Search results for: Tunisian hospital cohort

Authors: Jean-Paul Kapuya Bulaba Nyembwe, John Omomoluwa Ogundiran, Manuel Carlos Gameiro da Silva

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Indoor environmental quality (IEQ) remains a global concern because it impacts people's comfort, health, performance, and general well-being. People spend a significant amount of time in buildings or while commuting, hence ensuring the minimal risk in indoor spaces by ensuring suitable IEQ. IEQ studies are limited regarding developing sub-Saharan countries, whereas there is also a huge risk and concern for the current population and geometric growth as many cities in the region will become mega-cities by 2040 (World Bank report). The absence of suitable IEQ regulations and energy poverty are reasons to assess the IEQ gaps for increased awareness of sustainable interventions to minimize the associated risk. This study evaluates the gaps and potential hazards that exist in the IEQ of sub-Saharan countries using empirical studies of hospital occupants and BRT bus passengers and drivers. The Surveys were conducted in 3 cities of the Democratic Republic of Congo and Lagos metropolis of Nigeria. The results suggest that gaps exist in IEQ for these regions. The gaps indicate existential risk to people’s health, comfort, and well-being. The inferential conclusions are that there is a need for further scientific studies, improvement in IEQ conditions, and ensuring suitable regulations for developing sub-Saharan countries.

Keywords: health hazards, hospitals indoor environmental quality, indoor spaces, occupants, sub-Saharan countries, vehicles

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Authors: Qiang Guo, Ruying Qi

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This project aims to trace the developmental patterns of a child's Mandarin and English from China to Australia from age 3; 03 till 5; 06. In childhood bilingual studies, there is an assumption that age 3 is the dividing line between simultaneous bilinguals and sequential bilinguals. Determining similarities and differences between Bilingual First Language Acquisition, Early Second Language Acquisition, and Second Language Acquisition is of great theoretical significance. Studies on Bilingual First Language Acquisition, hereafter, BFLA in the past three decades have shown that the grammatical development of bilingual children progresses through the same developmental trajectories as their monolingual counterparts. Cross-linguistic interaction does not show changes of the basic grammatical knowledge, even in the weaker language. While BFLA studies show consistent results under the conditions of adequate input and meaningful interactional context, the research findings of Early Second Language Acquisition (ESLA) have demonstrated that this cohort proceeds their early English differently from both BFLA and SLA. The different development could be attributed to the age of migration, input pattern, and their Environmental Languages (Lε). In the meantime, the dynamic relationship between the two languages is an issue to invite further attention. The present study attempts to fill this gap. The child in this case study started acquiring L1 Mandarin from birth in China, where the environmental language (Lε) coincided with L1 Mandarin. When she migrated to Australia at 3;06, where the environmental language (Lε) was L2 English, her Mandarin exposure was reduced. On the other hand, she received limited English input starting from 1; 02 in China, where the environmental language (Lε) was L1 Mandarin, a non-English environment. When she relocated to Australia at 3; 06, where the environmental language (Lε) coincided with L2 English, her English exposure significantly increased. The child’s linguistic profile provides an opportunity to explore: (1) What does the child’s English developmental route look like? (2) What does the L1 Mandarin developmental pattern look like in different environmental languages? (3) How do input and environmental language interact in shaping the bilingual child’s linguistic repertoire? In order to answer these questions, two linguistic areas are selected as the focus of the investigation, namely, subject realization and wh-questions. The chosen areas are contrastive in structure but perform the same semantic functions in the two linguistically distant languages and can serve as an ideal testing ground for exploring the developmental path in the two languages. The longitudinal case study adopts a combined approach of qualitative and quantitative analysis. Two years’ Mandarin and English data are examined, and comparisons are made with age-matched monolinguals in each language in CHILDES. To the author’s best knowledge, this study is the first of this kind examining a Mandarin-English bilingual child's bilingual development at a critical age, in different input patterns, and in different environmental languages (Lε). It also expands the scope of the theory of Lε, adding empirical evidence on the relationship between input and Lε in bilingual acquisition.

Keywords: bilingual development, age, input, environmental language (Le)

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Authors: Jayeon Kim, Eunjung Yu, Taeki Yoon

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Most spontaneous miscarriage is believed to be a consequence of embryo aneuploidies. Transferring eukaryotic embryos selected by PGS is expected to decrease the miscarriage rate. Current PGS indications include advanced maternal age, recurrent pregnancy loss, repeated implantation failure. Recently, use of PGS for healthy women without above indications for the purpose of improving in vitro fertilization (IVF) outcomes is on the rise. However, it is still controversy about the beneficial effect of PGS in this population, especially, in women with a history of no more than 2 miscarriages or miscarriage of eukaryotic abortus. This study aimed to investigate if karyotyping result of abortus is a good indicator of preimplantation genetic screening (PGS) in subsequent IVF cycle in women with a history of spontaneous abortion. A single-center retrospective cohort study was performed. Women who had spontaneous abortion(s) (less than 3) and dilatation and evacuation, and subsequent IVF from January 2016 to November 2016 were included. Their medical information was extracted from the charts. Clinical pregnancy was defined as presence of a gestational sac with fetal heart beat detected on ultrasound in week 7. Statistical analysis was performed using SPSS software. Total 234 women were included. 121 out of 234 (51.7%) underwent karyotyping of the abortus, and 113 did not have the abortus karyotyped. Embryo biopsy was performed on 3 or 5 days after oocyte retrieval, followed by embryo transfer (ET) on a fresh or frozen cycle. The biopsied materials were subjected to microarray comparative genomic hybridization. Clinical pregnancy rate per ET was compared between PGS and non-PGS group in each study group. Patients were grouped by two criteria: karyotype of the abortus from previous miscarriage (unknown fetal karyotype (n=89, Group 1), eukaryotic abortus (n=36, Group 2) or aneuploidy abortus (n=67, Group 3)), and pursuing PGS in subsequent IVF cycle (pursuing PGS (PGS group, n=105) or not pursuing PGS (non-PGS group, n=87)). The PGS group was significantly older and had higher number of retrieved oocytes and prior miscarriages compared to non-PGS group. There were no differences in BMI and AMH level between those two groups. In PGS group, the mean number of transferable embryos (eukaryotic embryo) was 1.3 ± 0.7, 1.5 ± 0.5 and 1.4 ± 0.5, respectively (p = 0.049). In 42 cases, ET was cancelled because all embryos biopsied turned out to be abnormal. In all three groups (group 1, 2, and 3), clinical pregnancy rates were not statistically different between PGS and non-PGS group (Group 1: 48.8% vs. 52.2% (p=0.858), Group 2: 70% vs. 73.1% (p=0.730), Group 3: 42.3% vs. 46.7% (p=0.640), in PGS and non-PGS group, respectively). In both groups who had miscarriage with eukaryotic and aneuploidy abortus, the clinical pregnancy rate between IVF cycles with and without PGS was not different. When we compare miscarriage and ongoing pregnancy rate, there were no significant differences between PGS and non-PGS group in all three groups. Our results show that the routine application of PGS in women who had less than 3 miscarriages would not be beneficial, even in cases that previous miscarriage had been caused by fetal aneuploidy.

Keywords: preimplantation genetic diagnosis, miscarriage, kpryotyping, in vitro fertilization

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Authors: A. Alhusban, M. Alqawasmeh, F. Alfawares

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Introduction: Diabetes is a chronic health problem and a major risk factor of stroke. A number of therapeutic modalities exist for diabetes management. It’s still unknown whether the different oral hypoglycemic agents would ameliorate the detrimental effect of diabetes on stroke severity. The objective of this work is to assess the effect of pretreatment with oral hypoglycemic agents, insulin and their combination on stroke severity at presentation. Patients and Methods: Patients admitted to the King Abdullah University Hospital (KAUH)-Jordan with ischemic stroke between January 2015 and December 2016 were evaluated and their comorbid diseases, treatment on admission and their neurologic severity was assessed using the National Institute of Health Stroke Scale (NIHSS) were documented. Stroke severity was compared for non-diabetic patients and diabetic patients treated with different antidiabetic agents. Results: Data from 324 patients with acute stroke was documented. The median age of participants was 69 years. Diabetes was documented in about 50% of the patients. Multinomial regression analysis identified diabetes treatment status as an independent predictor of neurological severity of stroke (p=0.032). Patients treated with oral hypoglycemic agents had a significantly lower NIHSS as compared to nondiabetic patients and insulin treated patients (p < 0.02). The positive effect of oral hypoglycemic agents was blunted by insulin co-treatment. Insulin did not alter the severity of stroke as compared to non-diabetics. Conclusion: Oral hypoglycemic agents may reduce the severity of neurologic deficit of ischemic stroke and may have neuroprotective effect.

Keywords: diabetes, stroke, neuroprotection, oral hypoglycemic agents

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Authors: Helen Nelly Naiga, Christopher Garimoi Orach

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Introduction: Long-acting reversible contraceptive (LARC) methods are highly effective. However, LARC use in Uganda is low (13%). We assessed the factors associated with the use of long-acting reversible contraceptives among women of reproductive age (15-49 yrs) in Jinja District. Methods: We conducted a facility-based cross-sectional study. A total of 314 women aged 15–49 years attending public health facilities (1 hospital and 3 health center IV) in Jinja district, were randomly selected. A total of 6 key informants and 6 in-depth interviews were conducted. Logistic regression analysis was conducted using Stata version 14. Qualitative data were analysed using thematic analysis. Results: The study found that 40.45% of the respondents had ever used LARC. The commonest LARC method used was implanting (38.22%). The factors significantly associated with use of LARC were employment (AOR =2.91; 95% CI (1.05-8.08), access to LARC methods (AOR =4.48; 95% CI (1.24-16.21), husband support (AOR =4.90; 95% CI (1.56-15.41), and experience of no side effects (AOR =3.48; 95% CI (1.00-12.19). Conclusion and recommendations: The study showed that 4 in 10 women of reproductive age in Jinja District were using LARC. The factors associated with LARC use were employment, husband support, access to LARC methods, and the lack of side effects. There is a need to strengthen client education, improve accessibility to LARC methods at all levels of health centers, improve male partner’s decision-making in LARC use and manage the side effects effectively.

Keywords: family planning, implants, intrauterine device, long-acting reversible contraceptives (LARC)

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Authors: Yuhui Liu, Lydia Speyer, Jasmin Wertz, Ingrid Obsuth

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Childhood adversities refer to situations where a child's basic needs for safety and support are compromised, leading to substantial disruptions in their emotional, cognitive, social, or neurobiological development. Given the prevalence of adversities (8%-39%), their impact on developmental outcomes is challenging to completely avoid. Delinquency is an important consequence of childhood adversities, given its potential causing violence and other forms of victimisation, influencing victims, delinquents, their families, and the whole of society. Studying mediators helps explain the link between childhood adversity and delinquency, which aids in designing effective intervention programs that target explanatory variables to disrupt the path and mitigate the effects of childhood adversities on delinquency. The Dimensional Model of Adversity and Psychopathology suggests that threat-based adversities influence outcomes through emotion processing, while deprivation-based adversities do so through cognitive mechanisms. Thus, considering a wide range of threat-based and deprivation-based adversities and their co-occurrence and their associations with delinquency through cognitive and emotional mechanisms is essential. This study employs the Millennium Cohort Study, tracking the development of approximately 19,000 individuals born across England, Scotland, Wales and Northern Ireland, representing a nationally representative sample. Parallel mediation models compare the mediating roles of self-esteem (cognitive) and depression (affective) in the associations between childhood adversities and delinquency. Eleven types of childhood adversities were assessed both individually and through latent class analysis, considering adversity experiences from birth to early adolescence. This approach aimed to capture how threat-based, deprived-based, or combined threat and deprived-based adversities are associated with delinquency. Eight latent classes were identified: three classes (low adversity, especially direct and indirect violence; low childhood and moderate adolescent adversities; and persistent poverty with declining bullying victimisation) were negatively associated with delinquency. In contrast, three classes (high parental alcohol misuse, overall high adversities, especially regarding household instability, and high adversity) were positively associated with delinquency. When mediators were included, all classes showed a significant association with delinquency through depression, but not through self-esteem. Among the eleven single adversities, seven were positively associated with delinquency, with five linked through depression and none through self-esteem. The results imply the importance of affective variables, not just for threat-based but also deprivation-based adversities. Academically, this suggests exploring other mechanisms linking adversities and delinquency since some adversities are linked through neither depression nor self-esteem. Clinically, intervention programs should focus on affective variables like depression to mitigate the effects of childhood adversities on delinquency.

Keywords: childhood adversity, delinquency, depression, self-esteem

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Authors: Patricia O. Carvalho, Marcia C. F. Messias, Salvador Sanchez Vinces, Caroline F. A. Gatinoni, Vitor P. Iordanu, Carlos A. R. Martinez

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Lipidomics methods are widely used in the identification and validation of disease-specific biomarkers and therapy response evaluation. The present study aimed to identify a panel of potential lipid biomarkers to evaluate response to neoadjuvant chemoradiotherapy in rectal adenocarcinoma (RAC). Liquid chromatography–mass spectrometry (LC-MS)-based untargeted lipidomic was used to profile human serum samples from patients with clinical stage T2 or T3 resectable RAC, after and before chemoradiotherapy treatment. A total of 28 blood plasma samples were collected from 14 patients with RAC who recruited at the São Francisco University Hospital (HUSF/USF). The study was approved by the ethics committee (CAAE 14958819.8.0000.5514). Univariate and multivariate statistical analyses were applied to explore dysregulated metabolic pathways using untargeted lipidic profiling and data mining approaches. A total of 36 statistically significant altered lipids were identified and the subsequent partial least-squares discriminant analysis model was both cross validated (R2, Q2) and permutated. Lisophosphatidyl-choline (LPC) plasmalogens containing palmitoleic and oleic acids, with high variable importance in projection score, showed a tendency to be lower after completion of chemoradiotherapy. Chemoradiotherapy seems to change plasmanyl-phospholipids levels, indicating that these lipids play an important role in the RAC pathogenesis.

Keywords: lipidomics, neoadjuvant chemoradiotherapy, plasmalogens, rectal adenocarcinoma

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Authors: Chen-Yu Tsai, Wen-Te Liu, Chen-Chen Lo, Kang Lo, Yin-Tzu Lin

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Background: Driving drowsiness related to insufficient or disordered sleep accounts for a major percentage of vehicular accidents. Sleep deprivation is the primary reason related to low sleep efficiency. Nevertheless, the mechanism of sleep deprivation induces driving fatigue to remain unclear. Objective: The objective of this study is to associate the relationship between insufficient sleep efficiency and driving fatigue. Methodologies: The physical condition while driving was obtained from the questionnaires to classify the state of driving fatigue. Sleep efficiency was quantified as the polysomnography (PSG), and the sleep stages were sentenced by the reregistered Technologist during examination in a hospital in New Taipei City (Taiwan). The independent T-test was used to investigate the correlation between sleep efficiency, sleep stages ratio, and driving drowsiness. Results: There were 880 subjects recruited in this study, who had been done polysomnography for evaluating severity for obstructive sleep apnea syndrome (OSAS) as well as completed the driver condition questionnaire. Four-hundred-eighty-four subjects (55%) were classified as fatigue group, and 396 subjects (45%) were served as the control group. The ratio of stage three sleep (N3) (0.032 ± 0.056) in fatigue group were significantly lower than the control group (p < 0.01). The significantly higher value of snoring index (242.14 ± 205.51 /hours) was observed in the fatigue group (p < 0.01). Conclusion: We observe the considerable correlation between deep sleep reduce and driving drowsiness. To avoid drowsy driving, the sleep deprivation, and the snoring events during the sleeping time should be monitored and alleviated.

Keywords: driving drowsiness, sleep deprivation, stage three sleep, snoring index

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Authors: Kalyan Koganti

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Background: In India, platelet transfusions are given to large no. of patients suffering from dengue due to the fear of bleeding especially when the platelet counts are low. Though many patients do not bleed when the platelet count falls to less than 20,000, certain patients bleed even if the platelet counts are more than 20,000 without any comorbid condition (like gastrointestinal ulcer) in the past. This fear has led to huge amounts of unnecessary platelet transfusions which cause significant economic burden to low and middle-income countries like India and also sometimes these transfusions end with transfusion-related adverse reactions. Objective: To identify the role of Activated Partial Thromboplastin Time (APTT) in comparison with thrombocytoenia as an indicator to assess the real need of platelet transfusions. Method: A prospective study was conducted at a hospital in South India which included 176 admitted cases of dengue confirmed by immunochromatography. APTT was performed in all these patients along with platelet count. Cut off values of > 60 seconds for APTT and < 20,000 for platelet count were considered to assess the bleeding manifestations. Results: Among the total 176 patients, 56 patients had bleeding manifestations like malena, hematuria, bleeding gums etc. APTT > 60 seconds had a sensitivity and specificity of 93% and 90% respectively in identifying bleeding manifestations where as platelet count of < 20,000 had a sensitivity and specificity of 64% and 73% respectively. Conclusion: Elevated APTT levels can be considered as an indicator to assess the need of platelet transfusion in dengue. As there is a significant variation among patients who bleed with respect to platelet count, APTT can be considered to avoid unnecessary transfusions.

Keywords: activated partial thromboplastin time, dengue, platelet transfusion, thrombocytopenia

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Authors: Wooseok Byon, Eunyoung Kim, Junseong Kwon, Byung Joo Song, Chan Heun Park

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Background/Purpose: Previous preclinical and clinical data suggest that increased lymphocytic infiltration would be associated with good prognosis and benefit from immunogenic chemotherapy especially in triple-negative breast cancer (TNBC). We investigated a single-center experience of TNBC and relationship with lymphocytic infiltration. Methods: From January 2004 to December 2012, at the Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, we retrospectively reviewed 897 breast cancer patients-clinical outcomes, clinicopathological characteristics, breast cancer subtypes. And we reviewed lymphocytic infiltration of TNBC specimens by two pathologists. Statistical analysis of risk factors associated with recurrence was performed. Results: A total of 897 patients, 76 were TNBC (8.47%). Mean age of TNBC patients were 50.95 (SD10.42) years, mean follow-up periods was 40.06 months. We reviewed 49 slides, and there were 8 recurrent breast cancer patients (16.32%), and 4 patients were expired (8.16%). There were 9 lymphocytic predominant breast cancers (LPBC)-carcinomas with either intratumoral lymphocytes in >60% of tumor cell nests. 1 patient of LPBC was recurred and 8 were not. In multivariate logistic regression, the odds ratio of lymphocytic infiltration was 0.59 (p=0.643). Conclusion: In a single-center experience of TNBC, the lymphocytic infiltration in tumor cell nest might be a good trend on the prognosis but there was not statistically significant.

Keywords: tumor-infiltrating lymphocytes, triple negative breast cancer, medical and health sciences

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Authors: Dana Mohammed, Fatemah Abdullah, Hawraa Ali, Najat Al-Shaer, Rawan Al-Awadhi, , Magdy Helal

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We study the patient service performance at the emergency department of a major Kuwaiti public hospital, using discrete simulation and lean concepts. In addition to the common problems in such health care systems (over crowdedness, facilities planning and usage, scheduling and staffing, capacity planning) the emergency department suffered from several cultural and patient behavioural issues. Those contributed significantly to the system problems and constituted major obstacles in maintaining the performance in control. This led to overly long waiting times and the potential of delaying providing help to critical cases. We utilized the visual management tools to mitigate the impact of the patients’ behaviours and attitudes and improve the logistics inside the system. In addition a proposal is made to automate the date collection and communication within the department using RFID-based barcoding system. Discrete event simulation models were developed as decision support systems; to study the operational problems and assess achieved improvements. The simulation analysis resulted in cutting the patient delays to about 35% of their current values by reallocating and rescheduling the medical staff. Combined with the application of the visual management concepts, this provided the basis to improving patient service without any major investments.

Keywords: simulation, visual management, health care system, patient

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Authors: Pitchaporn Purngpiputtrakul, Suttasinee Petsakul, Sunisa Chatmongkolchart

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Nasogastric tube (NGT) insertion in anaesthetized and intubated patients can be challenging even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between the GlideScope visualization and neck flexion with lateral neck pressure techniques. This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery under relaxant general anaesthesia who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of first and second attempts, duration of insertion, and complications were recorded. The total success rate was 79.1% in Group G compared with 76.7% in Group F (P=1) The median time required for NGT insertion was significantly longer in Group G, for both first and second attempts (97 vs 42 seconds P<0.001) and (70 vs 48.5 seconds P=0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications in both techniques. Using GlideScope visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique in degree of success rate of insertion, while neck flexion with lateral neck pressure technique had fewer complications and was less time-consuming.

Keywords: anaesthesia, nasogastric tube, GlideScope, intubation

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Authors: S. M. P Manjula, Ishara Amarathunga, Aryan Nath Koura, Jaideepraj Rao

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Background: Laparoscopic D2 Gastrectomy for non metastatic advanced Gastric cancer (AGC) has become a controversial topic as there are confronting ideas from experts in the field. Lack of consensus are mainly due to non feasibility of the dissection and safety and efficacy. Method: Data from all D2 Gastrectomies performed (both Subtotal and Total Gastrectomies) in our unit from 2009 December to 2013 December were retrospectively analysed. Computor database was prospectively maintained. Pathological stage two A (iiA) and above considered advanced Gastric cancers, who underwent curative intent D2 Gastrectomy were included for analysis(n=46). Four patients excluded from the study as peritoneal fluid cytology came positive for cancer cells and one patient exempted as microscopic resection margin positive(R1) after curative resection. Thirty day morbidity and mortality, operative time, lymph nodes harvest and survival (disease free and overall) analyzed. Results: Complete curative resection achieved in 40 patients. Mean age of the study population was 62.2 (32-88) and male to female ratio was 23: 17. Thirty day mortality (1/40) and morbidity (6/40). Average operative time 203.7 minutes (185- 400) and average lymphnodes harvest was 40.5 (18-91). Disease free survival of the AGC in this study population was 16.75 months (1-49). Average hospital stay was 6.8 days (3-31). Conclusion: Laparoscopic dissection is effective feasible and safe in AGC.

Keywords: laparoscopy, advanced gastric cancer, safety, efficacy

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Authors: Sudheer Moorkoth, Leslie Edward Lewis, Pragna Rao

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Newborn screening (NBS) is a part of routine newborn care in many countries worldwide to detect early any rare treatable conditions and inborn errors of metabolism (IEM). India has not started this program yet. In an attempt to understand the challenges in implementing a national newborn screening program in India, we initiated a pilot newborn screening project funded by the Government of Canada. Along with initiating the newborn screening at Kasturba Hospital, Manipal in South India, for screening six disorders (Congenital Hypothyroidism(CH), Congenital Adrenal Hyperplasia (CAH), Galactosemia, Biotinidase deficiency, Glucose-6-Phosphate Dehydrogenase deficiency (G-6PD) and Phenylketonurea), we also studied the awareness of various stakeholders on the newborn screening. In a period of nine months from August 2017 to March 2018 we could screen 1915 newborns (999 male and 916 female). The result showed that there were seven babies screened positive. This interim result points to an incidence rate of 1 in 270 children for these rare disorders collectively. This includes three confirmed cases of CH, two cases of G-6PD deficiency, and one case each for Galctosemia and CAH. A questionnaire based study to understand the awareness among various stakeholders revealed that there is little awareness among parents, adolescents and anganwadi workers (public health worker). The interim data points to the need for a national newborn screening programme in India. There is also an immediate need to undertake large-scale awareness programme to create knowledge on NBS among the various stakeholders.

Keywords: awareness, inborn errors of metabolism (IEM), newborn screening, rare disease

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Authors: Lian Wu, Mervyn Merrilees

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Chronic Obstructive Pulmonary Disease (COPD) is a worldwide problem, characterized by irreversible and progressive airflow obstruction. In New Zealand, it is currently the 4th commonest cause of death and exacerbations of COPD are a frequent cause of admission to hospital. Serum levels of Clara cell secretory protein-16 (CC-16) are believed to represent Clara cell toxicity. More recently, CC-16 has been found to be associated with smoker COPD. It is produced almost exclusively by non-ciliated Clara cells in the airways, and its primary function is to protect the lungs against oxidative stress and carcinogenesis. After acute exposure to cigarette smoke, serum levels of CC-16 become elevated. CC16 is a potent natural immune-suppressor and anti-inflammatory agent. In vitro, CC16 inhibits both monocyte and polymorphonuclear neutrophils chemotaxis and phagocytosis. CC16 also inhibits fibroblast chemotaxis. However, the role of CC-16 in non-smoking related COPD is still not clear. In this study, we investigated serum CC-16 levels in non-smoking related COPD. Methods: We compared non-smoker patients with COPD (FEV1<60% of predicted, FEV1/FVC <0.7, n=100) and individuals with normal lung function FEV1≥ 80% of predicted and FEV1/FVC≥ 0.7, n=80). All subjects had no smoking history. CC-16 was measured by ELISA. Results and conclusion: Serum CC-16 levels are reduced in individuals with non-smoking related COPD, and there is a weak correlation with disease severity in non-smoking related COPD group compared to non-smoker controls.

Keywords: COPD, CC-16, ELISA, non-smoking-related COPD

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Authors: Gbenga Martins, Christopher J. Olowookere, Lateef Bamidele, Kehinde O. Olatunji

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The aims of this research are to measure the scattered dose rate during an X-ray examination in an X-ray room, compare the scattered dose rate with exposure parameters based on the body region examined, and examine the X-ray examination done with an over couch tube. The research was carried out using Gamma Scout software installation on the computer system (Laptop) to record the radiation counts, pulse rate, and dose rate. The measurement was employed by placing the detector at 900 to the incident X-ray. Proforma was used for the collection of patients’ data such as age, sex, examination type, and initial diagnosis. Data such as focus skin distance (FSD), body mass index (BMI), body thickness of the patients, the beam output (kVp) were collected at Obafemi Awolowo University, Ile-Ife, Western Nigeria. Total number of 136 patients was considered during this research. Dose rate range between 14.21 and 86.78 µSv/h for the plain abdominal region, 85.70 and 2.86 µSv/h for the lumbosacral region,1.3 µSv/yr and 3.6 µSv/yr in the pelvis region, 2.71 µSv/yr and 28.88 µSv/yr for leg region, 3.06 µSv/yr and 29.98 µSv/yr in hand region. The results of this study were compared with those of other studies carried out in other countries. The findings of this study indicated that the number of exposure parameters selected for each diagnostic examination contributed to the dose rate recorded. Therefore, these results call for a quality assurance program (QAP) in diagnostic X-ray units in Nigerian hospitals.

Keywords: X-radiation, exposure parameters, dose rate, pulse rate, number of counts, tube current, tube potential, diagnostic examination, scattered radiation

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Authors: Denis Nono, Catherine Abbo, Thomas Wenzel

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Introduction: The study explored socio-cultural perspectives of childhood disorders and its implications for health seeking. Emphasis was on exploring local understanding and perceptions and how these ideas affect health seeking. Study aim: To explore the socio-cultural perspectives of neuro-developmental disorders and its implications on health seeking behaviour. Methods: The methods used in this study included key informant interviews conducted with health professionals. Parents of the children aged (6-15 years) with neuro-developmental disorders were recruited from the hospital to participate in focus group discussion, participant observation and individual in-depth interviews. Results: The study found out that stigma extended from children to parents and caregivers who were also shunned by community members. Participants described their children as “a gift from God” others described them as “a test from God”. The communities perceive the disorders as a spiritual infliction and always insisted that the children be taken for Acholi cultural and traditional rituals to cleanse children and they believed that mental illness has spiritual linkages. Conclusion: This study gives unique insights into the perceptions of neuro-developmental disorders and health seeking behavior in Gulu District and neighboring communities. The results showed that communities linked disorders to spiritual affliction, misunderstandings between families, bewitching, and other supernatural forces. Some of the participants highly recommended biomedical approaches to prevention, management and control of the disorders.

Keywords: ethnography, health seeking, neuro-developmental disorders, socio-cultural

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Authors: Chaliya Wamaloon, Malee Chaisaena, Nusara Prasertsri

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Informal caregivers providing home-based palliative and end-of-life (EOL) care to people with advanced cancer is needed, however, there has not been develop caregiver skills for the EOL in cancer patients. The aim of this research was to study the model development of caregiver skills for the EOL in cancer patients. Mixed methods research was conducted in 3 phases. All subjects were in Ubon Rathchathani Cancer Hospital including 30 EOL cancer patient caregivers, 30 EOL cancer patients, and 111 health care professionals who provided care for the EOL cancer patients and 30 EOL target participants who had been trained to be cancer patient caregivers. The research tools were questionnaires, semi structured interviews, and caregiver skills questionnaires. Data were analyzed by using percentage, mean, standard deviation, pair t-test, and content analysis. The result from this study showed the model development of caregiver skills for cancer patients consisted of 9 domains skills: 1. monitoring, 2. interpreting, 3. making decisions, 4. taking action, 5. making adjustments, 6. providing hands-on care, 7. accessing resources, 8. working together with the ill patients, and 9. navigating the healthcare system. The model composed of skills development curriculum for cancer patient caregivers, Manual of palliative care for caregivers, diary of health care records for cancer patients, and the evaluation model of development of caregiver skills for EOL cancer patients. The results of the evaluation in the development model of caregiver skills for EOL cancer patients showed that the caregivers were satisfied with the model of development for caregiver skills at a high level. The comparison of the caregiver skills before and after obtaining the development of caregivers skills revealed that it improved at a statistically significant level (p < 0.05).

Keywords: caregiver, caregiver skills, cancer patients, end of life

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Authors: Kholood Baron

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Radiologic interventional studies use fluoroscopy imaging guidance to perform both diagnostic and therapeutic procedures. These could result in high radiation doses being delivered to the patients and also to the radiology team. This is due to the prolonged fluoroscopy time and the large number of images taken, even when dose-minimizing techniques and modern fluoroscopic tools are applied. Hence, these procedures are part of the everyday routine of interventional radiology doctors, assistant nurses, and radiographers. Thus, it is important to estimate the radiation exposure dose they received in order to give objective advice and reduce both patient and radiology team radiation exposure dose. The aim of this study was to find out the total radiation dose reaching the radiologist and the patient during an interventional procedure and to determine the impact of certain parameters on the patient dose. Method: The radiation dose was measured by TLD devices (thermoluminescent dosimeter; radiation dosimeter device). Physicians, patients, nurses, and radiographers wore TLDs during 12 interventional radiology procedures performed in two hospitals, Mubarak and Chest Hospital. This study highlights the need for interventional radiologists to be mindful of the radiation doses received by both patients and medical staff during interventional radiology procedures. The findings emphasize the impact of factors such as fluoroscopy duration and the number of images taken on the patient dose. By raising awareness and providing insights into optimizing techniques and protective measures, this research contributes to the overall goal of reducing radiation doses and ensuring the safety of patients and medical staff.

Keywords: dosimetry, radiation dose, interventional radiology procedures, patient radiation dose

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Authors: Sarmin, S., Ologuin, R.S.

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Background: Rapid population growth and land constraints in Singapore results in a possible situation in which we face a higher number of casualties and lack of operational space in healthcare facilities during disasters and HAZMAT events, collectively known as Civil Emergencies. This creates a need for available working space within hospital grounds to be amphibious or multi-functional, to ensure the institution’s capability to respond efficiently to Civil Emergencies. The Emergency Department (ED) mitigates this issue by converting the Ambulance Assembly Area used during peacetime into an Open Decontamination Facility (ODF) during Civil Emergency Response, for decontamination of casualties before they proceed to treatment areas into Ambulance Assembly Area used during peacetime. Aims: To effectively operationalize the Open Decontamination Facility (ODF) through the reduction of manual handling. Methods: From past experiences on Civil Emergency exercises, it was labor-intensive for staff to set up the Open Decontamination Facility (ODF). Manual handling to set up the Decontamination lanes by bringing down the curtains and supply of water was required to be turned on. Conclusion: The effectiveness of the design construction of an Open Decontamination Facility (ODF) is based on the use of automation of bringing down the curtains on the various lanes. The use of control panels for water supply to decontaminate patients. Safety within the ODF was considered with the installation of panic buttons, intercom for staff communication, and perimeter curtains were installed with stability arm to manage the condition with high wind velocity.

Keywords: civil emergencies, disaster, emergency department, Hazmat

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Authors: Fahmi Hassan, Noorizan Abdul Aziz, Yahaya Hassan, Hazlinda Abu Hassan

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Sepsis incidence in critical care settings is a major problem in health care. Extended antibiotic infusion is thought to be superior to traditional dosing especially when treating critically ill patients with sepsis. We compared clinical outcomes of critically ill patients with sepsis receiving 30-minute meropenem infusion and three-hour meropenem infusion. A retrospective case-control study was conducted among septic patients treated with meropenem infusion in ICUs of three hospitals. Patients included in the study received either extended or standard meropenem infusion as per the practice of individual settings. Outcomes and clinical data were retrospectively collected from the electronic databases and patients’ files. A total of 108 patients received extended meropenem infusion while another 117 patients received standard meropenem infusion. Patients receiving the extended meropenem infusion were found to have a significantly lower shorter length of hospital and ICU stay. It was also found that among those receiving extended meropenem infusion, 54.7% (64/117) had a reduction of SAPS II score, while only 44% (48/108) of patients receiving standard meropenem infusion had reduced scores. This study will strengthen the evidence in using extended meropenem infusion as a standard practice in critical care settings. As this is the first study of its kind done in Malaysia, it proves that prolonged meropenem infusion may be beneficial to critically ill patients with sepsis. However, randomized clinical trials with large sample size should be carried out in local settings in order to minimize other confounders that may influence with the result of the study.

Keywords: antibiotics, beta lactams, critical care, extended infusion, meropenem

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Authors: N. Varsamis, M. Gerasimou, P. Christodoulou, S. Mantzoukis, G. Kolliopoulou, N. Zotos

Abstract:

Purpose: Body fluids (pleural, peritoneal, synovial, pericardial, cerebrospinal) are an important element in the detection of microorganisms. For this reason, it is important to examine them in the Intensive Care Unit (ICU) patients. Material and Method: Body fluids are transported through sterile containers and enriched as soon as possible with Tryptic Soy Broth (TSB). After one day of incubation, the broth is poured into selective media: Blood, Mac Conkey No. 2, Chocolate, Mueller Hinton, Chapman and Saboureaud agar. The above selective media are incubated directly for 2 days. After this period, if any number of microbial colonies are detected, gram staining is performed. After that, the isolated organisms are identified by biochemical techniques in the automated Microscan system (Siemens) and followed by a sensitivity test on the same system using the minimum inhibitory concentration MIC technique. The sensitivity test is verified by Kirby Bauer-based plate test. Results: In 2017 the Laboratory of Microbiology received 60 samples of body fluids from the ICU. More specifically the Microbiology Department received 6 peritoneal fluid specimens, 18 pleural fluid specimens and 36 cerebrospinal fluid specimens. 36 positive cultures were tested. S. epidermidis was identified in 18 specimens, S. haemolyticus in 6, and E. faecium in 12. Conclusions: The results show low detection of microorganisms in body fluid cultures.

Keywords: body fluids, culture, intensive care unit, microorganisms

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Authors: Shadi Kanan, Ghada Shahrour, Barbara Broome, Donna Bernert, Muntaha Alibrahim, Dana Hansen

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Coronary artery disease is responsible for over 7 million deaths a year worldwide. In developing countries, such as Jordan, the incidence of coronary artery disease exceeds that of developed countries. One contributing factor to this disparity is decreased physical activity among the population, for reasons related to specific cultural and religious values. Using the theory of planned behaviour, the purpose of this study was to investigate the intentions of Jordanian patients with coronary artery disease regarding physical activity. A total of 109 patients with coronary artery disease were recruited for this cross-sectional study from King Abdullah University Hospital in Jordan. A 15-item questionnaire based on the theory of planned behaviour was used to assess participants’ attitudes, subjective norms, perceived behavioural control and intentions towards engagement in physical activity. Perceived behavioural control was found to have the strongest significant relationship with participants’ intentions to engage in physical activity. Barriers to physical activity included lack of time, lack of support from family or friends, and feelings of exhaustion. Lifestyle interventions for patients with coronary artery disease should focus on fostering a sense of control over the environment to encourage patients to engage in physical activity.

Keywords: coronary artery disease, perceived behavioural control, subjective norms, theory of planned behaviour

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Authors: Sheimah El Bejjaji, Lara Gorsek, Chandler Quilchez, Joaquim Suñer, Mireia Mallandrich

Abstract:

Flurbiprofen is an anti-inflammatory drug used in several treatments. The purpose of this study was to compare the permeation of two different formulations of flurbiprofen through the human skin. The first formulation was a solution of flurbiprofen dissolved with polyethylene glycol 3350 (PEG 3350). The second formulation was flurbiprofen encapsulated in poly-ɛ-caprolactone (PɛCL) nanoparticles (NPs), stabilized with poloxamer 188, submitted individually for freeze-drying with PEG 3350 as a cryoprotectant and sterilized by gamma-irradiation. Human skin was obtained from the abdominal region of a healthy patient. The experimental protocol was approved by the Bioethics Committee of Barcelona SCIAS Hospital (Spain), and they obtained the written informed consent forms. After being frozen to -20ºC, the skin samples were cut with a dermatome at 400 µm. The ex vivo permeation study was performed in Franz diffusion cells with a diffusion area of 2.54 cm². Skin samples were placed between two compartment sites, the dermal side in contact with the receptor medium and the epidermis side in contact with the donor chamber to which the formulation was applied. The permeation study was conducted for 24 hours at 32 ± 0.5 °C in accordance with sink conditions. The results were analyzed with an unpaired t-test, and the p-values indicate the formulation with nanoparticles had a higher permeability coefficient, flux, partition parameter, diffusion parameter, and lag time. The applicability of this formulation topically can benefit articulations and ligament inflammation as an alternative to oral drugs.

Keywords: anti-inflammatory drug, flurbiprofen, human skin, nanoparticles, skin permeation

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Authors: Lennart Dimberg, Lala Joulha Ian

Abstract:

Introduction: Overweight (BMI 25-30) and obesity (BMI 30+) have consistently been associated with cardiovascular (CV) risk and death since the Framingham heart study in 1948, and BMI was included in the original Framingham risk score (FRS). Background: Myocardial infarction (MI) poses a serious threat to the patient's life. In addition to BMI, several other indices of overweight have been presented and argued to replace FRS as more relevant measures of CV risk. These indices include waist circumference (WC), waist/hip ratio (WHR), sagittal abdominal diameter (SAD), and sagittal abdominal diameter to height (SADHtR). Specific research question: The research question of this study is to evaluate the interrelationship between the various body measurements, BMI, WC, WHR, SAD, and SADHtR, and which measurement is strongly associated with MI and death. Methods: In 1993, 1,000 middle-aged Caucasian, randomly selected working men of the Swedish Volvo-Renault cohort were surveyed at a nurse-led health examination with a questionnaire, EKG, laboratory tests, blood pressure, height, weight, waist, and sagittal abdominal diameter measurements. Outcome data of myocardial infarction over 28 years come from Swedeheart (the Swedish national myocardial infarction registry) and the Swedish death registry. The Aalen-Johansen and Kaplan–Meier methods were used to estimate the cumulative incidences of MI and death. Multiple logistic regression analyses were conducted to compare BMI with the other four body measurements. The risk for the various measures of obesity was calculated with outcomes of accumulated first-time myocardial infarction and death as odds ratios (OR) in quartiles. The ORs between the 4th and the 1st quartile of each measure were calculated to estimate the association between the body measurement variables and the probability of cumulative incidences of myocardial infarction (MI) over time. Double-sided P values below 0.05 will be considered statistically significant. Unadjusted odds ratios were calculated for obesity indicators, MI, and death. Adjustments for age, diabetes, SBP, and the ratio of total cholesterol/HDL-C and blue/white collar status were performed. Results: Out of 1000 people, 959 subjects had full information about the five different body measurements. Of those, 90 participants had a first MI, and 194 persons died. The study showed that there was a high and significant correlation between the five different body measurements, and they were all associated with CVD risk factors. All body measurements were significantly associated with MI, with the highest (OR=3.6) seen for SADHtR and WC. After adjustment, all but SADHtR remained significant with weaker ORs. As for all-cause mortality, WHR (OR=1.7), SAD (OR=1.9), and SADHtR (OR=1.6) were significantly associated, but not WC and BMI. However, after adjustment, only WHR and SAD were significantly associated with death, but with attenuated ORs.

Keywords: BMI, death, epidemiology, myocardial infarction, risk factor, sagittal abdominal diameter, sagittal abdominal diameter to height, waist circumference, waist-hip ratio

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Authors: Faris Alkhalil, Rana Bitar, Amer Azaz, Hisham Natour, Noora Almeraikhi, Mohamad Miqdady

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Background: Children with liver transplantation are achieving very good survival and so there is now a need to concentrate on achieving good health in these patients and preventing disease. Immunosuppressive medications have side effects that need to be monitored and if possible avoided. Glucocorticoids and calcineurin inhibitors are detrimental to bone and mineral homeostasis in addition steroids can also affect linear growth. Steroid sparing regimes in renal transplant children has shown to improve children’s height. Aim: We aim to review the growth and bone health of children post liver transplant by measuring bone mineral density (BMD) using dual energy X-ray absorptiometry (DEXA) scan and assessing if there is a clear link between poor growth and impaired bone health and use of long term steroids. Subjects and Methods: This is a single centre retrospective Cohort study, we reviewed the medical notes of children (0-16 years) who underwent a liver transplantation between November 2000 to November 2016 and currently being followed at our centre. Results: 39 patients were identified (25 males and 14 females), the median transplant age was 2 years (range 9 months - 16 years), and the median follow up was 6 years. Four patients received a combined transplant, 2 kidney and liver transplant and 2 received a liver and small bowel transplant. The indications for transplant included, Biliary Atresia (31%), Acute Liver failure (18%), Progressive Familial Intrahepatic Cholestasis (15%), transplantable metabolic disease (10%), TPN related liver disease (8%), Primary Hyperoxaluria (5%), Hepatocellular carcinoma (3%) and other causes (10%). 36 patients (95%) were on a calcineurin inhibitor (34 patients were on Tacrolimus and 2 on Cyclosporin). The other three patients were on Sirolimus. Low dose long-term steroids was used in 21% of the patients. A considerable proportion of the patients had poor growth. 15% were below the 3rd centile for weight for age and 21% were below the 3rd centile for height for age. Most of our patients with poor growth were not on long term steroids. 49% of patients had a DEXA scan post transplantation. 21% of these children had low bone mineral density, one patient had met osteoporosis criteria with a vertebral fracture. Most of our patients with impaired bone health were not on long term steroids. 20% of the patients who did not undergo a DEXA scan developed long bone fractures and 50% of them were on long term steroid use which may suggest impaired bone health in these patients. Summary and Conclusion: The incidence of impaired bone health, although studied in limited number of patients; was high. Early recognition and treatment should be instituted to avoid fractures and improve bone health. Many of the patients were below the 3rd centile for weight and height however there was no clear relationship between steroid use and impaired bone health, reduced weight and reduced linear height.

Keywords: bone, growth, pediatric, liver, transplantation

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Authors: Nafdha Thajudeen

Abstract:

Hijamah therapy is one of the leading alternative & complementary modalities in the World. It is a kind of detoxification, rejuvenation, and blood purification method. It comes under Ilaj bil Tadbeer (Regimental therapy) in the Unani medical system. In diabetes, hands and foot care in people is very important because of slow blood circulation, where blood sometimes is not able to fully penetrate the capillaries. Hijamah therapy works upon the following two principles- Tanqiyae Mawad (Evacuation of morbid humor) and Imalae Mawad (Diversion of humor). The aim of this study was to find out the effectiveness of hijamah therapy on the numbness of legs in a diabetic patient. This case study was carried out in Ayurvedic Research Hospital (Non-Communicable Diseases), Ninthavur, Sri Lanka. A 63 years old female diabetic patient came to the clinic with the complain of numbness in both feet for one year. The treatment history of the patient revealed that she had taken western medicine for her complaints for 7 months. In her first visit, wet cupping was done on local and distal points. The patient said there was a remarkable improvement; internal medicines were given to keep the sugar level in normal with some external applications. Every week, wet cupping was done on the same points, with repeating the same medicines. Foot numbness was fully cured within one month. The finding of this study shows that the complaint of numbness in the diabetic patient was treated with hijamah therapy with internal & external medicine. This case study can be concluded as hijamah therapy is very effective in treating diabetic numbness. This single case study may be the entrance for future clinical studies

Keywords: Hijamah therapy, Ilaj bil thadbeer, diabetes, numbness

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Authors: Anuruddha Jagoda, Samiddhi Samarakoon, Anil Jasinghe

Abstract:

In an emergency department ‘where every second count for patient’s management’ timely availability of X- rays play a vital role in early diagnosis and management of patients. Trauma care centers rely heavily on timely radiologic imaging for patient care and radiology plays a crucial role in the emergency department (ED) operations. A research study was carried out to assess timeliness of availability of X-rays and total turnaround time at the Accident Service of National Hospital of Sri Lanka which is the premier trauma center in the country. Digital Radiology system was implemented as an intervention to improve the timeliness of availability of X-rays. Post-implementation assessment was carried out to assess the effectiveness of the intervention. Reduction in all three aspects of waiting times namely waiting for initial examination by doctors, waiting until X –ray is performed and waiting for image availability was observed after implementation of the intervention. However, the most significant improvement was seen in waiting time for image availability and reduction in time for image availability had indirect impact on reducing waiting time for initial examination by doctors and waiting until X –ray is performed. The most significant reduction in time for image availability was observed when performing 4-5 X rays with DR system. The least improvement in timeliness was seen in patients who are categorized as critical.

Keywords: emergency department, digital radilogy, timeliness, trauma care

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Authors: Farnaz Firuzian, Farhad Choobdar, Ali Mazouri

Abstract:

As Very Low Birth Weight (VLBW) neonates cannot tolerate enteral feeding, parenteral nutrition (PN) must be administered shortly after birth. To find an optimal combination of nutrition, in this study, we compare administering high glucose versus high protein intake as a component of total parenteral nutrition (TPN) to test their effect on birth weight (BW) regain in VLBW. This study employs a multi-arm randomized trial: 145 newborns with BW < 1500 g were randomized to control (C) or experimental groups: high glucose (G) or high protein (P). All samples in each group received the same TPN regimens except glucose and protein intake: Glocuse was provided by dextrose water (DW) serum: 7-15 g/kg/d (10% DW) in groups C and P versus 8.75-18.75 g/kg/d (12.5% DW) in group G. Protein provided by amino acids 3 g/kg/d for groups C and G versus 4 g/kg/d for group P. Outcomes (weight, height, and head circumference) was monitored on a daily basis until the BW was regained. Data has been gathered recently and is being processed. We hypothesize that neonates with higher amino acid intake will result in sooner BW regain than other groups. The result will be presented at the conference. The findings of this study not only can help optimize nutrition, cost reduction, and shorter NICU admission of VLBW neonates at the hospital level but eventually contribute to reduced healthcare-associated infections (HAIs) and an improved health economy.

Keywords: very low birth weight neonates, weight gain, parenteral nutrition, glucose, amino acids

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Authors: S Eli, DGB Kalio, BOA Altraide, P Kua, DA MacPepple, FE Okonofua

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Background: Anaemia in pregnancy is worrisome morbidity encountered by obstetricians and gynaecologist in the developing countries of the world. It is an indirect cause of maternal mortality and also a cause of perinatal mortality. Aim: The study aimed to ascertain the prevalence of anaemia amongst antenatal clinic (ANC) attendees at booking at The Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Rivers State, Nigeria. Method: The method was a cross-sectional study of ANC attendees at booking at RSUTH. The cut-off for anaemia by the WHO used for this study was packed cell volume (PCV) less than 33%. Simple randomized sampling method was used. Information was analyzed using SPSS version 25. Result: A total of 500 questionnaires were distributed, and 488 questionnaires retrieved. The mean age was of the ANC attendees was 31.44 years, and the modal parity was 0. Three hundred and fifty-seven (73.2%) of the respondents had a tertiary level of education, 126(25.8%) had a secondary level of education while 5 (1%) of the respondents had a primary level of education. Five (1%) of the respondents did not volunteer their educational status. The modal packed cell volume was 32%. Three hundred and eighty-two (78.3%) of the ANC attendees had PCV level less than 33% compared to 106 (21.7%) who had PCV equal or greater than 33%. Conclusion: The study revealed that the prevalence of anaemia in pregnancy amongst ANC attendees at the RSUTH was high, representing 73.3% of the subjects. Anaemia was common amongst multiparas (38.5%). Malaria prophylaxis, as well as encouraging pregnant women to be compliant with their routine antenatal drugs as well as counseling on the right diet, cannot be overemphasized during pregnancy. In addition, women should use family planning for child spacing for them to recover from previous pregnancies.

Keywords: anaemia, ANC attendees, Nigeria, prevalence

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