Search results for: psychiatric treatment

Authors: Nagwa E. Abd Elazim, Maha S. El-naggar, Rania H. Mohamed, Sara M. Awad

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Background: Radiodermatitis is a common side effect of radiation therapy for breast cancer. However, there is no current consensus about effective standard therapy for the prevention and management of radiation dermatitis. Topical ectoine has demonstrated efficacy in the treatment of atopic dermatitis owing to its anti-inflammatory activity. Objective: To evaluate the efficacy of topical ectoine in comparison to traditional topical dexpanthenol treatment in the management of acute radiodermatitis in breast cancer patients undergoing adjuvant radiotherapy. Methods: Fifty patients were randomized to use either dexpanthenol 0.5% cream (25 patients), or ectoin 7% cream (25 patients), applied twice daily to the irradiated area during the radiation period and continued for 2 weeks after cessation of radiotherapy. Assessment of radiation skin toxicity using Common Terminology Criteria of Adverse Events (CTCAE) v4.0, radiation-associated symptoms, and adverse events were undertaken weekly during radiotherapy and 2 weeks after the end of radiotherapy. Results: Topical ectoine showed some clinical benefit over dexpanthenol, as shown by delayed time to onset (at week 3 versus week 2, respectively) and larger number of patients who reached grade 0 at the end of treatment (64% vs. 48%, respectively). The clinical symptoms of pain (p = 0.003) and itching (p = 0.001) attributable to radiation were less pronounced with ectoine than with dexpanthenol. Burning and hyperpigmentation were the most common side effects with ectoine. However, no significant difference between dexpanthenol and ectoine treatments was found in any of the side effects (p = 0.1). Conclusion: Ectoin was overall more effective in improving radiation dermatitis than topical dexpanthenol in breast cancer patients. Ectoin could be proposed as a preventive or curative treatment for patients undergoing postoperative irradiation for breast cancer. Further clinical studies with a larger number of patients are recommended for the confirmation of these preliminary results.

Keywords: breast cancer, dexapanthenol, ectoin, radiation dermatitis

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Authors: Silvia Carla Da Silva André, Angela Maria Magosso Takayanagui

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Introduction: The Medical Waste (MW) are responsible per 2% of total waste generated for a city and has merited attention due the risks that offers to the public health and environment, representing an important aspect in waste management. In Brazil, the Resolution 306/04 of the National Health Surveillance Agency classifies the MW into 5 groups as follows: Group A (GA) biological, Group B (GB) chemical, Group C (GC) radioactive waste, Group D (GD) common, and Group E (GE) sharps. Objective: This study aimed to determine the amount of waste generated in hospitals of Ribeirão Preto, São Paulo, Brazil. Material and Methods: This is a field research, exploratory, using quantitative variables. The survey was conducted in 11 hospitals in Ribeirão Preto, located in the State of São Paulo, Brazil. It is noted that the study sample included general hospitals, skilled, university, maternity, and psychiatric; public, private, and philanthropic; and large, medium, and small. To quantify the MW, the weighing of the waste was held for six days, following methodology adapted from PAHO. Data were analyzed using descriptive statistics, determining the average global generation of MW and for each group. This research was carried out after approval by the Ethics in Research of the University of São Paulo. Thus, in order to comply with the ethical principles of research, to present the results hospitals were numbered from 1 to 11. Results: The data revealed a greater generation of biological waste among teaching hospitals, which can be justified by the use of materials for the realization of techniques.

Keywords: environmental health, management of medical waste, medical waste, public health

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Authors: Syed Asif Hassan, Tabrej Khan

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The use of traditional medicines for the treatment of various diseases as well as maintaining a healthy lifestyle has gained a significant acceptance across the globe. The increasing popularity of Herbal Medicine can be owed to the fact that is relatively inexpensive and has lesser side effects as compared to general medicines. The Kingdom of Saudi Arabia has a rich heritage of herbal medicine for overages. However, the information about essential traditional herbs of Arabian origin and their implication in the treatment of various diseases are not well documented in an organized manner. Therefore, the requirement of a local platform (database system) for herbal medicines of Arab origin is the need of the day. In this context, various questionnaire and surveys were conducted over a period of 6 months. The surveys were targeted to identify a range of herbal remedies used by the communities of Saudi Arabia e.g., pharmacists and local people. The survey leads us to identify many of the mysterious local medicinal herbs used for the treatment of various ailments and thus reveals a unique insight into the natural herbal resource of Saudi Arabia. The information of the herbal medicines will be further used to develop a Saudi herbal database system using the principles of waterfall method. An interactive dynamic electronic web portal of the herbal database system will be built using MySQL and PHP for accessing the information available in the Saudi herbal database system. The web portal will be a step forward in creating awareness among the Arab nationals of their rich herbal heritage.

Keywords: Saudi herbal medicine, community survey, database system and design, MySQL, PHP

Procedia PDF Downloads 422

Authors: Xin Wu, Yongfeng Zhao, Qingxiang Meng

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In China, quite low proportion of crop residues were used as feedstuff because of its poor palatability and low digestibility. Steam explosion is a physical and chemical feed processing technology which has great potential to improve sapidity and digestibility of crop residues. To investigate the effect of the steam explosion on chemical compositions and efficient energy values, crop residues (rice straw, wheat straw and maize stover) were processed by steam explosion (steam temperature 120-230°C, steam pressure 2-26kg/cm², 40min). Steam-exploded crop residues were regarded as treatment groups and untreated ones as control groups, nutritive compositions were analyzed and effective energy values were calculated by prediction model in INRA (1988, 2010) for both groups. Results indicated that the interaction between treatment and variety has a significant effect on chemical compositions of crop residues. Steam explosion treatment of crop residues decreased neutral detergent fiber (NDF) significantly (P < 0.01), and compared with untreated material, NDF content of rice straw, wheat straw, and maize stover lowered 21.46%, 32.11%, 28.34% respectively. Acid detergent lignin (ADL) of crop residues increased significantly after the steam explosion (P < 0.05). The content of crude protein (CP), ether extract (EE) and Ash increased significantly after steam explosion (P < 0.05). Moreover, predicted effective energy values of each steam-exploded residue were higher than that of untreated ones. The digestible energy (DE), metabolizable energy (ME), net energy for maintenance (NEm) and net energy for gain (NEg)of steam-exploded rice straw were 3.06, 2.48, 1.48and 0.29 MJ/kg respectively and increased 46.21%, 46.25%, 49.56% and 110.92% compared with untreated ones(P < 0.05). Correspondingly, the energy values of steam-exploded wheat straw were 2.18, 1.76, 1.03 and 0.15 MJ/kg, which were 261.78%, 261.29%, 274.59% and 1014.69% greater than that of wheat straw (P < 0.05). The above predicted energy values of steam exploded maize stover were 5.28, 4.30, 2.67 and 0.82 MJ/kg and raised 109.58%, 107.71%, 122.57% and 332.64% compared with the raw material(P < 0.05). In conclusion, steam explosion treatment could significantly decrease NDF content, increase ADL, CP, EE, Ash content and effective energy values of crop residues. The effect of steam explosion was much more obvious for wheat straw than the other two kinds of residues under the same condition.

Keywords: chemical compositions, crop residues, efficient energy values, steam explosion

Procedia PDF Downloads 250

Authors: Sanan Raza, Muhammad Younus, Ahmad Yar Qamar, Tariq Abbas, Hamayun Khan, Amanullah Khan

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Mares are considered to be seasonally polyestrous animals. The breeding season of mare ranges from March to May in Pakistan. However, fertility problems of mares have been trifling the horse breeders and stud owners since long, and it comes out that the fertility status of mares in Pakistan is relatively lower than the world average. The aim of the present study was to compare the effect of hCG and GnRH in improving pregnancy rate of mares in a transition period of month March and April. A total of n=66 mares showing normal estrus cycles with age ranging 5-12 y, weighing between 400-600 kg, BCS 6 ± 0.5 (1-9) and lactation varied from first to 5th were included in the experiment. These mares were administered PGF2α (75 μg; Dalmazine®, Fatro, Italy; 1 ml; i.m.) and divided into 3 groups. Mares of group 1 (n=22) were administered GnRH (100 μg; Dalmarelin®, Fatro, Italy; 4ml; im) while group 2 (n=22) mares were given hCG (5000 IU; IVF-C, LG Pharma; 1ml; iv). Likewise, mares of group 3 (n=22) were injected normal saline. Each treatment was given, when follicle attained the size of 35mm, keeping in view, the maturity of ovulating follicle at 35mm size and response to each treatment after routine ultrasound examination. All the mares of three groups were bred at 12 and 36 hours of treatment when the follicle reached the size of 35mm measured by ultrasound examination. Pregnancy was diagnosed by ultrasonography on day 18th and 42nd mating. On day 18th, pregnancy rate was 81.8% for hCG followed by 54.5% for GnRH and 45.5% for control. On day 42nd, pregnancy rate was (47.4%) for hCG which is significantly high (p<0.05) followed by GnRH (31.6%) and control (21.1%). Additionally the pregnancy loss was (25%, 20% respectively) in control and GnRH treated groups; whereas, hCG treated group showed no pregnancy loss (0.00%). Since no embryonic loss has been observed with hCG treatment during current study. Also hCG treated mares were 7.87 times more likely to conceive than controls. There were two times more chances of pregnancy in hCG treated mares than GnRH treated mares Therefore, it is concluded that the use of hCG in breeding season can improve pregnancy rate at a significant level when compared with GnRH hormone.

Keywords: mares, ovulation, hCG, pregnancy rate

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Authors: Tiancheng Lan

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E10A is a kind of replication-defective adenovirus which carries the human endostatin gene to inhibit the growth of tumors. Kringle 5(K5) has almost the same function as angiostatin to also inhibit the growth of tumors since they are all the byproduct of the proteolytic cleavage of plasminogen. Tumor size increasing can be suppressed because both of the endostatin and K5 can restrain the angiogenesis process. Therefore, in order to improve the treatment effect on tumor, 2A peptide is used to construct a fusion gene carrying both E10A and K5. Using 2A peptide is an ideal strategy when a fusion gene is expressed because it can avoid many problems during the expression of more than one kind of protein. The overlap extension PCR is also used to connect 2A peptide with E10A and K5. The final construction of fusion gene E10A-2A-K5 can provide a possible new method of the anti-angiogenesis treatment with a better expression performance.

Keywords: E10A, Kringle 5, 2A peptide, overlap extension PCR

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Authors: Mohamed Khaled Ahmed Azzam

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Complete dentures, a non biological appliance, were and are still used to replace missing teeth and surrounding structures. Its main objectives are esthetics, speech, function and psychological state improvement. Dentists must realize that, just as dentate patients vary in their dental treatment complexity; edentulous patients also vary in the difficulty of their treatment plan. There are two main problems facing the removable Prosthodontist which harden his/her task how to please his patient with their new dentures being: Denture construction which however its fabrication is at the highest standards still is an unpleasant experience to all patients in the beginning and improves by time. This varies from one to several years according to the patient’s attitude, age, gender, socio-economical level and culture. The second problem of edentulous patients is both physical and psychological. Good interview, communication and note how patients present themselves for the concerns of their appearance, overall attitude and expectations concerning treatment is very important physically. On the psychological aspect patients have great difficulty to cope with new dentures to the extent of not using them at all. Hence their mind preparation should be commenced from day one by more than one method. This had a great impact on the acceptance which led to habituation to their dentures and patients were appreciative and pleased. In conclusion to successfully treat edentulous patients a great deal of information is required to complete a proper diagnosis, including patient mental attitude, past and present medical and dental conditions, and extra and intra-oral examinations. In addition to the clinical experience and skill of the whole dental team.

Keywords: complete dentures, edentulous patients, management of denture, psychological mind preparation

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Authors: Sumeet Dwivedi, Shweta Shriwas, Raghvendra Dubey

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Madhya Pradesh, a Central State of India is rich in natural heritage due to tribal impact. Herbal harmony present either cultivated or by naturally being used by the tribes of the state in the treatment of several human and animal disorders. Diseases of ear, nose and throat (ENT) often have serious consequences including hearing impairment, and emotional strain that lower the quality of life of patients. Traditional phytotherapy have now been found to be instrumental in improving chances of discovering plants with antimicrobial activity in new drug development. The present paper enumerates the uses of ten herbs viz., garlic, eucalyptus, marigold, tulsi, euphorbia, lemon grass, haldi, bhringraj, ginger and ajwain. An attempt has also been made to reveal the method of preparation, dose, duration possible MOA of these herbs used for ENT disorders.

Keywords: ENT, traditional phytotherapy, herbs, Madhya Pradesh

Procedia PDF Downloads 249

Authors: S. P. Gomes, D. C. Goncalves, E. Ribeiro, M. C. L. Seelaender

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Skin is susceptible to photo damage induced by exposure to sunlight, or ultraviolet (UV) radiation, which induces breakdown of extracellular matrix, DNA degradation, skin cell lesion and apoptosis, and development of cancer. Phytonutrients demonstrate protective effects against UV damage. The purpose of this study was evaluating the effect of an antioxidant juice (AJ) contaning Brazilian natural products upon skin damage. The juice was produced by Metabolics®. Male Wistar rats were divided in 4 groups: Animals receiving the antioxidant juice (AJ): orange, carrot, honey, tomato extract, avocado, ginger and camu-camu (Brazilian fruit, a major source of vitamin C) ad libitum for 21 days; or water (C), subdivided in groups exposed or not to UV radiation for 2 non consecutive days, during five hours each day, after 15 days of juice supplementation. On the 22nd day, rats were killed by decapitation and epithelium samples from the dorsal skin removed, fixed in bouin and embedded in paraffin. The sections were stained with hematoxylin and eosin or mallory and picrosirius red. Isolated DNA was submitted to electrophoresis (1.8% agarose gel, 0.5% ethidium bromide). UV radiation significantly induced sunburn of superficial epithelial cells of C, AJ treatment reduced this effect. Collagen changes were observed in UV groups, yet AJ treatment prevented collagen degradation. UV radiation induced significant DNA degradation, in C, which was prevented by AJ treatment. The antioxidant juice consumed chronically protected against acute skin damage.

Keywords: nutraceuticals, antioxidants, photoprotection, uv radiation

Procedia PDF Downloads 624

Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studies are shortcoming on individual patient experience. The aim of this study was to assess the patient’s satisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. For all patients managed with woodcast in our unit, we undertook a structured questionnaire that included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score and the pain numerical score at the time of injury and six weeks after. 30 patients were initially managed with woodcast. 80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Paris casting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Yun-Tsuen Chen, Shih-Ting Huang, Pi-Fen Cheng, Yu-Ting Su, Joffrey Hsu, Hui-Zhu Chen

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Acute intestinal obstruction is one of the differentials of acute abdomen and requires timely alleviation of intestinal distention and abdominal pain to avoid perforation, intra-abdominal infection, and peritonitis. Investigation to identify the cause of obstruction will direct treatment planning and allow for more effective management. In this study, we present a 71-year-old female presenting with symptoms of acute intestinal obstruction for five days. After extensive history taking, physical exam, medical imaging, and pathology, the patient was diagnosed with colon cancer with lung metastasis and acute intestinal obstruction. The patient was placed on nil per os status with intravenous fluid support, intravenous antibiotics, and a decompression nasogastric tube was placed. The patient received decompression with colostomy creation surgery. After assessing the patient’s clinical condition and tumor staging, a multidisciplinary healthcare team created an individualized treatment plan, which included plans to prepare the patient for home self-care and maintain good mental health with regular monitoring in the clinic setting. This case demonstrates the importance of early diagnosis, effective treatment, and a multidisciplinary approach to the management of acute intestinal obstruction secondary to colon cancer.

Keywords: acute intestinal obstruction, colostomy surgery, metastatic colon cancer, multidisciplinary healthcare team

Procedia PDF Downloads 114

Authors: Alireza Pishgahi, Mohammad Rahbar, Javad Shokri, Shahla Dareshiri, Yaghoub Salekzamani, Fariba Eslamian

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Background and Objectives: Hypertrophic scars are one of the complications following a burn injury. Intralesional corticosteroid injection is an invasive method for treatment of this complication. We had design a single blinded randomized control trial to deliver dexamethasone by phonophoresis and evaluate its efficacy on hypertrophic burn scars characteristics. Material and Methods: 56 cases of hypertrophic burn scar due to burn injury allocated randomly to dexamethasone and control group. Individuals in case group received 10 sessions of dexamethasone 0.4% phonophoresis. Patients in control group had placebo phonophoresis (ultrasound with normal routine aquatic gel without any dexamethasone) with the same protocol. At the beginning of study and one week after last session, hypertrophic scar characteristics and pruritus were measured by ‘Vancouver Scar Scale’, and ‘5-D Pruritus Scale’ respectively in both groups. Results: Despite mild improvement in Vancouver Scar Scale score one week after intervention in dexamethasone phonophoresis group in comparison to control subjects, but this difference was not significant (p=0.08). Pruritus score perceived subjectively were significantly lower one week after intervention in dexamethasone groups in comparison to control subjects (p=0.00). Conclusion: Dexamethasone phonophoresis is a safe and effective treatment method for burn hypertrophic scar pruritus, but its efficacy for scar characteristics improvement needs to be evaluated by larger studies with long-term follow-up period.

Keywords: dexamethasone, hypertrophic scar, phonophoresis, pruritus

Procedia PDF Downloads 173

Authors: Robert E. Kenney, Richard B. Aguilar, Efrain Antunez, Gregory Schor-Haskin, Rafael Rey, Catie Falcon, Luis Arce

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This study sought to explore the effect of Sarapin injections on chronic knee pain (CKP). Many adults suffer from CKP which is most often attributed to osteoarthritis. Current treatment regimens for CKP involve the use NSAIDS medications, injections with steroids/analgesic, platelet rich plasma injections, or orthopedic surgical interventions. Sarapin is a commercially available homeopathic aqueous extract from the pitcher plant. Studies on the use of Sarapin as a treatment for cervical, thoracic, and lumbosacral facet joint nerve blocks have been performed with mixed results. There is little available evidence on the use of Sarapin in CKP. This study examines the effect of a series of 3 weekly injections of aqueous Sarapin in 95 elderly patients with CKP in a primary care setting. Cano Health, a primary care group, identified 95 successive patients with CKP from its multimodal physiotherapy program for chronic pain. Patients underwent evaluation by a clinician, underwent diagnostic Xrays of the knees, and the treatment plan with three weekly Sarapin injections was discussed. A pain and functional limitation survey (a modified Lower Extremity Functional Scale (mLEFS)) was administered prior to initiating treatment (Entry Survey (ES)). Each patient received an intraarticular injection of 2 cc of aqueous Sarapin with 1cc 1% lidocaine during weeks 1, 2 and 3. The mLEFS was administered again at week 4, one week after the third Sarapin injection (Exit Survey (ExS)). Demographics: Mean Age 62 +/- 9.8; 73% female; 89% Hispanic/Latino; mean time between ES and ExS was 27.5 +/-8.2 days. Survey: The mLEFS was based on a published Lower Extremity Functional Scale and each patient rated their pain or functional limitation from 0 (no difficulty) to 5 (severe difficulty) for 10 questions. Answers were summed and compared. Maximum score for severe difficulty would be 50 points. Results: Mean pain/functional scores: ES was 30.3 +/-12.1 and ExS was 19.5 +/- 12.5. This represents a relative improvement of 35.7% (P<0.00001). A total of 81% (77/95) of the patients showed improvement in symptoms at week four as assessed by the mLEFS. There were 11 patients who reported an increase in their survey scores while 7 patients reported no change. When evaluating the cohort that reported improvement, the ES was 30.9 +/-11.4 and ExS was 16.3 +/-9.8 yielding a 47.2% relative improvement (P<0.00001). Injections were well tolerated, and no adverse events were reported. Conclusions: In this cohort of 95 elderly patients with CKP, treatment with 3 weekly injections of Sarapin significantly improved pain and function as assessed by a mLEFS survey. The majority (81%) of patients responded positively to therapy, 12% had worsening symptoms and 7% reported no change. The use of intraarticular injections of Sarapin for CKP was shown to be an effective modality of treatment. Sarapin’s low cost, tolerability, and ease of use make it an attractive alternative to NSAIDS, steroids, PRP or surgical intervention for this common debilitating condition.

Keywords: Sarapin, intraarticular, chronic knee pain, osteoarthritis

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Authors: Saman Khan, Imrana Naseem

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Copper is an essential trace element required for pro-angiogenic co-factors including vascular endothelial growth factor (VEGF). Elevated levels of copper are found in various types of cancer including prostrate, colon, breast, lung and liver for angiogensis and metastasis. Therefore, targeting copper via copper-specific chelators in cancer cells can be developed as effective anticancer treatment strategy. In continuation of our pursuit to design and synthesize copper chelators, herein we opted for a reaction to incorporate di-(2-picolyl) amine in 3-(bromoacetyl) coumarin (parent backbone) for the synthesis of complex 1. We evaluated lipid peroxidation, protein carbonylation, ROS generation, DNA damage and consequent apoptosis by complex 1 in exogenously added Cu(II) in human peripheral lymphocytes (simulate malignancy condition). Results showed that Cu(II)-complex 1 interaction leads to cell proliferation inhibition, apoptosis, ROS generation and DNA damage in human lymphocytes, and these effects were abrogated by cuprous chelator neocuproine and ROS scavengers (thiourea, catalase, SOD). This indicates that complex 1 cytotoxicity is due to redox cycling of copper to generate ROS which leads to pro-oxidant cell death in cancer cells. To further confirm our hypothesis, using the rat model of diethylnitrosamine (DEN) induced hepatocellular carcinoma; we showed that complex 1 mediates DNA breakage and cell death in isolated carcinoma cells. Membrane permeant copper chelator, neocuproine, and ROS scavengers inhibited the complex 1-mediated cellular DNA degradation and apoptosis. In summary, complex 1 anticancer activity is due to its copper chelation capability. These results will provide copper chelation as an effective targeted cancer treatment strategy for selective cytotoxic action against malignant cells without affecting normal cells.

Keywords: cancer treatment, copper chelation, ROS generation, DNA damage, redox cycling, apoptosis

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Authors: Sangkhao M., Butcher B. A.

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Diazepam (known as valium) is a medication for calming effect. Many reports on committed suicide cases shown that diazepam is frequently used for this purpose. This research aims to study effect of diazepam on the development of forensically important blowflies, Chrysomya megacephala (Diptera: Calliphoridae) using micro-computed tomography (micro CT). In this study, four rabbits were treated with three different lethal doses of diazepam and one control (LD₀, LD₅₀, LD₁₀₀ and LC). The rabbit’s livers were removed for rearing the blowflies. Pupae were sampled for two series (ages; S1: 24h and S2: 120h) of development. After preparing the specimens, all samples were performed Micro CT using Skyscan 1172. The results shown the effect of diazepam on internal organs and tissues such as brain, cavity of the body, gas bubble, meconium and especially fat body. In the control group, in series 1 (LCS1), fat body was equally dispersed in the head, thorax, and abdomen, development of internal organs were not completed, however, brain, thoracic muscle, wings, legs and rectum were able to observe at 24h after developing into the pupal stage. Development of each organ in the control group in the series two was completed. In the treatment groups, LD₀, LD₅₀, LD₁₀₀ (Series 1 and Series 2), tissues are different, such as gas bubble in LD₀S1, was observed due to rapidity morphological changes during the metamorphosis of blowfly’s pupa in this treatment. Meconium was observed in LD₅₀S2 group because excretion of metabolic waste was not completed. All of the samples in the treatment groups had differentiation of fat bodies because metabolic activities were not completed and these changes affected on functions of every internal system. Discovering of differentiated fat bodies are important results because fat bodies of insect functions as liver in human, therefore it is shown that toxin eliminates from blowfly’s body and homeostatic maintenance of the hemolymph proteins, lipid and carbohydrates in each treatment group are abnormal.

Keywords: forensic toxicology, forensic entomology, diptera, diazepam

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Authors: Selin Top, Raul Marcos, M. Sinan Bilgili

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Although there have been several studies related to collection, temporary storage, handling and disposal of solid wastes generated by hospitals, there are only a few studies related to liquid wastes generated by hospitals or hospital wastewaters. There is an important amount of water consumptions in hospitals. While minimum domestic water consumption per person is 100 L/day, water consumption per bed in hospitals is generally ranged between 400-1200 L. This high amount of consumption causes high amount of wastewater. The quantity of wastewater produced in a hospital depends on different factors: bed numbers, hospital age, accessibility to water, general services present inside the structure (kitchen, laundry, laboratory, diagnosis, radiology, and air conditioning), number and type of wards and units, institution management policies and awareness in managing the structure in safeguarding the environment, climate and cultural and geographic factors. In our country, characterization of hospital wastewaters conducted by classical parameters in a very few studies. However, as mentioned above, this type of wastewaters may contain different compounds than domestic wastewaters. Hospital Wastewater (HWW) is wastewater generated from all activities of the hospital, medical and non medical. Nowadays, hospitals are considered as one of the biggest sources of wastewater along with urban sources, agricultural effluents and industrial sources. As a health-care waste, hospital wastewater has the same quality as municipal wastewater, but may also potentially contain various hazardous components due to using disinfectants, pharmaceuticals, radionuclides and solvents making not suitable the connection of hospital wastewater to the municipal sewage network. These characteristics may represent a serious health hazard and children, adults and animals all have the potential to come into contact with this water. Therefore, the treatment of hospital wastewater is an important current interest point to focus on. This paper aims to approach on the investigation of hospital wastewater treatment by membrane systems. This study aim is to determined hospital wastewater’s characterization and also evaluates the efficiency of hospital wastewater treatment by high pressure filtration systems such as ultrafiltration (UF). Hospital wastewater samples were taken directly from sewage system from Şişli Etfal Training and Research Hospital, located in the district of Şişli, in the European part of Istanbul. The hospital is a 784 bed tertiary care center with a daily outpatient department of 3850 patients. Ultrafiltration membrane is used as an experimental treatment and the influence of the pressure exerted on the membranes was examined, ranging from 1 to 3 bar. The permeate flux across the membrane was observed to define the flooding membrane points. The global COD and BOD5 removal efficiencies were 54% and 75% respectively for ultrafiltration, all the SST removal efficiencies were above 90% and a successful removal of the pathological bacteria measured was achieved.

Keywords: hospital wastewater, membrane, ultrafiltration, treatment

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Authors: İ. Çelik, Goksel Demirer

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Turkey is the third largest producer of pistachio (Pistacia vera L.) after Iran and United States. Harvested pistachio nuts are covered with organic hull which is removed by de-hulling process. Most of the pistachio by-products which are produced during de-hulling process are considered as agricultural waste and often mixed with soil, to a lesser extent are used as feedstuff by local livestock farmers and a small portion is used as herbal medicine. Due to its high organic and phenolic content as well as high solids concentration, pistachio processing wastes create significant waste management problems unless they are properly managed. However, there is not a well-established waste management method compensating the waste generated during the processing of pistachios. This study investigated the anaerobic treatability and biogas generation potential of pistachio hull waste. The effect of pre-treatment on biogas generation potential was investigated. For this purpose, Biochemical Methane Potential (BMP) Assays were conducted for two Chemical Oxygen Demand (COD) concentrations of 22 and 33 g tCOD l-1 at the absence and presence of chemical and thermal pre-treatment methods. The results revealed anaerobic digestion of the pistachio de-hulling wastes and subsequent biogas production as a renewable energy source are possible. The observed percent COD removal and methane yield values of the pre-treated pistachio de-hulling waste samples were significantly higher than the raw pistachio de-hulling waste. The highest methane yield was observed as 213.4 ml CH4/g COD.

Keywords: pistachio de-hulling waste, biogas, renewable energy, pre-treatment

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Authors: Peter David Reiss

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The concept of the psychosis prodrome has allowed for the identification of adolescent and young adult patients who have a significantly elevated risk of developing schizophrenia spectrum disorders. A number of different interventions have been tested in order to prevent or delay progression of symptoms. To date, there has been no consistent meta-analytical evidence to support efficacy of antipsychotic treatment for patients in the prodromal state, and their use remains therefore inconclusive. Although antipsychotics may manage symptoms transiently, they have not been found to prevent or delay onset of psychotic disorders. Furthermore, pharmacological intervention in high-risk individuals remains controversial, because of the antipsychotic side effect profile in a population in which only about 20 to 35 percent will eventually convert to psychosis over a two-year period, with even after two years conversion rates not exceeding 30 to 40 percent. This general estimate is additionally problematic, in that it ignores the fact that there is significant variation in individual risk among clinical high-risk cases. The current lack of reliable tests for at-risk patients makes it difficult to justify individual treatment decisions. Preventive treatment should ideally be dictated by an individual’s risk while minimizing potentially harmful medication exposure. This requires more accurate predictive assessments by using valid and accessible prognostic markers. The following will compare prediction and risk modification potential of behavioral biomarkers such as disturbances of basic sense of self and emotion awareness, neurocognitive biomarkers such as attention, working and declarative memory, and neurophysiological biomarkers such as glutamatergic abnormalities and NMDA receptor dysfunction. Identification of robust biomarkers could therefore not only provide more reliable means of psychosis prediction, but also help test and develop new clinical interventions targeted at the prodromal state.

Keywords: at-risk mental state, biomarkers, glutamatergic system, NMDA receptor, psychosis prodrome, schizophrenia

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Authors: Nazanin Gerami, Shirin Adlparvar

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In the present time in the laboratory, one can create an ionized gas, that is to say, plasma from room temperature up to ten times more than the temperature of the sun center (150,000,000). All these temperature spectrums of plasma have applications in different disciplines, including dentistry, medicine, science, surface treatment, nuclear waste disinfection, nuclear fusion technology, etc. However, for the sick of simplicity, all these plasma temperature spectrums are classified as cold or low-pressure non-thermal plasma and warm or high-pressure equilibrium plasma. The cold plasma, as we are interested in this paper, exists at lower ion and neutral temperatures with respect to electron temperature, but in the equilibrium plasma, the temperatures of ion and electron are fairly equal. The cold plasma is a partially ionized gas comprising ions, electrons, ultraviolet photons and reactive neutrals such as radicals, excited and ground-state molecules. Cold atmospheric pressure plasmas are widely used in diverse fields of dental medicine, such as the titanium surface of dental implants, which helps in reducing contact angle and supporting the spread of osteoblastic cells and is known to aid in osteoblastic proliferation and osseointegration, thus increasing the success rates of implants. This article focuses on the anticipated uses of a newly designed water-cooled adjustable cathode cold atmospheric pressure plasma Jet (CAPPJ) for titanium surface treatment in dental implant placement.

Keywords: CAPPJ, surface modification, osseointegration, plasma medicine, dentistry

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Authors: Petros Gkotsis, Anastasios Zouboulis, Manasis Mitrakas, Dimitrios Zamboulis, E. Peleka

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The most serious drawback in wastewater treatment using membrane bioreactors (MBRs) is membrane fouling which gradually leads to membrane permeability decrease and efficiency deterioration. This work is part of a research project that aims to develop an integrated methodology for membrane fouling control, using specific chemicals which will enhance the coagulation and flocculation of compounds responsible for fouling, hence reducing biofilm formation on the membrane surface and limiting the fouling rate acting as a pre-treatment step. For this purpose, a pilot-scale plant with fully automatic operation achieved by means of programmable logic controller (PLC) has been constructed and tested. The experimental set-up consists of four units: wastewater feed unit, bioreactor, membrane (side-stream) filtration unit and permeate collection unit. Synthetic wastewater was fed as the substrate for the activated sludge. The dissolved oxygen (DO) concentration of the aerobic tank was maintained in the range of 2-3 mg/L during the entire operation by using an aerator below the membrane module. The membranes were operated at a flux of 18 LMH while membrane relaxation steps of 1 min were performed every 10 min. Both commercial and composite coagulants are added in different concentrations in the pilot-scale plant and their effect on the overall performance of the ΜΒR system is presented. Membrane fouling was assessed in terms of TMP, membrane permeability, sludge filterability tests, total resistance and the unified modified fouling index (UMFI). Preliminary tests showed that particular attention should be paid to the addition of the coagulant solution, indicating that pipe flocculation effectively increases hydraulic retention time and leads to voluminous sludge flocs. The most serious drawback in wastewater treatment using MBRs is membrane fouling, which gradually leads to membrane permeability decrease and efficiency deterioration. This results in increased treatment cost, due to high energy consumption and the need for frequent membrane cleaning and replacement. Due to the widespread application of MBR technology over the past few years, it becomes clear that the development of a methodology to mitigate membrane fouling is of paramount importance. The present work aims to develop an integrated technique for membrane fouling control in MBR systems and, thus, contribute to sustainable wastewater treatment.

Keywords: coagulation, membrane bioreactor, membrane fouling, pilot plant

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Authors: Alam Anshary, Flora Pasaru, Shahabuddin

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The Cocoa Pod Borer (CPB), Conopomorpha cramerella (Snell.) is present on most of the larger cocoa producing islands in Indonesia. Various control measures CPB has been carried out by the farmers, but the results have not been effective. This study aims to determine the effect of application of Beauveria bassiana treatments and pruning technique to the control of CPB in the cocoa plantation people. Research using completely randomized design with 4 treatments and 3 replications, treatment consists of B.bassiana, Pruning, B. bassiana+pruning (Bb + Pr), as well as the control. The results showed that the percentage of PBK attack on cocoa pods in treatment (Bb + Pr) 3.50% the lowest compared to other treatments. CPB attack percentage in treatment B.bassiana 6.15%; pruning 8.75%, and 15.20% control. Results of the analysis of production estimates, the known treatments (Bb + Pr) have the highest production (1.95 tonnes / ha). The model results estimated production is Y= 0,20999 + 0,53968X1 + 0,34298X2+ 0,31410X3 + 0,35629X4 + 0,08345X5 + 0,29732X6. Farm production costs consist of fixed costs and variable costs, fixed costs are costs incurred by the farmer that the size does not affect the results, such as taxes and depreciation of production equipment. Variable costs are costs incurred by farmers who used up in one year cocoa farming activities. The cost of production in farming cocoa without integrated techniques control of CPB is Rp. 9.205.550 million/ha, while the cost of production with integrated techniques control is Rp. 6.666.050 million/ha.

Keywords: cacao, cocoa pod borer, pruning, Beauveria bassiana, production costs

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Authors: A. Ortuzar, I. Escondrillas, F. Mijangos

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There is a need for new systems that can be attached to drinking water treatment plants and have the required treatment capacity as well as the selectivity regarding components derived from anthropogenic activities. In a context of high volumes of water and low concentration of contaminants, adsorption/interchange processes are appealing since they meet the required features. Iron oxides such as siderite and molysite, which are respectively based on FeCO₃ and FeCl₃, can be found in nature. In this work, their observed performance, raw or roasted at different temperatures, as adsorbents of some inorganic anions is discussed. Roasted 1:1 FeCO₃: FeCl₃ mixture was very selective for arsenic and allowed a 100% removal of As from a 10 mg L^-1 As solution. Besides, the 1:1 FeCO₃ and FeCl₃ mixture roasted at 500 ºC showed good selectivity for, in order of preference, arsenate, bromate, phosphate, fluoride and nitrate anions with distribution coefficients of, respectively, 4200, 2800, 2500 0.4 and 0.03 L g^-1.

Keywords: drinking water, natural adsorbent materials, removal, selectivity

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Authors: Gianna Zou

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Propensity score matching (PSM), introduced by Paul R. Rosenbaum and Donald Rubin in 1983, is a popular statistical matching technique which tries to estimate the treatment effects by taking into account covariates that could impact the efficacy of study medication in clinical trials. PSM can be used to reduce the bias due to confounding variables. However, PSM assumes that the response values are normally distributed. In some cases, this assumption may not be held. In this paper, a machine learning method - Bayesian Additive Regression Tree (BART), is used as a more robust method of matching. BART can work well when models are misspecified since it can be used to model heterogeneous treatment effects. Moreover, it has the capability to handle non-linear main effects and multiway interactions. In this research, a BART Matching Method (BMM) is proposed to provide a more reliable matching method over PSM. By comparing the analysis results from PSM and BMM, BMM can perform well and has better prediction capability when the response values are not normally distributed.

Keywords: BART, Bayesian, matching, regression

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Authors: Shirin Jalili, Ramin Ghasemi

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Lumbar microdiscectomy is the most commonly performed spinal surgery strategy; it is regularly performed to lighten the indications and signs of sciatica within the lower back and leg caused by a lumbar disc herniation. This surgery aims to progress leg pain, reestablish function, and enable a return to ordinary day-by-day exercises. Rates of lumbar disc surgery show critical geographic varieties recommending changing treatment criteria among working specialists. Few population-based considers have investigated the hazard of reoperation after disc surgery, and regional or inter specialty varieties within the reoperations are obscure. The conventional approach to recouping from lumbar microdiscectomy has been to restrain bending, lifting, or turning for a least 6 weeks in arrange to anticipate the disc from herniating once more. Traditionally, patients were exhorted to limit post-operative action, which was accepted to decrease the hazard of disc herniation and progressive insecurity. In modern hone, numerous specialists don't limit understanding of postoperative action due to the discernment this practice is pointless. There's a need of thinks about highlighting the result by distinctive scores or parameters after surgery for repetitive circle herniations of the lumbar spine at the starting herniation location. This study will evaluate the quality of life after surgical treatment of recurrent herniations with distinctive standardized approved result instruments.

Keywords: post-operative activity, disc, quality of life, treatment, movements

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Authors: Saule Balmagambetova, Zhenisgul Tlegenova, Saule Madinova

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Cardiotoxicity associated with anticancer treatment, now defined as cancer therapy-related cardiac dysfunction (CTRCD), accompanies cancer patients and negatively impacts their survivorship. Currently, a cardio-oncological service is being created in Kazakhstan based on the provisions of the European Society of Cardio-oncology (ESC) Guidelines. In the frames of a pilot project, a cohort study on CTRCD conditions was initiated at the Aktobe Cancer center. One hundred twenty-eight newly diagnosed breast cancer patients started on doxorubicin and/or trastuzumab were recruited. Echocardiography with global longitudinal strain (GLS) assessment, biomarkers panel (cardiac troponin (cTnI), brain natriuretic peptide (BNP), myeloperoxidase (MPO), galectin-3 (Gal-3), D-dimers, C-reactive protein (CRP)), and other tests were performed at baseline and every three months. Patients were stratified by the cardiovascular risks according to the ESC recommendations and allocated into the risk groups during the pre-treatment visit. Of them, 10 (7.8%) patients were assigned to the high-risk group, 48 (37.5%) to the medium-risk group, and 70 (54.7%) to the low-risk group, respectively. High-risk patients have been receiving their cardioprotective treatment from the outset. Patients were also divided by treatment - in the anthracycline-based 83 (64.8%), in trastuzumab- only 13 (10.2%), and in the mixed anthracycline/trastuzumab group 32 individuals (25%), respectively. Mild symptomatic CTRCD was revealed and treated in 2 (1.6%) participants, and a mild asymptomatic variant in 26 (20.5%). Mild asymptomatic conditions are defined as left ventricular ejection fraction (LVEF) ≥50% and further relative reduction in GLS by >15% from baseline and/or a further rise in cardiac biomarkers. The listed biomarkers were assessed longitudinally in repeated-measures linear regression models during 12 months of observation. The associations between changes in biomarkers and CTRCD and between changes in biomarkers and LVEF were evaluated. Analysis by risk groups revealed statistically significant differences in baseline LVEF scores (p 0.001), BNP (p 0.0075), and Gal-3 (p 0.0073). Treatment groups found no statistically significant differences at baseline. After 12 months of follow-up, only LVEF values showed a statistically significant difference by risk groups (p 0.0011). When assessing the temporal changes in the studied parameters for all treatment groups, there were statistically significant changes from visit to visit for LVEF (p 0.003); GLS (p 0.0001); BNP (p<0.00001); MPO (p<0.0001); and Gal-3 (p<0.0001). No moderate or strong correlations were found between the biomarkers values and LVEF, between biomarkers and GLS. Between the biomarkers themselves, a moderate, close to strong correlation was established between cTnI and D-dimer (r 0.65, p<0.05). The dose-dependent effect of anthracyclines has been confirmed: the summary dose has a moderate negative impact on GLS values: -r 0.31 for all treatment groups (p<0.05). The present study found myeloperoxidase as a promising biomarker of cardiac dysfunction in the mixed anthracycline/trastuzumab treatment group. The hazard of CTRCD increased by 24% (HR 1.21; 95% CI 1.01;1.73) per doubling in baseline MPO value (p 0.041). Increases in BNP were also associated with CTRCD (HR per doubling, 1.22; 95% CI 1.12;1.69). No cases of chemotherapy discontinuation due to cardiotoxic complications have been recorded. Further observations are needed to gain insight into the ability of biomarkers to predict CTRCD onset.

Keywords: breast cancer, chemotherapy, cardiotoxicity, Kazakhstan

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Authors: Mirian Graciella Dalla Porta, Humberto Jorge José, Danielle de Bem Luiz, Regina de F. P. M.Moreira

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Similar to most processing industries, fish processing produces large volumes of wastewater, which contains especially organic contaminants, salts and oils dispersed therein. Different processes have been used for the treatment of fishery wastewaters, but the most commonly used are chemical coagulation and flotation. These techniques are well known but sometimes the characteristics of the treated effluent do not comply with legal standards for discharge. Electrocoagulation (EC) is an electrochemical process that can be used to treat wastewaters in terms of both organic matter and nutrient removal. The process is based on the use of sacrificial electrodes such as aluminum, iron or zinc, that are oxidized to produce metal ions that can be used to coagulate and react with organic matter and nutrients in the wastewater. While EC processes are effective to treatment of several types of wastewaters, applications have been limited due to the high energy demands and high current densities. Generally, the for EC process can be performed without additional chemicals or pre-treatment, but the costs should be reduced for EC processes to become more applicable. In this work, we studied the treatment of a real wastewater from fishmeal industry by electrocoagulation process. Removal efficiencies for chemical oxygen demand (COD), total organic carbon (TOC) turbidity, phosphorous and nitrogen concentration were determined as a function of the operating conditions, such as pH, current density and operating time. The optimum operating conditions were determined to be operating time of 10 minutes, current density 100 A.m-2, and initial pH 4.0. COD, TOC, phosphorous concentration, and turbidity removal efficiencies at the optimum operating conditions were higher than 90% for aluminum electrode. Operating costs at the optimum conditions were calculated as US$ 0.37/m3 (US$ 0.038/kg COD) for Al electrode. These results demonstrate that the EC process is a promising technology to remove nutrients from fishery wastewaters, as the process has both a high efficiency of nutrient removal, and low energy requirements.

Keywords: electrocoagulation, fish, food industry, wastewater

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Authors: Farhad Ahmadi, Hamed Kimiaee, Fariba Rahimi

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This research study focuses on the effect of different levels and sources of calcium on egg production, egg traits, and calcium retention in laying Japanese quail. The study aims to determine the impact of nano calcium carbonate (NCC) and calcium carbonate (CC) on these factors. The research was conducted using a total of 280 laying quail with an average age of 8 weeks. The quails were randomly distributed in a completely randomized design (CRD) with 7 treatments, 4 replications, and 10 quails in each pen. The study lasted for 90 days. The experimental diets included a control group (T1) with a basal diet consisting of 3.17% CaCO₃, and other groups supplemented with different levels (0.5%, 0.1%, and 0.15%) of either calcium carbonate (CC) or nano calcium carbonate (NCC). The quails had free access to water and feed throughout the study period. Findings: The results of the study showed that NCC at the levels of 0.1% and 0.15% (T6 and T7) improved eggshell thickness, shell thickness, and shell breaking strength compared to the control group. Although not statistically significant, there was an increasing trend in quail egg production and calcium retention in the calcareous shell of the egg in birds that consumed the experimental diets containing different levels of NCC compared to the control and other treatment groups. Quail egg production was recorded monthly for each treatment group. At the end of the study, a total of 40 eggs (10 eggs/replicate) from each treatment group were randomly selected for analysis. Parameters such as eggshell thickness, shell thickness, shell breaking strength, and calcium retention were measured. Statistical analysis was performed to compare the results between the different treatment groups. In conclusion, this study suggests that NCC at the levels of 0.1% and 0.15% can improve the quantity and quality of eggs and calcium retention in laying Japanese quail. These findings highlight the potential benefits of using NCC as a calcium source in quail diets. Further research could be conducted to explore the mechanisms behind these improvements and optimize the dosage of NCC for maximum effect.

Keywords: egg, calcium, nanoparticles, physiology

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Authors: Maria L. McLeod

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This study examines the ways in which cancer patient narratives are portrayed and framed on the websites of three leading U.S. cancer care centers –The University of Texas MD Anderson Cancer Center in Houston, Memorial Sloan Kettering Cancer Center in New York, and Seattle Cancer Care Alliance. Thirty patient stories, ten from each cancer center website blog, were analyzed using qualitative and quantitative textual analysis of unstructured data, documenting repeated use of specific metaphors and tropes while charting common themes and other elements of story structure and content. Patient narratives were coded using grounded theory as the basis for conducting emergent qualitative research. As part of a systematic, inductive approach to collecting and analyzing data, recurrent and unique themes were examined and compared in terms of positive and negative framing, patient agency, and institutional praise. All three of these cancer care centers are teaching hospitals with university affiliations, that emphasizes an evidence-based scientific approach to treatment that utilizes the latest research and cutting-edge techniques and technology. Thus, the use of anecdotal evidence presented in patient narratives could be perceived as being in conflict with this evidence-based model, as the patient stories are not an accurate representation of scientific outcomes related to developing cancer, cancer reoccurrence, or cancer outcomes. The representative patient narratives tend to exclude or downplay adverse responses to treatment, survival rates, integrative and/or complementary cancer treatments, cancer prevention and causes, and barriers to treatment, such as the limitation of insurance plans, costs of treatment, and/or other issues related to access, potentially contributing to false narratives and inaccurate notions of cancer prevention, cancer care treatment and the potential for a cure. Both quantitative and qualitative findings demonstrate that cancer patient stories featured on the blogsites of the nation’s top cancer care centers deemphasize patient agency and, instead, emphasize deference and gratitude toward the institutions where the featured patients received treatment. Along these lines, language choices reflect positive framing of the cancer experience. Accompanying portrait photos of healthy appearing subjects as well as positive-framed headlines, subheads, and pull quotes function similarly, reflecting hopeful, transformative experiences and outcomes over hardship and suffering. Although patient narratives include real, factual scientific details and descriptions of actual events, the stories lack references to more negative realities of cancer diagnosis and treatment. Instead, they emphasize the triumph of survival by which the cancer care center, in the savior/hero role, enables the patient’s success, represented as a cathartic medical journey.

Keywords: cancer framing, cancer stories, medical gaze, patient narratives

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Authors: Ralene Sim, Stefan Mueller, N. Gopalakrishna Iyer, Ngian Chye Tan, Khee Chee Soo, R. Shetty Mahalakshmi, Hiang Khoon Tan

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Background: Regional failure in nasopharyngeal carcinoma (NPC) is managed by salvage treatment in the form of neck dissection. Radical neck dissection (RND) is preferred over modified radical neck dissection (MRND) since it is traditionally believed to offer better long-term disease control. However, with the advent of more advanced imaging modalities like high-resolution Magnetic Resonance Imaging, Computed Tomography, and Positron Emission Tomography-CT scans, earlier detection is achieved. Additionally, concurrent chemotherapy also contributes to reduced tumour burden. Hence, there may be a lesser need for an RND and a greater role for MRND. With this retrospective study, the primary aim is to ascertain whether MRND, as opposed to RND, has similar outcomes and hence, whether there would be more grounds to offer a less aggressive procedure to achieve lower patient morbidity. Methods: This is a retrospective study of 66 NPC patients treated at Singapore General Hospital between 1994 to 2016 for histologically proven regional recurrence, of which 41 patients underwent RND and 25 who underwent MRND, based on surgeon preference. The type of ND performed, primary treatment mode, adjuvant treatment, and pattern of recurrence were reviewed. Overall survival (OS) was calculated using Kaplan-Meier estimate and compared. Results: Overall, the disease parameters such as nodal involvement and extranodal extension were comparable between the two groups. Comparing MRND and RND, the median (IQR) OS is 1.76 (0.58 to 3.49) and 2.41 (0.78 to 4.11) respectively. However, the p-value found is 0.5301 and hence not statistically significant. Conclusion: RND is more aggressive and has been associated with greater morbidity. Hence, with similar outcomes, MRND could be an alternative salvage procedure for regional failure in selected NPC patients, allowing similar salvage rates with lesser mortality and morbidity.

Keywords: nasopharyngeal carcinoma, neck dissection, modified neck dissection, radical neck dissection

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Authors: Isabella Lobo Sasaoka, Felipe Q. da Luz, Zubeyir Salis, Phillipa Hay, Tamiris Gaeta, Paula Costa Teixeira, Táki Cordás, Amanda Sainsbury

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Background: A significant number of people with obesity that seek weight loss treatments experience binge eating episodes. Nonetheless, it is unknown whether binge eating episodes can hinder weight loss outcomes. Objective: To compare weight change in people with or without binge eating submitted to bariatric surgery, pharmacotherapy, nutritional orientation, and/or psychological therapies. Method: We conducted a systematic review with meta-analyses by searching studies in PubMed, American Psychological Association (APA), and Embase. Results: Thirty-four studies were included in our systematic review, and 17 studies were included in the meta-analyses. Overall, we found no significant difference in weight loss between people with or without binge eating submitted to any type of weight loss treatment. Additionally, we found no statistically significant differences in body weight between people with or without binge eating at short and long follow-up assessments following any type of weight loss treatment. We also examined changes in body weight in people with or without binge eating in three additional meta-analyses categorized by the type of weight loss treatment (i.e., behavioural and/or nutritional interventions; bariatric surgery; pharmacotherapy isolated or combined with behavior interventions) and found no difference in weight loss. Eleven out of the 17 studies that were assessed qualitatively (i.e., not included in meta-analyses) did not show differences in weight loss in people with or without binge eating submitted to any type of weight loss treatment. Conclusion: This systematic review with meta-analyses showed no difference in weight loss in people with or without binge eating submitted to a variety of weight loss treatments. Nonetheless, specialized therapies can be required to address eating disorder psychopathology and recurrent binge eating in people with obesity that seek weight loss.

Keywords: obesity, binge eating, weight loss, systematic review, meta-analysis

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