Search results for: Saman Jamal

Authors: Hasan Frookh Jamal

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This is a case of a 36-year-old Bahraini gentleman diagnosed to have Cushing's Syndrome with a large anterior mediastinal mass. He was sent abroad to the Speciality hospital in Jordan, where he underwent diagnostic video-assisted thoracoscopy, partial thymectomy and pericardial fat excision. Histopathology of the mass was reported to be an Atypical carcinoid tumor with a low Ki67 proliferation index of 5%, the mitotic activity of 4 MF/10HPF and pathological stage classification(pTNM): pT1aN1. MRI of the pituitary gland showed an ill-defined non-enhancing focus of about 3mm on the Rt side of the pituitary on coronal images, with a similar but smaller one on the left side, which could be due to enhancing pattern rather than a real lesion as reported. The patient underwent Ga68 Dotate PET/CT scan post-operatively, which showed multiple somatostatin receptor-positive lesions seen within the tail, body and head of the pancreas and positive somatostatin receptor lymph nodes located between the pancreatic head and IVC. There was no uptake detected at the anterior mediastinum nor at the site of thymic mass resection. There was no evidence of any positive somatostatin uptake at the soft tissue or lymph nodes. The patient underwent IPSS, which proved that the source is, in fact, an ectopic source of ACTH secretion. Unfortunately, the patient's serum cortisol remained elevated after surgery and failed to be suppressed by 1 mg ODST and by 2 days LLDST with a high ACTH value. The patient was started on Osilodrostat for treatment of hypercortisolism for the time being and his future treatment plan with Lutetium-177 Dotate therapy vs. bilateral adrenalectomy is to be considered in an MDT meeting.

Keywords: cushing syndrome, neuroendocrine tumur, carcinoid tumor, Thymoma

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Authors: Md. Z. Alam, Amal A. Elgharbawy, Muhammad Moniruzzaman, Nassereldeen A. Kabbashi, Parveen Jamal

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The enzymatic hydrolysis of lignocellulosic biomass is one of the obstacles in the process of sugar production, due to the presence of lignin that protects the cellulose molecules against cellulases. Although the pretreatment of lignocellulose in ionic liquid (IL) system has been receiving a lot of interest; however, it requires IL removal with an anti-solvent in order to proceed with the enzymatic hydrolysis. At this point, introducing a compatible cellulase enzyme seems more efficient in this process. A cellulase enzyme that was produced by Trichoderma reesei on palm kernel cake (PKC) exhibited a promising stability in several ILs. The enzyme called PKC-Cel was tested for its optimum pH and temperature as well as its molecular weight. One among evaluated ILs, 1,3-diethylimidazolium dimethyl phosphate [DEMIM] DMP was applied in this study. Evaluation of six factors was executed in Stat-Ease Design Expert V.9, definitive screening design, which are IL/ buffer ratio, temperature, hydrolysis retention time, biomass loading, cellulase loading and empty fruit bunches (EFB) particle size. According to the obtained data, IL-enzyme system shows the highest sugar concentration at 70 °C, 27 hours, 10% IL-buffer, 35% biomass loading, 60 Units/g cellulase and 200 μm particle size. As concluded from the obtained data, not only the PKC-Cel was stable in the presence of the IL, also it was actually stable at a higher temperature than its optimum one. The reducing sugar obtained was 53.468±4.58 g/L which was equivalent to 0.3055 g reducing sugar/g EFB. This approach opens an insight for more studies in order to understand the actual effect of ILs on cellulases and their interactions in the aqueous system. It could also benefit in an efficient production of bioethanol from lignocellulosic biomass.

Keywords: cellulase, hydrolysis, lignocellulose, pretreatment

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Authors: Amr A. El Hanafy, Muhammad I. Qureshi, Jamal Sabir, Mohamed Mutawakil, Mohamed M. Ahmed, Hassan El Ashmaoui, Hassan Ramadan, Mohamed Abou-Alsoud, Mahmoud Abdel Sadek

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β-Lactoglobulin (β-LG) is the dominant non-casein whey protein found in bovine milk and of most ruminants. The amino acid sequence of β-LG along with its 3-dimensional structure illustrates linkage with the lipocalin superfamily. Preliminary studies in goats indicated that milk yield can be influenced by polymorphism in genes coding for whey proteins. The aim of this study is to identify and evaluate the incidence of functional polymorphisms in the exonic and intronic portions of β-LG gene in native Saudi goat breeds (Ardi, Habsi, and Harri). Blood samples were collected from 300 animals (100 for each breed) and genomic DNA was extracted using QIAamp DNA extraction Kit. A fragment of the β-LG gene from exon 7 to 3’ flanking region was amplified with pairs of specific primers. Subsequent digestion with Sac II restriction endonuclease revealed two alleles (A and B) and three different banding patterns or genotypes i.e. AA, AB and BB. The statistical analysis showed that β-LG AA genotype had higher milk yield than β-LG AB and β-LG BB genotypes. Nucleotide sequencing of the selected β-LG fragments was done and submitted to GenBank NCBI (Accession No. KJ544248, KJ588275, KJ588276, KJ783455, KJ783456 and KJ874959). Two already established SNPs in exon 7 (+4601 and +4603) and one fresh SNP in the 3’ UTR region were detected in the β-LG fragments with designated AA genotype. The polymorphisms in exon 7 did not produce any amino acid change. Phylogenetic analysis on the basis of nucleotide sequences of native Saudi goats indicated evolutional similarity with the GenBank reference sequences of goat, Bubalus bubalis and Bos taurus.

Keywords: β-Lactoglobulin, Saudi goats, PCR-RFLP, functional polymorphism, nucleotide sequencing, phylogenetic analysis

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Authors: Jamal Alasiri, Naif Hakeem, Saoud Almaslmani

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Background: Patients with humeral shaft fractures have two different treatment options. Surgical therapy has lesser risks of non-union, mal-union, and re-intervention than non-surgical therapy. These positive clinical outcomes of the surgical approach make it a preferable treatment option despite the risks of radial nerve palsy and additional surgery-related risk. We aimed to evaluate patients’ outcomes and return to work after surgical vs. non-surgical management of shaft humeral fracture. Methods: We used databases, including PubMed, Medline, and Cochrane Register of Controlled Trials, from 2010 to January 2022 to search for potential randomised controlled trials (RCTs) and cohort studies comparing the patients’ related outcome measures and return to work between surgical and non-surgical management of humerus fracture. Results: After carefully evaluating 1352 articles, we included three RCTs (232 patients) and one cohort study (39 patients). The surgical intervention used plate/nail fixation, while the non-surgical intervention used a splint or brace procedure to manage shaft humeral fracture. The pooled DASH effects of all three RCTs at six (M.D: -7.5 [-13.20, -1.89], P: 0.009) I2:44%) and 12 months (M.D: -1.32 [-3.82, 1.17], p:0.29, I2: 0%) were higher in patients treated surgically than in non-surgical procedures. The pooled constant Murley score at six (M.D: 7.945[2.77,13.10], P: 0.003) I2: 0%) and 12 months (M.D: 1.78 [-1.52, 5.09], P: 0.29, I2: 0%) were higher in patients who received non-surgical than surgical therapy. However, pooled analysis for patients returning to work for both groups remained inconclusive. Conclusion: Altogether, we found no significant evidence supporting the clinical benefits of surgical over non-surgical therapy. Thus, the non-surgical approach remains the preferred therapeutic choice for managing shaft humeral fractures due to its lesser side effects.

Keywords: shaft humeral fracture, surgical treatment, Patient-related outcomes, return to work, DASH

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Authors: Ahmad Rasyadan Arshad, A. Rahman A. Jamal, N. Mohamed Ibrahim, Nor Azian Abdul Murad

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Introduction: Parkinson’s disease (PD) is a complex and asymptomatic disease where patients are usually diagnosed at late stage where about 70% of the dopaminergic neurons are lost. Therefore, identification of molecular biomarkers is crucial for early diagnosis of PD. MicroRNA (miRNA) is a short nucleotide non-coding small RNA which regulates the gene expression in post-translational process. The involvement of these miRNAs in neurodegenerative diseases includes maintenance of neuronal development, necrosis, mitochondrial dysfunction and oxidative stress. Thus, miRNA could be a potential biomarkers for diagnosis of PD. Objective: This study aim to identify the miRNA involved in Late Onset PD (LOPD) and Early Onset PD (EOPD) compared to the controls. Methods: This is a case-control study involved PD patients in the Chancellor Tunku Muhriz Hospital at the UKM Medical Centre. miRNA samples were extracted using miRNeasy serum/plasma kit from Qiagen. The quality of miRNA extracted was determined using Agilent RNA 6000 Nano kit in the Bioanalyzer. miRNA expression was performed using GeneChip miRNA 4.0 chip from Affymetrix. Microarray was performed in EOPD (n= 7), LOPD (n=9) and healthy control (n=11). Expression Console and Transcriptomic Analyses Console were used to analyze the microarray data. Result: miR-129-5p was significantly downregulated in EOPD compared to LOPD with -4.2 fold change (p = <0.050. miR-301a-3p was upregulated in EOPD compared to healthy control (fold = 10.3, p = <0.05). In LOPD versus healthy control, miR-486-3p (fold = 15.28, p = <0.05), miR-29c-3p (fold = 12.21, p = <0.05) and miR-301a-3p (fold = 10.01, p =< 0.05) were upregulated. Conclusion: Several miRNA have been identified to be differentially expressed in EOPD compared to LOPD and PD versus control. These miRNAs could serve as the potential biomarkers for early diagnosis of PD. However, these miRNAs need to be validated in a larger sample size.

Keywords: early onset PD, late onset PD, microRNA (miRNA), microarray

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Authors: Laila Nassiri, Aziza Irhza, Jamal Ibijbijen, Fouad Rachidi, Ghizlane Echchgadda

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The introduction of agroecological practices in ecosystems can contribute to meeting the challenges posed by the diversion of current agricultural production systems towards efficient production methods that are more respectful of the environment, including a reasoned use of inputs and resources. Intercropping is one of these practices that requires the production of two or more crops on the same plot and during the same growing season. Organic fertilization also can contribute to increase the yield due to the potential availability of nutrients. The objective of this work is to study the effect of intercropping and organic fertilization, which are two important practices of agroecology, on potato yield. Intercropping of potato and faba bean was carried out at the Agroecology and Environment platform (ENA, Meknes). The soil is silty-clay, the climate is warm with an average temperature of 17.1°C, and the annual average rainfall of 511mm. Four treatments were tested: Potato sole crop (T1), potato + organic fertilization (T2), Potato + faba bean (T3), Potato + faba bean + organic fertilization (T4). The results showed that there is a significant effect of the treatment on the evolution of the agronomical characters studied, especially the number of leaves and the yield. The number of stems at t0 was equal to 1 in all treatments; it began to grow after 30 days from the date of sowing with a slight increase in treatments containing organic fertilization (T2-T4), then it stabilized 60 days after sowing. In terms of the mean value of the number of leaves, a significant difference was noted between the treatments, the highest value was recorded in treatment T2. The T2 treatment showed the highest average yield, followed by the control (T1). As for the yield, treatments T2 and T1 recorded the highest number of tubers. In order to evaluate two of the practices of agroecology, this work focuses on the evaluation of the effect of intercropping and organic fertilization on the growth and yield parameters of the potato. The results obtained show that agroecological practices have a significant effect on the measured parameters.

Keywords: agroecology, intercropping, organic fertilization, potato yield

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Authors: Jamal Alqinai

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A pragmatic approach to translation studies the rules and principles governing the use of language over and above the rules of syntax or morphology, and what makes some uses of language more appropriate than others in [communicative] situations. It attempts to explain translation as a procedure and product from the point of view of how, why and what is done by the source text author (ST) and what is to be done in the target text (TT) rendition. The latter will be subject to evaluation not as generated by the linguistics system but as conveyed and manipulated by participants in a communicative situation according to the referential and pragmatic standards employed. The failure of a purely lexical or structural translation stems from ignoring the relation between words as signs and the effect they have on their users. A more refined approach would also consider those processes that are sometimes labeled extra-linguistic or intuitive and which translators strive to reproduce unscathed in the translation process. We need to grasp the kind of actions an ST author performs on his readers by combining linguistic and non-linguistic elements against a backdrop of beliefs and cultural values. In other words, aside from considering the cohesive ties at the textual level, one needs to understand how the whole ST discourse hangs together logically in order to reproduce a coherent TT. The latter can only be achieved by an analysis of the pragmatic elements of presuppositions, implicatures and acts performed in the ST. Establishing cohesive ties within a text may require seeking reference outside the immediate text. The illocutionary functions manifested in one language/culture are relatively autonomous cultural/linguistic categories, but are imaginable by members of other cultures and, to some extent , are translatable though not, of course, without translation loss. Globalization and the spread of literacy worldwide may have created a universal empathy to comprehend the performative aspect of utterances when explained by approximate glosses or by paraphrase. Yet, it is often the multilayered and the culture-specific nature of illocutionary functions that de-universalize their possible interpretations. This paper addresses the pragmatic interpretation of culturally specific texts with examples adduced from a number of distinct settings to illustrate the influence of the pragmatic factors at stake.

Keywords: pragmatic, presupposition, implicature, cohesion

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Authors: Jamal Almatawah, Hamad Matar, Abdulsalam Altemeemi

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The World Health Organization (WHO) has recognized environmental noise as harmful pollution that causes adverse psychosocial and physiologic effects on human health. The motor vehicle is considered to be one of the main source of noise pollution. It is a universal phenomenon, and it has grown to the point that it has become a major concern for both the public and policymakers. The aim of this paper, therefore, is to investigate the Traffic noise levels and the contributing factors that affect its level, such as traffic volume, heavy-vehicle Speed and other metrological factors in Ishbiliyah as a sample of a residential area in Kuwait. Three types of roads were selected in Ishbiliyah expressway, major arterial and collector street. The other source of noise that interferes the traffic noise has also been considered in this study. Traffic noise level is measured and analyzed using the Bruel & Kjaer outdoor sound level meter 2250-L (2250 Light). The Count-Cam2 Video Camera has been used to collect the peak and off-peak traffic count. Ambient Weather WM-5 Handheld Weather Station is used for metrological factors such as temperature, humidity and wind speed. Also, the spot speed was obtained using the radar speed: Decatur Genesis model GHD-KPH. All the measurement has been detected at the same time (simultaneously). The results showed that the traffic noise level is over the allowable limit on all types of roads. The average equivalent noise level (LAeq) for the Expressway, Major arterial and Collector Street was 74.3 dB(A), 70.47 dB(A) and 60.84 dB(A), respectively. In addition, a Positive Correlation coefficient between the traffic noise versus traffic volume and between traffic noise versus 85th percentile speed was obtained. However, there was no significant relation and Metrological factors. Abnormal vehicle noise due to poor maintenance or user-enhanced exhaust noise was found to be one of the highest factors that affected the overall traffic noise reading.

Keywords: traffic noise, residential area, pollution, vehicle noise

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Authors: Saif Ullah, Zaigham Hasan, Muhammad Ali, Qaisar Jamal, Kiran Salahuddin, Muhammad Awais

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Survey of avian fauna of Bara Gali Summer Campus, University of Peshawar situated in Abbottabad was conducted from April to October, 2013. A total of 21 species belonging to 5 orders and 15 families were recorded. Out of these, 6 were resident, 12 summer visitor and 3 rare. Order Passeriformes was represented by 16 species which are Certhia himalayana, Megalaima virens, Phylloscopus trochiloides, Garrulax lineatus, Passer rutilans, Corvus macrorhynchos, Hypsipetes leucocephalus, Acridotheres tristis, Delichon dasypus cashmeriensis, Hirundo rustica, Muscicapa thalassina, Saxicola ferrea, Myiophoneus caeruleus, Parus melonolophus, Parus rufonuchalis, Parus monticolus, belonging to 11 families. Two species Dendrocopos himalayansis and Picus squamatus belong to only one family Picidae of order Piciformes. Among rest of the three orders each is represented by only a single species; Accipitriformes by Accipiter virgatus, Coraciformes by Upupa epops while order Psittaciformes has been represented by Psittacula himalayana. The distribution and abundance varied with season and maximum number of species were found during the monsoon season when most of the birds migrate for breeding. Some habits and behaviors like nesting, feeding, breeding and vocalizations were also studied which are very unique from other birds found at lower elevations. Among bird species adapted to diverse habitat in the field, Himalayan Jungle Crow, Common Mynas, Bulbuls, Barn Swallows, barbets were prominent. Interesting feature of the avian fauna is its familiarity with flora, was also observed during the present studies that some birds are very quick and active in their movement on a tree surface i.e Certhia himalayana.

Keywords: avifauna diversity, distribution, Bara Gali, Abbottabad

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Authors: Asma Qudrat, Abid Ullah, Rafi Ullah, Ali Raza, Shah Zeb, Syed Ali Shan Ul-Haq, Shahkar Ahmed Shah, Attiya Hameed Khan, Saad Zaheer, Umama Qasim, Kiran Jamal, Zahoor khan

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Objectives: Coronary artery disease (CAD) is the major public health issue associated with high mortality and morbidity rate worldwide. Young patients with ACS have unique characteristics with different demographic profiles and risk factors. The precise diagnosis and early risk stratification is important in guiding treatment and predicting the prognosis of young patients with ACS. To evaluate the associated demographics, risk factors, and outcomes profile of ACS in young age patients. Methods: The research follow a retrospective design, the single centre study of patients diagnosis with the first event of ACS in young age (>18 and <40) were included. Data collection included demographic profiles, risk factors, and in-hospital outcomes of young ACS patients. The patient’s data was retrieved through Electronic Medical Records (EMR) of Peshawar Institute of Cardiology (PIC), and all characteristic were assessed. Results: In this study, 77% were male, and 23% were female patients. The risk factors were assessed with CAD and shown significant results (P < 0.01). The most common presentation was STEMI, with (45%) most in ACS young patients. The angiographic pattern showed single vessel disease (SVD) in 49%, double vessel disease (DVD) in 17% and triple vessel disease (TVD) was found in 10%, and Left Artery Disease (LAD) (54%) was present to be the most common involved artery. Conclusion: It is concluded that the male sex was predominant in ACS young age patients. SVD was the common coronary angiographic finding. Risk factors showed significant results towards CAD and common presentations.

Keywords: coronary artery disease, Non-ST elevation myocardial infarction, ST elevation myocardial infarction, unstable angina, acute coronary syndrome

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Authors: Shri Dubey, Jamal Ghorieshi

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Instability of the lumbar spine is caused by various factors that include degenerative disc, herniated disc, traumatic injuries, and other disorders. Pedicle screws are widely used as a main fixation device to construct rigid linkages of vertebrae to provide a fully functional and stable spine. Various technologies and methods have been used to restore the stabilization. However, loosening of pedicle screws is the main cause of concerns for neurosurgeons. This could happen due to poor bone quality with osteoporosis as well as types of pedicle screw used. Compatibilities and stabilities of pedicle screws with bone depend on design (thread design, length, and diameter) and material. Grip length and pullout strength affect the motion and stability of the spine when it goes through different phases such as extension, flexion, and rotation. Pullout strength of augmented pedicle screws is increased in both primary and salvage procedures by 119% (p = 0.001) and 162% (p = 0.01), respectively. Self-centering pedicle screws at different trajectories (0°, 10°, 20°, and 30°) show the same pullout strength as insertion in a straight-ahead trajectory. The outer cylindrical and inner conical shape of pedicle screws show the highest pullout strength in Grades 5 and 15 foams (synthetic bone). An outer cylindrical and inner conical shape with a V-shape thread exhibit the highest pullout strength in all foam grades. The maximum observed pullout strength is at axial pullout configuration at 0°. For Grade 15 (240 kg/m³) foam, there is a decline in pull out strength. The largest decrease in pullout strength is reported for Grade 10 (160 kg/m³) foam. The maximum pullout strength of 2176 N (0.32-g/cm³ Sawbones) on all densities. Type 1 Pedicle screw shows the best fixation due to smaller conical core diameter and smaller thread pitch (Screw 2 with 2 mm; Screws 1 and 3 with 3 mm).

Keywords: polymethylmethacrylate, PMMA, classical pedicle screws, CPS, expandable poly-ether-ether-ketone shell, EPEEKS, includes translaminar facet screw, TLFS, poly-ether-ether-ketone, PEEK, transfacetopedicular screw, TFPS

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Authors: Shizrah Jamal, Robia Ghafoor, Farhan Raza

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Porcelain fused to metal crown is the most versatile variety of crown that is commonly placed worldwide. Various complications have been reported in the PFM crowns with use over the period of time. These include chipping of the porcelain, recurrent caries, loss of retention, open contacts, and tooth fracture. The objective of the present study was to determine the frequency of these complications in crowns cemented over a period of five years in a tertiary care hospital and also to report the survival of these crowns. A retrospective study was conducted in Dental clinics, Aga Khan University Hospital in which 150 PFM crowns cemented over a period of five years were evaluated. Patient demographics, oral hygiene habits, para-functional habits, crown insertion and follow-up dates were recorded in a specially designed proforma. All PFM crowns fulfilling the inclusion criteria were assessed both clinically and radiographically for the presence of any complication. SPSS version 22.0 was used for statistical analysis. Frequency distribution and proportion of complications were determined. Chi-square test was used to determine the association of complications of PFM crowns with multiple variables including tooth wear, opposing dentition and betel nut chewing. Kaplan- meier survival analysis was used to determine the survival of PFM crowns over the period of five years. Level of significance was kept at 0.05. A total of 107 patients, with a mean age of 43.51 + 12.4 years, having 150 PFM crowns were evaluated. The most common complication observed was open proximal contacts (8.7%) followed by porcelain chipping (6%), decementation (5.3%), and abutment fracture (1.3%). Chi square test showed that there was no statistically significant association of PFM crown complication with tooth wear, betel nut and opposing dentition (p-value <0.05). The overall success and survival rates of PFM crowns turned out to be 78.7 and 84.7% respectively. Within the limitations of the study, it can be concluded that PFM crowns are an effective treatment modality with high success and survival rates. Since it was a single centered study; the results should be generalized with caution.

Keywords: chipping, complication, crown, survival rate

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Authors: Jamal A. Radaideh, A. J. Radaideh

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Being a problem threatening the planet and its ecosystems, the climate change has been considered for a long time as a disturbing topic impacting water resources in Jordan. Jordan is expected for instance to be highly vulnerable to climate change consequences given its unbalanced distribution between water resources availability and existing demands. Thus, action on adaptation to climate impacts is urgently needed to cope with the negative consequences of climate change. Adaptation to global change must include prudent management of treated wastewater as a renewable resource, especially in regions lacking groundwater or where groundwater is already over exploited. This paper highlights the expected negative effects of climate change on the already scarce water sources and to motivate researchers and decision makers to take precautionary measures and find alternatives to keep the level of water supplies at the limits required for different consumption sectors in terms of quantity and quality. The paper will focus on assessing the potential for wastewater recycling as an adaptation measure to cope with water scarcity in Jordan and to consider wastewater as integral part of the national water budget to solve environmental problems. The paper also identified a research topic designed to help the nation progress in making the most appropriate use of the resource, namely for agricultural irrigation. Wastewater is a promising alternative to fill the shortage in water resources, especially due to climate changes, and to preserve the valuable fresh water to give priority to securing drinking water for the population from these resources and at the same time raise the efficiency of the use of available resources. Jordan has more than 36 wastewater treatment plants distributed throughout the country and producing about 386,000 CM/day of reclaimed water. According to the reports of water quality control programs, more than 85 percent of this water is of a quality that is completely identical to the quality suitable for irrigation of field crops and forest trees according to the requirements of Jordanian Standard No. 893/2006.

Keywords: climate change effects on water resources, adaptation on climate change, treated wastewater recycling, arid and semi-arid regions, Jordan

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Authors: Adel Salem Bahakeem, Ahmad Jamal, Mir Md. Maruf Morshed, Elwaleed Awad Khidir

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Direct Current (DC) servo motors, or simply DC motors, play an important role in many industrial applications such as manufacturing of plastics, precise positioning of the equipment, and operating computer-controlled systems where speed of feed control, maintaining the position, and ensuring to have a constantly desired output is very critical. These parameters can be controlled with the help of control systems such as the Proportional Integral Derivative (PID) controller. The aim of the current work is to investigate the effects of Proportional (P) and Integral (I) controllers on the steady state and transient response of the DC motor. The controller gains are varied to observe their effects on the error, damping, and stability of the steady and transient motor response. The current investigation is conducted experimentally on a servo trainer CE 110 using analog PI controller CE 120 and theoretically using Simulink in MATLAB. Both experimental and theoretical work involves varying integral controller gain to obtain the response to a steady-state input, varying, individually, the proportional and integral controller gains to obtain the response to a step input function at a certain frequency, and theoretically obtaining the proportional and integral controller gains for desired values of damping ratio and response frequency. Results reveal that a proportional controller helps reduce the steady-state and transient error between the input signal and output response and makes the system more stable. In addition, it also speeds up the response of the system. On the other hand, the integral controller eliminates the error but tends to make the system unstable with induced oscillations and slow response to eliminate the error. From the current work, it is desired to achieve a stable response of the servo motor in terms of its angular velocity subjected to steady-state and transient input signals by utilizing the strengths of both P and I controllers.

Keywords: DC servo motor, proportional controller, integral controller, controller gain optimization, Simulink

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Authors: Yifat Koren Carmi, Abed Agbarya, Hazem Khamaisi, Raymond Farah, Yelena Shechtman, Roman Korobochka, Jacob Gopas, Jamal Mahajna

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Ovarian cancer (OC), the second most common form of gynecological malignancy, has a poor prognosis and is frequently identified in its late stages. The recommended treatment for OC typically includes a platinum-based chemotherapy, like carboplatin. Nonetheless, OC treatment has proven challenging due to toxicity and development of acquired resistance to therapy. Chemoresistance is a significant obstacle to a long-lasting response in OC patients, believed to arise from alterations within the cancer cells as well as within the tumor microenvironments (TME). Malignant ascites is a presenting feature in more than one-third of OC patients. It serves as a reservoir for a complex mixture of soluble factors, metabolites, and cellular components, providing a pro-inflammatory and tumor-promoting microenvironment for the OC cells. Malignant ascites is also associated with metastasis and chemoresistance. In an attempt to elucidate the role of TME in chemoresistance of OC, we monitored the ability of soluble factors derived from ascites fluids to affect platinum sensitivity of OC cells. This research, compared ascites fluids from non-malignant cirrhotic patients to those from OC patients in terms of their ability to alter the platinum sensitivity of OC cells. Our findings indicated that exposure to OC ascites induces platinum chemoresistance on OC cells in 11 out of 13 cases (85%). In contrast, 75% of cirrhosis ascites (3 out of 4) failed to confer platinum chemoresistance to OC cells. Cytokine array analysis revealed that IL-6, and to a lesser extent HGF were enriched in OC ascites, whereas IL-22 was enriched in cirrhosis ascites. Pharmaceutical inhibitors that target the IL-6/JAK signaling pathway were mildly effective in overcoming the platinum chemoresistance induced by malignant ascites. In contrast, Crizotinib an HGF/c-MET inhibitor, and 2-hydroxyestradiol (2HE2) were effective in restoring platinum chemoresistance to OC. Our findings demonstrate the importance of OC ascites in supporting platinum chemoresistance as well as the potential of a combination therapy with Crizotinib and the estradiol metabolite 2HE2 to regain OC cells chemosensitivity.

Keywords: ovarian cancer, platinum chemoresistance, malignant ascites, tumor microenvironment, IL-6, 2-hydroxyestradiol, HGF, crizotinib

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Authors: Angela T. H. Kwan, Saman Arfaie, Joseph Therriault, Zahra Azizi, Firoza Z. Lussier, Cecile Tissot, Mira Chamoun, Gleb Bezgin, Stijn Servaes, Jenna Stevenon, Nesrine Rahmouni, Vanessa Pallen, Serge Gauthier, Pedro Rosa-Neto

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Alzheimer’s disease (AD) can be detected in living people using in vivo biomarkers of amyloid-β (Aβ) and tau, even in the absence of cognitive impairment during the preclinical phase. [¹⁸F]-MK-6420 is a high affinity positron emission tomography (PET) tracer that quantifies tau neurofibrillary tangles, but its ability to predict cognitive changes associated with early AD symptoms, such as memory decline, is unclear. Here, we assess the prognostic accuracy of baseline [18F]-MK-6420 tau PET for predicting longitudinal memory decline in asymptomatic elderly individuals. In a longitudinal observational study, we evaluated a cohort of cognitively normal elderly participants (n = 111) from the Translational Biomarkers in Aging and Dementia (TRIAD) study (data collected between October 2017 and July 2020, with a follow-up period of 12 months). All participants underwent tau PET with [¹⁸F]-MK-6420 and Aβ PET with [¹⁸F]-AZD-4694. The exclusion criteria included the presence of head trauma, stroke, or other neurological disorders. There were 111 eligible participants who were chosen based on the availability of Aβ PET, tau PET, magnetic resonance imaging (MRI), and APOEε4 genotyping. Among these participants, the mean (SD) age was 70.1 (8.6) years; 20 (18%) were tau PET positive, and 71 of 111 (63.9%) were women. A significant association between baseline Braak I-II [¹⁸F]-MK-6240 SUVR positivity and change in composite memory score was observed at the 12-month follow-up, after correcting for age, sex, and years of education (Logical Memory and RAVLT, standardized beta = -0.52 (-0.82-0.21), p < 0.001, for dichotomized tau PET and -1.22 (-1.84-(-0.61)), p < 0.0001, for continuous tau PET). Moderate cognitive decline was observed for A+T+ over the follow-up period, whereas no significant change was observed for A-T+, A+T-, and A-T-, though it should be noted that the A-T+ group was small.Our results indicate that baseline tau neurofibrillary tangle pathology is associated with longitudinal changes in memory function, supporting the use of [¹⁸F]-MK-6420 PET to predict the likelihood of asymptomatic elderly individuals experiencing future memory decline. Overall, [¹⁸F]-MK-6420 PET is a promising tool for predicting memory decline in older adults without cognitive impairment at baseline. This is of critical relevance as the field is shifting towards a biological model of AD defined by the aggregation of pathologic tau. Therefore, early detection of tau pathology using [¹⁸F]-MK-6420 PET provides us with the hope that living patients with AD may be diagnosed during the preclinical phase before it is too late.

Keywords: alzheimer’s disease, braak I-II, in vivo biomarkers, memory, PET, tau

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Authors: Shekoufeh Behdad, Amirhossein Yadegari, Leila Ghodrati, Saman Yadegari

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Context: Preoperative anxiety is a common psychological reaction experienced by all patients undergoing surgery. It can have negative effects on the patient's well-being and even impact surgical outcomes. Therefore, finding effective interventions to reduce preoperative anxiety is important in improving patient care. Research Aim: The aim of this study is to compare the effects of oral administration of zaleplon (5 mg) and alprazolam (0.5 mg) on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Methodology: This study is a double-blind, randomized clinical trial conducted after receiving approval from the university's ethics committee and obtaining written informed consent from the patients. The night before the surgery, patients were randomly assigned to receive either 0.5 mg of alprazolam or 5 mg of zaleplon orally. Anxiety levels, measured using a 10-cm visual analog scale, and hemodynamic variables (blood pressure and heart rate) were assessed before drug administration and on the morning of the operation after the patient entered the pre-operation room. Findings: The study found that there were no significant differences in mean anxiety levels or hemodynamic variables before and after administration of either drug in both groups (P value > 0.05). This suggests that both 0.5 mg of alprazolam and 5 mg of zaleplon effectively reduce preoperative anxiety in women undergoing abdominal surgery without serious side effects. Theoretical Importance: This study contributes to the understanding of the effectiveness of alprazolam and zaleplon in reducing preoperative anxiety. It adds to the existing literature on pharmacological interventions for anxiety management, specifically in the context of gynecological abdominal surgery. Data Collection: Data for this study were collected through the assessment of anxiety levels using a visual analog scale and measuring hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate. These measurements were taken before drug administration and on the morning of the surgery. Analysis Procedures: Statistical analysis was performed to compare the mean anxiety levels and hemodynamic variables before and after drug administration in the two groups. The significance of the differences was determined using appropriate statistical tests. Questions Addressed: This study aimed to answer the question of whether there are differences in the effects of alprazolam and zaleplon on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Conclusion: The oral administration of both 0.5 mg of alprazolam and 5 mg of zaleplon the night before surgery effectively reduces preoperative anxiety in women undergoing abdominal surgery. These findings have important implications for the management of preoperative anxiety and can contribute to improving the overall surgical experience for patients.

Keywords: zaleplon, alprazolam, premedication, abdominal surgery

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Authors: Faiz N. K. Yusufi, Aquil Ahmed, Jamal Ahmad

Abstract:

Diabetes in India is growing at an alarming rate and the complications caused by it need to be controlled. Coronary heart disease (CHD) is one of the complications that will be discussed for prediction in this study. India has the second most number of diabetes patients in the world. To the best of our knowledge, there is no CHD risk score for Indian type 2 diabetes patients. Any form of CHD has been taken as the event of interest. A sample of 750 was determined and randomly collected from the Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N.M.C., A.M.U., Aligarh, India. Collected variables include patients data such as sex, age, height, weight, body mass index (BMI), blood sugar fasting (BSF), post prandial sugar (PP), glycosylated haemoglobin (HbA1c), diastolic blood pressure (DBP), systolic blood pressure (SBP), smoking, alcohol habits, total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), physical activity, duration of diabetes, diet control, history of antihypertensive drug treatment, family history of diabetes, waist circumference, hip circumference, medications, central obesity and history of CHD. Predictive risk scores of CHD events are designed by cox proportional hazard regression. Model calibration and discrimination is assessed from Hosmer Lemeshow and area under receiver operating characteristic (ROC) curve. Overfitting and underfitting of the model is checked by applying regularization techniques and best method is selected between ridge, lasso and elastic net regression. Youden’s index is used to choose the optimal cut off point from the scores. Five year probability of CHD is predicted by both survival function and Markov chain two state model and the better technique is concluded. The risk scores for CHD developed can be calculated by doctors and patients for self-control of diabetes. Furthermore, the five-year probabilities can be implemented as well to forecast and maintain the condition of patients.

Keywords: coronary heart disease, cox proportional hazard regression, ROC curve, type 2 diabetes Mellitus

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Authors: Saman Ahani, Aboozar Dehghan, Roham Vali, Hamid Salehian, Amin Ebrahimi

Abstract:

Pulsed-wave (PW) doppler ultrasonography is a non-invasive, relatively accurate imaging technique that can measure blood speed. The imaging could be obtained via the common carotid artery, as one of the main vessels supplying the blood of vital organs. In horses, factors such as susceptibility to depression of the cardiovascular system and their large muscular mass have rendered them vulnerable to changes in blood speed. One of the most important factors causing blood velocity changes is the administration of anesthetic drugs, including Ketamine and Acepromazine. Thus, in this study, the Pulsed-wave doppler technique was performed to assess the highest blood velocity in the common carotid artery following administration of Ketamine and Acepromazine. Six male and six female healthy Kurdish horses weighing 351 ± 46 kg (mean ± SD) and aged 9.2 ± 1.7 years (mean ± SD) were housed under animal welfare guidelines. After fasting for six hours, the normal blood flow velocity in the common carotid artery was measured using a Pulsed-wave doppler ultrasonography machine (BK Medical, Denmark), and a high-frequency linear transducer (12 MHz) without applying any sedative drugs as a control group. The same procedure was repeated after each individual received the following medications: 1.1, 2.2 mg/kg Ketamine (Pfizer, USA), and 0.5, 1 mg/kg Acepromizine (RACEHORSE MEDS, Ukraine), with an interval of 21 days between the administration of each dose and/or drug. The ultrasonographic study was done five (T5) and fifteen (T15) minutes after injecting each dose intravenously. Lastly, the statistical analysis was performed using SPSS software version 22 for Windows and a P value less than 0.05 was considered to be statistically significant. Five minutes after administration of Ketamine (1.1, 2.2 mg/kg) in both male and female horses, the blood velocity decreased to 38.44, 34.53 cm/s in males, and 39.06, 34.10 cm/s in females in comparison to the control group (39.59 and 40.39 cm/s in males and females respectively) while administration of 0.5 mg/kg Acepromazine led to a significant rise (73.15 and 55.80 cm/s in males and females respectively) (p<0.05). It means that the most drastic change in blood velocity, regardless of gender, refers to the latter dose/drug. In both medications and both genders, the increase in doses led to a decrease in blood velocity compared to the lower dose of the same drug. In all experiments in this study, the blood velocity approached its normal value at T15. In another study comparing the blood velocity changes affected by Ketamine and Acepromazine through femoral arteries, the most drastic changes were attributed to Ketamine; however, in this experiment, the maximum blood velocity was observed following administration of Acepromazine via the common carotid artery. Therefore, further experiments using the same medications are suggested using Pulsed-wave doppler measuring the blood velocity changes in both femoral and common carotid arteries simultaneously.

Keywords: Acepromazine, common carotid artery, horse, ketamine, pulsed-wave doppler ultrasonography

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Authors: Arafa A. Alholaisi, Jamal H. Madani, M. A. Alvi

Abstract:

The radial form of nuclear matter distribution, charge and the shape of nuclei are essential properties of nuclei, and hence, are of great attention for several areas of research in nuclear physics. More than last three decades have witnessed a range of experimental means employing leptonic probes (such as muons, electrons etc.) for exploring nuclear charge distributions, whereas the hadronic probes (for example alpha particles, protons, etc.) have been used to investigate the nuclear matter distributions. In this paper, p-^9,11Li elastic scattering differential cross sections in the energy range  to  MeV have been studied by means of Coulomb modified Glauber scattering formalism. By applying the semi-phenomenological Bhagwat-Gambhir-Patil [BGP] nuclear density for loosely bound neutron rich ¹¹Li nucleus, the estimated matter radius is found to be 3.446 fm which is quite large as compared to so known experimental value 3.12 fm. The results of microscopic optical model based calculation by applying Bethe-Brueckner–Hartree–Fock formalism (BHF) have also been compared. It should be noted that in most of phenomenological density model used to reproduce the p-¹¹Li differential elastic scattering cross sections data, the calculated matter radius lies between 2.964 and 3.55 fm. The calculated results with phenomenological BGP model density and with nucleon density calculated in the relativistic mean-field (RMF) reproduces p-⁹Li and p-¹¹Li experimental data quite nicely as compared to Gaussian- Gaussian or Gaussian-Oscillator densities at all energies under consideration. In the approach described here, no free/adjustable parameter has been employed to reproduce the elastic scattering data as against the well-known optical model based studies that involve at least four to six adjustable parameters to match the experimental data. Calculated reaction cross sections σ_R for p-¹¹Li at these energies are quite large as compared to estimated values reported by earlier works though so far no experimental studies have been performed to measure it.

Keywords: Bhagwat-Gambhir-Patil density, Coulomb modified Glauber model, halo nucleus, optical limit approximation

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Authors: Tasnuba Binte Jamal, Khan Mahmud Amanat

Abstract:

Carbon Fiber-Reinforced Polymer (CFRP) composite materials have proven to have valuable properties and suitability to be used in the construction of new buildings and in upgrading the existing ones due to its effectiveness, ease of implementation and many more. In the present study, a numerical finite element investigation has been conducted using ANSYS 18.1 to study the behavior of square HSS AISC sections under eccentric compressive loading strengthened with CFRP materials. A three-dimensional finite element model for square HSS section using shell element was developed. Application of CFRP strengthening was incorporated in the finite element model by adding an additional layer of shell elements. Both material and geometric nonlinearities were incorporated in the model. The developed finite element model was applied to simulate experimental studies done by past researchers and it was found that good agreement exists between the current analysis and past experimental results, which established the acceptability and validity of the developed finite element model to carry out further investigation. Study was then focused on some selected non-compact AISC square HSS columns and the effects of number of CFRP layers, amount of eccentricities and cross-sectional geometry on the strength gain of those columns were observed. Load was applied at a distance equal to the column dimension and twice that of column dimension. It was observed that CFRP strengthening is comparatively effective for smaller eccentricities. For medium sized sections, strengthening tends to be effective at smaller eccentricities as well. For relatively large AISC square HSS columns, with increasing number of CFRP layers (from 1 to 3 layers) the gain in strength is approximately 1 to 38% to that of unstrengthened section for smaller eccentricities and slenderness ratio ranging from 27 to 54. For medium sized square HSS sections, effectiveness of CFRP strengthening increases approximately by about 12 to 162%. The findings of the present study provide a better understanding of the behavior of HSS sections strengthened with CFRP subjected to eccentric compressive load.

Keywords: CFRP strengthening, eccentricity, finite element model, square hollow section

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Authors: Faiz N. K. Yusufi, Aquil Ahmed, Jamal Ahmad

Abstract:

Predicting the risk of diabetic retinopathy (DR) in Indian type 2 diabetes patients is immensely necessary. India, being the second largest country after China in terms of a number of diabetic patients, to the best of our knowledge not a single risk score for complications has ever been investigated. Diabetic retinopathy is a serious complication and is the topmost reason for visual impairment across countries. Any type or form of DR has been taken as the event of interest, be it mild, back, grade I, II, III, and IV DR. A sample was determined and randomly collected from the Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N.M.C., A.M.U., Aligarh, India. Collected variables include patients data such as sex, age, height, weight, body mass index (BMI), blood sugar fasting (BSF), post prandial sugar (PP), glycosylated haemoglobin (HbA1c), diastolic blood pressure (DBP), systolic blood pressure (SBP), smoking, alcohol habits, total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), physical activity, duration of diabetes, diet control, history of antihypertensive drug treatment, family history of diabetes, waist circumference, hip circumference, medications, central obesity and history of DR. Cox proportional hazard regression is used to design risk scores for the prediction of retinopathy. Model calibration and discrimination are assessed from Hosmer Lemeshow and area under receiver operating characteristic curve (ROC). Overfitting and underfitting of the model are checked by applying regularization techniques and best method is selected between ridge, lasso and elastic net regression. Optimal cut off point is chosen by Youden’s index. Five-year probability of DR is predicted by both survival function, and Markov chain two state model and the better technique is concluded. The risk scores developed can be applied by doctors and patients themselves for self evaluation. Furthermore, the five-year probabilities can be applied as well to forecast and maintain the condition of patients. This provides immense benefit in real application of DR prediction in T2DM.

Keywords: Cox proportional hazard regression, diabetic retinopathy, ROC curve, type 2 diabetes mellitus

Procedia PDF Downloads 186

Authors: Ahmed Bahieldin, Ahmed Atef, Jamal S. M. Sabir, Nour O. Gadalla, Sherif Edris, Ahmed M. Alzohairy, Nezar A. Radhwan, Mohammed N. Baeshen, Ahmed M. Ramadan, Hala F. Eissa, Sabah M. Hassan, Nabih A. Baeshen, Osama Abuzinadah, Magdy A. Al-Kordy, Fotouh M. El-Domyati, Robert K. Jansen

Abstract:

Wild salt-tolerant barley (Hordeum spontaneum) is the ancestor of cultivated barley (Hordeum vulgare or H. vulgare). Although the cultivated barley genome is well studied, little is known about genome structure and function of its wild ancestor. In the present study, RNA-Seq analysis was performed on young leaves of wild barley treated with salt (500 mM NaCl) at four different time intervals. Transcriptome sequencing yielded 103 to 115 million reads for all replicates of each treatment, corresponding to over 10 billion nucleotides per sample. Of the total reads, between 74.8 and 80.3% could be mapped and 77.4 to 81.7% of the transcripts were found in the H. vulgare unigene database (unigene-mapped). The unmapped wild barley reads for all treatments and replicates were assembled de novo and the resulting contigs were used as a new reference genome. This resultedin94.3 to 95.3%oftheunmapped reads mapping to the new reference. The number of differentially expressed transcripts was 9277, 3861 of which were uni gene-mapped. The annotated unigene- and de novo-mapped transcripts (5100) were utilized to generate expression clusters across time of salt stress treatment. Two-dimensional hierarchical clustering classified differential expression profiles into nine expression clusters, four of which were selected for further analysis. Differentially expressed transcripts were assigned to the main functional categories. The most important groups were ‘response to external stimulus’ and ‘electron-carrier activity’. Highly expressed transcripts are involved in several biological processes, including electron transport and exchanger mechanisms, flavonoid biosynthesis, reactive oxygen species (ROS) scavenging, ethylene production, signaling network and protein refolding. The comparisons demonstrated that mRNA-Seq is an efficient method for the analysis of differentially expressed genes and biological processes under salt stress.

Keywords: electron transport, flavonoid biosynthesis, reactive oxygen species, rnaseq

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Authors: Jamal Ahmad

Abstract:

The Sanctuary of the Kafirs is a sanctified place for the people of Kalash which contain the sacred remains of their culture. The existence of the cultural Sanctuary is not limited up to boundaries of culture but its canopy also contain the spiritual attachments in terms of religion, rituals, introspections, myths, customs and living standards. Culture is the manifestation of the human intellectual achievement in a qualitative phenomenon of a place. The ethnic people of Hindu Kush (Kalash) are an indigenous group that practices Animism. They believe in Animistic Symbology i-e the material universe has high spiritual power. The Animism in their living standard comes from the high spiritualized and sacred sacrifices of animals goats, sheep etc. in their festivals which is the symbol of purity. Similarly certain cultural and religious phenomena make its behavior, its living pattern, its fairy tales, its birth and even its death unique. The scattered and the vanishing fragments of the Kafiristan, demands the phenomenal solution which molds all these factors into preserving standards. It demands a place of belief where, their unique culture, religion, festivals and life style make a sincere base for future existence, and such phenomena of place will consciously or unconsciously molds these ideas into building fabric. The Sanctuary contains ancient vandalized cemetery, the qaliq* the mujnatikeen*, the jastaks*, dewadoor* an amphitheater for dancing and ritual performances, an herbal garden and a profile sanctuary of the blood line of Kalash. The Case-Analysis provokes a new architecture of place, as the Phenomenological Architecture, which requires a place and phenomenon to take place. The Animistic Symbology and Phenomenology both are the part of their life but needs to reveal its hidden meaning and existence i-e (The Balamain, the alpine meadows, the sacred river). The Architectural work is strengthened by the philosophies of Animism and Phenomenology which make it easy to understand. The Scope of work is to reincarnate the ethical boundaries between the neighboring tribes and the Kafirs, by a series of dwellings, cultural and religious communal buildings and spaces, gardens and streets layout under the umbrella of ethical beliefs of Kalash community. So we conclude to build the Sanctuary of the Kafirs, in Bamboret valley of Kalash.

Keywords: Qaliq, Mujnatikeen, Dewadoor, Jastaks

Procedia PDF Downloads 334

Authors: Ahmed Belgasem, Walid Ben Hussin, Emad Krekshi, Jamal Hashad

Abstract:

Waxy crude oil, characterized by its high paraffin wax content, poses significant challenges in the oil & gas industry due to its increased viscosity and semi-solid state at reduced temperatures. The wax formation process, which includes precipitation, crystallization, and deposition, becomes problematic when crude oil temperatures fall below the wax appearance temperature (WAT) or cloud point. Addressing these issues, this paper introduces a technical solution designed to mitigate the wax appearance and enhance the oil production process in Abu-Attifil Field via a 30-inch crude oil pipeline. A comprehensive flow assurance study validates the feasibility and performance of this solution across various production rates, temperatures, and operational scenarios. The study's findings indicate that maintaining the crude oil's temperature above a minimum threshold of 63°C is achievable through the strategic placement of two heating stations along the pipeline route. This approach effectively prevents wax deposition, gelling, and subsequent mobility complications, thereby bolstering the overall efficiency, reliability, safety, and economic viability of the production process. Moreover, this solution significantly curtails the environmental repercussions traditionally associated with wax deposition, which can accumulate up to 7,500kg. The research methodology involves a comprehensive flow assurance study to validate the feasibility and performance of the proposed solution. The study considers various production rates, temperatures, and operational scenarios. It includes crude oil analysis to determine the wax appearance temperature (WAT), as well as the evaluation and comparison of operating options for the heating stations. The study's findings indicate that the proposed solution effectively prevents wax deposition, gelling, and subsequent mobility complications. By maintaining the crude oil's temperature above the specified threshold, the solution improves the overall efficiency, reliability, safety, and economic viability of the oil production process. Additionally, the solution contributes to reducing environmental repercussions associated with wax deposition. The research conclusion presents a technical solution that optimizes oil production in the Abu-Attifil Field by addressing wax formation problems through the strategic placement of two heating stations. The solution effectively prevents wax deposition, improves overall operational efficiency, and contributes to environmental sustainability. Further research is suggested for field data validation and cost-benefit analysis exploration.

Keywords: oil production, wax depositions, solar cells, heating stations

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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 105

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

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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

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Authors: Saman Kumara, Duminda Guruge, Krishani Jayasinghe

Abstract:

Introduction: Nutrition strongly influences good health and development in early life. This study, based on a health promotion approach, used a community-based intervention to improve child nutrition. The approach provides the community with control of interventions, thereby building its capacity and empowering individuals and communities. The aim of this research was to reduce stunting, low birth weight and underweight in communities from Anuradhapura District in Sri Lanka, by identifying and addressing the underlying determinants of under-nutrition and strengthening families and communities to address them. Methods: A health promotion intervention was designed and implemented-based on a logical framework developed in collaboration with members of targeted community. Community members’ implements action, so they fully own the process. Members of the community identify and address the most crucial determinants of health including child health and development and monitor the initial results of their action and modify action to optimize outcomes as well as future goals. Group Discussion, group activities, awareness programs, cluster meetings, community tools and sharing success stories were major activities to address determinants. Continuous data collection was planned at different levels. Priority was given to strengthening the ability of families and groups or communities to collect meaningful data and analyze these themselves. Results: Enthusiasm and interest of the mother, happiness of the child/ family, dietary habits, money management, tobacco and alcohol use of fathers, media influences, illnesses in the child or others, hygiene and sanitary practices, community sensitiveness and domestic violence were the major perceived determinants elicited from the study. There were around 1000 well-functioning mothers groups in this district. ‘Happiness calendar’, ‘brain calendar’, ‘money tool’ and ‘stimulation books’ were created by the community members, to address determinants and measure the process. Evaluation of the process has shown positive early results, such as improvement of feeding habits among mothers, innovative ways of providing early stimulation and responsive care, greater involvement of fathers in childcare and responsive feeding. There is a positive movement of communities around child well-being through interactive play areas. Family functioning and community functioning improved. Use of alcohol and tobacco declined. Community money management improved. Underweight was reduced by 40%. Stunting and low birth weight among under-fives also declined within one year. Conclusion: The health promotion intervention was effective in changing the determinants of under-nutrition in early childhood. Addressing the underlying determinants of under-nutrition in early childhood can be recommended for similar contexts.

Keywords: birth-weight, community, determinants, stunting, underweight

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Authors: Jamal Alkoteesh, Mohammed Zeki, Mouza Alnaqbi

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Objective: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. Design: Retrospective study. In this study, most women opted for UFE as a fertility treatment after failure of myomectomy or in vitro fertilization, or because hysterectomy was the only suggested option. Background. Myomectomy is the standard approach in patients with fibroids desiring a future pregnancy. However, myomectomy may be difficult in cases of numerous interstitial and/or submucous fibroids.In these cases, UFE has the advantage of embolizing all fibroids in one procedure. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids. Study Methods: A retrospective study of 210 patients treated with UFE for symptomatic uterine fibroids between 2011-2016 was performed. UFE was performed using ((PVA; Embozen, Beadblock) (500-900 µm in diameter). Pregnancies were identified using screening questionnaires and the study database. Of the 210 patients who received UFE treatment, 35 women younger than the age of 40 wanted to conceive and had been unable. All women in our study were advised to wait six months or more after UFE before attempting to become pregnant, of which the reported time range before attempting to conceive was seven to 33 months (average 20 months). RESULTS: In a retrospective chart review of patients younger than the age of 40 (35 patients,18 patients reported 23 pregnancies, of which five were miscarriages. Two more pregnancies were complicated by premature labor. Of the 23 pregnancies, 16 were normal full-term pregnancies, 15 women had conceived once, and four had become pregnant twice. The remaining patients did not conceive. In the study, there was no reported intrauterine growth retardation in the prenatal period, fetal distress during labor, or problems related to uterine integrity. Two patients reported minor problems during pregnancy that were borderline oligohydramnios and low-lying placenta. In the cohort of women who did conceive, overall, 16 out of 18 births proceeded normally without any complications (86%). Eight women delivered by cesarean section, and 10 women had normal vaginal delivery. In this study of 210 women, UFE had a fertility rate of 47%. Our group of 23 pregnancies was small, but did confirm successful pregnancy after UFE. The 45.7% pregnancy rate in women below the age of 40 years old who completed a term pregnancy compares favorably with women who underwent myomectomy via other method. Of the women in the cohort who did conceive, subsequent birth proceeded normally (86%). Conclusion: Pregnancy after UFE is well-documented. The risks of infertility following embolization, premature menopause, and hysterectomy are small, as is the radiation exposure during embolization. Fertility rates appear similar to patients undergoing myomectomy.UFE should not be contraindicated in patients who want to conceive and they should be able to choose between surgical options and UFE.

Keywords: fibroid, pregnancy, therapeutic embolization, uterine artery

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Authors: Rajish Shil, Amal Alduhoori, Vipin Thomachan, Jamal Teir, Radhakrishnan Renganathan

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Background: Antiphospholipid antibody syndrome (APS) has a broad spectrum of thrombotic and non-thrombotic clinical manifestations. We present a case of APS presenting with seizure, stroke, and atrial mass. Case Description: A 38-year-old male presented with headache of 10 days duration and tonic-clonic seizure. The neurological examination was normal. Magnetic resonance imaging of brain showed small acute right cerebellar infarct. Magnetic resonance angiography of brain and neck showed a focal narrowing in the origin of the internal carotid artery bilaterally. Electroencephalogram was normal. He was started on aspirin, atorvastatin, and carbamazepine. Transthoracic and trans-esophageal echocardiography showed a pedunculated and lobular atrial mass, measuring 1 X 1.5 cm, which was freely mobile across mitral valve opening across the left ventricular inflow. Autoimmune screening showed positive Antiphospholipid antibodies in high titer (Cardiolipin IgG > 120 units/ml, B2 glycoprotein IgG 90 units/mL). Anti-nuclear antibody was negative. Erythrocyte sedimentation rate and C-reactive protein levels were normal. Platelet count was low (111 x 109/L). The patient underwent successful surgical removal of the mass, which looked like a thrombotic clot, and Histopathological analysis confirmed it as a fibrinous clot, with no evidence of tumor cells. The patient was started on full anticoagulation treatment and was followed up regularly in the clinic, where our patient did not have any further complications from the disease. Discussion: Our patient was diagnosed to have APS based on the features of high positive anticardiolipin antibody IgG and B2 glycoprotein IgG levels, Stroke, thrombocytopenia, and abnormal echo findings. Thrombotic vegetation can mimic an atrial myxoma on echo. Conclusion: APS can present with neurological and cardiac manifestations, and therefore a high index of suspicion is necessary for a diagnosis of the disease as it can affect both short and long term treatment plans and prognosis. Therefore, in patients presenting with neurological symptoms like seizures, weakness and radiological diagnosis of stroke in a young patient, where atrial masses could be thought to be the cause of stroke, they should be screened for any concomitant findings of thrombocytopenia and/or activated partial thromboplastin time prolongation, which should raise the suspicion of vasculitis, specifically APS to be the primary cause of the clinical presentation.

Keywords: antiphospholipid syndrome, seizures, atrial mass, stroke

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