Search results for: blood profile

Authors: Ahmed Slami, Med El Amine Brixi Nigassa, Nassima Labdelli, Sofiane Soulimane, Arnaud Pothier

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Many people suffer from diabetes, a disease marked by abnormal levels of sugar in the blood; 285 million people have diabetes, 6.6% of the world adult population (in 2010), according to the International Diabetes Federation. Insulin medicament is invented to be injected into the body. Generally, the injection requires the patient to do it manually. However, in many cases he will be unable to inject the drug, saw that among the side effects of hyperglycemia is the weakness of the whole body. The researchers designed a medical device that injects insulin too autonomously by using micro-pumps. Many micro-pumps of concepts have been investigated during the last two decades for injecting molecules in blood or in the body. However, all these micro-pumps are intended for slow infusion of drug (injection of few microliters by minute). Now, the challenge is to develop micro-pumps for fast injections (1 microliter in 10 seconds) with accuracy of the order of microliter. Recently, studies have shown that only piezoelectric actuators can achieve this performance, knowing that few systems at the microscopic level were presented. These reasons lead us to design new smart microsystems injection drugs. Therefore, many technological advances are still to achieve the improvement of materials to their uses, while going through their characterization and modeling action mechanisms themselves. Moreover, it remains to study the integration of the piezoelectric micro-pump in the microfluidic platform features to explore and evaluate the performance of these new micro devices. In this work, we propose a new micro-pump model based on piezoelectric actuation with a new design. Here, we use a finite element model with Comsol software. Our device is composed of two pumping chambers, two diaphragms and two actuators (piezoelectric disks). The latter parts will apply a mechanical force on the membrane in a periodic manner. The membrane deformation allows the fluid pumping, the suction and discharge of the liquid. In this study, we present the modeling results as function as device geometry properties, films thickness, and materials properties. Here, we demonstrate that we can achieve fast injection. The results of these simulations will provide quantitative performance of our micro-pumps. Concern the spatial actuation, fluid rate and allows optimization of the fabrication process in terms of materials and integration steps.

Keywords: COMSOL software, piezoelectric, micro-pump, microfluidic

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Authors: Rashmi Raghunandan, Sanjana Shankar, Rakshitha K. Bhat

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Social media contributes a vast amount of data and information about individuals to the internet. This project will greatly reduce the need for unnecessary manual analysis of large and diverse social media profiles by filtering out and combining the useful information from various social media profiles, eliminating irrelevant data. It differs from the existing social media aggregators in that it does not provide a consolidated view of various profiles. Instead, it provides consolidated INFORMATION derived from the subject’s posts and other activities. It also allows analysis over multiple profiles and analytics based on several profiles. We strive to provide a query system to provide a natural language answer to questions when a user does not wish to go through the entire profile. The information provided can be filtered according to the different use cases it is used for.

Keywords: social network, analysis, Facebook, Linkedin, git, big data

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Authors: Sana Ansari, Sirus Mohammadi

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In distribution systems, shunt capacitors are used to reduce power losses, to improve voltage profile, and to increase the maximum flow through cables and transformers. This paper presents a new method to determine the optimal locations and economical sizing of fixed and/or switched shunt capacitors with a view to power losses reduction and voltage stability enhancement. General Algebraic Modeling System (GAMS) has been used to solve the maximization modules using the MINOS optimization software with Linear Programming (LP). The proposed method is tested on 33 node distribution system and the results show that the algorithm suitable for practical implementation on real systems with any size.

Keywords: power losses, voltage stability, radial distribution systems, capacitor

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Authors: M. Turmanauli, T. Todua, O. Gvaberidze, R. Javakhadze, N. Chkhaidze, N. Khatiashvili

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Background: Mining process has the significant influence on human health and quality of life. In recent years the events in Georgia were reflected on the industry working process, especially minimal requirements of labor safety, hygiene standards of workplace and the regime of work and rest are not observed. This situation is often caused by the lack of responsibility, awareness, and knowledge both of workers and employers. The control of working conditions and its protection has been worsened in many of industries. Materials and Methods: For evaluation of the current situation the prospective epidemiological study by face to face interview method was conducted at Georgian “Manganese Zestafoni Ferroalloy Plant” in 2011-2013. 65.7% of employees (1428 bulletin) were surveyed and the incidence rates of temporary disability days were studied. Results: The average length of a temporary disability single accident was studied taking into consideration as sex groups as well as the whole cohort. According to the classes of harmfulness the following results were received: Class 2.0-10.3%; 3.1-12.4%; 3.2-35.1%; 3.3-12.1%; 3.4-17.6%; 4.0-12.5%. Among the employees 47.5% and 83.1% were tobacco and alcohol consumers respectively. According to the age groups and years of work on the base of previous experience ≥50 ages and ≥21 years of work data prevalence respectively. The obtained data revealed increased morbidity rate according to age and years of work. It was found that the bone and articulate system and connective tissue diseases, aggravation of chronic respiratory diseases, ischemic heart diseases, hypertension and cerebral blood discirculation were the leading among the other diseases. High prevalence of morbidity observed in the workplace with not satisfactory labor conditions from the hygienic point of view. Conclusion: According to received data the causes of morbidity are the followings: unsafety labor conditions; incomplete of preventive medical examinations (preliminary and periodic); lack of access to appropriate health care services; derangement of gathering, recording, and analysis of morbidity data. This epidemiological study was conducted at the JSC “Manganese Ferro Alloy Plant” according to State program “ Prevention of Occupational Diseases” (Program code is 35 03 02 05).

Keywords: occupational health, mining process, morbidity level, cerebral blood discirculation

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Authors: Agnes Simone

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A 52-year-old male with unknown psychiatric and medical history was brought to the Psychiatric Emergency Room by ambulance directly from jail. He had been detained for three weeks for possession of a firearm while intoxicated. On initial evaluation, the patient was unable to provide a reliable history. He presented with odd jerking movements of his extremities and catatonic features, including mutism and stupor. His vital signs were stable. Patient was transferred to the medical emergency department for work-up of altered mental status. Due to suspicion for opioid overdose, the patient was given naloxone (Narcan) with no improvement. Laboratory work-up included complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, vitamin B12, folate, magnesium, rapid plasma reagin, HIV, blood alcohol level, aspirin, and Tylenol blood levels, urine drug screen, and urinalysis, which were all negative. CT head and chest X-Ray were also negative. With this negative work-up, the medical team concluded there was no organic etiology and requested inpatient psychiatric admission. Upon re-evaluation by psychiatry, it was evident that the patient continued to have an altered mental status. Of note, the medical team did not include substance withdrawal in the differential diagnosis due to stable vital signs and a negative urine drug screen. The psychiatry team decided to check California's prescription drug monitoring program (CURES) and discovered that the patient was prescribed benzodiazepine alprazolam (Xanax) 2mg BID, a sedative-hypnotic, and hydrocodone/acetaminophen 10mg/325mg (Norco) QID, an opioid. After a thorough chart review, his daughter's contact information was found, and she confirmed his benzodiazepine and opioid use, with recent escalation and misuse. It was determined that the patient was experiencing alprazolam withdrawal, given this collateral information, his current symptoms, negative urine drug screen, and recent abrupt discontinuation of medications while incarcerated. After admission to the medical unit and two doses of alprazolam 2mg, the patient's mental status, alertness, and orientation improved, but he had no memory of the events that led to his hospitalization. He was discharged with a limited supply of alprazolam and a close follow-up to arrange a taper. Accompanying this case report, a qualitative review of presentations with alprazolam withdrawal was completed. This case and the review highlights: (1) Alprazolam withdrawal can occur at low doses and within just one week of use. (2) Alprazolam withdrawal can present without any vital sign instability. (3) Alprazolam withdrawal does not respond to short-acting benzodiazepines but does respond to certain long-acting benzodiazepines due to its unique chemical structure. (4) Alprazolam withdrawal is distinct from and more severe than other benzodiazepine withdrawals. This case highlights (1) the importance of physician utilization of drug-monitoring programs. This case, in particular, relied on California's drug monitoring program. (2) The importance of obtaining collateral information, especially in cases in which the patient is unable to provide a reliable history. (3) The importance of including substance intoxication and withdrawal in the differential diagnosis even when there is a negative urine drug screen. Toxidrome of withdrawal can be delayed. (4) The importance of discussing addiction and withdrawal risks of medications with patients.

Keywords: addiction risk of benzodiazepines, alprazolam withdrawal, altered mental status, benzodiazepines, drug monitoring programs, sedative-hypnotics, substance use disorder

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Authors: A. Magno-França, A. M. Magalhães-Neto, F. Bachini, E. Cataldi, A. Bassini, L. C. Cameron

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Sprint canoeing (SC) is part of the Olympic Games since 1936. Athletes compete in solo or double races of 200m and 1000m (40 sec and 240 sec, respectively). Due to its high intensity and duration, SC is extremely useful to study the blood kinetics of some metabolites in high energetic demand. Sportomics is a field of study combining “-omics” sciences with classical biochemical analyses in order to understand sports induced systemic changes. Here, we compare Sportomics findings during SC training sessions to describe metabolic responses of five top-level canoeists. Five Olympic world-class male athletes were evaluated during two days of training.

Keywords: biochemistry of exercise, metabolomics, injury markers, sportomics

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Authors: Amin Akbari, Dongcai Wang, Huiru Li, Xiaoping Du, Jie Chen

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The effect of vibrational force (VF) on accelerating orthodontic tooth movement depends on the level of delivered stimulation to the tooth in terms of peak load (PL), which requires contacts between the tooth and the VF device. A personalized device ensures the contacts, but the resulting PL distribution on the teeth is unknown. Furthermore, it is unclear whether the PL on particular teeth can be adjusted to the prescribed values. The objective of this study was to investigate the efficacy of apersonalized VF device in controlling the level of stimulation on two teeth, the mandibular canines and 2nd molars. A 3-D finite element (FE) model of human dentition, including teeth, PDL, and alveolar bone, was created from the cone beam computed tomography images of an anonymous subject. The VF was applied to the teeth through a VFdevice consisting of a mouthpiece with engraved tooth profile of the subject and a VF source that applied 0.3 N force with the frequency of 30 Hz. The dentition and mouthpiece were meshed using 10-node tetrahedral elements. Interface elements were created at the interfaces between the teeth and the mouthpiece. The upper and lower teeth bite on the mouthpiece to receive the vibration. The depth of engraved individual tooth profile could be adjusted, which was accomplished by adding a layer of material as an interference or removing a layer of material as a clearance to change the PL on the tooth. The interference increases the PL while the clearance decreases it. Fivemouthpiece design cases were simulated, which included a mouthpiece without interference/clearance; the mouthpieces with bilateral interferences on both mandibular canines and 2nd molars with magnitudes of 0.1, 0.15, and 0.2-mm, respectively; and mouthpiece with bilateral 0.3-mm clearances on the four teeth. Then, the force distributions on the entire dentition were compared corresponding to these adjustments. The PL distribution on the teeth is uneven when there is no interference or clearance. Among all teeth, the anterior segment receives the highest level of PL. Adding 0.1, 0.15, and 0.2-mm interferences to the canines and 2nd molars bilaterally leads to increase of the PL on the canines by 10, 62, and 73 percent and on the 2nd molar by 14, 55, and 87 percent, respectively. Adding clearances to the canines and 2nd molars by removing the contactsbetween these teeth and the mouthpiece results in zero PL on them. Moreover, introducing interference to mandibular canines and 2nd molarsredistributes the PL on the entireteeth. The share of the PL on the anterior teeth are reduced. The use of the personalized mouthpiece ensures contactsof the teeth to the mouthpiece so that all teeth can be stimulated. However, the PL distribution is uneven. Adding interference between a tooth and the mouthpiece increases the PL while introducing clearance decreases the PL. As a result, the PL is redistributed. This study confirms that the level of VF stimulation on the individual tooth can be adjusted to a prescribed value.

Keywords: finite element method, orthodontic treatment, stress analysis, tooth movement, vibrational force

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Authors: Mina Boroujerdi, Javad Tavakoli

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Hydrogels are extensively studied as matrices for the controlled release of drugs. To evaluate the mobility of embedded molecules, these drug delivery systems are usually characterized by release studies. In this contribution, an electronic device for swelling pressure measurement during drug release from hydrogel network was developed. Also, poly acrylic acid micro particles were prepared for prolonged and sustained controlled acetaminophen release. Effect of swelling pressure on drug release from micro particles studied under different environment pH in order to predict release profile in gastro-intestine medium. Swelling ratio and swelling pressure were measured in different pH.

Keywords: swelling pressure, drug delivery, hydrogel, polyelectrolyte

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Authors: Rahisham Abd Rahman

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In this paper, a nonlinear pollution model has been proposed to compute electric field distribution over the polymeric insulator surface under wet contaminated conditions. A 2D axial-symmetric insulator geometry, energized with 11kV was developed and analysed using Finite Element Method (FEM). A field-dependent conductivity with simplified assumptions was established to characterize the electrical properties of the pollution layer. Comparative field studies showed that simulation of dynamic pollution model results in a more realistic field profile, offering better understanding on how the electric field behaves under wet polluted conditions.

Keywords: electric field distributions, pollution layer, dynamic model, polymeric outdoor insulators, finite element method (FEM)

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Authors: Siva K. Bathina, Sudheer Siddapureddy

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Pool fires are formed when the flammable liquid accidentally spills on the ground or water and ignites. Pool fire is a kind of buoyancy-driven and diffusion flame. There have been many pool fire accidents caused during processing, handling and storing of liquid fuels in chemical and oil industries. Such kind of accidents causes enormous damage to property as well as the loss of lives. Pool fires are complex in nature due to the strong interaction among the combustion, heat and mass transfers and pyrolysis at the fuel surface. Moreover, the experimental study of such large complex fires involves fire safety issues and difficulties in performing experiments. In the present work, large eddy simulations are performed to study such complex fire scenarios using fire dynamic simulator. A 1 m diesel pool fire is considered for the studied cases, and diesel is chosen as it is most commonly involved fuel in fire accidents. Fire simulations are performed by specifying two different boundary conditions: one the fuel is in liquid state and pyrolysis model is invoked, and the other by assuming the fuel is initially in a vapor state and thereby prescribing the mass loss rate. A domain of size 11.2 m × 11.2 m × 7.28 m with uniform structured grid is chosen for the numerical simulations. Grid sensitivity analysis is performed, and a non-dimensional grid size of 12 corresponding to 8 cm grid size is considered. Flame properties like mass burning rate, irradiance, and time-averaged axial flame temperature profile are predicted. The predicted steady-state mass burning rate is 40 g/s and is within the uncertainty limits of the previously reported experimental data (39.4 g/s). Though the profile of the irradiance at a distance from the fire along the height is somewhat in line with the experimental data and the location of the maximum value of irradiance is shifted to a higher location. This may be due to the lack of sophisticated models for the species transportation along with combustion and radiation in the continuous zone. Furthermore, the axial temperatures are not predicted well (for any of the boundary conditions) in any of the zones. The present study shows that the existing models are not sufficient enough for modeling blended fuels like diesel. The predictions are strongly dependent on the experimental values of the soot yield. Future experiments are necessary for generalizing the soot yield for different fires.

Keywords: burning rate, fire accidents, fire dynamic simulator, pyrolysis

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Authors: Homayon Ahmad Panahi, Nika Shakerin, Farahnaz Zolriasatain, Elham Moniri

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In this research, poly-ethylene terephthalate granule was prepared from Tak Corporation. The granule was characterized by fourier transform infra-red spectroscopy. Then the effects of various parameters on brilliant green sorption such as pH, contact time were studied. The optimum pH value for sorption of brilliant green was 6. The sorption capacity of the granule for brilliant green was 4.6 mg g−1. The profile of brilliant green uptake on this sorbent reflects a good accessibility of the chelating sites in the poly-ethylene terephthalate granule. The developed method was utilized for the determination of brilliant green in environmental water samples by UV/Vis spectrophotometry with satisfactory results.

Keywords: poly-ethylene terephthalate granule, brilliant green, environmental sample, removal

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Authors: Leela Lakshmi Sai Srinivas Parasa, Pushpavalli Naidu, Bhaskar Kambhampati

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Background: Obstructive Sleep Apnea (OSA) is a common but underdiagnosed sleep disorder characterized by repeated upper airway collapse during sleep. It frequently coexists with Type 2 Diabetes Mellitus (T2DM), a chronic metabolic condition with significant global and national health implications. The interplay between these conditions increases the risk of severe complications such as stroke, hypertension, and cardiovascular diseases. Understanding the prevalence of high-risk OSA in T2DM patients is essential for improving clinical outcomes and guiding public health interventions. Objective: This study aimed to assess the prevalence of high-risk OSA among T2DM patients using the Berlin questionnaire and to identify demographic and clinical predictors of risk. Methodology: This cross-sectional study of 100 patients with Type2 diabetes was undertaken at a tertiary care hospital in India for a period of 2 months. OSA was evaluated using the Berlin questionnaire. Diabetes mellitus was diagnosed according to WHO criteria as fasting blood sugar level > 7 mmol/L or random blood sugar >126 mg/dl on 2 separate occasions. Particulars of patients were recorded following which detailed history and physical examination were done. Data was analyzed using spss version 21. Results: The prevalence of high-risk OSA was 72% among the study population. The mean age was 54.9 +- 12.47 years. Age groups were divided into 3 groups (less than 50, 50-65, and greater than 65) The highest prevalence was observed in the 50-65 age group, accounting for 59.7% of high-risk cases. Gender distribution revealed a higher proportion of high-risk females (88.46%) compared to males (66.21%). Normal-weight individuals (BMI 18.5–24.9 kg/m²) represented 74.02% of high-risk OSA cases, while overweight individuals (BMI 25–29.9 kg/m²) accounted for 65.21%. Additionally, 90.9% of hypertensive patients were identified as high-risk for OSA. Conclusion: The study highlights a high prevalence of OSA risk among T2DM patients, especially those with hypertension and those in the middle-aged group. These findings emphasize the importance of routine OSA screening and tailored interventions for diabetic patients to reduce associated health risks. Proactive management can help mitigate the compounded effects of these two conditions, improving overall patient outcomes and reducing the burden on healthcare systems.

Keywords: obstructive sleep apnea, type 2 diabetes mellitus, berlin questionnaire, prevalence, hypertension

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Authors: Vasileios Gerakis, Fontounasios Christos, Alkis Hatzopoulos

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A study of the impact of metal guard rings on the coupling between two square metal pads is presented. The structure is designed over a bulk silicon substrate with epitaxial layer, so the coupling through the substrate is also involved. A lightly doped profile is adopted and is simulated by means of an electromagnetic simulator for various pad distances and different metal layers, assuming a 65 nm bulk CMOS technology. The impact of various guard ring design (geometrical) parameters is examined. Furthermore, the increase of isolation (resulting in reduction of the noise coupling) between the pads by cutting the ring, or by using multiple rings, is also analyzed. S parameters are used to compare the various structures.

Keywords: guard rings, metal pad coupling, millimeter wave frequencies, substrate noise,

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Authors: Yuli Andrea P. Bermudez, Richard R. Lobo, Tamyres R. D. Amorim, Danny Alexander R. Moreno, Angelica Simone C. Pereira, Ives Claudio D. Bueno

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The use of natural antioxidants in animal feed can positively modify the profile of fatty acids (FAs) in meat, due to the presence of secondary metabolites, mainly phenolic and flavonoid compounds, which promote an increase in the associated polyunsaturated fatty acids (PUFA) with beneficial factors in human health. The goal of this study was to evaluate the effect of the dietary inclusion percentage of yerba mate extract (Ilex paraguariensis St. Hilaire) as a natural antioxidant on lamb meat quality. The animals were confined for 53 days and fed with corn silage and concentrated in the proportion of 60:40, respectively, were divided into four homogeneous groups (n = 9 lambs/group), to each of the treatments, one control group without yerba mate extract - YME (0%) and three treatments with 1, 2 and 4% the inclusion of YME on a DM basis. Samples of the Longissimus thoracis (LT) muscle were collected from the deboning of 36 lambs, analyzing pH values, color parameters (brightness: L*, red value: a*, and yellow: b*), fatty acid profile, total lipids, and sensory analysis. The inclusion of YME modified the value of b* (P = 0.0041), indicating a higher value of yellow color in the meat, for the group supplemented with 4% YME. All data were statistically evaluated using the MIXED procedure of the statistical package SAS 9.4. However, it did not show differences in the final live weight in the groups evaluated, as well as in the pH values (P = 0.1923) and the total lipid concentration (P = 0.0752). The FAs (P ≥ 0.1360) and health indexes were not altered by the inclusion of YME (P ≥ 0.1360); only branched-chain fatty acids (BCFA) exhibited a diet effect (P = 0.0092) in the group that had 4% of the extract. In the sensory analysis test with a hedonic scale it did not show differences between the treatments (P ≥ 0.1251). Nevertheless, in the just about-right test, using (note 1) to 'very strong, softness or moist' (note 5); the softness was different between the evaluated treatments (P = 0.0088) where groups with 2% YME had a better acceptance of tasters (4.15 ± 0.08) compared to the control (3.89 ± 0.08). In conclusion, although the addition of YME has shown positive results in sensory acceptance and in increasing the concentration of BCFA, fatty acids beneficial to human health, without changing the physical-chemical parameters in lamb meat, the absolute changes are considered to have been quite small, which was probably related to the high efficiency of PUFA biohydrogenation in the n the rumen.

Keywords: composition, health, antioxidant, meat analysis

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Authors: Amira E. Derbalah, Doaa M. Zaghloul

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10 clinically healthy hemal nodes were collected from male bulls aged 2-3 years. Light microscopy revealed a capsule of connective tissue consisted mainly of collagen fiber surrounding hemal node, numerous erythrocytes were found in wide subcapsular sinus under the capsule. The parenchyma of the hemal node was divided into cortex and medulla. Diffused lymphocytes, and lymphoid follicles, having germinal centers were the main components of the cortex, while in the medulla there was wide medullary sinus, diffused lymphocytes and few lymphoid nodules. The area occupied with lymph nodules was larger than that occupied with non-nodular structure of lymphoid cords and blood sinusoids. Electron microscopy revealed the cellular components of hemal node including elements of circulating erythrocytes intermingled with lymphocytes, plasma cells, mast cells, reticular cells, macrophages, megakaryocytes and endothelial cells lining the blood sinuses. The lymphocytes were somewhat triangular in shape with cytoplasmic processes extending between adjacent erythrocytes. Nuclei were triangular to oval in shape, lightly stained with clear nuclear membrane indentation and clear nucleoli. The reticular cells were elongated in shape with cytoplasmic processes extending between adjacent lymphocytes, rough endoplasmic reticulum, ribosomes and few lysosomes were seen in their cytoplasm. Nucleus was elongated in shape with less condensed chromatin. Plasma cells were oval to irregular in shape with numerous dilated rough endoplasmic reticulum containing electron lucent material occupying the whole cytoplasm and few mitochondria were found. Nuclei were centrally located and oval in shape with heterochromatin emarginated and often clumped near the nuclear membrane. Occasionally megakaryocytes and mast cells were seen among lymphocytes. Megakaryocytes had multilobulated nucleus and free ribosomes often appearing as small aggregates in their cytoplasm, while mast cell had their characteristic electron dense granule in the cytoplasm, few electron lucent granules were found also, we conclude that, the main function of the hemal node of cattle is proliferation of lymphocytes. No role for plasma cell in erythrophagocytosis could be suggested.

Keywords: cattle, electron microscopy, hemal node, histology, immune system

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Authors: Teresa Sarmento de Beires, Sofia Padilha, Pedro Arantes, Joana Ribeiro, Andreia Eiras

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Background: Trichotillomania is a psychiatric condition that is very challenging to treat, with no first-line medications approved by any medical agency. It is defined as a recurrent compulsive habit of pulling out one's own hair, usually from the scalp and eyebrows area, but it can also affect eyelashes or any other hair-bearing area. N-acetylcysteine, a glutamate modulator, has been studied as a possible treatment for several psychiatric and neurological disorders, considering its role in attenuating pathophysiological processes responsible for compulsive behaviors and, therefore, trichotillomania. Objective: This study aims to determine the efficacy of N-acetylcysteine in the treatment of adults with trichotillomania. Methodology: The authors researched guidelines, standards of clinical guidance, systematic reviews, meta-analyses, and randomized clinical trials, published in the last 20 years using the MeSH terms: "Trichotillomania” and “N-acetylcysteine” in the following databases: PubMed, Cochrane library, National Guideline Clearing House, National Institute of Health and Care Excellence (NICE), Canadian Medical Association Practice Guidelines and Database of Abstracts of Reviews of Effectiveness (DARE). The Strength of Recommendation Taxonomy (SORT) Scale, from the American Family Physician, was used to evaluate the level of evidence and assign the strength of recommendation. Results: The research found fifteen articles, among which only three were eligible according to the inclusion criteria: 1. systematic review and 2. meta-analyses. There was evidence of a probable beneficial effect of N-acetylcysteine on treatment response and reduction of trichotillomania symptom severity in adults, with moderate certainty in the effect estimate. There was no evidence of effectiveness with the use of inositol, antioxidants, naltrexone, or selective serotonin reuptake inhibitors (SSRIs) in the treatment of adults with trichotillomania. Clomipramine and Olanzapine showed potential treatment benefits, with low certainty. N-acetylcysteine had the least severe side effect profile in adults compared with the other potentially beneficial pharmacological treatments. Conclusion: Evidence points towards the effectiveness of N-acetylcysteine in the treatment of adults with trichotillomania, which exhibits a good tolerability profile with minimal adverse effects. Therefore, the authors attribute a level of evidence 2, the strength of recommendation B, to the prescription of N-acetylcysteine in the treatment of adults suffering from trichotillomania (SORT analysis). Further investigation is needed in order to extract high-quality conclusions from the meta-analysis.

Keywords: trichotillomania, hair pulling, treatment, n-acetylcysteine

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Authors: Maisa Haj-Tas, Jehad Alaraifi

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The significance of the study: This retrospective study examined the speech and language profiles of patients who received clinical services at the University of Jordan Hearing and Speech Clinic (UJ-HSC) from 2009 to 2014. The UJ-HSC clinic is located in the capital Amman and was established in the late 1990s. It is the first hearing and speech clinic in Jordan and one of first speech and hearing clinics in the Middle East. This clinic provides services to an annual average of 2000 patients who are diagnosed with different communication disorders. Examining the speech and language profiles of patients in this clinic could provide an insight about the most common disorders seen in patients who attend similar clinics in Jordan. It could also provide information about community awareness of the role of speech therapists in the management of speech and language disorders. Methodology: The researchers examined the clinical records of 1140 patients (797 males and 343 females) who received clinical services at the UJ-HSC between the years 2009 and 2014 for the purpose of data analysis for this study. The main variables examined in the study were disorder type and gender. Participants were divided into four age groups: children, adolescents, adults, and older adults. The examined disorders were classified as either speech disorders, language disorders, or dysphagia (i.e., swallowing problems). The disorders were further classified as childhood language impairments, articulation disorders, stuttering, cluttering, voice disorders, aphasia, and dysphagia. Results: The results indicated that the prevalence for language disorders was the highest (50.7%) followed by speech disorders (48.3%), and dysphagia (0.9%). The majority of patients who were seen at the JU-HSC were diagnosed with childhood language impairments (47.3%) followed consecutively by articulation disorders (21.1%), stuttering (16.3%), voice disorders (12.1%), aphasia (2.2%), dysphagia (0.9%), and cluttering (0.2%). As for gender, the majority of patients seen at the clinic were males in all disorders except for voice disorders and cluttering. Discussion: The results of the present study indicate that the majority of examined patients were diagnosed with childhood language impairments. Based on this result, the researchers suggest that there seems to be a high prevalence of childhood language impairments among children in Jordan compared to other types of speech and language disorders. The researchers also suggest that there is a need for further examination of the actual prevalence data on speech and language disorders in Jordan. The fact that many of the children seen at the UJ-HSC were brought to the clinic either as a result of parental concern or teacher referral indicates that there seems to an increased awareness among parents and teachers about the services speech pathologists can provide about assessment and treatment of childhood speech and language disorders. The small percentage of other disorders (i.e., stuttering, cluttering, dysphasia, aphasia, and voice disorders) seen at the UJ-HSC may indicate a little awareness by the local community about the role of speech pathologists in the assessment and treatment of these disorders.

Keywords: clinic, disorders, language, profile, speech

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Authors: Adama NS Bah

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Background: Loss of teeth has a negative influence on essential oral functions such as phonetics, mastication, and aesthetics. Dentists treat people with prosthodontic rehabilitation to recover essential oral functions. The oral health quality of life inventory reflects the success of prosthodontic rehabilitation. In many countries, the current conventional care delivered to replace missing teeth for adult patients involves the provision of removable partial dentures. Aim: The aim of this systematic review and meta-analysis is to gather the best available evidence to determine patients’ oral health-related quality of life improvement after treatment with partial dentures. Methods: We searched electronic databases from January 2010 to September 2019, including PubMed, ProQuest, Science Direct, Scopus and Google Scholar. In this paper, studies were included only if the average age was 30 years and above and also published in English. Two reviewers independently screened and selected all the references based on inclusion criteria using the PRISMA guideline, and assessed the quality of the included references using the Joanna Briggs Institute quality assessment tools. Data extracted were analyzed in RevMan 5.0 software, the heterogeneity between the studies was assessed using Forest plot, I2 statistics and chi-square test with a statistical P value less than 0.05 to indicate statistical significance. Random effect models were used in case of moderate or high heterogeneity. Four studies were included in the systematic review and three studies were pooled for meta-analysis. Results: Four studies included in the systematic review and three studies included in the meta-analysis with a total of 285 patients comparing the improvement in oral health-related quality of life before and after rehabilitation with partial denture, the pooled results showed a better improvement of oral health-related quality of life after treatment with partial dentures (mean difference 5.25; 95% CI [3.81, 6.68], p < 0.00001) favoring the wearing of partial dentures. In order to ascertain the reliability of the included studies for meta-analysis risk of bias was assessed and found to be low in all included studies for meta-analysis using the Cochrane collaboration tool for risk of bias assessment. Conclusion: There is high evidence that rehabilitation with partial dentures can improve the patient’s oral health-related quality of life measured with Oral Health Impact Profile 14. This review has clinical evidence value for dentists treating the expanding vulnerable adult population.

Keywords: meta-analysis, oral health impact profile, partial dentures, systematic review

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Authors: Astrid Tannert, Anuradha Ramoji, Christina Ebert, Frederike Gladigau, Lorena Tuchscherr, Jürgen Popp, Ute Neugebauer

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Staphylococcus aureus is a facultative intracellular pathogen, which by entering host cells may evade immunologic host response as well as antimicrobial treatment. In that way, S. aureus can cause persistent intracellular infections which are difficult to treat. Depending on the strain, S. aureus may persist at different intracellular locations like the phagolysosome. The first barrier invading pathogens from the blood stream that they have to cross are the endothelial cells lining the inner surface of blood and lymphatic vessels. Upon proceeding from an acute to a chronic infection, intracellular pathogens undergo certain biochemical and structural changes including a deceleration of metabolic processes to adopt for long-term intracellular survival and the development of a special phenotype designated as small colony variant. In this study, the endothelial cell line Ea.hy 926 was used as a model for acute and chronic S. aureus infection. To this end, Ea.hy 926 cells were cultured on QIAscout™ Microraft Arrays, a special graded cell culture substrate that contains around 12,000 microrafts of 200 µm edge length. After attachment to the substrate, the endothelial cells were infected with GFP-expressing S. aureus for 3 weeks. The acute infection and the development of persistent bacteria was followed by confocal laser scanning microscopy, scanning the whole Microraft Array for the presence and for detailed determination of the intracellular location of fluorescent intracellular bacteria every second day. After three weeks of infection representative microrafts containing infected cells, cells with protruded infections and cells that did never show any infection were isolated and fixed for Raman micro-spectroscopic investigation. For comparison, also microrafts with acute infection were isolated. The acquired Raman spectra are correlated with the fluorescence microscopic images to give hints about a) the molecular alterations in endothelial cells during acute and chronic infection compared to non-infected cells, and b) metabolic and structural changes within the pathogen when entering a mode of persistence within host cells. We thank Dr. Ruth Kläver from QIAGEN GmbH for her support regarding QIAscout technology. Financial support by the BMBF via the CSCC (FKZ 01EO1502) and from the DFG via the Jena Biophotonic and Imaging Laboratory (JBIL, FKZ PO 633/29-1, BA 1601/10-1) is highly acknowledged.

Keywords: correlative image analysis, intracellular infection, pathogen-host adaption, Raman micro-spectroscopy

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Authors: Yuping Zhang, Teng Ma, Nadia Everaert, Hongfu Zhang

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Supplying dietary fiber during gestation is known to improve the welfare of feed-restricted sows. However, whether high fiber supplementation during pregnancy can improve the performance of sows and their offspring depends on the type, amount, source, etc., in which the solubility plays a key important role. Insoluble fibers have been shown to increase feed intake of sows in lactation, meet the needs of sows for milk production, reduce sow’s weight and backfat loss, and thus improve the performance of sows and their offspring. In this study, we investigated the effect of the addition of fermented feed mulberry (FFM), rich in insoluble fiber, during the whole gestation on the performance of sows and their offspring and explored possible mechanisms by determining serum hormones and fecal microbiota. The FFM-diet contained 25.5% FFM (on dry matter basis) and was compared with the control–diet (CON, corn, and soybean meal diet). The insoluble fiber content of the FFM and CON diet are respectively 29.3% and 19.1%. both groups were allocated 20 multiparous sows, and they are fed different feed allowance to make sure all the sows get the same digestible energy for each day. After farrowing, all sows were fed the same lactation diet ad libitum. The serum estradiol, progesterone concentration, blood glucose, and insulin levels at gestation day 0, 20, and 60 were tested. And also, the composition and differences fecal microbiota at day 60 of gestation were analyzed. Fecal consistency was determined with Bristol stool scale method, those with a score below 3 were counted as constipation The results showed that there was no impact of the FFM treatment on sows’ backfat, bodyweight changes, blood glucose, serum estradiol, and progesterone concentration, litter size, and performance of the offspring(p > 0.05), Except significant decrease in the concentration of insulin in sows’ serum at 60 days of gestation were observed in the FFM group compare to the CON group (P < 0.01). FFM diet also significantly increased feed intake on the first, third, and 21st days of sow lactation. (p < 0.01); The α- and β- diversity and abundance of the microbiota were significant increased (p < 0.01) compared with the CON group, The abundance of Firmicutes and Bacteroidetes were significantly increased, meanwhile the abundances of Spirochetes, Proteobacteria, and Euryarchaeota, were significantly reduced in the feces of the FFM group. We also analyzed the fecal microbiota of constipated sows vs non-constipated sows and found that the diversity and abundance did also differ between these two groups. FFM and CON group < 0.01). The relationship between sow’s constipation and microbiota merits further investigation.

Keywords: fermented feed mulberry, reproductive performance, fecal flora, sow

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Authors: Suphaporn Rattanaphinanchai

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The purpose of this study is to 1) describe and analyze the travel motivations of tourists visiting Phi Phi Islands after the Tsunami in 2004 and 2) to better understand whether there are significant differences in the tourists’ motivations in visiting Phi Phi Island after the Tsunami hit across tourists with different demographic profile. This study used Phi Phi Islands, which was damaged by the 2004 Indian Ocean tsunami as a case study. The instrument used in the present study is a self-administered questionnaire. A survey with 200 questionnaires was collected in May - December, 2015. Descriptive statistics, Independent Sample Mean T-tests, and Analysis of Variances was used to analyze the data. The result of the study showed that beauty of nature, good climate, and relaxing atmosphere motivated tourists in visiting Phi Phi Islands after the tsunami.

Keywords: motivation, Thailand, Thai tourism, Thai beaches

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Authors: M. Grifoni, G. Petruzzelli, M. Barbafieri, I. Rosellini, B. Pezzarossa, F. Pedron

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Evapotranspiration (ET) covers are an alternative cover system that utilizes water balance approach to maximize the ET process to reduce the contaminants leaching through the soil profile. Microcosm tests allow to identify in a short time the most suitable plant species to be used as alternative covers, their survival capacity, and simultaneously the transpiration and evaporation rate of the cover in a specific contaminated soil. This work shows the soil characterization and ET results of microcosm tests carried out on two contaminated soils by using Triticum durum and Helianthus annuus species. The data indicated that transpiration was higher than evaporation, supporting the use of plants as alternative cover at this contaminated site.

Keywords: contaminated sites, evapotranspiration cover, evapotranspiration, microcosm experiments

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Authors: El Khaddam Safaa, Soulaymani Abdelmajid, Mokhtari Abdelghani, Ouammi Lahcen, Rachida Soulaymani-Beincheikh

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The poisonings represent a problem of health in the world and Morocco, The exact dimensions of this phenomenon are still poorly recorded that we see the lack of exhaustive statistical data. The objective of this retrospective study of a series of cases of the poisonings declared at the level of the region of Tadla-Azilal and collected by the Moroccan Poison Control and Pharmacovigilance Center. An epidemiological profile of the poisonings was to raise, to determine the risk factors influencing the vital preview of the poisoned And to follow the evolution of the incidence, the lethality, and the mortality. During the period of study, we collected and analyzed 9303 cases of poisonings by different incriminated toxic products with the exception of the scorpion poisonings. These poisonings drove to 99 deaths. The epidemiological profile which we raised, showed that the poisoned were of any age with an average of 24.62±16.61 years, The sex-ratio (woman/man) was 1.36 in favor of the women. The difference between both sexes is highly significant (χ2 = 210.5; p<0,001). Most of the poisoned which declared to be of urban origin (60.5 %) (χ2=210.5; p<0,001). Carbon monoxide was the most incriminated among the cases of poisonings (24.15 %), them putting in head, followed by some pesticides and farm produces (21.44 %) and food (19.95 %). The analysis of the risk factors showed that the grown-up patients whose age is between 20 and 74 years have twice more risk of evolving towards the death (RR=1,57; IC95 % = 1,03-2,38) than the other age brackets, so the male genital organ was the most exposed (explained) to the death that the female genital organ (RR=1,59; IC95 % = 1,07-2,38) The patients of rural origin had presented 5 times more risk (RR=4,713; IC95 % = 2,543-8,742). Poisoned by the mineral products had presented the maximum of risk on the vital preview death (RR=23,19, IC95 % = 2,39-224,1). The poisonings by pesticides produce a risk of 9 (RR=9,31; IC95 % = 6,10-14,18). The incidence was 3,3 cases of 10000 inhabitants, and the mortality was 0,004 cases of 1000 inhabitants (that is 4 cases by 1000 000 inhabitants). The rate of lethality registered annually was 10.6 %. The evolution of the indicators of health according to the years showed that the rate of statement measured by the incidence increased by a significant way. We also noted an improvement in the coverage which (who) ended up with a decrease in the rate of the lethality and the mortality during last years. The fight anti-toxic is a work of length time. He asks for a lot of work various levels. It is necessary to attack the delay accumulated by our country on the various legal, institutional and technical aspects. The ideal solution is to develop and to set up a national strategy.

Keywords: epidemiology, poisoning, risk factors, indicators of health, Tadla-Azilal grated by anti-toxic fight

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Authors: Jalil ur Rehman, Ramesh C. Tailor, Muhammad Isa Khan, Jahnzeeb Ashraf, Muhammad Afzal, Geofferry S. Ibbott

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Purpose: The purpose of this analysis was to investigate dose distribution of different techniques (3D-CRT, IMRT and VMAT) of head and neck cancer using 3-dimensional dosimeter called PRESAGETM Dosimeter. Materials and Methods: Computer tomography (CT) scans of radiological physics center (RPC) head and neck anthropomorphic phantom with both RPC standard insert and PRESAGETM insert were acquired separated with Philipp’s CT scanner and both CT scans were exported via DICOM to the Pinnacle version 9.4 treatment planning system (TPS). Each plan was delivered twice to the RPC phantom first containing the RPC standard insert having TLD and film dosimeters and then again containing the Presage insert having 3-D dosimeter (PRESAGETM) by using a Varian True Beam linear accelerator. After irradiation, the standard insert including point dose measurements (TLD) and planar Gafchromic® EBT film measurement were read using RPC standard procedure. The 3D dose distribution from PRESAGETM was read out with the Duke Midsized optical scanner dedicated to RPC (DMOS-RPC). Dose volume histogram (DVH), mean and maximal doses for organs at risk were calculated and compared among each head and neck technique. The prescription dose was same for all head and neck radiotherapy techniques which was 6.60 Gy/friction. Beam profile comparison and gamma analysis were used to quantify agreements among film measurement, PRESAGETM measurement and calculated dose distribution. Quality assurances of all plans were performed by using ArcCHECK method. Results: VMAT delivered the lowest mean and maximum doses to organ at risk (spinal cord, parotid) than IMRT and 3DCRT. Such dose distribution was verified by absolute dose distribution using thermoluminescent dosimeter (TLD) system. The central axial, sagittal and coronal planes were evaluated using 2D gamma map criteria(± 5%/3 mm) and results were 99.82% (axial), 99.78% (sagital), 98.38% (coronal) for VMAT plan and found the agreement between PRESAGE and pinnacle was better than IMRT and 3D-CRT plan excludes a 7 mm rim at the edge of the dosimeter. Profile showed good agreement for all plans between film, PRESAGE and pinnacle and 3D gamma was performed for PTV and OARs, VMAT and 3DCRT endow with better agreement than IMRT. Conclusion: VMAT delivered lowered mean and maximal doses to organs at risk and better PTV coverage during head and neck radiotherapy. TLD, EBT film and PRESAGETM dosimeters suggest that VMAT was better for the treatment of head and neck cancer than IMRT and 3D-CRT.

Keywords: RPC, 3DCRT, IMRT, VMAT, EBT2 film, TLD, PRESAGETM

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Authors: W. Meron Mebrahtu, R. Absi

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Velocity distribution in turbulent open-channel flows is organized in a complex manner. This is due to the large spatial and temporal variability of fluid motion resulting from the free-surface turbulent flow condition. This phenomenon is complicated further due to the complex geometry of channels and the presence of solids transported. Thus, several efforts were made to understand the phenomenon and obtain accurate mathematical models that are suitable for engineering applications. However, predictions are inaccurate because oversimplified assumptions are involved in modeling this complex phenomenon. Therefore, the aim of this work is to study velocity distribution profiles and obtain simple, more accurate, and predictive mathematical models. Particular focus will be made on the acceptable simplification of the general transport equations and an accurate representation of eddy viscosity. Wide rectangular open-channel seems suitable to begin the study; other assumptions are smooth-wall, and sediment-free flow under steady and uniform flow conditions. These assumptions will allow examining the effect of the bottom wall and the free surface only, which is a necessary step before dealing with more complex flow scenarios. For this flow condition, two ordinary differential equations are obtained for velocity profiles; from the Reynolds-averaged Navier-Stokes (RANS) equation and equilibrium consideration between turbulent kinetic energy (TKE) production and dissipation. Then different analytic models for eddy viscosity, TKE, and mixing length were assessed. Computation results for velocity profiles were compared to experimental data for different flow conditions and the well-known linear, log, and log-wake laws. Results show that the model based on the RANS equation provides more accurate velocity profiles. In the viscous sublayer and buffer layer, the method based on Prandtl’s eddy viscosity model and Van Driest mixing length give a more precise result. For the log layer and outer region, a mixing length equation derived from Von Karman’s similarity hypothesis provides the best agreement with measured data except near the free surface where an additional correction based on a damping function for eddy viscosity is used. This method allows more accurate velocity profiles with the same value of the damping coefficient that is valid under different flow conditions. This work continues with investigating narrow channels, complex geometries, and the effect of solids transported in sewers.

Keywords: accuracy, eddy viscosity, sewers, velocity profile

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Authors: Mustafa Metin Donma

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Metabolic syndrome (MetS) components are noteworthy among children with obesity and morbid obesity because they point out the cases with MetS, which have the great tendency to severe health problems such as cardiovascular diseases both in childhood and adulthood. In clinical practice, considerable efforts are being observed to bring into the open the striking differences between morbid obese cases and those with MetS findings. The most privileged aspect is concerning cardiometabolic features. The aim of this study was to derive an index which behaves different in children with and without MetS from the cardiac point of view. For the purpose, aspartate transaminase (AST), a cardiac enzyme still being used independently to predict cardiac-related problems, was used. One hundred and twenty four children were recruited from the outpatient clinic of Department of Pediatrics in Tekirdag Namik Kemal University, Faculty of Medicine. Forty-three children with normal body mass index, forty-one and forty morbid obese (MO) children with MetS and without the characteristic features of MetS, respectively, were included in the study. Weight, height, waist circumference (WC), hip C (HC), head C (HdC), neck C (NC), systolic and diastolic blood pressure values were measured and recorded. Body mass index and anthropometric ratios were calculated. Fasting blood glucose (FBG), insulin (INS), triglycerides (TRG), high density lipoprotein cholesterol (HDL-C) analyses were performed. The values for AST, alanin transaminase (ALT) and AST/ALT were obtained. Advanced Donma cardiac index (ADCI) values were calculated. The formula for the index was [(TRG/HDL-C) * (INS/FBG)] * [(WC+HC)/Height] * [(HdC+NC)/Height]. Statistical evaluations including correlation analysis were done by a statistical package program. The statistical significance degree was accepted as p<0.05. The index, ADCI, was developed from both anthropometric and biochemical parameters. All anthropometric measurements except weight were included in the equation. Besides all biochemical parameters concerning MetS components were also added. This index was tested in each of three groups. Its performance was compared with the performance of cardiometabolic index (CMI). It was also checked whether it was compatible with AST activity. The performance of ADCI was better than that of CMI. Instead of double increase, the increase of three times was observed in children with MetS compared to MO children. The index was correlated with AST in MO group and with AST/ALT in MetS group. In conclusion, this index was superior in discovering cardiac problems in MO and in diagnosing MetS in MetS groups. It was also arbiter to point out cardiovascular and MetS aspects among the groups.

Keywords: aspartate transaminase, cardiac, children, index, obesity

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Authors: Sofia Baldelli, Aman More

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Milk curd obstruction is commonly reported as being misdiagnosed for NEC, and they predominantly mimic each other in clinical presentation, including abdominal distension, vomiting, constipation, feeding intolerance and frank or occult blood PR. Using the case of a pre-term neonate misdiagnosed with necrotising enterocolitis when in fact, they had milk curd obstruction, we compare the two diagnoses and why they are hard to differentiate, the risk factors for clinicians to consider and the different management options. The main diagnostic tool for these conditions remains the plain radiograph and here we present the original radiograph of the neonate and discuss the classical radiological features of both diagnoses. We conclude that further imaging techniques such as ultrasound might be used to improve diagnosis when X-ray is inconclusive.

Keywords: milk curd obstruction, Necrotising Enterocolitis, radiology, pediatric surgery

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Authors: O. Bourkoukou, Essaid El Bachari

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The group composing is one of the key issue in collaborative learning to achieve a positive educational experience. The goal of this work is to propose for teachers and tutors a method to create effective collaborative learning groups in e-learning environment based on the learner profile. For this purpose, a new function was defined to rate implicitly learning objects used by the learner during his learning experience. This paper describes the proposed algorithm to build an adequate collaborative learning group. In order to verify the performance of the proposed algorithm, several experiments were conducted in real data set in virtual environment. Results show the effectiveness of the method for which it appears that the proposed approach may be promising to produce better outcomes.

Keywords: building groups, collaborative learning, e-learning, learning objects

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Authors: Tanima Chatterjee, Maitree Bhattacharyya

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The global challenge of type 2 diabetes mellitus is a major health concern in this millennium, and researchers are continuously exploring new targets to develop a novel therapeutic strategy. Type 2 diabetes mellitus (T2DM) is often coupled with dyslipidemia increasing the risks for cardiovascular (CVD) complications. Enhanced oxidative and nitrosative stresses appear to be the major risk factors underlying insulin resistance, dyslipidemia, β-cell dysfunction, and T2DM pathogenesis. Autophagy emerges to be a promising defense mechanism against stress-mediated cell damage regulating tissue homeostasis, cellular quality control, and energy production, promoting cell survival. In this study, we have attempted to explore the pivotal role of autophagy in T2DM subjects with or without dyslipidemia in peripheral blood mononuclear cells and insulin-resistant HepG2 cells utilizing flow cytometric platform, confocal microscopy, and molecular biology techniques like western blotting, immunofluorescence, and real-time polymerase chain reaction. In the case of T2DM with dyslipidemia higher population of autophagy, positive cells were detected compared to patients with the only T2DM, which might have resulted due to higher stress. Autophagy was observed to be triggered both by oxidative and nitrosative stress revealing a novel finding of our research. LC3 puncta was observed in peripheral blood mononuclear cells and periphery of HepG2 cells in the case of the diabetic and diabetic-dyslipidemic conditions. Increased expression of ATG5, LC3B, and Beclin supports the autophagic pathway in both PBMC and insulin-resistant Hep G2 cells. Upon blocking autophagy by 3-methyl adenine (3MA), the apoptotic cell population increased significantly, as observed by caspase‐3 cleavage and reduced expression of Bcl2. Autophagy has also been evidenced to control oxidative stress-mediated up-regulation of inflammatory markers like IL-6 and TNF-α. To conclude, this study elucidates autophagy to play a protective role in the case of diabetes mellitus with dyslipidemia. In the present scenario, this study demands to have a significant impact on developing a new therapeutic strategy for diabetic dyslipidemic subjects by enhancing autophagic activity.

Keywords: autophagy, apoptosis, dyslipidemia, reactive oxygen species, reactive nitrogen species, Type 2 diabetes

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Authors: M. G. Talasbayen, N. N. Dyussenbayev, Y. D. Kali, R. A. Zholbarysov, Y. N. Duissenbayev, I. Z. Mammadinova, S. M. Nuradilov

Abstract:

Background. Hemorrhagic stroke is an acute cerebrovascular accident resulting from rupture of a cerebral vessel or increased permeability of the wall and imbibition of blood into the brain parenchyma. Arterial hypertension is a common cause of hemorrhagic stroke. Male gender and age over 55 years is a risk factor for intracerebral hemorrhage. Treatment of intracerebral hemorrhage is aimed at the primary pathophysiological link: the relief of coagulopathy and the control of arterial hypertension. Early surgical treatment can limit cerebral compression; prevent toxic effects of blood to the brain parenchyma. Despite progress in the development of neuroimaging data, the use of minimally invasive techniques, and navigation system, mortality from intracerebral hemorrhage remains high. Materials and methods. The study included 78 patients (62.82% male and 37.18% female) with a verified diagnosis of hemorrhagic stroke in the period from 2019 to 2021. The age of patients ranged from 25 to 80 years, the average age was 54.66±11.9 years. Demographic, brain CT data (localization, volume of hematomas), methods of treatment, and disease outcome were analyzed. Results. The retrospective analyze demonstrate that 78.2% of all patients underwent surgical treatment: decompressive craniectomy in 37.7%, craniotomy with hematoma evacuation in 29.5%, and hematoma draining in 24.59% cases. The study of the proportion of deaths, depending on the volume of intracerebral hemorrhage, shows that the number of deaths was higher in the group with a hematoma volume of more than 60 ml. Evaluation of the relationship between the time before surgery and mortality demonstrates that the most favorable outcome is observed during surgical treatment in the interval from 3 to 24 hours. Mortality depending on age did not reveal a significant difference between age groups. An analysis of the impact of the surgery type on mortality reveals that decompressive craniectomy with or without hematoma evacuation led to an unfavorable outcome in 73.9% of cases, while craniotomy with hematoma evacuation and drainage led to mortality only in 28.82% cases. Conclusion. Even though the multimodal approaches, the development of surgical techniques and equipment, and the selection of optimal conservative therapy, the question of determining the tactics of managing and treating hemorrhagic strokes is still controversial. Nevertheless, our experience shows that surgical intervention within 24 hours from the moment of admission and craniotomy with hematoma evacuation improves the prognosis of treatment outcomes.

Keywords: hemorragic stroke, Intracerebral hemorrhage, surgical treatment, stroke mortality

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