Search results for: clinical rotation

Authors: Devieta Romadhon Saendardy

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Introduction: The case of aneurysmal subarachnoid hemorrhage (SAH) associated with intraventricular hemorrhage (IVH) in many way. In general, the anterior communicating artery and posterior circulation aneurysms cause Intraventricular Hemorrhage. The development of intraventricular hemorrhage (IVH) in aneurysmal subarachnoid hemorrhage (aSAH) is linked with higher mortality and poor neurological recovery. Case: This case report presents a 51-year-old female patient who developed IVH following SAH. The patient's Glasgow Coma Scale score was 14, the patient has a severe headache, and there were right extremity hemipharese neurological deficits. A non-contrast head CT scan revealed a massive intraventricular haemorrhage. In an hour, the patient got her headache and pharese worse. Discussion: Intraventricular hemorrhage is a serious complication of subarachnoid hemorrhage, necessitating prompt recognition and management. This case highlights the importance of a time management, medical management and surgical intervention to optimize outcomes in patients with intraventricular hemorrhage caused by subarachnoid hemorrhage. Placement of a shunt system improves clinical outcome in intraventricular hemorrhage.

Keywords: Intraventricular hemorrhage, subarachnoid hemorrhage, shunt, time

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Authors: Alireza Moghtaderi, Negin Khakpour

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Hallux Valgus is a kind of Toes aberration where the Metatarsophalangeal joint that connects the big toe to the foot, leading to the inner side and a protrusion on the inner surface of toe arise. This study aimed to determine the effect of botulinum toxin A injection to reduce pain and deviation angle of the thumb in Hallux Valgus and to increase outcomes of treatment as an adjuvant therapy. Randomized clinical study was performed on 18 patients at the Clinic of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences. In this study the Halgvs valgus angle (HVA) between the metatarsals (IMA) and cartilage distal metatarsal angle (DMAA) and pain were assessed before and after injection. Average of Hallux Valgus angle before and after Botox injections were 28/89 ± 10/21 and 21/56 ± 8/22 degrees and the angle deviation in the 6 months after treatment was significantly improved (p <0.001). Injection of botulinum toxin A is a suitable and acceptable method to reform the skeleton deformities and also to reduce the pain in patients with Hallux valgus.

Keywords: metatasal, hallux valgus, pain, botulinum toxuin

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Authors: K. B. Chathyushya, M. Shiva Prakash, R. Hemalatha

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Introduction: Gastrointestinal (GI) tract has a number of microorganisms (microbiota) that influences the host’s health. The imbalance in the gut microbiota, which is also called as gut dysbiosis, affects human health which causes various metabolic, inflammatory, and infectious diseases. Probiotics play an important role in reinstating the gut balance. Probiotics are involved in the maintenance of healthier gut microbiota and have also been identified as effective adjuvants in insulin resistance therapies. Methods: This paper systematically reviews different randomized, controlled, blinded trials of probiotics for the treatment of various diseases along with the therapeutic or prophylactic properties of probiotic bacteria in different metabolic, inflammatory, infectious and anxiety-related disorders. Conclusion: The present review summarises that probiotics have some considerable effect in the management of various diseases, however, the benefits are strain specific, although more clinical trials are need to be carried out with different probiotic and symbiotic combinations as some probiotics have broad spectrum of benefits and few with specific activity

Keywords: life style diseases, cognition, health, gut dysbiosis, probiotics

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Authors: Zainab Shaikh, Yusuf Miyanji

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Pilomatrixoma is a benign neoplasm of the hair follicle matrix that is not commonly diagnosed in general practice. This is a case report of a 9-year-old boy who presented with a one-year history of a 19mm x 11 mm swelling in the left infra-orbital region. This was previously undiagnosed in Spain, where the patient resided at the time of initial presentation, due to the language barrier the patient’s family encountered. An ultrasound and magnetic resonance imaging gave useful information regarding surrounding structures for complete tumor excision and indicated that the risk of facial nerve palsy is low. The lesion was surgically excised and a definitive diagnosis was made after histopathology. Pilomatrixoma, although not rare in its occurrence, is rarely this large at the time of excision due to early presentation. This case highlights the importance of including pilomatrixoma in the differential diagnosis of dermal and subcutaneous lesions in the head and neck region, as it is often misdiagnosed due to the lack of awareness of its clinical presentation.

Keywords: pilomatrixoma, swelling, infra-orbital, facial swelling

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Authors: Rasime Kalkan, Emine Ikbal Atli, Ali Arslantaş, Muhsin Özdemir, Sevilhan Artan

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Glioblastoma (WHO grade IV), is the malignant form of brain tumor, the genetic background of the GBM is highly variable. The tumor mass of a GBM is multilayered and every tumor layer shows distinct characteristics with a different cell population. The treatment planning of GBM should be focused on the tumor genetic characteristics. We screened primary glioblastoma multiforme (GBM) in a population-based study for MGMT and RARβ methylation and IDH1 mutation correlated them with clinical data and treatment. There was no correlation between MGMT-promoter methylation and overall survival. The overall survival time of the patients with methylated RARβ was statically (OS;p<0,05) significance between the patients who were treated with chemotherapy and radiotherapy. Here we showed the status of IDH1 gene associatied with younger age. We demonstrated that the together with MGMT gene the RARβ gene should be used as a potantial treatment decision marker for GBMs.

Keywords: RARβ, primary glioblastoma multiforme, methylation, MGMT

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Authors: Devi Eka Septiyani Arifin, Jrjeng Ruan

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As an approach to manipulate the performance of polymer thin film, epitaxy crystallization within polymer blends of poly(vinylidene fluoride) (PVDF) and its copolymer poly(vinylidene fluoride-trifluoroethylene) P(VDF-TrFE) was studied in this research, which involves the competition between phase separation and crystal growth of constitutive semicrystalline polymers. The unique piezoelectric feature of poly(vinylidene fluoride) crystalline phase is derived from the packing of molecular chains in all-trans conformation, which spatially arranges all the substituted fluorene atoms on one side of the molecular chain and hydrogen atoms on the other side. Therefore, the net dipole moment is induced across the lateral packing of molecular chains. Nevertheless, due to the mutual repulsion among fluorene atoms, this all-trans molecular conformation is not stable, and ready to change above curie temperature, where thermal energy is sufficient to cause segmental rotation. This research attempts to explore whether the epitaxial interactions between piezoelectric crystals and crystal lattice of hexamethylbenzene (HMB) crystalline platelet is able to stabilize this metastable all-trans molecular conformation or not. As an aromatic crystalline compound, the melt of HMB was surprisingly found able to dissolve the poly(vinylidene fluoride), resulting in homogeneous eutectic solution. Thus, after quenching this binary eutectic mixture to room temperature, subsequent heating or annealing processes were designed to explore the involve phase separation and crystallization behavior. The phase transition behaviors were observed in-situ by X-ray diffraction and differential scanning calorimetry (DSC). The molecular packing was observed via transmission electron microscope (TEM) and the principles of electron diffraction were brought to study the internal crystal structure epitaxially developed within thin films. Obtained results clearly indicated the occurrence of heteroepitaxy of PVDF/PVDF-TrFE on HMB crystalline platelet. Both the concentration of poly(vinylidene fluoride) and the mixing ratios of these two constitutive polymers have been adopted as the influential factors for studying the competition between the epitaxial crystallization of PVDF and P(VDF-TrFE) on HMB crystalline. Furthermore, the involved epitaxial relationship is to be deciphered and studied as a potential factor capable of guiding the wide spread of piezoelectric crystalline form.

Keywords: epitaxy, crystallization, crystalline platelet, thin film and mixing ratio

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Authors: P. Karpagam, Babu Joseph, P. Ashok Kumar

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The incidence of Candida infections is increasing worldwide. The serious nature of these infections is compounded by increasing levels of drug resistance. Pure cultures of the Candida sp. were obtained from clinical isolates and fresh garlic extracts were obtained by extraction techniques. The antifungal activity of garlic extract was investigated in an in vitro system. The extract (100%, 75% and 50%) showed significant antifungal activity against Candida, whereas, low concentration (25%) of the extract showed less antifungal activity against the test organism. Antifungal activities of honey and lemon juice were tested against the Candida; however, the growth was not inhibited by these extracts. On the other hand honey and lemon when combined with garlic exhibited a good antifungal activity. The study thus confirms the antifungal properties of garlic extract along with additives like honey and lemon have significant antifungal activity against isolates of Candida species.

Keywords: Candida, garlic extract, lemon, synergitic antifungal activity

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Authors: Vijayalakshmi Marella, NageswaraRaoPilli

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This paper describes a simple, rapid and sensitive liquid chromatography / tandem mass spectrometry assay for the determination of montelukast in human plasma using montelukast d6 as an internal standard. Analyte and the internal standard were extracted from 50 µL of human plasma via solid phase extraction technique without evaporation, drying and reconstitution steps. The chromatographic separation was achieved on a C18 column by using a mixture of methanol and 5mM ammonium acetate (80:20, v/v) as the mobile phase at a flow rate of 0.8 mL/min. Good linearity results were obtained during the entire course of validation. Method validation was performed as per FDA guidelines and the results met the acceptance criteria. A run time of 2.5 min for each sample made it possible to analyze more number of samples in short time, thus increasing the productivity. The proposed method was found to be applicable to clinical studies.

Keywords: Montelukast, tandem mass spectrometry, montelukast d6, FDA guidelines

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Authors: Lucia Liu, Matthew Koziol

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Obsessive-compulsive disorder (OCD), a long-lasting anxiety disorder involving recurrent, intrusive thoughts, affects over 2 million adults in the United States. Transcranial magnetic stimulation (TMS) stands out as a noninvasive, cutting-edge therapy that has been shown to reduce symptoms in patients with treatment-resistant OCD. The Food and Drug Administration (FDA) approved protocol pairs TMS sessions with individualized symptom provocation, aiming to improve the susceptibility of brain circuits to stimulation. However, limited standardization or guidance exists on how to conduct symptom provocation and which methods are most effective. This study aims to compare the effect of internal versus external techniques to induce obsessional stress in a clinical setting during TMS therapy. Two symptom provocation methods, (i) Asking patients thought-provoking questions about their obsessions (internal) and (ii) Requesting patients to perform obsession-related tasks (external), were employed in a crossover design with repeated measurement. Thirty-six treatments of NeuroStar TMS were administered to each of two patients over 8 weeks in an outpatient clinic. Patient One received 18 sessions of internal provocation followed by 18 sessions of external provocation, while Patient Two received 18 sessions of external provocation followed by 18 sessions of internal provocation. The primary outcome was the level of self-reported obsessional stress on a visual analog scale from 1 to 10. The secondary outcome was self-reported OCD severity, collected biweekly in a four-level Likert-scale (1 to 4) of bad, fair, good and excellent. Outcomes were compared and tested between provocation arms through repeated measures ANOVA, accounting for intra-patient correlations. Ages were 42 for Patient One (male, White) and 57 for Patient Two (male, White). Both patients had similar moderate symptoms at baseline, as determined through the Yale-Brown Obsessive Compulsive Scale (YBOCS). When comparing obsessional stress induced across the two arms of internal and external provocation methods, the mean (SD) was 6.03 (1.18) for internal and 4.01 (1.28) for external strategies (P=0.0019); ranges were 3 to 8 for internal and 2 to 8 for external strategies. Internal provocation yielded 5 (31.25%) bad, 6 (33.33%) fair, 3 (18.75%) good, and 2 (12.5%) excellent responses for OCD status, while external provocation yielded 5 (31.25%) bad, 9 (56.25%) fair, 1 (6.25%) good, and 1 (6.25%) excellent responses (P=0.58). Internal symptom provocation tactics had a significantly stronger impact on inducing obsessional stress and led to better OCD status (non-significant). This could be attributed to the fact that answering questions may prompt patients to reflect more on their lived experiences and struggles with OCD. In the future, clinical trials with larger sample sizes are warranted to validate this finding. Results support the increased integration of internal methods into structured provocation protocols, potentially reducing the time required for provocation and achieving greater treatment response to TMS.

Keywords: obsessive-compulsive disorder, transcranial magnetic stimulation, mental health, symptom provocation

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Authors: Areej Al-Khabbaz, Swapna Goerge, Majedah Abdul-Rasoul

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Introduction: The most prevalent periodontal disease among children is gingivitis, and it usually becomes more severe in adolescence. A number of intervention studies suggested that resolution of periodontal inflammation can improve metabolic control in patients diagnosed with diabetes mellitus. Aim: to assess the effect of non-surgical periodontal therapy on glycemic control of children diagnosed with diabetes mellitus. Method: Twenty-eight children diagnosed with diabetes mellitus were recruited with established diagnosis diabetes for at least 1 year. Informed consent and child assent form were obtained from children and parents prior to enrolment. The dental examination for the participants was performed on the same week directly following their annual medical assessment. All patients had their glycosylated hemoglobin (HbA1c%) test one week prior to their annual medical and dental visit and 3 months following non-surgical periodontal therapy. All patients received a comprehensive periodontal examination The periodontal assessment included clinical attachment loss, bleeding on probing, plaque score, plaque index and gingival index. All patients were referred for non-surgical periodontal therapy, which included oral hygiene instruction and motivation followed by supra-gingival and subg-ingival scaling using ultrasonic and hand instruments. Statistical Analysis: Data were entered and analyzed using the Statistical Package for Social Science software (SPSS, Chicago, USA), version 18. Statistical analysis of clinical findings was performed to detect differences between the two groups in term of periodontal findings and HbA1c%. Binary logistic regression analysis was performed in order to examine which factors were significant in multivariate analysis after adjusting for confounding between effects. The regression model used the dependent variable ‘Improved glycemic control’, and the independent variables entered in the model were plaque index, gingival index, bleeding %, plaque Statistical significance was set at p < 0.05. Result: A total of 28 children. The mean age of the participants was 13.3±1.92 years. The study participants were divided into two groups; Compliant group (received dental scaling) and non-complaints group (received oral hygiene instructions only). No statistical difference was found between compliant and non-compliant group in age, gender distribution, oral hygiene practice and the level of diabetes control. There was a significant difference between compliant and non-compliant group in term of improvement of HBa1c before and after periodontal therapy. Mean gingival index was the only significant variable associated with improved glycemic control level. In conclusion, this study has demonstrated that non-surgical mechanical periodontal therapy can improve HbA1c% control. The result of this study confirmed that children with diabetes mellitus who are compliant to dental care and have routine professional scaling may have better metabolic control compared to diabetic children who are erratic with dental care.

Keywords: children, diabetes, metabolic control, periodontal therapy

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Authors: Grace Omowunmi Soyebi

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A computerized medical record system is a collection of medical information about a person that is stored on a computer. One principal problem of most hospitals in rural areas is using the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved; this may cause an unexpected to happen to the patient. This data mining application is to be designed using a structured system analysis and design method which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the design and implementation of a computerized medical record system. This computerized system will replace the file management system and help to quickly retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: programming, data, software development, innovation

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Authors: Rebiahi Sid Ahmed, Boutarfi Zakaria, Rahmoun Malika, Antonio Galvez

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The objective of this study was to explore the possible correlation between resistance to antibiotics and tolerance to biocides in Gram-negative bacilli isolated from the University Hospital Center of Tlemcen. This study focused on 175 clinical isolates of Gram-negative bacilli, it is a question of exploring: their level and profile of resistance to antibiotics, their tolerance to biocides, as well as the identification of the genetic supports of this resistance. Enterobacter spp. was the most predominant bacterial genus, all isolates harbored at least one of the studied genes with significant resistance capacity. Our results show, in some cases, a possible positive correlation between the presence of biocide tolerance genes and those of antibiotic resistance; in fact, tolerance to biocides could be one of the co-selection factors for antibiotic resistance. The results of this study should encourage the good practice of hygiene measures as well as the rational use of antimicrobials in order to hinder the development and emergence of resistance in our hospital departments.Mots clés : Antibiotiques, Biocides, Enterobacter, Hôpital, Résistance,

Keywords: antibiotic, biocides, enterobacter, hospital, resistance

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Authors: Alejandra Sierra, Gloria Valadez, Adriana Dávalos, Mirliana Ramírez

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For years, the Pan American Health Organization/World Health Organization and other organizations have made efforts to the improve access and the quality of prenatal care as part of comprehensive programs for maternal and neonatal health, the standards of care have been renewed in order to migrate from a medical perspective to a holistic perspective. However, despite the efforts currently antenatal care models have not been verified by a scientific evaluation in order to determine their effectiveness. The teenage pregnancy is considered as a very important phenomenon since it has been strongly associated with inequalities, poverty and the lack of gender quality; therefore it is important to analyze the antenatal care that’s been given, including not only the clinical intervention but also the activities surrounding the advertising and the health education. In this study, the objective was to describe if the previously established activities (on the prenatal care models) are being performed in the care of pregnant teenagers attending prenatal care in health institutions in two cities in México and Chile during 2013. Methods: Observational and descriptive study, of a transversal cohort. 170 pregnant women (13-19 years) were included in prenatal care in two health institutions (100 women from León-Mexico and 70 from Chile-Coquimbo). Data collection: direct survey, perinatal clinical record card which was used as checklists: WHO antenatal care model WHO-2003, Official Mexican Standard NOM-007-SSA2-1993 and Personalized Service Manual on Reproductive Process- Chile Crece Contigo; for data analysis descriptive statistics were used. The project was approved by the relevant ethics committees. Results: Regarding the fulfillment of interventions focused on physical, gynecological exam, immunizations, monitoring signs and biochemical parameters in both groups was met by more than 84%; the activities of guidance and counseling pregnant teenagers in Leon compliance rates were below 50%, on the other hand, although pregnant women in Coquimbo had a higher percentage of compliance, no one reached 100%. The topics that less was oriented were: family planning, signs and symptoms of complications and labor. Conclusions: Although the coverage of the interventions indicated in the prenatal care models was high, there were still shortcomings in the fulfillment of activities to orientation, education and health promotion. Deficiencies in adherence to prenatal care guidelines could be due to different circumstances such as lack of registration or incomplete filling of medical records, lack of medical supplies or health personnel, absences of people at prenatal check-up appointments, among many others. Therefore, studies are required to evaluate the quality of prenatal care and the effectiveness of existing models, considering the role of the different actors (pregnant women, professionals and health institutions) involved in the functionality and quality of prenatal care models, in order to create strategies to design or improve the application of a complete process of promotion and prevention of maternal and child health as well as sexual and reproductive health in general.

Keywords: adolescent health, health systems, maternal health, primary health care

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Authors: Ravi Teja Mandapaka, Prasanna Kumar Kukkamalla

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Poor absorption of calcium, elevated levels in serum and loss of bone are major problems of astronauts during space travel. Supplementation of calcium could not reveal this problem. In normal condition only 33% of calcium is absorbed from dietary sources. In this paper effect of space environment on calcium metabolism was discussed. Many surprising study findings were found during literature survey. Clinical trials on ovariectomized mice showed that reduction of calcium particles to nano level make them more absorbable and bioavailable. Control of bone loss in astronauts in critical important In Fortification of milk with nana calcium particles showed reduces urinary pyridinoline, deoxypyridinoline levels. Dietary calcium and supplementation do not show much retention of calcium in zero gravity environment where absorption is limited. So, the fortification of foods with nano calcium particles seemed beneficial for astronauts during and after space travel in their speedy recovery.

Keywords: nano calcium, astronauts, fortification, supplementation

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Authors: Hsin-Yi Kathy Cheng, Yan-Ying JU, Wann-Yun Shieh, Chin-Man Wang

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Although the coordination of swallowing and respiration has been discussed widely, the influence of the positioning angle on swallowing and respiration during feeding has rarely been investigated. This study aimed to investigate the timing and coordination of swallowing and respiration in different seat inclination angles, with liquid and bolus, to provide suggestions and guidelines for the design and develop a feedback-controlled seat angle adjustment device for the back-adjustable wheelchair. Twenty-six participants aged between 15-30 years old without any signs of swallowing difficulty were included. The combination of seat inclinations and food types was randomly assigned, with three repetitions in each combination. The trunk inclination angle was adjusted by a commercialized positioning wheelchair. A total of 36 swallows were done, with at least 30 seconds of rest between each swallow. We used a self-developed wearable device to measure the submandibular muscle surface EMG, the movement of the thyroid cartilage, and the respiratory status of the nasal cavity. Our program auto-analyzed the onset and offset of duration, and the excursion and strength of thyroid cartilage when it was moving, coordination between breathing and swallowing were also included. Variables measured include the EMG duration (DsEMG), swallowing apnea duration (SAD), total excursion time (TET), duration of 2nd deflection, FSR amplitude, Onset latency, DsEMG onset, DsEMG offset, FSR onset, and FSR offset. These measurements were done in four-seat inclination angles (5。, 15。, 30。, 45。) and three food contents (1ml water, 10ml water, and 5ml pudding bolus) for each subject. The data collected between different contents were compared. Descriptive statistics were used to describe the basic features of the data. Repeated measure ANOVAs were used to analyze the differences for the dependent variables in different seat inclination and food content combinations. The results indicated significant differences in seat inclination, mostly between 5。 and 45。, in all variables except FSR amplitude. It also indicated significant differences in food contents almost among all variables. Significant interactions between seat inclination and food contents were only found in FSR offsets. The same protocol will be applied to participants with disabilities. The results of this study would serve as clinical guidance for proper feeding positions with different food contents. The ergonomic data would also provide references for assistive technology professionals and practitioners in device design and development. In summary, the current results indicated that it is easier for a subject to lean backward during swallowing than when sitting upright and swallowing water is easier than swallowing pudding. The results of this study would serve as the clinical guidance for proper feeding position (such as wheelchair back angle adjustment) with different food contents. The same protocol can be applied to elderly participants or participants with physical disabilities. The ergonomic data would also provide references for assistive technology professionals and practitioners in device design and development.

Keywords: swallowing, positioning, assistive device, disability

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Authors: Ahmed Elaksher

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Over the last few years, significant progresses have been made and new approaches have been proposed for efficient collection of 3D spatial data from Unmanned aerial vehicles (UAVs) with reduced costs compared to imagery from satellite or manned aircraft. In these systems, a low-cost GPS unit provides the position, velocity of the vehicle, a low-quality inertial measurement unit (IMU) determines its orientation, and off-the-shelf cameras capture the images. Structure from Motion (SfM) and photogrammetry are the main tools for 3D surface reconstruction from images collected by these systems. Unlike traditional techniques, SfM allows the computation of calibration parameters using point correspondences across images without performing a rigorous laboratory or field calibration process and it is more flexible in that it does not require consistent image overlap or same rotation angles between successive photos. These benefits make SfM ideal for UAVs aerial mapping. In this paper, a direct comparison between SfM Digital Elevation Models (DEM) and those generated through traditional photogrammetric techniques was performed. Data was collected by a 3DR IRIS+ Quadcopter with a Canon PowerShot S100 digital camera. Twenty ground control points were randomly distributed on the ground and surveyed with a total station in a local coordinate system. Images were collected from an altitude of 30 meters with a ground resolution of nine mm/pixel. Data was processed with PhotoScan, VisualSFM, Imagine Photogrammetry, and a photogrammetric algorithm developed by the author. The algorithm starts with performing a laboratory camera calibration then the acquired imagery undergoes an orientation procedure to determine the cameras’ positions and orientations. After the orientation is attained, correlation based image matching is conducted to automatically generate three-dimensional surface models followed by a refining step using sub-pixel image information for high matching accuracy. Tests with different number and configurations of the control points were conducted. Camera calibration parameters estimated from commercial software and those obtained with laboratory procedures were comparable. Exposure station positions were within less than few centimeters and insignificant differences, within less than three seconds, among orientation angles were found. DEM differencing was performed between generated DEMs and few centimeters vertical shifts were found.

Keywords: UAV, photogrammetry, SfM, DEM

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Authors: Vanda Ferreira Ribeiro, Daiane Tomacheski, Douglas Naue Simões, Michele Pitto, Ruth Marlene Campomanes Santana

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Indoor environments, such as car cabins and public transportation vehicles are places where users are subject to air quality. Microorganisms (bacteria, fungi, yeasts) enter these environments through windows, ventilation systems and may use the organic particles present as a growth substrate. In addition, atmospheric pollutants can act as potential carbon and nitrogen sources for some microorganisms. Compounds base SEBS copolymers, poly(styrene-b-(ethylene-co-butylene)-b-styrene, are a class of thermoplastic elastomers (TPEs), fully recyclable and largely used in automotive parts. Metals, such as cooper and silver, have biocidal activities and the production of the SEBS compounds by melting blending with these agents can be a good option for producing compounds for use in plastic parts of ventilation systems and automotive air-conditioning, in order to minimize the problems caused by growth of pathogenic microorganisms. In this sense, the aim of this work was to evaluate the effect of copper microparticles as antimicrobial agent in compositions based on SEBS/PP/oil/calcite. Copper microparticles were used in weight proportion of 0%, 1%, 2% and 4%. The compounds were prepared using a co-rotating double screw extruder (L/D ratio of 40/1 and 16 mm screw diameter). The processing parameters were 300 rpm of screw rotation rate, with a temperature profile between 150 to 190°C. SEBS based TPE compounds were injection molded. The compounds emission were characterized by gravimetric fogging test. Compounds were characterized by physical (density and staining by contact), mechanical (hardness and tension properties) and rheological properties (melt volume rate – MVR). Antibacterial properties were evaluated against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) strains. To avaluate the abilities toward the fungi have been chosen Aspergillus niger (A. niger), Candida albicans (C. albicans), Cladosporium cladosporioides (C. cladosporioides) and Penicillium chrysogenum (P. chrysogenum). The results of biological tests showed a reduction on bacteria in up to 88% in E.coli and up to 93% in S. aureus. The tests with fungi showed no conclusive results because the sample without copper also demonstrated inhibition of the development of these microorganisms. The copper addition did not cause significant variations in mechanical properties, in the MVR and the emission behavior of the compounds. The density increases with the increment of copper in compounds.

Keywords: air conditioner, antimicrobial, cooper, SEBS

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Authors: Rim Frikha, Nouha Bouayed, Afifa Sellami, Nozha Chakroun, Salima Douad, Leila Keskes, Tarek Rebai

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Recurrent pregnancy loss (RPL), classically defined as the occurrence of two or more failed pregnancies, is a serious reproductive problem, in which, chromosomal rearrangements in either carrier are a major cause; mainly the chromosome aneuploidy. This study was conducted to determine the frequency and contribution of X-chromosome aneuploidy in recurrent pregnancy loss. A retrospective study was carried out among 100 couples with more than 2 miscarriages, referred to our genetic counseling. In all the cases the detailed reproductive histories were taken. Chromosomal analysis was performed using RHG banding in peripheral blood. Of a total of 100 couples; 3 patients with a detected X-chromosome aneuploidy were identified with an overall frequency of 3%. Chromosome abnormalities are as below: a Turner syndrome with 45, X/46, XX mosaicism, a 47, XXX, and a Klinefelter syndrome with 46, XY/47, XXY. These data show a high incidence of X-chromosome aneuploidy; mainly with mosaicism; in RPL. Thus, couples with such chromosomal abnormality should be referred to a clinical geneticist with whom the option of pre-implantation genetic diagnosis in subsequent pregnancy should be discussed.

Keywords: aneuploidy, genetic testing, recurrent pregnancy loss, X-chromosome

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Authors: Ilker Ali Ozkan

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In this study, an artificial neural network model has been developed to estimate chronic kidney failure which is a common disease. The patients’ age, their blood and biochemical values, and 24 input data which consists of various chronic diseases are used for the estimation process. The input data have been subjected to preprocessing because they contain both missing values and nominal values. 147 patient data which was obtained from the preprocessing have been divided into as 70% training and 30% testing data. As a result of the study, artificial neural network model with 25 neurons in the hidden layer has been found as the model with the lowest error value. Chronic kidney failure disease has been able to be estimated accurately at the rate of 99.3% using this artificial neural network model. The developed artificial neural network has been found successful for the estimation of chronic kidney failure disease using clinical data.

Keywords: estimation, artificial neural network, chronic kidney failure disease, disease diagnosis

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Authors: Usha Barahmand, Ali Khazaee, Goudarz Sadeghi Hashjin

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The purpose of this study is to assess the relative mediating effects of impulsivity and internalizing problems in the relationship between childhood neglect and motives for opiate use. Seventy-two adolescent opiate users were recruited for the study. Participants completed assessments of childhood abuse history, distress, impulsiveness and motives for substance use as well as a socio-demographic information sheet. Findings from bootstrap mediator analyses indicated that distress, but not impulsiveness, mediated the relationship between childhood emotional abuse and expansion and enhancement motives for substance use. The current study provides preliminary evidence that internalizing problems may function as a mechanism linking prior childhood experiences of emotional neglect to subsequent motives for substance use. Clinical implications of these findings suggest that targeting emotion dysregulation problems may be an effective adjunct in the treatment of adolescents with a history of childhood maltreatment that are at risk for substance use.

Keywords: childhood neglect, impulsiveness, internalizing problems, substance use motives

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Authors: Zulkifli Yusop

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The severity of December 2014 flood on the east coast of Peninsular Malaysia has raised concern over the adequacy of existing land use practices and policies. This article assesses flood responses to selective logging, plantation establishment (oil palm and rubber) and their subsequent management regimes. The hydrological impacts were evaluated on two levels: on-site (mostly in the upstream) and off-site to reflect the cumulative impact at downstream. Results of experimental catchment studies suggest that on-site impact of flood could be kept to a minimum when selecting logging strictly adhere to the existing guidelines. However, increases in flood potential and sedimentation rate were observed with logging intensity and slope steepness. Forest conversion to plantation show the highest impacts. Except on the heavily compacted surfaces, the ground revegetation is usually rapid within two years upon the cessation of the logging operation. The hydrological impacts of plantation opening and replanting could be significantly reduced once the cover crop has fully established which normally takes between three to six months after sowing. However, as oil palms become taller and the canopy gets closer, the cover crop tends to die off due to light competition, and its protecting function gradually diminishes. The exposed soil is further compacted by harvesting machinery which subsequently leads to greater overland flow and erosion rates. As such, the hydrological properties of matured oil palm plantations are generally poorer than in young plantation. In hilly area, the undergrowth in rubber plantation is usually denser compared to under oil palm. The soil under rubber trees is also less compacted as latex collection is done manually. By considering the cumulative effects of land-use over space and time, selective logging seems to pose the least impact on flood potential, followed by planting rubber for latex, oil palm and Latex Timber Clone (LTC). The cumulative hydrological impact of LTC plantation is the most severe because of its shortest replanting rotation (12 to 15 years) compared to oil palm (25 years) and rubber for latex (35 years). Furthermore, the areas gazetted for LTC are mostly located on steeper slopes which are more susceptible to landslide and erosion. Forest has limited capability to store excess rainfall and is only effective in attenuating regular floods. Once the hydrologic storage is exceeded, the excess rainfall will appear as flood water. Therefore, for big floods, rainfall regime has a much bigger influence than land use.

Keywords: selective logging, plantation, extreme rainfall, debris flow

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Authors: Roxana Maria Angelescu, Raluca Ion, Anişoara Cîmpean, Doina Răducanu, Mariana Lucia Angelescu

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In an attempt to find titanium alloys that fulfill the requirements for mechanical and biological compatibility, laboratory and material related tests were performed during the years, as well as preclinical and clinical trials. The multidisciplinary scientific research facilitates the global evaluation of biocompatibility and osseointegration regarding the dental implant alloys. The aim of this study was to determine the in vitro biocompatibility of three modern titanium alloys: Ti-31.7Nb-6.21Zr-1.4Fe-0.16O (wt%), Ti-36.5Nb-4.5Zr-3Ta-0.16O (wt%) and Ti-20Nb-5Ta (wt%), in order to establish whether the use of these titanium alloys can have any toxic or injurious effects on biological systems. The commonly used Ti-6Al-4V alloy was investigated as a reference material. The behavior of MC3T3-E1 pre-osteoblasts on all these four metallic surfaces was evaluated. The tests of immunofluorescence, cytotoxicity and cellular proliferation lead to the conclusion that the newly-developed titanium alloys elicit a good cellular response in terms of cellular survival, adhesion, morphology and proliferative potential as well.

Keywords: biocompatibility tests, dental implants, titanium alloys, biomedical engineering

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Authors: D. Estrella, A. Silva, R. Zapata, H. Rubio

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A total of 100 primary caregivers (mothers, fathers, grandparents) with at least one child or grandchild with a diagnosis of congenital bilateral profound deafness were assessed in order to evaluate the functionality of families with a deaf member, who was evaluated by specialists in audiology, molecular biology, genetics and psychology. After confirmation of the clinical diagnosis, DNA from the patients and parents were analyzed in search of the 35delG deletion of the GJB2 gene to determine who possessed the mutation. All primary caregivers were provided psychological support, regardless of whether or not they had the mutation, and prior and subsequent, the family APGAR test was applied. All parents, grandparents were informed of the results of the genetic analysis during the psychological intervention. The family APGAR, after psychological and genetic counseling, showed that 14% perceived their families as functional, 62% moderately functional and 24% dysfunctional. This shows the importance of psychological support in family functionality that has a direct impact on the quality of life of these families.

Keywords: deafness, psychological support, family, adaptation to disability

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Authors: M. G. Nasuruddin, S. Ishak

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This paper deals with the traditional Malay healing ritualistic ceremony known as Main Puteri. This non-invasive intervention uses the vehicle of performance to administer the healing process. It employs the performance elements of Makyung, that is, music, movements/dance, and dramatic dialogue to heal psychosomatic maladies. There are two perspectives to this therapeutic healing process, one traditional and the other scientific. From the traditional perspective, the psychosomatic illness is attributed to the infestations/possessions by malevolent spirits. To heal such patients, these spirits must be exorcised through placating them by making offerings. From the scientific perspective, the music (sonic orders), movements (kinetic energy), and smell (olfactory) connect with the brain waves to release the chemicals that would activate the internal healing energy. Currently, in Main Puteri, the therapeutic healing ritual is no longer relevant as modern clinical medicine has proven to be more effective. Thus, Main Puteri is an anachronism in today’s technologically advanced Malaysia.

Keywords: exorcism, main puteri, shamans, therapeutic healing

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Authors: Angelis P. Barlampas

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The aim of this work is to denote that during an emergency state, an examination study may not be accomplished by state-of-the-art of imaging and, therefore, cannot obviously reveal all the existing findings. But, such a situation may have disastrous consequences for the patient. When interpreting radiological images, one must try to be as meticulous as possible, especially if the patient has alerting clinical symptoms. A case may be missed because its findings are not so obvious in rapid uncompleted radiological imaging. A thirty-seven years old female patient visited the emergency department because of a headache and hemiparesis of her left leg. Firstly, a CT examination without contrast was done, and mild serpentinous hyperintensities were depicted at the right parietal lobe. In addition to that, there was a linear, mildly hyperattenuating structure resembling a vessel in the nearby middle line. At first, an AVM was suspected, so an MRI examination with i.v. Gd was prescribed. The patient returned a few days later, not having done the MRI and complaining of persisting symptomatology. A new CT examination without and with i.v.c administration was done that showed no hyperintensities but a type-enhancing vessel in the posterior interhemispheric fissure. The latest findings are consistent with a venous malformation with previous bleeding.

Keywords: bleeding, brain, CNS, hemorrhage, CT, venous malformation

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Authors: Ashish Thakur

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This technical paper was written in view of focusing the biomaterials and its various applications in modern industries. Author tires to elaborate not only the medical, infect plenty of application in other industries. The scope of the research area covers the wide range of physical, biological and chemical sciences that underpin the design of biomaterials and the clinical disciplines in which they are used. A biomaterial is now defined as a substance that has been engineered to take a form which, alone or as part of a complex system, is used to direct, by control of interactions with components of living systems, the course of any therapeutic or diagnostic procedure. Biomaterials are invariably in contact with living tissues. Thus, interactions between the surface of a synthetic material and biological environment must be well understood. This paper reviews the benefits and challenges associated with surface modification of the metals in biomedical applications. The paper also elaborates how the surface characteristics of metallic biomaterials, such as surface chemistry, topography, surface charge, and wettability, influence the protein adsorption and subsequent cell behavior in terms of adhesion, proliferation, and differentiation at the biomaterial–tissue interface. The chapter also highlights various techniques required for surface modification and coating of metallic biomaterials, including physicochemical and biochemical surface treatments and calcium phosphate and oxide coatings. In this review, the attention is focused on the biomaterial-associated infections, from which the need for anti-infective biomaterials originates. Biomaterial-associated infections differ markedly for epidemiology, aetiology and severity, depending mainly on the anatomic site, on the time of biomaterial application, and on the depth of the tissues harbouring the prosthesis. Here, the diversity and complexity of the different scenarios where medical devices are currently utilised are explored, providing an overview of the emblematic applicative fields and of the requirements for anti-infective biomaterials. In addition to this, chapter introduces nanomedicine and the use of both natural and synthetic polymeric biomaterials, focuses on specific current polymeric nanomedicine applications and research, and concludes with the challenges of nanomedicine research. Infection is currently regarded as the most severe and devastating complication associated to the use of biomaterials. Osteoporosis is a worldwide disease with a very high prevalence in humans older than 50. The main clinical consequences are bone fractures, which often lead to patient disability or even death. A number of commercial biomaterials are currently used to treat osteoporotic bone fractures, but most of these have not been specifically designed for that purpose. Many drug- or cell-loaded biomaterials have been proposed in research laboratories, but very few have received approval for commercial use. Polymeric nanomaterial-based therapeutics plays a key role in the field of medicine in treatment areas such as drug delivery, tissue engineering, cancer, diabetes, and neurodegenerative diseases. Advantages in the use of polymers over other materials for nanomedicine include increased functionality, design flexibility, improved processability, and, in some cases, biocompatibility.

Keywords: nanomedicine, tissue, infections, biomaterials

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Authors: Shuge Lei, Haonan Hu, Dasheng Sun, Huabin Zhang, Kehong Yuan, Jian Dai, Yan Tong

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It remains challenging to measure reliability from classification results from different machine learning models. This paper proposes a reliable soup optimization algorithm based on the model weight fusion algorithm Model Soup, aiming to improve reliability by using dual-channel reliability as the objective function to fuse a series of weights in the breast ultrasound classification models. Experimental results on breast ultrasound clinical datasets demonstrate that reliable soup significantly enhances the reliability of breast ultrasound image classification tasks. The effectiveness of the proposed approach was verified via multicenter trials. The results from five centers indicate that the reliability optimization algorithm can enhance the reliability of the breast ultrasound image classification model and exhibit low multicenter correlation.

Keywords: breast ultrasound image classification, feature attribution, reliability assessment, reliability optimization

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Authors: Emma Worley, Mhairi De Sainte Croix, Savneet Lochab, Christopher Roberts, Mark Stroud, Mo Salehan, Kevin Jones

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Awareness about the importance of teaching about diversity at medical school is growing. In the realm of diversity includes discussion around the LGBTQ+ community. At Bristol, diversity is taught in first or second year. However, echoing and expanding that teaching throughout the curriculum is needed. This feeds into the spiral curriculum but also highlights the relevance of the topic. It is well known that some people in the LGBTQ+ community struggle the access healthcare due to previous negative experiences. In 2019, 1 in 7 LGBTQ+ people avoided seeking medical care due to fears about discrimination. If people have fears about seeking medical help, then seeking help from Palliative care when they are at their most vulnerable situation can be even harder. To improve positive healthcare situations for people who identify as LGBTQ+ needs to start with talking. Along with some of our CTAs (clinical teaching assistants) we created a teaching session to explore the barriers faced by LGBTQ+ and incorporated communication stations into this. Our plan is to run this session as a three-hour session first discussing different topics: ethnical diversity, ‘coming out’, LGBTQ+ in the older generation, transgender. This will be followed by looking more closely at the barriers to accessing the hospice. The next part of the session will encompass two or three communication scenarios hopefully prompting further discussion and reflection on ways to improve our communication. The first scenario outline is a gay man/lesbian woman with lung cancer discussing options around the hospice. The second scenario is a transgender person with female genitalia who now has cervical cancer (as was not followed up on pap smears after the change of name). The third scenario is a HIV homosexual male patient who has been admitted with dementia. He has a partner but is not married. His next of kin is down as his parents but his parents do not know about his sexuality and HIV status. It allows discussion around confidentiality as well as broaching the meaning of ‘family’ in the LGBTQ+ community. We have chosen to pitch this teaching session to Bristol Year 4 students. They will be currently doing their 6-week Palliative care block, which fits in well. Each session will have four students attend. We have been lucky enough to have two CTAs (clinical teaching assistants) who identify as LGBTQ+ offer their experiences and help. They have been able to help us with the preparation and delivery of the session. Given anecdotal evidence and stories helps to highlight the importance and relevance of this session. The aim is to increase awareness of some factors that may contribute to people who identify as LGBTQ+ having a negative healthcare experience. By starting to talk about it allows awareness and only then will we be able to start to change and improve. Our aim, if the sessions run well, is to expand these sessions to different academy hospitals. Therefore, all Bristol 4th year students would have the opportunity to take part in the teaching session. We would like to expand our portfolio of case scenarios, to address so tricker topics such as a transgender person with dementia who reverts back to a different gender. We would also like to recruit a diverse range of actors, ideally people who identify as the patient in the scenario does. For example, a transgender person acts the transgender scenario. This would give authenticity and enhance the student’s learning experience.

Keywords: communication skills, healthcare barriers, LGBTQ+, palliative care

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Authors: Amanda Coleman, Estefanía Gonzalez

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Empathy is considered an essential skill for engaging with social work clients. Drawing from developments in medical education, researchers will conduct and evaluate a three-part pilot theatre workshop with master level social work students (n ≈ 30) to evaluate the workshop's ability to enhance empathy among participants. Outcomes will be measured using semi-structured post-intervention interviews with a subset of participants (n ≈ 10) as well post-intervention written reflections and pre-and-post intervention quantitative evaluation of empathy using King and Holosko’s 2011 Empathy Scale for Social Workers. The content of the workshop will differ from traditional role plays, which are common in social work education, in that it will draw from role theory and research on creative empathy to emphasize role reversal with clients. Workshops will be held February and March of 2017 with preliminary findings available by April.

Keywords: education, empathy, social work, theatre

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Authors: Kourosh Fatehi, Niloofar Hanafi

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One of the challenges in providing optimal prosthetic legs for lower limb amputees is to select the appropriate foot stiffness that suits their individual needs and preferences. Foot stiffness affects various aspects of walking, such as stability, comfort, and energy expenditure. However, the current prescription process is largely based on trial-and-error, manufacturer recommendations, or clinician judgment, which may not reflect the prosthesis user’s subjective experience or psychophysical sensitivity. Therefore, there is a need for more scientific and technological tools to measure and understand how prosthesis users perceive and prefer different foot stiffness levels, and how this preference relates to clinical outcomes. This review covers how to measure and design lower leg prostheses based on user preference and foot stiffness. It also explores how these factors affect walking outcomes and quality of life, and identifies the current challenges and gaps in this field from a mechanical engineering standpoint.

Keywords: perception, preference, prosthetics, stiffness

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