Search results for: diagnosis and treatment

Authors: Asad Yousuf

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Purpose: The aim of the present study was to audit treatment planning system beam dataset for small field output factors against standard dataset produced by radiological physics center (RPC) from a multicenter study. Such data are crucial for validity of special techniques, i.e., IMRT or stereotactic radiosurgery. Materials/Method: In this study, multiple small field size output factor datasets were measured and calculated for 6 to 18 MV x-ray beams using the RPC recommend methods. These beam datasets were measured at 10 cm depth for 10 × 10 cm2 to 2 × 2 cm2 field sizes, defined by collimator jaws at 100 cm. The measurements were made with a Landauer’s nanoDot OSLDs whose volume is small enough to gather a full ionization reading even for the 1×1 cm2 field size. At our institute the beam data including output factors have been commissioned at 5 cm depth with an SAD setup. For comparison with the RPC data, the output factors were converted to an SSD setup using tissue phantom ratios. SSD setup also enables coverage of the ion chamber in 2×2 cm2 field size. The measured output factors were also compared with those calculated by Eclipse™ treatment planning software. Result: The measured and calculated output factors are in agreement with RPC dataset within 1% and 4% respectively. The large discrepancies in TPS reflect the increased challenge in converting measured data into a commissioned beam model for very small fields. Conclusion: OSLDs are simple, durable, and accurate tool to verify doses that delivered using small photon beam fields down to a 1x1 cm2 field sizes. The study emphasizes that the treatment planning system should always be evaluated for small field out factors for the accurate dose delivery in clinical setting.

Keywords: small field dosimetry, optically stimulated luminescence, audit treatment, radiological physics center

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Authors: Yoon Kyung Song, Seung Won Han, Sang Hyun Hwang, Do Hoon Lee

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Laboratory tests is a significant part for the diagnosis, prognosis, treatment of diseases. Blood collection is a simple process, but can be a potential cause of pre-analytical errors. Vacuum blood collection tubes used to collect and store the blood specimens is necessary for accurate test results. The purpose of this study was to validate Improve serum separator tube(SST) (Guanzhou Improve Medical Instruments Co., Ltd, China) for routine clinical chemistry laboratory testing. Blood specimens were collected from 100 volunteers in three different serum vacuum tubes (Greiner SST , Becton Dickinson SST , Improve SST). The specimens were evaluated for 16 routine chemistry tests using TBA-200FR NEO (Toshiba Medical Co. JAPAN). The results were statistically analyzed by paired t-test and Bland-Altman plot. For stability test, the initial results for each tube were compared with results of 72 hours preserved specimens. Their clinical availability was evaluated by biological Variation of Ricos data bank. Paired t-test analysis revealed that AST, ALT, K, Cl showed statistically same results but calcium (CA), phosphorus(PHOS), glucose(GLU), BUN, uric acid(UA), cholesterol(CHOL), total protein(TP), albumin(ALB), total bilirubin(TB), ALP, creatinine(CRE), sodium(NA) were different(P < 0.05) between Improve SST and Greiner SST. Also, CA, PHOS, TP, TB, AST, ALT, NA, K, Cl showed statistically the same results but GLU, BUN, UA, CHOL, ALB, ALP, CRE were different between Improve SST and Becton Dickinson SST. All statistically different cases were clinically acceptable by biological Variation of Ricos data bank. Improve SST tubes showed satisfactory results compared with Greiner SST and Becton Dickinson SST. We concluded that the tubes are acceptable for routine clinical chemistry laboratory testing.

Keywords: blood collection, Guanzhou Improve, SST, vacuum tube

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Authors: Nutnicha Wongpadungkiat, Suwit Siriwatanayotin, Aluck Thipayarat, Punchira Vongsawasdi, Chotika Viriyarattanasak

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Chicken products are major export product of Thailand. With a dramatically increasing consumption of chicken product in the world, there are abundant wastes from chicken meat processing industry. Recently, much research in the development of value-added products from chicken meat industry has focused on the production of protein hydrolysate, utilized as food ingredients for human diet and animal feed. The present study aimed to determine the effect of thermal pre-treatment on functional properties of chicken protein hydrolysate. Chicken breasts were heated at 40, 60, 80 and 100ºC prior to hydrolysis by Alcalase at 60ºC, pH 8 for 4 hr. The hydrolysate was freeze-dried, and subsequently used for assessment of its functional properties molecular weight by gel electrophoresis (SDS-PAGE). The obtained results show that increasing the pre-treatment temperature increased oil holding capacity and emulsion stability while decreasing antioxidant activity and water holding capacity. The SDS-PAGE analysis showed the evidence of protein aggregation in the hydrolysate treated at the higher pre-treatment temperature. These results suggest the connection between molecular weight of the hydrolysate and its functional properties.

Keywords: chicken protein hydrolysate, enzymatic hydrolysis, thermal pretreatment, functional properties

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Authors: Asad Iqbal, Feixiang Zan, Xiaoming Liu, Guang-Hao Chen

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Water, food, and energy nexus is a vital subject to achieve sustainable development goals worldwide. Wastewater (WW) and food waste (FW) from municipal sources are primary contributors to their respective wastage sum from a country. Along with the loss of these invaluable natural resources, their treatment systems also consume a lot of abiotic energy and resources input with a perceptible contribution to global warming. Hence, the global paradigm has evolved from simple pollution mitigation to a resource recovery system (RRS). In this study, the prospects of six alternative FW treatment scenarios are quantitatively evaluated for Hong Kong in terms of energy use and greenhouse emissions (GHEs) potential, using life cycle assessment (LCA). Considered scenarios included: aerobic composting, anaerobic digestion (AD), combine AD and composting (ADC), co-disposal, and treatment with wastewater (CoD-WW), incineration, and conventional landfilling as base-case. Results revealed that in terms of GHEs saving, all-new scenarios performed significantly better than conventional landfilling, with ADC scenario as best-case and incineration, AD alone, CoD-WW ranked as second, third, and fourth best respectively. Whereas, composting was the worst-case scenario in terms of energy balance, while incineration ranked best and AD alone, ADC, and CoD-WW ranked as second, third, and fourth best, respectively. However, these results are highly sensitive to boundary settings, e.g., the inclusion of the impact of biogenic carbon emissions and waste collection and transportation, and several other influential parameters. The study provides valuable insights and policy guidelines for the decision-makers locally and a generic modelling template for environmental impact assessment.

Keywords: food waste, resource recovery, greenhouse emissions, energy balance

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Authors: Smita Krishnan, Krittika Chandran, Chandra Mohan Sinnathambi

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Produced water and its treatment and management are growing challenges in all producing regions. This water is generally considered as a nonrevenue product, but it can have significant value in enhanced oil recovery techniques if it meets the required quality standards. There is also an interest in the beneficial uses of produced water for agricultural and industrial applications. Advanced Oxidation Process is a chemical technology that has been growing recently in the wastewater treatment industry, and it is highly recommended for non-easily removal of organic compounds. The efficiency of AOPs is compound specific, therefore, the optimization of each process should be done based on different aspects.

Keywords: advanced oxidation process, photochemical processes, degradation, organic contaminants

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Authors: Jaleh Shoshtarian Malak, Niloofar Mohamadzadeh

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Managing pre-hospital emergency patients requires real-time practices and efficient resource utilization. Since we are facing a distributed Network of healthcare providers, services and applications choosing the right resources and treatment protocol considering patient situation is a critical task. Delivering care to emergency patients at right time and with the suitable treatment settings can save ones live and prevent further complication. In recent years Multi Agent Systems (MAS) introduced great solutions to deal with real-time, distributed and complicated problems. In this paper we propose a multi agent based pre-hospital emergency management architecture in order to manage coordination, collaboration, treatment protocol and healthcare provider selection between different parties in pre-hospital emergency in a self-organizing manner. We used AnyLogic Agent Based Modeling (ABM) tool in order to simulate our proposed architecture. We have analyzed and described the functionality of EMS center, Ambulance, Consultation Center, EHR Repository and Quality of Care Monitoring as main collaborating agents. Future work includes implementation of the proposed architecture and evaluation of its impact on patient quality of care improvement.

Keywords: multi agent systems, pre-hospital emergency, simulation, software architecture

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Authors: Reinzo Vittorio B. Cardenas, Heather Venice L. Abogado, Andrea Therese V. Afable, Rhea D. Avillanoza, Marie Abegail P. Ayagan, Catherine D. Bantayan

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As the Internet provides fast and reliable health-related information, the tendency to self-diagnose increases to further understand medical jargon in a diagnosis with a physician and decreases costly consultation fees. The study aimed to explore and understand the factors affecting online health-seeking behaviors in middle-income class adults in Metro Manila. The study was conducted from March to April of 2021 with a sample size of 200 individuals aged 20 to 49 years old. The study was delivered via an online survey that used a questionnaire adapted from the research of Lee et al. (2015). Specifically, the survey consisted of three sections: assessing web-based health-seeking behaviors, consultation with health professionals, and participants' hesitancy to consult with physicians, which used a mix of a 5-point Likert-type scale with multiple responses and multiple-choice options. The results showed that the age and educational attainment of the respondents had a negative effect while presenting a positive effect of socio-economic status on health-seeking behavior. Lastly, there was a significant effect of participant’s hesitancy for professional consultation on their health-seeking behavior. The results gleaned from the study indicated that various individual and socio-economic factors might significantly affect one’s health-seeking behaviors. Although hesitancy had a significant effect on the spectrum of health-seeking behaviors, this does not imply that certain factors are specifically related to an individual’s tendency to seek health information. This information instead becomes essential in understanding the patient-physician relationship and giving patients a more holistic treatment.

Keywords: health-seeking behavior, health information, Internet, physician consultation

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Authors: Kamal Kaushik, Dandpani Epili, Ajay G. V., Ashutosh, S. Pradhaan

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Introduction: Radiation therapy has come a long way over a period of decades, from 2-dimensional radiotherapy to intensity-modulated radiation therapy (IMRT) or VMAT. For advanced radiation therapy, we need better patient position reproducibility to deliver precise and quality treatment, which raises the need for better image guidance technologies for precise patient positioning. This study presents a two tattoo simulation with roll correction technique which is comparable to other advanced patient positioning techniques. Objective: This is a site-specific study is aimed to perform a comparison between various treatment positioning techniques used for the treatment of patients of Ca- Breast undergoing radiotherapy. In this study, we are comparing 5 different positioning methods used for the treatment of ca-breast, namely i) Vacloc with 3 tattoos, ii) Breast board with three tattoos, iii) Thermoplastic cast with three fiducials, iv) Breast board with a thermoplastic mask with 3 tattoo, v) Breast board with 2 tattoos – A roll correction method. Methods and material: All in one (AIO) solution immobilization was used in all patient positioning techniques for immobilization. The process of two tattoo simulations includes positioning of the patient with the help of a thoracic-abdomen wedge, armrest & knee rest. After proper patient positioning, we mark two tattoos on the treatment side of the patient. After positioning, place fiducials as per the clinical borders markers (1) sternum notch (lower border of clavicle head) (2) 2 cm below from contralateral breast (3) midline between 1 & 2 markers (4) mid axillary on the same axis of 3 markers (Marker 3 & 4 should be on the same axis). During plan implementation, a roll depth correction is applied as per the anterior and lateral positioning tattoos, followed by the shifts required for the Isocentre position. The shifts are then verified by SSD on the patient surface followed by radiographic verification using Cone Beam Computed Tomography (CBCT). Results: When all the five positioning techniques were compared all together, the produced shifts in Vertical, Longitudinal and lateral directions are as follows. The observations clearly suggest that the Longitudinal average shifts in two tattoo roll correction techniques are less than every other patient positioning technique. Vertical and lateral Shifts are also comparable to other modern positioning techniques. Concluded: The two tattoo simulation with roll correction technique provides us better patient setup with a technique that can be implemented easily in most of the radiotherapy centers across the developing nations where 3D verification techniques are not available along with delivery units as the shifts observed are quite minimal and are comparable to those with Vacloc and modern amenities.

Keywords: Ca. breast, breast board, roll correction technique, CBCT

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Authors: Qiang Xu, Xingxin Wu, Wenjie Guo, Xingqi Wang, Yang Sun, Renxiang Tan

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The phosphatase SHP-2 is known to exert regulatory activities on cytokine receptor signaling and the dysregulation of SHP-2 has been implicated in the pathogenesis of a variety of diseases. Here we report several small molecule regulators of SHP-2 for the treatment of T cell-mediated diseases. The new cyclodepsipeptide trichomides A, isolated from the fermentation products of Trichothecium roseum, increased the phosphorylation of SHP-2 in activated T cells, and ameliorated contact dermatitis in mice. The trichomides A’s effects were significantly reversed by using the SHP-2-specific inhibitor PHPS1 or T cell-conditional SHP-2 knockout mice. Another compound is a cerebroside Fusaruside isolated from the endophytic fungus Fusarium sp. IFB-121. Fusaruside also triggered the tyrosine phosphorylation of SHP-2, which provided a possible mean of selectively targeting STAT1 for the treatment of Th1 cell-mediated inflammation and led to the discovery of the non-phosphatase-like function of SHP-2. Namely, the Fusaruside-activated pY-SHP-2 selectively sequestrated the cytosolic STAT1 to prevent its recruitment to IFN-R, which contributed to the improvement of experimental colitis in mice. Blocking the pY-SHP-2-STAT1 interaction, with SHP-2 inhibitor NSC-87877 or using T cells from conditional SHP-2 knockout mice, reversed the effects of fusaruside. Furthermore, the fusaruside’s effect is independent of the phosphatase activity of SHP-2, demonstrating a novel role for SHP-2 in regulating STAT1 signaling and Th1-type immune responses.

Keywords: SHP-2, small molecules, T cell, T cell-mediated diseases

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Authors: A. K. Aswathy, Asha Manoharan, Arya Manoharan

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The purpose of this study are to define the nature of oral sensory issues in children with autism spectrum disorder (ASD), identify important components of the assessment and treatment of this issues specific to this population, and delineate specific therapeutic techniques designed to improve assessment and treatment within therapeutic settings. Literature review and case example is used to define the predominant nature of the oral sensory issues that are experienced by some children on the autism spectrum. Characteristics of this complex disorder that can have an impact on feeding skill and behavior are also identified. These factors are then integrated to create assessment and intervention techniques that can be used in conjunction with traditional feeding approaches to facilitate improvements in eating as well as reducing oral apraxic component in this unique population. The complex nature of ASD and its many influences on feeding skills and behavior create the need for modification to both assessment and treatment approaches. Additional research is needed to create therapeutic protocols that can be used by speech-language pathologists to effectively assess and treat feeding and oro motor apraxic difficulties that are commonly encountered in children with ASD.

Keywords: autism, assessment, feeding, intervention, oral sensory issues, oral apraxia

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Authors: Mishell Vaca, Gema Gonzales, Francisco Quiroz

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Heavy metals present in wastewater constitute a danger for living beings in general. In Ecuador, one of the sources of contamination is artisanal mining whose liquid effluents, in many of the cases without prior treatment, are discharged to the surrounding rivers. Lead is a pollutant that accumulated in the body causes severe health effects. Nowadays, there are several treatment methods to reduce this pollutant. The aim of this study is to reduce the concentration of lead II through the use of a porous material formed by a matrix of chitosan, in which hydroxyapatite and moringa particles smaller than 53 um are suspended. These materials are not toxic to the environment, and each one adsorbs metals independently, so the synergic effect between them will be evaluated. The synthesized material has a cylindrical design that allows increasing the surface area, which is expected to have greater capacity of adsorption. It has been determined that the best conditions for its preparation are to dissolve the chitosan in 1% v/v acetic acid with a pH = 5, then the hydroxyapatite and moringa are added to the mixture with magnetic stirring. This suspension is frozen, lyophilized and finally dried. In order to evaluate the performance of the synthesized material, synthetic solutions of lead are prepared at different concentrations, and the percentage of removal is evaluated. It is expected to have an effluent whose lead content is less than 0.2 mg/L which is the limit maximum allowable according to established environmental standards.

Keywords: adsorption, chitosan, hydroxyapatite, lead, moringa, water treatment

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Authors: Osvaldo N. Oliveira Jr.

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The control of molecular architecture inherent in some experimental methods to produce nanostructured films has had great impact on devices of various types, including sensors and biosensors. The self-assembly monolayers (SAMs) and the electrostatic layer-by-layer (LbL) techniques, for example, are now routinely used to produce tailored architectures for biosensing where biomolecules are immobilized with long-lasting preserved activity. Enzymes, antigens, antibodies, peptides and many other molecules serve as the molecular recognition elements for detecting an equally wide variety of analytes. The principles of detection are also varied, including electrochemical methods, fluorescence spectroscopy and impedance spectroscopy. In this presentation an overview will be provided of biosensors made with nanostructured films to detect antibodies associated with tropical diseases and HIV, in addition to detection of analytes of medical interest such as cholesterol and triglycerides. Because large amounts of data are generated in the biosensing experiments, use has been made of computational and statistical methods to optimize performance. Multidimensional projection techniques such as Sammon´s mapping have been shown more efficient than traditional multivariate statistical analysis in identifying small concentrations of anti-HIV antibodies and for distinguishing between blood serum samples of animals infected with two tropical diseases, namely Chagas´ disease and Leishmaniasis. Optimization of biosensing may include a combination of another information visualization method, the Parallel Coordinate technique, with artificial intelligence methods in order to identify the most suitable frequencies for reaching higher sensitivity using impedance spectroscopy. Also discussed will be the possible convergence of technologies, through which machine learning and other computational methods may be used to treat data from biosensors within an expert system for clinical diagnosis.

Keywords: clinical diagnosis, information visualization, nanostructured films, layer-by-layer technique

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Authors: Mohd Salim Mahtab, Izharul Haq Farooqi, Anwar Khursheed

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Advanced oxidation processes (AOPs) based on Fenton are versatile options for treating complex wastewaters containing refractory compounds. However, the classical Fenton process (CFP) has limitations, such as high sludge production and reagent dosage, which limit its broad use and result in secondary contamination. As a result, long-term solutions are required for process intensification and the removal of these impediments. This study shows that Fenton sludge could serve as a catalyst in the Fe³⁺/Fe²⁺ reductive pathway, allowing non-regenerated sludge to be reused for complex wastewater treatment, such as landfill leachate treatment, even in the absence of Fenton's reagents. Experiments with and without pH adjustments in stages I and II demonstrated that an acidic pH is desirable. Humic compounds in leachate could improve the cycle of Fe³⁺/Fe²⁺ under optimal conditions, and the chemical oxygen demand (COD) removal efficiency was 22±2% and 62±2%% in stages I and II, respectively. Furthermore, excellent total suspended solids (TSS) removal (> 95%) and color removal (> 80%) were obtained in stage II. The processes underlying synergistic (oxidation/coagulation/adsorption) effects were addressed. The design of the experiment (DOE) is growing increasingly popular and has thus been implemented in the chemical, water, and environmental domains. The relevance of the statistical model for the desired response was validated using the explicitly stated optimal conditions. The operational factors, characteristics of reused sludge, toxicity analysis, cost calculation, and future research objectives were also discussed. Reusing non-regenerated Fenton sludge, according to the study's findings, can minimize hazardous solid toxic emissions and total treatment costs.

Keywords: advanced oxidation processes, catalysis, Fe³⁺/Fe²⁺ cycle, fenton sludge

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Authors: Moez Selmi, Mariem Kacem, Mehrez Jamei, Philippe Dubujet

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Earth pressure balance (EPB) tunnel boring machines are designed for digging in different types of soil, especially clay soils. This operation requires the treatment of soil by lubricants to facilitate the procedure of excavation. A possible use of this soil is limited by the effect of treatment on the hydro-mechanical properties of the soil. This work aims to study the effect of a foaming agent on the hydro-mechanical properties of clay soil. The injection of the foam agent in the soil leads to create a soil matrix in which they are incorporated gas bubbles. The state of the foam in the soil is scalable thanks to the degradation of the gas bubbles in the soil.

Keywords: EPB, clay soils, foam agent, hydro-mechanical properties, degradation

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Authors: Özgür Emi̇nağaoğlu, Hayal Akyildirim Beğen, Şevval Sali̇oğlu, Emrah Yüksel

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This study was carried out in order to determine the scientific name, common name, local names, location, botanical characteristics, used parts, intended use, local usage patterns, usage in the literature of plant species used for medicinal and aromatic purposes in Ardanuç (Artvin, Türkiye) between 2020-2023 years. The research area is located in the A9 square according to Davis’s grid system and is phytogeographically located in the colchic subsection of the Euxine part of the Euro-Siberian flora area of the Holarctic region. As a result of the studies, it has been determined that 167 plant species belonging to 79 families are used for medicinal and aromatic purposes. The families that contain the most taxa in the research area are, respectively, Rosaceae (19 taxa), Asterecaeae (15 taxa), and Lamiaceae (14 taxa). It has been determined that the medicinal, aromatic plants of the Ardanuç region are mostly used in the treatment of diseases (59%), and the plants are mostly used in the treatment of diabetes (37%). It was determined that the most applied method in the internal use of plants was decoction (48%). As a result of the research, the most commonly used plants in different diseases are Sambucus nigra, Plantago lanceolata, Satureja hortensis, Hypericum perforatum, Juniperus communis. These plants are used in the treatment of many diseases, such as colds, cancer, anemia and diabetes.

Keywords: Ardanuç, Artvin, Medicinal and Aromatic plant, Türkiye

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Authors: Nir Nissim, Erez Shalom, Tomer Lancewiki, Yuval Elovici, Yuval Shahar

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Background: A Medical Device (MD) is an instrument, machine, implant, or similar device that includes a component intended for the purpose of the diagnosis, cure, treatment, or prevention of disease in humans or animals. Medical devices play increasingly important roles in health services eco-systems, including: (1) Patient Diagnostics and Monitoring; Medical Treatment and Surgery; and Patient Life Support Devices and Stabilizers. MDs are part of the medical device eco-system and are connected to the network, sending vital information to the internal medical information systems of medical centers that manage this data. Wireless components (e.g. Wi-Fi) are often embedded within medical devices, enabling doctors and technicians to control and configure them remotely. All these functionalities, roles, and uses of MDs make them attractive targets of cyber-attacks launched for many malicious goals; this trend is likely to significantly increase over the next several years, with increased awareness regarding MD vulnerabilities, the enhancement of potential attackers’ skills, and expanded use of medical devices. Significance: We propose to develop and implement Cyber-Med, a unique collaborative project of Ben-Gurion University of the Negev and the Clalit Health Services Health Maintenance Organization. Cyber-Med focuses on the development of a comprehensive detection framework that relies on a critical attack repository that we aim to create. Cyber-Med will allow researchers and companies to better understand the vulnerabilities and attacks associated with medical devices as well as providing a comprehensive platform for developing detection solutions. Methodology: The Cyber-Med detection framework will consist of two independent, but complementary detection approaches: one for known attacks, and the other for unknown attacks. These modules incorporate novel ideas and algorithms inspired by our team's domains of expertise, including cyber security, biomedical informatics, and advanced machine learning, and temporal data mining techniques. The establishment and maintenance of Cyber-Med’s up-to-date attack repository will strengthen the capabilities of Cyber-Med’s detection framework. Major Findings: Based on our initial survey, we have already found more than 15 types of vulnerabilities and possible attacks aimed at MDs and their eco-system. Many of these attacks target individual patients who use devices such pacemakers and insulin pumps. In addition, such attacks are also aimed at MDs that are widely used by medical centers such as MRIs, CTs, and dialysis engines; the information systems that store patient information; protocols such as DICOM; standards such as HL7; and medical information systems such as PACS. However, current detection tools, techniques, and solutions generally fail to detect both the known and unknown attacks launched against MDs. Very little research has been conducted in order to protect these devices from cyber-attacks, since most of the development and engineering efforts are aimed at the devices’ core medical functionality, the contribution to patients’ healthcare, and the business aspects associated with the medical device.

Keywords: medical device, cyber security, attack, detection, machine learning

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Authors: Luís Fernando Cusioli, Leticia Nishi, Lucas Bairros, Gabriel Xavier Jorge, Sandro Rogério Lautenschalager, Celso Varutu Nakamura, Rosângela Bergamasco

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Focusing on the elimination of nitrogen and phosphorus from sewage, the study proposes to face the challenges of eutrophication and to optimize the effectiveness of sewage treatment through biofilms and filling produced by a 3D printer, seeking to identify the most effective Polylactic Acid (PLA), Acrylonitrile Butadiene Styrene (ABS). The study also proposes to evaluate the nitrification process in a Submerged Aerated Biological Filter (FBAS) on a pilot plant scale, quantifying the removal of nitrogen and phosphorus. The experiment will consist of two distinct phases, namely, a bench stage and the implementation of a pilot plant. During the bench stage, samples will be collected at five points to characterize the microbiota. Samples will be collected, and the microbiota will be investigated using Fluorescence In Situ Hybridization (FISH), deepening the understanding of the performance of biofilms in the face of multiple variables. In this context, the study contributes to the search for effective solutions to mitigate eutrophication and, thus, strengthen initiatives to improve effluent treatment.

Keywords: eutrophication, sewage treatment, biofilms, nitrogen and phosphorus removal, 3d printer, environmental efficiency

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Authors: Athanasia Eirini Zarkadi, Despoina Balli, Olga Elpis Kolokitha

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Objective: Impacted maxillary canines are a frequent condition and a common reason for patients seeking orthodontic treatment. Their simultaneous presence with dental anomalies raises a question about their possible connection. The aim of this study was to investigate the association of maxillary impacted canines with dental anomalies. Materials and Methods: Files of 874 patients from an orthodontic private practice in Greece were evaluated for the presence of maxillary impacted canines. From this sample, a group of 97 patients (39 males and 58 females) with at least one impacted maxillary canine were selected and consisted of the study group (canine impaction group) of this study. This group was compared to a control group of 97 patients (42 males and 55 females) that was created by random selection from the initial sample without maxillary canine impaction. The impaction diagnosis was made from the panoramic radiographs and confirmed from the surgery. The association between maxillary canine impaction and dental anomalies was examined with the chi-square test. A classification tree was created to further investigate the relations between impaction and dental anomalies. The reproducibility of diagnoses was assessed by re-examining the records of 25 patients two weeks after the first examination. Results: The found associated anomalies were cone-shaped upper lateral incisors and infraocclusion of deciduous molars. There is a significant increase in the prevalence of 12,4% of distal displacement of the unerupted mandibular second premolar in the canine impaction group compared to the control group that was 7,2%. The classification tree showed that the presence of a cone-shaped maxillary lateral incisor gave rise to the probability of an impacted canine to 83,3%. Conclusions: The presence of cone-shaped maxillary lateral incisors and infraocclusion of deciduous molars can be considered valuable early risk indicators for maxillary canine impaction.

Keywords: cone-shaped maxillary lateral incisors, dental anomalies, impacted canines, infraoccluded deciduous molars

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Authors: Jae Gon Kim, Yongchan Cho, Jungwha Lee

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Acid rock drainage (ARD) is generated by the oxidation of pyrite (FeS₂) contained in the excavated rocks upon its exposure to atmosphere and is an environmental concern at construction site due to its high acidity and high concentration of toxic elements. We developed the safe disposal method with the reduction of ARD generation by an alkali phosphate treatment. A pyrite rich andesite was collected from a railway construction site. The collected rock sample was crushed to be less than 3/8 inches in diameter using a jaw crusher. The crushed rock was filled in an acryl tube with 20 cm in diameter and 40 cm in height. Two treatments for the ARD reduction were conducted with duplicates: 1) the addition of 10mM KH₂PO₄_3% NaHCO₃ and 2) the addition of 10mM KH₂PO₄_3% NaHCO₃ and ordinary portland cement (OPC) on the top of the column. After the treatments, 500 ml of distilled water added to each column for every week for 3 weeks and then the column was flushed with 1,500 ml of distilled water in the 4th week. The pH, electrical conductivity (EC), concentrations of anions and cations of the leachates were monitored for 10 months. The pH of the leachates from the untreated column showed 2.1-3.7, but the leachates from the columns treated with the alkali phosphate solution with or without the OPC addition showed pH 6.7–8.9. The leachates from the treated columns had much lower concentrations of SO₄²⁻ and toxic elements such as Al, Mn, Fe and heavy metals than those from the untreated columns. However, the leachates from the treated columns had a higher As concentration than those from the untreated columns. There was no significant difference in chemical property between the leachates from the treated columns with and without the OPC addition. The chemistry of leachates indicates that the alkali phosphate treatment decreased the oxidation of sulfide and neutralized the acidic pore water. No significant effect of the OPC addition on the leachate chemistry has shown during 10-month experiment. However, we expect a positive effect of the OPC addition on the reduction of ARD generation in terms of long period. According to the results of this experiment, the alkali phosphate treatment of sulfide rich rock can be a promising technology for the safe disposal method with the ARD reduction.

Keywords: acid rock drainage, alkali phosphate treatment, pyrite rich rock, safe disposal

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Authors: B. J. Mahen, N. E. Lloyd-Gale, S. Johnson, W. P. Rakowicz, M. J. Harris, A. D. Miller

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Background: Migraine is a leading cause of disability in the world. Calcitonin gene-related peptide (CGRP) receptor antagonists offer an approach to migraine prophylaxis by inhibiting the inflammatory and vasodilatory effects of CGRP. In recent years, NICE licensed the use of three CGRP-receptor antagonists: Fremanezumab, Galcanezumab, and Erenumab. Here, we present the outcomes of CGRP-antagonist treatment in a cohort of patients who suffer from episodic or chronic migraine and have failed at least three oral prophylactic therapies. Methods: We offered CGRP antagonists to 86 patients who met the NICE criteria to start therapy. We recorded the number of headache days per month (HDPM) at 0 weeks, 3 months, and 12 months. Of those, 26 patients were switched to an alternative treatment due to poor response or side effects. Of the 112 total cases, 9 cases did not sufficiently maintain their headache diary, and 5 cases were not followed up at 3 months. We have therefore included 98 sets of data in our analysis. Results: Fremanezumab achieved a reduction in HDPM by 51.7% at 3 months (p<0.0001), with 63.7% of patients meeting NICE criteria to continue therapy. Patients trialed on Galcanezumab attained a reduction in HDPM by 47.0% (p=0.0019), with 51.6% of patients meeting NICE criteria to continue therapy. Erenumab, however, only achieved a reduction in HDPM by 17.0% (p=0.29), and this was not statistically significant. Furthermore, 34.4%, 9.7%, and 4.9% of patients taking Fremanezumab, Galcanezumab, and Erenumab, respectively, continued therapy beyond 12 months. Of those who attempted drug holidays following 12 months of treatment, migraine symptoms relapsed in 100% of cases. Conclusion: We observed a significant improvement in HDPM amongst episodic and chronic migraine patients following treatment with Fremanezumab or Galcanezumab.

Keywords: migraine, CGRP, fremanezumab, galcanezumab, erenumab

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Authors: Warda Jabeen, Romaisa Shamim Khan, Osama Shakeel, Ahmed Faraz Bhatti, Raza Hussain

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Background: The worldwide incidence of cutaneous melanoma (CM) has been on the rise over the past few decades. Primary prevention and early treatment remain the focus of management to reduce the burden of disease. This entails identification of risk factors to prompt early diagnosis. In Pakistan, there is a scarcity of clinico-pathological data relating to cutaneous malignant melanoma. Objective: The purpose of this study was to analyze the epidemiological and clinical characteristics of patients presenting with cutaneous malignant melanoma in Pakistan, and to compare the results with other studies. Method: Shaukat Khanum Memorial Cancer Hospital and Research Centre is currently the only dedicated cancer hospital in the country, accepting patients from all over Pakistan. Majority of the patients, however, belong to the northern half of the country. From the recorded data of the hospital, all cutaneous melanoma cases were identified and evaluated. Results: Between 1997 and 2017, a total of 169 cutaneous melanoma patients were registered at Shaukat Khanum. Mean age was 47.5 years. The highest incidence of melanoma was seen in the age group 40-59 years (n=69, 40.8%). Most commonly reported clinical subtype was unspecified melanoma (n=154, 91%). Amongst those in which T stage was reported, the most frequently observed T-stage at presentation was T4 (n=23, 13.6%). With regards to body distribution, in our study CM was seen most commonly in the lower limb including the hip. The yearly incidence of melanoma has increased/remained stable from 2007 to 2017. Conclusion: cutaneous malignant melanoma is a fairly common disease in Pakistan. Patients tend to present at a more advanced stage as compared to patients in developed countries. Identification of risk factors and tumor characteristics is therefore of paramount importance to deal with these patients.

Keywords: epidemiology of cutaneous malignant melanoma, cutaneous malignant melanoma, Pakistan, skin cancer

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Authors: Vineet Agrawal, Deepanjali S., Medha R., Subitha L.

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Background. Hospital malnutrition is a highly prevalent issue and is known to increase the morbidity, mortality, length of hospital stay, and cost of care. In India, studies on hospital malnutrition have been restricted to ICU, post-surgical, and cancer patients. We designed this study to assess the impact of hospital malnutrition on 30-day post-discharge and in-hospital mortality in patients admitted in the general medicine department, irrespective of diagnosis. Methodology. All patients aged above 18 years admitted in the medicine wards, excluding medico-legal cases, were enrolled in the study. Nutritional assessment was done within 72 h of admission, using Subjective Global Assessment (SGA), which classifies patients into three categories: Severely malnourished, Mildly/moderately malnourished, and Normal/well-nourished. Anthropometric measurements like Body Mass Index (BMI), Triceps skin-fold thickness (TSF), and Mid-upper arm circumference (MUAC) were also performed. Patients were followed-up during hospital stay and 30 days after discharge through telephonic interview, and their final diagnosis, comorbidities, and cause of death were noted. Multivariate logistic regression and cox regression model were used to determine if the nutritional status at admission independently impacted mortality at one month. Results. The prevalence of malnourishment by SGA in our study was 67.3% among 395 hospitalized patients, of which 155 patients (39.2%) were moderately malnourished, and 111 (28.1%) were severely malnourished. Of 395 patients, 61 patients (15.4%) expired, of which 30 died in the hospital, and 31 died within 1 month of discharge from hospital. On univariate analysis, malnourished patients had significantly higher morality (24.3% in 111 Cat C patients) than well-nourished patients (10.1% in 129 Cat A patients), with OR 9.17, p-value 0.007. On multivariate logistic regression, age and higher Charlson Comorbidity Index (CCI) were independently associated with mortality. Higher CCI indicates higher burden of comorbidities on admission, and the CCI in the expired patient group (mean=4.38) was significantly higher than that of the alive cohort (mean=2.85). Though malnutrition significantly contributed to higher mortality on univariate analysis, it was not an independent predictor of outcome on multivariate logistic regression. Length of hospitalisation was also longer in the malnourished group (mean= 9.4 d) compared to the well-nourished group (mean= 8.03 d) with a trend towards significance (p=0.061). None of the anthropometric measurements like BMI, MUAC, or TSF showed any association with mortality or length of hospitalisation. Inference. The results of our study highlight the issue of hospital malnutrition in medicine wards and reiterate that malnutrition contributes significantly to patient outcomes. We found that SGA performs better than anthropometric measurements in assessing under-nutrition. We are of the opinion that the heterogeneity of the study population by diagnosis was probably the primary reason why malnutrition by SGA was not found to be an independent risk factor for mortality. Strategies to identify high-risk patients at admission and treat malnutrition in the hospital and post-discharge are needed.

Keywords: hospitalization outcome, length of hospital stay, mortality, malnutrition, subjective global assessment (SGA)

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Authors: Basant Singh Sikarwar, Mukesh Roy, Ayush Goyal, Priya Ranjan

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This work combines two bodies of knowledge which includes biomedical basis of blood stain formation and fluid communities’ wisdom that such formation of blood stain depends heavily on physical properties. Moreover biomedical research tells that different patterns in stains of blood are robust indicator of blood donor’s health or lack thereof. Based on these valuable insights an innovative screening tool is proposed which can act as an aide in the diagnosis of diseases such Anemia, Hyperlipidaemia, Tuberculosis, Blood cancer, Leukemia, Malaria etc., with enhanced confidence in the proposed analysis. To realize this powerful technique, simple, robust and low-cost micro-fluidic devices, a micro-capillary viscometer and a pendant drop tensiometer are designed and proposed to be fabricated to measure the viscosity, surface tension and wettability of various blood samples. Once prognosis and diagnosis data has been generated, automated linear and nonlinear classifiers have been applied into the automated reasoning and presentation of results. A support vector machine (SVM) classifies data on a linear fashion. Discriminant analysis and nonlinear embedding’s are coupled with nonlinear manifold detection in data and detected decisions are made accordingly. In this way, physical properties can be used, using linear and non-linear classification techniques, for screening of various diseases in humans and cattle. Experiments are carried out to validate the physical properties measurement devices. This framework can be further developed towards a real life portable disease screening cum diagnostics tool. Small-scale production of screening cum diagnostic devices is proposed to carry out independent test.

Keywords: blood, physical properties, diagnostic, nonlinear, classifier, device, surface tension, viscosity, wettability

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Authors: Jungbin Lim, Bohee Kang, Heelim Lee, Sunjin Kim, GeumHee Choi, Jae-Suk Jung, Suk Ji

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Nonsurgical periodontal therapies have, for several decades, been the basis of periodontal treatment concepts. The aim of this paper is to investigate the effectiveness of non-surgical periodontal therapy according to the severity of periodontitis disease. Methods: Retrospective data of patients who visited Department of periodontics in Ajou University Medical Center from 2016 to 2022 were collected. Among the patients, those who took full mouth examination of clinical parameters and non-surgical periodontal therapy were chosen for this study. Selected patients were divided into initial, moderate, and severe periodontitis based on severity and complexity of management (2018 World Workshop EFP/AAP consensus). Recall visits with clinical periodontal examination were scheduled for 1,2,3 months or 1,3,6 months after the treatment. The results were evaluated by recordings of mean probing pocket depth (mean PD), mean clinical attachment levels (mean CAL), bleeding on probing (BOP%), mean gingival index (mean GI), mean regression, mean sulcus bleeding index (mean SBI), mean plaque scores (mean PI). All statistical analyses were performed with R software, version 4.3.0. A level of significance, P<0.05, was considered to be statistically significant. Results: A total of 92 patients were included in this study. 15 patients were diagnosed as initial periodontitis, 14 moderate periodontitis, and 63 severe periodontitis. The all parameters except for mean recession decreased over time in all groups. The amount of mean PD decreased were the greatest in severe periodontitis group followed by moderate and initial, which was found to be statistically significant. The changes of mean PD were 0.15±0.05 mm, 0.37±0.06 mm, and 1.01±0.07 mm (initial, moderate, and severe, respectively, P<0.001). When comparing before and after treatment, the reductions in BOP(%), mean GI, mean SBI, and mean PI were statistically significant. Conclusion: All patients who received non-surgical periodontal therapy showed periodontal healing in terms of improvements in clinical parameters, and it was greater in the severe group.

Keywords: periodontology, clinical periodontology, oral treatment, comprehensive preventive dentistry, non-surgical periodontal therapy

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Authors: M. G. Mostafa, Manjushree Chowdhury, Tapan Kumar Biswas, , Ananda Kumar Saha

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This study focused on effluents characterization and treatment process to reduce of toxicity from tannery effluents. Tanning industry is one of the oldest industries in the world. It is typically characterized as pollutants generated industries which produce wide varieties of high strength toxic chemicals. The study was conducted during the year 2008 to 2009 and the tannery effluents were collected three times in a year from the outlet of some selected leather industries located in Hagaribagh industrial zone Dhaka, Bangladesh. The analysis results of the raw effluents reveal that the effluents were yellowish-brown color, having basic pH, very high value of BOD5¬¬, COD, TDS, TSS, TS, and high concentrations of Cr, Na, SO42-, Cl- and other organic and inorganic constituents. The tannery effluents were treated with various doses of FeCl3 after settling and a subsequent filtration through sand-stone. The study observed that coagulant (FeCl3) 150 mg/L dose around neutral pH showed the best removal efficiency for major physico-chemical parameters. The analysis results of illustrate that the most of the physical and chemical parameters were found well below the prescribed permissible limits for effluent discharged. The study suggests that tannery effluents could be treated by a combined process consisting of settling, filtering and coagulating with FeCl3.

Keywords: characterization, effluent, tannery, treatment

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Authors: Cristina Hotoleanu

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Introduction: The recent Covid-19 pandemic accelerated the development of e-health, including telemedicine, smartphone applications, and medical wearable devices. Providing remote teleconsultations supposes challenges which may require further face-to-face medical interactions. The aim of this study was to assess the correlation between the types of teleconsultations and the need of onsite medical services (investigations and medical visits) for the diagnosis and treatment. Methods: a retrospective study including all the teleconsultations using the platform offered by a telehealth provider in Romania (Telios Care SA) between May 1, 2021- April 30, 2022, was performed. Binary data were analysed using the chi-square test with a significance level of p < 0.05. Results: out of 7163 consultations, 3961 were phone calls, 1981 were online messages, and 1221 were video calls. Onsite medical services were indicated in 3327 (46.44%) cases; the onsite investigations or the onsite visits were recommended for 2908 patients as follows: 2326 in case of phone calls, 582 in case of online messages, none in case of video calls. Both onsite investigations and visits were indicated for 419 patients. The need for onsite additional medical services was significantly higher in the case of phone calls than in the other 2 types of teleconsultations (Chi square= 1207.06, p= 0.00001). The indication for onsite services was done mainly after teleconsultations covering medical specialties (87.34%), significantly higher than the other specialties (Chi square=914.59, p=0.00001). Teleconsultations in surgical specialties and other fields (pharmacy, dentistry, psychology, wellbeing- nutrition, fitness) resulted in 12.13%, respective less than 1%, indication for onsite investigations or visits, explained by using of video calls in most of the cases. Conclusion: a further onsite medical service was necessary in less than a half of the teleconsultations. This indication was done mainly after phone calls and teleconsultations in medical specialties. Video calls were used mostly in psychology, nutrition, and fitness teleconsultations and did not require a further onsite medical service. Other studies are necessary to assess better the types of teleconsultations and the specialties bringing the biggest benefit for the patients.

Keywords: onsite medical services, phone calls, teleconsultations, telemedicine

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Authors: Kristine Joy Y. Sumanga, Clarissa Mae D. Derecho

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Telemedicine is providing health care services using electronic means at a distance, including the diagnosis, treatment, and prevention of diseases as well as the research and evaluation and education of health care providers. The role of telemedicine in this time of the COVID-19 pandemic is vital, especially in the practice of medicine. General Objective: To determine the extent of knowledge, preparedness and perception of telemedicine among Family Medicine Resident Physicians in different training institutions in Cebu City during the Coronavirus Disease 19 pandemic. Methods: A descriptive, cross-sectional survey research study was conducted in four hospital training institutions in Cebu City. A total of 41 respondents gave their consent and were given the online survey questionnaire pertaining to the extent of knowledge, preparedness and perceptions on telemedicine, including respondents’ demographic data and problems encountered in Telemedicine. Results: Out of the 41 respondents, 56.10% were young adults (26 to 30 years old), mostly females (70.73%), single (68.29%), first-year residents (43.90%), employed at a government hospital (70.73%) and are in the traditional residency pathway (82.93%). On relevant experience, 82.93% experienced telemedicine during residency, with 100% on follow-up consultations, and 95% were consulted due to infections. Respondents’ extent of knowledge was average, while the extent of preparedness and perception were great. Problems with low connectivity (80.48%) were noted by most of the respondents. Conclusion: Resident physicians moderately understood the information about telemedicine but with a great extent of preparedness and perception. They are always prepared for telemedicine modality because they are fully aware of its existence and need in the delivery of health care services among their patients at the time of the pandemic. Challenges to low connectivity and handling patients’ data privacy were the major concerns met by the resident physicians in the use of telemedicine.

Keywords: telemedicine, knowledge, preparedness, perception, family medicine, residents, COVID 19

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Authors: Nayif Alrasheedi, Sultan Almutairi

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Field-wide, a water supply wells’ downhole corrosion inhibition program is being applied to maintain downhole component integrity and keep the fluid corrosivity below 5 MPY. Batch treatment is currently used to inject the oil field chemical. This work is a case study consisting of analytical procedures used to optimize the frequency of the good corrosion inhibition treatments. During the study, a corrosion cell was fitted with a special three-electrode configuration for electrochemical measurements, electrochemical linear polarization, corrosion monitoring, and microbial analysis. This study revealed that the current practice is not able to mitigate material corrosion in the downhole system for more than three months.

Keywords: downhole corrosion inhibition, electrochemical measurements, electrochemical linear polarization, corrosion monitoring

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Authors: S. Anwar Sathik, K. Manoj Deepak, K. Venkatachalam

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Our study is a prospective study on the use of bio absorbable pins for the treatment of osteochondral fractures after patellar dislocation.22 patients who presented with osteochondral fractures were treated in our institution. They were followed for a minimum of 12 months by regular radiological evaluation. Of the 22 patients, 2 had fragments that detached from the fracture site which was treated arthroscopically. All the patients underwent open reduction and fixation of the pins using bio absorbable crews. They were immobilized in the cast for a minimum of 6 weeks after which mobilization was started according to our protocol. Fracture consolidation was found to occur in 20 of the 22 patients. Thus, Bio absorbable screws can be used as a reliable method of fixation of the osteochondral fragments.

Keywords: osteochondral fracture, bio absorbable pins, patella dislocation, physiotherapy

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Authors: Rima Al Garni, Emad Al Shdaifat, Sahar Elmetwalli, Mohammad Alzaid, Abdulrahman Alghothayyan, Sara Al Abd Al Hai, Seham Al Rashidi

Abstract:

Aim: To investigate the prevalence of non-adherence of patients on haemodialysis and explore their perception of the importance of adherence to the therapeutic regime and estimate the predictors for adherence to the therapeutic regime. Background: End-stage renal disease is commonly treated by haemodialysis. Haemodialysis treatment alone is not effective in replacing kidney function. Diet and fluid restrictions, along with supplementary medications, are mandatory for the survival and well-being of patients. Hence, adherence to this therapeutic regimen is essential. However, non-adherence to diet and fluid restrictions, medications, and dialysis is common among patients on haemodialysis. Design: Descriptive cross-sectional method was applied to investigate the prevalence of non-adherence to treatment, including adherence to diet and fluid restrictions, medications, and dialysis sessions. Methods: Structured interviews were conducted using the Arabic version of the End-Stage Renal Disease Adherence Questionnaire. The sample included 230 patients undergoing haemodialysis in the Eastern Region of Saudi Arabia. Data were analysed using descriptive statistics and multiple regressions. Results/Findings: Most patients had good adherence (71.3%), and only 3.9% had poor adherence. The divorced or widowed patient had higher adherence compared with single (P=0.011) and married participants (P=0.045) through using the post hoc test. Patients above 60 years had higher adherence compared to patients below 40 years old (P=0.016) using the post hoc test. For the perception of the importance of adherence to the therapeutic regime subscale, two-thirds of the patients had lower scores (<=11). Conclusion: Adherence to therapeutic regime is high for three fourth of patients undergoing haemodialysis in the Eastern Region of Saudi Arabia; this finding is similar to results abstracted from the local literature. This result would help us highlight the needs of patients who are not compliant with their treatment plans and investigate the consequences of non-adherence on their well-being and general health. Hence, plan individualised therapeutic programmes that could raise their awareness and influence their adherence to therapeutic regimes.

Keywords: adherence to treatment, haemodialysis, end stage renal disease, diet and fluid restrictions

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