Search results for: clinical interpretation

Authors: Zhao Jiashen, Serene Goh, Jerry Goo, Anthony Li, Lim Woan Wui, Paul Drakeford, Chen Qing Yan

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Introduction: Emergency laparotomy (EL) is one of the most common surgeries done in Singapore to treat acute abdominal pathologies. A significant proportion of these surgeries are performed in the geriatric population (65 years and older), who tend to have the highest postoperative morbidity, mortality, and highest utilization of intensive care resources. Frailty, the state of vulnerability to adverse outcomes from an accumulation of physiological deficits, has been shown to be associated with poorer outcomes after surgery and remains a strong driver of healthcare utilization and costs. To date, there is little understanding of the impact it has on emergency laparotomy outcomes. The objective of this study is to examine the impact of frailty on postoperative morbidity, mortality, and length of stay after EL. Methods: A retrospective study was conducted in two tertiary centres in Singapore, Tan Tock Seng Hospital and Khoo Teck Puat Hospital the period from January to December 2019. Patients aged 65 years and above who underwent emergency laparotomy for intestinal obstruction, perforated viscus, bowel ischaemia, adhesiolysis, gastrointestinal bleed, or another suspected acute abdomen were included. Laparotomies performed for trauma, cholecystectomy, appendectomy, vascular surgery, and non-GI surgery were excluded. The Clinical Frailty Score (CFS) developed by the Canadian Study of Health and Aging (CSHA) was used. A score of 1 to 4 was defined as non-frail and 5 to 7 as frail. We compared the clinical outcomes of elderly patients in the frail and non-frail groups. Results: There were 233 elderly patients who underwent EL during the study period. Up to 26.2% of patients were frail. Patients who were frail (CFS 5-9) tend to be older, 79 ± 7 vs 79 ± 5 years of age, p <0.01. Gender distribution was equal in both groups. Indication for emergency laparotomies, time from diagnosis to surgery, and presence of consultant surgeons and anaesthetists in the operating theatre were comparable (p>0.05). Patients in the frail group were more likely to receive postoperative geriatric assessment than in the non-frail group, 49.2% vs. 27.9% (p<0.01). The postoperative complications were comparable (p>0.05). The length of stay in the critical care unit was longer for the frail patients, 2 (IQR 1-6.5) versus 1 (IQR 0-4) days, p<0.01. Frailty was found to be an independent predictor of 90-day mortality but not age, OR 2.9 (1.1-7.4), p=0.03. Conclusion: Up to one-fourth of the elderly who underwent EL were frail. Patients who were frail were associated with a longer length of stay in the critical care unit and a 90-day mortality rate of more than three times that of their non-frail counterparts. PPOSSUM was a better predictor of 90-day mortality in the non-frail group than in the frail group. As frailty scoring was a significant predictor of 90-day mortality, its integration into acute surgical units to facilitate shared decision-making and discharge planning should be considered.

Keywords: frailty elderly, emergency, laparotomy

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Authors: Umair Shoukat Ali, Rashna Hoshang Sukhia, Mubassar Fida

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Introduction: The objective of the study was to compare outcomes in terms of Bleeding index (BI), Gingival Index (GI), and Orthodontic Plaque Index (OPI) with video graphics and plaque disclosing tablets (PDT) versus verbal instructions in adult orthodontic patients undergoing fixed appliance treatment (FAT). Materials and Methods: Adult orthodontic patients have recruited from outpatient orthodontic clinics who fulfilled the inclusion criteria and were randomly allocated to three groups i.e., video, PDT, and verbal groups. We included patients undergoing FAT for six months of both genders with all teeth bonded mesial to first molars having no co-morbid conditions such as rheumatic fever and diabetes mellitus. Subjects who had gingivitis as assessed by Bleeding Index (BI), Gingival Index (GI), and Orthodontic Plaque Index (OPI) were recruited. We excluded subjects having > 2 mm of clinical attachment loss, pregnant and lactating females, any history of periodontal therapy within the last six months, and any consumption of antibiotics or anti-inflammatory drugs within the last one month. Pre- and post-interventional measurements were taken at two intervals only for BI, GI, and OPI. The primary outcome of this trial was to evaluate the mean change in the BI, GI, and OPI in the three study groups. A computer-generated randomization list was used to allocate subjects to one of the three study groups using a random permuted block sampling of 6 and 9 to randomize the samples. No blinding of the investigator or the participants was performed. Results: A total of 99 subjects were assessed for eligibility, out of which 96 participants were randomized as three of the participants declined to be part of this trial. This resulted in an equal number of participants (32) that were analyzed in all three groups. The mean change in the oral hygiene indices score was assessed, and we found no statistically significant difference among the three interventional groups. Pre- and post-interventional results showed statistically significant improvement in the oral hygiene indices for the video and PDT groups. No statistically significant difference for age, gender, and education level on oral hygiene indices were found. Simple linear regression showed that the video group produced significantly higher mean OPI change as compared to other groups. No harm was observed during the trial. Conclusions: Visual aids performed better as compared to the verbal group. Gender, age, and education level had no statistically significant impact on the oral hygiene indices. Longer follow-ups will be required to see the long-term effects of these interventions. Trial Registration: NCT04386421 Funding: Aga Khan University and Hospital (URC 183022)

Keywords: oral hygiene, orthodontic treatment, adults, randomized clinical trial

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Authors: Faiz Bakhsh, Tahira Yasmeen

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The Afghan refugee children in Pakistan are considered as the most vulnerable persons in danger of being abused and treated badly as compared to the minimum criteria of the protection of refugee children under 1951 refugee convention. This paper explores the impact of the 1951 refugee convention on the protection of refugee children, affected by the armed conflict in Afghanistan, residing in refugee camps in Pakistan. Despite, protection available under Refugee Convention, there exist millions of refugees in the world, including a huge portion of women and children, that remain unprotected, and their protection remains a challenging task for the world community. This study investigates the status and number of refugees in Pakistan, especially children; protection and assistance of refugees under Refugee Convention; protection of the rights of refugee children in Pakistan; and implementation of the rules of Refugee Convention relating refugee children in Pakistan and measures for the protection of refugee children in Pakistan. This socio-legal study utilizes a qualitative research approach and applies mixed methods of data collection. The primary data is collected through the interpretation of the legal framework available for the protection of refugees as well as domestic laws of Pakistan. The secondary data is collected through previous studies available on the same topic. The result of this study indicates that lack of proper implementation of the rules, of the Refugee Convention, relating protection of refugee children cause sufferings to refugee children including the provision of basic health, nutrition, family life, education and protection from child abuse. Pakistan needs a comprehensive domestic legal framework for the protection of refugees, especially refugee children. Moreover, the government of Pakistan with the help of the United Nations High Commissioner for Refugees (UNHCR) must prioritize the protection of Afghan refugee children as per standard criteria provided by the refugee convention 1951.

Keywords: refugee children, refugee convention, armed conflict, Pakistan

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Authors: Christina Klippel, Lucia Pezzi, Silvio Neto, Rafael Bertani, Priscila Mendes, Flavio Machado, Aline Szeliga, Maria Cosendey, Adilson Mariz, Raquel Santos, Lys Bendett, Pedro Velasco, Thalita Rolleigh, Bruna Bellote, Daria Coelho, Bruna Martins, Julia Almeida, Juliana Cerqueira

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This project presents a framework for teaching intracranial pressure monitoring (ICP) concepts using a low-cost experimental model in a neurointensive care education program. Data concerning ICP monitoring contribute to the patient's clinical assessment and may dictate the course of action of a health team (nursing, medical staff) and influence decisions to determine the appropriate intervention. This study aims to present a safe method for teaching ICP monitoring to medical students in a Simulation Center. Methodology: Medical school teachers, along with students from the 4th year, built an experimental model for teaching ICP measurement. The model consists of a mannequin's head with a plastic bag inside simulating the cerebral ventricle and an inserted ventricular catheter connected to the ICP monitoring system. The bag simulating the ventricle can also be changed for others containing bloody or infected simulated cerebrospinal fluid. On the mannequin's ear, there is a blue point indicating the right place to set the "zero point" for accurate pressure reading. The educational program includes four steps: 1st - Students receive a script on ICP measurement for reading before training; 2nd - Students watch a video about the subject created in the Simulation Center demonstrating each step of the ICP monitoring and the proper care, such as: correct positioning of the patient, anatomical structures to establish the zero point for ICP measurement and a secure range of ICP; 3rd - Students train the procedure in the model. Teachers help students during training; 4th - Student assessment based on a checklist form. Feedback and correction of wrong actions. Results: Students expressed interest in learning ICP monitoring. Tests concerning the hit rate are still being performed. ICP's final results and video will be shown at the event. Conclusion: The study of intracranial pressure measurement based on an experimental model consists of an effective and controlled method of learning and research, more appropriate for teaching neurointensive care practices. Assessment based on a checklist form helps teachers keep track of student learning progress. This project offers medical students a safe method to develop intensive neurological monitoring skills for clinical assessment of patients with neurological disorders.

Keywords: neurology, intracranial pressure, medical education, simulation

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Authors: Neha P. Amin, Maliha Zainib, Sean Parker, Malcolm Mattes

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Purpose/Objectives: Combination immunotherapy (IT) and radiation therapy (RT) is an actively growing field of clinical investigation due to promising findings of synergistic effects from immune-mediated mechanisms observed in preclinical studies and clinical data from case reports of abscopal effects. While there are many ongoing trials of combined IT-RT, there are still limited data on toxicity and outcome optimization regarding RT dose, fractionation, and sequencing of RT with IT. Nivolumab (NIVO), an anti-PD-1 monoclonal antibody, has been rapidly adopted in the clinic over the past 2 years, resulting in more patients being considered for concurrent RT-NIVO. Knowledge about the toxicity profile of combined RT-NIVO is important for both the patient and physician when making educated treatment decisions. The acute toxicity profile of concurrent RT-NIVO was analyzed in this study. Materials/Methods: A retrospective review of all consecutive patients who received NIVO from 1/2015 to 5/2017 at 4 separate centers within two separate institutions was performed. Those patients who completed a course of RT from 1 day prior to initial NIVO infusion through 1 month after last NIVO infusion were considered to have received concurrent therapy and included in the subsequent analysis. Descriptive statistics are reported for patient/tumor/treatment characteristics and observed acute toxicities within 3 months of RT completion. Results: Among 261 patients who received NIVO, 46 (17.6%) received concurrent RT to 67 different sites. The median f/u was 3.3 (.1-19.8) months, and 11/46 (24%) were still alive at last analysis. The most common histology, RT prescription, and treatment site included non-small cell lung cancer (23/46, 50%), 30 Gy in 10 fractions (16/67, 24%), and central thorax/abdomen (26/67, 39%), respectively. 79% (53/67) of irradiated sites were treated with 3D-conformal technique and palliative dose-fractionation. Grade 3, 4, and 5 toxicities were experienced by 11, 1, and 2 patients, respectively. However all grade 4 and 5 toxicities were outside of the irradiated area and attributed to the NIVO alone, and only 4/11 (36%) of the grade 3 toxicities were attributed to the RT-NIVO. The irradiated site in these cases included the brain [2/10 (20%)] and central thorax/abdomen [2/19 (10.5%)], including one unexpected grade 3 pancreatitides following stereotactic body RT to the left adrenal gland. Conclusions: Concurrent RT-NIVO is generally well tolerated, though with potentially increased rates of severe toxicity when irradiating the lung, abdomen, or brain. Pending more definitive data, we recommend counseling patients on the potentially increased rates of side effects from combined immunotherapy and radiotherapy to these locations. Future prospective trials assessing fractionation and sequencing of RT with IT will help inform combined therapy recommendations.

Keywords: combined immunotherapy and radiation, immunotherapy, Nivolumab, toxicity of concurrent immunotherapy and radiation

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Authors: Natasha Venter

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Recent publications, including Truth to Power by André de Ruyter, Gangster State by Pieter-Louis Myburgh, and Enemy of the People by Pieter du Toit and Adriaan Basson, expose alleged corrupt acts by high-ranking members of State, as well as those in charge of State-owned entities. These literary contributions have gripped the attention of a nation plagued by corruption scandals and the alleged misappropriation of state funds on an almost daily basis. The books, however, leave the populace with the burning question of why “nothing happens” to these individuals who are so directly implicated in the literature. The process followed by the State in the largest successful prosecution of a corrupt state official, Jackie Selebi, sheds some light as to how such high-ranking persons might be brought to book. The Supreme Court of Appeal’s definition of corruption and the interpretation of the facts (as presented by the State prosecutors) by the court is also valuable. Furthermore, some insight into the laws that criminalise corruption in South Africa, as well as applicable international instruments, is necessary. South Africa is ranked as the 70th most corrupt country out of 180 countries by Transparency International’s 2021 Corruption Perceptions Index. This is worrisome as South Africa is a signatory of the United Nations Convention Against Corruption (2004) and, as such, has certain international obligations to fulfil. However, if the political will to prosecute corrupt officials in South Africa exists, there are laws and instruments available to punish these individuals. This would not only vindicate the authors of literature about corruption in the country but also restore the hope of South Africans that, ultimately, crime does not pay.

Keywords: corruption, eskom, state capture, government, literature, united nations, law, legal, Jackie selebi, supreme court of appeal

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Authors: Julianne Mullen-Williams

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This paper will provide an overview of a three year mixed methods research project that explores if methods from the supervision of dramatherapy can augment the occupational psychology of newly qualified secondary school teachers. It will consider how creativity and the use of metaphor, as applied in the supervision of dramatherapists, can be translated to an educational context in order to explore the explicit / implicit dynamics between the teacher trainee/ newly qualified teacher and the organisation in order to support the super objective in training for teaching; how to ‘be a teacher.’ There is growing evidence that attrition rates among teachers are rising after only five years of service owing to too many national initiatives, an unmanageable curriculum and deteriorating student discipline. The fieldwork conducted entailed facilitating a reflective space for Newly Qualified Teachers from all subject areas, using methods from the supervision of dramatherapy, to explore the social and emotional aspects of teaching and learning with the ultimate aim of improving the occupational psychology of teachers. Clinical supervision is a formal process of professional support and learning which permits individual practitioners in frontline service jobs; counsellors, psychologists, dramatherapists, social workers and nurses to expand their knowledge and proficiency, take responsibility for their own practice, and improve client protection and safety of care in complex clinical situations. It is deemed integral to continued professional practice to safeguard vulnerable people and to reduce practitioner burnout. Dramatherapy supervision incorporates all of the above but utilises creative methods as a tool to gain insight and a deeper understanding of the situation. Creativity and the use of metaphor enable the supervisee to gain an aerial view of the situation they are exploring. The word metaphor in Greek means to ‘carry across’ indicating a transfer of meaning form one frame of reference to another. The supervision support was incorporated into each group’s induction training programme. The first year group attended fortnightly one hour sessions, the second group received two one hour sessions every term. The existing literature on the supervision and mentoring of secondary school teacher trainees calls for changes in pre-service teacher education and in the induction period. There is a particular emphasis on the need to include reflective and experiential learning, within training programmes and within the induction period, in order to help teachers manage the interpersonal dynamics and emotional impact within a high pressurised environment

Keywords: dramatherapy supervision, newly qualified secondary school teachers, professional development, teacher education

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Authors: Kristina De Milt, Nicole Huang, Jihye Park

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Opioids have been a mainstay of the treatment of chronic pain, but their overprescription and misuse have led to an opioid epidemic. Recently, as an attempt to decrease the number of opioids prescribed, the use of cannabinoid therapy has become an increasingly popular adjunctive chronic pain management choice among providers. This review of literature investigates the effects of adjunctive cannabinoids to opioids in the management of chronic pain. The nine articles are included in the literature review range from observational studies to meta-analyses published in the year 2016 and after. A majority of the studies showed a decrease in the need for opioids after adjunctive cannabinoids were introduced and, in some instances, the cessation of opioid consumption. More high-quality evidence is needed to further support this stance and providers should weigh the benefits and risks of adjunctive cannabinoids according to the clinical picture.

Keywords: cannabis, chronic pain, opioids, pain management

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Authors: Osman Turkoglu, Alvin Estilo, Ritu Gupta, Liliam Pineda-Salgado, Rajesh Pandey

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Background: Hepatotoxicity can be linked to a variety of clinical symptoms and histopathological signs, posing a great challenge in the surveillance of suspected drug-induced liver injury (DILI) cases in the safety database. Additionally, the majority of such cases are rare, idiosyncratic, highly unpredictable, and tend to demonstrate unique individual susceptibility; these qualities, in turn, lend to a pharmacovigilance monitoring process that is often tedious and time-consuming. Objective: Develop a multifactorial algorithm to assist pharmacovigilance physicians in identifying high-risk hepatotoxicity cases associated with DILI from the sponsor’s safety database (Argus). Methods: Multifactorial selection criteria were established using Structured Query Language (SQL) and the TIBCO Spotfire® visualization tool, via a combination of word fragments, wildcard strings, and mathematical constructs, based on Hy’s law criteria and pattern of injury (R-value). These criteria excluded non-eligible cases from monthly line listings mined from the Argus safety database. The capabilities and limitations of these criteria were verified by comparing a manual review of all monthly cases with system-generated monthly listings over six months. Results: On an average, over a period of six months, the algorithm accurately identified 92% of DILI cases meeting established criteria. The automated process easily compared liver enzyme elevations with baseline values, reducing the screening time to under 15 minutes as opposed to multiple hours exhausted using a cognitively laborious, manual process. Limitations of the algorithm include its inability to identify cases associated with non-standard laboratory tests, naming conventions, and/or incomplete/incorrectly entered laboratory values. Conclusions: The newly developed multifactorial algorithm proved to be extremely useful in detecting potential DILI cases, while heightening the vigilance of the drug safety department. Additionally, the application of this algorithm may be useful in identifying a potential signal for DILI in drugs not yet known to cause liver injury (e.g., drugs in the initial phases of development). This algorithm also carries the potential for universal application, due to its product-agnostic data and keyword mining features. Plans for the tool include improving it into a fully automated application, thereby completely eliminating a manual screening process.

Keywords: automation, drug-induced liver injury, pharmacovigilance, post-marketing

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Authors: N. Garrós, P. Bustos, N. Beirampour, R. Mohammadi, M. Mallandrich, A.C. Calpena, H. Colom

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Atopic dermatitis (AD) is a persistent skin condition characterized by chronic inflammation caused by an autoimmune response. It is a prevalent clinical issue that requires continual treatment to enhance the patient's quality of life. Systemic therapy often involves the use of glucocorticoids or immunosuppressants to manage symptoms. Our objective was to create and assess topical liposomal formulations containing Baricitinib (BNB), a reversible inhibitor of Janus-associated kinase (JAK), which is involved in various immune responses. These formulations were intended to address flare-ups and improve treatment outcomes for AD. We created three distinct liposomal formulations by combining different amounts of 1-palmitoyl-2-oleoyl-glycero-3-phosphocholine (POPC), cholesterol (CHOL), and ceramide (CER): (i) pure POPC, (ii) POPC mixed with CHOL (at a ratio of 8:2, mol/mol), and (iii) POPC mixed with CHOL and CER (at a ratio of 3.6:2.4:4.0 mol/mol/mol). We conducted various tests to determine the formulations' skin tolerance, irritancy capacity, and their ability to cause erythema and edema on altered skin. We also assessed the transepidermal water loss (TEWL) and skin hydration of rabbits to evaluate the efficacy of the formulations. Histological analysis, the HET-CAM test, and the modified Draize test were all used in the evaluation process. The histological analysis revealed that liposome POPC and POPC:CHOL avoided any damage to the tissues structures. The HET-CAM test showed no irritation effect caused by any of the three liposomes, and the modified Draize test showed a good Draize score for erythema and edema. Liposome POPC effectively counteracted the impact of xylol on the skin, and no erythema or edema was observed during the study. TEWL values were constant for all the liposomes with similar values to the negative control (within the range 8 - 15 g/h·m2, which means a healthy value for rabbits), whereas the positive control showed a significant increase. The skin hydration values were constant and followed the trend of the negative control, while the positive control showed a steady increase during the tolerance study. In conclusion, the developed formulations containing BNB exhibited no harmful or irritating effects, they did not demonstrate any irritant potential in the HET-CAM test and liposomes POPC and POPC:CHOL did not cause any structural alteration according to the histological analysis. These positive findings suggest that additional research is necessary to evaluate the efficacy of these liposomal formulations in animal models of the disease, including mutant animals. Furthermore, before proceeding to clinical trials, biochemical investigations should be conducted to better understand the mechanisms of action involved in these formulations.

Keywords: baricitinib, HET-CAM test, histological study, JAK inhibitor, liposomes, modified draize test

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Authors: Peter J. Riley

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Medical Imaging students must understand the roles of Photo-electric Absorption (PE) and Compton Scatter (CS) interactions in patients to enable optimal X-ray imaging in clinical practice. A simulator has been developed that shows relative interaction probabilities, color bars for patient dose from PE, % penetration to the detector, and obscuring CS as Peak Kilovoltage (kVp) changes. Additionally, an anthropomorphic chest X-ray image shows the relative tissue contrasts and overlying CS-fog at that kVp, which determine the detectability of a lesion in the image. A series of interactive exercises with MCQs evaluate the student's understanding; the simulation has improved student perception of the need to acquire "sufficient" rather than maximal contrast to enable patient dose reduction at higher kVp.

Keywords: patient dose optimization, radiological physics, simulation, tissue contrast

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Authors: Nitin Shravan, Sudarsun Santhiappan, B. Sivaselvan

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Subsection identification, in the context of Electronic Health Records (EHRs), is identifying the important sections for down-stream tasks like auto-coding. In this work, we classify the text present in EHRs according to their information, using machine learning and deep learning techniques. We initially describe briefly about the problem and formulate it as a text classification problem. Then, we discuss upon the methods from the literature. We try two approaches - traditional feature extraction based machine learning methods and deep learning methods. Through experiments on a private dataset, we establish that the deep learning methods perform better than the feature extraction based Machine Learning Models.

Keywords: deep learning, machine learning, semantic clinical classification, subsection identification, text classification

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Authors: P. J. Sweeney, T. Ahtoniemi, J. Puoliväli, T. Laitinen, K.Lehtimäki, A. Nurmi, D. Wells

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Duchenne muscular dystrophy (DMD) is an X-linked, lethal muscle wasting disease for which there are currently no treatment that effectively prevents the muscle necrosis and progressive muscle loss. DMD is among the most common of inherited diseases affecting around 1/3500 live male births. MDX (X-linked muscular dystrophy) mice only partially encapsulate the disease in humans and display weakness in muscles, muscle damage and edema during a period deemed the “critical period” when these mice go through cycles of muscular degeneration and regeneration. Although the MDX mutant mouse model has been extensively studied as a model for DMD, to-date an extensive temporal, non-invasive imaging profile that utilizes magnetic resonance imaging (MRI) and 1H-magnetic resonance spectroscopy (1H-MRS) has not been performed.. In addition, longitudinal imaging characterization has not coincided with attempts to exacerbate the progressive muscle damage by exercise. In this study we employed an 11.7 T small animal MRI in order to characterize the MRI and MRS profile of MDX mice longitudinally during a 12 month period during which MDX mice were subjected to exercise. Male mutant MDX mice (n=15) and male wild-type mice (n=15) were subjected to a chronic exercise regime of treadmill walking (30 min/ session) bi-weekly over the whole 12 month follow-up period. Mouse gastrocnemius and tibialis anterior muscles were profiled with baseline T2-MRI and 1H-MRS at 6 weeks of age. Imaging and spectroscopy was repeated again at 3 months, 6 months, 9 months and 12 months of age. Plasma creatine kinase (CK) level measurements were coincided with time-points for T2-MRI and 1H-MRS, but also after the “critical period” at 10 weeks of age. The results obtained from this study indicate that chronic exercise extends dystrophic phenotype of MDX mice as evidenced by T2-MRI and1H-MRS. T2-MRI revealed extent and location of the muscle damage in gastrocnemius and tibialis anterior muscles as hyperintensities (lesions and edema) in exercised MDX mice over follow-up period.. The magnitude of the muscle damage remained stable over time in exercised mice. No evident fat infiltration or cumulation to the muscle tissues was seen at any time-point in exercised MDX mice. Creatine, choline and taurine levels evaluated by 1H-MRS from the same muscles were found significantly decreased in each time-point, Extramyocellular (EMCL) and intramyocellular lipids (IMCL) did not change in exercised mice supporting the findings from anatomical T2-MRI scans for fat content. Creatine kinase levels were found to be significantly higher in exercised MDX mice during the follow-up period and importantly CK levels remained stable over the whole follow-up period. Taken together, we have described here longitudinal prophile for muscle damage and muscle metabolic changes in MDX mice subjected to chronic exercised. The extent of the muscle damage by T2-MRI was found to be stable through the follow-up period in muscles examined. In addition, metabolic profile, especially creatine, choline and taurine levels in muscles, was found to be sustained between time-points. The anatomical muscle damage evaluated by T2-MRI was supported by plasma CK levels which remained stable over the follow-up period. These findings show that non-invasive imaging and spectroscopy can be used effectively to evaluate chronic muscle pathology. These techniques can be also used to evaluate the effect of various manipulations, like here exercise, on the phenotype of the mice. Many of the findings we present here are translatable to clinical disease, such as decreased creatine, choline and taurine levels in muscles. Imaging by T2-MRI and 1H-MRS also revealed that fat content or extramyocellar and intramyocellular lipids, respectively, are not changed in MDX mice, which is in contrast to clinical manifestation of the Duchenne’s muscle dystrophy. Findings show that non-invasive imaging can be used to characterize the phenotype of a MDX model and its translatability to clinical disease, and to study events that have traditionally been not examined, like here rigorous exercise related sustained muscle damage after the “critical period”. The ability for this model to display sustained damage beyond the spontaneous “critical period“ and in turn to study drug effects on this extended phenotype will increase the value of the MDX mouse model as a tool to study therapies and treatments aimed at DMD and associated diseases.

Keywords: 1H-MRS, MRI, muscular dystrophy, mouse model

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Authors: Ezgiamn Abraha Hagos

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Higher education is important for college students to develop their authentic identity by means of getting exposure to diverse ideas and experiences. However, current college students are not successfully achieving a satisfying sense of meaning and purpose in their lives, which often places them in a state of existential vacuum. Thus, this study uncovers the existential concerns of youth in higher education by means of assessing their view on meaningful life and integration of it as a guide into their lives and challenges faced in doing so. Data were procured from thirty undergraduate students of Addis Ababa University, Ethiopia via interview, naïve sketch method, and content analysis of selected magazines and newspapers. Data were analyzed using organization, immersion, generating themes, coding, offering interpretation as well as checking the data. Relationship, education, and belief were found to be main sources of meaning. But, many of the study participants failed to articulate their meaning in life explicitly and identified to be in a state of drifting. Moreover, hopelessness, economic problems and quality of training impinge their sense of meaning in life negatively. The content analysis principally embodied the youth in higher education as a group of people confronted with rafts of challenges such as debauchery, moral crisis, self-destructive behaviors and hankering for support and direction. Thus, crafting the asset-based approach and counseling services that will prepare the youth for the future and develop holistically in terms of body and mind are tremendously vital.

Keywords: higher education institutions; meaning in life; youth

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Authors: Harshit Mittal, Neeraj Garg

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Hand symbol recognition is a pivotal component in the domain of computer vision, with far-reaching applications spanning sign language interpretation, human-computer interaction, and accessibility. This research paper discusses the approach with the integration of the Canny Edge algorithm and convolutional neural network. The significance of this study lies in its potential to enhance communication and accessibility for individuals with hearing impairments or those engaged in gesture-based interactions with technology. In the experiment mentioned, the data is manually collected by the authors from the webcam using Python codes, to increase the dataset augmentation, is applied to original images, which makes the model more compatible and advanced. Further, the dataset of about 6000 coloured images distributed equally in 5 classes (i.e., 1, 2, 3, 4, 5) are pre-processed first to gray images and then by the Canny Edge algorithm with threshold 1 and 2 as 150 each. After successful data building, this data is trained on the Convolutional Neural Network model, giving accuracy: 0.97834, precision: 0.97841, recall: 0.9783, and F1 score: 0.97832. For user purposes, a block of codes is built in Python to enable a window for hand symbol recognition. This research, at its core, seeks to advance the field of computer vision by providing an advanced perspective on hand sign recognition. By leveraging the capabilities of the Canny Edge algorithm and convolutional neural network, this study contributes to the ongoing efforts to create more accurate, efficient, and accessible solutions for individuals with diverse communication needs.

Keywords: hand symbol recognition, computer vision, Canny edge algorithm, convolutional neural network

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Authors: Waleed El-Said Abou El-Amaiem

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Sole hemorrhages are considered as a main cause for sub clinical laminitis. In this study we aimed at discussing the most prominent risk factors associated with sole hemorrhages causing lameness in Egyptian water buffaloes and native breed cows. The final multivariate logistic regression model showed, a significant association between sub acute ruminal acidosis (P< 0.05), limb affected (P< 0.05) and weight (P< 0.05) and sole hemorrhages causing lameness in Egyptian water buffaloes and native breed cows. According to our knowledge, this is the first paper to discuss the risk factors associated with sole hemorrhages causing lameness in Egyptian water buffaloes and native breed cows.

Keywords: lameness, buffalo, sole hemorrhages, breed cows

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Authors: Belal Neazi

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'Larger Houses Consume More Resources’ – both in construction and during operation. The most important aspect of smaller homes is that it uses less electricity and fuel for construction and maintenance. Here, an urban interpretation of the contemporary minimal existence movement is explained. In an attempt to restrict urban decay and to encourage inner-city renewal, the Tiny House principles are interpreted as alternative ways of dwelling in urban neighbourhoods. These tiny houses are usually pretty different from each other in interior planning, but almost similar in size. The disadvantage of large homes came up when people were asked to vacate as they were not able to pay the massive amount of mortgages. This made them reconsider their housing situation and discover the ideas of minimalism and the general rising inclination in environmental awareness that serve as the basis for the tiny house movement. One of the largest benefits of inhabiting a tiny house is the decrease in carbon footprint. Also, to increase social behaviour and freedom. It’s better for the environmental concern, financial concerns, and desire for more time and freedom. Examples of the tiny house village which are sustaining homeless population and the use of different reclaimed materials for the construction of these tiny houses are explained in the paper. It is proposed in the paper, that these houses will reflect the diversity while proposing an alternative model for the rehabilitation of decaying row-homes and the renewal of fading communities. The core objective is to design small or micro spaces for the economically backward people of the place and increase their social behaviour and freedom. Also, it’s better for the environmental concern, financial concerns, and desire for more time and freedom.

Keywords: city renewal, environmental concern, micro-living, tiny house

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Authors: Sofia Papadimitriou

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INTRODUCTION: The differential diagnosis between acute viral and bacterial infections is an important cost-effectiveness parameter at the stage of the treatment process in order to achieve the maximum benefits in therapeutic intervention by combining the minimum cost to ensure the proper use of antibiotics.The discovery of sensitive and robust molecular diagnostic tests in response to the role of the host in infections has enhanced the accurate diagnosis and differentiation of infections. METHOD: The study used a sample of six independent blood samples (total=756) which are associated with human proteins-proteins, each of which at the transcription stage expresses a different response in the host network between viral and bacterial infections.Τhe individual blood samples are subjected to a sequence of computer filters that identify a gene panel corresponding to an autonomous diagnostic score. The data set and the correspondence of the gene panel to the diagnostic patents a new Bangalore -Viral Bacterial (BL-VB). FINDING: We use a biomarker based on the blood of 10 genes(Panel-VB) that are an important prognostic value for the detection of viruses from bacterial infections with a weighted average AUROC of 0.97(95% CL:0.96-0.99) in eleven independent samples (sets n=898). We discovered a base with a patient score (VB 10 ) according to the table, which is a significant diagnostic value with a weighted average of AUROC 0.94(95% CL: 0.91-0.98) in 2996 patient samples from 56 public sets of data from 19 different countries. We also studied VB 10 in a new cohort of South India (BL-VB,n=56) and found 97% accuracy in confirmed cases of viral and bacterial infections. We found that VB 10 (a)accurately identifies the type of infection even in unspecified cases negative to the culture (b) shows its clinical condition recovery and (c) applies to all age groups, covering a wide range of acute bacterial and viral infectious, including non-specific pathogens. We applied our VB 10 rating to publicly available COVID 19 data and found that our rating diagnosed viral infection in patient samples. RESULTS: Τhe results of the study showed the diagnostic power of the biomarker VB 10 as a diagnostic test for the accurate diagnosis of acute infections in recovery conditions. We look forward to helping you make clinical decisions about prescribing antibiotics and integrating them into your policies management of antibiotic stewardship efforts. CONCLUSIONS: Overall, we are developing a new property of the RNA-based biomarker and a new blood test to differentiate between viral and bacterial infections to assist a physician in designing the optimal treatment regimen to contribute to the proper use of antibiotics and reduce the burden on antimicrobial resistance, AMR.

Keywords: acute infections, antimicrobial resistance, biomarker, blood transcriptome, systems biology, classifier diagnostic score

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Authors: Gerard Bray, Arya Bahadori, Sachinka Ranasinghe

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Renal cell carcinoma (RCC) is among the top 10 most common cancers worldwide, where metastatic disease carries a poor prognosis. Herein, we present a 74-year-old male presenting with asymptomatic solitary metachronous metastasis to the gall bladder 4 years following nephrectomy for clear cell RCC. Solitary RCC metastasis to the gall bladder following nephrectomy is rarely reported in the literature and brings with it a clinical conundrum of whether surgical resection or systemic therapy should be utilized. In this case, surgical excision with cholecystectomy was employed without systemic therapy. We, therefore, contribute a rare and interesting case that highlights that metastasectomy of a solitary metastasis can improve survival according to current literature.

Keywords: renal cell carcinoma, gall bladder metastasis, solitary metastasectomy, metachronous

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Authors: Raheel Shakoor Siddiqui, Shahbaz Malik, Manikandar Srinivas Cheruvu, Sanjay Narayana Murthy, Livio DiMascio

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Background: elderly traumatic hip fracture patients frequently present to trauma services globally. Rising low energy falls amongst an osteoporotic aging population is the commonest cause for injury. Hip fractures in this population are a major cause for severe pain, morbidity and mortality. The term hip fracture is interchangeable with neck of femur fracture, fractured neck of femur or proximal femur fracture. Hip fracture pain management protocols and guidelines suggest conventional analgesia, nerve block and opioid based treatment as rescue analgesia. There is a current global opioid crisis with overuse, abuse and dependence. Adverse opioid related complications in vulnerable elderly patients further adds to morbidity and mortality. Systematic reviews in literature have evidenced superiority of multimodal analgesia in osteoarthritic primary joint replacements compared to opioids however, this has not yet been conducted for elderly traumatic hip fracture patients. Aims: The primary aim of this systematic review is to provide standardised evidence following Cochrane and PRISMA guidance in determining advantages of perioperative multimodal analgesia over conventional opioid based treatments in elderly traumatic hip fractures. Methods: 5 databases were searched from January 2000-2023 which identified 8 randomised controlled trials and 446 total participants. These trials met defined PICOS eligibility criteria of patient mean age ≥ 65 years presenting with a unilateral traumatic fractured neck of femur for operative intervention. Analgesic intervention with perioperative multimodal analgesia has been compared to conventional opioid based analgesia. Outcomes of interest include, primarily, the change in postoperative opioid consumption within a 0-30 postoperative period and secondarily, the change in postoperative adverse events and complications. A qualitative synthesis has been performed due to clinical heterogenicity and variance amongst trials. Results: GRADE evidence of moderate quality supports perioperative multimodal analgesia leads to a reduction in postoperative opioid consumption however, low quality evidence supports a reduction of adverse effects and complications. Conclusion: Perioperative multimodal analgesia whether used preoperative, intraoperative and/or postoperative leads to a reduction in postoperative opioid consumption for elderly traumatic hip fracture patients. This review recommends the use of perioperative multimodal analgesia as part of hip fracture pain protocols however, caution and clinical judgement should be used as the risk of adverse effects may not be lower.

Keywords: trauma, orthopaedics, hip, fracture, neck of femur fracture, analgesia, multimodal analgesia, opioid

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Authors: Tahir Ali Akbar, Hirra Jabbar

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Land cover change analysis plays a significant role in understanding the trends of urban sprawl and land use transformation due to anthropogenic activities. In this study, the spatio-temporal dynamics of major land covers were analyzed in the last twenty years (1988-2016) for District Lahore located in the Punjab Province of Pakistan. The Landsat satellite imageries were downloaded from USGS Global Visualization Viewer of Earth Resources Observation and Science Center located in Sioux Falls, South Dakota USA. The imageries included: (i) Landsat TM-5 for 1988 and 2001; and (ii) Landsat-8 OLI for 2016. The raw digital numbers of Landsat-5 images were converted into spectral radiance and then planetary reflectance. The digital numbers of Landsat-8 image were directly converted into planetary reflectance. The normalized difference vegetation index (NDVI) was used to classify the processed images into six major classes of water, buit-up, barren land, shrub and grassland, sparse vegetation and dense vegetation. The NDVI output results were improved by visual interpretation using high-resolution satellite imageries. The results indicated that the built-up areas were increased to 21% in 2016 from 10% in 1988. The decrease in % areas was found in case of water, barren land and shrub & grassland. There were improvements in percentage of areas for the vegetation. The increasing trend of urban sprawl for Lahore requires implementation of GIS based spatial planning, monitoring and management system for its sustainable development.

Keywords: land cover changes, NDVI, remote sensing, urban sprawl

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Authors: Y. Z. Gad

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Disorders of Sex Development (DSD) are defined as congenital conditions in which development of chromosomal, gonadal or anatomical sex is atypical. The DSD are relatively prevalent in Egypt. In spite of that, the relative rarity of the individual disease types or their molecular pathologies frequently resulted in reporting on single or few cases. This augmented the challenging nature of phenotype-genotype correlation in this disease group and its utilization in the management of such medical emergency. Through critical assessment of the published DSD reports, the current review aims at analyzing the clinical characteristics of the various DSD forms in relation to the underlying molecular pathologies. A systematic literature search was done in Pubmed, using relevant keywords (Egypt versus DSD, genital ambiguity or ambiguous genitalia, the old terms of 'intersex, hermaphroditism and pseudohermaphroditism', and a list of the DSD entities and their related genes). The search yielded 24 reports of molecular data in Egyptian patients presenting with ambiguous genitalia. However, only 21 publications fulfilled the criteria of inclusion of detailed clinical descriptions and definitive molecular diagnoses of individual patients. Curation of the data yielded a total of 53 cases that were ascertained from 40 families. Fifty-one patients present with ambiguous genitalia only while 2 had multiple congenital anomalies. Parental consanguinity was noted in 60% of cases. Sex of rearing at initial presentation was female in 75% and 60% in 46,XY and 46,XX DSD cases, respectively. The external genital phenotype in 2/3 of the 46,XY DSD cases showed moderate undermasculinization [Quigley scores 3 & 4] and 1/3 had severe presentations [scores 5 & 6]. For 46,XX subjects, 1 had severe virilization of the external genitalia while 8 had moderate phenotype. Hormonal data were inconclusive or contradictory to final diagnosis in a forth of cases. Collectively, 31 families [31/40, 77.5%] with 46,XY DSD had molecular defects in the genes, 5 alpha reductase 2 (SRD5A2) [12/31], 17 beta-hydroxysteroid dehydrogenase 3 [8/31], androgen receptor [7/31], Steroidogenic factor 1 [2/31], luteinizing hormone receptor [1/31], and fibroblast growth factor receptor 1 [1/31]. In a multiethnic study, 9 families afflicted with 46,XX DSD due to 11 beta hydroxylase (CYP11B1) deficiency were documented. Two recurrent mutations, G34R and N160D, in SRD5A2 were present, respectively, in 42 and 17% of cases. Similarly, 4 recurrent mutations resulted in 89% of the CYP11B1 presentations. In conclusion, this analysis highlights the importance of autosomal recessive inheritance and inbreeding among DSD presentations, the importance of founder effect in at least 2 disorders, the difficulties in relating the genotype with the indeterminate genital phenotype, the under-reporting of some DSD subtypes, and the notion that the reported mutational profiles among Egyptian DSD cases are relatively different from those reported in other ethnic groups.

Keywords: disorders of sex development, genital ambiguity, mutation, molecular diagnosis, Egypt

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Authors: Ilirian Laçi, Alketa Spahiu

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Modality of treatment in hepatocellular carcinoma (HCC) patients depends on the stage of the disease. The Barcelona Clinic Liver Cancer Classification (BCLC) is the preferred staging system. There are many patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. The differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Because of these differences, not all patients benefit equally from TACE. Several tools have been devised to aid the decision-making process, which have shown promising initial results but have failed external evaluation and have not been translated to the clinic aspects. Criteria for treatment decisions in daily clinical practice are needed in all stages of the disease.

Keywords: hepatocellular carcinoma, transarterial chemoembolization, TACE, liver

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Authors: Michael Zaidman, Naum Simanovsky

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The most of brachial birth palsies are transient. Children with incomplete recovery almost always develop an internal rotation and adduction contracture. The muscle imbalance around the shoulder results in glenohumeral joint deformity and functional limitations. Natural history of glenohumeral deformity is it’s progression with worsening of function. Anteversion glenoid osteotomy with latissimus dorsi and teres major tendon transfers could be an alternative procedure of proximal humeral external rotation osteotomy for patients with severe glenohumeral dysplasia secondary to brachial plexus birth palsy. We will discuss pre-operative planning and stepped operative technique of the procedure on clinical example.

Keywords: obstetric brachial plexus palsy, glenoid anteversion osteotomy, tendon transfer, operative technique

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Authors: Khiara Claudine C. Carbonel, Patricia Joy A. Canapi, Tracy Gabriella M. Canlas, Teresa Zaine C. Canseco, Reena Marie A. Capistrano, Vernon A. Carandang, Carlo G. Ranoco

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Research problem: The main problem of the study was to determine the effect of Projecting the Reflection of the Individual’s Self-esteem (PRIDE) therapy on the level of self-esteem of physically challenged adolescents. Objectives of the Study: The study determined the effect of PRIDE (Projecting the Reflection of the Individuals Self-esteem) therapy on the level of self-esteem among physically challenged adolescents. Methodology: A quasi-experimental study was used which involved 30 randomly-assigned subjects, 15 in the experimental group and 15 in the control group. The Projecting the reflection of the Individuals’ Self-Esteem (PRDIE) therapy was administered to the experimental group. The researchers utilized the Sorensen Self-Esteem test tool as a pretest and posttest questionnaire and yielded a Cronbach’s alpha of .912. Paired T-test was used to analyze the gathered data. Results: The results showed that after the administration of PRIDE therapy, there was an increase on the level of self-esteem. The experimental group had a value of 3.590, which was significant and meant that the level of self-esteem is significantly increased. On the other hand, the control group, had a value of -2.207 which was also significant, therefore, the level of self esteem significantly decreased. Conclusion: the PRIDE Therapy is effective in increasing the level of self-esteem among physically challenged adolescent. Recommendations: The researchers recommend the use of PRIDE Therapy as an intervention in handling physically challenged patients, especially adolescents, in order to enhance their self-esteem. Also, the researchers recommend that nursing students be informed on the efficacy of PRIDE Therapy in enhancing the self-esteem of physically challenged patients. Furthermore, the inclusion of a psychologist during the implementation of PRIDE Therapy, specifically art therapy, to be able to have a more focused interpretation of the drawings and really be able to see the projection of their self-esteem is also recommended.

Keywords: PRIDE therapy, physically challenged adolescents, self-esteem, art therapy

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Authors: Marilei Amadeu Sabino

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The aim of this study is to establish differences between the terms ‘false cognates’, ‘false friends’ and ‘deceptive cognates’, usually considered to be synonyms. It will be shown they are not synonyms, since they do not designate the same linguistic process or phenomenon. Despite their differences in meaning, many pairs of formally similar words in two (or more) different languages are true cognates, although they are usually known as ‘false’ cognates – such as, for instance, the English and Italian lexical items ‘assist x assistere’; ‘attend x attendere’; ‘argument x argomento’; ‘apology x apologia’; ‘camera x camera’; ‘cucumber x cocomero’; ‘fabric x fabbrica’; ‘factory x fattoria’; ‘firm x firma’; ‘journal x giornale’; ‘library x libreria’; ‘magazine x magazzino’; ‘parent x parente’; ‘preservative x preservativo’; ‘pretend x pretendere’; ‘vacancy x vacanza’, to name but a few examples. Thus, one of the theoretical objectives of this paper is firstly to elaborate definitions establishing a distinction between the words that are definitely ‘false cognates’ (derived from different etyma) and those that are just ‘deceptive cognates’ (derived from the same etymon). Secondly, based on Set Theory and on the concepts of equal sets, subsets, intersection of sets and disjoint sets, this study is intended to elaborate some theoretical and practical questions that will be useful in identifying more precisely similarities and differences between cognate words of different languages, and according to graphic interpretation of sets it will be possible to classify them and provide discernment about the processes of semantic changes. Therefore, these issues might be helpful not only to the Learning of Second and Foreign Languages, but they could also give insights into Foreign and Second Language Teaching Methodology. Acknowledgements: FAPESP – São Paulo State Research Support Foundation – the financial support offered (proc. n° 2017/02064-7).

Keywords: deceptive cognates, false cognates, foreign language learning, teaching methodology

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Authors: Ying Zhu

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Recent years have witnessed a boom of foreign investments in the field of artificial intelligence (AI). Foreign investments provide critical capital for AI development but also trigger national security concerns of host states. A notable example is an increasing number of cases in which the Committee on Foreign Investment in the United States (CFIUS) has denied Chinese acquisitions of US technology companies on national security grounds. On July 19, 2018, the Congress has reached a deal on the final draft of a new provision to strengthen CFIUS’s authority to review overseas transactions involving sensitive US technology. The question is: how to reconcile the emerging tension between, on the one hand, foreign AI investors’ expectations of a predictable investment environment, and on the other hand, host states’ regulatory power on national security? This paper provides a methodology to reconcile this tension under international investment law. Based on an examination, the national security exception clauses in international investment treaties and the application of national security justification in investor-state arbitration jurisprudence, the paper argues that a traditional interpretation of the national security exception, based on the necessity concept in customary international law, fails to take into account new risks faced by countries, including security concerns over strategic industries such as AI. To overcome this shortage, the paper proposes to incorporate an integrated national security clause in international investment treaties, which includes a two-tier test: a ‘self-judging’ test in the pre-establishment period and a ‘proportionality’ test in the post-establishment period. At the end, the paper drafts a model national security clause for future treaty-drafting practice.

Keywords: foreign investment, artificial intelligence, international investment law, national security exception

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Authors: Heruanda Alviana Giska Barabah, Hilda Rasnia Hapsari

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Acoustic phenomena create an acoustic interpretation condition that describes the characteristics of the environment. In urban areas, the tendency of heterogeneous and simultaneous human activity form a soundscape that is different from other regions, one of the characteristics of urban areas that developing the soundscape is the presence of vertical model houses or residential building. Activities both within the building and surrounding environment are able to make the soundscape with certain characteristics. The acoustics comfort of residential building becomes an important aspect, those demand lead the building features become more diverse. Initial steps in mapping acoustic conditions in a soundscape are important, this is the method to determine uncomfortable condition. Noise generated by road traffic, railway, and plane is an important consideration, especially for urban people, therefore the proper design of the building becomes very important as an effort to bring appropriate acoustics comfort. In this paper the authors developed noise mapping on the location of the residential building. Mapping done by taking some point referring to the noise source. The mapping result become the basis for modeling the acoustics wave interacted with the building model. Material selection is done based on literature study and modeling simulation using Insul by considering the absorption coefficient and Sound Transmission Class. The analysis of acoustics rays is ray tracing method using Comsol simulator software that can show the movement of acoustics rays and their interaction with a boundary. The result of this study can be used to consider boundary material in residential building as well as consideration for improving the acoustic quality in the acoustics zones that are formed.

Keywords: residential building, noise, absorption coefficient, sound transmission class, ray tracing

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Authors: O. Nthoi-Molefe, V. Makwinja

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In the North West district of Botswana, Heritage tourism has the potential to offer tremendous economic and social opportunities for local communities in terms of supporting Tourism product development and entrepreneurship. This paper Identifies that Cultural Heritage Entrepreneur brings to the market goods and services, organizes and runs cultural heritage in a commercial or non-profit manner depending on characteristics of cultural resources identified. Data was collected through a series of focus group discussions that included sixteen village community members within the region. Data collected was transcribed and then further analyzed thematically to bring forward results to be analysed. Using Tsodilo Hills World Heritage Site as a case study, the researchers acknowledged that Cultural Heritage Entrepreneurs in that area should use a creative approach in order toidentify suitable solutions for financing different tourism activities starting with sponsored events, grant funds, donations, including the benefits of financial opportunities brough be foreign visitors and domestic tourists alike. The researchers also identified a need for specialized training for the identified entrepreneurs in order to maintain quality services of tourism products and sites (interpretation), information for tourists, visitation services, diversification, and upgrading of the heritage experience. The research reveals that the identified Cultural Heritage Entrepreneurs prefer economic motivation, exploitation over the cultural value of their resources, further calling for recommendations of the research that emphasize on the need for detailed training on how to valorize their cultural resources for the growth of Tourism in the area.

Keywords: education, community development, entrepreneurship, cultural tourism

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Authors: A. Dudek, P. Tylec, G. Torbicz, P. Duda, K. Proniewska, P. Major, M. Pedziwiatr

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Background: Conservative treatments of obesity, based only on a proper diet and physical activity, without the support of an interdisciplinary team of specialist does not bring satisfactory bariatric results. Long-term maintenance of a proper metabolic results after rapid weight loss due to bariatric surgery requires engagement from patients. Mobile health tool may offer alternative model that enhance participant engagement in keeping the therapy. Objective: We aimed to assess the influence of constant monitoring and subsequent motivational alerts in perioperative period and on post-operative effects in the bariatric patients. As well as the study was designed to identify factors conductive urge to change lifestyle after surgery. Methods: This prospective clinical control study was based on a usage of a designed prototype of bariatric mHealth system. The prepared application comprises central data management with a comprehensible interface dedicated for patients and data transfer module as a physician’s platform. Motivation system of a platform consist of motivational alerts, graphic outcome presentation, and patient communication center. Generated list of patients requiring urgent consultation and possibility of a constant contact with a specialist provide safety zone. 31 patients were enrolled in continuous monitoring program during a 6-month period along with typical follow-up visits. After one year follow-up, all patients were examined. Results: There were 20 active users of the proposed monitoring system during the entire duration of the study. After six months, 24 patients took a part in a control by telephone questionnaires. Among them, 75% confirmed that the application concept was an important element in the treatment. Active users of the application indicated as the most valuable features: motivation to continue treatment (11 users), graphical presentation of weight loss, and other parameters (7 users), the ability to contact a doctor (3 users). The three main drawbacks are technical errors (9 users), tedious questionnaires inside the application (5 users), and time-consuming tasks inside the system (2 users). Conclusions: Constant monitoring and successive motivational alerts to continue treatment is an appropriate tool in the treatment after bariatric surgery, mainly in the early post-operative period. Graphic presentation of data and continuous connection with a clinical staff seemed to be an element of motivation to continue treatment and a sense of security.

Keywords: bariatric surgery, mHealth, mobile health tool, obesity

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