindi and English systematically. Community resource groups were constituted in each school for promoting storytelling, singing, painting, dancing, acting, riddles, humor, sanitation, health, nutrition, protection, etc. and were trained. School academic calendar was designed in each school to enable the community resource persons to visit the school as per the learning plan to assist children and teacher in facilitating rich cultural activities in mother-tongue. This enables children to take part in plethora of learning activities and acquire desired knowledge, skills and interest in mother-tongues. Also in this process, it is attempted to promote 21st Century learning skills by enabling children to apply their new knowledge and skills to look at their local issues and address those in a collective manner through team work, innovations and leadership.

Keywords: community resource groups, learning, MTB-MLE, multilingual, socio-linguistic survey

Procedia PDF Downloads 236

Authors: Carolin Schulze

Abstract:

Characterized by a positive interdependence of learners, cooperative learning (CL) is one possibility of successfully dealing with the increasing heterogeneity of students. Various positive effects of CL on the mental, physical and social health of students have already been documented. However, this structure is still rarely used in physical education (PE). Moreover, there is a lack of information about factors that determine the successful implementation of CL in PE. Therefore, the objective of the current study was to find out factors that determine the successful implementation of CL in PE using a digital questionnaire that was conducted from November to December 2022. In addition to socio-demographic data (age, gender, teaching experience, and education level), frequency of using CL, implementation strategies (theory-led, student-centred), and positive and negative effects of CL were measured. Furthermore, teachers were asked to rate the success of implementation on a 6-point rating scale (1-very successful to 6-not successful at all). For statistical analysis, multiple linear regression was performed, setting the success of implementation as the dependent variable. A total of 224 teachers (mean age=44.81±10.60 years; 58% male) took part in the current study. Overall, 39% of participants stated that they never use CL in their PE classes. Main reasons against the implementations of CL in PE were no time for preparation (74%) or for implementation (61%) and high heterogeneity of students (55%). When using CL, most of the reported difficulties are related to uncertainties about the correct procedure (54%) and the heterogeneous performance of students (54%). The most frequently mentioned positive effect was increased motivation of students (42%) followed by an improvement of psychological abilities (e.g. self-esteem, self-concept; 36%) and improved class cohesion (31%). Reported negative effects were unpredictability (29%), restlessness (24%), confusion (24%), and conflicts between students (17%). The successful use of CL is related to a theory-based preparation (e.g., heterogeneous formation of groups, use of rules and rituals) and a flexible implementation tailored to the needs and conditions of students (e.g., the possibility of individual work, omission of CL phases). Compared to teachers who solely implemented CL theory-led or student-adapted, teachers who switched from theory-led preparation to student-centred implementation of CL reported more successful implementation (t=5.312; p<.001). Neither frequency of using CL in PE nor the gender, age, the teaching experience, or the education level of the teacher showed a significant connection with the successful use of CL. Corresponding to the results of the current study, it is advisable that teachers gather enough knowledge about CL during their education and to point out the need to adapt the learning structure according to the diversity of their students. In order to analyse implementation strategies of teachers more deeply, qualitative methods and guided interviews with teachers are needed.

Keywords: diversity, educational technology, physical education, teaching styles

Procedia PDF Downloads 80

Authors: Yasmeen Jamal Alabdallat, Almutazballlah Bassam Qablan, Obada Ahmad Al Jayyousi, Ihdaa Mahmoud Bani Khalaf, Eman E. Alshial

Abstract:

Background: Bipolar disorder, formerly known as manic depression, is a mental health status that leads to extreme mood swings that include emotional lows (depression) and highs (mania or hypomania). This systematic review and meta-analysis aimed to assess the safety and efficacy of lithium versus valproate among bipolar patients. Methods: A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until June 2022. Studies comparing lithium versus valproate among bipolar patients were selected for the analysis, and all relevant outcomes were pooled in the meta-analysis using Review Manager Software. Results: 11 Randomized Clinical Trials were included in this meta-analysis with a total of 4159 patients. Our meta showed that lithium was superior to valproate in terms of Young Mania Rating Scale (YMRS) (MD = 0.00 with 95% CI, (-0.55 – 0.55; I2 = 0%), P = 1.00). The results of the Hamilton Depression Rating Scale (HDRS) showed that the overall effect favored the valproate treated group (MD = 1.41 with 95% CI, (-0.15 – 2.67; I2 = 0%), P = 0.03). Concerning the results of the Montgomery-Asberg Depression Rating Scale (MADRS), the results showed that the lithium was superior to valproate (MD = 0.03 with 95% CI, (-0.80 to 0.87; I2 = 40%), P = 0.94). In terms of the sexual side effect, we found that the valproate was superior to lithium (RR 1.19 with 95% CI, (0.74 to 1.91; I2 = 0%), P = 0.47). The lithium-treated group was superior in comparison to valproate treated group in terms of Abnormal Involuntary Movement Scale (AIMS) (MD = -0.03 with 95% CI (-0.38 to 0.32; I2 = 0%), P = 0.87). The lithium was more favorable in terms of Simpson-Agnes scale (MD = -0.40 with 95% CI, (-0.86 to 0.06; I2 = 0%), P = 0.09). The results of the Barnes akathisia scale showed that the overall effect of the valproate was more favorable in comparison to lithium (MD = 0.05 with 95% CI, (-0.12 to 0.22; I2 = 0%), P = 0.57). Conclusion: Our study revealed that on the scales of efficacy Lithium treated group surpassed Valproate treated group in terms of Young Mania Rating Scale (YMRS), Abnormal Involuntary Movement Scale (AIMS) and Simpson-Agnes scale, but valproate surpassed it in Barnes Akathisia scale. Furthermore, on the scales of depression Hamilton Depression Rating Scale (HDRS) showed that the overall effect favored Valproate treated group, but Lithium surpassed valproate in terms of Montgomery-Asberg Depression Rating Scale (MADRS). Valproate surpassed Lithium in terms of sexual side effects.

Keywords: bipolar, mania, bipolar-depression, sexual dysfunction, sexual side effects, treatment

Procedia PDF Downloads 152

Authors: Kauser Jahan, Jason Halvorsen, Kara Banks, Kara Natoli, Elizabeth McWeeney, Brittany LeMasney, Nicole Caramanna, Justin Hillman, Christopher Hauske, Meghan Sparks

Abstract:

The Virtual Engineers on Wheels (ViEW) is a revised version of our established mobile K-12 outreach program Engineers on Wheels in order to address the pandemic. The Virtual Engineers on Wheels' (VIEW) goal has stayed the same as in prior years: to provide K-12 students and educators with the necessary resources to peak interest in the expanding fields of engineering. With these trying times, the Virtual Engineers on Wheels outreach has adapted its medium of instruction to be more seamless with the online approach to teaching and outreach. In the midst of COVID-19, providing a safe transfer of information has become a constraint for research. The focus has become how to uphold a level of quality instruction without diminishing the safety of those involved by promoting proper health practices and giving hope to students as well as their families. Furthermore, ViEW has created resources on effective strategies that minimize risk factors of COVID-19 and inform families that there is still a promising future ahead. To obtain these goals while still maintaining true to the hands-on learning that is so crucial to young minds, the approach is online video lectures followed by experiments within different engineering disciplines. ViEW has created a comprehensive website that students can leverage to explore the different fields of study. One of the experiments entails teaching about drone usage and how it might play a factor in the future of unmanned deliveries. Some of the other experiments focus on the differences in mask materials and their effectiveness, as well as their environmental outlook. Having students perform from home enables them a safe environment to learn at their own pace while still providing quality instruction that would normally be achieved in the classroom. Contact information is readily available on the website to provide interested parties with a means to ask their inquiries. As it currently stands, the interest in engineering/STEM-related fields is underrepresented from women and certain minority groups. So alongside the desire to grow interest, helping balance the scales is one of the main priorities of VIEW. In previous years, VIEW surveyed students before and after instruction to see if their perception of engineering has changed. In general, it is the understanding that being exposed to engineering/STEM at a young age increases the chances that it will be pursued later in life.

Keywords: STEM, engineering outreach, teaching pedagogy, pandemic

Procedia PDF Downloads 129

Authors: Alexander Heckman, Rohan Goswami, Zachi Attia, Paul Friedman, Peter Noseworthy, Demilade Adedinsewo, Pablo Moreno-Franco, Rickey Carter, Tathagat Narula

Abstract:

Background: Postoperative atrial fibrillation (POAF) is associated with adverse health consequences, higher costs, and longer hospital stays. Utilizing existing predictive models that rely on clinical variables and circulating biomarkers, multiple societies have published recommendations on the treatment and prevention of POAF. Although reasonably practical, there is room for improvement and automation to help individualize treatment strategies and reduce associated complications. Methods and Results: In this retrospective cohort study of solid organ transplant recipients, we evaluated the diagnostic utility of a previously developed AI-based ECG prediction for silent AF on the development of POAF within 30 days of transplant. A total of 2261 non-cardiac transplant patients without a preexisting diagnosis of AF were found to have a 5.8% (133/2261) incidence of POAF. While there were no apparent sex differences in POAF incidence (5.8% males vs. 6.0% females, p=.80), there were differences by race and ethnicity (p<0.001 and 0.035, respectively). The incidence in white transplanted patients was 7.2% (117/1628), whereas the incidence in black patients was 1.4% (6/430). Lung transplant recipients had the highest incidence of postoperative AF (17.4%, 37/213), followed by liver (5.6%, 56/1002) and kidney (3.6%, 32/895) recipients. The AUROC in the sample was 0.62 (95% CI: 0.58-0.67). The relatively low discrimination may result from undiagnosed AF in the sample. In particular, 1,177 patients had at least 1 AI-ECG screen for AF pre-transplant above .10, a value slightly higher than the published threshold of 0.08. The incidence of POAF in the 1104 patients without an elevated prediction pre-transplant was lower (3.7% vs. 8.0%; p<0.001). While this supported the hypothesis that potentially undiagnosed AF may have contributed to the diagnosis of POAF, the utility of the existing AI-ECG screening algorithm remained modest. When the prediction for POAF was made using the first postoperative ECG in the sample without an elevated screen pre-transplant (n=1084 on account of n=20 missing postoperative ECG), the AUROC was 0.66 (95% CI: 0.57-0.75). While this discrimination is relatively low, at a threshold of 0.08, the AI-ECG algorithm had a 98% (95% CI: 97 – 99%) negative predictive value at a sensitivity of 66% (95% CI: 49-80%). Conclusions: This study's principal finding is that the incidence of POAF is rare, and a considerable fraction of the POAF cases may be latent and undiagnosed. The high negative predictive value of AI-ECG screening suggests utility for prioritizing monitoring and evaluation on transplant patients with a positive AI-ECG screening. Further development and refinement of a post-transplant-specific algorithm may be warranted further to enhance the diagnostic yield of the ECG-based screening.

Keywords: artificial intelligence, atrial fibrillation, cardiology, transplant, medicine, ECG, machine learning

Procedia PDF Downloads 131

Authors: Deepak Kumar, Ravi Rajwanshi, Mohd. Aslam Yusuf, Nisha Kant Pandey, Preeti Singh, Mukesh Saxena, Neera Bhalla Sarin

Abstract:

Global issues are leading to concerns over food security. These include climate change, urbanization, increase in population subsequently leading to greater energy and water demand. Futuristic approach for crop improvement involves gene pyramiding for agronomic traits that empower the plants to withstand multiple stresses. In an earlier study from the laboratory, the efficacy of overexpressing γ-tocopherol methyl transferase (γ-TMT) gene from the vitamin E biosynthetic pathway has been shown to result in six-fold increase of the most biologically active form, the α-tocopherol in Brassica juncea which resulted in alleviation of salt, heavy metal and osmoticum induced stress by the transgenic plants. The glyoxalase I (gly I) gene from the glyoxalase pathway has also been earlier shown by us to impart tolerance against multiple abioitc stresses by detoxification of the cytotoxic compound methylglyoxal in Brassica juncea. Recently, both the transgenes were pyramided in Brassica juncea lines through sexual crosses involving two stable Brassica juncea lines overexpressing γ-TMT and gly I genes respectively. The transgene integration was confirmed by PCR analysis and their mRNA expression was evident by RT-PCR analysis. Preliminary physiological investigations showed ~55% increased seed germination under 200 mM NaCl stress in the pyramided line and 81% higher seed germination under 200 mM mannitol stress as compared to the WT control plants. The pyramided lines also retained more chlorophyll content when the leaf discs were floated on NaCl (200, 400 and 600 mM) or mannitol (200, 400 and 600 mM) compared to the WT control plants. These plants had higher Relative Water Content and greater solute accumulation under stress compared to the parental plants having γ-TMT or the glyI gene respectively. The studies revealed the synergy of two components from different metabolic pathways in enhancing stress hardiness of the transgenic B. juncea plants. It was concluded that pyramiding of genes (γ-TMT and glyI) from diverse pathways can lead to enhanced tolerance to salt and mannitol stress (simulating drought conditions). This strategy can prove useful in enhancing the crop yields under various abiotic stresses.

Keywords: abiotic stress, brassica juncea, glyoxalase I, α-tocopherol

Procedia PDF Downloads 546

Authors: Elena Maria Scalisi

Abstract:

The increasing production and the use of TiO₂ nanoparticles (NPs) have inevitably led to their release into the environment, thereby posing a threat to organisms and also for human. Human exposure to TiO₂-NPs may occur during both manufacturing and use. TiO₂-NPs are common in consumer products for dermal application, toothpaste, food colorants, and nutritional supplements, then oral exposure may occur during use of such products. Into the body, TiO₂-NPs thanks to their small size (<100 nm), can, through testicular blood barrier inducing effect on testis and then on male reproductive health. The nanoscale size of TiO₂ increase the surface-to-volume ratio making them more reactive in a cell, then TiO₂ NPs increase their ability to produce reactive oxygen species (ROS). In male germ cells, ROS may have important implications in maintaining the normal functions of mature spermatozoa at physiological levels, moreover, in spermatozoa they are important signaling molecules for their hyperactivation and acrosome reaction. Nevertheless, an excess of ROS by external inputs such as NPs can increased the oxidative stress (OS), which results in damage DNA and apoptosis. The aim of our study has been investigate the impact of TiO₂ NPs on human spermatozoa, evaluating DNA damage and the expression of proteins involved in cell stress. According WHO guidelines 2021, we have exposed human spermatozoa in vitro to TiO₂ NP at concentrations 50 ppm, 100 ppm, 250 ppm, and 500 ppm for 1 hour (at 37°C and CO₂ at 5%). DNA damage was evaluated by Sperm Chromatin Dispersion Test (SCD) and TUNEL assay; moreover, we have evaluated the expression of biomarkers of oxidative stress like Heat Shock Protein 70 (HSP70) and Metallothioneins (MTs). Also, sperm parameters as motility viability have been evaluated. Our results not report a significant reduction in motility of spermatozoa at the end of the exposure. On the contrary, the progressive motility was increased at the highest concentration (500 ppm) and was statistically significant compared to control (p <0.05). Also, viability was not changed by exposure to TiO₂-NPs (p <0.05). However, increased DNA damage was observed at all concentrations, and the TUNEL assay highlighted the presence of single strand breaks in the DNA. The spermatozoa responded to the presence of TiO₂-NPs with the expression of Hsp70, which have a protective function because they allow the maintenance of cellular homeostasis in stressful/ lethal conditions. A positivity for MTs was observed mainly for the concentration of 4 mg/L. Although the biological and physiological function of the metallothionein (MTs) in the male genital organs is unclear, our results highlighted that the MTs expressed by spermatozoa maintain their biological role of detoxification from metals. Our results can give additional information to the data in the literature on the toxicity of TiO₂-NPs and reproduction.

Keywords: human spermatozoa, DNA damage, TiO₂-NPs, biomarkers

Procedia PDF Downloads 143

Authors: Randa M. T. Mohamed

Abstract:

Spices have long been used as traditional ingredients in the kitchen for seasoning, coloring, aromatic and food preservative properties. Besides, spices are equally used for therapeutic purposes. The objective of this study was to survey and document the medicinal properties of spices commonly used in the Sudanese kitchen for different food preparations. Also, extracts from reported spices were screened for the presence of secondary metabolites as well as their antioxidant and beta-lactamase inhibitory properties. This study was conducted in the Rekabbya Quartier in Omdurman, Khartoum State, Sudan. Information was collected by carrying out semi-structured interviews. All informants (30) in the present study were women. Spices were purchased from Attareen shop in Omdurman. Essential oils from spices were extracted by hydrodistillation, and ethanolic extracts by maceration. Phytochemical screening was performed by thin-layer chromatography (TLC). The antioxidant capacity of essential oils and ethanolic extracts was investigated through TLC bioautography. Beta lactamase inhibitory activity was performed by the acidimetric test. Ethnobotany study showed that a total of 16 spices were found to treat 36 ailments belonging to 10 categories. The most frequently claimed medicinal uses were for the digestive system diseases treated by 14 spices and respiratory system diseases treated by 8 spices. Gynecological problems were treated with 4 spices. Dermatological diseases were cured by 5 spices, while infections caused by tapeworms and other microbes causing dysentery were treated by 3 spices. 4 spices were used to treat bad breath, bleeding gum and toothache. Headache, eyes infection, cardiac stimulation and epilepsy were treated with one spice each. Other health problems like fatigue and loss of appetite, and low breast milk production were treated by 1, 3 and 2 spices, respectively. The majority (69%, 11/16) of spices were exported from different countries like India, China, Indonesia, Ethiopia, Egypt and Nigeria, while 31% (5/16) was cultivated in Sudan. Essential oils of all spices were rich in terpenes, while ethanolic extracts contained variable classes of secondary metabolites. Both essential oils and ethanolic extracts of all spices exerted considerable antioxidant activity. Only one extract, Syzygium aromaticum, possessed beta-lactamase inhibitory activity. In conclusion, this study could contribute to conserving information on traditional medicinal uses of spices in Sudan. Also, the results demonstrated the potential of some of these spices to exert beneficial antimicrobial and antioxidant effects. Detailed phytochemical and biological assays of these spices are recommended.

Keywords: spices, enthnobotany, antioxidant, betalactamase inhibition

Procedia PDF Downloads 27

Authors: Louise Penzenstadler, Tiphaine Robet, Radu Iuga, Daniele Zullino

Abstract:

Context: The outpatient clinic of the psychiatric addiction service of Geneva University Hospital has been providing support to individuals affected by various narcotics for 30 years. However, the increasing consumption of crack cocaine in Geneva has presented a new challenge for the healthcare system. Research Aim: The aim of this research is to evaluate the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder. Methodology: The research utilizes a combination of quantitative and qualitative retrospective data analysis to evaluate the effectiveness of the outreach intervention. Findings: The data collected from October 2023 to December 2023 show that the outreach program successfully made 1,071 contacts with drug users and led to 15 new requests for care and enrollment in treatment. Patients expressed high satisfaction with the intervention, citing easy and rapid access to treatment and social support. Theoretical Importance: This research contributes to the understanding of the challenges and specific needs of a complex group of drug users who face severe health problems. It highlights the importance of outreach interventions in establishing trust, connecting users with care, and facilitating medication-assisted treatment for opioid addiction. Data Collection: Data was collected through the outreach program's interactions with drug users, including street outreach interventions and presence at locations frequented by users. Patient satisfaction surveys were also utilized. Analysis Procedures: The collected data was analyzed using both quantitative and qualitative methods. The quantitative analysis involved examining the number of contacts made, new requests for care, and treatment enrollment. The qualitative analysis focused on patient satisfaction and their perceptions of the intervention. Questions Addressed: The research addresses the following questions: What is the impact of an outreach intervention on crack cocaine addiction in users with co-occurring opioid use disorder? How effective is the outreach program in connecting drug users with care and initiating medication-assisted treatment? Conclusion: The outreach program has proven to be an effective intervention in establishing trust with crack users, connecting them with care, and initiating medication-assisted treatment for opioid addiction. It has also highlighted the importance of addressing the specific challenges faced by this group of drug users.

Keywords: crack addiction, outreach treatment, peer intervention, polydrug use

Procedia PDF Downloads 62

Authors: Gizaw Mamo Gebeyehu, Marianna Pap, Geza Makkai, Tibor Z. Janosi, Shima Rashidian, Tibor A. Rauch

Abstract:

Sepsis poses a significant global health threat, necessitating extensive exploration of indicators tied to its pathological mechanisms and multi-organ dysfunction. While murine studies have shed light on sepsis, the intricate cellular and molecular landscape in human sepsis remains enigmatic. Exploring the influence of activated monocyte-derived exosomes in sepsis sheds light on a promising pathway for understanding the intricate cellular and molecular mechanisms involved in this condition in humans. In sepsis, exosome-borne mRNA and miRNA orchestrate immune response gene expression in recipient cells. Yet, the specifics of exosome-mediated cell-to-cell communication, especially how mRNA cargoes modulate gene expression in recipient cells, remain poorly understood. This study aims to elucidate the precise molecular pathways through which exosomal mRNA cargo, particularly MAFB, contributes to the developing sepsis-induced molecular aberrations in liver tissues, employing rigorously defined cell culture conditions. THP-1 cells were treated with LPS to induce changes in exosomal RNA profiles. Exosomes were isolated and characterized using microscopy and mass spectrometry. RNA was extracted from exosomes and sequenced. The most abundant exosomal mRNAs were subjected to GO analysis for functional annotation analysis and KEGG database analysis to identify the involved enriched pathways. PCR (Polymerase Chain Reaction), RNA sequencing, and Western blotting were involved to analyze changes in gene expression, protein levels, and signaling pathways within the liver cells( HepG2) after exposure to exosomal MAFB. This study pinpoints exosomal MAFB as a potential key regulator linked to liver cell damage during sepsis, along with associated genes (miR155HG, H3F3A, and possibly JARD2) forming a crucial molecular pathway contributing to liver cell injury, Together, these elements indicate a vital molecular pathway that plays a significant role in the emergence of liver cell injury during sepsis.. These findings suggest the importance of further research on these components for potential therapeutic interventions in managing acute liver damage in sepsis.

Keywords: sepsis, exososome, exosomal MAFB, LPS-induced THP-1 cells, RNA profiles, sepsis-triggered liver injury

Procedia PDF Downloads 62

Authors: Mia Schneeweiss, Joseph Merola

Abstract:

Atopic dermatitis (AD) is a chronic inflammatory skin condition with a prevalence of 9.6 million in children under the age of 18 in the US, 3.2 million of those suffer severe AD. AD has significant effects on the quality of life and psychiatric comorbidity in affected patients. We sought to quantify the use of psychotropic medications and mental health services in children. We used longitudinal claims data form commercially insured patients in the US between 2003 and 2016 to identify children aged 18 or younger with a diagnosis of AD associated with an outpatient or inpatient encounter. A 180-day enrollment period was required before the first diagnosis of AD. Among those diagnosed, we computed the use of psychiatric services and dispensing of psychotropic medications during the following 6 months. Among 1.6 million children <18 years with a diagnosis of AD, most were infants (0-1 years: 17.6%), babies (1-2 years: 12.2%) and young children (2-4 years: 15.4). 5.1% were in age group 16-18 years. Among younger children 50% of patients were female, after the age of 14 about 60% were female. In 16-18 years olds 6.4% had at least one claim with a recorded psychopathology during the 6-month baseline period; 4.6% had depression, 3.3% anxiety, 0.3% panic disorder, 0.6% psychotic disorder, 0.1% anorexia. During the 6 months following the physician diagnosis of AD, 66% used high-potency topical corticosteroids, 3.5% used an SSRI, 0.3% used an SNRI, 1.2% used a tricyclic antidepressant, 1.4% used an antipsychotic medication, and 5.2% used an anxiolytic agent. 4.4% had an outpatient visit with a psychiatrist and 0.1% had been hospitalized with a psychiatric diagnosis. In 14-16 years olds, 4.7% had at least one claim with a recorded psychopathology during the 6-month baseline period; 3.3% had depression, 2.5% anxiety, 0.2% panic disorder, 0.5% psychotic disorder, 0.1% anorexia. During the 6 months following the physician diagnosis of AD, 68% used high-potency topical corticosteroids, 4.6% used an SSRI, 0.6% used an SNRI, 1.5% used a tricyclic antidepressant, 1.4% used an antipsychotic medication, and 4.6% used an anxiolytic agent. 4.7% had an outpatient visit with a psychiatrist and 0.1% had been hospitalized with a psychiatric diagnosis. In 12-14 years olds, 3.3% had at least one claim with a recorded psychopathology during the 6-month baseline period; 1.9% had depression, 2.2% anxiety, 0.1% panic disorder, 0.7% psychotic disorder, 0.0% anorexia. During the 6 months following the physician diagnosis of AD, 67% used high-potency topical corticosteroids, 2.1% used an SSRI, 0.1% used an SNRI, 0.7% used a tricyclic antidepressant, 0.9 % used an antipsychotic medication, and 4.1% used an anxiolytic agent. 3.8% had an outpatient visit with a psychiatrist and 0.05% had been hospitalized with a psychiatric diagnosis. In younger children psychopathologies were decreasingly common: 10-12: 2.8%; 8-10: 2.3%; 6-8: 1.3%; 4-6: 0.6%. In conclusion, there is substantial psychiatric comorbidity among children, <18 years old, with diagnosed atopic dermatitis in a US commercially insured population. Meaningful psychiatric medication use (>3%) starts as early as 12 years old.

Keywords: pediatric atopic dermatitis, phychotropic medication use, psychiatric comorbidity, claims database

Procedia PDF Downloads 176

Authors: Patience Manjengwa-Hungwe, Carmen White

Abstract:

Background: Odyssean malaria refers to malaria acquired by infected mosquito bites from malaria endemic to non-endemic regions by mechanical modes of transport, such as airplanes, water vessels, trains and vehicles. Odyssean Malaria is rare and is characterised by absence of travel history to malaria endemic areas. As not anticipated in non-endemic areas, late diagnosis and treatment lead to a high case fatality rate. On 26 September 2014, the Outbreak Response Unit at the National Institute of Communicable Diseases was notified of a suspected death from Odyssean Malaria in Johannesburg, Gauteng Province, a non-endemic area. The main objective of this investigation was to identify the etiological agent's mode and source of transmission. Methods: Epidemiological surveys were conducted with the deceased’s family and clinical details were obtained from doctors who treated the victim in Southrand, Johannesburg. Blood samples were collected prior to death and sent to the National Health Laboratory Services, Johannesburg laboratory for a full blood count, urea electrolytes, creatinine, and C-reactive protein. Environmental assessments and entomological investigations, including collection of mosquito and larvae, were conducted at the deceased’s home and surrounding areas and sent to the laboratory for analysis. Results: Epidemiological surveys revealed no travel history, no mechanical transmission through blood transfusion and no previous possible exposure of the victim to malaria mosquitoes. Laboratory findings indicated that the platelet count was low. A further smear revealed that the malaria parasite was present and malaria antigen for P. falciparum was positive. Entomological findings revealed that none of the six adult or larval mosquitoes collected on site were malaria vectors. Dumping sites found at the back of the house were identified as possible sites where mosquitoes from endemic places could possibly breed. Conclusion: Given that there was no travel history or the possibility of mechanical transmission (blood transfusion or needle), the research team concluded that it is highly probable that the infection was acquired through an infective Anopheles mosquito inadvertently translocated from a Malaria endemic area by mechanical modes of transport. We recommend that clinicians in non-endemic malaria areas be aware of this type of malaria and test for malaria in patients showing malaria-like symptoms.

Keywords: Odyssean Malaria, vector Bourne, malaria, epidemiological surveys

Procedia PDF Downloads 337

Authors: L. D. Upegui, Isabel Alvarez-Solorza, Karina Garduno-Ulloa, Maren Boecker

Abstract:

Introduction: The increasing prevalence rate of resistant and multiresistant bacterial strains to antibiotics is a threat to public health and requires a rapid multifunctional answer. Individuals that are affected by resistant strains present a higher morbidity and mortality than individuals that are infected with the same species of bacteria but with sensitive strains. There have been identified risk factors that are related to the misuse and overuse of antibiotics, like socio-demographic characteristics and psychological aspects of the individuals that have not been explored objectively due to a lack of valid and reliable instruments for their measurement. Objective: To validate a questionnaire for the evaluation of the levels of knowledge related to the use of antibiotics in a Mexican population. Materials and Methods: Analytical cross-sectional observational study. The questionnaire consists of 12 items to evaluated knowledge (1=no, 2=not sure, 3=yes) regarding the use of antibiotics, with higher scores corresponding to a higher level of knowledge. Data are collected in a sample of students. Data collection is still ongoing. In this abstract preliminary results of 30 respondents are reported which were collected during pilot-testing. The validation of the instrument was done using the Rasch model. Fit to the Rasch model was tested checking overall fit to the model, unidimensionality, local independence and evaluating the presence of Differential Item Functioning (DIF) by age and gender. The software Rumm2030 and the SPSS were used for the analyses. Results: The participants of the pilot-testing presented an average age of 32 years ± 12.6 and 53% were women. The preliminary results indicated that the items showed good fit to the Rasch model (chi-squared=12.8 p=0.3795). Unidimensionality (number of significant t-tests of 3%) could be proven, the items were locally independent, and no DIF was observed. Knowledge was the smallest regarding statements on the role of antibiotics in treating infections, e.g., most of the respondents did not know that antibiotics would not work against viral infections (70%) and that they could also cause side effects (87%). The knowledge score ranged from 0 to 100 points with a transformed measurement (mean of knowledge 27.1 ± 4.8). Conclusions: The instrument showed good psychometric proprieties. The low scores of knowledge about antibiotics suggest that misinterpretations on the use of these medicaments were prevalent, which could influence the production of antibiotic resistance. The application of this questionnaire will allow the objective identification of 'Hight risk groups', which will be the target population for future educational campaigns, to reduce the knowledge gaps on the general population as an effort against antibiotic resistance.

Keywords: antibiotics, knowledge, misuse, overuse, questionnaire, Rasch model, validation

Procedia PDF Downloads 156

Authors: Emma Plante, Charles Ekwunwa, Diego Illanes

Abstract:

Introduction: Serum Sickness-Like Reaction (SSLR) is an inflammatory immune response characterized by a rash, polyarthralgias, and fever. SSLR usually occurs in response to a new medication (most commonly antibiotics, anticonvulsants, or antiinflammatory agents) and is believed to involve the formation of drug-specific immune complexes. Here we present a case of a 16-year-old female patient who developed an SSLR in response to the D-mannose-containing over-the-counter supplement, Uqora, used to promote bladder health. Methodology: The methodology for this study included a thorough literature search for other cases of SSLR associated with D-Mannose containing products. Data collection was performed through a review of the patient’s medical record, including history, physical examination, relevant laboratory results, and treatment plan. Findings: A 16-year-old female with a history of overactive bladder and anemia presented with a diffuse urticarial rash, headaches, joint pain, and swelling for three days. Her medications included oral contraceptive pills, iron, mirabegron, UQora, and a probiotic. Physical examination revealed a diffuse urticarial rash, and her musculoskeletal exam revealed swelling and tenderness in her wrists. Her CBC, basic metabolic panel, liver function panel, lyme titers, and urinalysis were all within normal limits. The patient was referred to an allergist, who diagnosed her with SSLR. All medications were discontinued, and she was treated with a 7-day course of prednisone and cetirizine. Her symptoms resolved, and her medications were slowly resumed sequentially over several months. However, UQora triggered a recurrence of her symptoms, and it was identified as the culprit medication. Consequently, UQora was permanently discontinued, and the patient has remained symptom-free. Conclusion: This case report describes the first documented case of SSLR caused by UQora (active ingredient D-mannose). D-Mannose is a monosaccharide found in many plants and fruits, and it is commonly used to prevent urinary tract infections. While the clinical features and timeline, in this case, were typical of SSLR, UQora as the trigger was highly unusual. Clinicians should be aware of the diverse triggers of SSLR and the importance of prompt identification and management to enhance patient safety. It is possible D-mannose was not the trigger, and further research is necessary to better understand the potential therapeutic applications of D-mannose, as well as the potential risks and interactions.

Keywords: serum sickness-like reaction, d-mannose, hypersensitivity reaction, urticaria

Procedia PDF Downloads 91

Authors: S. Arias

Abstract:

New housing developments and the technological changes that this implies, adapt the styles of living of its residents, as well as new family structures and forms of work due to the particular needs of a specific group of people which involves different techniques of dealing with, organize, equip and use a particular territory. Currently, own their own space is increasingly important and the cities are faced with the challenge of providing the opportunity for such demands, as well as energy, water and waste removal necessary in the process of construction and occupation of new human settlements. Until the day of today, not has failed to give full response to these demands and needs, resulting in cities that grow without control, badly used land, avenues and congested streets. Buildings and dwellings have an important impact on the environment and on the health of the people, therefore environmental quality associated with the comfort of humans to the sustainable development of natural resources. Applied to architecture, this concept involves the incorporation of new technologies in all the constructive process of a dwelling, changing customs of developers and users, what must be a greater effort in planning energy savings and thus reducing the emissions Greenhouse Gases (GHG) depending on the geographical location where it is planned to develop. Since the techniques of occupation of the territory are not the same everywhere, must take into account that these depend on the geographical, social, political, economic and climatic-environmental circumstances of place, which in modified according to the degree of development reached. In the analysis that must be undertaken to check the degree of sustainability of the place, it is necessary to make estimates of the energy used in artificial air conditioning and lighting. In the same way is required to diagnose the availability and distribution of the water resources used for hygiene and for the cooling of artificially air-conditioned spaces, as well as the waste resulting from these technological processes. Based on the results obtained through the different stages of the analysis, it is possible to perform an energy audit in the process of proposing recommendations of sustainability in architectural spaces in search of energy saving, rational use of water and natural resources optimization. The above can be carried out through the development of a sustainable building code in develop technical recommendations to the regional characteristics of each study site. These codes would seek to build bases to promote a building regulations applicable to new human settlements looking for is generated at the same time quality, protection and safety in them. This building regulation must be consistent with other regulations both national and municipal and State, such as the laws of human settlements, urban development and zoning regulations.

Keywords: building regulations, housing, sustainability, technology

Procedia PDF Downloads 346

Authors: Chao Li, Lei Zhou, Ruiqi Ren, Dan Li, Yali Wang, Daxin Ni, Zijian Feng, Qun Li

Abstract:

Background: In 2016, yellow fever had been first ever discovered in China, soon after the yellow fever epidemic occurred in Angola. After the discovery, China had promptly made the national protocol of control and prevention and strengthened the surveillance on passenger and vector. In this study, a descriptive analysis was conducted to summarize China’s experiences of response towards this import epidemic, in the hope of providing experiences on prevention and control of yellow fever and other similar imported infectious diseases in the future. Methods: The imported cases were discovered and reported by General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) and several hospitals. Each clinically diagnosed yellow fever case was confirmed by real-time reverse transcriptase polymerase chain reaction (RT–PCR). The data of the imported yellow fever cases were collected by local Centers for Disease Control and Prevention (CDC) through field investigations soon after they received the reports. Results: A total of 11 imported cases from Angola were reported in China, during Angola’s yellow fever outbreak. Six cases were discovered by the AQSIQ, among which two with mild symptom were initiative declarations at the time of entry. Except for one death, the remaining 10 cases all had recovered after timely and proper treatment. All cases are Chinese, and lived in Luanda, the capital of Angola. 73% were retailers (8/11) from Fuqing city in Fujian province, and the other three were labors send by companies. 10 cases had experiences of medical treatment in Luanda after onset, among which 8 cases visited the same local Chinese medicine hospital (China Railway four Bureau Hospital). Among the 11 cases, only one case had an effective vaccination. The result of emergency surveillance for mosquito density showed that only 14 containers of water were found positive around places of three cases, and the Breteau Index is 15. Conclusions: Effective response was taken to control and prevent the outbreak of yellow fever in China after discovering the imported cases. However, though the similar origin of Chinese in Angola has provided an easy access for disease detection, information sharing, health education and vaccination on yellow fever; these conveniences were overlooked during previous disease prevention methods. Besides, only one case having effective vaccination revealed the inadequate capacity of immunization service in China. These findings will provide suggestions to improve China’s capacity to deal with not only yellow fever but also other similar imported diseases in China.

Keywords: yellow fever, first import, China, suggestion

Procedia PDF Downloads 185

Authors: Anisah Ari

Abstract:

Effects of organized crime permeate all facets of life, including public health, socio-economic endeavors, and human security. If any element of this is affected, it impacts large-scale national and global interest. Seeking to address terrorist networks through technical thinking is like trying to kill a weed by just cutting off its branches. It will re-develop and expand in proportions beyond one’s imagination, even in horrific ways that threaten human security. The continent of Africa has been bedeviled by this menace, with little or no solution to the problem. Nigeria is dealing with a protracted insurgency that is perpetrated by a sect against any form of westernization. Reimagining approaches to dealing with pressing issues like terrorism may require engaging the right set of people in the conversation for any sustainable change. These are people who have lived through the daily effects of the violence that ensues from the activities of terrorist activities. Effective leadership is required for an inclusive process, where spaces are created for diverse voices to be heard, and multiple perspectives are listened to, and not just heard, that supports a determination of the realistic outcome. Addressing insurgency in Nigeria has experienced a lot of disinformation and uncertainty. This may be in part due to poor leadership or an iteration of technical solutions to adaptive challenge peacemaking efforts in Nigeria has focused on behaviors, attitudes and practices that contribute to violence. However, it is important to consider the underlying issues that build-up, ignite and fan the flames of violence—looking at conflict as a complex system, issues like climate change, low employment rates, corruption and the impunity of discrimination due to ethnicity and religion. This article will be looking at an option of the more relational way of addressing insurgency through adaptive approaches that embody engagement and solutions with the people rather than for the people. The construction of a local turn in peacebuilding is informed by the need to create a locally driven and sustained peace process that embodies the culture and practices of the people in enacting an everyday peace beyond just a perennial and universalist outlook. A critical analysis that explores the socially identified individuals and situations will be made, considering the more adaptive approach to a complex existential challenge rather than a universalist frame. Case Study and Ethnographic research approach to understand what other scholars have documented on the matter and also a first-hand understanding of the experiences and viewpoints of the participants.

Keywords: terrorism, adaptive, peace, culture

Procedia PDF Downloads 102

Authors: Virendra Nath, Vipin Kumar

Abstract:

Background: TypeII Diabetes mellitus is a foremost health problem worldwide, predisposing to increased mortality and morbidity. Undesirable effects of the current medications have prompted the researcher to develop more potential drug(s) against the disease. The peroxisome proliferator-activated receptors (PPARs) are members of the nuclear receptors family and take part in a vital role in the regulation of metabolic equilibrium. They can induce or repress genes associated with adipogenesis, lipid, and glucose metabolism. Aims: Investigation of PPARα/γ agonistic hits were screened by hierarchical virtual screening followed by molecular dynamics simulation and knowledge-based structure-activity relation (SAR) analysis using approved PPAR α/γ dual agonist. Methods: The PPARα/γ agonistic activity of compounds was searched by using Maestro through structure-based virtual screening and molecular dynamics (MD) simulation application. Virtual screening of nuclear-receptor ligands was done, and the binding modes with protein-ligand interactions of newer entity(s) were investigated. Further, binding energy prediction, Stability studies using molecular dynamics (MD) simulation of PPARα and γ complex was performed with the most promising hit along with the structural comparative analysis of approved PPARα/γ agonists with screened hit was done for knowledge-based SAR. Results and Discussion: The silicone chip-based approach recognized the most capable nine hits and had better predictive binding energy as compared to the reference drug compound (Tesaglitazar). In this study, the key amino acid residues of binding pockets of both targets PPARα/γ were acknowledged as essential and were found to be associated in the key interactions with the most potential dual hit (ChemDiv-3269-0443). Stability studies using molecular dynamics (MD) simulation of PPARα and γ complex was performed with the most promising hit and found root mean square deviation (RMSD) stabile around 2Å and 2.1Å, respectively. Frequency distribution data also revealed that the key residues of both proteins showed maximum contacts with a potent hit during the MD simulation of 20 nanoseconds (ns). The knowledge-based SAR studies of PPARα/γ agonists were studied using 2D structures of approved drugs like aleglitazar, tesaglitazar, etc. for successful designing and synthesis of compounds PPARγ agonistic candidates with anti-hyperlipidimic potential.

Keywords: computational, diabetes, PPAR, simulation

Procedia PDF Downloads 101

Authors: Bollu Mounica

Abstract:

Background: Nowadays drug related problems were seen very commonly within the health care practice. These could result in the medication errors, adverse events, drug interactions and harm to patients. Pharmacist has an identified role in minimizing and preventing such type of problems. Objectives: To detect the incidence of drug related problems for the hospitalized patient, and to analyze the clinical pharmacist interventions performed during the review of prescription orders of the general medicine, psychiatry, surgery, pediatrics, gynaecology units of a large tertiary care teaching hospital. Methods: It was a retrospective, observational and interventional study. The analysis took place daily with the following parameters: dose, rate of administration, presentation and/or dosage form, presence of inappropriate/unnecessary drugs, necessity of additional medication, more proper alternative therapies, presence of relevant drug interactions, inconsistencies in prescription orders, physical-chemical incompatibilities/solution stability. From this evaluation, the drug therapy problems were classified, as well as the resulting clinical interventions. For a period starting November 2012 until December 2014, the inpatient medication charts and orders were identified and rectified by ward and practicing clinical pharmacists within the inpatient pharmacy services in a tertiary care teaching hospital on routine daily activities. Data was collected and evaluated. The causes of this problem were identified. Results: A total of 360 patients were followed. Male (71.66%) predominance was noted over females (28.33%). Drug related problems were more commonly seen in patients aged in between 31-60. Most of the DRP observed in the study resulted from the dispensing errors (26.11%), improper drug selection (17.22%), followed by untreated indications (14.4%) Majority of the clinical pharmacist recommendations were on need for proper dispensing (26.11%), and drug change (18.05%). Minor significance of DRPs were noted high (41.11 %), whereas (35.27 %) were moderate and (23.61 %) were major. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high (86.66%). Conclusion: Our study showed that the prescriptions reviewed had some drug therapy problem and the pharmacist interventions have promoted positive changes needed in the prescriptions. In this context, routine participation of clinical pharmacists in clinical medical rounds facilitates the identification of DRPs and may prevent their occurrence.

Keywords: drug related problems, clinical pharmacist, drug prescriptions, drug related problems, intervention

Procedia PDF Downloads 303

Authors: Luis Guilherme Resende Santos, Ido Nevat, Leslie Norford

Abstract:

The Urban Heat Island (UHI) is characterized by increased air temperatures in urban areas compared to undeveloped rural surrounding environments. With urbanization and densification, the intensity of UHI increases, bringing negative impacts on livability, health and economy. In order to reduce those effects, it is required to take into consideration design factors when planning future developments. Given design constraints such as population size and availability of area for development, non-trivial decisions regarding the buildings’ dimensions and their spatial distribution are required. We develop a framework for optimization of urban design in order to jointly minimize UHI intensity and buildings’ energy consumption. First, the design constraints are defined according to spatial and population limits in order to establish realistic boundaries that would be applicable in real life decisions. Second, the tools Urban Weather Generator (UWG) and EnergyPlus are used to generate outputs of UHI intensity and total buildings’ energy consumption, respectively. Those outputs are changed based on a set of variable inputs related to urban morphology aspects, such as building height, urban canyon width and population density. Lastly, an optimization problem is cast where the utility function quantifies the performance of each design candidate (e.g. minimizing a linear combination of UHI and energy consumption), and a set of constraints to be met is set. Solving this optimization problem is difficult, since there is no simple analytic form which represents the UWG and EnergyPlus models. We therefore cannot use any direct optimization techniques, but instead, develop an indirect “black box” optimization algorithm. To this end we develop a solution that is based on stochastic optimization method, known as the Cross Entropy method (CEM). The CEM translates the deterministic optimization problem into an associated stochastic optimization problem which is simple to solve analytically. We illustrate our model on a typical residential area in Singapore. Due to fast growth in population and built area and land availability generated by land reclamation, urban planning decisions are of the most importance for the country. Furthermore, the hot and humid climate in the country raises the concern for the impact of UHI. The problem presented is highly relevant to early urban design stages and the objective of such framework is to guide decision makers and assist them to include and evaluate urban microclimate and energy aspects in the process of urban planning.

Keywords: building energy consumption, stochastic optimization, urban design, urban heat island, urban weather generator

Procedia PDF Downloads 130

Authors: Santi Maneewatchararangsri, Wanpen Chaicumpa, Patcharin Saengjaruk, Urai Chaisri

Abstract:

Leptospirosis is a globally neglected disease that continues to be a significant public health and veterinary burden, with millions of cases reported each year. Early and accurate differential diagnosis of leptospirosis from other febrile illnesses and the development of a broad spectrum of leptospirosis vaccines are needed. The LipL32 outer membrane lipoprotein is a member of Leptospira adhesive matrices and has been found to exert hemolytic activity to erythrocytes in vitro. Therefore, LipL32 is regarded as a potential target for diagnosis, broad-spectrum leptospirosis vaccines, and for passive immunotherapy. In this study, we established LipL32-specific mouse monoclonal antibodies, mAbLPF1 and mAbLPF2, and their respective mouse- and humanized-engineered single chain variable fragment (ScFv). Their antibodies’ neutralizing activities against Leptospira-mediated hemolysis in vitro, and the therapeutic efficacy of mAbs against heterologous Leptospira infected hamsters were demonstrated. The epitope peptide of mAb LPF1 was mapped to a non-contiguous carboxy-terminal β-turn and amphipathic α-helix of LipL32 structure contributing to phospholipid/host cell adhesion and membrane insertion. We found that the mAbLPF2 epitope was located on the interacting loop of peptide binding groove of the LipL32 molecule responsible for interactions with host constituents. Epitope sequences are highly conserved among Leptospira spp. and are absent from the LipL32 superfamily of other microorganisms. Both epitopes are surface-exposed, readily accessible by mAbs, and immunogenic. However, they are less dominant when revealed by LipL32-specific immunoglobulins from leptospirosis-patient sera and rabbit hyperimmune serum raised by whole Leptospira. Our study also demonstrated an adhesion inhibitory activity of LipL32 protein to host membrane components and cells mediated by mAbs as well as an anti-hemolytic activity of the respective antibodies. The therapeutic antibodies, particularly the humanized-ScFv, have a potential for further development as non-drug therapeutic agent for human leptospirosis, especially in subjects allergic to antibiotics. The epitope peptides recognized by two therapeutic mAbs have potential use as tools for structure-function studies. Finally, protective peptides may be used as a target for epitope-based vaccines for control of leptospirosis.

Keywords: leptospira lipl32-specific antibodies, therapeutic epitopes, epitopes characterization, immunotherapy

Procedia PDF Downloads 297