Search results for: hybrid virtual clinic
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3350

Search results for: hybrid virtual clinic

1340 Super-ellipsoidal Potential Function for Autonomous Collision Avoidance of a Teleoperated UAV

Authors: Mohammed Qasim, Kyoung-Dae Kim

Abstract:

In this paper, we present the design of the super-ellipsoidal potential function (SEPF), that can be used for autonomous collision avoidance of an unmanned aerial vehicle (UAV) in a 3-dimensional space. In the design of SEPF, we have the full control over the shape and size of the potential function. In particular, we can adjust the length, width, height, and the amount of flattening at the tips of the potential function so that the collision avoidance motion vector generated from the potential function can be adjusted accordingly. Based on the idea of the SEPF, we also propose an approach for the local autonomy of a UAV for its collision avoidance when the UAV is teleoperated by a human operator. In our proposed approach, a teleoperated UAV can not only avoid collision autonomously with other surrounding objects but also track the operator’s control input as closely as possible. As a result, an operator can always be in control of the UAV for his/her high-level guidance and navigation task without worrying too much about the UAVs collision avoidance while it is being teleoperated. The effectiveness of the proposed approach is demonstrated through a human-in-the-loop simulation of quadrotor UAV teleoperation using virtual robot experimentation platform (v-rep) and Matlab programs.

Keywords: artificial potential function, autonomous collision avoidance, teleoperation, quadrotor

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1339 Graphene Supported Nano Cerium Oxides Hybrid as an Electrocatalyst for Oxygen Reduction Reactions

Authors: Siba Soren, Purnendu Parhi

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Today, the world is facing a severe challenge due to depletion of traditional fossil fuels. Scientists across the globe are working for a solution that involves a dramatic shift to practical and environmentally sustainable energy sources. High-capacity energy systems, such as metal-air batteries, fuel cells, are highly desirable to meet the urgent requirement of sustainable energies. Among the fuel cells, Direct methanol fuel cells (DMFCs) are recognized as an ideal power source for mobile applications and have received considerable attention in recent past. In this advanced electrochemical energy conversion technologies, Oxygen Reduction Reaction (ORR) is of utmost importance. However, the poor kinetics of cathodic ORR in DMFCs significantly hampers their possibilities of commercialization. The oxygen is reduced in alkaline medium either through a 4-electron (equation i) or a 2-electron (equation ii) reduction pathway at the cathode ((i) O₂ + 2H₂O + 4e⁻ → 4OH⁻, (ii) O₂ + H₂O + 2e⁻ → OH⁻ + HO₂⁻ ). Due to sluggish ORR kinetics the ability to control the reduction of molecular oxygen electrocatalytically is still limited. The electrocatalytic ORR starts with adsorption of O₂ on the electrode surface followed by O–O bond activation/cleavage and oxide removal. The reaction further involves transfer of 4 electrons and 4 protons. The sluggish kinetics of ORR, on the one hand, demands high loading of precious metal-containing catalysts (e.g., Pt), which unfavorably increases the cost of these electrochemical energy conversion devices. Therefore, synthesis of active electrocatalyst with an increase in ORR performance is need of the hour. In the recent literature, there are many reports on transition metal oxide (TMO) based ORR catalysts for their high activity TMOs are also having drawbacks like low electrical conductivity, which seriously affects the electron transfer process during ORR. It was found that 2D graphene layer is having high electrical conductivity, large surface area, and excellent chemical stability, appeared to be an ultimate choice as support material to enhance the catalytic performance of bare metal oxide. g-C₃N₄ is also another candidate that has been used by the researcher for improving the ORR performance of metal oxides. This material provides more active reaction sites than other N containing carbon materials. Rare earth oxide like CeO₂ is also a good candidate for studying the ORR activity as the metal oxide not only possess unique electronic properties but also possess catalytically active sites. Here we will discuss the ORR performance (in alkaline medium) of N-rGO/C₃N₄ supported nano Cerium Oxides hybrid synthesized by microwave assisted Solvothermal method. These materials exhibit superior electrochemical stability and methanol tolerance capability to that of commercial Pt/C.

Keywords: oxygen reduction reaction, electrocatalyst, cerium oxide, graphene

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1338 Dynamic Bandwidth Allocation in Fiber-Wireless (FiWi) Networks

Authors: Eman I. Raslan, Haitham S. Hamza, Reda A. El-Khoribi

Abstract:

Fiber-Wireless (FiWi) networks are a promising candidate for future broadband access networks. These networks combine the optical network as the back end where different passive optical network (PON) technologies are realized and the wireless network as the front end where different wireless technologies are adopted, e.g. LTE, WiMAX, Wi-Fi, and Wireless Mesh Networks (WMNs). The convergence of both optical and wireless technologies requires designing architectures with robust efficient and effective bandwidth allocation schemes. Different bandwidth allocation algorithms have been proposed in FiWi networks aiming to enhance the different segments of FiWi networks including wireless and optical subnetworks. In this survey, we focus on the differentiating between the different bandwidth allocation algorithms according to their enhancement segment of FiWi networks. We classify these techniques into wireless, optical and Hybrid bandwidth allocation techniques.

Keywords: fiber-wireless (FiWi), dynamic bandwidth allocation (DBA), passive optical networks (PON), media access control (MAC)

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1337 [Keynote Talk]: From Clinical Practice to Academic Setup, 'Quality Circles' for Quality Outputs in Both

Authors: Vandita Mishra

Abstract:

From the management of patients, reception, record, and assistants in a clinical practice; to the management of ongoing research, clinical cases and department profile in an academic setup, the healthcare provider has to deal with all of it. The victory lies in smooth running of the show in both the above situations with an apt solution of problems encountered and smooth management of crisis faced. Thus this paper amalgamates dental science with health administration by means of introduction of a concept for practice management and problem-solving called 'Quality Circles'. This concept uses various tools for problem solving given by experts from different fields. QC tools can be applied in both clinical and academic settings in dentistry for better productivity and for scientifically approaching the process of continuous improvement in both the categories. When approached through QC, our organization showed better patient outcomes and more patient satisfaction. Introduced in 1962 by Kaoru Ishikawa, this tool has been extensively applied in certain fields outside dentistry and healthcare. By exemplification of some clinical cases and virtual scenarios, the tools of Quality circles will be elaborated and discussed upon.

Keywords: academics, dentistry, healthcare, quality

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1336 Modified Lot Quality Assurance Sampling (LQAS) Model for Quality Assessment of Malaria Parasite Microscopy and Rapid Diagnostic Tests in Kano, Nigeria

Authors: F. Sarkinfada, Dabo N. Tukur, Abbas A. Muaz, Adamu A. Yahuza

Abstract:

Appropriate Quality Assurance (QA) of parasite-based diagnosis of malaria to justify Artemisinin-based Combination Therapy (ACT) is essential for Malaria Programmes. In Low and Middle Income Countries (LMIC), resource constrain appears to be a major challenge in implementing the conventional QA system. We designed and implemented a modified LQAS model for QA of malaria parasite (MP) microscopy and RDT in a State Specialist Hospital (SSH) and a University Health Clinic (UHC) in Kano, Nigeria. The capacities of both facilities for MP microscopy and RDT were assessed before implementing a modified LQAS over a period of 3 months. Quality indicators comprising the qualities of blood film and staining, MP positivity rates, concordance rates, error rates (in terms of false positives and false negatives), sensitivity and specificity were monitored and evaluated. Seventy one percent (71%) of the basic requirements for malaria microscopy was available in both facilities, with the absence of certifies microscopists, SOPs and Quality Assurance mechanisms. A daily average of 16 to 32 blood samples were tested with a blood film staining quality of >70% recorded in both facilities. Using microscopy, the MP positivity rates were 50.46% and 19.44% in SSH and UHS respectively, while the MP positivity rates were 45.83% and 22.78% in SSH and UHS when RDT was used. Higher concordance rates of 88.90% and 93.98% were recorded in SSH and UHC respectively using microscopy, while lower rates of 74.07% and 80.58% in SSH and UHC were recorded when RDT was used. In both facilities, error rates were higher when RDT was used than with microscopy. Sensitivity and specificity were higher when microscopy was used (95% and 84% in SSH; 94% in UHC) than when RDT was used (72% and 76% in SSH; 78% and 81% in UHC). It could be feasible to implement an integrated QA model for MP microscopy and RDT using modified LQAS in Malaria Control Programmes in Low and Middle Income Countries that might have resource constrain for parasite-base diagnosis of malaria to justify ACT treatment.

Keywords: malaria, microscopy, quality assurance, RDT

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1335 Prevalence of Malocclusion and Assessment of Orthodontic Treatment Needs in Malay Transfusion-Dependent Thalassemia Patients

Authors: Mohamed H. Kosba, Heba A. Ibrahim, H. Rozita

Abstract:

Statement of the Problem: The life expectancy for transfusion-dependent thalassemia patients has increased dramatically with iron-chelation therapy and other modern management modalities. In these patients, the most dominant maxillofacial manifestations are protrusion of zygomatic bones and premaxilla due to the hyperplasia of bone marrow. The purpose of this study is to determine the prevalence of malocclusion and orthodontic treatment needs according to the Dental Aesthetic Index (DAI) among Malay transfusion-dependent thalassemia patients. Orientation: This is a cross-sectional study consist of 43 Malay transfusion-dependent thalassemia patients, 22 males, and 19 females with the mean age of 15.9 years old (SD 3.58). The subjects were selected randomly from patients attending Paediatrics and Internal Medicine Clinic at Hospital USM and Hospital Sultana Bahiyah. The subjects were assessed for malocclusion according to Angle’s classification, and orthodontic treatment needs using DAI. The results show that 22 of the subjects (51.1%) have class II malocclusion, 12 subjects (28%) have class І, while 9 subjects (20.9%) have class Ⅲ. The assessment of orthodontic treatment needs to reveal 22 cases (51.1%) fall in the normal/minor needs category, 12 subjects (28%) fall in the severe and very severe category, while 9 subjects (20.9%) fall in the definite category. Conclusion & Significance: Half of Malay transfusion-dependent thalassemia patients have Class Ⅱmalocclusion. About 28% had malocclusion and required orthodontic treatment. This research shows that Malay transfusion-dependent thalassemia may require orthodontic management; earlier intervention to reduce the complexity of the treatment later, suggesting functional appliance as a suitable treatment option for them, a twin block appliance together with headgear to restrict maxillary growth suggested for management. The current protocol implemented by the Malaysian Ministry of Health for the management of these patients seems to be sufficient since the result shows that about 28% require orthodontic treatment need, according to DAI.

Keywords: prevalence, DAI, thalassaemia, angle classification

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1334 Outcome of Using Penpat Pinyowattanasilp Equation for Prediction of 24-Hour Uptake, First and Second Therapeutic Doses Calculation in Graves’ Disease Patient

Authors: Piyarat Parklug, Busaba Supawattanaobodee, Penpat Pinyowattanasilp

Abstract:

The radioactive iodine thyroid uptake (RAIU) has been widely used to differentiate the cause of thyrotoxicosis and treatment. Twenty-four hours RAIU is routinely used to calculate the dose of radioactive iodine (RAI) therapy; however, 2 days protocol is required. This study aims to evaluate the modification of Penpat Pinyowattanasilp equation application by the exclusion of outlier data, 3 hours RAIU less than 20% and more than 80%, to improve prediction of 24-hour uptake. The equation is predicted 24 hours RAIU (P24RAIU) = 32.5+0.702 (3 hours RAIU). Then calculating separation first and second therapeutic doses in Graves’ disease patients. Methods; This study was a retrospective study at Faculty of Medicine Vajira Hospital in Bangkok, Thailand. Inclusion were Graves’ disease patients who visited RAI clinic between January 2014-March 2019. We divided subjects into 2 groups according to first and second therapeutic doses. Results; Our study had a total of 151 patients. The study was done in 115 patients with first RAI dose and 36 patients with second RAI dose. The P24RAIU are highly correlated with actual 24-hour RAIU in first and second therapeutic doses (r = 0.913, 95% CI = 0.876 to 0.939 and r = 0.806, 95% CI = 0.649 to 0.897). Bland-Altman plot shows that mean differences between predictive and actual 24 hours RAI in the first dose and second dose were 2.14% (95%CI 0.83-3.46) and 1.37% (95%CI -1.41-4.14). The mean first actual and predictive therapeutic doses are 8.33 ± 4.93 and 7.38 ± 3.43 milliCuries (mCi) respectively. The mean second actual and predictive therapeutic doses are 6.51 ± 3.96 and 6.01 ± 3.11 mCi respectively. The predictive therapeutic doses are highly correlated with the actual dose in first and second therapeutic doses (r = 0.907, 95% CI = 0.868 to 0.935 and r = 0.953, 95% CI = 0.909 to 0.976). Bland-Altman plot shows that mean difference between predictive and actual P24RAIU in the first dose and second dose were less than 1 mCi (-0.94 and -0.5 mCi). This modification equation application is simply used in clinical practice especially patient with 3 hours RAIU in range of 20-80% in a Thai population. Before use, this equation for other population should be tested for the correlation.

Keywords: equation, Graves’disease, prediction, 24-hour uptake

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1333 A Motion Dictionary to Real-Time Recognition of Sign Language Alphabet Using Dynamic Time Warping and Artificial Neural Network

Authors: Marcio Leal, Marta Villamil

Abstract:

Computacional recognition of sign languages aims to allow a greater social and digital inclusion of deaf people through interpretation of their language by computer. This article presents a model of recognition of two of global parameters from sign languages; hand configurations and hand movements. Hand motion is captured through an infrared technology and its joints are built into a virtual three-dimensional space. A Multilayer Perceptron Neural Network (MLP) was used to classify hand configurations and Dynamic Time Warping (DWT) recognizes hand motion. Beyond of the method of sign recognition, we provide a dataset of hand configurations and motion capture built with help of fluent professionals in sign languages. Despite this technology can be used to translate any sign from any signs dictionary, Brazilian Sign Language (Libras) was used as case study. Finally, the model presented in this paper achieved a recognition rate of 80.4%.

Keywords: artificial neural network, computer vision, dynamic time warping, infrared, sign language recognition

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1332 A New Distributed Computing Environment Based On Mobile Agents for Massively Parallel Applications

Authors: Fatéma Zahra Benchara, Mohamed Youssfi, Omar Bouattane, Hassan Ouajji, Mohamed Ouadi Bensalah

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In this paper, we propose a new distributed environment for High Performance Computing (HPC) based on mobile agents. It allows us to perform parallel programs execution as distributed one over a flexible grid constituted by a cooperative mobile agent team works. The distributed program to be performed is encapsulated on team leader agent which deploys its team workers as Agent Virtual Processing Unit (AVPU). Each AVPU is asked to perform its assigned tasks and provides the computational results which make the data and team works tasks management difficult for the team leader agent and that influence the performance computing. In this work we focused on the implementation of the Mobile Provider Agent (MPA) in order to manage the distribution of data and instructions and to ensure a load balancing model. It grants also some interesting mechanisms to manage the others computing challenges thanks to the mobile agents several skills.

Keywords: image processing, distributed environment, mobile agents, parallel and distributed computing

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1331 SkyCar Rapid Transit System: An Integrated Approach of Modern Transportation Solutions in the New Queen Elizabeth Quay, Perth, Western Australia

Authors: Arfanara Najnin, Michael W. Roach, Jr., Dr. Jianhong Cecilia Xia

Abstract:

The SkyCar Rapid Transit System (SRT) is an innovative intelligent transport system for the sustainable urban transport system. This system will increase the urban area network connectivity and decrease urban area traffic congestion. The SRT system is designed as a suspended Personal Rapid Transit (PRT) system that travels under a guideway 5m above the ground. A driver-less passenger is via pod-cars that hang from slender beams supported by columns that replace existing lamp posts. The beams are setup in a series of interconnecting loops providing non-stop travel from beginning to end to assure journey time. The SRT forward movement is effected by magnetic motors built into the guideway. Passenger stops are at either at line level 5m above the ground or ground level via a spur guideway that curves off the main thoroughfare. The main objective of this paper is to propose an integrated Automated Transit Network (ATN) technology for the future intelligent transport system in the urban built environment. To fulfil the objective a 4D simulated model in the urban built environment has been proposed by using the concept of SRT-ATN system. The methodology for the design, construction and testing parameters of a Technology Demonstrator (TD) for proof of concept and a Simulator (S) has been demonstrated. The completed TD and S will provide an excellent proving ground for the next development stage, the SRT Prototype (PT) and Pilot System (PS). This paper covered by a 4D simulated model in the virtual built environment is to effectively show how the SRT-ATN system works. OpenSim software has been used to develop the model in a virtual environment, and the scenario has been simulated to understand and visualize the proposed SkyCar Rapid Transit Network model. The SkyCar system will be fabricated in a modular form which is easily transported. The system would be installed in increasingly congested city centers throughout the world, as well as in airports, tourist resorts, race tracks and other special purpose for the urban community. This paper shares the lessons learnt from the proposed innovation and provides recommendations on how to improve the future transport system in urban built environment. Safety and security of passengers are prime factors to be considered for this transit system. Design requirements to meet the safety needs to be part of the research and development phase of the project. Operational safety aspects would also be developed during this period. The vehicles, the track and beam systems and stations are the main components that need to be examined in detail for safety and security of patrons. Measures will also be required to protect columns adjoining intersections from errant vehicles in vehicular traffic collisions. The SkyCar Rapid Transit takes advantage of all current disruptive technologies; batteries, sensors and 4G/5G communication and solar energy technologies which will continue to reduce the costs and make the systems more profitable. SkyCar's energy consumption is extremely low compared to other transport systems.

Keywords: SkyCar, rapid transit, Intelligent Transport System (ITS), Automated Transit Network (ATN), urban built environment, 4D Visualization, smart city

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1330 Screening for Diabetes in Patients with Chronic Pancreatitis: The Belfast Trust Experience

Authors: Riyas Peringattuthodiyil, Mark Taylor, Ian Wallace, Ailish Nugent, Mike Mitchell, Judith Thompson, Allison McKee, Philip C. Johnston

Abstract:

Aim of Study: The purpose of the study was to screen for diabetes through HbA1c in patients with chronic pancreatitis (CP) within the Belfast Trust. Background: Patients with chronic pancreatitis are at risk of developing diabetes, earlier diagnosis with subsequent multi-disciplinary input has the potential to improve clinical outcomes. Methods: Clinical and laboratory data of patients with chronic pancreatitis were obtained through the Northern Ireland Electronic Healthcare Record (NIECR), specialist hepatobiliary, and gastrointestinal clinics. Patients were invited to have a blood test for HbA1c. Newly diagnosed patients with diabetes were then invited to attend a dedicated Belfast City Hospital (BCH) specialist chronic pancreatitis and diabetes clinic for follow up. Results: A total of 89 chronic pancreatitis patients were identified; Male54; Female:35, mean age 52 years, range 12-90 years. Aetiology of CP included alcohol 52/89 (58%), gallstones 18/89 (20%), idiopathic 10/89 11%, 2 were genetic, 1: post ECRP, 1: IgG autoimmune, 1: medication induced, 1: lipoprotein lipase deficiency 1: mumps, 1: IVDU and 1: pancreatic divisum. No patients had pancreatic carcinoma. Mean duration of CP was nine years, range 3-30 years. 15/89 (16%) of patients underwent previous pancreatic surgery/resections. Recent mean BMI was 25.1 range 14-40 kg/m². 62/89 (70%) patients had HbA1c performed. Mean HbA1c was 42 mmol/mol, range 27-97mmol/mol, 42/62 (68%) had normal HbA1c (< 42 mmol/mol) 13/62 (21%) had pre-diabetes (42-47mmol/mol) and 7/62 (11%) had diabetes (≥ 48 mmol/mol). Conclusions: Of those that participated in the screening program around one-third of patients with CP had glycaemic control in the pre and diabetic range. Potential opportunities for improving screening rates for diabetes in this cohort could include regular yearly testing at gastrointestinal and hepatobiliary clinics.

Keywords: pancreatogenic diabetes, screening, chronic pancreatitis, trust experience

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1329 New Requirements of the Fifth Dimension of War: Planning of Cyber Operation Capabilities

Authors: Mehmet Kargaci

Abstract:

Transformation of technology and strategy has been the main factor for the evolution of war. In addition to land, maritime, air and space domains, cyberspace has become the fifth domain with emerge of internet. The current security environment has become more complex and uncertain than ever before. Moreover, warfare has evaluated from conventional to irregular, asymmetric and hybrid war. Weak actors such as terrorist organizations and non-state actors has increasingly conducted cyber-attacks against strong adversaries. Besides, states has developed cyber capabilities in order to defense critical infrastructure regarding the cyber threats. Cyber warfare will be key in future security environment. Although what to do has been placed in operational plans, how to do has lacked and ignored as to cyber defense and attack. The purpose of the article is to put forward a model for how to conduct cyber capabilities in a conventional war. First, cyber operations capabilities will be discussed. Second put forward the necessities of cyberspace environment and develop a model for how to plan an operation using cyber operation capabilities, finally the assessment of the applicability of cyber operation capabilities and offers will be presented.

Keywords: cyber war, cyber threats, cyber operation capabilities, operation planning

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1328 Osteoarticular Ultrasound for Diagnostic Purposes in the Practice of the Rheumatologist

Authors: A. Ibovi Mouondayi, S. Zaher, K. Nassar, S. Janani

Abstract:

Introduction: Osteoarticular ultrasound has become an essential tool for the investigation and monitoring of osteoarticular pathologies for rheumatologists. It is performed in the clinic, cheap to access than other imaging technics. Important anatomical sites of inflammation in inflammatory diseases such as synovium, tendon sheath, and enthesis are easily identifiable on ultrasound. Objective: The objective of this study was to evaluate the importance of ultrasound for rheumatologists in the development of diagnoses of inflammatory rheumatism in cases of uncertain clinical presentation. Material and Methods: This is a retrospective study conducted in our department and carried out over a period of 30 months from January 2020 to June 2022. We included all patients with inflammatory arthralgia without clinical arthritis. Patients' data were collected through a patient operating system. Results: A total of 35 patients were identified, made up of 4 men and 31 women, with a sex ratio M/F of 0.12. The average age of the patients was 48.8 years, with extremes ranging from 17 years to 83 years. All patients had inflammatory polyarthralgia for an average of 9.3 years. Only two patients had suspicious synovitis on clinical examination. 91.43% of patients had a positive inflammatory assessment with an average CRP of 22.2 mg/L. Rheumatoid factor (RF) was present in 45.7% of patients and anti-CCP in 48.57%, with respective averages of 294.43 and 314.63 international units/mL. Radiographic lesions were found in 54% of patients. Osteoarticular ultrasound was performed in all these patients. Subclinical synovitis was found in 60% of patients, including 23% Doppler positive. Tenosynovitis was found in 11% of patients. Enthesitis was objectified in 3% of patients. Rheumatoid arthritis (RA) was retained in 40% of patients; psoriatic arthritis in 6% of patients, hydroxyapatite arthritis, and osteoarthritis in 3% each. Conclusion: Osteoarticular ultrasound has been an essential tool in the practice of rheumatology in recent years. It is for diagnostic purposes in chronic inflammatory rheumatism as well as in degenerative rheumatism and crystal induced arthropathies, but also essential in the follow-up of patients in rheumatology.

Keywords: ultrasound, skeletal, rheumatoid arthritis, arthralgia

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1327 Cardiovascular Disease Is Common among Patients with Systemic Lupus Erythematosus

Authors: Fathia Ehmouda Zaid, Reim Abudelnbi

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Cardiovascular disease is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Patients and method: Cross-section study (68) patients diagnosed as systemic lupus erythematosus (SLE), who visited the outpatient clinic of rheumatology, these patients were interviewed with a structured questionnaire about their past and current clinically for presence of Cardiovascular disease in systemic lupus and use SLEDAI, specific tests [ECG –ECHO –CXRAY] the data are analyzed statistically by Pearson's correlation coefficient was calculated and statistical significance was defined as P< 0.05,during period (2013-2014). Objective: Estimation Cardiovascular disease manifestation of systemic lupus erythematosus, correlation with disease activity, morbidity, and mortality. Result: (68) Patients diagnosed as systemic lupus erythematosus' age range from (18-48 years), M=(13±29Y), Sex were female 66/68 (97.1%), male 2/68 (2.9%),duration of disease range[1-15year], M =[7±8y], we found Cardiovascular disease manifestation of systemic lupus erythematosus 32/68 (47.1%), correlation with disease activity use SLEDAI,(r= 476** p=0.000),Morbidity,(r= .554**; p=0.000) and mortality (r=.181; p=.139), Cardiovascular disease manifestations of systemic lupus erythematosus are pericarditis 8/68 (11.8%), pericardial effusion 6/68 (8.8%), myocarditis 4/68 (5.9 %), valvular lesions (endocarditis) 1/68 (1.5%), pulmonary hypertension (PAH) 12/68 (17.6%), coronary artery disease 1/68 (1.5%), none of patients have conduction abnormalities involvement. Correlation with disease activity use SLEDAI, pericarditis (r= .210, p=.086), pericardial effusion (r= 0.079, p=.520), myocarditis (r= 272*, p=.027), valvular lesions (endocarditis) (r= .112, p= .362), pulmonary hypertension (PAH) (r= .257*, p=.035) and coronary artery disease (r=.075, p=.544) correlation between cardiovascular disease manifestations of systemic lupus erythematosus and specific organ involvement we found Mucocutaneous (r=.091 p= .459), musculoskeletal (MSK) (r=.110 p=.373), Renal disease (r=.278*, p=.022), neurologic disease (r=.085, p=.489) and Hematologic disease (r=-.264*, p=.030). Conclusion: Cardiovascular manifestation is more frequent symptoms with systemic lupus erythematosus (SLE) is 47 % correlation with disease activity and morbidity but not with mortality. Recommendations: Focus research to evaluation and an adequate assessment of cardiovascular complications on the morbidity and mortality of the patients with SLE are still required.

Keywords: cardiovascular disease, systemic lupus erythematosus, disease activity, mortality

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1326 Combined Cervical Headache Snag with Cervical Snag Half Rotation Techniques on Cervicogenic Headache Patients

Authors: Wael Salah Shendy, Moataz Mohamed EL Semary, Hosam Salah Murad, Adham A. Mohamed

Abstract:

Background: Cervicogenic headache is a major problem in many people suffering from upper cervical dysfunction with a great conflict in its physical therapy management. Objectives: To determine the effect of C1-C2 Mulligan SNAGs mobilizations on cervicogenic headache and associated dizziness symptoms. Methods: Forty-eight patients with cervicogenic headache included in the study; from the outpatient clinic of Faculty of Physical Therapy, Cairo University, and New Cairo outpatient clinics, were randomly assigned into three equal groups; group A ( Headache SNAG), group B (C1-C2 SNAG rotation) and group C (combined). Their mean age was (29.37 ± 2.6), (29.31 ± 2.54) and (29.68 ± 2.65). Neck Disability Index used to examine neck pain intensity and CEH symptoms. 6 Items Headache Impact test '6-HIT' scale used to examine headache severity and its adverse effects on social life and functions. Flexion-Rotation Test 'FRT' also used to assess rotation ROM at the level of C1-C2 by 'CROM' device. Dizziness Handicap Inventory 'DHI' scale was used to evaluate dizziness symptoms. Evaluation is done pre and post treatment, and comparison between groups was quantified. Correlations between the examined parameters were also measured. Headache SNAG and C1-C2 Rotation SNAGs were done separately in group (A- B) and combined in group C as a treatment intervention. Results: Group C has Significant improvement in whole parameters compared to group A and B, positive correlation was found between NDI and 6-HIT scores compared to negative correlation between NDI and DHI scores. Conclusion: SNAGs mobilizations used in the study were effective in reducing cervicogenic headache and dizziness symptoms in all groups with a noticeable improvement in the combined group.

Keywords: cervicogenic headache, cervical headache snag, cervical snag half rotation, cervical dizziness

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1325 Investigation Particle Behavior in Gas-Solid Filtration with Electrostatic Discharge in a Hybrid System

Authors: Flávia M. Oliveira, Marcos V. Rodrigues, Mônica L. Aguiar

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Synthetic fibers are widely used in gas filtration. Previous attempts to optimize the filtration process have employed mixed fibers as the filter medium in gas-solid separation. Some of the materials most frequently used this purpose are composed of polyester, polypropylene, and glass fibers. In order to improve the retention of cement particles in bag filters, the present study investigates the use of synthetic glass fiber filters and polypropylene fiber for particle filtration, with electrostatic discharge of 0 to -2 kV in cement particles. The filtration curves obtained showed that charging increased the particle collection efficiency and lowered the pressure drop. Particle diameter had a direct influence on the formation of the dust cake, and the application of electrostatic discharge to the particles resulted in the retention of more particles, hence increasing the lifetime of fabric filters.

Keywords: glass fiber filter, particle, electrostatic discharge, cement

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1324 Polycaprolactone/Thermally Exfoliated Graphene Oxide Biocomposite Films: A Promising Moisture Absorption Behavior

Authors: Neetu Malik, Sharad Shrivastava, Subrata Bandhu Ghosh

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Biocomposite materials were fabricated using mixing biodegradable polymer polycaprolactone (PCL) and Thermally Exfoliated Graphene Oxide (TEGO) through solution casting. Various samples of biocomposite films were prepared by varying the TEGO wt% composition by 0.1%, 0.5%, 1% and 1.5%. Thereafter, the density and water absorption of the composites were investigated with respect to immersion time in water. The moisture absorption results show that with an increase in weight percentage (from 0.1 to wt 1.5%) of TEGO within the biopolymer films, the absorption value of bio-nanocomposite films reduced rapidly from 27.4% to 14.3%. The density of hybrid composites also increased with increase in weight percentage of TEGO. These results indicate that the optimized composition of constituents in composite membrane could effectively reduce the anhydrous conditions of bio-composite film.

Keywords: thermally exfoliated graphene oxide, PCL, water absorption, density

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1323 Advancing Early Intervention Strategies for United States Adolescents and Young Adults with Schizophrenia in the Post-COVID-19 Era

Authors: Peggy M. Randon, Lisa Randon

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Introduction: The post-COVID-19 era has presented unique challenges for addressing complex mental health issues, particularly due to exacerbated stress, increased social isolation, and disrupted continuity of care. This article outlines relevant health disparities and policy implications within the context of the United States while maintaining international relevance. Methods: A comprehensive literature review (including studies, reports, and policy documents) was conducted to examine concerns related to childhood-onset schizophrenia and the impact on patients and their families. Qualitative and quantitative data were synthesized to provide insights into the complex etiology of schizophrenia, the effects of the pandemic, and the challenges faced by socioeconomically disadvantaged populations. Case studies were employed to illustrate real-world examples and areas requiring policy reform. Results: Early intervention in childhood is crucial for preventing or mitigating the long-term impact of complex psychotic disorders, particularly schizophrenia. A comprehensive understanding of the genetic, environmental, and physiological factors contributing to the development of schizophrenia is essential. The COVID-19 pandemic worsened symptoms and disrupted treatment for many adolescent patients with schizophrenia, emphasizing the need for adaptive interventions and the utilization of virtual platforms. Health disparities, including stigma, financial constraints, and language or cultural barriers, further limit access to care, especially for socioeconomically disadvantaged populations. Policy implications: Current US health policies inadequately support patients with schizophrenia. The limited availability of longitudinal care, insufficient resources for families, and stigmatization represent ongoing policy challenges. Addressing these issues necessitates increased research funding, improved access to affordable treatment plans, and cultural competency training for healthcare providers. Public awareness campaigns are crucial to promote knowledge, awareness, and acceptance of mental health disorders. Conclusion: The unique challenges faced by children and families in the US affected by schizophrenia and other psychotic disorders have yet to be adequately addressed on institutional and systemic levels. The relevance of findings to an international audience is emphasized by examining the complex factors contributing to the onset of psychotic disorders and their global policy implications. The broad impact of the COVID-19 pandemic on mental health underscores the need for adaptive interventions and global responses. Addressing policy challenges, improving access to care, and reducing the stigma associated with mental health disorders are crucial steps toward enhancing the lives of adolescents and young adults with schizophrenia and their family members. The implementation of virtual platforms can help overcome barriers and ensure equitable access to support and resources for all patients, enabling them to lead healthy and fulfilling lives.

Keywords: childhood, schizophrenia, policy, United, States, health, disparities

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1322 Performance Optimization of Polymer Materials Thanks to Sol-Gel Chemistry for Fuel Cells

Authors: Gondrexon, Gonon, Mendil-Jakani, Mareau

Abstract:

Proton Exchange Membrane Fuel Cells (PEMFCs) seems to be a promising device used for converting hydrogen into electricity. PEMFC is made of a Membrane Electrode Assembly (MEA) composed of a Proton Exchange Membrane (PEM) sandwiched by two catalytic layers. Nowadays, specific performances are targeted in order to ensure the long-term expansion of this technology. Current polymers used (perfluorinated as Nafion®) are unsuitable (loss of mechanical properties) for the high-temperature range. To overcome this issue, sulfonated polyaromatic polymers appear to be a good alternative since it has very good thermomechanical properties. However, their proton conductivity and chemical stability (oxidative resistance to H2O2 formed during fuel cell (FC) operating) are very low. In our team, we patented an original concept of hybrid membranes able to fulfill the specific requirements for PEMFC. This idea is based on the improvement of commercialized polymer membrane via an easy and processable stabilization thanks to sol-gel (SG) chemistry with judicious embeded chemical functions. This strategy is thus breaking up with traditional approaches (design of new copolymers, use of inorganic charges/additives). In 2020, we presented the elaboration and functional properties of a 1st generation of hybrid membranes with promising performances and durability. The latter was made by self-condensing a SG phase with 3(mercaptopropyl)trimethoxysilane (MPTMS) inside a commercial sPEEK host membrane. The successful in-situ condensation reactions of the MPTMS was demonstrated by measures of mass uptakes, FTIR spectroscopy (presence of C-Haliphatics) and solid state NMR 29Si (T2 & T3 signals of self-condensation products). The ability of the SG phase to prevent the oxidative degradation of the sPEEK phase (thanks to thiol chemical functions) was then proved with H2O2 accelerating tests and FC operating tests. A 2nd generation made of thiourea functionalized SG precursors (named HTU & TTU) was made after. By analysing in depth the morphologies of these different hybrids by direct space analysis (AFM/SEM/TEM) and reciprocal space analysis (SANS/SAXS/WAXS), we highlighted that both SG phase morphology and its localisation into the host has a huge impact on the PEM functional properties observed. This relationship is also dependent on the chemical function embedded. The hybrids obtained have shown very good chemical resistance during aging test (exposed to H2O2) compared to the commercial sPEEK. But the chemical function used is considered as “sacrificial” and cannot react indefinitely with H2O2. Thus, we are now working on a 3rd generation made of both sacrificial/regenerative chemical functions which are expected to inhibit the chemical aging of sPEEK more efficiently. With this work, we are confident to reach a predictive approach of the key parameters governing the final properties.

Keywords: fuel cells, ionomers, membranes, sPEEK, chemical stability

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1321 Operating System Support for Mobile Device Thermal Management and Performance Optimization in Augmented Reality Applications

Authors: Yasith Mindula Saipath Wickramasinghe

Abstract:

Augmented reality applications require a high processing power to load, render and live stream high-definition AR models and virtual scenes; it also requires device sensors to work excessively to coordinate with internal hardware, OS and give the expected outcome in advance features like object detection, real time tracking, as well as voice and text recognition. Excessive thermal generation due to these advanced functionalities has become a major research problem as it is unbearable for smaller mobile devices to manage such heat increment and battery drainage as it causes physical harm to the devices in the long term. Therefore, effective thermal management is one of the major requirements in Augmented Reality application development. As this paper discusses major causes for this issue, it also provides possible solutions in the means of operating system adaptations as well as further research on best coding practises to optimize the application performance that reduces thermal excessive thermal generation.

Keywords: augmented reality, device thermal management, GPU, operating systems, device I/O, overheating

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1320 Behaviour of Beam Reinforced with Longitudinal Steel-CFRP Composite Reinforcement under Static Load

Authors: Faris A. Uriayer, Mehtab Alam

Abstract:

The concept of using a hybrid composite by combining two or more different materials to produce bilinear stress–strain behaviour has become a subject of interest. Having studied the mechanical properties of steel-CFRP specimens (CFRP Laminate Sandwiched between Mild Steel Strips), full size steel-CFRP composite reinforcement were fabricated and used as a new reinforcing material inside beams in lieu of traditional steel bars. Four beams, three beams reinforced with steel-CFRP composite reinforcement and one beam reinforced with traditional steel bars were cast, cured and tested under quasi-static loading. The flexural test results of the beams reinforced with this composite reinforcement showed that the beams with steel-CFRP composite reinforcement had comparable flexural strength and flexural ductility with beams reinforced with traditional steel bars.

Keywords: CFRP laminate, steel strip, flexural behaviour, modified model, concrete beam

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1319 Fatherhood and Migration among Chinese Returnees in Hong Kong: A Literature Review

Authors: Lucille Lok-Sun Ngan

Abstract:

There are significant gaps in both the migration and family literatures regarding the gendered parenting of Chinese migrants. Evidence from the literature informs us that the child-focused parenting style of the West has altered, with positive consequences, parent–child relationships in migrant families. In particular, second-generation migrants have developed hybrid identities distinct from those of their overseas-born parents and the locals. On returning to their place of origin, they may undergo yet another process of change in values, and in behaviour, in order to adapt to the local culture. As migration changes values, personality and practice at personal, interpersonal and familial levels, the cross-cultural experiences of returnees inevitably affect their own fatherhood journeys in their country of origin. This paper reviews current literature on fatherhood and migration and identifies the gaps and limitations that pertain to understanding the paternal experiences of Chinese return migrants.

Keywords: Chinese returnees, cross-cultural experiences, fatherhood, hybridity, migration

Procedia PDF Downloads 365
1318 Microarrays: Wide Clinical Utilities and Advances in Healthcare

Authors: Salma M. Wakil

Abstract:

Advances in the field of genetics overwhelmed detecting large number of inherited disorders at the molecular level and directed to the development of innovative technologies. These innovations have led to gene sequencing, prenatal mutation detection, pre-implantation genetic diagnosis; population based carrier screening and genome wide analyses using microarrays. Microarrays are widely used in establishing clinical and diagnostic setup for genetic anomalies at a massive level, with the advent of cytoscan molecular karyotyping as a clinical utility card for detecting chromosomal aberrations with high coverage across the entire human genome. Unlike a regular karyotype that relies on the microscopic inspection of chromosomes, molecular karyotyping with cytoscan constructs virtual chromosomes based on the copy number analysis of DNA which improves its resolution by 100-fold. We have been investigating a large number of patients with Developmental Delay and Intellectual disability with this platform for establishing micro syndrome deletions and have detected number of novel CNV’s in the Arabian population with the clinical relevance.

Keywords: microarrays, molecular karyotyping, developmental delay, genetics

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1317 Radiation Risks for Nurses: The Unrecognized Consequences of ERCP Procedures

Authors: Ava Zarif Sanayei, Sedigheh Sina

Abstract:

Despite the advancement of radiation-free interventions in the gastrointestinal and hepatobiliary fields, endoscopy and endoscopic retrograde cholangiopancreatography (ERCP) remain indispensable procedures that necessitate radiation exposure. ERCP, in particular, relies heavily on radiation-guided imaging to ensure precise delivery of therapy. Meanwhile, interventional radiology (IR) procedures also utilize imaging modalities like X-rays and CT scans to guide therapy, often under local anesthesia via small needle insertion. However, the complexity of these procedures raises concerns about radiation exposure to healthcare professionals, including nurses, who play a crucial role in these interventions. This study aims to assess the radiation exposure to the hands and fingers of nurses 1 and 2, who are directly involved in ERCP procedures utilizing (TLD-100) dosimeters at the Gastrointestinal Endoscopy department of a clinic in Shiraz, Iran. The dosimeters were initially calibrated using various phantoms and then a group was prepared and used over a two-month period. For personal equivalent dose measurement, two TLD chips were mounted on a finger ring to monitor exposure to the hands and fingers. Upon completion of the monitoring period, the TLDs were analyzed using a TLD reader, showing that Nurse 1 received an equivalent dose of 298.26 µSv and Nurse 2 received an equivalent dose of 195.39 µSv. The investigation revealed that the total radiation exposure to the nurses did not exceed the annual limit for occupational exposure. Nevertheless, it is essential to prioritize radiation protection measures to prevent potential harm. The study showed that positioning staff members and placing two nurses in a specific location contributed to somehow equal doses. To reduce exposure further, we suggest providing education and training on radiation safety principles, particularly for technologists.

Keywords: dose measurement, ERCP, interventional radiology, medical imaging

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1316 Fabrication of High Energy Hybrid Capacitors from Biomass Waste-Derived Activated Carbon

Authors: Makhan Maharjan, Mani Ulaganathan, Vanchiappan Aravindan, Srinivasan Madhavi, Jing-Yuan Wang, Tuti Mariana Lim

Abstract:

There is great interest to exploit sustainable, low-cost, renewable resources as carbon precursors for energy storage applications. Research on development of energy storage devices has been growing rapidly due to mismatch in power supply and demand from renewable energy sources This paper reported the synthesis of porous activated carbon from biomass waste and evaluated its performance in supercapicators. In this work, we employed orange peel (waste material) as the starting material and synthesized activated carbon by pyrolysis of KOH impregnated orange peel char at 800 °C in argon atmosphere. The resultant orange peel-derived activated carbon (OP-AC) exhibited a high BET surface area of 1,901 m2 g-1, which is the highest surface area so far reported for the orange peel. The pore size distribution (PSD) curve exhibits the pores centered at 11.26 Å pore width, suggesting dominant microporosity. The OP-AC was studied as positive electrode in combination with different negative electrode materials, such as pre-lithiated graphite (LiC6) and Li4Ti5O12 for making different hybrid capacitors. The lithium ion capacitor (LIC) fabricated using OP-AC with pre-lithiated graphite delivered a high energy density of ~106 Wh kg–1. The energy density for OP-AC||Li4Ti5O12 capacitor was ~35 Wh kg–1. For comparison purpose, configuration of OP-AC||OP-AC capacitors were studied in both aqueous (1M H2SO4) and organic (1M LiPF6 in EC-DMC) electrolytes, which delivered the energy density of 6.6 Wh kg-1 and 16.3 Wh kg-1, respectively. The cycling retentions obtained at current density of 1 A g–1 were ~85.8, ~87.0 ~82.2 and ~58.8% after 2500 cycles for OP-AC||OP-AC (aqueous), OP-AC||OP-AC (organic), OP-AC||Li4Ti5O12 and OP-AC||LiC6 configurations, respectively. In addition, characterization studies were performed by elemental and proximate composition, thermogravimetry, field emission-scanning electron microscopy, Raman spectra, X-ray diffraction (XRD) pattern, Fourier transform-infrared, X-ray photoelectron spectroscopy (XPS) and N2 sorption isotherms. The morphological features from FE-SEM exhibited well-developed porous structures. Two typical broad peaks observed in the XRD framework of the synthesized carbon implies amorphous graphitic structure. The ratio of 0.86 for ID/IG in Raman spectra infers high degree of graphitization in the sample. The band spectra of C 1s in XPS display the well resolved peaks related to carbon atoms in various chemical environments; for instances, the characteristics binding energies appeared at ~283.83, ~284.83, ~286.13, ~288.56, and ~290.70 eV which correspond to sp2 -graphitic C, sp3 -graphitic C, C-O, C=O and π-π*, respectively. Characterization studies revealed the synthesized carbon to be promising electrode material towards the application for energy storage devices. The findings opened up the possibility of developing high energy LICs from abundant, low-cost, renewable biomass waste.

Keywords: lithium-ion capacitors, orange peel, pre-lithiated graphite, supercapacitors

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1315 Comparison of Statins Dose Intensity on HbA1c Control in Outpatients with Type 2 Diabetes: A Prospective Cohort Study

Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Ahmed A. Khamis, Abeer Kharshid, Nor Azizah Aziz

Abstract:

The effect of statins dose intensity (SDI) on glycemic control in patients with existing diabetes is unclear. Also, there are many contradictory findings were reported in the literature; thus, it is limiting the possibility to draw conclusions. This project was designed to compare the effect of SDI on glycated hemoglobin (HbA1c%) control in outpatients with Type 2 diabetes in the endocrine clinic at Hospital Pulau Pinang, Malaysia, between July 2015 and August 2016. A prospective cohort study was conducted, where records of 345 patients with Type 2 diabetes (Moderate-SDI group 289 patients and high-SDI cohort 56 patients) were reviewed to identify demographics and laboratory tests. The target of glycemic control (HbA1c < 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, and the results were presented as descriptive statistics. From 289 moderate-SDI cohorts with a mean age of 57.3 ± 12.4 years, only 86 (29.8%) cases were shown to have controlled glycemia, while there were 203 (70.2%) cases with uncontrolled glycemia with confidence interval (CI) of 95% (6.2–10.8). On the other hand, the high-SDI group of 56 patients with Type 2 diabetes with a mean age 57.7±12.4 years is distributed among 11 (19.6%) patients with controlled diabetes, and 45 (80.4%) of them had uncontrolled glycemia, CI: 95% (7.1–11.9). The study has demonstrated that the relative risk (RR) of uncontrolled glycemia in patients with Type 2 diabetes that used high-SDI is 1.15, and the excessive relative risk (ERR) is 15%. The absolute risk (AR) is 10.2%, and the number needed to harm (NNH) is 10. Outpatients with Type 2 diabetes who use high-SDI of statin have a higher risk of uncontrolled glycemia than outpatients who had been treated with a moderate-SDI.

Keywords: cohort study, diabetes control, dose intensity, HbA1c, Malaysia, statin, type 2 diabetes mellitus, uncontrolled glycemia

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1314 Study on Seismic Response Feature of Multi-Span Bridges Crossing Fault

Authors: Yingxin Hui

Abstract:

Understanding seismic response feature of the bridges crossing fault is the basis of the seismic fortification. Taking a multi-span bridge crossing active fault under construction as an example, the seismic ground motions at bridge site were generated following hybrid simulation methodology. Multi-support excitations displacement input models and nonlinear time history analysis was used to calculate seismic response of structures, and the results were compared with bridge in the near-fault region. The results showed that the seismic response features of bridges crossing fault were different from the bridges in the near-fault region. The design according to the bridge in near-fault region would cause the calculation results with insecurity and non-reasonable if the effect of cross the fault was ignored. The design of seismic fortification should be based on seismic response feature, which could reduce the adverse effect caused by the structure damage.

Keywords: bridge engineering, seismic response feature, across faults, rupture directivity effect, fling step

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1313 Physical, Psychological, and Sexual Implications of Living with Rheumatoid Arthritis among Women in Re

Authors: Anwaar Anwar Tayel

Abstract:

Background: Rheumatic arthritis (RA) affect all aspects of patients' life, lead to various degrees of disability, and ultimately has a profound impact on the social, economic, psychological, and sexual aspects of the patient's life. Aim of the study: Identify physical, psychological, and sexual implications of rheumatoid arthritis among women in reproductive age. In addition to investigating the correlations between physical functional disability, psychological problems, and sexual dysfunction.Settings: The study was conducted at Rheumatology Clinic at the Main University Hospital of Alexandria. Subjects: Purposive sample was chosen from women patients with rheumatoid arthritis to be subjects of this study (n=250). Tools: Four tools were used to collect data. Tool I: Socio-demographic questionnaire. Tool II: Stanford Health Assessment Questionnaire Disability Index (HAQ- DI). Tool III: Depression Anxiety Stress Scale (DASS). Tool IV: The Sexual Dysfunction Questionnaire (SDQ) Results: The majority of the studied women suffer from severe physical disability, extreme level of depression, anxiety, and about half of them had an extreme level of stress. Also, the majority of the studied women had a severe level of sexual dysfunction. Also, statistically significant correlations between women's physical disability index, psychological problems, and sexual dysfunction were detected. Conclusion: The findings from this study confirm that women patients with RA suffer from multiple negative implications on the physical, psychological and sexual functions. Recommendations: Provide ongoing support to the patients from the time of diagnosis throughout their care and management. To help them to manage their pain and disabilities, improve their sexual function, promote their mental health, and optimize psychosocial functioning

Keywords: pysical, spycholgical, sexual, implication, rheumatic arthritis

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1312 Operating System Based Virtualization Models in Cloud Computing

Authors: Dev Ras Pandey, Bharat Mishra, S. K. Tripathi

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Cloud computing is ready to transform the structure of businesses and learning through supplying the real-time applications and provide an immediate help for small to medium sized businesses. The ability to run a hypervisor inside a virtual machine is important feature of virtualization and it is called nested virtualization. In today’s growing field of information technology, many of the virtualization models are available, that provide a convenient approach to implement, but decision for a single model selection is difficult. This paper explains the applications of operating system based virtualization in cloud computing with an appropriate/suitable model with their different specifications and user’s requirements. In the present paper, most popular models are selected, and the selection was based on container and hypervisor based virtualization. Selected models were compared with a wide range of user’s requirements as number of CPUs, memory size, nested virtualization supports, live migration and commercial supports, etc. and we identified a most suitable model of virtualization.

Keywords: virtualization, OS based virtualization, container based virtualization, hypervisor based virtualization

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1311 A Case of Mantle Cell Lymphoma Presenting With GI Symptoms and Noted to Have Extranodal Involvement of the Stomach and Colon on Presentation

Authors: Saba Amreen Syeda, Summaiah Asim, Syeda, Hafsa, Essam Quraishi

Abstract:

Mantle Cell Lymphoma (MCL) is a relatively uncommon type of lymphoma that comprises approximately 7 percent of non hodgkin's lymphomas (NHL), Classic MCL presents mostly in lymph nodes and occasionally in extranodal sites. About 26 % of MCL is present primarily in the Gastrointestinal tract. While both the upper GI tract and the lower GI tract could be involved, it is rare to present with concurrent upper and lower GI involvement with MCL. We present the case of a 51-year-old Asian Indian male that presented to our clinic with complaints of chronic diarrhea for the last one year, progressively worsening over the past three months. The Patient also reported black stool as well as bright red blood per rectum. Patient reported severe fatigue on minimal exertion. On a physical exam, the patient was noted to have matted lymphadenopathy in the neck. Patient was noted to be anemic with a hemoglobin to be 8 g/dl. Esophagogastroduodenoscopy and colonoscopy was performed. EGD showed a large 4 cm ulcer in the gastric antrum with thick heaped up edges. There was bleeding on contact. Colonoscopy showed a large 35 mm multilobulated polyp in the ascending colon, which was biopsied. The patient was also noted to have nodular proctitis in the mid rectum. This was localized and extended to about 5 cm. This area was biopsied as well. Biopsies from the stomach, colon, as well as the rectum, returned with findings of mantle cell lymphoma on pathology. Lymphoid cells in the biopsy were stained strongly positive for CD 20, cyclin D1, and CD 5. There was the absence of stain for CD 3 and CD 10. The IHC stain for CD 23 was negative. Biopsies from neck LAD were obtained and were also positive for MCL. The patient was referred to oncology for staging and treatment.

Keywords: mantle cell lymphoma, GI bleed, diarrhea, gastric ulcer, colon polyp

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